[Psoas haematoma due to irritation of the psoas tendon]. / Psoashämatom bei Iliopsoaskontaktphänomen.

Irritation of the tendon of the musculus iliopsoas after total hip replacement is a rare complication. In connection with the irritation of the iliopsoas tendon only one case report of a psoas haematoma due to anticoagulation has been published. We assume that these kinds of haematomas are more frequent than described. We report on 2 cases of haematoma caused by an iliopsoas impingement after total hip replacement. In one case a lesion of the femoral nerve was observed. Surgical treatment was composed of the revision of the acetabular component.

The sequential trauma score - a new instrument for the sequential mortality prediction in major trauma.

BACKGROUND: There are several well established scores for the assessment of the prognosis of major trauma patients that all have in common that they can be calculated at the earliest during intensive care unit stay. We intended to develop a sequential trauma score (STS) that allows prognosis at several early stages based on the information that is available at a particular time. STUDY DESIGN: In a retrospective, multicenter study using data derived from the Trauma Registry of the German Trauma Society (2002-2006), we identified the most relevant prognostic factors from the patients basic data (P), prehospital phase (A), early (B1), and late (B2) trauma room phase. Univariate and logistic regression models as well as score quality criteria and the explanatory power have been calculated. RESULTS: A total of 2,354 patients with complete data were identified. From the patients basic data (P), logistic regression showed that age was a significant predictor of survival (AUC(model P), area under the curve = 0.63). Logistic regression of the prehospital data (A) showed that blood pressure, pulse rate, Glasgow coma scale (GCS), and anisocoria were significant predictors (AUC(model A) = 0.76; AU(model P + A) = 0.82). Logistic regression of the early trauma room phase (B1) showed that peripheral oxygen saturation, GCS, anisocoria, base excess, and thromboplastin time to be significant predictors of survival (AUC(model B1) = 0.78; AUC(model P + A + B1) = 0.85). Multivariate analysis of the late trauma room phase (B2) detected cardiac massage, abbreviated injury score (AIS) of the head > or = 3, the maximum AIS, the need for transfusion or massive blood transfusion, to be the most important predictors (AUC(model B2) = 0.84; AUC(final model P + A + B1 + B2) = 0.90). The explanatory power - a tool for the assessment of the relative impact of each segment to mortality - is 25% for P, 7% for A, 17% for B1 and 51% for B2. A spreadsheet for the easy calculation of the sequential trauma score is available at: www.sequential-trauma-score.com CONCLUSIONS: This score is the first sequential, dynamic score to provide a prognosis for patients with blunt major trauma at several points in time. With every additional piece of information the precision increases. The medical team has a simple, useful tool to identify patients at high risk and to predict the prognosis of an individual patient with major trauma very early, quickly and precisely.

[Perioperative coagulation management controlled by thrombelastography. Clinical implementation illustrated by reference to a case of acquired coagulopathy following aortic stab injury]. / Durch Thrombelastographie gesteuertes perioperatives Gerinnungsmanagement. Klinische Umsetzung am Beispiel einer erworbenen Koagulopathie nach aortaler Stichverletzung.

Uncontrolled bleeding is one of the main reasons for a lethal outcome of severe trauma. Loss, consumption and dilution of clotting factors and platelets induce a complex acquired coagulopathy. Beside surgical control of bleeding, early and precise coagulation therapy is essential for successful treatment. We report on a patient whose life-threatening bleeding and perioperative coagulopathy after a knife injury to the aorta was successfully treated by surgical control of the bleeding and subsequent targeted coagulation therapy with factor concentrates and fresh-frozen plasma. The coagulopathy was diagnosed and managed by means of bed-side thrombelastography.

Cannabinoids inhibit excitatory neurotransmission in the substantia nigra pars reticulata.

The substantia nigra pars reticulata belongs to the brain regions with the highest density of CB(1) cannabinoid receptors. Since the level of CB(1) receptor messenger RNA is very low in the pars reticulata, most of the receptors are probably localized on terminals of afferent axons. The hypothesis was tested that terminals of glutamatergic afferents of substantia nigra pars reticulata neurons possess CB(1) cannnabinoid receptors, the activation of which presynaptically modulates neurotransmission. Rat midbrain slices were superfused and the electrophysiological properties of substantia nigra pars reticulata neurons were studied with the patch-clamp technique. Focal electrical stimulation in the presence of bicuculline evoked excitatory postsynaptic currents mediated by alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionate (AMPA)/kainate glutamate receptors. The excitatory postsynaptic currents were reduced by the metabotropic glutamate receptor agonist (+/-)-1-aminocyclopentane-trans-1,3-dicarboxylic acid (trans-ACPD; 10(-4)M). The mixed CB(1)/CB(2) cannabinoid receptor agonists R(+)-[2,3-dihydro-5-methyl-3-[(morpholinyl)methyl]pyrrolo[1,2, 3-de]-1,4-benzoxazin-yl]-(1-naphthalenyl)methanone (WIN55212-2; 10(-8)-10(-5)M) and (-)-cis-3-[2-hydroxy-4-(1, 1-dimethylheptyl)phenyl]-trans-4-(3-hydroxypropyl)cyclohexanol (CP55940; 10(-6)M) also produced inhibition. The maximal inhibition by WIN55212-2 was 54+/-6%. The CB(1) cannabinoid antagonist N-piperidino-5-(4-chlorophenyl)-1-(2, 4-dichlorophenyl)-4-methyl-3-pyrazole-carboxamide (SR141716A; 10(-6)M) prevented the effect of WIN55212-2, but had no effect when superfused alone. WIN55212-2 (10(-6)M) increased the amplitude ratio of two excitatory postsynaptic currents evoked with an interstimulus interval of 100ms. Currents evoked by short ejection of glutamate on to the surface of the slices were not changed by WIN55212-2. The results show that activation of CB(1) cannabinoid receptors inhibits glutamatergic synaptic transmission between afferent axons and neurons in the substantia nigra pars reticulata. The lack of effect of the cannabinoids on glutamate-evoked currents and the increase of the paired-pulse ratio indicate that the mechanism of action is presynaptic inhibition of transmitter release.