[Results of vacuum therapy (v.a.C.) of superficial and deep dermal burns]. / Ergebnisse der Vakuumtherapie (V.A.C.-Therapie) von oberflächlich und tiefdermalen Verbrennungen.

BASIS: This prospective multi-centre study in co-operation with the Wake Forrest University covered the area of applications for treatment of fresh, superficial and deep dermal burns and scalds (grade II a-b). The micro-circulation relationships, wound healing time, extent of germ settlement and the connective tissue edema were of particular interest (together with the increase or decrease in burn depth). Moreover, the economical aspects were compared with conservative therapy. MATERIAL AND METHODS: his study was carried out on our intensive care ward on 11 patients suffering from burn injuries and we took the healing process as the basis (2001-2003). Inclusion criteria for the study were burns on both hands, degree II a-b, occurring trauma less than 6 hours ago and a treatment period of minimum 48 hours. In any case the hands inflicted with deeper and extensive burns (assessment by 2 experienced, independent appraising plastic surgeons) were subject to V.A.C. therapy. The standard conventional, conservative therapy applied to the other hand was taken for comparison or control purposes to determine the success. Since October 2001 we use the IC-View perfusography with ICG colouring (ICG pulsion, PULSION Medical Systems AG, Munich, Germany) for objective findings both previously and during the course of treatment. A respective quantitative analysis and assessment of the recorded video sequences were made with the help of special software (IC-CALC, PULSION Medical Systems AG, Munich, Germany). Here too, the intensity of the fluorescence indicated the blood circulation through the connective tissue and is on the same level. Basis for this method of study was the work of Holm et al. in our department. RESULTS: Above all, the results of our study revealed a significant reduction or prophylaxis of the connective tissue edema. Due to improvement in the micro-circulation, also supported by dynamic IC-View laser-fluorescence videography it could be determined that the wound healing process was quicker and without complication in the majority of cases. This was all the more true, although even when the extent of the deep dermal hand burns treated by V.A.C. therapy was greater than on the hand taken for comparison. Extending the therapy applied to the hand to the entire extremity could contribute to avoiding operative stress (escharotomy) in selected cases. Troublesome supporting of the hands and the ergotherapeutic use of splints were not necessary because of the exact fixation of the extremities ensured by the vacuum method. The advantage became more obvious when both the cost factor and time expenditure were considered and compared with previous conservative therapy. CONCLUSIONS: In the near future the treatment of superficial and deep dermal burns/scalds by V.A.C. therapy can help in reducing the expenditure in time, material and personnel when treating large area wounds. A further advantage is not only to be seen in the optimised healing process in the case of superficial and deep dermal burn wounds but also in the reduction or even avoidance of extensive escharotomy with the accompanying operation trauma. In this respect close mesh control of the blood circulating conditions appeared to us to be important and as a result of our study V.A.C. therapy was approved in December 2002 for the treatment of superficial and deep dermal burns by FDA (Dept. of Health and Human Services).

Graz-BCI: state of the art and clinical applications.

The Graz-brain-computer interface (BCI) is a cue-based system using the imagery of motor action as the appropriate mental task. Relevant clinical applications of BCI-based systems for control of a virtual keyboard device and operations of a hand orthosis are reported. Additionally, it is demonstrated how information transfer rates of 17 b/min can be acquired by real time classification of oscillatory activity.

[Integration of preexisting diseases and risk factors in the Abbreviated Burn Severity Index (ABSI)]. / Integration von Vorerkrankungen und Risikofaktoren im Abbreviated Burn Severity Index (ABSI).

OBJECTIVE: There is no doubt that underlying medical problems such as concomitant diseases or risk factors play a role in increasing patient morbidity and mortality. These factors are already integrated in trauma scores but preexisting diseases have no impact on burn scores yet. This study was performed to examine the predictive value of the classical burn variables that are integrated in the Abbreviated Burn Severity Index (ABSI). The preexisting diseases and risk factors in burn patients within our burn center were evaluated, with the aim of incorporating these evaluations into a new burn score. This modified burn score was used to optimize the predictive value of burn mortality. METHODS: This study included 443 intensive care burn patients. Demographic, injury, age, total body surface area burned (TBSAB), full thickness burn (FTB), inhalation injury (IHT), sex, medical comorbidities, intensive care and outcome data were documented. Univariate analyses, stepwise logistic regression and the Receiver Operating Curve were used to generate values for the probability of death. RESULTS: Univariate analyses identified the following risk factors for their relationship with mortality: TBSAB, age, IHT, FTB, sex and medical comorbidities (cardiovascular, pulmonary, renal and endocrinological). Logistic Regression showed that total body surface area burned and age correlated most significantly with the probability of poor outcome. There were weaker correlations between IHT and FTB. No main effect was registered for gender and preexisting medical problems. The greatest area under the ROC curve was registered for our modified ABSI when comorbidities and risk factors were integrated. CONCLUSION: The results of this study show that the Abbreviated Burn Severity Index is an appropriate burn score for estimating the risk of mortality after burn trauma. However, in addition to the classical variables, preexisting diseases and risk factors have a significant influence on the outcome and therefore should be incorporated into a new burn score to predict mortality more accurately.

[Magnetic resonance imaging of the wrist--comparison of high resolution pulse sequences and different fat signal suppression techniques in cadavers]. / Magnetresonanztomographie des Handgelenkes--Vergleich hochauflösender Pulssequenzen und unterschiedlicher Fettsignalunterdrückungen an Leichenpräparaten.

PURPOSE: To evaluate high resolution sequences with and without fat-suppression techniques for MR imaging of the wrist. MATERIALS AND METHODS: 10 cadaver wrist specimens were imaged with 12 MR sequences (SE: 400 ms/20 ms, TSE: 3000 ms/119 ms/17 ms, fatsat (FS) TSE: 3000 ms/17 ms and 3000 ms/45 ms, STIR: 2619 ms/29 ms/160 ms, DESS 3D: 43.7 ms/9 ms/35 degrees FS and 25.4 ms/9 ms/35 degrees water excitation (WE), CISS 3D: 12.2 ms/5.9 ms/40 degrees and FLASH-sequences: 53 ms/11 ms/40 degrees FS, 23 ms/11 ms/40 degrees WE and 45 ms/11 ms/30 degrees FS) at 1.5 T. Slice thickness was 3 mm, FOV 80 x 70 mm (pixel size 0.31 x 0.31 mm). Signal intensity was measured by an ROI in bone marrow, fluid, hyaline cartilage, scapholunate (SL) ligament and triangular fibrocartilage and S/N- and C/N-ratios were calculated. Additionally, a visual evaluation was performed. RESULTS: The highest homogeneity and the least artifacts were achieved by the T1-w SE sequence. For the STIR and PD-FS TSE sequence high rankings were found for the detection of free water. The PD FS sequence had high ranking also for visualization of the SL ligament and the triangular fibrocartilage. The best sequence for the assessment of hyaline cartilage was the FLASH-FS sequence. For detailed analysis of bony structures the CISS sequence performed best. CONCLUSION: The isolated use of a PD-FS-TSE sequence enables for evaluation of all clinically relevant structures at the wrist. Dedicated questions for hyaline cartilage are answered best by the use of a FLASH 3D-FS sequence. Selective water excitation reduces acquisition time to 60%, nevertheless FS sequences are still diagnostically superior to WE sequences.

Posterior radial collateral artery as the basis of the lateral forearm flap.

The lateral forearm flap is being increasingly used for covering minor-to-moderate-sized defects for which soft and thin skin is required. Within the framework of an anatomic study carried out on 28 cadaveric arms, the authors investigated the principal artery that supplies blood to this flap namely, the posterior radial collateral artery (PRCA). They found that distal to the lateral epicondyle, the PRCA lies in a constant axial line lateral to the brachioradialis muscle. The average length of the artery distal to the epicondyle is 8 cm. Distal to the epicondyle side branches of the PRCA build an arterial plexus 6 cm (+/-3.5 cm) long and 5 cm (+/-1.1 cm) wide. The posterior cutaneous antebrachii nerve lies close to the artery. This permits the harvesting of a flap that is both innervated and has adequate vascular supply.

[Pattern and risk of injuries of profile athletes in snow boarding]. / Verletzungsmuster und -risiken von Profisportlern im Snowboardsport.

During winter 1994/95 and 1995/96 a retrospective study was carried out in which datasets supported by questionnaires from 31 female and 64 male professional snowboarders were evaluated. Included were personal data and details of other types of sports. Also the personal style preferred and equipment used was integrated. Particularly of interest were the localization and causes of injury-patterns with the degrees of severity and overexertion disorders. Among the professionals the most frequent injuries occurred in the metacarpals and fingers (37.3%), the shoulder (36.0%), knee joints (33.3%) and the ankles (28%). The predominating pattern of severe joint injuries were capsular/ligament lesions and fractures. Overexertion syndromes in the knee were predominant, followed by thigh and ankle-joint strains. In the alpine group the incidence of injuries and strains, the knee was the most frequent. 75 professionals suffered 195 traumas. In relation to 1000 snowboarding hours, the risk of injury among the professionals is 0.8. Self induced injuries were mostly cause of misjudgement in specific situations (40.1%).

[Anatomy of the labro-capsular complex]. / Anatomie des labrokapsulären Komplexes.

The acetabular labrum appears as a bundle of distinctly circular lined up collagenous fibers. It surrounds the limbus tangentially and is separated from the cartilagenous covered facies lunata through a thin gap (fissure) except of a small zone in the craniocaudal part. The labrum is strongly fixed with the transverse acetabular ligament. A vascular anastomotic ring surrounds the capsular attachment. It derives its blood supply especially from the superior gluteal vessels, the obturator artery and one ascending branch of the medial femoral circumflex artery. The innervation of the acetabular labrum is coming from a branch of the nerve to the quadratus femoris muscle and from the obturator nerve. There are all types of mechanoreceptors in the labrum. The acetabular labrum is able to exert a high tensional force on the rim of the acetabulum. This plays a very important role in view of the physiological, load depending incongruity of the articulating parts of the hip-joint.

Anatomy of the labrocapsular complex of the hip joint.

The acetabular labrum appears as a bundle of distinctly circular lined up collagenous fibers. It surrounds the limbus tangentially and is separated from the cartilagenous covered facies lunata through a thin gap (fissure) except of a small zone in the craniocaudal part. The labrum is strongly fixed with the transverse acetabular ligament. A vascular anastomotic ring surrounds the capsular attachement. It derives its blood supply especially from the superior gluteal vessels, the obturator artery and one ascending branch of the medial femoral circumflex artery. The innervation of the acetabular labrum is coming from a branch of the nerve to the quadratus femoris muscle and from the obturator nerve. There are all types of mechanoreceptors in the labrum. The acetabular labrum is able to exert a high tensional force on the rim of the acetabulum. This plays a very important role in view of the physiological, load depending incongruity of the articulating parts of the hip-joint.

Immune response of mallard ducks treated with immunosuppressive agents: antibody response to erythrocytes and in vivo response to phytohemagglutinin-P.

The ability of two in vivo tests to assay immune competence of mallard ducks (Anas platyrhynchos) treated with various immunomodulatory agents was examined. Skin responses to phytohemagglutinin-P (PHA-P) injected intradermally and serum antibody levels produced in response to sheep red blood cells (SRBC) were measured. As measured by the skin response to PHA-P, ducks injected intramuscularly with cyclophosphamide or cyclosporine did not respond differently from control-injected ducks. Dexamethasone injected intramuscularly significantly suppressed the skin response to PHA-P. As measured by antibody levels in response to SRBC, ducks injected intramuscularly with cyclophosphamide responded with antibody titers similar to controls. Cyclosporine injected intramuscularly reduced the level of immunoglobulin (Ig) G significantly in one of two experiments. Dexamethasone injected intramuscularly reduced peak total and IgG titers. These experiments provide information on the viability of these two in vivo tests to reflect immune competence of mallard ducks.