Reality or wishful thinking: do bicycle helmets prevent facial injuries?

Standard bicycle helmets are designed to protect the cranial vault. Numerous studies have demonstrated the beneficial effect of standard bicycle helmets on craniocerebral trauma, but their protective effect on facial injuries remains unclear. Therefore, this study used data obtained by an accident research unit to investigate the protective effect of standard bicycle helmets on facial injuries. A total of 31,634 bicycle accidents were registered between 1999 and 2015; of these, 7004 met the study requirements. Demographic characteristics, technical information (relative collision speed, collision type, collision partner, helmet use), and clinical data (injury type) relating to these accidents were analyzed. Of all affected cyclists, 1005 (14.3%) had a facial injury (fracture and/or soft tissue injury). Bicycle helmets were worn in 11.8% of accidents. Of these, 75.4% involved males and 24.6% involved females. The bicycle helmet did not protect against facial injuries. Furthermore, sex and the type of collision partner were found to be risk factors for facial injuries. In the future, helmet designs should be modified to improve facial protection, and better education should be provided to the public regarding the benefits of bicycle helmets.

Effect of mouth opening on bypass function after combined revascularization for Moyamoya disease.

Moyamoya disease represents a rare steno-occlusive disease of the internal carotid artery (ICA) with a reactive and pathological basal network of collateral vessels. It may lead to ischemic stroke or intracerebral hemorrhage. Treatment options are either direct or indirect revascularization procedures or a combination thereof. Specialized centers report sufficient revascularization in most patients and low complication rates.Between 2005 and 2008, direct extra-intracranial bypass surgery in combination with encephalomyosynangiosis (EMS) was performed in 71 Moyamoya patients at the Mannheim University Medical Center.Following one case of reversible neurological deficits associated with mouth opening, we prospectively evaluated the effect of mouth opening on bypass function in this patient and four further consecutive patients by digital subtraction angiography.Three out of five patients showed alterations in bypass patency upon mouth opening. The obstruction was located at the junction of the bypass and the temporal muscle. Two temporary occlusions and one case of decreased flow were observed. One patient demonstrated reversible hemiparesis and aphasia.

[Vertebral fractures due to osteoporosis. Kyphoplasty and vertebroplasty vs conservative treatment]. / Osteoporosebedingte Wirbelkörperfrakturen. Kyphoplastie und Vertebroplastie vs. konservative Therapie.

Vertebral compression fractures are among the most common forms of manifestations of osteoporosis. Conservative treatment comprises adequate analgesia, osteoporosis medication and individualized physiotherapy or braces. Nevertheless, vertebral compression fractures frequently lead to persisting pain and decrease daily activity and quality of life. In these cases, kyphoplasty and vertebroplasty can be efficient treatment options. Vertebroplasty is a minimally invasive procedure, in which bone cement is filled into the vertebral body under fluoroscopic control. In most cases, this internal stabilization leads to a rapid reduction in pain. Kyphoplasty additionally aims to correct the kyphotic deformation of the broken vertebra via introducing and inflating a balloon catheter. There is broad clinical experience with both procedures. For kyphoplasty, randomized controlled trials showed significant improvements in pain and quality of life in patients undergoing kyphoplasty. However, cement leakages lead to rare but severe complications such as pulmonary embolism and nerve palsies.

Features in families of boys with hyperkinetic and emotional disorders.

Standardized assessment of a family's characteristics (conflict management, cohesion, etc.) is not used routinely, although these variables may play an important role in the course of psychological disorders in children. The present study investigated differences within the features of families of children with hyperkinetic and emotional disorders. Families of 20 boys diagnosed with Attention Deficit Hyperkinetic Disorder and 20 boys with Emotional Disorder (ages 6-12 years) by giving the Mannheim Parents Interview and the teacher's form of the Conners scale were included for evaluation and compared with a matched, healthy control group of 20 boys. Parents were asked to complete a form assessing the family's characteristics ("Familienklima-Testsystem"), including Cohesion, Expressiveness, Conflict Tendency, Individual Independence, Achievement Orientation, Intellectual-Cultural Orientation, Active-Recreational Orientation, Moral-Religious Emphasis, and Organization. Comparison of groups was made by the Kruskal-Wallis test and Mann-Whitney U test. There are significantly more conflicts in families whose children belong to the two disorder groups. Compared with a matched healthy control group, there is low Expressiveness, Independence, and Cultural and Active-Recreational Orientation in the Emotional Disorder group and a significant lack of Organization and Cohesion in the Attention Deficit Hyperkinetic Disorder group. Altogether there seems to be a significant association of Attention Deficit Hyperkinetic Disorder symptoms with the family's Cohesion and Organization. One implication is that therapists focus their efforts not only on the children with disorders but also on their families.

[Reconditioning in groups: an effective programme for the rehabilitation of patients with low back pain?]. / "Rekonditionierung in Gruppen" - Ein wirksames Rehabilitationsprogramm bei chronischen Rückenschmerzen?

The article reports on a study in which elements of a group-oriented reconditioning programme for patients with low back pain were incorporated into the routine of an in-patient orthopaedic rehabilitation clinic. The specific elements of the new programme consisted of stable group structures during the whole stay of 3 to 4 weeks, and of 3 to 7 hrs. walks in hilly ground three times a week. The effects of this programme were tested against a standard programme with a mix of passive and active elements using a controlled study design. 92 persons participated in an experimental group and 81 persons in a control group with no significant differences found between the two groups at admission. Effects were measured by means of a physicians' questionnaire and a multidimensional patients' questionnaire (IRES) answered at admission, at discharge, and at six- and twelve-month follow-up. The results of a two-factorial analysis of variance with repeated measures showed that the interaction between group and time on the summary score of the IRES was not significant, although the experimental group showed somewhat better effects at all times of measurement. The discussion focuses on the reasons for this result, among which the unexpectedly good effects in the control group are named, as well as certain difficulties with the implementation of a strongly activity-oriented programme into the course of a "normal" rehabilitation clinic.

[Improved immunocompetence in two children with chronic Epstein-Barr virus infection under treatment with a standardized thymus hormone preparation (thymostimulin)]. / Verbesserte Immunkompetenz bei zwei Kindern mit chronischer Epstein-Barr-Virusinfektion unter der Behandlung mit einem standardisierten Thymushormon-Präparat (Thymostimulin).

Two children with chronic Epstein-Barr virus infection were treated with a standardized thymic hormone preparation (thymostimulin, TP-1 Serono). The treatment was well tolerated. No adverse reactions, no side effects were observed. Results of immunological investigations showed a trend towards normalisation. Additional clinical evidence showed up, which pointed to a response to the therapy.

[Coumarin embryopathy]. / Coumarin-Embryopathie.

Anticoagulant therapy using coumarin derivatives (vitamin K antagonists) during early pregnancy may result in a characteristic embryopathy appearing as a phaenocopy of chondrodysplasia punctata (Conradi-Hünermann's disease). This has been suggested in advance by observations made in newborns of mothers who had been treated previously with warfarin or acenocoumon. Similar observations made in a newborn after the mother's treatment with phencoumon in early pregnancy are described in this paper. Coumarin embryopathy is proposed as a common term.

[Psychological aspects of the preparation and performance of endoscopies in children and adolescents]. / Psychische Aspekte bei der Vorbereitung und Durchführung von Endoskopien bei Kindern und Jugendlichen.

Individual observations lead to the realisation that during endoscopy children may develop such a degree of seemingly unexplainable anxiety that the performance of the examination is considerably prejudiced. We therefore examined 39 children systematically, evaluating them according to fearsome products of their imagination on the one hand and real or warranted anxiety on the other. Adjusted to age the children were tested using drawings, projectional tests and role-playing in addition to interviewing, sometimes of their parents as well. The most prominent expressions of anxiety in conjunction with endoscopy were fear of suffocation; fear of damage to internal organs and, in girls, fear of lesions to a "baby inside". In adolescents problems with prudery became evident. On the basis of our experience we developed a systematic model of psychological preparation for endoscopic examinations.

Partial monosomy 22pter leads to q11 in a newborn with the clinical features of trisomy 13 syndrome.

In a female newborn with the clinical and postmortem findings of Pätau's syndrome no trisomy 13 could be found by chromosomal investigation. Rather, the karyotype 45,XX,-11,-22,+(11;22) (p15;q11) was ascertained by GTG-,RFA-and TFA-banding. The long arm of one chromosome 22 is translocated upon the short arm of one chromosome 11, and the remaining part of the derivative chromosome 22 is lost. The child therefore is monosomic for 22pter leads to q11 and probably for the telomeric region of 11p15. Since both parents possess normal karyotypes, it is a de novo translocation. The case in point illustrates that the more correlation of a given phenotype to a specific karyotype is not possible in all cases.