Predictors of short-term survival after helicopter rescue.

The purpose of the present retrospective study was to identify easily obtainable predictors of short-term outcome for emergency victims treated by a physician-staffed helicopter emergency medical system (HEMS). The study was conducted at the HEMS unit 'Christophorus 1' based at Innsbruck, Austria. Outcomes for 2139 patients rescued in primary missions during a 3-year period from 1 January 1989 to 31 December 1991 were included in the study. The majority of missions were in response to sports accidents, although missions included a wide spectrum of emergencies. Data were obtained from the 'Christophorus 1' operation protocols and by written, personal, or telephone request from admitting hospitals. Eleven parameters selected from the HEMS flight logs were tested for their predictive value on survival following helicopter rescue. In a univariate analysis, the cause of the emergency, time at the scene, total duration of the emergency mission, patient age, patient gender, severity of the emergency using the National Advisory Committee of Aeronautics (NACA) scoring system, state of consciousness, respiratory status and patient circulatory status each had a statistically significant influence on survival up to 90 days following the emergency. Flight time to the scene and the original specialty of the additionally trained emergency physician had no significant influence on outcome. Multivariate analysis using the Cox proportional hazards model revealed that severity of the emergency by the seven-level NACA scale (P = 0.0001), initial respiratory status (P = 0.0001), time at the scene (P = 0.0108), patient age (P = 0.0047) and patient gender (P = 0.0477) were each independent predictors of short-term survival following physician-staffed helicopter rescue. We conclude that the parameters described above can be used in an initial predictive assessment by the flight physician and the admitting institution.

Protective effects of various preservation solutions on cultured endothelial cells.

Vascular endothelium represents the first target in organ preservation and plays an important role in reperfusion injury. Bovine aortic endothelial cells were cultivated and the most commonly used preservation solutions, such as University of Wisconsin HTK (Brettschneider's histidine-tryptophane-ketoglutarate), and Euro-Collins solutions were tested on the endothelial monolayer. In addition, one group of cultivated cells was preserved with cold saline solution, and endothelial monolayers grown in culture medium were used as controls. The quality of preservation was assessed after 24, 48, and 72 hours of cold storage. Reperfusion was simulated and its effects were observed by reincubation in culture medium at 37 degrees C for 6 hours. The total number of cells, cell viability (determined using trypan blue exclusion), and morphologic alterations were determined. Prostacyclin release was evaluated as a biochemical marker. University of Wisconsin solution maintains more than 99% cell viability after rewarming after both 24 and 48 hours of cold storage. After 72 hours, 86.7% of cells were still viable. Preservation with HTK and Euro-Collins solution allowed cell survival for only 24 hours (96.7%, HTK; 49.9%, Euro-Collins), with no viable cells seen after 48 hours. The cold saline-preserved sample showed 57.8% viable cells after 24 hours and 29.7% after 48 hours. No viable cells were detectable after 72 hours. Light microscopy revealed several patterns of both structural damage and intracellular change (nucleus and cytoplasm) in the endothelial monolayer after preservation with HTK, Euro-Collins solution, and cold saline solution. No morphologic alterations were seen in the University of Wisconsin solution group for as long as 72 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

[Aseptic necroses and osteochondrosis dissecans of the elbow joint]. / Aseptische Nekrosen und Osteochondrosis dissecans des Ellbogengelenkes.

In our opinion, complete (Panner's disease) and incomplete (osteochondrosis dissecans; OD) necrosis of the elbow epiphysis form a nosologic unit. A review of the localization, pathogenetic hypotheses, symptoms, diagnosis and treatment of aseptic necrosis and OD of the elbow is presented with reference to the older and, especially, the current literature. In contrast to the procedures reported in the literature, we performed subchondral focus drilling in 10 patients over 10 years of age suffering from Panner's disease, with good functional results. Operative therapy was performed on 50 elbow affected by OD. Follow-up examinations were possible in 35, with an average observation period of 94.3 months. The results are categorized according to the stage of disease before treatment. It is desirable to perform surgical treatment at an early stage of the disease, since this can make it possible to avoid dissection. If dissecion is present, refixation early in the middle stage seems to be the treatment of choice.