[Reversible autonomic dysfunction in a young woman with septic multiple organ dysfunction syndrome]. / Reversible autonome Dysfunktion bei einer jungen Patientin mit septischem Multiorgan-Dysfunktionssyndrom.

HISTORY: A 24-year-old woman was admitted for treatment of a meningococcal infection accompanied by fulminant autonomic dysfunction. INVESTIGATIONS: Laboratory tests indicated acute renal failure and disseminated intravascular coagulopathy (creatinine 183 mmol, D-dimer 1.52 mg/l). The initial central venous oxygen saturation was 60-65%. The diagnosis of severe septic shock was supported by a high procalcitonin level of 66.7 ng/ml, CRP of 79.8 mg/l, and a WBC count of 12.2 Gpt/l. TREATMENT AND COURSE: Treatment of sepsis with antibiotics (ciprofloxacin, penicillin G, ceftriaxon and erythromycin in standard dosages), activated protein-C, hydrocortisone and GMA-embedded immunoglobulin led to complete cure and restoration of normal autonomic function. CONCLUSIONS: This case shows that even in multiple organ dysfunction syndrome autonomic dysfunction can occur which is improved by adequate treatment.

[Surgery for fractures of the lower extremities in cases of chronic spinal cord injury]. / Operative Therapie von Frakturen der unteren Extremitäten bei chronischen Querschnittlähmungen.

According to the literature, the need for surgical treatment of fractures of the lower extremity in patients with chronic spinal cord injury (SCI) is very limited. Conservative management is usually presented as the treatment of choice. We present the results of a retrospective review of 55 fractures in 44 patients from 1996 to 2000 which were managed surgically. Rating of the outcome was based on basic clinical and radiological criteria. The results of the radiological investigation on bone remodeling and bone positioning after healing were rated as good or excellent in 43 and fair in five limbs. In five cases, the treatment failed. For 53 of the 55 fractures, the patients regained their normal level of independence. Comparing our results to those presented in the literature, we clearly had fewer complications as well as better clinical and radiological results. We therefore advocate surgical treatment as an appropriate choice of treatment for lower extremity fractures of patients with chronic SCI.

Use of the ring fixator in the treatment of fractures of the lower extremity in long-term paraplegic and tetraplegic patients.

STUDY DESIGN: Retrospective study. OBJECTIVES: To examine the value of operative fracture stabilization by means of the ring fixator in fractures of the lower extremity in the presence of chronic paralysis caused by transverse lesions of the spinal cord. SETTING: A specialist center for the treatment of spinal cord injuries in Germany. METHODS: Clinical examination of the lower extremities with side-for-side comparison, radiological investigation of the fractures, patient survey. PATIENTS: In 21 patients with chronic spinal cord lesions, 22 fractures of the lower extremities were treated with the ring fixator. RESULTS: At follow-up a mean of 41.5 months after fracture healing it could be shown that movement in the knee and ankle joints on the same side as the fracture was not restricted by more than 10 degrees in any of our patients. No losses affecting activities of daily living were reported, and 19 of the 21 patients were satisfied with the result achieved with this technique. After four of the 22 operations there were complications. Malalignments were visible radiologically following five of the fractures. CONCLUSIONS: In osteoporosis-induced fractures of the lower extremities in chronically paraplegic and tetraplegic patients, fracture stabilization with the ring fixator, with fewer complications and better results in terms of joint mobility, is superior to the conservative treatment so far given preference in the literature. It should be offered as an alternative to conservative treatment in the case of pathological fractures.

Cell-elastometry: a new method to measure erythrocyte membrane elasticity.

A new method for measuring erythrocyte membrane elasticity in physiological media is presented. Cells are loaded with well-defined centrifugal forces and the resulting change in shape is observed indirectly by laser diffractometry. Only a small amount of data has to be acquired and evaluated to follow up all the shape information contained in the diffraction pattern. This method has been proven using native and chemically altered cells (glutaraldehyde and diamide treatment). Advantages of the proposed method are the ease of handling, the small blood volume (10 microliters) needed per measurement, a high sensitivity and the rational experimental setup.