[Reform of occupational insurance medical treatment from the perspective of an accident insurance consultant]. / Neuordnung des BG-lichen Heilverfahrens aus der Sicht eines niedergelassenen D­Arztes.

The reform of occupational insurance medical treatment in 2011 also resulted in many changes for occupational insurance consultants in private practice. The transformation of the physicians participating in treatment status (H-Arzt) to accident insurance consultant status (D-Arzt) has resulted in a significant increase in numbers in outpatient fields, which in some cases leads to increased competition. The tentative flexibilization of the conditions for participation of a D­Arzt is welcomed but must be broadened to safeguard the future. The relaxation of obligatory attendance of a D­Arzt is contemporary and is welcomed. The regularly checked obligation for further education initially led to irritation but has now been extensively coordinated with the mandatory further education for contract physicians. As from 1 January 2016 many smaller alterations and specifications in the implementation regulations have been undertaken. The scale of charges for physicians in invoicing with accident insurance companies as with other scales of charges is urgently in need of reform with respect to the performance rating and in particular to the classification.

[Salter-Harris type IV epipyseal fracture of the lateral malleolus. A rare injury in childhood]. / Salter-Harris-Typ-IV-Epiphysenfraktur am Außenknöchel. Eine seltene Verletzung im Kindesalter.

This is a case presentation of a 9-year-old boy who sustained a rare Salter-Harris type IV distal fibular fracture including an avulsion fracture of the anterior inferior tibiofibular ligament at the fibular attachment. Treatment consisted of open reduction and internal fixation by Kirschner wire and cerclage. Possible posttraumatic growth disturbances and the major implications are highlighted.

[The clinical effectiveness of a post milking teat disinfection method with a foaming iodophor teat dip]. / Untersuchungen zur klinischen Wirksamkeit eines Zitzendesinfektionsverfahrens nach dem Melken mit einem schaumbildenden jodophoren Dippmittel.

The effect of postmilking teat dipping with a foaming iodophor agent on incidence of intramammary infections (IMI), incidence of clinical mastitis, somatic cell count and the characteristics of udder tissue and teat was investigated in a positively controlled field study. Two groups of animals were compared. Teats were dipped with a foaming iodophor in the treatment group (TG, 122 animals) while teats in the control group (CG, 121 animals) were dipped with a conventional iodophor teat dip with the same iodine content. A bacteriological examination of quarter milk samples divided the study period in two parts. The incidence of new IMI did not differ between the groups (1st part of trial: TG vs. CG: 6.84% vs. 9.16%, 2nd part of trial: 7.78% vs. 7.82%). There were no differences between the treatment groups regarding incidence of clinical mastitis. We detected 0.64 clinical cases per 100 days in the treatment group vs. 0.50 in the control group. The development of SCC was comparable in both groups. Teat skin and teat duct conditions showed variation during the study period. Clinical efficacy of postmilking teat disinfection with a foaming iodophor was comparable to the treatment with a conventional iodophor product.

Efficacy of a herd-specific vaccine against Staphylococcus aureus to prevent post-partum mastitis in dairy heifers.

A placebo-controlled field study was performed to evaluate the effect of a herd-specific vaccine against Staphylococcus aureus on intramammary infection (IMI), somatic cell count (SCC) and clinical mastitis. Three hundred and twenty-one heifers were assigned to two groups. Heifers in the vaccination group (n = 164) were vaccinated twice, i.e. 5 and 2 weeks before their expected calving date. Animals of the control group (n = 157) received the same treatment with a placebo containing no bacterial antigen. Quarter milk samples were collected immediately after parturition prior to the first machine milking, 3-4 weeks after calving and before the onset of treatment in animals with signs of clinical mastitis during the first 3 months after calving. For comparison of SCC the data from the monthly milk test records were evaluated. The prevalence of S. aureus in quarter milk samples taken at calving and 3-4 weeks post-partum did not differ significantly between the vaccine and control group. Incidence of clinical mastitis during the first 3 months after calving and the prevalence of S. aureus in quarter milk samples taken before the onset of treatment did not differ significantly between the groups. The SCC was lower in vaccinated than in control heifers. However, the difference was only significant on the third milk test day. Regarding prevalence of IMI with S. aureus and incidence of clinical mastitis the use of a herd-specific vaccine against S. aureus did not prove to be efficient on this farm.

Effect of teat dipping with a germicide barrier teat dip in late gestation on intramammary infection and clinical mastitis during the first 5 days post-partum in primiparous cows.

The effect of teat dipping with a barrier teat dip prior to parturition on intramammary infection (IMI) and clinical mastitis during the first 5 days post-partum was investigated in a split udder trial in 149 Holstein-Frisian heifers. Their left front and right hind quarters were dipped three times weekly (i.e. Monday, Wednesday and Friday) with a barrier teat dip containing 0.1% polyvidon iodine from day 260 of gestation until parturition. The opposite quarters (right front and left hind quarter) served as untreated control. Bacteria were isolated from 52.2% of quarter milk samples collected immediately after parturition prior to first machine milking. Staphylococcus aureus and coagulase-negative staphylococci (CNS) were predominantly found in the samples (29.2 and 35.6% of the positive samples, respectively). At parturition 6.7% of the heifers showed signs of clinical mastitis and another 27.5% developed signs of clinical mastitis during the first five days of lactation. No significant differences were found between treated and control quarters regarding IMI and incidence of clinical mastitis. Teat dipping prior to parturition in primigravid dairy heifers did not improve udder health in this trial.

[Effect of puerperal mastitis in primiparous cows on milk production, cell count and culling]. / Einfluss von peripartalen Mastitiden bei Erstkalbinnen auf Milchleistung, Zellgehalt und Abgangsrate.

A retrospective cohort study was performed to investigate the effect of clinical mastitis in heifers during the first week post partum (p.p.) on subsequent health and productivity. Primiparous cows that had calved between August 15th, 1996 and August 14th, 1997 (n = 1389) were included in the study. Milk samples were collected from each quarter post partum prior to first milking. The predominant group of bacteria found were Staphylococcus spp. (69%) followed by Streptococcus spp.(12%) and E. coli (5%). Intramammary infections at calving increased the risk of clinical mastitis within the first week p.p. The cow incidence of mastitis until day 7 p. p. was 38%. Cows were classified into three groups. Group 1: Animals with clinical mastitis prior to calving (n = 35); Group 2: Animals with clinical mastitis between calving and 7 days p. p. (n = 503); Group 3: Animals without mastitis until 7 days p. p. (n = 851). Mastitis prior to parturition and mastitis within the first week p.p. increased the risk of further cases of mastitis and culling during the first 45 days of lactation. Milk yield of Group 2 was lower and somatic cell counts were higher than in Group 3.

[Individual animal risk factors for Prototheca mastitis in cattle]. / Tierindividuelle Risikofaktoren für die Protothekenmastitis des Rindes.

Risk factors for mastitis caused by Prototheca zopfii were determined in a retrospective case control study. 248 cows culled for protothecal mastitis in a large dairy herd were included in the study. The diseased cows were compared to their non affected herdmates in respect to age, stage of lactation, production and milk composition. The effect of previous cases of mastitis during the same lactation or in previous lactations and the effect of antibiotic pretreatment were determined in a split udder analysis comparing left quarters to right quarters. Age and mastitis history especially antimicrobial pretreatment were important risks factors for developing protothecal mastitis. Risk of protothecal mastitis increased with parity. Quarters with a history of clinical mastitis during the same or during previous lactations were at higher risk than other quarters (OR 1.98, p < 0.01 and 1.44, p = 0.06, respectively). Pretreatment with antibiotics increased the risk of protothecal mastitis (OR 3.19, p < 0.001). Milk yield was lower in cows that developed protothecal mastitis. Somatic cell counts were higher than in control cows. Incidence of protothecal mastitis peaked in the second month of lactation.

[First aid at the scene of the accident from the viewpoint of the trauma surgeon]. / Erstmassnahmen am Unfallort aus der Sicht des Unfallchirurgen.

A step-by-step therapy concept for prehospital care of the severely injured is presented. A schedule for effective organization of the rescue procedure is given, after which stress is placed on preservation of the vital functions. A therapy algorithm is explained, according to which the indications for intubation, ventilation and volume replacement depend on both physiological parameters (blood pressure, respiration frequency, Glasgow Coma Scale, capillary refill) and the type of injuries. Initial care of the injuries is discussed in some detail. Competent preclinical management of fractures and joint dislocations is a major topic. A flow chart for the selection of an adequate trauma center is proposed, which takes account of vital signs, the extent of the injuries, how the accident happened, and the force of the impact.