[Snowboarding accidents 1991 to 1994--an analysis]. / Snowboardunfälle 1991 bis 1994--Eine Analyse.

437 snowboard injuries were taken under surveilance in the years 1991 till 1994. The average age was 21.5 years. 422 (97%) injuries were caused by a crash, only 15 (3%) by a collision. 178 patients (41%) needed only one single office visit, 259 patients (59%) had to undergo longer outpatient treatment (mean 27d). Only 34 patients (8%) needed inpatient treatment with an average stay of 4.44 days. 127 patients (29%) were on sick leave for several days (mean 20.57d). The most common diagnosis was a distortion 183 (38%), followed by fractures 148 (31%) and contusions 98 (21%). The upper extremities were the predominant injury site in 51% (245) with no prevalence of left or right. The lower extremities were injured in 34% (163) with a prevalence of the left leg 2/3. Head, spine, chest and abdomen were injured in 15% (69). The typical snowboarders injury however is an injury of the wrist (182/27%). Here of 71 (39%) were fractures of the distal radius. The knee joint being the second most common injury sight in 109 (16%) cases, mainly with sprains (63p/60%), seldomly with meniscal tears and/or ligament ruptures (10p/10%) and rarely fractures (3p / 3%). The fixation of both legs during snowboarding seems to be protective against complex knee joint injuries. Other regions were injured in less than 10%.

[Radius fractures in typical sites in young patients--is it early osteoporosis?]. / Radiusfrakturen an typischer Stelle bei jungen Patientinnen--ist das frühe Osteoporose?

Fractures of the radius in premenopausal women caused by a slow speed trauma are often associated with osteoporosis. Out of 156 patients we were able to screen 26 for osteoporosis. Bone mineral density (BMD) of the lumbar spine and the femoral neck was compared with the age related control group. At the lumbar spine the mean decrease of BMD was 13.1% (CI 95% 8.78 to 17.4%; SEM = 2.1). The patients showed a BMD between Z = -1 and Z = -2 and 4 patients lessen than Z = -2. At the femoral neck the mean decrease of BMD was 15.8% (CI 95% 11.3 to 20.3%; SEM = 2.17). Z was between -1 and -2 in 10 patients and smaller -2 in 6 patients. There was no correlation between the number of risk factors and bone mineral decrease. All evaluated laboratory tests were within normal range. As a result of our investigation we suggest looking for osteoporosis in premenopausal women with fractures following slow speed trauma as a routine procedure to offer adequate therapy.

Unreamed intramedullary nailing of femoral fractures.

Seventy-five patients with 81 femoral shaft fractures were treated with unreamed antegrade intramedullary nailing using a titanium alloy implant (AIM femoral nail, ACE Medical) with static interlocking. There were 73 closed fractures and 8 open fractures. Six patients had bilateral femoral shaft fractures. In two cases there was an ipsilateral fracture of the femoral neck, two patients had an ipsilateral intertrochanteric fracture, in one case there was a concomitant subtrochanteric fracture, and four patients had sustained an ipsilateral fracture of the acetabulum in addition to their femoral shaft fractures. In 43 cases (53%) the fracture of the femoral shaft was a comminuted type fracture. Thirty-nine patients (52%) had suffered multiple injuries; the mean Injury Severity Score was 41.2. Sixty-nine fractures were stabilized primarily within 8 hours after admission and 12 fractures were treated secondarily, in a mean of 5.8 days after injury. Closed intramedullary nailing was performed in 73 femora and open nailing with cerclage wiring was done in 8. All 81 nails were implanted unreamed and static was used in every case. The diameters of the nails used were 9 mm (n = 68) and 10 mm (n = 13). Proximal interlocking was distally directed in 76 cases and proximally directed in 5 cases. Two patients died of severe head injuries and one patient died of multiple organ failure. The infection rate was 0%, and uneventful consolidation of the fractures was seen in all cases within a mean of 3.8 months. Neither in the case of nails nor in the case of interlocking bolts did an implant failure occur.

[Epiphyseal growth after replantation in childhood]. / Epiphysenwachstum nach Replantation im Kindesalter.

Long-term results in 17 patients with 19 replanted parts of the upper extremity after replantation during childhood are presented. Regarding longitudinal epiphyseal growth, three patients had normal growth. In 15 cases, average length of the replanted digits attained 88.6% of normal and one patient gained overgrowth of 118% of normal. In every case, consolidation of the fracture was seen. Four patients developed a deviation of the replanted finger in the frontal plane. The cause of deviation in every case was incorrect primary reposition and not a disturbance of growth of the replanted epiphysis.

Late results following proximal reinsertion of isolated ruptured ACL ligaments.

Between 1982 and 1984, 49 patients with fresh isolated proximal ruptures of the anterior cruciate ligament (ACL) were operated on in the Trauma Hospital, Salzburg. The operation was performed within 1 week of trauma. The operational technique used was proximal reinsertion of the ruptured ACL alone. Postoperatively the knee was immobilized for 6 weeks in an above-the-knee plaster cast. We were able to re-examine 42 of the 49 patients 5-7 years after injury. In addition to a clinical examination, testing with a KT-1000 arthrometer was performed. The objective and subjective results we found were evaluated using the Lsyholm score and OAK knee evaluation form. We found 12 (29%) absolutely stable knee joints. We accepted a KT-1000 result of up to 3 mm as satisfactory, and 81% of our patients were in this category. The same percentage (81%) scored between 85 and 100 points on the Lysholm scale. Only 52% scored over 90 points on the OAK form. Subjectively only 6 patients (14%) were dissatisfied with their result.

Inhibitory and bactericidal activity of cefpirome and cefotaxime against blood culture isolates.

Using a broth microtiter dilution method, minimum inhibitory (MIC) and minimum bactericidal concentrations (MBC) were determined for the aminothiazolyl cephalosporins cefpirome and cefotaxime against 436 blood culture isolates. At concentrations of less than or equal to 16 mg/l, cefpirome inhibited 82.3% of the isolates and cefotaxime 66.5%. At the same concentrations, cefpirome killed 60.0% of the isolates and cefotaxime 46.7%. Whereas the MIC values indicated a far better activity of cefpirome than cefotaxime against oxacillin-resistant Staphylococcus aureus, Enterococci and Pseudomonas aeruginosa, the MBC values showed a poor activity of both drugs against these strains. By comparison, cefpirome was the more active agent, covering a similar spectrum to that of cefotaxime with a slight additional activity against oxacillin-susceptible S. aureus and Staphylococcus epidermidis.

[Results of virologic studies in 620 children with abacterial meningitis over a 15-year period (1971-1985)]. / Ergebnisse virologischer Untersuchungen bei 620 Kindern mit abakterieller Meningitis in 15 Jahren (1971-1985).

Cases of non-bacterial meningitis being hospitalized at the Children's Hospital of the University of Bochum in the years 1971 to 1985 were analysed retrospectively according to etiological and epidemiological aspects. Altogether 620 non-bacterial cases of meningitis were included in this study. For 378 (60.9%) children the infecting agent could be identified while in 242 cases (39.1%) the etiology remained open. In 237 cases enterovirus had been the causative agent. The average age of the patients was 6.5 years, boys were more frequently involved than girls (65% versus 35%). The majority of enterovirus infections occurred during the summer months July to September whereas (mumps) parotitis infections were equally distributed over the whole year. Yearly increases in certain enterovirus types were correlated to an increase in ECHO 11-infections in 1982, Coxsackie B5-infection in 1983 and 84 and ECHO 7-infection in 1985 based on data from the whole Federal Republic of Germany. However the majority of enterovirus-caused meningitis occurred during local endemics.

[Legionnaires' disease in cystic fibrosis]. / Legionärskrankheit bei cystischer Fibrose.

A "new pneumonia" is named legionnaires' disease after a gramnegative bacillus - Legionella pneumophila, unknown until 1977. Sofar it has been observed mostly in older male patients, rarely in children and never before in Germany. The legionnaires' disease in our patient, a five and half years old boy with cystic fibrosis caused a severe dyspnea and multilobular pulmonary densifications on the chest X-ray film. The diagnosis was verified by the rise of the titer in the indirect immune fluorescence test and the success of the therapy with erythromycin.

Ticarcillin serum and tissue concentrations in gynecology and obstetrics.

Ticarcillin tissue concentrations were determined in 77 patients following an infusion of 5 g over 30 min. The tissues studied in gynecology were endometrium, tube, ovary and myometrium. The relative tissue levels ranged from 17% to 30% of the corresponding serum concentrations when ticarcillin was administered once, and from 22% to 32% when the drug was infused repeatedly. In no case did these tissue levels exceed the serum concentrations. The mean relative tissue levels in early pregnancy (decidua, placenta, embryo) were 10% of the corresponding serum concentrations. Levels in late pregnancy were determined in the placenta, amniotic fluid and in serum from the umbilical cord artery and vein immediately after delivery. Maximal placenta concentrations of 30 mg/kg were determined; these declined exponentionally with half-lives of 2.8 and 1.3 h, respectively, following single and repeated dosings. Amniotic fluid levels increased from 10 mg/l immediately after the first infusion to 60 mg/l after the seventh infusion. Individual umbilical cord levels in the artery and vein were significantly different, indicating that the fetus has properties of a deep compartment. The total amount of ticarcillin excreted daily in the mother's milk was strictly correlated to its volume and ranged from 2-2.5 mg/l.

[Investigation on the antimicrobial activity of cefoperazone (author's transl)]. / Untersuchungen über die antibakterielle Aktivität von Cefoperazon.

Cefoperazone has the usual antimicrobial spectrum of the cephalosporins, but the ratios of resistance to the various bacterial strains - even if they are problematic-are very low. It remains to be seen, however, whether a widespread use of the drug induces an increase in the number of resistant strains. An outstanding advantage of cefoperazone is its efficacy against Pseudomonas aeruginosa; only one of 75 strains investigated was resistant. In the case of Providencia, an important germ in the field of urology that is often difficult to be affected by antibiotics, we could not find any resistant strains. We did, however, find moderate sensitive strains. Concerning Enterococci we did not find any resistant strains, but 96% of the strains were classified as moderate sensitive. That leads to the conclusion that the drug should only be effective in high dosage, when Enterococci are found. Even multi-resistant bacterial strains still respond considerably to cefoperazone. This applies in particular to Pseudomonas aeruginosa.

[Therapy of surgical infections with dibekacin. Pharmacokinetic, clinical and bacteriological results]. / Therapie chirurgischer Infektionen mit dibekacin. Pharmakokinetische, klinische und bakteriologische Untersuchungsergebnisse.

Applicability, effect and toleration of dibekacin (Orbicin) were tested in pharmacokinetic, clinical and bacteriological studies treating 29 patients with severe surgical illnesses and 10 healthy volunteers as control group. The pharmacokinetic test results and the efficacy with severe infections showed dibekacin to be equivalent to the new aminoglycoside antibiotics gentamycin, sisomicin and tobramycin. Resistance was sporadic and severe side effects did not occur. Dibekacin proved itself to be a new alternative when aminoglycoside antibiotics are indicated

[Cefazedone in infectious diseases in gynecology. Clinical tests on efficacy and tolerance]. / Cefazedon bei infektiösen Erkrankungen in der Frauenheilkunde Klinische Prüfung zur Wirksamkeit und Verträglichkeit.

A clinical trial on efficacy and tolerance of Cefazedone, a new semisynthetic Cephalosporine-derivate, was carried out in a gynaecological clinic on 75 patients. In 38 of these cases, besides the gynaecological affection, urinary tract infections were determined microbiologically (E. coli, P. mirabilis, klebsiella or enterococci). Inflammation of the lower abdominal area was established in the remaining 37 patients (adnexitis, pelvic peritonitis, endometritis, salpingitis). The average duration of treatment was 10 to 11 days. Cefazedone was injected intravenously twice a day, the daily dose was 2 to 4 g. The clinical assessment of the treatment was very good in 28 cases, good in 43 cases, moderate in 3 patients and poor in 1 case. All initially identified pathogens were eliminated after treatment. A slight transitory diarrhea was observed in 5 cases. There were no further side-effects. The values of gamma-GT, serum-creatinin, hemoglobin and erythrozytes were controlled before and after medication and showed no detremental effect of the drug. The local tolerance of Cefazedone was good in more than 90% of the cases treated.