Causes of Death in the Seriously Injured -Why do Severely Injured Patients Die Today? / Todesursachen von Schwerverletzten - Woran stirbt das Polytrauma heute?

HINTERGRUND: Trauma ist die häufigste Todesursache bei unter 45-Jährigen und trotzdem gibt es nur wenig Daten zu den genauen Todesursachen Schwerverletzter nach Klinikeinlieferung in Deutschland aus den letzten 10 Jahren. Ziel der Arbeit ist 1. eine Auswertung der Daten der verstorbenen Schwerverletzten eines überregionalen TraumaZentrums aus den letzten 10 Jahren. Erforscht werden sollen Verlässlichkeit der Daten, Häufigkeit der Todesursachen und Zusammenhänge mit dem Unfallmechanismus und 2. die Nachvollziehbarkeit der Daten im TraumaRegister DGU. PATIENTEN UND METHODEN: Es erfolgte die Auswertung der Daten von 203 verstorbenen schwerverletzten Patienten aus dem Universitätsklinikum Jena, die von 2007 bis 2017 verunfallt sind. ERGEBNISSE: Eine eindeutige Festlegung der Todesursache ist anhand von Klinikdaten in ca. 85% der Fälle möglich. Häufigste Todesursache von Schwerverletzten nach Klinikeinlieferung ist mit 59,6% das Schädel-Hirn-Trauma, gefolgt von 17% Organversagen, 14% Hämorrhagie und 9,4% sonstigen Todesursachen. Die Verifizierung anhand von Daten aus dem TraumaRegister DGU ist möglich. Es besteht ein klarer Zusammenhang zwischen Unfallmechanismus und Todesursache. SCHLUSSFOLGERUNGEN: Welche Todesursache angegeben wird, unterliegt immer auch einer subjektiven Einschätzung. Insbesondere bestehen Schwierigkeiten bei Patienten, die vor weiterer Diagnostik im Schockraum versterben. Häufigste Todesursache ist heute das Schädel-Hirn-Trauma. Es ist sinnvoll, die Todesursache im TraumaRegister DGU extra zu erfassen, da diese anhand von anderen Registerdaten nur teilweise abgeleitet werden kann. Die Zusammenhänge zwischen Unfallmechanismus und Todesursache könnten ggf. für Präventionsmaßnahmen genutzt werden. BACKGROUND: The leading cause of death among people under 45 years of age is trauma. However, there is little information from the last 10 years on the exact causes of death of seriously injured people after hospital admission in Germany. The aim of the study is to evaluate the data of a level I trauma centre from the last 10 years. The reliability of the data, frequency of the causes of death and correlations with the mechanism of injury as well as the confirmability of the data in the TraumaRegister DGU are to be investigated. MATERIALS AND METHODS: The University Hospital Jena data were analysed for 203 deceased trauma patients from accidental death between 2007 and 2017. RESULTS: A clear determination of the cause of death is possible in about 85% of cases on the basis of hospital data. The most frequent cause of death of severely injured patients after admission to the hospital is traumatic brain injury (59.6%), followed by organ failure (17%), haemorrhage (14%) and other causes of death (9.4%). Verification using data from the TraumaRegister DGU is possible. There is a clear correlation between mechanism of injury and cause of death. CONCLUSIONS: The cause of death is very often a subjective assessment of the recording doctor. In particular, there are difficulties with patients who die in the resuscitation room before further diagnosis. The most frequent cause of death today is traumatic brain injury. For future evaluations, the new information in the TraumaRegister DGU is helpful because the cause of death can only be partially derived from other registry data. The correlation between the type of accident and the cause of death could be used for preventive measures.

Biomechanical evaluation of plate osteosynthesis of distal fibula fractures with biodegradable devices.

BACKGROUND: This study compared fixation with a titanium one-third tubular plate and one lag-screw vs. fixation with biodegradable plates with one lag-screw applied with two different plate-screw patterns. MATERIALS AND METHODS: Ten pairs of fibulas were osteotomied, plated (titanium plate with one lag screw vs. absorbable 2/8 plate-screws crossing vs. 0/8 plate-screws crossing the osteotomy gap). and tested in torsion and bending to obtain stiffness and neutral-zone (NZ) data. Tests were performed using 5 load cycles. No load to failure was performed. Biodegradation was simulated by 6 week immersion in phosphate-buffered saline after which the testing protocol was repeated. The specimens were then loaded with 100 N in bending. RESULTS: Post-implantation, there were no significant differences, in torsion and bending, regarding the NZ or the stiffness, between the 2/8 biodegradable plate and the titanium plate. The 0/8 pattern performed significantly less well in terms of stiffness and NZ in the initial torsion test, and significantly less well in terms of stiffness in the initial bending test. After 6 weeks' immersion, all biodegradable constructs showed a significantly larger NZ and significantly reduced bending and torsional stiffness. When loaded with 100 N, four of the six 0/8 osteosyntheses failed. There were no significant differences between the 2/8 pattern and the titanium plates. CONCLUSION: In a model of a Weber-B fracture, the use of a 2/8 biodegradable plate construct initially did not differ statistically to that obtained with a one-third tubular titanium plate. After immersion the 2/8 construct withstood some physiological load. CLINICAL RELEVANCE: For the fixation of ankle fractures with a biodegradable plate of the type employed in this study, the use of fracture-gap-crossing screws is recommended.

Expression of the oncofetal ED-B-containing fibronectin isoform in hematologic tumors enables ED-B-targeted 131I-L19SIP radioimmunotherapy in Hodgkin lymphoma patients.

Current treatment of hematologic malignancies involves rather unspecific chemotherapy, frequently resulting in severe adverse events. Thus, modern clinical research focuses on compounds able to discriminate malignant from normal tissues. Being expressed in newly formed blood vessels of solid cancers but not in normal mature tissues, the extradomain B of fibronectin (ED-B FN) is a promising target for selective cancer therapies. Using immunohistology with a new epitope retrieval technique for paraffin-embedded tissues, ED-B FN expression was found in biopsies from more than 200 Hodgkin and non-Hodgkin lymphoma patients of nearly all entities, and in patients with myeloproliferative diseases. ED-B FN expression was nearly absent in normal lymph nodes (n = 10) and bone marrow biopsies (n = 9). The extent of vascular ED-B FN expression in lymphoma tissues was positively correlated with grade of malignancy. ED-B FN expression was enhanced in lymph nodes with severe lymphadenopathy and in some hyperplastic tonsils. The in vivo accessibility of ED-B FN was confirmed in 3 lymphoma patients, in whom the lymphoma lesions were visualized on scintigraphy with (131)I-labeled L19 small immunoprotein ((131)I-L19SIP). In 2 relapsed Hodgkin lymphoma patients(131)I-L19SIP radioimmunotherapy induced a sustained partial response, qualifying ED-B FN as a promising target for antibody-based lymphoma therapies.