Der Unfallchirurg
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Randomized Controlled Trial Clinical Trial
[Clinical effects of supplemental enteral nutrition solution in severe polytrauma].
Previous studies in critically ill patients have shown the beneficial effects of early enteral nutrition supplemented with arginine, omega-3 fatty acids and nucleotides (Impact) on immunological response, infection rate and length of stay in hospital. No specific data exist for patients with severe multiple injury, who represent a high risk group for systemic inflammatory response syndrome (SIRS), septic complications and multiple organ failure (MOF). In this prospective, randomized, double-blind controlled clinical study on patients after severe trauma (ISS ca. 40) the primary study endpoints were incidence of SIRS and MOF [definitions according to Am Soc Crit Care Med (5) and Goris (23), Sauaia (43)]. ⋯ However, HLA-DR antigen presentation on peripheral monocytes was significantly elevated on day 7 in the test group (P < 0.05). According to the results, arginine, omega-3 fatty acids and nucleotides-enriched diet during early enteral feeding leads to reduction of SIRS after severe multiple injury. There is evidence for improvement of post-traumatic immunological response which helps to overcome the immunological depression after trauma.
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While a great part of the Anglo-American medical literature addresses the topic of penetrating trauma the German speaking countries rather publish on blunt abdominal injury. The presented paper discusses the strategic principles of acute clinical management of abdominal trauma on the combined basis of own research results and a comprehensive review of the literature. Blunt abdominal injuries in most cases from a part in the pattern of multiple trauma. ⋯ Splenectomy is indicated in patients with severe concomitating injuries or shock whereas in the remainder of cases the total or partial preservation of the spleen should be pursued. Hepatic injuries offer a broad spectrum of operative interventions, ranging from superficial hemostatic measures over compression techniques like 'packing' and 'mesh-wrapping' to atypical and anatomical resections and to liver transplantation in exceptional cases. Lesions of tubular organs and the pancreas pose especially difficult diagnostical problems but regularly allow a rather easy operative treatment.
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A group of experienced riders who qualified for the German riding badge 9.5 years ago answered a questionnaire pertaining to injuries during jumping, dressage and cross-country riding, as well as handling the horse. During riding 69% of the persons had had 187 injuries and while handling the horse 52% had had 124 injuries. Fractures and contusions were the most-frequent injuries; most riding injuries were located in the upper extremities and shoulder while handling mainly in the hands and feet. ⋯ No change in safety precautions had been implemented by 67% of the persons injured. The injury rate for equestrians is relatively low both in handling the horse and during riding. The frequent fractures and contusions may be reduced by following the required safety regulations.
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Comparative Study
[Prospective comparison of MRI vs. direct magnification radiography in occult fractures of the scaphoid bone].
The diagnosis of occult fractures of the scaphoid bone is even more challenging than that of conventional fractures of the scaphoid. This study aimed to compare prospectively the gold standard method (plain radiographs in four projections, after about 14 days) and the primary findings with direct magnification radiography (DIMA) and magnetic resonance imaging (MRI). ⋯ This may lead to a decreasing time of disease. DIMA was inferior in detecting occult fractures of the scaphoid.