Multicentre randomised trial of invasive and less invasive surfactant delivery methods showed similar spirometry results at 5-9 years of age

AIM

We explored whether subnormal forced expiratory volume within one second (FEV₁ ) at 5-9 years of age was lower in children born preterm who received less invasive surfactant administration (LISA) rather than surfactant via an endotracheal tube.

METHODS

The multicentre, randomised Nonintubated Surfactant Application trial enrolled 211 preterm infants born at 23-26 weeks of gestation from 13 level III neonatal intensive care units from April 2009 to March 2012. They received surfactant via LISA (n=107) or after conventional endotracheal intubation (n=104). The follow-up assessments were carried out by a single team blinded to the group assignments. The main outcome was FEV₁ <80% of predicted values.

RESULTS

Spirometry was successful in 102/121 children. The other children died or were lost to follow up. Median FEV₁ was 93% (interquartile range 80-113%) of predicted values in the LISA group and 86% (interquartile range 77-102%) in the control group (p=0.685). Rates of FEV₁ < 80% were 11/57 (19%) and 15/45 (33 %) respectively, which was an absolute risk reduction of 14% (95% confidence interval -3.1% to 31.2%, p=0.235). There were no differences in other outcome measures.

CONCLUSION

The proportion of children aged 5-9 years with subnormal FEV₁ was not significantly different between the groups.

Improved Upper Limit on the Neutrino Mass from a Direct Kinematic Method by KATRIN

We report on the neutrino mass measurement result from the first four-week science run of the Karlsruhe Tritium Neutrino experiment KATRIN in spring 2019. Beta-decay electrons from a high-purity gaseous molecular tritium source are energy analyzed by a high-resolution MAC-E filter. A fit of the integrated electron spectrum over a narrow interval around the kinematic end point at 18.57 keV gives an effective neutrino mass square value of (-1.0_{-1.1}^{+0.9})  eV^{2}. From this, we derive an upper limit of 1.1 eV (90% confidence level) on the absolute mass scale of neutrinos. This value coincides with the KATRIN sensitivity. It improves upon previous mass limits from kinematic measurements by almost a factor of 2 and provides model-independent input to cosmological studies of structure formation.

A prospective study with ten years follow-up of two-hundred patients with proximal femoral fracture

BACKGROUND

The proximal femoral fracture is one of the most common injuries in the elderly. Nevertheless, no results beyond the second year post surgery have been reported in the literature. Therefore, the purpose of this study was to evaluate any revision and mortality within 10 years follow-up as well as the walking ability of still alive patients.

METHODS

A total of 200 consecutive patients were included. A prospective database was first used to collect the demographic data. Exactly ten years after the surgery, a final evaluation was conducted by telephone for every patient. Any revision, any contralateral as well as other fractures and the date of death were recorded. For all patients who were still alive, the mobility score according to Parker was also surveyed.

RESULTS

The average age was 79.0 years (SD: 12.5); women were affected at higher numbers (73.5%). The total surgical revision rate was 17.5% (35/200), due in particular to hematoma (9×) or infection (7×). A surgical revision later than two years was only needed in three patients (1.5%). The risk of another fracture caused by a fall was 19% (38/200), most often a contralateral femoral fracture (22/200; 11%) that happened on average 51.9 months (1-97) after the initial surgery. The risk of a contralateral femoral fracture was 15.4% (22/143) in patients who survived the first year post surgery. The postoperative mortality was 1, 2, 5 and 10 years or 23.5%, 32.5%, 55% as well as 81.5%, respectively. An average Parker's mobility score of 6.3 points (0-9) was determined for the 37 patients (18.5%) who were still alive at the time of the follow-up.

CONCLUSION

The long-term study showed that revision surgery was only required in 3/200 patients (1.5%) beyond the second year of that surgery. On the other hand, more than half of all patients had already passed away five years after the initial surgery. The exact incidence of a contralateral femoral fracture was 11.9%, climbing to 15.4% if the patient survived at least one year. Nearly every fifth patient experienced another fall resulting in a severe fracture requiring treatment during the long-term course.

Isolated tracheoesophageal fistula versus esophageal atresia - Early morbidity and short-term outcome. A single institution series

PURPOSE

We compared the postnatal course, morbidity and early results after repair for cases of isolated or "pure" TEF with those for cases of esophageal atresia (EA) with distal tracheoesophageal fistula (TEF).

METHODS

Twenty-four consecutive infants were divided into two groups: isolated TEF [TEF group] (n = 5) and EA with distal TEF [EA group] (n = 19).

RESULTS

A high rate of prematurity (29%) and major cardiac and other surgically-relevant malformations (0.8 vs. 0.7 per infant) was found in both groups. The median age at surgery was 8 days for the TEF group vs. 1 day for the EA group (p < 0.01). Most infants of both cohorts had stable acid-base and respiratory parameters at admission. Generally, tracheoscopy provided valuable information regarding the position of the TEF. Surgery for isolated TEF was performed via right cervicotomy in 4 cases and via thoracotomy in one. Postoperative thoracostomy tubes were inserted in 3 cases and one emergency gastrostomy was created for acute gastric overextension (exclusively in patients with EA). The duration of postoperative mechanical ventilation (49 vs. 113 h, p = 0.045) and the median length of stay in the pediatric surgery unit (10 vs. 20.5 days, p = 0.003) were shorter for the isolated TEF group. Four EA patients experienced severe events. Total mortality was 8% (0 out of 5 with TEF vs. 2 out of 19 with EA).

CONCLUSION

Developmental delay and a high rate of morbidity were found in both groups. More complex surgery increased perioperative morbidity in cases of EA. With early recognition of isolated TEF, a less complicated course can be expected in comparison with esophageal atresia.

Direct bladder hernia after indirect hernia repair in extremely low birth weight babies: two case reports and a review of the literature

BACKGROUND

Inguinal hernia repair is the most common surgical procedure in babies. Despite a meticulous technique, relapses may occur. The occurrence of a direct bladder wall hernia in relapses has never before been reported in the literature.

CASE PRESENTATION

Here, we report two cases of direct bladder herniation: a white baby boy born after 25 weeks of gestation and a white baby boy born after 26 weeks of gestation. Both of the formerly extremely low birth weight babies were affected after open bilateral hernia repair. Recurrent hernias developed on the right side, and direct bladder herniation was identified intraoperatively. In one case, laparoscopy was applied to identify a supravesical type of hernia. Immaturity and a difficult postnatal course might have contributed to hernia relapse in these cases.

CONCLUSIONS

Misinterpretation of bladder herniation might have disastrous consequences. Laparoscopy is a helpful tool in comparable cases.

[Modified Pirogoff's amputation]

OBJECTIVE

The goal of Pirogoff's amputation of the hindfoot is a weight-bearing stump with minimal loss of limb length and stable soft tissue coverage with preservation of the sensation of the sole of the heel.

INDICATIONS

Non-reconstructable forefoot and midfoot after complex trauma, deep bony and soft tissue infection, infected Charcot foot, necrosis or gangrene due to vasculopathy, malignant tumors and deformities.

CONTRAINDICATIONS

Possibility for reconstruction of the forefoot and midfoot, minor amputation, loss or irreversible destruction of the sole of the heel.

SURGICAL TECHNIQUE

The incision runs from dorsal, 1-2 cm distal of the Chopart joint, to plantar, 5-6 cm distal of the Chopart joint for creation of an adequate plantar skin flap. Exarticulation of the foot from dorsal to plantar through the Chopart joint with preservation of the posteromedial neurovascular bundle. Enucleation of the talus. Minimal resection of the cuboidal and posterior facets of the calcaneus as well as the malleoli inclusive of the distal tibial joint surface. The calcaneus is brought under the tibia and a tibiocalcaneal arthrodesis is performed with two compression screws.

POSTOPERATIVE MANAGEMENT

No weight bearing until stable scar formation, early mobilization in a walker. Interim prosthesis after 2-4 weeks and definitive prosthesis after 2-3 months.

RESULTS

From January 2010 to December 2014 six patients were treated with a modified Pirogoff's amputation. Primary wound healing was achieved in four patients and in two patients wound healing was impaired. In one patient the wound was conservatively healed and the other patient needed below knee amputation. Early primary prosthetic treatment was possible in four patients. The tibiocalcaneal arthrodesis healed in all five remaining cases. All patients with a healed Pirogoff stump were able to walk for short distances in bare feet without the prosthesis.

[Amputation and exarticulation of the lesser toes]

OBJECTIVE

Amputations and exarticulations of the toes may be necessary due to several reasons. The goal is to remove necrosis or infection prior to its spread to the midfoot region. From a functional or cosmetic point of view, amputation/exarticulation of a single toe plays no major role. However, this can be different with exarticulation of several toes.

INDICATIONS

Necrosis, trauma, infection, tumor, deformity.

CONTRAINDICATIONS

Conditions where amputation/exarticulation of a toe is insufficient, e. g., in progressing peripheral arterial disease.

SURGICAL TECHNIQUE

The toe can either be amputated through the distal phalanx or exarticulated in the metatarsophalangeal joint.

POSTOPERATIVE MANAGEMENT

Orthopedic shoes or orthotic devices are rarely necessary when a single toe is amputated/exarticulated. However, concomitant deformities of the foot have to be thoroughly addressed. If more than one toe is amputated, silicone spacers may be necessary to prevent the remaining toes from deviating.

RESULTS

Amputations and exarticulations of the toes are frequent and the procedure is technically simple. However, the complication rate is high due to typical indications making amputation necessary.

[Orthotic Supply after Complex Trauma of the Foot]

BACKGROUND

After complex trauma of the foot, patients frequently need orthotic care. There have been no systematic studies on the quality of care or patient satisfaction. Therefore the goal of this study was to evaluate patient satisfaction and the quality of orthotic care.

PATIENT AND METHODS

In a prospective non-randomized, cross-sectional intervention study, the quality of care and patient satisfaction with orthotic devices were evaluated clinically and pedographically. This was followed by a lengthy discussion and recommendation to improve the insoles or shoes. These improvements were followed up by a written/telephone survey. 39 of the 50 recruited patients with complex trauma of the foot (78 %) were supplied with orthotic devices (insoles, modifications of the sole and orthopaedic shoes).

RESULTS AND CONCLUSION

Most patients (76 %) were content with their orthotic care. However, shortcomings were noted in 20 patients. These were: insufficient arch support/stabilization, inadequate support of roll-off and unsatisfactory unloading of the forefoot. 23 % of the patients did not use their orthotic devices. Compliance increased after counseling. However, half of the patients had problems in obtaining reimbursement for the modifications recommended. In conclusion, orthotic treatment of patients after complex trauma of the foot is demanding. Modifications of the devices are frequently needed. Interprofessional collaboration plays an important role.

[Congenital Intermittent Third-degree Atrioventricular Block Associated with Retinoid Exposure in Pregnancy]

BACKGROUND

The retinoid acitretin, which has been approved as an effective therapy for severe keratinization disorders, is highly teratogenic, and exposure in the first trimester of pregnancy is associated with the risk of miscarriage and various malformations, including congenital heart defects. Cardiac conduction system disorders have not been described so far.

CASE REPORT

A 24-year-old woman was treated with acitretin for dyskeratosis follicularis until pregnancy was diagnosed at 12 weeks of gestation. The female infant was born after 35 weeks gestation by cesarean section because of intermittent fetal bradycardia. The baby was vigorous at birth (Apgar 9, 10, 10 at 1, 5 and 10 min) but displayed intermittent third-degree atrioventricular block. A search for maternal autoantibodies and viral infections gave negative findings.

CONCLUSION

The spectrum of disorders caused by intrauterine retinoid exposure appears to include atrioventricular conduction failure.

Major Contributors to Hospital Mortality in Very-Low-Birth-Weight Infants: Data of the Birth Year 2010 Cohort of the German Neonatal Network

The German Neonatal Network (GNN) is a prospective cohort study with the focus on long term development of very-low-birth-weight infants. It was the aim of this study to determine detailed information on causes of mortality in the GNN birth cohort 2010.

Major contributors to hospital mortality were recorded by the attending neonatologists for the cohort of very-low-birth-weight (VLBW) infants born in centres of the German Neonatal Network (GNN) in 2010. The data quality was approved by on-site monitoring.

2 221 VLBW infants were born in GNN centres in 2010, and death occurred in 221 infants. Male infants carried a higher risk than females (58.8% males among non-survivors vs. 51.7% among survivors, p=0.047). In 11 infants, the major contributor to death was not determined by the attending neonatologist. In 25 infants born at the limit of viability, comfort palliative care was primarily initiated and 14 infants had lethal malformations. The majority of non-survivors suffered from inflammatory diseases including sepsis- or necrotizing enterocolitis (NEC)-associated death (n=56). Respiratory pathology was a major contributor to death in 65 infants including 11 infants who died from pulmonary haemorrhage.

Potentially preventable complications of preterm birth such as sepsis, NEC and pulmonary haemorrhage predominate the major contributors to mortality in the GNN 2010 cohort. In order to decrease the rate of these associated deaths, future trials should focus on prophylaxis and therapy optimization strategies for these outcomes.

"CITY 2020+": assessing climate change impacts for the city of Aachen related to demographic change and health – a progress report

Abstract. The research initiative CITY 2020+ assesses the risks and opportunities for residents in urban built environments under projected demographic and climate change for the year 2020 and beyond, using the city of Aachen as a case study. CITY 2020+ develops strategies, options and tools for planning and developing sustainable future city structures. The investigation focuses on how urban environment, political structure and residential behaviour can best be adapted, with attention to the interactions among structural, political, and sociological configurations and their impacts on human health. The interdisciplinary research is organized in three clusters. Within the first cluster, strategies of older people exposed to heat stress, and their networks as well as environmental health risks according to atmospheric conditions are examined. The second cluster addresses governance questions, urban planning and building technologies as well as spatial patterns of the urban heat island. The third cluster includes studies on air quality related to particulate matter and a historical perspective of city development concerning environmental issues and climate variability. However, it turns out that research topics that require an interdisciplinary approach are best addressed not by pre-structuring the work into related sub-projects but through combining them according to shared methodological approaches. Examples illustrating this rather practical approach within ongoing research are presented in this paper.

[Sports and activities after achilles tendon injury of the recreational athlete]

BACKGROUND

There is abundant literature on the treatment of Achilles tendon rupture; however data on sports and recreational activities after this injury is scarce.

PATIENTS AND METHODS

71 patients were assessed in a prospective cross-sectional study after an average of 3 years after Achilles tendon rupture. 44 patients were treated non-operatively, using a functional algorithm, and 23 patients were treated operatively. Outcome parameters were the AOFAS-Score and the SF-36 Score. The strength of plantar-flexion was measured using the Isomed 2000 system, the structural integrity of the tendon was assessed sonografically.

RESULTS

Patients treated operatively had a higher complication rate than patients treated non-operatively (p = 0.05). Re-rupture rate was identically in both groups. No difference was noted between the two groups for the AOFAS score (92 vs. 90). Moreover the SF-36 score did not show any significant difference between the groups. However, if compared to the age-adjusted normative population significant lower scores were achieved. A significant reduction in practicing sports was detected, as well as a reduction of plantar flexion of the affected foot (p = 0.04).

CONCLUSION

Except for complication rate no significant difference could be detected between the groups. Thus operative treatment in the recreational athlete should only be considered, if no adaptation of the ends of the tendon is diagnosed during the initial or repeated ultrasound. Regardless of the therapeutic intervention chosen an Achilles tendon rupture leads to marked changes in sports- and recreational activities.

Osteo-fasciocutaneous parascapular flap transfer for reconstruction of the first ray of the foot

BACKGROUND

Severe bone and soft tissue defects of the first metatarsal bone after trauma, tumor resection or osteomyelitis are challenging to treat. Partial amputation of the foot may be the consequence. However, due to its significance for gait, salvage of the first ray should be considered, whenever possible. One option for bone and soft tissue reconstruction, therefore, might be an osteo-fasciocutaneous parascapular flap transfer.

METHODS

Five patients with bone and soft tissue defects of the first ray of the foot but intact MTP joint were treated with osteo- fasciocutaneous parascapular flap transfer, two after tumor resection, and three after severe bone and soft tissue trauma. Patients were followed for 12-36 months clinically and radiologically.

RESULTS

All flaps survived. One revision was necessary because of venous thrombosis, which was treated successfully by thrombectomy and patch plastic. All osteosyntheses united and the scapular bone transplant adapted nicely to the new loading conditions. All patients were content with the result and would agree to have the operation again. Two patients were able to stand tiptoe and go jogging, one patient still had limitations of ADLs due to the concomitant injuries.

CONCLUSION

The osteo- fasciocutaneous flap proved to be very versatile and safe for foot reconstruction due to its favorable vascular anatomy. In all patients (partial), amputation of the foot could be avoided.

Cerebral blood volume changes during closure by surgery of patent ductus arteriosus

BACKGROUND

Surgical closure of a patent ductus arteriosus (PDA) in very low birth weight (VLBW) infants has been associated with impaired neurodevelopmental outcome. Surgical PDA closure may result in abrupt changes of cerebral haemodynamics.

OBJECTIVE

To examine the cerebral blood volume changes occurring after surgical closure of PDA.

DESIGN

Continuous cerebral near-infrared spectroscopy (NIRS) recording throughout PDA surgery.

SETTING

Tertiary neonatal intensive care unit, with PDA surgery performed on the ward.

PATIENTS

Ten VLBW infants, median birth weight 748 g (range 590-1070), gestational age 24 (23-27) weeks, chronological age 14 (12-22) days.

INTERVENTION

Surgical closure of PDA.

MAIN OUTCOME MEASURES

Changes in cerebral oxygenated haemoglobin, cerebral deoxygenated haemoglobin, and tissue oxygenation index (measured), changes in cerebral blood volume (CBV) and cerebral haemoglobin difference (calculated) as measured by NIRS.

RESULTS

During the first 2 minutes after closure of the PDA, CBV increased significantly (mean (SD) 0.14 (0.12) ml/100 g tissue; p = 0.01) and returned to baseline within 2-5 minutes. Cerebral oxygenation did not change.

CONCLUSIONS

There is a short-lasting increase in CBV immediately after surgical closure of PDA, but no change in cerebral oxygenation. These transient changes are unlikely to cause harm.

Recommendations to increase the validity and comparability of peripheral measurements by near infrared spectroscopy in neonates. 'Round table', section of haematology, oxygen transport and microcirculation, 48th annual meeting of ESPR, Prague 2007

Several studies of peripheral measurements with near infrared spectroscopy (NIRS) and venous or arterial occlusion have been performed in neonates. Results have been variable. Reasons include differences in patient populations, technical aspects of the devices used or the way measurements were made. It is therefore important that there should be common elements for measurement protocols. This statement proposes a standardised approach to allow comparison between different study populations and devices.

Plantare Lisfranc-Luxationsfraktur

We report a 30-year-old patient suffering a plantar dislocation fracture after he dropped a heavy weight on his foot. The patient was treated immediately after diagnosis was secured by CT scan. Median approach and dermatofasciotomy of the foot were followed by anatomic reduction of the fractures and the Lisfranc dislocation and fixed by internal osteosynthesis. After 3 months the patient was able to ambulate pain free without walking aids. Plantar dislocation is a very rare direction of comminuted Lisfranc dislocation fractures. The outcome may be favorable with early reduction and stable internal fixation of the fractures. One always has to be aware of the major soft tissue trauma associated with complex Lisfranc dislocation fractures.

[Training in sports medicine for medical students--Evaluation of a practice-oriented teaching concept]

INTRODUCTION

Education in Sports Medicine is offered heterogeneously in German medical schools. Efficacy and acceptance among medical students are unknown. The self-image of sports has changed from a traditional, competition-oriented way to adventure, entertainment, wellness and health. Therefore changes of our curricula to a practical oriented way of teaching are required. In this regard a new curriculum was developed. The main focus, besides an interdisciplinary class in sports medicine was to offer practical education in sports to the students.

METHODS

Efficacy and acceptance of the class were evaluated using a questionnaire. 90 medical students (58 male, 32 female) were included into the study .

RESULTS

The interdisciplinary topics of the class were graded positively. Most of the presentations were regarded as very useful for the future practice. Empathy and commitment of the professor were keystones to good scores. The "fun-factor" was the key for the success of the practical assignment. Practical training was regarded as fundamental for a sports medicine class.

DISCUSSION

Evaluation of the new concept as well as a discussion of the current practice to teach sports medicine at medical school confirm the need of a more practical oriented education, in order to meet the requirements of sports medicine in a time with changing self image of sports.

[Reduction of the amputation rate in bone and soft tissue sarcoma by interdisciplinary cooperation]

On the basis of three patients with bone and soft tissue sarcoma,we would like to illustrate the necessity of a well working inter-disciplinary cooperation of radiologists, internal oncologists, radiation therapists, orthopaedic surgeons and plastic surgeons. Functional extremity preservation in sarcoma patients can be achieved by a good interdisciplinary management without im-pairing the total prognosis of the patients. Patients with sarcoma should be treated in centres in which all specialised divisions are experienced and well trained in the treatment of tumour patients. Only then can a promising approach be achieved.

Histologische und immunhistochemische Untersuchungen bei Kapselkontraktur nach glatten Brustimplantaten

INTRODUCTION

A prospective study was performed to analyse the cellular and molecular composition of fibrous capsules around silicone breast implants. The necessity of an exact histological classification for comparing objectively the different findings of capsular contracture is shown.

PATIENTS AND METHODS

The prospective study (investigation time 1/2003 to 6/2005) included 24 female patients (average age: 40+/-12 years) with contracture after bilateral cosmetic breast augmentation with smooth silicone gel implants (Mentor). In each patient the baker score was determined preoperatively. Samples of capsular tissue from all patients were evaluated histologically and immunohistochemically and classified according to the histological classification introduced by Wilflingseder and co-workers.

RESULTS

All capsules showed the same basic histological structure with a three-layer composition. For the correlation analysis we had to exclude one patient with repeated implant change. There was no correlation between the patient's age, time of implantation, length of implant period, and capsular contracture. Greater amounts of silicone particles were associated with increased degrees of capsular contracture (Baker: r = 0.687, n = 23, p < or = 0.001; Wilflingseder: r = 0.784, n = 23, p < or = 0.001). High silicone amounts were associated with an increased local inflammation (r = 0.489, n = 23, p , 0.05). A moderate to severe local inflammation was found in 23 patients (95.8%). In summary, there was a positive correlation (r = 0.797, n = 23; p , or = 0.001) between the clinical classification (Baker score I to IV) and the histological classification (Wilflingseder score I to IV).

CONCLUSIONS

We demonstrated in our study, in spite of using implants with high gel cohesiveness (fourth generation), the presence of vacuolated macrophages with microcystic structures containing silicone and silicone particles in the capsular tissue. Greater capsular thickness was associated with an increased number of silicone particles ans silicone-loaded macrophages in the peri-implant capsule. The histological classification introduced by Wilflingseder and co-workers takes into consideration this pathogenetic mechanism of inflammatory reaction which seems to be one of the major key factors in the development of capsular contracture.

[Ambulation training with bilateral limited weight bearing after foot injuries]

AIM

Bilateral foot injuries are not uncommon. Operative treatment usually requires partial weight bearing over several weeks. This is a challenge for physiotherapy especially for ambulation training. We describe a new rehabilitation aid allowing for bilateral limited weight bearing during ambulation.

METHODS

Ambulation training was initiated in the early postoperative period using the Regensburg ambulation aid. A lift system allows for exact limitation of weight bearing on both sides controlled by balances integrated into the floor. Using a rail system a 15 m free walking distance is available. This study included 10 patients with bilateral foot fractures. The functional outcome was assessed using the AOFAS score and quality of life with the SF-36 score. Plain X-rays were used to evaluate loss of correction. The control group consisted of 20 patients where ambulation training was discontinued for at least 6 weeks postoperatively.

RESULTS

The system is very safe, during the entire period no complication was recorded. Acceptance among the patients was extremely high. Worries about unwanted weight bearing could be reduced. Patients mobilized with early ambulation training showed a better compensation of gait if compared to the control group. Secondary problems in the knee, hip or spine, as well as muscular deficiencies had a significantly lower incidence. No loss of correction could be seen in either of the two groups.

CONCLUSION

The presented ambulation aid is a significant contribution to the physiotherapy of bilateral foot injuries.

[The minimally invasive stabilization of the dorsal pelvic ring with the transiliacal internal fixator (TIFI)--surgical technique and first clinical findings]

The Trans Iliacal Internal Fixator (TIFI) is a minimally invasive technique for the stabilization of sacro-iliac joint ruptures and fractures lateral to the sacral ala or through the sacral foramen. In this study, 7.0 mm pedicle screws of the Universal-Spine-System (USS, Synthes) were inserted 1-2 cm on the cranial side of the posterior superior iliac spine and parallel to the superior gluteal line. The connecting bar was inserted subfascially and fixed with the locking head pedicle screws to form an fixed-angle construction. In a prospective study 31 patients with vertical shear injuries of the pelvis were treated with the TIFI. There were two wound infections and one loosening of a pedicle screw. None of the screws were incorrectly positioned and no neuro-vascular lesions were caused by the implant. 2 years postoperatively we found 50% good and excellent results for type C pelvic ring injuries. Early findings show that the TIFI is well suited to stabilization of sacro-iliac joint ruptures and fractures of the lateral sacrum. Closed reduction and minimally invasive insertion technique are possible. The implant leads to sufficient biomechanical stability but there is a very low intraoperative risk of neuro-vascular lesion.

[ How to gauge the importance of sports medicine for the medical training of medical students?]

AIM

Education in sports medicine is offered heterogeneously in German medical schools. The self-image of sports has changed from a traditional, competition-oriented way to adventure, entertainment, wellness and health. Therefore, changes of our curricula to a practical-oriented way of teaching are required. In a first step the motivations and expectations of the students have to be evaluated.

METHODS

90 students enrolled in a sports medicine class were evaluated using a questionnaire and compared to 60 students not participating in the sports medicine class.

RESULTS

The main motivation for the students to sign in was the future possibility to subspecialize in sports medicine, followed by interest in the subject. The main reasons not to participate were the time factor followed by lack of interest. 80 % of the students were regularly practising sports. 66 % commented on having been involved in sports trauma. 90 % of the students believe that practical-oriented education is absolutely necessary.

CONCLUSION

Evaluation of the students motivation, knowledge as well as a discussion of the current practice to teach sports medicine at medical school confirm the need for modification of our curricula to a more practical-oriented education.

Effect of doxapram on cerebral blood flow velocity in preterm infants

BACKGROUND

Doxapram is used to treat apnea of prematurity when there is an insufficient response to methylxanthine treatment. As an unwanted side effect, reduced cerebral perfusion has been seen in methylxanthine-treated infants while effects of doxapram on the cerebral perfusion have not been studied yet.

PATIENTS AND METHODS

Fifteen preterm infants treated with doxapram were included in the study. Birth weight ranged from 380 g to 1150 g (median 740 g), gestational age from 24 to 27 weeks (median 26 weeks). Infants received a doxapram loading dose (2.5 mg/kg) over a 30-minute period, followed by a continuous infusion of 0.5 mg/kg/h. Using Doppler sonography, blood flow velocities and the resistance index were measured in the anterior cerebral artery. Measurements were performed at baseline and 30 and 120 minutes after the start of doxapram.

RESULTS

Maximal systolic blood flow velocity (V(max)) decreased significantly after the infants had received the loading dose (V(max) baseline: 40.7 cm/s +/- 6.9 [mean +/- SD]; V(max) 30 min: 35 cm/s +/- 8.9; p = 0.0017) but returned to near baseline values at 120 min (38.5 +/- 9.0, p = 0.22). End-diastolic, time-averaged, and time-averaged maximal velocities did not change significantly at 30 or 120 min.

CONCLUSIONS

Doxapram induced a significant decrease in maximal cerebral blood flow velocity. Further studies are needed to assess whether this decrease may be critical to cerebral white matter perfusion in the vulnerable preterm infant.