BG Klinikum Duisburg

Smartphone-based first responder alert systems are akey component of the chain of survival in out-of-hospital cardiac arrest. In Germany, there are considerable regional differences in terms of qualification requirements and registration and approval processes. The impact of these barriers to access on the number of registered first responders has not yet been systematically investigated. Aretrospective secondary data analysis was performed based on freely available data. Ninety-nine regions with complete information on registration procedures, qualification requirements, and the number of registered first responders were included. In addition, the effect of voluntary 2 h short training courses on chest compressions on the subjective confidence of participants was examined in the Rheinisch-Bergisch district using asurvey. At the time of data collection, asmartphone-based first responder alert system had been implemented in 45% of emergency medical service areas. The average registration rate was 0.246% of the population. Regions with self-registration procedures had significantly higher registration rates than regions with formal registration (0.267% vs. 0.152%; p < 0.001). In two regions with self-declaration only and no verification of proof, rates of up to 0.489% were achieved. In the local case study, 2217 first responders were registered, 40% of whom had first aid qualifications only. The short training course was associated with asignificant increase in subjective safety. Low-threshold registration procedures are associated with higher registration rates in smartphone-based first responder alert systems. Accompanying short training courses can apparently increase the subjective confidence of first responders. Reducing formal barriers to access could help improve the availability of volunteer first responders. However, the effects of lower barriers to access on the psychological stress of first responders and on patient outcomes are unclear.

Ein 64-jähriger Patient wurde mit seit circa 30 Jahren bestehenden, rezidivierenden, an wechselnden Körperregionen auftretenden Hautveränderungen in unserer Ambulanz vorstellig. Mehrere in den vergangenen Jahren entnommene Probebiopsien erbrachten den histopathologischen Nachweis eines Ekzems. Unter Applikation diverser kortikosteroidhaltiger Salben zeigte sich der Hautbefund nur kurzfristig gebessert. Bei Vorstellung imponierten an beiden oberen Extremitäten, am Rücken, intertriginös sowie abdominell mittig über die Hüften bis zu beiden Oberschenkeln ziehend disseminierte, großflächig konfluierende, retikulär anmutende, indurierte, erythematöse Plaques (Abbildung 1a, b). Es bestanden weder Pruritus noch Schmerzen. Der Lymphknotenstatus sowie die orientierende körperliche Untersuchung verblieben ohne pathologischen Befund. B-Symptomatik und Allergien wurden verneint. Nebenbefundlich waren eine Hypothyreose, Hypercholesterinämie sowie arterielle Hypertonie vorhanden. Die Borrelien- sowie Syphilis-Serologie fiel, ebenso wie das Routinelabor und die Lymphozyten-Subpopulationsanalyse, unauffällig aus. Der CD4/CD8-Quotient lag im Referenzbereich. Die im Rahmen der Erstvorstellung durchgeführten Rebiopsien zeigten eine regelrecht geschichtete Epidermis mit abgeflachten Reteleisten sowie mildem Epidermotropismus. Abschnittsweise zeigte sich eine aufgelockerte Basalzellschicht mit Keratinozyten-Apoptosen und subepithelial gelegenen Melanophagen (Abbildung 2). In der Dermis fanden sich interstitielle und perivaskuläre Infiltrate mit junktionaler Aufreihung von T-Lymphozyten, welche immunhistochemisch einen CD3+CD4+CD30− Phänotyp aufwiesen. Vereinzelt fanden sich CD8+ T-Lymphozyten. Interstitiell fanden sich zudem zahlreiche CD68+ Makrophagen (Abbildung 3a–d). Auf molekularpathologischer Ebene erfolgte der Nachweis einer T-Zell-Klonalität. Ihre Diagnose? … Diagnose: Interstitielle Mycosis fungoides Mittels Computertomografie konnte eine extrakutane Beteiligung ausgeschlossen werden. Therapeutisch initiierten wir, nach bis dato frustraner Anwendung topischer Glukokortikosteroide und Bade-PUVA-Therapie, eine Behandlung mit Chlormethin-Gel im Bereich der betroffenen Hautareale. Aufgrund starker lokaler Entzündungsreaktionen unter Chlormethin-Gel erfolgte seitens des Patienten ein vorzeitiger Therapieabbruch, sodass wir uns für die Einleitung einer extrakorporalen Photopherese (ECP) im vierwöchigen Rhythmus entschieden. Bisher erfolgten vier Zyklen einer ECP-Monotherapie. Hierunter zeigte sich klinisch eine deutliche Befundverbesserung. Ergänzend verwendet der Patient aktuell pflegende Externa. Die interstitielle Mycosis fungoides (IMF), erstmalig 1994 von Shapiro und Pinto erwähnt, ist eine seltene Variante der Mycosis fungoides (MF),1, 2 die in der WHO-Klassifikation bisher keinen Eingang als Subentität gefunden hat.3 Bisher sind in der internationalen Literatur weniger als 100 Fälle der IMF veröffentlicht worden.1, 4 Die von Chung et al. publizierte, bisher größte retrospektive Studie zur IMF mit insgesamt 31 Patienten dokumentiert ein überwiegend männliches Patientenkollektiv (61 % der Fälle männlich; mittleres Alter bei Erstdiagnose: 43 Jahre), bei denen die Hautveränderungen im Durchschnitt bereits 7 Jahre vor Diagnosestellung bestanden.4 Klinisch manifestiert sich die IMF zumeist unter dem Bild der „klassischen“ MF mit Patches und Plaques an unterschiedlichen Körperregionen, die sich insbesondere intertriginös zeigen und die teilweise mit einer Alopezie einhergehen.4, 5 Häufig wird die IMF klinisch als Morphea, interstitielle granulomatöse Dermatitis, Granuloma anulare oder auch extragenitaler Lichen sclerosus fehlinterpretiert.6, 7 Differenzialdiagnostisch abzugrenzen sind ebenso die follikulotrope MF und das granulomatous slack skin syndrome.4, 8 Histopathologisch zeigt sich ein interstitielles lymphozytäres Infiltrat, welches zumeist, so auch in unserem Fall, einen CD3+CD4+-Phänotyp und einen fehlenden bis milden Epidermotropismus aufweist.4 Sowohl Therapie als auch Prognose der IMF entsprechen der „klassischen“ MF.5 Laut der zuletzt im Jahr 2021 aktualisierten S2k-Leitlinie der AWMF zu kutanen Lymphomen wird der therapeutische Einsatz der ECP erst ab Stadium III empfohlen. In unserem Patientenfall kam die ECP bereits in Stadium IB zum Einsatz und führte zu einem deutlichen klinischen Therapieansprechen. Weitere Untersuchungen sind unserer Meinung nach erforderlich, um zu überprüfen, inwieweit sich die ECP auch als Therapieoption in früheren Stadien der IMF eignet.10 Keiner.

PurposeBlunt carotid injuries (BCI) in pediatric trauma patients are rare. Using data from the TraumaRegister DGU®, this study aims to identify screening parameters and calculate the prevalence of pediatric BCI. By proposing potential risk factors for a BCI, this research seeks to reduce unnecessary radiation exposure in pediatric trauma cases. These findings may enhance understanding of pediatric BCI and highlight the necessity of cautious diagnostic approaches that balance clinical needs with radiation risks.MethodsThe TraumaRegister DGU® is a multicenter database established in 1993 to document the treatment of severely injured patients from initial injury to hospital discharge. Data are collected in four phases: demographics, injury patterns, treatments, and outcomes. Almost 700 hospitals, primarily from Germany, contribute to the registry annually. Statistical analysis was conducted using SPSS. For analysis, the dataset was divided into two groups: trauma patients diagnosed with BCI and trauma patients without BCI. The complete dataset from the TraumaRegister DGU® for 2006–2020 was screened for relevant cases. The dataset was limited to patients between 0 and 15 years old.ResultsOut of 9070 severely injured pediatric trauma patients analysed, 50 cases of pediatric BCI were identified, representing a prevalence of 0.6%. Patients with BCI presented with higher injury severity scores (ISS), lower Glasgow Coma Scale (GCS) scores, and a greater prevalence of head injuries, as well as thoracic, abdominal, and extremity injuries. These patients also experienced higher in-hospital mortality rates (34%) and required more frequent blood transfusions. Full-body CT scans were more commonly performed in patients with BCI.ConclusionThis study highlights the rarity and severity of BCI in pediatric trauma patients, with a prevalence of 0.6%. Significant risk factors for a BCI include high injury severity, head trauma, neurological deficits, and pre-hospital hypotension. The findings emphasise the importance of early diagnosis and targeted diagnostic strategies to balance the need for prompt intervention with reducing unnecessary radiation exposure.

Background/Objectives: Anterior cruciate ligament (ACL) injuries continue to present significant clinical and rehabilitative challenges. Despite advances in surgical techniques and rehabilitation protocols, persistent reinjury rates and increased pressure for early return to sport require a critical reassessment of current practices. This narrative review provides a comprehensive overview of the evolution, current standards, and future directions of ACL surgery and rehabilitation. Content: The literature search was conducted primarily in PubMed/MEDLINE and Web of Science using ACLRelated keywords, with emphasis on systematic reviews, randomized controlled trials, registry data, and consensus guidelines published within the past two decades. The evolution of ACL treatment is shaped by the transition from open to arthroscopic and anatomic reconstructions, as well as the refinement of fixation and augmentation techniques. In parallel, rehabilitation concepts shifted from rigid, time-based schedules to criteria-driven, individualized approaches. Key aspects include early mobilization, prehabilitation, and the integration of innovative tools such as anti-gravity treadmill and blood flow restriction training. Evidence on bracing suggests no routine benefit, while structured prevention programs have proven effective. Return-to-play strategies now emphasize objective functional criteria and psychological readiness. Conclusions: ACL therapy has evolved toward personalized, function-oriented rehabilitation. Future developments—including markerless motion analysis, AI-supported rehabilitation, and digital health applications promise for further individualization of care and optimization of long-term outcomes.

CT-guided transthoracic lung biopsy (CT-TTNB) is an essential method for the diagnosis of pulmonary nodules and masses. With a sensitivity of 85-97% and a specificity of 85-100%, it offers high diagnostic accuracy. By using core-needle biopsies, high-quality tissue samples can be obtained that enable molecular analyses for personalised therapy.At the same time, lung ablation has established itself as a valuable minimally invasive therapy. Procedures such as radiofrequency ablation (RFA), microwave ablation (MWA) and cryoablation enable targeted tumour destruction, particularly in inoperable patients with NSCLC or lung metastases. Studies have shown a high level of local tumour control with acceptable complication rates. The combination of imaging and interventional technique significantly improves patient safety and treatment outcomes and offers good results with low complication rates.Overall, CT-guided puncture and ablation are integral components of modern lung cancer diagnostics for primary and secondary lung tumours, while offering a new treatment option and therapy. They offer precise, low-risk alternatives to invasive procedures and can therefore make a significant contribution to effective patient care.

Tibial plateau fractures (TPFs) are complex injuries associated with significant postoperative complications including infection, deformity and wound healing disorders. Limited data exist on risk factors for complications following surgical treatment, particularly in large multicenter cohorts. This retrospective study analyzed 1027 patients with intra-articular TPFs treated surgically at two level-I trauma centers in Germany (2011-2020). Preoperative CT imaging and follow-up data were required for inclusion. Complications were categorized into seven groups (infection, deformity, wound healing disorders, postoperative compartment syndrome, range of motion deficit and others). Statistical analyses assessed associations with fracture type (Schatzker classification), surgical approach, duration, and patient factors (BMI, age, smoking). Nineteen percent of patients required surgical revision, with deformity (5.7 %), infection (5.4 %), and wound healing disorders (3.3 %) being the most common complications. Complex fractures (Schatzker V-VI) and prolonged or multi-approach surgeries were associated with higher complication rates. Elevated BMI increased overall complication risk, while smoking was linked to wound healing disorders. The 19 % revision rate highlights the challenges of managing TPFs. Surgical factors, including operative duration and approach, play a critical role in the occurrence of complications, emphasizing the need for tailored strategies based on fracture complexity and surgical considerations.