Anterior approaches to the acetabulum

Since the 1960s the ilioinguinal approach by Letournel with the three anatomic windows has been successfully established for the treatment of acetabular fractures involving predominantly the anterior column. The previous standard approach, the iliofemoral approach by Smith-Petersen, is still used for the therapy of anterior wall or isolated femoral head fractures. The increase in acetabular fractures in the elderly with lateral compression fractures after lateral falls, characterized by medial displacement of the quadrilateral plate and superomedial dome impaction, led to the use of the intrapelvic modified Stoppa approach with or without the first window of the ilioinguinal approach in the 1990s. To combine the advantages of the second and third windows of the ilioinguinal approach and the medial view of the modified Stoppa approach the Berne research group recently introduced the pararectus approach in acetabular surgery, which can be used as a less invasive acetabular surgical (LIAS) technique especially in the elderly.

Disorders of serum sodium in emergency patients: salt in the soup of emergency medicine

Electrolyte disorders are common and potentially fatal laboratory findings in emergency patients. Approximately 20 % of patients in the emergency department present with either hyponatremia or hypernatremia. Recently it was shown that disorders of serum sodium are not only an expression of the severity of the underlying disease but independent predictors for the outcome of patients. They directly influence patient daily life by causing not only gait and concentration disturbances but also an increased tendency to fall together with a reduced bone mass. Given these new data it is even more important to detect and adequately correct dysnatremia in patients in the emergency department. Acute, symptomatic dysnatremia should be corrected promptly by use of 3 % NaCl for hyponatremia and 5 % glucose for hypernatremia. A close monitoring of serum sodium concentration is, however, essential in any case of correction of hyponatremia or hypernatremia in order to avoid rapid overcorrection and subsequent complications. A profound knowledge of the mechanisms underlying the development of hyponatremia, e.g. diuretics, syndrome of inappropriate antidiuretic hormone secretion (SIADH), heart failure and cirrhosis of the liver and hypernatremia, e.g. dehydration, infusions, diuretics and osmotic diuresis is essential. The present article describes the epidemiology, etiology and correction of hyponatremia and hypernatremia on the basis of current knowledge with special emphasis on emergency department patients.

Magnet resonance imaging in common injuries of the wrist

Falling on the outstretched hand is a common trauma mechanism. In contrast to fractures of the distal radius, which usually are diagnosed on plain film radiographs, identifying wrist injuries requires further diagnostic methods, e.g., MRI or CT. This article provides a review of the use of MRI in the most common traumatic wrist injuries, including scaphoid fractures, TFCC lesions, and tears of the scapholunate ligament. Early and selective use of MRI as a further diagnostic method in cases of adequate clinical suspicion helps to initiate the correct treatment and, thus, prevents long-term arthrotic injuries and reduces unnecessary absence due to illness. MRI shows a high reliability in the diagnosis of scaphoid fractures and the America College of Radiology recommends MRI as method of choice after X-ray images have been made. In the diagnosis of ligament and discoid lesions, MR arthrography (MRA) using intraarticular contrast agent has considerably higher accuracy than i.v.-enhanced and especially unenhanced MRI.

Der Sicherheitsausschuß unmöglich: Die Vorfälle am 8. sind entscheidend zwischen Bürgerkrieg und Frieden ...

Welsch (Projektbearbeiter): Antisemitisches Flugblatt: Die " ... sich frech und anmaßend geberdende Judenpartei ohne Vaterland und Liebe für das allgemeine Wohl ... " wird für die Vorgänge des 8. Juli 1848 verantwortlich gemacht (Sturz des Ministeriums Pillersdorff aufgrund einer Intervention des Wiener Sicherheitsausschusses bei Erzherzog Johann)

Viehkongreß, oder approbirtes Assoziationsrecht: Hic ames dici pater atqueu princeps! ...

Welsch (Projektbearbeiter): Karikatur auf den Verlauf der Revolution in Frankreich: Nach dem Sturz der Julimonarchie ergibt sich mit der Niederschlagung des Arbeiteraufstandes durch Cavaignac sowie der Wahl des Prinzen Louis Napoléon zum Präsidenten (Amtsantritt am 20. Dezember 1848) eine faktische Restauration der alten politischen Zustände (mit veränderter personeller Besetzung): "Zopfius redivivus, princeps redux."

Colossaler Fortschritt: Hier oben ist zu sehen die traurige Geschichte von einem freien Wiener Kindlein zwischen Him̄el und Erde, und die Flucht des Oesterreicher Hercules ...

Welsch (Projektbearbeiter): Karikatur auf die revolutionären Ereignisse in Wien aus konservativ-reaktionärer Sicht: der als Bänkelsänger dargestellte Robert Blum erläutert - unterbrochen von den sarkastischen Kommentaren seines Drehorgelspielers - der Bevölkerung den 'colossalen Fortschritt', den der Sturz Kaiser Ferdinands darstellt

Der Engelsturz: 11. Feb. 1848

Welsch (Projektbearbeiter): Karikatur auf den Sturz der Lola Montez, die König Ludwig I. auf Druck der Münchener Bevölkerung am 11. Februar 1848 auszuweisen sich gezwungen sieht

Vorstellung deß Wunderbahren Schutzes und Vorsehung Gottes über seine Kinder

Knabe übersteht Sprung aus einem Fenster unverletzt

(Table 2) Mineralogy and carbon, oxygen, and hydrogen isotope ratios for secondary mineral samples from igneous rocks from ODP Hole 128-794D

The basaltic rocks of Hole 794D drilled during Leg 128 are strongly altered. Microprobe analyses and XRD spectra on small quantities of matter extracted from thin sections show that primary minerals and glassy zones of the groundmass are totally or partially replaced by clay minerals with chlorite/saponite mixed-layer composition whatever the rock sample considered. This mixed-layer was also identified in veins and vesicles where it crystallizes in spheroidal aggregates. The largest veins and vesicles are filled by a zoned deposit: the chlorite/saponite mixed-layer always occupies the central part and is rimmed by pure saponite. Calcite crystallizes in secondary fractures which crosscut the clayey veins and vesicles. Chemographic analysis based on the M+-4Si-3R2+ projection shows that the chemical composition of the saponite component in the mixed-layer is identical to that of the free saponite. This indicates that the clay mineral crystallization was controlled by the chemical composition of the alteration fluids. From petrographic evidence, it is suggested that both chlorite/saponite mixed-layer and free saponite belong to the same hydrothermal event and are produced by a temperature decrease. This is supported by the stable isotopic data. The isotopic data show very little variation: d18O saponite ranges from 13.1 per mil to 13.5 per mil, and dD saponite from -73.6 per mil to -70.0 per mil. d18O calcite varies from +19.7 per mil to +21.9 per mil vs SMOW and d13C from -3.2 per mil to +0.4 per mil vs. PDB. These values are consistent with seawater alteration of the basalt. The formation of saponite took place at 150°-180°C and the formation of calcite at about 65°C.