In a prospective clinical trial, plasma histamine levels were measured in 28 polytrauma patients on day 1, 5 and 14 after trauma. Only those subjects who died were drop-outs. All patients had severe polytrauma with at least 3 body regions involved. The median plasma histamine levels at all three time points were significantly higher than in patients with single trauma of the extremities or before selective orthopaedic surgery but still in the normal range (less than 1 ng/ml). However, all patients with plasma levels above 1 ng/ml on days 1 and 5 died, as did all patients with levels above 0.5 ng/ml on day 1. Thus the elevation of plasma histamine levels, for whatever reason, appears to be a prognostic factor for bad outcome in polytrauma patients.

No abstract

No abstract

The case of a 36-year-old male patient is reported who fell from 20 m, sustaining injuries to the abdomen and pelvis and fractures of both arms and the left leg as well as erect dislocation of both shoulders (luxatio erecta humeri). The injury on the right was subcoracoid, that on the left subglenoid-a compound dislocation of the humerus head through the axilla. Based on this case and the pertinent literature, the pathophysiology, diagnosis and treatment of this rare injury are discussed. After immediate closed reduction, soft tissue damage, fractures or neurovascular lesions should be operated on as soon as possible.

The possibility of a specific origin of joint infection should be considered in finding the diagnosis. This is demonstrated in a case of tuberculosis of the hip treated in the Dept. of Trauma Surgery in collaboration with the Medical Dept. of the Klinikum Minden. Microbiological and imaging examinations are essential to plan and perform a combined therapy of hip arthroplasty and concommitant medical antituberculous therapy. In accordance to a literature review, this procedure proved successful for both eliminating the local infection and the functional outcome of the operation.