A total of 86 patients suffering from fractures of the thoracolumbar spine were followed up after an average time period of 57 months (12-98). Of these patients, 56 were treated operatively and 30 conservatively. According to the AO/ASIF classification, 66% of the operated group were fractures of type A, 29% of type B, and 5% of type C. All patients were operated on by means of dorsal locking instrumentation with pedicular fixation and, apart from six patients, with transpedicular cancellous bone grafting. The conservative group was treated according to the guidelines of Böhler with closed reduction, plaster cast, and rehabilitation program. All fractures in the conservative group were of type A. At follow-up of all operated cases, the local gibbus angle had improved by a reduction of on average 18.6 degrees and was followed by a loss of correction of 12.5 degrees ending in a final gain of 6.1 degrees at follow-up. At follow-up of the conservatively treated cases, the local gibbus angle showed an improvement of 11.1 degrees at reduction and a loss of correction of 14.9 degrees after reduction. The remaining result was -3.6 degrees, that means an increase of kyphoses compared to the x-ray at admission. In order to be able to compare two homogeneous groups only fractures of type A were used. Comparison of the two groups showed an improvement of the vertebral body angle of 70% (11.3 degrees) after reduction in the surgical group and 46% (6.1 degrees) in the conservatively treated group. The subsequent loss of correction was 19% (3 degrees) in the surgical and 34% (4.5 degrees) in the conservatively treated group. The remaining gain at follow-up was 51% (8.3 degrees) in the surgical and only 12% (1.6 degrees) in the conservative group. The local gibbus angle had improved on average by 17.1 degrees after reduction in the surgical and by 11.1 degrees in the conservatively treated group. Loss of correction was 71% (12.2 degrees) and 132% (14.9 degrees), respectively. The final result at follow-up showed a decrease of kyphosis of 4.9 degrees in the surgical and an increase of kyphosis of 3.7 degrees in the conservatively treated group. The difference was significant. Within the surgical group, 75% of the loss of correction was caused by the discs and 25% by the vertebral body. In the conservatively treated group it was 69% and 31%, respectively. Concerning loss of correction, no difference was seen between patients with and without intercorporal bone grafting. There was no relationship between radiological and clinical outcome. Whereas 15% of the patients of the surgical group were not satisfied or moderately satisfied with the result, all patients in the conservatively treated group were satisfied or very satisfied. Based on the good clinical results of the conservative treatment we can conclude that in stable fractures without severe deformity, and in patients who are in bad general condition, conservative treatment can considered as an alternative to surgical treatment.

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The effects of 8-hour haemoperfusion through an activated charcoal column on fulminant hepatic failure were assessed in 10 dogs. The survival in the perfused animals was significantly prolonged and the onset of liver encephalopathy was markedly delayed compared to the controls. Significant decrease in plasma bilirubin and total plasma phenols was found in the perfused group. No other laboratory changes due to haemoperfusion were found. The charcoal column retained its adsorptive capability throughout the experiment as judged from phenol clearance values. In spite of current scepticism regarding its clinical use, further trials with haemoperfusion in acute liver failure seem to be warranted.

ZusammenfassungFragestellung: Die Akupunktur im Rahmen der Geburtsvorbereitung hat einen positiven Effekt auf den Geburtsverlauf. Welchen Einfluss hat die Nadelakupunktur auf den Serumspiegel von Prostaglandin E 2 in der Eröffnungsphase? Material und Methodik: Bei 40 Frauen mit Akupunktur (Gruppe A) und 40 Frauen ohne Akupunktur (Gruppe B) wurden folgende Parameter evaluiert: Länge der Eröffnungsphase und Austreibungsperiode, Serumspiegel von Prostaglandin E 2 am Ende der Eröffnungsphase. Ergebnisse: Kürzere Eröffnungsperiode von 226 min in der Gruppe A (85 ± 667) im Vergleich zu 348 min in Gruppe B (67 ± 1065) (p < 0,01), bei gleicher Dauer der Austreibungsperiode. Der mediane Serumspiegel am Ende der Eröffnungsphase von PGE 2 in Gruppe A war mit 31,4 pg/ml (0,17 ± 146) signifikant höher als in der Gruppe B mit 6,3 pg/ml (0,14 ± 32) (p = 0,04). Schlussfolgerung: Akupunktur führt zu einer verkürzten Eröffnungsphase und erhöht den Serumspiegel von PGE 2 .Schlüsselwörter: Akupunktur ± Geburtsdauer ± Prostaglandin Summary Objective: Prenatal acupuncture appears to shorten the duration of the first stage of labor. We evaluated the effect of prenatal acupuncture on serum levels of prostaglandin E 2 (PGE 2 ) during labor. Methods: We compared 40 primiparas with uneventful pregnancies who received prenatal acupuncture with 40 primiparas who did not. The serum levels of prostaglandin E 2 were measured at the end of the first stage of labor and the duration of the first and second stage were noted. Results: The median serum levels of prostaglandin E 2 at the end of the first stage in women with or without prenatal acupuncture were 31.4 (0.17 ± 146) pg/ml and 6.3 (0.14 ± 32) pg/ml, respectively (p = 0.04). The median duration of the first stage was 226 (85 ± 667) and 348 (67 ± 1065) min, respectively (p < 0.01). There was no difference in the duration of the second stage.Conclusion: Prenatal acupuncture was associated with increased serum levels of prostaglandin E 2 at the end of the first stage of labor and with a shorter duration of the first stage.