Purpose: The aim of this study was to investigate whether urinary bladder volume (UBV) and blood alcohol concentration (BAC) correlate in a cohort of emergency trauma patients. Furthermore, the feasibility of semi-automated 3D-CT volumetry for urinary bladder volumetry calculations in whole-body CT examinations was elucidated. Material and methods: Whole-body CT scans of 831 individuals treated in the emergency department with suspected multiple injuries were included. Manual 3D-CT volumetry of the urinary bladder was performed and the mechanism of injury, patient demographics, BAC, serum creatinine, and hematocrit were retrospectively analyzed. Semi-automated calculation of UBV was performed in 30 patients. Statistical analysis included ROC analysis to calculate cut-off values, sensitivity, and specificity. The Mann Whitney test and Spearman's correlation coefficient were used to detect significant correlations between UBV and BAC. Results: Manual 3D-CT volumetry showed maximum sensitivity and specificity with a cut-off value for urinary bladder volume of 416.3 mL (sensitivity 50.9%; specificity 76.3%; AUC 0.678). With a cut-off value of 4.2 mL/mu mol for the creatinine quotient (quotient of serum creatinine and UBV), the sensitivity was 64.2% (specificity 67.0%; AUC 0.681). Semi-automated 3D-CT volumetry resulted in lower UBV values compared to those obtained with manual 3D-CT volumetry. Conclusion: Semi-automated 3D-CT volumetry is a reliable method to quantify UBV. UBV correlates with positive BAC results. A UBV above 416 mL seen on an initial whole-body CT must raise suspicion of alcohol intoxication. The creatinine quotient is an even more sensitive and specific parameter for the detection of alcohol intoxication. (C) 2017 Elsevier Inc. All rights reserved.

After debridement and before dressing a wound with maggots of calliphorid flies, one frequently performed step is the application of antiseptics to the prepared wound bed. However, the concomitant application of antiseptic agents during maggot therapy is regarded controversial as antiseptics may interfere with maggots' viability. In this experimental in vitro study, the viability of fly maggots was investigated after exposure to various antiseptics frequently used in wound care. Here, we show that Lucilia sericata fly maggots can survive up to an hour's exposure to wound antiseptics such as octenidine, povidone-iodine or polihexanide. Concomitant short-term application of wound antiseptics together with maggots on wound beds is tolerated by larvae and does not impair their viability.

Background Staphylococcus aureus may be the most important wound pathogen and causative for most of surgical site infections. As many anti-staphylococcal drugs are useless because of resistance, novel antimicrobial strategies are strongly needed and may be provided by cold atmospheric plasma (CP), which is being currently investigated for antiseptic efficacy. Methods To test the antimicrobial properties of CP against Staphylococcus aureus , 168 methicillin-susceptible isolates (MSSA) and 50 methicillin-resistant isolates (MRSA) were treated with two technically different plasma sources [an atmospheric pressure plasma jet (APPJ) and a dielectric barrier discharge plasma (DBD)] in vitro. Results CP treatment allowed a reproducible and significant growth reduction of MRSA and MSSA. However, MRSA was significantly less susceptible to treatment with DBD than was MSSA, while no difference between MRSA and MSSA was found using APPJ. Conclusions As the initial physical antiseptic on skin, CP may be suitable for rapid decolonization of microbial pathogens in vivo. Each device must undergo validated efficacy testing prior to clinical application, as device related differences may occur.

Background: Cold atmospheric pressure plasma (CAP) with its many bioactive properties has defined a new medical field: the plasma medicine. However, in the related form of high-frequency therapy, CAP was even used briefly a century ago. The aim of this study was to review historic CAP treatments and to obtain data regarding the antimicrobial efficacy of a historical high-frequency plasma device. Methods: First, historic literature regarding the history of CAP treatment was evaluated, because in the modern literature no data were available. Second, the susceptibility of 5 different bacterial wound isolates, cultured on agar, to a historic plasma source (violet wand [VW]) and two modern devices (atmospheric pressure plasma jet [APPJ] and Dielectric Barrier Discharge [DBD]) was analyzed . The obtained inhibition areas (IA) were compared. Results: First, the most convenient popular historical electromedical treatments produced a so-called effluvia by using glass electrodes, related to today’s CAP. Second, all three tested plasma sources showed complete eradication of all tested microbial strains in the treated area. The “historical” cold VW plasma showed antimicrobial effects similar to those of modern APPJ and DBD regarding the diameter of the IA. Conclusion: Some retrograde evidence may be deducted from this, especially for treatment of infectious diseases with historical plasma devices. The underlying technology may serve as model for construction of modern sucessive devices.

Background and aims: Debridement therapy with sterile bred larvae in non-healing wounds is a widely accepted safe and efficient treatment modality. However, during application in the contaminated wound bed microbial contamination with potential microbial pathogen spread after escape from the wound or after unreliable disposal procedure may happen, particularly in the case of not using bio-bags. The aims of this work were first to investigate the release of ingested bacteria into the environment by maggots and second to examine the common practice of freezing the maggots after use and/or disposal in trash-bags. Potential methods for hygienic safe disposal of used maggots should be deduced. Methods: First, Maggots were contaminated with S. aureus by allowing them to crawl over an agar surface completely covered with bacterial growth over 24 h at 37°C. After external disinfection maggots were transferred onto sterile Columbia agar plates and shedding of S. aureus was visualized. Second, maggots were frozen at –20°C for 1, 2, 5, 10, 30, and 60 min. After exposure, the larvae were transferred onto Columbia blood agar with consecutive incubation at 37°C over 48 h. The larvae were analyzed visually for mobility and eating activities. The frozen bodies of dead larvae were examined for viable bacteria. Results: We could demonstrate that maggots release formerly ingested pathogens (S. aureus). Freezing at –20°C for at least 60 min was able to kill all maggots, however the contaminant bacteria inside could survive. Conclusion: Since freezing is apparently able to kill maggots but not to reliabely inactivate the ingested bacterial pathogens, we recommend the disposal of free-range larvae in screw cap vials after use to achieve full hygienic control.

Background. Today, highly sophisticated devices deliver cold atmospheric pressure plasma (CAPP) with a multitude of bioactive properties, opening the window to a new medical field: plasma medicine. Different techniques to create the optimal plasma device for different medical indications are currently being explored. However, even a 100 years ago, CAPP was briefly used in the related form of high-frequency therapy. The objective of our study was to compare historic with modern techniques regarding antimicrobial efficacy. Methods. First, 26 different clinical isolates of relevant wound pathogens were treated in vitro with a historic violet wand (VW) and 2 modern plasma sources (kINPen 09 and dielectric barrier discharge [DBD]) and the obtained inhibition areas (IAs) were compared. Second, a biofilm model was used to compare biofilm inactivation by VW, DBD, ethanol, and polyhexanide treatment. Results. DBD with the largest electrode produced the largest IAs. VW showed results similar to 2 different modes of the kINPen 09. IAs of VW were enlargeable by attaching a larger electrode. Against biofilms, VW was less effective than DBD but more effective than ethanol 70% and polyhexanide. Conclusion. The proven antimicrobial efficacy of VW may encourage the development of new, potent plasma devices based on the very simple and inexpensive technique of the historic high-frequency apparatus.

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