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Biomedical subjects

A Kohler

Publications and source records attributed to A Kohler.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Chylothorax after blunt thoracic trauma].

The diagnosis of chylothorax following blunt chest trauma is rare, only few cases have been reported. We describe three patients with chylothorax following blunt chest trauma. Conservative treatment consists of drainage, in severe cases mechanical ventilation with PEEP and total parenteral nutrition. In case of persisting and/or increasing chylus production, thoracotomy and ligation of the thoracic duct may be required. In all of our patients thoracostomy was the definite therapeutic modality, no thoracotomy was necessary.

Adult↗
PubMed1995

[Osteosynthesis of subcapital humerus fractures with unconventional use of implants].

The osteosynthesis of subcapital humerus fractures with the commonly used plates is often critical because of the little space subacromial, the irritation of the blood supply by the broad plates and the poor proximal anchorage without angle stability. The osteosynthesis with blade plates (children hip plate or blade plates for small adults) for isolated subcapital fractures or a blade plate like modified DC-plate for subcapital fractures with a shaft component or severe osteoporosis is thought to be a reliable alternative. We treated 34 patients aged between 18 and 85 years (mean 44 years) with blade plates. 33 patients had a good fracture healing and subjectively free shoulder motion after 3 months. One patient had distal implant loosening because of insufficient medial contact. The fracture healed after refixation.

Adolescent↗
PubMed1995

[Comparative value of transverse abdominal diameter and fetal abdominal perimeter. 3844 biometric examinations].

OBJECTIVE: Assess charts of abdominal size as they are used in a routine ultrasound screening, on a non selected population with 5 operators, to compare the interest of transverse abdominal diameter (TAD) with abdominal circumference (AC). METHOD: Retrospective study, in the department of Antenatal Diagnosis of the Centre Médico-Chirurgical et Obstétrical between September 1991 and August 1994. MAIN OUTCOME MEASURES: Abdominal biometry and gestational age to characterize the prenatal trophicity. Neonatal weight and gestational age at birth to characterize neonatal trophicity. RESULTS: Between 32 and 36 weeks, the TAD charts detected only one SGA (small for gestational age) out of 10. However, the AC sensitivity was 54.5% with a specificity of 94%. In the same period, the TAD charts suspect LGA (large for gestational age) for one exam out of two. The charts of AC have about the same performance to detect LGA and SGA. CONCLUSION: For a routine ultrasound screening between 32 and 36 weeks gestational age, the AC charts have to be preferred to TAD charts.

Abdomen↗
PubMed1994

Conduction block in vasculitic neuropathy.

We describe a 28-year-old man who developed a mononeuropathy with a conduction block of the median nerve in the forearm, during the acute stage of a polyarteritis nodosa. Sequential studies show progressive disappearance of the conduction block (together with the clinical symptoms), without signs of axonotmesis.

Adult↗
PubMed1994

[Patient management in polytrauma with injuries of the cervical spine].

Complex unstable cervical spine injuries in polytraumatized patients are stabilized ventro-dorsally in a two-stage procedure. The ventral stabilization is a day-one surgery with the goal to get primary stability for intensive care, early spinal decompression and protection against secondary damage of the spinal cord. The additional dorsal stabilization allows early functional treatment or in case of spinal cord lesions early neurorehabilitation. The combination of severe brain injury and unstable cervical spine injury is especially demanding concerning diagnostic and therapeutic procedures.

Adolescent↗
PubMed1993

[Management of the compartment syndrome in hemophilic patients].

Diffuse bleeding in the muscles or localized hematomas are illness-specific factors increasing the possibility of a posttraumatic compartment syndrome in hemophiliac patients. Sufficient substitution of coagulation factor is the first step after trauma. The main principals of surgical treatment are:--a generous fasciotomy with a sufficient skin incision to allow adequate hemostasis under direct visualization. Localized hematomas should be evacuated;--fractures must be definitively stabilized as soon as possible. Therefore, internal fixation should be performed primarily whenever possible;--primary skin grafting of all skin defects to insure early wound closure. Intraoperatively, the underlying exposed surfaces of split thickness skin grafts and donor areas are sealed with fibrin glue. All surgery must be done under sufficient coagulation factor substitution, which has to be continued during wound healing and mobilization.

Adult↗
PubMed1993

[Prevention of thromboembolism in hip fracture: unfractionated heparin versus low molecular weight heparin ( a prospective, randomized study)].

In a prospective, randomized study in patients with hip fracture we discuss whether a single dose of low-molecular-heparin (Sandoparin) has the same effect as a tripple dose of standard-heparin (Liquemin: 3 x 5000 I.E.) The first dose of low-molecular-heparin respectively standard-heparin is given in the emergency room before the operation. Between 4th and 6th day following operation the patients were screened for deep vein thrombosis: Clinical examination, Liquid Crystal Contact Thermography (LCCT), colour coded ultrasound examination and with phlebography. 33 patients have been treated with standard-heparin and 35 with low-molecular-heparin. In the group of standard-heparin 30% of all the patients showed a deep vein thrombosis, whereas only 17% deep vein thrombosis were found in the group treated with low-molecular-heparin. But to reach statistical significance in both groups 60 patients are needed. Postoperative haemorrhagic complications were seen in 6.1% in the group of standard-heparin and in 8% in the group of low-molecular-heparin. The LCCT and the ultrasound examination were compared with the phlebography. The LCCT had a sensitivity of 92% and a specificity of 85%. The ultrasound examination had a sensitivity of only 15%! Therefore the ultrasound examination is an unsuitable screening method to detect deep vein thrombosis in patients with fractures of the proximal end of the femur.

Aged↗
PubMed1993

[Osteosynthesis of subcapital humerus fracture with unconventionally applied implants].

The osteosynthesis of proximal humerus fractures with the commonly used plates is often critical because of the small space subacromial, the irritation of the blood supply by the broad plates and the poor proximal anchorage without angle stability. The osteosynthesis with a children hip plate or a angle plate like modified DC-plate is thought to be a reliable alternative.

Adult↗
PubMed1992

[Traumatic rupture of a kidney transplant in chronic lymphocele].

The lymphocele is a seldom complication after kidney transplantation (2.2% of our patients). This manifestation occurs typically 3-4 months after transplantation, as a late complication it's a rarity. The rupture of a kidney graft because of a trauma is unique in our clinical experience, which contains more than 1200 kidney transplantations. We report the case of a 28-year-old man who had 19 years after transplantation a traumatic rupture of the kidney graft. Because of the trauma a preexistent chronic lymphocele got clinically manifest. The histology of the lymphocele wall shows fatty and collagen tissue with a strong fibrosis. The diagnostic and therapeutic procedure is described. There are different possible relations between the rare problems:--the tight lymphocele carries over the force on the graft--the lymphocele has grown together with the graft at the lower pole and ruptures in this place--a little graft rupture makes a clinical manifest bleeding in the lymphocele because the deficiency of perirenal tissue.

Adult↗
PubMed1992

[Extended surgical indications in combined shoulder girdle fracture].

The combination of an ipsilateral clavicule and scapula fracture causes a double instability of the shoulder. In opposite to an isolated clavicule or scapula fracture this injury should be treated operatively. Diagnosis of the scapula fracture in polytrauma can be difficult. If there is a clinical or radiologic suspicion, the indication for a CT scan is given. Osteosynthesis with plates from separated approaches, first the scapula from dorsal then the calvicule from ventral has proven good. The nervus suprascapularis must be treated carefully and, if necessary, liberated from the fracture. The optimal treatment of this injury is not always possible in polytraumatised patient.

Clavicle↗
PubMed1992

[Surgical management of severe pelvic crush injuries].

Control of hemorrhage and prevention of septic complications are the predominant difficulties associated with severe pelvic crush injuries. According to our experience spontaneous tamponade, external compression (MAST/G-suits), and blind ligation of the hypogastric artery seem to be ineffective, whereas angiography followed by embolization, controlled ligation or vascular reconstruction, packing with scheduled 2nd look reexploration, and rigid fixation of the pelvic ring are recommended to control severe hemorrhage associated with these injuries. Moreover, early repair of bowel and urinary tract lesions, diverting colostomy with rectal wash-out, radical debridement, and open wound care of degloving avulsion injuries appear to be the most important procedures to prevent posttraumatic sepsis. Our pelvic crush trauma protocol is based on 84 consecutive cases treated between 1972 and 1990. In all cases the Injury Severity Score (ISS) was over 40 points, each patient required at least 10 units of whole blood or red cells, the overall mortality rate was 41 out of 84 patients.

Combined Modality Therapy↗
PubMed1991

Biosynthesis of ferulic acid esters of plant cell wall polysaccharides in endomembranes from parsley cells.

A microsomal preparation from suspension-cultured parsley cells is able to transfer ferulic acid from the respective CoA thioester to endogenous acceptors. The reaction is not enhanced by digitonin but stimulated by Mg2+, Ca2+ and Co2+. Spermine can partly replace divalent ions. Solubility properties and degradation by polysaccharide hydrolases suggest that the products are polymeric cell wall carbohydrates. Sucrose density gradient centrifugation revealed that the most active vesicle fraction is distinct from plasma membranes but does also not peak with IDPase. It is suggested that a subfraction of the Golgi-apparatus is the source of enzyme and acceptors.

Acyl Coenzyme A↗
PubMed1991

[Modified postoperative prevention of recurrence in euthyroid struma nodosa].

In a prospective clinical study after uni- or bilateral subtotal thyreoidectomy, cause of euthyreote goitre, no substitution with L-thyroxin was ordered postoperatively. The follow-up after three months and one year shows a representative time for judgement of the hormonal situation after three months. Over one year 55% with bilateral resection need hormone substitution but only 4% with unilateral. Bilateral subtotal thyroid resection seems to be a too extensive resection to leave enough functional thyroid tissue for a physiological function.

Euthyroid Sick Syndromes↗
PubMed1990

A controlled study of early neurologic abnormalities in men with asymptomatic human immunodeficiency virus infection.

BACKGROUND: Although neurologic complications are frequent in the acquired immunodeficiency syndrome, their incidence and progression in early human immunodeficiency virus (HIV) infection remain controversial. The goal of this study was to assess neurologic manifestations in asymptomatic carriers of HIV. METHODS: We studied 29 HIV-seropositive homosexual men and 33 seronegative homosexual controls by means of neurologic and neuropsychological examinations, magnetic resonance imaging (MRI), and electrophysiologic tests (electroencephalography, multimodal evoked-potential tests, and otoneurologic tests). After six to nine months, the tests were repeated in 27 seropositive men and 30 controls. The investigators were blind to the serologic status of the subjects. RESULTS: The seropositive subjects had a mean CD4+ lymphocyte count of 635 X 10(6) per liter. Neurologic and neuropsychological examination, MRI, and measurements of pattern visual evoked potentials did not show significant differences between the two groups. The latencies of the median-nerve somatosensory evoked potentials were slightly prolonged in the seropositive men. The initial electroencephalogram was judged abnormal in 8 of 27 of the seropositive subjects (30 percent) as compared with none of the controls, with a slowing of fundamental activity, anterior spread [corrected] of alpha rhythm, subnormal reactivity, and unusual anterior theta activities. These findings were confirmed by computerized spectral analysis. The second electroencephalogram was abnormal in 10 of 25 of the seropositive men (40 percent). The otoneurologic evaluation identified abnormalities in the central auditory or vestibulo-ocular pathways in 34 percent of the seropositive men (10 of 29), as compared with 6 percent of the controls (2 of 33), on the first examination and in 44 percent (12 of 27) and 7 percent (2 of 30), respectively, on the second examination. Altogether, electrophysiologic abnormalities were found in 67 percent of the seropositive men (18 of 27) and 10 percent of the controls (3 of 30) (P less than 0.00005). CONCLUSIONS: In persons with asymptomatic HIV infection, electrophysiologic tests may be the most sensitive indicators of subclinical neurologic impairment. Electrophysiologic abnormalities are far more common in asymptomatic carriers of HIV than in controls and tend to progress over time.

Adult↗
PubMed1986

[Olivo-ponto-cerebellar and striato-nigral atrophy. 3 anatomo-clinical cases. Review of the literature].

AOPC is frequently associated with degeneration in other systems, the striato-nigral in particular. Three anatomical-clinical cases of AOPC complicated by striato-nigral degeneration of varying gravity are described. Case 1 had a complex history: rigidity with axial predominance, plus signs in neurovegetative system, ocular palsy, myoclonia and fasciculation and a massive atrophy of the olivo-ponto-cerebellar and striato-nigral systems. Case 2 presented as a static and kinetic cerebellar syndrome; the anatomical confirmation of the AOPC involvement showing a patchy nigro-striatal degeneration but without clinical signs. Case 3 evolved as a Parkinson-type syndrome differentiated from true Parkinson's disease by signs affecting the pyramidal system and the relative importance of static signs, the lesions then involving namely the striato-nigral system. 69 allied cases in the literature are referred to and commented upon demonstrating the great clinical and anatomical variation in presentation of AOPC. The concept of "multiple system atrophy" allows most cases to be grouped under a general heading. The degenerative diseases of the CNS, in so far as their etiology remains obscure, make up a "waiting list".

Aged↗
PubMed1981

[Production of primary cells cultures by a semi-industrial technic. II. Use of active trypsin solutions for effective cell yields].

For effective cell yields in semi-industrial production of primary cell suspensions, the use of trypsin solutions with high enzyme activity has been proved to be an essential requirement. Enzyme solutions with a constant high activity may be obtained by using an optimal filtration method. Filtration results using the deep and membrane filtration method to sterilize trypsin solutions are demonstrated and discussed. A number of trypsin samples taken from the "Leidholdt-Firm" were tested concerning cell yields in the so-called 'Biomix-Procedure'. A correlation could be shown to exist between enzyme activity and cell yield. The so tested trypsin-L-samples out of the years 1976/78 were proved to be first-rate preparations for routine production of primary piglet and calf kidney cell cultures.

Animals↗