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Biomedical subjects

A Leutenegger

Publications and source records attributed to A Leutenegger.

17 recordsLinked to original sources
PubMed1992

[Vascular injuries--management in a non-university central hospital].

In a retrospective study the surgically treated vascular injuries (n = 35) of the last 10 years were evaluated. One third of the patients had multiple trauma and in 57% of the cases vascular injury was accompanied by a fracture. All patients (n = 28) except those who underwent delayed amputation (amputation rate 14%) have been followed personally for an average of 5.1 years. 90% of these patients showed an excellent or acceptable longtime result in regard to vascularity, nobody complained of claudication. Diagnosis of a vascular injury was mostly confirmed by direct surgical exploration, only one third of the lesions were diagnosed by arteriogram. A positive signal in Doppler examination does not exclude vascular injury and therefore cannot replace arteriography or exact clinical evaluation.

Adult↗
PubMed1991

Five years' follow-up of severely injured ICU patients.

We conducted a 5-year follow-up study of a group of 461 consecutive trauma patients treated in our Intensive Care Unit from 1980 to 1983. The entry criteria (initial survival and severe injury: ISS greater than or equal to 18) were fulfilled by 233 patients with a mean ISS of 29.3 and mean age of 35.6 years. Data on prehospital care, type and timing of surgery, and hospital and ICU stay were recorded during hospital discharge. The protocol strictly asked for a personal interview and a physical examination. Mailed questionnaires or phone interviews were not allowed. The areas of medical sequelae, aftercare, missed injuries, occupation, insurance, social integration, economics, legal aspects, and traffic involvement were covered. We were able to gather final information from 223 (95.6%) of the 233 cases. Forty-three patients (18.4%) died in the hospital, 13 patients (5.6%) died later, and 167 (76.5%) were eventually seen. Only 10 patients (4.4%) were lost to follow-up. Outcome was judged using the Glasgow Outcome Scale (GOS), which was compared with a GOS value given prospectively at the time of hospital discharge. Eighty-nine percent of the survivors were healthy or slightly disabled (GOS 5 and 4), 9% were severely disabled, and only 2% were in a persistent vegetative state. Outcome after 5 years was better than tentatively prognosed at the time of hospital discharge. Ninety-one patients with severe head injuries (AIS 4-5) were additionally tested using the Mini Mental State instrument. This test revealed normal mental functions in 77% and dementia, mostly of a minor degree, in 23% of the head-injured patients. Almost all the early deaths and two thirds of the late deaths were related to severe head injury. Seventy-nine percent of the survivors were working after 5 years. During the post-trauma period, patients experienced reduced social well-being and also changed professional and recreational activities. There appears to be extensive room for improvement in the posthospital recovery phase. We conclude that survivors of critical trauma have a very good chance, after 5 years, of regaining a high quality of life. All efforts at improving trauma survival and quality of trauma care are therefore worthwhile and deserve high priority.

Adolescent↗
PubMed1991

[Emergency screw osteosynthesis of femoral neck fractures].

27 patients with femoral neck fractures have been treated by ORIF with 3 or 4 large cancellous bone screws. The operation has been performed as an emergency intervention within 5 1/2 hours after accident. Anterior arthrotomy in direction of the long axis of the neck for evacuation of the intraarticular hematoma has been performed as a routine. Personal follow-up with X-ray documentation after 18 to 106 months (mean 29.5 months) showed complete rehabilitation in 22 patients and 2 femoral head necroses (7.4%). We conclude that these good results are due to the short interval between accident and operation as well as to the evacuation of the intraarticular hematoma, together with a stable internal fixation and functional rehabilitation.

Adolescent↗
PubMed1991

[Interlocking intramedullary nailing of the femur: is the advantage of early mobilization gained by risking a malposition?].

We report a follow-up of 57 consecutive femoral fractures treated by internal fixation with the AO Universal Interlocking Nall. All fractures (91% follow-up) had healed within a mean of 22 months (range 9-50) after operation. Full weight-bearing was possible after an average of 9 weeks (range 2-20). The only infection occurred after a secondary open lengthening osteotomy. In 5 cases a rotational malposition or length discrepancy had to be corrected shortly after initial surgery. Rotational malposition in excess of 10 degrees occurred in 26% of cases (mostly external rotation) and length discrepancy exceeding 1 cm in 13% (mostly shortening). The frequency of malposition is explained by the absence of rotational or length control during operation. We recommend that malposition be correlated without delay by reoperation.

Adolescent↗
PubMed1991

[Talus fracture. Injury pattern, treatment tactics and results of operation (1980-1989)].

The results of 25 operated talus fractures are presented. 7 of these were peripheral fractures with excellent results, 18 central fractures with only satisfying or even bad outcome. Although we didn't see any avascular necrosis of the talus, almost all patients had pain and slight or even severe signs of arthrosis in the ankle or subtalar joint.

Follow-Up Studies↗
PubMed1979

[The catabolic patient].

Trauma and stress can cause characteristic changes in metabolism: raised lipolysis and reduced glucose tolerance as well as major renal nitrogen losses are manifestations of a postoperative or posttraumatic excess of catabolism over anabolism. Excess catabolism is caused by immobilisation and inadequate oral or parenteral nutrition. Wasting in seriously ill patients for intensive treatment. Priority must be given to the prevention of insufficiencies of organs and systems, and to the elimination of stress factors. It is only then that mobilisation and the administration of calories and nitrogen will restore a normal anabolism-catabolism balance.

Cachexia↗
PubMed1978

[Management of postoperative intestinal fistulas with elemental diet (author's transl)].

From 1973-1976 sixteen patients with clinically manifest post-operative fistulas (7 small intestinal and 9 colonic) were studied. These patients received an elemental diet (ED) as their only nutritional support for 9-44 days. On ED spontaneous closure was observed in 4 out of 7 small intestinal fistulas and in 7 out of 9 colonic fistulas. Hemoglobin and serum albumin increased significantly on ED and nitrogen balance performed on 7 patients was in equilibrium or positive. Advantages of ED over intravenous nutrition in the treatment of intestinal fistulas are discussed.

Adult↗
PubMed1978

Glucagon, insulin, cortisol, and growth hormone levels following major surgery: their relationship to glucose and free fatty acid elevations.

Circulating hormone and substrate levels were measured in 7 patients at regular intervals before, during and after pulmonary surgery. During surgery, cortisol and growth hormone were significantly elevated, pancreatic glucagon was unchanged and insulin was depressed. One and two days after surgery, growth hormone had almost returned to preoperative fasting values, but cortisol, insulin and glucagon levels were significantly increased. The mean insulin:glucagon molar ratio declined from a preoperative fasting value of 3.2 +/- 0.5 (+/- SEM) to 1.7 +/- 0.4 during operation but was within normal limits 1 and 2 days after surgery due to a parallel rise and fall in plasma insulin and glucagon. Plasma glucose was elevated both during operation and for several days thereafter, whereas free fatty acid levels were increased only during operation. Thus, there was no consistent relation between insulin:glucagon ratio or any of the hormone levels and the observed elevations in plasma glucose and free fatty acids. It is concluded that neither any of the hormones assayed nor the insulin:glucagon ratio was the primary determinant of plasma glucose and free fatty acid responses to surgery. Rather, fuel homeostasis appeared to result from the combined effects of glucagon, insulin, growth hormone, cortisol and adrenergic activity.

Adult↗
PubMed1977

[Parenteral hyperalimentation (author's transl)].

Intravenous hyperalimentation allows complete nutrition and anabolism in patients who cannot be fed by the oral route. However, several complications have been reported, e.g. septicaemia and hyperglycaemina. In 51 intensive-care patients receiving hyperalimentation, 18% were found to be hyperglycaemic in spite of insulin administration. Hyperglycaemia was frequently associated with stress. In 8 patients undergoing major surgery, which was chosen as a stress model, decreased insulin and increased glucagon, growth hormone and cortisone levels were observed. These findings could explain stress-induced glucose intolerance. In a further experiment, 8 intensive-care patients were given alternative intravenous feedings with either 600g of a mixture of glucose, fructose and xylitol in a ration of 1:2:1 or 600g glucose per day. During both regimens insulin administration was required in 4 patients, but the insulin dosage was lower with the mixture. Plasma glucose during glucose infusion was 205+/-25mg/100ml(M+/-SEM) and the sum of plasma glucose, fructose and xylitol during infusion of the mixture was 176+/-33mg/100ml, the difference being of borderline significance (p less than 0.05). The advantages and disadvantages of infusable substrates are summarized on the basis of the available literature and it is concluded that, in general, glucose is preferable. However, if hyperglycaemia is difficult to control, partial replacement of glucose by glucose substitutes or fat emulsions may be advantageous. A routine infusion programme for central venous feeding is suggested. Causes and prevention of side-effects are reviewed. In many patients receiving central venous nutrition less hazardous and less expensive methods could be used such as nasogastric tube feeding, elemental diet or peripheral venous nutrition.

Blood Glucose↗
PubMed1977

[Elementary diet as an alternative to parenteral feeding in severe gastrointestinal diseases].

21 patients with gastroenterological disease and indication for the use of intravenous nutrition received an elemental diet (ED) for 5-44 days. In 6 out of 8 patients with exacerbation of Crohn's disease remissions were achieved, apart from 3 persistent fistulas. In 5 out of 9 cases with various primary diseases and postoperative intestinal fistulas, spontaneous healing was observed. Furthermore, 2 patients with ulcerative colitis, 1 with radiation enteritis and 1 with pancreatitis were treated with ED. On ED, hemoglobin increased from 11.3 +/- 0.4 (m +/- SEM) to 12.0 +/- 0.5 g% (p less than 0.01) and serum albumin from 2.7 +/- 0.1 to 3.4 +/- 0.1 g% (p less than 0.001). Nitrogen requirements were studied in 11 patients receiving various quantities of ED. Nitrogen balance was found to be in equilibrium or positive in 7 patients, and negative in 4. In one patient with severe ulcerative colitis, fecal nitrogen losses were higher than urinary nitrogen losses. The unpleasant taste of ED resulting from free amino acids limited the ED supply in 3 patients and led to premature ending of ED administration in 3 other patients. In such cases ED may be given by nasogastric tube feeding. From the results presented it appears that ED is indicated in Crohn's disease and intestinal fistulas. However, the results obtained require confirmation by further observations and comparison with an intravenously fed control group.

Adolescent↗
PubMed1977

Comparison of glucose and fructose tolerance before and after starvation.

Glucose and fructose were studied in eight healthy volunteers who fasted twice for 4 days. Before and after the fasts each subject received a 4-hr glucose or fructose infusion providing 0.5 g/kg/hr. Glucose infusion during starvation resulted in a mean maximal plasma glucose rise of 401 +/- 21 mg/100 ml (+/- SEM) as compared to 119 +/- 10 mg/100 ml before starvation. Insulin/glucose ratios were lower than normal in fasted subjects. Fructose infusion during fasting produced a maximal plasma glucose rise of 91 +/- 9 mg/100 ml as opposed to 5+/-1 mg/100 ml before starvation. During fructose infusion in the fasted state, plasma fructose levels were higher than control and the rise in blood lactate and pyruvate was delayed, but finally lactate concentrations were above control values. The antiketotic effects of intravenous glucose and fructose were similar during fasting but fructose was significantly less potent in reducing free fatty acid levels. After starvation, urinary carbohydrate losses during glucose infusion were 5 times higher than those observed during fructose infusion. Thus, fructose utillization was less impaired during fasting than was glucose utilization, although fasting induced abnormalities in both glucose and fructose metabolism.

Adult↗
PubMed1976

Postoperative tolerance to glucose and sugar substitutes.

In 51 surgical intensive-care patients, who were given 400 to 650 g glucose per day i.v., 18% of arterial blood sugar values were found to be above 250 mg/100 m1 in spite of frequent insulin administration. In 8 lobectomized patients increased plasma levels of pancreatic glucagon, cortisol, and growth hormone were observed which may in part explain postoperative glucose intolerance. In addition previous carbohydrate deprivation was found to impair glucose tolerance. Several measures are suggested to reduce the incidence of hyperglycemia during i.v. glucose feeding. In a further study 24 cholecystectomized or vagotomized patients received in alternate sequence either a combination of glucose (G), fructose (F) and xylitol (X), the G/F/X-ratio being 1/2/1, or glucose alone for 5 days. The infusion rate was 1.42 g carbohydrate/kg/24 hrs. On operation day and was increased by the same amount every day up to 7.14 g/kg/24 hrs. Tolerance was good in both groups but urinary losses of infused substrates were higher in the group receiving the GFX-combination. It is concluded that after surgery of intermediate magnitude the GFX-combination offers no advantage over glucose alone. However, in severely ill patients, where glucose intolerance is more pronounced, further carefully monitored studies with sugar substitutes appear of interest.

Adult↗