Biomedical subjects

C Waydhas

Publications and source records attributed to C Waydhas.

72 records · Page 4Linked to original sources

PubMed1993

[Venous thrombosis following severe multiple trauma].

The incidence of thromboembolic complications in patients with multiple injuries was reviewed as well with respect to our own prospective investigation (141 patients with a mean injury severity score of 37 points). The rate of deep venous thrombosis (DVT) in severely injured patients is reported to vary from 20 to 90% if invasive diagnostic procedures are used, whereas the rate of clinically relevant manifestations of DVT seems to be much lower. Although 96% of the patient population in our study were thought to be at high risk of having DVT (applying generally accepted risk factors), only 1.4% of the subjects actually developed clinically relevant DVT. The analysis of several parameters of the coagulation and fibrinolytic systems (platelet count, prothrombin time, partial thromboplastin time, antithrombin III, prothrombin, plasminogen, tissue-plasminogen-activator and its inhibitor) showed simultaneous activation of both systems in these severely injured patients. Thus, increased coagulation seems to be counteracted by increased fibrinolysis. In addition, fluid resuscitation with crystalloid and colloid infusions in the prehospital period (1970 ml and 573 ml, respectively) can be viewed as early prophylaxis of thromboembolic complications. Thus, the low DVT rate in a high-risk patient group with multiple injuries might be at least partially explained.

Adult↗

PubMed1992

Inflammatory mediators, infection, sepsis, and multiple organ failure after severe trauma.

The relation of (multiple) organ failure (OF) to the release of inflammatory mediators and the incidence of infection and sepsis was studied prospectively in 100 patients with multiple trauma (injury severity score = 37). Sixteen patients died of OF, 47 patients survived OF, and 37 patients had no OF. Fifteen (24%) of the patients with OF showed no signs of infection. In patients with early onset of OF (n=45), infection followed with a lag of 2 or more days. In 16 (44%) of these patients, infection led to a deterioration in organ function. With late onset of OF (n=18), infection preceded OF in nine patients. Polymorphonuclear leukocyte-elastase, neopterin, C-reactive protein, lactate, antithrombin III, and phospholipase A discriminated significantly among the three outcome groups. Of all factors, only polymorphonuclear leukocyte-elastase showed a difference between patients with and without infection or sepsis, respectively. These data indicate that infection might not play a crucial role in the pathogenesis of posttraumatic OF in a substantial portion of patients with trauma. Early OF, especially, seems to be mainly influenced by the direct sequelae of tissue damage and shock (eg, the release of inflammatory mediators). Since infection and sepsis did not lead to an augmented release of mediators in patients with trauma, the role of both entities remains unclear.

Adult↗

PubMed1992

[Biochemical factors as objective parameters for assessing the prognosis in polytrauma].

One hundred patients with multiple injuries (mean ISS 37 patients) were prospectively evaluated over a period of 14 days following trauma. Significant differences in the blood levels of PMN elastase, cathepsin B, lactate, neopterin, C-reactive protein (CRP) and antithrombin III (ATIII) were found in non-survivors and in survivors with and without organ failure. On admission, a prediction of organ failure was possible with an accuracy of 63% to 69% (PMN elastase, cathepsin B, ATIII). Death was predictable with an 80% to 90% accuracy within the first 4 days (PMN elastase, lactate, CRP, neopterin). The prognostic value of these factors was comparable to trauma scores regarding organ failure and better with respect to death. Biochemical parameters may be helpful in estimating the severity of the injury and prognosis and in monitoring the ICU course of such patients.

Acute-Phase Proteins↗

PubMed1992

[Trauma scores: reproducibility and reliability].

The inter-rater reliability of the Injury Severity Score (ISS) and the Polytraumaschlüssel (PTS) [multiple trauma code] was studied using diagnosis sheets filled in for 107 multiple injured patients. The scoring was performed by eight physicians with different levels of qualification. The scores for individual patients varied widely depending on the scorer, with extremes differing from the mean by about 80% and 70% for the ISS and PTS, respectively. The mean ISS and PTS for the whole study population also varied significantly between the scorers (P less than 0.0001, one-way analysis of variance). Raters with experience in trauma scoring calculated significantly higher scores (P less than 0.01, t-test) Neither the ISS nor the PTS seem reliable enough to describe injury severity in an individual patient. Treatment decisions must not be based on such grounds. Even for larger groups, caution must be exercised in comparison of different populations of multiple traumatized patients.

Humans↗

PubMed1991

Posttraumatic splenectomy does not influence human peripheral blood mononuclear cell subsets.

The immunological and functional consequences of splenectomy in patients with severe trauma are still controversial. In addition to the higher incidence of bacterial infections, including the post-splenectomy sepsis syndrome, alterations of the peripheral blood mononuclear cells (PBM) have been described in patients after splenectomy. We studied the effects of splenectomy in severely injured patients on the number of PBM subsets 30-80 (median 55) months after splenectomy. Compared to a control group of patients with a similar age and a similar severity of trauma there was no significant difference between splenectomized and non-splenectomized patients regarding the absolute and relative numbers of monocytes, B cells, T cells, CD4+ cells, CD8+ cells, NK cells, CD57+/CD8+ cells and CD4+/CD8+ cells. The CD4/CD8 ratios were within the normal range. In two trauma patients without splenectomy the CD57+/CD8+ cells were found to be elevated to 635 and 513 cells/mm3 compared to less than 100 CD57+/CD8+ cells in controls. Except for a slight thrombocytosis in the splenectomized patients (p less than 0.05) the differential cell count showed no difference between both groups. Our data thus suggest that, in a controlled study, splenectomy has little if any effect on peripheral blood mononuclear cell subsets, while severe trauma on its own may have a profound long term effect on T cell subsets in some patients.

Adolescent↗

PubMed1991

[Abdominal sonography versus peritoneal lavage in shock site diagnosis in polytrauma].

Diagnostic peritoneal lavage (DPL) and abdominal sonography (AS) were prospectively evaluated in emergency room diagnostics of blunt abdominal trauma in 106 multiple injured patients (ISS 40 pts). The incidence of intraabdominal lesions was 38.7%. 82 DPL and 64 AS were performed. In 45 patients both procedures were done, in 19 patients only AS and in 37 patients only DPL. The over-all accuracy of DPL and AS was 95% and 88%, respectively. Sensitivity was 91 vs. 74%, specificity 98 vs. 95%. The combined use of both procedures increased accuracy to 98%. We conclude that AS is the initial screening method for the detection of intraabdominal lesions in multiple injured patients. In any case of negative AS and hemodynamic instability or ambiguous AS, DPL should be performed immediately to improve diagnostic accuracy without delaying treatment.

Abdominal Injuries↗

PubMed1991

[Standards for preclinical resuscitation--requirements for efficient therapy and scientific analysis. A prospective study using as an example the combined emergency medical service of the Munich administrative district and capital].

A standardized treatment protocol is essential for scientific evaluation of parameters influencing the outcome and survival of patients who have suffered cardiac arrest in a non-hospital situation. In addition, a standardized therapy algorithm permits effective, time-saving interaction of all members of the emergency team who work together to perform cardiopulmonary resuscitation (CPR) in any emergency outside the hospital. This paper gives the results obtained in 50 patients in whom on-the-spot resuscitation was performed by a specially trained team [emergency medical team (EMT) + on-scene physician] using an ACLS (advanced cardiac life support) protocol modified from the AHA (American Heart Association) standard. Two different algorithms were used one for ventricular fibrillation (VF) and pulseless ventricular tachycardia and one for asystole and pulseless bradycardia. When indicated, countershocks were first administered at a continuous energy level of 360 J, up to three times one after the other. All patients then received epinephrine intratracheally, 2 mg, immediately after intubation. In the case or persisting asystole a further 2-mg dose of epinephrine and then one 5-mg dose were given i.v. in keeping with the ACLS protocol. In the case of persisting VF or pulseless tachycardia we gave one 100-mg dose of lidocaine i.v. and then performed the next countershock at the same energy level. The time the team members actually needed for the single steps of the ACLS protocol was meticulously documented with the aid of a stop watch.(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗

PubMed1990

[Is there a favorable time for the management of femoral shaft fractures in polytrauma?].

Despite the wide-spread opinion, that early stabilisation of femur fractures in multiply injured patients is of advantage, there are no publications that unambiguously prove this statement. In contrast, primary fracture stabilisation of the femur with concomitant thoracic trauma seems to increase the rate of complications. The biochemical data of the prospective study presented here suggest, that operative stabilisation of femoral fractures imposes an additional trauma on the already compromised organism. The period between days 2 to 4, when the primary activation of humoral and cellular mediators has returned to normal levels, seems to be the best time for osteosyntheses of these fractures. The operation in this period allows intramedullary fixation--the biologically and biomechanically best fixation procedure--with low risk.

Acute-Phase Proteins↗

PubMed1989

Prognostic value of serum phospholipase A in the multitraumatized patient.

Phospholipase A serum activity was prospectively studied in 39 patients with multiple trauma. There was no correlation of phospholipase A activity with type or severity of injury. With increasing phospholipase A levels, a rise in mortality was found. A prediction of fatal outcome on an individual basis was not possible. The sensitivity for complications was 90%, whereas the predictive value of the positive test (64%) and specificity (47%) were low. When the behavior of phospholipase A and elastase release were compared, no correlation between these two parameters could be detected. Therefore, PMN leukocytes do not seem to be a major source of phospholipase A in serum.

Acute Kidney Injury↗

PubMed1989

[Changes and progress in fracture treatment in polytrauma].

The last 20 years have seen a great deal of controversy about the indications for and the timing of operative fracture treatment in multiply injured patients. In central Europe a standardized concept of treatment has been widely adopted since the late 1970s. In this concept a few types of fractures are given a high priority and are operated on early. Most fracture types, however, are not stabilized by internal fixation until several days after the injury. The treatment of closed femoral shaft fractures is still hotly debated. So far, not a single prospective study proving the advantages or disadvantages of early fixation has been published.

Fracture Fixation, Internal↗

PubMed1989