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Biomedical subjects

F Gebhard

Publications and source records attributed to F Gebhard.

71 records · Page 4Linked to original sources
PubMed1996

[Are ISS and PTS unsuitable trauma scores for prediction of (possible) post-traumatic lung failure?].

Prostanoids are inflammatory mediators which originate from endothelial cells following local tissue damage. That is why plasma levels of prostanoids are possible markers of inflammatory response and severity of trauma. We were able to demonstrate that the systemic release of prostanoids does not depend on the score values (ISS, PTS) but rather on different trauma patterns (chest trauma, head injury). Influencing vascular permeability and resistance elevated plasma levels of prostanoids may explain the impairment of pulmonary function in traumatized patients. It seems to be useful to re-evaluate the scoring systems with respect to chest trauma and head injury.

Adolescent↗
PubMed1995

[Favorable outcome of orbital nasal sinus mucormycosis complicating the induction treatment of acute lymphoblastic leukemia].

BACKGROUND: Most cases of mucormycosis occur in immunosuppressed children. Intracranial extension is lethal and must be prevented with early specific treatment. CASE REPORT: A 42 month-old boy was admitted suffering from acute lymphoblastic leukemia. Edema of the left eyelid developed on the sixth day of induction chemotherapy. Mucormycosis was suspected because of gradual extension of infection to nasal ala and periorbital area with fever, edema of nasal turbinates and nasal black secretions. Chemotherapy was discontinued and the patient was given intravenous amphotericin B (1.0 mg/kg/day) and heparin associated with G.CSF. Improvement was only temporary and scan examination performed on day 17 showed involvement of the orbit, eye and wall of the maxillary sinus; cultures of secretions were positive for staphylococcus and Absidia corymbifera. Remission of leukemia was obtained a few days later permitting surgical resection of involved tissues on day 30. A relapse of mucormycosis was observed six weeks later despite prolonged administration of amphotericin B requiring extended resection of necrotic areas and replacement of amphotericin B by its liposomal form (Ambisome). Bone marrow relapse of leukemia required further chemotherapy. The patient is in good condition 30 months after the initial symptoms. CONCLUSION: Our patient seems to be the first with prolonged remission of facial mucormycosis and acute leukemia despite relapse of both diseases. This favorable outcome could be due to the use of Ambisome.

Amphotericin B↗
PubMed1995

[Ambulatory surgery in trauma surgery departments].

Establishing day care and short stay surgery in trauma departments requires a careful estimation of the perioperative risks. Having the therapy be successful for each patient admitted to day care surgery should have precedence over any economic limitations. In day care surgery a trauma surgeon has to make sure that appropriate postoperative supervision is available for each patient discharged from the hospital. The surgeon is responsible for qualified care on an outpatient basis.

Ambulatory Surgical Procedures↗
PubMed1994

Pancreatoblastoma in an adult: its separation from acinar cell carcinoma.

Pancreatoblastomas are rare tumours, which usually occur in childhood. Here we describe a pancreatoblastoma in a 39-year-old woman. The tumour was located in the tail of the pancreas and consisted of cells forming well-differentiated acinar structures and scattered solid components ("squamoid corpuscles"). Immunocytochemically, the acinar components were positive for pancreatic enzymes and pancreatic stone protein, while the cells of the "squamoid corpuscles" lacked these markers. There was no p53 overexpression nor any mutation at codon 12 of the Ki-ras oncogene. The main differential diagnosis of this tumour was acinar cell carcinoma, because both tumours have a number of features in common (scattered solid components, positivity for pancreatic enzymes, lack of p53 overexpression and of Ki-ras mutation). Findings which distinguished the pancreatoblastoma and separated it from acinar cell carcinoma were the negativity of the solid components ("squamoid corpuscles") for neuroendocrine markers and their very weak keratin positivity. As the patient is alive and well 30 months after tumour resection, this pancreatoblastoma also differs in biology from the usual acinar cell carcinoma.

Adult↗
PubMed1994

Peripheral blood immune responses to surgically induced lung tissue injury.

Surgically induced lung tissue trauma reveals an immune response in peripheral blood, the degree of which could depend on extent and severity of the organ trauma and the presence of lung malignancies. The study included 34 patients who underwent elective thoracic surgery because of benign and malignant lung tissue diseases. Flow-cytometric phenotyping of lymphocyte subsets shows a clear shift to reduced immunocompetent cells after lung tissue injury. Patients with lung tumors reveal a postoperative activation of the macrophage system as indicated by increased plasma levels of neopterin. Increased levels of soluble interleukin-2 receptor in the plasma of these patients may be the result of cellular shedding of the receptor. Lung tissue trauma is also followed by reduced immunoglobulin levels which are most pronounced in the presence of lung malignancies. These results suggest that lung tissue injury leads to postoperative immunosuppression especially in tumor patients.

Adult↗
PubMed1992

[Humerus reconstruction after gunshot fracture].

High-velocity bullits can cause severe blast injuries with shattering and defects of the large bones. Initial external fixation is followed by rebuilding of the bone, which is difficult due to concomitant infection, poor revascularization and lack of a suitable bone bed. A case report of an injured African soldier shows the follow-up and difficulties of reconstruction of the shattered humerus by repeated spongious bone grafting. After successful remodeling of the bone, external fixation is followed by ASIF dynamic compression-plate osteosynthesis.

External Fixators↗
PubMedDate not supplied

[Epidemiology of accidental falls in the elderly].

INTRODUCTION: There is a lack of epidemiological data on falls and fall-related injuries for the aged population in Germany. The purpose of the article is to present the available data focusing on the incidence of the fracture types that carry the highest risk for mortality, hospitalization and persisting disabilities. METHODS: The paper reports on a 10% representative sample that was drawn by the Federal Bureau of Statistics. A medline search for 1980-1998 was performed to identify relevant articles. The OECD database was used for mortality rates after injurious falls. If no sufficient data were published for Germany, incidence rates of demographic comparable European regions are reported. RESULTS: The number of fractures of the lower extremity (ICD 820-829) followed by hospitalization was 139,000 in 1996 for elderly (65+ years). Fractures of the upper extremities (ICD 810-819) requiring hospitalisation were reported for 65,000 persons aged 65+ years and head trauma (ICD 850-851) followed by hospitalization in this age group for 29,000 persons. There remains an information gap on the incidence of falls and fall-related sequelae without hospitalization in Germany. CONSEQUENCES: Facing, the demographic transgression the prevention of falls and fall-related injuries gains a high priority. Operative management and rehabilitation procedures for elderly trauma patients should be further evaluated and improved.

Accidental Falls↗
PubMedDate not supplied

[Therapy of para-articular hip fractures in the elderly].

UNLABELLED: Fractures of the hip in old patients are life-threatening events. A steady increase of that fracture type is likely in the near future. Surgical therapies and strategies have to consider the special requirements and problems of geriatric patients to achieve better results. They have to be designed together with new concepts of geriatric rehabilitation programmes. MATERIAL AND METHODS: In 1992 148 patients with hip fractures were treated at the department of traumatology, University Ulm. Follow-up parameters were daily activities in life pre- and postoperatively as well as mortality, type of fracture and surgical treatment. RESULTS: There were 79 femur fractures of the collum and 69 fractures of the trochanteric region. Mean age was at 81.2 and 81.9 years respectively (68 f/11 m versus 52 f/13 m). At the time point of accident 84 patients lived at home whereas the remaining stayed at a nursing home. The highest mortality was found in patients living in a nursing home (93%). The overall mortality one year following the trauma was 26%. 50% of the patients had hip prosthetic replacement, the remaining received a gliding screw, 9 patients a proximal femoral nail or lag screws (n = 6). CONCLUSION: Our results demonstrate that hip fractures in geriatric patients have a high mortality, especially in those living in a nursing home. The surgical concepts should aim to reduce that number and to allow the same daily activity of life as preoperatively. The main part in these concepts is an early start of geriatric rehabilitation. There are at least two groups. On the one hand, the active old patient who acquires his fracture during an activity. In this cases the aim must be the full rehabilitation and afterwards returning to normal environment. On the other hand there are the patients living in a nursing home who have the highest risk of injury related death. In these patients the first aim must be prevention of the accident.

Aged↗