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Biomedical subjects

F Neudeck

Publications and source records attributed to F Neudeck.

26 records · Page 2Linked to original sources
PubMed1996

[Emergency care and treatment costs of polytrauma patients].

Treatment costs of emergency therapy, surgery and intensive care were analysed in 20 randomly chosen, representative patients with severe multiple trauma (mean ISS 32 p). For an average stay of about 22.5 days on ICU, the total costs were DM 106924.36 (about 70,000 US $). DM 39,635.88 (= 37%) were the costs for physicians and nurses; DM 67,289.08 (= 63%) were needed for materials, X-rays, laboratory investigations, drugs and blood components. The whole treatment caused daily costs of DM 4752.22 or DM 3.30/min. The first emergency diagnostic procedures and emergency therapy take a mean time of 451.9 min from admission to the beginning of the ICU treatment and by itself already generates costs of about DM 12325.99. In Germany, a new way of compensation by a diagnosis-related group was introduced in 1996. These data suggest that treatment of severe multiple trauma is very expensive and trauma care could be economically harmful for smaller hospitals. We conclude that treatment of multiply injured patients (ISS > 16 p) should be compensated for by a special daily amount of about DM 5000 (about 3500 US $) for selected trauma centres.

Adolescent↗
PubMed1995

[Intermittent dorso-ventral positioning in therapy of severe post-traumatic lung failure].

The influence of intermittent prone positioning on pulmonary gas exchange and parenchymal densities was investigated in ten patients. Three patients fulfilled the criteria of "severe ARDS"; seven patients had moderate lung injury as documented by the "lung injury score" (LIS). Nine out of ten were trauma patients and had an average injury severity score of 32.3. The oxygenation index (paO2/FiO2) improved in all patients after prone positioning, showing an increase of 81 +/- 47 (20-197) mmHg (MV +/- SD). Total static lung compliance showed an increase of 7.6 (0-16) ml/mbar. Patients with ARDS benefitted especially from intermittent prone positioning, resulting in a substantial improvement of the LIS of 0.91 (0.75-1.0) points. In moderate lung injury the LIS improved 0.5 (0.25-1.0) points. In lung computerized tomography, we observed the disappearance of posterobasal densities. Repeated prone positioning may therefore be used in ARDS patients as well as in patients with moderate lung injury.

Adolescent↗
PubMed1995

[Continuous skin expansion for covering soft tissue defects of the foot sole].

Reconstruction of the weight-bearing area of the sole of the foot is a major surgical problem, regardless of the aetiology of the soft-tissue defects. Numerous reconstruction methods have been described for coverage of plantar defects of the heel with local and free flaps. Skin expansion and skin traction have been described by several authors. According to the Ilizarov technique, a new method has been devised for the closure of posttraumatic soft-tissue defects in the weight-bearing area of the sole by skin stretching with Kirschner wires without the aid of either local or free flaps. The operative procedure is very simple: the sharp ends of Kirschner wires are bent with pliers into hook-shaped semicircles. These ends are then inserted into the skin of the sole at intervals of 3-4 mm, alternately close to and distant from the wound edge. The opposite ends of the K-wires are sandwiched between two small AO plates. These plates are pressed together with screws and nuts; additionally, the ends of the K-wires are bent around the plates to prevent loosening. A frame is set up around the heel and connected to the tibial external fixator. The two plates with the K-wires clamped between are mounted on the threaded rods of an Ilizarov external fixation system. Then the foot is temporarily fixed to the tibia in neutral position by a Schanz screw inserted into the first metatarsal. The soft-tissue defect is treated with moist compresses changed daily.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Pathophysiologic consequences of various osteosynthesis procedures in polytrauma patients. Part I: Experimental studies of intramedullary pressure development in reamed and unreamed intramedullary nailing and plate osteosynthesis of the femur].

The aim of this study was to measure the intramedullary pressure (IP) of a) a reamed intramedullary nail (RN), b) an unreamed intramedullary nail (UN), and c) the AO-plate (PL) for stabilization of an experimental fracture of a sheep femur. The increase in IP whilst reaming or introducing intramedullary nails in long bone fractures is often said to be responsible for fat intravasation and secondary systemic and pulmonary damage after severe blunt trauma. 21 sheep were studied, 7 in each group (RN, UN, PL). The animal study was permitted by the local authorities. Under general anesthesia, the femoral fractures were produced by an oscillating saw, osteosynthesis was then performed whilst continuously measuring IP with a supracondylar IP-transducer-device. The results show similar intramedullary pressures measured during RN and during UN (maximal IP: UN: 203 mmHg, range 76-330; RN: 212 mmHg, range 70-425). The alternative extramedullary PL is not accompanied with any relevant increase of IP (maximal IP: 35 mmHg, range 16-70). In conclusion, RN and UN are not safe procedures concerning the danger of fat-intravasation by IP.

Animals↗
PubMed1985

[Bronchoalveolar lavage as a diagnostic method in intensive therapy].

Bronchoalveolar lavage is presented as a standardised diagnostic method in the clarification of interstitial pulmonary changes in the acute respiratory distress syndrome (ARDS). Its justification is based on the fact that changes in lung biopsies are reflected by early changes in the composition of the rinse and in the ability of the cellular components to function properly, independent of the origin of the immunological processes in ARDS. Pulmonary function is not adversely affected by the procedure provided it is carried out "lege artis". We hope that it will be possible in future to achieve early detection of a developing progressive failure of pulmonary function, by employing early markers. The procedure also allows continual follow-up of the success of an initiated therapy.

Bronchoscopy↗
PubMed1982

[Interatrial communication through the coronary sinus].

An unusual case of an interatrial communication through a defect of the coronary sinus together with coarctation of the aorta is reported. In spite of two cardiac catheterization studies, this diagnosis was missed by two different cardiology departments, and anomalous pulmonary vein connection was suspected instead. This illustrates the preoperative diagnostic difficulties which continue during surgery, when exploration of the right atrium fails to detect the suspected atrial defect. This rare anomaly should be considered in the differential diagnosis of an atrial left-to-right shunt, when the largest "oxygen step-up" is at the level of the lower right atrium, and no evidence of an atrial septal defect or transposition of the pulmonary veins can be found.

Aortic Coarctation↗