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Biomedical subjects

G Germann

Publications and source records attributed to G Germann.

At least 127 records · Page 7Linked to original sources
PubMed1997

[Growth hormone in surgery--an assessment of current knowledge].

The first clinical studies with the application of growth hormone (GH) under postoperative and post-traumatic conditions date back to the early 1960s. The introduction of recombinant human growth hormone made the drug generally available for clinical studies. Administration of GH after elective general surgery improves nitrogen balance. Interruption of the post-traumatic hypermetabolism has been occasionally described, but most studies only demonstrate a slight reduction of the catabolic response. An increasing number of papers report positive influence of GH on wound healing, especially skin graft donor sites. The impact on the immune system has yet to be clarified. This paper gives an comprehensive overview of the current state of knowledge of the clinical effect of GH in various surgical specialties with special respect to septic conditions, burns, trauma, and wound healing.

Animals↗
PubMed1997

[The distally pedicled suralis flap for the defect coverage of posttraumatic and chronic soft-tissue lesions in the "critical" lower leg].

Vascular diseases and/or sequelae of various systemic diseases are frequently associated with therapy-resistant soft tissue lesions in the lower extremity. Neurovascular pedicled island flaps without the need for the sacrifice of major vessels offer the possibility to save the lower limb from amputation. The long pedicle allows for a wide, tension-free arc of rotation. Major studies of clinical applications at the critical lower extremity have not been reported yet. 14 patients with chronic ulcerations in problematic areas (e.g. ankle, tibia) underwent definitive reconstruction using this flap. Complications were mostly observed at the donor site. In one patient major amputation was necessary due to the development of sepsis. In all other cases adequate coverage and limb salvage was achieved. Excellent padding, variable size and the modest nature of the flap enlarges the variety of plastic-reconstructive procedures in the lower extremity.

Adolescent↗
PubMed1997

The reverse pedicle heterodigital cross-finger island flap.

The use of the reverse pedicle island flap as a heterodigital cross-finger flap is reported in five patients in whom conventional cross-finger flaps or homodigital flaps could not be used. All flaps survived and patient satisfaction was high. However, the indication for the flap must be considered carefully as the dissection is technically demanding and there is some donor site morbidity.

Adult↗
PubMed1997

Adhesion receptors and cytokine profiles in controlled tourniquet ischaemia in the upper extremity.

Adhesion mechanisms mediated by cytokines have been recognized to play a crucial role in ischaemia-reperfusion mechanisms. Although this phenomenon has been well investigated in organ transplantation, little data is available from upper extremity surgery. Profiles of adhesion molecules (CD11/CD18), key cytokines (TNF-alpha and IL-1), CD4+ and CD8+ lymphocytes, and polymorphonuclear neutrophils were investigated following controlled tourniquet ischaemia of the upper extremity for elective hand surgery. Data suggest that relatively short periods of ischaemia activate a mediator cascade and cell-cell interactions that may be associated with adverse pathopyhsiological effects on peripheral tissues after prolonged ischaemia.

Antigens, CD↗
PubMed1997

Early intragastric feeding of seriously burned and long-term ventilated patients: a review of 55 patients.

Aims of this retrospective study were: (1) to evaluate the feasibility of a protocol for early intragastric feeding: (2) to examine whether the caloric needs can be provided via the intragastric route within 72 h postburn; (3) to determine the influence of a delayed onset of feeding on the success of the feeding protocol; (4) to evaluate whether delayed feeding has any impact on morbidity and mortality. Fifty-five long-term ventilated patients were enrolled in the study. Their mean age was 37.6 years and mean total body surface area burned 44.2 per cent. The mean duration of ventilation amounted to 24.8 days. Intragastric tube feeding was initiated as early as possible after admission. Forty-five patients (81.8 per cent) could be fed successfully and their caloric needs were met within 72 h. In these patients the mean interval between burn injury and the initiation of tube feeding was 11.5 h. The mean interval was 32.4 h in the 10 patients, demonstrating failure of early intragastric feeding. Only four of the 48 patients who had enteral feeding within 18 h postburn failed to meet the caloric needs. The patients fed successfully showed a significantly decreased mortality. Early intragastric feeding after serious burns can be initiated successfully. A time interval of more than 18 h is unfavourable and significantly decreases the success rate.

Adolescent↗
PubMed1997

The impact of risk factors and pre-existing conditions on the mortality of burn patients and the precision of predictive admission-scoring systems.

Clinical experience has shown that concomitant diseases and risk factors have a significant influence on the patient's outcome. Since none of the currently available score systems consider the impact of concomitant diseases or risk factors on burn trauma mortality, the present study was planned to further evaluate the role of these factors. Four hundred and ninety-eight patients could be included in this retrospective analysis of prospectively collected data. Parameters documented were: sex, age, weight, height, laboratory data, TBSA, inhalation trauma (IHT), full thickness (3 degrees) burn and pre-existing conditions. Single-variable analysis (SVA), logistic regression and CART analysis were performed. The data confirm the role of age and TBSA as the strongest prognostic variables. Chronic alcohol abuse and smoking, IHT and pre-existing cardiac and neurologic conditions were also found to be significant. Borderline groups could be identified in the ABSI score (7-10), where the risk factors cause 'mortality-shifting'. It can be concluded that risk factors and pre-existing conditions have a significant impact on the prognosis of burn mortality and should be incorporated into further refinements of burn admission scores.

Adolescent↗
PubMed1997

The value of early enteral nutrition in the prophylaxis of stress ulceration in the severely burned patient.

A retrospective analysis of prospectively collected data was performed to compare the frequency of upper gastrointestinal bleeding (GIB) in seriously burned patients treated with either cimetidine and antacids or enteral nutrition for ulcer prophylaxis. Five hundred and twenty-six seriously burned patients admitted to the burn intensive care unit of the BG Trauma Centre Ludwigshafen during a 4-year period were included into the study. All patients admitted to the burn unit from 1989 to 1991 received i.v. cimetidine (400 mg q4) for ulcer prophylaxis. If the intragastric pH dropped below 3.5, gastric pH was titrated with antacids up to > or = 4 via nasogastric tube. During the second 2-year period (1992-1993) early enteral nutrition alone was regarded to be ulcer protective and no further interventions for ulcer prophylaxis were routinely performed. Signs of overt upper GIB were monitored and documented through the entire study period. The overall occurrence rate of upper GIB in the cimetidine/antacids (C/A) group (n = 253) was 8.3 per cent with six cases of serious bleeding in five patients (1.98 per cent). In the enteral nutrition (EN) group (n = 273) the overall incidence of GIB was 3.3 per cent with two cases of serious bleeding (0.73 per cent). There were no deaths directly related to ulcer haemorrhage. The difference in the overall frequency of overt GIB between the groups studied was statistically significant (< 0.05). In our experience, early enteral nutrition is effective in the prevention of stress haemorrhage in the upper gastrointestinal tract. Additional medicinal prophylaxis is not required in burn patients.

Administration, Oral↗
PubMed1997

Salvage of an avascular thumb by arteriovenous flow reversal and a microvascular "kite" flap: case report.

This case report describes the salvage of an avascular thumb by retrograde venous arterialization. The thumb survived with a 30 percent tissue loss at the radial aspect. Soft-tissue reconstruction and contour correction were achieved with a new microvascular free flap--the free "kite" flap--from the contralateral index finger. Aesthetic and functional results were excellent, and the patient returned to his original occupation. It can be concluded that retrograde arterialization can provide successful salvage in replantation and revascularization under favorable circumstances.

Adult↗
PubMed1997

[Clinical examination of the injured wrist].

A highly differentiated clinical examination of the wrist joint has been established in the past years. The history of the accident is usually unreliable, but patient's statement of a hyperflexion injury should alert for a fracture of the scaphoid tubercle. First of all, X-rays of the wrist indicate therapy in the case of fractures and gross dislocations. Only after some days of reduction of pain and swelling, a thorough clinical examination will be possible, which consists of: localizing points of tenderness, in particular the scapho- lunate, lunato-triquetal and the scapho-trapezio-trapezoid (SL-, LT- and STT-) joints and the triangular fibrocartilage (TFC); testing for abnormal dorso-palmar shifts of the carpus and the ulnar head; provoking catch up clunks by radio-ulnar movements of the clenched fist; provoking subluxations, in particular of the scaphoid in Watson's test; provoking pain in the discuss grinding test. Comparing clinical diagnosis with arthroscopic findings in 37 patients, the results for ligamentous lesions in general, SL ligament lesions in particular and for TFC lesions were as follows: sensitivity 100%, 91% and 69%, resp.; specificity 77%, 77% and 67%, resp.; positive predictive values 75%, 62% and 61%, respectively. In conclusion, exact clinical examination is a reliable tool to determine further diagnostics and therapy of wrist injuries.

Arthroscopy↗
PubMed1996

Manifestation of multifocal heterotopic ossifications with unusual locations as a complication after severe burn injury.

Heterotopic bone formation is a well-known but rare complication after burns and other traumatic injuries. Pathology, aetiology, progression and management remain controversial. Joint immobilization in concert with an altered metabolism and aggressive physical therapy are suspected to be the cause of heterotopic bone formation. The most frequent sites of manifestation are major joints and large muscle groups. The formation of disseminated large ossifications in soft-tissue and juxta-articular bone bridges of small joints is barely mentioned in the literature. A case of most unusual, massive heterotopic bone formation as a complication after severe burn is presented. In this patient serious complications after the severe burn injury primarily attracted clinical attention, so that diagnostic measures were delayed. Four months later after successful weaning from ventilation, the patient could describe his sites of pain. The therapeutic options were limited because of extensive and unusual localizations. This case emphasizes the necessity of an early and specific radiological diagnosis in long-term ventilated patients to avoid this serious complication.

Burns↗
PubMed1996

The clinical reliability of vein grafts in free-flap transfer.

The use of interposition vein grafts has been associated in the literature with a high complication and flap failure rate. Ninety-three vein grafts in 55 patients over a 46-month period were analyzed to evaluate the clinical reliability of vein grafts in a predominantly trauma patient population (37/55). Fifty-two arterioarterial grafts and 41 veno-venous grafts were performed. A-V loops prior to flap transfer were created in 26 patients. The revision rate was 14.8 percent, with a salvage rate of 75 percent. Flap survival was 96.2 percent, compared to 96.7 percent for a large series of flaps without vein grafts. It can be concluded from the study, that the use of vein grafts is not associated with a higher flap failure rate, when technical pitfalls can be avoided, and close monitoring by an experienced staff is guaranteed.

Adult↗
PubMed1996

Hematogenous osteomyelitis of the hand skeleton in adults after dental maxillary infections.

Hematogenous ostemyelitis is infrequently seen in adults and primary involvement of the hand skeleton is extremely rare. Little has been reported about the foci of hematogenously spread infections. Two cases of hematogenous osteomyelitis of the hand originating from dental maxillary infections were reported. The first patient suffered an acute hematogenous osteomyelitis of the wrist join, spreading from dental granulomas and massive periodontitis. Despite early radical debridement, attempts to salvage the wrist joint and the extensor tendons failed, so that a wrist fusion had to be performed. The functional outcome was poor. The second patient demonstrated a chronic hematogenous osteomyelitis of the fourth and fifth metacarpals originating from chronic maxillary sinusitis. Radical debridement and use of "spare parts" of the fifth metacarpal prevented an amputation of the fourth ray. The functional outcome was excellent. These cases emphasize the importance of including an examination of the dental maxillary area when searching for a primary focus of hematogenous osteomyelitis.

Adult↗
PubMed1996

Breast reconstruction with the extended latissimus dorsi flap.

Autologous breast reconstruction started with the use of a myocutaneous latissimus dorsi flap. The need for an additional silicone implant to obtain sufficient breast volume intensified the search for new flaps, resulting in the microvascular TRAM flap, which is currently considered the "gold standard" in autologous breast reconstruction. For patients who are not suited for this procedure or reject this treatment option, a modified extended latissimus dorsi flap was designed and used in 47 patients. Additional volume is obtained by including the scapular fat fascia, based on perforators from the cranial edge of the latissimus dorsi muscle. Flap survival was 100 percent in the series, and sufficient volume could be achieved in 42 patients. Main complications were seromas at the donor site (n = 9). The results demonstrate that in selected patients the extended latissimus dorsi flap provides an excellent alternative to a TRAM flap in reconstruction of small and moderate-sized breasts.

Adult↗
PubMed1996

[Washington regime after-care of flexor tendon injuries in zone 2].

The Washington-regimen for the rehabilitation of flexor tendon injuries (Chow et al., 1987) represents a combination of the established Kleinert-method and the controlled passive motion of Duran and Houser. This paper presents the results of a study which was carried out in 99 patients with 113 injured fingers treated in the Department of Burns, Plastic and Hand Surgery of the Accident Hospital Ludwigshafen. 55 patients with injuries of the fingers and 29 patients with injuries of the thumb were evaluated according to functional and subjective criteria and compared to a group of 15 patients treated by the Kleinert-method. The results showed that the Washington-regimen yielded an improvement of up to 27% of very good and good results in injured fingers compared to the Kleinert-method. The improvement of results in thumb injuries was 8%. The subjective estimation of the results by the patients corresponded generally with the functional outcome. In cases with additional laceration of digital nerves, the subjective evaluation of two thirds of the patients was significantly worse than the objective functional results.

Adolescent↗