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Biomedical subjects

G Matthes

Publications and source records attributed to G Matthes.

At least 19 recordsLinked to original sources
PubMed2006

Does the frontal airbag avoid thoracic injury?

INTRODUCTION: The airbag is an established car safety device. However, recent studies pointed out that even the airbag might cause injuries. Nevertheless, most physicians do consider a lower risk in accident victims sustaining severe injury of the chest, when a deployed frontal airbag has been reported. We set out to verify the frequency and pattern of thoracic injury in car drivers protected by a frontal airbag during traffic accidents. METHODS: This investigation was conducted as part of a prospective surveillance analyzing traffic accidents. Enrolled were car drivers included in a databank between January 2001 and December 2004 consecutively. The chance for sustaining chest injury with or without a frontal airbag was described using the relative risk. RESULTS: A total of 188 car drivers were included in the analysis. In 54 (28.7%) cases a deployed airbag and in 134 (71.3%) the absence of an airbag has been documented. Out of those cases 16 (29.6%) drivers with airbag and 30 (22.4%) without airbag sustained a chest injury. The mean abbreviated injury scale (AIS) of chest injuries in drivers with deployed airbag was 2.3 (1-5; SD +/- 1.45; mean injury severity scale [ISS] 21.1 [SD +/- 17.18]), in drivers without airbag 1.6 (1-4; SD +/- 1.12; mean ISS 15.8 [SD +/- 20.6]). For belted drivers with an airbag the relative risk to sustain chest injury was 1.96 compared to those without an airbag. CONCLUSIONS: The airbag does not avoid chest injury definitively. Much more, it has been demonstrated that the relative risk to sustain relevant thoracic injury seems to be almost higher in restrained drivers with a frontal airbag.

Accidents, Traffic↗
PubMed2006

[Surgical management of abdominal injury].

PURPOSE: Accompanying abdominal injuries are frequent in multiply injured patients and are a common cause of death. A search of the literature was performed focusing on key aspects of initial surgical procedures in abdominal injury. METHODS: Literature was searched utilizing PubMed Medline, the Cochrane Central Register of Controlled Clinical Trials, and the German Institute for Medical Documentation and Information (DIMDI) database. The articles were classified according to the level of evidence following the suggestions of the Centre for Evidence Based Medicine. RESULTS: Vertical laparotomy should be favored for the initial surgical therapy of abdominal injury. Especially in instable patients, principles of "damage control surgery" should be applied. In case of hollow organ injury, a primary anastomosis should be made whenever possible. A hand suture is most suitable for this. DISCUSSION: Non-surgical treatment of blunt abdominal injury is gaining in importance. However, if a surgical intervention is recommended, especially in hemodynamic, instable patients, damage control principles should be favored.

Abdominal Injuries↗
PubMed2006

[Results after treatment of instable fractures of the proximal humerus using a fixed-angle plate].

BACKGROUND: Fixed-angle implants are being increasingly used in surgery of fractures of the proximal humerus. The aim of this retrospective investigation was to evaluate the outcome after fracture reduction utilizing a fixed-angle plate (Königsee). MATERIALS AND METHODS: Between January 2003 and April 2004, 58 patients were operated, 52 of whom received a fixed-angle implant; 46 cases were harvested for a follow-up examination. Each patient was re examined clinically and radiologically at least 6 and 18 months after surgery. The functional outcome was evaluated using the Constant Score and the Simple Shoulder Test. The results were compared to results of other investigations. RESULTS: The mean patient age was 68.8 years (34-94 years). Fractures were classified using the Neer Classification: 12 were classified as two-part, 25 as three-part, and 9 as four-part fractures. Three of the three-part and four of the four-part fractures were rated as luxation fractures. The overall functional outcome of all cases was good. More than 18 months after surgery the mean general "Constant Score" was 57; the mean side-related "Constant Score" was 89%. The Simple Shoulder Test revealed a pain-free range of motion in 41 (89.1%) of the individuals. The majority of the patients were satisfied with the results regarding remaining range of activity of the injured limb. In five cases significant complications occurred. In two cases the head of the humerus collapsed, and in one case a necrosis of the head occurred. In one individual the implant broke after an additional trauma. In this case a re-osteosynthesis utilizing a tibia plate was performed and the patient was excluded from further follow-up investigations. One soft tissue infection occurred after initial surgery. CONCLUSION: It has been shown that results after fixation of proximal humerus fractures with fixed-angle implants are good. The functional outcome is good and complications are rare. Our results correlate with other investigations regarding fracture reduction using fixed-angle plates and nails.

Adult↗
PubMed2006

Correlation of cognitive status, MRI- and SPECT-imaging in CADASIL patients.

Although there is evidence for correlations between disability and magnetic resonance imaging (MRI) total lesion volume in autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), the significance of structural MRI abnormalities for cognitive dysfunction remains controversial. We performed detailed neuropsychological testing, high resolution MRI, and Tc-99m-ethyl cysteinate-dimer SPECT in three CADASIL patients. MR-images were rated independently by two investigators for the presence of white matter lesions, lacunar infarcts, microbleeds, and ventricular enlargement. Cortical atrophy was quantified by the use of automatic morphometric assessment of the cortical thickness. In addition, laboratory and patients' history data were collected in order to assess the individual vascular risk factor profile. The differences in cognitive performance between the three patients are neither explained by structural-, or functional neuroimaging, nor by the patient-specific vascular risk factor profiles. The neuroradiologically least affected patient met criteria for dementia, whereas the most severely affected patient was in the best clinical and cognitive state. Conventional structural and functional neuroimaging is important for the diagnosis of CADASIL, but it is no sufficient surrogate marker for the associated cognitive decline. Detailed neuropsychological assessment seems to be more useful, particularly with respect to the implementation of reliable outcome parameters in possible therapeutic trials.

Adult↗
PubMed2005

[Solitary osteochondroma of the scapula. A rare differential diagnosis with unspecific shoulder pain].

Solitary osteochondroma of the scapula is rare. Because of the atypical location with unspecific shoulder pain, the diagnosis is often made late. We present a 35 year old patient with a solitary ostochondroma of the scapula with unspecific pain of the shoulder-neck region over about 4 years. In a thorax x-ray 2 years ago, a tumor like lesion was found. CT and MRI scan led to suspicion of a solitary osteochondroma of the scapula. Because of progressive thoracic pressure pain, a wide excision was made. The problems of diagnosis and therapy are presented and the literature is discussed.

Adult↗
PubMed2005

[Age and survival likelihood of polytrauma patients. "Local tailoring" of the DGU prognosis model].

INTRODUCTION: Age is one of five prognostic parameters identified based on data of the trauma registry of the German Association for Trauma Surgery (DGU). We asked ourselves if the suggested prognostic model provides the same predictive power of data from an independent hospital. Furthermore, we investigated whether age itself or age-associated comorbidity causes an unfavorable prognostic effect. METHODS: The investigation was based on data of 103 multiply injured patients (67 male, 36 female, mean age 35,4+/-SD 19,0 years, ISS 36,8+/-10,9). Data were collected prospectively following the guidelines of the trauma registry of the German Association for Trauma Surgery. Based on documented comorbidities, a risk calculation was performed using the ASA classification. Correlation between age and ASA was analyzed using Spearman's method. The prognostic value of the original model in our patient pool with or without ASA classification, possible interactions, and the discriminatory power of the model were estimated using logistic regression. RESULTS: Attributable mortality was 31,7% (95% CI 22,7-41,7%). Age, ISS, GCS and ASA were included into the final logistic model. Odds ratios of the origin model were reproducible nearly identical in our patinet pool (OR: age 1,048; ISS 1,066; GCS 0,822). In spite of the fact that we have found a strong correlation between age and ASA-Classification (rho=0,60, p<0,0001) there was no prognostic value of comorbidity. CONCLUSION: The suggested prognostic model based on multicenter data evaluation can be applied to a single center with only minimal loss of discriminatory power. In this context, age seems to have a prognostic value independent of comorbidity.

Adult↗
PubMed2005

[Modelling critical information measurement traumatic surgery decisions. "Sequential Information Appraisal Module (SIAM)"].

We studied the quality and quantity of information leading to the emergency physician's decision to intubate severely injured patients on scene. Our aim was to assess intuitive aspects of clinical decision making. The experiment involved three different phases, with a fourth phase examining retest reliability. We used trauma register data from 98 patients. Based on various parameters (physiological data, injury assessment on scene, definite injury pattern), three emergency surgeons were requested to decide on the need for endotracheal intubation.We applied multivariate logistic regression to estimate the likelihood of intubation given certain clinical characteristics or combinations of characteristics. We compared the participants' decisions to those made by "true" emergency physicians on scene. Kappa statistics marked inter-observer agreement beyond chance. The Glasgow Coma Scale (GCS) was the only single predictor of intubation in the ideal test setting (area under the receiver operating characteristics curve [AUC] >98%) as well as on scene (AUC 0.85, 95% confidence interval 0.78-0.92). There was no difference between the discriminatory features of the single item GCS and complex multivariate models that included anatomically defined injury scales (best model in phase 2: AUC 0.96, best model in phase 3: AUC 0.98). Overall inter-observer agreement was substantial in phase 1 (kappa=0.74), fair to moderate in phase 2 (kappa=0.49) and slight to fair in phase 3 (kappa=0.23). Retest reliability ranged from 51% to 91%. Doctors give priority to only a small part of the information available in deciding for or against a particular intervention.

Decision Support Systems, Clinical↗
PubMed2002

Albumin transport analysis of different collected and processed plasma products by electron spin resonance spectroscopy.

BACKGROUND: Changes of albumin conformation flexibility and binding characteristics in plasma products can be determined by electron spin resonance spectroscopy (ESR) with spin probes as reporter molecules. METHODS: Quality of albumin transport was analyzed in different processed plasma units using a new ESR method which provides estimation of albumin properties by examination of albumin molecular structure changes. RESULTS: In serum of healthy donors could not be obtained any abnormalities. Transport function of albumin in plasma products can be influenced by various methods of plasma collection, preparation, and filtration. Evident are changes in capacity of fatty acid binding sites and ordering changes of bound substrates. Transport respiratory detoxification efficiency is decreased between 30% and 70% in all FFP compared to control values. CONCLUSIONS: ESR spectroscopy can be used as a quality test for plasma. The ESR technique has a big potential for determination of conformation changes of macromolecules and as a global tumor marker test for donor screening.

Biological Transport↗
PubMed2001

[Early death of the severly injured patient--A retrospective analysis].

With 44.9 % trauma is the main cause of death in men under 40 years. From September 3(rd) 1997 to June 30(th) 1998 174 patients with severe injuries or polytrauma were treated in our hospital. The mean ISS was 29 (18-75). 15 (8.75 %) patients died within the first 24 hours. The mean age was 34.5 (2-85) years. The mean ISS of these patients was 48 (25-75). In a retrospective study we analyzed the pattern of injury as well as the preclinical and clinical management. The fact that orthopedic surgery still has got a poor position within the patient's satisfaction-scale and that 15 of 174 analyzed patients had to die within the first 24 hours points out the importance of internal and external quality improvement measurements.

Adolescent↗
PubMed2000

[Benign tenosynovial giant cell tumor in the region of the upper ankle joint. A rare differential diagnosis of a soft tissue tumor of the foot].

The giant cell synovioma is a benign neoplasia classically located in the fingers. It mostly rises from tendon sheaths, sometimes from the synovia. Other locations than the fingers are rare. Making a differential diagnosis to lipomas, gangliomas or even malignant soft tissue tumors can be very difficult especially in rare locations. We report the case of a 21 years old man suffering from a giant cell synovioma in the area of the right ankle joint. The clinical, radiological and patho-morphological findings are documented. The tumor was excised totally, other foci were not found. The problems of making the right diagnosis are described.

Adult↗
PubMed1998

Intracapillary haemoglobin oxygenation and interstitial pO2 in venous flaps: an experimental study in rats.

In order to be able to objectively evaluate capillary perfusion of venous flaps, we created arterialised venous flaps, venous flow-through flaps, and unilateral pedicled venous island flaps in the epigastric vascular system of Wistar rats and determined their oxygen supply with two different methods. Interstitial pO2 was polarographically measured with a probe placed intracutaneously in the center of the 4 x 2.5 cm flaps and continuously recorded on a connected computer. Moreover, we also noninvasively determined the oxygenation of the intracapillary haemoglobin with a micro-lightguide spectrophotometer. The statistical evaluation showed comparable results for both measurement methods: Arterialised venous flaps had a better oxygen supply with a pO2 of 16 mmHg and an Hb oxygenation of 23% than the other types of venous flaps, but they have a poorer oxygen supply than conventionally perfused flaps (pO2: 24 mmHg, Hb oxygenation: 30%). Venous flow-through flaps (pO2: 9 mmHg, Hb oxygenation: 17%) and unilateral pedicled venous island flaps had a significant better oxygen supply than skin flaps without any vascular connection. The results show that the capillary system in all types of venous flaps is reached by some of the inflowing oxygenated haemoglobin over the entire flap surface to different degrees.

Animals↗
PubMed1996

[Mechanisms of metabolic changes after in-line filtration of erythrocytes].

BACKGROUND: The reasons for the improved RBC storage after in-line filtration are not fully understood. MATERIAL AND METHODS: Red blood cell concentrates were in-line filtered and stored for 6 weeks at 4 degrees C in SAGM. Parameter 2,3-DPG, p50, density, cell electrophoresis, pH were measured. RESULTS/CONCLUSION: The obtained results may explain the metabolic findings: Cell retention (during filtration older, rigide RBC are retained in the filter- a relative increase of younger RBC); changes in RBC membrane permeability (a changed electrophoretic mobility is attributed to bound RBC membrane proteins to the filter material); blood cell depletion (a high depletion efficiency prevents toxic influences of degenerating/disintegrating WBC and PLT); release of substances from filter and blood bag material (during passage of anticoagulated blood some compounds may be released in ppm concentrations - the density of in-line filtered RBC is higher than unfiltered RBC after filtration procedure and hypothermic storage).

2,3-Diphosphoglycerate↗
PubMed1994

Improved red cell quality after erythroplasmapheresis with MCS-3P.

The cell separator MCS-3P is an apheresis system offering the flexibility to collect standardized red blood cells, plasma, and/or platelets from one donor. Two different programs were used for the red cell apheresis--RBCP (collection of one unit of red cells and two units of plasma) and RBCPS (one unit of red cells and one unit of plasma). The quality of the red cell concentrates (RCC resuspended in SAG-Mannitol) during the storage time of 42 days was measured by biochemical (ATP, 2,3-DPG, pH, free Hb, free potassium, glucose, lactose, p50, hemoglobin derivatives) and rheological (morphological index, filtration/rigidity index) parameters. The donation time with 53 donors was 20 min for 355 ml RCC-SAGM and 440 ml plasma and 7 min for 335 ml RCC-SAGM and 239 ml plasma. The donor tolerance was analogous to plateletpheresis or plasmapheresis. Twenty units of the RCC-SAGM were in-line filtered within 6 or 24 hours after donation. The results obtained for red blood cell storage are at least as good as with standard collection (free hemoglobin, free potassium, glucose, lactose, hemolysis) or better (ATP, 2,3-DPG, p50, hemoglobin derivatives, filtration/rigidity index) owing to prevention of collection lesion. All blood preparations were sterile after storage (red cells 42 days, plasma after freezing). The erythroplasmapheresis with MCS-3P can be especially recommended for application in an autologous blood program because the application of autologous blood donation in hospitals is often limited by the preconditions of component separation. The erythroplasmapheresis data with MCS-3P are encouraging for the development of a new blood collection methodology.

Blood Component Removal↗
PubMed1994

[In-line-filtration of erythrocyte concentrates using the Sepacell Integra System].

Using the Sepacell Integra System for in-line filtration of red cell concentrates in additive solution the leukocyte depletion was efficient enough to keep leukocyte contamination below the critical immunogenic load for leukocytes (CILL). The data indicate improved storage conditions, made evident by significantly lower cell damage.

Cytapheresis↗
PubMed1994

[4-Log leukocyte depletion of erythrocyte concentrates--a comparison with 3 other filters].

Whole blood (WB) and SAGM-resuspended red cell concentrates (RCC) were leucocyte-depleted 1 h after donation by filtration using BF 4 (PALL), Sepacell RS 200 (Asahi Med.) and Bio R01 Plus (Biotrans). We compared the handling of the filter system, focusing routine blood bank practice, filtration efficiency [residual white cell count; flow cytometry (Ortho Cytoron) and Nageotte chamber] and the loss of red cells. Spontaneous filling was found to be an advantage of the Bio R01 Plus system, whereas the BPF 4 and the RS 200 have to be filled by pressure. The filtrations were of similar duration, even those of WB and resuspended RCC. Red cell loss was found to be 10-15% on RCC higher than on WB (7-10%) and varied between the filters used: BPF 4 < Bio R01 Plus < RS 200. The residual white cell count on WB was 1.2-5.8 x 10(6) (RS 200 < Bio R01 Plus < BPF 4) and on RCC was 0.5-3.0 x 10(5) (RS 200 < BPF 4 < Bio R01 Plus). The filters used are highly effective (4-log depletion on RCC) even on fresh WB and are therefore potential in-line filters.

Blood Donors↗
PubMed1994

[In-line-filtration of erythrocyte concentrates using the Leukotrap-RC system].

'In-line filtration' was performed on whole blood (WB) of 12 healthy donors. The WB was drawn into the triple-bag Leukotrap-RC system. Six red cell concentrates (RCC) were filtrated 1 h after donation either with or without buffy-coat and stored 35 days in AS-3. We measured the loss of red cells, the residual white cell count (Nageotte chamber), platelet count in fresh frozen plasma (FFP); 2,3-DPG, K+, Hbe, pH, O2Hb and pO50. The system was easy to handle but needed circular centrifugation holders because the filter is placed and fixed just at the top of the bags during centrifugation. RCC without buffy coat led to a faster filtration (15 vs, 38 min) and to an improved FFP quality (platelet count 23 vs, 54 Gpt/l). The leucocyte removal rate of the integrated PALL-RC-350 was similar, residual white cell count less than 3 x 10(6), in both preparations. All storage parameters were found within the normal range except a significant increase of O2Hb in filtrated red cells compared with the unfiltered control.

Blood Donors↗