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Biomedical subjects

G Regel

Publications and source records attributed to G Regel.

At least 37 records · Page 2Linked to original sources
PubMed1998

Internal fixation of multiple fractures in patients with polytrauma.

Within the last decade understanding of the pathogenetic consequences of trauma has been improved significantly. An additional reduction of lethality has been achieved that in part is related to increasing discrimination of complex injury patterns. Accordingly, additional staging in fracture management of these injuries has been developed. An overview of the current status of fracture management in polytrauma is given and certain regimens that are still controversially are discussed. The principles determined are based on the treatment experience of 4003 multiply injured patients within the past 23 years. The most important principles within the first hours after trauma represent adequate hemorrhage control. In fracture treatment the primary goal remains to perform primary stable osteosynthesis. In severe polytrauma with severe injuries to the extremities, the first decision is whether limb salvage can be achieved without risk of deterioration of the patient's condition. If this is the case, open fractures Grades III b and c usually can be stabilized primarily by unreamed intramedullary nailing or percutaneous plating. The priority pattern in multiple closed fractures is as follows: (1) tibia; (2) femur; (3) pelvis; (4) spine; and (5) upper extremity. Exceptions may ensue if severe head or thoracic trauma is present. Delayed treatment is performed for complex joint reconstruction, definitive treatment of maxillofacial injuries, and soft tissue reconstruction.

Algorithms↗
PubMed1998

[The intestine as the central organ in the development of multiple organ failure after severe trauma--pathophysiology and therapeutic approaches].

Multiple organ failure is with an incidence of 10-25% and a mortality of 50-70% the most severe complication after severe trauma. Intestinal ischemia and a corresponding impaired gut barrier function is thought to have a high impact on the development of multiple organ failure after severe trauma. Under normal conditions the intestinal wall is a sufficient barrier against bacteria and their products. Gut ischemia is followed by mucosal lesions, the intestinal permeability is increased. Translocating bacteria and bacterial products (endotoxin, peptidoglykan) can lead to a local and/or systemic immun-inflammatory response, which is made responsible for the development of multiple organ failure. Tonometry as a possibility of monitoring intestinal ischemia as well as a tool to estimate the prognosis of multiple trauma patients is still discussed controversially. Dopexamin, which directly influences intestinal ischemia (goal directed therapy) might be a successful treatment option, however until now no clinical study about beneficial effects of dopexamine in severely injured patients is available. Selective gut decontamination showed no clinical benefits in multiple trauma patients. Early enteral nutrition especially with immunomodulating ingredients ("immunonutrition") decreases posttraumatic complications as well as the incidence of MOF. However a reduction of mortality could not be described in severely injured patients so far.

Bacterial Translocation↗
PubMed1998

[Intramuscular pO2 monitoring in compartment syndrome--an experimental study].

HYPOTHESIS: Measuring intracompartmental pressure is a well accepted method in evaluating a compartment syndrome, which may occur after limb ischemia followed by reperfusion. As a compartment syndrome is paralleled by a decreased microcirculation it should be possible to evaluate a compartment syndrome also by measuring intramuscular pO2. METHODS: Anesthetized rats (spontaneous breathing via tracheotomy) were subjected to infrarenal ligation of the aorta. A pressure catheter was placed subfascial in the crural muscle group of one hind limb, whereas the contralateral side was prepared with a pO2 catheter. Besides a sham operated group, three experimental groups were subjected to either 2 hrs, 4 hrs or 6 hrs of ischemia followed by 4 hrs of reperfusion. One further group was also subjected to 4 hrs of ischemia and 4 hrs of reperfusion but received a fasciotomy at the time of reperfusion. Compartment pressure and intramuscular pO2 were recorded every 15 min. For histological examination muscle specimen were obtained after each experiment. RESULTS: Two hours of ischemia followed by 4 hrs of reperfusion did not result in any morphological changes and also not in any significant change in compartment pressure during both phases, whereas pO2 significantly dropped during ischemia (from 19.0 mmHg to 3.0-5.0 mmHg) and returned to normal during reperfusion. In prolonged ischemia (4hrs) morphologically a severe interstitial edema was evident, compartment pressure increased during reperfusion (from 2.0 mmHg to 8.8 mmHg) and pO2 dropped during ischemia down to 3.0 mmHg and did not return to normal during reperfusion (10.5 mmHg versus 19.0 mmHg normal). In case of 6 hrs ischemia, partial necrosis and only little interstitial edema were found morphologically. There was no significant change in compartment pressure throughout the study; and pO2 remained significantly decreased even during reperfusion (2.0-3.0 mmHg). DISCUSSION: Normal compartment pressure could mislead to false negative interpretation of compartment syndrome, whereas pO2 clearly identifies the microcirculatory state of the muscle. Thus, intramuscular pO2 monitoring presents a valuable method in evaluating compartment syndrome, especially in case of suspect clinical signs but normal compartment pressure.

Animals↗
PubMed1998

[Is modification of systemic inflammatory response syndrome and multiple organ failure by parenteral feeding possible?].

In this prospective, randomized, double-blind controlled clinical study, 29 patients after severe trauma (ISS about 40) were randomized to receive either IMPACT (Test) or an isonitrogenous isocaloric diet (Control). The primary study endopoints were the incidence of SIRS and MOF (definitions according to Bone, Goris and Sauaia). Test-fed patients developed significantly less SIRS between days 1 and 28 (8 vs 13.3, P < 0.05) and especially between days 8 and 14 (3 vs 6.2, P < 0.001). In the control group the Goris score was significantly worse (P < 0.05) on days 3, 4, 6, 7, 10, 11, 16, 17 and the Sauaia score on days 8, 9, 10, 11 (P < 0.05, P < 0.01). According to the results, an arginine, omega-3-fatty acids and nucleotide-enriched diet during early enteral feeding leads to reduction of SIRS and MOF scores after severe multiple injury.

Critical Care↗
PubMed1997

[Not Available].

Explore the source record for details and available documents.

Journal Article↗
PubMed1997

[Long-term results of therapy of open and closed fractures of the elbow joint].

Fractures of the elbow joint are quite rare compared with the total incidence of injuries to the extremities. However, elbow fractures often result in significant disability. Therefore in a retrospective study, we have evaluated criteria that are of prognostic value for late functional outcome. Sixty-four (10.3%) of 622 patients with closed elbow fractures and 107 (89%) of 119 patients with open elbow fractures underwent a physical examination. The mean follow-up time was 8.2 years. The functional outcome was recorded by a modified score (0-max. 15) according to Morrey. Epidemiological data from both groups revealed a greater severity and higher degree of injury in open fractures than in closed fractures. In contrast, both groups presented a comparably good functional result. The most significant factor for poor outcome (score < 5) was identified as nerve lesions. Among all nerve lesions in open fractures, 45% resulted in a functional score of < 5; in 42% of closed fractures combined with a nerve lesion a similarly poor result was also noted. A second major factor appeared to be the method of primary therapy. An external joint transfixation resulted in a score of < 5 in 32% of patients that were treated primarily by transfixation. In cases initially treated with open reduction and internal fixation, only 18.5% of open fractures and 3.1% of closed fractures presented a similar low score. According to our results the late functional outcome of elbow fractures depends less on the type of fracture than on the presence of a nerve lesion and the method of primary treatment, which should facilitate early mobilization.

Elbow Joint↗
PubMed1997

[Initial cranial CT for evaluating the prognosis of craniocerebral trauma].

A total of 208 multiple trauma patients with head injury (HI) were investigated who had been treated in the period from 1990 to 1995. The average age was 35.2 +/- 17.7 years; the injury severity according to ISS was 30.2 +/- 8.6 points; 20.5% died as a result of the HI; the mortality of all patients was 26.5%. The Glasgow Coma Scale (GCS) was determined at an average of 22 min after trauma (8.0 +/- 4.3 points) at the scene of accident. The patients were classified according to GCS into minor HI (group 1: 14-15 points), moderate HI (group 2: 9-13 points) and severe HI (group 3: 3-8 points). Patient outcome was assessed by the Glasgow Outcome Scale (GOS) and was classified as good (GOS 4 and 5) and poor (GOS 1, 2 and 3) outcome. At the latest, 2 h after trauma, a CT scan of the head (CCT) was done. The HI groups are compared regarding frequency of types of injury. In all HI groups the fractures of the bony face occurred at the same frequency (36.0-38.9%). The frequency of calotte fractures (Kal-Fx) increased from group 1 (8.0%) to 2 (19.2%) and 3 (25.6%); fractures of the skull base significantly differed between group 1 (16.0%), 2 (7.8%) and 3 (33.4%). Epidural hemorrhage (EDB) appeared only in group 2 (7.8%) and 3 (6.7); subdural hemorrhage was found in group 1 (2.7%), 2 (7.8%) and 3 (10.0%). Subarachnoid hemorrhage (SAB) was significantly more frequently seen, dependent on HI severity, in group 3 (26.7%) compared to group 2 (11.7%) and 1 (8.0%). Intracerebral contusion (ICK) significantly increased from group 1 (12.0%) to 2 (27.3) and 3 (45.6%). Brain swelling (BS) also significantly increased from group 1 (8.0%) to 2 (19.5%) and 3 (49.0%) and lesions of ventricles (VL) from group 1 (2.7%) to 2 (11.7%) and 3 (20.0%). Midline shift (13.4%) and signs of herniation (4.5%) only occurred in group 3. The analysis of correlation/regression and receiver operating characteristics was able to predict 79% of patients' outcome accurately using GCS (r 0.54; P < 0.0001) alone, using CCT (r 0.65; P < 0.0001) 87% were correctly predicted with significant variables Cal-Fx, EDB, SAB and BS. CCT with GCS (r 0.74; P < 0.0001) were able to predict 88% accurately with significant variables Cal-Fx, EDB, BS and GCS. The combination of CCT with GCS, age and ISS (r 0.78; P < 0.0001) was able to predict only 87% correctly, although the r value was the highest; significant variable were Kal-Fx, EDB, BS, VL, GCS, age and ISS.

Adolescent↗
PubMed1997

[Bacillus cereus pneumonia after thoracic trauma. Case report and review of the literature].

We report on the case of a pneumonia caused by Bacillus cereus in a patient who sustained severe thoracic trauma, fractures of ribs 3-12, left lung contusion and haematopneumothorax. Bronchoscopic alveolar lavage (BAL) performed on ICU day four helped identifying the underlying cause of pneumonia. Inspite of early diagnosis and antibiotic treatment with clindamycin, cefotaxim and tobramycin, which rapidly eliminated the bacteria from the patient's lungs, the patient eventually died from the severe underlying injuries. However, this case emphasises that early performed BAL and rapid microbiological staining techniques can help diagnose pneumonia in critically ill patients. We also review the literature on pulmonary infections caused by Bacillus cereus.

Adult↗
PubMed1997

Rehabilitation results of patients with multiple injuries and multiple organ failure and long-term intensive care.

BACKGROUND: Multiple organ failure is regarded to be the major complication of trauma victims treated in the intensive care unit. Long-term rehabilitation results of this special group of patients have not been analyzed so far. METHODS: Fifty patients with multiple injuries and multiple organ failure (Injury Severity Score > or = 36.8) were followed-up 4.9 +/- 0.3 years after the trauma. To show any organotopic sequelae, laboratory tests for the function of lungs, liver, kidney, and the hematologic system were performed. Additionally their functional (locomotion and neurologic system) and occupational rehabilitation results were investigated. RESULTS: The laboratory tests showed entirely normal results. The only pathologic values could be found in the lung function tests. Nineteen percent of the patients showed nonphysiologic results in either spirometry, body plethysmography, or diffusion capacity of carbon monoxide. In more than 25% of the patients, permanently decreased range of motion (limitation of more than 30% of the entire range of motion) of the elbow, hip, knee, or ankle joint were found. In 40% of the patients, permanent motoric nerve lesions were identified; in 50% of the patients, permanent sensoric nerve lesions could be verified. The return to work rate was 60%. CONCLUSIONS: Patients with multiple injuries, who survived multiple organ failure during their long-term intensive care treatment, show an excellent functional and occupational rehabilitation result. They show no major sequelae in their organ function even years after the trauma. Although often these patients suffer from permanent central or peripheral paralysis and decreased range of motion, this finding does not correlate with the patients' ability to return to work.

Activities of Daily Living↗
PubMed1997

The effect of anti-L-selectin (EL-246) on remote lung injury after infrarenal ischemia/reperfusion.

The clinical concern in using neutrophil adhesion blocking agents is whether or not neutrophil function may be down-regulated, rendering neutrophils incapable of dealing with infections that may threaten the patient. In a sheep model of ischemia and reperfusion, we have investigated the effect of anti-L-selectin (EL-246) on the pulmonary injury as well as on the neutrophil function, assessed by in vitro chemiluminescence (CL) of isolated neutrophils. Infrarenal ischemia (3 h) followed by reperfusion (4 h) resulted in pulmonary capillary leakage as evident by an increased alveolar/plasma protein ratio (.76 vs. .19 in control, p < .01) and also led to a significant pulmonary neutrophil accumulation as assessed by the myeloperoxidase content in homogenized lung tissue (31.7 vs. 6.1 U, p < .01). Anti-L-selectin, infused at a dose of 1 mg/kg at the time of reperfusion, significantly reduced the pulmonary leakage by 59% (.42 vs. .76 U) and neutrophil accumulation by 84% (10.2 vs. 31.7 U). Pulmonary function improved by anti-L-selectin as represented by an increase of the arterio-venous oxygen ratio. CL decreased from 1.85 x 10(5) counts(c)/min to 1.02 x 10(6) c/min at 15 min of reperfusion in the positive control followed by a subsequent return to normal. In contrast to myeloperoxidase, the significant change in CL was not affected by the use of anti-L-selectin. Based on our data, we conclude that anti-L-selectin is able to significantly reduce the pulmonary injury in ischemia-reperfusion but in parallel does not result in neutrophil dysfunction regarding for example, the respiratory burst. Thus, using neutrophil adhesion blocking agents in patients appears to be unlikely to increase the risk of septic complications.

Animals↗
PubMed1997

Intramuscular partial oxygen tension monitoring in compartment syndrome--an experimental study.

Measuring intracompartmental pressure is a well-accepted method in evaluating a compartment syndrome, which may occur after limb ischaemia followed by reperfusion. As a compartment syndrome is paralleled by a decreased microcirculation it should be possible also to evaluate a compartment syndrome by measuring intramuscular partial oxygen tension (PO2). In this study, anaesthetized rats (spontaneous breathing via tracheotomy) were subjected to infrarenal ligation of the aorta. A pressure catheter was placed subfascial in the crural muscle group of one hind limb, whereas the contralateral side was prepared with a PO2 catheter. Besides a sham operated group, three experimental groups were subjected to either 2, 4 or 6 h of ischaemia followed by 4 h of reperfusion. One further group was also subjected to 4 h of ischaemia and 4 h of reperfusion but received a fasciotomy at the time of reperfusion. Compartment pressure and intramuscular PO2 were recorded every 15 min. For histological examination muscle specimens were obtained after each experiment. Two hours of ischaemia followed by 4 h of reperfusion did not result in any morphological changes and also in no significant change in compartment pressure during both phases, whereas PO2 significantly dropped during ischaemia (from 19.0 mmHg to 3.0-5.0 mmHg) and returned to normal during reperfusion. In prolonged ischaemia (4 h) morphologically a severe interstitial oedema was evident, compartment pressure increased during reperfusion (from 2.0 mmHg to 8.8 mmHg) and PO2 dropped during ischaemia to 3.0 mmHg and did not return to normal during reperfusion (10.5 mmHg versus 19.0 mmHg normal). In the case of 6 h ischaemia, partial necrosis and no interstitial oedema was found morphologically. There was no significant change in compartment pressure throughout the study, and PO2 remained significantly decreased even during reperfusion (2.0-3.0 mmHg). Normal compartment pressure could mislead to false negative interpretation of microcirculatory disorders preceding or following compartment syndrome, whereas PO2 clearly identifies the microcirculatory state of the muscle. Thus, intramuscular PO2 monitoring presents a valuable method in evaluating compartment syndrome, especially where there are suspected clinical signs and risk of ischaemia but normal compartment pressure.

Animals↗
PubMed1997

Prehospital care, importance of early intervention on outcome.

The improvement of rescue systems and on-scene therapy has lead to a significant reduction of early posttraumatic death. It was the goal of this study to critically analyse the value of prehospital care in respect to early but also to delayed complications (single = SOF or multiple organ failure = MOF) In a retrospective analysis 1223 polytraumatized patients treated during 1984 and 1994, with an injury severity of more than 20 points according to the Injury Severity Score = ISS, on-scene therapy ("field stabilization") was evaluated. We could show that a sufficient preclinical airway management has major influence on late prognosis (MOF). We therefore definitely recommend early intubation at the scene in these patients. The intravenous access at the emergency place is always necessary independent whether the patient is in hemorrhagic shock or not. Loss of time can increase shock mechanisms making intravenous access even more difficult. If there is already a peripheral vasoconstriction and the localisation of an peripheral vein renders more difficult, one possibility is a venae section to get safe access. Concerning the amount of preclinical infusion controverse opinions exist. Our evaluation could not give an satisfactory statement because of a differing high incidence of mass bleeding in the groups with low (< 1000 ml) and high (> 2000 ml) preclinical infusion. The improvement of rescue systems and on-scene therapy has lead to a significant reduction of early posttraumatic death. Especially in those injuries, that are directly associated with the development of early death, i.e. intracranial bleeding, massive hemorrhage from thoracic and intraabdominal lesions these regimens on scene improved survival significantly (Fig 1) (Trunkey 1983). Nevertheless it is still discussed whether a longer rescue time is then justified to intensify on scene therapy. Recent publications demonstrate for instance that infusion therapy beginning on scene is not always necessary and sometimes especially in severe hemorrhagic shock can even aggrevate bleeding (Bickell 1989, Bickell 1991, Bickell 1993, Crawford 1991, Gross 1988, Stern 1993). On the other hand the value of on scene intubation and ventilation and chest tubing in these patients is critically discussed (Mattox 1989). Most of these studies however have their origin in the USA and are related exclusively to penetrating trauma (knife and gunshot wounds), which is completely different from underlying pathomechanisms (pure hemorrhagic shock). Only one reports of the same experience with blunt trauma (Barone 1986). Thus for severe blunt trauma the question is still open: "field stabilization" or "load and go" (Krausz 1992). A decision that always has to be related to the definite rescue time (Smith 1985). It was the goal of this study to critically analyse the value of prehospital care in respect to early but also to delayed complications (single = SOF or multiple organ failure = MOF).

Abdominal Injuries↗
PubMed1997

[Functional, neuropsychological and social outcome of polytrauma patients with severe craniocerebral trauma].

The aim of this study was to identify, in (pre-) clinically obtained data, parameters predicting the outcome of patients with multiple trauma and severe head injury. Fifty-eight patients aged 27 +/- 10 years were investigated an average of 5.8 years after the accident. The Hanover Polytrauma Score was 34 +/- 11 points, the initially assessed Glasgow Coma Scale (GCS) was 6.2 +/- 3.2 points; and the duration of coma was 15.4 +/- 14.4 days. The primary length of stay in hospital averaged 33.4 days, including 22.9 days in the intensive care unit and 20.2 days of ventilation. For a further 223 days the patients were treated at the Neurologic Clinic of Hessisch Oldendorf. Besides different neurologic deficiency symptoms, the psychometric tests showed deficits in all areas. In particular, information processing speed, concentration, recent memory and learning performance were impaired. There was free mobility of all joints in 33% of the patients. Due to injury the elbow and ankle joint developed the worst restriction. Central paralysis and heterotopic ossification also caused a restriction in joint mobility. Half of the patients were confronted with different social changes. The rate of return to work was dependent on age. Some 42% of all patients had taken up their former profession, 5% were still in training or at college, 32% were retrained to other professions, 16% were unemployed and 5% were completely retired on pension. Age, injury severity, GCS, duration of coma and duration of weaning were suitable predictors in correlation- and regression analysis. The Glasgow Outcome Scale showed good recovery and moderate disability in 53%, severe disability in 33% and persistent vegetative state in 14% of the patients.

Activities of Daily Living↗
PubMed1997

[Complex trauma of the elbow].

The complex injury is characterized by a fracture and/or dislocation of the elbow in association with a serial injury of the upper extremity, or a severe soft tissue trauma, or a prolonged ischemia caused by vascular injury or compartment syndrome. They are defined as complex injuries because their treatment differs from that of a simple fracture implying that standardized concepts usually cannot be employed. The results of primary treatment show a high rate of complications. They are accompanied by functional deficits including pseudarthrosis and ankylosis. As a consequence, ulnar neuropathy may occur. Inadequate treatment leads to delayed rehabilitation and several secondary operations. The main goal points at the reconstruction of the elbow joint to restore function. Therefore, the logistical pathway of individual therapy is the key for success. The operation has to include fracture stabilisation of all injuries of the upper extremity. Only stable osteosynthesis makes early mobilisation possible. Transfixation of the elbow joint should be reserved for exceptional cases. The principals of AO have proven to be practical both for the distal humerus and the proximal forearm. Successful reconstruction of the elbow joint often demands extended approaches. ORIF of the proximal ulna can be achieved by indirect reposition techniques. Dynamic stabilisation should be established by conservation of the radial head and coronoid process. For treatment of soft tissue injury it is necessary to undertake local reconstructive measures. Operative treatment is widely indicated for forearm compartment syndrome. Diagnosis and therapy of possible accompanying vascular injury should be made early to avoid prolonged ischemia. Operative treatment of nerve injury is only indicated in case of sharp dissection of the nerve. Otherwise the reconstruction should be performed, but not earlier than three months. Rehabilitation outcome depends on primary therapy. Sufficient functional results are only achieved after early mobilisation and intensive physiotherapy. If necessary, arthrolysis is planned early and combined with removal of implants at 6 months post injury.

Compartment Syndromes↗