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Biomedical subjects

H J Oestern

Publications and source records attributed to H J Oestern.

At least 55 records · Page 3Linked to original sources
PubMed1986

[Isolated soft tissue trauma and combination injuries].

The special problem in severe soft tissue injuries of the lower limb are the thin soft tissue coverage and the diminished blood supply of the distal lower limb and foot. For this reason there is a big difficulty in estimating the severity of the injury. We developed a classification for severe lower limb and foot injuries and classified: soft tissue damage. concomitant local injuries. fracture type. classification of multiple injuries. time of treatment. This classification resulted in 4 groups, which have a prognostic value especially towards amputation or preservation of the limb.

Fractures, Bone↗
PubMed1986

Increased lung capillary permeability after trauma: a prospective clinical study.

Pulmonary dysfunction and permeability were prospectively studied in a group of severely traumatized patients. Ventilatory parameters (i.e., PaO2/FiO2, dynamic compliance, per cent shunt, and A-a DO2) and extravascular lung water (EVLW) measurements were compared with scintigraphic determinations of pulmonary albumin extravasation. Albumin extravasation data demonstrated a pulmonary capillary permeability increase occurring shortly following trauma. The median albumin extravasation value in the patients within 24 hours of trauma was 3.6 X 10(-5)/sec, compared to a control value of -0.1 +/- 0.7 X 10(-5)/sec. Intermediate levels of albumin extravasation were found in patients studied within 48 hours of total hip replacement (1.6 +/- 0.9 X 10(-5)/sec). Eighty per cent of patients studied within the first 48 hours of their trauma had albumin extravasation values exceeding the upper limit of normal as determined by the control value + 2 S.D. In contrast to albumin extravasation values, the PaO2/FiO2, dynamic compliance, per cent shunt, A-a DO2, and EVLW did not begin to deteriorate significantly until at least 48 hours after trauma. We conclude that severe multiple trauma induces an early increase in pulmonary capillary permeability as measured by albumin extravasation scintigraphy. This change is not detectable with other commonly used measures.

Adolescent↗
PubMed1985

[Thoracic trauma].

Thoracic trauma in multiple trauma increases mortality threefold, usually due to sepsis. Disturbances of the pulmonary vasculature are seen soon after trauma, as is increased EVLW. This can be due to 3 different mechanisms: 1. High pressure edema due to high intrathoracic pressure. Protein-poor edema. No hypervolemia, therefore no diuresis called for. 2. Hematoma: blood and dead tissue should be removed. Bronchial drainage is important. 3. Capillary permeability damage: areas of direct trauma with protein-rich interstitial edema. Can lead to ARDS. Modern ventilation techniques are helpful. No drug therapy (i.e. steroids) is proven.

Hemodynamics↗
PubMed1985

The German model for rescue of traumatized patients.

Accidents and their sequelae are the main cause of death in Germany among people under 40 years of age. The cost in disability payments and lost work averages $40 000 per injury. The author describes the German system for trauma rescue. The aims of rescue care in Germany are to reduce the interval between injury and hospital admission and to bring the patient to the right hospital, bypassing smaller hospitals if necessary. Ambulance rescue systems are of two types: the stationary, in which the physician travels with the ambulance, and the rendezvous, in which the physician and ambulance, travelling separately, meet at the accident site. At the beginning of the 1970s the air-rescue system was started and now comprises 32 stations and 25 BO-105 helicopters. The Hannover experience shows that of the initial diagnoses made at the accident site by helicopter rescue service, 51.9% of victims had head injuries, 35.5% fractures of extremities, 17.0% thoracic trauma, 10.2% abdominal trauma and 7.6% spinal fractures. Because of respiratory insufficiency or unconsciousness with danger of aspiration, 12.0% of the patients had to be intubated endotracheally. One hundred and twenty-two patients with a clinical diagnosis of death were successfully resuscitated at the accident scene. A study comparing the efficiency of the helicopter and ambulance systems showed that as the severity of the injuries increases, the death rate is greater in the group rescued by ambulance. Of 22 accidents involving rescue helicopters, 7 (32%) resulted in at least one death. Between 1973 and 1983, 16 doctors, pilots or attendants were killed.

Accidents, Traffic↗
PubMed1984

Studies of hemorrhagic and traumatic shock influence on liver oxygen tension: effects of a single large dose of dexamethasone.

Liver surface oxygen tension in response to hemorrhagic shock (hs) and to combined hemorrhagic-traumatic shock (hts) as well as to hemorrhagic-traumatic shock with glucocorticoid application ( htsc ) has been studied using male rats (Wistar strain, 250-300 g b.w.). The animals were anaesthetized by i.p. injection of ketamine/xylazine. All animals were bled through a catheter inserted into the vena jugularis until a hypotension of 40 mm Hg mean arterial blood pressure (MAP) was attained. The hts rats were traumatized by fracturing the left tibia and crushing the adjacent muscle tissue with 45 N/2.25 cm2 for 5 minutes. The htsc animals were traumatized and treated with a single injection of a large pharmacological dose of dexamethasone (6-8 mg/kg b.w.). Initial surface Po2 of the liver was higher than published by others (29 +/- 7 mm Hg) probably due to the narcotic agents. Maximal blood withdrawal was 24.4 +/- 2.2 ml/kg b.w. for hs, 17.9 +/- 3.8 ml/kg b.w. for hts and 20.6 +/- 4.5 ml/kg b.w. for htsc rats. Liver surface Po2 decreased to zero mm Hg in response to hypovolemic hypotension in all rats. Retransfusion of the shed blood caused a MAP and surface Po2 increase to only about half of the initial levels in hts and htsc rats while in hs animals the initial values were approximated. The hts and htsc rats showed signs of progressive hypotension to about 45 mm Hg MAP within 90 minutes post retransfusion. Dexamethasone improved the arterial pH to 7.15 compared with 7.05 of the control. Pao2 was elevated to 60 mm Hg vs. 49 mm Hg of the control animals. The beneficial influence of glucocorticoids on liver surface Po2 has not been substantiated as would have been desirable for the patient. Nevertheless, from a physiological standpoint a positive trend in the liver O2 supply has been evaluated as a small right shift of the surface Po2 histogram as well as the blood gas and pH data.

Animals↗
PubMed1984

[Stress tolerance of patients with multiple injuries and its significance for operative care].

Treatment of severely injured patients requires exact planning and mature management. For practical reasons the classification into 4 phases has been introduced: acute, primary, secondary and tertiary phases. During the acute phase all life-saving operations are performed. In the primary, secondary and tertiary phases the procedures vary according to priority. Reviewed on the basis of 781 severely injured patients, the most reliable criteria are: pulmonary artery pressure, creatinine, bilirubin, extravascular lung water, the PaO2/FiO2 quotient and fluid balance.

Creatinine↗
PubMed1984

[Errors and dangers in the treatment of fractures and pseudarthroses of the clavicle].

The rate of pseudarthrosis in 726 conservatively treated fractures of the clavicula was 0.69%. The danger of hyperporoses lies in neurovascular compression. Errors in treatment pertain to wrong operative indications and inadequate osteosyntheses. Surgery should be performed only in 2nd and 3rd degree open fractures and/or concomitant neurovascular lesions (2.06%), in distal fracture dislocations with instability of the AC-joint (1.6%) and in cases of painful pseudarthrosis (n = 46). The implant of choice is the 3.5 DCP. Six cortical contacts must be achieved in each fragment.

Clavicle↗
PubMed1984

[Disorders of fracture and osteotomy healing. An analysis of aseptic complications].

The analysis of aseptic complications of bone healing shows that after conservative treatment failures are based mainly on an inadequate indication (37 of 68 patients). An operative procedure would have been better in these cases. Insufficient and recurrent reductions (11 of 68 patients) as well as over-extension with diastasis (9 patients) were less frequent. Osteosyntheses without bone healing were very frequent after failures in the operative technique (92 of 219 patients) and when bone defects (56 patients) remained. It is generally noticed that there is a relatively small number of bone healing problems following intramedullary nailing (13 patients) compared with plate osteosynthesis (119 patients). Both techniques are separately analyzed concerning the kinds of complications. Therapeutic priorities for the treatment of fractures are derivated.

Bone Plates↗
PubMed1984

[Infected joint fracture. Diagnosis, treatment and results in 63 patients].

For diagnosis, treatment and prognosis of infected articular fractures special attention should be paid to the following: When conventional treatment with puncture and irrigation of the joint after a maximum of 7 days is not successful, synovectomy in the early stage of infection, before extensive cartilage destruction particularly in the knee, elbow joint and hand, is the appropriate treatment. The progressive destruction of the cartilage and bone is interrupted. As a result of the early functional after-treatment good mobility of the joint and cartilage nutrition are achieved. In patients who were treated with synovectomy the time for healing was only 4 months, after arthrectomy 7 months and arthrodesis 20 months. Taking into consideration the complaints, mobility and shortening of the leg synovectomies had better results. The overall result demonstrates that despite enormous therapeutic effort, the infection in articular fractures is a serious complication which often leads to permanently functional deficiencies. Of 55 re-examined patients 34 were free of complaints, 5 amputations were necessary as a result of severe neurovascular damage and sepsis. The best results were achieved with early synovectomy.

Adolescent↗