The survival rate of patients with multiple injuries can be improved by means of the modern possibilities of rescue services. The timespan preceding treatment can be shortened. A consequent symptomatic treatment of hemodynamic and respiratory disorders plays an important role. A causal therapy of the impaired permeability of the capillaries, which causes the shock, is possible only to some extent. The therapy should concentrate on the solution resulting from shock.

Blood Transfusion↗

PubMed1981

[Roentgenographic pulmonary findings in long term ventilated multiple trauma patients (author's transl)].

An analysis of roentgenographic pulmonary findings was done in 46 multiple trauma patients on controlled long term ventilation. 67% of the patients sustained thoracic trauma. The most common lung changes were interstitial and intraalveolar pulmonary edema and inflammatory pneumonia related to contusions, atelectasis and aspiration. The pulmonary lesions predominantly occurred in the middle and lower portions of each lung. The thoracic trauma group had four times as many lung changes than the non-thoracic trauma group. Daily roentgenographic controls are necessary in multiple trauma patients to explain a deterioration in pulmonary gas exchange leading to respiratory failure. To demonstrate discrete lesions in lung parenchyma, we recommend the high voltage technique for chest X-rays in intensive care units.

Adolescent↗

PubMed1981

[Results of a muscle-activated M. peroneus brevis graft [author's transl)].

The article introduces a new method of reconstruction of the lateral ligaments of the ankle. This is a modification of the well-tried tenodesis according to Evans, by which half of the tendon of the short peroneal muscle is retained as a dynamic stabilizer of the ankle. In this method, the tendon of the short peroneal muscle is cut in half about five fingers' breadth above the ankle, the incision being effected as a J-shaped cut behind the fibula; the incision goes distally beyond the proximal retinaculum of the peroneal muscle. A hole of 4.5 mm. is drilled diagonally forwards and downwards at an angle of about 50 degree. The half of the tendon is pushed forwards through this hole in the bone and sutured onto itself below the superior peroneal retinaculum, the foot being held in slightly eversed position. Like many non-anatomical methods of repair, this method is used with good results. 91 reconstructions of the lateral ligaments of the ankle have been performed from 1972 to 1980 in the Medical College Hannover. Of the 76 patients checked in follow-up examinations, 68 showed good results, while the balance of 8 patients was classified as satisfactory.

Adolescent↗

PubMed1980

Communicating-occluding junction complexes in the alveolar epithelium. A freeze-fracture study.

Because studies differ as to the presence of communicating (gap) junctions in the alveolar epithelium, lung tissue from several mammalian species (man, dog, rabbit, rat, and mouse) was studied with the freeze-fracture method to clarify this problem. Communicating junctions were found between pneumonocytes in each species examined. They were always located within the meshes of or closely attached to the occluding junctions, forming communicating-occluding junction complexes. It is assumed that the communicating junctions between pneumonocytes serve mainly for metabolic coupling. The particular location of communicating junctions within the meshes of the occluding junction may be related to an additional mechanical function.

Animals↗

PubMed1980

[Hemodynamics and pulmonary gas exchange in radiographically observed posttraumatic lung edema (author's transl)].

A prospective study of 46 multiple trauma patients was undertaken using standard intensive care techniques with special circulatory and respiratory monitoring. In 19 cases roentgenograms detected at least temporary pulmonary edema; only 3 of these patients sustained no discernible lung contusions. The hemodynamic data did not explain the pulmonary edema. Despite ventilatory support of all patients, pulmonary gas exchange was abnormal prior to radiological findings of pulmonary edema. The most significant explanation of the investigated data is early capillary leakage in the lung inducing an enlarged transit space at the interstitial site.

Adolescent↗

PubMed1980

[Significance of arthrography of the knee joint (author's transl)].

A survey on the double-contrast arthrographie of the knee is given. Speical problems of the method and the interpretation of the films are presented. Besides the delineation of the pathological alterations of the menisci, which is possible in about 85 to 95%, the possibility of delineation of other knee joint damage is discussed, their significance being far beyond that of the meniscal lesions. At last the post-operative changes of the knee joint following meniscectomy are summarized including the evaluation of plain films and repeat arthrography. Own investigations on 117 meniscectomized patients are presented. 35 patients had symptoms, on 23 of them a repeat arthrography could be performed. The symptoms could essentially be explained by meniscal remnants and degeneration of the cartilage at the operated site of the knee.

Arthritis↗

PubMed1980

[Extravascular lung water in traumatic shock of the dog (author's transl)].

Fourteen dogs underwent standardized traumatic hemorrhagic shock. Periodically, measurement of extravascular lung water (EVLW) was taken by thermo-green-dye dilution technique and related to microvascular pressure (MVP) values. An initial drop in EVLW, corresponding to MVP was seen. During shock time the EVLW rose again, while the MVP remained at low levels. This shows a permeability leak during shock time.

Animals↗

PubMed1980

[Haemodynamic, gas exchange and lung X-rays in multiple injuries with blunt chest trauma (author's transl)].

In a controlled prospective study of 50 multiple trauma patients special cardio-respiratory monitoring was performed from the moment of admission to the hospital up to seven days. We compared haemodynamic and respiratory data and roentgenograms from 34 patients with blunt thoracic trauma with those of 16 patients without thoracic trauma. The mortality of the thoracic trauma group was higher (56%) than in the control group (19%). Long term intubation was necessary in the first group for an average of 17 days and in the second group for 6.2 days. In the thoracic trauma group there was a higher total pulmonary resistance and a lower cardiac index. Despite mechanical ventilation the pulmonary gas exchange was impaired in the thoracic trauma cases, especially due to an increased shunt fraction. In 16 of the thoracic-trauma patients roentgenograms detected at least temporary pulmonary oedema simultaneously with the increase of shunt fraction and the impairment of pulmonary gas exchange of those patients.

Adolescent↗

PubMed1979

Cardiorespiratory and metabolic patterns in multiple trauma patients.

During the last 3 years we have performed a detailed study in 50 patients using the Swan-Ganz catheter to provide prognostic haemodynamic and metabolic values at an early stage. There was a total of 320 severe injuries in these 50 patients with a statistical mean of six to seven. The severity of injuries is documented by the volume replacement necessary within the first 24 hr. On average more than 8 litres of whole blood, albumin and dextran were given intravenously. Out of 50 patients, 28 survived. During the first 2h there was a significant difference between survivor and non-survivor in systolic blood pressure and shock index. From the very beginning the surviving patients demonstrated a higher cardiac index than non-survivors. Pulmonary artery pressure and total pulmonary resistance were also elevated from the very beginning. The right ventricular stroke work index was increased; the left ventricular stroke work index was decreased in the group of non-survivors. The arteriovenous oxygen content difference as well as oxygen extraction ratio was elevated, and the oxygen availability was decreased in the group of the non-surviving patients. Of the metabolic parameters, an increase in the lactate/pyruvate ratio as well as in serum glucose and a decrease in base excess values permit an early prediction of a favourable outcome. There were significant differences in the enzymes SGOT, SGPT, LDH, CHE, as well as bilirubin concentrations between survivors and non-survivors from sixth day on.

Acid-Base Equilibrium↗

PubMed1979

Cardiopulmonary parameters and prognosis after severe multiple trauma.

Comprehensive cardiopulmonary and metabolic monitoring of severely traumatized patients for 7 days from the time of injury has allowed us to determine parematers which correlate with survival and nonsurvival. The earliest and most persistent change is an increased pulmonary vascular resistance which results in right heart overload and failure. Left heart "failure" which has been previously described with acute respiratory failure and shock is shown to be a mathematical artifact caused by dilatation of the right heart and encroachment on left ventricular filling volume. Causes of death in most patients were not directly referable to right heart dysfunction but we postulate that hypercoagulability and microembolism could independently produce the observed pulmonary vascular changes as well as the multiple organ failure which usually was responsible for death. Resolution of this question will require more sophisticated hematologic evaluation.

Adolescent↗