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Biomedical subjects

H Kretschmer

Publications and source records attributed to H Kretschmer.

At least 37 records · Page 2Linked to original sources
PubMed1983

[Possibilities and limitations of intensive therapy in severe craniocerebral injuries].

In a retrospective, non-randomised study, the author examined the influence of additional drug treatment on the prognosis of severe injuries of the skull and brain. The emphasis of this study was on treatment with dexamethasone and barbiturates. Of 489 injured persons, 260 were treated with dexamethasone and 229 by the conventional standard treatment method only. Evaluation of the results showed that the high-dosage dexamethasone therapy clearly reduced the mortality in severe injuries of the skull and brain (from 57.4% to 32.4%), although this partly resulted in an increase of defective conditions. On the other hand, no definite effect of treatment was noticeable in extremeLy severe cases with high-grade substantial brain damage and with the milder forms of trauma in which the traumatic brain oedema did not play a prominent role. Barbiturates were used only where it proved impossible to reduce the increased brain pressure by other means. Good remissions were seen in some patients, but the total number is insufficient for a final evaluation. Independent of the treatment, however, other factors (depth and duration of the initial disturbance of consciousness, age, concomitant injuries) exercise a significant influence on the prognosis of severe injuries of the skull and brain.

Adolescent↗
PubMed1981

[Nerve grafting and other plastic procedures in traumatic injuries of the brachial plexus (author's transl)].

In 52 patients with traumatic injuries of the brachial plexus plastic procedures were carried out on the nerves in order to improve function: primary suture of the torn portion of the plexus (one case), external and internal neurolysis with division of the epineurium (four times), anastomosis of the secondary branches or the main arm nerves, with the intercostal nerves by insertion of sural transplants (47 times). Seventy per cent showed an improvement in protective sensation and in 48% a useful gain in motor function was achieved. The results are dependent on the age of the patient (better results in the younger patients), on the interval between injury and operation (failure when the injury was more than one year previously), and the anatomical site (good regeneration with axillary and musculo-cutaneous, partial success with the radial and median, and failure with ulnar nerves). Although complete recovery cannot be expected, we recommend that such a "plastic" nerve operation should be done before considering the radical step of a definitive arthrodesis or amputation.

Adolescent↗
PubMed1981

[Computerized tomographic findings in brain contusions (author's transl)].

Over a 1 1/2 year period computerized tomographical examinations were performed on 104 patients suffering from brain concussions. The evaluation of findings resulted in the following classification: Type 1: severe generalized brain oedema without visible contusional foci, Type IIa: typical contusion with solitary or multiple contusional foci, Type IIb: typical contusion with severe, locally pronounced oedema, Type IIIa: contusion with flat subdural contusional bleeding, Type IIIb: contusion with minor intracerebral contusional bleeding, Type IIIc: contusion with intraventricular bleeding. Space-occupying haemorrhages were excluded. The comparison of computerized tomographic findings with the clinical course justifies such a classification. There are significant correlation between CT findings and the clinical picture, especially with the degree of clouding of consciousness as well as with further prognosis.

Brain↗
PubMed1981

[Dynamics of the course and early prognosis of traumatic intracranial haemorrhages. I. Epidural haematomas (author's transl)].

79 epidural haematomas were surgically treated within a period of 3 years (66 acute and 13 sub-acute courses), half of the cases being due of traffic accidents. The average age was 31.6 years, and the sex distribution male : female = 4 : 1. The most frequent location of the haematoma was temporal (59.5%), followed by parietal (20.3%) as well as frontal and occipital (10.1% each). In only 20.3% of the cases, we found the classical three-stage course with free intervals, whereas primarily persistent and secondarily continuously increasing disturbances of consciousness (34.2% and 45.6% respectively) were more frequent. Dilatation of the pupils on the side of the focus was seen in barely one-half of the patients; in 88.6% of the patients, fracture of the skull was diagnosed on the haematoma side. Diagnosis of haematoma was confirmed either by computed tomography or by angiography of the carotid artery. Early prognosis (mortality = 21.5%) depended on the dynamics of the course of the haematoma (mortality in acute cases 25.8%, in sub-acute courses 0%), the extent of the primary traumatic cerebral damage (manifested by the severity of the disturbance of consciousness) and the rapidity of surgical intervention. The mortality was 45.5% in patients in whom the midbrain had already been affected, as demonstrated by relevant signs with extension spasms and comatose condition of consciousness, whereas the mortality was 75% if both pupils were wide and fixed.

Adolescent↗
PubMed1981

[Course dynamics and early prognosis in traumatic intracranial hemorrhage. II. Subdural hematoma].

181 subdural haematomas were subjected to surgery within a period of 3 years. Basing on the dynamics of their course and on their prognosis, we can differentiate between acute (50.8%, interval up to 24 hours), sub-acute (10.5%, interval 2 to 10 days) and chronic types (38.7%, interval 11 days to 6 months). Acute subdural haematomas are due to severe traumas, mostly combined with skull fractures; in most cases, there is no free interval, and they are associated with severe disturbances of consciousness. Their prognosis is poor (mortality 7.2%) and less due to a space-occupying growth, namely the haematoma, than to the primarily traumatic cerebral lesion. Sub-acute subdural haematomas are often characterized by a free interval; the disturbances of consciousness are less severe, and their prognosis is much more favourable (mortality 26.3%). Chronic subdural haematomas are the sequels of milder traumas, but it is clinically impossible to distinguish them from pachymeningiosis haemorrhagica interna. They become manifest by mental changes, headache and neurological focal symptoms. If treated in time, their prognosis is favourable, the mortality being 10%. All types of subdural haematoma present a characteristic clinical pattern. Atypical courses are much rare than with the epidural haematomas. Preoperative classification with assessment of prognosis can be achieved via findings obtained by computed tomography and angiography of the carotid artery.

Acute Disease↗
PubMed1981

[Course dynamics and early prognosis of traumatic intracranial hemorrhage. III. Intracerebral hematomas (author's transl)].

56 traumatic intracerebral haemorrhages were surgically treated within a period of 3 years. In most cases, they were dur to severe craniocerebral traumas, often (in 71,4% of the patients) combined with calvarial fractures. The average age was 44,7 years, and the sex distribution male : female = 4:1. The temporal and frontal regions were the preferential sites in approximately equal incidence. Depending sites in approximately equal incidence. Depending upon the rapidity of the clinical course, acute haematomas are different from the sub-acute ones (12-hours limit); both groups differ from each other especially with regard to the prognosis involved. Disturbances of consciousness were most prominent in the clinical patterns: they were either primary and consistent (41.1%) or secondary and continually increasing (53,6%); a free interval was only rarely observed. The findings obtained on angiography if the carotid artery are not haematoma-specific. Proof of the existence of a haematoma is most reliably established via computed tomography, which is also a safe method to identify severe accompanying damage and posttraumatic cerebral edemas. The indications for surgery can be restricted by means of computed tomography to major haemorrhages with space-occupying growths and clinical signs of cerebral pressure, as well as in patients where the clinical pattern deteriorates during conservative treatment. In all other cases, it is advisable to adopt a cautious conservative attitude coupled with CT controls. Early prognosis (mortality 62,5%) depended on the severity of the primary traumatic cerebral damage, the extent of disturbance of consciousness, rapidity of the clinical course localisation of haemorrhage, and age of the patient.

Adolescent↗
PubMed1980

[Cerebral missile injuries in civilian practice (author's transl)].

Over a 10 year period we have treated 63 cases of cerebral gunshot injuries, most of them attempted suicides. Following the presentation of ballistic data, and the classification and pathophysiology of the clinical symptoms, early and late complications are reported in detail and recommendations for therapy given. The mortality rate of all admitted patients in our material was 60.9%; a direct relation between the severity of primary brain damage (recognizable in the degree of initial unconsciousness) and the chance of survival was found.

Adult↗
PubMed1979

[A study on the problem of thoracic discprolapse (author's transl)].

The article reports on twenty patients with thoracic prolapsed discs treated by surgery within a period of ten years. The incidence in relation to prolapses at all levels was 1.2%. The average age was 50.3 years and there was no definite sex predominance. The segments Th 10-11 and Th 11-12 were the preferred sites. The period of the disease varied from a few hours to nine years. Among the most frequent subjective complaints were radiating pain, paraparesis of the legs and disturbed micturition. A definitely traumatic cause of the disease was present in one case only. Besides exact neurological diagnosis it is imperative to effect myelography with positive contrast medium, revealing the typical circular or oval-shaped filling defects. In our patients, laminectomy was performed 17 times, and hemilaminectomy three times. Besides removal of the prolapse, the dentate ligament was always divided. In some cases we also performed rhizotomy. Operation improved 15 patients, whereas in two patients the condition got worse and three patients showed neither improvement nor deterioration.

Adolescent↗
PubMed1975

[Rupture of the internal carotid artery following blunt cranio-cerebral trauma].

Report on an 18-year-old patient who died 6 hours after a blunt cerebro-cranial trauma due to a hemorrhage from the intracranial extradural part of the internal carotid artery. Autopsy revealed multiple fractures of the cranial basis, hemorrhages due to brain contusion and hemorrhages of the pons as well as a rupture of the wall of the right internal carotid artery within the fractured carotid canal.

Accidents, Traffic↗
PubMed1975

[Action of clostridial spores on transplantation tumors in alloxan-diabetic rats (author's transl)].

With the intention to improve the up to now unsatisfying effectiveness of tumour treatment by clostridial spores, the influence of Alloxan-induced hyperlglycemia on clostridial therapy in two transplantable tumours of the rat are examined. Contrary to the isolated clostridial application the combined treatment causes a significant improvement of therapeutic effects (tumour-necrosis and -liquefaction, decreased growth-rate-quotient). The examination of antibody titers against clostridial rods shows in animals with Alloxan-diabetes a more early and more powerful increase in comparison with the isolated clostridial application. The importance of these results for therapy and serological diagnosis of malignant tumours is discussed.

Animals↗