[Intensive care of severly injured].
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Coma↗
Biomedical subjects
H Tscherne
Publications and source records attributed to H Tscherne.
[The treatment of the seriously injured at an emergency station].
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Accidents↗
Investigation of neutrophil--endothelial cell interaction in multiple trauma by chemiluminescence.
The trauma-induced activation of neutrophils and their functional alterations, i.e., increase in adherence and release of oxygen derived metabolites, is considered to play a central role in the initiation and amplification of capillary endothelial cell damage and following organ failure. In the present study neutrophil-endothelial cell interaction was studied using an in vitro model of human umbilical cord vein endothelial cells and human neutrophils. Production of oxygen-derived metabolites was determined by comparing mean peak chemiluminescence of neutrophils from multiply traumatized patients (n = 40) and mean peak chemiluminescence of neutrophils from blood donors (n = 160). Adherence and endothelial injury by neutrophils of multiply traumatized patients were compared with data of healthy blood donors. Chemiluminescence response of 70,000 neutrophils isolated from healthy control individuals was 699 +/- 98 x 10(3) cpm and could be increased significantly by endothelial cells to 1410 +/- 135 x 10(3) cpm (p < 0.05). Chemiluminescence response to neutrophils of polytraumatized patients was 1174 +/- 94 x 10(3) cpm and could not be significantly increased by endothelial cells (1419 +/- 120 x 10(3) cpm). Adherence of neutrophils of blood donors to endothelial cells was 12.31 +/- 0.77%. Adherence of neutrophils of polytraumatized patients was significantly increased to values of 24.83 +/- 2.03%. Injury of endothelial cells was not detectable with neutrophils from blood donors (1.11 +/- 1.09% 111in-release). Significantly increased 111in-release was apparent upon incubation with neutrophils of polytraumatized patients (5.76 +/- 1.28%). The data shows evidence of in vivo preactivation of neutrophils of polytraumatized patients, and supports the hypothesis that endothelial cells play an active role in neutrophil-endothelial cell interactions by modulating production of oxygen-derived metabolites.
Abdominal Injuries↗
Effect of prostaglandin E1 on chemiluminescence response and adherence of human polymorphonuclear leukocytes to human cultured endothelial cells of prostaglandin E1 treated polytraumatized patients.
We investigated the effect of prostaglandin E1 on human polymorphonuclear leukocytes, in vivo. Polymorphonuclear leukocytes of a prostaglandin E1 and placebo study group were harvested and their function, as production of oxygen-derived metabolites and adherence to human cultured endothelial cells, was compared. Additionally, data obtained from polymorphonuclear leukocytes of a prostaglandin E1 and placebo group were compared with data obtained from polymorphonuclear leukocytes from 28 blood donors, who served as a control group. Production of oxygen-derived metabolites by polymorphonuclear leukocytes during contact with endothelial cells was measured by chemiluminescence. Chemiluminescence was significantly (p < 0.01) increased in the placebo group in comparison to the control group decreasing to values of control group after 6 d (post-trauma). Chemiluminescence response was not significantly suppressed in patients treated with prostaglandin E1 in comparison to the placebo group. Adherence of polymorphonuclear leukocytes (placebo group) to endothelial cells was significantly increased (p < 0.01) within the first 6d post-trauma. Following day 6, values were in the same range as values for the control group. Adherence was not significantly suppressed in patients treated with prostaglandin E1 in comparison to the placebo group. In conclusion, prostaglandin E1 at a dose of 20 ng/kg bw/min does not influence production of oxygen-derived metabolites and adherence in polytraumatized patients in comparison to a placebo group. Additionally, production of oxygen-derived metabolites by polymorphonuclear leukocytes in response to endothelial cells is shown and it is evident that endothelial cells might influence production of oxygen derived metabolites by polymorphonuclear leukocytes.
Alprostadil↗
Extension osteotomy in malunited clavicular fractures.
The association of a malunited clavicular fracture with a pattern of disability that includes not only pain but also impairment of shoulder function is rare. But in cases where such an association exists, correction of the clavicular deformity should be considered. We report on 4 patients with a malunited fracture of the clavicle after nonoperative treatment. In all 4 patients fracture union had occurred with shortening associated with pain and ipsilateral glenohumeral dysfunction. The deformity was not associated with neurovascular dysfunction. On preoperative radiographs the shortening of the malunited clavicle was between 0.9 and 2.2 cm compared with the contralateral clavicle. all patients underwent an extension osteotomy of the clavicle with interposition of an autogenous iliac crestbone graft secured with a plate and screws. The length of follow-up was 1 to 4 years in 3 cases and 6 weeks in 1 case. The functional outcome was evaluated with the Constant-Murley and University of California-Los Angeles scales. All patients had immediate pain relief after osteotomy and correction of the deformity. Shoulder function rapidly improved and functional outcome was good in 3 of the 4 patients. In cases of shoulder function impairment associated with malunited clavicular fractures, extension osteotomy combined with autogenous bone grafting is likely to produce good results.
Adult↗
Outcome after primary and secondary hemiarthroplasty in elderly patients with fractures of the proximal humerus.
Thirty-nine consecutive patients with 3- and 4-part proximal humeral fractures and fracture dislocations were treated with hemiarthroplasty. After an average of 42 months (range 5 to 98 months) of follow-up, 17 women and 8 men (average age 64.5 years) were evaluated with the University of California-Los Angeles (UCLA) scale, the Constant-Murley scale, the Hospital for Special Surgery (HSS) scale, and the visual analogue scale. Fair, good, or excellent results were achieved in 80% of the patients on the UCLA and Visual scales, in 72% of the patients on the HSS scale, and in 44% of the patients on the Constant-Murley scale. The highest correlation was between the HSS score and the Visual analogue score. According to the UCLA and Constant-Murley results, the outcome after early (<4 weeks) humeral head replacement was significantly better than after late (> or =4 weeks) humeral head replacement (UCLA score, P=.02; Constant-Murley score, P=.01). After early hemiarthroplasty active forward flexion was significantly better (P=.035). Thus the decision to perform prosthetic humeral head replacement in elderly patients should be made as early as possible after trauma.
Aged↗
Successful resuscitation of a child with severe hypothermia after cardiac arrest of 88 minutes.
A 4-year-old boy broke through the ice of a frozen lake and drowned. The boy was extricated from the icy water by a rescue helicopter that was dispatched shortly after the incident. Although the boy was severely hypothermic, no cardiac response could be induced with field resuscitation measures, including intubation, ventilation, suction, and cardiopulmonary resuscitation. On admission, the primary findings included fixed, nonreacting pupils and asystole. The first core temperature measured was 19.8 degrees C (67.6 degrees F). During active, external warming, the first ventricular beats were observed 20 minutes after admission, and changed 10 minutes later to a sinus rhythm. Continuous monitoring included repeated arterial blood gas and electrolyte tests; prophylaxis for cerebral edema was performed with hyperventilation and administration of sodium Brevimytal and dexamethasone. Seventy minutes after admission, hemodynamics stabilized and the boy was transferred to the pediatric intensive care unit (PICU), where active external warming was continued to raise the core temperature at a rate of 1 degree C/hour. Adult respiratory distress syndrome developed, and the boy had to be ventilated in the PICU for 10 days. He was discharged home after another two weeks. He recovered fully. The rapid heat loss with the induction of severe hypothermia (< 20 degrees C; 68 degrees F) was the main reason for survival in this rare event of a patient with cardiac arrest lasting 88 minutes after accidental hypothermia.
Child, Preschool↗
[The importance of roentgenological and scintigraphic studies in patients with and without thigh pain following cementless PCA hip endoprosthesis].
Persisting postoperative thigh pain is a common problem in cementless total hip prostheses occurring in a rate of about 15-20% of the patients. The reason for that phenomenon has not become clear so far. In a clinical, radiological and scintigraphic study 70 patients with 81 PCA cementless total hips were randomized in groups with (n = 34) and without significant thigh pain (n = 36). All patients underwent clinical examination including a standardized questionnaire, x-ray and 3-phase bone scintigraphy. Quantitative assessment of Tc-99m-MDP uptake was made. In the group of patients with persisting thigh pain the scintigraphic analysis showed an significantly increased uptake at the tip and the medial and lateral femur. These findings could not be correlated with clinical loosening of the prosthesis. Slight or moderate uptake in the area of the greater and lesser trochanter as well as the tip was a common finding in PCA prosthesis in all patients. In the radiological analysis no difference between both groups was evident. The study showed that patients with thigh pain after cementless PCA total hip prosthesis have specific regions of significantly increased uptake in scintigraphic examination (tip, medial and lateral femur), which cannot be correllated with clinically or radiologically signs of loosening. The morphologic reasons for the thigh pain remain unclear.
Adult↗
[Resorbable augmentationplasty and functional after care in fresh rupture of the anterior cruciate ligament. An improved treatment concept].
The initial stability of a reconstruction of an acute rupture of the ACL may be improved by a biodegradable augmentation with polydioxanon. This technique provides sufficient stability for a functional aftertreatment in a knee brace. The functional results of ACL reconstruction may be improved by this concept.
Braces↗
John Border Memorial Lecture. Trauma Care in Europe before and after John Border: the evolution in trauma management at the University of Hannover.
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History, 20th Century↗
Comminuted trochanteric femoral fractures in geriatric patients: the results of 231 cases treated with internal fixation and acrylic cement.
Instability, osteoporosis and the requirement of early mobilization are the main problems in comminuted trochanteric fractures in elderly patients. Correct reduction and the use of acrylic cement as an adjunct to internal fixation provide the stability for immediate weightbearing and subsequent bone union. In 213 patients there was no evidence of femoral head necrosis or non-union.
Aged↗