Search PubMed⌕ Search

Biomedical subjects

L Schweiberer

Publications and source records attributed to L Schweiberer.

At least 19 recordsLinked to original sources
PubMed1992

Inflammatory mediators, infection, sepsis, and multiple organ failure after severe trauma.

The relation of (multiple) organ failure (OF) to the release of inflammatory mediators and the incidence of infection and sepsis was studied prospectively in 100 patients with multiple trauma (injury severity score = 37). Sixteen patients died of OF, 47 patients survived OF, and 37 patients had no OF. Fifteen (24%) of the patients with OF showed no signs of infection. In patients with early onset of OF (n=45), infection followed with a lag of 2 or more days. In 16 (44%) of these patients, infection led to a deterioration in organ function. With late onset of OF (n=18), infection preceded OF in nine patients. Polymorphonuclear leukocyte-elastase, neopterin, C-reactive protein, lactate, antithrombin III, and phospholipase A discriminated significantly among the three outcome groups. Of all factors, only polymorphonuclear leukocyte-elastase showed a difference between patients with and without infection or sepsis, respectively. These data indicate that infection might not play a crucial role in the pathogenesis of posttraumatic OF in a substantial portion of patients with trauma. Early OF, especially, seems to be mainly influenced by the direct sequelae of tissue damage and shock (eg, the release of inflammatory mediators). Since infection and sepsis did not lead to an augmented release of mediators in patients with trauma, the role of both entities remains unclear.

Adult↗
PubMed1992

Refractures: a consequence of impaired local bone viability.

Bone necrosis secondary to avascularity may not only delay or inhibit consolidation of a fracture, it may also be a cause of refracture. Both initial trauma und surgical insult will determine the extent of necrosis. Only the latter is under the surgeon's control; it can be reduced by gentle soft tissue handling and by minimizing periosteal stripping. While the impact of avascular necrosis on fracture healing is well recognized, its role in the pathogenesis of refractures has received less attention. Cortical necrosis delays bridging of gaps; these gaps act as stress risers which, following resumption of full activity or after implant removal, can lead to refracture. Evaluation of 28 refractures in 25 patients, with biopsies in 14 patients, suggests that the duration of fracture immobilization through external or internal means must be sufficiently long to allow vascular invasion of necrotic areas, their substitution by new bone and bridging of the fracture. These processes must be followed by radiographic studies prior to implant removal. Special attention needs to be paid to adequate visualization of the fracture gap on successive radiographs.

Adolescent↗
PubMed1992

Hemodynamic effects following intraperitoneal infusion of pancreatic ascites fluid.

Severe necrotizing pancreatitis is accompanied by release of hemorrhagic ascites fluid (HAF), which is thought to be related to the occurrence and frequency of cardiocirculatory and pulmonary failure as a consequence of acute pancreatitis. The purpose of this study was to evaluate the role of HAF due to these systemic complications. Experiments were performed in 25 pigs (mean b.wt. 22 +/- 1 kg) under general anesthesia and mechanical ventilation. The animals received 50 ml/kg b.wt. i.p. of either physiologic saline solution (control CO, n = 9) or hemorrhagic ascites fluid (HAF, n = 16). HAF was obtained from 16 pigs with pancreatitis induced by intraductal infusion of bile salt. Eight animals in the HAF group were pretreated with indomethacin (10 mg/kg i.v. INDO/HAF). All animals were followed up for 6 h. Mean arterial pressure, cardiac output, and stroke volume fell significantly in the HAF (-25%, -27%, -27%) and in the INDO/HAF groups (-24%, -20%, -17%) as compared with controls (-6%, -6%, -6%). Also, left ventricular end-diastolic pressure (LVEDP) decreased by 52% and 48% in both HAF recipient groups, whereas LVEDP was unchanged in the control group. Myocardial contractility (Vmax) remained unaltered in all experimental groups. No significant differences in gas exchange and lung dry/wet weight ratio were observed. Lipase and PGI2 of the unpretreated HAF group rised to 203% and 198% in arterial blood at 6 h compared with unaltered levels in the control group. No increase of prostanoid concentrations was detected in the indomethacin-pretreated group, whereas lipase increase by a comparable extent as in the HAF group. We conclude that the early consequences of HAF are mainly characterized by systemic hypotension due to hypovolemia.

Acute Disease↗
PubMed1992

Establishment of a pneumococcal septicemia model in the miniature swine.

Human pneumococcal septicemia, the prominent postsplenectomy complication, was as yet difficult to study in the porcine model, since this species appeared to be fairly resistant against pneumococcal infections. We have used two strains of pneumococci (serotype 1 and 6B) both of which had been isolated from patients with systemic infection and both of which were maintained in a virulent state by regular mouse passage. After challenge with 10(9) type 1 pneumococci, however, only one of the 5 pigs developed fever, none showed profound hematological alterations and each animal exhibited a rapid clearance of bacteria from peripheral blood. By contrast, challenge of 7 animals with type 6B pneumococci resulted in a slower and incomplete bacterial clearance with persistent bacteremia for up to 24 hours. All animals developed fever and a profound leukopenia with less than 5,000 leukocytes/ml and 3 of the 7 animals died after injection of type 6B pneumococci. The results show that potentially the type 6B pneumococci can be successfully employed for studies of gram positive septicemia in the miniature swine.

Animals↗
PubMed1992

Is aggressive surgical palliation of proximal bile duct cancer with involvement of both main hepatic ducts worthwhile?

The only curative treatment for proximal bile duct cancer with involvement of both main hepatic ducts is liver transplantation. Most patients do not fulfill the requirements for liver transplantation. Our treatment strategy in appropriate cases is palliative tumor resection and reconstruction of the biliary passage by sutureless bilioenteric anastomosis. We have treated 12 patients, 5 in combination with intraluminal and percutaneous radiotherapy. Our results indicate that this strategy leads to effective palliation in some cases provided that only microscopic residual tumor is left in-situ. Our survival times compare favourably with survival after liver transplantation.

Aged↗
PubMed1992

Accurate diagnosis of acute appendicitis: a retrospective and prospective analysis of 686 patients.

OBJECTIVE: To formulate a score system that would make the preoperative diagnosis of acute appendicitis more accurate. DESIGN: Retrospective then prospective study. SETTING: City University Hospital. SUBJECTS: 536 patients who had their appendixes removed between 1981 and 1986 (retrospective study), and 150 consecutive patients admitted with a presumptive diagnosis of appendicitis between 1987 and 1988 (prospective study). MAIN OUTCOME MEASURES: Correlation between the histological diagnosis of appendicitis and variables representing history, clinical examination, and laboratory investigations. RESULTS: The rate of histologically proven negative appendicectomies in the retrospective series was 40% and in the prospective series 33%. The variables that were thought to be predictive were: male sex, white cell count of greater than 11 x 10(9)/l, history of less than 24 hours with no previous complaints, rebound tenderness, shift of pain from the epigastrium, and localised guarding, but all criteria had low specificities and sensitivities when applied prospectively, and combining the scores did not improve them. CONCLUSION: The accurate diagnosis of appendicitis depends largely on the experience of the surgeon and is not improved by the application of a score system that includes the above variables.

Acute Disease↗
PubMed1992

[Biochemical factors as objective parameters for assessing the prognosis in polytrauma].

One hundred patients with multiple injuries (mean ISS 37 patients) were prospectively evaluated over a period of 14 days following trauma. Significant differences in the blood levels of PMN elastase, cathepsin B, lactate, neopterin, C-reactive protein (CRP) and antithrombin III (ATIII) were found in non-survivors and in survivors with and without organ failure. On admission, a prediction of organ failure was possible with an accuracy of 63% to 69% (PMN elastase, cathepsin B, ATIII). Death was predictable with an 80% to 90% accuracy within the first 4 days (PMN elastase, lactate, CRP, neopterin). The prognostic value of these factors was comparable to trauma scores regarding organ failure and better with respect to death. Biochemical parameters may be helpful in estimating the severity of the injury and prognosis and in monitoring the ICU course of such patients.

Acute-Phase Proteins↗
PubMed1992

[Diagnosis, classification and indications for surgical treatment of pelvic ring fractures].

In cases of high-energy trauma, it is well known that there is a high incidence of pelvic fractures. The mechanism of injury, inspection and physical examination of the victim at the accident site direct attention to a pelvic fracture. In most cases, the first radiological examination (A.P. X-ray of the pelvis, oblique view of the obturator and oblique view of the ilium) shows the extent of the bony lesion. The diagnosis and therapy of lesions of the urinary tract, of intra-abdominal organs and blood vessels are vitally important. For the definitive operation of unstable pelvic ring fractures, additional diagnostic means, i.e., CT scans to distinguish posterior instability, can be necessary. Osteosynthesis can only be successful in the pelvis if one has a biochmechanical understanding of the physiological flux of force from the neck of the femur via the acetabular fossa to the sacroiliac joint. The sacroiliac ligaments have a particularly important support function. For assessing stability and classifying the traumatic patterns, it is helpful to use Pennal's classification, which takes the direction of the action of force into account. Three basic forms can be distinguished: anteroposterior compression, lateral compression and vertical avulsion. Depending on the extent of the traumatic pattern, one can distinguish three subtypes: type 1 is treated conservatively while types 2 and 3 require surgical treatment. The biochmechanics, traumatic patterns, diagnostics and treatment techniques applied are described clearly and with good illustrations.

Biomechanical Phenomena↗
PubMed1992

[The effect of various sterilization procedures on the osteoinductive properties of demineralized bone matrix].

To minimize potential infection following the transplantation of allogeneic bone, extremely rigorous selection of donors and careful processing and storage of samples are required. Other major problems related to allogeneic transplants, such as reduced osteogenic properties and immunological reactions, led to the development of demineralized bone matrix (DBM). This osteoinductive bone extract is largely free of antigens and is easy to produce. However, to eliminate the potential risk of infection, DBM should be sterilized prior to implantation. The purpose of this study was to investigate the influence of different sterilization techniques on the osteoinductive properties of DBM. A series of 76 cortical defects (drill holes) 0.6 cm in diameter in the tibiae of 11 Merino sheep were filled with DBM in addition to autogeneic and allogeneic cancellous bone. Prior to implantation DBM was sterilized by autoclaving, gamma irradiation, or application of ethylene oxide or ethyl alcohol. A further 12 drill holes were left empty as controls. The formation of new bone was examined 3 and 6 weeks postoperatively, using histological, fluorescent-optical and microradiographical techniques. The amount of newly formed bone was also quantified. Apart from autoclaved DBM all matrix grafts showed excellent new bone formation following sterilization, by far exceeding the formation with allogeneic cancellous bone.

Animals↗
PubMed1992

[Intra-articular calcaneus fracture. Classification in CT as a prerequisite for therapeutic decision and quantitative comparison].

Whether conservative or operative management is selected for intra-articular fractures of the os calcis depends on subjective factors and on the surgeon's experience. There is no classification available that allows ranking of such fractures according to the extent of destruction and the degree of dislocation at the same time. CT scans of 44 calcaneal fractures have been used to elaborate a new classification system for calcaneal surfaces. According to the involvement of joint surfaces, especially of the posterior facet, the degree of dislocation and the number of fragments of the posterior facet, six classes are defined. Within each class of fracture, the formation of "steps" in the posterior facet, widening of the heel, loss of height and deviation of axes are quantified. The new classification provides an instrument for use in the evaluation of joint destruction and dislocation. It helps to provide an objective basis for decisions between functional treatment and open reduction with internal fixation and for prospective analysis of fracture treatment.

Adolescent↗
PubMed1992

[Vascularized fibula transfer. A review].

The first vascularized fibula transfer was done by Ueba et al. (1983) in 1974 and has since become a standard technique for special indications in the English, French, Japanese and Chinese-world. Within the last 5 years this technique has received more and more attention in the German-speaking countries. The vascularized fibula transfer is successfully used to reconstruct segmental bone defects larger than 5 to 8 cm that are caused by trauma, tumor, pseudarthrosis or congenital defects. When used to treat osteomyelitis, the vascularized fibula transfer failed to fulfill expectations. Bone defects smaller than 10 cm can also be treated by vascularized iliac crest transfer. To achieve rapid healing, the following points must be followed carefully: when treating osteomyelitis, the infection must be healed--negative cultures and good granulation tissue--prior to bone transplantation. Application of systemic or local antibiotics and aggressive debridement of necrotic bone and soft tissue must be carried out until the cultures taken from the wound are negative. Soft tissue defects must be treated by soft tissue transfer in order to facilitate wound closure with well-vascularized tissue. Vascularized bone transfer should be the treatment of choice for the femur and upper extremities. Precise preoperative planning, especially in high-energy trauma cases, reduces the complication rate. Rigid internal fixation of the bone graft with the recipient site by a smaller proximal and distal plate or by a plate bridging the whole bone defect running parallel to the fibula graft leads to rapid healing without malalignment.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Neoplasms↗
PubMed1992

[The value of extended resection in locally advanced bronchial carcinoma].

A retrospective study on 68 patients with non-small-cell lung cancer (NSCLC) treated by extended resections is presented. Compared to simple resections extended resections carried a higher risk for postoperative complications, whereas 30-days-mortality was not influenced by type of resection. Analysis of survival rates after extended resections revealed no influence by T- or N-stage, whereas a residual tumor lowered the survival rates significantly. Overall, a 2-year-survival rate of 35% was observed after extended resections. In conclusion, even in locally advanced cases of NSCLC a resection with curative intent seems to be warranted, provided that a R0-stage can be achieved by surgery.

Carcinoma, Bronchogenic↗
PubMed1992

[Trauma scores: reproducibility and reliability].

The inter-rater reliability of the Injury Severity Score (ISS) and the Polytraumaschlüssel (PTS) [multiple trauma code] was studied using diagnosis sheets filled in for 107 multiple injured patients. The scoring was performed by eight physicians with different levels of qualification. The scores for individual patients varied widely depending on the scorer, with extremes differing from the mean by about 80% and 70% for the ISS and PTS, respectively. The mean ISS and PTS for the whole study population also varied significantly between the scorers (P less than 0.0001, one-way analysis of variance). Raters with experience in trauma scoring calculated significantly higher scores (P less than 0.01, t-test) Neither the ISS nor the PTS seem reliable enough to describe injury severity in an individual patient. Treatment decisions must not be based on such grounds. Even for larger groups, caution must be exercised in comparison of different populations of multiple traumatized patients.

Humans↗
PubMed1992

[Closed treatment of fractures of the humeral head. Indications, technique, limits].

Beginning with the specific mechanism of injury and characteristic physical and radiographic signs, the different forms of conservative treatment of fractures of the upper humerus are presented. As a result of biomechanical principles, the forces that generate the fracture cause dislocations of the fragments, and these dislocations follow basic rules. A fracture is considered dislocated if any of the fragments are displaced over 1 cm or if the angulation is more than 45 degrees. In dislocated fractures of the proximal humerus, reduction is indicated. The technique is presented in detail for the different types of fractures. Minimally displaced fractures or those that may be reduced by closed methods and do not redislocate are usually managed by conservative treatment. The affected shoulder is immobilized as a rule in a Gilchrist sling for 1-2 weeks. Functional exercises begin as soon as false motion of the fracture can be excluded by careful examination. In order to achieve optimal functional recovery, the exercises should be continued for longer than the bone union; that can be expected at 6-8 weeks. The special features and limitations of conservative treatment are discussed in relation to the different types of fractures.

Combined Modality Therapy↗
PubMed1992

[Corrective interventions subsequent to humeral head fractures].

The complications of old fractures of the proximal humeral head and fracture dislocations are nonunion, malunion, osteonecrosis, early traumatic arthritis, chronic dislocation and instability with subluxation. We reviewed a consecutive series of 34 shoulders that were treated between 1986 and 1990. We performed 7 hemiarthroplasties and 11 total shoulder arthroplasties (Neer type) in 17 patients (group I). Group II consisted of 12 osteotomies, 3 internal fixations for nonunion (AO technique), and 1 shoulder arthrodesis. The average follow-up was 27 months (group I) and 26 months (group II), respectively. The results were: good in 32%, fair in 50%, and poor in 18% in group I; excellent in 6%, good in 62%, and fair in 32% in group II. The results indicate that varus/valgus-osteotomies and derotation osteotomies should be considered as an alternative procedure prior to arthroplasties before traumatic arthritis has developed. Internal fixation for nonunion (AO technique) is a replacement for hemiarthroplasty.

Adult↗
PubMed1992

[Scapula fractures--classification and differential therapy].

The classification of fractures of the scapula (type A: body and process fractures; type B: neck fractures; type C: glenoid fractures) is shown, and the indications for conservative and operative treatment are described, as are the surgical approaches and operative techniques. In our hospital, 93 patients with 153 fractures of the scapula type A, B or C (ratio 1.6:1) were treated. This ratio was 1.7:1 in patients treated by operation. The indication for operation was usually glenoid fractures with accessory process fractures.

Adolescent↗
PubMed1992

[Special status of lateral clavicular fracture].

Fractures of the lateral clavicle have different biomechanical conditions compared with fractures of the medial and central third; they therefore demand different therapy. Some 237 patients with fractures of the clavicle were followed, of which 75 (33%) were located in the lateral third of the clavicle. At the 5-year follow-up after exclusively conservative treatment, good results were found for Neer types I and III and 3 Jäger/Breitner type IIb fractures, while 4 out of 13 Jäger/Breitner type II a fractures ended in pseudarthroses (31%). Conservative treatment is recommended for Neer types I and III, as well as for the more stable Jäger/Breitner type II b and old II a fractures. Therefore, a new bandage is presented. It prevents the posterior and upward dislocation of the proximal fragment by vertical compression and rotation of the distal fragment by fixation of the arm. Open reduction and internal fixation by preferably extraarticular implants is recommended for unstable and dislocated Jäger/Breitner type II a fractures. For fractures of the lateral clavicle, good results can be achieved when the instability is recognized and adequately treated.

Acromioclavicular Joint↗