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Biomedical subjects

L Schweiberer

Publications and source records attributed to L Schweiberer.

At least 145 records · Page 8Linked to original sources
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↗
PubMed1992

[Pelvic girdle fractures--must they be stabilized?].

Osteosynthesis can only be successful in the pelvis if one has a biomechanical 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 here. 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 traumatic patterns and treatment techniques applied are described clearly and with good illustrations.

Biomechanical Phenomena↗
PubMed1991

Oleic acid induced pancreatitis in pigs.

An experimental model of edematous pancreatitis in pigs was established and measurement of pancreatic macro- and microcirculatory parameters and determinations of pancreatic enzymes (lipase, phospholipase A) and vasoactive mediators (prostanoids, kallikrein, kininogen) were performed. During general anesthesia the pancreas was isolated in situ. Pancreatic microcirculatory parameters were measured using videofluorescence microscopy after iv administration of FITC-Dextran. In hourly collected samples lipase and phospholipase A activities were determined enzymatically, concentrations of kallikrein, kininogen, and selected prostanoids were measured by radioimmunoassay. Two experimental groups were studied: (1) control (n = 9); (2) edematous pancreatitis induced by injection of oleic acid into the pancreatic artery (free fatty acid, ffa; n = 10). The animals were followed up for 6 hr. Systemic hemodynamic parameters remained constant in both groups. In the pancreatitis group pancreatic blood flow and O2-consumption decreased significantly (-55 and -49%), while pancreatic vascular resistance increased significantly (+50%). During baseline conditions 41% of all capillaries were perfused. In the pancreatitis group there were both areas with persistent stasis as well as areas with continuous perfusion. However, in the latter areas the portion of perfused capillaries decreased significantly to 27%. In the control group the portion of perfused capillaries remained constant. Liberation of lipase and phospholipase A especially into lymph and ascites fluid was measured during pancreatitis. Furthermore, considerable releases of kallikrein into lymph (+50%) and ascites (+800%) and a marked consumption of kininogen in lymph (+90%) and in ascites fluid (+80%) were measured. Activation of the arachidonic acid cascade and a significant release of prostacyclin and thromboxane A2 into pancreatic venous blood and lymph was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1991

A triazolodiazepine platelet activating factor receptor antagonist (WEB 2086) reduces pulmonary dysfunction during endotoxin shock in swine.

We wanted to determine the effects of WEB 2086, a platelet activating factor (PAF) antagonist, in lipopolysaccharide (LPS) shock in anesthetized pigs. In a randomized study, LPS from S. abortus equi, 2 micrograms/kg/h was given IV for six hours. Thirteen animals received LPS and WEB 2086, 10 mg/kg/h IV for 6.5 hours, beginning 30 minutes before LPS. Eleven septic controls received saline and LPS, three nonseptic controls received saline and WEB 2086, and three nonseptic controls received saline only. In six animals we investigated the effect of synthetic PAF in doses between 50 and 10,000 ng on arterial (AP) and pulmonary arterial (PAP) pressure before and during infusion of WEB 2086. The LPS-induced rise in PAP was reduced by WEB 2086 (p = 0.01) but not the decrease in AP. The LPS-induced leukopenia, hypoxia, increase in airway pressure, and release of plasminogen activator inhibitor were reduced by WEB 2086. Platelet activating factor produced an increase in PAP and a biphasic response in AP. All PAF dose response curves were shifted to the right by WEB 2086. Platelet activating factor was a pulmonary hypertensive agent and contributed to the LPS-induced respiratory alterations.

Animals↗
PubMed1991

Beneficial effect of liposome-encapsulated muramyl tripeptide in experimental septicemia in a porcine model.

In a porcine model of pneumococcal septicemia, animals were pretreated with 1 mg of liposome-encapsulated muramyl tripeptide phosphatidylethanolamine (MTP-PE) or with liposomes alone. After 24 h each animal received an injection of either 10(9) or 10(10) pneumococcal serotype 6B cells. MTP-PE pretreatment resulted in less pronounced leukocytopenia, with a nadir of 6,700 (versus 4,100) leukocytes per mm3 after injection of 10(9) bacteria and a nadir of 4,400 (versus 3,800) leukocytes per mm3 after injection of 10(10) bacteria. At the same time bacterial clearance was substantially improved by MTP-PE pretreatment. Finally, pretreatment with MTP-PE dramatically reduced mortality; the average death rates for both series of animals used were 55% for liposome-pretreated animals and 3% for animals pretreated with MTP-PE-containing liposomes. These results in a preclinical model suggest that treatment with MTP-PE-containing liposomes might be beneficial in controlling septicemia in patients at risk.

Acetylmuramyl-Alanyl-Isoglutamine↗
PubMed1991

Posttraumatic splenectomy does not influence human peripheral blood mononuclear cell subsets.

The immunological and functional consequences of splenectomy in patients with severe trauma are still controversial. In addition to the higher incidence of bacterial infections, including the post-splenectomy sepsis syndrome, alterations of the peripheral blood mononuclear cells (PBM) have been described in patients after splenectomy. We studied the effects of splenectomy in severely injured patients on the number of PBM subsets 30-80 (median 55) months after splenectomy. Compared to a control group of patients with a similar age and a similar severity of trauma there was no significant difference between splenectomized and non-splenectomized patients regarding the absolute and relative numbers of monocytes, B cells, T cells, CD4+ cells, CD8+ cells, NK cells, CD57+/CD8+ cells and CD4+/CD8+ cells. The CD4/CD8 ratios were within the normal range. In two trauma patients without splenectomy the CD57+/CD8+ cells were found to be elevated to 635 and 513 cells/mm3 compared to less than 100 CD57+/CD8+ cells in controls. Except for a slight thrombocytosis in the splenectomized patients (p less than 0.05) the differential cell count showed no difference between both groups. Our data thus suggest that, in a controlled study, splenectomy has little if any effect on peripheral blood mononuclear cell subsets, while severe trauma on its own may have a profound long term effect on T cell subsets in some patients.

Adolescent↗
PubMed1991

[Organization of a bone bank].

The transmission of infectious diseases by allografts from bone banks has led to considerable restrictions on bone transplantations. HIV and hepatitis are considered to be the most dangerous diseases transmitted in this way. To prevent the transmission of any infections, extensive precautions have to be applied when allografts are taken and during their storage. Donors have been checked for infectious diseases at the time of collection and 3 months later. In addition, the donated grafts must be cultured for aerobic and anaerobic bacteria. This elaborate series of tests can only be mastered if the bone bank is tightly organised. The number of available grafts also be increased by sterilisation and the use of demineralised bone matrix.

Acquired Immunodeficiency Syndrome↗
PubMed1991

[Abdominal sonography versus peritoneal lavage in shock site diagnosis in polytrauma].

Diagnostic peritoneal lavage (DPL) and abdominal sonography (AS) were prospectively evaluated in emergency room diagnostics of blunt abdominal trauma in 106 multiple injured patients (ISS 40 pts). The incidence of intraabdominal lesions was 38.7%. 82 DPL and 64 AS were performed. In 45 patients both procedures were done, in 19 patients only AS and in 37 patients only DPL. The over-all accuracy of DPL and AS was 95% and 88%, respectively. Sensitivity was 91 vs. 74%, specificity 98 vs. 95%. The combined use of both procedures increased accuracy to 98%. We conclude that AS is the initial screening method for the detection of intraabdominal lesions in multiple injured patients. In any case of negative AS and hemodynamic instability or ambiguous AS, DPL should be performed immediately to improve diagnostic accuracy without delaying treatment.

Abdominal Injuries↗
PubMed1991

[Knee joint hemarthrosis. An absolute indication for operation?].

The degree of severity of an injury of the knee joint is estimated mainly on the basis of the history given by the patient, stability testing and hemarthrosis. Once these are known the surgeon usually decides whether an arthroscopy should be done or not. In a group of 365 patients who had undergone arthroscopy after acute knee injury, we made a retrospective check of the indications. The purpose of the study was to evaluate the sensitivity of hemarthrosis as an indicator of severe injury of the knee joint necessitating operative treatment. For stability testing we used the varus and valgus stress test, the Lachman test, the Anterior drawer test, the pivot shift test and the anterior drawer test with medial and lateral rotation. The Lachman test was repeated under general anesthesia in the majority of patients just before the arthroscopy. The results were evaluated retrospectively with the aid of electronic data processing. In nearly 70% of cases the arthroscopy was indicated because of positive signs of instability together with a typical history provided by the patient or hemarthrosis. In another 27%, the hemarthrosis was the sole reason for the surgeon's decision to perform an arthroscopic investigation of the injured knee joint. In 80.5% of all cases the clinical diagnosis of lesion of the anterior cruciate ligament (ACL) or combined injury to ligaments and menisci was confirmed by the arthroscopy. In addition to this group, in another 10.8% we found other severe lesions necessitating by operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[The value of computerized tomography and of the surgical assessment for lymph node staging in bronchial carcinoma. A prospective study].

We evaluated the accuracy of computed tomography (CT) and of surgical assessment for lymph node staging prospectively in 108 patients with bronchogenic carcinoma. For CT/surgical assessment a sensitivity of 29/90%, a specificity of 93/63%, a positive predictive value of 49/39% and a negative predictive value of 85/96% were calculated on a node-by-node basis. Sensitivity and specificity of CT were highly influenced by the lymph node region studied and by typing of the tumor. Adenocarcinomas showed a high proportion of normal-sized metastatic lymph nodes whereas squamous cell carcinomas exhibited a high proportion of enlarged tumor-free lymph nodes. The diagnostic accuracy in predicting the correct N-stage by CT was determined with 54% for squamous cell carcinoma and 56% for adenocarcinoma. The surgeon predicted the N-stage correctly in 39% of squamous cell carcinoma and 69% of adenocarcinoma. In conclusion, accuracy of CT-scan is too low to renounce mediastinoscopy for routine use in preoperative staging of bronchogenic carcinoma.

Adenocarcinoma↗
PubMed1991

[Injuries of the pelvis and retroperitoneal organs].

About 50% of all patients with pelvic fractures present with associated injuries. Diagnostic and therapeutic guidelines follow the step-by-step regimen used in polytraumatized patients. Whereas lifesaving emergency operations are rarely necessary, most associated injuries are operated on after completion of the first diagnostic phase in order to preserve organ function. Injuries of the pancreaticoduodenal system and ruptures of the digestive tract are particularly difficult to diagnose. Stabilization of pelvic fractures will take place in the phase of delayed reconstruction, usually several days after the accident.

Abdominal Injuries↗
PubMed1991

[Tarsal tunnel syndrome. Nerve compression syndrome in the foot].

Pathological changes in sensation over the sole of the foot do not always correspond to the full area of distribution of the posterior tibial nerve. Some neurologists advise separate examination of the tibial nerve, the medial and lateral plantar nerves, in order to ascertain whether either or both might be affected. 60 preparations of cadaveric feet in the Department of Anatomy were examined. Using a measuring grid, the position and size of the nerves in the tarsal tunnel were assessed and the facial band which define and divide the osteofibrous canal delineated. The corners of the measuring grid were the tip of the medial malleolus (A), the tip of the calcaneal tubercle at its greatest distance from the medial malleolus (B) and the tuberosity of the navicular bone (C). These points can also be clearly identified clinically. They define a triangle whose sides A-B and B-C are of constant equal length and whose base A-C varies little. The operative approach includes a T-shaped incision of the retinaculum. The vertical line of the T lies underneath the skin incision. The horizontal line corresponds with the upper border of the abductor hallucis muscle. The upper border of the abductor hallucis is defined and the muscle retracted medially to expose the deep fascia. This layer is removed together with the connective tissue bridge which stretches between the fascia and the calcaneus. The plantar nerves are discovered and run to the sole of the foot without further obstruction.

Diagnosis, Differential↗
PubMed1991

[Fibrin-coated collagen fleece in thoracic surgery. Initial clinical experience].

After resecting procedures to the parenchyma of the lung the resection site was sealed with a collagen vleece combined with fibrin glue in 26 patients. No patient exhibited rebleeding. An air leak was present up to the first postoperative day in 19 patients, up to the third postoperative day in 5 patients. In two patients, duration of air leak extended beyond the third postoperative day, this was defined as therapeutic failure. The use of collagen vleece combined with fibrin glue represents a valuable contribution in thoracic surgery.

Adolescent↗