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Biomedical subjects

M Nerlich

Publications and source records attributed to M Nerlich.

At least 55 records · Page 3Linked to original sources
PubMed1996

Algorithms for early management of pelvic fractures.

The successful management of pelvic fractures depends upon proper diagnosis and timely treatment. Severe pelvic fractures are life-threatening injuries in which a clear-cut treatment strategy is required to make decisions within the shortest possible time. An algorithm is presented in the form of a flow chart that has proven useful in facing difficult situations in the initial management of pelvic fractures. Decision-making is based on progressive clinical examination and a series of key questions. The sequence starts with the arrival of the patient, followed by the resuscitation phase, proceding through the initial examination and assessment of the patient to the final diagnosis and appropriate treatment. A safe approach to pelvic fractures is gained by following the proposed algorithm. The algorithm is an excellent teaching tool, but no guarantee can be given since every case is different and requires a specific approach.

Algorithms↗
PubMed1993

[Quality assurance in trauma surgery--what does the TRISS method offer ?].

The TRISS method offers a standard approach for evaluating the outcome of trauma care. Based on the data of more than 150,000 patients, TRISS offers a method of calculating the individual probability of survival of trauma patients. The calculation is based on anatomical, physiological data and the age of the patient. The basic scores for using TRISS are the Revised Trauma Score and the Injury Severity Score. Recent analyses demonstrate for blunt trauma patients a sensitivity of 60.9% and a specificity of 99.2%. What does TRISS offer in comparison to other trauma scores? TRISS offers a valid approach for the screening of trauma patients regarding unexpected survival/death. Based on the largest database of trauma patients, TRISS represents a method of maintaining quality assurance for prehospital and hospital trauma patient care; it also allows comparison with international standards of trauma care.

Adult↗
PubMed1993

[Primary management of polytrauma. Comparison of a German and American air rescue unit].

Hospital-based helicopter services from German and American university-affiliated trauma centers were reviewed. All multitrauma patients transported via helicopter from the scene of the accident to the trauma center during a 1-year period were included. The patients were comparable regarding mechanism of injury, age, flight times, mean ISS, ISS distribution, and number of severe injuries per body region (patients with AIS > 3 for head, thorax and abdomen). Overall mortality for the German system was 21/221 (9.5%) and 21/186 (11.3%) for the American system (not significant). Survivor-based TRISS analysis yielded Z-statistics of +2.459 for the German, and +1.049 for the American system. There were 9 unexpected survivors (Ps < 0.5) in the German, 6 in the American system. There was a significant higher (P < 0.01) number of early deaths (< 6 h) in the American population (12, ISS 56) than in the German (4, ISS 64). Analysis of the prehospital data demonstrated significant differences in the mean volume of IV fluids infused: 1800 cc German, 825 cc American (P < 0.05); rate of intubation: 82/221 (37.1%) German, 24/186 (13.4%) American (P < 0.001); and thoracic decompressions: 20/221 (9.1%) German, 1/186 (0.5%) American (P < 0.001). Pre-hospital care in the German system is directed on-scene by a trauma surgeon member of the flight crew, compared to a nurse/paramedic team with remote medical control in the American system. Compared to an American trauma system, the German system demonstrates improved overall outcome as measured by survivor-based TRISS Z-statistics. More favorable German Z-statistics are in part related to fewer early deaths.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Blunt abdominal trauma in cases of multiple trauma evaluated by ultrasonography: a prospective analysis of 291 patients.

Early recognition of blunt abdominal trauma in patients with multiple injuries and in shock is of utmost importance and calls for a rapid screening method. The reliability of diagnostic ultrasonography in detecting hemoperitoneum in patients with multiple trauma was evaluated prospectively. From 1986 to 1990, 291 patients with severe multiple injuries (ISS greater than 20, mean ISS 31.2) were included in the study. Laparotomy was performed on 117 patients (40%). Initial ultrasound (US) findings showed a sensitivity, specificity, and accuracy of 89%, 97%, and 94%, respectively, in detecting intra-abdominal injuries requiring surgical repair. The positive and negative predictive values were 94% and 95%, respectively. A standardized management of frequent repeat US studies can even improve on these numbers. In our department ultrasonography has replaced diagnostic peritoneal lavage (DPL) as the diagnostic study of first choice. Diagnostic peritoneal lavage is reserved for selected cases only.

Abdominal Injuries↗
PubMed1991

[Results of treatment of compartment syndrome of the upper arm].

Only a small number of cases of compartment syndrome in the upper arm has been reported in the literature. The authors have reviewed 14 patients with 14 cases of compartment syndrome treated at their institution from 1980 to 1988. In the majority of cases in this series, compartment syndrome was caused by blunt, high-energy trauma. There were 9 patients with multiple trauma, 7 of whom were motor cyclists, and fracture of the upper arm was present in most of these. In 5 patients scapulothoracic dissociation with disruption of the neurovascular bundle of the upper extremity concerned was present. In this series, 2 patients died of their injuries and three arms had to be amputated. At final follow-up after an average of 45 months (range 11-91 months) the functional result was dependent mainly on the severity of the associated injuries. Patients with isolated compartment syndrome had full recovery of upper limb function.

Adolescent↗
PubMed1991

[Compartment syndrome of the forearm].

This paper reviews the etiology, clinical picture, treatment and follow-up in 25 patients treated for a forearm compartment syndrome at the medical school in Hanover. A volar-ulnar and, when indicated, a straight dorsal incision gave adequate decompression in all operatively treated patients. Follow-up examination revealed no damage or deficit that could be related to fasciotomy. Therefore, these results support the concept that operative treatment is widely indicated for forearm compartment syndrome.

Adult↗
PubMed1991

[Compartment syndrome of the thigh].

Compartment syndrome in the thigh is an uncommon condition. Most of the patients have multiple injuries. The main etiological factors are ipsilateral fractures of the femur and isolated severe soft-tissue injuries following blunt trauma. If the diagnosis is made clinically, compartment syndrome is treated by lateral incision of the thigh with incision of the fascia lata and the lateral intermuscular septum. Dermatofasciotomy does not lead to severe complications. In the follow-up there is no functional loss or neurological deficit. The indications for decompressive fasciotomy should be broad.

Adolescent↗
PubMed1991

[Compartment syndrome of the lower leg. Long-term results].

An analysis of 134 surgically treated compartment syndromes of the lower leg was combined with a long-term follow-up concerning late sequelae. Direct trauma including simple closed as well as severely comminuted open fractures of the tibia and fibula were predisposing factors for the development of a compartment syndrome. Clinical symptoms led to the correct diagnosis, supported by intracompartmental pressure measurements. A unilateral parafibular dermatofasciotomy involving opening all four compartments was the therapy of choice. Fifty-nine per cent of the patients had no late sequelae at the 4.2 year follow-up. 12% poor results were characterized by loss of function and neurological deficits. This group included 8 amputations above the knee due to ischemic/infectious muscle necrosis. The time interval between trauma and operation was found to be the main contributing factor to the poor results, with a delay of 23 h due to secondary referral of the patients. Fasciotomy per se showed only minimal morbidity and is strongly recommended as an emergency procedure.

Adolescent↗
PubMed1988

Thromboxane receptor blockade in an animal model of ARDS.

Manipulation of arachidonic acid metabolism may be important in the prevention and treatment of the adult respiratory distress syndrome. This study evaluated a thromboxane receptor blocker, BM 13.177, in a sheep endotoxin model. Sheep with chronic lung lymph fistulas were pretreated with the blocker before being given endotoxin. The blocker attenuated the early increase in pulmonary artery pressure usually seen after endotoxin (blocker + endotoxin, 31.0 +/- 14.5 mm Hg; endotoxin alone, 42.1 +/- 9.6 mm Hg). There was no effect on lymph flows during the later (permeability) phase (at 6 hours: blocker + endotoxin, 574 +/- 287% baseline; endotoxin alone, 311 +/- 102% baseline). Administration of the blocker alone increased pulmonary artery pressure, arterial pressure, and central venous pressure and decreased heart rate and cardiac index. Thromboxane receptor blockade presumably has little effect on elements of arachidonic acid metabolism other than thromboxane. Thromboxane appears to be important in the early pulmonary hypertension of the sheep endotoxin model but is relatively unimportant in the development of increased pulmonary capillary permeability.

Animals↗
PubMed1988

[Significance of lung contusion in mortality following polytrauma. Possibilities for therapeutic influence].

Multiple trauma is often associated with blunt thoracic injuries. Especially lung contusion can result in respiratory insufficiency and therefore a higher mortality rate. In our prospective study comparing 8 multiple trauma patients with and without associated lung contusion, we found that respiratory function was already significantly disturbed (decrease of paO2/FiO2 and increase of AaDO2, a rise in extravascular lung water (EVLW) both early after trauma and also with a second peak following the 4th day. This group (LK) developed significantly more cases of respiratory distress (ARDS). The disturbance of respiratory function seen initially was interpreted as a consequence of the direct mechanical impact, leading to the formation of interstitial fluid and hematoma. The frequent development of ARDS in the LK-group probably results from a pronounced activation of cellular and humoral mechanisms and therefore an enforced injury of the pulmonary capillary bed. A significant increase of pulmonary infections or the development of sepsis was not seen in the LK-group and is probably not responsible for the higher ARDS-rate in this group.

Adolescent↗
PubMed1984

Effect of nonprotein colloid on postburn edema formation in soft tissues and lung.

We studied the effect of a nonprotein colloid solution--namely low molecular weight dextran (LMWD)--on edema formation in burned and nonburned soft tissue and lung. Adult sheep with lung and bilateral flank lymph fistulas were given a unilateral 25% to 30% full-thickness burn under ketamine anesthesia and followed for 72 hours. Resuscitation (24-hour period) was performed with lactated Ringer solution (LR) (n = 9) or 10% LMWD in saline (n = 8) to restore baseline vascular pressures and cardiac output. Interstitial edema and microvascular protein permeability were monitored by lymph flow (QL) and lymph to plasma protein ratio, respectively. With LR, QL values in nonburned skin and lung were increased twofold to threefold in the first 24 hours, while with LMWD, values remained at baseline. The nonburn edema with LR was due to the burn-induced hypoproteinemia state. The prevention of this process with LMWD was due to the generation of a twofold to threefold increase in the plasma to interstitial colloid osmotic pressure (COP) gradient. Burn QL was increased fivefold in both groups despite a higher COP gradient with LMWD. Net fluid requirements for the first 24 hours were 75 and 35 ml/kg for animals treated with LR and LMWD, respectively. After cessation of dextran administration in the second 24 hours, the COP gradients for the two groups were equal but QL in nonburned skin and net fluid requirements now increased significantly in the LMWD group. The development of nonburn edema was believed to be due to the persistent hypoproteinemic state. We conclude that edema formation in nonburned tissues, which is due to hypoproteinemia, accounts for a substantial amount of the net fluid requirements after thermal injury. This process can be prevented by infusion of a nonprotein colloid as long as the COP gradient is increased. Edema in burned tissue appears to be unaffected by changes in COP.

Animals↗
PubMed1983

Effect of thermal injury on endotoxin-induced lung injury.

We studied the effects of a burn injury on the response of the lung to endotoxin. Seventeen unanesthetized sheep with lung lymph fistulas were studied. Eight were given Escherichia coli endotoxin (1.5 micrograms/kg) alone and nine were given the same dose 72 hours after a 25% total body surface burn injury. At this time after burn, all physiologic parameters were at baseline levels. A characteristic two-phase lung injury was seen after administration of endotoxin with an initial hypertension phase, characterized by pulmonary artery hypertension, and a second or permeability phase, characterized by an increase in protein-rich lymph flow. all eight animals that underwent only endotoxin administration survived, whereas four of the nine burned animals died during the permeability phase in pulmonary edema. Major physiologic differences between the groups were noted during the permeability phase, including a more severe hypoxia, pulmonary hypertension, and increased postburn lymph flow. Major biochemical changes included significant increases in lymph thromboxane, thromboxane B2, and beta-glucuronidase activity in the burn group. We conclude that the lung is more sensitive to endotoxin after burn, probably as a result of an increased release of products of arachidonic acid metabolism and products of leukocyte activation caused by the body burn.

Animals↗
PubMed1983

Resuscitation from hemorrhagic shock with hypertonic saline or lactated Ringer's (effect on the pulmonary and systemic microcirculations).

We compared the use of hypertonic salt solution (300 mEq Na/liter) with Ringer's lactate as an initial resuscitation fluid for the treatment of hemorrhagic shock. We monitored vascular pressures and cardiac output as well as microvascular function using chronic lymph fistulae in the lung and soft tissues to reflect transvascular fluid and protein flux. Seven unanesthetized sheep were bled to an aortic pressure of 50 mm Hg (2 hours) on two occasions 4-5 days apart, and were resuscitated initially with either lactated Ringer's (LR) or hypertonic saline (HS) to restore left atrial pressure to baseline. This was followed later by the blood return. We found that cardiac output with HS was significantly increased over that with LR, 8.9 +/- 1.8, compared with 6.0 +/- 1.1, in the immediate postresuscitation period with comparable volumes in both groups. Urine output was increased twofold with HS over LR. The initial pulmonary hypertension seen with LR was eliminated with HS. Lymph flow in lung and soft tissue increased to a comparable degree in both groups, the increase being explained by the degree of plasma hypoproteinemia which was present. We conclude that HS increases cardiac output with less net fluid, decreases pulmonary vascular resistance, and does not result in more edema formation when compared with lactated Ringer's as an initial fluid for treatment of hemorrhagic shock.

Animals↗
PubMed1982

Prognostic aspects in operated ankle fractures.

A long-term follow-up (3.5 years mean) of 106 operated ankle fractures out of 167 patients revealed 73.7% excellent and good, 16% acceptable and 10.3% poor results. Anatomically exact reduction was shown to be a prerequisite for good results and was seen in 77.2% of all cases. By neglecting biomechanical principles an insufficient reconstruction led to a poor final outcome. But even in 11% of the excellent operatively treated fractures late arthrosis developed. Statistical analysis showed that the onset of posttraumatic arthrosis was correlated with and predicted best by the number of single lesions. Dorsiflexion testing was the clinical parameter correlating best with the extent of the injury, the degree of arthrosis and the subjective complaints. This underlines the importance of assessment of dorsiflexion as a clinical screening test for remaining sequelae after ankle fractures.

Adult↗