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Biomedical subjects

M Schnabel

Publications and source records attributed to M Schnabel.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Continuous stroke volume monitoring as "hemodynamic online monitoring" in polytrauma intensive care patients: technically possible--clinically necessary?].

PURPOSE: Is the measurement of continuous cardiac output useful for the management of polytrauma patients? METHODS: In a prospective non randomized study (ethic commission file 43/96) we evaluated the diagnostic and therapeutic impact of the CCO (continuous cardiac output measurement) for polytrauma patients on the ICU. The Baxter Vigilance System was used for measuring the continuous cardiac output. The CCO values were controlled once a day by the conventional "cold" thermodilution technique. RESULTS: All values are given as mean +/- standard deviation. The Patients were scored on the first day for ISS (injury severity score) (47 +/- 17) and APACHE II (15 +/- 5). The CCO was used no later than 12 hours after the initial treatment in 20 polytrauma patients. As clinical outcome parameters were chosen: days on ventilation (23 +/- 23 days), days on the ICU (31 +/- 26 days) and mortality (20%). The treating ICU physicians were asked in a standardized questionnaire, whether or not there was an impact of the CCO measurement on their therapy. Seven different surgeons were working with the system. CONCLUSION: The unique opinion was that the CCO device had an impact on their decision making in the fluid and drug management of the study patients. Our first experience, however, suggests that this device may become an important improvement in the management of haemodynamics in the early trauma phases. Before a wide-spread application of this method on the ICU an evidence based prospective randomized trial should be performed.

Adult↗
PubMed2001

[Selection of subjects: a problem of clinical trials in traumatology. Selection effects and the problem of representation as exemplified by a prospective randomized trial on whiplash injuries].

INTRODUCTION: The internal and external validity of studies is endangered by many factors, such as selection of subjects for inclusion. Selection bias itself is a major problem, but remains unmentioned and probably unexamined in the majority of published clinical trials in traumatology. AIM OF THE STUDY: The aim of this investigation was to detect effects of subject selection which occurred during our own prospective intervention study. The clinical trial compared subjects with whiplash injury who were either treated by early mobilization or immobilization (soft collar). MATERIAL AND METHODS: Source population, eligible subjects, study participants and final study participants were compared for differences on various items like age, gender and further sociodemographic as well as crash related factors and clinical findings. RESULTS: Between 21.08.1997 and 30.04.1999 a total of 732 patients was examined and treated after whiplash in our trauma department. The options for inclusion were met by 453 patients. While 346 escaped from the study, 107 agreed to participate. Of these another 39 patients dropped out of the study. Selection effects were detected on two different levels, leading to distinct statistical procedures from those proposed in the study protocol. CONCLUSIONS: Uncontrolled selection effects could undermine the interpretability of the results of clinical trials. Awareness of selection effects is mandatory regarding the applicability of these results to subjects, other than those in the group of the final study participants.

Humans↗
PubMed2000

[The Referral Field Hospital of the Emergency Response Unit (ERU) of the German Red Cross].

INTRODUCTION: Emergency Response units (ERUs) have been developed as a part of the International Federation of Red Cross and Red Crescent Societies strategy to provide fast and effective medical and technical help to victims of disasters of any kind. ERUs provide timely, professional and organised response in a standardised and streamlined way by a balanced composition of professional staff and predesigned equipment. METHODS: The German Red Cross ERUs "Referral Hospital" and "Specialised Water" took part in the world wide humanitarian help for refugees during the Kosovo war and actually for earthquake victims in Turkey. During the Kosovo-operation the ERU "Referral Hospital" and "Specialised Water" were situated in Macedonia close to the kosovarian boarder at refugee camp Stenkovec I. The Field-Hospital was responsible for all kind of medical emergencies, for a total number of more than 50,000 refugees. RESULTS: During the mission 6225 patients were treated in our Out Patient Department; 541 were hospitalised. Among those 102 medium and major surgical procedures and 105 deliveries were performed. Surprisingly there was no increased rate of infections or perinatal deaths. CONCLUSIONS: During the Kosovo war and actually in Turkey the ERU concept prove itself to be a powerful strategy to provide fast needed medical help to victims of different kind of disasters. Humanitarian work in situations of war, internal disorder and various states of emergency in foreign countries and cultures demand flexibility and the ability to improvise while working under such conditions. The confrontation with non-combatants injured by buried landmines is underlining the growing world-wide demand for a total ban on these vile weapons.

Adult↗
PubMed2000

[Dilatation technique with the TNS (transcutaneous nail insertion system) for minimally invasive implantation of intramedullary nails at the proximal femur].

A new technique of a minimally invasive approach to the proximal femur was developed for the management of per- and subtrochanteric fractures using intramedullary nail blade systems. For creating the entry portal at the proximal femur a transcutaneously applied Kirschner-wire is used. Subsequently, a new developed trocar system (TNS) for the protection of the soft tissue during reaming procedures is placed via a small cutaneous incision. The reaming of the femoral shaft can be performed through this trocar system. A new targeting jig especially adapted to the gliding nail was used in this first series. From December 1998 to June 1999 12 patients were treated with this new technique in the Department of Trauma Surgery of the Philipps-University in Marburg. The mean age of the 8 female and 4 male patients was 78 (+/- 12) years. The majority of the total group were old patients with a mean ASA score of 3-4. Relevant intraoperative complications using the new dilatation approach were not observed. All patients were mobilised after few days. Postoperative complications or infections were not found. In the clinical practice of the management of per- and subtrochanteric femoral fractures the new dilatation approach has proved to be more comfortable and minimally invasive than the standard technique existing to date.

Aged↗
PubMed2000

[The dilatation technique with the novel trocar system for minimally invasive implantation of intramedullary nails at the proximal femur].

A new technique of a minimally invasive approach to the proximal femur was developed for the management of per- and subtrochanteric fractures using intramedullary nail blade systems. For creating the entry portal at the proximal femur a transcutaneously applied Kirschner-wire is used. Subsequently, a new developed trocar system (TNS) for the protection of the soft tissue during reaming procedures is placed via a small cutaneous incision. The reaming of the femoral shaft can be performed through this trocar system. A new targeting jig especially adapted to the gliding nail was used in this first series. From December 1998 to June 1999 12 patients were treated with this new technique in the Department of Trauma Surgery of the Philipps-University in Marburg. The mean age of the 8 female and 4 male patients was 78 (+/- 12) years. The majority of the total group were old patients with a mean ASA score of 3-4. Relevant intraoperative complications using the new dilatation approach were not observed. All patients were mobilised after few days. Postoperative complications or infections were not found. In the clinical practice of the management of per- and subtrochanteric femoral fractures the new dilatation approach has proved to be more comfortable and minimally invasive than the standard technique existing to date.

Aged↗
PubMed1998

[Calcaneus cyst--an indication for surgery? Case report and review of the literature].

Simple bone cysts are asymptomatic, benign lesions which are usually an incidental finding on a radiograph. Etiology and treatment are controversially discussed. The weight-bearing status of the calcaneus and possible pathologic fracturing lead many authors to recommend therapeutic measures after diagnosis has been made. We present a case report of an intact unicameral bone cyst of the calcaneus concomitant with tibial and talar fractures following crush trauma. Several types of treatment for simple bone cysts of the calcaneus have been suggested. The question whether treatment is unconditionally necessary is controversially discussed. It is the author's opinion, that asymptomatic bone cysts of the calcaneus require no further treatment.

Adult↗
PubMed1998

Detection of differential gene expression in human osteoblastic cells by non-radioactive RNA arbitrarily primed PCR.

The aim of the present study was to detect differentially expressed genes in the human osteoblast-like osteosarcoma cell line SaOS-2 using non-radioactive RNA fingerprinting (RNA arbitrarily primed polymerase chain reaction, RAP-PCR). RNA was isolated at different time points from SaOS-2 cells grown with and without dexamethasone (DEX). By RAP-PCR we detected changes in band patterns of cells treated with DEX compared with untreated cells. PCR fragments further characterized and sequences from three of these gave perfect matches to the coding sequences of the human nucleophosmin gene B23, cDNA clone 4_c6 from P1 H25 and the human TRA1 gene, respectively. differential regulation of these genes in DEX-stimulated SaOS-2 cells could be demonstrated by RT-PCR.

Antineoplastic Agents, Hormonal↗
PubMed1995

[Pseudothrombocytopenia: case reports and review of the literature].

BACKGROUND: Pseudothrombocytopenia (PTP) is an in vitro phenomenon with falsely low platelet counts determined automatically. Usually the thrombocytopenia is noticed accidentally without a corresponding tendency to bleeding. If this phenomenon is not recognized, misinterpretation may bring the patient into a considerable risk by diagnostical and therapeutical mistakes. By own cases and analysis of the literature, causes, appearance. incidence, as well as diagnostic and clinical problems of PTP shall be explained in detail. CASUISTICS: We report on three patients who showed a significant decrease of platelet counts after surgery DIC (disseminated intravascular coagulation) and heparin-induced thrombocytopenia type II (white clot syndrome) were assumed primarily. In all three cases the reason for the low postoperative platelet counts was found to he due to PTP caused by cold agglutinins. CONCLUSION: From the cases described it can he concluded that PTP may develop during postoperative clinical course. Due to the broad differential diagnostic spectrum in the postoperative situation. PTP is hardly considered. Therefore, there is a greater chance of misinterpretation and therapeutic mistakes. In case of low platelet counts PTP should always be excluded, even when thrombocytopenia seems to be explicable differently.

Aged↗
PubMed1992

[Roentgen studies of the skull in head injuries--a multicenter study].

The multi-center study presented reveals that 76% of the conventionally performed X-ray investigations of the skull can be avoided without any relevance concerning the non-diagnosis of severe injuries. Only in 3.2% of all patients investigated a skull X-ray had instantaneous therapeutically consequences. Thus routinely performed skull X-rays are no longer acceptable in the light of cost reduction and radiation load. The clinical-neurological investigations however are inevitable to perform the state of the art treatment of patients with head injuries today, leading to computerized tomography if necessary. A check-list of clinical findings is presented to get the indications for conventional X-rays of the skull and to manage an effective use of such investigations in appropriate clinical situations.

Adolescent↗
PubMed1992

[Routine drainage following uncomplicated, elective cholecystectomy? A prospective, randomized study].

A prospective randomized and controlled study of prophylactic drainage after simple, elective cholecystectomy was carried out. From March 1988 to June 1991 80 patients received an Easy-Flow drain and 80 did not. Operation and perioperative management were standardized. The endpoint of the study was postoperative morbidity, especially postoperative pyrexia and subhepatic fluid collection. The latter was identified by ultrasonography performed daily on postoperative day 1-4. No patient died. The morbidity including postoperative pyrexia revealed no difference between drained and undrained patients. In 19 of the patients with (23.8%) and in 25 of the patients without drainage (31.3%) a subhepatic fluid collection could be demonstrated by ultrasonography. This difference was not statistically significant either. We conclude that prophylactic drainage after elective, simple cholecystectomy is of no use for the patient. As subhepatic fluid collections can be seen in drained as well as in undrained patients it has to be accepted that drainage does not guarantee the removal of subhepatic fluid. Therefore its indicatory function (bleeding) and the ability to prevent the patient having biliary peritonitis or local abscess has to be put in doubt.

Adult↗
PubMed1990

Histamine release induced by radiographic contrast media. Comparison between pulmonary and peritoneal mast cells derived from normotensive and spontaneously hypertensive rats.

Intravascular application of radiographic contrast media (RCM) can cause adverse allergic/pseudoallergic reactions in certain individuals. In view of the increased risk for the reactions associated with cardiovascular diseases, we have investigated histamine release from isolated mast cells derived from the peritoneal cavity and the lung of normotensive and spontaneously hypertensive rats. Six commonly used RCM were tested in their clinical formulations: Angiographin (amidotrizoate), Rayvist (ioglycate), Telebrix (ioxithalamate), Hexabrix (ioxaglate), Solutrast (iopamidol), and Ultravist (iopromide). The three RCM with low osmolality (Hexabrix, Solutrast and Ultravist) released little histamine from all cell populations tested. Mast cells derived from spontaneously hypertensive rats released significantly more histamine following challenge with high osmolar RCM than those derived from normotensive rats. Higher concentrations were required to elicit release from the peritoneal cells than from the pulmonary cells. These results indicate a role for underlying cardiovascular diseases in mediator release and should be followed up by investigations on basophils or mast cells obtained from control subjects and patients with cardiovascular disease.

Animals↗
PubMed1989

Radiographic contrast media-induced histamine release: a comparative study with mast cells from different species.

Radiographic contrast media in clinical use cause unwanted allergic and pseudoallergic reactions. To investigate the mechanisms of these reactions, studies on isolated mast cells from different species and sites are necessary. In this study, the effect of six commonly used contrast media on rat (peritoneal, lung) and human (lung) mast cells was investigated. The three preparations with low osmolalities (Hexabrix, Solutrast, Ultravist) released little or no histamine from the cells examined. In contrast, the three preparations with high osmolalities (Angiographin, Telebrix, Rayvist) were potent releasing agents. However, the degree of release and the order of potency was different depending on the cells investigated. Indeed, rat peritoneal mast cells required much higher concentrations before release was observed. Since the contrast media with low osmolality also cause histamine release and reactions in vivo, other systems (e.g. complement) must be additionally involved.

Animals↗