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Biomedical subjects

W Glinz

Publications and source records attributed to W Glinz.

At least 19 recordsLinked to original sources
PubMed1992

Intestinal infarction after nonabdominal trauma; association with cerebral trauma.

Nonocclusive bowel infarction in nonabdominal trauma has been ascribed to periods of hypotension. However, to our knowledge only 17 cases have been reported, and hypotension was not always found. We studied the frequency and possible causes of intestinal infarction in all patients treated at our traumatologic intensive care unit from 1977 through 1986 (n = 2350). Intestinal infarction was diagnosed at the time of surgery or autopsy; patients with pre-existing vascular disease were excluded. We found 12 patients (incidence: 0.5%) of age 45 +/- 20 years (mean +/- SD). All had severe cerebral trauma [Head and Neck Abbreviated Injury Scale (AIS) score: 4-5, admission Glasgow Coma Scale (GCS) score: 6.5 +/- 3.8]. Eight patients suffered from additional injuries. The Injury Severity Score (ISS) was 27 +/- 7. All patients received ventilator assistance continuously before the diagnosis of intestinal infarction or death. The leading symptom of intestinal infarction was sepsis and multiple organ failure with abdominal distention. Five patients with favorable cerebral prognosis underwent surgery: one survived with good cerebral and gastrointestinal recovery. Four patients did not have surgery because of a poor cerebral prognosis. Three patients died of their cerebral trauma before intestinal infarction was clinically manifested. The data show that early diagnosis in ventilated patients with head injuries is extremely difficult because of the heterogenicity of this group of patients, the low frequency of the complication, and the complexity of the clinical picture. Although patients inevitably were exposed to several agents or situations associated with intestinal infarction, the ubiquitous causes were dehydration and diuretic therapy.

Adolescent↗
PubMed1990

[Injuries of the large brain-feeding arteries].

Among 2923 severely injured patients in the period 1980-1988, 17 had injuries or large supraaortic arteries. The incidence was 0.58%, with an overall mortality of 53%. In 75% of survivors there was a persistent neurological deficit. We treated 5 penetrating (A. carotis 4, A. vertebralis 1) and 12 nonpenetrating (A. carotis 11, A. vertebralis 1) injuries. In all penetrating carotid injuries (4) repair was performed on admission and mortality was 50%; 1 of 2 survivors has postoperative hemiparesis. Localization of nonpenetrating carotid injuries (11) was intrathoracic (2), in the neck (7) and intracranial (2). Main complication of nonpenetrating extracranial carotid injuries is neurological deficit (7/9) due to thrombosis (3) or stenosis (4) with embolism (2). Surgery was performed in 3 cases comprising pseudoaneurysm in 2 and concomitant aortic rupture in 1. Mortality was 44%, and 80% of survivors had persistent neurological deficits. Extracranial carotid injuries (n = 13) carried a mortality rate of 83% in occluded and 29% in nonoccluded vessels (p less than 0.05). Location of carotid injury in the neck (n = 11) carried a mortality of 55%, and intracranial (n = 2) of 100% respectively. Duplex-Doppler scanning of carotid arteries is a safe, noninvasive method which is essential in blunt carotid artery trauma. Prognosis is dependent upon the size of cerebral infarction. Once neurologic deficit has been established for more than 24 hours, reconstruction of the artery should be postponed and performed only for complications (pseudoaneurysm or embolization). Clamping of arteries without hypothermic circulatory arrest or shunt should be avoided. The danger of rupture in dissection and pseudoaneurysm is slight.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Simple references of the differential blood picture in assessing the immune status of immunologically compromised severely injured patients].

Infectious complications threaten the survival of severe traumatized patients in the intensive care unit. Major cause is a secondary immunodeficiency syndrome as a consequence of overloading the immune system by tissue debris and microbial antigens. Antigen presenting cells of the monocyte-macrophage line become activated unspecifically and produce immunosuppressive monokines, which modulate the T- and B-cell systems and weaken the specific immune response to antigens. In 150 severe injured patients (mean ISS 31; 15 patients died due to infections) we found that a decrease of lymphocytes below 1000/microliters and an increase of monocytes up to more than 1000/microliters within the first 24 hours correlate with developing infection in such a manner, that the lymphocyte/monocyte-quotient on day 1 was 2.0 in survivors and 0.9 in subjects, who died due to infections.

Cross Infection↗
PubMed1989

[Immunologic changes and infection in severely injured patients].

The severity of major surgery determines the extent of immunodeficiency which follows. The most pronounced immunodepression is found after severe blunt trauma; in polytraumatized patients the alterations of many measured parameters correlate with the injury severity score (ISS) i.e. with the severity of the injuries. Infection is also followed by many changes in the immune response. A score including serum concentrations of IgA, beta 2-microglobulin and percentage of monocytes was found to be predictive for the first 3 days after trauma with regard to subsequent occurrence of infection. In the first post-trauma day the lymphocyte-monocyte ratio correlates with the probability of survival or death by infection. Pneumonia occurred in 47% and septicemia in 22% of 150 polytraumatized patients ventilated artificially for more than 24 hours. The first signs of these infections were already present during the first 5 days, i.e. in the period of the most severe immunodeficiency. The preliminary results of a pilot study with immunomodulation by thymopentin are encouraging and show a significant decrease in the frequency of infections.

Humans↗
PubMed1989

[Open knee joint injuries (including vascular and nerve lesions)].

Immediate definitive reconstruction of all damaged structures leads to better results than delayed operations. If direct closure of the joint is not possible, local rotational flaps, muscle flaps or free skin-fat tissue flaps (i.e. a scapular flap) may be used. In injuries of the popliteal artery, the interposition of a saphenic vein graft is preferable to local reconstruction of the artery. Nerve injuries are the only exception to comprehensive primary repair. Reconstruction in these lesions is usually done later when all wounds are healed. The postoperative treatment includes the use of continuous passive motion whenever possible.

Fractures, Open↗
PubMed1989

[Knee arthroscopy today].

Arthroscopy is not only the most reliable diagnostic tool in disorders of the knee joint but it also allows a one-step procedure of diagnosis and therapy in many cases. Most arthroscopic operations can be performed without hospitalisation. Post-operative morbidity is usually low. An excellent or good result was achieved in 91% of arthroscopic partial meniscectomies. Costs were reduced by sFr 6000 to 7000 for arthroscopic operations compared with arthrotomy. The advantage of most arthroscopic procedures performed today has been proven; however, the clinical value of others (i.e. arthroscopic suture of meniscal tears, repair of cruciate ligaments and abrasion-arthroplasty) is still not clear. The frequency of complications is low (0.56%), and infections occur in less than 1%.

Arthroscopes↗
PubMed1989

[Arthroscopic surgery--current status and perspectives].

The morbidity after arthroscopic surgery is low; a hospitalization is not necessary in most patients. The possible operations of the knee joint include removal of loose bodies, resections on meniscus, plicae and synovium as well as more complicated procedures as suturing of a meniscus, total synovectomy and operations in patients with osteoarthritis. The advantage of the arthroscopic operation compared with arthrotomy is well documented in meniscal resection (shorter treatment, stay in the hospital and sick leave, reduced costs, and nevertheless excellent results) whereas the indication and clinical value of other arthroscopic procedures (i.e. suturing of a meniscal tear, lateral release, abrasion-arthroplasty) still are discussed. Diagnostic and operative arthroscopy of the shoulder joint has found its place and will certainly improve our knowledge on significance and treatment of disorders and injuries of this joint. In selected cases, an arthroscopy of the elbow, the hip, the ankle, the wrist or the temporomandibular joint offers important diagnostic information and may allow operative treatment. Arthroscopic surgery is technically difficult and not without problems. However, the rate of complications is extremely low (0.56%). Infections occur in significantly less than 1% of the cases. In veterinary medicine, therapeutic arthroscopy is used mainly in horses, but arthroscopies have been performed in the ox, the cow, the pig, the dog, the cat, and the rabbit. Modern joint surgery includes arthroscopic techniques; the training of trauma surgeons and orthopedic surgeons in arthroscopy is therefore mandatory.

Arthroscopes↗
PubMed1989

[Diagnostic arthroscopy in injuries of the knee joint].

Diagnostic arthroscopy is indicated, if other methods of diagnosis have reached their limits. It has become indispensable to proper assessment of injuries of the menisci, cartilage, synovial folds, and plicae and for suspicion of isolated cruciate knee ligament rupture. The practicability or impracticability of an arthroscopic operation in a given case, of course, has bearings upon indication for diagnostic arthroscopy. Patients are usually examined in general anaesthesia, with the joint filled with liquid, using a 30-degree widle-angle lens and a video system. Probing of intra-articular structures is absolutely necessary. The following two specific groups of indications have gained particular importance in knee injuries: Acute arthroscopy is imperative in any case of hemarthrosis with unknown aetiology (ligament injuries were found in 67 per cent of these patients), and it is the diagnostic and therapeutic procedure of choice in acute locking of the knee. Diagnostic arthroscopy should be followed by re-arthroscopy, if the further clinical course cannot be explained by the findings already recorded or in case of new symptoms or additional symptoms in the wake of arthroscopic operation or if major symptoms persist. In the latter case, re-arthroscopy should be performed not later than four to six months from first treatment. Re-arthroscopy revealed a need for another arthroscopic operation after earlier diagnostic arthroscopy in 48 per cent of all cases and after previous arthroscopic operation in 63 per cent.

Arthroscopes↗
PubMed1989

[Immunosuppression caused by surgery and severe trauma].

The present prospective study was performed to describe physiological immunosuppressive effects dependent on minor surgical interventions and an immunodeficiency syndrome after major surgery and severe trauma. Parameters of cellular and humoral immunity were monitored in 64 patients of the Department of Surgery of the University Hospital Zurich preoperatively and on days 1, 2, 3 and 4 after selective surgery or polytrauma. 22 patients were multiply traumatized (mean ISS 34.7 +/- 13), 14 patients underwent Y-grafting of the abdominal aorta, 11 resection of colorectal carcinoma, 8 cholecystectomy and 9 inguinal herniotomy. There could be seen a decrease of parameters of cellular immunity (absolute lymphocyte count, CD-4-/CD-8-cell-ratio and release of IL2-receptors), a decrease of humoral defense (immunoglobulins and complement factors) and an increase of macrophage activation (serum levels of neopterin).

Humans↗
PubMed1989

[Surgery of traumatic aortic rupture].

This report describes the clinical presentation, diagnosis, surgery and results of patients with acute traumatic rupture of the aorta in a series of 21 consecutive patients. Direct cross-clamping without additional methods of spinal cord protection was used in 18/21 patients (86%). Direct suture was possible in 12/21 patients (60%). In the remaining patients, the repair was carried out by interposition of a Dacron graft. Overall mortality was 7/21 patients (33%). However, in 3 patients with severe polytrauma irreversible brain damage was the cause of death whereas 2 patients died from septicemia and myocardial infarction, respectively. No paraplegia nor paraparesis occurred in the surviving patients which were operated by direct cross-clamping of the aorta and rapid reanastomosis without additional methods of spinal cord protection.

Adolescent↗
PubMed1989

[Intestinal necroses in severely injured patients without abdominal trauma].

Bowel necrosis in the critical trauma patient without abdominal involvement or preexisting vascular disease is a known but rare complication. During 1977-1986 we observed 31 cases in 2530 patients. Symptoms were unspecific, and since most of the patients were artificially ventilated, pain and tenderness were of little diagnostic value. Twenty-three patients presented with paralytic ileus, fifteen with diarrhea, and four with melena. In eleven patients diagnosis was made clinically, and in twenty patients at autopsy. Twenty-three patients died from septic shock, six from cerebral complications, and one from myocardial infarction. Risk factors for bowel necrosis were fluid restriction, hypotension, hypoxemia, venous congestion, vasoconstrictive drugs, paralytic ileus, and constipation.

Humans↗
PubMed1988

[Cost and benefit of intensive care of seriously injured patients].

59 (82%) of 72 patients with multiple injuries but excluding severe brain trauma or paraplegia, studied 5 or 6 years after intensive care, were fully reintegrated, working normally, and not in receipt of insurance compensation. In patients with severe head injury studied 8 years after intensive care, 38 (55%) of 66 patients had the same final outcome. Disability due to head injury or paraplegia was the predominant factor in costs caused by trauma. Treatment during intensive care was found to be the most costly part of therapy. Considerations on costs and benefits demonstrate that the treatment of severely injured patients, who otherwise would die, results in a considerable social and economic saving (approximately 90 million Swiss francs for the 316 trauma patients analyzed).

Cost-Benefit Analysis↗