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Biomedical subjects

W Glinz

Publications and source records attributed to W Glinz.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1988

Immunodeficiency after major trauma and selective surgery.

The posttrauma immunodeficiency syndrome and the related postsurgery immunodeficiency syndrome are essential for the infections often occurring after polytrauma and major surgery. Data are given here showing that after such events the levels of immunoglobulins; the complement factors C3C, C4 and C Factor B; and the numbers of circulating lymphocytes and of the subpopulations CD3, CD4, CD8 and natural killer cells as well as the stimulatory capacity of mononuclear cells to mitogen fall; while the levels of acute phase proteins, neopterin and interleukin 2 receptors and the spontaneous uptake of thymidine by mononuclear cells become augmented. Extent and duration of these changes and the rate of subsequent infections depend on the extent and kind of surgery (minor, major, clean, contaminated). However, crucial factors of the posttrauma and postsurgery immunodeficiency syndromes are not yet elucidated and relevant predictive parameters for infections are not at hand. These are essential prerequisites to initiate future immunomodulatory measures which should be added to the use of intravenous immunoglobulins yielding so far distinct but limited benefits for the prevention of infections after polytrauma and major surgery.

Complement C3↗
PubMed1987

[Current aspects and future developments in infection prevention in intensive care units].

The high frequency of nosocomial infections in intensive care units can be reduced in two different ways. Methods which impede the colonization of the patient with pathogenic microorganisms are of primary interest. Replacement of invasive techniques of monitoring and treatment by alternative non-invasive methods will help to prevent infections caused or favoured by those techniques. The concept of selective decontamination of the digestive tract (SDD) is reported to reduce nosocomial infections considerably but needs further clinical evaluation. Furthermore, there is a danger of selecting highly resistant strains by this regimen. A second approach to prevention of infections is improvement of these patients' severely impaired immune defense. The prophylactic use of intravenous immunoglobulins has produced encouraging results, but the indication, dosage and timing of the medication, and a cost-benefit analysis, need further careful consideration. So far, no conclusive clinical studies have been reported on stimulation of cellular immune defense. Finally, improved information on immunodeficiency induced by drugs frequently used in intensive care is an urgent necessity.

Antisepsis↗
PubMed1987

[Diagnosis of meniscus damage].

Often, the clinical signs of an injured meniscus are not characteristic. The most reliable diagnostic tool in evaluation of meniscal damage is arthroscopy (diagnostic accuracy greater than 95%). It provides precise information on the nature and extent of a meniscal tear. The advent of arthroscopic surgery has favoured the use of endoscopy even as a diagnostic procedure. Arthrography is abandoned except in cases where arthroscopic meniscectomy is not feasible. As additional non-invasive examinations, magnetic resonance and ultrasound may be used; however, both methods are still not generally accepted and do not allow diagnosis and therapy as a one step procedure as does arthroscopy.

Arthrography↗
PubMed1987

[Value of imaging procedures in the diagnosis and therapy of severe thoracic injuries].

Plain chest radiographs allow the diagnosis of most intrathoracic injuries. However, they are only momentary pictures and give no information on the respiratory function. A tension pneumothorax, rib fractures and subcutaneous emphysema should be diagnosed clinically before radiographs are taken. Computed tomography is helpful in evaluation of intrapulmonary lesions, hemothorax, rupture of the diaphragm and dislocation of the heart. Further diagnostic tools include aortography in suspected aortic rupture, sonography in cardiac injuries and hemopericardium, bronchoscopy in suspected bronchial or tracheal rupture, ECG and enzyme determinations in cardiac contusion, and eventually pneumoperitoneum in suspected rupture of the diaphragm.

Diagnosis, Differential↗
PubMed1986

[Liver injuries].

Mortality in blunt hepatic trauma is still high, death being most frequently caused by hemorrhage. Associated injuries are present in nearly all cases. A variety of possible surgical procedures allow treatment tailored to fit the individual situation. Even the sophisticated intensive care required by the frequent posttraumatic complications is not a substitute for adequate surgery.

Abdominal Injuries↗
PubMed1986

[Blunt heart injuries].

Cardiac injuries were present in 16% of our patients suffering from blunt chest trauma. 25% of these cases had no concomitant rib fractures. Sonography is extremely important for evaluation. In myocardial contusion the electrocardiogram reveals mainly disturbances in repolarisation (66 out of 108 patients) and rhythm disturbances (59 patients). A ratio of CK-MB isoenzyme/total CK of over 8% is highly suggestive of myocardial injury. Continuous monitoring in ICU is mandatory. Prognosis is mainly based on additional injuries. Heart wall rupture and luxation of the heart require operative treatment. Lesions of the aortic valves are the most frequent valve injuries.

Coronary Vessels↗
PubMed1986

Priorities in diagnosis and treatment of blunt chest injuries.

The evaluation of thoracic injuries is only one aspect of the total assessment of a severely injured patient. In a series of 675 hospitalized patients, blunt chest injury was associated with craniocerebral injury in 55 per cent, with abdominal injuries in 20 per cent and with fractures of the extremities in 38 per cent. Both diagnostic and therapeutic procedures go hand in hand. Immediately life-threatening situations (hypovolaemia, respiratory insufficiency, tension pneumothorax and cardiac tamponade) should be diagnosed by clinical signs and treated before radiographs are taken. The chest radiograph is the basic tool for diagnosis of thoracic injuries, although it will not reveal a possible impairment of lung function. Special attention should be paid, and further evaluation is necessary, in suspected rupture of the diaphragm (present in 4 per cent), rupture of the aorta (2 per cent), bronchial rupture (0.5 per cent) and cardiac contusion (16 per cent). Most blunt thoracic injuries can be treated adequately by intercostal tube drainage. Operative intervention has been found necessary in 8 per cent of cases. Indications for thoracotomy are clearly defined.

Aortic Rupture↗
PubMed1986

Problems caused by the unstable thoracic wall and by cardiac injury due to blunt injury.

The treatment of flail chest remains highly controversial. In the literature convincing arguments can be found to support any therapeutic procedure. Newer concepts of mechanical ventilation such as SIMV and CPAP, as well as the use of epidural analgesia, have resulted in a significant reduction in the duration of artificial ventilation. Although the mechanical problems are generally overestimated in this situation, the use of a ventilator is indicated in many cases because of the associated lung damage. Internal fixation of the unstable thoracic wall is restricted to special, selected cases which would otherwise require artificial ventilation, without severe lung injury and without head injury. We found stabilization of bilateral parasternal rib fractures with a retrosternal Sulamaa bar most helpful. Cardiac injuries were present in 16 per cent of our patients admitted after severe blunt thoracic injury. Most of these had myocardial contusion. The analysis of 108 cases of cardiac contusion revealed that every possible variation of ECG can be observed. Repolarization disturbances and impairment of the cardiac rhythm and the conduction system were found most frequently. A ratio of CPK-MB: total CPK of over 6 per cent provides a very significant suspicion of myocardial contusion. The clinical course is characterized by cardiac rhythm disturbances, which required treatment in 40 out of 108 patients, and to a minor extent by heart failure for which treatment was required in 17 patients. Prognosis is generally good with adequate treatment.

Analgesia↗
PubMed1985

[Continuous arteriovenous hemofiltration for the treatment of acute kidney failure].

Continuous arterio-venous haemofiltration (CAVH), a simple technique not employing pumps, was used for treatment of acute renal failure in 25 intensive care patients (mean age 52 +/- 16 [SD] years). Acute renal failure was due to trauma in 9 patients, occurred after surgery in 7 patients and was related to septicaemia in 5 patients, peritonitis in 2 patients and pancreatitis in one patient; in one patient acute renal failure developed during pregnancy after preexisting renal disease. Seventeen patients were oliguric and 8 patients were non-oliguric, with a mean daily urine output of 507 +/- 407 ml. At the start of CAVH the serum creatinine level was 511 +/- 198 mumol/l. The duration of treatment with CAVH was 1 to 36 days (average 9.3 days). Access to the circulation was by cannulation of the femoral artery and vein in 23 patients and by Scribner shunt in 2 patients. After an initial systemic dose of 2000 IU heparin, a continuous infusion of 250-1000 IU/hr into the arterial blood line was administered, adjusted to a partial thrombin time of 58 +/- 28 sec. With this heparin regimen a single haemofilter could be used for an average time of 2.6 +/- 1.2 days. The mean spontaneous filtration rate was 6 +/- 2 ml/min, resulting in the following serum levels: creatinine 490 +/- 187 mumol/l; urea 39 +/- 12.5 mmol/l; potassium 4.5 +/- 0.5 mmol/l. Nine catheter-associated complications occurred in 5 patients. The most important aspect of CAVH was its simplicity, optimal control of fluid balance and the possibility of unlimited parenteral nutrition. Uremia was adequately and continuously controlled. Prognosis of ARF was related to the patients' underlying illness.

Acute Kidney Injury↗
PubMed1985

Polyvalent immunoglobulins for prophylaxis of bacterial infections in patients following multiple trauma. A randomized, placebo-controlled study.

One hundred and fifty severely injured patients requiring long-term artificial ventilation were evaluated in a prospective, randomized, double blind study comparing the prophylactic effect of an intravenous immunoglobulin (Sandoglobulin; IGIV) against nosocomial infections with a placebo preparation. The groups were comparable in age, sex, injury pattern, and severity of the trauma. Seventy-six patients received 12 g of Sandoglobulin as a 3% solution on day 0, day 5 and day 12, i.e. a total of 36 g. Sandoglobulin significantly reduced the incidence of pneumonia (28 cases in the IGIV group, 43 cases in the placebo group, p = 0.0111). This resulted in a reduced therapeutic use of antibiotics. For the occurrence of sepsis (IGIV: 14 cases; placebo 19 cases) and other infections (IGIV: 11 cases; placebo: 10 cases) no significant differences were found. No side effects of the administration of IGIV were observed. IGIV prophylaxis neither reduced the overall death rate nor those deaths caused by infection. On day 5 after administration of the first 12 g of IGIV, the IgG serum concentrations were significantly higher in the Sandoglobulin group (8.41 +/- 1.96 mg/ml and 7.42 +/- 2.25 mg/ml respectively, p less than 0.001) whereas later serum samples showed no significant differences.

Adolescent↗