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Biomedical subjects

W Mutschler

Publications and source records attributed to W Mutschler.

At least 55 records · Page 3Linked to original sources
PubMed2003

[Visualization of radiographically occult osteochondrosis dissecans of the talus using MRI].

Posttraumatic disorders of the ankle are a common cause of chronic pain. Magnetic resonance imaging (MRI) has proved to be highly useful in clarifying a wide spectrum of underlying lesions which frequently cannot be detected on radiographs. Even if the assessment of the lateral collateral ligaments of the ankle is not regarded as a primary indication for MRI, it allows the diagnosis of subchondral contusions or cysts, anterolateral impingement syndrome, sinus tarsi syndrome, osteochondral fractures and osteochondrosis dissecans of the talus (ODT),which may not be detected with other imaging modalities. A 42 year old female patient suffered from persisting non-specific pain following an inversion trauma 4 months previously. MRI enabled the detection of an ODT which was not diagnosed on plain radiographs and which was verified upon arthroscopy. A superficial cartilage defect, as shown arthroscopically,was not delineated using MRI. Our observations indicate that MRI may be useful in patients with unclear persisting pain following ankle trauma and that it may contribute to the early detection of lesions which require surgical intervention.

Adult↗
PubMed2003

[Operative or conservative treatment of anterior cruciate ligament rupture: a systematic review of the literature].

The aim of this paper was to examine all studies that compared operative and conservative treatment of anterior cruciate ligament (ACL) rupture. Covering a period of 22 years all relevant articles were retrieved from the medical databases Medline, Embase, and Cochrane. The results of these studies were judged on to the criteria of subjective stability (giving-way phenomenon), objective stability (pivot shift test), and return to the preinjury level of sports. There were 11 different studies published in 16 articles consisting of 2 randomized,2 prospective, and 7 retrospective trials. Except in one study the results in the operative groups were always better than in the conservative groups. The meta-analysis of both randomized studies showed significant advantages for the operative treatment. Although arthroscopic ligament plasty is an established standard method for the treatment of ACL rupture, there is almost no basis for this procedure in the literature.Thus,new clinically applicable studies are necessary to develop objective guidelines for the treatment of anterior cruciate ligament tears.

Anterior Cruciate Ligament↗
PubMed2003

[Diagnosis and therapy of osteoporosis. Strategy for effective treatment after fragility fractures].

Until about 20 years ago osteoporosis was considered an inevitable disease of ageing. Now the situation has completely changed and osteoporosis is classified as a disorder which is easily diagnosed and treated in the early stages of its development that is,before a skeletal fracture has occurred. Two types of medication are available today for prophylaxis and therapy of osteoporosis: the antiresorptive and the osteoanabolic drugs whose efficacy has been demonstrated in large randomized clinical trials (RCTs). These drugs are effective not only in the early stages of osteoporosis i.e. for prevention, but also when fractures have already occurred, to reduce the risk of further skeletal fractures. However, in this setting only about 7% of patients in Germany are being treated although all are at significant risk of sustaining additional fractures. Consequently all patients with osteoporosis-related fractures should be thoroughly investigated during their hospitalisation and effective treatment instituted. In addition, treatment should be continued and monitored by the family doctor. The strategy for the administration of therapy for successful prevention of secondary fractures in osteoporosis is presented.

Absorptiometry, Photon↗
PubMed2003

[Secondary decompression trepanation in progressive post-traumatic brain edema after primary decompressive craniotomy].

Besides evacuation of epidural or subdural hematoma, early decompressive craniectomy with duraplasty has to be performed in the neurotraumatological care of patients with moderate [Glasgow Coma Scale (GCS) score 9-12 points] or severe traumatic brain injury (TBI; GCS score </=8 points) and threatening herniation. The efficacy of secondary decompressive craniectomy and duraplasty after primary trepanation is under debate due to missing evidence of improved outcome. The objectives of this study were to register the incidence of increasing brain edema after isolated TBI and primary craniectomy, to identify possible decision criteria for secondary decompressive trepanation, and to evaluate the neurological performance 6 months after discharge with the Glasgow Outcome Score (GOS). Of 131 patients who suffered from isolated TBI and had to be primarily operated between January 1997 and December 2001, 58 (male:female = 48:10; median age of 50.9 years) were included in this analysis. In 11 patients (male:female = 9:2; median age of 40.0 years) a secondary unilateral extensive or contralateral decompressive craniectomy had to be performed in the clinical course. Four of the 11 patients (36.4%) did not survive TBI; they died at a median of 1 day after revision or 6 days after TBI, respectively. In the group of secondary decompressive craniectomy we recorded admission (80.0 min after TBI) 35 min later ( p=0.009) than in the group of primary trepanation. Prehospital otorrhagia was observed more frequently ( p=0.036). In univariate analysis, arterial hypotension ( p=0.018) and otorrhagia at admission ( p=0.035), intracranial pressure (ICP) immediately after primary operation ( p=0.024), and decrease of maximal postoperative cerebral perfusion pressure (CPP; p=0.031) below the median cutoff value of 70 mmHg correlated with the event of secondary decompression craniectomy. Multivariate analysis identified decreased maximal CPP after primary trepanation as the only independent prognostic parameter (score 10.496; df=1; p=0.043) for the necessity of secondary trepanation and unfavorable GOS 6 months after discharge. In patients with isolated moderate or severe TBI, prehospital arterial hypotension as well as otorrhagia negatively influenced the mortality and morbidity. Therefore, early adjustment of arterial hypotension and the rapid transport into a neurotraumatological center are to be required for prehospital management of TBI patients. The decrease of maximal CPP below 70 mmHg despite administration of catecholamines representing the only independent prognostic parameter during monitoring in the intensive care unit seems to indicate the necessity of an operative revision as well as an unfavorable GOS 6 months after discharge.

Adult↗
PubMed2003

[CT-guided aortic balloon occlusion in traumatic abdominal and pelvic bleeding].

PURPOSE: To introduce a new interventional method for CT-guided aortic balloon occlusion in patients with life-threatening abdominal or pelvic bleeding. MATERIALS AND METHODS: Three male patients (age 18, 30, and 45 years) with multiple trauma underwent CT-guided balloon occlusion of the aorta after CT identified an active abdominal or pelvic bleeding site and the patients became unstable (systolic blood pressure, BP < 80 mm Hg) despite resuscitation continuous volume. Using a right femoral approach, a 9F sheath was immediately introduced and the positions of the guide wire and balloon catheter (20 x 40 mm) were intermittently checked with CT scans and CT fluoroscopy. In one case, a C-clamp was applied to the pelvic ring under CT guidance for emergency stabilization of an unstable pelvic fracture. RESULTS: CT-guided aortic balloon occlusion and the mounting of the pelvic C-clamp were technically successful. Intervention time was 4 to 6 minutes for aortic balloon occlusion. All patients became at least temporarily stable hemodynamically with the blood pressure rising above 100 mmHg. The infrarenal occlusion catheters were left in place up to 60 minutes. Suprarenal occlusion was not performed. Two patients died due to protracted shock and complex injuries (injury severity score (ISS: 50 - 64). CONCLUSION: CT-guided aortic occlusion provides fast and effective bleeding control immediately after completion of the diagnostic CT. The procedure can be combined with other specific emergency surgical or interventional procedures. Experience with more patients is necessary for further evaluation of this new technique.

Adolescent↗
PubMed2003

Microcirculation associated with degenerative rotator cuff lesions. In vivo assessment with orthogonal polarization spectral imaging during arthroscopy of the shoulder.

BACKGROUND: Diminished vascular supply is associated with degenerative rotator cuff lesions. Orthogonal polarization spectral imaging allows noninvasive assessment of microcirculation without application of fluorescent contrast medium. The aim of our study was to visualize and quantify in vivo the microcirculation of the rotator cuff during arthroscopic surgery and to compare the results with the number of microvessels identified in vitro by immunostaining of biopsy specimens taken from the scanned areas. METHODS: Eleven patients with clinical signs of a degenerative rotator cuff lesion were studied. Prior to arthroscopic subacromial decompression, the superficial part of the supraspinatus tendon at the edge of the lesion as well as the unaffected tendon insertion was examined. Microvascular parameters established for the description of tissue perfusion with use of conventional intravital fluorescence microscopy (functional capillary density and capillary diameter) were assessed in vivo. Biopsy specimens were taken from the scanned areas, and the microvessels were localized by immunostaining for the endothelial surface marker CD31. RESULTS: In the region of the unaffected tendon insertion, the mean baseline functional capillary density (and standard deviation) was 106 +/- 13 cm/cm(2) and the mean capillary diameter was 10 +/- 0.7 microm. In contrast, at the edge of the lesion, the functional capillary density was significantly reduced to 20 +/- 14 cm/cm(2), whereas the diameter of the vessels that were present did not differ. The total number of vessels stained in vitro was also significantly reduced at the edge of the lesion compared with the number of vessels in the tendon insertion zone. CONCLUSIONS: Quantitative in vivo analysis of human microcirculation during arthroscopy demonstrated that the functional capillary density at the edge of a degenerative rotator cuff lesion was significantly reduced compared with that in the control tissue. The capacity to assess microcirculatory flow in vivo may help to identify specific repair strategies based on knowledge of individual perfusion patterns.

Arthroscopy↗
PubMed2002

Monitoring and healing analysis of 100 tibial shaft fractures.

BACKGROUND: We assessed the value of measuring biomechanical stiffness by assessing the fixator's external deformation as an objective means for monitoring fracture healing and determining the postoperative treatment regime, as compared to clinical and radiographic means of evaluation. PATIENTS AND METHODS: One hundred patients with tibial shaft fractures managed by unilateral external fixation had their fracture stiffness monitored. Stiffness was measured and clinical and radiological examinations were performed every 3-4 weeks. RESULTS: The time required for healing as indicated by stiffness measurement was an average of 2.5 weeks earlier than by radiological assessment. Eighty-two patients healed within 19 weeks (12.1+/-3.3 weeks) and ten patients in the following 6 weeks (24+/-4.3 weeks). Eight patients did not show an increase in fracture stiffness and received intramedullary nailing at a second operation. The average healing time was 11.3+/-4 weeks for type A, 13.1+/-3.6 weeks for type B fractures, and 15.1+/-5.9 weeks for type C fractures. The healing time for closed fractures was 11.3+/-3.2 weeks and for open fractures 14+/-4.9 weeks. CONCLUSIONS: The measurement of fracture stiffness allows the detection of patients at risk for nonunions. The healing time increased with increasing fracture gap size and was less in patients with younger age, less complex fractures, and lesser degrees of soft tissue damage.

Adolescent↗
PubMed2002

Rapid identification of high-risk patients after minor head trauma (MHT) by assessment of S-100B: ascertainment of a cut-off level.

BACKGROUND: Elevated blood S-100B levels were described by several authors for reliable identification of patients with intracerebral complications after minor head trauma (MHT). Yet, test systems used so far require more than 3 hours processing period which is too long to enable immediate further diagnostic or therapeutic consequences. Therefore we validate a new rapid test version for S-100B measurements and established an effective cut-off level to identify high risk patients. METHODS: 104 patients suffering from MHT were enrolled. After taking blood samples S-100B values were achieved by the long-term and rapid (40 min processing time) test system, respectively, and compared using linear regression analysis. For determination of an effective cut-off level receiver operating characteristics curves were calculated in accordance with cranial computed tomography findings. RESULTS: S-100B concentrations correlated significantly using both test systems. A cut-off level of 0.18ng/ml was calculated in plasma samples. CONCLUSIONS: S-100B concentrations above the cut-off level measured within 40 min after blood sampling allows safe identification and immediate treatment of intracerebral lesions (e.g. epidural and subdural hematoma, subarachnoid hemorrhage, diffuse brain edema etc.) in MHT patients.

Blood Chemical Analysis↗
PubMed2002

Polyploidization and centrosome hyperamplification in inflammatory bronchi.

OBJECTIVE AND DESIGN: Inflammatory and tumorous bronchi were screened in order to obtain new tumor relevant cytogenetic parameters. MATERIAL OR SUBJECTS: Bronchial cells of 32 patients were cultivated by standard cell culture procedures. METHODS: Tetraploidy and aneuploidy was determined by enumeration of chromosome 7 and 8 versus the number of centrosomes. The resulting data were correlated with histopathological data. RESULTS: Tetra- and aneuploidy of epithelial cells were detectable in 76% of tumor cell cultures, 75% of high grade inflammatory tissues and 40% of non- and low grade-inflammatory tissues. Additionally, we observed centrosome hyper-amplification and multipolar mitoses not only in the tumor but also in the early stages of inflammation. CONCLUSION: Inflammatory bronchi already show tumor-specific features and may consequently represent the preliminary genetic stage of cancer development in bronchi.

Adult↗
PubMed2002

[Teutschländer disease. A rare benign differential diagnosis in proliferating space-occupying lesions of soft tissues].

Tumoral calcinosis is a very rare benign soft tissue calcification. It occurs in all age-groups and prefers the shoulder, hip and elbow region as localisation. In most cases, local pain is the leading symptom. The aetiology remains unclear, so far, however, a certain connection to an imbalance of the calcium-/phosphate homeostasis is proposed. The adequate therapy is the complete surgical removal. Our presented case describes an extended occurrence at an unusual localisation and discusses characteristic signs in contrast of the differential diagnoses.

Aged↗
PubMed2002

[Algorithm for prehospital blunt trauma management].

Clinical algorithms can divide sophisticated treatment concepts for blunt trauma care into logical, systematic and easy to follow sequences. The presented algorithm for prehospital management of major and suspected blunt trauma will assure appropriate trauma care within narrow time windows. The risk of over- or undertreatment is reduced for both, the suspected and confirmed diagnosis of polytrauma. Due to the lack of evident data the algorithm was confirmed via consent expert opinion of trauma surgeons, incorporating the ABC priorities and also the concept of the ATLS((R))-programme. The algorithm was validated in simulated scenarios and was by affirmed by the German Trauma Surgeons Task Force on Emergency Care under the regulations of a nominal group process via resolution.

Algorithms↗
PubMed2002

[Algorithm for extrication and medical care in vehicular trauma].

The rescue and treatment of trapped persons in car accidents requires a close cooperation and coordination between firefighters and medical personnel. Priorities of medical care as well as aspects of extrication should be considered equally. Procedures on scene should follow a sequence securing life support and careful rescue of the trapped patient.The developed algorithm allows for prioritized and coordinated management and represents a transparent guide for both teams, during training as well as practical application. The concept incorporates the ABC priorities for polytrauma management and also the structure of the ATLS((R))-programme. The algorithm was validated in simulated scenarios and was by affirmed by the German Trauma Surgeons Task Force on Emergency Care under the regulations of a nominal group process via resolution.

Accidents, Traffic↗
PubMed2002

[Interdisciplinary shock room management: responsibilities of the radiologist from the trauma surgery viewpoint].

Efficient resuscitation of major trauma requests an interdisciplinary communication between trauma surgeons, anaesthesiologists and radiologists. Trauma outcome is significantly influenced by horizontal trauma team organisation and coherence to clinical algorithms, which allow fast diagnosis and intervention. A radiologist present on patients arrival in the trauma room provides a major impact on trauma care. Nevertheless optimal integration in the trauma team implies profound knowledge of the priorities of advanced trauma life support and trauma algorithms. His or her involvement is not limited to patient care only, also active participation in trauma room design, interdisciplinary algorithm development and trauma research are essential tasks for radiologists devoted to emergency radiology. Based on the pathophysiology of polytrauma and the structure of German trauma system, current concepts and proven clinical algorithms with special regard to the radiologist and his duties and tasks will are presented.

Advanced Cardiac Life Support↗
PubMed2002

[Standardized evaluation of trauma patients: requirements for diagnostic imaging].

INTRODUCTION: Evaluation of trauma systems requires a complete and exact injury classification. The purpose of this study was the introduction of the Abbreviated injury scale (AIS) for radiological trauma scoring. The development of these easy to use coding tools is essential for prompt quality management of trauma. MATERIAL AND METHODS: Standardized radiological injury description using a modified Abbreviated injury scale in combination with a Microsoft Excel spreadsheet allows an immediate calculation of the probability of survival according to TRISS methodology. RESULTS: Computed tomography is the main instrument for injury scoring in trauma care. Postmortem scanning provides a direct feedback for trauma teams especially in case when autopsy is not possible. CONCLUSION: Computed tomography enables in combination with a standardized injury description exact trauma scoring. Quality management of trauma care depends on a valid and reliable calculation of the probability of survival using TRISS.

Abbreviated Injury Scale↗
PubMed2002

[Detection of tibial condylar fractures using 3D imaging with a mobile image amplifier (Siemens ISO-C-3D): Comparison with plain films and spiral CT].

PURPOSE: To analyze a prototype mobile C-arm 3D image amplifier in the detection and classification of experimental tibial condylar fractures with multiplanar reconstructions (MPR). METHOD: Human knee specimens (n = 22) with tibial condylar fractures were examined with a prototype C-arm (ISO-C-3D, Siemens AG), plain films (CR) and spiral CT (CT). The motorized C-arm provides fluoroscopic images during a 190 degrees orbital rotation computing a 119 mm data cube. From these 3D data sets MP reconstructions were obtained. All images were evaluated by four independent readers for the detection and assessment of fracture lines. All fractures were classified according to the Müller AO classification. To confirm the results, the specimens were finally surgically dissected. RESULTS: 97 % of the tibial condylar fractures were easily seen and correctly classified according to the Müller AO classification on MP reconstruction of the ISO-C-3D. There is no significant difference between ISO-C and CT in detection and correct classification of fractures, but ISO-CD-3D is significant by better than CR. CONCLUSION: The evaluation of fractures with the ISO-C is better than with plain films alone and comparable to CT scans. The three-dimensional reconstruction of the ISO-C can provide important information which cannot be obtained from plain films. The ISO-C-3D may be useful in planning operative reconstructions and evaluating surgical results in orthopaedic surgery of the limbs.

Humans↗