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Biomedical subjects

A Leutenegger

Publications and source records attributed to A Leutenegger.

At least 19 recordsLinked to original sources
PubMed1992

[Vascular injuries--management in a non-university central hospital].

In a retrospective study the surgically treated vascular injuries (n = 35) of the last 10 years were evaluated. One third of the patients had multiple trauma and in 57% of the cases vascular injury was accompanied by a fracture. All patients (n = 28) except those who underwent delayed amputation (amputation rate 14%) have been followed personally for an average of 5.1 years. 90% of these patients showed an excellent or acceptable longtime result in regard to vascularity, nobody complained of claudication. Diagnosis of a vascular injury was mostly confirmed by direct surgical exploration, only one third of the lesions were diagnosed by arteriogram. A positive signal in Doppler examination does not exclude vascular injury and therefore cannot replace arteriography or exact clinical evaluation.

Adult↗
PubMed1991

[Pleural empyema--rational diagnosis and therapy].

A pyothorax is a relatively rare occurrence in a general hospital and is posing a number of problems. Among these the long mean duration of hospitalisation is of note lasting 47 days for 24 patients at our clinic. The course and the mortality rate are influenced by early detection and judicious use of interdisciplinary treatment. Small effusions accompanying pneumonia are frequent and likely to disappear after treatment of the underlying disease. In these instances a precipitate punction may lead to secondary infection. In case of a sterile punctate the pH value and consideration of glucose and LDH values determine further measures. Computed tomography is of great value since it yields decisive information not available from conventional radiography. If the empyema is not segregated in compartments a closed drainage with a large caliber chest-tube ist the method of choice. Limited thoracotomy is advised when several empyema chambers develop after short duration of the illness. Persistent disease or widespread scarring necessitate decortication in most cases.

Adolescent↗
PubMed1991

Five years' follow-up of severely injured ICU patients.

We conducted a 5-year follow-up study of a group of 461 consecutive trauma patients treated in our Intensive Care Unit from 1980 to 1983. The entry criteria (initial survival and severe injury: ISS greater than or equal to 18) were fulfilled by 233 patients with a mean ISS of 29.3 and mean age of 35.6 years. Data on prehospital care, type and timing of surgery, and hospital and ICU stay were recorded during hospital discharge. The protocol strictly asked for a personal interview and a physical examination. Mailed questionnaires or phone interviews were not allowed. The areas of medical sequelae, aftercare, missed injuries, occupation, insurance, social integration, economics, legal aspects, and traffic involvement were covered. We were able to gather final information from 223 (95.6%) of the 233 cases. Forty-three patients (18.4%) died in the hospital, 13 patients (5.6%) died later, and 167 (76.5%) were eventually seen. Only 10 patients (4.4%) were lost to follow-up. Outcome was judged using the Glasgow Outcome Scale (GOS), which was compared with a GOS value given prospectively at the time of hospital discharge. Eighty-nine percent of the survivors were healthy or slightly disabled (GOS 5 and 4), 9% were severely disabled, and only 2% were in a persistent vegetative state. Outcome after 5 years was better than tentatively prognosed at the time of hospital discharge. Ninety-one patients with severe head injuries (AIS 4-5) were additionally tested using the Mini Mental State instrument. This test revealed normal mental functions in 77% and dementia, mostly of a minor degree, in 23% of the head-injured patients. Almost all the early deaths and two thirds of the late deaths were related to severe head injury. Seventy-nine percent of the survivors were working after 5 years. During the post-trauma period, patients experienced reduced social well-being and also changed professional and recreational activities. There appears to be extensive room for improvement in the posthospital recovery phase. We conclude that survivors of critical trauma have a very good chance, after 5 years, of regaining a high quality of life. All efforts at improving trauma survival and quality of trauma care are therefore worthwhile and deserve high priority.

Adolescent↗
PubMed1991

[Emergency screw osteosynthesis of femoral neck fractures].

27 patients with femoral neck fractures have been treated by ORIF with 3 or 4 large cancellous bone screws. The operation has been performed as an emergency intervention within 5 1/2 hours after accident. Anterior arthrotomy in direction of the long axis of the neck for evacuation of the intraarticular hematoma has been performed as a routine. Personal follow-up with X-ray documentation after 18 to 106 months (mean 29.5 months) showed complete rehabilitation in 22 patients and 2 femoral head necroses (7.4%). We conclude that these good results are due to the short interval between accident and operation as well as to the evacuation of the intraarticular hematoma, together with a stable internal fixation and functional rehabilitation.

Adolescent↗
PubMed1991

[Interlocking intramedullary nailing of the femur: is the advantage of early mobilization gained by risking a malposition?].

We report a follow-up of 57 consecutive femoral fractures treated by internal fixation with the AO Universal Interlocking Nall. All fractures (91% follow-up) had healed within a mean of 22 months (range 9-50) after operation. Full weight-bearing was possible after an average of 9 weeks (range 2-20). The only infection occurred after a secondary open lengthening osteotomy. In 5 cases a rotational malposition or length discrepancy had to be corrected shortly after initial surgery. Rotational malposition in excess of 10 degrees occurred in 26% of cases (mostly external rotation) and length discrepancy exceeding 1 cm in 13% (mostly shortening). The frequency of malposition is explained by the absence of rotational or length control during operation. We recommend that malposition be correlated without delay by reoperation.

Adolescent↗
PubMed1991

[Talus fracture. Injury pattern, treatment tactics and results of operation (1980-1989)].

The results of 25 operated talus fractures are presented. 7 of these were peripheral fractures with excellent results, 18 central fractures with only satisfying or even bad outcome. Although we didn't see any avascular necrosis of the talus, almost all patients had pain and slight or even severe signs of arthrosis in the ankle or subtalar joint.

Follow-Up Studies↗
PubMed1991

Results of operative treatment for intra-articular fractures of the calcaneus.

Since 1980 our treatment of displaced intra-articular calcaneal fractures consists of open reduction with distractor, bone grafting, and internal fixation. Thereby no splints are applied and early postoperative movement is possible. For precise preoperative planning a CT scan is required. Proper timing and careful preoperative planning are essential to prevent soft-tissue complications. In a total of 16 fractures good clinical and radiologic results were achieved in 50% of the cases; results were satisfactory in 25% and poor in 25%. The patients returned to work after an average of 5 months. Only three patients (19%) received disability compensations, which compares favorably with nonoperative treatment. We believe that a majority of comminuted intra-articular fractures of the calcaneus profit from open reduction and internal fixation and that more reliable functional results are achieved than with conservative therapy.

Adult↗
PubMed1990

[Simple, safe postoperative parenteral nutrition with a ready-to-use all-in-one solution].

A newly developed, stable and ready-to-use industrially manufactured all-in-one solution for parenteral nutrition, containing amino acids, fat, glucose, xylitol and electrolytes, was tested in a prospective trial involving 21 patients from the 2nd to the 8th postoperative day. No side effects requiring interruption of the nutritional regimen, a positive nitrogen balance and a documented metabolic steady state proved that this solution is a safe therapeutic concept with respect to the typical postoperative metabolism. The all-in-one Vacu-Mix system is easy to handle, reduces the possibility of technical error and ensures safe and constant TPN administration.

Adolescent↗
PubMed1990

[Serial rib fractures: a differentiated treatment concept, illustrated by 59 severely injured intensive care patients].

In a group of 59 consecutive ICU trauma patients with blunt chest injury and considerable injury severity (ISS = 29) a three-staged therapeutic approach was followed, depending seriousness of chest injury, overall injury severity and age. Stage 1: i.v. analgesia and conventional respiratory therapy. Stage 2: continuous epidural analgesia (local anesthetics and opiates) and intermittent CPAP (continuous positive airway pressure) by face mask. Stage 3: Endotracheal intubation and internal pneumatic stabilization of the chest, preferably spontaneous breathing. Only 44% of the patients needed intubation, and none died. The authors recommend this three-step approach towards blunt chest injury and serial rib fractures.

Combined Modality Therapy↗
PubMed1990

[Post-traumatic osteitis. The acute infection].

The acute infection is defined as bacterial growth within the surgical wound, that may occur within days to weeks after initial surgery but before bone union. The chances of complete recovery after an acute soft tissue inflammation are closely related to the interval between initial surgery and first signs of infection, the early recognition of the complication, the type of bacteria involved and the therapeutic measures. The first symptoms of an impending infection are the classical clinical ones of any inflammation: tenderness, swelling and reddening. All imaging procedures are of little or no value. The therapy consists of very aggressive and, if required, repeated wound revisions with debridement of all necrotic tissue, removal of loose bone fragments or loose implant material, wash-outs with antiseptic solutions (e.g. Taurolin) or even deposition of gentamycin beads. Systemic antibiotics may be added temporarily. The in- or external fixation devices must provide stable fracture fixation and the bone as well as the soft tissue envelope must be well vascularized.

Acute Disease↗
PubMed1989

[Principles and practice of nutrition following trauma].

Nutrition should form part of intensive care for all polytrauma patients to prevent catabolic breakdown of body proteins. Enteral (tube) feeding is preferable whenever normal gastrointestinal function is confirmed. Parenteral nutrition is best tolerated via an adapted "all-in-one" solution. Due to the catabolic trauma reaction, a high protein content of 1.5-2 g/kg body weight/day and a calorie-nitrogen ratio of 80-100:1 is recommended. Energy supply should be partly in the form of fat and carbohydrates, mainly glucose. Xylitol as sugar substitute can be added to prevent hyperglycemia in the event of trauma-related glucose intolerance.

Energy Intake↗
PubMed1989

[Intra-articular fracture of the distal radius: results following osteosynthesis with a support plate].

The treatment of comminuted intra-articular fractures of the distal radius often requires an operative fixation. Beside the recently recommended external fixator, the support plate fixation offers a helpful alternative to treatment. Between 1980 and 1986, 30 wrists in 29 patients with intra-articular fractures of the distal radius were stabilized with a buttress plate an the Kantonsspital Chur, Switzerland. The mean follow-up-time was 15 months. These follow-ups showed that the buttress plate in treatment of complicated intra-articular fractures allows a satisfactory reduction and stabilization with restoration of the articular congruity and the possibility for early active assisted motion. Buttress plate fixation still remains a demanding technique, which in complicated cases, should be reserved for the experienced surgeon.

Adult↗
PubMed1989

[Initial results with the new tibial interlocking nail of the Orthopedic Study Group].

The new AO universal tibia nail with interlocking possibility has several new features. The wall thickness has been increased from 1.0 to 1.2 mm. In order to give the stiffer nail smoother insertion properties and better cortical contact, the overall design has been altered with the help of computer calculation. Proximally there are 3 holes for locking purposes in the frontal plane, while distally we find two holes in the frontal and one in the sagittal plane to accommodate the locking bolts. The new nail has been applied in 17 clinical cases with overall good results. The indications were deliberately pushed to the extremes and even 5 open fractures were nailed after minimal remaining. There were 2 major perioperative complications: one proximal blow-out of the anterior cortex due to a wrong point of insertion and several other technical mistakes. The situation was salvaged with an external fixator. In an 85-year-old multiple injured lady with a 3-degree open tibia, the initial fixateur externe was replaced after 3 weeks by a 10 mm universal nail. Due to severe porosis and rather proximal extensive cortical comminution, the locking bolts and therefore the nail did not find a good hold in the tibia plateau. After uneventful healing of the soft tissues and additional splinting, the fracture, however, consolidated within 4 months. There were two superficial soft tissue infections early postoperatively, but no cases of osteitis. Healing of the fractures seems to progress without delay.(ABSTRACT TRUNCATED AT 250 WORDS)

Follow-Up Studies↗
PubMed1989

[After-care of fractures, especially following osteosynthesis].

Depending on the choice of fixation and implant, the aftercare of fractures has to occur in different manners. Postoperatively the CPM-machines have taken the place of conventional supports, and there is a distinct tendency to even earlier mobilisation of fracture patients. Except for comminuted, intraarticular fractures, partial weight bearing with 10 to 15 kg (toe-touch) is encouraged as of the first postoperative week. Since the introduction of the locked nail for shaft fractures, we have to get used to look at X-rays with hardly reduced fragments and abundant callus formation. This contrasts to what we are used to from the conventional plate fixations. In case of stable plating, the old rules remain valid: anatomic reconstruction and direct fracture healing without visible callus.

Bone Plates↗
PubMed1989

[The dynamized external fixator. Use and problems].

We report our experience with 11 patients treated with an external fixator that was dynamized at some stage of the treatment. In 7 patients bone union occurred without any other measures, 2 patients were protected in a cast after the external fixator removal, while 2 patients developed a non union that was plated and subsequently healed. According to these experiences, dynamization of an external fixator seems to be a reliable and elegant way to treat simple open shaft fractures, the method is however not advocated for more complex or comminuted fractures.

Adult↗
PubMed1989

[Plate osteosynthesis in humeral shaft fractures. Indications and results].

Non operative management of humeral shaft fractures is well recognized as the standard of care for uncomplicated injuries. Operative treatment of humeral fractures may be performed when limited indications are present as in patients with multiple trauma including ipsilateral forearm injuries, arterial injury or primary radial nerve palsy. 18 patients with humeral shaft fractures underwent open reduction and internal fixation (ORIF) using the AO plating technique at the Kantonsspital Chur from 1980 to 1986. Follow-up was available for 17 patients of whom 16 suffered from multiple injury trauma. The broad DC plate combined with lag screws was used in most cases. Two brachial artery transections were repaired at the time of primary osteosynthesis by the same surgeons with full functional recovery. Concomitant nerve injuries were repaired primarily in one case and postprimarily in 3 more cases. The overall result was excellent in 9 patients, good in 5 patients, fair in 2 patients and poor in one patient with complete brachial plexus injury. Bone healing was uneventful in all 17 patients. No infection and no delayed union or pseudarthrosis has been observed.

Adult↗
PubMed1988

[Morbid obesity. Our results with the appetite-depressing stomach balloon].

Morbid obesity still remains a controversial topic with varied therapeutic approaches. In cases of unsuccessful conservative management we implant a gastric balloon or bubble. 30 balloons have been introduced in 24 patients with a mean age of 43 years (26-68 y.) and a mean body weight of 115 kg (87-160 kg). Mean overweight was 47 kg. The balloons were introduced immediately after gastroscopy performed to identify possible contraindications. Except in the initial 3 patients this procedure was carried out in the outpatient clinic. 25 silicon mammary prostheses were implanted until a special balloon (Ballobes-Balloon) became available for the last 5 cases. Implantation and follow-up has been uneventful in all cases. Our data suggest that a combination of this approach with close dietary management provides more efficient and rapid weight reduction than any diet alone.

Adult↗