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Biomedical subjects

C Gatzka

Publications and source records attributed to C Gatzka.

12 recordsLinked to original sources
PubMed2005

[Injury pattern and clinical course of children with multiple injuries in comparison to adults, Ab 11-year analysis at a clinic of maximum utilization].

Due to the small number of polytraumatized children treated in single clinics, only a few studies are available that compare multiply injured children and adults. However, the differences between the two groups with respect to type of injury, injury patterns and pathophysiology may have some crucial effect on the clinical course and are therefore essential for the treatment regime. In this study data about the epidemiology, the preclinical treatment, the clinical course and the complication rates of polytraumatized children and adults were analysed. The aim of this study was to point out the main differences between the two collectives and to compare the results with the current literature. Traffic accidents were the leading cause for trauma (children 77.8%, adults 62.6%). Children more often were transported by helicopter than adults. In both age groups head injuries and fractures of the extremities were most frequent. Adults had a prolonged ventilation time as well as an increased stay in ICU and a regular ward.

Accidents, Traffic↗
PubMed2004

[HWK-7 burst fracture in the cervical spine of a child with primary neurological impairment. Results of 1-year follow-up].

We report about a 6-year-old female patient who sustained a cervical spine (C7) burst fracture with initial neurological impairment. The treatment in our department on the day of the trauma included corporectomy and replacement of the C7 body with a tricortical iliac bone graft. One year after the trauma we were able to see the patient again. The functional outcome was good. Due to the rare entity of this case and the difficulty of predicting progress we would like to present our treatment regime and the 1-year follow-up results.

Bone Transplantation↗
PubMed2003

[Multislice CT (MSCT) in the detection and classification of pelvic and acetabular fractures].

PURPOSE: To assess the usefulness of MSCT in the detection and classification of pelvic and acetabular fractures. MATERIALS AND METHODS: Routine radiographs and MSCT of the pelvis with sagittal and coronal multiplanar reconstruction (MPR) were performed in 50 patients with clinically suspected pelvic or acetabular fractures. One trauma surgeon and a radiologist evaluated routine radiographs and CT images in terms of fracture detection, classification and visualization. The AO classification of fractures was used. RESULTS: MSCT excluded a suspected fracture in 15 patients. In the remaining 35 patients, 19 anterior pelvic ring fractures, 10 anterior and posterior pelvic ring fractures, 8 acetabular fractures and 4 sacral fractures were diagnosed. All MSCT diagnoses were made from the axial source images. In 7 (17 %) patients, MSCT detected additional fractures (2 acetabular and 5 posterior pelvic ring fractures) not seen on conventional radiographs. In 3 other patients, MSCT changed the fracture classification by delineating the full extent of the fracture. MPR visualized 7 acetabular and 4 sacral fractures better than the axial source images. CONCLUSIONS: MSCT of the pelvis is needed for correct fracture detection and classification and has therapeutic consequences.

Acetabulum↗
PubMed2003

Impact of bone density on distal radius fracture patterns and comparison between five different fracture classifications.

OBJECTIVE: To investigate the impact of bone mineral density (BMD) and bone geometry on failure loads and fracture patterns of the distal radius and to compare 5 different fracture classifications. DESIGN: Biomechanical and radiologic in vitro study. SETTING: Research laboratory. MAIN OUTCOME MEASUREMENTS: A total of 118 intact human forearms from elderly donors were examined by means of conventional radiography and peripheral quantitative computed tomography (PQCT) to determine BMD and geometry. The forearms were subjected to a standardized biomechanical test simulating a fall on the outstretched hand. The distal radius fractures were classified from x-rays using the AO ( 33), Cooney ( 9), Fernandez ( 15), Frykman ( 17), and Melone ( 31) classifications. The grading was repeated after preparation and direct visual inspection of the fracture site and was correlated with radiographic results. Fracture patterns also were correlated with BMD and geometry. RESULTS: Correlations between bone properties and fracture patterns (r = 0.09-0.70) suggested an increase in the severity of fractures with decreasing bone quality. The highest correlation between failure load and bone properties was found for the cortical area (r = 0.70) and trabecular density (r = 0.60). Good correlations between radiographic and direct visual classification were obtained for the Cooney ( 9) (r = 0.70), the AO ( 33) (r = 0.68), and the Fernandez ( 15) (r = 0.65) classifications. Smaller values were found for the Frykman ( 17) (r = 0.44) and the Melone ( 31) (r = 0.27) classifications. CONCLUSIONS: With increasing osteopenia, the load to failure decreases, and the severity of fractures increases. Fracture patterns in this patient population can be adequately graded with the AO ( 33) and Cooney ( 9) classifications. The severity of distal radius fractures tends to be underestimated by conventional x-ray examination, which needs to be taken into account when a fracture treatment plan is selected.

Aged↗
PubMed2002

[Isolated decrease of haptoglobin during pregnancy: diagnosis by chance or pathological? ].

Haptoglobin is an acute-phase-protein, which is important in many diseases like infections, trauma and neoplasma. An increase in haptoglobin is induced by cytocines like IL-6 und IL-1. The normal range for plasmatic haptoglobin is 50-220 mg/dl. During pregnancy the most likely diagnosis is the HELLP- Syndrome (hemolysis, elevated liver enzymes and low platelets), followed by rare diagnoses like viral hepatitis or favism. We report about a 31-year-old III-gravida 0-para at 31 weeks of gestation with a decrease of haptoglobin over a period of 6 weeks (cut off: < 13 mg/dl) and without any clinical signs of preeclampsia. Liver enzymes were constantly slightly elevated without any progress, other laboratory test results were normal. The patient had a caesarean section at 37 weeks of gestation. Serum haptoglobin returned to normal values within three days after delivery. The reason for the decrease of haptoglobin in our case remains uncertain. Further studies need to focus on the differential diagnosis of a decrease of haptoglobin as well as an isolated decrease of haptoglobin during pregnancy and on the valid ranges of the different haptoglobin subtypes.

Adult↗
PubMed1999

A novel ex vivo model for investigation of fluid displacements in bone after endoprosthesis implantation.

Tissue perfusion and mass transport in the vicinity of implant surfaces prior to integration or bonding may play a crucial role in modulating cellular activities associated with bone remodeling, in particular, at early stages of the integration process. Furthermore, fluid displacements have been postulated to transduct mechanical stress signals to bone cells via loading-dependent flow of interstitial fluid through the lacunocanalicular network of bone. Thus, an understanding and new possibilities for influencing these processes may be of great importance for implant success. An ex vivo model was developed and validated for investigation of fluid displacements in bone after endoprosthesis implantation. This model serves to explicate the effects of surgical intervention as well as mechanical loading of the implant-bone construct on load-induced fluid flow in the vicinity of the implant. Using this model, we intend to quantify perfusion and extravascular flow dynamics in the vicinity of implants and define optimal conditions for enhancing molecular transport of osteotropic agents from the implant surface to apposing bone as well as from the blood supply to the implant surface. Furthermore, the elucidation of main transport pathways may help in understanding the distribution of wear particles in bone surrounding implant, a process which has been postulated to cause osteolysis and implant loosening.

Journal Article↗
PubMed1997

Is endothelial function of the radial artery altered in human essential hypertension?

There is controversy over whether endothelial function is impaired in human essential hypertension. All studies to date have used measurements of forearm blood flow by plethysmography to assess endothelium-dependent vasodilation and endothelial function. In contrast to these studies, which have focused on resistance vessels, we have determined what effects the endothelium has on underlying smooth muscle cells in conduit arteries by measuring arterial compliance of the radial arteries (change in diameter of radial artery over pressure for each arterial pulse). In 13 normotensive healthy subjects and 11 young patients with essential hypertension, arterial compliance of the radial artery was assessed directly with a new high-precision ultrasonic device (NIUS 02) after infusion of acetylcholine (endothelium-dependent response) or sodium nitroprusside (endothelium-independent response). Arterial compliance of the radial artery was similar at baseline and with increasing doses of acetylcholine and sodium nitroprusside in normotensive and in hypertensive subjects. The increase in arterial compliance from baseline at each individual concentration of acetylcholine and sodium nitroprusside was the same in both normotensive and hypertensive subjects. However, after a single oral dose of a combination of the angiotensin converting enzyme inhibitor spirapril and the calcium entry blocker isradipine, the increase in arterial compliance in response to the maximum dose of intraarterial acetylcholine was enhanced in normotensives (0.38 +/- 1.23 to 0.76 +/- 1.01 mm2/mm Hg x 10(-3), P < .05), but not in hypertensives (+0.41 +/- 1.26 to 0.36 +/- 1.31 mm2/mm Hg x 10(-3), not significant), and differed significantly between normotensive and hypertensive subjects (P < .05). Thus, pharmacologic stimulation disclosed a blunted response of endothelium-dependent action in the arterial compliance of the conduit arteries in hypertensive subjects. This suggests an impaired endothelial function reserve in persons with essential hypertension.

Acetylcholine↗
PubMed1997

[New developments in the application of resorbable implants].

The application of biodegradable implants is combined with advantages and disadvantages. They offer a great deal of innovative ideas. Best evaluation has been done with pins for the fixation of low loaded osteochondral fractures. When using 2.7 mm Polypin primary mechanical stability of distal radius fractures is comparable with the fixation by 1.8 mm K-wires. A prospective and randomised study with two years follow up, including 183 radial head fractures, showed no significant difference in results and complications in metal and polyactide implants. For this localisation and other comparable indications the implant can be recommended. Despite the more extensive degradable device overall costs can be reduced with the polymer implant. Orientruded polyactide screws showed good clinical results, newetheless resorption was extremely late within 5 to 7 years.

Adolescent↗
PubMed1996

Treatment and post-treatment effects of alpha- versus beta-receptor blockers on left ventricular structure and function in essential hypertension.

This study was undertaken to compare the effects of alpha-receptor blockade and beta-receptor blockade on left ventricular structure and function in essential hypertension. The increase in left ventricular mass in patients with essential hypertension is at least partly induced by the sympathetic nervous system. We conducted a double-blind, randomized, controlled clinical trial to compare the effects of alpha-blockers and beta-blockers on left ventricular structure and function. Forty-three patients with mild to moderate essential hypertension were randomly allocated to receive antihypertensive therapy with either the alpha-blocker bunazosin (n = 23) or the beta-blocker metoprolol (n = 20). Twenty-four-hour blood pressure measurements and echocardiographic measurements of left ventricular structure and function were performed before therapy, after 6 months of therapy, and 4 weeks after discontinuation of therapy. Bunazosin and metoprolol led to similar reductions in systolic/diastolic blood pressure (-11 +/- 11/-9 +/- 8 mm Hg vs -11 +/- 12/-8 +/- 9 mm Hg, respectively) and left ventricular mass (-25 +/- 42 gm vs -28 +/- 44 gm, respectively) (p = no significant difference, bunazosin vs metoprolol). Neither metoprolol nor bunazosin significantly affected left ventricular systolic function. Diastolic left ventricular filling, however, was increased with beta-blocker medication, as indicated by a decrease in atrial filling fraction (39% +/- 5% to 34% +/- 5%; p < 0.05), but not with the alpha-blocker. The effect of metoprolol resulted from its bradycardiac effect. Four weeks after discontinuation of therapy, blood pressure and left ventricular mass increased to pretreatment levels in both groups similarly. Furthermore, the increase in diastolic filling was lost shortly after withdrawal of metoprolol concomitant with the increase in heart rate. We conclude that alpha-blockers and beta-blockers are equally capable of reducing left ventricular mass in hypertensive patients. beta-Blockers lead to an increase in diastolic left ventricular filling. This effect may be of therapeutic value because diastolic dysfunction may precede systolic dysfunction in hypertensive heart disease.

Adrenergic alpha-Antagonists↗
PubMed1994

Renal hemodynamic response to stress is influenced by ACE-inhibitors.

Cardiovascular responses to new antihypertensive agents have been studied extensively under resting and stress conditions. However, the effects of antihypertensive agents on renal hemodynamics have only been investigated at rest. To test whether antihypertensive therapy leads to disparate renal hemodynamic effects during exposure to mental stress as opposed to resting conditions, we performed a double-blind, placebo-controlled crossover study. In 17 normotensive healthy men, glomerular filtration rate (GFR; inulin clearance) and renal plasma flow (RPF; para-aminohippuric acid clearance) were measured at rest and after a standardized mental stress test, with or without one week's treatment with a new, long-acting ACE-inhibitor cilazapril 2.5 mg/day. ACE-inhibition did not change resting blood pressure, RPF, GFR, or derived parameters, such as filtration fraction, renal vascular resistance and renal fraction of cardiac output. Mental stress caused an acute increase in GFR (p < 0.001) and filtration fraction with both treatments (0.001). However, the increase in GFR and filtration with mental stress was greater (p < 0.05) with cilazapril treatment than with placebo. Thus, renal hemodynamic responses to mental stress were influenced by ACE inhibitors. We conclude that the impact of antihypertensive agents on renal hemodynamics during stress cannot a priori be delineated from measurements at rest.

Adult↗
PubMed1993

Obesity as a determinant for response to antihypertensive treatment.

OBJECTIVE: To test the hypothesis that beta blockers lower blood pressure more effectively than calcium entry blockers in obese hypertensive patients and that calcium entry blockers are more effective in lean patients. DESIGN: Double blind, randomised controlled trial of treatment over six weeks. SETTING: Tertiary referral centre. SUBJECTS: 42 white men with uncomplicated mild to moderate essential hypertension (World Health Organisation stage I or II); 36 completed the study. INTERVENTION: Patients were randomised to metoprolol 50-100 mg twice daily or isradipine 2.5-5.0 mg twice daily for six weeks after a two week run in phase. MAIN OUTCOME MEASURE: Blood pressure after six weeks of treatment. RESULTS: When stratified according to treatment and presence of obesity (body mass index < or = 27 kg/m2), the mean (SD) fall in blood pressure in the beta blocker group was 24 (13)/18 (10) mm Hg in obese patients and 18 (19)/12 (13) mm Hg in lean patients. In the calcium entry blocker group, the fall in blood pressure was 21 (15)/17 (6) mm Hg in lean patients and 18 (11)/8 (10) mm Hg in obese patients. After taking age and blood pressure before treatment into account there was a significant interaction between obesity and drug therapy (p = 0.019) with a better diastolic blood pressure response to calcium entry blockers in lean patients and to beta blockers in obese hypertensive patients. CONCLUSION: Obesity affects the efficacy of metoprolol and isradipine in reducing blood pressure.

Blood Pressure↗