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C Willy

Publications and source records attributed to C Willy.

At least 37 records · Page 2Linked to original sources

[Decubitus ulcer. Basic treatment intervention is pressure unloading].

With an incidence of between 3 and 34%, decubitus ulcers are common chronic wounds, many of which can be avoided by prophylactic measures. The most effective preventive measure is relieving pressure on the endangered part of the body, and this is most easily achieved by regularly changing the patient's position in bed. Since, however, this is not always possible for staff-shortage or illness-related (e.g. fractures of the spine) reasons, modern pressure-relieving systems are being increasingly used. The range of options extends from simple foam plastic underlays to water-filled cushions to pneumatic cushions or beds filled with tiny glass beads. Selection of the most appropriate system is often difficult. For effective prophylaxis, determination of the individual risk of developing a bedsore with the aid of special scales makes good sense. In this way, the measures required can be adapted to the particular needs of the individual patient. New approaches to decubitus ulcer prevention and wound management may help to ensure effective care of the endangered or affected patient.

Adolescent↗

[The significance of intracompartmental pressure values for the diagnosis of chronic functional compartment syndrome. A meta-analysis of research studies of pressures in anterior M. tibialis during exercise stress].

INTRODUCTION: The chronic exertional compartment syndrome of the musculus tibialis anterior is thought to be responsible for a major part of complaints of the lower leg among active sportsmen. There is an important role of tissue pressure measurement in diagnosing chronic anterior compartment syndrome during muscular activity. However, there is a controversial debate about the relevant parameters. METHODS: Metaanalysis of all the 21 studies (1979-1998) measuring intracompartmental pressures during muscular activity. Parameters of analysis: type of exercise, catheter technique, recommendations of diagnostic criteria. RESULTS: Analysis of literature shows that there has been no standardisation concerning the type of muscular exertion (isometrics for 5-10 min, exercise on the treadmill between 3.2 and 12 km/h). In 8 of the 21 studies the results have been attained through the unsuitable Wick-catheter-technique. In the overall view none of the suggested criterions for diagnosis is taken up by other teams. There are considerable variations up to 500% regarding the recommended parameters. CONCLUSIONS: From all studies no uniform recommendation for parameters of diagnostic relevance can be derived. On this background it should be demanded that future research is conducted by a uniform regimen for examination and modern technique of measuring with a high temporal resolution. Under these standardised conditions the investigated parameters of the intracompartmental pressure curve should be reconsidered once more regarding diagnostic predictability by calculations of specifity and sensitivity.

Adult↗

[The effect of soft care mattresses on subcutaneous tissue pressure and pO2 over the os sacrum].

In this study the influence of soft-care systems on subcutaneous tissue pressure and pO2 has been examined. In 14 volunteers 3 probes were implanted over the os sacrum for measurement during the 20-minute periods. Then the probands were asked to lie on a standard mattress, on 8 static beds of various kind and on 3 dynamic soft-care systems. The clinical mattress pressure values amounted to 25.5 mm Hg (+/- 5.2; n = 14). The gell-cushion showed increased values (26.9 +/- 9.5 mm Hg; n = 5). Compared to the standard mattress the other systems showed reductions in pressure from 32.7% to 83.1%. The lowest pressure was recorded with an air-supported mattress (8.3 +/- 2.3 mm Hg; n = 5). The pO2 initial values before lying down varied greatly from individual to individual (26.9-71.3 mm Hg). In the course of the 20-minute periods the pO2 value sometimes remained constant, sometimes increased and at other times it decreased. Under extreme conditions (with 8 probands asked to lie on the floor) a correlation (r = -0.787) between pressure and pO2 was observed (pressure values between 20.6 and 192.9 mm Hg). The results indicate the use of modern soft-care systems depending on the individual risk of pressure sores.

Adult↗

Estimating medical resources required following a nuclear event.

Large quantities of medical resources are necessary for the treatment of patients suffering from acute radiation syndrome in combination with blast and thermal injuries (combined injuries). So far, however, there is no tool available for evaluating the resources required for the treatment of combined injuries. The purpose of this manuscript is to describe the scientific basis for a newly developed software tool designed to estimate the medical resources needed for treating the combined injuries of individuals/high numbers of casualties who may be involved in civil defense, emergency medical care and various military activities (namely out of area) in the case of a nuclear event.

Blast Injuries↗

Inhibition of transforming growth factor beta1-induced hepatoma cell apoptosis by liver tumor promoters: characterization of primary signaling events and effects on CPP32-like caspase activity.

The effects of the liver tumor promoters phenobarbital, clofibrate, dieldrin, and DDT on transforming growth factor-beta1 (TGFbeta)-induced apoptosis were studied in FTO-2B hepatoma cells. Inhibition of apoptosis by these compounds was strongly correlated with a decrease in CPP32-like caspase activity. Similar effects were obtained with insulin and dexamethasone. CPP32-like activity may thus provide a useful tool for quantiation of apoptosis under various treatment conditions. Diverse effects on apoptosis-associated cellular signaling proteins were observed: insulin led to an activation of the MAP kinases ERK1/2, of PKB/Akt and of NF-kappaB, phenobarbital and clofibrate enhanced NF-kappaB activity solely, while dexamethasone slightly enhanced NF-kappaB activity and increased the expression of Bcl-xL. Since inhibition of apoptosis was still detectable if the anti-apoptotic compounds were administered more than 10 h after TGFbeta, the diverse primary signals appear to converge at a presumably late stage of apoptosis, but upstream of activation of CPP32 or related caspases.

Animals↗

Measurement of intracompartmental pressure with use of a new electronic transducer-tipped catheter system.

Laboratory and clinical tests were carried out to determine the clinical usefulness, validity, and safety of a new self-calibrating, battery-powered monitoring system for the measurement of intramuscular pressure with use of an electronic transducer-tipped catheter. The eight probes accurately recorded applied pressures ranging from zero to 160 millimeters of mercury (zero to 21.33 kilopascals). The system registered little temperature-induced drift (maximum, 1.25 millimeters of mercury [0.17 kilopascal]) between dry room temperature and 40 degrees Celsius. There were also minimum variations (range, -0.14 to 0.81 millimeter of mercury [0.02 to 0.11 kilopascal]) in the pressures recorded during a twenty-four-hour period. The resting pressure in the tibialis anterior muscle of twenty volunteers who had normal limbs was a mean (and standard deviation) of 13.1+/-8.3 millimeters of mercury (1.75+/-1.11 kilopascals). There was a good correlation between externally applied pressures (zero, twenty, forty, sixty, eighty, and 100 millimeters of mercury [zero, 2.67, 5.33, 8.00, 10.66, and 13.33 kilopascals] applied with use of antishock trousers) and the pressures measured in the tibialis anterior muscle of four volunteers (r = 0.997 to 0.999). The injection of sterile saline solution into the tibialis anterior muscle of a volunteer and the use of high-frequency recording during muscular activity showed a high degree of responsiveness and sensitivity to changes in intramuscular pressure. We also prospectively evaluated the clinical usefulness of the system and found it to be easy to assemble, calibrate, and use. Thus, this reusable, electronic transducer-tipped catheter system, which is based on a noninfusion technique, is simple, minimally traumatic, and highly precise. It is free of hydrostatic pressure artifacts and provides dynamic responses to changes in intramuscular pressure.

Adult↗

[Reduced muscular oxygen tension and nerve impulse transmission from antishock hose. Reduction of oxygen tension in the tibial muscle and impulse transmission in the peroneal nerve from pneumatic -1 pressure from antishock hose].

OBJECT OF THE STUDY: The aim of the study was to assess, whether the pneumatic pressure of an antishock-trouser (AST) of 20-40 mm Hg induces a decreased oxygenation of the anterior tibial muscle and attenuates muscular response potential (MRP) of n. peronaeus profundus? METHODS: Among 22 normotensive, healthy volunteers the AST were tested by applying pressure values between 0 and 100 mm Hg and measuring the intracompartmental pressure, the muscular oxygen pressure as well as the MRP by electroneurographic means within a period of 6 hours. RESULTS: The median initial intracompartmental pressure value of the m. tibialis anterior was 12.0 mm Hg (Q25%/Q75%: 8.9/17.3), the muscular oxygen pressure 14.8 mm Hg (Q25%/Q75%: 11.5/22.0). Transmission of the pneumatic AST-leg segment pressure to the muscle: 97.7% (Q25%/Q75%: 89.2/99.8). Already in the low AST pressure field (20-40 mm Hg) a severe hypoxia occurred in one case. A reduction of MRP was noticed at an AST pressure rate of 10 mm Hg. In 5 of 6 cases AST pressure values of 60 mm Hg led to pathological pO2-values within 5-20 minutes. Almost without exception AST-pressure rates < 60 mm Hg resulted in an anoxia of the muscle and loss of the MRP. CONCLUSIONS: We should demand that the AST are only applied with models where the pressure generated within the single segments can be controlled by pressure gauge. The application of the AST seems to be justified for polytraumatised in severe haemorrhagic shock where the risk of a local tissue ischemia with systemical consequences must deliberately be accepted.

Adult↗

Drainage systems in thyroid surgery: a randomised trial of passive and suction drainage.

OBJECTIVE: To investigate the effectiveness of high-vacuum and passive drainage systems after elective thyroid resection. DESIGN: Prospective randomised clinical study and multicentre postal survey. SETTING: Military hospital, Germany. PATIENTS: 80 patients, treated with passive closed drains (n = 40) or high-vacuum systems (n = 40). INTERVENTIONS: 1. Measuring the amount of blood collected during drainage and the extent of residual haematoma on ultrasonography. 2. Survey in Austria, Germany and Switzerland of annual number of bilateral thyroid resections, type of drainage used, and volume of postoperative drainage. RESULTS: 799 of the 1698 hospitals surveyed replied (47.2%). 785 (98.2%) of the 799 surgeons said that they used drainage systems of whom 766 (97.6%) used high-vacuum systems. In the 40 patients in whom passive closed drainage was used, the median volume drained was 34 ml (range 0-175) compared with 115 ml (40-346) in the high vacuum group (p < 0.01). In the passive drainage group the extent of residual haematoma measured by us was 4.4 ml (range 0-21.7) compared with 5.3 ml (0.6-24.9) in the high vacuum group. CONCLUSIONS: The high-vacuum drainage that is most commonly used in Austria, Germany, and Switzerland results in increased blood loss with no reduction in the extent of residual wound haematoma and offers no additional advantage over passive drainage systems in thyroid surgery.

Adult↗

[Systemic effect of extremity-ischemia reperfusion surgical trauma. Assessment of tourniquet ischemia induced activation of poplymorphonuclear neutrophic granulocytes].

Ischemia-reperfusion-injury represents a fundamental common pathway of tissue damage in a wide variety of disease processes, i.e. myocardial infarction, septic or hemorrhagic shock, multiple organ failure, trauma and organ transplantation. Ischemia-reperfusion-injury is said to be initiated by leukocyte accumulation and adhesion to vascular endothelium as well as oxygen free radicals playing a pivotal role in the pathogenesis of ischemia-reperfusion-injury. However, only few data exist for measuring influence of tourniquet-ischemia on the activation of granulocytes in humans. To assess the potential changes in activation of white blood cells immunophaenotyping (FacsScan, BD) of PMN was used in BTB-operated humans before and after 0, 5, 15, 30 and 120 min of tourniquet-ischemia of the lower and upper limb (no operation). We could show that tourniquet-ischemia (n = 20, 60-170 min) with operation significantly increased the CD 11b-expression to 149.5 +/- 73.4% (15 min after release of tourniquet, systemic, vs. bl: p < 0.05) and 160.1 +/- 55.1% (local, vs. bl: p < 0.001) and the CD 18-expression to 16.8 +/- 110.1% (systemic vs. bl: p < 0.01) and to 155.8 +/- 55.1% (local, vs. bl: p < 0.05). The tourniquet-ischemia of the upper limb without any operation (n = 10) induced an increase of the CD 11b-expression too (systemic, 149 +/- 76% and local 131 +/- 90%, both: p < 0.05 vs. bl). Furthermore there was a spontaneous release of free radical oxygen to 129.2 +/- 26.2% (systemic) und 154.8 +/- 35.9% (local: p < 0.01 vs. bl:) After stimulation by Phorbol-Myristat-Acetat (PMA) we demonstrated a decrease to 67.6 +/- 23.2% (systemic, p < 0.01 vs. bl) and to 68.3 +/- 15.6% (local, p < 0.01 vs. bl). These results indicate that ischemia-reperfusion-injury in humans induces a early measurable local and systemic activation of circulating PMN-granulocytes.

Adolescent↗

Computer-assisted training program for simulation of triage, resuscitation, and evacuation of casualties.

The purpose of this paper is to introduce a multimedia computer software package that has been developed for the Federal Armed Forces of Germany to train military physicians in trauma management. The program presents different groups of casualties with characteristic wounds and multiple injuries on a CD-ROM and provides many clinical options at each decision point. Automatically evaluating the decisions for accuracy, the objective of the program is to train for triage, resuscitation, and evacuation of wounded in combat under pressure of time. The computer-assisted instruction program is inexpensive and allows easily accessible self-instruction as a supplement to formal classroom training. Using this teaching software, it may be possible to teach a standardized emergency case-management algorithm for battlefield trauma. There was a high level of acceptance for this type of instruction. This is encouraging for medical educators involved in producing multimedia packages for teaching emergency medicine.

CD-ROM↗

[The internet--its uses in traumatology].

No other words have obtained such meaning in the computer world as the catchwords "Online" and "Internet". The possibilities are innumerable, even in the medical field, and therefore we must consider whether trauma and orthopedic surgeons can also benefit from this new telecommunications medium. As a result of this inquiry, a pilot program has been initiated through an Internet connection at the computer center in the University of Ulm to test and define the possibilities of the Internet in routine clinical applications and for scientific projects. For the surgeon, there is already an abundance of information available: (1) A medical search register consisting of more than 20 million words has been comprised. the source of such searches could be clinics, individuals publications, or even an e-mail answer from a patient's "Help" inquiry. (2) The literature can be researched without difficulty on the data highway. (3) It has become possible to communicate transfer figures, texts, sound and video data within seconds to any connected physician throughout the world over the e-mail system. (4) Included in the many scientific news-letters presented in the Internet ae also several specified for the surgical field. (5) It has also become apparent that a few of the rare German-speaking institutions available on the Internet (for example, the AO Institute in Davos, some university departments and a few research institutes) offer very detailed "Home Pages". In comparison to the American institutions, however, the majority of the German surgical world is not yet connected to the Internet. The Internet offers an enormous information service that is always available and is accessible worldwide. This information can already be used in clinical and scientific applications.

Computer Communication Networks↗

[Femur osteosynthesis in the polytrauma patient--considerations for reasonable surgery time frame from the viewpoint of military service medical treatment].

OBJECT: What are the concepts of secondary osteosynthesis in polytrauma patients? What are indicators underlying these concepts? Are there consequences for Military Medicine? RESULTS: Conservative stabilization techniques are unsuitable. The intramedullary nail is considered to be large-scaled and technically demanding. It leads to additional stress for the patient (second hit). The following parameters are not suitable: General status, soft-tissue condition, lung fluid, thrombocytes, PNM elastase, cathepsine, lactate, CRP, neopterin, AT III, t-PA-inhibitor, PFI-index, bilirubin. CONCLUSIONS: An objective parameter for the choice of the proper timing of definitive fracture treatment does not exist. In the literature, only few parameters are enumerated. Inconsistent recommendations are hardly discussed. Therefore, from the viewpoint of Military Medicine, we recommend external fixation for primary stabilization. Finally, the systemic inflammatory response has eased off after 5-7 days. Then the definitive operative procedure--intramedullary nailing--should be planned.

Biomarkers↗

[Possibilities of telemedicine within the scope of military medical interventions at foreign posts].

Telemedicine is the investigation, monitoring and management of patients and staff using systems which allow ready access to expert advice and patient information, no matter where the patient or the information is located. Telemedicine and teleconsulting have the potential to improve out-of-area military medical care by increasing patient/provider access to specialized medical facilities, services and talent. Similarly, telemedicine can help reduce medical costs by reducing the cost of traveling to and from remotely located medical facilities and services. The Army medical telemedicine effort allows electronic transmission of medical information from remote sites to a designated hub where the transmitted information is available for electronic diagnosis and consultation by health care specialists.

Germany↗

[Gravity or suction drainage in thyroid surgery? Control of efficacy with ultrasound determination of residual hematoma].

In a prospective randomized trial, the common high-vacuum drainage system according to Redon was compared with the nonsuction system according to Robinson in 80 patients undergoing elective thyroid surgery between January 1995 and August 1995. Forty patients were provided with nonsuction, passive drains, and another 40 patients were allocated to a control group with the high-vacuum system. Twenty-four h postoperatively, the wound area was analyzed by sonography after drainage removal. The dimension of the remaining hematoma was determined by scanning the operation field in six to seven layers (thickness per layer T = 1 cm). The area (A) of the hematoma was measured per layer, and thus the volume was determined by the formula: V = T x (A1 + A2.. + A(n)). Simultaneously, the quantity of discharge was determined. Patients receiving nonsuction drainage had significantly lower median drainage volume (34 ml; range: 0-175 ml vs-115 ml; range: 40-346 ml; P < 0.01) and a remaining hematoma, measured sonographically, of similar volume to that of the patients receiving high-vacuum treatment (4.4 ml; range: 0-21.7 ml vs 5.3 ml; range: 0.6-24.9 ml; not significant). No complications were observed. An advantage to using the nonsuction device is seen with respect to similar resting wound hematoma, lower fluid evacuation, and painless drain removal. This study supports prophylacity routine nonsuction wound drainage after elective thyroid surgery.

Adult↗

Unusual development of acute exertional compartment syndrome due to delayed diagnosis. A case report.

Our report describes the case of a 20 year old man who developed an acute exertional anterior tibial compartment syndrome after playing soccer for five minutes. No trauma was reported. Correct diagnosis was delayed for 18 hours, because pain was misinterpreted as resulting from acute muscular tetanic spasm induced by hyperventilation. Fasciotomy was contributed. After one year, the patient complained of early fatigue. Electromyographically the reinnervation had not yet been completed. This case illustrates the necessity for careful observation of non-trauma related acute tibial anterior pain appearing even at the beginning of strenuous exercise. It is important to recognize the possibility of a very acute onset of exertional compartment syndrome that does not subside with rest. Only early diagnosis and fasciotomy can prevent severe complications of an acute exertional compartment syndrome.

Acute Disease↗

Impact of vitamin E supplement in standard laboratory animal diet on microvascular manifestation of ischemia/reperfusion injury.

Aimed at improving animal fertility and health, diets for farm and laboratory animals have over the last few years been supplemented with increasing amounts of the antioxidant vitamin E. We now demonstrate by intravital microscopy that feeding hamsters with a vitamin E-supplemented "standard" rodent diet (60 ppm vitamin E) significantly reduces the microvascular manifestations of ischemia/reperfusion injury when compared to animals fed a nonsupplemented diet. Postischemic leukocyte adhesion to venular endothelium was reduced from 770 +/- 204 cells/mm2 at 24 h after reperfusion in control animals on the nonsupplemented diet to 403 +/- 105 cells/mm2 in animals on the "standard" rodent diet (means +/- SD, n = 7 animals per group, p < 0.01). Animals on the nonsupplemented diet showed a dramatic loss of capillary perfusion density until 7 days after reperfusion (to 21 +/- 13% of preischemic baseline values), whereas this loss was significantly attenuated (to 71 +/- 12% of preischemic values, p < 0.01) in animals on the "standard" rodent diet. No difference in the extent of reperfusion injury was seen between animals on the "standard" rodent diet and animals on diets with substantially higher vitamin E supplements (300 ppm-30,000 ppm). Besides underscoring the benefit of vitamin E in reducing the extent of ischemia/reperfusion injury, this study raises the concern that vitamin E supplements in "standard" laboratory animal diets may have a far-reaching impact on biomedical research by jeopardizing established animal models of disease.

Animals↗

[Experimental and clinical studies of the use of thin-lumen polyurethane gravity drainage in accident surgery].

A clinical randomized study was conducted to compare 28 closed polyurethane (PU) drainage systems and 28 open polyvinylchloride (PVC) (Redon) drainage systems. The aim was to find whether the Redon drains could be replaced by PU drains without suction in the field of joint and soft tissue surgery. In another study, 27 PU gravity-drainage systems were implanted for surface electron microscopy. There was no difference in the volume of fluid drained. The tendency to diversion of the secretion induced by a thrombus in the drain was significantly lower in the PU drainage group than in the PVC-Redon group. Extraction of the drain was significantly less painful in the PU group than in the group with Redon drains. No complications occurred in either group. The surface electron-microscope study revealed slight adherence of thrombotic material to the inner wall of the drain in the PU group only. The thrombi were mobile and had a smooth surface, so that they could not block the drainage of secretions. In our opinion, PU gravity-drainage systems could be substituted for PVC-Redon drainage systems in the field of traumatology. This would exclude the potential toxic effects of PVC.

Drainage↗

[Light and scanning electron microscopy studies of the pleura. A contribution to the pathogenesis of spontaneous pneumothorax in young patients].

In a prospective study of 10 patients (7 men, 3 women, mean age 26.2 years), who underwent thoracotomy because of recurrent spontaneous pneumothorax, we performed light and scanning electron microscopic investigations of the resected pleura. The purpose of our work was to explain pleural changes which allowed the penetration of air through the intact wall of the blebs. In 8 of 10 cases we found small bullae at the top of the upper lobe, the remaining 2 showed up with massive pleural scar. The morphological and ultrastructural findings indicated that the presence of air induced a reactive process at the visceral pleura which led to degeneration and scarification. The changes consisted of simple membrane formation up to complete destruction of the pleural layer. The development of blebs is due to an air fistula coming out of the lung parenchyma. Penetration of air through the bleb's wall is explained with the increasing pressure inside and the dehiscence of degenerated pleural structure. In our opinion spontaneous pneumothorax in young people is caused by a localized disease of the upper lobe. The pleural changes are the visible effects of a degenerative process induced by air fistula from lung parenchyma. Therefore wedge-resection of that region is a rational therapy in patients with spontaneous pneumothorax.

Adult↗