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D Nast-Kolb

Publications and source records attributed to D Nast-Kolb.

At least 19 recordsLinked to original sources
PubMed2006

[Management of polytrauma].

The first hours after trauma are decisive. Therefore the treatment chosen demands very strict planning according to concepts of modern quality management. This begins with the fastest possible and most efficient delivery of injured patients to the applicable clinic. Such institutions are permanently ready and have at their service all the necessary diagnostic techniques and surgical and intensive care methods. Effective shock treatment entails standardized procedures accompanied by up-to-date diagnostic and therapeutic measures. After admittance and therapy of life-threatening injuries (immediate measures, damage control surgery), early-stage surgery will follow (soft tissue injuries and fractures). Strategy of damage control orthopedics is growing in acceptance because of the potential danger to life functions due to pro- and anti-inflammatory response induced additional trauma caused by following surgery. Fractures initially stabilized by external fixation can consecutively be treated safely by secondary conversion osteosynthesis. A considerable improvement in quality can be attained through therapeutic procedures approved by all concomitant disciplines and standardized systems with internal and external control methods.

Emergency Medical Services↗
PubMed2006

[Chest injury. Part I: Significance--symptoms--diagnostic procedures].

Chest injuries can be sustained in isolation or in association with multiple injuries. Life-threatening complications may ensue because organs that are vital to survival of the organism are situated within the thoracic cavity. These complications include airway obstruction, tension pneumothorax, wide open pneumothorax, flail chest, cardiac tamponade and massive hemothorax. The mortality of patients hospitalized with chest injury can be as high as 10%. Clinical examination and awareness of the possibility of other injuries (high level of suspicion) are essential, and standard chest X-ray, ultrasound and thoracic computed tomography may also be needed for the diagnosis. The first part of this serial paper on the management of chest injuries focuses on anatomical aspects, pathophysiology and symptoms, but mainly on the indications for the standard diagnostic procedures and further high-tech examinations.

Aortic Rupture↗
PubMed2006

[Chest injury. Part II: Management of specific injuries].

Significant injuries to the thorax comprise pneumothorax, rib fractures, lung contusion, cardiac contusion, aortic laceration, ruptured diaphragm, and the very rare injuries to the tracheo-bronchial tree and the esophagus. A surgeon dealing with chest trauma patients needs to be familiar with the indications for and execution of chest tube insertion for thoracic drainage, pericardial puncture, and thoracoscopy and thoracotomy. Interventional techniques are gaining increasing acceptance in the management of major vascular injuries. The vast majority of patients with chest injury do not need an operative intervention, but it is necessary to place a thoracic drain in 10-15% of cases or to perform in a much lower proportion a pericardial puncture or a thoracotomy.

Critical Care↗
PubMed2006

[The significance of delayed diagnosis of lesions in multiply traumatised patients. A study of 1,187 shock room patients].

BACKGROUND: Multislice computed tomography (CT) technology has improved the diagnosis of relevant lesions within the phase of primary treatment of severely injured patients. The lack of time in this phase and the complexity of the multiple injuries there is still a risk that lesions will be missed at this stage. The purpose of this study was to evaluate the incidence, causes, implications and significance when injuries are not diagnosed until later. METHODS: The data were documented prospectively in the context of a quality management system for the care of severely injured patients in a primary urban trauma centre. Missed injuries were defined as any lesions that had not been recognised by the time the patient was admitted to the ICU. RESULTS: During a 44-month period 1,187 (ISS 21+/-17) patients were enrolled in the study, all of whom were admitted from May 1998 to April 2002 after attending the emergency room. In total 64 (4.9%) missed injuries were detected in 58 (ISS 30+/-16) patients; 26 of the 64 missed injuries were located on the torso, 8 injuries in the head and neck region, and 30 on the arms and legs. The missed injuries were categorised as follows: 1. Lesion not seen in diagnostics (n=15). 2. Incomplete diagnostics (n=8). 3. Primarily unsuspicuous examination (n=35). 4. Diagnostics interrupted due to hemodynamic instability (n=6). CONCLUSION: Despite intensified and standardised diagnostic procedures prescribed for use in trauma centres, injuries are still missed in severely injured patients. About 30% of lesions that are not diagnosed until after the patient has left the emergency room have clinically significant, but not lethal, consequences for the patient. Great importance attaches to the follow-up investigation on the intensive care station, so that lesions that have initially been overlooked can be diagnosed and treated as soon as possible so as to keep the complication rate low.

Adolescent↗
PubMed2005

[Current diagnostics for intra-abdominal trauma].

In case of suspected intra-abdominal injury, fast transport of the patient to a suitable hospital is of high priority. The initial clinical examination aims at identifying patients with potentially life-threatening bleeding that require emergency surgery. In patients with penetrating trauma, laparoscopy is favoured to exclude suspected perforation of the peritoneum. If a peritoneal perforation is identified, exploratory laparotomy is recommended to exclude or treat lacerations of the hollow viscus. Although clinical examination should be performed its sensitivity and specificity of up to 82% and 45%, respectively, are not sufficient as the sole screening method. For the further diagnostic workup, diagnostic peritoneal lavage has been completely replaced by abdominal ultrasound examination in Germany and many other countries. Focussing not only on the detection of free abdominal fluid but also searching for parenchymal organ lesions and performing repeated examinations increases accuracy up to 96%, with specificity of 99.8% and sensitivity of 72.1%. Computed abdominal tomography with a helical scanner with and without intravenous contrast media is currently the gold standard of imaging techniques to identify traumatic abdominal injuries. A sensitivity of 97.2% and specificity of 94.7% can be achieved. False negative findings must be expected with hollow organ injuries. Serial clinical and ultrasound examinations as well as lab testing in conjunction with repeated CT may help to identify such lesions. Increased intra-abdominal pressure (IAP) with consecutive abdominal compartment syndrome and multiple organ dysfunction is a delayed complication from conditions such as severe intra-abdominal bleeding, major bleeding from pelvic ring fractures, and profuse fluid resuscitation. The IAP should be measured routinely in patients at risk, and decompression laparotomy may be indicated with pressures of higher than 20 mmHg.

Abdominal Injuries↗
PubMed2005

[Traumatic aortic injuries in severely injured patients].

Herein we report our results of treatment of traumatic aortic ruptures in severely injured patients with either open surgery or endovascular stent graft repair. Data were analyzed retrospectively from the trauma registry of the DGU (Deutsche Gesellschaft fur Unfallchirurgie) over a time period from 1993 through 2002. All patients with traumatic rupture of the aorta were included and analyzed for injury severity (ISS), blood pressure (mmHg), hemoglobin (mg/%), and AIS (Abbreviated Injury Score) of the thoracic, abdominal, and upper extremity regions. Patients treated between 1998 and 2002 were further examined (operation within 24 h, duration of intervention, blood transfusion, and lethality with regard to either open surgical or endoluminal stent graft repair). Of 14,110 patients, 100 (0.7%) suffered from acute aortic rupture. Mean age was 38 years (+/-19) with an inhospital lethality of 39% (n=39). Mean ISS was 41 (+/-14); 36 patients were treated by open surgery and 5 patients by a stent-assisted endoluminal procedure. Lethality was 17% for open surgery and 0% for stent graft repair. Endovascular approach to traumatic rupture of the aorta is feasible and safe. It has been shown to reduce inhospital lethality and may offer an alternative to open surgery for severely injured patients.

Adult↗
PubMed2005

[Damage control orthopedics].

BACKGROUND: In the management of patients with multiple injuries, the concept of damage control orthopedics (DCO) is still a matter of controversy. Thus, the clinical value of DCO remains unclear and should be evaluated on an evidence-based level by a review of the current literature. RESULTS: The work of various authors has demonstrated an association between injury severity and the clinical immuno-inflammatory response and its prognostic relevance regarding organ dysfunction or organ failure and clinical outcome. Research data published by the authors and other investigators have clearly demonstrated an additional inflammatory response caused by surgical trauma which is significantly higher after primary intramedullary fracture treatment than after external fracture stabilization. In contrast, a generally minor inflammatory response seems to be associated with intramedullary nailing for secondary conversion osteosynthesis. Three retrospective cohort studies have shown a reduction of organ dysfunction and an improvement of survival with the DCO approach. Simultaneously, it was demonstrated that primary external fracture fixation and secondary conversion to definite osteosynthesis is not associated with an increased rate of local or systemic complications. CONCLUSIONS: The advocates of DCO claim that patients with multiple injuries including severe brain and chest injuries as well as those with an unstable cardiopulmonary or circulatory condition are at high risk of developing a severe systemic immuno-inflammatory reaction during early total fracture care. Therefore, they recommend primary minimally invasive external fracture stabilization in these patients to avoid additional surgical trauma and that definitive secondary fracture care should be performed after medical stabilization of the patient in intensive care.

Critical Care↗
PubMed2004

[Clinical course and prognostic significance of immunological and functional parameters after severe trauma].

Generalized severe trauma leads to an increased incidence of SIRS, sepsis, and MOF. The aim of this prospective study was to investigate the immunological parameters in terms of their predictive value for multiple organ failure (MOF).HLA-DR expression on peripheral monocytes was analyzed by flow cytometry, the ex vivo endotoxin-stimulated TNFalpha synthesis of whole blood, and the serum levels of IL-6, IL-10, procalcitonin (PCT), and CRP were analyzed by ELISA in 16 severely injured patients with an ISS >25. Initially after trauma elevated serum levels of IL-6, IL-10, and PCT were found, while TNFalpha-producing capacity and HLA-DR expression on monocytes decreased. In patients with MOF a further decrease of HLA-DR expression on days 3-4 after injury was observed accompanied by elevated levels of IL-10 at this time point. However, the TNFalpha-producing capacity was even enhanced in patients with MOF in the 2nd week after trauma. Later PCT levels were also higher in patients with MOF.Monitoring of immunological parameters after severe injury is useful to identify mediator constellations that are associated with the development and clinical course of MOF even in extremely injured patients.

Abbreviated Injury Scale↗
PubMed2004

[The infected hip prosthesis].

Therapy of infected hip prosthesis should always be based on a structured treatment concept. When short-termed early infection is present or impending, with meticulous debridement of the soft tissue surroundings, the implant may be left in place. Chronic infection (>30 days) should lead to complete removal of implant and cement. A one-staged revision of the implant may be considered for patients without additional chronic disease, good vascularization of soft tissue and bones and bacteria susceptible to antibiotics. In most cases though two-staged revision is indicated. The interval between implant removal and re-implantation ranges between one and four months. Re-implantation should only be performed when laboratory parameters are normalized and the local wound site has turned to an unsuspicious condition. By insertion of a cement spacer during the interval period soft tissue shortening and local scar formation can be prevented. Parenteral antibiotics should be applied for four to six weeks. In patients with reduced general health state and extremely severe infection permanent resection of the hip or limp ablation may be indicated.

Arthroplasty, Replacement, Hip↗
PubMed2004

[Diagnostics and treatment strategies for soft tissue sarcomas].

Soft tissue sarcomas (STS) represent a rare entity of all malignant tumors (1%). Thus, an in-depth understanding of multidisciplinary treatment strategies may not be sufficiently present at all operative units. Consecutively, optimal diagnostic and therapeutical pathways may not be applied. Magnetic resonance imaging (MRI) is the procedure of choice in diagnosing STS. Biopsies should be performed in specialized centers. Identification of cytogenetic factors has become more important for the typing and prognosis of STS. Management of STS should employ multimodal treatment concepts (Oncology, Radiotherapy, Surgical Oncology). The decision on whether radiotherapy, chemotherapy or another option is indicated should be taken by an interdisciplinary tumor board, which also determines the sequence of treatment in relation to resection. To obtain sufficient information from histopathologic examination of the resected tumor, a clear and distinct definition of critical margins and topography by the surgeon is essential. Following these concepts, optimal local tumor control associated with resections preserving function and limbs is achieved without impairment of overall prognosis. Tumor resection alone, without previous evaluation and where appropriate adopting multimodal treatment strategies, no longer meets modern standards. After primary treatment is complete, patients have to be enrolled in a standardized follow-up program.

Biopsy↗
PubMed2004

[Personnel and structural requirements for the shock trauma room management of multiple trauma. A systematic review of the literature].

The aim of the study was the description of personal and structural preconditions essential for adequate diagnostic requirements and treatment in severely injured patients. Herein we give detailed information regarding both the composition and qualification of the trauma team and the activation criteria as well as instructions for the design of the emergency room and technical requirements. Clinical trials were systematically collected (MEDLINE, Cochrane, and hand searches) and classified into evidence levels (1 to 5 according to the Oxford system). The trauma team should consist of (trauma) surgeons, anesthesiologists, radiologists, and one to two nursing staff members of each department. The attending physician should be present within 20 min. Trauma team activation criteria are among others: high energy/velocity trauma, penetrating injuries, GCS < or =14, and intubation. The emergency room should be integrated in the emergency department with all technical equipment being permanently available for optimal diagnostic and therapeutic management. A CT scanner should be positioned nearby.Adequate management of severely injured patients requires optimal personal and structural conditions. High costs and additional personnel are justified by improved quality of treatment.

Emergency Medical Services↗
PubMed2004

[Injuries- and frequency of complaints in competitive tennis- and leisure sports].

Tennis is one of the most popular sporting activities in Germany and worldwide. According to this fact injuries and complaints associated with this sport are common in tennis players. Here a retrospective analysis was undertaken in 60 tennis players with and 50 tennis players without tournament experience. Injuries were seen in all players. The most common lesions were blisters, sunburn and abrasions (65.5 %) followed by cramps (51.8 %), strains (35.5 %) and sprains (25.5 %). More severe injuries like meniscal lesions or ruptures of the cruciate- and ankle-ligaments or the achilles tendon were found in 2 % to 4 %. Fractures were not seen in this study. The majority of tennis injuries occurred in the lower extremity (182 vs. 62) whereas chronic complaints domain in the upper extremity (38/91). Most of the injuries and complaints have been treated conservatively with good results. Only 3.3 % of all acute and 2.2 % of the chronic lesions were treated by surgical intervention.

Adolescent↗
PubMed2003

Knee arthrodesis after infected tumor mega prosthesis of the knee using an intramedullary nail for callus distraction.

BACKGROUND: Infected tumor endoprosthesis of the knee in young patients can prove to be challenging. Common procedures are débridement and prosthesis reimplantation, amputation, revision arthroplasty, and arthrodesis. CASE PRESENTATION: We report the case of a 44-year-old man treated by arthrodesis followed by callus distraction after removal of an infected tumor mega prosthesis (Kotz type). Callus distraction was performed over a distance of 11 cm in 4 months using a femorotibial intramedullary nail with an external traction rope-winch system. METHODS AND FOCUS: The clinical, radiological, technical, and therapeutic features are discussed.

Adult↗
PubMed2003

[Tracheal rupture from blunt chest injury in a child].

Tracheobronchial lesions after blunt chest injury are rare. Diagnosis and therapy can prove to be challenging for the attending physician. Nonrecognition of this injury may entail severe complications. Herein we report the case of a 9-year-old girl with rupture of the trachea due to a fall against the handlebar of her kickboard. The clinical, radiological, and features of the therapy performed are discussed.

Athletic Injuries↗
PubMed2003

[Emergency room patients].

UNLABELLED: The aim of the study was to examine the predictive value of CT for severe intracranial lesions of mild (GCS 15-13) and moderate (12-9) head injuries. Further,we examined the possibility of predicting these lesions by various variables/factors. Data were collected prospectively from the trauma registry of the DGU (Deutsche Gesellschaft für Unfallchirurgie). Patients with a GCS score from 15-13 and from 12-9 were included in this study and examined for intracranial lesions (AIS(head) 3-6). Over a time period from 1993 to 1999, 1778 patients with mild head injury and 235 patients with moderate head injury were analyzed. Severe intracranial lesions were suffered by 18.6% of the patients with mild head injury and 50.4% of the patients with moderate head injuries. Of the predictive variables, heart rate,patients' age,and primary assessment by the emergency physician showed a strong correlation with the later observed intracranial lesions. IN CONCLUSION: (1) independently of the initially good GCS, a high percentage of patients suffered from severe intracranial lesions and (2) besides the GCS only the patients'age and primary assessment by the emergency physician were useful for identifying patients at risk for an intracranial lesion.

Adolescent↗
PubMed2003

[Humeral head fractures].

Humeral head fractures generally may be treated in a non-operative concept with early physiotherapy when fragment dislocation is minor. Dislocated 2-part fractures (head and shaft fragment) may be treated with closed reduction. If the fracture persists unstable, K-wire, cerclage, intramedullary nailing or plate osteosynthesis are the eligible methods. Particularly isolated K-wire osteosynthesis is associated with a high risk of implant or fragment dislocation. Dislocated 3- or 4-part fractures need additional reduction and fixation of the tubercles. In osteoporotic fractures, intraosseous fixation may lead to complications. Especially cerclage and/or isolated screws (eventually additional K-wires) osteosynthesis allows good reduction for functional treatment in the older patient. Sufficient results in long-term outcome are achieved by minimal invasive techniques even in partial avascular head necrosis. In 4-part fractures prosthetic replacement should be considered. Especially when old patients have severe destruction or luxation of the humeral calotte prosthetic treatment may be indicated. Early functional physiotherapy is important after all types of osteosynthesis or prosthesis.

Adult↗