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Biomedical subjects

D Nast-Kolb

Publications and source records attributed to D Nast-Kolb.

At least 127 records · Page 7Linked to original sources
PubMed1993

[The role of an abdominal injury in follow-up of polytrauma patients].

Patients with multiple injuries were studied retrospectively (n = 483, ISS = 28 pts) and prospectively (n = 133, ISS = 42 pts) to determine the significance of concomitant intraabdominal lesions in the management and outcome of these subjects. In the retrospective part of the investigation 134 patients with intra-abdominal trauma presented with significantly more severe injuries (ISS = 38) as compared to 349 subjects with bland abdomen (ISS = 25). This resulted in a significantly different mortality rate (27 vs 11%). 119 patients with abdominal trauma were managed operatively, with surgery instituted within 4 hrs after the accident in 104 cases. Delayed abdominal surgery was performed in 18 patients due to complications from the initial laparotomy and in 15 cases because of delayed diagnosis. Delayed operations resulted in an increased rate of local complications (33 vs. 6%). In the prospective part of the study 33 out of 133 patients succumbed during resuscitation. In 14 of these, intractable bleeding from abdominal lesions was identified as the cause. In the 100 primary survivors, there was found no difference between 41 patients with and 59 patients without abdominal pathology with respect to injury severity, mortality, complications, initial hemodynamic parameters or the secondary release of inflammatory mediators. However, the initial requirement for red blood cell substitution was significantly higher in subjects with intra-abdominal trauma. Our results demonstrate that massive intra-abdominal hemorrhage may cause early mortality. In primary survivors, abdominal lesions have not shown to be of prognostic relevance, provided that early resuscitation, early diagnosis and early operative therapy can be instituted.

Abdominal Injuries↗
PubMed1993

[Venous thrombosis following severe multiple trauma].

The incidence of thromboembolic complications in patients with multiple injuries was reviewed as well with respect to our own prospective investigation (141 patients with a mean injury severity score of 37 points). The rate of deep venous thrombosis (DVT) in severely injured patients is reported to vary from 20 to 90% if invasive diagnostic procedures are used, whereas the rate of clinically relevant manifestations of DVT seems to be much lower. Although 96% of the patient population in our study were thought to be at high risk of having DVT (applying generally accepted risk factors), only 1.4% of the subjects actually developed clinically relevant DVT. The analysis of several parameters of the coagulation and fibrinolytic systems (platelet count, prothrombin time, partial thromboplastin time, antithrombin III, prothrombin, plasminogen, tissue-plasminogen-activator and its inhibitor) showed simultaneous activation of both systems in these severely injured patients. Thus, increased coagulation seems to be counteracted by increased fibrinolysis. In addition, fluid resuscitation with crystalloid and colloid infusions in the prehospital period (1970 ml and 573 ml, respectively) can be viewed as early prophylaxis of thromboembolic complications. Thus, the low DVT rate in a high-risk patient group with multiple injuries might be at least partially explained.

Adult↗
PubMed1992

Inflammatory mediators, infection, sepsis, and multiple organ failure after severe trauma.

The relation of (multiple) organ failure (OF) to the release of inflammatory mediators and the incidence of infection and sepsis was studied prospectively in 100 patients with multiple trauma (injury severity score = 37). Sixteen patients died of OF, 47 patients survived OF, and 37 patients had no OF. Fifteen (24%) of the patients with OF showed no signs of infection. In patients with early onset of OF (n=45), infection followed with a lag of 2 or more days. In 16 (44%) of these patients, infection led to a deterioration in organ function. With late onset of OF (n=18), infection preceded OF in nine patients. Polymorphonuclear leukocyte-elastase, neopterin, C-reactive protein, lactate, antithrombin III, and phospholipase A discriminated significantly among the three outcome groups. Of all factors, only polymorphonuclear leukocyte-elastase showed a difference between patients with and without infection or sepsis, respectively. These data indicate that infection might not play a crucial role in the pathogenesis of posttraumatic OF in a substantial portion of patients with trauma. Early OF, especially, seems to be mainly influenced by the direct sequelae of tissue damage and shock (eg, the release of inflammatory mediators). Since infection and sepsis did not lead to an augmented release of mediators in patients with trauma, the role of both entities remains unclear.

Adult↗
PubMed1992

The role of the kininogens as cysteine proteinase inhibitors in local and systemic inflammation.

The contribution of the kininogens and cystatin C to the functional inhibitory capacity for cysteine proteinases of blood plasma and inflammatory secretions was estimated from ex vivo experiments. 98.5% of the inhibitory capacity of blood plasma for cathepsin L (4-5 microM) is provided by the kininogens ensuring a complete control of this enzyme even at a lowered kininogen concentration. Control of cathepsin B activity by the kininogens is incomplete and depends critically on the active concentration of cystatin C (70 nM in normal plasma), which is reduced in blood plasma of polytraumatized and septic patients and very low in epithelial lining fluid of the shock lung.

Cathepsin B↗
PubMed1992

[Biochemical factors as objective parameters for assessing the prognosis in polytrauma].

One hundred patients with multiple injuries (mean ISS 37 patients) were prospectively evaluated over a period of 14 days following trauma. Significant differences in the blood levels of PMN elastase, cathepsin B, lactate, neopterin, C-reactive protein (CRP) and antithrombin III (ATIII) were found in non-survivors and in survivors with and without organ failure. On admission, a prediction of organ failure was possible with an accuracy of 63% to 69% (PMN elastase, cathepsin B, ATIII). Death was predictable with an 80% to 90% accuracy within the first 4 days (PMN elastase, lactate, CRP, neopterin). The prognostic value of these factors was comparable to trauma scores regarding organ failure and better with respect to death. Biochemical parameters may be helpful in estimating the severity of the injury and prognosis and in monitoring the ICU course of such patients.

Acute-Phase Proteins↗
PubMed1992

[Trauma scores: reproducibility and reliability].

The inter-rater reliability of the Injury Severity Score (ISS) and the Polytraumaschlüssel (PTS) [multiple trauma code] was studied using diagnosis sheets filled in for 107 multiple injured patients. The scoring was performed by eight physicians with different levels of qualification. The scores for individual patients varied widely depending on the scorer, with extremes differing from the mean by about 80% and 70% for the ISS and PTS, respectively. The mean ISS and PTS for the whole study population also varied significantly between the scorers (P less than 0.0001, one-way analysis of variance). Raters with experience in trauma scoring calculated significantly higher scores (P less than 0.01, t-test) Neither the ISS nor the PTS seem reliable enough to describe injury severity in an individual patient. Treatment decisions must not be based on such grounds. Even for larger groups, caution must be exercised in comparison of different populations of multiple traumatized patients.

Humans↗
PubMed1991

Posttraumatic splenectomy does not influence human peripheral blood mononuclear cell subsets.

The immunological and functional consequences of splenectomy in patients with severe trauma are still controversial. In addition to the higher incidence of bacterial infections, including the post-splenectomy sepsis syndrome, alterations of the peripheral blood mononuclear cells (PBM) have been described in patients after splenectomy. We studied the effects of splenectomy in severely injured patients on the number of PBM subsets 30-80 (median 55) months after splenectomy. Compared to a control group of patients with a similar age and a similar severity of trauma there was no significant difference between splenectomized and non-splenectomized patients regarding the absolute and relative numbers of monocytes, B cells, T cells, CD4+ cells, CD8+ cells, NK cells, CD57+/CD8+ cells and CD4+/CD8+ cells. The CD4/CD8 ratios were within the normal range. In two trauma patients without splenectomy the CD57+/CD8+ cells were found to be elevated to 635 and 513 cells/mm3 compared to less than 100 CD57+/CD8+ cells in controls. Except for a slight thrombocytosis in the splenectomized patients (p less than 0.05) the differential cell count showed no difference between both groups. Our data thus suggest that, in a controlled study, splenectomy has little if any effect on peripheral blood mononuclear cell subsets, while severe trauma on its own may have a profound long term effect on T cell subsets in some patients.

Adolescent↗
PubMed1991

[Abdominal sonography versus peritoneal lavage in shock site diagnosis in polytrauma].

Diagnostic peritoneal lavage (DPL) and abdominal sonography (AS) were prospectively evaluated in emergency room diagnostics of blunt abdominal trauma in 106 multiple injured patients (ISS 40 pts). The incidence of intraabdominal lesions was 38.7%. 82 DPL and 64 AS were performed. In 45 patients both procedures were done, in 19 patients only AS and in 37 patients only DPL. The over-all accuracy of DPL and AS was 95% and 88%, respectively. Sensitivity was 91 vs. 74%, specificity 98 vs. 95%. The combined use of both procedures increased accuracy to 98%. We conclude that AS is the initial screening method for the detection of intraabdominal lesions in multiple injured patients. In any case of negative AS and hemodynamic instability or ambiguous AS, DPL should be performed immediately to improve diagnostic accuracy without delaying treatment.

Abdominal Injuries↗
PubMed1991

[The treatment of humeral shaft fractures. Results of a prospective AO multicenter study].

This prospective multicenter study conducted by the German section of the AO International analyzes 302 fractures of the humeral shaft, 170 (56%) of which were operated upon and 132 (44%), treated conservatively. Among those operated upon, 3.5% developed infections and 10% showed paresis of the radial nerve. In contrast, the only complication in the group treated conservatively was pseudarthrosis, in 1 case. However, further analysis revealed that complications were distributed unequally among the centers and the most complications were reported from only a few hospitals. We were able to contact 173 (57%) patients for follow-up. Results of operative and conservative treatment were compared for similar fractures. Both techniques resulted in predominantly good to excellent results. The somewhat inferior results in the group operated upon were explained by the higher percentage of associated local injuries and concomitant injuries to other organs. The results of this study were compared with those of other recent studies, and recommendations were established for the operative and conservative treatment of fractures of the humeral shaft.

Adolescent↗
PubMed1990

[Is there a favorable time for the management of femoral shaft fractures in polytrauma?].

Despite the wide-spread opinion, that early stabilisation of femur fractures in multiply injured patients is of advantage, there are no publications that unambiguously prove this statement. In contrast, primary fracture stabilisation of the femur with concomitant thoracic trauma seems to increase the rate of complications. The biochemical data of the prospective study presented here suggest, that operative stabilisation of femoral fractures imposes an additional trauma on the already compromised organism. The period between days 2 to 4, when the primary activation of humoral and cellular mediators has returned to normal levels, seems to be the best time for osteosyntheses of these fractures. The operation in this period allows intramedullary fixation--the biologically and biomechanically best fixation procedure--with low risk.

Acute-Phase Proteins↗
PubMed1989

Prognostic value of serum phospholipase A in the multitraumatized patient.

Phospholipase A serum activity was prospectively studied in 39 patients with multiple trauma. There was no correlation of phospholipase A activity with type or severity of injury. With increasing phospholipase A levels, a rise in mortality was found. A prediction of fatal outcome on an individual basis was not possible. The sensitivity for complications was 90%, whereas the predictive value of the positive test (64%) and specificity (47%) were low. When the behavior of phospholipase A and elastase release were compared, no correlation between these two parameters could be detected. Therefore, PMN leukocytes do not seem to be a major source of phospholipase A in serum.

Acute Kidney Injury↗
PubMed1989

[Changes and progress in fracture treatment of the proximal and distal lower leg].

In the treatment of proximal and distal tibial fractures, special attention has to be focused on the severity of tissue damage. Guidelines are given in the paper. (1) For tibial head fractures, stable internal fixation is usually necessary but should be delayed for 1 week. The best approach is lateral or ventral. The use of implants for buttressing has to be kept to a minimum. Concomitant ligamentous injuries are reconstructed, and damaged menisci should be preserved. (2) In the case of distal tibial fractures, those not involving the joint can be treated non-operatively. The internal fixation method by Ruedi is rarely indicated. When joint fractures involve tissue damage reconstruction is necessary. It is essential to achieve normal length of fibula. The joint is reconstructed with minimal use of implants. In addition, external fixation is usually necessary.

Adult↗
PubMed1989

[Changes and progress in fracture treatment in polytrauma].

The last 20 years have seen a great deal of controversy about the indications for and the timing of operative fracture treatment in multiply injured patients. In central Europe a standardized concept of treatment has been widely adopted since the late 1970s. In this concept a few types of fractures are given a high priority and are operated on early. Most fracture types, however, are not stabilized by internal fixation until several days after the injury. The treatment of closed femoral shaft fractures is still hotly debated. So far, not a single prospective study proving the advantages or disadvantages of early fixation has been published.

Fracture Fixation, Internal↗
PubMed1989

[Changes and progress in fracture treatment of the humeral shaft].

Most humeral shaft fractures are treated by early functional mobilization (Sarmiento-Bracing). In some situations (short transverse fractures, old age of patients living alone, extreme obesity, social circumstances) operative fixation may be warranted in individual patients. There are, however, several absolute and urgent indications for operative fracture stabilization: fractures involving nerve or vessel injury, open fractures, multiple fractures on the ipsilateral arm, and delayed fracture healing. Osteosythesis with a dorsally placed femoral DC plate gives the best results.

Amputation, Traumatic↗