Biomedical subjects

E Dolder

Publications and source records attributed to E Dolder.

At least 19 recordsLinked to original sources

PubMed1992

[Who should be hospitalized following mild craniocerebral trauma?].

The frequency of minor closed head injuries is high. These injuries may be complicated by the development of life-threatening intracranial hematomas. A well-defined selection criteria for admission must be proposed to guarantee an efficacious observation. In our series of 489 hospitalized patients with a GCS of 15 when seen in the emergency room: 4 patients required evacuation of an intracranial hematoma, 11 revision of a depressed skull fracture or a compound fracture of base of the anterior fossa. Using the existence of a skull fracture as a selection for admission, a strategy proposed by Jennett and colleagues, it would have been possible to reduce the number of patients hospitalized by 70% without missing a patient who developed an intracranial hematoma. Following these criteria no intracranial hematoma would be missed in our patients with a GCS of 15. We suggest that the use of plain x-rays to identify skull fractures and subsequent hospitalization prevents missing an intracranial hematoma. Those patients with diminished levels of consciousness of focal neurologic deficits require admission irrespective of skull fractures.

Adult↗

PubMed1992

[External fixation of the tibial with primary full weightbearing].

The external fixation of open fractures of the tibia has many advantages. Nevertheless by many surgeons it is used only as a temporary emergency fixation. There are two main problems to be solved: delayed fracture healing and pin-track infections. It is widely known that physiological weight-bearing leads to a better fracture healing. Weight-bearing needs stability. For transverse and even short oblique fractures of the tibia correct reduction and a good external fixation gives enough stability to stand on the leg completely. 27 patients with such fractures have been externally fixated during the last 5 years. With immediate weight-bearing the healing time was only 12 weeks on an average.

External Fixators↗

PubMed1991

[Progress in the treatment of severe craniocerebral injuries?].

This retrospective study of patients with severe head injuries requiring ICU admission between 1980 and 1982 was undertaken to determine to what extent head injury affected patients' outcome and whether there was any difference from patients admitted before the availability of CT scan for diagnosis. The 598 patients admitted between 1980 and 1982 underwent further analysis, and the long-term results were assessed 7 years postinjury for 427 patients (71%). These results are compared with those of a similar study made in 1985 in a comparable group of patients admitted to the same ICU just before the introduction of CT. We found that the long-term results were much better than those observed after 1 or 2 years. Many of the moderately disabled patients had learned to deal with their handicap and adapt better after several years, whereas most of the severely disabled or vegetative patients had died. The mortality rate was 51%. Using the Glasgow Outcome Scale, we found that 82% of the surviving patients had made a good recovery (GOS V), while 7% were moderately (GOS IV) and 11% severely disabled (GOS III). Seven years postinjury no patient was in a vegetative state (GOS II). Compared with the group treated before the use of CT scan we found more patients in GOS category V. The percentage of moderately disabled patients in GOS category IV had diminished, but the number of severely disabled patients and the mortality rate had not changed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1990

[Injuries of the large brain-feeding arteries].

Among 2923 severely injured patients in the period 1980-1988, 17 had injuries or large supraaortic arteries. The incidence was 0.58%, with an overall mortality of 53%. In 75% of survivors there was a persistent neurological deficit. We treated 5 penetrating (A. carotis 4, A. vertebralis 1) and 12 nonpenetrating (A. carotis 11, A. vertebralis 1) injuries. In all penetrating carotid injuries (4) repair was performed on admission and mortality was 50%; 1 of 2 survivors has postoperative hemiparesis. Localization of nonpenetrating carotid injuries (11) was intrathoracic (2), in the neck (7) and intracranial (2). Main complication of nonpenetrating extracranial carotid injuries is neurological deficit (7/9) due to thrombosis (3) or stenosis (4) with embolism (2). Surgery was performed in 3 cases comprising pseudoaneurysm in 2 and concomitant aortic rupture in 1. Mortality was 44%, and 80% of survivors had persistent neurological deficits. Extracranial carotid injuries (n = 13) carried a mortality rate of 83% in occluded and 29% in nonoccluded vessels (p less than 0.05). Location of carotid injury in the neck (n = 11) carried a mortality of 55%, and intracranial (n = 2) of 100% respectively. Duplex-Doppler scanning of carotid arteries is a safe, noninvasive method which is essential in blunt carotid artery trauma. Prognosis is dependent upon the size of cerebral infarction. Once neurologic deficit has been established for more than 24 hours, reconstruction of the artery should be postponed and performed only for complications (pseudoaneurysm or embolization). Clamping of arteries without hypothermic circulatory arrest or shunt should be avoided. The danger of rupture in dissection and pseudoaneurysm is slight.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1987