PubMed Health⌕ Search

Biomedical subjects

E Foltin

Publications and source records attributed to E Foltin.

15 recordsLinked to original sources
PubMed1999

[Effects of injury pattern on the predictability of 4 multiple trauma scores. Presentation of a method for identifying artifacts].

When comparing two populations of multiply injured patients differences in patient characteristics must be controlled for. To measure the overall severity of injury, scaling systems are used. If after adjustment for injury severity, the proportion of deaths in the two data sets are still different, the difference is to be considered as due to the quality of care. However, this conclusion is only valid after excluding the possibility that the scale in use fails to adequately reflect certain injuries. The scope of the study is to demonstrate a method for examining this potential interference. As an example, four widely used scales were applied to the data of 418 multiply injured patients. By means of multiple logistic regression analysis, variables were selected which have an influence on prognosis in addition to a scale, thus indicating a subgroup of patients who are underrepresented by the respective scoring system. For the scales examined, these additional variables were: Head and thoracic trauma for the Polytrauma score (Oestern), abdominal and thoracic trauma for the Trauma index (Schreinlechner), thoracic trauma and age for the Trauma score (Champion), head trauma and age for the Injury Severity Score (Baker). We conclude that each score analyzed had its characteristic weak points. Prognostic quality was affected by casemix. Therefore, comparisons between groups of polytraumatized patients may be invalidated. The method outlined here is a useful means for checking a scoring system for these types of interfering variables. Therefore, it is recommended to search routinely for potentially interfering variables before applying a scale. In a given data set of multiply injured patients, appropriate adjustments can then be made for the deficiencies of the scoring system.

Adult↗
PubMed1996

[Pediatric and adolescent accident victims (ICD-E 800 to 829) in Austria 1980 to 1989].

The object of this study are transport vehicle accidents (ICD-E Code 800 to 829) in children and adolescents. During the years 1980 through 1989 there were 3660 such casualties in persons under 20 years of age in Austria. The investigation is based on data available on death certificates. The mortality rate (per 10,000 child years) for pedestrians was 0.20, for pedal cyclists 0.06, for motor cyclists 0.35, and for others (mostly car occupants) 1.19. For older teenagers (15 to 19 years old) these rates were 0.23, 0.06, 1.12, and 3.25, respectively. The male to female ratio was 3.26:1. Subgroup-analysis of pedestrians revealed a difference in injury pattern due to different body proportions: the ratio of head injury deaths to spine injury deaths was 3.7:1 in children less than 10 years old, but 11.6:1 in teenagers. In this latter age group head trauma was more common an injury leading to death in pedal cyclists than in motorcyclists (79%:66%). It is worthwhile to recommend and promote the use of bicycle helmets. However, the problem with bicyclists is rather small compared with that of the motor-vehicle related mortality of adolescents.

Accidents, Traffic↗
PubMed1994

[Transfixation upper arm plaster bandage for treatment of comminuted fractures of the distal radius].

Thirty-five comminuted fractures of the distal radius in 34 patients were reduced by manipulation and pins, then immobilised with plaster. The Kirschner wires were inserted into the first metacarpal and the olecranon. In five cases, problems with the proximal pin occurred. A clinical and radiological examination could be done in 21 patients three to nineteen years after the accident. Using the demerit-point-system of Gartland and Werley, the result was excellent in three patients, good in nine, and fair in nine; there were no poor results. After careful retrospective consideration of treatment alternatives for these comminuted distal radial fractures, there remain the following indications for pins and plaster: 1. selected cases treated by surgeons experienced with the method, 2. as an emergency procedure when an external fixator seems to be indicated but is not available.

Adolescent↗
PubMed1993

[Polytrauma and predicting fatality. Comparative evaluation of the value of the Kirkpatrick-Youmans Trauma Index (TI), Schreinlechner-Eber modified TI (TI mod.), and the Baker Injury Severity Score].

The Trauma Index (TI) of Kirkpatrick and Youmans modified by Schreinlechner and Eber performed better than the Injury Severity Score (ISS) in predicting case fatality of 234 patients with major trauma treated during the years 1985 through 1987. Logistic regression was used for determining the cut-points: Death was considered as predicted by ISS if it was greater than 53 or by TI if it was greater then 3.74. Specificity was 95% for ISS and 94% for TI. Sensitivity was 49% for ISS and 73% for TI.

Adult↗
PubMed1992

Treatment of calculi of the common bile duct.

Endoscopic sphincterotomy (EST) is regarded as an alternative therapeutic approach to the surgical treatment of choledocholithiasis. To clarify the indication for each of these two methods, a prospective study has been performed comparing patients with calculi of the common bile duct who had undergone endoscopic or surgical treatment. Mortality, morbidity and stone clearance were used as criteria for the evaluation of the dependence of age on results achieved by the two modalities. Of 306 patients with choledocholithiasis, 199 underwent surgical exploration of the duct and 107 underwent endoscopic sphincterotomy. Patients who were more than 60 years of age and had previously undergone cholecystectomy underwent endoscopic sphincterotomy. All other patients had surgical treatment. There were no significant differences among the two groups with regard to mortality rates. The incidence of relevant complications as well as the incidence of surgical revisions related to postoperative complications in the operation group was, however, significantly higher (p less than 0.05). In contrast with this, the incidence of retained stones was significantly lower (p less than 0.01) in the group that underwent surgical treatment (2.5 percent) than in the group that had endoscopy (11.2 percent). When assessing the results in terms of stone clearance, complications and mortality rates, findings seem to indicate that a safe limit for the application of surgical treatment would be 60 years of age, whereas older patients should be primarily considered as candidates for EST.

Age Factors↗
PubMed1991

[Surface width index of the distal radius joint surface].

A new roentgenographic index for evaluation of the distal radial joint surface is described. The breadth of the carpal lunate bone und the breadth of the distal articular surface of the radius are measured on an X-ray in a typical lateral view. The quotient of these two measurements is the desired index. Mean and standard deviation of the quotients of 50 normal carpal joints were 0.99 +/-0.05. The corresponding values for 39 intraarticular fractures of the distal articular surface, AO classification C.2 and C.3, were 0.83 +/-0.09. The difference evaluated in a t-test for unpaired observations was significant (p less than 0.001). Widening of the distal articular surface in intraarticular radial fractures can thus be measured and numerically described in a single value.

Carpal Bones↗
PubMed1988

Osteoporosis and fracture patterns. A study of split-compression fractures of the lateral tibial condyle.

The initial radiographs of 42 split-compression fractures of the lateral tibial condyle were studied. The breadth of the wedge-shaped fragments, measured at the level of the articular surface, was found to decrease with increasing severity of osteoporosis. Ranks were assigned to the breadths and average ranks to the grades (low ranks for normals). Spearman's rank correlation co-efficient was -0.507, which is significant at the 1% level. The length of the fragments showed a similar decrease with advancing bone loss. Rank correlation with the degree of osteoporosis was -0.393, which is significant at the 5% level. These results support the hypothesis that the fracture pattern depends on the changes in bony architecture which results from osteoporosis.

Adult↗
PubMed1987

Bone loss and forms of tibial condylar fracture.

Bone loss and fracture type were determined in 358 tibial condylar fractures. Degree of osteoporosis at the knee was defined by analogy to Singh's grades of osteoporosis at the hip and to Jhamaria's classification of osteoporosis at the calcaneum: grade V-normal; grade IV-slight reduction of trabecular bone; grade III-osteoporosis, predominantly of trabecular bone; grade II-osteoporosis of trabecular and cortical bone. Five fracture types were distinguished, with the component of trabecular bone compression increasing from a to e: a-pure split fractures; b-split fractures with displacement of a piece of the articular surface; c-split compression fractures; d-local compression fractures; e-compression of a whole condyle. There was a highly significant rank correlation between the two sets of ordered categories. Fractures in osteoporotics tended to involve the lateral condyle; this is explained by the fact that crush fractures occurred more frequently at the lateral condyle. The influence of bone loss on fracture type was demonstrated to be independent of age. A clear understanding of these associations concerning three variables at a time was reached by the use of log-linear-model analysis for cross-classified qualitative data.

Adolescent↗
PubMed1978

[The risk of lacticate acidosis: a comparison of the 3 biguanides in treatment of diabetics (authors' transl)].

Hyperlactaemia was induced by means of a standard exercise test in 10 diabetics receiving normal treatment with biguanides (either buformin, metformin, or phenformin) in combination with either a sulfonylurea or insulin. The treatment regimen was then continued without biguanides for 3 weeks and the exercise test was repeated at the end of this period. All 3 biguanide preparations induce hyperlactaemia in diabetics. Physical stress leads to an additional increase in lactate, which reaches pathological proportions. Discontinuation of biguanide treatment leads to a significant decrease in resting and stress values. In a comparison of the 3 biguanide products, phenformin induced significantly higher lactate values in response to exercise than buformin. Of the biguanides, phenformin appears to carry the greatest risk of causing hyperlactaemia in susceptible patients, induced by concurrent circumstances, with progression to severe lacticate acidosis. The special pharmacokinetic properties of phenformin and the 8-fold higher incidence of lacticate acidosis than under buformin or metformin therapy support this observation.

Acidosis↗