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Biomedical subjects

F Gebhard

Publications and source records attributed to F Gebhard.

At least 19 recordsLinked to original sources
PubMed2003

[Prediction of mortality, mobility and admission to long-term care after hip fractures].

INTRODUCTION: Surgical treatment, discharge planning and rehabilitation procedures are rarely based upon defined assessment procedures. It might therefore be useful to develop simple and reliable screening tools to identify patients for early discharge, intensified rehabilitation and limited treatment. PATIENTS AND METHODS: 234 patients were initially contacted. From these 217 gave informed consent. The reported study included the 134 home dwelling elderly. All patients could be contacted or died after six month. Thus,data from more than 90% could be used for the analysis. The six month mortality was 10%. A population based cohort of elderly patients referred to five local hospitals was tested. Mortality, institutionalisation and mobility were defined as major outcome criteria. Only information that was available during the first week of treatment was used in the model. Predictors expressed as odd ratios (OR) were calculated using logistic regression with variable selection. RESULTS: The most important predictors for institutionalisation were age, inability to eat without assistance, postoperative night time confusion, stroke history, cognitive deficit and fear of falling. Outdoor mobility was strongly associated to the preoperative ADL performance measured as the Barthel-Index, history of malignancy and fear of falling. Six month mortality was associated with male sex, the Barthel-Index and fear of falling. DISCUSSION: It seems feasible to improve postoperative resource allocation by predictor led stratification. This need to be tested in intervention trials under the specific condition of the German health care system.

Activities of Daily Living↗
PubMed2003

[OR-manager: surgeon or anaesthetist?].

The heart of any surgical department is the operating room (OR) area. Any disturbances in the daily routine will affect the work flow of the whole hospital. On account of its central function, with numerous connections to other departments, the OR is the crystallisation point for deficiencies in various events and processes. As an example, the major complaints made by a surgical department regarding workflow and communication are outlined. To solve these problems, an "OR organization" team was established, which worked on the basis of a newly developed OR statute. Within 1 year the employees were more contentment and the workflow had improved. However, even in the second year of central OR management there is still the need to further stabilize the system as mismanagement still occurs.

Anesthesiology↗
PubMed2002

[Time optimized modern shock room management using digital techniques].

Emergency room management means time management. A time and four color based algorithm is described to improve workflow, follow up of diagnostic procedures and initial treatment. As a result introducing the time based interdisciplinary emergency algorithm within 60 minutes all necessary treatment and diagnostic procedures were completed. This algorithm is an effective tool to improve emergency room treatment.

Algorithms↗
PubMed2002

[Costs for acute, stationary treatment of polytrauma patients].

Are the costs required for a polytraumatised patient sufficiently paid by the health care companies?The study population consisted of 71 polytrauma patients. The treatment-costs were calculated and compared with the reimbursements. The mean patient age was 38.0 years with a mean injury severity score (ISS) of 23.0 points. The mean duration of hospitalisation was 25.9 days and the mean calculated cost per patient was Euro 21,866.30. The reimbursement was only Euro 16,863.03/patient. This leads to a financial deficit of approximately Euro 5,000/patient (Euro 167/polytrauma patient/hospital day) and nearly Euro 355,000 for all patients during the period of 1 year. The introduction of the DRG system endangers the high standard of polytrauma treatment because of insufficient reimbursement.It is necessary to consider the implementation of an additional polytrauma-reimbursement based on the injury severity and duration of hospitalisation. The concentration of the patients in trauma centres, where the optimum of therapy is guarantied, leads in these hospitals to a continuously increasing deficit. The latter may be deleterious for the concept of "trauma centers" in the future.

Adult↗
PubMed2002

[Injury prevention in the elderly population].

Injuries in the elderly population have more considerable consequences (more difficult treatment, higher costs,worse outcome) than in the younger population. Therefore, the prevention is especially important. The majority of the injuries are caused by traffic accidents and falls. TRAFFIC ACCIDENTS: An analysis of the current injury situation in elderly road users (65 years and older) involved in road traffic accidents was intended to allow conclusions regarding future prophylaxis. FALLS: Falls are mostly caused by numerous factors. The most important predictors for falls are dementia,Parkinson-Syndrome and neurologic deficits after cerebrovascular insults. The most important symptoms, that indicate an increased risk for fall are gait abnormalities, balance lack and underweight. The most important anamnestic indications are more than one falls in the recent 90 days, need for assistance in daily living and prevailing medication. Another important factor is the residential setting (lighting, stairs, floor conditions,bath installations). The most affective protective interventions involve multiple factors. The incidence of falls could be reduced by 30%. The hip protector is an effective protection against proximal femur fractures. which is the most frequent fracture in the elderly population that requires treatment as an inpatient. Injury prevention in the elderly population is an interdisciplinary task as for example shown by the successful fall clinics in the anglo-american area.

Accident Prevention↗
PubMed2002

[Sources of error and risks in CT based navigation].

Based on the experience of 4 cervical, 102 thoracic/lumbar pedicle screw and 14 transiliosacral screw implantations all problems and complications were collected. Problems noted within the data collection in the preoperative CT were an incomplete acquisition of the surgical target (n = 3), an exceeding of the processable scan slices (n = 1) and a non focused field of view. Transmission of the CT datas often were documented as incomplete (n = 16). Segmentation of the CT dataset turned out to be the significant problem with incorrect differentiation of the bone-soft tissue transition (n = 2), where as the choice of the matching points and the trajectories did not provoke any mistakes in the planning modus. The intraoperative matching of both corresponding datasets was insufficient (n = 7), while the assignment of the CT dataset to the correct vertebral was not a major problem (n = 1). Navigation was not possible (n = 2) due to an instability of the spinal process. All fiducial based matching procedures (pelvis) were carried out without any problems. During intraoperative navigation potential complications resulted from deformation of instruments (n = 1) and interaction of instruments and the data reference base (n = 2). Further, the CT-based navigation of fractured vertebrae or unstable iliosacral joints is not safe, because dislocations between acquisition of the dataset and operation will lead to misguidance.

Artifacts↗
PubMed2002

[Neurogenic spinal deformities. I. Conservative and surgical treatment of spinal deformities].

Neurogenic spinal deformities develop primarily due to insufficient dynamic stabilization against gravity. Unilateral muscle overactivity is another but rare cause. The aim of treatment is to provide stability as well as to prevent deformity. In mild cases, the treatment of choice is a spinal brace because stabilization can be combined with residual mobility and adequate correction of shape. Seating shells are more readily accepted but less appropriate for this purpose. In severe cases, surgery is a good option despite the considerable effort involved and high rate of complications.

Adolescent↗
PubMed2002

Operation planning of correction osteotomies in 3D.

This paper discusses an operation planning system for correction osteotomies. It is based on 3D data obtained from CT/MR of the bone and it allows to perform a 3D planning. The physician can individually determine anatomical landmarks for measuring geometric parameters of the bone like length, angle and torsion angle. In a virtual scene he or she can set a single cut or can remove/insert a wedge, dissecting the bones. The bone parts can be rearranged in 3D space. Optimization routines allow that the physician only defines the position of the cut, the orientation of the cut plane, the rearrangement of the bone and the optimization for the maximal overlap of the cortical bone can be processed automatically. The system is currently in use at the Trauma department at the University of Ulm. A case study shows the results by applying this system.

Bone Malalignment↗
PubMed2001

Spinal navigation in cervical fractures--a preliminary clinical study on Judet-osteosynthesis of the axis.

OBJECTIVE: To evaluate the accuracy of CT-based and computer-aided screw insertion into the pedicles of the axis using the method of Judet. Materials and Methods In two patients, four transpedicular implants of C2 were positioned using a computer-guided technique. One patient with iatrogenic destabilization of the posterior structures C3 and C4 and one patient with a hangman's fracture of the axis required pedicular fixation. In addition, intraoperative documentation of the additional time required for the navigation procedures was made. Finally, postoperative CTs of each patient provided further information about transpedicular implant localization. RESULTS: Image-guided implantation of screws was possible in all scheduled pedicles of the axis. In the postoperative CT scans, none of the inserted screws perforated the medial or lateral pedicle. All screws were accurately positioned within the pedicles, and no anterior perforation of the screws into the vertebral foramen was observed. CONCLUSIONS: Our initial results using computer-aided implantation of Judet screws showed that these screws were inserted correctly. However, it is important to realize that movements can occur in the vertebral arch and lateral mass during the time between preoperative CT and surgery. This possibility for movement should be taken into account when procedures such as CT-based insertion of image-guided screws into patients with fractures of the isthmus C2 are performed, because damage to neurovascular structures can result. Therefore, this navigation system should only be used by experienced surgeons who can, if necessary, continue the intervention with more conventional techniques. In addition, it is essential that the surgeon have a complete understanding of the principles of the tracking systems to prevent possible misinterpretation of computer-generated information.

Adult↗
PubMed2001

[New methods in polytrauma surgery. Results of a Study Congress at castle Reisenburg 27/28 February 2000].

Recently, in Germany the academic environment has changed and an upheaval occurred that directly do affect academic research activities. Increasingly, the funding of scientific projects is not provided anymore by the universities themselves or the government, but has to be acquired as grants. While in the past, research was conducted by single departments, nowadays and more and more in the future scientific networks have to be established by combining 'local' and even 'distant' knowledge. With this changing background in mind representatives of different scientific institutions met at the Reisensburg castle to discuss the current state and future trends in four major research fields: "Epidemiology of Severe Trauma", "Head Injury", "Pathophysiology of Damage to the Chest", and "Posttraumatic Soft Tissue Injury".

Germany↗
PubMed2001

[Influence of prosthesis design on intramedullary pressure formation in femur shaft implants of cemented hip endoprostheses].

The increase of intramedullary femoral pressure can lead to the intravasation of bone marrow and fat cells into the blood stream of the femoral vein and consequently into the pulmonary circulation. This effect is the same in intramedullary nailing and in the implantation of femoral stem prostheses. In a prospective study we evaluated the intraoperative, intramedullary pressure in the distal femur during the implantation of femoral stem prostheses with two different designs. In eight patients we implanted Müller straight stems and in another eight we implanted stem type Option 3000. Intramedullary pressure was recorded continuously by the implantation of a microtip pressure probe (piezoresistive principle, 50 Hz) in the distal femur. We found markedly higher pressure in Müller straight stem prostheses: range: 590-2,570 mmHg (median = 1,293, SD = 627 mmHg). Intramedullary pressure in stem prosthesis type Option 3000 was much lower: range: 59-574 mmHg (median = 289, SD = 219 mmHg). The differences were statistically significant (p = 0.0008). By changing the designs of femoral stem prostheses, the intramedullary pressure can be markedly reduced. In the case of elderly patients or those with pulmonary illness we recommend femoral stem prosthesis designs, which induce little increase in the intramedullary pressure, in order to reduce cardiopulmonary complications.

Bone Cements↗
PubMed2001

[Precision in standardized Iso-C-Arm based navigated boring of the proximal femur].

C-arm navigation is a new tool in computer assisted surgery. The aim of this study is to evaluate the accuracy of Iso-C-arm based drill holes in the proximal femur. In nine artificial proximal femura, two holes with an angle of 135 degrees and 100 degrees in relation to the shaft axis were drilled in the direction of the femoral head. The defined target of the 3.2 mm drillings was a 4 mm steel ball, which had previously been placed and fixed at the cranial center of the femoral head. All the drillings were standardized with a navigated drilling machine fixed to a frame which only allowed movement of the system in the direction of the drill. During navigation the positions of the drill before commencement and at the deepest point of the canal were recorded. After drilling all specimens were evaluated by CT, and the coordinates of the center of the start and the end of the drilled hole and the center of the ball were determined. Using vector calculation, the smallest distance between the straight line, defined by the center of the starting point and the end point of the drill hole, and the center of the ball was calculated. Additionally, the coordinates of the intersection between the perpendicular to the center of the ball and the straight line were determined (xv, yv, zv), to evaluate the direction of misplacement of the drilled canal in relation to the target. For the 135 degrees drill holes, a median of 2.5 mm for the smallest distance between the straight line, given by the center of the start and the end of the hole, and the center of the ball was investigated (range 1.6-3.7 mm). For the 100 degrees holes the median was 3.1 mm (range 1.8-4.2 mm). The main plane of deviation in all of the 135 degrees holes was posteriorly, whereas in the 100 degrees holes posterior deviation occurred in four cases, cranial in three cases, and in one case each caudal and anterior deviation occurred. In our opinion, the accuracy of fluoroscopy based navigation applied in the region of the proximal femur is sufficient and reproducible. This technique can be used for implant placement at the proximal femur in the future.

Equipment Design↗
PubMed2001

[Precision analysis of navigation-assisted implanted thoracic and lumbar pedicled screws. A prospective clinical study].

A prospective clinical trial was performed to study the accuracy of pedicle screw placement of consecutive computer-aided and conventional techniques. Concerning the clinical performance of the navigation system, the average time of matching has been 8.4 minutes per vertebrae. For evaluation of the results, only complete intraosseous placement of the pedicle screw has been defined as correct position. Any medial or lateral perforation of the cortical structure of the pedicle was recorded as malplacement. In the CT-controlled patients complete intrapedicular placement of the screw was obtained in 36 of 45 thoracic (80%) and in 22 of 27 navigated lumbar (81%) pedicles. In the conventional cohort group 27 of 34 (79%) thoracal and 43 of 52 (83%) lumbar screws were completely in. No radicular neurologic damage, caused by a malplaced transpedicular screw has been observed in both groups. In the presented study is shown, that the application of the computer-assisted freehand navigation can improve results concerning the precision of spinal screw placement. Although, the spinal navigator has to consider a learning curve for the clinical inauguration of the system and the qualification of the implant system for computer-assisted application.

Bone Plates↗
PubMed2001

[Computer-assisted surgery: developments and prospects in 2001. Results of a workshop at Schloss Reisenburg, 23-24 November 2000].

The progress in computer assisted surgery (CAS) is influenced by new technologies in imaging as well as by the input of the users. At present, CAS procedures are established in dorsal spine instrumentation, prosthetics and long bone surgery. Present status and future of CAS was a topic of an expert meeting at the Reisensburg castle. Imaging will speed up in the future using multi-detector techniques. C-arm navigation will gain more information using the 3D technology intraoperatively. CT based navigation procedures are standard in spine and will be established in pelvic surgery. CAS in robotics at the moment means the use of robot-assistance. A new concept is the modality-based navigated surgery, which can be used at various skeletal locations. Visualization of patient data will improve using 3D semi-transparencies with real time update. In the future it will be mandatory to find algorithms to fuse the different possibilities and techniques. A new concept of surgical training is necessary to teach CAS procedures. Therefore discussion must go on to improve these systems.

Arthroplasty, Replacement, Knee↗
PubMed2001

[Computer assisted surgery, 2001 development and prospects. Results of a congress at Reisensburg Castle, 23-24 November 2000]].

The progress in computer assisted surgery (CAS) is influenced by new technologies in imaging as well as by the input of the users. At present, CAS procedures are established in dorsal spine instrumentation, prosthetics and long bone surgery. Present status and future of CAS was a topic of an expert meeting at the Reisensburg castle. Imaging will speed up in the future using multi-detector techniques. C-arm navigation will gain more information using the 3D technology intraoperatively. CT based navigation procedures are standard in spine and will be established in pelvic surgery. CAS in robotics at the moment means the use of robot-assistance. A new concept is the modality-based navigated surgery, which can be used at various skeletal locations. Visualization of patient data will improve using 3D semi-transparencies with real time update. In the future it will be mandatory to find algorithms to fuse the different possibilities and techniques. A new concept of surgical training is necessary to teach CAS procedures. Therefore discussion must go on to improve these systems.

Forecasting↗
PubMed2001

Early inflammatory mediator response following isolated traumatic brain injury and other major trauma in humans.

The inflammatory response following isolated traumatic brain injury (TBI) is characterised by the release of pro- and anti-inflammatory mediators. In order to determine the important mediators regarding survival and outcome of patients with severe traumatic isolated head injuries, we performed this prospective preclinical and clinical study starting upon arrival at the site of the accident. After approval by the local ethics board committee, 94 multiple-injury patients were enrolled. Of these, 72 patients suffered from major injuries; the other 22 patients had a severe isolated brain injury and were allotted to subsets of survival or nonsurvival. Of the pro- and anti-inflammatory mediators (cytokines, arachidonic acid metabolites and soluble adhesion molecules), interleukin-6 (IL-6), IL-12 and malone dialdehyde (MDA) appeared to be of specific importance; maximum IL-6 plasma levels were eightfold higher in cases of nonsurvival than in those of survival. Patients that did not survive TBI were the only ones to express an IL-12 increase, whereas survivors and patients with other major trauma did not show any increase within the first 24 h. An early distinct decrease of MDA showed in patients who did not survive TBI, in contrast to survivor patients who exposed almost constant levels during the first 24 h.

Adult↗