PubMed Health⌕ Search

Biomedical subjects

F W Meinecke

Publications and source records attributed to F W Meinecke.

At least 19 recordsLinked to original sources
PubMed1997

Treatment of patients with spinal cord lesions in Germany 1996--state of the art.

Modern treatment of sufferers from spinal cord lesions according to the guidelines elaborated by Sir Ludwig Guttmann in the UK started in specialised centres in Germany some 45 years ago. At the present time the incidence is 18 cases/l million/year traumatic and non traumatic. Exact figures are available since 20 years ago. Twenty-one appropriate centres with altogether 1071 beds are able to admit almost all traumatic cases and 30% of non traumatic cases for 'comprehensive treatment'. That includes cervical lesions above C4 as well as patients with polytrauma, intensive care, spinal column surgery, sophisticated urological diagnostic and treatment, physio- and occupational therapy, psychological and social assistance. To fulfill all tasks arising from lifetime care and readmissions there is a need of another 800 beds in specialised centres not dealing with recent cases. The original principle to offer first treatment and life-time follow up 'under one roof' is to be given up as conservative treatment of the broken spine has been continually replaced by spinal surgery done in non specialised primary admitting regional hospitals. Priority is given to the aim to offer similar opportunities to everyone by providing 800 additional beds in new specialised centres.

Germany↗
PubMed1997

Trends in the treatment of patients with spinal cord lesions seen within a period of 20 years in German centers.

Twenty-one special centers are running treatment of spinal cord injuries in Germany. Their heads represent a study group to coordinate methods and to investigate results collecting data since 1976. So we have experiences for about 20 years. 1500 recent cases are treated per annum. Seventy-five percent got their lesion by trauma. Beside these there is only a little capacity to treat patients with non-traumatic or congenital lesions (25%). Sixty-two percent are para-, 38% are tetraplegic, 28% female, 2% are children. Within 22,212 recent cases 35% got their injury by traffic, 14% at work. Sports and diving caused 4%, suicide 5% and killing attempts 1%. Though numbers since 1976 are decreasing, traffic and work are main reasons causing spinal injuries. Readmission reasons are mainly disorders of soft tissues (23%) and the urinary tract (21%). Out-patients are checked in 67% of all cases. All investigation data represent very stable trends within the last 20 years. Altogether the special centers carried out treatment and consultation in about 22,000 recent cases, 45,000 readmissions and 80,000 out-patients.

Accidents↗
PubMed1993

[How good is our social network?--Experiences with referral and admission of paraplegic patients in Germany].

The care of patients with spinal cord injury is regarded as well organized in the FRG. Nevertheless one can state that by lack of bed-capacity in our SCIC the social service is insufficient. Recent cases often cannot be admitted immediately. Patients getting their impairment by diseases cannot be treated all, because there is few capacity left. Life-long care--demanded since the time of Sir L. Guttmann--today is an utopia. Increasing capacity for treatment of patients in hospital and after discharge is necessary.

Combined Modality Therapy↗
PubMed1991

Sequelae and rehabilitation of spinal cord injuries.

Basic research in spinal cord regeneration, neurological recovery after medical or surgical primary treatment, and electrostimulation of muscles, nerves, diaphragm, bladder and bowel are covered in this review. The best results are obtained in bladder and bowel stimulation. Basic research seems to provide new hopes for paralyzed individuals.

Animals↗
PubMed1990

[What has spinal stabilization contributed for the paraplegic patient?].

The aim of spondylodesis is to restore the injured spinal column to its previous shape and stability. In the transverse SCI patient, it entails easier intensive care in case of multiple injury as well as easier general nursing tasks, and greater intensity of physiotherapy in the acute and early phases. Compared to conservative management of the injured spinal column, mobilization is effected some 21 to 39 days earlier in surgical patients, total hospitalization in tetraplegics is shortened by 5 days, and by 34 to 57 days in paraplegic patients. Functionally valuable neurological recovery in primary complete paralysis occurs in 19%/20% of conservative/surgical cases, in primary partial paralysis in 67%/58%. Stabilization of the spinal column however does not at the same time achieve a stabilization of the transverse SCI patient's entire situation--physical, psychological, social. Irrespective of the scope of paralysis, the advantages of a spondylodesis should be considered also in case of total paraplegia. Conservative management retains its importance in cases where surgery is not indicated, or even contraindicated. Comparable results are very rarely achieved outside the specialized centres. Acute cases of SCI should therefore be referred to spinal centres as soon as possible, which for their part have to be able to admit patients 24 hours a day, as well as to provide adequate care until completion of the entire treatment.

Activities of Daily Living↗
PubMed1988

[History of the treatment of paralyzed patients in West Germany].

Based on the fundamental work of Sir Ludwig Guttmann coping with the comprehensive treatment of sufferers from spinal cord injuries, the Federal Republic of Germany developed a network of specialized Spinal Injuries Units after the second world war. This is described. There is no problem to admit this people by specialized services in time, regardless whether of traumatic or non traumatic origin. According to the prolonged life expectancy there may occur some difficulties in providing adequate aftercare for lifetime. Some tasks for the future are briefly mentioned.

Germany, West↗
PubMed1986

[Regression trends of neurologic damage in the surgical emergency management of patients with injuries of the cervical vertebrae with spinal cord involvement].

Sixty-five patients with cervical spine injuries and varied neurological deficits were treated operatively. Evaluation revealed an improvement in neurological findings dependent upon the promptness of anatomical reduction in patients with incomplete lesions. The more frequent neurological improvement seen with open reduction and internal fixation as compared with closed reduction was not statistically significant but was felt to justify the additional resources required for internal fixation. In complete lesions, there was no evidence that the time of anatomical reduction was related to improvement in neurological findings.

Adult↗
PubMed1985

'Some thoughts about neurological recovery in spinal cord injuries: a philosophical review'.

In 1969 Michaelis published an inquiry on diagnosis and prognosis in traumatic spinal cord lesions based on an international level of experience. Fifteen years later our own answers from 1967 are revised. The result of the first assessment depends on the patient's condition and the physician's experience during the examination in the early stage. A correction of the first diagnosis in due course is not rare. There was no great alteration necessary for comparison in 1983 with the answers given in 1969. Firm diagnosis and prognosis are urgently needed by patients, relatives, employers and insurance bodies as early as possible. They are required also in order to compare the results of different methods of treatment. In addition, we treated a greater number of incomplete tetraplegics below C5/6, accompanied by a complete irreversible paralysis of the M. deltoideus. The pathology of this syndrome is still unknown.

Humans↗
PubMed1984

Primary treatment of paraplegic patients.

Concerted investigations conducted within a period of seven years by the special centres of primary treatment of patients with paraplegia in the German Federal Republic show nearly constant distributions: injuries 84%, road accidents 48%, tetraplegia 39%. Every hospital must be able to perform the primary treatment of patients with paraplegia. A detailed primary examination is necessary. 20% of the patients suffer from a traumatic shock, which is frequently mistaken for a spinal shock. In 60% of the patients associated injuries of varying importance are found. Intensive control is therefore indispensable. Indications for surgery intended to ameliorate a paralysis are extremely rare, they are more frequent with the intention of stabilizing the spine. Conservative treatment of the spine is still very important in these injuries. Today, recent paraplegics are quickly admitted to the special services, eventually through the intermediary of the central office in Hamburg. The above aspects are briefly explained.

Accidents↗
PubMed1984

[Current status and future development of the comprehensive rehabilitation of transverse paralyzed patients].

The principles developed some 40 years ago by Sir Ludwig Guttmann and Ernest Bors for the treatment of spinal cord injured persons have in the Federal Republic of Germany been taken up, in the fifties, by a few doctors as well as the Central Association of Industrial Injuries Insurance Institutes. Their efforts have brought about a radically different situation concerning life expectancy and life-styles of SCI patients, not only the accident-injured but increasingly also for persons with disease-related spinal lesions. The emphases of development have been: improved mechanisms for referral to specialized facilities, rescue system progress, new findings in diagnosis and therapy, improvement of social and vocational re-integration, growing mutual understanding of paraplegics and their environments, as well as increased self-assertiveness of the paraplegic population. These aspects are examined more closely. Further improvements may be achieved through: admission to specialized treatment facilities immediately following onset, appraisal of relevant issues pertaining to indications for, and techniques of spinal surgery, improved preventive efforts relative to thromboses and embolism, control of the paralytic bladder, a smoother provision of adapted living conditions outside the clinic-based special facilities, and through extension as well as lifelong availability of adequate aftercare services. In the event of certain illnesses, up-to-date treatment of paraplegics must be ensured by the hospital departments concerned with the basis illness. Recreational facilities, and inclusion of psychological and psychotherapeutic services in residential rehabilitation programmes for SCI patients require further attention.

Combined Modality Therapy↗
PubMed1982

[The new Spinal Cord Injuries Centre of the Hamburg Industrial Injuries Insurance Institutes Accident Hospital--report on its 1st year].

The former Spinal Cord Injuries Department within the Hamburg Accident Hospital of the Industrial Injuries Insurance Institutes has been expanded from 33 to 100 beds. 60 beds started operation on Febr. 1, 1981, another 20 on Aug. 1, 1981 and the remaining 20 beds on Jan. 1, 1982. The present report is based on admissions during the first twelve months of the Centre's operation, i.e. 136 recent cases and 98 re-admissions, 92% of which had come from Northern Germany. 35% of the recent cases had been admitted during the first 48 hours post-onset. 39% of the patients were tetraplegics, 57% had complete paralysis, 13% non-traumatic affections. 60% of the patients had associated injuries. 60% were covered by statutory sickness insurance. The average length of stay was 113 days for tetraplegic, and 112 days for paraplegic patients. In 60% the extent of paralysis remained unchanged. Of 10 deaths, three were due to pulmonary embolism. Decubitus ulcers had been the indication for re-admission in 36%, of whom only 20% were tetraplegics. Average stay for decubitus ulcers was three times as long as in other re-admission causes. The services rendered by the various professional departments as well as by medical consultants are reported in tabular form. The expansion responded to an urgent need, and has, among others, contributed to easing many avoidable social problems (such as long distances from home).

Adolescent↗
PubMed1981

[The disabled--object or partner of rehabilitation? (author's transl)].

The experience made in the field of rehabilitation in the post-WW II period have not only led to the enactment of Parliamentary legislation. The personal experiences of rehabilitation workers has often entailed their having gradually formed guiding principles that are being strongly insisted upon in all their dealings with their disabled clients. Rejection of these guidelines may lead to the disabled being regarded as unfit or unwilling, and even more so if he tries to develop personal views on his part in rehabilitation. There is thus a great risk of rehabilitation becoming an end in itself for those who are pursuing it. The disabled for their part should not only underline their rights but accept the responsibilities as well. The risk of stiffening oppositions on all fronts is best countered by those involved talking with each other on a partnership footing. Partnership is however also needed among those who have to co-operate in the various field involved in rehabilitation.

Persons with Disabilities↗
PubMed1979

Two years of bed procurement for patients with spinal cord lesions. A report on progress and experiences at the Bed Procurement Service at the Industrial Injuries Insurance Institute for Research in Traumatology at Frankfurt/Main.

The total number of beds provided in all specialised centres for the treatment of patients with acute spinal cord lesions in the Federal Republic of Germany is still insufficient. Therefore the attempt to transfer those patients to a centre from another hospital immediately after the lesion has occurred is very difficult. In order to assist physicians of the hospitals (where the patient has been first admitted) in the time-consuming task to find a vacancy in a specialised unit, the Central Association of the Industrial Injuries Insurance Association of the Industrial Injuries Insurance Institutes set up a 'Bed Procurement Bureau for Patients with Spinal Injuries' on 2 August, 1976. The heads of the units concerned set up a special study group in close connection with this clearing-agency in order to elaborate reliable data about the present situation of care for recently paralysed people, and to discuss further problems as well as planning programmes. They meet every 6 months. The organisation of the clearing-agency, the experiences gained within the first 23 months of activity since the opening, the spinal units situation at the present time, and their further development are reported.

Accidents, Occupational↗