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Biomedical subjects

G Zellweger

Publications and source records attributed to G Zellweger.

13 recordsLinked to original sources
PubMed1992

[Severe necrotizing fasciitis].

The pathophysiology of necrotizing fasciitis remains unclear in patients with no apparent immunologic disorders. Between 1987 and 1990 we treated six patients with necrotizing fascitis and septic-toxic multiple organ failure, three patients survived. The mean age was 38 years (25-62). In all patients the primary bacteriological examination revealed streptococcus. Between the first symptoms and an adequate therapy were 4 days in surviving patients and 7 days in patients who died. Four patients showed spread of the gangrene into the adjacent tissue: muscles (n = 3), bowel (n = 2), mediastinum (n = 1). Adequate débridement was not possible or not performed in patients with spread into the abdominal cavity or the mediastinum. These patients did not survive. The duration of intensive care treatment in surviving patients were 14 to 78 days. We conclude that survival of patients with severe necrotizing fasciitis is influenced by the delay before adequate treatment, the localisation of the gangrene and intensive care facilities.

Adult↗
PubMed1991

Tissue expanders in reconstruction of burn sequelae.

In 20 patients with burn scars and 1 patient with a fresh burn, 33 tissue expanders were implanted. In 16 patients, the expansion fulfilled the goal set with the help of 27 expanders. The results are very satisfactory, but the effort of treatment and the trouble are substantial. Thirteen patients encountered no complications. In terms of expanders, there were 6 major and 11 minor complications. They were infection (three), wound dehiscence (two), insufficient expansion with hematoma (one), leakage (six), superficial skin damage (three), and intercurrent hematoma formation (two). There was no flap necrosis, and thus, apart from superfluous surgery, no real damage. Retrospectively, the major complications could have been avoided by more careful observance of indications. Unfortunately, this seems to be a process that every surgeon must learn by experience and not by theory alone. Here, infection was managed by removal of the expanders. Hematomas should be evacuated early (we drained most expanders), and incidences of leakage can be diminished by using larger valves. Small incisions in healthy tissue for expander insertion may lead to faster onset of expansion, thus, shortening the procedure. Late widening of scars was found only once, perhaps due to a rather long duration of expansion, averaging 13 weeks.

Adolescent↗
PubMed1989

[Therapeutic possibilities in hand burns].

Four methods of treating the burned hand are possible: conservative treatment of superficial dermal burns, tangential excision and immediate grafting of deep dermal and barely full thickness burns, granulation method with late grafting of deep dermal to deep full thickness burns, flap procedures of full thickness burns. The tangential excision and grafting of deep dermal and barely third degree burns has improved the well being of the patient by good functional and cosmetic results, less hospitalization time (10-14 days) and less pain. The procedure is described. Tangential excision is contraindicated in the very deep burn. In these the growth of granulations or in certain cases the application of skinflaps will produce better results. Important as to the result is the aftercare consisting of compression gloves and physiotherapy. Even with progress the deep burn remains a devastating injury to the delicately operating hand. Nevertheless the appropriate therapy can achieve good results.

Burns↗
PubMed1986

[Toxic epidermal necrolysis (Lyell syndrome)].

Toxic epidermal necrolysis, a serious allergically triggered skin reaction, has a mortality of about 30% largely due to internal diseases. The management involves several specialties. Clinical picture and therapy are described in a case probably induced by allopurinol, with 70% involvement of body surface.

Aged↗
PubMed1986

[Liver injuries].

Mortality in blunt hepatic trauma is still high, death being most frequently caused by hemorrhage. Associated injuries are present in nearly all cases. A variety of possible surgical procedures allow treatment tailored to fit the individual situation. Even the sophisticated intensive care required by the frequent posttraumatic complications is not a substitute for adequate surgery.

Abdominal Injuries↗
PubMed1979

[Burn mortality and morbidity: experience of the burn center in Zürich from 1967 to 1977].

Ten years of burn treatment in a burn center are compared to the ten years prior to 1967: --Survival has increased markedly, due to aggressive local treatment with débridement, topical ointments, biologic dressings, and rapid closure of wounds. --Functional and cosmetic results have improved since tangential excision and immediate autografting are routinely performed. --Favourable results with shorter duration of hospitalization are obtained if doctors and nurses can acquire and apply their knowledge in many cases as is possible in a burn center.

Burns↗
PubMed1978

[Experiences of tangential excision of burned hands].

Tangential excision and immediate grafting of deep burns of the hands enable wound closure within 14 days. Mobility of the hand is rapidly restored, pain is practically omitted, scar formation is minimized, and sensitivity is restored to normal in the majority of cases. Considering only surviving patients accounting for a total of 247 hand (hospitalisation from January 1974 to June 1977), we tangentially excised 118 hands. Two thirds of the tangential excisions needed no more corrections. One third had corrections of interdigital webs, dermabrasion of graft margins, excision of scars, or correction of contractions mainly of the fifth finger. On questioning, half of the patients admitted increased vulnerability of the transplanted skin but were not impeded by this. Work incapacity in those cases in which the hands determined the uptake of manual labour was only 5 weeks.

Burns↗
PubMedDate not supplied

Infection in the upper body: hand and burn-wound microbiology and considerations for antimicrobial therapy.

Gram-positive bacteria are the predominant organisms in hand infection and in burn wounds of the upper extremities. In a recent study of isolates from patients who were treated at our institution, Staphylococcus aureus and beta-hemolytic Streptococcus group A organisms were the most common organisms in infection of the hand; they were found in 36.3% and 14.4% of cases, respectively. The most common organisms in burn wounds were Enterococcus species, S. aureus, and Escherichia coli, which were found in 21.2%, 20.5%, and 16.7% of patients, respectively. Between 1969 and 1989, the prevalence of Pseudomonas species in burns decreased markedly, whereas that of S. aureus remained relatively stable and that of Enterococcus increased substantially. Over this period, both enterococci and coagulase-negative staphylococci emerged as troublesome pathogens in patients with burns. Methicillin-resistant S. aureus, which was first seen in our institution in 1981, continues to be found in a small proportion of patients. We have achieved successful results in certain surgical settings with the use of gentamicin-dispersing polymethyl-methacrylate beads to provide sufficient antimicrobial concentrations in poorly vascularized or avascular tissue. Additional topical antimicrobials that are potent against gram-positive bacteria are needed.

Anti-Bacterial Agents↗