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Biomedical subjects

J Böhler

Publications and source records attributed to J Böhler.

At least 55 records · Page 3Linked to original sources
PubMed1991

Crescentic glomerulonephritis in Wegener's granulomatosis: morphology, therapy, outcome.

Fourteen patients with Wegener's granulomatosis (WG) and severe renal and extrarenal involvement were studied (serum creatinine on admission 5.8 +/- 3.4 mg/dl). Renal histology showed a necrotizing, crescentic glomerulonephritis in all patients. Despite advanced renal disease on admission cyclophosphamide, steroids (in 13 patients) and plasma exchange (in 9 patients) caused a rapid and sustained improvement of renal function. Four patients required intermittent hemodialysis over a period of one week. After 2 weeks of treatment serum creatinine values below 2 mg/dl (n = 4) indicated a nearly complete recovery of renal function in the long-term follow up (mean serum creatinine achieved after 12 months therapy: 1.1 +/- 0.1 mg/dl (n = 4). Therefore serum creatinine values observed after 2 weeks of therapy, appear to be of prognostic value with regard to renal outcome. No relapse of active WG or progressive renal deterioration was observed during follow-up (22 +/- 13 months) except in one patient with persisting renal impairment. Three patients died (staphylococcus sepsis, intracerebral hemorrhage during hypertensive crisis, pulmonary embolism) during the first two months of therapy. The decline of serum creatinine seemed to be a better indicator of successful therapy than the decrease of anticytoplasmatic antibody (ANCA), erythrocyte sedimentation rate (ESR) and hematuria. On admission ANCA titer neither correlated with serum creatinine, the degree of renal involvement, nor was it of prognostic value. ANCA, serum creatinine and hematuria normalized within 2 to 8 months, whereas ESR and proteinuria remained elevated. Our data indicate a good prognosis of WG even with advanced renal involvement and generalized vasculitis provided aggressive treatment is performed early.

Acute Disease↗
PubMed1989

Single-dose kinetics of imipenem/cilastatin during continuous arteriovenous haemofiltration in intensive care patients.

The single i.v. dose kinetics of a fixed combination of imipenem/cilastatin were investigated in ten critically ill patients treated by continuous arteriovenous haemofiltration (CAVH). Eight patients suffered from acute renal failure and two had normal renal function. Both drugs were measured in plasma and ultrafiltrate by high-performance liquid chromatography. While the pharmacokinetics of both drugs are almost identical in patients with normal renal function, we found the following dissociation of pharmacokinetic parameters in our patients with renal failure: for imipenem the total clearance and elimination half-life was 104 +/- 12 ml/min and 2.2 +/- 0.1 h, respectively, and for cilastatin 29 +/- 10 ml/min and 13.8 +/- 4.5 h. The pharmacokinetics of imipenem and cilastatin differ from each other in renal failure because imipenem, unlike cilastatin, undergoes marked elimination by non-renal pathways. Our results did not differ from previously reported data in healthy volunteers and patients with impaired renal function. Elimination of imipenem by CAVH was low (7% of the dose). As a consequence of the unsatisfactory non-renal clearance of cilastatin, however, the fraction of the dose removed by CAVH was significantly greater (approximately 30%) than that of imipenem. This did not, however, correct the dissociation of the pharmacokinetic profiles of the two drugs. In conclusion, the dose of imipenem/cilastatin in critically ill patients with renal failure treated by CAVH should be modified according to renal function but elimination by CAVH does not need to be considered.

Acute Kidney Injury↗
PubMed1986

[Pseudarthrosis of the scaphoid].

For the treatment of scaphoid non-unions, innumerable curative and palliative operations have been recommended. Of the curative operations, the various methods of bone grafting give the best results, whereas screw fixation is not satisfactory. Bone pegs with a cortical graft are no longer used because of technical difficulties. Corticocancellous grafts (Matti-Russe) yield bony union in almost 90% of cases. The combination of corticocancellous grafts with plate stabilization gives the highest rate of bony union (99%). A cure should therefore always be attempted in all non-union cases, with the exception of cases already involving severe, generalized osteoarthritis or extensive necrosis of the scaphoid. Of the different palliative methods, the early results of prosthetic partial or total replacement of the scaphoid are satisfactory. Late results are less satisfactory, with a high rate of complications and carpal collapse. With severe osteoarthrosis, proximal carpectomy, especially the transscaphoideo-lunate resection, gives good results. Intercarpal arthrodeses have been disappointing. Radiocarpal arthrodesis results in a pain-free, strong wrist; however, there is complete loss of motion, whereas denervation gives satisfactory results in 57% and preserved mobility of the wrist.

Bone Plates↗
PubMed1986

Operative treatment of injuries to cervical spine.

Surgery is the treatment of choice in injuries of the cervical spine. In the upper cervical spine, fractures of the dens are stabilized by anterior screw fixation. In the lower cervical spine, injuries are stabilized with short fusions.

Bone Screws↗
PubMed1982

Anterior stabilization for acute fractures and non-unions of the dens.

The dens can be reached and directly stabilized from an anterior cervical approach, provided that x-ray image intensification is employed. Through this approach, twelve delayed unions and non-unions of the dens were treated with a bone graft impacted into a trough in the body of the second cervical vertebra and into a canal in the dens, together with a concomitant posterior arthrodesis. Fifteen additional fractures of the dens were stabilized with compression screws, introduced from the anteroinferior margin of the second cervical vertebra into the dens. Four of these fractures had delayed union, and an anterior onlay bone graft was added to the screw fixation. All of the delayed unions, non-unions, and acute fractures healed with bone union and without major complications. The acute fractures showed bone union in six to eight weeks after anterior fixation with compression screws alone. Delayed unions were found to need an anterior onlay bone graft in addition to the screw fixation. Established non-unions should be stabilized with a posterior arthrodesis of the first to the second cervical vertebra and inlay grafting of the non union itself to ensure both anterior and posterior healing.

Acute Disease↗
PubMed1982

[Laminar flow in the operating room (author's transl)].

After twenty years of clean-air operating rooms, no uniform opinion about the efficiency in preventing infections has been achieved. The reason is that with an infection rate around 1% only very large series of homologous material are statistically significant. Vertical flow is more efficient than horizontal flow. Clean-air technique is only one of the many facets of antisepsis and asepsis; it should be used especially in implantation and transplantation surgery in spite of the fact that its efficiency is not yet clearly proven.

Air Movements↗
PubMed1981

[Diagnostics and therapy of fractures and fracture-dislocations of the vertebral column (author's transl)].

Vertebral fractures with incomplete paraplegia should be reduced immediately. If the myelogram still shows compression of the medulla, an anterior decompression should be performed. All severe injuries to the cervical spine are stabilised with anterior bone block and plate osteosynthesis. Generally fractures of the lumbar spine are treated conservatively with reduction and plaster jacket. Operative treatment is necessary in dislocations with locked facets, secondary instability, and in cases with traumatic spondylolisthesis. Reduction and stabilisation can be performed either by interbody fusion or posterior fusion.

Diagnosis, Differential↗
PubMed1980

Anterior plate stabilization for fracture-dislocations of the lower cervical spine.

In fracture-dislocations of the cervical spine with associated injury to the supporting posterior elements, anterior interbody bone block or dowel fusion does not give sufficient stability to the involved area. Additional fixation using an H- or HH-ASIF plate has been employed over the past 2 years in 26 cases. All patients had achieved solid fusion of the involved region of the cervical spine without recurrence of the deformity. None has required additional external plaster fixation. In 21 patients with neurologic involvement, recovery (complete, marked, or partial) occurred in 14; there was no recovery in four; deaths in three patients were late and in two were not related to their operations.

Adult↗