[Pelvic fractures. Late sequelae and assessment for compensation (author's transl)].
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Biomedical subjects
Publications and source records attributed to J Probst.
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Parameters of the lungs as Compliance PaCO2, PaO2, have been measured in connection with experimental, pathophysiological insults like hematoma, bone marrow intravasation and hemorrhage, in rabbits. Concerning the compliance quotient, a statistically proved decrease was found within the groups, which have had a hematoma. Moreover, the histological picture of the lungs from rabbits with a hematom showed perivascular and intersitial edema and considerable atelectases. Serum of animals, which have had a hematom for at least 24 h has been fractionated by gel chromatography; low molecular weight substances of the fractionated serum were injected into healthy recipients. Thereafter, measurement of the centralvenous pressure suggests the appearance of substances, pharmacodynamic similar to 5-Hydroxytryptamin, in blood of rabbits with hematom.
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Fractures in Children need physio-and ergotherapy as much as fractures in adults. Before the seventh year monitoring is of prime importance, because malpositioning of fractures is frequent. In children between 7 and 12 years of age physio- and ergotherapy are essential factors in rehabilitation. Massage and irradiation are noxious. Passive exercise of the elbow joint is not successful but causes new injuries. Fractures of the vertebral column or injuries of the spinal cord should receive only functional treatment. Later consequences cannot be assessed until growth has ceased.
From the anamnestic data of 50 patients suffering from chronic posttraumatic osteomyelitis a severity scoring system was developed, based on the duration of the disease, the time of hospitalization and the number of surgical interventions. The clinical course of 18 patients, undergoing an autovaccination treatment, was registered by another scoring system ("Munich-Murnau-Scale") regarding wound morphology, bone radiology and erythrocyte sedimentation rate.
18 patients suffering from chronic posttraumatic osteomyelitis were treated by oral autovaccination. 11 patients showed significant improvement of clinical condition. The therapeutic effect was evaluated by a scoring system considering the wound morphology, the bone radiology and the erythrocyte sedimentation rate. The most pronounced clinical improvements were observed in patients with established delayed type hypersensitivity against staphylococci.
3. Immunological aspects 90 patients suffering from chronic posttraumatic osteomyelitis were examined immunologically. In 10-20% of the patients serum immunoglobulin levels were changed. Only 45% of the patients with staphylococcal infection had a positive anti-staphylolysin titer. In 10% of the patients so-called wound-specific antibodies were demonstrated; their possible autoimmune origin is discussed. A comparison of three groups of patients according to the immunological reactivity "hypoimmune", "humoral hyper-immune" and "cellular hyperimmune" showed that the worst clinical courses were observed in patinets with established delayed type hypersensitivity.
Blood volume and total body water was determined in 20 patients suffering from chronic posttraumatic osteomyelitis and compared to the values from 15 healthy volunteers. Only patients who were unable to leave the bed, showed a marked decrease in circulating blood volume of more than 10%. Total body water remained essentially unchanged.
50 patients suffering from chronic posttraumatic osteomyelitis were examined. In 66% an open fracture, caused either by traffic or industrial accidents was the primary reason for hospitalization. The most frequent pathogenic bacterium was staphylococcus aureus: 80% of the patients suffered from staphylococcal infections, mostly, however, in mixed culture with pseudomonas aeruginosa or clebsiella. Whereas the peripheral leukocyte count and the serum electrophoresis showed abnormal values only in a small percentage of the patients, the erythrocyte sedimentation rate proved to be a reliable index of the intensity of chronic infection.
The humoral and cell mediated immune response was investigated in 90 patients suffering from chronic posttraumatic osteomyelitis. In 10-20% of the patients the serum IgG and IgM was increased, in 5-10% the levels were decreased. The values were compared with those of a control group of 35 normal healthy volunteers. Of 55 patients with staphylococcal infection only 25 had a positive antistaphylolysin titer. Eleven out of 25 patients with staphylococcal osteomyelitis showed a positive in vitro lymphocyte transformation after stimulation with alpha-staphylolysin (mean transformation rate 5.4 equal to or less than 0.9). The phytohemagglutinin and the pokeweed-mitogen response were normal. A comparison of the immunological reactivity of the patients and the clinical severity of the disease showed that patients with established delayed-type hypersensitivity phenomena suffered a significantly worse clinical course of the disease.
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