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Biomedical subjects

J Wille

Publications and source records attributed to J Wille.

At least 19 recordsLinked to original sources
PubMed2004

[Acute compartment syndrome of the foot].

In two patients, a girl aged 2 and a man aged 52 years, who had suffered a severe crush trauma, acute compartment syndrome of the foot was diagnosed. Decompression by means of one medial and two dorsal dermato-fasciotomy incisions was carried out and fractures of the metatarsals were repaired using K-wires. The girl recovered completely, but the man developed progressive necrosis in the flexors of the foot and on the skin on the foot sole which necessitated amputation of the foot. Acute compartment syndrome of the foot is an uncommon disease and is mainly characterised by extreme pain and often diffuse swelling of the foot. It is a serious threat to the foot which can lead to severe long-term complications including contractures, deformity and paralysis. Compartment syndrome of the foot is a primary clinical diagnosis. When in doubt, direct pressure measurement of the foot compartments should be done by means of needle catheterisation. If compartment pressure exceeds 30 mm Hg, acute dermato-fasciotomy of all nine compartments is indicated. A combined medial and dorsal approach is adopted to release the foot compartments; three incisions are usually sufficient. If fractures are present, these are repaired at the same time. Within four hours an unnoticed compartment syndrome can lead to irreversible ischaemia of the nerves and muscle tissue with long-term irreversible consequences.

Acute Disease↗
PubMed2004

[Quality assurance in blood salvage and variables affecting quality].

Also intraoperative blood salvage (IBS) requires a system for quality management with controls of product an process quality. These can help early detection of malfunctions. For proper reaction and for improvement of quality a deep understanding of the process of blood salvage is necessary. This is supported by experimental testing of equipment, programs, and process variables, and by analysis of their effects on the process. The use of fresh whole blood and total protein as wash-out parameter in these tests is superior to outdated banked RBC and free haemoglobin. The process of aspiration turns out much less harmful than expected, when tested with fresh blood. Low wash volumes, fast washing rates, and half full bowls should be avoided. Plasma wash-out is improved by slower washing or by higher wash volumes, but the latter decrease RBC recovery. Such quality management helps to provide blood of excellent quality by IBS for optimal haemotherapy.

Blood Loss, Surgical↗
PubMed2002

Natural carbon isotopes used to study methane consumption and production in soil.

Changes in the isotopic composition of carbon can be used to reveal simultaneous occurrence of methane production and oxidation in soil. The method is conducted in laboratory jar experiments as well as in the field by using flux chambers. Simultaneous occurrence of production and oxidation of methane was suggested.

Carbon Isotopes↗
PubMed2001

Specificity of endothelial cell reorientation in response to cyclic mechanical stretching.

Evidence suggests that cellular responses to mechanical stimuli depend specifically on the type of stimuli imposed. For example, when subjected to fluid shear stress, endothelial cells align along the flow direction. In contrast, in response to cyclic stretching, cells align away from the stretching direction. However, a few aspects of this cell alignment response remain to be clarified: (1) Is the cell alignment due to actual cell reorientation or selective cell detachment? (2) Does the resulting cell alignment represent a response of the cells to elongation or shortening, or both? (3) Does the cell alignment depend on the stretching magnitude or rate, or both? Finally, the role of the actin cytoskeleton and microtubules in the cell alignment response remains unclear. To address these questions, we grew human aortic endothelial cells on deformable silicone membranes and subjected them to three types of cyclic stretching: simple elongation, pure uniaxial stretching and equi-biaxial stretching. Examination of the same cells before and after stretching revealed that they reoriented. Cells subjected to either simple elongation or pure uniaxial stretching reoriented specifically toward the direction of minimal substrate deformation, even though the directions for the two types of stretching differed by only about 20 degrees. At comparable stretching durations, the extent of cell reorientation was more closely related to the stretching magnitude than the stretching rate. The actin cytoskeleton of the endothelial cell subjected to either type of stretching was reorganized into parallel arrays of actin filaments (i.e., stress fibers) aligned in the direction of the minimal substrate deformation. Furthermore, in response to equi-biaxial stretching, the actin cytoskeleton was remodeled into a "tent-like" structure oriented out of the membrane plane-again towards the direction of the minimal substrate deformation. Finally, abolishing microtubules prevented neither the formation of stress fibers nor cell reorientation. Thus, endothelial cells respond very specifically to the type of deformation imposed upon them.

Actins↗
PubMed2001

Risk assessment for surgical site infections following total hip and total knee prostheses.

The purpose of the study was to assess the relative importance of risk factors for surgical site infections (SSI) following total hip and total knee prostheses in The Netherlands. In the period 1996-99 63 hospitals in The Netherlands registered SSI after 36,629 orthopedic operations. Total hip and total knee prostheses were analyzed in detail. The results of our study showed that a long preoperative stay was a risk factor for deep SSIs after both procedures. A dirty or contaminated wound and a serious systemic condition were risk factors for deep SSIs after total hip prostheses. If post-discharge surveillance was carried out, more SSIs were found, for total knee prostheses more than twice as many. Independent risk factors for SSIs after total hip prostheses were a contaminated/dirty wound and for total knee prostheses a short operation duration. The authors conclude that surveillance of surgical site infections following total hip and total knee prostheses revealed different risk factors for (deep) SSIs.

Adolescent↗
PubMed2000

Pulse oximeter-induced digital injury: frequency rate and possible causative factors.

OBJECTIVE: To study the frequency rate of and factors associated with pulse oximeter-induced digital injury (PIDI). DESIGN: Prospective descriptive study. SETTING: Surgical intensive care unit of a university hospital. PATIENTS: All patients with a length of stay of >2 days. INTERVENTIONS AND MAIN RESULTS: We monitored 125 patients by using a pulse oximeter with a nondisposable clip-on probe changed every 3-4 hrs from one finger to another. Daily inspection was performed with special attention to digital injury. Factors implicated in the pathogenesis of PIDI, such as vasopressor therapy, hypotension, hypoxia, hypothermia, and arterial cannulation of the radial or ulnar artery were recorded daily. A total of 22 patients received norepinephrine and dopamine, 34 patients were given dopamine, and 69 patients did not receive vasoactive drugs. PIDI developed in 6 of 125 patients, five in the norepinephrine/dopamine group, one in the dopamine group, and none in the patients not receiving vasopressors. When comparing the frequency rate of PIDI in patients receiving norepinephrine (5 of 22) with patients not receiving norepinephrine (1 of 103) the relationship between the use of norepinephrine and PIDI is significant (p < .001). However, this relationship may also be explained by the fact that patients in the norepinephrine group were more severely ill than patients not requiring norepinephrine were. This is reflected by a higher median severity of illness score (Simplified Acute Physiology Score II) (p = .001), median duration of hypotension (p < .001), median number of saturation drops (p < .001), and higher mortality rate (p < .001). Hypothermia did not occur in any of the patients. There was no significant difference between the median right-left difference in duration of arterial cannulation between the two subgroups (p = .8). In all surviving patients, PIDI healed without permanent damage. CONCLUSIONS: In the studied population of critically ill patients in a surgical intensive care unit, the frequency rate of PIDI was 5% (6 of 125). Although an association with the use of norepinephrine was found, this small number of cases does not allow definite statistical conclusions concerning a relationship between the possible causative factors and PIDI. However, severely ill patients, as indicated by their need for more aggressive vasopressors, are more likely to develop PIDI. In survivors, PIDI healed without sequelae.

APACHE↗
PubMed1999

[Restricting freedom of children and adolescents from the adolescent psychiatry and legal viewpoint].

Recent developments in child and adolescent psychiatry, youth welfare and the law concerning involuntary hospitalisation are discussed. Enforcement of control and coercive measures seems to be inevitable in some of the situations in adolescent psychiatry. The authors therefore recommend an open discussion on compulsory procedures in and between the institutions involved. They present clearcut rules for concerted action that have been jointly developed in their district.

Adolescent↗
PubMed1998

Pressure sores and tube feeding in patients with a fracture of the hip: a randomized clinical trial.

Pressure sores are a frequent problem, especially in elderly patients. Nutritional status may influence the incidence, progression and severity of pressure sores, data, however, are contradictory (1). The purpose of this study was to determine the effect of supplemental feeding on the nutritional status and the development and severity of pressure sores. The effect of supplemental feeding overnight (tube +) on patients with a fracture of the hip and a high pressure-sore risk score, was studied in a randomized clinical trial. The control group (tube -) had no supplemental feeding. After informed consent, 140 patients were randomized, and 129 of these took part in the trial (62 tube +, and 67 tube -). Protein and energy intake, haemoglobin, serum albumin, total serum protein and pressure-sore grade were measured at admission and after 1 and 2 weeks. Of the 62 patients randomized for tube feeding (tube +), only 25 tolerated their tube for more than 1 week and 16 for 2 weeks. Nevertheless, energy and protein intake was significantly higher in the tube + group (P < 0.001). This, however, did not significantly influence total serum protein, serum albumin and development and severity of pressure sores after 1 and 2 weeks. Comparison of the actually tube fed group (n=25 at 1 week, n = 16 at 2 weeks) and the control group showed a 2-3 times higher protein and energy intake (P < 0.0001), and a significantly higher total serum protein and serum albumin after 1 and 2 weeks in the actually tube fed group (all P < 0.001). Pressure-sore development and severity were not significantly influenced in the actually tube fed group. We conclude that we were not able to show a significant decrease in development and severity of pressure sores, because the nasogastric tube for supplemental feeding was not well tolerated in this patient group. Nevertheless, tube feeding overnight does result in a significant higher protein and energy intake, and has a significant effect on nutritional status in the actually tube-fed group. Other means of supplemental feeding will have to be used in order to answer the question of whether supplemental feeding can decrease development and severity of pressure sores.

Aged↗
PubMed1998

Epidermal expression of collagenase delays wound-healing in transgenic mice.

A vital characteristic of skin is its ability for wound repair in response to injury. A transient elevation of matrix metalloproteinases (MMP) in the epidermal and dermal compartments of healing wounds implicates the MMP family of enzymes in the regulation of events important to injury repair. Transgenic mice expressing human interstitial collagenase (MMP-1) in the epidermis were used to perturb the regulation of this proteinase in order to examine the role of epidermal collagenase during wound healing. The relative healing potential of collagenase transgenic mice and wild-type littermates was assessed by measurements of the wound area during closure of full-thickness wounds. Transgenic mice exhibited a 2-3 d delay in the time required to reach 50% closure of 6 mm wounds. Histologic analysis of the transgenic wound bed revealed the retarded migration of the epithelium across the open wound. The results are consistent with the hypothesis that control of collagenase (MMP-1) expression is important for re-epithelialization during wound healing and indicate that collagenase regulation is critical to the kinetics of normal wound closure.

Animals↗
PubMed1994

Pressure sores and pressure-decreasing mattresses: controlled clinical trial.

Pressure sores are a problem, especially in elderly patients. Our study was designed to determine the effectiveness in pressure-sore prevention of a new interface-pressure decreasing mattress. In a prospective randomised controlled clinical trial we tested the Comfortex DeCube mattress (Comfortex, Winona, USA) against our standard hospital mattress in 44 patients with femoral-neck fracture and concomitant high pressure-sore risk score. In addition both groups were treated according to the Dutch consensus protocol for the prevention of pressure sores. On admission and 1 and 2 weeks after admission, pressure sores were graded. The two groups were similar in patient characteristics and pressure-sore risk factors. At 1 week, 25% of the patients nursed on the DeCube mattress and 64% of the patients nursed on the standard mattress had clinically relevant pressure sores (grade 2 or more). At 2 weeks the figures were 24% and 68%, respectively. The maximum score over the several body regions of the pressure-sore grading, measured on a 5-point sale, was significantly different in favour of the DeCube mattress at 1 week (p = 0.0043) and 2 weeks (p = 0.0067) postoperatively. We show that the occurrence of pressure sores and their severity can be significantly reduced when patients at risk are nursed on an interface-pressure decreasing mattress.

Aged↗
PubMed1993

Analysis of the extractive and hydrolytic behavior of microthane poly(ester-urethane) foam by high pressure liquid chromatography.

Microthane foam, a poly(ester-urethane) (PU) used in the manufacture of Meme/Replicon breast implants, was analyzed by an HPLC method to determine whether 2,4- and 2,6-toluenediamine (TDA) were formed under a variety of physiological and nonphysiological extraction and hydrolytic conditions. At our detection limit of 20 ppb, no 2,4- or 2,6-TDA was observed in either methyl tert-butyl ether (MTBE), or aqueous buffer extracts of PU foam. The predominant extractable components identified by HPLC UV-analysis, were mixture of nonaromatic and aromatic PU fragments. Moreover, no detectable amounts of TDA were found in foam or MTBE extract of foam incubated in phosphate buffer, pH 7.4, at 37 degrees C for 5 days. By contrast, 2,4- and 2,6-TDA were found in foam and foam extracts exposed to low concentrations of either strong mineral acid or base; higher levels were found at higher acidity, treatment temperature, or durations of incubation. Moreover, 2,4- and 2,6-TDA were found in oligomers isolated by preparative HPLC and exposed to alkaline conditions. Finally, 1-2 ppm of 2,4-TDA was detected when PU foam extracts were prepared by the Snyder-Breder method, which employs acidic and alkaline conditions in the work-up procedure. Based on these findings, we suggest that published observations of 2,4-TDA formation from in vitro and ex vivo extractions of PU foam are artifacts resulting from pH effects on oligomeric PU fragments present in or extracted from the foam.

Biocompatible Materials↗