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K J Pfeifer

Publications and source records attributed to K J Pfeifer.

At least 55 records · Page 3Linked to original sources
PubMed1997

[Shock room diagnosis in polytrauma. Value of thoracic CT].

OBJECTIVE: The aim of this prospective study was to evaluate whether early thoracic computed tomography (TCT) is superior to routine chest X-ray (CXR) in the diagnostic work-up of blunt thoracic trauma and whether the additional information obtained influences subsequent decisions on therapy in the early management of severely injured patients. PATIENTS AND METHODS: In a prospective study of 103 consecutive patients with clinical or radiological signs of chest trauma (94 multiply injured patients with chest trauma, 9 patients with isolated chest trauma) who had an average ISS of 30 and an average AIS thorax of 3, initial CXR and TCT were compared after the first assessment in our emergency department (a level I trauma center). Mortality in this group was 10% (n = 10). RESULTS: In 67 patients (65%) TCT revealed major complications of chest trauma that had been missed on CXR: lung contusion (n = 33), pneumothorax (n = 27), residual pneumothorax after chest tube placement (n = 7), hemothorax ((n = 21), displaced chest tube (n = 5), diaphragmatic rupture (n = 2), myocardial rupture (n = 1); in 11 patients only minor additional pathologic findings (dystelectasis, small pleural effusion) were visualized on TCT; and in 14 patients CXR and TCT showed identical pathologic results. In 11 patients neither CXR nor TCT revealed pathologic findings. The TCT scan was significantly more effective than routine CXR in detecting lung contusions (P < 0.001), pneumothorax (P < 0.005) and hemothorax (P < 0.05). In 42 patients (41%) the additional TCT findings did affect, the therapy selected: chest tube placement or chest tube correction in mostly anteriorly located pneumothoraces or large hemothoraces (n = 31), influence on ventilation mode and respiratory care (n = 14), influence on the management of fracture stabilization (n = 12), laparotomy in cases of diaphragmatic lacerations (n = 2), bronchoscopy for atelectasis (n = 2), exclusion of aortic rupture (n = 2), endotracheal intubation (n = 1), pericardiocentesis (n = 1). CONCLUSIONS: TCT is highly sensitive in detecting thoracic injuries after blunt chest trauma and is superior to routine CXR in visualizing lung contusions and pneumo- and hemothorax. Early TCT influences therapeutic management in a considerable subset of patients. We therefore recommend TCT in the primary diagnostic work-up of multiple injured patients with suspected chest trauma, because early and accurate diagnosis of all thoracic injuries along with acceptance of the implications for therapy may reduce complications and improve the outcome in polytraumatized patients with blunt chest trauma.

Adolescent↗
PubMed1997

[Quality management in early clinical polytrauma management. II. Optimizing therapy by treatment guidelines].

To enhance the quality of treatment of patients with multiple injuries (blunt trauma), guidelines for the acute clinical management (trauma-algorithm) were implemented at our clinic in 1994. The impact of these guidelines was analysed, comparing two prospectively recorded collectives of polytraumatized patients 4/1988-12/1993 (A; n = 126) and 1/1994-6/1996 (B; n = 74). Nine specifically defined parameters were used to assess the therapeutic process of early clinical trauma management. All parameters showed an improvement after implementation of the algorithm (group B): (1) Complete radiological and sonographic basic diagnostics in 97% vs. 92% of patients; (2) time interval of 38 min vs. 55 min until cranial CT was done after severe head injury (GCS < 10); (3) reduction of delayed diagnosis of lesions to 5% vs. 24%; (4) duration of 16 min vs. 20 min until intubation; (5) period of 23 min to 30 min to pleural drainage; (6) duration of 18 min vs. 32 min until transfusion in shock; (7) period of 79 min vs. 98 min until emergency operation in shock; (8) duration of 95 min vs. 124 min until trepanation, and (9) operation rate within 24 h after admission to ICU in 3% vs. 12%. The lethality rates of each collective were assessed after subdivision in three groups (I-III) with middle (ISS: 18-24), high (ISS: 25-49) and extreme (ISS: 50-75) injury severity. In all groups of both collectives ISS values, age, initial loss of consciousness (GCS) and shock were comparable (except the higher injury severity of collective B in group I). In all groups a reduction of lethality could be shown for collective B: Group I, 0% vs. 20% (P < 0.05); group II, 8% vs. 24% (P < 0.05); and group III, 40% vs. 71%, not significant because of the small group in B (n = 5). The implementation of therapeutic management guidelines led to an improvement of both treatment processes and outcome. In order to regularly reassess validity and practicability of such guidelines as well as further enhance therapeutic quality, a continuous evaluation programme representing a quality management system should be inaugurated.

Adult↗
PubMed1997

Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study.

OBJECTIVE: The aim of this prospective study was to evaluate whether early thoracic computed tomography (TCT) is superior to routine chest x-ray (CXR) in the diagnostic work-up of blunt thoracic trauma and whether the additional information influences subsequent therapeutic decisions on the early management of severely injured patients. PATIENTS AND METHODS: In a prospective study of 103 consecutive patients with clinical or radiologic signs of chest trauma (94 multiple injured patients with chest trauma, nine patients with isolated chest trauma), an average Injury Severity Score of 30 and an average Abbreviated Injury Scale thorax score of 3, initial CXR and TCT were compared after initial assessment in our emergency department of a Level I trauma center. RESULTS: In 67 patients (65%) TCT detected major chest trauma complications that have been missed on CXR (lung contusion (n = 33), pneumothorax (n = 27), residual pneumothorax after chest tube placement (n = 7), hemothorax (n = 21), displaced chest tube (n = 5), diaphragmatic rupture (n = 2), myocardial rupture (n = 1)). In 11 patients only minor additional pathologic findings (dystelectasis, small pleural effusion) were visualized on TCT, and in 14 patients CXR and TCT showed the same pathologic results. Eleven patients underwent both CXR and TCT without pathologic fundings. The TCT scan was significantly more effective than routine CXR in detecting lung contusions (p < 0.001), pneumothorax (p < 0.005), and hemothorax (p < 0.05). In 42 patients (41%) the additional TCT findings resulted in a change of therapy: chest tube placement, chest tube correction of pneumothoraces or large hemothoraces (n = 31), change in mode of ventilation and respiratory care (n = 14), influence on the management of fracture stabilization (n = 12), laparotomy in cases of diaphragmatic lacerations (n = 2), bronchoscopy for atelectasis (n = 2), exclusion of aortic rupture (n = 2), endotracheal intubation (n = 1), and pericardiocentesis (n = 1). To evaluate the efficacy of all those therapeutic changes after TCT the rates of respiratory failure, adult respiratory distress syndrome, and mortality in the subgroup of patients with Abbreviated Injury Scale thorax score of > 2 were compared with a historical control group, consisting of 84 patients with multiple trauma and with blunt chest trauma Abbreviated Injury Scale thorax score of > 2, prospectively studied between 1986 and 1992. Age (38 vs. 39 years), average Injury Severity Score (33 vs. 38), and the rate of respiratory failure (36 vs. 56%) were not statistically different between the two groups, but the rates of adult respiratory distress syndrome (8 vs. 20%; p < 0.05) and mortality (10 vs. 21%; p < 0.05) were significantly reduced in the TCT group. CONCLUSIONS: TCT is highly sensitive in detecting thoracic injuries after blunt chest trauma and is superior to routine CXR in visualzing lung contusions, pneumothorax, and hemothorax. Early TCT influences therapeutic management in a significant number of patients. We therefore recommend TCT in the initial diagnostic work-up of patients with multiple injuries and with suspected chest trauma because early and exact diagnosis of all thoracic injuries along with sufficient therapeutic consequences may reduce complications and improve outcome of severely injured patients with blunt chest trauma.

Adolescent↗
PubMed1996

Initial clinical experience with spiral CT and 3D arterial reconstruction in intracranial aneurysms and arteriovenous malformations.

We studied 32 consecutive patients with known or suspected cerebrovascular abnormalities studied with spiral CT following a intravenous bolus injection of iodinated contrast medium with a power injector. Flow was 3 or 4 ml/s. In an attempt to define the appropriate delay time and scan duration a cranial angio-CT without table increment was performed on 10 patients. Enhancement was measured by manually placed regions of interest within the left middle cerebral artery and the inferior sagittal sinus. All patients except one had intraarterial angiography (DSA) for comparison. In 6 patients with an arteriovenous malformation (AVM) follow-up was possible after one and/or two embolisation procedures. These patients had plain and contrast-enhanced spiral CT. The diagnosis was aneurysm in 9 (8 berry aneurysms, one giant fusiform aneurysm), AVM in 13 (all supratentorial) and traumatic arteriovenous fistula in one. In 9 patients there were no detectable pathological vascular findings. After 3D reconstruction the size (between 5 and 28 mm), location and the relationship to the parent vessel of the aneurysms, the extent of the AVMs and the distribution of the embolisation material could be demonstrated clearly. The main feeding vessel(s), nidus and draining veins were reliably shown. The decreased extent of the AVMs after embolisation was clearly demonstrated. There was no difference in diagnosis when DSA and 3D-CT were compared by two independent radiologists. We consider arterial spiral CT with 3D reconstruction to have the potential of offering important diagnostic information for the treatment of intracranial AVMs and aneurysms.

Adult↗
PubMed1996

Bilateral bronchial balloon dilatation and Strecker stent implantation in a ventilated child with malignant carinal stenosis.

Tracheobronchial endoluminal reconstruction and stenting has become a valuable palliative tool in adults with intrathoracic tumors compromising the airways. Tracheobronchial balloon dilatation has been recently used in children and even neonates. We report a case of severe airway obstruction requiring emergency intubation and artificial ventilation in a 5-year-old child with intrathoracic recurrence of a rhabdomyosarcoma. Endoscopic balloon dilatation through the endotracheal tube with subsequent implantation of a non self-expanding metal mesh stent was used successfully, allowing extubation and discharge of the child from ICU.

Airway Obstruction↗
PubMed1996

[Studies on radiation exposure in retrograde sclerotherapy of the testicular vein].

PURPOSE: Prospective evaluation of different radiation exposure parameters in a large series of varicoceles. The dependency of the square area product on the different therapists was calculated in addition. MATERIAL AND METHOD: Between 5/91 and 12/93 a total of 737 sclerotherapies were performed on 465 patients. The following parameters were measured prospectively: Square area product (n = 737), fluorotime (n = 737), symphysis surface doses (n = 24), gonadal doses (n = 49), catheterisation time (n = 737). 608 of the sclerotherapies were performed by 4 similar experienced radiologists (U1 - U4). The individual fluorotimes, square area products and the average square area product per minute fluorotime were calculated. RESULTS: The average gonadal doses was 0.01 mSv. Calculation of the square area product per minute fluorotime revealed a useful parameter to demonstrate the potential for further dose reduction, because the results ranged from 566 mGy x cm2/min to 988 mGy x cm2/min. There is no need for a time limit for this interventional procedure. CONCLUSION: The gonadal doses is so low that it can be considered negligible. However, in view of the considerable differences in the square area product per minute, close attention must be paid to the technique by which th fluorotime is determined.

Adolescent↗
PubMed1996

[Percutaneous transhepatic stent implantation versus hepaticojejunostomy in palliative therapy of distal malignant bile duct stenosis].

The value of radiologically controlled stent implantation compared to hepatojejunostomy in palliative treatment of tumor induced cholestasis was examined in a non randomised retrospective study. 54 patients suffering of adenocarcinoma of the pancreas (n = 34), carcinoma of the distal bile duct (n = 10) and metastatic induced stenosis of the common bile duct (n = 10) were compared in regard to survival time, normalisation of cholestasis and complication rate. The survival time following stenting procedure (n = 31) is 6.0 months, after operation (n = 23) 7.1 months. The reduction of cholestasis showed no significant difference. The complication rate is lower (operated group 12.9%, stented group 9.6%) and the hospital stay following stenting procedure was much shorter (6.1 d vs. 18.0 d). Both a positive side effect of stent implantation.

Adult↗
PubMed1994

[Cerebral arteriovenous angiomas: 3-dimensional demonstration by spiral CT].

In 20 patients with known or suspected supratentorial arteriovenous malformations, an attempt was made to see how far CT angiography with 3-dimensional reconstructions is able to make a diagnosis and to differentiate the various components of the angioma. Spiral CT was performed following an intravenous bolus injection of 60-80 ml of iodine containing contrast medium. In all patients the diagnosis was confirmed by intra-arterial DSA of the vertebral vessels. In 13 patients, av malformations could be diagnosed following multiplanar 3-D reconstructions which agreed with the findings on DSA. The large supplying vessels, the nidus and the large draining veins could be defined with certainty. In 6 patients follow-up examination after embolisation was performed. The results could be demonstrated in three dimensions and the success of treatment could be documented unequivocally. CT angiography with 3-D reconstruction is able to supply important information in the majority of intracranial av malformations, both during initial investigation and following treatment.

Adolescent↗
PubMed1993

[Venous thrombosis--clinical aspects and diagnosis].

Physical examination is in most cases not specific or sensitive enough to diagnose venous thrombosis. Only in rare cases is it possible to diagnose thrombosis by history and examination alone. However, when the case history indicates that risk factors are present, one must suspect thrombosis even if the clinical findings are uncharacteristic. In this situation the diagnosis must be verified by additional technical examinations.

Edema↗
PubMed1993

[Technological diagnosis of venous thrombosis].

The bedside diagnosis of deep venous thrombosis is not accurate enough to implement invasive therapy, e.g., systemic administration of thrombolytic agents, so the diagnosis must be established by independent diagnostic means. The most useful diagnostic tests available include Doppler ultrasound, duplex sonography, color duplex sonography, and contrast venography. The common femoral vein and popliteal vein can be examined easily with a Doppler ultrasound probe. Reduced blood flow due to major venous thrombosis proximal or distal to the probe, qualitative blood flow and flow direction are all detectable. Duplex sonography allows imaging of thrombosed areas and provides structural information on thrombi and the attachment sites to the endothelium. These noninvasive methods are insensitive to thrombosis in the lower leg. Color duplex sonography in addition provides diagnostic information about the quantitative blood flow and simplifies the diagnostic procedure. If these tests are not available or the findings are equivocal, contrast venography is performed, which is the most sensitive and reliable test for confirming or excluding deep venous thrombosis.

Color↗
PubMed1991

[Abdominal sonography versus peritoneal lavage in shock site diagnosis in polytrauma].

Diagnostic peritoneal lavage (DPL) and abdominal sonography (AS) were prospectively evaluated in emergency room diagnostics of blunt abdominal trauma in 106 multiple injured patients (ISS 40 pts). The incidence of intraabdominal lesions was 38.7%. 82 DPL and 64 AS were performed. In 45 patients both procedures were done, in 19 patients only AS and in 37 patients only DPL. The over-all accuracy of DPL and AS was 95% and 88%, respectively. Sensitivity was 91 vs. 74%, specificity 98 vs. 95%. The combined use of both procedures increased accuracy to 98%. We conclude that AS is the initial screening method for the detection of intraabdominal lesions in multiple injured patients. In any case of negative AS and hemodynamic instability or ambiguous AS, DPL should be performed immediately to improve diagnostic accuracy without delaying treatment.

Abdominal Injuries↗
PubMed1988

Dynamic angioplasty--a milling catheter for transcutaneous and intraoperative treatment of vascular occlusive disease.

Balloon angioplasty and bypass graft surgery are common procedures for treating vascular occlusive disease. The purpose of this preliminary investigation was to evaluate the effectiveness and the safety of a new catheter system, first introduced by KR Kensey. The system involves a flexible catheter with a high speed rotating tip, driven by an electrical motor. The tip is cooled by a continuous flow of sterile saline containing dextran 40, heparin and urokinase. Radiopaque contrast medium may be infused through the catheter to allow the device to be guided and to detect lesions and to evaluate the efficacy of treatment. The system was applied in three patients with occlusive vascular disease (Stage IIb) and segmental or total occlusion of the superficial femoral artery (SFA). The milling catheter was introduced percutaneously into the common femoral artery and guided to the area of occlusion under DSA control. In two patients total recanalisation was achieved after passage of the milling catheter. In one patient the totally occluded SFA could not be cannulated and a femoro-popliteal bypass was performed one week later. Complications such as perforation of the vessel or peripheral embolisation were not observed. Pedal pulses were improved significantly in one patient. Further investigations will be necessary to demonstrate whether the milling catheter can be safely used to revascularise patients with limb threatening peripheral vascular disease.

Angioplasty, Balloon↗
PubMed1988

[Diagnosis of a perforating aortic aneurysm as a late complication following enlarging aortoplasty using central venous digital subtraction angiography].

11 years after patch aortoplasty due to coarctation of the aorta a 33 year-old patient experienced two spontaneous haemoptyses. A centralvenous digital subtraction angiography demonstrated a large aneurysm of the proximal descending aorta penetrating the left upper lobe of the lung. The successful emergency surgical treatment consisted of implantation of a dacron-prosthesis.

Adult↗
PubMed1987

[Spontaneous splenorenal shunt in liver cirrhosis].

A 52 year old patient was admitted to the hospital for further clarification of a cystic structure in the region of the spleen hilus noticed in the upper abdominal sonogram. The investigations revealed a spontaneous splenorenal shunt in hepatic cirrhosis.

Arterio-Arterial Fistula↗