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Biomedical subjects

L Kinzl

Publications and source records attributed to L Kinzl.

At least 181 records · Page 10Linked to original sources
PubMed1995

Endotoxemia and specific antibody behavior against different endotoxins following multiple injuries.

The aim of this study was to establish the incidence of endotoxemia and the influence of endotoxin on specific antibody response after multiple injury. Blood samples were collected from 39 patients (median Injury Severity Score: 20.5) at 0-3 and 6-12 hours, and 1, 3, 5, and 10 days after admission. The endotoxin plasma levels were high at the first time point (mean = 0.421 endotoxin units/mL) and decreased in the later course. Total immunoglobulin levels of IgM, IgG, or IgA were low and increased throughout the observation period. Specific antibodies of the IgM class against two lipid A and four lipopolysaccharide preparations increased transiently but significantly on day 3 and/or day 5. No changes of specific antibody content against endotoxin or lipid A was seen in the IgG or IgA class. The specific antibody content of the different classes against alpha-hemolysin of Staphylococcus aureus did not differ during 10 days after trauma. The specific antibodies of the IgM class reacted with all lipid A and LPS lipopolysaccharide preparations demonstrating cross-reactivity. These results suggest that endotoxin may be a specific stimulator of IgM antiendotoxin antibody secretion following trauma.

Adolescent↗
PubMed1995

[Ambulatory surgery in trauma surgery departments].

Establishing day care and short stay surgery in trauma departments requires a careful estimation of the perioperative risks. Having the therapy be successful for each patient admitted to day care surgery should have precedence over any economic limitations. In day care surgery a trauma surgeon has to make sure that appropriate postoperative supervision is available for each patient discharged from the hospital. The surgeon is responsible for qualified care on an outpatient basis.

Ambulatory Surgical Procedures↗
PubMed1995

[Open segmental bone transport. A therapeutic alternative in post-traumatic and osteitis soft tissue and bone defects].

Between 1990 und 1992, 22 patients with bone and soft tissue defects were treated by open segmental bone transport according to Ilizarov, and 20 of these were followed up over a period of 18 months after removal of the external fixator. In 19 cases the bone defect could be filled by callus distraction only, while 1 patient needed additional spongeous bone transplantation because of delayed ossification. In 1 case amputation was necessary because of extensive fistula carcinoma of the resected bone and soft tissue. Closure of soft tissue defect was achieved in 14 patients simultaneously with docking of the bone segments. In 5 patients additional skin transplantation was needed, and in 1 case a latissimus dorsi flap had to be transferred because of unstable scar formation. Transporting vital bone simultaneously with the overlying tissue into a defect allows for limb salvage even in poor biological conditions and in patients with vascular problems. Open bone transfer has extended the range of methods available for the treatment of bone and soft tissue defects.

Adolescent↗
PubMed1994

[Computerized tomography measurement of torsion angle of the lower extremities].

The precise evaluation of post-traumatic deformities is indispensable when planning a corrective osteotomy. Torsional angles of the lower extremities of 186 patients were measured using CT. The mean age of the studied population was 34 years (18-80). It consisted of 131 men and 55 women. All patients had sustained a fracture of at least one of the leg's bony segments. The normal femoral (n = 293) inward torsion measured 23.47 degrees +/- 17.16 degrees (mean +/- 2 SD). Normal tibia (n = 263) outward torsion was 34.03 degrees +/- 17.22 degrees. The intraindividual torsional differences were not normally distributed. Normal femoral (n = 103) intraindividual torsional difference measured 11 degrees (95% percentile) and 15 degrees (99% percentile), with a median of 4 degrees. The tibiae (n = 76) showed a normal intraindividual torsional difference of 12 degrees (95% percentile) and 15 degrees (99% percentile). Right tibiae showed a statistically significant greater outward rotation when compared to their left counterpart (P < 0.001). No correlation to sex could be established. Preoperative planning of a corrective osteotomy should include the geometric evaluation of all four bony segments of the leg. Intraindividual torsional differences must be considered. A corrective osteotomy appears to be unnecessary with a torsional difference smaller than 15 degrees in the femora and smaller than 15 degrees in the tibiae.

Adolescent↗
PubMed1994

[A UNIX-based electronic data processing system for routine use in a trauma surgery department].

A computer program for a UNIX workstation has been developed to support routine activities in a surgical department. A relational database contains reports on operations, medical letters and further data imported from independent computer subsystems outside the department. Data are accessible at 15 terminals and PCs through a simple and intuitive user interface with a mouse. The patient record is organized in a hypertext fashion and permits direct access to the various types of documents in a consistent manner. The implementation is currently used to manage information on 40,000 patients and has proved valuable in daily routine over a 2-year period.

Computer Systems↗
PubMed1993

The microtip intramedullary probe for intraoperative pressure measurement.

The implantation of femoral stem prostheses and intramedullary fracture stabilisation are well-established techniques in traumatology. Although the biomechanical advantages of intramedullary splinting are obvious, impairments of pulmonary circulation and respiratory function are typical and feared complications. These pulmonary disturbances are strikingly correlated with operation-induced intramedullary hypertension. A simple, low-invasive and reliable system for the measurement of intramedullary pressure is presented. At the heart of the system is a microtip probe, transforming changes of pressure into electric impulses, filtered and amplified in a pressure measuring system (PMS).

Femoral Fractures↗
PubMed1993

Thromboxane--co-factor of pulmonary disturbances in intramedullary nailing.

UNLABELLED: Pulmonary complications during and after intramedullary nailing particularly in trauma patients have directed clinical interest to thromboembolic events and metabolic alterations, as found in different methods of fracture stabilisation. In 30 patients (mean age 34 years) isolated, closed or 1 degree open fractures of the tibia were operated on in three groups with reamed nailing (RN; n = 11), unreamed nailing (UN; n = 11) and external fixation (EF; n = 8) respectively. In blood samples of the femoral vein of the fractured limb, a 5-7 fold increase of the thromboxane (TXB2) concentration was found in all patients. However, differences of TXB2 concentrations in the arterial blood after passage of the lungs were conspicuous. The highest arterial TXB2 concentrations were found in connection with RN, followed by UN and finally EF. The transpulmonary TXB2-clearance displayed the following relationship: EF > UN > RN (5.7:4,4:2.2). A similar correlation was found for PGF2 alpha while other arachidonic acid metabolites showed no significant behaviour. TXB2 and PGF2 alpha cause bronchoconstriction, pulmonary vasoconstriction and aggregation of thrombocytes. These pulmonary disturbances may results in ARDS, a feared complication after intramedullary nailing. CONCLUSION: Early fracture stabilisation particularly in severely injured patients is an established procedure. To prevent pulmonary disturbances the external fixator is preferrable to the UN and finally the RN. Our data suggest that for the prevention of pulmonary disturbances EF is superior to UN and RN.

Adolescent↗
PubMed1993

[Intraoperative recording of intramedullary pressures with a microprobe].

The implantation of femoral prostheses and intramedullary nailing for fracture stabilisation are well-established techniques in traumatology. Nevertheless, the obvious biomechanical advantages of intramedullary splinting are partly offset by occasional disturbances of pulmonary circulation and function. These disorders of pulmonary function are apparently correlated with an operation-induced increase in intramedullary pressure. A simple, low-invasive and reliable system for the measurement of intramedullary pressure is presented. The heart of the system is a microtip probe that converts changes in pressure into electrical impulses, which are then filtered and amplified in the pressure measuring system (PMS).

Bone Marrow↗
PubMed1993

Philosophy of osteosynthesis in shoulder fractures.

A wide range of workable instrumentation is available for the treatment of proximal humeral fractures, whereas osteosynthesis of scapular fractures is commonly achieved by plate/screw fixation. Older persons are confronted with a steadily rising incidence of osteoporotic fractures. Especially for this group of patients, minimally invasive and minimally instrumented surgical procedures, such as K-wiring and bone sutures, seem to have superseded plate fixation. For the treatment of scapular fractures, an important question remains: Which fracture types provide better functional results with open reduction and internal fixation, and which with conservative treatment? Our indications for an operative procedure are limited to the floating shoulder, dislocated scapular neck fracture, and dislocated glenoid fracture.

Fracture Fixation, Internal↗
PubMed1993

[Heart injury. Description of a traumatologic heart surgery patient sample].

Thoracic injuries can always involve cardiac structures. If the heart is affected, penetrating or blunt injuries need urgent treatment. An unstable cardiac situation with shock symptoms is life-threatening. The diagnostic method of choice is ultrasound examination. This can show pericardial effusion, enlargement of cardiac chambers, wall motion changes and intracardiac defects. Pathologic ultrasound and ECG findings or abnormal enzyme values arising after blunt traumas need intensive care monitoring. Surgical interventions should be done immediately by the first surgeon involved: time should not be wasted by sending patients to special units, as extracorporal circulation is seldom needed. If it is necessary treatment should be carried out by a cardiac surgeon. Between 1989 and 1990 seven patients with thoracic trauma and heart involvement were operated on at the University of Ulm. The indications applied and results achieved are discussed with reference to the literature.

Adult↗
PubMed1993

[Vacuum sealing as treatment of soft tissue damage in open fractures].

In 1992, 15 of 152 patients with open fractures were treated with vacuum sealing. Drainage tubes are inserted into polyvinyl foam, which is used to fill in the wound or tissue defect. Polyvinyl foam and adjacent skin are covered with a transparent polyurethane dressing which is impermeable to bacteria. The connection of the drainage tubes to a suction device, such as vacuum bottles, produces negative pressure in the polyvinyl foam, which means a high-contact zone of the foam-wound interface. This results in efficient cleaning and conditioning of the wound, with marked proliferation of granulation tissue. Bone infection did not occur in any of our 15 patients; 1 patient sustained a soft tissue infection due to an insufficient sealing technique. When the correct technique was applied the infection cleared up.

Adolescent↗
PubMed1993

[Management of the patient with craniocerebral injuries at the accident site and clinic admission].

Between January 1991 and December 1992, there were 686 rescue operations involving patients with craniocerebral trauma in the catchment area of Ulm. There were 376 patients who had to be graded as seriously injured according to the NACA classification. In 178 cases there was a severe craniocerebral trauma, and 131 of these patients were admitted to the traumatology department of the University of Ulm. The pattern of injuries was analysed; multiple injuries were found in 63 patients, with injuries to the extremities and the thorax being most-frequent. The primary preclinical treatment for patients with craniocerebral trauma is demonstrated; the indications for intubation and artificial respiration are discussed, and also the selection of drugs. Diagnostic procedures and immediate treatment must initially be directed at securing vital functions. Treatment of life-threatening haemorrhage has priority over neurosurgical diagnosis and therapy. The urgent indications for neurosurgical intervention are: space-occupying intracranial bleeding, open craniocerebral traumas, and space-occupying depressed fractures.

Brain Injuries↗
PubMed1993

[Endotoxin in blood plasma of patients after trauma].

Depending on the severity of the injury, high endotoxin levels may be found in patients with lung contusion but only slightly increased levels in patients with skull and brain trauma. This difference is highly significant. Patients with multiple injuries and fractures of the extremities as the main diagnosis and with a combination of injuries show a moderate increase in endoxin level on the day of admission. There is no relationship between the injury severity and endotoxemia.

Adolescent↗
PubMed1992

[Therapy of patients with multiple traumas: interdisciplinary organization at a specialized center].

By utilizing all its specialist facilities, the specialized trauma centre can optimize the chances of survival of the severely injured patient. However, this is possible only when the specialties involved have the ability to cooperate and when a "team leader" applying treatment guidelines worked out and accepted on an interdisciplinary basis is available to coordinate activities.

Humans↗
PubMed1992

Treatment of bone and soft tissue defects in infected nonunion.

In the treatment of infected pseudarthroses the general principles of osteitis treatment are applied. This includes radical excision of pseudarthrotic and infected bone tissue, and of diseased surrounding soft tissue. External fixation devices are the preferred method of stabilization of the bone. Based on the data of a retrospective study of 31 Papineau procedures, 65 local flap transfers, and 46 free flap transfers we found that the Papineau procedure works in minor bone and soft tissue defects. Unstable scar formation is a major disadvantage of this method. Local muscular flaps are indicated in the treatment of soft tissue defects in the proximal and medial portions of the lower leg. A prerequisite for free flap transfers is the availability of trained personnel and suitable technical equipment. The option is limited by the patient's vascular situation. This kind of tissue transfer seems to be superior to other methods. For the substitution of bone defects corticocancellous bone transplantation may be used. A promising alternative method to deal with extensive bone defects is osteogenesis produced by callus distraction.

Bone Transplantation↗
PubMed1992

[Ventral stabilization of thoracic and lumbar spinal injuries].

An isolated ventral approach to the thoracal or lumbar spine seems sufficient in special burst fractures (type A2/3) or older compression fractures. The most effective ventral decompression of the spinal cord is followed by the fusion of the ventral body. Ventral plate instrumentation avoid dislocations of the interposed bone transplants. Our own clinical results are demonstrated.

Bone Plates↗