Biomedical subjects
L Koslowski
Publications and source records attributed to L Koslowski.
[The physician and accidents. Legal and medical problems].
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[The physician and accidents. Legal and medical problems].
German law requires that any physician at a place of accident is obliged to help according to his training and ability. As an emergency doctor on duty he works in a warrantee position. In cases with multiple accident victims triage may be necessary, corresponding to the priority of medical care. In criminal procedures against a physician due to omitted help, there is no probative charge against the accused. On the other hand, civil law sets up an objective standard: attention as required in communication. In giving initial medical assistance for unconscious patients or injured children, rules of "authorized management without commission" become valid. Basic first aid measures involve: securing, saving and rescue. Life-threatening situations such as severe bleeding, airway obstruction and cardiac arrest must be dealt with immediately. Following this, such measures as proper positioning, clearing of the respiratory tract, removal of dental prostheses, evaluation of multiple injuries, avoidance of hypothermia and initiating infusions are mandatory. The orientating examination of the accident victim is described, as is the "ABCD Rule" for treating respiratory insufficiency or circulatory arrest and shock, using heart massage and artificial respiration. Finally, medical first aid is described for special injuries, such as cerebral or thoracic trauma, fractures and burns. The psychological situation affecting the physician at the place of an accident is characterized.
[When is a breast-preserving operation permitted?].
Breast preserving operations in cases of breast cancer are permitted only under following conditions: Tumor extension should not exceed stage pT1. Axillary lymph nodes have to be removed completely. Histological examination requires a competent pathologist. Carefully planned and consequently applied radiotherapy with a dosage of at least 60 Gy (6000 rad) is mandatory.
Changes in the cellular immune response by a subfraction of burned murine skin.
Sepsis due to impaired host defence mechanisms is one of the most frequent causes of death in severely burned patients. However, it is not precisely known to what extent syntheses and release of suppressive mediators of the burned tissue affect the cellular and humoral immune responses. In this study a decreased production of plasminogen activator by macrophages is demonstrated after incubation with skin components, indicating a decreased macrophage helper function for T-B cell cooperation. An additional effect of the skin fraction is a considerable increase in mitogenic activity as measured in the antibody-forming cell test. This enhancement of macrophage-T-B cell cooperation is concentration dependent and lower in the burned skin fraction as compared to the unburned control. A known skin-derived cytokine with mitogenic properties is epidermal cell-derived thymocyte activating factor (ETAF) exhibiting interleukin-1 (I1-1) like activity including mitogenic enhancement of murine thymocyte stimulation by phytohaemagglutinin. Burned and control skin fraction as tested in a thymocyte assay did not show interleukin-1-like activity. The experiments suggest the presence of a skin-derived growth factor which is not interleukin-1 but which stimulates T-B cell cooperation when there is depression of macrophage function. Further purification is required in order to assess the clinical relevance of the factor in burned patients.
[By what indications are limited interventions in breast cancer currently justified?].
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[Burns--introduction and organizational tasks].
A generally accepted treatment of severe burns has not yet been established. Important demands, such as early excision and avoidance of a granulating surface have not been asserted. Treatment frequently lasts too long, is too expensive, and results are disappointing. Organising preconditions are presented, increase of burn-centres and exact documentation of burns are postulated.
[Secondary immunodeficiencies following severe skin burns].
Despite of modern fluid resuscitation, electrolyte management and respiratory care techniques 70% of severely burned patients often survive the early posttraumatic phase only to later succumb to septic complications. Acquired deficiencies in host defense mechanisms are largely held responsible for this increase in susceptibility to sepsis. The thermal insult affects the complex interactions of cells of the immune system by generation and release of suppressive mediators which, in turn, either cause defective cellular functions or overstimulation of regulatory pathways of host defense.
[Early treatment of burn wounds].
Primary excision and immediate grafting are limited by blood loss and donor areas. This may never prevent primary excision of burnt hands and face. Excision should be limited to about 20% of the body surface. Delayed primary excision is recommended after pretreatment with Iodine solution, 5% tannic acid solution, and 10% silver nitrate solution. This prevents infection for several weeks when second degree burns healed spontaneously under the artificial scab. Autografts are preferred; if donor areas are lacking staged excision and Chinese intermingled transplantation are performed using homografts containing small autograft islands for covering up to 300 cm2 with 1 cm2 autograft.
[The problem of radical treatment of breast cancer].
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[Is there a concept of operable chronic appendicitis?].
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Phagocytic activity of granulocytes and alveolar macrophages after burn injury measured by chemiluminescence.
Despite substantial progress in handling the acute phase, about 50 per cent of all severely burned patients are still subject to lethal infections during the later stages of the burn disease. Such patients frequently succumb to infections by opportunistic bacteria and viruses of normally low virulence indicating that the antiinfectious host defences are severely compromised. The present study was conducted in order to evaluate the effects of severe thermal injury on the two major categories of phagocytic cells, the circulating phagocytes of the blood and the alveolar macrophages as one population of the fixed phagocytes of the reticulo-endothelial system. The cells were isolated from burned and unburned rats. For quantitative assessment of the phagocytic function the chemiluminescence associated with the phagocytosis of opsonized zymosan particles was measured, using luminol as a chemiluminigenic probe. It turned out that as a consequence of the thermal trauma the phagocytic activity as measured by chemiluminescence is reduced in granulocytes as well as in alveolar macrophages.
[New aspects of the treatment of larger bone defects].
A characterisation of mainly used implant materials into bone defects is performed. The materials are classified in two groups; their biological effects are described in detail. Using OCG as a typical osteoinductive implant histological and radiological findings are described which take place in animals after heterotopic and orthotopic implantation.
Osteoinduction. Part II: Purification of the osteoinductive activities of bone matrix.
Using a previously described experimental model for demonstration of osteoinduction biological activity of variably prepared fractions of demineralized bone matrix was studied. Sequential extraction of matrix using CaCl2, EDTA, LiCl and water results in an acceleration of the induction process and a reduction of immunological host reaction in the case of xenogenic implants. Application of chaotropic reagents such as guanidinium chloride and sodium thiocyanate has the consequency of lowering the inductive signal. From these results it is likely that noncollagenous constituents of bone matrix play a significant role in osteoinduction.
[Life prolongation as task and limit of the physician's dealings from the physician's view].
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[Results of radiotherapy in surgery].
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[The Tübing artificial stomach. A new method of passage reconstruction following gastrectomy].
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