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Biomedical subjects

M D Bircher

Publications and source records attributed to M D Bircher.

15 recordsLinked to original sources
PubMed2005

The hormonal and inflammatory responses to pelvic reconstructive surgery following major trauma.

Patients undergoing trauma sustain an initial injury followed by further physiological challenges during surgery. Plasma osteocalcin (OC), a marker of osteoblastic activity, declines after major surgery. Increased cortisol secretion, and other components of the perioperative stress response, may play a role in mediating this response. We have examined the osteocalcin, hormonal and cytokine responses in twenty patients undergoing post-traumatic pelvic reconstruction surgery. We measured plasma osteocalcin, serum cortisol, bone specific alkaline phosphatase (BSAP), IL-6, IL-8, IL-10, plasma epinephrine and norepinephrine concentrations for up to 3 days after surgery. We recorded an increase in IL-6, IL-10 and epinephrine concentrations perioperatively and a fall in OC and BSAP concentrations. There were no significant changes in cortisol or IL-8 concentrations. Patients undergoing pelvic reconstruction surgery following trauma have a preserved inflammatory and catecholamine response but the cortisol response may be obtunded. Osteocalcin concentrations are affected by factors other than glucocorticoids.

Adolescent↗
PubMed2004

Pelvic and acetabular fractures in the United Kingdom: a continued public health emergency.

In 1996 the quality of the early management of 100 consecutive patients referred to the SW Thames regional pelvic and acetabular unit between 1989 and 1992 was studied. The management of these patients was assessed in four specific areas, and guidelines were laid down. It was found that in 56% of patients the early management did not meet these suggested standards, with 34% having deficiencies in more than one area. These results were presented and published. Five years later, the early management of a further 100 consecutive referrals was assessed using these same guidelines, in order to close the audit loop. The treatment of 57% of patients still did not reach the guideline standards, but the number with problems in more than one area fell to 20%. There has been improvement in the early management of pelvic and acetabular injuries. The use of external fixation in cases of severe haemorrhage increased, but frames were often poorly applied. Early communication with the specialist centre was encouraged but unfortunately there was still an unacceptable delay in referral. The frequency of delayed referral actually increased during the 5 years between study groups.

Acetabulum↗
PubMed2004

Pelvic floor dysfunction in women after pelvic trauma.

The aim was to assess symptoms of pelvic floor dysfunction in women following pelvic trauma. A retrospective questionnaire survey of 24 consecutive women was performed in a tertiary referral orthopaedic centre and urogynaecology unit. Sixteen women had a type B and eight a type C pelvic fracture (Association Osteosynthesis manual classification). The median age was 24 years (11-92). Twenty-one women were nulliparous. Sixteen women reported de novo pelvic floor dysfunction. Bladder symptoms occurred in 12, bowel problems in 11 and sexual dysfunction in 7 of 17 sexually active women. Pelvic fracture seems to be a risk factor for pelvic floor dysfunction.

Adolescent↗
PubMed1996

Volume changes within the true pelvis during disruption of the pelvic ring--where does the haemorrhage go?

Fractures of the pelvis are not only common but are very varied in their complexity. They represent 3% of all fractures (1), they account for 1 in every 1000 surgical admissions and are the third most commonly encountered injury in motor vehicle accident fatalities (2). However, only a small percentage of all pelvic fractures are associated with major disruption of the pelvic ring (3). Life threatening haemorrhage is a frequent complication of major pelvic fractures (1, 4) and haemorrhage is the leading cause of death in these patients (5, 6). It was believed that fracture and subsequent displacement of the ring greatly increased pelvic volume. However, clinical practice seemed to indicate that this might not be true. This study aimed to assess the change in pelvic volume which occurs in severely displaced pelvic fractures. A model of the bony pelvis was designed to permit extreme displacements of the symphyseal and sacroiliac joints. The volume of a polythene balloon placed within the true pelvis was measured as an indication of true pelvic volume. Our finding was that the increase in the volume of the true pelvis which occurs in a fracture with massive diastasis is much smaller than previously assumed.

Fractures, Bone↗
PubMed1996

The early management of pelvic and acetabular fractures.

One hundred consecutive referrals with pelvic and acetabular fractures treated over a three year period were reviewed with regard to their early management. Early management was subdivided into four areas: 1. initial assessment and treatment; 2. imaging; 3. referral; 4. management of associated injuries. The cases comprised 26 pelvic fractures (18 treated operatively), 69 acetabular fractures (50 treated operatively), and 5 combination fractures (3 treated operatively). Guidelines were laid down in each of the four areas of management and each patient's management was compared with this ideal. 56% of cases had deficient management by our criteria. There were important failures in diagnosis and early treatment of these complex injuries. A set of simple guidelines is offered to help improve the situation.

Acetabulum↗
PubMed1996

Indications and techniques of external fixation of the injured pelvis.

High energy pelvic ring disruption represents a serious clinical problem with an overall reported mortality rate of approximately 10% (1). However, the mortality for open pelvic fractures approaches 50% (2). This alarmingly high rate has two major components. The first is death due to uncontrollable haemorrhage, often associated with terminal diffuse intravascular coagulation. The second is linked with the serious associated injuries. Improved resuscitation techniques have a direct bearing on both these components and should reduce morbidity and mortality (3,4). The external fixator has a major role to play during resuscitation and, in particular, in the control of bleeding. However, this primary function must not be confused with the more limited secondary role for the external fixator as a definitive form of treatment for certain pelvic fractures. This paper gives clear guidelines on the indications for the use of the external skeletal fixator with pelvic fractures and goes on to discuss pin placement and frame configuration in relation to the biomechanics and biology of the injury.

Adolescent↗
PubMed1988

Discitis following lumbar surgery.

Although well described in the orthopaedic literature and some orthopaedic textbooks, postoperative discitis is regularly missed or diagnosed late. Six cases of discitis were studied in detail with special reference to the clinical presentation. All patients with discitis had an erythrocyte sedimentation rate (ESR) greater than 50 at 2 or more weeks after surgery. A prospective study of 26 patients undergoing uncomplicated discectomy or fusion was made. ESRs were measured preoperatively and at 1,2, and 6 weeks after operation. Any patient with increasing back pain and an ESR greater than 52 or more weeks after surgery should be considered to have discitis until proven otherwise. If the ESR is measured routinely preoperatively and at 2 weeks postoperatively, this condition should not be missed.

Blood Sedimentation↗