Biomedical subjects

M El-Sheik

Publications and source records attributed to M El-Sheik.

6 recordsLinked to original sources

PubMed2003

[From clinical guidelines to clinical pathways: development of a management-oriented algorithm for the treatment of polytraumatized patients in the acute period].

INTRODUCTION: The treatment of polytraumatized patients in the acute period is an exemplary model of multidisciplinary cooperation in a very critical timeframe. Implementing standards formulated in the clinical guidelines of the German Association of Traumatology requires a detailed description of "how to do it." METHODS: Based on the guidelines and validated quality indictors, the optimal standard of care as the goal was defined. A clinical algorithm was developed and personal responsibilities and time limits were clearly assigned to each decision step and action. Checklists, documentation charts, and a full text supplement the algorithm. The complete pathway was adopted by representatives of all occupational groups involved in early trauma care in a consensus process. RESULTS: Improvement potentials were identified in those areas for which the guidelines did not provide explicit recommendations. These represent the key elements of the algorithm. Pathway-specific review criteria (quality indicators) were defined for scheduled reevaluation. CONCLUSIONS: Implementing clinical guidelines at the local level requires a problem-oriented and management-oriented elaboration towards a clinical pathway as the basis for a quantitative process and cost analysis.

Algorithms↗

PubMed2002

[Pathomorphology, diagnosis and treatment of "hangman's fractures"].

In a retrospective study diagnostic procedures and outcome of treatment were evaluated in 33 patients with traumatic spondylolisthesis of the axis (Hangman's fracture) who were treated in our department between 1986 and 1999. There were 18 men and 15 women with an average age of 41 (17-88) years. The cause of the injury was in 23 cases an accident as a driver of a car, in 2 cases an accident with a bike, 2 patients had an accident as a pedestrian. 5 patients fell on their head and 1 patient was hit by a beam. In 15 cases there were relevant accompanying injuries. To assess the stability of the injury, a subtle radiological examination was performed including functional X-rays. After introduction of the MRI and increasing experience with the method as a standard procedure in clinical practice it was used instead of functional X-rays to get a direct image of the involvement of the discoligamental structures.17 patients with stable lesions were treated conservatively, 15 with a Minerva-cast, 2 with a halo-jacket. One polytraumatized patient had temporary immobilization with a stiff-neck. 16 patients with discoligamental instability C2/3 were treated operatively by Robinson-spondylodesis with additional anterior plating. In one case an additional posterior fusion was necessary. After 6-8 weeks all of the conservative treated patients achieved solid bony consolidation. The patients operated on did so as well within 6 to 8 weeks. Two polytraumatized patients died. 18 of the 31 surviving patients were free of pain. 12 patients complained of pain or tension of the cervical muscles during physical stress. 1 patient suffered of paresthesia of the ulnar left hand. Average duration of hospital stay was 12,9 days (1-47). All working people returned to their job. Differences in the outcome of the conservative and the operative treatment group could not be seen. We derive from these results that Hangman's fractures, mostly caused by a hyperextension trauma, achieve solid bony fusion by conservative treatment in most of the cases. The Minerva-cast has proved its capability. In cases of instable luxation fractures including tearment of the anterior longitudinal ligament and affection of the intervertebral disc C2/3 we suggest operative stabilization. We prefer the modified Robinson-spondylodesis with additional anterior plating which proved its value as a method achieving solid bony fusion combined with low rate of complications.

Adolescent↗

PubMed2002

Rotational digital cholangiography (RDC) and 3D-cholangiography (3DC) for guidance of percutaneous biliary drainage procedures.

PURPOSE: To evaluate whether RDC and 3DC help clarifying anatomic details in biliary duct disease and is useful for guidance of drainage procedures. MATERIALS AND METHODS: RDC was conducted in 11 consecutive patients (8 male, 3 female, mean age 63 years). Nine patients underwent PTBD for malignant biliary duct stenosis, one patient because of ischemic stenosis after hepaticojejunostomy and one patient presented with an infected biloma. Images were obtained after initial bile duct puncture during single breath hold from 120 projection angles using a rotating C-arm. These images were immediately available and evaluated in order to facilitate the definitive drainage procedure. For additional 3D reconstruction, data were sent to a dedicated workstation and judged by a blinded observer. RESULTS: The availability of a rotating data set of images was judged to be helpful in three patients with complex anatomical situations. Additionally, RDC holds the potential to reduce fluoroscopy time. 3DC allowed analysis of the hepatic bifurcation from different viewing angles in 10 cases with high spatial resolution (mean voxel size 480 micro micro m 3). This may allow a better classification of hilar obstructions according to our preliminary observations. CONCLUSION: Images from RDC and 3DC are helpful in guiding PTBD procedures and for better diagnosis in selected patients with hilar biliary duct stenoses.

Adult↗

PubMed2001

Acute colonic diverticulitis: visualization in magnetic resonance imaging.

The incidence of acute colonic diverticulitis (ACD) is increasing. To allow rational therapeutic decisions to be made, a timely diagnosis is required. The feasibility of "on-admission-MRI" to establish the diagnosis has not yet been studied. Therefore, a prospective observational study was carried out in 20 patients with an established diagnosis of ACD. The diagnostic criteria for the MRI diagnosis of ACD were the demonstration of at least one diverticulum, pericolic exudation, and edema of the colonic wall. MRI was diagnostic in all but one patient. It is concluded that MRI has considerable diagnostic potential in ACD and should be formally evaluated.

Acute Disease↗

PubMed2001

Multiplanar reconstructions and three-dimensional imaging (computed rotational osteography) of complex fractures by using a C-arm system: initial results.

With use of a calibrated angiographic C-arm system and a postprocessing workstation, the authors acquired volume data sets from two-dimensional digital projection images obtained during a C-arm rotation around the patient axis. Multiplanar reconstruction and three-dimensional images of complex fractures were reconstructed and compared with spiral computed tomographic studies in a cadaveric pig study and in eight patients. Computed rotational osteography provided high-resolution multiplanar reconstruction and three-dimensional images of complex fractures.

Animals↗

PubMedDate not supplied

Feasibility of C-arm-supported CT fluoroscopy in percutaneous abscess drainage procedures.

PURPOSE: Evaluation of C-arm-supported CT fluoroscopy to facilitate percutaneous abscess drainage procedures. METHODS: Prospectively, 40 percutaneous drainage procedures were performed either with C-arm-supported CT fluoroscopy or with CT fluoroscopy alone. Hybrid imaging was performed on the CT couch after complementing a CT fluoroscopy scanner with a C-arm fluoroscopy unit. Procedure times, drainage revisions during follow-up, and postinterventional drainage periods were analyzed. RESULTS: When compared with exclusive CT fluoroscopic guidance, a median procedure time of 9 +/- 3.7 min versus 14.8 +/- 7.3 min was required for C-arm-supported CT fluoroscopy (p < 0.005, t-test). During follow-up, eight drainage catheters had to be revised within the exclusive CT fluoroscopy group, while only two revisions were necessary within the C-arm-supported CT fluoroscopy group. With C-arm-supported CT fluoroscopy, postinterventional drainage periods were reduced (median 13 vs 19 days; p < 0.001, t-test). CONCLUSION: Compared with exclusive cross-sectional image guidance, C-arm-supported CT fluoroscopy seems to improve placement of abscess drainage catheters to possibly reduce procedure times, drainage catheter revisions, and postinterventional drainage periods.

Abscess↗