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Biomedical subjects

O Bach

Publications and source records attributed to O Bach.

At least 19 recordsLinked to original sources
PubMed2004

Disability can be avoided after open fractures in Africa-results from Malawi.

UNLABELLED: In a free-at source hospital in Malawi, East Africa, 55 open fractures were treated within a 3-year period. The majority (33/55) involved fractures of the lower leg. The treatment regimen contained the following: primary external fixation; scheduled sequential debridement; immediate coverage of any bone devoid of periosteum using local muscle or fasciocutaneous flaps, alternatively limb shortening; no skin closure; controlled secondary healing under moist dressings; dynamisation and/or removal of the external fixator followed by functional treatment (Sarmiento and Latta) as soon as the soft tissues permitted. The first 34 consecutive cases were monitored from the time of treatment; 24 of them attended for clinical review at 36 (+/-16) weeks after injury. Only 72% (13/22) patients had reached the hospital within 24h after sustaining the fracture; 80% (18/22) had developed a septic wound infection, which healed in all cases after 20 weeks. At the time of follow-up, recovery of function was found in 20 (80%) of the injured extremities. Only three patients (12%) remained disabled due to the open fracture, one other patient died during treatment from tuberculosis secondary to AIDS and one patient required knee disarticulation. CONCLUSION: If the biological principles guiding the contemporary treatment of open fractures in the first world are respected, results under third world conditions do not differ as much as the differences in setting might suggest. The application of recent advances of global knowledge in trauma surgery into methods of treatment appropriate to the health care systems of highly resource constraint countries remains a rewarding task for modern trauma surgeons and their scientific community.

Developing Countries↗
PubMed2004

Musculo skeletal trauma in an East African public hospital.

The contribution of musculo skeletal trauma to morbidity and disability in developing countries is often underestimated. As Head of Department of Surgery and Orthopaedics for 3 years at a non-paying hospital in Malawi/East Africa (one of the least developed countries according to UNDP), I analysed my operation log book of 658 cases. Although there are many specific and local factors influencing the picture, the main problems of trauma care in rural Africa become evident. Based on personal experience views on non-operative versus operative fracture treatment, indications, quality control and training are presented. First world standards, equipment and implants of yesterday are often the only ones available but they scarcely meet the demands of clinical practice in developing countries. Contemporary state-of-the-art knowledge lacks most of its material basis to be successfully introduced. However, transforming it into "appropriate technologies" is most rewarding not only for the individual trauma surgeon, but for the wider community within orthopaedics.

Developing Countries↗
PubMed2003

[Locking plate osteosynthesis for fractures of the proximal humerus].

BACKGROUND: Beside non-operative treatment the therapeutic options for proximal fractures of the humerus range from closed reduction and transcutaneous K-wiring to total joint replacement. While the first is regarded as minimally invasive the latter is a rather complex intervention. Plating has been disregarded as combining the disadvantages of an extended approach with too often insufficient primary postoperative stability. The new concept of completely angle stabile plate fixation aims on improving this balance by achieving greater stability even in osteoporotic fractures. STUDY DESIGN: This retrospective analysis compares 51 patients treated with a partially (39) or complete (12) angle stabile humeral plate (Königseeplatte in two modifications) with 32 patients treated according to surgeons preference with conventional plates or K-wires. Both groups were treated at the same department during the same period and did not differ in their age nor sex distribution. RESULTS: Until discharge there were 2 secondary dislocations discovered in group 1 and 7 in group 2. The follow-up rate was 47.1 % (24/51) in group 1 and 46.8 % (15/32) in group 2. The time interval from surgery amounted to 1.2 (0.66-1.75) and 1.0 (0.72-1.32) years respectively. Among the patients available for follow-up in group 1 8 had sustained a two-, 8 a three- and 3 a four-part fracture according to Neer's classification. In group two there were accordingly 2 two-, 8 three- and 1 four part fractures. Clinical assessment using Neer's score revealed an average of 71,8 (63.9-79.8) points in group 1 and 67.6 (47.3-78.7) in group 2. When the results of Neer's scores were expressed in percentage of the unaffected arm a mean of 73.6 (65.6-81.8) in group 1 and 69.3 (51.8-86.9) was obtained. The only statistically significant difference was observed within the sub-group of three-part fractures: treated by angle stabile plates (group 1) these patients (n = 8) achieved a mean Neer-Score of 81 (77-86) compared to 68 (52-84) (n = 8). In group 1 70.8 % of patients followed-up presented an "excellent" or "good" result according to Neer's criteria, in group 2 60 % did so. CONCLUSION: We conclude from our first experience with angle stabile plates for fractures of the proximal humerus that particularly in three part fractures this method might improve functional outcome and is worth further consideration and testing.

Aged↗
PubMed2002

[Late results following avulsion injuries of the thumb].

Out of the 127 amputated thumbs replanted at our unit during the last 15 years, there were 27 avulsion injuries. The average age of the 24 male patients was 33 years, that of the three female patients was 34 years. 70 % of the injuries were occupational accidents. Among the 27 patients, 21 had a complete and six an incomplete avulsion of the thumb. The level of avulsion-amputation was at the MP-joint ten times, between MP and IP joint ten times and at the IP-joint seven times. The healing rate of the subtotally avulsed thumbs was 100 %, that of the completely amputated thumbs 36 %. The most important post-operative complications observed were venous and secondary arterial thrombosis, whereby most of them occurred within the first 24 hours after replantation. The duration of ischaemia had a significant influence on the healing rate. In 80 % of the cases reconstruction of nerves have been carried out secondarily. A two-point discrimination was achieved in two cases only. The osteosynthesis was done almost exclusively with K-wires. Ten of 19 patients had to change their profession, while nine of them were able to return to their previous jobs, which in these cases were pre-dominantly white collar jobs. Another patient went for early retirement (he was a painter). All 19 patients followed-up had a range of movement of their saddle joints which was sufficient for the needs of most of the activities of daily life. Stiffness of the MP and IP joints was a common finding but had little functional impact, as it has been reported by other authors previously. We conclude from the results presented that in cases of avulsion injury of the thumb replantation is a procedure with significant chances of success.

Accidents, Occupational↗
PubMed2002

[Microvascular complications following replantations and revascularisations].

PURPOSE/BACKGROUND: What are the options for early diagnosis, treatment and prevention of the occlusion of microvascular anastomosis after replantations? METHOD AND (CLINICAL) MATERIAL: This is a retrospective analysis of 336 cases involving primary microvascular repair after an injury between 1984 and 2000. In 272 cases this was a revascularisation and in 187 a replantation. In 23 cases the vascular anastomosis was located proximal to the wrist (macroreplantations) and 313 times distal to it (microreplantations/-revascularisations). RESULTS: Vascular complications developed in seven and 54 cases respectively. 40 % of these 61 patients showed a severe soft tissue compromise or/and had sustained an injury known to cause widespread intima lesions (15 avulsions, six crush injuries, one blast, one gun shoot, one RTA). 37 of the 61 patients had been injured by circulating saws. There were 34 arterial and 22 venous occlusions, four no-reflow-syndromes and one HIT-syndrome. Almost 90 % of these vascular complications occurred within the first four post-operative days, 50 % even within the first 36 hours. Treatment was surgical in 39/61 cases and conservative 22 times. In 55 % (33/61) of all cases this treatment was successful. CONCLUSION: With an overall incidence of 1 : 6 vascular crisis is not only the most consequential but also the most common post-operative complication after replantations. Timely operative and/or non-operative therapeutic measures can save more than half of the replants affected.

Amputation, Traumatic↗
PubMed2001

[Concepts of the German Society of Tropical Surgery].

The DTC promotes access to surgical care facilities of acceptable medical quality for all people in third world countries. To achieve this goal following concepts and activities are persued: Establishment of a 2-year training programme district surgery Postgraduate surgical training in Germany Workshops and annual scientific meetings Development of adapted surgical technologies Cooperation with national and international organisations Promotion of north-south partnerships between colleagues and hospitals.

Curriculum↗
PubMed2000

[Standardized documentation system for the complementary sector of psychiatric care. Development and trial in Saxony].

The necessity for a standardized documentation system for the complementary sector of psychiatric care is pointed out, and the goals and requirements to be met are debated. The test-version of such a documentation system (abbrev. BADO-K) is shown. It consists of modules for the assessment of client-centered data, and for the documentation of the treatment process in various facilities. Furthermore, a module of questionnaires and instruments for assessing outcome variables (e.g. quality of life) is integrated. The principles for using the paper-pencil-version and the EDP-version are outlined and discussed with regard to the legal regulations concerning the protection of personal data. Finally, possibilities and limitations of the presented documentation system are discussed. It is argued that the BADO-K is an useful instrument for evaluating the process and outcome of community psychiatric care.

Community Mental Health Services↗
PubMed1999

[Changes in regional cerebral perfusion in depression.SPECT monitoring of response to treatment].

The objective of this study was to investigate the relationship between the effect of sleep deprivation, recovery and regional brain perfusion in patients with major depression. Regional cerebral blood flow was assessed by 99mTc-HMPAO-SPECT before and after sleep deprivation in fourteen medicated patients. Three of the patients underwent a follow-up measurement after clinical recovery and with an unchanged antidepressant medication. Before sleep deprivation the responding patients had a significantly higher anterior cingulate perfusion than the nonresponding patients, that normalized after sleep deprivation. Cingulate perfusion uniquely differentiated eventual treatment response from non-responders, as perfusion in no other region under study discriminated the two groups. At baseline all patients revealed hypoperfusion in the left prefrontal cortex when compared to the right side, which was not affected by sleep deprivation, whereas prefrontal hypoperfusion was reversible upon remission. These findings are in agreement with previous PET investigations and provide evidence for cingulate and prefrontal dysfunction associated with depression, that are reversible by successful treatment and may represent state markers.

Brain↗
PubMed1999

[Development of a standardized documentation system for outpatient non-hospital based psychiatric care].

An instrument documenting the care process in in-patient psychiatric services within the German mental health care system has been developed (BADO). This paper reports on the development of a documentation system for all non-hospital based mental health services (day centres, community mental health centres, supported accommodation, work rehabilitation services for general adult psychiatric patients and people with substance misuse). The development process and the instrument (PC and paper and pencil version) are described. The documentation system (BADO-K) could be an important prerequisite for quality assurance in non-hospital based mental health care, and its structure ensures compatibility with the corresponding hospital-based documentation system.

Adult↗
PubMed1998

[Service expectations facing Saxony's newly established social psychiatric services. Attitudes of established neurologists, physicians in psychiatric clinics and social psychiatry service staff].

In the wake of the disintegration of the policlinical system which had prevailed in the former German Democratic Republic, far-reaching restructuring has become necessary in the "new" German laender in the field of complementary psychiatric care. Establishment throughout the state of Saxony of a uniform outreach-based ambulatory service ranks as a first component towards building regionalized community psychiatric networks. In light of some twenty years of experience in the old laender, this function is considered a task of the Social Psychiatric Services ("Sozialpsychiatrische Dienste", SPDIs). The present study had been directed at a state-wide investigation of the expectations community-practice psychiatrists (n = 165), physicians in psychiatric clinics (n = 95) and staff working in SPDIs (n = 138) in Saxony hold regarding service programmes and operating methods of these newly established service delivery structures. Given the high return rates in this anonymous postal questionnaire study, the findings presented are considered near-representative. A concurrent finding for all of the groups interviewed, expectations concerning the client population to be serviced by the SPDIs focus on the group of persons with chronic mental illness. Also, the expectations expressed concerning major care/therapeutic services to be rendered by the SPDIs concur in their emphasis on a core area of immediately client-oriented SPDI activities. Between the two medical groups, a major difference found is that community-practice psychiatrists more frequently expect high SPDI commitment regarding sociotherapeutic programmes at an institutional level, whereas clinical physicians expect them to focus on taking over medical therapies in the narrower sense. The expectations SPDI staff hold relative to the therapeutic services to be rendered by themselves go beyond the scope of what has so far been implemented in their current activity, and qualitative content analyses are presented in the article for each of the areas concerned. Along with better staffing levels, removal of in-service organizational and further education deficits are identified by SPDI staff as the two main requirements for stabilizing their operations. In order to counter undue burdening of the SPDI with service expectations and to enable a more clear-cut positioning of its programme structures within a complex psychosocial service delivery system, it is necessary--at least in the state of Saxony--that further needs-oriented establishment and/or extension of community-based psychiatric services and agencies take place.

Attitude of Health Personnel↗
PubMed1997

[Expectations and service performance of social psychiatry services in free Saxony. An analysis of viewpoints of psychiatric practice and clinical specialists and coworkers of social psychiatric services].

After the "Polyclinic system" that had predominated in the GDR had been dismantled, a far-reaching restructuring of the complementary psychiatric care sector became necessary. In the State of Saxony, comprehensive establishment of a homogeneous home-visit outpatient service is the first building block in an interlinked system of regionalized community psychiatry. Based on about 20 years of experience in the Federal States of the FRG, this function is fulfilled by social psychiatry services (SPS). The present study investigates the expectations of free-practising psychiatrists (n = 165), doctors in psychiatric hospitals (n = 95) and staff of social psychiatry services (n = 138) throughout the State of Saxony in respect of available care and the way these new care structures work. The results are approximately representative owing to the high rate of responses in an anonymous postal survey of three specified groups (48.5%, 67.4%, 84.0%). All the groups surveyed expected that the clientel to be looked after by SPS will chiefly consist of the group of chronically mentally ill persons. Moreover, the consistently expressed expectations as to the central care/therapy to be provided by SPS can be summarised as the core of directly client-oriented SPS work. This consists of the elements "welfare work", "individual and institutionalised social therapy", and "help in administrative measures". The main differences between the two groups of doctors is that free-practising psychiatrists more often expect a large SPS involvement with regard to social therapy provided at an institutional level, whereas hospital doctors expect this with regard to medical therapies in the strict sense. Hospital doctors have greater expectations that SPS will also fulfil further functions: work with relatives, public relations, establishment of a crisis service and running self-help groups. The expectations of SPS staff with regard to the therapy they should provide themselves exceed what has already been currently achieved in all sectors. A detailed analysis of contents is also presented in this article. Besides improved staffing, SPS employees state that eliminating internal organisational and postgraduate training deficits are two major requirements for stabilization of their work. Appraisals of the quality of care for the chronically mentally ill in the outpatient complementary sector requested by hospital doctors and SPS staff in comparison with former provision structures in the GDR, show deterioration in the economic security of patients as well as of possibilities available in occupational rehabilitation. On the other hand, there are some improvements in the training of specialist staff whereas protection of the personality rights of patients as well as care measures are now free from ideological bias. These are crucial prerequisites for an update individualised, need-orientated therapeutic procedure. To counteract overburdening of the SPS with expectations of care and to enable a more unequivocal positioning of its structure in a complex system of psychosocial care, further need-orientated development and establishment of psychiatric facilities close to the community concerned, are urgently required, a least as far as the State of Saxony is concerned.

Ambulatory Care↗
PubMed1996

[Functional fracture treatment of the upper arm].

Using a functional brace, we treated 67 patients who had a fracture of the humeral shaft over a 5-year period from 1987 to 1992. We analysed several parameters of the fractures to discover those which influence healing. Desault, plaster cast or traction were used before applying a brace in an average time of 15 days. The osseous consolidation was 10 weeks in the average. The functional results were very good and good in 78.3%, acceptable in 18.3% and poor in 3.4% of the cases. Twelve humeral-shaft fractures were associated with a radial nerve palsy. Every patient recovered a full radial nerve function under the treatment with a functional brace. The retentive management of an operative treatment of humeral-shaft fractures associated with a nerve injury can be supported because of our experience.

Adult↗
PubMed1994

[Suicide incidence and suicide methods in Saxony 1830-1990].

One of the highest rates of suicide occur in German-speaking countries and particularly in Saxonia. There are grounds for the assumption that the fact has been caused by a careful recording of suicides in this country since 1829. The paper describes the development of rates of suicide and the changes of the suicidal methods in Saxonia during the last one-hundred- and -fifty years with regard to age and sex.

Adolescent↗
PubMed1993

[Compulsory sterilization and euthanasia--on the origins of a development that lead to the Fascist management of psychiatric patients].

When discussing and dealing with the way things went with German psychiatry during fascism the question arises constantly as to the scientific and theoretic self-interpretation of a specialist discipline that allowed itself to be misused without offering much resistance, if at all. The article makes an attempt to trace a few paths of specialist ideology at the turn of the 19th to the 20th century. The misuse of psychiatry and by psychiatry that has been practised both in the past and in the present cannot be understood if the guiding concepts of science generally ruling at the time are ignored.

Euthanasia↗
PubMed1990

[Neuroleptic malignant syndrome--3 case reports].

An account is given of three patients who exhibited a malignant neuroleptic syndrome after the administration of neuroplegics. Like other authors, we identified typical elicitation factors and clinical characteristics. In one case a catatonic dilemma with lethal issue was observed. In the final case dealt with in this paper, the renewed application of neuroplegics following the termination of the malignant neuroleptic syndrome was tolerated without complications, whereas in the case of an epileptic patient with damage to the brain, the malignant neuroleptic syndrome returned upon dosage increase.

Adolescent↗
PubMed1990

[Life stress events preceding illness episodes in multiple sclerosis and ulcerative colitis--a comparison].

As to the prevention of somatic and psychosomatic diseases it should be tested, whether life-events are of interest to pathogenesis of disturbances like multiple sclerosis and ulcerative colitis. The social readjustment rating scale (Holmes, Rahe) was used and the life-change-unite-score of the groups of patients (n = 30) and a normal population was compared. Patients with m.s. and u.c. have a significant higher LCU-score than the normal group. Between the two diseases one can find no difference.

Colitis, Ulcerative↗
PubMed1988

[Use of psychological pain-control technics in psychiatry].

In recent years the initial attempts at algotherapy employing the predominating forms, such as medicinal treatment, electrotherapy, and operative treatment, have greatly improved the care of patients suffering pain. Psychological pain control techniques are a further feasible means of treatment. They include cognitive and behavioral intervention techniques in part already well known that can accompany and enhance traditional forms of anodyne therapy. By way of example, the concept of "pain inoculation" (Bullinger & Turk, 1982) is described in its sequence of phases. Methods of application in clinical practice are referred to.

Behavior Therapy↗