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Biomedical subjects

O Trentz

Publications and source records attributed to O Trentz.

At least 19 recordsLinked to original sources
PubMed1992

[How much experience is required for ultrasound diagnosis of blunt abdominal trauma?].

Between July, 1st 1989 and June, 30th 1991, 312 patients were entered into a prospective study concerning the reliability of sonographic evidence in blunt abdominal trauma. There were 231 male and 81 female patients aged between 15 and 88 years (mean: 39.9 years). The sonographic team consisted of one experienced sonographer/surgeon (greater than 4000 examinations) and 3 sonographic beginners (less than 200 examinations at the start of the study). The experienced sonographer and the beginners examined 168 and 144 patients, respectively. Patient distribution to the two groups was done according to the sonographic duty roster without consideration of injury severity. The examination was performed with a mobile ultrasound unit at the surgical intake as part of the primary diagnostic work-up. It consisted of four sonographic views (right and left lateral longitudinal, suprapubic and epigastric transverse view) and took about 2 min. Clinical evidence supporting blunt abdominal trauma could only be found in 64 cases, while in 153 patients physical examination was equivocal due to assisted ventilation or paraplegia. Sensitivity and specificity for the clinical examination amounted to 80.6% and 44.5%, respectively. Sensitivity and specificity for the sonographic finding of intraabdominal liquid were 100% each for the experienced sonographer and 96% and 100%, respectively for the beginners. Organ lesions were demonstrated with a sensitivity and specificity of 45% and 99% by the experienced and 36% and 100% by the beginners. The experienced sonographer misdiagnosed one case of free intraabdominal gas, which could not be corroborated both by clinical and radiological evidence.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1992

[Traumatic rupture of a kidney transplant in chronic lymphocele].

The lymphocele is a seldom complication after kidney transplantation (2.2% of our patients). This manifestation occurs typically 3-4 months after transplantation, as a late complication it's a rarity. The rupture of a kidney graft because of a trauma is unique in our clinical experience, which contains more than 1200 kidney transplantations. We report the case of a 28-year-old man who had 19 years after transplantation a traumatic rupture of the kidney graft. Because of the trauma a preexistent chronic lymphocele got clinically manifest. The histology of the lymphocele wall shows fatty and collagen tissue with a strong fibrosis. The diagnostic and therapeutic procedure is described. There are different possible relations between the rare problems:--the tight lymphocele carries over the force on the graft--the lymphocele has grown together with the graft at the lower pole and ruptures in this place--a little graft rupture makes a clinical manifest bleeding in the lymphocele because the deficiency of perirenal tissue.

Adult↗
PubMed1992

[Multiple trauma: definition, shock, multiple organ failure].

Multiple organ failure (MOF) following major trauma occurs in response to perfusion deficits, a persistent inflammatory focus, or a persistent focus of dead and/or injured tissue. Several pathophysiologic aspects are considered relevant to current clinical practice. Their application in settings of trauma and surgical sepsis reduces overall mortality and incidence of multiple organ failure. With regard to the pathophysiologic background (I) microcirculatory resuscitation, (II) source control, and (III) metabolic support appear to be important therapeutic principles. (I) Microcirculatory Resuscitation: Since time is a critical factor in damage control, resuscitation and restoration of microvascular perfusion needs to occur as soon as possible if multiple system organ failure is to be avoided during the later time course. (II) Source control: The best treatment for multiorgan failure appears to be prevention. With early, aggressive control or removal of risk factors for multiple organ failure, namely early surgical intervention for control of hemorrhage, control of potential septic sources, decompression, and early fracture stabilization reductions in the incidence and mortality of MOF have been observed. Metabolic support: Malnutrition appears to be an important cofactor in morbidity and mortality. (III) Metabolic support needs to be started early and prior to the phenomenon of nitrogen retention during the hypermetabolic state of multiple organ failure.

Humans↗
PubMed1992

[Differences of acute and chronic epidural hematoma].

Standard neurosurgical management demands prompt evacuation of all extradural hematomas to obtain a low incidence of mortality and morbidity. In selected cases some authors have suggested that moderate hematomas can be managed conservatively without risk to the patient and with a normal outcome. The goal of this study was to analyze the differences in preoperative clinical parameters between a group of acute and a group of chronic extradural hematomas (chronic extradural hematoma was defined as a delay of more than 72 h from the accident to diagnosis). One hundred fifteen (115) patients with extradural hematomas underwent a standard evaluation, documentation and neurosurgical management (prompt evacuation of all extradural hematomas through a craniotomy). Ninety-five patients (83%) had an acute extradural hematoma. Twenty patients (17%) had a chronic extradural hematoma. We analyzed the following parameters: age, cause of accident, clinical findings, Glasgow Coma Score, morphology of hematoma, location of hematoma, cause of bleeding and clinical outcome. The mean age (chronic 30/acute 32) and age distribution were not significantly different between groups. There were no differences in the cause of accident. All patients in both groups had skull fractures. There was no difference between groups regarding hematoma location, most of there being located in the temporal fossa. In the group of acute extradural hematomas, 62% of patients had a Glasgow Coma Score of less than 8 and 47% had pupillary dilation. In the group of chronic extradural hematomas, moderate clinical symptoms were found, with headache and discrete psychological changes most common. Eighty percent (80%) of the patients had a Glasgow Coma Score of greater than 13 and no patients had pupillary dilation.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1992

[Callus distraction in traumatology: concepts and indications].

The understanding of the conditions under which bone and soft tissue can be regenerated by distraction has opened a new era in the field of limb reconstruction. Success in lengthening for posttraumatic limb length discrepancy has led to different applications of the distraction techniques. We present an overview of the clinical new possibilities, the strategy, the techniques and the complications using the distraction technique in the trauma patient. The optimal biologic method (limb distraction after resection or callus distraction by a transport technique) and the optimal fixation devices depend on the indication (local aspect, polytrauma, patient, motivation).

Bone Lengthening↗
PubMed1992

[Extended surgical indications in combined shoulder girdle fracture].

The combination of an ipsilateral clavicule and scapula fracture causes a double instability of the shoulder. In opposite to an isolated clavicule or scapula fracture this injury should be treated operatively. Diagnosis of the scapula fracture in polytrauma can be difficult. If there is a clinical or radiologic suspicion, the indication for a CT scan is given. Osteosynthesis with plates from separated approaches, first the scapula from dorsal then the calvicule from ventral has proven good. The nervus suprascapularis must be treated carefully and, if necessary, liberated from the fracture. The optimal treatment of this injury is not always possible in polytraumatised patient.

Clavicle↗
PubMed1992

[Rupture of the Achilles tendon--fibrin gluing or suture?].

The rise of recreational sports activities and the incidence of ruptures of the Achilles tendons has increased simultaneously. Recently the use of fibrin sealing for surgical therapy of ruptured Achilles tendons has emerged as an alternative technique. Between 1982 and 1989 62 consecutive patients were operated for unilateral Achilles tendon rupture. Following causes for ruptures are known: 36 indirect traumas in sport (74%), 9 direct blunt injuries at occupational work (18%), 3 traffic-accidents (11%) and 1 rupture after operation of a Haglund exostosis. 25 patients (56%) were treated by suture technique and 20 patients (44%) with fibrin sealant. The mean long term follow-up of 49 months is known of 49 patients. There were 3 (12%) postoperative infections in the suture group and none in the fibrin group. After suturing the Achilles tendon 3 (12%) reruptures occurred 8-10 weeks after tendon repair and 1 (5%) rerupture after fibrin sealing. All reruptures are caused by a new adequate trauma. The time of return to social and recreational activities was 9 months in the suture group and 7 months in the fibrin group. The functional and cosmetic results after use of fibrin was significant better, and the long-term results were very satisfactory. We prefer fibrin sealing for the treatment of acute ruptures of Achilles tendons.

Achilles Tendon↗
PubMed1992

[Bone segment transport in femoral defects. Animal experiment study].

The aim of our experimental study was to realize the Ilizarov concept using a reamed intramedullary interlocking nail with an internal transport system. In 8 mature dogs a bone defect of 3 cm was performed at the femur. A distally osteotomized bone fragment (length 3.5 cm) was lowered through the bone defect. 4 times we had to exclude the animal from the evaluation. In this case the interlocking nails were broken within 6 weeks. In 3 dogs a regeneration of bone was found in the defect. In 6 dogs a deep infection along the transport system had developed.

Animals↗
PubMed1992

[Surgical management of severe pelvic crush injuries].

Control of hemorrhage and prevention of septic complications are the predominant difficulties associated with severe pelvic crush injuries. According to our experience spontaneous tamponade, external compression (MAST/G-suits), and blind ligation of the hypogastric artery seem to be ineffective, whereas angiography followed by embolization, controlled ligation or vascular reconstruction, packing with scheduled 2nd look reexploration, and rigid fixation of the pelvic ring are recommended to control severe hemorrhage associated with these injuries. Moreover, early repair of bowel and urinary tract lesions, diverting colostomy with rectal wash-out, radical debridement, and open wound care of degloving avulsion injuries appear to be the most important procedures to prevent posttraumatic sepsis. Our pelvic crush trauma protocol is based on 84 consecutive cases treated between 1972 and 1990. In all cases the Injury Severity Score (ISS) was over 40 points, each patient required at least 10 units of whole blood or red cells, the overall mortality rate was 41 out of 84 patients.

Combined Modality Therapy↗
PubMed1992

Reduction by superoxide dismutase of leukocyte-endothelial adherence after liver transplantation.

One hour after orthotopic rat liver transplantation, hepatic microcirculation and adhesion characteristics of leukocytes to the endothelial wall were studied with intravital microscopy. Cold storage for 1 and 8 hours in Euro-Collins solution resulted in reduction of perfused sinusoids to 83% and 48% and a decrease of leukocyte velocity from 417 microns/sec in controls to 311 microns/sec and 269 microns/sec, respectively. Additionally, the number of permanently adherent leukocytes rose from 4% in controls to 33% and 43% after cold storage for 1 and 8 hours. Intravenous injection of the free radical scavenger human recombinant superoxide dismutase (40 mg/kg) during reperfusion resulted in marked improvement of the hepatic microcirculation after both 1 and 8 hours of cold storage (91% and 69% perfused sinusoids; 420 microns/sec and 350 microns/sec leukocyte velocity; p less than 0.05). Furthermore, the percentage of permanently adherent leukocytes decreased to 13% and 28% after 1 and 8 hours of cold ischemia, respectively. These results support the hypothesis that oxygen-derived free radicals contribute to leukocyte adherence and microcirculatory failure after cold liver ischemia and transplantation. Thus, application of oxygen free radical scavengers during liver transplantation procedures might be useful to improve graft function.

Animals↗
PubMed1991

Role of oxygen radicals in tourniquet-related ischemia-reperfusion injury of human patients.

In the current study we evaluated effluent blood from extremities of human patients undergoing reconstructive surgical treatment which is routinely accompanied by upper extremity exsanguination and application of a tourniquet. Following tourniquet release (reperfusion), there were immediate increases in the plasma levels of xanthine oxidase activity, uric acid, and histamine. Xanthine dehydrogenase activity was not detectable. Plasma also contained products consistent with the formation of oxygen-derived free radicals, namely hemoglobin and fluorescent compounds. Our data indicate in humans that ischemia-reperfusion events are associated with the appearance of xanthine oxidase activity and its products in the plasma effluent.

Adult↗
PubMed1991

Microcirculatory disturbances and leucocyte adherence in transplanted livers after cold storage in Euro-Collins, UW and HTK solutions.

Integrity of the hepatic microcirculation and maintenance of endothelial cell viability are critical components in preventing primary non-function after liver transplantation. Therefore, hepatic microcirculation and leucocyte-endothelial interaction were studied in rat livers stored for 1 h in Euro-Collins (EC), University of Wisconsin (UW), and histidine-tryptophan-ketoglutarate (HTK) solutions and subsequently transplanted. One hour after transplantation surgery, the livers were exposed under an intravital fluorescence microscope. After injection of the leucocyte marker acridine orange (1 mumol/kg), six pericentral fields were observed for 30 s and experiments were recorded continuously. The percentage of perfused sinusoids was reduced in the livers in the EC group (82.9%) in contrast to the UW (93.2%) and HTK groups (91.0%). Livers in the EC group showed a reduction in the diameters of pericentral sinusoids (7.3 +/- 0.2 microns; mean +/- SEM) compared with the UW group (9.5 +/- 0.2 microns; P less than 0.05) and HTK group (10.2 +/- 0.8 microns; P less than 0.05), indicating substantial cell swelling in livers stored in EC solution. Permanent adherence of leucocytes was most frequently observed in the EC group (33.5 +/- 1%), while this phenomenon was less pronounced in the UW group (14.5 +/- 1.1%; P less than 0.05) and HTK group (16.3 +/- 0.7%; P less than 0.05). Conversely, temporary adherence of leucocytes was reduced in the EC group (19.7 + 1.3%) compared with the UW group (30.5 + 2.1%) and the HTK group (34.4 + 0.8%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗
PubMed1991

Transferred triage to a level I trauma center in a mass catastrophe of patients; many of them with burns.

Three airplanes were involved in an airshow accident at the Ramstein military airbase on 28th of August 1988 causing immediate 45 dead and approximate 400 injured people. As a Level I Trauma facility we received 47 patients in different state of distress direct from airfield within an hour. The disaster plan was activated and sufficient personal and infrastructure could be mobilized.

Accidents, Aviation↗
PubMed1990

Formation of free radicals and nitric oxide derivative of hemoglobin in rats during shock syndrome.

Free radicals have been postulated to play an important role as mediators in the pathogenesis of shock syndrome and multiple-organ failure. We attempted to directly detect the increased formation of radicals by Electron Spin Resonance (ESR) in animal models of shock, namely the endotoxin (ETX) shock or the hemorrhagic shock of the rat. In freeze-clamped lung tissue, a small but significant increase of a free radical signal was detected after ETX application. In the blood of rats under ETX shock, a significant ESR signal with a triplet hyperfine structure was observed. The latter ESR signal evolved within several hours after the application of ETX and was localized in the red blood cells. This signal was assigned to a nitric oxide (NO) adduct of hemoglobin with the tentative structure [alpha 2+ NO)beta 3+)2. The amount of hemoglobin-NO formed, up to 0.8% of total hemoglobin, indicated that under ETX shock a considerable amount of NO was produced in the vascular system. This NO production was strongly inhibited by the arginine analog NG-monomethyl-arginine (NMMA). The ESR signal of Hb-NO was also observed after severe hemorrhagic shock. There are three questions, namely (i) the type of vascular cells and the regulation of the process forming such a large amount of NO during ETX shock, (ii) the pathophysiological implications of the formed NO, effects which have been described as cytotoxic mediator, endothelium-derived relaxing factor (EDRF) or inhibitor of platelet aggregation, and (iii) the possible use of Hb-NO for monitoring phases of shock syndrome.

Animals↗
PubMed1990

[Indications and technic of external fixation in acute management of polytrauma].

The application of external fixation in the multiple injured patient permits rapid stabilisation of fractures and excellent preservation of soft tissue without an additional systemic load after traumatic shock. Acute fixation in the primary care is achieved by particular constructions for the pelvis and femur and modifications of standard-techniques for the tibia and joint-transfixation. In most cases secondary completions or alterations in the method of treatment are necessary.

Femoral Fractures↗