[Diagnostic management of children with craniocerebral trauma].
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
P Biberthaler
Publications and source records attributed to P Biberthaler.
[Tension pneumopericardium--a rare complication in multiply injured patients].
Thoracic injury is a relevant and common complication in multiply injured patients. Typical patterns of injury comprise rib fractures, serious lung trauma as well as diaphragmatic and aortic rupture. In contrast, posttraumatic tension pneumopericardium following blunt thoracic trauma is a very rare complication. However, if unrecognized it might provoke cardiac tamponade and death. For the development of a pneumopericardium, free air follows the vessel bundles up to the pericardium. Hence, if the number of ruptured alveoli is high, or these alveoli are placed close to the heart, and if additional risk factors, such as high inspiratory ventilation pressure, are present, a tension pneumopericardium can induce cardiac tamponade. The aim of this report is to illuminate diagnostic and therapeutic strategies for posttraumatic pneumopericardium by presentation of a case from our trauma centre and a critical discussion of the present literature.
Humans↗
[Estimation of surgical treatment capacity for managing mass casualty incidents based on time needed for life-saving emergency operations].
The surgical treatment capacity of a hospital constitutes a significant restriction in the capability to deal with critically injured patients from multiple or mass casualty incidents (MCI). With regard to the time needed for life-saving operative interventions there are no basic reference values available in the literature, which can aid in detailed planning for management of mass casualty incidents. The data of 20,815 trauma patients, recorded in the trauma registry hosted by the German Association for Trauma Surgery DGU, were analyzed to extract the median duration of life-saving surgical interventions carried out in an operating theatre. Inclusion criteria were an ISS > or = 16 and the performance of relevant ICPM coded procedures within 6 h after trauma room admission. Orthopedic procedures as well as the placement of ICP catheters and chest tubes or performance of laparoscopies were not included. Complete data sets with the required variables were available from 9,988 trauma patients with an ISS > or = 16, and included 7,907 interventions that took place within 6 h after hospital admission. From among 1,228 patients 1,793 operations could be identified as relevant life-saving emergency operations. Acute injury to the abdomen was the major cause accounting for 54.1% of all emergency surgical procedures with a median intervention duration of 137 min followed by head injuries accounting for 26.3% with a median duration of 110 min. Interventions in the pelvis amounted to 11.5% taking an average of 136 min, 5.0% were in the thorax requiring 91 min and 3.1% major amputations with 142 min. The average cut to suture time for all emergency surgical interventions was 130 min. A prerequisite for estimating the surgical operation capacity for critically injured patients of an MCI is the number of OR teams available during and outside of the normal working hours of the hospital. The average operation time of 130 min calculated from investigation of 1,793 emergency life-saving surgical procedures provides a realistic guideline. Used in combination with the number of available OR teams the prospective treatment capacity can be estimated and projected into an actual incident admission capacity. The identification and numerical value of such significant variables are the basis for operations research and realistic planning in emergency and disaster medicine.
Critical Care↗
[The presence of family members in the trauma room].
The fate of multiple trauma patients is witnessed by a considerable number of relatives. Although numerous studies report that the patient's course and treatment success are dependent on the family's confidence as well as its clarification over the clinical situation, scientifically based guidelines for contact with relatives in the context of acute care following severe traumatic injuries do not yet exist. The current guidelines of the European Resuscitation Council recommend the concept of "on scene" presence for the integration of the relatives into acute care in situations of circulatory and heart failure, thus recommending the presence of relatives during acute medical care. This article discusses this concept and argues for a possible assignment of management of trauma care for severe and gravely injured patients.
Attitude of Health Personnel↗
[Treatment of proximal humeral fractures with the PHILOS angular stable plate. Presentation of 225 cases of dislocated fractures].
BACKGROUND: Proximal fracture of the humeral head is the third most frequent fracture in humans. Most (70%) of those affected are over 60 years old. It is hoped that advanced locking medullary screws or plates will reduce the risk of secondary dislocation of screws or fracture segments when the bone of the humeral head is osteoporotic. METHODS: From January 2002 to August 2005, 225 displaced humeral head fractures in 223 patients aged on average 66+/-15 years were treated with a new locking proximal humeral plate. RESULTS: In 176 patients in whom follow-up was possible, the average Constant Score after 9 months was 70+/-19 points (raw data), or 81+/-22% in the normalized score. No significant difference was detected between the younger group up to 65 years of age (73% points) and those over 65 years of age (80% points). Axial deviations by more than 30 degrees were noted in 11 (5%), and of 159 displaced tubercles, malreduction by more than 5 mm was noted in 14 (9%). Two infections and two haematomas had to be treated so far. Primary screw perforations were seen in 24 (11%) cases as well as further implant dislocations in 3 (1,7%). Plate dislocations out of the shaft existed in 4 (2,4%) and 14 collapses of the humeral head with secondary screw perforations were recorded. All other complications arose out of technical faults, such as 24 screw perforations (11%) into the glenohumeral joint and 3 (1.7%) cases of secondary implant dislocation from the humeral head and 5 (3%) from the shaft, and 14 (8%) sinterings with glenohumeral screw perforation. So far, in addition to 1 case of pseudarthrosis with a broken plate, 5 (3%) cases of total and 9 (5%) of partial avascular humeral head necrosis have been observed. CONCLUSION: The new implant provides superior stability in the fixation of humeral head fragments and has proved its worth in everyday clinical practice when additional indirect fixation of the tubercle is needed, as it frequently is in elderly patients.
Aged↗
Cerebral perfusion pressure for prediction of recurrent intracranial hypertension after primary decompressive craniectomy.
BACKGROUND: Decompressive craniectomy (DC) with dural grafting may be performed in patients with moderate (Glasgow-Coma-Scale [GCS] score 9-12 points) or severe traumatic brain injury (TBI; GCS score <or= 8 points) and threatening herniation. However, its effectiveness especially after primary craniectomy is still discussed due to missing evidence of improved outcome. The objectives of this study were to show the incidence of recurrent intracranial hypertension after primary DC, to identify predictive parameters for secondary DC, and to evaluate the long-term neurological performance 12 months after TBI. METHODS: Between 01/1997 and 06/2001 all consecutive patients admitted with moderate or severe isolated TBI were enrolled in this study. They were treated according to the guidelines of the European Brain Injury Consortium, and the American Association of Neurosurgical Surgeons (AANS) for the management of severe TBI. Process and clinical data as well as every intervention were registered prospectively. The long-term neurological status was reassessed using the Glasgow Outcome Score (GOS) 12 months after TBI. Statistical comparison was performed using Mann-Whitney-U test, and multivariate testing by means of logistic regression analysis. RESULTS: Fifty-one (43 males, 8 females; median age 51.4 years) of 119 isolated TBI patients were included. Ten patients (8 males, 2 females; median age 38.4 years) underwent secondary extended or contralateral DC in their clinical course. Three of them (30%) died at a median of 1 day after revision respectively 6 days after TBI. According to univariate analysis, secondary DC significantly correlated with arterial hypotension (p = 0.020) and otorrhagia at admission (p = 0.041), skull base fracture (p = 0.011) and decreased maximum cerebral perfusion pressure (CPP; p = 0.006) after primary surgery. Multivariate analysis identified decreased maximum CPP as the only independent predictive parameter (p = 0.036) for secondary DC and unfavourable GOS after 12-months follow-up. CONCLUSION: Arterial hypotension, otorrhagia at admission and skull base fractures are negatively influencing the mortality and morbidity of patients with isolated moderate or severe TBI. However, only decreased maximum CPP may independently indicate secondary DC after primary craniectomy in case of recurrent intracranial hypertension.
Adult↗
[Osteoporosis in traumatology. Prevalence and management].
BACKGROUND: A fracture occurring in osteoporosis is a sentinel event but very rarely leads to bone mineral density (BMD) measurement or sufficient drug therapy. We designed an algorithm to evaluate BMD in older fracture patients and tested it for sustainability as well as acceptance among trauma/orthopedic surgeons. METHODS: For a 1-year period a prospective BMD test was carried out in women older than 50 and men older than 75 years of age with fractures. The commencement and conduction of therapy during the initial hospital stay and rehabilitation were also analyzed. RESULTS: From 228 members of the eligible age groups, 169 patients (74.1%) underwent BMD measurement. According to the WHO definition 71.6% showed reduced BMD in terms of osteoporosis and 24.3% in terms of osteopenia. In 84% therapy was started during initial hospital stay in 74.4% conducted during rehabilitation. CONCLUSIONS: The vast majority of older patients exhibited reduced BMD as a substantial underlying cause of their fracture. A standardized clinical plan can help to identify and treat most patients with fragility fractures.
Aged↗
[Identification of high-risk patients after minor craniocerebral trauma. Measurement of nerve tissue protein S 100].
The indication for an initial cranial computed tomography (CCT) in minor head trauma (MHT) patients remains the subject of discussion. The aim of this study was to investigate whether a newly developed, rapid test system (ELECSYS S100, Roche Diagnostics) might allow a diagnostically valid, reproducible measurement of S 100 in MHT patients. Blood samples were drawn from 75 MHT patients, a CCT scan was performed, and those with a post-traumatic intracranial lesion counted as CCT+. Results were compared to a healthy control group (n=17). Of the 75 patients included in the study, 14 were stratified as CCT+. The systemic concentration of S 100 in these CCT+ patients was significantly increased (0.31 microg/l) compared to the healthy control group (0.04 microg/l) as well as to the CCT-negative patients (0.08 microg/l). The ELECSYS S100 system allows a rapid, valid, and reproducible assessment of S 100B in patient serum and this concentration is significantly elevated in patients suffering from intracranial lesions as shown by initial CCT scan. Hence, this study is the basis for a multicenter trial currently underway to confirm the results of our pilot study.
Adult↗
[Chronic circumferential aortic dissection with intimo-intimal intussusception].
A circumferential aortic dissection with so-called intimo-intimal intussusception is a very rare complication of a dissecting aneurysm, in which the sock-like intimal flap is upended in the true lumen by the blood stream. The few cases reported thus far are based on radiological or intraoperative findings in acute dissections. The present postmortem study documents the very rare case of long-term survival of a chronic circumferential dissection with intimo-intimal intussusception.
Aortic Dissection↗
Evaluation of murine liver transmission electron micrographs by an innovative object-based quantitative image analysis system (Cellenger).
BACKGROUND: Transmission electron micrographs are widely used to demonstrate tissue damage. However, the results are qualitative and dependent on the experience of the investigator. Recently, a new multiscale object-based quantitative image analyzing systems (Cellenger) has been introduced to study highly textured black-and-white images. It is unknown, whether this system permits the quantitative image analysis of electron micrographs of parenchymal tissue. Therefore, we analyzed whether the Cellenge system permits the quantitative evaluation of electron micrographs of murine liver under normal conditions and after ischemia-reperfusion injury. The results were compared with those obtained by conventional qualitative classification. - METHOD: Transmission electron micrographs from murine liver that had been exposed to isolated reversible ischemia at hypothermic conditions of 4 degrees C, 15 degrees C, 26 degrees C and 37 degrees C, and of sham-operated animals, which served as controls (2 images per animal, n = 3 in each group), were analyzed qualitatively by an investigator with experience in electron microscopy. For quantitative analysis, the Cellenger was used and the following damage parameters were studied: ratio of area of endothelial cell nucleus to area of endothelial cell (N/C ratio), ratio of area of hepatocellular vacuoles to area of total hepatocyte cytoplasm (V/C ratio) and ratio of area of microvilli in the space of Disse to area of the sinusoids (M/S ratio). All values were sampled within one group (n=6) and the data given in [%] (MW +/- SEM). P-values were accepted as significant below 0.05. RESULTS: After normothermic ischemia, all quantitative damage parameter were significantly altered as compared to sham-operated animals (N/C 15 +/- 9% vs. 37 +/- 7%, V/C 18 +/- 4% vs. 0, and M/S 0 vs. 10 +/- 1%) and all hypothermia groups. The qualitative electron micrograph section analysis corresponded very well with these results. CONCLUSION: We demonstrate that an multiscale object-based quantitative analysis of transmission electron micrographs from mouse liver under control conditions and after I/R provide accurate classification of relevant tissue damage parameter. The system is now ready to use for further applications within the field of highly textured electron micrographs.
Animals↗
[Secondary decompression trepanation in progressive post-traumatic brain edema after primary decompressive craniotomy].
Besides evacuation of epidural or subdural hematoma, early decompressive craniectomy with duraplasty has to be performed in the neurotraumatological care of patients with moderate [Glasgow Coma Scale (GCS) score 9-12 points] or severe traumatic brain injury (TBI; GCS score </=8 points) and threatening herniation. The efficacy of secondary decompressive craniectomy and duraplasty after primary trepanation is under debate due to missing evidence of improved outcome. The objectives of this study were to register the incidence of increasing brain edema after isolated TBI and primary craniectomy, to identify possible decision criteria for secondary decompressive trepanation, and to evaluate the neurological performance 6 months after discharge with the Glasgow Outcome Score (GOS). Of 131 patients who suffered from isolated TBI and had to be primarily operated between January 1997 and December 2001, 58 (male:female = 48:10; median age of 50.9 years) were included in this analysis. In 11 patients (male:female = 9:2; median age of 40.0 years) a secondary unilateral extensive or contralateral decompressive craniectomy had to be performed in the clinical course. Four of the 11 patients (36.4%) did not survive TBI; they died at a median of 1 day after revision or 6 days after TBI, respectively. In the group of secondary decompressive craniectomy we recorded admission (80.0 min after TBI) 35 min later ( p=0.009) than in the group of primary trepanation. Prehospital otorrhagia was observed more frequently ( p=0.036). In univariate analysis, arterial hypotension ( p=0.018) and otorrhagia at admission ( p=0.035), intracranial pressure (ICP) immediately after primary operation ( p=0.024), and decrease of maximal postoperative cerebral perfusion pressure (CPP; p=0.031) below the median cutoff value of 70 mmHg correlated with the event of secondary decompression craniectomy. Multivariate analysis identified decreased maximal CPP after primary trepanation as the only independent prognostic parameter (score 10.496; df=1; p=0.043) for the necessity of secondary trepanation and unfavorable GOS 6 months after discharge. In patients with isolated moderate or severe TBI, prehospital arterial hypotension as well as otorrhagia negatively influenced the mortality and morbidity. Therefore, early adjustment of arterial hypotension and the rapid transport into a neurotraumatological center are to be required for prehospital management of TBI patients. The decrease of maximal CPP below 70 mmHg despite administration of catecholamines representing the only independent prognostic parameter during monitoring in the intensive care unit seems to indicate the necessity of an operative revision as well as an unfavorable GOS 6 months after discharge.
Adult↗
Noninvasive in vivo assessment of the pancreatic microcirculation: orthogonal polarization spectral imaging.
INTRODUCTION: Capillary perfusion failure of the pancreatic microcirculation is characteristic in the pathogenesis of acute pancreatitis and ischemia-reperfusion damage after pancreas transplantation. Up to now, no logistic suitable method for analyzing pancreatic capillary perfusion during operations in humans has been established without the use of fluorescent dyes. AIM: To compare the well-established technique of intravital epifluorescence microscopy with the novel noninvasive method of orthogonal polarization spectral (OPS) imaging for measurement of the pancreatic functional capillary density. METHODOLOGY: In eight anesthetized rats, six identical capillary regions of interest per animal were measured by both methods, and the results were compared. RESULTS: Absolute values from the capillary perfusion data were not significantly different between the two methods (fluorescence microscopy: 394 +/- 44 cm/cm2; OPS imaging: 385 +/- 45 cm/cm2). Correlation parameters were significant, and Bland-Altman analyses showed good agreement with a mean difference (bias) between the two methods of 6.9 cm/cm2, indicating that slightly smaller values are measured with OPS imaging. CONCLUSION: OPS imaging is a valid noninvasive method that analyzes the pancreatic microcirculation as accurately as the established intravital microscopy technique and therefore could be useful for clinical research and diagnosis during transplantation and operations.
Animals↗
Rapid identification of high-risk patients after minor head trauma (MHT) by assessment of S-100B: ascertainment of a cut-off level.
BACKGROUND: Elevated blood S-100B levels were described by several authors for reliable identification of patients with intracerebral complications after minor head trauma (MHT). Yet, test systems used so far require more than 3 hours processing period which is too long to enable immediate further diagnostic or therapeutic consequences. Therefore we validate a new rapid test version for S-100B measurements and established an effective cut-off level to identify high risk patients. METHODS: 104 patients suffering from MHT were enrolled. After taking blood samples S-100B values were achieved by the long-term and rapid (40 min processing time) test system, respectively, and compared using linear regression analysis. For determination of an effective cut-off level receiver operating characteristics curves were calculated in accordance with cranial computed tomography findings. RESULTS: S-100B concentrations correlated significantly using both test systems. A cut-off level of 0.18ng/ml was calculated in plasma samples. CONCLUSIONS: S-100B concentrations above the cut-off level measured within 40 min after blood sampling allows safe identification and immediate treatment of intracerebral lesions (e.g. epidural and subdural hematoma, subarachnoid hemorrhage, diffuse brain edema etc.) in MHT patients.
Blood Chemical Analysis↗
[Teutschländer disease. A rare benign differential diagnosis in proliferating space-occupying lesions of soft tissues].
Tumoral calcinosis is a very rare benign soft tissue calcification. It occurs in all age-groups and prefers the shoulder, hip and elbow region as localisation. In most cases, local pain is the leading symptom. The aetiology remains unclear, so far, however, a certain connection to an imbalance of the calcium-/phosphate homeostasis is proposed. The adequate therapy is the complete surgical removal. Our presented case describes an extended occurrence at an unusual localisation and discusses characteristic signs in contrast of the differential diagnoses.
Aged↗
Orthogonal polarization spectral imaging versus intravital fluorescent microscopy for microvascular studies in wounds.
The aim of this study was to validate orthogonal polarization spectral (OPS) imaging against intravital fluorescence microscopy (IFM) for microvascular measurements in normal skin and during wound healing. Experiments were performed on the ears of hairless mice (N = 8). The diameter of arterioles and venules, red blood cell velocity in venules, and the functional capillary density were assessed under normal conditions using OPS imaging and IFM. After creation of a circular wound, these observations were repeated at the identical microvascular regions on days 4, 7, 10, and 15. Images were videotaped, and CapImage was used for off-line computer-assisted analysis. Using OPS imaging, the microcirculation of wounded skin in hairless mice could be observed successfully. The regression analyses against standard IFM revealed a significant (p < 0.001) correlation for measurements of all microcirculatory parameters investigated (venular diameter: r(2) = 0.98, N = 345; red blood cell velocity: r(2) = 0.51, N = 326; functional capillary density: r(2) = 0.44, N = 156). However, for diameter as well as for functional capillary density measurements, OPS imaging yielded lower absolute values compared with IFM. The authors were able to validate OPS imaging against IFM for the measurement of microvascular parameters in an animal model of skin wound healing. Such a device should now help to study the role of microcirculation in physiology and pathophysiology during wound healing in patients. First clinical investigations are promising.
Animals↗
In vivo assessment of colon microcirculation: comparison of the new OPS imaging technique with intravital microscopy.
BACKGROUND: The Orthogonal Polarization Spectral (OPS) imaging technique has been introduced for in vivo assessment of microcirculation in humans. Unclear remains, whether the new technique would allow for accurate investigations of the colon microcirculation with respect to the unique conditions of the microvasculature in that particular tissue. Therefore, the aim of this study was to validate the new technique against intravital fluorescence microscopy (IFM) for the visualization of colon microcirculation in a murine model of inflammatory bowel disease (IBD). METHOD: IBD was induced in Balb/c mice by dextran sulfate sodium (DSS), controls received normal water. In each animal, both the CYTO-SCAN A/R and IFM were used to image the microcirculation (n = 7 in each group). Postcapillary venular diameter, venular red blood cell velocity (RBC-V) and functional capillary density (FCD) were analyzed on the colon muscularis and mucosa and compared to each other using linear regression analysis and Bland-Altman plots. RESULTS: All parameters correlated significantly between the both methods. The venular diameters and the RBC-V were significantly different between control and colitis group in contrast to FCD; these results were present while using both methods. CONCLUSION: Our study demonstrates that the new technique for visualization of microcirculation without use of fluorescent dyes, the OPS-imaging, allows for quantitative measurement of the key microcirculatory parameters of the mouse colon.
Animals↗
The influence of organ temperature on hepatic ischemia-reperfusion injury: a systematic analysis.
BACKGROUND: Although hepatic ischemia-reperfusion (I/R) injury can be reduced by cooling of the ischemic organ, a systematic in vivo analysis of the influence of organ temperature in I/R injury is missing. The aim of this study was to systematically investigate the impact of defined temperatures of the ischemic liver tissue on microvascular I/R injury. METHODS: Ischemia of the left liver lobe was induced in C57BL/6 mice for 90 min. The ischemic lobe was placed in a polyethylene well and the temperature was adjusted to 37 degrees C, 26 degrees C, 15 degrees C, and 4 degrees C by superfusion with cooled/warmed saline solution. The ischemia groups (n=7 each) were compared with a sham-operated group (n=7). The sinusoidal perfusion index and the number of leukocytes firmly adherent to the endothelium of postsinusoidal venules were assessed using intravital fluorescence microscopy at 30 min, 120 min, and 240 min of reperfusion, respectively. At the end of the experiment, serum activities of the liver enzymes aspartate aminotransferase/alanine aminotransferase were determined, and tissue specimens were examined by electron microscopy. RESULTS: Core body temperature did not differ significantly between the groups. In the 37 degrees C group, the sinusoidal perfusion index was significantly reduced and the number of adherent leukocytes was significantly increased compared with the sham group. In all hypothermia groups, however, the microcirculatory parameters did not differ from the sham group. Serum activities of aspartate aminotransferase/alanine aminotransferase were significantly increased and hepatocellular integrity was severely affected in the 37 degrees C group as compared with all other groups. CONCLUSIONS: These findings demonstrate that in the mouse liver the known protective effect of hypothermia is already encountered at 26 degrees C. Further reduction of temperature did not generate additional protection from I/R injury.
Alanine Transaminase↗
Orthogonal polarization spectral imaging as a tool for the assessment of hepatic microcirculation: a validation study.
BACKGROUND: Quantitative analysis of liver microcirculation using intravital fluorescence microscopy in animals has increased our knowledge about ischemia-reperfusion injury. However, because of the size of the instrumentation and the necessity of fluochromes for contrast enhancement, human liver microcirculation cannot be observed. Orthogonal Polarization Spectral (OPS) imaging is a recently introduced technique that can be used to visualize the microcirculation without the need for fluorescent dyes. It is a small, hand-held device and could potentially be used to study the microcirculation of the human liver in a clinical setting. However, before implementation into clinical use its ability to quantitatively measure microcirculatory parameters must be validated. METHODS: The livers of Spraque-Dawley rats (n=9) were exteriorized, and images were obtained using OPS imaging and intravital fluorescence microscopy of the identical microvascular regions before and after the induction of a 20-min warm lobar ischemia. Images were videotaped for later computer-assisted off-line analysis. RESULTS: OPS imaging can be used to accurately quantify the sinusoidal perfusion rate, vessel diameter, and venular red blood cell velocity. Correlation parameters were significant and Bland-Altman analyses showed good agreement for data obtained from the two methods at baseline as well as during reperfusion. CONCLUSION: OPS imaging can be used to quantitatively measure microcirculatory parameters in the rat liver under both physiological and pathophysiological conditions. Thus, OPS imaging has the potential to be used to make quantitative measurements of the microcirculation in the human liver.
Animals↗