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Biomedical subjects

R Hettich

Publications and source records attributed to R Hettich.

At least 37 records · Page 2Linked to original sources
PubMed1989

[Burns. Primary management and clinical therapy].

Following the saving of the patient in addition to the cool-water therapy an adequate infusion therapy with Ringerlactate should be initiated immediately. For the transport the wounds should only be covered sterile; in case of inhalation trauma early intubation. Adults with burns of more than 15% TBA (children already at 5%) as well as with burns of hands and face require an immediate transfer into a burncenter. After cleansing of the wounds in the hospital estimation of the burn depth and decision of treatment. Deep burns of hand and face should be necreted and covered within the first 72 hours if possible. For the remaining deep burns one should try a primary excision too or in case of a bad general condition a delayed primary excision after tanning. Up to the moment of operation one should choose between an open, half open or closed treatment. The covering of the necrectomized areas is done temporary with alloplastic material or xeogenic or allogenic skin respectively. Definitive covering can only be achieved by autogenic split skin or intermingled skin grafting. New possibilities are offered by "in vitro" grown keratinocytes.

Adult↗
PubMed1989

Computer-assisted infusion and nutrition planning in an intensive care burn unit.

The paper describes a computer-assisted infusion and nutrition programme, running on an IBM-compatible PC/XT or PC/AT, for a surgical intensive care unit specializing in burn treatment. Using inputs of patient and laboratory data relevant to infusion planning, the programme generates a schedule for balanced enteral or parenteral nutrition of adult and adolescent patients from the age of 14 upwards. Potential side effects and metabolic complications in nutrition therapy are minimized. Graphics provide a rapid status check on individual parameters whenever required.

Body Weight↗
PubMed1989

Intermingled skin grafts with in vitro cultured keratinocytes--experiments with rats.

In vitro cultured autogenic keratinocytes were used instead of autogenic skin islets in intermingled skin grafts on rats. According to the observations made with the original method, the allogenic epidermis is being rejected. The cultured keratinocytes start to grow out in circles, eventually covering the remaining allodermis in the form of a multilayered, well-differentiated epidermis. The prospects of these findings for possible future clinical applications are discussed.

Animals↗
PubMed1989

Immunology of intermingled skin grafts in rats: preliminary results.

Successful treatment of severely burned patients with the Chinese method of intermingled skin grafting has raised questions concerning the pathophysiological and immunological mechanisms which allow the survival of mixed allogeneic and autologous tissue. In creating a rat model and measuring systemic immunological status by means of mixed lymphocyte reactions (MLR) and histology, we found comparable levels of sensitization in intermingled and allografted rats; however, allografts were rejected and intermingled graft survival was significantly prolonged. We interpret our results to indicate that the survival of intermingled grafts is dependent upon an as yet undefined local protective effect exerted by the presence of auto-skin islands in the allotypic portion of intermingled grafts.

Animals↗
PubMed1989

Cytogenetic investigations of the allodermis after intermingled skin grafting.

In most instances intermingled skin transplants done according to the method developed in the PR China are not subject to a generalized rejection. During the healing process there is an integration of the allodermis instead, which eventually becomes covered by outgrowing auto-epidermal cells. To investigate the fate of allogenic cells experiments were done with intermingled skin grafts, using male Wistar rats as recipients and female DA-rats as donors. By studying karyotype analysis of cells growing out from intermingled skin biopsies the presence of viable allogenic cells was demonstrated on days 53 and 111 post-transplantation. It was concluded that the intermingled skin forms a cellular mosaic with different portions of autogenic and allogenic cells.

Animals↗
PubMed1989

Distribution of lymphocytes in intermingled skin grafts.

Chinese intermingled skin grafts of allogenic material interspersed with small autogenic islets heal permanently with no signs of a rejection reaction. A study of the T-helper and T-suppressor cells in the region of the autogenic islets and the remaining allodermis revealed a distinctly greater frequency of these cells in the islets, with marked massing of the cells between the autoepithelium and the autodermis. Histologically it could be shown, that the Langerhans' cells grow over the allodermis together with the epithelium, although compared with the autogenic islets their number in the newly formed epidermis remained reduced.

Humans↗
PubMed1988

Morphological changes of intermingled skin transplants on rats.

Experiments with rats demonstrate that free skin transplants between genetically distinct strains become totally rejected after no longer than 3 weeks. In intermingled skin transplants, however, the autogenic epidermis directly covers the allodermis, which results in a definitively covered wound with a mostly normal skin texture. It seems that during the first phase after the burn the allodermis is accepted as donor skin. In the second phase it becomes covered by the epidermis and surrounded by the connective tissue of the recipient. During this process all structures of ectodermal origin like skin adnexa are rejected. Since for the most part the elastic fibres in the allograft remain unchanged after a successful intermingled skin transplantation, the transplant shows elasticity similar to a mesh autograft, but it is incapable of regenerating skin adnexa. After complete healing cellular and humoral infiltrates, as in the case of immunological rejections, could no longer be detected.

Animals↗
PubMed1986

Interactions between local and generalised burn edema.

In judging the infusion therapy of burn injuries, not only the circulatory and pulmonary effects are considered but also the local effect on burned tissue. Local edema leads to hypoxia as well as to the burn-specific sludge phenomenon. Microcirculation and edema are often adversely influenced by our therapeutic efforts. Therapeutic proteinase inhibition, for example, has a beneficial effect on edema formation but reduces spontaneous fibrinolytic activity and thus increases the sludge phenomenon. Standardized experimental scalds of 30% of the body surface in rabbits increased density of the lungs, as determined by computed tomography. Colloidal infusion therapy was found to diminish fluid shift into the lung more than crystalloid infusion therapy. However, all tested infusion regimens, using identical quantity, increased edema formation in the burned skin. Biseco (natural serum proteins containing igG, igA and igM; Fa. Biotest, Frankfurt, F.R.G.) and Solcoseryl (a protein-free extract of calf blood stimulating the oxygen efficiency; Fa. Solco Basel) were demonstrated to diminish local edema formation as well as lung edema secondary to burn injuries.

Actihaemyl↗
PubMed1984

[Early treatment of burn wounds].

Primary excision and immediate grafting are limited by blood loss and donor areas. This may never prevent primary excision of burnt hands and face. Excision should be limited to about 20% of the body surface. Delayed primary excision is recommended after pretreatment with Iodine solution, 5% tannic acid solution, and 10% silver nitrate solution. This prevents infection for several weeks when second degree burns healed spontaneously under the artificial scab. Autografts are preferred; if donor areas are lacking staged excision and Chinese intermingled transplantation are performed using homografts containing small autograft islands for covering up to 300 cm2 with 1 cm2 autograft.

Burns↗
PubMed1984

Solcoderm as a tool for the plastic surgeon. The treatment of verrucae.

In 243 cases of verruca vulgaris, about 85% of the epidermal efflorescences caused by the wart virus were cured by two or more applications of Solcoderm in ambulant therapy. Of 127 cases of verruca plantaris treated, about 70% were cured after an initial course of four applications and 80% after further courses of treatment. More than 80% of recurrences responded to retreatment. A favorable effect on the pain caused by the plantaris warts was reported by 95% of the patients treated. No delayed complications were observed after the use of Solcoderm. The rate of incapacity for work after Solcoderm treatment, a total of 41 man-days, was extremely low when compared with that following cryosurgery and other surgical measures which, unlike Solcoderm therapy, often require immobilization, dressings or avoidance of soap and water.

Acetates↗
PubMed1984

[Formation of a microvascular, multilayer constructed transplant using the greater omentum].

The high potential for vascularisation of the greater omentum, described in the literature and in our own investigations was used to build microsurgical compound island flaps containing hard tissue grafts like Proplast. In the first operative procedure Proplast was inserted into the omentum and a flap was formed pedicled on the right gastro-epiploic vessels and transposed into the subcutaneous layer. Two to three weeks later the vascularized Proplast could be removed together with the overlying skin and fat. In another experiment Proplast was inserted into the pedicled omentum and put back into the belly. A second laparotomy was performed 14 days later to cover the omentum-Proplast sandwich with a split skin allograft. In both experiments the total compound sandwich flap was supplied only by the right gastro-epiploic vessels, which allowed a microsurgical transplantation.

Animals↗
PubMed1981

[Reabsorption of standardised intramuscular haematomas in rabbits treated with streptokinase per os (author's transl)].

Standardised i.m. haematomas in rabbits were studied with and without oral administration of Varidase (containing streptokinase and streptodornase). 125I-fibrinogen was mixed with 2 ml of rabbit blood and reinjected i.m. The standardised haematomas were reabsorbed after 12 to 14 days. During the 3-day administration period of streptokinase the counts measured over the haematoma were even higher than in control animals. As during the therapy a high fibrinolytic activity was found, additional spontaneous bleeding into the haematomas may be suspected. When oral administration of streptokinase was stopped the decrease of counts detected in those animals was significantly accelerated as compared to non-treated animals. This indicates an accelerated reabsorption of those haematomas treated with streptokinase in a low concentration. These results were confirmed by microscopic findings.

Absorption↗