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Biomedical subjects

S Coerper

Publications and source records attributed to S Coerper.

At least 19 recordsLinked to original sources
PubMed2004

[Possible interventions in impaired wound healing].

Chronic wounds are long-term results of various diseases. Evaluation and therapy of the underlying disorder must be the first goal of a comprehensive wound care protocol. Treatment of local (i.e. wound infection, necrosis, or foreign body) or systemic (i.e. diabetes, immunosuppression, or patient compliance) disturbing factors is the second major step for appropriate wound care. The third major point is wound bed preparation (i.e. debridement, moist wound dressings, or VAC therapy), and wound stimulation. After appropriate wound bed preparation, wounds can be closed by plastic surgery or wound stimulation through various agents (i.e. protease inhibitors, growth factors, or tissue engineering).

Debridement↗
PubMed2003

[The role of a radical surgical debridement and mesh graft tissue transfer for treatment of venous ulcers].

Many studies are published demonstrating remarkable results of skin grafting in venous ulcers, but only a few controlled randomised trials including a low number of patients are available. A review based on two controlled randomised trials concludes that there is no significant benefit for mesh graft tissue transfer compared to standard treatment. However, in all studies no adequate initial radical surgical debridement including fasciectomy for wound bed preparation has been performed. In a prospective study on 57 patients with venous ulceration we found significant lower recurrence rates after mesh graft tissue transfer and radical surgical debridement. In clinical practice the results of mesh graft tissue transfer following surgical debridement in the management of larger chronic venous ulcers have been encouraging, although the evidence-based recommendation is lacking. It may not be the treatment of first choice and should be preserved for large ulcers of long duration or history of recurrence. There is need for more randomised controlled studies comparing also cost effectiveness while ensuring baseline comparability.

Animals↗
PubMed2001

[Network of surgical wound centers using a new electronic data processing documentation system].

UNLABELLED: Care of chronic wounds is of enormous medical, social and economic importance. Nevertheless there is a lack of epidemiological and economical data. A network of ten wound care centers was created and data were documented in a new computerized wound documentation system. METHODS: Treatment was performed according to a comprehensive and standardized wound care protocol. The new documentation system is a network-capable solution. Digital images and planimetry as well as patient and wound related data are recorded. RESULTS: During the first year the ten centers treated and documented already 3281 wounds. There is a wide spectrum of different chronic wounds treated in the participating centers. Despite of long wound duration of several wounds with a median of 5 weeks (range 0-62 years), the healing rate was 80% within 455 days. CONCLUSION: Large amounts of data can be collected and scientifically evaluated in the wound net. This is realized by a new computerized documentation system, which was integrated into the clinical routine and enables clear and standardized documentation. Therefore even large multicenter therapy studies may be performed easily in the wound net and economical data could be collected.

Chronic Disease↗
PubMed2001

Insulin-like growth factor I accelerates gastric ulcer healing by stimulating cell proliferation and by inhibiting gastric acid secretion.

BACKGROUND: Given the importance of Insulin-Like Growth Factor I (IGF-I) to intestinal maintenance and the presence of IGF-I in salivary glands, we hypothesized that IGF-I participates in the healing of gastric ulcers. The aim of the study was to determine: 1) whether IGF-I applied locally would support gastric ulcer healing by increasing cell proliferation and 2) the effect of IGF-I on gastric acid secretion. METHODS: Gastric ulcers were induced with a cryoprobe. Immediately thereafter, IGF-I (0.4, 4.0 and 40 microg) or vehicle was infiltrated perifocally. In another group, animals received a daily dose of 40 micromol omeprazole subcutaneously. Ulcer healing was evaluated by ulcer size and histological examination at 7 days. Pentagastrin-stimulated gastric acid secretion was evaluated in conscious rats with gastric fistula, after IGF-I (400 microg) had been injected intravenously. RESULTS: IGF-I significantly reduced ulcer size, but only at low doses (0.4 microg/kg body weight (BW), P = 0.008; 4 microg/kg BW, P = 0.001). This effect was similar to omeprazole treatment. Histological examination after IGF-I administration showed increased cell proliferation, increased IGF-I content and down-regulated IGF-I receptors. The secretory studies demonstrated a significant decrease in gastric acid secretion 30 min after IGF-I bolus injection (IGF-I: 53 +/- 11 microEq; vehicle: 116 +/- 5 microEq; P=0.001), which lasted for more than 1 h. CONCLUSION: IGF-I stimulates gastric ulcer healing, stimulating cell proliferation and inhibiting gastric acid secretion.

Animals↗
PubMed2001

[Gene therapy in diabetic foot].

In gene therapy nucleic acids are used for therapy. There are three different concepts in gene therapy for chronic wounds. (1) Synthesis of human recombinant growth factors by gene therapy techniques, (2) Ex-vivo transfection of cell cultures (fibroblasts, keratinocytes) with growth factor DNA and subsequent transplantation of transfected cells on chronic wounds. (3) In-vivo transfection with growth factor DNA, e.g., gene gun, liposomes, viral vector. Clinical studies on gene therapy for diabetic foot ulcers are only available for the local application of human recombinant PDGF-BB growth factor. Meta-analysis shows there is a low but significant effect of PDGF-BB on neuropathic diabetic ulcers, leading to an increase of healing by 10-15% within 20 weeks of treatment.

Animals↗
PubMed2000

[Possibilities of demonstration of growth factors in chronic wounds. Demonstration of RNA and protein in wound tissue].

Growth factors are important modulators of wound healing. So far, there is little clinical data showing that healing defects in chronic wounds are attribute to deficiency of growth factor expression. Characterization of growth factor expression is necessary to provide new directions toward developing therapies in treating wounds. Present available molecular and immunological techniques allow the analysis of mRNA and protein expression in small amounts of wound material. We analyzed growth factor expression in wound tissue and wound fluid from acute and secondary healing wounds. Wound tissue of secondary healing wounds reveals a higher mRNA growth factor expression compared to acute wound tissue. Secondary healing wounds from our studies demonstrated no deficiency of growth factor expression however, functional analysis may be necessary to determine their activity.

Endothelial Growth Factors↗
PubMed1999

[The wound care center in surgery: an interdisciplinary concept for diagnostic and treatment of chronic wounds].

In Germany there is no standardized wound care for patients with chronic wounds in specialized centers. We have established a wound care unit for the past 6 years. The principal concept of therapy was characterized by standardized local surgery, moist wound dressings and concomitant treatment of the underlying disease. We performed local therapy, coordinated the interdisciplinary treatment and developed a new wound documentation system for quality control. We established a close network, integrating general practitioners and home care organizations to realize a mainly outpatient treatment supported by short hospital therapy. Exclusive outpatient treatment was performed in 42% of all patients. According to our prospective data, we achieved an improvement in wound care: 69% of the wounds resistant to therapy for a mean of 30 months healed within 12 months after therapy according to our protocol. Our data strongly supported the importance of local surgery: neither wound depth nor wound infection had any influence on the healing rate, presumably due to radical excisional debridement of necrotic tissue. The presented data justify on medical and economic grounds the establishment of such wound care centers in Germany.

Ambulatory Care↗
PubMed1999

Growth factors in distraction osteogenesis. Immuno-histological pattern of TGF-beta1 and IGF-I in human callus induced by distraction osteogenesis.

Although growth factors have been demonstrated during bone healing, their presence has not yet been confirmed in callus distraction. Therefore, in 3 patients we searched for cytokines during callus distraction. Bone biopsies were immuno-histochemically stained for TGF-beta1, IGF-I, TGF-beta type II receptor, IGF receptor, and proliferating cell nuclear antigen (PCNA). Histologically we found immature woven bone in the middle of the callus zone and increasing calcification and lamellar bone in the re-modelling zone. Osteoblasts and fibroblast-like cells in the middle zone, and osteoblasts in all zones stained for TGF-beta and its receptor. The number of positive staining cells related to proliferous activity as assessed both by PCNA, and by bone density in radiographs. IGF-I could be detected everywhere. In conclusion, growth factors are present in bone formation and in areas of re-modelling during callotasis. Their relation to proliferous activity and radiographic density supports their involvement in osteogenesis.

Adult↗
PubMed1999

Correlation of imaging techniques to histopathology in patients with diabetic foot syndrome and clinical suspicion of chronic osteomyelitis. The role of high-resolution ultrasound.

OBJECTIVE: To investigate the role of ultrasound in the diagnosis of osteomyelitis in the diabetic foot compared with magnetic resonance imaging (MRI), bone scintigraphy (BS), and plain film radiography (PFR). RESEARCH DESIGN AND METHODS: We investigated 19 consecutive diabetic patients (2 women, 17 men, age 60.7 +/- 9.8 years, BMI 27.0 +/- 3.8 kg/m2) with clinical suspicion of bone infection of the foot. A high-resolution ultrasound system (Esaote/Biosound, Munich) with a linear array transducer up to 13.0 MHz was used. The prospective and blinded results of each method were compared with histopathology as the reference method after metatarsal resection. RESULTS: In 14 of 19 patients, histopathology confirmed osteomyelitis. Ultrasound showed a sensitivity of 79% (PFR, 69%; BS, 83%; MRI, 100%), a specificity of 80% (PFR, 80%; BS, 75%; MRI, 75%), a positive predictive value of 92% (PFR, 90%; BS, 91%; MRI, 93%), and a negative predictive value of 57% (PFR, 50%; BS, 60%; MRI, 100%). CONCLUSIONS: Our data indicate that ultrasound might have a better diagnostic power for detecting chronic osteomyelitis in the diabetic foot than PFR and has similar sensitivity and specificity as BS. MRI is superior to the other three methods. We conclude that the use of ultrasound in the management of the diabetic foot is worthy of further investigation.

Diabetic Foot↗
PubMed1999

[Standardized wound documentation of chronic wounds].

Owing to the long periods of treatment and multi-factoral etiology of chronic wounds, standardized wound documentation is necessary to enable judgement of the course of healing. We have developed a documentation system which permits a standardized assessment of chronic wounds by means of defined parameters and graded divisions. Besides containing the diagnostic and therapeutic measures which have been carried out, the documentation should also contain parameters of wound healing. These are the following: wound localisation, size of wound, degree of injury, infection, and wound morphology. Planimetry and photographic documentation complete the documentation. Thus a documented course of healing can be presented, which enables rapid retrospective analysis and, if needed, a change in therapeutic approach at an early stage. This complete, exact documentation is required by modern administration of justice and is a protection against the reversal of the onus of proof in lawsuits. The extent of documentation can be adapted to the individual needs of the institution responsible for treatment. However, a minimal amount of documentation should always include localisation of the wound, size, the diagnostic and therapeutic measures, and complications if any.

Chronic Disease↗
PubMed1999

[Temporary expression pattern in wound secretions and peripheral wound biopsies].

The local availability of growth factors and oxygen plays an important role in the healing of cutaneous lesions. We were able to quantify the ischemia in a standardized ischemic full-wall flap by measuring the ptiO2, and investigate the healing of defined wounds. The analysis of the immune histochemical section showed a significantly reduced expression of IGF-I in the wound edge of ischemic wounds. Simultaneously the rate of proliferation was reduced here. Probably the local chronic hypoxia leads to reduced IGF-I synthesis and thus to reduced proliferation and delayed wound healing. Further investigation is necessary to confirm this hypothesis. In a clinical study of wounds which had been treated with vacuum sealing we could establish no difference in the concentration of IGF-I in the wound fluid of seriously contaminated wounds in comparison to primary fasciotomy wounds. We therefore postulate a primary endocrinal secretion for IGF-I in cases of cutaneous wound healing; higher local consumption or reduced serum levels could stimulate the autocrinal local secretion of IGF-I. Further investigation is, however, needed in order to confirm this hypothesis.

Animals↗
PubMed1998

[Interdisciplinary treatment concepts in chronic wounds].

Interdisciplinary concepts for the treatment of chronic wounds are mandatory because of the multifactorial reasons causing ulceration. This is a report on 6 years' experience at the wound care unit in Tübingen. Patients with chronic wounds (mainly diabetic, venous, and ischemic ulcers) were treated primarily as outpatients according to a standardised and interdisciplinary wound care protocol. Quality control was guaranteed by a standardised wound documentation system. The evaluation of this data demonstrates an overall healing rate of 69% within 52 weeks (mean). Before patients were referred to Tübingen, unsuccessful therapy was characterised by a mean wound duration of 35 weeks. The results presented justify this interdisciplinary wound care unit.

Chronic Disease↗
PubMed1997

Recombinant human transforming growth factor beta 3 accelerates gastric ulcer healing in rats.

BACKGROUND: Gastric ulcer healing is mediated by various endogenous growth factors. In this experimental study effect of locally and systemically applied recombinant human transforming growth factor beta 3 (rhTGF-beta 3) on gastric ulcer healing was investigated in the rat. METHODS AND RESULTS: Gastric ulcers were induced with a cryoprobe, and ulcer healing was evaluated 7 days after local infiltration (0.5 micrograms, 1.0 microgram, 2.5 micrograms, and 50 micrograms) or systemic (intravenous) application of TGF-beta 3 (500 micrograms/kg body weight). Compared with controls, a dose-dependent stimulation of ulcer healing (as evidenced by a reduction in ulcer size) was observed 7 days after local infiltration of TGF-beta 3 (1.0 microgram, 2.5 micrograms, and 50 micrograms). Corresponding increases in the levels of proliferating cell nuclear antigen (PCNA) and intracellular TGF-beta 3 expression and a downregulation of the TGF-beta type-II receptor expression were also observed in the granulation tissue of the ulcer margins. Systemic application of TGF-beta 3 produced effects similar to those observed after local treatment with 50 micrograms of the compound. CONCLUSION: Local and systemic TGF-beta 3 treatment accelerates gastric ulcer healing in rats.

Animals↗
PubMed1997

[Surgical wound consultation].

Treatment of patients with chronic wounds is characterized by high costs and low efficiency. Epidemiologic data are mainly based on retrospective studies. In 1992, we founded a wound care center and developed a diagnostic and therapeutic algorithm. Prospective data on 293 patients revealed an overall healing rate of 68% (diabetic foot syndrome) and 74% (venous stasis ulcer); mean treatment time was 4.5 months. Relevant prognostic factors were localization of ulcer (0.004), ischemia (0.002), age (0.02) and compliance (0.003), whereas the ulcer grading had no effect on healing.

Algorithms↗
PubMed1997

[Prognostic factors in treatment of diabetic foot ulcers].

138 patients with nonhealing diabetic foot ulcers were treated between 1994 and 1996. Sixty-nine percent of these foot ulcers healed within 17 weeks. Heel ulcers had a significantly lower healing rate, probably because of the difficulty of taking weight-bearing off this zone. Ischemia also correlated well with low healing rates, underlining the importance of vascular diagnosis and surgery. Since compliance is the most significant factor for success, it is mandatory to educate the patient about his disease and prevent further complications.

Adult↗
PubMed1997

[Surgery of Crohn disease in the course of time--a retrospective analysis of 1,044 operations].

In 591 patients with Crohn's disease, 1044 operations were performed within 16 years. The aim of this study was to evaluate the changes in treatment time, indication for surgery, surgical technique, and postoperative complications. There was a significant reduction in treatment time (in-patient), whereas the number of operations in general increased. The frequency of emergency operations has declined. The postoperative complication rate did not change, but there was a correlation between emergency operation and the complication rate. Surgery for perforating Crohn's disease, acute intestinal obstruction or intra-abdominal abscess also correlated with a significantly higher complication rate.

Colectomy↗