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T Joka

Publications and source records attributed to T Joka.

36 records · Page 2Linked to original sources
PubMed1988

Distribution and function of alveolar cells in multiply injured patients with trauma-induced ARDS.

To determine whether alveolar cells are involved in the pathogenesis of adult respiratory distress syndrome (ARDS), we assessed the distribution and function of alveolar cells from 30 polytraumatized patients with trauma-induced respiratory failure, 5 of whom also had lung contusion. Cells were obtained by bronchoalveolar lavage performed daily beginning on the day of trauma and continuing for 14 days. Neutrophils constituted about 60% of lavage cells in ARDS patients with lung contusion 0-2 days after polytrauma and about 50% in ARDS patients without lung contusion. In ARDS patients with lung contusion the neutrophil fraction decreased to 52% 3-6 days after trauma and to 40% 7-14 days after trauma. In patients without lung contusion the neutrophil fraction increased to 77% and then decreased to 60% at these times. Total cell counts in ARDS patients with lung contusion were more than twice as high as in patients without lung contusion 0-2 days after trauma. The difference in total cell counts decreased during days 3-6 and disappeared by day 7. In all patients morphologically altered alveolar cells were observed 4 days and more after trauma. In non-survivors significantly more altered cells were found. The chemiluminescence-response pattern of the alveolar cells was enhanced throughout the study and correlated with the neutrophil fraction (r = 0.6). The neutrophil fraction also correlated with the pulmonary vascular resistance during the first two days after trauma (r = 0.53). We conclude that alveolar cells are involved in the pathogenesis of trauma-induced ARDS and that the alveolar cell distribution is different in patients with and without lung contusion during the development of posttraumatic respiratory failure.

Acute Disease↗
PubMed1988

Adult respiratory distress syndrome as a specific manifestation of a general permeability defect in trauma patients.

To establish whether a general dysfunction, i.e., an increase in permeability, had occurred in 16 trauma patients (6 with adult respiratory distress syndrome [ARDS]), we measured beta 2-microglobulin (beta 2MG), myoglobin (MG), immunoglobulin G (IgG), and transferrin (TF) concentrations in bronchoalveolar lavage fluid (BAL), serum, and urine as well as extravascular lung water content (EVLW) over a period of 14 days. Our results show a positive correlation (p = 0.03) between increases of EVLW, reflecting lung edema, and beta 2MG concentrations in urine of all patients with ARDS, indicating systemically increased permeability. Generalized increase of permeability can also explain the elevation of MG urine concentrations (p = 0.03) together with an EVLW increase, and an increase of BAL protein concentrations (IgG, TF, p less than 0.01) in the early post-trauma phase during the first 48 h after admission. In contrast, commonly used kidney function tests remained unchanged over the time course of 14 days.

Adolescent↗
PubMed1987

Optic nerve trauma: clinical, electrophysiological and histological remarks.

18 patients with post-traumatic visual disease of the optic nerve are presented. In the post-traumatic stage, visual evoked potentials were monitored. In amaurosis there was a high incidence of midface or frontobasal fractures. The severity of the trauma is not correlated with the severity of visual deficits. Flash evoked potential (FEP) findings were different: In most cases there was a correlation of clinical and FEP findings. In some we found false positive potentials in the acute stage. In smaller visual field deficits the alterations of FEP could not be correlated with the clinical disorders. FEP alterations depended on time. The pathophysiological mechanisms are discussed in regard to the pathological findings in 51 unselected autopsies with an investigation of the visual pathway from the intraorbital optic nerve to the visual cortex. Because of the different morphological alterations the clinical, neurological and ophthalmological examination should be followed by standard CT scanning to evaluate intracranial haematomas and by CT scanning with thin slices of the optic nerves and the soft tissue of the orbit. Visual evoked potentials (VEP) and in the unconscious patient, flash evoked potentials (FEP) do not give much more security for therapeutic decisions in comparison with former times. The histological findings do not support the hypothesis that operative decompression is successful.

Accidents↗
PubMed1987

Altered arachidonic acid metabolism in granulocytes of polytraumatized patients.

The generation and metabolism of leukotrienes (LTs) from polymorphonuclear granulocytes of four polytraumatic patients on stimulation with the Ca-Ionophore A 23187 were studied by high performance liquid chromatography. In contrast to healthy donors the concentration of LTB4 within the supernatant of the stimulated granulocytes from these patients is reduced. The ratio of LTB4 versus the combined amounts of the biologically inactive 6-trans and 12-epi-6-trans-isomers is significantly decreased. In one patient who suffered from an Adult Respiratory Distress Syndrome (ARDS) a pronounced enhancement of LTC4 synthesis was observed.

Calcimycin↗
PubMed1987

[Normal values of cell distribution and function in the human alveolus. Bronchoalveolar lavage as a diagnostic tool in intensive care medicine].

The cell distribution and cell function in the normal human alveolar were determined in 23 healthy subjects by obtaining the pulmonary lavage fluid from bronchoalveolar lavage. A uniform alveolar cell spectrum was found. (Alveolar macrophages 95-98%, polymorphonuclear neutrophils 2-3%, lymphocytes 0-2%.) The cell systems reacted reproducibly to a defined phagocytosis stimulation in luminol-enhanced chemoluminescence. The phospholipid lung profile, which is important for the function of the surfactant, was determined by means of high-pressure liquid chromatography. The typical inflammation mediators were not present in the humoral spectrum of the supernatant part of the lavage fluid. Albumin, transferrin, and alpha-1-antitrypsin were regularly seen in healthy adults in the bronchoalveolar lavage fluid. The results supply the basis for the interpretation of the findings in polytraumatised patients in adult respiratory distress syndrome.

Acute-Phase Proteins↗
PubMed1986

High-performance liquid chromatography of adult human bronchoalveolar lavage: assay for phospholipid lung profile.

High-performance liquid chromatography has been used to separate pulmonary phospholipids from adult human bronchoalveolar lavage. A solvent system consisting of acetonitrile-water (80:20) as solvent A and pure acetonitrile as solvent B was used with a silica column (Bio-Sil HP 10) coupled to an Si-100 Polyol precolumn. A linear gradient from 87.5 to 25% of solvent B was found to separate all biologically relevant surfactant phospholipids in the following sequence and composition: phosphatidic acid (1.1%), phosphatidylglycerol (10.6%), phosphatidylinositol (9.9%), phosphatidylethanolamine (3.6%), phosphatidylserine (4.5%), phosphatidylcholine (60.8%), sphingomyelin (8.1%) and lysophosphatidylcholine (1.6%). These results were very similar to the phospholipid pattern obtained by two-dimensional thin-layer chromatography. It is concluded that high-performance liquid chromatography is a useful and rapid method for the separation of phospholipids in biological fluids containing pulmonary surfactant.

Adult↗
PubMed1985

[Bronchoalveolar lavage as a diagnostic method in intensive therapy].

Bronchoalveolar lavage is presented as a standardised diagnostic method in the clarification of interstitial pulmonary changes in the acute respiratory distress syndrome (ARDS). Its justification is based on the fact that changes in lung biopsies are reflected by early changes in the composition of the rinse and in the ability of the cellular components to function properly, independent of the origin of the immunological processes in ARDS. Pulmonary function is not adversely affected by the procedure provided it is carried out "lege artis". We hope that it will be possible in future to achieve early detection of a developing progressive failure of pulmonary function, by employing early markers. The procedure also allows continual follow-up of the success of an initiated therapy.

Bronchoscopy↗
PubMed1983

[Operative methods in adenocarcinoma of the cardia].

Adenocarcinoma of the oesophagogastric transition is only incompletely resectable in 40% of cases, if resection with intrathoracic anastomosis is desired. Death-rate of thoraco-abdominal or transthoracic resection is over 40% (in the authors' own series 47%). Survival time of patients is short, some develop a recurrence at the anastomotic site. More radical and carrying a lower postoperative mortality is resection of the tumour with subtotal oesophagectomy without opening the thorax. Anastomosis with the residual stomach is made at the cervical portion of the oesophagus.

Adenocarcinoma↗
PubMedDate not supplied

[10 years of emergency medical care at the traumatology center of the university clinic in Essen].

10 years of experience with emergency treatment at a University Center sufficiently proved the necessity of an emergency physician at the site of the accident. Because of its inefficiency, the separate and individual displacement of the doctor and the emergency vehicle to the site of the accident has been abandoned in 1976. The professional qualifications of the emergency team are as important as the technical equipment. Specific attention has to be paid to the education of nursing -, ambulance personnel and doctors belonging to the team. Very early and efficient shock therapy is essential in polytrauma victims. Intubation, artificial ventilation, fluid administration (electrolyte-solution) are of utmost importance for their survival and to reduce the frequency of major complications.

Emergency Medical Service Communication Systems↗
PubMedDate not supplied

Principles of treatment and indications for surgery in severe multiple trauma.

Despite major advances, pitfalls in diagnosis and emergency treatment influence the survival chances of multitraumatized patients considerably. Diagnosis of traumatic shock cannot be made by blood pressure, pulse rate and shock index. Immediate shock therapy is indicated in all cases with severe trauma of two body regions, combined injury of one body cavity and long bone fractures and in all cases with one major thoracic or pelvic injury. In a consecutive series of 418 multitrauma patients, extremity injuries were present in 90%, severe head injuries in 65%, major thoracic trauma in 50% and abdominal or pelvic injuries in 40%. The most frequent pattern of multitrauma was long bone fractures with associated head trauma and one thoracic, abdominal or pelvic injury. Priorities of treatment are based on a 4-stage-schedule: Stage 1 includes intubation and hyperventilation for cerebral trauma, volume replacement by central venous catheter, emergency x-ray of cervical spine, chest, abdomen, pelvis and diagnostic peritoneal lavage. In 25% of admitted cases, diagnosis of abdominal hemorrhage was missed by the referring surgeon despite hemorrhagic shock, falsely attributed to cerebral trauma. At Stage 2, emergency surgery of internal and external bleeding is indicated. Wide open fractures are stabilized by external fixation. Stage 3 is concerned with stabilization of vital systems and further diagnostic evaluation, its duration varying from 2 hours to 2 days. At Stage 4, internal fixation of fractures and other non-emergency-operations are indicated. Operating time can be reduced considerably by 2 surgical teams operating simultaneously or overlapping. Early shock diagnosis, immediate intubation, ventilator treatment and the "4-stages-schedule" are considered the most successful steps in the management of multitrauma, as well as volume replacement with Fox' hypertonic saline solution and blood constituents instead of colloids. This has reduced mortality due to respiratory failure from 31% to 20%.

Abdominal Injuries↗