[Reflections on the treatment of massive hemorrhage following trauma].
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Adult↗
Biomedical subjects
U Obertacke
Publications and source records attributed to U Obertacke.
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↗
[Concomitant osseous and ligamentous injuries of traumatic shoulder dislocation and its significance for the pathogenesis of habitual dislocation].
161 consecutive patients with traumatic shoulder luxation between 1975 and 1983 are followed, concerning their evolution to recurrent shoulder dislocation. In 26 patients there was a recurrent shoulder dislocation in a mean time of 19 months after the first luxation. In literature the common level of recurrent dislocation is higher than our 16.1%, despite of the shorter immobilising time after the first shoulder luxation in our center. When there is no evolution to recurrent dislocation, a stable shoulder and a normal shoulder function without pain can be expected in 95%. The compression fracture of the humeral head and the avulsion of the glenoid margin were made responsible for the recurrent dislocation, mostly appearing in adult men, younger than 35 (55% of all recurrent dislocations). Because avulsion fractures of the tuberculum majus don't lead to an unstable fracture neither the existence of a compression defect in the humeral head is pathognomonic for an unstable shoulder, nor a lack of such radiological appearance excludes a recurrent dislocation. In first instance rotatory cuff injuries could be responsible for the instability of the shoulder joint. All patients with this invalidating injuries should be stimulated to an operative procedure, because after correction of an unstable shoulder by a derotation osteotomy of Weber or the elevation of the anterior margin of glenoid in the technique of Trillat good results with normal functional capacities of the shoulder can be expected.
Adolescent↗
[Amaurosis caused by traumatic damage to the optic nerve].
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Adolescent↗
[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↗
Classifications in routine use: lessons from ICD-9 and ICPM in surgical practice.
OBJECTIVE: Classifications of diagnoses and procedures are very important for the economical as well as the quality assessment of surgical departments. They should reflect the morbidity of the patients treated and the work done. The authors investigated the fulfillment of these requirements by ICD-9 (International Classification of Diseases: 9th Revision) and OPS-301, a German adaptation of the ICPM (International Classification of Procedures in Medicine), in clinical practice. DESIGN: A retrospective study was conducted using the data warehouse of the Surgical Center II at the Medical Faculty in Essen, Germany. The sample included 28,293 operations from the departments of general surgery, neurosurgery, and trauma surgery. Distribution of cases per ICD-9 and OPS-301 codes, aggregation through the digits of the codes, and concordance between the classifications were used as measurements. Median and range were calculated as distribution parameters. The concentration of cases per code was graphed using Lorenz curves. The most frequent codes of diagnoses were compared with the most frequent codes of surgical procedures concerning their medical information. RESULTS: The total number of codes used from ICD-9 and OPS-301 went up to 14 percent, depending on the surgical field. The median number of cases per code was between 2 and 4. The concentration of codes was enormous: 10 percent of the codes were used for about 70 percent of the surgical procedures. The distribution after an aggregation by digit was better with OPS-301 than with ICD-9. The views with OPS-301 and ICD-9 were quite different. CONCLUSION: Statistics based on ICD-9 or OPS-301 will not properly reflect the morbidity in different surgical departments. Neither classification adequately represents the work done by surgical staff. This is because of an uneven granularity in the classifications. The results demand a replacement of the ICD-9 by an improved terminological system in surgery. The OPS-301 should be maintained and can be used at least in the medium term.
Disease↗
[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↗