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Biomedical subjects

V D Mohr

Publications and source records attributed to V D Mohr.

17 recordsLinked to original sources
PubMed2004

[Clinical performance measurement in surgery and orthopedics -- new aspects in 2004].

In 2004, principles and practice of clinical performance measurement (CPM) in German hospitals were changed according to new legislative and administrative regulations. In many respects, focus and methods of clinical performance measurement were improved in favour of hospitals. Starting from January 1, 2004, the new Gemeinsamer Bundesausschuss (Joint Federal Board) has competence for decisions on future focus and scope of CPM. Former agreements on implementation of CPM in 2004 will be effective as long as Gemeinsamer Bundesausschuss passes new resolutions. Methods to identify relevant cases for CPM particularly changed in 2004. Until end of 2003, obligations to report case data were based on special types of hospital reimbursement. In 2004, obligations for reporting no longer derive from financial criteria, but from medical criteria such as diagnoses and procedures. In 2003, reporting for CPM covered more than 30 subjects in medicine and nursing. For 2004, the scope of CPM has been reduced by 13 subjects which need to be reconsidered in order to secure unified quality goals for out-patients as well as in-patients and to allow long-term follow-up of outcome data. For their CPM expenditure, hospitals receive an additional fee of euro 0.58 per case reimbursed by DRG. Financial sanctions will be effective for hospitals with overall CPM reporting rates below 80 %. Starting from 2005, hospitals are obliged to publish CPM reporting rates for each CPM subject in annual hospital quality reports.

Diagnosis-Related Groups↗
PubMed2000

Plasmapheresis combined with continuous venovenous hemofiltration in surgical patients with sepsis.

OBJECTIVE: To examine the effect of continuous venovenous hemofiltration (CVVHF) combined with plasmapheresis (TPE) in critically ill surgical patients after treatment of the septic focus. DESIGN: Observational pilot study. SETTING: University teaching hospital intensive care unit. INTERVENTIONS: TPE and CVVHF were administered 24 h after surgical and/or interventional treatment of septic focus. Arterial blood pressure, cardiac output, and systemic vascular resistance values were monitored. We examined the effect of the combined extracorporeal detoxification on outcome related to age, morbidity, organic failure rate, and initial APACHE II score. MEASUREMENTS AND RESULTS: Forty-three patients with sepsis were treated; 19 received TPE in combination with CVVHF, and 24 did not receive extracorporeal therapy. Overall mortality was 44.2%. In the therapy group mortality was lower (42.1 vs. 45.8%), but the primary organic failure rate was higher. The relationship between mortality and age was similar in the two groups. There was also no difference between the groups in the course of scores on APACHE II, multiple-organ failure, and sepsis severity. Only patients with an initial APACHE II score of 21-25 had a significant reduction in mortality after combined extracorporeal detoxification. Mortality of 17% in TPE/CVVHF patients with single- (pulmonary) and double-organ failure (renal/pulmonary) was significantly lower (P < 0.0001) than in untreated patients. CONCLUSIONS: Reduction in mortality in single- and double-organ failure was as high as 28% in septic patients with combined extracorporeal detoxification. A prospective randomized trial in sepsis and double-organ failure should be projected.

APACHE↗
PubMed1999

Posttraumatic hypertension secondary to adrenal hemorrhage mimicking pheochromocytoma: case report.

We report the case of a 68-year-old man who presented with a mass 3 x 4 cm in size located in the right adrenal gland together with extreme hypertension, tripled urine levels for normetanephrine, and normal plasmatic levels of metanephrines. The patient had suffered a fall from a height of 2.5 meters before hospitalization. [123I]MIBG-scan was repeatedly positive in the area of the right adrenal gland. At laparotomy under alpha-adrenergic blocking agents, the suspected pheochromocytoma was histologically confirmed as hematoma. After resection of the adrenal gland, blood pressure returned to normal without drug therapy as did metanephrine levels in urine. Although adrenal insufficiency after distension of the gland caused by hemorrhage has been reported, there are no data available regarding the mimicking of a hormonally active pheochromocytoma. We conclude that intra-adrenal pressure rise caused by hematoma may cause partial ischemic necrosis to the gland but may also induce reactive hyperplasia with periodic excessive secretion of catecholamines. This interpretation is consistent with the finding that plasma levels of catecholamines were normal in contrast to the urinary normetanephrines in the presented case. It might be worthwhile to investigate patients with intra-adrenal hemorrhage immediately after sustaining multiple injuries and in the posttraumatic course of several months up to 1 or more years together with verification of abnormal urinary excretion of metanephrines as a sign of impaired adrenal function.

Adrenal Gland Diseases↗
PubMed1999

[Wound dressings in chronic wounds].

Hydroactive wound dressings retain exsudate in the wound region or incorporate wound exsudate by gel formation. They create the local environment for moist wound healing which is experimentally and clinically characterized by accelerated reepithelialization, inflammatory reaction and angiogenesis as well as reduced wound pain and wound infection rates. Clinically relevant product groups of hydroactive wound dressings (hydrocolloids and hydropolymers, semipermeable films, calcium alginates) are distinct as to chemical structure, physical properties and functional characteristics in local wound treatment. Between the product groups, there are considerable differences with respect to inflammatory reactions at the wound bottom, absorption of exsudate, occlusion properties, wound edge adherence, adaptability to the wound shape and material integrity of wound dressings. Experimental and clinical results of moist wound treatment by hydroactive wound dressings such as hydrocolloids and hydropolymers, semipermeable films or calcium alginates reveal a wide range of local response on the different types of dressings. They offer the opportunity of therapeutic differentiation. To elucidate the differential indication for different product groups of hydroactive wound dressings in local treatment of chronic wounds, additional experimental and clinical research is required.

Bandages↗
PubMed1998

[Plasma separation combined with CVVHF in septic and SIRS patients].

In a prospective non-randomized trial, 59 patients with sepsis (n = 43) and SIRS (n = 16) were treated on a surgical intensive care unit. In 22 patients plasmapheresis in combination with continuous venovenous hemofiltration (CVVHF) was administered. Lethality was 56% in the sepsis group; in the therapy group lethality was significantly lower in patients with plasmapheresis, even though in this population the organic failure rate was higher. Finally the dependency of lethality and age was similar in both groups. Lethality at 22% in the plasmapheresis group with double organ failure was significantly lower (P > 0.01) than in controls. Reduction of lethality seemed to be as high as 18% in patients with sepsis, while patients with SIRS did not profit from the additional therapy. A prospective randomized trial in sepsis and double organic failure should be projected.

Combined Modality Therapy↗
PubMed1996

[Endosonographic demonstration of extrapancreatic and extraintestinal gastrinoma].

HISTORY AND CLINICAL FINDINGS: No cause had been found for chronic diarrhoea in a 57-year-old man. Up to 15 watery stools daily had been without relation to food intake and without blood admixture. But muscular cramps had developed, especially in the legs. The patient had a history of recurrent peptic ulcers for which a selective proximal vagotomy had been performed 13 years ago. Physical examination was unremarkable. INVESTIGATIONS: Alkaline phosphatase activity (182 U/l) and C-reactive protein (9.3 mg/l) were slightly raised; serum iron was 42 micrograms/dl, while all other routine laboratory tests, including protein electrophoresis, blood picture and differential count were within normal limits. Gastroscopy revealed ulcerative duodenitis, gastritis with erosions and numerous ulcers and reflux oesophagitis, grade III-IV. Endosonography showed enlarged gastric mucosal relief as sign of foveolar hyperplasia and a ca. 4 x 3 cm tumour next to the duodenal bulb. Gastrin level was 7537 pg/ml (normal < 150 pg/ml). Computed tomography and somatostatin receptor scintigraphy confirmed the site and size of the gastrinoma. TREATMENT AND COURSE: Treatment with omeprazole (40 mg three times daily) slightly improved the symptoms. The tumour was excised a week after diagnosis. The patient has been symptom-free since then. CONCLUSION: Chronic diarrhoea of unknown aetiology can be caused by an endocrine tumour; endosonography can often provide information on the diagnosis and location of such a tumour.

Chronic Disease↗
PubMed1996

[Asymptomatic choledochal cyst].

HISTORY AND FINDINGS: A 45-year-old woman sustained an ankle fracture in an accident. At examination she was found to have marked pallor of skin and mucosae. There was no hint for melaena or haematemesis. INVESTIGATIONS: Biochemical tests showed marked iron deficiency anaemia (haemoglobin 7.5 g/dl) and raised serum bilirubin and C-reactive protein levels (1.94 mg/dl and 85.2 mg/l, respectively). Abdominal sonography revealed a cystic space-occupying mass (8 x 4.5 cm) projecting onto the gallbladder, interpreted as a choledochal cyst of unknown origins without bleeding. After treatment of the ankle fracture an endoscopic retrograde cholangiopancreatography was performed. This showed a large cyst of the choledochal duct into which the cystic and choledochal ducts entered, without evidence of tumour or haematoma. There was also a 1 cm prepapillary common choledochal and Wirsung duct. TREATMENT AND COURSE: With these findings, the diagnosis of a congenital choledochal cyst (type Ia of Todani) could be made. After healing of the ankle fracture the cyst was removed and a Roux Y-anastomosis created. The cystic tissue was benign. At follow-up 6 months later the patient was symptom-free and no longer anaemic. CONCLUSIONS: Congenital choledochal cysts are very rare in Europeans. The symptom-free course with anaemia and no manifestation until adulthood is also very unusual.

Anastomosis, Roux-en-Y↗
PubMed1996

Spontaneous pneumothorax in a patient with systemic sclerosis.

A 28-year-old woman developed spontaneously a right- sided pneumothorax, the leading clinical symptom of an as yet undiagnosed systemic sclerosis. The diagnosis was confirmed by Raynaud's phenomenon, microstomia, arthralgia, distal oesophageal dysfunction and antinuclear antibodies. Initial treatment with pleural suction was followed by thoracoscopy and segmental pulmonary resection. Spontaneous pneumothorax is a rare complication in patients with systemic sclerosis, most likely caused by the rupture of subpleural cysts.

Adult↗
PubMed1996

[Optimizing a conventional documentation system on the surgical intensive care unit--a contribution to cost reduction and preventive quality management?].

In Intensive Care Units (I.C.U.), the lack of staff and funds require the mobilisation of organisational reserves in order to ensure high-quality patient care. Traditional occupational-group organised documentation systems are burdened with lack of clarity, limited utilisation by the staff, insufficient information content and difficulties in synoptic patient monitoring. They cannot meet the demands of modern intensive-care medicine. At the inauguration of our Surgical I.C.U. in June 1992, an occupational-group oriented documentation system was introduced and put into operation. Because of negative repercussions on patient care, it was replaced by a patient-centered, conventional prescription and documentation system in April 1993. In April 1994, an evaluation of the patient-centered system was carried out. We report on our initial problem analysis, the subsequent developmental and introductory phases, and the results after having used the system in our I.C.U. for one year. Data condensation, standardised data recording, as well as structured prescription, examination, assessment and decision processes, saved 730 working hours for medical and nursing staff per year, reduced the cost for documentation materials by 58% and improved the extent of data recording. In our experience, improving a conventional documentation system is a suitable instrument to support cost reduction and preventive internal quality management in the I.C.U.

Cost Savings↗
PubMed1996

[Performance and cost analysis of surgical therapy of stomach carcinoma--results and sequelae].

In order to identify opportunities for cost containment in gastric cancer surgery, and analysis of pre-, peri-, and postoperative cost profiles was performed for 60 gastric cancer patients who underwent curative resections (76.6%), explorative laparotomies (18.3%), and palliative gastrojejunostomies (5%). While pre- and perioperative phases only offer limited opportunities for cost reduction, postoperative complications raised the mean length of hospital stay by 47%, the mean length of intensive care treatment by 865%, and the total treatment costs by 84-248% compared to an uncomplicated clinical course. Pre-, peri-, and postoperative cost-containment efforts must focus on the prevention of postoperative complications.

Costs and Cost Analysis↗
PubMed1995

External fixation of open femoral shaft fractures.

OBJECTIVE: To determine whether external fixation proves to be a sensible technique for definitive stabilization in open femoral fractures. DESIGN: Retrospective clinical study. MATERIALS AND METHODS: From 1985 to 1989, 18 patients (mean ISS 25.4) with open femoral fractures (type II 11%, type III 89%) were treated by primary and definitive external fixation. After failure of closed reduction procedures, open reduction via debrided soft tissue wounds was employed in 72%. Supplemental internal fixation of large wedge fragments was required in 66%. External fixators were removed after a mean of 166 days. Early deep infections developed in 11%. Additional cast, brace, or traction were not required. MEASUREMENTS AND MAIN RESULTS: After a mean follow-up period of 58 months, 88% of the surviving 17 patients were clinically and radiologically evaluated and 12% were interviewed by telephone. Eleven percent developed late deep infection of the femur concerned. Eighty percent have had full or slightly restricted knee motion. The mean knee flexion amounted to 130 degrees. Relevant shortening of the femur was diagnosed in 7%. Nonunions or relevant malunions were not observed in our series. CONCLUSIONS: These morphologic and functional results compare with those published for alternative stabilization techniques of femoral fractures. For special indications, external fixation is considered to be a sensible technique for primary and definitive treatment of open femoral fractures.

Adolescent↗
PubMed1995

[Thoracic actinomycosis].

Thoracic actinomycosis is a rare disease without characteristic clinical signs. Approximately 90% of patients suffering from thoracic actinomycosis have undergone diagnostic and therapeutic procedures based on a wrong diagnostic hypothesis (malignancies 35-44%, other pulmonary disorders 33-35%). The opportunities for a timely and adequate diagnosis by the use of clinical examination, laboratory studies, microbiology studies, radiologic imaging or invasive measures are limited. In 85%, thoracic actinomycosis has not been identified prior to thoracotomy, open biopsy and histological examination. Based on a wrong diagnostic hypothesis, resective thoracic surgery according to the principles of oncologic surgery can hardly be avoided. We report on a 43-year-old male suffering from actinomycosis of the left hemithorax. Clinical signs, differential diagnosis, treatment and clinical course are described. The role of surgery in the treatment protocol of thoracic actinomycosis is discussed. In pulmonary and pleural disorders of unknown origin, differential diagnosis should include thoracic actinomycosis as early as possible. Due to the considerably high mortality rate of untreated disease, the outcome of thoracic actinomycosis can only be improved by a timely and combined employment of surgical and antibiotic therapy.

Actinomycosis↗
PubMed1991

[Heparin-associated thrombocytopenia, thrombosis and embolism. Side effects of thromboembolism prevention with low molecular weight heparin enoxaparin?].

Heparin-associated thrombocytopenia (HAT) is a rarely described adverse reaction of systemic administration of heparin that may be complicated by thrombosis, embolism and bleeding. Unfractionated heparin as well as low molecular weight heparin may provoke HAT. A case of HAT complicated by thrombosis and pulmonary embolism is described that came about during preventive postoperative anticoagulation with the low molecular weight heparin enoxaparin. Pathogenesis, diagnosis, prophylaxis and therapy of HAT are discussed.

Aged↗
PubMed1990

[Osteoid osteoma at the end of the phalanx of the big toe].

A 20-year-old man with persistent pain in the left big toe associated with broadening, thickening and discolouration of the toenail had been treated unsuccessfully for 21 months by surgical measures (wedge excision, avulsion of the nail) and local applications (antibiotics, antimycotics, disinfectants). A radiograph of the left big toe showed an area of calcification 0.5 cm in diameter at the base of the terminal phalanx. It was surrounded by a narrow zone of transradiancy and projected upwards above the margin of the bone. Among the diagnostic possibilities were osteomyelitis and osteoid osteoma. Biopsy revealed the latter, and the patient was cured by "en bloc" resection of the tumour. This case shows that abnormalities of nail growth of the kind commonly associated with paronychia may occasionally be due to a neoplastic lesion in the terminal phalanx.

Adult↗