Biomedical subjects

V Heppert

Publications and source records attributed to V Heppert.

10 recordsLinked to original sources

PubMed2006

[Implant-associated post-traumatic osteomyelitis. Bacterial biofilms and the immune defence as protagonists of the local inflammatory process].

BACKGROUND: Formation of bacterial biofilms on implants is a severe complication following orthopaedic surgery. In the present study we addressed the role of the immune response, particularly with regard to the pathogenesis of the disease. METHODS: In a prospective study comprising 74 patients with implant-associated post-traumatic osteomyelitis, peripheral blood cells as well as cells recovered from the infected site during surgery were characterised phenotypically and functionally. RESULTS: We found massive infiltration of polymorphonuclear neutrophils (PMN), which were highly activated, particularly regarding their bactericidal potential, such as increased production of superoxides and upregulation of activation-associated surface receptors. CONCLUSION: PMN are activated in response to the implant-associated osteomyelitis; they also infiltrate the infected tissue, but cannot control the infection. By release of their cytotoxic entities they could contribute to tissue destruction and eventually to osteolysis.

Adolescent↗

PubMed2006

Cellular inflammatory response to persistent localized Staphylococcus aureus infection: phenotypical and functional characterization of polymorphonuclear neutrophils (PMN).

Persistent, localized Staphylococcus aureus infections, refractory to antibiotic treatment, can result in massive tissue destruction and surgical intervention is often the only therapeutic option. In that context, we investigated patients with S. aureus-induced infection at various sites, apparent as either olecranon bursitis, empyema of the knee joint or soft tissue abscess formation. As expected, a prominent leucocyte infiltrate was found, consisting predominantly of polymorphonuclear neutrophils (PMN) (up to 75%) and to a lesser extent of T lymphocytes and natural killer (NK) cells. In line with their bactericidal capacity, PMN expressed the high-affinity receptor for IgG, CD64 and the lipopolysaccharide (LPS) receptor CD14; moreover, the oxygen radical production in response to the bacterial peptide f-MLP was enhanced, while chemotactic activity was greatly reduced. The more intriguing finding, however, was that a portion of PMN had acquired major histocompatibility complex (MHC) class II antigens and CD83, indicative of a transdifferentiation of PMN to cells with dendritic-like characteristics. Of note is that a similar transdifferentiation can be induced in PMN in vitro, e.g. by gamma interferon or by tumour necrosis factor alpha. Co-cultivation of transdifferentiated PMN with autologous T lymphocytes resulted in prominent T cell proliferation, provided that S. aureus enterotoxin A was added. Taken together, persistent S. aureus infection induces PMN to acquire characteristics of dendritic cells, which in turn might promote the local immune response.

Aged↗

PubMed2004

[Postoperative and bacterial osteitis. New possibilities for therapy].

Current therapy concepts for post-trauma osteitis include radical debridement, stabilization of bone and soft tissue care using early flap transfers. With this more radical approach, the long term results are improved, however, total treatment time still is very long. In addition to the physical, mental and social consequences for the patient, treatment costs are also very high. Antibiotic therapy as an adjuvant is still standard and effective although the development of worldwide antibiotic resistance has increased treatment difficulties. One of the main aims of research is to reduce these problems or to prevent the development of osteitis entirely. However, research has not yet elucidated the complex immunologic changes involved. In addition, most results are obtained from animal studies and clinical investigations are required.

Anti-Bacterial Agents↗

PubMed2000

[Vastus lateralis flap--an ideal procedure for definitive surgery of infected cavities of the hip].

Between January 1994 and August 1998, 12 patients with 13 chronic infections after resection arthroplasty were treated successfully with vastus lateralis muscleflap. One patient was suffering from chronic infection on both sides. In all cases we found the infected cavity to be the origin of the persistent infection. The average duration of infection was 8.3 months. The patients had undergone an average of 3.8 operations. Up to now there was no recurrent infection, controlled by clinical investigation, ultrasound and laboratory findings in all 13 cases. Follow up investigation occurred 2.5 years (1.5-4.7) after flap transfer. The flap is easy to harvest. He has a very constant pattern of vascular pedicle and a wide arc of rotation. The functional deficits of donor side morbidity are minimal. That vastus lateralis flap seems to be an ideal procedure to stop draining infections due to infected cavities in the hip region.

Adult↗

PubMed1998

[Treatment of soft tissue damage--definitive management].

Fractures of the extremities combined with soft tissue damage are still a big challenge for the orthopaedic surgeon. Medical mismanagement leads very often to osteomyelitis and high treatment costs. Radical débridement is the key to therapy success. Closure of soft tissue lesions has to be done within 1 week. Methods of choice are vacuum sealing, meshgraft, flap transfer and the Ilisarov procedure. The chosen tool has to be harmonized with the fracture classification. Only individual decisions are possible. For the best results, orthopaedic surgeons should have a good knowledge of the reconstructive possibilities.

Debridement↗

PubMed1997

[The determinants of the quality of life after a type-III open tibial fracture. The results of a multicenter study].

This study investigated to what extent quality of life four years or more after the fracture is determined by initial staging (Gustilo subclassification, time from injury to arrival at hospital), by the therapeutic course (length of hospital stay, number of operations), by complications (amputation, infection) and by demographic factors (gender, age). A total of 197 patients after type III open tibial shaft fractures (type IIIA 70, type IIIB 85, type IIIC 42) from nine centers volunteered to participate in this study. During patients' follow-up appointments (mean duration of follow-up 50 months), therapeutic course, pre-surgical staging and demographic data were recorded by the surgeon. Patients were asked to rate quality of life on the Nottingham Health Profile and on a visual analogue scale. Multiple regression analysis (stepwise) identified two predictors for reducing overall quality of life (F-test: P = 0.007): number of operations (adjusted beta: -0.21) and age (adjusted beta: -0.17). Other factors showed no significant relationship with overall quality of life or with subscales of the Nottingham Health Profile. These findings indicate a dilemma between two therapeutic goals: good functional outcome, which often requires repeated operations, and quality of life, which suffers under prolonged surgical treatment.

Adult↗

PubMed1995

[Necrosis of the rectus abdominis muscle. Complication after ilioinguinal approach].

After a car accident, a 19-year-old man had to undergo laparotomy in a local hospital due to intra-abdominal bleeding. A right-sided transrectal incision was chosen, and to improve exposure the rectus muscle was cut horizontally at the cranial end of the incision. Ten days after the accident the patient was transferred to our hospital for stabilization of the pelvic and acetabular fracture on the right side. An ilioinguinal approach was chosen. Two days later the abdominal cavity was opened due to necrosis of the cranial part of the rectus abdominis muscle. Following a 10-day period without pathological symptoms, suddenly sepsis developed. Ultrasound showed a lot of fluid in the rectus sheath; no muscle structure could be identified. The operation showed total necrosis of the rectus muscle due to thrombotic occlusion of the inferior epigastric artery. The standardized tourniquets around the vessels used during the ilioinguinal approach seemed to be responsible for the rectus muscle necrosis. Therefore, if a combined intraabdominal and pelvic approach has to be used, median laparotomy is the better choice, because no risk is posed to the blood supply of the rectus muscle, in contrast to the ilioinguinal approach. The problem is discussed in detail.

Abdominal Injuries↗

PubMed1981

Posterior aortic wall motion and left atrial volume changes.

The motion characteristic of the posterior aortic wall has been used in precordial M-mode echocardiography as a parameter of cardiac function. However, the determinants of this characteristic motion pattern of the aorta are still unknown. In this study the posterior aortic wall motion was studied angiographically as it is related to left atrial volume changes. 21 patients with various heart diseases served as the study group. 18 patients were in sinus rhythm, 3 patients in atrial fibrillation. We found an excellent agreement between left atrial volume changes and the movement of the posterior aortic wall. The correlation coefficient between both parameters ranged from .73 to .95 irrespective of the underlying heart disease and heart rhythm. From this study one can conclude that left atrial volume changes are reflected by the motion of the posterior aortic wall.

Adult↗

PubMed1981

[Posterior aortic wall motion in mitral valve disease (author's transl)].

The posterior aortic wall motion was studied in 60 patients, 39 patients with mitral valve disease and 21 normals. The motion of the posterior aortic wall was measured by using the amplitude of the posterior aortic wall motion from the beginning of left ventricular contraction to aortic valve closure and an atrial filling and emptying index. The latter two indices were used, because left atrial volume changes were reflected by the motion of the posterior aortic wall. It could be demonstrated that normals differed in their motion pattern of the posterior aortic wall to those with mitral valve disease. Furthermore, patients with mitral stenosis, mitral insufficiency and mixed mitral valve disease could be differentiated from each other in terms of these indices and an atrial filling-emptying ratio. Thus careful inspection of the posterior aortic wall motion by precordial echocardiography can be used as a parameter of mitral valve function.

Adult↗

PubMed1980

[Motion of the posterior wall in the m-mode echocardiogram - a parameter of global left function (author's transl)].

The cardiac output was determined by thermodilution in 42 patients during heart catheterization and compared to the amplitude of the posterior aortic wall in the m-mode echocardiogram. The amplitude of the posterior aortic wall was measured at the time of the closure of the aortic cusps (KS) and at the time the maximal excursion of the posterior aortic wall occurred (GA). Both parameters correlated strongly to the cardia output (r = 0.84, KS; r = 0.76, GA) and to the forward stroke volume (r = 0.81, KS; r = 0.73, GA). Thus, the amplitude of the posterior aortic wall in the m-mode echocardiogram is a useful parameter in predicting left ventricular function especially in those patients, in whom determination of left ventricular function from the m-mode echocardiogram is limited due to left ventricular asynergy.

Aorta↗