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Biomedical subjects

W E Mutschler

Publications and source records attributed to W E Mutschler.

At least 19 recordsLinked to original sources
PubMed2003

[Relevance of CT-scans for pediatric head injuries].

AIM OF THE STUDY: Clinical evaluation of pediatric head injury is quite difficult and often cranial CT scans are performed. We investigated the relevance of CT scans in relation to the therapeutic outcome. METHODS: During a 5-year-period we retrospectively evaluated the results of x-ray and cranial CT scan in respect to primary clinical assessment and degree of head injury. RESULTS: From 408 children classified as mild head injury (GCS 15-13) 217 received CT scans with 2 presenting pathological intracranial findings, none of these children required neurosurgical treatment. Out of 29 children suffering from severe head injury (GCS <12) 12 suffered from intracranial bleeding, and 17 had intracranial bleeding and a skull fracture. CONCLUSION: Children encountering mild head injury combined with primary loss of consciousness or vomiting, require hospitalisation. Initial CCT did not lead to therapeutic consequences in this group. Children classified as severe head injury or multiple traumatized children need immediate cranial CT scan and hospitalisation.

Adolescent↗
PubMed2002

[Cooling and irrigation, volume replacement, pain management. First aid in burns].

Of decisive importance for the outcome of burn victims are the depth and extent of the burn, and the age and general state of health of the patient. At the site of the injury, the most important initial measure is the abundant application of cold water to the undressed victim. Early intubation of the burn victim should not be employed too readily. When the burns cover more than 10% of the body surface there is an acute danger of shock, and rapid fluid replacement must be aggressively pursued; the infused volume is calculated on the basis of the extent of the burn (Parkland formula). To treat pain, the i.v. administration of opiates or ketamine in combination with benzodiazepines has proven value. The onsite management of the burns should be restricted to the application of sterile dressings. Grade 1 and 2a burns may be treated out of hospital by cooling, cold water application, burn ointment dressings. More severe burns require hospitalization and surgical management. Since the severity of burn trauma is often underestimated, rapid hospitalization is to be recommended.

Adolescent↗
PubMed2002

[Evidence based trauma surgery].

It is wise for surgeons to critically analyze their decision making, to add evidence in addition to the normal approaches, i.e. expert opinion and pathophysiological rationale. What evidence, is how it works, how often it is used in orthopedic surgery are the main topics of this article, as well as problems and limits to evidence-based medicine (EbM). EbM operates in five steps: 1. formulate an answerable question with respect to the patient's problems; 2. search the relevant literature; 3. critically appraise the assembled information through evidence based standards; 4. implement these evidence supported findings in your daily practice; 5. evaluate your evidence-based practice. When one builds decisions upon evidence the following effects become apparent: rational choice of possible, alternative decisions, reduction of diagnostic and therapeutic risks, improvements in medical education and efficient delivery of health care. A literature search reveals few evidence-based investigations published in orthopedic surgery. Lastly, we discuss limitations of EbM, showing that both misunderstanding about EbM and technical problems contribute to mistrust in EbM. These may include problems with population heterogeneity, standardization of surgical procedures, conducting random studies, the lack of statistical power and often "publication bias". Overcoming present problems with EbM by further ("evidence-based") research should lead to better understanding of the evidence paradigm and eventually modify this approach. The literature already demonstrates that EbM attains its goal. A valid judgment of EbM will result if one evaluates one's own evidence-based practices. The implementation of EbM is also a matter of policy.

Decision Support Systems, Clinical↗
PubMed2001

Surgical treatment of pelvic sarcomas: oncologic and functional outcome.

The experiences in treating 93 consecutive patients (56 males, 37 females; mean age, 38.5 years; range, 4-69 years), including 76 patients with primary malignant bone tumors and 17 patients with soft tissue sarcomas involving the innominate bone, are reported. Oncologic and functional results were investigated in relation to the tumor stage, to the achieved surgical margin, and to the surgical procedure (hemipelvectomy, internal hemipelvectomy and endoprosthetic replacement, and continuity resection). The mean followup was 48 months (range, 8-222 months). The 5-year survival was 86% in patients with low-grade malignant bone tumors, 42% in patients with high-grade malignant bone tumors, and 25% in patients with high-grade soft tissue sarcomas. Survival was influenced by the grade of malignancy, the tumor stage, and the achieved surgical margins. Forty-six patients who survived were examined an average of 36 months after primary surgery. Excellent and good functional results were seen in 82% of patients who underwent continuity resection and in 55.5% of patients who underwent partial or total internal hemipelvectomy. All patients who survived hemipelvectomy had poor functional results. Surgical treatment of pelvic sarcomas is an extensive procedure with a considerable incidence of complications. It requires the knowledge of different techniques of resection and reconstruction of bone, joints, soft tissue, and intrapelvic organs.

Adolescent↗
PubMed1999

Megaprosthetic replacement of the pelvis: function in 17 cases.

Between 1980 and 1997, we treated 39 patients (mean age 39 (16-66) years, 24 men) with megaprosthetic replacement of a large bone defect (> 10 cm) of the pelvis. The bone resection was necessary in 38 cases due to malignant bone and soft tissue tumors and in 1 case due to hydatid disease. Polyacetal hemipelvic replacement was performed in 29 cases, CAD hemipelvic replacement in 8 cases, and a saddle prosthesis was inserted in 2 cases. All patients were followed clinically and radiographically. The mean follow-up was 58 (15-110) months. 20 patients have died of their tumor. 10 local infections occurred, in 2 cases necessitating hemipelvectomy. Hip dislocation occurred in 6 cases. 13 of the remaining 17 survivors had good or excellent clinical results according to the Enneking evaluation (MSTS). In 6 of the 17 survivors, radiographs revealed implant loosening.

Adolescent↗
PubMed1998

Treatment of severe injuries caused by attempted suicide: pattern of injury and influence of the psychiatric disorder on the postoperative course.

OBJECTIVE: To assess the influence of psychiatric disorders on the treatment and postoperative course of patients severely injured as a result of attempted suicide. DESIGN: Retrospective case study. SETTING: University hospital, Germany. SUBJECTS: 36 patients who had multiple injuries after attempting suicide during the five year period 1991-95. INTERVENTIONS: Operative and psychiatric treatment. MAIN OUTCOME MEASURE: Functional results assessed with the Trauma Outcome Profile (TOP) score, psychiatric state, and risk of further suicide attempts. RESULTS: 30 of the 36 patients attempted suicide by jumping from a height, and the most common injuries were fractures of the spine (n = 33) and lower limbs (n = 43). All patients had a psychiatric disorder, and 18 had previously attempted suicide at least once though had inflicted only minor injuries. 29 of the 36 were receiving psychiatric care at the time of the suicide attempt. Five patients died. 27 of the 31 survivors were available for follow up and 26 of them had good or excellent functional results. 30 of the 31 underwent psychiatric assessment (one refused) and none was judged to be at risk of a further attempt. CONCLUSIONS: The functional results were better than we expected. The psychological effect of severe injuries and a long hospital stay seems to reduce the risk of a further attempt, so all treatment (both surgical and psychiatric) is worthwhile.

Adult↗
PubMed1998

[Significance of molecular biology research for trauma surgery exemplified by wound and bone healing].

During the past years molecular biology has become increasing interesting for medical research. These techniques allow the identification of intra-, extra- and intercellular mechanisms, which are important for physiological and pathophysiological processes. Because healing takes place at the cellular level, molecular biology is also relevant for traumatological research. As of yet, there are only a few papers which deal with molecular biological and traumatological problems. For this reason, we only have little knowledge of the function of genes and proteins during wound and fracture healing, for example. To demonstrate the possibilities of molecular biology, we present an experimental strategy by which these techniques can help to answer special traumatological questions.

Animals↗
PubMed1997

[Osseous echinococcosis].

Hydatid disease is caused by the parasitic tapeworm Echinococcus. The larval stage of this parasite can thrive in many parts of the body, most frequently in the liver. Primary bone location is very rare, accounting for less than 2% of all hydatid lesions. We report on a case of left-sided extended pelvic infestation. The destruction of the hip joint, os pubis, large parts of the ileum and the femoral head made pelvic resection and prosthetic replacement necessary. Recurrence of a hydatid cyst 5 years later in the left groin originating from the proximal femur was treated with second femoral resection and new total hip replacement. Because of instability, the primarily inserted polyacetal pelvic replacement had to be exchanged for a custom-made device fabricated with the aid of computer-aided design (CAD) techniques. This surgical procedure was combined with chemotherapy (mebendazole). The necessity of radical resection in osseus hydatid disease is discussed.

Antinematodal Agents↗
PubMed1997

[Right-sided diaphragmatic rupture with intrathoracic displacement of the entire right lobe of the liver].

A case of rupture of the right hemidiaphragm resulting from blunt trauma with complete intrathoracic dislocation of the right hepatic lobe in a multiple trauma patient is presented. After a primary chest X-ray study had been interpreted as showing right-sided hemothorax, the thoracic drainage tube was accidentally placed into the liver. CT revealed a diagnosis of diaphragmatic rupture with intrathoracic liver dislocation. The liver was replaced and the extended dorsal diaphragmatic rupture was closed primarily via an abdominal approach. Problems of diagnosis and operative procedure in rare cases of fresh right-sided blunt traumatic diaphragmatic ruptures are discussed. CT may be helpful in the differential diagnosis of pulmonary contusions, hemothorax and diaphragmatic disruptions with intrathoracic herniation of intra-abdominal organs.

Adult↗
PubMed1997

Osteochondrosis dissecans of the lateral femoral condyle before skeletal maturity.

Many surgical techniques are available for the treatment of osteochondrosis dissecans before skeletal maturity with variable success. In this paper we present a simple and safe surgical technique of bone grafting and temporary stabilization. The rare case of a 10-year-old boy, who suffered from a large developing osteochondrosis dissecans of the lateral femoral condyle, is reported. This patient was treated by retrograde autologous bone graft and fixation of the fragment with K-wires. After 4 weeks partial weight-bearing was possible. During 5 months the lesion healed well which could be demonstrated by x-ray and MRI. Consequently, the K-wires were removed. Because there is a high risk of osteoarthritis developing in the weight-bearing areas, especially in large lateral lesions, prophylactic stabilization and bone grafting is suggested. This can be performed successfully by the demonstrated simple technique.

Bone Transplantation↗
PubMed1995

Hydatid disease of the pelvis and the femur. A case report.

We report a case of left-sided extended pelvic infestation of hydatid disease. The destruction of the hip joint, os pubis, larger parts of os ileum and the femoral head made pelvic resection and prosthetic replacement necessary. Recurrence of a hydatid cyst 5 years later in the left groin originating in the femur was treated with a second femoral resection and total hip replacement. Because of instability, the pelvic replacement also had to be changed to a custom-made CAD replacement. This surgical procedure was combined with chemotherapy by mebendazole. The need for radical resection in osseal hydatid disease is discussed.

Antinematodal Agents↗