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Biomedical subjects

W Hartel

Publications and source records attributed to W Hartel.

At least 19 recordsLinked to original sources
PubMed1992

Postgraduate education and role of surgical research in Germany.

In Germany at the very moment we have general surgery and 5 specialties, they are: traumatic, plastic and reconstructive, cardiac and central vessels as well as pediatric surgery. For qualification as a general surgeon one needs at least 6 years of straight training; two more years are necessary to qualify in one of the mentioned specialties. In some specialties one year of training can be taken into account for general surgery. The postgraduate education in each field requires a precisely defined kind and number of operations as well as an examination. There are some considerations in discussion, which should be outlined: Generally speaking this means, that the basis of 6 years of general surgery may be reduced to 4 years. Thus specialization could be started 2 years earlier. This special point is in strong discussion due to the fact that the surgical skillfulness of the young surgeons may be decreased. In university hospitals and in academic teaching hospitals surgical research is realized within the surgical department as well as in special departments for experimental surgery. The ideal would be that both institutions stimulate each other.

General Surgery↗
PubMed1992

[Humerus reconstruction after gunshot fracture].

High-velocity bullits can cause severe blast injuries with shattering and defects of the large bones. Initial external fixation is followed by rebuilding of the bone, which is difficult due to concomitant infection, poor revascularization and lack of a suitable bone bed. A case report of an injured African soldier shows the follow-up and difficulties of reconstruction of the shattered humerus by repeated spongious bone grafting. After successful remodeling of the bone, external fixation is followed by ASIF dynamic compression-plate osteosynthesis.

External Fixators↗
PubMed1992

[Disorders of hemostasis after polytrauma. On the extent of intrinsic fibrinolytic activity in the preclinical phase].

Coagulation disorders are of utmost importance in emergency surgery as well as for secondary organ failure of polytraumatized patients. In order to get hold of the early onset of these disorders, blood samples were harvested from 20 randomly selected patients (Injury Severity Score mean = 36.7 +/- 10.5) on the scene of emergency (mean = 18 [10-29] min after trauma) and at the time of hospital admission (mean = 78 [58-98] min after trauma). In addition to the activation of intravascular coagulation and the consumption of physiological inhibitors, high amounts (10- to 50-fold above normal) of degradation products (FgDP, FbDP, TDP, D-dimers) are present on the scene, already. The influence of hemodilution due to high-volume resuscitation is discussed.

Adolescent↗
PubMed1991

[Light and scanning electron microscopy studies of the pleura. A contribution to the pathogenesis of spontaneous pneumothorax in young patients].

In a prospective study of 10 patients (7 men, 3 women, mean age 26.2 years), who underwent thoracotomy because of recurrent spontaneous pneumothorax, we performed light and scanning electron microscopic investigations of the resected pleura. The purpose of our work was to explain pleural changes which allowed the penetration of air through the intact wall of the blebs. In 8 of 10 cases we found small bullae at the top of the upper lobe, the remaining 2 showed up with massive pleural scar. The morphological and ultrastructural findings indicated that the presence of air induced a reactive process at the visceral pleura which led to degeneration and scarification. The changes consisted of simple membrane formation up to complete destruction of the pleural layer. The development of blebs is due to an air fistula coming out of the lung parenchyma. Penetration of air through the bleb's wall is explained with the increasing pressure inside and the dehiscence of degenerated pleural structure. In our opinion spontaneous pneumothorax in young people is caused by a localized disease of the upper lobe. The pleural changes are the visible effects of a degenerative process induced by air fistula from lung parenchyma. Therefore wedge-resection of that region is a rational therapy in patients with spontaneous pneumothorax.

Adult↗
PubMed1990

[The use of bioresorbable implants (Biofix) in surgery. The indications, technic and initial clinical results].

Carrying out osteosyntheses with absorbable implants is a dream cherished by traumatologists for a long time. The absorbable rods available on the medical market comply within narrow ranges with the necessary conditions with regard to stability, absorption time and biocompatibility. In our clinical department 38 osteosyntheses with Biofix rods were performed. The complication rate amounted to 13%-5 abacterial disturbances of wound healing and secretions. The indications assured so far are limited to refixation of chondral and osteochondral fragments as well as the fixation of cortical-cancellous bone grafts.

Absorption↗
PubMed1990

[Lung injuries: diagnosis and surgical strategy].

Between 50 to 60% of all polytraumatized patients have a thoracic injury with a mortality of 30 to 60%. The first diagnostic steps involving symptoms such as in- or expiratory pain, emphysema of the skin, flail chest or sipping noise lead via clinical examination to first and often definitive therapeutic procedures, i.e. intubation, artificial respiration and insertion of chest tube. X-ray of the chest, computed tomography as well as ultrasonic screening and monitoring of arterial blood gases are important in in-door technical diagnosis. The decision for emergency room thoracotomy or a regular or delayed operation has to be made at times. Complications (20%) to consider are pneumo- and haematothorax, pleural rind, pneumonia, broncho-pleural fistula and most of all pleural empyema.

Follow-Up Studies↗
PubMed1990

[Recurrence of non-small cell bronchial cancer: indications and results of surgical treatment].

Bronchoscopic laser application and radiotherapy are very effective in treating the recurrence of bronchogenic carcinoma. Reoperation is rarely possible. During the period from January 1981 to June 1989, 242 patients underwent lung resection at the Bundeswehrhospital Ulm because of malignant airway disease. In ten of these patients reoperation was performed in case of tumour recurrence. The median survival time was 17 months (2 to 60 months). Comparing the literature with our own experience we conclude that operative treatment of bronchogenic recurrences is possible in few selected cases. The indication for reoperation depends on the stage of the primary tumour, the spread of the recurrence and the physiological status of the patient.

Adult↗
PubMed1989

[Pleural porosity in idiopathic spontaneous pneumothorax].

Intraoperative investigations after axillary thoracotomy in 28 patients with spontaneous pneumothorax shows true ruptures of subpleural bullae in 25% of the cases. In 75% structural pleural changes in the top of the lung are responsible for porosity and air leakage of the wall of the bullae. Pleural porosity causes a prolonged treatment of this illness. Appreciation of the phenomenon of "pleural porosity" is the key for understanding several questions regarding the diagnosis and treatment of spontaneous pneumothorax that had remained unanswered to date.

Cell Membrane Permeability↗
PubMed1987

[Measuring compartment pressure of the lower leg with a microtip probe].

In the acute compartment syndrome it is difficult to decide on the basis of clinical criteria alone whether or not fasciotomy is indicated. Reliable and objective parameters are required before a treatment schedule can be devised. Measurement of the pressure inside the acute compartment can facilitate the decision as to whether operative treatment is appropriate in the case of the muscular compartment involved. We performed compartment pressure measurements in the tibialis anterior compartment in 27 healthy volunteers using a microtip probe. Clinically relevant results were obtained. It was demonstrated that this method could be used either in acute cases or for long-time measurements. We think that using a microtip probe for intracompartmental pressure measurement provides reliable data and makes the decision on fasciotomy much easier.

Anterior Compartment Syndrome↗
PubMed1985

[Pathophysiology and methods of treatment in renal hypertension in renal artery aneurysms].

Aneurysms of the renal artery occur infrequently and remain mostly asymptomatic. A review of the pertinant literature reveals approximately 300 reports. Hypertension is the predominant sign and affects two thirds of all patients, particularly in aneurysms complicated by stenosis or thromboembolism of renal artery, which is caused by the renin-angiotensin-mechanism. A solitary renal aneurysm causes no renal hypertension; 66% of all diagnosed renal artery aneurysms require no treatment. Resection of the aneurysm and direct suture was done in half of all operated patients. Only in 27 cases operative treatment consisted of extirpation and patch-plastic (autologic or alloplastic). Two additional cases in our own hospital with resection and patch-plastic are described. By using those techniques it is possible to normalize renal artery blood flow as well as blood pressure. Other well-known surgical procedures are nephrectomy, aorto-renalbypass and several others.

Adult↗
PubMed1983

Closure of lung leaks by fibrin gluing. Experimental investigations and clinical experience.

In 28 male Wistar rats a standardized lung incision was closed by running suture and in half of the animals by additional application of fibrin adhesive. The animals were sacrificed 30 minutes and 5 days postoperatively. A significantly higher tolerance to increased inflation pressure was found in the fibrin-treated group. Ten patients undergoing pulmonary resection had conventional closure of parenchymatous lesions with additional fibrin gluing. Under positive air way pressure ventilation the sealing effect proved to be better after application of fibrin adhesive to the sutured area.

Animals↗
PubMed1980

[Thyroid hormone levels after surgical stress reaction (author's transl)].

In a larger collective of surgical patients the behaviour of the individual thyroid parameters (T4, T3, rT3, TBG and thyroxine-binding capacity) were studied before, during and after operation and set in relation to each other. There are significant shifts in T4 metabolism towards the formation of rT3. In spite of its greatly reduced metabolic activity compared with T3, an important regulatory effect is attributed to rT3, in thyroid metabolism in stress situations.

Adult↗