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Biomedical subjects

W Künzi

Publications and source records attributed to W Künzi.

16 recordsLinked to original sources
PubMed1992

[Differences of acute and chronic epidural hematoma].

Standard neurosurgical management demands prompt evacuation of all extradural hematomas to obtain a low incidence of mortality and morbidity. In selected cases some authors have suggested that moderate hematomas can be managed conservatively without risk to the patient and with a normal outcome. The goal of this study was to analyze the differences in preoperative clinical parameters between a group of acute and a group of chronic extradural hematomas (chronic extradural hematoma was defined as a delay of more than 72 h from the accident to diagnosis). One hundred fifteen (115) patients with extradural hematomas underwent a standard evaluation, documentation and neurosurgical management (prompt evacuation of all extradural hematomas through a craniotomy). Ninety-five patients (83%) had an acute extradural hematoma. Twenty patients (17%) had a chronic extradural hematoma. We analyzed the following parameters: age, cause of accident, clinical findings, Glasgow Coma Score, morphology of hematoma, location of hematoma, cause of bleeding and clinical outcome. The mean age (chronic 30/acute 32) and age distribution were not significantly different between groups. There were no differences in the cause of accident. All patients in both groups had skull fractures. There was no difference between groups regarding hematoma location, most of there being located in the temporal fossa. In the group of acute extradural hematomas, 62% of patients had a Glasgow Coma Score of less than 8 and 47% had pupillary dilation. In the group of chronic extradural hematomas, moderate clinical symptoms were found, with headache and discrete psychological changes most common. Eighty percent (80%) of the patients had a Glasgow Coma Score of greater than 13 and no patients had pupillary dilation.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1992

[Who should be hospitalized following mild craniocerebral trauma?].

The frequency of minor closed head injuries is high. These injuries may be complicated by the development of life-threatening intracranial hematomas. A well-defined selection criteria for admission must be proposed to guarantee an efficacious observation. In our series of 489 hospitalized patients with a GCS of 15 when seen in the emergency room: 4 patients required evacuation of an intracranial hematoma, 11 revision of a depressed skull fracture or a compound fracture of base of the anterior fossa. Using the existence of a skull fracture as a selection for admission, a strategy proposed by Jennett and colleagues, it would have been possible to reduce the number of patients hospitalized by 70% without missing a patient who developed an intracranial hematoma. Following these criteria no intracranial hematoma would be missed in our patients with a GCS of 15. We suggest that the use of plain x-rays to identify skull fractures and subsequent hospitalization prevents missing an intracranial hematoma. Those patients with diminished levels of consciousness of focal neurologic deficits require admission irrespective of skull fractures.

Adult↗
PubMed1991

Reconstruction of skin and soft-tissue defects in crush-injuries of the lower leg in children.

Severe crush injuries with open comminuted fractures of the lower extremity often result in extensive tissue loss. In such a situation early free microsurgical tissue transplantation offers most effective possibilities of treatment. Among others, two of the most eminent advantages of free microsurgical tissue transplantation are: 1. The possibility of tissue replacement which cannot be achieved by traditional procedures such as functional muscle transplantation or the replacement of extremely extensive tissue loss; moreover immediate or early bone coverage by well vascularized soft-tissue is most effective in the prevention of infection. 2. In many cases complete reconstruction can be achieved by a one-stage-procedure: this decreases the morbidity considerably. These advantages are demonstrated by clinical cases, where we used free microsurgical tissue transplantation.

Amputation, Traumatic↗
PubMed1991

Tissue expanders in reconstruction of burn sequelae.

In 20 patients with burn scars and 1 patient with a fresh burn, 33 tissue expanders were implanted. In 16 patients, the expansion fulfilled the goal set with the help of 27 expanders. The results are very satisfactory, but the effort of treatment and the trouble are substantial. Thirteen patients encountered no complications. In terms of expanders, there were 6 major and 11 minor complications. They were infection (three), wound dehiscence (two), insufficient expansion with hematoma (one), leakage (six), superficial skin damage (three), and intercurrent hematoma formation (two). There was no flap necrosis, and thus, apart from superfluous surgery, no real damage. Retrospectively, the major complications could have been avoided by more careful observance of indications. Unfortunately, this seems to be a process that every surgeon must learn by experience and not by theory alone. Here, infection was managed by removal of the expanders. Hematomas should be evacuated early (we drained most expanders), and incidences of leakage can be diminished by using larger valves. Small incisions in healthy tissue for expander insertion may lead to faster onset of expansion, thus, shortening the procedure. Late widening of scars was found only once, perhaps due to a rather long duration of expansion, averaging 13 weeks.

Adolescent↗
PubMed1991

[Injuries of the lower extremity with vascular lesions of the popliteal area. Management errors].

Lower extreemity injury complicated by limb-threatening vascular injuries of the popliteal artery present an infrequent but difficult management problem. In a retrospective study 37 consecutive patients with severely injured lower extremities after blunt trauma, all complicated by popliteal vascular injury, were evaluated. In 10 patients we found severe management errors: In 7 patients a delay in diagnosis of the vascular injury, in 3 patients with extensive bone and soft-tissue damage an inadequate stabilisation of the fracture. The optimal management of complex injury with associated vascular injuries requires a high index of suspicion and a treatment of all components of such an injury. The initial goals are the accurate diagnosis or exclusion of arterial injury, surgical debridement, adequate bony stabilization with minimal additional bone and soft-tissue trauma, revascularisation by interposition of a vein graft after resection of the damaged segment, immediate fascial decompression and early soft-tissue reconstruction.

Adult↗
PubMed1991

[Prognostic factors in craniocerebral trauma without primary surgically correctable space occupying lesion].

By means of a retrospective study involving 154 patients with diffuse brain injury, we could show, that simple factors, like coexisting injuries, pupil abnormalities and the Glasgow coma scale, allow us to assess the prognosis of patients outcome a short time after trauma. This prognosis is further modified by cerebral perfusion pressure and secondary pupil abnormalities. The prognostic value of an EEG and a SEP is the same for both methods and was found to be correct in about 2/3 of all cases.

Adolescent↗
PubMed1989

[Therapeutic possibilities in hand burns].

Four methods of treating the burned hand are possible: conservative treatment of superficial dermal burns, tangential excision and immediate grafting of deep dermal and barely full thickness burns, granulation method with late grafting of deep dermal to deep full thickness burns, flap procedures of full thickness burns. The tangential excision and grafting of deep dermal and barely third degree burns has improved the well being of the patient by good functional and cosmetic results, less hospitalization time (10-14 days) and less pain. The procedure is described. Tangential excision is contraindicated in the very deep burn. In these the growth of granulations or in certain cases the application of skinflaps will produce better results. Important as to the result is the aftercare consisting of compression gloves and physiotherapy. Even with progress the deep burn remains a devastating injury to the delicately operating hand. Nevertheless the appropriate therapy can achieve good results.

Burns↗
PubMed1989

[Lichen ruber ulcerosus plantae].

A 66-year-old patient suffering from painful ulcerative lichen planus of the feet is presented. Various treatments (topical and oral corticosteroids, irradiation and a 6-month therapy with acitretin) were tried without success. Skin grafting in the affected areas was helpful and resulted with an acceptable and painless state.

Aged↗
PubMed1986

[Toxic epidermal necrolysis (Lyell syndrome)].

Toxic epidermal necrolysis, a serious allergically triggered skin reaction, has a mortality of about 30% largely due to internal diseases. The management involves several specialties. Clinical picture and therapy are described in a case probably induced by allopurinol, with 70% involvement of body surface.

Aged↗