PubMed Health⌕ Search

Biomedical subjects

W Mutschler

Publications and source records attributed to W Mutschler.

At least 19 recordsLinked to original sources
PubMed1999

Monoclonal antibody to tumor necrosis factor-alpha modulates hepatocellular Ca2+ homeostasis during hemorrhagic shock in the rat.

Tumor necrosis factor-alpha (TNF-alpha) is a key mediator of shock-induced cellular and humoral inflammatory cascades. The present study investigated the role of TNF-alpha in oxidative membrane injury and altered hepatocyte Ca2+ regulation, both of which are critical steps in cellular dysfunction during ischemia/reperfusion events. Hemorrhagic shock was induced by bleeding male Sprague-Dawley rats (200-250 g, n=6/group) to a mean arterial blood pressure of 40 mmHg for 60 min. Rats were resuscitated with 60% of shed blood and twice the shed blood volume as Ringers' lactate. At the end of hemorrhage and 60 min after resuscitation, hepatocytes were isolated by liver collagenase perfusion. Hepatocyte Ca2+ uptake (Ca2+up) and Ca2+ membrane flux (Ca2+flux) were determined by 45Ca2+ incubation techniques. Hepatocyte reduced/oxidized glutathione and lipid peroxidation were determined fluorometrically. Both hemorrhage and hemorrhage/resuscitation significantly increased hepatocyte Ca2+up and Ca2+flux. The monoclonal chimeric mouse gamma1 TNF-alpha antibody (TN3gamma1.19.12; 20 mg/kg b.w.) given with resuscitation significantly decreased hepatocyte Ca2+up and Ca2+flux and prevented hepatocyte lipid peroxidation. These findings suggest that oxidative membrane injury could be the result of TNF-alpha modulation of hepatocellular Ca2+ regulation during hemorrhage/resuscitation.

Animals↗
PubMed1999

[Relevance of life sciences for traumatologic and orthopedic surgery].

During the last 15 years biology and life science underwent a dramatic development. Daily we hear about new discoveries in this area of research. There is for example the identification of new genes, which are responsible for different phenomena: cancer genes, adipositas genes and suicide genes. Furthermore there are reports of human ears growing on the back of a mice or cloning of complex organisms (i.e. Dolly). This kind of research is mostly summarized under terms like: genetic engineering, life science, genetics, molecular biology, biochemistry, bioanalytics, tissue engineering and reproduction medicine. Because of the indiscriminate use of these terms and the complexity of the single discipline only specialists are able to understand and to assess the relevance of results. Aim of this article is to explain some of these terms and to clarify the principles of some important techniques. By this we want to show the relevance of life science for traumatology which possibly leads to new diagnostic and therapeutic concepts.

Animals↗
PubMed1999

[Laparoscopic-transperitoneal and lumboscopic-retroperitoneal surgery of the spine. Developments from animal experiments for use in clinical practice].

With the use of an in vivo porcine training model we established the transperitoneal laparoscopic approach for the instrumentation of anterior lumbar spine fusion with Bagby-and-Kuslich (BAK) interbody implants as well as "Brantigan" cages. The transperitoneal laparoscopic approach caudally from the aortic bifurcation allows the spine fusion procedure of the caudal but not of the cranial part of the lumbar spine. Because ventral stabilization of the upper lumbar spine is frequently necessary, in particular in trauma patients with spine body fractures, an additional retroperitoneal minimal-invasive (lumboscopic) approach was established using again the in vivo porcine training model. We demonstrate that via this approach spine fusion can easily be performed including the Th12 segment after fenestration of the diaphragm. With the experience from the in vivo experiments, both techniques could safely and successfully be transferred to clinical practice with the advantage of markedly reducing the extent of operative trauma compared with the corresponding open approaches.

Animals↗
PubMed1998

Blunt rupture of the right hemi-diaphragm with complete dislocation of the right hepatic lobe: report of a case.

We present herein a case of blunt rupture of the right hemidiaphragm occurring with complete intrathoracic dislocation of the right hepatic lobe in a polytraumatized patient. The initial chest X-ray was interpreted as right-sided hemothorax, and a thoracic drainage tube was accidentally placed into the liver. A computed tomography scan subsequently revealed diaphragmantic rupture with intrathoracic liver dislocation. It was possible to reposition the liver, and the extended dorsal diaphragmatic rupture was closed primarily through an abdominal approach. The problems associated with the diagnosis and operative treatment of fresh right-sided blunt traumatic diaphragmatic ruptures are discussed following this case report.

Adult↗
PubMed1998

Tetraploidization is a physiological enhancer of wound healing.

To investigate the role of chromosomal alterations in the process of wound healing on the cellular level, we analyzed biopsies from well-healing (10) and chronic defect (8) wounds. Classical chromosome preparation and fluorescence in situ hybridization were performed with cultured cells and smear preparations. Results from both techniques showed an unusual high rate of tetraploid cells (4 n) in granulation tissue of well-healing wounds (6.5-60%), whereas we found only a low amount of tetraploid cells (from 0 to 5.5%) in chronic wounds. In fibroblast control cultures, there was a percentage of 2-5.5%. In chromosome preparations, we noticed an increased number of nonclonal structural and numerical chromosome aberrations in both well-healing and chronic wounds. Our data show clearly that especially tetraploidization is a typical phenomenon in the well-healing wound, where it apparently supports the healing process.

Cells, Cultured↗
PubMed1998

[Dorsal stabilization of fractures of the thoracic and lumbar spine by external fixator--technique and outcome].

Posterior stabilization by internal fixator is used as a frequent procedure for the surgical treatment of thoracolumbar spine fractures. The technique of internal fixator stabilization and its results regarding the correction of spinal posture and spinal canal clearance are described. By transpedicular spongiosal filling of the reduced vertebral body, a complete consolidation can be achieved. Occurring correction losses of the spinal alignment are mainly attributed to the collapse of intervertebral segments, thereby suggesting insufficient anterior fusion and support after transpedicular intercorporal cancellous bone grafting. Spinal canal narrowings can only be cleared partially through posterior approach and indirect reduction by internal fixator. In abscence of neurological deficits, residual spinal canal encroachments can be tolerated after surgery, since remodelling phenomenons occur subsequently. However, symptomatic spinal cord compression requires a more efficient decompression technique by direct posterior approach, risking manipulation damage of neural structures. The limited possibilities of internal fixator technique demand the discerning consideration of alternative anterior or combined anterior-posterior procedures for the planning of surgical treatment. For spinal fractures with pronounced destruction of the anterior column and associated intervertebral disc ruptures, an interbody fusion by anterior approach should be performed. In case of additional posterior or transverse instability, a supplemental stabilization by internal fixator is necessary. For severe spinal canal encroachments at thoracic spine level with symptomatic or imminent spinal cord compression, the most efficient decompression by an anterior approach is preferred.

Humans↗
PubMed1998

Modern therapy of chronic wounds with respect to radiation.

BACKGROUND: Descriptions of wound care techniques have been found in some of the oldest archeological findings and chronic wounds have been threaded man thousands of years. However, only in the last few decades substantial progress has been made in understanding the cellular and biochemical processes relevant in normal healing. PATHOPHYSIOLOGY: Wound healing is a complex process involving a variety of different cells, proteins, chemoattractants, proteinases and growth factors. The normal repair process is a coordinated cellular and biochemical event and can be characterized by 3 different healing phases (inflammatory, proliferative, and remodeling phase). Certain pathophysiologic conditions and metabolic disorders alter this preprogrammed course, leading to delayed healing or chronic non-healing wounds. DISTURBANCE OF WOUND HEALING AFTER RADIATION: Especially irradiation can complicate tissue repair and surgical wound healing. Therefore this article will review the basic understanding of the wound healing process and the knowledge of modern surgical and conservative wound therapy from a surgical point of view, which is essential to surpass pathophysiological situations and avoid chronic wounds.

Chronic Disease↗
PubMed1998

[Primary malignant tumors of the sacrum].

The oncological and functional results of 16 patients with primary malignant sacral tumors (12 chordomas, 3 chondrosarcomas, 1 fibrosarcoma) during the past decade are reported. Dorsal approach was used in 10 cases, ventral or combined ventrodorsal procedure in 5 cases; in 1 case only biopsy was taken. Amputation of rectum with colostomy was necessary in 9 cases, ileosacral stabilization in 2 cases. Eight patients died, 5 of the disease and 3 of complications, with a mean survival time of 25.8 months. Local recurrence occurred in 4, distant metastases in 3 cases. Six of the 8 survivors--mean survival is 59 (21-112) months--showed good or excellent functional results according to the Enneking score system. Local complications, mostly wound healing problems, were observed in 9 (56%), neurological disorders in respect of the resected sacral nerve roots in 11 (68%) cases. The oncological and functional results after resection of primary malignant sacral tumors, especially of chordomas, justify radical surgical procedures sacrificing the sacral nerve roots.

Chondrosarcoma↗
PubMed1997

Identification of human semaphorin E gene expression in rheumatoid synovial cells by mRNA differential display.

Rheumatoid arthritis (RA) is characterised by chronic inflammation of synovial tissue with aggressive proliferation of synovial cells causing destruction of cartilage and bone. Immunopathological mechanisms, infectious causes and genetic factors have been discussed, but the etiology of the disease has not been understood until now. Especially, the mechanisms driving tumourlike growth and invasive behaviour of fibroblastoid synovial cells have not been identified yet. Our aim is to find cellular factors which are mediators for such pathways. One possibility to approach this, is searching for disease-relevant genes. We applied the mRNA-differential display technique to compare mRNA expression patterns of normal and rheumatic synovial fibroblasts. We identified an upregulation of the human semaphorin E gene in rheumatoid synovial fibroblastoid cells. Interestingly semaphorin E is a member of a protein-family described to play an immunosuppressive role via inhibition cytokines. A relevance of this finding towards the pathogenesis of RA is discussed.

Arthritis, Rheumatoid↗
PubMed1997

[Pathological fractures].

Pathological fractures are defined as fractures that occur in patients with weakened bone due to systemic and local diseases. If osteoporosis is excluded, the frequency amounts to 5% of all fractures treated. The main diagnostic aim is to observe the pathological nature of the fracture and to perform interdisciplinary, causal therapy. For this, diagnostic and therapeutic algorithms are demonstrated, arranged according to osteopathies, constitution anomalies, myelogenous and inflammatory bone diseases, primary and secondary bone tumors and posttraumatic/postoperative disorders. These algorithms should help the trauma and orthopedic surgeon to select the proper conservative and operative therapy and to use all resection and reconstruction possibilities, such as osteosynthesis, alloarthroplasty and bone transplantation.

Algorithms↗
PubMed1997

[Injuries of the urinary system and management in multiple trauma cases].

Some of the most common lesions in patients with multiple traumas are injuries to the urinary system. A blunt trauma of the abdomen mainly leads to injuries of the kidney, ureter and/or bladder, whereas the external genitals are often damaged by contusions, decollements and even amputation. The multiply traumatized patient must necessarily be cared for and treated through an interdisciplinary cooperation. Thus, "urologisation" of the condition must be avoided, as must the non-recognition of urological injuries. Iatrogenic lesions are primarily observed in the context of urological, gynecological and surgical interventions. Immediate recognition may lead to early treatment, thereby avoiding possible, complications. The procedure for treating multiply traumatized patients will be shown using a plan of specific steps. Symptoms of injuries to the genitourinary system are usually not obvious. In most cases micro- and macro-hematuria are the leading symptoms, but they are not always demonstrable. In the acute phase the drainage of urine must be protected. It is mainly during the third step that urological lesions require surgical treatment. Catheterisation of the urethra may only be performed when the possibility of injury to it is excluded.

Amputation, Traumatic↗
PubMed1997

[A method for nidus localization in osteoid osteomas].

A method for localization of the nidus of osteoid osteomas using CT-controlled needle placement and subperiosteal marking with methylene blue is demonstrated. Our clinical experience in 13 patients is reported. This method allows proper intraoperative localization of the nidus of osteoid osteomas without problems. Thus, osseous resection can be reduced and additional stabilization by internal fixation or defect filling by bone graft are not necessary.

Adolescent↗
PubMed1996

Bilateral vertebral artery lesion after dislocating cervical spine trauma. A case report.

STUDY DESIGN: This case report illustrates the problems associated with diagnosis and management of vertebral artery injuries resulting from dislocating cervical spine trauma. OBJECTIVES: Treatment involved the principles of anterior stabilization of dislocating cervical spine fracture as well as the diagnostic procedures and therapeutic modalities appropriate for vertebral artery lesions. SUMMARY OF BACKGROUND DATA: Because vertebral artery injuries with cervical spine trauma are rarely symptomatic, they can easily be overlooked. Bilateral or dominant vertebral artery occlusion, however, may cause fatal ischemic damage to the brain stem and cerebellum. METHODS: Cervical spine dislocation was stabilized immediately after admission using internal fixation by ventral plate and corticocancellous bone graft. Immediate angiography was performed when brain stem neurologic dysfunction manifested 36 hours after surgery. The patient was treated with anticoagulation, osmotherapy, and controlled hypertension. RESULTS: A fatal outcome resulted in this case of dominant left vertebral artery occlusion. Necropsy even revealed bilateral vertebral artery damage at the level of the osseous lesion. CONCLUSIONS: The possibility of the complication of a vertebral artery lesion should be kept in mind when examining patients with cervical spine trauma, especially in patients with fracture-dislocation. Immediate identification by vertebral angiography, magnetic resonance imaging, or thin-slice computed tomography scan is necessary for optimal management of this injury.

Adult↗
PubMed1996

[Epimetaphyseal pseudarthroses].

Epi-metaphyseal pseudarthroses are rare. They occur in about 1% of cases after osteosynthesis and osteotomies and may cause deviation as well as painful limitation of motion and instability. Several different treatment methods can be advocated, including decortication and bridging of bone and articular defects, stable osteosynthesis and arthroplasty to regain motion. In selected cases endoprosthetic replacement can be a reliable procedure instead of an arthrodesis.

Arthrodesis↗