D Nast-Kolb

University Hospital Essen, Essen, North Rhine-Westphalia, Germany

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Publications (305)255.88 Total impact

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    ABSTRACT: Background: The relevance of hollow organ trauma in severely injured patients within a large collective has not been thoroughly reviewed as yet. This study aimed at assessing the prevalence of hollow organ trauma in relation to the outcome and the currently established method of treatment. Patients and Methods: Altogether data of all patients of the Trauma Register of the German Society of Trauma Surgery (DGU) (1993 - 2009) were interpreted retrospectively. All patients with an "Injury Severity Score" (ISS) ≥ 16, direct admission to a trauma centre and an age of ≥ 16 years were included. All patients with abdominal trauma (AISabdomen ≥ 2) were compared with patients with hollow organ trauma (AIShollow organ ≥ 2). The following organs were attributed to the hollow organs: stomach, small intestine (duodenum, jejunum / ileum), colon, gall bladder and urinary bladder. Results: From 9268 patients with abdominal injuries 1127 (12.2 %) additionally showed a hollow organ injury (AISabdomen ≥ 2, AIShollow organ 2 - 5) and were analysed in dependence on the classification of the "American Association for the Surgery of Trauma" (AAST) organ severity score. AAST-hollow organ: II°: 4.6 %, III°: 5.3 %, IV°: 2.1 %, V°: 0.2 %. Patients with leading hollow organ injury (grades IV and V) thereby showed a significant increase of lethality (IV°: 32.7 % and V°: 31.3 %). With an increasing grade of hollow organ injury, however, the ISS increased as well. Lethality was not increased over the expected lethality rate (RISC score) due to the additional hollow organ injury though. Conclusion: The results presented here show the prevalence and the outcome of hollow organ injury in a large collective within the Trauma Register of the DGU for the first time.
    Zentralblatt für Chirurgie 07/2012; · 0.69 Impact Factor
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    ABSTRACT: In einer Übersichtsarbeit von Abraham & Marshall (1999) wurde dargelegt, dass sämtliche, an über 15.000 Patienten durchgeführten Studien mit dem Ziel der Beeinflussung der dysregulierten, inflammatorischen Reaktion bei Sepsis und Multiorganversagen enttäuschende Ergebnisse aufwiesen. Ursache hierfür liegt vorrangig in dem theoretischen Konzept einer isolierten,überschießenden Bildung endogener proinflammatorischer Mediatoren ( z.B. TNF, Interleukine, PAF), welche durch Autodestruktion zur Entwicklung eines septischen Multiorganversagens führen.Untersuchungen der letzten Jahre zeigen jedoch, dass eine inflammatorische Reaktion nicht mit einer isolierten Ausschüttung proinflammatorischer Mediatoren einhergeht, sondern gleichzeitig eine erhebliche antiinflammatorische Reaktion nachweisbar ist, die proinflammatorische Reaktion eine essentielle Komponente einer adäquaten Wirtsreaktion darstellt und aufgrund der hohen Redundanz des Zytokinnetzwerkes der therapeutische Ansatz einer Neutralisation eines einzelnen Mediators nicht mehr gerechtfertigt ist. Zukünftige mediatormodulatorische Therapieansätze setzten neben einer Charakterisierung möglicher individueller inflammatorischer Reaktionsformen und der Identifizierung klinisch relevanter immunologischer Parameter ein engmaschiges immunologisches Monitoring voraus, wodurch eine individuell adaptierte Mediatormodulation ermöglicht wird.
    Der Unfallchirurg 05/2012; 103(10):903-907. · 0.64 Impact Factor
  • Udo Obertacke, Dieter Nast-Kolb
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    ABSTRACT: Die unfallchirurgische Versorgung älterer Menschen ist personell wie sachlich aufwendiger und mit höheren Kosten belastet, als die Versorgungg eines jüngeren Kollektivs. Die medizinischen Versorgungsstrategien müssen den Aspekt der mittel- bis langfristig gesteuerten ambulanten Rehabilitation mit einbeziehen, um einer durch den Unfall ausgelösten zu frühzeitigen dauerhaften Pflegebedürftigkeit vorzubeugen.
    Der Unfallchirurg 04/2012; 103(3):227-239. · 0.64 Impact Factor
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    ABSTRACT: Bei der operativen Versorgung petrochantärer Femurfrakturen im geriatrischen Krankengut stellt eine sofort übungs- und belastungsstabile Osteosynthese das Therapieziel dar. In einer klinischen Studie wurde vergleichend untersucht, ob dieses Ziel mit der DHS (dynamische Hüftschraube) bei allen pertrochantären Frakturtypen erreicht werden kann. Von 1994–1996 wurden 122 pertrochantäre Frakturen mit der DHS behandelt. Neben der Auswertung durch standardisierte Datenerhebungsprotokolle wurden die Patienten durchschnittlich 1,9 Jahre nach Trauma radiologisch und klinisch nach dem “Traumatic hip rating score” nachuntersucht; 22% waren verstorben, von den verbliebenen 95 Patienten konnten 51,6% nachkontrolliert werden. Bei einem Altersdurchschnitt von 75,5 Jahren lag mit dem ASA-Score von durchschnittlich 2,5 Punkten eine hohe präoperative Morbidität vor; 81% der Fälle wiesen eine fortgeschrittene Osteoporose auf. Nach der AO-Klassifikation handelte es sich um 47% stabile (Typ A1) und 53% instabile (Typ A2 und A3) Frakturen. Die mittlere Operationszeit war bei den instabilen im Vergleich zu den stabilen pertrochantären Frakturen mit 108 gegenüber 77 min signifikant höher, der Blutverlust um 43% größer. Direkt mit der Osteosynthese assoziierte Komplikationen betrafen ausschließlich instabile Frakturen (7%). Allgemeine Komplikationen (24,6%) überwogen ebenfalls mit 15,6% in der Gruppe der Typ A2 und A3 gegenüber der Typ-A1-Frakturen, was sich auch in einer entsprechend höheren Klinikletalität mit 5,7% gegenüber 1,6% ausdrückt. Bei der Bewertung des funktionellen Nachuntersuchungsergebnisses mit dem THRS wiesen 71% der Patienten im Vergleich zum präoperativen Ausgangswert eine deutliche Verschlechterung um durchschnittlich 20 Punkte auf. Die Osteosynthese instabiler pertrochantärer Femurfrakturen durch die DHS ist mit einer höheren Komplikationsrate belastet. Während die DHS für die stabilen Frakturen das Standardverfahren darstellt muss die Osteosynthese instabiler Frakturen vor dem Hintergrund neuerer, operationstechnisch und biomechanisch verbesserter intramedullärer Implantate kritisch betrachtet werden. The aim of all surgical procedures in the treatment of trochanteric fractures in elderly and even geriatric patients is achievement of initial stability. We examined in a clinical trial whether primary stability was achieved in all types of trochanteric fractures following osteosynthesis with the Dynamic Hip Scres (DHS). From 1994 to 1996, 122 patients with trochanteric fractures had osteosynthesis by dynamic hip screw. Patient records were evaluated and all data got registered with a standardized protocoll; clinical and radiological outcome was analysed after an average period of 1,9 years after injury according to the Traumatic Hip Rating Score. 22% of all patients died meantimes, 51,6% of the remaining 95 patients could get examined. The average age was 75,5 years, the patient population showed an increased preoperative morbidity (2,5 points) according to ASA-Score. 81% showed progressive osteoporosis. According to the AO-classification 47% stable fractures (type A-1) and 53% instable trochanteric fractures (type A-2 and A-3) occured. Surgery lasted 77 minutes average in osteosynthesis of stable fractures. The duration of 108 minutes in instable fractures was significantly higher, as well as the blood loss was 43% increased in these complex fractures. Complications closely associated to the osteosynthesis appeared only in instable fractures (7%). Also common complications (24,6%) predominated with 15,6% in tpy A-2 and A-3 fractures versus 9% in type A-1 fractures; mortality was also different with 5,7% versus 1,6%. Assesment of the functional outcome according to THRS showed a significant deterioration of 20 points in 71% of all patients compared with the preoperative score. The results show that dynamic hip screw osteosynthesis in instable trochanteric fractures is associated to a higher incidence of complications. While the dynamic hip screw still represents the standard implant in stable fractures of the trochanteric regio, beeing aware of improved intramedullary implants regarding biomechanical features and surgical technique, the results justify to critical consider the use of DHS for osteosynthesis in instable fractures of the trochanteric region.
    Der Unfallchirurg 04/2012; 103(9):741-748. · 0.64 Impact Factor
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    ABSTRACT: The cyr wheel is a modified gymnastic wheel with only one ring that can lead to extreme forces on the gymnast. We report on a distal radius shaft fracture (AO 22 A 2.1) and a fracture of the styloid process of the ulna that occurred after holding on to a slipping Cyr wheel and exposition to high pressure on the lower arm. The fracture was fixed by screws and a plate.
    Sportverletzung · Sportschaden 12/2011; 25(4):244-6. · 0.46 Impact Factor
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    ABSTRACT: The free microvascular fibula diaphysis transplant as femoral neck replacement with preservation of the patient's own femoral head due to a severe infection situation represents a rare indication in the treatment of young patients. In the current literature, such surgical methods do not exist. In the case described here, the free microvascular fibula transplant serves as femoral neck replacement with preservation of the patient's own femoral head without any postoperative mobility restrictions. The depicted course of the disease not only shows the effectiveness of this form of treatment in aseptic femoral head necrosis, but also represents a possible treatment in severe infection situations after trauma.
    Der Unfallchirurg 11/2011; 114(11):1018-23. · 0.64 Impact Factor
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    ABSTRACT: Das freie mikrovaskuläre Fibuladiaphysentransplantat als Schenkelhalsersatz mit Erhalt des eigenen Hüftkopfes aufgrund einer schweren Infektsituation nach Trauma stellt eine seltene Indikation in der Behandlung von jungen Patienten dar. In der aktuellen Literatur existieren derartige Operationsverfahren nicht. In dem hier dargestellten Fall dient das freie mikrovaskuläre Fibulatransplantat als Schenkelhalsersatz bei Erhalt des eigenen Hüftkopfs ohne postoperative Beweglichkeitseinschränkung. Der geschilderte Krankenverlauf zeigt die Wirksamkeit dieser Behandlungsform nicht nur bei aseptischen Femurkopfnekrosen, sondern stellt auch bei schweren Infektsituationen nach Trauma einen möglichen Behandlungspfad dar.
    Der Unfallchirurg 11/2011; 114(11). · 0.64 Impact Factor
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    ABSTRACT: Overuse syndromes of the elbow due to wheel gymnastics are unknown in medical literature. This study describes a common overuse syndrome of the elbow in wheel gymnastics. We conducted internet research and interviewed 260 wheel gymnasts, who trained the "hip roll" element. 60.4 % of the gymnasts reported changes of the elbow region. The intensity of pain during training was 1.51 out of 10 points. Lacerations were reported in 33.1 %, hematomas were reported in 68.7 %, and a loss of hair at the elbow region was reported in 11.7 %. 11.5 % of the gymnasts described a bump and 5.8 % described a depression of the proximal ulnar region that was not found before wheel gymnastics. Gymnasts using protective gear reported significantly higher levels of pain compared to gymnasts without protective gear. The "wheel gymnast's elbow" is a common overuse syndrome of the proximal ulnar due to direct contact and friction of the proximal ulnar to the giant wheel bars. The "wheel gymnast's elbow" describes a combination of lacerations, hematoma, hair loss, bumps, and depression of the proximal ulnar region with only slight pain. An early preventive use of protective gear during "hip roll" training can possibly reduce the "wheel gymnast's elbow" syndrome.
    Sportverletzung · Sportschaden 06/2011; 25(2):103-7. · 0.46 Impact Factor
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    ABSTRACT: The use of blood culture systems for sterile body fluids other than blood has proven to be superior to routine culture methods. This study was conducted in order to assess the performance of the BACTEC blood culture system compared to swab/tissue sample collection for the detection of infection from intraoperative samples taken during surgical procedures. Sensitivity was determined by taking samples (BACTEC and swab/tissue samples) from patients with clinically evident infection (Infection group). Specificity was tested by taking the same sample sets from patients who had aseptic operations with no history of infection (Control group). The sensitivity was found to be much higher for the BACTEC group (50 isolates from 56 samples, sensitivity: 89%) compared to the swab/tissue samples (29 isolates out of 56 samples, sensitivity: 52%). The specificity was lower in the BACTEC group (32 isolates out of 44 samples, specificity: 27%) compared to the swab/tissue samples (1 isolate out of 44 samples, specificity: 98%). We conclude that BACTEC is useful for intraoperative sample collection in cases of low-grade infection. However, it is less specific and there is always the possibility for contamination. Therefore, it is advisable to use this technique in combination with regular tissue samples.
    European Journal of Clinical Microbiology 05/2011; 31(2):201-6. · 3.02 Impact Factor
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    ABSTRACT: Thoracolumbar spine injuries represent the vast majority of unstable spine fractures. In common, patients are instrumented from a dorsal position while primary stabilization of those fractures using a ventral approach remains exceptional. Fracture morphology and concomitant injuries of the discoligamentous complex help to determine whether combined positions or second staged ventral positioned stabilization is indicated. While segmental stabilization and proper fracture reduction are the primary goals, the latter is of specific importance due to the angular point of the vertebral column in fractures of the thoracolumbar spine. The invasive surgical approach in open reduction and stabilization from a dorsal position seems to be replaced increasingly by less invasive angular stable internal spine fixator systems. This article describes the principle, suited indications and the limitations of one of the internal spine fixators available to achieve angular stable percutaneous dorsal stabilization.
    Der Unfallchirurg 02/2011; 114(2):149-59; quiz 160. · 0.64 Impact Factor
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    ABSTRACT: Dorsal stabilization of the thoracic and lumbar vertebral column is still the fundamental technique for acute treatment of unstable vertebral fractures and intervertebral ligament injuries as well as in tumor surgery and the treatment of degenerative and inflammatory diseases. The aim is to achieve the best possible anatomical and axis-correct stabilization of the physical lordosis and kyphosis. This article describes in detail the operational preparation (e.g. necessary imaging, possible positioning of the patient) and procedure (e.g. access, placement of screws and plates, wound closure and postoperative follow-up treatment) and possible complications due to misplaced pedicle screws, the rate of which can possibly be reduced by intraoperative 3D imaging.
    Der Unfallchirurg 02/2011; 114(2):161-6. · 0.64 Impact Factor
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    ABSTRACT: Zusammenfassung Hintergrund Die nicht kontrollierbare Blutung nach einem stumpfen Trauma und der damit einhergehende hämorrhagische Schock sind nach wie vor eine der Haupttodesursachen nach schwerem Trauma. Die bereits vor Klinikaufnahme begonnene Volumentherapie ist ein Hauptpfeiler der Sofortbehandlung. Die Aussagen zur Menge der präklinisch zu verabreichenden Flüssigkeit sind nach wie vor strittig und in der Literatur mit einem geringen Evidenzlevel belegt. Das schwere Bauchtrauma und die instabile Beckenfraktur zählen zu den relevantesten Ursachen des Blutungsschocks. Ziel dieser Untersuchung war es, den Einfluss der Menge präklinisch applizierter Flüssigkeit auf den posttraumatischen Verlauf von Patienten mit einer schweren Abdomen- und Beckenverletzung zu untersuchen. Patienten und Methoden Eingeschlossen wurden alle Patienten aus dem TraumaRegister der Deutschen Gesellschaft für Unfallchirurgie (DGU), die folgende Einschlusskriterien erfüllt haben: Injury Severity Score ≥16 Punkte, primäre Aufnahme, Alter ≥16 Jahre, initialer Blutdruck
    Der Unfallchirurg 01/2011; · 0.64 Impact Factor
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    ABSTRACT: Uncontrollable hemorrhaging after blunt trauma and the resulting hemorrhagic shock is still one of the main causes of death in trauma patients. Starting volume replacement before admission to hospital is one of the main pillars of immediate treatment. The statements concerning the quantity of the preclinically administered fluid are still controversial and have a low level of evidence in the literature. Massive abdominal trauma and unstable pelvic fractures belong to the most relevant causes of hemorrhagic shock. The aim of this study was to analyze the influence of the quantity of the preclinically administered fluid on the posttraumatic course of patients with massive abdominal and pelvic injuries. All patients of the trauma registry of the DGU (German Society for Trauma Surgery) who met the following criteria were included: injury severity score ≥16 points, primary admission to hospital, age ≥16 years, initial blood pressure <100 mmHg and transfusion of erythrocyte concentrate (EC). Out of this collective patients with an AIS abdomen ≥4 or an AIS pelvis ≥4 were analyzed. Both groups were divided into 4 subgroups subject to the preclinically infused volume (<1000 ml, 1000-2000 ml, 2001-3000 ml and >3000 ml). Of the 375 patients with abdominal trauma and 229 patients with pelvic trauma were consistent with the inclusion criteria. In both groups an increasing volume replacement was associated with an increased need for transfusion and a reduction of the coagulation ability (Quick 61% in the case of <1000 ml versus 49.1% in the case of >3000 ml). The rescue time had a relevant influence on the quantity of preclinically infused volume (62 min for <1000 ml versus 88 min for >3000 ml). On admission to hospital the blood pressure values were on average the same in all patients (~ 95 mmHg). With an increasing volume a slight elevation of lethality was found as well as a significant increase of the transfused erythrocyte concentrates, a significant deterioration of coagulation and an increase of patients with mass transfusions. In the case of a preclinical relevant bleeding after blunt pelvic or abdominal trauma moderate volume replacement (<1000 ml) results in an enhancement of the initial coagulation situation and in a reduction in the need for transfusion. The results of this study support the concept of a restrained volume therapy after massive trauma with and bleeding requiring transfusion.
    Der Unfallchirurg 12/2010; 114(8):705-12. · 0.64 Impact Factor
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    ABSTRACT: The relevance of renal trauma in severely injured patients within a large collective has not yet been thoroughly reviewed. This study aimed at assessing the prevalence of renal trauma in relation to the outcome and the currently established method of treatment. Altogether data of 35,664 patients of the TraumaRegister of the German Society of Trauma Surgery (DGU) (1996-2007) were interpreted retrospectively. All patients with an injury severity score (ISS) ≥16, direct admission to a trauma center and an age of ≥16 years were included. All patients with abdominal trauma (AIS(Abdomen) ≥2) were compared with patients with abdominal and renal trauma (AIS(Kidney) ≥2). A total of 18,416 patients fulfilled the inclusion criteria of which 6,218 (34.1%) had abdominal injuries. Of these patients with abdominal injury 835 (13.3%) additionally showed a kidney injury (AIS(Abdomen) ≥2, AIS(Kidney) 2-5) and were analyzed according to the classification of the American Association for the Surgery of Trauma (AAST) organ-severity-score. AAST kidney: II°: 45.5%, III°: 31.1%, IV°: 15.6%, V°: 7.8%. Patients with leading kidney injury (grade IV and V) thereby showed a significant increase in mortality (IV: 32.3% and V: 40.0%) and an increase in the need for surgical intervention (IV: 61.5 and V: 81.5%). With an increasing grade of renal injury, however, the ISS is also increased but mortality was not increased over the expected mortality rate (RISC score) due to the additional renal injury. Dialysis rate in the surviving patients showed an increased rate depending on the degree of the kidney injury (II: 5.5%, III: 7.6%, IV: 18.8%, V: 8.3%). The results presented here show the prevalence and the outcome of kidney injury in a large collective within the TraumaRegister of the DGU for the first time. Based on the current literature and the findings a treatment algorithm has been developed.
    Der Unfallchirurg 12/2010; 115(8):700-7. · 0.64 Impact Factor
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    ABSTRACT: Non-operative management of blunt splenic injury in adults has been applied increasingly at the end of the last century. Therefore, the lifelong risk of overwhelming post-splenectomy infection has been the major impetus for preservation of the spleen. However, the prevalence of posttraumatic infection after splenectomy in contrast to a conservative management is still unknown. Objective was to determine if splenectomy is an independent risk factor for the development of posttraumatic sepsis and multi-organ failure. 13,433 patients from 113 hospitals were prospective collected from 1993 to 2005. Patients with an injury severity score >16, no isolated head injury, primary admission to a trauma center and splenic injury were included. Data were allocated according to the operative management into 2 groups (splenectomy (I) and conservative managed patients (II)). From 1,630 patients with splenic injury 758 patients undergoing splenectomy compared with 872 non-splenectomized patients. 96 (18.3%) of the patients with splenectomy and 102 (18.5%) without splenectomy had apparent infection after operation. Additionally, there was no difference in mortality (24.8% versus 22.2%) in both groups. After massive transfusion of red blood cells (>10) non-splenectomy patients showed a significant increase of multi-organ failure (46% vs. 40%) and sepsis (38% vs. 25%). Non-operative management leads to lower systemic infection rates and mortality in adult patients with moderate blunt splenic injury (grade 1-3) and should therefore be advocated. Patients with grade 4 and 5 injury, patients with massive transfusion of red blood cells and unstable patients should be managed operatively.
    European journal of medical research 06/2010; 15(6):258-65. · 1.10 Impact Factor
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    ABSTRACT: Traumatic injury of supra-aortic vessels remains a challenge in the initial diagnostics of severely injured patients. The presented prospective study analyzed the impact of multislice computed tomography angiography (CTA) as the primary diagnostic method. Patients with the following criteria were included and screened for a dissection of the supra-aortic vessels: a) admission directly from the scene, b) resuscitation room treatment indicated by the official criteria of the DGU (German Society for the Surgery of Trauma), c) suspected blunt trauma to head or trunk as well as d) age over 16 years. During a period of 18 months 374 patients were treated for blunt trauma in the resuscitation room. In 176 cases CTA of the supra-aortic vessels was performed and pathological findings were observed in 16 patients. In 4 cases (2%) a traumatic dissection of supra-aortal vessels was diagnosed and confirmed by magnetic resonance imaging (MRI). All patients received heparin in a PTT effective dosage for 2 weeks and after rehabilitation there were no neurologic deficits. Traumatic supra-aortic dissection was found in 2% of cases in the presented study group. The mechanisms of injury were not distinct in this group. Essentially MSCT angiography screening was demonstrated to be a safe diagnostic tool.
    Der Unfallchirurg 05/2010; 113(5):394-400. · 0.64 Impact Factor
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    ABSTRACT: FragestellungDie traumatische Verletzung supraaortaler Gefäße stellt im Hinblick auf die deletären Folgen und die Möglichkeit einer frühen erfolgreichen Therapie eine besondere Herausforderung an die initiale Diagnostik Schwerverletzter dar. Im Rahmen dieser prospektiven Studie wurde die Bedeutung der CT-Angiographie (CTA) als primäres Diagnostikum analysiert. MethodikEingeschlossen und prospektiv mit der CTA untersucht wurden Patienten mit folgenden Kriterien: a) Aufnahme vom Unfallort, b) Indikation zur Schockraumversorgung entsprechend den DGU-Kriterien, c) Verdacht auf ein stumpfes schweres Trauma gegen Schädel oder Rumpf, und d) Alter über 16Jahre. ErgebnisseIm Zeitraum von 18Monaten wurden 374Patienten im Schockraum wegen stumpfem Trauma versorgt. In 176 Fällen wurde eine CTA durchgeführt. Bei 16Patienten zeigte sich ein pathologischer Befund, in 4 Fällen (2%) fand sich eine traumatische Dissektion der supraaortalen Gefäße, die durch die MR-Angiographie (MRA) bestätigt wurden. Alle Patienten wurden für 2Wochen PTT-wirksam heparinisiert. Nach Rehabilitation zeigten sich keine neurologischen Defizite. SchlussfolgerungEine traumatische supraaortale Gefäßverletzung fand sich im vorliegenden Kollektiv in 2% der Fälle. Der Unfallmechanismus war nicht eindeutig. Die CTA erwies sich als ein sicheres Diagnostikum. PurposeTraumatic injury of supra-aortic vessels remains a challenge in the initial diagnostics of severely injured patients. The presented prospective study analyzed the impact of multislice computed tomography angiography (CTA) as the primary diagnostic method. MethodsPatients with the following criteria were included and screened for a dissection of the supra-aortic vessels: a) admission directly from the scene, b) resuscitation room treatment indicated by the official criteria of the DGU (German Society for the Surgery of Trauma), c) suspected blunt trauma to head or trunk as well as d) age over 16 years. ResultsDuring a period of 18 months 374 patients were treated for blunt trauma in the resuscitation room. In 176 cases CTA of the supra-aortic vessels was performed and pathological findings were observed in16 patients. In 4 cases (2%) a traumatic dissection of supra-aortal vessels was diagnosed and confirmed by magnetic resonance imaging (MRI). All patients received heparin in a PTT effective dosage for 2 weeks and after rehabilitation there were no neurologic deficits. ConclusionTraumatic supra-aortic dissection was found in 2% of cases in the presented study group. The mechanisms of injury were not distinct in this group. Essentially MSCT angiography screening was demonstrated to be a safe diagnostic tool. SchlüsselwörterSchweres Trauma-Supraaortale Arterien-Gefäßdissektion-CT-Angiographie KeywordsSevere trauma-Supra-aortic arteries-Vessel dissection-CT angiography
    Der Unfallchirurg 01/2010; 113(5):394-400. · 0.64 Impact Factor
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    ABSTRACT: This study addresses the aspect of submicron-sized / nanocolloidal wear comparing stainless steel (316L) and titanium alloy (TiAl6V4) for their toxic and inflammatory potentials. Wear was generated in a tribometer using the disc-on-pin-method with pin and disc submerged in a sterile cell culture medium setting. The wear medium was separated according to Stokes' law into a fraction smaller 200 nm (nanocolloids) and a fraction greater 200 nm (particles). Vitality and inflammatory potential was measured in a cell culture model employing murine macrophages (J774). Cells were incubated with increasing concentrations (12.5, 25 and 50vol%) of either wear medium (particles and nanocolloids) from 316L and TiAl6V4. Vitality was measured by MTT assay and inflammatory reactions were quantified by TNF- ELISA.Nanocolloids from stainless steel and titanium induced strong, dose dependant toxic effects in the MTT assay while particles did not affect vitality in a dose dependant manner. The inflammatory response remained unaltered in all four groups. We conclude that interactions between soluble metallic wear and proteins forming nanocolloidal wear should be considered when conduction experiments addressing the aspect of biocompatibility in metallic implant materials.Die Erzeugung eines nanokolloidalen Verschleißmediums aus Edelstahl und einer Titanlegierung und deren toxische Effekte in einem Monozyten-ZellkulturmodellDiese Arbeit vergleicht die Wirkung von Verschleißpartikeln und Nanokolloiden von 316L Stahl und der Titanlegierung TiAl6V4. Verschleiß wurde mittels eines Tribometers mit dem Scheibe-auf-Stift-Versuch erzeugt, wobei Stift und Scheibe whrend des Verschleißvorganges von sterilem Zellkulturmedium umgeben waren. Partikel und Nanokolloide wurden mittels Zentrifugation nach dem Stokesschen Gesetz in die beiden Fraktionen Partikel (Durchmesser >200 nm) und Nanokolloide (Durchmesser <200 nm) getrennt. J774-Zellen wurden mit verschiedenen Konzentrationen (12,5, 25 und 50vol%) der beschriebenen Verschleißmedien inkubiert. Die Vitalitt der Zellen und die inflammatorische Wirkung wurden mittels MTT-Test und TNF- ELISA bestimmt.Nanokolloide, sowohl von Stahl als auch von Titan führten zu einem starken dosisabhngigen Rückgang der Vitalitt. Die inflammatorische Reaktion war in allen Gruppen (Partikel und Nanokolloide von jeweils 316L und TiAl6V4) konstant.Es lsst sich schlussfolgern, dass nanokolloidaler Verschleiß bei der Durchführung von Biokompatibilittsuntersuchungen berücksichtigt werden müssen, da dieser toxische Effekte in der Zellkultur hervorrufen kann.
    Materialwissenschaft und Werkstofftechnik 12/2009; 40(12):869 - 877. · 0.51 Impact Factor
  • Der Unfallchirurg 12/2009; 112(12):1062-5. · 0.64 Impact Factor
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    ABSTRACT: Accidental hypothermia is a common complication in severely injured patients. Risk factors include environmental exposure of the patient at the accident site or in the clinic, infusion of cold fluids, hemorrhagic shock and anesthetics which influence thermoregulation. In contrast to animal studies, human studies and clinical experiences have identified accidental hypothermia of the severely injured patient to be associated with increased complication and mortality rates. As a consequence, hypothermia together with acidosis and coagulopathy, have been coined the lethal triad in severely injured patients. On a cellular level hypothermia reduces cellular activity and metabolism resulting in reduced oxygen consumption, which is therapeutically used in patients following cardiac arrest. However, the activity of important enzymes, such as those of the coagulation pathway, is simultaneously down regulated. Hypothermia-induced coagulopathy, which is refractory to substitution of coagulation factors, is a major complication of hypothermia in traumatized patients. Therefore, hypothermic trauma patients with hemodynamic instability require aggressive rewarming.
    Der Unfallchirurg 12/2009; 112(12):1055-61. · 0.64 Impact Factor

Publication Stats

3k Citations
255.88 Total Impact Points

Institutions

  • 1998–2012
    • University Hospital Essen
      • Klinik für Unfallchirurgie
      Essen, North Rhine-Westphalia, Germany
  • 2010
    • Universitätsklinikum Gießen und Marburg
      • Klinik für Unfall-, Hand- u. Wiederherstellungschirurgie
      Marburg, Hesse, Germany
    • Philipps-Universität Marburg
      • Klinik für Unfall-, Hand- und Wiederherstellungschirurgie (Marburg)
      Marburg an der Lahn, Hesse, Germany
  • 2009
    • Heinrich-Heine-Universität Düsseldorf
      • Klinik für Unfall- und Handchirurgie
      Düsseldorf, North Rhine-Westphalia, Germany
  • 1998–2009
    • University of Duisburg-Essen
      • Faculty of Medicine
      Essen, North Rhine-Westphalia, Germany
  • 2008
    • Klinikum Braunschweig
      Brunswyck, Lower Saxony, Germany
    • Goethe-Universität Frankfurt am Main
      • Klinik für Unfall-, Hand-, und Wiederherstellungschirurgie
      Frankfurt am Main, Hesse, Germany
  • 2005
    • Katholisches Klinikum Essen
      Essen, North Rhine-Westphalia, Germany
    • Universität Mannheim
      Mannheim, Baden-Württemberg, Germany
  • 2001
    • Universität Heidelberg
      • Department of Orthopedics and Traumatology
      Heidelberg, Baden-Wuerttemberg, Germany
    • Pravara Rural College of Pharmacy
      Chānda, Mahārāshtra, India
  • 1991–1999
    • Ludwig-Maximilian-University of Munich
      • Cardiac Surgery Clinic
      München, Bavaria, Germany
  • 1989–1998
    • Technische Universität München
      • Clinic and Polyclinic for Surgery
      München, Bavaria, Germany