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  • 1
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 33 (1978), S. 0 
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 32 (1977), S. 0 
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 43 (1988), S. 0 
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The effects of puncture of fresh cadaver dura with 20-, 22-, 26- and 29-gauge needles were observed. A ‘tin-lid’ phenomenon, manifested with all needle sizes, was capable of sealing the resultant hole. The larger the needle, the larger the hole, while rotation of the needle bevel 90° to the fibres altered the shape of the hole. Holes made in thicker parts of the dura tended to retract more rapidly than those in thinner areas.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Der Anaesthesist 47 (1998), S. 409-413 
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Dura mater spinalis ; Meningen ; Rasterelektronenmikroskopie ; Key words Dura mater spinalis ; Meninges ; Scanning electron microscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Although there are various published descriptions of the dura mater spinalis [4, 7, 9, 11, 16], some points relating to the texture of the collagen fibres in the dura have still not been adequately explained. In this study the orientation of the collagen fibril bundles was revealed with the aid of scanning electron microscopy, and our observations have yielded new insights into the three-dimensional structure of the human dura mater spinalis. Materials and methods. The preparations used were taken from the bodies of four persons who had died of acute cardiac infarct at the ages of 70–78 years. The histories of these patients gave no indications of earlier neurological, endocrine or septic illnesses. The tissue examined was taken 8–12 h after death in all cases; it was immediately fixed in glutaraldehyde and then processed for scanning electron microscopy in the usual way. Results. In the outermost (epidural) layer of the dura mater spinalis the collagen fibres are bunched together in bands that run in all directions. Elastic fibres 2 mm thick are woven into this three-dimensional network of collagen systems. On the inside (the arachnoid side) thin collagen fibres are fused into layers in such a way that the innermost layer resting on the arachnoid has a smooth, shiny appearance comparable to that of a serosa. It is attached to the actual dura with a supporting band of connective tissue. Rests of the subdural neuroepithelium could contribute to the smooth appearance of the superficial aspect. Conclusions. The outermost layer of the dura is made up mainly of collegen fibres, which run in all three directions – longitudinal, horizontal and transverse – both singly and in groups. These findings are at odds with ”classic” descriptions, according to which the fibres in the dura mater spinalis all have a parallel course with a longitudinal orientation in tangential sections.
    Notes: Zusammenfassung Obwohl verschiedene Beschreibungen zur Anatomie der Dura mater spinalis vorliegen [4, 7, 9, 11, 16], bestehen immer noch Unklarheiten bezüglich der Textur der kollagenen Fasern in der Dura. Diese Studie zeigt die Verlaufsrichtung der kollagenen Fibrillenbündel mit Hilfe der Rasterelektronenmikroskopie und bringt neue Einsichten über die dreidimensionale Struktur der Dura mater spinalis des Menschen. Material und Methoden: Die verwendeten Präparate stammen von vier Leichen, die im Alter zwischen 70–78 Jahren an akuten Herzinfarkten verstorben waren. In den Anamnesen dieser Patienten ergaben sich keine Hinweise auf frühere neurologische, endokrinologische oder septische Erkrankungen. Das Untersuchungsmaterial konnte 8 bis 12 h post mortem gewonnen werden, wurde sogleich in Glutaraldehyd fixiert und danach der üblichen Vorbehandlung für die rasterelektronenmikroskopische Untersuchung unterworfen. Resultate: In der äußeren (epidural gelegenen) Schicht der Dura mater spinalis sind die kollagenen Fasern zu Bändern zusammengefaßt, die in allen Richtungen verlaufen. Eingewoben in dieses dreidimensionale Netz kollagener Systeme finden sich etwa 2 mm dicke elastische Fasern. Innen (arachnoidalseitig) sind dünne kollagene Fasern zu Schichten derart verschmolzen, daß die innerste, der Arachnoidea aufliegende Schicht einen glatten und glänzenden, einer Serosa vergleichbaren Aspekt bietet. Sie haftet mit Bindegewebstrabekel der eigentlichen Dura an. Reste des subduralen Neurothels dürften zur Glätte der Flächenansicht beitragen. Fazit: Die Außenschicht der Dura besteht hauptsächlich aus kollagenen Fasern, die alleine oder in Gruppen in allen drei Richtungen verlaufen, und zwar longitudinal, horizontal und transversal. Diese Befunde widersprechen den „klassischen” Beschreibungen, die den Faserverlauf der Dura mater spinalis als parallel und longitudinal im Tangentialschnitt darstellen.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 4 (1978), S. 193-197 
    ISSN: 1432-1238
    Keywords: Thoracic epidural analgesia ; Multiple ribfractures ; Flail chest ; Spontaneous breathing
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Thoracic epidural analgesia (EA) is described as an alternative to controlled ventilation in patients presenting with multiple rib fractures. Lung mechanics were especially studied in 6 patients selected from a total of 49. The average ICU stay for this group was 4.5 days (2–11) and the mean age 55.7 years. The EA group was compared with 51 patients primarily ventilated who had an average stay in the ICU of 9.8 days and a mean age of 44.7 years. Mean number of rib fractures of the ventilated group at 6.5 was almost equal to the mean of 6.8 in the EA group. There was a difference in the number of associated fractures, 98 in the ventilated group compared to 35 in the EA group. Severe pulmonary and cerebral contusion were the two most important factors in enforcing the need to ventilate. The success of the method is evidenced by the increase in functional residual capacity (FRC), dynamic lung compliance (Cdyn), vital capacity (VC), the decrease of airway resistance (R) and a significantly increase of PaO2 (p〈0,001) for the EA group with a balanced fluid therapy. All this accounts for the clinical observation of diminishing paradoxical movement of the flail segment.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 8 (1982), S. 89-92 
    ISSN: 1432-1238
    Keywords: Thoracic trauma ; Multiple rib fractures ; Thoracic epidural analgesia ; CPAP mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A protocol for treating thoracic trauma is proposed. Severe pulmonary lesion with increased venous admixture (e.g. contusio, atelectasis, aspiration) is treated by mechanical ventilation. Rib fractures with minor pulmonary lesion and therefore with only moderately abnormal gas exchange but with remarkably reduced vital capacity (even with flail chest) are controlled by thoracic epidural analgesia following vital capacity, tidal volume and respiratory rate. If both a severe pulmonary lesion and serial rib fractures are present, the patient is ventilated for 2–3 days and then extubated to breathe spontaneously with epidural analgesia. The indication for a mechanical ventilation or for spontaneous breathing with thoracic epidural analgesia is therefore deducted more from functional variables than from morphological facts. The course of consecutive series of 283 patients is presented. 155 patients were treated with primary ventilation and 112 patients with primary epidural analgesia, while 16 patients could be managed with general analgesia. The duration of treatment morbidity and mortality show this protocol to be very useful.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Intensive care medicine 1 (1975), S. 71-75 
    ISSN: 1432-1238
    Keywords: Epidural analgesia ; Polytrauma ; Multiple Ribfractures
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Epidural analgesia can be the choice of therapy for all patients with ribfractures and only minor coexisting injuries who are conscious and able to cooperate. In these cases we believe that EA is equivalent or even better than artificial ventilation with all its problems. Generally these patients are far easier to handle and one needs less nursing staff. The dignity of the patients can be maintained and the convalescent time in the intensive care unit is shorter. The criteria for the treatment and for measuring the progress of the patients with multiple ribfractures are discussed
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-1238
    Keywords: PEEP-Weaner ; CPAP ; postoperative oxygenation ; postoperative FRC ; postoperative CPAP
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract After intubation for elective upper abdominal surgery 30 patients were randomized in group A or B. Both groups had the same anaesthetics and were ventilated with a tidal volume of 12 ml/kg the rate keeping PaCO2 near 40 mm Hg. Group A was ventilated with ZEEP and group B with PEEP 10 cm H2O. Group A was extubated when VC reached 15 ml/kg and PaCO2 did not exceed 50 mm Hg breathing spontaneously. Group B was allowed to breathe spontaneously with CPAP and PEEP 5 cm H2O (Basel PEEP-WeanerR) for 3 hours before extubation. Measurements: BP, PAP, RAP, HR, Hb, arterial and mixed-venous blood gases with FIO2=0,21. Both groups were similar in age, sex, cigarette consumption, preoperative pulmonary pathology, surgical procedure pathology, surgical procedure and time of operation. Results: RAP, PAP, BP, HR, PaCO2, PaH, Pv−O2 did not show important differences. Mean PaO2 changed as follows: Postoperative chest X-rays showed in Group A a total of 56 negative scores, in Group B 25. Conclusion: After upper abdominal surgery the well known decrease of FRC with its increased venous admixture can be prevented if the patient is ventilated with PEEP during operation and is breathing spontaneously with CPAP and PEEP for 3 postoperative hours before extubation.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 355 (1981), S. 612-612 
    ISSN: 1435-2451
    Keywords: CPAP ; Spontaneous breathing ; Normal wards ; CPAP ; Spontanatmung ; normale Pflegestationen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Der postoperative Abfall der funktionellen Residualkapazität (FRC) gilt heute als eine der wichtigsten Faktoren für die Verschlechterung des Gasaustausches der Lunge. Der Film zeigt die Anwendung von kontinuierlich positivem Atemwegsdruck (CPAP) über eine Gesichtsmaske. Dies ist ein neues Konzept für Patienten auf normalen Pflegestationen. CPAP wirkt dem postoperativen FRC-Abfall entgegen. Der Gebrauch eines hierfür entwickelten CPAP-Generators (turbo-peep-weaner) und dessen klinische Indikationen werden vorgestellt.
    Notes: Summary The postoperative decrease in functional residual capacity (FRC) is considered to be one of the most important factors to impede gas exchange. The film demonstrates continuous airway pressure (CPAP) via a face mask, a new approach to patients on normal wards. CPAP counteracts the postoperative decrease in FRC. The use of a newly designed CPAP generator (turbo-peep weaner) and its clinical application is shown.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1435-2451
    Keywords: Thoracic epidural analgesia (TEA) ; Multiple rib fractures ; Polytrauma ; Spontaneous breathing ; Ventilation * Vortrag gehalten auf der 97. Tagung der Deutschen Gesellschaft für Chirurgie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfasssung In den letzten 7 Jahren behandelten wir 283 traumatisierte Patienten mit Rippenserienfrakturen und/oder instabilem Thorax. 16 Patienten konnten mit herkömmlichen Analgetica (Morphine) behandelt werden. 112 Patienten erhielten TEA und nur 155 mußten primär beatmet werden. Die Indikation zur Beatmung ergab sich immer aus den Zusatzverletzungen (contusio cerebri, Rückenmarksverletzungen,schwere Lungenkontusion, Aspiration). Die Instabilität des Thoraxskelettes warkeine Indikation zur Beatmung.
    Notes: Summary In the last seven years 283 trauma patients were treated for multiple rib fractures and/or flail chest. Primary management consisted of only morphine analgesia in 16 patients, TEA in 112 patients, and mechanical ventilation in 155 patients. The indication for mechanical ventilation was always associated injuries (cerebral contusion, para- and tetraplegia, aspiration,severe lung contusion) andnot the instability of the thoracic cage.
    Type of Medium: Electronic Resource
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