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  • 1985 - 1989  (410,773)
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  • 1
    Keywords: Arbeitsgemeinschaft der Großforschungseinrichtungen (Germany) ; Research institutes / Germany ; Research ; Germany
    Notes: Ceased with ed. 1995.
    ISSN: 0935-2236
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  • 2
    ISSN: 1435-1803
    Keywords: endothelium ; vasoconstriction ; EDCF ; oxygen-dependence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary To enlighten the role of endothelium in the generation of vasospasms we examined vascular tone after reduction of oxygen supply in dependence on endothelial function in isolated vessels (rabbit aorta abdominalis, pig coronary, and pulmonary artery). Therefore, after ligation of all side branches, vessel segments, prepared either with or without endothelium, were cannulated and arranged in two systems (with two segments each) in a serial manner (system I: endothelium-denuded vessel followed by an endothelium-denuded segment) and perfused with Tyrode's solution (constant flow 20 ml/min). Pressure gradient over each segment was continuously measured. Endothelial function was checked by perfusion with 1 μmol/l actetylholine after precontraction with 0.1 μmol/l norepinephrine, thereby inducing an EDRF mediated vasodilation (>70%) indicating normal endothelial function. After 2 h equilibration with Tyrode's solution the preparations of rabbit aorta abdominalis were perfused for 30 min with oxygen-deprived medium (reduction from 95% O2 and 5% CO2 to 95% N2 and 5% CO2) and a marked long lasting (60 min) increase in pressure gradient (indicating vasoconstriction) was observed in those endothelium-denuded vessel segments which were mounted distal to a normal vessel with an intact endothelium. This contraction could be inhibited by pretreatment with either 1 μmol/l dexamethasone, 1 μmol/l indomethacine or 10 μmol/l methylene blue or attenuated by the TXA2-antagonist BM 17133 (5 μmol/l) but not by radical scavengers as superoxid dismutase or by inhibition of the lipoxygenase by nordihydroguaretic acid. From these results it is concluded that endothelium releases a vasoconstricting factor (EDCF) at pO2 values beneath 550 mm Hg. This EDCF seems to depend on phospholipase A2 and cyclooxygenase, but because of the long-lasting effect it is probably no prostanoid itself, especially not TXA2.
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  • 3
    ISSN: 1435-1803
    Keywords: Nifedipine ; R 58735 ; myocardial ischemia ; protective effect ; biochemical parameters
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In the guinea pig heart-lung preparation, the protective effects of nifedipine and R 58735 on cardiovascular alterations following mild (35 min) and severe (60 min) ischemia and reperfusion (30 min) were studied. Nifedipine and R 58735 were equi-protective against the effects of mild ischemia with respect to functional (LVP, dp/dt, and cardiac output) and biochemical (ATP, CrP, and adenylate charge) parameters. A clear difference, however, was observed between nifedipine and R 58735 upon severe ischemia, where R 58735 produced a significantly greater protection of functional, but not of biochemical parameters. Since no significant differences between the two compounds were found with respect to the concentrations of high energy phosphates after 35 and 60 min of ischemia before reperfusion, an energy sparing effect is not likely to be responsible for the difference between nifedipine and R 58735 in severe ischemia. An additional protective effect of R 58735 upon reperfusion in severe ischemia experiments may explain the difference between the two compounds.
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  • 4
    ISSN: 1435-1803
    Keywords: Adenosine triphosphate (ATP) ; creatine phosphate (CP) ; contractile recovery ; rat heart ; contractile failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The adenosine triphosphate (ATP) content of isolated Langendorff-perfused rat hearts may be increased by more than 40% above the normal value by a 2-h perfusion with adenosine (15 μmol/l). This metabolic manipulation was used to investigate the hypothetical relationship between total tissue ATP content and ischaemia-induced contractile failure, ischaemic contracture and post-ischaemic functional recovery. Adenosine perfused hearts were submitted to 20 min of normothermic ischaemia and reperfused for 45 min with or without adenosine. Control experiments were performed with adenosine-free preischaemic perfusion. In identically designed experiments the tissue-protective effect of diltiazem (0.5 μmol/l) was determined and compared with the experiments with adenosine. At the end of 120 min of preischaemic perfusion, the ATP content of the adenosine treated hearts was 34.3±1.8 μmol/g dry weight (control=23.6±1.9 μmol/g, p<0.01). After a period of 20 min of normothermic ischaemia, the ATP content of the adenosine hearts decreased to 13.3± .4 μmol/g, whereas ATP fell to 8.3±1.6 μmol/g in the control hearts. The creatine phosphate (CP) levels of adenosine hearts were significantly lower than those of the control group before ischaemia, but did not show major differences following ischaemia. During ischaemia, the contractile activity measured via an intraventricular balloon catheter, as well as ischaemic contracture did not differ between the adenosine and control hearts. The inclusion of diltiazem into the perfusate significantly delayed the onset of contracture. After 45 min of reperfusion, ATP contents of adenosine and control hearts reached similar values (8.4±2.3 and 8.3±2.9 μmol/g, respectively). Inclusion of adenosine (15 μmol/l in the reperfusion perfusate of the adenosine experiments prevented a further decrease, but did not increase tissue ATP content. CP values of all groups showed a partial recovery upon reperfusion, they did not differ significantly. Contractile recovery was equal in all experimental groups except for the diltiazem treated hearts, which showed during the first 10 min of reperfusion an improved mechanical performance. It is concluded that total tissue ATP is not necessarily a good indicator of functional capabilities under conditions of normothermic ischaemia and reperfusion in the isolated rat heart.
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  • 5
    ISSN: 1435-1803
    Keywords: angiogenesis ; collateral circulation ; swine heart ; coronary stenosis ; myocardial infarction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We chronically implanted hygroscopic occluders around the left circumflex coronary artery in 49 mesthetized young male domestic pigs and we studied the development of a collateral circulation at 4, 8, 12, and 26 weeks after implantation. At these time intervals groups of animals were again anesthetized, the hearts were explanted and perfused in Langendorff-fashion with leucocyte-filtered pig blood. Maximal coronary vasodilation was induced with adenosine and global (electromagnetic), and regional (tracer microspheres) blood flow was measured at 40, 60, 80, and 100 mm Hg of perfusion pressure. At 4 weeks after occluder implantation maximal left circumflex collateral blood flow was about 20% of normal maximal flow. Collateral flow rose, to 60% of maximal normal flow between 4 and 8 weeks and did not improve further with longer time intervals. In contrast to the canine heart numerous small vessels develop in response to ischemia in the pig heart. These vessels develop throughout the entire risk region with a slight preference for the subendocardium. They appear on tomographic angiograms as a dense “blush”. The study of the relationship between peripheral coronary pressure vs collateral flow showed a relationship much steeper than that of normal maximal flow vs aortic perfusion pressure which indicates that the minimal resistance of the risk region was decreased as part of the mechanism to ensure adequate blood supply in a situation of progressive coronary narrowing.
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  • 6
    ISSN: 1435-1803
    Keywords: ketone bodies ; cardiac performance ; myocardial metabolism ; NMR spectroscopy ; citric acid cycle
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary It has been suggested that myocardial utilization of ketone bodies might cause deterioration of cardiac function. Therefore, the influence of ketonemia (mean: 1.3 and 3.3 mM) in the presence of hypoglycemia (mean: 33 mg/dl) on cardiac function, substrate utilization and myocardial high energy phosphate levels was studied in 10 mongrel dogs. Hypoglycemia alone led to a significant increase of mean aortic pressure, total peripheral resistance and myocardial oxygen consumption, but other hemodynamic parameters and regional myocardial function were not changed. Additional infusion of 3-hydroxybutyrate did not affect hemodynamic variables significantly. During both metabolic interventionsin vivo phosphorus-31 nuclear magnetic resonance (NMR) spectroscopy showed stable levels of myocardial Pi, PCr, ATP, as well as PCr/Pi (3.2–3.4) and PCr/ATP (3.0–3.2) ratios. Biochemical measurements revealed that ketonemia led to significant alterations in arterial concentrations and arterio-coronary venous differences of selected citric acid cycle intermediates, thus confirming previous reports which suggested a blockade of the 2-oxoglutarate-dehydrogenase reaction induced by ketone body oxidation. However, despite this blockade, the energy supply to the heart was not impaired as shown by normal NMR spectroscopy and cardiac perfomance. It is speculated that the blockade might be due to an enhanced NADH/NAD ratio.
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  • 7
    ISSN: 1435-1803
    Keywords: guinea-pig heart ; mechanical toxicity ; verapamil ; ouabain ; nifedipine ; calcium-overload ; mitochondria
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Isolated perfused guinea pig (Langendorff) heart was employed to determine if the myocardial mechanical dysfunction (mechanical toxicity) produced by toxic concentration of ouabain (1 μM) was accompanied by alterations in mitochondrial function. Ouabain (1 μM) produces a transient increase in the myocardial contractile force and then a continuous decline in the left ventricular mechanical function. Mitochondria isolated from ouabain perfused hearts showed a significantly higher rate of45Ca2+ uptake and reduction in oxidative phosphorylation. The rate of ATP generation was reduced by almost 50% at the time of contracture development. Verapamil or nifedipine, when combined with ouabain in the perfusion medium, delayed or abolished the mechanical toxicity in a dose dependent manner. The mitochondria isolated from these hearts demonstrated normal rate of Ca2+ uptake and ATP generation capacity. The data indicate that the cardiac mechanical dysfunction induced by toxic doses of ouabain may be associated with mitochondrial Ca2+ overload and dysfunction and that the Ca2+ channel blockers may have a protective effect.
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  • 8
    ISSN: 1435-1803
    Keywords: sarcomere work ; sarcomere shortening ; myocardial mechanics ; muscle shortening ; internal compliance ; connective tissue
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Cardiac muscle fibers are suspended within and attached to an elaborate connective tissue matrix that includes numerous compliant interconnections. Myocardial muscle fibers are not branched, but connect at small angles to each other to form a branched array. Therefore, fiber shortening occurs as a vector within a connective tissue framework and individual fiber work may exceed external muscle work. To evaluate the latter we measured isotonic muscle shortening simultaneous with sarcomere shortening. The hearts were obtained from rabbits (n=4) anesthetized with intravenous pentobarbital sodium. We isolated right ventricular trabeculae or free wall papillary muscles in Krebs-Ringer's solution (2.5 mM Ca2+, 28°C). Cross-sectional area was 0.038±0.003 mm2 (±SE throughout) and resting sarcomere length was 2.33±0.12 μm. Sarcomere length was measured with laser diffraction (He−Ne, λ=632.8 nm) during force clamps in single- and paired-stimulation twitches. Relative sarcomere shortening (¢SL) was isotonic sarcomere shortening divided by sarcomere length at the onset of isotonic shortening. Relative muscle shortening (δML) was isotonic muscle shortening divided by muscle length at zero load; the latter was estimated from the stress-strain relation of elastic recoil at the onset of load clamps. Average δSL/δML at peak shortening was 3.38±0.16 and was independent of stimulus pattern, isotonic load, amount of shortening, time during a twitch or laser beam position along a muscle. Therefore, the ratio >1 was neither a function of activation nor heterogeneous sarcomere length change. To account for (δSL/δML) >1 we developed a geometrical model based on the fact that muscle fibers, interconnect at small acute angles and are suspended in and interconnected by a connective tissue matrix. Developed force of individual angled muscle fibers must be greater than external muscle force. As a result, the inter-fiber connective tissue matrix will be strained and there will be proportionately more shortening of muscle fibers and their sarcomeres than overall muscle shortening. Also, fiber angle decrease during shortening may accommodate some excess fiber shortening. In this model fiber and sarcomere work during shortening will be greater than work measured at the muscle's ends.
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  • 9
    ISSN: 1435-1803
    Keywords: isolated myocytes ; ventricular myosin ; cardiac hypertrophy ; myocardial contractility ; monocrotaline
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The contractile properties of single rat cardiac cells isolated from normal and hypertrophied right ventricles have been investigated. These have been correlated with the isoenzyme composition of the whole ventricle. Right cardiac hypertrophy was induced by injecting rats with monocrotaline, an alkaloid which induces severe pulmonary hypertension. Ca2+ ATPase activity and myosin alpha-chain percentage were decreased in the hypertrophied right ventricle as compared with that of control rats. The contraction amplitude and speed of shortening of the isolated cells were measured using an inverted microscope, video camera, and edge detection device. Cells from the hypertrophied ventricle showed a significantly decreased contraction amplitude and speed of shortening in maximally activating concentrations of isoprenaline. A statistically significant correlation existed between myosin alpha-chain percentage and both contraction amplitude and speed of shortening in maximum isoprenaline. This was truc when all cells studied were included, as well as within the hypertrophy group. A similar, although not always statistically significant, correlation was observed when cells were maximally activated with calcium. These results suggest that changes in isomyosin pattern that occur in cardiac hypertrophy produce alterations in contraction amplitude and speed of shortening which can be detected in single cells isolated from the hypertrophied ventricles. Isolated cells appear to give responses representative of the function of the whole heart.
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  • 10
    ISSN: 1435-1803
    Keywords: myocardial infarction ; reperfusion ; β-blockade ; calcium antagonist
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The “mass of tissue at risk” and the myocardial infarct developed was studied in dogs subjected to either 24-h occlusion of the left anterior descending coronary artery or 2-h occlusion followed by 22-h reperfusion. The “mass of tissue at risk” was defined under anaesthesia at the time of occlusion using the microsphere technique. Twenty-four hours later the hearts were removed, sliced transversely and stained with 2,3,5-triphenyltetrazolium chloride to define the infarcted tissue. All myocardial tissue was mapped and cut into small pieces for weighing and radioactive counting. Radioactivity was present in all tissue, including the infarct. In the centre of the the infarct, counts remained low and then increased very rapidly with distance just beyond the edge. Tissue at risk from infarction was taken as that with less than 15% of the peak left ventricular (non-ischaemic) counts. A linear relationship was found between the mass of the left ventricular infarct and the left ventricular “mass of tissue at risk”. The effect of 22 hours reperfusion was examined by this method and expressed by a regression equation. There was a significant decrease in slope for the regression line of the reperfusion data, (p<0.05, analysis of covariance), indicating less infarcted tissue for each gram of underperfused tissue. None of the drug pretreatments explored had any effect on infarct size in the 24-h occlusion model. With reperfusion, propranolol and flunarizine diminished infarct size compared with reperfusion only (p <0.05 for reduced slope, the new slope being not significantly different from zero). The effect of diltiazem was not so marked. Thus infarct size can be reduced with pretreatment, as long as the myocardium is reperfused.
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  • 11
    ISSN: 1435-1803
    Keywords: coronary artery ; segment length ; diameter ; left ventricle volume ; right ventricle volume
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In the canine heart placed in a bath the ramus interventricularis anterior (RIA) was perfused under constant pressure. Segment length and diameter of RIA were monitored by ultrasound technique, coronary pressure by electromanometer. Increasing the volume of the left ventricle by up to 150% of the physiological value increased the segment length by 3.73–12.72% and decreased the diameter by 3.14–9.37%. Similar increments of right ventricular volume increased coronary segment length by 4.38–13.02% and decreased diameter by 2.85–16.45%. In concert with the dynamics of heart deformation segment length and diameter changes were larger in the proximal (close to the basis of the heart) than in the distal part of the artery (close to the apex). Implications of this phenomenon in physiological and/or pathophysiological regulation processes are presented. The results have a methodological implication for in situ studies of coronary smooth muscle activity. When the diameter of the coronary artery is taken as an indicator of smooth muscle activity the ventricular volumes should be kept constant.
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  • 12
    ISSN: 1435-1803
    Keywords: transmuralenzyme distribution ; 5′-nucleotidase ; adenosine deaminase ; cardiac hypertrophy ; chroniccardiac overload
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The transmural distribution of the adenosine-generating enzyme 5′-nucleotidase (5′N) and of the adenosine-degrading enzymes adenosine deaminase (ADA), AMP deaminase (AMP-D) and adenosine kinase (Ado-K) were determined across the walls of left and right ventricles of control and hypertrophic rat hearts. The enzyme distribution across the left ventricle wall (but not across the right wall) of normal hearts was not uniform: 5′N activity shows its highest levels in the subepicardial and in the subendocardial regions, whereas all the other enzyme activities show their lowest levels. A similar pattern of transmural distribution was also detected in other mammalian species (ox and pig). In the experimental cardiac hypertrophy, caused by two different types of chronic cardiac overload, the levels and the profiles of transmural distribution of 5′N and ADA enzyme activities may significantly change across the rat left ventricle wall.
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  • 13
    ISSN: 1435-1803
    Keywords: glutathione ; skinnedcardiac fiber ; oxidative stress ; calcium regulation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The glutathione status of cardiac muscle, that is the ratio of reduced glutathione (GSH) to oxidized glutathione (GSSG) changes in certain forms of cardiomyopathy and during reperfusion of ischemic heart. Here we show that it also affects the sensitivity of contractile proteins to calcium. GSH (4 mM) increased the pCa50 for force development in skinned fibers by 0.2 pCa units and increased force ba 44%±5.4% at pCa 5.6 whereas GSSG (4 mM) decreased it by 54%±17.8% at pCa 5.6. Half maximal activations and inhibitions were seen with 4 mM GSH or GSSG, respectively. In contrast to GSH, the reducing agent dithiotreitol at 5 mM had no activating effect. Our results suggest that the loss of contractility observed after a reperfusion of the ischemic heart my, at least in part, be due to a decreased responsiveness of the contractile proteins due to an altered glutathione status.
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  • 14
    ISSN: 1435-1803
    Keywords: calcium antagonist ; D-600 ; gallopamil ; myocardialprotection ; myocardialischemia ; myocardialreperfusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In this study we have investigated the possibility that D-600, a phenylalkylamine calcium antagonist, protects the isolated rabbit heart against ischemia and reperfusion-induced damage. D-600 was either subcutaneously injected (2 mg/kg, twice daily for 5 to 6 days) in the rabbit before isolation of the heart, or delivered to the isolated hearts in the perfusate (10−7 M), either at the onset of ischemia and during reperfusion, or only during post-ischemic reperfusion. Ischemia (90 min) was induced by reducing coronary flow from 25 to 1 ml/min, followed by 30 min of reperfusion. Myocardial damage was determined in terms of mechanical function, release of creatine phosphokinase (CPK) and noradrenaline, mitochondrial function, calcium homeostasis, and endogenous stores of ATP and creatine phosphate (CP). Administration of D-600 to the rabbits or to the isolated hearts at the time of ischemia exerted protection. There are four groups of evidence in support of this conclusion: 1) the rise in diastolic pressure during ischemia was diminished with greater recovery of developed pressure during reperfusion; 2) CPK and noradrenaline release during reperfusion were reduced; 3) the oxygen consumption and ATP generating capacities of mitochondria were better maintained; and 4) associated with this preservation of mitochondrial function was the maintenance of near normal calcium homcostasis and of endogenous ATP and CP stores. The two different modalities of administration did not produce substantially different results. When administered to the isolated hearts after the ischemic period, D-600 failed to improve mechanical recovery and release of endogenous substances. However, it reduced mitochondrial calcium overload and improved ATP production. The mechanism of the protective effect of D-600 seems to be multiple: energy-sparing effect, reduction of the toxicity mediated by endogenous catecholamines, and direct inhibition of mitochondrial calcium transport.
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  • 15
    ISSN: 1435-1803
    Keywords: bepridil ; cordium ; calcium antagonist ; isolatedmitochondria
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We investigated mass action of isolated rat heart mitochondria with the calcium antagonist bepridil. At pH 7.20 bepridil in basic form b associates rapidly with the mitochondrial membrane but the amount fixed is higher in non-energized mitochondria than in mitochondria energized by succinate or ATP Mg2+. This effect is related to the dissociation state of the drug since conditions favoring the acidic form bH+ suppress this difference. Tritiated bepridil bound to mitochondrial membrane is only partially displaced by high concentrations of unlabeled drug (≥5 10−5 M). No membrane energization effect is noted on this displacement. Binding values of bepridil to mitochondrial membrane (KD 1.7 10−5 M; Bmax 23.8 nmol·mg−1 protein) show only low affinity receptor sites. Bepridil binding to the lipid part of the inner membrane surface is postulated. This interaction is used to explain some of the in vitro effects of this calcium antagonist on membrane bound enzyme activities.
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  • 16
    ISSN: 1435-1803
    Keywords: trifluoperazine ; chlorpromazine ; calmidazolium ; ischemicmyocardium ; calmodulin ; erythrocyte membrane stabilization
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In the control perfused working rat hearts subjected to 25 min global ischemia, reperfusion resulted in a 50% recovery of the hemodynamic functions. A concentration-dependent improvement of this recovery and a reduction of the postischemic lactate dehydrogenase (LDH) release was caused by calmidazolium (CMZ), trifluoperazine (TFP), and chlorpromazine (CPZ) added prior to ischemia. The drugs were not effective when added only to the reperfusate. The concentrations of CMZ, TFP, and CPZ producing the half-maximal effects were 2.5×10−9 M, 1.5×10−7 M and 3×10−7 M, respectively. Prolongation of the ischemic period caused a progressive deterioration of the functional recovery of the hearts while the total postischemic LDH release showed, at the same time, an initial gradual rise followed by a later decay. In untreated hearts the duration of ischemia resulting in 50% loss of hemodynamic function and in a maximal LDH release was 25 min. TFP (10−6 M) and CMZ (10−7 M) prolonged these times by 4–7 min and 5–10 min, respectively. TFP, CPZ, and CMZ protected the erythrocytes from osmotic hemolysis. The maximum anti-hemolytic activity was produced by 3×10−6 M CMZ, 3×10−5 M TFP, and 10−4 CPZ. The concentration-dependency of this effect was not affected by low concentrations of sodium dodecyl sulphate (SDS). Neither TFP nor CMZ prevented the hemolysis produced by 10−3 M SDS. It is concluded that the delay in the development of the ischemic injury produced by TFP and CMZ is due to the effects of these drugs as calmodulin antagonists rather than as membrane stabilizers.
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  • 17
    ISSN: 1435-1803
    Keywords: calcium ; conjugateddiens ; contracture ; lipid peroxidation ; oxygen radicals
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In the present study we have investigated isolated rat hearts perfused with oxygen radicals generated by xanthine oxidase and hypoxanthine. The influence of verapamil (1 mg·l−1) pretreatment on oxygen radical-induced contracture development and decrease in contractility was examined. In addition, we have measured mitochondrial calcium and magnesium levels in control hearts and hearts perfused with oxygen radicals with and without addition of superoxide dismutase (SOD) and catalase. The presence of oxygen radical-induced lipid peroxidation was confirmed by the increased level of conjugated diens in lipid extracts from oxygen radical-perfused hearts. Verapamil prevented contracture development in hearts perfused with oxygen radicals. Diastolic pressure measured with a left ventricle balloon was at the end of the experiments, 18±3 mm Hg (mean±SEM) with verapamil and 66±9 mm Hg without (p<0.001). Perfusion with oxygen radicals resulted in a reduction in mitochondrial calcium from 14.63±0.93 to 8.26±0.61 nmol·mg−1 (p<0.001) which was partly reversed by superoxide dismutase and catalase. Mitochondrial magnesium levels were unchanged in all groups.
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  • 18
    ISSN: 1435-1803
    Keywords: blood pressure ; cardiopulmonarybypass ; vascular resistance ; vasomotor system
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Although vasomotor waves (VMW) (Mayer waves) were recognized more than one century ago their physiological role is still under discussion. During cardiopulmonary bypass (CPB) the appearance of VMW is random. The clinical significance of the phenomenon was studied by comparing open-heart patients with (n=33) or without (n=33) VMW of arterial pressure during CPB. The patients with VMW had higher perfusion pressure (p<0.05) and vascular resistance (p<0.01) during bypass and higher mean arterial pressure before and after CPB. During CPB the need for vasoconstrictors was of lesser magnitude (p<0.01) but the need for vasodilators was of greater magnitude (p<0.001) in patients with VMW and they also less frequently needed inotropic support at weaning from CPB (p<0.05) or after CPB (p<0.01). The use of inotropics was also shorter (p<0.01) during intensive care in the patients with VMW. Based on the present results the open-heart patients who had VMW during CPB appeared to have higher arterial blood pressure and to need less pharmacological cardiovascular support during the intraoperative and the immediate postoperative period.
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  • 19
    ISSN: 1435-2451
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 20
    ISSN: 1435-2451
    Keywords: Blood transfusion ; Colorectal carcinoma ; Survival
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Seit längerem wird in der Literatur ein möglicher negativer, vermutlich durch Suppression der körpereigenen Immunabwehr be dingter Effekt von perioperativer Verabreichung von Blut and Haemoderivaten auf die Prognose maligner Tumoren diskutiert. Für das homogene und gut dokumentierte Patientenkollektiv der zwischen 1979 and 1983 operierten Patienten mit colorectalem Carcinom der Chirurgischen Universitätsklinik Erlangen wurde versucht, die entsprechen den Zusammenhänge nachzuvollziehen. Es gelang zunächst, eine signifikant schlechtere 5-Jahresüberlebensrate der transfundierten Patienten im Vergleich zu den nicht transfundierten Patienten zu beobachten. Die genaue Analyse unter Einbeziehung zahlreicher möglicher prognostischer Faktoren in einem multivarianten Modell (Cox-Regressionsanalyse) zeigte jedoch, daß die beschriebenen Unterschiede durch andere Faktoren (Tumorlokalisation, Tumorstadium u.a.) hinreichend erklärt werden können and somit der Transfusion von Vollblut oder Erythrocytenkonzentrat keine eigenständige prognostische Bedeutung zukommt. Im weiteren wurde eine signifikant schlechtere Prognose derjenigen Patienten, bei denen Fresh Frozen Plasma (FFP) perioperativ verabreicht wurde, im Vergleich zu den Patienten, die das entsprechende Haemoderivat nicht erhielten, festgestellt. Die multivariante Analyse ergab uberraschenderweise, daß die Gabe von FFP einen eigenstandigen prognostischen Faktor darstellt und die Verschlechterung der Prognose nicht durch die ungleiche Verteilung anderer prognostisch bedeutsamer Parameter erklärt werden kann. Die Mechanismen der Verschlechterung der Prognose durch FFP Bind unbekannt und werden durch prospektive Studien derzeit untersucht.
    Notes: Summary In recent years in the literature several investigators described a negative effect of perioperative transfusion of blood and hemoderivatives on the prognosis of malignant tumors. Concerning the patients with colorectal carcinoma operated between 1979 and 1983 at Erlangen University Hospital these results could be proven. We observed a significantly worse 5-year survival rate for patients who received perioperative blood transfusion. However, multivariant analysis in Cox-regression model revealed other factors like tumor stage and localisation responsible for the poorer prognosis. Therefore blood transfusion seems not to have any influence on the prognosis itself. Furthermore we observed a significantly poorer prognosis concerning patients who perioperatively received fresh frozen plasma (FFP). Surprisingly multivariant analysis showed that FFP substitution in contrast to blood transfusion has an own prognostic influence. This difference in prognosis cannot be explained by selection criteria. The mechanism of the negative influence of FFP on the prognosis of colorectal carcinoma remains unclear and is investigation currently in prospective studies.
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  • 21
    ISSN: 1435-2451
    Keywords: Energy expenditure ; Abdominal surgery ; Indirect calorimetry ; Postoperative nutrition
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Nach großen abdominalchirurgischen Eingriffen ist der Energiebedarf frühoperativ um 30% and spätpostoperativ um 50%, bezogen auf den nach Harris-Benedict ermittelten basalen Energiebedarf, erhöht. Der Vergleich der indirekt calorimetrischen Meßwerte mit den Schätzwerten nach der Harris-Benedict-Formel zeigt für spätpostoperative Patienten eine gute Übereinstimmung (Korrelationskoeffizient r=0,76). Ähnlich genaue Angaben lassen sich auch mit einer einfachen Multiplikation des Körpergewichtes mit dem Faktor 30 erzielen. Eine aufgetretene Sepsis steigert den postoperativen Energiebedarf nicht erheblich, die Korrelation zwischen Messung und Schätzung ist jedoch gering. Eine einstiindige Meßdauer hat sich in unserer Meßserie als ausreichend genau erwiesen, wie auch der Vergleich mit Ergebnissen zeigt, die unter Verwendung von doppelt markiertem radioaktiven Wasser gemacht wurden.
    Notes: Summary Energy requirement after major abdominal operations, as calculated according to the formula for basic energy expenditure by Harris-Benedict, was increased by 30% in the early and by 50% in the late postoperative period. Correlation of these calculated values to measurements by indirect calorimetry was good. Even more simply a good estimation of caloric requirements can be obtained by multiplication of the body weight with a factor 30. The development of septic complications does not increase considerably postoperative energy expenditure, however, the correlation between measured and estimated values becomes poor. As supposed from isotope studies measuring gas exchange for indirect calorimetry for one hour provides sufficiently stable results.
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  • 22
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    Springer
    Langenbeck's archives of surgery 374 (1989), S. 129-130 
    ISSN: 1435-2451
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 23
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 374 (1989), S. 131-137 
    ISSN: 1435-2451
    Keywords: Pulmonary injuries ; Management ; Surgical therapy ; Results
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Obwohl die Lungen auch isoliert verletzt werden können, entstehen die meisten Lungenverletzungen im Rahmen von Polytraumen. Aufgrund der hieraus resultierenden, vielfältigen pathophysiologischen Abläufe ist die Beurteilung von Ausmaß, Verlauf und Prognose der Lungen-verletzungen schwierig. Je nach untersuchtem Krankengut wird die Mortalität der Thoraxverletzungen in der Literatur zwischen 6 bis 55% angegeben [3, 5, 8, 9]. Bei den von uns untersuchten Thoraxverletzungen handelte es um selektionierte schwere Thoraxtraumen. Dies erklärt die von uns gefundene relativ hohe Thoracotomierate von 17% sowie die hohe Mortalität von 34%. Zur besseren Vergleichbarkeit klinischer Untersuchungen ist wegen der geschilderten Verletzungsvielfalt die Aufschlüsselung nach allgemeiner und speziell thorakaler Verletzungsschwere — wie etwa nach dem Polytraumaschlüssel der Medizinischen Hochschule Hannover — notwendig. Vor allem die Lungenkontusionen werden häufig bei auffälligen Begleitverletzungen in Ausmaß und Folgen primär unterschätzt. Daher kann die Bedeutung subtiler Lungenbefunderhebung sowie lungenbewußter Therapie nur unterstrichen werden.
    Notes: Summary Even though lungs can be injured solitarily, most of pulmonary lesions occur within the scope of multiple trauma. Because of various patho-physiological processes resulting from the multiple trauma, the valuation of extent, course and prognosis of pulmonary injuries is difficult. Depending on examined cases, mortality of thoracic injuries as stated in various references amounts to between 6 and 55% [3, 5, 8, 9]. Concerning thoracic injuries we dealt with severe traumas of the thorax. This explains the relatively high rate of thoracotomy of 17% as well as the high mortality of 34% we confirmed. Because of described variety of injuries, it is necessary for better comparison of clinical investigations to specify the lesions in accordance with general and specific thoracic severity of injury — as described in the multiple trauma score of the Medical University of Hannover —. Especially pulmonary contusions with associated conspicuous injuries are often primarily underestimated concerning their dimensions and consequences. Therefore the importance of subtle inquiry of pulmonary findings must be strictly underlined.
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  • 24
    ISSN: 1435-2451
    Keywords: Ultrasound ; Spongiosa substance plasty ; Experimental examination
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die sonographische Verlaufskontrolle von Spongiosatransplantationen unterstützt die radiologische Diagnostik. Die guten klinischen Erfahrungen erfordern, daß der Stellenwert der Untersuchung experimentell gesichert wird. An der Tibia mit intaktem Integument werden auto und homologe Spongiosatransplantate, sowie in einem zweiten Versuch teilentkalkte Knochenspäne untersucht. Die Ergebnisse bestätigen den Einsatz, da sich gute Eindringtiefen an der teilentkalkten, aber auch an der normalen Spongiosa ergeben. Unterschiede zwischen auto- and homologer Spongiosa ergeben sich experimentell nicht.
    Notes: Summary The ultrasound control after spongiosa substance plasty is, as described, a supportive method to x-ray measurement. The clinical experience and results are most encouraging. Therefore an experimental proof of this method is necessary. The model is the complete lower leg after amputation. The tibia is prepared with autologous and homologous spongiosa substance with and without gradual decalcification. For fresh spongiosa there is an ultrasound examination from three to five mm and to a higher rate for decalcified spongiosa substance. The experimental results are the verification of clinical assessment.
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  • 25
    ISSN: 1435-2451
    Keywords: Hepatic failure ; Carbon-tetrachloride ; Ethanol ; Intoxication
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Tetrachlorkohlenstoff (CCl4) führt beim Menschen zu einem akuten Leberausfall. Dieser Effekt wird durch Alkohol (C2H5OH) potenziert. Um die Funktion isolierter and implantierter Hepatocyten an einem menschennahen Tiermodell zu überprüfen, wurden an drei Gruppen von Schweinen (je 2 Tiere) verschiedene Intoxikationsversuche durchgeführt. Die gewählten Dosierungen/kg KG führten in anderen Tiermodellen, z.B. bei Ratten, zu einem akuten Leberausfall. Gruppe 1 erhielt CCl4 intragastral, Gruppe 2 zusätzlich C2H5OH intragastral and Gruppe 3 CCl4 intragastral and C2H5OH intravenös. Anhand leberspezifischer Laborparameter and postmortalen Leberhistologien wurde das Ausmaß der Intoxikation überprüft. Intoxikationen mit den gewählten Dosierungen haben an Schweinen andere Effekte, als sie von Ratten oder aus Befundberichten beim Menschen bekannt sind. Mit den gewonnenen Ergebnissen ist daher ein standardisiertes Leberaus-fallmodell am Schwein nicht zu etablieren. Ein Großversuch zur Ermittlung einer geeigneten Dosierung ist aus ethischen Gründen abzulehnen.
    Notes: Summary It was intended to establish a model for acute hepatic failure in order to test the function of isolated and auxiliary transplanted hepatocytes. 6 pigs (19.75–27.0 kg) were intoxicated with different dosages of CCl4 and ethanol. According to publications on acute hepatic failure induced in rats by CCl4, adequate dosages were applied in pigs. Three different regimens of CCl4 and C2H5OH applications were used: CCl4 was administered intragastrically alone (group 1) or combined with ethanol (group 2), and CCl4 was given intragastrically and ethanol intravenously (group 3). Animals of group 1 and 2 survived intoxication for the period of observation. Histological examination of the livers revealed central necrosis, ghost cells and swollen hepatocytes. The animals of group 3 died shortly after intoxication. Histological examination did not show any evidence for acute hepatic failure. CCl4 and C2H5OH intoxication in pigs causes effects that are different from those described in humans or laboratory rats. Therefore it should be necessary to use a large number of animals to establish a standardized model for acute hepatic failure in pigs that reflects the observations in humans.
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  • 26
    ISSN: 1435-2451
    Keywords: Pneumothorax ; Pleurography ; Differentiated treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Bericht über die Behandlung von 209 Patienten mit 300 Pneumothoraces. Es werden die Therapieergebnisse des Behandlungszeitraumes 1980 bis 1983 (A) mit denen des Zeitraumes 1985 bis 1987 (B) verglichen. Da im zweiten Behandlungszeitraum eine sehr viel invasivere Diagnostik unter Einschluß von Pleurography, Computertomographie und Thoracoskopie durchgeführt wurde, kam es auch zu einer differenzierteren Therapie mit Rückgang der Pneumothoraxrezidivrate von insgesamt 41 auf 22%. Bezogen auf die einzelnen durchgeführten Therapieformen schnitt die alleinige Thoraxsaugdrainage mit insgesamt 44% Früh- and Spätrezidiven am schlechtesten ab. Günstiger waren die Resultate der ungezielten Fibrinpleurodese (24%), der thoracoskopischen Pleurodese (13%) and der operativen Behandlung (4%). Bei der Erstbehandlung eines Pneumothorax hatten die Saugdrainage 33% and die ungezielte Pleurodese 18% Rezidive, während die thoracoskopische und operative Behandlung rezidivfrei ausgingen. Für die Therapie von Rezidivpneumothoraces ist die Saugdrainage mit 64% Mißerfolgen nicht geeignet. In diesem Krankengut hatte die ungezielte Pleurodese auch eine hohe Rezidivquote von 30%. Am giinstigsten mit 19% bzw. 4% waren auch hier die thoracoskopische bzw. chirurgische Behandlung. Aufgrund der vorliegenden Ergebnisse wird eine differenzierte Behandlungsstrategie des Pneumothorax empfohlen.
    Notes: Summary Experience with 300 episodes of spontaneous pneumothorax in 209 patients is reported. The treatment results of two time periods 1980-1983 (A) and 1985-1987 (B) are compared. During the second period the diagnostic work-up was much more extensive and included pleurography, CT-scan and thoracoscopy. This resulted in a more differentiated therapy and a reduction in the recurrence rate from 41% to 22%. Among the different modes of treatment chest-tube drainage alone had the worst results with a 44% rate of early and late recurrence. Better results were obtained with pleurodesis using fibrin adhesive either through a pleural catheter (24%) or thoracoscopically (13%). Operative treatment had the lowest recurrence rate (4%). In the primary treatment of spontaneous pneumothorax chest-tube drainage had a recurrence rate of 33% and catheter-fleurodesis with fibrin adhesive of 18% while no relapse could be observed in the group treated by thoracoscopy or operation. In the treatment of recurrent pneumothorax chest-tube drainage alone is unsuitable because of a failure rate of 64%. Catheter pleurodesis also had a high rate of recurrence (30%). The best results were again obtained by thoracoscopic (19%) and operative treatment (4%). On the basis of the described experience an individualized approach to the treatment of spontaneous pneumothorax is recommended.
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  • 27
    ISSN: 1435-2451
    Keywords: Rectal carcinoma ; Preoperative staging ; Computed tomography ; Endorectal ultrasound
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In einer prospektiven Studie wurde bei 49 Patienten mit Rectumcarcinom die Korrelation des prä and postoperativen Stagings mit der endorectalen Sonographie (ES) mit der der CT unter Berüchtigung des Tumorstadiums nach TNM verglichen. Mit CT korrelierten die prä-und postoperativen Stadien in T1 bei 9/10, in T2 bei 10/16, in T3 bei 13/15 and in T4 bei 6/8 Patienten. Nach ES fanden sich prä- und postoperativ übereinstimmende Befunde in allen T1, in 10/12 T2, in 17/20 T3 und in 6/7 T4 Stadien. Insgesamt korre lierte das prä- und postoperative Staging nach CT bei 38 and nach ES bei 43/49 Patienten. Das Tumorstadium wurde mit beiden Methoden präoperativ fast gleich häuftg überschätzt: 5ma1 nach CT und 4mal nach ES. Eine Unterschätzung des Stadiums erfolgte häufiger nach CT in 5 Fällen gegenüber 2 nach ES. (CT: Richtigkeit 77,5%, Sensitivität 88,3%, Spezifitat 94,4%; ES: Richtigkeit 87,7%, Sensitivitat 91,5%, Spezifitat 97,8%). Diagnostische Kriterien werden diskutiert. In frühen Tumorstadien läßt sich die Infiltrationstiefe mit der ES besser beurteilen als mit CT. Bei fortgeschrittenen Tumoren geben beide Methoden wichtige Informationen für die Planung der chirurgischen Therapie.
    Notes: Summary In a prospective study in 49 patients with rectal carcinoma the correlation of pre- and postoperative staging by CT and endorectal ultrasound-(EU) was compared according to TNM-classification. With CT the pre/postoperative results correlated in T1 in 9/10, in T2 in 10/16, in T3 in 13/15 and in T4 in 6/8 patients. By EU identical results were found in all T1, in 10/12 T2, in 17/20 T3 and in 6/7 T4 stages. Overall, pre- and postoperative identical results were found by CT in 38 and by EU in 43/49 patients. Overestimation of the tumor stage was similar with both methods: 5 by CT and 4 by EU. Underestimation of the stage was more often by CT in 5 than by EU in 2 cases. (CT: accuracy 77.5%, sensitivity 88.3%, specificity 94.4%; ES: accuracy 87.7% sensitivity 91.5%, specificity 97.8%). Criteria for interpretation are discussed. In early tumor stages the depth of tumor invasion can be better evaluated by EU. In late stages both methods give important information for surgical strategy.
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  • 28
    ISSN: 1435-2451
    Keywords: Early gastric carcinoma treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung An der Chirurgischen Klinik Köln-Lindenthal wurden zwischen 1968 and 1983 94 Patienten, an der Klinik and Poliklinik für Allgemein- and Abdominalchirurgie Mainz zwischen 1972 and 1986 74 Patienten wegen eines Magenfrühcarcinoms operiert. Überlebensraten und Rezidivverhalten wurden abhängig von der operativen Therapie untersucht. In beiden Kollektiven war die Prognose des Mucosacarcinoms unabhängig von der durchgeführten Therapie günstig. Beim Submucosacarcinom war nach radikalchirurgischem Vorgehen die Häufigkeit von Rezidiven geringer und die Überlebensraten signifikant günstiger als nach alleiniger 2/3-Resektion. Die Ergebnisse sprechen für die Notwendigkeit eines radikalchirurgischen Vorgehens mit Dissektion der N2-Lymphknoten zumindest beim Submucosacarcinom des Magens.
    Notes: Summary At the department of surgery at the university hospital in Cologne 94 patients suffering from early gastric cancer of the stomach were operated in the years between 1968 and 1983. From 1972 till 1987 the department of surgery at the university hospital Mainz has had 74 patients. Survival rates and times without recurrence were calculated dependent on the surgical treatment carried out. In both collectives the prognosis for the patients with mucosal carcinoma was good no matter which operation was carried out. In the case of submucosal infiltration the frequency of recurrence was smaller and the survival rates significantly higher in those patients who subjected to a cancer operation than in those on whom only a resection of two third of the stomach was performed. The results indicate a radical approach in the treatment of early gastric cancer. At least in the case of submucosal carcinoma a dissection of the N2 lymph nodes is advisable.
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  • 29
    ISSN: 1435-2451
    Keywords: Burns ; Wound infection ; Staphylococcus aureus ; Bacterial virulence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung 30Staphylococcus aureus Stämme von drittgradig verbrannten Patienten wurden hinsichtlich ihrer Fähigkeit zur Hämolysingenerierung und ihres Vermögens zur Histaminfreisetzung aus Mastzellen (RPMC) untereinander verglichen. Die bakteriellen Kulturüberstande von 8 Stämmen aus Wundbiopsien zeigten signifikant niedrigere in vitro Aktivitäten als die übrigen Staphylokokken-Kulturüberstände. Bei dem Vergleich der in vitro Aktivitäten der gewaschenen Bakterienzellen ergab sich ein umgekehrtes Verhältnis. Diese Befunde zeigen, daß beiS. aureus Isolaten, welche zum Zeitpunkt einer invasiven Brandwundeninfektion isoliert werden können, die mikrobiellen Pathogenitätsfaktoren an die Bakterienzelle gebunden bleiben.
    Notes: Summary The hemolysin and histamine releasing activity of 30S. aureus strains isolated from third degree burns of heavily burned patients was detected. The culture supernatants (cs) ofStaphylococcus aureus isolated during episodes of invasive burn wound infection displayed significantly lower amounts of hemolysin and histamine releasing activity as compared to cs of bacteria isolated when no sign of septicemia was present. In contrast, when washed bacterial cells were analysed, a reversed ratio could be observed. These data clearly indicate that in strains isolated during invasive burn wound infection pathogenicity factors remain attached to the bacterial surface of the staphylococci investigated.
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  • 30
    ISSN: 1435-2451
    Keywords: Gallstones ; Laser ; Lithotripsy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Nachdem die laserinduzierte Stoßwellenlithotripsie von Gallengangssteinen technisch möglich ist, wurde in einer Tierversuchs reihe die percutane transhepatische Laserbehand lung von Gallenblasensteinen untersucht. In 8 Tierversuchen an weiblichen Schweinen konnte nachgewiesen werden, daß Punktion der Gallenblase, Dilatation des Arbeitskanals, (laserinduzierte) Steinzertrümmerung, Entfernung der Fragmente und des Instrumentariums in einer Sitzung möglich sind. Weder bei einfachem Hautverschluß, noch bei Fibrinklebung des Arbeitskanals wurden schwerwiegende Nebenwirkungen gesehen. Nach Laserlithotripsie finden sich Mucosadefekte und intramurale Hämatome, die sich innerhalb eines Monats komplett restituieren. Die Experimente zeigen, daß bei organerhaltender Gallenblasensteinlithotripsie die Ausbildung einer Fistel nicht abgewartet werden muß.
    Notes: Summary Since laserinduced shock wave lithotripsy of gallstones is possible for treatment of common bile duct stones, the percutaneous transhepatic laserlithotripsy of stones in the gallbladder is examined in an animal study. In 8 animal experiments it could by shown that puncture of the gallbladder, dilatation of the working channel, (laserinduced) shock wave lithotripsy, removal of the fragments and the instruments are possible in one session. Neither when performing simple closure of the wound by suture nor by fibrinsealing severe side effects could be recognized. After laserlithotripsyablation of epithelium and hematomas can be ob served, which are restituted within one month. The experiments show that in organ-saving shockwave lithotripsy there is no need for waiting for the development of a fistula and the percutaneous approach can be simplified.
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  • 31
    ISSN: 1435-2451
    Keywords: Mediastinal tumor ; Extragonadal seminoma ; Resection of vena cava superior
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die seltenen primären extragonadalen Seminome sind mit in die Differentialdiagnose des unklaren Mediastinaltumors einzubeziehen. Die Symptomatik ist uncharakteristisch, die Diagnose wird in den meisten Fällen durch eine Thoracotomie bzw. Sternotomie gestellt. Therapeutisch steht das chirurgische Vorgehen mit kurativer Zielsetzung oder palliativer Tumorverkleinerung im Vordergrund. Bei makroskopisch vollständig entferntem Tumor ist die Nachbestrahlung des Mediastinums zu diskutieren, bei metastasierendem Tumor sollte postoperativ eine Chemotherapie mit Cisplatin enthaltenden Kombinationen durchgeführt werden.
    Notes: Summary Primary mediastinal seminoma is an uncommon lesion and should be included in the differential diagnosis of mediastinal tumors. Symptoms and signs may not be clear and in most cases the diagnosis is made by sternotomy or thoracotomy. Our recommendation is that patients with primary mediastinal seminoma should undergo curative resection or reductive surgery. Curative resection should be followed by radiation therapy. Chemotherapy with cisplatin-containing combinations should be reserved for patients who have metastases at the time of diagnosis.
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  • 32
    ISSN: 1435-2451
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 33
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    Springer
    Langenbeck's archives of surgery 374 (1989), S. 193-193 
    ISSN: 1435-2451
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 34
    ISSN: 1435-2451
    Keywords: Lymphedema ; Microlymphaticovenous anastomosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Zwischen 1980 und 1986 wurden 110 Patienten mit Lymphödem der Extremitäten (n = 98), der männlichen und weiblichen äußeren Genitalien (n = 9), der Brüste (n = 2) und des Gesichtes (n = 1) mikrochirurgisch behandelt. Die Mikrochirurgie für das primäre (n = 6) und sekundäre (n = 104) Lymphödem beinhaltet zur Zeit die Anastomosen zwischen Lymphkollektoren und Venen. 98 Patienten mit Lymphödem der Extremitäten wurden nach 26 Monaten nachuntersucht. Die Kurzzeit- und Langzeitresultate waren sehr be friedigend. 76,5% aller Patienten erzielten ausgezeichnete oder gute Ergebnisse. Reduktion des Umfanges der ödematösen Extremitäten erreichte 6,2 cm und die Reduktion des übermäßigen Volumens der Extremitäten betrug 59,2±29,5% (703±850m1). Die Ergebnisse beweisen, daß bei standardisierter Technik die mikrochirurgischen lymphovenösen Anastomosen einen guten therapeutischen Erfolg erzeugen können. Auf der Basis unserer klinischen Erfahrung bei Lymphödemen mit lymphovenösen Anastomosen zeigt sich, daß die Anastomosen frühzeitig und in genügender Zahl durchgeführt werden müssen. Indikationen, Art der durchgeführten Eingriffe und Vorteile des Verfahrens werden vorgestellt.
    Notes: Summary Between 1980 and 1986, 110 patients with lymphedema of the extremities (n = 98), male and female external genitalia (n = 9), breast (n = 2), and face (n =1) were treated microsurgically. Microsurgery for primary (n = 6) and secondary (n = 104) lymphedema at present consists of anastomosis between collective lymphatics and veins. Ninety-eight patients with lymphedema of the extremities were followed-up for 26 months. The immediate and long-term results have been very satisfactory. Excellent and good results were obtained in 76.5%. An average reduction in circumference of the affected limb of 6.2 cm and an average reduction of excess volume of 59.2 ± 29.5% (representing 703 ± 850 ml) were obtained. These results prove that by standardized technique the microlymphaticovenous anastomoses can produce a good therapeutic result. On the basis of our clinical experience in treating lymphedema by microlymphaticovenous anastomoses, we believe that the anastomoses should be performed early and their number should be sufficiently high. Indications, types of procedures and advantages of the operation are presented.
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  • 35
    ISSN: 1435-2451
    Keywords: Tc-99m-WBC-scan ; Infection ; Orthopedic surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung 70 Patienten mit klinisch gesicherten (23 Patienten) bzw. fraglichen (47 Patienten) bakteriellen Infektionen am Skeletsystem bei unfallchirurgisch/orthopädischen Erkrankungen, Verletzungen oder Operationen wurden mit der Eigenleukocytenszintigrafe untersucht. Hierbei macht man sich das Prinzip der Leukocytenmigration zum Infektionsherd zunutze. Als Markierungssubstanz wurde gegenüber bisher geübten Verfahren das sehr vorteilhafte Tc-99m-HMPAO angewandt. Bei den 23 Patienten mit klinisch gesicherten Infektionen ergaben die szintigrafischen Untersuchungen positive Befunde. Von den 47 Patienten mit klinisch fraglichem Infekt ergab sich bei 14 ein szintigrafsch positiver Befund, was sich operativ als richtig bestätigen ließ. 28 Patienten zeigten einen durch klinischen Verlauf und Operation gesicherten richtig-negativen Szintigrafebefund. 5 Patienten mit klinisch fraglichen Infektzeichen und positiven Leukocyten-Szintigrammen wurden nach Rückgang der Infektsymptomatik nach der LS nicht operativ revidiert und einer Sondergruppe zugeordnet (Infection: Yes-Operation: No [IYON]-Gruppe). Bei der Gesamtbeurteilung des Verfahrens ergab sich eine Sensitivität von 97,1%, Spezifität von 82,9% und eine Gesamt-Genauigkeit von 90%. Die Tc-99m-HMPAO-Leukocytenszintigrafe erweist sich als geeignetes Verfahren zur Bestätigung/Ausschluß von bakteriellen Früh-, Spät- und akuten Schüben von chronischen sowie hämatogenen Infekten am Skeletsystem.
    Notes: Summary 70 patients with confirmed (23 patients) or suspected (47 patients) bacterial infection in the skeleton following diseases, injuries or operations in orthopedic surgery were investigated using Tc-99m-HMPAO leucocyte scintigraphy in order to evaluate the accuracy of this procedure. Infections could be detected correctly in 37 of 70 patients (right positives) while 28 patients had negative scans corresponding to the clinical course (right negatives). One false negative fording was observed. Five patients with clincially suspected infection had a focal uptake in the WBC-scan and were not operated subsequently. They range as false positive results, although they belong to a special group (Infection: Yes-Operation: No [IYON]-group). In the assessment of the Tc-99m-HMPAO-WBC-scan there was a sensitivity of 97.1%, specificity of 82.9% and an overall accuracy of 90%. The method is suitable for detection of early and late infection as well as chronic or hematogenous osteomyelitis in the locomotor system. This means an important contribution in diagnosis of infection determining further operative or conservative treatment.
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  • 36
    ISSN: 1435-2451
    Keywords: Esophageal cancer ; Nutritional status ; Total parenteral nutrition
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Bei 35 konsekutiven Patienten, die sich einer Oesophagusresektion wegen eines Malignoms unterzogen, wurde der Ernährungsstatus prospektiv erfaßt. 15 Patienten wurden als mangelernährt angesehen und präoperativ im Median für 7 Tage hochcalorisch parenteral ernährt. In der Kontrollgruppe (n = 20, keine TPN) wurde der Ernährungsstatus als normal bewertet. Durch die parenterale Ernährung konnten bestehende Defizite bei Parametern mit kürzerer Halbwertszeit ausgeglichen werden, so daß am Tage vor der Operation der Ernährungsstatus beider Gruppen vergleichbar war. Auch hinsichtlich präoperativer Risikofaktoren, Tumorstadium und Operationstrauma waren beide Gruppen vergleichbar. Der postoperative Verlauf präoperativ parenteral ernährter Patienten war verglichen mit der Kontrollgruppe insgesamt günstiger. So lag die postoperative stationäre Behandlungszeit bei 26 gegenüber 32 Tagen, kein Patient verstarb (versusn = 4), ein Patient bekam eine Sepsis (versusn = 4), kein Patient entwickelte ein akutes Nierenversagen (versusn = 3). Diese Unterschiede waren jedoch wegen der kleinen Gruppengrößen statistisch nicht signifikant.
    Notes: Summary In 35 consecutive patients who underwent esophagectomy for malignancy the nutritional status was evaluated. 15 patients were estimated to be malnourished and were therefore treated by total parental nutrition (TPN) for 7 days. In the control group (n = 20, no TPN) the nutritional status was normal. TPN corrected abnormal serum parameters with short half-life time. Therefore the nutritional status of both groups was equal at time of operation. The postoperative clinical outcome of both groups was as follows: In TPN-treated patients postoperative hospital stay for 26 days was shorter compared to 32 days in controls, no patient died (vsn = 4), one patient developed sepsis (vsn = 4), no patient developed acute renal failure (vsn = 3). These differences did not reach levels of significance due to the small patient groups. In conclusion our study shows that patients with esophageal cancer and regarded as well nourished seemed to suffer from nutritional deficits. Assessment of the nutritional status by commonly used nutritional parameters does not reveal these deficits.
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  • 37
    ISSN: 1435-2451
    Keywords: Coagulase negative Staphylococci ; Incidence ; Surgery ; Susceptibility testing ; Association
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die Zunahme von Infektionen durch hochresistente grampositive Kokken hat in den letzten Jahren vornehmlich auf Intensivstationen zu erheblichen therapeutischen Problemen geführt. Hierbei ist eine Gruppe von Erregern in den Vordergrund getreten, die früher als harmlose Saprophyten galten: coagulasenegative Staphylokokken (CNS). In der vorliegenden Arbeit werden zunächst Daten zur Incidenz in verschiedenen Versorgungsbereichen unserer Klinik und zur Coincidenz mit anderen Erregern auf unserer Intensivstation vorgestellt. Es konnte gezeigt werden, daßS. aureus zwar der zahlenmäßig häufigste grampositive Erreger war, aber CNS sowohl aus Wundabstrichen der Intensivstation als auch aus Blutkulturen deutlich häufiger isoliert werden konnte. Ein gleichzeitiger Nachweis von CNS mitS. aureus und den neun häufigsten Enterobacteriaceae konnte in durchschnittlich 6% erbracht werden. Durch mögliche Interaktionen zwischen unterschiedlichen Erregern kann eine Veränderung der in Einzeltestung beobachteten Resistenzen auftreten. Um dies nachzuweisen, wurden sechs Erregerpaare einzeln und in Assoziation gegen Amoxicillin und Amoxicillin/Clavulansäure getestet. Unter Assoziation wurde das gemeinsame Wachstum zweier Keime unter kontrollierten Bedingungen in Boullionverdünnungsreihen oder einem Laborautomaten zur Resistenztestung (Cobas Bact) verstanden. In allen Fällen zeigte sich, daß dieβ-Lactamasen der CNS in Assoziation die MHK der anderen Erreger deutlich erhöhte, was durch den Zusatz von Clavulansäure verhindert werden konnte. Eine Einzeltestung gibt also bei Mischinfekten mit Beteiligung vonβ-Lactamasebildnern nur einen eingeschränkten Eindruck von der tatsächlichen Resistenzsituation.
    Notes: Summary Infections due to coagulase negative staphylococci (CNS) are of growing concern mainly in patients hospitalized in intensive care units (ICU). The ability of CNS to adhere and to grow on plastic devices and resistance to many antibiotics, including oxacillin, contributes to their pathogenicity. Using the computer assisted system of the Medical Microbiology Department, the incidences of different pathogens and the coincidence of CNS with other bacteria were evaluated in a surgical department.Staphylococcus aureus revealed to be the predominant pathogen; however, CNS showed an increasing incidence in wound specimens and blood cultures of patients on the ICU. Coincidence of CNS withS. aureus and the nine most frequent species of gram negative bacteria could be shown in 6%. To investigate the influence ofβ-lactamases produced by CNS in mixed infections, association experiments were performed. Association means a controlled growth of two or even more bacteria in a susceptibility testing system, either a broth dilution method or an automated broth disk elution method (Cobas Bact). The association experiments showed a significant increase of amoxicillin MIC's of the pathogen associated with CNS. Addition of clavulanic acid restored activity of amoxicillin. It could be shown that in mixed infections CNS may contribute to the failure of antibiotic regimens by production ofβ-lactamases.
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  • 38
    ISSN: 1435-2451
    Keywords: Kardiacarcinom ; EGJ ; Oesophagusinfiltration ; Kardiadrüsenzone.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary This study concerns the definition of carcinoma of the gastric cardia. The topography of the esophagogastric mucosal junction (mucosal EGJ) was investigated with an endoscope in 182 patients who were free of hiatal hernias, ulcers, and neoplasms in the esophagus and stomach. The relationship between the EGJ and the cardiac gland area was then examined histologically in 56 resected specimens containing intact EGJs and cardia gland areas. Furthermore the cancerous center was determined; the shortest distance between the cancerous center and the EGJ and the amount of esophageal invasion were measured in 102 resected carcinomas located close to the junction; the carcinomas contained the EGJ and were good enough for pathohistological examination. The EGJ was located 0.5–1.0 cm proximal to the His angle (the gastric cardia) in radiological and endoscopic examinations. Histologically the cardiac gland area was found to straddle the EGJ at a range of about 1 cm proximal and 2 cm distal to the junction. Among the upper stomach carcinomas, most of the tumors (87.5%) whose center was located within 2 cm from the EGJ invaded the esophagus. In conclusion, carcinoma of the gastric cardia is defined as a lesion with its center located within 1 cm proximal and 2 cm distal to the EGJ.
    Notes: Zusammenfassung Diese Untersuchung befaßt sich mit der Definition von Carcinomen der Kardia. An 182 Patienten, die weder Hiatushernien, Ulcera noch Neoplasien des Oesophagus bzw. des Magens aufwiesen, wurde die Lage des Übergangs von der Oesophagus- zur Magenmucosa (esophagogastric mucosal junction, EGJ) endoskopisch untersucht. Dann wurde die Beziehung zwischen EGJ und dem Drüsengebiet der Kardia histologisch anhand von 56 Resektaten mit intaktem EGJ und Kardiadrüsenzone untersucht. Außerdem wurde an 102 resezierten Carcinomen mit Sitz in der Nähe des gastrooesophagealen Übergangs die kürzeste Ent fernung zwischen Carcinomzentrum und EGJ und das Ausmaß der Oesophagusinfiltration bestimmt; die Proben schlossen den EGJ ein und konnten pathohistologisch beurteilt werden. Bei der radiologischen und endoskopischen Untersuchung fand sind der EGJ 0,5–1,0 cm vom His-Winkel entfernt. Die histologische Untersuchung zeigte, daß die Kardiadrüsenzone sich vom EGJ etwa 1 cm nach proximal und 2 cm nach distal erstreckt. Die meisten Tumoren des oberen Magens (87,5%), deren Zentrum innerhalb von 2 cm vom EGJ entfernt lag, infiltrierten in den Oesophagus. Ein Kardiacarcinom ist demzufolge als Läsion zu definieren, deren Zentrum innerhalb von 1 cm proximal und 2 cm distal des EGJ liegt.
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  • 39
    ISSN: 1435-2451
    Keywords: Hepatic transplantation ; Portal blood flow reconstruction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Anhand einer Kasuistik wird eine neue Methode zur Durchführung einer Lebertransplantation auch bei geringem Pfortaderfluß dargestellt: hierbei werden die Pfortaderbereiche der rechten und linken Leberseite separiert, portales Blut in das linke und arterialisiert-caval-venöses Blut in das rechte Pfortadersystem eingeleitet. Die Funktion der so durchbluteten Transplantatleber und der frühpostoperative klinische Verlauf bei dem 36jährigen Patienten (nach HBs-positiver Cirrhose mit schwerer Krankheitssymptomatik) waren gut. Vermutlich verringerte sich oder sistierte die portale Perfusion ab einem Zeitpunkt 3 Wochen nach Transplantation links und ab einem nach 2 Monaten rechts. Vorübergehende Transaminaseerhöhungen können als Ausdruck hierfür gewertet werden. Doch ist der weitere Verlauf gut und der Patient hat eine wesentliche gesundheitliche Rehabilitation erfahren. Die Technik der arterialisierten caval-venösen Pfortaderdurchblutung kann vermutlich auch alleine, d. h. ohne die Einleitung eines portalen Restblutstromes in die linke Leberseite angewandt werden, damit braucht das Fehlen von Voraussetzungen zur Einleitung porral-venösen Blutes in das Lebertransplantat oder ein schwach ausgebildetes portales System wohl nicht mehr als technische Kontraindikation gegenüber einer Lebertransplantation angesehen zu werden.
    Notes: Summary A new method for the performance of a hepatic transplantation in spite of a low portal blood flow situation is described casuistically. In a 36-year-old-patient suffering from liver cirrhosis due to hepatitis B, the portal blood system of the right and left liver parts were divided, the left part was perfused with a low flow of portal blood, the right one with arterialized caval blood. The function of the transplanted liver and the early postoperative course were excellent. During the further postoperative course portal perfusion presumably diminished or stopped on the left side from three weeks and on the right side from two months post-operatively. Nevertheless the general condition of the patient improved continuously; transient elevations of transaminases may reflect the disturbance of portal perfusion. The technique of this arterialized caval blood perfusion of the portal system is presumably applicable also for situations, in which there is no portal blood flow available for perfusion of a liver graft. Thus, the absence of possibility for reconstruction of portal blood inflow or a situation with a hypoplastic portal vein may no longer be considered as a technical contraindication for liver grafting.
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  • 40
    ISSN: 1435-2451
    Keywords: Infection prophylaxis ; Risk factors ; Antibiotic therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Anhand von 581 Patienten, die 1975–1988 mit Kopfprothese versorgt wurden, wird gezeigt, daß durch gleichzeitige Verwendung eines prophylaktischen Antibioticums und Verwendung eines Reinraum-OP's die Infektionsrate von 5% auf 0,75% gesenkt werden kann. Die wichtigsten Risikofaktoren für die Entstehung einer Infektion sind reduzierter Allgemeinzustand, ein chronischer Harnwegsinfekt sowie Diabetes mellitus.
    Notes: Summary An account of 581 patients managed with head prosthesis after femoral neck fractures between 1975–1988 revealed that the administration of prophylactic antibiotics coupled with the use of a lamine airflow system in the operating room reduced the infection rate from 5% to 0.75%. The important risk factors which predispose infection are poor physical state, chronic urinary tract infection as well as diabetes mellitus.
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  • 41
    ISSN: 1435-2451
    Keywords: Rectum ; Surgery ; Anterior resection ; Suture-line insufficiency ; Blood supply ; Arteries
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Für die drei Rectalarterien lassen sich anhand von Injektionspräparaten Versorgungsareale definieren. Die A. rectalis superior versorgt von cranial, die A. rectalis inferior von caudal trichterförmig alle Wandschichten des Rectums bis zur Linea dentata. Ein keilförmiger Bereich der Tunica muscularis im proximalen A.-rectalis-inferior-Versorgungsgebiet ist vergleichsweise schwächer versorgt. Die A. rectalis media kann variabel Teile des distalen A.-rectalis-superior-Versorgungsgebietes für die Tunica muscularis übernehmen. Intramurale Verbindungen zwischen den genannten Arealen bestehen nur zwischen A. rectalis superior et inferior auf Höhe der Linea dentata in der Tela submucosa.
    Notes: Summary Based on selective dye injection studies, the regions of supply of the 3 rectal arteries have been defined. The cranial portion of the rectum receives its blood supply from the superior rectal artery, the inferior rectal artery supplies the entire rectal wall in a fan-shaped configuration up to the dentate line. A wedge-shaped portion of the muscularis in the proximal distribution of the inferior rectal artery receives a relatively reduced supply. The middle rectal artery can supply a variable portion of the muscularis which is usually supplied by the distal superior rectal artery. Intramural anastomoses between these regions exist only between the superior and inferior rectal arteries at the level of the dentate line in the submucosa.
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  • 42
    ISSN: 1435-2451
    Keywords: Hyperakute Abstoßung ; Leberransplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Out of 81 liver transplantations 2 graft failures were diagnosed to be due to hyperacute rejection. In the first patient the operative procedure was difficult requiring 19 units of blood and plasma, but the graft was functioning well from the beginning until day 1–2, when rapid deterioration occurred. The cross-match was positive. The second patient received a third graft after the first graft had failed due to donor reasons and the second ABO-incompatible graft had been rejected. The third graft transplanted in an uncomplicated operation requiring only 10 units of blood and plasma failed within hours. Both incidences are throught to be a consequence of an immunological assault, consistent with hyperacute rejection. Thus two different clinical appearances could be observed: the so-called delayed type in the first patient and the more classical type in the second patient. For establishing diagnosis of hyperacute rejection two prerequisites were considered essential: 1) histological findings of necrosis and patchy deposits of immunoglobulins, namely IgG, IgM, IgA, C-3 complement component, properdine and fibrinogen, and 2) the proof of at least a short period of an initial function of the graft prior to deterioration in order to exclude primary non-function due to other causes. The low frequency of the appearance of the classical hyperacute rejection and hypothetical causes for the more frequent appearance of the delayed type are discussed.
    Notes: Zusammenfassung Bei 2 von 81 Lebertransplantationen wurde ein Transplantatversagen beobachtet, das auf eine hyperakute Abstoßung zurückgeführt wurde. Bei der ersten Patientin, die in einer schwierigen, 19 Einheiten Blut und Plasma erfordernden Operation transplantiert wurde, zeigte sich zunächst eine gute Sofortfunktion des Transplantates, bis es am Tag 1–2 zu einem plötzlichen Funktionsverlust kam. Das Cross-match war positiv. Der zweite Patient erhielt ein drittes Transplantat, nachdem das erste eine spenderbedingte Nichtfunktion aufgewiesen hatte und das zweite, blutgruppeninkompatible Organ abgestoßen worden war. Das dritte Transplantat, das in einer unkomplizierten, nur 10 Einheiten Blut und Plasma erfordernden Operation transplantiert wurde, zeigte eine Sofortfunktion. Innerhalb weniger Stunden kam es jedoch zum Funktionsverlust. Beide Transplantatversagen werden auf immunologische, einer hyperakuten Abstoßung entsprechende Vorgänge zurückgeführt. Somit konnten zwei unterschiedliche Erscheinungsformen beobachtet werden: der sogenannte “Delayed Type” bei der ersten Patientin und die mehr klassische Form bei dem zweiten Patienten. Für die Diagnosestellung „hyperakute Abstoßung” werden zwei Befunde für erforderlich gehalten: 1. histologische Befunde von Nekrosen und herdförmige Immunglobulinablagerungen, besonders IgG, IgM, IgA, C3-Komplement-Komponente, Properdin und Fibrinogen, und 2. der Nachweis zumindest einer kurzzeitigen initialen Transplantatfunktion, um eine initiale Nichtfunktion aufgrund anderer Ursachen auszuschließen. Die seltene Diagnosestellung bei der klassischen Form einer hyperakuten Abstoßung und hypothetische Gründe für die häufigere Beobachtung des “Delayed Type” werden diskutiert.
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  • 43
    ISSN: 1435-2451
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 44
    ISSN: 1435-2451
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 45
    ISSN: 1435-2451
    Keywords: Complicated diverticulitis ; Primary resection ; Hartmann Operation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Von 1973 bis 1986 wurden 107 Patienten mit einer komplizierten Sigmadiverticulitis operiert. Es handelte sich um 47 Frauen und 60 Männer bei einem Durchschnittsalter von 62 Jahren. Von 107 Patienten wiesen 14 eine perforierte Diverticulitis mit diffuser eitriger/kotiger Peritonitis auf, 68 Patienten eine perforierte Diverticulitis mit lokalisierter eitriger Peritonitis/paracolischem Absceß und 25 Patienten eine akute phlegmonöse Diverticulitis ohne Perforation. Zusätzliche pathologische Befunde waren: innere Fisteln (13 Patienten), nekrotisierende Fasciitis (3 Patienten), Stenose mit Ileus (3 Patienten) und synchrone Carcinome (7 Patienten). Die Gesamtletalität der 107 Patienten betrug 9,3% (=10 Patienten), die Morbidität der 97 überlebenden Patienten 34,0% (= 33 Patienten). Die Letalität bei 14 Patienten mit perforierter Diverticulitis und diffuser eitriger/kotiger Peritonitis lag bei 50%, die der 68 Patienten mit perforierter Diverticulitis und lokaler eitriger Peritonitis/ paracolischem Absceß bei 4,4%, die der 25 Patienten mit akuter phlegmonöser Diverticulitis ohne Perforation bei 0%. Von den 10 Patienten verstarben 7 bei Operation ihrer perforierten Diverticulitis mit diffuser eitriger Peritonitis, 1 (5) nach primärer Resektion mit primärer Anastomose, 3 (5) nach Operation nach Hartmann, 3 (4) nach alleiniger Anlage einer Colostomie. Bei Operation der perforierten Diverticulitis mit lokaler Peritonitis verstarben 3 Patienten, 2 (6) nach Operation nach Hartman und 1 (5) nach alleiniger Anlage einer Colostomie. Trotz einer hohen Zunahme der Zahl primärer Resektionen mit primärer Anasto mose im Zeitraum 1980–1986 ergab sich im Vergleich zum 7-Jahresabschnitt 1973–1979 ein Rückgang der Letalität von 35,7% auf 0% bei dieser Operation. Ihre Anwendung ist auch gerechtfertigt bei der perforierten Diverticulitis mit lokaler wie diffus eitriger oder kotiger Peritonitis.
    Notes: Summary Of the 107 patients with complicated diverticulitis operated from 1973–1986 47 were females and 60 males. In 14 of the 107 patients a perforated diverticulitis with diffuse purulent/faecal peritonitis was found, a perforated diverticulitis with localized purulent peritonitis/paracolic abscess in 68 patients and an acute phlegmonous diverticulitis without perforation in 25 patients. Additional pathologic findings were internal fistulae (13 patients), necrotizing fasciitis (3 patients), obstruction (3 patients) and synchronous carcinoma (7 patients). The overall mortality of the 107 patients was 9.3 % (=10 patients) and the morbidity of the 97 survivors 34% (=33 patients). The mortality of the 1.4 patients with perforated diverticulitis and diffuse purulent peritonitis was 50%, of the 68 patients with perforated diverticulitis and localized purulent peritonitis 4.4% and of the 25 patients with acute phlegmonous diverticulitis 0%. Seven of the 10 patients died after operation of the perforated diverticulitis with diffuse purulent peritonitis — 1 (5) after primary resection with primary anastomosis, 3 (5) after Hartmann procedure, 3 (4) after loop colostomy alone. Three patients died after operation of the perforated diverticulitis with localized purulent peritonitis — 2 (6) after Hartmann procedure, 1 (5) after loop colostomy alone. In spite of forcing the primary resection with primary anastomosis in the years from 1980–1986 the mortality decreased for these operations from 35.7% in 1973–1979 to 0% in 1980–1986. The indication of primary resection with primary anas tomosis is justified also for perforated diverticulitis with localized and diffuse peritonitis.
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  • 46
    ISSN: 1435-2451
    Keywords: Electrostimulation ; Small intestine ; Intestinal pouches ; Motility
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die Kontrolle der Motorik von intestinalen Reservoiren kann zur Verbesserung der Entleerung und der Kontinenz beitragen. Bei 4 Tieren wurde ein U-förmiger Jejunumpouch und bei weiteren 4 ein Ileumpouch gebildet und mit Stimulationselektroden und Druckkathetern instrumentiert. Die akute Stimulation des Jejunumpouches mit 30 mA 200 μs 1,67 kHz erhöhte den Innen druck um 38 ± 4 mm Hg (n = 6). Eine Stimulation mit 500 μs 910 Hz 25 mA ergab eine Druckerhöhung von 60 ± 5 mm Hg. Bei 11 Messungen an zwei chronisch instrumentierten Tieren erhöhte dieselbe Stimulation den Druck um 25 ± 17 mm Hg. Die 200 μs Kombination zeigte variable Ergebnisse. Im Ileumpouch konnte im Akutversuch mit 50 ms 6 Hz 20 mA (n = 9) der Druck um 37 ± 10 mm Hg gesteigert werden. Diese Stimulationsform wurde vom wachen Tier nicht toleriert. Eine Elektrostimulation von Dünndarmreservoiren ist prinzipiell möglich, die Variabilität der Reaktion muß durch adjuvante Pharmacotherapie oder durch Stimulation vegetativer Nerven kontrolliert werden.
    Notes: Summary Voluntary control of the motility of intestinal reservoirs may be used to improve evacuation and continence. In 4 dogs a U-shaped jejunum pouch and in another 4 an ileum pouch was constructed and instrumented with stimulating and EMG electrodes and pressure lines. In the acute experiments jejunum pouch stimulation with 200 μs 1.67 kHz 30 mA increased the intrapouch pressure by 38 ± 4 mm Hg (n = 6) and 500 μs 910 Hz 25 mA by 60 ± 5 mm Hg (n = 3). The pressure increase in the awake animals was consistently lower (200 μs 4±6 mm Hg,n=9; 500 μs 25±17,n= 11). The ileum pouch responded with a 37 ± 10 mm Hg pressure increase (n=9) to 50 ms 6 Hz 20 mA pulse trains. Ileum pouches could not be stimulated in the awake animal due to contraction of the abdominal wall. Electrostimulation may be used to contract and evacuate intestinal reservoirs but additional drug therapy or autonomic nerve stimulation will be necessary to lower the thresholds especially for ileum stimulation in the awake animal.
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  • 47
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Immunoglobulin G (IgG) is quantitatively the predominent immunoglobulin protein in the distal airway of the human host. IgG enters the distal lung from circulating pools and plasma cells located largely in the interstitium. Although all four IgG subclasses are present in human lung secretions, only subclasses G3 and, to a lesser degree, G1 attach to pulmonary macrophage membrane receptors. IgG opsonic antibodies are essential for the optimal clearance of a very troubling pathogen,Pseudomonas aeruginosa. Nosocomial pneumonia caused by this gram-negative bacillus responds poorly to potent antimicrobial agents and is associated with a 70 % mortality. To a great extent the morbidity and mortality resulting from nosocomial pneumonia caused byPseudomonas spp. are attributable to ineffective humoral immune response to this bacterium. IgG2 antibodies in response to pseudomonal lipopolysaccharide are poorly opsonic in the macrophage system, and derepression of the potent pseudomonal elastase, an enzyme with broad substrate specificity, contributes to the disruption of other IgG antibodies.
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  • 48
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The organisms responsible for nosocomial pneumonia are continuously evolving. Gramnegative bacilli have become the most common etiologic agents over the past 20 years, and with this evolution has come a better understanding of the pathogenesis of gram-negative bacillary pneumonia. Some gram-positive cocci, such as enterococci, group B beta hemolytic streptococci and methicillin-resistantStaphylococcus aureus, haven taken on new significance in nosocomial respiratory infections.Streptococcus pneumoniae, nontypeableHaemophilus influenzae andBranhamella catarrhalis are increasingly reported in hospitalized patients with chronic lung disease. Etiologic agents will change as new antibiotics are introduced. A better understanding of etiologic agents and their pathogens may be the best tool toward preventing hospital-acquired pneumonia.
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  • 49
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The case is reported of a patient with gastric adenocarcinoma with metastases who developed a septic focus in a saphenous vein.Salmonella enteritidis was cultured from blood, sputum and stool specimens, and from a thrombus removed from a varicosity of the saphenous vein. Extraintestinal infections caused by non-typhoid salmonella usually afflict debilitated and immunocompromised patients. Metastatic septic foci may appear anywhere in the organism, including the vascular system, but involvement of the venous system has not previously been reported.
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  • 50
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A new selective and differential medium forBacteroides ureolyticus was compared with other commonly used selective media for anaerobes in a diagnostic trial with routine clinical specimens. AllBacteroides ureolyticus strains grew on nalidixic acid-teicoplaninurea agar, producing red colonies against a straw-coloured background. This medium was found to be the most selective forBacteroides ureolyticus. In the diagnostic trial with 185 clinical specimens a 20% increase in the isolation rate ofBacteroides ureolyticus was obtained with this new medium.
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  • 51
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 52
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    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 53
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 54
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In order to determine the optimal antipseudomonal therapy in patients with cystic fibrosis aztreonam plus amikacin was compared to ceftazidime plus amikacin, and these two-week hospital regimens were followed by oral ciprofloxacin given for four weeks. Fifty-six cases of acute pulmonary exacerbation of the disease in 42 patients associated with isolation ofPseudomonas aeruginosa from the sputum were randomly treated with either aztreonam or ceftazidime (300mg/kg/day i.v.; maximum daily dose 12g) in combination with amikacin (36 mg/kg/day i.v.; maximum daily dose 1,500mg). Other aspects of the two-week treatment were constant. The two therapy groups were comparable in all respects. Both regimens were well tolerated and resulted in similar improvements in clinical, bacteriologic, radiologic and laboratory findings, and pulmonary function. Fifty patients could be reevaluated after subsequent outpatient therapy consisting of oral ciprofloxacin (30 mg/kg/day; maximum daily dose 1,500mg) given for four weeks. During this period, the clinical and laboratory improvements persisted, and the rate of eradication ofPseudomonas aeruginosa from sputum decreased from 62% to 34%. Ciprofloxacin was well tolerated and there was no drug toxicity or serious adverse effect. In the 25 prepubertal patients there was neither subjective nor objective evidence of skeletal drug toxicity. In patients with cystic fibrosis, aztreonam or ceftazidime in combination with amikacin represents an effective and safe systemic anti-pseudomonal therapy. Subsequent oral ciprofloxacin therapy for four weeks prolongs the beneficial effects and is well tolerated.
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  • 55
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    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 56
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 57
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Modulation of the bacterial flora of patients with a high risk of acquiring an infection can be achieved in several ways. The approach used in the Leiden University Hospital is based on selective elimination of the aerobic bacteria in the oropharyngeal cavity and intestinal tract, leaving the anaerobic flora intact. This kind of selective modulation of the host flora has an advantage in that it does not affect the colonization resistance provided by bacterial antagonism, which prevents colonization by resistant but potentially pathogenic bacteria or fungi. The elimination of aerobic bacteria combined with nursing in protective isolation and consumption of food with few bacteria has led to a significant reduction of the incidence of major and fatal infections in patients during episodes of severe granulocytopenia. From these results it may be concluded that the objective of selective antibiotic modulation, namely, the prevention of infections, can be achieved with this approach.
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    Topics: Medicine
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    Topics: Medicine
    Notes: Abstract The optimal technique for diagnosing nosocomial bacterial pneumonia in critically ill patients cared for in the intensive care unit remains unclear, especially in the subgroup of patients requiring mechanical ventilation. An important advance has been the development of the protected specimen brush technique. We and others have demonstrated that secretions obtained using this technique and evaluated by quantitative cultures are useful in distinguishing patients with and without pneumonia. However, this procedure has important limitations in that results are not available immediately and in that a few false negative or false positive results may be observed. Recently, the use of bronchoalveolar lavage has been suggested to be of value in establishing the diagnosis of pneumonia, since the cells and liquid recovered can be examined microscopically immediately after the procedure and are also suitable for quantitative culture. We believe that microscopic identification of bacteria within cells recovered by lavage may provide a sensitive and specific means for early and rapid diagnosis of pneumonia in this setting and that the lavage technique can be conveniently incorporated into a protocol along with the quantitative culture of samples obtained using the protected specimen brush. This combination will probably improve the overall accuracy of diagnosis while allowing the administration of prompt empiric antimicrobial therapy in the majority of patients with pneumonia.
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    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Surveillance studies generally have underestimated the importance of viruses in the pathogenesis of nosocomial respiratory tract infections. The development of rapid, sensitive and reliable diagnostic techniques has permitted documentation of viral respiratory pathogens and has led to increased understanding of the epidemiology of these organisms in the hospital. These advances are exemplified by studies of respiratory syncytial virus infections in hospitalized children. The pulmonary sequelae of RSV infection are particularly serious in neonates and in children with underlying cardiopulmonary disease or immunodeficiency. Virus is spread by direct hand contact with the secretions of infected patients or with contaminated objects in the patients' environment. Personnel may infect themselves by rubbing their eyes or nose with contaminated hands, thus becoming vectors in the transmission of RSV to patients under their care. Compliance with contact precautions, which requires the use of gloves and gown, dramatically reduces the incidence of nosocomial RSV infection. When children do become ill, ribavirin may ameliorate the disease. Immunological approaches to treatment and prevention are being examined.
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    Topics: Medicine
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    Topics: Medicine
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    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The susceptibility of 22 clinical isolates ofCampylobacter pylori to eight antimicrobial agents was studied under varying pH conditions. Macrolides (erythromycin, dirythromycin), clindamycin and to a lesser extent quinolones lost efficacy at lowered pH. The activity of ampicillin and metronidazole remained relatively stable throughout the pH range tested. The effect of pH an antimicrobial efficacy may warrant consideration when selecting an antibiotic to clearCampylobacter pylori in vivo, since the pH of the gastric submucous environment is not known for certain.