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Biomedical subjects

A Thiede

Publications and source records attributed to A Thiede.

At least 145 records · Page 8Linked to original sources
PubMed1998

Procalcitonin in early detection of postoperative complications.

BACKGROUND: A prospective clinical study was performed to assess the accuracy of procalcitonin in 70 patients with elective colorectal or aortal surgery and to compare it with inflammatory mediators. Also the early prediction of complications and the outcome of these patients was taken into account. METHODS: Laboratory variables and cytokine determination were obtained preoperatively, on the day of operation and postoperatively on a daily basis from day 1 to 5, and on days 7 and 10 in the colorectal group and in the aortal surgery group at different times on the operation day after aortal clamping. The main outcome criteria were early recognition of complications and alterations in the production of procalcitonin and cytokines in order to detect severe infective complications. RESULTS: Procalcitonin was closely related to postoperative complications with significantly elevated levels at day 1 after surgery. The plasma concentrations of IL-6 increase on days 1-3 without a difference in the groups, also C-reactive protein demonstrates no differences. CONCLUSION: Procalcitonin presents itself as a new parameter of infection and sepsis. In the postoperative period PCT seems to be an interesting marker of early prediction of infective complications when high postoperative levels are found. Under routine conditions procalcitonin is a valid reproducible and detectable parameter.

Adult↗
PubMed1998

[Antroduodenal motility in patients with gastroesophageal reflux disease].

Beside the defective lower esophageal sphincter different mechanisms may be involved pathophysiology of GERD. This study shows antroduodenal motility disorders including a lower incidence of IMC's and lower frequencies of contractions in some study periods as possible pathophysiologic feature in selected patients with atypical symptoms and increased duodenogastric reflux.

Adult↗
PubMed1998

[Role of apoptosis in induction of tolerance after liver and liver/small intestine transplantation].

Liver induced tolerance and the protecting effect towards a co-transplanted organ are well known effects after liver transplantation in rats. Isolated liver transplantation and combined liver/small bowel transplantation are used to investigate the cellular mechanisms of those two phenomenons. In both transplantation models a transient rejection process can be observed. During this response recipient derived graft infiltrating T-cells are subsequently inactivated. The initial peak of apoptotic cell death in the liver lobuli decreases and is followed by an increase in apoptosis of the infiltrating T-cells during the end of the rejection response. Donor specific tolerance occurs after LTx and LDDTx respectively, proofed by indicator heart transplantation.

Animals↗
PubMed1998

[Selective immunosuppression with monoclonal antibodies against ICAM-1 and LFA-1 with FK 506 after experimental small intestine transplantation in the rat].

Prevention of allograft rejection remains a major problem after small bowel transplantation (SBT) and requires potent immunosuppressive regimens. In a variety of transplant models, e.g. liver or heart transplantation, the supplementary application of monoclonal antibodies (mabs) against adhesion molecules is effective in both prolonging graft survival and inducing long-term graft acceptance or tolerance in some cases. In this study anti ICAM-1 (1A29) and anti LFA-1 (WT1) mabs were used in combination with a subtherapeutic dose of FK 506 for 13 days after allogeneic SBT in the rat. The results of this study indicate that in contrast to the induction of allospecific tolerance after liver transplantation, the addition of anti ICAM-1 and/or of anti LFA-1 mabs after SBT reverses the FK 506 effect and results in early graft rejection. It has been shown that higher dosages of these mabs, given alone or in combination with CsA or FK 506, result in long-term survival of cardiac allografts in both, rats and mice [4-8]. Graft survival after pancreas transplantation is prolonged [6]. However, these negative therapeutic effects of the mabs 1A29 and WT1 after SBT have to be critically reevaluated and further analysed.

Animals↗
PubMed1998

[Cellular immune reactivity in xenogenic "human-anti-pig" transplant combination].

The worldwide lack of human organ donors puts the pig as potential xenogeneic donor species into the prime of interest. Aim of the present in vitro study is the analysis of T-cell activation in the clinically attractive combination "pig-to-human". Peripheral human blood leukocytes (hPBL) and peripheral porcine blood leukocytes (pPBL) were co-cultured for 4-8 days in the xenogeneic mixed lymphocyte reaction (xMLR) and cell proliferation was measured by 3H-thymidine uptake. Both cell populations were separated into T-cells and antigen presenting cells (APC) to analyze direct and indirect antigen recognition. The results show that (a) activation of human T-cells occurs, (b) the strength of activation depends e.g. on the human responder ("high" and "low" responders), (c) the strength of activation is independent of the responder's HLA-DR status, and (d) direct T-cell activation dominates over indirect activation. Thus, T-cell activation is another immunological barrier that has to be overcome before xenotransplantation can be clinically approached.

Adult↗
PubMed1998

[Stepwise concept for treatment of complex anal fistulas].

Most anal fistulas can be easily dealt with by simple fistulotomy. So called complex fistulas-in-ano need a differentiated, individually tailored surgical approach in order to avoid recurrence and sphincter incompetence. Complex fistulas comprise either tracks with high trans-, supra-, or extrasphincteric extension or fistulas that are complicated by multiple side branches, chronic inflammatory disease, previous operations etc. Prior to treatment a thorough preoperative diagnostic work-up is warranted. A precise intraoperative evaluation is paramount to allow radical excision of all inflamed tissue, often necessitating anal sphincter division with subsequent reconstruction. The treatment plan involves staged operations over a period of many months, usually with the (laparoscopic) fashioning of a protective stoma at the primary operation. Analysing our patients in the study period from 1/95 to 12/96 our different surgical approaches and their results are presented and discussed. During this period 96 patients with a fistula-in-ano were operated upon in the Department of Surgery at Würzburg University Hospital, of which 11 (11.5%) had complex disease. We encountered one early and one late recurrence as well as a parastomal hernia and a stoma prolapse. Anal continence was re-assessed three months following reversal of colostomy. All patients (n = 7) who had perfect continence preoperatively remained unchanged. Preoperatively, four patients were incontinent for gas and liquid stool. Two of these were fully continent, one remained unchanged at re-assessment. The fourth patient did not undergo stoma reversal as yet, because all examinations revealed an incompetent sphincter. This patient is therefore fully incontinent. Successful treatment of complex anal fistulas needs an individual approach and planning over a lengthy period of time, requiring a high level of motivation on the part of both patient and surgeon.

Adult↗
PubMed1998

[Laparoscopic anti-reflux surgery--report of experiences from Germany].

This is a report on a questionnaire in Germany reflecting the activity in antireflux surgery, both in open and laparoscopic modifications in the time period of 1990 through 1995. It serves as an overview of the acceptance of diagnostic workup, indication, applied techniques, and different antireflux procedures. In a total of 104 representative hospitals, 2,036 patients were operated during this time. Almost 80% of the hospitals provide antireflux surgery in the open technique and only 1/3 of the hospitals have experience in the laparoscopic technique. There is a total rise in antireflux surgery during the last 5 years, since the number of laparoscopic antireflux operations rises constantly with a total amount of open operations of about 250 cases per year. In open surgery the most favourite technique is the Nissen-Rossetti procedure, while in laparoscopic technique the choice for the original Nissen, the Nissen-Rossetti, or the floppy Nissen technique is divided in almost equal parts.

Cross-Sectional Studies↗
PubMed1998

Arterial reconstruction in diabetes and peripheral arterial occlusive disease: results in 192 patients.

OBJECTIVE: In the present study long-term patency and limb-salvage rates of femoro-distal bypasses were compared for patients with and without diabetes mellitus. METHODS: Between 1990 and 1994, some 192 femoro-crural bypass procedures were performed; 132 reconstructions were carried out on patients with peripheral arterial occlusive disease (PAOD), 60 bypasses on patients with PAOD and diabetes mellitus (DM). The two groups did not differ significantly regarding age, gender and risk pattern. RESULTS: The comparison of the two groups showed a significant advantage for the diabetic patients regarding the limb-salvage rate. In both groups there was also a significant difference regarding patency in favour of the diabetics. CONCLUSION: Patients suffering from diabetes and PAOD profit from femoro-distal bypasses. An aggressive vasosurgical reconstructive therapy is indicated for these patients.

Adolescent↗
PubMed1998

[Control of function before and after sphincter-preserving rectal resection].

Prior to sphincter-saving rectal surgery an in-depth evaluation of the patient's anorectal physiology is of paramount importance to avoid poor functional outcome. A detailed history comprising all previous operations and childbirths as well as a precise proctological examination are the most important steps in the diagnostic work-up. A standardized continence score is easy to obtain and can be used as a guideline preoperatively as well as during follow-up. Furthermore, endosonography, manometric studies and quality of life assessment can add valuable information before and after surgery. Electrophysiologic studies are generally not necessary and can therefore not be regarded as routine investigations.

Fecal Incontinence↗
PubMed1998

[Quality of life of patients with fecal incontinence].

Using the Gastrointestinal Quality of Life Index (GIQLI) we investigated the quality of life in a consecutive series of 35 patients with faceal incontinence compared with patients suffering from haemorrhoidal disease (n = 96), fissure in ano (n = 38) and healthy controls (n = 75). The mean score for the different groups were as follows: incontinence 93 (65% of best possible score of 144), haemorrhoids 120 (83%), fissure 104 (72%) and controls 134 (93%). Incontinent patients had the significantly lowest overall GIQLI.

Adult↗
PubMed1998

[Patient selection for laparoscopic gastric banding operation].

This study presents methods and results of a systematic selection of patients for laparoscopic gastric banding. A seven-step selection process considering anamnestic data, comprehensive counseling of patients and relatives, standardized psychological evaluation, specific medical work-up, including functional foregut testing, and economic issues was performed to select 50 of 163 referred patients (30.1%) for surgery. Long-term follow-up is needed to assess the value of this selection process.

Adult↗
PubMed1997

Influence of tumor position on accuracy of endorectal ultrasound staging.

UNLABELLED: Endorectal ultrasound is a well-established method of preoperative staging of rectal neoplastic lesions. PURPOSE: This study was undertaken to evaluate whether tumor site (in terms of height) and position (with respect to the rectal circumference) have an influence on the reliability of endoluminal ultrasound staging. METHODS: From January 1991 to May 1996, 154 consecutive patients with a total of 162 rectal tumors were examined preoperatively using endorectal ultrasound. Apart from staging all tumors using the uT/uN classification, tumor level and tumor position were recorded prospectively. Neoplasms were subdivided into low rectal (0-6 cm from the anal verge), mid rectal (7-12 cm), and higher lesions (> 12 cm). Furthermore, the lumen was divided into an anterior, left lateral, posterior, and right lateral position, and all tumors, apart from circular lesions (n = 9), were subclassified accordingly. RESULTS: Overall, we found 40 (25 percent) adenomas, 15 (9 percent) T1, 29 (18 percent) T2, 67 (41 percent) T3, and 11 (7 percent) T4 lesions. Overall accuracy was 78 percent. Staging accuracy for low rectal tumors (n = 41) was 68 percent, whereas 76 and 88 percent of mid (n = 96) and high (n = 25) neoplasms were staged correctly, respectively. The difference was not statistically significant. With regard to position, 47 tumors were situated anteriorly (77 percent accuracy), 42 in the left lateral position (69 percent accuracy), 33 posteriorly (73 percent accuracy), and 31 in the right lateral position (81 percent accuracy). Differences did not reach statistical significance. CONCLUSION: Endorectal ultrasound is currently the best method for preoperative assessment of the depth of infiltration of rectal tumors. However, rectal anatomy seems to affect staging accuracy in the lower rectum because the structure of the ampulla recti renders endosonographic examination more difficult. In addition, endosonographic layers are less well defined at this level. Both factors contribute to a lower reliability and predictive value of endorectal ultrasound staging in the lower rectum, although statistical significance was not reached in this study. On the other hand, tumor position with respect to rectal circumference does not influence the predictive value of endorectal ultrasound.

Endosonography↗
PubMed1997

The value of endorectal ultrasound in the assessment of adenomas, T1- and T2-carcinomas.

In a prospective study we examined the value of endorectal ultrasound (ERUS) in the preoperative staging of potentially locally excisable tumours. During the study period from 1.1.1991 to 1.3.1996 a total of 160 rectal tumours in 152 patients were staged endosonographically (uT/uN) and compared postoperatively with the histologic result (pT/pN) at the University Hospital of Würzburg. Thirty-eight (24%) patients had an adenoma and 15 (9%) a T1-carcinoma. In 29 (18%) cases a T2-cancer was diagnosed, further 67 (42%) and 11 (7%) patients presented with a T3 and T4 tumour, respectively. The sensitivity for adenomas and T1-Ca (uT0/1) was 81%, the specificity 98%. For T2 tumours, the sensitivity was only 41% and the specificity 92% as the majority (17 of 29) of pT2 neoplasias were overstaged (uT3). The overall staging accuracy (T1-4) was 77.5%. Two patients with a pT1-Ca and seven with a pT2-Ca had lymph node metastases which were detected preoperatively in five. The accuracy for lymph node staging was 83%. We conclude that adenomas and T1 tumours can be assessed with a high grade of accuracy using ERUS. In these tumours ERUS can be used to assist clinical decision-making (transanal vs. abdominal operation). Owing to the lack of sensitivity ERUS is of no help in the assessment of T2 carcinomas.

Adenoma↗
PubMed1997

Tailored augmentation of the lower esophageal sphincter in experimental antireflux operations.

BACKGROUND: Modern upper GI function studies allow for the detection of several pathophysiological factors that contribute to gastroesophageal reflux disease. The information obtained can lead to therapeutic consequences in patients with an indication for a surgical intervention, i.e., an individualized choice of antireflux procedure according to the existing pathophysiologic defect. METHODS: In an experimental study on mini-pigs the mechanical effect of four standardized antireflux operations (anterior and posterior 180 degrees hemifundoplication, Nissen-DeMeester and Nissen-Rossetti 360 degrees fundoplication) on the lower esophageal sphincter (LES) was investigated. It was the aim of the study to objectively determine the extent of changes in pressure and length parameters at the LES according to the performed antireflux procedure. RESULTS: It could be demonstrated that different degrees of fundic wrap formation lead to a proportional mechanical effect at the LES according to the size of this wrap. CONCLUSION: Choosing a distinct type of fundoplication will allow for a tailored augmentation of the LES according to the individual functional defect.

Animals↗
PubMed1997

The challenge of postoperative infections: does the surgeon make a difference?

Postoperative infections remain a challenge in many surgical procedures despite improved surgical technique and powerful antibiotics. The number of sepsis cases has tripled from 1979 to 1992 due to increased invasive procedures in older and immune-suppressed patients. Increasingly, in recent years, outbreaks of resistant pathogens have been published, provoking the question of how postoperative infections and resistant pathogens should be dealt with. Wound classification and risk stratification were developed to identify patients at risk for postoperative infection. However, other important intrinsic factors of the patient were not included, and further attempts have been made to increase sensitivity and specificity (eg, Study on the Efficacy of Nosocomial Infection Control project, National Nosocomial Infection Surveillance System score); the American Society of Anesthesiologists preoperative assessment score and the operation duration for specific procedures were introduced into the system as risk stratifiers. Advances in immunology have identified new ways in which the surgeon can moderate the immune response (eg, hemorrhage and blood transfusion-induced immune suppression). The increased rate of resistance in enterococci and staphylococci has refocused attention on infection control in surgery. However, there are recent reports from both sides of the Atlantic indicating that guidelines for infection control and antibiotic policy have not become reflected in standard procedures in many hospitals. New antibiotics may be developed, but resistance soon may follow. Sound techniques in surgery, with careful infection control and antibiotic policies, may be the only strategy to prevent further increases in resistance of pathogens in postoperative infections.

Antibiotic Prophylaxis↗
PubMed1997

Physical, biological and handling characteristics of surgical suture material: a comparison of four different multifilament absorbable sutures.

OBJECTIVE: Four different braided absorbable surgical materials (Dexon, Dexon II Bicolor, Vicryl and Polysorb) 2/0 USP, which basically share the same indications, were studied in vitro and in vivo with regard to their physical properties as well as tissue compatibility and surgical handling. Analyzing the results the authors tried to determine the most useful suture in surgical practice. METHOD: Physical tests to determine tensile strength, knot-breaking strength and knot security were carried out. Additionally an in vivo model (Wistar rat) was used to compare histocompatibility and loss of function due to hydrolytic resorption. Furthermore, a handling test was carried out by trained surgeons. RESULTS: Polysorb had the highest linear tensile strength but also the fastest loss of function following tissue implantation, whereas Vicryl showed the slowest loss of function. Similar results were obtained with regard to the knot-breaking strength. After pulsatile stressing Dexon II Bicolor and Dexon showed the highest irreversible elongation followed by Vicryl and Polysorb. Polysorb had the best knotting characteristics, scoring highest also in the handling study. CONCLUSIONS: The authors conclude that with Polysorb all features and properties of braided suture material have reached a high level of quality. This suture combines the positive characteristics of monofilament with those of multifilament materials, thus coming closest to being the 'optimal suture'.

Animals↗