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Biomedical subjects

B Kremer

Publications and source records attributed to B Kremer.

At least 163 records · Page 9Linked to original sources
PubMed1990

[Securing colon anastomoses by surrounding it with a polyglycolic acid filament net. An animal experiment study].

Resorbable polyglycolic-acid (PGA)-nets are used successfully for the treatment of traumatic ruptures of parenchymous organs. This experimental study was carried out to investigate whether PGA-nets can also re-enforce jeopardized colon anastomoses. In 75 Wistar rats the transverse colon was transsected and reanastomosed. Animals were divided into 2 groups: in one group the anastomosis was applied sufficiently, in the other group the anastomosis was applied potentially insufficient. Out of each group a PGA-net was placed around the anastomosis in one half of the animals. The results demonstrated that delayed healing of the anastomoses as well as spontaneous suture line disruptions followed by peritonitis only occurred in those animals in which a PGA-net had been used. The evaluation of the bursting strength could confirm this finding of delayed consolidation. The bursting pressure therefore was significantly decreased in all animals in which a PGA-net had been applied, compared to the control group operated without PGA-net application. We therefore conclude that PGA-net application in colon anastomoses inhibits the consolidation of the suture line, probably because of a lack of contact to the peritoneal and omental tissue.

Anastomosis, Surgical↗
PubMed1990

Immunochemical characterization and quantitative distribution of pancreatic stone protein in sera and pancreatic secretions in pancreatic disorders.

A fluorometric immunoassay has been established to quantitate pancreatic stone protein providing a sensitivity for concentrations from 0.015 to 0.5 micrograms/mL. When concentrations of pancreatic stone protein were determined from pancreatic secretions obtained either from patients suffering from chronic pancreatitis (n = 31) [including the calcifying forms (n = 10)], pancreatic cancer (n = 22), or nonpancreatic diseases (n = 17), no significant differences were found. In contrast, increased concentrations were found in serum samples from patients with chronic (39/66) and acute pancreatitis (16/20) compared with control patients. The differences between these diagnostic groups and controls were highly significant (P less than 0.0001) and independent of pancreatic enzyme activity. Immunochemical analyses of serum pancreatic stone protein showed an isoelectric point (pH 9) similar to that reported for the pancreatic thread protein. With respect to recent communications, these data do not support the etiopathogenic role postulated for pancreatic stone protein in chronic pancreatitis and chronic calcifying pancreatitis by other investigators.

Adult↗
PubMed1990

[Pregnancy following organ transplantation].

In 17 of 74 patients, in the 20-40 years of age group, who had undergone an organ transplantation (kidney or liver), the course and outcome of pregnancy were evaluated. In three cases, the pregnancies ended in premature miscarriage and in five cases they were terminated for medical reasons. Nine infants were born alive between the 32nd to the 40th week of gestation, six of them spontaneously, three of them by abdominal Caesarean section. One of these infants born in the 32nd week of gestation with a birth weight of 800 grams died on the second day after birth. One infant born in the 33rd week of gestation showed incidence of a persistent ductus arteriosis Botalli. Four of the nine newborns suffered from intrauterine dystrophy. The birth weight of four further infants corresponded to the 10th to 25th percentile. Neither the incidence of a maternal varicella zoster infection in the early stages of pregnancy nor the reactivation of a herpes simplex (HSV) and cytomegalia virus infection during the pregnancy resulted in any perceptible damage to the infant or transplant. During pregnancy, three of the mothers were treated with immunosuppressants, either with a combination of azathioprine and prednisone (conventional) or cyclosporine (CSA) and prednisone, or with a combination of all three drugs (triple therapy). As opposed to the newborn of those mothers, who had been treated conventionally, the newborn of those treated with CSA showed post partum a tendency towards hypocalcaemia. Two of the mothers gave birth to their infants outside the Federal Republic of Germany.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Drug-Induced↗
PubMed1990

Reinforcement of colon anastomoses with polyglycolic acid mesh: an experimental study.

Polyglycolic acid (PGA) meshes have successfully been used in the treatment of injured parenchymatous organs. In our study we investigated the value of PGA meshes for reinforcement of colon anastomoses in a rat model. In 75 Wistar rats the transverse colon was transected and reanastomosed in a single-layer technique. The anastomoses in half of the animals were performed with 6 stitches. In the other animals the anastomoses were performed with 4 stitches only and were therefore supposed to leak. In half of the animals of each group a PGA mesh was used to cover the anastomoses. Animals of each group were sacrificed after 2, 4, 8, 30 and 60 days. The bursting strength of the anastomoses was determined and the anastomosed region was examined histologically. The results demonstrate that regardless of how the anastomosis was applied motility disorders, delayed healing or leakage followed by peritonitis only occurred in animals in which a PGA mesh was used. The determination of the bursting strength also showed a marked decrease in all rats in which the anastomosis was reinforced with a PGA mesh. We therefore conclude that PGA mesh application in colon anastomoses results in impaired healing, which is probably due to reduced peritoneal or omental contact.

Anastomosis, Surgical↗
PubMed1990

Treatment of metastatic gastric carcinoma with a modified FAMTX chemotherapy regimen.

Fifty patients with locally far advanced or metastasizing gastric carcinoma were treated with 5-fluorouracil, adriamycin and methotrexate using a slightly modified FAMTX protocol. Complete remission was achieved in four (8%) patients, confirmed operatively, partial remission in 13 (26%) patients, two of these going into complete remission after operative removal of residual tumor. Median duration of remission for the six patients in complete remission was 21 months, for those in partial remission five months. Median survival for all 50 patients was seven months, for those in complete and partial remission 12 months, and for those without remission four months. These results indicate the possibility of a further improvement of treatment results in patients with metastasizing gastric carcinoma using this protocol of combined operation and chemotherapy.

Adult↗
PubMed1990

A psychological support concept and quality of life research in a liver transplantation program: an interdisciplinary multicenter study.

Considering the increasing number of liver transplantations with longer periods of transplant function, there is a growing need for quality of life research in the field. In addition to lethality, mortality and rehabilitation, parameters of 'quality of life' are to be evaluated: the patient's rating of his subjective physical symptoms, psychological condition (anxiety, depression and mental adjustment), social reintegration and life satisfaction. This paper describes our psychological support program that has been established at the Hamburg LTX center as well as the first results of the ongoing QoL research study. Using the methods developed by the Hamburg Study group on 'quality of life in surgery', 38 liver transplantation patients of the University of Chicago (cross-sectional study with control groups of patients with chronic liver disease as well as healthy individuals) and 29 patients of the University Clinic of Hamburg (longitudinal study with points of evaluation before and 2, 6, 12, 24 and 36 months after transplantation) have been evaluated. First results: (1) All successfully transplanted patients show a significant postoperative increase of their overall quality of life. (2) The psychological parameters of quality of life are only partly correlated with physical symptoms. (3) There is a high correlation between rejection crisis periods and the decrease of all quality of life parameters. (4) In both samples men have a lower quality of life than women, (5) Preoperative depression and lack of social support might be considered as being possible risk factors for long-term survival. (6) Long-term survivors rate their quality of life significantly higher than patients with chronic liver disease and--despite some persisting somatic restrictions--as high as healthy controls. (7) A psychotherapeutic support program increases the patient's compliance resulting a better adaption to the transplant procedure including rehabilitation.

Activities of Daily Living↗
PubMed1990

[Initial results of combined surgical-medical therapy for metastatic cancer of the stomach].

Fifty patients with advanced gastric cancer underwent chemotherapy in accordance with the FAMTX protocol. Complete tumor remission was achieved in 6 patients and partial remission in 11 patients. In this group 9 patients (tumor stage: T3-4, N2-3, M chi-1) underwent a second-look operation after chemotherapy either to confirm the complete remission or to resect the remaining tumor mass. It is concluded that even in advanced stages of gastric carcinomas a more aggressive approach involving a combination of surgical and chemotherapeutic treatment improves the survival time of these patients.

Adult↗
PubMed1990

[Use of blood components in 30 liver transplantations at the Hamburg Eppendorf University Clinic 1984 to 1989].

Among all major organ transplantations, orthotopic liver transplantation (LTX) requires the most extensive blood component support. From 1984 till 1989 we performed 30 LTX procedures on 27 patients. The number of blood components used totalled 1,000 units of packed red cells (RBC), 966 units of fresh-frozen plasma, 246 units of whole blood, 170 units of random-donor platelet-rich plasma and 71 units of platelet concentrates from cell separator. Three retransplantations were performed within 2 days after the first LTX. The lowest use of blood components was registered in patients with hepatoma, the highest in alcoholtoxic cirrhosis. Ten of the 27 patients are still alive.

Blood Transfusion↗
PubMed1990

[Prevention of adhesions by intraperitoneal administration of substances in abdominal interventions].

Various substances (saline solution, dextran, heparin, proteinase inhibitors, etc.) have been investigated to determine their influence on adhesion prevention, but until recently the results were controversial and lacked any implication for clinical use. The analysis of intraperitoneal plasminogen activating factor (PAA) and the fibronectin production rate of peritoneal macrophages promises new aspects of adhesion formation and prevention. The results of studies show a close correlation between ischemia/infection and the decrease of PAA as well as increased adhesion formation in patients (endometriosis) with increased fibronectin production by peritoneal macrophages.

Abdomen↗
PubMed1990

[Partial resection of primary liver cell cancer].

Between 1985 and 1990, 47 patients with primary hepatocellular carcinoma (HCC) underwent surgery (n = 27), chemoembolization (n = 12) or palliative resection followed by chemoembolization (n = 5). In 85% of the patients a T3/T4 tumor stage was found, 68% had liver cirrhosis and 42% were older than 70. Mortality was 18.7% after liver resection and 0% after chemoembolization or combined treatment. Average survival was 4.4 months after chemoembolization, 11.6 months after resection and 11.6 months after palliative resection of the HCC followed by chemoembolization with angiostat/adriblastin.

Aged↗
PubMed1990

[Comparative efficacy of sonography, computed tomography, ERCP and angiography in the diagnosis of primary carcinomas of the gallbladder].

Based on a patient material of 12 patients suffering from a histologically confirmed primary carcinoma of the gallbladder the preoperative diagnoses via the four imaging methods of sonography, CT, ERCP and angiography were compared with the intraoperative findings. Surprisingly, ERCP and angiography turned out to be the most accurate of these diagnostic methods.

Adult↗
PubMed1990

[Comparative efficacy of sonography, computed tomography, ERCP and angiography in the diagnosis of primary papillary carcinomas].

In a patient group of 19 patients suffering from a primary carcinoma of the papilla of Vater that had been confirmed by surgery and histology, the preoperative diagnoses arrived at by the four imaging methods of sonography, CT, ERCP and angiography were compared on the basis of the intraoperatively produced tumour findings, and the accuracy of the methods was assessed. It was found that ERCP is superior to all the other diagnostic methods in respect of carcinomas of the papilla of Vater, diagnosis being correct in more than half of the cases. Sonography yielded the diagnosis of a space-occupying growth in barely one-half of the cases, whereas CT reported a mass in two-thirds of the cases, but no clear organotopic diagnosis was possible. In no case did angiography supply a pointer towards the correct final diagnosis.

Adult↗
PubMed1989

[The results of a modified FAMeth chemotherapy protocol in metastatic stomach carcinoma].

Fifty patients with locally far progressed or metastasizing gastric carcinoma were treated with 5-fluorouracil, adriamycin and methotrexate using a slight modification of the FAMeth schema. Full remission was achieved in four patients, confirmed at a second-look operation. Partial remission was achieved in 13 patients, two of whom went into full remission after operative removal of residual tumour. Median duration of remission for the six patients in full remission was 21 months, for those in partial remission five months. Median survival of all 50 patients was seven months, of those in full and partial remission 12 months, and those without remission four months. The results indicate that this protocol of combined operation and chemotherapy can further improve the results of treating metastasizing gastric carcinoma.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

[Carbon tetrachloride poisoning in a swine model].

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.

Animals↗
PubMed1989

Intrasplenic hepatocyte transplantation: evaluation of DNA synthesis and proliferation in auxiliary transplanted cells.

The value of isolated hepatocyte transplantation as a temporary support in acute hepatic failure remains controversial regarding the functional capacities of freshly isolated and transplanted hepatocytes. To evaluate the survival rate of intrasplenically transplanted liver cells and their response to a proliferation stimulus like partial hepatectomy, 3H-thymidine incorporation into hepatic and auxiliary transplanted hepatocyte DNA was determined. The survival rate of intrasplenically transplanted hepatocytes was evaluated by analyses of m-albumin-RNA within the splenic tissue and compared to the morphological findings. The histological results show a marked decrease (greater than x 100) of intrasplenically transplanted hepatocytes within 1 week after injection. The amount of surviving cells then remained constant for 3 months without any signs of proliferation. After partial hepatectomy a stimulation of hepatic regeneration was observed in the remaining liver tissue but not in auxiliary transplanted hepatocytes. M-albumin-RNA determination of auxiliary transplanted hepatocytes revealed a decrease of m-albumin-RNA concentration of greater than 100 times within 24 h after transplantation indicating early cell necrosis of the transplanted cells. Since intrasplenically transplanted hepatocytes underwent an early cell necrosis without any evidence for a directly postoperatively inducible cell proliferation, it is concluded that a sufficient metabolic support in acute hepatic failure cannot be taken into consideration.

Albumins↗
PubMed1989

[A comparison of the efficacy of sonography, computed tomography, ERCP and angiography in the diagnosis of primary bile duct carcinoma].

Sonography, CT, ERCP and angiography were carried out in 22 patients with operatively and histologically confirmed primary carcinomas of the bile duct and the findings were compared with the appearances at operation. ERCP proved to have an accuracy of about 79% and is markedly superior to the other diagnostic methods. Sonography had an accuracy of about 39%, CT 42% and angiography 55%.

Adult↗