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Biomedical subjects

E Hanisch

Publications and source records attributed to E Hanisch.

At least 19 recordsLinked to original sources
PubMed2000

Markov cohort simulation study reveals evidence for sex-based risk difference in intensive care unit patients.

BACKGROUND: Despite great advances in intensive care medicine, sepsis still is the leading cause of death. Different strategies have been developed to file the patient data into scoring systems, primarily to predict the outcome. The Markov simulation-predominantly used in economic science to describe chains of events depending on and influencing each other-seems to be an interesting and new approach in analyzing the course of disease of critically ill patients in an intensive care unit (ICU). Using such a Markov model, this study analyzes data from 660 surgical ICU patients, 44 of whom died of sepsis. METHODS: A three-state Markov model (integrating sepsis, adult respiratory distress syndrome, and mortality) was constructed to describe the course of disease of critically ill patients in defined cycles and to develop the risk profile of different groups of patients. The model enables the comparison between age- and sex-related survival rates and shows the difference in life expectancy compared with an average untreated standard population. RESULTS: Women aged up to 30 years (G1F) show the best prognosis (mortality after 19 cycles 8.3%). On the contrary, the corresponding male group (G1M) demonstrates the worst outcome (mortality after 19 cycles 57.7 %). CONCLUSIONS: The findings of this study fit into the current discussion that female patients are better positioned to meet the challenge of sepsis.

Adult↗
PubMed1999

[Segmental anatomy of the liver--a sonomorphological viewpoint].

The liver is an ideal organ for ultrasonography. In this context, intrahepatic structures allow the identification of segments according to Couinaud by ultrasonography. This article describes, step by step, the ultrasonographic segmental anatomy of the liver.

Hepatectomy↗
PubMed1999

Surgical strategies -- anastomosis or stoma, a second look -- when and why?

INTRODUCTION: The indication for performing a primary anastomosis or an intestinal stoma has to be confirmed or negated for every individual case of intestinal ischemia. DISCUSSION: In right-sided colonic emergency, primary anastomosis is possible except when associated with generalized peritonitis. In left-sided colonic ischemia and necrosis, delayed anastomosis is the preferred alternative. In ischemia following surgery for abdominal aortic aneurysms, primary anastomosis is contraindicated. In ischemia of the small bowel, an end-to-end anastomosis should be established whenever possible. CONCLUSION: In the case of intestinal ischemia, a second-look laparotomy is mandatory 24-48 h after initial surgery to ensure bowel viability. This second look should be performed regardless of the patient's postoperative clinical status. Laparoscopy has been successfully used for reexploration in intestinal ischemia, but one has to be aware of the present limitations of experience using this technique.

Anastomosis, Surgical↗
PubMed1999

Hepatocyte growth factor effects on motility of stone-diseased and stone-free human gallbladders.

Hepatocyte growth factor (HGF) has unique morphogenic activity for several cell types. Besides its major effect upon liver regeneration, its motogenic activity to enhance motility has not been verified for smooth muscles. Therefore we evaluated the impact of HGF in an in-vitro model of human gallbladder motility. Twelve stone-diseased and eight stone-free muscle strips were preincubated with HGF (100 ng/ml, 200 ng/ml). For the analysis of motility, cholecystokinin (CCK) was added (0.1 nM, 0.5 nM, 2 nM, 10 nM, and 100 nM). Twelve stone-diseased and eight stone-free strips without HGF incubation served as the control group. The tone of healthy (tone/100 nM CCK: control group, 12.4 +/- 3.6 mN; HGF group, 19.5 +/- 4.5 mN) and stone-diseased (tone/100 nM CCK: control group, 10.8 +/- 3.8 mN; HGF group, 17.3 +/- 4.8 mN) muscle strips, preincubated with HGF, was increased, with a higher sensitivity to CCK. Our results suggest that there is a clear motogenic response of stone-diseased human gallbladders to HGF.

Cholecystokinin↗
PubMed1999

Endothelin-induced contraction of the portal vein in cirrhosis.

Endothelin (ET) is one of the most potent vasoconstrictors known so far. It has been proposed that the ET-induced contraction of hepatic stellate cells (Ito, endothelial cells) is an important mechanism for the development of portal hypertension. The purpose of this study was to investigate in an in vitro model whether ET causes a contraction of the portal vein which can contribute to portal hypertension in cirrhosis. Portal veins from normal and cirrhotic rats were used for experiments. Measurements were performed in vitro for cumulative concentrations of ET-1 and ET-3 (1, 5, 10, 50 and 100 nM). Both ETs caused a dose-dependent increase in portal venous tension; the maximal tension (Tmax) was measured at 50 nM. The measured Tmax was higher for cirrhotic (ET-1: Tmax = 189%; ET-3: Tmax = 175%) than for normal rats (ET-1: Tmax = 130%; ET-3: Tmax = 151%). ET-3 produced a higher tension of portal veins in normal rats than ET-1. In conclusion, this study shows that portal veins from cirrhotic rats react more sensitively to ET than those from normal rats. Besides the ET-induced contraction of hepatic stellate cells, contraction of the portal vein and its intrahepatic branches, especially in cirrhotic individuals, has to be considered as a further mechanism of ET contributing to portal hypertension.

Animals↗
PubMed1998

Impairment of peroxisomal structure and function in rat liver allograft rejection: prevention by cyclosporine.

BACKGROUND: During allograft rejection, cytokines and lipid mediators contribute to cell injury and organ failure. Peroxisomes play a crucial role in lipid metabolism, including the degradation of lipid mediators by peroxisomal beta-oxidation. Therefore, we investigated the alterations of hepatic peroxisomes after allogeneic rat liver transplantation. METHODS: MHC-incompatible Dark Agouti (RT1a) donor rats and Lewis (RT1(1)) recipient rats were used for allogeneic transplantation. For immunosuppression, a group of these animals received cyclosporine (CsA) intraperitoneally (1 mg/kg body weight per day). Lewis rats were used for isogeneic transplant combination. Ten days after transplantation, livers were investigated using morphometrical methods for determination of peroxisomal diameter and volume density. The activities of peroxisomal catalase (CAT) and acyl-coenzyme A oxidase (AOX) were determined, and the corresponding proteins were evaluated by quantitative immunocytochemistry and immunoblotting. The expressions of mRNAs encoding CAT and AOX were investigated by Northern blotting. RESULTS: The volume density and diameter of peroxisomes were significantly decreased in allogeneic transplanted livers but were unchanged in CsA-treated animals. Both the activities of CAT and AOX and their protein levels were significantly reduced in liver allografts. Moreover, the corresponding mRNA levels of CAT and AOX were decreased significantly in liver allografts, whereas CsA treatment led to an increase of those mRNAs. Isogeneic transplanted livers showed only a slight reduction of the corresponding enzyme values. CONCLUSIONS: Peroxisomes are severely affected both morphologically and functionally after allogeneic liver transplantation. These results suggest that impairment of peroxisomal lipid beta-oxidation could contribute to the pathogenesis of the rejection process by decreased catabolism of lipid mediators involved in the regulation of the inflammatory response. CsA, in addition to its immunosuppressive effects, may contribute to allograft survival by maintenance of those important peroxisomal functions.

Acyl-CoA Oxidase↗
PubMed1998

[Individual prognosis of critically ill patients with septic shock by neural network?].

From 1. 11. 93 to 30. 3. 97, 1149 patients were prospectively studied during their ICU stay. Of them, 114 met the criteria of septic shock, with lethality of 47.3%. A neural network was trained with datasets from 91 of these 114 patients. Testing the trained neural network with the remaining 23 patients, the following result was obtained: all 10 patients dying from septic shock were correctly predicted; of 13 surviving patients, 12 were correctly identified (sensitivity 100%; specificity 92.3%).

APACHE↗
PubMed1998

[Epidemiology of systemic inflammatory response syndrome, infection and septic shock in surgical intensive care patients].

This paper uses definitions of a consensus conference (ACCP/CCM) describing the epidemiology of SIRS, sepsis and septic shock in surgical ICU patients. During a period of 2 years a total of 656 patients were prospectively enrolled into the study. 335 patients (51.1% of the total population) developed SIRS (systemic inflammatory response syndrome); in 65 of these patients infection could be documented, i.e. they met the criteria of sepsis, 47 of these 65 septic patients developed septic shock, with mortality of 53.2%. SIRS is associated with a high sensitivity but a low specificity in predicting the outcome of ICU patients. Moreover, SIRS and sepsis appear to be of minor clinical relevance. On the contrary, septic shock describes a very high risk group of patients which should be characterized more closely in future studies.

Adolescent↗
PubMed1998

Late results of heterotopic autotransplantation of splenic tissue into the greater omentum.

There is still controversy about the beneficial effects of splenic autotransplantation. As a result, replantation of the spleen has almost been abandoned for surgical treatment of splenic injuries. To learn more about the long-term effects we have analyzed eight patients 9.2 +/- 1.2 years after autotransplantation of the spleen into the greater omentum. Splenic replants could be detected by scintigraphy in seven patients (87.5%). Splenic size, measured by single-photon emission computed tomography, varied between 19.344 and 471.705 units of volume (Uov). Two patients with the smallest replants had pathologic changes of leukocytes and lymphocyte subsets in 12 of 16 measurements (75%). These changes closely resembled a spleenless state and were similar to those in the patient with no detectable splenic autograft. In contrast, five patients with large splenic replants (49.192-471.705 UoV) revealed pathologic findings in only 2 of 40 measurements (5%). Based on an extensive review of the literature and our own results, it can be concluded that splenic autotransplantation into the greater omentum is superior to splenectomy but undoubtedly less effective than in situ preservation of the spleen. Therefore splenic replantation should still be considered, particularly in pediatric surgery, when in situ preservation of the spleen is not possible by other techniques.

Adolescent↗
PubMed1998

Time course-dependent evolution of nitric oxide-mediated arterial hyporeactivity to phenylephrine in rats with ligated bile duct.

BACKGROUND: Nitric oxide (NO) may be heavily involved the phenomenon of arterial vasodilation in cirrhosis. However, the subject is still controversial. AIM: This study therefore characterizes the dynamic role of the NO system during development of experimental cirrhosis. METHODS: The contractile response to phenylephrine of thoracic rat aortic rings was studied in vitro before and after nitric oxide blockade. Experiments were performed 1, 2, 3, and 4 weeks after induction of cirrhosis via bile duct ligation with an appropriate control group. RESULTS: In bile duct-ligated rats reduction of the maximum contractile response to phenylephrine was 4.4 +/- 7.3% after 1 week, 22.7 +/- 8.7% after 2 weeks, 48.4 +/- 8.3% after 3 weeks, and 64.6 +/- 8.9% after 4 weeks, in comparison with the control group. This reduction in contractility to phenylephrine was completely reversed by blocking NO synthesis. CONCLUSION: The data presented indicate a dynamic decrease in contractile response to phenylephrine even at an early stage of secondary cirrhosis. Reversibility of the effect after NO synthesis blockade suggests that increased NO synthesis is a major factor in vascular hyporeactivity to vasoconstrictors in cirrhosis.

Animals↗
PubMed1997

Local immunosuppression with budesonide after liver transplantation in the rat: a preliminary histomorphological analysis.

BACKGROUND: In this study we have analyzed the local immunosuppression with budesonide, a topically selective glucocorticosteroid, in rats after orthotopic liver transplantation. Because of its high first-pass hepatic clearance budesonide can be given orally, achieving high intrahepatic and low systemic concentrations. METHODS: Using an acute rejection model from Dark Agouti (DA) to Lewis rats, the histomorphological degree of rejection was assessed on histological sections at the ninth postoperative day. RESULTS: Livers of the DA to Lewis study group without immunosuppression revealed severe allograft rejection with vast cellular infiltrates, massive endothelialitis, and hepatocyte necrosis. In the three budesonide study groups (250 microg, 500 microg, and 1 mg/kg/day) a moderate to mild liver allograft rejection was seen. Rejection was most prominent in the 250 microg group, whereas the 1 g group showed almost no signs of rejection, similar to the Lewis to Lewis control group. Aspartate and alanine transaminase (sGOT, sGPT) as well as alkaline phosphatase serum levels correlated with the degree of rejection, achieving highest levels in the DA to Lewis group without immunosuppression. Animals treated with 1 g of budesonide had serum levels similar to Lewis to Lewis control animals. CONCLUSIONS: These results implicate a beneficial effect of local immunosuppression with budesonide in rats based on the histomorphological degree of liver allograft rejection.

Acid Phosphatase↗
PubMed1997

Significant increase of Kuppfer cells associated with loss of Na+,K+-ATPase activity in rat hepatic allograft rejection.

BACKGROUND: Cholestasis is a complication that occurs during the rejection of liver transplants. The aim of this study was to investigate the association of activated Kupffer cells (KCs) and Na+,K+-ATPase activity for taurocholate cotransport and bile canalicular (BC) Mg++-ATPase activity for hepatobiliary excretion in rat liver allograft. METHODS: Quantitative analyses of KC number and size in relationship to enzyme activity of Na+,K+-ATPase and of BC Mg++-ATPase were conducted in rejected liver after allogenic transplantation and after prevention of rejection using cyclosporine. RESULTS: The animals were examined on the 10th postoperative day. In the rejection group, the number of KCs significantly increased more than fourfold in comparison with the number of KCs in the control livers. Some KCs were found in the sinusoids, but the majority were located in the space of Disse. Na+,K+-ATPase activity vanished from the basolateral plasma membrane, whereas BC Mg++-ATPase activity was restored in the apical domain. With immunosuppression, KCs showed the same behavior as in the control group, and activity of both ATPases was observed as strong electron-dense precipitates in basolateral and apical plasma membrane domains. CONCLUSIONS: In this study, we demonstrate that activated KCs migrate into the donor liver and release cytokines, which leads to the loss of Na+,K+-ATPase activity in the rejection group. BC Mg++-ATPase activity was not influenced by these mediators of activated macrophages. Since Na+,K+-ATPase is the cotransporter for hepatocyte taurocholate uptake, these data may contribute to understanding the mechanisms for cholestasis during hepatic allograft rejection.

Animals↗
PubMed1997

[Etiology and clinical relevance of hyponatremia in general surgery intensive care patients].

For 1 year all patients in the Department of General Surgery who were transferred to the intensive care unit (n = 237) were prospectively studied as to the development of hyponatremia. Relevant hyponatremia developed in 6.3% of the patients. The lowest sodium concentration observed was 121 mmol/l, the mean duration was 1.2 days. In general, hyponatremia is related to hypovolemia and diuretics are often involved. In no patient were there any clinical consequences.

Critical Care↗
PubMed1997

[Incidence and prognosis of postoperative jaundice in surgical intensive care patients].

Jaundice in critically ill patients may be difficult to explain. This study analyzes pathophysiologically relevant data, and discusses the prognostic value of hyperbilirubinemia. A total of 1275 patients were prospectively enrolled; 7.6% developed hyperbilirubinemia of at least 2 mg/dl. Mortality in icteric patients was significantly higher (29%) than in the non-icteric group. Sepsis, shock and the number of blood transfusions are very important in hyperbilirubinemia. Nevertheless, in critically ill patients, jaundice per se is not a sign of poor outcome; indeed it only reflects the underlying disease.

APACHE↗