[Use of selective intestinal decontamination with non-absorbable antibiotics].
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Administration, Oral↗
Biomedical subjects
E Hanisch
Publications and source records attributed to E Hanisch.
[Surgical treatment of acute pancreatitis using the open abdomen technique].
There is as yet no agreement about a conservative surgical strategy in the therapy of acute necrotizing pancreatitis. This report describes our experience with "open packing" laparostomy. This procedure is only performed when renal and pulmonary insufficiency is proceeding, despite optimal conservative treatment. Since 1986 twenty-two patients were treated in this manner. Three compartments are established: an upper compartment (stomach, liver, spleen covered by the omentum majus, which is dissected from the colon transversum); a lower compartment (small bowel covered by the left colon) and the mid compartment that permanently opens the bursa omentalis and the left retrocolic space. Initially a careful necrosectomy is performed, followed by a tamponade. At the intensive care unit changing of the tamponade and lavage of the bursa omentalis was done every day. So far three patients (13.6%) have died pursuing this therapeutic regimen.
Abdomen↗
[Potentially dangerous moments in use of esophageal balloon tamponade. 4 case reports with critical analysis of the literature].
In general, balloon tamponade is still part of the therapy of bleeding esophageal varices, despite effective sclerotherapy. Four case reports demonstrate that the application of balloon tamponade may be associated with severe complications. Moreover, a critical analysis of the literature shows a very different handling with respect to volume of gastric balloon, duration of blockade and traction to the tube. To prevent serious side effects, a safe way is described in detail when using balloon tamponade.
Aged↗
Translocation of Thorotrast in the body.
To investigate whether there is a permanent translocation of Thorotrast in the body, the liver of male Lewis rats was removed 4 weeks after injection of Thorotrast (300 microliters) and replaced by a donor liver. In half of the animals the spleen was removed as well. Measuring the 232Th content in the donor liver at different times after implantation demonstrated a permanent transport of 232Th into the surrogate organ. After 231 days a 232Th depot of about 1.1 mg was found, representing about 3% of the total body burden. The additional removal of the spleen resulted in a significantly lower transport of 232Th into the implanted liver. Histological examinations of the donated livers revealed increasing local concentration of Thorotrast granules, leading to the development of conglomerates. A comparable translocation of Thorotrast was verified in two humans who required liver transplantation more than 40 years after Thorotrast injection.
Animals↗
[Orthotopic liver transplantation with arterial re-anastomosis in the rat--a detailed description of technique and analysis of possible errors].
Liver transplantation (LTX) in the rat is a frequently used transplantation model. In the present study we give a detailed description of the suture technique for all anastomoses, except the bile duct, with arterialization of the transplanted liver over an aortoceliac segment to the recipient's aorta. Using this technique, we finally achieved survival rates of 80%. During the development stages, the main cause of death was an exceedingly long anhepatic time (> 20 min); later on, complications occurred only from insufficient anastomoses. The advantage of the suture technique over the cuff technique is that a more physiological anastomosis is obtained with less trauma to the recipient when using rearterialization. Despite the complicated suture technique, the anhepatic time can be well reduced to below 20 min.
Anastomosis, Surgical↗
[Surgical intensive care of the elderly].
Intensive care treatment of elderly patients is discussed controversially. Especially the success of maximal therapeutic efforts is questioned in this group. Therefore, this paper analyses prospective data of 1572 patients of a surgical intensive care unit with respect to age-related outcome. Besides the anticipated high proportion of concomitant diseases and an associated increased mortality of aged patients, there are no specific age-dependent differences. Old patients benefit from maximal therapeutic efforts to the same extent like younger patients. The authors conclude from the data that the patient's age per se should not influence the indication for intensive therapeutic interventions.
Adult↗
[In vitro contractility of the musculature of human gallbladders with and without gallstones--relevance of the prostaglandin system for CCK regulated motoricity].
This study describes the influence of endogenous and exogenous prostaglandins upon CCK-induced motility patterns of human gallbladders with and without stones (indomethacin and nocloprost; an exogenous PGE2-analogon). From 48 gallbladders with- and 22 gallbladders without stones (control group) longitudinal muscle stripes were dissected and transferred to an organ bath and CCK, indomethacin and nocloprost dose response curves were established. In another experimental protocol, the effect of CCK after indomethacin or nocloprost preincubation is demonstrated. Moreover, specimens of gallbladders were taken for histology and gallstones for analyse. The results demonstrate that gallbladders with stones have a significant higher basic tonus and phasic activities compared to the stone-free controls. Because of these different responses to CCK, gallbladders of the stone-diseased group were divided in two groups: 64% of the gallbladders show a sensitivity and tonic response to CCK like the controls (contractors), 36% demonstrate a reduced sensitivity to CCK and only a slight tonic response (non-contractors). Indomethacin causes a fall in tonus in both stone-diseased groups. It stops spontaneous activity in the contractor and non-contractor group. With indomethacin preincubation all three groups response to CCK with a significant reduced sensitivity. CCK-induced activity is reduced in the control and contractor group. In the non-contractor group, muscle strips do not contract after indomethacin preincubation. Nocloprost induces significant contractions in the control and contractor group. In both groups, the response to CCK after nocloprost preincubation is stronger than the reaction without preincubation. In the non-contractor group, a change in tonus after nocloprost application cannot be demonstrated, there also is no response to CCK after nocloprost preincubation. These results corroborate the notion of a significant contribution of the endogenous prostaglandin system to the regulation of gallbladder motility by CCK.
Adult↗
[In vitro contractility behavior of portal veins in normal rats and in rats with liver cirrhosis--effect of calcium antagonists and octreotide].
According to Poiseuille's law portal pressure is inversely related to r4. Thus, minor changes in radius dramatically influence intravascular pressure. Since the radius is actively regulated by contraction, this study elucidates in vitro contractility patterns of portal veins from healthy and liver cirrhotic rats. The results demonstrate that contractility amplitudes of portal veins from cirrhotic rats are increased in comparison to healthy animals. Calcium antagonists reduce amplitude and motility both in cirrhotic and healthy rats to the same degree. The same holds true for octreotide but significantly more in the cirrhotic group. Obviously, the maintenance of portal hypertension is supported by an active element of the portal vein, which can be controlled in vitro.
Animals↗
A 3-year cohort study on short-term effects of air pollution in Germany. 1. Influences of medication and season.
A 3-year cohort study which started in September 1987 investigates the effect of air pollution in adult patients with chronic obstructive airway disease. Of 108 patients recruited during the pilot phase in 1987 only eight patients had left the study prematurely. The most important components of the study are the daily peakflow measurements and a diary on medication and symptoms. In a preliminary analysis the influence of medication and season has been analyzed for the period September 1988 to June 1989 for 53 patients. In general, the reactions to seasonal changes were small. However, a significant decrease in peak-flow values by about 5% was found for the months of May and June compared to December for patients with chronic bronchitis, emphysema and asthma.
Aged↗
Simplified microvascular suture techniques for rat liver transplantation as a microsurgical model with arterial blood supply.
The methods for liver transplantation in the rat mainly used do not include reconstruction of the arterial blood supply to the liver. Furthermore, to ensure a short anhepatic phase these methods almost all entail specially developed cuff anastomoses in the recipient operation instead of the conventional microvascular suture technique. Thus an acceptable survival rate can be attained in the experimental animals. This detailed description of simplified microvascular suture techniques is intended to present an alternative to the cuff anastomoses used almost exclusively. In the donor operation with this method, the liver is dissected with an arterial pedicle including the abdominal segment of the aorta, and the liver is flushed in situ not only via the portal vein, but also via the hepatic artery. The organ is implanted in the recipient animal using simplified microvascular suture reconstruction of the arterial blood supply to the liver. Use of telescopic spectacles with 2-fold magnification has proven to be adequate for the entire procedure. With mastery of this method of rat liver transplantation, the average duration of the anhepatic phase is about 20 min, substantially below the 30-min limit which is critical for the survival of the experimental animals. The donor operation requires about 60 min, and the recipient operation 70 to 80 min. With this method, the spectrum of investigations on liver transplantation which are possible in the rat is substantially extended in that clinical conditions can be reproduced very much more exactly by combination of portal and arterial in-situ flushing in the donor operation and rearterialization of the transplant in the recipient operation, as compared to the transplanted rat liver being supplied only with portal venous blood.
Anastomosis, Surgical↗
[Proliferation kinetic studies in the syngeneic liver transplantation mode in the rat. Effect of re-arterialization on the transplant].
Successful orthotopic liver transplantation (OLT) can be achieved in the rat. We used bromo-2-deoxyuridine (BrdU) as a proliferation marker to document morphological differences between OLT with and without rearterialization. Animals with portal anastomosis alone had a significantly increased proliferation rate of hepatocytes, Kupffer cells, and bile duct epithelial cells, as indicated by strong staining with BrdU, 8 days post-transplant compared to animals with rearterialization. Regeneration of ischemically damaged liver parenchymal cells may account for this observation. Thus, OLT with rearterialization appears to be the more physiological transplant model.
Anastomosis, Surgical↗
Somatostatin in acute bleeding oesophageal varices. Pharmacology and rationale for use.
Somatostatin was originally isolated from the hypothalamus, but has subsequently been found throughout the whole gastrointestinal tract. It exerts an inhibitory effect upon numerous functions of the body, and, therefore, increasing attention has been focused on its potential as a therapeutic agent with cytoprotective properties and a potent inhibitory action on a wide variety of functions in endocrine diseases, cancer and gastrointestinal haemorrhage, including bleeding from oesophageal varices. As somatostatin has a very short plasma half-life and requires administration by continuous infusion to maintain therapeutic levels, stable long-acting analogues have been developed. The analogue octreotide has been shown to have a plasma half-life of 113 minutes and to produce a profound selective inhibition of growth hormone. Hepatic excretion of octreotide has been estimated to be between 30 and 40% in healthy volunteers; no data are available in cirrhotic patients. A review of published data assessing systemic and hepatic haemodynamics in animals and humans over varying dosage regimens of somatostatin and octreotide reveals that cardiac output, arterial pressure and peripheral resistance are modified more in animals than in humans. Hepatic haemodynamics are significantly altered in animals as well as in humans in most of the studies. Circumstantial evidence is provided indicating that the mechanisms of action of somatostatin and octreotide in the therapy of bleeding oesophageal varices are mainly mediated by a splanchnic vasoconstrictive effect. Furthermore, gastric acid suppression and potential enhancement of platelet aggregation may contribute to the beneficial outcome after treatment of oesophageal varices with somatostatin.
Acute Disease↗
[Secondary sigmoido-rectal-anal invagination. Case report and review of the literature].
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Aged↗
[In-vitro activity pattern of gallbladder muscle tissues in patients with and without gallstones--variable response to cholecystokinin, motilin and neurotensin].
Data about gallbladder motility in stone disease and stone free conditions are discussed controversially. This study is aimed at to evaluate in vitro the responses of human gallbladder muscle stripes to cholecystokinin, motilin and neurotensin. Following the results, a stratification of the "stone-disease-group" seems to be necessary: 41% of the gallbladders (stone disease) demonstrate a deep reduction in contractility to cholecystokinin ("non-contractors"), whereas 59% of the gallbladders contract in the same pattern like the controls ("contractors"). Interestingly, the majority of the gallbladders in the "contractor" group demonstrate a high spontaneous activity which is absent in stone free gallbladders. Motilin and neurotensin either do not induce any effect.
Adult↗
[Primary open therapy of acute necrotizing pancreatitis by the "open abdomen"].
There is no agreement about a conservative surgical strategy in the therapy of acute necrotizing pancreatitis yet. This report describes our experience with "open packing" laparostomy. This procedure is only performed when renal and pulmonary insufficiency is proceeding, despite optimal conservative treatment. Since 1986 15 patients were treated in this manner. Three compartments are established: an upper compartment (stomach, liver, spleen--covered by the omentum majus, which is dissected from the colon transversum); a lower compartment (small bowel--covered by the left colon) and the mid compartment that permanently opens the bursa omentalis and the left retrocolic space. Initially a careful necrosectomy is performed, followed by a tamponade. At the intensive care unit changing of the tamponade and lavage of the bursa omentalis was done every day. So far two patients have died pursuing this therapeutic regimen.
Abdomen↗
[Occult hemorrhage from the small and large intestine].
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Gastrointestinal Hemorrhage↗
[MR tomography and computer tomography of alcohol-induced brain tissue changes].
Results of MRI in five alcoholics suffering from acute neurologic disorders such as ataxia, ophthalmoplegia and confusion are presented. The detection of focal cerebral lesions of high signal intensity in T2-weighted Spin-Echo- and Gradient-Echo-images in periventricular white matter, thalamus and pons combined with patients history and clinical presentation led to the diagnosis of Wernicke-Encephalopathia and Pontine Myelinolysis. MRI was far more sensitive compared with CT.
Adult↗
[Elective portasystemic shunt: selection criteria, choice of procedure,results].
The results of conservative medical (propranolol) and endoscopic therapy for bleeding esophageal varices show that the surgical shunt is indicated in both, acute and elective situations. The portocaval end-to-side-shunt should be preferred for hemodynamic reasons. However, special selection of patients is required to prevent postoperative liver failure. Linton, Drapanas and Warren shunts have a higher recurrence rate, but seem more appropriate for liver transplantation candidates. In our own series, preoperative diagnostic shunt-simulation by balloon-occlusion of the portal vein via an umbilical catheter has tremendously improved the results, even for child C-patients.
Esophageal and Gastric Varices↗