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Biomedical subjects

F Harder

Publications and source records attributed to F Harder.

At least 271 records · Page 15Linked to original sources
PubMed1984

[Prospective study of complications of central venous catheters].

The complications of central venous catheters used for immediate postoperative nutrition and monitoring were evaluated in 120 patients. Two patients had to be excluded due to an irregular protocol. 149 central venous catheters were placed in the remaining 118 patients. As to the access, the subclavian vein was used in 72.3%, the v. jugularis interna in 18.9%. The catheters were in average 11.7 days in place giving a total of 1392 catheter days. The end of therapy was the most frequent reason for removal of the catheter (81.6%) followed by septic (4.1%) and mechanical problems (8.8%). Venous thrombosis was observed in 2 patients, and embolisation of a catheter fragment and acute infusothorax each in 1 patient. 13% of the catheters were found to be malpositioned, and malposition was identified as a risk factor for thrombosis.--It is concluded from the comparison of these results with the literature, that the central venous catheter for parenteral nutrition has a risk of complication greater than 5% and therefore requires a clear indication. X-ray-control of catheter position is obligatory and malpositioned catheters are to be corrected. If the parenteral regimen is low in glucose concentration and osmolarity, blood sampling and monitoring via the same central venous line does not appear to increase the rate of complications.

Adult↗
PubMed1984

Prevention of radiation injuries to the small intestine.

The removable synthetic "pelvic spacer" prevents intestinal loops from sliding down into the area most heavily exposed to irradiation during a full course of radiotherapy for abdominopelvic neoplasia. Furthermore, it provides a homogeneous distribution of roentgenograms and allows higher dosages of radiation. It reduces possible sequelae and offers new possibilities for radiotherapy of tumors of the pelvis. The removal of the spacer is disadvantageous but clearly compensated by a more curative treatment.

Abdominal Neoplasms↗
PubMed1984

Trends in access surgery for hemodialysis.

Vascular access for chronic hemodialysis is for both doctors and nurses on one side and patients on the other a permanent, challenging problem. In respect to patency and complication rate, the direct AV fistula represents the most satisfactory solution and therefore should be achieved whenever feasible. In addition to the classic Brescia-Cimino and the brachiocephalic fistula, the most distal location in the snuff-box on one end and a transposed basilic vein at the upper arm on the other offer most satisfactory angioaccess alternatives that must be used stepwise from the periphery to more proximal sites. Graft fistulas should clearly be reserved for the patient for whom all autologous possibilities (with the exclusion of the autologous saphenous vein graft) have been used. Only ePTFE grafts have a patency rate comparable with direct autologous fistulas at a much higher cost.

Adult↗
PubMed1984

Lymphocyte subsets in human peripheral blood after splenectomy and autotransplantation of splenic tissue.

Leucocyte and lymphocyte subpopulations and serum immunoglobulins were studied in 14 patients who underwent splenectomy for trauma, nine patients with an autologous replant of splenic tissue after traumatic rupture of the spleen, and 23 age- and sex-matched healthy individuals. Buffy coat cells were stained by direct or indirect immunofluorescence with goat antihuman F(ab')2 immunoglobulin (B cells), Leu-1 (T cells), Leu-2a (T suppressor cells), and Leu-3a (T helper cells). Leucocytes and lymphocyte subsets were analyzed in a cytofluorograf . After splenectomy, patients showed a marked increase in both monocytes (135%) and lymphocytes (137%), with a fourfold rise in B cells, a nearly twofold rise in T cells, a reduced T/B cell ratio, and an unchanged T helper/T suppressor cell ratio. The number of B cells was significantly related to the serum immunoglobulin M level (r = 0.807, p less than 0.001). Patients with an autologous replant had moderate monocytosis (35%) and lymphocytosis (42%), with a selective rise of B cells (60%) and T suppressor cells (75%), which led to a 50% reduction of the T helper/T suppressor cell ratio. The changes observed after splenectomy indicate the major role of the spleen in cellular homing. In patients with an autologous replant , there is a tendency for normal storage of most cells, but an altered contribution of T suppressor cells to the circulating pool.

Adolescent↗
PubMed1983

Role of spleen in immune response to polyvalent pneumococcal vaccine.

The immune response of lymphocytes to subcutaneously administered pneumococcal vaccine was studied in five patients without spleens and in five healthy subjects. Seven days after immunisation circulating B cells synthesising IgG antipneumococcal capsular polysaccharides (anti-PCP) appeared in both groups. Twenty one days after vaccination this B cell population had disappeared and a B cell subset which secreted IgM and IgG anti-PCP in the presence of pokeweed mitogen was detected in the normal but not in the splenectomised subjects. In the splenectomised group polyclonal IgM synthesis induced by pokeweed mitogen was defective. It was concluded that the early events of the immune response to PCP may be mediated by lymph nodes but that, later, the spleen acquires a central role in producing lymphocyte subsets capable of synthesising specific antibodies and that this might explain the increased sensitivity of splenectomised subjects to pneumococcal infection.

Adult↗
PubMed1983

Cyclosporin A used alone or in combination with low-dose steroids in cadaveric renal transplantation.

The actual survival rate of 25 primary cadaveric kidney grafts in recipients treated initially with cyclosporin A (CyA) alone was 84%. The survival rate in 37 patients under conventional immunosuppression was 76%. The mean number of dialyses required in the first 4 weeks after transplantation was 1.2 per patient in both groups. At 15-28 months posttransplant, mean serum creatinine levels have remained stable at 175 mumol/l in the CyA group. The mean daily dose of steroids (including methylprednisolone i.v.) in the first two months was 2.07 mg/kg/d in patients under conventional immunosuppression and 0.76 mg/kg/d in the patients receiving CyA (p less than 0.001). The combination of CyA with low-dose steroids enabled the dose of CyA to be rapidly tapered off in once-weekly steps. CyA levels were monitored by determination of whole blood trough concentrations (target level: 300-800 ng/ml). At 60 days posttransplant the average dose of CyA was 6.0 +/- 0.5 mg/kg/d compared with an average daily dose of 11.4 +/- 0.9 as recommended for CyA alone in the protocol for the European multicentre study. This more rapid reduction in the CyA dose reduced nephrotoxicity (serum creatinine levels 174 +/- 14 as compared with 289 +/- 31 mumol/l) (p less than 0.05) and almost halved the number of methylprednisolone pulses given up to the end of the second month. We conclude from these results (1) that previously the dosage of CyA administered at this centre was probably too high, and (2) early adjustment of dose levels on the basis of blood concentrations and with low-dose prednisone cover appears to be safe and effective, but requires further verification.

Azathioprine↗
PubMed1983

[Mechanical ileus: analysis following 360 operations].

360 laparotomies in mechanical bowel obstruction were performed in a five year period at the Department of Surgery of the University Hospital, Basel. The overall mortality rate was 50/360 = 14%. The most frequent cause of death was cardio-respiratory insufficiency (19/50 = 38%) and postoperative peritonitis (15/50 = 30%). The most common etiology of bowel obstruction and the corresponding mortality rate was adhesion (151/360 = 42%; mortality 8.5%), large bowel cancer 83/360 = 23%; mortality 13.0%) and incarcerated hernia (57/360 = 16%; mortality 10.5%). The interval between onset of symptoms and hospitalization and between hospitalization and operation in the nonfatal group was 19 days and 28 hours respectively, and in the fatal group 26 days and 21 hours respectively. In conclusion, early surgical intervention in bowel obstruction and a meticulous technique for anastomosis when bowel resection is necessary are the most important factors in improving the results.

Adolescent↗
PubMed1983

Withdrawal of azathioprine in renal transplant patients with chronic active hepatitis: is it wise or not?

Withdrawal of azathioprine in renal transplant recipients with chronic active hepatitis and persisting HBs antigenemia was recommended for its beneficial effect on the course of liver disease. We report here three cases in which azathioprine treatment was stopped for this reason. One of these patients lost his graft due to irreversible vascular rejection 6 years after successful transplantation. Decrease of graft function paralleled azathioprine withdrawal in a second patient. Data from other reports indicate that cessation of azathioprine treatment may be followed by decreased graft function or even graft loss. We conclude that the risk of altered graft function is substantial and this is too high a price to pay for a procedure that may not prevent chronic active hepatitis from progressing cirrhosis.

Azathioprine↗
PubMed1983

Chemiluminescence of granulocytes and monocytes in diluted whole blood samples: a tumor marker?

Granulocytes and monocytes can attack malignant cells by activated oxygen species. They thereby emit photons which may be measured as chemiluminescence (CL). The zymosan-induced and luminol-amplified CL response of granulocytes and monocytes was measured in diluted whole blood samples of healthy volunteers and patients with benign and malignant disease. In tumor patients the CL activity was significantly stimulated. Following tumor reduction by radical or palliative operations, the CL values decreased to normal within weeks, whereas no response was seen after exploratory laparotomy without tumor reduction. Operations for benign disease did not influence the CL activity. The results suggest that the stimulation of CL activity in tumor patients is reversible. CL measurements in whole blood samples may play a future role as a nonspecific tumor marker.

Granulocytes↗