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Biomedical subjects

H Grimm

Publications and source records attributed to H Grimm.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Primary varices of the colon. A rare cause of gastrointestinal bleeding].

HISTORY: A 34-year-old patient presented with a two-day history of passing bright-red blood with his stools. There was no contributory past or family history and he had no accompanying symptoms. INVESTIGATIONS: Colonoscopy revealed many varices in the colon and terminal ileum without an active source of bleeding. Angiography failed to demonstrate any bleeding or vascular anomaly in the splanchnic region. Abdominal ultrasound and gastroscopy as well as biochemical tests did not indicate portal hypertension or liver cirrhosis. TREATMENT AND COURSE: On the night of admission there was a renewed fall in haemoglobin concentration. Emergency colonoscopy again failed to discover a source of bleeding. After transfusion of four units of erythrocyte concentrate the further course was uneventful. 8 months and 3 years later there were further episodes of marked bleeding per rectum. At the latest admission no source for the bleeding was found but there was some blood oozing in the sigmoid colon. Biochemical tests were unremarkable. The large varices were again seen in the colon and terminal ileum. Gastroscopy, Doppler sonography of the liver and repeat abdominal sonography again failed to demonstrate portal vein thrombosis, liver cirrhosis or portal hypertension. CONCLUSION: In case of colonic varices the differential diagnosis should include portal hypertension with chronic liver disease, portal vein thrombosis, vascular anomalies or postoperative complications. The treatment of primary varices, which are rare, is conservative.

Adult↗
PubMed1998

Simultaneous analysis of 4- and 5-series lipoxygenase and cytochrome P450 products from different biological sources by reversed-phase high-performance liquid chromatographic technique.

Quantification of lipoxygenase and cytochrome P450 products of both arachidonic acid (AA) and eicosapentaenoic acid (EPA) is of broad interest due to the multiple biological activities of these compounds. We developed a method combining (i) solid-phase extraction, (ii) isocratic reversed-phase high-performance liquid chromatographic separation, and (iii) online photodiode array detection with spectrum analysis for identification and measurement of all main 4- and 5-series eicosanoids (leukotrienes, hydroxyeicosatetraenoic acids/hydroxyeicosapentaenoic acids, epoxyeicosatrienoic acids) within one run. With these procedures, standard mixtures of AA- and EPA-derived lipid mediators were recovered from different biological liquids, like lung perfusate, human bronchoalveolar lavage fluid, and cell supernatant with linear characteristics for each compound. Recoveries of the different lipid mediators exceeded 80% showing excellent reproducibility. Application of the method to isolated, perfused, and ventilated human lungs challenged with the calcium ionophore A23187 and to human neutrophils stimulated in the presence of arachidonic acid and eicosapentaenoic acid with N-formyl-methionyl-leucyl-phenylalanine demonstrated the generation of a large array of lipoxygenase and cytochrome P450 products. Thus, convenient quantification of 4- and 5-series eicosanoids in fluids of biological interest is achieved by a technique comprising solid-phase extraction, isocratic reversed-phase high-performance liquid chromatography, and photodiode array-based online spectrum analysis of eluting compounds.

Arachidonate 5-Lipoxygenase↗
PubMed1998

[Esophageal carcinoma: guidelines in surgical therapy].

According to oncological criteria, resections for esophageal cancer require a combined abdominal and thoracic approach and should include two-field lymphadenectomy. The value of a three-field lymphadenectomy is still under discussion, because this extended lymph node dissection may provide better survival rates for patients with proximal esophageal cancer and positive lymph node stages on the one hand, but will cause increased morbidity, on the other. A neoadjuvant radio- and/or chemotherapy allows down staging in about 50% of patients with advanced esophageal cancer (stage IIB, III or IV). This leads to higher resectability rates, but is not necessarily associated with better survival rates.

Adenocarcinoma↗
PubMed1998

[Development of an immuno-neutral lipid emulsion for optimal postoperative management of intensive care patients].

Lipid emulsions prolong the rejection of allogeneic rat heart grafts in relation to their n-3 to n-6 fatty acid ratio. Because of the predominance of n-6 fatty acids soybean oil, which is clinically applied, shows an immunosuppressive effect. An n-3 to n-6 fatty acid ratio of 1 to 2 proved to be immunoneutral. Intravenous fat emulsions with an impaired n-3 to n-6 fatty acid ratio reduce cytokine release, infiltration and proliferation of immunocompetent cells. Lipids rich in n-3 fatty acids additionally reduce the release of the potent vasoconstrictor thromboxane A3 and increase the synthesis of leukotriene B5, which unlike leukotriene B4 does not activate polymorphonuclear neutrophils. Based on our results, the production of a clinically applicable lipid emulsion with a n-3 to n-6 fatty acid ratio of 1 to 2 can be recommended for the optimal parenteral nutrition of ICU patients with a markedly reduced immune system.

Animals↗
PubMed1997

Antimicrobial interactions (synergy) of teicoplanin with two broad-spectrum drugs (cefotaxime, ofloxacin) tested against gram-positive isolates from Germany and the United States.

Teicoplanin, a glycopeptide, has been widely used in some nations alone and in empiric therapy combinations to address infections caused by Gram-positive cocci. However, glycopeptide resistance and the increasing incidence of oxacillin-resistant staphylococci have compromised contemporary chemotherapy. In this study, teicoplanin was tested in combinations with ampicillin, cefotaxime with and without desacetylcefotaxime, and ofloxacin against 151 Gram-positive cocci to assess the potential for enhanced action. The strains included recent isolates from the United States and Germany having well-characterized resistance mechanisms (oxacillin-resistant staphylococci, vancomycin-resistant enterococci), each tested by NCCLS methods, checkerboard synergy tests, and kill-curves. Teicoplanin alone was active (MIC90s, 0.25-2 micrograms/mL) against all species except vanA enterococci. Drug interactions of teicoplanin with beta-lactams revealed synergy and partial synergy versus oxacillin-resistant Staphylococcus spp. (67-100%) and vancomycin-resistant enterococci (70-100%), many at clinically achievable drug concentrations. However, confirming kill-curve experiments showed static action and no significant bactericidal effect. Combinations of ofloxacin with teicoplanin or cefotaxime plus desacetylcefotaxime showed a dominant additive and indifferent interaction. Teicoplanin continues to be a viable alternative to vancomycin, especially in combination therapy with selected broad-spectrum cephalosporins or fluoroquinolones. Many emerging pathogens that test resistant to individual drugs appear to be inhibited by tested combinations, extending their potential clinical utility.

Anti-Bacterial Agents↗
PubMed1997

[Instrumental diagnosis for therapy decision making--what is possible and desirable, what is indispensible and what is superfluous in tumors of the pancreas?].

The spectrum of diagnostic procedures in patients with pancreatic malignancies today includes the patient's report and history, laboratory parameters, and modern techniques ranging from ERCP, EUS, CT, angiography, MRCP, and PET to molecular biology and parameters such as the cytological detection of ki-ras mutations. Anamnesis, laboratory parameters, tumor markers, ultrasound investigation, and ERCP are the relevant procedures for establishing the basic diagnosis of a pancreatic malignancy. MRCP will replace ERCP in most cases in future. EUS shows the highest accuracy in the diagnosis of vascular involvement by a pancreatic tumor.

Diagnostic Imaging↗
PubMed1997

[Is ambulatory surgery at a maximum care clinic justified?].

It is politically desirable to promote ambulatory surgery in private practice or in hospitals as a means to reduce costs. In contrast to this, one has to deal with unsatisfactory net profits. Even if a hospital is primarily running at a loss, ambulatory surgery should be performed. Offering the service of ambulatory surgery can improve the recruitment of patients and may help to compete with other hospitals.

Ambulatory Surgical Procedures↗
PubMed1997

[Value of preoperative diagnosis in struma surgery].

To determine the usefulness of so-called routine diagnostic procedures prior to thyroid operations, in 2007 consecutive patients undergoing thyroid surgery from 1976 until 1991, the results of 1833 scintigraphy examinations, 1358 tracheal X-rays, 773 ultrasound examinations, 302 fine-needle aspiration biopsies (FNAB), and 73 frozen sections (FS) performed during operation were evaluated. Scintigraphy and ultrasound showed similar positive predictive values, ranging between 85% and 95%, in detecting thyroid nodules. The sensitivity of FNAB and FS were 44% and 83%, respectively. Mechanical alteration of the trachea was found to correlate to a high degree with severe postoperative respiratory disorders, requiring prolonged ventilation or tracheotomy either during primary surgery or as a secondary procedure.

Biopsy, Needle↗
PubMed1996

Omega-3 lipid infusion in a heart allotransplant model. Shift in fatty acid and lipid mediator profiles and prolongation of transplant survival.

BACKGROUND: omega-3 Fatty acids may have a major impact on immune responses involved in heart transplant rejection. We compared the effects of posttransplant intravenous supplementation with omega-3-rich versus omega-6-rich lipid emulsions on graft survival, plasma fatty acid profiles, and levels of arachidonic acid versus eicosapentaenoic acid-derived lipid mediators. METHODS AND RESULTS: Inbred PVG and Wistar-Kyoto rats were used as donors and recipients, respectively, in a model of heterotopic heart transplantation. Animals received 9 g/kg body wt per day of either fish oil-derived (n = 8) or soybean oil-derived fat (n = 7) in the form of a continuously infused lipid emulsion; controls were sham-infused with saline (n = 8). Graft rejection was assessed by loss of activity of the transplant. The fish oil-derived preparation but not that originating from soybean oil caused an increase in total and free plasma fatty acids. Substantial quantities of eicosapentaenoic acid and docosahexaenoic acid appeared in the free fatty acid fraction, surpassing those of arachidonic acid. Ex vivo stimulation of neutrophils with the Ca2+ ionophore A23187 demonstrated an increase in 5-series leukotriene (LT) generation in animals undergoing omega-3 lipid infusion (LTB5, omega-oxidation products of LTB5, LTA5 secretion), with 5-series/4-series LT ratios ranging between 0.08 and 0.36. Ratios of TX B3/B2 liberated from ex vivo stimulated platelets even approached 1:1 in omega-3 supplemented rats. Graft survival was 7.6 +/- 0.3 (mean +/- SEM) days in saline-infused, 10.4 +/- 0.7 in omega-6 lipid-infused, and 12.9 +/- 0.4 in omega-3 lipid-infused animals. CONCLUSIONS: Posttransplant intravenous alimentation with fish oil-derived lipid emulsions prolongs heart transplant survival in excess to omega-6 lipids. Profound changes in fatty acid profiles and lipid mediator generation may underlie this finding.

Animals↗
PubMed1996

[Significant value and therapeutic implications of routine gastroscopy before cholecystectomy].

Endoscopy of the upper digestive tract was performed in 338 consecutive patients undergoing cholecystectomy between January 1991 and December 1992. Pathological findings were seen in 160 (47.3%), 6.8% of the patients had peptic ulcers, 1.8% gastric erosions, 25.7% gastritis, 3.2% polyps, 4.7% hiatal hernias, 3.0% oesophagitis and 0.6% gastric cancer. In most patients the gastroscopic results did not correlate with the clinical symptoms. The therapy concept had to be changed in 8.3% of the patients due to gastroscopic findings, 23 patients with ulcers, 2 with erosions and 1 with oesophagitis had to be treated medically and so the cholecystectomy was postponed. Two patients with gastric cancer underwent gastrectomy. These results underline the importance of a routine gastroscopy before elective cholecystectomy.

Adolescent↗
PubMed1996

[Immunosuppression by parenteral lipid emulsions in a model of defined immunostimulation].

The immunosuppressive effect of intravenous fat emulsions with different n-3/n-6 fatty acid ratio was studied in the heterotopic rat heart allotransplant model. Twenty percent emulsions of safflower oil (n-3/n-6 = 1/370), fish oil (7.6/1), soybean oil (1/6.5) and a 1:1 mixture of safflower and fish oil (1/2, 1; oil control group) were continuously infused (9 g fat/Kg b.w./day; n = 10 each group) after transplantation until rejection. Graft survival time, subpopulations of infiltrating and circulating immunocompetent cells and Interleukin-6 release of circulating monocytes were analyzed. In the safflower oil, fish oil and soybean oil groups graft survival was prolonged to 13.3, 12.3 and 10.4 days vs. 6.7 days in the oil control group and 7.8 days in the saline control group (p < 0.01). In the two groups with the highest prolongation of graft survival the number of infiltrating cells was reduced by up to 50 percent and the peripheral blood monocyte interleukin-6 release by up to 45 percent. Beyond that, circulating T-cells were reduced in the fish oil group. Intravenous fat emulsions show a varying immunomodulatory effect in dependence of the n-3/n-6 fatty acid ratio. Both n-6 and n-3 fatty acids, if applied as main fatty acid source, exert immunosuppressive effects by a diminished infiltration, mobilisation and cytokine release of immunocompetent cells. Soybean oil with a more balanced n-3/n-6 fatty acid ratio than safflower is significantly less immunosuppressive than safflower oil and fat emulsions with a n-3/n-6 fatty acid ratio of 1/2 are immunologically neutral.

Animals↗
PubMed1995

Discrepancies in susceptibility test results for imipenem employing different in vitro test methods and DIN 58,940 breakpoints.

During the first half of 1993, bacteria that were isolated from clinical materials and found to have intermediate susceptibility by an agar dilution breakpoint method were collected in a large service laboratory in Germany. All of these isolates were gram-negative bacteria. They were re-tested employing full-scale agar dilution, broth microdilution, E-test and agar diffusion procedures. The results obtained indicated that 76.9% of the isolates were actually susceptible upon re-testing with a reference agar dilution technique. The reason for the discrepant results remained largely unclear. There was a high correlation between agar dilution and E-test results while the agreement with broth microdilution and agar diffusion was less satisfactory. It is suggested that the breakpoint between susceptible and intermediate categories currently recommended by DIN 58,940 (standard set by Deutsches Institut für Normung e.V.) be raised to reduce erroneous interpretations of minimum inhibitory concentrations.

Bacteriological Techniques↗