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Biomedical subjects

H Grimm

Publications and source records attributed to H Grimm.

At least 55 records · Page 3Linked to original sources
PubMed1995

Nutrition and allorejection impact of lipids.

Polyene n-3 and n-6 fatty acids are claimed to have immunomodulating properties. The impact of nutritional variations on transplant rejection was therefore studied in the heterotopic rat heart allotransplant model with particular focus on lipids. Twenty per cent fat emulsions with differing n-3/n-6 fatty acid ratios were continuously infused (9 g fat per kg bodyweight per day; n = 10 in each group) after transplantation until rejection: 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). Graft survival time, subpopulations of infiltrating and circulating immunocompetent cells and interleukin-6 release by circulating mononuclear cells were analysed. 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% and the peripheral blood mononuclear cell interleukin-6 release by up to 45%. Beyond that, circulating T-cells were reduced in the fish oil group. The n-3/n-6 fatty acid ratio determines the immunomodulating effect of lipids. Both n-6 and n-3 fatty acids, if applied as the main fatty acid source, exert immunosuppressive effects by diminished infiltration, mobilization and cytokine release by immunocompetent cells. A n-3/n-6 fatty acid ratio of 1/2 proved to be immunologically neutral. The recipient's disposition to reject an allotransplant is influenced by the fatty acid composition of exogenously supplied lipids.

Animal Nutritional Physiological Phenomena↗
PubMed1995

Cholelithiasis with common bile duct obstruction in a 20-week-old infant.

Formation of bile calculi in the common bile duct is a rare event in early infancy. The following article describes the case of a 20-week-old infant with anal atresia and a deep rectovaginal fistula who presented with recurrent jaundice due to a single calculus in the common bile duct that led to intermittent obstruction of the papilla Vateri. Diagnosis was proven by endoscopically performed retrograde cholangiography and the concretion was successfully removed after transduodenal papillotomy using a Dormia basket.

Bile Pigments↗
PubMed1995

[Preoperative locoregional staging of stomach carcinoma with endosonography].

From January 1987 till February 1992, a total of 203 consecutive patients with gastric carcinoma were evaluated with endosonography before operation. Endosonographic findings were categorized according to the TNM classification and compared with the histology of the resected specimen (n = 165). The overall accuracy rate of EUS in the assessment of the depth of tumor infiltration was 78%. The sensitivity and specificity of EUS in the detection of regional involved nodes were 82% and 84% respectively. Microscopic tumor invasion and indistinguishable inflammatory changes were the most frequent causes of misinterpretation by EUS. Tumor stenosis was a clear limitation for endosonography in 14% of the cases.

Female↗
PubMed1995

[Immunosuppressive effect of parenteral fat emulsions in defined immunostimulation].

BACKGROUND: In the heterotopic rat heart allotransplant model we have previously shown that intravenous fat emulsions are to a various extent immunosuppressive or immunoneutral, dependent on their n-3/n-6 fatty acid ratio. Safflower oil (n-3: n-6 = 1:370), fish oil (7.6:1) and soybean oil (1:6.5) prolonged the transplant survival time to 13.3, 12.3 and 10.4 days compared to 6.7 days (oil control group; 1.2.1) and 7.8 days (saline control group) (p < 0.01), respectively. This study presents a correlation of graft survival to immunohistological, cell biological and biochemical parameters. MATERIALS AND METHODS: 20% emulsions of safflower oil, fish oil, soybean oil and a 1:1 mixture of safflower and fish oil (oil control group) were continuously infused (9 g fat/kg body weight/day; n = 10 each group) after transplantation. Subpopulations of infiltrating and circulating immunocompetent cells and leukotriene B4 and B5 release of circulating mononuclear cells were analyzed (on the 4th postoperative day). RESULTS: In the 2 groups with the highest prolongation of graft survival the number of infiltrating cells was reduced by up to 40% and the peripheral blood mononuclear cell interleukin-6 release by up to 45%. Beyond that, circulating T cells were reduced in the fish oil group. Leukotriene B4 was released in all groups to the same extent, leukotriene B5 exclusively in the fish oil group. CONCLUSIONS: 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 and mobilisation of immunocompetent cells. Soybean oil with a more balanced n-3/n-6 fatty acid ratio than safflower oil 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↗
PubMed1994

Lipid mediated modification of rat heart allograft survival.

The effect on allograft survival of intravenous fat emulsions that differed in the ratio of functionally important n-3 and n-6 fatty acids was studied in a heterotopic cardiac transplant model in rats. Twenty percent fat emulsions were administered by continuous infusion at a dosage of 9 g fat/kg body weight per day, starting immediately after transplantation and continuing until complete rejection. The n-6 and n-3 fatty acids represent 75%, 43%, 60%, and 59% of all fatty acids in safflower oil, fish oil, soybean oil, and a 1:1 mixture of safflower and fish oil, respectively. The n-6 fatty acids predominate in safflower oil (370/1) and soybean oil (6.5/1), while the n-3 fatty acids dominate in the fish oil (7.6/1). The 1:1 mixture of safflower and fish oil has the balanced composition (n-6/n-3 = 2.1/1) recommended by Kinsella and served as oil-treated controls. Continuous infusion of safflower oil, fish oil, and soybean oil prolonged graft survival time to 13.3, 12.3, and 10.4 days, respectively, compared to 6.8 days in the oil-treated controls (P < 0.01 for all comparisons). Another control group infused with saline rejected the allografts after 7.8 days (P = NS compared to oil-treated controls; P < 0.01 for all other comparisons). The data suggest that intravenous administration of polyunsaturated fat emulsions results in an immunosuppressive effect that seems to be dependent on the n-3/n-6 fatty acid ratio of the fat emulsion.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Prophylactic sclerotherapy for esophageal varices: long-term results of a prospective study.

Controlled trials of endoscopic sclerotherapy for the prevention of the first variceal hemorrhage have given controversial results. We continued a previously reported study and randomly assigned 141 patients with esophageal varices and no prior gastrointestinal bleeding to either prophylactic sclerotherapy (n = 70) or no treatment (n = 71). Sclerotherapy was performed until complete eradication of the varices was achieved; recurrent varices were treated with repeat sclerotherapy. The groups were well balanced in terms of demographic and clinical characteristics. Patients in both groups who bled from varices received sclerotherapy whenever possible. During a median follow-up of 56 months, variceal bleeding occurred in 7% in sclerotherapy patients and 44% of control patients (p < 0.01). In the sclerotherapy group 59% died, and in the control group 51% (n.s.). In both groups, the mortality rate increased with the severity of liver function impairment. Sclerotherapy was not found to improve survival in patients, irrespective of the etiology of cirrhosis (alcoholic or nonalcoholic) or variceal size (low-grade or high-grade). We conclude that sclerotherapy is a suitable method to reduce the occurrence of the first variceal hemorrhage, but it does not appear to have an effect on survival.

Adult↗
PubMed1994

Endoscopic ultrasonography with the ultrasonic esophagoprobe.

Forty-one patients with either stenosing esophageal and cardia carcinoma (n = 27) or suspected tumor stenosis (n = 14), in whom conventional endosonography had failed, were evaluated with the ultrasonic esophagoprobe (blind probe). The main indication was locoregional staging of esophageal and cardia carcinomas, or restaging after radiotherapy or combined chemotherapy and radiotherapy. In 37% of the patients (10 of 27) an EUS T4 carcinoma was diagnosed, and in 63% (17/27) an EUS-T3 one. Regional lymph-node metastases were diagnosed in 96% of the cases. EUS restaging after nonsurgical palliative treatment detected tumor lesions in three of eight patients. Despite the fact that the imaging quality is still not satisfactory, our results suggest that the limitations of endoscopic ultrasonography (EUS) examination due to stenosing tumor growth can be overcome by the use of this ultrasonic esophagoprobe or similar instruments. Further technical developments may improve the resolution as well as the imaging quality in the celiac axis region.

Cardia↗
PubMed1994

A multicentre in vitro evaluation of piperacillin/tazobactam in Germany.

In a multicentre study in Germany 10584 fresh clinical aerobic isolates were tested for susceptibility to piperacillin (30 micrograms or 100 micrograms discs) and piperacillin/tazobactam (30 micrograms/10 micrograms or 100 micrograms/10 micrograms discs). Preliminary breakpoints for piperacillin/tazobactam according to the German standard methods (Deutsches Institute für Normung) were: Resistant: inhibition zone < or = 14 mm; MIC > or = 64 mg/l. Susceptible: inhibition zone > or = 22 mm; MIC D or = 4 mg/l. For comparison, the National Committee for Clinical Laboratory Standards (USA) breakpoints for enterobacteria (100/10 micrograms/disc) are: Resistant: inhibition zone < or = 17 mm; MIC > or = 128/4 mg/l. Susceptible: inhibition zone > or = 21 mm; MIC < or = 6/4 mg/l. Using the DIN criteria, 73.2% of Enterobacteriaceae tested were susceptible to piperacillin and 91.2% to piperacillin/tazobactam. Of Staphylococcus aureus strains tested (including methicillin resistant Staphylococcus aureus, MRSA), 20.8% were susceptible to piperacillin and 78.7% to piperacillin/tazobactam. The MIC of piperacillin/tazobactam for most staphylococci and Enterobacteriaceae that had been classified on the first test as having intermediate susceptibility or resistance to piperacillin/tazobactam by DIN criteria were re-evaluated to solve methodological problems and inconsistencies among the participating laboratories. This second study resulted in a reduction of the zone diameter for susceptibility of staphylococci to > 14 mm and found that an additional 55.7% of resistant/intermediate Enterobacteriaceae and 91.0% of resistant/intermediate S aureus were susceptible to piperacillin/tazobactam, giving totals for susceptibility of 96.1% for Enterobacteriaceae and 98.1% for S aureus.

Drug Therapy, Combination↗
PubMed1993

"Endoscopy friendly" resection technique of choledochal cysts.

The resection of a choledochal cyst was performed in two patients (22 and 31 years old, both type Todani IVa). Reconstruction of the biliary-intestinal drainage was performed by interposition of a 15 cm jejunal segment between the liver hilum and duodenum. In both patients, hepatico-jejunostomy could be endoscopically evaluated 5-6 months after the operation, showing patent anastomoses without any signs of reflux or cholangitis.

Adult↗
PubMed1993

Endosonography for preoperative locoregional staging of esophageal and gastric cancer.

To assess the accuracy and limitations of endoscopic ultrasonography (EUS) in the preoperative staging of esophageal and gastric carcinoma, we performed a prospective controlled study over a five year period. Data from 63 patients with esophageal cancer and 147 patients with gastric cancer who underwent surgery were available for comparison of the endosonographic TNM classification to the histophathological findings of the resected specimens. The overall accuracy of EUS in the assessment of tumor infiltration depth was 85.7% and 78% in esophageal and gastric cancer, respectively. The sensitivity of EUS in the detection of regional lymph node metastases was 90% in esophageal and 87% in gastric carcinoma. The most frequent causes of misdiagnoses by endosonography were microscopic tumor invasion and peritumorous inflammatory changes. The inability to traverse a tumor stenosis restricted the endosonographic evaluation in 31.6 and 14% of the cases with esophageal and gastric cancer, respectively.

Endoscopy, Gastrointestinal↗
PubMed1992

Human pancreatic tissue concentration of bactericidal antibiotics.

Pancreatic infection represents the most important cause of fatal outcome in human acute pancreatitis. In a comparative analysis, human pancreatic tissue concentrations of 10 different bactericidal antibiotics were determined in 89 patients undergoing pancreatic surgery. Concentrations of the antibiotics were determined in the blood and pancreatic tissue using high-pressure liquid chromatography. Pancreatic tissue concentrations 120 minutes after intravenous administration were as follows: mezlocillin, 19.0 mg/kg; piperacillin, 20.3 mg/kg; cefotaxime, 9.1 mg/kg; ceftizoxime, 7.9 mg/kg; netilmicin, 0.4 mg/kg; tobramycin, 0.4 mg/kg; ofloxacin, 1.7 mg/kg; ciprofloxacin, 0.9 mg/kg; imipenem, 6.0 mg/kg; metronidazole, 3.5 mg/kg. Three groups of antibiotics were established: group A, substances with low tissue concentrations (netilmicin, tobramycin), which were below the minimal inhibitory concentrations of most bacteria found in pancreatic infection; group B, antibiotics with pancreatic tissue concentrations which were sufficient to inhibit some but not all bacteria in pancreatic infection (mezlocillin, piperacillin, ceftizoxime, cefotaxime); group C, substances with high pancreatic tissue levels as well as high bactericidal activity against most of the germs present in pancreatic infection (ciprofloxacin, ofloxacin, imipenem). These data could serve as the basis for adequate antibiotic prophylaxis or treatment of pancreatic infection.

Adult↗
PubMed1992

Occurrence of quinolone resistance in Staphylococcus aureus from nosocomial infection.

Among 63 Staphylococcus aureus isolates (one isolate per one patient) counted from infections (from August to November 1991) in hospital T., eight exhibited resistance to fluoroquinolones. Seven of these quinolone-resistant isolates were multiply- and methicillin-resistant S. aureus (QR-MRSA). The results of phage-, plasmid- and genotyping (pulsed field electrophoresis) revealed that six different strain-clones of these MRSA were spread in the hospital. In vitro spontaneous mutants resistant to fluoroquinolones are 10-100-fold more frequent in MRSA than in other S. aureus when selected on isosensitest-agar containing 1 microgram/ml of ciprofloxacin. However, the same mutant frequencies were found in strain 8325-4 with and without the mecA-determinant. The resistance phenotype was stable over 30 generations of subculture in nutrient broth as well in natural quinolone resistant MRSA as in mutants of other types of S. aureus selected in vitro. The phenotypic association of quinolone resistance and MRSA is rather likely due to a higher frequency of spontaneous resistant mutants which are present in natural populations of MRSA. Data of chemotherapy prior to the isolation of S. aureus show that three of seven patients from whom QR-MRSA were isolated were treated with a quinolone. In eight cases of infections with non-MRSA and quinolone treatment the isolated S. aureus strains were in vitro sensitive to quinolones.

Anti-Infective Agents↗
PubMed1992

Enlarged lymph nodes: malignant or not?

Prospective controlled data of lymph node evaluation by endoscopic ultrasound in esophageal, gastric and pancreatic cancer is presented. Lymph node pattern, changes of boundaries and echogenicity were considered. Preoperative findings of endoscopic ultrasound were classified according to TNM staging. Only those cases with subsequent histologic examination of the resected specimen were entered into the study. Sensitivity of endoscopic ultrasonography (EUS) was 90% for esophageal and 87% for gastric cancer. The specificity was 72% and 88%, respectively. In spite of the overall satisfactory results of EUS in evaluation of lymph nodes, further improvement in detection and differentiation of benign and malignant nodes is required.

Endoscopy, Digestive System↗
PubMed1991

Interpretive criteria of antimicrobial disk susceptibility tests with flomoxef.

320 recently isolated pathogens, 20 strains from each of 16 species, were investigated using Mueller-Hinton agar and DIN as well as NCCLS standards. The geometric mean of the agar dilution MICs of flomoxef were 0.44 mg/l for Staphylococcus aureus, 0.05 mg/l (Klebsiella oxytoca) to 12.6 mg/l (Enterobacter spp.) for enterobacteriaceae, 33.1 mg/l for Acinetobacter anitratus, 64 mg/l for Enterococcus faecalis, and more than 256 mg/l for Pseudomonas aeruginosa. For disk susceptibility testing of flomoxef a 30 micrograms disk loading and the following interpretation of inhibition zones using the DIN method were recommended: resistant-up to 22 mm (corresponding to MICs of 8 mg/l or more), moderately susceptible-23 to 29 mm (corresponding to MICs from 1 to 4 mg/l), and susceptible-30 mm or more (corresponding to MICs of 0.5 mg/l or less). The respective values for the NCCLS method using the American high MIC breakpoints are: resistant--up to 14 mm (corresponding to MICs of 32 mg/l or more), moderately susceptible--15 to 17 mm (corresponding to MICs of 16 mg/l), and susceptible--18 mm or more (corresponding to MICs of 8 mg/l or less).

Cephalosporins↗