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Biomedical subjects

H Grosse

Publications and source records attributed to H Grosse.

At least 37 records · Page 2Linked to original sources
PubMed1990

[The importance of high-dose alpha-receptor blockade for blood volume and hemodynamics in pheochromocytoma].

This prospective clinical study evaluates the possible beneficial effects of increased phenoxybenzamine dosage in the preoperative treatment of patients with pheochromocytoma. For this purpose total blood volume (TBV) prior to and after treatment with phenoxybenzamine and hemodynamic changes during surgery were determined in two groups of patients: group I (n = 12) received a mean dosage of 140 mg, group II (n = 12) 270 mg/day. The mean TBV in group I showed no changes after treatment with phenoxybenzamine, while the TBV in group II increased by 5.6 ml/kg body weight, corresponding to an increase in plasma volume (PV) of 10.2%. These changes were not significant, however. The intraoperative vasodilator requirement for the treatment of catecholamine induced hypertension during tumor manipulation was significantly less for group II: total nitroprusside administration averaged 8.7 mg in group I and 0.8 mg in group II (P less than 0.0005). Patients in group I received a total of 2.6 mg nitroglycerin compared with only 0.5 mg for patients in group II (P less than 0.005). In conclusion, preoperative treatment of patients with pheochromocytoma with increased dosages of phenoxybenzamine is beneficial to intraoperative management by decreasing hemodynamic instability due to tumor manipulation and following resection. This treatment was effective for preventing complications such as excessive tachycardia, cardiac arrhythmias, hypertensive crises, or left ventricular failure.

Adrenal Gland Neoplasms↗
PubMed1990

[Has the frequency of renal cell carcinoma increased in autopsies].

Earlier analyses of autopsy material may show no or only slight increase of renal cancer. However, in Scotland and Connecticut a significantly rise of male renal cell carcinoma was found. Since 1966 in the autopsy material of the area Rügen--Stralsund the frequency of female renal cell cancer have been significantly increased. In these cases the simultaneous occurrence of diabetes mellitus and earlier cholecystectomy is slightly elevated.

Adult↗
PubMed1990

[Ex situ surgery of the liver--anesthesiologic management].

In a 40-year old patient multiple liver tumours that were otherwise regarded as irresectable were removed in an ex situ operation--according to the authors' knowledge for the first time in a human. After protective perfusion with a hypothermic HTK solution hepatectomy was performed. After extirpation of the tumours ex situ, the residual liver was re-implanted. The total operation time was 13 h 50 min, the anhepatic period lasted for 6 h 9 min. During the anhepatic period a venous bypass shunted the blood from the a femoral and the portal vein to an axillary vein. Considerable blood loss was balanced by the transfusion of 26 units of banked blood. Severe disturbances of blood coagulation could be avoided by early substitution with fresh frozen plasma, platelets and fresh blood. The long anhepatic phase caused an acidosis that required the application of 330 mVal NaHCC3. In the discussion the necessity for an aggressive intraoperative monitoring of haemodynamic and laboratory parameters is emphasized.

Adult↗
PubMed1989

[Liver transplantation in low portal vein flow: separation of portal vein areas with divided portal-venous and arterialized caval-venous liver perfusion. 1. Clinical case report].

A new method for the performance of a hepatic transplantation in spite of a low portal blood flow situation is described casuistically. In a 36-year-old-patient suffering from liver cirrhosis due to hepatitis B, the portal blood system of the right and left liver parts were divided, the left part was perfused with a low flow of portal blood, the right one with arterialized caval blood. The function of the transplanted liver and the early postoperative course were excellent. During the further postoperative course portal perfusion presumably diminished or stopped on the left side from three weeks and on the right side from two months postoperatively. Nevertheless the general condition of the patient improved continuously; transient elevations of transaminases may reflect the disturbance of portal perfusion. The technique of this arterialized caval blood perfusion of the portal system is presumably applicable also for situations, in which there is no portal blood flow available for perfusion of a liver graft. Thus, the absence of possibility for reconstruction of portal blood inflow or a situation with a hypoplastic portal vein may no longer be considered as a technical contraindication for liver grafting.

Adult↗
PubMed1989

Surgical aspects of familial pheochromocytoma.

During a 15-year-period (1973-1987), 13 patients with familial pheochromocytoma (PCC) underwent unilateral (n = 7) or bilateral (n = 6) total adrenalectomy without major operative morbidity (1 incidental splenectomy in 8 left-side adrenalectomies) and no mortality. 1 patient died 3 years after unilateral adrenalectomy from unrelated cause. The remaining patients were followed up for a mean time of 5.2 years and could be traced and investigated. 3 patients have been adrenalectomised on the contralateral side because of PCC 5, 6 and 10 years after unilateral adrenalectomy. No patient had metastatic PCC. 1 patient sustained recurrent Addisonian crises after bilateral total adrenalectomy. 1 patient developed recurrent hypertension after bilateral adrenalectomy, but without evidence of recurrent disease. In 3 patients bilateral total adrenalectomy with adrenal cortex autotransplantation was performed, however, complete hormone supplementation therapy had to be continued because of autograft functional insufficiency. In considering the number of patients in this study, who only needed a unilateral adrenalectomy in familial PCC, the more pragmatic surgical approach to familial PCC seems to be supported. Bilateral total adrenalectomy with adrenal cortex autotransplantation was not as effective functionally as supposed by histological examination of transplant biopsy.

Adolescent↗
PubMed1988

[Changes in intraoperative total oxygen consumption in patients during liver transplantation].

The changes in O2-uptake (VO2) during 110 liver transplantations (LTX) were studied using Fick's principle (O2-uptake = cardiac index x arteriovenous O2-content difference). During each of the three operative periods [a dissecting period before clamping of the hepatic vessels (1), the anhepatic phase (2), and after reperfusion of the new liver (3)], two measurements (A and B) were taken. After removal of the liver (2A) the VO2 decreased about 11.4%, and increased after reperfusion (3A) about 44.0%; these changes were significant (P less than 0.001). To evaluate the influence of the various indications for LTX on the course of intraoperative VO2, the following patient groups were compared: patients with hepatic tumors (n = 17), patients with cirrhosis following hepatitis (n = 14), patients with primary biliary cirrhosis (n = 17), patients with cirrhosis plus tumor (n = 11), and patients in a hepatic coma (n = 20), regardless of the underlying liver disease. Groups with less than ten subjects were not considered. The drop of VO2 in the anhepatic period (1B----2A) was between -26.7% (patients with tumors) and -7.3% (patients with cirrhosis plus tumor). The patients with cirrhosis following hepatitis showed a special feature: their VO2 increased about 13.4% after cross-clamping the hepatic vessels. After revascularization, the VO2 increased in all groups between +37.2% and +69.8%. In all groups the level of VO2 was higher after reperfusion (3A) than in the dissecting period (1B), ranging from +5.3% in patients with tumors to +61.6% in patients with cirrhosis following hepatitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma, Bile Duct↗
PubMed1988

[Surgical therapy of sporadic and familial pheochromocytoma].

From 1975 through 1987, 54 patients underwent operations for pheochromocytoma (PCC): 37 patients for sporadic unilateral adrenal PCC, 9 for bilateral and familial PCC, and 4 patients for paraganglioma. In 4 additional patients, laparotomy failed to discover the reason for hypercatecholaminemia. There were no operative mortality and a low morbidity for unilateral (n = 43) as well as for bilateral adrenalectomy (n = 6). To avoid hormone replacement therapy after bilateral total adrenalectomy at least for some years, unilateral instead of bilateral adrenalectomy was preferred to be the initial surgical procedure of choice for familial and MEN-IIA-associated unilateral adrenal PCC. Autologous transplantation of the adrenal cortex were performed in 2 patients after bilateral adrenalectomy. 6 months postoperatively, the transplants were vital as proved by light-microscopy, but sufficiently functioning only in 1 patient.

Adolescent↗
PubMed1988

[Pheochromocytoma: blood volume and hemodynamics].

In 12 patients with phaeochromocytoma total blood volume (TBV) prior to and after treatment with phenoxybenzamine and the haemodynamic changes during surgery were determined. Our results were analysed with regard to the standard of our anaesthesiological management. The mean TBV was reduced in 6 of 12 patients. Great individual variations were found after treatment with phenoxybenzamine. In 6 patients alpha-blockade induced an increase of TBV (+ 10%), 2 patients showed no changes and 4 a decrease of TBV (-18%). Haemodynamic measurements prior to induction of anaesthesia revealed a reversal of catecholamine induced cardiovascular changes. During tumour manipulation the supply of vasodilatators not only prevented hypertensive crises but also induced a marked decrease of systemic vascular resistance. All patients received controlled volume loading until tumour removal, leading to progressive increase in pulmonary capillary wedge pressure and cardiac index. Hypotension or left ventricular failure never occurred. Thus, deep anaesthesia and continuous application of vasodilatators during tumour preparation are the main factors to prevent left ventricular failure from increased systemic vascular resistance and oxygen consumption.

Adrenal Gland Neoplasms↗
PubMed1987

[Correlation between cholelithiasis and cholesterosis of the gallbladder].

Cholesterosis of the gallbladder is more frequent among cases with cholesterol stones than among cases with pigmented stones. Also cholesterosis is more frequent among cases with cholesterol stones of little volume than among cases with stones with higher volume. From the 20. to the 49. year of life cholesterosis is more frequent among cases with gallstones than among cases without stones. From the 50. year of life cholesterosis is more frequent among cases without gallstones than among cases with gallstones. Cholesterosis of the gallbladder ist a reversible process, the petrification of cholesterol polyps is repeated observed.

Adult↗
PubMed1985

[Was the prognosis of gallstone disease improved? Analysis of 9,489 cholelithiasis sections].

Among 9,489 cholelithiasis autopsies the cases with cholecystectomy after 1970 significantly increased. At the same time the inflammatory complications with calculi (peritonitis, abscess, phlegmon, pylephlebitis, sepsis) became significantly more infrequent. But the remaining sequelae of calculi scarcely decreased, particularly not the lithogenic necroses of the pancreas and the non-suppurative cholangitis. After successful operation or conservative treatment many patients resume their old habits: but they are more endangered by dietary lapses and alcohol.

Aged↗
PubMed1982

[Metabolic changes after whole gut washout with an electrolyte solution (author's transl)].

Colonic lavage with physiological saline causes undesirable side effects. A solution as first described by Hewitt was modified and used clinically for whole gut lavage. In comparison with the original solution an unchanged high fluid resorption of 22% of the total was seen. However, changes in acid-base and electrolyte balance were less than after washout with normal saline. Hypokalaemia or metabolic acidosis were not seen any longer. The modified solution thus seems more suitable than saline but does not yet fulfill all the requirements of an optimal solution.

Acid-Base Equilibrium↗
PubMed1981

[Changes in water-electrolyte balance after orthograde intestinal irrigation].

Metabolic acidosis and hypopotassemia after whole gut irrigation (WGI) with 0.9% sodium chloride are probably caused by the following effects: 1. Sodium, chloride and fluid resorption with following renal compensatory mechanisms and inhibition of the ADH incretion and the renin-angiotensin-aldosterone System--2. Washing-out effect of the intestinal mucosa with loss of potassium-rich intestinal juice and protein. At the beginning of anaesthesia, 20 h after WGI, compensatory mechanisms did not reach a reconstitution of the balanced initial situation. Therefore, patients whose state is critical should be monitored carefully during WGI. Further investigations will develop an indifferent irrigation fluid to avoid serious complications of massive water resorption during WGI.

Colonic Neoplasms↗