[Manuscript and journal. Hints for authors which should be self-evident].
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Germany, West↗
Biomedical subjects
H Lippert
Publications and source records attributed to H Lippert.
[The lymphatic system of the uterus and its draining vessels].
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Female↗
[Biomechanical investigations on the great veins (author's transl)].
Tensile breaking load, extensibility, elasticity and breaking energy of superior vena cava, inferior vena cava and portal vein of 33 men and 18 women have been determined in different directions by means of an electronic tension testing machine. 315 test specimens have been investigated with the following results: 1. The average breaking load in the tranverse direction of all three veins exceeds that in the longitudinal direction. 2. The maximum elongation is larger in the longitudinal than in the transverse direction. 3. The elastic constant is larger in the transverse than in the longitudinal direction, i.e. the extensibility is larger in the longitudinal direction. 4. Breaking load, elastic constant, and breaking energy are largest for the inferior vena cava and smallest for the portal vein. 5. The maximum elongation of the three veins is approximately equal. 6. No significant dependence of the obtained data on age was found.
Adolescent↗
Transplantation of isologous islets of Langerhans in diabetic rats. Long-term immunohistochemical results.
Isologous isolated islets of Langerhans were transplanted into the peritoneum and through the portal vein into the liver of diabetic rats. This resulted in the normalization of fasting blood glucose levels, with clear improvement of glucose tolerance tests. The results after intrahepatic implantation were better than after intraperitoneal implantation. Three months after implantation of islets into the peritoneum diabetes recurred and after one year only 2 of the 15 rats were alive, with high blood glucoe levels. In the group with intrahepatic islets the normalization of blood glucose was maintained over a period of one year. Immunohistochemical insulin proofs were positive in the peritoneum over a period of 3 months and in the liver up to one year after implantation. Glucagon proofs were positive in the intraperitoneal islets for 6 weeks and in intrahepatic ones for one year. Morphological examination of transplanted islets suggested that the liver is better suited for islet transplantation than the peritoneum.
Animals↗
[Osteon count and tensile strength of human metacarpals and basic phalanges].
In a previous study the biochemical data of 45 metacarpal and 36 phalangeal bones of 21 male cadavers (24-69 years of age) were obtained by fracturing in a bending test. The present study attempts of correlate these data with the compacta area, the number of osteons, and the cross sectional area of the osteons. The relative and absolute number of osteons increase significantly with increasing age, whereas the average thickness of the compacta decreases significantly. The calibre of the bone marrow cavity increases with age. There is no correlation between age and osteon diameter. Ultimate bending deflection, bending breaking load, and breaking energy decrease following a reduction in compacta thickness or in the cross sectional area of the compacta. Bending tests on whole bones indicate that it is not so much bone tissue morphology, but rather the relationship of the marrow area to the total cross sectional area which is the significant factor in the bending behaviour of the whole bone.
Adult↗
Antimicrobial prophylaxis in laparoscopic and conventional cholecystectomy . Conclusions of a large prospective multicenter quality assurance study in Germany.
BACKGROUND: Postoperative infection following cholecystectomy poses a significant threat to recovery, with major cost repercussions. Though antimicrobial prophylaxis is commonly practiced, its value - particularly in laparoscopic cholecystectomy - has not yet been adequately documented. METHOD: In a prospective multicenter quality assurance study in 28 German hospitals, an analysis of data collected on 4,477 patients undergoing conventional (n = 1,349) or laparoscopic (n = 3,128) cholecystectomy was performed; 2,217 patients received and 2,260 did not obtain perioperative antibiotic cover. RESULTS: Postoperative infections occurred in a total of 136 patients, with infection rates of 5.0% in those without prophylaxis, 0.8% in those on ceftriaxone, and 1.2% in those on other antibiotic regimens. Patients receiving prophylaxis fared significantly better than those with no prophylaxis in terms of the rate of postoperative wound infections, chest infections, other complications, reoperation and mortality. CONCLUSION: Neither laparoscopic nor conventional open cholecystectomy should be performed without adequate perioperative antimicrobial prophylaxis in future, especially since such measures also reduce hospital stay and hence the costs.
Adult↗
Oxidative stress affects pancreatic proteins during the early pathogenesis of rat caerulein pancreatitis.
Rats received up to four subcutaneous injections of caerulein (20 microg/kg) in hourly intervals to induce a mild edematous pancreatitis. A single dose of caerulein resulted in significant oxidative modification of proteins in pancreatic homogenates as compared to saline-injected controls (p < 0.01). Repeated injections of the secretagogue were unable to induce a further increase in modified proteins. Protein oxidation preceded the formation of the lipid peroxidation product malondialdehyde as well as edema and the increase in serum amylase by 1-2.5 h. Western blotting for oxidatively modified proteins confirmed the results of the quantitative measurements and did not reveal individual, selectively modified proteins. These findings indicate that oxidative stress and oxidative protein modification are very early events in the initial period of caerulein pancreatitis. This may explain the poor success rate of most studies that administered antioxidants therapeutically during or after initiation of pancreatitis.
Amylases↗
Influence of titanium coating on the biocompatibility of a heavyweight polypropylene mesh. An animal experimental model.
INTRODUCTION: In light of the fact that, to date, no information is available about titanium relative to its application in prosthetic material employed for hernial repair, the aim of the present work was to evaluate the fundamental possibilities of titanium-coated polypropylene meshes. MATERIALS AND METHODS: In experiments with animals, two groups, each containing 11 pigs, received either a heavyweight polypropylene mesh (Atrium) or an identical but titanium-coated mesh (titanium-coated Atrium) implanted into the left groin using the totally endoscopic extraperitoneal patchplasty technique. RESULTS: A significant difference in the shrinkage behavior between conventional Atrium and titanium-coated Atrium was found (14.9 vs. 8.8%, p < 0.05). Furthermore, the partial volume of the inflammatory infiltrate also proved to be smaller with the titanium-coated mesh (14.9 vs. 12.4%). In addition, Ki-67 expression was lower in the group implanted with titanium-coated mesh (21.0 vs. 15.0%). No difference was observed with regard to the apoptosis index (7.6 vs. 6.5). CONCLUSIONS: Heavyweight titanium-coated polypropylene meshes induce a less pronounced foreign body reaction in comparison with identical meshes with no titanium coating, which, since the amount of material implanted is identical, must be attributed solely to the titanium coating.
Animals↗
Hepatic artery aneurysm associated with upper gastrointestinal bleeding after intrahepatic artery chemotherapy.
We present the course of illness of a 56 year-old patient with acute gastrointestinal bleeding after penetration of an aneurysm of the hepatic artery in the duodenal bulb. A diffuse intrahepatic metastasis of a carcinoid was treated with a loco-regional intraarterial chemotherapy via a catheter system implanted in the gastroduodenal artery. Five months after the catheter implantation melena occurred. The gastrointestinal arterial bleeding from the penetrating aneurysm presented a life-threatening situation. This cause of bleeding could not be brought under control endoscopically. Immediate surgical management became necessary.
Aneurysm, Ruptured↗
Hepatic and retroperitoneal tumor resection for late metastases of a Wilms' tumor in an adult patient--a case report.
Hepatic metastases after a Wilms' tumor in adult patients are seen extremely rarely. A 21 year-old male patient developed liver metastases 13 years after resection of a primary left extrarenal Wilms' tumor. In this case, without any other metastases, extended right curative hepatic lobectomy was performed. The patient was re-admitted 4 months after the hepatic lobectomy for a resection of a new Wilms' tumor metastatic mass in the area of the pancreatic tail. The patient received adjuvant high dose systemic chemotherapy with ordinary bone marrow cell rescue after the 2nd operation. He is alive and well with no signs of new metastases 18 months after surgery and adjuvant chemotherapy.
Adult↗
Oxidative stress in acute pancreatitis.
The present work critically reviews the evidence for an involvement of free radicals in the pathophysiology of acute pancreatitis and the potential of treatment with antioxidants and scavenger substances. Data originating from clinical trials, experimental pancreatitis studies and in vitro investigations are included. Enhanced free radical activities and increased concentrations of lipid peroxides in plasma and tissue have been found in both patients and experimental animals with acute pancreatitis. The individual contribution of possible sources of free radicals (e.g., invading inflammatory cells, xanthine oxidase, cytochromes P450, nitric oxide synthase) is not yet clear, however. Since prophylactic administration of antioxidants diminished, in particular, pancreatic edema formation, free radicals seem to play an important role in the genesis of edema in acute pancreatitis. An involvement of free radicals in the pathogenesis of pancreatic necrosis could not yet be proven. Thus, no antioxidant treatment has proven useful for therapy of fulminant pancreatitis in animals to date. However, in severe acute pancreatitis characterized by death occurring after 12-18 hours, the seleno-organic compound Ebselen, which has a glutathione peroxidase-like activity, and the membrane permeable ascorbic acid derivative CV-3611 have been demonstrated to be effective. To date, controlled clinical studies have failed to demonstrate the therapeutic efficacy of antioxidant selenium or glutathione precursor supplementation. Therefore, further controlled clinical trials are needed to determine whether supplements of antioxidants can alter the clinical course of acute pancreatitis. Since the nitric oxide radical may even protect the pancreas, a purely negative discussion of the role of free radicals on the pancreas is not justified. The actual role of free radicals in acute pancreatitis, i.e. serving the body's defense against infection, being an epiphenomenon of the inflammatory process without pathophysiological relevance, or having true pathogenic significance, is not yet clear. Lipid peroxidation may perhaps not be the cause but rather the sequel of pancreatic inflammation and may likely reflect the severity of the systemic inflammatory response rather than that of pancreatic parenchyma damage. In vitro, exposure of isolated pancreatic acinar cells to oxidative stress caused rapid cell damage and death. Such knowledge from cellular studies might help to plan therapeutical trials to evaluate potentially effective therapies in the experimental animal, as well as in patients suffering from pancreatitis. Thus, to further clarify the role of oxidative stress in acute pancreatitis, an integrated approach is needed, including investigations at various biological levels, from isolated cells or even organelles to laboratory animals and, finally, clinical studies in man.
Acute Disease↗
Diagnostic workup before laparoscopic cholecystectomy--which diagnostic tools should be used?
BACKGROUND/AIMS: A prerequisite for successful laparoscopic cholecystectomy is the exclusion of potential risks such as cholangiolithiasis, anatomical malformations or diseases of the stomach. As there is no general agreement regarding the appropriate preoperative diagnostic workup, we compared different diagnostic methods as to their value in detecting unknown accompanying diseases and complications. METHODOLOGY: Between 9/90 and 8/93, we performed 850 laparoscopic cholecystectomies. The first 700 were included in this study. A prospective comparison was carried out of the diagnostic accuracy of history, physical examination, laboratory tests, upper gastrointestinal endoscopy or barium meal, i.v. cholangiography and abdominal ultrasound. RESULTS: Measurement of the diameter of the common bile duct was found to be a good noninvasive method for diagnosing common bile duct stones (sensitivity 80%, specificity 99%). In combination with the history and the laboratory tests the sensitivity could be improved to 99%. The sensitivity of i.v. cholangiography in detecting common bile duct stones was 80%, the specificity 99.3%. 646/700 patients underwent preoperative endoscopy/barium meal. In 53 (8.2%) patients pathological findings were found, but only in 4 cases (0.6%) they influenced the indication for laparoscopic cholecystectomy. In 1 patient an advanced gastric cancer was diagnosed 6 months after laparoscopic cholecystectomy, the preoperative barium meal did not show any pathological findings. CONCLUSIONS: The results show that routine ultrasonography in combination with history and laboratory tests prior to laparoscopic cholecystectomy can be recommended for detecting common bile duct stones. In patients with 1 or more pathologic finding endoscopic retrograde cholangiopancreatography should be performed preoperatively. A gastroscopy should be done in patients with nonspecific upper abdominal pain, history of peptic ulcer disease and persisting pain after laparoscopic cholecystectomy.
Adult↗
Primary sarcoma of the inferior vena cava: review of diagnosis, treatment, and outcomes in a case series.
Leiomyosarcoma of the inferior vena cava is a rare mesenchymal tumor. The diagnostic approach, based on general guidelines of oncologic surgery, seems to be relatively routine; specific aspects of treatment, including vascular reconstruction, depend on tumor stage, grade, and location. In this report, the management of this disease in 5 patients is summarized and the literature is reviewed. A thorough diagnostic assessment includes sonography, computed tomography, angiography or duplex ultrasonography, perioperative pathohistologic examination, and appropriate differential diagnosis. Radical resection is associated with the best outcome and long-term survival. In this series, 4 of 5 patients underwent tumor resection. In 2 patients, the disease was classified as R0. Another patient had R1 status found at resection and underwent postoperative radiation after the tumor bed was marked intraoperatively. She has remained stable since treatment. One patient died of pulmonary metastases 32 months after primary R1 tumor resection. The 5th patient has been stable since diagnosis; resection was not possible because of severe accompanying diseases and because consent for surgical intervention could not be obtained from the patient. There is reasonable hope that leiomyosarcoma of the inferior vena cava can be treated successfully, even in advanced stages, with novel antineoplastic drugs and radiotherapeutic protocols. However, general treatment recommendations have not yet been compiled.
Aged↗
Acute or delayed surgical treatment of traumatic rupture of the descending aorta.
During a 20 year period, 33 patients with traumatic rupture of the descending thoracic aorta were operated upon. In the absence of an indication for acute surgery our policy was to defer operation at least 4 weeks after the trauma. Six patients were operated upon within 24 hours (Group I), 5 after 4-13 days due to suspected expansion of mediastinal widening (Group IIa), 10 were operated upon electively after 4-12 weeks (Group IIb), and 12 were operated upon for chronic traumatic aneurysms (Group III). The number of operative deaths/reoperations due to bleeding were: Group I, 2/1; Group IIa, 1/2; Group IIb, 0/0; and Group III, 1/0. There were no late deaths related to the operation or the inserted prosthesis. Of 26 survivors, 21 underwent a follow-up study 1.5-20 years (mean 8.2 years) postoperatively. Except for 6 patients with paralysis of the left recurrent laryngeal nerve none of the patients had sequelae which could be related to the operation or the inserted prosthesis. CT-scanning of the chest revealed neither pseudoaneurysms nor significant stenosis in the suture lines or prosthetic areas. The results indicate that delayed operation of traumatic thoracic aortic ruptures on selected patients may be performed with acceptable results.
Adult↗