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Biomedical subjects

H R Freund

Publications and source records attributed to H R Freund.

At least 91 records · Page 5Linked to original sources
PubMed1985

Modification of the catheterization procedure for the totally implantable infusion pump.

The totally implantable infusion pump is a new and expensive device. Once this pump is unpacked and is in contact with a patient, it is impossible to have it resterilized. For this reason, we suggest the use of a separate catheter for catheterization. Once the catheter is successfully placed in the appropriate artery, then the pump can be unpacked and attached to this catheter. If catheterization proves impossible, the pump is still sterile and can be used for the next patient.

Catheterization↗
PubMed1984

Appendicitis in the aged. Is it really different?

The case reports, operative findings, and results of surgery in 77 patients aged 60 years and older who underwent surgery for histologically proven acute appendicitis were analyzed. Based on this analysis, it was concluded that the clinical picture of appendicitis in the aged does not differ from that observed in younger patients. However, in the aged the disease course seems to be more rapidly progressing toward perforation and abscess formation. An aggressive diagnostic attitude and early surgery seem the sole means by which mortality and morbidity of appendicitis in the aged can be lowered.

Acute Disease↗
PubMed1983

Experience with the one-stage perineal repair of rectal prolapse.

Our experience with 27 patients undergoing 33 Altemeier procedures for repair of rectal prolapse is presented. The overall recurrence rate during a 1- to 17-year follow-up period is 35 per cent (per patients) or 50 per cent (per operations). There was no mortality and only minimal morbidity, although we were dealing with an elderly group of patients (average age 61 years) with many associated diseases (2.8 diseases per patient). Of 13 patients with successful anatomic repair, ten described it as a success, one developed an anal stricture, and two patients claimed only partial success, despite a perfect anatomic repair, due to lack of improved continence. Our results with the Altemeier procedure for the repair of rectal prolapse are unsatisfactory. However, as the procedure is well tolerated by elderly and sick patients, it should be reserved for those.

Adult↗
PubMed1982

Factors affecting the morbidity of colostomy closure: a retrospective study.

The use of a temporary colostomy is essential in the management of trauma, carcinoma, iatrogenic perforations, diverticulitis, and a number of congenital anomalies of the colon. Closure of a colostomy can be associated with a significant complication rate and even mortality and should not be considered a minor procedure. This is a retrospective study of 114 patients undergoing closure of colostomy, in which an attempt was made to investigate and single out the factors determining complications of colostomy closure. The results point toward timing and technique of closure as the two main factors determining complications associated with colostomy closure.

Adolescent↗
PubMed1982

Surgical treatment of gastroesophageal reflux with esophageal stricture in infancy and childhood.

During the past 5 years, 26 infants and children with gastroesophageal reflux were operated on. The results have been highly satisfactory and unattended by serious complications or mortality. Barium fluoroscopy was the most reliable diagnostic method. The indications for operation were persistent vomiting with failure to thrive, recurrent aspiration pneumonia, gastrointestinal bleeding and peptic stricture of the esophagus, not relieved by medical treatment. The high incidence of peptic stricture of the esophagus (50 percent) may reflect delay in diagnosis and medical treatment, which is successful in 60 to 87 percent of the infants with gastroesophageal reflux. Surgical treatment consisted of Nissen fundoplication combined with gastrostomy in cases of esophageal stenosis where dilatations were indicated. Complications related to the operation were minimal. In a follow-up period of 9 months to 5 years, all patients had obtained relief of symptoms of reflux and had excellent nutritional status and normal growth.

Age Factors↗
PubMed1982

Nitrogen sparing effects and mechanisms of branched-chain amino acids in the injured rat.

A series of experiments in a rat injury model were designed to elucidate the role and mechanisms of branched-chain amino acids in the post-injury catabolism. Our results suggest that: 1. Nutritional support can maintain nitrogen equilibrium in the early post-operative state. 2. Branched chain amino acids exert a nitrogen sparing effect and thus prevent or minimise post-operative catabolism. 3. Increasing the amount of infused branched chain amino acids results in nitrogen retention. 4. A balanced amino-acid mixture containing 45 per cent branched chain amino acids seems to be optimal for nutritional support in the post-injury state.

Journal Article↗
PubMed1982

Blood-brain barrier derangement in uremic encephalopathy.

A disturbance of cerebral neurotransmitters and an accumulation of octopamine, a putative false neurotransmitter, have been found in patients with uremic encephalopathy who manifest disorientation, somnolence, asterixis, and coma--symptoms also seen in portal systemic encephalopathy (PSE). Altered plasma concentrations of the neutral amino acids (NAAs) and increased blood-brain NAA transport may play a role in PSE, and in the present study plasma amino acid concentrations and blood-brain barrier NAA transport were investigated in rats with acute and chronic uremia. Acute uremia was produced by unilateral nephrectomy and occlusion of the renal artery of the remaining kidney for 70 minutes; the animals were studied 24 hours later. Chronic uremia was produced by unilateral nephrectomy and 70% to 80% devascularization of the remaining kidney; these animals were studied 2 weeks later. Brain uptake was studied with the technique of Oldendorf, and blood and brain amino acids (AAs) were measured. The blood urea nitrogen (BUN) level in rats with acute uremia increased to 108 mg/dl, in rats with chronic uremic 54 mg/dl, and in sham-operated rats 22 mg/dl. In both uremic groups there was a decrease in plasma branched-chain AAs. In the brain these AA levels were normal, while levels of phenylalanine, tyrosine, and histidine were increased in uremic rats.

Amino Acids↗
PubMed1981

Chemical phlebothrombosis of large veins. A not uncommon complication of total parenteral nutrition.

Thrombosis of large veins during total parenteral nutrition (TPN) is considered uncommon. Recently, clinical and phlebographic evidence of large-vein thrombosis were encountered in five patients among 200 consecutive patients receiving TPN. The symptoms, signs, and phlebographic findings occurred within one to two days, sometimes as early as a few hours after cannulation. It is suggested that thrombosis of large veins during TPN is not uncommon and is the result of chemical phlebothrombosis due to a hypersensitivity reaction of the venous wall to the polyvinyl catheter material. Early removal of the offending catheter is advocated.

Adolescent↗
PubMed1981

Blood-brain barrier derangement in sepsis: cause of septic encephalopathy?

Patients with sepsis often manifest disorientation, somnolence, asterixis and coma, symptoms also seen in portasystemic encephalopathy. Altered plasma concentrations of the neutral amino acids and in creased blood-brain transport of these acids may play a role in portasystemic encephalopathy. Plasma amino acids and blood-brain barrier transport of neutral amino acids were investigated in a rat model of abdominal sepsis, cecal ligation and puncture. The blood-brain transport was studied by the technique of Oldendorf with carbon-14-amino acids 12 and 24 hours after the induction of sepsis. In similar groups of animals, isolation of brain capillaries was carried out by the technique of Hjelle and the capillaries were incubated with carbon-14-amino acids to study transport activity. Plasma and brain amino acids were deranged in a fashion similar to the derangements seen in portasystemic encephalopathy, with a decrease in plasma branched chain amino acids and an increase in most neutral amino acids in brain. The changes were most pronounced after 24 hours. The brain uptake of several neutral amino acids was increased in the septic rats, while the uptake of lysine, a basic amino acid, was normal. In the brain capillaries isolated from septic rats, tyrosine and leucine transport was also greater than in sham-operated animals. Elevated neutral amino acids may play a role in the encephalopathy encountered in septic patients similar to its role in patients with portasystemic encephalopathy, as similar mechanisms appear to be operating.

Abdomen↗
PubMed1981

Reduced tissue content of vasoactive intestinal peptide in aganglionic colon of Hirschsprung's disease.

The colonic tissue content of immunoreactive vasoactive intestinal peptide was measured in four children with histologically proven Hirschsprung's disease. The concentration of vasoactive intestinal peptide was lower in the aganglionic bowel than in nearby normal bowel. Similar results have been described for another gastrointestinal peptide: substance P. Abnormalities of peptidergic control may contribute to the motility disorder of congenital aganglionic colon.

Child↗
PubMed1981

Nitrogen-sparing mechanisms of singly administered branched-chain amino acids in the injured rat.

Previous studies have demonstrated that the in vivo nitrogen-conserving quality of amino acid solutions might be improved by increasing the percentage of branched-chain amino acids (BCAA) and that infusion of a solution consisting only of the three BCAA-valine, leucine, and isoleucine-in the postoperative period resulted in nitrogen equilibrium. To clarify which of the properties ascribed to the BCAA is responsible for the improved postoperative nitrogen conserving quality, we infused rats undergoing laparotomy and jugular vein cannulation with each of the BCAA or alanine separately. Twenty-four hours before the were killed 5 microCi 14C-tyrosine was added to the infusate to determine total body protein degradation and fractional synthesis rate in liver and muscle. All four amino acid-containing solutions conserved nitrogen as compared with 6.5% dextrose. Fractional synthesis of rate mixed liver protein was significantly increased in all groups receiving BCAA. Only the infusion of valine significantly increased muscle protein synthesis. Total body protein breakdown rate was similarly decreased in all groups receiving amino acids (alanine, valine, leucine, or isoleucine). Total body protein breakdown correlated significantly with the nitrogen balance. The protein-sparing mechanisms of the BCAA in the post-traumatic period are mediated through reduction in whole body protein breakdown, as well as by increasing protein synthesis in both liver and muscle protein. These results appear specific for the BCAA as isonitrogenous amounts of alanine do not give similar results.

Alanine↗
PubMed1981

The influence of splenic tissue implantation upon platelet population in rabbits after splenectomy.

An investigation of the behavior of the blood platelet population following splenectomy and autologous splenic tissue implantation has been done on the rabbit. A bimodal rise in platelet size and count is observed in the postoperative period. After splenectomy, a 722 per cent increase in the platelet count and a 21.9 percent rise in the platelet size are found. These increases are abolished by the implantation of splenic tissue. The existence of a splenic humoral factor that controls platelet production in the bone marrow is possible.

Animals↗