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Biomedical subjects

H Rupprecht

Publications and source records attributed to H Rupprecht.

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

Intra-abdominal Candida infection during acute necrotizing pancreatitis has a high prevalence and is associated with increased mortality.

OBJECTIVES: To analyze the frequency of intra-abdominal Candida infection during acute necrotizing pancreatitis and to compare the outcome to patients without Candida infections. DESIGN: Retrospective analysis of data from 37 patients with and without Candida infection. SETTING: Surgical intensive care unit (ICU) in a university hospital. PATIENTS: Thirty-seven patients with acute necrotizing pancreatitis. INTERVENTIONS: Patients were subject to necrosectomy and programmed lavage. MEASUREMENTS AND MAIN RESULTS: Clinical parameters contained in the Acute Physiology and Chronic Health Evaluation (APACHE) II score were monitored, as were microbiological results from the intra-abdominal primary focus and from sites of secondary infections. Body mass index, distribution of underlying diseases, length of ICU stay, number of operations, and outcome were recorded. Multivariate logistic regression analysis for mortality as the dependent variable was performed. Intra-abdominal Candida infection was observed in 13 of 37 cases and was associated with a four-fold greater mortality rate compared with intra-abdominal bacterial infection alone. Multivariate logistic regression analysis demonstrated that Candida infection contributed to mortality significantly (p < .025) and independently from APACHE II (p < .006; mortality odds ratio for the two parameters=12.5). Lack of antimycotic treatment was associated with an increase to 29.2 (p<.001) in the odds ratio. CONCLUSIONS: Given the impact of Candida infection on mortality to acute necrotizing pancreatitis and the apparent benefit from antimycotic chemotherapy, the data argue for an early fungicide chemotherapeutic intervention.

APACHE↗
PubMed1998

[Postoperative pulmonary torsion and hemorrhagic lung infarct--report of a case].

Lung or lobe torsion may occur after thoracic surgery, chest trauma, pneumothorax, pneumonia or even spontaneously. Lung infarction is a possible complication. The characteristic radiological signs on plain radiographs are opacification and/or displacement of lobes and hilus structures. CT-signs of haemorrhagic infarction are opacification and multiple punctate gas accumulations. The bronchus could be interrupted at the level of the torsion ("bronchus-cutoff").

Aged↗
PubMed1998

Prospective use of platelet glycoprotein IIb/IIIa receptor blockers in the emergency department setting.

Platelets play a pivotal role in the pathophysiology of acute coronary syndromes (ACS) and thus are logical therapeutic targets for treatment of this disease process. Platelet glycoprotein (GP IIb/IIIa receptor antagonists, which interrupt the final common pathway of platelet aggregation, have been proven to reduce the 30-day incidence of death, acute myocardial infarction (MI), and urgent revascularization in both high-risk and low-risk patients undergoing percutaneous intervention procedures. Three-year follow-up has indicated that these benefits appear durable. Recent large-scale randomized trials have demonstrated the value of GP IIb/IIIa receptor inhibitors in reducing the risk of death and MI in unstable angina/non-Q-wave MI patients receiving pharmacologic management. And, emerging evidence suggests a future role for GP IIb/IIIa receptor inhibitors as an adjunct to low-dose fibrinolytic therapy in patients with acute MI. As the list of indications for GP IIb/IIIa receptor antagonists expands to encompass the full spectrum of ACS, there is increasing interest in the potential use of these agents in the emergency department setting. The integration of GP IIb/IIIa receptor inhibitors into emergency department protocols will ultimately depend largely on whether these drugs prove to be safe and effective regardless of the direction of ST-segment deviation, and irrespective of whether definitive therapy will be invasive or conservative.

Algorithms↗
PubMed1997

Tc-99m DTPA perfusion scintigraphy and color coded duplex sonography in the evaluation of minimal renal allograft perfusion.

AIM: The clinical impact of perfusion scintigraphy versus color coded Duplex sonography was evaluated, with respect to their potential in assessing minimal allograft perfusion in vitally threatened kidney transplants, i.e. oligoanuric allografts suspected to have either severe rejection or thrombosis of the renal vein or artery. METHODS: From July 1990 to August 1994 the grafts of 15 out of a total of 315 patients were vitally threatened. Technetium-99m DTPA scintigraphy and color coded Duplex sonography were performed in all patients. For scintigraphic evaluation of transplant perfusion analog scans up to 60 min postinjection, and time-activity curves over the first 60 sec after injection of 370-440 MBq Tc-99m diethylenetriaminepentaacetate acid (DTPA) were used and classified by a perfusion score, the time between renal and iliac artery peaks (TDiff) and the washout of the renogram curve. Additionally, evaluation of excretion function and assessment of vascular or urinary leaks were performed. By color coded Duplex sonography the perfusion in all sections of the graft as well as the vascular anastomoses were examined and the maximal blood flow velocity (Vmax) and the resistive index (RI) in the renal artery were determined by means of the pulsed Doppler device. Pathologic-anatomical diagnosis was achieved by either biopsy or post-explant histology in all grafts. RESULTS: Scintigraphy and color coded Duplex sonography could reliably differentiate minimal (8/15) and not perfused (7/15) renal allografts. The results were confirmed either by angiography in digital subtraction technique (DSA) or the clinical follow up. CONCLUSION: In summary, perfusion scintigraphy and color coded Duplex sonography are comparable modalities to assess kidney graft perfusion. In clinical practice scintigraphy and color-coded Doppler sonography can replace digital subtraction angiography in the evaluation of minimal allograft perfusion.

Adult↗
PubMed1997

[Concealed perforated aneurysm of an aberrant right hepatic artery: papillary bleeding. Case report and review of the literature].

A rare case of spurious aneurysm of an aberrant right hepatic artery is reported. Endoscopic retrograde cholangio-pancreaticography, computed tomography and selective angiography of the coeliac trunc are diagnostic. Resection of the aneurysm and interposition of saphenous vein is the preferred procedure. In selected cases ligation of the common hepatic artery is possible. Intrahepatic aneurysms are preferably treated interventionally.

Aged↗
PubMed1996

Transthoracic bronchial intubation in a case of main bronchus disruption.

We report on a case of blunt thoracic trauma that resulted in complete disruption of the right main bronchus. Due to massive loss of respiratory volume during thoracotomy, sufficient ventilation could not be maintained via the orotracheal tube. Transthoracic intubation of the left main bronchus via the right bronchial defect was the ultima ratio procedure that allowed reanastomosis of the disrupted right main bronchus.

Bronchi↗
PubMed1996

[Quality of life after survival of severe trauma].

Quality of life (QoL) was analyzed in 73 patients with severe multiple trauma (PTS > or = 40 patients) between 1 and 13 years after injury. QoL was assessed by the Aachen Longtime Outcome Score (ALOS), the Spitzer Index (SI) and individual self-assessment. The patients were asked about further social, financial, psychological and physical items. According to the ALOS, 81% of the patients showed moderate, 14% severe and 5% no disability. In 66% of the patients a favorable Spitzerindex (8-10 points) was found. Only 14% had poor SI scores (0-4 points). Also, two out of three patients regarded the current state of their health as "good" or "very good". Predominantly, handicaps resulted from permanent physical disability, in particular the lower extremities, whereas psychosocial and financial problems were reported infrequently. Besides injuries to the head or extremities, low QoL correlated with severity of injury and increasing age. Within the first 4 post-traumatic years SI and ALOS, as well as individual self-assessment, improved with time after injury. The rate of patients who returned to work (69%) was similar to other multiple trauma series, including series with less severe injuries. The reasonable long-term outcome even after severe multiple trauma seems to justify the enormous staff and economic expense required to manage these patients. Further improvement in QoL may be achieved by professional psychological support and early fracture treatment.

Adaptation, Psychological↗