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H Weidemann

Publications and source records attributed to H Weidemann.

At least 19 recordsLinked to original sources
PubMed2007

Transabdominal ligation of the thoracic duct as treatment of choice for postoperative chylothorax after esophagectomy.

Postoperative chylothorax after injury of the thoracic duct during esophagectomy is a rare but severe complication which may lead to serious problems such as loss of fat and proteins, and immunodeficiency. Without treatment mortality can rise to over 50%. From 1988 to 2005, we treated 10 patients with postoperative chylothorax after 409 resections of the esophagus (2.4%). Of these 10 patients nine underwent transthoracic esophagectomy with gastric pull-up to enable an intrathoracic (n = 7) or cervical (n = 2) anastomosis and one patient received a transhiatal esophagectomy with gastric pull-up and cervical anastomosis. The average amount of postoperative chylus was 2205 mL (200-4500 mL) per day. After a median postoperative interval of 10 days, relaparotomy and transhiatal double ligation of the thoracic duct was performed in nine out of 10 patients. One patient could be managed conservatively. The average amount of chylus was reduced to 151 mL per day (90.5%). Seven patients had no complications, and three suffered from postoperative pneumonia. Two of the patients with pneumonia recovered, and one died. Discharge from hospital, after ligation of the thoracic duct, was possible after a median time of 18 days (11-52). Ligation of the thoracic duct via relaparotomy appeared to be a simple and safe method to treat postoperative chylothorax.

Aged↗
PubMed2004

Diverse effects of stress and additional adrenocorticotropic hormone on digitalis-like compounds in normal and nude mice.

Digitalis-like compounds (DLC) are steroidal hormones that are synthesized in, and released from, the adrenal gland, whose regulation may be directed by the hypothalamic-pituitary-adrenal (HPA) axis. Increasing evidence points to antitumour properties of these compounds and we hypothesized that the establishment of tumours in athymic nude mice may be facilitated by an abnormal synthesis or secretion of DLC. To explore this hypothesis, DLC concentrations were determined in the plasma, and in adrenal and hypothalamic tissues of nude compared to normal mice under basal conditions, and 30 min after a stress stimulus (i.p. injection of 100 micro l saline) with or without additional adrenocorticotropic hormone (ACTH) 1 micro g/per animal. Simultaneously, plasma corticosterone and serum adrenocorticotropic hormone (ACTH) concentrations were analysed. The basal DLC concentrations were similar in the plasma and the hypothalamus of both strains, whereas the basal adrenal DLC concentration was significantly lower in the nude mice compared to normal mice. The stress stimulus induced in normal mice a significant increase in DLC concentrations in the adrenal gland, the plasma and the hypothalamus. However, in nude mice, it caused an increase only in the adrenal gland and the hypothalamus, whereas the plasma DLC concentration was not affected. In both strains, the administration of ACTH in addition to injection stress did not provoke a further increase in DLC concentrations while inducing a significant increase in plasma corticosterone concentration. Regardless of the applied stimulus, the nude mice expressed significant lower DLC concentrations in the adrenal gland and the plasma compared to normal mice. The low basal adrenal DLC concentration in nude mice and their impaired DLC response towards stress- and ACTH stimulation both support an involvement of DLC in tumorigenesis.

Adrenal Glands↗
PubMed2003

Plastic reconstruction of an extended corrosive injury of the posterior tracheal wall with an autologous esophageal patch.

We report on a patient with an extended corrosive injury of the posterior tracheal wall and left-sided tracheo-esophageal fistula after severe inhalative trauma. Resection of the fistula and necrotic tissue was followed by reconstruction of the posterior tracheal wall with an esophageal patch. Interposition of the stomach was performed to restore upper gastro-intestinal continuity. Revision was necessary due to an anastomotic insufficiency and a recurrent fistula between the trachea and the esophago-gastrostomy on the left side. The stomach was resected and the fistula was covered with a sternocleidomastoideus muscle flap. Several weeks later interposition of the right hemicolon was performed to establish the gastro-intestinal tract and the patient recovered completely, thereafter.

Adult↗
PubMed2000

Pulmonary artery catheterization and clinical outcomes: National Heart, Lung, and Blood Institute and Food and Drug Administration Workshop Report. Consensus Statement.

OBJECTIVE: The efficacy and safety of the pulmonary artery catheter are under scrutiny because of its association with increased morbidity and mortality in observational studies. In response, the National Heart, Lung, and Blood Institute (NHLBI) and the US Food and Drug Administration (FDA) conducted the Pulmonary Artery Catheterization and Clinical Outcomes workshop in Alexandria, Va, on August 25 and 26, 1997, to develop recommendations regarding actions to improve pulmonary artery catheter utility and safety. PARTICIPANTS: The NHLBI and FDA planning task force selected a workshop chairperson, subcommittee chairs, and participants. Approximately 85 participants were selected for their collective expertise in critical care, pulmonary medicine, cardiovascular medicine and surgery, pediatrics, nursing, biostatistics, and medical economics. The meeting was open to industry representatives and other government and lay observers. This workshop was funded by the NHLBI and the FDA's Division of Devices. EVIDENCE: Published reports relating to the efficacy and safety of the pulmonary artery catheter, especially consensus documents developed by professional societies. CONSENSUS PROCESS: The planning task force disseminated materials, held teleconferences, and developed draft position papers prior to the workshop. These were modified during the workshop and thereafter in the course of several teleconferences, and presented to the entire group for final modifications and approval. CONCLUSIONS: A need exists for collaborative education of physicians and nurses in performing, obtaining, and interpreting information from the use of pulmonary artery catheters. This effort should be led by professional societies, in collaboration with federal agencies, with the purpose of developing and disseminating standardized educational programs. Areas given high priority for clinical trials were pulmonary artery catheter use in persistent/refractory congestive heart failure, acute respiratory distress syndrome, severe sepsis and septic shock, and low-risk coronary artery bypass graft surgery. JAMA. 2000;283:2568-2572

Catheterization, Swan-Ganz↗
PubMed2000

Impersonation of a ruptured thoracic aneurysm by a transdiaphragmatic pancreatic cyst.

Pancreatic cysts can, in rare cases, expand into the posterior mediastinum and may require surgical resection. We present the case of a patient with a thoracic aneurysm, in whom the mediastinal involvement of a chronic pancreatic cyst masqueraded as a ruptured aneurysm. Surgery was undertaken: first, the initial resection and drainage of the thoracic portion of the pseudocyst, and second, a thorough cleansing of the entire cyst through median laparotomy 15 days later.

Aged↗
PubMed2000

[Dysphagia as the leading symptom: presentation of a rare course in chronic pancreatitis with formation of pseudocysts].

Pancreatic pseudocysts are a common complication of pancreatitis. Although 20% regress spontaneously, persistent pseudocysts may lead to various complications such as infection, bleeding or compression of adjacent structures or organs. Due to the barrier function of the diaphragm, infection of pancreatic pseudocysts with posterior mediastinal extension represents a rare entity. Because of the rareness and untypical symptoms of such events, a mediastinal extension of an infected pancreatic pseudocyst often ist not recognized. In our case the expansion of the infection to the mediastinum had led to a compression of the distal esophagus. Preoperative diagnostic evaluation was highly suggestive for a malignant distal esophageal tumor. A laparotomy was performed to further elucidate the origin of the mass. Intraoperative findings showed a pancreatic pseudocyst with infiltrative extension of an infection from retrogastral to the lower mediastinum. After histologic preparations from intraoperative tissue samples had ruled out malignancy, we performed a cystojejunostomy of the pseudocyst and partial resection of the infected surrounding tissue. Mediastinal masses with chronic pancreatitis should raise suspicion for extension of pancreatitis to the mediastinum. In our opinion, for this course of chronic pancreatitis operative intervention represent the standard for therapy.

Chronic Disease↗
PubMed2000

Complicated chronic pancreatitis causing mycotic aortic aneurysm: in situ replacement with a cryopreserved aortic allograft.

Mycotic aortic aneurysm, which resulted from infected pancreatic pseudocysts with retroperitoneal abscess, developed in a patient with chronic pancreatitis. The aorta was approached through median laparotomy. Necrotic material was debrided from the pancreatic pseudocysts, and the mycotic aneurysm was resected. The aorta was replaced in situ with a cryopreserved aortic allograft. This report discusses the rare complication of pancreatic pseudocysts, which affect the infrarenal abdominal aorta and cause a large mycotic aneurysm. This case suggests that the use of cryopreserved allografts is promising for in situ reconstruction, even in a grossly infected field.

Aneurysm, Infected↗
PubMed2000

Primary mucinous adenocarcinoma of the appendix: a rare entity in the differential diagnosis of ovarian cancer.

We report a 58-year-old female patient with the suspected diagnosis of ovarian cancer. Upon surgical exploration, examination of the appendix revealed the histological diagnosis of primary mucinous adenocarcinoma. This is an unusual consideration in the differential diagnosis of the ovarian cancer. We discuss the diagnosis, classification and treatment of the cancer of the appendix in relation to ovarian cancer.

Adenocarcinoma, Mucinous↗
PubMed1999

The TT genotype of the methylenetetrahydrofolate reductase C677T gene polymorphism is associated with the extent of coronary atherosclerosis in patients at high risk for coronary artery disease.

BACKGROUND: There are conflicting results on the relationship of N5,N10-methylenetetrahydrofolate reductase C677T gene variation in coronary artery disease and myocardial infarction. METHODS AND RESULTS: We analysed this gene variation in 2453 male Caucasians whose coronary anatomy was defined by coronary angiography. In the total sample, the C677T gene polymorphism was not associated with the presence or the extent of coronary artery disease (defined by the degree of vessel disease or by the coronary heart disease score according to Gensini). However, after excluding individuals with low risk profiles, an association between the C677T TT genotype and the Gensini score was found. This observation applies only to individuals (i) with high glucose levels, (ii) with low apolipoprotein Al/apolipoprotein B ratios, (iii) with low apolipoprotein Al/apolipoprotein B ratios and high lipoprotein (a) levels and (iv) with low apolipoprotein Al/apolipoprotein B ratios and high glucose concentrations. In patients with high glucose levels, the paraoxonase 191 A/B gene variation presupposed whether differences in Gensini scores between C677T C allele carriers and TT homozygotes became apparent, since only in paraoxonase 191 AA homoxygotes, but not in paraoxonase 191 B allele carriers, did C677T TT homozygotes have clearly higher Gensini scores than C allele carriers (two-way interaction; P = 0.013). The MTHFR C677T gene polymorphism was not associated with non-fatal myocardial infarction. CONCLUSION: The present study extends previous observations by the finding that carriers of the N5,N10-methylenetetrahydrofolate reductase C677T TT genotype with various coronary high risk profiles had clearly higher coronary heart disease scores than individuals with at least one C677T C allele.

Adult↗
PubMed1998

Operative results after primary and secondary debulking-operations in advanced ovarian cancer (AOC).

OBJECTIVE: To assess the role of primary and secondary radical surgery in advanced ovarian cancer (AOC). DESIGN: Retrospective study. METHODS: One hundred and fifty-one patients with AOC (FIGO III/IV) underwent altogether 191 extended multivisceral operations between 1/1992 and 2/1998. The statistic analysis compared the primary with the secondary operations. RESULTS: One hundred and seventeen patients had a primary, 63 patients had a secondary and 18 patients a tertiary operation because of relapse of ovarian cancer. Surgical procedures entailed respectively: small-bowel-resection (21%/48%), colon resection (39%/58%), colostomy (9%/11%), ileostomy (2%/4%), ileum-pouch (0%/6), splenectomy (3%/3%), pelvic floor-covering (4%/6%), peritoneal removal (24%/21%), infrared contact coagulation (4%/6%). Seventy-five percent of the patients had no complications: relaparotomy (3%/3%), fistula (3%/6%), short-bowel-syndrome (5%/11%), postoperatively mortality (2%/6%). Postoperative tumor-free were 26%/22%, 57% and 65% had residual disease < or = 2 cm, 16%/13% > 2 cm. CONCLUSIONS: Radical multivisceral surgery is feasible, safe and efficient in primary as well in secondary situation of advanced ovarian cancer.

Adult↗
PubMed1997

[Stenosis of the terminal ileum. Endometriosis as the differential diagnosis of Crohn's disease].

HISTORY AND CLINICAL FINDINGS: A 25-year-old woman had for 5 years complained of lower and mid-abdominal pain, at first monthly but later continuous and gradually increasing in severity. At the same time she had diarrhoea associated with nausea, vomiting and weight loss. Physical examination showed a markedly distended abdomen, diffuse pain on pressure over the whole abdomen, most marked in the left middle and lower part, and high pitched peristalsis, but was otherwise unremarkable. INVESTIGATIONS: Abdominal radiography indicated small-intestinal ileus, while ultrasound revealed absent peristalsis in the small intestine and a 10 cm stenosis in the terminal ileum. Coloscopy demonstrated a fibrosed stenosis of the terminal ileum but a biopsy showed no specific changes. TREATMENT AND COURSE: Under suspicion of Crohn's disease with stenosis of the terminal ileum a partial resection of the ileum was performed. The ileum was on inspection thickened with scar tissue but no inflammation. Histology revealed florid chronic mucosal and submucosal inflammation, haemorrhages and ulcers, as well as numerous islands of endometriosis in the subserosa and muscularis propria. CONCLUSION: Endometriosis is a rare disease in women of the reproductive age, but should be considered in the differential diagnosis of Crohn's disease of the terminal ileum.

Adult↗
PubMed1997

[Chronic mesenteric ischemia--surgical therapy in 3 level occlusion].

A 57-year-old patient with general arteriosclerosis and end-stage renal failure was found to be suffering from occlusion of the mesenteric arteries. The symptoms were rapidly progressive. The aortogram showed that nutrition of the whole intestine took place via a collateral vessel that originated at both internal iliac arteries. Revascularization of the superior mesenteric artery with interposition of Gore-Tex prosthesis and transposition to the aorta were performed. The postoperative course was uncomplicated, but prolonged due to the accompanying diseases. In conclusion, single-vessel revascularization for chronic intestinal ischemia is a safe and sufficient procedure. Interpositioning of a graft and transposition to the aorta have the advantages of infrarenal access with an antegrade blood flow and no kinking of the prosthesis.

Aortography↗
PubMed1997

High survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporeal membrane oxygenation.

OBJECTIVE: We investigated whether a treatment according to a clinical algorithm could improve the low survival rates in acute respiratory distress syndrome (ARDS). DESIGN: Uncontrolled prospective trial. SETTING: One university hospital intensive care department. PATIENTS AND PARTICIPANTS: 122 patients with ARDS, consecutively admitted to the ICU. INTERVENTIONS: ARDS was treated according to a criteria-defined clinical algorithm. The algorithm distinguished two main treatment groups: The AT-sine-ECMO (advanced treatment without extracorporeal membrane oxygenation) groups (n = 73) received a treatment consisting of a set of advanced non-invasive treatment options, the ECMO treatment group (n = 49) received additional extracorporeal membrane oxygenation (ECMO) using heparin-coated systems. MEASUREMENTS AND RESULTS: The groups differed in both APACHE II (16 +/- 5 vs 18 +/- 5 points, p = 0.01) and Murray scores (3.2 +/- 0.3 vs 3.4 +/- 0.3 points, p = 0.0001), the duration of mechanical ventilation prior to admission (10 +/- 9 vs 13 +/- 9 days, p = 0.0151), and length of ICU stay in Berlin (31 +/- 17 vs 50 +/- 36 days, p = 0.0016). Initial PaO2/FIO2 was 86 +/- 27 mm Hg in AT-sine-ECMO patients that improved to 165 +/- 107 mm Hg on ICU day 1, while ECMO patients showed an initial PaO2/FIO2 of 67 +/- 28 mm Hg and improvement to 160 +/- 102 mm Hg was not reached until ICU day 13. QS/QT was significantly higher in the ECMO-treated group and exceeded 50% during the first 14 ICU days. The overall survival rate in our 122 ARDS patients was 75%. Survival rates were 89% in the AT-sine ECMO group and 55% in the ECMO treatment group (p = 0.0000). CONCLUSIONS: We conclude that patients with ARDS can be successfully treated with the clinical algorithm and high survival rates can be achieved.

Adult↗
PubMed1996

The release of cytokines, adhesion molecules, and extracellular matrix parameters during and after reperfusion in human liver transplantation.

Poor initial graft function may increase postoperative morbidity including the risk of early allograft rejection. Various mediators, including immunostimulatory cytokines, may be released during reperfusion in relation to the extent of preservation and reperfusion injury. For this purpose, 81 patients with 85 liver transplants were monitored for cytokines, adhesion molecules, extracellular matrix (ECM) parameters, and neopterin at predefined time-points during and after transplantation. To estimate the origin of cytokine release, blood was obtained central and hepatic venously for the first 48 hr after reperfusion and subsequently from a peripheral vein. One-year patient survival was 88.9%; no relation to initial graft function was observed. Poor initial graft function failed to increase the risk for subsequent infectious complications but was associated with an increased risk of early allograft rejection. The incidence of steroid-resistant rejection was significantly increased in patients with poor initial graft function (35.7% versus 12.7% in patients with good and moderate initial graft function; P < or = 0.05). Various cytokines, adhesion molecules, and ECM parameters including sTNF-RII, sIL-2R, IL-8, IL-10, sVCAM-1, E-selectin, hyaluronic acid, sialic acid, and laminin correlated significantly with the extent of preservation and reperfusion injury. Although none of these parameters was more appropriate in determining the extent of preservation and reperfusion injury than currently established parameters (AST, ALT, and color and amount of bile production), the combined increase in these parameters may not only promote tissue repair but may also perpetuate liver allograft injury and thereby cause significant morbidity. Besides cytokines and adhesion molecules, the ECM may play a pivotal role in determining repair or ongoing tissue injury. Ongoing changes at the microvasculature and basement membrane may result in an increase of local and circulating cytokines and adhesion molecules, which increase the risk of subsequent early allograft rejection. Furthermore, the increase in sTNF-RII, E-selectin, and laminin during reperfusion was predictive of subsequent development of acute allograft rejection. These observations may be of value for further strategies to decrease reperfusion injury and prevent early allograft rejection.

Adult↗
PubMed1996

[Cardiologic rehabilitation. An orienting overview].

The European Society of Cardiology has dealt in detail with concepts of cardiological rehabilitation in 1992 and has published guidelines. According to the opinion of this society, the organization of cardiological rehabilitation can differ among the European countries considering the socio-economic structures, legal and insurance regulations as well as national traditions. Guidelines for the standards of cardiological rehabilitation have to be flexible and adaptable to the organization of each European country. According to the opinion of Müller-Fahrnow, the beginning of modern medical rehabilitation in the Federal Republic of Germany is clearly linked to the development of concepts for cardiological rehabilitation at the end of the sixties and beginning of the seventies with a holistic approach under consideration of a kinetotherapeutic and psychosocial focus. A countrywide introduction of the concept of the following curative treatment at the end of the seventies by the insurances contributed to a significant stabilization of the new qualities of rehabilitation and, again the cardiological rehabilitation played an important role (Müller-Fahrnow W., 1994). This paper demonstrates basic elements and structures of the cardiological rehabilitation in an orientating manner and contains conclusions about the future development.

Combined Modality Therapy↗
PubMed1995

[Traumatic thrombosis of the ulnar artery].

A case report describing thrombosis of the ulnar artery after blunt direct trauma of the hand is presented. Traumatic thrombosis of the ulnar artery is rare. An isolated direct trauma is the most frequent pathogenetic mechanism. The patient's history is of great importance for reconstruction of the accident and for insurance questions. To clarify the etiology and angiography or the new method of MRI-angiotomography is mandatory. The therapy is usually conservative, and only in selected cases (aneurysm, old thrombosis) should an operative therapy be considered.

Adult↗
PubMed1994

[Prognostic importance of diagnostic functional and social parameters for occupational rehabilitation of heart patients. Results of studies and practical applications for rehabilitation counseling].

Vocational and social reintegration is one of the main targets of cardiac rehabilitation programs. As prognosis bases on objective pathophysiological data and psychosocial data, those data have to be used in the practice of cardiologists and rehabilitation workers. The relevant diagnostic parameters are demonstrated in this publication.

Aftercare↗