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Biomedical subjects

J Hauss

Publications and source records attributed to J Hauss.

At least 91 records · Page 5Linked to original sources
PubMed1992

[Changes in liver function and morphology after various portocaval bypass operations].

Using an experimental animal model consequences of operatively changed modes of liver perfusion on hepatic function could be demonstrated. Three groups of 5 animals each (swine) had the following operations: Group I received a portocaval shunt. In group II in addition to the portocaval shunt a vein graft was interposed between the vena cava and the portal vein. In group III an arterialization of this graft was performed in addition to the two operations mentioned above. Follow-up at defined time intervals included clinical, laboratory and histological data. It could be demonstrated that animals in group II and III showed normal parameters as far as behavior and controlled lab data are concerned. Animals of group I had significantly poorer results in all tests. In this study we found that direct portal perfusion was not necessary for a normal liver function and could be fully compensated both by caval venous blood and by arterialized caval venous blood.

Animals↗
PubMed1991

[Acute posttraumatic lung failure. Its treatment through pressure-limited respiration and continuous postural change].

Nine patients (4 women and 5 men; mean age 31 [20-48] years) with severe posttraumatic adult respiratory distress syndrome (ARDS) were treated with continuous postural change (kinetic bed) and pressure-limited ventilation. Seven patients survived; only one patient died as a result of pulmonary insufficiency. As compliance was markedly reduced (less than 20 ml/cm H2O), low stroke volumes (up to 380 ml) and high respiratory rate (up to 45/min) were employed to keep airway peak pressure below 40 mmHg. Kinetic treatment lasted for a mean of 14 (2-28) days; artificial ventilation was maintained for 31 (9-49) days. Practical problems of the method are the intensive nursing care required for the kinetic bed and the risk of decubitus ulcers, as well as disconnection of infusion tubing. The results indicate that kinetic treatment with pressure-limited ventilation constitutes a low-risk and, in many cases, effective treatment of severe ARDS.

Adult↗
PubMed1991

[A review of the present status of liver transplantation].

Liver transplantation opens the view on the border lines of medicine. Its performance requires great surgical and anaesthesiological experiences. Based on the authors' own experience the selection of liver donors and the indications for liver transplantations are pointed out. Special pathophysiological aspects of liver transplantation as well as the anaesthesiological procedure and the intensive care in the early postoperative period are described. The results of liver transplantation can be improved by further research on preservation of explanted organs, early recognition of complications after transplantation and immunological suppression.

Anesthesia↗
PubMed1990

Technique and preliminary results of extracorporeal liver surgery (bench procedure) and of surgery on the in situ perfused liver.

The clinical experience with 11 patients undergoing ex situ operation of the liver (nine operations) or surgery on an in situ hypothermic perfused liver after vascular isolation (three operations) is described. These methods have been confined to situations and tumour stages otherwise deemed untreatable, or to situations where resection would not have been sufficiently radical. In one patient the ex situ approach avoided the need to undertake liver grafting for a benign tumour. To date, hepatocellular tumours and metastases not compromising global hepatic function or causing cholestasis are considered to be suitable conditions; cholestasis appears to be highly detrimental for the postoperative course after an ex situ procedure. Elaboration of methods for better grading of pre-existing liver damage and of its prognostic significance is essential. The assessment of the final therapeutic value of the described procedure requires further experience.

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

[The European liver surgery topic--recent developments in liver surgery (in situ protection and ex situ operation)].

Ex situ operations on the liver, a new surgical approach, and operations on a vascularly isolated and in situ hypothermic-perfused liver were performed in 12 patients. The indications for either approach were limited to patients for whom a conventional approach was impossible or seemed insufficiently radical. In one case a huge symptomatic focal nodular hyperplasia in segment IV became resectable only with the ex situ-technique. Our first experience showed that preoperative cholestasis is a high-risk factor for postoperative hepatic insufficiency; three patients with marked preoperative cholestasis died. In patients with good preoperative liver function these two approaches allow a more radical liver resection and are the only possibility for tumor resection in particular situations.

Hepatectomy↗
PubMed1988

[Ex situ operation on the liver. A new possibility in liver surgery].

A method for an ex situ operation of the liver is presented with the example of such an operation in a 40-year-old patient. With this operation bilateral liver metastases of a leiomyosarcoma--which were otherwise regarded as irresectable--were resected. Function of the liver after reimplantation was good. Liver protection was performed by perfusion with cardioplegic HTK-solution (Bretschneider). The techniques of liver ex- and implantation are based on the methods of liver transplantation. Extracorporal femoro-porto-axillary bypass for decompression of the inferior caval vein and portal vein was used throughout the anhepatic period of 6 h. It is supposed that the method described here--which according to the authors' knowledge has been performed for the first time in a patient--will open up new perspectives for the surgery of malignant and occasionally of benign tumors, if necessary also for other surgical liver diseases. As an additional possibility, in situ protection of the liver with consecutive operation of the bloodless liver in situ is discussed. This procedure will correspond for the most part to the ex situ technique described here.

Adult↗
PubMed1988

[Diagnostic localization and postoperative results of hormone-producing tumors of the adrenal cortex--review of 51 cases].

51 surgically treated cases with hormone-producing tumours of the adrenal cortex are evaluated for the reliability of preoperative localisation of diagnostic measures and postoperative results. 6 patients were children. The group contains 14 cases of Conn's syndrome, 32 cases of hypercortisolism, including 3 children, and 5 cases of AGS, 3 of which were children. The recommended work-up procedure is initiated by ultrasonography and followed by CT, possibly in combination with adrenal scintigraphy. This combination of a morphological and functional investigation established the correct diagnosis in all 51 cases. Laboratory values returned to normal levels in all cases, phenotypical aspects normalised in most cases. Deaths and complications occurred only in hypercortisolism and AGS.

Adenoma↗
PubMed1988

[Treatment of pheochromocytoma: changes in diagnosis and therapy].

Evident progress has been made in the treatment of pheochromocytoma. The results of hormone analysis became very accurate, the method for tumor localisation are non invasive and safe: with 131-I-MIBG, ultrasonography and CT-scan an exact preoperative localisation is possible without serious risks. Patients are prepared for the operation with alpha- and beta-blocking agents. Modern methods of anaesthesia with continuous monitoring of blood pressure, pulmonary pressure and cardiac output and a standardized operative procedure are essential. From 1965 to 1987 71 patients with a total of 87 catecholamine producing tumors have been operated. In all cases a transabdominal access was chosen. Biadrenal tumors were removed in 8 patients, multiple (7) tumors in 2 patients. The comparison of the 2 time intervals 1965 to 1976 and 1977 to 1987 showed a significant decrease of serious intra- and postoperative complications. Surgical specimens of 36 patients with pheochromocytoma were used for immunohistologic evaluation. Marked positivity was found in 44% of cases for calcitonin. The reaction for vasoactive intestinal polypeptide (VIP) was positive in 28% of cases. Somatostatin was not detected in any case, neuron-specific enolase (NSE) in all cases. 6 patients with malignant pheochromocytoma were treated with high doses of 131-I-MIBG, 4 other patients received a combined chemotherapy.

Adrenal Gland Neoplasms↗
PubMed1988

[Transplantation of a donor liver to 2 recipients (splitting transplantation)--a new method in the further development of segmental liver transplantation].

A donor liver was divided in such a way that the left part (segment II and III without caval vein) could be transplanted into a child, the right part (segment I, IV, V to VIII) into an adult successfully. Common bile duct and common hepatic artery remained with the left part of the liver, portal vein with the right one. In the recipient of the left part of the liver the own caval vein was preserved and anastomosed with the left hepatic vein; the other anastomoses were carried out in the typical way. In the recipient of the right part of the liver the right hepatic artery of the graft was anastomosed with the recipient's common hepatic artery using a saphenous interponate. Two separate intrahepatic bile ducts were anastomosed with a Roux-en-Y loop of the jejunum. The other anastomoses were carried out in the typical way. Thus the possibility of using one donor liver for two recipients (splitting transplantation) has been demonstrated.

Biliary Atresia↗
PubMed1987

Theory and methods of local tissue-pO2 monitoring in experimental angiology.

The platinum-multiwire-surface electrode after Kessler and Lübbers gives the opportunity of direct measuring of the local tissue-pO2-pressure; this 8-wire electrode with a Pt-wire-diameter of 15 microns operates on the polarographic principle. Each Pt-wire has a hemispheric collecting area of about 30 microns. Pressure ischemia by compression of capillaries is prevented by proportioning the weight (2.1 g) of the electrode. Data output is done by continuous pO2 measuring; pO2 histograms. During the continuous pO2 measurement the electrode stays on the tissue measuring point thus enabling the direct record of quickly proceeding reactions. The pO2-histogram exhibits the statistical distribution of the local partial oxygen pressures in a studied organ, a quasi sample inquiry is performed in the tissue, based on minimum 100 single values that are obtained by repeated manual repositioning of the electrode. By this, values are obtained on the level and distribution of local pO2 in the tissue so that condition and function of the microcirculation can be objectively assessed. Immediate alterations in the local tissue pO2 suggest regulatory adjustment after hemodynamic changes. Technical problems connected with pO2 measurement in clinical use (sterilization, data acquisition and presentation) are described. The presented technique gives the chance to exactly assess the effects of vasoactive drugs on the microcirculation and to quantify the results of operations, for example after bypass-surgery.

Blood Vessels↗
PubMed1987

Monitoring of tissue-pO2 for invasive diagnostics in angiology and vascular surgery.

Hypoxic and ischemic states are the main problem makers in angiology and vascular surgery. It is therefore suggestive to employ the technique of tissue-pO2 measurement for the verification and support of diagnostic and therapeutic measures. Two forms of registration are possible: continuous monitoring of partial oxygen pressures in eight different places and registration in the form of pO2-histograms, which represents a kind of "representative opinion poll" held in the tissue. The effects of a surgical intervention (endarterectomy, bypass operation) and the efficacy of blood flow-promoting drugs were studied in several series. In 9 patients the effect of the blood flow-promoting agent pentoxifylline (3,7-dimethyl-1-(5-oxohexyl)-xanthine) was studied. The pO2-histograms exhibited a shift to the right by an average of 7 mmHg after administration of this drug. Moreover, findings obtained with sodium nitroprusside and nitroglycerin during induced hypotension indicate that the continuous measuring of tissue-pO2 and recording of oxygen pressure distribution curves (pO2-histogram) provide the clinician with essential guidance data for the improvement of diagnostics and therapeutic control.

Blood Circulation↗