[Fournier's gangrene in a woman in computed tomography].
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Acute Disease↗
Biomedical subjects
J Sturm
Publications and source records attributed to J Sturm.
[Long-term survival after surgical therapy of T4 colorectal carcinomas].
Between 1972 and 1990, 456 patients with locally advanced colorectal carcinomas (tumor stage T4) were operated. In 187 cases the operation was extended by multivisceral resection and in 269 patients a conventional resection was performed. The rate of curative R0-resections was 74.9% for the extended resection group compared to 66.2% for the conventional group. The postoperative mortality after extended resection was 4.9% (2.9% conventional resection). Analyses of long-term results showed a 5-year survival for all R0-resected cases of 52.1% +/- 4.1. Further evaluation of additional lymph-node involvement in T4 colorectal tumors revealed significant differences in 5-year survival: 64.8% T4N0; 27.9% T4N1,2; 9.2% T4N3 for conventional R0-resection and 59.9% T4N0; 23.2% T4N1,2; 6.6% T4N3 for extended R0-resection. After curative resection (R0) the presence or absence of intraoperative tumor-cell dissemination could be identified as a significant prognostic factor. In all cases of T4 colorectal carcinomas-especially for N1-3-an adjuvant treatment after conventional or extended R0-resection is recommended.
Adult↗
[Resection of solitary liver metastases of malignant melanoma].
Patients with solitary metastasis of melanoma may benefit from resection, although diffuse organ involvement is common. Recent results in immunotherapy of metastatic melanoma are impaired by early local recurrence, leading to consolidation surgery. Two patients with solitary liver metastasis were treated by liver resection. In one patient in January 1993, atypical resection was performed after partial remission induced by regional adoptive immunotherapy with LAK-cells and Interleukin-2. In September 1983 right hemihepatectomy was done in one patient for large metastasis without preceding therapy. Until now there is no evidence of disease in both patients. The metastasis were 14 cm without and 3.5 cm after (5.3 cm before) immunotherapy in diameter. On histologic examination we found only a slight necrosis without marked immunological reaction like mononuclear cell infiltration or fibrotic demarcation in the specimen of the patient without forgoing therapy. In the specimen of the patient after immunotherapy, the metastasis was necrotic. It was encapsulated by fibrous tissue which was infiltrated by lymphoid cells. The microscopic evaluation revealed some clots of vital tumorcells. The resection of solitary liver metastasis of melanoma with or without immunotherapy is recommended. The rational for consolidation surgery for melanoma metastases after successful immunotherapy is based on the histologically proven vital tumor cells in necrotic metastasis, which are responsible for early local recurrence.
Combined Modality Therapy↗
[Mesh wrapping of the liver. A very promising method for managing severe liver trauma].
Mesh-wrapping is a quick and technically feasible method to achieve definitive hemostasis in severe liver trauma. It can be combined ideally with conventional procedures. Mesh-wrapping has the same spectrum of indications in severe liver trauma as packing with gauze pads. Whereas packing seems to be superior in cases with bleeding from juxta-caval injuries, Mesh-wrapping is considered to be superior in coagulopathy. The Mesh-wrapping technique provides a highly selective, tight compression confined to the liver and does not produce an increased intraabdominal pressure. The mesh is resorbable and therefore reoperation for removal is not necessary. In cases of postoperative fluid collections the Mesh-wrapping can easily be punctured. Because of its own bacteriostatic capacity Mesh-wrapping seems to be superior when the patient has concomitant gastrointestinal injuries. In summary we think that Mesh-wrapping is a useful alternative in the more conservative, organ preserving spectrum of liver trauma management.
Adult↗
Dynamics of DNA under pulsed-field gel electrophoresis as analyzed from birefringence rise and decay.
The orientation of DNA induced by electrophoretic transport in agarose gel has been studied by optical birefringence. From its field-free decay, it is clearly demonstrated that the degree of orientation results from two processes: alignment along the electric field (stretching of the end-to-end vector) and elongation of the primitive path in the gel (overstretching). Separation of the two contributions allows the experimental determination of the effective charge per base pair, the gel pore size seen by the reptating molecule, the reptation time, the degree of overstretching and the mean relaxation time of the overstretching. Their field and DNA length dependences compare well with theoretical predictions. Similarly, the time at which overstretching presents an overshoot in the rise of the orientation follows closely the predictions of a model based on the evolution of J-shaped conformations. The recovery of such conformations is studied by a sequence of two pulses with variable delay time. The use of directly measured or extrapolated characteristic times and fields in the design of efficient pulse schemes for pulsed-field gel electrophoresis is emphasized.
Birefringence↗
[Effect of continuous change in axial position in treatment of post-traumatic lung failure (ARDS). A clinical study].
In the treatment of posttraumatic adult respiratory distress syndrome (ARDS) so far no breakthrough has been achieved. In several cases of severe ARDS we have seen improvements of lung function by means of continuous body positioning. We therefore compared the effect of kinetic positioning (KIN) on lung function and hemodynamics in ARDS patients to conventional (KON) supine positioning. 22 ARDS patients with multiple trauma treated by supportive continuous body positioning (KIN) (KCI-Mediscus) and without continuous positioning (KON) were investigated daily. Pulmonary and systemic hemodynamics were determined on the basis of pulmonary artery catheter measurements. Oxygenation ratio (PaO2/FiO2) and pulmonary shunt (Qs/Qt,%) were calculated. Extravascular lung water (EVLW, ml/kg body weight) was determined by double indicator thermodilution technique. Total injury severity by injury severity score (ISS) was 29.6 +/- 6 points (KIN) and 31.6 +/- 5 points (KON). The oxygenation ratio (PaO2/FiO2) increased significantly from 140 +/- 45 (day 0) to 237 +/- 40 (p < 0.05) [day 5] (KIN), in KON patients no improvement (143 +/- 48 [day 0], 133 +/- 44 [ay 5]) was seen (p < 0.05 between groups). There were no significant changes of systemic hemodynamics between the groups or compared to day 0. Pulmonary shunt decreased significantly from 26.6 +/- 4% (day 0) to 12.5 +/- 2% (day 5) (p < 0.05) in KIN patients and was 36.6 +/- 6% at day 0 and 31.4 +/- 2% at day 5 in KON patients (p < 0.05 between groups). EVLW was 11.1 +/- 2 ml/kg body weight at day 0 and 9.4 +/- 1 ml/kg body weight at day 5 (KIN)-EVLW was 12.9 +/- 2 ml/kg body weight at day 0 and 17.4 +/- 3 ml/kg body weight at day 5 (KON) (not significant). We found no hemodynamic side effects from continuous body positioning. In ARDS-patients submitted to body positioning oxygenation and pulmonary shunt improved significantly and were significantly better compared to those with conventional supine positioning. Continuous body positioning appears to represent a promising supportive treatment regimen in posttraumatic ARDS.
Adolescent↗
[Leiomyosarcoma of the vena cava. Case report and review of the literature].
The leiomyosarcoma of vascular origin is a very rare tumor which is rarely recovered before the disease has reached an advanced stage because of non-specific and late symptoms. This is a report of 3 cases with leiomyosarcoma of the vena cava and a review of the literature. A high local recurrence rate and high frequency of distant metastases are responsible for the bad long-term prognosis. Early hematogenous tumor spread is favored by intraluminal tumor growth. Only complete surgical resection--if necessary with vascular reconstruction--can improve the bad long-term prognosis.
Aged↗
Enhanced urinary excretion of leukotriene E4 by patients with multiple trauma with or without adult respiratory distress syndrome.
1. The aim of the present study was to evaluate the systemic synthesis of cysteinyl leukotrienes in patients with multiple trauma. In order to do this, the urinary excretion of leukotriene E4 was assessed in the first 10 days after trauma. 2. Leukotriene E4 was unequivocally identified by g.c.-m.s. in the urine of healthy subjects and patients with multiple trauma after its conversion to 5-hydroxyeicosanoic acid. Leukotriene E4 was routinely isolated from 24 h urine samples by solid-phase extraction followed by reverse-phase h.p.l.c. and was subsequently quantified by r.i.a. 3. Healthy subjects excreted daily 10 +/- 3 nmol of leukotriene E4/mol of creatinine (mean +/- SEM, n = 16) into urine. 4. Patients with multiple trauma who did not develop adult respiratory distress syndrome (n = 7) excreted 76.8 +/- 6.7 nmol of leukotriene E4/mol of creatinine (mean +/- SEM) daily during the first 10 days after trauma, which was significantly (P less than 0.01) more than did healthy subjects. 5. Excretion of leukotriene E4 was even more enhanced in three patients with multiple trauma who developed adult respiratory distress syndrome. Maximal amounts of 593 +/- 185 nmol of leukotriene E4/mol of creatinine (mean +/- SEM) were excreted on day 9 after trauma by these three patients, which corresponds to a 7.7- and a 59-fold increase in excretion of leukotriene E4 compared with patients with multiple trauma who did not develop adult respiratory distress syndrome and healthy subjects, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Orientation and stretching of DNA chains during pulsed field gel electrophoresis].
The quantitative analysis of the decay of birefringence accompanying gel electrophoresis leads to the characterization of two phenomena respectively attributed to alignment of the tube and to overstretching of the chain in its tube. The major contribution to the molecular orientation is given by the overstretching which relaxes according to a stretched exponential law. The other process, slow, is characterized by a reptation time and a mean orientation factor in good agreement with the biased reptation model without overstretching.
DNA↗
[The AIDS problem in accident surgery].
In trauma surgery there is a particularly high proportion of patients in the age group most at risk of infection with AIDS. The result of an epidemiological study in our patients (HIV screening of all patients scheduled for surgery at a trauma center over 18 months) showed a prevalence of 0.1%. Specific therapeutic strategies must be developed to deal with the weakened immunity of HIV-infected patients. Fracture treatment in HIV-infected hemophiliacs is a special problem. Homogenous bone transplantation is described with reference to HIV. The particular danger of injury in trauma surgery is also investigated. The chain of infection is illustrated and used to demonstrate the precautions that can be taken against nosocomial HIV infections. Following infection with fluids containing HIV, specific measures must be taken. The legal aspects of HIV-antibody testing in the Federal Republic of Germany are elucidated. Finally, the problems of general preoperative HIV-antibody testing are discussed.
Acquired Immunodeficiency Syndrome↗
Direct observation of DNA chain orientation and relaxation by electric birefringence: Implications for the mechanism of separation during pulsed-field gel electrophoresis.
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Journal Article↗
Traumatic shock and head injury: effects of fluid resuscitation on the brain.
UNLABELLED: The effects of resuscitation of traumatic-hemorrhagic shock on the brain are unknown. Traumatic shock in sheep (fracture/crush injury, 2-hr hemorrhage to 40 mm Hg) was followed by resuscitation to baseline mean arterial pressure. Two groups without brain injury were resuscitated with lactated Ringer's (LR1, n = 7) or albumin (ALB1, n = 6). Focal brain injury was added in two further groups (LR2, n = 6; ALB2, n = 6). Hemodynamics, intracranial pressure (ICP), EEG, and colloid osmotic pressure (COP) were followed. Brain water (BW) and cerebral blood volume (CBV) were compared to those of controls (C, n = 7). RESULTS: ICP rose in all groups. Animals without brain injury did not have increased brain water. Below are results for brain-injured animals after resuscitation (mean +/- SEM). (table; see text) Maintaining COP during initial resuscitation does not minimize cerebral edema: the effects of LR and ALB were similar in this setting. Focal brain injury causes edema but does not cause large increases in ICP with initial resuscitation.
Albumins↗
[Tumor resections in the liver].
Over a 16-year period 54 patients presented with primary malignant liver tumours: 10 (18.5%) were considered inoperable, 44 underwent laparotomy. Nineteen (35%) turned out to be inoperable. A resection with curative intention was performed 25 times (47%) (11 right or extended right and 2 left hemihepatectomies, 12 mono- or bisegmentectomies). Hospital mortality was 8% (n = 2). The median survival time of those who died following resection was 22 months. Four patients have survived for more than 5 years, and three of them are still free of recurrence (5 year survival rate: 17% excl. hospital mortality).
Adenoma, Bile Duct↗
Posttraumatic plasma levels of mediators of organ failure.
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Bilirubin↗
[Risk of lung embolism following preventive intravenous use of heparin in polytraumatized patients].
The risk of thrombo-embolic complications in multiple injured patients is increased due to several pathophysiological factors. The purpose of this study was to analyse the effect of a continuous IV heparin prophylaxis (10000IE/24h) in polytraumatized patients. A post-mortem evaluation of 72 decreased patients out of 373 multiple trauma patients treated during 1984-1985 was performed. In one patient multiple major pulmonary emboli were found to contribute to his death. No deep vein thrombosis as well as no fulminant pulmonary embolism were found in any case.
Adolescent↗
Thromboxane receptor blockade in an animal model of ARDS.
Manipulation of arachidonic acid metabolism may be important in the prevention and treatment of the adult respiratory distress syndrome. This study evaluated a thromboxane receptor blocker, BM 13.177, in a sheep endotoxin model. Sheep with chronic lung lymph fistulas were pretreated with the blocker before being given endotoxin. The blocker attenuated the early increase in pulmonary artery pressure usually seen after endotoxin (blocker + endotoxin, 31.0 +/- 14.5 mm Hg; endotoxin alone, 42.1 +/- 9.6 mm Hg). There was no effect on lymph flows during the later (permeability) phase (at 6 hours: blocker + endotoxin, 574 +/- 287% baseline; endotoxin alone, 311 +/- 102% baseline). Administration of the blocker alone increased pulmonary artery pressure, arterial pressure, and central venous pressure and decreased heart rate and cardiac index. Thromboxane receptor blockade presumably has little effect on elements of arachidonic acid metabolism other than thromboxane. Thromboxane appears to be important in the early pulmonary hypertension of the sheep endotoxin model but is relatively unimportant in the development of increased pulmonary capillary permeability.
Animals↗