[Vena aberrans: a rare variant of doubled inferior vena cava with distal flow direction].
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Diagnosis, Differential↗
Biomedical subjects
J Tacke
Publications and source records attributed to J Tacke.
Improved cumulated nitrogen balance after administration of recombinant human growth hormone in patients undergoing gastrointestinal surgery.
OBJECTIVE: To examine the effect of recombinant human growth hormone (rhGH) on the catabolic state following major gastrointestinal surgery. DESIGN: The study was designed as a prospective controlled randomized clinical trial. SETTING: Intensive care unit and the surgical ward of the Department of Surgery, Städtische Kliniken Dortmund, FRG. PATIENTS: 39 patients were studied postoperatively following gastrectomy or resection of the rectum. The patients were 40-75 years old. INTERVENTION: 0.075 (n = 11), 0.15 (n = 9) or 0.30 IU rhGH/kg/day (n = 9) or placebo (n = 10) were given subcutaneously at 8:00 a.m. during 5 postoperative days. Resting energy expenditure (REE) on the 1st postoperative day was 2,042 +/- 82 kcal/24 h (REE/BEE 1.44 +/- 0.04). Isocaloric, isonitrogenous total parenteral nutrition provided the energy requirements (4 g carbohydrates/kg, 0.9 g fat/kg, 1.25 g amino acids/kg). RESULTS: After 5 days of treatment, cumulated nitrogen balance (CNB) was improved dose-relatedly. In controls, net nitrogen losses (-20.47 +/- 3.86 g) were significantly higher than after 0.15 (-12.14 +/- 3.5 g) and 0.30 IU rhGH/kg (-10.0 +/- 2.61 g). 0.075 IU rhGH/kg showed no significant effect on CNB (-18.07 +/- 5.73 g). The modulation of protein metabolism by GH may be mediated by insulin-like growth factor-I (IGF-I). Postoperatively serum (S)-IGF-I was decreased in all groups. rhGH caused a significant dose-related increase in S-IGF-I levels on day 6, whereas in controls it remained unchanged during the study period. Besides significant elevations in serum glucose in some cases of both larger dosage groups no side effects were detected. CONCLUSIONS: The protein-sparing effect of rhGH after major gastrointestinal surgery is dose related but not linear. A threshold value for a significant improvement in the CNB seems to be at least at 0.15 IU rhGH/kg/day.
Adult↗
Postoperative course of functional and cellular variables in liver resection.
The determination of total serum bile acids (BA) is a sensitive variable for detection of altered liver function. This study investigated the course of serum bile acids in 44 liver-resected patients with different factors possibly compromising liver function. These factors were 1) amount of resected parenchyma; 2) duration of intraoperative ischemia; and 3) patient's age. The course of BA was compared with that of transaminases, bilirubin, lactate, and NH3. Serum BA showed a course correlated to the amount of resected liver parenchyma and differentiated between groups with < or = 35% and > 35% resected parenchyma. Whereas BA were more accurate in paralleling the resected tissue in the first postoperative days, a rise of bilirubin indicated complications in the postoperative course. As BA did not increase in a case of pulmonary-induced multiorgan failure, the specificity of this variable for liver function is implied. Different amounts of resection could not be distinguished by determination of transaminases. Different ischemic periods did not result in significant differences in the postoperative course of BA or bilirubin. However, marked elevations of transaminases depending on the duration of hepatic inflow occlusion were seen. None of the traced variables were related to the patient's age.
Adolescent↗
Dynamic MRI of a hypovascularized liver tumor model: comparison of a new blood pool contrast agent (24-gadolinium-DTPA-cascade-polymer) with gadopentetate dimeglumine.
We evaluated the enhancement properties of a new blood pool contrast agent (24-gadolinium-diethylenetriamine pentaacetic acid [Gd-DTPA]-cascade-polymer) in comparison with gadopentetate dimeglumine in 24 rabbits with an experimentally induced VX-2 liver tumor. Dynamic MRI of the liver was performed before, immediately after, and within 15 seconds to 30 minutes after contrast agent administration. Relative signal intensities and contrast-to-noise ratios (CNRs) of both agents were evaluated. After blood pool agent administration a significantly higher CNR between liver and tumor was observed within 2 to 30 minutes after injection as compared with the CNR after gadopentetate dimeglumine. Within 4 to 30 minutes after injection of gadopentetate dimeglumine, the relative signal intensities of tumor were significantly higher than after administration of the blood pool agent. In conclusion, the new blood pool contrast agent demonstrated a significantly better CNR of the experimental hypovascularized liver tumor than gadopentetate dimeglumine.
Animals↗
MR urography today.
Magnetic resonance (MR) urography is performed by pursuing two different imaging strategies. On the one hand, heavily T2-weighted turbo spin-echo sequences are employed for obtaining unenhanced static-water images of the urinary tract. On the other, the T(1)-weighted MR urographic technique imitates conventional intravenous pyelography and is, therefore, referred to as excretory MR urography. For this reason, a gadolinium contrast agent is injected intravenously and, after its renal excretion, the gadolinium-enhanced urine is imaged with fast T1-weighted gradient-echo sequences. Both MR urographic techniques can be combined for a comprehensive examination of the upper urinary tract. This article reviews the current technical principles, imaging capabilities, and clinical applications of T2- and T1-weighted MR urography in adult and pediatric patients.
Adult↗
Use of a temporary caval filter to assist percutaneous iliocaval thrombectomy: experimental results.
PURPOSE: To test a new filter design that allows coaxial insertion of thrombectomy devices and active clot removal. MATERIALS AND METHODS: A prototype filter system was used in animal experiments. It is a transjugularly inserted coaxial system with a 16-F outer sheath and an inner tube that is covered by a tulip-shaped meshwork with a 22-mm diameter at its inserted end. The inner tube allows insertion of instruments up to 8 F. The filter was developed to assist with percutaneous mechanical thrombectomy in the iliofemoral and caval veins. The filter has been used as an assisting tool in nine sheep and eight pigs. It was combined with an impeller system in nine sheep for caval thrombectomy and with a hydrodynamic catheter for iliac thrombectomy in eight pigs after artificial induction of iliac or caval thrombosis. RESULTS: The filters captured emboli from the intervention in six of nine sheep. The amount of captured emboli was reduced within the filter cone by the impeller instrument in five of six instances. Residual thrombus was removed by closing the filter in five of six sheep. In pigs, the filter captured emboli in three cases during hydrodynamic embolectomy. Pulmonary embolization did not occur with the filter in place. After filter removal, minor pulmonary clot embolization occurred in one case. CONCLUSION: The temporary tulip filter was effective in these animal models in capturing and removing thrombus material that may dislodge from iliocaval veins during mechanical thrombectomy.
Animals↗
Long-term risk of gastrointestinal tumor recurrence after postoperative treatment with recombinant human growth hormone.
BACKGROUND: Recombinant human growth hormone (rhGH) promotes protein synthesis, accelerates wound healing, and maintains immune function in the catabolic state. It has also been claimed that rhGH may promote the activation of residual tumor cells, and therefore, increases the risk of tumor recurrence. This study aimed to investigate whether postoperative administration of rhGH increases the long-term risk of tumor recurrences in patients undergoing major gastrointestinal surgery for malignancy. METHODS: Patients (n =104) received three different doses of rhGH (0.075 IU/kg, 0.150 IU/kg, and 0.300 IU/kg) during 5 postoperative days in a placebo-controlled trial. Follow-up was performed for 56-70 months after radical tumor resection. Mean survival period and relapse-free survival were compared with the control group. RESULTS: Complete data were available for 75 patients. Thirty-five percent (n = 20) of all patients treated with rhGH showed tumor recurrences in comparison to 44% (n = 8) of patients given placebo. Mean survival period for rhGH-treated patients was 46 months (median 59 months); in controls, 42 months (median 58 months). The length of relapse-free survival tended to be longer in rhGH-treated patients (2-47 months; median, 21 months) compared with the patients who were given placebo (2-18 months; median, 13 months). CONCLUSIONS: The results demonstrate no evidence for an increased risk of tumor recurrence after rhGH treatment for a short period of time after removal of a gastrointestinal adenocarcinoma. Therefore, the positive metabolic effects of rhGH application can be used safely in the treatment of the postoperative catabolic state in the patient groups investigated.
Adenocarcinoma↗