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Biomedical subjects

P Bertram

Publications and source records attributed to P Bertram.

At least 19 recordsLinked to original sources
PubMed2006

[Abdominal compartment syndrome: significance, diagnosis and treatment].

A pathological increase of intraabdominal pressure (IAP) is frequently observed in severely ill patients suffering from surgical diseases. This may lead to the abdominal compartment syndrome (ACS) which is characterized by an IAP >20 mmHg (>2.67 kPa) and failure of one or more organ systems. The mortality of ACS exceeds 60%. Knowledge concerning the sequelae of ACS is abundant, however, measurement of IAP is not routinely performed even if patients present with corresponding risk factors. This is probably due to a variable incidence of ACS and scepticism regarding the results of bladder pressure measurement. However, measurement of IAP can now be performed semi-automatically, continuously and in a standardized fashion. The therapy of ACS, i.e. decompression laparotomy and laparostomy, is undisputed. Since a heterogeneous group of patients can be affected, monitoring of IAP is indicated in patients needing intensive care. A consistent registration of IAP will improve knowledge and guidelines regarding the therapy of a pathologically increased IAP. Nevertheless, patients in whom ACS is suspected should be decompressed as soon as possible.

Abdomen↗
PubMed2006

[Abdominal compartment syndrome].

Abdominal compartment syndrome (ACS) is characterized by a persistent pathologic increase in intra-abdominal pressure (IAP) exceeding 20 mmHg with consecutive dysfunction of multiple organ systems. The main causes of ACS are abdominal trauma, obstruction, infection, and sepsis, but it may also be initiated by extra-abdominal diseases. The gold standard for diagnosis is repeated assessment of the IAP measurements of bladder pressure. The incidence of ACS is up to 15% in operative ICUs and the therapy of choice for it is decompressive laparotomy. Nevertheless, mortality is high, up to 60%.

Abdomen↗
PubMed2006

Laparoscopy and collagen metabolism.

The collagens represent a vital component within the wound healing process and physiological scar formation. Therefore, analysing the influence of new operative procedures on collagen metabolism is of great surgical interest. As the endoscopic technique has, nowadays, become routinely applied for diverse abdominal diseases worldwide, we present a review of literature facing its impact on collagen biology.

Collagen↗
PubMed2003

[Material and structure of drainages].

The long history of surgical drainages stands in contradiction to available and reliable data. As of today, closed systems made of silicone are preferable. Taking possible complications into consideration and the good results of routine operations without drainages, indication for use should be critically evaluated. Interdisciplinary research,however, offers the chance of optimizing material and surface characteristics, biostability, biocompatibility, and flow rates. New drainages with improved performance and reduced side effects may counteract the current tendency to do without.

Animals↗
PubMed2002

[Sigmoid diverticulitis. Emergency intervention in abscess, hemorrhage and stenosis].

Interventional techniques in treatment of complicated diverticulitis gain more and more importance. In particular abscesses and bleeding are treated successfully. In case of diverticular abscess (Hinchey classification stage I and II) percutaneous drainages are placed sonographically or CT guided. Interventional drainage offers the possibility of elective one-stage surgical treatment of diverticulitis with significant reduce of mortality and morbidity rates. Diverticular bleeding is usually diagnosed and treated endoscopically. Only if endoscopy is not able to manage bleeding, angiography or nuclear scan is demanded. In case of stenosis endoscopic treatment has not jet gained clinical relevance.

Abscess↗
PubMed2001

The transcriptional repressor CDP (Cutl1) is essential for epithelial cell differentiation of the lung and the hair follicle.

The mammalian Cutl1 gene codes for the CCAAT displacement protein (CDP), which has been implicated as a transcriptional repressor in diverse processes such as terminal differentiation, cell cycle progression, and the control of nuclear matrix attachment regions. To investigate the in vivo function of Cutl1, we have replaced the C-terminal Cut repeat 3 and homeodomain exons with an in-frame lacZ gene by targeted mutagenesis in the mouse. The CDP-lacZ fusion protein is retained in the cytoplasm and fails to repress gene transcription, indicating that the Cutl1(lacZ) allele corresponds to a null mutation. Cutl1 mutant mice on inbred genetic backgrounds are born at Mendelian frequency, but die shortly after birth because of retarded differentiation of the lung epithelia, which indicates an essential role of CDP in lung maturation. A less pronounced delay in lung development allows Cutl1 mutant mice on an outbred background to survive beyond birth. These mice are growth-retarded and develop an abnormal pelage because of disrupted hair follicle morphogenesis. The inner root sheath (IRS) is reduced, and the transcription of Sonic hedgehog and IRS-specific genes is deregulated in Cutl1 mutant hair follicles, consistent with the specific expression of Cutl1 in the progenitors and cell lineages of the IRS. These data implicate CDP in cell-lineage specification during hair follicle morphogenesis, which resembles the role of the related Cut protein in specifying cell fates during Drosophila development.

Alleles↗
PubMed2001

[Role of surgical biliary bypass for palliation of pancreatic cancer - a retrospective study of 107 cases].

UNLABELLED: BACKGROUNDS AND STUDY AIMS: At the time of diagnosis most patients with pancreatic cancer are still irresectable for cure. The aim of this study was to evaluate surgical palliation, in particular against the background of endoscopic stent placement. PATIENTS AND METHODS: This retrospective study analyses the therapeutic results in 107 patients with an irresectable pancreatic carcinoma operated on between 1990 and 1998. RESULTS: 104 patients showed primary therapeutic success with adequate bile drainage. In 97 % a simultaneous gastrojejunostomy was performed. The overall complication rate was 24 % and the hospital mortality 3.7 %. Median survival after surgical treatment was 201 days. CONCLUSIONS: Because of a decrease in perioperative morbidity and mortality, surgical palliation of irresectable pancreatic carcinoma still remains an effective therapy, especially for patients expected to survive 6 months or more. The surgical procedure offers the better chance for long-term palliation of obstructive jaundice and duodenal obstruction compared to the endoscopic approach. However, to consider both, the surgical and the endoscopic treatment, complementing each other, seems to be important to guarantee optimal palliation for the individual patient.

Adenocarcinoma↗
PubMed2001

Studies on the expression of mRNA for anion transport related proteins in corneal endothelial cells.

PURPOSE: Chloride and bicarbonate are necessary for maintenance of fluid transport by the corneal endothelium, however there is little information on the identity of anion transport proteins that could serve as anion efflux mechanisms in endothelial cells. Therefore, we ask whether mRNA for the anion transport related proteins, CFTR, CLC-2, ClC-3, ClC-5 and AE2, are expressed in human, bovine or rabbit corneal endothelium. METHODS: RT-PCR was performed for CFTR, CLC-2, ClC-3, ClC-5 and AE2 using total RNA from fresh human, bovine and rabbit corneal endothelium as well as cultured bovine corneal endothelial cells (CBCEC). Specificity of PCR products was confirmed by sequencing. RESULTS: RT-PCR analysis gave positive bands at the predicted size for CLC-3 and CLC-5 from fresh human, rabbit and bovine as well as CBCEC. However, for CLC-2, no band was apparent around the predicted size from fresh and cultured corneal endothelium. A band at the predicted size was obtained for CFTR from fresh human, rabbit and bovine endothelium, as well as from CBCEC. RT-PCR analysis for AE2 produced specific bands from fresh human, rabbit and bovine corneal endothelium, but no positive band was obtained from CBCEC. Sequencing analysis further confirmed the identities of CLC-3, CLC-5, CFTR and AE2 in corneal endothelium. CONCLUSIONS: CFTR, CLC-3 and ClC-5 are expressed in fresh and cultured corneal endothelial cells. However, consistent with previous immunoblots studies, AE2 is only expressed in fresh corneal endothelium. These results have implications for modeling possible apical anion efflux mechanisms in corneal endothelium.

Animals↗
PubMed2000

Postoperative necrotizing soft-tissue infections of the abdominal wall.

OBJECTIVE: The aim of the underlying study was the evaluation of an aggressive surgical regimen for treatment of postoperative necrotizing soft-tissue infection (NSTI). METHODS: Eight patients with postoperative NSTI of the abdominal wall after emergency (n=6) and elective (n=2) surgery were reviewed over a 9-year period. RESULTS: Initially, three patients presented with general peritonitis. Cultured swabs from the necrotic tissue revealed three to four different types of bacteria in each patient. The mean interval between the primary operation and clinical symptoms of NSTI was 63.0 h. Control of NSTI and intra-abdominal infection was attained by scheduled re-operations on a daily basis accounting for three to six re-interventions in each patient. Temporary closure of the abdominal wall by absorbable polyglactid-acid mesh was used in six cases. Mean hospital stay was 65.3 days (18-110 days). Two of the eight patients died from cardiac arrest and multiple organ failure, respectively. CONCLUSIONS: Rapid diagnosis and onset of treatment is accomplished by the surgeons' knowledge of this disease and a close follow-up of the patients in an intensive care unit.

Abdominal Muscles↗
PubMed1999

Basic fibroblast growth factor in the presence of dexamethasone stimulates colony formation, expansion, and osteoblastic differentiation by rat bone marrow stromal cells.

Basic fibroblast growth factor (bFGF) is known to stimulate endosteal bone formation in vivo by a mechanism possibly mediated via osteoblast precursor cells present in the bone marrow. In high density cultures of primary bone marrow cells, and in the presence of glucocorticoids, bFGF stimulates the formation of a bone-like matrix; however, due to the dense nature of these cultures, the exact mechanism of action is unclear. In an adaptation of the fibroblastic colony formation unit assay, in which the bone marrow cells are grown in the presence of dexamethasone, beta-glycerophosphate, and ascorbate, mineralized colonies are formed which stem from single mesenchymal precursor cells and grow in isolation from each other. Using this system we have been able to investigate the mechanism by which bFGF stimulates the formation of bone like tissue in vitro. We have shown that bFGF increases the formation of a calcified collagenous matrix in vitro by (1) increasing the total number of fibroblastic colonies formed, (2) increasing the proportion of differentiated colonies that synthesize collagen and calcify, and (3) stimulating the proliferation and collagen accumulation of the individual colonies. A maximal increase in total and differentiated colony numbers was seen after only 5 days exposure to bFGF, however, continued exposure to bFGF continued to increase the size and collagen content of the individual colonies. Bearing in mind the endosteal location of newly formed bone seen after treatment with bFGF, these processes may well play an active role in this effect.

Animals↗
PubMed1999

Intraperitoneal transplantation of isologous mesothelial cells for prevention of adhesions.

OBJECTIVE: To study the effect of transplantation of mesothelial cells on the formation of adhesions after peritoneal abrasion. DESIGN: Animal study. SETTING: Teaching hospital, Germany. ANIMALS: 30 isologous eight-week old Lewis rats to allow for harvesting of the greater omentum from a separate group. INTERVENTIONS: The first group (n = 10) served as mesothelial cell donors. The other animals had laparotomy and induction of adhesions by standardised abrasion of the peritoneum. The trial group (n = 10) were given a suspension of 10(6) mesothelial cells/100 g body weight intraperitoneally and the control group (n = 10) an equal volume of culture medium. After 10 days the animals were killed. MAIN OUTCOME MEASURES: Measurements of the areas of adhesions by computer aided morphometry. RESULTS: The trial group developed a mean (SD) adhesion area of 122.7 (176.7) mm2, and the controls 310.5 (179.1) mm2. The corresponding medians (range) were 51.2 (0-547.1) and 274.3 (100.6-575.4). Transplantation of mesothelial cells resulted in a significant reduction in adhesion formation (Wilcoxon test, p<0.01). CONCLUSION: Intraperitoneal transplantation of mesothelial cells is an effective way of reducing the formation of adhesions.

Animals↗
PubMed1997

True carcinosarcoma of the colon. Case report.

A second case of true carcinosarcoma of the colon is reported. A 79-year-old women was diagnosed as having an obstructing tumour of the caecum and liver metastases in both lobes. Histological examination of operative specimen from a right hemicolectomy revealed malignant epithelial and mesenchymal components. Despite postoperative chemotherapy, the patient died of liver failure resulting from extensive metastatic growth.

Aged↗
PubMed1997

[Stage-oriented antibiotic therapy of peritonitis. Prospective study].

PATIENTS AND METHODS: In a prospective protocol 25 consecutive patients with diffuse peritonitis were treated in the Surgical Clinic of the RWT-University in Aachen, Germany, from January to December 1995. According to the "Mannheim Peritonitis Score" three different stages were treated with different surgical procedures and a selective antibiotic regimen. Group-A patients with prognostically favorable peritonitis (MPS 0-20) were treated with the so-called standard procedure, group-B patients (MPS: 21-29) with closed postoperative lavage. The antibiotic regimen was cefotaxime (2 x 2 g) and metronidazole (2 x 500 mg) for both group-A and group-B patients. Severe group-C cases (MPS > 29) were treated with the so-called Etappenlavage (multiple reexplorations and intra-operative lavage) and received a combination of three antibiotics (2 x 2 g cefotaxime; 2 x 500 mg metronidazole and 2 x 200 mg ofloxacin). RESULTS: Eight patients belonged to group A, 10 to group B, and 7 to group C. The mortality was 0% (group A), 20% (group B), and 29% (group C), respectively. The actual overall mortality of the whole group was 16% (4/25). The statistically expected mortality was 36%, according to the APACHE-II-Score (P = 0.0982).

Anti-Infective Agents↗
PubMed1997

[Artificial pressure increase in subcutaneous abscess with evidence of general systemic reaction].

Abscess is customarily thought of as a collection of a large number of microorganisms, inflammatory cells and necrotic debris separated from the surrounding tissue by a fibrous capsule. Modern work focussed attention on more physico-chemical parameters in abscess pathogenesis. Recent experiences from animal models underline the impact of abscess pressure and bio-physicochemical parameters in the "abscess compartment" for systemic spreading. Artificial raising of abscess-pressure in pigs up to 80 mmHg was followed by increase of temperature and heartbeat rate and decrease of median arterial pressure. Elevated levels of TNF alpha, IL-1 and positive blood cultures support the theory of abscess pressure as a most important variable in abscess formation. We conclude that abscess pressure may play a pivotal role in systemic spreading of the primarily localized process.

Abscess↗
PubMed1997

[Pyogenic infections of the skin and skin appendages].

In Germany more than 120,000 soft tissue infections are treated in hospital per year. Articles about soft tissue infections caused by Strept. pyogenes, presented in the lay press as "flesh-eating bacteria", accentuate this picture. Among these soft tissue infections, necrotising fasciitis and the associated "toxic shock syndrome" and "toxic shock-like syndrome" remain a challenge to the surgeon. The most important role of surgery is to achieve the right diagnosis and introduce definitive therapy in time. Central to surgical therapy is immediate incision and open drainage. Our own experience in animal models underlines the important role of abscess pressure and physicochemical parameters in the "abscess compartment" for systemic spread. Based on this pathophysiological background, the traditional "ubi pus ibi evacua" has lost nothing of its importance.

Abscess↗