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Biomedical subjects

P Lamesch

Publications and source records attributed to P Lamesch.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Ergotamine-induced anorectal lesions].

During the past 10 years several reports on perianal ulcerations secondary to chronic use of ergotamine suppositories were published. The present case reports deal with 2 female patients who used ergotamine suppositories for treatment of sick head aches for several years. In both cases the suppositories were used chronically. The first patient, a 60 year old woman has been treated repeatedly because of recurrent perianal ulcerations. An infection and a carcinoma could be excluded. The diagnosis of ergotamine induced ulcerations could be suspected only after a detailed work up of the patients past medical history and interview of family members. The ulcerations healed within a few months after broad excision and withdrawal of the medication. The second patient, a 51 year old woman complained of severe obstipation which occurred within a few months. The investigations showed a circular stenosis in the lower third of the rectum. The patient was treated successfully by bougienage under general anaesthesia. These case reports demonstrate the difficulties in diagnosis such lesions and emphasize the importance of a close medical follow-up when ergotamine suppositories are used for treatment of migraine. Whenever possible, a continuous treatment should be avoided.

Anal Canal↗
PubMed1993

Anomalies of the position of the spleen in the child. Case report and review of the literature from 1896 to 1990.

We report on the case of a 6-year-old girl admitted as an emergency with an acute abdomen with the diagnosis of peritonitis; clinical examination under anesthesia revealed the presence of an abdomino-pelvic mass. Laparotomy confirmed the diagnosis of torsion of an ectopic spleen. Splenectomy was required because the spleen was gangrenous. A review of the literature from 1896 to 1990 revealed reports of 74 cases. Epidemiology, etiology, pathophysiology, the diagnostic and therapeutic problems are discussed.

Child↗
PubMed1991

[In situ protection of the liver with Bretschneider HTK solution].

Liver resections are usually performed under occlusion of the hepatoduodenal ligament (Pringle manoeuvre) in order to limit operative blood loss. The maximal ischemic tolerance, although individually different, is generally accepted to be 60 min. Resections of centrally located tumors require precise preparation, sometimes combined with vascular reconstructions. In such cases a prolonged ischemic time is inevitable. A save prolongation of the ischemic tolerance could be useful for extensive liver resections. In an experimental study in pigs ischemic tolerance of the liver was studied under hypothermic protection with the HTK solution of Bretschneider during 2 and 3 h. Deterioration of liver function was compared with a warm ischemia during 2 h. Results showed significantly less serum transaminase activities and better hepatic blood flow (ICG test) after an ischemia under protection with the HTK solution compared to a warm ischemia during 2 h. A prolonged ischemia during 3 h under protection with the HTK solution was well tolerated. First clinical applications of hypothermic hepatic protection during resection were successful.

Animals↗
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↗
PubMed1990

HTK-solution (Bretschneider) for human liver transplantation. First clinical experiences.

The cardioplegic HTK-solution (Bretschneider) has not been used in human liver transplantation as yet. Herein the first results obtained from 14 patients with HTK-preserved liver grafts are presented. The suitability of HTK-solution could be shown. All grafts functioned primarily except one, where initial non-function was obviously due to donor reasons. The early postoperative peak values of transaminases as a sign of ischemic damage were average and similar to the values of other flushout solutions. Using HTK primary function could be achieved even in livers prospectively assessed as only of fair quality, and livers with poor donor function tests (MegX) functioned from the beginning. HTK-solution therefore seems to allow widening of the acceptance criteria for donor livers. It was not the aim of this trial to extend cold ischemic time, but 3 livers with 11 h and 12 h 25 showed immediate function. How far cold ischemic time can be extended is a still open question. All livers were rapidly cooled and homogeneously flushed out due to the low viscosity of HTK-solution. All livers had a soft consistency after perfusion indicating a low degree of cell edema. HTK therefore is an effective solution for liver preservation.

Adenosine↗
PubMed1990

Glycogen effects on energy state and passive electric properties of liver during protection.

In order to evaluate the importance of glycogen for the hepatic tolerance to ischemia, livers of swine fed a glucose-potassium solution for premedication were perfused with either Bretschneider's HTK-solution (histidine-tryptophan-ketoglutarate) or with Euro-Collins-solution (EC) prior to subsequent ischemia at 25 and 5 degrees C. During ischemia, in regular intervals or continuously, energy rich phosphates, lactate, intrahepatic pH and the electrical impedance of liver tissue were determined. The results were compared with corresponding data from swine which had starved for 48 h. Corresponding to the higher glycogen content, energy supply during ischemia was markedly improved by the premedication. Despite high amounts of glucose in the EC-solution, energy supply after glucose-potassium premedication was no better with EC-solution than with HTK-solution. Moreover, glucose uptake led to concomitant cellular water uptake. Electrical impedance measurements during ischemia mirrored improved energetical protection by the glucose-potassium premedication.

Acid-Base Equilibrium↗
PubMed1989

Lignocaine metabolite formation as a measure of pre-transplant liver function.

A method for rapid assessment of hepatic function in liver donors based on the formation of the lignocaine metabolite monoethylglycinexylidide (MEGX), was used in a prospective study of 69 donor-recipient pairs. The probability of graft survival over 120 days was significantly higher for livers from donors with MEGX test values above 90 micrograms/l than for those from donors with MEGX values of 90 micrograms/l or below. Other liver function tests (bilirubin, prothrombin time, activity of aminotransferases, glutamate dehydrogenase, and cholinesterase, indocyanine green clearance, and galactose elimination capacity) were inefficient at predicting early outcome of transplantation. For a 20-day graft survival, the MEGX test showed prognostic sensitivity of 73% and specificity of 78%. These findings suggest that the MEGX formation test could be valuable for selection of donor organs.

Adolescent↗
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↗