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Biomedical subjects

R Grundmann

Publications and source records attributed to R Grundmann.

At least 37 records · Page 2Linked to original sources
PubMed1989

[A simple point score for definition of the risk of postoperative complications].

During a 5-year-period we recorded prospectively 5,823 patients who had undergone general surgery and documented the postoperative complications as wound infection, pneumonia, reoperations and death. A score including all these complications was developed to evaluate the risk of an operation more exactly than using the wound infection rate alone. This method seems to provide a continuous monitoring and the comparison of the complication risks of certain operations within a quality assurance program. For gastric and colon surgery we found a correlation between postoperative antibiotic use and score, but not between score and postoperative hospitalization time.

Anti-Bacterial Agents↗
PubMed1989

[The value of tumor markers in colorectal cancer].

In 137 patients with colorectal carcinoma carcinoembryonic antigen (CEA) was preoperatively measured in serum. Sensitivity of CEA was dependant on the tumor stage. Patients in early tumor stages (TNM stages I + II) demonstrated only in 10% grossly elevated CEA levels compared with 43% of patients with progressive tumor stages (TNM III + IV). The main importance of tumor markers lies still in postoperative follow-up. In patients with a local recurrence of colorectal carcinoma we measured in 57% CEA levels greater than 10ng/ml, in patients with distant metastases even in 75%. CA 19-9 achieved a lower sensitivity in postoperative follow-up of colorectal carcinoma than CEA. Only 22% of patients with a recurrence of colorectal carcinoma had CA 19-9 levels beyond the normal range (37 U/ml) compared with 67% elevated CEA levels in the same group of patients. CEA is still the most important tumor marker in colorectal carcinoma. Measurement of CA 19-9 in postoperative follow-up is no substitute for CEA, it can only be a supplement.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1988

[Follow-up of infected patients in an intensive care unit using the "infection score," endotoxin and AT III determination].

74 patients treated in the intensive care unit for postoperative sepsis were prospectively documented. The severity of sepsis was monitored by a scoring system. Additionally, daily measurements of antithrombin III (AT-III) levels, thrombocytes and endotoxin plasma concentrations were performed. The sepsis score only discriminated between surviving and non-surviving patients. The sensitivity in predicting death due to sepsis was 94%, the specificity 80% in case that a sepsis score of 19 was achieved. In contrast, thrombocytes, endotoxin plasma concentrations and AT-III levels were not able to predict the final outcome, but could be correlated to the severity of sepsis. Since high score levels can also be caused by multiple organ failure due to other reasons, the septic condition of the patients should be defined in the future by the combination of this scoring system with the endotoxin or AT-III measurement.

Adolescent↗
PubMed1988

[DSA in the postoperative diagnosis of patients with kidney transplants].

Image quality and diagnostic significance of intravenous and intraarterial DSA following renal transplantation were assessed in 40 angiographic studies. In 27 of 40 DSA (67.5%) there were pathologic findings such as a renal artery stenosis, aneurysms or rejection within this selected group of patients. There were significant differences in image quality between intravenous and intraarterial DSA. The value of intravenous DSA is limited, particularly in patients with complex anastomosis, implanted polar arteries and kinking stenosis.

Adult↗
PubMed1988

[Preoperative nonspecific immunostimulation with Propionibacterium granulosum KP-45 in patients with colorectal cancer. A prospective randomized study].

The effect of preoperative unspecific immunomodulation with Propionibacterium granulosum KP-45 (P.g.) on postoperative complications and patient survival was evaluated in a prospectively randomized trial in patients with colorectal tumor resection. Patients of the therapy group (n = 51) received at least 3 days before operation an infusion of 10 mg P.g., patients of the control group (n = 49) were not treated at all. The wound infection rate and the number of re-explorations were significantly lower in the therapy group, however, patient survival and tumor recurrence rates were not positively affected by this P.g. pre-treatment.

Clinical Trials as Topic↗
PubMed1987

Graft survival and long-term renal function after sequential conventional cyclosporin A therapy in cadaver kidney transplantation--a prospective randomized trial.

In a prospective randomized trial 50 renal transplant patients (group A) received a sequential course of 14 days conventional immunosuppression (Lymphocytoglobulin (ALG), azathioprine, steroids) and cyclosporin and steroids thereafter, while 50 patients (group B) received the conventional immunosuppression for 7 days followed by cyclosporin and steroids. In the latter group ALG was tolerated for the whole period while in the first group conversion from conventional to cyclosporin A therapy had to be performed after a mean of 11 days, due to ALG intolerance. Actual patient survival rates 1 year posttransplant were 100% in both groups and graft survival rates 96% in group A and 86% in group B (P less than 0.05). There was a mean dialysis frequency per patient of 0.7 +/- 2.0 in group A and 1.8 +/- 3.4 in group B (P = 0.064). Serum creatinine 1 year posttransplant was 1.8 +/- 0.8 mg/dl in group A and 2.2 +/- 1.4 in group B. A total of 58 patients had a serum creatinine of less than 2 mg/dl at the time of conversion to cyclosporin. These patients had a significantly better graft survival rate (98.3%) and serum creatinine 1 year posttransplant (1.6 +/- 0.5 mg/dl) than the 40 patients with a serum creatinine of more than 2 mg/dl at the time of conversion (85%; 2.4 +/- 1.4 mg/dl), indicating that a delayed onset of cyclosporin therapy might benefit the kidney in the immediate posttransplant period when it is susceptible to nephrotoxicity due to the damage from hypothermic storage.

Adult↗
PubMed1987

[Cytomegalovirus hyperimmunoglobulin prophylaxis following kidney transplantation. Results of a prospective randomized study].

The effectiveness of preventing cytomegalovirus (CMV) infections by administering CMV hyperimmunoglobulin was evaluated in a prospective randomized trial. The patients in the treatment group (n = 50) had intravenous infusions of 2 ml/kg bodyweight of CMV-Polyglobin at three-week intervals, up to day 105 after kidney transplantation. The 50 patients in the control group received no infusions. There was no significant difference between the treatment and control groups in transplant survival or patients survival rates. But the number of symptomatic CMV infections was higher in the control (n = 11) than the treatment group (n = 5). There were also significantly fewer symptomatic herpes-simplex infections in the treatment (n = 6) than in the control group (n = 25). It is concluded from these results that prophylaxis with CMV hyperimmunoglobulin should be undertaken either selectively or for shorter periods than those chosen for the reported trial.

Adult↗
PubMed1987

[Quality assurance in surgery by prospective assessment of the risk of complications by a simple point score].

3654 general surgical interventions were prospectively registered during a 40 month period. Postoperative complications (wound infection, pneumonia, reoperation, mortality) were recorded and were quantified numerically by a complication score which describes the precise number of complications per ten operations. In this way the risk of a single operation can be monitored continuously and quality control programs can do without classification of operations in clean, contaminated and dirty interventions. The length of postoperative hospital stay and the amount of postoperatively applied antibiotics correlated well with the score.

Humans↗
PubMed1987

[Postoperative endotoxin determination and immunoglobulin therapy of infected patients in the intensive care unit].

Seventy-four patients with septic postoperative complications were prospectively listed. Plasma-borne endotoxin was daily determined in all of them by means of the limulus-amoebocyte-lysate test. Maximum sensitivity of the test amounted to 64 per cent, related to days of illness due to severe septicaemia. The conclusion is drawn that additional parameters should be used in future studies to define sepsis, including determination of sepsis score. Endotoxin titres declined in response to immunoglobulin therapy. Lethality went down, as well.

Adolescent↗