One versus three doses of metronidazole/mezlocillin for antibiotic prophylaxis in colon surgery.
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Clinical Trials as Topic↗
Biomedical subjects
R Grundmann
Publications and source records attributed to R Grundmann.
[Human albumin therapy and prognostic value of determining colloid osmotic pressure at the surgical intensive care station].
367 patients treated on the intensive care unit were prospectively documented during a 1-year observation period. Plasma colloid osmotic pressure (COP) was daily measured. Human albumin therapy was required only in 10% of all patients. These mainly long-term (greater than 10 days) treated patients also showed the lowest levels of COP (minimum COP means: 21 cmH2O (= 15.4 mmHg]. In the majority of all cases an extreme decrease of COP (less than 20 cmH2O (= 14.7 mmHg] was due to sepsis associated with an unfavorable prognosis. 67% of all patients with at least a single decrease of COP less than 20 cmH2O died, as compared to 15% of the patients where the COP never fell below 25 cmH2O. When a low COP was secondary to sepsis, the therapeutic benefit of an albumin therapy could not be evaluated.
Adolescent↗
[Quality assurance in surgery: possibilities and limits].
Quality control in surgery is undertaken to check on effects of preoperative risk, choice of surgical technique, use of surgical technique, and peri-operative therapy on the results of an operation. Attention is given, in this context, not only to complications but also to postoperative quality of life and prognosis, with efforts being made to quantify these latter aspects. Useful information can be obtained only by neutral data collection undertaken independent of the surgeons involved.
Humans↗
[immunosuppression following kidney transplantation using antilymphocyte globulin followed by treatment with cyclosporin. A prospective study].
In a prospective study three different immunosuppressive schemata after renal transplantation were compared. In group A (47 patients) conventional treatment with azathioprin and steroids was administered; in group B (47 patients) antilymphocyte globulin (ALG) was additionally given for three weeks. In group C (47 patients) ALG-azathioprin-steroid administration lasted for a mean of nine days after the transplantation, followed by ciclosporin. One-year transplant survival rate was 59.6% in group A, 70.2% in group B and 89.4% in group C; one-year patients survival rate 95.7%, 89.4% and 100%, respectively. Thus conventional immunosuppression with ALG followed by ciclosporin was statistically significantly superior to the other two treatment schedules, both with respect to patient and transplant survival. This was also true of postoperative dialysis rate, which was lowest in group C, at 17%, compared with group A (85.1%) and group B (42.6%). Under the chosen study conditions there was no evidence of a negative effect of ciclosporin on long-term renal function.
Adult↗
[Postoperative determination of endotoxin levels. Prognostic and diagnostic value in intensive care units].
197 patients monitored postoperatively for more than two days in an intensive-care unit were followed up prospectively for nine months. Endotoxin plasma levels were determined daily by means of the limulus amoebocyte lysate test. In endotoxin-positive patients there was a statistically significantly higher incidence of peritonitis, sutural insufficiency, pneumonia, and sepsis. The diagnostic value of the test was found to be higher if the patients were considered "septic" only when endotoxin was positive for more than two days. In that case the specificity of the test was 80.6%; this was superior to that of a corresponding rise in leukocyte count or in body temperature. The positive predictive value for septic complications was 67.6%. Determination of the course of the endotoxin titre is more relevant than recording an isolated rise. This allows differentiation between septic and non-septic diseases.
Endotoxins↗
[Indications for postoperative human albumin therapy in the intensive care unit--a prospective randomized study].
In a prospectively randomised study (n = 161) we examined whether postoperative human albumin administration is justified in intensive care patients whenever the colloid osmotic pressure (COP) decreases below 26 cm H2O. Postoperative complication rates did not increase in the control group, although only 22% of these patients received albumin as compared to 100% in the therapy group. A decline of the COP below extreme values (even under 20 cm H2O) was compatible with survival. This study established only one indication for postoperative human albumin therapy: acute volume substitution in patients on dialysis. Consequently, in the second half year of this study only 3 of 49 patients of the control group received human albumin therapy.
Abdomen↗
Transplantation of cryopreserved hepatocytes or liver cytosol injection in the treatment of acute liver failure in rats.
Intraperitoneally injected cryopreserved hepatocytes or liver cytosol were used for the treatment of acute galactosamine-induced liver failure in rats. Both methods were similarly capable to improve the survival rates as compared to control groups. Furthermore, a new viability test for transplanted hepatocytes, using a nuclearmedical tracer technique, was evaluated in this study. This test demonstrated viability of intraperitoneally transplanted hepatocytes for at least 6 days after operation. Cytosol injection should be preferred to hepatocyte transplantation in the treatment of acute liver failure, avoiding the problems of cell storage and post-transplant immunosuppression.
Acute Disease↗
[Quality assurance in general surgery by prospective patient documentation. A comparison over 5 years].
All patients who had undergone general surgery in three different periods of time were prospectively recorded. Results were found to have been improving with significance owing to peri-operative antibiotic prophylaxis, mechanical suturing (for gastro-intestinal anastomoses), and introduction of a system of regular documentation. Rates of postoperative complications were also affected by the individual surgeon's efficiency and techniques.
Anti-Bacterial Agents↗
[Transplantation of cold-preserved hepatocytes in the therapy of acute liver failure in rats].
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Acute Disease↗
[Leiomyoma of the small intestine].
Diagnosis and surgical treatment of a leiomyoma of the small bowel are described. The special findings in this case are the unusual location of this tumors and the fact that histological examination revealed a benign process, although the tumor had a diameter of more than 16 cm.
Aged↗
[Prophylactic immunoglobulin administration after major gastric resections. A prospective randomized study].
Immunoglobulins in a dosage of 0,25 g/kg body weight were administered in a prospective randomised study prophylactically to 90 out of 180 patients with gastric surgery of variable extent on the day of operation and on the first postoperative day. Wound infection rates of the treated group were 4.4%, of the control group 14.4%. In addition, the control group had a pneumonia rate of 21% and the treatment group of 11%. However, there were no differences between both groups as regards other assessments (mortality, further postoperative complications, time of hospitalisation, duration of ventilation, postoperative use of antibiotics). It can be concluded that although immunoglobulins lower the risk of infection prophylactic administration should for reasons of expense be limited to patients with preoperatively increased pulmonary risks. The appropriate therapeutic use is to be evaluated.
Gastrectomy↗
Postoperative albumin infusion therapy based on colloid osmotic pressure. A prospectively randomized trial.
In a prospectively randomized trial of 220 patients, 106 were given albumin when their colloid osmotic pressure (COP) fell below 24 cm H2O and 114 were given albumin when their COP fell below 29 cm H2O. There was no difference in the postoperative course between the two groups; however, by using the lower COP limit the postoperative albumin consumption in the intensive care unit was reduced significantly and thus the costs of treatment were lowered. In the case of extremely low COP, the prognosis of the disease worsened, indicating that the COP is of prognostic value. The albumin supply, however, did not influence the final outcome of the patients under these circumstances because it treated only a characteristic symptom and not the cause of the disease.
Abdomen↗
[Results following colorectal interventions--an analysis over 36 years].
The data of 407 patients with colon carcinoma and 346 patients with rectum carcinoma treated in the last 36 years were analysed retro- and prospectively as regards the operative technique, the perioperative treatment and the postoperative complication rates. It was shown that the number of tumour resections increased continuously and that the percentage of deep anterior rectal resections rose since 1981. The mortality rate after tumour resections could be reduced to 1.5%. Most decisively for the improvement of the results was the introduction of a regular quality control system.
Anti-Bacterial Agents↗
[Cryotherapy of rectal cancer. Immunologic results].
On the basis of experimental studies carried out in animals several authors could demonstrate that cryotherapy is able to induce a raise of auto- and tumour-antibodies. The specificity of these reactions has been proved. Comparative analysis could verify greater immune response after 'in situ-destruction' of tumours than after conventional surgical excision. In 13 patients cryosurgically treated for inoperable rectal carcinoma a raised concentration of IgG and IgA could be shown in several patients in the area surrounding the carcinomatous cells by means of a direct immune fluorescent technique in biopsies of the tumour. Immune globulines of the class IgA seemed to be important. Our results suggest a probable correlation of immune response and clinical course. The prognostic value of our method has to be examined in a larger group of patients and laboratory experiments. Cryotherapy can be regarded as one of several possible forms of treatment to brake the barrier of immunity in cancer patients.
Adenocarcinoma↗
[Somatostatinoma of the liver].
A case report is given of a 45 year old patient, who had a tumor of the liver, pain in the upper abdomen and relapsing fever. Surgery was done and part of the liver was removed. On microscopic examination a somatostatinoma was found. The clinical symptoms of this very rare type of tumor, which belongs to the APUD cell system, is discussed as well as therapeutical implications.
Adenoma, Islet Cell↗
[Cytomegalovirus infections after kidney transplantation and passive immunization].
Cytomegalovirus infection after renal transplantation impairs the survival rate of patient and graft. An incidence of 24 to 92% of CMV infections after renal transplantation is reported, but only 15 to 77% of these patients show clinical symptoms. Contaminated donor organs, blood transfusions and reactivation by immunosuppression are the main causes of this infection. Active immunisation cannot prevent the reactivation of the infection, but also antiviral agents can hardly influence the course of the disease. Passive immunisation showed promising effects in bone-marrow transplantation and is now also tried in renal transplantation. The first results of a randomized study do not allow a final conclusion, but show less clinical symptomatic CMV infections, and statistically significant less herpes simplex infections in the group receiving anti CMV IgG prophylaxis.
Antibodies, Viral↗
Infectious diseases under prophylactic ALG treatment and their prevention in a prospectively randomized trial.
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Antilymphocyte Serum↗
[Current status of therapy of liver metastases of colorectal carcinoma].
Surgical removal of liver metastases stemming from colo-rectal carcinoma is the therapy of choice of this disease. Postoperative mortality is 8%, 5 years survival rate ranges between 22 and 52% and can be considered to be good. However in 85% of patients surgery is not possible because of widespread involvement of the liver. Systemic chemotherapy yields remission rates up to 23% without increase of survival time, and therefore is no real alternative. Infusion of cytostatic drug into the hepatic artery yields better results, e.g. remission rates up to 85% and average survival times up to 26 months.
Antineoplastic Agents↗