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Biomedical subjects

R Grundmann

Publications and source records attributed to R Grundmann.

At least 73 records · Page 4Linked to original sources
PubMed1985

Improvement in cyclosporine handling by anti-lymphocyte globulin in the early post-operative period.

The value of prophylactic anti-lymphocyte globulin (ALG) treatment after transplantation was examined in a prospectively randomised study. The control group was treated with azathioprine and steroids only. In a third group prophylactic ALG combined with azathioprine and steroids was given for 8.7 +/- 2.25 days after transplantation and was then replaced by cyclosporine and steroids. Renal graft survival rates could be improved if the conventional immunosuppression was accompanied by ALG prophylaxis. However, additional cyclosporine treatment proved to be desirable since in this way the number of early acute rejection episodes could be further reduced.

Antilymphocyte Serum↗
PubMed1985

[Experiences with 2 years of quality control following general and vascular surgery in 3193 patients].

3193 general and vascular surgical interventions were prospectively controlled regarding the postoperative complication rates. The examination of all complication data was necessary to define the risk of the various operations. By a regular follow-up system the risk of wound infections and other complications decreased. Although perioperative antibiotic prophylaxis and stapling devices for gastrointestinal end-to-end anastomoses were routinely used, the surgeon still influenced the complication rates.

Arteries↗
PubMed1985

[Effect of postoperative human albumin therapy on serum protein fraction of septic and aseptic patients].

The effects of 20 and 40 g postoperative intravenous human albumin (HA) infusion on the serum protein fractions and on the colloid osmotic pressure (COP) were analyzed in 72 septic and aseptic patients. Only aseptic patients showed an increase in the COP as well as the serum albumin concentration during at least a 24-h-period. In septic patients, however, the increased serum albumin concentration dropped rapidly to the initial values. This can be only explained by a disturbance of the membrane permeability. In contrast, the behavior of the serum globulin concentration was not essentially influenced by septic or non septic conditions.

Adult↗
PubMed1984

[Risks in pregnancy after kidney transplantation].

Two women had four supervised pregnancies after renal transplantation. A striking feature was that the children had fetal growth retardation which led to premature termination of pregnancy by section. Likely causes of the growth retardation are, in the first instance, long-term treatment with corticosteroids and increased incidence of toxaemia. There is no evidence for a significant rise in the risk of teratogenicity for the embryo by the immunosuppressive treatment. However, an increased mutagenicity risk must remain a possibility in view of the one case of Turner's syndrome. Close interdisciplinary control of mother and child makes it possible to reduce risks to a reasonable level in case of pregnancy after renal transplantation.

Cesarean Section↗
PubMed1984

[Sympathetic activity in terminal renal failure and kidney transplants].

Blood pressure as well as noradrenaline, creatinine and electrolytes in blood and urine were compared in normal controls (n = 25), patients with chronic renal failure (n = 39), patients with continuous ambulatory peritoneal dialysis (CAPD) (n = 28) and haemodialysis patients before and after renal transplantation (n = 63). The average blood pressures of the control group and the CAPD patients were lower than those of the renal failure patients without and with haemodialysis. After renal transplantation elevated blood pressure normalised in 18% within the following 6 months. In all groups of patients with renal failure the mean noradrenaline plasma concentration was increased more than three-fold of normal values: 1,470 pg/ml in patients with chronic renal failure, 1,366 pg/ml in CAPD patients and 1,284 pg/ml in patients with haemodialysis. No correlation was found between these elevated noradrenaline plasma levels and blood pressure. However, there was a significant correlation between noradrenaline excretion and sodium excretion. Compared to the controls, the urine excretion of noradrenaline was significantly lower in patients with chronic renal failure and almost zero in patients with dialysis treatment. Two days after renal transplantation the mean noradrenaline urine excretion increased to 15.7 +/- 1.8 micrograms/day and 4 days after transplantation the noradrenaline plasma concentration decreased to 592 +/- 155 pg/ml. Nine months after renal transplantation the creatinine clearance was 76 ml/min and the mean noradrenaline plasma concentration 438 +/- 153 pg/ml. It is concluded that in chronic renal failure the level of noradrenaline plasma concentration is dependent on renal function.

Blood Pressure↗
PubMed1984

[Use and limits of preventive antilymphocyte globulin therapy following kidney transplantation. A prospective randomized study].

The influence of prophylactic ALG treatment immediately after transplantation on the results of renal transplantation was examined in a prospectively randomized trial (n = 94). An improved graft survival rate was found after 9 months (ALG group 72.3%, control group 59.6%) which, however, was associated with an increased risk of infections. The increased infection rate was due to the duration of the ALG treatment which was too long in this study (21 days). Prophylaxis should rather be finished after 14 days. The immediate renal function after transplantation was significantly improved in the ALG group. Therefore, it is suggested to give ALG directly after transplantation until normalization of renal function and to change over to cyclosporin afterward.

Antilymphocyte Serum↗
PubMed1984

[Parameters affecting the results of kidney transplantation. Critical analysis of the literature].

On the basis of a critical analysis of 227 studies reported in the literature it was examined to which extend the results of renal transplantation depend on the age of the recipient, the length of preoperative dialysis treatment, HBs-antigenemia, former pregnancies, preoperative blood transfusions, tissue compatibility and donor age. A negative influence of the recipient's age on the results was found, but nevertheless older patients can be also transplanted. HBs-antigenemia is not a contraindication for transplantation either. Preoperative blood transfusion can improve the graft survival, but the value of intraoperative transfusions is not quite clear. The same applies to donor age, former pregnancies and tissue compatibility.

Age Factors↗
PubMed1984

[Treatment of colorectal cancer in the last 35 years--perioperative requirements and postoperative results].

The development of colorectal surgery during the last 35 years was analyzed on the basis of case reports of a University Surgical Department. It was found, that lethality of the procedure was reduced during this period and that the number of tumor resections per year increased. In cases of carcinoma of the rectum extirpation of the rectum was reduced in favour of deep resection of the tumor in the recent time. In addition the analysis showed, that time of hospitalization was definitely reduced. Postoperative results have improved considerably due to improved methods of preparing the intestinal tract for surgery, due to preoperative prophylactic treatment with antibiotics--this reduces the postoperative need of antibiotics rather definitely--but only due in a limited extent to change of suturing techniques. The extent of pre- and postoperative diagnostic and therapeutic procedures increased, which however was justified because results improved quite definitely.

Adult↗
PubMed1984

[Importance of postoperative endotoxin determination. A pilot study].

In a prospective pilot study a daily test for the presence of endotoxin was performed on the blood of 145 patients that were admitted to the intensive care unit for at least 3 days. Endotoxin positive patients showed a significantly higher mortality rate and the period of admittance to the intensive care unit and the period of ventilation were prolonged.

Adolescent↗
PubMed1983

[APUDoma of the abdominal area and bronchial system. Surgical therapy and prognosis].

28 patients with APUDomas of the abdomen or bronchial system were reexamined up to 30 years after operation to take a view on therapy and prognosis of these tumors. All patients with benign hyperinsulinism remained free of symptoms after partial pancreatectomy or tumor enucleation, in the mean 12.9 years after operation. In contrast the two patients with islet cell carcinoma died 5 months after operation at the latest. The prognosis of the carcinoid tumors depended decisively on tumor location: The prognosis was favorable in patients with carcinoid tumors of the appendix or bronchial carcinoid (survival time up to 10 years after operation). In contrast all patients with carcinoid tumors of the small intestine died within two years after operation. Tumor size had the most important influence on the prognosis of the disease.

Adult↗
PubMed1983

[Hepatic resection for tumors, trauma and Echinococcus].

52 patients with hepatic resection due to liver tumor, metastases, Echinococcus or liver trauma are reported. Hepatic resection represents a relatively harmless procedure in case of benign liver tumor; however, in case of a malignant disease, the prognosis after hepatic resection is impaired by the difficulty to predict the regeneration capability of the liver. The indication for the different operative procedures is being discussed. It is suggested to perform hepatic resection in the border lines of the liver lobes without extensive preparation of the liver hilus and to clamp the liver hilus during resection. If the liver hilus was occluded after steroid pretreatment, 40 min of hepatic ischemia were well tolerated without any consequences and intraoperative bloodloss could be reduced significantly.

Echinococcosis, Hepatic↗
PubMed1983

[Value of the routine documentation of wound infection and complication rates following general surgical interventions].

1430 patients who underwent general surgery were analysed in a prospective study. The examinations were aimed at showing how the results obtained were influenced by prophylactic antibiotic treatment, bowel preparation and suturing technique. Additionally, it was investigated whether the ordered steps were performed in an adequate manner. Finally the regular documentation of wound infection and complication rate could be found to contribute to improving the operative results by detecting avoidable complications.

Anti-Bacterial Agents↗
PubMed1983

[Colloid osmotic pressure--a parameter of postoperative protein therapy. A pilot study].

120 intensive-care patients were examined postoperatively in a pilot study. The patients were divided into two groups. In group 1 human albumin was given when the serum protein concentration decreased below 5 g%, in group 2 when the colloid osmotic pressure (COP) decreased below 27 cmH2O. Patients of group 2 received less human albumin, but despite the lower human albumin supply these patients did not worse postoperatively as compared to group 1. On the contrary, the trend could be observed that the periods of ventilation were shorter (possibly due to the lower volume load of the patients) and the serum creatinine concentrations were lower (possibly due to the increased supply of crystalloid solutions) if smaller amounts of albumin were given. It may be concluded that the postoperative human albumin supply is unnecessary if the COP ranges 27 cmH2O or more.

Adult↗