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Biomedical subjects

W Haupt

Publications and source records attributed to W Haupt.

At least 37 records · Page 2Linked to original sources
PubMed1997

The challenge of postoperative infections: does the surgeon make a difference?

Postoperative infections remain a challenge in many surgical procedures despite improved surgical technique and powerful antibiotics. The number of sepsis cases has tripled from 1979 to 1992 due to increased invasive procedures in older and immune-suppressed patients. Increasingly, in recent years, outbreaks of resistant pathogens have been published, provoking the question of how postoperative infections and resistant pathogens should be dealt with. Wound classification and risk stratification were developed to identify patients at risk for postoperative infection. However, other important intrinsic factors of the patient were not included, and further attempts have been made to increase sensitivity and specificity (eg, Study on the Efficacy of Nosocomial Infection Control project, National Nosocomial Infection Surveillance System score); the American Society of Anesthesiologists preoperative assessment score and the operation duration for specific procedures were introduced into the system as risk stratifiers. Advances in immunology have identified new ways in which the surgeon can moderate the immune response (eg, hemorrhage and blood transfusion-induced immune suppression). The increased rate of resistance in enterococci and staphylococci has refocused attention on infection control in surgery. However, there are recent reports from both sides of the Atlantic indicating that guidelines for infection control and antibiotic policy have not become reflected in standard procedures in many hospitals. New antibiotics may be developed, but resistance soon may follow. Sound techniques in surgery, with careful infection control and antibiotic policies, may be the only strategy to prevent further increases in resistance of pathogens in postoperative infections.

Antibiotic Prophylaxis↗
PubMed1997

Association between preoperative acute phase response and postoperative complications.

OBJECTIVE: To find out if there is an association between the acute phase response preoperatively and the development of postoperative infective complications. DESIGN: Prospective open study. SETTING: Teaching hospital Germany. SUBJECTS: 229 patients who were to undergo major abdominal operations. INTERVENTIONS: Measurements of serum concentrations of interleukin 6 (IL-6), alpha-1-antitrypsin, C-reactive protein (CRP), albumin, and prealbumin. MAIN OUTCOME MEASURES: Abnormal values of substances measured. RESULTS: Serum concentrations of IL-6, alpha-1-antitrypsin and CRP were raised, and those of albumin and prealbumin were reduced in 5% to 14% of patients. 25 (11%) developed major complications, of whom 9 (4%) died. 9 Patients (4%) had a severe systemic inflammatory response caused by infective complications that did not result from technical failure of the operative technique. Of these 9 patients, 7 (78%) already had signs of an increased acute phase response before operation that was significantly different from the incidence among patients who recovered without complications (21/204. p < 0.001) CONCLUSION: These data suggest that if there are signs of an acute phase response preoperatively the patient's response to operation and infection during the postoperative period may be adversely affected.

Acute-Phase Reaction↗
PubMed1997

Treatment of cirrhotic rats with L-ornithine-L-aspartate enhances urea synthesis and lowers serum ammonia levels.

CCl4-induced cirrhosis of rats was used for studying the influence of L-ornithine-L-aspartate (OA) on hyperammonemia. OA given to cirrhotic rats (2 g/kg daily) for 2 wk slightly increased net body weight and led to a significant increase in plasma urea levels and a decrease in plasma ammonia levels. Serum concentrations of glutamate, glutamine and arginine decreased significantly. In the livers of the OA-treated rats the activities of carbamoylphosphate synthetase I and arginase increased by 30 and 40%, respectively, approaching normal levels. No change in the activities of the other urea cycle enzymes as well as of glutamate dehydrogenase, glutaminase and glutamine synthetase was found. The negative correlation between glutamine synthetase activity and plasma ammonia levels reported previously for cirrhotic rats (Gebhardt and Reichen, Hepatology 20:684-691, 1994) was corroborated for cirrhotic animals not treated with OA, but was no longer apparent in OA-treated cirrhotic rats. Despite this improvement, plasma ammonia levels still varied considerably reflecting the variable accessibility and activities of glutamine synthetase in cirrhotics. Cultured hepatocytes from the two groups of rats showed a similar stimulation of urea production by addition of ammoniumacetate and/or OA to Hanks' buffered salt solution. In Williams medium E, however, the hepatocytes from the OA group produced significantly more urea than those from controls. These results suggest that treatment of cirrhotic rats with OA considerably improves urea production favoring the detoxification of ammonia that, however, is still limited by the severe alterations in liver architecture that are not influenced by OA in a 2-wk period.

Amino Acids↗
PubMed1996

[Optimizing a conventional documentation system on the surgical intensive care unit--a contribution to cost reduction and preventive quality management?].

In Intensive Care Units (I.C.U.), the lack of staff and funds require the mobilisation of organisational reserves in order to ensure high-quality patient care. Traditional occupational-group organised documentation systems are burdened with lack of clarity, limited utilisation by the staff, insufficient information content and difficulties in synoptic patient monitoring. They cannot meet the demands of modern intensive-care medicine. At the inauguration of our Surgical I.C.U. in June 1992, an occupational-group oriented documentation system was introduced and put into operation. Because of negative repercussions on patient care, it was replaced by a patient-centered, conventional prescription and documentation system in April 1993. In April 1994, an evaluation of the patient-centered system was carried out. We report on our initial problem analysis, the subsequent developmental and introductory phases, and the results after having used the system in our I.C.U. for one year. Data condensation, standardised data recording, as well as structured prescription, examination, assessment and decision processes, saved 730 working hours for medical and nursing staff per year, reduced the cost for documentation materials by 58% and improved the extent of data recording. In our experience, improving a conventional documentation system is a suitable instrument to support cost reduction and preventive internal quality management in the I.C.U.

Cost Savings↗
PubMed1996

Selective cytokine release induced by serum and separated plasma from septic patients.

OBJECTIVE: To investigate the activating properties of serum from septic patients on monocytes and the potential effect of plasmapheresis. DESIGN: Prospective controlled study. SETTING: Teaching hospital, Germany. SUBJECTS: 7 Patients with life-threatening systemic inflammatory response syndrome (SIRS) and 4 control patients with serious but not life-threatening conditions. INTERVENTIONS: We measured the amount of mediators released by healthy donor monocytes incubated in serum and separated plasma from septic patients. MAIN OUTCOME MEASURES: Release of interleukin 6 (IL-6), prostaglandin E2 (PGE2), interleukin 1 (IL-1), and tumour necrosis factor (TNF). RESULTS: The serum and separated plasma from infected patients selectively induced the release of IL-6 and PGE2. The mean PGE2 production in serum was 10,895 pg/ml/10(5) cells, and in plasma was 14,023 pg/ml/10(5) cells compared with a control of 0 (p < 0.05). The mean IL-6 production in serum was 4925 pg/ml/10(5) cells and in plasma 4262 pg/ml/10(5) cells compared with a control of 0 (p < 0.05). In contrast, IL-1 and TNF did not seem to be associated with sepsis and were present in small amounts if at all. Additional stimulation with lipopolysaccharide (LPS) increased the serum and plasma induced release of PGE2 and IL-6 (p < 0.05). Serum and plasma from septic patients did, however, selectively reduce the maximum LPS-stimulated release of PGE2 and TNF (p < 0.05) compared with healthy donor monocytes. CONCLUSION: Serum and separated plasma from septic patients contained agents which induced monocytes to release mediators without additional stimulation, and modified their response to LPS. Removing plasma from septic patients may therefore reduce the deleterious effect of the inflammatory response.

Catecholamines↗
PubMed1995

Variables influencing the Thrombostat 4000: recommended standardization.

The in vitro bleeding test (IVBT) (Thrombostat 4000) was performed on blood samples from healthy blood donors using a "preliminary standard test." Only one factor of the test procedure was changed each time. We found the following parameters to have a significant influence on the test results: time interval between sampling and testing, diameter of the filter's aperture, capillary diameter, aggregating agents and their concentration, temperature of the blood and cartridges, method of drying the capillaries, the aspiration pressure, and the hematocrit of the blood sample. According to our data, we propose a standard IVBT for routine application and modifications for special diagnostic use.

Adenosine Diphosphate↗
PubMed1994

[Possibilities of contagion of gastrointestinal and lung nematode infections of fallow deer for cattle, sheep and goats raised in the same fenced area as fallow deer].

Cattle as well as sheep and goats may be infected with parasitic nematodes of fallow deer under natural conditions, but heavy infections do not occur. Most nematode species were recorded in goats, cattle harboured the fewest number of species. The specific abomasal parasites of fallow deer (Spiculopteragia asymmetrica, Apteragia quadrispiculata, Skrjabinagia ryjikovi, Ostertagia drozdzi) were only seen in goats in greater number while both cattle and sheep were only poor susceptible. Capillaria bovis was observed in goats and sheep, cattle and sheep harboured Cooperia pectinata and Nematodirus roscidus. Oesophagostomum venulosum was recorded in cattle, sheep and goats. Oesophagostomum sikae was recovered only from fallow deer. Dictyocaulus eckerti was seen in fallow deer and in one cattle.

Animals↗
PubMed1992

[Ambulatory cataract operation--a new concept becomes established].

Outpatient cataract surgery, in particular employing phacoemulsification, has now become established practice in Germany. It is as safe as the inpatient procedure but for most cataract patients less stressful, cheaper and associated with shorter waiting lists. As experience in more than 2,500 cases has shown, the outpatient procedure is fully acceptable--also with respect to complications.

Ambulatory Surgical Procedures↗
PubMed1991

[Disorders of primary hemostasis caused by albumin infusion in hemodilution].

Previous studies using the In-vitro Bleeding Test have shown that albumin impairs primary hemostasis more pronouncedly than other infusion solutions. For this reason we compared ADP (4 microM)-induced platelet aggregation in samples of platelet rich plasma containing 50% albumin. We added the same amount of platelet-poor plasma to the controls. Using this method we could show the inhibitory effect of albumin once more. This means that not only changes in rheology are responsible for the impairment of hemostasis by albumin. Platelet aggregation itself is influenced.

Blood Viscosity↗
PubMed1990

[Venous long-term indwelling catheter and port systems in children. Progress in pediatric oncology].

Long-term indwelling catheters of the Broviac, Hickman, Groshong type, and the Port Systems have proved highly suitable as a supportive measure in pediatric oncology. They are indicated for cytostasis, bone marrow transplantation and long-term parenteral nutrition. They provide reliable and safe venous access for therapy and blood sampling. Therapy is thus faciliated, and the quality of the patient's life is significantly improved by reducing the number of venipunctures required.

Blood Specimen Collection↗
PubMed1990

[Experimental detection of hemorrhage in the circulation area of the superior mesenteric artery by intra-arterial nuclide angiography].

A new experimentally proven method for diagnosis and localisation of acute bleeding in the flow area of the arteria mesenterica superior is reported. By selective intra-arterial nuclide injection microhemorrhage below the proof limit of angiography can be registered and relatively exact localized by additional geometric procedure. Using this method, the exact location of angiographic, negative bleedings could be determined in experimentally produced bleedings in the jejunoileal transit and in the distal ileum. We explain the experimental arrangement and the results. The diagnostic value of the examination is discussed.

Angiography, Digital Subtraction↗
PubMed1990

Primary hemostasis in hemodilution--1) Hematocrit.

There are still controversies about the influence of acute preoperative hemodilution on coagulation. Therefore, we examined the platelet function by the In-vitro bleeding test (IVBT) using composed blood samples of different hematocrit but constant platelet concentration. We found an inverse correlation between hematocrit and bleeding time (p less than .05), volume (p less than .001) and flow (p less than .001). These data suggest a considerable impairment of primary hemostasis, due to low hematocrit. The cause may be an alteration of the hemorheology as well as the interaction between red cells and platelets themselves.

Bleeding Time↗
PubMed1990

Primary hemostasis in hemodilution--2) Infusion solutions.

Various infusion solutions are used during preoperative hemodilution or for substituting intraoperative blood loss. We examined the influence of saline 0.9%, albumin 5%, dextran 6% gelatin 3.5% and hydroxyethyl starch 6% (HES, mw 40,000 and 450,000) on primary hemostasis using the In-vitro bleeding test (IVBT) on composed blood samples of different hematocrit but constant platelet concentration. All infusion solutions tested caused longer bleeding times, depending on the volume used. Saline and albumin had the strongest effect, whereas high molecular weight HES or dextran showed hardly any impairment, if used in a quantity of less than 20% of the blood volume. Autologous plasma seems to be the best substitute in hemodiluted patients, at least if more than 20% of the blood volume has to be substituted by infusion solutions.

Bleeding Time↗
PubMed1990

[Postoperative parenteral nutrition following segmental liver resection--are fat emulsions a risk?].

Thirty-two patients with segmental liver resection were fed 3 different parenteral infusion programs postoperatively. These differed in carbohydrate and lipid content, with the latter representing up to 40% of the total caloric content. Laboratory parameters, including nitrogen balance, acute phase proteins and liver function tests, were found to have a postoperative course similar to that seen following other major abdominal procedures. A transient rise of bilirubin observed may be related to the temporary decrease in the excretory function of the liver. The rise in acute phase proteins, beginning a few days postoperatively, was attributed to the ability of the remaining liver parenchyma to synthesize protein. There was no significant difference observed between the 3 parenteral solutions. Finally, we conclude that in the early postoperative period lipid solutions can be used as an important source of energy.

Alanine Transaminase↗
PubMed1989

[Fascioliasis in moufflons].

Subacute fascioliasis was diagnosed by pathomorphological and parasitological investigations on 13 dead moufflons (Ovis ammon musimon) from a herd of 21 animals (mortality 62%) which had succumbed between January and April 1988. The flock had been kept on meadow in the so-called Leipziger Auenwald. The main findings like severe hepatitis traumatica fasciolosa, fibrinous and fibrous perihepatitis, chronic interstitial hepatitis (pseudocirrhosis), cholangitis fasciolosa (X 13), wasting (X 8), heart dilatation (X 10), lung oedema (X 12), anemia (X 5), ascites (X 3), gut oedema (X 3) and occasionally observed lesions are described in detail and discussed with regard to diagnosis and pathogenicity. Beside severe infection with Fasciola hepatica (juvenile and adult flukes) the parasitological investigation demonstrated, in some cases, various additional but unimportant infections with protostrongylids, gastro-intestinal nematodes, coccidia (X 2) and Moniezia expansa (X 1). The analysis of meteorological data (January 1987 till March 1988) established optimal conditions for F. hepatica development stages and Galba truncatula so that high multiplication and infection rates of the snails and long surviving of metacercariae must be assumed.

Animals↗
PubMed1986

[A new assessment model for the evaluation of late results following a decompressive operation of the median nerve].

Of ninety patients who had undergone carpal tunnel release in the years from 1970 to 1980, 67% could be reinvestigated after a follow-up period of five years and six months (average interval). A new scheme for classification of long-term results was used. This was achieved by the use of objective clinical and electro-physiological observations. Postoperatively 71% could be classified as "cured" or "much improved". Only 15% were graded as "improved" and 14% remained "unchanged" or "worse".

Carpal Tunnel Syndrome↗