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W Uhl

Publications and source records attributed to W Uhl.

At least 37 records · Page 2Linked to original sources
PubMed2001

Alkylindium subhalides derived from the tetrahedral indium(I) cluster compound [In4[C(SiMe3)3]4].

Partial oxidation of the tetraalkyltetraindium(I) compound In4[C(SiMe3)3]4] 1 with halogen donors such as 1,2-dibromoethane and hexachloroethane or with mixtures of bromine and aluminum tribromide afforded novel alkylindium halides in which the indium atoms still possess unusually low oxidation states. Indium-indium single bonds between bivalent indium atoms were found in the compounds In2X2R2 (R = C(SiMe3)3, X = Cl (2) or Br (4)), which gave dimers in the solid state with all four halogen atoms in a bridging position. The tetrahedral arrangement of four indium atoms in a cluster was retained in the compound In4Br2R4 (3), in which one bromine atom occupied a mu3-bridging position above one triangular face of the In4 tetrahedron. One edge of that triangle was bridged by the second bromine atom. Mixed-valent indium atoms resulted with an average oxidation state of + 1.5.

Journal Article↗
PubMed2001

Dialkylaluminum hydrazides derived from free hydrazine N2H4. Molecular Structures of [(MeC)2AlN2H3]2 and [(MeC)2Al]4(N2H2)2.

The reaction of di(tert-butyl)aluminum hydride with hydrazine N2H4 afforded the hydrazide (Me3C)2AlN2H3, 1, by the release of elemental hydrogen. Compound 1 is a dimer in solution and in the solid state and possesses a six-membered Al2N4 heterocycle in a twist conformation with two intact N-N bonds. Further reaction of 1 with an excess of HAl(CMe3)2 yielded the tricyclic aluminum and nitrogen rich Al4N4 compound [(Me3C)2AlN2H2]2[Al(CMe3)2]2, 2, in which each N-N bond of a central six-membered Al2N4 ring similar to that of 1 is side-on-coordinated to an Al(CMe3)2 group. The structure of 2 may be interpreted as a dimer of the dialuminum hydrazide (Me3C)2Al-NH-NH-Al(CMe3)2.

Journal Article↗
PubMed2001

Synthesis of aluminum hydrazides by hydroalumination of 2,3-diazabutadienes--formation of an Al4(N2)3 cage compound and an Al3(N2)3 macrocyclic ligand.

Treatment of 1,1,4,4-tetramethyl-2,3-diazabutadiene with the alane adduct [AlH3(NMe2Et)] yielded the hydrazine derivative (AlH2)2-(AlH)2(N2iPr2)3 (1) by the hydroalumination of both C N double bonds. Compound 1 has a complicated cage structure formed by three hydrazido groups and four aluminium atoms. As a particularly interesting structural motif it contains a N-N group side-on-coordinated to one aluminium atom through its lone pairs of electrons. Sublimation of 1 gave a heterocubane-type compound (HAlNiPr)4 (2) by the complete cleavage of all N-N bonds, one face of which is bridged by weakly coordinated diisopropyldiazene with a N-N double bond. Repeated sublimation gave the pure, unsupported heterocubane molecule 3. Heating of the rough product of the reaction of alane and diazabutadiene to 90 degrees C in a closed vessel yielded another product Al(AlH2)3(N2iPr2)3 (4), which contains a cyclic chelating ligand formed by three hydrazido groups and three aluminium atoms. This heterocycle coordinates a fourth aluminum atom in the molecular center by close contacts to all six nitrogen atoms. A strongly flattened, distorted octahedral coordination sphere results for the inner metal atom.

Journal Article↗
PubMed2001

Reaction of Ni2Cp2(mu-CO)2 with the alkylgallium(I) and alkylindium(I) compounds E4[C(SiMe3)3]4 (E = Ga, In). Insertion of E-R groups into the Ni-Ni bond versus replacement of CO by the isolobal E-R ligands.

The monomeric fragment In-C(SiMe3)3 was inserted into the Ni-Ni bond of Ni2Cp2(mu-CO)2 upon treatment of the carbonyl complex with the tetraindium(I) compound In4[C(SiMe3)3]4, 1, in a molar ratio of 4 to 1. The product (3) contains an indium atom coordinated to one alkyl substituent and two Ni(Cp)CO groups in a planar coordination sphere. Reaction of the starting compounds in a molar ratio of 2 to 1 led to the replacement of both CO ligands by two InR groups. A compound (4) was formed that is isostructural to the carbonyl nickel complex and has a Ni2 couple bridged by two InR ligands and two terminally coordinated cyclopentadienyl groups. The insertion product was not observed with the gallium derivative Ga4[C(SiMe3)3]4 (2); instead, a nickel gallium complex (5) analogous to 4 containing two bridging GaR ligands was isolated as the only product regardless of the ratio of the starting compounds. On the basis of quantum chemical calculations, we conclude that there is no evidence for an In-In or Ga-Ga bond in complexes 4 or 5, respectively. This, however, supports a butterfly geometry, which is isostructural to the starting carbonyl complex Ni2Cp2(mu-CO)2.

Journal Article↗
PubMed2001

Pancreatic infection in severe pancreatitis: the role of fungus and multiresistant organisms.

HYPOTHESIS: Recent controlled clinical studies suggest a positive effect of early antibiotic treatment on late morbidity and mortality in severe acute pancreatitis. However, widespread use of antibiotics may lead to an increased number of fungal infections and multiresistant bacteria, thereby worsening the outcome of the disease. DESIGN: Single-center prospective study. SETTING: University hospital, gastrointestinal surgical service. PATIENTS: One hundred three patients with necrotizing pancreatitis seen consecutively in our service. INTERVENTIONS: In addition to standard treatment, patients with proven necrotizing pancreatitis received a prophylactic intravenous antibiotic treatment. Pancreatic infection was regarded as an indication for surgery. MAIN OUTCOME MEASURES: Pancreatic infection, microbiological findings, drug resistance, fungal infections. RESULTS: Thirty-three patients (32%) had infected necrosis. Gram-negative organisms were isolated from 19 patients (58%), Gram-positive organisms were isolated from 18 patients (55%), fungal organisms were isolated from 8 patients (24%), and multiresistant organisms were isolated from 3 patients (9%). In 7 patients (21%), the organisms cultured from the pancreatic tissue were resistant to the antibiotics given in for prophylaxis. Infection with multiresistant organisms or organisms resistant to the antibiotic used for prophylaxis, but not with fungal infection or Gram-positive or Gram-negative infection, was correlated with a negative outcome. CONCLUSIONS: Fungal infection under adequate treatment is not associated with a negative outcome. The occurrence of multiresistant organisms seems to be a rare finding (3 of 103 patients). Antibiotic prophylaxis is effective in preventing infection in necrotizing pancreatitis, but optimal choice and duration of administration of the antibiotic agent(s) need to be carefully determined to avoid the sequelae of multiresistant organisms.

Adult↗
PubMed2001

Prophylactic antibiotics and pancreatic necrosis.

Recent controlled clinical studies suggest a positive effect of early antibiotic treatment on late morbidity and mortality in severe acute pancreatitis. In contrast, widespread use of antibiotics may lead to an increased number of fungal infections and multiresistant bacteria. Optimal choice, duration, and route of administration of the antibiotic agent(s) are far from being established. The additional administration of an antifungal agent with prophylactic intention cannot be supported by the currently available data.

Animals↗
PubMed2001

Hydrocortisone treatment of early SIRS in acute experimental pancreatitis.

This work studied the effects of hydrocortisone treatment in experimental acute pancreatitis on cytokines, phospholipase A2, and breakdown products of arachidonic acid and survival. Edematous and necrotizing pancreatitis were induced in Wistar rats by cerulein hyperstimulation and retrograde intraductal infusion of sodium taurocholate, respectively. Hydrocortisone (10 mg/kg) was administered intravenously 10 minutes after induction of acute pancreatitis. Serum was assayed for phospholipase A2; interleukin (IL) 1beta, IL-6, IL-10, thromboxane B2; Prostaglandin E2; and leukotriene B4 at five different time points. A significant release of inflammatory mediators was seen only in the severe model. Hydrocortisone powerfully suppressed arachidonic acid breakdown products and only mildly attenuated the systemic increase of phospholipase A2 and pro- and antiinflammatory cytokines. The mortality rate after 72 hr in the severe model was 86%. Hydrocortisone treatment reduced mortality to 13% (P = 0.001; Fisher's exact test). Hydrocortisone seems to be effective in the treatment of the early systemic inflammatory response syndrome associated with severe acute pancreatitis.

Acute Disease↗
PubMed2001

[Surgery of reflux esophagitis--a renaissance].

Gastroesophageal reflux disease (GERD) has a high prevalence of 40% in Western countries. A dysfunction of the lower esophageal sphincter of unknown origin is the main etiology. Less common pathophysiological reasons are disorders of esophageal motility, delayed gastric emptying, gastric acid hypersecretion and bile reflux. As causal surgical therapy for these disorders fundoplication has been developed 50 years ago. This technique uses a wrap of gastric fundus around the distal esophagus as reflux barrier. Because of severe postoperative complications (dysphagia, gas bloat syndrome, gastric ulcer) and recurrence after fundoplication, medical therapy became the treatment of choice with the development of H2-receptor antagonists and proton pump inhibitors in the 1970s. However, after improvement of surgical technique and introduction of laparoscopic fundoplication in 1991 surgery offers a secure and effective causal therapy. Randomized controlled trials proof the superiority of fundoplication versus medical therapy in regard of long term results, recurrence and cost effectiveness as well as the superiority of laparoscopic versus conventional open fundoplication in regard of recovery and cost effectiveness with equal long term results. Therefore, laparoscopic fundoplication by an experienced laparoscopic surgeon is the surgical therapy of choice. However the high prevalence of GERD requires careful selection of patients for surgery. A thorough preoperative evaluation including upper gastrointestinal endoscopy with biopsy, esophageal manometry and 24 h-pH monitoring as well as upper gastrointestinal contrast study is essential. Today the indication for fundoplication is seen in young symptomatic patients, requiring a long-term medical therapy, in hiatal hernia with threatening complications as well as in complications of severe GERD, especially Barrett-esophagus. At present the advantages of total (Nissen) or partial (Toupet) wrap as well as the benefit of dissection of the short gastric vessels for total fundoplication are still unclear, especially concerning long-term results. To answer these technical questions further randomized controlled trials with long-term follow-up have to be performed.

Esophagitis, Peptic↗
PubMed2001

Late mortality in patients with severe acute pancreatitis.

BACKGROUND: Mortality due to severe or necrotizing acute pancreatitis most often results from multiorgan dysfunction syndrome (MODS) occurring either early (within the first 14 days) or 2 weeks or more after the onset of symptoms due to septic complications. The aim of this study was to analyse the course of the disease in patients who died from severe acute pancreatitis. METHODS: Between January 1994 and August 2000 details of 263 consecutive patients with acute pancreatitis were entered prospectively into a database. All patients were treated in an intermediate or intensive care unit. RESULTS: The overall mortality rate was 4 per cent (ten of 263 patients). The mortality rate was 9 per cent (ten of 106) in patients with necrotizing disease. No patient died within the first 2 weeks of disease onset. The median day of death was 91 (range 15-209). Six patients died from septic MODS. Ranson score, Acute Physiology and Chronic Health Evaluation (APACHE) II score during the first week of disease, pre-existing co-morbidity, body mass index, infection and extent of necrosis were significantly associated with death (P < 0.01 for all parameters). However, only infection of the necrotic pancreas was an independent risk factor in the multivariate analysis. CONCLUSION: Early deaths in patients with severe acute pancreatitis are rare, mainly as a result of modern intensive care treatment. Nine of the ten deaths occurred more than 3 weeks after disease onset. Infection of pancreatic necrosis was the main risk factor for death.

APACHE↗
PubMed2001

Phospholipase A2 isoforms in acute pancreatitis.

OBJECTIVE: To assess phospholipase A2 isoforms during human and experimental acute necrotizing pancreatitis. Phospholipase A2 isoforms (group I, II, and IV) were examined in acute pancreatitis tissues in humans and rats to determine whether the exocrine pancreas itself is a source of these mediators. SUMMARY BACKGROUND DATA: Phospholipase A2 has important regulatory functions, especially in inflammation. METHODS: Using Northern blot analysis and immunohistochemistry, the expression and localization of phospholipase A2 isoforms were analyzed in pancreatic tissue obtained from 21 patients with acute necrotizing pancreatitis and in pancreatic tissues of rats with acute edematous and necrotizing pancreatitis. Rat samples were examined daily for 1 week. RESULTS: In human acute pancreatitis, phospholipase A2-I mRNA expression was 8.9-fold decreased. By contrast, phospholipase A2-II (7.8-fold) and phospholipase A2-IV (8.1-fold) mRNA levels were increased. By in situ hybridization, phospholipase A2-IV was found to be expressed in remaining acinar and ductal cells adjacent to the necrotic areas. Immunostaining revealed moderate to intense phospholipase A2-II immunoreactivity in remaining acinar and ductal cells next to the necrosis. In rat pancreatitis, phospholipase A2-II mRNA levels in the pancreas were unchanged in the early phase (8 hours) but markedly increased after 24 hours, with a fluctuating pattern until day 7. CONCLUSIONS: Enhanced expression of phospholipase A2-II and A2-IV isoenzymes in human and experimental acute pancreatitis suggests that these enzymes play a role in modulating the inflammatory reaction in the pancreas. Because phospholipase A2-II and A2-IV mRNA was strongly present in remaining viable pancreatic acinar and ductal cells, the pancreas itself seems to be at least partly a source and a regulator of phospholipase A2-II- and A2-IV-dependent inflammatory reactions in acute pancreatitis.

Adolescent↗
PubMed2001

A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis.

BACKGROUND: Resection of the pancreas requires control of tributaries of the superior mesenteric vein (SMV) inferior to the head of the pancreas as well as separation of the posterior surface of the pancreas from the SMV and from eventually existing collateral veins. This usually is the most tedious part when performing a resection of the pancreatic head, in particular if there are signs of portal hypertension. Portal vein pathology contributes to intra- and postoperative morbidity in pancreatic surgery. OPERATIVE TECHNIQUE: Instead of dissecting the pancreas along the anterior surface of the SMV our proposed technique allows resection of the head of the pancreas without division of the gland. This approach combines elements of Beger's duodenum-preserving pancreatic head resection and of Frey's limited local pancreatic head excision combined with a longitudinal pancreaticojejunostomy. This modified technique avoids the risk of a bleeding complication which is increased in the presence of portal hypertension and dilation. SUMMARY: The advantages of this modified technique over standard Beger and Frey procedures are: (1) the minimized risk of a bleeding complication in case of portal hypertension because pancreatic transsection does not need to be done, and (2) the considerably more radical excision as compared to local excision. Also, it represents the most minimal surgical trauma for resecting the head of the pancreas as compared to other commonly used techniques.

Anastomosis, Surgical↗
PubMed2000

[Surgical clinical studies and their practical realization].

The employment of the optimal therapeutic option according to the best current knowledge is called evidence-based medicine (EBM). Moreover, considering the cost explosion in public health systems, EBM should contribute towards economical and targeted use of the restricted resources and towards quality assurance in medicine. Obviously, this is applicable to the operative specialties and can be termed as evidence-based surgery. Surgeons have to do their "homework" about this subject and to perform randomized controlled trials (the gold standard with the greatest evidence) on a large scale, in order to come up to this expectation in future. Evidence-based therapy is essential for the preservation and especially for the further development and evolution of high-quality surgery with, at the same time, quality assurance in the new millenium. This article presents the definition of EBM and its implication in the operative fields. Fundamental principles for the practical conduct of clinical randomized controlled trials are defined and the specific problems in surgery are discussed.

Evidence-Based Medicine↗
PubMed2000

[Acute pancreatitis--clinical and technical laboratory diagnostic and prognostic assessment].

The incidence of acute pancreatitis within 100,000 inhabitants a year differs between 5 (Bristol) and 80 (USA). Even though the diagnosis of pancreatitis has become easier by the measurement of specific pancreatic enzymes there are still 30-40% of the fatal cases which are first diagnosed at autopsy. It is of utmost importance to assess the diagnosis and the severity of acute pancreatitis in the beginning to identify those patients with severe or necrotising disease who benefit from an early initiated intensive care therapy. Additionally, in view of new therapeutical concepts (e.g. antibiotic therapy in severe forms) and for the evaluation of new drugs, patients should be staged into mild and severe disease as early as possible. In most cases it is not possible to assess the severity clinically on hospital admission. Up to now the "gold standard" are imaging procedures (contrast-enhanced CT and MRI) which should be reserved for the severe cases to estimate the extent of pancreatic necrosis. The ideal predictor in blood or in urine should be objective, reliable, inexpensive, easy to measure, widely available, sensitive and specific. There are a variety of mediators of the "systemic inflammatory response syndrome" which are elevated in this disease (C-reactive protein, antiproteases, enzyme activation peptides like trypsinogen activation peptide (TAP) and carboxypeptidase B activation peptide (CAPAP), PMN-elastase, complement factors, chemokines and interleukins and others). Among all these mediators, C-reactive protein is the parameter best analysed. It has to be taken into account that it is not specific for AP and it's highest efficacy is reached after > 48 hours after the onset of disease. However, because usually a certain time elapses (approximately 24-48 hours) until patients are hospitalised the time delay seems not to a major disadvantage.

Acute Disease↗
PubMed2000

[Indications for surgical therapy and operative technique in acute pancreatitis].

Eighty to eighty-five percent of all episodes of acute pancreatitis are mild and self-limiting, subsiding within a few days. In the remaining 15 to 20% of cases, however, severe necrotizing disease complicated by multiple organ dysfunction syndrome (MODS) develops. Early stratification according to disease severity is a cornerstone in the management of patients with acute pancreatitis. Patients suffering from mild disease do not need to be operated upon unless specific conditions such as bile duct stones, a tumour at the papilla of Vater or in the head of the pancreas are present. Patients suffering from severe disease are best managed by early intensive care treatment, including antibiotics penetrating into the pancreas in order to prevent infection of the necrotic tissue. Despite such a treatment infection occurs in up to one third of necrotizing cases, asking for surgical treatment. The latter consists of an organ preserving procedure, combined with a continuous postoperative lavage of the retroperitoneum. In 75% of our patients treated operatively, one surgical intervention was sufficient. Overall mortality in patients with necrotizing pancreatitis ranges, according to the current literature, between 6 and 50% and reaches 8% in our own series.

Critical Care↗
PubMed2000

Influence of asimadoline, a new kappa-opioid receptor agonist, on tubular water absorption and vasopressin secretion in man.

AIMS: The purpose of the study was to investigate the effects of asimadoline, a new kappa-opioid agonist, on renal function and on hormones related to body fluid balance as well as its tolerability in healthy subjects. METHODS: In a placebo-controlled, randomised, double-blind crossover design we studied the effects of single oral doses of 1, 5, and 10 mg of asimadoline, in 24 healthy volunteers. Two hour control urine collections were followed by 2 h postdose urine collections and subsequently 2.5% saline was given i.v. at a rate of 0.3 ml min(-1) kg(-1) during another 2 h urine collection. Blood was obtained hourly. Arginine-vasopressin (AVP), atrial natriuretic peptide (alpha-hANP), endothelin (ET-1) and cAMP were determined by r.i.a. or ELISA. RESULTS: GC-MS measurements revealed Cmax values of asimadoline in plasma ranging from 18 ng ml(-1) at the 1 mg dose, 91 ng ml(-1) at the 5 mg dose, to 214 ng ml(-1) at the 10 mg dose after an average of 1.1-1.4 h. Without effects on blood pressure, heart rate, GFR or urine electrolyte excretion, urine volume increased after 1-2 h after administration of 5 and 10 mg asimadoline from 3.3+/-1.3 to 5.6+/-1.4 (P<0.05) and from 3.2 +/-1.6 to 5.5+/-2.2 ml min(-1) (P<0.01), respectively. CH2O rose from 0.2+/-1.5 to 2.0+/-1.6 (P<0.05) and from 0.6+/-1.6 to 3.0+/-1.6 ml min(-1) (P<0.01). Urinary excretion of AVP was suppressed only with the 10 mg dose from 46+/-23 to 25+/-15 fmol min(-1) (P<0.05) without and from 410+/-206 to 181+/-125 fmol min(-1) (P<0.05) with stimulation by 2.5% saline. Plasma AVP was suppressed only by the 10 mg dose of asimadoline in six of eight subjects during the 2.5% saline infusion. Changes in the alpha-hANP or ET-1 systems were not affected by asimadoline. CONCLUSIONS: Asimadoline is diuretic in man after single doses of 5 or 10 mg probably through a direct effect at the renal tubular level. Suppression of AVP secretion was observed only at the highest dose level of 10 mg of asimadoline.

Acetamides↗
PubMed2000

Acute necrotizing pancreatitis: treatment strategy according to the status of infection.

OBJECTIVE: To determine benefits of conservative versus surgical treatment in patients with necrotizing pancreatitis. SUMMARY BACKGROUND DATA: Infection of pancreatic necrosis is the most important risk factor contributing to death in severe acute pancreatitis, and it is generally accepted that infected pancreatic necrosis should be managed surgically. In contrast, the management of sterile pancreatic necrosis accompanied by organ failure is controversial. Recent clinical experience has provided evidence that conservative management of sterile pancreatic necrosis including early antibiotic administration seems promising. METHODS: A prospective single-center trial evaluated the role of nonsurgical management including early antibiotic treatment in patients with necrotizing pancreatitis. Pancreatic infection, if confirmed by fine-needle aspiration, was considered an indication for surgery, whereas patients without signs of pancreatic infection were treated without surgery. RESULTS: Between January 1994 and June 1999, 204 consecutive patients with acute pancreatitis were recruited. Eighty-six (42%) had necrotizing disease, of whom 57 (66%) had sterile and 29 (34%) infected necrosis. Patients with infected necrosis had more organ failures and a greater extent of necrosis compared with those with sterile necrosis. When early antibiotic treatment was used in all patients with necrotizing pancreatitis (imipenem/cilastatin), the characteristics of pancreatic infection changed to predominantly gram-positive and fungal infections. Fine-needle aspiration showed a sensitivity of 96% for detecting pancreatic infection. The death rate was 1.8% (1/56) in patients with sterile necrosis managed without surgery versus 24% (7/29) in patients with infected necrosis (P <.01). Two patients whose infected necrosis could not be diagnosed in a timely fashion died while receiving nonsurgical treatment. Thus, an intent-to-treat analysis (nonsurgical vs. surgical treatment) revealed a death rate of 5% (3/58) with conservative management versus 21% (6/28) with surgery. CONCLUSIONS: These results support nonsurgical management, including early antibiotic treatment, in patients with sterile pancreatic necrosis. Patients with infected necrosis still represent a high-risk group in severe acute pancreatitis, and for them surgical treatment seems preferable.

Adolescent↗
PubMed2000

Role of procalcitonin and granulocyte colony stimulating factor in the early prediction of infected necrosis in severe acute pancreatitis.

BACKGROUND: Infected pancreatic necrosis (IPN) is the main cause of death in patients with severe acute pancreatitis. Therefore an early prediction of IPN is of utmost importance. AIM: Analysis of new blood variables as potential early predictors to differentiate between IPN and sterile pancreatic necrosis (SPN). PATIENTS: 64 consecutive patients with acute pancreatitis were enrolled in this prospective study; 29 were suffering from acute oedematous pancreatitis (AIP), and 35 from necrotising disease (NP) as diagnosed by contrast enhanced computed tomography. METHODS: Procalcitonin (PCT) and granulocyte colony stimulating factor (G-CSF) in the serum were examined and compared with C reactive protein (CRP). CRP was measured with a turbidimetric immunoassay (Autokit CRP; Wako, Osaka, Japan), and PCT and G-CSF by ELISA (Lumitest PCT; Brahms Diagnostica, Berlin, Germany; G-CSF-Elisa; R&D Systems, Abingdon, Oxon, UK). Monitoring was performed daily and related to the onset of symptoms. RESULTS: Within the first week, all three variables (CRP, PCT, and G-CSF) were significantly higher in patients with NP than in those with AIP (CRP, p<0.001; G-CSF, p<0. 001; PCT, p<0.001). During the course of the study, 12 of the 35 patients with NP developed late IPN after a median of 20.5 (range 3-49) days. Neither the peak nor the lowest concentrations during the monitoring period were of any value for predicting IPN (median peak values in SPN v IPN: PCT, 0.93 v 1.93 ng/ml; G-CSF, 347 v 421 pg/ml; CRP, 270 v 325 mg/l). CONCLUSIONS: Serum PCT, G-CSF, and CRP concentrations are of similar value for early differentiation between mild and severe acute pancreatitis. However, these variables are not suitable for the early prediction of IPN.

Acute Disease↗