PubMed Health⌕ Search

Biomedical subjects

D Löhlein

Publications and source records attributed to D Löhlein.

At least 37 records · Page 2Linked to original sources
PubMed1994

Improved cumulated nitrogen balance after administration of recombinant human growth hormone in patients undergoing gastrointestinal surgery.

OBJECTIVE: To examine the effect of recombinant human growth hormone (rhGH) on the catabolic state following major gastrointestinal surgery. DESIGN: The study was designed as a prospective controlled randomized clinical trial. SETTING: Intensive care unit and the surgical ward of the Department of Surgery, Städtische Kliniken Dortmund, FRG. PATIENTS: 39 patients were studied postoperatively following gastrectomy or resection of the rectum. The patients were 40-75 years old. INTERVENTION: 0.075 (n = 11), 0.15 (n = 9) or 0.30 IU rhGH/kg/day (n = 9) or placebo (n = 10) were given subcutaneously at 8:00 a.m. during 5 postoperative days. Resting energy expenditure (REE) on the 1st postoperative day was 2,042 +/- 82 kcal/24 h (REE/BEE 1.44 +/- 0.04). Isocaloric, isonitrogenous total parenteral nutrition provided the energy requirements (4 g carbohydrates/kg, 0.9 g fat/kg, 1.25 g amino acids/kg). RESULTS: After 5 days of treatment, cumulated nitrogen balance (CNB) was improved dose-relatedly. In controls, net nitrogen losses (-20.47 +/- 3.86 g) were significantly higher than after 0.15 (-12.14 +/- 3.5 g) and 0.30 IU rhGH/kg (-10.0 +/- 2.61 g). 0.075 IU rhGH/kg showed no significant effect on CNB (-18.07 +/- 5.73 g). The modulation of protein metabolism by GH may be mediated by insulin-like growth factor-I (IGF-I). Postoperatively serum (S)-IGF-I was decreased in all groups. rhGH caused a significant dose-related increase in S-IGF-I levels on day 6, whereas in controls it remained unchanged during the study period. Besides significant elevations in serum glucose in some cases of both larger dosage groups no side effects were detected. CONCLUSIONS: The protein-sparing effect of rhGH after major gastrointestinal surgery is dose related but not linear. A threshold value for a significant improvement in the CNB seems to be at least at 0.15 IU rhGH/kg/day.

Adult↗
PubMed1994

[Increased wound healing disorders in patients with inguinal hernia caused by administration of antithrombotic agents in the abdominal wall].

In a prospective, randomized study, including 108 patients, we investigated the effect of different locations for the subcutaneous injection of low dosed or low molecular heparin following standard herniotomia. In the group with injection into the contralateral abdominal wall the rate of local surgical complications was four times higher compared to those patients with injections into the thigh. Thus we conclude that after herniotomia low dosed or low molecular heparin should be applied into the subcutis of the thigh.

Adult↗
PubMed1994

[Experiences with reliability and rate of complications in collar or thoracic anastomosis after subtotal esophagectomy].

In the period from 1988-1992 we performed 148 subtotal esophagectomies. In 69% (102 cases) the operation was carried out because of squamous cell carcinomas of the esophagus, in 27% (40 cases) because of adenocarcinomas and in 4% (6 cases) because of other indications. In 97% (143 cases) the passage was reconstructed by means of a tubulized gastric pull-up established by Akiyama and in of a tubulized gastric pull-up established by Akiyama and in 3% (5 cases) by means of a colon interposition, whereby all interponates were pulled up through the posterior mediastinum. The esophago-gastrointestinal anastomosis was performed in 98% (145 cases) by a hand made suture end-to-side. In 2% (3 cases) we performed the anastomosis by a mechanical EEA device. The collar anastomoses (n = 88) on the posterior wall were covered with the remainder of the gastric fundus, the thoracal anastomoses (n = 60) on the anterior wall were secured by means of a plication. Postoperative surgical complications occurred in 22.7% of the collar and in 25.0% of the thoracal anastomoses. Insufficiencies (n = 3) were observed with thoracic anastomoses only 2 of the 3 insufficiencies were lethal. Postoperative paralysis of the n. recurrens, disturbance of swallowing coordination and aspiration occurred in 29.5% of the collar and in 13.4% of the thoracal anastomoses. In contrast to other reports we were able to show that the collar esophago-enteroanastomosis after subtotal esophagectomy is safer than the thoracic anastomoses with regard to anastomotic insufficiencies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1993

Postoperative course of functional and cellular variables in liver resection.

The determination of total serum bile acids (BA) is a sensitive variable for detection of altered liver function. This study investigated the course of serum bile acids in 44 liver-resected patients with different factors possibly compromising liver function. These factors were 1) amount of resected parenchyma; 2) duration of intraoperative ischemia; and 3) patient's age. The course of BA was compared with that of transaminases, bilirubin, lactate, and NH3. Serum BA showed a course correlated to the amount of resected liver parenchyma and differentiated between groups with < or = 35% and > 35% resected parenchyma. Whereas BA were more accurate in paralleling the resected tissue in the first postoperative days, a rise of bilirubin indicated complications in the postoperative course. As BA did not increase in a case of pulmonary-induced multiorgan failure, the specificity of this variable for liver function is implied. Different amounts of resection could not be distinguished by determination of transaminases. Different ischemic periods did not result in significant differences in the postoperative course of BA or bilirubin. However, marked elevations of transaminases depending on the duration of hepatic inflow occlusion were seen. None of the traced variables were related to the patient's age.

Adolescent↗
PubMed1993

[Results of preoperative radio-chemotherapy in locally advanced squamous epithelial cancer of the esophagus].

In a 4-year period (1988-1991) 122 patients with a squamous cell carcinoma of the esophagus were studied prospectively and analysed. 64 patients of them could be primary resected (primary resectability rate 52%), 36 patients were in general inoperable and 22 patients had an advanced stage of cancer with local inoperability. Due to a preoperative combined radiotherapy and chemotherapy 16 of the 22 patients with local inoperability had a clinical remission of the tumor (73%). 11 patients (50%) showed a histological verified down staging and 3 cases of them a complete remission (no primary tumor was found, no infiltration of the regional lymphnodes and no metastatic disease). Curative resection was possible in 14 of 16 patients with clinical remission (2 patients refused surgical treatment). So the resectability rate now increases from 52 to 63%. We conclude that there was no increased rate of postoperative complications or mortality in the combined radio-/chemotherapy group compared with the primary resected patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

[Diagnostic and therapeutic strategies in locally recurrent rectal cancer].

Following curative operation for rectal cancer, 14-44% of the patients develop a local recurrence, in most instances situated in the operative bed. Differentiation of recurrent tumor, scar tissue and inflammation is not always possible by computerized tomography and magnetic resonance imaging. Recurrent tumor in these patients is diagnosed by percutaneous biopsy and histological analysis. In 24 patients in whom operation was impossible and a maximum irradiation dose was also applied, chemotherapy was administered in the form of regional perfusions. The internal iliac arteries were perfused with folinic acid and 5-fluorouracil in these patients. This procedure reduced the intensity of pain or achieved a pain-free interval of 9 days to 8 months.

Chemoembolization, Therapeutic↗
PubMed1991

[Approaches in parenteral nutrition].

The central venous catheter, on the one hand, and the peripheral venous cannula, on the other hand, are available as fundamental access possibilities for parenteral nutrition. While the implantation of a central venous catheter is technically tiresome and subject to a complication rate up to 5%, the peripheral venous cannulization, in general, does not represent any technical problem. However, in case of peripheral venous access, due to the local venous compatibility, not only the duration of application is generally limited to 4-6 days, but the feeding of nutritious substances as such (excepting fat emulsions) is restricted, too. This means a limitation of the applicability in temporary and acute phases of a disease, as well as its application as a supplementary therapy in the event of oral or enteral nutrition. The advantage of the central venous parenteral nutrition refers to the possibility of a long-term high-doses, and thus to a complete parenteral, nutritional therapy. It is, however, subject to an aggravating rate of thrombotic (0.5-5%) and septic complication (3-6%), so that the indication and duration of application should be looked upon very closely and critically. The low-risk alternatives of a peripheral venous parenteral nutrition should be observed more closely.

Catheterization, Central Venous↗
PubMed1988

[Technic and problems of resection of small intestine segments for free transplantation].

The removal of a segment of the small bowel for free microvascular transplantation corresponds to a small bowel resection in routine abdominal surgery. Attention must be given to the careful preparation of a sufficiently long vascular pedicle, clear separation and marking of the artery and vein, and adaptation of the mesentery to the graft location. According to the author's experience inflammatory small bowel disease and general occlusive vascular disease are contraindications to small bowel transplantation.

Humans↗
PubMed1988

[Multiple colorectal cancers: properties and long-term prognosis].

In our own patient population with primary colorectal cancer (n = 1352, 1971-1984) we analyzed the frequency, characteristics and prognosis of multiple carcinomas. The overall incidence was 7.3% (4.5% synchronous and 2.8% metachronous carcinomas). Compared to single cancer synchronous tumors had a worse and metachronous tumors had a better 5 year-prognosis (58%, 43% and 86% respectively). This suggests that synchronous and metachronous colorectal carcinomas may be two biologically separate entities. Conclusions from our observations are discussed in regard to diagnosis, therapy and follow-up.

Colonic Neoplasms↗
PubMed1987

[Postoperative low-calorie parenteral feeding].

In parenteral nutrition a distinction can be made between hypocaloric, normocaloric, and hypercaloric forms, depending on the amount of energy supply. Hypocaloric parenteral nutrition has been specifically adjusted to the conditions of postoperative metabolism. Doses between 1.2 g and 1.5 g/kg body weight/d of amino acids are the most important components of peripheral venous nutrition. The economy of amino acid utilisation, primarily by patients not adapted to fasting or to ketone body utilisation, can be improved by a low dosage of 2.5 g of carbohydrates to 1 g of amino acids. Polyols were found to be decisively superior to glucose as energy carriers by taking into much closer consideration the mechanisms of autoregulation in postoperative metabolism and by favouring synthesis of intrahepatic functional proteins to peripheral synthesis. Hypocaloric peripheral venous parenteral nutrition has proved to be effective therapeutic concept by which to bridge the early postoperative phase in elective surgery.

Amino Acids↗