Biomedical subjects

D Löhlein

Publications and source records attributed to D Löhlein.

At least 55 records · Page 3Linked to original sources

PubMed1985

[New aspects of the reconstruction of large defects of the oral mucosa with microvascularly anastomosed small intestinal grafts].

Our experience in reconstruction of extensive defects in the oral mucosa with free jejunal grafts in 15 patients is reported. The jejunum provides a well vascularised mucosal lining, which is resistant to mechanical stress and being a thin flap contours well in the mouth. Methods of avoiding technical failure are described. The technique permits radical resection of oral tumours.

Carcinoma, Squamous Cell↗

PubMed1985

[Reconstruction of large defects of the oral mucosa with free, revascularized jejunum transplants].

The resection of oropharyngeal cancer often creates large mucosal defects which may impair chewing, swallowing or speech function severely. Therefore, proper reconstruction is crucial for the patient. In five cases with cancer of the floor of the mouth, the tongue, the cheek and the soft palate respectively, a successful reconstruction was achieved by means of a free revascularized jejunal graft. Tumour resection and preparation of the jejunal graft are performed synchronously by two surgical teams. After suturing the graft into the oropharyngeal defect its mesenteric vessels are usually anastomosed to the facial artery and the external jugular vein. Results showed that the jejunal graft is a most adequate substitute for oropharyngeal defects and superior to skin flaps. In a sixth patient the graft was lost because of an arterial thrombosis. This failure was not life threatening, but led to a poor functional result. Postoperative radiation therapy was tolerated by the transplanted jejunal mucosa in spite of a marked inflammatory reaction.

Adult↗

PubMed1984

Free jejunal graft for reconstruction of oral, oropharyngeal, and pharyngoesophageal defects.

A free jejunal graft was used either as a patch or as a conduit in 40 cases of reconstruction of the oral cavity, hypopharynx, and upper esophagus. Compared with previous intraoral reconstructive techniques using skin or myocutaneous flaps, one-stage free jejunal grafts result in low morbidity, rapid postoperative recovery, and no additional head and neck scars. Because of secure vascularization, the retention of temporary mandible implants is made safer. In addition to tongue reconstruction, facial contouring can also be achieved by the use of mesenteric fatty tissue. The well-vascularized physiologic lining created by utilizing the jejunal graft is highly resistant to mechanical stress and postoperative radiation therapy.

Adolescent↗

PubMed1984

[Computed tomography of malignant stomach tumors].

Forty-four patients with malignant disease of the stomach (41 carcinomas, three non-Hodgkin lymphomas) and two patients with chronic gastric ulcers were examined by computer tomography before undergoing surgery. The ulcers, the non-Hodgkin lymphoma and the carcinomas stages pT2 to pT4 were easily demonstrated, as well as 66% of carcinomas in stage pT1. In addition to the primary tumour, it was possible to recognise lymph node and organ metastases. Two of the 46 patients were not submitted for surgery because of extensive metastases.

Adult↗

PubMed1984

[The free jejunal graft for the reconstruction of the hypopharynx and cervical esophagus].

The free jejunal transfer for primary reconstruction of the cervical oesophagus after laryngo-pharyngectomy was described more than 20 years ago. Its popularity as a surgical method has increased in recent years with improvement in microsurgical techniques. Tumour resection and preparation of the jejunal graft are performed synchronously by two surgical teams. After suturing the graft into the defect the mesenteric vessels are usually anastomosed to the superior thyroid pedicle. In this series four patients are presented, in three there were no complications, in the fourth a fistula developed despite adequate vascularisation of the transfer. The jejunal graft has proved to be a good functional replacement for the cervical oesophagus. Experience in other series have shown the risks of necrosis, fistulae, stenosis and abdominal complications to be minimal.

Adult↗

PubMed1984

[Protein-sparing mechanisms of parenteral feeding. I. Principles and methods].

The first part of this review deals with the response of organism to protein losses in relation to basic conditions of healthy subjects. Then it is differentiated between the consequences of substrate shortage observed in fasting metabolism and the impact of increase losses of substance occurring after trauma or operation. This distinction seems to be important not only because of the different metabolic responses of organism but also with respect to the different quantitative aspects underlying rational assessment and use of clinical treatment. In the second part an overview is given concerning the possibilities of the measurements of protein losses as well as the methodical assumptions of their valuation. At this, such methods which can be used and performed in clinical conditions are placed into the foreground. It is pronounced, that protein losses measured can only be interpreted correctly, if the clinical situation of the day as well as the time course of disease are carefully taken into consideration.

Blood Proteins↗

PubMed1984

[Protein-sparing mechanisms of parenteral feeding. II. Clinical aspects].

Based on primarily clinical findings this review tries to give a survey on the influence of parenteral application of single substrates, different nutritional regimens or special amino acids mixtures on acute protein losses. It can be emphasized that adequate amino acids substitution as such represents the dominating protein sparing mechanism during acute diseased states. The additional influence of calorie supply, however, is relatively limited, demonstrated by the fact, that already low-dosed carbohydrate supply shows a comparably favourable protein-sparing effect. At increased energy expenditure after major trauma or operation the relatively early use of fat emulsions--after decline of acute hormonal trauma reaction--for partial replacement of calories clearly seems to be of metabolic advantage compared to an exclusive and high-dosed carbohydrate supply. Further positive influence on acute protein losses can be expected by the adaption of the rates of amino acids supplementation to the trauma dependent alterations in behaviour of free amino acids, however, comprehensive clinical experiences are still lacking.

Amino Acids↗

PubMed1983

[Choice of method and long-term results of therapy for complicated gastric ulcers].

65 patients with a complication of a gastric ulcer without any known ulcerative noxa had been treated surgically. In 2 of 3 patients, bleeding or perforation occurred without a longer history of ulcer. In bleeding ulcer, we performed a partial gastric resection, only in older patients a simple suture of the bleeding source. Therefore, mortality of simple suture was higher than of partial gastric resection (overall 13.9%). Perforation of gastric ulcer had only been oversewn with good results. In the last years, we did not see any indication for performing a selective proximal vagotomy in complicated gastric ulcer. The overall mortality rate of perforated gastric ulcer was 17.2%. There was no ulcer recurrence, neither in the group of gastric resection for gastric ulcer bleeding nor in the group of oversewing for gastric ulcer perforation.

Female↗

PubMed1983

[Correction of amino acid imbalances as adjuvant therapy in septic peritonitis].

A prospective and randomized study was performed in 18 patients with septic peritonitis to investigate the behavior of free amino acids in serum before and during parenteral nutrition with 2 different amino acid solutions. One group received a so called "liver-solution" with 45% branched chain amino acids and reduced aromatic and sulphur-containing amino acids, the other group a conventional solution with 10,5% branched chain amino acids. Amino acid imbalances typically in sepsis--elevation of aromatic and sulphur-containing amino acids as well as alanine and proline, normal or decreased branched chain amino acids--could be observed only to some extend, because the influence of preceding operative trauma was overlapping. However, with conventional parenteral nutrition these imbalances then became clearly apparent. On the other hand, in patients treated with the special amino acid solution nearly complete normalization of amino acid levels took place. This effect was mainly due to the increased supplementation of branched chain amino acids positively influencing protein metabolism, and less produced by the changes in amino acid proportions supplied. Clinically these patients also had a clear improvement of consciousness status. The positive effect of such balanced solution on amino acid metabolism and mental situation of septic patients could be confirmed. Their use in septic peritonitis during necessary parenteral nutrition as an adjunctive treatment therefore seems to be efficient.

Adult↗

PubMed1982

[Selective proximal vagotomy with ulcer excision or Billroth I resection in chronic stomach ulcer. A prospective randomized multicenter study].

In a prospective randomised multicenter study in 41 patients with chronic gastric ulcer type I according to Johnston we compared selective proximal vagotomy (SPV) plus ulcerectomy (21 patients) with a standardised Billroth I gastrectomy (20 patients). The follow-up period was at least 2 years. Preoperative characteristics of both groups did not differ. Intraoperatively, in 5 patients of the SPV group technical problems during dissection of the lesser curvature occurred. The main postoperative complaints were pain and epigastric fullness after SPV and bile vomiting, early dumping or diarrhea after Billroth I gastrectomy. 3 of 21 patients after SPV developed recurrent ulceration, whereas after BI resection no recurrence was observed. This study indicates a higher recurrence rate in gastric ulcer patients after SPV compared to Billroth I gastrectomy.

Clinical Trials as Topic↗

PubMed1982

[Indication and practical aspects of perioperative parenteral nutrition].

By means of the present clinical findings it is demonstrated that an improvement of the preoperative nutritional status goes along with a reduction of the postoperative rates of mortality and complications. The effects of postoperative catabolism compared with chronic protein losses are shown. It is demonstrated that acute catabolism is essentially at the cost of viscerally synthesized and functionally important protein systems whereas chronic states of catabolism mainly affect the structural protein of the overall organism. This differentiation appears to be of importance in selecting the perioperative nutritional treatment. It must be distinguished between a specific protein replacement therapy in cases of acute protein losses and a calorically adequate parenteral nutrition in chronic deficiency states and calorie deficits. On the basis of our own findings these conceptions are illustrated, and practical hints for performing the infusion therapy are given.

Adolescent↗

PubMed1981

[Protein-sparing effect of various types of peripheral parenteral nutrition].

A randomized clinical study was performed postoperatively in a total of 47 patients comparing three different concepts of peripheral parenteral nutrition. Substituting 1 g amino acids (AA)/kg b.w. daily, the amount of carbohydrates (CH) was changed solely: gr. II no carbohydrates (sole AA-substitution), gr. III 2 g CH/kg b.w. (hypocaloric nutrition) and gr. IV 5 g CH/kg b.w. (basic nutrition). The influence on protein metabolism was examined by cumulative N-balances, various plasma proteins viscerally synthesized and serum amino acids predominantly utilised in peripheral tissues. In comparison to a non-fed-control group (I), hypocaloric nutrition showed the qualitative most favourable protein-sparing effect. Besides, 87% of N-retention serum levels of plasma proteins and amino acids investigated could be normalized completely. Peripheral basic nutrition also had a 88% rate of N-retention, however, only peripherally utilised amino acids were influenced beneficially whereas the plasma proteins remained depleted. Sole AA-substitution neither affected amino acid levels nor plasma proteins, and the N-retention rate was significantly lowered (67%). Possibly this type of therapy increases protein turnover solely, while true protein-sparing took place only with additional CH supply. However, a positive effect on visceral protein synthesis was observed exclusively with hypocaloric nutrition.

Abdomen↗

PubMed1981

[Sugar substitutes or glucose in peripheral venous hypocaloric nutrition?].

Postoperative hypocaloric peripheral-venous nutrition with the same content of amino acids (1 g/kg BW/d) and carbohydrates (2 g/kg BW/d) was performed in two groups of patients, one group receiving xylitol and sorbitol (1:1), the other pure glucose only. Regarding the behavior of different parameters of the protein metabolism it could be demonstrated, that glucose supply although improving the N-retention by 12% had no significant favourable effect on viscerally synthesized plasma proteins in contrast to the polyols. Because of the nearly identical endogenous insulin stimulation in both groups it can be assumed, that glucose supply inhibits lipolysis completely thus reducing free fatty acids levels in plasma and therefore increasing peripheral insulin sensitivity resulting in enhanced utilisation of the amino acids supplied mainly in muscle. Additionally the improvement in synthesis of visceral proteins supplying polyols can be also due to a specific effect of these substrates, because the known activation of pentose-phosphate-cycle, especially by xylitol, increases RNA-synthesis and therefore lately improving protein synthesis, too.

Abdomen↗

PubMed1979

[Hepato-biliary sequential scintigraphy for diagnosis of bile-passage after bilio-digestive anastomosis (author's transl)].

37 patients with bilio-digestive anastomosis--18 choledocho- and 19 hepatico-jejunostomies Roux-en-Y--had been followed up for 6--62 months. Hepato-biliary sequential scintigraphy showed in 26 patients both unimpeded bile passage and normal function of the jejunal loop. 6 patients had stenosis in the common bile duct or the anastomotic region with cholangitis and cholostasis. In 5 patients we observed an impaired function of the jejunal loop. Though all of these patients had clinical symptoms only one patient developed cholostasis.

Bile Duct Diseases↗

PubMed1979

[Supply of amino acids only in the early postoperative phase. Preliminary report].

The effect on protein metabolism was studied in patients, who received 4 different types of peripheral-venous infusions in the early postoperative period. Group 1 (control): Electrolytes + vitamins; group 4: 1 g/kg b. w. amino-acids alone; group 6: 1 g/kg b. w. amino-acid plus 2 g/kg b. w. carbohydrates, and group 7: 1 g/kg b. w. amino-acids plus 5.5 g/kg b. w. carbohydrates. Compared to the control-group in all patients supplemented with amino-acids a significantly improved 24 h-nitrogen balance was observed. Regarding the cumulative nitrogen balance (4 days), it was noticed that the balance was more negative in patients given amino-acids alone than in patients, who received carbohydrates additionally. At no time serum protein levels (albumin, transferrin, prealbumin and retinol-binding protein) were found to be significantly improved by the addition of amino-acids alone. Therefore, our study indicates that there is no reason to leave the proven concept of peripheral-venous feeding with amino-acids plus carbohydrates to the favor of sole amino-acid infusions in the early postoperative period.

Amino Acids↗

PubMed1979

[Alternatives to peripheral-venous parenteral feeding].

The protein-sparing effect of different programs of peripheral-venous parenteral feeding was studied in 31 patients following abdominal surgery. 10 patients (group II) received 1 g amino acids/kgBW/day, 11 patients (group III) 1 g amino acids and 2 g carbohydrates/kgBW/day and 10 patients (group I, control) were infused only with water and electrolytes. Patients with simultaneous addition of amino acids and carbohydrates had significantly better nitrogen balances than patients given amino acids alone. The normalisation of amino acids metabolised and delivered predominantly by muscle, just as the significant improvement in serum levels of transport and acute-phase proteins demonstrated that the utilisation of added amino acids took place not only in peripheral but also in visceral tissues. Comparable positive effects could not be seen with sole amino acid infusion. Our study indicates that this program, being effective in the state of keto-adapted starvation, is of no use in the early postoperative period, because of lacking corresponding metabolic conditions.

Amino Acids↗

PubMed1979

[Effect of peripheral venous parenteral feeding on the postoperative protein status].

Following limited abdominal surgery peripheral-venous parenteral feeding was performed in 30 patients: 15 patients (group II) received 0.8 g amino acids and 4 g carbohydrates/kg BW; and 15 patients (group III) 1 g amino acids and 5 g carbohydrates/kg BW. As a control group (I) 10 patients were infused only with water, electrolytes and vitamins. A significant improvement of nitrogen balances was noticed in both groups of patients with parenteral nutrition, and about 90% of the infused amino acids was retained as nitrogen. However, the serum levels of various proteins--albumin, transferrin, pre-albumin and retinol-binding protein--presented no significant changes. There was no evidence that peripheral parenteral nutrition improved postoperative metabolism of plasma proteins. It is assumed that the administered amino acids are probably utilised in peripheral tissues (e.g. muscle, wound-repair) and are, therefore, not or only in low measures available for synthesis of plasma proteins in liver.

Blood Proteins↗

PubMed1979

[Contraindications of combined surgical procedures in abdominal surgery (author's transl)].

Combined surgical procedures can often increase the entire trauma of operation. A comparative study of our patients showed, that small additional procedures did not influence the operative stress and had only few contraindications. On the other hand medium sized and greater simultaneous operations caused an increased number of postoperative complications, which to some extent resulted from additional surgery. Among other risk factors the increased rate of postoperative complications should be considered concerning the performance of combined surgical procedures.

Abdomen↗