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Biomedical subjects

D Wilker

Publications and source records attributed to D Wilker.

At least 19 recordsLinked to original sources
PubMed1990

[Therapeutic concept in incidentaloma of the adrenal gland].

The operative approach to adrenal incidentalomas depends on the subclinical hormoneactivity and the risk of malignancy. In our 18 patients there were two pheochromocytomas (3 and 5 diameter), one with subclinical hormoneactivity and three malignancies, an adrenocortical carcinoma, a metastasis without primary and a lymphoma. The malignant tumors were larger than 5 cm. As tumors smaller than 3 cm are usually benign they should be observed. Because of the risk of malignancy there is a relative indication to operate on larger tumors.

Adrenal Gland Neoplasms↗
PubMed1990

[Cervical transverse spinal cord injury caused by knife stab injury].

This clinical report refers to a case of quadriplegia caused by a knife stab wound in the cervical spine. Open removal of the knife made it possible to avoid such complications as bleeding and infection. Nevertheless, the tetraplegic signs and symptoms were the result of complete severance of the cervical spinal cord and therefore persisted.

Adult↗
PubMed1988

[Early phase of healing of anastomoses with special reference to peritonitis and ischemia].

Experimental sutureless colonic anastomosis was evaluated under various conditions during the first 24 postoperative hours. Adaptation of large bowel segments was achieved by interrupted inverting sutures, which were removed after one hour. This short adaptation period was sufficient for fibrinous contact of bowel segments. Breaking strength of intestinal anastomosis was determined under normal conditions, in peritonitis, complete ischemia and unilateral ischemia of one bowel segment. As control parameter breaking strength of conventional anastomosis was determined under normal conditions. We obtained the following results: 1) Sutureless anastomosis exhibited significantly lower breaking strength than conventional anastomosis. 2) Sutureless anastomosis showed a significant increase in breaking strength under normal conditions after the first 6 h, on the contrary breaking strength remained at lower levels in peritonitis. 3) In complete ischemia anastomotic failure was observed even after 3 h of adaptation. Therefore breaking strength was not measurable. 4) Under unilateral ischemia breaking strength of intestinal anastomosis was significantly lower than under normal conditions.

Anastomosis, Surgical↗
PubMed1988

[Sutureless anastomoses in the rat, rabbit and pig].

Healing of intestinal anastomoses was found to be effective in rat, rabbit and pig even after temporary approximation by sutures for one hour. Approximation of bowel segments was achieved by interrupted inverting sutures. After one hour a fibrinous connection of inverted serosa segments was to be observed. Bursting pressure was determined on the 1st, 3rd and 7th postoperative day. There was no significant difference between sutureless and regular anastomoses. Determination of breaking strength of approximated anastomoses one hour and twenty-four hours after removal of sutures was found to be 0.19 N and 0.8 N, respectively. Extent of adhesions was similar in conventional and sutureless anastomoses. Histologic analyses revealed areas of necrosis in sutured anastomoses, whereas in sutureless anastomoses no necrosis could be detected.

Anastomosis, Surgical↗
PubMed1988

[Anastomoses of the large intestine in standardized diffuse peritonitis in the rat].

A standardized experimental diffuse peritonitis model was developed for the purpose of studying the mechanisms of impaired anastomotic healing in cases of peritonitis. Sham peritonitis or standardized diffuse peritonitis was induced to 42 animals, and anastomosis of the ascending colon was performed 24 hours later. Bursting pressures were measured at six different time intervals, following performance of anastomosis. Significant differences in bursting pressure between sham peritonitis and real peritonitis were restricted to the shortest time interval after performance of anastomosis. More studies will be necessary to investigate the high rates of insufficiency in peritonitis cases.

Anastomosis, Surgical↗
PubMed1987

Nonsuture microsurgical vessel anastomosis.

An alternative microsurgical method for achieving vessel union without applying sutures is presented. The basic principles of the technique involve the creation of an extraluminal cuff that permits exact adaptation of both endothelial layers, without intraluminal damage or application of foreign material. When used for microsurgical procedures, the method can be further simplified by using a Teflon cuff secured by means of a mini-clip. The anastomosis can be accomplished quickly, in an uncomplicated and precise fashion. On the basis of preliminary experiments, this method appears to offer a wide range of applications, particularly if absorbable material is used.

Anastomosis, Surgical↗
PubMed1987

Cysteinyl leukotrienes as mediators of staphylococcal enterotoxin B in the monkey.

The role of cysteinyl leukotrienes (LTs) in the action of staphylococcal enterotoxin B (SEB) was investigated in unsensitized monkeys using inhibitors of prostanoid synthesis and LT action and by measuring generation of LT in vivo. LY 171883, a selective LTD4/LTE4 receptor antagonist, proved highly efficient in inhibiting immediate-type hypersensitivity reactions in the skin and protecting against the emetic response provoked by SEB in a concentration-dependent manner. Inhibition of prostanoid formation by pretreatment of monkeys with indomethacin or aspirin did not influence SEB responses. Based on chromatographic and radioimmunologic analysis, the generation of endogenous cysteinyl LTs was demonstrated in vivo. The concentration of LTE4, the major biliary cysteinyl LT detected, increased ten-fold and a novel cysteinyl LT metabolite in urine indicated strongly enhanced LT generation upon challenge with SEB. Cysteinyl LTs are important mediators in the pathophysiology of SEB-induced enteric intoxication. Therefore, cysteinyl LT antagonists may be of therapeutic value in the treatment of this intestinal disorder.

Acetophenones↗
PubMed1987

Staphylococcal enterotoxin B as a nonimmunological mast cell stimulus in primates: the role of endogenous cysteinyl leukotrienes.

The immediate-type skin reaction and the emetic response in unsensitized monkeys on challenge with staphylococcal enterotoxin B (SEB) were studied to define the role of cysteinyl leukotrienes (LTs) in the action of the toxin. LY 171883, a selective LTD4/LTE4 receptor inhibitor, antagonized SEB-induced skin reactions and emetic responses completely. Inhibition of prostanoid formation by indomethacin, however, and pretreatment with BW 755C, a dual lipoxygenase and cyclooxygenase inhibitor, did not influence these reactions. The generation of endogenous cysteinyl LTs upon intragastric SEB administration was established in vivo. There was a tenfold increase in LTE4, the major biliary cysteinyl LT, and a novel cysteinyl LT metabolite in urine occurred, indicating strongly enhanced LT generation on SEB challenge. These results provide the first evidence that cysteinyl LTs may be important mediators in the pathophysiology of SEB-induced effects, as a model for pseudo-allergic reactions.

4,5-Dihydro-1-(3-(trifluoromethyl)phenyl)-1H-pyraz↗
PubMed1987

[Microvascular anastomosis of the iliac crest transplant in mandibular reconstruction].

In 12 patients with extensive lower jaw defects following tumor removal or after radioosteonecrosis, a free osteocutaneous iliac crest flap with microvascular anastomoses was used to reconstruct the lower jaw in a single session. The results are reported in brief for this group, in many of whom conditions were not optimal for transplantation because of previous surgery, infection, or radiological tissue damage.

Arteries↗
PubMed1986

Metabolism and analysis of cysteinyl leukotrienes in the monkey.

Predominant hepatobiliary elimination from blood and subsequent enterohepatic circulation of cysteinyl leukotrienes is demonstrated in the monkey Macaca fascicularis. From intravenous [3H]leukotriene C4, about 40% were recovered as metabolites in bile and about 20% in urine within 5 h. [3H]Leukotriene E4 was a predominant metabolite of defined structure in blood plasma, bile, and urine. From intraduodenal [3H]leukotriene C4, about 5% were recovered as metabolites in bile and about 8% in urine within 8 h. Endogenous cysteinyl leukotrienes generated in vivo were measured after implantation of a subcutaneously looped biliary bypass. Tapping of the loop allowed access to bile and prevented interference by leukotrienes produced by surgical trauma (Denzlinger, C., Rapp, S., Hagmann, W., and Keppler, D. (1985) Science 230, 330-332). Endogenous cysteinyl leukotrienes were analyzed in bile, urine, and blood plasma by the sequential use of high-performance liquid chromatography and a radioimmunoassay that was optimized for leukotriene E4 as a predominant metabolite detected in the tracer studies. Biliary leukotriene E4 rose from less than 0.2 to 9 nmol/liter, when leukotriene synthesis was elicited in anesthesized monkeys by staphylococcal enterotoxin B administered intragastrically. This study provides an approach to the analysis of cysteinyl leukotrienes in primates and serves to define the role of these mediators under pathophysiological as well as physiological conditions in vivo.

Animals↗
PubMed1986

[Plastic surgery measures in connection with bone transplantation in bone and soft tissue defects].

Free tissue transfer by means of microvascular anastomoses has opened up new dimensions in reconstructive surgery. However, a free microvascular myocutaneous flap should only be used, if a local pedicled flap is impossible. In treatment of complicated soft-tissue and bone defects, there are clear-cut and gradual therapeutic steps: wound debridement; soft tissue repair; bone reconstruction.

Adult↗
PubMed1986

[Incidence of stab injuries of the heart in the clinic and forensic autopsy practice. Experiences with 6 surgical procedures].

During a period when 6 patients were operated following a cardiac stab wound 4 patients survived the procedure. In 45 persons forensic autopsies were performed. The analysis of both groups elucidate that successful treatment is possible if pericardial tamponade inhibits free bleeding into the cavity of the thorax. But this situation must be treated very quickly avoiding cardiac arrest due to cardial blockage. In contrast to the autopsies in the clinical group no atrial wounds or incisions of coronary arteries were observed.

Adolescent↗
PubMed1986

[Therapeutic procedure in "incidentaloma" of the adrenal glands].

Incidentally discovered adrenal masses are a therapeutic challenge. As benign lesions, like hyperplasias and adenomas, are much more common than malignant ones, an approach is needed, which incidental discovered mass should be removed. If the tumor is hormonally active or the lesion has a diameter of more than 3 cm, we advice surgery. The smaller mass should have a careful follow-up.

Adenoma↗
PubMed1985

[Soft tissue and bone defects of the tibia. Treatment with pedicled muscle transfer and a microvascular anastomosed myocutaneous flap].

The free tissue transfer by microvascular anastomoses has opened new dimensions in reconstructive surgery. However a free microvascular myocutaneous flap should only be used in case of a local pedicled flap being impossible. In treating complicated defects of soft tissue and bones a clear cut gradation of therapeutic steps has to be observed: 1. control of wound infection, 2. wound debridement, 3. soft tissue repair, 4. bone reconstruction.

Adult↗