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Biomedical subjects

E H Farthmann

Publications and source records attributed to E H Farthmann.

At least 91 records · Page 5Linked to original sources
PubMed1992

Value of endoscopic retrograde cholangiopancreatography in determining the cause but not course of acute pancreatitis.

We have recently shown that ERCP is the most useful technique for detecting a biliary origin of acute pancreatitis and can be done without side effects. We now report on a second series of 50 patients with acute pancreatitis in whom ERCP, computed tomography (CT), ultrasound (US), and clinical and laboratory assessment were performed within the first 24 to 48 hours of hospitalization. A score for ERCP, CT and US was used to assess the severity of the disease. Patients were followed up until discharge or death and their condition classified according to outcome as mild (less than or equal to 1 complication), severe (greater than 1 complication) or fatal. ERCP was superior in detecting choledochal stones (ERCP 100%, US 25%, CT 50%) and dilated intrahepatic ducts (ERCP 75%, US 75%, CT 37%) but not gallbladder stones (ERCP 70%, US 100%, CT 60%). When the ERCP severity score was calculated there was no relevant difference between patients thereafter having a mild course (0.66 +/- 0.91, range 0-3), a severe course (1.3 +/- 0.80, range 0-3), or a fatal outcome (1.0 +/- 1.1, range 0-3). In contrast, the CT score was different in all three groups (mild: 3.0 +/- 1.9; severe: 5.3 +/- 3.2; lethal: 6.3 +/- 3.1) as was the US score (mild: 1.5 +/- 1.3; severe: 3.2 +/- 2.3; lethal: 4.4 +/- 1.4). It is concluded from these results that ERCP is of value in defining the origin of acute pancreatitis. When a biliary origin is detected this can lead to immediate treatment using endoscopic sphincterotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1992

Interleukin-8 and neutrophil activation in acute pancreatitis.

It has been suggested that leucocytes play an important role in the pathogenesis of complicated pancreatitis. Indeed, increased plasma concentrations of neutrophil elastase as a marker of neutrophil activation could be detected in patients with a severe course of the disease. Recently, interleukin-8 (IL-8) has been described as a novel neutrophil activating peptide. To determine the role of IL-8 in acute pancreatitis we measured its serum concentrations by a specific enzyme-linked immunosorbent assay in 10 patients with acute pancreatitis daily during the first week of hospitalization. IL-8 levels were compared with plasma concentrations of neutrophil elastase and the clinical course of the disease. Three of the patients had uncomplicated pancreatitis, while seven showed various extrapancreatic complications. Patients with complicated pancreatitis had statistically significant (P less than 0.05) higher mean values of IL-8 (121 +/- 41 pg/ml-1 vs. 13 +/- 6 pg ml-1, mean +/- SEM) and neutrophil elastase (547 +/- 35 ng ml-1 vs. 250 +/- 20 ng ml-1) than patients with uncomplicated disease. There was a positive correlation (r = 0.52, P less than 0.0001) between IL-8 and neutrophil elastase in the lower concentration range of IL-8 (less than 100 pg ml-1). At IL-8 levels greater than 100 pg ml-1 neutrophil elastase was always greatly elevated; however, under these conditions the relationship between IL-8 and elastase was no longer linear. No measurable IL-8 concentrations were found when plasma elastase was less than 200 ng ml-1. During follow-up, initially elevated IL-8 concentrations decreased in correlation with clinical improvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1992

[Palliative interventions].

The German Gastric Cancer TNM Study included 1335 patients, of whom 657 (49.2%) underwent palliative surgery. The rate of resection was 50.6%. Postoperative complications occurred twice as often after palliative resectional surgery than after non-resectional procedures. In contrast, operative mortality rates did not differ. The median time of survival was 3 months after non-resectional procedures and 11 months after palliative resections. A considerable restriction of the quality of life occurred 2-3 months before death in both patient groups. Therefore, patients with non-resectional surgery hardly profit from the operation.

Follow-Up Studies↗
PubMed1992

[Serum gastrin level in patients with colorectal adenoma or carcinoma].

During the last years interest has focused on the trophic effect of gastrin in colorectal carcinomas. Some reports indicated an increased serum level of gastrin in patients with colorectal adenomas or carcinomas. In a prospective study in 261 patients submitted to colonoscopy fasting serum gastrin concentrations were determined. 91 patients served as control, 89 patients had one or more adenomas, 55 patients suffered from a colorectal carcinoma, 17 had a benign, postoperative stenosis of the colon, and 9 had a chronic inflammatory bowel disease. All patients fulfilled the following criteria: No regular drug intake, no previous gastric or small bowel operation, no known ulcer disease, no abnormalities in serum calcium, creatinine, triglycerides, cholesterol and blood urea. Mean gastrin level was 86.63 +/- 23.8 pg/ml in the control, 84.57 +/- 25.1 pg/ml in the adenoma group and 84.6 +/- 24.4 pg/ml in the carcinoma group. No difference of serum gastrin levels were observed regarding sex, age, tumor stage and localisation.

Adolescent↗
PubMed1991

[Clinical value of ultrasonography and computerized tomography prior to abdominal interventions].

We studied the value of ultrasound and computed tomography in the preoperative diagnosis of abdominal diseases in 100 patients. Reference methods were the reports of surgery and pathology. A computed tomography or ultrasound diagnosis could be correct or false and was considered uncertain, if the main diagnosis was missed but computed tomography or ultrasound suspected pathology, which then could be clarified by other procedures. Overall, computed tomography was superior with 75 correct, 13 false and 12 uncertain diagnoses compared to ultrasound with 58 correct, 31 false and 11 uncertain diagnoses. Ultrasound often failed because obesity or gas impaired visibility. If only cases without technical problems of ultrasound were taken into account, diseases of liver, gallbladder, pancreas, kidney, the adrenal region and other abdominal masses were equally well diagnosed by ultrasound and computed tomography. As expected, the diagnostic value of both modalities was markedly reduced in diseases of the bile duct and the gastrointestinal tract. Because the study design required both, ultrasound and computed tomography, cases already clarified by ultrasound were not included. This fact might have further reduced the sensitivity of ultrasound in comparison to computed tomography. Furthermore, ultrasound was mostly one of the first diagnostic procedures performed right after the patient's admission with little information on anamnestic and clinical data. The information given prior to computed tomography was in general more detailed.

Adult↗
PubMed1991

[20 years kidney transplantation. Experience of a practice].

Between September, 1969, and May, 1990, 1,086 kidney transplantations were performed in Freiburg. In the majority of cases, the transplantations were allografts and had been made possible by close cooperation with the Eurotransplant Foundation. The results of this long-term study show that the transplant function rates at one year in the period under observation were comparable. Only the introduction of the immunosuppressive agent cyclosporine A brought about any improvement. On the basis of the results achieved at our center, the HLA system had an influence on transplantation function rate only in the case of the DR system. However, this does not mean that, for organ matching, the HLA system should no longer be complied with, since multicentric studies have substantiated its importance. High-risk groups, such as diabetics and elderly patients who undergo a transplantation achieve the same good results as the low-risk groups, provided that each case is carefully considered on its individual merits.

Adolescent↗
PubMed1991

[Laparoscopic cholecystectomy].

In a short space of time, laparoscopic cholecystectomy has become the operative treatment of choice in cholecystolithiasis. The performance of the operation, however, requires complex equipment, and became at all possible only with the aid of video technology. The indication depends both on the patient's symptoms and the experience of the operator. Prior surgery in the upper abdomen and complications of gallstones are considered relative contraindications, and portal hypertension an absolute contraindication. The advantages of this minimally invasive operative procedure are the minimal traumatization and improved postoperative well-being. The need for pain-killer is low, gastric tube and selective drainage are not required. Dietary build-up and mobilization are possible early on. Postoperative hospitalization is 2 to 3 days. The future will bring further developments in the field of laparoscopic operative interventions.

Cholecystectomy↗
PubMed1991

[Prolongation of hospital stay by nosocomial pneumonia and wound infection].

From June 1988 to September 1989, a prospective survey comprising a total of 1183 patients in a university hospital was carried out to ascertain the additional length of stay in intensive care units because of nosocomial pneumonia associated with artificial ventilation (418 patients, 296 men, 122 women, mean age 48.8 +/- 21 years, ventilated for more than 24 h) or by postoperative wound infections (765 patients, 501 men, 264 women, mean age 60 +/- 11 years, after operations on the large bowel, heart or biliary tract). Each patient with a nosocomial infection was matched against a variable number of control patients (for cases of pneumonia a maximum of 6, for wound infections a maximum of 10) without nosocomial infection. Pneumonia developed in 100 (23.9%) of artificially ventilated patients, and 46 of these patients together with 101 controls were entered into the matching procedure. 24 patients with pneumonia had to be excluded from analysis because no controls could be found for them, and also 30 patients who died while in the intensive care unit. 49 (6.4%) of the surgical patients contracted postoperative wound infections. 43 of them, together with 210 controls, were entered into the matching procedure. Among patients with pneumonia the average additional duration of stay was 11.5 days, and among patients with post-operative wound infections it was 13.9 days. The results confirm that nosocomial infections contribute substantially to prolongation of hospital stay and hence to the costs.

Adult↗
PubMed1991

Effects of a three-drug antineoplastic protocol of wound healing in rats: a biomechanical and histologic study on gastrointestinal anastomoses and laparotomy wounds.

Using biomechanical and histologic approaches, the effect of perioperative administration of a drug protocol containing 5-fluoruracil, Adriamycin, and mitomycin C (FAM) on the healing of gastrointestinal anastomoses and laparotomy wounds in rats was examined. Application of FAM immediately before operation resulted in significant impairment of wound healing in the early postoperative period. Once the proliferation of fibroblasts and collagen synthesis had led to an increase of mechanical strength, no negative effect on wound healing could be detected applying the same chemotherapeutic agents. These findings indicate the early inflammatory phase of the wound healing process to be most vulnerable to the chemotherapeutic effects. This has significant implications if the theoretical advantages of starting adjuvant chemotherapeutic treatment in the immediate postoperative period are implemented.

Anastomosis, Surgical↗
PubMed1991

[Postoperative hemorrhage].

Postoperative hemorrhage is the second most frequent indication for early relaparotomy. The incidence depends on the level of care in a given hospital. It is highest, therefore, in institutions delivering maximal care with many trauma cases. We performed 3443 laparotomies from January 1988 to March 1991. 214 (5.9%) patients had to be reoperated, 48 of them because of postoperative bleeding. This amounts to 1.3% of the total number of laparotomies. Bleeding was identified through drains, ultrasonography or endoscopy, ultrasonography having the highest sensitivity and specificity. Total mortality was 30%. Analysis of the literature shows that mortality is lowest when relaparotomies are performed on 3%-6% of patients.

Abdominal Injuries↗
PubMed1991

[Diagnosis and management of lower gastrointestinal hemorrhage. Retrospective analysis of 233 cases].

In a retrospective analysis the diagnostic procedure was evaluated in patients with acute lower gastrointestinal bleeding. Bleeding sources were localized distally to the ligament of Treitz in 233 patients (1979-1988). Patients with hemorrhoidal bleeding were not included. Following exclusion of an upper gastrointestinal bleeding the diagnostic procedure was initiated with a recto-/colonoscopy. Lesions were detected in 77% of the treated patients (n = 136). Angiography localized the bleeding in 68%, in combination with colonoscopy the identification of the bleeding source reached 86.5% in the treated patients. Following scintigraphy the bleeding source was determined in 89.7% of these patients. The sensitivity of colonoscopy (0.93) was superior to the angiography (0.78) and to the scintigraphy (0.75). Apart from neoplasms and adenomas angiodysplasia and Meckel's diverticula were the most common sources of the bleeding in patients who underwent operation. In 61 patients endoscopic therapy was performed, however, 6.5% of these patients had to be operated on later because of persistent bleeding. All together 79 patients underwent operation, 31 for bleeding and 48 for other reasons. 12 patients died, 6 of them were operated on for the bleeding, the other for neoplasms.

Adolescent↗
PubMed1991

Scintigraphic assessment of leukocyte infiltration in acute pancreatitis using technetium-99m-hexamethyl propylene amine oxine as leukocyte label.

The infiltration of leukocytes has been linked to the pathophysiology of complicated or severe pancreatitis. We have tested the ability of leukocyte scintigraphy using technetium-99m-hexamethyl propylene amine oxine (HM-PAO) as label to demonstrate the localization of leukocytes in the pancreas during acute pancreatitis. Twenty-eight patients with acute pancreatitis (eight with biliary, 13 with alcoholic, and seven with unknown origin) were studied with leukocyte scintigraphy using planar imaging and single photon emission computed tomography (SPECT). Fourteen patients had a mild (group I), II a severe (group II), and three a lethal outcome (group III) of pancreatitis. All patients of group III, six of group II, and two of group I had a positive leukocyte scan. Thus, the sensitivity of leukocyte scintigraphy for the detection of a lethal course of acute pancreatitis was 100%, of a severe course 54%, and of a severe or lethal course 64%. The specificity of a negative scan for a mild pancreatitis was 86%. Comparison of the results of leukocyte scintigraphy with those of contrast enhanced CT showed that six of eight patients with pancreatic necrosis in CT had a positive leukocyte scan, but only five of 20 patients without detectable pancreatic necrosis in CT. In summary, leukocyte infiltration into the pancreas during pancreatitis can be demonstrated by noninvasive leukocyte scintigraphy using technetium-99m-HM-PAO as label. A correlation between the severity of the disease and leukocyte infiltration exists.

Acute Disease↗
PubMed1991

Influence of gastrin, gastrin receptor blockers, epidermal growth factor, and difluoromethylornithine on the growth and the activity of ornithine decarboxylase of colonic carcinoma cells.

Polyamines are essential factors of cell growth and differentiation. Modulation of the cellular polyamine content by 2-difluoromethylornithine (DFMO) inhibiting ornithine decarboxylase (ODC), or by hormones inducing ODC, influences cell growth. Gastrin acts trophically on some colonic carcinomas and their growth is inhibited by gastrin receptor blockers. The mechanism of the trophic action of gastrin on colonic carcinomas is not known. In this study the effect of gastrin, gastrin receptor blockers, epidermal growth factor (EGF) and DFMO on growth and ODC activity of four human colon carcinoma cell lines (SW 403, SW 1116, LS 174 T and Lovo) was investigated. Growth and ODC activity of all cell lines were inhibited by DFMO. Growth of the SW 403 cell line was increased by gastrin and inhibited by the gastrin receptor blocker benzotrypte. The other cell lines did not respond to gastrin and the gastrin receptor blocker. In SW 403 cells ODC activity was increased by gastrin, and was also elevated after treatment with the gastrin receptor blocker. These in vitro results were confirmed by studies on tumours that developed from SW 403 cells in nude mice. Combination of benzotrypte and DFMO did not enhance the antiproliferative effect. EGF increased growth of SW 403 cells, but no induction of ODC activity was measured. LS 174 T cells were not stimulated by EGF. Medium replacement was the strongest stimulus of ODC activity in SW 403 cells already inducing ODC after 3 h. During cell culture ODC activity was high after seeding and decreased continuously with increasing cell density. These data suggest that gastrin induces ODC in gastrin-sensitive colonic carcinoma cells. DFMO appears to be a valuable antiproliferative agent in colonic carcinoma cells.

Animals↗
PubMed1991

Loss of zonal heterogeneity and cell polarity in rat liver with respect to bile acid secretion after bile drainage.

Functional liver heterogeneity depends on the current perihepatic environment. The effect of chronic bile drainage on hepatic secretion of bile acids in periportal and pericentral rat liver cells was studied. After 4 days of biliary drainage, rat livers were perfused in vitro in either forward (through the portal vein) or backward direction (through the vena cava) in single-pass arrangement with taurodeoxycholate (32 nmol.min-1.g liver-1). Tritium-labeled taurodeoxycholate (0.5 muCi) was injected as a pulse to determine uptake, biotransformation, and hepatic secretion. During bile drainage, bile flow fell from 1.8 microL.min-1.g liver-1 to approximately 0.6 microL.min-1.g liver-1. Bile acid secretion rate dropped from initially 50 nmol.min-1.g liver-1 to approximately 5 nmol.min-1.g liver-1 within 24 hours and remained at this level for the next 3 days. After bile drainage, liver histology was well preserved and was indistinguishable from controls. During liver perfusion of controls in both directions, bile flow exceeded 1 microL.min-1.g liver-1, whereas bile-drained animals demonstrated a bile flow between 0.4 and 0.6 microL.min-1.g liver-1. In contrast to controls, the drained-animal liver did not excrete label exclusively in bile but simultaneously excreted about one third back to the perfusate medium (regurgitation). Biliary bile acid recovery within the first 10 minutes after 3H-taurodeoxycholate bolus injection was 90% (of label taken up) in forward-perfused controls but only 40% in forward-perfused drained animals. Backward-perfused control and drained animals. Backward-perfused control and drained animals excreted about 20% in this time interval and did not differ significantly. T50, the time to excrete 50% of label taken up in bile or both bile and effluent, increased from 4.3 +/- 0.36 minutes (SD) in forward-perfused controls to 13.2 +/- 2.28 minutes in forward-perfused, drained animals. T50 of backward-perfused controls and backward-perfused drained animals did not differ significantly (17.8 +/- 1.75 minutes vs. 21.0 +/- 3.95 minutes). In conclusion, chronic bile drainage reduces liver heterogeneity with respect to velocity of bile acid excretion and cell polarity is lost with respect to hepatocellular translocation of bile acids.

Anastomosis, Surgical↗
PubMed1991

Elevation of serum interleukin-6 concentration precedes acute-phase response and reflects severity in acute pancreatitis.

Experimental studies have shown that interleukin-6 induces all major acute-phase proteins in the liver, including C-reactive protein. In 50 patients with acute pancreatitis, the serum concentrations of interleukin-6 and C-reactive protein were determined daily during the first week of hospitalization. Patients were divided into three groups according to clinical criteria: mild pancreatitis (less than or equal to 1 complication; n = 25), severe pancreatitis (greater than or equal to 2 complications; n = 15), and lethal outcome (n = 10). Patients with mild disease showed initially slightly elevated levels of interleukin-6 (22.0 +/- 9.8 U/mL) that decreased to low levels within 4 days (5.0 +/- 1.0 U/mL). In patients with severe pancreatitis, serum concentrations of interleukin-6 were initially clearly elevated (35.0 +/- 7.5 U/mL) and remained slightly elevated until day 7 (13.0 +/- 2.0 U/mL). Patients with lethal outcome had markedly elevated initial interleukin-6 concentrations (61.0 +/- 15.0 U/mL) that decreased but were still elevated at day 7 (26.0 +/- 2.5 U/mL). In all three groups, C-reactive protein concentrations followed the course of interleukin-6 concentrations by 1 day. There was a positive correlation between maximal interleukin 6 concentrations and maximal increases in the serum concentrations of C-reactive protein (r = 0.66). At days 1 and 2, increased (greater than 15 U/mL) interleukin-6 concentrations (positive predictive value, 91%; negative predictive value, 82%) predicted a severe or lethal course of the disease more accurately than elevated [greater than 0.10 g/L (greater than 10 mg/dL)] C-reactive protein concentrations (positive predictive value, 67%; negative predictive value, 79%). In conclusion, elevated serum concentrations of interleukin-6 followed by increased levels of C-reactive protein reflect the severity of acute pancreatitis.

Acute Disease↗