PubMed Health⌕ Search

Biomedical subjects

F Pfeffer

Publications and source records attributed to F Pfeffer.

At least 19 recordsLinked to original sources
PubMed2004

[The non-healing wound].

The most common chronic wounds are pressure ulcers, diabetic ulcers, arterial occlusive disease and venous ulcers. The therapeutic aim after appropriate diagnostic work-up is causal treatment. Pressure relief, revascularisation or compression head the list of potential measures. Apart from local factors such as infection or necrosis, systemic factors such as patient compliance, renal insufficiency and immunosuppression are of relevance. If there is a chance of healing, wound management comprises repeated debridement and wet dressings. In the presence of an infection, local antiseptic treatment is indicated. In the individual case, wound stimulation can be supported by protease inhibitors, growth factors or tissue engineering. Definitive wound closure is achieved by epithelial migration from the margins of the wound, or by plastic surgery. Regular documentation of the course and success of wound healing is mandatory. In the wound care center, surgical disciplines, diabetology, dermatology and diagnostic work-up are coordinated, and liaison with the family doctor and home care providers practiced. This wound healing concept successfully heals approximately 80% of the cases of chronic wounds in 18.8 months (mean healing duration 4.8 months).

Adult↗
PubMed2004

Pancreas graft thrombosis: is there a role for trypsin.

PURPOSE: Thrombosis of the pancreas graft is the main cause of early graft loss in pancreas transplantation. We investigated whether hypercoagulability develops locally in the pancreas and contributes to thrombosis formation because of ischemia or reperfusion injury. It was further hypothesized that this might be induced by excessive intravascular trypsin activity. METHODS: Ten Patients undergoing pancreas transplantation were studied. In addition to the standard operation a 14 French catheter was inserted in the distal part of the splenic vein of the pancreas graft. After reperfusion blood samples were drawn simultaneously from the splenic vein of the pancreas graft (local samples) and the radial artery (systemic samples) at 0,1,2,5,10,30, and 60 minutes after reperfusion. RESULTS: After reperfusion a progressive hypercoagulability developed locally in the pancreas as seen by an increase of thrombin-antithrombin complexes and only a transient increase of plasmin-antiplasmin complexes. In addition antithrombin 3 and protein c decreased systemically. The alterations seem not to be triggered by trypsin because trypsin activity locally remained low despite trypsinogen release and activation as assessed by trypsinogen activation peptides. CONCLUSION: Local hypercoagulability might contribute to the development of graft thrombosis, however, the mechanism seems not to be related to ectopic trypsin activation.

Antithrombins↗
PubMed2003

Collagen synthesis during pregnancy, vitamin C availability, and risk of premature rupture of fetal membranes.

OBJECTIVE: To examine the relationship between plasma and leukocyte concentration of ascorbic acid and collagen type I propeptide C during pregnancy and subsequent premature rupture of membranes (PROM). METHODS: Fifteen women with PROM and 26 controls were compared for plasma and leukocyte concentration of vitamin C and for Pro-C during pregnancy. RESULTS: A statistically significant difference in maternal leukocyte ascorbic acid concentration was found between the two groups at week 28 of gestation (P50 was 16.90 for PROM group vs. 21.46 for control group; P>0.05). Increased risk for PROM (odds ratio, 10.99; 95% confidence interval, 2.40-49.91) was found with elevated concentrations of Pro-C at week 16 of gestation. CONCLUSIONS: A higher rate of collagen synthesis early in pregnancy was demonstrated in PROM cases. However, no correlation with ascorbic acid availability was found. This study supports the findings of others that collagen metabolism disturbances are associated with PROM.

Ascorbic Acid↗
PubMed2002

[Post-discharge surgical wound infection: what is to be done?].

Infection of the laparotomy wound cannot always be prevented--for a variety of reasons including patient-related, disease-related and surgery-related factors. Of importance is the early detection of a wound infection--with confirmation or exclusion of underlying pathology (e.g. anastomotic leakage)--before sepsis develops. As a rule, a laparotomy wound infection can be adequately controlled by re-opening, debridement and moist management. Innovative dressing techniques involving vacuum sealing and suction accelerate healing.

Bandages↗
PubMed2002

Effect of nitric oxide in ischemia/reperfusion of the pancreas.

BACKGROUND: Ischemia/reperfusion injury, and thus graft pancreatitis, remains a major problem in pancreas transplantation. Contradictory results about the role of nitric oxide (NO) in pancreatic ischemia/reperfusion have been reported; however, in none of the reports has a detailed comparison between inhibition of NO synthase and NO supplementation been carried out. METHODS: Vascular isolation of the pancreatic tail was performed in landrace pigs. After splenectomy catheters placed in the distal part of the splenic vessels allowed collection of the venous effluent and perfusion of the pancreatic tail. Three hours of complete warm ischemia was followed by 6 h of reperfusion. The effect of the NO donor sodium nitroprusside (SNP) and L-arginine was compared to a control group and NO synthase inhibition with L-NAME. RESULTS: Lipase in the venous effluent of the pancreas was significantly decreased in the SNP and the L-arginine groups. Vascular resistance was markedly elevated in the L-NAME group and reduced in the NO donor groups. Tissue pO2 after reperfusion was only significantly elevated in the SNP group. Granulocyte infiltration and also overall histological tissue injury were most severe in the control group followed by the L-NAME group, the SNP group, and the L-ARG group. CONCLUSION: The data show that supplementation of nitric oxide is clearly protective in pancreatic ischemia/reperfusion. However, inhibition of NO synthesis does not lead to an equally clear aggravation of tissue injury.

Acute Disease↗
PubMed2002

Modified shoelace technique for delayed primary closure of the thigh after acute compartment syndrome.

The authors report a case of acute compartment syndrome in the thigh in a 19-year-old man with multiple injuries including fracture of the femoral diaphysis. Decompressive fasciotomy was performed emergently. Complete progressive closure of the wound without split-thickness skin grafting was achieved using a modified shoelace technique: sutures were run inside wide drains placed in contact with the muscles and were then tightened over the skin. These drains enlarged the contact area between sutures and muscles, preventing damage to muscles.

Acute Disease↗
PubMed2002

[A new locking nail for proximal humerus fractures: the Telegraph nail, technique and preliminary results].

We present a new nail, the telegraph nail, designed for the treatment of proximal fractures of the humerus. This nail has a new locking system providing a self-stabilization of the cancelous screws inserted in small fragments. We discuss the surgical technique and present preliminary results. The anterolateral approach and nail insertion through the medial and well vascularized part of the cuff is described for simple fractures. With the cup and ball technique, this nail can also be used for complex fractures of the proximal humerus with three or four fragments and major displacement. With this method, the nail is inserted before reduction and locked in the distal humerus before fixation of the head and tuberosities around the head once the targeting device removed. We report results for the first 64 nails inserted in our unit during the first year (1998-1999). Outcome was assessed at 11 months mean follow-up using the Constant score. Outcome was favorable, including in patients with complex fractures involving 3 or 4 separate displaced fragments. Besides providing an anatomically stable reconstruction, the telegraph nail has the advantage of allowing early mobilization of the shoulder joint. This method is a useful alternative to prosthetic reconstruction for traumatic fractures of the proximal humerus.

Adolescent↗
PubMed2001

Impairment of microcirculation in the early reperfusion period predicts the degree of graft pancreatitis in clinical pancreas transplantation.

BACKGROUND: Graft pancreatitis is thought to be induced by ischemia/reperfusion. Animal experiments have suggested that an impaired microcirculation is crucial in this process. We have therefore studied the relevance of microcirculation in clinical pancreas transplantation. METHODS: In 17 patients undergoing pancreas transplantation, tissue pO2 was monitored continuously by an electrode implanted into the pancreatic tail. A catheter was inserted in the distal part of the splenic vein of the pancreas graft. After reperfusion blood samples were taken from this catheter and blood flow was measured by the venous outflow method. The degree of graft pancreatitis was assessed by peak-C-reactive protein (CRP) defined as highest CRP within 3 days after transplantation. RESULTS: Tissue pO2 increased within 5 min after reperfusion. Thereafter, in most patients a transient decrease was noted, indicating impairment of nutritive perfusion. During this period there was an increasing negative correlation between peak-CRP and tissue pO2 which was highly significant at 60 min after reperfusion (r=-0.70, P<0.002). Also donor age correlated significantly with peak-CRP (r=0.64, P<0.005) and to a somewhat lesser extend with tissue pO2 60 min after reperfusion (r= -0.55, P<0.03). CONCLUSION: These data show that the degree of organ damage in clinical pancreas transplantation is directly related to an impairment of microcirculation in the early reperfusion period. These data also support the idea that grafts from older donors have a higher probability to develop graft pancreatitis and that this might be due to an increased incidence of microcirculatory disturbances in these organs.

Adult↗
PubMed2001

[Network of surgical wound centers using a new electronic data processing documentation system].

UNLABELLED: Care of chronic wounds is of enormous medical, social and economic importance. Nevertheless there is a lack of epidemiological and economical data. A network of ten wound care centers was created and data were documented in a new computerized wound documentation system. METHODS: Treatment was performed according to a comprehensive and standardized wound care protocol. The new documentation system is a network-capable solution. Digital images and planimetry as well as patient and wound related data are recorded. RESULTS: During the first year the ten centers treated and documented already 3281 wounds. There is a wide spectrum of different chronic wounds treated in the participating centers. Despite of long wound duration of several wounds with a median of 5 weeks (range 0-62 years), the healing rate was 80% within 455 days. CONCLUSION: Large amounts of data can be collected and scientifically evaluated in the wound net. This is realized by a new computerized documentation system, which was integrated into the clinical routine and enables clear and standardized documentation. Therefore even large multicenter therapy studies may be performed easily in the wound net and economical data could be collected.

Chronic Disease↗
PubMed2001

An organic psychosis due to a venlafaxine-propafenone interaction.

OBJECTIVE: An extraordinary case of an organic psychosis during the treatment of a patient with a bipolar affective disorder. METHODS: Clinical observation and further investigations including monitoring of serum levels (case report). RESULTS: A significant interaction between venlafaxine and propafenone causes markedly increased serum levels of venlafaxine correlating with unexpected psychopathological changes. CONCLUSIONS: There is a potentially dangerous interaction between venlafaxine and propafenone. Serum levels of venlafaxine should be monitored if propafenone is added.

Aged↗
PubMed2000

Does glucagon stimulation predict oral glucose tolerance in patients after simultaneous pancreas-kidney transplantation?

BACKGROUND: Exogenous glucagon rapidly stimulates insulin secretion. This test has been used to estimate insulin secretory capacity, which may predict oral glucose tolerance in patients after pancreas transplantation. METHODS: In 32 pancreas-kidney transplant recipients, in 10 nondiabetic kidney transplant recipients, and in 9 healthy control subjects, a glucagon stimulation test (1 mg i.v.) and a 75-g oral glucose tolerance test were performed with determination of glucose, insulin, and C-peptide profiles. RESULTS: Of 16 pancreas transplant recipients with the lowest insulin responses after glucagon, 7 had an impaired oral glucose tolerance, in contrast to 1 of 16 with high insulin responses (P=0.037). A low insulin response after glucagon was associated with significantly lower 120-min glucose concentrations (P=0.043) and a lower integrated incremental insulin response after oral glucose (P=0.006). CONCLUSIONS: In pancreas-kidney transplant recipients, a low insulin response after intravenous glucagon predicts a reduced insulin response after oral glucose and an impaired oral glucose tolerance. This simple test may be helpful in the follow-up of pancreas transplant recipients.

Adult↗
PubMed2000

[Filling of bone defects with tricalcium phosphate beta in traumatology].

AIM OF STUDY: Synthetic bone substitutes like calcium phosphate ceramics have been used in orthopaedic surgery for several years. The aim of this study was to assess the results of the use of tricalcium phosphate beta for filling bone defects in trauma cases. PATIENTS AND METHOD: beta tricalcium phosphate was used in 24 trauma cases. The GESTO classification (Association pour l'étude des Greffes et Substituts Tissulaires en Orthopédie) and a qualitative scale were used to estimate the integration. RESULTS: With a mean follow-up of 20 months, integration was excellent in 41.2%, good in 29.2% and moderate in 17.4%. No fibrous encapsulation was observed around the implants in any case. Sepsis occurred in 3 cases with open fractures. CONCLUSION: beta-Tricalcium phosphate seems in our experience to be an excellent bone substitute for filling bone defects in trauma cases.

Adult↗
PubMed1999

Critical islet mass for successful porcine islet autotransplantation.

A major reason for the failure of clinical islet transplantations may be a limited islet mass. The aim of this study was to determine the critical islet mass necessary for normalization of glucose metabolism in a porcine model. Diabetes was induced by total pancreatectomy. The splenic lobe of the pancreas was intraductally distended with UW-solution containing 2.67-3.33 mg/ml collagenase, and the distended pancreas was digested in a continuous digestion filtration device. The islets were purified on a isoosmotic Ficoll-sodium-diatrizoate gradient. The survival period of the diabetic recipients in group 2 and 3 receiving, respectively, a low (2.14+/-0.39 microL/kg body weight) and a high (4.99+/-0.83 microL/kg body weight) islet mass was significantly prolonged compared to that of diabetic recipients in group 1 receiving no islet transplantation. However, the survival period of the recipients in group 2 was not significantly different to that in group 3. Three recipients of an islet mass of >5 microl/kg body weight became normoglycemic (fasting blood glucose <100 mg/dl) for more than two months. Furthermore, the glucose and insulin release reactions to the glucose challenge were comparable to that before pancreatectomy. Contrarily, another five diabetic recipients of an islet mass of <4 microL/kg body weight became a fasting blood glucose level of <200 mg/dl. The glucose and insulin release reactions to the glucose challenge were improved only, but not normalized compared to that before pancreatectomy. The data presented in this study demonstrate that metabolic normalization in pancreatectomized diabetic minipigs can be established by autotransplantation of an islet mass of >5 microl/kg body weight.

Animals↗
PubMed1999

First clinical application of a newly developed device for intragastric surgery for the treatment of pancreatic pseudocysts.

BACKGROUND: Instruments that have been used during GI endoscopy have always been confined to the accessory channel of the endoscope. We have therefore developed a device that allows transabdominal manipulation in the stomach under gastroscopic control. Here we report the first clinical application of this device, which was used for the drainage of pancreatic pseudocysts. METHODS: The device is similar to a PEG tube and consists of a 7 mm polyethylene tube that is inserted by the "thread pull through" method. A trocar valve is mounted at the external tip of the tube. Four pseudocysts were treated in three patients. The retrogastric pseudocysts were punctured through the device under endoscopic (n = 2) and CT (n = 2) guidance. External drainage was used for 3 to 5 days; thereafter the drain was cut and internalized. The device was also cut and sealed. After 10 days it was removed as with a standard PEG tube. RESULTS: No complications related to the device occurred. In two patients the pseudocysts resolved completely. One patient had to undergo pseudocystojejunostomy for an infected pseudocyst containing large amounts of necrotic material. CONCLUSIONS: We believe that our new device is valuable to the further development of intragastric surgery and can be used to safely perform pseudocystogastrostomy.

Adult↗
PubMed1999

[Secondary diabetes in pancreatic carcinoma and after pancreatectomy: pathophysiology, therapeutic peculiarities and prognosis].

Diabetes and pancreatic cancer are known to be associated. The relative risk for pancreatic carcinoma is dependent on the time after onset of diabetes. Diabetes in patients with pancreatic carcinoma is frequently of recent onset and partially caused by the tumor. Diabetes in a patient without obesity, no family history and unusual requirement for aggressive management including a rapid start of insulin treatment, may be early symptoms of pancreatic cancer. Recognition of atypical diabetes as an early symptom of pancreatic cancer may lead to earlier diagnosis and improved survival in these patients. Pancreatic carcinoma and chronic pancreatitis with untractable, incapacitating pain are the main reasons for (partial) pancreas resection. Pancreas resection may lead to a deterioration of pancreatic endocrine function. In healthy humans, hemipancreatectomy leads to impaired glucose tolerance after oral stimulation in 25% of the patients. To reduce morbidity resulting from operation, several operation techniques have been developed. Postoperative glucose metabolism is primarily dependent on the degree of preexisting endocrine function and on the amount of pancreatic tissue being resected. Early surgical intervention may, on the other hand, prevent the progression of endocrine insufficiency in the course of chronic pancreatitis. Good results of resective procedures now allow earlier operation. Any operative technique should aim on stopping the inflammatory process while preserving as much pancreatic tissue as possible. The choice of operation to be performed is dependent of morphological changes and individual local complications of the patient.

Diabetes Mellitus, Type 1↗
PubMed1998

The nitric oxide donor sodium nitroprusside is protective in ischemia/reperfusion injury of the pancreas.

BACKGROUND: The role of nitric oxide in the ischemia/reperfusion injury of the pancreas is still unclear. In other organs, protective as well as aggravating effects have been described. We have, therefore, investigated the effect of the nitric oxide donor sodium nitroprusside on pancreatic ischemia/reperfusion injury. METHODS: In Landrace pigs, after transsection of the pancreas, complete vascular isolation of the pancreatic tail was performed. The tail was subjected to 3 hr of warm ischemia and thereafter reperfusion (6 hr). The animals were divided into a control group (n=7) and a treatment group (n=7) that received 15 mg of sodium nitroprusside after reperfusion intra-arterially into the splenic artery. RESULTS: The morphological tissue damage and lipase activity in the venous effluent of the pancreas were significantly lower in the treatment group. Partial oxygen tension in the tissue after reperfusion was markedly reduced in the control group, indicating an impairment of microcirculation. In the treatment group, however, partial oxygen tension in the tissue was significantly higher (43 vs. 20 mmHg; P<0.014). Furthermore, total blood flow through the pancreatic tail in the treatment group was found to be significantly higher in the late reperfusion period (14 vs. 9.5 ml/min at 5 hr after reperfusion; P<0.05). CONCLUSION: There is a marked impairment of pancreatic microcirculation after reperfusion. Sodium nitroprusside counteracts this impairment and has a protective effect on ischemia/reperfusion injury of the pancreas.

Adenosine Triphosphate↗