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Biomedical subjects

G Winde

Publications and source records attributed to G Winde.

69 records · Page 4Linked to original sources
PubMed1989

Differential ventilation with low-flow CPAP and CPPV in the treatment of unilateral chest trauma.

A case of severe unilateral chest trauma with bronchopleural fistula is presented. Ventilatory therapy consisted of asynchronous independent lung ventilation (AILV). The injured lung was ventilated with intermittent positive pressure ventilation (IPPV) [tidal volume (TV) = 200 ml, f = 25/min, I:E = 0.5, minute volume (MV) = 5.0 l/min, FiO2 = 0.4], and the unaffected lung was ventilated with continuous positive pressure ventilation (CPPV) (TV = 600 ml, f = 12/min, I:E = 0.5, MV = 7.2 l/min, PEEP = 0.5 kPa, FiO2 = 0.4). Adequate gas exchange was obtained (PaO2 = 14.5 +/- 2.3 kPa, PaCO2 = 5.5 +/- 0.7 kPa), but high air leakage volumes persisted. Thus, differential low-flow CPAP (V = 5.0-7.5 l/min, PEEP = 0.5 kPa, FiO2 = 0.4) of the injured lung and CPPV (TV = 600 ml, f = 12/min, MV = 7.2 l/min, I:E = 0.5, PEEP = 0.5 kPa, FiO2 = 0.4) of the unaffected lung was applied for 36 hours. Further deterioration of pulmonary function was prevented, and the bronchopleural fistula closed after several hours. After another period of AILV the patient was treated with conventional mechanical ventilation, and finally weaned with high-flow CPAP.

Adolescent↗
PubMed1989

[Duplex sonography in the diagnosis of renal artery stenoses following allogenic kidney transplantation].

Posttransplant renal artery stenosis (TRAS) as a cause of secondary hypertension is reported with an incidence of 1 to 10%. Early diagnosis of TRAS should be made by non-nephrotoxic and non-invasive means to lower the risk of hypertension. One to 66 months after kidney transplantation 335 patients underwent Duplex-scanning, 38 of cases for clinical tentative diagnosis of TRAS. Parameters for clinical diagnosis of TRAS were diastolic hypertension greater than 100 mm Hg with resistance to therapy (A), an abdominal bruit over the transplant (B), disturbance of renal function (serum-creatinine greater than 2 mg/dl) (C). Admission to study followed the parameter-combination A + B. A + C, B + C. Rejection crisis was excluded in 18/38 cases by fine needle biopsy, cyclosporine over-dosage was negative in 38/38 cases, 20/38 cases had normal renal function. Duplex-/Doppler-ultrasound criteria for TRAS were systolic peak velocity greater than 100 cm/s-1 and broadening of the diastolic frequency spectra with a smooth decline in diastole to an elevated diastolic level. In 32/38 cases (84.2%, n = 38) diagnosis of TRAS was made by duplex-scanning, angiography confirmed the result in 30/32 cases (93.75%, n = 32); sensitivity was 88.2% with a specificity of 66.6%. Duplex-scanning as a primary diagnostic means for TRAS seems a promising method compared to e.g. radionuclide imaging or angiography. Duplex-scanning is a non-nephrotoxic and non-invasive procedure repeatable at any time with only few preliminary conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Immunohistological differentiation of the cells of the arterial wall in transplanted kidneys].

22 nephrectomy specimens of renal allografts in chronic rejection after 3 months to 96 months were studied immunohistologically. The various cell types in the arterial wall were characterised with specific antibodies against different cells of the mononuclear phagocyte system, against smooth muscle cells, and for differentiating lymphatic cells. In addition, the metabolism of lipoproteins was studied using different antibodies against several apolipoproteins. According to our results, subendothelial plaques of foam cells consist of macrophages in foamy transformation. In the stage of intimal fibrosis, smooth muscle cells are more prominent. Lymphatic infiltration consists almost exclusively of T lymphocytes. Apolipoprotein analysis reveals deposits of Apolipoproteins A1 and B, mostly extracellular. On the whole, these results show that not only immunologic factors are involved in the reaction of the arterial wall in chronic transplant arteriopathy, but that like in atherosclerosis, disorders of lipoprotein metabolism, probably due to endothelial dysfunction, play an important role.

Desmin↗
PubMed1989

[Protein oriented peripheral venous nutrition following surgical trauma].

In the postoperative state, hypercaloric parenteral nutrition is not indicated in every patient where enteral nutrition is not feasible. Low caloric protein oriented peripheral venous parenteral feeding might be an alternative nutritional regimen in moderate catabolic postoperative states. In a prospective study, 18 females received a completed nutritional solution during 4 days postoperatively following major colon surgery. The solution contained 80 g Sorbitol, 40 g Xylitol, 70 g amino acids and electrolytes (700 kcal/day). A slightly negative nitrogen balance with daily losses of about 4 g of N were observed. Routine biochemical data did not change compared to preoperative values. Plasma free amino acid homeostasis has been maintained so that conditions for optimal utilisation of the infused nutrients were given. No general side effects could be observed. This protein oriented nutritional solution may be recommended for hypocaloric peripheral venous nutrition in moderate catabolic states.

Amino Acids↗
PubMed1989

[Experiences with a new fat emulsion in surgical intensive care medicine].

As far as energy availability is concerned, it is advantageous to give lipid emulsions to severely catabolic patients, in comparison to lipid-free TPN. It is important to administer essential fatty acids, especially linoleic and linolenic acid, which play a major part in synthesis of membrane phospholipids and prostaglandin metabolism. Lipid emulsions with linoleic acid content and high linoleic-linolenic ratio might be of great value in posttraumatic situations, where the need for linoleic acid might be increased up to 50 g/day. We have examined the safety of a new lipid emulsion with a linoleic-linolenic acid ratio of 16:1 in 14 severely catabolic surgical ICU patients. As a result, neither liver enzyme elevation nor allergic reactions occurred. The limited elevation of triglycerides under lipid infusion and the rapid fall of these values to normal levels account for the satisfactory utilization of the examined lipid emulsion in critically ill patients.

Adult↗
PubMed1988

[Morgagni hernia. A rare form of diaphragmatic hernia].

The Morgagni hernia is the rarest form of diaphragmatic hernias. Knowledge has been accumulated over time of combinations with other congenital malformations, familial occurrence, and traumatic genesis. Morgagni hernia has been more often recordable from women, along with rising age and usually located on the right hand side. Embryonic disorder of diaphragmatic differentiation is believed to be the major aetiological factor. Vitamin deficit as well as some chemical substances, primarily active in the foetal period, have become known as additional factors of predisposition. Intensive diagnosis to rule out malignancy is absolutely essential because of the variability of symptoms of this type of hernia. Colon fragments and large omentum were found to be most often contained in the hernial sac. Contrast medium X-ray checks of the gastrointestinal tract and pneumoperitoneum are preferential methods of examination. Exploratory laparotomy is generally considered the optional therapeutic approach because of possible saving of liver veins, safe removal of the hernial sac, and the possibility of abdominal exploration. Preoperative wide-range sterile covering of the patient's body around the site of surgery is recommended to allow for possible thoractomy, as may be required.

Female↗
PubMed1988

[Perforation of sigmoid diverticula. A complication following allogenic kidney transplantation].

In the early post-operative follow-up after allogenic kidney transplantation sigmoid perforation due to diverticula is a life-threatening complication. As immunosuppression is indispensable perforation is favoured. Due to pharmacotherapy the risk of sepsis is implied because clinical symptoms might be masked. Reference is made in this paper to four cases to describe clinical course, diagnostic and surgical approaches as well as diagnostic-therapeutic consequences for the patient of the waiting list.

Adolescent↗
PubMed1987

[Bilhemia--a review of diagnosis and therapy].

Bilhemia is a rare complication after liver injuries with high mortality. Clinical signs are rapid increase of direct and total bilirubin up to extreme values and increase of bile acids in serum. The reason is an intrahepatic connection between biliary and venous system. The bilio-venous fistula can be shown by ERCP and retrograde cholangiography via T-drainage. Localisation can be ensured by ultrasonography und computertomography. Treatment consists in resection of bilio-venous fistula, tamponade of intrahepatic cavities by use of a net of polyglactin-910 (Vicryl) or polyglycolic acid (Dexon) or sucking T-drainage.

Abdominal Injuries↗
PubMed1986

[Early diagnosis of diffuse peritonitis].

Treatment for diffuse peritonitis was applied to 62 patients at the Surgical Clinic of Münster University, between 1983 and mid-1985. Mortality accounted for 46.8 per cent. Therapeutic approaches depended on both clinical patterns and intraoperative findings. Repetitive laparotomy with abdominal lavage and generous drainage was predominant. Only five cases were given treatment with opened abdominal cavity. With early diagnosis and immediate laparotomy, 17.7 per cent of all patients were cured, and no further operation was required. A second operation was necessary for 19.3 per cent, and several laparotomies were needed by another 16.1 per cent. Twenty of the above 62 patients (32.3 per cent) died in spite of several laparotomies. Nine patients (14.5 per cent) had been received in moribund and thus inoperable condition. The mean interval between first and second laparotomies was 5.3 days. Repeated abdominal lavage became necessary in cases in which the start of therapeutic action was delayed to 6.4 days on average. This interval had been 8.3 days for patients who died despite repeated surgery. Early diagnosis was found to be the decisive prerequisite to lower peritonitis lethality. Clinical parameters in conjunction with routine laboratory checks have proved to be sufficient for adequate diagnosis in 95 per cent of all cases. High-risk patients have to be identified long time in advance. They require early surgery and intensive postoperative supervision and monitoring, if the fatal vicious circle of peritonitis is to be overcome.

Adult↗