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Biomedical subjects

H B Reith

Publications and source records attributed to H B Reith.

At least 37 records · Page 2Linked to original sources
PubMed1998

Procalcitonin in early detection of postoperative complications.

BACKGROUND: A prospective clinical study was performed to assess the accuracy of procalcitonin in 70 patients with elective colorectal or aortal surgery and to compare it with inflammatory mediators. Also the early prediction of complications and the outcome of these patients was taken into account. METHODS: Laboratory variables and cytokine determination were obtained preoperatively, on the day of operation and postoperatively on a daily basis from day 1 to 5, and on days 7 and 10 in the colorectal group and in the aortal surgery group at different times on the operation day after aortal clamping. The main outcome criteria were early recognition of complications and alterations in the production of procalcitonin and cytokines in order to detect severe infective complications. RESULTS: Procalcitonin was closely related to postoperative complications with significantly elevated levels at day 1 after surgery. The plasma concentrations of IL-6 increase on days 1-3 without a difference in the groups, also C-reactive protein demonstrates no differences. CONCLUSION: Procalcitonin presents itself as a new parameter of infection and sepsis. In the postoperative period PCT seems to be an interesting marker of early prediction of infective complications when high postoperative levels are found. Under routine conditions procalcitonin is a valid reproducible and detectable parameter.

Adult↗
PubMed1997

[Therapy of peritonitis today. Surgical management and adjuvant therapy strategies].

Acute necrotizing pancreatitis and fylecal or diffuse purulent peritonitis are the diseases primarily responsible for mortality due to surgical infections of the abdomen. The most recent figures indicate that a mortality rate of 50%-80% in this specialized treatment group is still a reality. Without doubt, surgical sanitation of the focus is the most important therapeutic measure. A generalized inflammation reaction has been regularly observed in nearly all patients within this disease category. Local surgical therapy has the greatest effect on prognosis. If the therapeutic goal is not reached with the first intervention, adjuvant surgical therapy is necessary. The different forms are continuous peritoneal lavage (CPL), open dorsoventral lavage, and relaparotomy or scheduled reoperation ("Etappenlavage"). Adjuvant medical treatments include TNF alpha and interleukin-1 synthesis inhibitors or antibodies. Unfortunately, clinical studies with these mediators have only been partly successful in the subgroups, so that a general clinical adjuvant treatment is not considered viable. The bacterial properties of taurolidine destroy the bacterial membrane and, at the same time, lead to cross-linking of the membrane components and functional proteins (LPS), so that a bactericidal effect and endotoxin reduction take place simultaneously. Both local and intravenous routes of administration can be used.

Anti-Infective Agents↗
PubMed1997

The oncological approach to pylorus preserving pancreatoduodenectomy (PPPD) in pancreas malignancies.

There has been a considerable debate about whether pylorus preservation significantly detracts from the radicality in a palliative procedure where a conventional Whipple operation would have been curative. We know now, that the extending radicality of the Whipple operation does not improve the long-term survival rates. Our results of 127 PPPD and 54 Whipple procedures in pancreas malignancies from 1985 to 1996 showed the nutritional benefits of the PPPD group as compared to the standard Whipple group. 84% (99/121) vs. 24% (13/50) were able to gain postoperatively. The long-term survival rates of both groups and the results in the literature are similar.

Breath Tests↗
PubMed1997

[Simultaneous intervention in vascular surgery. Risk assessment and cost-benefit analysis].

Thirty-four simultaneous vascular operations were performed from 1993 to 1996. Postoperative complications were similar to additive complication rates of carotid endarterectomies and other vascular operations undertaken during this period. Operation time and postoperative hospital stay was significantly shorter, and cost-benefit analysis revealed clear advantages for the simultaneous group.

Comorbidity↗
PubMed1996

[Current indications for pylorus saving duodenopancreatic head resection in malignancy].

The Whipple procedure has been improved by preservation of a functioning pylorus. A functioning pylorus is important because marginal ulceration is avoided and, compared to the standard Whipple procedure with gastric resection, more patients can gain weight postoperatively. The most common indications are carcinomas of ampulla of Vater and periampullary tumors. In patients with pancreatic adenocarcinoma the pylorus-preserving variety results in equal or better survival rates. In 56 patients with pylorus preservation, 32 with ductal carcinoma, and 28 with Kausch-Whipple between 1985 and 1993, our results showed slightly better survival rates and better postoperative nutrition. The weakest aspect of the radical resection addresses the retroperitoneal margin of the pancreas head and not the gastric resection.

Adenocarcinoma↗
PubMed1995

[Morphology and biological integration of autodermoplasties in large incisional hernias. Results of an experimental study].

UNLABELLED: Their aim of the experimental study was to investigate the morphology and wound healing of "Kutisplastik"-technique, originally introduced by Loewe (1913) and Rehn (1914), from different conditions. We want to clarify the mechanism and development of revascularisation. RESULTS: The well known phases of wound healing also appear in the situation of a cutisplasty. In the exsudative reaction the cutis is covered from fibrin fibers. This leads to the development of granulation tissue. The cellular reaction demonstrates first the in-growth of capillary bundles and vessels in the collagen network of corium. The revascularisation is finished up to 14 days after the operation. The other part is the immigration of granulocytes and macrophages in the graft. The release of enzymes leads to the lysis of epidermal structures, cutaneous appendages and at least to collagen fibers of corium. There is also a proliferation from fibroblasts. The genesis from new collagen fibers is then observed so a scar tissue reveals. The "Kutisplastik"-technique contains that the epidermal side of the graft is turned upside-down towards the peritoneum and is sutured under as high tension as possible to the healthy fascia around. This morphology of healing is seen only under high-tension suturing. In the experimental mode of non-tension suturing there is a lack of success in cutisplasty for abdominal wall defects.

Animals↗
PubMed1994

[Morphology and healing of skin repair in abdominal wall defects. An animal experiment study].

UNLABELLED: The aim of the experimental study was to investigate morphology and wound healing following the skin plasty ("Kutisplastik") technique originally introduced by Loewe [11] and Rehn [17] under different conditions. We wanted to clarify the mechanism and development of revascularisation. RESULTS: The familiar phases of wound healing take the usual course after a skin plasty. In the exsudative reaction the cutis is covered with fibrin fibres. This leads to the development of granulation tissue. The cellular reaction takes place in two parts: first comes the ingrowth of capillary bundles and vessels in the collagen network of corium; revascularization is complete within 14 days after the operation. This is followed by the immigration of granulocytes and macrophages into the graft. The release of enzymes leads to the lysis of epidermal structures, cutaneous appendages and ultimately to collagen fibres of corium. There is also proliferation from fibroblasts. Genesis from new collagen fibres is then observed as scar tissue. The skin plasty technique involves turning the epidermal side of the graft to the peritoneum and suturing it under the highest tension possible to the surrounding healthy fascia. This course of healing is seen only with such high-tension suturing. Experimental nontension suturing has led to failure of skin plasty for abdominal wall defects.

Abdominal Muscles↗
PubMed1994

A comparison of long term results of the standard Whipple procedure and the pylorus preserving pancreatoduodenectomy.

The standard Whipple procedure involves intestinal disturbances, such as dumping, diarrhea, dyspeptic complaints and the occurrence of ulcers of the anastomoses. A postoperative weight loss was observed ranging between 10 and 40 kilograms. Only a few patients were able to compensate after several months. It was thought that preservation of the intact stomach would prevent the complications arising from a loss of gastric reservoir function and thus the malnutrition could be improved postoperatively. Between 1985 and March 1992, we performed the pylorus-preserving Whipple procedure and treated a group of 43 patients with this method. In the same period, 15 patients were operated upon with the standard Whipple procedure. The present evaluation of the accumulated patient data, including extensive functional studies, led to the following results comparing the pylorus preserving Whipple procedure with the standard Whipple procedure. First, the capacity for food uptake and the development of body weight postoperatively is significantly better. Second, gastric or jejunal ulcers were not observed. Third, there were no clinical signs of digestive disorders, such as different forms of dumping. Nutrition and digestion were not impeded by the preserved opening mechanism of the pylorus. Fourth, the postoperative exocrine function was only slightly decreased. Fifth, glucose metabolism postoperatively was influenced only slightly by preservation of the pylorus. In taking the results of all the examinations into consideration, it can be said that the restricted organ loss in the Whipple procedure with pylorus preservation leaves the secretory and functional capacity of the upper part of the gastrointestinal tract almost unchanged.

Adult↗
PubMed1993

[Treatment of pancreatic injuries. Study of a series of 34 patients].

Routine retrograde imaging of Wirsung's duct, an essential investigation of pancreatic injuries, should be carried out preoperatively and, in case of failure of the intervention, intraoperatively. Whereas simple drainage is sufficient treatment for injuries to the pancreatic parenchyma, lesions of Wirsung's duct require either duodeno-cephalic pancreatectomy or left pancreatic resection, depending on the site of the ductal wound, conservative treatment carrying the major risk of a post-traumatic acute pancreatitis with its particularly elevated mortality rate. Of the 34 cases, reported: 24 (70.6%) were treated by resection: 3 by duodenocephalic pancreatectomy and 21 by left pancreas resection, 6 (17.6%) by suture of the parenchyma and contact drainage and 4 (11.8%) by drainage of Wirsung's duct by catheter or excluded loop in Y. Mortality was 14.7% (5 of the 34 patients). Complications included pseudocysts requiring operative removal in 3 of the 6 patients treated by suture-drainage, and severe sepsis in 5 patients with a fatal outcome in 3 cases. Treatment was unsuccessful in 2 of the 4 patients treated by drainage by catheter or excluded loop in Y, whereas mortality was nil after pancreatic resection.

Adult↗
PubMed1992

[Results of treatment of early functional therapy following incomplete fibular ligament rupture].

Up to now, the inversion trauma of the ankle joint is one of the most important and frequent injuries. The functional treatment has come to a point of advantages in the therapeutic regime. Nevertheless a follow-up is necessary. In a follow-up examination, in the average of 27 months after trauma, 90.3% of the patients have satisfactory or better results. In all patients a stress tenography is carried out. Between radiologic finding and clinical situation is no direct correlation. In the treatment of fibular ligament rupture it is necessary to find out the patients with chronic instability. They have a benefit in an early reconstructive operation of the fibular ligaments.

Adolescent↗
PubMed1991

[Diagnosis and interdisciplinary therapy of spinal cord compression caused by spinal metastases].

Metastatic tumours of the bone system occur up to 60% in the spinal cord. The epidural spinal cord compression is also found by metastatic tumour, so patients with metastatic disease in this localisation carry a poor prognosis. From 1986 to 1988 35 patients with symptomatic spine metastasis are operated upon. 43% of these patients recover their capability of walking. 90% from the operated collective show a reduction of pain. The primary tumour is first found from cancer of the lung and second from the kidneys. The most common localisation of metastatic tumour is the thoracic spine. The ratio from male to female is 2:1. If the risk of operation and differential therapy is discussed, the decompression and tumour resection will be the first. The concept for postoperative mobilisation and therapy concludes the stabilisation of spinal cord with internal fixation. Treatment of metastatic tumours takes aim at the improvement of life quality.

Adenocarcinoma↗