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Biomedical subjects

H G Beger

Publications and source records attributed to H G Beger.

At least 361 records · Page 20Linked to original sources
PubMed1991

Surgery in acute pancreatitis.

The most important diagnostic step in the management of patients with severe acute pancreatitis is discrimination between interstitial-edematous pancreatitis and necrotizing pancreatitis. In this respect, laboratory measures like CRP, LDH, and antiproteases, and the application of contrast-enhanced CT are highly sensitive methods. Surgical decision-making should be based on clinical, bacteriological and contrast-enhanced CT data. Persistent or progressive systemic or local organ complications occurring despite ICU treatment for a minimum of three days are indicators for surgical management of necrotizing pancreatitis. Patients suffering from sepsis syndrome, cardiovascular shock, multisystemic organ failure syndrome, or surgical acute abdomen should be treated surgically early in the course of the disease. The use of a major pancreatic resection for the surgical management of necrotizing pancreatitis should be excluded from treatment protocols. Carefully performed necrosectomy or debridement, in combination with continuous or repeatedly applied surgical evacuation techniques for necrotic tissue, bacteria, and biologically active compounds, has proved to be very effective in experienced treatment centers. Necrosectomy and postoperative continuous local lavage is a well-adapted, safe, and atraumatic procedure. It results in a hospital mortality of less than 10% in patients with necrotizing pancreatitis.

Acute Disease↗
PubMed1991

[Results of surgical treatment of mechanical ileus of the small intestine].

Between 1982 and 1988 275 patients with obstruction of the small intestine were operated. The etiology of obstruction: adhesions 48%, malignancies 26%, strangulated hernias 8%. The duration of obstruction symptoms was 3.7 days prior to hospital admission and 1.9 days from admission to operation. 78% of patients had a history of previous laparotomies, in 73% there were serious accompanying diseases. Strangulation obstruction was found in 18% of patients. Operative procedures included small bowel resection in 30%, creation of stomata in 14%, and deviation anastomoses in 12%. Postoperative complications were mainly pulmonary. Median time of hospitalization was 24 days, hospital mortality amounted to 7.6%. A low mortality was encountered especially in strangulation obstruction and after resections. Reduction of surgery induced morbidity is primarily made responsible for the good results.

Aged↗
PubMed1991

[Surgical treatment results in colonic obstruction].

Between 1982 and 1988 94 patients with obstruction of the colon were operated (52 male, 42 female, median age 66 years). Carcinoma accounted for the majority of cases: in 51% of patients enteral, in 9% local tumor growth extraenteral, in 17% peritoneal carcinosis. Therapeutic procedures were chosen according to the necessities in benign courses and in extraenteral tumor growth. In obstructing colorectal carcinoma (48 patients) a policy of primary tumor resection was pursued. 48 patients (40%) developed postoperative complications, 3 patients (3.1%) had to be reoperated. The overall mortality rate in patients with acute obstructions of all courses was 9.6%, in patients with obstruction secondary to carcinoma 14.6%. 74% of patients with colorectal tumors had TNM tumor stage III and IV. The 5-years-survival rate amounted to 21% overall, but after primary tumor resection it was 47%.

Aged↗
PubMed1990

Correlation between endotoxin-neutralizing capacity of human plasma as tested by the limulus-amebocyte-lysate-test and plasma protein levels.

In the present study the endotoxin-neutralizing capacity of human plasma obtained from healthy volunteers was determined by use of the limulus-amebocyte-lysate test. The extent of the endotoxin-neutralizing capacity which showed a very broad variation was correlated to the plasma levels of some proteins which are believed to contribute to endotoxin transport and detoxification. The plasma levels of alpha 2-macroglobulin and transferrin, the major transport proteins, as well as the levels of IgG, IgA and IgM and apoprotein A were not significantly correlated to the neutralizing capacity. Only the apoprotein B, the major apoprotein of the low density lipoprotein fraction shows a significant correlation. Together with previously published results it should be concluded that low density lipoproteins are involved in the endogenous endotoxin-neutralizing reaction occurring in human plasma, at least when high doses of endotoxin are administered. Nevertheless the endotoxin-neutralizing reaction seems to be a very complex multistep process.

Apolipoproteins A↗
PubMed1990

Oxygen radicals in intestinal ischemia and reperfusion.

Intestinal ischemia, however, caused, is still a serious and growing clinical problem with an unacceptable mortality rate of over 60%. This high mortality rate is mainly due to the fact that the patients are not admitted to the hospital or not treated early enough. Even if the patients are operated on within 24 h, their mortality rate is still over 50%, and those surviving the initial treatment suffer from postischemic complications. These damages have been accounted until now to tissue ischemia. It has been proven experimentally that also reperfusion or revascularization after time-limited ischemia add to the tissue damages observed, due to the formation of O2-radicals. Thereby the prerequisites for the production of these radicals (the conversion of xanthine dehydrogenase to xanthine oxidase and the increase of hypoxanthine concentrations in the tissue and plasma) are generated during tissue ischemia. These radicals damage directly or initiate several vicious circles leading to mucosal lesions, impaired intestinal function and an enhanced absorption of bacteria and endotoxin. Various substances (SOD, catalase, DMSO, allopurinol, deferoxamine etc.) detoxify oxygen radicals or inhibit the pathomechanisms leading to the enhanced radical generation. Hopefully, the combination of early revascularization with these already available scavengers will improve the high mortality and morbidity of patients suffering from intestinal ischemia.

Aged↗
PubMed1990

Influence of human transferrin and group-specific protein on endotoxicity in vitro.

The present study concerns the endotoxin neutralizing activity of human iron-free transferrin, and group-specific protein also called Gc-globulin. Iron-free transferrin was used because former studies showed that the endotoxin binding capacity is restricted to apotransferrin. The endotoxin neutralizing activity of the different protein preparations was tested by use of the limulus-amebocyte-lysate test after solubilizing in an isotonic electrolyte buffer at pH 7.0. Surprisingly, in the presence of transferrin the limulus test detected about 200% and 150%, respectively, of the endotoxin content measurable in the presence of human albumin or without any protein. The addition of Gc-globulin leads to a loss of endotoxin of about 40%.

Albumins↗
PubMed1990

Serum phospholipase A2 in patients with multiple injuries.

Catalytic phospholipase A2 activity (CA-PLA2) and the concentration of immunoreactive pancreatic PLA2 (IR-PLA2) were measured in serum samples from 12 patients with multiple injuries (median Injury Severity Score: 41). CA-PLA2 was increased in all patients and positive correlations were found between the extent of the increase of CA-PLA2, mortality, and impairment of pulmonary function. IR-PLA2 values were slightly increased in the serum of nine patients with multiple injuries. Of these nine patients, eight had an additional blunt abdominal trauma. On the other hand, no relationship was found between IR-PLA2 and CA-PLA2 values. This finding was confirmed by immunoadsorption experiments with an antiserum to human pancreatic PLA2, which demonstrated that the increased serum levels of IR-PLA2 were not responsible for the increased CA-PLA2 values. The results suggest the existence of at least two immunologically different phospholipase A2 enzymes in sera of patients with multiple injuries.

Adolescent↗
PubMed1990

Oxygen free radicals in acute pancreatitis of the rat.

This study aimed to assess the role of oxygen free radicals in acute pancreatitis. Acute pancreatitis was induced in rats by infusion of the CCK-analogue cerulein (5 micrograms/kg per hour) for 30 minutes, 3.5 hours, and 12 hours. After the infusion, serum enzymes and conjugated tissue dienes and malondialdehyde were measured and tissue samples were subjected to electron and light microscopy. Electron microscopy after 30 minutes showed moderate intracellular alterations. After 3.5 hours of cerulein infusion interstitial oedema and intravascular margination of granulocytes in the pancreatic gland were seen. After 12 hours histological evaluation showed pronounced zymogen degranulation, extensive tissue necrosis, and migration of granulocytes into the tissue. Amylase and lipase activities increased 15 and 35-fold respectively during this time. After 30 minutes of cerulein infusion conjugated dienes and malondialdehyde increased, they reached their peak after 3.5 hours and decreased to normal values after 12 hours. Treatment with superoxide dismutase (100,000 U/kg/hour) and catalase (400,000 U/kg/hour) either before or after the start of the cerulein infusion prevented lipid peroxidation and reduced zymogen degranulation and tissue necrosis. Tissue oedema and inflammatory response, however, were not affected in any of the treated rats. Oxygen free radicals are instrumental in the development of acute pancreatitis. Even after its onset, scavenger treatment reduced the tissue damage normally observed.

Acute Disease↗
PubMed1990

Regional chemotherapy in liver metastases of colorectal carcinoma: monitoring with arterial computed tomography.

Continuous chemotherapy was administered to 82 patients through the hepatic artery via Infusaid pumps. In order to obtain a primary status and to evaluate the success of therapy, the perfusion patterns of the liver and of the existing tumor masses in the liver were estimated by conducting arterial angiocomputed tomographies (AACTs) immediately after pump implantation of every 3 months thereafter. In 70% of the patients, findings showed both liver lobes to be homogeneously perfused, 24% demonstrated distinct inhomogeneities. The response of the latter cases should depend primarily on the efficacy of the administered cytostatic agent. Six percent of the patients showed selective perfusion of either the left or right hepatic lobe. In these cases, only the perfused liver regions exhibited stable disease or regression of the metastases, whereas the metastases of the nonperfused regions progressed. At 3-month follow-up, the majority of the patients (50-57%) showed homogeneous hepatic perfusion. Inhomogeneities were found in 26-36% of the patients, 12 patients demonstrated incomplete perfusion. There was no association between the perfusion patterns of the metastases or of the prechemotherapeutic liver involvement and the response of the metastases to regional chemotherapy. In regional chemotherapy, liver perfusion should be controlled both intraoperatively or directly postoperatively and during therapy.

Antineoplastic Agents↗
PubMed1990

Duodenum-preserving resection of the head of the pancreas--an alternative to Whipple's procedure in chronic pancreatitis.

Duodenum-preserving resection of the head of the pancreas is a low-risk operation for patients with chronic pancreatitis. Subtotal resection of the head of the pancreas does not result in a significant diminishment in the exocrine and endocrine functions of the pancreas. Owing to the limited nature of the intervention, hospital and late mortality rates are low. More than 80% of the patients with CP have experienced long-lasting relief of pain after this procedure. In comparison with the Whipple operation duodenum-preserving resection of the head of the pancreas spares the patient a gastrectomy, a duodenectomy, and resection of the extrahepatic bile duct.

Anastomosis, Surgical↗
PubMed1990

[Gallstone therapy--cooperation or competition?].

The gold standard in the therapy of the gallstone disease ist cholecystectomy, which today is performed by way of a minilap-cholecystectomy. Therapies in competition with the operative treatment are: oral chemolitholysis, shock wave lithotripsy and the direct, intraluminal methods of lithotripsy. For each procedure there is a special range of indications; therefore treatment of gallbladder stones should be decided on individually, as each therapeutic procedure has its advantages and disadvantages.

Cholecystectomy↗
PubMed1990

[Models for cooperation between experimental and clinical surgery--from the clinical viewpoint].

In order to cope with the tasks in the field of surgical research manifold models of cooperation have developed in Germany: 1. the independent Institute for Experimental Surgery, 2. the partly independent Section for Experimental Surgery, 3. the unindependent Section for Research, 4. the Clinical Research Group and 5. the Interdisciplinary Research Group. The efficiency of this cooperation between researchers and clinicians is dependent on the availability of research laboratories, the inclusion of methodological specialists, an adequate keeping of laboratory animals, independent funds for research, and on a certain amount of free time which can be dedicated to research activities, devoid of clinical obligations; a high methodological standard and a good knowledge of the clinical and scientific fields are fundamental.

Animals↗
PubMed1990

[Effect of liver passage on peripheral glucose and hormone concentrations in early postoperative enteral nutrition].

Early postoperative disorders of blood glucose homeostasis and its hormonal regulation do not allow a normal caloric enteral or parenteral substrate supply in this period. Eleven land pigs were investigated to find out how the surgical trauma of a partial gastrectomy influences the absorptive capacity of the small intestine and the hormonal regulation after intraduodenal administration of a glucose solution. We therefore conducted portal vein measurements to correlate the influence of the liver passage of early postoperative changes in blood glucose and hormonal levels. Our data show that neither the porto-arterial differences in blood glucose nor those in hormonal concentrations are significant. Therefore, we conclude that peripheral measurements can be used as good and reliable parameters for such investigations of absorption or hormonal regulation in the early postoperative period.

Animals↗
PubMed1990

The clinical relevance of the tumor marker CA 19-9 in the diagnosing and monitoring of pancreatic carcinoma.

The tumor marker test CA19-9 is based on monoclonal antibody to colonic carcinoma cell lines. In this study, the utility of the tumor marker in the diagnosis of pancreatic carcinoma was evaluated. CA19-9 is strongly expressed in most tissue specimens from pancreatic carcinomas. However, this antigen is also found in normal pancreas and specimens from chronic pancreatitis. CA19-9 is released into the circulation, and was found in increased concentrations (greater than 37 U/ml) in 87% of the patients with pancreatic carcinoma (N = 145), as compared with only 13% in the group of patients with benign diseases (N = 1081) and 29% of those with extrapancreatic malignancies (N = 691). The preoperatively raised CA19-9 concentration in patients with stage I of pancreatic carcinoma decreased after curative resection of the carcinoma to values within normal range. However, in no CA19-9 estimation following a palliative surgical intervention of stage III and IV patients or in cases of inoperable carcinomas was a serum concentration of less than 37 U/ml recorded. The mean survival rate of stage I patients was 29 months, whereas it was only 6 months for stage III, IV and patients with inoperable carcinomas.

Antibodies, Monoclonal↗