PubMed Health⌕ Search

Biomedical subjects

H Keck

Publications and source records attributed to H Keck.

At least 73 records · Page 4Linked to original sources
PubMed1993

[Experiences with simultaneous exploration of the bile ducts in surgical therapy of gallstone ileus].

During the last 16 years, 14 patients with a gallstone ileus were treated at our institution. In 11 cases we performed in addition to the enterolithotomy, a cholecystectomy and a resection of the fistula as one-stage repair. Despite the high average age (74.3 years) and the presence of various other serious morbidity in our patient population, we only observed a hospital mortality of 7.1%. Serious postoperative complications, such as sepsis and/or shock were not observed. Utilizing today's advanced anesthesia and proper intensive-care therapy, as well as early operative intervention and safe surgical technique, we believe that enterolithotomy with cholecystectomy and fistula resection as one-stage operation, should primarily be considered before performing enterolithotomy alone.

Aged↗
PubMed1993

[Special "supportive" therapy (nutrition, control of infection, intensive care) in transplantation medicine].

With the increase in clinical organ transplantation the importance of specific "supportive" therapy in addition to surgical technique and immunosuppression is being recognized more widely. Our own experience is based on 273 orthotopic liver transplants which were performed in 255 adult patients between September 1988 and May 1992 with an one-year survival rate of 91%. With the routine use of selective bowel decontamination (SBD) pre- and postoperatively 63 bacterial or fungal infections occurred in 57 of 230 liver graft recipients during the first 4 postoperative weeks, 4 of these infections with fatal outcome. The incidence of cytomegalovirus (CMV) disease reached 18.6% (39 of 210 patients). The risk of developing CMV disease depended upon the previous serological status of donor and recipient but also showed an increase after anti-rejection therapy with steroids or OKT3. One death due to CMV pneumonitis occurred. The importance of nutritional support, infectious disease control and intensive care therapy for solid organ transplantation is being discussed in general.

Critical Care↗
PubMed1992

Quadruple immunosuppression including a new IL-2-receptor antibody and the incidence of infections after liver transplantation.

Immunosuppression is a primary concern after orthotopic liver transplantation (OLT). On the one hand, the graft is at jeopardy through acute or chronic rejection, and on the other, immunosuppression and antirejection therapy increase the risk of infectious complications. Effective immunosuppression therefore should prevent rejections without leading to a high rate of infections, bearing in mind the fact that infections and infection-related complications are the most frequent causes of early death after liver transplantation. With more specific immunosuppression the infectious complications can potentially be minimized. Antithymocyte globulin (ATG) and the first monoclonal antibody OKT3 immunosuppression are non-specific. The replacement of these antibodies in a quadruple immunosuppressive regimen with the new monoclonal IL-2R antibody BT 563 probably reduces the early infection rate. We report on our first experience with BT 563. The incidence of infection was compared with a historical control group with ATG.

Adult↗
PubMed1992

Protection of pancreatic and biliary anastomosis after partial duodenopancreatectomy by external drainage.

The pancreaticojejunostomy after duodenopancreatectomy is the "Achilles' heel" of the procedure. Herein we describe a technique for percutaneous drainage of the efferent limb of the Roux-en-Y loop relieving tension from the anastomosis. Seventy-six Whipple procedures, using this technique, have been done. The operative mortality rate was 1.3 per cent and anastomosis leakage occurred in two instances. In addition, one patient had to be reoperated upon for biliary fistula. Our technique for external Roux-en-Y loop drainage after partial duodenopancreatectomy is safe and efficient and permits rapid diagnosis of anastomotic complications.

Adult↗
PubMed1992

[Progress in the field of liver transplantation in the last 10 years].

During the past 10 years, liver transplantation has developed into an established form of treatment. In 1991 alone, almost 450 liver transplants were performed in Germany with a mean 1-year survival of 70%. Consistent progress in the fields of organ preservation, surgical techniques, and prevention of disease recurrence has made a more than 90% 1-year survival rate achievable during the last 3 years in Berlin. Progress in organ preservation is based on the use of colloidal solutions, pharmacological improvement of microcirculation, and probably prevention of reperfusion injury by the use of calcium antagonists and free oxygen radical scavengers. Improvements in surgical techniques have led to a reduction in blood loss and vascular complications, and to a drastic reduction of biliary leaks and stenosis. The introduction of cyclosporin, FK-506, and monoclonal antibodies into immunosuppressive therapy has contributed to the improvement of results in a major way. Furthermore, progress in intensive care in the areas of fluid therapy and blood component substitution, respiratory care and prophylaxis of infection as well as postoperative nutrition has led to a reduction in early postoperative morbidity and mortality. Efficient prophylaxis of the recurrence of hepatitis-B-virus-related disease by using hepatitis B hyperimmunoglobulin after liver transplantation has prevented this lethal recurrence, which was previously frequent, in a large group of patients.

Critical Care↗
PubMed1992

[The splenic steal syndrome and the gastroduodenal steal syndrome in patients before and after liver transplantation].

The study describes new pathologic entities, the splenohepatic steal-syndrome and the gastroduodenal steal-syndrome, which could be demonstrated by angiography in 17 patients before and after liver transplantation. After the first observation of a splenohepatic steal-syndrome in a patient with unexplained elevation of hepatic enzymes after liver transplantation, a prospective angiographic study was performed, including all liver transplant recipients and patients after liver transplantation with unexplained impaired liver function tests. 9 splenohepatic steal-syndromes could be demonstrated before and 7 after hepatic transplantation, one gastroduodenal steal was seen after liver transplantation. The different therapeutic modalities are discussed.

Angiography↗
PubMed1991

[The differential diagnosis of liver metastasis and regional fatty liver: a comparison of CT and MRT].

Differentiation between liver metastases and local fat deposition may be difficult when using CT; the value of MRI was therefore investigated in 18 patients with metastases and ten patients with fat deposits. CT shows both lesions as similar hypodense areas. MRI, however, produces different appearances: T1- and 2-weighted images show marked differences in the signal arising from metastases, whereas local fat collections in both sequences differ little in their signal from normal liver. Quantitative MRI signal intensity of the two types of lesion were also different. Where the differentiation by CT may be difficult, it may be made with certainty by means of MRI.

Adult↗
PubMed1991

[Protection of the anastomosis by a special drainage procedure in the Kausch-Whipple operation].

The pancreaticojejunostomy after duodenopancreatectomy is the "achilles heel" of the procedure. We describe herein a technique for percutaneous drainage of the efferent limb of the Roux-en-Y loop relieving tension from the anastomosis. 66 Whipple procedures have been carried out using this technique. Operative mortality was 1.5% and anastomotic leakage occurred in 2 cases (3%). In addition one patient had to be reoperated for biliary fistula. Our technique for intraluminal loop drainage is a safe and reliable method for protection of the pancreaticojejunostomy.

Adult↗