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H Lippert

Publications and source records attributed to H Lippert.

At least 37 records · Page 2Linked to original sources
PubMed1988

[Blunt abdominal trauma].

Serious intraabdominal injury due to intraabdominal hemorrhage, gastro-intestinal laceration with peritonitis or incarceration of abdominal organs. The most important question in the management is to ascertain a laparotomy or the diagnostic of a specific organ injury is needed. The peritoneal lavage is a great help in making this decision. The x-ray examinations of thorax, abdomen and bones are required. Adjunctive diagnostic modalities for subtile examination of organs are ultrasound, computed tomography and angiography. These examinations have a limited application. Exploratory laparotomy should be done if there are signs of peritoneal irritation with an increased tendency. 168 patients with blunt abdominal trauma where treated in Charity-hospital of Berlin. The laparotomy was necessary in 78 patients. In 70 cases we found organ injuries. It was pointed to splenic repair, the management of liver injury especially the packing of the laceration and the treatment of the injuries of gastro-intestinal tract, pancreas- and diaphragmatic rupture.

Abdominal Injuries↗
PubMed1987

[Pancreatic cancer from the viewpoint of the surgeon].

The incidence of carcinoma of the exocrine pancreas has gone up by factors of something between 2 and 4 in countries of advanced civilization over the past 30 years. Modern diagnostic methods have enabled safe detection of the carcinoma in 85 per cent of all cases. Laparotomy is justified in situations in which the operability of a pancreas tumour cannot be reliably established by other approaches. Radical therapy should include cephalic or total duodenopancreatectomy and romal of regional lymph nodes. Diffuse metastasation or infiltration of the mesenteric superior arteries and veins, the hepatic artery, and the portal vein result in inoperability. Operations for exocrine pancreas carcinoma were performed on 226 patients at the Surgical Department of Charité, between 1979 and 1985. Tumours were radically removed in 104 cases. Surgical mortality accounted for 14 per cent. Chemotherapy or radiotherapy of pancreas carcinoma should be reverified for their life-extending effectiveness. Aggravating fatty degeneration of the liver was found to develop two years after pancreatectomy and calls for modified treatment.

Combined Modality Therapy↗
PubMed1986

[Current status of allogeneic pancreas transplantation].

Up to now we registered all over the world 485 transplantations of the pancreas. The partial donation of organs of relatives was performed in forty cases. On August 1st 1984 297 patients (70%) survived after a transplantation of the pancreas; of them 131 had a functioning transplant (30%). 54 transplanted organs (13%) had a good function for longer than 1 year. The most frequent complications were the thrombosis of the transplant, the pancreatitis, the fistulae of the pancreas and the rejection. Of 166 human allogenic islet transplantations at present none is functioning. Early rejections were the causes for the short function times. There were no cases of death by an islet transplantation. The present research concentrates to new methods of the islet isolation from the human pancreas and the immunological influence on the isolated islets.

Blood Glucose↗
PubMed1986

[Allogeneic heart-lung transplantation--present state and perspectives].

The paper gives a survey of indication, technique, immunosuppression as well as results of the isolated heart transplantation. The isolated heart transplantation represents a genuine therapeutic alternative for many hopeless patients with heart disease who cannot be helped neither with medicamentous nor with the usual cardiosurgical methods. In future the combined heart-lung transplantation might be an essential enlargement of the treatment of patients with terminal heart diseases and with a pulmonary hypertension or of patients with a terminal pulmonary disease.

Cardiomyopathies↗
PubMed1986

[Current status of liver transplantation].

The importance of the liver transplantation for the treatment of infaust liver diseases is nowadays regarded as undisputed. The results could be improved during the last years: on an average 40% of the patients still live one year after the transplantation. The control of the transplant rejection and the diminution of the ischaemic liver damage are preeminent pathophysiological problems. Clinical routine and experience essentially further the optimization of the results.

Common Bile Duct↗
PubMed1986

Integration of clinical problems in teaching gross anatomy: living anatomy, X-ray anatomy, patient presentations, and films depicting clinical problems.

In addition to lectures and the dissection course, four supplements are described to stimulate first-year medical students to learn gross anatomy. All topics are coordinated with the dissection course. The additional options are living anatomy, X-ray anatomy by a roentgenologist, presentation of patients by clinicians, and films on clinical problems. This integrated curriculum of basic and applied anatomy generates a high level of student interest in gross anatomy.

Anatomy↗
PubMed1986

[Pancreatic donor operation for islet cell isolation and transplantation].

Preservation of B-cells, following organ collection and cold ischaemia, was defined on 19 donor organs by means of histological tests and testing for insulin content in pancreatic tissue. The degree of preservation declined by 50 per cent after two hours of cold ischaemia. The Velcro technique and uncrushed organ digestion were used for isolation. Islet yield was calculated by determination of insulin levels in isolated tissue (nmol/ml) and in the islet (pmol/islet). The average islet yield was 2 076 islets to one gram pancreas, that is ten per cent of the original amount. Studies conducted into in-vitro insulin secretion from isolated islets have revealed damage to organs due to handling, especially to organs which had undergone extended cold ischaemia.

Adolescent↗
PubMed1986

[Autologous heterotopic partial transplantation of the pancreas in the dogs with reference to different drainage methods].

Pancreatic autotransplantation is a necessary requirement for studies on the technical aspects of pancreatic grafting. In the allograft model immunological problems influences the graft survival. In 25 mongrel dogs the left limb of the pancreas was transplanted into the grain with end to side vascular anastomosis. The body and right limb of the pancreas was removed and discarded. We have compared various technique for management the exocrine pancreas section (Neoprene-injected duct; open duct technique). Currently the rate of complications in segmental pancreas autotransplantation was high especially in Neoprene injected dogs. Reasons for this result from technical failures like venous thrombosis and pancreatitis. In every case it was possible to ameliorate the diabetes mellitus up to the 7th day. Histological we found dilated interlobe space up to 7 days after transplantation with open ducts and there were no signs of disturbance in the endocrine tissue. In the Neoprene-injected group we found a severe intraacinous oedema and 5 days after transplantation already a beginning fibrosis with destroyed islets of Langerhans.

Animals↗
PubMed1986

[Pancreatic duct occlusion compared with intraperitoneal secretion drainage after partial pancreatic resection in the dog].

One of the main problem for pancreatic transplantation and treatment of chronic pancreatitis is the handling of exocrine secretion. We compared in an experimental study pancreatic segments in dogs after removing the right lobe of the pancreas with free drainage of exocrine secretion into the peritoneal cavity, duct occlusion with Ethibloc or Neoprene. The lowest complication rate was seen in group with open duct technique. Plasma glucose levels was normally in all groups without significant differences. The pattern of blood glucose after the intravenous administration of 0.5 g glucose/kg was characterized by an assimilation coefficient (k-value) which was significantly (p less than 0.05) higher for open duct and Ethibloc than in Neoprene dogs. Peak insulin values appeared delayed and significant lower than in normal control group. Histologically was at first seen an oedema in all groups. The occlusion of the pancreatic duct specially in Neoprene dogs resulted in a marked interstitial progressive fibrosis. The substance Ethibloc was totally reabsorbed after the 10th day.

Animals↗
PubMed1986

[Preoperative examination findings in patients with a perforated appendix].

Symptoms and clinical findings recorded from 379 patients (6.7 per cent of all cases of appendectomy) with perforated appendicitis, between 1970 and 1984, were retrospectively evaluated. Children up to 14 years of age accounted for 32.8 per cent, adults for 37.8 per cent, and adults above 50 years of age accounted for 30.2 per cent of the above group. More than three typical appendicitis symptoms were recordable from only 30 per cent of all patients. Decompressive and jolting pain was the most common clinical symptom and was recorded from 66.6 per cent of the above 379 patients. 50 per cent of the patients did not exhibit leucocytosis, and normal body temperatures were measured from 21.1 per cent in spite of perforated appendicitis. The event of perforation occurred both six hours after onset of complaints as well as four days later. Obesity, enteritis, and cardiovascular diseases were the most common diseases established in concomitance with perforated appendicitis. 9 patients (2.3 per cent) died of the consequences of peritonitis or accompanying diseases. In patients with suspected appendicitis it is not justified to delay surgery even in the presence of serious associated disease.

Adolescent↗
PubMed1986

[Surgical treatment of benign liver tumors].

We reviewed the records of 105 patients treated for benign hepatic disease at the Department of Surgery of the Charité since 1979. Treatment has to be tailored to the different pathological processes. Modern imaging techniques are of utmost importance for diagnosis and follow up of all patients regardless if they underwent operative therapy or were treated conservatively. Indications and contraindications in the treatment of benign liver tumours are developed on the basis of 44 liver resections with special reference to adenomas and hemangiomas. In all cases a hemihepatectomy seemed justified inspite of the benign disease process. Postoperative complications were mostly related to the surgical incision and caused by abnormalities of protein synthesis and coagulation, frequently observed after major hepatic surgery. Close monitoring and immediate correction of all clinical and biochemical parameters are essential in the postoperative period.

Adenoma↗
PubMed1985

Morphological investigations in human islets of Langerhans isolated by the Velcro-technic.

The lower yield of viable, isolated islets from one donor pancreas and the immunogenicity are responsible for disappointing results in human islet transplantation. Our preliminary results in the application of Velcro-technic (Lacy, 1982) studied by morphological investigations demonstrate the feasibility of this technic in human islet isolation. If we compare the influence of Velcro-technic with regard to the first step of Velcro-technic, the duct perfusion, we can conclude that A-cell granules, stained by Grimelius, are reduced during the collagenase perfusion. On the other side, we recognized B-cell granules up to 60 min after duct perfusion. Connective tissue is reduced by the isolation technic and absent completely up to the Ficoll separation. The exocrine tissue of the pancreas is damaged continuously, and after Ficoll separation we detected singular acinar cells only. The yield from the used lienal human pancreas were about 80 000 islets. Islets after Ficoll separation, studied by electron microscopic investigation, showed non-damaged A and B cells with granules in the typical manner.

Cell Separation↗
PubMed1985

[Diagnosis and surgical therapy of organic hyperinsulinism].

The diagnosis of an insulin producing tumour can be confirmed by a minimum of biochemical investigations. Its preoperative localisation is more difficult. Sonogram, Computertomogram, selective angiography and percutaneous transhepatic collecting of blood samples for insulin analysis from the portal system were preoperative measured to localize the tumours in 32 of 37 patients of our series. In 2 patients intraoperative tumour localisation by measurement of incorporated p32 proved to be effective. In B-cell-carinomas pancreas resection is the adequate therapy. With regard to the therapeutic effects a high risk is involved in the 'blind' left or right sited resection of non-localized tumours.

Adenoma, Islet Cell↗
PubMed1985

[Experimental diabetes mellitus induced by total pancreatectomy with preservation of the duodenum in dogs].

The total pancreatectomy without duodenectomy was carried out in 16 dogs. The postoperative diabetes mellitus leads to death on average until the 11th postoperative day. A prolongation of the survival time was possible only by an insulin injection or by pancreas transplantation. Bleedings and circulatory disturbances of the duodenum occurred in 3 of 16 dogs as a complication of the operation. The diabetes mellitus was confirmed by the estimation of the fasting blood glucose and the glucose stimulated plasma insulin concentration. The irreversible hyperglycemia syndrome after pancreatectomy proved as a pattern for the pancreas segmental transplantation.

Animals↗