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Biomedical subjects

H Rupprecht

Publications and source records attributed to H Rupprecht.

At least 19 recordsLinked to original sources
PubMed2001

Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study.

BACKGROUND: Despite the use of aspirin, there is still a risk of ischaemic events after percutaneous coronary intervention (PCI). We aimed to find out whether, in addition to aspirin, pretreatment with clopidogrel followed by long-term therapy after PCI is superior to a strategy of no pretreatment and short-term therapy for only 4 weeks after PCI. METHODS: 2658 patients with non-ST-elevation acute coronary syndrome undergoing PCI in the CURE study had been randomly assigned double-blind treatment with clopidogrel (n=1313) or placebo (n=1345). Patients were pretreated with aspirin and study drug for a median of 6 days before PCI during the initial hospital admission, and for a median of 10 days overall. After PCI, most patients (>80%) in both groups received open-label thienopyridine for about 4 weeks, after which study drug was restarted for a mean of 8 months. The primary endpoint was a composite of cardiovascular death, myocardial infarction, or urgent target-vessel revascularisation within 30 days of PCI. The main analysis was by intention to treat. FINDINGS: There were no drop-outs. 59 (4.5%) patients in the clopidogrel group had the primary endpoint, compared with 86 (6.4%) in the placebo group (relative risk 0.70 [95% CI 0.50-0.97], p=0.03). Long-term administration of clopidogrel after PCI was associated with a lower rate of cardiovascular death, myocardial infarction, or any revascularisation (p=0.03), and of cardiovascular death or myocardial infarction (p=0.047). Overall (including events before and after PCI) there was a 31% reduction cardiovascular death or myocardial infarction (p=0.002). There was less use of glycoprotein IIb/IIIa inhibitor in the clopidogrel group (p=0.001). At follow-up, there was no significant difference in major bleeding between the groups (p=0.64). INTERPRETATION: In patients with acute coronary syndrome receiving aspirin, a strategy of clopidogrel pretreatment followed by long-term therapy is beneficial in reducing major cardiovascular events, compared with placebo.

Aged↗
PubMed2001

Spinal-thoracic dumbbell meningioma: a case report.

STUDY DESIGN: Total excision of a large dumbbell cervicothoracic intra- and extraspinal meningioma that had grown into the posterior mediastinum is described. This excision involved a two-step neurosurgical-thoracosurgical procedure within a short interval. OBJECTIVES: To document that the described laminectomy and thoracotomy techniques are adequate, safe, and effective for the treatment of this intra- and extraspinal meningioma lesion. SUMMARY OF BACKGROUND DATA: The management of intra- and extraspinal dumbbell tumors is based on anecdotal reports of mostly neurinomas, and thus remains a controversial issue. Even large series of spinal meningiomas lack adequate information on how best to treat large cervicothoracic meningiomas. METHODS: The authors have modified standard techniques used for resection of spinal and mediastinal tumors, respectively, adapting them for a large, invasive dumbbell meningioma in a 72-year-old lady. The patient initially underwent laminectomy and microsurgical excision of the intraspinal tumor portions encasing vascular structures. A week thereafter, a thoracotomy was performed, and the mediastinal tumor portions were removed completely. RESULTS: Restitution was remarkably good. The patient, who had been unable to walk on her own, regained some mobility. At this writing, she was able to walk considerable distances without support. There was no evidence of tumor recurrence during a follow-up interval of 3 years. CONCLUSIONS: The authors recommend a two-staged procedure for complete excision of a large spinal-thoracic meningioma. Even in elderly patients with major neurologic deficits, an impressive recovery can be achieved with such lesions.

Aged↗
PubMed2001

Successful removal of a giant recurrent chondrosarcoma of the thoracic wall in a patient with hereditary multiple exostoses.

Chondrosarcoma represents the most common malignant tumour of the chest wall, with a tendency for local recurrence after resection. Here we report the successful complete resection of a giant, local recurrent chondrosarcoma of the chest wall (max. diameter 25 cm), in a patient with hereditary multiple exostoses, who had had a wide resection 8 years before. Clinical features and surgical management are described.

Bone Neoplasms↗
PubMed2001

[Spontaneous splenic rupture in metastatic malignant melanoma].

Spontaneous splenic rupture is a rare cause of non-traumatic haemorrhage and is of infectious origin in most instances. We present a patient under treatment for abdominal manifestations of metastatic malignant melanoma who developed signs of haemorrhagic shock and where, upon emergency laparotomy, metastases were found to have caused rupture of the spleen. The patient recovered after splenectomy and was continued on systemic chemoimmunotherapy. One year after the incident he died of cerebral metastases.

Adult↗
PubMed2000

Prognostic value of trauma scores in pediatric patients with multiple injuries.

BACKGROUND: For the quantification of multiple injuries in children, a range of different trauma scores are available, the actual prognostic value of which has, however, not so far been investigated and compared in a group of patients. METHODS: In 261 polytraumatized children and adolescents, 11 trauma scores (Abbreviated Injury Scale [AIS], Injury Severity Score [ISS], Glasgow Coma Scale [GCS], Acute Trauma Index [ATI], Shock Index [SI], Trauma Score [TS], Revised Trauma Score [RTS], Modified Injury Severity Score [MISS], Trauma and Injury Severity Score [TRISS]-Scan, Hannover Polytrauma Score [HPTS], and Pediatric Trauma Score [PTS]) were calculated, and their prognostic relevance in terms of survival, duration of intensive care treatment, hospital stay, and long-term outcome analyzed. RESULTS: With a specificity of 80%, physiologic scores (TS, RTS, GCS, ATI) showed a greater accuracy (79-86% vs. 73-79%) with regard to survival prediction than did the anatomic scores (AIS, HPTS, ISS, PTS); combined forms of these two types of score (TRISS-Scan, MISS) did not provide any additional information (76-80%). Overall, the TRISS-Scan was the score that showed the highest correlation with duration of treatment and long-term outcome. Trauma scores specially conceived for use with children (PTS, MISS) failed to show any superiority vis-à-vis trauma scores in general. CONCLUSION: With regard to prognostic quality and ease of use in the practical setting, TS and the TRISS-Scan are recommended for polytrauma in children and adolescents. Special pediatric scores are not necessary.

Adolescent↗
PubMed2000

[Quality assurance in appendicitis--what has changed? Analysis of 2 prospective multicenter quality assurance studies].

AIMS OF THE STUDY: The present study aims to determine the influence of introduction of laparoscopic techniques and of DRG (diagnosis related gains) on the quality of appendicitis therapy. PATIENTS AND METHODS: All consecutive patients admitted for suspected appendicitis were recruited into this prospective multicenter study. Two different periods of time were considered: from 1.7.1988 to 31.12.1989, 6,266 patients from 18 hospitals were included, and from 1.6.1996 to 31.5.1997, 7,398 patients from 34 institutions. RESULTS: In the first period (1988/89), 1,869 patients were treated conservatively (29.8%), 4,397 (70.2%) were operated. Histopathological analysis of the appendix documented no acute inflammation in 28.8%, the perforation rate was 8.3% and the wound infection rate 9.6%. In the second period (1996/97), 2,430 patients were treated conservatively (32.8%), in 24.9% of all operated cases, the histopathological examination shows no acute inflammation of the appendix, the perforation rate was 5.9% and the rate of wound infections 2.5%. During this second period, 33.2% of all appendectomies were performed using the laparoscope, the conversion rate was 7.2%. CONCLUSIONS: The introduction of laparoscopic techniques and of DRG did not modify the operative indications for treatment of appendicitis. An increase in the number of normal appendices removed was not observed. The number of perforations and the incidence of wound infections was significantly reduced in the second period.

Adolescent↗
PubMed1999

[The significance of hierarchy in postgraduate education].

There are structures of hierarchy in the postgraduate education. The postgraduate education is organized as a programme the young doctor has to absolve. The instruction and the control of the implementation of that programme must be carried out by a competent and experienced older physician, who is responsible for the correctness of that, the young doctor has to learn in his postgraduate education. The older physician unequivocally is integrated in the hierarchy above the young doctor legitimated by his knowledge, his experience and his personality. The hierarchy demonstrates itself as an indication of the moral integrity of the community and of each only individual.

Curriculum↗
PubMed1998

Plasma separation and bilirubin adsorption after complicated liver transplantation: a therapeutic approach to excessive hyperbilirubinemia.

BACKGROUND: Severe hyperbilirubinemia is known to exert multiple toxic effects. Thus, a reduction in bilirubin by use of various adsorbent columns has been reported for a variety of hepatic disorders, but no experience with liver transplant patients is available as yet. METHODS: Plasma separation and bilirubin adsorption by an anion-exchange adsorbent column (BR-350) were performed in two patients with severe jaundice (total serum bilirubin > 55 mg/dl) and multiple organ failure that had developed after orthotopic liver transplantation. RESULTS: The procedure resulted in an 18% to 35% reduction in total bilirubin after each session, accompanied by a remarkable clinical improvement. Both patients finally recovered and had a favorable outcome. No complications or side effects of bilirubin adsorption were observed during any of the six sessions. CONCLUSIONS: Bilirubin adsorption is a safe and effective treatment. It should be considered as supportive therapy for excessive hyperbilirubinemia after liver transplantation. In selected cases, retransplantation may thus be avoided.

Adsorption↗
PubMed1998

[Post-traumatic arteriovenous fistula between splenic artery and vein as a rare cause of acute myocardial ischemia].

Arteriovenous fistulas of the portal system are rare. Congenital fistulas have to be differentiated from acquired fistulas; the latter are of posttraumatic or iatrogenic origin. The case presented demonstrates a history of diffuse abdominal pain and the first description of myocardial ischemia caused by a posttraumatic splenic arterioportal fistula. After diagnostic and therapeutic difficulties, the definitive treatment consisted in resection of the fistula system including the pancreatic tail.

Adult↗
PubMed1998

Prospective use of glycoprotein IIb/IIIa receptor blockers in the emergency department setting.

Platelets play a pivotal role in the pathophysiology of acute coronary syndromes (ACS) and thus are logical therapeutic targets for treatment of this disease process. Platelet glycoprotein (GP) IIb/IIIa receptor antagonists, which interrupt the final common pathway of platelet aggregation, have been proved to reduce the 30-day incidence of death, acute myocardial infarction (MI), and urgent revascularization in both high-risk and low-risk patients undergoing percutaneous intervention procedures. Three-year follow-up has indicated that these benefits appear durable. Recent large-scale randomized trials have demonstrated the value of GP IIb/IIIa receptor inhibitors in reducing the risk of death and MI in patients with unstable angina or those with MI with non-Q-wave abnormalities who are receiving pharmacologic management. In addition, emerging evidence suggests a future role for GP IIb/IIIa receptor inhibitors as an adjunct to low-dose fibrinolytic therapy in patients with acute MI. As the list of indications for GP IIb/IIIa receptor antagonists expands to encompass the full spectrum of ACS, there is increasing interest in the potential use of these agents in the emergency department setting. The integration of GP IIb/IIIa receptor inhibitors into ED protocols will ultimately depend largely on whether these drugs prove to be safe and effective regardless of the direction of ST-segment deviation, and irrespective of whether definitive therapy will be invasive or conservative.

Acute Disease↗
PubMed1998

Intra-abdominal Candida infection during acute necrotizing pancreatitis has a high prevalence and is associated with increased mortality.

OBJECTIVES: To analyze the frequency of intra-abdominal Candida infection during acute necrotizing pancreatitis and to compare the outcome to patients without Candida infections. DESIGN: Retrospective analysis of data from 37 patients with and without Candida infection. SETTING: Surgical intensive care unit (ICU) in a university hospital. PATIENTS: Thirty-seven patients with acute necrotizing pancreatitis. INTERVENTIONS: Patients were subject to necrosectomy and programmed lavage. MEASUREMENTS AND MAIN RESULTS: Clinical parameters contained in the Acute Physiology and Chronic Health Evaluation (APACHE) II score were monitored, as were microbiological results from the intra-abdominal primary focus and from sites of secondary infections. Body mass index, distribution of underlying diseases, length of ICU stay, number of operations, and outcome were recorded. Multivariate logistic regression analysis for mortality as the dependent variable was performed. Intra-abdominal Candida infection was observed in 13 of 37 cases and was associated with a four-fold greater mortality rate compared with intra-abdominal bacterial infection alone. Multivariate logistic regression analysis demonstrated that Candida infection contributed to mortality significantly (p < .025) and independently from APACHE II (p < .006; mortality odds ratio for the two parameters=12.5). Lack of antimycotic treatment was associated with an increase to 29.2 (p<.001) in the odds ratio. CONCLUSIONS: Given the impact of Candida infection on mortality to acute necrotizing pancreatitis and the apparent benefit from antimycotic chemotherapy, the data argue for an early fungicide chemotherapeutic intervention.

APACHE↗
PubMed1998

[Postoperative pulmonary torsion and hemorrhagic lung infarct--report of a case].

Lung or lobe torsion may occur after thoracic surgery, chest trauma, pneumothorax, pneumonia or even spontaneously. Lung infarction is a possible complication. The characteristic radiological signs on plain radiographs are opacification and/or displacement of lobes and hilus structures. CT-signs of haemorrhagic infarction are opacification and multiple punctate gas accumulations. The bronchus could be interrupted at the level of the torsion ("bronchus-cutoff").

Aged↗
PubMed1998

Prospective use of platelet glycoprotein IIb/IIIa receptor blockers in the emergency department setting.

Platelets play a pivotal role in the pathophysiology of acute coronary syndromes (ACS) and thus are logical therapeutic targets for treatment of this disease process. Platelet glycoprotein (GP IIb/IIIa receptor antagonists, which interrupt the final common pathway of platelet aggregation, have been proven to reduce the 30-day incidence of death, acute myocardial infarction (MI), and urgent revascularization in both high-risk and low-risk patients undergoing percutaneous intervention procedures. Three-year follow-up has indicated that these benefits appear durable. Recent large-scale randomized trials have demonstrated the value of GP IIb/IIIa receptor inhibitors in reducing the risk of death and MI in unstable angina/non-Q-wave MI patients receiving pharmacologic management. And, emerging evidence suggests a future role for GP IIb/IIIa receptor inhibitors as an adjunct to low-dose fibrinolytic therapy in patients with acute MI. As the list of indications for GP IIb/IIIa receptor antagonists expands to encompass the full spectrum of ACS, there is increasing interest in the potential use of these agents in the emergency department setting. The integration of GP IIb/IIIa receptor inhibitors into emergency department protocols will ultimately depend largely on whether these drugs prove to be safe and effective regardless of the direction of ST-segment deviation, and irrespective of whether definitive therapy will be invasive or conservative.

Algorithms↗
PubMed1997

Tc-99m DTPA perfusion scintigraphy and color coded duplex sonography in the evaluation of minimal renal allograft perfusion.

AIM: The clinical impact of perfusion scintigraphy versus color coded Duplex sonography was evaluated, with respect to their potential in assessing minimal allograft perfusion in vitally threatened kidney transplants, i.e. oligoanuric allografts suspected to have either severe rejection or thrombosis of the renal vein or artery. METHODS: From July 1990 to August 1994 the grafts of 15 out of a total of 315 patients were vitally threatened. Technetium-99m DTPA scintigraphy and color coded Duplex sonography were performed in all patients. For scintigraphic evaluation of transplant perfusion analog scans up to 60 min postinjection, and time-activity curves over the first 60 sec after injection of 370-440 MBq Tc-99m diethylenetriaminepentaacetate acid (DTPA) were used and classified by a perfusion score, the time between renal and iliac artery peaks (TDiff) and the washout of the renogram curve. Additionally, evaluation of excretion function and assessment of vascular or urinary leaks were performed. By color coded Duplex sonography the perfusion in all sections of the graft as well as the vascular anastomoses were examined and the maximal blood flow velocity (Vmax) and the resistive index (RI) in the renal artery were determined by means of the pulsed Doppler device. Pathologic-anatomical diagnosis was achieved by either biopsy or post-explant histology in all grafts. RESULTS: Scintigraphy and color coded Duplex sonography could reliably differentiate minimal (8/15) and not perfused (7/15) renal allografts. The results were confirmed either by angiography in digital subtraction technique (DSA) or the clinical follow up. CONCLUSION: In summary, perfusion scintigraphy and color coded Duplex sonography are comparable modalities to assess kidney graft perfusion. In clinical practice scintigraphy and color-coded Doppler sonography can replace digital subtraction angiography in the evaluation of minimal allograft perfusion.

Adult↗
PubMed1997

[Concealed perforated aneurysm of an aberrant right hepatic artery: papillary bleeding. Case report and review of the literature].

A rare case of spurious aneurysm of an aberrant right hepatic artery is reported. Endoscopic retrograde cholangio-pancreaticography, computed tomography and selective angiography of the coeliac trunc are diagnostic. Resection of the aneurysm and interposition of saphenous vein is the preferred procedure. In selected cases ligation of the common hepatic artery is possible. Intrahepatic aneurysms are preferably treated interventionally.

Aged↗