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Biomedical subjects

H Schelzig

Publications and source records attributed to H Schelzig.

8 recordsLinked to original sources
PubMed2006

[Thorax injuries].

Thorax injuries may be divided etiologically into blunt and penetrating types, depending on the nature of the insult. In European practice, the former predominates by far, and in only about 5% of cases thoracotomy provides the necessary thorax drainage. Morbidity in this type of injury typically involves concomitant lung contusion, sometimes with fatal acute respiratory distress syndrome. In these cases, special ventilation forms, optimal reduction of pain, and organ replacement are the decisive therapeutic methods. In contrast, about 80% of penetrating trauma to the thorax require prompt transpleural or trans-sternal surgery, depending on the type of injury. Emergency first aid must follow the principle of "scoop and run". Each minute elapsed until emergent thoracotomy can be decisive to survival in these cases, and the fastest possible transport from the place of injury takes priority over time-consuming stabilization.

Contusions↗
PubMed2006

[The vascular surgeon's role in intensive care].

The role of vascular surgeons in the intensive care unit includes two major tasks: (1) consultant activity in complications of different operative specialties, for instance postoperative venous thrombosis after Wertheim's operation, mesenteric superior artery embolus, or arterial injury after total prosthetic replacement of the hip, (2) postoperative care following vascular surgery in order to identify and treat specific complications such as limb ischemia after reconstructive surgery, compartment monitoring after reperfusion injury of the aorta or extremities, carotis monitoring after postoperative apoplexy, and subsumed identification and treatment of ischemic and postischemic states in organs and tissues. Keeping vascular reconstructive options open is particularly important for polytrauma patients with blunt or open vascular injuries beginning from the thoracic aorta ending with subtotal amputation of the lower leg. Vascular surgeons in an intensive care setting play the central role in setting diagnostic course and therapy measures, while organ substitute therapy is within the administrative jurisdiction of the intensivist. Considering the complexity of morbidity in vascular patients, consultation by the intensivist, cardiologist, and neurologist is warranted.

Critical Care↗
PubMed2006

Use of integrated FDG PET/CT imaging in pulmonary carcinoid tumours.

BACKGROUND: Integrated positron emission tomography (PET)/computed tomography (CT) scanners have been recently introduced in the diagnostic work-up of suspected pulmonary malignancy and demonstrate encouraging results in the staging of nonsmall-cell lung cancer. OBJECTIVE: To evaluate the usefulness of integrated FDG PET/CT in pulmonary carcinoid tumours. SETTING: University hospital. METHODS: We studied 13 patients (mean age +/- 1 SD, 57 +/- 11 years) with pulmonary carcinoid tumours. All patients demonstrated a single pulmonary lesion. Integrated PET/CT scan and surgical resection were performed in all patients. RESULTS: The pulmonary lesion size ranged from 1.1 to 5.0 cm. Final histological diagnosis confirmed 12 typical and one atypical pulmonary carcinoid. Mean proliferation rate of the typical carcinoids was 1.7 +/- 1.4%. None of the patients had recurrent carcinoid disease or died during follow-up (864 +/- 218 days). Mean standardized uptake value (SUV) of (18)F-fluorodeoxyglucose (FDG) in typical carcinoids was 3.0 +/- 1.5 (range 1.2 - 6.6); SUV in the atypical carcinoid was remarkably high with a value of 8.5. The SUV was lower than 2.5 in 6 of 12 patients (50%). Mediastinal lymph node metastases or extrathoracic metastases were not detected in any patient. CONCLUSIONS: (18)F-fluorodeoxyglucose PET/CT imaging improves accurate localization of metabolic activity and thus the interpretation of pulmonary lesions on CT. FDG uptake in pulmonary carcinoid tumours is often lower than expected for malignant tumours. Therefore, surgical resection or biopsy of lesions suspected to be carcinoids should be mandatory, even if they show no hypermetabolism on FDG PET images.

Adult↗
PubMed2006

Renal ischemia/reperfusion and its influence on telomere length and expression of cell cycle regulatory genes.

The aim of the study was to evaluate the influence of renal ischemia/reperfusion (I/R) on telomere (T) length and tissue expression of cyclin-dependent kinase inhibitor genes (CDKIG). An experimental model of ex-vivo hemoperfusion of the kidney was used as described earlier. Telomere length measurement and expression of p16((INK4a)), p21((WAF1/CIP1)) and p27((Kip1)) CDKIGs was studied immunohistochemically in kidney biopsy samples at baseline and different time points after the reperfusion. The mean T length decreased after reperfusion from 5.56+/-0.60 kbp to 5.46+/-0.36 kbp (p=NS). All 3 genes were up-regulated in kidney tissue however their activation was different in diverse renal cells according to the reperfusion time. Expression of p16 significantly increased in tubular cells at 180 min of reperfusion as compared with the baseline. Activation of the p27 in glomerular cells was significantly higher at 60, 120 and 180 min of reperfusion as compared with 0 and 15 min. The marker started increasing in tubular cells at 15 min and was elevated at every time point afterwards. p21 was significantly over-expressed in all renal cells after the reperfusion. The current study shows that renal I/R causes T shortening and over-expression of CDKIGs indicating on substantial DNA damage and/or accelerated tissue senescence. The tissue expression of CDKIGs is positively related with the reperfusion time.

Animals↗
PubMed2005

[Resection of lung metastases--risk or chance?].

INTRODUCTION: The resection of pulmonary metastases can extend life of patients, even offering the possibility of cure. A risk analysis of the surgical procedure under the current practice of the thoracic surgery has been performed in this study. MATERIALS AND METHODS: Using a prolective method, data from 199 patients with 300 lung resections for pulmonary metastases done in our university department (1/1994-01/2003) were evaluated. Risk factors and therapy results were investigated in an uni- and multivariate analysis (Fishers Exact Test, Chi-Square and logistic regression). RESULTS: Overall lethality was 1 % and the total morbidity rate was 19 %. The 232 atypical resections were associated with 14 % morbidity rate, while the anatomical and combined ones were associated with 38 % (p = 0.0001). 19 patients revealed a FEV (1) < 1.6 l linked with a morbidity of 42 %. In patients without FEV (1) restriction morbidity was 18 % (p = 0.0172). Both, risk factors and the anatomical resection showed in the multivariate analysis a statistically significant increased morbidity. Additional risk factors (ASA > 2, age over 65, sex or cardial risk factors) did not influence postoperative morbidity. DISCUSSION: According to our data, no patient with good lung function should be withhold from atypical resection of pulmonary metastases offering the possibility of cure with low morbidity. However the indication should be critically evaluated if anatomical resection is required.

Aged↗
PubMed2001

Ex-vivo hemoperfusion (eHPS) of pig-lungs with whole human blood: effects of complement inhibition with a soluble C1-esterase-inhibitor.

OBJECTIVES: Xenotransplantation could be a future alternative to allotransplantation due to increasing organ shortage. Complement activation plays a major role in hyperacute rejection (HAR) in pig-to-human combinations. We developed an ex-vivo hemoperfusion (EHP) system to investigate pathophysiology of HAR in the lung. After standardizing the model, the effect of a soluble complement inhibitor (C1-INH, Berinert) was investigated. METHODS: Pig lungs were harvested following cold perfusion with Celsior preservation solution. EHP was performed using fresh heparinized human blood plus C1-INH (n = 6) or heparinized human blood as control (n = 4). Bloodgas analyses (BGA), pulmonalarterial pressure (PAP) were monitored. P-selectin and L-selectin were measured. Tissue samples were taken and microscopic changes evaluated. RESULTS: BGA, PAP, macroscopic and microscopic changes in the control group showed HAR, while the C1-INH group showed significantly longer function. Leucocytes and platelets were markedly activated in the control, whereas in the treated group L-selectin and P-selectin values indicated lower activation. HE stainings showed maintained lung architecture after perfusion of pig-lungs with human blood plus C1-INH. Immunohistochemistry showed less C1q, C3, C5b-9 activation in the C1-INH group. CONCLUSIONS: Investigation of interaction of human blood with pig lung endothelium could be done in this model. C1-INH attenuates HAR in a pig-to-human lung transplantation model by decreasing the activation of adhesion molecules. C1-INH could play a role in induction therapy of future lung xenotransplantation.

Animals↗