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Biomedical subjects

J Erhard

Publications and source records attributed to J Erhard.

At least 109 records · Page 6Linked to original sources
PubMed1992

Lactic acidosis from thiamine deficiency during parenteral nutrition in a two-year-old boy.

This is a case report of a two-year-old boy who was operated electively for a blind-loop syndrome of the proximal jejunum. Because of the appearance of chylous ascites, parenteral nutrition was carried out postoperatively. The boy developed a severe uncompensated acidosis and paralytic ileus. Relaparotomy on suspicion of ischemic bowel did not explain the cause of the acidosis and ileus. Postoperatively, the child's condition worsened, requiring intensive care. The drastically elevated lactate levels corroborated the eventually suspected diagnosis of a vitamin B1 deficiency syndrome. The administration of thiamine within two hours produced correction of the acidosis without further bicarbonate therapy. In 24 hours circulation was stabilized. Two months post-operatively the boy had completely recovered from the sequelae of his shock event.

Acidosis, Lactic↗
PubMed1992

[Management of the organ donor].

Brain death is associated with loss of hypothalamic, pituitary and brain stem function resulting in apnea, bradycardia and hypotension, poikilothermia, and diabetes insipidus. In order to preserve body functions mechanical ventilation is continued with the aim to maintain an arterial partial pressure of oxygen of more than 100 mmHg. Previous fluid restrictions and the application of diuretics during the treatment of high intracranial pressure frequently result in dehydration. Progressive vasodilation may induce severe hypotension and fluid replacement with cristalloids and if necessary colloids may be called for until the central venous pressure reaches 10 cm H2O. Continuous substitution of potassium and the use of hypotonic solutions such as glucose 5% may avoid hypokalaemia and hypernatraemia, respectively. Inotropic support with dopamine (5-10 micrograms/kg.min) or adrenaline (0.01-0.1 micrograms/kg.min) may be needed to maintain normal mean arterial blood pressure (65 mmHg). Polyuria (5000 ml/24 h) can be treated by continuous intravenous infusion of antidiuretic hormone (0.5-2-10 U/h). Hypothermia must be prevented by warming all fluids (37 degrees C) and covering the patient with heat saving blankets.

Brain Death↗
PubMed1992

[Immunosuppression after organ transplantation].

Immunosuppression after organ transplantation is based on pharmacologic interventions using steroids, azathioprin, sandimmun and anti-T-cell-globulins. During the induction-period the use of a high-dose combination-therapy guaranties a low incidence of rejection episodes. However infective complications may predominate. In the long-term phase the results of different immunosuppressive protocols are similar in respect to patient- and graft survival. This circumstance promotes the possibility to perform an individualised immunosuppression, which compiles to the personal demands of the graft recipient.

Graft Rejection↗
PubMed1992

[The integration of thoracic epidural anesthesia into anesthesia for intra-abdominal surgery].

Upper abdominal and thoracic surgeries require efficient pain management. The complications of postoperative analgesia include respiratory depression and--when choosing the epidural route--possible damage to the spinal cord by infection, trauma, or bleeding. Therefore, thoracic epidural analgesia may appear to be too risky and is frequently cancelled although many studies have shown its excellent efficacy. Controlled studies comparing thoracic epidural analgesia to lumbar epidural analgesia or intravenous analgetic regimens with special regard to the patient's outcome are contradictory. To make the preoperative decision on the method of pain control more rational, we studied catheter-related complications from 2056 thoracic epidural catheters used for intra- and postoperative analgesia retrospectively (n = 1002) and prospectively (n = 1054) over a 5 1/2-year period. In all patients the thoracic epidural catheter was inserted preoperatively using local anaesthesia, in most cases by the paramedian approach between level T 5/6 and T 8/9. During the clinical course of all patients there were no clinical signs of any epidural bleeding or infection. Neurological complications caused by the epidural catheter did not occur. Seven patients (0.035%) experienced radicular pain that disappeared after removal of the catheter or interruption of the puncture, respectively. A primary perforation of the dura mater was noticed in 0.5% of cases retrospectively and 1.23% prospectively. Respiratory depression following epidural application of 0.3 mg buprenorphine was seen in 1 patient (0.05%). Continuous analgesia with local anaesthetics and/or opioids applied epidurally by a thoracic catheter was performed on the peripheral ward (n = 829, 40%) if close monitoring of the neurological status as well as rapid diagnosis of any painful paraesthesia or paraplegia was possible.

Abdomen↗
PubMed1991

[Experiences with a modified implantation technique of Port-A-Cath systems as continuous venous access in infants and children].

Since April 1987 we implanted the Port-A-Cath infusion system in 60 children in the age of 2 months to 16 years (median: 4.3 years). We only used the adult system (Pharmacia). By one right side infraclavicular incision the silicon catheter was implanted into the jugular vein and also the port was fixed on the pectoral fascia. We saw one severe complication as a port perforation through the skin. 1.6% was the very low rate of complications which appeared in the median of the port using time of 168.5 days.

Adolescent↗
PubMed1991

Alterations of the immune system following splenectomy in childhood.

After splenectomy due to blunt abdominal trauma, splenectomized children showed a restricted pattern of T-cell immunodeficiency compared to age and sex-matched normal children. Peripheral blood total (CD3) T-cell counts of 11 splenectomized children of 43%, double positive helper (CD4) inducer subpopulation (CD29) cell counts of nine splenectomized children of 7%, and phytohemagglutinin (PHA)-induced T-cell proliferation of 11 splenectomized children of 53,206 c.p.m. were significantly (p less than 0.05) lower than values of normal children (61% CD3 cells, n = 12; 13% CD4CD29 cells, n = 11; 107,832 c.p.m. PHA-induced proliferation, n = 12). The deficit of CD4CD29 cell numbers may be due to impaired maturation of these particular CD4 lymphocytes and may explain diminished PHA-induced proliferation in small children. The significantly higher B-lymphocyte counts of splenectomized children (21%, n = 11; 558 cells/mm3, n = 10) compared with 12 normal children (14%; 329 cells/mm3) may be due to loss of the reservoir function of the spleen.

Adolescent↗
PubMed1991

[Porto-femoro-subclavian bypass and the rapid infusion technique in orthotopic liver transplantation].

Veno-venous bypass during orthotopic liver transplantation is commonly performed as a porto-femoro-axillary bypass. Right-angle positioning of one patient's arm and surgical preparation of the femoral and axillary veins are necessary. In 17 patients and 20 consecutive orthotopic liver transplant procedures the common porto-femoro-axillary veno-venous bypass was substituted by porto-femoro-subclavian bypass with a percutaneous 20 F cannulation set (LAUB catheter, Cook). The 20 F catheter was introduced into the left subclavian vein by Seldinger's technique before the operation and was connected intraoperatively to the outflow tube of the biopump. Surgical preparation of the axillary vein was not performed. In 10 patients a Y-connector was used to connect up the Rapid Infusion System in addition. Postoperatively the catheter was left in place for 2-4 days. Introduction and removal of the catheter were uneventful in all cases. High blood flow through the catheter could be maintained by a low driving pressure of the pump (4000 ml/min; 100 mmHg). No intraoperative complications were observed. Shunt flows remained stable throughout the surgical procedure during the anhepatic stage. There was no bleeding from the puncture site, especially after removal of the catheter, though several patients had a poor coagulatory status in the early postoperative period. Two postoperative complications were observed: air embolism due to disconnection and formation of a thrombus at the catheter tip, which it was possible to remove together with the catheter itself. Installation of an irrigation infusion in the postoperative period and well-tightened connections help avoid such complications as thrombus formation, bleeding or air embolism.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[A new mechanical anastomosis technique in deep anterior resection for Hirschsprung's disease in infancy].

Since 1987 we perform a new technique of colorectal anastomosis in 6 babies resected because of severe Hirschsprung's disease. The operation was done electively in the seventh to eight month of age. In the method of the so-called compression anastomosis the instrument is inserted through the anorectal canal at the head fitted with two plastic rings (see illustrations). In the rectal stump the instrument is opened up, the rectal bowel edge is slipped over the distal ring. The prepared proximal bowel edge is slipped over the second white coloured ring. The rings are approached to one another and the instrument is released. The knife on the inside cuts the bowel. The two rings are then joined by means of springs. The compression anastomosis is completed. The two bowel edges are joined by compression via the two intraluminal plastic rings. These rings will pass spontaneously with the faeces days after operation. The diameter of the rings is 18 mm. Different diameters are available. Our good experiences in more than 160 compression anastomoses in colorectal surgery of adults encouraged us to use the method also in children. We saw one complication of a rectovaginal fistula 4 weeks after the operation followed by a severe stenosis of the anastomosis. The passing of the plastic rings was without any problem in all the cases. In the follow-up a bouginage was required only in the case mentioned above.

Anastomosis, Surgical↗
PubMed1987

[Endoscopic pressure measurement in distal esophageal varices. A prospective study].

Portal pressure in distal oesophageal varices near the cardia was measured 71 times directly during endoscopy in 44 patients (average age: 52 years; 18 female and 26 male subjects) with confirmed diagnosis of liver cirrhosis and portal hypertension who had suffered from bleeding of oesophageal varices. No significant differences in portal pressure were seen on grouping the patients according to individual Child stages. However, a significant difference was found (P less than 0.01) on comparing the patients (n = 26) without recurrent bleeding (average follow-up period 10 months) with those who had an early (n = 5) and a late recurrent bleeding (n = 13). Although the number of cases was small a risk group for recurrent bleedings was defined at portal pressure values of 25 mm Hg and higher.

Blood Pressure Determination↗
PubMed1987

[Acute ischemia of the limbs caused by concomitant vascular injury in proximal shaft fractures with soft tissue damage].

Combined skeleto-vascular lesions of the proximal parts of the extremities endanger not only the limb but also life. Operative treatment has to be carried out as soon as possible. Stabilisation of the fracture has priority over vascular reconstruction. This paper reports 39 skeleto-vascular lesions. The most important singular factor to improve the prognosis is the reduction of the time interval between the accident and the restoration of regional blood flow. This can be achieved by avoiding time consuming diagnostic measures, quick stabilisation of the fracture by external fixation, temporary circulation by an intraluminal shunt, and by simultaneous operation. It is important to avoid a post-ischaemic compartment syndrome by early fasciotomy.

Adolescent↗
PubMed1987

[Reconstruction of the chest wall].

In cases of malignant disease of the chest wall, such as primary tumors or extensive metastases, a particularly large resection is necessary. This leads to great problems in restoring an adequately functional chest wall. In addition to the cosmetic effect one must pay particular consideration to the dynamic parameters of pulmonary function. In a 54 years old male suffering from recurrent malignant schwannoma we performed an extensive chest wall resection. It included the ribs 3-8 on the right. The extension of the defect was 15 X 22 cm. We reconstructed the pleura with Vicryl-mesh. The covering was done with musculus pectoralis major, musculus rectus abdominis and a musculocutaneous obliquus externus abdominis flap. Three months after operation a small restriction of vital capacity is observed. In a 29 years old male partial resection of the right chest wall had to be done for a local extended chondro-sarcoma. The tumor included the ribs 4-9: chest wall defect after resection amounted to 15 X 18 cm. We performed a primary reconstruction using Vicryl-mesh as substitute for the pleura. We covered the pleura with a musculocutaneous latissimus dorsi flap. Three months after successful reconstruction the parameters of pulmonary function reached normal values again. In these and further cases the combination of Vicryl-mesh as a resorbable substitute for the pleura and musculocutaneous flaps for the chest wall has been successful in restoring a good pulmonary function.

Humans↗