Cardiorespiratory disturbances following antibiotic prophylaxis in general surgery: reasons for a complex reappraisal of a common problem.
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Anaphylaxis↗
Biomedical subjects
K P Reimund
Publications and source records attributed to K P Reimund.
Management of leucopenic sepsis.
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Adult↗
Granulocyte colony-stimulating factor prophylaxis before operation protects against lethal consequences of postoperative peritonitis.
BACKGROUND: Postoperative peritonitis has a high mortality in human beings. It is accepted that cytokines are important mediators in pathophysiology of sepsis. The recent failure of clinical trials increased the necessity to proof new drugs in more clinically relevant animal models. The aim of this study was to examine the effect of granulocyte colony-stimulating factor (G-CSF) in addition to an antibiotic in postoperative peritonitis. METHODS: Dose-response curves and experimental conditions were developed in a total of 295 rats. The main experiment included three groups: control animals receiving a fecal inoculum, a group treated with antibiotic, and a third group receiving G-CSF in addition to the antibiotic. The main outcome was death, but in addition, serum tumor necrosis factor (TNF) level was determined. RESULTS: The mortality rate of 60% in antibiotic treated animals was considerably reduced by G-CSF to 20%. All animals of the control group died during the observation period of 120 hours. A correlation between TNF levels and mortality rate was observed. In G-CSF treated animals total suppression of TNF serum levels was accessible in contrast to the others. CONCLUSIONS: In a clinically relevant animal model G-CSF was effective as an additional concept of prophylaxis. These data are promising toward clinical trials.
Animals↗
[Diagnostic and therapeutic procedures in splenic and hepatic artery aneurysms].
The diagnosis and therapy of splenic and hepatic artery aneurysms is besides clinical findings based on ultrasound and selective arteriography. Surgical treatment depends on the exact localization of the aneurysm. Because of postsplenectomy sepsis preservation of spleen should be reached. Otherwise splenectomy with resection of the aneurysm must be performed. If the aneurysm is localized at the common hepatic artery ligation of the vessel is possible. The interposition of an autologous vein graft is the most favorable proceeding in aneurysms of proper hepatic artery. Those of intrahepatic arteries should be treated just as aneurysms in high risk patients by selective percutaneous embolization.
Adult↗
[Parathyroid gland cancer. Problems in diagnosis and therapy].
Parathyroid carcinoma occurs in 0.1 to 5% as the cause of primary hyperparathyroidism (HPT). It is difficult to determine the true incidence, because parathyroid carcinoma is diagnosed too often due to unreliable histologic criteria. It is only justified to make the diagnosis, when a local recurrence or metastases with the clinical picture of a recurrent or persistent HPT occurred. Treatment of choice is the initial en-bloc resection, which may result in long disease-free intervals. Pharmacological treatment, chemotherapy, and radiation are mostly ineffective in the treatment of parathyroid carcinoma. A satisfactory long-term palliation can only be achieved with repeated resections of the local recurrences and metastases. Diagnostic efforts should be made to localize the recurrent tumor before every reoperation, whereby ultrasonography of the neck is the most sensitive procedure. Occasionally the parathyroid tissue cannot be identified in spite of preoperative diagnostic studies or hypercalcemia persists after surgery. In these cases forced diuresis and medical treatment with calcitonin, diphosphonates or mithramycine can briefly control hypercalcemia. The clinical courses of 3 patients with metastasizing parathyroid carcinoma are presented and discussed. In these patients 3 to 11 surgical interventions were performed in combination with an intermittent medical treatment. By this regimen we achieved long-term palliations up to 13 years.
Adenoma↗
[The value of preoperative diagnosis for surgical treatment of liver tumor. Results of a consecutive study series from the surgical viewpoint].
Value of preoperative diagnostic procedures in the surgical treatment of liver tumors. Results of a consecutive examination series from surgical view. Between September 1985 and December 1988 93 patients with tumors of the liver were operated at the University Hospital of Mainz. Most of them had metastases of colorectal cancer. The accuracy of preoperative diagnostic proceedings was very high using abdominal ultrasonography and computed tomography. The sensitivity of both methods for detecting a tumor amounts 88 and 95%. In spite of this high accuracy the intraoperative findings were different in 29% of the treated patients. An unfavourable intraoperative situation did not exclude a radical resection of the tumor. Therefore we think that the indication to operation is correct if there is any doubt about the expansion of the tumor.
Adenoma, Bile Duct↗
[Hematobilia--a rare complication after traumatic liver rupture].
Hematobilia is a rare complication after traumatic liver injury and has a high mortality. Clinical signs are hyperbilirubinemia and increase of bile acids in serum by rarely increased liver enzymes. Pathophysiologically there is a connection between bile duct system and liver veins. To determine the diagnosis giving rise to the clinical signs, after abdominal ultrasonography and computed tomography the ERCP seems to be the most suitable method. The treatment of hematobilia is not necessarily operative; a successful conservative therapy is also possible.
Adult↗
[Rational diagnosis in diseases of the esophagus and stomach].
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Esophageal Diseases↗
[Diagnostic strategy of the liver and bile ducts].
The diagnosis of gallbladder and liver diseases depends primarily on noninvasive techniques (ultrasound and computer tomogram). Gallstones can be detected by ultrasonography in more than 90% of such patients and this is a sufficient indication for operation. The preoperative diagnosis of stones of the biliary tract by sonography is however, unreliable. Even a preoperative endoscopic retrograde cholangio-pancreaticography cannot justify foregoing an intraoperative cholangiogram. Detection of metastasis is still a problem in the diagnosis of liver tumors. Further developments in computed tomogram and scintigram techniques, however, promise improvements.
Bile Duct Diseases↗