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Biomedical subjects

L Lehr

Publications and source records attributed to L Lehr.

At least 37 records · Page 2Linked to original sources
PubMed1989

[Postoperative energy requirements following large abdominal surgery interventions: comparison of measuring by indirect calorimetry with estimated values].

Energy requirement after major abdominal operations, as calculated according to the formula for basic energy expenditure by Harris-Benedict, was increased by 30% in the early and by 50% in the late postoperative period. Correlation of these calculated values to measurements by indirect calorimetry was good. Even more simply a good estimation of caloric requirements can be obtained by multiplication of the body weight with a factor 30. The development of septic complications does not increase considerably postoperative energy expenditure, however, the correlation between measured and estimated values becomes poor. As supposed from isotope studies measuring gas exchange for indirect calorimetry for one hour provides sufficiently stable results.

Aged↗
PubMed1989

[Nutritional status in esophageal cancer: assessment and significance for preoperative risk assessment].

In a prospective study including 60 patients with esophageal carcinoma the nutritional status was evaluated by means of anthropometric, biochemical and immunological data. As a first measure of malnutrition the diminuation of each single parameter was estimated in a 10%-scale, according to this a linear rising number of points given and the sum for all 11 parameters expressed as a score (Gofferje and Fekl). Second the nutritional status was judged by the prognostic nutritional index (Buzby and Mullen). Both score and index were correlated with serious postoperative complications (wound infection, anastomotic leakage, sepsis, organ failure, death). The results show that it was not possible to assess the risk of esophagectomy preoperatively on the ground of nutritional parameters solely. The reason could be that the nutritional status was rather normal in most cases and its risk burden therefore low. In conclusion performing preoperative nutritional therapy routinely seems not to be justified.

Aged↗
PubMed1989

[Renal function and sleep apnea syndromes].

Obstructive sleep apnea (OSA) patients have increased diuresis and natriuresis during sleep. In order to investigate the possible mechanisms of these changes in renal function, 35 consecutively diagnosed OSA patients were studied during sleep before and during nasal continuous positive airway pressure (CPAP) treatment, and were compared with 23 non-snoring controls. The excretion of urine and of electrolytes was increased before treatment and normalized with nasal CPAP treatment. The mechanism involved seems to be decreased sodium reabsorption at the level of the ascending limb of the loop of Henle. The observed increase in cyclic guanosine monophosphate excretion supports the hypothesis of increased atrial natriuretic peptide release during sleep in OSA patients.

Adult↗
PubMed1989

Urinary excretion of guanosine 3':5'-cyclic monophosphate during sleep in obstructive sleep apnoea patients with and without nasal continuous positive airway pressure treatment.

1. It has recently been shown that obstructive sleep apnoea (OSA) patients have increased urinary water and salt excretion during sleep which tends to normalize with nasal continuous positive airway pressure (CPAP) treatment. 2. To investigate the mechanisms of these changes in renal function, nocturnal urinary excretion of catecholamines and guanosine 3':5'-cyclic monophosphate (cyclic GMP), which reflects atrial natriuretic factor (ANF) release, and next-morning plasma active renin concentrations were studied in 21 OSA patients on 2 consecutive nights, either untreated or treated with nasal CPAP. 3. In keeping with previous results, fractional urine flow and fractional Na+ and Cl- excretions were higher during untreated than during CPAP-treated nights. 4. No difference in plasma active renin concentration or in urinary excretion of noradrenaline, adrenaline, free dopamine and total dopamine could be demonstrated, but cyclic GMP excretion was significantly higher during untreated than during CPAP-treated nights. 5. The data are consistent with the hypothesis that the increased water and salt excretion in OSA patients is due to increased ANF release. 6. The proposed mechanism is an atrial distension due to increased (more negative) intrathoracic pressures during ineffective inspiratory efforts against the occluded upper airways which have been found in OSA.

Adult↗
PubMed1989

Elevated serum levels of soluble interleukin-2 receptors in HIV infection: no correlation with activated T cells.

Serum levels of soluble interleukin-2 receptors (sIL-2R) were measured in 105 HIV-seropositive individuals simultaneously with T cell subsets and activated T cells (CD3+ and HLA-DR+). Significantly elevated levels of serum sIL-2R were found (564 +/- 259 U/ml versus 258 +/- 87 U/ml in 70 controls, p less than 0.001), as well as increased numbers of activated T cells (mean numbers, 579/microliters in the patients versus 113/microliters in 26 controls, p less than 0.0001). Correlation analysis did not disclose any significant association between elevated sIL-2R and increased activated T cells, nor with decreased CD4+ lymphocytes. These data suggest that sIL-2R in HIV infection do not emanate from activated T cells and are not linked to CD4+ cell loss.

Adolescent↗
PubMed1988

[Experiences with 3151 central venous catheters at a surgical clinic].

The incidence of infection among over 3,000 central venous catheters, placed over a period of 18 months, was analysed, 1,570 retrospectively and 1,581 prospectively. The Shaldon catheter had the highest infection rate of the various catheter types. Taking the findings of 983 catheters of one type, Cavafix, the infection rate was significantly higher when the internal jugular vein was the site of puncture instead of the cubital or subclavian veins. Signs of inflammation at the site of catheter entry were a further risk factor for infection. Although the clinical suspicion of catheter-induced sepsis proved groundless in nearly half the cases, early catheter removal is at present the most effective prophylactic means, while routine weekly catheter replacement did not reduce the infection rate. Catheter colonization and catheter sepsis are predominantly problems of nursing and hygiene. The infection rate was reduced through nursing and supervision by personnel specially trained in infectious precautions.

Arm↗
PubMed1988

[Early postoperative enteral feeding following esophageal resection].

In a prospective randomized study, total parenteral alimentation was compared with early postoperative enteral alimentation in a group of patients who had undergone esophageal resection. In addition to mechanical problems with the jejunal catheter abdominal complications arose during enteral alimentation (meteorism, distension), leading to discontinuation in one-third of cases. The limited prognostic value of ultrasound examination of the abdomen - now often used postoperatively as a decisive aid to diagnosis - is a further serious disadvantage; overall, since there are no particulars in which enteral alimentation can be shown to be superior to parenteral alimentation, it no longer seems justified in the early postoperative phase. The jejunal catheter has, however, proved its worth as a means of direct access to the intestine that can be exploited any time after the initial postoperative period (a week to some months after surgery). For this reason we now insert a jejunal catheter routinely following esophagectomy or gastrectomy.

Clinical Trials as Topic↗
PubMed1988

Assessment of resectability of esophageal cancer by computed tomography and magnetic resonance imaging.

Sixty patients with esophageal cancer infiltration of mediastinal structures and metastasis to lymph nodes were prospectively evaluated by computed tomography and magnetic resonance imaging and then underwent surgical resection of the tumor (n = 57) or diagnostic thoracotomy (n = 3). Lymph nodes were excised from standardized locations and examined histologically. Sensitivity and specificity of both methods for all criteria were found so low that the value of these methods for planning surgery--or for stratification to different therapeutic arms in comparative studies--must be questioned.

Adenocarcinoma↗
PubMed1986

[Percutaneous transluminal irradiation of biliary tract cancer using iridium].

In ten patients with biliary carcinomas, percutaneous biliary drainage was instituted and intracavitary irradiation performed, using 192iridium with a dose of 40 to 80 Gy. Eight of these patients had been found to be inoperable at laparotomy and two had had a recurrence. In half the patients there was a reduction in the degree of stenosis due to the tumour, but in only one patient was it possible to remove the draining catheter. Survival time in eight patients was between one and eight months, average 5 months. Two patients survived for eleven and twelve months respectively. The relatively poor results are due to extensive metastases. On the other hand, there can be no doubt about the effectiveness of this treatment on locally confined tumours, in view of the reduction in the obstruction caused by the tumour.

Adult↗
PubMed1986

[Bile duct surgery in the light of modern endoscopic and radiologic technics].

Biliary surgery and interventional endoscopy and radiology are not competitors but supplement and enlarge their capacities mutually. This holds true for improved diagnostic capabilities and differentiated indication settings as well as for therapeutic splitting by combining surgical and non-surgical methods. Promising reports from the newer literature and increasing own experiences in favour of these concepts form the basis of this topical review.

Ampulla of Vater↗
PubMed1985

[Endocavitary radiotherapy in an after-loading technic in malignant stenoses of the upper gastrointestinal tract and bile ducts].

Palliative brachytherapy with 192iridium in high dose rate technique was applied until August 1985 in 44 patients: 40 suffering from an inoperable malignant stenoses of the esophagus or cardia, and 4 from bile duct carcinomas located in the upper part of the duct. The patients with malignant stenoses of the upper gastrointestinal tract underwent laser therapy until an endoscope could be passed beyond this stenoses. Then an after-loading tube was placed endoscopically and the stenoses irradiated endocavitarily (7/Gray/session in 1 cm distance). In the patients with malignant bile duct obstruction a PTCD-catheter served to guide the iridium wire up to the stenotic region.

Adenocarcinoma↗
PubMed1984

[Changes in total body potassium and ion distribution compartments in general surgery and intensive care patients].

Measurements of total body potassium in a whole body counter revealed significant total body potassium depletion in patients suffering from high output enteric fistulas, short bowel syndrome and Crohn's disease. The clinical importance of this finding is derived from the fact that the degree of potassium depletion was found to be related to mortality, and that the introduction of an infusional regimen for preparation for surgery in Crohn's disease which effected intracellular potassium refilling resulted in a decreased surgical mortality and complication rate. In conclusion specific nutritional support as an essential measure in preparing such patients for elective surgery is particularly recommended. Significant cellular potassium depletion was also found in critically ill patients dying from sepsis. In contrast to the aforementioned diseases with malnutrition, where an increased fecal loss of potassium is the most likely cause of potassium deficiency, a different mechanism for cellular potassium loss is suggested in this condition from additional indicator dilution studies. Rather here the finding of increased distribution volumes for ions physiologically predominantly restricted to the extracellular space (82Br and 24Na) indicates a change of cell membran permeability suggestive of so called sick cell syndrome.

Adult↗
PubMed1983

Altered potassium homeostasis in Crohn's disease.

The total body potassium (TBK), serum potassium, and the number of red blood cell ouabain-binding sites was studied in 94 patients with Crohn's disease. TBK was measured by counting the endogenous 40K in a whole body counter. TBK was 87% +/- 13% in 94 patients with Crohn's disease, while in control subjects, it was 97% +/- 12% (n = 24). This significant reduction in TBK was accompanied by normal serum potassium levels (4.4 +/- 0.5 mM). TBK was significantly correlated with the Crohn's disease activity index (r = 0.79, n = 113, P less than 0.01). The number of red cell ouabain binding sites measured by equilibrium binding of 3H-ouabain showed a significant increase in the number of Na-K pumps in Crohn's disease (396 +/- 65, n = 27) compared with the control group (290 +/- 45; n = 24). These results support the suggestion that changes in TBK may regulate the synthesis of Na-K pump molecules. The total body potassium depletion and the need for a preoperative nutritional support in Crohn's disease are discussed.

Adolescent↗
PubMed1983

[Resection of juxtahilar bile duct carcinoma instead of palliative drainage of the biliary tract].

Instead of the widely recommended approach of treating hilar carcinoma of the bile ducts by simple palliative biliary drainage, step by step a policy of primarily aiming at resection for cure has been adopted. So far in 11 out of 22 patients excision of the tumor was possible by resection of the hepatic duct confluence; in 4 cases a left hemihepatectomy had to be added because of carcinomatous infiltration of the left liver lobe or the left hepatic artery. The multiple bile duct openings remaining after resection of such tumors were reconstructed to one or two orifices and a bi- or unilateral Roux-en-Y cholangiojejunal anastomosis performed. In further 3 cases orthotopic liver transplantation was necessary to remove all visibly infiltrated tissue. In the remaining 8 patients because of documented extrahepatic carcinomatous spread palliative biliary drainage by a percutaneous U-tube or an endoprothesis was indeed considered the only reasonable measure. Despite the relatively high resectional rate of 60% and the extensive operations performed early mortality was confined to one patient who succumbed to septic endocarditis 6 weeks after the operation. At present the longest postoperative interval without recurrence amounts to 3 1/2 years. Nine patients free of recurrent disease are in perfect health; in 3 patients in whom a recurrence was observed after 1/2, 1 1/2 and 2 years meanwhile palliation was perfect. In contrast all patients with unresected tumors but carrying draining stents suffered from cholangitis and after 1 1/2 years all but one had died. In conclusion resectional therapy for hilar carcinoma seems possible with acceptable risk. Since only resection can provide potential cure and also palliation was better than that achieved by draining tubes a more aggressive attitude to the treatment of these lesions is advocated from our experience.

Adenocarcinoma↗
PubMed1983

[Correction of amino acid imbalances as adjuvant therapy in septic peritonitis].

A prospective and randomized study was performed in 18 patients with septic peritonitis to investigate the behavior of free amino acids in serum before and during parenteral nutrition with 2 different amino acid solutions. One group received a so called "liver-solution" with 45% branched chain amino acids and reduced aromatic and sulphur-containing amino acids, the other group a conventional solution with 10,5% branched chain amino acids. Amino acid imbalances typically in sepsis--elevation of aromatic and sulphur-containing amino acids as well as alanine and proline, normal or decreased branched chain amino acids--could be observed only to some extend, because the influence of preceding operative trauma was overlapping. However, with conventional parenteral nutrition these imbalances then became clearly apparent. On the other hand, in patients treated with the special amino acid solution nearly complete normalization of amino acid levels took place. This effect was mainly due to the increased supplementation of branched chain amino acids positively influencing protein metabolism, and less produced by the changes in amino acid proportions supplied. Clinically these patients also had a clear improvement of consciousness status. The positive effect of such balanced solution on amino acid metabolism and mental situation of septic patients could be confirmed. Their use in septic peritonitis during necessary parenteral nutrition as an adjunctive treatment therefore seems to be efficient.

Adult↗