PubMed Health⌕ Search

Biomedical subjects

M Höllwarth

Publications and source records attributed to M Höllwarth.

At least 19 recordsLinked to original sources
PubMed2006

The role of nuclear factor-kappa B in bacterial translocation in cholestatic rats.

Xanthinoxidase (XO) derived radical species are involved in bacterial translocation (BT) in cholestatic rats. The mechanism by which XO influences remains unclear. It has been shown recently that nuclear factor-kappa B (NF-kappaB), a ubiquitous transcription factor, can be activated by oxidative stress and thereby promote the process of BT. We investigated the effects of NF-kappaB inactivation on the incidence of BT in cholestatic rats. Sprague-Dawley rats were randomly assigned to one of eight groups: groups 1-4 were sham laparotomized rats either untreated (S1) or treated for 5 days with thalidomide (S2), curcumin (S3), or Inchin-ko (ICK; S4); groups 5-8 underwent common bile duct ligation (CBDL) for 5 days and were either untreated (C1) or treated with thalidomide (C2), curcumin (C3), or ICK (C4). After 5 days bacteriological cultures were performed from portal blood and V. cava, from the central mesenteric lymph node complex (MLN), spleen, and liver. The intensity of the activated NF-kappaB-subunit p65/p50 in the ileum mucosa was estimated by light microscopy and a scoring system from 1 to 20. Malondialdehyde (MDA) and myeloperoxidase activity (MPO) in the ileum were evaluated and expressed as U/g dry weight. Thalidomide and ICK reduced in CBDL-rats significantly the BT rate (63% vs. 18%, 63% vs. 30%, P<0.01). Enzyme estimations (MDA, MPO, and GSH) in sham operated animals showed no significant changes in the untreated groups compared with the treated groups. CBDL-rats pre-treatment with all three compounds caused a significant increase of MDA levels if groups were compared with the untreated C1-group (C1 31.6+/-7.7, C2 54.5+/-12.2, C3 53.3+/-11.2, and C4 47.2+/-9.4). GSH was reduced after the pre-treatment by all compounds but only significantly after curcumin pre-treatment (C1 vs. C3: 13.9+/-1.8 vs. 7.1+/-1.8; P<0.05). MPO estimations were significantly higher in the untreated C1-group if compared with groups C2, C3, and C4 (C1 1036.4+/-340.9, C2 709.9+/-125.9, C3 545.2+/-136.6, and C4 556.7+/-247.4; P<0.05). Thalidomide inhibited significantly the activation of NF-kappaB (C2 vs. C1: 6.0+/-4.5 vs. 12.7+/-5.3; P<0.01). Likewise, Curcumin and ICK suppressed NF-kappaB activation, but this did not reach significance in this experiment. NF-kappaB is involved in the process of BT in cholestatic rats and may be activated by XO derived ROS. We assume that the activated NF-kappaB initiates transcription of target genes inducing cytokine production, which in turn disrupts the tight junctions leading to BT from the intestinal lumen to the MLNs and circulation.

Analysis of Variance↗
PubMed2002

[Lateral clavicular fractures in children and adolescents].

From 1996 to 1999, 572 fractures of the clavicle were treated in our department, 26 of which were located at the lateral end of the clavicle. Two children were operated: in one a closed reduction of the fracture under general anesthesia was performed, and in the other the fracture required open reduction with internal fixation. All other fractures were treated conservatively with a figure-of-eight clavicle strap for 3 weeks. A follow-up study was performed in autumn 2000. Sixteen patients came to our outpatient department for clinical and radiological control, and three patients informed us by phone. All patients including the two treated under general anesthesia were fully recovered and had no problems doing their job and engaging in different sports. The radiological controls showed a good ossification without visible deformity of the clavicle.

Adolescent↗
PubMed2002

Management of Budd-Chiari syndrome by hepatic vein stenting after extended right hepatectomy.

Massive splenomegaly and ascites production with hypoproteinemia and hypocoagulability was observed in a 15-year-old boy after extended right hepatectomy for hepatocellular carcinoma (HCC). Angiography disclosed a kinking of the left hepatic vein immediately before the junction with the inferior vena cava. Ascites disappeared completely, and laboratory values normalized after placement of a 3-cm long balloon expandable stent. The current case shows that Budd-Chiari syndrome caused by hepatic outflow obstruction after major hepatic surgery can be managed effectively by percutaneous stent placement.

Adolescent↗
PubMed1998

"Emergency hepatectomy" in a 16-month-old boy with a hepatoblastoma, severe cytomegalovirus-induced pancytopenia, and intractable diarrhea.

A 16-month-old boy presented with massive abdominal enlargement. Magnetic resonance imaging (MRI) revealed a liver tumor measuring 11 x 11 x 10 cm. Pulmonary metastases were detected by chest computed tomography. The diagnosis of a hepatoblastoma was made from the patient's age, the location of the tumor, and marked elevation of alpha1-fetoprotein (AFP). Chemotherapy according to the German Cooperative Pediatric Liver Tumor Study HB-94 was started, leading to a rapid and dramatic decrease in AFP levels. Despite an excellent response to chemotherapy, however, the abdominal distension increased. On a second MRI scan the tumor was unchanged in size, showing large areas of necrosis and cystic transformation. In addition, the patient acquired a cytomegalovirus infection with intractable diarrhea and severe pancytopenia. Since the patient's clinical course had worsened, the decision was made to alleviate the life-threatening tumor compression by an extended right hepatic lobectomy despite platelet-transfusion dependence and a white blood cell (WBC) count of only 300/microliter. Postoperative necrosis of the common bile duct necessitated a secondary resection with Roux-en-Y hepaticojejunostomy. The boy recovered quickly, and the white blood and platelet counts increased to normal values immediately after the first surgery so that chemotherapy could be finished after the postoperative recovery period. He is now in good condition without evidence of local or metastatic disease 1 year after the primary diagnosis.

Cytomegalovirus Infections↗
PubMed1987

[Functional assessment, using micturition cystourethrography, of the unstable bladder in childhood].

The accuracy and reliability of a modified method of micturating urethrocystography for the diagnosis of uncontrolled detrusor contraction in unstable bladders (sphincter-detrusor dyssynergy during bladder filling) was studied in 100 patients aged between four and 15 years. A comparison with a urodynamic method showed an accuracy of 92%, sensitivity of 93% and specificity of 90.7%. The technique and indications are described and the clinical relevance of the results is discussed.

Adolescent↗
PubMed1987

[Results following surgical treatment of ligament ruptures of the ankle joint in children].

A follow-up study was done in 49 children one to five years after surgical repair of traumatic rupture of the fibular ligaments of the ankle joint. Surgery has been performed when the unstable ankle joint showed radiologically a difference in the supinatory subluxation of more than 7 degrees in comparison to the opposite side. 30 children were free of complaints and showed identical stability of both ankle joints. Further eleven patients had minor complaints but the ankle joints were stable, clinically and radiologically. Four patients without complaints had a slightly differing weakness of the ankle joint. Further four patients had substantial complaints. Three of them also showed radiologically instability of the joint. Ruptures of the fibular ligament in childhood are not infrequent. Early operative treatment obviously gives better results when compared with those of conservative plaster cast therapy. The radiologically confirmed difference in supinatory subluxation of the traumatised ankle joint in comparison to the other side provides an excellent parameter for the indication to surgery.

Adolescent↗
PubMed1986

[Antibiotic treatment of perforated appendicitis in childhood--a prospective study].

A prospective randomised study (I) was carried out on 130 children undergoing laparotomy for perforated appendicitis. The present study evaluates the therapeutic effectiveness of different antibiotic regimens in modifying the rate of post-operative complications (intraabdominal abscess, ileus, wound infiltration or abscess). During the first year of this study two treatment groups were used. Group A consisted of 29 children treated with Sulfometrol/Trimethoprim; the rate of postoperative complications was 44.8%. Group B consisted of 36 children treated with mezlocillin, the rate of complications being 13.8%. However, the same treatment with mezlocillin during the second year of the prospective study showed an increase of this rte to 39% (28 children--group C). The final group of 37 children was treated during the second year with mezlocillin and metronidazole (group D). The postoperative rate of complications was 10.8%. A retrospective analysis of further 80 children (study II) with perforated appendicitis treated with mezlocillin and metronidazole showed a consistent low rate of postoperative complications at 10.2%. In 6.8% of children studied, an operative intervention was necessary (four cases of ileus, four wound abscesses). The mean postoperative hospitalisation period decreased from 22.7 days in group A to 15.2 days in group D and finally to 14 days in study II. The present study shows that an effective and persistent attenuation of the rate of postoperative complications after perforated appendicitis in children depends on an early onset of therapy and on the appropriate choice of antibiotic drugs that are effective against aerobic and anaerobic microorganisms.

Anti-Bacterial Agents↗
PubMed1986

Unstable bladder in children: functional evaluation by modified voiding cystourethrography.

A slightly modified technique for voiding cystourethrography was applied in 100 patients between 4 and 15 years of age and used to study uninhibited detrusor contractions in the so-called unstable bladder syndrome. Uninhibited detrusor contractions result in a slowing or cessation of the flow of contrast material into the bladder and a simultaneous minimal or marked opening of the bladder neck, with variable filling of the posterior urethra. Comparison of the radiologic findings with the results of urodynamic studies demonstrated an overall accuracy of 92%, sensitivity of 93%, and specificity of 90.7% for the radiologic technique.

Adolescent↗
PubMed1986

[Sleep apnea in infants and the risk of SIDS].

The examination of the respiratory function in 184 sleeping infants gave evidence of a significant difference in several parameters between the so-called SIDS risk group and the control group. The risk group (97 babies) consists of 60 infants with frequent prolonged apneas, 30 infants with postnarcotic apneas and 7 near miss infants. Polygraphic registration during sleep showed significantly more apneas in the risk group. These apneas often appeared more frequently during certain periods. The average respiratory deficit expressed as the MA-value (MA = average apnea duration) in the risk group was significantly higher than in control infants. Besides that we were able to prove a more frequent pathological gastroesophageal reflux in the risk infants than in control infants.

Anesthesia, General↗
PubMed1985

Physiology and pathophysiology of the esophagus in childhood.

Gastroesophageal reflux (GER) is the most important disorder of the esophagus and the lower esophageal sphincter (LES) in early childhood. Functional disturbances with inadequate relaxation of the LES have to be considered as pathogenetic factors. In the 1st month many newborns have some disorder of motor coordination of the esophagus. After that time, persisting GER may be seen as a delay in maturation, which fades away by the end of the first half year. GER after 6-9 months is to be considered as a definitively pathological condition that will not spontaneously normalize. Nevertheless, it is important to realize that the typical clinical signs of reflux stop generally between the 6th and 12th month, and so simulate healing independent of whether spontaneous maturation occurs or there is continued existence of reflux. Reflux-induced apneic spells are severe complications of this esophageal disorder in the 1st year of life. Esophagitis, usually a late complication, occurs when the aggressive factors win their fight against clearance and mucosal resistance of the esophagus. Brachyesophagus and endobrachyesophagus are severe late complications.

Child↗
PubMed1985

Correlation between manometric and roentgenologic findings of diseases of the esophagus in infants and children.

Roentgenologic and manometric findings in diseases of the esophagus in infants and children were compared. With both procedures combined it was possible to determine the exact localization of the lower esophageal sphincter. For the demonstration of gastroesophageal reflux the roentgenologic water siphon test was used. The excellent correspondence of the results of the water siphon test with manometric findings demonstrated the reliability of this roentgenologic method for detection of reflux. In borderline cases simultaneous manometric and roentgenologic studies were also of great use for demonstration of hiatus hernia.

Child↗
PubMed1985

Hematological and oncological indications for splenectomy in children.

The most common hematologic and oncologic indications for splenectomy in childhood are hereditary spherocytosis, chronic idiopathic thrombocytopenic purpura, hypersplenism, and Hodgkin's disease. Because of the increased incidence of septic complications after splenectomy, benefits to be gained from the operation should be weighed against the risks. A retrospective study was done on the charts of 42 consecutive children with hematologic and oncologic disorders, who underwent splenectomy between 1967 and 1982. The incidence of septic complications after splenectomy was 12%; sepsis, however, only occurred in patients with severe underlying diseases (three patients with Hodgkin's disease, one patient with systemic lupus erythematosus, and one patient with chronic pseudo-malignant immunoproliferation). In contrast, none of the patients who were splenectomized for other reasons (mainly hereditary spherocytosis and chronic immune thrombocytopenic purpura) had a septic complication. Two patients with end-stage Hodgkin's disease (5%) experienced fatal septic complications. Although splenectomy is well established for diagnostic and therapeutic considerations in patients with Hodgkin's disease, not all of them might benefit from this operation, and studies with a more limited approach to splenectomy might prove to be of the same therapeutical value.

Adolescent↗
PubMed1985

Combined disturbance of respiratory regulation and esophageal function in early infancy.

An evident coincidence exists between increased and extended apneas during sleep and frequent gastroesophageal reflux as well as disturbances of propulsive esophageal peristalsis. The tendency to develop apnea and disturbed esophageal function are related to the degree of the maturity of the patient. This indicates that in some infants, a combined regulatory immaturity of the autonomic centers persists. Moreover, the gastroesophageal reflux fosters the clinical manifestation of sleep apneas. The risk of a reflex apnea accompanied by gastroesophageal reflux increases in proportion to the disturbance in the central respiratory regulation present at the same time. This pathomechanism can be considered one of the causes of the sudden infant death syndrome. The possibility of effective prophylaxis consists in treating the apneic tendency with aminophylline and the treatment of reflux by elevating the upper body and thickening the nourishment given.

Age Factors↗
PubMed1985

[Risk of infection of central venous catheters in childhood--results of a prospective study].

Contamination rate of 228 central venous catheters and incidence of catheter related septicaemia were studied prospectively in 133 children (98 newborn, 11 infants, 14 children). An exact protocol determined all details related to catheter insertion, subcutaneous tunneling, local disinfection with polyvinyliodide ointment, procedure of mixing the solutions for parenteral feeding, etc. Culture swabs were taken routinely from the feeding solutions and the infusion device. After removing the catheter additional bacteriological studies were performed from the catheter tip and the skin at the site of insertion. Although the results showed a low incidence of contamination at the infusion device (1.1%) and the parenteral solutions (3.6%), the contamination rate of the skin (31.6%) and the catheter tip (35.3%) were exceedingly high. While the bacteriological studies of the infusion and the infusion set showed mostly apathogenous cocci, staphylococci epidermidis and staphylococci aureus were predominant on the skin and the catheter tip. Despite this high contamination rate a catheter related septicaemia was suspected in 17 cases only (7.4%). In six catheters (2.6%) the infection was confirmed by bacteriological results which always showed the typical micro-organisms found on the skin at the catheter insertion site. Therefore, the most important infection route seems to be the way from the skin to the catheter tip. Despite negative bacteriological results in the other eleven catheters a septicaemia was highly suspected on the basis of the laboratory findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteriological Techniques↗
PubMed1985

[Flexor tendon injuries in childhood].

Follow-up examinations were performed on 41 children with 51 flexor tendon injuries of the hand. Eighty per cent of the accidents were caused by a cut mostly from broken glass. The results were classified according to Buck-Gramcko. Primary repair (n = 32) was followed in 72% of an acceptable, good or optimal result. Half on these patients had been treated according to Kleinert's method. Secondary repair (n = 19) showed a good or optimal result in 53%. A more detailed analysis gives no evidence that the patient's age or the localisation of the injury are of major importance in achieving good results. However, primary repair, optimal surgical technique and early mobilisation according to Kleinert seem to be essential for an adequate outcome. Therefore, acute flexor tendon injuries in childhood should only be treated under optimal circumstances (e.g., daytime, surgical team). Otherwise, surgical repair should be delayed for 12 to 48 hours until the best circumstances are available. Furthermore, exact surveillance of the postoperative mobilisation is of crucial importance. In patients who need a flexor tendon transplant, early mobilisation according to Kleinert also seems to produce favourable results.

Adolescent↗