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Biomedical subjects

M Heberer

Publications and source records attributed to M Heberer.

At least 91 records · Page 5Linked to original sources
PubMed1993

[Modification of ischemia and reperfusion damage of skeletal muscles with allopurinol: in vivo 31P MR spectroscopy of the posterior limb of the rat].

The effect of Allopurinol on energy metabolism (re-utilisation of hypoxanthine) was studied in a in vivo skeletal muscle ischemia rat model by 31-P-MR spectroscopy. Allopurinol-treatment showed no benefit to the kinetics of PCr/(Pi + PCr) and ATP/(Pi + PCr). The role of re-utilisation of hypoxanthine has to be further investigated.

Adenosine Triphosphate↗
PubMed1993

[Proximal femoral fractures: trochanteric area (classification 31 A1-A3)].

The increasing incidence of trochanteric fractures renders their treatment a challenging task concerning both medical and increasingly socio-economical questions as well. The majority of these fractures occurs in elderly patients compromised by various preexisting medical problems. The primary goal of treatment therefore has to be early mobilisation to avoid secondary complications. This can only be achieved by operative treatment. Regarding the perioperative management an antibiotic as well as an antithrombotic prophylaxis is advisable. Recent data also suggest to add an enteral nutritional supplement during the postoperative period. The social reintegration depends however primarily upon the rapid restoration of the walking capacity. In this concern the Dynamic Hip Screw (DHS) is an optimal implant for ORIF, since it allows early full weight-bearing and shows a lower complication rate than static implants (e.g. the condylar blade plate).

Aged↗
PubMed1993

[The dynamic hip screw support plate for management of unstable proximal femoral fractures].

The DHS-Implant system is a technically simple and widely used operative treatment modality for pertrochanteric fractures of the femur. In unstable 4 part-fractures rotation of the head and neck fragment around the lag screw and a significant impaction might lead to a lateralisation of the greater trochanter and therefore to an important shortening. To prevent these effects we treated 17 patients with 4 part-fractures with a prototype of a modular trochanteric DHS buttress plate. With this additional implant the lateralisation of the greater trochanter could be prevented in all cases. This also leads to a limitation of the telescoping, with less shortening even with immediate full weight bearing.

Adult↗
PubMed1992

Stable temporary traction substitute with the Pinless external fixator.

The stable traction substitute with a JBPF seems a very promising indication for pinless clamps, offering good patient comfort and easy care. The implantation of a JBPF is possible under the same conditions as for conventional calcaneal traction. Although the stability provided is less than for conventional external fixators, it is sufficient for a temporary traction device. The JBPF does not affect secondary ORIF.

Adult↗
PubMed1992

[Proximal femoral fractures. Is there an indication for the condylar screw (DCS)?].

Between 1983 and 1989 66 consecutive fractures of the proximal femur were treated with a condylar screw DCS. 42 patients were available for a follow-up study, 12 subtrochanteric fractures (mean age 58.5 years) and 30 intertrochanteric fractures (mean age 73 years). The primary union rate was clearly higher in the subtrochanteric group (10/12) compared to the intertrochanteric group (22/30). All the 8 implant complications (pull-out, metal fatigue) in the intertrochanteric group were associated with important posteromedial comminution in elderly patients who cannot be mobilized with only partial weight bearing postoperatively. Unstable intertrochanteric fractures in elderly patients should not be treated with the DCS. These are indications for the DHS which allows controlled telescoping. The indication for the DCS is limited to proximal shaft fractures in younger patients capable of partial weight bearing.

Adult↗
PubMed1992

[Donor allopurinol treatment improves organ preservation of the kidney also when using UW solution].

Kidney function following hypothermic preservation with Eurocollins (EC) was previously shown to be improved by donor treatment with Allopurinol (AP) [1]. The University of Wisconsin organ preservation solution (UW), however, contains Allopurinol (1 mM). A syngeneic rat kidney transplant model was used to investigate concurrent Allopurinol donor-pretreatment (40 mg/kg b.w.). Kidney graft function resulted to be improved by AP pretreatment following organ preservation with both EC or UW as evidenced by significant reduction in serum creatinine values. On day two following transplantation the respective serum creatinine values (mumol/l) with and without AP-pretreatment were 424 +/- 39 and 662 +/- 25 for EC, and 259 +/- 48 and 387 +/- 48 for UW organ preservation. Furthermore survival- and histology-data were also superior for recipients of kidney grafts from AP-pretreated donors. We conclude that Allopurinol concentration in the UW solution might be to low or that adding AP into an organ storage solution is not the best application modality.

Adenosine↗
PubMed1991

[Artificial nutrition in surgery: status, current problems and perspectives].

Parenteral and enteral nutrition are safe and efficacious substitutes of normal oral intake even for prolonged periods of time and offer adequate treatment of protein-calorie malnutrition and effective palliation of cancer cachexia. Perioperative nutritional support reduces operative morbidity and mortality in malnourished patients. Furthermore, parenteral and enteral nutrition are an effective primary treatment for acute inflammatory bowel disease, short bowel syndrome and small bowel fistulae. Enteral nutrients specifically support structure and function of both the intestinal mucosa and the mucosa-associated lymphatic tissues: Recent clinical data emphasize the need to feed enterally whenever possible, especially in critically ill patients. Continuing efforts to include new substrates and to create more balanced and disease-adapted solutions of parenteral and enteral nutrition will improve the available systems. In addition, parenteral and enteral nutrition as a component of new complex treatment modalities including growth factors and cytokines will improve treatment and patient care in general surgery, oncology and traumatology.

Diet↗
PubMed1991

Protective effect of allopurinol and superoxide dismutase in renal isografts in cyclosporin A-treated rats.

Acute tubular necrosis (ATN) after renal transplantation is related to the duration of warm and cold ischemia and leads to temporary or permanent impairment of graft function. An increased incidence of ATN has been reported since the introduction of cyclosporin A. Kidney damage resulting from hypothermic storage is generated in part during reperfusion rather than during ischemia itself. Potential mediators of the reperfusion injury are oxygen-derived free radicals. Therefore, the influence of two oxygen radical antagonists, allopurinol and superoxide dismutase, was evaluated in syngeneic rat kidney transplantation with and without concurrent administration of cyclosporin A. At 15 h cold ischemia, 28-day survival increased from 8% (no treatment) to 22% (superoxide dismutase), 33% (superoxide dismutase and allopurinol), and 73% (allopurinol). Cyclosporin A cotreatment (10 mg/kg over 14 days) resulted in survival rates of 0%, 25%, 17%, and 50% for the respective treatment groups. The results of serum creatinine values and morphological evaluation of biopsies paralleled the survival rates. Cyclosporin A nephrotoxicity was evidenced by significant serum creatinine elevations throughout the 28-day period of observation. In conclusion, allopurinol significantly protects syngeneic rat kidney transplants against a critical duration of cold ischemia. Under the conditions of this experiment, allopurinol was clearly superior to superoxide dismutase treatment. Cyclosporin A nephrotoxicity was, however, not ablated by the oxygen radical antagonists employed.

Allopurinol↗
PubMed1991

Quantification of absorption, intestinal and hepatic first pass effect in a chronic dog model.

A chronic dog model was used to measure the absorption and to elucidate the site and extent of presystemic metabolism of a selective D1-agonist (CY 208-243). The dog was instrumented with portal vein and carotid artery catheters together with an electromagnetic flow measuring device around the portal vein. After administering [14C]CY 208-243 intrajejunally, absorption rate was defined as the product of porto-arterial substrate difference and portal venous blood flow. The extent of absorption amounted to 34% for total radioactivity and 31% for unchanged drug, this indicating a gastrointestinal first-pass of 9%. In an additional study [14C]CY 208-243 was injected intravenously to the dog; the absorption (29%) and the bioavailability (5%) of CY 208-243 were calculated from the ratio of dose normalized, oral versus intravenous AUC values for total radioactivity and unchanged drug, respectively. These data confirm the absorption value found with the chronic dog model and indicate a global presystemic, i.e. intestinal and hepatic, first-pass effect of 83%. In conclusion, this chronic dog model allows an accurate assessment of drug absorption and a quantification of the gastrointestinal and hepatic first-pass effects.

Administration, Oral↗
PubMed1990

[Enteral nutrition at home with jejunostomy catheter].

Ten patients with obstructive tumors of the upper gastrointestinal tract received a catheter jejunostomy (CJ) for long periods of enteral nutritional support. Seven of those patients received home enteral nutritional support for a period of 2-9 months. Body weight and serum albumin remained constant during the nutritional therapy. Complications (diarrhea, leakage) were rare and could successfully treated without interruption of feeding. In our experience CJ is a safe and effective method for home enteral nutritional support.

Catheters, Indwelling↗
PubMed1990

[Financial planning for surgical research. Project portfolio as an instrument for research planning].

Planning of research funding should assure both volume and continuity of economic support. Funding of new research concepts usually depends largely on the internal budget of the research institution (primary economical resources). More mature projects can be funded by governmental and non-profit (secondary) or industrial sources (tertiary economical resources). In general, a balanced proportion of financial support will assure maximal research independence. The respective funding of a research project should be regarded as extrinsic to the quality of the said project. Portfolio analysis of research projects is introduced as a new means of planning and controlling academic and industrial research. In principle, research projects will be evaluated with regard to the inherent potential of development (e.g. potential impact on clinical or scientific concepts) and the current productivity (e.g. output of results and publications). The 2-dimensional portfolio-matrix will be used to analyse these factors, manifesting both the overall activity of a research unit and the development of new research and funding strategies. In addition, repetitive project-portfolio analyses will enable control of both spending and efficiency in research. The application of the current project-portfolio method is exemplified by an analysis of the research activities of the department of surgery at the university of Basel. To date, project-portfolio analysis is not a mature method: Development of more quantitative portfolio strategies and of multidimensional project-portfolios are proposed. However, project-portfolio analysis is a promising means of planning and controlling research. It should be used and developed further in institutions with a number of concurrent research activities.

Animals↗
PubMed1989

[Reduction of renal reperfusion damage following warm ischemia by allopurinol and superoxide dismutase].

Preserved organs are damaged not only by the ischemic injury due to lack of oxygen. The reperfusion injury mediated by oxygen free radicals is an important factor in the postischemic organ failure. The prevention of free radical-induced reperfusion injury with allopurinol (AP) and superoxide dismutase (SOD) is shown in a warm ischemia kidney model. Rats were treated with allopurinol (40 mg/kg i.v.) one hour, or with SOD (20,000 IU/kg i.v.) one minute before reperfusion after a period of 35 minutes of warm ischemia. Allopurinol and SOD reduced significantly the postischemic kidney failure with a less important increase of creatinine. Creatinine levels on day three in the control group: 517 +/- 87 mumol/ml, in the SOD-group: 206 +/- 105 mumol/ml, and in the AP-group: 163 +/- 81 mumol/ml (anal. of variance: p = 0.0001). AP has a wide therapeutic range. We feel, that it is important to confirm the prevention of reperfusion injury by allopurinol prophylaxis clinically.

Allopurinol↗
PubMed1989

[Preoperative assessment of at-risk patients in traumatology].

In a randomized, prospective double blind trial evaluating antibiotic prophylaxis for internal fixation of proximal femur fractures, the prognostic value of preoperative risk parameters, namely triceps skinfold, upper arm circumference, dynamometry, serum albumin, transferrin, prealbumin, lymphocyte count and serum zinc was analyzed. A population at risk of postoperative infection could be defined with serum albumin value and lymphocyte count: a serum albumin of less than 40 g/l correlated with increased local complications and a lymphocyte count under 1400 microliters coincided with increase in systemic infections. No correlation between perioperative transfusion and postoperative infections was found.

Aged↗
PubMed1988

Absorption of protein in the early postoperative period in chronic conscious dogs.

Postoperative alterations in amino acid exchange across the intestinal tract and in the capacity for protein absorption were investigated in a chronic canine model. Changes in postoperative splanchnic amino acid exchange consisted of a temporary decrease of total splanchnic amino acid release, including a significant reduction in alanine production, and an increase in glutamine consumption. Contrary to results under stable metabolic conditions, branched chain amino acids were also taken up by the intestine in the early postoperative period. The changes in postoperative amino acid exchange were not, however, reflected by a corresponding alteration in protein transport capacity. The absorptive capacity for a protein hydrolysate remained stable during the early postoperative period.

Amino Acids↗
PubMed1987

Indications for needle catheter jejunostomy in elective abdominal surgery.

Needle catheter jejunostomy for postoperative nutritional support is now employed worldwide. However, there is a large discrepancy regarding indications for this technique which this study attempts to rectify. The need for nutritional support after elective abdominal procedures in 464 patients was analyzed and compared with the experience with needle catheter jejunostomy in 42 patients. The results show that needle catheter jejunostomy is indicated after extensive operations of the upper gastrointestinal tract, for example, esophagectomy, total gastrectomy, and the Whipple procedure. With minor upper gastrointestinal operations, or procedures of the lower gastrointestinal tract, needle catheter jejunostomy should be performed only in patients with poor nutritional status or in the presence of postoperative chemotherapy or radiotherapy. In an unclear situation, liberal insertion of the needle catheter jejunostomy and a postponed decision on enteral feeding is recommended, as there is no significant catheter-related morbidity.

Abdomen↗