Biomedical subjects

R Heemken

Publications and source records attributed to R Heemken.

4 recordsLinked to original sources

PubMed1996

Thoracoscopic pulmonary surgery: indications and results.

OBJECTIVE: To report our experience of thoracoscopic pulmonary operations from May 1991 to May 1994. DESIGN: Prospective open study. SETTING: District hospital, Germany. SUBJECTS: 93 patients who underwent 120 thoracoscopic procedures. INTERVENTIONS: Wedge resection (n = 56), pleural biopsy (n = 21), early decortication (n = 16), partial pleurectomy (n = 9), pleurodesis (n = 5), pulmonary biopsy (n = 4), segmentectomy (n = 3), evacuation of haemothorax (n = 3), biopsy of mediastinal tumor (n = 2), and costal biopsy (n = 1). MAIN OUTCOME MEASURES: Morbidity, mortality, and avoidance of open thoracotomy. RESULTS: Indications for thoracoscopic intervention were: solitary pulmonary nodule (n = 37), recurrent pneumothorax (n = 17), pleural empyema (n = 14), diffuse pulmonary disease/multiple nodules (n = 10), recurrent pleural effusion (n = 11), haemothorax (n = 3), and mediastinal tumour (n = 1). In 29 of 37 patients in whom we attempted resection of a solitary pulmonary nodule we obtained enough tissue for diagnosis, and avoided thoracotomy in 18 patients. Complications included pulmonary embolus (n = 1), recurrent empyema (n = 1), haemorrhage (n = 2), infection of the drain site (n = 3), and two persistent air leaks. One was closed at a second thoracoscopy and the other required open thoracotomy after which he developed pulmonary failure and died. One patient with a haemothorax developed multiple system organ failure and died, and attempted resection of a mediastinal tumour was unsuccessful. Three thoracoscopic procedures had to be abandoned because of dense adhesions. CONCLUSIONS: Thoracoscopic surgery is a safe, well tolerated, and cost effective alternative to open thoracotomy in selected patients.

Adolescent↗

PubMed1996

Predictors of outcome in patients with postoperative intra-abdominal infection.

OBJECTIVE: To assess those factors which predict prognosis in patients with postoperative intra-abdominal infections. DESIGN: Open study. SETTING: Teaching hospital, Germany. SUBJECTS: 48 patients who developed postoperative intra-abdominal infections between January 1989 and July 1993. INTERVENTIONS: Calculation of APACHE II score and Mannheim Peritonitis Index (MPI). Evaluation of single components of APACHE II score. MAIN OUTCOME MEASURE: Correlation between outcome and these variables together with time between first operation and reexploration, whether the source of infection was eliminated, whether the abdomen was managed by a closed or open technique, and the extent and origin of the infection. RESULTS: Both APACHE II and MPI predicted outcome. Of the single components of the APACHE II score studied, those that correlated significantly with outcome were the Glasgow coma scale and chronic health evaluation (p < 0.001 in each case), and age (p < 0.01). The extent of peritonitis (local or diffuse) correlated with the APACHE II score and with outcome (p < 0.001 in each case). The time that elapsed before reoperation was significantly shorter in patients who died (8 days) than in those who survived (16 days, p = 0.03). In 37 of the patients the source of infection was eliminated resulting in 7 deaths (19%); all 11 of those in whom it was not eliminated died. Of the 35 patients who underwent closed treatment of the abdominal cavity 8 died (23%) compared with 10 of the 13 who underwent etappenlavage (77%, p < 0.01). Patients who underwent closed treatment, however, had fewer risk factors. No other variable correlated with outcome. CONCLUSIONS: Outcome of patients with postoperative intra-abdominal infections correlates significantly with APACHE II and MPI, and in particular with age, Glasgow coma scale, and chronic health evaluation. It also correlates with time between the first and subsequent operations. Elimination of the source of infection and closed treatment of the abdominal cavity are associated with less risk factors and increased survival.

APACHE↗

PubMed1996

Upper gastrointestinal surgery and the appendix.

In healthy humans the stomach, duodenum and proximal small bowel are almost sterile. Under pathological conditions, however, bacterial overgrowth occurs. The need for and duration of postoperative antibiotic treatment is based on the time from perforation to operation, and the degree of contamination or infection. Our recommendation ranges from no antibiotic in early cases with minimal contamination to 5 days of treatment when established peritonitis is encountered. The duration of treatment following appendectomy for acute appendicitis depends on the intraoperative findings: simple appendicitis: no postoperative antibiotics; phlegmonous or gangrenous appendicitis: 3 day course; perforated appendicitis with peritonitis or abscess formation: 3- to 5-day therapy.

Anti-Bacterial Agents↗

PubMedDate not supplied

Peritonitis: pathophysiology and local defense mechanisms.

The peritoneal cavity can be divided in the supracolic infracolic and paracolic spaces, the lesser sack and the pelvis. The peritoneum is a semipermeable membrane which allows a flux of solutes into and from the peritoneal cavity. In addition, particles can be absorbed through the stomata of the diaphragmatic peritoneum. Secondary peritonitis is always a polymicrobial infection. The flora consists of aerobic enterobacteriaeceae and anaerobs mainly B. fragilis. These two groups of bacteria act synergistically. Besides unspecific defence mechanisms, i.e. the direct absorption of bacteria and the entrapment of bacteria in fibrin, the immunological defence mechanisms of the peritoneal cavity are triggered by endotoxin contained in the cell wall of the invading bacteria leading to the production of cytokines by macrophages, activation of complement and as a result the migration of granulocytes from the intervascular space into the peritoneal cavity.

Animals↗