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S Debus

Publications and source records attributed to S Debus.

15 recordsLinked to original sources
PubMed2004

Hyperbaric oxygen therapy for chronic wounds.

BACKGROUND: Chronic wounds are common and present a health problem with significant effect on quality of life. The wide range of therapeutic strategies for such wounds reflects the various pathologies that may cause tissue breakdown, including poor blood supply resulting in inadequate oxygenation of the wound bed. Hyperbaric oxygen therapy (HBOT) has been suggested to improve oxygen supply to wounds and therefore improve their healing. OBJECTIVES: To assess the benefits and harms of adjunctive HBOT for treating chronic ulcers of the lower limb (diabetic foot ulcers, venous and arterial ulcers and pressure ulcers). SEARCH STRATEGY: We searched the Cochrane Wounds Group Specialised Trial Register (searched 6 February 2003), CENTRAL (The Cochrane Library Issue 1, 2003), Medline (1966 - 2003), EMBASE (1974 - 2003), DORCTHIM (1996 - 2003), and reference lists of articles. Relevant journals were handsearched and researchers in the field were contacted. SELECTION CRITERIA: Randomised studies comparing the effect on chronic wound healing of therapeutic regimens which include HBOT with those that exclude HBOT (with or without sham therapy). DATA COLLECTION AND ANALYSIS: Three reviewers independently evaluated the quality of the relevant trials using the validated Oxford-Scale (Jadad 1996) and extracted the data from the included trials. MAIN RESULTS: Five trials contributed to this review. Diabetic foot ulcer (4 trials, 147 patients): Pooled data of three trials with 118 patients showed a reduction in the risk of major amputation when adjunctive HBOT was used, compared to the alternative therapy (RR 0.31, 95% CI 0.13 to 0.71). Sensitivity analysis for the allocation of dropouts did not significantly alter that result. This analysis predicts that we would need to treat 4 individuals with HBOT in order to prevent 1 amputation in the short term (NNT 4, 95% CI 3 to 11). There was no statistically significant difference in minor amputation rate (pooled data of two trials with 48 patients). Healing rates were reported in one trial (Abidia 2003) which showed a significant improvement in the chance of healing 1 year after therapy (RR for failure to heal with sham 2.3, 95%CI 1.1 to 4.7, P=0.03), although no effect was determined immediately post HBOT, nor at 6 months. Further, the beneficial effect after 1 year was sensitive to allocation of dropouts. Venous ulcer: (1 trial, 16 patients): This trial reported data at six weeks (wound size reduction) and 18 weeks (wound size reduction and healing rate) and suggested a significant benefit of HBOT in terms of reduction in ulcer area only at 6 weeks (WMD 33%, 95%CI 19% to 47%, P<0.00001). Arterial and pressure ulcers: No trials that satisfied inclusion criteria were located. REVIEWERS' CONCLUSIONS: In people with foot ulcers due to diabetes, HBOT significantly reduced the risk of major amputation and may improve the chance of healing at 1 year. The application of HBOT to these patients may be justified where HBOT facilities are available, however economic evaluations should be undertaken. In view of the modest number of patients, methodological shortcomings and poor reporting, this result should be interpreted cautiously however, and an appropriately powered trial of high methodological rigour is justified to verify this finding and further define those patients who can be expected to derive most benefit from HBOT. Regarding the effect of HBOT on chronic wounds associated with other pathologies, any benefit from HBOT will need to be examined in further, rigorous randomised trials. The routine management of such wounds with HBOT is not justified by the evidence in this review.

Amputation, Surgical↗
PubMed2002

[Pseudoaneurysm of the right gastric artery].

Mostly, the rare pseudoaneurysm of the right gastric artery is a complication of a pancreatitis. Clinical findings might be normal, but there is also a hemorrhagic shock in case of rupture. Diagnostic procedures are ultrasound, colour doppler ultrasound, computertomography and angiography for treatment. While endoscopy does not enable a therapeutic approach, interventional radiology with transcatheter embolization is a modality, which can be performed fast, sure and without complications. In case of an intractable acute hemorrhage the embolization is an alternative to surgical emergency.

Aneurysm, False↗
PubMed2002

[Clinical application--suture materials].

The surgical suture should be chosen in dependence of the tissue being operated upon and be oriented on the main properties of its chemical composition. Synthetic absorbable suture materials are the first choice in the majority of the procedures, to prevent the formation of foreign body reaction--excepting sites subjected to continuous mechanical stress, for example hernias, orthopedic and vascular surgery. By causing lesser tissue damage and interfilament bacterial transport, monofilament sutures are preferable than multifilament ones. However, knotting monofilament sutures requires additional skills in comparison to multifilament strains, due to their special handling an knotting properties.

Humans↗
PubMed2001

Colour flow Doppler ultrasound of the carotid bifurcation: can it replace routine angiography before carotid endarterectomy?

The objective of this study was to assess the diagnostic accuracy of colour flow Doppler ultrasound (CFD) and its potential to replace digital subtraction angiography (DSA) before carotid endarterectomy (CEA). All patients undergoing CFD of the carotid bifurcation in our department over a period of 1-1/2 years for whom both CFD and DSA results were available were included in the study. We evaluated the feasibility of CFD, its diagnostic accuracy and its potential to diagnose clinically significant stenosis (50%, 70% and 90% NASCET type diameter stenosis) compared with DSA. 225 carotid bifurcations in 116 patients met the criteria for evaluation (biplane arterial DSA without superimposition). Data analysis yielded the following diagnostic performance of CFD: sensitivity for a 50% stenosis 91.4% (95% confidence interval (CI) 83.3--96.2%), specificity 93.2% (95% CI 87.1--96.8%) and accuracy 92.4% (95% CI 88.4--95.4%); sensitivity for a 70% stenosis 89.2% (95% CI 81.9--94.1%), specificity 96.2% (95% CI 90.5--98.6%) and accuracy 92.4% (95% CI 88.4--95.4%). In 9 of 116 cases, carotid angiography was used to evaluate inconclusive CFD results. DSA disclosed relevant information not suspected by CFD in only 1 of the 116 cases. Thus, 91% (106/116) of the angiographies could have been dispensed with without loss of information. One major stroke occurred during diagnostic DSA. We conclude that DSA of the carotid arteries is unnecessary when CFD is unequivocal. The diagnostic gain of DSA must be counterweighted against its potential risks.

Angiography, Digital Subtraction↗
PubMed2001

[Restoration of blood circulation in reperfusion of ischemic tissues].

In experiment there were studied changes of the tissue blood circulation and microcirculation during postischemic reperfusion of skeletal muscles with various density of capillaries. It was established that reactive hyperemia, caused mainly by enhancement of extracapillary tissue blood flow. While persistence of durable arterial hypertension the capillaries quantity and potential volume of microcirculatory bed are reducing, negatively influencing the blood circulation restoration process during postischemic reperfusion. In chronic ischemia the potential volume of microcirculation is increasing, securing complete restoration of blood circulation in postischemic reperfusion.

Animals↗
PubMed1998

Chemokines IL-8, GROalpha, MCP-1, IP-10, and Mig are sequentially and differentially expressed during phase-specific infiltration of leukocyte subsets in human wound healing.

Healing of cutaneous wounds requires a complex integrated network of repair mechanisms, including the action of newly recruited leukocytes. Using a skin repair model in adult humans, we investigated the role chemokines play in sequential infiltration of leukocyte subsets during wound healing. At day 1 after injury, the C-X-C chemokines IL-8 and growth-related oncogene alpha are maximally expressed in the superficial wound bed and are spatially and temporally associated with neutrophil infiltration. IL-8 and growth-related oncogene alpha profiles also correlate with keratinocyte migration and subsequently subside after wound closure at day 4. Macrophage infiltration reaches the highest levels at day 2 and is paralleled by monocyte chemoattractant protein-1 mRNA expression in both the basal layer of the proliferative epidermis at the wound margins and mononuclear cells in the wound area. Other monocyte-attracting chemokines such as monocyte chemoattractant protein-3, macrophage inflammatory protein-1alpha and -1beta, RANTES, and 1309 are undetectable. At day 4, perivascular focal lymphocyte accumulation correlates with strong focal expression of the C-X-C chemokines Mig and IP-10. Our results suggest that a dynamic set of chemokines contributes to the spatially and temporally different infiltration of leukocyte subsets and thus integrates the inflammatory and reparative processes during wound repair.

Adult↗
PubMed1996

Low dimensional attractors in discharges of sensory neurons of the rat spinal dorsal horn are maintained by supraspinal descending systems.

Background activity was recorded from sensory neurons in laminae I-V of the lumbar spinal dorsal horn of the rat prior to and during cold block spinalization at the cervical cord. To graphically and quantitatively describe the complexity of the discharge patterns, phase space portraits were plotted and the correlation dimension D2 was calculated by using the Grassberger-Procaccia algorithm adopted for point processes, i.e. for series of interspike intervals. The algorithm is validated both for the Baker transformation, which is a simple point process, and for the Lorenz model, whereby a transformation from continuous to point process variables is achieved. A method of surrogate data is provided in order to show the difference between original neuronal patterns and their surrogate stochastic data. Therefore, this method shows that neuronal discharge patterns cannot be fully described in terms of interspike interval histograms. However, in the intact cord most (73%) of the neurons displayed background activity with low (0.28-4.3) D2 values. During spinalization, D2 values significantly increased in 68% of the neurons showing previously low D2 values, irrespective of classification and laminar location of neurons, thus proving that tonic descending systems may maintain a high order in the discharge of sensory dorsal horn neurons.

Animals↗
PubMed1995

Peritoneal seeding of gallbladder cancer after laparoscopic cholecystectomy.

We report a case of peritoneal seeding of an unsuspected adenocarcinoma of the gallbladder following laparoscopic cholecystectomy despite the use of a retrieval bag. The metastasis developed at the umbilical trocar site, which was also used to extract the resected gallbladder. There was no evidence foe a leak of the retrieval bag. Most likely malignant cells became desquamated during the operation, implanting themselves in the tissue during the removal of the bag. Taking into consideration previous reports and the dismal prognosis of the disease, we discuss the management in the case of an incidental carcinoma.

Adenocarcinoma↗
PubMed1995

[Open thrombendarterectomy of the carotid arteries with routine intraluminal shunt implantation, a reliable method for decreasing the risk of apoplexy--results of 11 years experience with 546 consecutive elective interventions].

The operative removal of haemodynamical significant carotid artery stenosis by endarterectomy nowadays is one of the vascular surgical standard procedures. Purpose of the operation is prevention of ischemic strokes. For a long-term prognostic advantage the patient has to take the risk of perioperative mortality and morbidity. While efforts are being made to minimize this risk, the question of optimal surgical strategy has not yet finally been solved. Since 1982 in our hospital all carotid endarterectomies are carried out with routine insertion of an intraluminal shunt. The distal intima step of the internal carotid artery is secured by a running suture and closure of the longitudinal arteriotomy is accomplished by dacron patch plasty. In this manner 546 successive operations have been performed under general anaesthesia until 1993. Intra- and postoperative mortality was 0.9% with an ischemic cerebral infarction rate of 1.8%. According to the preoperative stage of cerebrovascular insufficiency the frequencies for mortality and perioperative ischemic stroke were 0.6% and 1.3% for CVI I, 0.4% and 0.7% for CVI II and 2.8% and 5.7% for CVI IV. Apart from perioperative mortality for patients with CVI IV, these complication rates are clearly below the suggested limits of the Ad hoc Committee on Carotid Surgery Standards by the Stroke Council of the American Heart Association. Routine use of a temporary, intraluminal shunt in carotid artery operations therefore can be considered as a safe measure, with complication rates still not underbid by those achieved with intraoperative cerebral monitoring and selective shunting.

Aged↗
PubMed1994

Human monoclonal antibodies from stomach carcinoma patients react with Helicobacter pylori and stimulate stomach cancer cells in vitro.

BACKGROUND: In recent studies, an increased incidence of gastric adenocarcinomas was observed in patients with Helicobacter pylori infection. However, the extent to which this coincidence is caused by immunologic mechanisms is unknown. METHODS: Two human monoclonal antibodies (MoAbs) from patients with stomach carcinoma and H. pylori-associated gastritis were isolated and established by fusion of spleen cells with the heteromyeloma HAB-1. The reactivity of these human MoAbs was investigated in functional adhesion assays and on Western blots of tissue, tumor cell, and bacterial extracts. Their stimulation and proliferation were tested by the MTT test and 3-H-thymidine incorporation tests. RESULTS: The two monoclonal immunoglobulin-M antibodies, 103/51 and 105/79, inhibited adhesion of tumor cells. On bacterial extracts antibody 103/51 identified protein bands of 55 kilodaltons (kd) and 80 kd, and in tumor cell extracts, a specific protein of approximately about 110 kd and 140 kd. Antibody 105/79 identified a 55 kd protein in bacterial extracts and a 110 kd protein in tumor extracts. In addition, in the 3-H-thymidine incorporation and MTT assay the antibodies showed a stimulatory and growth-enhancing effect on tumor cells in vitro. A similar activity was observed in sera from patients with gastric carcinoma, indicating a physiologic role of such antibodies in vivo. CONCLUSION: The human monoclonal antibodies described here react with H. pylori and cross-react with and stimulate gastric carcinoma cells. It is possible that the production of these antibodies is primarily stimulated by bacterial antigens which cause chronic gastritis and that they might be indirectly responsible for the recently described higher incidence of gastric cancer because of the simultaneous reaction and stimulation of tumor cells they cause.

Adenocarcinoma↗
PubMed1993

[Healing of the anastomosis in various suture techniques in the gastrointestinal tract. Physiology, experimental and clinical results].

New and further development of anastomoses induce new orientation for selection and indication of the several suture procedures in the gastrointestinal tract. Based on the wound healing principles, the different techniques are evaluated experimentally and in clinical tests. The results allow to discriminate indications for the different suture techniques. For the gastrointestinal tract the technique of choice is the serosubmucous single row suture with an absorbable 4.0 monofilament. For the esophagus and rectum, the stapled anastomosis offers more safety and better practicability than manual sutures. Studies have shown comparable results in colonic surgery for compression ring anastomoses. Additional procedures are of minor importance for the safety of anastomoses.

Anastomosis, Surgical↗
PubMed1990

[Duration of wound healing and tissue resistance as important criteria for selecting suture materials in colon surgery].

The modern absorbable suture materials are well introduced in colonic surgery. Surgeon's intension is to reduce foreign body reactions by using small sized sutures and will be limited by the suture holding capacity of the tissue. Suture holding capacity of the human colon is about 9 +/- 2 N. Wound healing of colon anastomoses normally lasts 10 to 12 days. The braided absorbable suture materials Dexon, Dexon plus and Vicryl (size 3-0 USP) have a knot breaking strength of about 10 N after 12 days implantation in the human colon, the monofilament absorbable sutures PDS and Maxon have about 20 N resting strength after implantation. These results document that the size 3-0 USP (2-metric) should be the lowest limit for the braided absorbable suture materials used in colonic surgery.

Colon↗