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Biomedical subjects

W Hartig

Publications and source records attributed to W Hartig.

At least 19 recordsLinked to original sources
PubMed1998

A comparison of lipase and amylase in the diagnosis of acute pancreatitis in patients with abdominal pain.

The clinical value of amylase and lipase measurement for the diagnosis of acute pancreatitis was evaluated in 253 patients presenting with acute abdominal pain. Acute pancreatitis was detected in 32 patients by computed tomography or ultrasound. In the serum samples collected on days 0-1 after the onset of symptoms, lipase was elevated in 100% and amylase in 95%. A 95% sensitivity/specificity was reached at a lipase cutoff near twofold above normal. The receiver-operating characteristics (ROC) showed similar curves for both enzymes, lipase being slightly superior to amylase. The ROC curves from days 2-3 demonstrated a much lower sensitivity/specificity of both enzymes. Lipase, however, was notably superior to amylase: at a sensitivity of 85% the specificity of lipase (amylase) was 82% (68%). In samples from days 4-5 the accuracy of the enzyme assays was even worse; at a sensitivity of 60% the specificity did not increase above 70%. The diagnostic value of simultaneous measurement of amylase and lipase was tested at different cutoffs in two groups: the OR group, in which one of the two parameters had to be elevated, and the AND group, in which both parameters had to be above normal. Combination of both parameters mainly improved the specificity of the assay (from 91 to 98% on days 2-3 and from 93 to 97% on day 4-5) but only when, in the OR group, twofold elevated amylase was combined with lipase. We conclude that the simultaneous determination of serum lipase and amylase marginally improved the diagnosis of acute pancreatitis in patients with acute abdominal pain, however, the sensitivity of the assay with samples collected 4-5 days after onset of the disease remained low.

Abdominal Pain↗
PubMed1989

[Nutritional therapy using tubes and pumps in cancer patients].

The success in the therapy of patients suffering from malignant tumours is among others depending on nutritional treatment. If correctly indicated, the enteral nutrition is more economic, complication reduced, easier to maintain and a biologically optimal alternative method to the parenteral nutrition. Nutritional solutions via tube have to be given continuously or intermittently. For that purpose a pump had been developed meeting certain special requirements. It is reported on the technique of an electronically controlled, partly net independently working pump.

Enteral Nutrition↗
PubMed1989

[Studies of solutions with various branched-chain amino acid contents on protein metabolism in the postoperative period. 1. A 15N tracer kinetic animal model for evaluating the effect of parenteral amino acid administration on nitrogen metabolism].

We were able to estimate nitrogen or protein metabolism on the basis of a 15N metabolic model that delivered a high amount of data during a parenteral nutrition period over 72 h. We describe the basic principles of the necessary N or 15N-analyses in blood, as well as in sera, in urine, in tissues of selected organs and in hepatocytes. This 15N-metabolic model allows the estimation of the utilization of amino acid infusion solutions. Because of the great similarity of parameters of the N or protein turnover between man and pig it is possible to provide relevant information for the clinical practice regarding amino acid infusion solutions.

Alanine Transaminase↗
PubMed1989

[The current risk of gallbladder and bile duct surgery].

The lethal operative risk in gallbladder and bile duct operations decreased from 2.16% in the period 1964-1976 to 1.32% in the period 1979-1987.--Main operative risk factors are gallbladder and bile duct complications and the age beyond the 6th decade of life.--The lethality of choledocholithiasis actually amounts to the 37-fold of uncomplicated cholecystolithiasis and the lethality of all primary and secondary gallstone operations after the 6th decade of life amounts to the 38-fold in comparison with younger patients.--A further reduction of operative risk appears possible by reason: 1. Consequent early operation. 2. immediate operative or endoscopic removal of extrahepatic cholestasis, 3. complex intraoperative diagnostics of bile duct and papilla Vateri, 4. preoperative single dose AB prophylaxis or short-term therapy, 5. general low dose heparin prophylaxis, 6. primary endoscopic therapy in residual stones or irreversible stenosis of papilla Vateri and 7. interdisciplinary diagnosis and treatment of senile complications.

Aged↗
PubMed1988

Evaluation of protein metabolism in clinical practice.

The application of stable isotopes creates further possibilities for our understanding of the metabolism. New concepts especially for non-invasive diagnostic procedures could be developed. An important step in our research program was the performing of a 1-year experiment on a volunteer. On the basis of a 10-pool model we received a lot of informations. Based on this knowledge we developed 2 simplified methods for calculating whole body protein turnover. Knowing the problems with whole body protein calculations we intensified our intentions for determining the protein enrichment in organs and isolated cells (hepatocytes), estimating at the same time the precursor pool in the cells. Of special importance was an extensive study, wherein all those 15N-estimations were performed we are able to do up to now. We calculated whole body protein, but especially we studied the enrichment of the cellular protein fractions in hepatocytes, of plasmaproteins, and of the intracellular precursor pool. This study is the base for further tracer investigations.

Animals↗
PubMed1988

[Postoperative small intestine absorption--principles for enteral nutrition].

The intestinal absorption of nutrients is disturbed to an extent dependent on the degree of trauma in the immediate postoperative period. In a clinical study, the d-xylose absorption was investigated in 3 groups of patients after cholecystectomy. On the day of surgery a significant restriction of the absorption could be observed after intraduodenal administration. After gastric and duodenal administration of d-xylose and simultaneous enteral early nutrition a significant restriction of absorption could be observed on the day surgery was carried out. Optimal conditions for early nutrition can be achieved by combining intraduodenal feeding and a continuous decompression of the stomach. In cases of a gastric drainage an improvement of the postoperative absorptive function can be supported by the results of the nitrogen balance. In 4 pigs (type: country race) the step-by-step normalization of the absorptive kinetics could be demonstrated after catheters were implanted into the portal and subclavian veins.

Adult↗
PubMed1988

[Resorbate kinetics in the pre- and posthepatic blood compartment in the immediate postoperative phase in swine].

Catheters were implanted in the portal vein by the superior mesenteric vein in pigs for valuation of the absorbant kinetics of enterically applied substances in the mesenteric veins. The blood level kinetics after applying 10 g D-xylose into the jejunum was measured continuously simultaneously in the pre- and posthepatic blood compartment 6, 24, 36, 48, and 72 hours after the operative procedure. An enteric resorption of the pentose is provable already 6 hours after the operation, with their utter normalization in the next 36 hours. The differences between the pre- and the posthepatic concentration-time-graphs admits conclusions on the metabolism of the absorbant in the liver.

Animals↗
PubMed1987

[Assessment of risk status using nutrition diagnostic studies in surgical patients. 1. Determination of preoperative risk status in patients with stomach cancer].

The diagnosis of the nutritional state is an essential component in determining the risk in patients with carcinoma of the gastrointestinal tract. Based on the results of multivariate, statistical analyses of numerous biochemical, anthropometric and immunologic parameters in 63 patients with gastric carcinoma, we can now simplify the determination of the nutritional state considerably. With the help of cluster analysis and together with clinical aspects, the nutritional state can be divided into 2 groups ('normal' and 'disturbed'), in contrast to the former classification ('normal' and several degrees of disturbed). Using discrimination analysis, a combination of parameters was found which allows a sufficiently good classification of subjects into either the 'normal' group or the 'disturbed' group, and in this way characterizes the nutritional state. Classification of the patients is accurate in 97% of the cases. 6 practically relevant parameters were determined with the discrimination analysis: serum albumin, serum transferrin, hemoglobin, upper arm circumference, triceps skin fold thickness, and the intracutaneous skin test quotient. The nutritional quotient, EQ2, can be determined from these values (in comparison to the nutritional quotient, EQ1, which is based on the 33 point evaluation scale), thus enabling a quantification of the nutritional state. The use of only individual parameters yields major differences from the results obtained with 6 parameters. However, a relation between the nutritional state and the existing immuno-competence can be suspected when the results - especially of the skin test reactions - are in agreement with the results of the lymphocyte transformation. The test results of cell-mediated immunity in particular represent the extent of a reduced immunological reaction as opposed to the results of humoral immunity. Inclusion of less complex immunological investigation procedures must be reserved for future studies. The determination of daily urea production (urea production rate; dependent on protein supply) can be implemented as a practically relevant and reliable supplemental test for the evaluation of the existing metabolic state.

Anthropometry↗
PubMed1987

[Postoperative low-calorie parenteral feeding].

In parenteral nutrition a distinction can be made between hypocaloric, normocaloric, and hypercaloric forms, depending on the amount of energy supply. Hypocaloric parenteral nutrition has been specifically adjusted to the conditions of postoperative metabolism. Doses between 1.2 g and 1.5 g/kg body weight/d of amino acids are the most important components of peripheral venous nutrition. The economy of amino acid utilisation, primarily by patients not adapted to fasting or to ketone body utilisation, can be improved by a low dosage of 2.5 g of carbohydrates to 1 g of amino acids. Polyols were found to be decisively superior to glucose as energy carriers by taking into much closer consideration the mechanisms of autoregulation in postoperative metabolism and by favouring synthesis of intrahepatic functional proteins to peripheral synthesis. Hypocaloric peripheral venous parenteral nutrition has proved to be effective therapeutic concept by which to bridge the early postoperative phase in elective surgery.

Amino Acids↗
PubMed1987

[Value of various amino acid mixtures for the treatment of chronic liver damage].

A reproducible liver lesion was caused in 28 pigs by intermittent, intraperitoneal administration of thioacetamide. The morphological degree of the liver lesion was checked by histological investigations (material drawn from the liver by biopsy). During a 3-day infusion period a so-called liver solution (Aminofusin hepar) was given to one group of animals, a normal solution (Infesol) to a second group, and only an electrolyte infusion solution under oral nutrition ad libitum to a third one. The solutions were labelled with (15N) glycine. The amounts of total N, total 15N, 15N with single non-protein fractions, a number of enzymes of 15N incorporated into the liver protein were measured in urine, and the following points were established: 1. The catabolic situation of metabolism is eliminated both by the so-called normal solution and the specific amino acid solution. The two mixtures of L-amino acids thus have a nutritive effect. 2. The toxic liver lesion is an indication for parenteral nutrition. Oral nutrition alone is not sufficient. 3. The so-called liver solution influences the liver metabolism of the protracted liver lesion more than the so-called normal solution does, and considerably more than an electrolyte infusion solution under oral nutrition ad libitum.

Amino Acids↗
PubMed1986

[The intravenous 15N metabolism test in assessing the effect of parenteral feeding on protein synthesis].

It is possible to investigate the influence of parenteral applicated L-amino acids on protein metabolism of whole organism by the help of 15N-tracer technique in this paper described. We can determine the utilization of nitrogen parenteral applicated quantitatively. On the basis of graphical methods the protein synthesis rate can be calculated. We get this from mathematical models, based on 3-pool-model. The calculation bases on 15N-elimination in urine after intravenous infusion of 15N labeled amino acids solution during the time of 24 h (endproduct method). We describe 3 graphical methods, using the so-called values of plateau of cumulative 15N-excess amount (96 h) (plateau method A) or 15N abundance after 24 h (plateau method B) and the slope of the curve of 15N excess, amount at 24 h ('slope' method). By the help of these methods the therapeutical nutritive conceptions can be evaluated.

Amino Acids↗
PubMed1985

[Methodological aspects of the determination of nitrogen metabolism parameters from 15N-tracer experiments on swine based on nitrogen metabolism models. 2. Calculation of N metabolism parameters from the time of urinary excretion of 15N].

After a 45-hour infusion of 15N-lysine and 15N-glycine resp. with pigs of 25 kg live weight, the infusion of the tracer was disrupted and a 3-day reduction phase was made part of the experiment. The N-metabolism parameters such as protein synthesis and decomposition quotas were calculated on the basis of the temporal development of 15N-amounts excreted in urine. The labelling and reduction phases were evaluated simultaneously. By means of including the total N-amount of the animal body the balance calculation becomes more stable. The possible influence of the tracer amino acid in connection with the 3-pool-model is discussed on the basis of the ascertained parameters.

Animals↗
PubMed1985

[Our surgical heritage. Max Bürger and surgical pathophysiology. On the 100th birthday of Max Bürger (16 November 1885-5 February 1966].

Max Bürger, born in 1885 in Hamburg, was an outstanding physician in the first half of this century. He markedly influenced many fields in internal medicine. Even in 1922 he investigated the postoperative changes in protein metabolism on the basis of clinical experiments made together with the surgeon M. Grauhan. The discovery of the postoperative loss of nitrogen must be attributed to M. Bürger, not to D. P. Cuthbertson. In 1937 he was appointed to the vacant chair of internal medicine in the University of Leipzig. His work and his great achievements in the medical field were duly appreciated during his life and even after his death in 1966.

General Surgery↗
PubMed1984

[The thyrotropic function of the hypophysis and peripheral thyroid hormones after removal of bland and autonomous nodular goiters].

Bilateral subtotal resection or enucleation or unilateral resection was performed in 60 patients (36 with bland nodular goitre, 24 with autonomic adenoma). The thyrotropic pituitary activity and the peripheral thyroid function were examined in all patients preoperatively and followed up for 12 months postoperatively. The results show that all patients with bilaterally resected bland nodular goitre require postoperative administration of thyroid hormone, since enhanced thyrotropic activity is seen not later than three months after surgery. Since thyrotropic function remains normal in unilaterally operated nodular goitre, thyroid hormone administration does not appear generally necessary. In patients with autonomic adenoma there is postoperatively variability of function, independent of the surgical method employed. In view of possible functional recompensation, final decision on the administration of thyroid hormones should not be made before the end of the sixth postoperative month. These results can be considered as guidelines for a differentiated postoperative management.

Goiter, Nodular↗