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W Seitz

Publications and source records attributed to W Seitz.

At least 37 records · Page 2Linked to original sources
PubMed1991

[A review of the present status of liver transplantation].

Liver transplantation opens the view on the border lines of medicine. Its performance requires great surgical and anaesthesiological experiences. Based on the authors' own experience the selection of liver donors and the indications for liver transplantations are pointed out. Special pathophysiological aspects of liver transplantation as well as the anaesthesiological procedure and the intensive care in the early postoperative period are described. The results of liver transplantation can be improved by further research on preservation of explanted organs, early recognition of complications after transplantation and immunological suppression.

Anesthesia↗
PubMed1991

[Interdisciplinary preventive use of iodine in former East Germany following reunification and the status of packaged iodized table salt for improving alimentary iodine supply. Retrospect and prospects].

The general interdisciplinary iodine prophylaxis which began in the former GDR in 1985/86 led to the amelioration of the alimentary supply with iodine and to success which was taken notice of also internationally. The amelioration of the supply with iodine was above all derived from the use of iodized mineral mixtures in animal production. According to the analyses performed up to 1990 the state of development could be maintained for the time being. With the German reunification the general iodine prophylaxis was deprived of its legal fundament and with the reorganization of agriculture the expanding use of iodized mineral mixtures was no more guaranteed. Respecting the principle of voluntariness the application of iodized kitchen salt is to be propagandized above all in children, adolescents and pregnant women and the use in big kitchens, restaurants and in the foodstuff industry.

Adolescent↗
PubMed1991

[Stress and the endocrine system. A contribution to the value of endocrine parameters in anesthesia and surgery].

This study examined prospectively the effects of different anaesthetic techniques on the plasma concentrations of adrenocorticotrophic hormone (ACTH), aldosterone, cortisol, dehydroepiandrosterone (17-DHEA), insulin, prolactin, thyroxine, triiodothyronine as well as the effects on the plasma concentrations of epinephrine, norepinephrine and dopamine. Forty patients for trauma surgery were randomly allocated to one of the following anaesthetic techniques: halothane-N2O/O2-anaesthesia, isoflurane-N2O/O2-anaesthesia, midazolam-fentanyl-N2O/O2-anaesthesia, midazolam-ketamine-N2O/O2-anaesthesia or tramadol-N2O/O2-anaesthesia. The results of this endocrinological study demonstrate differences in the quality of the anaesthetic techniques used even without extreme stress situations for the patient. The elimination of pain can reduce, but not avoid, endocrinologic response to stress. Endocrine values are influenced by a lot of different control mechanisms. It is not always possible to distinguish between pharmacologic and indirect or direct effects of anaesthesia or surgery. For this reason, single plasma hormone levels should not be overvalued and equated with "stress" indicators, which is a much more complicated issue.

Anesthesia↗
PubMed1991

[Propofol for induction and maintenance of anesthesia during heart surgery. Results of pharmacological studies in man].

Numerous reports have concluded that propofol is suitable for maintenance of anesthesia by continuous infusion. The aim of this study was to evaluate the use of propofol and fentanyl for coronary bypass surgery in patients with good left ventricular function. The effects of this anesthetic combination on quality of anesthesia, hemodynamic status, and endocrine and metabolic responses were assessed. Postoperative recovery and side effects were also noted. The effects were compared with those of a standard method using etomidate, midazolam, and fentanyl. METHODS. Twenty patients who presented for aortocoronary bypass surgery (NYHA class II-III) were randomly allocated to one of two groups: propofol-fentanyl (group A) or etomidate-midazolam-fentanyl (group B). In each patient the dosage of the drugs was adjusted to obtain the optimum responses during induction and maintenance. RESULTS. Propofol in combination with fentanyl diminished mean arterial pressure (-28.7%) and heart rate (-17.3%) when used for induction in patients with ischemic heart disease, even in low doses and with slow administration. In 5 of the 10 patients it was impossible to prevent a critical fall in coronary perfusion without active intervention. However, during maintenance anesthesia, stable circulatory parameters were obtained with both drug regimens. Clinical signs thought to reflect myocardial ischemia were not observed. In both groups reductions in basal and stimulated catecholamine secretion were demonstrated. Similarly, perioperative cortisol secretion was reduced with both techniques. Despite all the complicated metabolic inhibitory effects seen, preoperative hormonal levels were restored within 1 h of the end of anesthesia. The magnitude and duration of the metabolic changes were found to be related to the duration of surgery. There was no evidence of non-homogeneous tissue perfusion as assessed by increases in lactate concentration, cardiac ischemia, or liver dysfunction in any of the patients. There were no postoperative complications in either group, but the return of consciousness, adequate spontaneous ventilation, and psychomotor activity was more rapid in the propofol patients. CONCLUSION. In summary, it can be concluded that a propofol infusion technique positively enhances the recovery period after cardiac surgery and provides good control during anesthesia. However, the use of propofolfentanyl for induction of anesthesia in patients with limited coronary perfusion is not recommended because of its hypotensive effect.

Anesthesia, Intravenous↗
PubMed1990

[Dietary iodine deficiency in East Germany following introduction of interdisciplinary preventive use of iodine].

The interdisciplinary iodine prophylaxis introduced in 1985/86 comprises the iodination of 84% of the packaged salt with 32 mg KIO3/kg salt and the use of iodized mixtures of mineral substances in animal production. At the beginning of this measure with an average renal ioduria of 19.0 +/- 1.0 micrograms J/g creatinine in the GDR there was at least still an iodine deficiency of 2nd degree. It increased from north to south: 20.3 +/- 1.0 in contrast 13.4 +/- 1.5 micrograms J/g creatinine. In the middle of 1986 a clear improvement of the supply with iodine began. The renal iodurias had more than doubled. For the GDR the mean ioduria was 43.4 +/- 0.9. The relation from north to south had, if anything, inverted: 37.3 +/- 2.1 in the north, 42-49 micrograms J/g creatinine in the centre and south of the GDR. Nearly one third of the population no more undergoes an iodine deficiency. The intrathyroidal iodine content increases. The improved supply with iodine among others is evident in: reduction of the connatal goiter below 1%, reduction of the recall rate in the TSH hypothyroidism newborn screening, normal thyroid gland mass of the newborn, reduction of the goiter frequency in children and adolescents, transient increase of the frequency of hyperthyroidism, in particular based on functional autonomies in persons older than forty years. In animal production losses of produce amounting to 181 Mic/a were eliminated.

Adolescent↗
PubMed1990

[Clonidine supplemented analgesia and sedation in prevention of postoperative delirium].

In an open prospective study we investigated the efficacy of the supplementation of analgosedation by clonidine. 40 patients with oesophagus malignancy and definite alcohol abuse were on respiration therapy postoperatively after having been treated with oesophago-gastro anastomoses. With regard to manifestation intensity and development of withdrawal symptoms we found that during basic medication with piritramid-diazepam continuously i.v. administered clonidine can eliminate haemodynamic and psychovegetative symptoms related to alcohol withdrawal. The clonidine group required less analgosedation. The measurement of the urinary catecholamine output showed a normalised endogenous output. As a finding of importance the gastrovolume was reduced, and the haemodynamically firm, stable and less sedated patients of the clonidine group required fewer days of respiration therapy. Hence, the hazard of aspiration pneumonia and insufficienty anastomosis was lower. Risk of bradycardia of high potential danger did not occur with a median daily dosage of 1.09 mg/d clonidine. We consider clonidine to be a potent supplement to analgosedation for the surgical patient who is at high risk of alcohol withdrawal.

Adult↗
PubMed1990

[Brachytherapy using Ru-106 applicators in ophthalmology].

Two Ru-106 applicators of the type CCB as manufactured by the "Zentralinstitut für Isotopen- und Strahlenforschung" (Berlin, GDR) were investigated. The homogeneity of the relative dose distribution at the surface of the applicators was determined. For the evaluation of the data extremely small TLD crystals (2 x 1 x 1 mm) had to be manufactured as well as an almost tissue equivalent acrylic eye phantom. In order to assure reproducibility of the applicator positioning, the plaque suture eyelets had to be placed on locating pins. 120 points of measurements located within the active plaque area of 20 mm diameter were evaluated. The results show that the area to be used in tumor treatment is about 20 to 25% less than expected. One plaque shows a considerable inhomogeneity with respect to dose distribution (up to 40%). A modified eye phantom was used for the determination of the central axis depth dose distribution.

Brachytherapy↗
PubMed1990

[Interstitial radiotherapy of breast cancer. Preliminary report of a prospective study of 165 cases subjected to breast-conserving treatment].

UNLABELLED: The results of a prospective study on breast conserving therapy in early stage breast cancer are presented. From January 1983 to June 1987 165 patients were treated by a standardized therapy-protocol. The criteria for entering the trial were stage T1 to T2 and N0 to N1. Surgical breast conservation was achieved by segmental resection in 148 cases and by tumorectomy in 17 cases. 160 patients underwent axillary lymph node dissection. Obligatory 45 to 50 Gy were delivered percutaneously to the operated breast and optional 50 Gy to the regional lymph nodes (axillary lymph node involvement greater than 3 nodes). In addition, the area of the primary breast lesion itself was boosted interstitially by an Iridium 192 implant (LDR-technique: 15 to 20 Gy, HDR-technique: 10 to 12 Gy). RESULTS: Progression of disease in 10% of the patients (16/165), local recurrence rate in the operated breast: 2% (3/165), axillary recurrence: 0.5% (1/165). 5% of the patients (8/165) died from metastatic disease, two patients died free of recurrence for reasons unrelated to cancer, two other patients died on unknown reasons. Because of the low number of local recurrences and the observation period of 32 months, no statistically contribution on high risk factors for local failure could be found.

Adult↗
PubMed1990

A 5 year interdisciplinary control of iodine deficiency in the GDR.

The interdisciplinary iodine prophylaxis in the GDR is a successful measure for control of ID. The iodization of nearly all the salt is planed perhaps with reduction of the iodine concentration. However, next further steps may be done in cooperation of the Interdisciplinary Iodine Commission with the "Arbeitskreis: Jodmangel" in the FRG.

Germany, East↗
PubMed1989

[Liver transplantation in low portal vein flow: separation of portal vein areas with divided portal-venous and arterialized caval-venous liver perfusion. 1. Clinical case report].

A new method for the performance of a hepatic transplantation in spite of a low portal blood flow situation is described casuistically. In a 36-year-old-patient suffering from liver cirrhosis due to hepatitis B, the portal blood system of the right and left liver parts were divided, the left part was perfused with a low flow of portal blood, the right one with arterialized caval blood. The function of the transplanted liver and the early postoperative course were excellent. During the further postoperative course portal perfusion presumably diminished or stopped on the left side from three weeks and on the right side from two months postoperatively. Nevertheless the general condition of the patient improved continuously; transient elevations of transaminases may reflect the disturbance of portal perfusion. The technique of this arterialized caval blood perfusion of the portal system is presumably applicable also for situations, in which there is no portal blood flow available for perfusion of a liver graft. Thus, the absence of possibility for reconstruction of portal blood inflow or a situation with a hypoplastic portal vein may no longer be considered as a technical contraindication for liver grafting.

Adult↗
PubMed1989

Assessment of severity of coronary stenoses using a Doppler catheter. Validation of a method based on the continuity equation.

The coronary Doppler catheter has been used primarily in the measurement of coronary vasodilator reserve, most often as the ratio of peak to resting velocity in response to an intracoronary dose of papaverine. We have developed a new method based on the continuity equation using a Doppler catheter for the assessment of stenosis severity in the coronary circulation by means of quantitative velocity measurements obtained by complex spectral analysis of the Doppler signal. With this system we have been able to detect a high-velocity stenosis jet in a canine model of coronary stenosis of known cross-sectional area. Using the peak velocity obtained by complex spectral analysis, we found a strong correlation between cross-sectional areas determined by the continuity equation and known cross-sectional areas (r = 0.93, SEE = 0.23 mm2). We also found a strong correlation between the ratio of peak stenosis velocity to proximal vessel velocity and percent diameter and percent area stenosis (r = 0.91 and 0.92, respectively). When the velocity was determined with conventional zero-crossing methods for these parameters, there was no correlation between calculated and known values for cross-sectional area and percent diameter or area stenosis. Measurements of the vasodilator reserve in response to intracoronary papaverine before and after implantation of the stenosis did not correlate with any of the anatomic parameters of stenosis severity regardless of the method of signal analysis (zero-crossing or complex spectral analysis). The measurement of quantitative peak coronary velocity with a Doppler catheter using complex spectral analysis may provide an accurate method for determining the severity of a coronary stenosis.

Animals↗
PubMed1989

[Initial clinical experiences with the S & W Kaloximet, a device for measuring oxygen consumption in anesthesia and intensive medicine].

The system is based on the principle of indirect calorimetry in the closed-circuit rebreathing system with CO2 absorber. The decrease in circulating gas volume (i.e. O2 uptake) is measured by an ultrasonic technique and a microprocessor controls the replenishment of the system with oxygen from an external O2 supply. The Kaloximet can be used to measure the O2 uptake of both spontaneously breathing and mechanically ventilated patients. In ventilator patients, the system works according to the bag-in-bottle principle. The O2 consumption is measured as the average of at least 50 breaths and then this value is used to calculate the resting energy expenditure. The estimated value of the respiratory quotient is entered on the keyboard, either before or after measurement. We tested the accuracy of the system in 48 measurements of O2 consumption using the Kaloximet and the Fick principle (cardiac output x arteriovenous O2-content difference) simultaneously. We found a mean difference of 5.6% and a positive correlation (r = 0.97). Our results indicate that the Kaloximet is suitable for measurements of O2-consumption, especially in ICU patients. Intraoperatively, it can be used only in the absence of inhalation anesthetics.

Adolescent↗
PubMed1989

[Complications caused by a Swan-Ganz catheter. An inadvertent entrapment in the right atrium during cardiac surgery].

Insertion of a Swan-Ganz catheter for measurement of pulmonary artery and pulmonary capillary wedge pressures is common for operative management of patients with borderline left ventricular function. However, use of the catheter has associated risks. This case report illustrates the inadvertent snaring, by a suture, of a Swan-Ganz line in the right atrium and its subsequent removal transvenously during rethoracotomy.

Catheterization, Swan-Ganz↗
PubMed1988

[Changes in intraoperative total oxygen consumption in patients during liver transplantation].

The changes in O2-uptake (VO2) during 110 liver transplantations (LTX) were studied using Fick's principle (O2-uptake = cardiac index x arteriovenous O2-content difference). During each of the three operative periods [a dissecting period before clamping of the hepatic vessels (1), the anhepatic phase (2), and after reperfusion of the new liver (3)], two measurements (A and B) were taken. After removal of the liver (2A) the VO2 decreased about 11.4%, and increased after reperfusion (3A) about 44.0%; these changes were significant (P less than 0.001). To evaluate the influence of the various indications for LTX on the course of intraoperative VO2, the following patient groups were compared: patients with hepatic tumors (n = 17), patients with cirrhosis following hepatitis (n = 14), patients with primary biliary cirrhosis (n = 17), patients with cirrhosis plus tumor (n = 11), and patients in a hepatic coma (n = 20), regardless of the underlying liver disease. Groups with less than ten subjects were not considered. The drop of VO2 in the anhepatic period (1B----2A) was between -26.7% (patients with tumors) and -7.3% (patients with cirrhosis plus tumor). The patients with cirrhosis following hepatitis showed a special feature: their VO2 increased about 13.4% after cross-clamping the hepatic vessels. After revascularization, the VO2 increased in all groups between +37.2% and +69.8%. In all groups the level of VO2 was higher after reperfusion (3A) than in the dissecting period (1B), ranging from +5.3% in patients with tumors to +61.6% in patients with cirrhosis following hepatitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma, Bile Duct↗
PubMed1988

Radiotherapy of metastatic renal cell carcinoma.

Modern oncological treatment of metastatic renal cell carcinoma may have different goals: first of all, improvement of survival rates; secondly, elimination of symptoms like pain from osseous lesions or disorders of central nervous system functions. Chemotherapy or radiotherapy or the combination of both should improve life quality and be tolerable to the patient. Close interdisciplinary contacts of medical and radiological oncologists are therefore necessary. Radiotherapy should be carried out under conditions of high-voltage energy and modern treatment planning to concentrate and limit the irradiation volume as much as possible. Split-course technique and radiation as interval treatment between chemotherapy courses seem to be optimal. Our clinical results indicate that the reported radioresistance of renal cell carcinoma might result from radiobiological and methodological misinterpretations.

Bone Neoplasms↗
PubMed1988

[Endocrine reaction pattern: midazolam-fentanyl anesthesia versus inhalation anesthesia].

In a randomised controlled study in 16 orthopaedic patients, the influence of midazolam-fentanyl-N2O/O2 anesthesia (group A) resp. halothane-N2O/O2 anesthesia (group B) on the plasma concentrations of the endocrine parameters ACTH, aldosterone, cortisol, 17-DHEA, insulin, prolactin, T3, T4, TBG (thyroxine bounded globuline) as well as adrenaline, noradrenaline, and dopamine was investigated. Additionally the metabolites glucose, lactate, free glycerin, and acetacetate were measured. Beside prolactin values, only the values for ACTH, aldosterone, cortisol, and 17-DHEA differed with respect to both anesthesia methods. Under halothane-N2O/O2 anesthesia free T4 rose initially also, here represented by T4/TBG-ratio (= FTI). However, the fall of T3 concentration showed no phase - resp. anesthesia-specific changes. Catecholamine levels reached highest values towards the end of operation resp. one hour after extubation in both groups. The insulin secretion, however, was not significantly raised in either group during acute stress phases. As an expression of modified metabolic regulation comparable rises of plasma levels of glucose, lactate, free glycerin, and acetacetate were observed under midazolam-fentanyl-N2O/O2 anesthesia as well as under halothane-N2O/O2. According to presented data, both methods of anesthesia modulated the endocrine metabolic response of the organism to surgical stress, without showing any clinically relevant advantages or disadvantages attributable to either method.

Adult↗
PubMed1988

[Combined midazolam-ketamine anesthesia in traumatologic interventions. Patterns of endocrine reactions].

For anesthesia, ataranalgesic combinations of benzodiazepines and ketamine have been reported to be advantageous alternatives to inhalation agents or high-dose opioids. In this study, the influence of midazolam-ketamine-N2O/O2 anesthesia on the endocrine metabolic response of patients during the course of reconstructive orthopedic surgery (n = 8) was investigated. METHODS. The dosage of anesthetic agents was calculated according to body weight. Thus, the amount of ketamine given in young adults (mean age = 24.1 years) was 30 micrograms/kg per minute. Pre-, intra-, and postoperatively, each of following hormones was measured by either radioimmunoassay or radioenzyme-linked assay: ACTH, aldosterone, cortisol, 17-dehydroepiandrosterone (17-DHEA), prolactin, insulin, T3, T4, thyroxine-binding globulin (TGB), epinephrine, norepinephrine, and dopamine. Additionally, the metabolites glucose, lactate, and free glycerin were measured perioperatively. RESULTS and CONCLUSION. The circulation remained relatively stable under midazolam-ketamine-N2O/O2 anesthesia (MAP +23%; HR +17%). ACTH secretion and prolactin secretion showed a significant rise (p less than 0.01) even before skin incision (Figs. 1, 3). A significant rise in cortisol levels occurred intraoperatively (+80%; p less than 0.01). Secretion of aldosterone (+246%; p less than 0.05) and 17-DHEA (+49%; p less than 0.05) essentially followed the secretory profile of cortisol, while insulin secretion did not rise significantly under acute surgical stress (Fig. 4).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗