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  • 1
    Electronic Resource
    Electronic Resource
    Microcirculatory disturbances and leucocyte adherence in transplanted livers after cold storage in Euro-Collins, UW and HTK solutions (1991)
    Springer
    Transplant international 4 (1991), S. 45-50 
    Details
    ISSN: 1432-2277
    Keywords: Cold storage, rat liver, microcirculation ; Microcirculation, rat liver ; Euro-Collins, microcirculation, rat liver ; UW, microcirculation, rat liver ; HTK, microcirculation, rat liver ; Transplantation rat liver, micro-circulation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Integrity of the hepatic microcirculation and maintenance of endothelial cell viability are critical components in preventing primary non-function after liver transplantation. Therefore, hepatic microcirculation and leucocyte-endothelial interaction were studied in rat livers stored for 1 h in Euro-Collins (EC), University of Wisconsin (UW), and histidine-tryptophan-ketoglutarate (HTK) solutions and subsequently transplanted. One hour after transplantation surgery, the livers were exposed under an intravital fluorescence microscope. After injection of the leucocyte marker acridine orange (1 μmol/kg), six pericentral fields were observed for 30 s and experiments were recorded continuously. The percentage of perfused sinusoids was reduced in the livers in the EC group (82.9%) in contrast to the UW (93.2%) and HTK groups (91.0%). Livers in the EC group showed a reduction in the diameters of pericentral sinusoids (7.3±0.2 μm; mean±SEM) compared with the UW group (9.5±0.2 μm; P〈0.05) and HTK group (10.2±0.8 μm; P〈0.05), indicating substantial cell swelling in livers stored in EC solution. Permanent adherence of leucocytes was most frequently observed in the EC group (33.5±1%), while this phenomenon was less pronounced in the UW group (14.5+1.1%; P〈0.05) and HTK group (16.3±0.7%; P〈0.05). Conversely, temporary adherence of leucocytes was reduced in the EC group (19.7+1.3%) compared with the UW group (30.5+2.1%) and the HTK group (34.4+0.8%). Microcirculatory failure and cell swelling in the EC group might be due to the lack of osmotic substances or oxygen radical scavengers included in UW (allopurinol, glutathione) and HTK (mannitol) solutions. In conclusion, cold storage of livers in UW and HTK solutions results in better preservation of the microcirculation and prevention of adhesion of leucocytes after transplantation compared with the EC solution.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00335515
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  • 2
    Electronic Resource
    Electronic Resource
    Methyl palmitate prevents Kupffer cell activation and improves survival after orthotopic liver transplantation in the rat (1991)
    Springer
    Transplant international 4 (1991), S. 215-220 
    Details
    ISSN: 1432-2277
    Keywords: Liver transplantation, rat, Kupffer cell ; Kupffer cell, liver transplantation, rat ; Methyl palmitate, liver transplantation, rat ; Reperfusion injury, liver transplantation, rat
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The purpose of this study was to determine whether prevention of Kupffer cell activation following orthotopic liver transplantation improves postoperative survival. First, particle phagocytosis by Kupffer cells was monitored continuously from the uptake of colloidal carbon by the perfused liver. Unstored livers took up carbon at rates of around 150 mg/g per hour, whereas storage for 24 h in Euro-Collins solution nearly doubled values to about 290 mg/g per hour. Treatment of rats with methyl palmitate, an inhibitor of phagocytosis by Kupffer cells, reduced carbon uptake to about one-third to one-half of control values in unstored and stored livers, respectively. Oxygen uptake, which was increased about 25% in stored and unstored livers by infusion of colloidal carbon, was only increased 5%–10% in both groups following treatment with methyl palmitate, suggesting that Kupffer cell activation was prevented by methyl palmitate. In livers transplanted after storage for 6 h in Euro-Collins solution (nonsurvival conditions), control rats survived only about 12 h, while treatment with methyl palmitate increased survival time significantly — more than threefold — to about 40 h. These data are consistent with the hypothesis that activation of Kupffer cells following cold ischemic storage and reperfusion is an early event involved in liver graft failure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00649106
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  • 3
    Electronic Resource
    Electronic Resource
    Retrograde Nailing of Distal Femoral Fracture – Clear and Potential Indications (2000)
    Springer
    European journal of trauma 26 (2000), S. 155-168 
    Details
    ISSN: 1615-3146
    Keywords: Key Words Retrograde femur nail ; Transarticular approach ; Femur fracture ; Intramedullary nailing
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Despite the fact that fracture treatment of the supracondylar region of the femur is known to be a therapeutic challenge, a high incidence of complications was reported with extramedullary osteosynthesis. New techniques of biological osteosynthesis and specific implants have been developed to improve treatment of supra- and diacondylar fractures of the femur. In the present series, we report on various clear indications for the use of the distal femur nail (DFN). Moreover, some potential indications for the DFN are presented and their advantages discussed. Clinical evaluation demonstrated that 92% of the fractures treated with the DFN healed without bone grafting, and the clinical results were excellent or satisfactory according to the criteria of Neer et al. Failure of the technique or infection was not observed. Based on our results, we feel that retrograde nailing of the femur, either with percutaneous or open techniques, is a suitable addition to the established techniques of osteosynthesis of the distal femur.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00002439
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  • 4
    Electronic Resource
    Electronic Resource
    Sequential Changes and Pattern of Bone-Specific Alkaline Phosphatase after Trauma (2000)
    Springer
    European journal of trauma 26 (2000), S. 33-38 
    Details
    ISSN: 1615-3146
    Keywords: Key words Alkaline phosphatase ; Bone ; Lectin precipitation ; Fracture ; Osteoblast activity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Serum activity of bone specific alkaline phosphatase, a product of differentiated osteoblasts, is thought to mirror fracture healing. The precise time course after various conditions involving bone healing is, however, poorly described. The aim of our study was to evaluate sequential changes of bone alkaline phosphatase over a period of 20 weeks in traumatized patients with and without bone injuries. The bone isoenzyme of alkaline phosphatase was determined in frozen serum samples using a new automated procedure based on the wheat germ lectin precipitation method. Patients were stratified into different groups: 1. ST – soft tissue injury without bone participation; 2. DF – diaphysial fracture of tibia or femur; 3. MT – patients suffering from multiple traumas; 4. PF – proximal femur fracture, treated with dynamic hip screw; and 5. EP – femur neck fracture, treated with cemented endoprosthesis. Similar values were obtained in all measured groups on the day of admission (ST 35.83±6.15 U/l; PF 27.37±4.43 U/l; EP 31.09±7.42 U/l). In the following measurements, enzyme activity decreased significantly in all groups to reach a nadir within the first week, ranging between 41 and 82% of the activity immediatly postoperative. Thereafter, a substantial increase occurred in all groups investigated. In the ST group, this increase led to an activity level that was comparable to the first posttraumatic value (39.06±7.81 U/l). In contrast, average values in all other groups revealed a further increase, which was significantly elevated compared to measurements taken the first day after trauma (DF 74.36±10.84 U/l; MT 177.87±30.0 U/l; PF 93.39±22.08 U/l; EP 51,52±7.33 U/l). Additionally, the time to reach the peak in enzyme activity differed between groups. In the MT group, it was observed as early as 3 weeks after injury, in the DF group the peak was reached as late as 6 weeks after trauma. The results of the study indicate that bone alkaline phophatase activity undergoes a specific pattern of changes after trauma. It may be assumed that the initial decrease is part of a general stress response to trauma and operation. The subsequent increase seems to depend from the magnitude of bone repair and the type of fracture healing, e.g. diaphysial fracture healing takes longer time than cancellous bone healing. These results seem to be a useful basis in order to establish a laboratory monitoring of fracture healing in subsequent studies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00002436
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  • 5
    Electronic Resource
    Electronic Resource
    Evidence for a Sustained Inflammatory Response of the Hepatic Microcirculation after Hemorrhagic Shock (2000)
    Springer
    European journal of trauma 26 (2000), S. 176-184 
    Details
    ISSN: 1615-3146
    Keywords: Key Words Hemorrhagic shock ; Liver microcirculation ; Intravital microscopy ; Inflammation ; Leukocyte adhesion ; Tumor necrosis factor α ; Intercellular adhesion molecule-1
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Defined microcirculatory disturbances have been demonstrated during the first hours after hemorrhagic shock involving complex pathophysiological mechanisms. Since clinical complications associated with the inflammatory reaction that accompanies shock and resuscitation become apparent within days, our aim was to establish an experimental model of hemorrhagic shock which simulates this clinical situation. Therefore, a nonlethal rat model was developed allowing for the investigation of the hepatic microcirculation by intravital microscopy up to 4 days after hermorrhagic shock. Anesthetized Sprague-Dawley rats were subjected to hemorrhagic hyptension by blood withdrawal reducing MAP (mean arterial blood pressure) to 40 mm Hg. After 60 min of hypovolemic hypotension, the animals were resuscitated. After 1, 2, 3, or 4 days, sinusoidal perfusion pattern and leukocyte adhesion characteristics were investigated using intravital fluorescence microscopy. In separate, but parallel experiments, the time course of TNFα (tumor necrosis factor α) and ICAM-1 (intercellular adhesion molecule-1) mRNA expressio was examined in enriched parenchymal and non-parenchymal liver cell fractions by Northern blot hybridization. At day 1, sinusoidal narrowing as seen in previous experiments a few hours after shock was not observed but occurred at days 2 and 3 after shock. Permanent adhesion of leukocytes to the sinusoidal endothelium reached a maximum at day 2 after shock and remained significantly increased until day 4 compared with controls. An early TNFα mRNA accumulation was observed in shock animals but not in sham operated controls. In contrast, a sustained expression of ICAM-1 and prolonged accumulation of white blood cells were observed. The data reflect an early transient TNFα mRNA response and a sustained inflammatory reaction associated with shock and resuscitation. The inflammatory pathological alteration of the hepatic microcirculation after hemorrhagic shock are paralleled by a sustained disturbance of the sinusoidal flow patterns.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00002441
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  • 6
    Electronic Resource
    Electronic Resource
    Primäre und sekundäre freisetzung von interleukin 6 und 8 bei der gestuften polytraumaversorgung (1999)
    Springer
    European journal of trauma 25 (1999), S. 100-107 
    Details
    ISSN: 1615-3146
    Keywords: Polytrauma ; Multiorganversagen ; Zytokine ; Interleukin 6 ; Interleukin 8 ; Multiple trauma ; Multiple organ failure ; Cytokines ; Interleukin 6 ; Interleukin 8
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The combination of shock, soft tissue damage, organ injury and fractures in patients with multiple trauma is responsible for the development of the systemic inflammatory response and multiple organ failure. To minimize the release of proinflammatory mediators a staged treatment of patients suffering from multiple trauma has been established. This includes immediate stabilization of long bone fractures and treatment of soft tissue injuries with definitive osteosynthesis or secondary reconstructive surgery following later on. The aim of this prospective study was to evaluate the influence of consecutive surgery on the stimulation of proinflammatory mediators, depending on the timepoint of operation. Therefore, interleukine (IL) 8 and IL-6 plasma levels were measured the day before and the day after surgery. We found that the proinflammatory response was increased markedly when surgery was performed between day 2 and 5 in comparison with surgery between day 6 and 28. Surgery between day 2 to 5 after trauma caused an increase in IL-8 values in 14 out of 26 patients, in contrast only 5 out of 28 showed an increase when surgery was performed after day 6. Significant changes of the IL-6 response following surgery was not observed between the 2 time periods. The patients undergoing unscheduled surgery between days 2 to 5 because of vital indications had significant higher multiple organ failure-scores than those with elective minor surgery in the respective period. In conclusion, our results stress the importance of a staged treatment of patients suffering from multiple trauma furthermore.
    Notes: Zusammenfassung Der polytraumatisierte Patient entwickelt wegen der unfallbedingten Kombination aus Schock, Weichteilschaden, Organverletzungen und Frakturen regelmäßig ein systemisches Entzündungssyndrom mit dem Risiko eines Multiorganversagens. Zur Minimierung der Belastung mit proinflammatorischen Mediatoren hat sich daher ein gestuftes Versorgungskonzept polytraumatisierter Patienten mit Primärstabilisierung aller relevanten Frakturen und Weichteilschäden und einer zeitlichen Aufschiebung sekundärer Rekonstruktionen oder Verfahrenswechsel durchgesetzt. Ziel dieser prospektiven klinischen Studie war die Evaluation der durch Sekundäreingriffe verursachten konsekutiven Entzündungsstimulation in Abhängigkeit vom Zeitpunkt ihrer Durchführung. Hierzu wurden die proinflammatorischen Zytokine Interleukin (IL) 8 und IL-6 am Tag vor und nach einem operativen Eingriff in der vulnerablen Phase bis Tag 5 und danach analysiert. Die Auswertung der Plasmaspiegel der Zytokine IL-8 und IL-6 zeigte, daß operative Eingriffe zwischen Tag 2 und 5 eine wesentlich ausgeprägtere proinflammatorische Antwort als Eingriffe ab dem sechsten Tag verursachen. Zwischen dem zweiten und fünften Tag boten postoperativ 14 von 26 Patienten erhöhte IL-8-Werte und neun von 27 erhöhte IL-6-Werte. Im Vergleich hierzu wurden nach dem sechsten Tag für IL-8 nur noch bei fünf von 28 Patienten (p = 0,017) und für IL-6 bei zehn von 30 Patienten erhöhte postoperative Werte festgestellt. Diejenigen Patienten, die außerhalb des gestuftes Versorgungskonzepts als Notfall großen Eingriffen zwischen Tag 2 und 5 unterzogen wurden mußten, hatten signifikant höhere Werte im Multiorganversagen-Score als Patienten mit geplanten kleineren Eingriffen im gleichen Zeitintervall (p = 0,001). Die beobachteten Veränderungen der proinflammatorischen Zytokine IL-8 und IL-6 bestätigen eindrücklich das Konzept der gestuftes Polytraumaversorgung.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00578717
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