K Buttenschoen

Universität Ulm, Ulm, Baden-Württemberg, Germany

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Publications (30)70.85 Total impact

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    ABSTRACT: Vacuum-assisted closure (vacuum sealing) is a surgical procedure for the local treatment of severe soft-tissue damage. However, systemic consequences to the host are unknown. The aim of this study was to disclose the effects of vacuum sealing on the host’s immune response and to demonstrate the early time course of endotoxin, interleukin-6 (IL-6), C-reactive protein (CRP), haptoglobin, transferrin, orosomucoid, 6-keto-prostaglandin (6KPG), α1-antitrypsin and complement C3 and C4. A total of 35 patients with closed ankle fractures were randomized into two groups and operated on within 6 h after injury. After osteosynthesis, one group was treated by vacuum sealing (VS) and the other by immediate skin closure (IS). Blood was collected immediately after admission and regularly up to 96 h after surgery. Morbidity was checked during the first year after injury. Preoperative endotoxin plasma level was increased compared with that of voluntary individuals (0.06 ± 0.02 EU/ml versus 0.021 ± 0.001 EU/ml) and peaked in patients with immediate skin suture 0.5 h after the surgical procedure at 0.11 ± 0.03 EU/ml. However, in patients with vacuum sealing, this peak was absent (0.07 ± 0.02 EU/ml). Endotoxaemia decreased to almost normal values after 24 h. Plasma IL-6 peaked 12 h postoperatively, decreasing thereafter with no difference between the groups. The plasma level of 6KPG decreased immediately after the surgical procedure in vacuum-sealed patients (before operation, 415 pg/ml; 12 h later, 251 pg/ml), but increased first in patients with immediate skin suture. CRP peaked 48 h after injury (VS, 48 ± 6 mg/l; IS, 38 ± 7 mg/l) with no difference between the groups. Transferrin decreased postoperatively (pre-op: VS, 2.49 ± 0.14 g/l; IS, 2.85 ± 0.19 g/l; 24 h: VS, 2.16 ± 0.08 g/l and IS 2.33 ± 0.11 g/l), whereas haptoglobin (pre-op: VS, 2 ± 0.21 g/l; IS, 1.7 ± 0.18 g/l; 96 h: VS, 3.4 ± 0.25 g/l, IS, 3.2 ± 0.24 g/l) and orosomucoid (pre-op: VS, 0.85 ± 0.05 g/l, IS, 0.83 ± 0.07 g/l; 96 h: VS, 0.85 ± 0.05 g/l, IS 1.14 ± 0.08 g/l) increased until day 4 with no significant difference between VS and IS. There was no relevant intergroup difference for complement C3, C4, α1-antitrypsin and morbidity (VS/IS: wound infection, 1/1; metal loosening, 1/1; prolonged healing, 1/0; prolonged pain, 3/2; and motor disturbance, 1/1). Surgery for ankle fractures is associated with temporary endotoxaemia and substantial changes in acute-phase proteins. Vacuum-assisted closure has only limited and no negative systemic immune consequences after surgery for malleolar fractures, is safe and can be used to manage severe soft-tissue damage. However, if feasible, primary skin closure is preferable.
    No preview · Article · Jun 2008 · Foot and Ankle Surgery
  • B Grüner · W Kratzer · K Buttenschön · P Kern · S Reuter
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    ABSTRACT: A 67-year-old woman with cystic echinococcosis (CE) is presented. She had complained of upper abdominal discomfort due to large hepatic cysts. These cysts showed no typical infrastructure characteristic for CE and she had never left the rural areas of southern Germany. Most remarkably, this area is highly endemic for alveolar echinococcosis, caused by Echinococcus multilocularis, but only sporadic cases of CE have been described. Due to the discrepancy between positive Echinococcus serology, atypical morphology and residency in an area non-endemic for Echinococcus granulosus, diagnostic puncture was performed with albendazole coverage. Puncture was complicated by anaphylaxis, from which the patient recovered without sequelae. The diagnosis of CE was highly likely due to the combination of positive serology with post puncture anaphylaxis, increasing antibody titers and eosinophilia. Retrospectively, the cysts had initially corresponded to the WHO stage CE 1. The patient was treated with albendazole for 15 weeks. Under treatment, the parasitic membrane detached from the cyst wall, revealing characteristic morphology for CE, now corresponding to the WHO stage CE 3. The patient remained asymptomatic during follow-up visits.
    No preview · Article · Mar 2008 · Infection
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    ABSTRACT: A broad spectrum of hepatobiliary disorders are found in patients with inflammatory bowel diseases. The aim of the present work was to study interactions between gut and liver in experimental rat models of colitis and small bowel inflammation. Colitis was induced either by trinitrobenzene sulphonic acid or dextran sodium sulphate. Small-bowel inflammation was induced by indomethacin. Bile acid secretion, bile acid pool, and cholesterol 7-alpha hydroxylase were studied. Cholesterol 7-alpha hydroxylase protein expression was analysed in the microsomal liver fraction. As portal mediators released form the inflamed gut we measured lipopolysaccharide, tumour necrosis factor-alpha and interleukin-1beta in portal serum. The hepatic inflammatory response was evaluated by binding activity of nuclear factor-kappaB, activator protein-1 and alpha-2-macroglobulin. Increased bile acid secretion, total bile acid content in gut and liver (bile acid pool size), and hepatic cholesterol 7-alpha hydroxylase protein and mRNA levels were found in the two colitis models associated with only a minor hepatic acute phase and cytokine response. In contrast, during indomethacin-induced small-bowel inflammation bile acid secretion, pool size, and cholesterol 7-alpha hydroxylase decreased in parallel to a strong hepatic cytokine and acute phase response. Colitis without portal cytokine release and acute phase reaction shows an induction of bile acid secretion, pool size, and cholesterol 7-alpha hydroxylase. In contrast, intestinal inflammation after indomethacin treatment is associated with an acute phase response and a repression of bile acid synthesis.
    Full-text · Article · Apr 2007 · European Journal of Clinical Investigation
  • G. Leder · S. Klein · K. Buttenschoen · D. Henne-Bruns
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    ABSTRACT: Chronic pancreatitis may be characterized by a wide variety of causes, clinical appearances and morphologic findings. The disease may be well managed by adequate conservative treatment over long periods. Standardized operations with gradually minimized operative and perioperative morbidity and mortality have increasingly established their role in the treatment of stenoses and pain. Challenges, however, still are the differentiation from pancreatic tumors, particularly pancreatic cancer and the detection and treatment of acute complications in this chronic disease. These challenges are discussed in this review. To allow application of the conclusions drawn from literature to clinical practice two cases are presented for illustration: A 63 year old female with a history of alcohol and nicotine consumption, hyperlipidemia and pancreas divisum, who developed a necrotising pancreatitis and subsequently pseudocysts as a consequence of pancreatic duct obstruction due to cancer of the pancreatic head. This patient was treated by partial duodenopancreatectomy. The second, a 47 year old male with chronic alcoholic pancreatitis, who developed an acute abdomen after arrosion bleeding from the pseudoaneurysmatic splenic artery and rupture of the spleen after hemorrhagic infarction illustrates the inherent dangers of a seemingly stable chronic pancreatitis.
    No preview · Article · Jan 2007
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    ABSTRACT: Cystic echinococcosis (CE) is a world-wide zoonosis but is relatively rare in Western industrial countries. Surgery is the treatment of choice. However, the technical procedure varies and evidence-based knowledge is fragmentary. Cystectomy and partial resection of the liver (pericystectomy, segmental resection, hemihepatectomy) are the procedures under debate. We present a descriptive analysis of the patients suffering from CE (anamnesis, cyst location, procedures, morbidity, lethality, hospital stay, and long-term follow-up). A retrospective analysis was made of the medical records and questionnaires of patients surgically treated within a period of 16 years at a German university hospital. Sixty-four patients had 101 parasitic cysts which were treated by 67 operations. The average volume of the cysts was about 400 ml (range 10 - 2200 ml). Eighty-six cysts were located within the liver and 15 in extrahepatic sites. The parasitic lesions were removed by hemihepatectomy (n = 4), segmental liver resection (n = 9), pericystectomy (n = 24), cystectomy (n = 34), and cysto-jejunostomy (n = 1). During the first half of the observation period resective procedures were preferred (81 %) whereas during the second half cystectomy predominated (82 %). Lethality was 0 %. Postoperative morbidity after resective procedures and cystectomy was 47 % and 17 %, respectively. Relapses were not observed after cystectomy, but occurred in four cases following resective procedures (twice after hemihepatectomy, 4 and 7 years later, respectively; once after segmental liver resection and once following cysto-jejunostomy, both 2 years after the respective procedure). The more extensive the surgical procedure the longer was the hospital stay. Cystectomy should be performed as the procedure of choice because it proved to be safe, simple, effective, and meets all criteria of the surgical treatment for hydatid disease, i. e., complete elimination of the parasite, no intra-operative spillage especially by the use of Aaron's cone, and saving healthy tissue. Pericystectomy should be used for peripheral liver cysts only partially surrounded by liver tissue.
    No preview · Article · Nov 2004 · Zeitschrift für Gastroenterologie
  • KD Buttenschoen · D Carli Buttenschoen
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    ABSTRACT: Cystic echinococcosis (CE) is a worldwide zoonosis caused by larval stages of the cestode Echinococcus granulosus. Surgery, chemotherapy, and interventional procedures are the therapeutic options. Surgery can cure the patient if the parasite is removed entirely. However, the technical procedures are inconsistent and comprise partial liver resection or opening of the parasitic cyst and removal of the parasite. Laparotomy is the most common approach. In selected cases laparoscopic methods are successful. Retrospective studies outweigh prospective ones by far. However, proper management gives favorable results. We critically review the literature and present a brief summary of current surgical strategy and focus on issues relevant for surgeons: diagnosis, indication for medical treatment, indication for surgical treatment, surgical procedures, scolicidal agents, morbidity, mortality, recurrence, perioperative medication, standards. All surgical procedures aim at the complete removal of the parasite. Liver resection and pericystectomy are procedures that resect the closed cysts with a fairly wide safety margin. A meta-analysis shows the best results regarding lethality (1.2%), morbidity (11.7%), and recurrence rates (2%) for resective operations. However, most surgeons consider these methods as too radical for a benign disease. Procedures that remove the parasite and keep the pericyst (=cystectomy) are easier to carry out than resective ones. The meta-analysis presented revealed a lethality of 2%, morbidity of 23%, and recurrence rate of 10.4% for these operations. Omentoplasty is the option of choice for the management of the remaining cyst cavity. Despite alternative procedures surgery is the treatment of choice. Supportive measures comprise the use of scolicidal agents and postoperative benzimidazole administration. However, a critical review of the literature disclosed a lack of scientific confirmation of established treatment modalities and procedures. The results of ultrasound imaging were classified and correlated to the developmental phases of CE. Cystectomy and omentoplasty for CE should be the standard surgical procedure because it is safe, simple, and effective and meets all criteria of surgical treatment for hydatid disease: entire elimination of the parasite, no intraoperative spillage especially by using a cone, and saving healthy tissue. Pericystectomy should be used for peripherally located liver cysts that are surrounded by parenchyma only partially. Ultrasonic classification of the parasitic lesion should be used as a guideline for therapeutic measures.
    No preview · Article · Oct 2003 · Langenbeck s Archives of Surgery
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    C Vasilescu · V Herlea · K Buttenschoen · H G Beger
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    ABSTRACT: To test the hypothesis that endotoxin is absorbed from the gut into the circulation in rats with experimental acute pancreatitis we studied two different animal models. In the first model necrotizing pancreatitis was induced by the ligation of the distal bilio-pancreatic duct while in the second, experimental oedematous acute pancreatitis was induced by subcutaneous injections of caerulein. In both experiments, in the colon of rats with acute pancreatitis endotoxin from Salmonella abortus equi was injected. Endotoxin was detected by immunohistochemistry in peripheral organs with specific antibodies. The endotoxin was found only in rats with both acute pancreatitis and endotoxin injected into the colon and not in the control groups. The distribution of endotoxin in liver at 3 and 5 days was predominantly at hepatocytes level around terminal hepatic venules, while in lung a scattered diffuse pattern at the level of alveolar macrophages was identified. A positive staining was observed after 12 hours in the liver, lung, colon and mesenteric lymph nodes of rats with both caerulein pancreatitis and endotoxin injected into the colon. We conclude that the experimental acute pancreatitis leads to early endotoxin translocation from the gut lumen in the intestinal wall and consequent access of gut-derived endotoxin to the mesenteric lymph nodes, liver and lung.
    Full-text · Article · Oct 2003 · Journal of Cellular and Molecular Medicine
  • K Buttenschoen · P Schorcht · S Reuter · D C Buttenschoen · P Kern · H G Beger
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    ABSTRACT: The incidence of alveolar echinococcosis (AE) is low, and studies and progress reports with regard to surgical procedures are rare. Retrospective analysis of surgical therapy of AE and its long-term results between 1983 and 2000 by evaluating medical records and questionnaires. German university hospital within the endemic area. Twenty-five surgical procedures were performed in 19 patients with AE (12x partial resection of the liver, 3 of them with additional extrahepatic resection; 3x just extrahepatic resection, 4x bilidigestive anastomosis, 5x exploratory laparotomy, 1x bypass procedure). Fifteen patients were operated on the first time with that diagnosis, four due to a relapse. Seven surgical procedures were estimated to be curative, whereas 18 were palliative, because the parasitic mass could not be resected in toto. One patient died from persistent systemic sepsis as a consequence of microbial superinvasion of a splenic parasitic mass. Morbidity was 28%. All patients had additional medical treatment and periodic follow-up. Three of seven patients estimated for curative surgery developed a relapse. One of the patients discharged following palliative surgery died 13 years after diagnosis with liver insufficiency. Advances in conservative and interventional treatments have greatly improved the prognosis of the disease. Curative surgery for AE is feasible only in a minority of patients, because frequently the disease has already spread widely when diagnosed. The minimum distance between the lesion and the cut surface should be 2 cm. Taking the advances in conservative treatment into consideration, the benefit of palliative surgery is uncertain and today there is no evidence for prolonged survival by palliative surgical procedures. Palliative surgery should therefore be reserved for cases with complications that could not be managed by conservative and interventional treatment.
    No preview · Article · Jun 2001 · Der Chirurg
  • K Buttenschoen · P Schorcht · S Reuter · DC Buttenschoen · P Kern · HG Beger
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    ABSTRACT: Introduction: The incidence of alveolar echinococcosis (AE) is low, and studies and progress reports with regard to surgical procedures are rare. Methods: Retrospective analysis of surgical therapy of AE and its long-term results between 1983 and 2000 by evaluating medical records and questionnaires, Setting: German university; hospital within the endemic area. Results: Twenty-five surgical procedures were performed in 19 patients with AE (12 x partial resection of the liver, 3 of them with additional extrahepatic resection; 3x just extrahepatic resection, 4x bilidigestive anastomosis, 5x exploratory laparotomy, 1x bypass procedure). Fifteen patients were operated on the first time with that diagnosis, four due to a relapse. Seven surgical procedures were estimated to be curative, whereas 18 were palliative, because the parasitic mass could not be resected in tote. One patient died from persistent systemic sepsis as a consequence of microbial superinvasion of a splenic parasitic mass. Morbidity was 28%. All patients had additional medical treatment and periodic follow-up. Three of seven patients estimated for curative surgery developed a relapse. One of the patients discharged following palliative surgery died 13 years after diagnosis with liver insufficiency. Advances in conservative and interventional treatments have greatly improved the prognosis of the disease. Conclusion: Curative surgery for AE is feasible only in a minority of patients, because frequently the disease has already spread widely when diagnosed. The minimum distance between the lesion and the cut surface should be 2 cm. Taking the advances in conservative treatment into consideration, the benefit of palliative surgery is uncertain and today there is no evidence for prolonged survival by palliative surgical procedures. Palliative surgery should therefore be reserved for cases with complications that could not be managed by conservative and interventional treatment.
    No preview · Article · May 2001 · Der Chirurg
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    ABSTRACT: Introduction: The incidence of alveolar echinococcosis (AE) is low, and studies and progress reports with regard to surgical procedures are rare. Methods: Retrospective analysis of surgical therapy of AE and its long-term results between 1983 and 2000 by evaluating medical records and questionnaires. Setting: German university hospital within the endemic area. Results: Twenty-five surgical procedures were performed in 19 patients with AE (12 × partial resection of the liver, 3 of them with additional extrahepatic resection; 3 × just extrahepatic resection, 4 × bilidigestive anastomosis, 5 × exploratory laparotomy, 1 × bypass procedure). Fifteen patients were operated on the first time with that diagnosis, four due to a relapse. Seven surgical procedures were estimated to be curative, whereas 18 were palliative, because the parasitic mass could not be resected in toto. One patient died from persistent systemic sepsis as a consequence of microbial superinvasion of a splenic parasitic mass. Morbidity was 28 %. All patients had additional medical treatment and periodic follow-up. Three of seven patients estimated for curative surgery developed a relapse. One of the patients discharged following palliative surgery died 13 years after diagnosis with liver insufficiency. Advances in conservative and interventional treatments have greatly improved the prognosis of the disease. Conclusion: Curative surgery for AE is feasible only in a minority of patients, because frequently the disease has already spread widely when diagnosed. The minimum distance between the lesion and the cut surface should be 2 cm. Taking the advances in conservative treatment into consideration, the benefit of palliative surgery is uncertain and today there is no evidence for prolonged survival by palliative surgical procedures. Palliative surgery should therefore be reserved for cases with complications that could not be managed by conservative and interventional treatment.
    No preview · Article · Mar 2001 · Der Chirurg
  • P Kern · S Reuter · K Buttenschoen · W Kratzer

    No preview · Article · Feb 2001 · DMW - Deutsche Medizinische Wochenschrift
  • P Kern · S Reuter · W Kratzer · K Buttenschoen

    No preview · Article · Feb 2001 · DMW - Deutsche Medizinische Wochenschrift
  • P Kern · S Reuter · W Kratzer · K Buttenschoen

    No preview · Article · Jan 2001 · DMW - Deutsche Medizinische Wochenschrift
  • P Kern · S Reuter · K Buttenschoen · W Kratzer

    No preview · Article · Jan 2001 · DMW - Deutsche Medizinische Wochenschrift
  • E Boelke · M Storck · K Buttenschoen · D Berger · A Hannekum
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    ABSTRACT: Endotoxemia in man is a controversial issue. However, endotoxin is a potent trigger of the inflammatory response. Therefore, endotoxin translocation and mediator release was investigated in patients undergoing cardiac surgery. In 40 patients (13 women and 27 men, ages ranging from 30 to 73 years with a median of 60 years), plasma concentrations of endotoxin, interleukin-6 (IL-6), and C-reactive protein (CRP) were determined during and after cardiovascular bypass. In a subgroup of 10 patients, myeloid-related proteins: MRP8, MRP14, and the soluble heterocomplex (MRP8/MRP14) levels were additionally studied. A significant increase (p < 0.01) of plasma endotoxin concentrations was found during surgery, culminating in a peak (median value of 0.82 EU/mL) during reperfusion. Plasma levels of endotoxin continued to be slightly raised until the 5th postoperative day, whereas those of interleukin-6 rose at the end of the operation and were at their highest level 6 hours postoperatively (median value of 218 pg/mL). CRP levels were increased 24 hours postoperatively with a median value of 114 mg/L and peaked on day 2 (191 mg/L). A statistically significant correlation between the intraoperative endotoxin plasma concentrations and IL-6 concentrations was established (p < 0.05). The MRP8/MRP14 heterocomplex increased until day 2 after surgery, except MRP14, which showed the highest level at day 1 (55 ng/mL). Cardiac surgery is associated with endotoxemia and a marked acute-phase response. Therefore, endotoxin must be regarded as a pathophysiologic mediator. The role of the gut as a source of endotoxemia following cardiac surgery deserves further attention.
    No preview · Article · Oct 2000 · Angiology
  • S Reuter · B Jensen · K Buttenschoen · W Kratzer · P Kern
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    ABSTRACT: Mebendazole and albendazole are the drugs of choice for the treatment of alveolar echinococcosis. In this open-labelled observational study we present and evaluate the outcome of long-term treatment with these drugs and present results of different treatment regimens. Thirty-five patients were started on either mebendazole or albendazole at the beginning of 1992 and followed for an average of 39 months (range 12-79 months). Treatment was classed as successful if the disease had not progressed for >1 year and if there were no side-effects necessitating a change of treatment. Lack of progression was evaluated mainly using ultrasound and computed tomography and was further substantiated by laboratory tests and clinical findings. The overall success rate was 97%. An initial regimen for cases of alveolar echinococcosis was recurrence-free in 71% of those treated with mebendazole and in 78% of those treated with albendazole. Four out of five cases with progressive disease stabilized after the therapeutic regimen was changed. Seven patients received a continuous regimen with albendazole. These patients were observed over an average of 28 months (range 13-50 months) without signs of progression or significant side-effects. This open-labelled prospective study demonstrates the high therapeutic efficacy of both mebendazole and albendazole with similar response rates in the treatment of alveolar echinococcosis. Albendazole reduced costs by >40% and is easier for patients to take, further arguing in favour of its preferred use. Albendazole in alveolar echinococcosis is only licensed for intermittent application. None the less, continuous treatment is safe and well tolerated and showed promising results when applied to patients in whom other treatment regimens had failed. It should thus be strongly considered in inoperable cases or progressive disease.
    No preview · Article · Oct 2000 · Journal of Antimicrobial Chemotherapy
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    ABSTRACT: To elucidate the time course of endotoxaemia and antiendotoxin antibodies in patients with acute pancreatitis. Prospective clinical study. University hospital, Germany. 25 patients with oedematous (n = 9) or necrotising (n = 16) pancreatitis, and 20 healthy controls. Concentrations of endotoxin and immunoglobulins (classes G, M, and A) directed at two lipid A molecules, four lipopolysaccharides, and alpha-haemolysin of Staphylococcus aureus measurements in plasma during a 12 day period. There were no differences in the degree of endotoxaemia between patients with oedematous and necrotising pancreatitis on admission. However, from the day after admission and throughout the observation period patients with necrotising pancreatitis had significantly higher concentrations of endotoxin than those with oedematous pancreatitis. Concentrations of IgM specific for endotoxin peaked at day 4, and then decreased in patients with oedematous pancreatitis while remaining high for those with necrotising pancreatitis. There was only a slight increase in IgA specific for endotoxin, and IgG and immunoglobulins to gamma-haemolysin remained steady throughout the observation period. There was strong cross-reactivity (r > 0.7) between IgM specific for endotoxin (70%), but this was less with IgA (52%), and IgG (20%). Necrotising pancreatitis is accompanied by persistent endotoxaemia with an extended rise in antiendotoxin antibodies. Patients with oedematous pancreatitis have a transient endotoxaemia with a temporary increase of Ig specific for endotoxin. Endotoxin stimulates the synthesis of specific antibodies (IgM) despite general immunosuppression.
    No preview · Article · Jul 2000 · The European Journal of Surgery
  • K Buttenschoen · W Fleischmann · U Haupt · L Kinzl · D C Buttenschoen
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    ABSTRACT: Translocation of endotoxins was demonstrated for multiple injury but not for minor trauma such as isolated malleolar fractures. Major trauma leads to substantial changes in the plasma concentration of acute-phase proteins. However, isolated malleolar fractures are minor trauma. The objective of this study was to elucidate the kinetics of endotoxemia and the ability of plasma to inactivate endotoxin of patients operated on malleolar fractures and to demonstrate the early time course of the acute-phase proteins C-reactive protein, transferrin, alpha1-acid glycoprotein, haptoglobin, and interleukin-6 and to correlate them with the amount of endotoxemia. Thirty patients with malleolar fractures were operated on within 6 hours after injury. Blood was collected immediately after admission and regularly up to 96 hours after surgery. Preoperative endotoxin plasma levels were increased compared with that of healthy individuals (0.05 +/- 0.017 vs. 0.02 EU/mL). Endotoxemia peaked 0.5 hours after the surgical procedure at 0.096 +/- 0.03 (p < 0.05 vs. healthy) and decreased to almost normal values after 24 hours. The ability of the plasma to inactivate endotoxin was significantly reduced after the surgical procedure compared with normal subjects (recovery, 0.17 +/- 0.028 EU/mL vs. 0.04 +/- 0.01 EU/mL; p < 0.05). Plasma interleukin-6 peaked 0.5 hours postoperatively (114 +/- 11 pg/mL, p < 0.05 vs. healthy), decreasing thereafter. C-Reactive protein peaked at 45 +/- 5 mg/mL (p < 0.05) 48 hours after injury. Transferrin decreased significantly postoperatively (2.41 +/- 0.12 mg/mL vs. pre-OP 2.65 +/- 0.1 mg/mL) and remained on this level for 96 hours. Both, alpha1-acid glycoprotein and haptoglobin increased postoperatively until day 4 (0.78 +/- 0.06 mg/mL to 1.15 +/- 0.08 mg/mL and 1.51 +/- 0.12 mg/mL to 3.24 +/- 0.22 mg/mL). There was no correlation between endotoxemia and the concentrations of the acute-phase proteins and interleukin-6. Surgery for malleolar fractures is associated with temporary endotoxemia and temporary reduced endotoxin inactivation capacity of the plasma. The injury and the surgical procedure leads to substantial changes in the plasma concentrations of acute-phase proteins. The relation between endotoxemia and acute-phase response is not dose dependent.
    No preview · Article · Feb 2000 · The Journal of trauma
  • K. Buttenschoen · D. C. Buttenschoen

    No preview · Article · Jan 2000 · Viszeralchirurgie
  • D Berger · K Buttenschoen
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    ABSTRACT: Today the management of the different forms of peritonitis is generally standardised. The classification of primary and secondary peritonitis is well accepted. From a pathophysiological point of view, postoperative and post-traumatic peritonitis should be considered as independent entities. The bacteriological isolates from the inflamed peritoneal cavity do not correlate with the clinical course, and the occurrence of enterococci and bacteroides may be slightly related to ongoing infectious complications. Valuable scoring systems mainly rely on systemic signs of the septic disease and seem to better differentiate the prognosis of the disease than more surgically oriented scores do. Although the scoring systems did not allow any clinical decision, they should be used to help better compare patients treated in different institutions. The observation of the minor relevance of bacteriology and the superiority of general sepsis scores agrees with the fact that pre-existing septic organ dysfunction and pre-existing comorbidity are the main determinants of mortality. Surgical therapy focuses on the control of the source of infection because it has been clearly shown that, without resolving the source of infection, the prognosis remains poor. Adjuvant surgical measures aim at the further reduction of the bacterial load in the peritoneal cavity. Planned relaparotomy, relaparotomy on demand, and continuous closed peritoneal lavage are used. Clinical results proved these methods to be equally effective although pathophysiological considerations favour closed peritoneal lavage. Summarising the available data, we need a more sophisticated understanding of the pathophysiology of the peritonitis, and well-designed clinical studies are necessary to define the optimal surgical treatment modalities.
    No preview · Article · Apr 1998 · Langenbeck s Archives of Surgery