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Biomedical subjects

A Heintz

Publications and source records attributed to A Heintz.

At least 37 records · Page 2Linked to original sources
PubMed2003

Metabolic and psychosocial effects of minimal invasive gastric banding for morbid obesity.

Obesity is considered a primary risk factor for cardiovascular disease and related mortality. The current study aimed to investigate the efficacy of minimal invasive gastric banding (GB) surgery for reducing caloric intake in morbid obesity, and to analyze the effects of weight loss on body composition and metabolic and psychosocial outcomes. Twenty-six adult severely obese patients (mean body mass index [BMI], 48.1 kg/m(2); range, 42 to 56) underwent adjustable silicone laparoscopic GB. Nine additional obese patients who declined surgery were treated with metformin (2 g daily) and served as a small additional group (BMI, 50.5 kg/m(2); range, 41 to 68). Presurgery and 17 +/- 2.2 months postoperatively, body composition (fat mass [FM], lean body mass [LBM], body water) and serum parameters (lipids, glucose, thyrotropin-stimulating hormone [TSH]) were determined. Quality of life (QoL) was evaluated by a standardized self-rating questionnaire (Short Form-36 [SF-36]), and supplemented by measures of physical complaints and psychological distress. After GB, weight loss was 21 +/- 14.9 kg (14%, P <.001). It was associated with a decrease in FM by 14 +/- 8.6 kg (18%, P <.001), LBM by 4 +/- 2.7 kg (5%, P <.001), body water by 4 +/- 3.4 L (7%, P <.01), systolic blood pressure by 16 +/- 26.3 mm Hg (10%, P <.05), total cholesterol by 0.69 +/- 1.29 mmol/L (12%, P <.05), and low-density lipoprotein cholesterol (LDL-C) by 0.38 +/- 0.39 mmol/L (10%, P <.05). Highly significant interactions between surgery and time were noted for weight (P <.005), BMI (P <.005), and FM (P <.007, analysis of variance [ANOVA]). Preoperatively, 14 of 26 patients (54%) had high fasting blood sugar levels (type 2 diabetics) and 11 (42%) had impaired glucose tolerance, whereas postoperatively, for baseline glucose levels a trend to decrease was noted. Neither malabsorption nor anemia was observed. QoL improved after GB; in particular, physical functioning and well being increased (P <.01), and somatic complaints (eg, dyspnea and heart complaints, pain in legs and arms) markedly decreased (P =.008). In the metformin group, neither relevant weight loss nor a significant decrease of biochemical values was observed. Minimal invasive GB is a successful therapeutic tool for reducing FM in morbidly obese patients. Weight loss resulted in improved metabolic parameters, suggesting a lowered atherogenic risk.

Activities of Daily Living↗
PubMed2002

[Cryotherapy for primary and secondary liver tumours].

AIMS: We assessed the morbidity, mortality and efficacy of cryotherapy for primary and secondary malignant liver tumours in a prospective case control study. METHODS: Since 1996 we performed 77 cryosurgical procedures on 71 patients. 6 patients had hepatocellular carcinoma, the remainders metastases, mainly of colorectal origin (n = 49). Cryotherapy was used when a complete tumour resection was not feasible, but complete tumour destruction by cryotherapy seemed possible. Mean follow-up was 21 months. RESULTS: The mean number of lesions per patient was 2.6 (1-10) with a mean maximum diameter of 3.7 cm (1-11). In 36 of 71 patients cryotherapy was used in combination with liver resection. Morbidity and hospital mortality were 23 % and 2.8 %. In 25 of 34 patients with colorectal primary and preoperatively elevated CEA it returned to normal postoperatively (74 %). 40 of the 60 patients with "R0-treatment" developed tumour recurrence, 10 of these at the cryosite (17 %). Median survival for all patients (colorectal metastases) was 28 (29) months with a 3- and 5-year survival rate of 38 % (43 %) and 30 % (33 %), respectively. CONCLUSION: Cryotherapy is an effective parenchyma sparing method for the treatment of malignant liver tumours in a curative approach. It can be performed safely and a long-term local tumour control is achieved in a high percentage of patients. Survival rates following cryotherapy appear comparable to the results of liver resection. It seems justified to conduct a prospective randomised trial comparing liver resection and cryotherapy for resectable tumours.

Adult↗
PubMed2001

Suppressed levels of serum cortisol following high-dose oral dexamethasone administration differ between healthy postmenopausal females and patients with established primary vertebral osteoporosis.

Hypercortisolism and glucocorticoid treatment, even in a low dose or administered topically, may influence bone metabolism. It was the aim of this study to investigate whether there might be differences in the regulation of endogenous cortisol secretion between patients with established primary vertebral osteoporosis and healthy controls. Suppressed morning serum cortisol concentrations in a 3 mg dexamethasone overnight suppression test were compared in well-defined healthy postmenopausal women (n = 149) and osteoporotic patients classified as having established primary vertebral osteoporosis with no clinical features of hypercortisolism (n = 78). Suppressed cortisol in the healthy controls was 1.08 +/- 0.44 microg/dl and in the primary osteoporotics 1.58 +/- 1.42 microg/dl (p < 0.0001). Of the investigated primary osteoporotics 15.4% (n = 12) had suppressed cortisol levels above the 97.5th percentile (1.96 microg/dl) of the healthy controls. Subgroup analysis regarding the influence of gonadal steroid hormone replacement in both groups and gender in the osteoporotic group did not change the results. Four of the 12 patients with incomplete suppressive cortisol underwent adrenal endosonography, unilateral adrenal nodular hyperplasia being detected in three cases. In two patients the diagnosis was confirmed by histology and normalisation of a dexamethasone suppression test following endoscopic adrenalectomy. These data yield evidence for a difference in the regulation of cortisol secretion following high-dose dexamethasone administration between healthy subjects and a subgroup of patients with primary osteoporosis. This might be due to a relevant amount of autonomous cortisol secretion in some of these patients; however, even cortisol resistance has to be taken into account.

Aged↗
PubMed2000

Laparoscopic resection of an epiphrenic diverticulum of the esophagus.

Diverticulectomy of epiphrenic diverticula of the esophagus is conventionally performed via left thoracotomy. We report the case of a 57-year-old man who presented with an epiphrenic diverticulum that was resected using a transperitoneal laparoscopic technique.

Diverticulum, Esophageal↗
PubMed2000

Cryotherapy for liver metastases.

Cryotherapy is undergoing a renaissance in the treatment of nonresectable liver tumors. In a prospective case control study we assessed the morbidity, mortality, and efficacy of hepatic cryotherapy for liver metastases. Between January 1996 and September 1999 a total of 54 cryosurgical procedures were performed on 49 patients (median age 66 years, 21 women) with liver metastases. Patient, tumor, and operative details were recorded prospectively. Liver metastases originated from colorectal cancer (n=37), gastric cancer (n=3), renal cell carcinoma (n=2), and other primaries (n=7). Median follow-up was 13 months (1-32). The median number of liver metastases was 3 (range 1-10) with a median diameter of 3.9 cm (range 1.5-11). Twenty-one patients (43%) had cryoablation only, and 28 (57%) had liver resection in combination with cryoablation. One patient (2%) died within 30 postoperative days. Another 13 patients (27%) developed reversible complications. In 19 of 25 patients (76%) with preoperatively elevated serum CEA and colorectal metastases it returned to the normal range postoperatively. Twenty-eight patients (57%) developed tumor recurrence, eight of which with involvement of the cryosite. Overall median survival patients was 23 months, and survival in patients with colorectal metastases was 29 months. Hepatic cryotherapy is associated with tolerable morbidity and mortality. Efficacy is demonstrated by tumor marker results. Survival data are promising; however, long-term results must be provided to allow comparison with other treatment modalities.

Adult↗
PubMed2000

[Endoscopic obesity surgery: gastric banding. A new trend without scientific basis?].

Indication for operation in morbid obesity is a body mass index greater than 40 kg/m2. Various operative procedures such as vertical banded gastroplasty and gastric bypass are used for therapy. Since 1994 the laparoscopic performed gastric banding is an alternative to conventional techniques. The mortality rate of this technique is below 1%, summarizing data from the literature of 905 patients the complication rate ranged to 24%. These results are comparable to conventional operations. Regarding the weight loss the results are comparable to the vertical banded gastroplasty. 80% of the patients loss 60% of their excess weight at 12 months. The rate of conversion to open procedure is low and ranges to 2.4%. Especially in obese patients the laparoscopic approach offers the well known advantages of endoscopic procedures. Open questions are the long-term effects and complications of laparoscopic gastric banding.

Adolescent↗
PubMed1999

The examiner's learning effect and its influence on the quality of endoscopic ultrasonography in carcinoma of the esophagus and gastric cardia.

BACKGROUND: The preoperative diagnosis of tumors of the esophagus and the gastric cardia is an important element in their stage-oriented therapy. The goal of the present study was to evaluate the accuracy of endosonographic ultrasound (EUS) and to test its usefulness in tumor staging and the assessment of operability. METHODS: A total of 139 tumors were scanned via EUS by one examiner </=14 days prior to resection (TNM staging per UICC, 1987). RESULTS: The accuracy for completely traversable tumors was 60.8% for T1, 82.1% for T2, 77.5% for T3, and 33% for T4 stages. This accuracy was somewhat reduced in cases of nontraversable tumor stenosis (51.9%). In T staging, a significant case-dependent improvement in accuracy to 89.5% was found; this was regarded as a learning effect. In N staging, we considered only those tumors that were resected by the transthoracic approach with systematic node dissection and complete EUS (n = 80). N-stage accuracy (T1-T4) was 71.3%, and no improvement could be shown. To assess operability, discrimination between T1/T2 and T3/T4 tumors is crucial. Accuracy, sensitivity, and specifity can thus be improved significantly. CONCLUSIONS: The quality of EUS depends on the experience of the examiner. Reliable results can be obtained after >75 examinations have been done. EUS is a valuable tool in tumor staging when it is performed by an experienced examiner or under the direct supervision of such a person.

Cardia↗
PubMed1999

[Risk of malignant degeneration of preoperatively-classified benign large sessile rectal polyps. A comparison with adenoma size].

From January 1986 to December 1995 307 patients with preoperatively as benign classified rectal polyps underwent transanal endoscopic microsurgery or transanal excision at the Hospital of General and Abdominal Surgery, Johannes Gutenberg-University Mainz. Mean polyp size was 3.9 cm in diameter. Postoperatively in 233 patients (75.9%) a benign rectal adenoma was found. In 69 patients (22.5%) with the preoperative diagnosis "benign rectal adenoma" the postoperative histologic result was a carcinoma. No residual polyps were encountered on snare excision in 5 patients (1.6%) with inconclusive evidence of surgical margin involvement. The mean size of malignant polyps was 3.4 cm and significantly below the mean size of benign polyps (4.1 cm, p = 0.009). Especially in polyps with a size to 1 cm and from 1 to 2 cm in diameter the part of malignant rectal polyps was unexpected high (8/15 polyps, 53.3%, respectively 16/37 polyps, 43.3%. Patients with preoperatively as benign classified large sessile rectal polyps had a high risk of malignancy even when polyp's size was small. Therefore in toto excision has to be done also in small polyps.

Adenocarcinoma↗
PubMed1999

[Rectal carcinoma. Optimizing therapy by knowledge of anatomy with special reference to the mesorectum].

The connective tissue spaces of the pelvis and pelvic floor originate from an urogenital and perirectal mesenchymal cell complex, which can be clearly discerned. In the adult, the final compartments, which arise from these distinct tissue complexes, are still functionally separated. The perirectal tissue gives rise to the rectal fascia or rectal adventitia, also known as mesorectum. The connective tissue space between rectal and parietal pelvic fascia can be dissected as a plane free of vessels and nerves. Surgical dissection along this plane with complete mesorectum excision results in reliable excision of all relevant lymphatic pathways with extensive preservation of continence and sexual function.

Adult↗
PubMed1999

[Rectal carcinoma. Optimizing therapy by local excision].

The results of local excision and radical surgery in patients with T1-carcinomas of the rectum were compared. In a retrospective study (1.1.1985-1.7.1997) the results obtained in 107 patients with T1-rectal carcinoma ("low risk" T1: n = 83, "high risk" T1: n = 24) undergoing local excision or radical surgical therapy were compared. The complication rate in patients undergoing local excision was 3.3% (2/60) and ranged at 19% (9/47) in the group treated with radical surgery. Two out of 47 patients (4.2%) died after radical resection; there were no deaths after local excision. With regard to the actuarial 5-year survival rate, in the group with "low risk" T1 carcinoma no difference was observed between patients treated with local excision (79%) or radical resection (81%) (p = 0.72). In patients with "high risk" T1 carcinoma lymph node metastases were identified in 4 out of 11 patients undergoing radical resection (36%). 4 out of 13 patients with "high risk" T1 carcinoma treated by local excision developed recurrences, while none of the patients undergoing primary radical surgery had a recurrence. This underlines the necessity of radical surgery in "high risk" T1-carcinomas. Local excision for the treatment of "low risk" T1-carcinoma is associated with a significantly lower complication rate than the performance of a radical surgical therapy. There is no difference in five-year-survival between local and radical surgical therapy in patients with "low risk" T1 carcinoma.

Follow-Up Studies↗
PubMed1998

[Cryotherapy of liver metastases. Initial results].

PATIENTS AND METHOD: Between 1 Jan 1996 and 1 Apr 1998 29 patients underwent cryosurgical therapy for liver metastasis at the Department of Surgery at the University of Mainz. RESULTS: No complications occurred following cryosurgery alone (n = 12). Within the group of patients with a combined procedure (n = 11) 1 patient had temporary liver failure and 1 patient died of sepsis. Following freezing of the cutting zone (n = 6) 1 patient showed a bile fistula and 1 ascites. In 15 cases of 28 dismissed patients with remaining destroyed tumor tissue the follow-up showed no tumor recurrence (median follow-up 11 months). On the other hand 9 patients had a tumor recurrence within the liver, 3 patients at extrahepatic regions and 7 patients developed a tumor recurrence within the freezing zone.

Colorectal Neoplasms↗
PubMed1998

[Cholecystectomy in high risk patients. A comparison between conventional and laparoscopic procedures].

Laparoscopic cholecystectomy offers many advantages, but cardiopulmonary impaired patients may be endangered by the haemodynamic and respiratory effects of the pneumoperitoneum. Between June 1990 and December 1995, laparoscopic cholecystectomies were performed on 19 high-risk patients (ASA IV) and conventional cholecystectomies on 26 patients with the same operative risk (ASA IV). Out of 45 patients, 5 (11.1%) suffered intraoperative cardiopulmonal complications. Three belonged to the group with laparoscopic cholecystectomy (15.8%) and two to the group with open laparotomy (7.7%). General postoperative complications occurred in 15 cases (33.3%), whereby patients of the conventional cholecystectomy group were concerned more often [46.2% (n = 12) versus 15.8% (n = 3), P = 0.03]. The number of days spent in hospital after open cholecystectomy was higher (P = 0.01) (11.6 +/- 5.6 days in the laparotomy group versus 7.6 +/- 5.0 days in the laparoscopy group). The classification as a high-risk patient indicates an elevation of the perioperative rate of complications in laparoscopic and open cholecystectomy, whereby the rate of postoperative complications is lower in the laparoscopic group.

Aged↗
PubMed1998

Technique and results of the retroperitoneoscopic adrenalectomy via a lumbar approach.

INTRODUCTION: Since 1992, endoscopic techniques have been used increasingly in adrenal-gland surgery. In the present paper, the technique of the retroperitoneoscopic adrenalectomy via a lumbar approach is described. METHODS: The patient is placed in a lateral decubitus position. In the first step, a dilatation trocar is introduced in the retroperitoneal space to create an artificial cavity. The dilatation trocar is replaced by a blocking trocar to close off the operating field. After insufflation of CO2, two additional trocars are introduced in the area of the conventional flank incision. Adrenalectomy is performed via these ports. Once the adrenal gland is completely mobilized, it is inserted into a sterile plastic bag and removed through the 1.5-cm incision. CONCLUSION: The retroperitoneoscopic approach to the adrenal gland appears to be suitable for benign adrenal-gland tumors up to a size of 6 cm.

Adrenalectomy↗
PubMed1998

Follow-up after transanal endoscopic microsurgery or transanal excision of large benign rectal polyps.

METHODS: Between January 1986 and December 1995, 238 patients with benign rectal polyps underwent either transanal endoscopic microsurgery (n = 226) or transanal excision (n = 12) at the Clinic of General and Abdominal Surgery, Johannes Gutenberg-University, Mainz. RESULTS: Mean polyp size was 4.2 cm; 89.1% of polyps measured more than 2 cm in diameter. In 89.1% of cases, histological analysis revealed polyps containing tubulovillous or villous adenomas. Synchronous colonic polyps were detected in 12.5% of patients. Follow-up data are available on 222 patients (94%). At follow-up examination, 169 of the 193 surviving patients (87.6%) were recurrence free. Seven of 193 patients (3.6%) had developed neoplastic colonic polyps and, in 17 patients (8.8%), metachronous polyps were detected. CONCLUSIONS: Transanal endoscopic microsurgical polypectomy was furthermore demonstrated to be a low-risk procedure with a low recurrence rate for the complete resection of large rectal polyps. At a follow-up rate of 61.1 %, the incidence of metachronous carcinoma ranged at 3.1%, which is markedly below the rate of 8-18% for tubulovillous or villous adenomas larger than 1 cm in diameter cited in the literature.

Adenoma, Villous↗
PubMed1998

Comparison of results after transanal endoscopic microsurgery and radical resection for T1 carcinoma of the rectum.

BACKGROUND: We compared the results of transanal endoscopic microsurgery and radical surgery in patients with T1 carcinomas of the rectum. METHODS: We performed a retrospective study (1985-96) to compare the results obtained in 103 patients with T1 rectal carcinomas (low-risk T1, n = 80; high-risk T1; n = 23) undergoing transanal endoscopic microsurgery and radical surgical therapy. RESULTS: The complication rate in patients undergoing local excision was 3.4% (two of 58); it was 18% (eight of 45) in the group treated with radical surgery. Two of 45 patients (3.8%) died after radical resection; there were no deaths after local excision. With regard to the actuarial 5-year survival rate, no difference was observed in the group with low-risk T1 carcinoma between patients treated with local excision (79%) and those who had radical resection (81%) (p = 0.72). In patients with high-risk T1 carcinoma, lymph node metastases were identified in four of 11 patients undergoing radical resection (36%). Four of 12 patients with high-risk T1 carcinoma treated by local excision developed recurrences, whereas none of the patients undergoing primary radical surgery had a recurrence. CONCLUSIONS: Transanal endoscopic microsurgery for the treatment of low-risk T1 carcinomas is associated with a significantly lower complication rate than radical surgical therapy. There is no difference in 5-year survival between local and radical surgical therapy in patients with low-risk T1 carcinoma.

Adenocarcinoma↗
PubMed1998

[Non-parasitic liver cysts: laparoscopic and conventional fenestration].

From 1992 till 1997 10 patients with solitary non-parasitic liver cysts were treated by laparoscopically fenestration of the cysts. The size of the cysts varied between 8 and 16 cm (median 13.5). Conversion to laparotomy was required in one patient because of intraoperative bleeding. In nine patients the laparoscopic procedure was finished successfully. In these cases we observed no intraoperative complications (9/10), intraoperative blood loss amounted up to 100 ml. Median operative time amounted to 82.5 minutes (55-155). No postoperative complications were observed. In two patients a cystadenoma was proven by postoperative histology, in both cases a liver resection was performed. During a median follow-up of 33 (2-43) months 2 of 7 patients treated with laparoscopically fenestration developed a recurrence (28%).

Adult↗
PubMed1997

Clinicopathologic study for the assessment of resection for ampullary carcinoma.

In a prospective observational study including 34 patients with carcinoma of the ampulla of Vater, postoperative morbidity, mortality, and long-term survival were analyzed to determine the surgical procedure of choice. Surgically related postoperative complications were observed in 35.4% of patients after pancreatic resection. No patient died within the first 30 days postoperatively, and in-hospital mortality was 3%. Lymph node metastases were associated only with moderate or undifferentiated tumors larger than 0.6 cm in diameter that infiltrated beyond the ampulla of Vater. The median follow-up time was 4.3 years. The 5-year survival rate for the 31 patients undergoing radical resection was 62.7%. Multivariate analysis (including the covariates depth of tumor infiltration, lymph node metastases, and the ratio of metastatic to dissected lymph nodes) demonstrated that only this ratio exerted an independent influence on the prognosis (p = 0.001). The present series demonstrates that radical resection of ampullary cancer is the procedure of choice even in elderly patients. The most important factor influencing the survival rate is the extent of the lymph node dissection. The histopathologic investigation of our pancreatoduodenectomy specimens demonstrates clearly that local excision of ampullary cancer may be indicated only in high risk patients with a pT1, well differentiated tumor smaller than 0.6 cm in diameter.

Adult↗