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A Heintz

Publications and source records attributed to A Heintz.

At least 55 records · Page 3Linked to original sources
PubMed1997

[Results of endoscopic, retroperitoneal adrenalectomy with special reference to the intraoperative course].

In 20 patients the hemodynamic and ventilatory data during endoscopic retroperitoneal adrenalectomy were checked retrospectively to analyze the hemodynamic and ventilatory effects of a pneumoretroperitoneum. After insufflation of CO2 into the retroperitoneal space we observed an increase in systolic blood pressure [median 180 mm Hg ([130-200)]. Analyzing the ventilatory parameters we noted that the minute ventilation had to be increased by a median value of 4.25 I (0.4-13) to reduce the increased carbon dioxide levels during CO2 insufflation. After insufflation of CO2 into the retroperitoneal space we observed no major complications. We therefore believe that retroperitoneal endoscopic adrenalectomy is also indicated in patients with cardiac or pulmonary diseases.

Adrenal Gland Neoplasms↗
PubMed1997

[Laparoscopic cholecystectomy in high risk patients].

As opposed to the advantages of laparoscopic cholecystectomy, patients with cardiopulmonary impairment may be endangered by the haemodynamic and respiratory effects of the pneumoperitoneum. Between June 1990 and December 1995, laparoscopic cholecystectomies were performed in 19 high-risk patients (ASA IV) and 465 patients with a lower operative risk (ASA I-III). Out of 484 patients, 24 (5%) suffered intraoperative cardiopulmonary complications. Three belonged to the high-risk group (15.8%) and 21 to the lower risk groups (4.5%). General postoperative complications occurred in 14 cases (2.9%), whereby patients of the ASA IV group were, again, concerned more often [15.8% (n = 3) of ASA IV versus 2.4% (n = 11) of ASA I-III]. The number of days spent in hospital was 7.6 +/- 4.96 days in the high-risk group versus 4.8 +/- 2.23 days in groups ASA I-III. The evaluation as a high-risk patient indicates an elevation of the perioperative rate of complications in laparoscopic cholecystectomy; however, it is not basically a contraindication for this operative method.

Adolescent↗
PubMed1997

[Influence of the number of dissected lymph nodes on local recurrence of rectal carcinomas. A staging effect].

In 386 patients with rectal carcinoma of UICC stage I-III operated on between 1 January 1985 and 31 December 1995 we investigated the influence of the number of dissected lymph nodes on tumor stage and local recurrence retrospectively. We found a significant correlation between the number of lymph nodes dissected and the number of detected lymph node metastases. Following this result we found an increase in UICC stage III (P = 0.013) and pTx pN2 tumors (P = 0.000) in correlation with the number of dissected lymph nodes. Significantly lower rates of local recurrence were found only in UICC stage I and UICC stage II. Overall and in a multivariate analysis the number of dissected lymph nodes had no influence on local recurrence. It was shown that lower local recurrence rates in UICC stage I and II did not depend on therapeutic benefit but on stage migration because of more exact tumor staging. The influence of other surgical factors, especially total mesorectal excision, remains to be discussed.

Adult↗
PubMed1997

[Endoscopic therapy of incidentaloma].

Since 1992 endoscopic surgical techniques have gained importance in adrenal gland surgery. In this review the actual laparoscopic and retroperitoneoscopic techniques and results-taking the own case material into consideration-are represented. The laparoscopic, transperitoneal adrenalectomy shows a low rate of complications (12%). Disadvantages of the transperitoncal approach are the risk of an intraabdominal injury and the problems caused by adhesions after abdominal operations. The retroperitoneoscopic access to the adrenal gland avoids disadvantages of the transperitoneal approach. Concerning the rising frequency of accidentally diagnosed tumors of the adrenal gland the retroperitoneoscopic approach represents a technique which allows a removal of these tumors up to a size 6 centimeters with low morbidity. In case of large tumors of the adrenal gland (size > 6 centimeters) suspected for malignancy we see the indication for the transperitoneal approach.

Adrenal Gland Neoplasms↗
PubMed1996

Results of endoscopic retroperitoneal adrenalectomy.

BACKGROUND: From March 1994 to August 1995 we performed extraperitoneal endoscopic adrenalectomy in 18 patients with adrenal gland tumors. METHODS: Two of these patients underwent bilateral adrenalectomy. For the extraperitoneal approach a pneumoretroperitoneum was established and three 10-mm trocars were inserted in the area of the conventional flank incision. Adrenalectomy was performed via these ports. Endoscopic retroperitoneal adrenalectomy was successful in 15 patients; three patients required a conventional operation via an extraperitoneal lumbar approach because of inadequate exposure of the adrenal gland. In patients with endoscopic retroperitoneal adrenalectomy median operative time amounted to 180 min (95-330). RESULTS: No postoperative complications were observed; median postoperative hospital stay was 5 days (3-12). CONCLUSIONS: The described approach produces rapid recovery and creates less postoperative pain.

Adrenal Gland Neoplasms↗
PubMed1996

[Lymph node dissection, stage migration and perioperative risk in rectal carcinoma].

In 348 patients with an initial diagnosis of rectal carcinoma operated on between 1985 and 1994 we investigated the quality of lymph node dissection, its influence on the perioperative risk and tumor staging. The same histopathological work-up was carried out in all cases. Whether resections or extirpations were performed, the number of dissected lymph nodes increased from 5.3 and (1985/1986) to 16.7 and 17.3 (1991/1992) and to 15.8 and 17.3 (1993/1994) respectively. Neither the type of operation nor the surgeon's experience had a significant influence on the number of lymph nodes dissected. The increase in the number of lymph nodes dissected had no negative effect on the length of the operation, the amount of blood infused during the operation or the perioperative risk. We found a significant correlation between the number of lymph nodes dissected and the number of lymph node metastases (P = 0.02) and between an increase in UICC stage III (P = 0.005) and pN2 tumors (P = 0.000) and an increase in the number of lymph nodes dissected. Central lymph node dissection by high ligation of the inferior mesenteric artery did not increase the perioperative risk in spite of the fact that in recent years we have observed more patients with multiple diseases.

Adult↗
PubMed1996

[Comparative DNA cytometric and cytogenetic ploidy determination of chondrosarcoma and osteosarcoma].

10 chondrosarcomas and 10 osteosarcomas were examined using cytogenetics and DNA-image-cytometry. Cytogenetically 6 of 10 chondrosarcomas and 4 of 10 osteosarcomas showed hyperdiploid tumorcells. By DNA-cytometry in 8 of 10 chondrosarcomas and 9 of 10 osteosarcomas hyperdiploid tumorcells resp. hyperdiploid stemlines were detected. This discrepancy reflects an in-vitro-selection depending on the different entities. In 7 aneuploid clones of chondrosarcomas the chromosomal ploidy was calculated using the relative length of the chromosomes and compared with the DNA-ploidy of the native tumor. There was a close relation between both parameters of nuclear DNA-content. The interpretation of cytogenetic results is improved using a combination of karyotypic and DNA-cytometric examination. This is particularly important for the search for relations between numeric chromosomal aberrations and morphological parameters (grading).

Aneuploidy↗
PubMed1996

[DNA cytometry of solitary and aneurysmal bone cysts and low malignancy and high malignancy central osteosarcomas. Current significance within the scope of morphologic diagnosis of intraosseous cystic and osteoblastic lesions].

DNA cytometric investigations of intraosseous cystic lesions and osteoblastic tumors may be helpful in morphological diagnosis. The detection of a DNA-aneuploid stemline supports the diagnosis of a high-grade malignant bone neoplasm, even in small biopsies. Solitary and aneurysmal bone cysts have DNA-diploid cell populations. Low-grade central osteosarcomas may show single-cell aneuploidies of varying extent as well as a DNA-diploid stemline. Their presence may be a sign of genetic instability within the population of neoplastic cells before a DNA-aneuploid stemline is established and should prompt careful postoperative observation.

Aneuploidy↗
PubMed1996

[Prognostic factors in local recurrence rate after surgical therapy of rectal carcinomas].

From January 01, 1985 to December 31, 1993 515 patients with primary rectal cancer underwent operative treatment at the hospital of general and abdominal surgery of the university of Mainz. In 294 patients with conventional surgical treatment and R0-resection of the tumor we investigated the influence of tumor-, patient- and therapeutic factors on local tumor recurrence. At a univariate analysis the following factors were significant: UICC-staging (p = 0.001), pT-classification (p = 0.001), pN-classification (p = 0.013) and localisation of the tumor (p = 0.013). These results could be verified for the pT-classification and pN-classification in a multivariate analysis. The significant influence of operative treatment (p = 0.034), blood transfusion (p = 0.018) and preoperative raised CEA (p = 0.026) depended on significant differences of UICC - staging and tumor - localisation of the different groups. Grading, sex and age had no influence. Inspite of a shift of local resurrence from 13% to 50% (0% to 42.9% for resections, respectively 6.7% to 55.4% for exstirpations) we could not find a significant influence of the surgeon. This fact depended on the dividing of a small number of cases on a lot of surgeons. In our opinion the influence of the surgeon or of different hospitals on local recurrence should be investigated in further studies.

Blood Transfusion↗
PubMed1996

[Local excision of rectal carcinoma].

From January 1985 till December 1994 109 patients with rectal carcinoma were treated by local excision, in 36 patients a radical operation was performed afterwards. In the assessment of tumor infiltration endosonography was superior to rectal-digital examination. In 34 patients with local excised "low risk" T1-carcinomas and tumor free margins no local recurrence was observed. Two of ten patients with local excised "low risk" T1-carcinoma and no adequate margin of healthy tissue developed a local recurrence. Regarding our results the local excision of "low risk" T1-carcinomas seems justified, if final histological workup reveals an adequate margin of healthy tissue.

Adult↗
PubMed1996

[Does the surgeon modify risk of local recurrence in rectal carcinoma?].

Investigating long-term operative results of nine surgeons, we found a variation in the local recurrence rate of 13% to 50%. Operative quality should not only be verified by investigating the perioperative risk, but also by investigating the local recurrence rate or prognosis.

Clinical Competence↗
PubMed1996

[Endoscopic, extraperitoneal adrenalectomy--an expansion of the approach to the adrenal gland].

From March 1994 to march 1996 we performed extraperitoneal adrenalectomy in 25 patients with adrenal gland tumors; three of these patients underwent bilateral adrenalectomy. Endoscopic extraperitoneal adrenalectomy was successful in 22 patients. No postoperative complications were observed, median postoperative hospital stay was 5 days (2-12). The described approach produces rapid recovery and creates less postoperative pain.

Adenoma↗
PubMed1995

[Endoscopic retroperitoneal adrenalectomy].

AIM OF STUDY: To determine prospectively in consecutive patients the value of endoscopic retroperitoneal adrenalectomy. PATIENTS AND METHODS: Between March 1994 and March 1995, endoscopic adrenalectomy via a retroperitoneal approach was performed in eleven patients (three men, eight women; median age 61 [48-73] years), unilateral in nine, bilateral in two. The procedure was indicated if the adrenal tumour was thought to be benign and no larger than 5 cm in diameter (two adrenal and two central Cushing's syndromes; three incidentally detected adrenal adenomas, two phaeochromocytomas, two Conn adenomas). RESULTS: Twelve of the 13 procedures were successfully performed. In one case the primary incision in the mid-axillary line had been too large and no satisfactory pneumoretroperitoneum was achieved. Median duration of operation was 180 (125-330) min, and the intraoperative blood loss was 200 (125-330) ml. There were no postoperative complications and the median postoperative hospital stay was 6 days (3-12). CONCLUSION: In small (up to 5 cm) adrenal tumours not suspected to be malignant the endoscopic retroperitoneal approach constitutes a sparing alternative to the conventional access to the adrenal gland.

Adenoma↗
PubMed1995

[Laparoscopic surgery for hepatic, splenic and mesenteric cysts].

Five women and one man (average age 62.5 [20-64] years) with symptomatic intraabdominal cysts at different sites (liver: n = 3; spleen: n = 2; mesentery: n = 1) had them removed by laparoscopic surgery. Broad fenestration was performed with the hepatic and splenic cysts, while the mesenteric cyst was enucleated from the mesentery. There were no intra- or postoperative complications. Median duration of operation was 60 (45-125) min, postoperative hospital stay was 5 (3-6) days. After a median follow-up period of 8 (1-12) months a 3 cm residual cyst was found in the patient with the splenic cyst, but all patients were free of symptoms. -Laparoscopic surgery is a low-stress alternative to conventional surgical removal of intraabdominal cysts.

Adult↗
PubMed1995

[Risk and follow-up after multi-visceral resections including the left side of the pancreas].

Aim of this study was to analyze the operative risk of multivisceral resection including the left side of the pancreas. Between September 1 th, 1985 and May 31 th, 1994 18 multivisceral resections including the left side of the pancreas and 8 left-sided pancreatic resections were performed at the University Hospital for General and Abdominal Surgery, Mainz. Postoperatively 5 of the 18 patients with multivisceral resections and 3 of the 8 patients with left-sided pancreatic resections developed minor complications (wound infections, pneumonia). One insufficiency of an esophagojejunostomy was seen. One patient died after gastrectomy and left-sided pancreatic resection due to a pneumonia. In this case the operation was performed after substitution of 22 red cell packs under emergency conditions because of an infiltration of the splenic artery by a lymphoma of the stomach. The best prognosis had patients with neuroendocrine tumors. These results show that in case of an elective operation the risk of multi-visceral resections including the left side of the pancreas is comparable to that of left-sided pancreatic resections alone.

Adrenalectomy↗
PubMed1995

In vitro studies of lymph node analysis.

Endosonography has become a widely accepted diagnostic procedure in the staging of gastrointestinal tumors over the past 10 years. The question of whether endosonography is equally as effective in the diagnosis of regional lymph node metastases has not been conclusively answered. This article presents a brief review of in vitro studies of lymph node analysis in the upper and lower gastrointestinal tract.

Computers↗
PubMed1995

[Diagnostic and therapeutic strategy in multiple insulinoma].

Four of 59 patients with organic hyperinsulinism had multiple insulinomas and two patients a micro- and macroadenomatosis. Excluding patients with adenomatosis 3 of 10 tumors could be detected preoperatively by ultrasound (5 of 10 by CT). 6 of 7 macroadenomas could be visualized by angiography. Intraoperatively 9 of 10 macroadenomas were palpable. The nonpalpable tumor could be localized by intraoperative ultrasound. Pancreatic resection had better results than multiple enucleations. Excisional biopsy is recommended to exclude nesidioblastosis or microadenomatosis.

Adenoma, Islet Cell↗