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Biomedical subjects

A Hirner

Publications and source records attributed to A Hirner.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Aortic rupture in Behçet's disease].

Behçet's disease is a vasculitis of unknown aetiology, which becomes apparent by ocular and mucocutaneous symptoms. In rare cases, owing to vasculitis of the vasa vasorum of large arteries, necrosis of the vascular wall and thus spurious aneurysms occur. The case of a 41-year-old patient is described who presented with a rupture of an infrarenal aortic aneurysm due to Behçet's disease. Therapy consisted of placement of an aortic-aortic Dacron prosthesis. On the basis of the case report, the diagnostic approach, the therapy and the value of secondary prophylaxis of Behçet's disease are discussed.

Adult↗
PubMed2001

[History of surgical esophageal replacement].

At the beginning of the twentieth century, surgeons often attempted operative esophagus replacement. At first, these operations had a palliative intent to help the patients eat. Setbacks because of lack of experience in thorax surgery, infection problems and technical difficulties led to different approaches to a solution. The first successes occurred when a stomach tube was formed with a abdominocollar high course and collar anastomosis. The history of surgical replacement of the esophagus is given in detail to the present day and the development is discussed.

Esophageal Neoplasms↗
PubMed2001

Use of the Polyflex stent in the palliative therapy of esophageal carcinoma: results in 14 cases and review of the literature.

BACKGROUND: Several prospective randomized trials have shown that self-expanding stents have advantages over conventional plastic tubes. Nevertheless, the optimal stent has not yet been developed. The Polyflex stent is a completely new model that represents an improvement over the old metal stents. We have used this stent in a prospective study and herein our present preliminary results. METHODS: In 14 patients with nonresectable esophageal carcinoma, the Polyflex stent was implanted to reduce dysphagia. The grade of dysphagia, the complications following intervention, and the patients' total survival time were documented prospectively every 4 weeks. RESULTS: The implantation of the stent was successful in all cases. The grade of the dysphagia was reduced from 3.0 to 0.5 after stent implantation. One patient died during the hospital stay from a non-stent-induced complication. Stent dislocation occurred once, and tumor overgrowth at the stent margins was observed twice. The mean survival time was 6.2 months, and the reintervention rate was 21.3%. CONCLUSION: The new Polyflex stent, which is based on a completely new design, can be implanted without any difficulty and has had very good short- and long-term results. Therefore, it is a worthy alternative to the metal stents in current use.

Adenocarcinoma↗
PubMed2001

[Choledochus revision in the age of endoscopic papillotomy. Indications and outcome].

OBJECTIVE: In the age of endoscopic papillotomy (EPT) the operative revision of the bile duct needs to be used stringently and interventional therapeutic options have to be considered primarily in the treatment of gallbladder and bile duct stone disease. PATIENTS AND METHODS: 70 patients treated by choledochus revision for cholecysto- and choledocholithiasis in our department between 1988-1999 were analyzed retrospectively for indication and results. RESULTS: ERCPs were performed in only 24 patients. In 17 patients no endoscopic papillotomy could be accomplished due to a former operation (Billroth II or Whipple-OP). 70 patients underwent a surgical bile duct exploration with insertion of a T-drainage. The postoperative surgical complication rate amounted to 36%. The most frequent complications after revision of the common bile duct were edematous pancreatitis as well as bile duct fistula. 37 of 70 patients could be reexamined 4-48 months postoperatively. A pancreatitis or stenosis of papilla Vateri were not seen in these patients. In the sonography the common bile duct was inconspicuous. CONCLUSIONS: In the therapy of bile duct stones the therapeutic splitting has become generally accepted. The patients should be submitted to a ERCP with EPT and subsequent laparoscopic cholecystectomy. Surgical revision of the common bile duct nevertheless remains an important tool in the therapy of choledocholithiasis.

Adult↗
PubMed2001

Percutaneous translymphatic thoracic duct embolization for treatment of chylothorax.

A modified technique for transabdominal, translymphatic occlusion of the thoracic duct is described. During unilateral lymphangiography an abdominal lymph vessel was punctured with a fine needle under fluoroscopic guidance, and a 4 French access to the lymph system established. The thoracic duct was successfully embolized with coils and tissue adhesive in a patient with postoperative high output chylothorax. Chylous drainage immediately decreased after the intervention, the intercostal drain could be removed after seven days. Long term follow up over a ten months period confirmed the clinical success; the patient is still free of pleural effusions.

Aged↗
PubMed2001

[Experiences in stage-adapted therapy of pleural empyema].

INTRODUCTION: Up till now the phases adapted treatment of a pleural empyema unfortunately is still not obvious, but recently the operative spectrum has been widened in the field of video-assisted thoracoscopic surgery (VATS) of the pleural empyema. PATIENTS AND METHODS: In the present study we examined all our patients with a pleural empyema and we followed them for a postoperative period of 4 years analysing our therapy-efficacy and our treatment concept of pleural empyema. RESULTS: 52 out of 102 patients--who suffered from a pleural empyema in the last 10 years--were reexamined postoperatively. In 96% of the 102 cases we found a phase II-III empyema. Initially all patients were treated with a closed-chest-tube drainage, followed by an operation in 78%. In 6 cases a video-assisted-thoracoscopic evacuation of the cavity with an early decortication was performed. All the 52 patients who were treated in an early phase showed the best functional results 4 years later. CONCLUSION: Especially in phase III the open operative revision of a pleural empyema is the method of choice. In the fibrinopurulent phase the drainage therapy may be sufficient. If the empyema cavity is divided we recommend the early video-assisted-thoracoscopic revision of the thoracic empyema.

Adolescent↗
PubMed2001

[An uncommon form of gastric rupture in giant scrotal hernia].

The spontaneous gastric rupture without a preexisting gastric ulcer is an extremely rare event. In the case presented we report the occurrence of a gastric rupture in context with a giant left scrotal hernia. The entire intestine was transposed into the hernial sack and this obviously led to a chronic distension of the stomach and finally to the spontaneous gastric rupture. Other reasons of a spontaneous gastric rupture as well as the surgical therapy are discussed. Important are a fast diagnosis and surgical revision in order to prevent patients from a massive diffuse peritonitis.

Aged↗
PubMed2001

Detection of APC and k-ras mutations in the serum of patients with colorectal cancer.

Detection of tumor DNA in peripheral blood of patients with colorectal cancer (CRC) may allow early diagnosis of tumor disease and be of prognostic value. However, a reliable tumor marker detectable in the serum of patients with this disease is missing. Because k-ras and APC mutations occur frequently and at an early stage in CRCs, these mutations might also be detected in the serum of CRC patients and serve as tumor markers. Hence, tumor tissues of CRC patients were examined for the presence of mutations in the k-ras and APC genes. If a mutation was detected in the tumor, the serum of the patient was screened subsequently for the presence of this mutation. K-ray mutations were detected in 22 of 30 colorectal tumor tissues, but only in six patients was the mutation identified in their serum samples. Mutations of the APC gene were identified in 25 of 65 tumors: 20 of these 25 patients showed the respective mutation in their serum. Given their higher detection rate, APC mutations could be a more informative serum marker than k-ras in CRC patients.

Adenocarcinoma↗
PubMed2000

[The parathyrotoxic crisis - a surgical emergency].

INTRODUCTION: The extremely rare but life-threatening hypercalcemic crisis is caused by an exacerbation of a chronic hyperparathyroidism. The etiologic reasons for this exacerbation are conditions which increase the serum calcium level in addition to the hyperparathyroidism with a complete breakdown of the calcium homeostasis, e. g. malignant tumors, primary and tertiary hyperparathyroidism, vitamin D poisoning or overdoses of calcium, vitamin D and calcium-containing ionizer in patients with renal insufficiency. METHODS: We present the clinical course of five patients with an acute hypercalcemic crisis and discuss the diagnostic procedure and the principles of surgical treatment with regard to the current literature. RESULTS: A hypercalcemic crisis develops if the total serum calcium concentration is over 4 mmol/l and parathormone over 90 pmol/l. The resulting syndrome is manifested by nausea and vomiting, polyuria and consecutive dehydration and hypotonia culminating in lethargy, hallucinations and coma. Hypercalcemia is the single most important diagnostic finding. CONCLUSION: The emergency therapy predominantly consists on the one hand in rehydration and parallel stimulation of diuresis. Urgent surgery is required if conservative therapy is not successful.

Acute Disease↗
PubMed2000

[Surgical gowns and patient drapes in routine practice: discrepancy between requirements and reality]].

BACKGROUND: Since the law regulating medical devices was introduced, hospital staff can only use surgical textiles that can guarantee 100% protection against infection. Conventional cotton products have shown themselves to be unsuitable, and must be replaced with barrier textiles. However, the changeover to innovative barrier textiles has turned out to be more difficult than expected. There is uncertainty among the qualified staff regarding the choice of material because of a lack of legal standardization. The objective of our study was to uncover the existing discrepancies between clinical practice and the legal requirements. METHODS: Based on a literature review we examined the suitability of the available surgical textiles with regard to the requirements. We then analyzed the situation based on standardized questionnaires, which were sent out to basic care and maximum care hospitals. RESULTS: According to the currently published data, barrier textiles best fulfill the requirement criteria. In contrast, the hospital staff questioned in our situation analysis noticeably preferred cotton textiles for the surgical gowns. The most common reason given was comfort. The laminates were considered most suitable as coverage material. Forty-four percent of those responding to the survey proved to have large gaps in their knowledge of the law regulating medical devices. Furthermore, only 41% of the hospital personnel were aware of the plan to standardize the requirement criteria. CONCLUSION: We were able to confirm that there is considerable discrepancy between the requirements and practice. The reasons for this are ignorance and lack of enforcement of the existing requirements. In this respect we stress that a quick introduction of the planned European standards is urgently necessary.

Cross Infection↗
PubMed2000

Detection of thrombosis in the portal venous system: comparison of contrast-enhanced MR angiography with intraarterial digital subtraction angiography.

PURPOSE: To determine whether intraarterial digital subtraction angiography (DSA) can be replaced by contrast material-enhanced magnetic resonance (MR) angiography in the assessment of patency or thrombosis of the portal venous system in patients with portal hypertension. MATERIALS AND METHODS: Thirty-six patients with portal hypertension underwent contrast-enhanced MR angiography and intraarterial DSA for assessment of the portal venous system. The images were evaluated for vessel patency or thrombosis of the portal, splenic, or superior mesenteric vein. RESULTS: Of the 101 vessels evaluated, 42 were thrombosed. Overall sensitivity, specificity, and accuracy for the detection of thrombosis were 100%, 98%, and 99%, respectively, for MR angiography and 91%, 100%, and 96%, respectively, for DSA; differences between the imaging methods were not statistically significant. Only in four patients with six vessels (6%) were there discordant findings between MR angiography and DSA. CONCLUSION: Noninvasive contrast-enhanced MR angiography has the potential to replace intraarterial DSA as the standard method to assess the whole portal venous system.

Adolescent↗
PubMed2000

[Plastic surgery of the anorectal area. Indications, technique and outcome].

Anal canal stenosis with alteration of the sensoric continence or mucosal ectropion may occur after anorectal operations. Island flaps with perianal skin or the VY-anoplasty are simple plastic methods to reconstruct the anorectal region and cure patients--who often have suffered for a long time--from anal strictures or mucosal ectropion. In the period from 1994-1998 we reconstructed the anodermal region of seven patients using one of the above mentioned anorectal plastic procedures. Three patients complained of an anal stenosis and one patient suffered from an ectropion of the rectal mucosa after an improperly performed Whitehead hemorrhoidectomy. Three patients had a sensomotoric incontinence twice due to a congenital anal atresia and in one case caused by an accident. All patients were highly pleased after the operation--no complication occurred.

Adolescent↗
PubMed1999

[Experiences in surgery of proctologic diseases in patients with HIV infection].

Individuals who are seropositive for the human immunodeficiency virus (HIV) often suffer from disorders affecting the anorectum, but unfortunately the best kind of treatment frequently seems questionable. In a retrospective investigation we reviewed 29 HIV-positive patients with anorectal lesions who had experienced a proctologic operation. Our impression correlates with other findings according to which HIV-positive patients in advanced stages have a poorer post-operative outcome in terms of morbidity and survival than patients in an early CDC disease stage. This implies that the indication for a proctologic operation in an immunocompromised state has to be considered carefully.

AIDS-Related Opportunistic Infections↗
PubMed1999

Surgery for portal hypertension and transjugular intrahepatic portosystemic shunts in Germany: results of a national survey.

A national survey was conducted to determine the role of portosystemic shunt surgery and transjugular intrahepatic portosystemic shunt (TIPS) in Germany. A questionnaire was mailed to 1324 surgical units at 1273 hospitals, and 941 responses (74%) were received. Interventional endoscopy for variceal bleeding is carried out predominantly (73%) in medical departments. From 1992 to 1997 the annual number of surgical shunts dropped from 253 to 120, whereas the respective numbers of TIPS increased from 202 to 920. In this 6-year period a total of 1042 shunts and 3575 TIPS were reported by 109 and 64 centers, respectively. TIPS was applied mainly in university hospitals (88.9%), whereas shunt surgery was more broadly used in non-university hospitals (58.8%). Clearly, prospective randomized comparisons of TIPS and surgical shunts are needed to reveal which treatment is best in patients with variceal bleeding stratified for mortality risk and stage of liver disease. However, the decreasing number and experience with shunt surgery may impede such studies. Probably, liver transplant centers which currently do only 41.2% of shunt procedures are most familiar with surgery in portal hypertension and are therefore most appropriate to maintain quality and expertise in this palliative and demanding branch of surgery.

Germany↗
PubMed1999

[Littré's hernia--clinical aspects and review of the history].

In 1700, the French surgeon Alexandre de Littré described for the first time a new form of inguinal hernia. This hernia varied from the known forms of hernias in its clinical course and in the postmortem examination results performed by Littrè himself. The characteristic feature of this hernia was the fact that the entire circumference of the bowel wall was not part of the hernial sac, but only the antimesenteric part of the intestinal wall. The underlying pathomechanism was explained 100 years later by Meckel. In a scientific paper about hernias some years earlier, Richter described the intestinal wall hernia, and this initiated the confusing use of the clinical entity known as the Richter-Littré hernia in Germany. In this case report we describe the historic development of this entity.

Aged↗
PubMed1999

Endoscopic vs conventional hernia repair from an immunologic point of view.

BACKGROUND: In this study we tried to estimate the local surgical trauma in patients undergoing endoscopic or conventional hernia repair via the changes in peripheral blood T cell subpopulations (i. e., T-helper 1 (TH1) and TH2 cells), recently shown to be recruited differentially to inflammatory sites. METHODS: Cells were identified flow-cytometrically by intracellular cytokine staining on a single cell level in 30 patients undergoing conventional (Shouldice) or total extraperitoneal patch (TEPP) hernia repair. RESULTS: The TH1 cells decreased postoperatively in Shouldice patients on an average of 20.8-31.4%, whereas in TEPP patients only a minor decline (mean, 7.8-9.2%) was observed. The TH2 cells did not change significantly in TEPP patients, and a small increase (mean, 7.7%) was detected in Shouldice patients. CONCLUSIONS: Our results suggest that the postoperative reduction in TH1 cells reflects local surgical trauma and can be helpful in evaluating different surgical procedures. When conventional and endoscopic hernia repair were compared, the latter proved less traumatizing.

Adult↗