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Biomedical subjects

A Hirner

Publications and source records attributed to A Hirner.

At least 55 records · Page 3Linked to original sources
PubMed1999

[Portal contrast medium-enhanced spiral computed tomography of the liver--the correlation of radiological and intraoperative findings and the evaluation of resectability].

PURPOSE: To evaluate the accuracy of spiral computed tomography during arterial portography (SCTAP) in the detection, localization, and resectability of liver tumors in a correlative study between radiology and intraoperative findings. METHOD AND MATERIALS: Retrospectively, SCTAP images of 168 consecutive patients before liver tumor resection were analyzed. The SCTAP studies (100 ml lopromid 300 by automated injector with a flow of 3 ml/s; slice thickness, table feed and reconstruction index 5 mm each; scan-delay 30 s; 120 kV; 250 mAs) were evaluated for the detection, localization, and resectability of focal liver lesions by three experienced radiologists in consensus and were correlated with histopathological and intraoperative findings where available (59/168). RESULTS: The sensitivity of SCTAP for the detection of liver tumors was 91% for all lesions and 84% for lesions < 1 cm. The specificity was only 19% due to a high rate of false-positive lesions (30%) and preselection effects. Typical pitfalls in false positive lesions were inhomogeneous liver perfusion near the portal vein, the falciform ligament, and the gallbladder (19/42). In 30% of the patients SCTAP correctly diagnosed inoperability, in 23% the intraoperative tumor expansion was larger than expected from SCTAP images, which would have changed operability. CONCLUSION: The SCTAP has a high sensitivity in the detection and localization of liver tumors and is a valuable method in the preoperative diagnostic procedure. The method is limited by many false-positive lesions often due to inhomogeneous liver perfusion and the insufficient evaluation of local tumor spread. Therefore, SCTAP should be replaced by MRI in the near future.

Adult↗
PubMed1998

[Progress of acute liver failure and indications for liver transplantation].

OBJECTIVE: To analyse the course of acute liver failure and the indications for liver transplantation. PATIENTS AND METHODS: In 16 patients who developed acute liver failure between July 1992 and July 1997 the indications for liver transplantation and total survival time were analysed retrospectively. RESULTS: Intensive medical care (ventilation, dialysis) was necessary in 60% of the patients to bridge organ failure until liver transplantation. In 14 patients liver transplantation was indicated. Eleven of the patients, with a minimal Quick value of less than 10%, presented with the prognostically poorest London criteria. In two patients the combination of three additional criteria of the London classification led to liver transplantation being indicated. In one patient with Wilson's disease the transplantation was undertaken despite good clotting factor synthesis, because an encephalopathy occurred. In two patients liver transplantation was not undertaken even though indicated, in one because liver functions improved, in the other because necrotizing pancreatitis had occurred. In another patient, who had been poisoned by eating the mushroom Amanita phalloides, the attempted transplantation was cut short, because intestinal necrosis had developed, and the patient died during the operation. Nine of the eleven patients who had a transplantation and three of the four treated conservatively survived. CONCLUSION: The 60-day survival rate in this series, achieved in a recently established transplantation programme, is high (12 of 16; 75%), being comparable to those in larger transplantation centres.

Adult↗
PubMed1998

[Gastric teratoma].

Gastric teratomas are rare and mostly benign. They frequently become evident as a palpable abdominal mass. A malignant, aggressive solid tumor must be excluded. We present a 6-month-old male infant with a history of bleeding of the upper gastrointestinal tract. After in toto excision the histopathology was that of a benign gastric teratoma. Our method of reading the diagnosis and the subsequent therapy are described.

Diagnostic Imaging↗
PubMed1998

Microbial translocation and impairment of mucosal immunity induced by an elemental diet in rats is prevented by selective decontamination of the digestive tract.

OBJECTIVE: To assess the effect of selective decontamination of the digestive tract (SDD) on intestinal secretory immunoglobulin A (sIgA) concentrations in a model of intestinal bacterial overgrowth and bacterial translocation induced by an elemental diet in rats. DESIGN: Laboratory study. SETTING: University hospital, Germany. MATERIAL: 45 specific pathogen free female Crl:CD(R) BR rats. INTERVENTIONS: For 7 days, 3 groups of rats were fed orally with standard chow (n = 15), total parenteral nutrition solution (ORAL-TPN, n = 15), or ORAL-TPN plus tobramycin (20 mg/L) and polymyxin E (25 mg/L) (ORAL-TPN + SDD). MAIN OUTCOME MEASURES: Bacterial translocation to mesenteric lymph nodes (MLN), numbers of gram negative enterobacteria and total aerobic bacteria in the caecum, and intestinal concentrations of sIgA. RESULTS: The incidence of bacterial translocation was significantly increased in the group given ORAL-TPN (8/15, 53%) compared with the group given chow (1/15, 7%, p < 0.01). Supplementation of ORAL-TPN with SDD reduced translocation to 0/15. The ORAL-TPN group had a pronounced overgrowth of aerobic bacteria in the caecum, mainly by gram negative enterobacteria, which was prevented by the SDD. The concentrations of intestinal sIgA were significantly reduced in the ORAL-TPN group. SDD resulted in both the soluble and insoluble sIgA fractions in the gut being within the reference ranges. CONCLUSION: SDD prevents gram negative caecal overgrowth and translocation to MLN in rodents fed on ORAL-TPN. The significantly reduced mucosal immunity caused by ORAL-TPN alone is restored by SDD, although one might have expected a further reduction in sIgA concentrations with lower microbial populations than in the ORAL-TPN group. Not only does SDD not seem to affect the mucosa associated immune system adversely, but also depressed mucosal immunity was restored.

Administration, Oral↗
PubMed1998

[Diagnosis of liver tumors--what is necessary for therapy planning?].

For the surgical treatment of liver tumors, two initial steps are necessary: functional operability must be proven and oncological and local inoperability must be ruled out. The diagnostic process consists of a series of steps, beginning with non-invasive procedures such as laboratory findings and sonography, continuing with CT, CTAP, laparoscopy in the case of hepatic cirrhosis, up to explorative laparotomy. The potential operability is re-checked after each step. Punction, MRI and scintigraphy are implemented in special cases. The early implementation of MRI is of particular value for the diagnosis of certain benign processes.

Diagnostic Imaging↗
PubMed1998

[Palliative therapy of esophageal carcinoma].

For palliative endoscopic treatment of malignant dysphagia many different techniques are practiced. The differentiated usage of all techniques depending on the characteristics of the tumor leads to a good result with favorable costs. The following differentiated palliative regimen is presented: in the cervical part of the esophagus laser therapy or stent implantation are used, depending on the type of tumor growth. In the center section and the distal part of the esophagus usually palliative endoscopic pertubation is performed. If the stenosis is very soft and short a stent is implanted as alternative. In the gastroesophageal part flexible stents achieve the best results. Alternative laser therapy can be used.

Aged↗
PubMed1998

[Duplication of the stomach as a rare cause of cystic epigastric tumor].

Duplications of the gastrointestinal tract are congenital anomalies seen in about 0.2% of all children. These include the rare gastric duplications. Latter diagnosis is usually made in the first months after birth on recurrent vomiting by detection of an abdominal tumor. The most important imaging modality is ultrasonography. The case of a prematurely born child weighing 1900 g is presented in whom at the age of three weeks a gastric duplication of the greater curvature was diagnosed and who was successfully treated by resection. The postoperative follow-up for 24 months was uncomplicated.

Cysts↗
PubMed1998

[Increased CA-19-9 caused by a splenic cyst: a rare differential diagnosis].

Adenocarcinoma of the gastrointestinal tract, particularly primary adenocarcinoma of the pancreas lead to elevation of serum carbohydrate 19-9 (CA19-9) levels. Some benign disorders, like inflammatory diseases also cause CA19-9 tumor marker elevation. An extremely rare entity are benign splenic cysts which express this tumormarker as reported here.

Adult↗
PubMed1998

[Portal hypertension and variceal bleeding: shunt in concomitant or general prehepatic block].

Thrombosis of the portal system should be ruled out in all patient with esophagogastric varices. Such patients with no evidence of concomitant liver disease and with a high risk of rebleeding (e.g. gastric varices, low platelet counts, endoscopic criteria) should be referred to decompressive shunt surgery. The type of shunt is dictated by the patent segments of the portal system. Splenectomy should be avoided. The results show a low operative mortality, a zero encephalopathy and a low rebleeding rate. Patients with prehepatic thrombosis and liver cirrhosis represent a more severe problem since the risk and mortality of variceal hemorrhage is high and on the other hand TIPS procedure and liver transplantation may be impossible. In case of a high risk of rebleeding or endoscopic therapy failure we advocate surgical shunting as the risk of encephalopathy appears to be low when portal flow diversion already exists.

Adolescent↗
PubMed1998

[The employment schedule act from the viewpoint of the ordinary surgeon].

In Germany, the law of labor time was instituted in hospitals on January 1st, 1996 to regulate working hours, times of rest, breaks, and Sunday and holiday work. Problems in the realization of this law arise in daily practice, especially with regard to maximum working hours and post on-call times of rest. The compliance with the law would necessitate an enormous increase in new jobs for physicians, which is associated with an unfinanceable rise in costs. Solutions are either a reduction in performance or the omission to document the productivity. Therefore, surgeons in salaried employment in German hospitals constantly face the conflict of legality and legitimacy.

Attitude of Health Personnel↗
PubMed1998

[Value of diagnostic laparoscopy in primary malignant liver tumors].

The advent of new imaging modalities such as CT-AP and MRT has markedly improved the diagnosis and staging of primary liver tumors and will change the diagnostic impact of laparoscopy. Diagnostic laparoscopy in this retrospective study was not found to add information in regard to tumor staging and resectability, and there was no clear benefit by avoiding diagnostic laparotomies when all imaging and biopsy techniques available were used preoperatively. Therefore, we advocate the use of diagnostic laparoscopy only in selected cases suspicious for superficial small tumor lesions and cirrhosis with impact on the treatment modality.

Adult↗
PubMed1997

[Forensic aspects of complicated laparoscopic cholecystectomy].

As laparoscopic cholecystectomy becomes more established, interest in legal aspects increases. The legal cases dealt with in Germany since the introduction of this laparoscopic method in 1989 were studied to determine the legal consequences of complications. Of 40 cases, 16 were judged to be cases of malpractice, whereas 24 were not. The most common cause was injury of the common bile duct (26 cases). Seven of these 26 cases were judged to be cases of malpractice, 2 of these as grave errors. The main reasons for the acceptance of a case as malpractice were delay in changing to conventional cholecystectomy, delayed revision, laparoscopic revisions and not reverting to conventional cholecystectomy in unclear situations.

Cholecystectomy↗
PubMed1997

Perioperative use of recombinant human erythropoietin in patients refusing blood transfusions. Pathophysiological considerations based on 5 cases.

The efficacy of the administration of recombinant human erythropoietin (rHuEPO) in the treatment of anaemia in critically ill surgical patients refusing red cell transfusions requires further documentation. Herein, we report the outcome of 5 consecutive severely anaemic Jehovah's Witness patients (lowest haemoglobin concentration 27 g/1), who were discharged from the hospital in good condition after treatment. RHuEPO (50-280 U/kg body weight) was daily administered to 4 of the patients, who either exhibited preoperative anaemia or developed postoperative anaemia refractory to endogenous EPO probably due to inflammation. RHuEPO treatment was followed by a steep rise in reticulocytes and haemoglobin concentration. The fifth patient, who exhibited no signs of systemic inflammation following emergency hemicolectomy, was also treated with intravenous iron, but not with rHuEPO. His blood haemoglobin concentration rose from 27 g/l to 92 g/l in 3 wk. These observations indicate that the administration of rHuEPO is justified in the management of life-threatening anaemia, although only on a humanitarian basis, because there is no predictor for the possible spontaneous recovery.

Adult↗
PubMed1997

[Spontaneous liver rupture after thrombolytic therapy with streptokinase].

Two months after an osteosynthesis of a Maisonneuve-fracture a 45-year-old patient developed a thrombosis of the deep veins on the side of the fracture. Subsequent to two days of lysis with Streptokinase a rupture of the liver occurred and was treated by hemihepatectomy. A traumatic event or a tumor could be excluded as reason for the rupture. Therefore a rupture of the liver due to the application of Streptokinase has to be assumed.

Chemical and Drug Induced Liver Injury↗
PubMed1997

[Changes in the cytokine concentration (Il-6, Il-8, Il-1ra) and their cellular expression of membrane molecules (CD25, CD30, HLA-DR) after surgical trauma].

UNLABELLED: Elective surgical approaches and trauma cause changes in the production of different cytokines, an increased production of acute phase protein and changes in the expression of different cell surface markers. METHODS: In a prospective study we examined the C-reactive protein level, the production of the cytokines IL-6, IL-8 and IL-1 RA in 25 laparoscopic and 21 conventional cholecystectomies. In addition the cell surface markers CD25 and CD30 on different cell populations and HLA-DR on monocytes were measured. Statistical analysis was made by Student's-t-test and Mann-Whitney's rank sum test. RESULTS: The humoral markers showed a more distinct increase in patients operated on conventionally two and 24 hours after surgery, the differences between the two surgical approaches were significant (p < 0.01). The cell surface markers CD25 and CD30 showed the same reaction. The HLA-DR expression on monocytes was significantly lower in patients operated on conventionally. CONCLUSIONS: Elective surgical approaches cause changes in the immune system, which can be evaluated by the reaction of cytokines and cell surface markers. Laparoscopic cholecystectomies cause less activation of the immune system than conventional operations.

Acute-Phase Reaction↗