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Biomedical subjects

A Hirner

Publications and source records attributed to A Hirner.

At least 91 records · Page 5Linked to original sources
PubMed1994

[Abdominal emergencies in patients with AIDS].

This is a report on five patients suffering from AIDS who underwent emergency abdominal surgery: One patient with gangrenous appendicitis, three with a small bowel perforation and a third with a colonic bleeding. The first outlived the appendectomy by seven month; the second and the third the small bowel resection by eight weeks resp. by 10 weeks. The fourth died four weeks after hemicolectomy and a relaparotomy with colonic resection for profuse bleeding. The fifth died because of infiltration of the heart by a malignant lymphoma. None of the patients developed any complications due to surgery. A review is given on emergencies caused by abdominal diseases which a surgeon must be aware of in patients with AIDS. The palliative character of surgery in these patients is stressed.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Results of devascularization surgery of the gastroesophageal junction in recurrent hemorrhage of esophageal and fundus varices].

Bleeding esophageal and gastric varices caused by portal hypertension with (group I) or without (group II) liver damage should be treated primarily by sclerotherapy or shunt-operation if there is no indication for liver transplantation. In the case of rebleeding associated with thrombosis of portal-/mesenteric or splenic vein we performed in 17 patients a complete devascularisation of the proximal stomach, cardia and distal esophagus (Hassab's operation 1967) (N = 5--group I; N = 12--group II). In group I, the early postoperative (0-30 days p.o.) course was complicated by one necrosis of the gastric fundus. In group II, postoperative bleeding from gastric varices was noted in four patients, three of which were treated by proximal gastric resection; two of twelve patients died. No serious complications in the long-term follow-up (min. 171--max. 1217 days) occurred in group I. In group II, half of the patients died (1 bleeding episode, 1 liver coma, 1 hepatocellular carcinoma, 2 other causes). The operative risk and the long-term prognosis are essentially influenced by the basic disease and to a much lesser degree by the type of operation. The devascularisation of the esophago-gastric junction is per se a low risk intervention which is always practicable, even in high risk patients.

Adolescent↗
PubMed1993

[The expanded ileal pouch as a reservoir in continence preserving proctocolectomy. An experimental study on the pig].

Silicone balloons were inserted into bypassed segments of terminal ileum of five mini-pigs. The balloons were expanded over a period of 3 months, thereby creating pouches with a mean volume of 700 cm3 (a 9.5-fold increase). Functional proctocolectomy was performed and the bypassed segment was than placed in continuity with its terminal end at the previous site of the anus, thus creating a neorectum. One year later, the three pigs were still alive. They were continent and stool frequency was 2-3 times a day. The final mean volume of the pouch was still 360 cm3, corresponding to a 5.7-fold increase. At the end of the experiment significant hypertrophy of the bowel wall thickness was observed compared to the controls. The rectal X-ray contrast study demonstrated a new rectal reservoir without fistula or stenosis.

Animals↗
PubMed1993

Tc-99m labeled monoclonal antibodies against granulocytes (BW 250/183) in the detection of appendicitis.

Scintigraphy with Tc-99m labeled antigranulocyte antibodies (BW 250/183 MoABs) was performed in 32 patients with suspected appendicitis. Abdominal imaging (planar/SPECT) was performed 2 hours after injection of the tracer. All patients also had surgery and a histologic examination of the resected tissue. Of the patients, 17 suffered from "acute appendicitis" and 12 had right positive scans (sensitivity = 70.6%). In 15 patients, acute appendicitis could have been ruled out, and in 11 of these cases the scan was true negative (specificity = 73.3%). The overall accuracy was 71.8% (23/32 cases). The use of Tc-99m antigranulocyte MoABs may overcome the problems associated with the Tc-99m HMPAO granulocyte and In-111 oxine approaches, which include nonspecific intestinal activity or the lack of timeliness. The use of Tc-99m labeled antigranulocyte antibodies is suitable as an emergency procedure and may play a role in the management of patients with suspected appendicitis.

Adolescent↗
PubMed1993

[Angiodysplasia of the intestine--rational diagnosis and therapy].

Vascular ectasias of the gastrointestinal tract are local changes in the development of blood vessels, frequently associated with an arteriovenous shunt. The reported rates of such angiodysplasias have been increased in the past years due to improved diagnostic procedures as well as a general increase in the age of the population. The majority of these changes is found in the right colon. It is often difficult to localize the bleeding. We treat our patients according to the following diagnostic regimen: esophagogastroduodenoscopy, proctorectoscopy, colonoscopy, angiography, erythrocyte scintigram and diagnostic laparotomy. Therapeutic approaches include the surgical resection of the bleeding area as well as interventional endoscopy. To further reduce the high mortality rate associated with this disease, an early diagnosis and treatment are essential.

Aged↗
PubMed1993

[Acute upper gastrointestinal hemorrhage caused by ruptured aneurysm of the right gastroepiploic artery].

Visceral aneurysms are very rare (0.1% in autopsy-statistics). In our own review of literature we have found only 9 described cases of an aneurysm of the gastroepiploic artery. In the presented case an aneurysm was found when the patient developed an acute upper gastrointestinal bleeding. Due to the high risk of rupture (20% of all visceral aneurysms), which can be either intraperitoneally, intraluminally or into the satellite vein, the treatment should be surgically on finding.

Aged↗
PubMed1992

[Boerhaave syndrome in pyloric hyperplasia].

Boerhaave's-syndrome is a rare illness, usually caused when sudden intense vomiting leads to a spontaneous rupture of the healthy esophagus. Alcoholism and neurological diseases are considered to be the main predisposing factors. Because the complaint is so rare the casuistic of Boerhaave's-syndrome is described in connection with pyloric stenosis. In order to confirm the diagnosis the following practice is recommended: During gastrografin swallowing the pylorus should be examined in order to remedy the possible cause of the complaint when the operative therapy is carried out.

Esophageal Diseases↗
PubMed1991

Infected pancreatic necrosis possibly due to combined percutaneous aspiration, cystogastric pseudocyst drainage and injection of a sclerosant.

This paper reports on a patient who was treated by percutaneous aspiration, instillation of a sclerosant (polidocanol) and cystogastric drainage for a post-acute pancreatic pseudocyst. Five weeks after admission to hospital for the first episode of an acute necrotizing pancreatitis, the 60-year-old man underwent a percutaneous, ultrasound-guided puncture and aspiration of a voluminous pancreatic pseudocyst. Ten days later, recurrent fluid collection led to a second puncture, combined with the injection of polidocanol (15 ml; 1%) into the cyst cavity. Since this treatment failed, a percutaneous cystogastric drain ("double--pigtail") was inserted five days later. After developing acute abdominal pain and incipient sepsis, the patient was sent for surgical intervention twelve days after the second treatment with percutaneous aspiration and injection of polidocanol. During the operation an infected pancreatic pseudocyst with extensive contaminated necrosis of the pancreas and duodenal perforation was found. Necrectomy was performed, followed by continuous lavage of the omental bursa. Intensive care therapy was necessary for one week. Duodenal leakage persisted for nearly three weeks, the stopped spontaneously. The patient was discharged in quite a good state of health after 33 days of postoperative treatment. Although spontaneous development of infected pancreatic pseudocysts and pancreatic abscesses in necrotizing pancreatitis is known, a possible involvement of the drainage procedures, especially in combination with the injection of a sclerosant must be considered.

Bacterial Infections↗
PubMed1990

[Interdisciplinary computerized evaluation of perioperative risk factors].

The identification and assessment of perioperative risk factors combined with interdisciplinary management may lead to minimized risk for the patient. The numerous medical and administrative data should be collected by a computer. This was done in a preliminary study at the university of Bonn, where 9772 anaesthesias given for general surgery were evaluated. The necessary outcome studies should be based on statistical evaluation of the data (factor analysis) and their interpretation should be an interdisciplinary concern.

Adolescent↗
PubMed1990

[Emergency and early portasystemic shunt: indications and results].

The definitive hemostasis is the key to successful therapy of variceal bleeding. There is a difference between the emergency operation for persistent bleeding in spite of initial sclerosing therapy and the planned early operation for primary massive bleeding, early recurrence of bleeding and bleeding of fundus varicosis. The lethality is about 50% for the emergency operation, about 12% for the early operation (Berlin). For the emergency situation the portacaval end-to-side anastomosis is favoured. The result of this therapeutical concept in Bonn (1989-1990) for 47 patients admitted for bleeding was a hospital lethality of 23%.

Aged↗
PubMed1989

[Status of the portosystemic shunt in the therapy concept of portal hypertension].

The 5-years-survival rate of patients with liver cirrhosis is limited to about 25%. Still, one of the most important therapeutic procedures in case of bleeding oesophageal and fundic varices is a portasystemic shunt 6 randomized studies have been performed to compare the complete portacaval shunt with the incomplete splenorenal Warren-shunt: The hospital mortality rate (8-10%) and the 5-years-survival rate (43-47%) do not differ; but the rate of postoperative encephalopathy significantly is higher after PCA (40-26%) and the rate of recurrent bleeding significantly is higher after Warren-shunt (13-6%). In case of massively or early recurrent bleeding, we favour an emergency PCA: the mortality rate amounts to 12% in case of the socalled "early operation" (after initially successful balloon tube or sclerotherapy, 52 patients) and 47% in case of "absolute emergency shunt" because of continuing bleeding (119 patients). In the elective situation (58 patients) we favour the Warren-shunt in elderly patients with diabetes mellitus, preexisting encephalopathy or Child-B-classification.

Adult↗
PubMed1989

[Early relaparotomy in postoperative peritonitis].

The most frequent reason for relaparotomy is peritonitis, followed by mechanical ileus and secondary hemorrhage. The most common cause of postoperative peritonitis is insufficient anastomosis. The relative proportion of cases of localized peritonitis is increasing. Diffuse peritonitis is still treated by operation, according to instructions of Kirschner 1926, whereas localized peritonitis is more and more treated by percutaneous puncture. The prognosis of postoperative peritonitis is poor.

Aged↗
PubMed1989

Effects of thoracic epidural anesthesia on systemic hemodynamic function and systemic oxygen supply-demand relationship.

The effects of thoracic epidural anesthesia (TEA) on total body oxygen supply-demand ratio are complex due to potential influences on both O2 delivery (QO2) and consumption (VO2). One hundred and five patients undergoing abdominal aortic surgery were randomly assigned to one of three groups to compare the cardiovascular and metabolic responses associated with (1) thoracic epidural anesthesia plus light general anesthesia (group TEA); (2) general anesthesia with halothane (group H); and (3) neuroleptanalgesia (group NLA). Values of cardiac index (CI) and QO2 were less intraoperatively in the TEA group than in the H or NLA groups, while VO2 values were similar. VO2 during recovery was greater in both the TEA and NLA groups than in the H group. Consequently the oxygen supply-demand ratio (QO2/VO2) was less in the TEA group throughout the perioperative period and about 30% below baseline values during early recovery. At comparable VO2, CI and mixed venous O2 saturation were always less in the TEA group than in the NLA group. Heart rate was slowest intraoperatively during TEA, and stroke work was less with TEA than with NLA. As cardiac filling pressure and systemic vascular resistance did not differ among the three groups, reduced adaptation of CI to tissue O2 needs during TEA was attributed to negative inotropic and chronotropic effects of the sympathetic blockade. We conclude that in patients undergoing abdominal aortic surgery, TEA has no apparent advantage over general anesthesia.

Anesthesia, Epidural↗
PubMed1988

Transplantation of a horseshoe kidney en bloc: report of a case.

Transplantation of a horseshoe kidney rarely has been reported. We report a case of successful en bloc transplantation of a horseshoe kidney. The kidney could not be divided because of a complex vascular situation in the isthmus region. The recipient was discharged from our hospital with normal kidney function 12 days postoperatively. We recommend the use of kidneys with anatomical malformations for transplantation.

Adult↗