[Clinical structures of the future].
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Forecasting↗
Biomedical subjects
A Thiede
Publications and source records attributed to A Thiede.
Retroperitoneal gas gangrene after colonoscopic polypectomy without bowel perforation in an otherwise healthy individual: report of a case.
BACKGROUND: Abdominal gas gangrene caused by clostridia species is rare and usually associated with organ perforation, immune suppression, or advanced malignoma. CASE REPORT: A 61-year-old man was admitted with severe back pain 1 day after uncomplicated colonoscopic polypectomy. With the exception of preexisting minor depression, the patient had been previously in excellent health. The computed tomography scan showed retroperitoneal emphysema in the left psoas muscle. During exploratory laparotomy, a spreading retroperitoneal phlegmon with pneumoretroperitoneum and a secondary peritonitis were found. A macroscopic perforation of the gut, particularly at the polypectomy sites was excluded. After the operation, the patient evolved in a septic shock condition and had pulmonary failure. Before hyperbaric oxygen therapy could be employed, the patient died. The autopsy showed a massive gas gangrene of the retroperitoneum caused by Clostridium perfringens, but no macroscopic bowel perforation was detected. RESULTS: This is the first report of a case of gas gangrene after uncomplicated polypectomy without macroscopic perforation in an otherwise healthy individual. A microperforation due to mucosal defect after polypectomy was most likely the entry point for the bacteria. CONCLUSION: We conclude that clostridial myonecrosis should be considered in unclear abdominal infections, even if the patient's history is not typical as in the present case.
Clostridium perfringens↗
MHC class II-mediated antigen presentation by alloreactive rat CD4+ T cells does not induce regulatory properties.
Activated CD4+ T cells have the capacity to express major histocompatibility complex (MHC) class II molecules and to present processed antigens to T cells. Because the role of MHC class II positive T cells in allograft rejection is unknown, the purpose of this study was to investigate their function as antigen-presenting cells (APCs) in the allogeneic immune response. For this, alloreactive CD4+ T cells were induced in Lewis rats by immunization with the allogeneic peptide P1. The P1-specific T cells are involved in the rejection of allografts from Wistar Furth rats. With monoclonal antibodies specific for the alphabeta T-cell receptor (clone R73) and MHC class II molecules (clone Ox6), the presence of antigen-specific T cells, with and without expression of MHC class II molecules, was demonstrated. Concerning their ability to bind these antibodies they were characterized as R73(pos), Ox6(pos) and R73(pos), Ox6(neg), respectively. The R73(pos), Ox6(pos) T cells loaded with P1 were indeed very effective in restimulating R73(pos), Ox6(neg) T cells but not vice versa. Further on, R73(pos), Ox6(pos) T cells, but not R73(pos), Ox6(neg) T cells, were able to activate naïve allogeneic T cells demonstrating their capacity to express co-stimulatory molecules. In addition, specific mRNA for CD86, MHC class II, and CIITA, the master regulator of MHC class II expression, were detectable in the R73(pos), Ox6(pos) T cells only. In conclusion, the R73(pos), Ox6(pos) T cells act as professional APCs with the possible biological capability of amplifying the local immune response to the allograft.
Animals↗
[Legal matters -- decisions and backgrounds].
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Expert Testimony↗
[Jural - decisions and background].
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Fees, Medical↗
[The Würzburg polytrauma algorithm. Concept and first results of a sliding-gantry-based computer tomography diagnostic system].
BACKGROUND: The purpose of this study was to show the practicability of a new algorithm in the management of polytraumatized patients based on Advanced Trauma Live Support (ATLS) and using mobile whole body multislice CT (MMDCT) as the primary imaging system. PATIENTS AND METHODS: A series of 120 trauma patients referred to the Würzburg University Hospital Trauma Emergency Room were categorized into suspected polytrauma and suspected non-polytrauma groups. The polytraumatized patients were investigated using the Würzburg polytrauma-algorithm including whole body multislice CT with a 16-row-scanner. The algorithm is described. The time for the diagnostic procedure was measured and compared with data from the Trauma Registry of the German Society of Trauma Surgery. RESULTS: From 120 patients 78 (66%) underwent whole body CT. The diagnostic procedure was quick with significant advantages especially for cranial and trunk diagnostics. CONCLUSION: The Würzburg polytrauma algorithm worked well. There was excellent cooperation within the interdisciplinary leading team consisting of anaesthesiologists, surgeons, and radiologists. The principles of ATLS could be respected. Mobile whole body multislice CT was an effective tool in the diagnostic evaluation of polytrauma patients.
Algorithms↗
[Nononcologic abdominal surgery in the elderly].
Due to rising life expectancy of the population, the proportion of elderly patients requiring surgery is rising as well. Present aspects of selected, typical, nononcologic diseases of elderly people are discussed. The key to success in their treatment is not to consider primarily the patient's calendrical age but to assess the individual profile of risk factors on the basis of comorbidities. The kind, extent, and timing of an operation has to be based on this assessment. For the treatment of acute diseases (e.g., complicated ulcera, cholecystitis, appendicitis, mesenteric ischemia, and diverticulitis), a rapid and efficacious diagnostic algorithm is essential that takes into account the reduced functional reserve of old people. Constructive interdisciplinary cooperation and minimally invasive techniques play dominant roles in both diagnosis and therapy. Given these prerequisites, there is no reason to withhold surgical intervention from elderly patients.
Abdomen↗
[Terminolateral esophagojejunostomy after gastrectomy with the biofragmentable anastomosis ring in the dog model].
INTRODUCTION: Esophagojejunostomy after total gastrectomy still remains a high risk anastomosis with a considerable morbidity and mortality. The majority of these anastomoses are performed by the intraluminal stapler technique, yet stenoses are a known late complication even after an uneventful postoperative course. In the present study, the osophagojejunostomy with the biofragmentable anastomosis ring (BAR) was examined in dogs. METHODS: 28 dogs were randomized into a group of manual suture (n = 14) and a BAR-group (n = 14). After gastrectomy, the esophagojejunostomy was performed by hand-suture with polypropylene 4-0 in the manual suture group, and with the 25/1.5 mm BAR in the BAR-group. In both groups the Roux-en-Y jejunojejunostomy was performed by hand-suture. The dogs were evaluated on postoperative days 4, 7 and 14 with regard to macroscopy, bursting strength, tissue hydroxyproline and histology. RESULTS: There was one leakage without clinical effect in the hand-sewn group on postoperative day 4; there was no leak in the BAR-group. In observing fibre-free enteral feeding, neither functional disorders nor obstruction of the BAR were observed. The general anastomosis parameters were matchable between the groups. CONCLUSION: The infracarinal BAR-esophagojejunostomy is comparable to the hand-sewn anastomosis in the dog-model.
Anastomosis, Surgical↗
[The non-tropical pyomyositis--a rare disease in the moderate climate zone].
Pyomyositis is in the moderate climate zone a rare and acute bacterial infection of the skeletal muscles without an obvious origin of infection. Initial symptoms contain muscle pain and localized swelling and tension. As different causes are taken into account first, the diagnosis of a pyomyositis is often delayed. We report on three cases of pyomyositis and discuss diagnosis and therapy against the background of the available and recent literature.
Abscess↗
[Therapeutically options for primary and secondary hepatic malignancies].
Therapeutically options for the treatment of patients with primary hepatic malignancies have grown in recent years. Apart from liver resection and organ transplantation, representing the only curative strategies for primary hepatic malignancies, a variety of palliative procedures have been introduced. Some of these result in extended patient survival. However, the combination of a malignant disease and an irreversible organ damage remains to be the main problem in the majority of patients with primary liver Cancer. Liver resection is the only curative therapy for patients with isolated hepatic colorectal metastases and can be performed with low morbidity and mortality if a correct indication and a standardized procedure is applied. In case of intrahepatic tumour recurrence re-resection is indicated as long as extrahepatic metastases can be excluded. In patients with primary unresectable metastases a downstaging-chemotherapy, two-stage hepatectomy or portal vene embolization might result in a secondary respectability. Locally ablative procedures are being evaluated at present, in the palliative Situation survival can be prolonged. In the future multimodal therapeutic approaches will dominate the treatment of primary and secondary hepatic malignancies.
Colorectal Neoplasms↗
[New concepts in treatment of gastric carcinoma].
Despite interdisciplinary approach to gastric cancer the outcome of patients remains poor. Even after curative resection most patients suffer from progression of disease and metastasizing course. Adjuvant treatment like chemotherapy or radiation can not improve survival substantialy. This is discussed to be due to dissemination of tumor cells, which are not affected by most treatment options. The new concept of tumor specific antibody therapy with a monoclonal antibody is discussed as an effective treatment especially to fight disseminated tumor cells and thus might help to improve the outcome in stomach cancer.
Adenocarcinoma↗
[Anastomotic fistula. Complication caused by surgery].
Chronic anastomotic fistula are an expression of a complication after anastomoses caused by surgery. The cause of this is diverse and reaches from incorrect seam technology, over factors of the comorbidity up to the fateful process. All regions from the esophagus to the rectum and, in addition, the biliary and pancreatic ducts can be affected. To evaluate the general problem localization diagnostics are necessary, whereby different endoscopic, radiological and combining techniques are being applied. The treatment of fistulas contains therapies of conservative, conservatively medicamentous over the intervention in endoscopic management up to the surgical treatment. In most cases the treatment of anastomotic fistula require an individual patient-fair therapy; exceptions are the pancreatic fistula.
Anastomosis, Surgical↗
IgM-enriched immunoglobulin (pentaglobin) positively influences the course of post-surgical intra-abdominal infections.
BACKGROUND: Polyvalent IgM-enriched intravenous human immunoglobulin (IVIG) preparations are discussed to be beneficial regarding sepsis outcome. MATERIALS AND METHODS: Sixty-four patients with abdominal infection were treated with Pentaglobin or Albumin. Serum levels of endotoxin and chemokines were determined. RESULTS: Incidence of fever was 19/28 in the pentaglobin and 18/26 in the albumin group, the percentage of days with fever was 34 +/- 26 for pentaglobin and 43 +/- 25 for albumin (mean +/-SD). Procalcitonin levels of the pentaglobin treated patients fell under the upper limit of normal on day six whereas levels of albumin patients remained elevated. CONCLUSION: Pentaglobin has a positive influence on the course of post-surgery intra-abdominal infection.
APACHE↗
Endoscopic ultrasound-guided transrectal aspiration of pelvic fluid collections.
BACKGROUND: The aim of this study was to evaluate the feasibility, safety, and diagnostic accuracy of endorectal ultrasound-guided aspiration and drainage of pelvic fluid collections. METHODS: All patients who underwent endorectal ultrasound-guided aspiration and/or drainage of pelvic fluid collections were included in this prospective study. Patients were prepared using bowel lavage and a single-dose antibiotic combination. The procedure was carried out in the lithotomy position usually without sedation. All aspirates were examined microbiologically and/or cytologically. RESULTS: Twenty-nine patients [18 females and 11 males; median age, 67 years (range, 18-79)] underwent 33 endosonographic controlled aspirations. No procedure-related complications were encountered. In 22 cases (76%) the lesions were encountered following a surgical procedure. Fluid amounts varied between 5 and 750 ml. Fluids were sterile in 14 cases (42%). These fluid collections were hematomas, seromas, peritoneal cysts, and a mucocele. Microorganisms were found in the remaining 19 aspirations (58%), i.e., abscesses (n = 16) and infected hematomas (n = 3). A transrectal (n = 14) or transvaginal (n = 2) drainage catheter was placed in 16 patients under endosonographic guidance. Only two patients required a subsequent laparotomy for definitive treatment of their septic focus, whereas all other patients could be treated successfully by this conservative approach. CONCLUSION: Endoscopic ultrasound-guided transrectal aspiration and drainage of pelvic fluid collections is a safe method with a favorable outcome because it avoids unnecessary operations in selected patients.
Adult↗
[Gastrointestinal stromal tumor of the abdominal wall. An unusual localization of a rare tumor].
Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. We describe here for the first time a patient with a huge GIST of the abdominal wall without any relation to the gastrointestinal tract, omentum, or mesentery. With regard to the size of 24 cm and a low mitotic index, this GIST is considered an intermediate risk for metastasis. Radical surgical resection was performed with negative pathologic resection margins. The classic immunohistochemical phenotype of the tumor described facilitates the differential diagnosis to exclude abdominal desmoid tumor and solitary fibrous tumor (SFT). In the case of metastasis, therapeutic nihilism no longer seems justified with the availability of imatinib, a tyrosine kinase inhibitor, which shows encouraging results in the therapy of metastatic GIST.
Abdominal Neoplasms↗
[Diagnosis and treatment of chronic anastomotic fistulas].
Treatment of anastomotic fistulas generally implies an individualized concept. The origin of these complications is multifactorial and comprises such factors as primary operation, oncologic situation, comorbidity, and patient age as well as fistula-specific considerations such as anatomic localization, secretion volume, etc. In the case of high-output fistulas, it is of great importance to counteract fluid and electrolyte imbalances. Furthermore, skin maceration due to aggressive secretion needs to be averted. Therapeutic options include operative and endoscopic interventions. Octreotide plays a role in high-output and pancreatic fistulas. Any underlying ailment (e.g., Crohn's disease) requires an optimal disease-specific treatment which characterizes an interdisciplinary approach to such fistulas. The following article discusses general and site-specific considerations in the diagnosis and treatment of anastomotic fistulas.
Anastomosis, Surgical↗
Endometrial carcinoma recurrence in an abdominal scar 14 years after total hysterectomy.
BACKGROUND: Abdominal scar recurrence of endometrial carcinoma after hysterectomy has been only occasionally described and occurred mostly within 5 years after surgery. Direct tumor cell seeding in the abdominal wound at the time of operation is thought to be most likely the cause of recurrence. CASE: The patient underwent total abdominal hysterectomy for early stage endometrial carcinoma. She presented 14 years later with an abdominal scar recurrence that was radically resected. Histology of the tumor was similar to that of the primary carcinoma. CONCLUSION: Recurrences of endometrial carcinoma in an abdominal scar can occur even many years after hysterectomy and the concept of dormant cancer tumor cells is discussed as cause of recurrence rather than direct tumor cell implantation at the time of operation.
Abdomen↗
A teaching model for endorectal ultrasound-guided biopsy and drainage of pararectal tumors.
For determination of histology of small solid and microbiology of liquid pararectal tumors there is no other method than endorectal ultrasound-guided biopsy. Also for therapy of abscesses or seromas drainage application is possible. With this technique an operation may be prevented. In awareness of possible complications such as major injury of rectal wall, bleeding, persistent fistula and sepsis, teaching and training in this method is consequently necessary. For a training program a lifelike model of the rectum was developed. It has been used by 780 participants in 20 training courses organized by the Surgical Department of University Hospital Würzburg.
Abscess↗