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Biomedical subjects

A Tuchmann

Publications and source records attributed to A Tuchmann.

At least 19 recordsLinked to original sources
PubMed1992

Nd:YAG laser treatment of colorectal malignancies: an experience of 4 1/2 years.

Between 1985 and 1990, 517 patients were treated for colorectal malignancies at our department of surgery. Nd:YAG laser therapy was used in 37 cases (7.1%). The mean age of these 22 men and 15 women was 71.4 years (range: 22-96 years). One hundred-twenty-nine Nd:YAG laser treatments were performed. Indications for laser treatment were (1) palliative tumor reduction (n = 21), (2) preresectional laser recanalization for obstructing carcinoma (n = 6), and (3) curative treatment (n = 10). Laser related complications included one perforation of the rectum and one rectovaginal fistula. One fatal pulmonary embolism occurred. After palliative treatment, five patients died because of tumor progression (mean survival time: 16 months), two because of other reasons. All patients with obstructing tumors could be recanalized successfully. After curative treatment, eight patients are still alive without tumor recurrence (mean survival time: 25.5 months), and two died of other causes. Palliative Nd:YAG laser treatment of colorectal malignancies is a competitive alternative to conventional surgery. Recanalization of obstructing tumors is an excellent treatment for large bowel obstruction, making one-stage resections possible. Curative treatment should be reserved for special cases only.

Adenocarcinoma↗
PubMed1990

[Intra-arterial chemotherapy of the liver].

Hepatic artery infusion chemotherapy was introduced to treat non-resectable liver metastases or tumors. Although growth patterns of hepatic metastases and pharmacokinetics of cytostatics are well known, the response rate to intraarterial chemotherapy amounts to a maximum of 50% only, the mean survival time being 1 year or less. Until now, complete healing was not observed. Future efforts should be directed at increasing the response rate, decreasing regional adverse side effects and avoiding extrahepatic disease.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Hepatic artery infusion chemotherapy.

Hepatic artery chemotherapy was given to 36 patients, using totally implantable devices consisting of a port and external pump. Twenty-seven patients had inoperable liver metastases of colorectal origin. The infusion system was inserted by laparotomy into the hepatic artery via the gastroduodenal artery. There was no operative mortality. Thirteen infusion systems could not be used for chemotherapy due to dislodgement, early death and lack of follow-up. FUdR was infused every two weeks. There were minor local complications like thrombosis of the system and dislodgement of the port. Toxic effects could be managed by reducing the dose. Response to chemotherapy was evaluated by survival, clinical condition, CEA, ultrasound and CT six months after onset of arterial chemotherapy. Ten/twenty-three patients (43%) responded to therapy, eight of them died on the average 19 months after initial chemotherapy. Six patients were non-responders, seven had stable disease. Five/ten patients developed extrahepatic metastases. Mean survival time was 13.1 months, mean interval until relapse 10.6 months.

Adult↗
PubMed1990

[Prevention of adhesions in abdominal surgery. A dose finding study with streptokinase/streptodornase].

UNLABELLED: Measurement of intraperitoneal fibrinolytic activity on 50 patients having undergone abdominal surgery (four of them controls). Instillation of streptokinase/streptodornase (Varidase) into the abdominal cavity. Determination of total protein, plasminogen, antiplasmin, alpha 2 Mx-plasmin-complex, spontaneous fibrinolysis and fibrinolysis + activator at different points in time p.op. RESULTS: Intraperitoneal fibrinolysis may be stimulated by local substitution of a plasminogen activator (Varidase). Systemic effects are confined to a high dose. No impaired wound healing nor increased propensity to hemorrhaging occurred.

Abdomen↗
PubMed1990

[Appendix cancer].

Explore the source record for details and available documents.

Adenocarcinoma, Mucinous↗
PubMed1989

[Gastric bypass in the management of morbid obesity].

A report is presented on 82 gastric bypass operations performed from 1979 to 1988. The average preoperative body weight was 132 kg, the body mass index (BMI) 45.0 +/- 7.0. 1 patient died (mortality 1%). 88 per cent of all patients were followed up 2 months to 9 years (2.5 years on average) postoperatively. The mean weight loss was 40.8 kg (reduction of BMI 15.1). Obesity-related diseases decreased remarkably, 3 stomal ulcers and 5 cases of anemia occurred as late complications. On the basis of these results gastric bypass is shown to be an effective and safe treatment of morbid obesity.

Adolescent↗
PubMed1989

[Tumor diagnosis by immunoscintigraphy with anti-CEA antibodies (Tc-99m MAK BW 431/26)].

We evaluated the clinical application of the monoclonal antibody MAb, BW 431/26, which is easy to label with Tc-99m for tumor localization. This is an anti-CEA antibody and a murine immunoglobulin (Ig G1, Isotype). We investigated patients with colorectal carcinoma (n = 14), with colorectal carcinoma recurrences (n = 24), breast carcinoma (n = 2), stomach carcinoma (n = 1), carcinoma of the urinary bladder (n = 3), lung carcinoma (n = 2) and patients with an elevated CEA level. In primary colorectal tumors (n = 14) all carcinomas were correctly localized by IS and ECT technique. In these patients the diagnosis was already known. The planar pictures showed a false negative result in 3 patients. In patients with colorectal recurrences the investigations were performed twice in 2 patients and three times in 1 patient. In these 31 ECT investigations we found 17 true positive results, 12 true negative results, 1 false positive result and 1 false negative result. The lesions were already visualized within 4 to 6 hours, but 24-hour pictures are desirable. SPECT pictures are absolutely necessary because sensitivity is considerably improved thereby. Elevated CEA levels increase the probability of a positive IS low CEA levels do not exclude positive tumor visualization. HAMA was found in only 1 patient, but follow-up investigations are indicated.

Adult↗
PubMed1989

[Circular staplers in esophagojejunal and esophagogastric anastomoses].

A report on 100 consecutive esophagoenteric anastomoses (EEA stapler) following total (esophagojejunostomy) or proximal gastrectomy (esophagogastrostomy) is presented. The following intraoperative problems occurred: insufficiency of the purse string suture [4], lumen of the esophagus too small [1], rupture of the esophageal wall [4], incomplete rings [4]. Fatal postoperative complications included two cases of insufficiency of the esophagojejunostomy, whilst the remaining six postoperative deaths were not linked to the use of the stapler (operative mortality 8%). Follow-up showed no recurrence at the stapler line, but two anastomotic strictures occurred. The EEA stapler is a helpful instrument to reduce leakage at the esophagoenteric anastomosis and, hence operative mortality after total and proximal gastrectomy.

Adult↗
PubMed1989

[Clinical relevance of extracorporeal shockwave lithotripsy (ESWL) in choledocholithiasis].

Primary endoscopic removal of bile duct stones is an established method of treatment. However, the extraction of stones is impossible in about 10% of cases despite successful endoscopic papillotomy and manual lithotripsy. Over a period of two years extracorporeal shock-wave lithotripsy (ESWL) was performed in 32 patients. Piezolith 2200, a second generation lithotripter was used, which requires neither analgesia nor anaesthesia for the patient. Localisation of the stones was carried out by means of a 3.5 MH 2 sector scanner. ESWL treatment was successful in 24 of 32 patients (75%). In 6 patients the bile duct stones were too large or too numerous and in 2 patients sonographic localisation was impossible. Out of a total of 131 patients with stones in the biliary tract only 9 (6.8%) needed surgery. Piezoelectric lithotripsy is a safe and effective adjunct procedure for the treatment of bile duct stones which were not extractable by endoscopy.

Aged↗
PubMed1989

Below-knee femoropopliteal bypass using externally supported polytetrafluoroethylene (PTFE) grafts.

Twenty-seven externally supported polytetrafluoroethylene (PTFE) grafts were implanted in the femoropopliteal position crossing the knee joint. All patients underwent surgery because of limb threatening ischemia (rest pain or gangrene). There was one early graft failure (successful thrombectomy). No patient died postoperatively. The mean follow-up period was 17.32 months (range 3-44 months). Cumulative patency rate for this follow-up period was 73%. Absence of kinking when bending the knee joint was determined by ankle Doppler pressure measurements and arteriography. If an adequate saphenous vein is not available for knee-crossing femoropopliteal bypass, externally supported PTFE can be used, yielding short-term patency rates comparable to those obtained with autologous venous bypasses.

Aged↗
PubMed1989

[Noninvasive diagnosis of post-puncture vascular complications of the femoral artery: i.v. DSA and duplex sonography].

In 1200 cases of angiographic or invasive procedures with puncture of the femoral artery, vascular complications occurred in 10 patients (0.8%). In a prospective study, duplex sonography and intravenous digital subtraction angiography were used as diagnostic methods in these cases. All 10 cases with vascular complications were diagnosed correctly by means of i.v. DSA, and the underlying pathology was documented exactly. Duplex sonography yielded the correct diagnosis in 8 cases, and 1 case was incorrectly diagnosed as an aneurysm; angiography suggested an arteriovenous fistula, which was surgically verified. In one case duplex sonography was negative. The noninvasive procedure of duplex sonography plays an important role in the diagnosis of post-puncture vascular complications. Because of its high accuracy, this simple method should be the first diagnostic step. Intravenous DSA should be used in cases where the results obtained with duplex sonography are equivocal.

Aged↗
PubMed1989

[Indications for primary anastomosis following resection of acute diverticulitis of the large intestine].

A retrospective review of 102 patients (1979-1987) was performed to evaluate the surgical management of complicated diverticulitis. The following operative strategy was found to be effective: 1. the Hartmann procedure in free perforation and diffuse peritonitis; 2. resection with primary anastomosis in free perforation and localized peritonitis, covered perforation, inflammatory tumor and fistulas, if healthy bowel ends could be used for anastomosis.

Acute Disease↗
PubMed1986

[Scalpel and CO2 laser in the animal experiment. A comparative study of inoculation tumors of the mouse].

The study hereby submitted has been designed to show whether there are any differences between using a conventional knife or a CO2-laser when excising and grafting tumors in animal experiments. The animals were C57Bl/6 mice, the tumor was the Lewis lung carcinoma. Eight days after tumor inoculation into the subcutaneous layer of the back, 213 mice were treated by tumor excision either with a conventional knife or a CO2-laser. 86 excised tumors were cut and the tumor surface was swabbed into the subcutaneous layer on the nape of 86 tumor-free mice. Survival times of the laser-operated animals were insignificantly longer. However, small tumors showed markedly longer survival times. The interval without recurrence was longer for all tumor sizes when the laser was used (p less than 0.005). The laser method yielded lower growth rates when the tumor surface was swabbed into tumor-free mice (p less than 0.0001). Histological and cytological tests of the laser-excised and -swabbed specimen demonstrated a high rate of cell destruction. Therefore, the CO2-laser seems to have some importance in cases where the incision is made close to the tumor or where the tumor surface may be lesioned.

Animals↗
PubMed1986

Comparative study of conventional scalpel and CO2-laser in experimental tumor surgery.

The study hereby submitted has been designed to show whether there are any differences between using a conventional knife or a CO2-laser when excising and grafting tumors in animal experiments. The animals were C57B1/6 mice, the tumor was the Lewis lung carcinoma. Eight days after tumor inoculation into the s.c. layer of the back, 213 mice were treated by tumor excision either with a conventional knife or a CO2-laser. Eighty-six excised tumors were cut, and the tumor surface was swabbed into the s.c. layer on the nape of 86 tumor-free mice. Survival times of the laser-operated animals were insignificantly longer. However, small tumors showed markedly longer survival times. The interval without recurrence was longer for all tumor sizes when the laser was used (P less than 0.005). The laser method yielded lower growth rates when the tumor surface was swabbed into tumor-free mice (P less than 0.0001). Histological and cytologic tests of the laser-excised and- swabbed specimen demonstrated a high rate of cell destruction. Therefore, the CO2-laser seems to have some significance in cases where the incision is made close to the tumor or where tumor surfaces may be lesioned.

Animals↗