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Biomedical subjects

B Böhm

Publications and source records attributed to B Böhm.

At least 37 records · Page 2Linked to original sources

[Differences in the assessment of 9-14-year-old sons of divorced and not divorced parents].

Twenty-eight 9- to 14 years old boys from divorced families were compared with twenty-six 9- to 14 years old boys from two-parent families. Californian Child Q-Sort assessments (Block and Block 1980) were obtained from themselves, as well as from mother, father, a friend, and from the trained interviewer. Boys with divorced parents indicated more stress without showing it to others. They longed for appreciation from the others, showed lower self-esteem and more helplessness, but not more dissocial behavior. Supportive representation of their mother correlated positively with ego-resiliency and self-esteem, and negatively with helplessness, while others did not seem to notice the boys' helplessness. They indicated less dissocial and more social behavior, they were more sensitive and had better relations with other children. Supportive representation of fathers was beneficial only for the control group. The data correspond to differences in quality of narrative language published previously. They are discussed from an attachment theory perspective.

Adolescent↗

[Can colorectal carcinomas be resected laparoscopically? Technically possible, long-term outcome is still uncertain].

DESIGN: The efficacy of laparoscopic resection of colorectal tumours was evaluated in a prospective observational study. PATIENTS: All patients with elective laparoscopic resection for colorectal tumours between 1995 and 1997 were included. MAIN RESULTS: Laparoscopic resections were accomplished in 70 patients with a mean age of 61.9 +/- 15.6 years--most of them (n = 45) left-sided. The operative time was 232 +/- 75 minutes and the estimated blood loss 235 +/- 123 ml. In six patients (8.6%) laparoscopic-assisted procedures were performed, and no patient had to be converted to a conventional midline incision. Intraoperative complications occurred in one patient, postoperative general complications in 2.9% and surgical complications in 5.7%. Clinically relevant anastomotic leaks were not recorded. No patient died postoperatively. Reconvalescence was short, first bowel movement was documented after 3.3 +/- 1.3 days. Postoperative hospital stay was 10.1 +/- 3.1 days. CONCLUSION: Laparoscopic resection of colorectal tumours can be accomplished with a low complication rate with proper selection of patients and experience of the surgical team. However, the indication for laparoscopic resection must consider all aspects of an oncological treatment.

Adult↗

Localization of lower right molars in a panoramic radiograph, lateral cephalogram and dental CT.

In this investigation, the radiological status of angular measurements in the wisdom tooth area was examined. The angles of the tooth center lines of the second and third lower molars (48, 47) to the occlusal plane and to one another in 25 orthodontically untreated patients (average age: 16.3 years) were measured and compared with angular values of the patients concerned measured in a dental CT. The assessment of these 3 radiological documents in an absolute comparison revealed closely corresponding angular values. However, the dental CT provided a considerably more accurate and, in addition, a three-dimensional topographical localization of lower wisdom teeth.

Cephalometry↗

[Tolerance of early oral feeding after operations of the lower gastrointestinal tract].

INTRODUCTION: Oral feeding is usually offered following surgery of the lower gastrointestinal tract when clinical signs of normal intestinal motility are present. However, some studies have shown that early oral feeding is well tolerated with low morbidity. METHODS: A prospective cohort study was performed to evaluate whether early oral feeding according to a standardized schedule is tolerated under normal clinical circumstances. One hundred consecutive patients following small- or large-bowel resection with anastomosis were offered fluids on post-operative day 1, soup on post-operative day 2, mashed food on post-operative day 3 and a regular diet on post-operative day 4. Parenteral nutrition was only given if necessary. Tolerance of oral feeding and the amount of food were checked twice a day. End points of the study were nausea (VAS score 1-100), vomiting (> 200 ml), reinsertion of a nasogastric tube, level of food intake, parenteral nutrition (ml), appetite and well-being. RESULTS: Loop ileostomies were done in 21 patients, colonic resections above the sigmoid in 32, and sigmoid and rectal resections in 47. The average age was 63 +/- 13 years. The frequency of nausea was less than 30% and of vomiting less than 10%. Only in two cases was a nasogastric tube inserted. Forty-three percent of all patients tolerated feeding very well according to the schedule. On post-operative day 3 more than 60% tolerated oral intake, on post-operative day 4, 74% and on post-operative day 5, 88%. Only 22% of the patients needed parenteral fluids on post-operative day 4. The first bowel movement was noted after 2.8 +/- 1.1 days. Surgical complications were documented in 18 patients and general complications in 6 patients. CONCLUSION: Most patients tolerated early oral feeding very well according to the schedule with low morbidity. Therefore, early feeding is now a substantial component of the postoperative treatment following small- or large-bowel resections.

Aged↗

Inflammatory response after laparoscopic and conventional colorectal resections - results of a prospective randomized trial.

BACKGROUND: Short-term benefits of laparoscopic relative to conventional colorectal resections have been demonstrated in randomized controlled trials. It has been suggested that a diminished cytokine and acute-phase response may be responsible for these advantages. METHODS: In a randomized controlled trial, patients underwent laparoscopic (n=30) or conventional (n=30) resection of colorectal tumors. Plasma levels of interleukin-1 receptor antagonist (IL-1RA), interleukin-6 (IL-6), interleukin-10 (IL-10), and C-reactive protein (CRP) were analyzed repeatedly. Postoperative peak levels and area under the curve values were calculated and compared between groups using the Mann-Whitney U-test. RESULTS: Patient characteristics, preoperative cytokine, and CRP plasma levels were not different between each group. Postoperative peak concentrations of IL-6 (P=0.05) and CRP (P<0.001) and the overall postoperative plasma concentrations of IL-6 (P=0.03) and CRP (P=0.002) were lower in the laparoscopic than in the conventional group. Peak and overall IL-1RA (P=0.2; P=0.2) and IL-10 (P=0.4; P=0. 6) plasma concentrations, respectively, were not different between groups. CONCLUSIONS: IL-6 and CRP plasma levels were lower after laparoscopic than conventional colorectal resections. The less intense inflammatory response may be an indicator of the milder surgical trauma inflicted by laparoscopic than conventional colorectal resection.

Acute-Phase Reaction↗

Influence of nitrous oxide anesthesia on venous gas embolism with carbon dioxide and helium during pneumoperitoneum.

BACKGROUND: Gas embolism is a potential hazard during laparoscopic procedures. The aim of this study was to evaluate the effects of nitrous oxide (N(2)O) inhalation in the case of gas embolism with carbon dioxide (CO(2)) and helium during pneumoperitoneum. METHODS: For this study, 20 anesthetized pigs were ventilated with N(2)O (67% inspired) in O(2) (n = 10) or with halothane (0.7-1.5 inspired) in O(2) (n = 10). In each group, CO(2) (n = 5) or helium (n = 5) pneumoperitoneum was established and gas embolism induced at different rates (CO(2) at 0.5, 1, or 2 ml/kg/min; helium at 0.025, 0. 05, or 0.1 ml/kg/min) through the left femoral vein a maximum of 10 min while all hemodynamic parameters were continuously monitored. RESULTS: In the CO(2) group without N(2)O, all the animals tolerated rates of 0.5 and 1 ml/kg/min over the 10 min, whereas only 3 of 4 animals in the CO(2) group with N(2)O tolerated a rate of 0.5 ml/kg/min, and 2 of 4 animals a rate of 1 ml/kg/min. In the helium group without N(2)O, all the animals tolerated gas embolism at all rates, whereas in the helium group with N(2)O, 4 of 5 animals needed to be resuscitated at a rate of 0.1 ml/kg/min and one death occurred. CONCLUSIONS: Inhalation of N(2)O worsens the negative cardiovascular effects of venous CO(2) or helium gas emboli and increases the risk of emboli-induced death when CO(2) or helium are used to establish pneumoperitoneum. The volume of venous venous helium gas emboli causing such effects is substantially smaller than that for venous CO(2) gas emboli.

Anesthesia, Inhalation↗

Prospective randomized blinded trial of pulmonary function, pain, and cosmetic results after laparoscopic vs. microlaparoscopic cholecystectomy.

BACKGROUND: The size of laparoscopic instruments has been reduced for use in abdominal video endoscopic surgery. However, it has yet to be proven that microlaparoscopic surgery will actually result in clinically relevant benefits for patients. METHODS: Fifty patients were randomized in a blinded fashion to receive either elective laparoscopic (MINI), (n = 25) or microlaparoscopic (MICRO) (n = 25) cholecystectomy. Pulmonary function (FVC, FEV (1)), analgesic consumption during patient-controlled analgesia (PCA), pain perception by visual analogue score (VAS), and the cosmetic result (by the patient's self-assessment) were evaluated postoperatively as clinically relevant end points. RESULTS: Age, sex, body mass index (BMI), preoperative pulmonary function, pain perception, and operative time were similar for the two groups. At 8:00 PM on the day of surgery, FVC (MINI: 1.96 L [range, 1.48-2.48]; MICRO: 2.13 L) [(range, 1.61.-2.50)] and FEV (1) (MINI: 1.17 L/sec) [range, 0.87-1. 48]; MICRO: 1.34 L/sec [range, 1.05.-2.14] were also similar (each p = 0.5). From surgery to the 3rd postoperative day, cumulative PCA morphine doses were comparable (MINI: 0.15 mg/kg bw [range, 0.09-0. 23]; MICRO: 0.21 mg/kg bw [range, 0.10-0.42]; p = 0.4), but overall VAS scores for pain while coughing were higher in the laparoscopic group (406 [range, 358-514]) than in the microlaparoscopic group (365 [range, 215-427]; p = 0.02). The cosmetic result was judged to be slightly superior by the microlaparoscopic patients (10 [range, 9-10]), as compared to those in the laparoscopic (9 [range, 8-10]) group (p = 0.04). CONCLUSION: Because microlaparoscopic cholecystectomy has some minor advantages over laparoscopic surgery, it should be considered for use in selected patients.

Adult↗

[Minimally invasive surgery in malignant tumors? A concept of quality assurance by phased evaluation exemplifed by colorectal carcinoma resection].

The concept of phased clinical scientific evaluation new surgical procedures in oncology is introduced. The principles of this concept are illustrated with the example of laparoscopic resection of colorectal carcinoma. In Phase I animal studies and anatomical studies on human cadavers it has been shown that the anatomical extent of laparoscopic and conventional colorectal resections is comparable. Uncontrolled clinical trials and registries of laparoscopic operations with a low level of evidence did not detect any severe disadvantages of laparoscopic resection of colorectal carcinoma. Controlled randomised phase III a-studies with a a high level of evidence have proven that laparoscopic colorectal resection has important short-term patient benefits when compared to conventional surgery. Controlled randomised Phase III b-Muticentertrials to compare the long-term results of laparoscopic and conventional resections or colorectal cancer are currently on their way worldwide. These multicenter trials will evaluate with the highest level of evidence wether the results of laparoscopic colorectal cancer resection are as good as those for conventional surgery. Patients scheduled for minimal-invasive resection of colorectal carcinoma should be included in one of these multicenter trials. Only after the phased clinical evaluation of the new procedure has been completed, the risk or benefit of minimal-invasive surgery for colorectal cancer can be assessed.

Colorectal Neoplasms↗

[Quality assurance aspects of laparoscopic colorectal tumor surgery].

It is still controversial whether a laparoscopic resection should be accomplished to treat colorectal cancer for cure. Some surgeons strongly believe that the new approach causes less pain, adhesions and abdominal hernias and allows faster oral intake. However, some surgeons hesitate to use this technique because they fear that it may compromise the long term results. It was evaluated whether the current quality of treatment is improved by the laparoscopic approach. Therefore, the short- and long-term benefits of laparoscopic and conventional surgery were compared. Following a systematic analysis of available scientific data it can be concluded that there are some clinically relevant short-term benefits for patients. Reliable long-term results from controlled trials are not available yet. There are not any published data which allow to conclude that the prognosis may be worsened using the laparoscopic technique. Thus, the surgeon should consider to learn this technique properly and apply it in selected cases.

Clinical Trials as Topic↗

Pulmonary function following laparoscopic or conventional colorectal resection: a randomized controlled evaluation.

BACKGROUND: Laparotomy causes a significant reduction of pulmonary function, and atelectasis and pneumonia occur after elective conventional colorectal resections. OBJECTIVE: To evaluate the hypothesis that pulmonary function is less restricted after laparoscopic than after conventional colorectal resection. DESIGN: A randomized clinical trial. SETTING: The surgical department of an academic medical center. PATIENTS: Sixty patients underwent laparoscopic (n = 30) or conventional (n = 30) resection of colorectal tumors. The 2 groups did not differ significantly in age, sex, localization or stage of tumor, or preoperative pulmonary function. MAIN OUTCOME MEASURES: Forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, mid-expiratory phase of forced expiratory flow, and oxygen saturation of arterial blood. RESULTS: The forced vital capacity (mean +/- SD values: conventional resection group, 1.73+/-0.60 L; laparoscopic surgery group, 2.59+/-1.11 L; P<.01) and the forced expiratory volume in 1 second (conventional resection group, 1.19+/-0.51 L/s; laparoscopic surgery group, 1.80+/-0.80 L/s; P<.01) were more profoundly suppressed in the patients having conventional resection than in those having laparoscopic surgery. Similar results were found for the peak expiratory flow (conventional resection group, 2.51+/-1.37 L/s; laparoscopic resection group, 3.60+/-2.22 L/s; P<.05) and the midexpiratory phase of forced expiratory flow (conventional resection group, 1.87+/-1.12 L/s; laparoscopic surgery group, 2.67+/-1.76 L/s; P<.05). The oxygen saturation of arterial blood, measured while the patients were breathing room air, was lower after conventional than after laparoscopic resections (P<.01). The recovery of the forced vital capacity and forced expiratory volume in 1 second to 80% of the preoperative value took longer in patients having conventional resection than in those having laparoscopic resection (P<.01). Pneumonia developed in 2 patients having conventional resection, but no pulmonary infection occurred in the laparoscopic resection group (P>.05). CONCLUSIONS: Pulmonary function is better preserved after laparoscopic than after conventional colorectal resection. Pulmonary complications may be reduced after laparoscopic resections because of the better postoperative pulmonary function.

Aged↗

[Effects of argon gas embolism during pneumoperitoneum].

In a porcine model, ten animals with a mean body weight of 18.9 (15-24) kg were exposed either to intravenous boli of 10, 20, and 30 ml argon (n = 5) or CO2 gas (n = 5). Gas embolism with argon led to increased pulmonary artery pressure (P > 0.001) and induced a decrease in end tidal CO2 (P < 0.001) and reduced cardiac output (P < 0.001) with a consecutive decrease in mean arterial pressure (P < 0.05). One animal died in cardiac shock after a 20 ml argon gas embolism and another after a 30 ml argon bolus. A third animal recovered after resuscitation with noradrenaline after a 30 ml argon bolus. Animals in the CO2 group receiving 10, 20, or 30 ml bolus neither required resuscitation nor died. Hemodynamic parameters were not affected by a 10 to 30 ml bolus of CO2 gas. Thus, gases with a low solubility in blood like argon should not be used during procedures with an increased risk of gas embolism.

Animals↗

[Long-term results after laparoscopic resection of colorectal carcinoma].

BACKGROUND: Laparoscopic techniques are currently used for curative resection of colorectal cancer although long-term results from controlled clinical trials are not available yet that prove laparoscopic procedures are adequate. METHODS: All patients who under-went a curative resection of a colorectal tumor from 1995 to 1997 were included in a prospective cohort study to evaluate the short- and long-term results. RESULTS: Laparoscopic colorectal resections were accomplished in 68 patients. In only 3 patients was an adenoma (stage 0) found, and 10 patients had multiple liver metastases at the time of palliative resection. An oncological resection was performed in 55 patients. The average age was 62.8 +/- 14.6 years (29 female and 26 male patients). Eleven right colectomies, 1 left colectomy, 21 sigmoid resections, 16 proctosigmoidectomies and 6 abdominoperineal resections were carried out. Two patients (3.6%) were lost during follow-up. The median follow-up was 27.1 months (range 9.1-45.1 months). No port-site metastases were found. Two patients who are still alive after sigmoid resection suffered from a recurrence. The first patient underwent only limited lymphadenectomy because of synchronous malignant lymphoma. The second patient developed bilateral lung metastases. Only one patient died during the follow-up period because of myocardial infarction. CONCLUSION: Although the follow-up is short, it seems that the recurrence rate is low. Controlled multicenter clinical trials are currently performed to evaluate whether laparoscopic surgery is really adequate to treat colorectal cancer.

Cohort Studies↗

Endoscopic surgery: fit for malignancy?

Neither experimental nor clinical data confirm the repeatedly published opinion that video-endoscopic surgery promotes tumor growth or the occurrence of implantation metastases in cancer patients. On the contrary, alterations due to pneumoperitoneum by the application of different gases, pressures, and temperatures might provide the basis for a new therapeutic approach to cancer surgery. Oncologically adequate resections defined by such terms as "no touch isolation" and "monobloc resection" can be performed video-endoscopically in a variety of intraabdominally or intrathoracically located cancers if a standardized technique is used. The benefit of video-endoscopic surgery is limited in large tumors, especially if they have reached the organ surface. There is still a major deficit in the clinical evaluation of video-endoscopic interventions in most oncologic diseases. Randomized studies comparing video-endoscopic and conventional surgery have been reported only for the resection of colorectal carcinoma. They show that laparoscopic resections can be performed with a minimum of postoperative complications to the same extent as conventional resections and offer several advantages during the early postoperative period. No reliable data from comparative trials are as yet available on the long-term results.

Endoscopy↗

Randomized controlled trial to examine the influence of thoracic epidural analgesia on postoperative ileus after laparoscopic sigmoid resection.

BACKGROUND: The aim of the study was to evaluate whether perioperative epidural analgesia had any effect on the duration of postoperative ileus after laparoscopic sigmoid resection. METHODS: Twenty patients were randomized to surgery either with (group 1; n = 10) or without (group 2; n = 10) thoracic epidural analgesia. The major endpoint of the study was the time to the first postoperative bowel movement. Secondary endpoints were the interval until oral feeding was tolerated, incidence of postoperative vomiting, postoperative analgesic consumption use of patient-controlled analgesia (PCA) until the fourth day after operation, subjective pain perception and the incidence of epidural-related side-effects. RESULTS: Age, sex and American Society of Anesthesiologists classification were similar in the two groups. The first bowel movement was documented after a median of 54 (95 per cent confidence interval 32-127) h in group 1 and 77 (31-99) h in group 2 (P = 0.8). Oral feeding without additional parenteral therapy was tolerated after 48 (40-64) h in group 1 and after 56 (48-64) h in group 2 (P = 0.6). Postoperative vomiting occurred in two patients from each group. During epidural therapy the use of PCA was lower in group 1 (0.30 (0.19-0.96) mg morphine per kg) than in group 2 (0.56 (0.37-0. 80) mg/kg) (P < 0.05). Postoperative pain perception during rest and while coughing was similar in both groups. Three patients experienced reversible side-effects of epidural therapy (motor deficit, two patients; bladder dysfunction, one). CONCLUSION: Perioperative thoracic epidural analgesia did not have a clinically relevant effect on the duration of postoperative ileus after laparoscopic sigmoid resection.

Aged↗

Evaluation of the profile line in prognathic patients in the Saxony-Anhalt region of Germany.

The aim of the present study was to investigate the soft-tissue morphology and profile line of prognathic patients in the Saxony-Anhalt region of central Germany. To this effect, the profile photographs and lateral cephalograms taken at treatment start for 34 adults (17 female patients, mean age: 22.6 years; 17 male patients; mean age: 23.2 years), Class III subjects who had not undergone orthodontic treatment, were measured and, by means of statistical analysis, the findings were compared with those of an age-matched control group (17 female subjects, mean age: 21.4 years; 17 male subjects, mean age: 23.8 years). Patients with Class III anomalies had a significantly longer and thinner lower lip and a smaller lower subnasal angle than the control subjects. The lower face was markedly enlarged. Furthermore, the osseous profile line was significantly flatter and the soft-tissue convexity was considerably reduced compared with the control group. Hence the prognathic patients of central Germany manifested typical features of the prognathic profile line. To elucidate typical regional features, further comparative studies are required.

Adolescent↗

[Recovery and duration of work disability after laparoscopic and conventional appendectomy. A prospective randomized study].

To evaluate whether laparoscopic appendectomy shortens the convalescence and the postoperative period until return to work when compared to conventional appendectomy, a prospective randomized trial was performed. The major endpoint of the study was the time until return to work; minor endpoints were postoperative pain, fatigue, operative time and postoperative morbidity. In all, 54 patients with a mean age of 29.5 +/- 10.1 years were randomized to open (n = 28) or laparoscopic appendectomy (n = 26). Age, sex, body mass index (BMI), American Society of Anesthesiology (ASA) rating, job status as well as histologic degree of inflammation of the appendix were comparable in the two groups. Operative time was 59.2 +/- 15.8 min for laparoscopic and 59.8 +/- 24.4 min for conventional appendectomy (P = 0.9). Some 16 laparoscopic appendectomies (62%) were performed by board-certified surgeons, while 23 conventional appendectomies (82%) were performed by residents (P = 0.003). Postoperative morbidity was comparable between the two groups. After laparoscopic appendectomy, pain was rated significantly lower on the first, second and fourth postoperative day when compared to the conventional group. There were no difference in postoperative fatigue between the groups. Time to return to work was 17.0 +/- 6.2 days in the laparoscopic group and 18.2 +/- 6.0 days in the conventional group (p = 0.5). Laparoscopic appendectomy has no advantages in terms of convalescence and time to return to work when compared to open appendectomy and should therefore be limited to selected cases.

Adolescent↗

Laparoscopic versus conventional colorectal resection: a prospective randomised study of postoperative ileus and early postoperative feeding.

BACKGROUND: A shorter duration of postoperative ileus and earlier oral alimentation of patients may be a clinically relevant benefit of laparoscopic compared with conventional colorectal resection. PATIENTS/METHODS: A total of 60 patients were randomised to either laparoscopic (n=30) or conventional (n=30) resection of colorectal tumours. Major endpoints were the postoperative time to the first bowel movement and the time until oral feeding without parenteral alimentation was tolerated. Minor endpoints were the postoperative interval to the first peristalsis and first passage of flatus, the distribution of radio-opaque markers in abdominal radiographs on day 3 and day 5 and the incidence of postoperative vomiting. RESULTS: Age, gender. ASA-classification and type of resection were comparable in the two groups. Peristalsis was first noticed 26+/-9 h after laparoscopic and 38+/-17 h after conventional colorectal resection (P<0.01). First flatus occurred 50+/-19 h after laparoscopic and 79+/-21 h after conventional surgery (P<0.01). The incidence of postoperative vomiting was similar in both groups. Three days after surgery radio-opaque markers were found more often in the right colon (P<0.01) and less often in the small intestine (P<0.05) in laparoscopic compared with conventional patients. Five days after laparoscopic surgery, more markers had reached the left colon (P<0.05). The first bowel movement occurred 70+/-32 h after laparoscopic and 91+/-22 h after conventional resection (P<0.01). Oral feeding without additional parenteral alimentation was tolerated 3.3+/-0.7 days after laparoscopic and 5.0+/-1.5 days after conventional surgery (P<0.01). CONCLUSION: The shorter duration of postoperative ileus allows earlier restoration of oral feeding after laparoscopic compared with conventional colorectal resection and therefore increases quality of life immediately after resection of colorectal tumours.

Aged↗