Use of cotton tapes in laparoscopic intestinal surgery.
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Gossypium↗
Biomedical subjects
B Böhm
Publications and source records attributed to B Böhm.
Our approach to the management of congenital presacral tumors in adults.
This study reviews the recent overall experience in one colorectal surgery department with congenital presacral tumors in adults. 24 patients greater than 21 years of age, who underwent curative resection between January 1980 and August 1992, were analyzed retrospectively. The growths were divided into two broad categories: developmental cysts and chordomas. The most common presenting symptom was pain (19/24). A preoperative evaluation regimen is outlined in the study and includes use of CT scanning, MRI imaging, and possibly the use of endoluminal ultrasound to document the relationship of presacral tumors to pelvic viscera. There were 20 developmental cysts and 4 chordomas treated in this series. 15 of 19 developmental cysts were excised by a posterior approach alone, 2 were excised by an anterior approach alone, and 3 were treated by a combined approach. Trans-sacral excision was carried out in 4 patients with developmental cysts. One chordoma was resected posteriorly and the other 3 through a combined anterior and posterior approach. Three recurrences were diagnosed after excision of developmental cysts at 8, 18, and 41 months postoperatively. Recurrence occurred in 3 of 4 chordoma patients after 25, 32, and 55 months. Reexcision was carried out in all patients. None of the developmental cyst cases developed a second recurrence but 2 of the 3 chordoma patients have recurred, but have undergone local irradiation, which has controlled their disease.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Does methodic long-term follow-up affect survival after curative resection of colorectal carcinoma?
Records of 487 patients in long-term follow-up after Ro resection of colorectal carcinomas between January 1, 1980 and December 31, 1989 were analyzed. Every patient underwent regular examinations according to a defined schedule after curative resection of colorectal carcinoma. The date of evaluation was June 31, 1991. During a median observation time of 48 months (range, 15-132 months), tumor recurrence was observed in 149 patients (30.6 percent), with 56.4 percent of these suffering from tumor-associated symptoms. As the primary manifestation of tumor recurrence, only distant metastases (DM) were found in 76 patients (51 percent), only local recurrence (LR) in 46 patients (30.9 percent), and both DM and LR in 27 patients (18.1 percent). Patients with rectal carcinoma developed LR more frequently (P < 0.05) (19.5 percent) than patients with colon carcinoma (11.8 percent). The probability of developing distant metastases was not different (P < 0.05) for colon or rectal carcinoma but depended on primary tumor stage (P < 0.05). Only 36 patients (24.2 percent) with recurrence could undergo further curative resection. Fifty patients (33.5 percent) were given palliative therapy, and 63 patients (42.3 percent) were given no oncologic treatment. Only 9 of the 36 patients (6 percent of all recurrence patients) undergoing Ro resection were free of tumor for more than two years. In no case was a third Ro resection possible. The survival time of these patients was increased significantly after Ro resection of tumor recurrence (P = 0.03). Our study suggests that only a very few patients may live longer as a result of regular follow-up programs after curative resection for colorectal carcinoma.
Aged↗
Laparoscopically assisted ileocolectomy in Crohn's disease.
Laparoscopically assisted intestinal surgery has been described in a variety of different intestinal diseases but not in inflammatory bowel disease. The study shows that laparoscopically assisted ileocolectomy is feasible in patients with Crohn's disease with low morbidity.
Colectomy↗
[Surgical treatment of habitual patella dislocations by combined soft tissue surgery].
Since January 1988 21 operations using a modified Madigan and Goldthwait method have been carried out on 18 patients suffering from recurrent dislocation of the patella. This soft tissue procedure is presented here in its individual operational steps. The average age of the patients was 22 years and the majority were female (6:1). The mean follow-up time was 19.3 months. One patient who had both knees operated on reported recurrent luxation 6 months after the operation in one knee and subluxation in the other. None of the other patients suffered further dislocations. In the opinion of the patients, 17 (81%) knee operations were evaluated as favorable (good/very good, satisfactory) while 4 (19%) were considered unsatisfactory. All patients had stable knee joints and a full range of motion. The modified soft tissue operation presented here can be recommended for all patients with recurring patella dislocations if previous conservative functional therapy remains unsuccessful.
Adolescent↗
The serine-protease inhibitor of cartilage matrix is not a chondrocytic gene product.
Human articular cartilage contains significant amounts of antileukoprotease, a cationic low-molecular-mass serine-protease inhibitor, which was originally purified from mucous secretions (synonym: secretory leukocyte proteinase inhibitor). As it was not known whether the inhibitor molecule is also synthesized locally, we investigated antileukoprotease gene expression in chondrocytes. No antileukoprotease-specific mRNA was detected in adult or foetal human chondrocytes by in situ hybridization, Northern-blot analysis or polymerase chain reaction. Concurrently, the chondrocytes remained unstained on immunohistology, whereas immunoreactive antileukoprotease was demonstrated in the cartilage matrix. By Northern-blot analysis, the antileukoprotease message was detected in the promyelocytic cell line HL60, the myelomonocytic cell line U937 and even in mature polymorphonuclear leukocytes from the peripheral blood of healthy donors. Immunoperoxidase staining of polymorphonuclear leukocytes for the antileukoprotease protein indicated that this cell is likely to be the physiological source of the inhibitor in serum. The results further suggest an accumulation of the inhibitor in the cartilage matrix.
Base Sequence↗
Point mutations in two conserved glycine residues within the integral membrane protein FhuB affect iron(III) hydroxamate transport.
A region of substantial homology, comprising 32 amino acids around a highly conserved glycine residue, is located near the C-terminal ends of the hydrophobic Fhu, Fec, Fep, Fat, and Btu transport proteins involved in the uptake of ferrisiderophores and vitamin B12 into Escherichia coli and Vibrio anguillarum. Furthermore, a region similar in location and sequence containing an invariant glycine at an equivalent position was identified in the hydrophobic component of all other periplasmic binding protein-dependent (PBT) systems. In the FhuB protein, which is twice the size of the other PBT-related inner membrane proteins and which displays an internal homology, two conserved glycine residues are present. Alteration of Gly at positions 226 and 559 to Ala, Val, or Glu reduced iron(III) hydroxamate uptake, suggesting that this homologous region may play a general role in the mechanism of PBT-dependent transport.
Amino Acid Sequence↗
[Perioperative treatment in elective colorectal resection in Germany].
The perioperative treatment of patients with elective colorectal resections in 1086 german hospitals was analysed. In 40% of all hospitals preoperative parenteral nutrition was administered. Following resection iv-fluids were administered in every hospital (6.2% hypo-, 72.4% normo-, 18.7% hypercaloric). Systemic chemoprophylaxis with iv-antibiotics was given in 95.4% of all hospitals. Preoperative bowel preparation included orthograde lavage in 86.1% of the hospitals and oral non-resorbable antibiotics were given in 22.5%. 40.1% of all surgeons performed intraoperative testing of colorectal anastomoses and abdominal drains were used on a regular basis in more than 83% of the hospitals. The principles in perioperative treatment of patients with elective colorectal resections are almost identical all over Germany. Minor differences in perioperative treatment occurred in association with localisation, class of hospital, size of surgical department and annual amount of resections. Also differences between clinical practice and results of recent scientific studies can be observed.
Anastomosis, Surgical↗
[Preoperative esophagogastroduodenoscopy before elective surgical therapy of symptomatic cholelithiasis].
We evaluated the data of 1143 patients who underwent preoperative gastroscopy or upper gastrointestinal series before elective surgical treatment of cholelithiasis between January 1, 1981 and December 31, 1990. On these 824 women and 319 men we performed 1064 (93.1%) gastroscopies and only 78 (6.8%) upper gastrointestinal series. The incidence of pathological findings was 30.2% (345 patients), with 68.3% findings of inflammatory nature. In 28 patients (2.5%) cholecystectomy or bile duct exploration was combined with an additional gastrointestinal surgical procedure. In 227 cases (19.8%) biliary surgery was followed by pharmacological treatment of the gastrointestinal disease. Because of the high incidence of simultaneous disease of the upper gastrointestinum we believe that routine preoperative gastroscopy is indicated before elective surgical treatment of cholelithiasis.
Adult↗
[Slit drainage--progress in drainage treatment after herniotomy].
In a prospective randomized study was conducted on 80 patients undergoing elective hernia repair to assess whether a new slit-suction drainage is less painful than a Redon-suction drainage. Main endpoint of the study was the traction power in order to remove the drain. Other endpoints were pain at the time of removal of the drain and the effectiveness to draw off secretion. To remove redon drain the average traction power was 226 pond and to remove slit drain the average traction power was only 25 pond. The difference was significant (p less than 0.01). At the time of removal patients with slit drain rarely complained about pain (p less than 0.01). On contrary, patients with Redon drain always complained about pain. Clotting were seldom shown in slit drains and were frequently shown in redon drains. Both slit drains and redon drains were effective to drain secretion. As the new slit drain was more comfortable for patients following hernia repair slit drain should always be used as subcutaneous suction drainage.
Drainage↗
[Preoperative hemodilution before elective resections of colorectal cancers for sparing homologous blood transfusion].
The records of 389 patients following elective resection of colorectal carcinoma were analysed in order to examine perioperative transfusion. Preoperative hemoglobin levels of 12.8 g/dl in women and 14.2 g/dl in men were found (p less than 0.01). Only 11% of the patients had an anemia. Increasing age and sex had both a significant relation to decreasing preoperative hemoglobin level and higher frequency of transfusion (p less than 0.01). Women got perioperative more often blood transfusion (84.4%). On an average 2.1 units of blood were transfused. There were no relation to tumor stage or tumor location be found (p greater than 0.01). 48.8% of the patients had attendant diseases. Cardiac insufficiency and pulmonary diseases became more frequent. Excluding all patients with contraindication to preoperative hemodilution it was possible to do preoperative hemodilution by 61.2% of the patients. In conclusion preoperative hemodilution should be done before elective resection of colorectal cancer if there was no contraindications to reduce the number of autologous blood transfusion.
Aged↗
[Tumor follow-up in colorectal carcinoma].
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Colorectal Neoplasms↗
Purification of a serine-proteinase inhibitor from human articular cartilage. Identity with the acid-stable proteinase inhibitor of mucous secretions.
An inhibitor of the serine proteinases human leucocyte elastase (EC 3.4.21.37), of cathepsin G (EC 3.4.21.20) and of trypsin (EC 3.4.21.4) has been purified from human articular cartilage. The apparent Mr of the cationic (pI greater than 10) protein was determined to 15,000 by SDS/PAGE. It was shown to cross-react in Western blot with a specific antibody to a recombinant-derived serine-proteinase inhibitor of human mucous secretions. Identity of both inhibitors is indicated by the determination of the N-terminal amino acid sequence of the cartilage-derived serine-proteinase inhibitor. In all 24 residues the cartilage inhibitor was shown to be identical with the human secretory leucocyte proteinase inhibitor ('SLPI'). The inhibitor molecule may play a crucial role in the protection of cartilage matrix proteins against proteolytic attack.
Adolescent↗
[Individual risk-related after-care in colorectal cancer?].
Efficacy of the regular follow-up program and influence on survival rate following treatment of recurrence were evaluated. 556 follow-up records of patients after resection of colorectal cancer were analysed. The primary drop-out rate was 12.4%. Recurrences were found in 26.6% (n = 128). 53.1% of recurrences were symptomatic at diagnosis of recurrence. Curative resection of recurrence was only performed in 19.5%. 46.1% were given palliative and 34.4 no specific oncologic treatment. We define efficacy as the rate of curative asymptomatic recurrence. This was 3.5% of all patients. From the curative resection of recurrence only 6 patients were free of recurrence longer than 2 years. No second resection of recurrence was possible. Different treatment of recurrence did influence the survival rate (p = 0.09). There was no difference in prognosis for asymptomatic and symptomatic recurrences (p greater than 0.8). In order to increase the efficacy of follow-up for colorectal cancer we are introducing a new concept based on individual risk factors.
Aftercare↗
[Morbidity and mortality after elective resections of colorectal cancers].
There are few actual published results about morbidity and mortality after elective resection of colorectal cancer. Out of 596 patients with colorectal cancer, the medical records of 492 who had been prepared preoperatively according to our predefined standards and electively operated on, were analysed. We studied the results of morbidity and mortality and their association with preexisting conditions and preoperative complications. We found that 50% of our patients had preexisting conditions and that 18.7% had preoperative complications (obstruction, ileus, infections). The rate of general postoperative complications was 30.5%. While for pneumonia (13%) there was age and sex relation, for urinary infection (12.7%) there was only sex relation. We were able to reduce urinary infections by half (5.7%), by using a suprapubic catheter. 11.4% of our patients had local complications (anastomotic leakage 2%, ileus 2.2%, bleeding 1.6%, fistula 1.2%). These were neither dependent on age or sex, nor on preoperative complications or preexisting conditions. Mortality within 30 days was 2% and overall mortality was 2.6%. Our results show that careful diagnosis and treatment of preexisting conditions, bowel preparation and an improvement in operating techniques can all lead to improved results after elective resection.
Aged↗
[Follow-up in stomach carcinoma].
For ten years after resection of stomach cancer patients were routinely examined to detect early asymptomatic recurrence, 96 records were analyzed, 21 patients with recurrence of cancer were found--3 local recurrence and 18 distant metastases. There was no anastomosis recurrence, 20 of these patients had clinical symptoms. About 90 percent of all recurrences were found in the first two years. After diagnosis of recurrence the one-year-survival-rate was only eight percent. We believe that the regular follow-up following resection of stomach cancer is not an effective method of detections asymptomatic curable recurrence. For this reason we recommend intensifying individual care and decreasing endoscopic or radiological examinations.
Adenocarcinoma↗
[The effect of age and sex on localization, tumor stage and prognosis of colorectal carcinoma].
In a retrospective study including 946 cases with colorectal cancer we analysed age, sex, distribution and stage. There was a significant higher prevalence in women and in all tumor stages women were older than men. The frequencies of Dukes C and proximal colon cancer was significantly higher in women. In older patients we found an increasing incidence of proximal cancer. Instead of tumor stage the age, sex and distribution showed no influence on the outcome.
Aged↗
[Clinical variations of the so-called wedge-shaped defect].
Clinical variations of 288 so-called wedge-shaped defects were described at the model and in the clinic in 50 patients aged 21 to 67 years and classified according to depth, profile and en face contour. Defect formation starts in early adult age increasing in dependence on age. The term "wedge-shaped defect" is only partly indicative and incorrect.
Adult↗