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Biomedical subjects

B Sattler

Publications and source records attributed to B Sattler.

At least 37 records · Page 2Linked to original sources
PubMed1999

Surgical treatment of cholangiocellular carcinoma.

Cholangiocarcinoma is a primary liver tumor arising from the small bile ducts within the liver. According to its different location, clinical features, frequency of metastases, treatment modalities and prognosis, intrahepatic cholangiocarcinoma should well be differentiated from proximal bile duct carcinoma. To date, there is no therapeutic measure with curative potential apart from surgical treatment. Partial hepatectomy is the treatment of choice. It is of overriding importance to achieve microscopically tumor-free margins. However, only few patients treated in an early stage have a prolonged recurrence-free survival or a chance for cure. Liver transplantation is not an alternative therapeutic option for unresectable cholangiocarcinoma, due to early tumor recurrence in almost all recipients. Liver transplantation has a place in preventing cholangiocarcinoma in primary sclerosing cholangitis, although the timing of replacement is still a matter of debate. Results of surgery need further improvement by adjuvant or neoadjuvant treatment protocols.

Bile Duct Neoplasms↗
PubMed1999

Systemic mycoses during prophylactical use of liposomal amphotericin B (Ambisome) after liver transplantation.

We investigated the prophylactical administration of liposomal amphotericin B (Ambisome) in the early phase after liver transplantation (LTx). Fifty-eight patients received Ambisome prophylactically after LTx. Ambisome (1 mg kg-1 day-1) was given intravenously for 7 days after LTx. Immunosuppressive prophylaxis was cyclosporin A (CsA) based in 11 patients. Forty-seven patients had a tacrolimus-based immunosuppressive regimen. CsA and tacrolimus dosages were adjusted to trough levels of 150-250 ng ml-1 (EMIT) and 5-15 ng ml-1 (MEIA II) respectively. Three patients died from sepsis due to Aspergillus fumigatus infection. Reasons for a fatal outcome were foudroyant Aspergillus pneumonia in a patient transplanted for fulminant hepatic failure on post-operative day (pod) 8; Aspergillus sepsis with severe endocardidtis in a patient with two retransplantations for graft non/dysfunction on pod 24; and disseminated aspergillosis due to Aspergillus fumigatus in a patient retransplanted for primary non-function (pod 19). All three patients underwent haemofiltration for renal failure. One patient with Candida albicans sepsis (pod 4) recovered under increased dosage of Ambisome (3 mg kg-1 per day). Ambisome (1 mg kg-1 per day) seems to be beneficial against systemic Candida infections. However, the onset of systemic Aspergillus infections could not be prevented. Obviously, higher Ambisome doses appear to be necessary against Aspergillus. We recommend the use of Ambisome (3 mg kg-1 per day) for patients with risk factors such as graft dys-/non-function, retransplantation, haemofiltration and complicated acute liver failure to prevent invasive aspergillosis.

Adolescent↗
PubMed1998

[Incidence of damage to the recurrent laryngeal nerve in surgical therapy of various thyroid gland diseases--a retrospective study].

UNLABELLED: We investigated the incidence of the recurrent laryngeal nerve (RLN) palsy after thyroid gland surgery in 725 cases. The incidence was correlated to the different diseases of the thyroid gland, to the operative procedure (subtotal resection, lobectomy, thyroidectomy), to the intraoperative exploration of the nerve and to the surgeons' state of training. RLN palsy was found in 7.6 per cent (4.8 per cent nerve at risk) five days after surgery. A permanent RLN damage was defined as a persisting paralysis of the vocal cord six months after surgery. Permanent nerve damage occurred in 2.1 per cent for euthyroid nodular goitre, for recurrent goitre in 11.7 per cent and for thyroid carcinoma in 10.1 per cent. There was a statistically significant difference between the number of RLN pareses occurring after nerve exposure with 4.2 per cent and that occurring after non-exposure with 1.1 per cent for subtotal lobectomy. 67.7 per cent of these pareses at day five were transient. The RLN palsy rate for Senior House Officers was 6.7 per cent but there where none for registrars and consultants. CONCLUSIONS: The RLN damage five days after thyroid gland surgery is mainly caused by the great number of recurrent goitre and thyroid cancer (16.1 per cent), the rate of procedures performed by younger surgeons and the near total resection of euthyroid goitre. The exposure of RLN is important for the training to manage thyroid gland surgery.

Cross-Sectional Studies↗
PubMed1998

[Indications and surgical therapy of thyroid gland diseases--analysis of 725 operated patients].

Diseases of the thyroid gland are an important part of elective surgical procedures. The adequate surgical therapy is at present standardized and requires a permanent qualitative control to reduce avoidable complications. The relation between men and women in our patients (n = 725) was 1 to 5. The mean age was 51.2 years. 10% (n = 79) of the patients were hyperthyroid. 646 patients had benign disease; and 79 patients were found to have malignancy of the thyroid gland. The most common indication for an operation was bilateral multinodular goitre (n = 325) in combination with a cold nodule (n = 123), in 79 patients latent hyperthyroidism or Morbus Basedow (n = 22). Struma nodosa with retrosternal extension (n = 49), recurrence of goitre (n = 34), thyroiditis (n = 12) and dystopic goitre (n = 2) were rare in these patients. Patients with malignancy of the thyroid gland were always treated by thyroidectomy or completed thyroidectomy with lymphnode dissection. In the cases of benign disease the surgical methods were variable, although the bilateral subtotal resection (n = 413) predominated. While doing so the radical resection of parenchyma with a persistent functioning remnant of goitre of 5 cm3 was favoured. The resulting postoperative complications are discussed. An endocrinological appropriate follow-up of the patients is necessary.

Female↗
PubMed1998

Transjugular intrahepatic portosystemic stent-shunt after orthotopic liver transplantation in a patient with early recurrence of portal hypertension of unknown origin.

A 65-year-old italian patient developed complicated portal hypertension immediately after orthtopic liver transplantation (OLT) necessitating shunt creation. One to five weeks after OLT, massive ascitic fluid losses of up to 121/day developed. Vascular and major hepatic-parenchymal abnormalities were excluded by duplexsonography, angiography and initial histology, respectively. A peritoneovenous shunt (Denver-shunt) on day 31 after OLT reduced (by about 50%) but did not stop ascitic fluid losses. Furthermore, three variceal bleedings occurred after implantation of the Denver-shunt. Direct portography on day 45 after OLT revealed portal hypertension (pressure gradient of 26 mmHg) requiring the implantation of a transjugular intrahepatic portosystemic stent-shunt (TIPS) leading to a reduction of the pressure gradient to 13 mmHg. Subsequently, ascites resolved within ten days and esophageal varices improved. Liver function parameters normalized inspite of recurrence of HCV infection with detection of HCV RNA in serum already in the fifth week after OLT. During follow-up, histological findings deteriorated from mild changes to extended fibrosis at day 61 after OLT, which might have contributed to the maintenance of portal hypertension. The deterioration of liver histology was accompanied by an improvement/normalization of liver graft function. There was no evidence for additional viral liver infections, e.g. hepatitis B or cytomegalovirus infection. This case illustrates an etiologically unclear syndrome developing directly after OLT and reaffirms the effectiveness of TIPS in the treatment of complicated portal hypertension even after liver transplantation.

Aged↗
PubMed1998

[Technique, risks and results of additional portal vein resection in surgical therapy of proximal bile duct carcinoma].

The infiltration of the portal vein is not considered an absolute contraindication for resection therapy of proximal bile duct carcinomas. Portal vein resection and reconstruction may be performed without additional perioperative risk after hilar resection and hepatectomy. The resected hepatic vein is a suitable material for portal vein reconstruction. The median survival of patients with additional portal vein resection is comparable with patients without vascular infiltration in the same tumor stage.

Adult↗
PubMed1997

Attenuation correction by simultaneous emission-transmission myocardial single-photon emission tomography using a technetium-99m-labelled radiotracer: impact on diagnostic accuracy.

Irregular photon attenuation may limit the diagnostic accuracy of myocardial single-photon emission tomography (SPET). The aim of this study was to quantify the potential benefit of attenuation correction by simultaneous emission and transmission imaging for the detection of coronary artery disease (CAD) of vessels supplying the inferoposterior wall segments. In 25 male patients with >/=50% stenoses of the right coronary artery and/or circumflex artery but without significant narrowing of the left anterior descending artery, stress studies using technetium-99m tetrofosmin (400 MBq) were carried out with and without attenuation correction. A dual-head camera with L-shaped detector positioning was equipped with two scanning gadolinium-153 line sources. Tomograms were reconstructed and quantified using circumferential count rate profiles of myocardial activity (two in each patient). The profiles were compared with the respective normal ranges obtained from a database of 25 male patients with a <10% likelihood of CAD. In patients without CAD, the maximal differences in count density of different wall segments were reduced from 29.0% in non-corrected (NC) studies to 9.5% in attenuation-corrected (AC) studies. In particular, the inferoposterior and septal wall segments were represented by significantly increased relative count densities after attenuation correction. The effects of attenuation correction proved independent of body mass. In patients with CAD, segmental count densities were abnormal in 84% of the NC studies and 100% of the AC studies. In single-vessel disease the stenotic vessel was identified in 66% of cases by NC studies and in 100% by AC studies. In AC studies, the extent and depth of defects exceeded those in NC studies. For the detection of CAD of the right coronary artery, the receiver operating characteristic (ROC) curves relating to the AC studies demonstrated improved discrimination capacity (P<0.05). ROC analysis of CAD detection yielded normalcy rates of 82% (NC) and 94% (AC) for the circumflex artery and 65% (NC) and 97% (AC) for the right coronary artery area at a sensitivity level of 95%. It is concluded that attenuation correction using the above system may enhance the diagnostic accuracy of myocardial SPET when inferoposterior wall segments are to be evaluated.

Algorithms↗
PubMed1997

Age-specific cerebral perfusion in 4- to 15-year-old children: a high-resolution brain SPET study using 99mTc-ECD.

This study addresses the question of whether the normal range for distribution of local cerebral blood flow (lCBF) in adults can be transferred to the 4- to 15-year-old age group. Twenty-three children (age: 4-15 years; mean 11+/-3 years, group I) and 10 adults (age: 27-56 years; mean 45+/-10 years, group II) without evidence of cerebrovascular disease or other brain diseases underwent technetium-99m ethyl cysteinate dimer single-photon emission tomography. Counts in cortical and subcortical regions of interest (ROIs) were related to those in cerebellar ROIs (= 100%). Relative cortical activity in group I exceeded that in group II, particularly in left parietal (107.6%+/-9.8% vs 84.1%+/-12.4%), left frontal (97. 7%+/-6.7% vs 79.4%+/-8.9%) and left temporal areas (99.7%+/-7.4% vs 84.9%+/-10.1%) and in the cingulate cortex (112.1%+/-9.1% vs 95. 9%+/-10.1%, P<0.05). Cerebral activity uptake per injected dose was inversely correlated with age in 19 children of group I (r = -0.77, P<0.001). In group I, there was also an inverse correlation between age and the relative local count density in the parietal (r = -0.42 to -0.57), frontal (r = -0.48), temporal (r = -0.42 to -0.58) and occipital cortex (r = -0.44). In these cortical regions relative counts differed when subgroups of children aged 4-10 and 11-15 years were analysed. It is concluded that there are systematic differences between 4- to 15-year-old children and adults with regard to normal lCBF. Diagnostic use of perfusion agents has to consider age-adjusted normal flow maps; normal ranges should be determined separately for the age groups 4-10 and 11-15 years.

Adolescent↗
PubMed1997

[Age dependence of cerebral Tc-99m-ECD distribution between preschool and school-age children and adults].

AIM: This present study deals with the question whether normal distribution of local cerebral blood flow (ICBF) agents in adults can be transferred to the age group of 4 to 15 years old children. METHODS: 23 children (age: 4-15 years, mean 11 +/- 3 y) (group I) and 10 adults (age: 27-56 years, mean 45 +/- 10 y) (group II) without evidence of cerebrovascular disease or other brain diseases underwent Tc-99m-ECD-SPECT imaging. Counts in the cortical ROIs were related to those of cerebellar ROIs (= 100%). RESULTS: In group I, relative cortical activity exceeded that of group II, particularly in parietal (107.6 +/- 9.8 vs. 84.1 +/- 12.4%), frontal (97.7 +/- 6.7 vs. 79.4 +/- 8.9%), left temporal areas (99.7 +/- 7.4 vs. 84.9 +/- 10.1%) and in the singular cortex (112.1 +/- 9.1 vs. 95.9 +/- 10.1%, p < 0.05). Cerebral activity uptake/injected dose/acquisition period was linearly correlated with age in group I (r = -0.78, p < 0.001). There was also a correlation of the relative local count density with age in 5 parietal ROIs (r = -0.42 to -0.57), in 2 frontal ROIs (r = -0.48), in 7 temporal ROIs (r = -0.42 to -0.58) and in 2 occipital ROIs (r = -0.44). In 14 cortical regions relative counts differed when subgroups of children aged 4-10 and 11-15 years were analysed. CONCLUSION: There are systematic differences between 4 to 15 years old children and adults regarding the normal distribution of ICBF. Diagnostic use of perfusion agents has to consider the respective age-adjusted normal flow maps; respective normal ranges should be determined for age groups of 4-10 and of 11-15 years separately.

Adolescent↗
PubMed1996

Postinfarction stress testing and one year outcome of stable patients after myocardial infarction treated with thrombolytics.

OBJECTIVE: The purpose of our study was to evaluate the predictive power of early postinfarction stress testing in survivors of uncomplicated MI treated with thrombolytics. METHODS: The study population consisted of 102 consecutive, thrombolyzed survivors (56 +/- 11 years) of acute, transmural myocardial infarction with uncomplicated postinfarction course. All patients were clinically stable in the postinfarction period and underwent cycle ergometry, 99mTc perfusion scintigraphy and dobutamine stress-echocardiography within three weeks after the acute event. Coronary angiography was used to determine the extent of CAD, LV ejection fraction (LVEF), TIMI grade and residual stenosis of the infarct-related coronary artery. A follow up questionnaire was performed one year after hospital discharge to determine the relation to the occurrence of cardiac events (unstable angina, reinfarction, PTCA, bypass surgery and death). RESULTS: 30 patients developed 34 cardiac events. Four patients died. Two thirds of the 'cardiac events' in the year of follow-up were revascularization procedures mostly selected by evidence of ischemia on 99mTc perfusion scintigraphy and/or stress-echocardiography. These two methods were significantly associated with the development of new cardiac events (stress-echocardiography: p < 0.01; 99mTc perfusion scintigraphy: p < 0.006). Parameters of bicycle ergometry and variables of coronary angiography were not related to an increased risk of future cardiac events. The number of 'hard cardiac events'--death or nonfatal AMI--was too small (8%) in these patients who are able to exercise to make statistical comparisons. CONCLUSIONS: The study underlines the necessity of early noninvasive risk assessment to identify patients at a greater risk among survivors of uncomplicated AMI treated with thrombolytics who are clinically stable in the early postinfarction period. PTCA and coronary bypass surgery is performed in one third of these patients selected mostly by evidence of ischemia on 99mTc perfusion scintigraphy and/or stress-echocardiography. Results of bicycle ergometry are of limited value in these patients within the first year after acute myocardial infarction.

Coronary Angiography↗
PubMed1996

Intraindividual comparison of three stress tests during the early postinfarction period in stable patients with thrombolysis.

The intention of the study was to intraindividually compare the ischemic yield of three stress tests early after acute myocardial infarction. At a large community hospital 107 stable patients who survived acute transmural myocardial infarction after thrombolytic therapy followed by an individual optimized medical treatment, were prospectively investigated by three noninvasive stress tests. All patients received bicycle ergometry, 99mTc perfusion scintigraphy and stress-echocardiography within three weeks after the acute event. Each patient underwent diagnostic cardiac catheterization for determination of angiographic data. 99mTc perfusion scintigraphy had the highest rate of positive test results (61%), as compared to bicycle ergometry (32%), stress echocardiography (34%) and stress induced angina in any of the stress tests performed (40%). In 79% of the patients studied, at least one of four ischemic parameters was positive. The combination of bicycle ergometry, stress induced angina and 99mTc perfusion scintigraphy detected myocardial ischemia in 78% of the patients studied. Concordance of at least three positive parameters was seen in only 27%. Intraindividual comparison between positive and negative test results was inconclusive. Only stress-echocardiography versus stress-induced angina showed a moderate agreement (kappa = 0.44). Stress-induced angina was the only ischemic parameter which corresponded to the grade of the residual stenosis of the infarct related coronary artery (p < 0.01) and reduced left ventricular function (p < 0.005). These findings show, that concordance of three common stress tests in detecting myocardial ischemia anywhere in patients after acute transmural myocardial infarction and thrombolytic therapy is poor. Stress-echocardiography and stress inducible angina show a moderate agreement. Follow-up studies of these patients are currently performed to clarify prognostic significance and therapeutic consequences of positive test results in these patients.

Angina Pectoris↗