Biomedical subjects

C Ackermann

Publications and source records attributed to C Ackermann.

At least 37 records · Page 2Linked to original sources

PubMed1995

[Abdominal cicatricial hernia--results of various surgical techniques].

Incisional hernias and recurrent hernias are frequent after abdominal operations. We studied possible reasons for the occurrence of recurrent hernia. From 1986 to 1990, 150 patients were operated for recurrent hernia in the St. Claraspital Basel. After a mean follow up of 5 years, 125 patients (83.3%) were evaluated. The recurrence rate of hernias--mostly first recurrences--was 19.2%; two thirds occurred in the first 24 months after operation. The time between the primary repair of the incisional hernia and the first recurrence was 23.1 months, between first and second recurrence 15.8 months and between second and third recurrence 12 months. Patients operated by a consultant showed a lower recurrence rate (16.6%) than patients operated by residents (30.4%). In primary hernias, repaired by a simple direct closure, a recurrence rate of 23.2% was observed and after a second or third operation even one of 50%. After implantation of a non-resorbable mesh, this rate was 12.5% of 14.3%, respectively. The recurrence rate was independent of the size of the defect. As result of our investigation, we would recommend to repair recurrent hernias by inserting a non-resorbable mesh by experienced operators.

Adult↗

PubMed1994

[Results of surgical therapy in esophagus and cardia carcinoma].

Surgery for carcinoma of the esophagus and cardia represents potentially curative therapy in early stage of tumor. In the advanced stage of tumor palliation is the only remaining therapeutic aim. In a retrospective study covering the period 1984-1992 we analyzed 51 patients who underwent surgery for esophageal or cardia cancer to determine whether palliation by surgery is feasible. We also analyzed morbidity and mortality of peri- and postoperative complications. In 88% we carried out standard esophagectomy consisting of abdomino-thoracic access, gastric interposition with thoracic anastomosis and extramucous pyloromyotomy. In the light of postresection histology, 53% of the operations were potentially curative (UICC stage I and II) [1], 47% palliative (UICC stage III and IV) [1]. Perioperative 30-days mortality was nil, perioperative 30-days morbidity 11% (3 patients developed pneumonia postoperatively, 2 patients with cervical anastomosis developed dehiscence of anastomosis which in both cases healed completely with conservative therapy, while a further patient with cervical anastomosis suffered persistent paralysis of the recurrent nerve. All patients were fully able to feed themselves at the time of discharge. 43% of patients had recurrent dysphagia and 24% underwent endoscopic dilatation. Three-year survival was 26%. From these results it may be concluded that esophageal resection represents either good palliation with low morbidity for the majority of patients with non-resectable carcinoma of the esophagus or potentially curative therapy with low morbidity in early stage of tumor.

Adenocarcinoma↗

PubMed1994

[Sphincter-preserving surgery of trans-sphincteric anal fistulas].

The "laying open" technique is the standard method of treating fistulas-in-ano. Laying open transsphincteric (high anal) fistulas involves division of a part of the external anal sphincter and may result in incontinence. In 12 patients with high transsphincteric fistula (7 with previous surgery to attempt fistula healing) we have used a sphincter-saving surgical method: excision of the fistula tract and closure of the internal opening by suture of the internal anal sphincter. Fistulas were eradicated in 8 patients (67%) without incontinence. In 4 patients the fistulas persisted. It is concluded that transanal closure of the internal opening and perianal fistula excision can be an effective method of treating transsphincteric fistulas without sphincterotomy, thus avoiding the risk of incontinence.

Adult↗

PubMed1994

[Cholecystectomy today. A prospective study].

Between 13 June 1990 and 12 June 1993, we performed 1145 consecutive cholecystectomies. 127 patients who had undergone additional surgery were excluded from the prospective study. Of the remaining 1018 patients, 806 (78.2%) underwent laparoscopic cholecystectomy. The conversion rate to open procedure was 11.2% (90/806). The operative morbidity associated with laparoscopic cholecystectomy was 2.1% (17/806) and with open surgery 1.9% (4/212); mortality was 0.12% (1/806) and 0.47% (1/212) respectively. The reoperation rate after laparoscopic cholecystectomy was 0.6% (5/806). Reoperation was performed for lesions of the common bile duct, bleeding, and abscess formation. If the indications for open cholecystectomy are respected the morbidity and mortality were low for both laparoscopic and conventional cholecystectomy.

Adolescent↗

PubMed1994

Maternal sensitivity as an external organizer for biobehavioral regulation in infancy.

Recent findings from both animal and human research have clearly demonstrated connections between behavioral coping mechanisms and adrenocortical function. The aim of this study was to address the role of maternal sensitivity as an external organizer of psychobiological function in infants during the first year of life. Forty-one infants and their mothers were observed during play at 3, 6, and 9 months of age. Age-specific patterns of relation between maternal sensitivity and infant behavioral organization were found indicating contextual dependence of infant behavior at 3 months and experience-related behavioral function at 9 months. An affect of maternal sensitivity on adrenocortical function during the free play was demonstrated at 3 and 6 months, because an increase in cortisol was most frequently observed in infants of highly insensitive mothers. The findings indicate the importance of maternal behavior for infant biobehavioral organization.

Adrenal Cortex↗

PubMed1994

Acute and chronic presentation of intestinal nonrotation in adults.

Intestinal nonrotation has been recognized as a cause of obstruction in neonates and children and may be complicated by volvulus and intestinal necrosis. It is very rarely seen in the adult and may present acutely as a bowel obstruction and intestinal ischemia associated with midgut or ileocecal volvulus, or chronically as vague intermittent abdominal pain. The purpose of this communication is to reveal the pathogenesis and the surgical significance of intestinal nonrotation in adults and to review the English and German language literature since 1923 to establish the optimal therapeutic management. Between 1983 and 1992, we have managed and observed prospectively 10 adults with intestinal nonrotation. In four patients the nonrotation has been detected at emergency laparotomy owing to midgut or ileocecal volvulus. Four patients suffered from chronic symptoms of intermittent volvulus or small bowel obstruction and in two patients the nonrotation has been noted as an incidental finding at laparotomy for another condition. A survey of the literature from 1923 to 1992 revealed 40 adults with symptomatic intestinal nonrotation to which we contribute nine patients. We establish that in the acute symptomatic pattern, only emergency laparotomy can provide the correct diagnosis and decrease the risk of bowel disturbance. In the chronic situation, barium studies of the upper and lower gastrointestinal tract reveal varying degrees of midgut malrotation and confirm the nonrotation in each case. Also, in these forms the explorative laparotomy with a consequent staging of the abdominal situs is to be recommended. All reported cases at our institutions are without complaints after surgery. Adult patients with intestinal nonrotation and acute or chronic obstructive symptoms or those detected incidentally at laparotomy for other conditions should undergo a Ladd procedure because of the risk of midgut volvulus. In this operation, the nonrotation is left in place and the ascending colon is sutured at the colon descendens and sigmoideum. After this procedure the mesenteric pedicle is fixed and the risk of midgut torsion remains minimal.

Abdomen, Acute↗

PubMed1993

[Results of esophagectomy in carcinoma of the esophagus and cardia].

Surgery for carcinoma of the esophagus and cardia represents potentially curative therapy in the early stage of the tumor. In the advanced stage of tumor, palliation is the only remaining therapeutic aim. In a retrospective study covering the period 1984-1992 we analyzed 51 patients who underwent surgery for esophageal or cardia cancer to determine whether palliation by surgery is feasible. We also analyzed mortality and morbidity of peri- and postoperative complications. In 88% we carried out standard esophagectomy consisting of abdomino-thoracal access, gastric interposition with thoracal anastomosis and extramucosal pyloromyotomy. In the light of postresection histology, 53% of the operations were potentially curative (UICC stage I and II) and 47 palliative (UICC stage III and IV). Perioperative 30-day mortality was nil, and perioperative 30-day morbidity 11% (3 patients developed pneumonia postoperatively, 2 patients with cervical anastomosis developed dehiscence of anastomosis which in both cases healed completely with conservative therapy, while a further patient with cervical anastomosis suffered persistent paralysis of the recurrent nerve. All patients were fully able to feed themselves at the time of discharge. 43% of patients had recurrent dysphagia and 24% underwent endoscopic dilatation. Three-year survival was 26%. From these results it may be concluded that esophageal resection represents good palliation with low morbidity for the majority of patients with non-resectable carcinoma of the esophagus.

Adenocarcinoma↗

PubMed1993

[Incidence of ileus following rectum resection in rectal carcinoma with or without radiotherapy].

Between 1984 and 1989 240 patients underwent radical abdominal resection of a rectal carcinoma. Out of 201 patients surviving 12 months or more postoperatively, two groups are surveyed. The first group presents patients undergoing adjunctive radiation therapy (n = 47), while the second group did not undergo postoperative radiation therapy (n = 134). Mean follow-up time postoperatively is 39 months. Within the irradiation group, the incidence of ileus was found to be 23% (11/47), and in the non-irradiated group 8% (11/134). Subsequent reoperations in order to clear intestinal obstruction were performed on 4% (5/134) of non-irradiated patients and on 21% (10/47) of the irradiated group. Considering the increased risk of postoperative ileus after rectal resection for rectal carcinoma, serious reflection should be given to assessing the appropriateness of adjunctive radiation therapy.

Combined Modality Therapy↗

PubMed1993

[Native radiologic staging of osteoporosis--CT densitometry of lumbar vertebral spongiosa. A correlation study].

Lumbar spine radiographs in 47 patients with manifest or clinically suspected osteoporosis were evaluated, using a staging system, and correlated to quantitative computed tomography (QCT) of lumbar vertebrae. The accuracy of osteoporosis assessment, obtained with plain film analysis, was 60%, the sensitivity 67%, the specificity 56%. Statistical correlation showed high standard deviation of each of the QCT-mean values according to the respective stage groups, and altogether poor linear correlation between increasing morphological stages of osteoporosis and decreasing QCT-values. As our results show plain film differentiation of normal from reduced trabecular bone mineral content is unreliable, even by use of a staging system. The diagnostic value of spine radiographs therefore remains limited to demonstration of advanced osteoporotic changes.

Absorptiometry, Photon↗

PubMed1993

[Perioperative morbidity and mortality in colon resection for colon cancer].

The operative risk of colon resections was evaluated by a retrospective analysis of 231 according patients who were operated on between 1984 and 1988. Mean age of the patients was 70 years with a range from 37 to 91 years. Colonic resection consisted of ileocecal resection in 3 cases, right hemicolectomy in 144 cases, segmental resection of transverse colon in 10 cases, left hemicolectomy in 22 cases, resection of sigmoid colon in 77 cases and 5 times a subtotal colectomy was performed. In two patients (0.9%) an anastomotic leak occurred. Three patients were reoperated on: one due to an anastomotic disruption, two others due to a mechanical small bowel obstruction. Two patients (0.9%) died due to systemic complications without any evidence of anastomotic or wound problems. Thus a low morbidity and mortality of colonic resection is documented in our study. Factors contributing to these results are a standardized bowel preparation, perioperative antibiotics and modern anaesthetic techniques.

Adult↗

PubMed1993

[The incidence of ileus after resection for rectal cancer with and without radiotherapy].

Between 1984 and 1989 240 patients had radical abdominal resection of a rectal carcinoma. Out of 201 patients surviving 12 months or more postoperatively, two groups are surveyed. The first group presents patients undergoing adjunctive radiation therapy (n = 47), the second group did not undergo postoperative radiation therapy (n = 134). Mean follow-up time postoperatively is 39 months. Within the irradiation group, the incidence of ileus was found to be 23% (11/47), in the non-irradiated group 8% (11/134). Subsequent reoperations in order to clear intestinal obstruction were performed on 4% (5/134) of non-irradiated patients and on 21% (10/47) of the irradiated group. Considering the increased risk of postoperative ileus after rectal resection for rectal carcinoma, serious reflection should be given to assessing the appropriateness of adjunctive radiation therapy.

Adult↗

PubMed1992

[Perioperative morbidity and mortality of colon resection in colonic carcinoma].

An analysis of the local and systemic perioperative complications is conducted to explore the risk of resection of colon cancer. In a retrospective study we analyzed 231 consecutive patients operated on between 1984 and 1988. The mean age was 70 (37-91) years. The operations consisted in 3 ileocecal resections, 144 right hemicolectomies, 10 resections of the transverse colon, 22 left hemicolectomies, 77 resections of the sigmoid colon and 5 subtotal colonic resections. 2 patients (0.9%) had a clinical leakage of the anastomosis. 3 patients were reoperated: one because of anastomotic leakage and two because of ileus due to small bowel adhesions. 2 patients with uncomplicated local healing died within 30 days after the operation from systemic complications (mortality 0.9%). It is concluded that with standardized preoperative bowel preparation, prophylactic perioperative antibiotics and modern anesthesia, the resection of colon cancer is today possible with minimal perioperative risk.

Adult↗

PubMed1992

[Fundus plication with or without proximal selective vagotomy?].

The aim of this study was to determine the influence of proximal gastric vagotomy on the outcome after fundoplication. Of 141 patients operated on for reflux disease between 1972 and 1988, 53 had fundoplication alone (group A) and 88 fundoplication combined with proximal gastric vagotomy (group B). The two groups were similar with regard to the severity of the reflux disease (esophagitis: A 69%, B 73%) but had a different incidence of concomitant ulcer disease (A 2%, B 55%). After a mean follow-up of 9 years, 111 patients (79%) were evaluated by clinical examination and 57 patients (40%) by endoscopy. Perioperative morbidity was similar (A 22%, B 19%). Successful reflux control (A and B 81%) and overall clinical outcome (Visick I and II: A 78%, B 80%) were identical. The frequency of adverse side effects was approximately the same in both groups (dysphagia: A 28%, B 26%; gas-bloat: A 52%, B 37%). We conclude that the long term results after fundoplication are not improved by additional proximal gastric vagotomy. The combined procedure is therefore only justified if both reflux disease and ulcer disease are present.

Adolescent↗

PubMed1992

[Laparoscopic cholecystectomy. Initial experiences and results in 278 patients].

Of 467 cholecystectomies (performed between 13. 6. 1990 and 12. 9. 1991) 278 were done by laparoscopy (196 women, 82 men; mean age 53 [18-86] years). Contraindications to a laparoscopic procedure were acute cholecystitis, severe chronic cholecystitis with adhesions, abnormal clotting and suspected gallbladder carcinoma. In 31 patients (11.1%) the initial laparoscopic cholecystectomy was continued as a conventional cholecystectomy, usually because of unclear conditions in severe chronic cholecystitis. Mean duration of hospital stay was 6.3 days for the laparoscopic procedure compared with 11.5 days for the conventional one. Complications occurred in four patients (in 12 with the conventional method): one occlusion (by clip) of the common bile duct, one bile leak, one bleeding and one pneumothorax, requiring re-operation in three patients. There were no deaths (compared with two in the conventional group). Assuming correct indications, laparoscopic cholecystectomy is a sparing method for the treatment of cholecystolithiasis.

Adolescent↗

PubMed1992

[Incidence of ileus following rectum resection in rectal carcinoma with or without radiotherapy].

Between 1984 and 1989 240 patients underwent radical abdominal resection of a rectal carcinoma. Out of 201 patients surviving 12 months or more postoperatively, 2 groups are surveyed. The first group presents patients undergoing adjunctive radiation therapy (n = 47), while the second group did not undergo postoperative radiation therapy (n = 134). Mean follow-up time postoperatively is 39 months. Within the irradiation group, the incidence of ileus was found to be 23% (11/47), and in the non-irradiated group 8% (11/134). Subsequent reoperations to clear intestinal obstruction were performed in 4% (5/134) of non-irradiated patients and 21% (10/47) of the irradiated group. Considering the increased risk of postoperative ileus after rectal resection for rectal carcinoma, the appropriateness of adjunctive radiation therapy should be carefully assessed.

Adult↗

PubMed1992

[Laparoscopic cholecystectomy--experiences and results with a new surgical technique].

Laparoscopic cholecystectomy is a genuine alternative to open cholecystectomy. Acute cholecystitis, chronic cholecystitis with adhesions and gallbladder cancer are absolute, and bile duct stones in rare situations and previous surgery relative contraindications. Ultrasound and intravenous cholecysto-cholangio-tomography are obligatory preoperative investigations. Over 14 months we performed 253 laparoscopic cholecystectomies. Mortality was 0%. Relaparotomy was necessary in 3 of 4 complications (injury of the common bile duct, bile leak and hemorrhage), the reoperation rate is 1.18%. The fourth complication was a pneumothorax after injury of the diaphragm with the electrohook. Conversion to open cholecystectomy was necessary in 10.7%, usually after severe chronic cholecystitis with adhesions. The length of hospitalization was 11 days after open cholecystectomy and could be reduced to 6.5 days after laparoscopic cholecystectomy. With similar results concerning mortality and reoperation rate, the advantages of laparoscopic cholecystectomy are reduced postoperative pain, a shorter recovery time, shorter hospitalization and a better cosmetic result.

Adolescent↗

PubMed1992

[What is the contribution of surgery in cholelithiasis today?].

1631 patients with cholelithiasis were operated on between 1984 and 1989 at the St. Clara Hospital in Basel. Mortality and rate of reinterventions were evaluated. 1357 patients had cholecystectomy with a mortality of 0.07%, 217 patients needed an exploration of the common bile duct, which increased the mortality rate to 0.9%. 57 patients had a transduodenal papillotomy, biliodigestive anastomosis or a reoperation without any death. The overall mortality was 0.18%. The mortality for patients over 60 years was 0.4%, there were no deaths for patients under 60 years. The mortality did not increase when there was an acute inflammation of the gallbladder. Reinterventions had to be done in 1.3%. The most common reason for reoperation was a retained common duct stone, which was then removed by endoscopic sphincterotomy (0.86%). Operative injury of the common duct occurred in 0.6% (1 of 1631 patients). Cholecystectomy is still standard treatment of cholelithiasis because of its low mortality and reintervention rate.

Adolescent↗

PubMed1991

[Esophageal manometry prior to and following anti-reflux surgery].

We analysed the esophageal manometry of 36 patients before, and of 25 patients 1 to 14 years (5.8 years) after, fundoplication. The results were compared with the findings in 30 asymptomatic volunteers. Fundoplication raised the mean lower esophageal sphincter pressure from 6.2 mm Hg to 14.5 mm Hg, i.e. normal values (controls 20.2 mm Hg). The shortened lower esophageal sphincter length and its intraabdominal segment were overcorrected (increase from 3.2 to 5.2 cm [controls 4.1 cm] and 1.3 to 2.6 cm [controls 2.1 cm] respectively). The rate of non-specific motility disorders after fundoplication was reduced from 61% to 28% (controls 7%). A clear relationship between the success of fundoplication and either preoperative or postoperative manometric results could not be established.

Adult↗