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Biomedical subjects

C Gebhardt

Publications and source records attributed to C Gebhardt.

At least 91 records · Page 5Linked to original sources
PubMed1990

[Laser therapy of colorectal tumors].

Between Jan. 1, 1986 and March 31, 1988 a total of 128 patients with tumours of the colon and rectum were treated by Nd-Yag laser at Nürnberg City Hospital. There were 36 benign and 92 malignant lesions. The indications for laser therapy were stenosis, bleeding, spasms of the pelvic floor and increased mucous production. Initial control of these problems could be achieved in 105 patients (82%), however, the symptoms recurred in 50% of the malignant and 47% of the benign tumours. Complications of laser treatment were encountered in 13 patients necessitating an operative intervention in 6. In all, 34 patients underwent additional surgery after laser treatment. Most frequently, a diverting colostomy had to be provided (n = 18) while 12 patients underwent anterior resection; in three an abdomino-perineal resection was performed and in one patient a Hartman procedure was necessary. The median observation time of patients with benign tumours is, at present, 16 months with 72% being free of disease. In malignant tumours the median survival time of patients with laser therapy only is 4.5 months; those with additional surgical treatment survived a median of 17.5 months.

Adult↗
PubMed1990

Duodenal pancreatectomy with occlusion of the pancreatic duct.

In 1978 partial duodenopancreatectomy with Ethibloc duct occlusion of the pancreatic remnant was introduced for use in patients with severe chronic cephalic pancreatitis. Our intention was to remove the largely destroyed part of the gland, and to induce controlled glandular atrophy in the residual portion in order to prevent further recurrence of pancreatitis. Since then this surgical procedure has been performed in 328 patients. The perioperative mortality was 1.2%, the complication rate requiring relaparotomy 7.1%. So far pancreatitis has recurred in only 2.2% of cases, due, we believe, to incomplete ductal block. Some 53% of the patients remained free of pain and symptoms, while 35% have occasional minor complaints. In a prospective follow-up study of 23 patients, Ethibloc duct occlusion was shown to be highly effective in inducing controlled atrophy of the gland and thereby terminating the inflammatory process. Endocrine function was preserved at the post-resectional level.

Adult↗
PubMed1989

[Treatment of spontaneous pneumothorax].

Experience with 300 episodes of spontaneous pneumothorax in 209 patients is reported. The treatment results of two time periods 1980-1983 (A) and 1985-1987 (B) are compared. During the second period the diagnostic work-up was much more extensive and included pleurography, CT-scan and thoracoscopy. This resulted in a more differentiated therapy and a reduction in the recurrence rate from 41% to 22%. Among the different modes of treatment chest-tube drainage alone had the worst results with a 44% rate of early and late recurrence. Better results were obtained with pleurodesis using fibrin adhesive either through a pleural catheter (24%) or thoracoscopically (13%). Operative treatment had the lowest recurrence rate (4%). In the primary treatment of spontaneous pneumothorax chest-tube drainage had a recurrence rate of 33% and catheter-pleurodesis with fibrin adhesive of 18% while no relapse could be observed in the group treated by thoracoscopy or operation. In the treatment of recurrent pneumothorax chest-tube drainage alone is unsuitable because of a failure rate of 64%. Catheter pleurodesis also had a high rate of recurrence (30%). The best results were again obtained by thoracoscopic (19%) and operative treatment (4%). On the basis of the described experience an individualized approach to the treatment of spontaneous pneumothorax is recommended.

Adolescent↗
PubMed1989

[Resection of the superior vena cava in tumor occlusion].

Report about three cases of resection of the superior vena cava for tumor stenosis or occlusion. In one patient no reconstruction was performed while in the other two interposition of an armored PTFE-prosthesis between right brachio-cephalic vein and vena cava superior was carried out. In agreement with other authors it is concluded that best results can be obtained by reconstruction with a PTFE-prosthesis or autologous vein graft.

Adult↗
PubMed1989

[Early endoscopic retrograde cholangiopancreatography in acute pancreatitis].

Based on a prospective trial on 91 patients diagnostic and therapeutic evaluation of ERCP in the early phase of acute pancreatitis was carried out. Detection of biliary stone disease and visualization of tumours of the papilla or main bile duct leads to therapeutic consequences (Papillotomy, exstirpation of the tumour). In addition to that, ERCP yields radiomorphologic informations, which seem to be typical for necrotizing pancreatitis. Showing a correlation to severity and prognosis of necrotizing pancreatitis these informations can be used for planning surgical tactics in the course of the disease.

Acute Disease↗
PubMed1988

[Villous adenoma of the papilla of Vater and acute necrotizing pancreatitis].

In two patients a villous adenoma of the papilla of Vater was found to be the cause of an acute necrotizing pancreatitis. The diagnosis was largely made by early gastroduodenoscopy and endoscopic retrograde cholangiopancreatography. After initially conservative treatment of the pancreatitis the adenoma was excised transduodenally in both patients. Histological examination in both revealed a completely removed benign villous adenoma. Both patients have remained free of symptoms after 18 and 6 months, respectively. These observations support the call for intensive diagnostic measures when a diagnosis of pancreatitis has been made: tumours of the pancreas and of the periampullar region should be ruled out.

Acute Disease↗
PubMed1988

[Wound healing of the pelvis following abdominoperineal rectum extirpation. A comparison of 2 drainage procedures in a prospective randomized study].

In a prospectively randomized study we used two different ways of drainage of the sacral space after an abdomino-perineal-resection of the rectum. One group with 25 patients had a drainage anteriorly through the abdominal wall, the other 25 patients got a drainage posteriorly through the buttocks. In each case we used two closed silicone-drainage-systems without active suction. In 60% of the anterior and in 50% of the posterior drained cases we saw an unaffected primary healing of the sacral wound. There was no significant difference. The patients felt the anterior way of drainage to be more convenient. Contamination of the sacral space by disrupture of the rectum during the operation was followed by a sacral abscess in 50%.

Adult↗
PubMed1988

[Diagnosis and surgical tactics in adrenal gland tumors].

Adrenal tumours are relatively rare. For localisation and reliable identification, stepwise radiological or nuclearmedical diagnosis should be added to targeted endocrinological diagnosis. Highest accuracy has been recordable from computed tomography, followed by phlebography, and arterial angiography. The authors feel that the extraperitoneal, lumbar approach can be considered a non-invasive, low-complication surgical method. It should be applied more often to cope with benign unilateral adrenal processes.

Adrenal Gland Neoplasms↗
PubMed1987

Whipple's procedure plus intraoperative pancreatic duct occlusion for severe chronic pancreatitis: clinical, exocrine, and endocrine consequences during a 3-year follow-up.

The present investigation provides follow-up data (up to 36 months) of exocrine and endocrine pancreatic function, inflammatory activity, pain, and body weight in 23 chronic pancreatitis patients submitted to Whipple's procedure plus intraoperative Ethibloc occlusion of the remaining pancreatic duct system between January 1983 and February 1984. Clinically, Whipple's procedure plus intraoperative pancreatic duct occlusion resulted in almost complete and continuous cessation of pain as well as significant (p less than 0.05) increase in body weight. With regard to exocrine pancreatic function (Secretin-Pancreozymin test, plasma amino acid consumption test, Pankreolauryl test, fecal chymotrypsin determination), intraoperative pancreatic duct occlusion was shown to induce high-grade insufficiency and thus exocrine parenchymal atrophy in all patients. Simultaneously, the inflammatory process (represented by serum levels of trypsin, lipase, and pancreatic isoamylase) was terminated in all 23 patients. Endocrine pancreatic function, evaluated by serum levels of insulin and C-peptide measured under fasting conditions and subsequent maximal combined beta-cell stimulation as well as corresponding integrated hormone releases, was reduced by partial pancreas resection by about 50%, while there was no further impairment during the 36-month follow-up period in consequence of additional intraoperative pancreatic duct occlusion. Altogether, Whipple's procedure plus intraoperative Ethibloc occlusion of the residual pancreatic duct system seems suitable for termination of the inflammatory process and thus preservation of residual endocrine pancreatic function in chronic pancreatitis.

Chronic Disease↗
PubMed1986

Upper gastrointestinal bleeding as an unusual presentation of a duodenal carcinoid.

Carcinoid tumors may develop in any part of the gastrointestinal tract. They constitute 1.5% of all gastrointestinal tumors (1). The duodenum is one of the least common sites of this tumor, with a reported incidence varying between 0.2% and 8.9% (2, 3). We report on a case of a bleeding duodenal carcinoid in a patient who underwent bilateral nephrectomy for malignant hypertension.

Carcinoid Tumor↗
PubMed1986

[Complications in pancreatic duct occlusion: passage of the occlusant into the venous system].

In two cases, occlusion of the residual pancreas remaining after a Whipple's procedure was associated with a "spillover" of the occlusant into the venous system of the pancreas, resulting in one of the cases in embolisation of intrahepatic branches of the portal vein. In both cases, the parenchyma of the residual pancreas was well preserved. The cause of the spillover into the venous system was the injection of a too large volume into the ductal system, with subsequent rupture of small side branches. To avoid this rare complication, the filling of the ductal system should be carried out under intraoperative radiological control.

Amino Acids↗
PubMed1986

Intravenous glucose tolerance after Whipple's procedure in patients with chronic pancreatitis--relative influence of occlusion of the pancreatic duct.

An intravenous glucose tolerance test was carried out to compare chronic pancreatitis patients (n = 17) who had undergone partial duodenopancreatectomy with (n = 9) and without (n = 8) occlusion of the residual pancreatic duct by Prolamin. The results obtained in 10 healthy volunteers were plotted as background information reflecting the normal metabolic response. Insulin- and C-peptide secretion were greatly decreased after both resection alone, and resection plus occlusion. However, the glucose tolerance (integrated glucose; K-values) appeared relatively well preserved in the two groups. The decrease in insulin appeared more marked after resection plus occlusion as compared with the non-occluded group. It is concluded that partial duodenopancreatectomy without or with ductal occlusion impairs insulin secretion, and leaves tolerance to an intravenous glucose load relatively stable. The mechanism underlying the latter observation is unknown at present.

Adult↗
PubMed1986

Ultrastructure of the islets of Langerhans after long-term occlusion of the pancreatic duct system.

The long-term effect of surgically induced atrophy and fribrosis of the exocrine parenchyma of the pancreas on the islets of Langerhans was examined electron-microscopically in animal experiments in mini-pigs. Ligature of the pancreatic duct, occlusion of the pancreatic duct system with an alcoholic solution of amino acids and the combination of this occlusion with ligature of the pancreatic duct were compared. A largely similar result was found in all three experimental groups 9 months post-operatively: The islets of Langerhans are mostly subdivided into predominantly small and apparently intact islet cell complexes by peri- and intra-insular fibrosis, and, where larger islet cell complexes are found, these are, in places, also destroyed in the peripheral region. The diffusion distance between the capillaries and the endocrine cells is, in part, considerably dilated by the interposition of collagen fibres. In the capillaries, thickenings and duplications of the basement membrane, as well as swelling of the endothelial cells can be found. There are rarely signs of atrophy in the islet cells lying in clusters. Only the granular structure of the B-cells diverges from the norm. From our morphological findings a delayed and diminished hormone output after pancreatic duct occlusion can be deduced, whereby, compared to earlier short-term experiments of our own, no significant progression of the peri- and intra-insular fibrosis can be determined.

Animals↗
PubMed1986

[Improved prognosis in acute pancreatitis].

An initial retrospective analysis of cases treated between 1963 and 1980 showed the main factors improving prognosis to be delayed operative treatment, radical removal of all necrotic tissue, post-operative use of irrigation and suction drainage. The prospective use of this regime during the years 1981 to 1982 resulted in an operative mortality of 29%. A further decrease in the operative mortality to 14% could be achieved in 1983 and 1984 by performing preoperative ERCP, because the knowledge of preexisting pancreatic fistulae and other pathologic changes of the duct system allow an individualized operative treatment adopted to the special problems of each cases.

Acute Disease↗