PubMed Health⌕ Search

Biomedical subjects

D Rühland

Publications and source records attributed to D Rühland.

At least 19 recordsLinked to original sources
PubMed1999

[Preventive surgery: cost-efficiency relationship--an introduction].

The problems of financial costs in our health care system have led to preventive surgery being criticized as well, since valid data regarding the value for patients are often missing. The decrease in resources should induce the physician to check the efficacy of his therapy in comparative studies, especially when taking preventive measures. To reach an optimum for the benefit of the patient it is ethically justifiable to also mention economic aspects in these studies in order to gain financial resources further on.

Germany↗
PubMed1999

[The so-called medical team system in surgery, an alternative to hierarchy?].

Since some years representatives of the "Bundesärztekammer" (German Board of physicians)--induced too by the German parliament of physicians--demanded the establishment of "team-work-models" as a new form of administration of our clinical departments. There are many reasons argueing against a reformation of the present structures like economical considerations, a well-organized education and especially patient-care-management. Only scientifically-based evidence could justify a change of the well-approved head-physician-system in Germany.

General Surgery↗
PubMed1997

[Managing position of the surgery executive].

Recent legislation on health service has once again made the head of the department of surgery aware of his managing responsibilities. Cost saving will be possible in the areas of laboratory and high-tech diagnoses, surgery materials, storage of supplies, and administration of drugs. Since 70% of hospital costs are personnel costs, a substantial reduction in the hospital budget can only be obtained by reducing staff. In planning for the long term, we will be obliged to discuss "total quality management", which demands continuous improvement of the quality of our management and our patient treatment.

Cost Savings↗
PubMed1996

[What treatment expectations does the elderly patient have from surgery and what can surgery achieve? From the viewpoint of vascular surgery].

Vascular surgery represents 70% of surgery in over 60-year-old patients and 50% in over 70-year-old patients. For prophylactic reasons indications for operating should be made carefully in carotid and aneurysm surgery. In the case of chronic aorto iliacal obstructions extraanatomic procedures like femoro-femoral, ilio-femoral or axillo-femoral reconstruction should be preferred in high-risk patients. Combined intraoperative interventional procedures or percutaneous transluminal angioplasty including regional thrombolysis should be considered in the elderly.

Aged↗
PubMed1985

[Value of EEG monitoring in operations of the supra-aortic arteries].

Experiences with 207 patients operated under EEG monitoring have shown changes of EEG in 20% which made the application of an intraluminal shunt necessary. The majority of these patients had multimorbidity of supraaortic branches. Earliest changes could be seen after seven seconds of clamping time. In these cases an operation of the carotic artery should be avoided and an extra-intracranial bypass is recommended.

Brain Ischemia↗
PubMed1985

[Urologic complications following vascular prosthetic interventions in the aortofemoral area].

After vascular graft surgery within the pelvic area, urological complications occur in about ten percent of the patients. Overlooking 310 cases, four patients suffered from ureteral lesions and 21 patients had ureteral obstructions. Possible causes for ureteral obstructions are positioning of the ureter between vessel and prosthesis, hematoma, lymphoma, anastomotic aneurysm, prosthesis infection, Morbus Ormond as well as trophical lesions of the ureter wall. Use of ureteral splint could prevent surgical intervention in many cases. Application of prophylactic pre-operative splinting is recommended in case of large aneurysm, previously injured kidney and single kidney.

Aged↗
PubMed1985

[Angiospasm and dihydroergotamine--dangers in thromboprevention].

The advantages of perioperative low dose heparinization as well known. Angiospastic reactions of Heparin-DHE have been described. In some cases additional factors such as interruption of blood flow and application of sympathicomimetics, are supposed to be decisive for the course. In cases where the application of sympathicomimetics might be necessary, perioperative treatment with DHE should therefore be avoided. Consequent observation of the peripheric blood flow is required in traumatized patients. In addition to other vasodilating agents the intraarterial application of Prostaglandin E1 is of advantage in case of angiospastic reactions.

Adult↗
PubMed1984

[Restoration of work capacity after major vascular surgical interventions. Expectations and reality].

130 patients who had been working pre-operatively were examined and interviewed at least one year after an aorto-femoral bypass operation; 40.8% had continued smoking. Although 83.8% of patients were satisfied with the result of the operation, 73.9% could not be fully rehabilitated despite a successful operation. The majority of patients in whom work capacity had not been restored was in the group which was economically best protected (civil servants and employees). Apparently it is not the operation but the standard of socio-economic protection which is decisive in restoring work capacity.

Aorta↗
PubMed1984

[Transient reduced adrenal gland function following large vascular surgical interventions].

In 48 patients with aorto-femoral bypass-operations pre- and postoperative measurements of total serumcorticoids were performed. All serum levels were then compared to a control group undergoing large abdominal operations. In contrast to the control group twelve patients with aorto-femoral bypass-operations showed values that were for a time clearly below preoperative levels. In six patients with bypass-operations values could be found which were for a short time within the limits of relative adrenal insufficiency. ACTH-stimulation test performed in these patients showed significant lower values than those preoperatively measured. Due to systemic overdose heparinization we believe haemorrhage within the adrenal glands to be responsible for these changes.

Adrenal Cortex↗
PubMed1984

[Somatostatin in pancreas and small intestine fistulas].

Infusing 6 mg of somatostatin continuously for 24 hours will lead to a reduction of pancreatic secretion and perfusion of the splanchnic area. Due to this mechanism, secretion is significantly reduced in case of pancreatic or small intestine fistulae. Somatostatin was applied continuously in 39 patients for a period of 7 days. This led to a healing of pancreatic fistulae in 85.7% and small intestine fistulae in 63.6% of cases.

Adult↗
PubMed1982

[Xeroangiographic findings in patients with haemodialysis fistulas in the arm (author's transl)].

The authors report on a simple and accurate method for xeroangiographic visualisation of haemodialysis shunts in the arm which has been performed so far in 98 patients without complications. By this method, approx. 45 ml metrizamide (80 mg iodine/ml) are injected into the venous limb during short-term hypersystolic congestion. Single xeroradiography performed subsequently shows both the arterial and the venous vessels. The pathological findings established during the examinations (stenoses, pseudoaneurysms, venous thromboses) were confirmed by subsequent surgery.

Adolescent↗
PubMed1982

[Experience with the surgical treatment of peripheral arterial occlusions].

A total of 293 patients were treated 320 times for acute peripheral vascular occlusion. Arterial embolism was most frequent followed by arterial thrombosis and traumatic vascular occlusion. For differential diagnosis other causes had to be considered. The method of choice is extraction of the thrombus by Fogarty catheter or ringstripper. The results depend on the time between occurrence and operative treatment of the occlusion. Angiography is not necessary in a clear case of embolism, but essential when exact preoperative classification of the vascular occlusion is not possible.

Aged↗
PubMed1981

[Arteriosclerosis].

Explore the source record for details and available documents.

Arteriosclerosis↗
PubMed1980

[Clinical symptoms and morphology of ischemic proctitis (author's transl)].

Obliterating arteriosclerotic lesions of pelvic vessels may induce inflammation and fibrosis of the rectum and subsequently ischemic proctitis. This may lead to damage of the sphincter muscle and to complete incontinence. Clinical symptoms are pain and bloody stools, as in ischemic colitis. The combination of periproctitis and perianal necrosis may be misinterpreted as anal fistulas. An anus praeter sigmoideus is to be recommended for palliation. A case report of this particular disease is given including clinical, angiographic and morphological data.

Colostomy↗
PubMed1979

[Clinical experience with acute mesenteric vascular occlusion (author's transl)].

Between 1964 and 1978 twenty patients suffering from acute mesenteric vascular occlusion were treated in the surgical department (University of Münster). The average duration of the anamnesis until their hospitalization was 3.1 days and the actual operation was performed 11.35 hours later on the average. In only 15% of the cases had a correct preoperative diagnosis been given. As regards the frequency of causation, 60% of the mesenteric vascular occlusions were caused by a mesenteric arterioembolism, 20% by a mesenteric venous embolism, 10% by a mesenteric arterial thrombosis and 10% by a non-obstructive occlusion. In a post cardiac infarction condition was the predisposing factor in 50% of all cases, valvular defect in 33.5% and tachyarrhythmia in 16.6%. The causes found for the mesenteric venous tbrombosis were insufficiency of the right heart, absolute bradyarrhythmia, recurrent venous thrombosis of the leg, and myeloproliferative syndromes.

Adolescent↗