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Biomedical subjects

E H Farthmann

Publications and source records attributed to E H Farthmann.

At least 109 records · Page 6Linked to original sources
PubMed1991

[The effect of Federal Public Health Service guidelines on air, surface and floor germ count in a general surgery and an orthopedic operating room].

In a prospective study the environmental contamination in an old and a new operating theatre was investigated. The old operating rooms were constructed in 1936 whereas the new rooms were built in 1986. The study was conducted in surgical and orthopedic surgical operating rooms. There was a slight increase in floor as well as in surface contamination in the new operating rooms. On the other hand there was a slight decrease in the airborne microorganisms in the orthopedic surgery and nearly identical colony counts in the general surgery operating rooms. All the differences were statistically not significant. The spectrum of microorganisms and the occurrence of Staphylococcus aureus in the old and the new operating rooms showed no difference.

Air Microbiology↗
PubMed1991

[Percutaneous diagnosis and therapy of the bile ducts and gallbladder. Feasibility and status].

Percutaneous transhepatic access to the bile duct has opened up new possibilities not only for diagnosis by means of cholangiography and cholangioscopy with endoscopically guided biopsy by small-bore equipment, but also for the treatment of benign and malignant obstructive jaundice. In malignant disease recanalization of the obstruction is possible by means of laser, intracavitary irritation, internal bile drainage in Klatskin tumors, large-diameter endoprostheses (e.g., a Y-shaped prosthesis) or metal stents. In benign disease, balloon dilatation of inflammatory stenoses, stone extractions from the bile duct or gallbladder by means of Dormia baskets, ultrasound or piezoelectric shockwave-contact lithotripsy and chemical litholysis are possible. Very often percutaneous access is a real alternative to surgical intervention.

Bile Duct Diseases↗
PubMed1990

[Expert commission for questions of physician malpractice. More than 10 years service for the patient and physician--report from the Südbaden District Chamber of Medicine].

The provision of an objective expertise on medical practice by an expert commission and arbitration board aims to make it easier for the patient to prove a justified claim, and for the physician to reject unfounded accusations made against him. A retrospective consideration of the activities of the expert commission on questions of medical liability at the Medical Society of Baden-Württemberg for the region covered by the District Medical Society Südbaden shows that the expert commission is being approached progressively more often. The medical discipline most frequently involved is surgery. Although claims are more frequently made against hospital doctors than against doctors in private practice, the latter are more likely to be guilty of maltreatment. Iatrogenic mistakes made during routine treatments can lead to serious consequences for the patient. An analysis of the activities of the expert commissions can open up new possibilities for quality control in medical care and further medical education.

Expert Testimony↗
PubMed1990

Granulocyte elastase in assessment of severity of acute pancreatitis. Comparison with acute-phase proteins C-reactive protein, alpha 1-antitrypsin, and protease inhibitor alpha 2-macroglobulin.

Complexes of granulocyte elastase and alpha 1-antitrypsin are markers for granulocyte activation. In 75 patients with acute pancreatitis these complexes were immunologically determined daily in plasma during the first week of hospitalization. Patients were classified into three groups: mild pancreatitis (I, less than or equal to 1 complication, N = 34), severe pancreatitis (II, greater than or equal to 2 complications, N = 29), lethal outcome (III, N = 12). Initially, granulocyte elastase (mean +/- SEM) was lower in group I (348 +/- 39 micrograms/liter) as compared to groups II (897 +/- 183 micrograms/l) and III (799 +/- 244 micrograms/liter), P less than 0.001 for I vs II + III. Initial elastase concentrations greater than 400 micrograms/liter were consistent with a severe or fatal course of the disease but did not distinguish between severe and lethal pancreatitis. In patients with mild or severe disease, mean elastase concentrations decreased continuously during the following days (197 +/- 15 micrograms/liter in mild cases, 325 +/- 30 micrograms/liter in severe cases at day 7). In patients with lethal disease, however, mean elastase concentrations even increased at day 2 and remained higher than 700 micrograms/liter during the observation period. At days 1 and 2 the predictive value for severe or lethal disease of raised (greater than 400 micrograms/liter) elastase concentrations [positive predictive value (PPV) 82%, negative predictive value (NPV) 81%] was better than that of elevated (greater than 100 mg/liter) C-reactive protein (PPV 73%, NPV 73%), elevated (greater than 4.0 g/liter) alpha 1-antitrypsin (PPV 59%, NPV 50%), or decreased (less than 1.5 g/liter) alpha 2-macroglobulin (PPV 82%, NPV 67%).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1990

[Is advanced age by itself a risk factor in large abdominal surgical interventions].

A logistic regression analysis was performed retrospectively in 237 patients over 70 years of age (group 1) who underwent surgery for diseases of the biliary tract, stomach, and colon and rectum. The data were compared with those of 273 patients with identical operations under the age of 60 years (group 2). The results of our analysis differed according to the cohort of patients. Age was shown to be a significant risk factor for perioperative mortality according to the analysis of young and old patients (group 1 and 2). Analysis of group 1 showed that the urgency of the operation and the sum of coexisting morbidities were significant. The combination of age and urgency is a significant risk factor following colorectal but not gastric and biliary surgery.

Aged↗
PubMed1990

[Blunt abdominal trauma: practical diagnostic strategy].

The principal aim of a practical diagnostic strategy is rapidly identify the organ injury following blunt abdominal trauma. A general diagnostic strategy and special technical investigations are described and their relative values discussed. From 1 January 1986 to 31 December 1989, 440 patients were treated for blunt abdominal trauma which had resulted in 166 organ injuries. Ultrasound was used in the initial investigation. Its sensitivity was 96% and specificity 98%. Following examination by ultrasound the rate of negative laparotomies was 1.3%.

Abdominal Injuries↗
PubMed1990

Nonendoscopic percutaneous gastrostomy.

Tight peritoneal adherence of the stomach to the abdominal wall as a prerequisite of percutaneous gastrostomy can be achieved by a newly developed cannula. It serves for puncture and fixation of the gastric wall. Thus, percutaneous gastrostomy can be established safely even in instances of an endoscopically nonaccessible stomach. Further applications of the device for the purpose of intestinopexy and facilitation of endoscopic procedures are being evaluated.

Esophageal Neoplasms↗
PubMed1990

[Injuries of the small and large intestine following blunt abdominal trauma].

From 1979 to 1987 1428 patients with blunt abdominal trauma were treated in the Department of Surgery of the University of Freiburg; 119 patients had intestinal injuries. They were mainly young adults who had sustained a car accident. 71.3% of the small bowel injuries were overseen, 14.2% needed resection, and in 14.5% an operative procedure was not necessary. The surgical procedure for colonic injuries has to be chosen with regard to the age and general condition of the patient, to the severity of the trauma, to associated injuries and to the stage of peritonitis. Accordingly, 18% of the patients were treated with and 58% without a protective colostomy, 24% could be treated conservatively. Mortality and morbidity correlated with the severity of associated injuries. Morbidity was also dependent on the time interval between accident and operative therapy.

Adult↗
PubMed1989

Growth of colorectal carcinoma cells: regulation in vitro by gastrin, pentagastrin and the gastrin-receptor antagonist proglumide.

The growth-regulating effects of pentagastrin, gastrin and the gastrin-receptor antagonist proglumide were investigated in three established cell lines derived from human colorectal carcinomas in vitro and after transplantation into nude mice. In vitro a significant increase of cell growth in the SW 403 cell line incubated with pentagastrin or gastrin was observed. In the Lovo cell line this effect was only detected after synchronization of cell growth. Pentagastrin and gastrin had no effect on the growth of the Ls 174 T cell line. Proglumide reduced cell proliferation in all three cell lines as well as in the L929S cell line derived from fibroblasts, which served as control. After transplantation into nude mice all tumor cell lines increased, Lovo and Ls 174 T as undifferentiated tumor, SW 403 as differentiated. Pentagastrin increased and proglumide decreased growth in SW 403 tumors, whereas no effect was observed on Ls 174 T and Lovo tumors. We therefore conclude that growth of some colorectal carcinomas is regulated by gastrin, but that the effect of proglumide is unspecific rather than related to blockage of gastrin receptors. The growth-regulating effect of gastrin could be due to tumor differentiation.

Animals↗
PubMed1989

Detection of biliary origin of acute pancreatitis. Comparison of laboratory tests, ultrasound, computed tomography, and ERCP.

Fifty consecutive patients with acute pancreatitis were assessed with respect to a biliary origin of the disease. Endoscopic retrograde cholangiopancreaticography, surgery, and autopsy were used to define biliary pancreatitis. Ultrasound, computed tomography, and several laboratory tests (SGOT, SGPT, alkaline phosphatase, and bilirubin) were analyzed for their ability to detect a biliary origin of the disease. Ultrasound and computed tomography could not reliably make the diagnosis in the 10 patients found to have biliary disease. Receiver-operator-characteristic curves revealed that none of the laboratory tests assessed had sufficient sensitivity and specificity to determine the diagnosis, although all tests showed higher mean values in biliary pancreatitis. SGPT gave the best discrimination (positive predictive value 53%, negative predictive value 94%, cut off 40 units/liter). Therefore, initial ERCP is suggested for a reliable diagnosis of biliary origin of acute pancreatitis.

Acute Disease↗
PubMed1989

Monitoring of the inflammatory response in early peritonitis.

The inflammatory response which is similar in all forms of peritonitis was recorded by determining the levels of parameters shown to represent the activation state of plasmatic and cellular systems as well as the inhibitory capacity of the plasma. In a selected series of patients with different underlying diseases, blood sampling was started at the time of admission when the clinical finding of an acute abdomen led to emergency laparotomy. Depending upon the duration of the illness and the severity of the peritonitis, a significant increase in fibrinopeptide A and of C3a could be detected within a few hours, which was followed by an increase in the elastase alpha-1-proteinase inhibitor complex. Differences due to variable cause could not be found. There was a striking correlation between the preoperative values of these three parameters and the postoperative course of the patients. Additionally, there was a significant enhancement of an endothelial proliferation-inhibiting capacity in the serums of the lethal group, whereas endotoxin could only be detected in trace amounts in four patients with intraabdominal infection in the preoperative period.

Adult↗
PubMed1989

[Sonography in acute pancreatitis--diagnosis, assessment of etiology and evaluating prognosis].

Fifty consecutive patients suffering from acute pancreatitis were studied prospectively with regard to the role of ultrasound (US) in diagnosis, in detection of a biliary origin, and in initial assessment of prognosis. In six patients the pancreas could not be visualised, whereas in 19 only partial examination was possible. In 34% no diagnostic abnormalities were found. US was superior to computed tomography (CT) in respect to the detection of small amounts of ascites, but less suitable than CT for the detection of necrosis. Compared to endoscopic retrograde cholangiography US was of little help in detecting bile duct stones. Neither a lethal outcome nor a severe course could be predicted with sufficient accuracy. The positive predictive value for the presence of necrosis was 33% and the negative predictive value 67%. The data demonstrate a limited role of US in diagnosis and staging in acute pancreatitis.

Acute Disease↗
PubMed1989

[Contents and curriculum in continued education for surgeons].

The need for continuing medical education results from the challenge of retaining competence in treating patients. The quality of care is thus directly related to continuing medical education. Contents are knowledge as well as behaviour. Methods should be orientated towards personal needs and problems encountered. Selective and critical reading is of paramount importance. Of equal impact are more or less formalized personal interactions. Learning by teaching is an effective means of continuing medical education.

Clinical Competence↗
PubMed1989

[Deep rectal cancer: local excision--methods, results, complications, recurrences].

Early rectal carcinoma of the lower rectum without involvement of the muscularis propria should be considered for local treatment. Factors indicating a poor prognosis can be identified histologically by "total biopsy". Definitive management depends on the postoperative tumor stage, type, histologic grading, lymphatic invasion and incomplete surgical excision. Survival rates after limited procedures or radical surgery do not differ, provided that clinical and histologic criteria are observed.

Follow-Up Studies↗
PubMed1989

[The effectiveness of sonography in preoperative thyroid diagnosis].

Real time sonography is the main method used to distinguish between diffuse and focal pathological variations in the thyroid gland. It always detects the presence of the cysts, thus obviating the need for scintigraphy. The sensitivity of sonography for the thyroid nodules is nearly 100%, whereas its specificity is only 60%. The value of sonography in thyroid gland disease is discussed and a diagnostic scheme for thyroid nodules is given.

Diagnosis, Differential↗