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Biomedical subjects

E H Farthmann

Publications and source records attributed to E H Farthmann.

At least 163 records · Page 9Linked to original sources
PubMed1981

[Necessity and field of application of retrospective analyses in a time of prospective controlled studies (author's transl)].

Prospective controlled studies give the most reliable background for clinical decisions. To use them correctly, however, many strict premises have to be fulfilled that are often impossible in practice. If no research is conducted in these cases, however, that means disastrous dependence on one method. The main application of retrospective analyses is therefore in the sense of a second-best solution. Furthermore, retrospective consideration is a genuine necessity for medical research if you are interested in the critical reflection of your own work and in dealing with new problems.

Humans↗
PubMed1979

[Goitres with "cold" nodules in an endemic goitre area (author's transl)].

Of 339 goitres with "cold" nodules 17.7% were histologically malignant. Related to all cold nodules which were examined, this suggest a "true" malignancy rate of nodules of about 0.4%. The risk of malignancy is highest in patients over 60 years of age. The malignancy rate was high, at 23%, in cold nodules of recurrent goitres. Fine-needle aspiration biopsy pre-operatively will correctly diagnose over 90% of malignant nodules.

Age Factors↗
PubMed1978

[Postoperative intestinal obstruction: introduction (author's transl)].

Postoperative intestinal obstruction is the indication for one-third of early reoperations. Mortality increases with age and time interval. Operations on the lower intestinal tract are predominant among the primary procedures. The main causes of obstruction are adhesions involving the small intestine. Diagnosis requires differentiation from paralytic ileus and physiologic postoperative paralysis. The outcome depends on early recognition, immediate reoperation, and adequate surgical management.

Diagnosis, Differential↗
PubMed1977

[Preoperative treatment of hyperthyroidism (author's transl)].

The preoperative preparation of hyperthyroidism requires the selective use of various drugs. As in the past, Plummer's iodine therapy takes precedence. Thyrostatics or beta receptor blockers, on the other hand, are only used in selected cases. The aim of preoperative preparation is euthyroidism. It is most rapidly and safely attained with Endoiodin (prolonium iodide) or combination of Endoiodine plus beta receptor blokkers. Thyrostatics appear to be less suitable for preparation, because they have a slow onset of action. Moreover, thyrostatics lead to densifications and adhesions of the thyroid gland capsule to the surrounding tissue, so that the preparation becomes complicated. 254 patients with hyperthyroidism and decompensated toxic adenoma were surgically treated without complications as a result of preparation with Endoiodin.

Adrenergic beta-Antagonists↗
PubMed1977

[Endoscopic retrograde pancreatography (author's transl)].

Endoscopic retrograde pancreatography is indicated in suspected malformations, chronic inflammation, and tumors of the pancreas. It is contraindicated in acute inflammation and severe obstruction of the main duct. The signs of chronic inflammation are deformities of the ductal system and/or intraductal calculi. Diffuse changes with beading were prominent in 51 patients studied. Malignant tumors cause stenosis, obstruction, tapering, or cavernous deformation of the ductal systm. Complete obstruction of the main duct was seen in the majority of 67 patients studied.

Acute Disease↗
PubMed1977

[The thoracic stomach. Etiology--diagnosis--therapy].

Congenital, acquired, and traumatic defects of the diaphragm are reported. Special consideration is given to positional changes of the stomach due to the above lesions. Clinical examples are used to point out the diagnostics and surgical possibilities of reparation.

Abnormalities, Multiple↗
PubMedDate not supplied

Principles and limitations of operative management of intraabdominal infections.

Operative management of intraabdominal infections still rests on the principles of elimination of focus, reduction of contamination of the peritoneal cavity, and treatment of residual infection. To control the source of contamination from a perforated viscus primary closure, exclusion or resection may be considered with respect to the severity of peritonitis and to the underlying disease. The principle of "peritoneal toilet" with complementary use of systemic and/or local antibiotics is generally accepted even if the value of aggressive debridement is still debated controversely. For the treatment of residual and the prevention of recurrent infection, closed and open lavage techniques, the left-open abdomen, and planned relaparotomy represent the major approaches in severe generalized peritonitis when the infectious focus might not be securely controlled. The values and disadvantages of different regimens are discussed, additional measures are briefly described, and an outlook on areas of further research is given.

Abscess↗
PubMedDate not supplied

Epidemiology and pathophysiology of intraabdominal infections (IAI).

Intraabdominal infection continues to be one of the major challenges in general surgery. Whilst the term "peritonitis" means an inflammation of the peritoneum regardless of its etiology, intraabdominal infections encompass all forms of bacterial peritonitis, of intraabdominal abscesses and of infections of intraabdominal organs. Several classification systems have been suggested for peritonitis and intraabdominal infections, respectively. However, neither phenomenological classifications nor classification systems with respect to the origin of bacterial contamination have a proven relevance for the clinical course of this disease. Moreover, most of the studies dealing with secondary peritonitis or intraabdominal infections are ill-comparable because of wide variations of inclusion criteria. Thus the true incidence of secondary bacterial peritonitis is difficult to assess. With respect to its etiology perforation of hollow viscus is the leading cause followed by postoperative peritonitis, ischemic damage of bowel wall, infection of intraabdominal organs and translocation in nonbacterial peritonitis. The anatomic origin of bacterial contamination and microbiological findings are no major predictors of outcome. However, the preoperative physiological derangement, the surgical clearance of the infectious focus and the response to treatment are established prognostic factors. The pathogenesis of intraabdominal infections is determined by bacterial factors which influence the transition from contamination to infection. Intraabdominal adjuvants and the local host response are additionally important. Bacterial stimuli lead to an almost uniform activation response which is triggered by reaction of mesothelial cells and interspersed peritoneal macrophages and which also involves plasmatic systems, endothelial cells and extra- and intravascular leukocytes. The local consequences of this activation are the transmigration of granulocytes from peritoneal capillaries to the mesothelial surface and a dilatation of peritoneal blood vessels resulting in enhanced permeability, peritoneal edema and lastly the formation of protein-rich peritoneal exudate.

Abdomen↗
PubMedDate not supplied

Hepatic cryotherapy involving the vena cava. Experimental study in a pig liver model.

Liver tumors located near the retrohepatic vena cava are often considered nonresectable. For these patients cryoablation could be a therapeutic option. In this study the safety and efficacy of hepatic cryosurgery involving the retrohepatic vena cava were investigated. Cryolesions involving the vena cava were created in 26 pigs. Follow-up was 24 h and 14 days. The extent of the cryolesion, damage to the vena cava and complications were assessed after autopsy. The cyronecrosis extended into the wall of the vena cava in 81% of the animals. All animals had an uneventful recovery without any complications such as ruptures of the vessel, thrombosis or pulmonary embolism. Microscopically elastic and collagenous fibers of the cava wall remained intact. The continuity of the vessel wall was conserved. In conclusion, the safety and efficacy of cryosurgical treatment involving the retrohepatic vena cava were shown in a pig model.

Animals↗
PubMedDate not supplied

Ergonomics: requirements for adjusting the height of laparoscopic operating tables.

BACKGROUND AND OBJECTIVES: In the last few years many new instruments and devices have been developed and introduced into the operating room (OR). A debate has been ongoing about the optimal ergonomic posture for the operating staff. From practical experience, we have learned that the operating tables cannot be adjusted adequately to allow surgeons of different stature to maintain a comfortable posture. The goal of this study was to establish the most ergonomic table height for the particular physique of the surgeon and the different types of laparoscopic instrument handles that he or she uses. METHODS: In a simulated model, two probands of different stature (50th [BS 50] and 95th [BS 95] percentile) used laparoscopic instruments with four different handle designs (shank, pistol, axial, and rod). The instruments were inserted into a board in three different angles ([IA] = 20 degrees, 30 degrees, 40 degrees). Additionally the elbow angles (EA) of the volunteers were fixed to either 90 degrees or 120 degrees. For every variable (size of surgeon and his or her elbow angle, design of handle, insertion angle of the instrument) the height of the board, as a parameter for the level of the abdominal wall of a patient with pneumoperitioneum, was measured from the floor. RESULTS: All parameters had an effect on the optimal operating table height. The lowest required operating table level was 30 cm, the highest was 60.5 cm. In laparoscopic surgery-long shafted instruments and patients with pneumoperitoneum-the tabletops are too high for over 95% of all surgeons. As skin incision and wound suture are performed the conventional way, the operating tabletop must be adjustable up to the common height of 122 cm. The maximal difference between the optimal heights of the OR-table for one volunteer using two different handles with different insertion angles of the instruments (BS 95, EA 90 degrees, IA 20 degrees, rod handle to BS 50, EA 120 degrees, IA 40 degrees, axial handle) was about 27 cm. CONCLUSION: New operating tables with a much lower adjustability are necessary to fulfill ergonomic requirements. The use of differently designed handles can hinder the ergonomic posture of the surgeon, because each handle requires a different working height.

Equipment Design↗
PubMedDate not supplied

[Contribution and limitations of peroperative radiotherapy combined with excision-curettage in the treatment of gastric cancers].

Macro- or microscopic residual tumor after surgery is the dominating prognostic factor in the treatment of gastric cancer. The majority of patients die of local recurrence and peritoneal spread. Therefore, in addition to gastrectomy and extended lymphadectomy (compartments 1 & 2) in some centers a adjuvant intraoperative radiotherapy is performed. Recent results of adjuvant intraoperative radiotherapy for gastric cancer revealed a lower local recurrence but there was no improvement in the survival rate for advanced tumor stages. These results are confirmed by our prospective study including 36 patients till now: in the group of 21 survivors there is no sign of a local recurrence. In 15 patients which died meanwhile there was only one case of local recurrence (median follow-up: 9 months, range 1-30 months). Peritoneal spread and liver metastasis were observed as the most frequent cause of death (tumor stage IIIB and IV only).

Combined Modality Therapy↗
PubMedDate not supplied

Phenotypical and functional characteristics of tumor-infiltrating lymphocytes from colon carcinomas stimulated with rIL-2 and rIL-4 in vitro: comparison with lymphocytes of the normal colon mucosa and the peripheral blood.

The phenotypical composition of tumor-infiltrating lymphocytes (TIL) from colorectal carcinomas was compared with that of intraepithelial lymphocytes of the autologous normal colon mucosa (IEL) and autologous peripheral blood lymphocytes (PBL). The CD4+/CD8+ ratios of the freshly isolated TIL, IEL and PBL were comparable and always > 1. CD25+, HLA-DR+ and CD56+ cells accumulated significantly in the TIL, while CD45RA+ cells were less frequent compared to the autologous IEL and PBL. CD29+ memory-cells were found with the highest frequency in the TIL. Stimulation with rIL-2 in vitro induced an outgrowth of CD56+ cells in the TIL. Concordantly the expression of CD3+ and the alpha/beta T-cell receptor was low. In a standard 51Cr-release assay these phenotypically LAK-cells representing effectors displayed an unspecific lytic activity against the autologous tumor as well as against allogeneic K562 and Daudi targets. The number of CD56+ cells could be reduced in TIL and PBL by simultaneous stimulation with rIL-2 and rIL-4, while the number of CD3+ cells increased.

Adult↗