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Biomedical subjects

E Hagmüller

Publications and source records attributed to E Hagmüller.

29 records · Page 2Linked to original sources
PubMed1995

[Long-term survival after surgical therapy of T4 colorectal carcinomas].

Between 1972 and 1990, 456 patients with locally advanced colorectal carcinomas (tumor stage T4) were operated. In 187 cases the operation was extended by multivisceral resection and in 269 patients a conventional resection was performed. The rate of curative R0-resections was 74.9% for the extended resection group compared to 66.2% for the conventional group. The postoperative mortality after extended resection was 4.9% (2.9% conventional resection). Analyses of long-term results showed a 5-year survival for all R0-resected cases of 52.1% +/- 4.1. Further evaluation of additional lymph-node involvement in T4 colorectal tumors revealed significant differences in 5-year survival: 64.8% T4N0; 27.9% T4N1,2; 9.2% T4N3 for conventional R0-resection and 59.9% T4N0; 23.2% T4N1,2; 6.6% T4N3 for extended R0-resection. After curative resection (R0) the presence or absence of intraoperative tumor-cell dissemination could be identified as a significant prognostic factor. In all cases of T4 colorectal carcinomas-especially for N1-3-an adjuvant treatment after conventional or extended R0-resection is recommended.

Adult↗
PubMed1994

[Mesh wrapping of the liver. A very promising method for managing severe liver trauma].

Mesh-wrapping is a quick and technically feasible method to achieve definitive hemostasis in severe liver trauma. It can be combined ideally with conventional procedures. Mesh-wrapping has the same spectrum of indications in severe liver trauma as packing with gauze pads. Whereas packing seems to be superior in cases with bleeding from juxta-caval injuries, Mesh-wrapping is considered to be superior in coagulopathy. The Mesh-wrapping technique provides a highly selective, tight compression confined to the liver and does not produce an increased intraabdominal pressure. The mesh is resorbable and therefore reoperation for removal is not necessary. In cases of postoperative fluid collections the Mesh-wrapping can easily be punctured. Because of its own bacteriostatic capacity Mesh-wrapping seems to be superior when the patient has concomitant gastrointestinal injuries. In summary we think that Mesh-wrapping is a useful alternative in the more conservative, organ preserving spectrum of liver trauma management.

Adult↗
PubMed1993

Effects of ornithine aspartate on plasma ammonia and plasma amino acids in patients with cirrhosis. A double-blind, randomized study using a four-fold crossover design.

This paper documents dose-dependent effects of ornithine aspartate (OA) on postprandial hyperammonemia and plasma amino acids. Ten patients with cirrhosis were randomized to undergo 1 out of 4 infusion series. Each series consisted of four 8-h infusions (09:00 h-17:00 h), with placebo (NaCl), 5 g, 20 g or 40 g of OA being administered on separate days in varying sequences. This 4-fold crossover design was double-blind. On infusion days, patients received 2 oral protein loads (0.25 g/kg at 09:00 h and 0.5 g/kg at 13:00 h). Venous blood samples were drawn every 2 h and the 24-h urine was collected. In addition to measuring plasma ammonia and amino acids, the urea production rate, serum glucose and serum insulin were analyzed. A significant postprandial rise in the ammonia concentration was noted during the infusions of placebo and 5 g of OA but did not occur with the dosages of 20 g (after the second protein load) and 40 g (after both protein loads). Furthermore, the latter dose, compared with placebo, significantly reduced plasma ammonia after the minor protein load. Urea production rate increased when 20 g or 40 g of OA was administered. Of the amino acids involved in the metabolic pathways of ornithine and/or aspartate, glutamate showed a rise in its plasma level following infusion of 40 g of OA, whereas glutamine did not. Concentrations of methionine, phenylalanine, tyrosine, threonine, serine and glycine declined progressively with increasing doses of OA (5-40 g). The highest dose of the drug caused hyperglycemia and hyperinsulinemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Crohn disease: resection therapy over the course of two decades].

Between 1972 and 1992 394 bowel resections were performed on 344 patients with Crohn's disease at the Surgical University Hospital Mannheim. The aim of this retrospective study was to examine the changes in indication, surgical technique, complication rate and mortality during this period. With the increasing incidence of Crohn's disease, the yearly number of resections has increased (from 9.8 to 30.8), while the frequency of emergency operations has declined (from 24.8% to 15.4%). During the last ten years, surgery was performed at an earlier stage; more often stenoses were resected before complications (chronic or acute intestinal obstruction, fistula and perforation) occurred. Complication rate and mortality has been reduced in the last ten years (complication rate: from 35.6% to 10.6%, mortality: from 3% to 0.7%). A significant higher complication rate was seen after emergency operations (37.1%) as compared to elective operations (12.6%) (p < 0.0001).

Adolescent↗
PubMed1992

[Gunshot and stab injuries of the abdomen].

From 1973 to 1991 a total of 422 patients underwent surgery because of an abdominal trauma. 12 patients had gunshot wounds and 46 patients stab wounds. In a retrospective study the diagnostic and therapeutic procedure and the indication for surgery are analysed. After gunshot wounds of the abdomen we always performed a laparotomy. In 11 od 12 cases we found serious intra-abdominal injuries. Only in one case the laparotomy was "unnecessary", because of a tangential wound without penetrating of the abdominal wall. After stab wounds the diagnostic and therapeutic management was more selective. Indications for mandatory laparotomy after stab wounds were a manifest hemorrhagic shock, evisceration and a still left weapon in the abdomen (n = 22). The first clinical examination was completed by ultrasound or peritoneal lavage. Pathological findings like free intraperitoneal fluid or a positive lavage also were indications for laparotomy (n = 9). The other patients were observed closely, including repeated physical examination. The indication for surgery then based on the development of clinical signs. The time between first examination and laparotomy was never more than 12 hours. 39 patients (84.7%) had injuries of intraabdominal organs. 5 patients (10.8%) had a negative laparotomy. The mortality rate was 3.4%, but there was no death as a result of the selective approach.

Abdominal Injuries↗
PubMed1991

[Coincidence of sigmoid cancer and sigmoid diverticulitis].

From 1985 to 1989 265 patients with a carcinoma of the sigmoid or sigmoid diverticulitis have been operated in our clinic. 23 of the treated patients synchronously had a carcinoma and a diverticulitis. The carcinoma in these cases was found to be significantly more frequent in a stage T1 or T2. We also found a significantly higher rate of perforations in this group of patients.

Adenocarcinoma, Mucinous↗
PubMed1991

[The prognostic value of a mucin histochemical study for the detection of a elevated risk of recurrence after surgical therapy of colorectal carcinoma].

Increased sialomucin production may occur in mucosa surrounding malignant colorectal tumors. The authors examined the value of sialomucin production for prognostication of subsequent local tumour recurrence. Colorectal mucosa was evaluated from 73 patients who had undergone curative surgery for colorectal carcinoma. Sialomucin production was semi-quantitatively measured, using a high iron-diamine/alcian-blue staining technique. Significant increases in sialomucin production was recorded from mucosa, at least along resection margins, from 17 in 39 patients (44%) who did not develop any local recurrence. On the other hand, increased sialomucin synthesis was recordable from only 10 of 27 patients (37%) who did develop local recurrence. Moreover, only one of 7 patients who developed metachronous recurrence had exhibited sialomucins predominantly on resection margins. These findings are likely to suggest that evidence to increased sialomucin production is not conclusively indicative of high risk of local recurrence.

Colectomy↗
PubMed1990

[Uses and risks of drainage following elective colon resection. A prospective, randomized and controlled clinical study].

The results of a controlled randomized and prospective clinical study including 113 patients from March 1987 until August 1988 showed that prophylactic drainage in elective resection for cancer of the colon was not necessary. 60 patients received a drain, 53 patients were not drained. The drain turned out to be ineffective even concerning its expected function of draining intraabdominal fluid: its diagnostic and therapeutic value failed in clinical practice. The rate of surgical complications--i.e. anastomotic leakage, impaired wound healing and relaparotomy--was significantly higher in the drained group. In elective colon resection the use of a drain as a routine procedure cannot be recommended.

Aged↗
PubMedDate not supplied

The role of laparoscopy in the preoperative staging of pancreatic carcinoma.

Between January 1990 and December 1995, a total of 398 patients underwent laparotomy for pancreatic or periampullary carcinoma at the Surgical Clinic of Mannheim. The tumor was located in the pancreatic head in 290 patients (72.9%), in the body of the pancreas in 42 patients (10.6%), and in the pancreatic tail in 19 patients (4.7%). Forty-seven patients (11.8%) presented with periampullary carcinoma. The preoperative diagnostic workup included abdominal ultrasound, CT scan, endoscopic retrograde cholangiopancreatography, and angiography. One hundred seventy-two patients (43.2%) underwent a tumor resection, 150 (37.7%) had a palliative bypass operation, and 76 (19.1%) underwent only an exploratory laparotomy. Preoperative diagnosis had predicted unresectability in 66 (87%) of the patients who underwent exploratory laparotomy. In 76 patients the intraoperative findings showed an unresectable tumor, which was located in the head of the pancreas in 54 cases (71%), in the body of the pancreas in 17 (22.4%), in the tail region in four (5.3%), and in the periampullary region in one (1.3%). Local signs of unresectability were found in 47 patients (62%) and peritoneal or hepatic metastases in 29 (28.2%). Given that local inoperability can be reliably assessed only at laparotomy, this leaves just 29 (7%) of 398 patients who did not require palliation and whose signs of unresectability could possibly have been discovered by means of the laparoscopic approach. Laparoscopy (including laparoscopic ultrasound) should be used selectively in patients considered probably unresectable who do not require a palliative procedure immediately before the planned operation.

Ampulla of Vater↗
PubMedDate not supplied

Quality-of-life after curative surgery for gastric cancer: a comparison between total gastrectomy and subtotal gastric resection.

BACKGROUND/AIMS: Quality-of-Life has become an increasingly important factor for long term survivors after surgery for gastric cancer. Quality-of Life also includes social and psychological aspects. Many gastric carcinomas are located in the distal two thirds of the stomach. In these cases, a subtotal gastric resection may be adequate if a proximal safety margin of 5 cm in intestinal type tumors according to Laurén and 10 cm in diffuse type cancers respectively can be achieved. On the other hand total gastrectomy "de principe" has been advocated for all gastric malignancies because of high local recurrence rates after subtotal resection. The aim of the present study was to assess the Quality-of-Life in long term survivors after resection for gastric cancer comparing subtotal gastric resection with total gastrectomy. METHODOLOGY: One hundred ninety-five patients were examined with the Gastrointestinal Quality-of-Life-Index (GLQI). Hard clinical data such as postoperative weight loss, frequency of daily meals and bowel emptying were evaluated. One hundred five patients were submitted for total gastrectomy and in 90 patients a subtotal gastric resection was performed. None of the patients had clinical, radiological or endoscopic evidence of recurrence. RESULTS: After subtotal gastric resection, patients achieved statistically significant better scores concerning disease/therapy-related symptoms, physical functions resulting in a better overall score (p < 0.02). Following subtotal resection, patients had a significantly lower weight loss compared to patients after total gastrectomy (p < 0.02), a smaller number of daily meals (p < 0.001) and a lower frequency of bowel emptying/day (p = 0.031). There was no statistically significant difference in emotional status or social activities showing a similar acceptance of disease and therapy in both groups. CONCLUSIONS: In those cases where an adequate proximal safety margin can be achieved by a subtotal gastric resection, this procedure is preferable to a total gastrectomy. However preservation of the gastric stump should never be allowed to compromise oncological radicality.

Adult↗