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Biomedical subjects

E Kohlberger

Publications and source records attributed to E Kohlberger.

16 recordsLinked to original sources
PubMed2001

[Diagnosis of acute cholecystitis. Ultrasound diagnosis is reliable].

In the presence of typical ultrasonographic signs (Murphy's sign, established pericholecystitis) in patients with a relevant history and clinical presentation, diagnosis of acute cholecystitis can be established with a high degree of accuracy. As a non-invasive method, ultrasound can be used at the bedside of the severely ill patients, thus enabling the more economical use of more sophisticated and expensive examination methods. In the acute stage, the urgency of surgical intervention can be assessed. During follow-up, the effectiveness of conservative measures can be checked, failed treatment detected early on, and complications avoided. In high-risk patients, interventional procedures (puncture, percutaneous drainage) can be performed under US-control. Thus, US is the diagnostic modality of first choice for the diagnosis of acute cholecystitis. It has relevance for decision-taking, and is an indispensable procedure in the emergency setting.

Acute Disease↗
PubMed2000

A new method for extracting wooden foreign bodies from the upper esophagus.

A foreign body impacted in the esophagus is an emergency case that requires immediate treatment. Often the foreign body can be removed easily using forceps or loops. Sometimes, however, safe grasping and extraction may become very difficult. A patient swallowed a chestnut which then stuck in the upper esophagus. The chestnut was removed with a gynecological instrument with a spiral tip used for myoma fixation. Thereafter this technique was applied to in vitro tests with various kinds of meat and wood. In the clinical case, the chestnut could be removed with the spiral tip of the instrument for myoma fixation, whereas in the in vitro tests it was impossible to grasp meat or cut it into pieces. The removal of foreign bodies, such as wood, with the spiral tip of the instrument for myoma fixation during rigid esophagoscopy is an alternative to extraction with forceps or loops. This method is ineffective for the removal of pieces of meat.

Esophagoscopy↗
PubMed1998

[Strategy and outcome of interdisciplinary therapy of ovarian carcinomas].

In this retrospective trial we analyzed the data for 200 patients with serous papillary ovarian cancer. The patients were treated with various operation strategies following an interdisciplinary conference among a surgeon, a gynecologist, and an oncologist. Mean overall survival was 26 months. It was significantly better in patients with primary and secondary debulking operations in combination with sufficient postoperative chemotherapy. The morbidity rate reached 16.8%, the overal mortality rate was 5.7%. The mortality for the first surgical intervention was 0%.

Adult↗
PubMed1997

[Instrumental diagnosis for therapy decision making in abdominal injuries].

The aim of diagnostic procedures following abdominal injuries is rapid assessment of the necessity for surgical intervention and specification of the organ lesion, thus reducing the number of negative laparotomies. The extent of the diagnostic approach must be reduced in unstable patients. Sonography is the standard procedure in stable as well as in unstable patients, both in the initial period and the subsequent follow-up. CT-scan is complementary to sonography in detecting organ lesions. Sonographically guided puncture has replaced diagnostic peritoneal lavage. Laparoscopy following blunt abdominal injuries is not useful; however, it may be helpful following penetrating abdominal trauma.

Abdominal Injuries↗
PubMed1997

[Strategy and outcome in bowel injuries after blunt abdominal trauma].

In this retrospective trial, we examined 215 patients with bowel lesions following abdominal injuries. We analyzed the diagnostic procedures, the time to diagnosis, the subsequent surgical therapy, and complications. The diagnosis of bowel lesions remains a diagnostic challenge. All apparative diagnostic procedures (sonography, CT-scan, lavage, laparoscopy, X-ray) fail to diagnose bowel lesions. In our trial, most patients showed clinical signs of peritonitis leading to diagnosis. Ultrasonographically guided puncture was important, if clinical signs remained unclear. This study underlines the importance of repeated clinical examination for early diagnosis and treatment of bowel injury.

Abdominal Injuries↗
PubMed1996

[Diagnosis and therapy of diaphragmatic rupture after blunt thoracic and abdominal trauma].

Diagnosis of diaphragmatic rupture is often missed after blunt thoracic and abdominal injuries because diaphragmatic injury does not play an important role beside severe injuries of intrabdominal and/or thoracic organs. Between 1976 and 1993, 141 patients were treated for traumatic injury of the diaphragm. In 42 patients with penetrating injuries following stab or shot wounds diaphragmatic lesions were diagnosed by the emergent surgical therapy. 99 had diaphragmatic tears from blunt thoracic or abdominal trauma by accidents. 14 of 99 patients sustained isolated diaphragmatic rupture, in 85 the rupture was combined with other injuries, 24 had fractures of the pelvic ring. Preoperatively the following diagnostic procedures were performed: chest radiograph in 99 patients, abdomen radiograph in 75, contrast radiographs in 34, angiography in 9, sonography in 74 and computed tomography in 48. Sensitivity and specificity of these diagnostic methods depend on the dimension of intrathoracic prolaps of abdominal organs. The sensitivity of contrast radiographs ranged from 72-78%. With the additional experience of ultrasonography since 1985 the sensitivity came up to 82%. In 11 patients additional diaphragmatic rupture was diagnosed by laparotomy indicated by liver and/or splenic rupture. Therapy of diaphragmatic injury was performed in 83 patients within 4 days, in 9 within 4 months and in 7 later than one year. For diaphragmatic repair 87 patients underwent laparotomy and 12 thoracotomy. Local complications were found in 13 patients (13.1%). 19 patients (19.2%) died postoperatively due to accompanying injuries.

Abdominal Injuries↗
PubMed1996

[Strategy and results of advanced tumors in emergency situations].

In this retrospective trial we examined 142 patients with advanced unresectable cancer, who had bowel obstruction, bleeding, bowel lesion and abscesses and who were treated with different surgical procedures (resection, bypass, enterostomy). Mean survival rate was 8.6 months (range: 0-57 months). The mortality rate reached 21.7%. Surgical reintervention was necessary in 15.8% because of bowel obstruction and did not influence the survival rate. Despite advanced tumor disease and intestinal obstruction most patients had a good quality of life after surgical intervention.

Abdominal Abscess↗
PubMed1994

[Duplex ultrasound studies after organ saving intervention in traumatic splenic rupture].

The increased risk of overwhelming postsplenectomy sepsis (OPSI) led to the development of organ preserving procedures. However, little is known about the long-term results of organ preserving. A reduced blood flow has been suspected. In the period from 1982 till 1990 144 patients were operated on for a ruptured spleen. Thirty patients had organ preserving procedures. These failed to stop the bleeding in eight patients. Two patients died. Nineteen patients (group A) out of twenty were reexamined clinically, by ultrasound and by Duplex sonography. They were compared with matched test persons. Three patients in group A complained of recurrent minor infections. Changes in the shape and the location of the spleen were a common sonographic finding. The diameter of the hilus was 3.8 +/- 0.5 cm and the blood flow was 221 +/- 75 ml/min in group A. There was no difference to group B with 3.8 +/- 0.6 cm and 224 +/- 76 ml/min, respectively. The hemodynamic preconditions necessary for a functioning spleen could be preserved in all patients.

Adolescent↗
PubMed1993

[The value of colon contrast enema in ileus diagnosis].

In 115 patients with clinical and radiological signs of small and/or large bowel obstruction the contrast enema of the colon was evaluated prospectively to localize the site of occlusion in the colon. Contrast enema was performed in 76 patients with Gastrografin and in 39 with barium. In 22 of 24 patients with large bowel obstruction, in 7 of 11 with combined small and large bowel obstruction, in 4 of 14 with small bowel obstruction and in 19 of 66 with partial obstruction the site of obstruction was identified in the colon. In 107 of 115 patients the site of intestinal obstruction in the colon was either confirmed or excluded (sensitivity 89.2%, specificity 96.6%). In 6 patients the contrast enema failed due to incontinence, missing cooperation or insufficient preparation. In two cases with coprostasis the occlusion was missinterpreted as a carcinoma. Electrolytes and serum fluid concentration before and after the enema were not significantly influenced using the different contrast media. Contrast enema is indicated in patients with intestinal obstruction of unknown site, malignancies, after radiation therapy and recurrent partial obstruction.

Adolescent↗
PubMed1989

[Preoperative staging of rectal cancer: endosonography versus computerized tomography].

In a prospective study in 49 patients with rectal carcinoma the correlation of pre- and post-operative staging by CT and endorectal ultrasound (EU) was compared according to TNM-classification. With CT the pre/postoperative results correlated in T1 in 9/10, in T2 in 10/16, in T3 in 13/15 and in T4 in 6/8 patients. By EU identical results were found in all T1, in 10/12 T2, in 17/20 T3 and in 6/7 T4 stages. Overall, pre- and postoperative identical results were found by CT in 38 and by EU in 43/49 patients. Overestimation of the tumor stage was similar with both methods: 5 by CT and 4 by EU. Underestimation of the stage was more often by CT in 5 than by EU in 2 cases. (CT: accuracy 77.5%, sensitivity 88.3%, specificity 94.4%; ES: accuracy 87.7% sensitivity 91.5%, specificity 97.8%). Criteria for interpretation are discussed. In early tumor stages the depth of tumor invasion can be better evaluated by EU. In late stages both methods give important information for surgical strategy.

Adenocarcinoma↗
PubMed1989

[The value of transrectal sonography and computerized tomography in the diagnosis of rectal cancer].

In a prospective study in 49 patients with rectal carcinoma the correlation of pre- and postoperative staging by CT and endorectal ultrasound was proven according to TNM-classification. With CT the pre/postoperative results correlated in T1 in 9/10, in T2 in 10/16, in T3 in 13/15 and in T4 in 6/8 patients. By endorectal ultrasound identical results were found in all T1, in 10/12 T2, in 17/20 T3 and in 6/7 T4 stages. Totally, pre- and postoperative identical results were found by CT in 38 and by endorectal ultrasound in 43/49 patients. Overestimation of the tumor stage was similar with both methods: 5 by CT and 4 by endorectal ultrasound. Underestimation of the stage was more often by CT with 5 than by endorectal ultrasound with 2 cases (CT: accuracy 77.5%, sensitivity 88.3%, specificity 94.4%; endorectal ultrasound: accuracy 87.7%, sensitivity 91.5%, specificity 97.8%). Criteria for interpretation are discussed. In early tumor stages the depth of tumor invasion can be better evaluated by endorectal ultrasound. In late stages both methods give important information for the surgical strategy.

Adult↗
PubMed1988

[The value of ultrasound diagnosis in blunt abdominal and thoracic injuries].

In a prospective study, real-time ultrasonography was applied as the initial imaging procedure in 103 consecutive patients with blunt abdominal or thoracic trauma. Additional peritoneal lavage was not performed. Pathological findings were present in 22 patients (21%). Sensitivity of the examination was 95.5%, with two false positive results, specificity was 97.5% with one false negative result. Lesions of intraabdominal or thoracic organs were demonstrated directly by ultrasonography in 14 patients. In the remaining patients free fluid was discovered in the abdominal cavity. Splenic and hepatic lesions occurred most frequently followed by hematothorax. Ultrasonography can be recommended as the initial imaging procedure, giving a high amount of information in the primary diagnosis of blunt abdominal thoracic trauma.

Abdominal Injuries↗
PubMed1987

[Real-time controlled pleural puncture in surgical intensive care patients].

The sensitivity of ultrasonographic diagnosis of pleural fluid accumulations and the value of ultrasonography guided thoracentesis were studied prospectively. 110 patients were investigated after abdominal operation and chest trauma. Most investigations were performed in a half sitting position. Pleural fluid of clinical relevance diagnosed by real time ultrasonography was treated by thoracentesis under ultrasonographic guidance in 38 cases. The amount of aspirated fluid ranged from 150 ml to 1350 ml. Sensitivity of the method was 97.1%, complication rate was 2.6%. From our view ultrasonography guided thoracentesis represents the method of choice in critically ill and immobile patients.

Biopsy, Needle↗
PubMed1981

Determination of protease-cleaved p-aminobenzoic acid (PABA) in serum after oral administration of N-benzoyl-L-tyrosyl-p-aminobenzoic acid (PABA-peptide) in children.

A modification of the urine PABA tet published by Imondi et al. is described. Ninety minutes after oral administration of PABA peptide, PABA was determined in serum. The average concentration in healthy children was 0.42 +/- 0.055 mg per 100 ml. Up to that time we recovered in the urine 66.1 +/- 6.1% of the substance previously administered. In the children with cystic fibrosis of the pancreas (CF) serum PABA concentrations were less than 0.1 mg per 100 ml. The infants under 2 months old also had clearly low serum concentrations, on average 0.29 +/- 0.06 mg per 100 ml, whereas the PABA concentrations in the older babies lay within the range for the older children (0.40 +/- 0.07 mg%).

4-Aminobenzoic Acid↗