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Biomedical subjects

F Köckerling

Publications and source records attributed to F Köckerling.

137 records · Page 8Linked to original sources
PubMed1986

Measures of prevention and technical problems during reoperations in cardiac surgery.

Reoperations after cardiac valve replacement are unavoidable: their frequency depends on surgical technique, type of valve used, and the anatomical situation. Erlangen, almost 300 such procedures were required among 3500 valve replacements, while 19 out of 700 bioprostheses had to be exchanged. Statistically relevant complications occurring with variable frequency are paravalvular leakage, thrombosis and degeneration of the bioprostheses which have to be corrected for hemodynamic reasons. Other indications are thromboembolism and endocarditis. Rare complications are: rupture of the posterior wall of the ventricle or aortic root with subsequent development of aneurysm, entrapment of the occluder due to long sutures, pannus, muscle chordae, strut fracture (Björk) or wear of the occluder (Wada, Starr, Edwards, Beall). Some complications as dehiscence, entrapment, rupture and aneurysm of the posterior wall of the ventricle and aortic root can largely be avoided by good surgical techniques. Reoperative mortality rate is slightly higher due to greater possibilities of injury and bleeding. Emergency procedures in grade IV NYHA have the highest rate (50%), elective procedures for leakage, calcified or regurgitant bioprostheses the lowest. The most frequent indication for re-operation is perivalvular leakage. Dehiscence requires surgery to deal with hemolysis or for hemodynamic reasons. Dehiscence is more common in aortic than in mitral position; the latter can be closed by felt-padded stitches in 80%. This technique is the most reliable in preventing leakage, although thrombosis is more likely. Causes of dehiscence are endocarditis, suture-line tearing, calcium in the annulus. The incidence of valve thrombosis is related to valve type, usually associated with inadequate or abruptly terminated anticoagulation therapy (rebound). Disc valve are at particular risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

[Vascular anatomic principles of surgery of the terminal ileum].

The terminal ileum has a reputation for poor vascularisation. In nontumoral lesions a maximum preservation of the terminal ileum and the ileocaecal valve for functional reasons should be aimed at. Therefore we carried out a study on 200 cadavers by preparation of the superior mesenteric artery and the ileocolic artery and their branches. We used the classification of the arrangements of the arteries of the terminal ileum of Chevrel und Guéraud. We found a lower origin of the anastomosis between the superior mesenteric artery and the ileocolic artery in 56%, an upper origin in 44%. A recurrent ileal artery was present in 84%. Surgical applications can be drawn from this study.

Arteries↗
PubMed1985

[Results of the microsurgical reconstruction of peripheral nerves using a functional anatomical follow-up procedure].

Between 1969 and 1980 in a total of 557 patients 623 severed peripheral nerves were reconstructed by microsurgical technique. In 31,1% of the cases primary reconstruction was performed, in 18,6% secondary reconstruction and in 50,3% a free nerve transplantation. For evaluation we used a functional anatomic technique. The best results occurred after direct suturing without tension. In children results were much better than in adults. In free nerve transplantation results depended on length of nerve gap.

Adult↗
PubMedDate not supplied

Specific sample preparation in colorectal cancer.

Large tissue samples from ten patients operated for colorectal cancer were prepared in the operating room in iced phosphate buffered saline, containing ethylene diaminetetraacetic acid and protease inhibitors. After cutting the specimens into small fragments, the tissues were gently pressed through a steel mesh. Membranes were permeabilized in chilled ethanol 70% to allow cytosolic fluoresceine isothiocyanate labeling, performed with anti-cytokeratin (CAM 5.2) antibodies. Samples were quantitatively sorted with a fluorescence activated cell sorter (FACS) and denatured before processing separation by two-dimensional electrophoresis on polyacrylamide gels. This procedure made it possible to sample about 4 x 10(7) viable normal and tumoral cells before fixation, and up to 4 x 10(6) cells after FACS. The gels run before and after fixation showed no major differences. The rate of cytokeratin-positive cells in the samples was the following (mean, CI 5-95%): mucosa 29.5% (8.9-66.7%), tumor 44.3% (6.6-94.8%). The epithelial cell content in colorectal cancer and normal mucosa shows important intersample variations. This is important for any comparison of fresh samples, whether at DNA, RNA, or at the protein level. We propose a method allowing the preparation of pure epithelial cell samples from normal and tumoral colonic fresh mucosa.

Colorectal Neoplasms↗
PubMedDate not supplied

Extended gastrectomy: who benefits?

In the area of radical surgical treatment of gastric carcinoma, extended or multiorgan resection is--as is systematically extended lymph node dissection--becoming increasingly important. One indication for extended gastrectomy is intramural or transmural infiltration of neighboring organs or the gross presence of metastatic involvement of the lymph nodes associated with the celiac trunk, splenic artery, or splenic hilum. Because the mortality rate associated with extended gastrectomy is hardly any higher than that for nonextended gastrectomy, the indication for the former may be generously applied. The prognostically most unfavorable case is histologic evidence of transmural infiltration of neighboring organs (pT4). Multiorgan resection with improved systematic extension of lymph node dissection is of greatest benefit to patients with inflammatory adhesion of the stomach to neighboring organs or pN2 lymph node metastases. Intramural infiltration of the esophagus can be treated by including the thoracic part of the esophagus in the gastric resection done via an abdominothoracic approach, ensuring an appropriate margin of clearance, with no significant worsening of the prognosis.

Follow-Up Studies↗
PubMedDate not supplied

Radical operations for carcinoma of the gallbladder: present status in Germany.

Despite the overall poor prognosis of gallbladder carcinoma, it appears that, in resectable lesions, an aggressive surgical approach promises improvement in survival rates. Radical treatment of gallbladder carcinoma is based on a detailed knowledge of the lymphatic, venous, direct, and intraductal modes of spread of gallbladder carcinoma. Customized therapy of gallbladder carcinoma takes staging into consideration: if one is dealing with gallbladder carcinoma with macroscopic liver infiltration (T3 or T4), or with a pre- or intraoperatively diagnosed gallbladder carcinoma with an unknown depth of infiltration, an en bloc resection of the gallbladder with adjacent liver segments IVb and V, perhaps including IV, as well as a dissection of the hepatoduodenal ligament should be performed. If the carcinoma is missed intraoperatively at the time of cholecystectomy for other indications, in the presence of a T2 gallbladder carcinoma in proximity to the liver bed, reoperation with dissection of the hepatoduodenal ligament and resection of liver segments IVb and V should be performed. In the presence of T1 gallbladder carcinoma, simple cholecystectomy is adequate. This concept is based on our experience with 113 patients with gallbladder carcinoma who underwent treatment in our department from January, 1970 to June, 1989. Sixty-seven percent of the gallbladder carcinomas were resected, 30% for cure and 37% palliatively. In 33%, the operation was limited to an exploratory laparotomy or a palliative operation, or no operation was performed. Of the curatively resected carcinomas (n = 34), 7 were Stage I, 7 Stage II, 9 Stage III, and 11 Stage IV.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMedDate not supplied

The pathogenesis of port-site recurrences.

The major factors underlying the seeding of tumor cells during laparoscopy are mechanical, with CO2 playing only a secondary role. The peritoneal wound is of great importance, especially in advanced tumor stages, when cells are present within the abdominal cavity. Most reported port-site metastases were found within the extraction port when no protective measures were taken. Gasless laparoscopy is no solution to the problem, since numerous port-site metastases have been described after thoracoscopy, during which no C02 is used. The surgeon's role in the seeding of tumor cells is based on tumor perforation, excessive manipulation, and replacement of trocars. This presumably explains the large differences (0% and 21 %) in the reported incidence of port-site metastases. Prospective studies now show that it is possible to keep the incidence of abdominal wall metastases to about 1%-which is comparable to that seen in open surgery-by the use of a meticulous operating technique and preventive measures.

Abdominal Neoplasms↗
PubMedDate not supplied

Influence of titanium coating on the biocompatibility of a heavyweight polypropylene mesh. An animal experimental model.

INTRODUCTION: In light of the fact that, to date, no information is available about titanium relative to its application in prosthetic material employed for hernial repair, the aim of the present work was to evaluate the fundamental possibilities of titanium-coated polypropylene meshes. MATERIALS AND METHODS: In experiments with animals, two groups, each containing 11 pigs, received either a heavyweight polypropylene mesh (Atrium) or an identical but titanium-coated mesh (titanium-coated Atrium) implanted into the left groin using the totally endoscopic extraperitoneal patchplasty technique. RESULTS: A significant difference in the shrinkage behavior between conventional Atrium and titanium-coated Atrium was found (14.9 vs. 8.8%, p < 0.05). Furthermore, the partial volume of the inflammatory infiltrate also proved to be smaller with the titanium-coated mesh (14.9 vs. 12.4%). In addition, Ki-67 expression was lower in the group implanted with titanium-coated mesh (21.0 vs. 15.0%). No difference was observed with regard to the apoptosis index (7.6 vs. 6.5). CONCLUSIONS: Heavyweight titanium-coated polypropylene meshes induce a less pronounced foreign body reaction in comparison with identical meshes with no titanium coating, which, since the amount of material implanted is identical, must be attributed solely to the titanium coating.

Animals↗
PubMedDate not supplied

Liver regeneration following 68% partial orthotopic liver transplantation in the rat.

Liver regeneration following transplantation in 'small for size' conditions is not fully understood. We therefore evaluated the regenerative response of transplanted partial liver grafts in outbred rats without the use of immunosuppression and compared it to liver regeneration following resection. The transplanted livers showed enhanced regeneration compared to controls. We suggest that this is caused by activation of the immune system.

Animals↗
PubMedDate not supplied

Exon 14-skipping of the adenomatous polyposis coli gene in purified epithelial cells of colonic mucosa and tumors.

Adenomatous polyposis coli (APC) exon 14-skipped transcripts encode putative APC proteins of low molecular weight. To prove that exon 14-skipped mRNA variants do not simply represent tissue culture artifacts, expression of these APC transcript variants was demonstrated in native colorectal epithelium. Fresh surgical specimens of human colon were processed and epithelial cells were affinity-purified with the dynabead-immobilized monoclonal antibody Ber-EP4. Epithelium derived cDNA was PCR-amplified in the range of linear accumulation. RT-PCR products with and without APC exon 14 were evaluated by densitometry. Analyses of normal mucosa (n = 8) and matching mucosa--tumor samples (n = 4) revealed a consistent 4 to 1 ratio of APC exon 14-positive to exon 14-negative mRNA levels. We conclude, a) that APC exon 14-skipped transcripts are physiologically expressed in native human colon mucosa, and b) that ratios of exon 14-negative to exon 14-positive isoforms were not altered when colorectal tumor cells were compared with matching normal mucosa (p = 0.80).

Colon↗