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Biomedical subjects

F Kümmerle

Publications and source records attributed to F Kümmerle.

At least 37 records · Page 2Linked to original sources
PubMed1986

[Acute necrotizing pancreatitis. Synoptic observation of clinical and pathologic-anatomical findings].

In 95 patients with acute necrotising pancreatitis the clinical severity of the disease was compared with morphological criteria of operative specimens. In addition, various morphological phenomena, typical in acute and chronic pancreatitis, were investigated in 3 aetiologically different groups. In these groups pathohistologic alterations, associated with aetiological factors, were seen frequently. Furthermore, there was a good correlation between classifications according to gravity criteria in the assessment of the underlying disease. About 90% of cases clinically classified as acute pancreatitis proved, on the basis of the morphology, to be chronic recurrent pancreatitis. It thus follows that "genuine" acute pancreatitis is a rather rare syndrome.

Acute Disease↗
PubMed1986

[Effect of the patient's risk factors on surgical indications].

Surgical decision making includes the objective and quantitative estimation of the patient's risk for each individual case in his given situation. For classification of risk checklists should be established to serve as basis of the decision on indication. Intraoperatively the risk should be related to the extent of operation (extension, limitation, two stages). In the postoperative period complications can occur on the basis of general and local risks, who might also newly develop. Perioperative morbidity and mortality are valuable parameters for evaluation of risk and of indication as well as the operative procedure itself.

Diabetes Complications↗
PubMed1986

[Technical aspects of the use of ultrasound diagnosis in surgical interventions].

The following are the specifications for intraoperative sonography equipment: Small, easy-to-manipulate 7-10 mHz probes which can be gas-sterilised. The sound head contact surface should be 2 X 3 X 1 to 2 cm. Three probes of different shape. Transmission cable 2-3 m in length. Gas-sterilisable ultrasound unit, cable and plug. Large screen monitor. Control panel which can be encased with a plastic foil according to sterility requirements. 8 step gray scale. Integrated image storage. Documentation possibility using videotape and/or photographic unit. For intraoperative sonography the body parts to be examined are sonographed at a distance of 1-2 cm using a precursor water gap. Interpretation of sonographic images can be performed only in connection with the palpation findings of the surgeon.

Bile Duct Diseases↗
PubMed1986

Role of surgical treatment in pancreatic carcinoma.

From 1964 through 1984, we treated 810 patients for carcinoma of the pancreas. In 129 patients PDE was possible (16%). Up to 1977, we had performed Whipple's procedures, while from 1978 through 1982 total pancreatectomy was our principal procedure. Since 1983, partial PDE again has been the procedure of choice for the potentially curative treatment of pancreatic cancer. Comparing the results of both methods (60 partial/64 total), we did not find any advantages of total pancreatectomy. Operative mortality increased after total PDE and survival time related to tumor stage did not extend. The 2-year survival rate for partial PDE was 26 and for total PDE 14%. Regarding the patients with unresectable cancer of the pancreas, the rate of those not undergoing surgery rose to 25% due to better preoperative staging by modern imaging techniques, while the rate of exploratory laparotomies was reduced to 5%. Since the preoperative use of PTCD, the mortality rate of our palliative procedures dropped to 12%. The biliodigestive anastomosis of choice is the hepaticojejunostomy. Gastroenterostomy is not routinely added (6% only).

Female↗
PubMed1985

[Cystadenoma and cystadenocarcinoma of the pancreas. Clinical aspects, therapy and prognosis].

Cystadenoma and cystadenocarcinoma are relatively rare forms among tumors of the pancreas (10% and 1%, respectively). Imaging methods have increased the numbers diagnosed. Between 1964 and 1984 nine cystadenomas and ten cystadenocarcinomas have been observed. Correct diagnosis is often delayed until there is a palpable upper abdominal mass. Histologically there are three different forms: benign, serous cystadenoma (multicystic, with clear fluid); mucoid cystadenoma (sticky, glass-like; single cavity; potentially malignant); and cystadenocarcinoma. Treatment of choice is complete tumour resection. The prognosis is definitely better for cystadenoma than ductal adenocarcinoma.

Adult↗
PubMed1985

[Hemorrhagic necrotizing pancreatitis and imaging procedures].

Ultrasound and computed tomography have been used routinely over the last five years in the diagnosis of acute pancreatitis. This has made classification as to degrees of severity easier. In addition to the direct imaging of destruction of pancreatic parenchyma, these imaging methods also (preoperatively) make an exact assessment of the extension of peripancreatic necrosis and necrosis paths possible, as well as the presence of any gallstone disease or pancreatic abscess. Under the influence of these imaging procedures the indications for operation and the extent of surgical intervention has become more limited. High-risk "early operation" has been drastically reduced in number and is indicated only in very severe disease with organ complications. The "delayed operation" in the postacute stage of disease is largely restricted to local septic complications. Here excision of necrotic tissue and drainage is now largely preferred to resection, previously practised more frequently. Extensive necrotising processes with only minor clinical symptoms have now been observed as a result of early employment of ultrasound and computed tomography. The successful conservative treatment of these uncomplicated disease processes has contributed to an overall reduction in the mortality of postacute pancreatitis.

Acute Disease↗
PubMed1985

[Reconstruction of the gastroesophageal sphincter in reflux disease].

Valvuloplasties of which, for example, the Nissen fundoplication is perhaps the most effective operation, have been devised to correct gastroesophageal reflux. Fundopexia, a more anatomical antireflux procedure has been performed in 326 patients with 80% good (Visick I + II) clinical results. Postoperative complications and side effects are more frequent after fundoplication. In grade IV patients fundopexia is less successful. Since the introduction of H2-receptor antagonists the number of operations, especially fundopexia, has been considerably reduced.

Esophagogastric Junction↗
PubMed1985

[Intraoperative sonography in surgical diseases of the liver].

Intraoperative ultrasonography was performed in 24 patients with single or multiple liver metastases of colorectal cancer, in 4 patients with a hepatocellular carcinoma, in 2 patients with an hepatic abscess and in one patient with a focal nodular hyperplasia and one with a liver hemangioma. In 9 of 32 patients with inflammatory or malignant liver disease the tumors were not palpable or visible. These hepatic lesions were localized by intraoperative ultrasound. In 5 cases preoperative unknown hepatic tumors were diagnosed by intraoperative sonography.

Carcinoma, Hepatocellular↗
PubMed1984

[Cholelithiasis and acute pancreatitis].

In acute biliary pancreatitis it is the acute inflammatory pancreatitis rather than the cholelithiasis which dominates. Among 2161 patients with cholelithiasis seen from 1972 to 1983, 21% were found to have choledochal stones at operation. A total of 121 patients (5.6%) had "associated pancreatitis" according to the history as well as clinical and intra-operative findings. Frequency and site of cholelithiasis, as well as treatment and its results were compared with those in a group of patients with "acute pancreatitis of biliary origin" (145 of 447 patients from 1972 to 1983). Choledocholithiasis occurred equally often in both groups (36-39%). Impacted papillary concrements were found in 2.9% of patients with acute biliary pancreatitis, in 7.4% of those with "associated pancreatitis". Early intervention is practised only in case of impacted papillary stones, preferably by endoscopic papillotomy. Otherwise the timing of any operative procedure will be determined entirely by the severity and course of the acute pancreatitis.

Acute Disease↗
PubMed1984

Intraoperative ultrasonic localization of endocrine tumors of the pancreas.

Small endocrine tumors of the pancreas can be located before operation by computerized tomography, ultrasonography, angiography, or percutaneous transhepatic venous sampling for hormone assay; to these may eventually be added nuclear magnetic resonance studies. Precise preoperative localization of insulinomas is possible in 80% to 90% of the cases if a stepwise approach combining these methods is used. In as many as 10% of the patients with organic hyperinsulinism and as many as 50% of the patients with Zollinger-Ellison syndrome problems are encountered during the operation because either the tumor cannot be palpated or there are multiple tumors. Only 25% of the multiple tumors are known by angiography before operation. Forty percent of the tumors have a diameter of less than 1 cm. Numerous methods have been reported for intraoperative localization of endocrine pancreatic neoplasms.

Adenoma, Islet Cell↗