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Biomedical subjects

F Kümmerle

Publications and source records attributed to F Kümmerle.

At least 55 records · Page 3Linked to original sources
PubMed1984

[Changes in the diagnosis and therapy of acute pancreatitis].

Currently clinical diagnosis of acute pancreatitis is heavily supported by abdominal sonography and computed tomography. Imaging procedures do not only give direct information on parenchymal destruction of the pancreas but do also allow the extent of peripancreatic necrosis to be recognized. While indications for and extent of surgical treatment are more restrictive under the influence of imaging diagnostics, an early operation is required in case of acute hemorrhagic pancreatitis with organ complications (stage II-III). In view of complications after surviving the acute phase of disease, imaging diagnostics are of utmost importance for tactical considerations regarding surgical approach. In the postacute phase necrosectomy and drainage are preferable to the formerly more common but less radical resection. Localized septic complications due to remaining necrosis call for delayed operation. Timing of relaparotomy, more than once, if necessary, is of essential prognostic importance. A more restrictive indication is confined to an early operation and an intensive conservative treatment will lead to a decrease of mortality in severe hemorrhagic-necrotizing pancreatitis.

Acute Disease↗
PubMed1983

[Intraoperative ultrasound studies in pancreatic surgery].

In 32 patients with benign or malignant disease of the pancreas direct ultrasound imaging of the pancreas was performed during the operative procedure. Benign could be distinguished from malignant lesions on the basis of different ultrasound patterns, changes in the pancreatic duct and size of the organ. A further improvement in diagnostic accuracy was obtained by intraoperative staging with ultrasound-directed small-needle biopsy of that part of the pancreas which looked suspicious macroscopically and by ultrasound. Previously unknown tumour infiltration was also revealed by ultrasound imaging. Intraoperative ultrasound is a new helpful method for the surgeon. Since it is easy it should be used in all doubtful instances, even though the interpretation requires considerable experience.

Humans↗
PubMed1983

[Surgical treatment in acute pancreatitis. The change as influenced by sonography and computer tomography].

The diagnosis of acute pancreatitis is based on anamnestic, clinical and chemical data. Ultrasound and computed tomography permit direct visualisation of the pancreas and establish the diagnosis. In cases of haemorrhagic-necrotising pancreatitis they demonstrate the extent of morphological changes and permit exclusion of other causes of an acute abdomen. The imaging methods support indications for operation in cases of subtotal or total parenchymatous necrosis and in pancreatic abscesses. Conservative expectant approaches in patients with severe clinical course and slight morphological changes as well as in agreement of clinical and morphological findings are facilitated. Complete demonstration of parenchymatous and peripancreatic necroses furnishes useful additional information for total extirpation. Gallstone disease can be demonstrated or excluded preoperatively. Since introduction of ultrasound and computed tomography for the diagnosis of acute pancreatitis a marked diminution of early surgical intervention and delayed operation has been achieved.

Acute Disease↗
PubMed1983

[Intraoperative sonographic localization of insulinomas].

Intraoperative Real-time scanning of the pancreas is described as a method of localizing insulinomas. In 3 cases small but palpable insulinomas are demonstrated as well-defined, incapsulated, hypoechoeic structures in surrounding normal pancreatic tissue. The pancreatic duct and the splenic vessels can be differentiated in the neighbourhood of the tumour. Real-time, high resolution, intraoperative sonography of the pancreas is suggested as a simple adjunct to the methods of intraoperative localization of occult insulinomas.

Adenoma, Islet Cell↗
PubMed1983

[Secondary hyperparathyroidism. Modern concepts of its diagnosis and treatment. Apropos of 45 cases].

An analysis of different problems raised by secondary hyperparathyroidism. This condition most often follows chronic renal failure responsible for hyperphosphataemia followed by hypocalcaemia which causes parathyroid stimulation with hyperplasia. Clinical features are dominated by osteopathic manifestations and pruritus. The diagnosis is based upon radiological examination of the skeleton, repeated measurement of serum calcium and phosphate levels and above all iliac crest biopsy. Surgical treatment is based essentially on total parathyroidectomy with autologous transplantation of parathyroid tissue into the muscles of the forearm. This is followed by study of 45 cases undergoing surgery with details concerning surveillance and postoperative care. The results were very satisfactory since amongst these 45 patients undergoing total parathyroidectomy, only two continued to suffer from bone pain.

Humans↗
PubMed1982

[Trends in surgery for chronic pancreatitis (author's transl)].

Improved preoperative assessment (ERCP, sonography, computer tomography) of pathological changes of the pancreas has impressively changed indications for surgery, timing of the operation and surgical methods used. Intraoperative diagnostics have lost ground due to newer techniques. The aim of surgical treatment is pain relief and the prevention of complications (cholestasis, duodenal stenosis, segmental portal hypertension). Introduction of endoscopic duct visualisation was followed by an increase of resecting techniques based on impressiveness of pathology of ductal changes. Non-invasive methods such as sonography and computer assisted tomography have improved definition of pathological changes and re-encouraged less radical surgery using drainage and anastomosing techniques. Therapeutic consequences of diagnostic progress are demonstrated in 503 cases treated surgically between 1964 and 1981.

Cholestasis↗
PubMed1982

[Diagnosis of the site of insulinomas: percutaneous transhepatic portal vein catheterisations with selective blood sampling for hormone determination (author's transl)].

Percutaneous transhepatic portal vein catheterisation with blood sampling from the various areas of drainage, especially the pancreatic veins, was undertaken in seven patients with insulinoma to diagnose its site. In six patients measurement of serum-insulin levels revealed an abrupt rise in the vascular area later found to drain the area of the insulinoma. Insulin measurement in one patient with insulinoma in the head of the pancreas falsely indicated an islet-cell tumour in the region of the tail of the pancreas. C-peptide concentration in serum followed the concentration of insulin, but did not show such a marked rise. The method of percutaneous transhepatic portal vein catheterisation with selective blood sampling for the measurement of hormonal concentration was superior to ultrasound, computer tomography or coeliacography for determining the site of the tumour.

Adenoma, Islet Cell↗
PubMed1982

[General tactical and technical principles].

Gastric cancer requires radical surgery, together with repair of resection by anastomosis in accordance with physiological aspects. There is still no reason for adopting total gastrectomy as the only operative principle. In antral tumours and early cancer there are arguments for and against the general use of total gastrectomy. The Japanese studies underline the favourable effect of a meticulous lymph node dissection on the outcome of the disease. If subtotal resection is performed the Billroth II anastomosis is preferred, as it is more radical. For replacement of the stomach, interposition of a jejunal segment is the procedure of choice. In general there is a trend towards total gastrectomy combined with lymphadenectomy.

Gastrectomy↗
PubMed1981

[Surgical treatment of oesophageal carcinoma (author's transl)].

Between 1977 and 1980 55 in-patients were treated for oesophageal carcinoma. Tumour stage and general state permitted curatively aimed treatment in only 19 patients. Combined pre-irradiation and operation were the treatment of choice in these cases. Subtotal oesophageal resection and reconstruction were performed in one session. The stomach was used as replacement organ in all cases. In five cases with cervical or immediate supracardial tumour localisation the oesophagus could be extirpated by bimanual dissection without thoracotomy. Fourteen patients required surgery in both cavities. In nine out of the remaining patients, in whom only palliative surgery could be performed, retrosternal tumour bypass with the stomach was performed. During admission, lasting on average 17 days after the operation in 28 patients, three patients with resection and one with bypass died. In the other 24 patients operation led to normal ability to swallow.

Esophageal Neoplasms↗
PubMed1981

[Autotransplantation of cryopreserved human parathyroid tissue (author's transl)].

Following the third operation, aparathyroidism occurred in a 70-year-old female with primary hyperparathyroidism due to parathyroid hyperplasia. Part of the parathyroid obtained during the last operation was cryopreserved immediately after resection and replanted successfully after 15 days into the lower arm muscles. The function of the transplanted tissue was demonstrated by successful stepwise reduction of hormone substitution. Parathyroid hormone concentrations in the blood of the veins draining the transplanted tissue were more than double in comparison with the contralateral side. Functional and morphological investigations of the defrosted tissue prior to transplantation showed vitality and intact morphology.

Aged↗
PubMed1981

[Staging laparotomy for malignant lymphoma: interdisciplinary aspects and results (author's transl)].

Between 1963 and 1979 a total of 357 patients with malignant systemic lymphatic disease underwent splenectomy in the course of exploratory laparotomy. There were three groups: 1. Hodgkin's disease (215 patients), 2. non-Hodgkin's lymphoma (93), and 3. chronic lymphoid leukaemia (49). Comparing pre- and postoperative findings, primary exploratory laparotomy remained the most exact foundation for the differentiated treatment of Hodgkin's disease in stages I-III. Systematic staging laparotomy was of less importance for non-Hodgkin's lymphoma and chronic lymphoid leukaemia because of the much more frequent invasion of bone marrow, spleen and liver. However, it should be considered more often in the management of such cases.

Adult↗
PubMed1981

[Localization of islet cell tumors using sonography, computed tomography, arteriography and selective transhepatic venous sampling for hormone assay (author's transl)].

Of 29 patients examined operation revealed a malignant tumor in 9 and a benign insulinoma in 18, 2 insulinomas were not found. The problems of preoperative tumor localization were limited to small insulinomas (size 7-35 mm). Ultrasound detected all of 3 insulinomas as low echogenic structures (size 7, 8, 17 mm). Computed tomography demonstrated 4 of 5 insulinomas (size 7, 8, 15, 17 mm) due to contrast enhancement following bolus injection. Arteriography localized 12 of 18 insulinomas preoperatively and 14 of 18 retrospectively. Selective transhepatic venous sampling for insulin assay identified 7 of 8 tumors. Real-time ultrasound and dynamic CT are promising in the diagnostics of insulinomas over 7 mm and should precede arteriography. Selective transhepatic venous sampling as the last diagnostic step is a major procedure and most specific, but not always without problems in interpretation.

Adenoma, Islet Cell↗
PubMed1980

[Surgery of the adrenals: result of 154 operations (author's transl)].

Biochemical and radiological results, surgical technique and its results were critically analysed in a retrospective study of 154 operations on the adrenals in 127 patients, operated on between 1957 and 1980. There were no complications in 95 patients. In the remaining 32, both intra- and postoperative complication rate was greater after extraperitoneal than transabdominal approach to the adrenals. Postoperative mortality was 6%, but since 1967 only two patients have died in the postoperative period. Thromboembolic phenomena were the main cause of death, patients with Cushing's disease most commonly having this complication.

Adrenal Gland Neoplasms↗