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Biomedical subjects

G D Giebel

Publications and source records attributed to G D Giebel.

18 recordsLinked to original sources
PubMed1996

[Possibilities and limits of scores. Theoretical considerations about scores].

Scores are intended to facilitate an accurate appreciation of the overall situation from a few characteristic, reasonably weighted parameters. This definite result in the form of a score means a reduction of reality. For the individual it cannot reasonably be applied in practice. Despite a long list of problems and limitations, a score can describe a collective and thus make it comparable to some extent. Because of the different compositions of the collectives, the value of scores for quality control is limited. The more physiological variables a score contains the more difficult it is to distinguish between the effect of therapy and the clinical course. Therefore, repeated measurement of scores is not useful to verify a therapeutic effect, but it can indicate a trend regarding the endpoint.

Data Interpretation, Statistical↗
PubMed1996

Ileal pouch-anal anastomosis for ulcerative colitis and polyposis coli: is the risk of carcinoma formation conclusively averted?

We took biopsies from the ileal pouch mucosa of 26 patients (13 with ulcerative colitis, 13 with polyposis coli) at least 1 year after the newly formed pouch was finally linked to the faecal flow. Histochemical mucin differentiation was carried out in addition to the ordinary stains. All patients underwent colonization of pouch mucosa with goblet cell multiplication, reduction or loss of villi, and formation of crypts. Only 19 patients could be classified morphologically as bearing large bowel mucosa in the ilea] pouch. Patients with one incidence of ulcerative colitis developed one criterion, those with two incidences two criteria, and those with seven incidences three criteria of the original colitic disease. Patients with two incidences of colitis and those with 10 incidences of polyposis coli developed an excess of sialomucine formation, which is known as an obligate pre-cancerosis. These findings prove, that in ileal pouches, even when affected by systemic diseases with extraintestinal manifestations, a new kind of mucosa develops, which is also prediposed to carcinoma formation. Papers reporting adenocarcinoma arising in ileostomy areas as well as in ileoanal anastomosis, and ileal reservoirs, confirm this presumption. Assuming this conclusion, restorative proctocolectomy cannot hinder malignant transformation of intestinal mucosa, but only delay the onset of cancer, thereby making lifelong follow-ups necessary.

Adolescent↗
PubMed1996

Elastofibroma and pre-elastofibroma--a biopsy and autopsy study.

Two biopsy cases of elastofibroma--one unilateral and one bilateral--are described. A study of 100 autopsies revealed 13 elderly patients with elastofibroma. Males (n = 10; 16.9%) were more affected than females (n = 3; 7.3%). Pre-elastofibroma-like morphological changes (e.g. few or many degenerated elastic fibres) were observed in 81% of the autopsies. Minor pre-elastofibroma-like changes were seen in males and major changes predominantly in females. In addition to physiological ageing as yet unknown factors, rather than abnormal elastogenesis or degeneration, seem to be involved in this pseudotumour.

Adolescent↗
PubMed1994

Histochemical and metabolic changes in functioning ileal pouches after proctocolectomy for familial adenomatous polyposis and ulcerative colitis.

Ulcerative colitis and familial adenomatous polyposis may be treated by proctocolectomy with ileal pouch reconstruction, anastomosing the pouch to the anus. We studied 24 patients who underwent this procedure, of whom 12 had ulcerative colitis and 12 had familial adenomatous polyposis. Ileal absorption was investigated and pouch histology assessed more than one year after closure of the protective defunctioning loop ileostomy. The results showed a reduction in bile acid reabsorption and vitamin B12 absorption. These observations were associated with a morphologic transformation in the small bowel mucosa to large bowel mucosa. In 10 of the 12 colitis patients one or more of the histological features of the original disease (such as active inflammation, increased regeneration, atypia) were evident. Histological examination of the biopsies taken from the polyposis patients showed areas with an excess of sialomucins.

Absorption↗
PubMed1993

[Deep rectovaginal fistula and incontinence after labor trauma].

The commonest cause of traumata to the organ of continence is the injury during childbirth. Specially after negligent or missing reconstruction apart from incontinence rectovaginal fistulas can arise. This report deals with 24 incontinent women with a perineal laceration. After delivery 17 women had developed a low rectovaginal fistula. In addition to clinical recording of the incontinence, the proctological examination including anal manometry was carried out before and 25 months after surgery on an average. All patients get the same operation: Section of the anterior commissure, cutting out the fistula if necessary, separated suture of the animalic and voluntary sphincter, vaginal plasty. Preoperative resting pressure was 30 cm H2O and the voluntary pressure 46 cm H2O-on an average. Postoperative there was an increase to 61 cm H2O for the resting pressure and to 77 cm H2O for the voluntary pressure. 22 patients reported an improvement. 13 women are completely continent, 7 x soiling, 2 x incontinence for flatus, one incontinence for liquid stool and one stool incontinence were found. One fistula occurred again during follow up. Our surgical procedure compared with others has the advantage to give similar results avoiding protective colostoma. Besides the option for an other surgical procedure is still remained.

Adolescent↗
PubMed1991

[Single-stage exposure of the fistula in surgical treatment of the peri-proctitis abscess].

117 anorectal abscesses has been operated by one operateur. 68x a fistulectomy was done. 2x there has been a high fistula. Of the remaining 47 patients 44 have had a followup for 15 months. In this time 37 showed a fistula-in-ano. Procedure and the position of the fistulous tracks are shown. The assumptions and dangers of the single-stage approach are demonstrated.

Abscess↗
PubMed1990

[The effect of lung diminishing interventions on immediate postoperative lung function and their modification by various forms of analgesia].

The influence of different lung resection methods on pulmonary function was studied in 34 patients suffering from bronchial carcinoma. Daily measurements from the 1st to 10th postoperative day reveal the greatest losses of function after right upper lobectomy. Lower lobectomies or left upper lobectomy resulted in a less extensive loss of function. Recovery of function mainly occurs in the first 4 days after operation. Centrally acting analgetics are followed by a loss in pulmonary function whereas locally applied analgetics improve early postoperative function.

Adult↗
PubMed1989

Treatment of anal fissure: a comparison of three different forms of therapy.

454 patients with a fissure-in-ano were treated by different forms of therapy. In a follow-up we examined 314 patients, 178 of them having been treated by anal stretch, 60 of them by subcutaneous lateral sphincterotomy and 76 of them by conservative measures. Most of the anal stretched patients were free of symptoms. Only few of them had to be treated again for the same disease by their physician. Anal stretch--similar to sphincterotomy--breaks the pathologically raised sphincter tone. We therefore propose anal stretch gently performed over a period of 3-5 minutes under general anaesthesia as the method of choice for the initial treatment of anal fissure. In cases of relapse we recommend lateral sphincterotomy by an experienced operator.

Evaluation Studies as Topic↗
PubMed1989

[Osteosynthesis procedures in microsurgery].

In microsurgery the indications and techniques of osteosynthesis are often different from normal orthopaedic surgery. Simple methods which do not require much time or metal and which guarantee sufficient stability and minimal soft-tissue trauma are preferable. The external fixator has a good indication in the tibia and the plate osteosynthesis in the upper extremity and in the femur. Kirschner wires are useful in peripheral osteosyntheses.

Arm↗
PubMed1989

[Tactics and results of surgical treatment of hyperparathyroidism].

Following a brief overview on parathyroid surgery, ontogenesis, anatomy and physiology of the parathyroids are described. Clinical symptoms and signs of hyperparathyroidism are as variable as the topography of parathyroid bodies may be. While parathyroid hyperfunction can easily be demonstrated by determination of serum calcium and parathyroid hormone levels, preoperative localization of adenoma or hyperplastic gland remains unsatisfactory in spite of great technical efforts. Therefore, the operative procedure has to be standardized and rational. Methylen blue staining of parathyroid bodies was proven to be helpful. Clinical results of 58 patients are presented.

Adenoma↗
PubMed1987

[Treatment of osteomyelitis using free myocutaneous flap in the lower leg].

The primary indication for free muscle transfer to the lower leg is post-traumatic osteomyelitis with soft tissue and bony defects. The intention is to provide sufficient soft tissue covering and a new blood supply. Our experience with 24 free muscle transfers to infected areas on the lower leg is presented. The longest bone infection was 25 years. The indications were early bone infections, infected pseudoarthrosis and chronic osteomyelitis. The indications, contra-indications, method and results are reported. Economic and social advantages of the procedure are also discussed.

Adolescent↗
PubMed1987

[Variants in the management of decubitus ulcers].

Decubitus ulcers of the fourth or fifth degree often tend to heal only after years. The result is a bad scar which is unstable and likely to breakdown. It is still surgically correctable, however. The ulcer should be cleaned and after tamponage one should perform excision without opening into the ulcer. Cover can be achieved with either a rotation flap with accompanying muscular padding or a myocutaneous flap. To protect against recurrence, the bone debridement has to be carried out aggressively.

Humans↗
PubMed1986

[Measuring the sensitivity before and following breast reduction-plasty in 2 competitive surgical procedures].

All non-operated breasts have an irregular pattern of sensibility. The areola is distinctly more sensitive than its periphery; the nipple has a very low grade of sensitivity. The postoperative sensitivity increases for about 2 years without reaching the former level. The loss of sensitivity is unrelated to the method of operation (Strömberg, Pitanguy). The loss of sensitivity is proportional to the reduction of tissue. Most important is to keep the ability for breast-feeding (sympathetic innervation by the arterior branch of the 4th ramus cutaneous lateralis).

Breast↗
PubMed1986

[Surgical therapy of malignant melanoma].

148 patients with malignant melanoma are presented. Localization, prognosis and clinical stadium are summarized. The surgical procedure is still three-dimensional excision. The latitude of defects asks for a specialists surgeon.

Humans↗
PubMedDate not supplied

Arthroscopic repair of traumatic longitudinal meniscal tears. A 3 to 5-year follow-up.

The healing potential of the meniscal tissue has been known for a century but has only been broadly introduced into surgical treatment during the last years. Open surgical suture of the meniscus has increasingly been replaced by arthroscopic refixation. We report 34 meniscal refixations with a minimal follow-up of at least 3 years and a mean of 4 years. Using our own simple and economic surgical technique, 34 refixations were performed in 32 patients from January 1987 to December 1988. All patients had traumatic meniscal tears close to the capsule. Frequently the injury was associated with a fresh or old rupture of the anterior cruciate ligament. Without additional trauma, one meniscus had to be partially resected after 4 months; a second one was partially resected in an unstable knee. Both the clinical examination and the satisfaction of the patient demonstrate that meniscal refixation is feasible and appropriate with a correct indication.

Adult↗