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Biomedical subjects

G Heberer

Publications and source records attributed to G Heberer.

At least 19 recordsLinked to original sources
PubMed1992

Surgical interventions for bile duct stones.

Based on our experience of 420 common bile duct procedures for stone disease and a literature review, it is evident that treatment of common duct stones today is based on a wide variety of non-operative and surgical methods which are still being developed. The mode of treatment is basically related to the time of diagnosis. Methods also differ depending on the localization of calculi, on inflammatory complications of stone disease, and whether combined or isolated cholecystocholedocholithiasis is present. At the moment, traditional operative methods as well as newly developed advanced techniques have to be evaluated. Selection of patients and their appropriate surgical and non-surgical treatment is an important issue to be further developed in the next few years. Therefore, therapeutic indications and definitive therapy present a much more demanding challenge for the surgeon than in the period when only open surgery was available.

Bile Duct Diseases↗
PubMed1990

Immunoprotective effects of cyclooxygenase inhibition in patients with major surgical trauma.

Dysfunctional monocytes (M phi), exerting their inhibitory functions via prostaglandin E2 (PGE2), have been implicated in the depression of immune responses following major surgical, accidental, and burn trauma. A randomized prospective study of the PG-synthetase inhibitor indomethacin (Indo) was performed in 43 patients undergoing major surgical procedures, to evaluate its efficacy in correcting postoperative abnormalities of the cell-mediated immune system (CMI) and preventing infectious morbidity and mortality. Patients, following gastrectomy (GX) or reconstruction of the abdominal aorta (AG), in the treated group (PIndo), received 100 mg IV of Indo 6 hours postoperatively and 3 x 50 mg IV Indo over 24 hours on postoperative days (D) 1,2,3,4. The rate of infectious complications was recorded. Parameters of CMI evaluated preoperatively (D0) and on D1,D3,D5,D7 were: Delayed type hypersensitivity (DTH) response to recall antigens, mitogen-induced lymphocyte proliferation (LP), interleukin 2 (IL-2) synthesis, and phenotyping of mononuclear blood leukocytes (PBMC's) with the monoclonal antibodies for CD3+, CD4+, IL-2 receptor (IL-2R)+ and LeuM3+ receptor sites. In contrast to the group of untreated patients (Pc), PIndo did not show a depression of their preoperative DTH responses, and they also showed a lower rate of early opportunistic infections. The in vitro test of CMI revealed that there was a higher LP capacity in PBMC's of PIndo (p less than 0.05); the postoperative profile of IL-2 synthesis was not statistically different between the groups. Indomethacin administration resulted in a considerable alleviation of postoperative monocytosis (p less than 0.05) and in a protective effect on lymphocyte receptor expression of CD3+, CD4+, and IL-2R+ cells. From these data it is concluded that in vivo cyclooxygenase inhibition may be useful to prevent impairment of CMI, a crucial predisposing factor of the high susceptibility to postoperative infection.

Aged↗
PubMed1990

The place of lithotripsy and surgery in the management of gallstone disease.

In summary, 10% to 20% of all symptomatic and uncomplicated gallbladder stones can be treated by ESWL under the current entry criteria. Further, ESWL is suitable for patients with bile duct stones in whom the primary endoscopic approach is not successful (about 10%). The algorithm in Figure 7 shows the therapeutic modalities that may be employed if the least invasive therapy is chosen. The different methods shown in this diagram are usually carried out by different specialists including surgeons, gastroenterologists, or radiologists. Therefore, an interdisciplinary approach is desirable. The technology of shock wave therapy of gallbladder stones will be improved in the future, for example the efficacy of stone fragmentation while maintaining a low level of discomfort for the patient. Moreover, repeated shock wave treatments may increase the success rate in patients with multiple stones and possibly in those with slightly calcified stones as well. Repeated procedures for recurrent stones appear feasible. Long-term follow-up studies are needed to define the place of ESWL in the management of gallstone disease. Surgery of the gallbladder remains the "gold standard" of curative therapy of gallbladder stones, against which ESWL and other nonsurgical techniques have to be evaluated. For the therapy of bile duct stones, ESWL is a helpful and effective nonsurgical adjunct.

Animals↗
PubMed1979

[Diagnosis and treatment of acute injuries to the heart and intrathoracic vessels (author's transl)].

The massive blood loss that accompanies penetrating chest wounds involving the heart or intrathoracic vessels generally leaves no option but to act immediately. Blunt chest trauma in combination with other injuries makes particularly stringent demands on diagnostic and therapeutic skills. Most injuries to the intrathoracic aorta are in the form of intiially closed tears of the descending part; but rupture is an ever-present threat. The symptoms are: enlargement of the mediastinum in the chest roentgenogram, differences in blood pressure between the upper and lower half of the body and haemothorax. Whenever possible aortography should be performed to locate the site of the rupture. The therapeutic measures are determined by the extent and severity of the various injuries.

Aortic Rupture↗
PubMed1979

[Tracheoesophageal fistula after blunt thoracic trauma: recognition and treatment].

Three cases of tracheoesophageal fistula as a result of nonpenetrating chest trauma were surgically repaired. Another 31 cases were found in the literature. 'Thrown against a steering wheel' was the cause of injury in the majority of patients. Though the fistula became characteristically symptomatic 3 to 7 days after the accident, the diagnosis was often delayed for several months. No patient recovered without operation. After demarcation of the area of contusion and necrosis, especially in the esophagus wall, surgical repair is the therapy of choice.

Accidents, Traffic↗
PubMed1978

[Surgical treatment of inflammatory diseases of the colon : ulcerative colitis, Crohn's disease, diverticulitis].

Operations and follow-up examinations were conducted on 106 patients with ulcerative colitis, 33 with colitis Crohn, and 163 with diverticulitis, at the University Clinics of Cologne and Munich. Overall mortality rates were 24.5% (n = 26), 6.1% (n = 2) and 16% (n = 26), respectively. In the surgical treatment of ulcerative colitis the possibility of malignant degeneration and, in the case of Crohn's disease, prevention of recurrences must be taken into consideration. Whether Crohn's disease is a precancerous conditions remains to be clarified. Choosing the optimal time for operative intervention is as important in diverticulitis as in ulcerative colitis. Because of the possibility of complications and the high risk of operation, early intervention is recommended for diverticulitis.

Adult↗
PubMed1978

[Clinical aspects, diagnosis and treatment of organic hyperinsulinism. Experience with 46 operated patients (author's transl)].

The clinical picture of organic hyperinsulinism is presented with reference to experience in 46 operated patients. For the recognition of disease, a careful history is a decisive contribution. The hunger test showed a characteristic hypoglycemic reaction in 100%; the tolbutamide test gave a positive result in 92%. Insulinomas could be localized angiographically in 71%; in one patient this could only be done with an ERCT. The treatment of choice is operation as soon as possible. If possible, enucleation is to be given preference over pancreas resection because of the low complication rate. A search for ectopic (2%) and multiple (12%) adenomas is important. A cure was achieved in 76% of all those operated on. The hospital mortality was about 4%.

Adenoma↗
PubMed1978

[Malignant polyps and early recognized carcinomas of the rectum. Morphological aspects and selective surgical treatment (author's transl)].

The lymphatic drainage of the colon and rectum originates in the submucosal layer. Therefore metastases do not arise from carcinomas confined to the mucosa, and for the same reason the WHO lately recommended to call these lesions severe atypism. The term adenocarcinoma should be reserved in the case of infiltration of the carcinoma into the submucosa. According to the features outlined above adenomas of the rectum showing severe atypism can be removed by careful excision of the mucosa. Even adenomas containing an early diagnosed adenocarcinoma up to 2.5 cm in diameter often can be cured by a local resection of the rectal wall, if no metastases have occurred. From 1971--December 1, 1977, 12 rectal adenomas with severe atypism and 14 rectal adenomas with adenocarcinoma had been removed locally without complications. After 6 years there was no recurrence of carcinoma.

Aged↗
PubMed1978

[Surgery of hyperthyroidism: introduction (author's transl)].

Of the patients operated upon for goiter (n = 1891) within the last 10 years, 625 had hyperthyroidism. Exophthalmia was present in 22.7% toxic nodular goiter in 26.5%; the remaining patients had autonomous adenoma. The different prognosis and treatment of Graves' disease in contrast to other kinds of hyperthyroidism is discussed. The importance of radioimmunoassays and scintigraphic methods as a basis of differentiated and functional surgical treatment is emphasized. Close cooperation among all medical branches involved in the treatment of goiter is recommended.

Adenoma↗
PubMed1978

[Transvaginal surgical removal of a sacrococcygeal teratoma (author's transl)].

For the operative treatment of presacral sacrococcygeal teratomas perineal, abdominal, and combined abdominal-perineal routes are described. In this paper the transvaginal surgical removal of a benign teratoma after partial abdominal resection of the tumor in a 19-year-old woman is reported. No recurrence was observed within 5 years.

Adult↗