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Biomedical subjects

G Hohlbach

Publications and source records attributed to G Hohlbach.

At least 37 records · Page 2Linked to original sources
PubMed1995

Cancer of the rectum--palliative endoscopic treatment.

Three methods of palliative endoscopic treatment of malignant strictures of the rectum are presented: laser therapy and its combination with the implantation of either plastic prostheses, or self-expanding metal stents. The aim of all procedures is to avoid a colostomy at least in older patients with shorter life expectancy and incurable tumours. The additional application of a stent maintains the luminal patency and prevents the repetition of laser therapy. Since 1988 we have treated 60 patients with these techniques. First, two to six sessions of laser therapy were necessary for recanalization of the stenosis. In the time following this the patients returned two to eight times for regular laser therapy before they died from the carcinoma. In spite of laser therapy one patient developed an obstruction and another suffered from an iatrogenic perforation of the rectal cancer. In both cases a stoma was fashioned. To avoid repetitive laser sessions we successfully inserted a plastic endoprosthesis in seven cases. In another two cases the implantation failed because of perforation and the patients had to undergo surgery. For the next 10 cases we have used flexible self-expanding metal stents. Serious complications or signs of re-obstruction were not observed until the patients' death. The survival time ranged from 2 to 25 months.

Aged↗
PubMed1995

[Effect of intestinal ultrasound on choice of surgical procedure in acute abdominal pain].

UNLABELLED: Differential diagnosis in patients with acute abdominal pain represents a difficult assignment in surgery involving the indication for urgent operation and the operation technique. AIM: The value of sonography in diseases of the bowels for correct indication for early laparotomy was investigated. METHOD: In a retrospective analysis we compared the result of sonography on 159 patients with acute abdominal pain with the first clinical assessment. RESULTS: The sensitivity of this technique was found to be 38.9% for acute appendicitis, 57.1% for diverticulitis and 76.9% for obstructive ileus. The specificity ranged above 90% in each case. In consideration of more than two sonomorphological criterias for pathological alterations of the intestines the positive predictive value achieved 100%. CONCLUSION: Low diagnostic sensitivity with high specificity implies the necessity to intensity routine ultrasonic investigation of the gut.

Abdomen, Acute↗
PubMed1995

[Complications after laparoscopic cholecystectomy].

We report on complications of laparoscopic cholecystectomy which needed surgical intervention. These complications occurred in 10 out of 250 patients operated at our hospital and 2 patients admitted with complications. In 3 cases the common bile duct was cut and a hepaticojejunostomy was carried out. 3 patients with an insufficiency of the cystic duct were treated by laparotomy. In 2 cases common bile duct stones had to be endoscopically removed. 1 patient suffered from a pneumothorax due to damage of the diaphragm. The tear was laparoscopically sewn. In one case the abdominal aorta had to be oversewn because of its damage by the needle during creation of the pneumoperitoneum. One patient with adhesions suffered from a perforation of the gut as the trocar was introduced. 2 patients developed an umbilical hernia and underwent surgical herniotomy. In spite of all advantages minimal access surgery of the gallbladder seems to be affected with more serious complications than open approach.

Adult↗
PubMed1995

[Benefit-risk assessment of surgical treatment of asymptomatic carotid lesions].

In this review we draw a conclusion on the benefit and risks of the operation of asymptomatic stenotic lesions of the carotid artery referring to different pro- and retrospective studies. Long-term follow up observations on high grade carotid stenosis (> 80%) revealed an incidence of ipsilateral strokes of 2.5% per year [38], whereas after operation the incidence has been reduced to 0.2-0.5% per year [20]. The characteristics, the clinical significance of stenotic carotid lesions and the diagnostical features are summarized. Nowadays a perioperative mortality rate of 1.1% and morbidity rate (stroke) of 1.6% can be expected in experienced vascular surgical departments. Even advocates of non-operative treatment, who demanded a combined perioperative mortality and morbidity rate below 3% perceive that a prognostical benefit has been achieved within the first year after the operation. We therefore recommend the prophylactic operation for patients with asymptomatic high grade (> 80%) carotid stenosis, in ulcerative and smooth plaques, in stenosis of the contralateral side and prior or simultaneous with bypass operation, whenever there is a high expectation of life and low anaesthetic risk.

Carotid Stenosis↗
PubMed1995

Postprandial bile-duct kinetics under the influence of 4-methylumbelliferone (hymecromone).

The physiological correlate of biliary colic is a rapid increase in pressure in the presence of biliary obstruction. The relaxing action of hymecromone on the biliary tract provides a pharmacotherapeutic approach. As the symptoms usually occur postprandially we used ultrasonography to examine whether hymecromone was able to reverse the contraction of the common bile duct (CBD) after ingestion of a standardized test meal. The study was designed as prospective, double-blind randomized crossover study versus placebo in 20 healthy volunteers. The width of the CBD was measured ultrasonographically in the fasting subjects and at 1, 3, 5, 10, 15 and 20 minutes after ingestion of a test meal. Then the subjects were given either 400 mg of hymecromone or placebo and the measurement series was repeated. After ingestion of the test meal the width of the CBD decreased by a maximum of 20% after 15 minutes. While there was only a slight increase in the width of the CBD after subsequent administration of placebo, a maximum increase of 36% was measured 10 minutes after administration of hymecromone. The postprandial contraction of the CBD can be reversed within a short time by i.v. administration of hymecromone.

Adult↗
PubMed1995

[Pump-assisted intraoperative colon lavage].

We report about a time saving method of on-table lavage of the colon. For irrigation a balloon-catheter is inserted into the colon through a small caecotomy. This catheter is connected to an irrigation pump which we usually use for abdominal lavage in peritonitis. After mobilisation the oral end of the later colonic anastomosis is led over the lateral abdominal wall into a plastic tube. Now a continuous irrigation with a controlled flow-rate of 1 l/min is achieved with the aid of the lavage pump. As irrigation liquid we use Ringer's solution. Pressure is limited by an overflow mechanism. In addition after rearrangement the high irrigation flow of the system allows a thorough cleansing of the rectal stump. Between 1992 and 1995 we carried out intra-operative colonic irrigation using the method set out above in 24 patients. The average volume was 8.9 l of Ringer's solution. The irrigation itself lengthened the operation time by an average of 10 min.

Anastomosis, Surgical↗
PubMed1994

[Baker's cyst in osteoarticular tuberculosis of the knee joint].

A Baker cyst (synovial cyst) in the right knee-joint was demonstrated by ultrasound in a 70-year-old woman with recurrent knee-joint effusions after minimal trauma to the knee. Radiological examination in two planes showed degenerative changes corresponding to age. Needle puncture of the knee-joint demonstrated numerous neutrophil granulocytes. As the effusion recurred after one week, despite rest and avoidance of weight bearing, arthroscopy with removal of the cyst was indicated. But surprisingly histological examination of synovial tissue revealed epithelioid granulomas and Langerhans giant cells. Culture of fluid obtained on repeat puncture finally grew Mycobacterium tuberculosis. There was no evidence of pulmonary tuberculosis. The knee-joint tuberculosis healed completely without residual damage on antituberculosis treatment, initially 600 mg rifampicin daily, 300 mg isoniazid daily and 2.5 g pyrazinamide daily for 3 months, followed by rifampicin and isoniazid for a further 6 months.

Aged↗
PubMed1994

[Holmium laser versus mechanical cartilage resection. Comparative studies in the rabbit arthrosis model].

The aim of this work was to investigate and evaluate the tissue reactions after sham operation and after mechanical and holmium laser chondral debridement in a rabbit model at different postoperative intervals. In 27 rabbits an arthrosis was induced by implantation of a piece of polyethylene sheeting in one knee joint. After 5 months, distinct arthritic changes had developed. Nine animals each were randomized for sham operation, mechanical debridement, and holmium laser chondral debridement. At 1 day, 1 month, and 3 months postoperatively, three animals in each group were sacrificed and their joints examined grossly and microscopically. At 3 months after mechanical debridement the articular surface was relatively smooth, and tears and defects were filled with fibrous repair tissue. After holmium laser debridement chondral necroses were regularly found, occasionally with damage to the subchondral bone and distinct inflammation in the marrow space. The articular surface remained rough and uneven. These preliminary results suggest that use of the holmium laser is not superior to mechanical methods for remodelling and smoothing of fairly large chondral areas.

Animals↗
PubMed1994

[The value of mini-tracheotomy as a new interventional technique in treatment of postoperative tracheobronchial retention of secretions. Results of a prospective study of 152 surgical intensive care patients].

OBJECTIVE: Since minitracheotomy has been established in 1984 for prophylaxis and therapy of postoperative sputum retention, numerous publications represent technical descriptions, case reports or empirical results, but only few specific facts related to this method have been investigated. In this study we review the efficiency, complications and late follow-up results of minitracheotomy in a department of general surgery. DESIGN: Between 1987 and 1991 we prospectively included 152 intensive-care patients who received minitracheotomy. The average follow-up was 24.2 +/- 6.1 (4-50) months. RESULTS: Endotracheal secretion could be sucked off significantly more often after mini-tracheotomy. The rate of endotracheal suction increased from 5.9 +/- 4.5/d to 18.4 +/- 6.1/d (p < or = 0.01). The pulmonary gas exchange improved at the same time. PaO2 level of 78.9 +/- 9.9 mmHg that decreased to critical values of 60.7 +/- 8.9 mmHg, rose after minitracheotomy above the original levels. Although the PaCO2 level remained constant, a compensatory hyperventilation with a rate of 27.3 +/- 6.9/min was normalised by minitracheotomy. Furthermore, the various methods of minitracheotomy were opposed in this study. In the group of minitracheotomy by cricothyroideal stab incision (n = 55) we recorded 5.4% serious complications. In contrast minitracheotomy by the Seldinger technique (n = 87) could be accomplished without any disturbance. CONCLUSION: Minitracheotomy seems to be an effective and safe treatment for therapy and prophylaxis of postoperative complications due to tracheobronchial sputum retention in critically ill patients. Manipulation was simplified and rendered more safe by the technique of transcutaneous bouginage.

Adult↗
PubMed1994

[Endometriosis of the inguinal ligament as a rare differential diagnosis of inguinal space-occupying lesion].

A case of endometriosis infiltrating the inguinal ligament is presented. As a rare condition involving of the extraperitoneal portion of the round ligament was not seen. Ultrasonography revealed a hypoechoic tumor with internal anechoic areas. Surgical exploration was carried out in the assumption of a relapse of an inguinal hernia. Microscopically, endometrial glands, fibrosis and old hemorrhage were seen. Laparoscopy revealed no evidence of pelvic endometriosis. We conclude that endometriosis must be considered in the differential diagnosis of palpable lesions of the groin in women of reproductive age. Surgery in cooperation with the gynecologist is the treatment of choice.

Adult↗
PubMed1994

[Baker's cysts. A follow-up study after surgical therapy].

Baker's cysts have to be regarded as a secondary phenomenon of knee-joint diseases. In the treatment of Baker's cysts, therefore, arthroscopy should be done before extirpation. In our study we wanted to look at the results of this therapeutic concept. In the surgical clinic within the Ruhr University of Bochum 34 patients with Baker's cysts underwent an operation between 1985 and 1992. In 22 patients the main symptom was swelling in the hollow of the knee, while the others reported effusions of the knee joint, pain or restricted joint movement. In 27 cases the diagnosis was made by ultrasound alone; in the others arthrography or NMR tomography was necessary. Arthroscopy was performed in all patients, revealing lesions of the meniscus in 12 cases, rupture of the cruciate ligament in 1, degenerative changes in 15 and chronic polyarthritis in 1. In 5 patients we could not find any pathologic changes. We observed 1 severe postoperative complication in the form of a joint infection. Histological examination of the cysts showed chronic synovialitis in 21 patients and tuberculous arthritis in 1. In 25 of our patients clinical and ultrasound examination were then performed on average of 34 months after their operations. In 4 patients we found recurrence of cysts: 2 of these patients were found to be suffering from chronic knee-joint disease with effusions; 1 had recurrent hydrarthrosis together with chronic renal insufficiency; and the fourth patient had constant knee pain, though the arthroscopy did not show any pathologic changes. In the last case our diagnosis was therefore called in question.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Comparative experimental studies of mechanical and holmium laser synovectomy].

The goal of this study was to evaluate tissue reactions in rabbit knees following laser synovectomy using a holmium:YAG laser (wavelength: 2.1 microns) and to compare these results with those found after conventional mechanical abrasion treatment. Chronic arthritis was immunologically induced in one knee joint each of 48 rabbits. Twelve served as controls, 12 were sham-operated, 12 were exposed to laser radiation, and 12 others were treated according to conventional methods. In the laser group, a pulse length of 1 ms at a repetition rate of 3 Hz resulted in a pulse energy of 600 mJ. After periods of 1 day, 1 week and 1 and 3 months, respectively, three animals from each group were sacrificed and the synovialis was examined macroscopically and histologically using light and electron microscopy. Edema, acute inflammation, and coagulation necrosis occurred immediately following laser therapy. After 1 week, the synovial layer showed slight fibrosis, which was comparable to that found in the controls. One month later the surface appeared to be smooth. The mechanical abrasion caused hemorrhage and necrosis. Fibrosis was pronounced in all capsular layers, and after 3 months the surface appeared coarse and villous in this group. Based on these preliminary findings, holmium-laser synovectomy may offer an alternative to existing therapeutic techniques in the treatment of rheumatoid arthritis. The arthroscopic approach could prevent additional capsular fibrosis associated with mechanical irritation.

Animals↗
PubMed1993

[Ultrasound dissection in laparoscopic cholecystectomy].

An ultrasound dissector especially developed for laparoscopic surgery was used during laparoscopic cholecystectomy on 34 patients. The ultrasound power, the volume of suction and irrigation could be determined individually at the generator and activated during the operation with a foot pedal. With the dissector it was possible to fragmentate, emulgate and aspirate simultaneously fat tissue as well as infected edematous structures. The cystic artery and cystic duct, small vessels, lymphatic and connective tissue were not damaged. Therefore this system seems to be excellent for the preparation of Calot's trigonum and blunt dissection of the gallbladder out of its bed, particularly in fatty, acute or chronic infected tissue. No complications were observed within the peri- and postoperative period.

Adult↗
PubMed1993

Temperature controlled angioplasty (preliminary results in heritable hyperlipidemic rabbits).

The purpose of this investigation has been to demonstrate the safety of temperature controlled angioplasty (TCA) with a coaxial heating element, particularly during heat application, and to ascertain the short- and long-term arterial tissue response in 7 month old homozygous Heritable Hyperlipidemic rabbits. In 7 animals, a defined segment of the abdominal aorta was treated with TCA for 40 seconds at 175 degrees C, and 2 animals served as untreated controls. At sacrifice, 1 day, 1 and 2 weeks after TCA, in one animal each a coagulation necrosis with condensation of elastic fibers was found. One year later, 1 of 2 animals revealed irregularly structured elastic fibers combined with only minor atherosclerotic lesions. Treated segments of the second animal and of the 2 remaining animals 2 years after TCA did not appear to differ from the control segments. In conclusion, the TCA never resulted in perforation or carbonization or in adhesion of the heating element to the vascular wall, representing a safe angioplastic technique.

Angioplasty↗
PubMed1993

[Aortofemoral bypass and extensive profunda-plasty in combined arterial occlusive disease of the pelvic-femoral type--a stage oriented analysis].

121 patients with multilevel, lower extremity arterial occlusive disease were treated by aortofemoral reconstruction and extended profundoplasty. Early and late results of 201 limbs were analyzed according to their preoperative grade of ischemia. In the case of moderate claudication the success rate was 43% postoperatively and 81% after 5 years. When having severe claudication the success rate was 62% and 79% after 5 years. The revascularisation of the deep femoral artery helps developing the collateral arteries, responsible for an improvement after a considerable period of time. In limbs with rest pain we got a success rate of 78% postoperatively and 76% after 5 years. In the case of gangrene the primary success rate was 40% and 68% after 5 years. Angiographically, severe arteriosclerotic lesions were documented in the deep femoral artery and popliteal artery when limb-threatening ischemia was present. Nevertheless, the combined aortofemoral and extended deep femoral artery reconstruction was efficient in treating the multilevel occlusive disease; subsequent femoro-distal bypass was necessary only in case of threatening ischemia for 9.3% of limbs. Our findings show there is no indication for simultaneous aortofemoral and femoro-distal bypass grafting in the treatment of the multilevel disease.

Aorta, Abdominal↗
PubMed1992

Holmium-laser synovectomy of immune synovitis in rabbits.

Holmium-laser synovectomy was carried out to remove allergically inflamed synovial membranes in rabbit knee joints. The healing process was then investigated at different periods. Left knee joints of 12 rabbits were exposed to Ho:YAG-laser radiation at a wavelength of 2.1 microns, pulse energy of 600 mJ, pulse length of 1 ms, and repetition rate of 3 Hz. Twelve others were treated conventionally and 12 served as controls. After 1 day, 1 week, and 1 and 3 months, respectively, 3 animals from each group were sacrificed and the synovialis grossly and microscopically examined. Coagulation necrosis, inflammation, and edema resulted following laser therapy. After 1 week, the synovial layer consisted of a scarlike formation of fibers and within 1 month, its surface appeared smooth. The mechanical abrasion caused hemorrhage and necrosis. Fibrosis developed in the capsular layers, and after 3 months, the surface appeared coarse and villous. Based on these preliminary findings, holmium-laser synovectomy may offer an alternative method to existing therapeutic techniques.

Aluminum Silicates↗