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Biomedical subjects

G Lexer

Publications and source records attributed to G Lexer.

At least 19 recordsLinked to original sources
PubMed1994

[Choledocholithiasis--therapeutic splitting].

Despite new developments like chemolitholysis and extracorporeal shock wave lithotripsy, conventional cholecystectomy was the "gold standard" in the treatment of gallstones. The range of indications and the operative strategy were well standardized, although the management of common bile duct stones in gallstone disease was still under debate. For high-risk and elder patients endoscopic retrograde cholangio-pancreatography (ERCP), papillotomy and stone extraction was established, in younger patients the best management was questionable. According to better and more accurate preoperative tests like ultrasound and the ample evidence of the function of the papilla after endoscopic papillotomy the trend seemed to be the preoperative endoscopic bile duct clearance in all patients, just when the "bushfire" of laparoscopic cholecystectomy arised and until then praised standards were thrown overboard because of technical difficulties. Routine intraoperative cholangiography (IOC) was replaced by indicated selective IOC due to the lack of talent of many surgeons. Only the therapeutic concept of the removal of the stone-bearing gallbladder survived all new concepts and the debate of whether to perform routine IOC and whether to clear the bile ducts--pre-, intra- or postoperatively or primarily or secondarily convert to open cholecystectomy and bile duct revision. In the eye of a new "gold standard" and according to the literature and our own results we should standardize our management especially in the era of laparoscopic cholecystectomy as "therapeutical splitting" with indicated and selective preoperative ERCP and bile duct clearance offers the best results and facilitates minimally invasive surgery.

Adult↗
PubMed1992

Aggressive extracorporeal shock wave lithotripsy of gall bladder stones within wider treatment criteria: fragmentation rate and early results.

Two hundred and twenty patients with a total of 412 gall bladder stones of between 8 and 38 mm in size were treated with extracorporeal shock wave lithotripsy, using the overhead module Lithostrar Plus. Fifty six per cent of stones were solitary (mean (SD) diameter 23 (5) mm) and 9.5% of the patients had more than three stones. Stones were successfully disintegrated in 218 patients (fragmentation size less than 5 mm in 80%, less than 10 mm in 19%). Some 65% of patients required one treatment and the rest two or three. A mean (SD) of 4100 (1800) shock waves with a pressure of 700 bar were applied. Twenty four to 48 hours after lithotripsy a transient but significant increase in serum transaminase activities (31%) and in bilirubin (29%), urinary amylase (27%), and blood leukocyte (62%) values was observed. In 29% of patients there was a transient microhaematuria, in 2% transient macrohaematuria, and in 25% painless petechiae of the skin. Ultrasound showed temporary gall bladder wall oedema in 13%, temporary distension of the gall bladder in 11%, and transient common bile duct distension in 8% after treatment. After discharge from hospital, 31% of patients complained of recurrent colic that responded to simple analgesics. Four to eight weeks after therapy, four patients developed biliary pancreatitis and 11 biliary obstruction that was managed by endoscopy. To date, 105 patients have been followed for over 12 months. Sixty one of these had a solitary stone, 17 had two, and 27 had three or more stones. A total of 59 patients, including 44 with a primary solitary stone, eight with two stones, and seven with three or more stones are completely stone free.

Adolescent↗
PubMed1992

[Extracorporeal shock wave treatment of calcium containing gallbladder calculi].

A total of 50 patients--37 female and 13 male--with an average age of 50 +/- 27 years (23-86 years), suffering from rim-calcified gallbladder stones, underwent extracorporeal shock-wave lithotripsy (ESWL), using an ultrasound-guided overhead module of Lithostar Plus (Siemens Company). The total number of stones was 87, with an average diameter of 16 +/- 7 (7-38) mm. 29 patients had a solitary stone, 13 had two and 8 patients three or more stones. All patients received adjunct medication of 10 mg/kg body weight chenodeoxycholic and ursodeoxycholic acid 14 days prior to ESWL as a single bedtime dose. An average number of 5,300 +/- 2,200 shock waves (1,200-15,000) was applied for stone disintegration. The corresponding energy amounted to 750 bar. 29 patients needed one, 21 two or more treatments. After ESWL a variety of clinical abnormalities was observed: flank pain (15%), transient microhaematuria (33%) and transient macrohaematuria (2%). Subsequent to ESWL 5 patients suffered from complications such as biliary obstruction 3 weeks to 9 months after treatment and had to undergo ERCP. Three times endoscopic papillotomy was performed to remove stones from the common bile duct. Up to now 4 patients have undergone cholecystectomy: acute cholecystitis (n = 3), recurrent colicky pain (n = 1). 20 patients have been followed up over a 12-month period; 12 of them are completely free of stones and fragments.

Adult↗
PubMed1992

[Prevention and treatment of postoperative fistulae--new indications for fibrin gluing].

The additional sealing of bronchial and gastrointestinal sutures and anastomoses, respectively, by means of fibrin sealant helped to significantly reduce the postoperative dehiscence rate; this rate amounted to 3.6% for additionally sealed bronchus stump occlusions and to 4.2% in gastrointestinal operations, whereby naturally in emergency abdominal operations the rate was higher (7.7%) than in elective surgery (3.8%). Eight postoperative bronchus stump fistulae and eleven out of the twenty-five gastrointestinal anastomotic dehiscences could be closed using a fibrin clot. Furthermore, fibrin occlusion of the pancreatic duct following Whipple's operation for the protection of the pancreatic-digestive anastomosis (n = 67) has turned out to be a success, since no postoperative pancreatic fistulae occurred, which resulted in the very low mortality rate of 1.5%. One more indication for fibrin sealing was the prevention of postoperative lymph fistulae by additional wound sealing (n = 123) and the fibrin occlusion of these fistulae (n = 18); the postoperative lymph fistulae rate amounted to only 3.3%. All 4 cases, as well as 14 other cases of existing lymph fistulae were healed quickly by instillation of fibrin. These relatively new, partly endoscopic, procedures using fibrin sealing proved to be very successful, because on the one hand postoperative fistulae could be largely avoided and on the other hand they could be treated without further operation.

Bronchial Fistula↗
PubMed1990

[Mediastinal lymphadenectomy. Anatomical basis and its surgical relevance in central bronchus carcinoma].

102 patients with potentially curable bronchial carcinoma were subjected to pneumonectomy and mediastinal lymph node dissection regardless of gross appearance of the mediastinum at the time of surgery. 83 of these patients were analysed retrospectively. In 34 patients (41%) enlarged mediastinal lymph nodes were found; in 19 of these (56%) malignant invasion was verified histologically, whereas in 15 of these 34 patients (44%) the enlarged lymph nodes revealed only inflammatory changes. On the other hand, in 49 patients (59%) the mediastinum was grossly inconspicuous, yet in 2 of these patients (4.1%) microscopic invasion by carcinoma was found. This confirms that the assessment of the mediastinum by gross appearance is unreliable. As a consequence, mediastinal lymph node dissection should be performed routinely in all patients in order to detect occult metastases since only patients who had a complete resection have a change of cure. This approach is justified as in our experience mediastinal lymph node dissection does not impose an additional operative risk and long-term survival or even cure may be achieved in individual patients. Estimated 5-year survival in our patients with histologically proven mediastinal lymph node metastases was 22%; 3 of 21 patients with N 2 carcinoma are alive 8, 10 and 13 years p.o., without evidence of recurrence. The operative strategy and technical aspects based on anatomical knowledge of pathways of lymphatic spread of carcinoma of the lung are presented.

Bronchial Neoplasms↗
PubMed1990

[Non-occlusive disease--ultrasound diagnosis and trend analysis as a treatment guideline].

16 patients with angiographically proved NOD underwent immediate abdominal sonography (age: 76 +/- 24 years). All patients suffered from "low cardiac output syndrome". The sonographic criteria were as follows: bowel wall edema [16], hyper-peristalsis [16], free peritoneal fluid [14], and signs of incomplete ileus [14]. 11 patients were successfully treated with conservative therapy on the basis of followup ultrasound observation and analysis. 5 patients underwent operation because of worsening ultrasound findings. These patients died from the underlying cardiac illness.

Adult↗
PubMed1990

[Therapy of suspicious fine needle puncture from nodular struma with reference to thyroid function and morphology].

A suspicious preoperative cytology (= class "III") may be the result of various disorders of the thyroid presenting with cell atypia. For example hyperthyroidism or thyroiditis can show a cytological aspect, mimicing a differentiated carcinoma. Our study, comprising 231 patients with cytology "III" revealed a low malignancy rate (1%) in cases of concurrent hyperthyroidism or thyreoiditis. In contrast, 26% of the patients presenting with euthyroid nodular goiter and cytology "III" had a malignant histology such patients should be treated by primary lobectomy.

Biopsy, Needle↗
PubMed1989

[Temporary and permanent recurrent laryngeal nerve paralysis following thyroid surgery. Modifying factors: the educational status of the surgeon].

17 of 525 patients (3.2%) showed an laryngoscopically established palsy of the recurrent laryngeal nerve after surgery for struma. The analysis of these operations, performed by five surgeons during or within three years after the period of surgical training, revealed that the operations performed under assistance of the senior surgeons were high grade selected (p = 0.026). Thus 14.8% of the operations performed because of simple goiter but only 4.8% of the operations performed because of thyroid cancer/recurrent goiter/extensive nodular goiter were assisted in this way. On the other hand it was necessary to call for help of a senior surgeon because of intraoperative difficulties in only 1.26% of the cases operated on for simple goiter, but in 19.6% of the more complex forms of goiter (p less than 0.001). The risk of recurrent laryngeal nerve palsy was nearly 10 times higher in the complex forms of goiter than in the simple forms (p less than 0.001). More extensive surgical training in the forms of complex goiters should be able to improve the results.

Clinical Competence↗
PubMed1989

[Long-term laryngoscopic follow-up in vocal cord paralysis following struma surgery].

Of 525 patients 17 (3.2%) showed a laryngoscopically established palsy of the recurrent laryngeal nerve after surgery due to goiter. A laryngoscopic follow-up of all these patients, performed at least one year after the operation, revealed that 76.5% of the recurrent nerve palsies were temporary and 23.5% were permanent. Danger of permanent palsy increased in the sequence--uncomplicated nodular goiter--struma maligna--recurrent goiter. The outcome of long-term follow-up showed a palsy rate of 0.8%, which was much lower than the corresponding rate reported by short-term control (p = 0.005). Therefore laryngoscopic long-term follow-up in cases of postoperative abnormal laryngoscopic function should be a standard part of follow-up in thyroid gland surgery.

Adult↗
PubMed1988

Artificial heart and cardiac transplantation: report on the first European combined procedure.

It became necessary to perform a staged procedure by means of total artificial heart followed by cardiac transplantation in a 26-year-old, female patient. The Ellipsoidheart, as an artificial heart, fitted excellently in the chest without compromising the surrounding structures. As soon as the patient recovered with the artificial heart, a consecutive transplantation was performed. This first European clinical experience gained confidence and suggests applying more artificial hearts as a bridge towards transplantation.

Adult↗
PubMed1988

Cardiac allotransplantation across major blood group barriers in the baboon.

In heterotopic heart transplantation experiments in Chacma baboons, some of the animals were significantly immunosuppressed with cyclosporine, resulting in prolonged cardiac allograft survival. ABO blood group incompatibility between recipient and donor did not significantly influence mean allograft survival, but early hyperacute (vascular) or acute (cellular) rejection occurred only when ABO incompatibility was present.

ABO Blood-Group System↗
PubMed1985

[Space-occupying rectal cancer. Concept of the operation and early results in 15 patients].

In 1982 and 1983, 15 patients (14 women, 1 man) suffering from large tumors of the rectum and of the rectosigmoidal junction totally filling the small pelvis, underwent operation. Depending on the extent of the tumor, 8 patients underwent a hysterectomy (53.3%), 7 a resection of the small intestine (46.6%), five a resection of part of the bladder (33.3%), three a resection of the vagina (20%), two an extirpation of the bladder (13.3%), and one each a nephrectomy, a resection of the ureter, a resection of the pelvic vein, and a resection of the abdominal wall. In two cases an ileal conduit was applied, in three an ureter splint. Hospital lethality rate was 20% (3 patients) with an average hospital stay of 53 days. After an average observation period of 18.3 months, 8 patients were still alive. The probability of surviving 12 months was 63%. - The surgical concept applied is presented.

Aged↗