Biomedical subjects

H Bergert

Publications and source records attributed to H Bergert.

10 recordsLinked to original sources

PubMed2006

Contrast-enhanced ultrasonography to detect liver metastases : a prospective trial to compare transcutaneous unenhanced and contrast-enhanced ultrasonography in patients undergoing laparotomy.

BACKGROUND/AIMS: The advent of contrast-enhanced ultrasound (CEUS) has called into question the efficacy of standard ultrasonographic techniques. In this study, we evaluated B-mode and color-duplex imaging and CEUS in the detection of liver metastases, using intraoperative and histological findings as a reference. MATERIALS AND METHODS: Before laparotomy, 108 patients suspected of having liver metastases were prospectively examined with B-mode and color-duplex imaging, followed by contrast-enhanced ultrasound (2.4 ml SonoVue). Patients with unresectable tumors (n=8) were excluded from the analysis. The sonographic diagnosis in the remaining 100 patients was compared to the intraoperative and histological findings. RESULTS/FINDINGS: CEUS improved the sensitivity for detecting liver lesions from 56.3% (B-mode) to 83.8% (CEUS) (p=0.004). In particular, the contrast agent led to an improvement in ultrasonographic detection in the following cases: nodular metastases smaller than one centimeter; after adjuvant chemotherapy; for tumors near the surface of the liver; and for lesions situated around the ligamentum teres. INTERPRETATION/CONCLUSIONS: CEUS provides significant improvement in the detection of liver metastases, and should therefore, be performed routinely in the surveillance of cancer patients.

Adult↗

PubMed2006

Matrix metalloproteinase 2 polymorphisms in a caucasian population with abdominal aortic aneurysm.

BACKGROUND: The formation of sporadic abdominal aortic aneurysm (AAA) is explained by remodeling of the extracellular matrix (ECM) and breakdown of structural components of the vascular wall. Matrix metalloproteinase 2 (MMP2) is one of the principal matrix-degrading proteases and is known to play a major role in the remodeling of the extracellular matrix in arterial vessels. Increased MMP2 expression in the extracellular matrix of the walls of AAAs has been shown in several studies. To investigate the possible impact of genetic variants of the MMP2 gene in the etiology of AAA, we conducted this case-control study. PATIENTS AND METHODS: We analyzed MMP2 single-nucleotide polymorphisms (SNPs) in 51 patients with AAA and 48 controls. Differences in genotype and allele frequencies of identified polymorphisms were determined after sequencing the entire coding region and three selected parts of the promoter. RESULTS: Eighteen polymorphisms were identified, 6 of which are newly described, with 3 located in the introns (c.IVS1+31C>G, c.IVS7-18G>A, c.IVS10+26C>T) and 3 located in the coding region (c.124G>A, c.1368C>T, c.1860C>T). There were no statistically significant differences in genotype or allele frequencies between the two groups. CONCLUSIONS: Our analysis of the entire coding region and three parts of the promoter of the MMP2 gene failed to show an association between genetic polymorphisms and AAA, suggesting that variations in the MMP2 gene do not contribute to the development of AAA.

Aged↗

PubMed2004

Prevalence and treatment of bleeding complications in chronic pancreatitis.

OBJECTIVES: As spontaneous major haemorrhage in patients with chronic pancreatitis is rare, limited data have been reported, and no evidence-based guidelines are currently available regarding the optimal treatment modality. PATIENTS AND METHODS: We report our experience with 36 patients with severe bleeding complications from a series of 541 patients presenting with chronic pancreatitis (representing a prevalence of 6.7% of admitted patients), treated in one surgical department over a period of 9.5 years, with a median follow-up of 4.1 years. RESULTS: Haemorrhage was indirectly related to chronic pancreatitis in eight patients (22.2%) with ulcer or variceal bleeding. Three patients (8.4%) demonstrated spleen infarction or rupture. The most common causes of major haemorrhage were pseudoaneurysms in 25 patients (69.4%). Nine of them were treated with primary embolization. Sixteen patients with pseudoaneurysms underwent surgery. The only mortalities (8.3%) observed were from bleeding-associated complications of pseudoaneurysms. Two patients died after surgery, and one after primary embolization. We observed a higher re-bleeding rate after surgery (25% vs 11% after embolization). The presence of haemorrhagic shock, and the amount of blood transfused, were significant determinants of hospital mortality. Patient age, pseudoaneurysm location, and treatment modality had no significant influence on mortality. CONCLUSIONS: Any haemodynamically stable patient with haemorrhage due to arterial pseudoaneurysms should undergo angiography with embolization when technically possible. If there are no other pancreas-related indications for surgery, embolization remains the definitive treatment. If embolization is not available or has failed, surgery is indicated, although perioperative morbidity will be higher.

Adult↗

PubMed2004

[The dermatologic consultation].

BACKGROUND: Dermatology and venereology, as a cross-sectional discipline, plays an important role in the interdisciplinary care of inpatients. Nonetheless, only a few studies on dermatological consultations have been performed. We reviewed the dermatological consulting service at the University Hospital of the Martin-Luther-University, Halle, Germany. PATIENTS AND METHODS: All consultations performed in 2001 and 2002 were retrospectively assessed. In addition, the time spent in consulting activities was prospectively recorded over a period of six months (January-June 2003). RESULTS: A total of 2390 consultations were evaluated. Most of the consultations (42.8%) were made on internal medicine wards, followed by pediatrics (11.7%), neurology (9.9%) and cardiothoracic surgery (5.7%). Infectious skin diseases accounted for the most frequent diagnosis at 24.4%. The time lapse between request and performance of the consultation averaged 1.1 days. Patients older than 40 years needed dermatological consultation more frequently than younger patients. The duration of consultation averaged 23 minutes (time to site, patient examination, documentation). Thus, the man-hours required for the consulting service is 33.6 per month. CONCLUSION: The study emphasizes that dermatological consultation services make an important contribution to the care of inpatients. In light of increasing specialization in medicine, the consulting service guarantees interdisciplinary treatment of the patients and is thus an important quality parameter for inpatient care.

Comorbidity↗

PubMed2004

Infragenicular polytetrafluoroethylene bypass with tapered versus straight vascular grafts: results from a prospective multicenter cohort study.

Both straight and tapered arterial grafts are commonly used for infragenicular bypass surgery. Opinions vary considerably regarding the use of each type of graft and depend on individual experience, as no trial yet has assessed clinical outcomes comparing both groups. We conducted a prospective, multicenter, cohort study to analyze results for each graft type. From a total of 81 patients, 50 underwent infragenicular bypass surgery with straight PTFE prostheses and 31 with tapered prostheses in a prospective, multicenter trial. Six different centers for vascular surgery took part in the trial. In clinical follow-up at discharge as well as 3, 6, 12, 18, 24, and 36 months after revascularization, various parameters were evaluated comparing patency rates, limb salvage, and major amputation rates. Significant differences were found in limb salvage rates between the two groups. Patients receiving a straight graft fared better in this regard. Further data suggest that short-term primary patency is also improved in straight prostheses. Sixty-four percent of these remained patent after 1 year, while only 50% of tapered prostheses were still patent. No differences between the groups were found for secondary patency. The advantages of straight prostheses seem to be reduction of thrombus formation and intimal hyperplasia. Furthermore, it appears that the surgeons participating in this study prefer the use of straight prostheses. Even though the group of patients that received tapered grafts had slightly more unfavorable preoperative conditions, the data still support the superiority of straight vascular grafts. However, prospective randomized trials are necessary to evaluate the benefit of different bypass designs definitively.

Aged↗

PubMed2004

Quality of life and long-term results after ruptured abdominal aortic aneurysm.

OBJECTIVES: Quality of life as an endpoint of surgery and the long-term prognosis for patients who have survived surgery for a ruptured abdominal aortic aneurysm (RAAA) is not well-documented. PATIENTS AND METHODS: The records of all patients from 1993 to 2000 who underwent resection of RAAA were reviewed. Survival data were calculated from direct contact with the patients or follow-up records. All patients who were alive at the time of our study were invited to participate in follow-up investigations. They received the internationally comparable WHO-QOL-BREF-test. RESULTS: In a period of 7 years, 80 patients underwent surgery for RAAA. The average follow-up time was 5.1 years (1-7.9 years). Our data show that 51% of our patients died within 6 months postoperatively because of the complications of the aortic rupture (in-hospital mortality 39%). Patients who survived the first 6 months after surgery died for the same reasons as the normal population. However, patients who were younger than 75 at the time of RAAA had a higher relative survival rate than a matched sample of the population. There was no significant difference in the quality of life between the study group and the general population. CONCLUSIONS: RAAA survivors had no difference in long-term survival as compared to the general population and also had very few long-term complications. The WHOQOL-BREF-test suggests that the quality of life of survivors of RAAA is similar to the general population.

Aged↗

PubMed2004

[Therapeutic options in the treatment of pyogenic liver abscess].

BACKGROUND/AIMS: Pyogenic liver abscess is a rare and life-threatening disease. Our aim is to discuss the aetiology and problems of diagnosis and treatment of this disease, based on our own clinical experience. We present and compare different therapeutic options, i. e. ultrasound-guided percutaneous abscess drainage, CT-guided drainage and open surgical drainage. PATIENTS/METHODS: In a time period of 8 years, 62 patients with pyogenic liver abscesses were treated. The therapeutic procedure used most frequently was ultrasound-guided percutaneous abscess drainage in 41 patients, followed by CT-guided drainage in 13 cases. 8 patients were primarily treated with surgical drainage or liver resection, respectively. RESULTS: With an overall mortality of 9.6 % we achieved an encouraging result. The comparison of mortality between groups treated with ultrasound-guided percutaneous abscess drainage (7.3 %) and CT-guided drainage (7.7 %) revealed no significant prognostic difference. The comparison of local complications and drainage failure between ultrasound-guided percutaneous abscess drainage (2.4 %) and CT-guided drainage (15.4 %), however, showed better results for the ultrasound-guided interventions (1/41 vs. 2/13 patients). Two patients undergoing open surgical drainage died due to an advanced septic shock syndrome. CONCLUSIONS: Our study suggests that ultrasound duplex imaging with percutaneous abscess drainage is a reliable and effective approach for the treatment of pyogenic liver abscess. Based on other studies in the literature and our own results we developed a diagnostic and therapeutic algorithm for the treatment of liver abscesses.

Adult↗

PubMed2002

[Results and complications of ruptured abdominal aortic aneurysm repair].

During 1993 to 2000 85 patients were treated for a ruptured abdominal aortic aneurysm. The average age of the patients was 72.4 years (46-90). 71 patients showed an infrarenal rupture and the remaining 14 a suprenal rupture. 76 of 85 cases were covered ruptures. All patients were operated upon. A tube graft was required in 43 cases and 31 needed a bifurcated graft. In further two cases an extraanatomical bypass was necessary due to a mycotic aneurysm. The operation on 11 patients could not be completed and 21 patients died in hospital during the postoperative period. On the other hand, 53 patients survived the rupture of the aneurysm. The mortality rate was 37.6 %. The early non-surgical complications dominated during the postoperative period. Respiratory failure, renal failure and cardiac failure were responsible for the mortality rate. It is unforseeable which patients will survive the emergency operation. Therefore it is always appropriate to attempt the reconstruction of an acutely ruptured AAA.

Aged↗

PubMed2001

[Jejunal reservoir for pouch. Anal reconstruction].

Jejunal reservoir for pouch. Anal reconstruction. For restaurative proctocolectomy the ileal J-pouch is a world-wide accepted procedure. In some cases the mesenteric vascular anatomy does not allow to bring the ileum down to the dentate line. In these patients a jejunal reservoir can be a good alternative. The different architecture of arteries and veins within the jejunal mesentery makes the bridging of a longer distance possible. Within a group of 38 restaurative proctocolectomies, jejunal pouch was performed in 2 cases. Failure of an ileal pouch was the reason in one patient. In the other, the ileal mesentery was too short to achieve a tension free ileal pouch-anal anastomosis. The functional result is good in both cases.

Adenomatous Polyposis Coli↗

PubMed1999

[Therapy of deep leg vein thrombosis. When is surgical therapy indicated?].

In spite of quite a few clinical trials the benefit of venous thrombectomy is seen controversially. The primary objectives of treating venous thrombosis are survival rate, prevention of pulmonary embolism and of postthrombotic syndrome. We report our experience with 47 patients who underwent venous thrombectomy. The mortality rate was 0%. We did not observe clinically relevant pulmonary embolism. After two years 90% of thrombectomised veins were patent. The mortality rates given in the literature of conservative treatment with heparin and following oral anticoagulation are 0.4 to 1.6%. Fibrinolysis shows mortality rates of 1 to 2.4, and thrombectomy of 3.8%, respectively. Venous thrombectomy is an effective treatment to prevent pulmonary embolism. In our own experience we saw no clinically significant pulmonary event. The danger of embolism rises with the proximity of the venous thrombus. Therefore those patients may have the greatest potential benefit from thrombectomy who present with a mobile inguinal thrombus or a thrombus in the iliac vein. So far there are no statistically sufficient data to support the indication of thrombectomy to prevent a postthrombotic syndrome.

Adult↗