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Biomedical subjects

H D Saeger

Publications and source records attributed to H D Saeger.

At least 19 recordsLinked to original sources
PubMed1992

[Gunshot and stab injuries of the abdomen].

From 1973 to 1991 a total of 422 patients underwent surgery because of an abdominal trauma. 12 patients had gunshot wounds and 46 patients stab wounds. In a retrospective study the diagnostic and therapeutic procedure and the indication for surgery are analysed. After gunshot wounds of the abdomen we always performed a laparotomy. In 11 od 12 cases we found serious intra-abdominal injuries. Only in one case the laparotomy was "unnecessary", because of a tangential wound without penetrating of the abdominal wall. After stab wounds the diagnostic and therapeutic management was more selective. Indications for mandatory laparotomy after stab wounds were a manifest hemorrhagic shock, evisceration and a still left weapon in the abdomen (n = 22). The first clinical examination was completed by ultrasound or peritoneal lavage. Pathological findings like free intraperitoneal fluid or a positive lavage also were indications for laparotomy (n = 9). The other patients were observed closely, including repeated physical examination. The indication for surgery then based on the development of clinical signs. The time between first examination and laparotomy was never more than 12 hours. 39 patients (84.7%) had injuries of intraabdominal organs. 5 patients (10.8%) had a negative laparotomy. The mortality rate was 3.4%, but there was no death as a result of the selective approach.

Abdominal Injuries↗
PubMed1991

[Coincidence of sigmoid cancer and sigmoid diverticulitis].

From 1985 to 1989 265 patients with a carcinoma of the sigmoid or sigmoid diverticulitis have been operated in our clinic. 23 of the treated patients synchronously had a carcinoma and a diverticulitis. The carcinoma in these cases was found to be significantly more frequent in a stage T1 or T2. We also found a significantly higher rate of perforations in this group of patients.

Adenocarcinoma, Mucinous↗
PubMed1991

[Injuries of the small and large intestine in the traumatized abdomen].

Between 1973 and 1989 a total of 388 patients underwent laparotomy because of abdominal trauma. In 98 cases, injuries of the small bowel, the colon or the mesentery were found. The injuries were caused by motor vehicle accidents in 55 patients; 12 had gunshot or stab wounds and 12 committed suicide. There were 78 patients who had sustained a blunt abdominal trauma and 20 patients with a penetrating trauma. Only 21 patients had suffered a solitary injury of the gastrointestinal tract. In 41 patients there were also lesions to other intraabdominal organs, in 11 patients, thoracic injuries and in 24 patients, a craniocerebral trauma. Combined injuries of skull, thorax and abdomen were present in 24 patients. Neither ultrasound nor peritoneal lavage allows reliable prediction of injuries of the gastrointestinal tract. In 51 cases a defect of the mesentery or serosa was repaired. In 54 patients there was a rupture of the small or large intestine: in 20 of these cases primary repair without resection was performed and in 34, resection and anastomosis. Ileostomy or colostomy was done in only 8 patients. An anastomotic leak developed in 2 patients. Lethality is correlated to the extent of concomitant injuries. Solitary injury of the small bowel or colon was followed by lethality of only 4.1%, increasing to 50% in patients with combined injuries of skull, thorax and abdomen.

Abdominal Injuries↗
PubMed1991

[The prognostic value of a mucin histochemical study for the detection of a elevated risk of recurrence after surgical therapy of colorectal carcinoma].

Increased sialomucin production may occur in mucosa surrounding malignant colorectal tumors. The authors examined the value of sialomucin production for prognostication of subsequent local tumour recurrence. Colorectal mucosa was evaluated from 73 patients who had undergone curative surgery for colorectal carcinoma. Sialomucin production was semi-quantitatively measured, using a high iron-diamine/alcian-blue staining technique. Significant increases in sialomucin production was recorded from mucosa, at least along resection margins, from 17 in 39 patients (44%) who did not develop any local recurrence. On the other hand, increased sialomucin synthesis was recordable from only 10 of 27 patients (37%) who did develop local recurrence. Moreover, only one of 7 patients who developed metachronous recurrence had exhibited sialomucins predominantly on resection margins. These findings are likely to suggest that evidence to increased sialomucin production is not conclusively indicative of high risk of local recurrence.

Colectomy↗
PubMed1990

Long-term results of palliative endoscopic and surgical intubation of benign oesophageal stenoses.

Benign oesophageal stenosis can be treated by different methods. Besides surgical procedures and established conservative treatment (e.g. dilatation), more invasive endoscopic techniques such as cryosurgery and laser therapy have recently been developed. Intubation, which has been used to treat malignant strictures, can also be used in benign oesophageal strictures. Between 1977 and 1989 a total of 43 tubes were implanted in 26 patients (mean age 62.3 years). The mean duration of intubation was 149 days. We report our experience in patients intubated for (1) acid burns, (2) actinic strictures, (3) peptic strictures, (4) postoperative stenosis, (5) postoperative complications and (6) tracheo-oesophageal fistulae. We also discuss the complications (dislocation, disintegration, bleeding, perforation, operative removal) and long-term results. Because of the prolonged survival of patients with benign oesophageal stenosis, follow-up and late complications are of particular importance in this report. Despite drawbacks, intubation is an option in the management of patients with benign oesophageal stenosis.

Adult↗
PubMed1990

Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality.

Twenty-one years ago, Howard published a paper entitled "Forty-one Consecutive Whipple Resections Without an Operative Mortality." That paper stimulated the present analysis of the last 118 consecutive pancreatoduodenectomies (107 Whipple and 11 total resections) performed at the Surgical University Clinic Mannheim from November 1985 to the present day with no deaths. Ninety-one resections were performed for neoplasms and 27 were for complicated chronic pancreatitis. The preoperative evaluation, operative technique, and postoperative care of these cases is discussed in detail and compared to the experience of Howard. While there was general agreement on operative technique, there were differences concerning preoperative evaluation (modern imaging methods) and postoperative care (simplification). In this series 21 postoperative complications required seven relaparotomies. Long-term survival after resection for carcinoma was analyzed for 133 consecutive patients who were shown to have true ductal adenocarcinoma. In 76 patients, who had radical (R0-) resections, the actuarial 5-year-survival rate was 36%. In 44 patients, whose R0-resections for pancreatic cancer occurred more than 5 years ago, the actual survival rate was 25%.

Actuarial Analysis↗
PubMed1990

[Peripheral vein requirement-adjusted parenteral feeding: renaissance of maltose?].

A requirement-adapted peripheral-venous parenteral nutrition was developed by exchanging the conventional carbohydrates like glucose, etc., for disaccharide maltose in combination with a fat emulsion (650 mosm/l; 2,000 kcal). In a clinical randomised study, we compared this nutrition regimen with a common requirement-adapted parenteral nutrition regimen, which was applicated by central-venous catheter (2,000 mosm/l; 2,000 kcal). All results, including the results of tracer-investigations with the strable isotope 13C-leucine, showed no metabolic difference between these two nutrition regimens.

Blood Glucose↗
PubMed1987

[Results of surgical therapy of esophageal cancer].

Between 1973 and 1986, 141 patients with esophageal carcinoma have been operated. The overall resection rate was 59% (83/141). We preferred the operative resection by abdominal and right-sided thoracic approach. Only in 4 patients with generally high risk an abdomino-cervical blind dissection of the esophagus was performed. Reconstruction was done in all cases by oesophago-gastrostomy. During the last 14 years hospital mortality decreased from 36.4% (n = 8/22) in the first 7 years period to 7% (n = 3/43) during the last 4 years. Resection rate increased from 47% in the first to 65% in the second period. The 5 years survival rate of all resected patients was 23.5%.

Adenocarcinoma↗
PubMed1987

[Continent proctocolectomy--difficulties caused by previous operation].

Since 1981 23 Patients (19 with adenomatosis coli, 4 with colitis ulcerosa) underwent proctocolectomy with preservation of continence: total colectomy, proctomucosectomy, ileo-anal anastomosis with formation of an ileal S-pouch, and protective loop ileostomy. In 3 patients previous operations caused difficulties in performing the procedure. Critical points of the operative technique are explained, with special regard to the possibility of previous surgery. Postoperative complications and functional results are presented.

Adenomatous Polyposis Coli↗
PubMed1986

[Computed tomographic study of portal venous contrast medium perfusion of the liver].

Contrast medium was injected in the portal vein at a low flow rate via a transumbilical catheter in twelve patients. The distribution of the contrast medium in the liver was investigated by computed tomography. The results of this study demonstrate an incomplete mixture of splenic and mesenteric venous blood in the portal vein. In addition, there is layering of the contrast medium and blood in the portal vein, causing inhomogeneous contrast medium perfusion of the liver.

Aged↗
PubMed1986

[Amino acid uptake and release by colorectal cancer in man].

Little information is available regarding the amino acid exchange by human tumors. To characterize this exchange in vivo, 21 patients with resectable colorectal carcinomas were studied during curative operations. Concerning the amino acid uptake and release by peripheral tissues, 20 non-cancer patients served as controls. Both groups of subjects were well-nourished, as indicated by anthropometric and biochemical variables. In the cancer patients, we cannulated a peripheral artery and vein as well as a central tumor-draining vein and the portal vein. Plasma concentrations and concentration differences were determined in mumol/l and in percentages of the total amino acid amounts. Peripheral glutamate uptake per liter plasma was reduced in the cancer patients (p = 0.02). In these patients, the central tumor-draining vein contained less glutamine (p = 0.002) and more glutamate (p = 0.002) than the peripheral vein. Glutamine uptake by the tumor occurred more often than glutamine release, while glutamate had a negative balance across the tumor in all but three cases. The qualitative differences between the peripheral tissues and the tumors with respect to glutamine and glutamate exchange reached high levels of significance (p = 0.002 for both of the amino acids). In addition, the tumors released more glycine, ornithine, and tyrosine than the periphery. As to glutamine and glutamate metabolism, there was a significant difference between the tumors and the portal-drained organs (p greater than or equal to 0.05). The discussion of the results emphasizes the contributions made by the periphery and the tumor to the plasma amino pattern. The role of glutamine as a potential high importance energy source for neoplastic tissues is delineated.

Aged↗