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Biomedical subjects

H D Saeger

Publications and source records attributed to H D Saeger.

At least 91 records · Page 5Linked to original sources
PubMed1994

Immunotherapy of metastatic melanoma with interferon-alpha and interleukin-2: pattern of progression in responders and patients with stable disease with or without resection of residual lesions.

This evaluation was performed in melanoma patients after successful immunotherapy to describe the pattern of relapse. 63 patients received interferon (IFN)-alpha and high-dose interleukin (IL)-2, resulting in three complete responses (CR), 13 partial responses (PR), three mixed responses (MR) and 17 stable diseases (SD). Median duration of response was 7 months (range 3-28) without surgery. Most relapses occurred at pre-existing sites. Duration of CR was 14-37+ months. In 11 patients, residual tumour lesions were resected. Interestingly, histology revealed almost complete tumour regression in 6 patients, including 2 of 4 with SD. 5 of these 11 patients have relapsed so far, 6 patients are still free of disease with a median of 17 months (range 8-34). Following relapse, 4 of 6 patients responded to retreatment with the identical IFN alpha/IL-2 protocol. The authors conclude that initial disease progression is mostly at previous sites of disease. Resection of residual lesions may offer a chance for extended disease-free survival similar to patients with CR to immunotherapy. Retreatment of relapsing patients is favourable.

Cohort Studies↗
PubMed1994

[Results of surgical therapy of soft tissue sarcoma of the retroperitoneum].

Between 1.1.1973 and 30.6. 1993 57 patients underwent operation for soft-tissue sarcoma of the retroperitoneum. The histological classification showed in 21 cases a liposarcoma and in 14 cases a leiomyosarcoma. Other histological types like fibrosarcoma, malignant fibrous histiocytoma or malignant schwannoma were only rarely seen. Complete resection (R-0-resection) was possible in 39 cases (73.5%). 6 patients underwent partial resection (R-2-resection) and 8 patients had only an explorative laparotomy because of an unresectable tumor. To realize a complete resection in 23 cases a multivisceral resection was necessary. The postoperative staging according to AJCC showed for 47.7% of the patients a stage III- or stage IV- disease. The clinical follow-up was observed between 3 months and 14.3 years. The cumulative 5-year-survival-rate for all patients was 38.2%. The most important factor for prognosis was the complete resection, while other factors like sex and age of patients, size of the tumor and histological type did not predict outcome. After complete resection the cumulative 5-year-survival-rate was 46.7%, while after partial resection or explorative laparotomy no patient survived 5 years.

Adult↗
PubMed1994

[Management of abdominal stab injuries].

This is a retrospective study of 56 abdominal stab wounds analysed with reference to aetiology, pattern of injury, diagnostic and therapeutic procedures and indications for surgery. Indications for mandatory laparotomy were a manifest haemorrhagic shock (n = 20), evisceration (n = 13) and persisting presence of a weapon in the abdomen (n = 2). All patients who did not undergo immediate surgery were observed closely in repeated physical examination, in some cases complemented by ultrasound examination or peritoneal lavage. The indications for surgery were then based on the development of clinical signs. As a result of this selective approach, 31 patients underwent surgery immediately, 21 patients within 4 h and 4 patients more than 4 h after the initial assessment. The unnecessary laparotomy rate was 10.8%. The mortality rate was 3.5%, but in no case did death result from the selective approach.

Abdominal Injuries↗
PubMed1994

[Mesh wrapping of the liver. A very promising method for managing severe liver trauma].

Mesh-wrapping is a quick and technically feasible method to achieve definitive hemostasis in severe liver trauma. It can be combined ideally with conventional procedures. Mesh-wrapping has the same spectrum of indications in severe liver trauma as packing with gauze pads. Whereas packing seems to be superior in cases with bleeding from juxta-caval injuries, Mesh-wrapping is considered to be superior in coagulopathy. The Mesh-wrapping technique provides a highly selective, tight compression confined to the liver and does not produce an increased intraabdominal pressure. The mesh is resorbable and therefore reoperation for removal is not necessary. In cases of postoperative fluid collections the Mesh-wrapping can easily be punctured. Because of its own bacteriostatic capacity Mesh-wrapping seems to be superior when the patient has concomitant gastrointestinal injuries. In summary we think that Mesh-wrapping is a useful alternative in the more conservative, organ preserving spectrum of liver trauma management.

Adult↗
PubMed1994

[Results of treatment of esophageal cancer].

From 1.10.1972 until 1.1.1993 176 patients underwent esophageal resection for cancer of the esophagus. There were 72.7% squamous cell carcinomas and 24.4% adenocarcinomas. pTNM staging was as follows: Stage I: 7.3%; stage IIa: 33.5%; stage IIb: 11.9% and stage III 47.1%. The resection was performed in 92.6% by an abdominothoracic approach. Reconstruction was usually performed by transposition of the stomach. Only in 8 patients colon was used for esophageal replacement. The complication rate was 34.6%, mainly pulmonary complications were seen. The rate of anastomotic insufficiency was 6.2%. Hospital mortality was 15.3%, but decreased from 29.1% in the years 1972-1982 to 10.1% in the last decade. There was a significant correlation between the 5-year-survival-rate and the tumor staging respectively the lymph node involvement. The long-term results showed a relatively high percentage of reflux complaints and persistent dysphagia. But the general condition and quality of life were considered subjectively by 53.5% as good and by 42.8% as moderate. From these results it can be concluded, that surgery today offers the best chances for potential cure and a high quality of life.

Adenocarcinoma↗
PubMed1993

[Crohn disease: resection therapy over the course of two decades].

Between 1972 and 1992 394 bowel resections were performed on 344 patients with Crohn's disease at the Surgical University Hospital Mannheim. The aim of this retrospective study was to examine the changes in indication, surgical technique, complication rate and mortality during this period. With the increasing incidence of Crohn's disease, the yearly number of resections has increased (from 9.8 to 30.8), while the frequency of emergency operations has declined (from 24.8% to 15.4%). During the last ten years, surgery was performed at an earlier stage; more often stenoses were resected before complications (chronic or acute intestinal obstruction, fistula and perforation) occurred. Complication rate and mortality has been reduced in the last ten years (complication rate: from 35.6% to 10.6%, mortality: from 3% to 0.7%). A significant higher complication rate was seen after emergency operations (37.1%) as compared to elective operations (12.6%) (p < 0.0001).

Adolescent↗
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↗