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Biomedical subjects

H F Kienzle

Publications and source records attributed to H F Kienzle.

At least 19 recordsLinked to original sources
PubMed1995

[Mesenteric panniculitis].

We report three cases of mesenteric panniculitis in which the disease took different courses. The first case clinically mimicked an acute diverticulitis and consequently laparotomy was performed. During this operation a large space-occupying tumour was found in the lower abdomen. After resecting this tumour mass of uncertain classification (benign or malignant) a preternatural anus of sigmoid colon was formed. Histological exploration revealed mesenteric panniculitis. Six months later we restored continuity of large bowel by end-to-end anastomosis. No residues of the preexisting panniculitic alterations were seen. The second case concerned a female patient who again complained of discomfort after surgical treatment of colon carcinoma. We measured an elevated erythrocyte sedimentation rate and suspected a relapse of the malignant disease. Notwithstanding radiological and endoscopic diagnostics, the origin and classification of an intra-abdominal tumour could not be determined preoperatively. Laparoscopically we took a biopsy of the local mass, but a definite diagnosis was not found. Postoperatively undulant fever occurred, uninfluenced by cortisone treatment. Finally the patient died because of unstoppable hemorrhage under coagulopathy. Mesenteric panniculitis was identified as causative disease by autopsy.

Aged↗
PubMed1995

[Medical malpractice in ambulatory surgery].

Due to the structural reform of the public health service on Jan. 1, 1993, totally new conditions are generated for the hospital and partially for the surgical practice to extend the outpatient surgery, especially to transfer stationary tasks to the ambulant area. Additionally, to the basic contract according to SGB V for ambulant surgery, a special agreement about procedures for quality control in ambulant surgery according to sec. 14 of the contract regarding sec. 115b par. 1 SGB V has been added since June 13, 1994. Minimal requirements of quality are demanded to achieve a high quality in the outpatient area and maintain the standards of the stationary surgery. However, any detail has to be prospectively and more intensively considered, discussed and documented since the patient will not be available for supervision or discussion before and after surgery. The preoperative setting has to be checked carefully to avoid a situation where an elective surgery has to be postponed due to other pathologic findings or a faulty organization. The principle of trust may be applied when findings from other physicians are adopted but the final liability has the physician undertaking the surgery. The information of the patient after surgery has to be adapted to the symptoms. Thus, the symptoms of any problem or complication after surgery have to be explained to the patient that he can act properly if such problems occur. Actually, the patient's information after surgery is very important: pain, bleeding, prophylaxis of thrombosis, immobilization, transport problems and the availability of the surgeon at any time as well as a regular attendance during the consulting hours have to be clarified and discussed to maintain the demanded expert status of the physician and the valid medical standards as well as to meet the legal requirements for liability.

Ambulatory Surgical Procedures↗
PubMed1992

[Can endoscopic methods decrease the mortality and complication rate of bleeding stomach and duodenal ulcer? A study of the literature].

Bleedings from gastroduodenal ulcers still pose a major threat to health and life of a patient. Recent technical developments have provided the endoscopist with several methods for achieving hemostasis. In the present paper the results from clinical studies concerning interventional endoscopy shall be discussed. Criteria for the therapeutic approach for an individual patient shall be presented. Optimal results are possible if diagnosis and initial treatment are handled quickly by an experienced endoscopist. Early cooperation with the surgeon will further improve the outcome.

Duodenal Ulcer↗
PubMed1991

[Preventive operations of the gallbladder and bile ducts].

Prophylactic cholecystectomy is indicated for cholelithiasis in diabetic patients, in hemolytic anemias, before transplantations for focus treatment or implantation of a cardiac valve and also before travelling to countries with poor infrastructure; or for precancerous lesions like GB papilloma, porcelain gallbladder or cystic choledochus. Furthermore one can consider prophylactic indication for cholecystectomy for asymptomatic cholecystolithiasis in young patients in order to prevent complications in future.

Bile Duct Diseases↗
PubMed1990

[Gastrointestinal leiomyosarcoma].

The clinical course of 12 patients was analyzed in a retrospective study; all of these patients were operated on a gastrointestinal leiomyosarcoma. The most common site of metastasis was the liver (33%). These data confirm that histologic grade, size and the extent of resection are the most important prognostic factors. Because the differential diagnosis between benign and malignant smooth muscle tumors is often quite difficult and a high risk of local recurrence the enucleation of these tumors is insufficient.

Adult↗
PubMed1990

[Primary non-Hodgkin lymphoma of the stomach: diagnostic and therapeutic procedure].

It is reported on 13 patients with gastric non-Hodgkin's lymphoma, who underwent surgery between Jan 1st, 1984, and Sept 1st, 1987. Common symptoms included abdominal pain, weight loss and decline in health and strength. Endoscopy or barium studies had established the diagnosis of a gastric neoplasma in 12 cases. A total gastrectomy (n = 4) or a distal resection (B I n = 3, B II n = 5) was performed, depending on the size of the tumor and its location. Potentially curative resection was followed by radiotherapy in patients with high-grade lymphoma (stage I E). Patients with involvement of regional lymph nodes and advanced gastric lymphoma (stage II E1-IV E) underwent postoperative chemotherapy. So far follow-up (mean 25.3 months) revealed one case of relapse. These results confirm the value of surgical treatment in diagnosis, staging and treatment of primary gastric lymphoma. Survival in patients with advanced lymphoma and high-grade malignancy can be improved significantly by radical tumor resection, followed by multiagent chemotherapy and radiation.

Adult↗
PubMed1990

[Diffuse eosinophilic gastroenteropathy].

Eosinophilic gastroenterocolitis is a very rare disease of the gastrointestinal tract. As a result, frequently the diagnosis is missed and/or symptoms get misinterpreted. Histological examination and blood analysis however support the finding of the correct diagnosis in most cases. We report here the case of a 47 year old female patient with diffuse gastroenterocolitis and we will comment the diagnostic problems.

Colitis↗
PubMed1989

[The solid-cystic pancreas tumor].

Solid-cystic pancreas neoplasia is a rare condition mostly observed in young adults and women. We report three cases of this rare tumor. In all three instances the patients were young, slender women. The tumors were removed by total resection of the pancreas. In two cases these tumors were very large. In two cases we also observed criteria which could indicate that these tumors were malignant: the tumors had infiltrated the adjacent spleen and adjoining lymphnode or displayed a destroyed capsula. Until now, such infiltrative or malignant qualities have not been reported. That such criteria can be conclusively evaluated as an indication of malignancy, remains, however, unclear.

Adenoma, Islet Cell↗
PubMed1989

[Late results following dilatation of Vater's papilla in benign stenosis].

Between 1.1. 1978-31. 12. 1984 685 patients of Städtisches Klinikum Karlsruhe underwent choledochotomy for common bile duct stones. In 178 cases (27.1%) the papilla of Vater was dilated because of inflammatory stenosis. 2 until 8 years after operation 117 patients could be reexamined. 113 patients showed no complaints. Our results show that a single intraoperative dilatation of the papilla of Vater during common bile duct surgery is a valuable and effective treatment. Furthermore it proves to be of additional diagnostic value in the indication for transduodenal papillotomy.

Ampulla of Vater↗
PubMed1989

[Chemolitholysis of gallstones as ambulatory treatment by the established physician].

General Surgeons and physicians for internal medicine were asked for their results of dissolution-therapy of gallstones. 405 physicians were asked, 283 (69.9%) answered; 33.6% of these had some experience with the dissolution therapy. Data from 100 patients could be gathered completely: from 72 women (mean age 48 years) and from 27 men (mean age 53 years). The age-distribution resembled those of surgical gallstone-patients. In 27 cases the dissolution was successful (mean duration of therapy 49.6 weeks), in 25 cases there was a partial success (mean duration of therapy 54.8 weeks), and in 48 cases the dissolution-therapy failed (mean duration of therapy 55.5 weeks). In 60 cases therapy was stopped, but only 25 of these patients underwent cholecystectomy. In summary there is some evidence, that many collegues are sceptical against dissolution of gallstones, that the preoperative diagnostic procedure is ineffective, that the results of dissolution therapy in a common praxis is not as effective as in controlled studies, that dissolution therapy mainly is forced in patients at a normal risk--and not in high-risk patients, that only few patients are ready to take the pills longer than 1 year, and that in the case of stopping the therapy not all patients undergo consequently cholecystectomy.

Adult↗
PubMed1988

[Portable infusion pump for ambulatory cytostatic therapy in inoperable liver metastases].

Liver metastases were demonstrated in a 48-year-old man 12 years after resection of a carcinoma of the sigmoid colon (pT2, G2, N0, Mx). A computer-driven external infusion pump was implanted and regional liver perfusion instituted with 5-fluoro-uracil. After seven chemotherapy cycles, 4-7 weeks apart, the liver metastases were no longer demonstrable by ultrasound and computed tomography. During the entire course of chemotherapy the patient was able to continue his profession as a teacher without any restriction.

Adenocarcinoma↗
PubMed1987

[Clinical aspects and therapy of benign pleural mesothelioma. A case report].

It is reported on a large benign monophasic fibrous mesothelioma. Despite its enormous size it was clinically silent and caused considerable problems in diagnosis and localisation. Computed tomography and arteriography suggested that the tumour, which was attached to the diaphragm and vascularized by strong vessels of the left gastric artery arose from the retroperitoneum. Therefore, falsely, the patient underwent initial laparotomy. At thoracotomy, the pedunculated tumour war easily removed. Histiogenesis and prognosis are evaluated in detail.

Diagnosis, Differential↗