PubMed Health⌕ Search

Biomedical subjects

H Hamelmann

Publications and source records attributed to H Hamelmann.

At least 19 recordsLinked to original sources
PubMed1991

[The personality of the surgeon].

The surgeon's image has been altered considerably throughout the past decades by social and political influences. Most important of course are the many innovations within the field of surgery. A surgeon must be capable of adapting to changes within the realm of basic concepts and operative techniques. The qualifications of the individual surgeon therefore require an invariably high standard.

Clinical Competence↗
PubMed1991

Randomized comparison of endoscopic palliation of malignant esophageal stenoses.

In a randomized study, palliative therapy of malignant esophageal and gastric stenosis was investigated by a comparison of endoscopic laser therapy (ELT) with palliative endoscopic perturbation (PEP). A total of 124 patients exhibiting a malignant stenosis in the esophagus and proximal stomach were referred to our unit between January 1, 1987, and March 31, 1990. Criteria for randomization were: (1) inoperable malignant stenosis, (2) dysphagia enabling the ingestion of semi-solid food, (3) the possibility of performing ELT and PEP, and (4) the absence of fistula formation. Only 40 patients met these criteria; the remaining 84 subjects were assigned to an escape group whose treatment consisted of ELT, PEP, percutaneous endoscopic gastrostomy, transnasal feeding tube, radiotherapy, and endoscopic bougienage. We found no significant difference between ELT and PEP with regard to survival, food passage, or quality of life. We recommend the application of PEP in patients exhibiting advanced tumor disease and a poor general condition and favour the use of ELT combined with afterloading in patients with a life expectancy of greater than or equal to 3 months.

Adenocarcinoma↗
PubMed1991

[Value of endorectal sonography in the follow-up of patients treated surgically for rectum carcinoma].

This prospective study included 80 patients in routine follow-up examinations after rectal cancer treatment. We performed anamnesis, clinical examination, total colonoscopy and endorectal sonography and tested the level of tumour markers CEA and CA 19-9. In 10 cases we detected local cancer recurrence of the rectal tumour. In 8 cases tumour markers were pathologically raised. Endoscopy detected the local recurrence in 4 patients only. Endorectal US was able to detect all of the recurrence cases. A histological confirmation was possible by EUS-guided needle biopsy in all cases. We were able to perform R 0-re-resection with the hope of curing in 4 patients out of 10 recurrence cases. Only endorectal US was able to detect two of those 4 recurrent tumours. In the follow-up of rectal cancer endorectal US seems to be a highly sensitive examination that may raise the number of re-resection with the hope of curing after rectal cancer treatment.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1990

Small bowel transplantation: report of a clinical case.

Extensive small bowel resection may become necessary for several reasons in children and adults. The only causal therapy of short bowel syndrome is small bowel transplantation. So far severe immunological problems have caused deleterious results despite technically successful transplantation. A clinical case of small bowel transplantation in a child is reported. The 3-year-old boy had been operated on for volvulus which had led to nearly total gangrene of the whole small bowel. Finally, only 4 cm of jejunum could be saved. Total parenteral nutrition (TPN) therefore became necessary. Small bowel transplantation was carried out with the mother as donor; transplantation technique is described in detail. Postoperative immunosuppression was performed by administration of cyclosporin A and prednisolone. Because of graft rejection, the graft had to be removed on the 12th postoperative day. At present, the child is well and on TPN again. This case shows that small bowel transplantation by living related organ donation is technically possible without impairment of the donor's quality of life. Further experimental and clinical work should be encouraged.

Child, Preschool↗
PubMed1990

[Surgical measures for preventing abdominal adhesions].

The extent of intraabdominal adhesions can be limited by reducing the degree of operative trauma. This may be achieved by: prevention of ischaemia, moistening of the peritoneal surface, gentle handling of tissue, and the use of thin atraumatic suture material. The most recent development, minimally invasive surgery, reduces the actual area of operative trauma, and possibly lessens the risk of postoperative adhesions. Should a re-laparotomy be indicated for complaints due to adhesions, the laparoscopic approach to adhesiolysis has increased in importance.

Abdomen↗
PubMed1990

[Animal experiment studies of amnion transplantation as peritoneal replacement].

In view of the favorable properties of the amniotic membranes as a peritoneal substitute, the following questions were posed: (1) Can the vitality of the amniotic epithelium be preserved by cryoconservation? (2) Which reactive changes occur in an intraabdominal amniotic graft? Animal studies gave the following findings. The vitality of the amniotic cells was not impaired by cryoconservation. A histiocytic demarcation zone developed on the membrane.

Animals↗
PubMed1989

[New aspects of the diagnosis of pancreatic cancer by determination of granulocyte elastase].

Elastase determination via elastase-alpha 1-antitrypsin-complex is recommended for the prognosis of septic infections. Since it is described that elastase values are increased in the serum of tumor patients it was the aim of the investigations to test elastase in the serum of different surgical tumor patients postoperatively. For comparison patients with septic complications as well as patients without any postoperative complication were also tested. It could be shown that in septic patients elastase values are markedly increased. They were measured at 390 ng/ml in mean, whereas patients without complications after operation had only values of 229 ng/ml. Elastase values in tumor patients were only slightly increased (290 ng/ml). It was, however, generally noticed that patients with pancreas head carcinoma showed regularly markedly increased elastase values (375 ng/ml). From this it was concluded that the determination of elastase values in tumor patients gives no reliable information except in patients with pancreas head carcinoma. In these patients the determination of the elastase could be helpful especially because the normal enzyme diagnosis is often misleading.

Female↗
PubMed1989

[Technical prerequisites for performing controlled studies with the goal: postoperative quality of life after gastrectomy].

A study of 78 cases of gastrectomy in which two reconstruction procedures Roux-en-Y + pouch and interposition + pouch were compared and which is still in progress, yielded the following results: 1. It is possible to use both methods only with staplers and have few complications in a time-saving procedure. 2. A Roux-en-Y + pouch takes mean = 50 min; an interposition + pouch requires mean = 90 min (net time of reconstruction). 3. It is sometimes impossible for anatomical reasons to use an interposition + pouch. 4. The more complex procedure--the interposition + pouch--does not have a higher rate of complications. 5. Technical development permits controlled studies investigating the long-term target: quality of life.

Anastomosis, Roux-en-Y↗
PubMed1989

[Diagnosis and therapy of gastrointestinal hemorrhage].

In the upper gastrointestinal tract endoscopic hemostasis has not replaced surgery, but reduced it to a necessary minimum. Active bleeding can be stanched by the injection method during emergency endoscopy. For bleeding esophageal varices we use polidocanol, in other lesions in the upper gastrointestinal tract we apply thrombin and in the lower intestinal tract adrenalin. If endoscopic hemostasis is successful in small bleeding vessels, the efficiency of hemostatic injections can be trusted. Large visible vessels need to be operated early electively. After the introduction of this therapeutic concept, for example the operation frequency in bleeding gastroduodenal ulcers could be reduced from 51% in 1982 to 28% in 1988. Mortality was improved from 22.1% to 4.7%. In gastrointestinal bleeding diagnostic problems occur especially with angio dysplasia in the small intestine and colon. This is due to impaired accessibility in the small intestine and problematic cleaning of the colon. In the intestine surgical therapy of bleeding lesions has very few alternatives, for example palliative embolization of infusion of vasoconstrictiva.

Emergencies↗
PubMed1989

[Surgical indications status in ileus using a simple clinical index].

Based on a retrospective analysis of a group of patients with ileus disease in regard of the indication for operative intervention an "ileus index" was created which is derived from simple clinical and radiological findings and laboratory data. Prospective evaluation of this index showed its effectiveness in separating patients who had to undergo an emergency operation from those who could be operated electively after preceding diagnostic procedures or could be treated conservatively.

Gastrointestinal Motility↗