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Biomedical subjects

H Hamelmann

Publications and source records attributed to H Hamelmann.

At least 37 records · Page 2Linked to original sources
PubMed1988

[Surgical possibilities in recurrence of colorectal carcinoma].

Locoregional recurrences occur in 10 to 15% of curatively operated rectal carcinomas. Technically conditioned relapses can be largely avoided by proper procedure, such as taking into consideration the localisation, staging, grading, safety zones and step-by-step procedure, e.g. "no-touch-isolation" technique, radicular approach and rinsing with cytocides. In this manner, locoregional relapses can be reduced to about 10%. Only technically conditioned relapses can be cured by surgery, but, as already stated above, these should be avoided by an appropriate technique. It is quite out of place to indulge in euphoria in respect of treating locoregional recurrences, as shown by long-term examination of actual survival rates; calculated survival rates are certainly inappropriate for spreading euphoria. Such locoregional relapses can be recognised relatively early and reoperated "curatively" only if aftercare follow-up is regular and intensive. It seems that endorectal sonography is of special diagnostic importance for the early detection of relapses while being a relatively simple method. It must be stated quite clearly that efficient preventive measures during the first operation will be much more effective than any efforts put into follow-up or aftercare. Every surgeon should therefore know that it is imperative to proceed subtly and carefully during the first operation so as to avoid any relapses due to faulty technique, the more so since all relapses have a poor prognosis even with so-called "curative" operations.

Colonic Neoplasms↗
PubMed1987

[Manual suture versus/or mechanical suture from the German viewpoint].

There is a definite increase in the application of stapled sutures in the gastrointestinal tract and the lung. This is due to high level of technical perfection of modern staplers whose preceding models were actually already developed at the beginning of this century. The introduction of circular staplers since approx. 1978/79 has resulted in a true breakthrough for gastrointestinal tract surgery. Thanks to these circular staplers surgeons have been especially innovative regarding the principles of reconstruction. Thus the procedures for the formation of substitute stomachs (Roux-Y and pouch, interposition and pouch) allow an unprecedented degree of standardization and offer new physiological perspectives. The use of circular staplers in the rectum is generally accepted. However, a recent development concerning manual sutures using medium-term absorbable suture material should not be disregarded.

Gastrointestinal Diseases↗
PubMed1987

Direct immunostaining of TSH receptor related autoantibodies in Graves' disease.

Ten thyroid specimens from patients with Graves' disease were investigated immunohistologically with respect to the localisation of thyrotropin (TSH) receptor related autoantibodies. After conventional preparation of formalin-fixed and paraffin-embedded thyroid slices for immunostaining, 3-5 micron tissue sections were incubated with a porcine thyrotropin receptor containing membrane preparation (pTSH-R). The TSH receptor containing membrane fragments bound to the thyroid tissue were revealed with a slightly modified unlabelled PAP technique according to Sternberger, using an antiserum to pTSH-R obtained from immunized rabbits. This technique resulted in a staining of a considerable portion of plasma cells within the lymphoplasmacellular infiltrates of all the Graves thyroids. No staining occurred if for negative control either pTSH-R or its antiserum from rabbit was omitted. In addition, the staining reaction was markedly reduced by pretreatment of pTSH-R with serum from patients with Graves' disease in order to occupy its binding sites for autoantibodies prior to the staining procedure. It is concluded that the staining of the intrathyroidal plasma cells is due to their synthesis of autoantibodies directed against TSH receptor related structures of thyroid epithelia. The results are in keeping with the concept that the thyroid as the target organ itself is the site of autoantibody synthesis in Graves' disease.

Autoantibodies↗
PubMed1987

Evidence of autoimmune pathogenesis in autonomous thyroid adenoma.

Using an immunohistochemical attempt to immunostain thyroid related autoantibodies, 30 specimens of autonomous adenomas of the thyroid were investigated. Twelve out of 23 inflammatory infiltrates surrounding the 'hot' nodules contained plasma cells, which gave a positive staining reaction for thyroid related autoantibodies. Seven adenomas showed no significant lymphoplasmacellular infiltration. It is concluded that this phenomenon might be due to an autoimmune pathogenesis in a part of patients with autonomous adenomas, indicating that there is no sharp line between autoimmune and non autoimmune thyroid disorder.

Adenoma↗
PubMed1987

[Principles of particle resorption in the gastrointestinal tract].

The uptake of allergens by the epithelium of gastrointestinal tract is not sufficiently investigated. This is true especially for the absorption of small particles like spores and pollen. By means of scanning-electron-microscopy it is possible to locate particles easily and to observe absorption solutions of 0.5 micron and 1 micron latex particles, of 15 microns Urtica pollens and of 35 microns Lycopodium spores and further on by cannulation of the thoracic duct the transport of particles was investigated. After a short time of absorption latex particles were found to be concentrated on M-cells of Peyer's patches (PP) and were found in a close contact to macrophages inside the lymph follicles. There was a constant proportion of M-cells to absorptive-like cells in PP from about 1 to 12. Obviously all particles were also transported by thoracic duct lymph. The results obviously indicate: primary absorption of small particles occurs in M-cells of PP; absorption time is dependent on particle size and transport of particles is achieved by abdominal lymph.

Allergens↗
PubMed1986

[Roux-Y reconstruction following distal stomach resection using only staplers].

The spreading of stapled suture techniques has also entailed the utilization of staplers in gastric surgery. A functional, up-to-date, and exclusively stapled reconstruction procedure, Roux-Y-reconstruction, after subtotal gastrectomy was established and analyzed in a pilot study (n = 25). In doing so, one proceeded as follows after subtotal gastrectomy and systematic lymphadenectomy in cases of carcinoma: duodenal closure (GIA or TA30), gastric resection (TA90), jejunojejunostomy (EEA25), gastrojejunostomy (EEA25/28), closure of the projecting efferent loop (GIA). This study intended to achieve the following advantages: increased suture safety, saving of time, reduction of complications, and especially the extension of indications regarding age and localization of the tumor. A special program to eliminate mistakes in handling is required for the sole and systematic application of staplers in the upper gastrointestinal tract. Every complication occurring during and after surgery was carefully recorded in this study and the attainable quality of life after subtotal gastrectomy was assessed.

Adult↗
PubMed1986

[Functional pathomechanisms of anal fissure].

In a prospective consecutive study of 40 patients with anal fissure we analysed the anal sphincter function at rest and rectal distension. Healthy persons with comparable age and sex distribution were controls. The anal pressures were registered with thin water perfused catheters (2 ml/min). Our patients with anal fissure showed significant elevation of anal pressures at rest along the whole length of anal canal. During rectal distension only the distal part of anal sphincter (up to a level of 2 cm from the anocutaneous line) showed a spasm with reduced relaxation. Our results are useful for operative therapy, since lateral internal sphincterotomy corresponds very well to functional pathomechanism of anal fissure.

Adult↗
PubMed1986

[Risk of infection following splenectomy].

The problem of a reduced resistance against infections in splenectomized patients is again described on the occasion of one patient who died within a very short time after the beginning of a severe infection. A retrospective study of 150 patients without spleen showed that 2.6% died in a consequence of a severe infection. From the surviving patients 20% complained of very frequent infections. Immunological laboratory data as well as the reaction against recall antigens were reduced in those patients. So not all patients without spleen bear a high risk with regard to severe infections. In spite of this fact surgeons should try to preserve the spleen even in adults.

Humans↗
PubMed1986

[Surgical indications in isolated splenic diseases].

In clinical routine isolated diseases of spleen are rare manifestations. Absolute criteria for splenectomy are massive bleeding, malignancy, hypertrophic cysts and signs of perforation. Most other cases are relative indications for total splenectomy. Awareness of the spleen's immunological function prompted a search for other methods of management. Therefore an individual consideration on further medical treatment is necessary. Total splenectomy should withdraw from nonoperative or partial operative management of spleen diseases. By a correct preoperative diagnosis criteria should be established for selection of patients most likely to derive benefit from splenectomy.

Cysts↗
PubMed1986

[Effectiveness and side effects of low-molecular weight heparin-dihydroergotamine in preventing thromboembolism in abdominal surgery].

Low-molecular heparin-dihydroergotamine had been applied once a day to 103 patients and heparin-dihydroergotamine twice a day to 97 patients as part of a double-blind, controlled, consecutive, and randomised clinical study, with 200 abdominal surgery patients being involved. High-risk patients above 40 years of age and potentially affected by thrombotically predisposing factors were almost equally represented in both groups. Evidence to postoperative thrombosis was phlebographically produced in either group. No fatal pulmonary embolism was found to be among ten deaths. No significant differences of clinical relevance were found to exist between both groups with regard to coagulative values, intra-operative and postoperative blood and drainage loss, and complications due to bleeding. No accumulated occurrence of major postoperative complications was recordable from either group. The vascular status of all patients was unchanged from beginning to end of the period of observation. The following conclusion was drawn as a result of the study: One single NMH/DHE injection daily is comparable with two HDHE applications per die for action and undesired side-effects.

Abdomen↗
PubMed1986

[Heparin and the prevention of thromboembolism in surgery].

Heparin was introduced to medical prophylaxis against postoperative thromboembolic complications 50 years ago, following its discovery, structural elucidation, and first clinical use. Isolated subcutaneous application with and without control of coagulative data was followed by additional administration of dihydroergotamine. Results were thus substantially improved. The principle has now been scrutinised for the first time at the Surgical Hospital of Kiel University by computerised monitoring of large-scale application to more than 3,000 patients.

Dihydroergotamine↗