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H Lippert

Publications and source records attributed to H Lippert.

At least 91 records · Page 5Linked to original sources
PubMed2000

Emergency stent-graft repair of a ruptured hepatic artery secondary to local postoperative peritonitis.

PURPOSE: To describe the use of a stent-graft for emergent repair of life-threatening hepatic artery hemorrhage. METHODS AND RESULTS: A 57-year-old man with a 17-year history of myxoid liposarcoma underwent surgery for a recurrent abdominal mass. Multivisceral resection including a Kausch-Whipple procedure with an extended right hemicolectomy was performed. Three weeks later, an episode of gastrointestinal bleeding prompted surgical repair of the hepatic artery, which had been eroded by infection due to a leaking bilioenteric anastomosis. After 3 weeks of programmed abdominal lavage, bleeding recurred. Angiography documented another rupture of the proximal hepatic artery. After an unsuccessful attempt at coil embolization, a Hemobahn stent-graft was implanted percutaneously during simultaneous cardiopulmonary resuscitation. Hemostasis was secured, and the patient recovered. Over the 10-month follow-up, no bleeding or infection has been observed at the site of the repair, and flow through the hepatic artery endograft remains satisfactory. CONCLUSIONS: Percutaneous stent-graft placement can be employed for emergent treatment of visceral artery rupture in patients at high risk for conventional surgical repair.

Abdominal Neoplasms↗
PubMed2000

Solid pseudopapillary tumor of the pancreas.

BACKGROUND: Its considerable size at the time of diagnosis and low grade of malignancy are typical features of the solid-pseudopapillary tumor, which has a tendency to predominantly affect young females. A relationship to the long-term intake of oral contraceptives is discussed. Invasive tumor growth or metastases have been observed only rarely until now. METHODS: The 53-yr-old female patient we report on here was treated by radical partial pancreatoduodenectomy for a nonmetastasizing solid-pseudopapillary tumor of the pancreatic head (T1bN0M0) 19 mo ago. RESULTS: Histopathological studies made a definitive diagnosis of solid-pseudopapillary tumor. The patient is recurrence-free, and there are no signs of metastases at present. Since a microscopically invasive tumor growth is assumed, oncologically curative resection should be preferred vs the less radical enucleation. CONCLUSION: In this report, a case of the rare solid-pseudopapillary tumor of the pancreas is described. In contrast to other pancreatic tumors, the semimalignant solid-pseudopapillary tumor has a favorable prognosis.

Female↗
PubMed2000

[Outcome of treatment of iatrogenic vascular lesions].

The incidence and etiology of iatrogen vascular injuries have changed during the last years due to the fact that many vascular procedures, including invasive catheter procedures, minimally invasive interventions and osteosynthetic operations are more frequently performed. 66 patients who were treated between 1993 and 1997 were retrospectively analysed. The most common cause of surgical repair were lesions after catheter procedures (n = 47; 71.2%) followed by various other causes (traumatology n = 6, orthopedics n = 5, gynecology n = 4, general surgery n = 4). In patients with complicated catheterizations and need for acute vascular-surgical repair, the limb could only be preserved in 12 of 21 cases (57.1%). Vascular lesions on account of other operative specialities finally required an amputation in 3 patients. One patient in this group died. Besides the seriousness of injury one main reason for an unfavourable outcome was a delayed diagnosis with subsequent exceeding of the ischemic tolerance in 18 patients (27.3%). Some rare and serious complications are especially discussed.

Adult↗
PubMed2000

[Acute upper gastrointestinal hemorrhage as a complication of hepatic artery port catheter].

We report a case of a 56-year-old patient with an acute upper gastrointestinal bleeding following penetration of an aneurysm of the gastroduodenal artery in the duodenal bulb. The patient received an i.a. portsystem five month before the reported acute gastrointestinal bleeding. The portsystem was implanted for treatment of multiple liver metastases of an neuroendocrine tumor. This life-threatening situation could not controlled endoscopically. Also an embolisation was impossible so we carried out a laparotomy with ligation of the proper hepatic artery. The postoperative course was uneventful. Due to her tumor disease the patient died 13 month after surgery.

Aneurysm, False↗
PubMed2000

Telomerase activity and expression of hTRT and hTR in gastrointestinal stromal tumors in comparison with extragastrointestinal sarcomas.

Stromal tumors of the gut (GISTs) have rarely been analyzed for genetic alterations. This study aimed at determining telomerase activity and the expression of the telomerase subunits human telomerase reverse transcriptase (hTRT) and human telomerase RNA (hTR) in GISTs and extragastrointestinal neurogenic or myogenic sarcomas. Telomerase activity was investigated using the telomeric repeat amplification protocol assay in 21 GISTs, recurrences and liver metastases from 16 patients, and in 22 leiomyosarcomas and 21 malignant peripheral nerve sheath tumors (MPNSTs), which served as reference tumors. Expression of hTRT and hTR mRNA was investigated using reverse transcription-PCR. Thirteen GISTs were localized in the stomach and three in the small intestine. Two tumors were benign. In one case, the biological behavior was uncertain. In 67% of GISTs, high telomerase activity was found, whereas high activity was noted in only 18% of leiomyosarcomas and in 48% of MPNSTs. There was no activity in two benign and two malignant GISTs. In one malignant tumor of the small intestine, the primary tumor showed no activity at first but a marked activity in its recurrence. In the tumor with uncertain behavior, telomerase activity and hTRT expression were only weak. In all GISTs showing telomerase activity, the catalytic subunit hTRT was expressed. All GISTs and extragastrointestinal sarcomas expressed hTR. In comparison with leiomyosarcomas and MPNSTs, malignant GISTs showed a higher telomerase activity, which, however, was not seen in benign GISTs. It is possible that telomerase activity occurs during the progression of malignant GISTs. There was a correlation between telomerase activity and the expression of hTRT.

Adult↗
PubMed2000

["Acute cholecystitis"--laparoscopic cholecystectomy is often possible. Results of a multicenter study by the East German Study Group for Performance Assessment and Quality Assurance in Surgery].

With the introduction of laparoscopic cholecystectomy (LCE) the method became very fast successful in clinical practice. To describe the actual situation we initiated in 1994/95 a clinical multicenter study with the name CESAQ. 29 hospitals participated in the study. 4,675 cholecystectomies were performed, a total number of 2,960 patients were operated upon with the laparoscopic and 1,468 with the conventional technique. Furthermore, conversion to open cholecystectomy was necessary in 247 cases. One part of the study focused on the results achieved for patients with acute cholecystitis. 9.4% of the laparoscopic but 37.3% of the conventional cholecystectomies were performed due to acute cholecystitis. We differentiated a simple (adhesions to gallbladder, hydrops) and complicated form (empyema, gangrenous gallbladder) of acute cholecystitis. Treating acute cases the incidence of intraoperative (simple 8.3%, complicated 12.1%) and specific postoperative complications (simple 9.2%, complicated 6.9%) was higher compared to elective procedures (intraoperative 4.6%, specific postoperative 3.7%). This is well known from the experience of open surgery. Nevertheless there were lower general complication rates (simple 5.5%, complicated 5.2%) and no mortality in acute cholecystitis when LCE was performed. Considering an early conversion to open cholecystectomy in cases of severe acute cholecystitis the indication for LCE can be made generously. Great surgical experience in LCE is a requirement for the laparoscopic management of acute cholecystitis.

Acute Disease↗
PubMed2000

[Quality assurance in appendicitis--what has changed? Analysis of 2 prospective multicenter quality assurance studies].

AIMS OF THE STUDY: The present study aims to determine the influence of introduction of laparoscopic techniques and of DRG (diagnosis related gains) on the quality of appendicitis therapy. PATIENTS AND METHODS: All consecutive patients admitted for suspected appendicitis were recruited into this prospective multicenter study. Two different periods of time were considered: from 1.7.1988 to 31.12.1989, 6,266 patients from 18 hospitals were included, and from 1.6.1996 to 31.5.1997, 7,398 patients from 34 institutions. RESULTS: In the first period (1988/89), 1,869 patients were treated conservatively (29.8%), 4,397 (70.2%) were operated. Histopathological analysis of the appendix documented no acute inflammation in 28.8%, the perforation rate was 8.3% and the wound infection rate 9.6%. In the second period (1996/97), 2,430 patients were treated conservatively (32.8%), in 24.9% of all operated cases, the histopathological examination shows no acute inflammation of the appendix, the perforation rate was 5.9% and the rate of wound infections 2.5%. During this second period, 33.2% of all appendectomies were performed using the laparoscope, the conversion rate was 7.2%. CONCLUSIONS: The introduction of laparoscopic techniques and of DRG did not modify the operative indications for treatment of appendicitis. An increase in the number of normal appendices removed was not observed. The number of perforations and the incidence of wound infections was significantly reduced in the second period.

Adolescent↗
PubMed2000

[Results of 188 gastric banding operations].

The gastric banding is an effective operation for treatment of the morbid obesity. We report about 188 patients, we treated from April 1997 to December 1999. This review takes a stand on the indication for operation, the operative technique, the lost of weight and the complications. The benefit of this operation is the minimal invasive technique.

Adolescent↗
PubMed1999

[Surgical therapy of morbid obesity with laparoscopic "gastric banding". Technique and results of 370 cases].

The application of an adjustable silicone gastric band is a very efficient and long-term method to reduce the weight in morbid obesity. The surgical technique is exacting; standardization of the procedure diminishes the complication rate. 370 patients with morbid obesity underwent the laparoscopic application of a gastric band between May 1996 and September 1997. Two different kinds of gastric bands were used in these surgeries. The data are shown in two series. The total morbidity rate was 16.8%, in series II 4.5%. The mortality rate was 0%. The average loss of weight came to 12 kg (5.3%) after 4 weeks, 18% after 3 months, 37.4% after 6 months and 48.4% after 1 year.

Adult↗
PubMed1999

[Permanent stomata].

The implantation of preternatural orifices is a procedure frequently performed by the visceral surgeon in spite of the advances of modern surgery concerning preservation of continence. In order to avoid unnecessary complications, certain strict principles of operating technique must be followed. The cumulative rate of complications is found to be at least 50%. Especially prolapse, peristomal hernias and stenoses are of profound surgical relevance. A well-implanted and adequately cared for stoma will have a positive influence on a patient's quality of life.

Colostomy↗
PubMed1999

[Gastrointestinal stromal tumors--problems in diagnosis and therapy].

Gastrointestinal stromal tumors (GIST), which form a rare group of neoplasias of the gastrointestinal tract, have not yet been fully investigated. Although good progress has been made in their diagnosis, classification of these lesions with regard to their histogenesis and biological behavior remains problematic. Between 1994 and 1998, 18 GIST patients underwere operation in the Department of Surgery. Twelve of these patients (67%) had stromal tumors in the stomach, and six (33%) had intestinal stromal tumors. The primary tumor could be removed in all patients with R0 resection. Six patients developed hematogenous liver metastasis, with the size of their primary tumor exceeding 10 cm. Extrahepatic distant metastases were not found in any case. Lymphadenectomy showed that lymph node metastases did not occur. Histological evaluation was made according to the guidelines of Lewin, Weinstein and Riddell. Currently established therapy is limited to complete surgical resection of the primary tumor and its metastases. Adjuvant or neoadjuvant chemotherapy approaches have failed.

Adult↗
PubMed1999

High-dose therapy with combined 5-fluorouracil and folinic acid with and without amifostine in the treatment of patients with metastatic colorectal carcinoma.

In a prospective clinical trial we treated 27 patients with metastatic colorectal carcinoma a continuous 24-h high-dose regimen of 2.6 g/m2 5-fluoroucil and 500 mg/m2 folinic acid per week for 6 weeks. To evaluate the effect of amifostine, a selective cyto- and radioprotector, in reducing chemotherapy-related mucositis, 740 mg/m2 amifostine was administered before chemotherapy, and the results were compared to 15 patients without amifostine treatment. In the amifostine group the dose was reduced or treatment was stopped because of mucositis observed in 6 of the 12 patients, while 13 of the 15 control patients could not be treated according to the treatment plan. The incidence of gastrointestinal side effects of WHO grade III or higher was reduced in the amifostine group, with no mucositis of this severity, versus 3 of 15 in the control group. The response rate was identical in the two treatment arms (33.3%).

Amifostine↗
PubMed1999

Myxoid liposarcoma with transition to round-cell lesion-cell cycle regulator genes and telomerase activity characterizing tumor progression: a case report.

A mixed myxoid/round cell liposarcoma was macrodissected in its 2 histologic components and investigated for genetic differences between its low-grade myxoid and the high-grade round-cell region. For both, we failed to detect p53 gene mutations, loss of heterozygosity at the p53 or Rb genes, and p53 protein expression. The round-cell component showed a high telomerase activity, and an elevated c-myc mRNA and protein expression. The myxoid component was characterized by a lack of telomerase activity and low c-myc mRNA expression, and immunohistochemistry failed to detect the c-myc protein. There was a higher Mib-1 proliferation index in the round-cell portion. The same specific translocation t(12;16) and the fusion transcript type II in both components confirmed the close relationship between myxoid and round-cell liposarcomas. Telomerase activity and increased c-myc expression seem to be helpful molecular markers for characterizing tumor progression in myxoid liposarcoma.

Abdominal Neoplasms↗
PubMed1999

Epithelial-myoepithelial carcinoma of the salivary gland--a low grade malignant neoplasm? Report of two cases and review of the literature.

Epithelial-myoepithelial carcinomas (EMC) are rare neoplasms of the salivary gland with an incidence of less than 1% arising predominantly in the parotid gland. Although they are thought to be of low grade malignancy, fatal courses are described. We report a case of EMC of the parotid gland in a 58-year-old woman with an unfavorable course of this disease in long term follow-up. The malignant potential of this tumor is discussed. In addition, we include another case of EMC of the submandibular gland.

Carcinoma↗
PubMed1999

Multimodal treatment of neuroendocrine tumors of the pancreas and the ampulla of Vater.

Neuroendocrine tumors are not seen frequently. They are most commonly located in the small bowel including the vermiform appendix. Neuroendocrine tumors of pancreatic origin are extremely rare. Symptoms caused by excessive hormone production by large liver metastases often lead to their diagnosis. Preoperative diagnostics include analysis of specific hormones in serum and urine, ultrasound, CT and somatostatin receptor scintigraphy. Liver metastases of neuroendocrine tumors of the pancreas are common at the time of diagnosis. Curative resection should be performed whenever possible, although patients often benefit from debulking procedures, too. Liver metastases can be subjected to surgical resection, embolization, regional chemotherapy or local procedures such as alcohol injection or cryoablation. As an exception, liver transplantation can be considered in selected cases where radical surgery for the primary tumor could be performed and extrahepatic metastases are not present. Supplementary or alternative options include octreotide and/or interferon-alpha administration. In this article, we report on 6 patients suffering from primary neuroendocrine tumors of the pancreas or the ampulla of Vater who were treated at our department over the past 5 years. In addition, we discuss our own experience with this rare condition in the light of the recent literature.

Adult↗
PubMed1999

[Value of the vena cava filter in treatment of deep venous thrombosis in the pelvis and leg].

The indication of vena cava filter implantation is controversially discussed. A pure prophylactic indication is increasingly favoured, especially for temporary filter systems without any anamnestic pulmonary embolisms. On the basis of the available literature and our own results a critical analysis of this issue is given. Between 1994 and 1997, we inserted a total of 24 vena cava filters; 21 temporary and 3 permanent filters. In ten patients, the placement of the filter was indicated due to pulmonary embolism and a contra-indication to dose adjusted heparin therapy. Seven additional patients experienced a recurrent pulmonary embolism despite adequate heparin therapy. A prophylactic filter insertion was carried out in seven patients. The temporary vena cava filters were left in place between 7 to 38 days with an average of 19 days. Total implantation time of temporary filters was scheduled until complete mobilisation of the patients, generally in conjunction with an effective dosage of oral anticoagulants. No patient died in connection with the insertion of the filter and no further pulmonary embolisms occurred. One case of inferior vena cava thrombosis occurred in each group of temporary and permanent filters. In one third of the removed filter systems thrombi in the filter were found. Local infections of the catheter and introducer sets were observed in two patients. Moreover, in one case the strut of a temporary filter broke and subsequently dislocated 17 days after insertion. We conclude on the basis of these complication rates that until the results of randomised studies are available the usage of all filter systems should be limited to highly selected cases.

Adult↗