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Biomedical subjects

H Nier

Publications and source records attributed to H Nier.

At least 19 recordsLinked to original sources
PubMed1999

[In Process Citation]

Intraoperative radiotherapy (IORT) is a new concept in the treatment of recurrent and primary advanced colorectal tumors. Between October 1994 and December 1997 27 patients (primary tumor: 8, first recurrent tumor: 12, second recurrent tumor: 7) received IORT (32 applications). Chemotherapy and percutaneous radiotherapy had already been given to all patients with advanced and recurrent colorectal tumors. The intraoperative irradiation was performed through HDR iridium afterloading. A flexible flab--individually adapted to the "tumor bed"--was used as applicator. The contact dose ranged from 10 to 15 Gy. The mean operation time (rectum resection: 5, rectum amputation: 14, debulking: 8) increased by 30 min on average. Eight patients had postoperative complications: perianal wound infections (3), sacrovesical fistulas (3), leakage of anastomosis (1) and neural ureter dysfunction (1). To date--on average 17.1 months (range: 3-33) after operation--13 patients are free of tumor recurrence or show stable disease. Ten patients--all of them had macroscopic residual tumor--have local tumor progression combined with good quality of life. Only 4 patients died (acute kidney failure, stroke, marasmus, systemic progression). The afterloading flab technique represents a technically simple, minimally harmful procedure in the therapy of colorectal tumor. Even when IORT with electrons is not feasible or the patients have already been irradiated, a higher radiation dose is possible. Given the demonstrated rate of local tumor recurrence, the afterloading flab technique seems to be a valuable treatment alternative to extended, high-risk resections. Long-term follow-ups will be necessary.

Journal Article↗
PubMed1996

[Colorectal carcinoma. Which factors are decisive for development of postoperative complications?].

This retrospective study analyses the prognostic effect of different factors on morbidity and lethality based on selected, primarily resecting colon carcinoma operations (n = 222). In all, 12.2% of our operations were performed under emergency conditions. The total complication rate was 31.5%, the lethality rate 7.7%. The left hemicolectomy cases showed the highest morbidity (48.4%), the rectum amputation the highest lethality (11.8%). Tumour staging tumour differentiation and the sex of the patient showed no significant influence on the postoperative morbidity and lethality. However, a correlation was proved between the age of the patient, tumour localisation, co-morbidity, duration of operation and the conditions under which the operation was performed (emergency or elective), on the one hand, and morbidity and lethality on the other.

Adult↗
PubMed1996

[Mechanical duodenal stump suture. Report of experiences: metal staples versus resorbable staples].

The main observation criterion of the present retrospective study is the insufficiency rate after machine closing of the duodenal stump (TA-clip seam device, Auto-Suture), as a consequence of gastrectomy, resection of the stomach with Billroth II respective Roux-Y reconstruction, depending on the used type of clip. Between January 1, 1985 and October 2, 1989 the closing of the duodenal stump was routinely carried out with metal clips (n = 253) in the City Hospital Offenbach. Between October 3, 1989 and December 31, 1991 polysorb staples (n = 96) were exclusively used. The patient collectives were comparable regarding age, sex, health status, basic diseases, accompanying diseases and surgical methods. Closing of the duodenal stump by polysorb staples demonstrated with 13.5% more dehiscent seams than with metal clips (4.7%). As a result of the present study, we cannot recommend the use of polysorb clips for the closing of the duodenal stump.

Adolescent↗
PubMed1993

[Endoscopic ultrasound in TN staging of stomach cancer. A comparison with computerized tomography and conventional ultrasound].

64 patients with histologically proven gastric carcinoma were investigated by endosonography (EUS), computed tomography (CT) and conventional transcutaneous sonography (US). In 50 patients a resection of the stomach was performed and the histological findings were compared with the results of preoperative staging. In all cases EUS was successful in demonstrating the tumour. With CT tumour visualisation was possible in 17 (35.4%), with US in 7 (14.6%) cases. The pT-stage was correctly determined preoperatively by EUS in 40 (81.6%) with CT and US in only 12 (25%) and 4 (8.3%) patients, respectively. The staging accuracy of EUS amounted to 80% in T1-, 81% in T2-, 100% in T3-, and 67% in T4-stage. The sensitivity in demonstrating lymph node metastases was 81.3% for EUS, 25.8% for CT and 9.7% for US. The specificity in this regard was 72.2% for EUS, 83.3% for CT and 100% for EUS. The overall accuracy for determination of pN-stage was 78% for EUS, 47.9% for CT and 41.7% for US. EUS is clearly superior to CT and US in the locoregional TN-staging of gastric carcinoma.

Adult↗
PubMed1986

[Primary retroperitoneal tumors].

73 patients, 41 males and 32 females, were treated for primary retroperitoneal tumours between 1974 and 1984. Mean age of the patients was 45.9 years (range: 1 day-79 years). Early symptoms of the tumours were atypical. Initial diagnosis showed a palpable abdominal tumour in 47 patients. Computed tomography is the most important radiologic tool for the diagnosis. In 32 patients the tumour could be removed completely. Intraoperatively, at least one additional organ had to be removed in all patients to ensure radicality of extirpation. Histology showed most tumours to be lymphomas or sarcomas. At the time of diagnosis, 21 patients were found to have metastases. Operative mortality rate was 11%. The overall prognosis in patients with primary retroperitoneal tumours is poor; the 5-year survival rate for malignant tumors was 9%. Combination of radio- and chemotherapy has somewhat improved this dim prognosis in recent years.

Adolescent↗
PubMed1986

[Indications and results of transdiaphragmatic stomach transposition (without thoracotomy) in advanced hypopharyngeal and esophageal cancer].

During the period between 1980 and 1985 the technique of pharyngo-oesophageal reconstruction with gastric pull up was used in 7 late-stage cases with carcinomas of the hypopharynx and cervical oesophagus. In one patient the colon was connected with the pharynx. Oral ingestion of food was achieved 3 weeks after operation in 7 patients. The blunt dissection method of the oesophagus allowed a radical resection of the tumor as well as a one-step reconstruction of the nutritional pathway. Palliative therapy is often achieved. The significance of the operation should be evaluated both from the viewpoint of the length of survival as well as of the palliative purpose desired.

Adenocarcinoma↗
PubMed1985

[Transdiaphragmatic esophagus resection--a procedure for the curative and palliative treatment of esophageal cancer].

From 12/80 to 1/85 133 patients with a carcinoma of the esophagus were admitted to the hospitals in Düsseldorf and Würzburg. 105 (7 total, 98 subtotal) of them were resected (79%). 14 were treated with a substernal bypass (average age: 60 years). 76% of all tumors were found in stage III and IV. The esophagus was replaced with stomach (98) and colon (7). For bypass the stomach (12) and jejunum (2) were used. The hospital mortality was 17.6% (all operations), 16.2% (resection) and 28.2% (bypass). The 2-year-survival-rate was only 15% (due to 76% of stage II and IV).

Adenocarcinoma↗
PubMed1984

[Gas gangrene--still a diagnostic and therapeutic problem].

From 1970 to 1980 132 patients were admitted to our Dept. under the diagnosis of gas gangrene. In 54 cases there was no bacteriological evidence of clostridium perfringens. In all patients surgery was performed immediately, followed by hyperbaric oxygen therapy. The overall mortality rate among 78 patients with proven gas gangrene came up to 38%, the amputation after limb injuries to 55%. In our experience we can not state a clear cut advantage of hyperbaric oxygenation as far as the death rate is concerned.

Adult↗
PubMed1983

[Postgastrectomy syndromes with special reference to reflux esophagitis].

60 patients without suspicion of recurrence of stomach cancer have had a follow-up by mean of 65 months after the procedure of a total gastrectomy. In 16 cases an additional esophagomanometric and endoscopic-bioptic examination was performed. Up to 1975 the operative procedure of stomach replacement was a jejunal interposition, afterwards the technique of a jejunoplicationn. Clinical signs of an esophageal reflux were found in one half of the patients with a jejunoplicatio and in a third of the cases with a jejunal interposition. Endoscopic-bioptic evidence of a reflux-esophagitis has been found in 13 of 16 patients. A functioning sphincter mechanism of the lower esophagus could be demonstrated in 5 of 16 cases. There was no proof of a correlation between the results of endoscopic-bioptic and manometric examinations. A prevention or reduction of esophageal reflux is as well possible by the technique of jejunal interposition as by jejunoplication.

Esophagitis, Peptic↗
PubMed1980

Traumatic mediastinal emphysema.

The traumatic mediastinal emphysema occurs along with severe combined injuries. A typical feature is the subcutaneous emphysema as well as crackling sounds and frequently a pneumothorax. The radiography of the chest shows air in the mediastinum surrounding the mediastinal structures. The pleura drainage could be done as an emergency performance in cases of pneumothorax. In cases of an increasing subcutaneous and mediastinal emphysema as well as circulatory failure a cervical mediastinotomy should be carried out. The tracheobronchial tree should be examined bronchoscopically for possible ruptures. Esophagus injuries will be detected by the distribution of a contrast fluid. Even a thoracotomy may be necessary.

Accidents, Traffic↗
PubMed1979

[Post-traumatic aneurysm of the thoracic aorta; the results of surgical repair (author's transl)].

29 patients aged 11-55 years underwent surgery an aneurysm of the descending part of the thoracic aorta that had developed after a blunt chest trauma. In all patients continuity of the vessel was restored by interposition of a prosthesis. Surgery was performed during the acute stage in 5 patients, two of whom died postoperatively due to infection of the prosthesis and shock lung respectively. One of the 24 patients who were operated on during the chronic stage died on the 16th postoperative day of apoplexy. One of the 26 patients who were discharged from hospital after the operation died of a spurious aneurysm that had developed at the site of the prosthesis. Follow-up examinations of 21 patients showed normal postoperative function. In 5 cases there was an angiographically demonstrable slight narrowing at the site of the anastomosis; the pressure gradient, measured intravascularly, did not exceed 30 mm Hg.

Adolescent↗
PubMed1979

[Treatment of late occlusions and stenoses after an aortofemoral bypass operation].

Thirty-three patients with one or several late occlusions in 43 limbs of aortofemoral dacron grafts underwent 56 reconstructions because of impending limb loss. Thrombectomy alone with patch closure was less successful. Excision of the femoral anastomosis, resection of the distal part of the occluded prosthetic limb and replacement by a new velours graft tube together with profundaplasty and further downstream reconstruction revealed the best results. The early reocclusion rate was 10%, the late reocclusion rate was 10%. There was no operative mortality and no amputation. Two late deaths occurred, in one case due to grade III infection with sepsis. Another late graft infection was successfully managed by an extraanatomic bypass and excision of the infected limb. The reasons for late occlusions of aortofemoral grafts were found to be incomplete reconstruction of the outflow tract, technical failure at the time of primary reconstruction and progressive atherosclerosis. Hypertonus was common in all cases with progression of the disease. Technical details of the operative management for late occlusion are presented.

Adult↗
PubMed1978

[Hyperbaric oxygen treatment in gas gangrene (author's transl)].

Among 100 patients with proven gas gangrene surgical treatment was undertaken in 34 who also received 30--60 mega-units of penicillin, in addition to appropriate shock treatment. Since 1967, additional treatment in a hyperbaric chamber was undertaken in 66 patients. There was no clear-cut advantage of hyperbaric oxygenation as far as the death-rate was concerned. There was merely a moderate decrease in the amputation rate after limb injuries. Wide incision of the wound and radical surgical excision of all tissue affected by gas gangrene continues to be an essential form of treatment.

Amputation, Surgical↗