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H Pichlmaier

Publications and source records attributed to H Pichlmaier.

At least 19 recordsLinked to original sources
PubMed1992

[Transanal endoscopic microsurgery: technique and clinical results].

A new system has been developed for transanal endoscopic microsurgery (TEM), which allows all the conventional surgical techniques within the rectal cavity. The main indication is the removal of sessile adenomas. "Early rectal carcinomas" are also suitable for local excision. We perform local excision of advanced cancer only in cases where a contraindication exists to perform radical surgery or when the patients is unwilling to undergo demolitive surgery. The system has been employed at our Surgical Department on 206 patients in 223 cases. In 192 cases (87.7%) only one local excision was carried out due to sufficient excision as confirmed by histology (including patients with early "low risk" cancer). the postoperative course of 208 cases (93.3%) was free from any complications. The recurrence rate of adenomas amounted to 5.2%. This technique is particularly applicable for elderly, high risk patients and those with broad based adenomas so that anterior resection, abdominoperineal resection or other invasive operations can be avoided.

Adenoma↗
PubMed1992

[Resection of esophageal cancer without thoracotomy by manual dissection and eversion stripping].

At the department of surgery of the university of Cologne-Lindenthal, 184 patients (142 with squamous cell carcinoma of the esophagus, 42 with adenocarcinoma of the gastroesophageal junction) underwent blunt dissection of esophageal cancer between 1983 and 1991. Tumor expansion classified by the pathologist was stage I in 13.6%, stage II in 31.0%, stage III in 41.8%, and stage IV in 13.6% of all cases. Histological tumor differentiation was graded well in 4.3%, moderate in 71.7%, and poor in 19.6%. Principally a gastric tube was used for esophageal replacement (96.3%), while interposition of the large bowel was performed in 5 cases. All the patients were prospectively monitored for perioperative complications. 64.7% fared without any complications intraoperatively. The most frequent intraoperative complications were damage of the pleura parietalis (16.3%), rupture of the tumor during dissection (13.0%), and lesion of the spleen (11.4%). 29.9% of the patients had a postoperative course without any complications. Pleural effusion (38.6%) and insufficiency of the cervical anastomosis (22.8%) were the most frequent complications seen postoperatively. Hospital mortality amounted to 6.0%. Six months after the operation most patients deemed their quality of life satisfying or excellent, respectively. The cumulative survival rate (without hospital mortality) was 78.3% after the first year, 24.7% after the third year and 20.6% after the fifth year.

Adenocarcinoma↗
PubMed1992

[Penetrating thoracic injuries].

In a period of peace in Germany and other westeuropean countries, penetrating trauma of the thorax (PTT) is much more rarer than blunt trauma. An analysis of 103 patients with PTT, treated in the Surgical Department of the University of Cologne from 1980 to 1990, showed, that these are usually isolated injuries in young patients. These occur usually following violence as stab wounds and less commonly gunshot wounds. Two thirds of the patients could be treated adequately with intensive care therapy and the use of thoracic drains. One third of the patients underwent thoracotomy, which was carried out in two thirds within one hour after hospital admission and in the remaining one third within the first 24 hours. The mortality for all PTT was 13%, being 10% for isolated thoracic injuries and 19% for patients with multiple trauma.

Adolescent↗
PubMed1992

[Preoperative intestinal lavage with a polyethyleneglycol-containing solution. A prospective randomized study in comparison with Ringer's lactate solution].

UNLABELLED: Aim of that study was to prove, whether a solution containing polyethyleneglycol (PEG) is more useful in comparison to the normal method using Ringer's-lactate solution for preoperative bowel preparation. METHODS: From January 1990 up to February 1991 we compared in a prospective randomized simple blind study on 110 patients the whole gut solution (Hewitt) to a bowel preparation with PEG (Oralav). RESULTS: The patients, that were prepared in the common way (Ringer's-lactate, control group; n = 54) were approximately given the double amount of liquid (9663 ml) as those in the other group (target group; n = 54: 4777 ml). We found no significant differences concerning the electrolytes. Hemoglobin (-1.1 g/dl) and hematocrit (-3.5%) were significantly lower in the control group. Both groups showed a similar frequency of nausea (control group 25% vs target group 34%). Vomiting was mainly found in the control group (20.8% vs 1.9%). Both groups showed comparably good results in bowel cleansing. Between the two groups we found no differences in specific bowel bacterial flora. Characteristic and number of postoperative complications were similar low (5.7 vs 3.8%). CONCLUSIONS: Due to a better compliance by oral application, the lower given amounts of liquid and the equal cleansing effect we prefer the use of the PEG containing solution (Oralav).

Adult↗
PubMed1992

[Minimally invasive surgery of the rectum].

Low precision of transanal techniques, their limited area of application and high rate of complications of extensive surgical techniques led to the development of an endoscopic surgical system. Its main indication is the removal of broad based adenomas and early rectal cancers. Further indications are palliative excisions of advanced cancers. From July 1983 till December 1990 the endoscopic system has been employed on 233 patients. The total sum of operations raised to 251 cases due to recurrences and new tumour formations. The overall crude 5 year survival with merely local removal of rectal cancer was 67% for early rectal carcinoma patients and 75% for patients with pT2 carcinomas. Early postoperative complications consisted of 5 intraperitoneal perforations, 4 recto-vaginal fistulas and 4 haemorrhages (complication rate 5.2%). There were 2 postoperative deaths due to cardiopulmonary failure (clinical lethality 0.8%). The overall recurrence rate of adenomas was 4.9%. In accordance with the selection criterias of other authors, our selection criteria for curative local excisions of rectal cancers enclose tumour diameter less than 4 cm, pT1 carcinomas, low grade malignancy and tumour free margins of locally excised specimen.

Adult↗
PubMed1991

[Palliative surgical treatment of cancer of the esophagus].

Palliative surgery, including cleaning resection, colon or stomach bypass, intubation or fistula is all one can offer to the majority of patients suffering from oesophageal carcinoma due to an usually advanced tumor stage at the time of diagnosis. The primary goal is to prevent or resolve dysphagia. A prolongation of survival time can - with the exception of cleaning resection - not be expected by these procedures. The average survival time was 9.4 months after cleaning resection and 4.7 months after other palliative procedures in our series. If a cleaning resection is not possible, the endoscopic implantation of an endotube is the treatment of choice because of its low mortality and morbidity.

Adenocarcinoma↗
PubMed1991

[Thoracotomies in thoracic injuries--indications and results].

Most thoracic injuries can be treated adequately with intensive care, pleural drainage and judicious physiotherapy. From the total of 571 patients with severe thoracic injuries treated in the Surgical Department of the University of Cologne over the last 10 years, 14% of those with blunt trauma (BT) and 33% with penetrating trauma (PT) underwent thoracotomy. Thoracotomy for PT was usually performed earlier and gave better results than thoracotomy for BT. With one exception, all PT underwent thoracotomy in the first 24 h after admission. For thoracotomy carried out for BT however, 38% took place after 24 h and 21% after 5 days. Postoperative mortality for BT was 3 times higher than for PT (56% vs. 18%). Reasons for this are to be found in the severe thoracic and general injuries associated with BT. The surgical procedure will depend on the type and extent of the thoracic and general injuries and on the general condition of the patient.

Adolescent↗
PubMed1991

[Treatment of advanced non-small cell bronchial cancer--a review of the literature of the last 5 years].

In the course of a metaanalysis concerning adjuvant therapy and the therapy of inoperable non-small-cell carcinoma of the lung, undertaken from 1.1. 1985 to 1.5. 1990, 376 publications were evaluated on a point system based on a decision tree. Out of a maximum of 71 obtainable points only 5.4% of the publications on adjuvant therapy and only 7.3% of publications on palliative therapy obtained more than 45 points. Regarding inoperable cases X-ray therapy with a median survival of 11 months and satisfactory life quality demonstrated the best results. Significant increases in survival are also possible with chemotherapy (7.4 months) in standard-dose pair combinations which, however, are associated with negative side effects on the treated patients. Immune and radio-chemotherapy cannot be recommended on account of treatment toxicity without a gain in life quality. Adjuvant therapy shows no life-prolonging effect. Consequently surgical treatment remains the first choice of therapy.

Carcinoma, Non-Small-Cell Lung↗
PubMed1991

[Surgical therapy of bronchial cancer. Healing or palliation?].

In spite of the revolutionary innovations concerning diagnostic and intensive care techniques as well as better understanding of tumour biology during the last decade, rates of resection and long-term survival in bronchogenic carcinoma could not be improved. Nevertheless there is no reason for therapeutic nihilism. On the contrary all efforts are to be done in investigation on practicable, suitable, and supportable screening programmes to improve the patients outcome.

Carcinoma, Bronchogenic↗
PubMed1991

[Role of the spleen in tumor surgery].

Tumorigenesis and tumor growth are connected with the immune system. Therefore the role of the spleen respectively splenectomy have gained increasing influence. The existing experimental and clinical results are discussed with the help of a general review of the literature. A manipulation of the immune system by splenectomy seems possible. A common pathomechanism has not yet been found. But experimental investigations are transferrable to human beings only under special conditions.

Humans↗
PubMed1991

[Mortality and morbidity conference. Perioperative fatalities].

Postoperative complications in 4675 patients were investigated. There were specific patterns of complications with significant differences between vascular and general surgery and transplantation. On the basis of test operations (inguinal hernia, cholecystectomy, resection of colon and rectum) it could be shown that differences were ward-specific. Over a period of 12 years, a certain decrease of complication rates could be demonstrated (wound infection, from 9% to 1.25%; pneumonia, from 8% to 2.5%; mortality, from 6.3% to 1.8%). Changes in clinical practice (antibiotic prophylaxis, bowel cleansing, introduction of new techniques, etc.) may be responsible for these improvements. We are convinced that a regular complication conference essentially influences the actions of physicians and nurses.

Cause of Death↗
PubMed1991

[Effect of accidental splenectomy on long-term outcome in colorectal tumor surgery].

In the period from 1967 till 1988 an accidental splenectomy was carried out at 1318 colon resections because of a malignant tumor in 34 cases (2.5%). The preoperative risk of this patient group was increased clearly in opposite to the whole patient clientele. So every fifth suffering from ileus or subileus was operated as in emergency. The complication rate, time of rest and clinic lethality were increased. The five-years survival rate did not change significantly in stage T1 and T2 in comparison with the whole patient clientele. In the stage T3, however, a significant prolonged survival rate was found out in the target group. Therefore the oncological aspect does not supply any reason to preserve the spleen in colorectal tumor surgery.

Adenocarcinoma↗