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H R Nürnberger

Publications and source records attributed to H R Nürnberger.

8 recordsLinked to original sources
PubMed1997

[Complicated intestinal tuberculosis of the mesenteric root].

HISTORY AND CLINICAL FINDINGS: In the course of 2 1/2 years a 72-year-old man had five episodes of intestinal bleeding with anaemia, but no cause was at first found by routine diagnostic tests. After the fourth episode a diagnostic laparotomy was performed at which a diffusely infiltrating growing tumour was found. As it encircled the mesenteric vascular axis resection was not possible. But because of threatened ileal obstruction by the tumour a segmental ileal resection was performed, but no intraoperative diagnosis could be established. INVESTIGATIONS: Repeated oesophago-gastro-duodenoscopies and a coloscopy all revealed blood, especially in the upper gastrointestinal tract, but no bleeding source was found. Angiography suggested bleeding in the terminal ileum. Computed tomography demonstrated a tumour in the region of the mesenteric root. DIAGNOSIS, TREATMENT AND COURSE: At a second laparotomy because of another bleeding, which required a blood transfusion, tuberculosis was diagnosed. Triple drug treatment was initiated and the patient has been free of symptoms and bleedings since then and fully active for 1 1/2 years. CONCLUSION: This case clearly demonstrates the difficulty of diagnosis and the long delay until specific treatment, because the combination of "tumour", bleeding and stenosis of the small intestine by an infiltrative lesion at first pointed to malignant process.

Aged↗
PubMed1996

[Is splenectomy "en principe" necessary for radical gastrectomy with systematic lymphadenectomy?].

SUMMARY: In order to screen the necessity of splenectomy "en principe" we evaluated all patients suffering from gastric carcinoma between Jan. 1988--Apr. 1993 retrospectively. In total a group of 318 patients were treated and from these 261 patients were operated (resection rate 82%). In 30% of the patients (77 pat.) we performed a subtotal distal gastrectomy and in 70% (184 pat.) a radical gastrectomy with a D 2-lymphadenectomy. The splenectomy rate in the group of gastrectomy was 94% (173 pat.). In total 13% of the lymph nodes of the hilus of the spleen were infiltrated and an additional metastasis of the spleen was found in 1%. In carcinomas located at the minor curvature 13% had an infiltration of the lymph node station 10, in carcinomas located at the greater curvature in 17% and in carcinomas with a diffuse tumor growth in 10% respectively. Patients with a tumor located in the proximal stomach had an infiltration of the lymph nodes in 14% and in carcinomas of the antrum in 7% respectively. None of the patients having a UICC stage I/II had an infiltration of the lymph nodes at the hilus of the spleen, but 25% of the patients having a UICC stage III/IV. 2 patients from the latter group had an additional metastasis of the spleen. CONCLUSION: The indication of splenectomy is given only in advanced proximal tumor locations, especially in tumors of the greater curvature. In the early tumor stages and in the distal locations of gastric carcinoma it might be useful to perform a selective lymph node dissection of the hilus of the spleen in order to increase the completeness of the radical gastrectomy.

Gastrectomy↗
PubMed1994

[Experiences with reliability and rate of complications in collar or thoracic anastomosis after subtotal esophagectomy].

In the period from 1988-1992 we performed 148 subtotal esophagectomies. In 69% (102 cases) the operation was carried out because of squamous cell carcinomas of the esophagus, in 27% (40 cases) because of adenocarcinomas and in 4% (6 cases) because of other indications. In 97% (143 cases) the passage was reconstructed by means of a tubulized gastric pull-up established by Akiyama and in of a tubulized gastric pull-up established by Akiyama and in 3% (5 cases) by means of a colon interposition, whereby all interponates were pulled up through the posterior mediastinum. The esophago-gastrointestinal anastomosis was performed in 98% (145 cases) by a hand made suture end-to-side. In 2% (3 cases) we performed the anastomosis by a mechanical EEA device. The collar anastomoses (n = 88) on the posterior wall were covered with the remainder of the gastric fundus, the thoracal anastomoses (n = 60) on the anterior wall were secured by means of a plication. Postoperative surgical complications occurred in 22.7% of the collar and in 25.0% of the thoracal anastomoses. Insufficiencies (n = 3) were observed with thoracic anastomoses only 2 of the 3 insufficiencies were lethal. Postoperative paralysis of the n. recurrens, disturbance of swallowing coordination and aspiration occurred in 29.5% of the collar and in 13.4% of the thoracal anastomoses. In contrast to other reports we were able to show that the collar esophago-enteroanastomosis after subtotal esophagectomy is safer than the thoracic anastomoses with regard to anastomotic insufficiencies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1993

[Results of preoperative radio-chemotherapy in locally advanced squamous epithelial cancer of the esophagus].

In a 4-year period (1988-1991) 122 patients with a squamous cell carcinoma of the esophagus were studied prospectively and analysed. 64 patients of them could be primary resected (primary resectability rate 52%), 36 patients were in general inoperable and 22 patients had an advanced stage of cancer with local inoperability. Due to a preoperative combined radiotherapy and chemotherapy 16 of the 22 patients with local inoperability had a clinical remission of the tumor (73%). 11 patients (50%) showed a histological verified down staging and 3 cases of them a complete remission (no primary tumor was found, no infiltration of the regional lymphnodes and no metastatic disease). Curative resection was possible in 14 of 16 patients with clinical remission (2 patients refused surgical treatment). So the resectability rate now increases from 52 to 63%. We conclude that there was no increased rate of postoperative complications or mortality in the combined radio-/chemotherapy group compared with the primary resected patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

[The value of thoracic computed tomography in the intensive care diagnosis of blunt thoracic trauma].

92% of all patients with a thorax-trauma suffer from a blunt chest trauma. In the early diagnosis by plane chest X-ray only a quarter of all pathological findings in comparison to the CT of the thorax are found. In addition to that the special deviations and imaging of the thoracic organs in the plane chest X-ray have to be noted. With the demonstration of same examples the special value of the thorax-CT in early diagnosis and patient control was demonstrated. Specially in showing the grade of lung contusion, the volume of bilaterally hemato-serothoraces, ventral pneumothoraces and additional injuries CT was more sensitive. The main disadvantage is the possibly long way of transportation and a contraindication is a severe trauma of the upper extremities and an instable fracture of the spine column.

Contusions↗
PubMedDate not supplied

Hypertonicity-induced cation channels.

Whenever studied in a quantitative fashion, hypertonicity-induced cation channels (HICCs) are found to be the main mediators of regulatory volume increase. In most instances, these channels are either inhibited by amiloride (but insensitive to Gd3+ and flufenamate) or they are efficiently blocked by Gd3+ and flufenamate (but insensitive to amiloride). Of note, however, from two preparations so far a mixed type of pharmacology has also been reported. Whereas the ion selectivity of amiloride-sensitive HICCs has not been studied in much detail yet, amiloride-insensitive channels are either equally permeable to Na+, K+, Cs+ and Li+ but impermeable to N-methyl-D-glucamine (NMDG+) or they exhibit a permeability to Li+ and NMDG+ that amounts to some 50% when compared with that of Na+. Also in this respect, however, some peculiarities do exist. Concerning the actual molecular correlate, evidence was reported that HICCs may be related to the (amiloride-sensitive) epithelial Na+ channel and/or to transient receptor potential channels. Recent findings suggest that HICCs may contribute to cell proliferation, just as the K+ channels that are employed in regulatory volume decrease are mediators of the opposing process, i.e. apoptosis.

Amiloride↗