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Biomedical subjects

H R Zachert

Publications and source records attributed to H R Zachert.

6 recordsLinked to original sources
PubMed2003

[From endoscopic mucosa ressection to gastrectomy. How radical must surgery be for stomach cancer?].

The aim of surgical treatment is complete resection (Ro-resection) of the tumor in all dimensions of its growth, i.e. resection of the tumor infiltrated stomach including the locoregional lymph nodes. This can be achieved by stage- or histology adapted surgery resulting in subtotal distal and total gastrectomy as complementary procedures. Local excision of gastric carcinoma in curative intent is indicated only in mucosal carcinoma of the intestinal type. The extent of lymph node dissection is still under discussion; the results depend on the experiences of the surgeon. Several studies have shown a prognostic improvement after systematic (D2) lymphadenectomy in stage II/IIIA-disease or in patients with a low incidence of lymph node metastases. Pancreas preserving splenectomy is suggested in tumors of the proximal stomach or after direct infiltration of these organs. The Roux-en-Y procedure represents the most commonly used method of reconstruction after subtotal distal or total gastrectomy. The importance of the duodenal passage as well as of the pouch construction must be investigated in prospective studies in the future. This is true for the value of perioperative multimodal treatment options.

Gastrectomy↗
PubMed2001

[Multimodality therapy concepts in stomach carcinoma].

The prognosis of gastric cancer is still poor even after curative R0 resection. Therefore, among various multimodality treatments a lot of phase II/III studies have been carried out evaluating preoperative chemotherapy. Although some positive results have been obtained after this procedure, neoadjuvant chemotherapy is still an experimental approach. In the future the prediction and evaluation of response must be defined more exactly. Using intraoperative radio- or intraperitoneal (hyperthermal) chemotherapy reduction of regional relapse or peritoneal carcinomatosis could be obtained without increased survival in general. According to experience in Japan adjuvant (immuno-)chemotherapy can increase the overall survival rates and even in the Western hemisphere some actual studies with adjuvant chemo- +/- radiotherapy could demonstrate a benefit of survival in patients with lymph node metastases. Nevertheless, multimodality treatment strategies must be investigated in further uniform prospective study protocols.

Clinical Trials as Topic↗
PubMed1998

[Acute appendicitis in advanced age].

In the elderly, both the diagnosis and treatment of acute appendicitis require particular attention. The diagnosis is often made very late with 40% to 80% of the cases already having perforated. Reasons for the delayed hospitalisation include atypical course, reduction in sensitivity to pain in old age, and an inadequate ability to communicate. The prognosis of uncomplicated appendicitis is just as good in the old as in the young patient, but perforation and concomitant diseases worsen the situation appreciably. Early operation is therefore desirable. The preference of the author is for open, rather than laparoscopic, appendectomy.

Acute Disease↗
PubMed1995

[Degenerative colorectal polyps].

In 23 patients with malignant colorectal polyps we reviewed the frequency of recurrence. In the group without subsequent local resection, 8 of 11 patients were without recurrent tumour after 2.7 (0.8-4.1) years, in the group with subsequent local or conventional colon resection, 10 of 12 patients after 5.3 (0.8-9.0) years. None of the patients showed any evidence of residual tumour or lymph node metastasis. All recurrent tumours (2 x carcinoma, 3 x benign polyps) could be resected curatively. There was no difference in recurrence in both groups. For safe histopathological examination of malignant colorectal polypi in respect of depth of invasion, free resection margins and lymphatic vessel invasion, intraoperative fixation and marking must be performed, since local recurrence was seen after more than 5 years, long-term follow up is necessary.

Adult↗
PubMed1992

[Cemented bipolar prosthesis in multimorbidity patients with coxarthrosis. Short- and intermediate-term results].

The treatment of coxarthrosis with the cemented Duopleet prosthesis represents an efficient alternative to total hip prosthesis in elderly and polymorbid patients. The early results show a tolerable rate of complications. The patients can be mobilized early. The mortality seems to be low. Medium-term results are satisfactory. The rate of protrusions is lower than in patients with common femoral head prosthesis. Paraarticular ossifications are seen frequently. In numerous patients we found pain with projection to the operated hip.

Aged↗