Biomedical subjects

H Scheuerlein

Publications and source records attributed to H Scheuerlein.

5 recordsLinked to original sources

PubMed1998

[Surgical therapy of liver metastases in breast carcinoma].

The literature contains little information on the surgical treatment of metastases from carcinoma of the breast. Advanced stages of mammary cancer with generalised metastatic spread are considered to be the therapeutic domain of systemic chemotherapy. Patients with isolated liver metastases may, under certain circumstances, be considered candidates for partial resection of the liver. Another therapeutic option in this group of patients is intraarterial chemotherapy via a port catheter system implanted in the hepatic artery. A number of institutions employ a combination of both treatment modalities. Overall 5-year survival rates are low for both the regional and the systemic form of treatment. A carefully selected group of patients may be expected to benefit from partial resection of the liver, intraarterial chemotherapy or a combination of the two by having their survival time prolonged--provided that due consideration is given to all contraindications, and there are no extrahepatic manifestations. Wherever possible, resections should be carried out in curative intent. However, palliative resection may be justified in individual cases where alleviation of symptoms and an improvement in the patient's quality of life is to be expected. The present paper discusses the results achieved in 21 women who underwent liver resection at the surgical department of the University of Erlangen between 1980 and 1997, and compares these results with those reported in the literature. The average age of the patients was 54 years, and 9 had a solitary metastasis. As was to be expected, the R classification had a decisive influence on survival. The 2-year survival rate was 60% for R0 resections as compared with 16.7% for R1 or R2 resections.

Adult↗

PubMed1998

[Laparoscopic splenectomy].

To date more than 400 laparoscopic splenectomies have been reported in the literature. The main indications for the procedure are benign haematological diseases, in particular idiopathic thrombocytopenic purpura. Laparoscopic splenectomy to treat malignant illnesses is rare and is usually restricted to small or only moderately enlarged spleens. Technically, the lateral abdominal approach with the patient in a right decubitus position has the advantage over the anterior approach in the supine patient of permitting better access to the organ. Under the force of gravity the stomach and intestines drop out of the operating field, and the splenic ligaments are placed under tension. This facilitates dissection with the harmonic scalpel and safe divisioning of the hilar vessels using the linear stapler. The individual steps of the procedure are described in detail.

Humans↗

PubMed1998

[Surgical therapy of choledocholithiasis].

Following the introduction of endoscopic papillotomy and stone extraction, surgical bile duct revision has decreased considerably in importance during the past two decades. Surgical bile duct revision is associated with an appreciably higher rate of complications than endoscopic stone extraction. The result has been that most working groups now favour a "therapeutic splitting" approach. This means that, wherever possible, endoscopic revision of the bile duct is first attempted. If, during laparoscopic cholecystectomy, intraoperative cholangiography reveals the presence of bile duct stones, they may, after consultation with the endoscopist, be left in place for removal by endoscopic papillotomy at some later date. Only in the case of very young patients and exceptionally, a highly experienced laparoscopic surgeon may attempt a transcystic extraction of such stones. Continuing indications for conventional surgical treatment of choledocholithiasis are local factors obstructing access to the papilla (gastrectomy, stenosis of the pylorus) and other bile duct changes requiring correction (choledochocele, strictures, stenoses, Mirizzi's syndrome, over-looked impacted stone obstructing an over-long cystic duct stump, intrahepatic lithiasis).

Adult↗

PubMed1998

[Thoracoscopic resection of epiphrenic esophageal diverticula by an intracavitary/endoluminal combined intervention].

Epiphrenic oesophageal diverticula are of the pulsation type, the underlying cause is a motility disorder. Resection is indicated by severe symptoms like dysphagia, regurgitation or aspiration and should be performed after endoscopic dilatative treatment of the neuromotor disturbance. Thoracoscopic resection under endoluminal endoscopic surveillance is considered to be a reliable procedure with low morbidity for the patient.

Dilatation↗

PubMed1997

[Laparoscopic fenestration of non-parasitic liver cysts].

Cysts of the liver may be parasitic or non-parasitic, the non-parasitic cysts being further subdivided into neoplastic, inflammatory, post-traumatic and congenital. Symptomatic congenital solitary cysts represent a good indication for laparoscopic treatment. During the therapeutic procedure, the roof of the cyst is fenestrated or removed such that at least one-third of the circumference of the cyst is removed, which is best done using a harmonic scalpel. In order to prevent a recurrence, it is recommended that a portion of the greater omentum be placed in the floor of the cyst, thus filling the cystic cavity.

Cysts↗