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H Shekarriz

Publications and source records attributed to H Shekarriz.

11 recordsLinked to original sources
PubMed2005

[Fungi in the mediastinum: rare, but relevant].

Fungal infections of the mediastinum are rare. There are five forms to be differentiated: (i) hematogenous fungal infection of the mediastinum after fungemia; (ii) postoperative fungal infection after cardiosurgical sternotomy; (iii) as special form of a descending necrotizing fasciitis; (iv) infection of the mediastinum per continuitatem; (v) fungal infection of the posterior mediastinum after esophageal perforation. In the surgical department, University of Schleswig-Holstein, Campus Lübeck, five patients with a fungal mediastinitis were treated during a period of 10 years. Three patients suffered from a descending mediastinitis, one patient from a fungal infection after pseudarthrosis of the sternum (postoperatively after cardiosurgery). The section results of one other patient with pulmonary aspergillosis showed a complete invasion of the mediastinum by Aspergillus fumigatus.

Fungi↗
PubMed2003

Anastomotic leakage following low anterior resection: results of a standardized diagnostic and therapeutic approach.

BACKGROUND AND AIMS: This study analyzed the results of a standardized approach in anastomotic leakage following low anterior resection for rectal cancer without performance of a protective ileostomy during the primary operation. PATIENTS AND METHODS: The study included all 306 patients with rectal cancer electively undergoing low anterior resection with retroperitonealization of the anastomosis over 9 years. The diagnostic procedure for anastomotic leakage included serum laboratory investigations and abdominal CT together with contrast enema. Minor leakages, i.e., small leakages and pelvic abscess, were treated with rectoscopic lavage and/or CT-guided drainage of the abscess, respectively. Major leakage was defined as broad insufficiency with or without septicemia. Nonseptic patients were treated by ileostomy and rectoscopic treatment. In septic patients a revision of the anastomosis with loop ileostomy was performed. RESULTS: Anastomotic leakage was diagnosed in 30 patients (overall 9.8%; 12 major, 18 minor leakages). Common clinical signs were pelvic pain and fever. No patient developed a peritonitis. The most accurate diagnostic instrument was CT (96.7%). CONCLUSION: Retroperitonealization appears to prevent peritonitis in patients with anastomotic leakage following low anterior resection. A differential treatment leads to good results in terms of mortality and anorectal function.

Adenocarcinoma↗
PubMed2002

[Anticoagulation in the treatment of sepsis. Correction of microcirculation: a new approach manipulating endothelial cell function].

The correction of coagulation disorders is only one aspect in the treatment of severe sepsis. The metabolic changes caused by sepsis are complex. They include the interactions of hundreds of plasma proteins. The system works in balanced patterns of agonists and antagonists, not allowing a preference for single substances. The endothelial cell plays a key role in multiple defence functions in sepsis. Thus, future research in sepsis has to focus on the manipulation of endothelial cell function.

Animals↗
PubMed2000

Hydro-jet assisted laparoscopic partial nephrectomy: initial experience in a porcine model.

PURPOSE: Hemostasis represents a challenge when performing laparoscopic partial nephrectomy. Hydro-Jet cutting is an advanced technology that has been used to create an ultra-coherent water force that functions like a sharp knife. In the surgical field, it has mainly been used for liver surgery and initial clinical experience with laparoscopic cholecystectomies has been favorable. This technique allowed selective parenchymal cutting with preservation of vessels and bile ducts. We describe a novel Hydro-Jet assisted dissection technique for laparoscopic partial nephrectomy in a porcine model. MATERIALS AND METHODS: Ten partial nephrectomies were performed in 5 pigs using a Muritz 1000 (Euromed Medizintechnik, A. Pein, Schwerin, Germany) Hydro-Jet generator. A thin stream of ultra coherent fluid is forced at a high velocity through a small nozzle. A modified probe allows both blunt dissection concomitantly with high-pressure water application. Coagulation can be applied via a bipolar thermoapplicator as needed. RESULTS: Laparoscopic partial nephrectomy was successful in all animals. Water-jet cutting through the parenchyma was virtually bloodless and preserved the vasculature and the collecting system. The vessels were then ligated or coagulated under direct vision. The continuous water flow established a bloodless operating field and a clear view for the surgeon. The mean dissection time and warm ischemia time were 45+/-9 and 17+/-3 minutes, respectively. CONCLUSIONS: This preliminary study supports the suitability of this technique for laparoscopic partial nephrectomy to improve hemostasis. The improved anatomical dissection and hemostasis may further decrease morbidity and operative time. Further studies are underway to compare this technique with laser coagulation for laparoscopic partial nephrectomy.

Animals↗
PubMed1999

Outcome of palliative urinary diversion in the treatment of advanced malignancies.

BACKGROUND: It is unclear whether palliative endourologic or percutaneous urinary diversion in the treatment of advanced cancer provides significant improvement in quality or duration of life. The purpose of this study was to evaluate survival and performance status after endourologic palliative urinary diversion in patients with advanced malignancy and to compare the results for different malignancies. METHODS: One hundred three patients with advanced malignancies underwent palliative urinary diversion (stent or nephrostomy) between 1986 and 1997. Ninety-two patients and 11 patients had bilateral and unilateral obstruction, respectively. Indications, complications, performance status after diversion, and survival for patients with different malignancies were identified and compared. A modified Karnofsky performance scale (KPS) was used for assessment of physical performance. A scale of 0-4 was used: 0) hospitalized until death; 1) bedridden at home, severe pain despite analgesia; 2) moderate disability, moderate pain despite analgesia; 3) mild disability, pain free with medication; and 4) normal. RESULTS: The mean age of patients was 68 years. The mean pre- and postoperative creatinine levels were 6 mg/dL and 3.3 mg/dL, respectively (P < 0.0001). The median survival and days of hospitalization were 112 and 45, respectively. The median postdiversion KPS score was 2 (range, 0-4), and 15% of patients never left the hospital. Overall, 51% required secondary percutaneous procedures, and 68.4% had complications (minor, 63%; major, 5.4%). CONCLUSIONS: Most patients with advanced cancers had poor performance status and survival after diversion. Eighty six percent had cancer-related symptoms despite the diversion. The average survival was 5 months, 50% of which was spent in the hospital. Primary endourologic procedures had a high failure rate, and additional procedures were required.

Aged↗
PubMed1999

Hydro-jet dissection for laparoscopic nephrectomy: a new technique.

OBJECTIVES: The Hydro-Jet technique has been used to cut various industrial materials. In the medical field, this technique has been successfully used for selective dissection of the parenchyma of organs such as the liver. Recently, this technique was successfully used for laparoscopic cholecystectomy in humans. We developed a new Hydro-Jet probe and a technique of Hydro-Jet dissection during laparoscopic nephrectomy (LN) in a porcine model and compared the results with those of conventional laparoscopy. METHODS: Fourteen pigs underwent unilateral LN using the Hydro-Jet and a conventional LN on the contralateral side. A Muritz 1000 Hydro-Jet generator was used. An adjustable water pressure gauge allowed manual control up to a maximum of 30 atm, and coagulation was applied by way of a bipolar thermoapplicator. The bent end of the probe allowed both blunt dissection and concomitant high-pressure water application. Results were compared with regard to ease of anatomic dissection, complications, and operative time between the two techniques. RESULTS: LN was successful in all animals with no conversion to open surgery. The dissector allowed anatomic planes to be created in a relatively bloodless field, and continuous water flow allowed a clear view for the operator. The high-pressure stream resulted in excellent dissection of adventitial and soft tissue adjacent to vascular structures, with complete preservation of vessels and ureter for selective ligation. The dissection time was shortened (mean 27 minutes for the Hydro-Jet versus 40 minutes for the conventional technique). CONCLUSIONS: To our knowledge, we describe the first report of Hydro-Jet dissection for LN as an alternative to the conventional technique. The improved anatomic dissection may decrease complications. Moreover, shorter operating times were achieved, which may result in cost savings. Further studies in humans are necessary to investigate this technique.

Animals↗
PubMed1997

[Choice of vascular prosthesis material in treatment of infrarenal abdominal aortic aneurysms--initial results of a prospective randomized study].

A prospective, randomized trial was performed to compare 40 patients with aortic aneurysms which were treated by implantation of dacron or PTFE prostheses. Follow up was done according to a defined protocol for 3 to 34 months postoperatively. There was observed neither graft failure, vascular occlusion, perigraft-reaction nor infection in any case. In one patient a periprosthetic haematoma occurred. During postoperative follow up in each group one patient died. There were no significant differences in dilation of the material in both groups. Dacron prostheses dilated to 28.2%, PTFE to 30.5%. In both groups the graft limb dilated more in comparison to the tube.

Aged↗
PubMed1997

[In vitro evaluation of blood vessel prosthesis dilatation--Dacron and PTFE--a new measuring technique].

Dilatation is the most significant complication of prosthetic vascular grafts. It is suspected to be a nidus of other graft complications. There have been a few studies on in-vitro-dilatation of the prosthetic vascular grafts. This is due to the lack of an effective and simple method to measure the transverse dilatation of the graft. We developed a new simple, reliable and cost-effective technique to evaluate the in-vitro-dilatation of prosthetic vascular grafts. The dilatation behavior of two different types of grafts (dacron and PTFE) was observed and compared under static pressure between 0 and 300 mmHg. The in-vitro- dilatations of dacron and PTFE grafts were 6.9% and 8.4% respectively. Interestingly, the dilatation rate for PTFE vascular grafts is higher than the indicated rate in the literature.

Blood Vessel Prosthesis↗
PubMed1997

[Clostridium myonecrosis as a sequelae of intramuscular injections--description of 3 fatal outcomes].

In three fatal cases of clostridial myonecrosis, the following criteria were found: repeated intramuscular injections over several years with anti-inflammatory substances, delay in diagnosis in outpatient care, and following uncontrollable systemic septic complications, despite radical surgical treatment. Only early, aggressive surgical interventions can stop the rapid course of necrotizing soft-tissue infections.

Adult↗
PubMed1997

[Quality assurance in surgical education].

UNLABELLED: The authors determine the reliability, validity and usefulness of the "QuaSi"-test, a test for the evaluation of surgical residents. METHODS: A test with multiple-choice (MC) answers was given to 47 surgeons, residents and interns of our surgery clinic. The reliability and validity of the tests were determined using statistical methods. RESULTS: The reliability of the test was very high. Performance varied significantly according to the level of training (postgraduate year). Surgeons performed best, then the senior residents; students and interns performed worst. CONCLUSION: The QuaSi-test is a highly reliable and valid examination that provides unique information about the performance of individual residents and the quality of postgraduate-training programs.

Clinical Competence↗