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H Stöltzing

Publications and source records attributed to H Stöltzing.

At least 19 recordsLinked to original sources
PubMed2007

[Case studies of iatrogenic tracheal injury during intraoperative ventral positioning. Symptoms, diagnostics, and differential therapy].

Two patients 16 and 21 years old developed tracheal rupture during elective surgery following trouble-free orotracheal intubation and intraoperative ventral positioning. The injuries remained undetected in both patients for more than 12 h. Diagnostic investigation after the onset of first symptoms indicated in each a tear in the posterior tracheal wall. Early operation prevented the development of serious complications in both patients. The casuistics indicate that tracheal injuries can emerge in minor elective surgery that may be carried out on an outpatient basis, and ventral positioning for surgery may represent a risk factor for their occurrence. Clinical symptoms, diagnostic procedure, findings, and therapy are discussed.

Adolescent↗
PubMed2000

[Angiodysplasia of the colon as the etiology of severe, chronic recurrent intestinal hemorrhage. Idiopathic thrombocytopenia hinders early diagnosis and therapy].

MEDICAL HISTORY: In 1992 a 54-year-old female patient was admitted to hospital for a severe episode of intestinal bleeding. Her medical history dated back till 1958, when an increased hemorrhagic tendency due to a thrombocytopenia was first diagnosed at the age of 20. Despite several hospital admissions and intense diagnostics, an etiological cause of the thrombocytopenia could not be found. Finally, a combination of thrombocytopenia and pathological thrombocytes had to be assumed. Because of recurrent intestinal bleedings requiring more than 250 blood transfusions and almost 100 platelet transfusions a wide spectrum of diagnostics was performed. After the cause seemed to have been found in the large bowel system during another bleeding episode, the patient was transferred to our hospital for operation. DIAGNOSTICS: In clinical examination, except of pathological blood in her stool, nothing abnormal could be detected. The patient's hemoglobin on admission was 8.3 mg/dl. The thrombocytes ranged from 9,000 to 25,000/microliter. An ultrasound examination revealed multiple gallbladder stones. The cause of the bleeding in the right colon could finally be assured by blood scintiscanning. THERAPY: As the bleeding was localized in the right colon, a right hemicolectomy as well as a cholecystectomy were performed. After a normal postoperative course the patient could be discharged from hospital after 12 days. Without another occurrence of an intestinal bleeding the thrombocytes ranged between 50,000 and 100,000/microliter during the following 6 years. In 1998 2 further intestinal hemorrhagic episodes with severe thrombocytopenia occurred without successful localization of the bleeding due to its spontaneous cessation. CONCLUSION: The combination of thrombocytopenia and recurrent angioblastic bleeding of the colon has not yet been described. A more sophisticated search for the cause of the bleeding was thus hindered, as the thrombocytopenia was misinterpreted to be more the reason for than the result of the recurrent bleeding episodes.

Angiodysplasia↗
PubMed2000

Perforated appendicitis: is laparoscopic operation advisable?

AIMS: A retrospective study was used to compare laparoscopic appendectomy for perforated appendicitis to open operation. METHODS: Between July 1991 and June 1999 a total of 734 patients, all over 14 years of age, underwent operation for acute appendicitis. Of these patients, 125 (17%) displayed perforated appendicitis and were treated with either a laparoscopic appendectomy (n = 80; total conversion rate 36/80, 45%) or a primary open procedure (n = 45). RESULTS: Due to selection, the 3 treatment groups (laparoscopic, laparoscopy with conversion, open operation) showed differences with respect to gender, duration of symptoms, proportion of obese patients and patients with generalized peritonitis. The median operating time was 75 min for the laparoscopic procedure, 90 min for a converted procedure and 70 min for open operation. Only 1 of 44 (2%) patients who had a laparoscopic operation, but 8 of 36 (22%) who had a converted operation, and 8 of 45 (18%) who had an open operation developed wound infection. A similar frequency of intra-abdominal abscess formation was observed in the 3 treatment groups (2/44, 5%; 3/36, 8%; 2/45, 5%). Fatal outcome occurred only in patients who underwent an open operation and presented with severe peritonitis (5/45, 11%). CONCLUSIONS: Despite limitations in comparability of patient groups, laparoscopic appendectomy was associated with a significantly lower rate of septic wound complications (p < 0.05). This was especially true for the subgroup of obese patients (BMI >26). Therefore, for patients with perityphlitic abscess or fresh purulent lower abdominal peritonitis, but not for patients with generalized peritonitis, laparoscopic appendectomy is not only justifiable but even recommended as the procedure of choice.

Adolescent↗
PubMed1995

[Surgical hemostasis in recurrent peptic ulcer hemorrhage after endoscopic hemostasis--indications and results].

The identification of prognostic factors in patients with bleeding peptic ulcer is an important step for improving the outcome. Besides of age, concomitant diseases and bleeding activity, recurrent bleeding is the principal determinant of mortality in peptic ulcer bleeding. Obviously, there is still a considerable proportion of patients who cannot be successfully managed by endoscopic treatment alone. Therefore the identification of high-risk patients before rebleeding, an adequate early surgical intervention during a stable period after endoscopic haemostasis can prevent recurrent haemorrhage. Emergency endoscopy and, possibly, Doppler ultrasound provide prognostic relevant information allowing 'prospective' therapeutic decisions. By using this strategy in a clinical trial (291 patients) the overall mortality rate could be reduced markedly from 14% (139 patients) to 5% (152 patients). The results were mainly reproducible under clinical routine circumstances.

Adult↗
PubMed1992

[Acute ulcer hemorrhage: when to operate--when to wait?].

The identification of prognostic factors in patients with bleeding peptic ulcer is an essential step for improving the outcome. Since recurrence of bleeding is associated with increased mortality, we therefore developed a new treatment policy based on prognostic information identified at emergency endoscopy. Patients with actively bleeding lesions or visible vessel and high risk of recurrent bleeding were operated upon within 6 h (duodenal ulcer) or 24 h (gastric ulcer) even after successful endoscopic control of bleeding. All other patients with oozing type of bleeding or with signs of recent bleeding during emergency endoscopy were primarily treated in a conservative manner. By using this strategy in a prospective trial the overall mortality rate could be markedly reduced from 14 to 5%.

Age Factors↗
PubMed1991

Histamine and the stomach: chemical histamine assays.

Histamine assays in gastroduodenal tissues and body fluids are not an absolute objective of scientific interest but are related to the role of histamine in health and disease. Hence, the reliability of histamine assays has to be assessed in relation to this aim. Sensitivity and specificity of the chemical histamine assays are similar in tissues and body fluids. The modern developments in a fluorometric-fluoroenzymatic assay guarantee the highest sensitivity and specificity, especially by tests that monitor specificity in each single run of histamine determinations. Precision and accuracy of histamine measurement were especially investigated for the fluorometric assay. They included tests on the coefficient of variation over the whole concentration range, long-term precision with double-sample standard control charts, comparison of several methods for histamine assay including bioassay, and long-term accuracy with the use of Cusum charts. Finally, appropriate sample preparation, sample-taking, relevant body fluids and tissues, and the right time for sample-taking were evaluated in extended methodologic studies. Histamine assays are not just methods for a normal routine laboratory. Extended knowledge about histamine release and metabolism will be necessary to analyse data in this particular field with reasonable validity.

Animals↗
PubMed1991

Diagnostic emergency endoscopy in upper gastrointestinal bleeding--do we have any decision aids for patient selection?

The benefit of emergency endoscopy and therapeutic policies based on certain stigmata of bleeding has recently been demonstrated in patients with peptic ulcer hemorrhage. Applying a simple method of computer-aided diagnosis to a set of prospective data (n = 571) we investigated the question as to whether information on the history (28 variables) and clinical examination (8 variables) could be used to predict ulcer bleeding or certain stigmata of bleeding, with a view to deciding when to perform an emergency endoscopy in patients with upper gastrointestinal bleeding. The patients were assigned to either a high-risk group (probability greater than 0.50 for ulcer bleeding, arterial bleeding, etc.) or a low-risk group (p less than 0.50), and the prediction was compared with the actual findings at endoscopy. The results were disappointing, with an overall accuracy of 71% for the prediction of bleeding peptic ulcer and 71% for the prediction of a bleeding or non-bleeding visible vessel. Despite a relative risk of 2.8 for "bleeding ulcer" and 2.5 for "visible vessel" in the high-risk group, only 72% of all "bleeding ulcer" patients, and 69% of the "visible vessel" patients could be identified by the model. These results indicate that neither a bleeding ulcer nor stigmata of bleeding can be reliably predicted by the patient's history and clinical examination. Emergency endoscopy should therefore be performed in all patients with gastrointestinal bleeding.

Diagnosis, Computer-Assisted↗
PubMed1990

[Status of gastrectomy in the multi-modality therapy concept of primary non-Hodgkin's lymphoma of the stomach].

Retrospectively analyzed data of 41 patients with gastric non-Hodgkin lymphoma are presented with special regard to the required extent of gastric resection in multimodality treatment. Thirty lymphomas of low, 2 of intermediate and 9 of high grade malignancy were distributed on stage Ie in 44%, stage IIe in 15%, stage IIIe in 12% and stage IV in 29%. The cumulative 5 years survival rate was 85% for stage Ie and 55% for the stages IIe and IIIe. Stage IV showed a 3 years survival of 10%. The proximal part of the stomach was involved in 73%, polycentric lesions were found in 15%. The majority (71%) of the tumours showed an infiltrating growth, an invasion of the oesophagus and/or the duodenum was seen in 20%. Five patients (12%) had synchronous adenocarcinoma as second gastric tumour. Regarding our morphological and topographical data curative surgery for primary gastric lymphoma required total gastric resection.

Adult↗
PubMed1990

Prognostic scores in oesophageal or gastric variceal bleeding.

Numerous scoring systems have been developed for the prediction of outcome of variceal bleeding; however, only a few have been evaluated adequately. The object of this study was to improve the classical Child-Pugh score (CPS) and to test other scores from the literature. Patients (n = 82) with endoscopically confirmed variceal bleeding and long-term sclerotherapy were included in the study. Linear logistic regression (LR) was applied to different sets of prognostic variables with regard to 30-day mortality. In addition, scores from the literature were evaluated on the data set. Performance was measured by the accuracy and receiver-operating characteristic curves. The application of LR to all five CPS variables (accuracy, 80%) was superior to the classical CPS (70%). LR with selection from the CPS variables or from other sets of variables resulted in no improvement. Compared with CPS only three scores from the literature, mainly based on subsets of the CPS variables, showed an improved accuracy. It is concluded that CPS is still a good scoring system; however, it can be improved by statistical analysis using the same variables.

Esophageal and Gastric Varices↗
PubMed1989

[The value of computerized tomography for preoperative staging of stomach cancer].

The validity of computed tomography (CT) for the preoperative staging (TNM) of gastric carcinoma was studied in 74 patients, first in a prospective study, then under routine clinical conditions. Comparing CT-staging to intraoperative findings in the study patients showed correct assessment of the T-category in 70%, the N-category in 36%, and of both T and N in 26%. Validity was also low with 27% for both T- and N-staging when the CT was set against pathological-anatomical findings. The results in clinical routine were even more disappointing. The examination is of little value for deciding on operative indication and planning. Computed tomography therefore should not be part of a preoperative routine diagnostic assessment in gastric carcinoma.

Adult↗
PubMed1989

[Computer-assisted documentation in upper gastrointestinal endoscopy: experiences with routine use at 3 clinics].

The introduction of powerful and inexpensive personal computers (PC) enabled us to develop a documentation system for upper gastrointestinal endoscopy. The system was programmed using the database management system dBASE III. It works on-line, and no computer knowledge or additional staff is needed to run the system. It is now routinely used in the endoscopic units of three different hospitals. Features of performance are a menu-driven data input, automatic report generation and record retrieval, listing according to different criteria as well as other dBASE III facilities. This paper deals with the quality, time effort and user acceptance of the PC-aided system in clinical routine. The analysis showed a good data quality with respect to completeness and adequate use of terminology. Reliability and validity of the documentation were satisfactory considering the methodological problems encountered at their determination. The system was generally judged useful, but time effort was increased compared to conventional documentation.

Documentation↗
PubMed1987

Reliability and practicability of the fluorometric-fluoroenzymatic histamine determination in pathogenetic studies on peptic ulcer: detection limits and problems with specificity.

Histamine, among various "biologic-physiologic" abnormalities, is considered as a pathogenetic factor in chronic duodenal ulcer disease. The 10-30 per cent difference between its concentration in gastric and duodenal mucosa of patients compared to healthy controls, however, has to be demonstrated to be specific for the disease. It has to be shown to be neither a methodological artefact nor a common effect, concomitant factor or consequence. This study, after a series of pathogenetic trials examines systematic errors (biases) in the fluorometric-fluoroenzymatic histamine assay under the conditions of field studies including tests on specificity over a time period of 10 years. It concentrates on sensitivity (detection limits) and specificity of a standard technique described herein. A modified Shore procedure for large scale assays in human biopsies was developed including reference luminescence values for all reagents, cleaning material and glassware, reduction of OPD concentration to 0.05%, purification of n-heptan, omission of centrifugation steps in the extraction procedure and use of 2 ml 1 M HClO4 in the homogenization step to prevent losses of histamine due to adherence to the mechanical homogenizer. This assay was sensitive enough to measure histamine without difficulty in any biopsy taken. The detection limit was 3 ng/biopsy, but the smallest quantities of the amine ever obtained were 10.6 and 18.3 ng/biopsy (depending on both histamine content and biopsy weight). A series of problems had to be solved both in achieving and demonstrating specificity. It had to be defined not only for the assay in general, but also for assessing the difference in histamine content between ulcer patients and healthy controls. Exogenous more than endogenous fluorescing material interfering with the determination had to be excluded. A series of pitfalls were detected which had to be overcome in demonstrating the specificity of the assay by physicochemical and enzymatic tests. The specificity of the identification tests was more often impaired than the histamine assay itself. Fluorescing material interfering with the assay occurred in the homogenization, extraction and condensation steps, was found in water, OPD, the organic solvents, the cleaning material and in all kinds of plastic vessels. Plasticizers were shown by physicochemical characteristics including fluorescence spectra to be most likely responsible for this interfering material. Rules were developed to exclude such hazards in specificity in longterm pathobiochemical studies. Enzymatic identification test were applied to exclude endogenous fluorecing substances interfering with the standard technique. Simil

Biopsy↗
PubMed1987

[Principles of risk research in surgery: definition, calculation and clinical use in the problem of upper gastrointestinal hemorrhage].

In surgery, risk research is of great importance at the present time but is controversely discussed with contradictory definitions, calculations and applications. In this paper standardized and quantitative definitions of risk and risk factors using probabilities are given. A calculation of risk, risk factors and risk rates is performed using data from studies on bleeding duodenal ulcers. Possible applications of risk and risk factor research (risk analysis) in suitable treatment policies are demonstrated using data from patients with bleeding duodenal ulcers. The utility of this type of approach, using decision tree analysis, clearly manifests itself in the reduction of lethality. Objective and quantitative surgical risk research and its application as risk analysis using probabilities can improve patient care in standard surgical situations.

Duodenal Ulcer↗
PubMed1986

[Principles of surgical indications: aids in decision making].

Several types of clinical studies provide important decision aids for surgical indications. They include quantitative data on outcomes and utility analysis, graphic illustration of the various possibilities for decisions by decision trees, controlled clinical trials with data used in decision trees and--if these trials fail for several reasons--carefully conducted and documented prospective and retrospective trials. Items for defining the term "surgical indication" were illustrated by constructing a decision tree for treatment of chronic duodenal ulcer.

Diagnosis↗