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Biomedical subjects

H U Zieren

Publications and source records attributed to H U Zieren.

At least 19 recordsLinked to original sources
PubMed2000

[Repair of inguinal hernia in the elderly. Results of the plug-and-patch repair with special reference to quality of life].

In a prospective study the perioperative results of plug-and-patch repair were investigated in patients > or = 65 years, and quality of life was assessed using the SF36 preoperatively and 3 months after the procedure in 34 consecutive patients. From August 1994 to February 1999 147 patients with a mean age of 73 +/- 5 years (65-92 years) were operated on using the plug-and-patch technique, mostly under local anesthesia (LA: n = 124, 84%, ITN: n = 23, 16%). Preoperative risk factors were alcohol consumption, hypertonus, diabetes mellitus, ischemic heart disease, smoking, cerebrovascular disease, hyperlipidaemia and pulmonary disease. Most of the patients were ASA II (ASA I: n = 14, 9%, ASA II: n = 82, 56%, ASA III: n = 51, 35%). No intraoperative complications occurred, postoperative complications consisted of superficial wound hematoma (n = 6, 3.7%) and infection (n = 1, 0.6%), seroma (n = 7, 3.8%), urinary retention (n = 3, 1.8%) and ilioguinal pain syndrome (n = 3, 3.8%). The total amount of postoperative analgesic consumption was 4.9 +/- 1.8 g Novalgin for about 4 +/- 3 days. The duration of postoperative hospitalization was 2 +/- 1 days and limitation of daily activities 6 +/- 3 days. Clinical examinations after 3 months revealed no recurrence or late complications. Investigation of quality of life showed a significant improvement in the SF36 domains of physical activity, pain, vitality, and social functioning after the operation. No significant change was observed for physical, emotional, and global health.

Adult↗
PubMed1999

Regular scintigraphic measurements of food transit following different types of reconstruction after total gastrectomy.

HYPOTHESIS: Ideal reconstruction after gastrectomy should ensure that the patient has a sufficiently large enteric reservoir to accommodate normal meals. Little is known about the transit of food after different methods of stomach reconstruction. The hypothesis of this trial was that food transit after gastrectomy is delayed by a pouch reconstruction compared with reconstructions without a pouch. DESIGN: Prospective. SETTING: University hospital. PATIENTS AND METHODS: A total of 27 patients underwent an interposition of a jejunal loop between the esophagus and the duodenum with (n = 19) or without (n = 8) a 7- or 15-cm proximal pouch reconstruction. Standardized scintigraphic measurements were performed to evaluate the food transit at fixed postoperative times. MAIN OUTCOME MEASURE: Scintigraphically measured food transit time. RESULTS: The food transit time 1 year postoperatively was significantly prolonged in patients with the 15-cm pouch in comparison with those with the 7-cm pouch and those without a pouch reconstruction (P = .005, P = .012). Patients with a pouch reconstruction tended to have better eating habits. CONCLUSIONS: Our results confirm the hypothesis and suggest that interposition of a large 15-cm jejunal pouch can lead to a prolonged food transit time with enteric reservoir function resulting in better patient nutritional status.

Adult↗
PubMed1999

[Gastrointestinal quality of life after duodenopancreatectomy in pancreatic carcinoma. Preliminary results of a prospective randomized study: pancreatoduodenectomy or pylorus-preserving pancreatoduodenectomy].

BACKGROUND: The Whipple operation (PD) is the standard operation in patients with cancer of the head of the pancreas and the periampullary region. However, the pylorus-preserving duodenopancreatectomy (PPPD) is supposed to be superior in gastrointestinal function. METHODS: In a prospective randomized trial (October 1994-October 1998) PD and PPPD were compared in terms of global and gastrointestinal quality of life, operation time, duration of hospital stay, transfusions and perioperative morbidity. Quality of life was analyzed under standardized conditions (EORTC-QLQ-30) pre- and postoperatively (weeks 2, 6, 12, 24, 36, 48, and 60). RESULTS: A duodenopancreatectomy was performed in 48 patients because of cancer of the head of the pancreas (n = 38) and the periampullary region (n = 10) (PD, n = 24; PPPD, n = 24). The PD and PPPD groups did not differ according to age, gender or UICC stage. Operation time was shorter in the PPPD group (206 +/- 48 vs 306 +/- 54 min) (P < 0.05). Morbidity did not differ between the two groups (PPPD 20% vs PD 30%, P > 0.05). While there was no difference in global quality of life, gastrointestinal quality of life was postoperatively increased in the PPPD group regarding appetite, nausea and diarrhea (P < 0.05). While the preoperative body weight was reached after 6 months in 85% of the PPPD group (n = 20), this was true in only 60% of the PD-group (n = 14) (P < 0.05). CONCLUSION: PPPD seems to be associated with a better postoperative gastrointestinal quality of life than PD.

Adult↗
PubMed1999

[Hormone therapy of postoperative recurrent pancreatic carcinoma with octreotide and tamoxifen].

BACKGROUND: In a prospective trial (October 1996-April 1998) the effect of octreotide and tamoxifen on the recurrence of pancreatic carcinoma after R0 resection was evaluated. METHODS: Patients with a local recurrence after curative resection of ductal adenocarcinoma of the pancreas were treated with 100 micrograms of octreotide three times a day and tamoxifen 20 mg once daily. The median survival time, quality of life (EO-RTC-QLQ-30) and side effects of the octreotide-tamoxifen group were compared with a historic cohort (n = 14) of patients treated in our department (9/95-9/96) according to the "best supportive care" concept. RESULTS: Recurrences were diagnosed after R0 resection in a mean time of 13 +/- 6.8 months. Patients treated with octreotide and tamoxifen had a significantly (P < 0.05) longer median survival time (7 months; range: 3-12) vs 3.5 months; range: 1.5-5). The octreotide-tamoxifen group suffered less from lack of appetite, nausea, fatigue, and pain and needed fewer analgesics. The only side effect of the octreotide-tamoxifen therapy was moderate diarrhea in 2 patients at the beginning of the therapy. CONCLUSION: Since combined therapy with octreotide and tamoxifen can be administered comfortably for outpatient treatment, this seems to represent progress in the palliative therapy of pancreatic cancer.

Aged↗
PubMed1999

Is mesh fixation necessary in abdominal hernia repair? Results of an experimental study in the rat.

BACKGROUND: Abdominal hernia repair with implantation of synthetic meshes using the sublay technique has resulted in low recurrence rates and high patient satisfaction. AIM: The purpose of this experimental animal study was to investigate whether mesh fixation is necessary in abdominal hernia repair using a polypropylene mesh in the sublay technique. METHODS: Forty-five rats were divided into three groups after creating an abdominal wall defect (CG control group, no mesh implantation; NoFixG mesh implantation without fixation group; SG mesh with suture fixation group) with 15 animals in each group. End-points were clinical herniation pressure, hydroxyproline (HP) concentration, mesh shape and number of fibroblasts/collagen fibres of the anchor zone 7, 14 and 90 days after implantation. RESULTS: Herniation pressure, HP content and number of fibroblasts were similar between NoFixG and SG, although significantly higher in these groups than in the CG (P<0.05). Both mesh groups had significantly higher counts of fibroblasts and collagen fibres than the CG. Mesh shrinking occurred in both groups but was less in the SG. CONCLUSION: Mesh fixation was not mandatory in abdominal hernia repair using this animal model.

Animals↗
PubMed1999

Repeated boluses of local anaesthetic for pain relief after inguinal hernia repair.

OBJECTIVE: To compare the effect of repeated boluses of local anaesthetics with an oral analgesic for pain management after tension-free inguinal hernia repair. DESIGN: Prospective randomised study. SETTING: University hospital, Germany. SUBJECTS: 104 patients undergoing elective hernia repair. INTERVENTIONS: 52 patients were given boluses of 0.5% bupivacaine 10 ml through a subcutaneous catheter and 52 dipyrone 500 mg orally 6, 12 and 24 hours after operation. MAIN OUTCOME MEASURES: Postoperative pain measured on a visual analogue scale, complications, systemic side effects, supplementary analgesics, costs, and time taken to give the analgesics. RESULTS: There were no significant differences between the groups in absolute pain scores, course of pain, and the effects of analgesics. Thirteen patients [5 in the bupivacaine group and 8 in the dipyrone group] required additional dipyrone [mean (range) 2000 mg (500-5000) and 2500 mg (500-4000) respectively]. There were no systemic side effects of either treatment. There were 5 wound haematomas in the bupivacaine group (10%), and 2 wound haematomas and 1 superficial wound infection in the dipyrone group (6%). Mean costs of material and time taken to give the analgesics were pound sterling 104.70 and 47 minutes in the bupivacaine group compared with pound sterling 3.40 and 6 minutes in the dipyrone group. The median (range) hospital stay was 2 (1-3) days in both groups. CONCLUSIONS: Repeated boluses of local anaesthetic did not result in better or cheaper pain control than oral analgesics after tension-free inguinal hernia repair.

Analgesics↗
PubMed1999

Does dietary alpha-linolenic acid promote liver metastases in pancreatic carcinoma initiated by BOP in Syrian hamster?

BACKGROUND: alpha-Linolenic acid (ALA) has been shown to have a promoting effect on pancreatic carcinogenesis. The purpose of this study was to evaluate the influence of ALA on liver metastases in a model of BOP-induced pancreatic ductular carcinoma in the Syrian golden hamster. METHODS: While the control group (group V) received a standard diet low in fat (soya oil, 3 w/v) without ALA, groups I-IV were fed a diet high in fat (soya oil 25 w/v) with increasing percentages of ALA (2.5, 5, 7.5 and 10%) for 16 weeks. RESULTS: No significant differences in mean body weight and pancreas weight were found between the groups. But significant differences (p = 0.0001) were observed in the mean weight of the resected liver. Treatment with BOP alone resulted in the induction of well-differentiated ductal pancreatic adenocarcinoma in 91%, while all groups treated with different amounts of ALA had induction of 100%. The incidence of liver metastases differed significantly between the groups. The incidence of liver metastases in group I (2.5% ALA) was 18%, in group II (5% ALA) 27%, in group III (7.5% ALA) 50%, and in group IV (10% ALA) 91%. Moreover, the diameter of liver metastases increased significantly according to ALA supplementation (p = 0.001). CONCLUSION: The results indicate that dietary ALA increases liver metastases in BOP-initiated pancreatic cancer.

Animals↗
PubMed1998

Is tissue oxygen tension during esophagectomy a predictor of esophagogastric anastomotic healing?

PURPOSE: The genesis of anastomotic leakage and late stenosis of esophagogastrostomy is still unknown, although minimal blood flow and tissue hypoxia of the gastric tube are discussed as main reasons. However, the changes in tissue oxygen tension (PtO2) on esophagogastric anastomoses have not yet been evaluated in the perioperative course. METHODS: Submucosal tissue oxygen tension (PtO2) was measured in 33 patients with cervical esophagogastrostomy during resection of esophageal carcinoma and reconstruction by a gastric tube. Measurements were taken close to the projected resection line and latter anastomosis using a Clark-type oxygen electrode. RESULTS: Mean baseline PtO2 was 55.1 +/- 10.4 mmHg. Following the ligature of the vasa gastricae brevis and the left gastroepiploic artery (46.1 +/- 9.7 mmHg), the left gastric artery (34.8 +/- 9.8 mmHg), and the pull up of the gastric tube, PtO2 decreased to 25.8 +/- 9.4 mmHg. Anastomotic leakage occurred in 6 patients and late stenosis in 10 patients. During the operation there was no significant evidence of decreased PtO2 levels in these two groups. Postoperative PtO2 levels showed a significant increase in patients with anastomotic leakage. CONCLUSION: A disorder in oxygen consumption may cause a significant increase of PtO2 in anastomotic tissue, which is associated with anastomotic leakage.

Adult↗
PubMed1998

Increased systemic inflammation after laparotomy vs laparoscopy in an animal model of peritonitis.

OBJECTIVE: To study the influence of laparotomy and laparoscopy on local and systemic inflammation in a rat model of peritonitis. DESIGN: Bacteremia, peripheral leukocyte subpopulations, tumor necrosis factor alpha (TNF-alpha) plasma levels, and ex vivo secretion of peripheral blood mononuclear cells were investigated after laparotomy and laparoscopy in a prospective randomized experimental study. SETTING: Surgical department of a university hospital. ANIMALS: 60 male inbred Wistar rats. INTERVENTIONS: Standardized fecal inoculum was injected intraperitoneally and rats underwent laparotomy (n=20), laparoscopy (n=20), or no further manipulation (control group, n=20). Blood samples were obtained during the perioperative course to determine bacteremia, leukocytic subpopulations, TNF-alpha plasma levels, and ex vivo secretion. The number of intraperitoneal abscesses was determined in each animal after 1 week. MAIN OUTCOME MEASURE: The hypothesis of the experiment was that laparoscopy with carbon dioxide leads to an increase of local and systemic inflammation in comparison with the laparotomy and control groups. RESULTS: One hour after intervention, bacteremia was significantly higher in the laparotomy and laparoscopy groups compared with the control group (P=.01). Fecal inoculum caused significant monocytopenia and lymphocytopenia in all groups within 1 hour after intervention (P<.05), with complete recovery on day 2 only in the laparoscopy and control groups. Laparotomy caused a significant increase in TNF-alpha plasma levels and decrease of ex vivo production of TNF-alpha compared with the other 2 groups (P<.05). CONCLUSIONS: Laparotomy and laparoscopy increased the incidence of bacteremia and systemic inflammation in this peritonitis model. The inflammatory response was significantly higher in the laparotomy group compared with the laparoscopy group.

Abdominal Abscess↗
PubMed1998

Prospective randomized study comparing laparoscopic and open tension-free inguinal hernia repair with Shouldice's operation.

BACKGROUND: Although tension-free techniques of hernia repair using synthetic meshes revealed encouraging results, the best method of inguinal hernia repair is still unclear. METHODS: In a prospective randomized phase-II-B study, early postoperative results of laparoscopic transabdominal preperitoneal repair (n = 80), open plug and patch repair (n = 80), and Shouldice's operation (n = 80) were compared. Postoperative pain and patient's comfort were defined as main endpoints. RESULTS: The laparoscopic approach had significantly longer operation time and was more expensive (61 +/- 12 minutes; $1,211) than plug and patch repair (36 +/- 14 minutes; $124) and Shouldice's operation (47 +/- 17 minutes; $69). Main postoperative complications were wound hematomas, seromas, and superficial wound infection, without significant difference between the groups. Postoperative pain, analgesia requirements, limitation of daily activities, and return to work did not differ between laparoscopic and open tension-free repair but were significantly lower in both groups compared with Shouldice's operation. So far, no recurrence was observed after a mean follow-up of 25 months. CONCLUSION: Open plug and patch repair is a promising technique of hernia repair in adults, because it offers the same excellent patient comfort as the laparoscopic repair but is less expensive and can be performed under local anesthesia.

Adult↗
PubMed1998

Quality of life after surgical treatment of gastric carcinoma.

OBJECTIVE: To see if there was a correlation between self-assessment and external evaluation of quality of life (QL) after resection of gastric carcinoma, a correlation between overall QL and different components, and the impact of social and medical factors on QL. DESIGN: Prospective study. SETTING: University hospital, Germany. SUBJECTS: 71 patients assessed once 12 months after R0-resection of gastric carcinoma and 35 patients assessed regularly, starting postoperatively. INTERVENTIONS: QL was assessed by the patients using the European Organisation for Research and Treatment of Cancer (EORTC) core QL questionnaire (QLQ-C36) and by a psychologist using the Spitzer Index. MAIN OUTCOME MEASURES: Correlations between self-assessment and external assessment, between overall scores and single items of QL, and between social and medical factors and QL, as well as changes in QL-scores during postoperative follow-up. RESULTS: Self-assessment and external evaluation of global QL showed a significant but not particularly close correlation (r = 0.40) and QL was evaluated as better by the external observer using the Spitzer Index. All physical, emotional, and social components of the QLQ-C36 correlated significantly with patients overall evaluation of QL. Postoperative QL was affected mainly by somatic complaints and physical limitations. Of several factors analysed, tumour recurrence was the decisive factor in deciding patients' QL. Compared with the preoperative assessment, QL had deteriorated on discharge from hospital but was restored during the following six months in patients who remained disease-free. CONCLUSION: Compared with the Spitzer Index the QLQ-C36 differentiates the QL of patients with gastric cancer better and disease-specific complaints are included.

Adult↗
PubMed1998

[Effect of splenectomy on intra- and extraperitoneal tumor growth with reference to the immune system in a rat model].

In this model, splenectomy does not significantly influence the intra- and extraperitoneal tumor growth. Although the spleen accounts 25% of the cellular immune capacity, we found no difference in pro- or antiinflammatory cytokines but a significant increase of the white blood count after splenectomy compared with the control group. The influence of splenectomy on growth of intraperitoneal disseminated tumor cells must be investigated in further studies.

Adenocarcinoma↗
PubMed1998

[Effect of intra-abdominal pressure in laparoscopy on intraperitoneal tumor growth and development of trocar metastases. An animal experiment study in the rat model].

The results of the study indicate that elevated pressure during gas incubation in vitro leads to suppression of tumor growth probably due to direct damage of the cells. In vivo, laparoscopy with carbon dioxide and slightly elevated intraperitoneal pressure (5 and 10 mmHg) leads to promotion of intraperitoneal tumor growth while higher pressure (15 mmHg) causes again suppression of intraperitoneal tumor growth. Subcutaneous tumor growth is stimulated by carbon dioxide insufflation in all groups with elevated intraperitoneal pressures. The hypothesis that elevated intraperitoneal pressure might influence the immune system of the tumor host and increase immune suppression after laparoscopy remains theoretically and has to be investigated in further studies.

Air Pressure↗
PubMed1998

[Surgical therapy of non-Hodgkin lymphoma of the stomach].

The value of surgical treatment is less well defined in gastric lymphoma than in gastric carcinoma. Therefore, we analysed the outcome of 245 patients with gastric malignancies, which were treated from 1.1.1988 to 31.12.1995 in the Department of Surgery/Charité. Twenty patients suffered from a non-Hodgkin-lymphoma and only 14 (8%) were diagnosed correctly by preoperative endoscopical biopsy. Seven patients with limited lymphoma underwent primary surgical therapy (total gastrectomy n = 4, subtotal gastrectomy n = 3). Seven patients with disseminated lymphoma (stage EIII-IV) were treated by neoadjuvant chemotherapy (CHOP), that was followed by gastrectomy (R0: n = 2, R1: n = 4) or explorative laparotomy (n = 1). Five patients (25%) were diagnosed as undifferentiated carcinoma and underwent total gastrectomy with D2-lymphadenectomy (R0: n = 5). One patient (5%) underwent emergency surgery due to gastric perforation. One patient (5%) died in hospital due to insufficient anastomosis after total gastrectomy and preoperative chemotherapy. Nine patients with high-grade malignant lymphomas received postoperative chemotherapy. The 1-, 2,- and 5-year-survival-rate was 95%, 89% and 44%. Although, many questions are still open, surgical therapy remains an important option in the multimodal treatment of gastric lymphoma.

Adult↗
PubMed1998

[Hormone therapy of postoperative recurrent pancreatic carcinoma with octreotide and tamoxifen].

In a prospective trial a combination of octreotide and tamoxifen was evaluated for its effect on tumour recurrence of R0-resected pancreatic carcinoma. Compared to the control group (n = 14), which was treated according to "best supportive care", the median survival times for the octreotide-tamoxifen group (n = 14) were 7 and 3.5 months respectively. In the octreotide-tamoxifen group patients suffered less from nausea, pain and fatigue (p < 0.05). Furthermore, there was a benefit of octreotide-tamoxifen therapy for global life quality.

Adenocarcinoma↗
PubMed1998

[Does the pouch modify food transit after gastrectomy?].

A prospective, randomized study of patients with gastric cancer was performed to examine whether or not the jejunal pouch interposition between esophagus and duodenum after gastrectomy is of importance. At fixed postoperative times, standardized scintigraphic measurements were performed; the quality of life was evaluated by the EORTC quality of life questionnaire. Our findings suggest that interposition of a jejunal pouch reservoir between esophagus and duodenum may be due to a prolonged transit time and a better quality of life.

Duodenum↗
PubMed1997

[Comparison of local and systemic inflammation after laparotomy or laparoscopy in the rat sepsis model].

BACKGROUND: Laparoscopic techniques are frequently used in patients with peritonitis or intra-abdominal inflammatory diseases although increased intraperitoneal pressure may cause sepsis by promoting bacteraemia and systemic inflammatory response. METHODS: This experimental study investigates the influence of laparotomy and laparoscopy on bacteraemia, tumour necrosis factor (TNF)-alpha and endotoxin plasma levels. Standardized foecal inoculum was injected intraperitoneally and rats underwent either laparotomy (n = 20), laparoscopy (n = 20), or no further manipulation in the control group (n = 20). RESULTS: One hour after intervention, bacteraemia was significantly higher in both the laparotomy or laparoscopy groups than in the control group (P = 0.01). Foecal inoculum caused a significant increase in TNF-alpha and endotoxin plasma levels 1 h after intervention with the significantly highest levels after laparotomy (P < 0.05). In addition, the mean number of intraperitoneal abscesses were also significantly higher (P < 0.05) after laparatomy (n = 10) than after laparoscopy (n = 8) or in the control group (n = 5). CONCLUSIONS: Laparotomy and laparoscopy increased the incidence of bacteraemia and systemic inflammation compared to control group. However, inflammatory response and intraperitoneal abscess formation were significantly higher in the laparotomy group than in the laparoscopy group.

Abdominal Abscess↗