PubMed Health⌕ Search

Biomedical subjects

H W Keller

Publications and source records attributed to H W Keller.

At least 19 recordsLinked to original sources
PubMed1992

[Surgical treatment of dislocated 3 and 4-segment fractures of the proximal humerus].

Twenty-eight three- and four-segment fractures of the proximal humerus were treated by plate fixation (n = 22), screw or Kirschner wire stabilization (n = 5), and primary endoprothesis (n = 1). There were no early postoperative complications. Fourteen months after the operation, 80% of the patients examined showed good results; 4 cases had poor results. In comparison to other reports our results are positive and support plate fixation as the method of choice in these situations.

Aged↗
PubMed1992

[Preoperative intestinal lavage with a polyethyleneglycol-containing solution. A prospective randomized study in comparison with Ringer's lactate solution].

UNLABELLED: Aim of that study was to prove, whether a solution containing polyethyleneglycol (PEG) is more useful in comparison to the normal method using Ringer's-lactate solution for preoperative bowel preparation. METHODS: From January 1990 up to February 1991 we compared in a prospective randomized simple blind study on 110 patients the whole gut solution (Hewitt) to a bowel preparation with PEG (Oralav). RESULTS: The patients, that were prepared in the common way (Ringer's-lactate, control group; n = 54) were approximately given the double amount of liquid (9663 ml) as those in the other group (target group; n = 54: 4777 ml). We found no significant differences concerning the electrolytes. Hemoglobin (-1.1 g/dl) and hematocrit (-3.5%) were significantly lower in the control group. Both groups showed a similar frequency of nausea (control group 25% vs target group 34%). Vomiting was mainly found in the control group (20.8% vs 1.9%). Both groups showed comparably good results in bowel cleansing. Between the two groups we found no differences in specific bowel bacterial flora. Characteristic and number of postoperative complications were similar low (5.7 vs 3.8%). CONCLUSIONS: Due to a better compliance by oral application, the lower given amounts of liquid and the equal cleansing effect we prefer the use of the PEG containing solution (Oralav).

Adult↗
PubMed1992

[Symptomatic stenoses following stapler anastomosis of the large intestine].

Since 1978 the stapled colonic anastomosis belongs to the technical standard in surgery of the rectosigmoid. It is followed by an extension of indications for sphincter-preserving excisional treatment. The main advantages of the mechanical suturing are the shortening of operation time as well as the practical and easy management, especially when the anastomosis is located low in the pelvis. Early respectively late postoperative strictures represent the most frequent complications of stapled anastomosis. From 1989 to 1991, the stapling technique was used for colorectal anastomosis in 196 cases in our hospital. Clinical stenosis occurred in 5 cases, an incidence of 2.5%. Causative the size of the cartridge, the healing by second intention because of the metallic staples, a disturbed microcirculation depending on the tension around the anastomosis, missing normal fecal dilation because of protective colostomy and an incongruity of the combined lumina are discussed. Independent of localisation and grade of the stricture, repeated dilation was a successful therapy in all 5 cases.

Adenocarcinoma↗
PubMed1991

[The effectiveness of hypercaloric and hypocaloric postoperative parenteral nutrition in large abdominal surgery. A prospective randomized study].

By means of a prospective randomised trial protein turnover and general energy expenditure were measured after stomach or bowel resections in patients receiving either hypercaloric or hypocaloric parenteral nutrition. The results were correlated with the availability of various blood proteins and amino acids as well as the concentration of different substrates of the intermediary metabolism. The results show that there is no need for a hypercaloric parenteral nutrition even after major abdominal surgery. Apart of a slightly better nitrogenbalance, which is, however, connected with an increased nitrogen impact on the organism there was no advantage over hypocaloric intravenous nutrition at least until the fifth day after the operation.

Blood Glucose↗
PubMed1991

[Role of the spleen in tumor surgery].

Tumorigenesis and tumor growth are connected with the immune system. Therefore the role of the spleen respectively splenectomy have gained increasing influence. The existing experimental and clinical results are discussed with the help of a general review of the literature. A manipulation of the immune system by splenectomy seems possible. A common pathomechanism has not yet been found. But experimental investigations are transferrable to human beings only under special conditions.

Humans↗
PubMed1991

[The management of complete shoulder joint dislocation without metallic implants].

In 14 patients reduction of the acromioclavicular joint was reinforced by completely absorbable polydioxanon cord. In 3 cases parts of the cord were rejected and a fistula formed through the scar without further impairment following as a result of healing local treatment. Altogether we had 12 good and 2 poor results with respect to function, X-ray appearance and pain. The complication rate and general outcome of the method described do not differ substantially from those of other commonly used procedures. However, no second operation for removal of the metal implants is necessary.

Acromioclavicular Joint↗
PubMed1991

[Effect of accidental splenectomy on long-term outcome in colorectal tumor surgery].

In the period from 1967 till 1988 an accidental splenectomy was carried out at 1318 colon resections because of a malignant tumor in 34 cases (2.5%). The preoperative risk of this patient group was increased clearly in opposite to the whole patient clientele. So every fifth suffering from ileus or subileus was operated as in emergency. The complication rate, time of rest and clinic lethality were increased. The five-years survival rate did not change significantly in stage T1 and T2 in comparison with the whole patient clientele. In the stage T3, however, a significant prolonged survival rate was found out in the target group. Therefore the oncological aspect does not supply any reason to preserve the spleen in colorectal tumor surgery.

Adenocarcinoma↗
PubMed1990

[Splenic cysts: indications for surgery and surgical procedures].

Based on a late physical examination of 18 patients with splenic cysts, we discuss symptoms, diagnostics and indication to operate and the procedure of operation. We found no specific symptoms. The ultrasound is the most important diagnostic method and may be supplemented by computerized axial tomography. The indication depends on the symptoms, the diameter within the organ and, most important, the dignity of the cyst. For pseudocysts we prefer resection of the cyst wall, because it is a simple and safe procedure. Splenectomy is the treatment of choice for cysts with unknown dignity.

Adolescent↗
PubMed1989

[Does parenteral fat administration modify immunocompetence?].

Evidence from studies in carcinoma patients who received intravenous glucose or glucose-lipid solutions preoperatively indicates that fibrinogen, alpha-II-macroglobulin, and coeruloplasmin serum levels remain unchanged. On the other hand, parenteral administration of lipids or glucose induces an increase of IgM, IgG, IgA and complement C3 serum concentrations. Cutaneous allergy testing shows no significant difference whether only glucose was used or half of the calories were replaced by 2.4 g lipids/kg BW x day.

Antibody Formation↗
PubMed1987

[Spontaneous and other non-tumor-induced esophageal perforations].

The outcome of esophageal perforation is determined by the cause and localisation, but mainly by the time lapse between trauma and therapy. Spontaneous and intraoperative ruptures are most dangerous. Treatment of choice is direct closure and drainage. If this is not possible, esophagectomy or exclusion and diversion in continuity should be considered. The injury may present itself with rather unspecific symptoms. Pathological findings in the plain chest roentgenogram and gastrographin study will confirm diagnosis in nearly all cases.

Adolescent↗
PubMed1987

The daily intake of 234,235,238U, 228,230,232Th and 226,228Ra by New York City residents.

The daily intake of long-lived alpha-emitting members of the U, Th and Ac series by New York City residents has been estimated from measurements of diet, water and air samples. The total daily intakes from inhalation, food and water consumption in mBq are 18 (234U), 0.7 (235U), 16 (238U), 6 (230Th), 4 (232Th) and 52 (226Ra). From this, we infer that the total daily intakes of 228Th and 228Ra are 4 and 35 mBq, respectively.

Air Pollutants↗
PubMed1987

[Comparison of prognostic nutrition indices in preoperative detection of risk patients. A prospective trial].

Malnutrition must be considered as a factor of risk in surgery and therefore it has to be taken into account in surgical planning. Many authors aggregated several measurements into an index or another mathematical model by stepwise regression or discriminant analysis. Hitherto none of these approaches has been subjected to a critical analysis designed to determine whether the information gained differentiates patients with increased operative risk from those without, to a degree that is clinically relevant. In a prospective study the predictive values of nutritional assessment techniques of various authors were examined in 246 surgical patients undergoing a major surgical procedure. The specificity, sensitivity, and validity of each assessment technique were determined. The statistical analysis showed that none of the assessment techniques separated patients who were at high risk from those who were at low risk in a statistically significant predictive power. Serum albumin level was a quite accurate prognostic indicator of postoperative morbidity and mortality. The mean complication rate in this study was 26.8%. Concerning the specificity, sensitivity, and validity the single measurement of the serum albumin had a predictive value as high as all other determined assessment techniques in this study. We contend that combining measurements into a statistically derived index is time-consuming and expensive and does not produce an assessment technique with sufficient predictive power to identity high risk patients in a clinically relevant fashion.

Humans↗
PubMed1986

[Indications for splenectomy in non-malignant systemic diseases].

The benign systemic disorders with involvement of the spleen are divided into haematologic diseases, thesaurismosis, collagenosis, morbus Boeck, infectious diseases, parasitosis and others. 4/5 of the cases are haematologic diseases of the erythrocytic, the thrombocytic and lymphatic system as well as myeloproliferative and aplastic syndromes. 227 of 1214 splenectomies of the last 20 years were done in benign systemic diseases. The functional and mechanical hypersplenism as a rule is the cause for operation. The specific indications, the medical pretreatment and the combination of surgery and non-surgical measures are discussed.

Collagen Diseases↗
PubMed1986

[Adjuvant artificial nutrition in tumor surgery].

Malnutrition can effect negatively the results of major cancer surgery. Adequate preoperative nutritional therapy helps to overcome the catabolic situation of malnourished cancer patients and leads to a reduction of postoperative morbidity and mortality. The beneficial effect of nutritional therapy after major cancer surgery is generally accepted, despite there is a lack of comparative clinical trials which could support this opinion. Forced feeding stimulated tumor growth in certain animal models. These findings seem to have not any clinical relevance in cancer surgery.

Blood Proteins↗
PubMed1986

[Assessment of nutritional status for surgical planning].

72 patients with gastro-intestinal carcinomas were involved in a retrospective study in which 97 metabolic parameters were pre-operatively determined from each of them and subsequently tested by stepwise discriminant analysis for their bearings on clinical mortality. A discriminant function of seven parameters was obtained and can be used as a prognostic nutritional index for successful subdivision of patients into differentiated risk groups. Two prospective control studies were conducted into 605 patients consecutively operated on for benign and malignant diseases for the purpose of testing the nutritional index for its prognostic information potential. The discriminant function proved to be applicable to differentiation between patients with high, moderate, and low surgical risk. Findings were unambiguous. The nutritional index can thus be used as an aid for decision-making in cases in which alternatives exist between several surgical approaches. The importance of malnutrition as a possible causative factor of complications is likely to grow along with the invasiveness of the intervention.

Body Weight↗