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Biomedical subjects

H Wacha

Publications and source records attributed to H Wacha.

At least 19 recordsLinked to original sources
PubMed1995

Planned relaparotomy vs relaparotomy on demand in the treatment of intra-abdominal infections. The Peritonitis Study Group of the Surgical Infection Society-Europe.

OBJECTIVE: To define the role of planned relaparotomy (PR) in the treatment of intraperitoneal infection, compared with that of relaparotomy on demand (RD). DESIGN: Case-control study on the basis of a prospective multicenter cohort analytic study. Statistical evaluation was done by the McNemar test for qualitative data and the Wilcoxon matched-pairs signed rank test for qualitative data. SETTING: Eighteen hospitals of different care levels in Austria, Germany, and Switzerland. PATIENTS: Thirty-eight of 42 patients with intra-abdominal infections who underwent PR were matched for APACHE II (Acute Physiology and Chronic Health Evaluation II) score, age, cause of infection, site of origin of peritonitis, and the ability of the surgeon to securely eliminate the source of infection with 38 patients taken from a cohort of 278 undergoing RD. INTERVENTIONS: Planned relaparotomy was defined as at least one relaparotomy decided on at the time of the first surgical intervention; RD, relaparotomy indicated by clinical findings. MAIN OUTCOME MEASURES: Mortality and incidence of postoperative multiple organ failure and infectious complications. RESULTS: There was no significant difference in mortality between patients treated with PR (21%) or RD (13%). Postoperative multiple organ failure as defined by a Goris score of more than 5 was more frequent in the group of patients undergoing PR (50%), compared with the group undergoing RD (24%) (P = .01), as were infectious complications (68% vs 39% [P = .01]). Infectious complications were due to more frequent suture leaks (16% vs 0% [P = .05]), recurrent intra-abdominal sepsis (16% vs 0% [P = .05]), and septecemia (45% vs 18% [P = .05]) in the PR vs the RD groups. The incidence of other complications was not different in the two groups. CONCLUSIONS: Until larger prospective studies are available, the indication for PR should be evaluated with caution.

Abdomen↗
PubMed1991

[Postoperative mechanical ileus].

Postoperative GI obstruction is the third most common postoperative complication, after peritonitis and bleeding, leading to laparotomy. The mortality has declined in the last decade from around 20%-35% to 10%-20%. This is probably caused by better intra-operative surgical techniques and better understanding of the pathophysiology of gastrointestinal motility. The problem most frequently lies in the proximal small bowel particularly after operations on the colon, especially in the presence of inflammation or peritonitis. Differentiation between postoperative paralysis and mechanical obstructions is very difficult. Modern diagnostic techniques have not changed this fact. For assessment of the abdomen, repeated surgical investigations is still of more value than laboratory data alone.

Colonic Pseudo-Obstruction↗
PubMed1987

[Symptomless gallstone disease--when to treat surgically?].

The cholecystolithiasis is the symptom of a disease. Recent radiological procedures, above all sonography, can be helpful not only in more frequent detection of gallstones, but they can also provide information, even without clinical symptoms, on pathological changes to gallbladder and biliary tracts. However, early diagnosis of carcinoma of the gallbladder still is rare. Mortality of gallbladder carcinoma has remained unchanged in the Federal Republic of Germany over the past ten years, whereas mortality following cholecystolithiasis has been lowered due to progress in medicine. The surgical risk rises along with age and is low up before 60 years. Indication for cholecystectomy continues to be a highly individual decision which should be considered with particular caution in cases of "asymptomatic" gallstones.

Cholecystectomy↗
PubMed1987

[The Mannheim peritonitis index. An instrument for the intraoperative prognosis of peritonitis].

Based on the experience with 1243 patients suffering from purulent peritonitis 255 patients of two surgical departments were studied prospectively in a cohort study. Lethality was 24%. For intraabdominal infection an index is established that allows for the first time to predict lethal outcome of the disease in the individual patient. For each index-score the expected mortality is given by a modern mathematical calculation. The 'Mannheim Peritonitis Index' includes only clinical risk-factors that are routinely documented pre- and intraoperatively. Methods of evaluation, validation and the comparison with other prognostic indices are presented.

Humans↗
PubMed1986

[The asymptomatic gallstone].

There are several sound arguments to operate on "silent" gallstones: The operative mortality following simple cholecystectomy in patients under 40 is zero. 50% of all patients with silent gallstones will be operated upon or develop symptoms within 10-20 years after the initial diagnosis. Carcinoma of the gallbladder is very rarely diagnosed in time and in most cases is incurable at the time of operation. The number of deaths in the FRG due to a carcinoma of the gallbladder has been consistently high in the last decade. Risk factors for cholecystectomy increase with the patients age. Therefore early cholecystectomy is recommended. Nevertheless indication for cholecystectomy is an individual decision.

Cholecystectomy↗
PubMed1986

[Interwoven wire suture with fascia lata-plasty in the treatment of subcutaneous rupture of the Achilles tendon--an obsolete method?].

Lately there has been an increased incidence of rupture of the Achilles tendon following the general increase in mass sports. Surgery is the treatment of choice, and various methods are being described. We have been using the wire suture method with fascia lata plasty for more then twenty years. The rate of infection is 3.8% and that of rerupture 1.2%, figures that correspond to those stated for other surgical methods. Moreover, 87% of the patients were very satisfied with the result of the operation; they are fit for work without any restriction, and some of them even practise their sports activities as before. For this reason we consider that wire suturing with fascia lata plasty is by no means obsolete in the treatment of rupture of the Achilles tendon.

Achilles Tendon↗
PubMed1986

[Mediastinal metastases of extrathoracic tumors--important findings in mediastinoscopy].

From 700 mediastinoscopies performed between 1976 and 1985, 11 revealed metastases from extrathoracic malignancies. Primary tumours were eventually located in the gastrointestinal tract (5), the breasts (2), the kidneys (2) and the thyroid gland (1). All lymphatics join within the mediastinum. Therefore mediastinal secondaries from tumours of all body regions may be encountered. Mediastinoscopy facilitates safe biopsy and histological diagnosis. It is essential for adequate therapy.

Adult↗
PubMed1984

[Healing of the sacral wound cavity after abdomino-perineal extirpation of the rectum. A prospective randomized study using metronidazole].

In a prospective, controlled randomised study of 100 patients the healing of the sacral wound after abdomino-perineal exstirpation of the rectum with and without metronidazole parenterally was compared. A significant reduction in hospital stay and in postoperative time of drainage of the sacral wound was found. The primary wound healing, defined as healing without complications within 14 days, was registered in 84% in the treated group and in 56% in the controls. No influence was seen in the number of urinary tract infection by this treatment.

Abdomen↗
PubMed1983

[Peritonitis].

Explore the source record for details and available documents.

Abdomen, Acute↗
PubMed1983

[Significance of clinical symptoms in the early diagnosis of bronchial cancer].

The lack of symptoms in lung cancer is the main reason for its late diagnosis and therapy. In the surgical clinic of Northwest Hospital, Frankfurt/Main, only 32,5% of 1494 bronchogenic carcinomas (1970-1980) were operable. 40% of these lung cancers were detected by routine examination, 45,7% of the operable carcinomas and 25% of the inoperable carcinomas. Peripherally located carcinomas showed very few symptoms; even at an early stage, centrally located carcinomas showed as many symptoms as inoperable carcinomas.

Carcinoma, Bronchogenic↗
PubMed1983

[Accidental finding: the small, differentiated thyroid carcinoma. Report of 46 thyroid carcinomas of up to 15 mm diameter].

Review of 190 cases of thyroid carcinoma between 1974 and 1981 showed an increasing rate of small papillary carcinoma. The study included 46 tumors which did not exceed 15 mm in diameter. Most of these lesions (3/4) were discovered incidentally at thyroid operations of various types. In spite of the early stage of carcinoma 6 tumors were already associated with cervical nodal metastasis, cases showed multiple lesions within the thyroid gland, homolateral and bilateral. With respect to these cases total thyroidectomy and subsequent radium therapy are generally suggested.

Adolescent↗
PubMed1981

[Is surgical treatment of small cell bronchial carcinoma still indicated?].

Based on own results, general negation of operation in small cell carcinoma of the lung does not appear warranted. Surgical treatment is indicated when a non-metastasizing tumour is present. Small cell bronchial carcinoma operated in tumour stage I has a clearly better prognosis than a carcinoma of the same stage treated by chemo- or radiotherapy. A certain response of these carcinomas to cytostatic or radiotherapy has not been established. Should tumour metastases be demonstrable, i.e. lymph node metastases in the mediastinum or distant metastases, as is the case in the majority of these rapidly metastasizing carcinomas, chemo- or radiotherapy has been shown to be superior to operative treatment.

Aged↗
PubMed1981

[Drug therapy in surgical biliary diseases. A microbiological and animal experiment study].

In this study type and occurrence of microorganisms in gallbladder and choledochal bile are compared to results of other authors. The value of antibiotic therapy in acute cystic duct obstruction in a clinical study and in animal experiments are discussed. Efficacy of different antibiotic substances (mezlocillin, cefazolin, cefotaxim, rolitetracyclin and aminoglycosides) are measured by means of the reduction in colony count in T-tube bile. Antibiotic effect was least when tetracyclines and aminoglycosides were given. Beta-lactam antibiotics caused marked reduction and even elimination of bacteria in choledochal bile. Antibiotic therapy for the treatment of bacterial infection of the bile is reasonable only after decompression of the biliary tract in the presence of obstructive jaundice. In case of cystic duct obstruction antibiotic therapy is uncertain.

Acute Disease↗
PubMed1981

[Lung resections in bronchial carcinoma of patients older than 70 years (author's transl)].

In a retrospective study (1969--1979) of 530 resections performed because of bronchial carcinoma, there were 70 patients older than 70 years (13.2%). Two-thirds of their resections were carried out on T 1--2 N0M0 and one-third on T 1--2-N1M0. For 22 central and 48 peripheral carcinomas, 25 pneumonectomies, 40 lobectomies, and 5 bilobectomies were performed. The mortality was 14.2% (lung embolism, pneumonia, apoplexia, and one insufficiency of the bronchial resection stump). Postoperative complications were atelectasis (28.5%), pneumonia (4%), lung embolism (6%), and two pleura empyemas. Of the patients operated on from 1976 to 1978, 40% (T1N0M0) and 30% (T2N0M0) and 30% (T2N0M0) are alive after 2.5 years.

Adenocarcinoma↗
PubMed1980

[Value of sputum cytology in preoperative diagnosis of bronchial carcinoma].

Of 492 in patients with primary lung cancer, pathological proof of diagnosis after thoracotomy was obtained by sputum cytology in 53,87%. Better results were obtained in patients over the age of 70 years and even in peripheral lung tumors. The results were analyzed according to tumor size, localization and malignant cell type. The prognosis of patients with positive and negative cytological specimens are compared.

Adult↗
PubMed1980

[Peritonitis after perforation of the gallbladder].

The high risk of peritonitis following a perforation of the gall bladder is discussed in a short review of the literature. In 15 years 9084 operations of the bile ducts were performed at Nord-West-Hospital, Franfurt/M., among these were 36 cases of free gall bladder perforation. Our experiences with abdominal drainage only, without perfusion of the abdomen following cholecystectomy and revision of the bile ducts with simultaneous systemic appliance of antibiotics are reported.

Adult↗