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Biomedical subjects

J Jähne

Publications and source records attributed to J Jähne.

At least 19 recordsLinked to original sources
PubMed2006

[Does internal quality control reduce mistakes and complications? A plea for structured surgical education and increased transparency in clinical day-to-day work].

Quality control in most surgical departments shows major deficiencies. Only 50% have daily conferences on the surgical indication, and morbidity and mortality conferences are held in less than 20% of the institutions. However, pre-, intra- and postoperative quality control may be able to reduce mistakes and complications. Among others, the possibilities to reduce perioperative morbidity and mortality include preoperatively an early evaluation of the patient in the outpatient-clinic, intraoperatively a structured and didactic teaching of the surgical trainee and postoperatively a morbidity and mortality conference. In particular the latter one may promote surgical training and may increase transparency of the perioperative results. The delicate nature of morbidity and mortality conferences can be overcome in an atmosphere of mutual respect and personal honesty.

Attitude of Health Personnel↗
PubMed2005

[The catalogue of ambulatory sickness benefits -- realistic? Feasible? Put into practice?].

Ambulatory surgery at German hospitals is an underdeveloped field. New legal regulations allow contracts between hospitals and insurance companies which will improve this situation. Besides the establishment of quality parameters and a fixed payment for the operations the contract lists 307 operations which can be performed on an outpatient basis. However, only few operations need to be done obligatory as ambulatory surgery. This reflects just incompletely what is already operated ambulatory outside the hospitals. Due to altered financial structures in case of in-patient treatment and because of a decrease of hospital beds, the listed operations in the contract may be reviewed and ambulatory surgery at the hospitals will increase in the future. The hospitals need to change their structure to establish successfully ambulatory surgery within the hospital setting. Finally, German patients need to be convinced that operations done on an out-patient basis show the same quality standards like procedures under in-patient conditions.

Ambulatory Surgical Procedures↗
PubMed2004

[Volvulus of the small intestine, a rare complication during laxative period before colonoscopy].

HISTORY AND CLINICAL FINDINGS: A 69-year-old patient was hospitalized 16 h after investigation of the colon (screening colonoscopy), suffering from abdominal pain, which had started during the laxative period the day before colonoscopy. INVESTIGATIONS: Clinical and technical investigations showed signs of a peritonitis. TREATMENT AND COURSE: By laparotomy a volvulus of the small intestine was found, caused by adhesions after appendectomy years before. A resection of a part of the small intestine got necessary, there were no problems during the postoperative course. CONCLUSIONS: If pain appears during the laxative period before colonoscopy, rare complications like volvulus of the small intestine should be considered.

Aged↗
PubMed2002

[Lymphadenectomy in gastric carcinoma?].

Lymphadenectomy in gastric carcinoma is still discussed. Based on non-randomised and randomised studies D2-lymphadenectomy is indicated only in R0-resections. D2-lymph-node dissection requires great experience with this technique as well as for the management of possible postoperative complications. Survival advantages can be expected in patients with a limited nodal involvement, a favorable lymph node ratio between resected and involved nodes and in stage II disease. Therefore, survival improvement can be expected in 15-20 % of all R0-resections. Despite these limited prognostic advantages D2-lymphadenectomy should be performed in all R0-procedures since only the pathologic data of the resected specimen supply reliable prognostic parameter. If in the future sentinel lymphadenectomy allows selection criteria for a balanced indication for D2-lymphadenectomy in gastric carcinoma, needs to be awaited.

Gastrectomy↗
PubMed2001

[Castleman tumor as a rare differential diagnosis of cervical space-occupying lesion].

Based on the case report of a 35-year-old patient presenting a Castleman tumor of the neck, we describe the diagnostic challenge of identifying this tumor entity. It is important to consider this type of tumor. Diagnostic imaging methods such as ultrasound and CT/MRI cannot identify the Castleman tumor due to the lack of tumor-specific signs but yield important information concerning exact tumor localization. Only surgical resection and conventional histology give a correct characterization of this tumor and possibly allow further additive treatment modalities.

Adult↗
PubMed2001

[Principle and indications for debulking operation in peritoneal carcinosis].

Recent studies demonstrate that cytoreductive surgery (debulking) is a feasible option for the treatment of peritoneal carcinomatosis. Indications for such an approach, often combined with intraperitoneal chemotherapy, are malignant conditions of the appendix, the colon, the ovary and peritoneal mesothelioma. Cytoreduction may also be performed in gastric carcinoma predominantly however in prospectively planned studies. Carcinomas of the hepato-pancreatobiliary system should not be subjected to cytoreduction. The operation itself consists of complete peritonectomy of the parietal peritoneum, multivisceral resection including cholecystectomy, gastric and colonic resection as well as anterior rectal resection. Morbidity and mortality of these procedures are 30% and 1-6% respectively. Depending on the histology of the primary tumor, 5 years survival rates of up to 50-75% can be achieved.

Gastrointestinal Neoplasms↗
PubMed2000

Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma.

AIMS: The management of anastomotic leakage of the oesophago-jejunostomy after total gastrectomy for gastric carcinoma was evaluated in a retrospective study. PATIENTS AND METHODS: Over a 30-year period, a total of 1114 oesophago-jejunostomies were performed during total gastrectomy for gastric cancer. In 83 cases (7.5%) a leak of the oesophago-jejunostomy was diagnosed. RESULTS: Frequency of anastomotic leakage was independent of the type of reconstruction and of surgical radicality. Therapeutic management was conservative in 58 cases (69.9%), with placement of a naso-jejunal tube along the anastomoses and with percutaneous drainage of intraabdominal abscesses. In 25 patients re-operation with resuturing of the anastomoses or surgical drainage of an abscess was performed. Mortality was 11/58 (19%) after conservative treatment of the anastomotic leakage and 16/25 (64%) after re-operation. CONCLUSION: Conservative management with a naso-intestinal tube and percutaneous drainage of intraabdominal abscesses is realistic for anastomotic leaks. Re-operation results in a high morbidity and should only be considered when conservative management is not successful.

Aged↗
PubMed1999

Lymph node dissection for gastric cancer.

Complete tumor removal with margins of clearance at the resection lines must be the aim of today's surgical treatment of gastric cancer, and this must be applied even in lymph node dissection. But, over the last few decades, the extent and impact of lymphadenectomy remains controversial. Whereas Japanese centers advocate extensive lymph node dissection as the base of their excellent results, many Western surgeons, supported by actual randomized trials, believe that the potential benefit of such procedures cannot outweigh the risk of increased postoperative morbidity and mortality. However, if lymphadenectomy is restricted to the removal of nodes only, it does not influence the operative risk. Further, the lymph node ratio and number of lymph nodes involved are relevant prognostic parameters. Survival improvement can be achieved in a moderate degree of metastatic involvement of the nodes (pN0,1). Therefore, systematic lymph node dissection should be an integral part of the curative resection sought. Limited or no lymphadenectomy might be indicated in noncurative surgery or in special types of mucosal early gastric cancer, respectively.

Humans↗
PubMed1999

[Results of surgical therapy of primary adenocarcinoma of the duodenum].

Between January 1983 and August 1998, a total of 18 patients (14 men, 4 women; median age 58 years, range 36-75 years) with primary adenocarcinoma of the duodenum underwent surgical therapy. Main clinical symptoms were upper abdominal pain (61%), weight loss (44%) and anaemia (38%). The tumors were resectable in 10 patients (56%), and eight Whipple operations and two segmental duodenectomies were performed. Tumor classification according to the TNM system was pT2 (n = 2), pT3 (n = 6) and pT4 (n = 2). In eight patients, local lymph nodes were tumor positive (pN1), and in two patients synchronous liver metastases were excised. The UICC stage of the resected tumors was: stage I (n = 1), stage II (n = 1), stage III (n = 6) and stage IV (n = 2). In irresectable cases (n = 8), the patients underwent palliative (n = 6) or explorative (n = 2) operations. With no operative mortality, overall morbidity was 22% (4/18). Patients' survival was 90%, 66.7% and 53.3%, respectively, at 1, 3 and 5 years after resection. None of the patients with irresectable tumors survived longer than 25 months. Survival was significantly better for the resection group (P = 0.0027). Due to the often unspecific symptoms, the diagnosis of duodenal adenocarcinoma is frequently established at advanced tumor stages, resulting in a low resectability rate. Radical surgical resection of the tumors, however, is able to provide a more favorable prognosis for duodenal carcinoma than for other periampullary tumors.

Adenocarcinoma↗