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J Rädecke

Publications and source records attributed to J Rädecke.

14 recordsLinked to original sources
PubMed1999

Hepatopathy in two infants with short-bowel syndrome and cytomegalovirus infection.

In children with short-bowel syndrome and the need for long-term parenteral nutrition, hepatic dysfunction is a multifactorial phenomenon that has not been completely understood. Alterations in gut motility lead to intraluminal stasis which is thought to be a major etiologic factor for bacterial overgrowth and subsequent cholestasis, especially when the ileocecal valve is absent. We report on two infants with short-bowel syndrome caused by gastroschisis and intestinal atresia. The intestinal lengths after resection were 18 and 55 cm. Long-term parenteral nutrition (PN) was obligatory due to intestinal shortness in the first patient and dilatation of the preatretic bowel segment with ineffective peristalsis in the second patient. Despite multiple trials of enteral nutrition and medical therapy for gut decontamination and stimulation of bowel motility, hepatopathy developed in both patients in a similar period of time and to about the same degree. At the age of 4 and 6 weeks, respectively, increasing bilirubin values were measured. Deterioration of liver function and thrombocytopenia at the age of 3 to 4 months led to the diagnosis of acute cytomegalovirus (CMV) infection. Treatment with ganciclovir followed. Both patients died of acute liver failure at the age of 7 and 9 months, respectively. Additional hepatic injury secondary to CMV infection might have contributed to the rapid deterioration of liver disease. Screening for further hepatotoxic factors, especially infectious etiologies, is therefore recommended in children with short-bowel syndrome. Liver transplantation should be considered early in cases of progressive hepatic dysfunction.

Cytomegalovirus Infections↗
PubMed1994

[Acute cholecystitis--surgical therapy].

Acute cholecystitis as a rule requires operative treatment. When it occurs as a complication of gall stone disease, early cholecystectomy within two to three days has been accepted as a safe procedure. If possible, the laparoscopic approach should be preferred. In cases of technical difficulties conventional open cholecystectomy should be planned as a primary approach or be performed by conversion of the laparoscopic approach. Cholecystostomy performed as an interventional procedure is indicated in high-risk patients due to comorbidity only. For acalculous cholecystitis, however, this approach is regarded as the initial procedure of first choice.

Acute Disease↗
PubMed1993

[Sequelae of cholecystectomy--a prospective study].

In a prospective study designed to assess the situation following cholecystectomy carried out at the Department of Surgery of the University of Freiburg, 105 patients were examined between August, 1988 and December, 1989. Out of 80 patients who were followed up, 64 had undergone cholecystectomy alone and the remaining 16 had been additionally subjected to exploration of the common bile duct. 80% of the patients reported that their preoperative symptoms had disappeared altogether, 8% admitted some improvement and 10% complained that their condition was unchanged. Specific questioning resulted in the reporting of persistent symptoms in 54%, and these consisted mostly of general complaints such as dyspepsia, flatulence, food intolerance and dull upper abdominal pain. These complaints were vanished or appeared with equal frequency following operation. Objective clinical findings could not be confirmed. Comparison between the pre- and postoperative signs in these patients established a statistically significant correlation (p < 0.05) between the patient's age and the severity of the preoperative symptoms on the one hand and a satisfactory postoperative outcome on the other. This also applied to patients for whom an examination of the bile duct was necessary.

Adult↗
PubMed1992

Laparoscopic cholecystectomy after unsuccessful shock-wave therapy.

Extracorporeal shock-wave therapy of gallstones was begun at the Surgical Department of the University of Freiburg, Germany, in March 1988; 85 patients were treated up to September 1991. The stone-free rate differed with the gallstone group. Patients with solitary stones less than 20 mm in diameter showed a significantly higher rate after 18 months of lithotripsy and dissolution therapy than patients with multiple stones (p < 0.01), that is, 83% and 49%, respectively. Open cholecystectomy was necessary for seven patients with complications following fragmentation. After starting laparoscopic cholecystectomy, eight patients decided in favor of this procedure because of constant biliary symptoms. These patients had a mean duration of dissolution therapy of 19 months. The minimal invasive procedure is an alternative for patients with unsuccessful lithotripsy and lysis who initially demanded conservative treatment. Indication for shock-wave therapy is limited to only a small group of patients with solitary cholesterol gallstones less than 20 mm who reject laparoscopic surgery.

Cholecystectomy↗
PubMed1990

Large-bile-duct stones--extracorporeal piezoelectric lithotripsy as adjuvant measure for endoscopic basket extraction.

Extracorporeal piezoelectric lithotripsy (EPL) was performed in 12 patients with large-bile-duct stones and intrahepatic stones. The Piezolith 2300 lithotripter (Wolf, Knittlingen, FRG) was used in all patients in whom routine endoscopic approaches for removal of the calculi had failed or were considered inappropriate because of large stone size or difficult localization. In 9 of the 12 patients the stones were fragmented. Complete stone clearance from the bile ducts was obtained in 8 of 10 patients by EPL alone or combined with one of the following: endoscopic extraction, mechanical lithotripsy or installation of solvents. Adjuvant EPL in conjunction with endoscopic therapy increased the success rate of nonsurgical treatment for bile duct stones from 73% to 95%. No clinically significant side effects or complications were noted.

Aged↗
PubMed1990

[Extracorporeal piezoelectric gallstone lithotripsy: initial surgical experience with a new treatment. Technique and indications].

The extracorporeal piezoelectric lithotripsy (EPL) is a new method for non-operative therapy of symptomatic gallbladder and problematic bile duct stones. The rare intrahepatic calculi were similarly disintegrated. Best results were reached with EPL as adjuvant measure or combined with oral cheno- and ursodeoxycholic acid therapy. EPL compared to other lithotripsy techniques is performed without any analgesia. That means advantage and patient's benefit.

Cholelithiasis↗
PubMed1989

[Litholysis and lithotripsy of gallstones. State of the art and prospects].

The combination of dissolution and shockwave treatment for cholesterol stones is successful in 80% of the patients. The indication is strictly limited to cholesterol stones of between ten and thirty millimeters in diameter, or three stones of similar mass. In 80% of common duct stones which cannot be removed by endoscopy, shockwave treatment is a successful adjuvant procedure. It is estimated that recurrent stones will occur in 50% of the cases after five years. As long as the problem of recurrent stones persists, the group of stone carriers suitable for conservative treatment cannot be definitevely defined.

Chenodeoxycholic Acid↗
PubMed1989

[Preoperative staging of rectal cancer: endosonography versus computerized tomography].

In a prospective study in 49 patients with rectal carcinoma the correlation of pre- and post-operative staging by CT and endorectal ultrasound (EU) was compared according to TNM-classification. With CT the pre/postoperative results correlated in T1 in 9/10, in T2 in 10/16, in T3 in 13/15 and in T4 in 6/8 patients. By EU identical results were found in all T1, in 10/12 T2, in 17/20 T3 and in 6/7 T4 stages. Overall, pre- and postoperative identical results were found by CT in 38 and by EU in 43/49 patients. Overestimation of the tumor stage was similar with both methods: 5 by CT and 4 by EU. Underestimation of the stage was more often by CT in 5 than by EU in 2 cases. (CT: accuracy 77.5%, sensitivity 88.3%, specificity 94.4%; ES: accuracy 87.7% sensitivity 91.5%, specificity 97.8%). Criteria for interpretation are discussed. In early tumor stages the depth of tumor invasion can be better evaluated by EU. In late stages both methods give important information for surgical strategy.

Adenocarcinoma↗
PubMed1989

[The value of transrectal sonography and computerized tomography in the diagnosis of rectal cancer].

In a prospective study in 49 patients with rectal carcinoma the correlation of pre- and postoperative staging by CT and endorectal ultrasound was proven according to TNM-classification. With CT the pre/postoperative results correlated in T1 in 9/10, in T2 in 10/16, in T3 in 13/15 and in T4 in 6/8 patients. By endorectal ultrasound identical results were found in all T1, in 10/12 T2, in 17/20 T3 and in 6/7 T4 stages. Totally, pre- and postoperative identical results were found by CT in 38 and by endorectal ultrasound in 43/49 patients. Overestimation of the tumor stage was similar with both methods: 5 by CT and 4 by endorectal ultrasound. Underestimation of the stage was more often by CT with 5 than by endorectal ultrasound with 2 cases (CT: accuracy 77.5%, sensitivity 88.3%, specificity 94.4%; endorectal ultrasound: accuracy 87.7%, sensitivity 91.5%, specificity 97.8%). Criteria for interpretation are discussed. In early tumor stages the depth of tumor invasion can be better evaluated by endorectal ultrasound. In late stages both methods give important information for the surgical strategy.

Adult↗
PubMed1987

[Dissolution of a bile duct stone with methyl tert-butyl ether].

Methyl-t-butylether is a new agent to dissolve gallstones. The substance proves to be very successful and acts very rapidly. A percutaneous transhepatic drainage supplies an adequate access route to dissolve calculi within the bile ducts. We report the case of a patient where before insertion of an internal stent a stone in the common bile duct was dissolved within 3 1/2 hours.

Aged↗
PubMedDate not supplied

[An unusual course of fetal gastroschisis].

We report on prenatal diagnosis of gastroschisis at 20th gestational week. In addition to gastroschisis intraabdominal intestinal stenosis was detected. As a consequence cesarean section was planned close to term. Control examinations in the last trimester didn't confirm initial diagnosis so that the recommended mode of delivery was changed. However postpartum diagnosis again confirmed the early diagnosis of gastroschisis including spontaneous necrosis of dislocated intraamniotic intestinal parts. The course demonstrates that even at unambiguous prenatal diagnosis control examinations are recommended as dynamic changes may occur in the second and third trimester. Thus mode of delivery may have to be adapted close to term to reduce maternal risk.

Abdominal Muscles↗