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Biomedical subjects

J Scheele

Publications and source records attributed to J Scheele.

At least 91 records · Page 5Linked to original sources
PubMed1981

[The use of fibrin tissue adhesive in parenchymal organs of the abdomen. An experimental study in rabbits and dogs (author's transl)].

In rabbits and dogs standardized lesions of the liver, kidney, and spleen were treated by application of human fibrinogen tissue adhesive. In all cases this procedure resulted in a complete control of bleeding as well as a stable and lasting closure of the wounds. During the postoperative observation time of one month, the fibrinogen tissue adhesive was initially infiltrated by leucocytes and macrophages and subsequently resorbed by a granulating tissue, characterized by the early appearance of numerous fibroblasts. Our clinical experience, until now, confirms these promising experimental results.

Animals↗
PubMed1981

[Risk of hepatitis in fibrin adhesion (author's transl)].

A prospective trial was performed on 146 patients, in whom fibrin tissue adhesive was applied during operations. 130 patients, who had received no fibrin glue, served as a control group, and were submitted to the same examinations as the first group of probands. In both groups we could not see any infections with hepatitis B.

Alanine Transaminase↗
PubMed1981

[Potency disorders following aorto-bifemoral bypass prosthesis].

The sexual potency of 170 patients treated for obstructions of the pelvic arteries by implantation of an aortobifemoral dacron graft was investigated 2--4 years after the operation. About half of these patients reported preoperative sexual disorder. Postoperatively, 60% of those capable of cohabitation prior to the operation developed either new or further sexual dysfunction. A lasting normalization of potency was reported by 12 patients, a transitory improvement by 4 others. Avoiding damage to the preaortal sympathetic plexus led to a decrease in the rate of isolated disorder in ejaculation from 15% to 1%, but not, however, to a lower frequency of potency disturbance in general. The evaluation of 142 informative preoperative angiograms showed a clear dependence of preoperative potency on the orthograde perfusion of the internal iliac artery. Similarly, the postoperative changes in potency correlated with the angiographically expected improvement or worsening of the interna-poerfusion by retrograde blood flow. It therefore seems possible to decrease the occurrence of postoperative potency disorders by the additional revascularization of the internal iliac artery in certain patients.

Adult↗
PubMed1981

[Initial clinical experiences with fibrin adhesives in traumatic and intraoperative splenic injury].

Over a period of 14 months, 2 traumatic and 14 intraoperative splenic lesions were managed by application of fibrin tissue adhesive, mostly in combination with the use of a collagen sponge. In all cases hemorrhage could be stopped completely with out mobilization of the spleen. This method proved to be very suitable in the repair of smaller incidental capsular tears. In the management of more extensive traumatic ruptures, it should support the conventional surgical techniques described in the literature. It certainly will make these procedures safer and easier to perform.

Adolescent↗
PubMed1979

[Indication margins for pulmonary embolectomy].

Pulmonary embolectomy is the most effective form of treatment in acute, massive pulmonary embolism. Persistent cardio-respiratory failure, in spite of intensive medical therapy, presents a clear indication for embolectomy. A relative indication is given with the occlusion of more than 50% of the pulmonary arterial tree, especially in the case of beginning circulatory failure and contraindications to fibrinolytic therapy. Preoperative angiography is essential and should be performed whenever possible. A dramatic deterioration of the patient's condition may, however, require a prior reestablishment of sufficient circulation with relief of the right ventricle. According to the clarity of symptoms, either immediate thoracotomy or peripheral canulation and partial cardio-pulmonary bypass with subsequent angiography on the operating table should be preferred. Even a long resuscitation with persistently dilated, non-reactive pupils does not exclude operative success, and justifies neither the ommission nor the premature discontinuance of a resolute and consistent therapy.

Acute Disease↗
PubMed1978

[Comparative studies of various suture techniques in transthoracic esophagogastric anastomoses in dogs (author's transl)].

In 27 dogs esophagogastric anastomoses were performed in a single-layered end-on, a three-layered end-on and a double-layered inverting technique. The anastomoses were reinvestigated on the 2., 4., 7., 15. and 30. postoperative day. Suture line leakages were not observed. The inverted suture resulted in considerable anastomotic stenosis, ulceration of the mucosa, disordered and initially incomplete revascularisation, and widespread granulomatous inflammatory reaction. In contrast, the end-on technique led to almost no stenosis, ordered revascularisation, and narrow and delicate scar tissue formation while maintaining a normally layered structure. The single-layered methode was superior to the three-layered one. The best results were obtained by the extramucous technique.

Animals↗
PubMed1978

[Colonic anastomoses. Mechanical and morphological findings].

In healthy mongrel dogs 45 colonic anastomoses were performed in one--and two layered inverting and single layered end-on technique. They were compared 4, 8, and 18 days after surgery macroscopically, histologically and by tension testing. All criteria showed the single layered end-on technique to be superior. The principle of Lembert, aiming for contact of large areas of serosa, should be replaced by a technique resulting in exact reconstruction of intestinal wall without mucosal damage.

Animals↗
PubMed1978

[Fibrin glue protection of digestive anastomoses (author's transl)].

In animal experiments the additional sealing of colonic anastomoses using fibrin glue resulted in especially fast healing with formation of a delicate scar. Between April 1, 1976 and March 31, 1977, this method was used in 118 out of 355 patients undergoing extensive abdominal procedures. Suture line leakage was seven times less frequent than in the control group. This resulted in a considerable decrease of postoperative mortality.

Animals↗
PubMed1978

[Fibrin glue. A new treatment technic in persistent recurrent spontaneous pneumothorax].

The treatment of choice in idiopathic spontaneous pneumothorax is continuous suction drainage by chest tube for 8--10 days. If this method is not successful, i.e., in patients with a persistent or recurrent pneumothorax, an attempt can be made to produce local pleural adhesions by means of a special fibrin glue, especially in patients with poor general condition. This fibrin glue pleurodesis was performed successfully in seven patients, four of them having a persistent, two a recurrent, and one an iatrogenic pneumothorax. Six of them are now, 3--10 months after therapy, without a recurrence and free of discomfort. One patient died 6 days after treatment from a cerebral stroke. Autopsy showed fibrinous adhesions in the area of the upper lobe. Good tissue compatibility was confirmed histologically.

Adult↗
PubMedDate not supplied

Resection of colorectal liver metastases.

From 1960 to 1992 a total of 1718 patients with liver metastases from colorectal carcinoma were recorded. Of these patients, 469 (27.3%) underwent hepatic resection, which was performed with curative intent in 434 patients (25.3%). Operative mortality in this group was 4.4%, being 1.8% (2 of 114) during the last 3 years. Significant morbidity was observed in 16% of patients with a decrease to 5% (6 of 112) for the last 3 years. A 99.8% follow-up until November 1, 1993 was achieved. Excluding operative mortality, there are 350 patients with "potentially curative" resection and 65 corresponding patients with minimal macroscopic (n = 19) or microscopic (n = 46) residual disease. The latter group demonstrated a poor prognosis, with median and maximum survival times of 14.4 and 56.0 months, respectively. Among the 350 patients having potentially curative resection, the actuarial 5-, 10-, and 20-year survivals were 39.3%, 23.6%, and 17.7%, respectively. Tumor-free survival was 33.6% at 5 years. In the univariate analysis, the following factors were associated with decreased crude survival: presence and extent of mesenteric lymph node involvement (p = 0.0001); grade III/IV primary tumor (p = 0.013); synchronous diagnosis of metastases (p = 0.014); satellite metastases (p = 0.00001); metastasis diameter of > 5 cm (p = 0.003); preoperative carcinoembryonic antigen (CEA) elevation (p = 0.03); limited resection margins (p = 0.009); extrahepatic disease (p = 0.009); and nonanatomic procedures (p = 0.008). With respect to disease-free survival, extrahepatic disease (p = 0.09) failed to achieve statistical significance, whereas patients with primary tumors in the colon did significantly better than those with rectal cancer (p = 0.04). The presence of five or more independent metastases adversely affected resectability (p < 0.05). However, once a radical excision of all detectable disease was achieved, no significant predictive value of an increasing number of metastases (1-3 versus > or = 4) on either overall (p = 0.40) or disease-free (p = 0.64) survival was found. Using Cox's multivariate regression analysis, the presence of satellite metastases, primary tumor grade, the time of metastasis diagnosis, diameter of the largest metastasis, anatomic versus nonanatomic approach, year of resection, and mesenteric lymph node involvement each independently affected both crude and tumor-free survival.

Actuarial Analysis↗
PubMedDate not supplied

Radical operations for carcinoma of the gallbladder: present status in Germany.

Despite the overall poor prognosis of gallbladder carcinoma, it appears that, in resectable lesions, an aggressive surgical approach promises improvement in survival rates. Radical treatment of gallbladder carcinoma is based on a detailed knowledge of the lymphatic, venous, direct, and intraductal modes of spread of gallbladder carcinoma. Customized therapy of gallbladder carcinoma takes staging into consideration: if one is dealing with gallbladder carcinoma with macroscopic liver infiltration (T3 or T4), or with a pre- or intraoperatively diagnosed gallbladder carcinoma with an unknown depth of infiltration, an en bloc resection of the gallbladder with adjacent liver segments IVb and V, perhaps including IV, as well as a dissection of the hepatoduodenal ligament should be performed. If the carcinoma is missed intraoperatively at the time of cholecystectomy for other indications, in the presence of a T2 gallbladder carcinoma in proximity to the liver bed, reoperation with dissection of the hepatoduodenal ligament and resection of liver segments IVb and V should be performed. In the presence of T1 gallbladder carcinoma, simple cholecystectomy is adequate. This concept is based on our experience with 113 patients with gallbladder carcinoma who underwent treatment in our department from January, 1970 to June, 1989. Sixty-seven percent of the gallbladder carcinomas were resected, 30% for cure and 37% palliatively. In 33%, the operation was limited to an exploratory laparotomy or a palliative operation, or no operation was performed. Of the curatively resected carcinomas (n = 34), 7 were Stage I, 7 Stage II, 9 Stage III, and 11 Stage IV.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMedDate not supplied

Chlorinated hydrocarbons in human bone marrow of healthy individuals and leukemia patients.

In this pilot study, concentrations of chlorinated hydrocarbons in bone marrow were determined by capillary-column gas chromatography. Bone marrow was obtained from a total of 29 healthy adults and from patients with leukemia or lymphoma. The chlorinated hydrocarbons in adults that occurred in the highest concentrations were dichlorodiphenyltrichloroethane and its derivatives (mean = 129 mg/g DNA). Hexachlorobenzene, the hexachlorohexane isomers, and dieldrin were also found, but in reduced concentrations (i.e., mean concentrations: 49.5 mg/g DNA, 14.9 mg/g DNA, and 5.9 mg/g DNA, respectively). Patients who had leukemia and lymphoma did not have significantly increased concentrations of chlorinated hydrocarbons.

Adult↗
PubMedDate not supplied

Implications of laparoscopic cholecystectomy for surgical residency training.

BACKGROUND: Widespread adoption of minimal access techniques forced a generation of abdominal surgeons to re-learn many standard abdominal procedures. This threatened to reduce the pool of suitable "training" operations for surgical residents. METHODS: Operator grade, duration of operation, acute/elective operation, conversion rate, complications, and postoperative stay were recorded prospectively on all laparoscopic cholecystectomies (LC) since 1992. This data was evaluated to determine how the introduction of LC affected residents' training. RESULTS: The percentage of LCs performed by residents increased progressively to reach 58%. Operating time was longer for trainee surgeons, particularly for acute cases (145+/-50 minutes vs 111+/-54 minutes, p<0.05); however, conversion rate, incidence of complications, and postoperative stay were no different. CONCLUSIONS: LC can be performed by surgical trainees with similar complication rates and outcomes as those of qualified surgeons. Once institutional experience has accumulated, this procedure can be integrated into residency training.

Adolescent↗
PubMedDate not supplied

Presarcomatous lesions of experimentally induced sarcomas in rats: morphologic, histochemical, and immunohistochemical features.

Morphological studies have been performed mainly on manifest sarcomas, leading to divergent views of its histogenesis. However, histogenesis requires understanding of the tumor precursor cells and cannot be resolved by static morphologic studies. Defining presarcomatous lesions is made more difficult because they do not possess a basement membrane that serves as biologic and nosologic boundary like in epithelial cancers. The present study, therefore, investigated the early phases of experimentally induced rat sarcoma, which closely resembles human malignant fibrous histiocytoma (MFH). Histological, enzyme- and immunohistochemical methods were used to define the sequential events involved in tumorigenesis. A benzo[a]pyrene-oil mixture was injected intramuscularly into the thighs of rats, producing MFH 120 days later. Groups of animals were sacrificed every 10 days. The injections produced soft tissue lesions characterized by three distinct phases that overlapped or existed simultaneously in one animal: an initial acute inflammatory reaction characterized by an infiltration of lymphocytes, monocytes and macrophages, a second mesenchymal fibromatous phase characterized by the predominance of spindle-shaped, focally atypical fibroblast-like cells and collagen, and a third premalignant neovascularization phase characterized by dominant capillary proliferations. Overt MFH developed 120 days after injection and consisted of spindle-shaped fibroblast- and histiocyte-like cells containing atypical mitoses and arranged in a storiform pattern. Control animals injected with olive oil revealed acute inflammatory reactions after 30 days and no signs of chronic inflammation or malignancy after 60 and 120 days. We concluded that these experimentally-induced rat sarcomas develop in a triphasic pattern that resembles non-healing granulation tissue, with neovascularization preceding the occurrence of overt MFH.

Animals↗