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Biomedical subjects

J Scheele

Publications and source records attributed to J Scheele.

At least 109 records · Page 6Linked to original sources
PubMed1982

[Anastomotic technique in tracheal resection. Animal experiments (author's transl)].

In 24 rabbits and 6 dogs, two subtotal tracheal transsections each were reanastomosed using Dexon , Vicryl, Prolene and Mersilene in running or interrupted suture technique. In order to avoid traumatisation of the perichondrium, sutures included the marginal cartilagenous ring and all layers of the tracheal wall. By putting every second stitch in a 8-figure, an ideal adaptation could be achieved. Half of the anastomoses were secured by additional application of fibrin tissue adhesive. Macroscopical and histological examinations were carried out 5, 10, 21 and 63 days postoperatively. Mersilene resulted in remarkable inflammatory tissue reaction - increasing from the 5th day on - leading to extensive granulomas, abscesses, ulcerations of the mucosa and erosion of the cartilage. In contrast, by using synthetic absorbable materials as well as prolene, minimal tissue reaction occurred with an even and delicate scar formation. The findings do not support the view, that an extramucosal stitch technique is essential. The additional sealing with fibrin tissue adhesive increased the safety of the anastomoses during the early postoperative period.

Animals↗
PubMed1982

[Successful reconstruction of the completely transsected hepato-duodenal ligament. Case report on ischemia tolerance of the human liver].

Incidental complete transsection of the hepato-duodenal ligament occurred in a 59-year-old female patient during gastric surgery. More than three hours later reconstruction of the portal vein, hepatic artery and common bile duct was started, performing end-to-end anastomoses in all cases. The time interval between transsection and restoration of blood flow was 225 minutes for the portal vein and 255 minutes for the right hepatic artery. The left hepatic artery could not be reconstructed. The postoperative course was unremarkable clinically, however, there was an extreme initial rise in the levels of SGOT, SGPT, LDH, and alpha-amylase, followed by a somewhat delayed jaundice with bilirubin levels above 10 mg/dl. In-hospital follow-up examinations were performed 6 and 13 month postoperatively. They revealed good clinical condition, patent blood vessels, slight displacement of the biliary anastomosis by scar tissue without functional stenosis and gradual normalisation of biochemical parameters. The left hepatic lobe became initially necrotic, later atrophic.

Constriction↗
PubMed1981

[Importance of peritoneal lavage in the diagnosis of blunt abdominal trauma (author's transl)].

Peritoneal lavage was carried out in 830 patients with blunt abdominal trauma. Positive as well as negative results proved to be very reliable (98% and 99.5% accuracy). With weakly positive findings, however, significant internal injuries were present in only half of the cases. If compared to circulatory parameters, laboratory investigations and clinical evaluation of the abdomen at the time of hospitalization, peritoneal lavage proved to be the superior aid in making a decision to operate. It therefore should be used routinely--even in smaller hospitals--especially before transferal of a patient to a distant special surgical center.

Abdominal Injuries↗
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↗