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Biomedical subjects

J Schleef

Publications and source records attributed to J Schleef.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Laparoscopic staging in abdominal tumors in children: an alternative to staging laparotomy].

INTRODUCTION: In abdominal tumors in childhood, staging laparotomy is usually an essential diagnostic tool to obtain information about the histology and the extension of the tumor, when less invasive methods do not reach to clarify the process. PATIENTS: In fourteen children between 3 months and 17 years a laparoscopical procedure was performed. MATERIAL AND METHOD: Only in patients without a clear diagnosis after noninvasive exploration were submitted to an explorative laparoscopy in order to define the histology, the extension of the illness or to locate it. The laparoscopical instrumentarium used was from Dufner, adapted to children. RESULTS: The patients tolerated well this procedure, the posoperative period was short (mean 2.07 days), no complications after the operation are reported. Only one case of hemorrhage lead to a conversion after biopsy of a neuroblastoma. In all cases the diagnosis and staging was achieved. CONCLUSIONS: When non invasive diagnostic methods are not conclusive an explorative laparoscopy should be performed because it offers a lot of advantages over a laparotomy.

Abdominal Neoplasms↗
PubMed1998

[Congenital sternal cleft. Diagnosis and treatment].

The first known case of sternal cleft was described by Torres in 1740. Since then, many publications have appeared concerning sternal cleft, which have led to introduce a classification and some therapeutical procedures. This disease is a developmental anomaly of the sternum that usually shows vascular and cardiac malformations as well as diaphragmatic, abdominal wall, pericard and middle line organs anomalies. Two cases of sternal cleft are presented who have been treated in the neonatal period with different associated anomalies. Diagnostic procedures and therapeutical aspects are discussed.

Abnormalities, Multiple↗
PubMed1997

Technical aspects of laparoscopic splenectomy in children.

Different authors reported about their experiences in laparoscopic splenectomy. The preparation of vessels and ligaments are feasable without major problems. Nevertheless the handling of the organ during the operation and during splenic extraction can be very difficult, especially in larger organs. The authors report experience with the technique of laparoscopic splenectomy and describe a new technical aspect in handling the spleen during this procedure. A loop of an umbilical band is used for retracting the organ during the preparation and placing the spleen into a sterile bag for the removal of the organ. This device helps prevent damages to the capsule caused by forceps. Large organs can be placed into the pelvis, and the bag is placed and opened in the upper abdomen. The authors used this technique successfully in seven patients. The results are compared with previous experiences.

Adolescent↗
PubMed1997

[Diaphragm replacement. An animal experiment study].

BACKGROUND: Only a few indications exist for diaphragm replacement: aplasias, tumours and accidents. The defect may be so extensive that it is impossible to close the gap. Allogenic and autologous materials are proposed for replacement of the diaphragm. The disadvantages of allogenic materials are recurrence rates of up to 20% and a high rate of malalignment of thoracic muscles and bones; the implication of autologous materials requires a longer operation time and no long-term results exist. To avoid these disadvantages, we have tested a material from bovine serosa, which is absorbable for a short time, for diaphragm replacement. METHODS: The merits of four methods of diaphragmatic hernia repair were evaluated in animals. One hundred Sprague-Dawley rats underwent laparotomy. The control group had an incision in the diaphragm with primary repair. The other four groups underwent partial resection of the left hemidiaphragm. The defects were repaired in 20 rats with lyophilized dura, in 20 with polytetrafluoroethylene (PTFE), in 20 with autologous transversus muscle and in another 20 with absorbable serosa from a cow. The animals were followed up by electromyography (EMG) and post-mortem physical and histological examinations after 3 and 6 months. RESULTS: Eighty-nine animals survived the operations. The EMG showed normal function for the absorbable material and the transversus muscle. Only scanty physiological waves were recorded in the PTFE group. The examination for stretching and stress showed good results for all materials tested. The histological examinations showed strong foreign body reactions in the dura and PTFE groups. The absorbable bovine serosa had vanished after 3 months postoperatively. CONCLUSION: We conclude that bovine serosa can be recommended for the treatment of diaphragmatic defects.

Absorption↗
PubMed1997

[Incidence of contralateral inguinal hernias in infancy and childhood].

Inguinal hernia is a frequent surgical disease during infancy, occurring in 1 to 2% of all mature newborns and rise up to 30% of all premature babies. In 9.5% a contralateral hernia is found after unilateral operation. In our own patients this rate was 5.6%. The development of a contralateral hernia was significantly more often found in boys than in girls. If the hernia occurred during the first two months of life, a contralateral hernia developed later highly significant (p > 0.0001). Within the first two postoperative years the second hernia arose in 84.9%. We recommended to routinely operation for a contralateral hernia in all children younger than two months.

Adolescent↗
PubMed1996

Laparoscopic and thoracoscopic surgery in infancy and childhood, the Münster/Gent experience.

Laparoscopic and thoracoscopic surgery have had a tremendous impact on adult surgery, but are still rarely used in children. In the past 3 years 168 children have been treated endoscopically in the three cooperating institutions. The course of all patients was documented prospectively in order to determine the value and prove the safety of endoscopic surgery in children. The operations performed endoscopically comprised appendectomy (n = 39), diagnostic procedures (24), adhesiolysis (n = 22), cholecystectomy (n = 13), bowel resection (n = 8), pyloromyotomy (n = 6), ovarial resection (n = 6), hiatus hernia repair (n = 22), splenectomy (n = 6), first stage of Fowler-Stephens operation for kryptorchidism (n = 3) and interruption of persistent botallic ducts (n = 6) in preterm infants. Apart from four wound infections (2.4%) following perforated appendicitis, one of which required laparotomy for perityphlitic abscess there were no serious complications. No patient died, and overall morbidity related to the procedure was 1.8% (i.e. incidence of uneventful minor intraoperative complications). Furthermore endoscopic surgery provides a better diagnostic survey of the abdomen or thorax so that missing of secondary pathology is unlikely. Pain and reflectory impairment of bowel-function or respiration were diminished, the aesthetic results were excellent and hospitalization could be reduced to a minimum. It is concluded that laparoscopic and thoracoscopic surgery are safe and reliable procedures for children and yield very encouraging results.

Adolescent↗
PubMed1996

[Post-traumatic gaseous gangrene in childhood: a case report].

Gas gangrene is caused by multiple species of Chlostridium, generally as a complication of traumatismus producing necrotic infections. This kind of infection is rare and specially uncommon in childhood. A case of post-traumatic Chlostridium perfringens infection is presented in a two year old girl after an open fracture of the hand. In order to reveal the extension of the process different examinations were performed including radiography of the hand, angiography and infrared thermography. These studies are describen and correlated, specially the angiography and the infrared thermography as a non-invasive method, as well as the treatment and evolution.

Child, Preschool↗
PubMed1995

[Reconstruction of the diaphragm with various materials. An animal experiment study].

The relative merits of three methods of diaphragmatic hernia repair were evaluated in animals. Eighty Sprague-Dawley rats underwent laparotomy. The control group had an incision in the diaphragm with primary repair. The other three groups underwent partial resection of the left hemidiaphragm. The defects were repaired in 20 rats with lyophilized Dura, in 20 with polytetrafluoroethylene (PTFE) and in another 20 with absorbable serosa from a cow. Seventy-two animals survived the operation; they were followed up by electromyography (EMG) and post-mortem physical and histological examinations after 3 and 6 months. The EMG showed normal function for the absorbable material. Only scanty physiological waves were registered in the PTFE group. The examination for stretching and stress showed good results for all materials tested. The histological examinations amount to strong foreign body reactions with Dura and PTFE groups. The absorbable bovine serosa had vanished after 3 months postoperatively. It is concluded that bovine serosa can be recommended for diaphragmatic hernia.

Animals↗
PubMed1993

[Critical evaluation of laparoscopic hernia surgery].

The success of the laparoscopic cholecystectomy was remarkable and well-founded, thus it seems necessary to examine whether this procedure could be also used for other general surgical operations. Since Dec. 29th, 1990 the transperitoneal repair of hernias by laparoscopy has been performed in 177 patients. The patients were followed up in regular intervals. The first 100 patients were treated with the "plug repair" technique of Schultz and Corbitt. In this group one recurrence (4 month after operation) and one dislocation of a mesh roll (2 weeks after the operation) were observed. In the middle of April 92 we changed the laparoscopic operation technique to a preperitoneal mesh fortification analogous to the procedure of Stoppa. This requires a detailed preparation of all possible positions of the hernia (medial and lateral compartment). A cutting through all layers of the abdominal wall can be avoided. After the preparation all abdominal wall defects can be fortified effectively and clearly. In this group we have treated 77 patients, so far without complications. With the exception of scrotal hernias and adhesions the laparoscopic hernioplastique can be used in any indication of inguinal hernia repair. An evaluation of the long-term results can only be performed in the future although the early results are encouraging.

Equipment Design↗
PubMed1992

[Results of angled plated osteosynthesis in per- and subtrochanteric fractures in the elderly].

From 1/86 to 12/89 62 old patients (average age: 82.6) with intertrochanteric and subtrochanteric fractures underwent surgery by using angeled plates. The postoperative course showed complications in 32.2%, while only 1 patient died. In 3 of 5 cases with dislocation of the angeled plate re-osteosynthesis was performed. 4 other complications (2x haematoma, 2x wound dehiscence) needed further surgery. During the first three months 3 other dislocations occurred. In two cases re-osteosynthesis was carried out. Due to these results and the high rate of complications we are of the opinion that the indication for the use of the angeled plate osteosynthesis in old patients has to be limited in favor of other methods like the dynamic hip screw or total hip replacement.

Aged↗
PubMed1992

[Endoscopic hernia repair].

A laparoscopic procedure for surgical hernia repair is reported. In comparison to other methods we do not only remove the peritoneal sac, but close although the inguinal canal with a nonresorbable marlex mesh. Up to now we practiced this technique in 35 patients. First post-operative results are encouraging but nothing can be said about longterm results, especially the recurrence rate.

Adolescent↗
PubMed1989

Effect of HELP-LDL-apheresis on serum concentrations of human lipoprotein(a): kinetic analysis of the post-treatment return to baseline levels.

In addition to LDL, Lp(a) can be quantitatively eliminated from plasma in an extracorporeal LDL-apheresis procedure based on precipitation with heparin at pH 5.12. The rates of return of post-apheresis Lp(a) and LDL-cholesterol concentrations to baseline levels were investigated in six individuals with familial hypercholesterolaemia (one homozygote, five heterozygote) and one normolipaemic individual. The first-order disappearance constants (kappa) were derived for LDL and Lp(a) according to Apstein et al. The kappa values for LDL in the homozygous FH and the normolipaemic individual were 0.082 and 0.43 respectively while the heterozygous FH patients had kappa values intermediate between the two (median 0.231; range 0.116-0.261). The first-order disappearance constants of Lp(a) did not correlate with those of LDL. The homozygous FH and normolipaemic individuals had Lp(a) kappa values of 0.158 and 0.199 respectively; the corresponding values in the heterozygous FH patients were: median 0.142; range 0.045-0.179.

Adult↗
PubMed1989

[Stapler-dependent surgical procedures in the colorectal area].

Since its introduction, stapling has gained considerable interest in colon surgery. The double stapling technique is a further development. From 1984 to 1989, 110 low anterior resections were performed at the Department of General Surgery, University of Goettingen. In 73 patients anastomosis was performed by double stapling; in 37 cases the EEA stapler was used. The double stapling group had an insufficiency rate of 2.7% compared with 5.4% in the EEA group. Another useful indication for stapler techniques is a reconstructive operation according to the Hartmann procedure. In none of 43 such interventions between 1983 and 1988 was insufficiency of the anastomosis seen. Another useful employment of staplers is construction of colonic reservoirs after proctocolectomy.

Anastomosis, Surgical↗