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Biomedical subjects

J Wedell

Publications and source records attributed to J Wedell.

At least 19 recordsLinked to original sources
PubMed1999

[Early operation of acute cholecystitis in advanced age].

In a 20-year period (1974-1993), 4230 patients underwent surgery of the gallbladder. Acute cholecystitis was the indication for emergency laparotomy in 869 patients (20.5%). Retrospective analysis demonstrated that after adjustment for age, sex, and mode of surgery--elective versus emergency--advanced age is not a risk factor contributing to mortality in uncomplicated cases of emergency surgery. Cases of acute cholecystitis complicated by perforation, peritonitis, and/or the presence of concrements in the biliary duct are associated with an increased mortality, however. We were able to demonstrate that advanced age is a risk factor in complicated cases and contributes to increased postsurgical mortality.

Acute Disease↗
PubMed1998

[Acute abdomen in endemic sprue--a rare complication].

BACKGROUND: The celiac sprue, a small intestinal disease usually becoming apparent by a malabsorption syndrome, is caused by gluten respectively gliadin intolerance which leads to intestinal mucosal damage finally resulting in complete villous atrophy. CASE REPORT: A propos of the case of a 60-year old woman with an uneventful course of celiac sprue of many years we report about a rare complication of this disease. Investigating recurrent attacks of abdominal pain a barium contrast examination revealed an intestinal stenosis which clinically resulted in an acute abdomen finally requiring surgery. Histologically a chronic ulcerative jejunoileitis was found. The main differential diagnosis is a malignant intestinal lymphoma, this however couldn't be found. Regarding this differential diagnosis surgical removal of the diseased parts of the bowel is the therapy of choice. Because of the possible transition from ulcerative jejunoileitis to intestinal lymphoma a postoperative close follow-up is recommended.

Abdomen, Acute↗
PubMed1997

Surgical management of complicated colonic diverticulitis.

BACKGROUND: Improvements in surgical techniques, advances in intensive care medicine and progress in the management of peritoneal sepsis have recently favoured colonic resection with primary anastomosis in the treatment of complicated diverticulitis. METHODS: Some 224 patients with complicated diverticulitis who had undergone surgery in the preceding 22 years were reviewed. Complications present on admission included acute phlegmon without pus formation (92 patients), paracolic abscess and/or localized peritonitis (99), diffuse purulent peritonitis (33), complete obstruction of the sigmoid colon (eight) and paracolic abscess complicated by fistula (27). RESULTS: The overall mortality rate was two (1 per cent) of 183 for resection with primary anastomosis, seven of 31 for Hartmann's operation and four of ten for the delayed three-stage procedure. The anastomosis was made by instruments employing the double-stapled technique in 130 patients and hand-sutured in 94. Reversal of Hartmann's operation was undertaken in only 31 per cent compared with 89 per cent for closure of the protective colostomy in patients with primary anastomosis. CONCLUSION: The Hartmann operation may be the most popular at present, but resection with primary anastomosis is the safest procedure for all stages of complicated diverticulitis, and reduces costs. There is no longer any clinical indication for the three-stage operation.

Adult↗
PubMed1993

[Preventive ovariectomy in colorectal cancer].

Between 1975 and 1989 we carried out a total of 567 resections of the colon and rectum and performed a uni- or bilateral ovarectomy in 53 (9.3%) cases. Histopathological findings in the case of 41 (7.2%) patients were unremarkable whereas 8 cases (1.4%) revealed metastases of the colorectal cancer. In the case of 4 patients (0.7%) synchronous ovarian cancer occurred. According to the TNM-scheme primary tumors included T2 in 2 cases, T3 in 5 and T4 in 1 of the cases. Reported figures of ovarian metastases in colorectal cancer vary between 2.0 and 10.3%, we found 2.1% in our series. Prophylactic ovarectomy even in premenopausal patients is indicated if one or both ovaries show pathological findings on laparotomy since infiltrative growth of the tumor can be proved only histologically. In addition we performed bilateral oophorectomy on postmenopausal women as a method of preventing occurrence of other ovarian tumors.

Adult↗
PubMed1991

[Atypical thyroid gland adenoma. Experiences during 12 years struma surgery].

In a period of 12 years atypical adenomas were found in 82 cases and thyroid carcinomas were diagnosed in 93 patients in the main group of 2176 patients undergoing a thyroid resection. Mean age was 46.5 years for atypical adenomas and 48 years for carcinomas. In 76.8% of the cases with atypical adenomas the postoperative course and long term results were followed up. None of these patients developed a recurrence or malignancy. 93.3% of the patients were treated with Levothyroxin for prevention. Hyperthyroidism did not occur pre- or postoperatively.

Adenoma↗
PubMed1990

[Experiences with a subcutaneous, fully resorbable bridge in construction a double loop ileo- and colostomy].

Our experience with the subcutaneous absorbable bridge for constructing a temporary loop ileostomy and loop colostomy is described. The use of this subcutaneous absorbable bridge in 15 patients - 6 with loop ileostomy and 9 with loop colostomy - was almost without complications. The absorbable bridge is a progress for maturation of the stoma and for immediate postoperative as prospective fitting of a watertight appliance. The actual trend substituting the temporary loop colostomy by the loop ileostomy may be advanced by the unlimited use of the subcutaneous absorbable bridge for constructing a temporary loop ileostomy.

Adult↗
PubMed1989

[Recommendation for primary resection with primary anastomosis in complicated sigmoid diverticulitis. Report of experiences of the Herford Surgical Clinic 1973 to 1986].

Of the 107 patients with complicated diverticulitis operated from 1973-1986 47 were females and 60 males. In 14 of the 107 patients a perforated diverticulitis with diffuse purulent/faecal peritonitis was found, a perforated diverticulitis with localized purulent peritonitis/paracolic abscess in 68 patients and an acute phlegmonous diverticulitis without perforation in 25 patients. Additional pathologic findings were internal fistulae (13 patients), necrotizing fasciitis (3 patients), obstruction (3 patients) and synchronous carcinoma (7 patients). The overall mortality of the 107 patients was 9.3% (= 10 patients) and the morbidity of the 97 survivors 34% (= 33 patients). The mortality of the 14 patients with perforated diverticulitis and diffuse purulent peritonitis was 50% of the 68 patients with perforated diverticulitis and localized purulent peritonitis 4.4% and of the 25 patients with acute phlegmonous diverticulitis 0%. Seven of the 10 patients died after operation of the perforated diverticulitis with diffuse purulent peritonitis - 1 (5) after primary resection with primary anastomosis. 3 (5) after Hartmann procedure, 3 (4) after loop colostomy alone. Three patients died after operation of the perforated diverticulitis with localized purulent peritonitis - 2 (6) after Hartmann procedure, 1 (5) after loop colostomy alone. In spite of forcing the primary resection with primary anastomosis in the years from 1980 - 1986 the mortality decreased for these operations from 35.7% in 1973 - 1979 to 0% in 1980 - 1986. The indication of primary resection with primary anastomosis is justified also for perforated diverticulitis with localized and diffuse peritonitis.

Adult↗
PubMed1989

[Results of 10 years' experience with peranal Parks and Stuart extirpation of villous and tubulo-villous adenomas of the rectum].

From 1973 to 1983 68 patients with villous and tubulovillous adenomas were operated by the peranal technique of Parks and Stuart. Seven patients had a circumferential adenoma and in ten patients (14.7%) an invasive cancer was found, four patients with Dukes A and six patients with Dukes B. The lethality of the 68 patients was 1.5% and the morbidity 4.5%. By a follow-up between 5 and 15 years the recurrence rate was 20.9%. There was no recurrence of cancer, especially not in the two patients with primary excision of an invasive carcinoma.

Adult↗
PubMed1987

Sliding flap advancement for the treatment of high level fistulae.

The technique of sliding flap advancement for the treatment of high anal fistulae is described. The technique is not suitable for cases with an acute abscess and is reserved for patients with a well-established chronic fistula track. Thirty patients with anal fistulae were treated by sliding flap advancement from 1980 to 1984. Twenty-nine patients had satisfactory results. With a follow-up ranging from 18 months to 4 years no recurrence of fistulae or abscess were observed. The advantages of the advancement flap technique over the staging division technique with application of a seton and over the rerouting technique are discussed.

Adult↗
PubMed1987

[Problems of pelvic infection following rectopexy using synthetics and its treatment].

The complication of the infected Ivalon-sponge after rectopexy is described in five patients. In two patients the pelvic sepsis perforated spontaneously into the vagina and in another two patients the pelvic abscess perforated through the levator muscles into the ischio-rectal fossa formating a typical horse-shoe abscess in one case. The management of choice in cases of pelvic sepsis is the complete removal of the infected Ivalon-sponge. We personally prefer the laparotomy for the complete removal of the prosthesis and not the removal through the vagina or through the rectum.

Abscess↗
PubMed1985

[Current aspects of the surgical treatment of colonic ileus caused by stenosing colonic carcinoma].

Formerly it was considered dangerous to undertake resection in the presence of colonic obstruction. This idea has been abandoned. Immediate right hemicolectomy is the accepted treatment for obstructed lesions of the right colon. For obstruction of the left colon proximal colostomy or caecostomy are being challenged by immediate resection as a Hartmann operation with iliac colostomy or finished with a colo-colonic or colo-rectal anastomosis. A subtotal colectomy with ileo-sigmoid or ileo-rectal anastomosis is a further method with encouraging experiences. From 1979-1984 a series of 33 patients with obstruction from a carcinoma of the left colon underwent emergency abdominal colectomy with primary ileosigmoidostomy or ileorectostomy without diversion. The mortality and morbidity was favourable compared with those reported in series of similar cases treated by stages procedures or primary resection. Several advantages of this method are explained and further encouraging experiences from other centers are reported.

Adenocarcinoma↗