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J Zieren

Publications and source records attributed to J Zieren.

18 recordsLinked to original sources
PubMed1997

[The plug and patch repair for managing the inguinal hernia of the adult].

The basic principles of the Plug and Patch Repair of inguinal hernia are positioning of a prolene plug behind the internal ring in combination with a prolene onlay patch on the fascia transversalis. From July 1994 until December 1996 243 inguinal hernias were operated in this technique in a consecutive series of 221 patients. There were 211 primary and 32 recurrent hernias. 187 operations were performed in local anesthesia and 34 patients wished general anesthesia. No intraoperative complications were noted. The average operation time was 36 +/- 14 minutes. Postoperative complications were 8 subcutaneous hematomas and 1 superficial wound infection, which healed spontaneously. The average stay in hospital was 2 +/- 2 days and the patients returned to work after 17 +/- 11 days. Patients' self assessment of postoperative pain and limitations of daily activities revealed an excellent comfort. The follow-up rate is 97% and no late complications were observed after a median follow-up time of 21 months. The Plug and Patch technique is a very promising procedure for inguinal hernia repair in adults.

Activities of Daily Living↗
PubMed1996

Quality of life following resection of oesophageal carcinoma.

Quality of life following resection of oesophageal carcinoma was assessed by patients using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and by a psychologist using the Spitzer Index. Quality of life was evaluated in 119 patients on one occasion 12 months after operation and in 30 patients regularly, starting with a preoperative assessment. Self and external evaluation showed a significant correlation (r = 0.61), but quality of life was assessed as being higher by the external observer. Limited physical performance status and somatic complaints were the most important postoperative dysfunctions, whereas emotional, social and economic disorders were found to be less frequent and less severe. Of several factors analysed only tumour recurrence (P < 0.01) and anastomotic stricture (P < 0.05) lowered quality of life significantly. Compared with the preoperative assessment, quality of life had decreased on discharge from hospital but was restored within 6 months of operation in disease-free patients. Further studies are required to determine the impact of adjuvant therapy for quality of life in patients undergoing surgery for oesophageal cancer.

Activities of Daily Living↗
PubMed1996

[Laparoscopic or conventional repair of inguinal hernia with synthetic mesh?].

Laparoscopic inguinal hernia repair by means of the transabdominal preperitoneal technique (TAPP) was compared with open plug-and-patch-repair (PP) in a prospective study. From September 1992 until July 1994, 86 patients were operated using the TAPP technique; after introduction of PP in August 1994, 105 patients were operated using this technique. From August 1994 until April 1995, 24 more patients wanted the laparoscopic procedure. The two groups were comparable with regard to age, sex and the distribution of hernia types. Eighty-eight (84%) of the PP patients were operated under local anesthesia, while the others chose general anesthesia. The only intraoperative complication was a bleeding from the epigastric vessel in the laparoscopic group. Postoperative complications were three wound hematomas after TAPP (2.2%) and two wound hematomas and one superficial wound infection after PP (2.4%). All complications healed spontaneously. No detectable statistical difference was noted between the two groups with respect to postoperative pain, the consumption of analgetics, duration of hospitalization and reconvalescence. After a median follow-up of 34 months, two recurrences after TAPP (1.4%) and no recurrences after PP has been detected. Based on our experience we prefer PP for inguinal hernia repair in adults because it affords the same patient comfort as TAPP but is less expensive and can be performed under local anesthesia.

Adolescent↗
PubMed1996

[Assessment of quality of life after resection of colorectal carcinoma].

Quality of life (QL) following resection of carcinoma of the colon (n = 68) and rectum (n = 58) was studied in 126 patients 12 months postoperatively and in 34 patients at regularly intervals, starting with a preoperative assessment. QL was assessed by the patients themselves using the EORTC QL questionnaire (QLQ-30) and by a psychologist using the Spitzer index. Between self-assessment and evaluation by the independent observer, a significant but not very strong correlation (r = 0.48) was determined and QL was evaluated as being better by the observer. Although somatic and emotional problems were significantly more common in patients with rectal cancer following abdominoperineal resection and the Spitzer index was significantly lower in these patients, the subjectively perceived global QL did not differ from that after sphincter-preserving resection. Of several factors analysed, tumour recurrence was the decisive factor determining postoperative QL. In disease-free patients QL had deteriorated on discharge from hospital but was restored within 3-6 months postoperatively.

Activities of Daily Living↗
PubMed1995

[Surgical therapy of leiomyosarcoma of the inferior vena cava].

Leiomyosarcoma of the inferior vena cava is a rare tumor. Radical surgical resection is the treatment of choice. Depending on the localization of the tumor surgical therapy includes the local resection of the vena cava with primary closure and the segmental resection of the cava with prosthetic reconstruction. On the basis of four cases the symptomatology, diagnostic procedures, surgical therapy and the results of treatment of leiomyosarcoma of the inferior vena cava are discussed.

Aged↗
PubMed1995

Diagnosis, treatment and prognosis of the leiomyosarcoma of the inferior vena cava. Three cases and summary of published reports.

OBJECTIVE: To describe our experience with three cases of leiomyosarcoma of the inferior vena cava, and summarise current methods of diagnosis and treatment. DESIGN: Descriptive study. SETTING: University hospital, Germany. SUBJECTS: 3 Patients with histologically confirmed leiomyosarcoma of the inferior vena cava. INTERVENTIONS: Resection, with or without vascular reconstruction. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: Case 1 was diagnosed on magnetic resonance imaging, the tumour was resected, and the vena cava replaced with a polytetrafluoroethylene (PTFE) graft. She made an uncomplicated recovery and was well and free of symptoms 10 months later. Case 2 was diagnosed at operation (the differential diagnosis on computed tomography was a retroperitoneal tumour), the tumour was resected, and the defect oversewn. She made an uneventful recovery and was well and free of symptoms 14 months later. Case 3 was diagnosed at operation (a diagnosis of pancreatic cancer had been made preoperatively), the tumour was resected, and the defect oversewn. She was well and free of symptoms 10 months after operation. CONCLUSIONS: Magnetic resonance imaging is superior to computed tomography in the diagnosis of leiomyosarcoma of the inferior vena cava. The treatment of choice is resection; small defects can be closed by suture or PTFE patch, and large defects by PTFE prostheses. Reported resectability is 40% to 60%, but the prognosis is poor; the local recurrence rate is about 36%, most patients are dead within 2.5 years, and the 5-year survival is 30%. Chemotherapy and radiotherapy will give some degree of palliation, but do not affect the outcome.

Aged↗
PubMed1994

[Liver resections for primary liver malignancies. Personal results and analysis of the literature].

In a retrospective study we analysed 50 resections for primary liver tumors performed between 1 July 1979 and 31 December 1991 at the Department of Surgery of the University of Cologne. The mean resectability rate was 28%. Hospital mortality after resection was 22% and could be reduced to 4% during the last 4 years. The overall survival rates after 1, 3 and 5 years were 55%, 30% and 24% respectively. The surgical radicality is the most important prognostic factor. In a review of the literature the results of 8,725 resections for primary liver malignancies published between 1980 and 1992 were analyzed. The mean resectability rate was 32 +/- 17%. The hospital mortality after resection could be reduced from 15 +/- 5% (resections before 1970) to 6 +/- 2% (resections after 1980). The overall survival rates after 1, 3 and 5 years were 66 +/- 17%, 39 +/- 15% and 27 +/- 10%, respectively. Apart from a lower hospital mortality in Asian studies (4% vs. 7%) the resection rates and long-term results of Asian, American and European studies were similar. Long-term prognosis predominantly depended on the surgical radicality and on the size and extension of the tumor at the point of resection. The effectivity of an adjuvant tumor therapy is not analyzed sufficiently.

Carcinoma, Hepatocellular↗
PubMed1994

[Traumatic pseudoaneurysm of the axillary artery after shoulder dislocation].

By means of a case report the diagnostic and therapeutic procedures and prognosis of a pseudo-aneurysm of the axillary artery after shoulder dislocation are demonstrated. The diagnosis of aneurysms of the axillary artery is difficult in some cases. It is important to mention a possible vascular injury in case of close reduction of the shoulder. Therefore in all patients with a penetrating or blunt trauma of the shoulder or the upper arm a thorough neurovascular examination is required. In patients with neurologic deficits or alteration of the pulse a duplex ultrasound examination should be performed and in dubious cases an additional arteriography is indicated.

Aged↗
PubMed1994

Minimal invasive surgery in the local treatment of rectal cancer.

At the Surgical Department of the University of Cologne, a system has been developed for transanal endoscopic surgery, which allows all the conventional surgical techniques within the rectal cavity. The clinical and long-term results regarding local excision of broad based adenomas and small (< 4 cm) carcinomas of the rectum were the subject of the study. The main indication was the removal of sessile adenomas. Early rectal carcinomas with favourable histological grading (Grade 1 and 2) and staging (Mason I and II) were also suitable for endorectal therapeutical approach. Infiltrative cancers can be removed endoscopically in one session, but the authors performed local excisions of these cancers only in cases where the patient was unwilling to undergo extensive surgery or due to medical reasons. Nevertheless several Dukes B carcinomas were removed locally. Most of the histological findings of the subsequent radical operations (rectum resection, rectum extirpation) revealed that the carcinoma had already been totally removed. During the period July 1983 to December 1992, the techniques have been employed on 313 patients in 348 cases. Early postoperative complications consisted of intraperitoneal perforations (five cases); rectovaginal fistulae (four cases); haemorrhages (four cases), death due to cardiopulmonary failure (two cases). All the complications occurred within the first three years of the learning phase. The recurrence rate of adenomas amounted to 5%. The technique allows accurate endoscopic microsurgical excision of giant adenomas and early cancers with minimal morbidity and excellent presentation of specimens for complete histological analysis. Open invasive surgery can thus be avoided.

Adenoma↗
PubMed1994

[Laparoscopic therapy of nonparasitic liver cysts].

Minimal invasive surgery has become an important part of surgical therapy of non-parasitic cysts of the liver. At the moment there exist only a few but in all cases positive experiences with the laparoscopic unroofing of liver cysts. Until now we treated 3 patients with non-parasitic liver cysts by means of this method. In all cases we had no intra- or postoperative complications and the average hospital stay was 5 days. In agreement with other authors we think that laparoscopic unroofing of non-parasitic liver cysts is a method with promising future. The necessity of an intraoperative cholangiography in case of a bile leak respectively recurrence prophylaxis by means of an omentum major plastic will be decided by further clinical investigation.

Biliary Fistula↗
PubMed1994

[Leiomyosarcoma of the vena cava inferior--a rare retroperitoneal tumor].

The leiomyosarcoma of the inferior vena cava is a rare retroperitoneal tumor. In this article two more cases are reported and its clinical and diagnostic features including ultrasound, computed tomography and magnetic resonance tomography are described. Prevalence, localisation, complications, therapy and differential diagnosis are discussed based on the own cases and the current literature.

Aged↗
PubMed1994

Resection of colorectal liver metastases in old patients.

In a consecutive series of 90 patients in whom colorectal liver metastases were resected over a ten-year-period at a single institution, 18 patients (20%) were older than 70 years. In these patients 9 major and 9 minor hepatic resections were performed. The postoperative complication rate was 28% and resection mortality 6%. Operative mortality included, the median survival time was 18 months. Estimated 1-, 3-, and 5-year survival rates were 69%, 38% and 25%, respectively. In comparison with 72 younger patients, no significant differences were found in surgical strategies, operative procedures, or early and late postoperative results. As a result of these findings, even older patients should be regarded as potential candidates for curative resection of colorectal liver metastases.

Adult↗
PubMed1993

[Laparoscopic hernia surgery].

While classical inguinal hernia repair has recently been brought up for discussions among surgeons, at present various modified techniques are being reintroduced in general surgery. Surgical hernia repair techniques which partly are known since several decades are being carried out laparoscopically since 1989. Between August 1992 and June 1993, the authors performed 52 laparoscopic inguinal hernia repairs using the preperitoneal placement of nonresorbable mesh. There were no intraoperative complications. Merely one patient had an abdominal wall hematoma at the site of a trocar which resolved spontaneously. All patients have been followed up for 3-13 months. To date, all postoperative check ups revealed no recurrences, testicular atrophy or paresthesia. Even though little can yet be said regarding long-term results especially about recurrences, laparoscopic preperitoneal hernia repair seems to be a promising surgical procedure concerning early postoperative results.

Adult↗
PubMed1993

Closure of partial median sternotomy with absorbable sutures: a practical and safe option.

A technique for the closure of upper median sternotomy with absorbable polyglycolid acid sutures is described. In a consecutive series of 130 refixations, no major complications occurred. After a mean follow-up period of 66 +/- 61 months, the long-term results concerning sternotomy closure were determined in 86 patients: 84 (98%) sternotomies were completely consolidated, in 75 cases (87%) without any dislocation and in nine cases (11%) with a minor dislocation in the transverse osteotomy. In two patients (2%) who had received postoperative radio- and chemotherapy, an isolated pseudarthrosis of the transverse osteotomy was observed, whereas the median sternotomy was consolidated completely. As a result of our clinical experience, we consider the closure of partial upper sternotomy with absorbable polyglycoid acid sutures as a practical and safe technique.

Absorption↗
PubMed1992

[Closure of upper median sternotomy with resorbable polyglycolic acid sutures].

Since 15 years we use absorbable polyglycolic acid sutures (Dexon) for closure of partial median sternotomies. In a consecutive series of 121 refixations, minor superficial wound infections developed in 4 patients. All infections healed completely by local treatment. No major sternal complication occurred. Of 92 patients, who were still living, 82 patients were controlled between 3 and 180 months postoperatively. 80 (98%) sternotomies were consolidated completely; 71 (87%) without any dislocation and 9 (11%) with a small dislocation of the fragments. In 2 cases (2%) an isolated pseudarthrosis of the transverse osteotomy occurred; in both cases the median osteotomy was consolidated completely. In the literature no comparable publication about closure of partial median sternotomies could be found. According to our experiences we consider, that the closure of partial upper sternotomies with polyglycolic acid sutures is as a practical and reliable method.

Adult↗
PubMedDate not supplied

The impact of patient's age on surgical therapy of colorectal liver metastases.

In a consecutive series of 90 hepatic resections for colorectal liver metastases which were performed during a 10-year period at one institution, the influence of patient's age on surgical strategies and postoperative results was investigated. The mean age of all patients was 61 +/- 11 years with a range from 27-78 years; 19 patients (21%) were younger than 50 years and 18 patients (20%) were older than 70 years. Thirty-six (40%) major and 54 (60%) minor hepatic resections were performed. The postoperative complication rate was 26% and resection mortality 3%. Estimated overall median survival time was 27 months, operative mortality included. 1-, 3-, and 5-year survival rates were 78%, 45%, and 32%, respectively. Although there is some suggestion that selection criteria are more aggressive in younger patients, neither surgical procedures nor postoperative results were found to be determined by the numeric age of the patient in a significant way.

Adenocarcinoma↗