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Biomedical subjects

K A Lennert

Publications and source records attributed to K A Lennert.

At least 19 recordsLinked to original sources
PubMed1991

[Intraoperative cholangioscopy].

There are the best diagnostic results by endoscopic examination of the common bile duct. Both rigid and flexible instruments can be used for the examination. The advantages and disadvantages will be discussed. The stump of the cystic dust will be useful to clarify pathological finding by x-ray in the distal bile duct. Usually, however, the instrument is introduced by means of a choledochotomy. In the last 16 years in 1023 cases the bile duct were examined endoscopically, 330 via the cystic duct, 693 via a choledochotomy. Stones were detected in 541 cases (52.9%), in 16 cases (2.9%) a stone was overlooked. Severe complications by operative choledochoscopy were not seen.

Cholangiography↗
PubMed1991

[Fistula--fistula disease].

Management of the fistula disease is complex and requires definition of the exact underlying pathological anatomy by inspection and fistulography. Surgical intervention is required treatment of cause. The incision of fistula is the basic surgical treatment.

Female↗
PubMed1990

[Therapy of acute cholecystitis--importance of early operation].

The acute cholecystitis is caused in over 95% by an stone occlusion of the cystic duct. The diagnosis can be made securily by ultrasound. The early cholecystectomy, th.i. within 48 hours, is the management of choice. The urgent cholecystectomy is indicated in free perforation of gallbladder or empyema with septicaemia. The late cholecystectomy should be refused avoiding unsuspected further complications. The mortality of 551 patients, operated in 16 years, has been totaly 27 (= 4.9), only 7 Patients (= 1.3%) immediately as an consequence of the gallbladder operation.

Acute Disease↗
PubMed1990

[How great is the risk in surgical treatment of choledocholithiasis?].

With a success-rate of approximately 95 percent non-operative removal of bile duct stones following endoscopic sphincterotomy is a valuable alternative to operative treatment. If the gallbladder has not been removed previously an acute cholecystitis may develop in up to 20 percent of the patients. Approximately 50 percent of complications following non-operative treatment require emergency surgery. The most serious complications following operative treatment are retained bile duct calculi (2.8%), wound infection and biliary fistulae. In our experience with 499 patients postoperative morbidity was 16.0% and mortality 3.8%. Cause of death was related to surgical bile duct exploration in only two patients (0.4%). Operative treatment of bile duct stones remains the treatment of choice. Endoscopic intervention is a valuable alternative for the removal of retained stones or in frail patients not fit for general anaesthesia.

Adolescent↗
PubMed1989

Endoscopic appearance of the normal biliary system.

Both rigid and flexible instruments can be used for endoscopic examination of the biliary tract. The approach is via the cystic duct or by means of a choledochotomy. The stump of the ductus cysticus will be useful if it is necessary to clarify a pathological finding in the distal bile duct or in the region of the papilla of Vater. Usually, however, the instrument is introduced by means of a choledochotomy. First of all, the distal region including the papilla of Vater and then the proximal part of the biliary system are closely examined. The normal biliary duct wall appears yellowish-red without showing the vascular structure. The papilla of Vater region presents a honeycomb appearance. Special emphasis in endoscopic examination is on papilla function, i.e. the opening or closing of the papilla if liquid is allowed to flow in. Results of 935 endoscopic examinations are reported.

Bile Ducts↗
PubMed1988

[Is spontaneous, internal bilio-digestive fistula a surgical indication?].

Spontaneous enterobiliary fistulas are recognized preoperatively in only about 50 per cent of patients. Ultrasonography and intravenous cholangiogram merely demonstrate alterations of cholelithiasis. In plain abdominal radiograph biliary gas is presumptive evidence of enterobiliary fistula formation. Barium studies or ERC often succeed in outlining fistula preoperatively. Because of additional findings in more than 70 per cent of cases, such as calculous biliary disease, carcinoma of gallbladder and ascending cholangitis surgical repair of enterobiliary fistula always should be performed. This counts among the most difficult surgical procedures in biliary tract and is burdened with a mortality of 4 to 22 per cent. Experience with 33 patients operated on are reported. In 5 patients enterobiliary fistula was associated with carcinoma of gallbladder, which was discovered in 3 patients only at histopathologic investigation.

Adult↗
PubMed1987

Technique and result of intraoperative choledochoscopy.

The use of intraoperative choledochoscopy represents a significant advance in biliary surgery. Flexible instruments are ideal for examining the intrahepatic bile ducts, while rigid instruments are best suited for the extrahepatic ductal system. The cystic duct stump may be occasionally used for access, but, as a rule, a supraduodenal choledochotomy is necessary. Our experience with 776 examinations is reported. A total of 348 patients (44.8%) had ductal stones. In 10 patients (2.8%), a stone was overlooked. Equivocal cholangiograms, ductal stones, and obstructive tumors constitute the most important indications for endoscopic examination.

Biliary Tract Surgical Procedures↗
PubMed1985

[Does synchronous abdominoperineal rectum excision have real advantages?].

From January 1st, 1974 through December, 31st, 1984 a total of 421 patients with cancer of the rectosigmoid was operated upon. 269 patients (63.8%) underwent operations in which continence was maintained. In 17 of the cases the rectum was removed and the sphincter muscle was left intact. In 86 cases (=20.4%) a combined abdominoperineal rectum excision was performed (42X metachronous and 44X synchronous) in one session. The operating time involved in the synchronous method is on the average 34 min shorter than in metachronous. The mortality was reduced from 19% to 9%.

Abdomen↗
PubMed1984

[Closure of the bile ducts following exploration].

One indication for cholangioscopy is a doubtful intraoperative cholangiogram. Cholangioscopy is usually performed by a choledochotomy, occasionally it can be done via the cystic duct stump. Primary closure of the choledochotomy using a forward and backward suture is possible. In cases of severe cholangitis T-tube external drainage of the bile is performed. The method and experience of 208 endoscopic examinations is reported, 71 via the cystic duct stump and 137 via a choledochotomy.

Bile Duct Diseases↗
PubMed1982

[Rectosigmoid cancer. Report on 442 cases].

Between 1961 and 1980 442 patients with rectosigmoidal carcinoma were treated. As preparation for operation and technique changed in 1974, two groups were formed: those between 1961 and 1973 (n = 196) and those from 1974 to 1980 (n = 246). The average duration of treatment was reduced from 63 to 36 due to out-patient preoperative measures. Resection (continent and incontinent) was the standard procedure, with local transanal excision in occasional cases. Continence preserving resection increased two-fold when compared with amputation in the second period. The death rate in 337 resected tumours was 18.5% and could be reduced from 22% to 16%. The death rate unrelated to operation remained unchanged whereas the operative mortality after a curative procedure fell from 11% to 2%. The reduction in death rate directly due to the operation was particularly noticeable in the simultaneous abdomino-perineal rectal amputation. Only one out of 18 patients operated on in this way died due to massive pulmonary embolism.

Adolescent↗
PubMed1979

[Early operation in acute cholecystitis].

104 patients with acute cholecystitis were divided into four groups according to the kind of pre-operative treatment received: immediate; early; late; and interval operation. Total duration of hospital stay depended on the duration of pre-operative treatment. It was shortest (24.9 days) in those operated on within the first week, longest (71.1 days) in those operated on during the interval. Evidence of severe gallbladder wall changes (macroscopic and microscopic) was obtained in two thirds of patients, even after weeks of conservative treatment. Six patients (5.7%) died postoperatively, three of them after early operation. Overall mortality was only in part due to severe complications of the gallbladder disease.

Acute Disease↗
PubMed1979

[Benign surgical icterus (author's transl)].

Among 3192 operations on the gall bladder and biliary ducts clinically and chemically a benign icterus was found in 318 patients (9.9%) (maximal serum bilirubin values 21 mumol/l). 140 patients (44%) had a typical biliary history over many years, 173 patients (54%) had only cholelithiasis, 98 patients (30.9%) had concrements in the gall bladder and biliary ducts and 9 patients (2.8%) had concrements in the biliary ducts only. In 141 patients (44.3%) additional complications were found. The post-operative mortality was 5% among which were 9 patients dying of the final stages of their basic disease or its complications; 7 patients died of cardiopulmonary complications. An improvement of the prognosis can only be reached by early operation of patients with gallstones.

Cholelithiasis↗
PubMed1979

[The small-intestine-stasis syndrome following side-to-side anastomosis].

This review describes the small intestine stasis syndrome after side-to-side anastomosis. Symptoms of intermittent abdominal pains with steatorrhea and loss of weight are caused by disturbance of passage with a rise in bacterial concentrations. Of 27 patients observed 15 had no disorders, while 12 had gastrointestinal symptoms which had been misinterpreted and given conservative treatment for a long time (3--22 years). Treatment is either by antibiotics or by excision of the lateral anastomosis followed by end-to-end anastomosis of the normal intestine. Special attention must be paid to the consequences of side-to-side anastomosis in childhood.

Adult↗
PubMed1978

[Early operation for acute cholecystitis (author's transl)].

104 patients with acute cholecystitis were divided into four groups according to the kind of pre-operative treatment received: immediate; early; late; and interval operation. Total duration of hospital stay depended on the duration of pre-operative treatment. It was shortest (24.9 days) in those operated on within the first week, longest (71.1 days) in those operated on during the interval. Evidence of severe gallbladder wall changes (macroscopic and microscopic) was obtained in two thirds of patients, even after weeks of conservative treatment. Six patients (5.7%) died postoperatively, three of them after early operation. Overall mortality was only in part due to severe complications of the gallbladder disease.

Acute Disease↗