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Biomedical subjects

K D Rückauer

Publications and source records attributed to K D Rückauer.

At least 19 recordsLinked to original sources
PubMed2004

Comparison of economic and environmental impacts between disposable and reusable instruments used for laparoscopic cholecystectomy.

BACKGROUND: The economic and environmental effects were compared between disposable and reusable instruments used for laparoscopic cholecystectomy. Special consideration was given to the processing of reusable instruments in the Miele G 7736 CD MCU washer disinfector and the resultant cost of sterilization. METHODS: The instruments frequently used in their disposable form were identified with the help of surgeons. Thus, of all the instruments used for laparoscopic cholecystectomy, the disposable and reusable versions of trocars, scissors, and Veress cannula were compared. RESULTS: For the case examined in this study, the performance of laparoscopic cholecystectomy with disposable instruments was 19 times more expensive that for reusable instruments. The higher cost of using disposable instruments is primarily attributable to the purchase price of the instruments. The processing of reusable instruments has little significance in terms of cost, whereas the cost for disposing of disposable instruments is the least significant factor. The number of laparoscopic cholecystectomies performed per year does not substantially influence cost. In the authors' opinion, assessment of the environmental consequences shows that reusable instruments are environmentally advantageous. CONCLUSIONS: Considering the upward pressure of costs in hospitals, disposable instruments should be used for laparoscopic cholecystectomy only if they offer clear advantages over reusable instruments.

Cholecystectomy, Laparoscopic↗
PubMed2001

[Laparoscopic gastric banding in therapy of obesity. Which patients benefit?].

In view of concomitant illnesses and sequelae associated with significantly increased morbidity and mortality, obesity is considered a major pathological condition. The aim of treatment must be the lasting reduction of overweight. The prerequisite for this is a fundamental change in the patient's inappropriate eating habits, as also other lifestyle aspects. This requires comprehensive and long-term disciplinary management. Within this framework, surgical treatment, in particular the laparoscopic placement of an adjustable gastric band, is the most effective form of achieving weight reduction. The band delays passage of food, and causes early distension of the stomach wall, thus inducing a sensation of satiety. To ensure therapeutic success, nutritional and surgical counseling of the patient has a major role to play.

Body Mass Index↗
PubMed2001

Dynamic graciloplasty in children with fecal incontinence: a preliminary report.

BACKGROUND: Various therapeutic methods have been developed for anal incontinence. A reconstruction of the sphincter system with functional adaptation can be achieved by stimulation of the transposed gracilis muscle with an implanted stimulator. METHODS: The authors performed a dynamic graciloplasty in 4 boys, aged between 6 and 10 years. Causes for the incontinence were polytrauma with pelvic rupture, VACTERL syndrome with rectal urethral fistula, anal atresia with primary reconstruction and 6 consecutive operations, and coccygeal teratoma in a premature infant with surgical treatment of the recurrent tumour. All children had grade III incontinence. Postoperatively, the duration of stimulation was increased successively by telemetric programming of the pulse generator up to a continuous mode. RESULTS: One child is now almost continent, 2 show grade I incontinence, 1 is incontinent with frequent soiling (the programming has not been completed yet). CONCLUSION: An evaluation of this method for children will not be possible until more operations have been performed, under the conditions of a prospective study, which appears indicated in view of the preliminary but encouraging results presented.

Child↗
PubMed2001

[Percutaneous placement of feeding tubes for long-term nutrition and decompression. Indications, techniques and complications].

In the recent past, PEG/PEJ has found worldwide acceptance. The uncomplicated nature of the method has resulted in a considerable increase in endoscopic gastrostomies. Provided that the method is properly applied, and appropriate aftercare is offered, complications rarely occur. In principle, the indications are chronic diseases requiring tube feeding for longer than one month, such as cachexia in patients with cancer or stenotic tumors of the mouth and throat, or of the upper gastrointestinal tract.

Aged↗
PubMed2000

Evidence-based surgery: diverticulitis--a surgical disease?

Sigmoid diverticulitis is an increasingly common disorder. While there is no gender difference, the incidence increases with age. Many reports have been published on the topic, but there is no consensus on certain aspects of treatment. We conducted a literature search covering the past 30 years and report our own data. Two major areas of controversy exist. One concerns indications for elective surgery for symptomatic diverticulitis. The consensus is that there is no indication for prophylactic surgery. The first attack should be treated conservatively; elective surgery is considered following a second attack, but in immunocompromised patients earlier. The second controversy concerns surgical strategy in peritonitis from perforation. Three-stage operations have generally been abandoned. The question is whether to perform a sigmoid resection with primary anastomosis. One end of the spectrum is recent perforation which can be treated safely by resection and anastomosis. The other end is advanced feculent peritonitis in high-risk patients. In this situation a Hartmann procedure is recommended. Although data from prospective randomized studies are lacking, there seem to be indicators in the individual situation that allow a rational selection of the appropriate procedure. Diverticulitis can thus be treated surgically for a broad range of its forms of presentation.

Digestive System Surgical Procedures↗
PubMed2000

[Working posture of laparoscopy-practicing surgeons: ideal and reality].

Since laparoscopic surgery has been established the advantages for the patients of minimal invasive surgery have been discussed extensively. But this method holds considerable disadvantages, due to the non-ergonomic surgeons working position. This is mainly caused by the false positioning of the monitor and operating table as well by the use of foot switches and differing instrument handles. The common working position of the laparoscopically working surgeon leads to serious risks for the patient. The industry and hospital administrations do not know anything about this and only few surgeons are aware of these dangers. The authors want to draw attention to the insufficiencies of the laparoscopic working place. Due to missing resources until now no general concept has been developed that meets current standards.

Ergonomics↗
PubMed2000

A new method for extracting wooden foreign bodies from the upper esophagus.

A foreign body impacted in the esophagus is an emergency case that requires immediate treatment. Often the foreign body can be removed easily using forceps or loops. Sometimes, however, safe grasping and extraction may become very difficult. A patient swallowed a chestnut which then stuck in the upper esophagus. The chestnut was removed with a gynecological instrument with a spiral tip used for myoma fixation. Thereafter this technique was applied to in vitro tests with various kinds of meat and wood. In the clinical case, the chestnut could be removed with the spiral tip of the instrument for myoma fixation, whereas in the in vitro tests it was impossible to grasp meat or cut it into pieces. The removal of foreign bodies, such as wood, with the spiral tip of the instrument for myoma fixation during rigid esophagoscopy is an alternative to extraction with forceps or loops. This method is ineffective for the removal of pieces of meat.

Esophagoscopy↗
PubMed2000

[Postoperative peripheral neuropathies in general surgery].

INTRODUCTION: Postoperative nerve lesions beyond the operative area, the so called positioning traumas are considered uncommon in general surgery. But they can have serious consequences for the patient and the surgeon, including forensic sequelae. The objective of this work was to describe the incidence, pattern, risk factors and course of postoperative neuropathies in general surgery and to identify indicators to prevent these complications. METHODS: Based on neurologic records we reviewed all postoperative peripheral neuropathies that occurred in the Department of General Surgery of the University Hospital Freiburg in the time period from January 1979 to December 1990. Lesions that occurred as a direct operative effect were excluded. RESULTS: In 35 patients 50 nerve lesions were observed, representing an incidence of 0.12% of all operations during this time period. Most frequently lesions of the n. peroneus occurred, followed by the n. ulnaris, n. cutaneous femoris lateralis and n. medianus. Nerve lesions were observed in every body position and as early as after 15 min. Postoperative nerve lesions have a favorable prognosis. DISCUSSION: Nerve lesions caused by positioning can occur during any operation with any duration in general surgery. They should be avoided by thorough and careful positioning. Also the patient must be informed about the possibility of nerve lesions caused by the positioning.

Adult↗
PubMed1998

[Cytokine regulated expression of Fas-Ligand by colon carcinoma cells].

We studied the proliferative response of tumor-infiltrating lymphocytes (TIL) from colorectal carcinomas to rIL-2 as well as their cytotoxic activity which was reduced as compared to autologous peripheral blood lymphocytes. We observed TIL to be polyclonal and asked if Fas-ligand-expressing tumor cells are responsible for the elimination of specific T-cells. Therefore we studied the expression of Fas-ligand by LS174T colon carcinoma cells which we showed to be induced by cytokines.

Colorectal Neoplasms↗
PubMed1997

[Telesurgery: standards--consultations--continuing education].

The aim of the TESUS project is to bring together several European university hospitals in a federation as well as a certain number of clinical centers in a network, the purpose of which is the online and offline transmission of surgical procedure imaging and advice. The innovation is threefold: It provides the surgeon with online information, diagnostic and therapeutic tools and expert advice, the need for which might come up before and during surgical procedures, as well as the same services in the context of teaching and training through regular staff. The developed services will be a major contribution to EU-wide standardisation of health care procedures and therapeutic approaches.

Computer Communication Networks↗
PubMed1993

[Perioperative risk factors in esophageal cancer: a retrospective study of independent variables].

The postoperative outcome of 127 patients with an esophageal carcinoma was investigated retrospectively, to identify independent factors for the perioperative mortality (hospital mortality). Chi-square single factor analysis was employed to test 35 independent variables, in a second analysis stepwise logistic regression was used to determine the factors correlating with the morality. In 41 patients the esophagus was resected by a thoraco-abdominal approach, in 86 by blunt dissection. The hospital mortality was 17.3%, the 30-day mortality 12.6%. Single factor analysis revealed a significant correlation with the variable smoking (p < 0.003), post-operative morbidity (p < 0.008), CEA (p < 0.02), time of operation (p < 0.02) and surgical procedures (p < 0.02). The influence of the surgeon's experience was significant. In the stepwise logistic regression the duration of operation (p < 0.0039), the surgical procedures (p < 0.016), and the units of blood (p < 0.03) were correlated with mortality. The logistic regression showed a significant increase of mortality for the thoracoabdominal approach with increasing duration of the operation. The estimation of survival time according to Kaplan and Meier revealed a significant correlation with the stage of the tumor, but not with the surgical procedure.

Adenocarcinoma↗
PubMed1989

[Surgical treatment of cholelithiasis].

The indication for cholecystectomy has undergone a distinct change over the last few years due to the development of endoscopic and medical forms of therapy. The incidence of silent gallstones discovered incidentally has greatly increased owing to the widespread use of ultrasound. While surgery is not indicated in these cases, it is mandatory in acute and chronic septic complications, obstruction of the cystic duct or non-functional gallbladder. In a small number of patients, cholecystolithiasis can be treated with ESWL and chemolitholysis, but most will need surgery. Cholecystectomy is the sole causal therapy. Except in young patients, common bile duct stones are the domain of endoscopic papillotomy, even when the gallbladder is left in situ temporarily or (in high-risk patients) permanently. Here, endoscopy supplements the therapeutic concept even in emergency cases; stone extraction can obviate the need for common bile duct revision. Morbidity and mortality of gallstone surgery increase appreciably with patient age. Early operation is recommended in acute cholecystitis because of the lower morbidity and mortality rates. Present possibilities of individualized therapy require good interdisciplinary cooperation to prevent serious complications.

Ampulla of Vater↗
PubMedDate not supplied

Influence of cytokines on the expression of fas ligand and CD44 splice variants in colon carcinoma cells.

The expression of Fas ligand (FasL) by malignant cells might be a mechanism for tumor immune escape. We investigated FasL expression by LS 174T colon carcinoma cells. Furthermore, the effects of in vitro stimulation with rIL-2, rIFN-gamma and rTNF-alpha were investigated with regard to a possible regulation of the FasL expression by cytokines. FasL expression was detected by flow cytometry and RT-PCR. We observed a spontaneous expression of FasL by LS 174T cells. Incubation with high-dose rTNF-alpha induced an upregulation of FasL of 23%. rIL-2 and rIFN-gamma did not significantly affect FasL expression. To control whether our cytokine stimulation experiments were suitable to prove an upregulation of membrane proteins by tumor cells, we investigated the expression of ICAM-1, N-CAM, CD44s, CD44v6 and CD44v10. These adhesion molecules were spontaneously expressed by LS 174T cells. Only ICAM-1 and CD44v10 were significantly upregulated by rIFN-gamma and rTNF-alpha, respectively. These results could indicate that cytokines, released by tumor-infiltrating leukocytes, may induce the FasL-dependent apoptotic signal by which tumors downregulate an immunological host response.

Adenocarcinoma↗