[Automatic suture devices: advantages and indications for gastrointestinal surgery].
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Digestive System Surgical Procedures↗
Biomedical subjects
K Dinstl
Publications and source records attributed to K Dinstl.
[Surgical treatment of peripheral arterial occlusive diseases].
Within a period of 18 months 75 operations (25 aorto-femoral, 50 femoro-popliteo-crural reconstructions) were performed: early failure in lower limb reconstructions 8% (rate of amputation 4%), operative mortality 2,7%. Only 15% of the patients had claudication, 85% rest pain or gangrene. Because of the low number of reinterventions (8% postoperative rethrombosis or hemorrhage), the 2,7% mortality and the reasonable 20-2 months' follow-up results (83% good function) we believe that arterial reconstructive surgery has a place in the field of operative activities of a municipal hospital.
Adult↗
[Assessment of the tracheal cross-section by computerised tomography (author's transl)].
Tracheal cross-sections can be measured by means of computerised tomography with hitherto unparalleled accuracy. Among the patients examined by the authors (43) women following tracheopexy because of tracheomalacia), computerised tomography yielded approximately 3 times as many pathological findings as was possible by conventional x-ray diagnosis. Over and above this, it is always possible to calculate the flow resistance, a fact which can be of great importance for therapy planning and control. Hence, in all cases where accurate visualisation of the tracheal cross-section is necessary, computerised tomography appears to be the method of choice at the present time.
Adult↗
[Hyperparathyreoidism and chronic lymphocytic leukemia (author's transl)].
A 55 year old patient with chronic lymphocytic leukemia is reported in whom hypercalcemia occurred associated with hypophosphatemia and elevated parathyroid hormone levels (C-terminal assay). Bone histology gave further evidence for hyperparathyroidism. During neck and mediastinal exploration numerous lymph nodes were exstirpated. Although pathologic parathyroid tissue could not be identified it is concluded from postoperative normalisation of calcium levels that hyperparathyroidism had been cured by surgery. The patient died the seventh postoperative day on bronchopulmonary infection. Early differential diagnostic evaluation of the rare symptom hypercalcemia in chronic lymphocytic leukemia is postulated.
Diagnosis, Differential↗
[New aspects on diagnosis and therapy of primary hyperparathyroidism (author's transl)].
26, out of them 20 surgically proven cases of primary hyperparathyroidism are presented. The value of different laboratory, radiographic and scintigraphic analysis is examined. The estimation of calcium and phosphate in serum, the iPTH-determination and fine detail hands radiographs were found to be sufficient to establish diagnosis and indication for surgery. The chloride/phosphate-ratio proved valuable in comparative statistical analysis between pHPT and two control groups. Venous sampling at present seems to be the superior method for preoperative localization of parathyroid disease. It should be performed before second surgical intervention in the cervical region, in elderly (more than 60 years old) and risk patients. Early diagnosis and therapy of pHPT is important as pHPT is a chronic disease with many organ complications. The value of calcium-screening in an age group between 40 and 60 years is discussed.
Aged↗
[Anaplastic spindle and giant cell carcinoma of the thyroid (author's transl)].
77 cases of spindle and giant cell carcinoma of the thyroid were reviewed. This rapidly fata neoplasm extended beyond the capsule of the thyroid gland in all cases but one, with infiltration of the trachea or oesophagus in 3/4 of these cases at the time of diagnosis. 60% of the patients had lymph node metastases and 26% distant metastases. Due to the advanced stage of the primary tumour at the time of presentation, total resection was feasible in 13% of cases only. The prognosis is very poor; all patients died within 18 months. Correlations were demonstrated between lymph node metastases, distant metastases, tumour infiltration of trachea or oesophagus and shorter survival times. The survival time is prolonged in patients with partial tumour resection by adjuvant radiotherapy. 28% of all thyroid carcinomas seen at the 1st Department of Surgery of the University Hospital in Vienna between 1965 and 1976 were anaplastic. The high incidence in Austria is caused, in our opinion, by the higher rate of anaplastic transformation of long-standing, differentiated carcinomas in adenomatous goitres, which remain undetected clinically for years in this endemic goitre region because of their slow rate of growth.
Adult↗
Healing of enterotomies with preexisting peritonitis. An experimental study in guinea pigs.
The question of whether the presence of peritonitis has any influence upon the process of healing and the load capacity of a standard enterotomy was studied in guinea pigs. Laparotomy was performed 4 h after induction of peritonitis by a standardized method. Fecal peritonitis could be confirmed clinically, histologically and bacteriogically in all cases. A standardized enterotomy was carried out. The animals were killed 3 or 5 days later, anastomoses inspected, and the intraluminal pressures for anastomotic rupture measured. Comparison with a control group showed: (1) there can be normal healing of an enterotomy even with coexisting peritonitis; (2) anastomotic breakdown takes place at the same pressure as in the control group (p less than 0.01), and (3) primary lethality is significantly higher in cases operated in the presence of peritonitis (33 vs. 20%).
Animals↗
[Exploration of pancreaticojejunal anastomosis by postoperative endoscopic pancreaticography (author's transl)].
Endoscopic pancreaticography (EP) was performed in 9 patients after pancreaticojejunal anastomosis had been established surgically; in 2 of these patients EP was not successful. The anastomosis could be demonstrated in 5 cases to be functioning 1-6 years after operation; in 3 cases the duct system was found to be dilatated, in 2 cases diameters were normal. EP and clinical symptoms correlated well in 4 of 5 cases.
Humans↗
[Whole gut irrigation for large bowel preparation (author's transl)].
In a controlled trial whole gut irrigation (w.g.i.) was compared with elemental diet for 4 days as large bowel preparation. Cleansing effect, caloric intake and preparation time were significantly better in the first group (w.g.i.). In addition w.g.i. was routinely used studying 42 patients in an open trial which showed also a reliable cleansing effect and good practicability. At present the experience refers to a total of 163 preparations by means of w.g.i. In a further study the efficacy of w.g.i. for removal of blood from the intestinal tract in patients with bleeding esophageal varices was investigated. In 8 out of 11 cases a complete removal of the blood masses was obtained, 3 of these patients showed an improvement of the preexisting coma-stage.
Aged↗
Perforation of the oesophagus with an oblique--viewing endoscope in a patient with caustic stenosis.
A case of accidental oesophageal perforation during endoscopy in an elderly woman with acute alimentary obstruction of a caustic stenosis is presented. This demonstrates the risks in routine use of oblique-viewing endoscopes, especially in oesophageal exploration. The lesion was successfully treated by internal splinting with a Celestin tube. The indications for this kind of treatment arise in elderly patients with poor general condition in whom a preexisting stenosis guarantees the tight fitting of the tube.
Aged↗
[Incidence of gastric mucosal changes in multiple injuries].
In a prospective study the frequency of gastric mucosal lesions was investigated in patients with polytrauma. 23 out of 24 patients had mucosal lesions of different degrees of severity. 5 had petechiae only, 9 developed erosions and 9 ulcers. 11 had symptoms of gastrointestinal bleeding, 3 had to be operated.
Adolescent↗
[Corrective surgical procedures following partial gastrectomy for gastro-duodenal ulcer (authors transl)].
Corrective surgical procedures for postgastrectomy syndromes are well-established in abdominal surgery. The indications for early corrective intervention are clearly defined on the basis of the patients' postoperative course. Corrections at a later date should only be considered in presence of major symptoms which did not respond to conservative therapy and following careful morphological and functional assessment of the patient. An analysis of gastric acid secretion should be carried out before and after the operation. The aim of corrective interventions is the restitution, as far as possible, of physiological conditions: prevention of rapid gastric emptying and reduction of gastric hypersecretion. Through postoperative follow-up examination of the patients over many years is essential. The case history, operation technique and outcome is presented in this review of 92 patients treated at the First Department of Surgery, University of Vienna and the findings are discussed.
Adolescent↗
[Early operation in toxic megacolon complicating ulcerative colitis].
A case report of toxic megacolon complicating ulcerative colitis serves as basis for a discussion of the diagnosis, therapeutic management and assessment of the indications for surgical interference in this condition. In this particular case, colectomy with retention of the rectal stump proved a life-saving measure. The rectal stump had to be removed three months subsequently in view of the persistence of the mucosal pathology.
Adult↗
[Late results of the Noble operation. Clinical and radiological follow-up examination].
The results of 58 Noble operations performed during the period between 1964 and 1973 are reported. A partial operation was carried out in 9 cases. In 4 cases there were fatal complications due to technical errors such as too long a terminal ilial loop and direct suture to the intestine. Two cases of late ileus were observed after 2 and 6 months respectively following a partial plication. Follow-up examination at an average of 4 years after Noble operation showed that 26 patients were free of complaint. The Noble operation is best suited for cases with chronic recurrent adhesion ileus when a permanent folding of the small intestine is necessary. For other indications, the newer alternative procedures. (Childs and Phillips and Reiffersceid and Phillip's small intestine splinting) should be used.
Humans↗
[A clinical-radiological investigation concerning the accuracy of diatrizoate (Gastrografin) in the demonstration of anastomosis dehiscence and perforation of the gastro-intestinal tract (author's transl)].
A Gastrografin test is described for diagnosing perforations and dehiscence of anastomoses in the gastro-intestinal tract by carrying out a simple urine analysis. False positive and false negative results can be avoided by obtaining radiographs of urine samples under standard conditions. The accuracy of the method was checked in 97 patients by comparing the results of the urine analysis with radiographic examinations and with the clinical course. From this, it appears that the test is reliable, simple and capable of being used anywhere. The test is therefore recommended a) where there is a lack of radiographic facilities, b) for immobile patients, c) where there is clinical suspicion of a perforation or dehiscence of an anastomosis in the absence of radiographic findings and d) in individual cases where the radiographic changes are positive.
Abdomen, Acute↗
[Segmental necrosis of the duodenum and jejunum following caustic burn by hydrochloric acid].
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Adult↗
[Douglas' abscess with ureteric obstruction (author's transl)].
In a 19 year old man with a single kidney the development of a large Douglas' abscess was followed by anuria; The various causes are discussed. It is resonable to assume, that the obstruction resulted from longitudinal tension of the ureter over the iliace vessels (iliac sign).
Abscess↗
[Acute hemorrhage of the upper digestive tract with special regard to stress ulcer. Prevention and surgical therapy].
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Acute Disease↗