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Biomedical subjects

K H Treutner

Publications and source records attributed to K H Treutner.

At least 19 recordsLinked to original sources
PubMed1995

Invasive squamous-cell carcinoma in giant anorectal condyloma (Buschke-Löwenstein tumor).

Giant condyloma acuminata, first described by Buschke and Löwenstein in 1925 as a penile lesion, is extremely rare in the anorectal region. The cauliflower-like tumor behaves clinically in a malignant fashion, although it shows no histomorphological criteria of malignancy. Up to the time of writing only 33 cases of anorectal origin, 42% with malignant transformation, have been published. The authors report 2 more cases of squamous-cell carcinoma in giant anorectal condylomata acuminata. Buschke-Löwenstein tumor is an intermediate entity between "ordinary" condyloma acuminata and squamous-cell carcinoma. Benign condyloma acuminata is caused by human papillomavirus 6 or 11. Carcinogenic cofactors promote the transition to giant, locally destructive condyloma acuminata and subsequent malignant transformation. Cure can only be achieved by early and radical excision. Formation of multiple fistulas and destruction of the sphincter may necessitate abdomino-perineal resection. Adjuvant radiation therapy should only be considered to render a tumor operable, as radiation may act as a cocarcinogenic effect and lead to a less differentiated and more aggressive cancer. The small number of cases reported and the variety of treatment regimens applied, however, do not allow the formulation of definitive therapeutic guidelines.

Anal Canal↗
PubMed1995

Stapled ileal pouch-anal anastomosis with resection of the anal transition zone.

We assessed the outcome of stapled ileal J-pouch-anal anastomosis with intersphincteric resection of the anal transition zone in 83 consecutive patients with ulcerative colitis (n = 71) or familial adenomatous polyposis (n = 12). There was no postoperative mortality. Two patients (2.4%) required permanent ileostomy for manifestation of unsuspected Crohn's disease. Major postoperative complications consisted of pelvic sepsis, anastomotic leakage, and pancreatitis with 3.6% each. Both, frequency of bowel movements and degree of continence improved with time. Two years after takedown of the diverting ileostomy 45 patients with ulcerative colitis and 12 with familial adenomatous polyposis were assessed with a frequency of bowel movements of 5.6 +/- 2 and 3.2 +/- 1 per 24 h, respectively (P < 0.05). At this time none of them had major daytime or nighttime incontinence. Minor incontinence was reported by 9% and 14% of the patients with ulcerative colitis during day-time and night-time, respectively. The patients with familial adenomatous polyposis demonstrated better results, without day-time seepage and intermittent nocturnal seepage in only 9%. It is concluded that direct ileal J-pouch-anal anastomosis is a safe procedure with excellent functional results for patients with ulcerative colitis and familial adenomatous polyposis.

Adenomatous Polyposis Coli↗
PubMed1995

[Prevention and therapy of intra-abdominal adhesions. A survey of 1,200 clinics in Germany].

A survey of 1200 hospitals in Germany was undertaken to estimate the current standards of prevention and treatment of postoperative peritoneal adhesions. The 751 (62.2%) evaluated questionnaires showed a representative distribution according to postal zones and annual laparotomies. The rate of coeliotomies for adhesional bowel obstruction is 2.6%. Starch-powdered gloves are used in 54.2% and washed before operating in 69.3%. Dry swabs and towels are used in 60.7 and 22.5%, respectively. Most of the surgeons suture the peritoneum. Adhesions are divided in patients with respective symptoms but without intestinal obstruction by 32.6% and during laparotomies for non-adhesion-related diseases by 20.4%. Long intestinal tubes and plication procedures are applied by 43.9 and 33.7%, respectively. Medication is administered for routine prophylaxis of adhesion by 6%, for prevention of recurrencies by 17.2%. Although it has been revealed that adjuvant measures for prevention of adhesions are needed, as of today, no regimen has proofed its efficacy and gotten accepted for clinical usage.

Abdomen↗
PubMed1994

[A new suture device for continuous sutures in the intestinal tract].

A new surgical sewing device for continuous sutures of gastrointestinal anastomoses with needle and suture material was used for the first time to construct a latero-lateral enterostomy (functional end-to-end anastomosis) in the small intestine of pigs. In ten animals the course was mainly uneventful during the observation period of 10 days. One animal developed a postoperative anastomotic leakage. In five cases adhesions between the anastomotic region and the small intestine were found on postmortem examination, but there was no evidence of any slight leakage. On the whole, the sewing device operated faultlessly. At present, clinical use seems possible for long sutures, which are time-consuming when sewn manually, but it is still premature. One major disadvantage of the device is its size, which restricts its application to extra-abdominal tasks. Nonetheless, the principle of a mechanical device for running sutures should be investigated further.

Anastomosis, Surgical↗
PubMed1994

[Laparoscopy versus laparotomy. An animal experiment study comparing adhesion formation in the dog].

We performed laparoscopy (n = 7) or laparotomy (n = 7) for exploration of the small intestine, cecal resection with Endo-GIA or TA-30, deserosation of 2 cm2 of the abdominal wall and resection of the omentum majus in dogs. After 8 days all dogs were re-examined and the adhesions were quantified by computer-aided measurement. Laparoscopic operations were followed by significantly (P < 0.001) fewer adhesions. After conventional operations extensive adhesions to the abdominal incision and interenteric adhesions were found, together with frequent conglomerates of adhesions, intestinal kinkings or adhesive bands. Identical manipulations, such as cecal resection or deserosation of the lateral abdominal wall, led to the same frequency and severity of adhesions in both groups. Based on our results, the risk of adhesion-related complications may be reduced by the laparoscopic approach.

Abdomen↗
PubMed1994

Vectormanometry for differential diagnosis of fecal incontinence.

PURPOSE: This study was designed to investigate the reliability of three-dimensional vectormanometry for differential diagnosis of fecal incontinence. METHODS: Eight-channel, continuous pull-out perfusion manometry was performed on 23 female patients with traumatic (n = 11) or idiopathic (n = 12) incontinence, respectively. RESULTS: At rest, the minimum sector pressure of patients with traumatic incontinence (32 +/- 14 mmHg) was significantly lower than it was in the controls (76 +/- 16 mmHg) and in those with idiopathic incontinence (64 +/- 28 mmHg) (P < 0.001). At maximum squeezing, the minimum sector pressure was 57 +/- 22 mmHg in patients with traumatic incontinence and 79 +/- 33 mmHg in those with idiopathic incontinence, both being significantly lower than in the control group with 152 +/- 27 mmHg (P < 0.001). The asymmetry index of the patients with a sphincter defect was significantly higher, both at rest (23 +/- 13 percent) and squeeze (26 +/- 12 percent), in comparison with the control group (7 +/- 2 percent at rest and 6.2 +/- 1.6 percent at squeeze) and the patients with idiopathic incontinence (10 +/- 5 percent at rest and 8.4 +/- 4 percent at squeeze). CONCLUSION: Three-dimensional vectormanometry identifies localized pressure deficits in the anal canal, thereby differentiating between sectorial and global sphincter insufficiency.

Adult↗
PubMed1994

[Classification of inguinal hernias].

Classification of inguinal hernia is a necessary prerequisite for a reliable analysis of different methods of repair. The underlying categorization is done intraoperatively based on the localization ('M' medial, 'L' lateral, 'F' femoral) and transverse diameter (I = < 1.5 cm, II = 1.5-3.0 cm, III = > 3.0 cm) of the hernial orifice. In cases of combined hernias the diameters of both fascial defects is added up, the hernia is classified according to the part of major importance for the development of recurrences, the medial defect, with the index 'c'. The classification can be applied to open as well as laparoscopic approaches. The diameters of the tip of the index finger or the length of branch of endoscopic scissors (1.5 cm), respectively, serve as standards for measurement.

Fasciotomy↗
PubMed1992

Results of intersphincteric resection of the rectum with direct coloanal anastomosis for rectal carcinoma.

Between 1977 and 1987, 519 patients underwent operation for rectal carcinoma. Sixty-three patients underwent intersphincteric resection with direct coloanal anastomosis (CAA), and 77 had an abdominoperineal resection (APR). Curative surgery was achieved in 57 and 65 patients, respectively. Both groups were comparable regarding age, stage of tumors, and localization of tumors. During the mean period of 6.7 years (range: 3 to 13.6 years), all patients were examined according to a predefined follow-up plan. From those patients with curative surgery, 11% presented with pelvic recurrence and 33% with distant metastases after coloanal anastomosis; the rates of recurrence and distant metastases after APR were 17% and 35%, respectively. The corrected 5-year survival rates were 62% following CAA and 53% following APR. Eighty-five percent of the patients with CAA reported good functional results regarding anal continence. Our study demonstrates that the intersphincteric resection with CAA is a valuable surgical technique for rectal carcinoma with the benefit of preservation of continence. It is suitable for neoplasms with high- and medium-grade differentiation (G1 to G2) and a localization that allows a minimum distal clearence of 3 cm.

Abdominal Muscles↗
PubMed1992

[Results of treatment in esophageal cancer].

204 patients were treated for esophageal cancer from 1.1.1986 until 1.6.1992 (carcinoma of the hypopharynx: n = 12, adenocarcinoma of the endobrachyesophagus: n = 82, primary esophageal cancer: n = 110). Out of the primary esophageal cancers 84 tumors (76%) were resected and 24% had palliative endoscopic and/or irradiation therapy. The stage distribution of the resected patients was: stage I: 7.1%, stage IIa: 35.7%, stage IIb: 11.9%, stage III: 33.3%, stage IV: 11.9%. The total morbidity of the resected patients amounted to 32.1%, the 30 days mortality to 7.1%, and the in hospital mortality to 9%. These data show no significant difference to the results of palliative endoscopic procedures (morbidity: 42.3%, mortality: 7.7%). None of the conservatively treated patients survived longer than 12 months whereas resected individuals had a 5-year-survival rate of 20%. The most predictive factors for prognosis were: Depth of tumor invasion (p less than 0.01), R-classification (p less than 0.05), and the lymphonodular status (p less than 0.05). A perioperative irradiation was effective in T3- and T4-tumors.

Adenocarcinoma↗
PubMed1992

[Differential surgical therapy in diffuse peritonitis].

96 patients were operated on for diffuse peritonitis from January 1986 to June 1990. They underwent a differentiated therapeutical concept according to the severity of the underlying peritonitis. Mild forms were handled with the standard approach, while mid-severe cases were treated by continuous postoperative peritoneal lavage. Patients with severe peritonitis were operated on by open abdomen management. Mortality was 32% (31/96) and with that obviously better than the statistically expected mortality, based on the Mannheim-Peritonitis-Score (49%). The same findings could be demonstrated in the therapeutic subgroups. The management of diffuse peritonitis using such a differentiated surgical concept seems to be an effective approach to reduce mortality rates.

Adolescent↗
PubMed1991

Anal sphincter function after intersphincteric resection and stapled ileal pouch-anal anastomosis.

This study was done to determine the effect of the direct ileal pouch-anal anastomosis upon pressure and sensory components of the anal canal and ileal pouch. These findings were related to postoperative continence. Thirty-three patients with ileal pouch-anal anastomosis (25 continent, eight with episodic minor incontinence) were studied 3 +/- 0.3 and 25 +/- 5 months after ileostomy takedown. The maximum resting pressure in the anal canal was significantly lower in patients with an imperfect result (35 +/- 5 mm Hg) than in continent patients (44 +/- 5 mm Hg) (P less than 0.05). Postoperatively the maximum squeeze anal pressure was slightly greater in continent than in incontinent patients (99 +/- 8 mm Hg vs. 87 +/- 7 mm Hg) (P greater than 0.05). The postoperative recto-(ileo-)anal inhibitory reflex was present in 27 percent. The linear correlation between strength of rectal (ileal) distension and depth resp. duration of internal sphincter relaxation as preoperatively observed disappeared postoperatively in every group of patients. Simultaneous measurements of pouch and anal pressure in patients with imperfect results revealed a reduced positive pouch anal pressure gradient compared to the continent group. This low pouch-anal pressure gradient is thought to be responsible for the increased incidence of soiling in some of our patients.

Adenomatous Polyposis Coli↗
PubMed1990

[Incisional hernia. Causes and principles of repair].

Up to 11% of all coeliotomies result in incisional hernias, their repair is followed by recurrences in up to 46%. To control the incidence of these complications transverse and oblique incisions with a skin incision of sufficient length should be prefered. At the first operation the abdominal wall should be closed by a single continuous suture with an absorbable material. Non-absorbable materials should be used for hernia repair. The doubling of the facial structures gives no advantage. Alloplastic materials are restricted to problem hernias.

Abdominal Muscles↗
PubMed1990

[Liver hemangioma. I. Diagnosis, spontaneous course, complications].

Hemangioma is the most frequent benign tumor of the liver. Clinical signs range from complete absence of any complaints to the life threatening complication of hemorrhage. Ultrasound, computed tomography, angiography, scintigraphy and magnetic resonance tomography are appropriate diagnostic tools. The spontaneous course depends on diameter and localization of the tumor; the majority of complications are documented for hemangiomas of more than 5 cm in diameter and superficial position.

Diagnostic Imaging↗
PubMed1990

[Liver hemangioma. II. Surgical indications, choice of procedure, results].

From our point of view surgical therapy for liver hemangioma is indicated for tumors with a diameter exceeding 5 cm, with superficial position, and complaints. Further criteria are changes in size or internal structure of the tumor. Treatment of choice are atypical and anatomical resections, respectively, according to the size of the hemangioma. Elective surgery can be performed with considerable low risks with respect of the spontaneous course.

Adult↗
PubMed1990

Endoscopic therapy and early elective operation as a therapeutic regimen in ulcer bleeding.

In a prospective protocol we treated 63 consecutive patients admitted to our surgical department with bleeding gastroduodenal ulcers between January 1986 and December 1987. The therapeutic regimen included emergency endoscopy in all cases. Active Forrest Ia or II hemorrhage was treated endoscopically with submucosal injection. Endoscopic control of hemorrhage was achieved in all but one case. Low-risk ulcers, e.g. Forrest II without visible vessel and III or ulcers caused by antirheumatic drug medication were treated definitively by therapeutic endoscopy (31 patients). Ulcers with high risk of rebleeding even after endoscopic therapy underwent additional early elective operation. Thirty patients were treated surgically by this means. Two patients required emergency operation because of failure to control the bleeding (Ia and second rebleeding) endoscopically. The overall mortality of the surgically treated patients was 6% (2/32). The mortality of the therapeutic endoscopy was 0%. Thus, the mortality of the overall group was 3%. The major advantages of this concept were: low mortality rates, elimination of rebleeding in the follow-up period, optimal conditions for the surgical therapy resulting in low death-rates and a reduced need for transfusions.

Adult↗