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K H Treutner

Publications and source records attributed to K H Treutner.

48 records · Page 3Linked to original sources
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↗
PubMed1989

Intraabdominal abscesses--percutaneous catheter drainage versus operative treatment.

From 65 patients with 73 abscesses 38 were treated by operation and 27 by PCD. The mean duration of drainage was 6.8 days (OP) and 7.4 days (PCD) respectively. In the surgical group 2 patients needed reintervention and 1 died due to sepsis. In the PCD group 1 patient had to be operated on because of insufficient drainage and 1 died after perforation of the colon. With modern techniques of imaging (Ultrasound, CT) PCD is a useful tool in the therapeutic regimen of intraabdominal abscesses. PCD has to be considered as definitive treatment or preparation for surgical eradication. Above all indication to PCD depends on localization and cause of the abscess.

Abdomen↗
PubMed1989

[Postoperative, intra-abdominal adhesions--a new standardized and objective animal model and testing of substances for the prevention of adhesions].

80 male Sprague Dawley rats were divided in 8 groups of equal size. After median laparotomy defined abrasions of the serosa of abdominal wall, cecum and ileum were performed (400p, abrasive paper 280 grains/cm2, 8 cm2). The control group (I) received no medication. In the treatment groups 5 ml of the following agents were instilled before closure of the abdominal wall: normal saline (II), 16,250 IE Neomycin with 1250 IE Bacitracin (III), 30% dextrose (MW 70,000) (IV), 50,000 IE Streptokinase with 12,500 IE Streptodornase (V), or TCDO in concentrations of 10% (VI), 50% (VII), and 100% (VIII). All animals were relaparotomized on the 7th postoperative day, the adhesions were dissected and their extent was calculated by computer aid. Furthermore specimens were obtained for microscopic studies. Compared to the controls no reduction of adhesions could be achieved by dextrose. Significantly more adhesions were observed after treatment with Neomycin/Bacitracin. A reduction of about 23% was registered with normal saline and TCDO 10%. The greatest reduction of adhesions was seen after application of Streptokinase/Streptodornase as well as TCDO in concentrations of 50% and 100% (63%). The results were significant after evaluation with the t-test. Histologically there was a correlation between the extent of adhesions and the fibrin film. The new animal model has proven to result in reproducible data if used to evaluate substances for prevention of adhesions. Clinical studies with the best of these agents could serve as an approach to solve the problem of adhesion ileus.

Abdomen↗
PubMed1989

[Intraluminal splinting of problematic intestinal anastomoses with biomaterial tubes].

We performed small intestinal dissection in 80 laboratory rats. A critical anastomosis was achieved by two point adaptation of small intestine with single sutures. 10 control animals receiving no intestinal splinting died within two days of operation. The remaining 70 animals underwent intestinal internal splinting with tubes of different absorbable (Polyglactine, Collagen, and B111) and non-absorbable (Polyurethane) biomaterials. Significantly smaller leakage rates in the therapy groups proved the principle of internal splinting of complicated anastomoses in this animal model to be effective.

Anastomosis, Surgical↗
PubMed1989

[Parasitic liver cyst. Indications and choice of procedure in cystic echinococcosis].

About 60-90% of clinically diagnosed cases of echinococcosis are found in the liver. Half of these patients show episodes of acute abdominal or back pain. The others complain about discrete and unspecific symptoms. Diagnosis is confirmed by combination of imaging techniques and serologic tests. Operation still is the only way for eradication of the parasite. This paper presents a summary of the literature and clinical data of 27 patients treated in our hospital from 1966 to March 1988. Cystectomy with omentoplasty is confirmed to be a simple and effective surgical method in operative treatment of echinococcosis.

Adolescent↗
PubMed1989

The role of intestinal endotoxin in experimental peritonitis.

Escape of endotoxin from the intraintestinal site was investigated in experimental models of intestinal ischemia and during intraabdominal infection in rats. Following the instillation of Salmonella abortus equi endotoxin (S-form) into the proximal large bowel, we recorded the presence of the lipopolysaccharide molecule in the bowel wall, the intestinal lymph nodes, the peritoneal cavity, and in the liver sinusoids by immunohistochemical methods. At 3, 6, 12, 24, and 48 hr after the operative procedure, peritoneal fluid, blood, and tissue samples were taken. Survival rates were similar between the two test-groups (occlusion of the superior mesenteric artery [SMA] and cecal ligation and puncture [CLP]) and were not influenced by the amount of the injected endotoxin. There was no detectable morbidity in the sham-operated control animals with endotoxin doses up to 20 mg. Endotoxin could only be detected at 24 and 48 hr in the SMA group in the liver as well as in the peritoneal sediment and in intestinal lymph nodes. CLP and control samples remained negative throughout the observation period. Bacteria were found intraperitoneally within 12 to 24 hr in the SMA group and within 3 to 12 hr in the CLP group.

Animals↗
PubMed1988

[Surgical therapy in the treatment concept of ulcer disease. A critical evaluation].

Since the introduction of H2-receptor antagonists ulcer therapy has changed in favour of conservative management against surgery. In spite of this shift in therapy mortality from peptic ulcer did not decrease through the last three decades. Obviously conservative management does not influence the rate of ulcer complications but postpones them to the aged. Peptic ulcer surgery offers differentiated therapies for complications as well as for uncomplicated ulcer disease. In bleeding ulcers combination of therapeutic endoscopy and early elective surgery reduced mortality to 5%. Targets of therapy are both bleeding and ulcer disease. Obstruction is cured in the same way as uncomplicated ulcers with additional pyloro- or duodenoplasty. In cases of perforation the decision for simple suture or definitive treatment should be orientated to ulcer history. Due to their localisation uncomplicated ulcers are treated best by selective proximal vagotomy, combined resection or Billroth I resection. After surgery the monthly recurrence risk of uncomplicated ulcers is about ten times lower than throughout long-term conservative therapy. From the present point of view only surgery seems to be able to reduce persisting rates of ulcer mortality in the future.

Combined Modality Therapy↗
PubMed1988

[Splenic cyst. Diagnosis, indications and choice of procedure].

Based on two cases of splenic cysts diagnosis, indication, and selection of surgical methods are discussed. Ultrasound and computerized axial tomography prove to be the most important diagnostic methods. The indication to operate on cysts with a diameter exceeding 2 cm follows from possible complications. Because of the immunological importance of the spleen and the technical means of today a splenic resection should always be considered.

Adult↗
PubMedDate not supplied

Recurrent inguinal hernias in infants and children.

The objective of this study was to analyze the etiologic factors possibly associated with the development of recurrent groin hernias in infants and children. For this purpose we analyzed the records of 2754 pediatric patients operated on for primary hernias between 1966 and 1990 at our department who have not had recurrences. They were compared with 28 boys and 4 girls we treated for recurrent hernias during the same period. We found an indirect hernia in 29 cases, a direct hernia in 4 patients, and a femoral hernia in 1 child at the time of reoperation. A significantly high recurrence rate was found to be associated with incarceration (21.9% versus 7.6%), postoperative complications (9.4% versus 1.8%), concomitant diseases (31.2% versus 5.7%), and premature birth. Day case treatment was closely related to concomitant diseases. No impact on the development of recurrences was seen for the surgeons' educational level and the time of day the surgery was performed. Knowledge of the factors contributing to hernia recurrence and perfect surgical technique with reduction of incarcerated hernias and early elective operation may result in fewer recurrences in infants and children.

Child↗
PubMedDate not supplied

Low-dose, single-shot perioperative antibiotic prophylaxis in colorectal surgery.

Reductions of frequency of administration and dosage of antibiotic agents used in colorectal surgery may lower costs and the occurrence of adverse side effects. In a prospective randomized trial we evaluated two single-short regimens, a low dose of 1 g cefotiam against a standard dose of 2 g cefotiam, both in combination with 500 mg metronidazole. The low-dose group had twice the number of patients with wound sepsis (4 of 30) than the group receiving the standard antibiotic regimen (2 of 30). Two hours after infusion, the antibiotic concentrations in samples of serum, subcutaneous fatty tissue, and colonic wall of those patients receiving 1 g cefotiam were < 1 mg/l. The concentrations after administration of 2 g cefotiam were higher, as expected, and without any adverse side effects. In conclusion, we prefer infection prophylaxis by the standard dose of 2 g cefotiam plus 500 mg metronidazole in colorectal surgery.

Aged↗