PubMed Health⌕ Search

Biomedical subjects

K Kraft

Publications and source records attributed to K Kraft.

At least 55 records · Page 3Linked to original sources
PubMed1998

[Risks and benefits of laparoscopic hernia-plasty (TAPP). 5 years experiences with 3,400 hernia repairs].

In the present study, for the first time the aspects of risk, benefit and the costs of laparoscopic hernioplasty in the transabdominal technique with preperitoneal placement of a polypropylene mesh are examined prospectively in a very large group of patients with 3,400 hernia repairs. The median operation time was 45 min for unilateral primary hernias, 50 min for unilateral recurrent hernias and 76 min for bilateral hernias. The frequency of complications showed a significant dependence on the individual steps in the development of the method and the individual learning curve. The same is true for the rate of recurrency. Whereas initially the rate of serious complications was 2.75%, the rate of minor complications 11% and the rate of recurrences 4.5% the corresponding figures are at present 0.4%, 4.4% and 0.5%. Laparoscopic hernioplasty proved to be equally as effective in the treatment of primary hernias, recurrent hernias and bilateral hernias. The large number of 11 surgeons participating proves that laparoscopic hernioplasty can be learned and that even in a teaching hospital it can be performed safely, efficiently and cost-effectively.

Adolescent↗
PubMed1998

A single institution's experience with transperitoneal laparoscopic hernia repair.

BACKGROUND: Previous evaluations of endoscopic hernia surgery mostly are based on small prospectively documented series or on a few randomized comparative studies. In the following, results of a large single-institution experience concerning the transabdominal preperitoneal patch (TAPP) technique with regard to the development of methods and the routine use are described. METHODS: From April 1993 to March 1997, 2,700 TAPP procedures were performed at the Department of General and Visceral Surgery, Marien-hospital, Stuttgart, Germany. The follow-up was documented prospectively in all cases by use of computed data base. RESULTS: The majority of patients (83.8%) were operated because of primary hernias. In 17.2% a first or multiple recurrence of an inguinal hernia was indicated. At a median postoperative observation period of presently 20 months and a follow-up rate of 86.5%, 28 recurrences have been determined so far (total recurrence rate 1.03%), 6 of which occurred after a recurrent hernia reparation (1.33%) and 22 after primary hernia repair (0.97%). The most common cause for recurrence was in 39.3% a mesh (12 x 8 cm) being too small. The total complication rate was 4.6%; as an expression of the learning curve it was reduced from 7.8% (operations 1 to 500) to 2.8% (operations 2,200 to 2,700). CONCLUSIONS: According to our experience, the TAPP technique is sufficiently applicable as a standard method for an unselected group of patients in a routine setting. It is especially suited to the repair of recurrent and bilateral hernias as well as for patients with a high risk for recurrence that can profit from a tension-free endoscopic procedure, particularly in case of obesity.

Female↗
PubMed1998

Representativity of incisional biopsies for the assessment of flow cytometric DNA content in head and neck squamous cell carcinoma.

DNA flow cytometry studies of squamous cell carcinoma of the head and neck have shown that patients with diploid tumours have favourable prognoses, whereas the outcomes of those with DNA aneuploid tumours are poor. DNA flow cytometry is therefore increasingly used as an integral part of diagnostic procedures. To evaluate how representative biopsies predict the DNA ploidy of oral carcinomas, incisional biopsies taken pretherapeutically from 256 tumours were compared with the corresponding surgical resection specimens. Sixty-six tumours exclusively displayed cells with flow cytometrically diploid DNA content in both the biopsy and the subsequent resection specimen, while 182 carcinomas expressed DNA aneuploid tumour cell lines in matched samples. There were only 8 tumours (3.1%) with heterogeneity in the DNA ploidy status between the biopsy and the resection specimen. These results emphasise the usefulness of incisional biopsies to reliably prognosticate the DNA ploidy status of oral carcinomas.

Biopsy↗
PubMed1998

Reliability of reporting self-measured blood pressure values by hypertensive patients.

For self-measurement of blood pressure to be useful, patient reporting of test results must be reliable and accurate. Until now no study directly measured the accuracy and reliability of patients' reporting of self-measured blood pressure values. Thirty hypertensive patients (69 +/- 11 years) were instructed to measure blood pressure at home over 14 days with the highly accurate Omron IC monitor and to keep a record of all readings in a patient logbook. To assess the reliability of the records, patients were not informed about the memory capacity of the device. We compared automatically stored blood pressure readings with the respective logbook entries to analyze deletion (under-reporting), addition (over-reporting), and precision of reporting of test results. The prevalent pattern was under-reporting, averaging 36% +/- 24% (3% to 89%), which occurred significantly more than over-reporting (9% +/- 11%; 0% to 38%). The precision of reporting (identical values at corresponding times) was 76% +/- 34% (0% to 100%). This observer error did not affect group comparisons of automatically stored values and logbook entries, although the estimated limits of agreement were wide. Blood pressure control, duration of hypertension, age, or previous use of self-measurement and patterns of logbook entries were not found to be predictive of the patients' reliability. Our results demonstrate a substantial observer error in the reporting of self-measured blood pressure values. This bias may be reduced by memory-equipped blood pressure devices.

Blood Pressure Determination↗
PubMed1998

The significance of DNA flow cytometry in predicting survival and delayed clinical manifestation of occult lymph node metastasis to the untreated neck in patients with oral squamous cell carcinoma.

A total number of 116 clinically neck-negative patients with squamous cell carcinoma of the oral cavity who underwent radical primary tumour surgery without simultaneous neck treatment were entered into this prospective study. The 5 year overall survival rate was 87% for patients with flow cytometrically diploid tumours and 58% for the aneuploid group (P < 0.05). By multivariate survival analysis, tumour stage (P < 0.05) and DNA ploidy (P < 0.05) were significantly associated with the outcome. The cumulative 3 year rate of delayed clinical manifestation of lymph node metastasis to the previously untreated neck was 12.6% for patients with flow cytometrically diploid tumours and 41.3% for the aneuploid group (P < 0.01). By multivariate analysis, the DNA ploidy status of the primary tumour was the only factor among tumour stage, localization and degree of histological differentiation predictive of occult metastasis development (P < 0.05). Also, patients with T1 tumours who frequently are not considered to benefit from elective neck dissection were at high risk of subclinical lymph node involvement if the primary tumours were aneuploid (47%), whereas only 10% of the diploid T1 sample showed occult neck disease. Particularly in patients with less extensive oral carcinomas, DNA aneuploidy is therefore an important decisive factor in elective neck dissection.

Carcinoma, Squamous Cell↗
PubMed1998

High-resolution DNA flow cytometry in papillary cystadenoma lymphomatosum (Warthin's tumour).

Twenty-eight examples of papillary cystadenoma lymphomatosum (Warthin's tumour) of the parotid gland were analysed by high-resolution DNA flow cytometry. The mean coefficient of variation was found to be 1.19% (SD: 0.41). All tumours were DNA diploid. These results did not correspond with expected deviations based on published chromosomal studies. Also, the homogeneously low S-phase fractions (mean: 4.8%; SD: 2.7) found did not support the hypothesis of etiologically distinctive subgroups in these tumours.

Adenolymphoma↗
PubMed1998

Update: what is left for laparoscopic hernia repair?

The risks, benefits and costs of laparoscopic hernia repair are still being debated. According to a current survey on the situation of hernia surgery in Germany in 1996, laparoscopic hernioplasty was done in about 60% of the answering hospitals; about a quarter of all hernia repairs are done laparoscopically. Since April 1993, about 2, 700 laparoscopic hernia repairs were done at Marienhospital Stuttgart. The operating time was on the average 50 min. The rate of complications was about 3%. The postoperative period of disablement was a median of 20 days; included in this time was the postoperative hospital stay. The recurrence rate was about 1%. It is remarkable that laparoscopic hernia repair was equally efficient in repairing unilateral primary hernias, recurrent hernias or bilateral hernias. The cost analysis showed that the application of multipath articles will make the operation costs of laparoscopic hernia repair only about DM 100 higher than for a conventional operation.

Costs and Cost Analysis↗
PubMed1998

[Biliary pancreatitis--epidemiology, progress with a new therapy concept?].

In our patients with symptomatic cholelithiasis (n = 3618 in a 6-year period), we found biliary pancreatitis in 4.4% (0.4% severe pancreatitis). Because of therapeutic splitting (ERC/EPT, followed by laparoscopic cholecystectomy), we are able to reduce the hospital stay by about 60%, reduce morbidity significantly (P < 0.05) and reduce lethality.

Adult↗
PubMed1997

[Laparoscopic cholecystectomy in therapy of acute cholecystitis: immediate versus interval operation].

From January 1991 to May 1996 a total of 3,010 cholecystectomies was performed for cholelithiasis. Pathohistologically an acute cholecystitis was found in 483 patients (16%). The overall proportion of laparoscopic operations has increased from 12.5% in 1991 to 96.6% at present. In patients with acute cholecystitis the proportion of laparoscopic operations has increased from initially only 1.87% up to 83.3%. The duration of surgery (81 min versus 54 min), rate of conversion (12% versus 1.07%) and rate of complications (7.76% versus 2.2%) were all significantly higher in cases of acute cholecystitis than in those without inflammation. There was no mortality in either group. Furthermore no significant difference was found between patients with histopathologically proven acute inflammation and patients with an acute episode of chronic cholecystitis. The duration of complaints, however, had a significant influence on surgical results. In patients that were either operated on within 48 h after the onset of disease or more than 10 days later, the length of the operation was shorter and the rates of conversion and complications were lower. Our results prove that laparoscopic cholecystectomy is also very successful in cases of acute cholecystitis, though a long learning curve has to be expected. Taking efficiency and economy into consideration, surgery within a few days of the onset of disease must be recommended.

Acute Disease↗
PubMed1997

Investigation of the Met-267 Arg exchange in isoform 1 of the human plasma membrane calcium pump in patients with essential hypertension by the amplification-created restriction site technique.

Alterations in Ca2+ homeostasis have been proposed to be a primary factor in the pathogenesis of essential hypertension. In this disease increased intracellular Ca2+ levels have repeatedly been reported in various cell types. Because of its prominent role in cellular calcium homeostasis in vascular smooth muscle cells, modifications of the plasma membrane Ca2+-ATPase (PMCA) pump have been suggested to contribute to an increased contractile tone of small blood vessels. This pump is a calmodulin-dependent Ca2+-ATPase that ejects Ca2+ from the cytosol into the extracellular space. Recently a mutational thymidine (T)-->guanosine (G) transversion in isoform 1 of the PMCA has been identified resulting in the substitution of a methionine (Met) by an arginine (Arg) at amino acid position 267 in a highly conserved domain of the pump molecule. The aim of our study was to determine the prevalence of this polymorphism in the normal population and to investigate whether the Met-267 Arg occurs more frequently in patients with essential hypertension than in normotensives. To detect the mutational change we modified a method based on the technique of amplification-created restriction sites (ACRS) using three base exchanges in the diagnostic primer. Samples from 100 hypertensive and 60 normotensive subjects revealed a thymidine at nucleotide position 981. These data suggest that ACRS is feasible in spite of extensive primer modifications (e.g., three mismatched bases) in contrast to the previously used one or two and may therefore be conceptually suitable to detect almost any base changes in the genome. The described T-->G transversion is a rare polymorphism and is presumably not related to common forms of essential hypertension.

Adult↗
PubMed1997

[Problems in diagnosis and therapy planning in a patient with retroperitoneal yolk sac tumor. Case report and review of the literature].

The case of a 26 years old patient with a primary paraaortic extragonadal yolk sac tumor is presented. After operative reduction of the tumor polychemotherapy with PEB was performed. Following chemotherapy testicular biopsy did not show histological changes typical for testicular intraepithelial neoplasia (TIN). Three years after the initial manifestation of the yolk sac tumor, a malignant tumor of the testis with components of undifferentiated teratoma and yolk sac tumor was observed. In this paper the problems of development of testicular malignancy after polychemotherapy and the validity of a small exploratory excision of testicular tissue in retroperitoneal germ cell tumors and following chemotherapy are discussed.

Adult↗
PubMed1997

Structural changes in the gastric foveolar epithelium in Helicobacter pylori-positive gastritis revealed by keratin immunohistochemistry.

To clarify structural changes in the gastric foveolar epithelium in Helicobacter pylori (Hp)-positive gastritis, the expression rates of keratins 8, 18, 19, and 20 were assessed immunohistochemically in normal tissue and chronic gastritis. In normal tissue, keratin 8 was found in 100% of the cells. Staining for keratins 18 and 19 was abundantly positive. Keratin 20 was not expressed in the deep foveolae, but present in the upper foveolae and on the tips. No differences were found between the antrum and the body. In chronic gastritis, both Hp-positive and -negative, keratins 8, 18, and 19 were expressed comparably to normal tissue. Keratin 20 expression in the antrum was significantly lower in Hp-positive compared with Hp-negative gastritis (P < .05) and normal tissue (P < .05). In the body, staining for keratin 20 did not differ significantly between all groups. The difference in keratin 20 expression between the antrum and the body in Hp-positive gastritis was significant (P < .05). After successful eradication, staining for keratin 20 in the antrum normalized within 6 months (P < .05). These findings indicate structural changes in the gastric foveolar epithelium in Hp-positive gastritis. They predominantly include the antral region and show full reversibility after eradication.

Adult↗
PubMed1997

[Chondroma of the petrous bone. A contribution to differential skull base tumor diagnosis].

INTRODUCTION: Cartilaginous tumors of the mid-face and the skull base are rare. CASE REPORT: For the first time, a case report of a chondroma of the base of the ear in a 56-year-old woman is presented. In 1974 the patient developed a facial nerve paralysis while she was pregnant. Twenty-two years later the patient developed persistent headache and CT studies of the head were obtained, which showed an extensive tumorous lesion located at the base of the ear. A tumor was resected through an otoneurosurgical approach. The histological examination showed a chondroma. CONCLUSIONS: Even the rare diagnosis of a chondroma should be considered for a differential diagnosis of skull base tumors.

Chondroma↗
PubMed1997

[Planning, realization and evaluation of post-marketing surveillance studies. Recommendations of the Society for Phytotherapy].

Post-marketing-surveillance studies with herbal drugs usually are prospective prescription-epidemiological studies, which should allow statements on quality, efficacy and safety. Until now neither laws nor concrete normative guidelines for the methodology and the evaluation of post-marketing-surveillance studies are existing which could be used for pharmacovigilance. In the present paper guidelines for planning, realisation and evaluation are presented which should allow studies of high quality. The essential components required for the investigational plan are focussed. Also recommendations on the obligatory, optional and special components of the study protocols are made. Additionally statistical methods which allow the evaluation of the therapeutic efficacy are presented.

Humans↗
PubMed1997

[Laparoscopic hernia repair: prevention and therapy of complications].

Following the surgical steps in laparoscopic (transperitoneal) hernia repair, the corresponding groups of complications relate to: (1) laparoscopy; (2) the trocars; (3) the dissection of the inguinal region; (4) the hernia sac dissection; (5) the mesh placement; (6) the peritoneal closure. Inadequate surgical technique can lead to injuries of the intestine, urinary bladder and blood vessels; peri- and postoperative bleeding and hematoma; severing of testicular blood vessels, with consecutive testicular atrophy; and nerve lesions when fixing the mesh with clips and intestinal obstruction subsequent to insufficient peritoneal closure. With an adequate surgical technique, complication rate is very low. Preconditions for this are: strict compliance with the safety tests, when establishing the pneumoperitoneum; application of blunt conical trocars; precise knowledge of the anatomy; gentle dissection in the avascular tissue layers; subtle hemostasis; absolutely no diffuse electrocoagulation or placement of any clips below or up to 1 cm above the ileopubic tract; and safe peritoneal closure by suture under reduced intraabdominal pressure.

Hernia, Inguinal↗
PubMed1996

Beta-endorphin and catecholamine concentrations during chronic and acute stress in intensive care patients.

BACKGROUND: Only little information is available on the effects of acute and chronic stress on the opioid and adrenergic systems in patients at intensive care units. Animal models showed a stimulation of beta-endorphin and catecholamines. METHODS: In the present study, in 12 patients who were intubated and were receiving artificial respiration because of cardiopulmonary resuscitation or primary respiratory failure, venous plasma concentrations of adrenaline, noradrenaline and beta-endorphin immuno-reactive material (IRM) were determined by a radioimmunoassay. In these patients, regular endobronchial suctioning was necessary. For inducing acute stress patients underwent three different methods of endobronchial suctioning or lavage. RESULTS: In all patients concentrations of both adrenaline (529 +/- 117 pg/ml) and noradrenaline (2694 +/- 262 pg/ml) were increased above normal resting values. In 5 patients plasma beta-endorphin IRM concentration was below the detection limit, the other patients had beta-endorphin IRM concentrations above normal (26.65 +/- 3.80 pg/ml). Epinephrine (227 +/- 33 vs. 743 +/- 189 pg/ml; p < 0.01) and norepinephrine (1673 +/- 161 vs. 3423 +/- 368 pg/ml; p < 0.001) were significantly lower in the group with undetectable beta-endorphin IRM concentrations than in the group with detectable beta-endorphin IRM whereas heart rate was significantly higher (120/min vs. 99/min; p < 0.0003). beta-endorphin IRM concentrations were correlated negatively to heart rate (-0.55; p < 0.0005) and positively to the noradrenaline concentration (0.56; p < 0.0004). Artificially ventilated patients showed increased levels of beta-endorphin (19.27 +/- 3.16 pg/ml) as compared to the spontaneously breathing patients (13.29 +/- 4.34 pg/ml). Following acute stress due to endobronchial suctioning or lavage, blood pressure (150/70 mmHg vs. 172/81 mmHg; p < 0.01) and heart rate (107/min vs. 119/min; p < 0.005) increased in all patients, the other parameters did not. CONCLUSION: It is concluded that beta-endorphin IRM concentration in the plasma is linked to epinephrine and norepinephrine concentrations under intensive care conditions. Endobronchial lavage or suctioning does not influence beta-endorphin IRM levels in plasma.

Acute Disease↗
PubMed1996

[Comparative antihypertensive action of 20 mg delayed-action nifedipine with either 25 or 50 mg atenolol. A study on the treatment of patients with mild to moderately severe arterial hypertension].

In the present double-blind, randomized, placebo-controlled study 36 untreated patients (57.8 +/- 8.4 years) with mild to moderate hypertension were included. After a 14 days' placebo period they were treated with a combination of 20 mg retarded nifedipine and 25 or 50 mg atenolol for six weeks each. Group A started with 25 mg, group B with 50 mg atenolol. Casual sitting blood pressure was measured automatically every second week, routine laboratory parameters and side effects were evaluated at the end of placebo and the verum periods. The blood pressure of the two groups was comparable during placebo and was reduced by 31.6/14.7 mmHg in group A or 29.9/15.8 mmHg in group B (p < 0.001 vs. placebo) after six weeks. In the second treatment period with verum, blood pressure was not further reduced. Both combinations were equally efficient also in the female and the elder subgroups (> 60 years) who were characterized by higher systolic blood pressure. The response rates were 83% and 86% for the combination with 25 and 50 mg atenolol respectively. Heart rate was significantly reduced in all groups during 50 mg atenolol. Laboratory parameters were not altered by treatment. Frequency and severeness of side effects were equal in both groups. It is concluded that in patients with mild to moderate uncomplicated hypertension the combination of 20 mg retarded nifedipine with 25 mg atenolol is equally efficient to the combination with 50 mg atenolol.

Aged↗