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Biomedical subjects

M Gawenda

Publications and source records attributed to M Gawenda.

At least 19 recordsLinked to original sources
PubMed1999

[Minimal invasive video-assisted vein preparation (Endoscopic vein harvesting-EVH) in peripheral bypass surgery].

Saphenous vein harvesting remains a 20% source of morbidity in patients who require lower extremity bypass or coronary artery bypass grafting. In an attempt to reduce the complications associated with this procedure, minimally invasive video-assisted vein harvesting is propagated. The technique uses currently available endoscopic equipment with mechanical retraction to dissect the great saphenous vein with two limited incisions. The dissection is visualized on the video monitor to isolate and control side branches by clips. The vein is removed for reverse arterial bypass grafting or dissection is completed for an in situ bypass procedure. Initial experience with ten patients undergoing peripheral bypass procedures showed a mean vein-preparation time of 60 min. Two of seven in situ bypass procedures were complicated by side branch damage controlled through longer skin incision. After a mean follow-up of 12 months, all bypasses are patent. Taking our own experience as well as that reported in the literature into consideration, aspects of cost-effectiveness are discussed.

Arterial Occlusive Diseases↗
PubMed1999

[Peripheral ischemia and persistent sciatic artery--interdisciplinary management].

Persistent sciatic artery as a rare entity results from lack of regression of the femoral artery blood supply of the leg and is often combined with an abnormally developed superficial femoral artery. We describe the case of a complete, persistent sciatic artery with peripheral ischemia caused by thrombo-embolism from buttock aneurysmal formation. Combined therapy of catheter fibrinolysis, followed by proximal and distal ligation of sciatic artery and peripheral bypass procedure, restored regular leg perfusion.

Aged↗
PubMed1998

[Renal angiomyolipoma as a rare cause of retroperitoneal hemorrhage].

Angiomyolipomas are hamartomas that may be found sporadically or associated with tuberous sclerosis (M. Bourneville-Pringle). Clinically, this long-term asymptomatic tumor becomes evident as an acute retroperitoneal hemorrhage or by symptoms of a flank mass. Due to the high percentage of fat components in this tumor type, computed tomography is far superior to other radiological procedures. In view of two of our own case reports, the therapeutic strategies are discussed, paying regard to the actual literature in this field.

Adult↗
PubMed1998

[Complications of CT guided lumbar sympathectomy: our own experiences and literature review].

AIM: To review the complications of CT guided lumbar sympathicolysis (CTLS) on the basis of our own experience and the available literature. METHODS: 241 CTLS were performed by a standard technique according to Haaga's method. Clinical follow-up revealed 4 serious complications; these were analysed and compared with published cases. RESULTS: Amongst our patients there were three fibrotic ureter stenoses and one retroperitoneal abscess. Analysis of the serious complications described in the literature indicates that introduction of CT guided lumbar sympathicolysis has reduced the severity and frequency of complications as compared with surgical and "blind" procedures. With CTLS, no deaths due to the procedure have been reported in the literature. The results indicate that damage to the ureters can be caused by substances used for the neurolysis. CONCLUSION: Provided certain safeguards are obeyed, CTLS is a very save treatment. However damage to the ureter may follow even when the procedure was technically satisfactory. Therefore, sonographic control of the kidneys after three months is recommended.

Abscess↗
PubMed1997

Palliative iodized talc pleurodesis with instillation via tube thoracostomy.

Pleural effusions are a severe complication of advanced malignant disease. Palliative treatment strategies should be simple and effective. We investigated iodized talc pleurodesis through tube thoracostomy for this purpose. A total of 43 patients received a suspension of 5 g talc with 3 g thymol iodine via chest tube. The procedure was well tolerated without major complications in all cases. Unfortunately, 4 patients died of disease within the 1st month after treatment, so that only 39 patients were evaluable for treatment outcome. Follow-up ranged from 1 to 14 months. The success rate after 3 months was 92.5%. In conclusion, iodized talc pleurodesis is an excellent tool in the palliative management of malignant pleural effusions. Administration via chest tube is sufficient for treatment success.

Adult↗
PubMed1997

[Cervical anastomotic stenosis after gastric tube reconstruction in esophageal carcinoma. Evaluation of a patient sample 1989-1995].

Common late complications after esophagectomy and gastric tube reconstruction for esophageal carcinoma are symptomatic, benign fibrotic stenoses of the cervical anastomosis, which require dilatation. Since the prognosis of esophageal carcinoma still remains poor, bad functional results such as dysphagia affect quality of life. In a retrospective analysis, our patients were evaluated with regard to the underlying effects of cervical anastomotic stenosis after esophagectomy and gastric tube reconstruction. From 1 January 1989 to 31 July 1995, 173 patients with carcinoma of the esophagus were operated in our institution. Transhiatal esophageal dissection was performed in 133 patients; 40 patients underwent transthoracic en bloc resection. The 30-day mortality rate was 7.5% (13 patients). Postoperative fibrotic stenosis of the cervical anastomosis requiring dilatation occurred in 36.4% (63 patients) 6-12 weeks after operation. Fibrotic stenosis of the cervical anastomosis did not develop in 97 patients. There was a significant difference concerning the incidence of anastomotic leaks within both groups: whereas in 23.8% of the 63 patients who developed a fibrotic stricture of the cervical anastomosis an anastomotic leak preceded this event (P < 0.001), no anastomotic leak occurred in the group of 97 patients with normal healing of the cervical anastomosis. In addition, significantly (P < 0.01) more patients (37.5%, n = 23) with preexisting diabetes mellitus could be found among the 63 patients who developed a fibrotic stricture of the cervical anastomosis, in contrast to the 97 patients without anastomotic stenosis.

Adenocarcinoma↗
PubMed1997

[Fatal outcome factors of intestinal infarct of primary vascular origin].

Despite diagnostic and therapeutic advances, mesenteric vascular occlusion with intestinal infarction is often fatal. Parameters determining the high mortality are seldom discussed in the literature. By univariate statistical analysis we correlated the therapeutic outcome of our patients to 20 parameters. Between 1 January 1984 and 30 April 1996 we treated 22 men and 18 women with acute bowel ischemia of vascular origin. All patients underwent laparotomy, 40% (n = 16) due to the diagnosis of mesenteric infarction. In 15% (n = 6) the laparotomy was only exploratory; in 34 cases (85%) bowel resection was carried out. Mortality for all patients was 55% (n = 22). Univariate analysis of the 20 parameters showed that the therapeutic outcome was significantly correlated to a pre-existing diabetes, the course of hospitalization, and the high ASA class. There was no correlation to the length of resected bowel. Most parameters that determine the mortality of bowel infarction are pre-existing and cannot be influenced, but survival can be achieved in some patients if radical and aggressive resection is carried out at the side of almost complete small bowel infarction and followed by an elective second-look operation. Even short-bowel syndrome can be treated. Patients can return to a near normal lifestyle with an acceptable quality of life with the aid of parenteral nutrition at home.

Aged↗
PubMed1997

[Treatment strategies in bite injuries].

Animal and human bites are a extremely common problem. Despite the prevalence of this problem, few systematic studies have been done. There is astounding sparsity of factual information in the literature to aid the therapeutic decision. Crucial questions regarding suturing, antibiotics, and other matters have been left unanswered. Therefore the literature was reviewed and therapeutic guidelines extracted.

Animals↗
PubMed1996

[Long-term parenteral nutrition in vascular-induced short bowel syndrome].

Mesenteric vascular occlusion with intestinal infarction is often regarded as a fatal illness. Often the diagnosis of severe ischemia is made during laparotomy. Sometimes resection is not performed because the conditions is thought to be incurable, and in such cases the mortality is 100%. If radical and aggressive resection is carried out even at the site of almost complete small bowel infarction and followed by an elective second-look operation, survival can be achieved in some patients. The motivation to attempt treatment should be further enhanced by the observation that the short-bowel syndrome following resection can be successfully treated, giving an acceptable quality of life for the patients. Between 1 January 1979 and 31 December 1979 we treated 9 male and 6 female patients with short-bowel syndrome after mesenteric occlusive disease; their ages ranged between 4 and 78 years, and the total duration of parenteral nutrition was 30,494 patient-days. With a median of 1503 days, the longest individual periods of parenteral nutrition were 4,919 and 5,015 days. We show the problems of long-term parenteral nutrition, including catheter-associated and nutritional complications, with reference to the individual courses of patients with short-bowel syndrome after mesenteric infarction. Despite some problems, patients of all ages can return to near-normality with an acceptable quality of life with the aid of parenteral nutrition at home.

Adolescent↗
PubMed1996

[Surgical therapy of advanced hemorrhoidal disease--is an ambulatory surgery intervention possible?].

Hemorrhoidal disease is the most common pathophysiologic abnormality in the anus in the western civilized world. Sixty years after publication of the method in The Lancet, hemorrhoidectomy according to Milligan and Morgan and modifications of their methods are still considered the standard procedure in cases of advanced hemorrhoidal disease. During the last 5 years, 107 patients underwent hemorrhoidectomy in the Department of Surgery at the University of Cologne. In most of these patients, the operation followed Milligan and Morgan's method. There were 69 males and 38 females with a mean age of 47.9 years. Mean length of hospital stay was 4.5 days. We saw one case of postoperative bleeding that required operative review. The patients' risk profile (age, concomitant diseases, ASA classification) did not influence the length of the hospital stay. Operative hemorrhoidectomy according to Milligan and Morgan allows a short stay in hospital according to the individual needs of the patient, with a high degree of safety concerning possible postoperative complications.

Adult↗
PubMed1996

Value of bronchoscopic pneumonia diagnosis: prospective study.

In a prospective clinical study we examined whether bronchoscopically controlled suctioning is preferable to the blind suctioning of mucus aspirates for bacterial identification of intensive care unit patients with pneumonia. Forty patients with clinical and radiologic signs of pneumonia underwent both bronchoscopically controlled and blind endotracheal lavage. Bronchoscopically controlled suctioning did not demonstrate greater sensitivity for identifying organisms than the results obtained from blind suctioning (58 organism were bronchoscopically identified, compared to 57 organisms identified by blind suctioning; p = 0.32, NS). Arterial and mixed venous partial oxygen pressure and shunt also showed no significant differences 15 minutes before and after examination, nor did the blood pressure or pulse. The use of four of the bronchoscopes resulted in preinterventional contamination with Pseudomonas. Bronchoscopically controlled lavage shows no advantages over blind endotracheal lavage for diagnosing pneumonia. Blind suctioning with single-use sterile catheters can be done more quickly and inexpensively with fewer personnel and a lower complication rate.

Adult↗
PubMed1996

The prevalence of lung cancer in vascular surgery patients.

Inhalative cigarette smoking is a major risk factor for atherosclerotic disease as well as primary carcinoma of the lung. On that account, this study was performed to determine the prevalence of primary lung cancer on admission in patients scheduled for vascular surgery. All patients presenting to our department for an intervention are screened for lung diseases. If this pretherapeutic examination suggests the existence of a lung tumor further diagnostic procedures are performed. Making use of a prospective computer-assisted patient-documentation system, we analysed incidental findings of lung cancer in those patients admitted for elective surgery. Between Jan. 1st 1990 and October 31st 1994, we electively treated 2214 patients with the diagnosis of vascular stenosis (n = 1711/77.3%) or atherosclerotic aneurysms (n = 503/22.7%) in our department. In 16 of these patients (m:f = 13:3; age 50-72 [mean: 61.1] years) a carcinoma of the lung was detected during preoperative diagnostic procedures, a prevalence of 0.72%. All these patients were smokers, with a daily inhalative nicotine consumption averaging 25 cigarettes per day for a mean of 35 years. 8 patients underwent a surgical (n = 6) or other invasive (n = 2) vascular interventions. In 8 patients no vascular intervention was performed because of the revealed lung carcinoma. The prevalence of lung cancer in a population of vascular patients in the present study is in accord with data of older investigations of high-risk groups. Only 2 out of 16 lung cancers were detected at a prognostically favourable stage. Smokers with symptoms of vascular disease should be carefully examined for signs of lung cancer.

Aged↗
PubMed1996

[Ambulatory artificial nutrition: 15 years experiences at the Cologne University Surgical Clinic].

Beetween 1979 and 1994 629 respectively 223 patients were treated by home enteral and parenteral nutrition. The duration of the treatment on average was 361 days in case of enteral and 346 days for home parenteral nutrition, in special cases however up to 15 years. In enteral nutrition there were no metabolic complications and only minor technical problems. Catheter related problems represented the most challenging complications in parenteral feeding. 12 out of 14 patients treated more than 1 year with home parenteral nutrition because of non-cancerous disease died from recurrent pulmonary embolism or catheter-related septicemia.

Adolescent↗
PubMed1996

[The "buried bumper" syndrome--a rare complication of percutaneous endoscopic gastrostomy].

Since initially being described in 1980, percutaneous endoscopic gastrostomy (PEG) has had a dramatic impact on enteral access and alimentation techniques. Knowledge of the problems makes it possible to lower the complication rate of this method. We report a case of partial penetration of the gastric wall by the internal bolster of the tube. We focus on the prevention, recognition, and management of this PEG-related problem.

Catheters, Indwelling↗
PubMed1996

[Local fibrinolytic therapy of arterial occlusions of the lower extremity: initial success and clinical outcome].

INDICATIONS: The efficiency of local fibrinolysis therapy in patients with chronic and acute peripheral arterial occlusions of the lower extremities has been investigated. PATIENTS AND METHODS: A total of 33 patients were examined following a local fibrinolysis therapy (in 14 cases with supplementary percutaneous transluminal angioplasty) for chronic or acute peripheral arterial occlusion of the lower extremities. The success of the intervention was first evaluated by angiography and then by subsequent controls by means of treadmill ergometry. RESULTS: A primary intervention success was achieved in 75.8% (25 of 33 patients) of the cases. In 18.2% (6 of 33 patients) a vascular surgical operation was required within 30 days of the intervention (5 therapy failures, 1 complication of the intervention). In two further patients, vascular surgery was necessary after five or six months. In 22 of the 25 successfully treated patients (92%), the Fontaine stage was reduced by at least one step after an average of 7.6 (range: 1 to 30) months. CONCLUSIONS: Local lysis with or without PTA represents an effective alternative therapy to vascular surgery for the treatment of peripheral arterial occlusions in not immediately endangered lower extremities. On the basis of our results and a survey of the literature, an aid for selecting therapeutic measures for patients with arterial occlusion of the extremities is presented.

Adult↗
PubMed1995

[Brain and gallbladder metastases 10 years after local excision of a cutaneous malignant melanoma].

A 52-year-old man had a generalized seizure resulting in fracture of two vertebrae 10 years after excision of a superficially spreading melanoma (Clark level III) on the left flank. Additional to pain on pressure over the right upper abdomen, the erythrocyte sedimentation rate was increased (41 mm) and the activity of the liver enzymes was raised. Neurological examination indicated a loss of short-term memory, signs of meningeal irritation, unsteady gait and falling tendency. Cerebrospinal fluid showed mild pleocytosis and cells suspicious of tumour. Upper abdominal ultrasonography revealed an enlarged gallbladder with contents of soft-tissue density. Magnetic resonance imaging showed numerous round lesions in the brain which looked nodular after contrast-medium injection. Cholecystectomy revealed metastases of a malignant melanoma. It was likely that the cerebral lesions also represented metastases. The confusional state increased in severity. Neither cytostatic drugs nor radiotherapy were administered, because of the poor prognosis. The patient, now fully disoriented, died 54 days after hospital admission.

Brain Neoplasms↗