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Biomedical subjects

M Golling

Publications and source records attributed to M Golling.

68 records · Page 4Linked to original sources
PubMed1995

Experience with ileostomy and colostomy in Crohn's disease.

This study involved 746 patients with Crohn's disease treated surgically within a 13-year interval in whom 227 stomas (159 primary, 68 secondary) were created. The main indication (64 per cent) for primary stoma was severe perianal or genital fistulous disease. Revisional surgery for stomal complications was more common following colostomy than ileostomy (31 versus 5 per cent, P < 0.01). Twenty years after the first symptoms of Crohn's disease the cumulative risks of receiving any stoma or a permanent stoma were 41 and 14 per cent respectively. Four parameters were shown by proportional hazards analysis to be independently associated with the risk for any stoma as well as a permanent one; increased risk coincided with rectal inflammation, perianal fistula or abscess, and absence of small intestinal involvement. In addition, long-standing symptomatic disease before the first surgical intervention reduced the risk of a permanent stoma. The long-term chances of closure following temporary stoma were 75 per cent when used for anastomotic protection or avoidance, 79 per cent after postoperative complications, and 40 per cent for perianal or genital fistulas or for rectal inflammation or stenosis. Rectal disease and perianal fistula were the only independent predictors of a low possibility of stoma closure during follow-up.

Abdominal Abscess↗
PubMed1995

Modes of reperfusion in clinical liver transplantation.

A retrospective analysis of 60 orthotopic liver transplantations was performed to elucidate the effect of three types of rinse solutions (Ringer's solution, modified Carolina rinse, and autologous blood) and two types of revascularization (simultaneous vs sequential portal and arterial reperfusion) on various parameters of early postoperative graft function. The only statistically significant association revealed by multivariate analysis was a positive correlation between donor age and SGOT/SGPT peak levels postoperatively. In this limited sample no beneficial properties of Carolina rinse and/or simultaneous arterialization were verified. Despite modifications of reperfusion, there were 2 cases of primary nonfunctioning graft. However, these cases were associated with elderly donors, prolonged cold storage and, in 1 case, marked steatosis. Large-scale prospective trials are required to verify or disprove experimental data on the use of varying modes of reperfusion.

Adolescent↗
PubMed1995

[Ischemic type lesions of the bile ducts after liver transplantation: 2 years results].

Ischemic type lesions (ITL) after orthotopic liver transplantation are characterized by bile duct necroses leading to alterations of the ductal lumen, biliary leakage, cast formation and, thereby, to cholestasis. After exclusion of causative factors, such as arterial thrombosis, ABO incompatibility and chronic rejection, ITL occurred in 21 of 165 patients. The rate of ITL after UW preservation was higher (25%) in grafts preserved for > 10 hours in comparison to < 10 hours (7%; p < 0.05). Treatment consisted of endoscopic and percutaneous intervention, surgical revision and retransplantation. Retransplantation is indicated in many patients with lesions of extra- and intrahepatic bile ducts (type A). Other methods are of palliative character and may only be successful in type B (extrahepatic) lesions. Morbidity in patients with ITL is considerable. In comparison to patients without ITL, mortality, however, is not increased.

Bile Ducts↗
PubMed1995

[Effect of anastomosis reconstruction on vascular complications after liver transplantation].

AIM: Besides primary non function (PNF), vascular complications are responsible for the majority of early surgical and interventional therapy following liver transplantation. The purpose of this study was to evaluate the influence of the variety of arterial anastomosis on postoperative morbidity and mortality. METHOD USED: In 179 liver transplantations, vascular (arterial and portal) complications within the first 3 months were analyzed with respect to the type of reconstruction. The arterial anastomoses were divided into 3 groups according to the recipient artery used [Group (I): common hepatic artery (CHA), (II): hepatic artery (HA), (III): aorta]. For statistical analysis comparison of two proportions and the logrank test were used. RESULTS: The reconstruction was done primarily to the recipient CHA (69%, n = 124), less often to the HA (15%, n = 26) or directly to the aorta (16%, n = 29). The portal anastomosis-with the exception of two cases (dacron graft and internal iliac vein interposition)-was always end to end and resulted in four reinterventions (2.2%, kinking: n = 1, thrombosis: n = 3). Arterial complications (11.7%) like thrombosis, stenosis and dissection (n = 17), bleeding (n = 2) and steal phenomenon (n = 2) occurred more frequently. The difference in one year survival between patients with (n = 12/25, 47%) and without (n = 42/53, 79%) vascular complications was significant (chi 2 = 4.72, FG 1, logrank test p < 0.05). CONCLUSION: The rate of complications causing surgical or interventional therapy is independent of the choice of arterial reconstruction. The one year survival rate in patients with vascular complications is significantly decreased.

Adolescent↗
PubMed1994

T cell receptor repertoire and mitotic responses of lamina propria T lymphocytes in inflammatory bowel disease.

Human intestinal lamina propria T lymphocytes (LPL-T) physiologically exhibit minimal proliferation in response to antigen receptor stimulation in vitro. This is thought to occur as a consequence of regulatory influences which are exerted by the mucosal microenvironment. The present study is aimed at investigating whether proliferative responses of intestinal LPL-T to antigen receptor stimulation are altered in patients with inflammatory bowel disease. Accordingly, proliferative responses of LPL-T in patients with Crohn's disease and ulcerative colitis to stimulation with CD3 MoAb plus IL-2 were examined and compared with controls. In addition, T cell receptor (TCR) repertoires of LPL-T and peripheral blood T lymphocytes were determined by indirect immunofluorescence using a panel of 11 TCR V beta specific antibodies. In most patients with inflammatory bowel disease, LPL-T showed enhanced proliferation to antigen receptor stimulation compared with controls. Moreover, perhaps as a consequence, an enhanced frequency of in vivo preactivated T cells was seen as judged from an increased spontaneous proliferative response to low concentrations of exogenous IL-2. LPL-T and peripheral blood T lymphocytes exhibited similar percentages of TCR V beta gene usage both in controls and in patients. In summary, polyclonal activation of LPL-T due to impairment of local adjustment, i.e. insufficient down-regulation of TCR/CD3-dependent signalling processes, may contribute to the pathogenesis of inflammatory bowel disease.

Adolescent↗
PubMed1992

[Gunshot injuries--their incidence and surgical problems].

Since the time when firearms became readily available, surgeons have had to deal with the gunshot wounds which have presented for treatment. In middle europe, in peace time, gunshot wounds account for only a small percentage of the total number of trauma cases seen. This is reflected in our patient census in which a mere 0.065% of cases were associated with such injuries. It would seem that a relevant knowledge of the technical and physical attributes of firearms is important. With this understanding, the formulation of an according treatment plan is made easier. Gunshot wounds are frequently not confined to the extremities. The trauma surgeon, who largely deals with limb injuries, is now confronted with an increasing number of chest and trunk wounds and their particular therapeutic consequences.

Abdominal Injuries↗