PubMed Health⌕ Search

Biomedical subjects

M Trede

Publications and source records attributed to M Trede.

At least 73 records · Page 4Linked to original sources
PubMed1990

Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality.

Twenty-one years ago, Howard published a paper entitled "Forty-one Consecutive Whipple Resections Without an Operative Mortality." That paper stimulated the present analysis of the last 118 consecutive pancreatoduodenectomies (107 Whipple and 11 total resections) performed at the Surgical University Clinic Mannheim from November 1985 to the present day with no deaths. Ninety-one resections were performed for neoplasms and 27 were for complicated chronic pancreatitis. The preoperative evaluation, operative technique, and postoperative care of these cases is discussed in detail and compared to the experience of Howard. While there was general agreement on operative technique, there were differences concerning preoperative evaluation (modern imaging methods) and postoperative care (simplification). In this series 21 postoperative complications required seven relaparotomies. Long-term survival after resection for carcinoma was analyzed for 133 consecutive patients who were shown to have true ductal adenocarcinoma. In 76 patients, who had radical (R0-) resections, the actuarial 5-year-survival rate was 36%. In 44 patients, whose R0-resections for pancreatic cancer occurred more than 5 years ago, the actual survival rate was 25%.

Actuarial Analysis↗
PubMed1990

[Therapeutic decision in gallstone disease: from the surgical viewpoint].

Cholecystectomy, hitherto the "golden standard" in gallstone treatment, and all the other alternative methods must pass the test of applicability, morbidity, mortality, rate of success and recurrence. According to these criteria, cholecystectomy (removing not only the stones but also the offending gallbladder)--in particular with the advent of the laparoscopic approach--is the therapy of choice.

Cholecystectomy↗
PubMed1990

[Becoming a surgeon--at the university clinic].

The "surgeon's road" in an university department is marked by the demands of research, clinical work and teaching. The demands made by all 3 can hardly be met in the prescribed 6 years of training when adhering to the statutory 38.5 hours week. At present there are 1227 surgeons "on the road" at West German surgical departments (12% are women). Of these some 24% will reach a consultant post and less than 2% will become chairmen of a university department.

Curriculum↗
PubMed1990

[Uses and risks of drainage following elective colon resection. A prospective, randomized and controlled clinical study].

The results of a controlled randomized and prospective clinical study including 113 patients from March 1987 until August 1988 showed that prophylactic drainage in elective resection for cancer of the colon was not necessary. 60 patients received a drain, 53 patients were not drained. The drain turned out to be ineffective even concerning its expected function of draining intraabdominal fluid: its diagnostic and therapeutic value failed in clinical practice. The rate of surgical complications--i.e. anastomotic leakage, impaired wound healing and relaparotomy--was significantly higher in the drained group. In elective colon resection the use of a drain as a routine procedure cannot be recommended.

Aged↗
PubMed1989

[Tumor resections in the liver].

Over a 16-year period 54 patients presented with primary malignant liver tumours: 10 (18.5%) were considered inoperable, 44 underwent laparotomy. Nineteen (35%) turned out to be inoperable. A resection with curative intention was performed 25 times (47%) (11 right or extended right and 2 left hemihepatectomies, 12 mono- or bisegmentectomies). Hospital mortality was 8% (n = 2). The median survival time of those who died following resection was 22 months. Four patients have survived for more than 5 years, and three of them are still free of recurrence (5 year survival rate: 17% excl. hospital mortality).

Adenoma, Bile Duct↗
PubMed1988

The complications of pancreatectomy.

This paper analyses the early postoperative complications after 285 pancreaticoduodenectomies performed during the past 15 years in the Surgical University Clinic, Mannheim. There were 235 partial (Whipple) and 52 total pancreatectomies performed for pancreatic and periampullary tumors (181 patients) and complicated chronic pancreatitis (104 patients). A total of 92 complications requiring relaparotomy in 42 patients ended fatally in nine patients. The overall operative and hospital mortality rate was 3.1%. The most frequent and most dangerous were complications at or around the pancreaticojejunal anastomosis, which occurred 25 times with five deaths. Postoperative hemorrhage was seen in 16 patients; endoscopic treatment in four patients and operation in 12 patients was successful in stopping the bleeding in all but one patient. Eight biliary fistulae either ceased spontaneously (3 patients) or after operative reintervention (5 patients) without any mortality. Control of these complications depends on four lines of approach: (1) before operation: optimal preparation of the jaundiced patient including endoscopic transpapillary decompression of the common duct; (2) during operation: a meticulous and standardized technique is mandatory; (3) after operation: continuous observation in the surgical intensive care unit is essential for the timely detection of possible complications; and (4) early reintervention can salvage the great majority of these patients with deleterious complications.

Adenocarcinoma↗
PubMed1987

[Results of surgical therapy of esophageal cancer].

Between 1973 and 1986, 141 patients with esophageal carcinoma have been operated. The overall resection rate was 59% (83/141). We preferred the operative resection by abdominal and right-sided thoracic approach. Only in 4 patients with generally high risk an abdomino-cervical blind dissection of the esophagus was performed. Reconstruction was done in all cases by oesophago-gastrostomy. During the last 14 years hospital mortality decreased from 36.4% (n = 8/22) in the first 7 years period to 7% (n = 3/43) during the last 4 years. Resection rate increased from 47% in the first to 65% in the second period. The 5 years survival rate of all resected patients was 23.5%.

Adenocarcinoma↗
PubMed1987

[Therapy of chronic pancreatitis].

1) Chronic pancreatitis is a medical disease. 2) If operation is unavoidable - and at present too many patients are being operated upon - then the correct indication seems more important than the particular operative technique. 3) Late results must be seen against the background of the spontaneous course of the disease. 4) The various operative methods can only be compared in a randomized controlled study.

Chronic Disease↗
PubMed1987

[Continent proctocolectomy--difficulties caused by previous operation].

Since 1981 23 Patients (19 with adenomatosis coli, 4 with colitis ulcerosa) underwent proctocolectomy with preservation of continence: total colectomy, proctomucosectomy, ileo-anal anastomosis with formation of an ileal S-pouch, and protective loop ileostomy. In 3 patients previous operations caused difficulties in performing the procedure. Critical points of the operative technique are explained, with special regard to the possibility of previous surgery. Postoperative complications and functional results are presented.

Adenomatous Polyposis Coli↗
PubMed1987

[Acute aortic and iliac artery occlusion: a banality in vascular surgery?].

From 1972 to 1986 70 acute occlusions of the aorta or bilateral iliac arteries were operated in our clinic. The occlusion was caused in 41 cases by embolisation, in 29 cases by thrombosis. Amputation rate was 22.8%, the mortality rate 42.8%. 71% of the patients were of extreme high risk regarding the operation as well as the anesthesia. In 44% of the patients the duration of complete ischemia was more than 6 h. Performance of intraoperative angioplasty (n = 10 patients) for dilatation of stenoses leading to thrombotic occlusions may lower the mortality rate.

Acute Disease↗