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Biomedical subjects

M Wunderlich

Publications and source records attributed to M Wunderlich.

At least 73 records · Page 4Linked to original sources
PubMed1984

Postoperative infections in colonic surgery after enteral bacitracin-neomycin-clindamycin or parenteral mezlocillin-oxacillin prophylaxis.

In a prospective randomized, blind trial, three groups of patients undergoing elective colonic surgery were compared for frequency of surgical wound infection, intra-operative wound contamination and other postoperative infections. All patients allotted to the three groups received whole gut irrigation (101 balanced salt solution) by gastric tube on the evening before surgery and were treated as follows. Group A: no antibiotics; Group B: neomycin (1 g/l) + bacitracin (50,000 IU/l) + clindamycin (900 mg/l), contained in the last 31 of irrigation fluid; Group C: mezlocillin (4 g) + oxacillin (2 g) intravenously (iv) at induction of anaesthesia, followed by two identical doses at 8 and 16 h. The rate of postoperative wound infection was highest in A (38 per cent) and much lower in B (3.3 per cent, P less than 0.002) and C (6.9 per cent, P less than 0.004). The difference between B and C was statistically not significant. In A a correlation was established between the degree of wound contamination and the occurrence of wound infection. Intra-operative wound contamination was lowest in B (30 per cent), equal in A (58.1 per cent) and B (55.2 per cent). Other infections were least frequent in group C (four of 29 patients), but were not significantly different to groups B (six of 30) and A (nine of 31). It is concluded that antibiotics together with an effective mechanical preparation considerably reduce the rate of wound infection in colonic surgery.

Adult↗
PubMed1983

[Sphincter preservation in rectal cancer: possibilities and limits of anterior resection].

The feasibility of sphincter preservation was studied in surgery of tumours in the upper, middle and lower third of the rectum. All patients operated on for rectal cancer between January 1977 and May 1980 were included in the investigation. Preoperative localization of the tumours was performed with the rigid sigmoidoscope. Every patient was scheduled for post-operative follow up. Altogether 211 patients were operated on for rectal cancer. 111 were treated by anterior resection, 90 by abdominoperineal excision, and 10 by other sphincter-saving methods. All of the 59 tumours located in the upper third of the rectum (12 to 16 cm from the anus) were treated by anterior resection. 62 tumours were located in the middle third (8 to 12 cm). In these cases anterior resection was carried out in 60% of the men and in 82% of the women, whereas the other patients underwent abdominoperineal excision. 80 tumours were located in the lower third (4 to 8 cm). Anterior resection was possible in only 4.4% of the men and in 14% of the women. Irrespective of their localization on sigmoidoscopy, 37% of the tumours which were within reach of the finger on rectal palpation could be removed by anterior resection. Local recurrence after anterior resection occurred in 18.3%, the median follow-up time being 50 months. The cumulative probable survival for all stages was more than 5 years for 60% of the patients.

Aged↗
PubMed1983

[Value of computer tomography of the small pelvis for the early diagnosis of local recurrence after surgery of rectal cancer].

The value of pelvic computed tomography (CT) in the detection of local recurrence following radical operation for rectal cancer was assessed in a prospective study on 15 patients. A positive CT finding was checked in every instance by a second-look operation (11 cases). Tumour tissue in the pelvis was found in 9 patients, whereas in 2 patients the positive CT finding was proven to be false. 5 out of 9 cases with recurrent tumour underwent radical surgery. In the 4 cases with a negative CT finding no recurrence has developed after a median observation time of 34 months. Pelvic CT is a useful and reliable method of detecting pelvic recurrence before it becomes clinically obvious. However, the method does not allow certain prediction of whether or not the recurrence will be radically operable.

Adenocarcinoma↗
PubMed1983

[Therapy of local recurrence after colorectal cancer].

A prospective study was undertaken of the incidence, symptoms, diagnostic measures and therapy of local recurrence of colorectal carcinoma following radical surgical management. 69 (16%) out of 434 patients developed recurrence of the tumour, which was local in 51 patients (12%). Half of the latter group was symptom free at the time of diagnosis. 45 out of the 51 patients were treated by surgery, a radical operation being feasible in 25 cases. 60% of these have survived for at least 30 months. The operative mortality was very low, with only one death, although extensive surgery was necessary in most of the cases. The preliminary results of this study support the hypothesis that a postoperative follow-up programme for patients with colorectal cancer leads to early detection of local recurrence and improves the chance of cure by surgical treatment.

Colonic Neoplasms↗
PubMed1983

The overlapping innervation of the two sides of the external anal sphincter by the pudendal nerves.

Unilateral pudendal neurectomy in the monkey results in histological changes consistent with partial denervation on both sides of the external anal sphincter muscle, but much more marked ipsilaterally than contralaterally. Histological features consistent with reinnervation developed during the 9-13 weeks after unilateral neurectomy in the anterior parts of the muscle on both sides. These observations suggest that there is a substantial overlap in the pudendal innervation of the external anal sphincter muscles on the 2 sides. This derives from interdigitation of muscle fascicles across the midline in this circular muscle. This functionally overlapping innervation enables reinnervation to be partially accomplished from the contralateral side. This is important in understanding the results of electrophysiological and histopathological studies of this muscle in patients with idiopathic faecal incontinence, itself a neurogenic disorder.

Anal Canal↗
PubMed1982

[CT in relapsing rectal carcinomas (author's transl)].

In 12-15% of rectal carcinomas a relapse appears during the first two years. Until now, early radiological diagnosis by means of conventional methods was extremely difficult and subject to high and negative error rates. Computerized tomography--in comparison to conventional radiological methods--allows early recognition of these tumour relapses and finds excellent use for purposes of radiological post-operative management.

Adult↗
PubMed1980

[Facial hemihypertrophy and anomalies of the optic disk (author's transl)].

After a brief review of total and partial hemihypertrophies, a case of facial hemihypertrophy with pitting of the optic disk and a defect in the adjacent retinal pigment epithelium is reported. The common teratogenetic period of termination suggests that the facial and ocular defects may be pathogenetically related.

Amblyopia↗
PubMed1980

[Possibilities for misinterpretation of direct fetal electrocardiography].

Direct foetal electrocardiography doses help the experienced examiner to detect cardiac arrhythmia. It can be an early signal of imminent danger. However, errors may occur to the interpreter of foetal electrocardiograms. They may be caused by materno-foetal ECG conduction in a case of intra-uterine foetal death, appearance of maternal pulses in the foetal curve, errors in pole connection of the scalp electrode, and superposition of alternating current on the ECG curve. Knowledge of those potential sources of error is essential, if erroneous decisions are to be avoided.

Arrhythmias, Cardiac↗
PubMed1980

[Risk of surgical polypectomy in the colon (author's transl)].

Morbidity and lethality of 143 patients who had undergone surgical polypectomy in the colon were evaluated retrospectively; the transanal, transphincteral and transabdominal approaches have been used. Because of the size of the adenoma transabdominal surgery was done in 92 patients (54 colotomy, 10 segmental resections, 28 more extended resections of the colon). Colotomy alone had a complication rate of 23.7% and a lethality of 3.3%. On comparing results of colotomy and coloscopic polypectomy it can be stated, that the surgical approach is no alternative any more because of its high complication rate. Surgery is only indicated, when polyps are too big to be removed by the coloscopic approach.

Adenoma↗