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N Runkel

Publications and source records attributed to N Runkel.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Risk factors for postoperative course after resection for Crohn disease].

Conservative surgery in Crohn's disease causes multiple enteral anastomoses. In 120 patients who underwent resectional surgery for Crohn's disease with a total of 165 anastomoses we analyzed the risk factors (a) number of anastomoses per operation, (b) preoperative cortisone, and (c) the resection margins in relation to the major postoperative complications. With a total of five major complications and no mortality we could not observe an increased risk for a higher morbidity in Crohn's disease surgery with multiple anastomoses.

Adolescent↗
PubMed1998

[Intraoperative isotope-controlled probe localization after somatostatin receptor scintigraphy of occult neuroendocrine tumors].

Intraoperative gamma detection of GEP tumors with a manual probe following i.v. 111In-DTPA-D-Phe1-Pentetreotide is a new and expensive procedure. This study analyses its value in nine patients with occult lesions (undetected preoperatively). All lesions with the exception of a 8-mm liver metastasis were correctly diagnosed intraoperatively. The tumor/normal tissue ratios were in vivo 1.3 (1.1-2.0) and ex vivo 23.0 (9.4-24.0). False-positive results were obtained three times in vivo and once ex vivo. Sensitivity was 89% and specificity 57%, respectively. All lesions were successfully detected by careful surgical exploration. We conclude that intraoperative gamma detection offers little additional information over standard diagnostic procedures.

Adult↗
PubMed1998

[Benign thyroid gland diseases in childhood and adolescence--early indications for surgical therapy].

Thyroid diseases in childhood and adolescence are mainly diffuse goiters due to iodine deficiency, which should be treated conservatively. Thyrotoxicosis, in the majority due to Graves' disease, is usually treated conservatively, and remissions can be expected in only 20%. Our prospective data from 21 patients under 20 years of age show that primary surgery is favored in young patients because of its prompt and permanent success. Minimal postoperative morbidity is the precondition for this approach. Preoperative conservative treatment for more than 2 years causes a significantly higher incidence of persistent ophthalmopathy postoperatively. Thyroid nodes in children are malignant in 20-30%. Consequently, all children and adolescents with nodular thyroid disease should have a primary lobectomy.

Adolescent↗
PubMed1997

Low acute toxicity of radiotherapy and radiochemotherapy in patients with cancer of the anal canal and HIV-infection.

Although not an AIDS-defining malignancy, anal cancer is an evolving problem in HIV-infected patients. Treatment-tolerance to radiotherapy as well as to chemotherapy is supposed to be reduced in patients with HIV-infection. From January 1995 to January 1997, four patients with epidermoid cancer of the anal canal and a long history of HIV-infection but without symptoms of AIDS or repeated severe infections were treated with radiotherapy (n = 1) or radiochemotherapy (n = 3). External beam radiotherapy with 45 Gy to the tumor and pelvic as well as inguinal lymphatic drainage was administered. In tumors larger than T2 N0 lesions an additional boost of 9 Gy was given. Chemotherapy consisted of 5-fluorouracil 1000 mg/m2/24 h, d 1-4 two cycles and Mitomycin C either 1 x 15 mg/m2, d 1 in the first, or 2 x 10 mg/m2, d 1, in the first and fifth week of radiotherapy. Acute reactions were mild to moderate in all patients and all but one treatment could be given as scheduled (1 patient with a delay of 4 days). No excessive acute reactions were seen. Because of the short follow-up, late reactions and local control are not yet evaluable.

Adult↗
PubMed1997

[Prognostic factors in mesenteric infarct].

Between 1979 and 1995 we operated 141 (80 female/61 male) patients with acute mesenteric ischemia (AMI) in our department with a median age of 71.5 years. We found 107 arterial occlusions of the intestinal arteries, 16 patients with splanchnic vein thrombosis and 18 non-occlusive-AMI. We performed 46 bowel resections, 24 vascular interventions, 11 combinations of both and in 60 cases laparotomy alone. The mortality rate was 70.9% (75% in over 70 years old patients and 65% in under 70 years old patients). Acute mesenteric ischemia remains a disease with a high mortality between 60 and 80%. Prognostic factors include the time interval until surgical intervention, elevated WBC and serum-lactate level. The mortality rate is higher in elderly patients than in younger patients which is mainly due to delayed surgery in the elderly group. If surgery is performed early the survival rate increases independent of age. The most important prognostic factor and the only factor that can be influenced by the surgeon is the time interval between onset of symptoms and surgery. Therefore angiography or laparotomy should be performed as early as possible in cases of suspected AMI.

Adult↗
PubMed1997

Alcoholism and carcinoma change the intracellular pH and activate platelet Na+/H+-exchange in men.

The occurrence of carcinoma in chronic alcoholics exceeds that of the general population. Cytoplasmic alkalinization, due to the influence of different factors on the transmembrane Na+/H+ exchange (NHE), has been put forward as a triggering event in cell growth and division. In accordance with these findings, the carcinogenic potential of NHE deficient cell types is reported to be diminished. The aim of this study was to investigate whether the intracellular pH and the NHE activity is altered in chronic alcoholics. Seventy-two Caucasian males were assigned to one of four groups: non-alcoholics without carcinoma, chronic alcoholics without carcinoma, non-alcoholics with carcinoma and chronic alcoholics with carcinoma. Alcoholism was diagnosed according to DSM-III-R. The groups did not differ in relation to basic patient characteristics, such as age and blood pressure. Intracellular calcium, pH and NHE in platelets were determined by spectrofluorometry before and after thrombin stimulation. In chronic alcoholics with carcinoma, the intracellular pH was significantly more alkaline and the NHE activity was elevated. In contrast, a decrease in intracellular pH associated with an increased activity of NHE and a more acidic set point was found in chronic alcoholics without carcinoma. Basal and thrombin stimulated intracellular Ca2+ did not differ between groups except in chronic alcoholics with carcinoma in whom a thrombin-induced increase of Ca2+ due to liberation of Ca2+ from intracellular stores was demonstrated. In chronic alcoholics with carcinoma, cytoplasmic alkalinization was observed and this may be an indication of an increase in cell proliferation. The possibility that the increased incidence of carcinomas in chronic alcoholics is related to the increased activity of NHE and whether this may be prevented by NHE inhibitors requires further investigation.

Adult↗
PubMed1997

[Between bench and bedside: examples of clinically oriented basic surgery research].

Animal experimental studies are an effective modality for testing new therapeutic strategies, provided that the animal model and the study protocol simulate the clinical situation. This is exemplified by various animal experimental studies on the therapy of infectious complications in acute necrotizing pancreatitis that were performed preliminary or supplementary to clinical studies. The results show that basic surgical research with close clinical orientation can be usefully and fruitfully combined with clinical studies and enables the academically active young surgeon to overcome the dualism between laboratory work and clinical practice.

Animals↗
PubMed1997

[Surgical research with limited resources: research concepts and research cooperation in a surgical University Clinic].

The decreasing financial support of surgical research requires new strategies and, in particular, an intensive collaboration with basic science and biotechnology. This concept of "lean research" includes output-orientated research activities, which can be measured, using the "impact factor". Effective research requires a well-organized and structured department.

Cost-Benefit Analysis↗
PubMed1996

Intensive care unit stay is prolonged in chronic alcoholic men following tumor resection of the upper digestive tract.

BACKGROUND: The prevalence of chronic alcohol misuse in patients with oral, pharyngeal, laryngeal or esophageal carcinomas exceeds 60%. No data is available, to our knowledge, on the morbidity and mortality of chronic alcoholics in surgical intensive care units (ICU) following tumor resection. We investigated whether the subsequent ICU stay in chronic alcoholics following tumor resection was prolonged and whether the incidence of pneumonia and sepsis was increased. METHODS: 213 patients with carcinomas of the upper digestive tract were evaluated regarding their drinking habits. Chronic alcoholics met either the DSM-III-R criteria for alcohol abuse or dependence. Conventional laboratory markers and serum carbohydrate-deficient transferrin were determined preoperatively. Major intercurrent complications during ICU stay such as an alcohol withdrawal syndrome, pneumonia and sepsis as well as the frequency of death were documented. RESULTS: Patients did not differ significantly between groups regarding age or APACHE score on admission to the ICU.121 patients were diagnosed as being chronic alcoholics, 39 as being social drinkers and 61 as being non-alcoholics. In chronic alcoholics the frequency of death was significantly increased. Due to the increased incidence of pneumonia and sepsis the ICU stay was significantly prolonged in chronic alcoholics by approximately 8 days. CONCLUSIONS: The increased mortality and morbidity rate demonstrates that chronic alcoholics undergoing major tumor surgery have to be considered as high-risk patients during their postoperative ICU stay. Further studies are required with respect to the immuno-competence of chronic alcoholics and the prevention of alcohol withdrawal syndrome, pneumonia and sepsis in these patients.

APACHE↗
PubMed1996

Fulminant metastatic calcinosis with cutaneous necrosis in a child with end-stage renal disease and tertiary hyperparathyroidism.

Metastatic calcinosis is a common feature of chronic renal failure. Its first manifestations are bone demineralization and non-visceral and/or visceral calcification with mostly mural deposits in arteries and arterioles. It is initially characterized by hyperphosphataemia followed by secondary or tertiary hyperparathyroidism. Cutaneous involvement is a rare complication. Histologically, the lesions show vascular calcification with ischaemic skin necrosis. Extreme cases may produce calcinosis cutis (calciphylaxis), i.e. disseminated calcification of the subcutaneous tissue and dermis in the form of hard painful cutaneous nodules and plaques with subsequent ulceration. Metastatic calcinosis is a disease affecting adults, while the dystrophic or idiopathic type can develop in children. We present the case of a 6-year-old boy with end-stage renal disease, attributed to congenital renal hypoplasia, and accompanied by secondary hyperparathyroidism. He developed fulminant tertiary hyperparathyroidism and metastatic calcinosis of the lungs, as well as cutaneous necrosis of the buttocks and legs, subsequent to calcification of arteries and arterioles. A maternal renal transplant failed to function. The serum parathormone, calcium and phosphate levels could not be controlled by maintenance dialysis, phosphate binders and calcitriol. Total parathyroidectomy without autotransplantation of parathyroid tissue rapidly returned the serum parathormone, calcium and phosphate levels to normal. In addition, topical treatment using merbromine solution and hydrocolloid dressings, healed the ulcers with significant scar formation, within 2.5 months after parathyroidectomy. A renewed increase of the calcium x phosphate product, 2 months after parathyroidectomy, was attributed to mobilization of calcium compounds from the viscera, as confirmed by a chest X-ray.

Calcinosis↗
PubMed1994

[Surgical standards in primary colon cancer].

The surgical standards in the treatment of primary cancer of the colon include the radical resection of the tumor-bearing colon with truncal ligation of its vessels. Eradication of the tumor with complete dissection of the lymphatic drainage area increases the chance for cure (R0). The lymphatic dissection determines the extent of colonic resection: right hemicolectomy (ileo-transversostomy) with truncal ligation of the iliocolic and right colonic arteries for carcinomas of the cecum and ascending colon; transverse colectomy (ascendo-descendostomy) with ligation of the middle colic artery for carcinomas in the middle of the transverse colon; left hemicolectomy (transverso-rectostomy) with ligation of the inferior mesenteric artery at the aorta for cancer of the descending and sigmoid colon; extended sigmoid resection (descendo-rectostomy) with central lymphadenectomy and ligation of the inferior mesenteric artery distal to the left colic artery for cancer of the distal sigmoid colon. Carcinomas located in between two drainage areas (lateral transverse colon, hepatic or splenic flexure) are treated by extended hemicolectomies or subtotal colectomies with dissection of two lymphatic drainage areas. The monobloc no-touch isolation technique requires the ligation of vessels prior to the mobilisation of the colon. Exceptions from these standard operations (limited resections) are necessary for metastatic disease or in the acute emergency situation of perforation or obstruction. Application of these surgical principles will ensure the best possible treatment results in primary colonic cancer.

Anastomosis, Surgical↗
PubMed1993

[Mesenteric cysts: rare cause of abdominal pain].

For about two years a now 47-year-old woman had been suffering from heartburn, diarrhoea and constipation, at times also abdominal colic and a pressure sensation in the right lower abdomen. Physical examination and biochemical tests were according to age, except for an raised erythrocyte sedimentation rate of 25/50 mm. Ultrasound revealed an intraperitoneal echo-free multi-chambered structure, 11 x 5 x 2 cm, with dorsally increased echo density and smooth entry echo, apparently arising from the mesentery. Computed tomography confirmed these findings and at laparoscopy a cyst, 12 x 8 x 5 cm, was identified. It was filled with yellow clear fluid and arose from the mesentery of the ascending colon. The cyst was scooped out surgically. Histological examination showed a single-layered mesothelial coat. The postoperative course was unremarkable. At re-examination 8 months later the patient had remained symptom-free.

Abdominal Pain↗
PubMed1993

Use of the hydrogen clearance technique for measurements of pancreatic blood flow.

The hydrogen clearance technique (HCT) was employed for measurements of local pancreatic blood flow (PBF) in dogs, opossums, and rats under normal conditions and in opossums during biliary pancreatitis. Local PBF (ml/min/100 g) in dogs was 57.6 +/- 10.4, in opossums 60.6 +/- 9.5, and in rats 144.7 +/- 23.4, under resting conditions. Regional distribution of local PBF in dogs showed no statistical differences. Technical aspects of the HCT were described in detail. Under physiological conditions parenchymal trauma following electrode implantation was negligible in nearly all cases. More than 95% of registered clearance curves were monoexponential and showed excellent reproducibility of PBF values in repeated measurements (percentage deviation < or = 6.7). Five days after initiating biliary pancreatitis by common channel ligation in opossums local PBF was 72.1 +/- 14.7 after implantation of new electrodes. Chronically implanted electrodes, however, recorded only 39.7 +/- 15.8, due to massive fibro-proliferative alterations around the implanted electrode tips. We therefore conclude that the HCT as described is a useful tool for measuring local PBF in acute experimental settings only. Biliary pancreatitis in our model causes no significant alterations of PBF after 5 days.

Animals↗
PubMed1993

Is the hydrogen clearance technique a useful tool for measurements of pancreatic blood flow during acute experimental pancreatitis?

Changes of pancreatic blood flow (PBF) during acute pancreatitis (AP) have been under investigation by means of electromagnetic flowmeters, radioactive microspheres, isotope fractionation, radioactive gas clearance, and venous outflow techniques. All methods, however, have certain drawbacks, which make the application of other techniques desirable. In this study, the hydrogen clearance technique (HCT) was tested for the first time in a well-established foxhound model of AP. PBF, systemic blood pressure, and heart rate were monitored over 90 min after the onset of AP and 60 min after therapeutic infusion of Dextran-40 (10 ml/kg body wt). Our results fully agree with the data found by other techniques in this experimental model. Sixty-five of 73 electrodes implanted into the pancreas of eight foxhounds were found working. From 1,024 registered clearance curves, 876 were identified as monoexponential. In the other cases, and only then, we found either dislocation of the electrode tips (n = 6) or perielectrodal hemorrhage during histological examination (n = 4). We believe that the HCT is a feasible and reliable tool for measuring PBF in experimental settings like AP.

Acute Disease↗
PubMed1993

[Isolated Ledderhose fibromatosis plantaris].

Plantar fibromatosis or Ledderhose syndrome has rarely been discussed in the medical literature. This clinical entity includes nodular Dupuytren-like indurations of the plantar aponeurosis. We present a case of a young man with isolated disease of his right foot and describe the clinical and pathomorphological features of this disease as well as its characteristic findings at magnetic resonance tomography. The therapy of choice is a subtotal resection of the plantar aponeurosis to prevent irreversible contractions of the toes. The prognosis following fascietomy is good.

Adult↗
PubMed1992

Hormonal control of opossum sphincter of Oddi motility: role of myoneural continuity to duodenum.

Motilin and caerulein are known to affect motility of the sphincter of Oddi (SO) and the gastrointestinal tract. The role of SO-duodenal myoneural continuity in the action of these peptides was studied. Five opossums had translocation of the duodenal papilla into the jejunum, while preserving the blood supply to the SO and duodenum. Serosal electrodes were placed in the SO, duodenum, and jejunum. Five control animals had electrode placement alone. Myoelectric recording was obtained during fasting and after administration of motilin (400 ng/kg) or caerulein (500 ng/kg/hr). Motilin induced premature phase III-like activity in the SO and intestine in controls. After the translocation of the papilla, the spike frequencies during phase II and phase III were significantly lower than in controls, whereas those during phase I and phase IV were not different. Motilin caused premature intestinal phase III and increased SO spike activity. However, the increase in SO spike activity was insufficient to form phase III. Caerulein produced a sustained increase in spike activity in both regions in both groups, but the increase was less in the translocation group than in controls. These data suggest that duodenal activity stimulated by motilin and caerulein participates in the activation of SO motility via intrinsic myoneural pathways.

Animals↗