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Biomedical subjects

R E Hermann

Publications and source records attributed to R E Hermann.

137 records · Page 8Linked to original sources
PubMedDate not supplied

Trends in bile duct injuries from laparoscopic cholecystectomy.

Bile duct injuries are a serious complication of cholecystectomy. Laparoscopic cholecystectomies (LC) were originally associated with an increased incidence of injuries. Patients referred to a tertiary center were reviewed to assess the trends in the number, presentation, and management. Seventy-three patients were referred over a 6-year period with a maximum of 17 patients referred in 1992, but the number has not declined substantially over time. The persistent number of referrals is a consequence of ongoing injuries. One third of injuries were diagnosed at LC, and the use of cholangiography has not increased. The number of cystic duct leaks has not decreased and they represent 25% of all cases. The level of injury has remained unchanged with Bismuth types I and II in 37% and types III and IV in 38%. Excluding patients with cystic duct leaks, 58% were referred after a failed ductal repair. Definitive treatment with biliary stenting was successful in 37%, and 34 patients (47%) required a biliary-enteric anastomosis. Complications occurred in 18 patients (25%) including seven with postoperative stricture or cholangitis. No biliary reoperations have been performed at a mean follow-up of 36 months.

Acute Disease↗
PubMedDate not supplied

Chronic mesenteric venous thrombosis: difficult diagnosis and therapy.

Chronic mesenteric venous thrombosis is an uncommon problem that can occur spontaneously or secondary to trauma, contiguous inflammation, or hypercoagulable states. Diagnosis is often difficult, and therapy is controversial. Surgery and/or anticoagulation may be needed. The authors describe the clinical presentation and management of a patient with this unusual condition.

Chronic Disease↗
PubMedDate not supplied

Perioperative blood transfusion and survival of breast cancer patients after modified radical mastectomy.

To investigate the effect of perioperative blood transfusion on the survival of patients with breast cancer, the authors reviewed the clinical records of 455 patients who underwent modified radical mastectomy between 1960 and 1979. Thirty-eight patients (8.4%) received blood transfusions. For stage I patients who received perioperative transfusions, 5- and 10-year survival rates were 53% and 47%; for the no-transfusion group, the rates were 93% and 85%. There was also a significant difference in disease-free survival for stage I patients: for the transfusion group, 5- and 10-year survival rates were 47%; for the group not receiving a transfusion, the rates were 89% and 84%. For stage II patients, there was no difference in total or disease-free survival between those who received transfusions and those who did not, and both groups had comparable distribution of nodes.

Blood Transfusion↗
PubMedDate not supplied

Breast-conserving surgery: how much is enough?

Breast-conserving operations for the treatment of small, apparently localized invasive breast cancer are now accepted by most surgeons. Still controversial are (1) the size of the primary tumor selected for breast conservation treatment, (2) how much breast tissue must be removed to provide an "adequate" margin to achieve local control, and (3) whether the entire breast needs to be treated by radiation therapy in all patients after adequate partial mastectomy. The results of breast-conserving operations at the Cleveland Clinic are presented and the case for selected, individualized therapy utilizing partial mastectomy without radiation therapy for selected patients with small invasive cancers is made.

Breast Neoplasms↗
PubMedDate not supplied

Removal of trypsin complexed alpha-2 macroglobulin by plasma fractionation.

The aim of this study is to assess in vitro the efficacy of a plasma fractionator to remove trypsin complexed alpha 2MG (alpha-2 macroglobulin) from human plasma in a manner analogous to the reticuloendothelial system (RES). Eval filter type "4A" (Kuraray Co., Osaka, Japan) was chosen as a plasma fractionator. Two and one half liters of bovine trypsin spiked human plasma was perfused in vitro through the fractionator in a single pass mode (n = 5). The concentrations of complexed alpha 2MG, total alpha 2MG, albumin, and IgM were measured before and after fractionation, and the concentration of free alpha 2MG and the sieving coefficients of each solute were calculated. The concentration of the trypsin complexed alpha 2MG measured by ELISA was significantly decreased by fractionation with Eval "4A" from 103.7 +/- 16.7 to 13.8 +/- 8.2 mg/L (reduction of 86.7%). Mean sieving coefficients of each solute were 0.133 +/- 0.079 in complexed alpha 2MG, 0.203 +/- 0.065 in free alpha 2MG, 0.203 +/- 0.065 in total alpha 2MG, 0.770 +/- 0.130 in albumin, and 0.070 +/- 0.010 in IgM. Although in vivo study will be required in patients with acute pancreatitis, in vitro study shows the feasibility of membrane plasma fractionation in eliminating trypsin complexed alpha 2MG.

Acute Disease↗