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Biomedical subjects

R Engemann

Publications and source records attributed to R Engemann.

At least 19 recordsLinked to original sources
PubMed2006

[Interdisciplinary clinical pathway for colorectal cancer].

Limited financial resources in public health care have led to the introduction of clinical pathways as a means to a better effectivity and efficacy. Colorectal cancer met the requirements for establishing such a pathway in a distinguished way: high patient volume, high costs, interdisciplinary multi-modal treatment concepts in a relevant frequency, and existing evidence based guidelines. This article gives an example of a clinical pathway for colorectal cancer as established in our hospital. The potential of such pathways to save costs as well as their implications on treatment results and patients' satisfaction will have to be critically analyzed in the future before their value can be definitely estimated.

Colorectal Neoplasms↗
PubMed2004

IgM-enriched immunoglobulin (pentaglobin) positively influences the course of post-surgical intra-abdominal infections.

BACKGROUND: Polyvalent IgM-enriched intravenous human immunoglobulin (IVIG) preparations are discussed to be beneficial regarding sepsis outcome. MATERIALS AND METHODS: Sixty-four patients with abdominal infection were treated with Pentaglobin or Albumin. Serum levels of endotoxin and chemokines were determined. RESULTS: Incidence of fever was 19/28 in the pentaglobin and 18/26 in the albumin group, the percentage of days with fever was 34 +/- 26 for pentaglobin and 43 +/- 25 for albumin (mean +/-SD). Procalcitonin levels of the pentaglobin treated patients fell under the upper limit of normal on day six whereas levels of albumin patients remained elevated. CONCLUSION: Pentaglobin has a positive influence on the course of post-surgery intra-abdominal infection.

APACHE↗
PubMed2004

[Pancreatic tail tumor as an unusual first manifestation of Wegener's disease].

A fifty-year-old, previously healthy woman presented with abdominal pain and weight loss. Diagnostic work-up revealed a mass in the tail of the pancreas with the appearance of a pancreatic carcinoma. Partial pancreatectomy was performed. Postoperatively, the patient's kidney function deteriorated. Pathohistological examination of the resected tissue showed a granulomatous vasculitis but no maligant tumor. Renal biopsy revealed a rapid progressive glomerulonephritis. Positive C-ANCA screening confirmed the diagnosis of Wegener's disease and an immunosuppressive therapy was established. This case demonstrates the difficult management of a potentially benign pancreatic mass, as reliable discrimination from pancreatic adenocarcinoma is not always possible.

Abdominal Pain↗
PubMed2001

Success in treatment of complicated diverticular disease is stage related.

The clinical stage of disease is one of the many factors affecting outcome after treatment for complicated diverticular disease. We retrospectively assessed surgical results during the period 1994-1999 in 406 patients with complicated diverticular disease, according to the stage of disease, surgical technique, postoperative complications, and mortality. Single-stage resection and primary anastomosis were performed safely in most patients with stage I or II disease. Severe complications were rare in stage I but increased in incidence with higher stages. Patients with stage III are a high-risk group. This stage often requires a two-stage procedure (primary anastomosis and protective ileostoma or the Hartmann procedure). Despite these measures, many severe complications occurred in stage III.

Anti-Bacterial Agents↗
PubMed1998

Overview on compression anastomoses: biofragmentable anastomosis ring multicenter prospective trial of 1666 anastomoses.

This study represents a European prospective clinical multicenter trial and was undertaken to evaluate the applicability of the biofragmentable anastomosis ring (BAR) as a routine anastomotic tool in teaching hospitals. The trial results analyzed consisted of 1666 BAR anastomoses performed in 1360 patients from March 1989 to May 1996 in the upper (1042 anastomoses) and lower (624 anastomoses) gastrointestinal (GI) tract. Only patients selected for elective procedures and having previously undergone orthograde bowel cleansing were entered into the trial. In the upper GI tract six anastomoses (0.58%) developed clinically relevant and radiologically detectable leaks with indications for reoperation. In the lower GI tract 42 (6.73%) anastomoses showed a radiologically detectable leak with clinical manifestations in 28 cases (4.48%). Reoperation was performed in 18 cases (2.80%). The overall leakage rate with clinical relevance was 2.04%. Three gastrojejunostomy episodes of bleeding were observed (0.18%) at the BAR anastomotic site. During the early postoperative course there was no ileus due to obstruction of a BAR anastomosis. Reintroduction of diet after the operation was not delayed. In two centers a follow-up evaluation reported no BAR-related late anastomotic stenoses. There were no intraoperative deaths, but 54 patients died postoperatively. Peritonitis following anastomotic leakage was responsible for postoperative deaths in four cases; three of them were related to BAR anastomoses. In conclusion, the BAR anastomotic procedure is an established, rapid, simple to learn, highly standardized, safe technique with the advantage of no persistent foreign material in the anastomotic region and therefore no induction of stenosis. At present, the application of anastomoses in various segments of the GI tract, from the stomach to the middle third of the rectum, can be recommended.

Adolescent↗
PubMed1995

[Combined liver-islet transplantation after epigastric exenteration in carcinoma of Vater's ampulla].

A 44 year old female underwent an upper abdominal exenteration because of an adenocarcinoma of the pancreas with liver metastases (T1 N1 M1). Reconstruction was performed by orthotopic liver transplantation and intraportal islet transplantation. Due to initial non function of the first liver graft, a second liver transplantation was performed. Thereafter, the patient received 375,000 islet equivalents of the primary liver donor in addition to 295,400 islet equivalents of another donor. Six months postoperatively, the patient is off insulin except irregular injections of 4-6 units of insulin to protect her from hyperglycemia after lunch. CT scans of the liver do not show any signs of tumor recurrence. Upper abdominal exenteration with consecutive islet transplantation offers a good method of reconstruction after radical surgery in the upper abdomen. The oncological aspects of the procedure have to be further investigated.

Adenocarcinoma↗
PubMed1994

[The functionally inactive endocrine pancreas tumor].

Endocrine tumors of the pancreas are extremely rare (1-3%). We present two cases with functional inactive tumors--one benign and one malignant--, which were immunohistologically secreting glucagon without having clinical symptoms. Differential diagnosis, operative strategy and therapy of endocrine tumors of the pancreas are discussed.

Adult↗
PubMed1994

[Pelvic pouches].

Since Nissen performed his first ileo-anal anastomosis for a benign large bowl disease in 1933, restorative proctocolectomy has undergone substantial developments, thus especially in the last two decades. Different pouch designs (J-, S-, W- and H-pouch) obtain normal defecation in patients treated with proctocolectomy. Many groups prefer the J-Pouch for it's technical simplicity and good results.

Adenomatous Polyposis Coli↗
PubMed1993

[Possibilities for the use of 2nd generation cephalosporins in perioperative antibiotic prophylaxis].

Perioperative antibiotic prophylaxis has proven to prevent infections in a variety of surgical interventions such as colorectal, biliary and vascular surgery. The antimicrobial spectrum of an antibiotic used for perioperative prophylaxis should include Staphylococcus spp., Streptococcus spp. and Escherichia coli which are among the most frequent pathogens isolated from surgical infections. Second generation cephalosporins provide appropriate activity against these microorganisms. In colorectal surgery, combination with an anti-anaerobic agent is mandatory. During the past few years no major resistance development has been observed against second generation cephalosporins which are used at a dosage of 1.5 to 2 g. A single dose may provide sufficient serum levels for approximately three hours. Prolonged surgical procedures need an additional dose. Single dose prophylaxis with a second generation cephalosporin appears to be an appropriate strategy for infection prevention in surgery with regard to efficiency, safety and costs.

Bacterial Infections↗
PubMed1993

[Use of surgical staplers on the upper gastrointestinal tract].

Mechanic or stapled anastomoses of hollow organs represent a safe and attractive alternative to the manual suture. The rate of complications for the duodenal stump closure by linear staplers is minimal with leakages below 1%; the same is true for the jejunum. In esophagogastrostomies which are often performed cervically, the stapler offers more safety compared to manual sutures, but the rate of stenoses is higher with about 15%. Stenoses have been observed especially with smaller magazines (25 mm diameter). For esophagojejunostomies safety is much greater with mechanic staplers than with manual sutures. Only most experienced surgeons would achieve the same results with the same low rate of leakages of less than 10%; stenoses do not have clinical relevance.

Anastomosis, Surgical↗
PubMed1993

[Use of surgical staplers in the lower gastrointestinal tract].

Practicability and indication for continuity preserving surgery increase by the use of staplers in the lower gastrointestinal tract. The mean rate of complications for the deep colorectal and colo-anal anastomosis decreased. Locoregional relapses occur as often as with other techniques, when the criteria of radicality have been observed. Stenoses are prevalently due to complications of extraperitoneal anastomoses. In higher large bowel sections, only a few surgeons favor the use of staplers, as the risk for the patient increases without offering particular advantages. The double stapling technique in deep anterior resection is possible for small tumors and a large pelvis. For colonic pouches linear staplers are completed by circular staplers for the subsequent pouchanal anastomosis. Studies are running, actually, regarding indication of the colonic pouch.

Anastomosis, Surgical↗
PubMed1993

[Enteral anastomoses in the area of the upper gastrointestinal tract with the biofragmentable anastomosis ring].

In a prospective study, 184 enteral anastomoses in the upper G1-tract using the biofragmentable anastomosis ring (BAR) Valtrac are described in 136 patients. 43 patients had 2 or 3 BAR in upper GIT, 4 patients one BAR in upper and one BAR in lower GIT and 1 patient had 2 BAR in lower GIT. 152 small bowel-small bowel anastomoses, 23 gastroenterostomies, 2 small bowel-colon and 6 colon anastomoses were created. One insufficiency was seen in a small bowel to small bowel anastomoses and one in a gastroenterostomy. One bleeding occurred in the anastomotic region of a gastroenterostomy. Even in cases of multiple use of the BAR no stenoses occurred. The use of these rings can be recommended beside in colon and small bowel to colon anastomoses also in upper GIT.

Adult↗