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Biomedical subjects

R Häring

Publications and source records attributed to R Häring.

At least 19 recordsLinked to original sources
PubMed1992

[Multivisceral and extended resection in tumor surgery: stomach cancer].

The aim of curative surgery in gastric cancer is the complete removal of all tumour bulk both macroscopically and microscopically (R0 resection). The operative strategy should consider the location of tumor, its histological character (Laurén classification), and the stage of disease according to the TNM-classification. Lymphadenectomy of compartments I and II does not increase operative morbidity and mortality if performed routinely, but seems to increase long-term survival in patients with stages II and IIIa disease. Routine removal of the spleen does not lead to better results. Gastrectomy in locally advanced gastric cancer with combined resection of adjacent organs can prolong survival in absence of peritoneal disseminating or distant metastases if R0 resection is achieved. The indication for gastrectomy of patients with an incurable stage of disease (peritoneal dissemination, distant metastases) should be determined after considering the individual status of the patient and surgical risk and can be performed as a so-called ultima ratio resection with the aim of palliation.

Follow-Up Studies↗
PubMed1992

[Cystadenoma and cystadenocarcinoma of the pancreas. Symptoms, diagnosis and surgical consequences].

Seven cases of cystadenomas and cystadenocarcinomas were presented and the treatment of the cystic tumours of the pancreas was discussed in a surgical point of view. Distinction between true cysts like cystadenomas and pseudocysts following pancreatitis is of paramount importance. The clinical findings are mostly uncharacteristic and determinated by the late symptoms. The diagnosis of cystic tumours can usually be made by radiological imaging technique. Intraoperative examination of the frozen-sections is of paramount importance for the choice of the surgical procedure and hence the prognosis of the patient. Radical surgery is indicated in case of cystadenoma or cystadenocarcinoma. Every mucinous cystic neoplasm should be completely examined in carefully lamillated sections in order to identify its malignancy.

Adult↗
PubMed1991

Evaluation of endosonography in TN staging of oesophageal cancer.

Strategies for the treatment of cancer of the oesophagus depend on the tumour stage at the time of diagnosis. Resection, the only curative treatment, is confined to early tumour stages. Tumours with local infiltration are usually unresectable and require palliative treatment. Computed tomography has been widely used for preoperative staging but often fails to define this correctly. Endoscopic ultrasound allows direct visualisation of the parietal wall and may be useful in staging gastrointestinal tumours. In a comparative prospective study, 52 patients with tumours of the oesophagus were investigated preoperatively both by endoscopic ultrasound and computed tomography to determine the stage of tumour infiltration and local lymph node involvement. Thirty seven of these patients underwent operation, resection, or dissection and entered the study. The intraoperative findings or the histopathological assessment, or both, were taken as a reference. For all TN stages of oesophageal tumours, correct preoperative staging was accomplished by endoscopic ultrasound in 89% for T stage and 69% for N stage compared with 51% and 51% respectively by computed tomography (highly significant using Fisher's exact test). This study shows that endoscopic ultrasound is useful in preoperative TN staging of tumours of the oesophagus.

Adult↗
PubMed1991

[Therapeutic protocols in the treatment of liver metastases].

The liver is the main site for metastatic spread from many cancer, particularly those of the colorectum. Surgical treatment of liver metastases is nowadays a safety therapeutical approach, which has been improved by the development of modern imaging procedures, clear indications and standardized surgical techniques. In carefully selected patients the 5-year survival ranges between 30-40%. Unfortunately only 20% of the patients with liver metastases are candidates for this potentially curative therapy. Palliative modalities remain for the majority of patients with unresectable metastases limited to the liver. Although various types of intrahepatic arterial chemotherapy, sometimes in combination with whole liver irradiation or embolization shows a higher response rate than systemic chemotherapy no significant impact on survival time has been proven. One of the main unsolved problem is the extrahepatic spread. For getting better results--median survival of responders ranges between 18 to 24 months versus 8 months of non-responders--a more exact selection is needed.

Antineoplastic Agents↗
PubMed1991

[Results of surgical therapy of esophageal carcinoma].

In esophageal cancer radical resection of the affected segment is the therapy of choice for tumours confined to the wall. Palliative resection at advanced tumour stages does not improve survival and markedly increases mortality. Neither chemotherapy nor radiation influence the survival rates. Tumours of the middle third are resected by the thoracic approach, while tumours of the lower third may be resected by blunt dissection. The best reconstruction is achieved by interposition of the stomach. The jejunum or colon may be interposed in the case of a previous gastric resection. In our department, postoperative mortality was 8.8%, corresponding to 137 operations with stomach interposition. The 5 year survival rate was 39.9% in stage I and II and 10.6% in stage III and IV. Complications and mortality were markedly increased in advanced tumour stages. The thoracic approach was not correlated with higher postoperative lethality.

Adult↗
PubMed1991

[Experiences with intraoperative radiotherapy in gastric carcinoma (Berlin method)].

The aim of our pilot study is to determine whether intraoperative radiotherapy in gastric cancer cannot only prevent a local relapse but also improve the survival rate. Since November 1987, 26 patients with resectable gastric cancer were irradiated intraoperatively with the linear accelerator using fast electrons (single dose: 12 to 16 Gy). Percutaneous radiotherapy was performed postoperatively with 24 to 38 Gy (4 x 2 Gy per week). For intraoperative and percutaneous radiotherapy the target absorbed dose was selected in a way that their combined effect on the tumor was approximately equivalent to that of a total dose of 60 Gy in the usual fractionating. Up to now, the median survival time for stage III patients (UICC 1987) has been twelve months. In five patients who died of a relapse or of peritoneal carcinosis, histologic evaluation revealed in every case a diffuse tumor type according to Lauren-classification. All relapses occurred within the first eight months. The two-year survival rate according to Kaplan-Meier is 67% for stage III. Advanced resectable gastric cancer of the intestinal tumor type seems to profit from adjuvant intraoperative radiotherapy. The results warrant further research within the framework of a prospective randomized multicenter study.

Adenocarcinoma↗
PubMed1990

[Prevention of thrombosis with low molecular weight heparin as the only substance and/or with DHE: results of clinical studies].

In aspect of the high incidence of thrombosis and the resulting risk of fulminant pulmonary embolism and late complications, there is a demand for a general medical prophylaxis in operative medicine. A new chance to reduce the incidence of thrombosis is the recently developed low weight molecular heparine (LWMH). Current studies of different LWMH in general and thoracic surgery prove, that an effective decrease of thrombosis can be achieved with a single daily injection. Effectiveness of LWMH in high risk patients have not been sufficient evaluated yet in some of the used preparations.

Dihydroergotamine↗
PubMed1990

[Emergency and early portasystemic shunt: indications and results].

The definitive hemostasis is the key to successful therapy of variceal bleeding. There is a difference between the emergency operation for persistent bleeding in spite of initial sclerosing therapy and the planned early operation for primary massive bleeding, early recurrence of bleeding and bleeding of fundus varicosis. The lethality is about 50% for the emergency operation, about 12% for the early operation (Berlin). For the emergency situation the portacaval end-to-side anastomosis is favoured. The result of this therapeutical concept in Bonn (1989-1990) for 47 patients admitted for bleeding was a hospital lethality of 23%.

Aged↗
PubMed1990

[Sequelae and long-term results following portasystemic anastomoses and significance of ambulatory after care].

After portocaval anastomosis 149 cirrhotic patients were treated on an outpatient basis. Liver insufficiency was observed in 24%. Encephalopathy was chronic in 14% and episodic in 11%. The most common postoperative complication was edema of the ankle (48%). Further operations bore a minimal risk (mortality 3/22). Sixty-eight percent of the patients agreed to abstain from alcohol; 85% took vacation trips and 95% were satisfied with the operation.

Aftercare↗
PubMed1990

[Differentiated cancers].

A total of 119 papillary and 67 follicular thyroid carcinomas were subdivided according to the WHO classification of 1988 in the morphological subtypes of occult, encapsulated and invasive carcinomas. The patients were monitored over a followup period of 16 years postoperatively. Initially 10.6% of all patients with early follicular carcinoma had distant metastases and 2 of 19 died of carcinoma. In cases of early papillary carcinoma there were no distant metastases and no deaths. Limited thyroid surgery is recommended as curative surgery only for such patients.

Adenocarcinoma↗
PubMed1990

[Surgical and oncologic principles of the removal of the rectum].

Excision of the rectum should take in account that the main lymphatic spread follows the cranial route and that dissection of the rectal wall should be performed across its adjacent anatomical lamellae. It is not clear whether an extensive pelvic dissection and high ligature of the inferior mesenteric artery are beneficial. Spontaneous or iatrogenic perforation of the tumour considerable increases the incidence of local recurrence. The frequency of postoperative urinary and sexual dysfunction ranges from 3.5-57% and 14-38% respectively. The reported surgical mortality averages 5-6%.

Follow-Up Studies↗
PubMed1990

[Injuries of the small and large intestine following blunt abdominal trauma].

From 1979 to 1987 1428 patients with blunt abdominal trauma were treated in the Department of Surgery of the University of Freiburg; 119 patients had intestinal injuries. They were mainly young adults who had sustained a car accident. 71.3% of the small bowel injuries were overseen, 14.2% needed resection, and in 14.5% an operative procedure was not necessary. The surgical procedure for colonic injuries has to be chosen with regard to the age and general condition of the patient, to the severity of the trauma, to associated injuries and to the stage of peritonitis. Accordingly, 18% of the patients were treated with and 58% without a protective colostomy, 24% could be treated conservatively. Mortality and morbidity correlated with the severity of associated injuries. Morbidity was also dependent on the time interval between accident and operative therapy.

Adult↗
PubMed1989

[Experiences with endoscopic recanalization using the Nd-YAG laser in tumor ileus and inoperable rectal cancer].

In the time period from January 1, 1987 until October 1, 1988, a total of 17 patients with an advanced colorectal tumor underwent transendoscopic laser treatment with the Nd-YAG laser. Eight patients had a tumor-dependent passage disorder with a large intestinal ileus as initial finding. Recanalisation and decompression of the intestine were successfully performed in 7 cases, so that placement of an anus praeternaturalis could be avoided. In another 8 patients the advanced rectal tumors were subjected to laser irradiation, 6 times because of subtotal stenosis and 3 times because of tumor bleeding. A locoregional radiatio (afterloading) was performed in each case.

Aged↗
PubMed1989

[Basic principles of rectal excision].

Rectal excision has decreased by half in favour of anterior resection of the rectum. The following points should be observed during operation: (1) dissection close to the rectal wall to avoid injury to the sacral veins and nerves for both bladder and sexual function; (2) ligature of the sup. rectal artery; ligature of the inf. mesent. artery has not been established to be advantageons; (3) avoidance of tumor perforation; (4) primary occlusion of the sacral cavity with extravulnar suction drainage. The results are as follows: 5-6% death rate in the literature and 2.4% in our own patients; bladder dysfunction in 3.5-59%; sexual dysfunction 14-36%; impotence 14-28%; local recurrence 39-57% with and 34% without perforation.

Colostomy↗