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Biomedical subjects

R Horch

Publications and source records attributed to R Horch.

33 records · Page 2Linked to original sources

Fractures of the pelvis: problems and results of surgical treatment.

Pelvic fractures have been the domain of conservative treatment and reduction by closed methods for a long time. In the last decades advances in classification and understanding of these often very complex fractures have been made. They are now discriminated into fractures of the apophysis, acetablar fractures and fractures of the pelvic ring. By a better understanding of the functional biomechanics and the morphological changes a number of clear and valid indications for operative procedures has been worked out. Certain pelvic ring disruptions and acetabular fractures can be stabilized after open reduction and provide better functional long time results. As the surgical approach and operative technique can be rather difficult and the concept has to be fitted to the individual case it is almost impossible to give general guidelines for the surgical management.

Acetabulum↗

Venous anastomoses for dialysis access--special techniques with the use of E-PTFE vascular prosthesis at the forearm.

Suitable veins of great diameter should not be the limitation for the use of E-PTFE prosthesis as a vascular access of second choice for chronic hemodialysis. A sufficient venous drainage has to be attempted inspite of possibly generally bad state of veins regarding the need for retrograde use of vessels. This can be achieved in such cases by careful vascular surgical technique performing multiple-anastomosis or establishing multiple-drainage. By the application of these rules vessels that would otherwise remain unused can be utilized for vascular access in chronic hemodialysis patients. Thus even few months of function after these procedures can be regarded as a success.

Anastomosis, Surgical↗

[The effect of lung diminishing interventions on immediate postoperative lung function and their modification by various forms of analgesia].

The influence of different lung resection methods on pulmonary function was studied in 34 patients suffering from bronchial carcinoma. Daily measurements from the 1st to 10th postoperative day reveal the greatest losses of function after right upper lobectomy. Lower lobectomies or left upper lobectomy resulted in a less extensive loss of function. Recovery of function mainly occurs in the first 4 days after operation. Centrally acting analgetics are followed by a loss in pulmonary function whereas locally applied analgetics improve early postoperative function.

Adult↗

[Results of treatment of anal cancer].

Symptoms, results of therapy as well as prognosis of carcinoma of the anal canal and anal margin are analyzed in 37 own patients, treated within 1977 and 1988. Most of the patients were between 55 and 75 years old. Women (n = 24) were twice as often afflicted as men. Bleedings and pain were the most frequent symptoms. At the end of this study 25 (71%) of the registered patients were still alive, 12 (34%) of them for more than 5 years. Different therapeutical procedures had been applied. Because of the own results the value of radical abdomino-perineal rectum amputation is stressed for invasive cancers, relapses and rest cancer after preceding adjuvant therapy. Multimodal treatment strategy with combined radiation-chemotherapy and individually adapted surgery is performed according to the literature. Valid results of the value of this procedure in our own patients however can not be given at the present time.

Adult↗

Anal cancer: current concepts and treatment results.

37 patients were treated upon carcinoma of the anal canal or anal margin between 1977 and 1989. Although combined radiochemotherapy is of increasing interest as the treatment of choice our patients who underwent radical surgery in form of abdominoperineal rectum resection only had a very good outcome. Combined multimodal therapy by radiation and chemotherapy may possibly be able to reduce the rate of necessary resections. Difficulties in finding out a relapse of disease after such treatments are discussed. The own experience with combined radio-chemotherapy is not large enough at the present time to make significant statements. Long term results have to be expected yet. Abdominoperineal rectum resection as a means of radical surgery still has its place in the spectrum therapeutic modalities of treating anal carcinoma.

Adenocarcinoma↗

[Results of the treatment of hepatic echinococcosis by hydatectomy].

In 72 patients with hydatid disease results and complications of different operation techniques are compared. Whereas we previously preferred pericystectomy and resecting methods we now perform irrigation and drainage in hydatid cysts of the liver. By use of a simple, flexible instrument even poorly accessible cysts can be transferred to irrigation and drainage therapy. Results of this procedure are good. The complication rate was decreased.

Adolescent↗

Treatment of anal fissure: a comparison of three different forms of therapy.

454 patients with a fissure-in-ano were treated by different forms of therapy. In a follow-up we examined 314 patients, 178 of them having been treated by anal stretch, 60 of them by subcutaneous lateral sphincterotomy and 76 of them by conservative measures. Most of the anal stretched patients were free of symptoms. Only few of them had to be treated again for the same disease by their physician. Anal stretch--similar to sphincterotomy--breaks the pathologically raised sphincter tone. We therefore propose anal stretch gently performed over a period of 3-5 minutes under general anaesthesia as the method of choice for the initial treatment of anal fissure. In cases of relapse we recommend lateral sphincterotomy by an experienced operator.

Evaluation Studies as Topic↗

[The incidence of recurrent laryngeal nerve paralysis following thyroid surgery].

We examined the histories of 789 thyroid resections for the influence of the type of disease and the kind of operative procedure on the frequency of recurrent laryngeal nerve lesions. In operations for benign goiter the amount of recurrent nerve palsy was 1.8%, in cases of recurrent symptomatic goiter it was 9.5%. In cases of total thyroidectomy for carcinoma it was 10% (7.9% when related to the number of nerves that could be damaged). By literature review and own results a dissection of the recurrent nerves usually does not seem to offer any advantages.

Adolescent↗

[Prevention of infection in teflon prostheses for dialysis access. Experiences with a resorbable combined collagen-antibiotic system].

40 patients with renal insufficiency and chronic hemodialysis received a E-PTFE prosthesis as vascular access either at the upper or lower extremity. The efficacy of prophylaxis of infection through application of a local aminoglycosid, administered as a resorbable collagen-antibiotic-sponge, was studied in two different groups. All patients had a high risk of infection. The use of the collagen-gentamycin-sponge was effective in preventing an infection of the vascular graft. Systemic side effects were not registrated in spite of the reduced renal function. Further studies are necessary to evaluate the efficacy of the collagen-gentamycin-sponge in preventing vascular prosthesis infection in high risk patients.

Adult↗

[Postoperative hemoglobin course and septic complications following stomach resection].

Preoperative and postoperative haemoglobin curves were studied in male patients, following two-third gastrectomy. A group with early septic complications was compared to one without. The groups were comparable for age distribution and pathological patterns (ulcer/gastric stenosis and carcinoma). Preoperative haemoglobin mean values were a the lower normal limit and dropped to 10.8 g/dl in the group with complications on the fifth day from surgery, but stayed constant at 12 g/dl in the control group, as of the second postoperative day. Haemoglobin dropped to mean values around 11 g/dl immediately after surgery in patients with severe complications, such as suture dehiscence. All groups deviated clearly from normal Hb.

Female↗

Radiologic findings in lymphangioma of the posterior tibial nerve.

A case of lymphangioma of the posterior tibial nerve is reported. MRI showed an elongated multiseptated cystic lesion along the tibial nerve leading to axonal degeneration and progressive left calf pain. A similar cystic lesion in a second patient was shown to be a ganglion. The diagnosis was made by surgical resection.

Adult↗