Biomedical subjects

R Kasperk

Publications and source records attributed to R Kasperk.

At least 37 records · Page 2Linked to original sources

PubMed1999

[Effect of transanal excision on rate of recurrence of stage I rectal carcinoma in comparison with radical resection methods].

INTRODUCTION: In the case of T1 low-risk rectal cancer, transanal excision is an established method. Now the question arises whether we can also treat higher stages, i.e. T1 high-risk and T2 tumors, by transanal excision with an acceptable recurrence rate. METHOD: The hospital notes of 152 patients treated by radical resection and transanal excision were examined retrospectively with special regard to the rate of recurrence after an average follow-up of 9.5 years. RESULTS: Twenty-five patients were treated by rectal exstirpation, 105 by anterior resection. In 22 cases local tumor excision was performed: in 12 T1 carcinomas with curative intent and in 10 T2 carcinomas as a minimally invasive procedure for high-risk patients. Recurrence rates were between 8% and 9% in the three different groups. CONCLUSIONS: We recommend transanal excision with curative intent only in T1 low-risk tumors. Local excision is seen as an alternative minimally invasive treatment for patients in poor general condition with T2 carcinomas.

Adult↗

PubMed1999

[Rational preoperative diagnosis of insulinoma].

An insulinoma is the most common pancreatic endocrine tumor. Typical is the presence of a solitary tumor. In 10% of the cases an insulinoma may occur in multiple sites, especially in MEN syndrome. Malignant insulinomas appear in 10% of cases. Insulinomas occur at every age, but mainly about the 50th year. Because of its small size (a diameter of 1-2 cm) diagnostic localization is often difficult. With costly imaging techniques such as CT and MRI, only 60% of the adenomas can be detected preoperatively. If reoperation is a possibility, CT and MRI are advisable. Based on our own experience and the reports of other authors, we advise the combination of transabdominal ultrasound and endosonography for the primary operation. With these methods 90% of the adenomas can be localized preoperatively. If the clinical and biochemical insulinoma diagnosis is definite, explorative laparotomy is indicated even without preoperative morphological tumor detection. With intraoperative ultrasound and systematic palpation more than 97% of insulinomas can be found and resected. We report the case of a 54-year-old woman with unsuccessful preoperative localization in spite of extensive clinical, biochemical and imaging procedures over a 6-month period.

Diagnostic Imaging↗

PubMed1999

[Ischemia-related small intestine perforation 15 days after car accident. Fate or avoidable complication?].

Intraabdominal organ lesions after blunt abdominal injuries often are missed, especially in the contest of a polytrauma because of the absence of obvious clinical injury signs, difficult examination conditions of an intubated patient and the possibility of secondary development of lesions. For an exact recognition of the abdominal injuries a standard diagnostic procedure is necessary. Clinical and laboratory parameters which determine the circulatory situation, initial abdominal ultrasound, x-ray and follow up examinations are indispensable. In equivocal situations CAT scan respectively angiography are recommended. The correct initial diagnosis of intestinal perforations still is problematic and requires repeated examinations. We report the case of a patient with initial blunt abdominal injury and a non dislocated Weber-A-fracture after a car accident. 15 days after trauma the patient was seen with the clinical signs of an acute abdomen. After emergency laparotomy an ischemic necrosis of the ileum, covered with net, was seen.

Abdominal Injuries↗

PubMed1999

Prognostic value of DNA image cytometry in resected colorectal hepatic metastases.

OBJECTIVE: To determine the role of DNA image cytometry (DNA ICM) as a useful predictor of outcome following the resection of colorectal hepatic metastases. STUDY DESIGN: In 75 patients (56 R0 resections) with resected colorectal hepatic metastases, DNA ICM was performed on paraffin-embedded specimens. The DNA content of 250 tumor cells was determined in each specimen, and the 2c level was evaluated using 30 granulocytes from the same sample. RESULTS: Common algorithms of DNA ICM, such as maximum DNA content, 5c exceeding rate, 9c exceeding rate, 2c deviation index and the DNA grade of malignancy, identified a group of patients with favorable survival following R0 resection. Clinical findings failed to serve as a prognostic factor. A multivariate analysis revealed the maximum DNA content to be an independent factor influencing postoperative survival. CONCLUSION: DNA ICM is associated with the biologic aggressiveness of colorectal hepatic metastases and is useful as a prognostic marker in patients after resection.

Adenocarcinoma↗

PubMed1999

[Transport management in blunt abdominal trauma. Case report of a patient with delayed diagnosis of splenic rupture].

Missed abdominal injuries after blunt abdominal trauma belong to the most frequent causes of death, especially in polytraumatized patients. Primary missing these injuries often is a tragedy due to a mortality-rate up to 50% after delayed treatment compared with a low complication- and mortality-rate after diagnosis in time. We report the case of a patient with a missed spleen lesion to discuss the special problems of the transport stages. Transport and diagnostic procedures are critical stages because of limited diagnostical and therapeutical possibilities. There is a risk of inadequate therapy in case of a sudden debasement of the patient's condition. Therefore sufficient monitoring and the availability of emergency medicals and tools are essential to secure an adequate treatment of secondary decompensation. These conditions are indispensable for the primary transport, innerhospital transfers and also for secondary interhospital transfers. Supervision during the transport stages by a doctor who is able to carry out life-saving emergency treatments is essential. Sudden debasement of the patient's condition often requires short-dated decision making concerning the following diagnostical and therapeutical strategy.

Abdominal Injuries↗

PubMed1999

[Multiorgan surgery in rectal cancer--extended therapy or improvement of prognosis?].

About 10% of rectal cancers have to be treated by a multivisceral resection. Within a period of 14 years we performed 103 of these operations, 60 for primary cancers, 43 for recurrent cancers with a significant increase in the latter. The total or partial removal of 204 extra-rectal organs allowed for a R0 resection in 67% of cases. 69% were confirmed as being pT4 by histologic examination. In comparison with conventional rectal resection morbidity is higher at 32% while mortality is identical with 4%. A significant benefit (p < 0.05) in terms of survival is found for primary cancers as opposed to recurrences, R0 resections compared to R1 or R2 resections, lymphnode negative compared to lymphnode positive patients and patients who underwent IORT. The number of additionally removed organs did not influence survival. Compared with the natural course even palliative resections carry a survival benefit and allow the treatment of the often devastating specific morbidity of the disease. Despite adjuvant multimodal therapies the high rate of local and distant recurrences after multivisceral resection of the rectum still poses a major problem.

Colectomy↗

PubMed1998

[Adjuvant regional arterial port chemotherapy after resection of colorectal liver metastases].

Between 1986 and 1995 we performed radical hepatic resections (R0 resections) in 109 patients with hepatic metastases following colorectal carcinoma. In 50 patients a hepatic arterial port device was implanted for adjuvant regional chemotherapy (HAI). Mitomycin C, 5-fluorouracil, and since 1993 folinic acid have been administered during 6 monthly repeated courses. In 9 patients, the treatment had to be withdrawn because of complications. The remaining 59 patients were not treated. In 73% of the patients after port implantation mostly minor complications occurred during chemotherapy. Our results confirmed a markedly increased survival rate during the first 3 postoperative years, followed by a prolongation of median survival time of treated patients compared to untreated patients. Nevertheless, the observed differences of median survival were not statistically different. In contrast, the 5-year survival rates of both groups were not different. The frequency, localization, and resectability of recurrences were not influenced by adjuvant chemotherapy. However, the lengthening of mean survival time in the treated group might reflect a delay in the occurrence of early recurrences. In conclusion, adjuvant hepatic arterial chemotherapy following resection of colorectal hepatic metastases might be able to prolong the time until recurrence, but does not help to avoiding it. Therefore, it did not increase the rate of cure following R0 resections of colorectal hepatic metastases in our series. Taking into account the high rate of local complications of the port systems in our series, angiographic controls are strongly recommended prior to each chemotherapeutic cycle.

Adult↗

PubMed1998

Sphincter preserving techniques: from anterior resection to coloanal anastomosis.

Nowadays surgery offers a complete spectrum of techniques for the treatment of rectal cancers. Progress in preoperative diagnostic techniques, especially in endoluminal ultrasound, and in the knowledge of anorectal physiology allows the surgeon to adopt a very individual strategy for the various tumor types. The situation has changed even for tumors of the middle and distal thirds of the rectum, which formerly were treated predominantly by abdominoperineal exstirpation. These can also be treated by sphincter-preserving techniques, the most ambitious of which is intersphincteric resection with coloanal anastomosis. Our experience shows that this method is not only comparable to the alternatives of conventional anterior resection and extirpation in terms of postoperative morbidity and mortality but also achieves excellent oncological results. Of course, anorectal function is significantly altered by this type of surgery. Still, after an adaptive period of about 6-12 months a very satisfactory functional result is reached. Further functional improvement, especially in the early postoperative period, can possibly be expected from reconstruction with creation of a colon pouch.

Anal Canal↗

PubMed1998

[In vivo ICG fluorescence photometry for quantification of warm ischemia damage of to the liver in a rat model].

The clearance of indocyanine green (ICG) from the peripheral blood has been used for the study of hepatic function in clinical and experimental investigations. We describe a method of simultaneous, semiquantitative measurement of the kinetics of ICG in the peripheral blood, liver, kidney and bile system following intraoperative bolus injection. The method is based on the fluorescence of ICG in the near infrared spectrum. Using this method, we have recognized a temporary extrahepatic storage of ICG within the kidney. Our first results prove changes in the ICG-metabolism fifteen minutes after reperfusion following a 30-minute hepatic ischemia and partial liver resection in the rat.

Animals↗

PubMed1998

[Surgical intervention in severe acute pancreatitis--retrospective study of 79 patients of the RWTH Aachen Surgical Clinic].

This is a report on the surgical intervention in 79 patients with acute pancreatitis, who were operated in the Department of Surgery of the University Clinic RWTH Aachen in the period from 1986 to 1993. The main objective was the stratification of pancreatitis according to the Ranson-Score, the analysis of the surgical treatment and the timing of operation depending on the clinical condition. The average Ranson-score was 3.3 (median 3). 56 patients had necroses, which were removed because of the deteriorating clinical condition. In these cases the average Ranson-score was 4.2 (median 4). Seven patients (8.9% of the total number and 12.5% of the patients with necroses of the pancreas) died. This small number is the result of a severity-adapted management in a modern intensive care-unit and the good cooperation with the Department of Internal Medicine.

Adult↗

PubMed1997

Morbidity of ileostomy and colostomy closure: impact of surgical technique and perioperative treatment.

The operative results and complications after stoma closure in 548 patients operated on between 1972 and 1993 are described in this retrospective study. The patients were divided into three groups (group I,n = 74, 1972-1976; group II,n = 256, 1977-1985; group III,n = 218, 1986-1993) according to the year of operation and changing concepts in colorectal surgery. The overall mortality rate was 2.0%. The morbidity rate including minor complications was significantly reduced from 70.3% in group I to 27.1% in group III. Postoperative wound infections and fever were the most common complications. The location of the stoma and the operative technique did not markedly influence the morbidity rate. The most striking decrease in complications was achieved by the combined usage of orthograde lavage and perioperative antibiotic treatment (14.6% wound infections, 6.9% postoperative fever). In conclusion, a standardized perioperative treatment protocol including orthograde lavage and antibiotics is recommended.

Antibiotic Prophylaxis↗

PubMed1997

[Perioperative antibiotic prophylaxis in visceral surgery--pro and contra].

Perioperative antibiotic prophylaxis aims at reducing the enormous cost of hospital-acquired infections. Primary indications for antibiotic prophylaxis are wounds of the clean-contaminated and contaminated category. Use of antibiotic prophylaxis in clean surgery is still very controversial. To be effective, the antibiotic must be given in the period immediately before incision. A single-dose application is at least as effective as a multiple-dose regimen. Second-generation cephalosporins are still the main stay of antibiotic prophylaxis. In colorectal surgery they should be combined with, e.g., Metronidazol.

Antibiotic Prophylaxis↗

PubMed1996

[Principles and value of lymph node excision in tumors of the pancreatobiliary system].

Malignancies of the gallbladder, bile ducts and pancreas have a very bad prognosis compared with other gastrointestinal malignomas. Lymph node metastasis has frequently been identified as an important prognostic factor. This leads to some surgeons to embark on an extremely aggressive resectional strategy, including wide lymphadenectomy. So far, reported results of these procedures have varied considerably and concomitant morbidity has often exceeded that of standard resections. Until there is unequivocal proof of the benefit of an extended lymphadenectomy in controlled studies this strategy cannot be recommended generally.

Biliary Tract Neoplasms↗

PubMed1996

Repeat resection of recurrent hepatic metastases--improvement in prognosis?

OBJECTIVE: To find out if resection of recurrent hepatic metastases improves survival. DESIGN: Retrospective study. SETTING: University hospital, Germany. SUBJECTS: 25 patients who had recurrent metastases after radical resection of hepatic metastases from colorectal and other primary carcinomas. INTERVENTIONS: Repeat liver resection with the intention to cure. Limited hepatic resections were preferred if they could be done without loss of radicality. MAIN OUTCOME MEASURES: Operative morbidity and mortality, survival time after second hepatic resection, analysis of possible prognostic factors. RESULTS: Hemihepatectomy was done for 4 patients, and infiltration of the diaphragm led to extended resections in a further 4. Locoregional recurrence of rectal carcinoma together with a solitary pulmonary metastases in another patient were removed simultaneously. The remainder were limited resections. Seventeen procedures were regarded as radical. There were no operative deaths, and five patients developed minor complications. Actuarial survival rates after radical repeat liver resections were 94% after one year, 53% after two years, and 24% after three years. Radicality was the main prognostic factor of survival. CONCLUSIONS: Repeat hepatic resections seem to improve prognosis and are recommended in patients with recurrent metastases confined to the liver.

Adult↗

PubMed1996

[Benefits and risk of resection of liver metastases in elderly patients].

Between 1986 und 1995 we performed 60 hepatic resections in 52 patients aged over 70 years for liver metastases of different primary tumours. The results were comparable regarding morbidity, mortality and long-term prognosis to the group of 176 patients under the age of 70 undergoing a total of 210 hepatic resections for metastases during the same time period. Thus liver resections for metastases can be performed with tolerable risks even in aged patients; postoperative mortality is independent of the patients' age and is due to the extent of resection; the survival rate is mainly influenced by radical resection.

Aged↗

PubMed1996

[Palliative therapy of inoperable malignant occlusive jaundice--stent implantation or biliodigestive anastomosis].

For therapy of malignant jaundice different methods are possible: The palliative operative bypass and the monoperative stent implantation by endoscopic or transhepatic procedure. The primary success rate of both methods is similarly high (> 90%). The rate of early complication and the lethality of the stent implantation compared to the operative procedure are lower. The rate of occlusion and incidence of later cholangitis by operative bypass are lower. Postoperative lethality is related to the ASA classification. The preoperative diagnosis of resectability by CT, NMR, angiography and diagnostic laparoscopy has a success rate of maximally 95%. The choice of therapeutic method is therefore related to the general condition of the patient (ASA, staging, duodenal stenosis, expected survival time).

Anastomosis, Surgical↗

PubMed1995

Intraoperative radiotherapy for pancreatic carcinoma.

Intraoperative radiotherapy (IORT) with an electron beam is a therapeutic modality employed predominantly in tumours with a high risk of local recurrence. In this department 35 patients with proven adenocarcinoma of the pancreas underwent surgery and IORT, while 41 patients underwent surgery only. Irradiated patients suffered more serious postoperative complications (21 per cent versus 7 per cent), spent more time in hospital (32 days versus 26 days) and did not show a survival advantage (median of 326 days versus 366 days for two patients with curative resection). Anastomotic breakdown (twp patients), abscess formation (two patients) and pancreatitis in the pancreatic remnant (one patient) occurred only in this group. It is concluded that IORT may increase the risk of postoperative complications. As, on the basis of experimental data, an additional serious long-term risk is to be expected, application of IORT should be limited to well controlled study conditions.

Aged↗

PubMed1995

[Enterocutaneous fistula after Marlex net implantation. A rare complication after incisional hernia repair].

Erosions of intraabdominal hollow viscus are possible complications following reconstructive surgery of the abdominal wall after hernia repair with non-absorbable biomaterials. A rare case of manifestation of a enterocutaneous fistula by chronical erosion of a Marlex mesh after repair of an incisional hernia is presented. Successful treatment was achieved by fistulectomy, small bowel segmental resection and limited resection of the implanted Marlex mesh.

Cutaneous Fistula↗