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R Salm

Publications and source records attributed to R Salm.

At least 19 recordsLinked to original sources
PubMed2003

[Sigmoid diverticulitis -- indications for surgery and choice of procedure].

The first attack of uncomplicated diverticulitis is treated conservatively. Sigmoid resection is indicated for recurrent diverticulitis, in patients with manifest stenosis or fistula and for such emergencies as perforation, ileus or bleeding. Early surgery after the first episode is recommended for patients under 50 years of age, or immunocompromised patients. This is particularly true for patients with radiological signs of severe diverticulitis. Today elective sigmoid resection is a laparoscopic procedure. Properly carried out, the operation effects a definitive cure. The morbidity and mortality of the operation is low, and re-operations for recurrent diverticulitis are the exception. In the emergency situation a two-stage procedure is often necessary.

Adolescent↗
PubMed2001

[Indications for intramedullary stabilization of shaft fractures in childhood. What is reliable, what is assumption?].

For some 15 years the elastically stable medullary nailing (ESIN) has been used in fracture treatment in children. The group of Nancy (Prevot and colleagues) first described the procedure for shaft fractures in children. Now the method is the standard procedure for stabilisation of long bone diaphyseal and metaphyseal fractures. During recent years a number of papers have described good and excellent results with this method, especially for shaft fractures of femur and forearm. In some papers there are also methods for articular fractures in more demanding techniques presented. Also when we have no evidence-based studies, we can say from the experience out of the last years that the ESIN is a biological, minimally invasive fracture treatment to achieve a high level of reduction and stabilisation in fractures in children. The use of titanium nails leeds to a higher rate of flexural elasticity and so the titanium nails are more recommended for this method.

Bone Nails↗
PubMed1996

Emergency laparoscopy. Technical support for the laparoscopic diagnosis of intestinal ischemia.

BACKGROUND: Laparoscopic diagnosis of intestinal ischemia is difficult. Dark-colored bowels are not a reliable indicator for infarction, because there is no correlation between color and oxygenation. The same picture is produced by intraluminal blood or feces. False diagnoses are described. METHODS: We analyzed various techniques for assessing intestinal oxygenation and perfusion to support laparoscopic diagnosis. In this study laparoscopy was performed on eight pigs. A 10-cm segment of intestine was fixed to the abdominal wall and rendered ischemic. Measurements of the ischemic segment and normal intestine were taken using laser-Doppler, Doppler ultrasound, spectrophotometer, and pulse oximeter. Doppler ultrasound and pulse oximetry were unsuitable in our model, as was laser-Doppler flowmetry. RESULTS: Only the spectrophotometer proved a highly sensitive means of assessing bowel oxygenation. CONCLUSIONS: This method provides the desired additional information about intestinal oxygenation, thus helping to interpret the laparoscopic picture of dark bowels.

Animals↗
PubMed1996

Effects of the Pringle maneuver on hemodynamics during laparoscopic liver resection in the pig.

The Pringle maneuver (PM) is recognized in conventional liver surgery as a method of controlling bleeding. To determine the hemodynamic effects of the PM during pneumoperitoneum (PP) for laparoscopic liver resection, we measure hemodynamic and blood gas changes in 7 healthy pigs. All variables were recorded 5 min before and 10 and 30 min after employing PP or PM and 10 min after discontinuation of PM. After the induction of PP, cardiac index and arterial carbon dioxide tension significantly increased, accompanied by a significant decrease in pH. After the beginning of PM, cardiac index and mean arterial and central venous pressures decreased significantly, whereas the heart rate rose markedly. After discontinuation of the PM, the systemic vascular resistance index decreased, and the heart rate remained elevated. These results demonstrate severe hemodynamic deterioration with PP and a subsequent PM. The latter should, therefore, be considered only as a last resort for the control of bleeding during laparoscopic liver surgery.

Animals↗
PubMed1996

Comparison of laparoscopic handsewn suture techniques for experimental small-bowel anastomoses.

Laparoscopic techniques have only rarely been applied to procedures on the small bowel. A comparison of three handsewn intracorporeal anastomoses was carried out. Thirty pigs were divided into three groups, and a different technique was used in each group (SK, single knot; RS, running suture; CL, clip suture). Half of the animals had a relaparoscopy on day 4. The duration of the procedure was recorded, and the quality of anastomotic healing was assessed by morphological, radiological, mechanical, and biochemical examinations. The animals were sacrificed on postoperative day 14. The anastomoses in the SK group took significantly longer than in the RS or CL groups. The mean duration of relaparoscopy was 28 min. Bursting pressure values and hydroxyproline concentrations were without any significant difference. The SK and CL groups showed a good alignment of the layers and the RS showed necrosis and overlying mucosa. Most complications were noted in RS. The results demonstrate that manual small-bowel anastomoses can be performed laparoscopically. Single-knot and clip sutures are reliable techniques. The ongoing development of new instruments and the three-dimensional technique will basically improve the construction of intracorporeal anastomoses.

Anastomosis, Surgical↗
PubMed1996

[Endoscopic hemostasis in bleeding gastroduodenal ulcer--a contribution to the cost aspect].

Endoscopic injections of fibrin glue for the treatment of gastroduodenal ulcer hemorrhage have been increasingly used instead of sclerosing agents since 1987. Sclerosants have the drawback that they themselves have tissue-destroying or rather ulcerogenic effects. A difficult form of administration and a relatively high price are set against the good biological properties of the fibrin glue. In a randomized study comparing fibrin glue with polidocanol there was a statistically significant lower rebleeding rate in the fibrin group. The data of this study were analysed with regard to economic aspects. They showed an improved cost-benefit and cost-effectiveness ratio of the fibrin glue compared with polidocanol.

Cost-Benefit Analysis↗
PubMed1995

[Therapy and follow-up of gastroesophageal chemical burns].

We report a retrospective analysis of 61 patients admitted during the years 1974 to 1992 after having recently swallowed a corrosive agent. Within 24 hours, the localisation, severity and extent of the injury had been determined by endoscopy. In 13 patients the injury was restricted to the oropharynx, and in 48 it involved esophagus, stomach and duodenum. Fourteen had sustained a second degree injury, and 16 a third degree injury. Out of five patients with third degree injuries who were treated by operation within the first three days, two survived. Two patients operated upon for complications after 10 days of conservative treatment died. The total mortality was 21%, but 56% for those who had received a third degree injury. Thirteen patients developed a stenosis (27% of those with gastroesophageal lesions). Esophageal strictures were dilatated with bougies, but stomach stenoses were treated by resection. Of the 12 patients treated by dilatation, 4 sustained perforations and 4 of them were free of symptoms for a considerable period of time (more than 4 years).

Adolescent↗
PubMed1995

Vacuum-supported endoscopic access.

The rapid increase in the number of endoscopic operations performed has resulted in a corresponding rise in the incidence of severe complications. This issue has generated widespread concern at recent congresses. It is now indisputable that safer access to the abdominal cavity is required. We have developed a technique of vacuum-supported visual access which allows the surgeon to anticipate dangerous sites of access and avoid injuries to internal organs or retroperitoneal blood vessels. The procedure has two major advantages: Firstly, a pre-peritoneal approach allows the surgeon to visualise the structures behind the peritoneum, and secondly, puncture of the insufflation-needle is facilitated and the depth of insertion is minimised. The underlying principle is to use negative pressure to elevate the peritoneum. Using this approach, the principles of open surgery are adhered to during abdominal access, thereby avoiding visceral injury.

Animals↗
PubMed1994

Effect of human bowel wall distension on translocation of indigenous bacteria and endotoxins.

The effect of colonic distension on the translocation of indigenous bacteria and endotoxins was prospectively assessed in 50 consecutive patients undergoing colonoscopy. Semiquantitative bacteriologic cultures, chromogenic LAL testing for endotoxemia, and serial determinations of inflammatory markers were used. At the end of the endoscopic procedure, true bacteremia was found in only two patients with obstructing colorectal cancer. There was no evidence of systemic endotoxemia either being induced or increased during the observation period. The endotoxin detoxifying plasma capacity was elevated in patients with preexisting inflammation and did not change within this period. Levels of TNF-alpha, interleukin-6 (IL-6), and elastase (E alpha 1PI) did not differ from baseline values. C3 alpha levels increased in 20% of the patients, whereas fibrinopeptide A values rose by up to 10(2) during colonoscopy. However, since neither endotoxin, TNF alpha, nor IL-6 levels were found to be elevated in this study, the excessive activation of the coagulation system must be related to the distension of bowel wall vessels rather than to an effect of endotoxins escaping from the lumen.

Bacteremia↗
PubMed1994

Experience with TEM in Germany.

Transanal endoscopic microsurgery (TEM) presents a minimally invasive procedure for local removal of large adenomas as well as early carcinomas of the rectum. 57 surgical departments/clinics, which practice this method in Germany were asked about their experience. 44 questionnaires were evaluated. Indications for the 1,900 recorded operations were 1,411 adenomas, 433 carcinomas (curative intention: 286; palliative intention: 147), and 56 other procedures. The conversion rate to laparotomy was dependent on the experience with this surgical method (1.2%-11.6%). A radical rectal resection as a second step was performed in 5.7% of patients in the case of advanced carcinoma in the histologic examination of the specimen. Complications appeared in 120 patients (6.3%), 77 patients (4.0%) recovered with conservative treatment, and 43 (2.3%) had to undergo surgery. The mortality rate was 0.2% (3/1,900 pts).

Anal Canal↗
PubMed1994

[Laparoscopic techniques in therapy of choledocholithiasis].

Several methods for therapy of common bile duct stones (CBDS) during laparoscopic cholecystectomy are available. After intraoperative cholangiography laparoscopic removal of CBDS can be achieved via the cystic duct or a choledochotomy using a thin cholangioscope, balloon catheters and Dormia baskets. Lithotripsy (electrohydraulic or laser) is necessary in presence of larger stones. Also combined procedures with intraoperative antegrade or retrograde papillotomy have been described. Published studies show that laparoscopic common bile duct exploration can be performed successfully by experienced surgeons. However, these procedures are demanding and time-consuming. Further evaluation is essential.

Cholangiography↗
PubMed1992

[PC-assisted planning and documentation of the surgical schedule].

A computer program for personal computers was developed to support and control the schedule in the operation theatre. With this program a great amount of operational and medical data will be recorded (e.g. the duration of operation and anesthesia, the number of operating rooms occupied, the personnel involved, the diagnosis and surgical therapy). The screen shows up-to-date information about the ongoing events. All data can be easily evaluated for different criteria. In a four years period the program presented has proved valuable for daily routine planning and documentation in a great operation unit.

Database Management Systems↗
PubMed1992

Value of endoscopic retrograde cholangiopancreatography in determining the cause but not course of acute pancreatitis.

We have recently shown that ERCP is the most useful technique for detecting a biliary origin of acute pancreatitis and can be done without side effects. We now report on a second series of 50 patients with acute pancreatitis in whom ERCP, computed tomography (CT), ultrasound (US), and clinical and laboratory assessment were performed within the first 24 to 48 hours of hospitalization. A score for ERCP, CT and US was used to assess the severity of the disease. Patients were followed up until discharge or death and their condition classified according to outcome as mild (less than or equal to 1 complication), severe (greater than 1 complication) or fatal. ERCP was superior in detecting choledochal stones (ERCP 100%, US 25%, CT 50%) and dilated intrahepatic ducts (ERCP 75%, US 75%, CT 37%) but not gallbladder stones (ERCP 70%, US 100%, CT 60%). When the ERCP severity score was calculated there was no relevant difference between patients thereafter having a mild course (0.66 +/- 0.91, range 0-3), a severe course (1.3 +/- 0.80, range 0-3), or a fatal outcome (1.0 +/- 1.1, range 0-3). In contrast, the CT score was different in all three groups (mild: 3.0 +/- 1.9; severe: 5.3 +/- 3.2; lethal: 6.3 +/- 3.1) as was the US score (mild: 1.5 +/- 1.3; severe: 3.2 +/- 2.3; lethal: 4.4 +/- 1.4). It is concluded from these results that ERCP is of value in defining the origin of acute pancreatitis. When a biliary origin is detected this can lead to immediate treatment using endoscopic sphincterotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1992

Laparoscopic cholecystectomy after unsuccessful shock-wave therapy.

Extracorporeal shock-wave therapy of gallstones was begun at the Surgical Department of the University of Freiburg, Germany, in March 1988; 85 patients were treated up to September 1991. The stone-free rate differed with the gallstone group. Patients with solitary stones less than 20 mm in diameter showed a significantly higher rate after 18 months of lithotripsy and dissolution therapy than patients with multiple stones (p < 0.01), that is, 83% and 49%, respectively. Open cholecystectomy was necessary for seven patients with complications following fragmentation. After starting laparoscopic cholecystectomy, eight patients decided in favor of this procedure because of constant biliary symptoms. These patients had a mean duration of dissolution therapy of 19 months. The minimal invasive procedure is an alternative for patients with unsuccessful lithotripsy and lysis who initially demanded conservative treatment. Indication for shock-wave therapy is limited to only a small group of patients with solitary cholesterol gallstones less than 20 mm who reject laparoscopic surgery.

Cholecystectomy↗
PubMed1992

[Percutaneous interventions on the bile duct in obstructive jaundice. A meaningful or excruciating prolongation of life?].

The percutaneous transhepatic access to the bile duct opens a wide spectrum of diagnostic and therapeutic procedures. This means specific diagnosis and therapy of the obstructive jaundice even in patients in bad general conditions and therefore unfavourable prognosis. As in most cases curative therapy is no longer possible, survival time can be taken into consideration. There are no great problems concerning the performance of technical procedures. But it is the justifiability of the interventions that has to be reconsidered in each of the cases. The facts that the quality of life can be improved and the possibility to discharge the patient as soon as possible should be the guidelines in having the patients undergo these therapeutic procedures. The evaluation of our case material from 1985-1991 show that just in this respect the introduction of the endoprosthesis (thick calibrated endoprosthesis, stents) is a great progress, with a mean survival time between 8 and 10 months, and with normalization of laboratory values in 75-100%.

Adult↗
PubMed1991

[Laparoscopic cholecystectomy].

In a short space of time, laparoscopic cholecystectomy has become the operative treatment of choice in cholecystolithiasis. The performance of the operation, however, requires complex equipment, and became at all possible only with the aid of video technology. The indication depends both on the patient's symptoms and the experience of the operator. Prior surgery in the upper abdomen and complications of gallstones are considered relative contraindications, and portal hypertension an absolute contraindication. The advantages of this minimally invasive operative procedure are the minimal traumatization and improved postoperative well-being. The need for pain-killer is low, gastric tube and selective drainage are not required. Dietary build-up and mobilization are possible early on. Postoperative hospitalization is 2 to 3 days. The future will bring further developments in the field of laparoscopic operative interventions.

Cholecystectomy↗