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Biomedical subjects

T Kreusser

Publications and source records attributed to T Kreusser.

14 recordsLinked to original sources
PubMed1994

Fibrin-glue-coated collagen fleece in lung surgery--experimental comparison with infrared coagulation and clinical experience.

Diffuse parenchymal bleeding and major air leaks still present a challenge to the thoracic surgeon. This study was therefore designed to evaluate efficacy and handling of fibrin-glue-coated collagen fleece, to address these problems. In an experimental part defects were produced in lungs of troll pigs to compare the use of the fleece with infrared coagulation. Immediate airtightness and postoperative adhesions were evaluated. Scores were designed to evaluate quality and extension of the adhesions. In a clinical study parenchymal resection sites were sealed with fibrin-glue-coated collagen fleece in 52 patients. No patient suffered from postoperative bleeding. In three cases air leaks were still present on the third postoperative day, representing a 5.8% failure rate. 92.3% of the patients showed neither postoperative hemorrhage nor prolonged air leaks. A fixed combination of collagen fleece and fibrin glue consequently can be considered as a valuable tool in thoracic surgery.

Animals↗
PubMed1992

Accuracy of computed tomographic scan and surgical assessment for staging of bronchial carcinoma. A prospective study.

There is an increasing demand for accurate preoperative and intraoperative staging of bronchial carcinoma with respect to neoadjuvant therapy protocols and parenchyma-sparing operations. This study prospectively evaluated accuracy of computed tomographic scan and surgical assessment for staging of bronchial carcinoma in 108 consecutive patients. The stage of the primary tumor (T stage) was correctly determined in 85% of the patients, and surgical evaluation correctly determined the T stage in 92%. Invasion of major mediastinal structures posed a major problem for computed tomographic scan. On a node-by-node basis, computed tomographic scan predicted involvement of lymph nodes in 81% (sensitivity 29%, specificity 93%, positive predictive value 49%, negative predictive value 85%). The surgeon correctly determined the lymph node status in 69% of lymph nodes (sensitivity 90%, specificity 63%, positive predictive value 39%, negative predictive value 96%). On a patient-by-patient basis, computed tomographic scan correctly predicted the nodal status in 58% of patients. Accuracy of computed tomographic scan and surgical assessment in determination of the lymph node status strongly depended on tumor type and lymph node region (hilar or mediastinal region) studied. This was partly due to the fact that adenocarcinomas exhibited a high proportion of tumor-positive normal-sized lymph nodes, whereas squamous cell carcinomas showed a high proportion of enlarged tumor-free lymph nodes. In conclusion, computed tomographic scan and surgical assessment are sufficiently accurate for determination of the tumor stage but are insufficient in determining the nodal status.

Carcinoma, Bronchogenic↗
PubMed1992

[Thoracic actinomycosis versus bronchial cancer].

We report on 4 thoracic actinomycoses; in three of these four cases a bronchial carcinoma was suspected, and in case No. 2 this carcinoma had been considered to be in a very advanced and inoperable stage. A man of 51 years of age was in a generally run-down condition. He also noticed that his sputum was tinged with blood. The x-ray film showed a large space-occupying growth at the right lung hilus. Repeated perbronchial biopsies of the focus did not yield any diagnosis. Actinomycosis was identified histologically only in the tissue samples obtained via thoracotomy. After a three-month penicillin course the hilar shadow receded. A 61-year old male patient was transferred to our Pneumological Hospital, being strongly suspected of suffering from an extensive bronchial carcinoma, and having multiple intrathoracic space-occupying growths as well as pleural effusions, a pericardial effusion, and an infiltration of the left thoracic wall with fistula formation; however, histological examination of skin biopsies revealed that he was suffering from actinomycosis. Antibiotic therapy cured him completely in a six-month course. In a man of 32 years of age who had been indulging for many years in a severe abuse of nicotin, we suspected a central bronchial carcinoma on the basis of his x-ray, but histology of the tissue taken from the space-occupying growth via diagnostic thoracotomy revealed that this patient, too, suffered from actinomycosis. Complete recession occurred after several months of antibiotic treatment. A woman of 82 years had been an inpatient for several months in another hospital because of relapsing pleuropneumonias on the right side. She was transferred to us as an outpatient after a renewed relapse. We conducted a transcutaneous fine-needle biopsy of the right indurating pleural effusion. A few actinomyces filaments were seen on histological examination of the purulent exudate. Hence, actinomycosis was confirmed. After antibiotic therapy the finding receded completely.

Actinomycosis↗
PubMed1991

[The value of computerized tomography and of the surgical assessment for lymph node staging in bronchial carcinoma. A prospective study].

We evaluated the accuracy of computed tomography (CT) and of surgical assessment for lymph node staging prospectively in 108 patients with bronchogenic carcinoma. For CT/surgical assessment a sensitivity of 29/90%, a specificity of 93/63%, a positive predictive value of 49/39% and a negative predictive value of 85/96% were calculated on a node-by-node basis. Sensitivity and specificity of CT were highly influenced by the lymph node region studied and by typing of the tumor. Adenocarcinomas showed a high proportion of normal-sized metastatic lymph nodes whereas squamous cell carcinomas exhibited a high proportion of enlarged tumor-free lymph nodes. The diagnostic accuracy in predicting the correct N-stage by CT was determined with 54% for squamous cell carcinoma and 56% for adenocarcinoma. The surgeon predicted the N-stage correctly in 39% of squamous cell carcinoma and 69% of adenocarcinoma. In conclusion, accuracy of CT-scan is too low to renounce mediastinoscopy for routine use in preoperative staging of bronchogenic carcinoma.

Adenocarcinoma↗
PubMed1991

[Fibrin-coated collagen fleece in thoracic surgery. Initial clinical experience].

After resecting procedures to the parenchyma of the lung the resection site was sealed with a collagen vleece combined with fibrin glue in 26 patients. No patient exhibited rebleeding. An air leak was present up to the first postoperative day in 19 patients, up to the third postoperative day in 5 patients. In two patients, duration of air leak extended beyond the third postoperative day, this was defined as therapeutic failure. The use of collagen vleece combined with fibrin glue represents a valuable contribution in thoracic surgery.

Adolescent↗
PubMed1990

Ewing's sarcoma of the hand: localization and treatment.

Ewing's sarcoma of the hand is rare. Only 20 cases of Ewing's sarcoma of the hand have been reported in the literature. Although Ewing's sarcoma of the hand is rare and highly malignant, modern combinations of treatment are possibly curative due to the tumors surgical accessibility and apparent restricted involvement of only tubular bone. This case study illustrates currently accepted combination therapy consisting of chemotherapy, radiation therapy, and surgical tumor reduction. In spite of the advances of adjuvant therapy, surgical removal of the tumor still remains the most effective treatment.

Adult↗
PubMed1990

[Load capacity of capsule and tendon tissue].

The data referred to in this article show that the load capacity values of capsular and tendinous tissue are significantly higher than had been assumed so far; this applies to the macroscopic as well as the microscopic and submicroscopic ranges and is also based on our own experimental studies, which were mainly focussed on load capacity and tissue damage. For example, the tear resistance to static load is 50% higher and to dynamic load 100% higher than most of the maximum load data known so far. Thus, the dynamic tear resistance exceeds the static resistance by one third. The maximum load capacity decreases with increasing age; the peak value is attained at about the third decade of life. Tear resistance is related to the smallest cross-section of the tendon. It has been safely established that cross-section and tear resistance decrease with advancing age. There is definite mathematical and histological proof that even a healthy tendon can tear under unfavourable load conditions and can thus well be the weakest link in a healthy muscle-tendon-bone system. This fact assumes increasing importance in these times of increasing leisure and sports activities practised by persons of all age brackets. The commonly used terms of "load" and "load capacity" thus acquire a new dimension. We know that the load exercised on a tendon is permanently increased especially in sports activities. We also know that load capacity can be promoted. Hence, it depends on us to learn how to master the functioning of the tendon and to develop measures to help to avoid acute and chronic tendon damage.(ABSTRACT TRUNCATED AT 250 WORDS)

Achilles Tendon↗
PubMed1990

[Treatment of phalangeal fractures].

Due to anatomical reasons the therapy of phalangeal fractures is a domain of conservative treatment in contrary to metacarpal fractures. Special attention must be focused on defective position in axis and rotation of the fractured phalanx. We use the Iselin splint. The indication for operation depends on the patients compliance, the type of fracture and its localisation. Indications for operation in our opinion are open fractures, dislocated, non reponible fractures, fractures involving the joint, condylar fractures. Conservative treatment gains the more importance the more the fracture is localized at the end of the phalanx.

Bone Screws↗
PubMed1990

[Nerve compression syndromes of the elbow and hand].

The importance of nerve compression syndrome in the upper extremity for making a diagnosis or differential diagnosis in orthopedics, surgery, especially hand surgery, and neurology is evident. We review the characteristics of this entity, demonstrate the pathophysiological findings, and stress their importance on the diagnosis, therapy, indications for operation, and operative techniques in our patients. With special regard to the topographic anatomy each of these nerve compression syndromes of the elbow and the wrist region is demonstrated systematically and consequences are discussed for surgical therapy.

Carpal Tunnel Syndrome↗
PubMed1990

[Reconstructive surgery of malunited joint fractures of the hand].

Malunion of fractures, joint fractures and pseudoarthroses leads to therapy-resistant pain during function and loading, especially in the wrist, with a risk of early arthrosis. In spite of the extraordinary adaptability of the hand, malunion in the axis and rotation can lead, for example, to cross-finger malfunction. Because of the relatively thin layer of soft tissue, secondary operations to correct the axis, rotation and the length of the phalanx are possible. Each reoperation on the hand diminishes the blood flow, and the anatomical structures change with cicatrices. Thus, the risk of damaging blood vessels or nerves is increased. Operative correction of the position, arthroplasties, joint prostheses, arthrodeses, arthrolyses and denervation are all part of the operative repertoire. It is necessary to repair the joint surface as well as the capsule-ligament structures. Furthermore, we also express our opinion regarding the indications and contraindications of secondary operations. We discuss the risks and complications during operations and especially stress the aspect of having enough patient information. Finally, we describe the operative techniques in special cases. The necessity for reconstructive secondary operations is increasing as more and more replantations are being done and hand lesions in polytraumatized patients are being neglected. To date, not enough attention has been given to these problems in the scientific literature.

Arthrodesis↗
PubMed1989

Thermotoxicity of palacos cement. Clinical observation.

In total hip joint replacement with cemented prostheses, Palacos (polymethyl methacrylate, PMMA) involves a high perioperative risk for the patient, on account of the effects on both the systemic and the pulmonary circulation. Data were assembled retrospectively from the records of 203 patients who underwent hip joint operation with Palacos implantation in the Inner City Surgical Clinic and the Surgical Polyclinic of the University of Munich from 1982 to 1986. In the hemiarthroplasty series, hemiarthroplasty was performed in 61% of patients in risk group III, whereas in the risk groups I and II it was done in 31% of cases. The mortality following hemiarthroplasty was greater than that following implantation of total prostheses in risk groups I and II. In risk groups II and III the mortality was 17% with surgery on the day of injury, lower, at only 10%, when the operation was performed on the day after injury, and markedly higher, at 31% and 38%, respectively, when surgery was postponed to the 2nd or 3rd day. It has been shown in burn research that the prostanoid levels in the plasma of untreated animals show a typical curve with two peaks, the first on the day of the injury and the second on the 3rd day after injury. Our observations support the assumption that the effect of trauma and surgical treatment are complementary.

Aged↗
PubMed1989

[Skier's thumb].

Over a period of 9 years (1979-1988), more than 1000 patients have been seen in the Department of Hand Surgery with a tentative diagnosis of skier's thumb or a painful metacarpophalangeal of the thumb. Most injuries were treated conservatively, but 562 operations on the ulnar collateral ligament were done during this period. An X-ray Film was taken in all cases to exclude a fracture. The indications for an operation depend on the clinical symptoms. Swelling, pain just over the ulnar collateral ligament, and instability of the joint with a widening of the ulnar aspect of the joint of more than 30 degrees in comparison to the other hand are typical clinical symptoms, which together with the widening in the flexion position, prove a rupture of the collateral ligament. As part of our standard examination we take X-ray films of the hand in two projections to exclude a fracture, followed by abducted stress views in comparison to the other side. The best results were obtained when surgical therapy was performed within the first 8 days. Fractures of the base of the proximal phalanx of the thumb were operated on by pin wire fixation of the bone fragment in the anatomically correct position along with temporary transarticular pin wire arthrodesis. In ligamentous ruptures, periostal sutures together with a temporary arthrodesis were carried out. Old injuries without sufficient regeneration of the ligament and capsule necessitated plastic surgery using the long pulmar tendon or a PDS wire. In each case the joint was immobilized with a cast for 5-6 weeks, followed by active physiotherapy.

Adolescent↗