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T Manger

Publications and source records attributed to T Manger.

53 records · Page 3Linked to original sources
PubMed1997

[Laparoscopic transperitoneal adrenalectomy--technique and personal experiences].

Laparoscopic transperitoneal and endoscopic extraperitoneal adrenalectomy are two safe options in minimally invasive surgery associated with very low morbidity. The anterior transperitoneal approach we prefer yields a better exposure of the anatomic structures and allows the surgeon to orient himself more easily. In addition, various other laparoscopic maneuvers may be performed synchronously. We report on our own experience with eight laparoscopic transperitoneal adrenalectomies performed in four cases unilaterally and in two additional cases bilaterally during April, 1996, and January, 1997, in six patients aged 20 to 56 years. The indications were in four cases pheochromocytoma (operated on bilaterally in two cases), and in the remaining two cases adrenal Cushing's syndrome. The duration of surgery was approximately 240 min for bilateral adrenalectomy and 166 min for unilateral adrenalectomy, respectively, with an intraoperative blood loss of about 50 to 400 ml. Except for haematoma of the abdominal wall there were no other postoperative complications. The serum levels of interleukin 6 and 10 underline the minimal invasiveness of this technique, since there were only small increases of interleukin 6 and interleukin 10.

Adrenal Gland Neoplasms↗
PubMed1997

[Instrumental diagnosis and therapeutic decision making in biliary surgery].

Preoperative evaluation before cholecystectomy includes detailed history of the disease and blood chemistry. Hepatobiliary ultrasonography is the main noninvasive preoperative investigation. The decision to evaluate the common bile duct for stones prior to planned laparoscopic cholecystectomy by ERC may be prompted by clinical suspicion or evidence of jaundice, recent pancreatitis, or a dilated common duct on sonography. Preoperative ERC has the advantage of allowing the simultaneous treatment of duct stones. Intraoperative cholangiography should be available.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1997

[Prevention and therapy of complications in laparoscopic appendectomy].

It has been verified that laparoscopic appendectomy increases safety. The indications for laparoscopic appendectomy depend on the surgeon's confidence in diagnosis, his skills and the stage of appendicitis. The complications could be prevented by placement of open trocars and (dividing the mesoappendix and appendix with sutures, clips or staples. Electrosurgery should never be used. Bipolar electrosurgery should be limited to 20 Watt power for 5 s. The appendix is removed either though a trocar or in a specimen bag.

Abdominal Abscess↗
PubMed1996

[Problems with gallbladder carcinoma in laparoscopic cholecystectomy].

The postoperative finding of gallbladder cancer after laparoscopic cholecystectomy is unavoidable. Because of the special technique, tumor dissemination with serious consequences is seen more frequently than after open cholecystectomy. For prevention, the general use of saving bags and a reduced indication in cases of advanced inflammation and high-risk groups is discussed.

Aged↗
PubMed1994

[Diagnosis and surgical therapy of benign liver tumors].

Between 1/1980 and 12/1992 at the Surgical Clinic (Charité) 251 patients were treated for benign liver tumors. In 139 cases a laparotomy was necessary. Fourty of these operations were explorative laparotomies only, whereas among the resections there were mainly atypical and segmental resections, respectively (n = 81). In the case of focal nodular hyperplasia (FNH) and hemangioma the indication for operation resulted from the patients' complaints (n = 45) and the preoperatively uncertain dignity of the process (n = 50). If an adenoma was suspected (n = 38) an absolute indication for operation was assumed with respect to the danger of rupture or bleeding reported in the literature as well as the uncertain differentiation from malignancy often experienced. The suspected diagnosis was proved in 30 cases, in 8 patients a FNH was found intraoperatively without the consequence of resection. Six patients were resected for a suspected hepatocellular carcinoma (HCC) which could not be confirmed postoperatively. In conclusion, the rate of preoperative uncertain or wrong diagnoses concerning definitive histology was 25.4%. The mortality rate of the performed liver resections was 2%, but was not directly related to the liver resection per se. In 4 patients the postoperative course required a relaparotomy. By a follow-up starting with 3-months intervals, two patients with an hepatocellular carcinoma were detected 12 weeks after the first diagnosis of FNH. A successful resection was carried out in both cases.

Adenoma↗
PubMed1991

[Laparoscopic cholecystectomy. An alternative procedure in the treatment of symptomatic cholecystolithiasis].

The authors report about their first experiences concerning the treatment of gallbladder stones using a laparoscopic approach. 40 patients (33 female, 7 male) were treated with this new method. The age of the patients, who had undergone this procedure, varied from 24 to 76 years, the average age was 42 years. Our current indication is the symptomatical chronic gallbladder lithiasis. The average time of operation was 60 to 90 minutes. The mortality rate was zero. Slight operative bleeding from an accessory artery and vein occurred in two cases. This was controlled by electrocoagulation. We observed no complications in the postoperative phase. The patients were dismissed from the hospital on the 3. to 5. day. This method is very favourable with regard to the operative strain on the patients.

Adult↗
PubMed1991

[Experiences and results in 200 laparoscopic cholecystectomies].

Laparoscopic guided cholecystectomy was attempted in 200 patients from September 1990 until May 1991. Wound infection rate was 6% in first 100 operations. In the second group of 100 operations the wound infection rate was 1%. Antibiotic prophylaxis was used in this group. Mortality was 0%. Complications were 7 wound infections, 1 urinary tract infection and 1 bile fistula treated by drainage. Five patients required conversion to a standard laparotomy, due to 3 cases of bleeding of a. cystica, 1 biliodigestive fistula and 1 extensive meteorism. Laparoscopic cholecystectomy is now a routine operation.

Adolescent↗
PubMed1991

Cellular mechanisms of Cl- transport in outer medullary collecting duct.

The OMCDi secretes Cl- when perfused and bathed with symmetrical solutions. The route for this transepithelial Cl- movement appears to be the paracellular pathway, and the driving force is the lumen positive voltage generated by the process of electrogenic H+ secretion. Currently, there is no evidence to support the existence of a significant transcellular route for transepithelial Cl- movement. Although the primary function of the OMCDi is related to urine acidification, Cl- plays an important role in this process. The basolateral membrane of the OMCDi cell contains a band-3 related Cl-/HCO3- antiporter and a Cl- conductance. The Cl-/HCO3- antiporter serves as the primary route for the efflux of HCO3- generated during the process of H+ secretion. The Cl- conductance allows Cl- brought into the cell by the antiporter to recycle across this membrane. This conductance also serves to maintain cell charge balance. Accordingly, for each equivalent of H+ leaving the cell across the apical membrane, a Cl- equivalent exits the cell across the basolateral membrane. Based on whole-cell patch-clamp studies, this Cl- conductance is blocked by the Cl- channel blocker DPC. This conductance may also have a finite permeability to HCO3-, and thus could serve as a secondary route for cellular HCO3- efflux. Lastly, the conductance is activated by the beta-adrenergic agonist isoproterenol.

Animals↗
PubMed1991

[Diagnosis and surgical procedure in intestinal hemorrhage as a sequela of vascular abnormalities (angiodysplasia)].

Angiodysplasia is in 5-20% the source of massive lower gastrointestinal bleeding in the elderly. The etiology is unknown. We describe 8 patients with multiple intestinal bleeding from an angiodysplasia, treated between 1986 and 1989. The mean age of the patients was 49.1 years. Four patients were older than 65 years. The localisations were in 6 cases the ascendic colon, in one case the terminal ileum and rectum each. Selective mesenteric arteriography has proved to be the best method of diagnosis. Isotope studies and endoscopies may not demonstrate the localisation in acute bleeding. The treatment of angiodysplasia is the segmental resection of the effected portion of the bowel. In 5 of 8 patients we performed the right hemicolectomy, in 3 patients the resection of the terminal ileum (n = 2) or rectum (n = 1). The follow up of our patients was 15 to 44 month.

Adult↗
PubMed1990

[Experiences with intraluminal small intestinal intubation].

Seventy-six patients were treated for postoperative ileus of the small intestine, between 1983 and 1987. Forty-four of them received intraluminal intestinal intubation, with indications being established by stringent criteria. One case of recurrent ileus was recorded eight weeks after removal of the Miller-Abbott tube, but no tube-related lethality was observed. The average age of our patients was as low as 49 years. Post-operative lethality amounted to 21.2 percent (eight in 44). Ileus was not removed until death in three cases. Intraluminal intestinal intubation may be recommended after long-distance lysis of adhesions for postoperative ileus of the small intestine as well as in cases of severe ileus in concomitance with controllable peritonitis.

Aged↗
PubMed1989

Cytosolic-free calcium and neurotransmitter release with decreased availability of glucose or oxygen.

Exposing brain slices to reduced oxygen tensions or impairing their ability to utilize oxygen with KCN decreases acetylcholine (ACh) but increases dopamine (DA) and glutamate in the medium at the end of a release incubation. To determine if these changes are due to alterations in the presynaptic terminals, release from isolated nerve endings (i.e. synaptosomes) was determined during histotoxic hypoxia (KCN). KCN reduced potassium-stimulated synaptosomal ACh release and increased dopamine and glutamate release. Since several lines of evidence suggest that altered calcium homeostasis underlies these changes in release, the effects of reducing medium calcium concentrations from 2.3 to 0.1-mM were determined. In low calcium medium, KCN still increased dopamine and glutamate release, but had no effect on ACh release. Hypoxia increased cytosolic-free calcium in both the normal and low calcium medium, although the elevation was less in the low calcium medium. Thus, the effects of histotoxic hypoxia on cytosolic free calcium concentration paralleled those on glutamate and dopamine release. Reducing the glucose concentration of the medium also increased cytosolic-free calcium. The data are consistent with the hypothesis that hypoxia and hypoglycemia increase cytosolic-free calcium, which stimulates the release of dopamine and glutamate, whose excessive release may lead to subsequent cellular damage postsynaptically.

Animals↗
PubMed1988

Changes in cytosolic free calcium with 1,2,3,4-tetrahydro-5-aminoacridine, 4-aminopyridine and 3,4-diaminopyridine.

The effects of 1,2,3,4-tetrahydro-5-aminoacridine (THA), 4-aminopyridine (4-AP) and 3,4-diaminopyridine (3,4-DAP) on cytosolic free calcium (Ca2+i) were determined. Both 4-AP and THA have been used to treat Alzheimer's disease. THA is a structural analog of the aminopyridines, which alter calcium homeostasis in nerve terminals. The structural similarities between these compounds suggest a common mechanism of action. The aminopyridines raised Ca2+i concentrations in non-depolarized synaptosomes, whereas THA had no effect. Neither the aminopyridines nor THA had any effect on Ca2+i concentrations in potassium-depolarized synaptosomes. These results suggest that the beneficial effects of THA may be mediated by other mechanisms (i.e. neurotransmitter degradative enzyme inhibition), whereas those of 4-AP and 3,4-DAP may be due, at least in part, to their elevation of Ca2+i, which may enhance neurotransmitter release or other calcium-dependent processes.

4-Aminopyridine↗
PubMed1986

[Immunologic diagnosis of glomerulonephritis by basement membrane antibodies].

In the immunological diagnostics of glomerulonephritis by basement membrane antibodies highly sensitive demonstration methods for circulating antibodies increasingly gain significance for judgements of courses. The results which were achieved by a new non-competitive ELISA using chimaera antibodies in comparison to the indirect immunofluorescence confirm the advantages of the enzyme immunoassay with regard to its higher sensitiveness.

Anti-Glomerular Basement Membrane Disease↗
PubMedDate not supplied

Hepatic and retroperitoneal tumor resection for late metastases of a Wilms' tumor in an adult patient--a case report.

Hepatic metastases after a Wilms' tumor in adult patients are seen extremely rarely. A 21 year-old male patient developed liver metastases 13 years after resection of a primary left extrarenal Wilms' tumor. In this case, without any other metastases, extended right curative hepatic lobectomy was performed. The patient was re-admitted 4 months after the hepatic lobectomy for a resection of a new Wilms' tumor metastatic mass in the area of the pancreatic tail. The patient received adjuvant high dose systemic chemotherapy with ordinary bone marrow cell rescue after the 2nd operation. He is alive and well with no signs of new metastases 18 months after surgery and adjuvant chemotherapy.

Adult↗
PubMedDate not supplied

Diagnostic workup before laparoscopic cholecystectomy--which diagnostic tools should be used?

BACKGROUND/AIMS: A prerequisite for successful laparoscopic cholecystectomy is the exclusion of potential risks such as cholangiolithiasis, anatomical malformations or diseases of the stomach. As there is no general agreement regarding the appropriate preoperative diagnostic workup, we compared different diagnostic methods as to their value in detecting unknown accompanying diseases and complications. METHODOLOGY: Between 9/90 and 8/93, we performed 850 laparoscopic cholecystectomies. The first 700 were included in this study. A prospective comparison was carried out of the diagnostic accuracy of history, physical examination, laboratory tests, upper gastrointestinal endoscopy or barium meal, i.v. cholangiography and abdominal ultrasound. RESULTS: Measurement of the diameter of the common bile duct was found to be a good noninvasive method for diagnosing common bile duct stones (sensitivity 80%, specificity 99%). In combination with the history and the laboratory tests the sensitivity could be improved to 99%. The sensitivity of i.v. cholangiography in detecting common bile duct stones was 80%, the specificity 99.3%. 646/700 patients underwent preoperative endoscopy/barium meal. In 53 (8.2%) patients pathological findings were found, but only in 4 cases (0.6%) they influenced the indication for laparoscopic cholecystectomy. In 1 patient an advanced gastric cancer was diagnosed 6 months after laparoscopic cholecystectomy, the preoperative barium meal did not show any pathological findings. CONCLUSIONS: The results show that routine ultrasonography in combination with history and laboratory tests prior to laparoscopic cholecystectomy can be recommended for detecting common bile duct stones. In patients with 1 or more pathologic finding endoscopic retrograde cholangiopancreatography should be performed preoperatively. A gastroscopy should be done in patients with nonspecific upper abdominal pain, history of peptic ulcer disease and persisting pain after laparoscopic cholecystectomy.

Adult↗