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Biomedical subjects

T Reck

Publications and source records attributed to T Reck.

At least 19 recordsLinked to original sources
PubMed1998

Plasma separation and bilirubin adsorption after complicated liver transplantation: a therapeutic approach to excessive hyperbilirubinemia.

BACKGROUND: Severe hyperbilirubinemia is known to exert multiple toxic effects. Thus, a reduction in bilirubin by use of various adsorbent columns has been reported for a variety of hepatic disorders, but no experience with liver transplant patients is available as yet. METHODS: Plasma separation and bilirubin adsorption by an anion-exchange adsorbent column (BR-350) were performed in two patients with severe jaundice (total serum bilirubin > 55 mg/dl) and multiple organ failure that had developed after orthotopic liver transplantation. RESULTS: The procedure resulted in an 18% to 35% reduction in total bilirubin after each session, accompanied by a remarkable clinical improvement. Both patients finally recovered and had a favorable outcome. No complications or side effects of bilirubin adsorption were observed during any of the six sessions. CONCLUSIONS: Bilirubin adsorption is a safe and effective treatment. It should be considered as supportive therapy for excessive hyperbilirubinemia after liver transplantation. In selected cases, retransplantation may thus be avoided.

Adsorption↗
PubMed1998

[Laparoscopic splenectomy].

To date more than 400 laparoscopic splenectomies have been reported in the literature. The main indications for the procedure are benign haematological diseases, in particular idiopathic thrombocytopenic purpura. Laparoscopic splenectomy to treat malignant illnesses is rare and is usually restricted to small or only moderately enlarged spleens. Technically, the lateral abdominal approach with the patient in a right decubitus position has the advantage over the anterior approach in the supine patient of permitting better access to the organ. Under the force of gravity the stomach and intestines drop out of the operating field, and the splenic ligaments are placed under tension. This facilitates dissection with the harmonic scalpel and safe divisioning of the hilar vessels using the linear stapler. The individual steps of the procedure are described in detail.

Humans↗
PubMed1998

[Thoracoscopic resection of epiphrenic esophageal diverticula by an intracavitary/endoluminal combined intervention].

Epiphrenic oesophageal diverticula are of the pulsation type, the underlying cause is a motility disorder. Resection is indicated by severe symptoms like dysphagia, regurgitation or aspiration and should be performed after endoscopic dilatative treatment of the neuromotor disturbance. Thoracoscopic resection under endoluminal endoscopic surveillance is considered to be a reliable procedure with low morbidity for the patient.

Dilatation↗
PubMed1997

[Thoracoscopic truncal vagotomy].

Abdominal re-operation in patients with recurrent peptic ulcer disease is associated with a high morbidity rate and a mortality rate of 5%. As an alternative procedure, therefore, transthoracic truncal vagotomy was early recommended as a less invasive intervention, and good results can be achieved with it. With the development of minimal invasive surgery, this procedure can now be performed via thoracoscopy and patient stress thus reduced even further. Via a left-sided thoracoscopy, the parietal pleura is incised and a 3-5 cm long segment of the distal oesophagus mobilised and dissected free. Both the posterior and anterior trunks of the vagus nerves are identified and, after applying clips, transected. In order to achieve complete vagotomy, further fine branches have to be searched out and, if found, also divided.

Endoscopes↗
PubMed1997

[Percutaneous laparoscopic gastrostomy].

Percutaneous endoscopic gastrostomy (PEG) has now largely replaced the conventional operative procedure of gastrostomy. However, in patients with endoscopically non-passable pharyngo-oesophageal tumours or facial injuries rendering the stomach inaccessible to endoscopy, this technique has so far been unavailable. In this group of patients it is nevertheless possible to apply minimally invasive percutaneous gastrostomy using laparoscopy (PLG). The employment of a purse-string suture clamp facilitates the performance of the procedure and makes it reliable.

Gastrostomy↗
PubMed1997

[Laparoscopic operation of a Morgagni hernia].

Morgagni hernias are the least common form of diaphragmatic hernias. Although they are congenital, most of them are not diagnosed until later in life. The indication for surgery is based on the patient's symptoms or on the radiological evidence of incarcerated tissue, and until quite recently involved a laparotomy or thoracotomy. Laparoscopy not only permits the suspected diagnosis to be confirmed--which is otherwise often difficult--but also makes it possible to close the hernia site by suturing. For improved security, the hernia site is augmented by fixing in place a non-absorbable mesh. The operative technique employed is described.

Hernia, Diaphragmatic↗
PubMed1997

[Laparoscopic fenestration of non-parasitic liver cysts].

Cysts of the liver may be parasitic or non-parasitic, the non-parasitic cysts being further subdivided into neoplastic, inflammatory, post-traumatic and congenital. Symptomatic congenital solitary cysts represent a good indication for laparoscopic treatment. During the therapeutic procedure, the roof of the cyst is fenestrated or removed such that at least one-third of the circumference of the cyst is removed, which is best done using a harmonic scalpel. In order to prevent a recurrence, it is recommended that a portion of the greater omentum be placed in the floor of the cyst, thus filling the cystic cavity.

Cysts↗
PubMed1996

Impact of arterialization on hepatic oxygen supply, tissue energy phosphates, and outcome after liver transplantation in the rat.

The importance of arterial reconstruction in experimental orthotopic rat liver transplantation is widely acknowledged in the literature. Non-rearterialization of the graft leads to impaired microcirculation and, in chronic models, to severe hepatobiliary damage, together with bile duct proliferation and fibrosis in such livers. The aim of the current study was to investigate the impact of rearterialization on hepatic oxygen tension (pO2), hepatic tissue content of adenine nucleotides, early graft function, and postoperative outcome. Orthotopic liver transplantation was performed in 27 male inbred rats. Ten rats underwent rearterialization and while 17 did not. A group of sham-operated animals (n = 6) served as controls. After reperfusion, liver grafts without arterial reconstruction showed significantly reduced levels of oxygen tension (mean +/- SD, 3.79 +/- 2.20 vs. 10.03 +/- 2.84 mmHg; P < 0.05) and a clear shift toward lower pO2 values in the pO2 histograms, as compared with arterialized grafts. Without arterialization, the level of liver ATP was 65% of that in sham animals, compared with 84% in arterialized livers. Without arterialization, bile secretion was reduced (0.42 +/- 0.04 vs. 0.71 +/- 0.06 mg/min x g liver; (P < 0.001), and the postoperative course of serum alanine transaminase, bilirubin, and alkaline phosphatase revealed severe hepatobiliary damage. These findings allow us to conclude that graft rearterialization is essential to ensure both an adequate oxygen supply and maintenance of tissue ATP. Arterialization may thus be a necessary part of liver transplantation models in this animal species, and should be considered when designing studies on the biochemical, microcirculatory, and histopathological status of the graft.

Adenine Nucleotides↗
PubMed1996

[Open laparoscopy for prevention of puncture injuries].

Perforating lesions occurring during the establishment of the pneumoperitoneum using the Veres needle and blind introduction of the camera trocar are among the major complications of laparoscopic surgery. Even when all the necessary safety measures are observed and despite complete mastery of the technique, this complication cannot be completely avoided during the blind procedure. The technique of open laparoscopy, so-called, with the introduction of a blunt trocar under direct vision is the sole alternative available for the prevention of such injuries. The advantages of this procedure are that, with appropriate practice, it takes no longer, can be employed in all possible situations, including previous surgery, and, in particular, when assisting a surgeon who is in the process of gaining experience in laparoscopic surgery. Severe perforating injuries and their sequelae are often advanced as an argument against the use of laparoscopic surgical procedures. Through the use of open laparoscopy, injuries to blood vessels and viscera can be virtually completely eliminated, and patient safety considerably improved. On the basis of our own experience, we can unreservedly recommend open laparoscopy as the routine approach for all laparoscopic interventions.

Abdominal Injuries↗
PubMed1995

Partial orthotopic liver transplantation in rats.

A partial orthotopic liver transplantation technique (70% POLT) for use in rats and comparable with the corresponding recipient operation in the 'splitting transplantation' in man was developed. Body weight, liver function, histological and electron-microscopic findings were studied in comparison with whole rat liver transplantation with rearterialization, 30% POLT and corresponding liver resections. After 70 and 30% POLT typical signs of hepatic regeneration were found, but no pathological alterations in the electron-microscopic picture. This POLT model might be helpful for the investigation of unresolved questions in 'splitting transplantation'.

Animals↗
PubMed1995

[Hamartoma of aberrant breast tissue in the inguinal region].

Ectopic mammary tissue reportedly has an incidence of 1 to 6%, and is usually found in the axilla. Neoplasias in ectopic breast tissue are rarely observed. This is the first report of an hamartoma of ectopic breast tissue in the inguinal region. A 50-year old woman presented with a large tumor in the groin. The unusual site and form of the tumour preoperatively suggested a chronic incarcerated hernia. When laparoscopy excluded a hernia, the tumour was resected in accordance with oncological criteria and the histopathological work up revealed the surprising findings. This case shows that ectopic mammary tissue, in particular when it is the site of a tumor, may be a rare differential diagnosis of an inguinal tumor.

Breast↗
PubMed1994

[Intraperitoneal colon anastomosis with laparoscopic purse string suture clamp and Valtrac ring].

In combination with the biofragmentable Valtrac ring a newly developed purse-string suture clamp offers the possibility of performing intraperitoneal anastomoses of the small and large bowel without the need for stapling devices. During this experimental study end-to-end anastomoses of the descending colon were constructed in five pigs. One animal was re-examined on day 1 after the operation and the others were all sacrificed on day 21 after. None of the animals showed any signs of an anastomotic leakage. Little scar tissue was seen macroscopically or histologically in the anastomotic region of the animals sacrificed 3 weeks after the operation. The operative technique presented in this paper might render the so-called assisted laparoscopic procedures for the right hemicolon unnecessary in the future.

Anastomosis, Surgical↗
PubMed1994

Hamartoma of an ectopic breast arising in the inguinal region.

Ectopic mammary tissue in the inguinal region giving rise to a hamartoma is reported. This localization of ectopic breast is infrequent and hamartomas of the breast at this site have not been described previously. The unusual size of the lesion caused pre-operative diagnostic difficulties.

Breast↗
PubMed1993

[Cystic pancreatic tumors].

Before 1978, where cystic tumors of the pancreas were concerned, pathologists only differentiated between cystic adenomas and cystadenocarcinomas. Recently, however, further tumor entities have been introduced. We now differentiate between the generally benign serous cystic adenoma, the potentially malignant mucinous cystadenoma, the possibly malignant papillary cystic tumor, and the always malignant mucinous cystadenocarcinoma. Other rare tumors include the solid cystic acinous-cell tumor, the cystic islet tumor, and mucinous ductal hyperplasia. Because of their slow growth and primary displacement nature, all of these tumors can usually be detected only after they have attained considerable size. Computed tomography (CT), sonography and endoscopic retrograde cholangiopancreatography (ERCP) have an established role in diagnosis. With these methods, as a rule, it is possible to identify pseudocysts; however, differentiation between the individual tumor types is almost impossible. In our study from 1979 to 1990, we observed ten cases of serous cystic adenomas, nine cystadenocarcinomas, and four malignant papillary-cystic tumors. Of these, nine of the ten serous cystic adenomas, four of the five mucinous cystadenomas, all four papillary-cystic tumors, and five of the nine cystadenocarcinomas were curatively resected. All patients with curatively resected adenomas and one patient with an R1-resected cystic adenoma remained free of recurrence throughout the follow-up period. One 86-year-old female patient in whom a serous cystic adenoma was histologically determined still has no symptoms 8 years after diagnosis despite slow tumor progression. Two of the five patients in whom a cystadenocarcinoma was curatively resected died postoperatively; a third patient died of tumor recurrence 4 months following resection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Combined radiation and chemotherapy for epidermoid carcinoma of the anal canal.

Between 1985 and 1992, 46 patients with epidermoid carcinoma of the anal canal were treated prospectively by a protocol of combined radiation and chemotherapy with 5-Fluorouracil and Mitomycin C. The survival rate, NED-survival rate and local tumour control rate were 84%, 71% and 83% at 5 years. Anorectal function was retained in 33 of 41 patients (80%). We observed severe acute toxicity including three deaths, but very little late morbidity. The only marginally significant prognostic factor (P = 0.06) for local tumour control was T-stage. NED-survival was significantly affected (P = 0.02) by reduction of chemotherapy during the second course.

Adult↗
PubMed1992

Bilateral rupture of the patellar tendon without predisposing systemic disease.

Bilateral rupture of the patellar ligament in a 49-year-old woman is reported. She sustained a relatively minor trauma and no underlying systemic disease could be found. This is the 14th case of simultaneous spontaneous rupture of the patellar tendons reported in the literature. The diagnostic features were diffuse swelling around the knees, visible and palpable infrapatellar defects, and an inability to extent either leg.

Female↗