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T Schmitz-Rixen

Publications and source records attributed to T Schmitz-Rixen.

At least 19 recordsLinked to original sources
PubMed1998

Talc pleurodesis in recurrent pleural effusions.

BACKGROUND AND AIMS: The treatment of recurrent malignant pleural effusions is known to be difficult and varies from observation in asymptomatic patients to pleurectomy with varying results. This prospective study presents the efficacy and the limits of iodized talc pleurodesis in patients with malignant and non-malignant recurrent pleural effusions. METHODS: In a prospective trial talc pleurodesis was performed in 50 patients with recurrent pleural effusions (malignant effusions: n=36, non-malignant effusions: n=14). After insertion of a chest tube and complete re-expansion of the lung, 5 mg of talc and 3 mg of thymol iodine were installed with 0.5 ml of 1% xylocaine/kg body weight and 30 ml 0.9% saline solution. The chest tube was removed after an average time of 4 days and chest radiographs were performed 1 month after instillation to evaluate the efficacy of pleurodesis. RESULTS: Successful therapy was achieved in 31 of 33 patients (94%) with malignant effusions within a follow-up period of 7 months. Three patients died within 1 month after therapy due to progressive malignant disease. The treatment was successful in all cases of non-malignant effusions and complications did not occur in either group. CONCLUSIONS: These results indicate that pleurodesis with iodized talcum slurry is a simple and inexpensive method with high efficacy in controlling malignant and non-malignant pleural effusions.

Chest Tubes↗
PubMed1998

[History of surgical instruments: 8. Instruments and development of amputation technique exemplified by amputation sets from the middle of the 19th century].

The amputation of a limb is one of the oldest surgical procedures. However, in the course of medical history operative techniques and surgical instruments have been improved continuously. With an example of an amputation case of the last century we will summarize this development until the middle of the nineteenth century. Even in the first century Celsus gave a description of an amputation (circular cut). A major step in the development of the operative technique was the introduction of artery forceps by A. Paré in the sixteenth century. Nevertheless, due to a lack of analgesics and narcotics the operation had to take only a few minutes. Therefore the amputation was completed in one cut, i.e. detachment of the skin, muscles and bone at the same level. This technique known as "classic circular cut" was modified several times in the following period: in order to reduce suture tension Petit recommended to transect the skin first and the muscles and bone more proximal ("two-stage circular cut", 1718) and Bromfield approved to cut in turn the skin first, the muscles more proximal and the bone most proximal ("three-stage circular cut", 1773). Finally, Lowdham (1679), Verduyn (1696) and C. J. M. Langenbeck (1810) changed the operative technique to the effect that they used a soft-tissue flap in order to cover the bone without tension ("flap amputation").

Amputation, Surgical↗
PubMed1998

[Is the type of vessel wall change a risk factor in implantation of prostheses in the aortofemoral segment? Dilatative versus obliterating arteriopathy].

The question of what effect role obliterative vessel disease has on postoperative outcome was analysed with the help of uni- and multivariate analysis. The univariate analysis showed significantly more preoperative risk factors in patients with obliterative vessel disease. Our multivariate analysis found three independent factors: ASA class, age, duration of surgery. Obliterative vessel disease seems to be a disadvantageous factor, but may be influenced by preoperative existing risk factor.

Aged↗
PubMed1997

[Long-term results of abdominal surgery interventions. Different evaluation from the viewpoint of the patient, the surgeon and the public health office].

The patient, the surgeon and the public health officer (Versorgungsamt) assess the long-term results of abdominal operations differently. We tried to objectivize these different assessments. The clinical data were collected retrospectively. Data on postoperative subjective state and degree of handicap were obtained in a written patient survey (March 1995). Two groups with benign diseases and one group with malignant disease were examined: 59 patients who had undergone sigmoidectomy for diverticulitis (30 female and 29 male patients, median age: 61.5 years), 347 patients subjected to proximal gastric vagotomy for duodenal ulcers (72 female and 275 male patients, median age: 46 years) and 158 patients who had undergone gastrectomy for gastric carcinoma (56 patients female, 102 patients male, median age: 61 years). The public health officer, classed 35.6% of the patients who had undergone sigmoidectomy and 34.6% of the patients who underwent vagotomy as officially handicapped with a stated grade of disablement, 77.2% of the patients with gastrectomy were officially classed as handicapped. When other diseases were taken into account in addition, 27.1% of the patients who had undergone sigmoidectomy, 27.4% of those who had undergone vagotomy and 75.9% of the patients with gastrectomy had received passes officially identifying them as severely handicapped persons. In the vast majority of cases, the combination of several different ailments had resulted in recognition of a graded handicap and severely disabled person's pass, skeletal, cardiac and circulatory ailments being the most frequent. In spite of this, the evaluation of post-operative course by our patients, the surgeon and the public health officer (as reflected in the official state classification) in terms of the degree of handicap clearly differed.

Adult↗
PubMed1997

[Changes in biomechanical properties of biological and synthetic prostheses].

Arterial compliance which is an expression of the structural properties of the vessel wall is defined as the fractional change in diameter in response to a unit change in pressure. It is likely to play an important role as a predictive parameter for maintenance of arterial reconstruction. Usually, vascular grafts are implanted with an arbitrarily applied longitudinal tension. The current study was designed to evaluate in vitro the effects of longitudinal tension on the dynamic circumferential compliance of different Dacron, Polytetrafluorethylene, Polyurethane and newly developed synthetic vascular grafts as well as arteries and veins. Longitudinal tensions between 0 and 1000 g were applied. Different grafts showed characteristic peak compliance values due to the used graft material, fabrication and extent of tension. Concerning their different compliance-tension profiles two groups of vascular grafts could be differentiated: 1) grafts which develop best compliance values after implementation of longitudinal traction and 2) prostheses which gain optimal biomechanical properties without any traction. There is strong evidence for modulation of compliance by implementation of longitudinal tension which suggests that it is useful to improve long term patency of arterial reconstruction.

Biomechanical Phenomena↗
PubMed1996

Tumors after renal transplantation.

The purpose of this retrospective study was to analyze the development of malignancies after renal transplantation. 633 renal graft recipients with an organ function longer than 1 year were followed up over a mean period of 67.6 +/- 48.7 months. Only 12 recipients received grafts from living-related donors. 38 recipients (6.0%) exhibited cancer of either the skin, the genitourinary system, the bronchial system, the female breast, or the colon. All tumors were de novo malignancies. The number of patients developing a tumor was significantly higher in the cyclosporine-treated group than in patients with conventional immunosuppression. 15 patients died within a mean survival time of 7.7 +/- 12.1 months. The frequency of disorders makes it necessary for organ transplant recipients to have routine examinations both before and at regular intervals after transplantation. This includes examination of the patient's skin, native kidneys and cervical smears for females.

Adolescent↗
PubMed1996

[Current treatment strategy in malignant pleural effusion].

Malignant pleural effusions are a grave consequence of advanced cancer disease. The successful suppression of pleural fluid reaccumulation can make a major contribution to the management and palliative care of patients with disseminated cancer. Many treatment concepts have been reported in the literature. The recommended therapy in malignant pleural effusions consists of intrapleural instillation of a sclerotic agent to produce pleurodesis. Different substances have been used, including tetracyclines, cytostatic agents, fibrin, talc, Corynebacterium parvum, cytokines and others. We reviewed the most frequently used techniques of pleurodesis in order to define the most effective treatment concept. In 15 prospective randomized trials the success rates varied from 13% with bleomycin to 100% with talc or Corynebacterium parvum. Talc was superior to other agents in 6 of 6, Corynebacterium parvum in 3 of 4 and bleomycin or tetracycline only in 3 of 8 studies. Adverse effects were frequently observed with cytostatic agents, but were very rare in the case of talc or fibrin instillation. Comparing the recently published data pleurodesis with talc appears to be the most effective treatment strategy, followed by Corynebacterium parvum, bleomycin and tetracycline.

Antibiotics, Antineoplastic↗
PubMed1996

[Talc pleurodesis in recurrent malignant pleural effusion--a prospective follow-up study].

Talc pleurodesis was performed in a prospective trial in 38 patients with recurrent malignant pleural effusion. After insertion of a chest tube a slurry containing 8g of iodined talcum, 0.5 ml of 1% xylocain/kg/body weight, and 80 ml of 0.9% NaCl was administered and suction drainage was performed. The chest tube could be removed after 4 +/- 1.7 days. A successful therapy could be achieved in 33/38 patients (86.8%). 2 patients (5.3%) suffered from recurrent pleural effusion which only in 1 case had to be drained. 3 patients died within the first month after talc pleurodesis due to an advanced cancer stage. Complications did not come to evidence in any case.

Adult↗
PubMed1996

[Preliminary results of a prospective randomized study vascular replacement above the knee].

In case of insufficient or missing greater saphenal vein or if the saphenal vein might be of important use for future bypass grafts, the question arises which alternative bypass material is the more appropriate choice. A literature review to that topic produced only unsatisfactory results. In a prospective randomized controlled clinical study (n = 250 patients) we compare the patency rates of either PTFE or Dacron as bypass material for femoropopliteal P-I-Bypass in chronic arterial occlusive disease. A preliminary evaluation of n = 103 patients (PTFE n = 52; Dacron n = 51) reveals an operative and immediate mortality rate of 0% and a loss of limb rate of 3.9% (PTFE) and 3.8% (Dacron). The secondary cumulative patency rate after 540 days of observation is 79.6% (PTFE) and 87.1% (Dacron). We so far find no statistically significant difference between both graft materials.

Adult↗
PubMed1995

Photodynamic therapy inhibits experimental allograft rejection. A novel approach for the development of vascular bioprostheses.

BACKGROUND: Biological vascular allografts have proved unsatisfactory because of thrombosis, occlusion, and aneurysmal degeneration during chronic rejection. Photodynamic therapy (PDT), a technique that leads to the production of cytotoxic free radicals, was investigated as a novel method to prepare arterial allografts. METHODS AND RESULTS: Shortly after impregnation with the photosensitizer drug chloroaluminum sulfonated phthalocyanine, infrarenal aortas of ACI rats were PDT-treated and orthotopically grafted in Lewis rats (PDT). The transplanted grafts were sequentially analyzed at 2, 4, and 8 weeks by morphometry, immunohistochemistry, and scanning electron microscopy. Of 25 untreated allografts, 4 (16%) developed aneurysms compared with 0 of 33 in PDT or untreated isografts (ISO, P < .001). PDT treatment of allografts significantly inhibited intimal hyperplasia (P < .001) and resulted in intimal areas comparable to those in ISO. However, medial thickness in both control allografts and PDT grafts was markedly decreased compared with ISO. External graft diameters of control allografts at 8 weeks were significantly enlarged (P < .02) compared with PDT or ISO. At all time points, T lymphocytes were found in a substantially larger number in untreated control grafts than in PDT or ISO. Scanning electron microscopy at 4 weeks confirmed complete repopulation with endothelial cells in PDT, which was not seen in the control allografts. CONCLUSIONS: Our findings suggest that local PDT treatment of arterial allografts inhibits inflammatory infiltration, aneurysmal dilatation, and development of intimal hyperplasia and may be used to develop vascular bioprostheses for use in humans.

Aluminum↗
PubMed1994

Endothelial seeding of compliant polyurethane vascular graft material.

Compliance was measured in a new compliant polyurethane vascular graft material and in polytetrafluoroethylene (PTFE) graft material using an ultrasonic device; attachment of indium-111 oxine-labelled human endothelial cells to both surfaces with a range of surface coatings was assessed. Compliant polyurethane was six to eight times more compliant than PTFE (P < 0.01) at all pressures in the range 50-120 mmHg, and endothelial cell attachment to uncoated polyurethane was three times better than to uncoated PTFE at times up to 90 min (P < 0.01). Attachment to polyurethane was also better after blood clot, collagen and fibronectin treatment at times up to 30 min (P < 0.05). Endothelial seeding of compliant graft material may provide a prosthetic vascular substitute with characteristics similar to those of autologous vein.

Aged↗
PubMed1994

[Fournier gangrene].

Since first described in 1883 by Fournier only 420 cases of Fournier's gangrene have been published worldwide during the last 100 years. The anatomic association between the fascies of penis, scrotum, perineum, groin and gluteal favors the fast spread of tissue necrosis. We report two cases in which the penis, scrotum and a great part of the trunk and extremities were affected. Extensive débridement, including removal of the scrotum, and antibiotic treatment permitted us to get rid of the symptoms. Reconstruction of the skin defects was done in a second step by applying mesh grafts. The histological findings correspond to those found in cases of necrotizing fasciitis. The basic difference between these two illnesses is their localization. While Fournier's gangrene, as a special form, is localized primarily in the anogenital area, fasciitis may arise in all locations. For successful treatment of Fournier's gangrene speedy radical débridement and local application of antibiotics to cover the entire area are required.

Adult↗
PubMed1994

Hemodialysis via the Scribner shunt in childhood: a surgical evaluation.

From 1973 to 1988, 105 children with renal failure (average age, 6.5 years; range, 5 days to 16.2 years) were treated with hemodialysis via surgically implanted Scribner shunts (n = 120). The average duration of dialysis was 16 days (range, 1 to 194 days). Twenty-three patients died during treatment or during the hospital stay because of the underlying disease; no patient died because of shunt complications. The treatment was initially successful for 82 children, but 14 of them died within several months of discharge. Among the initially surviving 82 patients, the shunt was the only means of access for dialysis in 52. In the other 30, the primary Scribner shunt was unsuccessful; it required replacement, or the type of dialysis had to be changed. The shunts were implanted in the forearm in 23%, the groin in 40%, and the ankle in 37%. Early complications were local bleeding (17%) after an average of 37.3 days, shunt occlusion (34%) after an average of 47.3 days, infections (9.3%) after an average of 43.9 days, and decreased blood flow (8.5%) after an average of 47.7 days. Vessels were reconstructed after discontinuation of dialysis in 28 cases, in which the Scribner shunt had been implanted in the groin. No patient experienced immediate ischemic problems. Long-term follow up results were obtained for 60% (n = 40) of the surviving 68 children after an average of 7 years (range, 2.1 to 15.2 years). We found no evidence of arterial or venous complications at the former shunt site.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1994

[Chemical pleurodesis with iodized talcum in persistent therapy refractory bronchocutaneous fistula].

The common therapy of a persistent bronchocutaneous fistula is the operative endoscopic repair of the leak, the parietal pleurectomy or the endoscopic pleurodesis with different agents. Therefore the thoracotomy with all the risks for the patient can be avoid. Complications seen in the thoracoscopic treatment are low and often the result of techniqual problems. However there must be an alternative therapy for patients with a high operational risk. In our case we treated a bronchocutaneous persistent fistula by the instillation of iodized talc effectively. Although talc and others agents are used in the therapy of malignant pleural effusions, the talc poudrage in the therapy of bronchocutaneous fistulas is a good alternative treatment for patients in a bad condition.

Bronchial Fistula↗
PubMed1993

Compliance of vascular anastomoses with polybutester and polypropylene sutures.

PURPOSE: Polybutester suture is more easily stretched than other vascular sutures and may produce more compliant anastomoses. The effects of using polybutester and polypropylene sutures were compared acutely in arterial autografts and in chronic implants of cephalic vein grafts into the femoral arteries of dogs. METHODS: Paraanastomotic profiles of diameter and compliance were measured with echo-tracked ultrasonography, and profiles of intimal thickening were generated from histologic sections of the vessels harvested after 3 months. RESULTS: Polybutester produced more compliant anastomoses, compared with polypropylene, in arterial autografts (in vitro: 5.9% +/- 2.0% vs 3.3% +/- 0.6% diameter change/100 mm Hg, p < 0.01; in vivo: 3.1% +/- 1.1% vs 1.6% +/- 0.5%, p < 0.05), but this difference was not observed with vein as the graft material, either initially (1.1% +/- 1.2% vs 1.7% +/- 0.5%) or after 3 months (2.1% +/- 1.2% vs 2.4% +/- 0.8%). This dichotomy may reflect a governing influence of the stiffer veingrafts, compared with host artery (2.6% +/- 1.0% vs 5.4% +/- 1.2%), or the use of suboptimal tension on the polybutester suture when creating the anastomosis. CONCLUSIONS: Both sutures produced similar compliance and thickness profiles. Polybutester initially produces a more compliant anastomosis when both artery and graft are compliant, reducing anastomotic compliance mismatch. However, this benefit may not apply when the anastomosis includes a vessel of low compliance.

Anastomosis, Surgical↗
PubMed1993

[An aneurysm of the portal vein].

Portal vein aneurysms are rare. We describe a patient with an aneurysmal dilatation (3 x 4.5 cm) of the right portal vein. Real-time ultrasonography revealed an anechoic lesion communicating with the portal vein, suggesting a portal vein aneurysm. Colour Doppler, contrast-enhanced computed tomography, and portal venography confirmed the diagnosis. No evidence of portal hypertension was found. Follow-up examinations did not reveal a significant change in the size of the aneurysm after 18 months.

Adult↗
PubMed1992

[Necrotizing fasciitis. Case report and review of the literature].

The necrotizing fasciitis is an infection with no or only a small trauma. It is a rapidly progressing process especially with necrosis and edema of subcutaneous fat and adjacent fascia underlined by systemic toxicity but spearing of skin and muscle by the initial process. Late recognition and lack of immediate aggressive surgical treatment contribute to the distressingly high mortality. Early and complete debridement offers the best chance for cure.

Adult↗