PubMed Health⌕ Search

Biomedical subjects

U Herzog

Publications and source records attributed to U Herzog.

At least 19 recordsLinked to original sources
PubMed1995

[Initial results with laparoscopic fundoplication].

17 patients underwent laparoscopic Nissen fundoplication for gastroesophageal reflux disease not responding to medical treatment. Conversion to laparotomy was necessarily due to large paraesophageal hiatus hernia (3) or severe peri-esophagitis (1) in 4 patients. There was no perioperative morbidity or mortality. At 3 months all patients were symptom-free. Esophageal manometry revealed a rise in mean lower esophageal sphincter pressure from 4 mm Hg preoperatively to 11 mm Hg postoperatively, and lengthening of the high pressure zone from 2.3 to 3.3 cm. One patient needed reoperation one year after fundoplication due to wrap disruption with recurrent reflux disease. Laparoscopic fundoplication involves low perioperative morbidity and shortens the postoperative recovery time in selected patients.

Adult↗
PubMed1995

[Results of follow-up after apicoectomy with 2 different root canal filling materials].

Clinical and radiological findings in two groups of patients in whom apicectomies were done are presented. In one group root canal filling was by means of phosphate cementum; in the other, Diaket and guttapercha points were used. Evaluation was according to the methods applied already by Lüders in 1990. Preoperative diagnoses most often had been chronic periapical periodontitis followed by traumatic injuries to frontal teeth and complications encountered during endodontic treatment. In those persons in whom phosphate cementum had been applied, treatment was successful in 210 teeth (77.2%) and a failure was noted in 62 teeth (22.8%). In the Diaket/guttapercha group the success rate was 167 teeth (80.7%), while treatment was without success in 40 teeth (19.3%).

Adult↗
PubMed1994

[Perianal extramammary Paget's disease].

Extramammary perianal morbus Paget is a rare disease; so far, only a few more than 100 cases have been reported on or described worldwide. Diagnosis, differential diagnosis, therapy, and prognosis of intra-epidermally growing adenocarcinoma are explained and discussed by means of a well-documented case.

Anus Neoplasms↗
PubMed1994

[Results of surgical therapy in esophagus and cardia carcinoma].

Surgery for carcinoma of the esophagus and cardia represents potentially curative therapy in early stage of tumor. In the advanced stage of tumor palliation is the only remaining therapeutic aim. In a retrospective study covering the period 1984-1992 we analyzed 51 patients who underwent surgery for esophageal or cardia cancer to determine whether palliation by surgery is feasible. We also analyzed morbidity and mortality of peri- and postoperative complications. In 88% we carried out standard esophagectomy consisting of abdomino-thoracic access, gastric interposition with thoracic anastomosis and extramucous pyloromyotomy. In the light of postresection histology, 53% of the operations were potentially curative (UICC stage I and II) [1], 47% palliative (UICC stage III and IV) [1]. Perioperative 30-days mortality was nil, perioperative 30-days morbidity 11% (3 patients developed pneumonia postoperatively, 2 patients with cervical anastomosis developed dehiscence of anastomosis which in both cases healed completely with conservative therapy, while a further patient with cervical anastomosis suffered persistent paralysis of the recurrent nerve. All patients were fully able to feed themselves at the time of discharge. 43% of patients had recurrent dysphagia and 24% underwent endoscopic dilatation. Three-year survival was 26%. From these results it may be concluded that esophageal resection represents either good palliation with low morbidity for the majority of patients with non-resectable carcinoma of the esophagus or potentially curative therapy with low morbidity in early stage of tumor.

Adenocarcinoma↗
PubMed1994

[Sphincter-preserving surgery of trans-sphincteric anal fistulas].

The "laying open" technique is the standard method of treating fistulas-in-ano. Laying open transsphincteric (high anal) fistulas involves division of a part of the external anal sphincter and may result in incontinence. In 12 patients with high transsphincteric fistula (7 with previous surgery to attempt fistula healing) we have used a sphincter-saving surgical method: excision of the fistula tract and closure of the internal opening by suture of the internal anal sphincter. Fistulas were eradicated in 8 patients (67%) without incontinence. In 4 patients the fistulas persisted. It is concluded that transanal closure of the internal opening and perianal fistula excision can be an effective method of treating transsphincteric fistulas without sphincterotomy, thus avoiding the risk of incontinence.

Adult↗
PubMed1994

[Prognostic factors in resected stomach carcinoma].

Between January 1982 and December 1991, 232 consecutive patients (121 male, 111 female) with gastric adenocarcinoma were treated at our clinic. Resection of the tumors (resectability 73.7%) included lymphadenectomy of compartment I (D1 resection). The tumors were classified according to the Borrmann's and Laurén's criteria and according to the TNM system. 171 patients underwent resection of the tumor, 49 palliative surgery and 12 were treated nonsurgically. The operative morbidity in patients with resection and palliative operations was 20.5% and 10.2% respectively, and the mortality rate was 0.6% and 8.2% respectively. Follow-up data (median 6 years postoperatively) were available for 229 out of 232 patients (98.7%). After resection, the five year actuarial survival rate according to the method of Kaplan-Meier was 38.2%. The probability of survival increased to 47.5% after potentially curative resection. An univariate and a multivariate analysis by the proportional hazard model (Cox regression analysis) identified several significant prognostic parameters for survival (in order of their significance): tumor stage (TNM), N-stage, percentage of positive lymph node metastases among removed nodes, Borrmann criteria, T-stage, metastases in five and more lymph nodes, diameter of the tumor, serosal involvement, peritoneal and hepatic metastases, and patient's age. The following parameters did not have a prognostic value in our analysis: grading, Laurén classification, and localization of the tumor. We conclude that the identification of several prognostic factors allows us to estimate the probability of survival for each individual patient. In future these factors may influence decision-making on adjuvant treatment of gastric cancer.

Actuarial Analysis↗
PubMed1994

[Cholecystectomy today. A prospective study].

Between 13 June 1990 and 12 June 1993, we performed 1145 consecutive cholecystectomies. 127 patients who had undergone additional surgery were excluded from the prospective study. Of the remaining 1018 patients, 806 (78.2%) underwent laparoscopic cholecystectomy. The conversion rate to open procedure was 11.2% (90/806). The operative morbidity associated with laparoscopic cholecystectomy was 2.1% (17/806) and with open surgery 1.9% (4/212); mortality was 0.12% (1/806) and 0.47% (1/212) respectively. The reoperation rate after laparoscopic cholecystectomy was 0.6% (5/806). Reoperation was performed for lesions of the common bile duct, bleeding, and abscess formation. If the indications for open cholecystectomy are respected the morbidity and mortality were low for both laparoscopic and conventional cholecystectomy.

Adolescent↗
PubMed1994

[Results following resection in early stomach carcinoma].

The results of surgical resection in early gastric cancer were analyzed retrospectively. These operations were performed between 1982 and 1991 on 52 consecutive patients (29 women, 23 men; average age 64 [35-85] years). The tumours were resected by total gastrectomy in 11, by subtotal gastrectomy in 31, and by Billroth I resection in 10, followed by limited lymphadenectomy of the perigastric group of lymph-nodes (D1 dissection). There was one operative death (1.9%). The tumor was confined to the mucosa in 36 patients (69%), while submucosal infiltration was present in 16 (31%) and metastases to the regional lymph-nodes in seven (13%). Follow-up examination took place in all patients, after an average period of observation of 6.1 years. For the total group the 5-year survival rate, including operative mortality, was 83.7%. It correlated with the depth of penetration of the tumour and nodal involvement. 5-year survival rate for mucosal tumour was 90%, with submucosal infiltration 66.7% (P < 0.03), without lymph-node metastasis 86.4%, with it 68.6% (P < 0.05). The extent of resection and the tumour classification (according to Laurén--intestinal or diffuse) did not influence survival.--Early gastric cancer, contrary to that in the advanced stages, has a very good prognosis. But it is significantly altered by the depth of penetration of the tumour and nodal metastasis.

Adult↗
PubMed1994

Endoanal ultrasonography in the follow-up of anal carcinoma.

As the modern treatment for anal carcinoma is either radiotherapy alone or combined radiochemotherapy, an exact histological staging is impossible. Therefore we have to depend on an accurate preoperative staging method. Endoanal ultrasonography enables imaging of the normal anal canal and its pathologies. In a prospective investigation we were able to confirm the histological proven diagnosis of an anal epidermoid carcinoma in 12 patients with a 10-MHz transducer covered with a sonolucent plastic cone. The depth of infiltration can be determined in relation to the normal layers of the anal canal. Six patients treated with radiotherapy alone or combined radiochemotherapy were followed and the success or failure of the treatment was documented. Endosonography of the anal canal allows an exact staging of a primary anal carcinoma and the follow-up in irradiated carcinomas. Besides digital palpation and proctoscopy with biopsy, endosonography complements the preoperative staging of anal carcinomas.

Anal Canal↗
PubMed1994

Acute and chronic presentation of intestinal nonrotation in adults.

Intestinal nonrotation has been recognized as a cause of obstruction in neonates and children and may be complicated by volvulus and intestinal necrosis. It is very rarely seen in the adult and may present acutely as a bowel obstruction and intestinal ischemia associated with midgut or ileocecal volvulus, or chronically as vague intermittent abdominal pain. The purpose of this communication is to reveal the pathogenesis and the surgical significance of intestinal nonrotation in adults and to review the English and German language literature since 1923 to establish the optimal therapeutic management. Between 1983 and 1992, we have managed and observed prospectively 10 adults with intestinal nonrotation. In four patients the nonrotation has been detected at emergency laparotomy owing to midgut or ileocecal volvulus. Four patients suffered from chronic symptoms of intermittent volvulus or small bowel obstruction and in two patients the nonrotation has been noted as an incidental finding at laparotomy for another condition. A survey of the literature from 1923 to 1992 revealed 40 adults with symptomatic intestinal nonrotation to which we contribute nine patients. We establish that in the acute symptomatic pattern, only emergency laparotomy can provide the correct diagnosis and decrease the risk of bowel disturbance. In the chronic situation, barium studies of the upper and lower gastrointestinal tract reveal varying degrees of midgut malrotation and confirm the nonrotation in each case. Also, in these forms the explorative laparotomy with a consequent staging of the abdominal situs is to be recommended. All reported cases at our institutions are without complaints after surgery. Adult patients with intestinal nonrotation and acute or chronic obstructive symptoms or those detected incidentally at laparotomy for other conditions should undergo a Ladd procedure because of the risk of midgut volvulus. In this operation, the nonrotation is left in place and the ascending colon is sutured at the colon descendens and sigmoideum. After this procedure the mesenteric pedicle is fixed and the risk of midgut torsion remains minimal.

Abdomen, Acute↗
PubMed1994

A nation's experience in laparoscopic cholecystectomy. Prospective multicenter analysis of 3722 cases.

In a national prospective multicenter study 3,722 laparoscopic cholecystectomies (LC) performed by 179 surgeons in 50 institutions were analyzed with special regard to technique and complications. Conversion to open cholecystectomy was necessary in 259 patients (7.0%), either without intraoperative complications (4.5%) or due to intraoperative complications (2.5%). Three patients (0.08%) died within 30 days after operation and a total of 39 patients (1.0%) had to be reoperated; 22 (0.6%) bile duct injuries were registered. Common bile duct (CBD) stones were treated mainly by ERCP. In eight cases laparoscopic removal of common bile duct stones was attempted, and it was performed successfully in six patients. Postoperatively patients were discharged home after a mean of 4.4 days and returned to work after 14.0 days (range: 2-28). Laparoscopic cholecystectomy became the golden standard to remove the gallbladder, but further development is needed to establish laparoscopic treatment of biliary tract stones in the near future.

Adolescent↗
PubMed1994

[Laparoscopic and open cholecystectomy in 954 patients. A prospective evaluation].

In 2 1/2 years we performed at the St. Clara Hospital in Basel 954 cholecystectomies; 661 were done laparoscopically. In the laparoscopic group we observed a morbidity of 2.3%, a reoperation rate of 0.6% and a mortality of 0.15%. In the group with open cholecystectomy the morbidity was 9.9% and the mortality 1.3%. In all 954 patients who had a cholecystectomy the morbidity was 4.6%, reoperation rate 0.4% and mortality 0.5%. Because of negative patient selection a comparison with the open cholecystectomy in our series is not possible. In summary we can say that the laparoscopic procedure has a low morbidity and low mortality. With the lesser operative trauma it allows a shorter hospital stay. We believe that laparoscopic cholecystectomy with good indication will replace open cholecystectomy as the gold standard therapy of symptomatic gallstone disease.

Adult↗
PubMed1993

[Results of esophagectomy in carcinoma of the esophagus and cardia].

Surgery for carcinoma of the esophagus and cardia represents potentially curative therapy in the early stage of the tumor. In the advanced stage of tumor, palliation is the only remaining therapeutic aim. In a retrospective study covering the period 1984-1992 we analyzed 51 patients who underwent surgery for esophageal or cardia cancer to determine whether palliation by surgery is feasible. We also analyzed mortality and morbidity of peri- and postoperative complications. In 88% we carried out standard esophagectomy consisting of abdomino-thoracal access, gastric interposition with thoracal anastomosis and extramucosal pyloromyotomy. In the light of postresection histology, 53% of the operations were potentially curative (UICC stage I and II) and 47 palliative (UICC stage III and IV). Perioperative 30-day mortality was nil, and perioperative 30-day morbidity 11% (3 patients developed pneumonia postoperatively, 2 patients with cervical anastomosis developed dehiscence of anastomosis which in both cases healed completely with conservative therapy, while a further patient with cervical anastomosis suffered persistent paralysis of the recurrent nerve. All patients were fully able to feed themselves at the time of discharge. 43% of patients had recurrent dysphagia and 24% underwent endoscopic dilatation. Three-year survival was 26%. From these results it may be concluded that esophageal resection represents good palliation with low morbidity for the majority of patients with non-resectable carcinoma of the esophagus.

Adenocarcinoma↗
PubMed1993

[Strengths and weaknesses of endorectal ultrasonography].

Endorectal ultrasound is the most reliable method in staging rectal cancer and is superior to computed tomography. In a prospective series of 152 consecutive patients, comparison of preoperative ultrasound staging and postoperative histopathological staging resulted in an overall accuracy of 90.1%. Overstaging was observed in 9.2%, understaging in 0.7%. Peritumoral inflammatory changes, preoperative radiotherapy and localization of the tumor in the lower rectum were the main reasons for overstaging. Understaging was seen in stenotic or only minimal invasive tumors. Accuracy in staging lymph nodes was 78.5%. Inflammatory changes in the nodes were responsible for either overstaging or understaging. Whether diagnosis will be improved with a higher frequency--mainly in lymph nodes--has yet to be proved. With knowledge of the reasons for misinterpretation, endorectal sonography is--mainly in the lower rectum--a valuable aid in evaluation of surgical procedure.

Adult↗