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Biomedical subjects

U Kunath

Publications and source records attributed to U Kunath.

At least 19 recordsLinked to original sources
PubMed1999

[Laparoscopically-assisted trans-mediastinal esophagectomy].

In esophageal cancer blunt dissection of the esophagus is reasonable in high-risk patients. Manual dissection can compromise the heart and reduce blood pressure. This can be avoided by laparoscopically assisted transmediastinal dissection of the esophagus. We describe the operative procedure and report on a patient with coronary heart disease who suffered from cancer of the cardia spreading into the esophagus as well as into the stomach. Esophagogastrectomy was performed with jejunal replacement.

Cardia↗
PubMed1998

[Success and failure in laparoscopic "gastric banding". A report of 3 years experience].

During 3 years, the adjustable gastric band (AGSB) was laparoscopically implanted in 224 of 873 patients with morbid obesity. The operation was done by 7 surgeons. Problems arising from the operative technique are: early pouch dilatation, gastric slippage, gastric perforation, penetration of the band, port infection, penetration of the port, defect of the band catheter. These can be avoided by care and increasing experience. The late pouch dilatation and the insufficient loss of excess weight arise from the unsatisfactory compliance of the patient. Critical selection of patients is necessary. Total morbidity in this seria was 19%, the letality 0.4% and the average excess weight loss within 2 years was 50 +/- 28%. The results may be improved by restrictive selection of patients and great operative routine.

Adult↗
PubMed1996

[Surgery in elderly patients].

The percentage of elderly people among surgical patients has been continuously rising. The purpose of this study was to show the course of operation and hospitalization of seniors in a department for general surgery. 191 patients aged 75 or older underwent surgery during the six months of observation. Information about preoperative social and environmental conditions, operative and postoperative treatments, complications, secondary symptoms and rehabilitation and homecare after discharge was retrospectively compiled. Women comprised 76.4% (146 cases) of the patients; men 23.6% (45 cases). Mandatory surgery was necessary in 37.7% of all operations, while 62.3% were required to be handled on an emergency basis. The average age was 83.2 years (+/- 5.26). 33 (17.3%) of the patients on whom had been operated did not survive. 84.8% (28) of these cases had undergone emergency surgery, 15.2% (5) had been operated on routinely. For 66% (126) of the patients the course of hospitalization was without any complications. Discharge into the accustomed environment was possible for 74.7% (118) of the successful cases. Old patients show a good physical and psychological acceptance of surgery and hospitalization, if they are well prepared and secondary symptoms are appropriately therapied. The decision for routine operation in sufficient time can help avoid an emergency operation with poor prognosis.

Activities of Daily Living↗
PubMed1995

[Laparoscopic hernioplasty].

The laparoscopic hernioplasty is an operative technique with a biomechanical background. The thin-walled inguinal triangle of the abdominal wall is reinforced without tension. Regarding a few details this technique may repair groin hernia without recurrence and nearly uncomplicated.

Adolescent↗
PubMed1995

[An unusual case of cavernous portal vein transformation].

This paper reports the case of a 36-year-old patient with extensive cavernous transformation of the portal vein, the omentum, and the stomach due to a portal vein thrombosis in the childhood. The morphology of the cavernous transformation using different imaging modalities is demonstrated; etiology and therapeutic procedures are discussed.

Abdominal Neoplasms↗
PubMed1995

[Laparoscopic gastric banding for treatment of pathologic obesity].

Since 1983 gastric banding is a proven operative method, which reduces effectively excess weight in morbid obesity. The laparoscopic procedure, which was performed in July 1994 for the first time in Germany, is described. Indications, results and operative-technical problems are discussed.

Adult↗
PubMed1994

[Thoracoscopic myotomy of the esophagus in achalasia].

Report on four patients with achalasia of the oesophagus. Longitudinal myotomy was performed by thoracoscopy as minimally invasive procedure. The advantages of the transthoracic, thoracoscopic versus the transabdominal operation are discussed.

Adult↗
PubMed1989

Repetitive intercostal nerve block via catheter for postoperative pain relief after thoracotomy.

After anterolateral thoracotomy, before incision closure, indwelling plastic catheters were inserted percutaneously under digital and/or visual control into the intercostal space of access and the two neighbouring ones. Initially, we injected 25 mg of bupivacaine through each catheter (to a total of 75 mg), and subsequently - on the patients demand - another 15 to 25 mg per catheter. To date, 25 patients received repetitive intercostal nerve blocks by this method (ICB-group). We compared their personal and perioperative data with those of another 30 patients, receiving opiates systemically after major thoracic surgery (SA-group). Multiple blood samples from the ICB-group were analyzed by gaschromatography for bupivacaine concentration-time-profiles. In 19 of 25 patients (76%) the bupivacaine-injections provided sufficient analgesia, 6 patients required additional analgesics. The duration of general anaesthesia (ICB: 174 min vs. SA: 136 min) and the operation time (ICB: 103 min vs. SA: 94 min) were not statistically different in both groups. The periods of intensive care therapy (ICB: 0.7 d vs. SA: 1.2 d), artificial respiration (ICB: 11.2 h vs. SA: 21.6 h) and hospital stay (ICB: 12.1 d vs. SA: 14.2 d) were shorter for the ICB-group. Atelectasis (ICB: 20% vs. SA: 37%) and pneumonia (ICB: 0 vs. SA: 13%) were observed less frequently than in the control group, whereas tachyarrhythmia occurred in 6 of 25 ICB-patients compared to 4 of 30 SA-patients. Nevertheless, none of these parameters reached statistical significance (p less than 0.05). Maximum bupivacaine levels of 0.65 +/- 0.21 micrograms/ml were found after 29 +/- 12 min of intercostal application.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

[Indications and results of portal shunt surgery].

Bleeding esophageal varices are treated in the first line as emergency by sclerosing procedures. Later on shunt surgery is still to be considered as an important definite procedure. Criteria to be met before surgery are discussed. In our experience the shunting procedure as described by Warren yields good results, low incidence of thrombosis and low lethality. In special cases subtotal esophagectomy can be performed, lethality being as low as after the Warren shunt. Repeating sclerosing over years in contrast carries a high risk of complications and death and does not prevent further bleeding safely enough.

Adult↗
PubMed1984

[Radical nature and life expectancy in the surgical treatment of esophageal and cardial carcinoma].

Fifty-four patients with carcinoma of the oesophagus and cardia were selected to have either a two-cavity radical operation or blunt oesophagectomy without thoracotomy. Squamous-cell carcinomas were randomized for postoperative radiotherapy or none. Neither the two-cavity radical operation nor additional radiotherapy prolonged life expectancy. The results cast doubt on the effectiveness of local radical or curative surgery for carcinoma of the oesophagus and cardia. The only objective in the choice of treatment must be to decrease operative mortality and to make the course of the disease tolerable to the patient.

Adenocarcinoma↗
PubMed1984

[Portal perfusion following Warren shunt].

Report on 15 controlled patients with open Warren-Shunt. The pre- and postoperative percentage of portal liver perfusion was determined by the sequential liver perfusion scintigraphy. The portal liver perfusion was significantly reduced after Warren-Shunt, presumably because the perfusion of the spleen is derived from portal perfusion. The preoperative size of the spleen may be correlated to the reduction of portal perfusion. Therefore, spleen perfusion and its percentage of portal perfusion should be measured preoperatively.

Adult↗
PubMed1984

[Intrathoracic-extrapleural esophageal replacement with gastroplasty].

We carried out replacement of the oesophagus by transposing the stomach in 87 patients, 64 with carcinoma of the oesophagus. There is an immediate operative mortality of 20-30%, but this is followed by a relatively low morbidity, which is well demonstrated radiologically (stricture at the anastomosis, which can be mechanically dilated, about 22%; external fistula with a tendency to spontaneous closure about 25%; ectasia of the thoracic stomach, 15-25%). Average survival time is eight to ten months. There is a 24% risk of post-operative pulmonary oedema and daily chest x-rays are indicated.

Adult↗
PubMed1984

[The stomach as replacement of the esophagus in esophageal cancer].

The advantage in using the stomach as an oesophageal substitute are demonstrated by operative technique, function and physiology. The preference of the stomach in oesophageal replacement is based upon a lot of experimental and clinical experiences, which are mentioned.

Esophageal Neoplasms↗
PubMed1983

[Operative methods in adenocarcinoma of the cardia].

Adenocarcinoma of the oesophagogastric transition is only incompletely resectable in 40% of cases, if resection with intrathoracic anastomosis is desired. Death-rate of thoraco-abdominal or transthoracic resection is over 40% (in the authors' own series 47%). Survival time of patients is short, some develop a recurrence at the anastomotic site. More radical and carrying a lower postoperative mortality is resection of the tumour with subtotal oesophagectomy without opening the thorax. Anastomosis with the residual stomach is made at the cervical portion of the oesophagus.

Adenocarcinoma↗