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U Sulkowski

Publications and source records attributed to U Sulkowski.

At least 37 records · Page 2Linked to original sources
PubMed1991

[Results of treatment of paralytic ileus caused by diffuse intra-abdominal metastasis with motilin. A pilot study of 25 patients].

In a pilot-study 25 patients presenting with a paralytic ileus due to diffuse intraabdominal metastases were treated with motilin. There were 16 male (64%) and nine female (36%) patients. Gastric cancer was the most frequent cause (40%), followed by pancreatic (36%), and colorectal (20%) cancer. 36% had received a postoperative chemotherapy before commencing the motilin-scheme. In 92% motilin therapy was started within 48 hours after the diagnosis of paralytic ileus. There were no serious side-effects of motilin therapy. In approximately 80% the pretherapeutic state was improved. Thus, it seems worthwhile to investigate the influence of motilin on paralytic ileus in incurable cancer patients in a prospective controlled trial.

Combined Modality Therapy↗
PubMed1991

[Artificial respiration in the prone position in a case of acute respiratory distress syndrome].

A patient is presented in whom an acute respiratory distress syndrome (ARDS) developed after severe lung contusion. Exchange of gas was markedly restricted under aggressive respiration (FiO2 = 1.0, PEEP = 10 mmHg, breathing time quotient = 0.5, respiratory minute volume = 16 litres; gas exchange values: PaO2 = 67 mmHg, PaCO2 = 45 mmHg, PA-aO2 = 461 mmHg). After control of the computed tomogram of the lungs showed marked densifications in those parts of the lung that are lower most by gravitation according to the positioning of the patient at a particular time the patient was ventilated in ventricumbent (prone) position for 60 hours. After having remained in this position for 48 hours, there was a significant improvement in the gas exchange (PaO2 = 89 mmHg, PaCO2 = 36 mmHg, PA-aO2 = 77 mmHg at FiO2 = 0.3, PEEP = 6 mmHg, breathing time quotient = 0.5 and respiratory minute volume = 9 litres). The control CT in dorsal position showed that the dorsal densifications had disappeared completely. Five days later the patient could be extubated. Respiration in ventricumbent (prone) position may considerably improve oxygenation by perfusion of well-ventilated regions of the lung that are lower-most by gravitation according to the relative positioning of the patient. Besides regions not well ventilated or not ventilated at all (according to the patient's position) may be better ventilated or re-opened and made accessible to ventilation by this method.

Adult↗
PubMed1991

[The historical development of resection surgery in pancreatic carcinoma].

Based on the pitfalls of the past the development of pancreatic resection therapy is outlined, starting with the first distal pancreatic resection in 1882 performed by Trendelenburg. Giving details of operations from the first decades of this century the Whipple operation is described as the early cornerstone in the history of radical therapy of pancreatic cancer. Summarizing the disappointments of the seventies gives the clue to the present situation with a modified Whipple operation as the standard curative approach to pancreatic carcinoma today. Additionally, various aspects of palliative therapy for pancreatic carcinoma are discussed.

Europe↗
PubMed1990

[Clinical aspects, diagnosis and therapy of genuine bile duct cysts].

During an eight-year period eight patients with intra- or extrahepatic bile duct cysts were treated at our institution. One patient belonged to Type I, four to Type IV and three to Type V according to the classification by Alonso-Lej/Todani. The main symptom among the Type IV patients was jaundice, among the Type V patients abdominal pain. The correct diagnosis could be established by ERCP in seven of eight cases. Two type V patients with disease mainly confined to one lobe of the liver could be resected, one patient was treated endoscopically, the others underwent biliary drainage procedures.

Adolescent↗
PubMed1989

[Invasive pulmonary monitoring in acute necrotizing pancreatitis. A decision aid for indications for surgery?].

From January 1986 to September 1988 16 patients with necrotizing forms of acute pancreatitis underwent invasive pulmonary monitoring at the Departments of General Surgery and Anesthesiology of Münster University Hospitals. Six patients had Stage II and ten Stage III disease according to the Mainz Clinical Classification for acute pancreatitis. Mortality was 37.5% in the reported series. Acute pancreatitis is characterized in cardiopulmonary terms by elevated levels for Cardiac Output (CO), Cardiac Index (CI) and Intrapulmonary Shunting (vAdmix), whereas Systemic Vascular Resistance (SVR) is significantly reduced. A decrease of SVR of more than 200 dyn s cm-5 may be an early indicator for a septic period, and, therefore, warrant operation.

Abdomen, Acute↗
PubMed1989

[Arguments for a revised concept in the therapy of acute pancreatitis. On the indications for conservative, endoscopic and surgical procedures].

From January 1, 1973 to October 31, 1987 we treated 271 patients suffering from acute pancreatitis at the Department of General Surgery at the University Münster, Westphalia. 159 (58.7%) presented with stage I, 75 (27.7%) with stage II, and 39 (13.6%) with stage III disease according to the Mainz classification for acute pancreatitis. In 147 cases an endoscopic sphincterotomy (EST) was performed. At a low method-specific morbidity (5.4%) we observed a mortality rate of 0% for stage I, 8% for stage II, and 22% for stage III. Altogether, a mortality rate of 13.3% was calculated for the necrotizing forms of acute pancreatitis after EST, compared to 36.5% for a conventionally (conservative therapy, operation) treated group.

Acute Disease↗
PubMed1988

[Caroli syndrome. Clinical aspects--diagnosis--therapy].

The Caroli syndrome is a rare autosomal-recessively inherited disease with cystic dilatation of the intrahepatic bile ducts. Cystic bile duct dilatations are usually accompanied by cholelithiasis and subsequent cholangitis. This is the most substantial danger implied in the Caroli syndrome. It has often been left unconsidered as a cause in differential diagnosis of cholangitis, resulting in undetected protracted course of the disease. Once an unambiguous diagnosis has been established, the authors, by their own experience from three cases and with reference to the literature, recommend subtotal hepatectomy as optional therapy.

Adult↗
PubMed1987

[Value of diagnostic procedures in pancreatic cancer].

At the Surgical Department of Münster University in-patient treatment was applied to 320 patients for pancreas carcinoma, between 1977 and 1984. These cases were concomitantly studied for informative potentials of computed tomography (CT), sonography (Sono), and endoscopic retrograde cholangiopancreatography (ERCP). CT was performed on 163 patients (50.3 per cent), Sono on 180 (56.3 per cent), and ERCP on 90 (28.1 per cent). Highest sensitivity was recorded from ERCP, with 91.1 per cent of correctly positive diagnoses. CT gave correct positive findings in 70.5 per cent of all cases and Sono in 61.1 per cent. Resection rates were not increased by introduction of these new techniques, but the rate rather stayed at 14.8 per cent. While the period between hospitalisation and operation was slightly reduced, surgical intervention was too late for curative resection in most cases. In some highly advanced cases with distant metastases but absence of symptoms on the basis of CT findings, exploratory laparotomy was abandoned. The new methods have improved diagnostic accuracy rather than prognosis of pancreas carcinoma.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1987

[Clinical aspects and surgical therapy of papillary cancer].

In-patient treatment was applied to 64 patients for carcinoma of Vater's papilla at the Surgical Department of Münster University, between 1974 and 1985. Their average age was 57.3 years. Most of the tumours investigated were highly or moderately differentiated. The average time that passed from the first symptoms was 2.4 months, before most of the patients sought medical consultation for jaundice and loss of weight. Tumours were removed from 54 patients (84.4 per cent). No curative therapy was possible in ten cases. Lymph node or distant metastases were recorded at the time of treatment from 16 of all 64 patients or from six of those who had undergone radical resection. Five-year survival probability after curative surgery was attributed to 42.1 per cent of all patients concerned.

Ampulla of Vater↗
PubMed1985

[Perioperative staging and the Münster TNM classification in ampullary and pancreatic cancer].

From 1974 to 1982 607 patients with diseases of the pancreas were treated at the Surgical University Clinic of Münster/West Germany. 256 of those suffered from pancreatic and 42 from ampullary cancer. All patients were grouped according to a TNM-System for pancreatic cancer developed for that particular purpose. Of the curative resections performed (n = 73) with a resection rate of 78.6% for ampullary and 15.6% for pancreatic cancer, a distinct preponderance of early stages (T1N0M0/T2N0M0 greater than 60%) was noticed for the first, of late stages for the latter (T1N0M0/T2N0M0 = 25%). The frequencies of distant metastases for all operations also differed significantly, being 9.5% respectively 43.4% at the time of operation (p less than 0.05). At the low mean survival time for palliative operations an mean survival time of 40.3 months for the Whipple operation was evaluated, of 28.0 months for total pancreatectomy. At the stage T1N0M0/T2N0M0 the mean survival time was greater than 63 months.

Ampulla of Vater↗
PubMed1985

[Complications following duodenohemipancreatectomy. Results of 112 patients 1974-1983].

From 1974 to 1983, 112 patients were treated at the Chirurgische Universitätsklinik Münster according to the procedure first published by Whipple in 1935. 40 patients (35.7%) were operated for chronic pancreatitis, 39 for (34.8%) ampullary cancer and 33 (29.5%) for pancreatic cancer. As to operative mortality which amounted to 10.7% (12/112) for all patients, figures of 10.0% (4/40) could be found for relapsing pancreatitis and 7.7% or 15.2% respectively for cancer patients. The underlying cause was circulatory arrest in 6 cases, anastomotic leakage in 4 cases, liver failure and gas gangrene in 1 case each. Altogether eight relaparotomies were performed (7.1%). As non-letal complications, pancreatic fistula, rise of liver enzymes, wound healing disturbances, and pleural effusion were the most frequent non-letal complications. By using the Ethibloc for pancreatic duct occlusion the rate of complications could be lowered. Hardly ever, glucose-metabolism was markedly affected by this extensive procedure.

Adult↗
PubMed1984

[Papilla and pancreas cancer. An epidemiologic-clinical case control study of 298 patients].

The study is based on the case records of 816 in-patients (256 adenocarcinoma of the pancreas, 42 carcinoma of Vater's papilla and 518 controls) admitted to the Surgical Clinic of Münster University between 1974 and 1982. With respect to preliminary diseases only pancreatitis and cholecystectomy showed a significant difference between cancer group and control group. 36% of the patients with ampullary and 6.7% with pancreas cancer survived the five-year limit. Prognosis was best among patients over 60.

Adenocarcinoma↗
PubMedDate not supplied

SPIO-enhanced 2D-TOF MR angiography of the portal venous system: results of an intraindividual comparison.

The purpose of this study was to investigate whether MR angiography (MRA) of the portal venous system may be improved by means of superparamagnetic iron oxides (SPIOs) during accumulation phase imaging and to study the underlying contrast mechanisms. MRA of the portal venous system was performed on 48 patients before and after intravenous injection of a new SPIO (Resovist, Schering AG, Berlin, Germany). Resovist, as a predominantly liver parenchymal darkening agent on T2-weighted MR images with uptake into the reticuloendothelial cell system, was administered intravenously by bolus injection of 8 to 12 micromol Fe/kg body weight. Patients were scanned with breath-hold coronal and axial two-dimensional (2D) time of flight (TOF) MRA (TR = 31.0 msec, TE = 9.8 msec, flip angle (FA) = 50 degrees, and 6.9-second acquisition time per section) sequences. Signal intensity values of liver parenchyma, the portal venous system, and background were obtained for quantitative analysis. The clinical relevance of additional plain and contrast-enhanced MRA studies for surgical planning was assessed by independent reading of three readers. Liver signal-to-noise ratio (SNR) significantly decreased following iv injection of Resovist; however, SNR values of the portal veins or hepatic veins did not change significantly. Visibility of the portal venous system improved significantly (tertiary branches visible: pre in 15.2% versus post in 87.0% of patients). Resovist-enhanced 2D-TOF MRA may improve planning of liver resections by better demonstrating the relationship of central liver lesions and vessels on source images. The decrease in liver SNR at a constant vessel SNR after iv injection of Resovist improves MRA of the liver. SPIO-enhanced 2D-TOF MRA scans are superior to plain 2D-TOF MRA studies and may be added for the workup of preoperative patients.

Contrast Media↗
PubMedDate not supplied

Preliminary clinical experience with laser-induced interstitial thermotherapy in patients with hepatocellular carcinoma.

The purpose of this preliminary study was to evaluate whether laser-induced interstitial thermotherapy (LITT) may be used for palliative treatment of localized hepatocellular carcinomas (HCC). We applied LITT to two patients suffering from unresectable localized hepatocellular carcinomas of different sizes (2.5 and 4 cm). LITT was performed with an Nd:YAG laser (1,064 nm) at 5 W laser power (15-20 minutes). Thermometry during LITT was performed by MRI using a temperature-sensitive T1-weighted fast low-angle shot (FLASH) sequence. Follow-up for local tumor control was performed by MRI and ultrasound. LITT was well tolerated and no adverse events occurred during or after LITT; no secondary liver lesions were seen in the follow-up (11 or 12 months, respectively). Only minimal tumor growth was observed in the larger HCC (from 4 to 5 cm), whereas the smaller HCC remained unchanged in size during 11 months of follow-up. We conclude that LITT might be an effective minimally invasive palliative treatment option for patients with small unresectable HCC.

Aged↗