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Biomedical subjects

U Wolters

Publications and source records attributed to U Wolters.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Prospective hospital documentation as an instrument of surgical quality assurance].

UNLABELLED: In this study expenditure and benefits of a differentiated internal hospital documentation were analyzed. We particularly wanted to find out whether an independent prospective documentation of all postoperative complications has a reducing effect on the frequency of these events and therefore can be used as a means of control. METHOD: In the time between May 1989 and September 1992 the data of 8682 patients of our hospital were documented. Scientific assistants who regularly visited every ward registered every course of treatment. All data were coded and simultaneously checked. RESULTS: We found the risk of postoperative pneumonia (3.6%) especially high in units for vascular surgery and in the intensive care unit. Wound infections (5.2%) were mostly seen after transplantations and vascular surgery. Specific complications after operations showed an accumulation in certain wards. If we look at the progress since 1979 we can perceive a significant regression in the rate of wound infections and pneumonia and a constant rate of clinical lethality. In elective bowel-resections a significant reduction of wound infections and leakages could be recorded. Concerning the patient's characteristics we saw apart from a general increase in the number of operations a clear increase of endoscopic performances. CONCLUSION: Hospital documentation can uncover internal correlations and thus takes part in clinical quality assurance. Helpful are evaluations of each specific ward and the specific operations. Basis for this is the selection of suitable data and their independent evaluation. Measures of external quality assurance have not yet solved these problems convincingly.

Adolescent↗
PubMed1993

[Development of colorectal tumor surgery in the last 20 years].

Early and longterm results in surgery for colorectal cancer during the last two decades were investigated by a retrospective analysis of the data of 1,203 patients. During the last 10 years we registered a significant increase in more advanced tumors of the stage III and IV from 37 to 52%. Nevertheless operative mortality was reduced from 8.5 to 3.5%. The amount of curative resections was 80% constantly. The incidence of local recurrence decreased from 18 to 12%, distant metastases however were observed twice as much during the last decade (16%) as compared to the first 10 years of the observation period. Longterm survival has only slightly improved, concerning mainly stage III patients with an increase of 5-year-survival from 31 to 48%. The results of a rigorous follow up after surgery for colon and rectal carcinoma were disappointing.

Adult↗
PubMed1992

[Preoperative intestinal lavage with a polyethyleneglycol-containing solution. A prospective randomized study in comparison with Ringer's lactate solution].

UNLABELLED: Aim of that study was to prove, whether a solution containing polyethyleneglycol (PEG) is more useful in comparison to the normal method using Ringer's-lactate solution for preoperative bowel preparation. METHODS: From January 1990 up to February 1991 we compared in a prospective randomized simple blind study on 110 patients the whole gut solution (Hewitt) to a bowel preparation with PEG (Oralav). RESULTS: The patients, that were prepared in the common way (Ringer's-lactate, control group; n = 54) were approximately given the double amount of liquid (9663 ml) as those in the other group (target group; n = 54: 4777 ml). We found no significant differences concerning the electrolytes. Hemoglobin (-1.1 g/dl) and hematocrit (-3.5%) were significantly lower in the control group. Both groups showed a similar frequency of nausea (control group 25% vs target group 34%). Vomiting was mainly found in the control group (20.8% vs 1.9%). Both groups showed comparably good results in bowel cleansing. Between the two groups we found no differences in specific bowel bacterial flora. Characteristic and number of postoperative complications were similar low (5.7 vs 3.8%). CONCLUSIONS: Due to a better compliance by oral application, the lower given amounts of liquid and the equal cleansing effect we prefer the use of the PEG containing solution (Oralav).

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↗
PubMed1991

[Does parenteral linoleic acid modify tumor growth? Studies with the Yoshida sarcoma model].

In an experimental study with sprague-dawley-rats we tested the effect of parenteral substituted LCT-fats on tumor growth of the Yoshida sarcoma in its ascites form. Therefore we tested 4 groups with 10 tumor-bearing and 10 non-tumor-bearing rats. We added group 1-3 LCT-fats in different doses. Group 4 was fed enterally. We found that tumor-bearing rats had a higher nitrogen retention than non-tumor-bearing rats. Non-tumor-bearing rats showed a higher nitrogen concentration in the muscles. The portion of nitrogen increased with increasing portion of fat. The content of nitrogen in the ascites, the quantity and the number of tumor cells was reversed in proportion to the portion of fat. For the host we showed that he cannot make use of the energy directly. The tumor does not grow in proportion to the available energy but has to support itself from the catabolism of the host.

Animals↗
PubMed1991

[Role of the spleen in tumor surgery].

Tumorigenesis and tumor growth are connected with the immune system. Therefore the role of the spleen respectively splenectomy have gained increasing influence. The existing experimental and clinical results are discussed with the help of a general review of the literature. A manipulation of the immune system by splenectomy seems possible. A common pathomechanism has not yet been found. But experimental investigations are transferrable to human beings only under special conditions.

Humans↗
PubMed1991

[Mortality and morbidity conference. Perioperative fatalities].

Postoperative complications in 4675 patients were investigated. There were specific patterns of complications with significant differences between vascular and general surgery and transplantation. On the basis of test operations (inguinal hernia, cholecystectomy, resection of colon and rectum) it could be shown that differences were ward-specific. Over a period of 12 years, a certain decrease of complication rates could be demonstrated (wound infection, from 9% to 1.25%; pneumonia, from 8% to 2.5%; mortality, from 6.3% to 1.8%). Changes in clinical practice (antibiotic prophylaxis, bowel cleansing, introduction of new techniques, etc.) may be responsible for these improvements. We are convinced that a regular complication conference essentially influences the actions of physicians and nurses.

Cause of Death↗
PubMed1991

[Postoperative nitrogen loss].

Total nitrogen excretion was studied prospectively in 54 surgical patients during the first and second postoperative day by the Chemiluminescence method. The results were compared to three different methods for approximation of the total nitrogen excretion. Daily total nitrogen excretion was 13.13 +/- 5.7 g after peripheral vascular procedures, 15.97 +/- 8.1 g after major surgical procedures and 20.42 +/- 5.2 g in septic patients. The assessment of total nitrogen excretion by the three other methods underestimated real nitrogen losses by 20-52%. The nitrogen concentration in various secretions was relatively constant. We conclude that measuring the urine nitrogen losses only and adjusting them for the calculation of the total nitrogen excretion by several factors in incorrect. Direct measurement of total nitrogen excretion is too costly for the use in daily clinical practice.

Adult↗
PubMed1991

[Does varied parenteral zinc administration modify interaction between tumor and host? Studies based on an animal model].

Zinc speeds up a lot of metabolic processes because it is essential for a lot of enzymatic reactions. A modification of the zinc pool may influence the tumor growth. We used an animal model where we applied the Yoshida sarkoma intraperitoneally in its ascites form to parenterally fed Sprague-Dawley rats. Four groups with ten tumor bearing (TBR) and ten non-tumor-bearing rats (NTBR) each received different parenteral nutrition. The normocaloric Group 1 and the hypocaloric (reduced to 1/3 energy) Group 2 were fed without zinc. In Groups 3 (normocaloric) and (hypocaloric) high doses of zinc (0.519 mg/500 g Kg/d) were substituted. In Group 3 we found the quantitatively and qualitatively highest proof of tumor mass. The nitrogen content of the ascites wasn't significantly changed within the groups. We found a weight loss of the NTBR with zinc substitution. Zinc improves the synthesis of the tumor and leads to a weight loss of the host in our animal model.

Animals↗
PubMed1991

[Effect of accidental splenectomy on long-term outcome in colorectal tumor surgery].

In the period from 1967 till 1988 an accidental splenectomy was carried out at 1318 colon resections because of a malignant tumor in 34 cases (2.5%). The preoperative risk of this patient group was increased clearly in opposite to the whole patient clientele. So every fifth suffering from ileus or subileus was operated as in emergency. The complication rate, time of rest and clinic lethality were increased. The five-years survival rate did not change significantly in stage T1 and T2 in comparison with the whole patient clientele. In the stage T3, however, a significant prolonged survival rate was found out in the target group. Therefore the oncological aspect does not supply any reason to preserve the spleen in colorectal tumor surgery.

Adenocarcinoma↗
PubMed1990

[Preparation for colonoscopy using Golytely--a sure method? Comparative histological and clinical study between lavage and saline laxatives].

UNLABELLED: Looking at clinical side-effects, effectiveness and tolerability, we compared the salinic solution "Golytely" vs. a conventional preparatory procedure (Cascara-Salax) in a prospective study including 28 patients with macroscopic normal mucosa. Mucosal changes in colonic step biopsies were investigated according to prefixed criteria. RESULTS: There was no significant difference concerning weight, blood pressure, pulse rate, body temperature or essential laboratory findings. Whereas preparation using Cascara-Salax was less molesting stated by the patients, there was no difference in the way colonoscopy itself was tolerated in both groups. The performing doctor's evaluation of the colonic cleaning effect and examination conditions showed "Golytely" significantly ahead of Cascara-Salax. Histologically, colonic mucous layers depicted changes in the control groups in 63% vs. 40% in the "Golytely" group. "Golytely" seems to provide a safe and effective method of preparation for colonoscopy.

Colon↗
PubMed1990

[Splenic cysts: indications for surgery and surgical procedures].

Based on a late physical examination of 18 patients with splenic cysts, we discuss symptoms, diagnostics and indication to operate and the procedure of operation. We found no specific symptoms. The ultrasound is the most important diagnostic method and may be supplemented by computerized axial tomography. The indication depends on the symptoms, the diameter within the organ and, most important, the dignity of the cyst. For pseudocysts we prefer resection of the cyst wall, because it is a simple and safe procedure. Splenectomy is the treatment of choice for cysts with unknown dignity.

Adolescent↗
PubMed1989

[Nitrogen balance in tumor and host in the animal model].

The importance of malnutrition as major cause of morbidity and mortality in cancer patients is well documented. It has been shown that nutritional therapy improves well-being and nutritional status of the patient, but the tumor can also be accelerated by hypercaloric nutrition. Our study does not confirm the induction of tumor growth. A high positive metabolic rate of the host lowers the tumor's growth rate and its tendency to spread. The retention of nitrogen in host increase with decreasing rate of energy and nutrition. Our results show that the tumor itself uses energy and nutrients from host cell catabolism and does not directly exploit exogenous nutrient substrates. It should not be forgotten that the animal model leads to specific changes affecting the energy and nutrient metabolism.

Animals↗
PubMed1989

Results of esophagectomy and gastric bypass for cancer of the esophagus.

Improvements in operative technique and perioperative management have lowered hospital mortality of esophageal resection at our department from 31% to 8% during the past decade. Cumulative 5-year-survival rate depending on the tumor stage only remained unchanged at 21%. Neither extended resection nor perioperative chemo- or radio-therapy show any advantage compared to conventional resection or blunt dissection regarding long-term survival.

Adenocarcinoma↗
PubMedDate not supplied

Anthropometric parameters for preoperative screening to predict high-risk patients.

Prediction of serious postoperative complications by using standard anthropometric variables was attempted in 460 patients undergoing a major surgical procedure. Handgrip dynamometry was also carried out in 249 of the patients. None of the preoperative variables were of predictive value to postoperative complications, relating the method to its specified, sensitivity and validity. Upper arm anthropometry and handgrip dynamometry are rapid and inexpensive tests for detecting malnutrition, but they are not useful for preoperative screening to predict postoperative morbidity because appropriate standards are locking.

Anthropometry↗
PubMedDate not supplied

Immunostimulation by propionibacteria--effects on immune status and antineoplastic treatment.

Experimental studies were performed to investigate further the effects of immunotherapy with Propionibacterium avidum KP-40 on thymocyte proliferation, maturation and emigration in BALB/c-mice. Thymus weight and thymocyte counts, especially cells presenting the immature or cytotoxic/suppressor phenotype were significantly increased. Due to enhanced emigration, peripheral blood lymphocyte and monocyte counts as well as expression of activation markers were significantly upregulated. The antimetastatic effect of Propionibacterium avidum KP-40 was demonstrated in BALB/c-mice, where RAW 117-H10 lymphosarcoma liver colonization was significantly reduced after immunostimulation. Clinical investigations proved that surgical treatment of colorectal carcinoma induced an evident decrease of peripheral blood lymphocytes as compared with preoperative counts. However, single preoperative Propionibacterium avidum KP-40 administration induced a considerable increase of peripheral white blood cell counts, especially lymphocytes. Clinical effects of preoperative immunostimulation by Propionibacterium granulosum KP-45 were investigated in a prospective randomized trial in colorectal carcinoma patients. Positive effects on survival time, local tumor recurrence and distant metastasis could be demonstrated in stages I and II, whereas no advantage of immunotherapy was found in advanced stages III and IV. A recent prospective randomized clinical trial was initiated on the quality of life of colorectal carcinoma patients. Three months after surgical treatment negative effects could not be determined after immunotherapy. Quality of life even proved to be better in patients with abdominoperineal resection as compared to non Propionibacterium avidum KP-40 treated control patients.

Adjuvants, Immunologic↗
PubMedDate not supplied

Gender related survival in colorectal cancer.

The importance of patient characteristics to long term survival in colorectal carcinoma is the subject of much debate. The importance of female gender as an advantagous factor in prognosis is difficult to determine. A retrospective study based on data from 1050 patients resected for colorectal carcinoma was carried out. A complete follow-up and survival data were available. Categorical variables such as age, sex, tumor stage and location, perioperative blood transfusions, and postoperative complications were used. Standard univariate and multivariate descriptive analysis was applied. In addition to tumor staging patients' sex was a strong significant factor on prognosis. When analysed independently of tumor location, blood transfusions, and severe complications, sex was revealed to be a statistically significant independent prognostic factor in longterm survival. The 5-year survival rate for men was 43.5 % and 54.7 % for women. When the observed survival was compared with sex related life expectancy of a representive population, similar differences of survival were seen for both sexes.

Adenocarcinoma↗