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Biomedical subjects

W Köle

Publications and source records attributed to W Köle.

At least 19 recordsLinked to original sources
PubMed2003

SAP and partners: IS-H and IS-H* MED.

OBJECTIVES: The Styrian Hospital Organization with 21 hospitals including the Graz University Hospital, and the Heidelberg University Hospital implemented a new HIS based on SAP/R3, ISH, ISH* MED with the objective to have an integrated system to support patient administration and management, patient care, clinical documentation, research etc. METHODS: Heidelberg University Hospital chose a step by step method for the introduction of the system, beginning with patient administration (ISH) and proceeding with clinical functions (ISH* MED). In Styria, the full functionality was implemented--as part of the selection process--in one peripheral hospital and in the Ear, Nose and Throat (ENT) Department of the Graz University Hospital, including special documents to support the processes in the highly specialized ENTunits. RESULTS AND CONCLUSIONS: The standard modules are performant, stable and basically well accepted. Particularly in Graz, it has been shown that the requirements of highly specialized departments for work flow management, documentation and integration of subsystems and data from different sources can be fulfilled by special documents and programs--although at the expense of additional workload particularly in the initial phases of such a project.

Austria↗
PubMed2001

Multislice CT-image-guided endoscopic sinus surgery using an electromagnetic tracking system.

Our objective was to assess the practicability and accuracy of a computer-assisted multislice CT-guided frameless electromagnetic tracking for endoscopic sinus surgery. Eighty-two patients with various paranasal sinus diseases were evaluated. Prior to surgery, axial multislice spiral-CT scans with 2.5-mm collimation, 0.8-mm reconstruction increment, and a pitch of 3 were acquired. After Ethernet transfer of the CT data set to the guidance system, coronal and sagittal images were reconstructed. For intraoperative navigation the Insta Trak System (Visualization Technology, Boston, Mass.) was used. Navigational procedures are described in detail in the paper. Accuracy was assessed by means of visual landmarks which could be clearly identified endoscopically as well as on CT images. A second parameter for accuracy was calculated by the system itself as the root mean square (RMS). The system was able to display the position of the aspirating tip relative to anatomical structures with an average accuracy of 0.70 +/- 0.40 mm. Root mean square values showed a mean value of 0.40 +/- 0.20 mm. During surgical procedures the Insta Trak System provides the surgeon with additional image-based information to the endoscopic view. The device accuracy is high and the system proves to be practicable and efficient in ENT surgery.

Adolescent↗
PubMed2000

Bilateral sensorineural hearing disorders in children: etiology of deafness and evaluation of hearing tests.

OBJECTIVE: The purpose of this study was to determine the etiology of bilateral sensorineural hearing disorders in children and to evaluate the performed hearing tests by comparison of the results of the objective and subjective tests. METHODS: The medical history and the hearing tests (behavioral observation audiometry, acoustic evoked potentials and pure tone audiometry) of 106 bilaterally hearing impaired children were analyzed in a retrospective follow-up study. RESULTS: The total group included 52 males and 54 females. The ages at first diagnosis ranged from 4 months to 11 years with a mean age of 42 months and a median of 33 months. The degree of hearing loss for the better hearing ear was mild in one child, moderate in 28 children, severe in 29 children, profound in 32 children and total in 16 children. The delay between the first examination and diagnosis ranged from 0 to 597 days with a mean of 83 days and a median of 28 days. In 47 children (44%) no cause of hearing impairment could be determined. Nineteen children (18%) had a history of familial hearing loss, 40 (38%) suffered from acquired hearing loss (seven children had prenatal causes, 21 perinatal and 12 postnatal). A comparison between behavioral observation audiometry and brainstem evoked response audiometry revealed a statistically good agreement. Twenty-nine children (32%) showed progressive hearing loss, which was defined as a threshold shift of +10 dB or more in the pure tone average in at least one ear. CONCLUSIONS: In a significant number of children with early hearing impairments the etiology still remains uncertain. Further research in the field of genetic disorders will diminish this number. Evaluation of hearing tests showed that behavioral observation audiometry still is an excellent tool in the hands of an experienced examiner. The age at identification of hearing disorders in industrialized countries still is unacceptably high. To obtain ideal care of hearing impaired children, universal neonatal hearing screening programs are mandatory.

Age Distribution↗
PubMed2000

[91 dB hearing loss--the threshold for cochlear implant?]].

BACKGROUND AND OBJECTIVE: Recent indications for cochlear implant in children are bilateral total cochlear deafness and an age of 2 or more. Reports on successful implantations in adults with residual hearing pose the question of whether this indication might be expanded to children with residual hearing. PATIENTS/METHODS: In a retrospective analysis of 106 hearing-impaired children with binaural amplification, we were able to ask parents in 90 cases about their children's education. The pure-tone average of the frequencies of 1-4 kHz was correlated to education. RESULTS: The results showed that all children except one with a pure-tone average of < or = 90 dB could successfully attend regular school or kindergarten. However, those with a pure-tone average of > or = 91 dB had to be educated in special units for children with impaired hearing. CONCLUSIONS: Our results indicate that amplification in children with profound hearing loss (pure-tone average > or = 91 dB) is not sufficiently effective to enable them to attend regular schools or kindergarten. We conclude that the only chance to integrate these children into the world of hearing might be cochlear implantation.

Adult↗
PubMed2000

HIS purchase projects in public hospitals of Styria, Austria.

The Steiermärkische Krankenanstaltenges. m.b.H (KAGes) is a company, owned by the province of Styria in Austria, which operates 21 hospitals with about 8000 beds and 14000 employees, serving a population of ca. 1.2 million people. KAGes has purchased a new hospital information system (HIS) for its hospitals. Within the strategic IT plan and the 'system structure new' (SSN) project, a methodology was developed for making an effective HIS purchase. Several steps of this project are described in the paper, request for product information, evaluation of vendor proposals, product presentations, test site evaluation, reference site visits and selection of vendor finalists. The authors present the internal project management methodology, including the structure of the project team, project information management through intranet, criteria for different steps of the evaluation and evaluation site organization. Four major HIS vendors with leading HIS products qualified for this stage of the project (evaluation site). About 60 teams with 400 members (end users and IT-experts) have assessed all the products installed, during one or more, repeated test sessions. The decision on which new HIS to purchase were based on the recommendations derived from this evaluation. After completing SSN-project with the suggestion to KAGes-top-management for negotiations with two vendor finalists, the new project named MEDOCS was started mid-1999. Two pilot installations (one general hospital and one teaching hospital department) are nowadays in the pilot implementation and subsequent roll-out (including substitution of the legacy system) is scheduled until the year 2003.

Austria↗
PubMed2000

The function of tensor veli palatini muscles in patients with aural symptoms and temporomandibular disorder. An EMG study.

This preliminary study investigated Myrhaug's neuromuscular hypothesis by means of audiological and electromyographic assessment. After a clinical examination of the TMJ system, the activity of the tensor veli palatini muscles in the state of rest and during swallowing was investigated in 16 patients with the help of an EMG recording, and the tube-opening function was evaluated endoscopically. Results showed that 6.25% of the patients suffered from mild joint-dysfunction (group I), 81.25% from a moderate dysfunction (group II), and 12.5% from severe dysfunction (group III). Although five patients suffered from tinnitus and 11 from fullness in the ear, both the audio- and tympanogram performed on 15 patients displayed normal recordings. Only one patient suffered from moderate sensorineural hearing loss. In the EMG recording, 11 of the 16 subjects displayed normal EMG patterns in state of rest and during swallowing contraction. In two cases, abnormal EMG recordings were obtained due to incorrect insertion of the EMG needle. The study's results indicate that spasm in the masticatory muscles of TMJ patients neither seems to cause reflex spasm of the tensor palatini muscles nor to effect significant alterations in Eustachian tube function.

Adult↗
PubMed2000

The minimally invasive approach to olfactory neuroblastoma: combined endoscopic and stereotactic treatment.

OBJECTIVES: To describe a new treatment modality of olfactory neuroblastoma consisting of endoscopic nasal and paranasal sinus surgery and stereotactic radiosurgery. STUDY DESIGN: Retrospective review of three patients suffering from olfactory neuroblastoma. METHODS: Review of the charts, the computed tomography, and magnetic resonance imaging scans, the operation reports, radiosurgical data, and follow-up. RESULTS: All three patients remained free of disease with excellent quality of life in respective follow-up periods of 71, 50, and 39 months. CONCLUSION: The combination of two minimally invasive therapies, endoscopic sinus surgery and stereotactic radiosurgery, provide a reliable new approach to the treatment of a series of olfactory neuroblastomas that offers excellent quality of life, less injury to the patient, fewer side-effects, and fewer long-term effects than other treatment strategies.

Adult↗
PubMed2000

Paperless hospital: reality, dream or a nightmare?

Public Hospitals of Styria (KAGes) are implementing new hospital information system (MEDOCS--MEdical and nursing DOcumentation and Communication network of Styria) in its 21 hospitals. One of the outstanding features of this system is the coverage of virtually all communication and documentation functions related to the patient. This should be the way to fulfill the conditions for gradually removing the paper as an information medium from daily hospital practice. This approach will be tested in the MEDOCS project at two evaluation sites. In this paper the authors discuss in form of "pros and contras" the chances and risks of this approach, as well as possible strategies during the steps of implementing the "paperless" hospital. Besides of general technological, medical and cultural considerations the paper discuss also the technical and economical aspects of "paperless" hospital implementation and production.

Austria↗
PubMed1999

[Computer assisted localization in endoscopic sinus surgery--state of the art? The Insta Trak system].

BACKGROUND: Image-guided surgery is increasingly acknowledged as useful technology also for endoscopic sinus surgery. For many years our department has been involved in the development and testing of devices for image-guided endoscopic sinus surgery. Since January 1997 we have been testing the "Insta Trak" System, which is based on electromagnetic tracking and was especially designed for use in endoscopic sinus surgery. METHODS: We tested practicability and accuracy of the system in a wide range of cases from standard sphenoethmoidectomies to tricky frontal sinus surgery, from endoscopic tumour surgery to endoscopic repair of CSF fistulas. System accuracy was assessed by means of visual landmarks which could be clearly identified endoscopically as well as via computer screen. Additionally we measured the time for setting up the system, total operating time and rating of the subjective surgeon's assessment of the system's usefulness in each particular case. RESULTS: We present the results according accuracy and practicability in 45 patients, who were operated on under computer-aided guidance. Our overall experience with the "Insta Trak" system was very positive. It was no longer the indeed promising, but still rather circumstantial and not always reliable technique we were used to. Operating the system was relatively easy and did not require excessive computer skills. We measured an average accuracy of 0.69 mm with a maximum deviation of 2 mm in a single test measurement. Incorrect use of the device, however, may significantly increase the possible weight of system errors. CONCLUSIONS: The system accuracy was high and "Insta Trak" proved to be practicable and efficient in daily clinical routine. Especially in complicated cases like revision surgery "Insta Trak" proved to be extremely helpful. Whether a system like "Insta Trak" will be definitely able to lower complication rates in FESS is still an open question. Certainly in the near future no such navigational device will become a substitute for the surgeon's understanding of anatomy. In our opinion and experience "Insta Trak" is a significant development in sinus surgery. However, one must be aware of the fact that it cannot be more than yet another and indeed helpful tool.

Endoscopes↗
PubMed1997

[Endovascular embolization treatment for intractable epistaxis].

BACKGROUND: Intractable epistaxis has been treated with surgical intervention for many years, including ligation of the internal maxillary artery. As an alternative approach, endovascular therapy has gained increased acceptance. The purpose of our study was to evaluate the efficacy and safety of endovascular treatment of untractable epistaxis. METHODS: Embolotherapy was performed in 26 patients. The indication for embolization was persistent epistaxis even after anterior and posterior nasal packing. In all but two patients, who required general anesthesia, the procedure was performed in local anesthesia. Endovascular embolization of the internal maxillary artery was performed by using microcatheters, which were introduced intraarterially. Particulate embolic agents were used in all but one patient, who was treated by means of minicoils. RESULTS: The embolization of the territory of the internal maxillary artery was possible in all cases, the technical success rate was 96%, the clinical success rate was 100%. No complications were encountered. Because of an acute recurrent bleeding in one case, a second embolization was performed. No delayed hemorrhages were noted. CONCLUSIONS: Endovascular embolotherapy seems to be an excellent, safe, and less invasive alternative to surgery in patients with intractable epistaxis.

Adolescent↗
PubMed1995

[A rare case of malignant otitis external in a non-diabetic patient].

One case of malignant external otitis in a non-diabetic patient is presented. Malignant external otitis is a rare but severe bacterial infection, caused by Pseudomonas aeruginosa, predominantly in elderly diabetic patients. The process starts in the external auditory canal and after crossing the cartilaginous-osseus junction invades the connective tissue, cartilage, bone, and nerves of the temporal bone and the surrounding parts of the base of the skull. The clinical syndrome is a severe, painful inflammation of the external auditory canal with edematous obstruction of the external canal and typical granulation tissue in the canal wall. Diagnostic criteria are pain, edema, exudate, granulations, microabscess, diabetes, old age, identification of Pseudomonas aeruginosa, and even cranial nerve involvement. Further important criteria are failure of local treatment and a positive Tc-99 scan demonstrating osteomyelitis of the temporal bone as a sign of connective tissue, cartilage, and bone invasion. In most cases there is also a positive radiograph or HR-CT of the base of the skull. Except for sequestrations, surgical treatment in malignant external otitis is impractical because of the deep penetration into the base of the skull and the lack of demarcation lines in this diffuse pathological process. Nowadays long term i.v. antibiotic therapy is preferred. In our case we applied Ceftazidim (Fortum) 2 g for 12 weeks twice a day. After this period the patient was completely cured. Our case demonstrates that malignant external otitis should be considered even in non-diabetic patients.

Aged↗
PubMed1983

[Problems of the stone-free gallbladder, a report on 276 cholecystectomies].

Different kinds of disease of the gallbladder without stones are demonstrated. The indication for cholecystectomy is given by anamnesis, radiological findings and the exact exploration of the adjoining organs. There is made a difference between absolute and relative indications. Among 6,311 cholecystectomies there are 276 gallbladders without stones (4.37%). The results of postoperative controls are reported, more than 76% of the patients are absolutely free, 16% are relatively free of complaints.

Adult↗
PubMed1981

[The classic resection in perforated duodenal ulcer (author's transl)].

In patients with perforated duodenal ulcer the choice of the operating method is made according to the security for the patient, the indication during the operation and the experience and the training of the surgeon. After representation of the own cases and the results after oversewing and resection the personal point of view is defined. Patients with bad initial condition, progressively peritonitis and advanced age and treated with oversewing. In patients with lokal peritonitis, good general condition and a long anamnesis of the ulcer a resection is made. A vagotomia was not performed in patients with perforated duodenal ulcer.

Adult↗
PubMed1980

[Results of surgical treatment in 558 patients with carcinoma of the rectum (author's transl)].

Reviewing 558 patients with carcinoma of the rectum the symptomatology and diagnosis, the different surgical methods and especially the indication for amputation and resection are discussed. Although only 5.5% of 344 (61.6) patients, who had a radical surgical treatment (mortality rate 6.9%), were classified as Dukes A cases, 118 (34.3%) were cured for at least 5 years. The importance of early diagnosis and radical surgery strictly according to the principles of either amputation or resection are stressed. Local techniques in suitable cases are described also.

Adenocarcinoma↗
PubMed1980

[Stenosis of the papilla of Vater; indication and surgical technique of papillotomy (author's transl)].

Between 1977 to 1979 1077 patients underwent surgery for benign diseases of the bile duct, 41 (3.8%) were papillotomies. 31 of these patients (2.9%) out of 1,045 were operated on for the first time and 10 (31.2%) for the second time. Absolute indications for papillotomy: indurative stenoses of the bile papilla, intrapapillary stone formation, which could not be removed by other means, suspicion of carcinoma. Relative indications are: indurative papillitis, chronic pancreatitis. The mortality rate amounted to 2 (4.8%), all other patients (90.4%) could be cured except two.

Ampulla of Vater↗