Biomedical subjects

W Schwenk

Publications and source records attributed to W Schwenk.

At least 19 recordsLinked to original sources

PubMed1996

[Effect of orthograde intestinal irrigation with Prepacol and polyethyleneglycol solution on duration of postoperative ileus after colorectal resections].

In a prospective randomized study in 100 patients undergoing conventional (n = 66) or laparoscopic (n = 34) colorectal resection, mechanical lavage with 2 l of a polyethylene glycol (PEG) solution (group A, n = 50) combined with a laxative was compared with lavage with 4 l of PEG alone (group B, n = 50). The influence of bowel preparation on postoperative ileus was investigated. The efficacy of bowel preparation was determined intraoperatively by a surgeon blind to the type of preparation. The time interval between the end of the operation an first flatus or bowel movement was recorded. The efficacy of preparation was no different between the groups (group A: 94%, group B: 84%; P = 0.5). The time lapse before first flatus (A: 3.1 +/- 1.2 days, B: 3.2 +/- 1.3 days; P = 0.6) or bowel movement (A: 3.9 +/- 1.3 days, B: 4.1 +/- 1.3 days; P = 0.5) also did not differ between the groups. The only factor found in multivariate analysis (age, sex, operation, duration and type of surgery, bowel preparation) to prolong the duration of postoperative ileus was the type of surgery. The first bowel movement occurred 3.2 +/- 1.1 days after conventional surgery and 4.3 +/- 1.2 days (P < 0.001) after laparoscopic surgery. The type of preoperative bowel preparation had no influence on the duration of postoperative ileus. The postoperative interval before the first bowel movement was shorter after laparoscopic surgery.

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PubMed1996

Colorectal stapled anastomoses. Experiences and results.

PURPOSE: Stapled anastomoses are currently an established technique in colorectal surgery. Larger series about the use of circular staplers in rectal anastomoses within daily clinical routine are rare. METHODS: We evaluated the morbidity, clinical leakage rate, and mortality in an unselected population of a teaching hospital after elective, left-sided colorectal resections with stapled rectal anastomoses. In the course of our study, manually sewn rectal anastomoses were not performed. All anastomoses were tested intraoperatively by instillation of liquid. RESULTS: A total of 615 elective colorectal resections with stapled rectal anastomoses was performed by 18 surgeons from 1984 to 1993. A protective colostomy was created in 2.9 percent (n=16) of all patients. Clinical anastomotic leakage occurred in nine patients (1.5 percent). The mortality rate was 1 percent (n=6). CONCLUSION: Use of the stapling technique facilitates the performance of anastomoses, particularly in regions with difficult anatomy. The rate of local complications is low, and protective colostomy can thus be dispensed with in most cases

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PubMed1996

[Psychological stress on patients in tumor after-care after R0 resection of colorectal carcinomas].

In a prospective study 70 patients after curative resection for colorectal carcinoma were asked about the psychological strain in the follow-up program. Of these patients, 80.1% felt that they did the right thing and 70% were optimistic and confident regarding the follow-up examinations. Only 5 patients (7.1%) had no intention of keeping the follow-up appointment and 12 patients (17.1%) were thinking about recurrence. The patients were afraid of further examinations, and the majority (45 patients) hoped that further invasive examinations would not be necessary. Patients with a higher frequency of follow-up examinations did not report with more stress than patients fewer follow-up visits (P = 0.7 fisher exact). Older, single and female patients are special risk groups with a high level of psychological strain and should receive special attention within the follow-up (P < 0.08, fisher exact). In spite of the disappointing medical effectiveness of the regular follow-up program, psychological support in coping with cancer is the main result of regular follow-up visits to the hospital after curative resection of colorectal carcinoma and should be maintained.

Adaptation, Psychological↗

PubMed1996

[Maltose--an alternative in hypocaloric parenteral nutrition?].

OBJECTIVE: The carbohydrate balance and nutritive efficacy of a completed nutritional solution with maltose were compared to an isocaloric completed nutritional solution with glucose by means of a hypocaloric parenteral nutrition after colorectal resections. METHODS: Prospective, randomised, double blind phase II trial (study group: maltose; control group: glucose). The infusion rate of maltose amounted to 0.05g maltose/kg body-weight/hour and was given postoperatively over 5 days by an infusion pump. RESULTS: Plasma glucose concentrations were similar low in both groups; indeed in the study group a significant higher renal carbohydrate loss of 7.1% was found compared to the control group with 0.4% (p < 0.001). In the study group three patients showed renal carbohydrate losses over 10% without finding a risk factor for these high renal losses. The cumulative nitrogen balance amounted to -3g N in both groups (p > 0.1). The labile plasma proteins in the 2 groups revealed almost identical concentration courses. No essential surgical complications occurred; no clinical side effect or incompatibility of the maltose solution were observed. CONCLUSION: Postoperative hypocaloric nutrition with maltose is possibly nutritive and energetic sufficient under conditions of a clinical study. Indeed, the deviations of the carbohydrate balance show the problems of the low and individual different metabolic capacity of maltose. Thus general use in daily routine seems not favourable due to the necessary precise management (application by infusion pump, daily quantitative examination of renal carbohydrate losses).

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PubMed1995

[Is the surgeon a prognostically relevant factor after R0-resection of colorectal carcinoma?].

Although the principles of resection of colorectal carcinoma have been defined quite exactly, some studies report considerable variations in recurrence rate and survival between different surgeons and clinics. We have therefore evaluated whether this surgeon-related influence can be found within one surgical department if operative procedures are strictly standardized. The data of 651 patients who underwent R0-resection of colorectal carcinoma between 1980 and 1992 was evaluated. Since all resections were accomplished by 5 groups of surgeons who strictly obeyed the same principles of resection, patients were divided in 5 groups. These 5 groups showed similar distribution of age, sex, tumor location, operative procedures and UICC-tumor-stages. The locoregional recurrence rate ranged from 1.7%-13.3% in stage I (p > 0.05), 9.3-20.6% in stage II (p > 0.05) and 13.6-52.4% in stage III (p < 0.05). Metachronous distant metastases occurred in 3.2 to 13.3% in stage I (p > 0.05), 2.9 to 16.7% in stage II (p > 0.05) and 21.8 to 30.2% in stage III (p > 0.05). 5-year-survival-rates of the 5 groups of patients varied from 74.4-84.5% in stage I (p > 0.05), 61.6-76.8% in stage II (p > 0.05), and 38.1 to 57.7% in stage III (p < 0.05). Although the surgeon-related variability of these results was surprisingly high, multivariate analysis did not show the surgeon as a significant prognostic factor. If the same principles of resection are strictly obeyed within one department of surgery, the surgeon is not a factor of prognostic significance.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1995

[Diverticulitis of the jejunum as a rare cause of acute gastrointestinal hemorrhage--diagnosis and therapy].

Small bowel diverticulosis is in contrast to large intestine diverticulosis an uncommon, acquired entity. In most cases it was found in duodenum and as a Meckel's diverticulum. Jejunal or ileal diverticulosis is a relatively rare disease. Although the majority of the patients do not require surgical treatment because of the absence of clinical signs, in 10% complications may necessitate small bowel resection. The clinical significance, diagnostic evaluation, and treatment of jejunal diverticular disease are reviewed.

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PubMed1995

[Acceptance and effectiveness of surgical vascular consultation--is it worthwhile?].

In a retrospective analysis the meaning of the vascular outpatient clinic and the follow-up after vascular reconstructive surgery were investigated. 6889 patients were checked within 8 1/2 years in the vascular consultant hour of the Marien-Hospital Düsseldorf with a fixed diagnostic schedule related to the vascular surgery. More than 40% of the patients did not have any vascular disease. Only 6.5% of the 276 patients with aortoiliac reconstructive surgery visited the follow-up terms regularly. The additional vascular training group was visited by only 1.2%. While 93 patients (33.7%) were hospitalized to further treatment because of new clinical findings, 54 patients got another vascular reconstruction and 12 patients were operated because of secondary disease. In 12 cases (10.5%) we found a clinical asymptomatic deterioration of the vascular status. The vascular consultant hour is time-consuming and expensive. The important task is the differentiation of vascular clinical findings. Although the acceptance and the effectiveness are disappointing the vascular outpatient clinic and the long-term follow-up after reconstructive vascular surgery is necessary for the improvement of the quality of care of the department and for acquiring new knowledge.

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PubMed1994

[Primary hemangiosarcoma as a rare form of an incidentally discovered mass of the adrenal glands].

A 50-year-old man with sudden onset of nausea, vomiting and diarrhoea was on ultrasonography of the upper abdomen found to have an adrenal tumour, 5.5 cm in diameter. This was excised transperitoneally with its connective-tissue pseudocapsule, there being no enlarged regional lymph nodes or other pathological findings. But the histological diagnosis was haemangiosarcoma of the adrenal. Seven months later the patient was re-admitted because of suspected acute cholecystitis. Emergency laparotomy revealed a gangrenous, stone-free gallbladder without abscess. Further exploration was not possible because of inflammatory changes and marked adhesions. Recurrent vomiting postoperatively indicated endoscopic retrograde cholangiopancreatography and computed tomography, which showed a space-occupying lesion in the right adrenal region with compression of the choledochal duct, lesser gastric curvature and duodenum. At re-laparotomy tumour recurrence was found with histologically proven intraluminal metastases of the haemangiosarcoma in the jejunum. As curative resection was not possible, a palliative gastrojejunostomy was performed. The patient died 9 months after the diagnosis had been made from the advanced malignancy. This case of a rapidly fatal very rare malignant adrenal tumour underlines the need to remove all hormone-active asymptomatic adrenal tumours 4 cm in diameter or larger.

Adrenal Gland Neoplasms↗

PubMed1994

[Risk analysis of primary endoprosthetic management of proximal femur fractures].

From 1984 to 1991 439 patients with fractures of the coxal femur (303 femoral neck fractures, 136 pertrochanteric fractures) were treated by primary arthroplasty. The average age of the 370 female and 69 male patients was 80.9 (+/- 9.9) years. In 368 patients (83.8%) concomitant diseases were diagnosed and 212 patients (48.3%) showed more than 1 risk factor. There were 205 alloarthroplasties and 234 hemiarthroplasties performed. The percentage of patients treated by total hip endoprosthesis was 31.2% in 1984 and increased to 63.1% in 1991. In 49.2% of all cases general complications occurred, pre-dominantly nosocomial infections and pressure sores. Local (surgical) complications were diagnosed after 10.5% of all operations. The 30-day-mortality was 5.2%, the in-hospital-mortality 5.9%. Statistical analysis by multivariate logistic regression showed an independent negative influence of pre-operative immobility, pertrochanteric fractures, diabetes mellitus and multiple concomitant diseases on mortality. Age, sex or other single risk factors were not independently associated with an increased mortality. Patients with the above mentioned risk factors are easy to identify pre-operatively and do perform better after intensive preparation, short operation time and early mobilisation after surgery.

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PubMed1994

[Effectiveness of regular after-care in R0-resected rectal carcinoma].

Regular follow-up programs after radical resections of rectal carcinoma have been introduced in numerous hospitals. The main goal of a regular follow-up program is the early diagnosis of tumor recurrence in the asymptomatic stage to allow further radical resection. We evaluated the efficiency (quote of further resections of asymptomatic tumor recurrences) of regular follow-up after resection of 288 rectal carcinomas. 88 patients developed recurrent disease (47 primary locoregional recurrence, 27 distant metastasis, 14 locoregional and distant recurrence). Only 31 patients were asymptomatic at the time of recurrence (metastasis 55.6%, locoregional recurrence 31.9%, local and distant recurrence 7.1%; p < 0.05). In 31 patients (13 asymptomatic, 18 symptomatic) further R0-resection was possible. Locoregional recurrences were resected more often following anterior resection than after abdominal perineal resection. With 13 radical resections of asymptomatic recurrence the efficiency of regular follow-up was only 4.5%. Therefore efficiency alone does not justify regular follow-up examinations. Follow-up still makes sense for psychosocial support, diagnosis of metachronous colonic carcinoma, treatment of postoperative complications and critical evaluation of the results of surgery. Furthermore the follow up data can be used to plan adjuvant therapy studies.

Aftercare↗

PubMed1994

[Total endoprosthesis or dual head prosthesis in endoprosthetic management of femoral neck fractures?].

From 1.1.1984 to 31.12.1992, a total of 363 femoral neck fractures were treated by primary hip arthroplasty, with 213 total hip endoprostheses (58.7%) and 150 bipolar endoprostheses (41.3%). The average age of the 51 (14.0%) male and 312 (86.0%) female patients was 80.3 (+/- 8.9) years. While only 15.8% of all patients were treated with alloarthroplasty in 1984, the proportion treated in this way increased to 88.9% in 1992. In the same period, the percentage of patients with total hip arthroplasty who were above 80 years rose from 15.6% to 54.5% (p < 0.05), and the percentage in this group with multiple concomitant diseases rose from 28.1% to 48.2% (p < 0.05). General postoperative complications occurred after 43.5% of the operations (total arthroplasty 38.0%, bipolar prosthesis 51.3%, p < 0.01), with no substantial change during the observation period (1984-1986, 43.6%; 1990-1992, 43.2%). Surgical complications were observed in 9.1% of all cases (total arthroplasty 11.7%, bipolar prosthesis 5.6%, p < 0.05), decreasing slightly from 11.7% in 1984-1986 to 8.1% in 1990-1992. The postoperative mortality was 3.3% (total arthroplasts 1.9%, bipolar prosthesis 5.3%, p > 0.05). The higher rate of general complications and the insignificantly higher mortality after insertion of bipolar endoprostheses cannot be attributed to the endoprosthetic technique itself; they are probably due to the higher age and poorer general condition of patients in whom hemiarthroplasty was performed. Although there has been an increasing frequency of total hip replacement even in older and sicker patients in recent years, no significant changes in morbidity and mortality were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1994

[Incidence of peptic ulcers in patients with arterial occlusive diseases--a further risk factor?].

Acute bleeding of the upper gastrointestinal tract found in patients with arterial occlusive disease lead us to analyse the coincidence of arterial occlusive disease and pathological changes of the upper gastrointestinal tract. While waiting for reconstructive vascular surgery between 1986 and 1992 420 patients underwent esophago-gastro-duodenoscopy for preoperative risk assessment. In 59% endoscopy revealed pathological findings in the upper gastrointestinal tract. Inflammation was found in 61.6% of the patients, in 15% gastric ulcer. Patients with gastrointestinal symptoms had no significant more pathological findings in gastroscopy (p = 0.1). We excluded 9.3% patients from primary elective vascular surgery because of their severe pathological findings. 19 patients were operated on their gastrointestinal disease at first. In 7 patients we found an unknown carcinoma of the stomach. 5 patients got a resection of the stomach, in 2 patients an operation was unable. The diagnosis and therapy of risk factors are a major objective in the treatment of arterial occlusive disease. The results of the study stress the necessity of routinely performed endoscopy in patients awaiting vascular surgery. Beside a preoperative risk assessment this will lead to a lower incidence of serious gastrointestinal complications postoperatively.

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PubMed1994

[Results of management of pertrochanteric comminuted fractures in the elderly with a tumor shaft endoprostheses].

Pertrochanteric fractures are typical injuries of elderly people, that can be treated with osteosynthesis in most cases. From 1984 to 1991 we performed 105 implantations of tumor-endoprosthesis in elderly patients with comminuted pertrochanteric fractures with simultaneous coxarthrosis or osteoporosis. The mean age of these patients was 82.7 years. 81.9% of the patients had concomitant systemic diseases (coronary heart disease, hypertension, diabetes etc.), 51.4% showed several risk factors. General postoperative complications were diagnosed in 63.8% of all cases, mostly nosocomial urinary tract infections, pressure sores and cardiovascular disorders. In 14.3% of the patients local (surgical) complications occurred. 83.3% of the patients were able to walk when they left the hospital, the in-hospital mortality was 13.3% (30-day-mortality 12.4%). Although primary osteosynthesis of pertrochanteric fractures with dynamic hip screw or gamma-nail show a smaller risk, implantation of a tumor-endoprosthesis can be an alternative in patients with severe osteoporosis, coxarthrosis or after instable osteosynthesis.

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PubMed1993

[Results of regular follow-up after removal of colorectal adenomas].

After resection of colorectal adenoma 453 patients were included in a follow-up program between 1. 1. 1980 and 30. 6. 1991. 275 patients underwent regular follow-up examinations, the primary drop-out rate was 39.2%. In the 275 participating patients 492 primary adenoma were removed. 174 patients (63.3%) had a single adenoma, while 101 patients showed multiple primary adenoma (36.7%). The average follow-up interval was 37 (+/- 28.2) months. During follow-up we found new adenoma in 105 patients (38.2%), the Kaplan-Meier estimation of the five-year-recurrence rate was 55.9% (95% confidence-interval 46.9 to 64.8%). The risk of recurrence was increased in patients with multiple primary adenoma (p = 0.003) and multivariate risk analysis showed an independent influence of histology on recurrence rate (p = 0.07). In six patients colorectal carcinoma were detected during adenoma follow-up. During regular follow-up examinations after surgical treatment for colorectal adenoma in more than 30% of all patients new colorectal polyps were detected and removed. Therefore follow-up for colorectal adenoma is effective in prevention of colorectal carcinoma. Still frequency of follow-up examinations have to be adapted to the individual risk of recurrence for each patient.

Adult↗

PubMed1993

[Histopathological changes of gallbladder and liver parenchyma in symptomatic cholelithiasis].

In a retrospective study of 1101 patients (302 men, 799 women; mean age 56,7 [19-88] years) with symptomatic cholelithiasis who had undergone elective cholecystectomy and intraoperative liver biopsy, histological examination revealed inflammatory changes in the gallbladder in 96.7%, chronic fibrotic cholecystitis in 94.5% and a severe form of cholecystitis in 8.8%. Clinically relevant changes in the liver parenchyma were present in 27.9%, most frequently intrahepatic cholangitis (21.8%). The latter was significantly more common in choledocholithiasis than in isolated cholecystolithiasis. 27 patients had signs of severe liver disease, namely viral hepatitis, cirrhosis or fatty liver. Since the gall-bladder in cholelithiasis is almost always inflamed, cholecystectomy is the treatment of choice. Not uncommonly liver biopsy will reveal clinically relevant changes in the liver parenchyma. This will be useful information, especially in the management of symptoms which persist postoperatively.

Adult↗

PubMed1993

Does methodic long-term follow-up affect survival after curative resection of colorectal carcinoma?

Records of 487 patients in long-term follow-up after Ro resection of colorectal carcinomas between January 1, 1980 and December 31, 1989 were analyzed. Every patient underwent regular examinations according to a defined schedule after curative resection of colorectal carcinoma. The date of evaluation was June 31, 1991. During a median observation time of 48 months (range, 15-132 months), tumor recurrence was observed in 149 patients (30.6 percent), with 56.4 percent of these suffering from tumor-associated symptoms. As the primary manifestation of tumor recurrence, only distant metastases (DM) were found in 76 patients (51 percent), only local recurrence (LR) in 46 patients (30.9 percent), and both DM and LR in 27 patients (18.1 percent). Patients with rectal carcinoma developed LR more frequently (P < 0.05) (19.5 percent) than patients with colon carcinoma (11.8 percent). The probability of developing distant metastases was not different (P < 0.05) for colon or rectal carcinoma but depended on primary tumor stage (P < 0.05). Only 36 patients (24.2 percent) with recurrence could undergo further curative resection. Fifty patients (33.5 percent) were given palliative therapy, and 63 patients (42.3 percent) were given no oncologic treatment. Only 9 of the 36 patients (6 percent of all recurrence patients) undergoing Ro resection were free of tumor for more than two years. In no case was a third Ro resection possible. The survival time of these patients was increased significantly after Ro resection of tumor recurrence (P = 0.03). Our study suggests that only a very few patients may live longer as a result of regular follow-up programs after curative resection for colorectal carcinoma.

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PubMed1992

[Postoperative complications of elective resection of the colon in diverticulitis].

Data on 142 patients (57 men, 85 women; mean age 64.2 [37-91] years) who had elective colon resection for diverticulitis were retrospectively analysed with respect to postoperative morbidity and mortality. Associated systemic disease was present in 47.9% of patients; intraabdominal complications were found preoperatively in 55.6%. Resection with primary anastomosis was performed in 97.9% of patients. Local postoperative complications were noted in 14.1%, general complications in 31.7%. Two patients died postoperatively of the consequences of local complications. In both cases diverticulitis had been complicated by fistulas (mortality rate 1.4%). With careful preparation, standardized operative technique and intensive perioperative supervision the risk of elective colon resection for diverticulitis is low. It can thus be undertaken, even after the first severe attack of diverticulitis, in patients without associated disease.

Adult↗

PubMed1992

[Inguinal hernia repair modified by Kirschner. A critical analysis after 11 years of clinical experience].

In a retrospective study the early and late complications and the recurrence rate of inguinal hernia 10 years after elective repair by a modification of Kirschner's procedure are presented and compared with those following other established surgical techniques. Questionnaires were sent to 1400 patients, and 1029 patients (73.5) also underwent clinical examination. With all techniques, the most frequent postoperative complications were haematomas and seromas (10.1%). Postoperative mortality was 0.2%. Late complications were reported by 36.4% of the patients followed up by questionnaire. The most frequently reported symptom (by 23.8%) was transitory hypaesthesia in the scar area. In 2.7% of the male patients examined testicular atrophy was found. All patients who reported a recurrence on their questionnaire underwent follow-up examination in the clinic. Thus, the cumulative recurrence rate was 9.6%. Over two-thirds of all recurrences were lateral recurrences (P < 0.01). It was not possible to determine potential risk factors for a recurrence of inguinal hernia. The recurrence rate increased with time before follow up: among the patients examined after 5 years the recurrence rate was 5.7%, while it was 12.1% for patients examined after a period of 10 years. Kirschner's modification involves a risk of lateral recurrence that should not be underestimated, and its use should be reconsidered. The Shouldice repair appears to be the method of choice. However, further results confirming this choice should be awaited.

Adult↗