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W Teichmann

Publications and source records attributed to W Teichmann.

At least 19 recordsLinked to original sources
PubMed2004

[Mucocele of the appendix. Incidental sonographic discovery and laparoscopic resection].

HISTORY AND ADMISSION FINDINGS: A 76-year-old currently asymptomatic man was admitted for routine sonography of the abdomen. 15 years he had had intermittently symptomatic cholecystolithiasis. 25 years before a colon contrast showed a normal coecum but no filling of the appendix. SUBSEQUENT INVESTIGATION: Sonographic examination showed the known cholecystolithisasis but additionally revealed as an incidental finding a tubular-cystic structure with a thin, echogenic wall and a hypoechogenic lumen. The lesion was located in the right upper quadrant, not compressible and arising from the coecum. Computed tomography confirmed a mucocele of the appendix without ascites and no inflammatory changes, peritoneal thickening or nodules. TREATMENT AND COURSE: Laparoscopic resection of the unruptured appendiceal mucocele together with cholestectomy was performed. On gross examination, the resected mucocele proved to be macroscopally an intact mass with a thin wall and full of white gelatinous material measuring 3 cm in diameter and 8 cm long. The histologic diagnosis was mucinous cystadenoma. The patient was discharged on the second postoperative day and recovered uneventfully. Because of the clear association of appendiceal cystadenoma with colorectal tumor a colonoscopy was performed which showed a normal colon. CONCLUSION: The differential diagnosis of a cystic mass in the right lower quadrant without previous appendectomy should include an appendiceal mucocele. If preoperatively there are no signs of malignancy, laparoscopic resection can be performed. In patients with histologic diagnosis of appendiceal cystadenoma: the colon should be examined to exclude synchronous colon tumors.

Aged↗
PubMed2001

[Myocardial ischemia in hypertensive patients].

AIM: To examine the frequency of myocardial ischemia in hypertensive patients with insufficiently adjusted blood pressure. It was to clarify the question if there is a difference between hypertensives with silent ischemic episodes alone and hypertensives with symptomatic episodes as well, referring to the degree of severity of ischemia. A resulting question was: if there is a difference between them, might it be possible to influence this by lowering the blood pressure? PATIENTS AND METHODS: 104 hypertensive patients had a check-up before and after the suspension of normotensive blood pressure by means of a 24-hour long-term ECG. Significant results for a myocardial ischemia were horizontal and descending ST segment depression > or = 0.1 mV for the duration > or = 1 min. RESULTS: 38 of the examined hypertensives showed 316 silent and 19 symptomatic episodes of myocardial ischemia. Hypertensives with additionally symptomatic episodes (n = 8) showed a severity of ischemia (ST-total area) which was significantly higher than in patients with only silent episodes (9.3 [2.7-65.3] mV min vs 2.6 [0.1-42.6] mV min, p < 0.05). After reduction of the blood pressure these patients as well as patients with silent episodes a lone (2.6 [0.1-42.6] mV min vs 0 [0 to 39.3] mV min, p < 0.0001) were found to have a decline of the ST-total area (9.3 [2.7-65.3] mV min vs. 0 [0-46.5] mV min, p < 0.05). There was no significant difference between them any longer. CONCLUSION: The severity of ischemia in insufficiently adjusted hypertensive patients with additionally symptomatic myocardial ischemia is higher than in the case of patients with silent episodes alone. After reaching a normotensive blood pressure again a difference was no longer evident.

Aged↗
PubMed2001

[Surgical therapy of abdominal infection--reliable strategies].

The differential treatment of abdominal sepsis is based on surgical eradication of the infectious focus, intensive care, and administration of antibiotics. The eradication of the focus can be done by interventional or operative procedures. Between January 1980 and December 2000, 2214 patients with peritonitis were treated in AK Hamburg-Altona. A total of 1520 cases were successfully treated by standard therapy; 694 cases needed treatment by staged lavage. The postoperative mortality in this group was 17.3%. Objective comparison is difficult because of diversity of patient groups and the complexity of chosen surgical therapy. Therefore none randomized clinical study does exist up to the present. Indication and application of selected therapeutic technique result from clinical criteria and experience.

Aged↗
PubMed1998

Low-density lipoprotein receptor-related protein in atherosclerosis development: up-regulation of gene expression in patients with coronary obstruction.

The low-density lipoprotein receptor-related protein (LRP) is a multifunctional cell-surface receptor that binds and mediates the endocytosis of several structurally and functionally distinct ligands. Involved in a variety of biological processes, including the regulation of the coagulation-fibrinolysis balance, the lipoprotein metabolism, cellular migration, proliferative processes and degenerative diseases, it has very recently become an interesting candidate for functional studies of the development of atherosclerosis. We investigated the individual cellular LRP gene expressions in 100 patients with angiographically confirmed severe coronary obstructions (myocardial infarction, patients with coronary angioplasty and patients with coronary bypass). Using a competitive reverse transcriptase polymerase chain reaction analysis we measured the specific LRP mRNA levels in monocytes from venous blood. In comparison with 110 unselected controls (122.1 ag/cell) the patient group demonstrated significantly higher LRP message levels (171.92 ag/cell). We found the most evident increase in the coronary angioplasty group (+43.5%). Investigating the intraindividual range of expression in healthy controls over a period of 4 weeks, we found nearly constant individual levels. Our results demonstrate a significant correlation of increased LRP mRNA levels with atherosclerotic processes (P<0.001), suggest an important implication of the LRP in atherosclerotic vascular processes, and emphasize the inclusion of LRP investigations in risk constellation studies.

Adult↗
PubMed1997

[Open foramen ovale in patients with arterial vascular occlusions of the retina and optic nerve].

BACKGROUND: We examined the frequency and significance of persistent foramen ovale (PFO) in patients with ocular circulatory disturbance. PATIENTS AND METHODS: Forty patients with acute arterial occlusions of the posterior bulb segment were investigated by means of transthoracic and transesophageal echocardiography (TEE). The parallel presence of cerebral ischemia was clarified on the basis of existing CCT findings and by additional HMPAO-SPECT investigation. RESULTS: PFO was identified in nine of the patients investigated. The probability of paradoxical embolism arises from further findings: eight of those with PFO (89%) showed echocardiographic signs of right heart strain, indicating previous pulmonary embolism, compared with only three of those without PFO (10%). Five of those with PFO showed a potential source of embolism, two of them with phlebothromboses in their clinical history and three with additional atrial septal aneurysm. Cardiovascular risk factors were prevalent in the group without PFO. Both groups had a mean age of approximately 60 years. Signs of cerebral ischemia were present in the SPECT or CT findings for four of the patients with PFO and nine of those without. CONCLUSIONS: From our findings, it appears highly probable that ocular arterial occlusion is caused by paradoxical embolism. PFO should be taken into account in establishing a diagnosis, including diagnosis in elderly patients.

Adult↗
PubMed1997

[Fournier gangrene].

Fournier's gangrene is a rapidly spreading soft tissue infection. Applying our main principles of therapy to the four patients we have treated in the past 4 years, all patients survived. One case report is presented in detail. Early diagnosis is essential. CT plays an important role. Aggressive resuscitation, daily surgical exploration and debridement remain the key to the management of this disease. The prevention of orchidectomy is one of our aims. Faecal diversion is seldom necessary.

Adult↗
PubMed1997

[Surgical therapy of diffuse peritonitis--staged lavage].

Better understanding of pathophysiology and improved techniques of intensive medical care resulted in new concepts of aggressive treatment for diffuse peritonitis. All consider the importance of surgical removal of the infectious focus but also the necessity of further treatment following first surgical intervention in cases of severe peritonitis. No randomised clinical study yet exists. Indication and application of selected therapeutic technique result from clinical criteria and experience. Presently used concepts are described and evaluated from a clinical viewpoint.

Adult↗
PubMed1996

Effects of cardiac output on disposition kinetics of sorbitol: recirculatory modelling.

1. The purpose of this study was to determine the effects of cardiac output on distribution and elimination kinetics of the marker compound sorbitol. 2. The disposition kinetics of sorbitol were investigated after rapid intravenous injection and arterial sampling in nine patients who had undergone cardiac catheterization whereby the cardiac output was measured. 3. A minimal circulatory model consisting of pulmonary and systemic subsystems, both of which were characterized by an inverse Gaussian transit time density function, fitted the data very well. The method involves numerical inverse Laplace transform of the model equations. 4. The mixing clearance introduced as a novel non-compartmental parameter of distribution dynamics was significantly correlated with cardiac output. The steady-state volume of 14 l matched the extracellular volume. The systemic extraction ratio of 23% may reflect the fractional liver blood flow. 5. This pharmacokinetic model can be applied when an independent observation of cardiac output is available. In contrast to the conventional compartmental (or sum of exponential) approach it contains fewer adjustable parameters which can be more readily interpreted in physiological terms.

Aged↗
PubMed1994

[Endoscopic therapy of postoperative biliary fistula].

A postoperative biliary fistula is a rare but severe complication of biliary surgery. Clinical signs, ultrasound and ERC lead to the diagnosis. Within three years, 37 patients with postoperative bile duct fistulas after cholecystectomy underwent endoscopic therapy. In all patients the biliary fistula healed completely within seven days after insertion of a nasobiliary tube. The nasobiliary tube for postoperative biliary fistulas offers regular radiological controls and reduces the necessity of operative reinterventions on the biliary system.

Biliary Fistula↗
PubMed1992

[Case reports of arteriovenous fistulas of coronary vessels in adulthood].

It is reported on the diagnosis and therapy of arteriovenous fistulae of coronary arteries. With the help of 5 casuistic instances external fistulae could be demonstrated by invasive diagnostic procedures. In three cases the fistulae drained from the left coronary into the pulmonary artery, at the second instance from the right coronary artery into the right ventricle, in the fifth instance from the right coronary artery into the right atrium. In addition to this there were coronary stenoses which needed a bypass. In all cases the tentative diagnoses were confirmed intraoperatively. The indication to operative ligatures of the congenital fistulae is discussed and supported depending upon the picture of the complaint.

Adult↗
PubMed1991

Positive phase II study in the treatment of advanced malignant melanoma with fotemustine.

To date, dacarbazine (DTIC) has been the most effective drug in the treatment of advanced metastatic melanoma, achieving response rates of up to 28% (mean, 21%). Multidrug responses were generally no better than those obtained using monotherapy. A quite promising clinical trial was conducted using the new nitrosourea fotemustine. A total of 19 patients presenting with advanced malignant melanoma (clinical stage IV according to the 1987 UICC classification system) underwent treatment involving a more rapid infusion of the drug and a reduction in the rest period from 5 to 3 weeks. This monotherapy with fotemustine yielded two complete responses and seven partial responses; in addition, four patients showed no change and six cases progressed after the induction cycle (median duration of response to date, 7.6 months, including four cases that have not relapsed). Fotemustine was well tolerated by the patients, with the only mild side effects being thrombocytopenia, leukocytopenia and easily controlled nausea/vomiting. Preclinical studies performed previously indicated that fotemustine inhibits enzymes involved in the ribonucleotide reduction pathway (i.e. DNA synthesis), whereby responding patients (n = 3) appeared to favor the thioredoxin reductase/thioredoxin electron transfer to ribonucleotide reductase, whereas non-responders (n = 4) expressed the alternate glutathione reductase/glutaredoxin mechanism. The 47% response rate obtained in these studies vs the 24% reported previously for fotemustine may reflect variations in enzymes in the ribonucleotide reduction pathway in different patients. However, the efficacy of fotemustine against advanced melanoma warrants more extensive trials of this drug, especially since the quality of life of the patients during and after chemotherapy was not severely affected.

Adult↗
PubMed1991

[The effect of continuous thoracic peridural anesthesia on the pulmonary function of patients undergoing colon surgery. Results of a randomized study of 116 patients].

In a prospective randomized clinical investigation, we examined the influence of continuous thoracic epidural analgesia (TEA) on pulmonary function and pathologic chest X-ray findings. METHODS. One hundred sixteen patients having resection and/or anastomosis of the colon participated in this study; 57 were randomly assigned to the epidural group, whereas 59 were given systemic analgesia. Both groups were comparable with regard to ASA classification and pre-existing disease, as well as operative procedures and surgeons. Bupivacaine 0.75% was given to the TEA patients pre- and intraoperatively (epidural catheter T8/9), and postoperatively they received bupivacaine 0.25% continuously by motor pump for 3 days. We aimed to reach an analgesic spread from T5 to L2. In order to maintain sufficient analgesia, we had to increase the dosage from 19.2 mg/h on the evening of the operative day to 22.2 mg on the 3rd postoperative day. However, under these conditions the number of blocked segments decreased from 9.3 postoperatively to 6.6 on the 3rd postoperative day. Balanced anesthesia (isoflurane plus fentanyl) was given to the control group. Postoperatively, these patients received systemic analgesia on request (piritramide i.m., tramadol, or a simple analgesic). Vital capacity and pain score (10-point nominal analog score) were evaluated at 1, 8, 24, 36, 48, 60 and 72 h postoperatively. Blood gas analyses were taken at 1, 8, 24, 48 and 72 h, and chest X-rays were performed on the 1st, 3rd, and 8th postoperative days. Statistically significant results are indicated by "*" (P less than 0.05) and "*" (P less than 0.005) and "***" (P less than 0.001). The standard deviations were shown in cases of statistical significance. RESULTS. There were significantly lower pain scores by 1.0-2.2 points at 1, 8, 24 and 36 h postoperatively in the TEA group. Fourteen patients in group I required adjustments of the postoperative pain treatment regime: 6 had a unilateral epidural block; in 4 the catheter was withdrawn involuntarily. Up to the 2nd postoperative day, patients in the control group received systemic analgesics significantly more often. The vital capacity (percentage of preoperative value) was significantly higher in the TEA group than in the control group after 1 h (58.5% vs 51.7%) and 8 h (63.9% vs 56.7%). From the 1st postoperative day on there was no difference between both groups with regard to arterial blood gases, there was no difference in pCO2 between both groups 1 h postoperatively; it was, however, significantly lower in patients receiving bupivacaine at 8, 24, 48 and 72 h. There was no difference in pO2 at any time. The number of pathologic chest X-ray findings showed no difference between both groups. Looking especially for infiltrates, dystelectasis, atelectasis, and congestion, we also could not demonstrate any difference between the groups. (ABSTRACT TRUNCATED AT 400 WORDS)

Anastomosis, Surgical↗
PubMed1990

[The incidence and localization of colorectal adenomas and carcinomas in 4109 patients].

Findings at coloscopy were analysed retrospectively for 4109 patients (2257 women, 1852 men; mean age 62.3 [5-100] years) who had undergone a high coloscopy between 1982 and 1987. The aim was to determine the site of colorectal adenomas and carcinomas, as well as the relationship between adenoma and carcinoma. Main indications for the coloscopy were polyps at previous ambulatory endoscopy (15.4%), abdominal pain (11.3%) and changed bowel habits (11.2%). In 752 patients 1273 adenomas were detected and in 354 patients there were 374 carcinomas (333 solitary, 21 multiple). 21.6% of the adenomas and 21.4% of the carcinomas were proximal to the right flexure. In 75 of 177 patients (42.4%) with both adenoma and carcinoma both tumours occurred in the same intestinal segment. The severity of the dysplasia increased with increasing size of the adenoma. 52 adenomas (4.1%) already had evidence of malignant degeneration. But 7.7% of the adenocarcinomas were only 5-10 mm in diameter. The increasing incidence of right-sided tumour (right shift) compared with the hitherto known distribution pattern argues for total coloscopy as the primary procedure in the diagnosis of colorectal tumour.

Adenoma↗
PubMed1990

[The treatment of acute heart failure].

Acute cardiac failure is a symptom of a defined heart disease. Therapeutic efforts will only be successful, if the casual disease can be recognized. The clinical picture of cardiac failure is composed of a lot of pathophysiological and pathobiochemical developments. Some of them are still today completely or partly unknown. Each pharmacological intervention influences these regulations and reacts in every situation not only in the desirable but also in an unexpected way. Since we do not know the speed and direction of the developing cardiac failure, patients in NYHA II-III have to be sent to hospital. Starting the efficient treatment in time success can be expected without expensive diagnostics and monitoring techniques. But in some cases highly specialized equipment will be necessary and must be available.

Acute Disease↗