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Biomedical subjects

W W Rittmann

Publications and source records attributed to W W Rittmann.

At least 19 recordsLinked to original sources
PubMed1996

[Is a minimally-invasive treatment concept in the late stage of pleural empyema successful?].

INTRODUCTION: Thoracoscopic treatment of pleural empyema is still a controversial method, especially in the chronic stage of the disease. The issue is raised whether the thoracoscopic approach to the empyema-possibly combined with a small additional thoracotomy in advanced stages-is successful and of low risk. PATIENTS AND METHODS: Between January 1993 and May 1995 we treated 13 patients in advanced stages of pleural empyema. The patients were all seriously ill and had severe underlying disease. The procedures were performed under general anesthesia involving intubation with a double-lumen endotracheal tube. The steps of our standard operative procedure are outlined. RESULTS: In 5 patients with a pleural empyema in stage III thoracoscopy was facilitated by a small additional thoracotomy. A complete resolution of the disease was obtained in 12 cases and a secondary intervention was necessary in 1 patient. There was no peri- or postoperative mortality, and apart from a prolonged drainage of the pleural cavity in 3 patients no morbidity was registered. In the long-term follow up, 3 patients had died. There was no correlation between the deaths and the intervention or the empyema disease. DISCUSSION: We discuss the advantages of a limited additional thoracotomy in case of intraoperative difficulties encountered with late stages of empyema. This treatment can still be considered minimally invasive. All patients tolerated the procedure well, and the overall results were favourable in 92% of our collective. However, thoracoscopic treatment should preferably take place at an earlier stage. CONCLUSION: We recommend the thoracoscopic approach-possibly combined with a limited thoracotomy-as primary treatment in late stages of pleural empyema.

Adult↗
PubMed1994

[Signet ring cell carcinoma of Vater's papilla: a very rare malignancy].

We describe a rare variant of carcinoma of the ampulla of Vater. A 70-year-old man with several illnesses and a newly appeared jaundice was investigated and a signet-ring cell carcinoma of the ampulla of Vater diagnosed. We performed a local transduodenal excision. One year after operation the patient is asymptomatic. This is the second case report in the literature.

Aged↗
PubMed1992

[Incidence of recurrence in long-term follow-up of 100 patients after surgery for primary hyperparathyroidism].

The percentages for recurrence or persistence of hyperparathyroidism after operation for pHPT vary between 3 and 7% according to the pertinent literature. These groups of authors have a broad experience based on a large number of patients treated. At our institute we have operated for pHPT an average of 5 patients per year. Given our limited experience we reexamined 100 consecutive patients which were operated for pHPT between 1968 and 1988 in order to determine our own rate of recurrence. The rate for persistent or recurrent hyperparathyroidism was at 8% slightly higher than in the literature reviewed. When reexamining the patients we took the history concerning the preoperative symptomatology and its postoperative course. Furthermore we compared a radioimmunoassay measuring the midmolecule region of the parathyroid hormone with a immunochemiluminometric assay determining the intact and biologically active hormone regarding sensitivity and specificity. The results are presented and compared with the literature reviewed.

Aged↗
PubMed1991

[Rectum resection with colo-anal anastomosis and formation of a colonic J pouch in deep rectal cancer].

Sphincter-saving operations are now generally accepted for the treatment of mid-rectal cancers. Different techniques have been described: low colorectal anastomosis with staplers, pull-through procedures and coloanal anastomosis. The functional results following these procedures are impaired by loss of the reservoir function of the rectum. To avoid frequency and urgency a J-shaped colonic reservoir is constructed and anastomosed to the anal canal. We are presenting our first four cases using this technique. All patients are personally reviewed 19-29 months after the operation. In correspondence with the literature all our patients had a good functional result with good continence and only one bowel movement per day. We conclude the creation of a neorectum makes the functional result of a coloanal anastomosis more predicable.

Anal Canal↗
PubMed1990

[Value of systemic and local administration of antibiotics in soft tissue and bone infections].

There is little data to support the efficacy of prophylactic antibiotics in traumatology. In closed fractures three randomized controlled studies using a 1-3 day prophylaxis with Cephalosporins of the first or second generation or a Penicillinase-resistent Penicillin demonstrated a reduction of the infection rate. For the Cephalosporins of the second generation it was shown, that a single dose was less efficient than five repeated applications over 24 hours. In hip-fractures a prophylaxis with Cephalothin or Cefotiam reduced the frequency of infections when compared with controls. In open fractures a treatment over 10 days using Cephalothin or Isoxazolyl-Penicillin showed a significant drop of the infection rate. If however the fractures were not treated using the principles of rigid internal fixation and were covered with Dicloxacillin over 2 days only there was no significant improvement. A multicenter study finally indicates that a one day course of cefonicid sodium is not inferior to a prolonged course of antibiotics for prevention of early postoperative fracture-site infections. We conclude, that open and closed fractures can profit from antibiotic prophylaxis which starts immediately before surgery and is continued over 24 hours. We favour Isoxazolyl-Penicillin because of its efficacy against staphylococcus aureus and epidermidis which predominate in early infection. In established bone and soft tissue infections antibiotics are used when there is local spreading, sepsis, involvement of joints or when reinterventions in the infectious focus are necessary. In these cases bacteriological testing in the laboratory is essential for the selection of antibiotics. Local application of antibiotics in irrigation-drainage solutions can not be recommended. PMMA-chains serve as temporary spacers, but should be removed early before their extraction becomes difficult and resistant bacteria develop. When defects are closed with cancellous bone or soft tissues the use of Gentamycin-fleece or Taurolin-gels is recommended.

Administration, Topical↗
PubMed1989

[Paralyses of the recurrent laryngeal nerve following strumectomy in late follow-up].

Over a period of 5 years, 323 patients underwent an operation on a goiter. A postoperative paralysis of the recurrent laryngeal nerve occurred in 31 patients, most in malignancies and recurrent goiters. 26 patients were controlled at least 1 year after operation. 65% of the patients have a fully recovered voice and normal vocal cord function. Another 14% showed a normal voice for daily use by functional compensation of the paralysis. Only in 4 patients (16%) the operation resulted in a permanent modest or severe hoarseness as consequence of a thyroidectomy in cancer.

Follow-Up Studies↗
PubMed1987

A double-blind clinical trial of prophylactic cloxacillin in open fractures.

In 100 patients with first-, second-, and third-degree open fractures, a randomized, double-blind study was carried out to compare prophylactic cloxacillin and placebo. Prophylaxis was started preoperatively and continued for 10 days. The standard fracture treatment consisted of operative stabilization, mostly by means of plates or external fixators. In the cloxacillin group two infections were observed as compared to 12 in the control group. This difference was significant.

Adolescent↗
PubMed1980

[Chemical structure and biological activity of cholecystokizin octapeptides with respect to the stomach and pancreas].

Dose response curves of the octapeptide of cholecystokinin (CCK-8) and 3 of its methoxinine analogues have been established in 4 conscious dogs with respect to gastric and pancreatic secretion. In the analogues the methionine was replaced by methoxinine in position 3 (B) and (D) or 6 (C). Of the 4 tested substances CCK-8 exhibited most activity with regard to pancreatic protein secretion, followed by B, C, and D. Analogue C had the strongest stimulating effect on gastric acid secretion, while its effect on pancreatic secretion was minor. Correlation of chemical structure with biological activity points to the importance of the methionine residue in position 6.

Animals↗
PubMed1980

[Antibiotic prophylaxis in colon surgery with Cefazolin].

In a prospective randomized and controlled double-blind trial the effect of prophylactic systemic administration of Cefazolin in elective colorectal surgery on postoperative wound infection was investigated. The incidence of wound infection was significantly reduced (P less than 0.01) from 32% in the control group to 10% in the treated group. Furthermore there was a significant reduction (P less than 0.05) in hospital stay of about 3 days.

Cefazolin↗
PubMed1979

[Caerulein and the test meal: a comparison of their effects on pancreatic exocrine secretion in the dog].

Relatively small doses of caerulein (10, 20, 40, 100 ng/kg/h) were given to conscious dogs with chronic duodenal and gastric fistulas and the exocrine pancreatic response was compared with that obtained by a test meal. Test meal stimulated pancreatic secretion was nearly equivalent to that achieved with 10 ng caerulein/kg/h. Plasma secretin levels did not significantly change during test meal stimulation.

Animal Feed↗
PubMed1978

Comparison of the biological potency of a new synthetic preparation of secretin with that of natural porcine secretin in the dog.

The biological activity of the new synthetic secretin, Roche, on exocrine pancreatic secretion was determined in conscious dogs with chronic gastric and duodenal fistulae and compared with that of pure porcine secretin (GIH, Karolinska Institutet, Stockholm). The two secretin preparations were found to be equipotent as to pancreatic volume and bicarbonate response on a molar basis. It was concluded that the new synthetic secretin is useful for clinical and research purposes.

Animals↗