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Biomedical subjects

A Thiede

Publications and source records attributed to A Thiede.

At least 37 records · Page 2Linked to original sources
PubMed2004

[Usefulness of anal endosonography in the assessment of fistula-in-ano].

AIM: The purpose of the present study was to define the diagnostic value of anal endosonography in the diagnostic work-up of fistula-in-ano. METHODS: A retrospective study was carried out on 191 consecutive patients (m: 121; f: 70; mean age: 44.0 +/- 12.5 years; range: 0.5-77 years) who were diagnosed to suffer from fistula-in-ano by performing anal endosonography in an outpatient setting. All images were obtained with a Combison 310A ultrasound scanner (Kretz GmbH, Zipf, Osterreich) and 5-Mhz and 7.5-MHz transducer. 131 patients underwent surgery. According to the endosonographic findings fistulas were classified as transsphincteric in 44 %, intersphincteric in 22 %, subanodermal in 16 %, anovaginal in 8 %, suprasphincteric in 5 %, extrasphincteric in 1 % and others in 4 %. RESULTS: In 125 patients (95 %) the preoperative diagnosis was confirmed intraoperatively. This cohort included 12 patients with a complex fistula system. In only 6 patients the preoperative ultrasound finding was misinterpreted. CONCLUSION: In conclusion this study has shown that anal endosonography is a useful and reliable tool in the preoperative evaluation of uncomplicated and complicated anorectal fistulas.

Adolescent↗
PubMed2003

Immunogenicity of parathyroid allografts in the rat: immunosuppressive dosages effective in passenger leukocyte-rich small bowel transplants are not effective in parathyroid gland transplants with few passenger leukocytes.

BACKGROUND AND AIMS: The passenger leukocytes harboured within an allograft induce a massive allo-immune response that leads to allograft rejection if not countered by immunosuppression. We compared the response to short-term immunosuppression of parathyroid gland transplants possessing few passenger leukocytes with that of passenger leukocyte-rich small bowel transplants. METHODS: Heterotopic parathyroid and orthotopic small bowel transplantation was performed in a Wistar Furth-to-Lewis rat strain combination. Immunosuppression with cyclosporine A (CsA) was administered in different dosages for 14 days. Dysfunctional allografts were examined immunohistologically. RESULTS: CsA more effectively suppressed the immune response provoked by immunogenic small bowel grafts than that induced by less-immunogenic parathyroid grafts. Immunosuppression with 20 mg/kg per day induced long-term survival in the small bowel (165+/-21 days) but not in the parathyroid (28+/-3 days). All rejected grafts featured massive cellular infiltration by activated T cells as a sign of immune rejection. CONCLUSION: Immunosuppressive dosages effective in passenger leukocyte-rich small bowel transplants were not as effective in parathyroid gland transplants harbouring few passenger leukocytes. In spite of the paucity of passenger leukocytes in parathyroid grafts it is more difficult to control by immunosuppression the immune response to them than that to the passenger leukocyte-rich small bowel.

Animals↗
PubMed2003

[Tumescent local anesthesia in proctologic surgery].

INTRODUCTION: Tumescent local anesthesia (TLA) was introduced to facilitate liposuction and other procedures mainly in plastic surgery. The aim of our study was to evaluate if this new technique can also be safely applied in proctologic surgery. METHODS: The following 50 proctologic procedures were performed using TLA as day surgery cases: perianal vein thrombectomy (n=15), subanodermal fistula resection (n=7), anal polyp resection (n=7), fissurectomy ( n=6), perianal abscess revision (n=6), excision of anal skin tags (n=3), hemorrhoidectomy for thrombosed piles (n=3), intersphincteric fistula extirpation (n=1), pilonidal sinus (n=1), and perianal tumor excision (n=1). The subcutaneously infused solution contained 200 ml of Ringer's solution, 50 ml of 2% Mepivacain, and 2.5 ml of epinephrine diluted 1:10,000. RESULTS: During an average application time of 14.3+/-4.9 min, a mean of 93.1+/-40.7 ml tumescent solution was infused. This dosage resulted in complete pain relief after 18.3+/-5.0 min. Local anesthesia was maintained up to 14 h postoperatively, with a mean duration of 6.7+/-1.9 h. Two patients developed moderate hematomas which required no further treatment. CONCLUSIONS: Our pilot study demonstrates that slow infusion tumescent local anesthesia can be widely and safely applied in proctologic surgery and enables the performance of these procedures on an outpatient basis.

Abscess↗
PubMed2003

[Adjusting a surgery department to new conditions in the German health service: day surgery, short-stay surgery, vascular centers and wound centers].

In April 1994, after the preconditions for ambulatory surgery came into effect, the day surgery ward was opened in the Hamburg-Harburg General Hospital. Besides ambulatory operations, this ward provides all surgical pre- and postoperative care. In addition to the surgical sections, different departments (urology, gynecology, dentistry, radiology, ophthalmology) take advantage of the ward. As preoperative diagnostics also could be completed ambulatorily, we were then able to establish a short-stay surgery department. This ward was opened in June 1996. One year later, the vascular center ("Gefässcentrum Harburg") was established by the departments for surgery, radiology, and angiology. This structure has been integrated into the day and short-stay surgery wards functionally and spatially. With the organizational structures mentioned and by setting up a wound consultation service, it is possible to optimize the capacity for admissions, operations, and beds. Government and health insurance demands for better processing can be filled and efficiency is increased.

Ambulatory Surgical Procedures↗
PubMed2003

[Which functional diagnostic tools do German coloproctologists favour?].

AIM: We tried to evaluate the role of anorectal functional diagnostic tools according to the judgement of German coloproctologists. METHOD: Questionnaires concerning accuracy of different diagnostic tests were sent to 585 physicians specialized in coloproctology. RESULTS: 261 (44.6 %) completed forms were returned. An analysis of the answers revealed that endorectal sonography is widely (73 %) regarded as useful and reliable diagnostic tool. Though manometry is still frequently used, only 50.5 % of the coloproctologists made their decision concerning the further treatment depending on the results of this method. Other radiologic methods as defecography and colon transit time are still regularly performed, though video-defecography is not accepted by most coloproctologists. Neurological investigations as pudendal nerve terminal latency, surface-EMG and needle-EMG are exclusively applied in specialized departments. DISCUSSION: Regarding the variety of diagnostic tools and its different appraisal a consensus should be defined. The usefulness of neurological examination techniques needs to be clarified before their performance can be recommended for a wide-spread routine work up.

Colonic Diseases↗
PubMed2003

[Laparoscopic anti-reflux surgery].

The indication for antireflux surgery despite consequent PPI medication includes: persisting disease with non-acid associated symptoms, such as volume reflux, recurrent hoarseness bronchiopulmonal reflux symptoms, in compliance with PPI, recurrent or persisting esophagitis. Our standard procedure is the short full Nissen wrap. Only in a 70% esophageal pump disturbance we actually apply a partial Toupet wrap. In 412 operations (Nissen 82%, Toupet 18%) during one year we observed 1.9% persisting postoperative dysphagia, 5% reflux relapses and 2% gas bloat syndrome of which 1 patient (0.2%) was re-operated. Significant differences between both procedures regarding the rate of function and complication have not been seen. Quality of life nearly came up to that of non-operated healthy patients and was much better than before surgery. The high acceptance of laparoscopic antireflux surgery in a highly selected collective caused a revival of antireflux surgery by minimal invasive methods.

Fundoplication↗
PubMed2003

[Multimodality therapy in progressive rectal carcinoma].

Rectal carcinoma cannot be controlled only by surgical technique despite radical resection (TME, systematic lymphadenectomy). Therefore, progressive rectal carcinoma of stage 2 + 3 that are detectable pre-operatively by CT and 3-D endosonography, should be treated by a multimodal concept. Based on recent Scandinavian and Dutch studies, we introduced a modified post-operative short-term radiation in which the acute toxicity on tumor tissue corresponds to that of the Swedish and Dutch studies (5 x 5 Gy), its late toxicity, however, is reduced by 20%. Thus, we expect to reduce long-term damages to the pelvic organs, i.e. incontinence. A phase 2 study revealed good therapeutic management due to interdisciplinary tumor conference and a high acceptance by patients. The post-operative rate of wound healing is a bit higher, but does not influence the time of hospitalization.

Carcinoma↗
PubMed2003

[Treatment of chronic wounds with an alginate dressing containing calcium zinc and manganese].

BACKGROUND: Treatment of chronic wounds comprises adequate debridement, reduction in the bacterial burden, and application of a dressing to absorb excess exudate. METHODS: In a prospectively documented, multicenter observational study involving 1285 chronic wounds of varying etiologies, carried out in 314 doctor's offices in Germany, the effect of the new alginate dressing, containing calcium zinc and manganese was investigated. RESULTS: After twelve weeks of treatment with the dressing, 95% of all wounds had improved appreciably, and 52.5% had healed completely. The drop out rate was 4.4% and side effects were observed in 2.6% of the cases. 73.8% of the patients reported markedly improved tolerability in comparison with previous treatment. 604 patients (47.0%) considered handling of the dressing to be "much better", and 411 (32.0%) to be "better" than previous treatment. The frequency of dressing changes decreased from 5.2 to 3.2 a week.

Aged↗
PubMed2002

[Primary glomangioma of the liver. A new differential benign liver tumor diagnosis].

Glomus organs are arteriovenous anastomoses which control the thermoregulation of the extremities. Benign tumors of these glomus organs, termed "glomangiomas", are therefore most frequently located in the fingers and toes. Case reports of primary glomangiomas in the respiratory- and gastrointestinal tracts as well as in the genital organs have been published. On the other hand, glomus tumors of the liver have not yet been described. We report the case of a 61-year-old patient with a smooth subcapsular lesion within the liver detected by a routine ultrasound scan. Further diagnostic imaging did not match with one of the common liver tumors. The diagnosis of a glomangioma was finally made by liver biopsy and subsequent histology. A review of the literature revealed a potential transformation of glomangiomas. Since the patient reported on inappetence weight loss and the tumor showed growth tendency, the indication for surgical excision was made. Final histologic investigation revealed no signs of malignancy. The primary glomangioma of the liver is a new differential diagnosis of benign liver tumors. As there is a possibility of malignant degeneration, we propose the decision for surgical removal once there are clinical symptoms and a growth tendency of the lesion.

Diagnosis, Differential↗
PubMed2002

[Myelosarcoma of the proximal jejunum. A rare primary condition of acute myelogenous leukemia].

Myelosarcoma (chloroma) is a rare primary condition in patients with either a myelodysplastic syndrome, or an acute or chronic leukemia. It is an extramedullary neoplasm which does not commonly present with changes in peripheral blood or bone marrow. The rarity and histomorphological similarity to malignant non-Hodgkin lymphoma renders the diagnosis notoriously difficult. Due to its coincidental or secondary manifestation followed by myelogenous leukemia, this tumor needs to be seen as a primary systemic disease. We present a 40 year old man with myelosarcoma of the jejunum and discuss this entity and its therapeutic options.

Adult↗