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A Thiede

Publications and source records attributed to A Thiede.

At least 73 records · Page 4Linked to original sources
PubMed2001

[Sweat gland carcinoma in the axillary area. A case report and review of the literature].

The sweat gland carcinoma is a rare tumor, representing in approximately 1% of primary skin lesions. In the literature 220 cases of sweat gland carcinomas have been presented over the last three decades. The medium age is 57 years, with an equal male-to-female distribution. Topographically, the tumor is located at the lower limbs (32.9%), the upper extremities (28%), and the head (26%). Involvement of the trunk is rare. Diagnosis can be complicated as the carcinoma is a rare entity, with no correlation of its histologic classification and biologic presentation. This can only implicate the difficulties in treatment.

Adenocarcinoma↗
PubMed2001

Success in treatment of complicated diverticular disease is stage related.

The clinical stage of disease is one of the many factors affecting outcome after treatment for complicated diverticular disease. We retrospectively assessed surgical results during the period 1994-1999 in 406 patients with complicated diverticular disease, according to the stage of disease, surgical technique, postoperative complications, and mortality. Single-stage resection and primary anastomosis were performed safely in most patients with stage I or II disease. Severe complications were rare in stage I but increased in incidence with higher stages. Patients with stage III are a high-risk group. This stage often requires a two-stage procedure (primary anastomosis and protective ileostoma or the Hartmann procedure). Despite these measures, many severe complications occurred in stage III.

Anti-Bacterial Agents↗
PubMed2001

Morphologic changes of the anal sphincter musculature during and after temporary stool deviation.

BACKGROUND AND AIMS: Temporary stool deviation, using a stoma, is a well-known surgical principle to protect low colorectal or coloanal anastomoses. The purpose of this study was to evaluate any morphologic changes with regard to the anal sphincter muscles during and after temporary ileostomy. PATIENTS AND METHODS: Forty-four patients with rectal carcinomas were studied prospectively. All patients underwent low anterior resection. Reconstruction was performed using either a coloanal pouch or a straight end-to-end anastomosis. A protective stoma was fashioned in all 44 patients (ileostomy n=41; colostomy n=3). Stoma closure was carried out after a median of 85 days (41-330 days). Using a standard protocol, anal-sphincter thickness [m. puborectalis, external anal sphincter (EAS) and internal anal (IAS) sphincter] was assessed by means of endoanal ultrasonography preoperatively, at the time of stoma closure, and every 3 months thereafter for 1 year. RESULTS: The diameter of the puborectal muscle decreased from a median preoperative value of 6.3 mm to 5.7 mm at the time of stoma closure (P=0.03). After 3 months, 6.2 mm was measured. This value remained stable for the complete follow-up period. Similar results were recorded for the EAS. The IAS thickness remained stable throughout the study period, measuring between 2.1 mm and 2.4 mm. CONCLUSION: Temporary stool deviation does lead to morphologic changes of the anal sphincter. While the smooth muscle remains unchanged, the striated counterpart undergoes atrophic transformation. However, after passage reconstruction, i.e., stoma closure, a rapid regeneration of the voluntary muscles is observed.

Aged↗
PubMed2001

How long should a long-term esophageal motility study be?

It was the aim of this study to analyze whether a shorter measuring period would render the same diagnostic information on esophageal motility as a circadian measuring period in ambulatory esophageal manometry. In an investigation on normal volunteers (n = 10), patients with gastroesophageal reflux disease without esophageal motility disorders (n = 13), and patients with esophageal motility disorders (n = 14), a comparison was performed between a 5-hr and a 24-hr motility study. An analysis was performed on inter- and intraindividual reproducibility of time periods, prandial phases, and motility sequences (Wilcoxon and Spearman test). There was no significant difference between the two analyzed measuring periods in all three groups with regard to the diagnostic information on esophageal motility in 44 of 45 comparisons for intraindividual variability. A measuring period restricted to 5 hr offers the same diagnostic information on esophageal peristaltic activity as a 24-hr motility study.

Adult↗
PubMed2001

Prospective study on plasma clotting parameters in diabetic children--no evidence for specific changes in coagulation system.

In a prospective study, clotting parameters of 37 children and adolescents with insulin-dependent diabetes mellitus (type 1 diabetes) were compared with those of a healthy control group. In a longitudinal follow-up over two years we found no statistical difference for most of the coagulation parameters investigated, including single factor analysis and coagulation inhibitors. The duration of type 1 diabetes was of no influence on these parameters. The only difference we found between patients and healthy controls was an elevation of PAI-1 in diabetics: median for PAI-1: 2.12 IU/ml in diabetics (range 0.50-8.40 IU/ml) and 0.84 IU/ml in normal controls (range 0.50-1.78 IU/ml). This difference was of statistic significance (p < 0.002) and also found in newly diagnosed patients. During observation time, none of our patients developed thrombosis or signs of vascular disease. In conclusion, we could not confirm the development of a hyper-coagulable state in pediatric diabetics, as it is described for adults with type 1 diabetes mellitus.

Adolescent↗
PubMed2001

[Conceptual and practical aspects of creating an internet presentation of a surgical department].

Until recently an internet presentation of a surgical department could rarely be found on the World Wide Web (WWW). Today an increasing number of departments provide a Web site, but often contents and graphics can still be improved. For more than 4 years the Department of Surgery at the University Hospital of Würzburg has maintained an internet presentation (www.chirurgie.uni-wuerzburg.de). Contents and technical features have been continuously updated. In order to provide a powerful Web site, contents were structured for the 3 target groups: visitors, that are patients including their relatives (consultation hours, directions, maps of campus and wards), physicians (main points in diagnostics and therapy, research, publications, further education, job offers) and medical students (teaching schedules, courses, learning materials). Concerning the technical aspects of the Web site, emphasis was put on a distinct layout and clear design. Therefore, text was arranged in tables or lists and a limited number of standard fonts was used. Graphics were compressed to a minimum file size. To allow effortless navigation for the visitor two roll-over menu banners, a sitemap, a search tool and easy-to-follow symbols were implemented. The internet is an important source of information, and used correctly, the WWW is very useful for the presentation and communication of a surgical department.

Family↗
PubMed2001

[Perioperative antimicrobial prophylaxis for colonic surgery: Present status in Germany. A prospective multicenter study with and without Metronidazole].

INTRODUCTION: The objective of a multicentric observational study, that was performed in Germany between 1(st) September 1996 and 30(th) September 1997, was to assess postoperative infections as a function of risk factors and antibiotic prophylaxis under everyday clinical conditions. 2 481 patients from 114 centres who received infection prophylaxis prior to elective colonic resection were included. In the descriptive analysis of the study it was noted that 36.1 % of the patients had received no prophylaxis with metronidazole despite the fact that the study protocol recommended the use of this drug in preoperative antibiotic combinations. The present analysis therefore considers the influence of metronidazole on the postoperative infection rate. METHODS: In order to exclude any bias due to intergroup differences in risk profile, the groups with and without metronidazole were subjected to a matched-pair analysis. Matching parameters were: duration of operation, blood loss, age, diabetes mellitus, hepatic, renal, or chronic airways disease, immunosuppressive therapy, and rectal resection. This led to the formation of 800 pairs that were matched with respect to these parameters. The 800 pairs were then stratified into the following treatment groups: Group 1 a and b: long-acting cephalosporine (ceftriaxone) with or without metronidazole (n = 2 x 491); Group 2 a and b: short-acting cephalosporines with or without metronidazole (n = 2 x 133); Group 3 a and b: broad-spectrum penicillines with or without metronidazole (n = 2 x 176). RESULTS: In all three treatment groups combination therapy with metronidazole was found to be significantly superior. Postoperative infection rates were 9.4 % and 18.7 % (p = 0.000) respectively in Group 1 a and b, 12.0 % and 25.6 % (p = 0.008) respectively in Group 2 a and b, and 19.9 % and 29.0 % (p = 0.009) respectively in Group 3 a and b. CONCLUSION: Preoperative administration of metronidazole in addition to an effective beta-lactam antibiotic is strongly advised in elective colonic surgery, as absence of antibiotic cover against anaerobic colonic flora leads to a significantly higher postoperative infection rate.

Aged↗
PubMed2001

[Reconstruction modes following gastrectomy. Results of experimental and clinical controlled trials].

Reconstruction modes following gastrectomy. Results of experimental and clinical controlled trials. In animal experiments four reconstruction methods following gastrectomy were compared: Roux-en Y reconstruction with (n = 33) and without pouch (n = 50) and isoperistaltic jejunum interposition with (n = 26) and without pouch (n = 55). The results were mostly influenced by the extent of esophagitis, documenting the reflux reduction by a pouch. Weight gain was slightly higher following jejunum interposition.Roux-en Y pouch reconstruction with jejunum interposition with pouch was compared in a randomized controlled trial. The additional operative effort of jejunum interposition did not achieve benefits in outcome. Therefore, Roux-en Y reconstruction should be advocated as standard reconstruction. The second randomized controlled trial compared Roux-en Y reconstruction with and without pouch. After more than three years, there was an advantage in life quality for patients with pouch indicating that patients with a favorable prognosis following gastrectomy should be reconstructed with a pouch.

Anastomosis, Roux-en-Y↗
PubMed2001

[Small bowel transplantation as an experimental and clinical replacement procedure].

Small bowel transplantation as an experimental and clinical replacement procedure. The routine use of human small bowel isografts as a treatment for mucosal defects, e. g. in the hypopharynx, demonstrates clearly that early surgical problems with this procedure have almost been solved. However, human small bowel allografts show a high risk for complications after transplantation. They provoke severe rejection episodes in the recipients which have to be treated with high-dose immunosuppression. These rejection episodes are of major interest for our own experimental research in rats: Video-microscopy (clinically established as zoom-endoscopy) makes early recognition and immediate therapy of these events possible. Concommittant liver transplantation from the identical donor even eliminate them. However, further research of the specific small bowel immune system is needed, to make this organ transplantation even clinically more successful.

Adult↗
PubMed2001

[Pouch reconstruction after resection of the rectum].

Pouch reconstruction after resection of the rectum. Functional results after low anterior resection of the rectum and straight end-to-end coloanal anastomosis are often poor. Patients are frequently troubled by the so called "anterior resection syndrome" which comprises faecal incontinence, urge, frequency and fragmentation. To investigate the potential functional benefit of a coloanal pouch reconstruction we conducted a prospective study. Some 55 patients [29 men; median age 66,4 (30-85)] underwent low anterior resection of the rectum followed by coloanal J-pouch reconstruction. Pouch size was 5-7 cm, a temporary stoma was fashioned in 32 patients. Indications for the operation were: 1. rectal cancer: n = 51, 2. recurrent adenoma n = 2, 3. recto-vaginal fistula n = 1 and 4. severe non-specific proctitis n = 1. We observed 5 anastomotic leakages of which two patients required reoperation. A pelvic abscess was encountered in three patients as well as one pelvic haematoma. Micturition was impaired in five patients. To date 47 patients have completed 12 months follow-up after reversal of the ileostomy. Patients were seen at three-monthly intervals. Mean stool frequency/day was 3.9 after 3 and 2.6 after 12 months. After 3 months 38 patients (69 %) reported complete continence which increased to 83 % at 1 year. 18 Patients (33 %) complained of urge defaecation initially, which decreased to 14.5 % after 1 year. Fragmentation was observed in 40 % at 3 and and 22 % at 12 months, respectively. In conclusion, our initial experience with colonic J-pouch reconstruction shows good functional results.

Adult↗
PubMed2001

[Defecation properties after coloanal reconstruction in the pig model].

UNLABELLED: Defecation properties after coloanal reconstruction in the pig model. OBJECTIVE: Functional aspects after low anterior resection are of major interest. While patients with straight coloanal anastomoses may suffer from disabling stool frequency and incontinence, evacuation difficulties can be a problem in coloanal pouch anastomoses. The aim of the study was to investigate functional results by establishing a standardized defecation protocol after low anterior resection of the rectum in the pig model. METHOD: 24 adult Göttinger mini pigs were studied. They were randomly assigned to three groups: 8 animals served as control animals (group 1), the remaining 16 underwent low anterior resection with small colon-J-pouch (4-5 cm) reconstruction (n = 8) and large pouch design of 8-9 cm length (n = 8). The animals were investigated after 12 weeks postoperatively. Defecation properties we studied using a Ceruletide-induced defecography (0.3 microgram kgKG) with a 100 ml barium sulfate bolus, placed just above the anastomosis. RESULTS: Evacuation was significantly impaired in the large pouch (45 min.). However, the small pouches evacuated completely after 14 min. which was comparable to the unoperated controls (17.3 min.). CONCLUSION: Ceruletide-induced defecation reveals reproducible results in pigs. Evacualtion properties are highly depending upon the coloanal reconstruction. A small colon-J-pouch design reveals nearly physiologic results 3 months after surgery.

Anal Canal↗
PubMed2001

[Skin substitutes in chronic wounds].

Skin substitutes in chronic wounds. There is a large demand for skin substitutes for the coverage of chronic wounds. Due to a intensive and local wound treatment the impaired dermal and epidermal repair still remains a major problem. Known treatmentes as split-skin-, reverdin- and pinch grafts make a sufficient and solid wound closure possible. However in such procedures the take rate of grafting often failes. The graft healing is increased with combined mesh-graft and vacuum-sealing technique. Temporary and permanent skin substitutes extend the spectrum in closure of chronic defects. Sheets and single cell suspensions of keratinocytes are available for clincial treatments. First clinical results with autologous keratinocyte transplantation are described. In the future approaches in gen therapy becomes more and more important for skin substitutes.

Chronic Disease↗
PubMed2001

[Restoration of blood circulation in reperfusion of ischemic tissues].

In experiment there were studied changes of the tissue blood circulation and microcirculation during postischemic reperfusion of skeletal muscles with various density of capillaries. It was established that reactive hyperemia, caused mainly by enhancement of extracapillary tissue blood flow. While persistence of durable arterial hypertension the capillaries quantity and potential volume of microcirculatory bed are reducing, negatively influencing the blood circulation restoration process during postischemic reperfusion. In chronic ischemia the potential volume of microcirculation is increasing, securing complete restoration of blood circulation in postischemic reperfusion.

Animals↗
PubMed2001

[Growth factors for preventing amputation in delayed wound healing].

Growth factors are mediators with essential importance for undisturbed repair process after wounding. The coordinated concert of these substances is necessary for healing with complete restoration of function and morphology. These complex mechanisms are disturbed during secondary and delayed repair. Local and systemic application of these growth factors seems to add important instruments for therapeutic use in the treatment of chronic wounds. Knowledge from experimental research is encouraging, although the exact mechanisms of synergistic action are not completely understood. However, the results from clinical use in controlled studies do not meet these expectations by far. Leading results from experimental and clinical studies are summarized in detail. Further intensive research however is required for the rational use of growth factors in the clinical setting.

Amputation, Surgical↗
PubMed2001

Highly efficient isolation of porcine islets of Langerhans for xenotransplantation: numbers, purity, yield and in vitro function.

UNLABELLED: Xenogeneic transplantation of porcine islets of Langerhans is regarded as a potential future treatment for diabetes mellitus. Despite considerable biotechnological progress, however, it is still very difficult and often unreliable to isolate sufficient numbers of highly purified, intact islets from the porcine pancreas with good in vitro function. OBJECTIVE: Of this study was to describe an efficient and reliable method to isolate sufficient numbers of highly purified islets of Langerhans with good in vitro function from adult as well as from young hybrid pigs. METHODS: Islets were isolated from the pancreas of young (4-6 months) hybrid pigs and old (2-3 years) retired breeders using Liberase PI and digestion-filtration. Average islet size was detected by dithizone staining of tissue sections prior to isolation; only organs with an average islet size > or = 200 microns were used. Density gradient purification with OptiPrep was performed in a COBE 2991 cell processor. Viability was investigated using fluorescence staining. Perifusion studies were carried out to asses in vitro function of isolated islets. RESULTS: Islets were successfully isolated from young hybrid pigs (3,671 +/- 598 IEQ/g) and old retired breeders (5,182 +/- 545 IEQ/g). After purification islet purity was 92% for retired breeders and 87% for young hybrid pigs. Yield after purification was still not satisfactory: 64% for retired breeders (3,209 +/- 444 IEQ/g) and 44% for young hybrid pigs (1,669 +/- 386 IEQ/g). Viability of isolated islets was 80-95%. Perifusion studies of porcine islets showed sufficient insulin release upon glucose challenge; however, the level of insulin release depended on the density of islets within the perifusion chamber. Low temperature culture (24 degrees C) prior to perifusion studies had no detrimental effect on insulin release. Long-term culture over 11 days was followed by a dramatic loss of islet function. CONCLUSIONS: If xenograft rejection can be overcome and the risk of xenosis can be minimised, sufficient numbers of purified porcine islets with good in vitro function can be isolated to serve as a potential source for islet transplantation in diabetic patients.

Animals↗
PubMed2000

Tolerance of rat liver allografts induced by short-term selective immunosuppression combining monoclonal antibodies directed against CD25 and CD54 with subtherapeutic cyclosporine.

BACKGROUND: Our purpose was to develop and evaluate protocols for selective immunosuppression after liver transplantation using the monoclonal antibodies (mAbs) NDS-61, directed against the interleukin-2 receptor (CD25), and 1A29, directed against the intercellular adhesion molecule-1 (CD54), in combination with subtherapeutic cyclosporine (CsA). METHODS: Orthotopic rat liver transplantation (ORLT) was performed in a DA-to-LEW strain combination. Immunosuppression was administered from day 0 to +13. Functional parameters such as survival time, body weight, and serum bilirubin levels were measured and the liver grafts were evaluated histologically. RESULTS: A stepwise tapering of CsA from 3 to 0.25 mg/kg/day reduced the long-term survival rate. All animals died at a CsA dosage of 0.25 mg/kg/day, which was therefore defined as subtherapeutic. Monotherapy with the anti-CD25 mAb was performed at dosages of 600 and 1800 microg/kg/day. The lower mAb dosage resulted in a long-term survival rate of 12% and was defined as subtherapeutic. The combination therapy of CsA (0.25 mg/kg/day) and anti-CD25 mAb (600 microg/kg/day) produced a synergistic effect and led to a long-term survival rate of 84%. This survival rate was significantly higher than those after either CsA (P<0.005) or anti-CD25 mAb (P<0.001) monotherapy. Both dosages (10 and 30 microg/kg/day) of anti-CD54 mAb monotherapy as well as anti-CD54 mAb combined with a subtherapeutic dosage of CsA were ineffective in preventing acute allograft rejection. The addition of anti-CD54 mAb (30 microg/kg/day) to combined CsA plus anti-CD25 mAb therapy (triple therapy), however, increased the long-term survival rate to 100%. In the triple therapy group there was no rejection process in the liver allografts at any time, and donor-specific tolerance could be shown by donor-specific and third-party heterotopic heart transplantation. CONCLUSIONS: The synergistic action of subtherapeutic CsA plus anti-CD25 mAb NDS-60 could be demonstrated, whereas anti-CD54 mAb only had a positive effect in a triple therapy group. Triple therapy prevented both acute and chronic rejection and induced donor-specific tolerance.

Animals↗