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Biomedical subjects

B Rau

Publications and source records attributed to B Rau.

At least 109 records · Page 6Linked to original sources
PubMed1995

[The role of oxygen radicals in acute pancreatitis. Clinical and experimental results of therapy with free radical scavengers].

Numerous studies support the theory that oxygen free radicals (OR) are involved in the development of tissue damage in all forms of experimental acute pancreatitis. OR are generated in an early phase of the disease before tissue damage is detectable by histology. The pathomechanism that leads to this oxidative stress is not fully understood. The efficacy of scavenger treatment was clearly proven in most models of experimental acute pancreatitis. In first clinical trials applying antioxidant treatment with selenium show favorable results in reducing the lipidperoxidation and improving the antioxidant status. However these preliminary results but must be supported in a larger series of patients to allow proper evaluation of patient outcome.

Free Radicals↗
PubMed1995

[Significance of serum beta-hCG as a tumor marker for stomach carcinoma].

INTRODUCTION: Recent investigations indicate that in 50% of patients with gastric cancer, beta-hCG-positive cells can be found in the tumour by immunohistochemical investigations. The objective of this study was to investigate how often beta-hCG-immunoreactive gastric carcinomas were accompanied by an elevation in serum beta-hCG, that could have been used as a course control variable. METHODS: In 54 patients with gastric carcinoma a monoclonal antibody directed against beta-hCG was used for immunohistochemical marking in the APAAP system. The evaluation was graded positive or negative. In parallel, serum beta-hCG was determined preoperatively using an enzyme immunoassay (MEIA). Tumour stage, grading and tumour localization were determinants in the evaluation. RESULTS: We found that 41% (22 of 54) of the carcinomas induced a positive immunohistochemical response to beta-hCG, regardless of their location in the stomach. In relation to tumour stage, a positive beta-hCG immunoreactivity was apparent in 27% (6/22) of tumours without lymph node or distant metastases (T1-4N0M0), in 54% (7/13) of tumours with lymph node and without distant metastases (T1-4N > or = 1M0) and in 47% (9/35) of tumours with distant metastases. Poorly differentiated tumours (G3-4) were positive in 42% (15/36) and well-differentiated tumors (G1-2) in 39% (7/18) of cases. In only 1 patient was the beta-hCG level in serum elevated, however. CONCLUSIONS: beta-hCG-Positive gastric carcinomas are found more frequently in advanced tumour stages and poorly differentiated carcinomas. These carcinomas, however, seem not to excrete beta-hCG in sufficient amounts to produce measurable serum values. Therefore, beta-hCG cannot be used a prognostic factor or for course control. The relevance of beta-hCG expression of tumour cells to the patients' prognosis remains obscure.

Adenocarcinoma↗
PubMed1995

Laparoscopy and laparoscopic ultrasound for staging of upper gastrointestinal tumours.

Conventional imaging studies are often not sensitive enough to allow accurate preoperative staging of intra-abdominal tumour spread. Laparoscopy and laparoscopic ultrasound appear to be suitable to improve staging of gastrointestinal tumors. Within a 10-month period 40 patients with upper GI tract cancer underwent laparoscopy for intra-abdominal staging. Additionally laparoscopic ultrasound was performed on 20 of these patients using a flexible echo-endoscope equipped with a curved array transducer (5/7.5 MHz). By laparoscopy additional information compared to conventional staging was obtained in 16 patients (40%). Laparoscopy revealed peritoneal carcinomatosis and liver metastases in seven and four patients, respectively. M1-lymph nodes were detected in four patients. Laparoscopic ultrasound was able to image otherwise inaccessible regions of the abdominal cavity and induced a change of staging in seven of 20 patients in whom laparoscopy was uneventful. Ultrasound also proved to be valuable for localization of M1-lymph nodes. In summary, combination of laparoscopy and laparoscopic ultrasound improved staging in 23 of 40 patients (57%). Consequently surgery was abandoned in 16 patients due to incurable or non-resectable disease, while down-staging occurred in seven patients, who subsequently underwent resection. Laparoscopy is capable of improving staging of intra-abdominal malignancy by detection and subsequent biopsy of small lesions. Laparoscopic ultrasound can replace the lack of tactile sensitivity in laparoscopy, thus enabling the detection of non-superficial lesions.

Evaluation Studies as Topic↗
PubMed1995

[Laparoscopy and laparoscopic endosonography as staging examination of tumors of the upper gastrointestinal tract].

UNLABELLED: Accurate staging of gastric and oesophageal cancer is of major importance for the therapeutic strategy. However conventional imaging procedures are often not sensitive enough for precise assessment of resectability and curability. In this study laparoscopy and laparoscopic ultrasound were evaluated for preoperative staging. PATIENTS AND METHODS: Laparoscopy was performed on 21 patients for staging of intraabdominal malignancy using a standard equipment. Laparoscopic ultrasound was done with a flexible echoendoscope equipped with a curved array transducer (5/7,5 MHz). The ultrasound probe was introduced via a 15 mm trocar. RESULTS: By laparoscopy and laparoscopic ultrasound additional informations compared to conventional staging were obtained and revealed a disseminated disease in 15 out of 21 (71%) patients. These informations induced a change of the initially planned treatment concept in 14 of these patients (67%). A definitive palliative treatment was performed in 5 patients after diagnosis of incurable disease. Laparoscopic ultrasound proved to be useful for the detection of small non superficial lesions followed by biopsy and can improve laparoscopic staging of intraabdominal tumor spread.

Esophageal Neoplasms↗
PubMed1995

Management of sterile necrosis in instances of severe acute pancreatitis.

BACKGROUND: The clinical management of sterile pancreatic necrosis is still a matter of debate. In this study we analyzed the clinical course and outcome of patients with sterile necrotizing pancreatitis treated surgically versus nonsurgically. STUDY DESIGN: Between May 1982 and December 1993, 249 patients with necrotizing pancreatitis (NP) entered this study, of which 172 (69 percent) had intraoperatively or fine needle aspiration-proven sterile NP. One hundred seven of 172 patients underwent surgery (S group) with necrosectomy and continuous postoperative closed lavage and 65 of 172 were treated by nonsurgical means (NS group). RESULTS: Median Ranson and admission APACHE II scores were 4.7 (range, 1 to 10) and 11 (range, 1 to 29) in the S group, significantly higher than those in the NS group with 3.0 (range, 0 to 6) (p = 0.022) and 8 (range, 1 to 23) (p = 0.036). After 48 hours of intensive care treatment, APACHE II scores persisted at 10.5 (range, 1 to 29) in the S group and decreased to 6 (range, 0 to 15) (p = 0.013) in the NS patients. Median C-reactive protein (CRP) levels on admission were 179 mg/L and 68.5 mg/L (p = 0.023), respectively. Within 72 hours, 61 (94 percent) of 65 NS-managed patients responded to intensive care therapy, whereas organ complications persisted or increased and thus led to surgery in the S group. Mortality rates were 13.1 percent in the surgically treated patients and 6.2 percent in the nonsurgically treated patients (p = NS). CONCLUSIONS: Most patients with limited and sterile pancreatic necrosis respond to intensive care treatment. Indication for surgery in sterile NP should be based on persisting or advancing organ complications despite intensive care therapy. APACHE II scores and admission CRP levels represent a helpful tool in decision making for surgical or nonsurgical management of NP.

APACHE↗
PubMed1995

[Diagnosis and therapy of primary pancreatic abscess].

Local septic complications in acute pancreatitis (AP) should be characterized and defined in order to assess the validity of early diagnosis and various therapeutic measures. The purpose of this study was therefore to distinguish between two local septic complications which have been termed 'abscess' and 'infected necrosis' in regard to their morphological, clinical, laboratory criteria. Moreover, the validity of various diagnostic procedures and therapeutic interventions were compared. Septic necrosis is defined as a diffuse bacterial inflammation of necrotic pancreatic and peripancreatic tissue. The morphologic substrate of pancreatic abscess is a localized collection of pus surrounded by a capsula or pseudocapsula. Infected necrosis become clinically evident in the early phase of AP. The patients suffer from a fulminant course of AP with signs of sepsis and laboratory alterations typical for AP. Concomitantly, these patients develop pulmonary and renal insufficiency, in 71.5 and 44.2% of the patients, resp. Overall mortality rate of patients with infected necrosis amounts to 20.8%. In contrast, pancreatic abscess develops not before week 5 after onset of AP. Concomitantly, the laboratory signs of AP like amylasemia and hypocalcemia as well as LDH and C-reactive protein increases are rarely observed. Correspondingly, these patients suffer significantly less form pulmonary insufficiency (22.6%) or other organ complications. Consequently, the mortality rate is with 6.5% significantly lower. Timely diagnosis is possible with acceptable sensitivity by contrast-enhanced CT scan and fine-needle aspiration. Other imaging procedures do not show similar sensitivity and specificity. Therapeutically, patients with infected necrosis as well as pancreatic abscess have to be operated.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMed1994

[Thoracoscopic localization of intraparenchymal pulmonary coin lesion using intraoperative ultrasound].

Generally, thoracoscopic resection of peripheral round lesions of the lung is a viable alternative to open surgery. However, due to the lack of tactile sensitivity intraparenchymal lesions often escape thoracoscopic detection and therefore this approach is limited to superficial lesions. The use of thoracoscopic endosonography may be valuable to localize intraparenchymal lesions which are not visible and enable subsequent thoracoscopic wedge resection.

Diagnosis, Differential↗
PubMed1994

[Laparoscopic sonography with an ultrasound endoscope].

Abdominal ultrasound is one of the major diagnostic tools for preoperative staging of malignancies. However this technique is limited by meteorismus and other physical factors (adipositas, ribs). Intraabdominal laparoscopic ultrasound is a valuable technique to overcome these limitations. A flexible echoendoscope was evaluated for this purpose. Being flexible the echoendoscope can be directed easily even to regions that are usually not accessible. Therefore this minimally invasive technique provides the chance to obtain precise tissue diagnosis by ultrasound guided biopsies through the biopsy channel while contemporary visualisation is possible.

Biopsy, Needle↗
PubMed1993

Surgery for congenital malformations of the lung.

In the course of a survey conducted in 59 hospitals performing thoracic surgery, 14 hospitals supplied data that could be used for the study. Out of 1347 anomalies diagnosed 1343 were surgically treated, with a 30-day mortality rate of 0.3% (5 patients). In a retrospective study over a period of 10 years (1978-1988) we identified 198 anomalies out of a total of 6350 thoracotomies; so our percentage grading of pulmonary anomalies is supported by the data of the above-mentioned survey according to which cystic pulmonary malformations such as inhibition malformations, excess malformation and lobar emphysema represent a majority with 72.2% (survey 83%). Congenital anomalies of lung formation occurred in 23% of the patients of the survey and in 15% of our own patients. Therapy consisted of parenchyma-saving surgery, i.e. enucleation (n = 87), segmental resection (n = 65) and lobectomy (n = 63) with bronchoplastic reconstruction; there was no 30-day mortality. Adenomatoid-cystic malformation, lymphangiectasis, congenital lobar emphysema and stenosis of the tracheobronchial tree are often an indication for immediate surgical treatment in neonates. Solitary cysts, bronchiectasis, sequestration of the lung, an AV-fistula present with symptoms mostly between the ages of 20-40 and therefore were surgically treated secondarily.

Adolescent↗
PubMed1992

Surgery for congenital malformations of the lung.

In the course of a survey conducted in 59 hospitals performing thoracic surgery, 14 hospitals supplied data that could be used for the study. Out of 1347 anomalies diagnosed 1343 were surgically treated, with a 30-day mortality rate of 0.3% (5 patients). In a retrospective study over a period of 10 years (1978-1988) we identified 198 anomalies out of a total of 6350 thoracotomies; so our percentage grading of pulmonary anomalies is supported by the data of the above-mentioned survey according to which cystic pulmonary malformations such as inhibition malformations, excess malformation and lobar emphysema represent a majority with 72.2% (survey 83%). Congenital anomalies of lung formation occurred in 23% of the patients of the survey and in 15% of our own patients. Therapy consisted of parenchyma-saving surgery, i.e. enucleation (n = 87), segmental resection (n = 65) and lobectomy (n = 63) with bronchoplastic reconstruction; there was no 30-day mortality. Adenomatoid-cystic malformation, lymphangiectasis, congenital lobar emphysema and stenosis of the tracheobronchial tree are often an indication for immediate surgical treatment in neonates. Solitary cysts, bronchiectasis, sequestration of the lung, an AV-fistula present with symptoms mostly between the ages of 20-40 and therefore were surgically treated secondarily.

Adolescent↗
PubMed1990

[Congenital lung hypoplasia in adulthood].

This is a report on a largely asymptomatic patient with a unilaterally non-functional lung. The differential diagnosis between an acquired, "destroyed" lung and congenital hypoplasia of the lung with secondary inflammatory changes proves difficult. The various imaging procedures that are available, used in conjunction with the histological findings, permit a classification.

Diagnosis, Differential↗
PubMed1988

[Ideal indications for the use of a textile ligament of high strength Trevira in alloplastic replacement of the anterior cruciate ligament in chronic isolated rupture].

Between August 1980 and December 1986, 120 patients suffering from chronic instabilities of the knee ligament were submitted to corrective surgery at the Berufsgenossenschaftliche Unfallklinik Frankfurt am Main. A textile ligament made of polyethylene terephthalate (Trevira hochfest type 730) was substituted in all cases for the disturbed or missing ligament structure. 67 out of 100 patients came to the check-up appointments. A precise and objective comparison between the preoperative and postoperative findings of each patient was now possible for the first time thanks to the most recent computer technique. Until now we were not able to do this. Possibly the results published hitherto had a subjective touch and were too much dependent on the feelings of the individual investigators. Full objective stability over several years was reached anyhow in 51.4% of the patients checked up. Especially in case of inveterate isolated rupture of the anterior cruciate ligament, the alloplastic substitution by a ligament made of Trevira hochfest is at present an ideal possibility to restore stability for a long time and to prevent severe secondary wear symptoms of the other interior structures of the knee. The failures and insatisfactory results with respect to stability are explained by an insufficient consideration of the implantation technique recommended. In order to help this method to achieve its welldeserved propagation which would be to the advantage of patients with chronic instabilities of the knee ligament, this technique is explained in detail once more and possible errors are indicated.

Adult↗
PubMed1987

[Cement-free implanted total hip endoprosthesis of the Mittelmeier model. Clinical experiences and results following 6 years of use mainly in accident-induced hip changes].

We give a review of the results of 165 implantations in 143 patients. Uncemented endoprostheses (type Mittelmeier) for replacement of hip joints were implanted from September 1979 to December 1985 at the Berufsgenossenschaftliche Unfallklinik Frankfurt/Main. When we started to implant uncemented prostheses the complication rate was higher than in conventional implantations. Most of the complications could be gradually avoided. The current complication rate is equal in both procedures. Long-term results will be known in a few years' time. We will they also know whether the method is advantageous for younger patients.

Adult↗
PubMed1975

Voodoo in the general hospital. A case of hexing and regional enteritis.

We have observed the case of a hexed patient that emphasizes the interplay between modern medical practice and the influence of a supernatural voodoo subculture. Psychosocial stresses involved in the patient's illness (regional enteritis) added to the complexity of the clinical problem. The presence of ambivalence in the patient and her mother concerning their systems of belief, and their unwillingness to accept totally the treatment modalities of either modern medicine or voodoo, probably prevented the patient's predicted death.

Adult↗