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Biomedical subjects

B Ulrich

Publications and source records attributed to B Ulrich.

At least 19 recordsLinked to original sources
PubMed2003

Structure and process quality illustrated by fibreoptic intubation: analysis of 1612 cases.

The purpose of this investigation was the description of structure and process quality based on the analysis of 1612 fibreoptic intubations. We evaluated all fibreoptic intubations (nasotracheal in awake patients and orotracheal in anaesthetised patients) from a previously described database over a period of 2 years. We assessed structure quality by evaluating the distribution of the fibreoptic intubations across all staff anaesthetists, and process quality by analysing the number of attempts, the time required, the cases where we had to switch to conventional intubation and the complications. In all, 955 nasotracheal and 657 orotracheal intubations were evaluated. Almost all anaesthetists performed at least 15 nasotracheal and 10 orotracheal intubations. The success rate was 85.2% at the first attempt. Within 3 min, 93.9% of all fibreoptic intubations were successfully completed. In 24 cases, fibreoptic intubation was abandoned. Severe nasal bleeding as a major complication occurred in 1.3% of the nasotracheal intubations.

Adolescent↗
PubMed2002

[Prospective multi-center study colon/rectum carcinoma (primary tumors)--Results of the year 2000].

INTRODUCTION: Surgical quality control in the form of multicentre studies make it possible to analyse the treatment status of a given surgical illness under quality assurance aspects. MATERIAL/METHODS: On 1. 1. 2000, under the patronage of the Convent of Hospital Chief Surgeons a project (ongoing) - organised and conducted by the Institute for Quality Management in Operative Medicine at the Otto-von-Guericke University of Magdeburg - was initiated to document and collect the data of patients with colorectal cancer throughout the whole of Germany. This work is supported by the German Society of Surgery, and the Surgical Working Group, Quality Assurance within the German Society of Surgery. Currently, some 282 hospitals throughout the country are involved in establishing a prospective documentation of colorectal carcinoma. Participation in this study is on a voluntary basis. The anonymity of both patients and hospitals is guaranteed, and no hospitals wishing to participate are excluded. Both operatively and conservatively treated patients are being documented, and no randomization takes place. RESULTS: In the year 2000, the participating hospitals documented a total of 9 477 patients with a colorectal carcinoma, including 6 975 patients with a carcinoma of the colon, and 3 402 with a rectal carcinoma. The average age of the patients was 68.5 years, and there were 5 010 men and 4 467 women. The operation rate was 99.2 %, the resection rate 95.6 %. The abdominoperineal resection rate was 27.4 %. The indicators for diagnostic quality as set out by Hermanek were largely complied with, but some deviations were noted. DISCUSSION: On the basis of the data collected, structures were established for a uniform Germany-wide quality management for a clinical condition with a major health policy impact. This information make it possible for the hospitals to identify and eliminate deficits in the structural and process quality in the diagnosis and treatment of colorectal cancer, and in this way to improve outcome quality. This means that the results of medical care research have an immediate impact on the individual treatment received by a given patient.

Adult↗
PubMed2002

[The Transverse Coloplasty Pouch (TCP)--function and subjective judgement in comparison with the surgically more complicated J-Pouch].

The present study shows the comparison of function and subjective judgement between two pouch-constructions after TME as treatment for rectal cancer. In 61 cases we constructed a J-Pouch, in 25 cases a transverse coloplasty pouch (TCP). The sex distribution was nearly the same. The influence of additional treatment like neoadjuvant radiotherapy or adjuvant chemo-radiatio was considered. Patients were asked about stool frequency, -consistency, continence, quality of life etc. 9 patients were not alive at follow up. 54 patients (70 %) could be interviewed and examined. 6 months after operation patients with a J-Pouch had a daily stool frequency of 4 times versus 6 times with a TCP. 19 % of patients with a J-Pouch suffered from incontinence problems compared to 33 % with a TCP. Obstipation was only a problem after J-Pouch-construction (12 %). The question on a "good" quality of life was positively answered by 56 % of patients in the J-pouch-group versus 39 % in the TCP-group. 17 % after J-pouch-construction versus 6 % after TCP-construction judged the quality of life as "bad". The results of this study show the TCP being a good alternative pouch-construction instead of the surgically more complicated J-pouch after TME.

Aged↗
PubMed2001

Costs and efficiency of a tumor follow-up program for the detection of colorectal liver metastases.

From January 1987 until July 1999 we admitted 1003 patients with colorectal cancer and 31 with resected colorectal liver metastases to our tumor follow-up program. After R0 resection of the primary tumor 60 patients developed liver metastases during the postoperative follow-up. R0 resection of the metastases was performed in 16 of these cases without lethality and low morbidity. In the further course of the follow-up 8 of these patients again developed liver metastases, two of whom underwent reoperation. The overall 5-year survival rate after R0 resection of liver metastases was 20%. In 726 patients we performed 3719 follow-up examinations. Following the German regulations on physicians' fees for follow-up-examinations we calculated the cost of detecting a liver metastasis to be DM 16,500 per patient. Mean costs were DM 62,000 in patients in whom the metastases were successfully resected. The results of this study show that although the costs are very high for patients who benefit from the follow-up program, 26.7% of those with liver metastases are detected in such an early stage, and that an R0 resection can be performed. This study shows that the high costs of tumor follow-up programs for detecting liver metastases in patients with resected colorectal cancer can be justified by the good outcome of patients in whom an early diagnosis of recurrent disease is made.

Adenocarcinoma↗
PubMed2001

Technical aspects and results of the transhiatal resection in adenocarcinomas of the gastroesophageal junction.

The distribution of lymph node metastases of adenocarcinomas of the gastroesophageal junction is classified into three types. The R0 resection with complete lymphadenectomy therefore requires different resection methods for type 1 and type 2/3 tumors. Comparing the subtotal esophagectomy and the extended gastrectomy, no advantage in survival can be seen for one method or one tumor type (type 1 or type 2/3). The same is true for the lethality. Indeed, the transhiatal resection is accompanied by a higher complication rate. However, the different operation methods for cardiacarcinomas, with subtotal esophagectomy in type 1 and extended gastrectomy in type 2/3 tumors, should be maintained because of increased rates of local recurrence that may be expected if all cardiacarcinoma types were treated using subtotal esophagectomy with gastric tube interposition. Therefore, we suggest a subtotal esophagectomy only in type 1 tumors. In type 2/3 tumors, an extended gastrectomy with resection of the distal esophagus, lymphadenectomy of the lower mediastinum, and D2 lymphadenectomy should be performed.

Adenocarcinoma↗
PubMed2001

Validation of a simple algorithm for tracheal intubation: daily practice is the key to success in emergencies--an analysis of 13,248 intubations.

A fundamental skill of the anesthesiologist is airway management. We validated a simple endotracheal intubation algorithm with a large proportion of fiberoptic tracheal intubations used for years in daily practice. Over 2 yr, 13,248 intubations (>90% of all intubations, including obstetrics and ear, nose, and throat patients) in a heterogeneous patient population at our acute care hospital were evaluated prospectively. About 80 physician and nurse anesthetists were involved. Once the indication for intubation (oral or nasal) was established, the first step was to choose between the primary conventional technique (laryngoscope with Macintosh blades) and the primary fiberoptic technique. For the conventional technique, a well defined procedure had to be followed (maximum of two attempts at intubation; if unsuccessful, switch to secondary oral fiberoptic intubation). For the primary fiberoptic technique, the anesthesiologist had to decide between nasotracheal intubation in awake patients and oral intubation in anesthetized patients. Fiberoptics were used for 13.5% of the intubations. By following our algorithm, intubation failed in 6 out of 13,248 cases (0.045%; 95% confidence interval 0.02%-0.11%). We demonstrate that a simple algorithm for endotracheal intubation, basically limited to fiberoptics as the only aid, is successful in daily practice. Only methods that are practiced daily can be used successfully in emergencies.

Adolescent↗
PubMed2001

Fiberoptically-guided insertion of transtracheal catheters.

IMPLICATIONS: Regular use of the transtracheal catheter (TTC) both offers an opportunity for training for the difficult airway and facilitates elective endoscopic surgery. Fiberoptic guidance and exploratory puncture improve the insertion of the TTC.

Adolescent↗
PubMed2000

Dimenhydrinate and metoclopramide alone or in combination for prophylaxis of PONV.

PURPOSE: Dimenhydrinate and metoclopramide are inexpensive antiemetic drugs. Metoclopramide, especially, has been studied extensively in the past, but there are no studies on the combination of both drugs for prevention of postoperative nausea and vomiting (PONV). METHODS: One hundred and sixty male inpatients undergoing endonasal surgery were randomized to receive one of four antiemetic regimens in a double-blind manner: placebo, 1 mg x kg(-1) dimenhydrinate, 0.3 mg x kg(-1) metoclopramide, or the combination of both drugs was administered after induction of anesthesia. Patients received a second dose of these drugs six hours after the first administration to mitigate their short half-life. Standardized general anesthesia included benzodiazepine premedication, propofol, desflurane in N2O/O2 vecuronium, and a continuous infusion of remifentanil. Postoperative analgesia and antiemetic rescue medication were standardized. Episodes of vomiting, retching, nausea, and the need for additional antiemetics were recorded for 24 hr. The incidences of PONV were analyzed with Fisher's Exact test and the severity of PONV (rated by a standardized scoring algorithm) with the Jonckheere-Terpestra-test. RESULTS: The incidence of patients free from PONV was 62.5% in the placebo-group and increased to 72.5% in the metoclopramide-group (P = 0.54), 75.0% in the dimenhydrinate-group (P = 0.34), and 85.0% in the combination- group (P = 0.025). In the latter group, the severity of PONV was reduced compared with placebo treatment (P = 0.017; Jonckheere-Terpestra-test). CONCLUSION: Dimenhydrinate and metoclopramide were ineffective in reducing the incidence and the severity of PONV. Their combination reduced the incidence of PONV compared with placebo.

Adult↗
PubMed2000

[Short-term hypofractionated radiotherapy followed by total mesorectal excision].

PURPOSE: Is preoperative short-term radiotherapy of operable rectal carcinoma feasible with regard to early side effects and perioperative complications? PATIENTS AND METHODS: As of December 1996 to March 1999, 34 patients with locally advanced rectal cancer have been irradiated preoperatively with 5 times 5 Gy. After CT-planning, radiotherapy was administered using a 3-field or 4-field box technique with 2 anterior-posterior fields or a posterior field of 9 +/- 2 cm x 11.5 +/- 2.4 cm and 2 opposed bilateral fields of 9 +/- 1.5 cm x 11.5 +/- 2 cm with 6- to 25-MV photons. Surgery was performed 14 +/- 6 days after irradiation in 33/34 patients (82% anterior resection with total mesorectal excision, 18% abdomino-perineal resection). Patients with a positive lymph node status or pT3/4 lesions underwent adjuvant chemotherapy with 5-Fluorouracil (5-FU). The median follow-up period is 189 days (range: 15 to 548 days). RESULTS: The following early side reactions were registered: increased bowel movements (4/34), fatigue (2/34), pain in the groins (1/34), nausea and perianal smart (1/34), vertigo (1/34), temporary urinary obstruction (1/34). One patient with heart failure NYHA Grade III died of a heart attack after 21 days. Preoperative T and N categories showed a distribution of 3, 29 and 2 for T4, T3 and unknown and 20, 11 and 3 for N+, N- and unknown; postoperative T and N categories showed a distribution of 3, 19 and 11 for T4, T3 and T2 and 19 and 14 for N+ and N-. In 32 of 33 patients tumor-free margins were achieved. One patient with peritoneal metastases had a R1 resection. In 3 patients metastases were detected intraoperatively. Perioperative complications were: 2 cases of leaking anastomosis and postoperative bowel atonia, 1 case with bowel obstruction, delayed wound healing, wound dehiscence and temporary renal dysfunction. CONCLUSION: Preoperative radiotherapy is feasible with moderate toxicity and is able to induce down staging despite the short time interval between radiotherapy and surgery.

Adenocarcinoma↗
PubMed2000

Surgical treatment of non-ampullary duodenal cancer: good long term survival after radical tumour resection including lymphadenectomy.

AIMS: The aim of this study is to evaluate the role of surgery in the treatment of duodenal cancer. METHODS: From October 1987 to January 1999, 7 patients (3 female/4 male) with primary non-ampullary duodenal adenocarcinoma underwent surgical treatment in our department. Presenting signs and symptoms were abdominal pain, weight loss, anaemia and obstruction. Upper gastrointestinal contrast study, computed tomography (CT) and duodenoscopy were the primary diagnostic procedure modalities. All diagnoses were confirmed histologically. Five of 7 patients were resectable for cure at the time of their first surgical intervention. RESULTS: In 5 patients, the tumour could be removed with tumour-free margins. One patient, where the histopathological workup revealed tumour cells in the resection margins, died 29 months after the surgical intervention. In another patient, complete tumour resection could not be achieved. Subsequently, postoperative survival was only 2 months. Operative mortality was 0%. Patients with R0-status showed a postoperative survival of at least 24 months. CONCLUSION: In the management of resectable non-ampullary malignancies of the duodenum, surgical radicality including lymphadenectomy should be pursued. The radical operative treatment with lymphadenectomy offers a reasonable chance for cure in some patients.

Adenocarcinoma↗
PubMed1999

Rectal cancer surgery in a district general hospital: controlled follow-up study.

Local recurrence after curative surgery of rectal cancer indicates failure of the initial treatment. In recent years reported local recurrence rates have steadily decreased. In this study 364 patients treated for rectal cancer were analyzed retrospectively to determine if it is still justified to treat this disease in small nonspecialized hospitals. An overall local recurrence rate of 9.7% was found for all operation methods used. Local recurrence rates were 11.6% for patients treated by low anterior resection, 8.4% for the patients who sustained an amputation of the rectum, and 7.1% for the patients treated by transanal tumor resection. None of the patients in whom we performed a total mesorectal excision has developed local recurrent disease during the observation period. Careful surgical technique and close follow-up of the patients being prerequisites, the results of this study justify continuing to treat rectal cancer in nonspecialized centers.

Adult↗
PubMed1999

[In Process Citation]

Twenty-seven patients presenting with complete rectal prolapse were treated by extracorporal resection using a stapling device. The mean age of the female patients was 74 +/- 15 years, the mean operation time 61 +/- 17 min, the mean length of hospital stay 17 +/- 8 days. 96% of the patients suffered from at least one concurrent disease necessitating treatment. Perioperative mortality was 3.7%, postoperative complications occurred in 18% of our patients. After surgery 19% of the patients were incontinent. Extracorporal resection using a stapling device proves to be a secure and technically easy-to-perform procedure in the treatment of complete rectal prolapse. Due to several advantages compared with transabdominal procedures, the indication for perineal repair of a complete rectal prolapse by extracorporal resection should not be confined to high-risk patients.

Journal Article↗
PubMed1999

[Dimenhydrinate and metoclopramide for prevention of nausea and vomiting following septorhinoplasties in women].

OBJECTIVES: Dimenhydrinate and metoclopramide are inexpensive antiemetic drugs. Metoclopramide, especially, has been studied extensively in the past, but there are no studies that used the combination of both drugs for prevention of postoperative nausea and vomiting (PONV). METHODS: 120 female inpatients undergoing endonasal surgery were randomised to receive one of four antiemetic regimes: placebo, dimenhydrinate (1 mg x kg-1), metoclopramide (0.3 mg x kg-1), or the combination of both drugs (1 mg x kg-1 + 0.3 mg x kg-1) were administered intravenously after induction of anaesthesia and repeated 6 hours after the first administration. For general anaesthesia a standardised technique including benzodiazepine premedication, propofol, desflurane in N2O/O2 vecuronium and a continuous infusion of remifentanil was used. Postoperative analgesia (diclofenac or metamizole supplemented with piritramide) and antiemetic rescue medication (dolasetron and droperidol) were standardised. Episodes of vomiting, retching, nausea, and the need for additional antiemetics were recorded in the recovery room and 2, 5, 8, and 24 hours after surgery. The main goal of the study was to increase the number of females staying completely free from PONV (Chi 2-test). Furthermore, the severity of PONV was analysed, using a standardised scoring algorithm. RESULTS: There were no differences between the two groups with regard to biometric data and distribution of risk factors for developing PONV. In all four groups nearly the similar number of patients stayed completely free from PONV: Placebo: 60.7%, metoclopramide: 66.7%, dimenhydrinate: 64.3%, combination: 64.4% (differences not significant). There was also no difference in the severity of nausea and emetic sequel. DISCUSSION: In females undergoing endonasal surgery under propofol-desflurane-remifentanil anaesthesia the incidence of PONV is about 40%. In this setting, both metoclopramide and dimenhydrinate were ineffective to reduce the incidence and the severity of PONV. The combination of both drugs revealed no additional synergistic effect.

Adult↗