Search PubMed⌕ Search

Biomedical subjects

B Ulrich

Publications and source records attributed to B Ulrich.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1999

The human gene for the poly(A)-specific ribonuclease (PARN) maps to 16p13 and has a truncated copy in the Prader-Willi/Angelman syndrome region on 15q11-->q13.

The deadenylation nuclease or poly(A)-specific ribonuclease (PARN) is a 3' exonuclease, which degrades the poly(A)-tail of eukaryotic mRNA molecules. By DNA sequence analysis of cDNA and genomic clones, fluorescence in situ hybridization, and reverse transcriptase-PCR, we have determined that the active human PARN gene is located in 16p13 and that a truncated copy lacking the 5' end is located in 15q11. The truncated gene maps close to a copy of the D15F37 gene family at the proximal Prader-Willi/Angelman (PWS/AS) deletion breakpoint region. Other copies of the F37 gene family are located at the distal PWS/AS deletion breakpoint region and on 16p11.2. Although PARN and F37 gene sequences are present on 15q and 16p, our data suggest that the synteny of these loci is the result of independent genetic events.

3' Untranslated Regions↗
PubMed1999

[Localized Castleman disease. Diagnostic difficulties in a surgically treatable disease].

Castleman's disease is a rare cause for a retroperitoneal mass. The disorder can be classified into two histopathological groups: the hyalin-vascular and plasma-cell types. The former type, particularly in its localized form, is often asymptomatic and benign, the surgical therapy may cure the patient. The latter type is frequently associated with systemic manifestations and an uncertain prognosis. We present a case in which the diagnosis of localized Castleman's disease proved to be extremely difficult. In these cases, the correct diagnosis, however, is indispensable, as these patients can be cured by radical surgical tumor excision.

Adult↗
PubMed1998

[The difficult intubation. The value of BURP and 3 predictive tests of difficult intubation].

UNLABELLED: The value of BURP (= backwards-upwards-rightwards-pressure of the larynx) was tested as a improvement of the visualisation of the larynx. Simultaneously we wanted to assess the value of different predictive tests of a difficult intubation, which are easy to perform as bedside tests. PATIENTS AND MATERIAL: 1993 patients of all different surgical clinics in a tertiary care hospital in Switzerland were tested, the complete anaesthesiological staff was involved. We registered the original Mallampati classes, the thyromental distances of Patil and Frerk and the difference of the jugulomental distances in maximally reclined and neutral head position according to Chow. Every anaesthetist also noted his personal, subjective opinion of a possible difficult intubation. Under optimal conditions for intubation we assessed the grade of laryngoscopy according to Wilson and applied BURP if the grade was 3 or higher. Both laryngoscopic grades and the difficulty of intubation were noted. RESULTS: In our study we found 12.5% awkward (Wilson G3-G5) and 4.7% difficult (Wilson G4-G5) laryngoscopies. These could be changed with BURP into 5.0% and 1.9% respectively. With BURP we found 1.8% of difficult intubations. During our study we did not find any patients, whom we could not intubate either with a mandrin inside the tube or with help of the fiberoptic. The relation between sensitivity and specificity was in all single predictors and in two combinations very low. Our personal subjective predictions proofed to be better, but the rate of false negatives was too high for clinical use. CONCLUSION: BURP is a valuable method for rendering the majority of difficult laryngoscopies into easy ones. It is very easy to learn and does not need any additional equipment. Three commonly used and recommended predictive tests of the difficult intubation proofed to be of little use in clinical practice.

Adolescent↗
PubMed1998

[Indications and follow-up of total pelvic exenteration].

From 1988 to 1996 we performed 18 total pelvic exenterations in patients with an average age of 59.8 years who could be followed up for a mean 29.8 months. In 10 cases a recurrent tumor of the pelvic viscera and 7 times a primary carcinoma of the rectum, bladder or prostate were treated. In 1 patient a radiogenic fistula led to this operation. Intestinal continuity could be reconstructed in 7 cases. Following cystectomy, urinary diversion was accomplished in half of the cases by an ileal conduit. Due to septic multiorgan failure 2 patients died postoperatively (hospital mortality rate 11%). In 82% a complete resection (R0) was possible. Subsequently 5 patients (29%) developed tumor recurrence. Distant metastases were observed in 3 patients, 8-9 months after surgery. So far 10 further patients have died. Their mean survival time was 28.9 months (range 5-99 months). The remaining 6 patients are still alive between 22 and 36 months postoperatively. Despite the extent of this kind of major surgery, which also requires multidisciplinary cooperation, and the psychosocial problems resulting from two permanent stomas, total pelvic exenteration should be regarded as an adequate alternative in the treatment plan in selected patients with locally advanced or recurrent pelvic disease.

Adult↗
PubMed1998

[Significance of CT in the detection of regional lymph node metastases in colorectal carcinoma].

PURPOSE: For preoperative staging of colorectal cancer a CT scan is frequently performed. This report examines the sensitivity of CT for regional lymph node metastasis of colorectal cancer using different criteria. MATERIALS AND METHODS: Preoperative CT scans of 153 patients with colorectal cancer were analyzed using different criteria for N1. The results were then compared to the postoperative histological findings. RESULTS: For N1 = lymph nodes (LN) > 1 cm the sensitivity was 47%. For N1 = LN > 1 cm or an increased number of LN < 1 cm the sensitivity was 71%. In patients with a primary tumor seen on CT, sensitivity rose to 87%. DISCUSSION: Evidence of regional nodal metastatic disease is only relevant for rectal cancer, colon polyps, and for locally excised tumors when considering present surgical concepts for the treatment of colorectal cancer. In these cases CT analysis using the broadened criteria for N1 proposes a valuable argument regarding possible preoperative radiotherapy or an operative revision.

Aged↗
PubMed1998

Surgical treatment of locally advanced rectal cancer. Options and strategies.

AIMS: The results of surgical treatment of locally advanced rectal cancer with special regard to multivisceral resections and preoperative radiotherapy should be analyzed. METHODS: From 10/86 until 12/95, 40 patients with preoperatively assessed T4 stage rectal cancer were treated in our department whose data were evaluated retrospectively. RESULTS: Apart from 10 nonresecting procedures we performed 30 resections in which the mortality rate was 7%. In 50% of these patients a multivisceral resection was conducted. A R0 situation could be achieved in 70%. But only in 53% the operation was carried out with curative approach due to distant metastasis. After extended resections more frequent urological complications resulted in prolonged hospitalization. Survival time was markedly longer in patients without tumor residuals or metastasis. Following preoperative radiotherapy a higher number in tumor free patients and better prognosis was noticed. CONCLUSIONS: In accordance to the literature it is suggested to submit patients with T4-stage rectal cancer to preoperative radiation to improve the overall outcome.

Adult↗
PubMed1998

Pulmonary infiltrates in neutropenic patients with acute leukemia during chemotherapy: outcome and prognostic factors.

STUDY OBJECTIVE: To determine predictors of mortality from pulmonary infiltrates in neutropenic patients with acute leukemia during chemotherapy, and the significance of those factors related to the underlying malignancy and its therapy as well as of those related to the severity of the illness associated with pulmonary infiltrates. DESIGN: A historical cohort study. SETTING: A university teaching hospital and tertiary referral center. PATIENTS AND METHODS: Overall, 53 patients with neutropenia during chemotherapy and with first episodes of pulmonary infiltrates during a 4-year period were studied. Prognostic analysis included 38 variables. Multivariate analyses were performed by logistic regression. RESULTS: The survival rate from pneumonia was 57% (30/53). The following eight parameters were significantly associated with death in univariate analysis: comorbidity present; development of "late" pulmonary infiltrates (> or = 14 days after hospital admission); heart rate > or = 100 beats/min; a ratio heart rate/systolic blood pressure (HR/SBP) > or = 1.2; urea nitrogen > 7 mmol/L; radiographic score > or = 3; neutropenia < 1.0x10(9)/L at the treatment end point; and failed complete remission. In a multivariate model including only parameters available at diagnosis of pulmonary infiltrates, the presence of a ratio HR/SBP > or = 1.2 and of a radiographic score > or = 3 remained independently associated with death. In a second model also including the evolutionary parameter neutropenia < or = 1.0x10(9)/L at the treatment end point, both parameters remained significant together with neutropenia <1.0x 10(9)/L at the treatment end point. The presence of a ratio HR/SBP > or = 1.2 was a strong marker of early death. CONCLUSION: Both therapy- and malignancy-associated neutropenia as well as the severity of illness associated with pulmonary infiltrates are independent prognostic factors. Patients with a ratio HR/SBP > or = 1.2 at diagnosis of pulmonary infiltrates suffer from potentially reversible acute illness, are at risk for early death and, therefore, may be appropriate candidates for treatment in an ICU.

Adult↗
PubMed1998

[Urologic reconstruction within the scope of interdisciplinary pelvic exenteration for treatment of invasive tumors of the pelvis].

In radical surgical treatment of primary or recurrent locally advanced pelvic carcinoma involving the bladder, urinary diversion after cystectomy significantly increases the overall morbidity rate. Analyzing 20 patients retrospectively who underwent total pelvic exenteration from 1988-1997, we found that reconstruction by ileal conduit can be performed safely but leaves the patient with a (mostly second) stoma. The advantage of continence with pouch or neobladder reconstruction needs to be weighed up in view of the more demanding and complicating surgical technique, hence it should be reserved for younger, cooperative patients presenting with a favorable long term prognosis.

Adult↗
PubMed1997

[Preoperative instrumental diagnosis of rectal carcinoma. Value of various methods with reference to therapeutic decision making].

A retrospective analysis of 238 patients with rectal cancer undergoing primary surgery was performed in respect of preoperative diagnostic examinations. It is shown that stage-adjusted therapeutic approaches (e.g. peranal rectal excision, preoperative radiotherapy, or palliative surgery) can be pin-pointed with a high degree of certainty using colonoscopy, endorectal ultrasound and abdominal ultrasound. With the possible exception of selected patients with far-advanced rectal cancer there is no need for intravenous pyelography or computed tomography of the abdomen or lower pelvis.

Adult↗
PubMed1996

[Problems in diagnosis and surgical therapy of choledochus cysts. A case report].

We report a case of choledochal cyst accompanied by an adenoid gallbladder carcinoma, in an adult patient. Diagnosis was complicated by coexisting primary hyperparathyroidism. In view of the pathological laboratory tests, which suggested acute pancreatitis, the visualized cystic abdominal mass was regarded as a pancreatic pseudocyst. Neither ultrasound nor CT could clearly define the cyst's origin. Laparotomy, performed later because of deteriorating clinical condition, showed an extended carcinoma which was already invading the liver. Only palliative resection and choledochocystojejunostomy was technically feasible. To prevent the development of malignancies in dilated bile ducts, early treatment by cyst resection and reconstruction of the extrahepatic biliary system is recommended, especially in younger patients.

Aged↗