Biomedical subjects
Publications and source records attributed to C Klaiber.
This report describes the case of a 73-year-old patient who presented with symptomatic uncomplicated liver cysts. Treatment of this case by laparoscopic surgery is described and a short review of the literature is presented.
The analysis of 135 laparoscopic procedures since 1987 shows the possible indications of this new method. 77 cases were emergencies, mainly suspicion of acute appendicitis. 28 laparoscopic appendectomies were performed. Of the 58 elective operations 42 were laparoscopic cholecystectomies without complications. We believe that these minimally invasive procedures have many advantages compared to open surgery.
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100 patients underwent laparoscopic cholecystectomy for symptomatic gallbladder stones. In seven cases the laparoscopic procedure had to be converted into an open cholecystectomy due to bleeding, choledochus injury and acute cholecystitis. There were no complications postoperatively. We feel that the indication of this method is advantageous. Independent of the size, the number and the chemical composition, this method is used for symptomatic gallbladder stones. All together the main advantages are higher comfort for the patient, better cosmetic results, shortening of hospital stay and sooner return to full activity.
100 patients underwent laparoscopic cholecystectomy for symptomatic gallbladder stones. In seven cases the laparoscopic procedure had to be converted into an open cholecystectomy due to bleeding, injury to the choledochus and acute cholecystitis. There were no postoperative complications. We feel that the indication for this method is broad. Independent of the size, the number and the chemical composition of calculi, this method is used for symptomatic gallbladder stones. All together the main advantages are higher comfort for the patient, better cosmetic results, shortening of hospital stay and sooner return to full activity.
20 patients underwent laparoscopic cholecystectomy for symptomatic gallbladder stones. Only in one case the laparoscopic procedure had to be converted into an open cholecystectomy due to cystic arterial bleeding. There were no complications postoperatively. We feel that in selected cases laparoscopic cholecystectomy is a real alternative to the standard operation. The main advantages are higher comfort for the patient, better cosmetic results, shortening of hospital stay and sooner return to full activity.
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Streptococcus bovis is a relatively frequent causative agent of endocarditis or bacteriaemia, particularly in the elderly. In the past S. bovis has often been incompletely or even falsely classified. For therapeutic and prognostic reasons it is important to classify this agent exactly with biochemical methods even in the routine laboratory. Endocarditis or bacteriaemia due to S. bovis are often seen in conjunction with malignant, potentially malignant or benign colorectal neoplasias. After endocarditis or bacteriaemia due to S. bovis thorough investigation of colon and rectum is indicated. On the other hand, in presence of fever in patients with colorectal tumors, S. bovis bacteriaemia or endocarditis must be considered. The available literature is inconclusive on the question whether, after S. bovis endocarditis or bacteriaemia with initially normal colorectal findings, examination of the upper gastrointestinal tract and periodic inspection of the colon is needed. Up to now there has been no satisfactory explanation for the concomitant occurrence of endocarditis or bacteriaemia due to S. bovis and colorectal neoplasia.
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Report on a 64-year-old man who presented with ileus and rupture of the ileum due to diffuse ganglioneuromatosis of the small bowel. The patient had a 16-year history of recurrent ileus. In addition, there were clinical and radiographic signs of an inflammatory bowel affection which were interpreted as Crohn's disease, a diagnosis which could not be proven by pathologic examination of the resection specimen. The features of intestinal ganglioneuromatosis and its possible relation to the accompanying inflammation are discussed in the light of the pertinent literature.
A case of intestinal obstruction in an adult due to congenital diaphragma of the duodenum (DD) is presented. Aetiology, pathology and diagnostic problems are discussed and the literature is reviewed. Various therapeutic procedures are evaluated. Excision or duodeno-duodenostomy are the only measures recommended. The correct choice depends on the relation of the DD to the ampulla of Vatter. Duodeno-duodenostomy was successfully applied in the reported case.
UNLABELLED: Introduction of percutaneous drainage (pcd) of subphrenic space in early subphrenic abscesses or fluid collections (e.g. bile) seems to be an alternative to common surgical treatment, if the indication is restricted to single contaminated abscesses. Septicemia, continued contamination, hematomas and multiple abscesses are contraindications. METHOD: A modified angiocatheter is placed directly or by a Seldinger technique. Adjunct antibiotic treatment is important. The advantages of subphrenic pcd are: simple low risk procedure in local anesthesia, rapid improvement of associated respiratory symptoms, no further contamination of the abdomen. 4 of 6 patients were treated successfully by this procedure.
Thoracoscopic surgery is decidedly expanded by the ability to perform pulmonary wedge resections of the lung by using the Endo-GIA-stapler. In addition to thoracoscopic biopsies, since July 1991 we have carried out wedge resections in 12 patients suffering from spontaneous pneumothorax (nine) or peripheral bronchial carcinoma (three). Postoperatively one air fistula persisted over 9 days. The chest tube was removed within 48 h in all other patients. There was no other major complication. The postoperative hospitalization period lasted 4.6 days (1-9 days). Operating time was 44 min (30-70 min). The benefit for the patient consists in the little-impaired breathing mechanics, the short hospital stay, and the favorable cosmetic result.
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Primary neuroendocrine tumors of the cystic duct are extremely rare. Only 4 cases have been described to date. We report 2 patients in whom a primary neuroendocrine tumor of the cystic duct was incidentally detected during histological examination following cholecystectomy. With regard to the primary neuroendocrine tumor both patients were asymptomatic at the time of diagnosis. However, histologic examination did not confirm that the neuroendocrine tumors had been completely removed. Both patients underwent a second procedure. They are well after 47 and 49 months, respectively.
Monopolar current has been part of surgical practice for decades. The introduction of laparoscopic surgery has led to new developments in electrosurgery, in instrumentation and in operative techniques. The hook electrode is a device specially created for laparoscopic surgery. Some essentials of modern electrosurgery and the technique of the hook electrode are reviewed, with special emphasis on its use during laparoscopic cholecystectomy.