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Biomedical subjects

C Nies

Publications and source records attributed to C Nies.

At least 55 records · Page 3Linked to original sources
PubMed1997

[Laparoscopic adrenalectomy].

Minimally-invasive adrenalectomy is a new and attractive procedure, which has advanced to the method of choice in the surgical treatment of benign adrenal diseases. This technique is contraindicated in the treatment of adrenal malignancies. The endoscopic removal of large benign adrenal tumors (> 6-8 cm) may be difficult. The preoperative management of the patients does not differ from the preparation for conventional adrenalectomy. Like in open adrenalectomy several different endoscopic approaches to the adrenals have been described: the transperitoneal approach with the patient in supine position, the transperitoneal approach in lateral position, the retroperitoneal approach in lateral position and the retroperitoneal approach in prone position. Excellent results have been achieved with all four techniques. The approaches with the patient in lateral position have the disadvantage that in case of bilateral adrenalectomy the patient has to be repositioned during the operation. Large tumors are more difficult to be removed with the retroperitoneal techniques, because of the limited space in the retroperitoneum. Operative times and conversion rates have been markedly reduced with increasing experience with these techniques.

Adrenal Gland Diseases↗
PubMed1996

[Impalement injury of the colon, iliac vein and sacrum--a rare combination in penetrating abdominal trauma. A case report].

We report on the treatment of a patient who sustained a penetrating abdominal wound with injury of the left common iliac vein, the sigmoid colon and the sacrum in a motorbike accident. The left iliac vein injury was treated using a Gore-Tex vein patch and an A-V fistula. The colon was restored after an intraoperative washout. The punched fragment of the sacrum was removed. An additional fracture of the proximal left humerus was managed with an osteosynthesis in a second operation. The principles of management of combined colon and vascular injuries are discussed and a short review of the literature is given.

Abdominal Injuries↗
PubMed1996

Prospective evaluation of different diagnostic techniques for the detection of liver metastases at the time of primary resection of colorectal carcinoma.

OBJECTIVE: To evaluate preoperative and operative methods of detecting liver metastases in patients undergoing primary resection for colorectal carcinoma. DESIGN: Prospective, open study. SETTING: Teaching hospital, Germany. SUBJECTS: 51 Patients with confirmed primary colorectal carcinoma. INTERVENTIONS: Computed tomography during arterial portography (CT-AP), percutaneous ultrasonography (US), operative palpation and examination of the liver, operative US, and computed tomography (CT) follow-up 6-12 months postoperatively. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive value, and accuracy. RESULTS: Overall accuracy was worst for CT during portography, because of the diagnosis of many false positive lesions. Exploration and palpation of the liver had the highest sensitivity (83%) and specificity (100%), and operative US did not give any useful additional information. CONCLUSIONS: Preoperative percutaneous US is recommended as the best non-invasive screening test; otherwise careful inspection and palpation during operation are sufficient for the evaluation of the liver during primary resection for colorectal carcinoma.

Colonic Neoplasms↗
PubMed1995

Clinical and surgical aspects of double adenoma in patients with primary hyperparathyroidism.

The incidence of double parathyroid adenoma in 277 prospectively documented patients suffering from primary hyperparathyroidism was 5.4 per cent (15 patients). Patients with double adenoma were all symptomatic and had a significantly higher parathyroid hormone (PTH) level and tumour weight than those with a solitary adenoma or four-gland hyperplasia. In 11 patients the adenomas were located bilaterally. Bilateral neck exploration must be performed routinely to deal successfully with this condition at initial operation. In six patients one enlarged gland was found in the thymus or posterior mediastinum. These locations should be explored, especially in patients with high PTH levels, in those in whom all four parathyroid glands cannot be detected or if only one small adenoma is found. In all such patients, selective resection of the enlarged parathyroid glands resulted in normocalcaemia (median follow-up 3.5 years). Selective resection of the pathological glands is the treatment of choice.

Adenoma↗
PubMed1995

Influence of ceruletid on gallbladder contraction: a possible prophylaxis of acute acalculous cholecystitis in intensive care patients?

The purpose of this study was to investigate the utility of repeated applications of ceruletid to reduce gallbladder volume and its feasibility as a means of prophylaxis of acute acalculous cholecystitis in intensive care patients. First, a dose-response curve of ceruletid was obtained in 20 mechanically ventilated patients of a surgical intensive care unit (SICU) not receiving enteral nutrition. An effective dose of ceruletid, defined by a 50% reduction of gallbladder volume was established and subsequently studied in 40 mechanically ventilated SICU patients on total parenteral nutrition in a prospective, randomized, controlled, triple-blind trial. Gallbladder volume, sludge formation and side effects were evaluated. A dose of 1.5 micrograms/kg body weight ceruletid was established as the effective dose, causing 50% reduction of gallbladder volume in all patients studied and reduction of gallbladder sludge in 95%. In 67.5% of patients side effects were observed, requiring therapeutic intervention in 68%. It is concluded that ceruletid is effective in stimulating gallbladder contraction and reducing sludge formation in severely ill patients on intensive care units. Its routine use as prophylaxis of acute acalculous cholecystitis, however, may be limited by the nature, severity and frequency of side effects.

Acute Disease↗
PubMed1994

[Routine intravenous urography before colorectal resections?].

The value of preoperative intravenous urography (IVU) to prevent iatrogenic damage to the urogenital tract was investigated in a series of 236 females and 188 males (mean age 54 [5-87] years) who underwent an operation on the colon or rectum between April 1988 and March 1992. The operations were: 101 right and 49 left hemicolectomies, 125 sigmoid resections, 74 anterior rectum resections, 58 abdomino-perineal rectum amputations and 17 total colectomies. Preoperative IVU was performed in 279 patients (65.8%), while in 145 (34.2%) urgency of the operation or intolerance to contrast medium prevented the procedure being done. The results were abnormal in 75 of the 279 IVUs (26.9%). Of the latter, only 19 (6.8%) of the abnormalities were related to the colorectal disease (renal obstruction due to tumour: 9, malignant invasion of the bladder: 5, ureter displacement: 5). Other diagnostic procedures had given abnormal results in six patients, although the preoperative IVU had been unremarkable. Iatrogenic damage to a ureter occurred in only one patient: the IVU had been normal. No ureteral damage occurred in any of the patients who had not had an IVU. These data indicate that the decisive factor in preventing intraoperative damage to a ureter is not a preoperative IVU but careful intraoperative dissection and visualization of the ureter. There is, therefore, no need for routine preoperative IVU in these cases.

Adolescent↗
PubMed1994

Parathyroid function following ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy.

A randomized controlled trial was performed to compare two techniques of bilateral subtotal thyroidectomy for non-toxic nodular goitre with regard to postoperative parathyroid function. The 50 patients in group 1 underwent ligation of the trunks of the inferior thyroid arteries. In group 2 (50 patients) the branches of these arteries were suture-ligated at the thyroid capsule. Total calcium, ionized calcium and parathyroid hormone levels were determined before operation, and 6, 24 and 72 h after surgery. Ninety-one patients were seen at follow-up 5-10 months after operation. Ten patients in group 1 and 12 in group 2 required calcium and/or vitamin D supplementation for symptomatic hypocalcaemia in the immediate postoperative period. At follow-up only one patient in each group had mild hypoparathyroidism. No statistically significant differences were found between groups regarding total calcium, ionized calcium and parathyroid hormone levels. Truncal ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy does not cause hypoparathyroidism or hypocalcaemia.

Calcium↗
PubMed1994

Pheochromocytoma: laparoscopic approach with CO2 and helium pneumoperitoneum.

A number of different surgical approaches have been devised for adrenalectomy in patients with pheochromocytoma. The anterior transabdominal approach was at one time considered a source of postoperative morbidity; the advent of laparoscopy however, may result in a resurgence in its use. The laparoscopic approach was used with a CO2 pneumoperitoneum in one patient with a left pheochromocytoma, and using a helium pneumoperitoneum in another with bilateral pheochromocytoma. The left adrenalectomy took 135 minutes to perform and the total bilateral adrenalectomy 330 minutes. No transfusion was necessary. The postoperative stay was 4 days for both patients. To prevent the risk of CO2 retention during extended laparoscopic procedures, helium can serve as an alternative gas, as was documented in the patient who underwent total adrenalectomy. Unilateral or bilateral resection of pheochromocytoma can safely be performed laparoscopically and has the advantage of avoiding both the muscular trauma related to laparotomy and the rib resection necessary for the extraperitoneal approach.

Adrenal Gland Neoplasms↗
PubMed1994

[Laparoscopic cholecystectomy in morbid obesity. Indications or contraindications?].

In early reports on the experience with laparoscopic cholecystectomy severe obesity was considered a contraindication for this procedure. The prospectively documented data of 370 consecutive patients undergoing laparoscopic cholecystectomy were analysed to investigate, whether this point of view is still justified. 35 of these 370 patients were classified as being severely obese (body-mass-index greater than 33 kg/m2). Median operation time was significantly longer in these patients than in the remaining patients (p < 0.05). In selected cases the operative technique had to be slightly modified due to extreme abdominal wall thickness. Dissection of Calot's triangle was not more difficult than in non-obese patients. There was no statistically significant difference concerning conversion rates between severely obese patients (11.4%) and the other group of patients (15.5%). Also, the number of complications was not increased in the obese patients. Since the higher complication rate in severely obese patients after conventional abdominal surgery is mainly due to the incision, laparoscopic cholecystectomy is the preferable procedure to treat symptomatic gallstone disease in these patients.

Adolescent↗
PubMed1994

[Atony of the gallbladder as a risk factor for acalculous cholecystitis. What is the effect of intensive care?].

The incidence of acute acalculous cholecystitis (AAC) is increasing and associated mortality is high. Biliary stasis and sludge formation are probably important factors in the pathogenesis of this disease. No data concerning the dynamics of these changes in the early phase of intensive care therapy are available. The gallbladders of 20 patients treated after major abdominal surgery in the surgical intensive care unit (SICU) with mechanical ventilation and without enteral feedings were therefore observed sonographically during the first 5 postoperative days in a prospective observational study. 20 patients treated on a regular ward after major abdominal surgery also not receiving any enteral nutrition served as control group. 24 hours after admission to the intensive care unit and on all subsequent days of observation the gallbladders of the patients in the SICU-group were significantly larger than in the control group. Sludge also appeared earlier and more frequently in the gallbladders of the SICU-patients. Lack of enteral feedings alone cannot explain these results. Positive-pressure ventilation and medications used in SICU are most likely responsible for the observed differences. Besides the necessity to make the diagnosis of AAC as early as possible, it appears to be worthwhile to investigate measures of prophylaxis. Since gallbladder distension in patients treated in SICU can be already observed on the first postoperative day it seems to be reasonable to initiate a regimen of prophylactic measures (e.g. with cholecystokinin or ceruletide) early in the course of ICU-therapy.

Abdomen↗
PubMed1993

[Laparoscopic adrenalectomy].

Between June and September 1993, laparoscopic adrenalectomy was indicated in five patients (three women, two men; aged 25-50 years). Three had a phaeochromocytoma, two had an adenoma (Conn's syndrome). Four of the five tumours were localized to the right adrenal gland, one to the left. Tumour diameter ranged from 3 to 5 cm. The laparoscopic procedure was successful in four of the patients (three right, one left). In the fifth case the operations had to be completed by conventional surgery, because of non-controllable haemorrhage. Duration of operation ranged between 165 and 360 min for right adrenalectomy and was 135 min for the left one. Rapid convalescence, lower dose of pain-killing drug required, short hospital stay and good cosmetic results characterized the postoperative course after the laparoscopic procedure. This technique thus opens up new perspectives for adrenal surgery.

Adrenal Gland Neoplasms↗
PubMed1993

Perioperative nonspecific histamine release: a new classification by aetiological mechanisms and evaluation of their clinical relevance.

As a consequence of the performance of a randomized controlled clinical trial on perioperative histamine release and cardiovascular and respiratory disturbances, several types of increases in plasma histamine had to be distinguished instead of only two which existed at the beginning of the study: drug-induced allergic and pseudoallergic reactions. First of all, the new classification by aetiology (clinical epidemiology) was derived from a meta-analysis (secondary analysis) of the most recent literature. According to that histamine release in the perioperative period has several, different causes and is involved in several, different disease manifestations. A clear distinction (classification), however, is necessary if histamine release as an unwanted (adverse) effect has to be recognized, value judged according to its clinical relevance and therefore also prevented by histamine antagonists. Histamine release by neuro-endocrine and neuro-inflammatory mechanisms, cytotoxic histamine release and local, cytokine induced histamine release have been distinguished from pseudoallergic histamine release, but its functions are not yet clear. It has been analysed in prospective trials which used special clinical situations as models: patients on a normal ward or before and during upper GI endoscopy without premedication, but also in specific phases of laparoscopic cholecystectomy (trocar phase and dissection phase). Their existence in the clinical reality is now very likely, but new trials must investigate the pathophysiological effects such as in metabolism, coagulation, pulmonary haemodynamics (shunt volume) and gastric acid secretion. Histamine release by pseudoallergic mechanisms, however, was identified in the very vulnerable post-induction phase of anaesthesia up to skin incision. Its incidence was much higher than ever expected and its clinical relevance was demonstrated by the severity of reactions and the intervention strategies of the anaesthetists who were blinded concerning the type of the plasma substitute given and the prophylaxis with antihistamines. Pseudoallergic histamine release was clearly unwanted (adverse). Its occurrence in the other phases of anaesthesia has to be further evaluated in the tedious procedure of data analysis of the Mainz-Marburg-trial. The overall incidence of histamine release in the trial was so incredible high (72% of all patients, some of them with up to 4 episodes of histamine release) that a distinction between pseudoallergic (unwanted) and other types of histamine release (possibly less unwanted or even beneficial) is urgently needed. In the phase of steady state (maintenance) of anaesthesia the H1-(+)H2-prophylaxis was highly effective. Further analysis must show whether this is also the case during the phases of induction of anesthesia.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1993

[Broad use of laparoscopic cholecystectomy in the teaching clinic. Experiences and results of 300 operations].

Laparoscopic cholecystectomy (LC) was integrated early in surgical training according to the concept "observe, assist and then operate under the assistance of an experienced surgeon". 300 LC's were performed by 27 different surgeons (8 board certified surgeons, 19 residents in the year 2-6 of training). 60.3% of all LC's and 73% of LC's performed for acute cholecystitis were done by residents. Our results including an overall complication rate of 5.3% shows, that LC can be performed by residents without additional complications or unacceptable length of operations, provided the threshold for conversion is low and the surgeon is assisted by an experienced laparoscopist. We therefore suggest that the early integration of LC in surgical training is justified.

Cholecystectomy↗
PubMed1992

[Cystic parathyroid gland adenomas: pathologic-anatomic variants of parathyroid gland adenomas or a separate disease entity?].

Between 01.01.1987 and 31.12.1990 a primary operation was performed on 126 patients in the Dept. of General Surgery, University of Marburg Hospital for primary hyperparathyroidism due to a parathyroid adenoma. Their clinically relevant data were prospectively documented. In 6 patients (4.8%) a total of 7 cystic parathyroid adenomas was found. While there was no difference in age- and sex-distribution, patients with cystic adenomas were found to have markedly higher serum parathormone and alkaline phosphatase levels than patients with solid adenomas. Calcium levels were similar in both groups. Cystic adenomas were much heavier than solid adenomas. A significant number of cystic adenomas was found to be displaced into the posterior mediastinum. The property of cystic parathyroid adenomas to be frequently located away from their usual anatomical position can make the intraoperative search for them difficult.

Adenoma↗
PubMed1992

Carcinoid tumors of Meckel's diverticula. Report of two cases and review of the literature.

Two cases of carcinoid tumors in Meckel's diverticula are reported. Additionally, data of 104 published cases of carcinoids in this rare location are analyzed. The average age of the patients is 56.6 years and corresponds to the age of patients with ileal carcinoids. Carcinoids in Meckel's diverticula also resemble ileal carcinoids in their biological behavior more than they do appendiceal carcinoids. Tumors larger than 5 mm have a marked risk to metastasize. By the time symptoms are present, 77 percent of these tumors have already metastasized. Men are affected by this tumor 2.5 times more often than women. Carcinoids in Meckel's diverticula metastasize twice as often in female as in male patients. More than 70 percent of carcinoids in Meckel's diverticula are found at the tips of the diverticula. An aggressive surgical management of tumors larger than 5 mm is recommended.

Adult↗