Search PubMed⌕ Search

Biomedical subjects

F Harder

Publications and source records attributed to F Harder.

At least 19 recordsLinked to original sources
PubMed1992

[Fundus plication with or without proximal selective vagotomy?].

The aim of this study was to determine the influence of proximal gastric vagotomy on the outcome after fundoplication. Of 141 patients operated on for reflux disease between 1972 and 1988, 53 had fundoplication alone (group A) and 88 fundoplication combined with proximal gastric vagotomy (group B). The two groups were similar with regard to the severity of the reflux disease (esophagitis: A 69%, B 73%) but had a different incidence of concomitant ulcer disease (A 2%, B 55%). After a mean follow-up of 9 years, 111 patients (79%) were evaluated by clinical examination and 57 patients (40%) by endoscopy. Perioperative morbidity was similar (A 22%, B 19%). Successful reflux control (A and B 81%) and overall clinical outcome (Visick I and II: A 78%, B 80%) were identical. The frequency of adverse side effects was approximately the same in both groups (dysphagia: A 28%, B 26%; gas-bloat: A 52%, B 37%). We conclude that the long term results after fundoplication are not improved by additional proximal gastric vagotomy. The combined procedure is therefore only justified if both reflux disease and ulcer disease are present.

Adolescent↗
PubMed1992

[Development of the helicopter-rescue concept in the Basel region].

1927 medical helicopter transports were performed in Basle between 1986 and 1989. Of the total flights, 173 transports without patients and 186 incubator transports were excluded from the study. Treatment and transportation were provided for 1085 victims of trauma (70.2%) and 461 medical-surgical patients (29.8%), mostly with life-threatening conditions. 589 trauma patients were treated at the scene of accident and later transported by helicopter to a nearby medical center (54.3%). The 4.3% rate of negative emergency flights is low. Since introduction of the helicopter rescue system at Basle in 1975, scene flights have increased from 29% in 1984 to 46% in 1989. 47.4% of all patients were categorized as seriously ill or severely injured. 36.4% of all patients required intubation and assisted ventilation. Of the trauma patients, 54.3% involved scene-flights requiring in-field intensive therapy. Helicopter transport provides not only a rapid source of transportation, but also vital medical assistance at the scene of emergency. Transport generally occurs only after stabilization of vital functions. These factors contribute to the low mortality before return flights (3%) as well as during transport (0.3%). We conclude that early aggressive in-field intensive therapy can help to decrease both morbidity and mortality in emergency-care patients.

Aircraft↗
PubMed1992

[Accidents with bicycles and motorcycles. The injury pattern, costs, and possibilities for prevention].

This review comprises all 641 patients subjected to inpatient treatment in 1976, 1980 and 1984 at the Basel district hospital after accidents involving bicycles or motorcycles. A study of the case histories--supplemented by phone conversations--yielded the following results: Accidents involving bicycles or motor-driven bicycles were seen in all age groups, but motorcycle accidents occurred exclusively among the younger generation. Whereas motorcycle accidents mostly happened during joyrides, accidents with bicycles or mobikes mainly occurred on the way to work. The incidence rate was highest during summertime and in the rush hours at noon or in the evening. Motorcycle accidents resulted in more severe injuries, longer hospitalisation, longer periods of disability and higher costs than bicycle or mobike accidents the latter being mainly characterised by mostly slight head injuries and the former by injuries of the legs and arms.

Adolescent↗
PubMed1992

[Prevention of thromboembolism in hip traumatology: low molecular weight heparin versus dextran].

A prospective, randomized trial has been undertaken to evaluate the prophylactic effects of low molecular weight heparin (LMWH) and dextran-70 in 216 patients with hip fracture during a postoperative period of ten days. Deep vein thrombosis (DVT) was diagnosed using the 125Iodine fibrinogen uptake test, confirmed by ascending venography. 113 patients received LMWH and 103 dextran-70. The frequency of DTV of 14.2% in the LMWH group was significantly lower compared with the 30.1% in the dextran group (p less than 0.003). During the first 10 days postoperative there were no fatal pulmonary embolism (PE). After this period PE occurred in 2 patients (1.8%) in the LMWH group and 1 patient (1.0%) in the dextran group. In each group one patient died from PE. There was no major bleeding in either group. The frequency of local complications was slightly higher in the dextran group (10.7%) compared with the LMWH group (3.5%). The postoperative hemoglobin level was significantly lower in dextran treated patients than in patients receiving LMWH (p less than 0.0001).

Adult↗
PubMed1992

[Meckel's diverticulum: surgical complications].

A 20-year (1971-1990) retrospective follow-up of all patients with a Meckel diverticulum (MD) out of the Kantonsspital and St. Claraspital Basel is reported. There were 57 men and 34 women with a mean age of 46.7 years (14-89). 60.4% of the cases were occasional findings, 39.6% were symptomatic MD. During the same period of time 5000 appendectomies were performed (ratio diverticulectomy to appendectomy was 1:50). 38.5% of the resections of MD were done when an acute appendicitis was supposed. In one third of the cases the MD was responsible for the symptomatology. Histological findings were 13% unspecific inflammation, 10% perforation, 9.8% ectopic tissue, 6.5% bleeding and 4.3% tumors. 8 out of 36 patients with pathological findings showed postoperative complications (21.6%), the mortality rate was 8.1%. In 55% resected MD without any additional histological findings only one complication (postoperative ileus) (1.9%) was found; mortality was zero per cent. The analysis of these data shows that complications of MD does not only appear in young patients. Complications occur more often in patients with MD with additional ectopy. We recommend the resection of an incidentally discovered Meckel diverticulum.

Abdomen, Acute↗
PubMed1992

[Breast saving treatment of breast cancer: 10 questionable aspects].

Conservative treatment of breast cancer includes all those techniques by which a sizable amount of the gland is left behind after tumor resection, where the axilla is partially cleared and radiotherapy follows surgery. Thus, the subcutaneous mastectomy as a means of treating breast cancer does not fall into this category. Conservative treatment of breast cancer is a well-established technique as long as some basic principles concerning indication, technical details and general therapeutic plans are respected. Among many questions that have arisen from this kind of treatment, 10 are discussed. Among those is the fact of leaving behind vital carcinoma cells within breast tissue, the question of radiation-induced malignant tumours and other radiation sequelae, advantages and drawbacks of a simultaneous combination of radio- und chemotherapy, the quality of life, questions of follow-up and especially technical aspects in relation to the more radical quadrant resection or the cosmetically more advantageous tumorectomy. Considering all these aspects and open questions, conservative treatment of breast cancer has nevertheless to be regarded as the treatment of choice, at least for T1-lesions, as long as some clearly defined conditions are fulfilled. The aim of this multimodality treatment must be to achieve a cosmetic result better than that to be expected by reconstructive surgery after amputation of the breast, as long as the same survival figures can be obtained as after amputation.

Breast Neoplasms↗
PubMed1992

[Diagnostic problems in local recurrence after breast saving treatment].

353 patients with stages pTis, pT1-2, pN0-1, cM0 breast cancer have been treated consecutively by breast conserving therapy in a prospective, nonrandomized study at the University Hospital Basel and the Women's Clinic Rheinfelden/Baden/Germany. The median age was 47 years, the median follow-up time 67 months, and 4% only of this collective were lost to follow-up after a median time of 42 months. In 79% of the cases the tumor was excised totally, while in 19% the resection margins were positive and in 2% only the margins were not available for histological judgement. The rate of local failure reached 8% with a median time interval of 53 months. 116 patients showed postactinic induration in the primary tumor region. 73 of these were given additional diagnostic examination: The postactinic induration was judget clinically suspicious in 51 cases and clinically nonsuspicious of local failure in 22 cases. All 73 patients received additional examination by mammography and biopsy. By comparison with the histological results the clinical results were correct in 59% and false in 41%, while the mammographic results were correct in 82% and false in 18% of the cases.

Biopsy↗
PubMed1992

[Emergency surgery of a case of perforated gastroduodenal ulcer].

Surgical treatment of acute perforated gastric and duodenal ulcer is connected to high postoperative lethality. By emergency procedure it has to be decided between performing a simple closure or performing initially a definitive operation to control the peptic disease. The therapeutic options at our institution are based on a severity score which includes patient's age, associated pathology, grade of the peritonitis, delay between the onset of symptom and surgery, history of ulcer disease. Charts of 90 patients consecutively operated during 6 years for acute perforated ulcer were analysed. The average age was 65.5 years, the operation was performed within 6 h in 47.3% of the patients. To perform or not a definitive operation is an important therapeutic option as by simple closure 45% recurrence is observed with a lethality of 36%. Based on our scoring system, 87.9% of all the patients underwent definitive operation. The lethality rate of this series of nonselected patients (52% were older than 70 years) was low: 6.3%. The use of the severity score help to choose patients to be treated by simple closure and patients which may be submitted to definitive emergency operation with low operative risk.

Adult↗
PubMed1991

[Artificial nutrition in surgery: status, current problems and perspectives].

Parenteral and enteral nutrition are safe and efficacious substitutes of normal oral intake even for prolonged periods of time and offer adequate treatment of protein-calorie malnutrition and effective palliation of cancer cachexia. Perioperative nutritional support reduces operative morbidity and mortality in malnourished patients. Furthermore, parenteral and enteral nutrition are an effective primary treatment for acute inflammatory bowel disease, short bowel syndrome and small bowel fistulae. Enteral nutrients specifically support structure and function of both the intestinal mucosa and the mucosa-associated lymphatic tissues: Recent clinical data emphasize the need to feed enterally whenever possible, especially in critically ill patients. Continuing efforts to include new substrates and to create more balanced and disease-adapted solutions of parenteral and enteral nutrition will improve the available systems. In addition, parenteral and enteral nutrition as a component of new complex treatment modalities including growth factors and cytokines will improve treatment and patient care in general surgery, oncology and traumatology.

Diet↗
PubMed1991

[Surgical significance of intestinal non-rotation in adults].

Intestinal non-rotation has been recognized as a cause of obstruction in neonates and children. It is very rarely seen in the adult and assumes surgical significance owing to the potential risk of midgut or ileocecal volvulus. However, it can also cause significant intermittent abdominal pain in the adult. We describe six personally observed patients with this malformation and analyze 38 case reports published in the English and German literature since 1923. We establish that in the acute symptomatic form only emergency laparotomy can provide the correct diagnosis and decrease the risk of bowel disturbance. In the chronic forms, barium studies of the whole intestinal tract reveal varying degrees of midgut malrotation and the non-rotation is confirmed in each case. Also in these forms, exploratory laparotomy with a consequent staging of the abdominal situs is to be recommended. In the operation described by Ladd the ascending colon is sutured at the colon descendens and sigmoideum. After this procedure the mesenterial pedicle is fixed and the risk of midgut torsion remains minimal. All reported cases after surgery are symptom-free.

Abdominal Pain↗
PubMed1991

[Results of the surgical treatment of gastroduodenal hemorrhage].

383 operations for peptic ulcer were performed between 1984 and 1989. There were 114 operations for hemorrhage. The average age of patients was 65 years (21 to 90). 93% of our patients underwent preoperative endoscopy. 52.6% underwent emergency surgery whereas 47.4% had early elective operation. 91.1% of all patients underwent surgery with curative intention for peptic disease in the form of a highly selective vagotomy or partial gastrectomy. The overall mortality rate of 13.2% was influenced by age (less than 70 years: 6.5% / greater than 70 years: 20.4%), by localization of ulcer (stomach: 7%/duodenum: 16%), by time of operation (emergency: 22%/early elective: 6.3%) and by number of blood transfusions (less than 5 units: 7.7% / greater than 5 units: 21%). We conclude that bleeding gastroduodenal ulcers remain a significant complication of peptic ulcer disease. Only a multidisciplinary approach to gastroduodenal hemorrhage, including stabilization of vital functions, endoscopic hemostasis and early elective operation, will contribute to a reduction of mortality.

Adult↗
PubMed1991

Role of cholecystokinin in the regulation of gastric emptying and pancreatic enzyme secretion in humans. Studies with the cholecystokinin-receptor antagonist loxiglumide.

The role of cholecystokinin (CCK) in the regulation of gastric emptying and pancreatic enzyme secretion was evaluated by infusing the CCK-receptor antagonist loxiglumide. Gastric emptying rates and pancreatic secretory outputs were measured in five healthy volunteers by the double-indicator perfusion technique using a multiple-lumen tube in the duodenum. Placebo or loxiglumide (22 mumol.kg-1.h-1) was infused throughout each experiment. Five hundred-milliliter liquid intragastric meals of (a) fat, protein, and glucose (Ensure; Abbott, Chicago, IL); (b) glucose, 20 g/dL; and (c) guar gum, 1.1 g/dL, were given in random order. In addition, the effect of a physiologic CCK-8 dose (20 pmol.kg-1.h-1) after an intragastric 500-mL saline meal (0.154 mol/L) was tested. Intravenous CCK-8 induced a marked retardation of the gastric emptying rate of the saline solution (P less than 0.05) while stimulating pancreatic secretory outputs; both effects were completely abolished by the infusion of loxiglumide. Loxiglumide markedly accelerated the gastric emptying rates (by approximately 40%) and simultaneously diminished lipase (by approximately 75%) and trypsin (by approximately 50%) outputs of both the mixed meal (P less than 0.01) and the pure glucose meal (P less than 0.05). Additional experiments using gamma camera scintigraphy confirmed the accelerating effect of loxiglumide on gastric emptying of the mixed meal (P less than 0.01). The gastric emptying rate of the guar meal, which did not release CCK, was not influenced by the infusion of loxiglumide. Loxiglumide distinctly augmented plasma CCK levels after the mixed (2.6 times) and the pure glucose (2.1 times) meals while markedly reducing (approximately 76%) pancreatic polypeptide release (P less than 0.02). It is concluded that endogeneous CCK exerts a major role in the regulation of both gastric liquid emptying and pancreatic secretion in humans.

Adult↗
PubMed1991

[Accidents involving bicycles: pattern of injuries and costs in relation to type of vehicle].

This review comprises all 641 patients subjected to inpatient treatment in 1976, 1980 and 1984 at the Basel university hospital after accidents involving bicycles or motorcycles. A study of the case histories--supplemented by 'phone conversations--yielded the following results: Accidents involving bicycles or motordriven bicycles were seen in all age groups, but motorcycle accidents occurred exclusively among the younger generation. Whereas motorcycle accidents mostly happened during joyrides, accidents with bicycles or mobikes mainly occurred on the way to work. The incidence rate was highest during summertime and in the rush hours at noon or in the evening. Motorcycle accidents resulted in more severe injuries, longer hospitalisation, longer periods of disability and higher costs than bicycle or mobike accidents the latter being mainly characterised by mostly slight head injuries and the former by injuries of the legs and arms.

Accidents, Traffic↗
PubMed1991

[How much subspecialty does the general surgeon need?].

In this context general surgery is that which is practised in peripheral hospitals. Specialisation in a broad spectrum of current problems is needed. Knowledge in subspecialties clearly depends on hospital categories. After a 4-year basic block in general surgery a curriculum for the surgeon in peripheral hospitals is needed. It has to differ from a more narrow but highly specialized curriculum for academic and central hospitals.

Curriculum↗
PubMed1991

[Is cecostomy still current for emergency relief of the colon?].

The policy of treatment in patients with acute obstruction of the left colon remains controversial. One-stage emergency colectomy and primary anastomosis is usually recommended. Is a multiple-stage approach with primary blowhole cecostomy still a valuable solution? This retrospective analysis of 117 patients with emergency cecostomies shows an overall perioperative mortality and morbidity which are favourable compared with those reported in series of similar cases treated by one-stage procedures. In all patients the colon obstruction was treated effectively by the cecostomy. Only two of the stoma-related complications required operative intervention. The second operation was performed after a mean interval of 12 days. The low perioperative mortality of 2.1% shows, that the time was successfully used to optimize the perioperative conditions. It is concluded that patients with a very poor risk may profit by preliminary decompression by blowhole cecostomy.

Aged↗