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Biomedical subjects

F Harder

Publications and source records attributed to F Harder.

At least 199 records · Page 11Linked to original sources
PubMed1989

[Paraesophageal hiatal hernia--risks and surgical indications].

During a 25-year period, 40 patients with paraoesophageal hiatus hernia were operated on by narrowing of the hiatus and gastropexy. The main symptoms were: epigastric pain (40%), reflux symptoms (25%), cardiac symptoms (20%), dysphagia (20%) and dyspnea (8%). Six patients were free of symptoms. Anaemia was present in 33%, gastric ulcer in 15%. Six patients (18%) had to be operated on as emergencies because of gastric ulcer complications in 4 (3 perforations, 1 severe bleeding) and incarceration in 2 patients. Considering the important risk of acute complications in paraoesophageal hernia an elective gastropexy seems generally advisible--also in patients with few or no symptoms, provided there are no contraindications.

Adult↗
PubMed1988

[Loco-regional recurrence following surgery of breast carcinoma: prognostic factors and therapeutic consequences].

The course following local relapse after mastectomy was studied prospectively in 225 women. Factors significantly influencing the further course were determined. On the whole the prognosis was relatively good, with a projected 5-year relapse-free survival of 47%, a median time interval of 53 months until development of distant metastases, and an estimated death rate of 41% after 5 years. The most important factor influencing the incidence and time interval until appearance of distant metastases is the axillary lymph node status at the time of mastectomy. N0 patients have a much better prognosis than N+ patients in univariate as well as multivariate analysis. Other factors in univariate analysis which play a role in either the incidence of distant metastases or overall survival include estrogen receptor content, site of the local relapse (skin or regional lymph nodes), time interval between mastectomy and the occurrence of the local relapse, and number of tumor nodules in the local relapse. In multivariate analysis virtually the only really independent prognostic factors are primarily the initial axillary lymph node status for survival free of distant metastases and the time interval from mastectomy to local relapse for overall survival.

Breast Neoplasms↗
PubMed1988

[Long-term results following fundus plication. Symptoms after 10 to 20 years].

10 to 20 years (median 15.1 years) after fundoplication for primary reflux disease, 257 patients were asked to complete a questionnaire concerning their symptoms. Data of 163 patients (64.3%) were analyzed. Results were as follows: 21.4% of the patients had persistent or recurrent reflux symptoms, about half (9.8%) needing medical treatment. Adverse side effects of fundoplication were frequent (dysphagia in 28.2% and gas-bloat in 50.3%). Using the Visick classification criteria we found Visick grade I and II in 75.5%, grade III in 17.2%, and IV in 7.4%.

Follow-Up Studies↗
PubMed1988

Absorption of protein in the early postoperative period in chronic conscious dogs.

Postoperative alterations in amino acid exchange across the intestinal tract and in the capacity for protein absorption were investigated in a chronic canine model. Changes in postoperative splanchnic amino acid exchange consisted of a temporary decrease of total splanchnic amino acid release, including a significant reduction in alanine production, and an increase in glutamine consumption. Contrary to results under stable metabolic conditions, branched chain amino acids were also taken up by the intestine in the early postoperative period. The changes in postoperative amino acid exchange were not, however, reflected by a corresponding alteration in protein transport capacity. The absorptive capacity for a protein hydrolysate remained stable during the early postoperative period.

Amino Acids↗
PubMed1988

Venous mesenteric infarction: a particular entity.

Ninety-eight patients with documented mesenteric infarction during a 19-year period were reviewed. In 13 patients infarction was due to a mesenteric venous thrombosis (MVT). Patients with MVT distinguished themselves from those having another aetiology by: (1) longer history of pain before admission (median 8 days, P less than 0.0001); (2) typical appearance of the bowel at laparotomy (10/13); (3) a localized segment of ischaemic jejunum or ileum of less than 120 cm in length (12/13) allowing better operability at the first laparotomy (P = 0.006). In hospital the mortality was lower for venous mesenteric infarction (5/13, 38 per cent) than for mesenteric infarction of other aetiologies (70/85, 82 per cent) (P = 0.002). Patients with primary venous mesenteric infarction showed a better survival rate (one death in eight patients) than patients with associated diseases such as liver cirrhosis, sepsis or previous operation who had a poor prognosis with a mortality comparable to other aetiologies of acute bowel ischaemia (four deaths in five patients). Since the high recurrence rate of this disease in the early postoperative period was due to residual venous thrombosis and to a hypercoagulable state, a wide bowel resection is recommended followed by early and long-term anticoagulation. Thrombectomy is probably inefficient since it removes only centrally located thrombi and leaves peripheral occlusion, which is responsible for the recurrence.

Adult↗
PubMed1988

Single-layer end-on continuous suture of colonic anastomoses.

The single-layer end-on continuous suture technique for intestinal anastomoses on mobile intraperitoneal bowel segments is at least as safe and probably safer than a corresponding single-layer interrupted suture technique. Although the evaluation of this technique included a substantial number of surgeons who were performing their first anastomosis or who contributed only a single one to the series in a teaching university setting, there were no instances of clinical leak among 143 consecutive colonic anastomoses. Furthermore, 27 percent of the operations were performed as emergencies, thus optimal bowel preparation was lacking. The anastomosis time is distinctly shorter than the time needed for an interrupted single-layer technique, and contamination of the operative field is reduced to a minimum. The anastomosis is extremely simple, comfortable to perform, and reliable.

Anastomosis, Surgical↗
PubMed1988

[Progress in the treatment of inguinal hernia].

Modified Bassini's procedure until recently used to be the optional surgical approach to inguinal hernia at the authors' hospital. A ten-year retrospective study was conducted into 1,687 patients. Contact was actually established with 1,037 of them. Of these 762 returned a questionnaire sent to them, and 345 were available for clinical follow-up checks. These clinical examinations revealed a rate of recurrence of 7.2 per cent, following primary surgery. We have, therefore, changed our approach and have adopted a modified Shouldice procedure.

Female↗
PubMed1987

Treatment of mesenteric infarction.

Eighty-one cases of mesenteric infarction documented by angiography, laparotomy or autopsy were reviewed to assess the cause of the persistently high mortality. Thirty-seven patients (46 per cent) were felt to have inoperable lesions and were treated by supportive care only, while forty-four (54 per cent) underwent bowel resection and/or revascularization. Of these 44 patients 20 (45 per cent) survived, 14 (32 per cent) died of an early recurrence of infarction and 10 (23 per cent) died of an unrelated cause. In view of the high recurrence rate in the early postoperative period, treatment must prevent the causes of persistent or recurrent ischaemia such as vasoconstriction and reperfusion tissue damage. On the basis of recent clinical and experimental research we suggest that treatment should include routine angiography with selective perfusion of vasodilators through the superior mesenteric artery, pharmacological prevention of ischaemic and reperfusion tissue damage before surgery, and postoperative anticoagulation.

Adult↗
PubMed1987

[Hiatal hernia and reflux disease--long-term results following fundoplication and consequences in therapeutic failures].

UNLABELLED: 10 to 20 years (median 15.1 years) after fundoplication for primary reflux disease 257 patients were questioned about their symptoms. Data of 163 patients could be analyzed. RESULTS: 21.4% of the patients have persistent or recurrent reflux symptoms, about half of them (9.8%) need medical treatment. Adverse side-effects of the fundoplication are frequent: dysphagia in 28.2%, gas-bloat in 50.3%. Using the Visick criteria for classification we found Visick grade I and II for 75.5%, grade III for 17.2%, and IV for 7.4%. Diagnostic and therapeutic concepts in case of failed reflux control are discussed.

Esophagogastric Junction↗
PubMed1987

[Value of subtotal stomach resection in stomach cancer].

The controversy about the extent of resection of gastric cancer has been lasting for decennies. The extreme viewpoints may have become less divergent recently although controlled data are still lacking. As gastrectomy has generally become safer, a somewhat broader indication for it is justified. Subtotal resection is still justified for cancer of the antrum of the intestinal type (Laurén-classification) without evidently involved distant nodes and as long as a clear margin can be expected, furthermore in some advanced disease situations and finally in high risk patients, especially with severe cardiopulmonary handicaps.

Gastrectomy↗