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Biomedical subjects

F Harder

Publications and source records attributed to F Harder.

At least 55 records · Page 3Linked to original sources
PubMed1998

[Hyperthyroidism and thyroid carcinoma--coincidence or association?].

In a series of 617 patients undergoing thyroidectomy, 86 cases (13.9%) were identified as having hyperthyroidism. Forty-nine out of these 86 patients suffered from Graves disease. Histopathologic evaluation revealed a low grade papillary thyroid carcinoma in two out of the 86 specimens from the hyperthyroid patients. Therefore, the incidence of malignancy among all our patients with hyperthyroidism is 2.3% and among those with Graves disease is 4.1%. Patients with hyperthyroidism and concurrent nodular or diffuse goiter are at possible risk for thyroid carcinoma. The indication for surgical resection is given in these cases where the success of thyroistatic treatment is low and where patients are at higher risk for thyroid malignancy. In a short review of the literature, we discuss the coincidence of the two pathologic entities and their possible association.

Carcinoma, Papillary↗
PubMed1998

[Mesh-plug operation: a simple, rapid and complication-free technique for managing inguinal hernia].

INTRODUCTION: The optimal inguinal hernia repair technique is a matter of debate. The Shouldice operation has long been regarded as the gold standard. While specialized hernia clinics have reproduced good results, a recurrence rate for trainees and non-specialized surgeons of between 10% and 15% seems to be more common. Laparoscopic hernia surgery has brought decreasing postoperative morbidity, low post-operative disability and early return to work. These advantages of a tension-free technique are due to the use of a prosthetic mesh. It is largely the efforts of Gilbert, Lichtenstein and Rutkow/Robbins which have popularized the use of prosthetic mesh by an open anterior approach in the USA. METHODS: Since January 1997 we have prospectively evaluated the open mesh plug repair described by Rutkow/Robbins in Basel and Lugano. We have operated on 110 patients (103 male, 7 female). All patients were interviewed 4 weeks postoperatively at our clinic. RESULTS: There were no major complications. Two patients underwent reoperation for drainage of a haematoma. There was no early recurrence or infection. After 4 weeks 82% of all patients were back to normal activity. An early return to work has been noted (10 days on average for sedentary workers). CONCLUSION: The main advantages of this technique are simplicity, low cost, reduced post-operative disability and early return to work. It is much too early to say anything concerning recurrence in this series.

Adult↗
PubMed1998

[Reflux disease: laparoscopic treatment].

Laparoscopic surgery offers the patient the advantages of a minimally-invasive surgery for the treatment of gastroesophageal reflux disease. With appropriate training the safe application of the laparoscopic fundoplication is achieved. Our experience with 46 laparoscopic fundoplications is favorable. The indications for surgery for patients with esophageal reflux disease remain unchanged and should not be extended. However, the good results should facilitate the decision for surgery. Several comparative studies show the safe application of laparoscopic techniques in the surgical treatment of gastroesophageal reflux disease.

Adult↗
PubMed1998

[The Advanced Breast Biopsy Instrumentation (ABBI), a system for stereotactic excision of mammographically suspect nonpalpable findings in the breast].

Advanced Breast Biopsy Instrumentation (ABBI) allows radiologically guided stereotactic excision of non-palpable radiodense lesions with high accuracy. Tissue cylinders of 5, 10, 15 or 20 mm diameter and of variable lengths can be removed very accurately under local anaesthesia and on an outpatient basis. Thirty-six patients with suspicious clusters of microcalcifications (n = 29) and with round lesions (n = 7) of the breast were qualified for ABBI. We were able to perform the excisional biopsy in a total of 34 patients. The breast of one woman was too small to safely fit into the system and in another woman the lesion could not be visualized by the system. In 2/34 cases (6%), the excision was imprecise due to slight dislocation of the breast parenchyma by the advancing cylinder knife. In one case (3%), ABBI missed the target within a dense mastopathic breast. In all cases the excisions were well tolerated. No wound complications occurred and the cosmetic result was excellent. Histology revealed 28 benign (82%) and 6 malignant (18%) lesions. Among the 27 small microcalcifications there were 3 invasive carcinomas, 3 ductal carcinomas in situ (DCIS), 1 lobular hyperplasia, 14 mastopathies, 1 fibroadenoma, 1 duct papilloma and 4 calcifications in scars. Four of the 7 round-shaped lesions were found to be fibroadenomas, 1 lobular hyperplasia, and 2 mastopathies. With the ABBI system, non-palpable breast lesions can be precisely localized and excised.

Adult↗
PubMed1998

Endoscopic surgery to the axilla--a substitute for conventional axillary clearance?

Nonpalpable, mammographically detected breast cancers are on the increase. The percentage of patients with histologically involved nodes is therefore decreasing. Axillary clearance aims at reducing the probability of later clinical involvement of the axilla and at establishing a sound basis for adjuvant treatment planning. Minimally invasive techniques have been applied to a growing number of surgical procedures now including exploration of the axilla. The technique used and results achieved in a series of 50 consecutive patients treated by liposuction and axilloscopy by one single surgeon, including all the patients from the very first attempt, are presented here. Patients were excluded with palpable lymph nodes or a primary tumor in the direct vicinity of the axilla that could be injured by the liposuction canula. The average number of lymph nodes removed was 13.4. Thirty-four percent of patients had involved nodes. The mean number of involved nodes in these patients was 3.1. After a median follow-up time of only 15 months no axillary recurrences or trocar site metastases have been found in the first 40 patients. Using a self-assessment questionnaire, the patients rate this technique as excellent. There was no lymphedema. The cosmetic result is certainly better than after conventional axillary clearance. Great experience of laparoscopic surgery and an excellent knowledge of the axillary anatomy are prerequisites for the practice of axilloscopic treatment of the axilla. The working space within the axilla is small and a number of structures need absolutely to be preserved. A longer follow-up period than the one so far achieved in this series or any other in the literature to date is necessary before this technique can be generally recommended.

Axilla↗
PubMed1998

Pelvic floor herniation after modified York-Mason approach to the rectum: report of a case.

The York-Mason approach to the rectum with resection of the coccyx provides an excellent exposure for the treatment of large villous adenomas and low-risk rectal cancers. Morbidity related to this operation primarily arises as local infection (septic pelvis, fistulation), chronic coccygeal pain, and fecal incontinence. This is the first report to describe a pelvic floor herniation two years after a York-Mason approach to the rectum.

Aged↗
PubMed1998

[Hemorrhagic pseudocysts and pseudoaneurysms in pancreatitis. Diagnosis and therapy].

Acute hemorrhage from pseudocysts and pseudoaneurysms is a threatening complication of chronic pancreatitis. Whilst surgical intervention still has high perioperative mortality (16.8%), transcatheter arterial embolization is becoming more frequently used for suitable cases and appears to have lower mortality (6.1%). We report on six patients treated in our unit. Four of them underwent primary surgical treatment, the other two were treated by embolisation. One of the latter patients subsequently required laparotomy for further treatment. All six patients survived. Comparing the literature covering the periods between 1951 and 1981 and between 1982 and 1996, transcatheter embolisation seems to be valuable in controlling this type of bleeding, thereby reducing mortality.

Adult↗
PubMed1998

[Open antireflux surgery].

In over 80% of patients with gastroesophageal reflux disease, the Nissen antireflux fundoplication gives good long-term results. Dysphagia, inability to belch or vomit as well as the gas bloat syndrome are possible sequelae after fundoplication. The frequency of these symptoms could be reduced by modification of the original Nissen-Rossetti fundoplication into the so-called "floppy" Nissen fundoplication, a short and loose wrap of mobilized gastric fundus. Failures of the antireflux procedure are mainly due to disruption or displacement of the wrap with the telescope phenomenon. Here, reoperation with refashioning of the original wrap may lead to same functional results like a primary fundoplication. Technical alternatives may selectively be chosen, when gastroesophageal reflux disease is complicated by fixated hiatal hernia, esophageal shortening, or serious esophageal motility disorders. Such specific anatomic or functional abnormalities are detected by preoperative endoscopy, barium swallow, 24-h pH monitoring, and manometry. Alternative techniques are mainly transthoracic repairs, including the Nissen fundoplication, Collis gastroplasty, and the Belsey Mark IV. Modifications of the 360 degrees Nissen operation are partial fundoplications like the Hill repair and the Toupet dorsal fundoplication. Because of a high failure rate in the long-term follow-up, application of the ligamentum teres cardiopexy and of the Angelchik prosthesis is not recommended.

Follow-Up Studies↗
PubMed1998

[A new anal retractor for hand-sutured colo-anal anastomoses].

The hand-sutured coloanal anastomosis requires adequate and atraumatic exposure of the anal canal in order to avoid sphincter damage. We evaluated a new modified anal retractor to improve exposure of the anal canal and thread handling during construction of hand-sutured coloanal anastomosis. This new device was used during all coloanal and transperineal procedures performed in 1997 in our hospital. This new device is safe and extremely comfortable for the surgeon. It speeds up the procedure and keeps sutures out of the way when completing a coloanal anastomosis.

Anal Canal↗
PubMed1998

Clinical results using the trochanter stabilizing plate (TSP): the modular extension of the dynamic hip screw (DHS) for internal fixation of selected unstable intertrochanteric fractures.

OBJECTIVE: To evaluate whether the implantation of the modular trochanter stabilizing plate (TSP) in addition to the dynamic hip screw (DHS) prevents excessive telescoping and limb shortening in four-part and selected three-part trochanteric fractures. DESIGN: Prospective clinical study. SETTING: The study was conducted at the trauma unit of the Surgical Department of the University of Basel, Switzerland. PATIENTS: Forty-six consecutive patients with unstable intertrochanteric fractures were treated with an additional TSP super-imposed on the regular DHS at our institution between July 1991 and July 1993. Five patients died before the first follow-up, one patient was lost to follow-up, and another patient refused follow-up. Thus, thirty-nine patients were followed for at least twelve months (mean 14 months, range 12 to 20 months). INTERVENTION: The fractures treated were classified according to the OTA classification, which is based on the AO classification. Seventeen were 31-A2.2, seven were 31-A2.3, and fourteen were 31-A3.3 fractures. RESULTS: Lateralization of the greater trochanter was successfully prevented in all fractures. Limited fracture impaction was found in 90 percent (n = 35) of the patients with telescoping of 9.5 millimeters (range 0 to 30 millimeters), resulting in mean limb shortening of 5.37 millimeters (range 0 to 14.9 millimeters). Four patients suffered limb shortening exceeding fifteen millimeters (range 15.6 to 21.3 millimeters). Functional results were excellent and good in 87 percent of patients and fair in 13 percent according to the Salvati-Wilson score. All fractures had healed six months after the operation. Three complications required a secondary procedure: one from not inserting a second screw parallel to the gliding hip screw to prevent rotation of the head-neck fragment ("antirotation screw"), one because of deep infection, and one because of a refracture after premature implant removal. CONCLUSION: In unstable pertrochanteric fractures with small or missing lateral cortical buttress, the addition of a TSP to the DHS effectively supports the unstable greater trochanter fragment and can prevent rotation of the head-neck fragment. Excessive fracture impaction and consecutive limb shortening was prevented by this additional implant in 90 percent of these patients.

Adult↗
PubMed1998

[Endoscopic axilla dissection in invasive breast carcinoma. Initial experiences with a new technique].

The presence or absence of involved axillary lymph nodes is the single best predictor of survival of breast cancer, and important treatment decisions are based on it. For staging purpose as well as for local control a level I and II dissection is recommended. In order to lower the morbidity of axillary lymph node dissection less invasive treatment modalities have been evaluated. Beside the sentinel lymph node biopsy another new method is discussed: the endoscopic axillary lymph node dissection. After liposuction of the axillary fat the lymph nodes of level I and II are removed by endoscopy. With this technique enough lymph node can be removed which allows a sufficient staging as well as local control. This technique is not to be recommended for general use unless long term results have proven its value.

Axilla↗
PubMed1998

[B7 costimulation molecules improve induction of tumor specific cytotoxic T-cells against MART-1(27-35)].

The expression of B7-1/2 molecules in addition to TAA in APC significantly improves the generation of specific CTL in vitro. Moreover, human fibroblasts, usually devoid of APC capacity, can be engineered into effective APC upon infection with recVV encoding costimulatory molecules together with specific epitopes. The generation of artificial APC by infection of non professional APC with appropriately engineered recVV is a new concept that may be useful in the implementation of immunotherapy strategies.

Antigens, CD↗
PubMed1998

[Recombinant vaccinia viruses as efficient vectors of biologically active, human B7 costimulation molecules].

A specific antigenic ligand and a costimulatory signal are required for optimal T cell activation. We constructed and tested recombinant Vaccinia viruses (recVV) expressing hB7-1 or hB7-2 as a gene expression vector system for delivery of costimulatory function in vitro. Upon infection with replication incompetent and non-cytopathic recVV B7, all human tumour cell lines tested expressed the recombinant molecules. Cell lines expressing recombinant B7 molecules provided effective costimulation for proliferation of resting CD4+ T helper cells in the presence of suboptimal PMA concentrations. The costimulatory effect could be blocked with soluble CTLA-4 proteins. RecVV B7-1 infected EBV transformed B-lymphocytes overexpressed the costimulatory molecules resulting in enhanced costimulation. The capacity of these cells to stimulate autologous CD4+ memory cells of VV immunocompetent donors was not impared by the recVV infection indicating an intact capacity for processing and presenting antigenic proteins in the context with MHC Class II molecules remained. RecVV encoding human B7 molecules therefore appear to be promising experimental and clinical tools to enhance immune responses.

B-Lymphocytes↗
PubMed1998

[Reflux disease: "laparoscopic therapy"].

Laparoscopic surgery offers the patient the advantages of minimally-invasive surgery for the treatment of gastroesophageal reflux disease. Our experience with 46 laparoscopic fundoplications is favorable. The indications for surgery for patients with esophageal reflux disease remain unchanged and should not be extended. However, the good results should facilitate the decision for surgery. Several comparative studies show the safe application of laparoscopic techniques in the surgical treatment of gastroesophageal reflux disease.

Adult↗
PubMed1998

[Ileo-cecal segment as stomach substitute].

In clinical practice a long Roux-en-Y reconstruction is most often used for gastric replacement. Among various postgastrectomy symptoms, alcaline reflux is the most disturbing. A great variety of different pouch reconstructions with or without duodenal bypass only control reflux in part. The ileocoecal interposition has been placed between the oesophagus and the duodenum as a gastric substitute in 14 patients without postoperative mortality. This preliminary series demonstrates an excellent control of alcaline reflux and a good quality of life, according to the Eypasch score. Dysphagia or stasis in the distal oesophagus are absent as is gas bloating. This type of reconstruction, which is simpler than some of the pouch reconstructions, probably deserves more attention and may perhaps be perfected by varying the length of ileum and volume of ascending colon to be interposed.

Cecum↗
PubMed1998

[Initial experiences with the Advanced Breast Biopsy Instrumentation (ABBI), a system for stereotactic excision of non-palpable breast lesions].

The advanced breast biopsy instrumentation (ABBI) allows the radiologically guided stereotactic excision of non-palpable radiodense lesions with high accuracy. Forty-six patients with suspicious clusters of microcalcifications (n = 37) and with round lesions (n = 9) of the breast were investigated using the ABBI. Tissue cylinders were successfully removed in 98% of cases. No wound complications occurred and cosmesis was excellent. Histopathology revealed 35 benign (76%) and 11 malignant (24%) lesions. With the ABBI system, non-palpable breast lesions can be precisely localized and excised.

Adult↗
PubMed1997

Functional and morphological outcome of knee joint transplantation in dogs depends on control of rejection.

BACKGROUND: The reconstruction of massive osteochondral defects extending to weight-bearing joints remains a surgical challenge. Total knee joint transplantation has been performed experimentally, but these studies lacked prospective evaluation of functional outcome, graft vascularization, and graft viability. METHODS: Replantation and transplantation of vascularized knee joints was performed in dogs (n=4 per group), comparing functional and morphological results during a 6-month follow-up. RESULTS: All replant recipients and three transplant recipients survived the 6-month follow-up period. At this time, duplex sonography and angiography revealed patent anastomoses in all animals. Increases in volumetric flow rates and vascular collateralization were observed in allografts, as compared with replanted joints (100+/-16 ml/min vs. 31+/-15 ml/min at 6 months after transplantation). Bone fusion at the graft-host interface was verified by fluorography in all animals at 3 months after transplantation. Six months after transplantation, microradiographies and computerized tomographies revealed spongialization of the cortical bone and filling of the medullary space by trabecular bone in transplanted joints. Such alterations were not detectable in replanted joints. Chondrocyte viability exceeded 80% in all but one transplanted joint. Lymphocyte infiltration of synovia and arterial walls was detected in all transplanted joints, suggesting the presence of chronic rejection. Weight-bearing capacity recovered in all replanted animals (weight-bearing index before transplantation: 0.499+/-0.080; 6 months after transplantation: 0.38+/-0.16) but only in two of four transplanted animals (weight-bearing index 6 months after transplantation: 0.37, 0.28, and 0.00). CONCLUSIONS: These data demonstrate the potential of joint grafting and the critical dependence of allotransplantation on the control of rejection.

Angiography↗