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Biomedical subjects

F Harder

Publications and source records attributed to F Harder.

At least 163 records · Page 9Linked to original sources
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↗
PubMed1991

[Colorectal cancers: adjuvant therapy and after care (including tumor markers)].

Perioperative adjuvant treatment after radical surgery for colorectal cancer has proven to be possible without an increase of postoperative complications and postoperative mortality. In overcoming this surgical fear, a number of randomized studies, all of them investigating the role of adjuvant treatment, have been initiated. Preliminary results of these trials show, some of them already statistically significant, an advantage of the adjuvant treated patient group. Unless these results have been confirmed, adjuvant treatment should only be given in well designed, randomized clinical trials. Only these trials can prove the effectiveness of adjuvant therapy in radical surgery of colorectal neoplasms. In addition, these studies should be used to define the group of patients who really benefit of adjuvant treatment. The main goal of follow up methods after surgery for colorectal cancer should be the detection of asymptomatic and still treatable tumor recurrences. For this reason, frequent clinical investigations and frequent CEA level determinations seem to be the most important components at this time.

Biomarkers, Tumor↗
PubMed1991

[Helicopter and emergency physician at the accident site. Medical comparison between altitude and flat land emergency care].

In-field intensive care reduces lethality and morbidity in severe trauma. We analyze and compare 400 medical helicopter rescue flights in the region of Basel and 325 medical air-rescues in the mountains of Interlaken. The presence of a physician in the helicopter is based on an interventional concept, with clinical diagnosis, monitoring and early intensive in-field care. Compared to the mountains, we find a predominance of road accidents (44%) in the region of Basel, with more head injuries (47.3%) and more polytrauma (19.4%) and thoraxtrauma (20.5%). In the mountains, with a majority of sport accidents (65.5%), pelvis and extremity injuries (73.4%) prevailed. As a consequence of inaccessible accident sites in the mountains, 23% of the rescues had to be performed by winch. An endotracheal intubation was performed in 35.5% of the patients in the Basel region, and in 11.6% in the mountains. Fixation of fractures and hemostasis was performed in both regions in 22% and 12% of the cases. In spite of high rates of severe conditions in both regions (57% in Basel, 17% in the mountains), the low mortality prior to and during air transport (2.5% in the Basel and 2.7% in the Interlaken region) confirms the necessity of the concept of early in-field intensive therapy. This concept allows good analgesia, is save and comfortable for the patients. The presence of a physician in the air rescue team has to be recommended not only for rescues in the plain, but also in the mountains.

Aircraft↗
PubMed1990

[A year experience with extracorporeal shockwave lithotripsy of gallstones].

43 patients with symptomatic gallbladder stones were treated by extracorporeal shockwave lithotripsy and oral bile acids. In all patients the stones were successfully fragmented during the first lithotripsy session. 33 patients underwent 2-4 treatment sessions. In 16 out of 43 patients the stones disappeared within 7.9 months. The rate of stone dissolution was dependent on the number and size of stones. 3 patients required surgery because of frequent colic in one case, cholecystitis in one case and lack of cooperation in one case. No important side effects were noted except mild pancreatitis 3 weeks after lithotripsy in one patient. Results at this center of extracorporeal shockwave lithotripsy combined with oral bile acids indicate that this treatment may become an alternative to cholecystectomy in patients with a small number (less than 3) of stones not exceeding 30 mm in diameter.

Adult↗
PubMed1990

[Reoperation for para-esophageal hiatal hernia following fundus plication].

A paraesophageal hiatus hernia was found in 15 of 86 patients examined radiologically due to symptoms after fundoplication (Nissen-Rosetti). 7 patients were reoperated 4 months to 12 years after fundoplication. Hernia repair was achieved by narrowing of the hiatus with sutures (4), attachment of the left lobe of the liver (1) or a Gore-tex patch (1). Additional surgical measures were fundophrenicopexy (4) and ventral corpopexy (4). At follow-up 2-19 years later, 4 of 5 patients had symptomatic improvement but none was symptom free. On x-ray 2 patients had recurrent paraesophageal hernias and 1 patient a slipped fundoplication. We conclude that reoperation for paraesophageal hiatus hernia after fundoplication, with the attendant technical difficulties, is only indicated if severe symptoms are present.

Adult↗
PubMed1990

[Enteral nutrition at home with jejunostomy catheter].

Ten patients with obstructive tumors of the upper gastrointestinal tract received a catheter jejunostomy (CJ) for long periods of enteral nutritional support. Seven of those patients received home enteral nutritional support for a period of 2-9 months. Body weight and serum albumin remained constant during the nutritional therapy. Complications (diarrhea, leakage) were rare and could successfully treated without interruption of feeding. In our experience CJ is a safe and effective method for home enteral nutritional support.

Catheters, Indwelling↗
PubMed1990

[What is the value of tumor debulking and intraperitoneal cytostasis].

Local recurrences of intraperitoneal malignancies are mainly localized at the primary tumor site and the peritoneal surface. Surgical procedures alone are neither able to further reduce the development of local recurrence nor to treat the already established recurrent disease. In this situation intraperitoneal chemotherapy as an "adjuvant" treatment modality could be thought helpful. Experimental and clinical trials have shown that high doses of cytotoxic agents can be applied to the abdominal cavity with less systemic side effects. While the recent published data are not promising for gastrointestinal malignancies, they seem to be more encouraging for ovarian cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

[Splenic injuries: diagnosis and therapy (with reference to organ saving/replantation)].

Diagnosis of splenic injury is influenced by both the type of injury and the diagnostic possibilities at the place of evaluation. Noninvasive examination with ultrasonography, computed tomography, or radionuclide scanning detects the injury. If not available diagnostic peritoneal lavage can indicate the necessity of laparotomy. Splenic salvage is the treatment of choice in splenic injury. Selective non-operative treatment of blunt trauma, splenorrhaphy, and partial splenectomy were used successfully to preserve 67% of injured spleens. Clinical and experimental findings indicate that replantation of splenic autologous tissue will not protect the host from septicemia.

Fibrin Tissue Adhesive↗
PubMed1990

[Thoracic drainage at the accident site].

The helicopter medical team of the Basel University Hospital treated and evacuated 710 patients in 1987/88. 484 were trauma patients (68.2%) and the intensive medical care began on the accident scene in 56% of the cases. We treated 90 thoracic injuries. 58.9% of these patients needed a chest tube which was directly inserted at the emergency place in 41.4% of the cases. An endotracheal intubation was necessary for 83.8% of the patients with in-field insertion of a chest tube and for 33.9% of other injured persons. No iatrogenic complications were observed. The clinical follow-up showed less complications for infield treated patients. We conclude that in-field insertion of chest tubes, if correctly performed, is a safe procedure contributing to diminish the lethality and the morbidity of trauma patients.

Accidents, Traffic↗
PubMed1990

[Following curative resection of colorectal cancer, portal chemotherapy especially benefits non-transfused patients].

After curative resection of colorectal cancer, immediate short-term postoperative intraportal adjuvant chemotherapy reduces the relative risk of recurrence and death in the non-transfused patient significantly, when compared to transfused patients without chemotherapy. This is demonstrated in a multivariate analysis using the Cox model on a group of 469 patients who have been intraoperatively randomized to receive either intraportal chemotherapy for 7 days or no further treatment. The transfused patients with chemotherapy and those receiving neither transfusions nor chemotherapy had a relative risk of recurrence and death situated in between the two groups mentioned above, not statistically different from either of them. In the setting of this study, 7 days postoperative intraportal chemotherapy seems particularly effective in the non-transfused patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

ITI implants with overdentures: a prevention of bone loss in edentulous mandibles?

Changes in the bone mineral content (BMC) of edentulous mandibles with osseointegrated ITI implants supporting overdentures were measured in vivo by dual-photon absorptiometry. The BMC measurements were performed 3 weeks postoperatively and at the 2-year follow-up visit. Measurements were made in the ITI site (anteriorly), the premolar region just behind the fixtures, and the standard site of the mandible for obtaining reference values of the age-related MBC loss. The increased function of the mandible after this treatment seems to cause a load-related bone formation that minimizes, or in some cases may counteract, the physiologic age-related BMC loss leading to osteoporosis.

Absorptiometry, Photon↗
PubMed1990

Gastro-intestinal metastases as first clinical manifestation of the dissemination of a breast cancer.

Of 1192 patients treated for breast cancer, four had extrahepatic gastro-intestinal metastases as first clinical manifestation of the tumour dissemination. One woman presented with gastric metastases mimicking a linitis plastica. Another had metastases localized to the rectum also mimicking a linitis plastica. Two women had peritoneal and retroperitoneal metastases that caused, in one case, a right hydronephrosis. Histology of the four primary tumours showed invasive lobular carcinoma (ILC) mixed with invasive ductal carcinoma in two. However, ILC exclusively was found at the site of the gastro-intestinal metastases involving the serosal layer (two cases) and extending to the submucosa (one case) or to the mucosal stroma (one case). Thus, when a women with previous history of invasive lobular breast cancer experiences gastro-intestinal symptoms, particular attention should be paid to the large and deep biopsy of lesions to ascertain the histological type and whether oestrogen or progesterone receptors differ from those of the primary breast lesion. Since survival is extremely variable (one woman is alive 7 years after the discovery of gastro-intestinal metastases), treatment including surgery, hormonal manipulation and chemotherapy with the expectation of a cure is often justifiable, particularly if no other extensive metastases are present.

Aged↗
PubMed1990

[Financial planning for surgical research. Project portfolio as an instrument for research planning].

Planning of research funding should assure both volume and continuity of economic support. Funding of new research concepts usually depends largely on the internal budget of the research institution (primary economical resources). More mature projects can be funded by governmental and non-profit (secondary) or industrial sources (tertiary economical resources). In general, a balanced proportion of financial support will assure maximal research independence. The respective funding of a research project should be regarded as extrinsic to the quality of the said project. Portfolio analysis of research projects is introduced as a new means of planning and controlling academic and industrial research. In principle, research projects will be evaluated with regard to the inherent potential of development (e.g. potential impact on clinical or scientific concepts) and the current productivity (e.g. output of results and publications). The 2-dimensional portfolio-matrix will be used to analyse these factors, manifesting both the overall activity of a research unit and the development of new research and funding strategies. In addition, repetitive project-portfolio analyses will enable control of both spending and efficiency in research. The application of the current project-portfolio method is exemplified by an analysis of the research activities of the department of surgery at the university of Basel. To date, project-portfolio analysis is not a mature method: Development of more quantitative portfolio strategies and of multidimensional project-portfolios are proposed. However, project-portfolio analysis is a promising means of planning and controlling research. It should be used and developed further in institutions with a number of concurrent research activities.

Animals↗
PubMed1990

[Single-layer suture to re-establish the digestive continuity following partial gastrectomy].

We have introduced progressively since 1985 the single-layer continuous suture technique for gastroenteric anastomoses, since this technique has been proved to be safe in colonic anastomosis. From 117 gastrectomies performed between 1985 and 1988, 68 gastroenteric anastomoses were performed with the single-layer continuous suture technique (58%). In 1988 this technique has been applied to 92.5% of the gastroenteric anastomoses. The complication rate is low: 3% clinical leakage were found. We concluded that the single-layer continuous suture technique for gastroenteric anastomoses is safe, very simple and easy to perform. It is the logical extension to large and small bowel anastomoses that we have been doing, using this technique for over 4 years now with excellent results.

Aged↗
PubMed1990

[Traumatology and emergency medicine: helicopter evacuation in the Basel area].

999 patients were treated and evacuated by medical helicopter in the region of Basel between 1986 and 1988. 687 were trauma patients (70.5%) and among them 53.9% were directly treated on the accident scene. Mortality during the stabilization prior to transport (2.6%) and during transport (0.3%) was low. The presence of a physician in the helicopter allows fast and intensive in-field care. All life-saving procedures like endotracheal tubes (36.3%), closed intercostal drainage (7.4% of trauma patients) and cardiovascular reanimation (1.9), even hemostasis, or fixation of fractures are performed. Early in-field intensive care by medical helicopter decreases lethality and mortality and must be recommended by severe trauma.

Aircraft↗