Biomedical subjects

F Marusch

Publications and source records attributed to F Marusch.

At least 19 recordsLinked to original sources

PubMed2003

[Importance of rectal extirpation for the therapy concept of low rectal cancers].

INTRODUCTION: The main objective of surgery of rectal carcinomas is to avoid a permanent colostomy by sphincter-sparing surgical procedures. A variety of different abdominoperineal resection rates is described in the literature. MATERIAL/METHOD: The study was performed in 2000 within the framework of a multicentric study including 282 hospitals. The purpose of the study was to document the quality of diagnosis and therapy for colorectal carcinomas.A total of 9477 patients were included in this study: 3402 suffering from a rectal carcinoma and 6075 suffering from a colon carcinoma. RESULTS: A total of 866 abdominoperineal resections was performed. This corresponds to an abdominoperineal resection rate of 27.4%. In 30.4% of all men and in 23.0% of all women an abdominoperineal resection was performed. Of all tumor patients who underwent abdominoperineal resection, 8.3% had a pT4 carcinoma and 57.5% a pT3 carcinoma. Adapted to the localization of the tumor in the rectum, i.e., the distance of the aboral tumor margin to the anal verge, the following abdominoperineal resection rates were found: <4 cm from the anal verge 84.6%, 4-7.9 cm 43.9%, 8-11.9 cm 5.8%, and 12-16 cm 0.5%.Intraoperative complications occurred in 11.8%, specific postoperative complications in 33.1%, and general postoperative complications in 27.4% of the patients. The postoperative lethality was 2.8%. The mean postoperative hospital stay was 21.7 days. Logistic regression identified the body mass index, gender, the distance of the carcinoma from the anal verge, and the T category as independent factors influencing the abdominoperineal resection rate. DISCUSSION: Despite an overall decrease in use, abdominoperineal resection will continue to play an important role for the surgical treatment of low rectal cancers in routine clinical practice in Germany. It will remain an individual decision for each patient whether the tumor and the patient allow sphincter preservation or whether abdominoperineal resection seems to be necessary. According to the results of the present study,a general definition of an abdominoperineal resection rate in an unselected group of patients should be viewed critically.

Adult↗

PubMed2003

[Solitary renal cell carcinoma metastasis to the thyroid gland--a paradigm of metastasectomy?].

We investigated the usefulness of thyroidectomy for solitary metastases from renal cell carcinomas in ten patients. In the absence of postoperative morbidity and mortality, a mean survival time of 3.4 years was observed. Subsequently, four patients developed intracerebral metastases. Swelling of the neck and the discovery of a nodule in the thyroid of patients who have undergone nephrectomy for renal cell carcinoma should raise suspicion of a metastasis, possibly after a long latency period. With the aid of modern immunohistochemical methods, renal cell carcinoma metastasis can now be identified unequivocally, with differentiation from a primary follicular carcinoma of the thyroid rendered possible by a combination of TTF-1, thyroglobulin, and CD 10. In the event of a solitary lesion with no extrathyroidal tumour manifestation, an R0 resection of the metastasis should always be attempted. If tumour dissemination has occurred, palliative measures and endoscopic intervention (e.g. placement of an endotracheal stent) with the aim of improving quality of life by preventing obstruction of the airways are justified.

Adenocarcinoma, Follicular↗

PubMed2003

[The value of intraoperative neuromonitoring in thyroid surgery--a prospective observational study with 926 patients].

The data obtained from 926 patients who, between 01.01.1998 and 31.12.2000, underwent thyroid gland surgery involving the use of neuromonitoring (NM) were recorded prospectively. Every patient was submitted to a preoperative and postoperative laryngoscopic examination by an ENT specialist unrelated to the department. Immediately following surgery, 58 patients were diagnosed as having unilateral or bilateral laryngeal nerve palsy. All of these patients were subsequently followed up by an ENT specialist on an outpatient basis, and 68.3 % (n = 41) of the laryngeal nerve palsies detected immediately after surgery were seen to have resolved. For first operations for benign goitre, a side-related nerve palsy rate ("nerve at risk") of 0.51 % was found. For recurrence surgery, this rate increased to 6.6 %, and for surgery of malignant lesions it was 4.8 %. The conclusion is drawn that in first operations for benign goitre, NM can be employed when and as dictated by the intraoperative findings. In the case of surgery for recurrences or malignant disease, however, intraoperative NM should be applied on a routine basis.

Electrodes↗

PubMed2002

Repair of diaphragmatic rupture by laparoscopic implantation of a polytetrafluoroethylene patch.

Diaphragmatic hernias after blunt traumatic damage are serious complications, and diagnosis often might be delayed. In most cases, early symptoms are missed, but in the further posttraumatic period, patients experience recurrence of pulmonary dysfunction or intestinal symptoms such as obstruction, nausea, and pain. Most of these defects are diagnosed by laparotomy performed to investigate other major abdominal lesions. These diaphragmatic ruptures are managed by suturing using a thoracic or abdominal approach. An original diaphragmatic repair technique using a patch is presented. A 40-year-old woman was admitted to our clinic because of chronic abdominal pain. Chest x-ray and computed tomography scan showed a migration of the large intestine into the left hemithorax. A large diaphragmatic hernia was diagnosed and repaired laparoscopically using a patch. In the reported patient, laparoscopic suture of a diaphragmatic hernia using a polytetrafluoroethylene (PTFE) (GORETEX) patch proved to be safe, successful, elegant, and uneventful.

Adult↗

PubMed2002

["Colon-/rectal carcinoma" prospective studies as comprehensive surgical quality assurance].

INTRODUCTION: Currently, only a small percentage of the diagnostic and therapeutic data on colonic carcinomas has been confirmed by data obtained in randomized controlled studies. For this reason, the results of prospective multicentre observational studies are extremely important. METHOD: Within a multicentre observational study involving 75 surgical departments carried out between 01.01. and 31.12.1999, 3,756 patients with a colorectal carcinoma (2,293 carcinoma of the colon; 1,463 carcinomas or the rectum) were investigated prospectively using a standardised questionnaire. RESULTS: The OP rate was 98.4%, the resection rate 92.5% (colon 94.1%, rectum 89.9%). The rate of rectal extirpations was relatively high at 30.3%. General postoperative morbidity was 27.4% (colon 27.0%, rectum 27.9%); the specific postoperative morbidity was 24.6% (colon 21.8%, rectum 29.1%). The anastomotic insufficiency rate was 5.2% (colon 3.7%, rectum 9.5%). The 30-day mortality rate was 4.7%, and the postoperative mortality rate 5.7%. CONCLUSIONS: Surgical quality control in the form of prospective multicentre observational studies make possible the analysis of the therapeutic situation of a surgical disease under quality assurance aspects. At the same time, the comprehensive data material available will serve the specific planning of prospective randomized studies. With the aid of the present study, a basis for a thorough and complete evaluation of colorectal carcinoma has been created.

Adolescent↗

PubMed2002

[Significance of prospective multicenter observational studies for gaining knowledge in surgery].

The meta-analysis of randomised controlled studies (RCS) achieves the highest degree of reliability. Although the status of prospective multicenter clinical trials (PMS) is the subject of controversial discussion, recent publications suggest that these two forms of analysis reveal comparable results. On the other hand, particularly in the operative part of medicine, the problem of recruitment and performing of controlled studies for the more rapid evaluation of new surgical procedures becomes more evident. We followed these two aspects by using a separate analysis of data and biostatistical models. In the evaluation of single aspects, under no circumstances can non-controlled clinical trials replace randomised clinical studies in surgery. Only the use of a variety of forms of analysis in clinical research will lead to the desired scientific findings.

Data Interpretation, Statistical↗

PubMed2002

[Open vs. laparoscopic appendectomy].

This article discusses the question of whether open or laparoscopic appendectomy is preferable in today's clinical routine. The article is based on data from randomized studies, evaluation of meta-analyses, and data from nonrandomized, multicentric studies evaluating the treatment of appendicitis in routine clinical practice. According to the data analysis, open appendectomy (OA) offers advantages with regard to a significantly shorter operative time and lower hospital costs. Laparoscopic appendectomy (LA) is characterized by a significantly decreased rate of failed septic wound healing and faster recovery. Both procedures can be performed with the same degree of safety and comparable outcome for acute appendicitis. Laparoscopic appendectomy offers significant advantages for establishing a precise diagnosis in young fertile women and overweight patients suffering from lower abdominal pain. The currently available data do not provide precise guidelines for the treatment of perforating appendicitis. However, we found significant evidence indicating an increased rate of postoperative intra-abdominal abscess after laparoscopic appendectomy. Thus, a laparoscopic approach cannot be regarded as a standard technique in advanced appendicitis.

Abdominal Abscess↗

PubMed2002

Routine use of transrectal ultrasound in rectal carcinoma: results of a prospective multicenter study.

BACKGROUND AND STUDY AIMS: Preoperative transrectal ultrasound (TRUS) can establish the depth of penetration of a tumor, and thus provide important information for decisions about further management. In the literature, this method is reported to have a high level of sensitivity and specificity. Our investigation aimed at establishing the quality of the diagnostic procedure and treatment of colorectal carcinoma. PATIENTS AND METHODS: This investigation, which covered a 1-year period, and involved 75 hospitals, was conducted in the form of a prospective multicenter study and included a total of 3756 patients. For rectal carcinomas, all endosonographically determined uT categories were compared with histologically established T categories (pT). RESULTS: At 49 hospitals a total of 499 TRUS examinations in 1463 rectal carcinomas (34.1 %) were performed. A comparison of uT with pT category was possible for 422 TRUS examinations. Agreement between the preoperative endosonographic diagnosis with the histological diagnosis was found in 63.3 % (n = 267) of cases (95 % confidence interval 58.5 % - 67.9 %). The diagnostic accuracy was 50.8 % for pT1 carcinomas, 58.3 % for pT2 lesions, 73.5 % for pT3 tumors, and 44.4 % for pT4 carcinomas. Overstaging was observed in 23.9 %, overall, and understaging in 12.8 %. Understaging was significantly less common than overstaging (P < 0.05, s.). CONCLUSION: The accuracy of transrectal ultrasound used as a routine clinical examination in rectal carcinoma patients was clearly lower than that reported in the literature. We conclude that TRUS may aid decisions relevant to treatment only when used by well-trained investigators with a large case load of rectal carcinoma patients. Centralization of transrectal ultrasonography service is mandatory if a high level of quality is to be achieved with this method.

Carcinoma↗

PubMed2002

[Laparoscopic treatment of iatrogenic perforations of the colon].

Iatrogenic perforations of the colon are serious complications that have been observed in association with both diagnostic and therapeutic colonoscopies, and are not always avoidable, even in the hands of an experienced investigator. Patients suffering from a perforation during elective colonoscopy are starving, and have a clean bowel. If the perforation is quickly diagnosed with only local mild peritonitis, laparoscopic treatment is often possible. The therapeutic options available are: oversewing, wedge resection and, in the individual case, tubular resection, as well as laparoscopic-assisted reconstruction, if indicated including a protective stoma. The decision to perform a laparoscopic procedure should depend on the time of detection of the lesion, and on the skills of the existing surgical team; otherwise, a laparotomy is indicated. We describe four cases that reflect the relevance of the laparoscopic approach.

Aged↗

PubMed2002

[Appendicitis in the last decade of the 20th century--Analysis of two prospective multicenter clinical observational studies].

AIMS OF THE STUDY: The authors present an accurate and comprehensive snapshot of appendicitis in the last decade of the 20 (th) century. The present study also aims to determine the influence of introduction of laparoscopic techniques on the quality of appendicitis therapy. PATIENTS AND METHODS: All consecutive patients admitted for suspected appendicitis were recruited into this prospective multicenter study. Two different periods of time were considered: from 1. 7. 1988 to 31. 12. 1989, 6 266 patients from 18 hospitals were included, and from 1. 6. 1996 to 31. 5. 1997, 7 398 patients from 34 institutions. RESULTS: In the first period (1988/89), 1 869 patients were treated conservatively (29.8 %), 4 397 (70.2 %) were operated. Histopathological analysis of the appendix documented no acute inflammation in 28.8 %, the perforation rate was 8.3 % and the wound infection rate 9.6 %. In the second period (1996/97), 2 430 patients were treated conservatively (32.8 %), in 24.9 % of all operated cases, the histopathological examination shows no acute inflammation of the appendix, the perforation rate was 5.9 % and the rate of wound infections 2.5 %. During this second period, 33.2 % of all appendectomies were performed using the laparoscope, the conversion rate was 7.2 %. CONCLUSIONS: The introduction of laparoscopic techniques did not modify the operative indications for treatment of appendicitis. An increase in the number of normal appendices removed was not observed. The number of perforations and the incidence of wound infections was significantly reduced in the second period.

Adolescent↗

PubMed2002

[Prospective multi-center study colon/rectum carcinoma (primary tumors)--Results of the year 2000].

INTRODUCTION: Surgical quality control in the form of multicentre studies make it possible to analyse the treatment status of a given surgical illness under quality assurance aspects. MATERIAL/METHODS: On 1. 1. 2000, under the patronage of the Convent of Hospital Chief Surgeons a project (ongoing) - organised and conducted by the Institute for Quality Management in Operative Medicine at the Otto-von-Guericke University of Magdeburg - was initiated to document and collect the data of patients with colorectal cancer throughout the whole of Germany. This work is supported by the German Society of Surgery, and the Surgical Working Group, Quality Assurance within the German Society of Surgery. Currently, some 282 hospitals throughout the country are involved in establishing a prospective documentation of colorectal carcinoma. Participation in this study is on a voluntary basis. The anonymity of both patients and hospitals is guaranteed, and no hospitals wishing to participate are excluded. Both operatively and conservatively treated patients are being documented, and no randomization takes place. RESULTS: In the year 2000, the participating hospitals documented a total of 9 477 patients with a colorectal carcinoma, including 6 975 patients with a carcinoma of the colon, and 3 402 with a rectal carcinoma. The average age of the patients was 68.5 years, and there were 5 010 men and 4 467 women. The operation rate was 99.2 %, the resection rate 95.6 %. The abdominoperineal resection rate was 27.4 %. The indicators for diagnostic quality as set out by Hermanek were largely complied with, but some deviations were noted. DISCUSSION: On the basis of the data collected, structures were established for a uniform Germany-wide quality management for a clinical condition with a major health policy impact. This information make it possible for the hospitals to identify and eliminate deficits in the structural and process quality in the diagnosis and treatment of colorectal cancer, and in this way to improve outcome quality. This means that the results of medical care research have an immediate impact on the individual treatment received by a given patient.

Adult↗

PubMed2002

[The importance of laparoscopy in blunt abdominal trauma].

The importance of laparoscopy in the management of blunt abdominal trauma should be evaluated. Therefore we retrospectively analysed all patients with blunt abdominal trauma treated in the Department of Surgery at the Carl-Thiem-Hospital Cottbus between 1998 and 2000. Within this period a total number of 53 patients with blunt abdominal trauma underwent operative treatment, 20 (37.7 %) of them had primary laparoscopy. Of the 11 cases where laparoscopic operation could be completed without conversion to exploratory laparotomy, 8 patients had intra-abdominal injuries and underwent sufficient laparoscopic treatment. The percentage of so called "negative" exploratory laparotomies within this study was 13.2 %. Our analysis suggests that laparoscopy should become firmly established in the diagnostic management and, if indicated, in the treatment of blunt abdominal trauma as well.

Abdominal Injuries↗

PubMed2002

[Which factors are responsible for postoperative mortality in colorectal cancer patients?].

INTRODUCTION: The postoperative decease is the most severe complication in surgery. PATIENTS AND METHOD: Within the framework of a multicentre study between January 1 (st) and December 31, 1999, 3,756 patients, 1,463 of them suffering from rectal cancer and 2 293 from colon carcinoma, from 75 clinics were documented with the help of a standardized questionnaire. We compared data of 211 patients who died postoperatively with data of 3,484 patients who survived after surgical treatment of colorectal cancer. Logistical regressions, under inclusion and exclusion of intra- and postoperative complications, show independent influence factors on the postoperative decease and provide models for the prediction of the postoperative death. RESULTS: Compared to the patients who survived, the postoperative deceased patients were significantly older. They had a poorer risk profile and therefore a higher ASA-score (p < 0.001). 20.4 % of the patients underwent an emergency operation. General and specific postoperative complications occurred significantly more frequently. The model of a logistical regression allowed the prediction of postoperative decease with a sensitivity and specificity of 91 %. General postoperative complications such as pulmonary embolism (relative risk: 30.3), cardiac (relative risk: 24.1), renal (relative risk: 22.1), and pulmonary complications (relative risk: 12.0) are crucial for lethality. DISCUSSION: The postoperative decease is influenced by several factors. It is impossible to reduce the number of influence factors for the prediction of outcome. The general postoperative complications, however, represent a crucial problem. It is important to avoid these problems in order to reduce postoperative lethality.

Adolescent↗

PubMed2002

[Laparoscopic adrenalectomy--experiences with transperitoneal approach].

INTRODUCTION: We report our results of laparoscopic anterior transperitoneal adrenalectomy. PATIENTS: Between 4/1996 to 05/2001, a laparoscopic adrenalectomy was performed in 34 patients (median age 48 years). The adrenalectomy was performed transperitoneally (31 unilateral; 3 bilateral). The adrenaline level was measured in 7 patients with a pheochromocytoma. RESULTS: All tumors (mean size 3.5 cm; 0.4 to 8.0 cm) could be extirpated by laparoscopy. 9 pheochromocytomas; 9 cortisol producing tumors (one patient with a Carney's syndrome); 7 Conn's adenomas and 9 incidentalomas constituted these tumors. In the first third of the observation period, the surgery lasted 176 (95-270) minutes, in the last third 82 (50-130) minutes (p < 0,01). We postoperatively observed the following complications: one abdominal wall hematoma at a port-site and one edematous pancreatitis after alteration of the pancreatic tail. The adrenaline level continually rose from the beginning of surgery to the ligature of the suprarenal vein. CONCLUSION: Transperitoneal adrenalectomy in benign tumors (< 8 cm) is our method of choice. The resulting learning curve allowed the performance of adrenalectomy within an acceptable operative time and without significant blood loss. The transperitoneal technique is safe and well reproducible. The cosmetical results are convincing. We recommend an early ligature of the suprarenal vein in a pheochromocytoma.

Adrenal Gland Neoplasms↗

PubMed2001

Laparoscopy of a traumatic rupture of a dysontogenetic splenic cyst. A case report.

The role of laparoscopy in the stepped approach to the diagnosis and treatment of blunt abdominal trauma has not yet been fully elucidated. Despite the use of a variety of imaging modalities, it can still be difficult to make a proper evaluation in cases where there are questionable abdominal injuries. In particular, when there is a discrepancy between a bland clinical picture and the results of diagnostic imaging procedures, laparoscopy should be given preference over laparotomy, provided the patient's circulatory situation is stable. Herein we describe a case in which laparoscopy allowed the detection and treatment of a traumatic rupture of a dysontogenetic splenic cyst that had mimicked a rupture of the spleen on both the ultrasound (US) and computed tomography (CT) images.

Abdominal Injuries↗

PubMed2001

A proteinase inhibitor decreases tumor growth in a laparoscopic rat model.

BACKGROUND: The balance between proteolysis and protease inhibition in the formation and breakdown processes of the extracellular matrix plays a major role in tumor cell invasion. An understanding of this relationship gave rise to the therapeutic concept of lowering tumor cell invasion by inhibiting protease activity. Phosphoramidon is an unspecific proteinase inhibitor. This experimental study investigated the effect of intraperitoneal phosphoramidon administration on tumor growth in a laparoscopic rat model. METHODS: In the first phase of the study, we investigated the influence of phosphoramidon on tumor cell invasion in a collagen matrix gel chamber in vitro. In a second experiment, a suspension of colon carcinoma cells (CC531) was introduced into the peritoneal cavity of male WAG rats. Prior to laparoscopy (at 6 mmHg for 20 min), the animals were randomized to two groups. At the start of laparoscopy, the test substance was applied intraperitoneally (group 1: controls, 1 ml 0.9% NaCl; group 2: 250 mg phosphoramidon in 1 ml 0.9% NaCl). Three weeks after the injection of tumor cells, the animals were autopsied and the tumor mass determined. RESULTS: In comparison with the control group (tumor weight 7.42 +/- 1.01 g), intraperitoneal tumor growth in the experimental group was significantly (p < 0.001) reduced by the application of phosphoramidon (tumor weight, 3.22 +/- 1.06 g). Phosphoramidon also significantly (p < 0.05) reduced tumor cell invasion through the matrix gel. CONCLUSION: The proteinase inhibitor phosphoramidon reduced tumor cell invasion in vitro and tumor cell growth in vivo in this laparoscopic rat model.

Animals↗

PubMed2001

Importance of conversion for results obtained with laparoscopic colorectal surgery.

PURPOSE: The need for a conversion is a problem inherent in laparoscopic surgery. The present study points up the significance of conversion for the results obtained with laparoscopic colorectal surgery and identifies the risk factors that establish the need for conversion. METHOD: The study took the form of a multicentric, prospective, observational study within the Laparoscopic Colorectal Surgery Study Group. A total of 33 institutions in Germany, Austria, and Switzerland participated. The study period was 3.5 years. Cases were documented with the aid of a standardized questionnaire. RESULTS: Within the framework of the Laparoscopic Colorectal Surgery Study Group, a total of 1,658 patients were recruited to a multicenter study over a period of three and one-half years (from August 1, 1995 to February 1, 1999). The observed conversion rate was 5.2 percent (n = 86). The patients requiring a conversion were significantly heavier (body mass index, 26.5 vs. 24.9) than those undergoing pure laparoscopy. Resections of the rectum were associated with a higher risk for conversion (20.9 vs. 13 percent). Intraoperative complications occurred significantly more frequently in the conversion group (27.9 vs. 3.8 percent). The duration of the operation was significantly increased after conversion in a considerable proportion of the procedures performed. Postoperative morbidity (47.7 vs. 26.1 percent), mortality (3.5 vs. 1.5 percent), recovery time, and postoperative hospital stay were all negatively influenced by conversion, in part significantly. Institutions with experience of more than 100 laparoscopic colorectal procedures proved to have a significantly lower conversion rate than those with experience of fewer than 100 such interventions (4.3 vs. 6.9 percent). CONCLUSION: Although, of itself, conversion is not considered to be a complication of laparoscopic surgery, it is true that the postoperative course after conversion is associated with appreciably poorer results in terms of morbidity, mortality, convalescence, blood transfusion requirement, and postoperative hospital stay. The importance of experience in laparoscopic surgery can be demonstrated on the basis of the conversion rates. Careful patient selection oriented to the experience of the surgeon is required if we are to keep the conversion, morbidity, and mortality rates of laparoscopic colorectal procedures as low as possible.

Age Distribution↗

PubMed2001

Effect of caseload on the short-term outcome of colon surgery: results of a multicenter study.

This prospective multicenter study investigated the effect of hospital caseload on early postoperative outcome of surgery for carcinoma of the colon in 75 German hospitals and included 2293 patients. The hospitals were divided into those with a caseload of 1-30 (group A), 31-60 (group B), and more than 60 (group C) operations. Increasing caseload was associated only with fewer general postoperative complications. It was also associated with significantly greater use of antibiotic prophylaxis. No significant differences between the groups were found in resection rates, intraoperative complications, specific postoperative complications, overall postoperative morbidity, hospital mortality, or 30-day mortality. The significance of hospital caseload for the short-term postoperative outcome following surgery on the colon should not be overestimated. Basing conclusions about the results to be expected simply on the case volume is impermissible. On the basis of the available data it is not possible to establish a threshold value, that is, a minimum number of required operations.

Adenocarcinoma↗