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Biomedical subjects

G Hohlbach

Publications and source records attributed to G Hohlbach.

At least 19 recordsLinked to original sources
PubMed2005

[Improvements in detection of rectal cancer recurrence by multiplanar reconstruction].

PURPOSE: To evaluate the advantages of multiplanar reconstruction and different axial slice thickness in diagnostic of rectal cancer recurrence after operation and radiotherapy. METHOD: We included 83 patients after operation and radiotherapy of rectal cancer in this study. All patients got a minimum of three CT-examinations in their follow-up program. A total of 294 CT-scans were evaluated. Each examination was reviewed by two experienced radiologists in respect to recurrence. Each examination was presented in axial reconstruction with a slice sickness of 8, 5, and 1.25 mm and in multiplanar reconstruction. The sensitivity, specificity, positive predictive value and accuracy were calculated. RESULTS: Multiplanar reconstructions showed better results for the detection of recurrence than axial reconstruction. A reduced slice thickness did not lead to better results in axial reconstruction. Multiplanar reconstruction showed a sensitivity of 0.88, a specificity of 0.98, an accuracy of 0.96 and a positive predictive value of 0,94, for axial reconstruction we calculated: 0.82, 0.97, 0.94 and 0.88, respectively. Sensitivity and accuracy showed a significant increase after the first and second examination. CONCLUSION: Multiplanar reconstructions allow a significant better detection of rectal cancer recurrence when compared to axial reconstructions. Thinner axial slice thickness shows no diagnostic advantage.

Germany↗
PubMed2005

[Is the thyroidectomy a surgical standard procedure for therapy of Graves' disease?].

Surgery is an important therapeutic option in the treatment of Graves' disease. Nevertheless it is still controversial discussed wether the extent of resection correlates with the rate of surgical complications and the therapeutic success. Therefore we performed a retrospective analysis on 75 surgically treated patients. 58 of these 75 patients were examined after a median interval of 34.2 months. The examination focussed on the appearance of temporary and permanent palsy of the recurrent laryngeal nerve, hypoparathyroidism, recurrences, and on the postoperative course of thyroid-stimulating-hormone-receptor antibody (TSH-ab) titers. Total thyroidectomy has been performed in 51 and bilateral resection with a remnant thyroid volume less than 2 ml each side in 24 patients. We could not confirm a significant difference concerning the postoperative complication rates between both groups. In the bilateral resection group we saw 3 cases of recurrent goitre and a more unfavourable course of TSH-ab titers than in the thyroidectomy group. For these reasons we propose the total thyroidectomy as surgical standard procedure for therapy of Graves' disease.

Autoantibodies↗
PubMed2004

[Laparoscopic heller cardiomyotomy either combined with a Dor or Toupet procedure in the treatment of achalasia].

INTRODUCTION: The treatment of achalasia has undergone a dramatic evolution over the past ten years with the introduction of advanced laparoscopic techniques beside the use of balloon dilatation and injections of botulinumtoxin. With the introduction of the laparoscopic Heller cardiomyotomy the question was raised again whether and if so which antireflux measures are meaningful in combination with the cardiomyotomy. PATIENTS AND METHOD: Since 1998, 51 patients underwent laparoscopic cardiomyotomy in the surgical department of the Marienhospital Herne, Ruhr University Bochum. To prevent postoperative gastroesophageal reflux we performed a Dor fundoplication in 13 patients and a Toupet fundoplication in 38 patients. The mean period of observations was 17 months (3-45 months). All patients were evaluated through a symptoms score. 16 patients could be clinically and objectively followed-up. RESULTS: The mean operation time was 170 min. (80-290 min). The intraoperative complications were 8 mucosal disruptions without further morbidity and 1 pneumothorax. Postoperative complications were 1 scarring restenosis and 1 wrap dislocation. Improvement of symptoms was reported in 94.2 % of patients with good or excellent results. In 5.8 % of patients symptoms of reflux were claimed. There was no significant difference in results between Dor- and Toupet-fundoplication. CONCLUSION: Laparoscopic Heller cardiomyotomy with either a Dor or Toupet fundoplication are equivalent with respect to short- and middle-term outcome and efficient procedures with low rate of morbidity and mortality in the treatment of achalasia. A long-term observation period is necessary for determining which type of fundoplication has to be performed particularly regarding restenosis and reflux rate.

Adolescent↗
PubMed2003

[Reconstruction of bile duct lesions by an autologous vein graft and a bio-degradable endoluminal stent in an animal model: technique and clinical impact].

INTRODUCTION: In this study a new treatment of bile duct lesions was investigated. A segment of the bile duct was replaced by an autologous venous interponate which had been endoluminally stented with a braided bio-degradable stent. METHODS: A total of 18 pigs (20-28 kg) was divided into three equal groups (I-III). In each group a 2 cm segment of the jugular vein was harvested. The animals in Group I (vein group, n = 6) underwent resection of a 2 cm long segment of the common bile duct which was replaced solely by the venous interponate, in Group II (stent group, n = 6) the venous interponate had been endoluminally stented by a braided bio-degradable stent. Group III (control group, n = 6) underwent only a circular mobilization of the common bile duct. Postoperatively survival rate, general condition as well as the weight were observed and checked for 6 months. During surgery and finally after sacrifice after 6 months blood and tissue samples were taken and semiquantitatively scored concerning grade of inflammation and fibrosis. RESULTS: In the stent and control group all animals survived in good condition. 3 pigs of the vein group died within 3 weeks showing signs of biliary peritonitis, another one died due to a high grade stenosis of the common bile duct with secondary biliary cirrhosis after 4 months. In the stent group all animals survived until sacrifice after 6 months. On examination the venous interponate was laminated with bile duct epithelium showing the diameter of the implanted stent. CONCLUSION: The reconstruction of bile duct lesions by a venous interponate in combination with a bio-degradable stent is easy to perform and represents a clinically interesting alternative to the biliodigestive anastomosis because of the preservation of the sphincter oddi. After 6 months the stent is completely absorbed and the venous interponate is laminated with bile duct epithelium.

Absorbable Implants↗
PubMed1999

Studies on an immunologically induced synovitis model in pigs and sheep.

Chronic synovitis was induced in seven sheep and nine pigs to investigate the potential applicability of laser treatment in arthroscopic synovectomy. Systemic sensitization was accomplished using chicken egg or turkey egg albumin antigens with Freund's incomplete adjuvant, enriched with killed and dried Mycobacterium tuberculosis. Ten days after the second immunizing dose, skin sensitization testing was undertaken. After a satisfactory systemic reaction had been observed, the respective antigen was injected once or twice into the left knee of each animal at 2-week intervals. After chicken egg albumin sensitization at varying systemic immunization and joint injection doses, sheep (five of five) showed neither strong morphologic nor continuous synovitis, despite a positive systemic reaction. In pigs (three of three) the inflammatory signs also were unsatisfactory for the manifestation and characterization of a synovitis model. In contrast, the application of turkey egg albumin to pigs (six of six) during the 4-month study provided a persistent, clearly manifested synovitis that developed visible villi formation and an amber to gray synovial fluid and microscopically showed follicular aggregations of lymphocytes and plasma cells. In similarly immunized sheep (two of two), only a light synovitis developed with occasional perivascular inflammatory foci.

Animals↗
PubMed1997

[Pharmacologic modification of postprandial bile duct kinetics--ultrasound measurement of the lumen of the bile duct].

UNLABELLED: The physiological correlate of biliary colic is a rapid increase in pressure in the presence of biliary obstruction. The relaxing action of hymecromone on the biliary tract provides a pharmacotherapeutic approach. PURPOSE: Since the symptoms usually occur postprandially, we used ultrasonography to examine whether hymecromone could reverse the contraction of the common bile duct (CBD) after ingestion of a standardised test meal. METHOD: The study was designed as a prospective, double-blind randomised cross-over study versus placebo in 20 healthy volunteers. The width of the CBD was measured ultrasonographically in the fasting subjects and 1, 3, 5, 10, 15 and 20 minutes after ingestion of a test meal. The subjects were then given either 400 mg of hymecromone or placebo i.v. and the measurement series was repeated. RESULTS: After ingestion of the test meal the width of the CBD decreased by a maximum of 20% after 15 minutes. While there was only a slight increase in the width of the CBD after subsequent administration of placebo, a maximum increase of 36% was measured 10 minutes after administration of hymecromone. CONCLUSION: The postprandial contraction of the CBD can be reversed within a short time by i.v. administration of hymecromone. Sonography proved a suitable tool for examining the physiological changes.

Adult↗
PubMed1997

[Wound rupture--incisional hernia].

The development of incisional hernias after major laparotomies depends on several factors: preoperative risk factors, constitution of the patient, site of incision, and technique of abdominal closure. There is a strong correlation of postoperative incisional hernias and the number of risk factors in a range of 11 to 44%; transverse or oblique incisions are followed by hernias in a rate of 3.8% in contrast to midline incisions (13.6%).

Hernia, Ventral↗
PubMed1997

[Risk factors and follow-up of recurrent laryngeal nerve paralysis after first surgeries of benign thyroid diseases. Results of a retrospective analysis of 1,556 patients].

PATIENTS AND METHODS: risk factors of recurrent laryngeal nerve (RLN) palsy after thyroid gland surgery were evaluated retrospectively in 1556 patients who were submitted to an operation because of a benign thyroid disease. Recurrences were also excluded. RESULTS: RLN palsy occurred in 6.6%. In relation to the nerves at risk the incidence of primary postoperative nerve damages was 4.3%. After a long-term follow-up of in total 18 months the incidence of permanent nerve palsy was 1.6% (related to the nerves at risk: 1.1%) as 75.5% of the paralyses were transient in an average of 6.2 months. Substernal goitres especially when sternotomy became necessary, the ligature of the inferior laryngeal artery, serious perioperative complications and total lobectomy in comparison to subtotal resection were important risk factors for primary postoperative RLN palsy (p < 0.05 resp. p < 0.01). The ligature of the inferior laryngeal artery and the extension of resection were indeed significant risk factors also for permanent nerve damages, but the other factors had no influence on the risk of permanent RLN palsy. However, the non-exposure of RLN in subtotal lobectomy was significantly associated (p < 0.01) with permanent, but not with transient nerve palsy. CONCLUSION: The exposure of the RLN is one of the most important procedures during thyroid surgery and particular also during subtotal lobectomy to reduce the rate of permanent RLN damages.

Adolescent↗
PubMed1997

[Value of preoperative angiography in surgery of the hemodialysis shunt].

Contrast angiography is still very important in evaluating the luminal anatomy of failing shunts and their venous runoff systems prior to intervention or surgical revision. For access monitoring, prior to primary AV fistulas or in case of a thrombosed access, angiography can be replaced by less invasive methods (physical examination, pressure measurements, color-flow doppler).

Angiography↗
PubMed1997

[Necrotizing fasciitis of the lower extremity].

Three cases of a necrotizing fasciitis, a rare but life- and limb-threatening infection, were treated in the Department of Surgery at the University Hospital of the Ruhr University Bochum (MHH) between October 1992 and January 1994. We compare our experiences with regard to bacteriological etiology, risk factors, localization, and place of entry, course, therapy and mortality with those in the literature.

Bacteriological Techniques↗
PubMed1997

[Value of mediastinoscopy versus thoracic CT for prediction of mediastinal tumor lymph nodes].

The value of mediastinoscopic staging in bronchial carcinoma is evaluated controversially. The literature gives a wide range of specificity of CT scans, varying from 30%-100% and 29%-95%, respectively [1, 2, 3]. We have reviewed a consecutive series of 182 patients who underwent a high-resolution mediastinal CT scan followed by mediastinoscopy (MS) because of pulmonary or mediastinal disease. The specificity of CT versus MS revealed 32% versus 100% and the sensitivity 47% versus 74%. Although we have observed complications and a limited histological prediction in the MS within the paratracheal area on the left side, we continue to recommend a standard staging MS, taking this area into careful consideration.

Carcinoma, Bronchogenic↗
PubMed1997

[Staging mesenteric ischemia based on histopathologic findings in the animal model].

With a minimal invasive access, a segmental intestinal ischemia of different duration was established in 25 pigs. After 24 h of reperfusion, the bowel was resected and examined by light microscopy. Considering these results, we developed a histopathological grading of intestinal ischemia to distinguish between viable and necrotic segments.

Animals↗
PubMed1996

[Torsion of the gallbladder--a rare cause of acute cholecystitis].

Torsion of the gallbladder with onset of gangrene is a rare condition which is generally due to an abnormal anatomical variation: loss of the fixation of the organ to the inferior margin of the liver with the presence of a long mesocyst. This case shows that ultrasound is able to make the right diagnosis which was so often confirmed not before laparotomy. In the future lethality should be reduced by early operation.

Acute Disease↗
PubMed1996

[Surgical management of bone metastases of the lower extremity with AO interlocking nail].

Between January 1991 and June 1995 we have operated on 19 patients (9 male, 10 female) with 22 skeletal metastases of the lower limb (19 femora, 3 tibiae) using a static interlocking nail. Closed intramedullary nailing without resection of the metastasis has been established as our standard procedure. We have stabilized 15 patients with advanced osteolysis and seven pathological fractures. Sixteen patients underwent postoperative local radiation therapy with 40 Gy. As intraoperative complications we have observed one fracture of an osteolysis and one death due to fat embolism. Postoperatively there were observed one seroma, one haematoma and one patient with non fatal pulmonary embolism following DVT. Two patients died within the first 30 postoperative days because of tumor progression. All patients surviving longer than 30 days could be mobilized under full weight-bearing. Morphine like analgetics for metastasis related pain were no longer needed. A secondary instability has not been observed within a mean survival time of 199 days (811 longest follow up). Closed intramedullary nailing in combination with postoperative local radiation therapy seems to be an appropriate and technically non demanding procedure to stabilize skeletal metastases of the lower limb in patients with a short or medium-term expectation of life.

Aged↗
PubMed1996

[Puncture tracheotomy in long-term ventilated intensive care patients].

In a prospective trial we tested the percutaneous dilatational tracheostomy in 53 ICU-patients treated with long-term artificial respiration. The tracheostomy was carried out under bronchoscopic supervision. Of a total complication rate of 15.1% we observed two serious complications with perforation of the pars membranacea of the trachea, one requiring thoracotomy and the other leading to exitus letalis by mediastinal emphysema.

Adult↗
PubMed1995

[Carcinoma of the gastric stump. Diagnosis, surgical procedure and prognosis].

The results of a retrospective analysis of cases of gastric stump cancer are reported. Among 298 gastric carcinomas treated between 1. 1. 1986 and 1. 3. 1994, we found 28 (9.5%) cases of gastric stump cancer. Gastric carcinoma showed a male preponderance, with a male:female ratio of ca. 4:1. Two thirds of the patients were older than 70 years at the time of diagnosis. In 27 of 28 patients the original operation performed was a Billroth II resection without Braun's enteroanastomosis. The mean time lag before the development of gastric stump cancer was significantly shorter in the group of patients older than 45 years at the time of first operation (n = 16) than in patients 45 years or younger (n = 12, P = 0.03). Endoscopy with biopsy and endosonography were highly reliable diagnostic instruments. The capability of CT for recognizing lymphatic metastasis is poor (42.1% sensitivity). The main risk factors for the development of gastric stump cancer, according to our data, are male sex, Billroth II resection for first reconstruction, age over 45 years at first operation, and gastric ulcer as reason for the original gastric resection. The cost benefit ratio and timing of endoscopic screening of partially gastrectomized patients are discussed.

Adult↗