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Biomedical subjects

G Winkeltau

Publications and source records attributed to G Winkeltau.

At least 37 records · Page 2Linked to original sources
PubMed1992

[Differential surgical therapy in diffuse peritonitis].

96 patients were operated on for diffuse peritonitis from January 1986 to June 1990. They underwent a differentiated therapeutical concept according to the severity of the underlying peritonitis. Mild forms were handled with the standard approach, while mid-severe cases were treated by continuous postoperative peritoneal lavage. Patients with severe peritonitis were operated on by open abdomen management. Mortality was 32% (31/96) and with that obviously better than the statistically expected mortality, based on the Mannheim-Peritonitis-Score (49%). The same findings could be demonstrated in the therapeutic subgroups. The management of diffuse peritonitis using such a differentiated surgical concept seems to be an effective approach to reduce mortality rates.

Adolescent↗
PubMed1991

[Non-Hodgkin's lymphomas of the stomach. Therapy from the surgical viewpoint].

About 2-5% of all gastric tumours are Non-Hodgkin Lymphomas (NHL). In the last years we treated 15 patients with NHL of the stomach. Six of these patients were classified to group IE according to Ann Arbor classification, four to group II (three II 1 E and one II 2 E). In group III E were two patients (one III S and one III E) and one patient was classified to group IV. Ten patients displayed low grade and five high grade malignancies with respect to the Kiel classification. We performed in group I three gastrectomies and three BI resections. In four patients of group II two gastrectomies and two BI resections were carried out and in group III two BI resection. Our treatment policy consisted of operation and radiation in IE, to operation and chemotherapy in high grade lymphomas of group II, and operation plus radiation in low grade malignancies of group II. In group III we treated radiation, chemotherapy and operation and in group IV radiation and chemotherapy. In group I five patients survived, in group II two out of four and in group III one of two. The patient of group IV died within two years after diagnosis.

Adult↗
PubMed1990

[Liver hemangioma. I. Diagnosis, spontaneous course, complications].

Hemangioma is the most frequent benign tumor of the liver. Clinical signs range from complete absence of any complaints to the life threatening complication of hemorrhage. Ultrasound, computed tomography, angiography, scintigraphy and magnetic resonance tomography are appropriate diagnostic tools. The spontaneous course depends on diameter and localization of the tumor; the majority of complications are documented for hemangiomas of more than 5 cm in diameter and superficial position.

Diagnostic Imaging↗
PubMed1990

[Liver hemangioma. II. Surgical indications, choice of procedure, results].

From our point of view surgical therapy for liver hemangioma is indicated for tumors with a diameter exceeding 5 cm, with superficial position, and complaints. Further criteria are changes in size or internal structure of the tumor. Treatment of choice are atypical and anatomical resections, respectively, according to the size of the hemangioma. Elective surgery can be performed with considerable low risks with respect of the spontaneous course.

Adult↗
PubMed1990

Endoscopic therapy and early elective operation as a therapeutic regimen in ulcer bleeding.

In a prospective protocol we treated 63 consecutive patients admitted to our surgical department with bleeding gastroduodenal ulcers between January 1986 and December 1987. The therapeutic regimen included emergency endoscopy in all cases. Active Forrest Ia or II hemorrhage was treated endoscopically with submucosal injection. Endoscopic control of hemorrhage was achieved in all but one case. Low-risk ulcers, e.g. Forrest II without visible vessel and III or ulcers caused by antirheumatic drug medication were treated definitively by therapeutic endoscopy (31 patients). Ulcers with high risk of rebleeding even after endoscopic therapy underwent additional early elective operation. Thirty patients were treated surgically by this means. Two patients required emergency operation because of failure to control the bleeding (Ia and second rebleeding) endoscopically. The overall mortality of the surgically treated patients was 6% (2/32). The mortality of the therapeutic endoscopy was 0%. Thus, the mortality of the overall group was 3%. The major advantages of this concept were: low mortality rates, elimination of rebleeding in the follow-up period, optimal conditions for the surgical therapy resulting in low death-rates and a reduced need for transfusions.

Adult↗
PubMed1989

[Postoperative, intra-abdominal adhesions--a new standardized and objective animal model and testing of substances for the prevention of adhesions].

80 male Sprague Dawley rats were divided in 8 groups of equal size. After median laparotomy defined abrasions of the serosa of abdominal wall, cecum and ileum were performed (400p, abrasive paper 280 grains/cm2, 8 cm2). The control group (I) received no medication. In the treatment groups 5 ml of the following agents were instilled before closure of the abdominal wall: normal saline (II), 16,250 IE Neomycin with 1250 IE Bacitracin (III), 30% dextrose (MW 70,000) (IV), 50,000 IE Streptokinase with 12,500 IE Streptodornase (V), or TCDO in concentrations of 10% (VI), 50% (VII), and 100% (VIII). All animals were relaparotomized on the 7th postoperative day, the adhesions were dissected and their extent was calculated by computer aid. Furthermore specimens were obtained for microscopic studies. Compared to the controls no reduction of adhesions could be achieved by dextrose. Significantly more adhesions were observed after treatment with Neomycin/Bacitracin. A reduction of about 23% was registered with normal saline and TCDO 10%. The greatest reduction of adhesions was seen after application of Streptokinase/Streptodornase as well as TCDO in concentrations of 50% and 100% (63%). The results were significant after evaluation with the t-test. Histologically there was a correlation between the extent of adhesions and the fibrin film. The new animal model has proven to result in reproducible data if used to evaluate substances for prevention of adhesions. Clinical studies with the best of these agents could serve as an approach to solve the problem of adhesion ileus.

Abdomen↗
PubMed1989

[Intraluminal splinting of problematic intestinal anastomoses with biomaterial tubes].

We performed small intestinal dissection in 80 laboratory rats. A critical anastomosis was achieved by two point adaptation of small intestine with single sutures. 10 control animals receiving no intestinal splinting died within two days of operation. The remaining 70 animals underwent intestinal internal splinting with tubes of different absorbable (Polyglactine, Collagen, and B111) and non-absorbable (Polyurethane) biomaterials. Significantly smaller leakage rates in the therapy groups proved the principle of internal splinting of complicated anastomoses in this animal model to be effective.

Anastomosis, Surgical↗
PubMed1989

[Parasitic liver cyst. Indications and choice of procedure in cystic echinococcosis].

About 60-90% of clinically diagnosed cases of echinococcosis are found in the liver. Half of these patients show episodes of acute abdominal or back pain. The others complain about discrete and unspecific symptoms. Diagnosis is confirmed by combination of imaging techniques and serologic tests. Operation still is the only way for eradication of the parasite. This paper presents a summary of the literature and clinical data of 27 patients treated in our hospital from 1966 to March 1988. Cystectomy with omentoplasty is confirmed to be a simple and effective surgical method in operative treatment of echinococcosis.

Adolescent↗
PubMed1988

[Significance of pancreatic and duodenal secretions for the protection of gastrointestinal anastomoses following stomach resection--an animal experiment study].

The consequences of deviation of pancreatic juice and bile after gastric resection were studied in an experimental animal model in 66 rats. After hemigastrectomy and Billroth I resp. Billroth II anastomoses papilla vateri was transplanted into a deep jejunal limb in a B I and a B II group each. Absence of alkaline secretions of Papilla vateri was followed by a marked increase in acidity in the gastric remnant and connected intestine. Especially in the Billroth II operated stomach we found an increased ulcer risk under these circumstances. With additional histamine-stimulation frequency of ulcer was 75% in Billroth II but only 33% in Billroth I animals. When alkaline reflux was preserved the ulcer rate ranged from 15 to 40% in all groups. These results confirmed the protective property of postresectional reflux for the integrity of anastomoses after gastric resection. The increased resistance of Billroth I anastomoses in spite of deficient luminal acid buffers could be explained by the mucus-bicarbonate-barrier of the duodenal mucosa.

Anastomosis, Surgical↗
PubMed1988

[Surgical therapy in the treatment concept of ulcer disease. A critical evaluation].

Since the introduction of H2-receptor antagonists ulcer therapy has changed in favour of conservative management against surgery. In spite of this shift in therapy mortality from peptic ulcer did not decrease through the last three decades. Obviously conservative management does not influence the rate of ulcer complications but postpones them to the aged. Peptic ulcer surgery offers differentiated therapies for complications as well as for uncomplicated ulcer disease. In bleeding ulcers combination of therapeutic endoscopy and early elective surgery reduced mortality to 5%. Targets of therapy are both bleeding and ulcer disease. Obstruction is cured in the same way as uncomplicated ulcers with additional pyloro- or duodenoplasty. In cases of perforation the decision for simple suture or definitive treatment should be orientated to ulcer history. Due to their localisation uncomplicated ulcers are treated best by selective proximal vagotomy, combined resection or Billroth I resection. After surgery the monthly recurrence risk of uncomplicated ulcers is about ten times lower than throughout long-term conservative therapy. From the present point of view only surgery seems to be able to reduce persisting rates of ulcer mortality in the future.

Combined Modality Therapy↗
PubMed1988

[The surgical treatment concept in acute intestinal hemorrhage].

A clinically developed and prospectively verified therapeutic concept for acute intestinal bleeding is presented in this paper. Emphasis is laid on orthograde lavage likely to enable sooner and more effective use of diagnostic means and to provide optimal conditions for surgical therapy. Prognosis can be further improved by differentiated use of therapeutic endoscopy and early elective surgery. The effectiveness of this new therapeutic concept has been successfully verified on 81 patients, between 1975 and 1986. Lethality amounted to five per cent.

Colectomy↗
PubMed1987

[Recurrent gastroduodenal ulcer: controversies in primary and secondary interventions].

Today controversial points of view in ulcer surgery are related to operative tactics. In principal resective and non-resective procedures and the type of anastomosis are discussed. Physiopathological criteria for decision are the effects on acid reduction, motility, intestinal acid exposure and entero-gastric reflux. Therapeutic security and the frequency of side effects are determined by these parameters. Postpyloric ulcer remains the domain of vagotomy. Gastric ulcers should be resected or treated by a combined procedure. In reconstructing the gastrointestinal tract the dualism of residual acid and postresectional reflux must be taken into account.

Anastomosis, Surgical↗
PubMed1987

[Diagnosis and therapy of late intestinal radiation sequelae].

Diagnosis and therapy of the complications of intestinal radiation is characterized by uncertainty due to the lack of data. We report our experience of 285 patients who have been followed through the years 1967-1984 which might serve as a basis for diagnosis and therapy. In emergency situations diagnosis includes ileus, perforation and massive bleeding. Operative therapy should be performed stepwise and with caution. During free intervals complete diagnosis of all possible complications including a restaging of the underlying disease should be performed. Resection of the affected intestine is the surgical method of choice. The rate of severe complications was lowered substantially; mortality was 4% (7/159).

Abdominal Neoplasms↗