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H Böhner

Publications and source records attributed to H Böhner.

31 records · Page 2Linked to original sources
PubMed1998

[Is ultrasound examination in acute appendicitis dispensable? Acute Abdominal Pain Study Group].

In a prospective multicenter observational trial, the performance and clinical benefit of ultrasound of the appendix was evaluated in the clinical routine. Ultrasound of the appendix was performed in 870 of 2280 patients (38%); the overall sensitivity was 55% (range: 13 to 90%), specificity 95%, positive and negative predictive value 81 and 85%. There was no correlation between the frequency or accuracy of ultrasound and the accuracy of the clinician, the negative appendectomy or perforation rate.

Abdomen, Acute↗
PubMed1997

Indications for and results of splenectomy in different hematological disorders.

The objective of this retrospective study was to determine the indications for splenectomy in hematological disorders and to analyze the results depending on the indication leading to surgery. Fifty-six patients with various hematological disorders were splenectomized between 1990 and 1994. The main indication was noted. Operative success was defined as: return to normal platelet counts without further medication in thrombocytopenia, relief of pain and local compression syndrome in painful splenomegaly, hemoglobin levels > 10 g/dl without the need for further transfusions in hemolytic anemia, response to chemotherapy after splenectomy for prior resistance because of massive splenic infiltration, and relief of infection in splenic infection. Morbidity and mortality were noted. Five major indications for splenectomy were found: thrombocytopenia (n = 36, success 78%), painful splenomegaly (n = 8, success 100%), hemolytic anemia (n = 5, success 60%), resistance to chemotherapy because of massive splenic infiltration (n = 5, success 100%). One patient with thrombocytopenia died (mortality 2%). Seven patients had major complications (13%). In hematological diseases, thrombocytopenia, painful splenomegaly and splenic infection are likely to be improved by splenectomy. In hemolytic anemia it can be a helpful approach, while in resistance to chemotherapy because of massive splenic infiltration success is less likely.

Female↗
PubMed1997

[Is routine tumor after-care after gastrectomy sensible?].

Only 22.3% of patients with recurrence after potentially curative gastrectomy are discovered in asymptomatic stages. Their prognosis is not different from those with symptomatic recurrence. Routine follow-up after gastrectomy can be abandoned.

Aftercare↗
PubMed1996

[Clinical standardization in acute abdominal pain].

The correct diagnosis in acute abdominal pain is necessary for adequate treatment. In several clinical studies it has been shown that, despite improvements in laboratory and technology medicine, errors occur in a considerable proportion of cases due to insufficient history-taking and clinical examination. By the introduction of a standardised and structured history and clinical examination, the diagnostic accuracy can be improved by at least 10%. The aim of this publication is to improve history-taking, clinical examination and diagnostic decision-making by exact definition of all relevant parameters. This was performed by a national clinical expert group, international standardisations were taken in consideration. The standardisation was based mainly on these existing international standardisations (World Organisation of Gastroenterology); however, revisions and corrections were necessary. In order to introduce the standardisation into clinical routine, a documentation form and a documentation program can be provided.

Abdomen, Acute↗
PubMed1996

[Splenectomy in osteomyelofibrosis. Indications and outcome].

Osteomyelofibrosis is a myeloproliferative disorder in which fibrosis and sclerosis finally lead to bone marrow obliteration. Liver and spleen compensate for bone marrow loss with extramedullary hematopoiesis. In some patients the resulting splenomegaly causes severe symptoms such as local compression, thrombocytopenia and hemolytic anemia. In such patients, splenectomy is the only promising treatment, although it represents a significant risk.

Adult↗
PubMed1994

[Chronic mesenteric ischemia].

Thirty-four patients (twelve men, 22 women, mean age 53[16-71] years) with chronic mesenteric ischaemia were operated upon between 1979 and 1992. The most frequent symptom was loss of weight (50%) and postprandial pain (44%). The mean interval between onset of symptoms and diagnosis was 35 months. Angiography revealed disease of the coeliac trunk (CT) or the superior mesenteric artery (SMA) in 16 patients, of only the SMA in ten, and of only the CT in eight. Revascularisation was obtained with an autologous vein graft in 21 patients (on the TC in 12, AMS in nine), while transaortic endarterectomy was performed in 15 (on the CT in seven, the AMS in nine). There was one perioperative death. 20 patients were symptom-free 1-126 months after the operation, while five still had residual symptoms even though improved in three. Seven patients had a recurrence of symptoms, three immediately after operation and four after an initial symptom-free period. These results show that freedom from symptoms can be achieved even in advanced stages of chronic mesenteric ischaemia by reconstructive surgery of the intestinal and visceral arteries. However, residual symptoms that are possibly not of a vascular nature may persist after successful vascular reconstruction. Patients with recurrent obstruction may become symptom-free by repeat surgery even many years later.

Adolescent↗
PubMed1994

[Significance of anamnesis and clinical findings for diagnosis of acute appendicitis. Acute Abdominal Pain Study Group].

UNLABELLED: Acute appendicitis raises considerable diagnostic difficulties. This is proven by rates of negative appendectomies that sometimes extent 30%. In order to find reasons for this we tested 211 patients findings for diagnostic relevance. METHOD: Within the European Community--Acute Abdominal Pain Survey, a study to support diagnosis in acute abdominal pain, 1254 patients were seen in the six participating German hospitals. 16.8% had appendicitis. History data and physical findings were tested for positive and negative predictive value (PPV/NPV), sensitivity and specificity (SEN/SPE). RESULTS: We had 15% negative appendectomies and 16% perforated appendicies. Only few of the parameters tested show a PPW significantly higher than the prior probability of appendicitis: (PPV/NPV/SEN/SPE in %) rebound tenderness 39/63/91/80, tenderness in the right lower quadrant 36/82/95/70, pain right lower quadrant at presentation 34/77/94/70, onset of pain right lower quadrant 29/49/88/75, rigidity 28/9/84/95, guarding 26/43/87/76. All other parameters had a lower PPV. The combination of three parameters leads to maximal PPV of 85%. CONCLUSION: Very few symptoms are helpful in diagnosing appendicitis: the pain related symptoms (spontaneous pain, tenderness and rebound tenderness, guarding) and the history of the pain hint at an appendicitis. A structured and complete medical history and physical examination focussing on these few symptoms, a systematic combination of these and possibly ultrasonography will improve diagnostic accuracy.

Abdomen, Acute↗
PubMedDate not supplied

Detection and prognosis of recurrent gastric cancer--is routine follow-up after gastrectomy worthwhile?

BACKGROUND/AIMS: Although routine follow-up after surgery for gastric cancer is recommended its value after gastrectomy has not been evaluated. METHODOLOGY: All patients who underwent gastrectomy for gastric cancer entering the routine follow-up program between January 1987 and August 1996 were identified. The patients studied were those with either histologically proven recurrence or those in whom recurrence was highly probable from clinical course. Two groups were compared. The first group comprised the patients whose recurrence was detected by routine follow-up prior to the development of clinical signs (asymptomatic group). The second group consisted of the patients who developed clinical symptoms due to a recurrence that was detected subsequently (symptomatic group). The main parameters were the time until recurrence occurred, the pattern of recurrence, treatment and survival. RESULTS: Out of 184 patients entering the routine follow-up 135 patients had undergone potentially curative gastrectomy. Sixty-seven patients (49.6%) had recurrences. Only 15 (22.3%) belonged to the asymptomatic group and 52 (77.7%) to the symptomatic one. The time until recurrence occurred was not different between the 2 groups (17.1 vs. 18.0 months). Chemotherapy was performed more frequently in the asymptomatic group and survival was longer (8.4 vs. 5.9 months). This difference was due to the time the patients remained asymptomatic (average 43 months). No effect of either early detection or chemotherapy was seen. In the asymptomatic group distant recurrence was common while recurrence in the symptomatic group was more often local but this difference did not reach statistic significance. CONCLUSIONS: Routine follow-up after gastrectomy for gastric cancer does not contribute to early detection of gastric cancer recurrence. It has no benefit with respect to treatment and survival of patients with recurrent disease and should therefore be reduced to symptomatic and psychological aftercare.

Adult↗