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Biomedical subjects

H Bektas

Publications and source records attributed to H Bektas.

33 records · Page 2Linked to original sources
PubMed1997

Results of portal thrombectomy and splanchnic thrombolysis for the surgical management of acute mesentericoportal thrombosis.

BACKGROUND: Acute venous mesenteric ischaemia is rare and there is no standard conservative or operative treatment. METHODS: The results of surgical treatment for acute mesentericoportal thrombosis were retrospectively analysed in 31 patients. The thrombotic occlusion affected the superior mesenteric vein in 19 patients, the portal vein in eight and both vessels in four. Surgical treatment comprised venous thrombectomy (nine patients), bowel resection (17), a combination of thrombectomy and bowel resection (two), distal splenorenal shunt (one) and simple laparotomy (two). RESULTS: When the mesentericoportal blood flow was restored, the mortality rate was lower, but not significantly so, than after bowel resection alone (two of nine versus seven of 17). In addition to thrombectomy, local thrombolysis with recombinant tissue plasminogen activator was performed in five patients via a catheter placed into a distal mesenteric vein and all survived. The overall hospital mortality rate was 11 (35 per cent) of 31. CONCLUSION: An active approach should be encouraged in patients with this condition employing thrombectomy in addition to bowel resection. Early results are encouraging and local thrombolysis warrants further study.

Adolescent↗
PubMed1997

[Surgical therapy of pancreatic carcinoma].

Among different treatment modalities for exocrine pancreatic cancer from the surgical point of view the performance of complete tumor resection must be the aim independent any controversies about principles of surgery. Although the overall prognosis is generally poor, therapeutic nihilism is not justified any longer because postoperative mortality could be decreased to less than 5% in the past years. Nevertheless, the rate of long-term survival can only be improved by early diagnosis based on the knowledge of individual risk factors as well as by multimodality strategies including perioperative regimens (chemo- and/or radiotherapy) to increase survival rates even in advanced stages of this tumor with its dismal prognosis.

Adult↗
PubMed1997

Acute mesenteric ischemia following cardiac surgery.

BACKGROUND: The results of surgical intervention for acute mesenteric ischemia following major cardiac surgery were analysed. EXPERIMENTAL DESIGN: Retrospective investigation. Setting. University Hospital of Hannover Medical School. PATIENTS: Eleven patients (five women and six men) amongst a total of 90 patients operated from 1972 to 1993 because of an acute splanchnic ischemia. This subgroup represented 12%. The causes of splanchnic ischemia were arterial embolism in 55% and nonocclusive disease in 45%. INTERVENTIONS: Surgical intervention comprised embolectomy in one patient (9%), bowel resection in 36% and exploratory laparotomy only in 55%. MEASURES: Hospital mortality, causes of death and long term survival were analysed. RESULTS: The inhospital mortality of the 11 patients was 91% and only one female patient with arterial embolism survived after bowel resection. In the 79 patients without previous cardiac surgery the postoperative mortality of mesenteric ischemia was significantly (p<0.001) lower with 62%. CONCLUSIONS: Following cardiac surgery mesenteric infarction is a rare complication with an incidence of 0.06% and the chance of survival is minimal. Whenever acute abdominal disease occurs after cardiac surgery, the differential diagnosis should include mesenteric ischemia. Only an immediate surgical intervention with revascularisation and/or removal of gangrenous bowel segments may eventually improve the patient's prognosis.

Acute Disease↗
PubMed1996

[Surgical therapy of acute mesenteric ischemia].

Between 1972 and 1993 a total of 90 patients were operated on for acute mesenteric ischemia at Hanover Medical School, Department of Abdominal- and Transplantation Surgery. As causes of mesenteric ischemia, arterial embolism (23%), arterial thrombosis (30%), venous thrombosis (33%), and non-occlusive disease (14%) were differentiated. The overall hospital mortality was 66%. The hospital mortality after venous thrombosis was 37%, significantly lower than after arterial (79%) and functional (83%) types of mesenteric ischemia. Besides the pathogenesis of mesenteric infarction, a multivariate analysis revealed age and presence of peritonitis and intestinal perforation to be independent prognostic factors of hospital lethality. Patients with venous thrombosis had a mean age of 48 years and were significantly younger than the remaining patients who had an average age of over 60 years. Surgical procedures comprised solitary bowel resection (60%), isolated embolectomy and/or thrombectomy (10%), a combination of embolectomy/thrombectomy and bowel resection (4%), and exploratory laparotomy only (21%). Vascular reconstruction was associated with a significantly better survival rate than bowel resection only. While hospital mortality was dependent on the type of mesenteric ischemia, long-term survival after exclusion of hospital deaths proved independent of the original pathogenesis. Of the patients who survived the acute attack of mesenteric ischemia, 70% were alive 2 years later and 50% 5 years later. The survival probability of these patients was not determined by recurrence of mesenteric ischemia, but was mainly related to their cardiovascular comorbidity and a high incidence and prevalence of malignancies.

Adult↗
PubMed1996

[Indications for liver transplantation in severe amanita phalloides mushroom poisoning].

The clinical course of 12 patients with mushroom poisoning was evaluated in order to define the parameters considered to be relevant to the indication for liver transplantation. Eight patients recovered under conservative therapy; one patient died due to pre-existing, concomitant cardiopulmonary disease. In three patients transplantations had to be performed because of severe liver failure. On admission, the transplanted patients had a decreased Quick's test score and factor V value (< 10%). The peak of liver enzymes, serum bilirubin, serum creatinine, partial thromboplastin time and azotemia were not of any prognostic value. Main indications for liver transplantation were a very low initial Quick's test score and factor V value (both < 10%) and their inadequate response under substitution therapy. The development of encephalopathy and renal failure were further parameters indicating poor prognosis.

Adolescent↗
PubMed1996

Experience with color-coded duplex sonography after combined kidney/pancreas transplantation--preliminary results.

The value of color-coded duplex sonography in the assessment of combined kidney and pancreatic transplantations (KTX/PTX) was studied in 9 patients. In normal graft function the median resistive index (RI) was 0.69 (range 0.60-0.80) for the kidney and 0.61 (range 0.55-0.70) for the pancreas. Ten episodes of graft dysfunction (kidney n = 4; pancreas n = 6) were observed. During renal rejection and hemolytic uremic syndrome the RI was above 0.80. In pancreatic rejection the RI exceeded 0.80 while all other causes of pancreatic dysfunction were not associated with changes in the RI. Color-coded duplex sonography may prove to be a reliable noninvasive diagnostic method in the evaluation of the posttransplant course after combined KTX/PTX, in particular in the diagnosis of pancreatic rejection.

Diabetes Mellitus, Type 1↗
PubMed1996

[Possibilities and limitations of curative resections in cancers of the pancreas].

Univariate and multivariate analysis was used to assess the potential and limitations of curative resection in cancer of the pancreas. From 1971 to 1993, we operated 466 patients with cancer of the pancreas, using tumor resection in 192 cases. Among these, 40% required resection of the vessels or neighboring organs allowing RO resection in 85% of the patients. The most valuable prognostic factor was curative resection, followed by tumor grading and tumor size. Non-curative tumor resection did not improve survival over exploratory laparotomy or palliative anastomoses. Operative mortality after resection was lower than for procedures leaving the tumor in situ. Extended resection with vessel resection had no effect unless combined with local curative ablation, but cannot be indicated in cases with synchronous metastases or invasion of the neighboring organs. Preoperative explorations do not provide a precise indication of extension in cancer of the pancreas which can only be evaluated in an open procedure by an experienced surgeon.

Adenocarcinoma↗
PubMed1995

[Multivariate analysis of prognostic factors after resection of ductal pancreatic carcinomas].

At Hanover Medical School 466 patients were operated for ductal pancreatic cancer from 1971 to 1993. In 192 cases the pancreatic tumor could be resected, which amounts to a resection rate of 41%. These patients were subjected to uni- und multivariate factorial analysis in order to evaluate factors of significant prognostic value. Extended pancreatic resection because of vascular involvement or invasion of adjacent organs was performed in 40% (n = 77) of the cases. A curative R0 resection was possible in 85% of patients. The operative lethality dropped with time and from 1985 to 1993 was 3.5%. Patient survival at 5 years was 13.4% with a median survival time of 10.9 months. According to the univariate analysis the prognosis deteriorated with increasing tumor size and lymphatic and hematogenic metastases. There was a significant correlation between tumor stage according to the UICC and prognosis. The prognosis after resection was also significantly influenced by the residual tumor state and tumor grading. Extended pancreatic resections, however, had no significant prognostic impact. The multivariate analysis showed that only three factors were of independent significant relevance: residual tumor state, tumor size and tumor grade. The presence or absence of lymphatic and hematogenic metastases had no independent prognostic significance after resection of ductal pancreatic carcinomas.

Adult↗
PubMed1994

[Value of magnetic resonance tomography in diagnosis of tethered cord syndrome in children].

The tethered cord syndrome is considered a trouble complex that is caused by fixation of the spinal cord by intra- or extradural components. Clinically it is characterized by motor and sensory dysfunction of the lower extremities, muscle atrophy, decreased or hyperactive reflexes, urinary and bowel incontinence, spastic gait, or orthopedic deformities. Traditionally, positive-contrast myelography has been the diagnostic procedure of choice, often supported by CT (post myelo-CT). With the improvement of surface-coil technology, MR imaging has become a useful diagnostic tool for the assessment of the spinal cord and canal without ionizing radiation. MR examinations of 80 patients with the clinical diagnosis of tethered spinal cord were reviewed retrospectively in order to define normal anatomy and pathological findings as well as to establish MR strategies in the diagnosis of tethered cord syndrome in children. In order to evaluate intraspinal lipomas, the width of the spinal canal and dysraphic lesions, T1-weighed sagittal and transverse images are useful. In case of deformities of the spinal column the corona slice orientation should be used. The filum terminale and its thickness is best seen in T2-weighed transverse and sagittal images. The extension of fat within the spinal canal over more then 6 vertebral bodies and more then 1.2 cm width could be an indication of a lipomatous malformation in the sacral spinal canal.

Adolescent↗
PubMedDate not supplied

Surgery for exocrine pancreatic cancer--who are the 5- and 10-year survivors?

38 of 306 patients survived beyond 5 years after resection of an exocrine pancreatic carcinoma during a period from 1971 to 1993. Amongst the long-term survivors there were 12 patients with ductal, 22 with ampullary, 3 with distal bile duct and 1 with duodenal cancer. An active operative strategy was employed in order to resect the tumor whenever this was surgically possible. In a a retrospective analysis we have identified prognostic factors influencing long-term survival. The long-term prognosis was largely dependent on the tumor entity. Ampullary carcinomas had a significant advantage in terms of long-term survival over all other tumor entities. Other prognostic factors associated with long term survival were curative tumor resection, absence of lymphatic and distant metastases and a low tumor malignancy.

Adult↗
PubMedDate not supplied

Extended resections of ductal pancreatic cancer--impact on operative risk and prognosis.

114 patients received a standard and 75 patients an extended resection of ductal pancreatic carcinoma at the Hanover Medical School, Germany, from 1971 until 1993. Standard pancreatic resections were combined with vascular resection and reconstruction in 46 and additional organ resections in 45 cases. Vascular resections affected the mesentericoportal vein in 37, the common hepatic in 10 and the superior mesenteric artery in 7 cases. Pancreas resections were combined with total gastrectomy in 23, partial colectomy in 17, hemihepatectomy in 14, adrenalectomy in 8 and nephrectomy in 5 patients. Curative resections could be accomplished in 86% of patients without and 81% with extended resections. Additional vascular resections neither increased the operative risk nor deteriorated the long-term prognosis after resection. Additional organ resections, however, significantly increased the risk of lethality and impaired the long-term prognosis. Especially resections of synchronous hepatic metastases and colectomies were associated with a poor survival probability.

Carcinoma↗