[Arterio-mesenteric duodenal obstruction].
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Adolescent↗
Biomedical subjects
H F Kienzle
Publications and source records attributed to H F Kienzle.
[Can endoscopic methods decrease the mortality and complication rate of bleeding stomach and duodenal ulcer? A study of the literature].
Bleedings from gastroduodenal ulcers still pose a major threat to health and life of a patient. Recent technical developments have provided the endoscopist with several methods for achieving hemostasis. In the present paper the results from clinical studies concerning interventional endoscopy shall be discussed. Criteria for the therapeutic approach for an individual patient shall be presented. Optimal results are possible if diagnosis and initial treatment are handled quickly by an experienced endoscopist. Early cooperation with the surgeon will further improve the outcome.
Duodenal Ulcer↗
[Isolated traumatic dislocation of the fibula head. A rare injury in soccer].
The case presented of a rare injury of the left knee joint underlines the necessity for meticulous examination. We report on isolated dislocation of the head of the fibula in a 25-year-old football player; the diagnosis and therapy for this rare injury are presented.
Adult↗
[Preventive operations of the gallbladder and bile ducts].
Prophylactic cholecystectomy is indicated for cholelithiasis in diabetic patients, in hemolytic anemias, before transplantations for focus treatment or implantation of a cardiac valve and also before travelling to countries with poor infrastructure; or for precancerous lesions like GB papilloma, porcelain gallbladder or cystic choledochus. Furthermore one can consider prophylactic indication for cholecystectomy for asymptomatic cholecystolithiasis in young patients in order to prevent complications in future.
Bile Duct Diseases↗
[Gastrointestinal leiomyosarcoma].
The clinical course of 12 patients was analyzed in a retrospective study; all of these patients were operated on a gastrointestinal leiomyosarcoma. The most common site of metastasis was the liver (33%). These data confirm that histologic grade, size and the extent of resection are the most important prognostic factors. Because the differential diagnosis between benign and malignant smooth muscle tumors is often quite difficult and a high risk of local recurrence the enucleation of these tumors is insufficient.
Adult↗
[Primary non-Hodgkin lymphoma of the stomach: diagnostic and therapeutic procedure].
It is reported on 13 patients with gastric non-Hodgkin's lymphoma, who underwent surgery between Jan 1st, 1984, and Sept 1st, 1987. Common symptoms included abdominal pain, weight loss and decline in health and strength. Endoscopy or barium studies had established the diagnosis of a gastric neoplasma in 12 cases. A total gastrectomy (n = 4) or a distal resection (B I n = 3, B II n = 5) was performed, depending on the size of the tumor and its location. Potentially curative resection was followed by radiotherapy in patients with high-grade lymphoma (stage I E). Patients with involvement of regional lymph nodes and advanced gastric lymphoma (stage II E1-IV E) underwent postoperative chemotherapy. So far follow-up (mean 25.3 months) revealed one case of relapse. These results confirm the value of surgical treatment in diagnosis, staging and treatment of primary gastric lymphoma. Survival in patients with advanced lymphoma and high-grade malignancy can be improved significantly by radical tumor resection, followed by multiagent chemotherapy and radiation.
Adult↗
[Diffuse eosinophilic gastroenteropathy].
Eosinophilic gastroenterocolitis is a very rare disease of the gastrointestinal tract. As a result, frequently the diagnosis is missed and/or symptoms get misinterpreted. Histological examination and blood analysis however support the finding of the correct diagnosis in most cases. We report here the case of a 47 year old female patient with diffuse gastroenterocolitis and we will comment the diagnostic problems.
Colitis↗
[The solid-cystic pancreas tumor].
Solid-cystic pancreas neoplasia is a rare condition mostly observed in young adults and women. We report three cases of this rare tumor. In all three instances the patients were young, slender women. The tumors were removed by total resection of the pancreas. In two cases these tumors were very large. In two cases we also observed criteria which could indicate that these tumors were malignant: the tumors had infiltrated the adjacent spleen and adjoining lymphnode or displayed a destroyed capsula. Until now, such infiltrative or malignant qualities have not been reported. That such criteria can be conclusively evaluated as an indication of malignancy, remains, however, unclear.
Adenoma, Islet Cell↗
[Late results following dilatation of Vater's papilla in benign stenosis].
Between 1.1. 1978-31. 12. 1984 685 patients of Städtisches Klinikum Karlsruhe underwent choledochotomy for common bile duct stones. In 178 cases (27.1%) the papilla of Vater was dilated because of inflammatory stenosis. 2 until 8 years after operation 117 patients could be reexamined. 113 patients showed no complaints. Our results show that a single intraoperative dilatation of the papilla of Vater during common bile duct surgery is a valuable and effective treatment. Furthermore it proves to be of additional diagnostic value in the indication for transduodenal papillotomy.
Ampulla of Vater↗
[Chemolitholysis of gallstones as ambulatory treatment by the established physician].
General Surgeons and physicians for internal medicine were asked for their results of dissolution-therapy of gallstones. 405 physicians were asked, 283 (69.9%) answered; 33.6% of these had some experience with the dissolution therapy. Data from 100 patients could be gathered completely: from 72 women (mean age 48 years) and from 27 men (mean age 53 years). The age-distribution resembled those of surgical gallstone-patients. In 27 cases the dissolution was successful (mean duration of therapy 49.6 weeks), in 25 cases there was a partial success (mean duration of therapy 54.8 weeks), and in 48 cases the dissolution-therapy failed (mean duration of therapy 55.5 weeks). In 60 cases therapy was stopped, but only 25 of these patients underwent cholecystectomy. In summary there is some evidence, that many collegues are sceptical against dissolution of gallstones, that the preoperative diagnostic procedure is ineffective, that the results of dissolution therapy in a common praxis is not as effective as in controlled studies, that dissolution therapy mainly is forced in patients at a normal risk--and not in high-risk patients, that only few patients are ready to take the pills longer than 1 year, and that in the case of stopping the therapy not all patients undergo consequently cholecystectomy.
Adult↗
[The perforated gastroduodenal ulcer. Clinical aspects and diagnosis as well as treatment and results].
Reviewing our cases from 1960-1978 an increasing rate of perforation in gastroduodenal ulcers is registered. The perforation-rate of all treated ulcers is 17%. The most important data of anamnesis and clinical findings are analyzed. The diagnosis was correct preoperatively in 93,5%. The diagnosis has to be established as soon as possible, as the prognosis depends on surgical therapy in due time. General state, duration of anamnesis and the severity of peritonitis are criteria for deciding on suture of the perforated ulcer or resection therapy. Both--suture and resection--show identical late results, if indication was correct. The lethality in patients with a perforated ulcer is high and depends on duration of perforation, age and general state of the patient as well as severity of peritonitis. In our collective lethality was 26%. The good early results after resection therapy are depending on the selected collective and on the fact, that resection therapy is performed under better circumstances than suture.
Abdomen↗
[Differential diagnosis of acute and chronic pain in the upper abdomen].
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Abdomen↗
[Postoperative abdominal hernia and its treatment. Results in 438 patients].
The postoperative incisional hernia can be found after any incision, any suture, and also when the technique was as subtle as possible. The frequency ranges from 1--5%. The causes, the frequency, the suture-techniques, and the methods for reparation of an incisional hernia are described. In our clinic in 18 years (1.5. 1960--30.4. 1978) 438 patients were operated with an incisional hernia. The localizations, preoperative diseases, and the methods of operations applied are described and discussed. We were able to get postoperative information of 277 patients, information by letters and own investigations as well. The results are discussed. As far as we know our figures represent the greatest number of cases published. The own late results of operated hernias are described. In other publications a frequency of 15--20% of recurrencies is quoted. In respect to this our own results with "edge-to-edge-technique" and "doubling of the fascia" are satisfacotry.
Age Factors↗
[An intraperitoneally positioned IUD--mistaken for a Spieghel hernia].
A 40-year-old woman presented with the typical signs and symptoms of a Spigelian hernia. Upon operation, an inflammatory conglomerate tumor in the lower omentum was found, containing a copper T. As there were no signs of perforation it is to be discussed whether the IUCD migrated through the right Fallopian tube or penetrated through the uterine wall without leaving a scar.
Diagnostic Errors↗
[Spieghel's hernia and its treatment].
It is reported about 12 patients with hernias through the spigelian fascia, among them one case with a rare bilateral hernia. The cause of these hernias are congenital or acquired gaps in the fascia transversalis medial to the linea semilunaris. Mostly they are discovered below the umbilicus in the height of the linea semicircularis, lateral to the rectussheath and medial to the spigelian line. All clinical details are shown in a table (Tab. 1). There is referred about localisation, sex, age, complications before operation (e.g. incarceration), complaints of the patients and operative findings. The results correspond to those of other authors. Seldom a spigelian hernia is noticed in children. To diagnose a spigelian hernia it is very important to think of it, for the symptoms are often not very characteristically and the clinical findings misleading. At times only operation reveals the real diagnosis. The operation is often simple and remaining complaints are very seldom; we didnt see any. Sometimes the operative finding requires an extensive laparotomia and bowel resection. If one finds the abdominal wall intact, one should open the abdomen in every case.
Abdominal Muscles↗
[The carcinoma of the gastric stump--clinical experiences and observations in 15 years (author's transl)].
From 1960 to 1975 29 patients were treated at our clinic for carcinoma of the gastric stump following resection for benign causes. These cases are casuistically put together and their history, clinic, method of operation, and course after operation are described. 2.38p.c. of all carcinomas of the stomach were carcinomas of the stump. The patients were averagely 38.9 years old at the time of resection for benign causes; they were averagely 60.6 years old at the time of diagnosis of the carcinoma. The so called free interval was therefore 22.2 years. The younger a patient is at the time of primary resection, the longer the free interval will be. The history of complaints lasted 3.4 months; main complaints were pains in the epigastrium, loss of weight, vomiting, and aversion for meat. The carcinomas were located in 60p.c. at the anastomosis, in 36p.c. at the cardia of the stomach. Other locations were distributed over the whole gastric stump. 14 patients could be subjected to gastrectomy with interposition of jejunum, while the rest of the cases were primarily inoperable or were treated with prothesis. All types of carcinomas of the stomach were found in the stump, in 56p.c. the adeno-carcinoma prevailed. 32p.c. of the patients died in the clinic; 17 patients could leave the clinic more or less complaintless. These patients were on the average 24.8 days in the clinic and survived at home averagely 8.5 months. In the introduction, the discussion and on a table the informations of other workers are discussed and their results compared with our findings. We come impressively to the conclusion, that a resection for ulcer is no predisposing factor in the development of a carcinoma of the gastric stump. This causal connection may be established, when wide range statistics are available, which are compiled under controlled and comparable conditions.
Adenocarcinoma↗