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Biomedical subjects

H Lippert

Publications and source records attributed to H Lippert.

At least 145 records · Page 8Linked to original sources
PubMed2000

[Quality assurance in appendicitis--what has changed? Analysis of 2 prospective multicenter quality assurance studies].

AIMS OF THE STUDY: The present study aims to determine the influence of introduction of laparoscopic techniques and of DRG (diagnosis related gains) on the quality of appendicitis therapy. PATIENTS AND METHODS: All consecutive patients admitted for suspected appendicitis were recruited into this prospective multicenter study. Two different periods of time were considered: from 1.7.1988 to 31.12.1989, 6,266 patients from 18 hospitals were included, and from 1.6.1996 to 31.5.1997, 7,398 patients from 34 institutions. RESULTS: In the first period (1988/89), 1,869 patients were treated conservatively (29.8%), 4,397 (70.2%) were operated. Histopathological analysis of the appendix documented no acute inflammation in 28.8%, the perforation rate was 8.3% and the wound infection rate 9.6%. In the second period (1996/97), 2,430 patients were treated conservatively (32.8%), in 24.9% of all operated cases, the histopathological examination shows no acute inflammation of the appendix, the perforation rate was 5.9% and the rate of wound infections 2.5%. During this second period, 33.2% of all appendectomies were performed using the laparoscope, the conversion rate was 7.2%. CONCLUSIONS: The introduction of laparoscopic techniques and of DRG did not modify the operative indications for treatment of appendicitis. An increase in the number of normal appendices removed was not observed. The number of perforations and the incidence of wound infections was significantly reduced in the second period.

Adolescent↗
PubMed2000

[Results of 188 gastric banding operations].

The gastric banding is an effective operation for treatment of the morbid obesity. We report about 188 patients, we treated from April 1997 to December 1999. This review takes a stand on the indication for operation, the operative technique, the lost of weight and the complications. The benefit of this operation is the minimal invasive technique.

Adolescent↗
PubMed1999

[Surgical therapy of morbid obesity with laparoscopic "gastric banding". Technique and results of 370 cases].

The application of an adjustable silicone gastric band is a very efficient and long-term method to reduce the weight in morbid obesity. The surgical technique is exacting; standardization of the procedure diminishes the complication rate. 370 patients with morbid obesity underwent the laparoscopic application of a gastric band between May 1996 and September 1997. Two different kinds of gastric bands were used in these surgeries. The data are shown in two series. The total morbidity rate was 16.8%, in series II 4.5%. The mortality rate was 0%. The average loss of weight came to 12 kg (5.3%) after 4 weeks, 18% after 3 months, 37.4% after 6 months and 48.4% after 1 year.

Adult↗
PubMed1999

[Permanent stomata].

The implantation of preternatural orifices is a procedure frequently performed by the visceral surgeon in spite of the advances of modern surgery concerning preservation of continence. In order to avoid unnecessary complications, certain strict principles of operating technique must be followed. The cumulative rate of complications is found to be at least 50%. Especially prolapse, peristomal hernias and stenoses are of profound surgical relevance. A well-implanted and adequately cared for stoma will have a positive influence on a patient's quality of life.

Colostomy↗
PubMed1999

[Gastrointestinal stromal tumors--problems in diagnosis and therapy].

Gastrointestinal stromal tumors (GIST), which form a rare group of neoplasias of the gastrointestinal tract, have not yet been fully investigated. Although good progress has been made in their diagnosis, classification of these lesions with regard to their histogenesis and biological behavior remains problematic. Between 1994 and 1998, 18 GIST patients underwere operation in the Department of Surgery. Twelve of these patients (67%) had stromal tumors in the stomach, and six (33%) had intestinal stromal tumors. The primary tumor could be removed in all patients with R0 resection. Six patients developed hematogenous liver metastasis, with the size of their primary tumor exceeding 10 cm. Extrahepatic distant metastases were not found in any case. Lymphadenectomy showed that lymph node metastases did not occur. Histological evaluation was made according to the guidelines of Lewin, Weinstein and Riddell. Currently established therapy is limited to complete surgical resection of the primary tumor and its metastases. Adjuvant or neoadjuvant chemotherapy approaches have failed.

Adult↗
PubMed1999

High-dose therapy with combined 5-fluorouracil and folinic acid with and without amifostine in the treatment of patients with metastatic colorectal carcinoma.

In a prospective clinical trial we treated 27 patients with metastatic colorectal carcinoma a continuous 24-h high-dose regimen of 2.6 g/m2 5-fluoroucil and 500 mg/m2 folinic acid per week for 6 weeks. To evaluate the effect of amifostine, a selective cyto- and radioprotector, in reducing chemotherapy-related mucositis, 740 mg/m2 amifostine was administered before chemotherapy, and the results were compared to 15 patients without amifostine treatment. In the amifostine group the dose was reduced or treatment was stopped because of mucositis observed in 6 of the 12 patients, while 13 of the 15 control patients could not be treated according to the treatment plan. The incidence of gastrointestinal side effects of WHO grade III or higher was reduced in the amifostine group, with no mucositis of this severity, versus 3 of 15 in the control group. The response rate was identical in the two treatment arms (33.3%).

Amifostine↗
PubMed1999

Myxoid liposarcoma with transition to round-cell lesion-cell cycle regulator genes and telomerase activity characterizing tumor progression: a case report.

A mixed myxoid/round cell liposarcoma was macrodissected in its 2 histologic components and investigated for genetic differences between its low-grade myxoid and the high-grade round-cell region. For both, we failed to detect p53 gene mutations, loss of heterozygosity at the p53 or Rb genes, and p53 protein expression. The round-cell component showed a high telomerase activity, and an elevated c-myc mRNA and protein expression. The myxoid component was characterized by a lack of telomerase activity and low c-myc mRNA expression, and immunohistochemistry failed to detect the c-myc protein. There was a higher Mib-1 proliferation index in the round-cell portion. The same specific translocation t(12;16) and the fusion transcript type II in both components confirmed the close relationship between myxoid and round-cell liposarcomas. Telomerase activity and increased c-myc expression seem to be helpful molecular markers for characterizing tumor progression in myxoid liposarcoma.

Abdominal Neoplasms↗
PubMed1999

Epithelial-myoepithelial carcinoma of the salivary gland--a low grade malignant neoplasm? Report of two cases and review of the literature.

Epithelial-myoepithelial carcinomas (EMC) are rare neoplasms of the salivary gland with an incidence of less than 1% arising predominantly in the parotid gland. Although they are thought to be of low grade malignancy, fatal courses are described. We report a case of EMC of the parotid gland in a 58-year-old woman with an unfavorable course of this disease in long term follow-up. The malignant potential of this tumor is discussed. In addition, we include another case of EMC of the submandibular gland.

Carcinoma↗
PubMed1999

Multimodal treatment of neuroendocrine tumors of the pancreas and the ampulla of Vater.

Neuroendocrine tumors are not seen frequently. They are most commonly located in the small bowel including the vermiform appendix. Neuroendocrine tumors of pancreatic origin are extremely rare. Symptoms caused by excessive hormone production by large liver metastases often lead to their diagnosis. Preoperative diagnostics include analysis of specific hormones in serum and urine, ultrasound, CT and somatostatin receptor scintigraphy. Liver metastases of neuroendocrine tumors of the pancreas are common at the time of diagnosis. Curative resection should be performed whenever possible, although patients often benefit from debulking procedures, too. Liver metastases can be subjected to surgical resection, embolization, regional chemotherapy or local procedures such as alcohol injection or cryoablation. As an exception, liver transplantation can be considered in selected cases where radical surgery for the primary tumor could be performed and extrahepatic metastases are not present. Supplementary or alternative options include octreotide and/or interferon-alpha administration. In this article, we report on 6 patients suffering from primary neuroendocrine tumors of the pancreas or the ampulla of Vater who were treated at our department over the past 5 years. In addition, we discuss our own experience with this rare condition in the light of the recent literature.

Adult↗
PubMed1999

[Value of the vena cava filter in treatment of deep venous thrombosis in the pelvis and leg].

The indication of vena cava filter implantation is controversially discussed. A pure prophylactic indication is increasingly favoured, especially for temporary filter systems without any anamnestic pulmonary embolisms. On the basis of the available literature and our own results a critical analysis of this issue is given. Between 1994 and 1997, we inserted a total of 24 vena cava filters; 21 temporary and 3 permanent filters. In ten patients, the placement of the filter was indicated due to pulmonary embolism and a contra-indication to dose adjusted heparin therapy. Seven additional patients experienced a recurrent pulmonary embolism despite adequate heparin therapy. A prophylactic filter insertion was carried out in seven patients. The temporary vena cava filters were left in place between 7 to 38 days with an average of 19 days. Total implantation time of temporary filters was scheduled until complete mobilisation of the patients, generally in conjunction with an effective dosage of oral anticoagulants. No patient died in connection with the insertion of the filter and no further pulmonary embolisms occurred. One case of inferior vena cava thrombosis occurred in each group of temporary and permanent filters. In one third of the removed filter systems thrombi in the filter were found. Local infections of the catheter and introducer sets were observed in two patients. Moreover, in one case the strut of a temporary filter broke and subsequently dislocated 17 days after insertion. We conclude on the basis of these complication rates that until the results of randomised studies are available the usage of all filter systems should be limited to highly selected cases.

Adult↗
PubMed1999

Heparin-induced vascular occlusion in vasculosurgical patients. An evaluation of the disease in 13 cases.

OBJECTIVE: To describe the diagnosis and treatment of adverse reaction to heparin (heparin-induced thrombocytopenia [HIT]) administered prophylactically for thrombosis and embolism. EXPERIMENTAL DESIGN: case series. SETTING: vascular surgical division in a University hospital. PATIENTS: thirteen patients treated for HIT type II between October 1994 and June 1997. Measures/Interventions: diagnosis of heparin-induced complications is based on exact medical history and regular measurement of platelet counts. Confirmation can be obtained with the aggregation test, serotonin-release test, heparininduced platelet release (HIPA) test, and platelet factor 4/heparin ELISA. Vasculosurgical reconstruction is usually required to eliminate vessel occlusion. RESULTS: In our series, HIT was confirmed by HIPA test (11 patients) and aggregation test (2 patients). All patients had positive cross reaction with low-molecular-weight heparin, and six had cross reaction with heparinoid danaproid sodium (Orgaran). Occlusions occurred between day 2 and 22 after the start or resumption of heparin administration (mean, 11 days). Anticoagulation treatment with hirudin or danaproid sodium was given to 5 patients, in conjunction with vasculosurgical reconstruction. Three of those patients died and the other two required amputation. CONCLUSIONS: Heparin-induced vascular occlusion is a rare but severe adverse effect of heparin treatment. When HIT is suspected, heparin administration must be stopped, with substitution of dextran and acetylsalicylic acid. Laboratory tests must be used for confirmation or exclusion. However, the diagnosis can be obscured by a normal platelet count due to pre-existing polycythemia and by false-negative test results. Surgery is usually warranted, depending on the degree and localization of ischemia.

Adult↗
PubMed1999

Aneurysm of the vertebral artery near the atlas arch.

In this case report, we describe an nontraumatic extracranial aneurysm of the vertebral artery at the V3 segment. Its etiology and pathogenesis could not be clarified completely. The walnut-sized aneurysm was treated surgically by proximal ligation. There were no postoperative complications.

Aneurysm↗
PubMed1999

[Peritonitis models in the rat with special reference to laparoscopic therapy options].

With ongoing development of minimally invasive surgery the laparoscopic techniques are increasingly used also in patients with intra-abdominal inflammatory diseases. The systemic sequelae of laparoscopy are not yet clear. In this study, we investigated three experimental models of peritonitis in rats (cecal ligation and puncture n = 14, cecal stent peritonitis n = 14, implantation of a standardized fecal inoculum n = 18) concerning the therapeutic potential of laparoscopy, reproducibility of the results and clinical relevance (elimination of the inflammatory focus, intraperitoneal modulation of inflammation). The peritonitis model of implantation of a standardized fecal inoculum was shown to be the experimental model with the closest clinical relevance. In this technically simple, reproducible model, the primary inflammatory focus can be eliminated by laparoscopic lavage. A significant difference (p < 0.002) of survival between the groups with and without laparoscopic lavage was found. In addition, the intraperitoneal application of drugs is possible in order to modulate peritoneal and systemic inflammation.

Animals↗
PubMed1999

[Aorto-duodenal fistula--a rare cause of upper gastrointestinal hemorrhage].

Upper gastrointestinal hemorrhage is the most frequent indication for emergency endoscopy. In most of the cases the bleeding is primarily treated endoscopically. The duodenal penetration of an aortic graft implant is a rare condition, only accidentally diagnosed by endoscopy. This condition represents a difficult situation for the endoscopist since it is usually not included in the differential diagnosis. Additionally hemostasis can not be achieved by endoscopic intervention. Therefore the instant realization of this dangerous diagnosis is extremely important, because only surgical therapy in a center of vascular surgery may save the live of the patient.

Aged↗
PubMed1999

[Therapy options for postoperative fistulas of the upper gastrointestinal tract].

The mortality of anastomotic leakage following esophageal reconstruction has been reported to be as high as 60%. For the treatment of these dehiscences the use of endoscopy is a tempting option. The standard treatment consisted of endoscopic lavage, drainage and subsequent closure of the leak by application of fibrin glue. 2 patients was tried with a novel approach permitting rapid closure by plugging the fistula with a vicryl cylinder. Endoscopic management of postoperative leaks of the upper gastrointestinal tract represents a safe and relatively gentle therapeutic option.

Anastomosis, Surgical↗