Search PubMed⌕ Search

Biomedical subjects

H Pichlmaier

Publications and source records attributed to H Pichlmaier.

At least 55 records · Page 3Linked to original sources
PubMed1993

Prospective randomized study of one- or two-layer anastomosis following oesophageal resection and cervical oesophagogastrostomy.

In a prospective randomized study, one- and two-layer anastomoses were compared following subtotal oesophagectomy and gastric substitution with cervical oesophagogastric anastomosis. After 54 one- and 53 two-layer procedures the rates of anastomotic leakage were the same (19 per cent). After a mean follow-up of 44 weeks, 13 of 51 patients (25 per cent) undergoing one-layer anastomosis and 28 of 50 (56 per cent) having the two-layer procedure complained of cervical dysphagia and required dilatation. The anastomotic strictures were fibrotic in 11 of 51 patients (22 per cent) undergoing one-layer anastomosis and in 24 of 50 (48 per cent) receiving the two-layer operation. Strictures were malignant in two and four patients (4 and 8 per cent) respectively. The lower incidence of fibrotic stricture following one-layer anastomosis was significant (P < 0.01), but not that of malignant stricture. With comparable leakage rates, one-layer anastomosis is superior to the two-layer procedure because of the lower incidence of fibrotic stricture.

Anastomosis, Surgical↗
PubMed1993

[Laparoscopic hernia surgery].

While classical inguinal hernia repair has recently been brought up for discussions among surgeons, at present various modified techniques are being reintroduced in general surgery. Surgical hernia repair techniques which partly are known since several decades are being carried out laparoscopically since 1989. Between August 1992 and June 1993, the authors performed 52 laparoscopic inguinal hernia repairs using the preperitoneal placement of nonresorbable mesh. There were no intraoperative complications. Merely one patient had an abdominal wall hematoma at the site of a trocar which resolved spontaneously. All patients have been followed up for 3-13 months. To date, all postoperative check ups revealed no recurrences, testicular atrophy or paresthesia. Even though little can yet be said regarding long-term results especially about recurrences, laparoscopic preperitoneal hernia repair seems to be a promising surgical procedure concerning early postoperative results.

Adult↗
PubMed1993

[Requirement for thoracotomy in thoracic trauma].

With intensive care, pleural drainage and judicious physiotherapy most thoracic injuries can be treated adequately. 571 patients were treated for severe thoracic injuries over the last 10 years. A thoracotomy was necessary in 14% of the patients with blunt trauma (BT) and 33% with penetrating trauma (PT). Thoracotomy for PT was performed earlier and had better results than thoracotomy for BT. Seventy-five percent of PT were operated in the first hour after admission against 29% of BT. Postoperative mortality for PT was three times lower than for BT (18% vs 56%). Reasons for this are the higher rate of injuries associated with BT. Surgical procedure depends on the type and extent of the thoracic and general injuries and on the patient's general condition.

Adolescent↗
PubMed1993

[Prospective hospital documentation as an instrument of surgical quality assurance].

UNLABELLED: In this study expenditure and benefits of a differentiated internal hospital documentation were analyzed. We particularly wanted to find out whether an independent prospective documentation of all postoperative complications has a reducing effect on the frequency of these events and therefore can be used as a means of control. METHOD: In the time between May 1989 and September 1992 the data of 8682 patients of our hospital were documented. Scientific assistants who regularly visited every ward registered every course of treatment. All data were coded and simultaneously checked. RESULTS: We found the risk of postoperative pneumonia (3.6%) especially high in units for vascular surgery and in the intensive care unit. Wound infections (5.2%) were mostly seen after transplantations and vascular surgery. Specific complications after operations showed an accumulation in certain wards. If we look at the progress since 1979 we can perceive a significant regression in the rate of wound infections and pneumonia and a constant rate of clinical lethality. In elective bowel-resections a significant reduction of wound infections and leakages could be recorded. Concerning the patient's characteristics we saw apart from a general increase in the number of operations a clear increase of endoscopic performances. CONCLUSION: Hospital documentation can uncover internal correlations and thus takes part in clinical quality assurance. Helpful are evaluations of each specific ward and the specific operations. Basis for this is the selection of suitable data and their independent evaluation. Measures of external quality assurance have not yet solved these problems convincingly.

Adolescent↗
PubMed1993

[Peripheral neurogenic tumors--surgical therapy of nerve sheath tumors. Review and personal results].

Nerve sheath tumors are rare tumors originating from the Schwann's cover cells. Neurinomas, neurofibromas and schwannomas can be separated due to a diverse growth behavior. 24 patients with neurinomas and 13 patients with neurofibromas were operated on from January 1, 1987 to December 31, 1992 at the Department of Surgery, University Cologne. A total of 10 patients received treatment during the last ten years because of schwannoma. The concepts of treatment and differentiation of the various tumors are demonstrated and compared based on the patients records and on a review of the literature.

Adolescent↗
PubMed1993

[Peripheral neurogenic tumors--surgical therapy of neuroblastoma. Review and personal results].

From January 1, 1982 to November 1, 1992 24 patients suffering from neuroblastoma were operated in the course of a neuroblastoma study at the Department of Surgery, Cologne University. 23 patients were in advanced stages 3, 4 and 4s. In 13 cases the initial operation was prior to applying chemotherapy, whereas in 10 cases chemotherapeutical treatment had taken place before. As a result of preoperative chemotherapy operation time and blood loss could be reduced, respectively, and despite delayed operative treatment a better demarcation of the tumor and an easier preparation were seen. Due to the preoperative treatment, tumors could be operated on more radically without increasing the rate of complications. Utilizing all possible surgical means, secondary and tertiary operative procedures and chemotherapeutical treatment. all patients in stage 2, 3 and 4s survived with safe remission. Nine of the fifteen patients in stage 4 died due to side effects from bone marrow transplantation or from recurrent neuroblastomas and not because of the surgical procedures. In the light of existing current multicenter neuroblastoma studies stage oriented surgical and chemotherapeutical concepts were developed, that are presented in this paper.

Adolescent↗
PubMed1993

Closure of partial median sternotomy with absorbable sutures: a practical and safe option.

A technique for the closure of upper median sternotomy with absorbable polyglycolid acid sutures is described. In a consecutive series of 130 refixations, no major complications occurred. After a mean follow-up period of 66 +/- 61 months, the long-term results concerning sternotomy closure were determined in 86 patients: 84 (98%) sternotomies were completely consolidated, in 75 cases (87%) without any dislocation and in nine cases (11%) with a minor dislocation in the transverse osteotomy. In two patients (2%) who had received postoperative radio- and chemotherapy, an isolated pseudarthrosis of the transverse osteotomy was observed, whereas the median sternotomy was consolidated completely. As a result of our clinical experience, we consider the closure of partial upper sternotomy with absorbable polyglycoid acid sutures as a practical and safe technique.

Absorption↗
PubMed1993

Technique and clinical results of endorectal surgery.

At the Surgical Department of the University of Cologne, a new system has been developed for transanal endoscopic surgery that allows all the conventional surgical techniques within the entire rectal cavity. The method has been in clinical use since 1983. The main indication is the removal of sessile adenomas. Early rectal carcinomas with favorable histologic grading (grades 1 and 2) and staging (Mason I and II) are also suitable for the method. Advanced cancers can also be removed endoscopically in one session, but we perform local excisions of advanced cancers only in cases in which the patient is unwilling to undergo extensive surgery. During the period from July 1983 to December 1990, this method has been employed on 233 patients in 251 cases. The intraoperative and postoperative course of 236 (94%) operations out of 251 was free from any complications. Early postoperative complications consisted of intraperitoneal perforations (five cases), rectovaginal fistulas (four cases), hemorrhages (four cases), and death as a result of cardiopulmonary failure (two cases). The recurrence rate of adenomas is 4.9%. Endorectal surgery allows endoscopic local transanal excision of large adenomas and early cancers with minimal morbidity and excellent presentation of specimens for complete histologic analysis.

Adenoma↗
PubMed1993

[Pyogenic liver abscess. Analysis and follow-up examination of a personal patient sample 1981-1992].

From January 1, 1981 to January 1, 1992 a total of 30 liver abscesses were treated in the University Clinic for Surgery in Cologne. 23 patients underwent an primary operative treatment and seven patients received a controlled guided percutaneous drainage. During the observation period four patients (13.3%) died by the effect of the liver abscess. 20 patients (66.7%) were subjected to clinical, laboratorical and computertomographical post examinations. The primary rate of operation success amounted to 47.8%, that of controlled guided percutaneous drainage of 42.8% (NS). The secondary success rate (that means after successful operative reintervention) amounted to 86.9% by the operative and to 85.7% by the percutaneous drainaged cases. During the post examination no relapse was determinated. Larger or chambered liver abscesses as well as extrahepatic spreading required operative drainage and, in cases of multifocal spreading, a resection with concomitant antibiotics. In case of solitary abscesses the controlled guided percutaneous drainage is the least harmful and low-prices method.

Cause of Death↗
PubMed1993

[Metabolic changes after transperitoneal vascular interventions].

Thirty patients who had undergone transperitoneal vascular surgery were examined for hormonal disturbances and alterations of energy and protein metabolism. Of all hormonal alterations only the increased level of insulin activity in the early postoperative period is clinically important. The higher oxygen consumption and carbon dioxide production together with the increased protein turnover indicate an elevated energy expenditure. In order to prevent decompensation of the hypermetabolic metabolism, a reduced nutritional support after major vascular surgery is justified.

Aged↗
PubMed1993

[The importance of lectins for formation of tumor metastases and bacterial infection processes].

Adhesion of bacteria and adhesion of tumor cells have much in common, especially the participation of lectins in this process. In the future it might be possible to inhibit the metastatic process into the liver (e.g. during surgical operations of malignant tumors) and bacterial adherence to mucosal linings or plastic devices by blocking of adhesion molecules (lectins) with appropriate glycoconjugates. Initial clinical trials are very promising.

Bacterial Adhesion↗
PubMed1992

[Transanal endoscopic microsurgery: technique and clinical results].

A new system has been developed for transanal endoscopic microsurgery (TEM), which allows all the conventional surgical techniques within the rectal cavity. The main indication is the removal of sessile adenomas. "Early rectal carcinomas" are also suitable for local excision. We perform local excision of advanced cancer only in cases where a contraindication exists to perform radical surgery or when the patients is unwilling to undergo demolitive surgery. The system has been employed at our Surgical Department on 206 patients in 223 cases. In 192 cases (87.7%) only one local excision was carried out due to sufficient excision as confirmed by histology (including patients with early "low risk" cancer). the postoperative course of 208 cases (93.3%) was free from any complications. The recurrence rate of adenomas amounted to 5.2%. This technique is particularly applicable for elderly, high risk patients and those with broad based adenomas so that anterior resection, abdominoperineal resection or other invasive operations can be avoided.

Adenoma↗
PubMed1992

The risk of infection following OKT3 and antilymphocyte globulin treatment for renal transplant rejection: results of a single center prospectively randomized trial.

Some 43 of 60 (72%) renal allograft recipients who were prospectively randomized to receive either OKT3 monoclonal antibody (n = 30) or ALG (antilymphocyte globulin) polyclonal antibody (n = 30) for steroid-resistant rejection suffered from infection, 25 (83%) following OKT3 and 18 (60%) following ALG treatment (P < 0.05). Clinically evident herpes infection was most frequently seen (9 and 7, respectively), followed by pneumonia (6 and 1, respectively P < 0.05), urinary tract infection and wound infection (2 of each in both groups) fungal (Candida) and multibacterial infections. One patient died in each group due to cytomegalovirus (CMV) pneumonia, giving a mortality of 4.3% in each group. Actuarial 1-year graft and patient survival rates were 80% and 97% in both groups, respectively. It is concluded that ALG and OKT3 are equally effective in renal allograft rejection resistant to steroid treatment, however, the risk of infection appears to be higher with OKT3.

Adult↗
PubMed1992

[Resection of esophageal cancer without thoracotomy by manual dissection and eversion stripping].

At the department of surgery of the university of Cologne-Lindenthal, 184 patients (142 with squamous cell carcinoma of the esophagus, 42 with adenocarcinoma of the gastroesophageal junction) underwent blunt dissection of esophageal cancer between 1983 and 1991. Tumor expansion classified by the pathologist was stage I in 13.6%, stage II in 31.0%, stage III in 41.8%, and stage IV in 13.6% of all cases. Histological tumor differentiation was graded well in 4.3%, moderate in 71.7%, and poor in 19.6%. Principally a gastric tube was used for esophageal replacement (96.3%), while interposition of the large bowel was performed in 5 cases. All the patients were prospectively monitored for perioperative complications. 64.7% fared without any complications intraoperatively. The most frequent intraoperative complications were damage of the pleura parietalis (16.3%), rupture of the tumor during dissection (13.0%), and lesion of the spleen (11.4%). 29.9% of the patients had a postoperative course without any complications. Pleural effusion (38.6%) and insufficiency of the cervical anastomosis (22.8%) were the most frequent complications seen postoperatively. Hospital mortality amounted to 6.0%. Six months after the operation most patients deemed their quality of life satisfying or excellent, respectively. The cumulative survival rate (without hospital mortality) was 78.3% after the first year, 24.7% after the third year and 20.6% after the fifth year.

Adenocarcinoma↗
PubMed1992

[Penetrating thoracic injuries].

In a period of peace in Germany and other westeuropean countries, penetrating trauma of the thorax (PTT) is much more rarer than blunt trauma. An analysis of 103 patients with PTT, treated in the Surgical Department of the University of Cologne from 1980 to 1990, showed, that these are usually isolated injuries in young patients. These occur usually following violence as stab wounds and less commonly gunshot wounds. Two thirds of the patients could be treated adequately with intensive care therapy and the use of thoracic drains. One third of the patients underwent thoracotomy, which was carried out in two thirds within one hour after hospital admission and in the remaining one third within the first 24 hours. The mortality for all PTT was 13%, being 10% for isolated thoracic injuries and 19% for patients with multiple trauma.

Adolescent↗