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Biomedical subjects

H Pichlmaier

Publications and source records attributed to H Pichlmaier.

At least 73 records · Page 4Linked to original sources
PubMed1992

[Preoperative intestinal lavage with a polyethyleneglycol-containing solution. A prospective randomized study in comparison with Ringer's lactate solution].

UNLABELLED: Aim of that study was to prove, whether a solution containing polyethyleneglycol (PEG) is more useful in comparison to the normal method using Ringer's-lactate solution for preoperative bowel preparation. METHODS: From January 1990 up to February 1991 we compared in a prospective randomized simple blind study on 110 patients the whole gut solution (Hewitt) to a bowel preparation with PEG (Oralav). RESULTS: The patients, that were prepared in the common way (Ringer's-lactate, control group; n = 54) were approximately given the double amount of liquid (9663 ml) as those in the other group (target group; n = 54: 4777 ml). We found no significant differences concerning the electrolytes. Hemoglobin (-1.1 g/dl) and hematocrit (-3.5%) were significantly lower in the control group. Both groups showed a similar frequency of nausea (control group 25% vs target group 34%). Vomiting was mainly found in the control group (20.8% vs 1.9%). Both groups showed comparably good results in bowel cleansing. Between the two groups we found no differences in specific bowel bacterial flora. Characteristic and number of postoperative complications were similar low (5.7 vs 3.8%). CONCLUSIONS: Due to a better compliance by oral application, the lower given amounts of liquid and the equal cleansing effect we prefer the use of the PEG containing solution (Oralav).

Adult↗
PubMed1992

[Minimally invasive surgery of the rectum].

Low precision of transanal techniques, their limited area of application and high rate of complications of extensive surgical techniques led to the development of an endoscopic surgical system. Its main indication is the removal of broad based adenomas and early rectal cancers. Further indications are palliative excisions of advanced cancers. From July 1983 till December 1990 the endoscopic system has been employed on 233 patients. The total sum of operations raised to 251 cases due to recurrences and new tumour formations. The overall crude 5 year survival with merely local removal of rectal cancer was 67% for early rectal carcinoma patients and 75% for patients with pT2 carcinomas. Early postoperative complications consisted of 5 intraperitoneal perforations, 4 recto-vaginal fistulas and 4 haemorrhages (complication rate 5.2%). There were 2 postoperative deaths due to cardiopulmonary failure (clinical lethality 0.8%). The overall recurrence rate of adenomas was 4.9%. In accordance with the selection criterias of other authors, our selection criteria for curative local excisions of rectal cancers enclose tumour diameter less than 4 cm, pT1 carcinomas, low grade malignancy and tumour free margins of locally excised specimen.

Adult↗
PubMed1991

[Palliative surgical treatment of cancer of the esophagus].

Palliative surgery, including cleaning resection, colon or stomach bypass, intubation or fistula is all one can offer to the majority of patients suffering from oesophageal carcinoma due to an usually advanced tumor stage at the time of diagnosis. The primary goal is to prevent or resolve dysphagia. A prolongation of survival time can - with the exception of cleaning resection - not be expected by these procedures. The average survival time was 9.4 months after cleaning resection and 4.7 months after other palliative procedures in our series. If a cleaning resection is not possible, the endoscopic implantation of an endotube is the treatment of choice because of its low mortality and morbidity.

Adenocarcinoma↗
PubMed1991

[Thoracotomies in thoracic injuries--indications and results].

Most thoracic injuries can be treated adequately with intensive care, pleural drainage and judicious physiotherapy. From the total of 571 patients with severe thoracic injuries treated in the Surgical Department of the University of Cologne over the last 10 years, 14% of those with blunt trauma (BT) and 33% with penetrating trauma (PT) underwent thoracotomy. Thoracotomy for PT was usually performed earlier and gave better results than thoracotomy for BT. With one exception, all PT underwent thoracotomy in the first 24 h after admission. For thoracotomy carried out for BT however, 38% took place after 24 h and 21% after 5 days. Postoperative mortality for BT was 3 times higher than for PT (56% vs. 18%). Reasons for this are to be found in the severe thoracic and general injuries associated with BT. The surgical procedure will depend on the type and extent of the thoracic and general injuries and on the general condition of the patient.

Adolescent↗
PubMed1991

[Treatment of advanced non-small cell bronchial cancer--a review of the literature of the last 5 years].

In the course of a metaanalysis concerning adjuvant therapy and the therapy of inoperable non-small-cell carcinoma of the lung, undertaken from 1.1. 1985 to 1.5. 1990, 376 publications were evaluated on a point system based on a decision tree. Out of a maximum of 71 obtainable points only 5.4% of the publications on adjuvant therapy and only 7.3% of publications on palliative therapy obtained more than 45 points. Regarding inoperable cases X-ray therapy with a median survival of 11 months and satisfactory life quality demonstrated the best results. Significant increases in survival are also possible with chemotherapy (7.4 months) in standard-dose pair combinations which, however, are associated with negative side effects on the treated patients. Immune and radio-chemotherapy cannot be recommended on account of treatment toxicity without a gain in life quality. Adjuvant therapy shows no life-prolonging effect. Consequently surgical treatment remains the first choice of therapy.

Carcinoma, Non-Small-Cell Lung↗
PubMed1991

[Surgical therapy of bronchial cancer. Healing or palliation?].

In spite of the revolutionary innovations concerning diagnostic and intensive care techniques as well as better understanding of tumour biology during the last decade, rates of resection and long-term survival in bronchogenic carcinoma could not be improved. Nevertheless there is no reason for therapeutic nihilism. On the contrary all efforts are to be done in investigation on practicable, suitable, and supportable screening programmes to improve the patients outcome.

Carcinoma, Bronchogenic↗
PubMed1991

[Role of the spleen in tumor surgery].

Tumorigenesis and tumor growth are connected with the immune system. Therefore the role of the spleen respectively splenectomy have gained increasing influence. The existing experimental and clinical results are discussed with the help of a general review of the literature. A manipulation of the immune system by splenectomy seems possible. A common pathomechanism has not yet been found. But experimental investigations are transferrable to human beings only under special conditions.

Humans↗
PubMed1991

[Mortality and morbidity conference. Perioperative fatalities].

Postoperative complications in 4675 patients were investigated. There were specific patterns of complications with significant differences between vascular and general surgery and transplantation. On the basis of test operations (inguinal hernia, cholecystectomy, resection of colon and rectum) it could be shown that differences were ward-specific. Over a period of 12 years, a certain decrease of complication rates could be demonstrated (wound infection, from 9% to 1.25%; pneumonia, from 8% to 2.5%; mortality, from 6.3% to 1.8%). Changes in clinical practice (antibiotic prophylaxis, bowel cleansing, introduction of new techniques, etc.) may be responsible for these improvements. We are convinced that a regular complication conference essentially influences the actions of physicians and nurses.

Cause of Death↗
PubMed1991

[Effect of accidental splenectomy on long-term outcome in colorectal tumor surgery].

In the period from 1967 till 1988 an accidental splenectomy was carried out at 1318 colon resections because of a malignant tumor in 34 cases (2.5%). The preoperative risk of this patient group was increased clearly in opposite to the whole patient clientele. So every fifth suffering from ileus or subileus was operated as in emergency. The complication rate, time of rest and clinic lethality were increased. The five-years survival rate did not change significantly in stage T1 and T2 in comparison with the whole patient clientele. In the stage T3, however, a significant prolonged survival rate was found out in the target group. Therefore the oncological aspect does not supply any reason to preserve the spleen in colorectal tumor surgery.

Adenocarcinoma↗
PubMed1990

[Neopterin as a marker of aspecific immunostimulation with Propionibacterium avidum KP-40 in patients with gastrointestinal tumors. A prospective randomized study].

This prospective randomized study demonstrated that a preoperative intravenous infusion of 10 mg of the bacterial preparation Propionibacterium avidum KP-40 to patients with gastrointestinal tumors significantly (P less than 0.001) enhanced the secretion of neopterin, measurable as long-lasting (greater than 16 days) elevated urine excretion. Postoperative re-infusion of P. avidum KP-40 caused (statistically significant (p less than 0.001] re-enhancement of neopterin urine levels.

Adult↗
PubMed1990

Surgical therapy of oesophageal carcinoma.

During the past 10 years, postoperative mortality associated with surgical treatment of oesophageal carcinoma has been reduced by one-half. However, it appears that all efforts to improve long-term survival with extensive excisional procedures and adjuvant chemotherapy and radiotherapy have failed. Fifty-six of 100 patients presenting to the surgeon with an oesophageal carcinoma have resectable disease. Recent studies suggest that seven of them will die from postoperative complications and 49 patients will be discharged from the hospital after an average of 3 weeks. Of these patients, 27 will survive the first, 12 the second, and ten the fifth year. Although it may be possible to further reduce postoperative complications and mortality, the chances of improving the long-term prognosis of patients with oesophageal carcinoma seem small.

Combined Modality Therapy↗
PubMed1990

[Splenic cysts: indications for surgery and surgical procedures].

Based on a late physical examination of 18 patients with splenic cysts, we discuss symptoms, diagnostics and indication to operate and the procedure of operation. We found no specific symptoms. The ultrasound is the most important diagnostic method and may be supplemented by computerized axial tomography. The indication depends on the symptoms, the diameter within the organ and, most important, the dignity of the cyst. For pseudocysts we prefer resection of the cyst wall, because it is a simple and safe procedure. Splenectomy is the treatment of choice for cysts with unknown dignity.

Adolescent↗
PubMed1990

[Monitoring and management of the central nervous system in treatment of tumor cachexia].

After palliative surgery artificial nutrition is indicated primarily in patients receiving postoperative chemotherapy or radiotherapy. The techniques of ambulatory enteral or parenteral nutrition have been standardized during the past decade. They can be used with minimal risk even in patients with advanced cancer. An improvement of the nutritional status can be expected in most of the patients. Further clinical trials are needed to determine whether the patients' quality of life improves.

Cachexia↗
PubMed1990

[Effect of errors (particularly one's own!) on making surgical decisions].

Looking for medical errors in clinical practice we reviewed several cases from our daily indication and case conference, 6 cases discussed in the lethality conference and 9 which were treated by legal institutions. The points of criticism were analysed. We discriminated between diagnostic, therapeutic failures and those of organisation. The basis were 4045 patients with 4583 operations during the year 1989. The overall lethality was 1.2%. The instruments of avoiding medical errors in individual and general sense were shown.

Clinical Competence↗