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Biomedical subjects

H Pichlmaier

Publications and source records attributed to H Pichlmaier.

At least 109 records · Page 6Linked to original sources
PubMed1987

[Spontaneous and other non-tumor-induced esophageal perforations].

The outcome of esophageal perforation is determined by the cause and localisation, but mainly by the time lapse between trauma and therapy. Spontaneous and intraoperative ruptures are most dangerous. Treatment of choice is direct closure and drainage. If this is not possible, esophagectomy or exclusion and diversion in continuity should be considered. The injury may present itself with rather unspecific symptoms. Pathological findings in the plain chest roentgenogram and gastrographin study will confirm diagnosis in nearly all cases.

Adolescent↗
PubMed1987

[Surgical therapy of squamous cell carcinoma of the esophagus--limited radical intervention].

Within 23 years 237 esophageal resections were performed in patients with carcinoma of the esophagus. 115 had epidermoid cell carcinoma. After resection of the esophagus 15.3% survived 5 years. The follow-up rate over the whole period is 96%. In respect to survival only the degree of differentiation, the stage and the hospital lethality significantly influence survival. In historical comparison the blunt dissection was able to lower hospital lethality. This could not be shown in our material within a comparable time. In order to evaluate the outcome after 5 years in regard to radical transthoracic operation and blunt dissection we did a matched-pairs-analysis. There was no difference in both groups.

Carcinoma, Squamous Cell↗
PubMed1987

[Value of preoperative risk factors in patients with resectable esophageal cancers].

Since 1. 1. 1964 245 patients with oesophageal carcinoma underwent resection at the department of surgery of the university of Cologne. A significant correlation between stage, localisation or type of carcinoma and the postoperative mortality was not found. It was possible to develop organ specific scores which were able to detect groups of patients with a high postoperative mortality, but the predictive value of these scores was too small for relevant clinical decision making.

Adenocarcinoma↗
PubMed1987

[Limits of cancer surgery].

Cancer patients show special characteristics which the doctor has to know. The therapy is based on the knowledge of the course of common forms of cancer. The documentation, classification and stratification of these forms of cancer is the basis for therapeutic decisions. The latter especially depends on an assessment of probabilities amongst which the quality of life plays a major role. In the advanced stage it is the control of symptoms, the relief of pain and the encouragement of social rehabilitation that are important. The experiences in the treatment of 129 patients over a period of 3 years are described.

Humans↗
PubMed1987

[Aneurysm of the infrarenal abdominal aorta].

Preoperative and postoperative treatment as well as standardisation of surgical techniques over the past 20 years have helped to bring about considerable reduction of operative mortality in cases of asymptomatic aortic aneurysm. Yet, with all improvement, rupture of aneurysm has continued to be associated with high rates of mortality. At the Department of Surgery of Cologne University, between 1963 and 1985, operations were performed on 681 patients for abdominal aortic aneurysm. Asymptomatic aneurysm were surgically removed from 41.7 per cent of them, while 27.5 per cent underwent surgery in symptomatic stages. Aneurysm had ruptured in 210 patients. Operative mortality accounted for 5.3 per cent of all asymptomatic patients. High mortality rates among patients with ruptured aortic aneurysms were attributable to preoperative shock. Only 16.3 per cent of patients survived in this group. The mortality rate among patients without shock amounted to 39.5 per cent.

Adult↗
PubMed1987

[Quality assurance in surgery: possibilities and limits].

Quality control in surgery is undertaken to check on effects of preoperative risk, choice of surgical technique, use of surgical technique, and peri-operative therapy on the results of an operation. Attention is given, in this context, not only to complications but also to postoperative quality of life and prognosis, with efforts being made to quantify these latter aspects. Useful information can be obtained only by neutral data collection undertaken independent of the surgeons involved.

Humans↗
PubMed1986

[Vagotomy and vagotomy follow-up--results of a survey].

A survey of 1006 surgical clinics in the Federal Republic of Germany in 1984 showed that the general surgical procedure for duodenal ulcers was vagotomy in 65.9%. 21.9% of the clinics checked the effectiveness of vagotomy intraoperatively by either performing electrostimulation (69.6%), leucomethylene-blue staining (20.9%), monitoring of the intragastric pH-value (7.3%), or Congo-red test (1.4%). Postoperative vagotomy controls were performed in 51% of the hospitals. Judging by the present results, application of intraoperative effectiveness control is not necessarily advisable. Evaluating the pre- and postoperative acid production allows the establishment of a quality control, however without any prognostic relevance.

Duodenal Ulcer↗
PubMed1986

[Indications for splenectomy in non-malignant systemic diseases].

The benign systemic disorders with involvement of the spleen are divided into haematologic diseases, thesaurismosis, collagenosis, morbus Boeck, infectious diseases, parasitosis and others. 4/5 of the cases are haematologic diseases of the erythrocytic, the thrombocytic and lymphatic system as well as myeloproliferative and aplastic syndromes. 227 of 1214 splenectomies of the last 20 years were done in benign systemic diseases. The functional and mechanical hypersplenism as a rule is the cause for operation. The specific indications, the medical pretreatment and the combination of surgery and non-surgical measures are discussed.

Collagen Diseases↗
PubMed1986

Oesophageal stenosis--a complication of sclerotherapy of oesophageal varices.

A total of 246 non-selected patients with oesophageal variceal haemorrhage were treated with the intravascular high-pressure injection technique. Approximately 200 ml of the sclerosant were injected in three sessions. Reliable destruction of the varices in the absence of necrosis/ulceration along the variceal "column" must be considered doubtful. Owing to misplaced (paravasal) injection, 11 patients (4.4%) developed an oesophageal stenosis. All these stenoses were curatively treated with the ESKA-Buess multiple-diameter bougie. The stenosis can be negotiated under endoscopic vision, and, in the immediately following bougienage procedure, dilated up to 16 mm. The presence of mucosal bridges in the stenotic oesophagus is essential for curative bougienage. The use of a circular paravascular injection technique in the distal oesophageal mucosa is not to be recommended.

Adult↗
PubMed1985

[Prophylactic immunoglobulin administration after major gastric resections. A prospective randomized study].

Immunoglobulins in a dosage of 0,25 g/kg body weight were administered in a prospective randomised study prophylactically to 90 out of 180 patients with gastric surgery of variable extent on the day of operation and on the first postoperative day. Wound infection rates of the treated group were 4.4%, of the control group 14.4%. In addition, the control group had a pneumonia rate of 21% and the treatment group of 11%. However, there were no differences between both groups as regards other assessments (mortality, further postoperative complications, time of hospitalisation, duration of ventilation, postoperative use of antibiotics). It can be concluded that although immunoglobulins lower the risk of infection prophylactic administration should for reasons of expense be limited to patients with preoperatively increased pulmonary risks. The appropriate therapeutic use is to be evaluated.

Gastrectomy↗
PubMed1985

[Functional anatomy of the anorectal sphincter].

Sensory component, reflexes and motor components are responsible for anorectal continence. The most important factors are the extraperitoneal part of the rectum, the M.m. sphincter ani internus and externus, the levator ani muscles and the corpus cavernosum recti. The diagnostic of anal incontinence is usually evident from history and physical examination. Additionally intraluminal pressure recordings and electrical measurements are helpful.

Anal Canal↗
PubMed1985

[Results following colorectal interventions--an analysis over 36 years].

The data of 407 patients with colon carcinoma and 346 patients with rectum carcinoma treated in the last 36 years were analysed retro- and prospectively as regards the operative technique, the perioperative treatment and the postoperative complication rates. It was shown that the number of tumour resections increased continuously and that the percentage of deep anterior rectal resections rose since 1981. The mortality rate after tumour resections could be reduced to 1.5%. Most decisively for the improvement of the results was the introduction of a regular quality control system.

Anti-Bacterial Agents↗
PubMed1985

Endoscopic surgery in the rectum.

A new transanal endoscopic operative technique permits microsurgery in the rectal cavity and the placing of surgical sutures. Compared with other procedures this one is non-aggressive, and there were not postoperative complications in twelve cases. A stereoscopic optical system, a new operating rectoscope and special surgical instruments, as well as a modification to an insufflation device are necessary for the endoscopic operation.

Adenocarcinoma↗
PubMed1985

[Cryotherapy of rectal cancer. Immunologic results].

On the basis of experimental studies carried out in animals several authors could demonstrate that cryotherapy is able to induce a raise of auto- and tumour-antibodies. The specificity of these reactions has been proved. Comparative analysis could verify greater immune response after 'in situ-destruction' of tumours than after conventional surgical excision. In 13 patients cryosurgically treated for inoperable rectal carcinoma a raised concentration of IgG and IgA could be shown in several patients in the area surrounding the carcinomatous cells by means of a direct immune fluorescent technique in biopsies of the tumour. Immune globulines of the class IgA seemed to be important. Our results suggest a probable correlation of immune response and clinical course. The prognostic value of our method has to be examined in a larger group of patients and laboratory experiments. Cryotherapy can be regarded as one of several possible forms of treatment to brake the barrier of immunity in cancer patients.

Adenocarcinoma↗
PubMed1985

[Current status of therapy of liver metastases of colorectal carcinoma].

Surgical removal of liver metastases stemming from colo-rectal carcinoma is the therapy of choice of this disease. Postoperative mortality is 8%, 5 years survival rate ranges between 22 and 52% and can be considered to be good. However in 85% of patients surgery is not possible because of widespread involvement of the liver. Systemic chemotherapy yields remission rates up to 23% without increase of survival time, and therefore is no real alternative. Infusion of cytostatic drug into the hepatic artery yields better results, e.g. remission rates up to 85% and average survival times up to 26 months.

Antineoplastic Agents↗
PubMed1985

[Experiences with 2 years of quality control following general and vascular surgery in 3193 patients].

3193 general and vascular surgical interventions were prospectively controlled regarding the postoperative complication rates. The examination of all complication data was necessary to define the risk of the various operations. By a regular follow-up system the risk of wound infections and other complications decreased. Although perioperative antibiotic prophylaxis and stapling devices for gastrointestinal end-to-end anastomoses were routinely used, the surgeon still influenced the complication rates.

Arteries↗