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Biomedical subjects

H Troidl

Publications and source records attributed to H Troidl.

At least 145 records · Page 8Linked to original sources
PubMed1990

[Relevant "end points" for evaluation of the colon pouch after deep rectum resection].

After low colo-rectal anastomosis there is in 25% a degree of urgency and increased bowel movements. In order to improve the reservoir continence the construction of a J-shaped colonic pouch seems reasonable. We have operated 5 patients with the new technique and worked up our preliminary results in connection with a literature overview. Increased bowel movements and urgency are reduced postoperatively but some patients report pouch evacuation problems, using enemas or suppositories to empty their reservoirs. To estimate the value of this new technique innovative endpoints as overall well-being and quality of life might be more important than conventional endpoints measuring only functional results.

Aged↗
PubMed1990

[Effect of different fibrin sealants on fibroblast activity in skin wounds. Experimental studies in rats].

The effects of two different fibrin sealants on synthetic activity of fibroblasts in incisional skin wounds of rats were studied by tracer experiments with 14C-proline. Additionally the wounds and the subcutaneous rests of the fibrin sealants were examined histologically. When the sealants were applied immediately after wounding there was no difference to untreated controls. However, administration on day 3 after injury resulted in a significant increase of 14C-incorporation by both preparations. This stimulation of synthetic activity after retarded treatment must be caused by the direct contact between the sealants with their soluble components and the fibroblasts, which are more frequent in the wounds on day 3. Differences between the two preparations could only be observed in the histological examination of the subcutaneous fibrin clots. Preparation 2 induced stronger encapsulation, cell invasion, and fibrinolysis of the clots than preparation 1.

Animals↗
PubMed1990

[Pain in ambulatory surgery. A prospective follow-up study].

Although acute pain is most often the dominant symptom that causes a patient to visit the out-patient clinic there is a lack of data concerning duration, intensity and quality of pain. Therefore, the physician's treatment is most often insufficient and the patient has to fix the dose of drugs himself. To get reliable and objective data a prospective trial on 161 patients in our out-patient clinic was performed using clinical instruments for measurement. 84% of the patients reported significant pain in the out-patient clinic compared to 96% during the prehospital period. Pain intensity is highly depended on the type of injury (bone injuries hurt more than soft tissue injuries). To get more reliable data on the acute pain situation and to improve therapeutic interventions it is suggested to use the methods presented routinely.

Ambulatory Surgical Procedures↗
PubMed1989

[Quality of life as deciding criterion in routine practice and in research by the surgeon].

Symptoms and their effects on quality of life are reasons for the patient to consult the physician. They are the basis for active treatment, choice of therapeutic concepts and evaluation of success. However, quality of live parameters are rarely used and accepted as relevant endpoints to be determined after surgical interventions. 5 typical clinical situations demonstrate that only evaluating different dimensions of quality of life parameters can help to examine the success of surgical interventions. It is therefore emphasized that such parameters should be more widely used in everyday clinical case as well as in surgical research.

Activities of Daily Living↗
PubMed1989

[Quality of life--criterion in the treatment strategy of severely injured patients].

A cohort study of 202 patients showed that all different aspects of quality of life--physical function, psychological function, social function and symptoms--were altered after multiple injury. Sixty-three percent of the patients rated their quality of life after trauma as average or bad. Since the quality of life is a relevant problem after trauma, it is necessary to use it as an important endpoint to judge results after multiple injury. Findings from such studies must be integrated into existing diagnostic and therapeutic concepts.

Activities of Daily Living↗
PubMed1989

[Quality of life as a justification for high risk therapeutic concepts--pouch or simple reconstruction].

The classic endpoints of mortality and morbidity are no longer sufficient to evaluate new therapeutic concepts. Since significant differences are rarely found between the different patient groups, e.g. pouch vs simple reconstructions in the intestinal tract. Patients undergoing total gastrectomy have a better quality of life after receiving a Hunt-Lawrence-Rodino-pouch than after simple esophagojejunostomy. Similarly ileoanal pouch reconstruction in the pelvis after total colectomy impairs a patient's well-being less than classic enterostomas. Colonic pouch after following very low anterior resections could provide a new approach by substituting for rectum capacity.

Activities of Daily Living↗
PubMed1989

[Pouch formation in resection of deep rectal cancer: a recommendable method?].

A degree of urgency and increased bowel movements are experienced by 25% of patients who have a low colorectal or coloanal anastomosis. The construction of a J-shaped colonic pouch seems a reasonable way to improve reservoire continence. We used this new technique in five patients and worked up the preliminary results in connection with a survey of the literature. Increased bowel movements and urgency were reduced postoperatively, but some patients reported pouch evacuation problems, having to use enemas or suppositories to empty their reservoirs. To estimate the value of this new technique, innovative endpoints such as overall well-being and quality of life, might be more important than conventional endpoints which measure only functional results.

Aged↗
PubMed1989

[Score systems, their importance for the intensive care patient].

Scoring systems are a technique for defining patients for scientific and management purposes. A hypothetical, severely ill patient with cirrhosis, peritonitis, renal insufficiency and coagulation problems can be precisely classified: Child C, Mannheim-Peritonitis-Index 34 and APACHE II score 27 which results in a mortality of at least 70% of patients. At our own hospital, the continuous APACHE score (CAPS) has been developed and tested. The CAPS performed better than daily APACHE scores and provided useful trend information for the individual patient.

Critical Care↗
PubMed1989

[Surgical treatment of malignant tumors of the appendix].

Malignant epithelial tumours of the appendix are rare. They are mostly diagnosed by the pathologist rather than by the surgeon. Very frequently patients with these tumours present themselves with clinical signs of acute appendicitis. Right hemicolectomy is postulated to be the appropriate treatment of choice in all patients with adenocarcinomas of the appendix (colon type, cystic type). On the other hand this radical approach should be applied only to selected cases with carcinoid tumours.

Adenocarcinoma↗
PubMed1988

Usefulness and limitations of colonoscopy in a proctological clinic.

Colonoscopy is a superior diagnostic tool for the detection of cancer of the colon. Its limitations include that it is not always available and there is a great deal of discomfort for the patient. It should therefore be used as effectively as possible. The goal of this retrolective cohort study was to analyze the usefulness of colonoscopy, especially by relating it to the subsequent therapeutic impact. Indication-related groups included "rectal bleeding," "other symptoms suggestive of malignancy," and "follow-up." In 714 patients selected as a result of admission to the proctological unit of our surgical clinic, a carcinoma was discovered in 9% and an adenoma in 13.4%. Patients with rectal bleeding were found to benefit most from colonoscopy since active therapeutic management followed in 56% of the cases. On comparison, there was a direct therapeutic impact in only 10% of the colonoscopies performed for follow-up. Identification of additional factors such as mucosal proliferation markers may help to improve the efficiency of endoscopy by more specifically designating the populations at risk for colonic neoplasia.

Adult↗
PubMed1988

[Evaluating endoscopy].

Endoscopy is a safe technique with a sensitivity and specificity superior to those of conventional diagnostic procedures, which it has consequently replaced. In doing so, it has also altered many diagnostic and therapeutic concepts. Moreover, endoscopy has positively influenced the previously unaffected course of certain diseases, e.g. upper G. I. bleeding. Endoscopy benefits both the patient and the physician. Although no complete cost-benefit analysis is available, preliminary reports have been favourable. These aspects indicate that endoscopy is highly valuable in a clinical setting. It must be pointed out, however, that endoscopy as a whole has not yet been fully analyzed in any single given clinical study.

Diagnosis, Differential↗
PubMed1987

Long-term results of Troidl's technique of endoscopic pneumatic dilatation for achalasia of the esophagus. A prospective clinical trial.

In a prospective clinical trial, 26 consecutive patients underwent endoscopic pneumatic dilatation over a 10-year period. Dilatation was achieved by means of a balloon attached to a normal gastrointestinal fiberscope. With the endoscope in an inverse position, the device was placed in the cardia and the dilatation process was monitored macroscopically. Before dilatation, patients suffered from dysphagia (92%), reduced speed of swallowing (100%), symptom aggravation under stress (73%), weight loss (50%), aspiration, pain, regurgitation, and vomiting. After dilatation and long-term follow-up (mean of 5 years), symptoms could be markedly reduced, especially the speed of eating and symptom aggravation under stress. Excellent and good results (Visick scale) were achieved in 76%. Fair results were achieved in 20%. To date, perforation and other complications have not occurred. Mortality was zero. Our series was an uncontrolled trial, so the results are hardly comparable to other studies. Furthermore, the small number of patients in our study represents a weak point with regard to complications. We conclude that the main advantages of the procedure are its simplicity and practicability. The simple procedure may be the method of choice in elderly patients. Of course, no final decision can be made until a well-designed controlled trial has been carried out.

Catheterization↗
PubMed1987

[The devil's advocate--commentary on sutures].

The decision between hand suture or stapler was tested for the large bowel in randomized trials whereas retrospectively only in the upper gastrointestinal and respiratory tract. No clear difference was seen concerning patient's security and cost-time consumption. The stapler is more comfortable but the handsuture technique is still recommended. By the stapler anatomically very difficult anastomoses can be performed. Whether this is an advantage for the patient has to be tested because the technical progress may decrease physical function (incontinence!) and quality of life. In summary, the stapler, if applied critically, seems to be useful.

Gastrointestinal Diseases↗