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Biomedical subjects

H W Keller

Publications and source records attributed to H W Keller.

At least 19 recordsLinked to original sources
PubMed2001

[Idiopathic sclerosing mesenteritis. Case report and differential diagnosis of a rare disease picture].

We report the case of a 78-year-old woman with the endoscopic tentative diagnosis of a malignant tumor of the colon ascendens (biopsy without malignancy) that was removed by right hemicolectomy. Extensive mesenteric infiltration and colonic obstruction seemed to confirm this diagnosis. Surprisingly histology revealed invasion by sclerosing mesenteritis. The differential diagnoses include inflammatory pseudotumor, tumor-like fibromatosis at traumatized sites, idiopathic retroperitoneal fibromatosis, sclerosing malignant lymphoma, liposarcoma and drug-induced sclerosing mesenteritis, as well as mesenteric infiltration and metastases. Though preoperative diagnosis is not possible in most cases, the intraoperative macroscopic appearance and the histopathologic picture are conclusive.

Aged↗
PubMed1997

[Spontaneous retroperitoneal hematoma in adrenal metastasis].

HISTORY AND CLINICAL FINDINGS: A 58-year-old man was hospitalized because of acute dull upper abdominal pain, radiating into the right flank and lower abdomen. The past history was unremarkable expect for thyroidectomy, performed 30 years previously for thyroid carcinoma. There was painful resistance on palpation of the right upper abdomen. The patient had not recently sustained any trauma. BIOCHEMICAL AND IMAGING INVESTIGATIONS: Erythrocyte sedimentation rate was increased to 38 mm/h, haemoglobin concentration was 11.7 g/dl but fell to 9.9 g/dl within the first 24 hours. Ultrasound and computed tomography (CT) revealed a large retroperitoneal mass (5 x 6.5 x 15 cm), its density of 64 Hounsfield units most strongly suggesting an haematoma. CT also showed enlargement of the right adrenal. Chest radiography demonstrated a space-occupying lesion in the right upper lobe. DIAGNOSIS, TREATMENT AND COURSE: As a retroperitoneal haematoma of uncertain aetiology was suspected, a laparotomy was performed. The haematoma was evacuated and the adrenal, showing tumours changes, was excised. Histologically it was a mucocellular metastasis. The chest radiograph suggested carcinoma of the lung as the primary. The illness took a rapidly fatal course. Autopsy confirmed a poorly differentiated adenocarcinoma of the lung. CONCLUSION: Trauma or anticoagulation should be considered first in the differential diagnosis of retroperitoneal haematoma of uncertain aetiology. However, adrenal metastasis should be thought of as a rare possibility.

Adenocarcinoma↗
PubMed1996

Colorectal cancer--a multivariate analysis of prognostic factors.

The data from 1050 patients who had undergone colorectal carcinoma resection at the University of Cologne between 1976 and 1990 were studied. The aim of the study was to determine the concomitant effects on survival of several patient characteristics (sex, age, tumour localization, blood transfusion) and histopathological variables (Dukes' staging). We first calculated survival rates, both including and excluding post-operative mortality. We set up a hierarchical log-linear model for the detection of relationships between selected crossclassified categorial variables. We then used Cox's proportional hazard regression method to study the relationship between survival and different prognostic patterns. Dukes' staging was shown to be a highly discriminating factor in survival (P<0.001). Survival rates were better in women (P<0.001), and better for younger patients (<70 years; P<0.001). Tumour site (colon; P = 0.0362) and blood transfusion (P = 0.0857) also correlated with survival.

Aged↗
PubMed1996

210Pb in indoor air by total alpha measurement.

210Pb has been measured in indoor air by two methods. Low flow rate pumps and membrane filters were used to collect the samples. The air filter samples were stored for 1.7 y, after which total alpha activity was determined by scintillation counting. 210Pb was then chemically separated and measured by alpha spectrometry. The efficacy of determination of 210Pb by total alpha measurement was empirically proven. The average air concentration determined by total alpha counting was 340 microBq 210Pb m-3 and 360 microBq 210Pb m-3 by radiochemical analysis.

Air Pollutants, Radioactive↗
PubMed1996

[Current status of surgical treatment of short bowel syndrome].

Massive small bowel resection results in a short bowel syndrome, characterized by malabsorption, weight loss, diarrhea and steatorrhea. Different surgical techniques have been used to slow down intestinal transit time or to increase the area of absorption. Techniques for the deceleration of intestinal transit are reconstruction of the ileocecal-valve, antiperistaltic intestinal segments, colon interposition, recirculating intestinal loops and intestinal pacing. For increase of the area of absorption growth of neomucosa, mucosal autotransplantation, intestinal lengthening and small bowel transplantation have been performed. All these procedures are still at different experimental levels. Due to inconsistent results so far the surgical therapy of the short bowel syndrom cannot be recommended for routine use. However, some techniques offer hope of a successful surgical development.

Follow-Up Studies↗
PubMed1996

[Ambulatory artificial nutrition: 15 years experiences at the Cologne University Surgical Clinic].

Beetween 1979 and 1994 629 respectively 223 patients were treated by home enteral and parenteral nutrition. The duration of the treatment on average was 361 days in case of enteral and 346 days for home parenteral nutrition, in special cases however up to 15 years. In enteral nutrition there were no metabolic complications and only minor technical problems. Catheter related problems represented the most challenging complications in parenteral feeding. 12 out of 14 patients treated more than 1 year with home parenteral nutrition because of non-cancerous disease died from recurrent pulmonary embolism or catheter-related septicemia.

Adolescent↗
PubMed1995

Middle and lower third rectum carcinoma: sphincter saving or abdominoperineal resection?

Sphincter saving resections (SSR) are performed with increasing frequency in carcinoma of the lower and middle third of the rectum. In this retrospective study local and distant recurrence and survival were compared to abdominoperineal resection (APR). In 71 women and 71 men (mean age: 64 years) with a primary adenocarcinoma between 5 and 10 cm from the anal verge 89 SSR, and 53 APR, were performed (Dukes stages--SSR--A 19%; B 30.3%; C 50.7% vs APR--A 15%; B 45.3%; C 39.6%). Patients have been followed up for a minimum of 24 months (mean time 62 months). There were no differences in intraluminal diameters of the tumours in each operative procedure. The distal tumour-free distance was more than 6 cm in 52% after APR (SSR: 10%) and less than 3 cm in 43% after SSR. Survival was not different between procedures in Dukes stages A and B. A survival advantage for patients with Dukes C carcinoma after APR did not reach statistical significance. No differences in distant spread were found for SSR (Dukes stage A 0%; B 7%; C 18%) and APR (Dukes stage A 0%; B 8%; C 14%) for local recurrence in Dukes stages A and B after SSR (A and B 0%) and APR (A 0%; B 8%) whereas a significant increase in local recurrence rate was seen in Dukes stage C after SSR (24% vs, APR 5%). Although a further resection could be performed in almost all of these patients a negative effect of local recurrence on survival occurred (25.4 months with and 80 months without local recurrence). While SSR seems to be favourable in Dukes stages A and B, APR should be considered in carcinoma of the lower and middle third of the rectum with lymphatic spread. Effective preoperative staging determines selection of the appropriate operation.

Abdomen↗
PubMed1994

Prospective randomized study of preoperative bowel cleansing for patients undergoing colorectal surgery.

Three different methods of preoperative bowel preparation were tested in a prospective randomized trial examining efficacy and morbidity. In all, 163 patients were treated by gut irrigation with Ringer's lactate, Prepacol or polyethylene glycol (PEG). Fluid retention, cleansing effect, postoperative complications and subjective acceptance were documented. Relevant weight gain and decrease in haematocrit indicating fluid retention were seen only after the use of Ringer's lactate. There were no significant differences in bowel cleansing. In the Prepacol group the postoperative complication rate was significantly increased. Prepacol was tolerated best, with few side-effects. PEG was better tolerated than Ringer's lactate, but vomiting occurred in 2 and 21 per cent of patients respectively. PEG is most suitable for bowel preparation in patients undergoing colorectal surgery.

Adult↗
PubMed1994

Influence of various fatty acids on tumour growth in total parenteral nutrition.

The aim of parenteral nutrition in tumour patients is to offer an alternative nutritional support to the patient without accelerating the growth of the tumour. For this purpose we fed a total of 100 rats, divided into five groups of 20 animals each (10 with and 10 without tumours), for a total period of 15 days with various nutritional regimes. Group 1 received glucose, group 2 long-chain triglycerides, group 3 medium-chain triglycerides (MCT), group 4 omega-3 fatty acids, and group 5 an oral diet. On the 10th day the Yoshida sarcoma in its ascites form was implanted into the tumour-bearing rats. In animals receiving MCT or omega-3 fatty acids tumour growth was considerably smaller than in the other groups (group 1 vs. groups 3 and 4; p < 0.05). Unfavourable effects of the administration of these fatty acids on the general condition of the animals were not observed [muscle nitrogen content (mg/kg body weight): MCT = 82.3, omega-3 fatty acids = 65.25]. The impulse cytophotometric measurements did not demonstrate any influence on the pattern of cell division (p > 0.05). We think that modulation of the immune system by feeding with MCT or omega-3 fatty acids was responsible for the reduced tumour growth in relation to the other groups. The extrapolation of these results to the clinical situation, however, may not be possible.

Animals↗
PubMed1994

[Myiasis of the scalp--an incidental finding in ambulatory surgery].

Because of the increase of travels to tropical countries the physician in Germany is more often confronted with parasitic tropical diseases. In an apparently routine case a 28 year old patient suffered from infected stitches of the scalp, caused by an unknown insect, after returning from Sri Lanka. Four larvae of Dermatobia hominis, which causes the cutaneous myiasis, were found into the pyogenic furuncles and were removed by surgical approach.

Adult↗
PubMed1994

[Congenital duodenal obstruction in combination with heterotopic gastric mucosa in the gallbladder. Case report and etiology].

A hitherto unique case of ectopic gastric mucosa of the gallbladder in combination with a congenital duodenal stenosis in an young male adult is presented and the etiology of both anomalies is elucidated. While the intestinal obstruction was confirmed prior to the operation, the diagnosis of the gastric heterotopia in the gallbladder has been established, as usually, first by histopathologic examination. Both anomalies required surgical treatment. The long-standing indistinct abdominal complaints of the patient vanished after cholecystectomy and duodenojejunostomy.

Adult↗
PubMed1994

[Experience with surgical treatment of ruptures of the symphysis pubis].

Ten patients with symphyseal rupture and dehiscence of more than 10 mm who underwent different surgical procedures were reexamined between 8 and 59 months after surgery. In case of treatment within 3 weeks after the accident (n = 7) banding with completely absorbable Polydioxanon (PDS) cord (n = 4), PDS cord and crossing K-wires (n = 1), PDS-banding and plate-fixation for concomitant pubic fractures (n = 1), and wire banding (n = 1) were performed. In case of delayed operation (9 till 12 weeks after the injury n = 3) autologous bone grafts from the iliac crest were placed into the symphyseal split after removal of fibrous tissue, and double plate fixation (n = 2) respectively plate fixation and wirebanding (n = 1) were performed. There were no intraoperative and only 2 minor postoperative complications. The follow up revealed good and satisfactory results in 9 patients, and failure in one case. These results are better than to be expected from conservative management of this kind of injury. Banding with cord is a noteworthy alternative to wire banding and plate fixation.

Adult↗
PubMed1994

Intramedullary reduction and stabilisation of adult radial neck fractures.

We report the treatment of six adult patients with displaced fractures of the radial neck by intramedullary reduction and stabilisation. Nine months after operation all the patients had good joint function, little or no pain, complete healing and no significant periarticular calcification. This simple semi-closed procedure may help to avoid resection of the radial head in some cases.

Adolescent↗
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

[Intramedullary nailing of fractures during the growth period with a new implant].

Intramedullary nailing with flexible titan pins is a simple and safe method for the treatment of fractures in children. Avoiding the epiphysis two pins are introduced into the medullary space in a double-crossing way to stabilise diaphysial fractures of bigger bones such as femur, tibia or humerus. Forearm fractures are splinted with a single pin each to radius and ulna. The method is also practicable in proximal fractures of the radius, reduction and stabilisation can be achieved with an intramedullary pin in one step avoiding arthrotomy.

Adolescent↗
PubMed1993

[Development of colorectal tumor surgery in the last 20 years].

Early and longterm results in surgery for colorectal cancer during the last two decades were investigated by a retrospective analysis of the data of 1,203 patients. During the last 10 years we registered a significant increase in more advanced tumors of the stage III and IV from 37 to 52%. Nevertheless operative mortality was reduced from 8.5 to 3.5%. The amount of curative resections was 80% constantly. The incidence of local recurrence decreased from 18 to 12%, distant metastases however were observed twice as much during the last decade (16%) as compared to the first 10 years of the observation period. Longterm survival has only slightly improved, concerning mainly stage III patients with an increase of 5-year-survival from 31 to 48%. The results of a rigorous follow up after surgery for colon and rectal carcinoma were disappointing.

Adult↗