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I Gastinger

Publications and source records attributed to I Gastinger.

At least 37 records · Page 2Linked to original sources
PubMed2004

Emergency operation in carcinomas of the left colon: value of Hartmann's procedure.

BACKGROUND: Colonic resection according to the procedure by Hartmann is considered a fast and safe surgical intervention, which has been used for years, in particular, in emergency situations. METHODS: Using data of a prospective multicentre study on the operative treatment of colorectal carcinoma over the time period from 1 January 2000 to 31 December 2002, the value of Hartmann's procedure was investigated in carcinoma of the left colon (n=8825) compared with alternative surgical options under emergency circumstances. The significant impact of independent variables on the type of the selected approach was determined by means of logistic regression. RESULTS: While in total 422 primary Hartmann's procedures (4.8%) were executed under curative intention, 213 (50.5%) of those were carried out in emergency situations. Hartmann's procedure was beneficial in cases with tumour-associated obstruction and perforation of the left colon as it resulted in the lowest mortality (7.5%) of the radical operations. Even under palliative intention, Hartmann's procedure was preferred at the left colon but led to a postoperative mortality (32.7%) very similar to that in creation of a colostoma (33.3%) or segmental colonic resection (38.9%). CONCLUSIONS: Hartmann's procedure has been widely accepted as a curative intervention in emergency cases (oncosurgically adequate R0 resection) for the carcinoma of the left colon. Because of the high postoperative morbidity and mortality in emergency situations with only palliative options (R0 resection not possible), alternative endoscopic treatment should be considered more frequently.

Adenocarcinoma↗
PubMed2004

Perineal wound closure after abdomino-perineal excision of the rectum.

Wound infections have a significant impact on the postoperative morbidity after abdomino-perineal rectum resection (APR). However, the technique of perineal wound closure after APR has not been standardised yet. The prospective German multicentre trial "Colorectal Carcinoma (primary tumor)" (study I) enrolled 10 335 patients with rectal cancer over a time period from 1 January 2000 to 31 December 2002. The APR rate was 24.7% (n=2517). Four hundred and forty-five patients (17.6%) developed an infectious complication of the perineal incision. In contrast, the data of the reporting single centre participating in study I were as follows: patients with rectal cancer, n=206; APR, n=37; APR rate, n=18.0% (study II). In our surgical department, a standardised technique of perineal wound closure comprising tight sutures of the tissue in three layers (muscle, ischiorectal and subcutaneous fat), local administration of carriers releasing antibiotics and a redon drainage were used. Using these tools, the rate of septic perineal wound complications was considerably lower with 5.4% vs. 17.6% in the multicentre trial.

Adenocarcinoma↗
PubMed2004

[Benefits and effectiveness of recording somatosensory evoked potentials in surgery on the carotid artery].

BACKGROUND: Operative treatment of high-grade carotid stenosis is an established procedure. The question whether a temporary - either selective or routine - shunt is needed, is a matter of controversy, and the decision is based on a number of available monitoring procedures. Within the framework of quality assurance based on the regular collection of our own patient data, carotid thromboendarterectomy (TEA) with recording of somatosensory evoked potentials (SEP) was analysed for its effectiveness. PATIENTS AND METHODS: Two non-randomised groups of patients were analysed retrospectively: Group I: 99 carotid TEAs with no recording of SEP (1.1.99-31.12.99); Group II: 139 carotid TEAs with SEP recording (1.1.01-31.12.01). These two groups were unselected in terms of procedure, as also with regard to age, sex, stage or degree of carotid stenosis or surgeon, and were homogeneously distributed. A comparison was made of anaesthesia and operating times, shunt rate and the outcome of the two groups. Additionally, the two subgroups surgery with no shunt, and surgery with shunt, and the subgroups thromboendarterectomy with patchplasty (TEA) and eversion endarterectomy (EEA), were analysed. RESULTS: A temporary shunt was employed in 41 (41.4 %) of the patients in Group I (no SEP recording) and in 16 (11.5 %) of those in Group II (SEP recording). The average operating time in Group II was 11.4 min shorter (p < 0.001) than in Group I. The average carotid clamping time in Group II was significantly reduced (by 4.2 min; p < 0.001), while the duration of anaesthesia prior to skin incision was increased by an average of 18.3 min (p < 0.001), and the overall duration of anaesthesia by an average of 15.8 min (p < 0.001). A comparison of the subgroups surgery with no shunt and surgery with shunt revealed - both in Group I and Group II - a significant prolongation of the anaesthesia time and operating time (p < 0.001). In both Groups I and II, the subgroup TEA revealed a significant prolongation of both the anaesthesia and operating times vis-à-vis EEA. The major stroke rate was 2.0 % in Group I and 1.4 % in Group II, and the minor stroke rate 3.0 in Group I and 3.6 % in Group II; no deaths were observed. CONCLUSIONS: A reduction in the shunt rate to 11 % (by means of SEP) significantly decreased the average operating time (incision - suture) and the clamping time, with identical outcome in Groups I and II. Despite a reduction in the average incision-suture time in Group II (with SEP recording), the average overall operating time (anaesthesia time) was significantly increased due to the greater technical effort required. Carotid TEA with a selective shunt as determined by SEP is a high-cost procedure with no demonstrable benefit. At a stroke rate < 5 % and a need for stratification into several groups in accordance with the AHA classification, it is not possible to achieve adequate patient recruitment for a randomised analysis of outcome of the individual monitoring procedures. Alternative procedures are the routine use of a shunt and operation under regional anaesthesia.

Adult↗
PubMed2003

[Importance of rectal extirpation for the therapy concept of low rectal cancers].

INTRODUCTION: The main objective of surgery of rectal carcinomas is to avoid a permanent colostomy by sphincter-sparing surgical procedures. A variety of different abdominoperineal resection rates is described in the literature. MATERIAL/METHOD: The study was performed in 2000 within the framework of a multicentric study including 282 hospitals. The purpose of the study was to document the quality of diagnosis and therapy for colorectal carcinomas.A total of 9477 patients were included in this study: 3402 suffering from a rectal carcinoma and 6075 suffering from a colon carcinoma. RESULTS: A total of 866 abdominoperineal resections was performed. This corresponds to an abdominoperineal resection rate of 27.4%. In 30.4% of all men and in 23.0% of all women an abdominoperineal resection was performed. Of all tumor patients who underwent abdominoperineal resection, 8.3% had a pT4 carcinoma and 57.5% a pT3 carcinoma. Adapted to the localization of the tumor in the rectum, i.e., the distance of the aboral tumor margin to the anal verge, the following abdominoperineal resection rates were found: <4 cm from the anal verge 84.6%, 4-7.9 cm 43.9%, 8-11.9 cm 5.8%, and 12-16 cm 0.5%.Intraoperative complications occurred in 11.8%, specific postoperative complications in 33.1%, and general postoperative complications in 27.4% of the patients. The postoperative lethality was 2.8%. The mean postoperative hospital stay was 21.7 days. Logistic regression identified the body mass index, gender, the distance of the carcinoma from the anal verge, and the T category as independent factors influencing the abdominoperineal resection rate. DISCUSSION: Despite an overall decrease in use, abdominoperineal resection will continue to play an important role for the surgical treatment of low rectal cancers in routine clinical practice in Germany. It will remain an individual decision for each patient whether the tumor and the patient allow sphincter preservation or whether abdominoperineal resection seems to be necessary. According to the results of the present study,a general definition of an abdominoperineal resection rate in an unselected group of patients should be viewed critically.

Adult↗
PubMed2003

[Solitary renal cell carcinoma metastasis to the thyroid gland--a paradigm of metastasectomy?].

We investigated the usefulness of thyroidectomy for solitary metastases from renal cell carcinomas in ten patients. In the absence of postoperative morbidity and mortality, a mean survival time of 3.4 years was observed. Subsequently, four patients developed intracerebral metastases. Swelling of the neck and the discovery of a nodule in the thyroid of patients who have undergone nephrectomy for renal cell carcinoma should raise suspicion of a metastasis, possibly after a long latency period. With the aid of modern immunohistochemical methods, renal cell carcinoma metastasis can now be identified unequivocally, with differentiation from a primary follicular carcinoma of the thyroid rendered possible by a combination of TTF-1, thyroglobulin, and CD 10. In the event of a solitary lesion with no extrathyroidal tumour manifestation, an R0 resection of the metastasis should always be attempted. If tumour dissemination has occurred, palliative measures and endoscopic intervention (e.g. placement of an endotracheal stent) with the aim of improving quality of life by preventing obstruction of the airways are justified.

Adenocarcinoma, Follicular↗
PubMed2003

[The value of intraoperative neuromonitoring in thyroid surgery--a prospective observational study with 926 patients].

The data obtained from 926 patients who, between 01.01.1998 and 31.12.2000, underwent thyroid gland surgery involving the use of neuromonitoring (NM) were recorded prospectively. Every patient was submitted to a preoperative and postoperative laryngoscopic examination by an ENT specialist unrelated to the department. Immediately following surgery, 58 patients were diagnosed as having unilateral or bilateral laryngeal nerve palsy. All of these patients were subsequently followed up by an ENT specialist on an outpatient basis, and 68.3 % (n = 41) of the laryngeal nerve palsies detected immediately after surgery were seen to have resolved. For first operations for benign goitre, a side-related nerve palsy rate ("nerve at risk") of 0.51 % was found. For recurrence surgery, this rate increased to 6.6 %, and for surgery of malignant lesions it was 4.8 %. The conclusion is drawn that in first operations for benign goitre, NM can be employed when and as dictated by the intraoperative findings. In the case of surgery for recurrences or malignant disease, however, intraoperative NM should be applied on a routine basis.

Electrodes↗
PubMed2003

[Prospective multicenter study for quality management of breast cancer surgery].

Over the last 10 years a dramatic decrease became apparent in primary treatment of breast cancer in general surgical departments. A prospective 1-year observational study involving 84 surgical departments was carried out to describe the current therapeutic situation. A total of 1,416 patients undergoing primary surgical treatment for mammary carcinoma were recorded, and their data evaluated. 68.9% of the carcinomas were treated in departments with an annual case load for this disease of more than 20 operations, with 50% of them being operated on in 8 departments with a case load of 40-100 procedures per year. 94.4% of the carcinomas were confirmed histologically, and in 91% of the patients surgery was performed in curative intention. The rate of breast-preserving procedures was 40%, and breast amputations accounted for 60%. An analysis of the data allowed an evaluation of this specific patient group in the surgical departments. Deficits in terms of management quality are identified.

Adult↗
PubMed2003

[Life-threatening complication of the Nuss-procedure for funnel chest. A case report].

This report is the first description of an additional major complication seen with the Nuss repair. In addition to the conventional Rehbein and Ravitch operations for funnel chest, the minimally invasive procedure developed by Nuss has recently been added to the therapeutic options. The present report describes the case of a 21-year-old man who underwent a Nuss repair with implantation of 2 pectus bars 4 months previously. During the primary operation the central tendon of the left diaphragm was unnoticed injured. We performed an emergency operation on the patient to repair an incarcerated diaphragmatic hernia. The thorax was found to contain not only the entire, twisted stomach, but also the transverse colon and the spleen. During induction of anaesthesia the patient suffered a cardiovascular collapse. After successful resuscitation, thoraco-abdominal surgery was performed and the diaphragm closed from the thoracic side. Other authors have also reported major life-threatening complications of the Nuss-procedure, such as perforation of the heart. A careful evaluation of this procedure and the establishment of clear indications taking the age of the patient, the thoracic deformity and connective tissue disease into account, are mandatory to avoid discredit of this method.

Adult↗
PubMed2002

["Colon-/rectal carcinoma" prospective studies as comprehensive surgical quality assurance].

INTRODUCTION: Currently, only a small percentage of the diagnostic and therapeutic data on colonic carcinomas has been confirmed by data obtained in randomized controlled studies. For this reason, the results of prospective multicentre observational studies are extremely important. METHOD: Within a multicentre observational study involving 75 surgical departments carried out between 01.01. and 31.12.1999, 3,756 patients with a colorectal carcinoma (2,293 carcinoma of the colon; 1,463 carcinomas or the rectum) were investigated prospectively using a standardised questionnaire. RESULTS: The OP rate was 98.4%, the resection rate 92.5% (colon 94.1%, rectum 89.9%). The rate of rectal extirpations was relatively high at 30.3%. General postoperative morbidity was 27.4% (colon 27.0%, rectum 27.9%); the specific postoperative morbidity was 24.6% (colon 21.8%, rectum 29.1%). The anastomotic insufficiency rate was 5.2% (colon 3.7%, rectum 9.5%). The 30-day mortality rate was 4.7%, and the postoperative mortality rate 5.7%. CONCLUSIONS: Surgical quality control in the form of prospective multicentre observational studies make possible the analysis of the therapeutic situation of a surgical disease under quality assurance aspects. At the same time, the comprehensive data material available will serve the specific planning of prospective randomized studies. With the aid of the present study, a basis for a thorough and complete evaluation of colorectal carcinoma has been created.

Adolescent↗
PubMed2002

[Significance of prospective multicenter observational studies for gaining knowledge in surgery].

The meta-analysis of randomised controlled studies (RCS) achieves the highest degree of reliability. Although the status of prospective multicenter clinical trials (PMS) is the subject of controversial discussion, recent publications suggest that these two forms of analysis reveal comparable results. On the other hand, particularly in the operative part of medicine, the problem of recruitment and performing of controlled studies for the more rapid evaluation of new surgical procedures becomes more evident. We followed these two aspects by using a separate analysis of data and biostatistical models. In the evaluation of single aspects, under no circumstances can non-controlled clinical trials replace randomised clinical studies in surgery. Only the use of a variety of forms of analysis in clinical research will lead to the desired scientific findings.

Data Interpretation, Statistical↗
PubMed2002

[Open vs. laparoscopic appendectomy].

This article discusses the question of whether open or laparoscopic appendectomy is preferable in today's clinical routine. The article is based on data from randomized studies, evaluation of meta-analyses, and data from nonrandomized, multicentric studies evaluating the treatment of appendicitis in routine clinical practice. According to the data analysis, open appendectomy (OA) offers advantages with regard to a significantly shorter operative time and lower hospital costs. Laparoscopic appendectomy (LA) is characterized by a significantly decreased rate of failed septic wound healing and faster recovery. Both procedures can be performed with the same degree of safety and comparable outcome for acute appendicitis. Laparoscopic appendectomy offers significant advantages for establishing a precise diagnosis in young fertile women and overweight patients suffering from lower abdominal pain. The currently available data do not provide precise guidelines for the treatment of perforating appendicitis. However, we found significant evidence indicating an increased rate of postoperative intra-abdominal abscess after laparoscopic appendectomy. Thus, a laparoscopic approach cannot be regarded as a standard technique in advanced appendicitis.

Abdominal Abscess↗
PubMed2002

Routine use of transrectal ultrasound in rectal carcinoma: results of a prospective multicenter study.

BACKGROUND AND STUDY AIMS: Preoperative transrectal ultrasound (TRUS) can establish the depth of penetration of a tumor, and thus provide important information for decisions about further management. In the literature, this method is reported to have a high level of sensitivity and specificity. Our investigation aimed at establishing the quality of the diagnostic procedure and treatment of colorectal carcinoma. PATIENTS AND METHODS: This investigation, which covered a 1-year period, and involved 75 hospitals, was conducted in the form of a prospective multicenter study and included a total of 3756 patients. For rectal carcinomas, all endosonographically determined uT categories were compared with histologically established T categories (pT). RESULTS: At 49 hospitals a total of 499 TRUS examinations in 1463 rectal carcinomas (34.1 %) were performed. A comparison of uT with pT category was possible for 422 TRUS examinations. Agreement between the preoperative endosonographic diagnosis with the histological diagnosis was found in 63.3 % (n = 267) of cases (95 % confidence interval 58.5 % - 67.9 %). The diagnostic accuracy was 50.8 % for pT1 carcinomas, 58.3 % for pT2 lesions, 73.5 % for pT3 tumors, and 44.4 % for pT4 carcinomas. Overstaging was observed in 23.9 %, overall, and understaging in 12.8 %. Understaging was significantly less common than overstaging (P < 0.05, s.). CONCLUSION: The accuracy of transrectal ultrasound used as a routine clinical examination in rectal carcinoma patients was clearly lower than that reported in the literature. We conclude that TRUS may aid decisions relevant to treatment only when used by well-trained investigators with a large case load of rectal carcinoma patients. Centralization of transrectal ultrasonography service is mandatory if a high level of quality is to be achieved with this method.

Carcinoma↗
PubMed2002

[Laparoscopic treatment of iatrogenic perforations of the colon].

Iatrogenic perforations of the colon are serious complications that have been observed in association with both diagnostic and therapeutic colonoscopies, and are not always avoidable, even in the hands of an experienced investigator. Patients suffering from a perforation during elective colonoscopy are starving, and have a clean bowel. If the perforation is quickly diagnosed with only local mild peritonitis, laparoscopic treatment is often possible. The therapeutic options available are: oversewing, wedge resection and, in the individual case, tubular resection, as well as laparoscopic-assisted reconstruction, if indicated including a protective stoma. The decision to perform a laparoscopic procedure should depend on the time of detection of the lesion, and on the skills of the existing surgical team; otherwise, a laparotomy is indicated. We describe four cases that reflect the relevance of the laparoscopic approach.

Aged↗
PubMed2002

[Appendicitis in the last decade of the 20th century--Analysis of two prospective multicenter clinical observational studies].

AIMS OF THE STUDY: The authors present an accurate and comprehensive snapshot of appendicitis in the last decade of the 20 (th) century. The present study also aims to determine the influence of introduction of laparoscopic techniques on the quality of appendicitis therapy. PATIENTS AND METHODS: All consecutive patients admitted for suspected appendicitis were recruited into this prospective multicenter study. Two different periods of time were considered: from 1. 7. 1988 to 31. 12. 1989, 6 266 patients from 18 hospitals were included, and from 1. 6. 1996 to 31. 5. 1997, 7 398 patients from 34 institutions. RESULTS: In the first period (1988/89), 1 869 patients were treated conservatively (29.8 %), 4 397 (70.2 %) were operated. Histopathological analysis of the appendix documented no acute inflammation in 28.8 %, the perforation rate was 8.3 % and the wound infection rate 9.6 %. In the second period (1996/97), 2 430 patients were treated conservatively (32.8 %), in 24.9 % of all operated cases, the histopathological examination shows no acute inflammation of the appendix, the perforation rate was 5.9 % and the rate of wound infections 2.5 %. During this second period, 33.2 % of all appendectomies were performed using the laparoscope, the conversion rate was 7.2 %. CONCLUSIONS: The introduction of laparoscopic techniques did not modify the operative indications for treatment of appendicitis. An increase in the number of normal appendices removed was not observed. The number of perforations and the incidence of wound infections was significantly reduced in the second period.

Adolescent↗
PubMed2002

[Prospective multi-center study colon/rectum carcinoma (primary tumors)--Results of the year 2000].

INTRODUCTION: Surgical quality control in the form of multicentre studies make it possible to analyse the treatment status of a given surgical illness under quality assurance aspects. MATERIAL/METHODS: On 1. 1. 2000, under the patronage of the Convent of Hospital Chief Surgeons a project (ongoing) - organised and conducted by the Institute for Quality Management in Operative Medicine at the Otto-von-Guericke University of Magdeburg - was initiated to document and collect the data of patients with colorectal cancer throughout the whole of Germany. This work is supported by the German Society of Surgery, and the Surgical Working Group, Quality Assurance within the German Society of Surgery. Currently, some 282 hospitals throughout the country are involved in establishing a prospective documentation of colorectal carcinoma. Participation in this study is on a voluntary basis. The anonymity of both patients and hospitals is guaranteed, and no hospitals wishing to participate are excluded. Both operatively and conservatively treated patients are being documented, and no randomization takes place. RESULTS: In the year 2000, the participating hospitals documented a total of 9 477 patients with a colorectal carcinoma, including 6 975 patients with a carcinoma of the colon, and 3 402 with a rectal carcinoma. The average age of the patients was 68.5 years, and there were 5 010 men and 4 467 women. The operation rate was 99.2 %, the resection rate 95.6 %. The abdominoperineal resection rate was 27.4 %. The indicators for diagnostic quality as set out by Hermanek were largely complied with, but some deviations were noted. DISCUSSION: On the basis of the data collected, structures were established for a uniform Germany-wide quality management for a clinical condition with a major health policy impact. This information make it possible for the hospitals to identify and eliminate deficits in the structural and process quality in the diagnosis and treatment of colorectal cancer, and in this way to improve outcome quality. This means that the results of medical care research have an immediate impact on the individual treatment received by a given patient.

Adult↗
PubMed2002

[The importance of laparoscopy in blunt abdominal trauma].

The importance of laparoscopy in the management of blunt abdominal trauma should be evaluated. Therefore we retrospectively analysed all patients with blunt abdominal trauma treated in the Department of Surgery at the Carl-Thiem-Hospital Cottbus between 1998 and 2000. Within this period a total number of 53 patients with blunt abdominal trauma underwent operative treatment, 20 (37.7 %) of them had primary laparoscopy. Of the 11 cases where laparoscopic operation could be completed without conversion to exploratory laparotomy, 8 patients had intra-abdominal injuries and underwent sufficient laparoscopic treatment. The percentage of so called "negative" exploratory laparotomies within this study was 13.2 %. Our analysis suggests that laparoscopy should become firmly established in the diagnostic management and, if indicated, in the treatment of blunt abdominal trauma as well.

Abdominal Injuries↗
PubMed2002

[Which factors are responsible for postoperative mortality in colorectal cancer patients?].

INTRODUCTION: The postoperative decease is the most severe complication in surgery. PATIENTS AND METHOD: Within the framework of a multicentre study between January 1 (st) and December 31, 1999, 3,756 patients, 1,463 of them suffering from rectal cancer and 2 293 from colon carcinoma, from 75 clinics were documented with the help of a standardized questionnaire. We compared data of 211 patients who died postoperatively with data of 3,484 patients who survived after surgical treatment of colorectal cancer. Logistical regressions, under inclusion and exclusion of intra- and postoperative complications, show independent influence factors on the postoperative decease and provide models for the prediction of the postoperative death. RESULTS: Compared to the patients who survived, the postoperative deceased patients were significantly older. They had a poorer risk profile and therefore a higher ASA-score (p < 0.001). 20.4 % of the patients underwent an emergency operation. General and specific postoperative complications occurred significantly more frequently. The model of a logistical regression allowed the prediction of postoperative decease with a sensitivity and specificity of 91 %. General postoperative complications such as pulmonary embolism (relative risk: 30.3), cardiac (relative risk: 24.1), renal (relative risk: 22.1), and pulmonary complications (relative risk: 12.0) are crucial for lethality. DISCUSSION: The postoperative decease is influenced by several factors. It is impossible to reduce the number of influence factors for the prediction of outcome. The general postoperative complications, however, represent a crucial problem. It is important to avoid these problems in order to reduce postoperative lethality.

Adolescent↗