Search PubMed⌕ Search

Biomedical subjects

I Gastinger

Publications and source records attributed to I Gastinger.

At least 73 records · Page 4Linked to original sources
PubMed1999

[Intuition and surgical responsibility].

The vast majority of surgical tasks can be managed by using basic, special and experts' knowledge gained during many years of clinical training and by applying solid surgical skills. This refers to elective cases as well as to emergency surgery and to general surgeons as well as to subspecialists. Consensus statements and standards of care derived from objective study results are aimed to be helpful as practice guidelines and in the decision making process. Only rare, non-foreseeable, unexpected and suddenly occurring exceptional situations require actions based on intuition, which results from a quick, sharp and brilliant decision founded on huge knowledge and experience. But in the scope of surgical work an overstatement or a mystic glorification of intuition should always be avoided.

Evidence-Based Medicine↗
PubMed1998

[The plastic surgery concept as an important prerequisite in operative treatment of breast carcinoma].

Between 1992 and 1997, 424 female patients were treated for primary breast cancer at the Department of Surgery of the Carl-Thiem-Klinikum in Cottbus. The percentage of breast conserving surgical methods hat increased from 10% (1992)-30% (1997). The rate of local recurrence after breast conserving surgery was 8% in 1997. We found a ratio of breast cancer surgery to diagnostic biopsies of 1:1, 1 in 1992 and of 1:2,1 in 1997. After the introduction of reconstructive breast surgery in 1997 we carried out 3 immediate reconstructions with endoprosthesis and 7 cases with myocutaneous flapping. Our own concept of plastic surgery as well as indications for breast conserving therapy will be demonstrated and discussed.

Adult↗
PubMed1998

[Surgery of lung metastases in breast carcinoma].

The resection of lung metastases as a component of a multistep therapeutic concept is an established treatment approach. 5-year survival rates of 30% are attainable in combination with a low postoperative lethality. We performed 99 operations on 89 patients with lung metastases between 1977 and 1997 in the Department of Thoracic Surgery on the Carl-Thiem-Klinikum Cottbus. No postoperative lethality was observed.

Adult↗
PubMed1998

[Postoperative recurrent nerve paralysis after initial interventions for benign goiter].

Between January 1st, 1979 and December 31st 1993, 2501 operations for benign diseases of the thyroid gland were performed. The documentation was done prospectively. The operation technique remained the same during these years. The recurrent laryngeal nerve wasn't routinely identified. All together we saw 0.6% permanent vocal cord palsies. The incidence of nerve paralysis was correlated to the size (weight), to the expansion of the goiter, to the performed operative procedure and to patients' age and gender.

Adult↗
PubMed1998

[Abdomino-thoracoscopic esophagus resection--an animal experiment study].

Based on animal trials the presented study results describe a method of abdomino-thoracoscopic oesophagectomy for the treatment of oesophageal carcinoma of the middle and lower third. Technical details and the advantages of the surgical procedure, including the avoidance of thoracotomy and the practicability of the thoracoscopic dissection of the oesophagus are shown. Problems exist in the salvage of the specimen, especially in the transcervical passage of the tumorbearing oesophageal part. A final evaluation of the importance of the minimally invasive techniques in oesophageal surgery should not be given until the results of clinical studies are available.

Anastomosis, Surgical↗
PubMed1998

[Indications for surgical therapy of gallstones].

4675 patients which underwent a cholecystectomy because of gallstone disease were included in a prospective multi-institutional study from 01/09/1994 to 31/08/1995 at 29 east-german hospitals. 3,207 (68.6%) patients had done a laparoscopic cholecystectomy (LCE). 1,468 (31.4%) patients received a primary open cholecystectomy (KCE). A conversion rate of 7.7% (n = 247) was seen. In 32.8% of LCE and in 39.5% of KCE diagnostic procedures of the common bile duct were not performed at all. The rate of open revision of the common bile duct was 4.5% (n = 211). The highest postoperative morbidity and operative mortality were found in KCE with revision of the common bile dutct.

Cholecystectomy↗
PubMed1998

[Current surgical treatment status of gallstones in East Germany].

The changes of surgical treatment of gallstone disease to the laparoscopic procedure was performed just at the same time in East Germany was destroyed the socialism. That's why the new operative technique was possible in many hospitals in 1992/93 first. To describe the actually situation and the trend we started a prospective multi-institutional study included 29 East German surgical departments of all kinds. The most interesting things were perioperative antibiotic prophylaxis, laparoscopically procedures in elderly or high risc patients, the management of common bile duct stones and the minor and major complications. We discuss the results and the comparison with the results of externe quality assurance.

Adult↗
PubMed1998

[Laparoscopy-assisted harvesting of free small intestine transplants for reconstruction of voice and deglutition after total laryngopharyngectomy--an animal experiment study].

Based on animal trials the presented study results describe a laparoscopic assisted removal of an extra-long free jejunal graft to reconstruct voice and swallowing after a total laryngo-pharyngectomy in cases with advanced malignancies of the larynx including invasion in the upper oesophagus. With a microvascular anastomosed small bowel segment, we have been able to reconstruct parts of the pharynx and to create a speaking syphon as devised by Ehrenberger in an one-stage procedure. The concept of avoidance of an extensive laparotomy may result in an decreased morbidity of this surgical procedure. Therefore it represents a challenging single indication of minimally invasive surgery of the oesophagus. A well established interdisciplinary teamwork is the key for success in this extensive procedure.

Animals↗
PubMed1998

[Current status of treatment of appendicitis. Results of 2 prospective multicenter studies in East Germany. East German Working Group "Outcome Assessment and Quality Assurance in Surgery" of the CAQ of the German Society of Surgery].

In a period of 10 years we carried out two prospective multicentric trials to evaluate the state of the art in treatment of appendicitis. One study was performed before introduction of laparoscopy. Important criteria like new diagnostic methods (sonography, laparoscopy), frequency of operation, perforation rate, frequency of appendectomies in case of non acute inflammation and postoperative complications were compared.

Appendectomy↗
PubMed1998

[Value of ultrasound in diagnosis of appendicitis. Results of the East German Multicenter Study. East German Working Group "Outcome Assessment and Quality Assurance in Surgery" of the CAQ of the German Society of Surgery].

Based on the East German quality assessment study our investigation was aimed to evaluate if sonography has a diagnostic value for the indication to appendectomy or if it is only relevant for the differential diagnosis of acute abdominal pain. In a prospective trial we recorded and analysed all sonograms which were obtained in a period of one year at 34 East German hospitals. 3924 patients were examined by ultrasonography. The sex distributions was 1:1.8 on behalf of the female patients. The correlation of sonogram and intraoperative macroscopic findings showed a high rate (68.2%) of acute inflamed appendices in cases with negative ultrasound results. A positive sonogram with an inflamed appendix was confirmed in 90% of the cases intraoperatively. In our study the routine use of ultrasonography for the diagnosis of acute appendicitis shows a sensitivity of 21.5% an a specificity of 80.1%. The positive predictive value is 95.6% and the predictive value for negative results is 9.8%. In conclusion, if clinical examination shows the presumptive diagnosis of acute appendicitis, a negative sonogram should not withhold the surgeon to perform an operative intervention.

Appendectomy↗
PubMed1997

[Results of a multicenter study in colon surgery for quality assessment].

Surgery of colorectal cancer is suited for assurance of surgical quality. The R0-resection rate in 1927 operations for colorectal cancer was 74.4%. The postoperative mortality was 7.1%. Wound suppuration occurred after surgery of the colon in 6.5%, after surgery of rectal cancer in 9.9% of the cases. In 68.6% of pT4-tumors we found lymphoid metastasis, in 19.3% around the trunk of the inferior mesenteric artery. For compilation of comparative data the quality assurance in colorectal surgery should be realised every 3 to 5 years.

Adolescent↗
PubMed1997

[Endoscopic fusion of the lumbar vertebrae].

For certain indications, anterior fusion of the lumbar spine is a standard operation. The surgeon specializing in operations on the vertebral column needs to learn to utilize the advantages of laparoscopic surgery. However, an absolute must before employing the technique in patients is adequate training in its use in living animals. For this purpose, the pig is a highly suitable model. The surgical team comprises a surgeon experienced in spinal procedures, an abdominal surgeon with skills in laparoscopic surgery and an experienced camera assistant. In the animal model and in clinical trials, a change in position-organ preparation from the cranial direction, a suprasym-physial approach to the vertebrae-has proved expedient. The use of a special instrumentarium for maintaining the pneumo-peritoneum, for protecting the spinal cord and for exact centering, including the application of a special dowel (ESKA-spacer and instruments) is essential. The greater technical effort may be expected to result in shorter hospitalization (2-3 days) in the future.

Animals↗
PubMed1997

[Instrumental diagnosis and therapeutic decision making in biliary surgery].

Preoperative evaluation before cholecystectomy includes detailed history of the disease and blood chemistry. Hepatobiliary ultrasonography is the main noninvasive preoperative investigation. The decision to evaluate the common bile duct for stones prior to planned laparoscopic cholecystectomy by ERC may be prompted by clinical suspicion or evidence of jaundice, recent pancreatitis, or a dilated common duct on sonography. Preoperative ERC has the advantage of allowing the simultaneous treatment of duct stones. Intraoperative cholangiography should be available.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1995

[Surgical quality assurance exemplified by surgical therapy of colorectal carcinoma].

In the period of time between September 1, 1991 and August 31, 1993 a total of 1927 patients at 22 East German hospitals were operated for colorectal carcinoma. In anticipation of quality assuring aspects these surgeries were registered and interpreted. An application of a constant classification (pTNM, R-classification) at this was essential. The resection rates of 87.3% on the colon (R0-resections 74.4%) and of 83.1% on the rectum (R0-resection 70.8%) were established in total patient group. Preoperative measures and technique of surgery were also registered. The rate of the colonic anastomosis insufficiencies was about 3.2%, resp. of the rectum 8.2%. Wound suppurations occurred after surgery of the colon in 6.5% of the cases, resp. the rectum in 9.9%. The postoperative mortality was 7.1% in the overall patient group. The practical realization and the efficiency of studies for quality assurance is pointed out.

Colectomy↗