Search PubMed⌕ Search

Biomedical subjects

J C Rückert

Publications and source records attributed to J C Rückert.

14 recordsLinked to original sources
PubMed2001

[Virtual bronchoscopy].

Flexible bronchoscopy represents a clinically well-established invasive diagnostic tool. Virtual bronchoscopies, calculated from thin-slice CT sections, allow astonishing immitations of reality although principal differences exist between both technologies: the fact that colour representation is artificial and concommitant interventions are impossible limits the clinical use of virtual bronchoscopy. However, its value increases when calculations can be attained within minutes due to technological advancements, and when virtually any chest CT is suitable for further postprocessing. Indications, findings and the clinical role of virtual bronchoscopy are discussed.

Bronchoscopy↗
PubMed2000

Pulmonary function after thoracoscopic thymectomy versus median sternotomy for myasthenia gravis.

BACKGROUND: Impaired pulmonary function due to myasthenia gravis (MG) is further compromised by thymectomy, which is necessary in most cases. Thoracoscopic thymectomy (tThx) can achieve the same resection and functional improvement of MG as median sternotomy (sThx). The possible advantage of tThx in maintaining better perioperative lung function was quantified. METHODS: In a prospective trial, 20 patients with MG were randomly allocated to undergo tThx (n = 10) by three-trocar left-sided approach or sThx (n = 10) performed as an extended procedure. Complete pulmonary function was measured at 12-hour intervals, beginning 6 hours postoperatively. Effective postoperative pain control in both groups was achieved by patient-controlled analgesia with morphine sulfate assessed by a visual analogue scale. Statistical analysis for comparison of tThx and sThx was performed using the Mann-Whitney U test. RESULTS: Postoperative vital capacity, forced vital capacity, forced expiratory volume per second, and peak expiratory flow, measured as a percentage of the individual preoperative capacity, were significantly better with tThx compared with sThx. Immediate postoperative lung function was reduced to 35% and 65% after tThx and sThx, respectively. By the third postoperative day, recovery of pulmonary function was complete after tThx but only 55% after sThx. CONCLUSIONS: Less pronounced impairment and faster recovery of pulmonary function after tThx characterize this new approach for thymectomy as minimally invasive. These results could make tThx the preferred surgical treatment of MG, which was improved to the same extent as after sThx.

Adolescent↗
PubMed2000

Colonography using multislice CT.

Computed tomography (CT) represents the preferred imaging modality for imaging the large bowel when virtual endoscopic reconstructions are desired. Using the spiral acquisition technique, it has become possible to scan the entire abdomen within a single breathhold, however, slice thicknesses of 5 mm or more are necessary should the breathhold not last longer than 30-40 s. With the advent of multislice CT, contiguous 1-mm slices can be obtained through the entire abdomen while even shortening the breathhold to 25-30 s. The improved speed and spatial resolution of multislice CT results in remarkably sharp virtual reconstructions allowing detection of polyps with sizes less than 3 mm. The disadvantages must still be considered including a dataset consisting of up to 800 images representing a new challenge for postprocessing hard- and software.

Colon↗
PubMed2000

[Postoperatively detected gallbladder carcinoma. Follow-up or reoperation?].

BACKGROUND: The prognosis of gallbladder carcinoma is generally poor. The 5-year survival rate amounts to less than 5% in most series due to the high proportion of advanced stages at the time of diagnosis. Early stages are commonly found only with histological work-up after cholecystectomy (CCE). In these cases the question arises whether or not reoperation for completion resection would be indicated. PATIENTS/METHODS: A retrospective analysis examined all patients of the Clinic of Surgery (Charité) in Berlin with gallbladder carcinoma operated on between January 1981 and August 1993. A literature search was carried out using the MEDLINE retrieval system for the key words "gallbladder carcinoma", "surgical therapy", and "reoperation" limited to the period after 1970. RESULTS: The retrospective results of the own clinic and the analysis of the literature review demonstrate significantly higher survival rates after reoperation compared to CCE alone and observation for all cases of gallbladder carcinoma with stages T1b or higher stages. The extended radical CCE can be performed with low morbidity. With preceding laparoscopic CCE the trocar sites have to be completely excised. DISCUSSION: To avoid the situation of postoperative diagnosis of gallbladder carcinoma, the surgeon should intraoperatively during CCE perform a careful macroscopic control of the gallbladder. Suspect findings should be followed intraoperatively by histological examination. Nevertheless, local spread of GBCa and distribution of lymphatic metastases can certainly not be assessed completely after simple CCE. Based on the published results and because of low morbidity reoperation is indicated for most cases of GBCa when diagnosed postoperatively.

Cholecystectomy↗
PubMed1999

Operative technique for thoracoscopic thymectomy.

In most cases, myasthenia gravis (MG) and thymoma require complete removal of the thymus gland and resection of the pericardial fatty tissue. There is some debate however, over which surgical approach is best for thymectomy. We have developed a new technique for complete thoracoscopic thymectomy. Between October 1994 and February 1998, we performed a prospective observational study of thoracoscopic thymectomy in 19 patients. The results were analyzed with special reference to perioperative morbidity, short- and intermediate-term improvement of MG, and quality of life. This study showed the feasibility of complete thoracoscopic thymectomy. The procedure was successfully applied in 19 of 20 cases. Thoracoscopic thymectomy was accomplished with zero mortality and a very low perioperative morbidity. While the short-term improvement of MG after this procedure was comparable to that seen with conventional surgery, the short- and intermediate-term quality of life was much better. The preliminary results of thoracoscopic thymectomy appear to be excellent for both patients and neurologists. A prospective randomized trial has been designed to compare thoracoscopic thymectomy with the gold standard of median sternotomy for thymectomy.

Adult↗
PubMed1999

Dissecting aneurysm of the infrarenal abdominal aorta.

The aim of this study was to report the case of a patient with chronic dissecting infrarenal abdominal aortic aneurysm (AAA) and to review the literature for this rare vascular disorder. The preoperative assessment, surgical treatment, and postoperative course of a patient with a dissecting AAA and associated left iliac artery dissection were analyzed. The literature is reviewed with respect to etiology and pathogenesis as well as diagnostic and therapeutic management of infrarenal dissecting AAA. The preoperative diagnosis of dissecting infrarenal AAA was made by computed tomography and aortography and confirmed during surgery. Successful repair was accomplished by use of a bifurcated aortobiiliacal Dacron graft. A review of the literature demonstrates the rarity of dissecting aneurysm exclusively involving the infrarenal aortic segment. Primary dissecting aneurysm of the infrarenal abdominal aorta is a rare morphologic finding. Principles of diagnostic and therapeutic management of common atherosclerotic AAA also apply to dissecting AAA.

Aortic Dissection↗
PubMed1998

Scintigraphic localization of lymphatic leakage site after oral administration of iodine-123-IPPA.

UNLABELLED: Chylothorax can occur secondary to traumatic lesions of the thoracic duct caused by chest injuries, surgical procedures involving the pleural space, neoplasms or malformations of the lymphatics. METHODS: Lymphatic leakage sites were localized by scintigraphy after oral administration of the 123I-labeled long-chain fatty acid derivative iodophenyl pentadecanoic acid (IPPA). We report on three patients with different lymphatic leakage sites and on one normal control subject. RESULTS: IPPA scintigraphy localized the lymphatic leakage site correctly in all three patients. In two of them, the method even guided the successful surgical treatment of the leakage. CONCLUSION: This approach is suitable for detecting lymphatic leakages of intestinal origin.

Administration, Oral↗
PubMed1994

[Diagnosis and surgical therapy of benign liver tumors].

Between 1/1980 and 12/1992 at the Surgical Clinic (Charité) 251 patients were treated for benign liver tumors. In 139 cases a laparotomy was necessary. Fourty of these operations were explorative laparotomies only, whereas among the resections there were mainly atypical and segmental resections, respectively (n = 81). In the case of focal nodular hyperplasia (FNH) and hemangioma the indication for operation resulted from the patients' complaints (n = 45) and the preoperatively uncertain dignity of the process (n = 50). If an adenoma was suspected (n = 38) an absolute indication for operation was assumed with respect to the danger of rupture or bleeding reported in the literature as well as the uncertain differentiation from malignancy often experienced. The suspected diagnosis was proved in 30 cases, in 8 patients a FNH was found intraoperatively without the consequence of resection. Six patients were resected for a suspected hepatocellular carcinoma (HCC) which could not be confirmed postoperatively. In conclusion, the rate of preoperative uncertain or wrong diagnoses concerning definitive histology was 25.4%. The mortality rate of the performed liver resections was 2%, but was not directly related to the liver resection per se. In 4 patients the postoperative course required a relaparotomy. By a follow-up starting with 3-months intervals, two patients with an hepatocellular carcinoma were detected 12 weeks after the first diagnosis of FNH. A successful resection was carried out in both cases.

Adenoma↗
PubMed1992

[Experiences with surgical therapy of Budd-Chiari syndrome].

The obstruction of the hepatic venous outflow tract with or without involvement of the inferior vena cava results in the Budd-Chiari syndrome (BCS). With its very heterogenous etiology and variable epidemiology the rare disease either takes a chronic or an acute foudroyant clinical course. In general the prognosis is poor. Together with the clinical signs the diagnosis is based on radiological measures and the histology of the hepatic parenchyma. The exact etiological investigation of the BCS is of great significance. Typical findings are discussed and a diagnostic scheme is developed. Between 1979 and 1991, altogether 16 operations were carried out in 13 patients with a BCS. Predominantly there were undertaken a porto-systemic shunt procedure or an orthotopic liver transplantation, respectively, in 6 cases each. The need for an always individually tailored therapeutic strategy of the BCS is underlined by a case history. An overview analyzes the different therapeutic modalities of the BCS and their differential indications.

Adolescent↗
PubMedDate not supplied

Primary hepatic neuroendocrine tumor: successful hepatectomy in two cases and review of the literature.

BACKGROUND/AIMS: Primary hepatic neuroendocrine tumor represents an extremely rare clinical entity with only very few cases having been reported to date. METHODS: The case histories of 2 patients with presumably primary hepatic neuroendocrine tumor were analyzed and a complete follow-up obtained. The literature was reviewed to provide comprehensive data collection. RESULTS: Both patients underwent partial hepatic resection. Histomorphologic diagnosis revealed a neuroendocrine tumor in both cases. Extensive preoperative as well as intra- and postoperative search for the primary tumor did not identify another site of neuroendocrine tumor tissue. Six and ten years after hepatic segmentectomy, the 2 patients are alive and show no clinical signs of malignancy. Their most recent thorough follow-up included computed tomography and somatostatin receptor scintigraphy. Neither a nonhepatic primary neuroendocrine tumor site nor recurrent disease was found in the 2 patients. The literature review resulted in a complete survey of all previously reported cases of primary hepatic neuroendocrine tumors. CONCLUSION: We conclude that the liver was the primary site of the neuroendocrine tumor in both patients. Radical surgery was successfully performed as the only treatment option with curative intention.

Aged↗
PubMedDate not supplied

Recurrence of the Budd-Chiari syndrome after orthotopic liver transplantation.

Obstruction of the hepatic venous outflow with or without involvement of the vena cava results in the Budd-Chiari syndrome (BCS). BCS may be limited to the liver but there is a variety of systemic disorders forming the etiology of BCS in the majority of cases. Surgery has a major impact on treatment of the BCS within a wide range of therapeutic strategies. The ultimate option of surgical management of the BCS is orthotopic liver transplantation (OLTx). The case of a patient with recurrent disease more than 5 years after OLTx for BCS due to paroxysmal nocturnal hemoglobinuria is analyzed with complete documentation. The literature is reviewed and the probable underlying causes for recurrent disease after OLTx for BCS are discussed including therapeutic consequences.

Adult↗
PubMedDate not supplied

Surgery for carcinoma of the gallbladder.

BACKGROUND/AIMS: Carcinoma of the gallbladder is one of the gastrointestinal malignancies with an extraordinarily poor prognosis. The 5-year survival rate amounts to less than 5 per cent in most series. Our aim was to analyze the experience of a single center with surgery for gallbladder carcinoma with special reference to liver wedge resection. MATERIALS AND METHODS: A retrospective analysis examined all patients of the Clinic of Surgery of the Humboldt University Medical School (Charité) with diagnosed gallbladder carcinoma operated on between January 1981 and August 1993. The analysis was based on patient documentation. Cumulative survival rates were calculated according to the method of Kaplan/Meier. Statistical significances were calculated using logrank and Wilcoxon's tests. RESULTS: Eighty one patients (61 female, 20 male) were included in the study. The preoperative diagnoses were confirmed in 33 patients (40.7%). The stage distribution according to the TNM-system revealed 6, 10, 12, and 53 patients at the stages I-IV, respectively. The curative resection rate was 22.2%. Stage-dependent surgical procedures resulted in cumulative survival rates of 33.3% for stages I and II, 8.3% for stage III and 1.9% for stage IV. The overall prognosis was significantly determined by metastatic spread to the lymph nodes. CONCLUSIONS: Diagnostic efforts should focus on detecting the low stages I and II of gallbladder carcinoma. Our results suggest that aggressive surgical management with second intervention and wedge resection or more extended liver resection is the method of choice for stage T1b or more advanced stages of gallbladder carcinoma.

Adenocarcinoma↗