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J Zieren

Publications and source records attributed to J Zieren.

At least 19 recordsLinked to original sources
PubMed2006

[First clinical experience with a video presentation informing patients before surgery for inguinal hernia].

BACKGROUND: Although it is a significant part of surgical treatment, informing patients beforehand seems to be more and more neglected, mainly due to the enormous amount of work and time pressure on surgical personnel. MATERIAL AND METHODS: A video clip explaining groin hernia surgical repair was produced as additional information for patients. In it, visual material from actual practice describes the disease, the operation itself, all the perioperative aspects, and patients' own experiences. In a prospective comparison study, the length of patient education, its quality, patient satisfaction, and the duration of hospitalization and time off work were compared between patients who saw the video clip (n=50) and those who did not (n=50). RESULTS AND CONCLUSION: In summary, the time spent informing the video group was shorter (P<0.05) and their total satisfaction and evaluation of the information material were both higher (P>0.05) for comparable duration of treatment and time off work. This informative video was adopted without problems in our daily clinical life and, besides reducing the time needed to inform patients, it has significantly improved patient understanding of the operative procedure and their satisfaction with treatment.

Adult↗
PubMed2002

[What is the value of the internet as a source of information for patients with inguinal hernias? First results of an observational study].

INTRODUCTION: The increasing use of the internet has led to a variety of medical web pages and an increasing amount of information about hospitals. Little is known about the extent to which this new medium is already used by patients as a source of information. For patients with inguinal hernia, for example, a frequent surgical symptom with large method variety, the value of the internet as a source of information should be examined. METHODS: One hundred patients facing an elective inguinal hernia repair at the Surgical Department Charité Berlin took part in a prospective observation study (a questionnaire with 10 questions) between July 1999 and March 2001. The questions referred to the possibility of PC/internet access, other sources of information (e.g., general practitioner, friends, internet) as well as the criteria by which the clinic was chosen. Patients were asked to answer basic questions about the development and treatment of inguinal hernia and to give a self-assessment of their knowledge of inguinal hernia (0 = no knowledge; 10 = maximum knowledge). RESULTS: The questionnaire revealed that 39% of the patients (average age 47 +/- 16 years) had a PC in their homes, 24% of those with internet access; 11% had internet access at other places. It also showed that 53% of the patients sought medical information from their general practitioner, 29% from friends, and 18% from the internet. Young patients (median age 29 years), employees and patients with private internet access use the internet with significantly more frequency. Their medical knowledge as well as their self-assessment of medical knowledge was significantly higher (median 19 versus 7 points and median 8.6 versus 5.7, respectively) and they chose the clinic because of the information from their research on the internet. CONCLUSION: At present, the internet still plays a subordinate role as a source of information for patients with an inguinal hernia. The increasing presence of this medium as well as the higher internet acceptance of future patients indicates that it has a promising future as a source of medical information.

Adult↗
PubMed2001

Inguinal hernia repair in the new millennium: plug and patch repair with local anesthesia.

Plug and patch repair is a safe, economic method for repairing inguinal hernias, with patient comfort comparable to that with laparoscopic hernia repair. The technique is simple to perform under local anesthesia and easily learned without a learning curve. Complications are rare, and recovery and return to work are rapid. After performing plug and patch repair on 400 patients with a follow-up examination rate of 93% and a median postoperative observation time of 42 months, we have recorded a recurrence rate of only 0.25%.

Adult↗
PubMed2001

Sexual function and testicular perfusion after inguinal hernia repair with mesh.

BACKGROUND: Open tension-free techniques of hernia repair using synthetic meshes revealed an excellent patient comfort with low recurrence rates. The influence of the resulting fibrosis on testicular perfusion and sexual function is still unclear. METHODS: In a prospective observation study testicular volume, perfusion, and sexual function was investigated before plug and patch repair, after 3 months, and every 6 months thereafter. Testicular volume and perfusion was examined by a standardized scrotal ultrasound and duplex sonography. Sexual function was assessed by a validated anonymized questionnaire. RESULTS: Seventy-three patients were included and follow-up examinations by questionnaire and sonography, respectively, were completed in 73 and 68 patients after 3 months, 51 and 43 after 6, and 24 and 14 after 12 months. Preoperative testicular volume and flow volume was comparable between the side of hernia and the contralateral side (average 10.2 +/- 4.8 cm3 versus 9.8 +/- 5.3, respectively) and showed no significant differences during follow-up. In 11 (15%) patients with preexisting disorders sexual function was normalized postoperatively. Ten (14%) other patients (3 of them with neuralgia pain) described limitations of sexual activity due to inguinal pain (n = 4; 6%) or a loss of sensitivity in the inguinal area (n = 6; 8%) after the procedure. Among these, sexual function recovered spontaneously within 12 months postoperatively in 6 patients (2 with inguinal pain, 4 with loss of sensitivity). In all other patients sexual function showed no changes after inguinal hernia repair. CONCLUSIONS: So far there is no evidence for a significant impairment of the cord structures and the sexual function after inguinal hernia repair in the plug and patch technique.

Hernia, Inguinal↗
PubMed2000

[Repair of inguinal hernia in the elderly. Results of the plug-and-patch repair with special reference to quality of life].

In a prospective study the perioperative results of plug-and-patch repair were investigated in patients > or = 65 years, and quality of life was assessed using the SF36 preoperatively and 3 months after the procedure in 34 consecutive patients. From August 1994 to February 1999 147 patients with a mean age of 73 +/- 5 years (65-92 years) were operated on using the plug-and-patch technique, mostly under local anesthesia (LA: n = 124, 84%, ITN: n = 23, 16%). Preoperative risk factors were alcohol consumption, hypertonus, diabetes mellitus, ischemic heart disease, smoking, cerebrovascular disease, hyperlipidaemia and pulmonary disease. Most of the patients were ASA II (ASA I: n = 14, 9%, ASA II: n = 82, 56%, ASA III: n = 51, 35%). No intraoperative complications occurred, postoperative complications consisted of superficial wound hematoma (n = 6, 3.7%) and infection (n = 1, 0.6%), seroma (n = 7, 3.8%), urinary retention (n = 3, 1.8%) and ilioguinal pain syndrome (n = 3, 3.8%). The total amount of postoperative analgesic consumption was 4.9 +/- 1.8 g Novalgin for about 4 +/- 3 days. The duration of postoperative hospitalization was 2 +/- 1 days and limitation of daily activities 6 +/- 3 days. Clinical examinations after 3 months revealed no recurrence or late complications. Investigation of quality of life showed a significant improvement in the SF36 domains of physical activity, pain, vitality, and social functioning after the operation. No significant change was observed for physical, emotional, and global health.

Adult↗
PubMed2000

Fundoplication: a model for immunologic aspects of laparoscopic and conventional surgery.

BACKGROUND AND PURPOSE: Immunologic investigations of laparoscopic and conventional procedures have recently been performed during cholecystectomy or colon resection, but the results might have been influenced by the amount of dissection or the presence of malignant tumor. Because fundoplication is characterized by moderate dissection and no resection, we supposed it to be an appropriate procedure for comparing immunologic changes during laparoscopic and conventional surgery. PATIENTS AND METHODS: Immunologic analysis (interleukin [IL]-6, IL-10, leukocytes, HLA-DR monocytes) was carried out on the peripheral blood of 34 patients who underwent elective Nissen fundoplication by the laparoscopic (LAP; N = 26) or conventional (OPEN; N = 8) technique for gastroesophageal reflux disease. Blood samples were obtained before and 1 and 4 hours after the beginning of the operation and on days 1, 2, 4, 7 after the procedure. RESULTS: A very fast and significant (P < 0.01) increase of the proinflammatory cytokines (IL-6, IL-10) and leukocytes and a decrease of cell-mediated functions (HLR-DR monocytes) were detected. Most of the analyzed measures had returned to preoperative values by 2 days after the procedure. All of the changes were similar in the two groups with the exception of IL-6. Throughout the post-operative study period, IL-6 concentrations were higher in the OPEN group, being significant 4 hours, 1 day, 2 days, and 4 days after the operation. CONCLUSION: The investigation measures do not give evidence that laparoscopic fundoplication is superior to conventional fundoplication in its immunologic effects.

Adult↗
PubMed2000

Prognosis factors in carcinoma of the head of the pancreas.

BACKGROUND: Due to a low survival rate even after a R0 resection of cancer of the head of the pancreas, a strict indication for a pancreaticoduodenectomy seems to be sensible. We have therefore analyzed our patients for possible prognosis factors. METHODS: In a retrospective trial the courses of disease of all patients (1981-1996) with resected histologically proven carcinoma of the head of the pancreas were analyzed. The following patient-specific parameters were evaluated and examined in a single or multivariate analysis of prognosis factors: age, gender, tumor size (T status), lymph node involvement (N status), dimension of resection, operation method, time of operation, morbidity, clinic lethality and survival rate. RESULTS: Between 1981 and 1996, 500 patients with ductal adenocarcinoma of the head of the pancreas were treated surgically. The rate of resection increased from 32.1% (1981-1986) to 37.8% (1991-1996) whereas the mortality rate decreased from 13.3 to 7.3%. The 5-year survival rate after resection was 11.8% with a median survival time of 13.8 months. In a multivariate analysis, only small tumors (T1, p < 0.016), the R0 status (p < 0.017) and the resection had a significant influence on the survival rate. CONCLUSION: Prognosis factors in the treatment of pancreatic cancer were tumor size (T1), tumor resection and R0 status.

Adenocarcinoma↗
PubMed2000

Disaster with a new type of band for gastric banding.

BACKGROUND: Laparoscopic gastric banding has become an established therapy for morbid obesity. Typical complications are band dislocation, pouch dilatation and stomach slippage. A new type of adjustable silicone band with eyes for suture fixation was proposed to avoid these complications. The experience with this new kind of band is reported. METHODS: Between April 1998 and August 1998, 15 morbidly obese patients were treated by laparoscopic adjustable gastric banding using a new band type (manufactured by MEDING, Heinsberg, Germany). The band was fixed by single sutures using the eyes at each side of the buckle. There were 13 women and 2 men, with mean age 34 (range 21-54) years and mean body-weight 138.6 (range 113-213) kg. RESULTS: Intraoperative complications did not occur. Postoperatively 8 patients (53%) had increasing capacity for food intake and 2 (13%) had uncharacteristic abdominal pain. Radiographs revealed band rupture in 13 of 15 patients 3-11 months postoperatively. These patients were operated laparoscopically using a new technique for band change. Now, a Lap-band (BioEnterics, Carpinteria, CA, USA) was inserted and fixed to the ventral stomach with three sutures similar to a ventral fundoplication. Radiographic and clinical follow-up have been uneventful in all patients until now. CONCLUSION: This series demonstrated: 1) the importance of clinical follow-up; 2) a material defect of a new band type; and 3) development of a new laparoscopic technique for band change.

Adult↗
PubMed2000

Pylorus preservation after complete gastrectomy and jejunal interposition: experimental study investigating motility and alkaline reflux.

BACKGROUND: Pylorus preservation has been proposed to reduce the disturbance in gastric emptying following gastrectomy but little is known about the role of the pylorus regarding motility patterns and alkaline reflux. AIMS: To assess the motility patterns and alkaline reflux following pylorus preservation after complete gastrectomy and jejunal interposition in the pig. METHODS: Motility patterns and alkaline reflux were studied in 12 conscious pigs before and after gastrectomy and jejunal interposition with preservation of the pylorus and a 1 cm antral ring (PYL+) or excised pylorus (PYL-) 6 and 14 weeks postoperatively. Gastroduodenal motility was investigated by manometry after fasting and fed, respectively and alkaline reflux by a fiberoptic system for detecting bilirubin. RESULTS: The number of propagated phase-III activities of the jejunal interponat to the duodenum and propagating velocity were lower in the PYL+ group after 6 weeks (p < 0.05) but higher after 14 weeks (p < 0.05) compared to the PYL- group. In the PYL+ the number of intrapyloric pressure waves (IPPWs) was lower after 6 weeks (p < 0.05) but higher after 14 weeks (p < 0.05) in comparison to preoperative controls. Alkaline reflux was significantly higher in the PYL- group than in the PYL+ group throughout the time observed. CONCLUSIONS: Pyloric function shows a delay after 6 weeks but restores within 14 weeks postoperatively. Pylorus preservation was associated with a significant decrease of alkaline reflux compared to PYL- in this setting.

Animals↗
PubMed1999

Effects of fibrin glue and growth factors released from platelets on abdominal hernia repair with a resorbable PGA mesh: experimental study.

INTRODUCTION: The purpose of this study was to investigate if the strength and quality of an abdominal wall repair with a resorbable PGA (polyglycolic acid) mesh can be improved by fibrin glue or releasates from platelets. MATERIALS AND METHODS: An abdominal wall defect in the rat was repaired using a PGA mesh in a sublay technique (CG) alone and either with additional fibrin glue (FG) or with platelet releasates (REL). Endpoints were clinical herniation pressure and hydroxyproline concentration (HP) as well as number of fibroblasts and collagen fibers at 7, 14, and 90 days after implantation. RESULTS: In both experimental groups (REL and FG) higher herniation pressures, hydroxyproline contents, and number of fibroblasts/collagen fibers were found at all times of measurement compared to the CG. The PGA mesh alone showed a significant lack of stability after 14 days which can be compensated for by the investigated components. Significant differences (P < 0.05) were observed regarding the herniation pressure (REL vs CG at 7 and 14 days; FG vs CG at 14 days) and the number of collagen fibers (REL vs CG at 14 days). CONCLUSIONS: These results suggest that the quality of a PGA mesh repair can be improved by application of fibrin glue or platelet releasates in the described experimental setting.

Animals↗
PubMed1999

[Hormone therapy of postoperative recurrent pancreatic carcinoma with octreotide and tamoxifen].

BACKGROUND: In a prospective trial (October 1996-April 1998) the effect of octreotide and tamoxifen on the recurrence of pancreatic carcinoma after R0 resection was evaluated. METHODS: Patients with a local recurrence after curative resection of ductal adenocarcinoma of the pancreas were treated with 100 micrograms of octreotide three times a day and tamoxifen 20 mg once daily. The median survival time, quality of life (EO-RTC-QLQ-30) and side effects of the octreotide-tamoxifen group were compared with a historic cohort (n = 14) of patients treated in our department (9/95-9/96) according to the "best supportive care" concept. RESULTS: Recurrences were diagnosed after R0 resection in a mean time of 13 +/- 6.8 months. Patients treated with octreotide and tamoxifen had a significantly (P < 0.05) longer median survival time (7 months; range: 3-12) vs 3.5 months; range: 1.5-5). The octreotide-tamoxifen group suffered less from lack of appetite, nausea, fatigue, and pain and needed fewer analgesics. The only side effect of the octreotide-tamoxifen therapy was moderate diarrhea in 2 patients at the beginning of the therapy. CONCLUSION: Since combined therapy with octreotide and tamoxifen can be administered comfortably for outpatient treatment, this seems to represent progress in the palliative therapy of pancreatic cancer.

Aged↗
PubMed1999

Is mesh fixation necessary in abdominal hernia repair? Results of an experimental study in the rat.

BACKGROUND: Abdominal hernia repair with implantation of synthetic meshes using the sublay technique has resulted in low recurrence rates and high patient satisfaction. AIM: The purpose of this experimental animal study was to investigate whether mesh fixation is necessary in abdominal hernia repair using a polypropylene mesh in the sublay technique. METHODS: Forty-five rats were divided into three groups after creating an abdominal wall defect (CG control group, no mesh implantation; NoFixG mesh implantation without fixation group; SG mesh with suture fixation group) with 15 animals in each group. End-points were clinical herniation pressure, hydroxyproline (HP) concentration, mesh shape and number of fibroblasts/collagen fibres of the anchor zone 7, 14 and 90 days after implantation. RESULTS: Herniation pressure, HP content and number of fibroblasts were similar between NoFixG and SG, although significantly higher in these groups than in the CG (P<0.05). Both mesh groups had significantly higher counts of fibroblasts and collagen fibres than the CG. Mesh shrinking occurred in both groups but was less in the SG. CONCLUSION: Mesh fixation was not mandatory in abdominal hernia repair using this animal model.

Animals↗
PubMed1999

K-ras mutations in tissue and stool samples from patients with pancreatic cancer and chronic pancreatitis.

BACKGROUND AND AIM: K-ras oncogene is the most promising molecular marker of pancreatic cancer. However, the incidence of single and combined K-ras mutations in stool and pancreatic tissue is unknown, and it is not clear whether detection of the K-ras oncogene in stool could be employed in screening tests. PATIENTS/METHODS: Stool and pancreatic tissue of patients with ductal adenocarcinoma (n = 36), cystadenocarcinoma (n = 1), periampullary carcinoma (n = 7), endocrine tumour (n = 2) and chronic pancreatitis (CP, n = 5) were analysed for mutated K-ras sequences prospectively. DNA of stool and pancreatic tissue was amplified by polymerase chain reaction and K-ras status was analysed by hybridisation. RESULTS: K-ras mutations were detected in the pancreatic tissue of 28 patients with ductal adenocarcinoma (78%), in 1 patient with cystadenocarcinoma, in 1 patient with periampullary carcinoma (14%) and in 1 patient with CP (20%). In 1 patient with an endocrine tumour, no K-ras mutations were diagnosed. K-ras mutations were detected in stool in 7 patients with ductal adenocarcinoma (20%), in 1 patient with cystadenocarcinoma and in 2 patients with CP (40%). Sensitivity of K-ras mutations for pancreatic cancer was 78% in tissue and 20% in stool. CONCLUSION: K-ras mutations lack specificity to discriminate malignant pancreatic disease from chronic inflammation in tissue and stool.

Adenocarcinoma↗
PubMed1999

Tumor size and lymph-node status in pancreatic carcinoma - is there a correlation to the preoperative immune function?

BACKGROUND AND AIMS: It has not been clarified whether there is a correlation between the tumor size and the preoperative immune function in pancreatic carcinoma. PATIENTS/METHODS: In a prospective trial, the influence of tumor size and lymph-node status on different immune system factors [interleukins (IL)-6 and -10, tumor necrosis factor (TNF)-alpha, CD3-, CD4-, and CD8-lymphocytes, and human leukocyte antigen (HLA)-DR-monocytes] was analyzed in 28 patients with pancreatic carcinoma and compared with a control group (n=20). There were 3 pancreatic carcinomas of the T1-tumor type, 20 T2- and 5 T3-tumors; 14 patients were in stage N1. RESULTS: In comparison with the control group, tumor patients preoperatively showed a significant increase of leukocytes (P=0.02), monocytes (P=0. 04), and granulocytes (P=0.03). The total count of lymphocytes, the number of CD3-, CD4- and CD8-lymphocytes, and the expression of HLA-DR on monocytes were significantly decreased as a sign of immunosuppression in tumor patients. A multivariate analysis proved that only tumor size (T-stage) but not lymph-node status correlates with the deficiency of immune competence. Progressive tumor size correlated with decreasing expression of HLA-DR on monocytes, CD3- (P=0.04) and CD8- (P=0.02) lymphocytes. In contrast IL-6, IL-10 (P=0. 04) and TNF-alpha (P=0.02) increased with progressive tumor size. CONCLUSION: Regarding the negative prognosis after resection, the preoperative immune status could be an additional help for decision between a resection or a preoperative immune stimulation in pancreatic carcinoma.

Case-Control Studies↗
PubMed1999

Tube thoracostomy complicates unrecognized diaphragmatic rupture.

A case of traumatic diaphragmatic rupture is reported in which herniated stomach mimicked a tension pneumothorax. Tube thoracostomy by trocar caused insertion of the pleural drain into the intrathoracic stomach. CT scan of the thorax after oral administration of contrast material revealed the correct diagnosis. After removal of the drain and retraction of the stomach into the abdomen the gastric perforation and diaphragmatic defect could be closed by suture. The further course of the patient was uneventful. This case report underlines the importance of differential diagnosis of symptoms in a case with a history of blunt chest trauma and shows the risks of unnecessary use of a trocar.

Adult↗
PubMed1999

Repeated boluses of local anaesthetic for pain relief after inguinal hernia repair.

OBJECTIVE: To compare the effect of repeated boluses of local anaesthetics with an oral analgesic for pain management after tension-free inguinal hernia repair. DESIGN: Prospective randomised study. SETTING: University hospital, Germany. SUBJECTS: 104 patients undergoing elective hernia repair. INTERVENTIONS: 52 patients were given boluses of 0.5% bupivacaine 10 ml through a subcutaneous catheter and 52 dipyrone 500 mg orally 6, 12 and 24 hours after operation. MAIN OUTCOME MEASURES: Postoperative pain measured on a visual analogue scale, complications, systemic side effects, supplementary analgesics, costs, and time taken to give the analgesics. RESULTS: There were no significant differences between the groups in absolute pain scores, course of pain, and the effects of analgesics. Thirteen patients [5 in the bupivacaine group and 8 in the dipyrone group] required additional dipyrone [mean (range) 2000 mg (500-5000) and 2500 mg (500-4000) respectively]. There were no systemic side effects of either treatment. There were 5 wound haematomas in the bupivacaine group (10%), and 2 wound haematomas and 1 superficial wound infection in the dipyrone group (6%). Mean costs of material and time taken to give the analgesics were pound sterling 104.70 and 47 minutes in the bupivacaine group compared with pound sterling 3.40 and 6 minutes in the dipyrone group. The median (range) hospital stay was 2 (1-3) days in both groups. CONCLUSIONS: Repeated boluses of local anaesthetic did not result in better or cheaper pain control than oral analgesics after tension-free inguinal hernia repair.

Analgesics↗