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Biomedical subjects

M K Walz

Publications and source records attributed to M K Walz.

71 records · Page 4Linked to original sources
PubMed1996

Hemodynamic changes after retroperitoneal CO2 insufflation for posterior retroperitoneoscopic adrenalectomy.

Intraoperative complications and hemodynamic alterations during posterior capnoretroperitoneoscopic adrenalectomy in the prone position were investigated in 16 consecutive patients using invasive hemodynamic monitoring. Under general anesthesia with propofol and fentanyl, hemodynamic changes were made before (M1) and during retroperitoneal CO2 insufflation (15 mm Hg) [M2]; 20 mm Hg [M3]. Retroperitoneal insufflation resulted in a significant increase of cardiac output (+72%), stroke volume (+42%), mean arterial pressure (+39 %), and mean pulmonary arterial pressure (+36%). Although retroperitoneal inflation was accompanied by a significant increase of central venous pressure (+37%), an increase of preload may have lead to higher filling pressures. Heart rate, systemic vascular resistance, and pulmonary vascular resistance did not show significant changes. One pneumothorax and two cutaneous emphysemas occurred. We have demonstrated, in a small number of patients, that retroperitoneal CO2 insufflation for posterior capnoretroperitoneoscopic adrenalectomy in the prone position results in hemodynamic changes without apparent adverse effects.

Adolescent↗
PubMed1996

Combined preoperative chemotherapy and radiotherapy in patients with locally advanced esophageal cancer. Interim analysis of a phase II trial.

PURPOSE: The prognosis of patients with locally advanced esophageal cancer (LAEC) remains poor when treated with local modalities. An intensive preoperative program with chemoradiotherapy was used to evaluate the curative resection rate, pathologic response, and survival of patients with LAEC. PATIENTS AND METHODS: Ninety patients with LAEC were treated preoperatively with chemotherapy (three courses of fluorouracil, leucovorin, etoposide, and cisplatin [FLEP]) followed by concurrent chemoradiotherapy (one course of cisplatin plus etoposide in combination with 40 Gy of radiation). Transthoracic esophagectomy was performed 4 weeks after the end of radiation. RESULTS: Seventy-two patients were included in this evaluation. Forty-four (61%) underwent a complete tumor resection, and 16 (22%) had no tumor in the resected specimen (pathologic complete response [PCR]). The operative mortality rate was 15%. At a median follow-up time of 22 months (range, 12 to 41), the median survival duration of all 72 patients was 17 months (range, 1 to 41+). The calculated survival rates at 3 years were 33%, 42%, and 68% for all patients, patients after complete resection, and patients with PCR, respectively. CONCLUSION: This combined treatment modality is active in LAEC, with a PCR in 33% of the patients undergoing surgery. The results appear improved compared with those reported with surgery alone, by approximately doubling the 3-year survival rate. The high efficacy of preoperative chemoradiation warrants evaluation of the role of surgery in LAEC.

Adenocarcinoma↗
PubMed1996

[Methodology in puncture tracheostomy. Technique, indications and contraindications].

Percutaneous dilatational tracheostomy is a relatively new minimally invasive method for bedside tracheostomy of immobilized adult patients. This procedure is based on the Seldinger technique: after percutaneous puncture of the trachea beneath the cricoid a guidewire is placed into the trachea. Afterwards the wound channel around the wire is dilated until a tracheal cannula can be put in place. The surgeon requires not only precise knowledge of cervical anatomy and manual skills to perform this technique but should also be aware of contraindications and how to proceed if there are technical problems. Based on our personal experience of more than 300 percutaneous dilatational tracheostomies, appropriate recommendations are given.

Adolescent↗
PubMed1996

[Basic principles of melanoma surgery].

Today, excisions of primary malignant melanomas of the skin are performed with a margin of 1 cm (Breslow-index < or = 1 mm) or 2-3 cm (Breslow-Index > 1 mm). Elective lymphadenectomy of locoregional lymph nodes is still under debate but therapeutic lymphadenectomy is always indicated. Unilocalized distant metastases should be resected in cases of slow growth and of a long-term interval (> 1 year) between the primary lesion and the occurrence of the metastases.

Adult↗
PubMed1995

[Results of surgical treatment of local and locoregional recurrence of rectal carcinoma--an analysis of 54 patients].

The role of secondary resections of locally and locoregionally recurrent rectal cancer is still unclear concerning local tumor control and survival. A retrospective study of 54 patients undergoing resections of recurrent rectal cancer from 1984 to 1992 was done to define the role of secondary surgery and additive or adjuvant therapies. Extended resections of adjacent organs were performed in 37 patients. Potentially curative surgery was possible in only 7/54 patients, in 14 patients microscopically residual tumor (8 of these patients receiving intraoperative radiation therapy [IORT], and in 33 patients (11 of these cases with distant metastases) macroscopic tumor had to be left. A preoperative or postoperative radiation therapy partly in combination with IORT, hyperthermia or chemotherapy was applied in 26 patients. Median survival was 12.5 months in all patients, 19 months in patients without distant metastases and 8 months in patients with distant metastases, respectively. Radical surgery and localisation of the recurrent tumors were the main prognostic factors: Median survival of patients without distant metastases (n = 43) was 17 months in patients with pelvic wall recurrence, 33 months in patients with anastomotic or perineal recurrence and 39, 20 and 16 months in R0-, R1 and R2-resected patients, respectively. Local tumor control was achieved in only 10 of all patients, but in 4 of 8 patients receiving IORT. In total, only 5 of 54 patients are cured potentially. In conclusion, resection of recurrent rectal cancer, even in combination with additive or adjuvant therapies, only rarely leads to local tumor control and final cure.

Adult↗
PubMed1995

[Dorsal retroperitoneoscopic adrenalectomy--a new surgical technique].

For the first time the surgical technique of right and left adrenalectomy by a posterior percutaneous retroperitoneoscopic access is described. The adrenal gland is mobilized after creation of a pneumoretroperitoneum and insertion of 3-4 trocars beneath the 12th rip. Indications for this new method are small, benign adrenal tumours or adrenocortical hyperplasias. By this method, the potential advantages of a posterior approach and minimally-invasive surgery are combined. This surgical technique might become a major advancement in adrenal surgery.

Adrenal Cortex↗
PubMed1994

[Laparoscopic Kader fistula].

A laparoscopic modification of a gastrostomy by a catheter following the method first described by Kader is presented. Characteristic features are large luminal catheters being introduced into the stomach over a guide-wire and a special trocar under laparoscopic control. The gastric wall is additionally attached to the abdominal wall by laparoscopically applied sutures. Advantages and disadvantages of the presented method are compared and discussed to alternative and established procedures.

Catheters, Indwelling↗
PubMed1994

[Results of transgenicular amputation with dorsal skin-muscle flap-plasty in patients in the final stage of arterial occlusive disease].

A modified technique of knee joint disarticulation by using a dorsal musculocutaneous flap of the gastrocnemius muscle was first described in 1985. The retrospective operative results in 60 patients with gangrene due to peripheral vascular disease (mean age 69 +/- 12 [43-93] years, 29 female, 31 male) with 62 knee disarticulations are reported. After a mean survival period of 18 (1-53) months 47% (n = 28) of the patients had died due to cardiopulmonal reasons after a mean follow-up period of 26 (3-71) months. In-hospital 48 day-lethality was 10%. 9 patients (15%) were re-amputated at above-knee level and in 5 patients operative revisions of the soft tissue were performed. After discharge from hospital 29 of 54 patients (54%) were able to walk with the aid of a prosthesis. We conclude that knee disarticulation with the use of a myocutaneous gastrocnemius flap is a safe and functionally acceptable operative method in high-risk vascular patients.

Adult↗
PubMed1994

[Combined interventions in heart and thyroid surgery--an example of interdisciplinary cooperation].

The anatomic closeness of heart and thyroid gland makes it feasible to operate on both organs simultaneously if required. Between January 1988 and February 1994 we did simultaneous procedures on heart and thyroid gland in 14 patients. We did not see any procedure-specific complications. The cumulative risk of the combined operation seems to be less than in the two stage procedure, because of the better exposure of the thyroid. The main advantage for the patient is the avoidance of a second intervention. Because of the high frequency of thyroid diseases liable for operation endocrinological diagnostics should be performed in all patients undergoing cardiac surgery. The indication for a simultaneous intervention should be made generously in order to avoid a second operation.

Adenoma↗
PubMed1993

[Late pelvic recurrence of rectal cancer].

We report on a case of late pelvic recurrence of a rectal carcinoma 15 years after primary abdominoperineal resection and radiotherapy (primary stage T2 N0 M0; Dukes B). The origin of the recurrent tumour was undoubtfully proved by histological examination of the palliatively resected recurrent carcinoma.

Adenocarcinoma, Papillary↗
PubMed1993

[Puncture tracheostomy in intensive care patients. Technique and results of a minimally invasive method].

The so-called percutaneous dilatational tracheostomy-essentially a minimally invasive puncture method-inserting the tracheal cannula by a modified Seldinger-technique is an alternative method to the conventional operative tracheostomy. The percutaneous dilatational tracheostomy was evaluated in a prospective trial (June 92-January 93) on 50 consecutive surgical (n = 36), medical (n = 10), and neurological-neurosurgical (n = 4) critically ill patients (29 m, 21 f; age 14-87 years) with need for prolonged mechanical ventilation. After an average duration of endotracheal intubation of 6 (0-22) days, the procedure was endoscopically guided and controlled via the endotracheal tube. An 8 mm cannula was inserted in each case. Eight patients had severe thrombocytopenia (< or = 50,000 Plt./microL). The percutaneous tracheostomy was always performed with success. The average procedure duration was 8 (5-15) minutes. The perioperative complications were: one patient died of acute cardiac failure independent from the method of tracheostomy, one sustained a temporary subcutaneous emphysema and one a minor bleeding. During a mean duration of cannulation of 21 (0-113) days only one bleeding from the skin margin was observed postoperatively. Infection of stoma site, misplacement of cannula, rupture of the tube cuff, and pneumothorax were not noticed. On 13 decannulated patients stenosis of the trachea was not found in a period of 6-8 weeks following the tracheostomy. As a bedside procedure the percutaneous dilatational tracheostomy is safe and quick and should therefore be the method of choice for critically ill patients who require a tracheostomy.

Adolescent↗
PubMed1992

[De novo malignant tumors during drug immunosuppression. The findings following 1245 cadaveric kidney transplants in 1080 patients].

Thirty new malignant tumours were found in 1080 patients (634 men, 446 women; mean age 37.6 +/- 13.6 years) after a median follow-up period of 5 years following 1245 cadaveric kidney transplantations performed between 1972 and 1990. The mean dialysis period before transplantation had been 4.0 +/- 3.1 years. Regarding the type of tumour, carcinomas were by far the most frequent, while there was only one lymphoma. The annual malignancy incidence for renal transplant patients was 0.5%. This is 3.5 times higher for men and 4.2 times for women than in the normal population. Immunosuppression with azathioprine and/or antithymocytic globulin (n = 395) produced the same malignancy incidence (0.54%) as with cyclosporin (n = 685; 0.60%). On the other hand, malignant tumours occurred much earlier under cyclosporin than under azathioprine/antithymocytic globulin (27 and 68 months, respectively).

Age Factors↗
PubMed1992

[Pulmonary embolism caused by liver tissue].

Embolism of hepatic tissue to the lung in coincidence with severe injury to the liver is a rare complication. We report on a case of a 22-year old motor-cyclist who was involved in a traffic accident and incured a blunt abdominal trauma. The autopsy revealed a crushed right hepatic lobe. Careful microscopically investigations of the lungs showed multiple small emboli composed primarily of hepatic tissue in pulmonary arterial branches.

Adult↗
PubMed1991

[Splenic cysts. Their morphology, diagnosis and therapy].

Over a 10-year period, nine patients (four men, five women, mean age 27 years) underwent surgery for splenic cysts (six epidermoid cysts, two mesothelial cysts and one pseudocyst). Six patients had had suggestive clinical symptoms, but, in the other three, the cysts were only discovered by chance on ultrasound scan. Three of the patients with epidermoid cysts had raised serum concentrations of the tumour markers carcinoembryonic antigen (CEA) or carbohydrate antigen (CA 19-9. All six benign epidermoid cysts contained immunohistochemically demonstrable CEA and/or CA 19-9 in the inner epithelial layer, implying a mesothelial origin for these cysts. In five cases the splenic cysts were completely extirpated (splenectomy in two, hemisplenectomy in one, enucleation in two); in four cases cyst resection was performed, leaving part of the cyst adherent to the spleen. In one of these four patients, a 4 cm cyst persisted postoperatively in the hilus of the spleen, but has remained unchanged over an 8-year period. Splenic cysts are usually benign, despite the presence of tumour markers in the cyst wall, and do not require removal. The only indications for surgical intervention are complications (e.g. rupture), symptomatic cysts or asymptomatic cysts with an increased risk of rupture (diameter greater than 5 cm). The very rare parasitic and infective forms must always be surgically sterilized.

Adolescent↗