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Biomedical subjects

M M Kaiser

Publications and source records attributed to M M Kaiser.

5 recordsLinked to original sources
PubMed2000

[Omphalocele and gastroschisis. Outcome--complications--follow-up--quality of life].

From 1970 to 1998, 35 children with omphalocele (OC) and 31 with gastroschisis (GS) were treated at the Department of Paediatric Surgery at Lübeck Medical University. Forty of 43 survivors were examined in 1990, the data of 30 patients were renewed in 1999 and 12 new cases added. Total follow-up was 1-28 years. Primary closure was possible in 25 OCs and 20 GSs. Eighteen children with OC and 8 with GS suffered from additional abnormalities, which were treated simultaneously. Twenty percent of the babies with OC died mostly because of severe congenital anomalies and 12.9% of GS because of infectious complications in combination with other diseases. There were no more deaths in the last decade. Accordingly, there was a reduction in consecutive operations. Improvements were due to better operative and perioperative treatment as well as abortions following improved ultrasound examinations. The results of the literature and our own experience show the benefit of primary closure. A two-stage approach with dura/amnion or a silo procedure prevents high intra-abdominal pressure, therefore, indirect measurements of intra-abdominal pressure can be used exceptionally. Umbilical preservation offers better cosmetic results. Long-term follow-up reveals normal growth and development of the children except for those with severe congenital anomalies. All the others are participating without problems in normal activities and education without reduction in their quality of life. Today an isolated OC or GS is not an indication for abortion. If prenatal OC or GS is diagnosed, paediatric surgeons should be involved in the consultations.

Adolescent↗
PubMed1997

[Treatment strategy in inguinal injection abscess and complications].

From 1994 to March 1997, 12 patients with 15 drug-related abscesses of the groin were treated at the Surgical Department of Lübeck Medical University. Besides laboratory, serological and microbiological examinations, the standard diagnostic investigation consisted of sonography or duplex sonography. If indicated, the diagnosis was extended to include, for example, clarification of the retroperitoneum by CT. The most common accompanying disease was deep femoral vein thrombosis. Substitution was planned individually. After surgical débridement and perioperative administration of a beta-lactam-protected acylaminopenicillin, open wound treatment was successfully carried out in 13 cases; secondary closure was performed four times in cases of good compliance. One abscess led to necrotising of the femoral artery; saphenous vein was interposed because of erosion bleeding and formation of aneurysm. In a second case, the bifurcation was reconstructed with saphenous vein after external resection of an infected false aneurysm and early occlusion. Both defects were covered by rotation of sartorius muscle and mesh graft. On the basis of the treatment concept, a rapid and successful intervention was possible; complications such as sepsis, amputation or withdrawal delirium did not occur. Resistance against the antibiotic was not observed. In the case of infected aneurysm, we prefer the autogenous saphenous vein graft followed by rotation of sartorius muscle and mesh graft. Ligation or excision leads to high rates of claudication or amputation; extended reconstructions are threatened by insufficient compliance of the patients; the use of synthetic grafts is endangered by further bacteraemia or infections.

Abscess↗
PubMed1996

[Ischemic colitis after vascular surgery reconstruction of an abdominal aortic aneurysm].

Between 1978 and 1994, a total of 678 patients were operated on for infrarenal (abdominal) aortic aneurysm at the Department of Surgery of Lübeck Medical University. Rupture had occurred in 165 patients, 351 were treated electively, and 162 presented with severe symptoms but no rupture. Only CT, angiography and intraoperative judgement were used for diagnosis. Reconstruction of the inferior mesenteric artery (IMA) was performed only in exceptional cases. Severe ischemic colitis occurred in 1.03% (in no case following elective surgery, in 0.66% of patients presenting with symptoms, and in 3.6% of patients in whom rupture had occurred prior to the operation). Three patients presented with mild ischemia, two with grade B ischemic colitis and three with transmural infarction. One patient had to be operated on for ischemic colitis despite open reconstruction of the IMA. We conclude from our data that there is no need to reconstruct the IMA as a routine procedure; this topic has been a controversial issue in the literature. We do reimplant a patent IMA when there is only oozing from the IMA and/or a borderline perfusion of the sigma following the operation, with at least one open internal iliac artery. When rupture had occurred, reconstruction should be performed if there is the slightest suspicion because of the increased risk, but only if the patient's cardiopulmonary condition allows this to be done. Analysis of our patients with ischemic colitis demonstrates the importance of maintaining stable circulatory conditions to prevent intestinal ischemia. Further diagnostic procedures (Doppler ultrasound, measuring of oxygen saturation or pH) may identify more patients at risk, but at the moment we do not consider these to be routine procedures.

Aged↗
PubMed1994

[PTFE prostheses in infrarenal aneurysms of the abdominal aorta].

Postoperative dilatation of Dacron vascular grafts can lead to aneurysms and rupture of the prosthesis making it necessary to change the graft by operation. Therefore, 15 patients at Lübeck University Hospital underwent replacement of the aorta with PTFE prostheses due to infrarenal aortic aneurysms. Ultrasound measurements 2-12 months postoperatively revealed a dilatation of 11.6% concerning tubular grafts, 11.5% for the shafts and 14.6% for the limbs of bifurcation grafts compared to the higher dilatation rate of Dacron prostheses described in the literature. There was no evidence of anastomotic false aneurysms, thrombosis of the limbs of bifurcation grafts, peripheral embolization or perigraft reaction. In conclusion, PTFE prostheses seem to be a means of preventing patients from having secondary complications as a result of graft dilatation. Based on our early results and the results described in the literature, PTFE prostheses can be regarded as an alternative to dacron prostheses.

Aged↗