Search PubMed⌕ Search

Biomedical subjects

M Manner

Publications and source records attributed to M Manner.

At least 19 recordsLinked to original sources
PubMed2001

[Invagination caused by angiolipoma of the small intestine--a rare cause of occult gastrointestinal hemorrhage].

We present the case of a 71-year-old woman who was hospitalized because of a severe hip contusion. She had no symptoms or clinical signs of abdominal disease. Routine blood testing showed anemia, presumably owing to occult bleeding. Ultrasonographic abdominal screening revealed ileo-ileal intussusception with a central hyperechoic tumor suggestive of a lipoma as lead point. This diagnosis was confirmed at surgery, where a small bowel resection was performed. Histologic examination disclosed a benign angiolipoma of the ileum with a superficial shallow ulceration which obviously was the source of the occult blood loss. Diagnostic and therapeutic procedures and a literature review are discussed.

Aged↗
PubMed2001

[Diagnosis in suspected appendicitis. Can ultrasonography rule out acute appendicitis?].

INTRODUCTION: Acute appendicitis is often difficult to confirm and even harder to rule out by physical examination. In order to assess the diagnostic reliability of sonography we compared the results of physical (p) and sonographic (s) examination. METHOD: One hundred and fifty consecutive patients presenting with right lower quadrant abdominal pain were evaluated in a prospective study. Based on the respective findings patients were classified into three groups: I: appendicitis confirmed; II: appendicitis ruled out; III: equivocal findings. The results were compared with the discharge diagnoses established by histologic examination or clinical observation. RESULTS: Ultrasonography showed significantly higher sensitivity (group I s vs group I p: 95% vs 45%) and specificity (group I s vs group I p: 100% vs 75%) in confirming as well as in ruling out acute appendicitis (group II s vs group II p: sensitivity 73% vs 53%; specificity 100% vs 81%) than physical examination alone. Owing to additional sonographic findings the group with indeterminate abdominal pain was much smaller after ultrasound examination (group III s vs group III p: 35 vs 69 patients). CONCLUSIONS: After discussing the literature and sonomorphologic criteria that distinguish an inflamed from a normal appendix, we conclude that ultrasonography is a valuable tool in confirming as well as in ruling out acute appendicitis.

Acute Disease↗
PubMed2000

[Orthograde Kirschner wire osteosynthesis. Experiences with intramedullary fixation of the distal metacarpal V fracture].

Dislocated metacarpal V fractures, fixed by percutaneous Kirschner wires or other implants near the metacarpophalangeal joint, often show impaired movement despite excellent radiologic findings. We therefore chose an alternative method using intramedullary Kirschner wire osteosynthesis according to Foucher. Twenty-five patients were operated on in a 3-year period and movement of the fingers and complications were examined. Six weeks after operation all fractures were consolidated in anatomical reduction. One patient suffering from an early stage of Sudeck's dystrophy was healed, and no other complications appeared. Three months after treatment all patients achieved free movement of the fingers with anatomical alignment. We therefore recommend intramedullary Kirschner wire osteosynthesis in distal metacarpal V fractures.

Adolescent↗
PubMed1999

[In Process Citation]

Cryophlebectomy, a more recent technique in varicose veins surgery, was evaluated in comparision with conventional techniques. Group IA: Microphlebectomy, invaginative stripping of the long saphenous vein, tourniquet, n = 90; group IB: only microphlebektomie and tourniquet, n = 72. Group IIA: Cryostripping of the long saphenous vein in combination with cryosurgical distal avulsion of varicosities and microphlebectomy, n = 112; gr. IIB: only cryosurgical distal avulsion of varicosities and microphlebectomy. Data were compared regarding duration of operation and hospitalisation and cosmetic outcome. Hospital stay (gr. IA: 9.1 +/- 5.1 d vs. gr. IIA: 6.1 +/- 2.1 d, gr. IB: 5.5 +/- 2.3 d vs. gr. IIB: 4.8 +/- 2.5 d) and duration of operation (gr. IA: 113.6 +/- 35 min vs. gr. IIA: 67 +/- 21.3 min, gr. IB: 74.4 +/- 35.3 min vs. gr. IIB: 53.3 +/- 15.5 min) were found to be significantly shorter and cosmetic result and postoperative discomforts improved in the cryophlebectomy-group. We conclude that the use of this combination of methods reduces invasivity, rises the patient's well-being and helps in cost-reduction.

Journal Article↗
PubMed1999

[Vascular injuries complicating osteosynthesis in proximal femur fractures].

While there are quite a number of reports on vascular injuries complicating hip arthropasty by acetabular component screw fixation, retractor tip pressure or extruding bone cement, the incidence of deep femoral vessel injuries in operative fixation of proximal femoral fractures is comparatively seldom described. We report on two patients with per- and subtrochanteric femoral fractures who sustained injuries of deep femoral artery branches during the implantation of a dynamic hip screw (DHS) and a dynamic condylar screw (DCS), which resulted in a massive thigh hematoma and a fist-size pseudoaneurysm respectively and necessitated surgical intervention in either case. We blame these vascular injuries on the pressure of Hohmann retractors exposing the femoral bone or on the drilling of boreholes for plate attachment. After discussing various operative procedures, we conclude that intramedullar implants are safer than plates with regard to potential vascular complications.

Aged↗
PubMed1998

[Ultrasound criteria of gallstone ileus].

During a 4-year period we treated four patients with gallstone ileus by enterotomy and extraction of the impacted concrement. Diagnosis was quickly established by abdominal ultrasound examination in all cases. Lacking visibility of the gallbladder in the clinical setting of ileus and subileus proved to be a sonographic clue of gallstone ileus and prompted a thorough search for the obturating gallstone which could definitely be demonstrated as an intraluminal semicircular reflex with strong echos and a sonic shadow in all patients. Thus, due to early diagnosis and timely surgical intervention, even in the absence of full-blown ileus, all of our elderly patients and those with a multitude of diseases still had a favorable outcome.

Abdomen, Acute↗
PubMed1995

[Hepatic echinococcosis with gallstones of the echinococcal cavity].

HISTORY AND CLINICAL FINDINGS: A 65-year-old woman was hospitalized with suspected cholelithiasis. The only contributory item in the history was jaundice of uncertain cause 15 years previously. Physical examination elicited pain in the right upper abdomen on deep palpation. INVESTIGATIONS: Alkaline phosphatase and gamma-GT activities were raised (324 and 407 U/ml, respectively). Ultrasound revealed cholecystolithiasis; the bile duct was 5 mm in diameter. Intravenous contrast-medium cholangiography showed choledocholithiasis and circular flat calcification in the bifurcation of the hepatic duct. Computed tomography revealed this structure to be a space-occupying mass (10 x 6 x 5 cm), with a calcified border (density of 27 Hounsfield units), raising the suspicion of a blood-containing hydatid cyst. Additionally there were two calculi in the left hepatic duct. But the echinococcus test (by indirect haemagglutination and enzyme-linked immunosorbent assay) was negative. TREATMENT AND COURSE: Endoscopic retrograde cholangiography (ERC) with papillotomy was performed and two choledochal concrements removed. Concrements within the mass were also visualized. Obstructive jaundice developed 3 days after the ERC and a laparotomy was performed. Excision of the hydatid was not possible because the stone-filled hydatid cavity could not be punctured. Choledochal exploration discovered membranes which histologically were chitin-like structures and corresponded to scolices. Under chemical litholysis the hydatid became smaller. In addition, albendazole was given in two four-week cycles (400 mg twice daily). The patient quickly recovered and 5 months later was symptom-free.

Aged↗
PubMed1991

Arterial steal: an unusual cause for hepatic hypoperfusion after liver transplantation.

Case reports of two patients with an unusual cause for a rapid increase in transaminases following liver transplantation are described. In the postoperative course, angiography revealed an arterial hypoperfusion of the liver due to a steal phenomenon with blood shunting from the hepatic to the splenic artery. In one case, the underlying pathophysiology was a pre-existing filiform stenosis of the celiac trunk with insufficient recruitment of arterial blood from the superior mesenteric artery via the pancreatic arcade. Adequate liver perfusion was restored by simple ligation of the common hepatic artery. In the other case, angiography showed an arteriovenous fistula formation of the splenic vessels and minimal blood flow through the hepatic vessels. This was successfully corrected by angiographic embolization of the splenic artery with metal coils. After therapeutic intervention, both patients rapidly recovered with excellent liver function.

Adult↗
PubMed1991

Rapid increase in the activity of enzymes of eicosanoid synthesis in hepatic and extrahepatic tissues after experimental liver transplantation.

Previous studies have demonstrated a marked release of prostanoids from hepatic tissue after liver grafting. In addition, eicosanoid synthesis was shown to be regulated at the level of key enzymes. The present study addressed changes of the local availability of these enzymes during and after porcine orthotopic liver transplantation. We determined kinetic parameters of cyclooxygenase (CO), the initial enzyme of prostaglandin synthesis, of prostacyclin and thromboxane synthase (PCS, TXS), two more peripheral enzymes, in microsomal preparations of hepatic and gluteal muscle biopsies, and the activity of 5-lipoxygenase (5-LO), the key enzyme of leukotriene synthesis. Maximal velocity (Vmax) of CO and PCS showed a 4-fold increase both in liver and gluteal muscle tissue 1 hr after reperfusion of the grafted liver and a more than 20-fold increase after 24 hr (P less than 0.001), whereas apparent affinities (Km) remained unchanged. In contrast, Vmax of TXS and the activity of 5-LO disclosed a striking increase only within the hepatic graft (P less than 0.001). No changes of enzymatic activity could be observed during donor operation, cold storage, and 5 min after reperfusion. Results were independent of the duration of preservation (3 hr and 20 hr with Euro-Collins) and the addition of Iloprost, a prostacyclin-analogue. These results suggest that after liver grafting, abnormalities at the level of local enzyme expression in hepatic and extrahepatic tissues might contribute to preservation damage and systemic injury of the host.

6-Ketoprostaglandin F1 alpha↗
PubMed1990

[Improved intraoperative leak control in cytostatic drug isolation perfusion of tumors of the extremities].

The success of extremity perfusion and the protection from systemic side effects largely depend upon the prevention of systemic drug leakage from the extremity circulation. The use of autologous 111-Indium labelled erythrocytes for leakage control allows a continuous exact surveillance and timely correction of the tourniquet position in case a major leak should occur. A total of 97 patients were studied. In 6 patients (= 6%) the perfusion had to be discontinued within the first 30 min due to an uncorrectable leak of greater than 20%. In 31 patients (= 32%), a major leak could be reduced by manipulation of the tourniquet. No systemic side-effects could be observed in any of our patients. Applying leakage control by means of 111-Indium labelled erythrocytes extremity perfusion has proved to be a safe procedure in patients with high risk or recurrent malignant melanoma and soft tissue sarcoma.

Adolescent↗