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Biomedical subjects

M Rothmund

Publications and source records attributed to M Rothmund.

At least 199 records · Page 11Linked to original sources
PubMed1991

Lymph node counts in the upper abdomen: anatomical basis for lymphadenectomy in gastric cancer.

The number of regional lymph nodes was determined in sites relevant to lymphadenectomy in gastric cancer in 30 cadavers. Tissue was cleared by dissolving fatty tissue, thus making lymph nodes with a diameter of at least 1 mm visible. All lymph node stations indicated by the Japanese Research Society for Gastric Cancer were studied. In stations 1-11 (corresponding with R2 resection) an average of 27 nodes (range 17-44 nodes) was found, whereas stations 1-16 (corresponding with R3 resection) showed an average of 43 nodes (range 25-64 nodes). These values are higher than those usually obtained from lymphadenectomy for gastric cancer. Striking individual differences in the total number of lymph nodes and the number of single stations was observed. The number of lymph nodes in these investigations are the normal anatomical values and serve as quality control of lymph node dissection in gastric carcinoma.

Adult↗
PubMed1991

Primary hyperparathyroidism due to solitary adenoma. A comparative multicentre study of early and long-term results of different surgical regimens.

Surgical regimens for treatment of solitary parathyroid adenoma were compared in a multicentre study in five departments of surgery in the United States and Europe. Three hundred and twenty-five patients fulfilled the inclusion criteria. Eight years after the operation 272 patients (84%) were available for follow-up investigation. Severe postoperative hypocalcaemia (less than 2.00 mmol) was significantly more common after bilateral than unilateral exploration (p less than 0.001), and in women (p less than 0.01). Neither age nor preoperative serum calcium concentration was related to the severity of postoperative hypocalcaemia. At follow-up, 96% of the patients who had had unilateral, and 89% of those who had had Bilateral exploration had remained normocalcaemic without further treatment. Of the patients who had had incisional biopsies of normal glands 8% had hypercalcaemia and 8% had hypocalcaemia. Of patients operated on without a biopsy being taken or who had had one whole normal gland removed 1% were hypercalcaemic and 4% were hypocalcaemic. Early and late hypocalcaemia are reduced by atraumatic handling of the normal parathyroid gland without increasing the risk of persistent or recurrent hypercalcaemia.

Adenoma↗
PubMed1991

[Ultrasonic diagnosis in suspected acute appendicitis: probable or certain indications for surgery?].

The diagnostic accuracy and the clinical impact of routine ultrasonography performed by 4 surgeons, were prospectively studied in 366 unselected patients admitted for suspected acute appendicitis. Clinical and sonographic findings on admission were correlated with laparotomy findings, pathological outcome and clinical as well as follow-up data. The overall sensitivity, specificity and accuracy of the clinical diagnosis of acute appendicitis were 55.3%, 94.6% and 84.2% respectively (positive predictive value (PPV) 75.8%, negative predictive value (NPV) 87.3%). Ultrasound enabled visualization of the disease in 67 of 85 (prevalence 23.3%) patients with a histologically confirmed acute appendicitis; false positive results were recorded in 7 cases (sensitivity 78.8%, specificity 97.5%, accuracy 93.1%, PPV 90.5%, NPV 93.8%). Ultrasound was particularly useful in patients presenting with equivocal or highly unsuspective signs of acute appendicitis: of 38 patients with an acute appendicitis in this group ultrasonography enabled to make the diagnosis in 26. The combined approach of clinical evaluation and routine ultrasonography markedly improved the diagnostic accuracy (sensitivity 85.9%, specificity 96.4%, accuracy 94%) and substantially reduced the negative laparotomy rate (7.9%) in patients with suspected acute appendicitis. It is concluded, that ultrasonographic evaluation of the patient with suspected acute appendicitis performed by surgeons is of great assistance in surgical practice.

Abdomen, Acute↗
PubMed1991

[Making a surgical decision: indications conference].

One of the most important parts of a surgeon's education is learning to develop an adequate system of indications for a surgical procedure. In medical structures with a "one department--one boss system" the indication conference lends itself well to this. The day prior to surgery all information on the particular patient are presented and there is an analysis of risk and benefit of the planned procedure and a discussion on the type of procedure. Prerequisites are the presentation of all relevant information and clarity in the decision-making process including an open discussion on the basis of objective facts.

Diagnosis↗
PubMed1991

[Theoretical surgery and making a clinical decision].

Theoretical surgery--if available in departments of surgery--participates in clinical decisions as a supportive system with concepts, structures, and methods of formal (statistical) and heuristic (problem-solving, individual) decision making. Decision making for groups of patients and for individual subjects is not identical, but also not mutually exclusive. Decision support is realized in terms of a defined instrument: the permanent, integrated working team of surgeons, theoretical surgeons, technical staff, and medical students. Hence the process and progress of decision support is determined by the effectiveness of these working groups.

Diagnosis↗
PubMed1991

[Conservative surgical techniques: thyroid gland and adrenal gland surgery].

Atraumatic surgery in endocrine tumors means both anatomically atraumatic and functionally adequate. Anatomically, in thyroid diseases above all both the recurrent nerve and the parathyroids have to be preserved; also an minimally visible scar is of importance for the patient. Functionally, adequate technique in nontoxic goiter rendering the patient euthyroid despite the removal of all nodules. In diffuse autonomy and Graves' disease, hypothyroidism must be taken into account. Among adrenal tumors, pheochromocytomas deserve a careful approach: adequate preparation and early ligation of the adrenal vein after transabdominal access are the main goals. All other benign tumors should be resected through a posterior incision. Preserving a remnant of a normal adrenal gland after surgery for bilateral tumors is controversial.

Adrenal Gland Neoplasms↗
PubMed1991

[Stress ulcer or pneumonia: effect of prevention with H2 blockers on gastric juice pH].

In a study with 30 consecutive ventilated patients in a surgical ICU, the course of gastric pH was measured for 24 h. Cimetidine, 1.2 g per 24 h, was given to prevent stress bleeding. In the course of the evaluation period complete alkalization was found in only 4/30 patients (high responders); 10/30 patients showed no alkalization of gastric juice to above pH 4; and in 16/30 patients irregular pH changes were observed. These results suggest that the risk of developing pneumonia under this regimen will only be elevated in the high responder group. Although the alkalization of gastric juice was incomplete in our group, we saw no evidence of upper gastrointestinal bleeding. There is evidence that alkalization is not the only mechanism involved in successful prevention of bleeding.

Adult↗
PubMed1991

Endocrine pancreatic carcinoma.

Endocrine carcinomas of the pancreas are rare, but they should be treated aggressively because they threaten the patient's life by both malignant growth and hormone excess. Resection for cure should be attempted, but is hardly ever possible. Debulking should be performed primarily in hormone-active tumours so that symptoms can be controlled by subsequent medical treatment; this can be directed against tumour growth and/or hormone production, and it can reduce stomach acid secretion in the gastrinoma syndrome. Surgery should be undertaken whenever possible since the patient's life can be considerably prolonged in most cases. Palliative surgery can reduce the patient's symptoms that may be caused by excessive hormone production and/or obstruction of the bile duct or the duodenum.

Adenoma, Islet Cell↗
PubMed1991

[Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation in secondary hyperparathyroidism. A randomized study].

In this randomised study subtotal parathyroidectomy (PTX) is being compared with total parathyroidectomy including autotransplantation (PTX + AT) in 40 patients with secondary hyperparathyroidism. Both groups were followed up twice, first 19 +/- 6 months (PTX + AT) respectively 19 +/- 7 months (subtotal PTX) and secondly 43 +/- 9 respectively 40 +/- 7 months after surgery. In each group there were 17 patients alive at the time of the second postoperative follow-up. In the meantime 2 patients with subtotal PTX required reoperation because of recurrences originating from the remaining parathyroid tissue, another 2 patients of this group were hypercalcaemic. After PTX + AT serum-calcium normalized significantly more often (p less than 0.03), a corresponding result was seen in alkaline phosphatase. Reoperation was not required in this group. Also radiological alterations reformed significantly more often after PTX + AT, so did clinical signs like pruritus (p less than 0.005) and muscular weakness (p less than 0.04). Considering these results and the fact that in case of recidive a reoperation of the autograft in the forearm is much easier to perform than a reoperation in the neck, PTX + AT is recommended as method of choice in surgical treatment of sHPT.

Adult↗
PubMed1990

[Long-term results after implantation of autologous cryopreserved parathyroid tissue].

Autologous cryopreserved parathyroid tissue was implanted into 25 patients (12 men and 12 women, median age 45 [24-75] years, and an 18-month-old child) who after a parathyroidectomy for primary or secondary hyperparathyroidism, had developed permanent postoperative hypoparathyroidism. In 12 of the patients it had developed after a second operation for persisting or recurrent hyperparathyroidism. In ten patients it had occurred after total parathyroidectomy and autologous transplantation of fresh parathyroid tissue, in two patients after subtotal parathyroidectomy and in one patient after excision of a solitary parathyroid adenoma following goitre resection. In 22 patients the state of the tissue to be implanted was examined histologically before implantation after defrosting and any necrosis made up by replacement with more than 20 tissue particles. Re-examination took place a median of 40 [3-120] months postoperatively. The high doses of calcium and vitamin D preparations required preoperatively were reduced stepwise in all patients, completely discontinued in 16. At the time of follow-up nine patients were still receiving low doses of calcium and/or vitamin D. Symptoms of hypocalcaemia disappeared in all patients. Thus implantation of autologous cryopreserved parathyroid tissue is a reliable method for the treatment of permanent postoperative hypoparathyroidism.

Adenoma↗
PubMed1990

[Lessons from reoperations in 55 patients with primary hyperparathyroidism].

On the basis of 70 re-operations in 55 patients (34 women, 21 men, median age 58 [43-83] years) suffering from primary hyperparathyroidism the reasons for failure of the first operations were analysed. The main reasons were inadequate exploration of the neck (failure to identify all four glands), failure to recognize multiple gland involvement, or inadequate resection in cases where more than one gland was affected. An abnormally situated gland was a less common cause, as shown by the fact that 41 out of the 73 glands removed at the last re-operation were situated in the normal position or in its immediate vicinity; in 20 cases the surgeon had failed to recognise multiple gland disease. Next in order of importance were anatomical variations in the location (32 out of 73 tumours) or the number of the glands (9 patients with hyperplasia of 5 glands). At the re-operations 89% of the parathyroid tumours were found in the neck region or would have been accessible from the neck at the time of the first operation. Overall, the hypercalcaemia was permanently rectified in 96.6% of the patients. During the last 10 years 94% of patients have been normocalcaemic postoperatively, thanks mainly to the re-implantation of autologous parathyroid tissue, preserved by low-temperature storage. The incidence of permanent unilateral recurrent nerve paresis attributable to the re-operations was 6%.

Adult↗
PubMed1990

[Primary hyperparathyroidism. A disease picture has changed].

Data were retrospectively analysed on 544 consecutive patients (362 females and 182 males, mean age 53.6 [2 weeks and 86 years]) who had been operated on for primary hyperparathyroidism between 1965 and 1989. During this period the rate of renal, bone and intestinal complications decreased from 90% in the first 5 years to 29% in the last 5 years. Organ manifestations and hypercalcaemia were often combined (70% in the early period, 30% now). The proportion of those with an asymptomatic course gradually and continuously rose to 21% now. The patients' average age at diagnosis rose from 46 +/- 10 to 58 +/- 14 years. Serum calcium concentrations in the last few years averaged 3.1 mmol/l, as high during the last few years as at the beginning of the period. Age, serum calcium concentration and parathyroid weight of the asymptomatic patients did not differ from those of the group as a whole.

Adolescent↗
PubMed1990

[Is simultaneous cholecystectomy and choledochal exploration obsolete?].

Perioperative data on 284 patients who had simultaneously undergone cholecystectomy and surgical exploration of the bile duct were analysed. The procedures had been performed electively in 234 patients (145 females, 89 males; median age 61.5 [20-84] years). Freedom from stone was achieved in 96.2%; complication rate was 25.2% and death rate 2.6%. There was no death among patients without any or only one risk factor, while the morbidity rate for them was 18%. There were five deaths among 34 patients with four or more risk factors, and 13 (38.2%) had complications. Three of the patients who had died had been operated on because of septic, obstructive cholangitis with fever greater than 37.5 degrees C and bilirubin levels greater than 5 mg/dl. The operation was performed as an emergency in 50 patients (32 females, 18 males; median age 71.5 [24-93] years. 94% of them were free of stone afterwards; death rate was 10%, complication rate 44%. These data suggest that indications for the double surgical procedure in case of cholecysto-choledocholithiasis should be related to risk factors. In an emergency and in patients at risk, endoscopic papillotomy and stone extraction should precede cholecystectomy. But the one-time and thus definitive double surgical procedure remains the management of choice for patients with few or no risk factors.

Age Factors↗
PubMed1990

Extracorporeal gas exchange in adult respiratory distress syndrome: associated morbidity and its surgical treatment.

Extracorporeal carbon dioxide removal (ECCO2-R) over a membrane lung is a new therapy for patients with adult respiratory distress syndrome (ARDS) who frequently suffer from lung complications caused by long-term artificial ventilation and who may require major thoracic surgery. This is a report of 76 patients with severe ARDS who were treated by ECCO2-R. Twenty-six of these 76 patients required thoracotomy: 19 for pneumothorax and pneumatocele, and seven for haemothorax, infected lung necrosis or oesophagotracheal fistula. Most pneumothoraces were bilateral. Ten of these 26 patients required reoperation, usually for extensive persisting alveolar air leaks. Sixteen (62 per cent) of the 26 patients who had a thoracotomy and 22 (44 per cent) of the 50 patients without surgery survived. These results demonstrate that performing a thoracotomy, if necessary, does not diminish the survival chance of high-risk patients with severe ARDS.

Adolescent↗