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Biomedical subjects

M Rothmund

Publications and source records attributed to M Rothmund.

At least 217 records · Page 12Linked to original sources
PubMed1990

[Making a surgical decision: interplay between experience and clinical study].

Although the final, individual decision making in patients always has to be in the hand of the doctor, it has hitherto been much less a matter of scientific analysis than formal decision making on the basis of clinical trials. To change this, several types of individual decision making were characterized, four in the field of intuition (very fast logical decisions, consciously and unconsciously heuristic decisions using special instruments, the deep remainder of intuition which can and should not be the subject of scientific analysis) and discursive (purely logical) decision making as a fifth type. The prospective think-aloud technique including an hierarchical heuristic decision tree was presented as a method for scientific analysis of individual decision making which is open to repetition and criticism. The place of various types of formal trials in this process was defined. Via a posit and the heuristic instrument of representativeness, the problem of the transfer of results from clinical trials to the individual patient was solved.

Clinical Competence↗
PubMed1990

[Effects of intuition on determining indications and intraoperative procedure].

Intuition is used in medical decision-making, especially in a decision for surgery and in selection of the surgical procedure. Intuitive decisions are made without reasoning. They are often correct if the prerequisite experience and knowledge are available to the physician. Intuition is related to heuristic techniques and uses them (representativeness, availability, anchoring). Decisions made on the basis of intuition must be controlled by systematic and logical reasoning.

Clinical Competence↗
PubMed1990

[Analysis of risk in the perioperative period].

Operative risks should be assessed before surgical intervention not only by heuristic means, but in addition also by quantitative methods. ASA-classification and Recovery Index (McPeek) are offered for a critical routine assessment of global perioperative risk.

Aged↗
PubMed1990

[Surgical therapy of lung complications of long-term ventilation for severe adult respiratory distress syndrome].

Long-term respiratory therapy with high pressure levels in case of ARDS can lead to several symptoms requiring surgical treatment. Various forms of manifesting barotrauma predominate (bronchopleural fistula, pneumothorax, pneumatocele and soft tissue emphysema), while hematothorax, infected necrosis of parenchyma or esophagotracheal fistula are rare. Most of the operations became necessary because of bronchopleural fistula resp. pneumothorax, and with this indication the number of reoperations was especially high. Of 21 patients 13 (62%) survived.

Adolescent↗
PubMed1990

[Simplified storage procedure of cryopreserved human parathyroid tissue].

Parathyroid tissue that is stored for replantation purposes is usually kept in a special tank containing fluid nitrogen at -196 degrees C. Our studies demonstrate that storage is also possible in a deep-freezer at -70 degrees C without any loss of quality. Most hospitals own such freezers for storing bone marrow cells at the same temperature. Parathyroid tissue of 11 patients who were operated on because of primary hyperparathyroidism was stored in this way. After six months the tissue showed 75.7% morphologically intact cells. The control group's tissue was stored in liquid nitrogen according to the common method; after the same period of time it showed 76% histologically normal cells.

Adenoma↗
PubMed1990

[Acute acalculous cholecystitis. A stress-induced complication].

The acute acalculous cholecystitis is a stress induced complication following surgery and trauma. A totally different disease is a large atonic gallbladder during parenteral nutrition. The symptoms of the acalculous cholecystitis are similar to acute cholecystitis in patients with cholelithiasis. The diagnosis can be very difficult, because in the postoperative period patients are usually very sick, treated with analgetic and antibiotic drugs and therefore the symptoms are mostly lacking or equivocal. Typical signs are fever and leucocytosis. An ultrasound scan should be performed at the intensive care unit. Although the disease is rare according to the literature, in future it may be diagnosed more frequently because of extended surgical intensive care, higher age of patients, modern methods of surgery and early ultrasound scans in equivocal cases. Having the possibility of postoperative and posttraumatic acute acalculous cholecystitis in mind, surgeons may be able to make the right diagnosis earlier than the pathologist.

Acute Disease↗
PubMed1989

Ultrasonography in the diagnosis of acute appendicitis: a prospective study.

The diagnostic accuracy and practical impact of high-resolution sonography were prospectively studied in 523 consecutive patients admitted to the hospital with suspected appendicitis. The criteria for ultrasound diagnosis of acute appendicitis included visualization of a noncompressible aperistaltic appendix, with a targetlike appearance in transverse view and a diameter greater than or equal to 7 mm. In 115 of 130 patients with proven appendicitis the inflamed appendix or appendiceal abscess could be visualized, giving a sensitivity of 88.5%. The mean diameter of ultrasonically visible appendices was 11.4 +/- 3.2 mm. The overall accuracy and specificity of sonography in the diagnosis of acute appendicitis were 95.7% and 98%, respectively. The predictive value of a positive test was 94.5% and that of a negative result 96.3%. In a separate analysis of the results in 121 women of childbearing age, who have a high risk of preoperative misdiagnosis, the overall accuracy was found to be 96.7%, with 82.6% sensitivity and 100% specificity. Twenty-four (89%) of the 27 patients with appendiceal rupture (incidence 20.8%) were correctly diagnosed with ultrasound. The other 3 cases (11%) were missed. Routine use of ultrasonography has significantly improved the diagnostic accuracy in patients with suspected appendicitis and has reduced the negative laparotomy rate from 22.9% to 13.2%.

Adult↗
PubMed1989

Sonography versus peritoneal lavage in blunt abdominal trauma.

The reliability of sonography and peritoneal lavage in assessing the need for immediate surgical intervention in blunt abdominal trauma was examined in a prospective study (n = 71). Statistical analysis revealed a sensitivity of 100% for peritoneal lavage compared to 84% for sonography; the accuracy was 99% versus 86%, the predictive value 97% vs. 89%. The statistical difference was significant (p less than 0.05). The results demonstrate that sonography cannot replace peritoneal lavage in the diagnosis of blunt abdominal trauma. The discussion of the advantages and disadvantages of both methods shows that sonography and peritoneal lavage are not competing, but rather, are complementary examinations.

Abdominal Injuries↗
PubMed1989

[Ultrasound in surgery--value and dangers of a new development].

The value of US in enlarging the spectrum of diagnostic examination has been recognized. This also true for surgery in elective as well as emergency and intraoperative situations. Problems with US may arise when used by surgeons who do not have time enough for qualified training in this field due to intensive operation schedules or in cases where a 24-h US service is unavailable. Intensive education in diagnostic US for surgeons can help to avert this problem.

Germany↗
PubMed1989

[Percutaneous puncture and drainage of pancreatic pseudocysts].

A total of 63 patients with cystic pancreatic lesions (60 pseudocysts, 3 true cysts) underwent percutaneous therapeutic procedures with ultrasound guidance. Repeated needle aspirations were performed in 50 patients, 13 underwent transabdominal catheter drainage. Complete resolution of the cystic lesion was obtained in 37 (59%) patients overall, while 41% required further therapy. Thirty seven (62%) of the 60 pancreatic pseudocysts were successfully drained by percutaneous procedures, in 23 (38%) fluid collections recurred. Complications of the drainage procedures occurred in two patients (3.2%). Considering these results, ultrasound guided needle aspiration and catheter drainage of pancreatic pseudocysts have proved to be of value for both nonsurgical temporary and definitive treatment.

Adolescent↗