Search PubMed⌕ Search

Biomedical subjects

M Rothmund

Publications and source records attributed to M Rothmund.

At least 163 records · Page 9Linked to original sources
PubMed1994

[Laparoscopic cholecystectomy in morbid obesity. Indications or contraindications?].

In early reports on the experience with laparoscopic cholecystectomy severe obesity was considered a contraindication for this procedure. The prospectively documented data of 370 consecutive patients undergoing laparoscopic cholecystectomy were analysed to investigate, whether this point of view is still justified. 35 of these 370 patients were classified as being severely obese (body-mass-index greater than 33 kg/m2). Median operation time was significantly longer in these patients than in the remaining patients (p < 0.05). In selected cases the operative technique had to be slightly modified due to extreme abdominal wall thickness. Dissection of Calot's triangle was not more difficult than in non-obese patients. There was no statistically significant difference concerning conversion rates between severely obese patients (11.4%) and the other group of patients (15.5%). Also, the number of complications was not increased in the obese patients. Since the higher complication rate in severely obese patients after conventional abdominal surgery is mainly due to the incision, laparoscopic cholecystectomy is the preferable procedure to treat symptomatic gallstone disease in these patients.

Adolescent↗
PubMed1994

[Atony of the gallbladder as a risk factor for acalculous cholecystitis. What is the effect of intensive care?].

The incidence of acute acalculous cholecystitis (AAC) is increasing and associated mortality is high. Biliary stasis and sludge formation are probably important factors in the pathogenesis of this disease. No data concerning the dynamics of these changes in the early phase of intensive care therapy are available. The gallbladders of 20 patients treated after major abdominal surgery in the surgical intensive care unit (SICU) with mechanical ventilation and without enteral feedings were therefore observed sonographically during the first 5 postoperative days in a prospective observational study. 20 patients treated on a regular ward after major abdominal surgery also not receiving any enteral nutrition served as control group. 24 hours after admission to the intensive care unit and on all subsequent days of observation the gallbladders of the patients in the SICU-group were significantly larger than in the control group. Sludge also appeared earlier and more frequently in the gallbladders of the SICU-patients. Lack of enteral feedings alone cannot explain these results. Positive-pressure ventilation and medications used in SICU are most likely responsible for the observed differences. Besides the necessity to make the diagnosis of AAC as early as possible, it appears to be worthwhile to investigate measures of prophylaxis. Since gallbladder distension in patients treated in SICU can be already observed on the first postoperative day it seems to be reasonable to initiate a regimen of prophylactic measures (e.g. with cholecystokinin or ceruletide) early in the course of ICU-therapy.

Abdomen↗
PubMed1993

[Palliative therapy of complex hilar biliary obstructions using self-expanding metal stents].

Implantation of self-expandable metal stents was planned for 21 patients (12 women, 9 men; mean age 64.7 +/- 11.6 [38-80] years) with malignant obstructive jaundice due to complex hilar biliary obstruction (Bismuth II: n = 5, Bismuth III: n = 13, Bismuth IV: n = 1, state after hepaticojejunostomy: n = 2). Stents were implanted bilaterally in 18 patients (one each on the right and left, n = 12; two stents on right, one stent on left, n = 6), one patient had three stents on one side, another had one unilateral stent. Thus there was a 93.3% success rate (46 of 49 planned stent implantations). The mean bilirubin level fell from 14.7 +/- 7.7 mg/dl before stent implantation to 3.9 +/- 5.4 mg/dl afterwards (P = 0.0001). One patient experienced late bleeding with haemorrhagic shock and consumption coagulopathy after a failed drainage attempt. She died despite superselective embolization, operative suturing of the puncture site, and wide-ranging intensive care measures. Procedure-related death rate was thus 4.8%, the 30-day death rate 9.5%. During the follow-up period, averaging 145 +/- 152 (16-529) days, jaundice recurred in six patients (30%) and was successfully treated by re-intervention in five. 13 patients died after a mean survival time of 98 +/- 119 (16-432) days. It is concluded from these data that self-expandable metal stents provide minimally invasive palliative treatment of complex biliary hilar obstruction in the type of case in which plastic stents are known to fail.

Adult↗
PubMed1993

[Laparoscopic adrenalectomy].

Between June and September 1993, laparoscopic adrenalectomy was indicated in five patients (three women, two men; aged 25-50 years). Three had a phaeochromocytoma, two had an adenoma (Conn's syndrome). Four of the five tumours were localized to the right adrenal gland, one to the left. Tumour diameter ranged from 3 to 5 cm. The laparoscopic procedure was successful in four of the patients (three right, one left). In the fifth case the operations had to be completed by conventional surgery, because of non-controllable haemorrhage. Duration of operation ranged between 165 and 360 min for right adrenalectomy and was 135 min for the left one. Rapid convalescence, lower dose of pain-killing drug required, short hospital stay and good cosmetic results characterized the postoperative course after the laparoscopic procedure. This technique thus opens up new perspectives for adrenal surgery.

Adrenal Gland Neoplasms↗
PubMed1993

[Standardized surgical concept for the diagnosis and therapy of Zollinger-Ellison syndrome].

Between 1987 and 1991, 16 patients (13 females, three males; mean age 52.4 [33-73] years) with Zollinger-Ellison syndrome (ZES) were treated according to a standardized surgical concept. The diagnostic work-up consisted of measuring serum gastrin levels, pre-operative localization by ultrasound and abdominal computed tomography, as well as extensive staging by laparotomy. As complete a tumour resection as possible was the aim of treatment in 15 patients, while in one patient it was to reduce the tumour mass. In six patients who had resection of a solitary tumour there was no evidence of recurrence after 6-42 months of follow-up. Exploration of the duodenum made it possible to identify and then remove a small gastrinoma of the duodenal wall in three patients. No gastrinoma was found in one patient despite extensive exploration. In a further four patients the laparotomy was purely exploratory, because diffuse metastasization was found. In four patients the primary tumour and, where present, the regional lymph nodes were removed, but the signs of ZES persisted, i.e. the intervention was merely palliative. In one female patient, reduction of tumour mass was necessary because the symptoms could not be controlled by conservative measures: she died postoperatively from toxic hepatitis. This experience indicates that standardized surgical intervention achieves potentially curative results in nearly 40% of patients. Including the duodenum in the surgical exploration allows the identification of even small gastrinomas of the duodenal wall. It is concluded that all patients with ZES but no evidence of diffuse metastases should undergo surgical treatment.

Adult↗
PubMed1993

Gastric argyrophil (enterochromaffin-like), gastrin, and somatostatin cells after proximal selective vagotomy in man.

The number, size, and volume density of endocrine cells was determined in biopsies obtained endoscopically in patients after proximal selective vagotomy (PSV; N = 31), antrectomy (N = 9), untreated duodenal ulcer (DU) disease (N = 11), and in controls (N = 15). Serum gastrin was significantly elevated after PSV (mean 60 pg/ml) compared to DU patients (29 pg/ml), controls (26 pg/ml), and after antrectomy (11 pg/ml). Volume density of fundic argyrophil (largely enterochromaffin-like) cells after PSV (0.74%) and in DU disease (0.63%) were significantly (P < 0.001) higher when compared with controls (0.37%) but lower after antrectomy (0.24%; P < 0.02). The density of argyrophil cells was not influenced by the interval following PSV or the magnitude of hypergastrinemia. Antral gastrin cells were increased after vagotomy, whereas the antral and fundic somatostatin cell numbers were reduced after PSV. It is concluded that: (1) a major role of the vagal nerve as a trophic factor for enterochromaffin-like cells could not be demonstrated after PSV, and (2) moderate hypergastrinemia after PSV did not induce proliferation of ECL cells.

Adult↗
PubMed1993

Perioperative nonspecific histamine release: a new classification by aetiological mechanisms and evaluation of their clinical relevance.

As a consequence of the performance of a randomized controlled clinical trial on perioperative histamine release and cardiovascular and respiratory disturbances, several types of increases in plasma histamine had to be distinguished instead of only two which existed at the beginning of the study: drug-induced allergic and pseudoallergic reactions. First of all, the new classification by aetiology (clinical epidemiology) was derived from a meta-analysis (secondary analysis) of the most recent literature. According to that histamine release in the perioperative period has several, different causes and is involved in several, different disease manifestations. A clear distinction (classification), however, is necessary if histamine release as an unwanted (adverse) effect has to be recognized, value judged according to its clinical relevance and therefore also prevented by histamine antagonists. Histamine release by neuro-endocrine and neuro-inflammatory mechanisms, cytotoxic histamine release and local, cytokine induced histamine release have been distinguished from pseudoallergic histamine release, but its functions are not yet clear. It has been analysed in prospective trials which used special clinical situations as models: patients on a normal ward or before and during upper GI endoscopy without premedication, but also in specific phases of laparoscopic cholecystectomy (trocar phase and dissection phase). Their existence in the clinical reality is now very likely, but new trials must investigate the pathophysiological effects such as in metabolism, coagulation, pulmonary haemodynamics (shunt volume) and gastric acid secretion. Histamine release by pseudoallergic mechanisms, however, was identified in the very vulnerable post-induction phase of anaesthesia up to skin incision. Its incidence was much higher than ever expected and its clinical relevance was demonstrated by the severity of reactions and the intervention strategies of the anaesthetists who were blinded concerning the type of the plasma substitute given and the prophylaxis with antihistamines. Pseudoallergic histamine release was clearly unwanted (adverse). Its occurrence in the other phases of anaesthesia has to be further evaluated in the tedious procedure of data analysis of the Mainz-Marburg-trial. The overall incidence of histamine release in the trial was so incredible high (72% of all patients, some of them with up to 4 episodes of histamine release) that a distinction between pseudoallergic (unwanted) and other types of histamine release (possibly less unwanted or even beneficial) is urgently needed. In the phase of steady state (maintenance) of anaesthesia the H1-(+)H2-prophylaxis was highly effective. Further analysis must show whether this is also the case during the phases of induction of anesthesia.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1993

Preoperative localization of gastrointestinal endocrine tumors using somatostatin-receptor scintigraphy.

OBJECTIVE: The purpose of this study was to determine the value of somatostatin-receptor scintigraphy (SRS) in the preoperative localization of gastrointestinal endocrine tumors. The authors report their preliminary experiences with this new technique as compared to conventional imaging studies like computed tomography (CT) and ultrasonography (US). SUMMARY BACKGROUND DATA: Most endocrine tumors possess high-affinity somatostatin-receptors. Using the stable, 111Indium labelled somatostatin analogue pentatreotid, which binds to these receptors, it is possible to detect somatostatin-receptor-positive tumors scintigraphically. METHODS: In nine patients with various gastrointestinal endocrine tumors, SRS, CT, and US were performed before surgical exploration. The preoperative imaging studies and intraoperative ultrasound (IOUS) were then compared to findings on surgical exploration. RESULTS: Twelve primary tumors were found in 8 patients at surgical exploration. These primary tumors were correctly identified with SRS in five patients, with US in four patients, and with CT in three patients. In one patient with the Zollinger-Ellison syndrome, scintigraphy suggested a tumor in the area of the hepatoduodenal ligament, while CT and US had negative results. The underlying gastrinoma could not be identified despite extensive surgical exploration. Scintigraphy, CT, and US showed comparable results in the detection of metastases in four patients. CONCLUSIONS: The data from this small series suggest that SRS is helpful in the preoperative localization of gastrointestinal endocrine tumors.

Adult↗
PubMed1993

Partial hepatectomy affects pancreatic size and function in rats.

The effect of partial hepatectomy (62 +/- 2% of liver mass) or sham laparotomy on the pancreas was studied in rats. Pancreatic contents of DNA, protein, and digestive enzymes were measured 14 days postoperatively. Pancreatic acini were prepared to study exocrine pancreatic function after hormonal stimulation. Islet hormone release was investigated in the isolated perfused pancreas. Liver regeneration reached 93 +/- 1% within 14 days. Water contents in liver and pancreas remained unaltered. Simultaneously, the pancreatic weight increased significantly. Pancreatic enzymes showed a parallel elevation, whereas DNA remained unaffected. Amylase secretion from pancreatic acini was unaltered. Stimulated insulin and somatostatin release from the perfused pancreas were both increased. Plasma cholecystokinin levels were elevated, whereas neurotensin was decreased. Insulin and gastrin remained unchanged. In conclusion, after partial hepatectomy, enhanced cholecystokinin and decreased neurotensin blood levels are suggested to contribute to a hypertrophic effect on the exocrine pancreas and an adaptive regulation of the endocrine gland.

Amylases↗
PubMed1993

Expression and distribution of VLA receptors in the pancreas: an immunohistochemical study.

Very late activation (VLA) receptors mediate cell adhesion to extracellular matrix, mainly by acting as adhesion receptors to fibronectin, collagen, and laminin as well as to other cells. These interactions not only regulate normal cell-extracellular matrix contact, but also are thought to be involved in metastasis and invasive tumor growth. Using immunohistochemistry [the alkaline phosphatase-anti-alkaline phosphatase (APAAP) technique] we compared the expression and distribution of VLA receptors in normal pancreatic tissue, chronic pancreatitis, and ductal pancreatic adenocarcinoma. Immunohistochemically, VLA alpha 2 and VLA alpha 6 were moderately to strongly expressed on the basal surface of ductal and acinar cells in normal pancreatic tissue, whereas centroacinar cells predominantly expressed VLA alpha 3 and VLA alpha 5. Similarly, pancreatic carcinoma showed an intensive staining for VLA alpha 2 and VLA alpha 6 with a diffuse distribution on the cell surface. Expression of VLA alpha 3 and VLA alpha 5 in pancreatic carcinoma was heterogeneous, ranging from moderate to weak and lost in about 50% of the cells. As our results suggest, cell-basement membrane interaction in ductal and acinar pancreatic cells is primarily mediated through VLA alpha 2 and VLA alpha 6, whereas VLA alpha 3 and VLA alpha 5 are the major VLA receptors on centroacinar cells. In pancreatic carcinoma a loss (VLA alpha 5) or redistribution (VLA alpha 2, VLA alpha 6) of VLAs was observed. This redistribution of VLA alpha 2 and VLA alpha 6 may reflect a loss of spatial arrangement of tumor cells and their ability to randomly interact with extracellular matrix structures during invasion and metastasis.

Cell Membrane↗
PubMed1993

[Colon diverticulitis: imaging diagnosis with ultrasound--a prospective study].

In a prospective study, we investigated the value of high resolution sonography for the imaging diagnosis of colonic diverticulitis. A total of 161 patients with abdominal complaints on account of which acute diverticulitis entered into differential diagnosis were included in the study. 74 of these finally had proven colonic diverticulitis (prevalence, 46%). The results of intestinal sonography and the working diagnoses on admission were evaluated on the basis of final diagnoses. According to history, symptoms, and clinical findings on admission, the working diagnosis of diverticulitis was graded as being "highly suspect" in 26 (35.1%) of these 74 diverticulitis patients, as being "possible/equivocal" in 36 (48.6%), and as being "very unlikely" in in 12 (16.2%). In 7 (9.5%) patients with diverticulitis, the diagnosis was clinically unsuspected and primarily established by ultrasound. Overall accuracy, sensitivity, and specificity of intestinal sonography with regard to the diagnosis of diverticulitis were 97.5%, 98.6%, and 96.5%, respectively. There were three false positive ultrasonic diagnoses of diverticulitis which were made in two patients with perforated carcinoma of the sigmoid and in one case of sigmoid volvulus (positive predictive value, 96%). Ultrasound failed to visualize sigmoid diverticulitis with perforation in one patient (negative predictive value, 98%). In 19 out of 20 patients with abdominal abscesses (prevalence, 12.4%), the diagnoses were established by means of sonography. Nine of these patients with abscesses initially were treated by ultrasound guided percutaneous drainage enabling elective surgery. In 26 (70%) of 36 patients with morphological disorders other than diverticulitis, ultrasound findings substantially added for the definite diagnoses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Diagnostic and therapeutic procedures in splenic and hepatic artery aneurysms].

The diagnosis and therapy of splenic and hepatic artery aneurysms is besides clinical findings based on ultrasound and selective arteriography. Surgical treatment depends on the exact localization of the aneurysm. Because of postsplenectomy sepsis preservation of spleen should be reached. Otherwise splenectomy with resection of the aneurysm must be performed. If the aneurysm is localized at the common hepatic artery ligation of the vessel is possible. The interposition of an autologous vein graft is the most favorable proceeding in aneurysms of proper hepatic artery. Those of intrahepatic arteries should be treated just as aneurysms in high risk patients by selective percutaneous embolization.

Adult↗
PubMed1993

[Broad use of laparoscopic cholecystectomy in the teaching clinic. Experiences and results of 300 operations].

Laparoscopic cholecystectomy (LC) was integrated early in surgical training according to the concept "observe, assist and then operate under the assistance of an experienced surgeon". 300 LC's were performed by 27 different surgeons (8 board certified surgeons, 19 residents in the year 2-6 of training). 60.3% of all LC's and 73% of LC's performed for acute cholecystitis were done by residents. Our results including an overall complication rate of 5.3% shows, that LC can be performed by residents without additional complications or unacceptable length of operations, provided the threshold for conversion is low and the surgeon is assisted by an experienced laparoscopist. We therefore suggest that the early integration of LC in surgical training is justified.

Cholecystectomy↗
PubMed1993

Ultrasonography in blunt abdominal trauma: influence of the investigators' experience.

The validity of routine ultrasonography (US) in the evaluation of patients with blunt abdominal trauma (BAT) was investigated in a prospective study. From April 1989 to April 1990, 140 patients with suspected BAT were included in this study. Ultrasonography was performed by 17 surgeons using a standardized technique. The influence of the investigators' experience in US was manifested in the positive predictive value (PPV). Surgeons with a learning period of less than 1 year had a PPV of 60%. Investigators with experience of more than 1 year but less than 3 years had a PPV of 76%. For the most experienced investigators (> 3 years) a PPV of 92% was recorded. The sensitivity for intra-abdominal lesions was 100%, 100%, and 92%, and the specificity 94%, 89%, and 98% for the three levels of experience, respectively. We conclude that US is a suitable test for screening patients with BAT since it is highly sensitive, highly specific, complication free, and easy to learn. The positive findings of surgeons who are learning to use this method should be verified by reinvestigation by an experienced sonographer, by diagnostic peritoneal lavage (DPL), or by a CT scan if the patient is hemodynamically stable.

Abdominal Injuries↗
PubMed1993

[Parathyroid gland cancer. Problems in diagnosis and therapy].

Parathyroid carcinoma occurs in 0.1 to 5% as the cause of primary hyperparathyroidism (HPT). It is difficult to determine the true incidence, because parathyroid carcinoma is diagnosed too often due to unreliable histologic criteria. It is only justified to make the diagnosis, when a local recurrence or metastases with the clinical picture of a recurrent or persistent HPT occurred. Treatment of choice is the initial en-bloc resection, which may result in long disease-free intervals. Pharmacological treatment, chemotherapy, and radiation are mostly ineffective in the treatment of parathyroid carcinoma. A satisfactory long-term palliation can only be achieved with repeated resections of the local recurrences and metastases. Diagnostic efforts should be made to localize the recurrent tumor before every reoperation, whereby ultrasonography of the neck is the most sensitive procedure. Occasionally the parathyroid tissue cannot be identified in spite of preoperative diagnostic studies or hypercalcemia persists after surgery. In these cases forced diuresis and medical treatment with calcitonin, diphosphonates or mithramycine can briefly control hypercalcemia. The clinical courses of 3 patients with metastasizing parathyroid carcinoma are presented and discussed. In these patients 3 to 11 surgical interventions were performed in combination with an intermittent medical treatment. By this regimen we achieved long-term palliations up to 13 years.

Adenoma↗