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Biomedical subjects

O Boeckl

Publications and source records attributed to O Boeckl.

At least 37 records · Page 2Linked to original sources
PubMed1992

[Technique of recurrent laryngeal nerve exposure within the scope of interventions of the thyroid gland].

In anatomical preparations performed during autopsy we developed a well-defined approach for the identification of the recurrent laryngeal nerve during surgery on the thyroid gland. The principle of this concept is to visualize the nerve near the branching of the inferior thyroid artery, where it shows a 30 degree angle to the trachea in a direction running from caudal lateral to cranial medial and lies in front of, behind, or between the branches of the artery. This preparation mode has been prospectively performed in 100 patients undergoing thyroid surgery. In 159 (= 97.6%) sides of the neck out of 163 we identified the nerve at the typical site. The topographical relation of the recurrent nerve to the inferior thyroid artery revealed the following differences for the right and left side of the neck: On the right side the nerve was found to be behind in 48%, in front in 33% and between the branches of the artery in 15% of cases. In contrast, on the left side the nerve was found to be dorsal in 53%, ventral in 23% and between the branches in 23%. Of 163 nerves at risk we observed primary nerve palsy in 2 cases (1.2%), and a definitive palsy rate of 0.6% at the 3-month follow-up. In conclusion, we recommend the described approach for the identification of the recurrent laryngeal nerve during thyroid surgery whenever complete mobilisation of the thyroid lobe (e.g. thyroidectomy, lobectomy, resection of retrotracheal adenomas) is necessary.

Female↗
PubMed1992

[Laparoastoma (open packing) in the treatment concept of infected pancreatic necroses].

Out of 284 patients with acute pancreatitis 73 (26%) had pancreas necrosis. Of these 73 cases 43 patients with infected pancreas necrosis were treated surgically, whereas conservative treatment proved successful in the remaining 30 cases with so-called sterile necrosis. Our interdisciplinary treatment combined delayed surgery for the better demarcation of the necrotic tissue, with extended intensive care therapy and epigastral laparostomy; through this laparostomy surgical revision with necrosectomy and peritoneal lavage was performed daily for 15 (+/- 6) days, necessitating long-term artificial respiration for an average of 15 (4/168) days. The mortality rate in the 43 patients with infected pancreas necrosis amounted to 16.2% (n = 7); none of the patients with sterile necrosis died. In cases of multiple organ failure the mortality rate was significantly higher (30%) than with failure of only one organ system (4.3%). The mortality rate in all cases with pancreas necrosis (n = 73) amounted therefore to 9.5%. Serious complications of laparostomy occurred in 28% (n = 12) of the 43 patients, whereby 8 of these cases were gastrointestinal fistulae, with a fatal outcome in one patient. The overall mortality rate in the total group of 284 patients with acute pancreatitis was 2.8%.

Acute Disease↗
PubMed1992

[A combined endoscopic surgical treatment concept in acute biliary pancreatitis].

This paper presents the results of a combined endoscopic-surgical approach with management of acute biliary pancreatitis in 91 patients. The diagnosis was always made by means of endoscopic-retrograde cholangiography. Papillary or bile duct stones, or unmistakable signs of previous stone passage, and in exceptional cases flow obstruction due to preiampullary diverticuli were considered criteria for a positive diagnosis. All 91 patients were subjected to endoscopic sphincterotomy with/without stone extraction subsequent to the diagnostic cholangiogram. Endoscopic intervention was performed as soon as possible after admission to hospital, but by 48 hours at the latest. Cholecystectomy was carried out in all patients who were free of risk factors and without previous cholecystectomy, during the disease-free interval. The complication rate of this combined endoscopic-surgical approach amounted to 10.9%; the mortality rate was 3.3%. The achieved results suggest that endoscopic sphincterotomy with stone extraction in the acute phase of biliary pancreatitis is the method of choice in order to interrupt the process of this disease. In combination with the final surgical treatment of gallstone disease by cholecystectomy to avoid recurrences, the prognosis of acute biliary pancreatitis can be significantly improved by using this combined endoscopic-surgical management.

Adult↗
PubMed1992

[Extracorporeal shock wave treatment of calcium containing gallbladder calculi].

A total of 50 patients--37 female and 13 male--with an average age of 50 +/- 27 years (23-86 years), suffering from rim-calcified gallbladder stones, underwent extracorporeal shock-wave lithotripsy (ESWL), using an ultrasound-guided overhead module of Lithostar Plus (Siemens Company). The total number of stones was 87, with an average diameter of 16 +/- 7 (7-38) mm. 29 patients had a solitary stone, 13 had two and 8 patients three or more stones. All patients received adjunct medication of 10 mg/kg body weight chenodeoxycholic and ursodeoxycholic acid 14 days prior to ESWL as a single bedtime dose. An average number of 5,300 +/- 2,200 shock waves (1,200-15,000) was applied for stone disintegration. The corresponding energy amounted to 750 bar. 29 patients needed one, 21 two or more treatments. After ESWL a variety of clinical abnormalities was observed: flank pain (15%), transient microhaematuria (33%) and transient macrohaematuria (2%). Subsequent to ESWL 5 patients suffered from complications such as biliary obstruction 3 weeks to 9 months after treatment and had to undergo ERCP. Three times endoscopic papillotomy was performed to remove stones from the common bile duct. Up to now 4 patients have undergone cholecystectomy: acute cholecystitis (n = 3), recurrent colicky pain (n = 1). 20 patients have been followed up over a 12-month period; 12 of them are completely free of stones and fragments.

Adult↗
PubMed1992

[Reconstruction-plasty of iatrogenic choledochal stenoses using human pericardium. An experimental study in the domestic pig].

The effect of human pericardial patch plastic for reconstruction of iatrogenic common bile duct stenosis was investigated in experiments performed in pigs. All patches (n = 8) were overgrown with immature biliary epithelium detectable on light and electron microscopy within 6 weeks. No restenosis nor any fistula developed during this observation period. Liver function tests, especially bilirubin, were not suitable parameters for the detection of biliary obstruction (preoperative value 0.38 +/- 0.09 mg/dl; 1 week after subtotal stenosis 3.36 +/- 1.53 mg/dl; 2 weeks after subtotal stenosis 1.49 +/- 0.62 mg/dl; 3 weeks after subtotal stenosis 0.50 +/- 0.27 mg/dl; 6 weeks after pericardial patch plastic 0.33 +/- 0.05 mg/dl, mean +/- SD. Ultrasonographic measurement of the common bile duct diameter was the diagnostic method of choice. Preoperative dimension 4.5 +/- 0.5 mm; 1 week after subtotal stenosis 8.5 +/- 2.0 mm; 2 weeks after subtotal stenosis 10.5 +/- 1.8 mm; 3 weeks after subtotal stenosis 14.0 +/- 3.6 mm; 6 weeks after pericardial patch plastic 9.0 +/- 1.6 mm, mean +/- SD.

Animals↗
PubMed1992

[Prevention and treatment of postoperative fistulae--new indications for fibrin gluing].

The additional sealing of bronchial and gastrointestinal sutures and anastomoses, respectively, by means of fibrin sealant helped to significantly reduce the postoperative dehiscence rate; this rate amounted to 3.6% for additionally sealed bronchus stump occlusions and to 4.2% in gastrointestinal operations, whereby naturally in emergency abdominal operations the rate was higher (7.7%) than in elective surgery (3.8%). Eight postoperative bronchus stump fistulae and eleven out of the twenty-five gastrointestinal anastomotic dehiscences could be closed using a fibrin clot. Furthermore, fibrin occlusion of the pancreatic duct following Whipple's operation for the protection of the pancreatic-digestive anastomosis (n = 67) has turned out to be a success, since no postoperative pancreatic fistulae occurred, which resulted in the very low mortality rate of 1.5%. One more indication for fibrin sealing was the prevention of postoperative lymph fistulae by additional wound sealing (n = 123) and the fibrin occlusion of these fistulae (n = 18); the postoperative lymph fistulae rate amounted to only 3.3%. All 4 cases, as well as 14 other cases of existing lymph fistulae were healed quickly by instillation of fibrin. These relatively new, partly endoscopic, procedures using fibrin sealing proved to be very successful, because on the one hand postoperative fistulae could be largely avoided and on the other hand they could be treated without further operation.

Bronchial Fistula↗
PubMed1990

[Value of preoperative fine needle puncture cytology in the diagnosis of highly malignant thyroid tumors].

Highly malignant thyroid tumours are frequently diagnosed only at an advanced stage where radical resection is no longer feasible. By the wide application of fine needle aspiration biopsy as a diagnostic tool in nodular thyroid diseases occasionally early stages of these tumours can be diagnosed. Despite early detection in 23% of our patients with anaplastic carcinomas and sarcomas of the thyroid gland and subsequent radical resection an improvement in the long-term outcome was not achieved. In contrast, thyroidectomy and appropriate oncologial therapy may result in long-term survival of patients with early stages of thyroid lymphomas.

Adult↗
PubMed1990

[Ultrasonic diagnosis in appendiceal perforation].

In a prospective study comprising 154 patients, the efficacy of clinical, sonographic and combined assessment of appendiceal perforation was evaluated. 39 patients had appendiceal perforation, 44 no signs of inflammation and 71 chronic appendicitis as proven by histologic examination. Cases of 'simple' acute appendicitis were excluded. Clinical assessment yielded with respect to appendicitis a sensitivity of 87%, a specificity of 97% and an accuracy of 94%. With respect to appendiceal perforation a sensitivity of 74%, a specificity of 97% and an accuracy of 91% were observed. Sonographic diagnosis of acute appendicitis as the cause of complaints gave a sensitivity of 85%, a specificity of 98% and an accuracy of 95%, and with special respect to real appendiceal perforation a sensitivity of 69%, a specificity of 98% and accuracy of 91%. By overlap of clinical and sonographic findings, diagnosis of perforation was feasible in 80%, diagnosis of acute appendicitis in 92%. Our results indicate that sonography is a valuable adjunct to clinical assessment, whereas clinical assessment alone seems to be superior to ultrasonography as an isolated procedure.

Adolescent↗
PubMed1990

[Non-occlusive disease--ultrasound diagnosis and trend analysis as a treatment guideline].

16 patients with angiographically proved NOD underwent immediate abdominal sonography (age: 76 +/- 24 years). All patients suffered from "low cardiac output syndrome". The sonographic criteria were as follows: bowel wall edema [16], hyper-peristalsis [16], free peritoneal fluid [14], and signs of incomplete ileus [14]. 11 patients were successfully treated with conservative therapy on the basis of followup ultrasound observation and analysis. 5 patients underwent operation because of worsening ultrasound findings. These patients died from the underlying cardiac illness.

Adult↗
PubMed1990

[Intermittent incomplete ileus of the small intestine. Sonographic diagnosis and trends].

Intermittent incomplete intestinal obstruction was proven by sonography in 25 male and 48 female patients with an age range of 10 to 88 years. All of them suffered from intermittent colicky pain, nausea and meteorism followed by liquid stools. Only 52 patients had undergone a total of 69 abdominal operations. The pertinent symptoms could be traced back for 6 months to 10 years (4 +/- 3 years). In 47 patients, intake of bulky food during the last 12 to 48 hours triggered the onset of disorders. The preadmission diagnoses were: incomplete intestinal obstruction (only 21), gastroenteritis (15), biliary colic (13), peptic ulcer (10), renal colic (4), food intoxication (4), appendicitis (3), adnexitis (3). Sonographic findings were: inconstant lumen distension, visible bowel wall movements with contractions of 3 to 6 mm, food bolus, enhanced paradoxical peristalsis, proof of distended and collapsed gut segments, bowel wall edema and free peritoneal fluid. Based on these ultrasonic findings and trend observation, conservative treatment was successfully instituted. All patients were discharged symptom-free with no subsequent attacks for 12 months. 20 patients, subsequently suffering from complete intestinal obstruction after 1 to 3 years, were operated on, comprising 8 cases of intestinal resection, 7 cases of adhesiolysis and intestinal tube splinting, 3 cases of band dissection and 2 cases of palliative bypass procedures. The diagnostic accuracy of abdominal ultrasonography is clearly demonstrated by the fact, that 11 of these patients with intermittent incomplete intestinal obstruction and now suffering from complete obstruction had no previous abdominal surgery.

Adolescent↗
PubMed1990

[Biliary extracorporeal shockwave lithotripsy in the surgical treatment concept of cholelithiasis].

Extracorporeal shock-wave lithotripsy (BESWL) using the "Obertisch" module Lithostar Plus (Siemens AG) was carried out in 100 patients, comprising a total of 189 gallbladder stones with a size range from 8 to 35 mm. Chenodeoxycholic and ursodeoxycholic acid was given as adjuvant litholytic therapy, beginning 14 days before treatment. 53% of the patients suffered from radiolucent solitary stones with an average size of 21 +/- 6 mm. 14% had more than 3 stones, another 12% had solitary stones with a small rim calcification. In 99 patients all stones could be disintegrated. In 90% we achieved a fragment size smaller than 5 mm, in 10% smaller than 8 mm. 68 patients were treated in a single session, in 32% a 2nd or 3rd treatment was necessary. In the average 4100 +/- 2200 shock-waves with energy level 9 (650 bar) were applied. During treatment 15 patients suffered from slight right kidney pain. In the following 48 hours after BESWL we observed a transitory significant elevation of transaminases (32%), urinary amylases without clinical symptoms (31%), bilirubin (31%) and white blood cells (71%). A microhematuria was seen in 33%, a macrohematuria in 2%. Post-BESWL sonographically we found a transitory edema of the gallbladder wall in 18%, in 15% a hydrops, in 10% a dilatation of the common bile duct and in 4% free fluid surrounding the gallbladder. After dismission 31% of the patients suffered from slight colicky pain. In 3 patients acute biliary pancreatitis was observed 4 and 8 weeks after BESWL which could be treated by EPT and endoscopic stone removal.

Adult↗
PubMed1989

Selective ERCP and preoperative stone removal in bile duct surgery.

This project was undertaken to evaluate in a prospective fashion the effects of selective preoperative endoscopic-retrograde cholangiography and stone extraction (ERCP-ST EXTR) on the results of biliary tract surgery. Over a 6-year period, 728 patients with primary or secondary biliary tract disease were admitted to the First Surgical Department, landeskrankenanstalten, Salzburg, Austria. If, based on preoperative screening, the possibility of common bile duct stones (CBDS) existed, the patients were subjected to ERCP-ST EXTR. Two to 4 days later, these patients underwent a simple cholecystectomy with intraoperative cholangiogram and functional manometry. Evaluation criteria for this study were morbidity, mortality, and retained stone (RST) rates. The overall complication rate for the entire series was 6%. In patients who underwent operative common duct stone removal (n = 78), the complication rate amounted to 21.8%. The rate was reduced to 2.1% by ERCP-ST EXTR. The RST rate was likewise reduced from 2.2% to 0.5% by ERCP-ST EXTR. Mortality in patients with CBDS fell from 3.8% to 1% through the use of this method. In those patients with secondary stones who were treated by ERCP-ST EXTR only, morbidity was 2%, the RST rate was 0%, and mortality was 0%. It is concluded that selective ERCP-ST EXTR, followed by simple cholecystectomy, is a suitable treatment protocol and that this approach may reduce complication and mortality rates.

Adult↗
PubMed1989

Immunocytochemical localization of estrogen and progesterone receptors in human thyroid.

The presence of steroid hormone receptors has previously been suggested in thyroid tissue by biochemical means. Our studies were designed to confirm these results and to localize the specific receptor-containing cell type using a novel immunocytochemical method. Monoclonal antibodies specific to estrogen receptors (ER) and progesterone receptors (PgR) were used to localize these steroid hormone receptors in the human thyroid gland. Frozen tissue sections from surgical specimens excised from 22 patients of both sexes with benign thyroid disease were studied. The sections were incubated with rat antiestrophilin and antiprogesterone receptor antibodies and were then exposed to rabbit anti-rat IgG and to rat peroxidase-antiperoxidase complex. The reaction product was visualized with diaminobenzidine tetrahydrochloride and hydrogen peroxide. Four specimens were positive for both ER and PgR, 16 were ER-positive and PgR-negative, and two were negative for both ER and PgR. Positive reactivity was limited to the follicular lining cell nuclei and varied from focal to diffuse. The immunohistochemical findings confirmed the presence of ER and PgR in the thyroid tissue and demonstrated for the first time that these receptors are present only in the nuclei of the lining cells of the thyroid follicle. The role of steroid hormone receptors in the thyroid in health and disease remains to be explained.

Antibodies, Monoclonal↗
PubMed1989

[Current aspects of prevention of struma recurrence].

Prevention of struma recurrence is a major aspect in postoperative management, following struma surgery. Prophylaxis is based on substitution of L-thyroxine, depending on TSH levels. The latter should be somewhere between 0.5 and 2.0 microU/ml. The rate of struma recurrence was below two per cent.

Adenoma↗