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Biomedical subjects

O Boeckl

Publications and source records attributed to O Boeckl.

At least 55 records · Page 3Linked to original sources
PubMed1988

[Influence of preoperative selective endoscopy on the results and treatment concept of bile duct surgery].

Combined endoscopic and surgical intervention was undertaken in 728 consecutive patients with primary or secondary gallstone disease. In primary gallstone disease the combined treatment resulted in a residual stone rate of 1.28%, and 1.09% for the total group. Intervention on the lower biliary tract (n = 228) resulted in a morbidity rate of 7.4% and a mortality rate of 1.3%. The corresponding figures with purely endoscopic procedures were 1.2 and 0.0%, respectively. Intraoperatively manometrically tested papillary function after endoscopic papillotomy (EPT) revealed no significant difference from normal. In patients with proven biliary pancreatitis the mortality rate after EPT was 2.9%. These results indicate that routine inclusion of endoscopy into the surgical treatment concept for gallstone disease can improve the overall results.

Adult↗
PubMed1987

Combined endoscopic and surgical approach to primary gallstone disease.

Over a 5-year period, 443 patients were treated for primary gallstone disease. There were 333 patients with negative preoperative findings in the common bile ducts (CBD) on sonography and liver enzymes estimation who underwent cholecystectomy without endoscopic retrograde cholangiography (ERC). Thirty-eight surgical explorations of the choledochus were necessary, and in 11 patients a second intervention (endoscopically) had to be performed. There were 110 patients with signs of stone formation in the bile ducts. These patients were submitted to examination of the CBD by ERC. Choledocholithiasis was found in 67 patients; in 47, endoscopic papillotomy and stone extraction were successful. On 7 occasions it was insufficient and in 13 patients it was not attempted due to the size of the stone. One second intervention (endoscopically) had to be performed in this group of patients. The sonographical and laboratory suspicion of bile duct-stones could be disproved in 43 patients. In these cases, the preoperative ERC was negative. We therefore had information on the bile duct system preoperatively and no surgical bile duct exploration was necessary for diagnosis. Thirty-eight of 333 patients (11.4%) had a false-negative and 43 of 110 (39%) a false-positive sonographical or laboratory diagnosis. This shows that there is no other preoperative diagnostic test other than ERC for the precise preoperative evaluation of common bile duct stones. Morbidity, mortality and the rate of choledochus revision (especially negative explorations) can be reduced by preoperative endoscopic bile duct stone removal.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1987

Estimation of the mortality rate of patients with severe gastroduodenal hemorrhage with the aid of a new scoring system.

The widely differing mortality rates of severe gastroduodenal hemorrhage reported in the literature (10-30%), are due to very inhomogeneous patient groups. The purpose of this study was therefore to rank various clinical and endoscopical factors by giving them points from 0 to 6, both to establish comparable groups and to use them as prognostic parameters for a potential fatality rate. One hundred and ninety-three patients with severe gastroduodenal bleeding, verified at emergency gastroscopy immediately after admission, were admitted to this prospective study. The statistical assessment of the prognosis for these 8 factors revealed a linear correlation between increasing score and mortality rate for the following risk factors: patient age, activity and intensity of hemorrhage, type and number of associated illnesses, various therapeutic procedures. Only the type of the source and the site of the hemorrhage did not correlate well. By adding up the points of all risk factors for every patient we calculated the overall score and established a correlation to the mortality rate: A definite statistical correlation was demonstrated between increasing score and fatal outcome. If a patient with a score of less than 20 points did survive in 100%, the mortality rate increased linearly to 83.3% in patients with a score of 40 points. Using this scoring system it is possible to establish comparable groups of patients - which seems indispensable for a critical examination of various therapeutic procedures. Furthermore, this score can serve as a predictor of the probability of a fatal outcome shortly after patient admission.

Adult↗
PubMed1987

[Effect of a modified struma resection technic on the rate of lesions of the recurrent laryngeal nerve].

Recurrent laryngeal nerve injury still remains the major problem in thyroid gland surgery and is influenced both by morphology and function of the goitre and essentially by the resection technique. Between 1982 and 1985 a total of 825 patients was operated on for the first time due to a benign goitre. In period A (Jan. 1982 to Dec. 1983) we always-- preceding the resection of the goitre--performed the ligature of the A.thyreoidea inferior (n = 412) whereas in period B (Jan. 1984 to Dec. 1985) we dispensed with it (n = 413). In neither of the two periods the preparation of the N.laryngeus recurrens--save few exceptional cases--was performed. The immediate postoperative recurrent laryngeal nerve palsy rate decreased from 4.9% in period A to 2.2% in period B, the persistent palsy rate (laryngeal control half a year postoperatively) from 2.18% to 0.48%. Due to the change to smaller, more hyperfunctional goitres in endemic areas we believe it possible to perform the resection of benign goitres without the preliminary ligature of the A.thyreoidea inferior and the preparation of the recurrent laryngeal nerve. On one hand this can lead to the facilitation of the surgical task, on the other hand to the decrease of the injury risk on the recurrent laryngeal nerve.

Adult↗
PubMed1986

Intraoperative manometry--a useful tool in biliary surgery?

Intraoperative manometry was performed in 771 patients undergoing cholecystectomy with (n = 158) and without (n = 613) interventions on the common bile duct and papilla. The method measures the resting pressure (RP) and pressure increase (PI) after injection of 1 ml NaCl/s as well as the time (TR) used for return to the initial pressure, using a Statham transducer. All values are recorded and statistically processed by the two-tailed t test. All three manometric parameters (RP, PI and TR) were statistically different (p less than or equal to 0.0001) between patients with and without alterations of the bile duct and papilla respectively. There was also a clear difference (p = 0.0001) of the TR (which is an indirect measure of the bile flow) between patients with stenosis of papilla (n = 55) and those who showed calculi in the bile duct (n = 103). In a further study we could demonstrate that histopathological changes of the papilla (specimen was taken during transduodenal papilloplasty because of isolated papilla stenosis) led to a prolonged TR, whereas TR in patients with negative histology was decreased. The sensitivity and specifity of this manometric method was very high, 92.4 and 98.6% respectively. This method of manometry enables to obtain precise data about pressure and flow in the bile duct uninfluenced by subjective reading errors in a simple and reproducible way. In our opinion it should complete other intraoperative diagnostic methods during cholecystectomy, particularly as manometry was the only method which led to the correct final diagnosis in 2% of 771 patients.

Aged↗
PubMed1986

[Clinical experience with fibrin gluing in general and thoracic surgery].

Fibrin sealing was applied in 615 cases to patients in the Surgery I Department of Salzburg County Hospitals, between April 1st, 1978 and April 30th, 1985. Fibrin glue Tissucol (Immuno, Vienna) was used in all cases. Need for additional sealing of sutures and anastomoses (n = 331), haemostasis and wound dressing on parenchymatous organs (n = 125), and glueing of skin grafts (n = 97) were the most common indications. Postoperative complications occurred to eight cases (6.4 per cent) in the wake of haemostatic glueing of parenchymatous organs, with lethality being 1.6 per cent (n = 2). One of the patients had to be relaparotomised. Fistulation, following additional sealing of anastomoses and sutures, was recorded from 4.9 per cent of the patients, with the rate of lethality being 0.6 per cent. Inadequate healing of skin grafts was observed in eleven per cent of all cases. Side effects of the fibrin sealant, say, hepatitis, were not observed at all.

Abdomen↗
PubMed1984

[Complete regeneration of the right liver after hemihepatectomy].

Right hemi-hepatectomy was performed in two patients because of metastases in one and a malignant hepatoma in the other. After five and six months, respectively, a right hepatic lobe was again demonstrated, at first by ultrasound, then by isotope scanning. Further studies by coeliacography, 99Tc hepatobida, CT scan and liver-biopsy histology from the regenerated lobe revealed a functionally and morphologically normal picture of a right hepatic lobe, the external form of the regenerated right lobe being identical with the original one. A histologically and functionally unchanged residual liver is considered the prerequisite for satisfactory regeneration after resection. Liver regeneration, as far as regulating factors are concerned, seems to be under similar hormonal control mechanism as external wound healing.

Carcinoembryonic Antigen↗
PubMed1980

[Clinical significance of pathohistological findings of the ampulla of Vater (author's transl)].

The 116 transduodenal papilloplasties were performed for common duct stones, ampulla, or for benign stenosis without stones. The indication for these operations were based on the results of intraoperative radiomanometry. Biopsies were taken from the papilla and the liver. Of the patients, 64% had pathohistological changes in the papilla and 69% in the liver. A close relationship existed between histological changes of the papilla and pathological liver biopsies or enlargement of the common duct. If it is suspected that the papilla is involved a primary operative revision is advised.

Adult↗
PubMed1977

[Concordant medullary thyroid carcinoma in identical twins with discordant phaeochromocytoma (Sipple syndrome) (author's transl)].

The first case of Sipple syndrome in identical twins is reported. It is concluded that the concordant medullary carcinoma of the thyroid is the result of a germinal mutation, whilst the discordant solitary phaeochromocytoma is caused by a somatic mutation according to the two mutation model. The practical conclusion to be drawn from this report is that if one identical twin develops carcinoma of the thyroid or a phaeochromocytoma, the other twin should be throughly investigated and surgical exploration undertaken, even in the absence of clinical evidence of disease.

Adult↗
PubMed1976

Rationale for primary operations on the papilla of Vater.

A procedure is described which allows to objectify the indication for primary operations on the papilla of Vater. During operations on the gallbladder or biliary tract, a radiomanometric examination of the common bile duct is carried out. The study comprises 255 patients. Based upon the results of radiomanometry in 77 patients, a transduodenal revision (papilloplasty) of the papilla was performed. Biopsies from the papilla revealed a high incidence of histological changes. There was a significant correlation between pathological findings on the papilla and abnormal bile pressures. Biochemical signs of cholestasis also correlated significantly with bile pressures. The results of intraoperative manometry allowed therefore conclusions on the functional and morphological state of the papilla. By this method, the indication for operations on the papilla can be objectified and unnecessary papillotomies avoided.

Ampulla of Vater↗
PubMed1976

[Etiology of benign papillary stenoses].

In domestic pigs repeated applications of gastrointestinal hormones (pancreozymin, secretin) as well as cholecystectomy lead to histologic transformation of the epithelium in the area of the papilla of Vater and to inconstant pressure changes in the common duct.

Ampulla of Vater↗
PubMed1976

[Combined radiomanometric and histological studies in the surgery of Vater's ampulla].

In 34 patients a transduodenal sphincteroplasty was performed for benign stenosis of the papilla of Vater or stones in the area of the papilla. The combined intraoperative radiomanometric investigations as well as the histological examinations of intraoperative biopsis of the liver and the papilla of Vater suggest that in most cases with elevated pressure values of the common duct pathological changes of the liver with signs of cholostasis as well as of the papilla of Vater either with pathohistological alterations or with stones in this area can be detected. Constantly, histological changes of the papilla of Vater lead to pathologically elevated pressures in the common duct. In these cases transduodenal sphincteroplasty is recommended instead of only treating with a bougie or dilating the papilla. The indication for this procedure can be objectified by intraoperative radiomanometry.

Adolescent↗