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Biomedical subjects

P Kujath

Publications and source records attributed to P Kujath.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Carcinoma of the gastric stump. Diagnosis, surgical procedure and prognosis].

The results of a retrospective analysis of cases of gastric stump cancer are reported. Among 298 gastric carcinomas treated between 1. 1. 1986 and 1. 3. 1994, we found 28 (9.5%) cases of gastric stump cancer. Gastric carcinoma showed a male preponderance, with a male:female ratio of ca. 4:1. Two thirds of the patients were older than 70 years at the time of diagnosis. In 27 of 28 patients the original operation performed was a Billroth II resection without Braun's enteroanastomosis. The mean time lag before the development of gastric stump cancer was significantly shorter in the group of patients older than 45 years at the time of first operation (n = 16) than in patients 45 years or younger (n = 12, P = 0.03). Endoscopy with biopsy and endosonography were highly reliable diagnostic instruments. The capability of CT for recognizing lymphatic metastasis is poor (42.1% sensitivity). The main risk factors for the development of gastric stump cancer, according to our data, are male sex, Billroth II resection for first reconstruction, age over 45 years at first operation, and gastric ulcer as reason for the original gastric resection. The cost benefit ratio and timing of endoscopic screening of partially gastrectomized patients are discussed.

Adult↗
PubMed1994

[Mortality in proximal femur fractures in elderly people].

Retrospectively we studied 30 patients with fracture of the proximal femur, who were no less than 75 years old and who died during their hospitalization in the Department of Surgery of the Medical University of Lübeck from 1986 to 1991. Mortality was 6% (30/498). The mean time of death was the 13th day after administration. Nineteen patients have had 1, 7 patients 2 serious preexisting diseases. Twelve patients developed 1, 8 patients 2, and 1 patient 3 serious complications. The high amount of patients (30%, 9/30) who could not be operated reflects the great influence of the trauma itself on the mortality of the old multimorbid surgical patient. Intra-operative complications were seldom (1 pulmonary embolism), postoperative complications, however, were the limiting factors of the course of illness and are associated with a poor outcome.

Aged↗
PubMed1993

Incidence and prophylaxis of deep venous thrombosis in outpatients with injury of the lower limb.

253 outpatients were included in a prospective randomized study. All patients had incidence of injuries of the lower limb immobilized by a plaster cast. 126 patients (group I) received a subcutaneous injection of Fraxiparin daily, and 127 patients (group II) received no thromboprophylaxis. Without prophylaxis 21 (16.5%) cases developed a thrombosis, and with prophylaxis a thrombosis could be proven in 6 (4.8%) patients only (p < 0.01). Thus, for all patients with an injury of the lower limb being immobilized by a plaster cast, a thromboprophylaxis with a low-molecular-weight heparin is recommended.

Adolescent↗
PubMed1993

Low molecular weight heparin for the prevention of thromboembolism in outpatients immobilized by plaster cast.

In an open, randomized, prospective, interindividual trial, the incidence of thrombosis with (n = 126) and without (n = 127) LMWH prophylaxis once a day was determined in 253 outpatients immobilized in a plaster cast due to an injury of the lower limb. Furthermore, the influence of possible risk factors on the thrombus formation was determined. The histories of the patients were comparable. The average period of plaster cast immobilization was 15.7 days and did not differ between treatment groups. Thrombosis was diagnosed by compression ultrasound; patients with positive findings were investigated by means of ascending phlebography. There were 21 cases of thrombosis in the group without prophylaxis (16.5%) and only six cases of thrombosis (4.8%) with LMWH. This difference is statistically significant (2p < 0.01). Crucial risk factors were age over 30 years, obesity, varicose veins, and fractures. Patients without prophylaxis who had fractures developed DVT in 29% in contrast to 11.3% in patients with soft-tissue injuries. This study shows that LMWH prophylaxis should be mandatory for plaster cast immobilized patients regardless of preexisting risk factors for thromboembolism.

Adolescent↗
PubMed1992

[Thrombosis prevention in outpatients with lower limb injuries].

The antithrombotic effect of a low molecular weight heparin was examined in a prospective randomized trial of 204 outpatients (121 men, 83 women, mean age 34.7 [16-76] years) who required immobilization with a plaster cast because of injury to the lower limb. Subjects in group I (n = 99) received a daily subcutaneous injection (36 mg) of heparin fragment calcium throughout their period in plaster (mean of 15.6 [7-66] days), while group II subjects (n = 105, mean period in plaster 15.7 [7-41] days) acted as untreated controls. Thrombosis was diagnosed by compression sonography, and positive findings were confirmed by phlebography. Thrombosis occurred in 24 patients altogether, 6 in group I (6.1%) and 18 in group II (17.1%) (P less than 0.05). While patients with thromboses had a mean of 1.96 risk factors overall, those in group I had a mean of 2.6 risk factors. Patients without thrombosis had a mean of 1.24 risk factors. The rate of thrombosis was higher in patients with fractures (4 out of 27 in group I; 10 out of 35 in group II) than in those with ligament and soft-tissue injuries (2 out of 72 in group I; 8 out of 70 in group II). The severity of trauma is apparently an important thrombogenic factor.--General thrombo-prophylaxis seems advisable for surgical outpatients requiring immobilisation treatment with a plaster cast.

Adolescent↗
PubMed1992

Hepatobiliary elimination of temafloxacin.

The biliary excretion of temafloxacin and temafloxacin glucuronide was characterised in this study after administration of a single oral temafloxacin 600mg dose to 8 patients with T-tube drainage of the common bile duct inserted after cholecystectomy or choledochotomy. High performance liquid chromatographic analyses of plasma, urine and bile samples collected during the 72h after temafloxacin administration showed that biliary concentrations of unchanged temafloxacin followed a time-course parallel to plasma concentrations but were 5- to 10-fold higher. Biliary temafloxacin peak concentrations ranged from 18.74 to 64.35 mg/L and time to peak concentrations from 0.71 to 10.23h. Mean hepatobiliary clearance of temafloxacin was 3.10 ml/min (0.19 L/h) when calculated for the unchanged drug and 1.43 ml/min (0.09 L/h) when calculated for its biliary excretion as glucuronic acid conjugates. Patients with higher bile production had markedly higher clearance of both temafloxacin and temafloxacin glucuronide. The elimination time-course of the conjugate in bile generally paralleled those of temafloxacin in bile and plasma, although there was a lag in the rate of appearance of the conjugate in bile. Biliary excretion of unchanged temafloxacin and temafloxacin glucuronide accounted for approximately 2.2 and 1% of the administered dose, respectively. Thus, it appears that hepatobiliary elimination of temafloxacin and its glucuronide acid accounts for only a small fraction of total temafloxacin clearance. Nonetheless, concentrations attained in the bile are far above the minimum inhibitory concentration values of pathogens relevant in biliary tract infections.

Administration, Oral↗
PubMed1991

[Prevention of thrombosis with low molecular weight heparin in ambulatory patients with injury of the lower extremity: an ultrasound study].

The aim of the study was to evaluate the risk of thrombo-embolism in outpatients with traumatic injuries of the lower limb, which are immobilised by plaster cast. 204 patients were randomly divided into 2 groups. Group I (99 pat.) got a daily injection of a low molecular weight heparin. In group II (105 pat.) no prophylaxis was done. The diagnosis of deep venous thrombosis (DVT) was carried out by compression sonography. A total of 24 patients developed DTV: In group 16 patients (6.1%), in group II 18 (17.1%) (p less than 0.05). In patients with fractures in group I (22 pat.) 4 DVT (14.8%) occurred and in group II (35 pat.) 10 (28.6%), respectively. The median age of all the patients was 34.7 years and relatively low. A general prophylaxis in all outpatients having traumatic injuries of the lown limb with immobilisation by cast is recommended.

Adult↗
PubMed1990

[Fungal peritonitis].

Mycotic peritonitis can be demonstrated by microbiological, histological and serological tests. The disease can be proved histologically by a deep invasion of fungi. Initially, the mycotic peritonitis can be caused by polymicrobial infections and also by genuine mycotic invasion after perforation of the gastrointestinal tract. In the final phase of the disease only these fungi are of relevance. In most of the cases candida albicans can be verified. In the procedure of programmed peritoneal lavage the mycotic peritonitis provides a severe complication. Untreated, it would cause death by dissemination, fungemia and candida sepsis. 8 out of 12 patients with candida peritonitis died. Most of the patients had been severely ill previously and had shown several risk factors promoting mycotic disease. Antimycotic treatment has to be initiated as soon as possible, in order to diminish the high lethality.

Adult↗