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Biomedical subjects

P Thul

Publications and source records attributed to P Thul.

27 records · Page 2Linked to original sources
PubMed1987

[The acute physiology score as a stratification and prognostic criterion in patients in a surgical intensive care ward].

In order to compare different groups of intensive-care patients and therapeutic interventions a measuring system is needed reflecting the patient's pathophysiologic status with great accuracy. The APACHE-system designed by Knaus et al. (APS) meets the requirements when comparing groups of patients. This prospective study was undertaken to determine whether APS is useful to forecast survival and death of 764 individual patients of a surgical ICU. The results were compared to daily statements obtained from the head surgeon of the intensive-care department. Both the physician and APS gave true judgements in 95% of the cases. Overestimation of the operative procedures by the physician was revealed to be a major source of error in wrong statements. When a combination of APS and physician's judgement was used the forecasts were found true in 99% of the patients. The authors conclude that APS by itself is not able to give a sufficient prognosis in an individual ICU patient but is an excellent tool to assure or modify the physician's opinion.

Humans↗
PubMed1987

[Comparison of prognostic nutrition indices in preoperative detection of risk patients. A prospective trial].

Malnutrition must be considered as a factor of risk in surgery and therefore it has to be taken into account in surgical planning. Many authors aggregated several measurements into an index or another mathematical model by stepwise regression or discriminant analysis. Hitherto none of these approaches has been subjected to a critical analysis designed to determine whether the information gained differentiates patients with increased operative risk from those without, to a degree that is clinically relevant. In a prospective study the predictive values of nutritional assessment techniques of various authors were examined in 246 surgical patients undergoing a major surgical procedure. The specificity, sensitivity, and validity of each assessment technique were determined. The statistical analysis showed that none of the assessment techniques separated patients who were at high risk from those who were at low risk in a statistically significant predictive power. Serum albumin level was a quite accurate prognostic indicator of postoperative morbidity and mortality. The mean complication rate in this study was 26.8%. Concerning the specificity, sensitivity, and validity the single measurement of the serum albumin had a predictive value as high as all other determined assessment techniques in this study. We contend that combining measurements into a statistically derived index is time-consuming and expensive and does not produce an assessment technique with sufficient predictive power to identity high risk patients in a clinically relevant fashion.

Humans↗
PubMed1986

[Magnetic resonance tomographic findings in esophageal cancer].

The value of MRT and CT for staging and for determining operability of carcinoma of the oesophagus was assessed in 20 patients with histologically confirmed diagnoses. Both methods are limited in this respect. In some cases magnetic resonance provides more accurate concerning the extent of the tumour; this, however, is true only for lesions in the upper and middle thirds of the oesophagus. Where tumours of the distal third of the oesophagus are concerned, and particularly in those extending into the fundus of the stomach, CT is clearly superior. Both methods are of limited value in assessing the depth of tumour penetration, infiltration of neighbouring organs and involvement of regional lymph nodes.

Aged↗
PubMed1985

[Prophylactic immunoglobulin administration after major gastric resections. A prospective randomized study].

Immunoglobulins in a dosage of 0,25 g/kg body weight were administered in a prospective randomised study prophylactically to 90 out of 180 patients with gastric surgery of variable extent on the day of operation and on the first postoperative day. Wound infection rates of the treated group were 4.4%, of the control group 14.4%. In addition, the control group had a pneumonia rate of 21% and the treatment group of 11%. However, there were no differences between both groups as regards other assessments (mortality, further postoperative complications, time of hospitalisation, duration of ventilation, postoperative use of antibiotics). It can be concluded that although immunoglobulins lower the risk of infection prophylactic administration should for reasons of expense be limited to patients with preoperatively increased pulmonary risks. The appropriate therapeutic use is to be evaluated.

Gastrectomy↗
PubMed1985

[Somatostatinoma of the liver].

A case report is given of a 45 year old patient, who had a tumor of the liver, pain in the upper abdomen and relapsing fever. Surgery was done and part of the liver was removed. On microscopic examination a somatostatinoma was found. The clinical symptoms of this very rare type of tumor, which belongs to the APUD cell system, is discussed as well as therapeutical implications.

Adenoma, Islet Cell↗
PubMed1982

Successful treatment of streptozotocin diabetes of the rat by transplantation of the islets from a single donor pancreas.

A new digestion chamber was developed which made it possible to isolate 500 islets from the pancreas of one adult rat. The mesh chamber enabled us to remove islets out of the collagenase solution as soon as they are separated from pancreatic tissue. The islet injury due to collagenase was diminished, and the time of warm ischemia during digestion was considerably reduced. With this method it was possible to treat the diabetes successfully in eight of 14 rats. The condition of the remaining six rats was considerably improved, and no animal died due to diabetes during 90 days of surveillance as compared to a 50% death rate in the diabetic control group. A cataract did not occur in any transplanted rat, whereas it was observed in all surviving animals of the diabetic control group. If the complete separation of endocrine and exocrine tissue in a density gradient was abandoned the transplantation results improved significantly.

Animals↗
PubMed1981

[Treatment outcome in de Quervain's dislocation fracture].

In De Quervains dislocation fracture pseudarthroses of the scaphoid bone following closed reduction are very common, 59% being reported in a former publication. Exact adaptation of the fragments after reduction of the perilunar dislocation is essential for healing of the fracture. In cases where this is not possible by conservative means, open reduction and screwing of the scaphoid fracture is necessary for better result with a rate of pseudarthroses of only 16%.

Bone Screws↗