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Biomedical subjects

R Bähr

Publications and source records attributed to R Bähr.

At least 19 recordsLinked to original sources
PubMed2006

[Intraoperative neuromonitoring of the recurrent laryngeal nerve - results and learning curve].

Intraoperative neuromonitoring was introduced in thyroid surgery several years ago resulting in a facilitated identification of the recurrent laryngeal nerve and less recurrent laryngeal nerve injuries. Between 1999 and 2004 data of all patients (n=937) undergoing thyroid resection were recorded prospectively and analyzed yearly. The intraoperative identification of recurrent laryngeal nerve succeeded in 99.2% (1665 nerves at risk). The percentage of completely resecting surgical procedures raised from 17% to 56%. Minimal vocal cord dysfunction associated with hematoma and edema in most cases was diagnosed laryngosopically in 1.4-2.4%. Transient recurrent nerve palsies were seen in 2.3% without changes throughout the years. The permanent palsy rate of 0.8% in the first years decreased. No permanent palsies were diagnosed in the last 3 years. Routine introduction of intraoperative neuromonitoring in thyroid surgery is associated with a demonstrable learning curve lasting several years. Permanent palsy rate is decreased. The rate of minimal vocal cord movement disorders and transient recurrent laryngeal nerve palsies is not changed.

Adult↗
PubMed2004

[Prolapsed malignant polyp of the stomach causing acute pancreatitis].

Polyps of the stomach are rare lesions with an incidence between 1.7% and 3.9%. Until now, most cases were asymptomatic and found during endoscopic examination. Only three cases of prolapsing gastric polyps causing acute pancreatitis have been reported. Prolapsed polyps of the stomach should be included in the differential diagnosis of secondary pancreatitis. If endoscopic polypectomy is impossible, surgical treatment is necessary. In case early gastric cancer of the mucosa is detected in a polyp, limited surgery is possible. Otherwise, gastrectomy with lymphadenectomy of the D2 compartment is required

Acute Disease↗
PubMed2002

[Muir-Torre syndrome].

The Muir-Torre syndrome (MTS) is an autosomal dominant disease defined by the coincidence of at least one sebaceous skin tumor and one internal malignancy. We describe an additional case and give a review of the literature. Over a period of 7 years, 19 skin tumors were excised in a 50 year old male patient. A total of 3 colonic carcinomas, one gastric carcinoma and one laryngeal carcinoma were operated successfully. The underlying defective mutation in the hMSH2 gene and the microsatellite instability were demonstrable. MTS is graded as a subgroup of hereditary non-polyposis colorectal cancer (HNPCC). In patients with MTS and with family members with known defective mutation, regular follow-up and search for new malignancies are mandatory.

Carcinoma, Squamous Cell↗
PubMed2002

[Esophageal perforation. Etiology, diagnosis, therapy].

METHOD: Between 10/1997 and 2/2000 we treated eight patients (-66.5 y, 31-92 y, 5 male, 3 female). These cases were analyzed retrospectively. RESULTS: In one case the the perforation was located in the cervical part, in three cases in the intermediate part, and in four cases in the distal part oesophagus. In seven cases the perforation was caused by endoscopic and one acid burn in suicidal intention. Surgical treatment was performed in seven cases (87.5%), five of them with primary suture, two with primary esophageal resection. The mortality rate was 50%. There was no insufficiency of the suture, but two patients died because of pulmonary complications, one patient with known hepatic cirrhosis (Child C) because of an uncontrollable bleeding of his fundus and esophageal complications 5 days after successful surgical treatment, and one patient because of fulminant sepsis after dislocation of an enteral catheter. Three of the patients were operated within 12 hours after perforation, seven of them were operated within less than 24 hours. CONCLUSIONS: Surgical treatment of esophageal perforation within 24 hours after perforation shows good results. The outcome of the treatment depends on whether there are postoperative pulmonary complications and concomitant diseases. Enteral nutrition should be avoided in cases of primary esophageal resection to facilitate the surgical reconstruction at the second operation.

Adult↗
PubMed2002

[Relaxation and the electromyographic identification of the recurrent laryngeal nerve].

INTRODUCTION: Electromyography for the identification of the recurrent laryngeal nerve is gaining ever more acceptance in thyroid surgery. Relaxation of the patient, e.g., to improve intubation conditions for anesthesia, carries a potential risk for error. METHOD: After definite identification of the recurrent laryngeal nerve and the vagus nerve (Neurosign 100, Magstim Co., Wales), ten consecutive patients were relaxed with mivacurium and atracurium besylate at a weight-dependent ED95 dosage. After peripheral relaxation was achieved (TOF-Watch, Organon Teknika Corp., at the adductor muscle of the thumb), the signal derived via the vocal muscle was assessed acoustically in 3-min intervals by the surgeon and graphically recorded by computer (EWACS, Inomed Co.). RESULTS: Complete peripheral relaxation was attained with mivacurium after 3-7 min and with atracurium after 7-11 min. A decrease in amplitude of the vocal muscle signal of >60% was recognized by the surgeon as a weakened signal and could be confirmed during an average duration of 13.3 min with mivacurium (maximum: 37 min) and 17.7 min with atracurium besylate (maximum: 23 min), respectively. Complete obliteration of the acoustic signal (<20% of the initial signal) occurred in three of six patients treated with mivacurium and in four of four patients treated with atracurium. CONCLUSIONS: The accuracy of electromyography of the recurrent laryngeal nerve can be substantially impaired by the administration of relaxants. If this medication cannot be dispensed with, the surgeon must be aware of the situation. In these cases, a peripheral relaxometer should also be employed to monitor relaxation as it subsides.

Adult↗
PubMed2001

[Gastrointestinal autonomic nerve tumor].

Gastrointestinal autonomic nerve tumors (GAN-tumor) are rare malignant neurogenic stromal tumors of the intestinal tract. The origin is suspected in the autonomic nerve plexus Meissner or Auerbach with the interstitial cells of Cajal as precursors. We report on a 53-year-old patient with a clinical apparent and radiological 5 cm measuring tumor of the jejunum, which was resected and immunohistochemically verified as GAN-tumor. Within the follow-up of 29 months metastases appeared within the omentum majus with a diffuse peritoneal spreading. Several trials of adjuvant chemotherapy (adriamycine/ifosamide, taxotere, gemcitabine/xyloda) were ineffective. 15 months after the second operation the patient died. Since the first description of the GAN-tumor in 1984 87 patients were reported in the literature. No recurrences or metastasis were seen in tumors with a seize less than 5 cm. A tumor seize of more than 10 cm is associated with recurrences in 64% of the cases within 2 years. Since there is no option for medical treatment, surgical resection is the treatment of choice and has to be considered also in the case of recurrence.

Autonomic Nervous System↗
PubMed2001

[Hemithyroidectomy on principle in cases of unclear fine needle biopsy and frozen section findings].

SUMMARY: Fine needle aspiration biopsy (FNB) and frozen section (FS) may help to validate pre- and intraoperatively dignity of thyroid nodules. Credibility and clinical valuation of both methods have to be taken into consideration of surgical treatment. Between 7/96 and 6/00 82 patients were operated for thyroid lesions using both diagnostic methods to verify thyroid lesions. The sensitivity of both methods is low. With FNB only 5/11 malignancies (45.5 %) were recognized. Within the group of "suspicious" FNB findings (22/82; 26.8 %) definitive histology demonstrated another 6 carcinomas. Only 1 of these initially not recognized carcinomas was verified by FS intraoperatively whereas 5 carcinomas were judged to be benign lesions. Follicular carcinomas and follicular variants of papillary carcinomas could not be assessed by FNB in 6/8 and by FS in 8/9 cases. Only very few malignancies, which are not found by FNB, can be verified by FS. A routine use of intraoperative FS to verify FNB results is not justified, but can give additional information about tumor size, lymph node status and extra-/intrathyroid nodules, which are not examined by FNB preoperatively. Hemithyroidectomy with lymph node dissection represents the operation of choice in cases with unclear FNB results to avoid a second operation with increased risk of recurrent nerve palsy and hypoparathyroidism.

Adenocarcinoma, Follicular↗
PubMed2000

[Intraoperative electromyographic identification of the recurrent laryngeal nerve].

BACKGROUND: Recurrent nerve palsy is the most important complication of thyroid surgery. Correct identification of the nerve during the surgical procedure is essential to avoid damage. METHOD: We evaluated the intraoperative electromyographic identification procedure of the recurrent laryngeal nerves in 77 consecutive patients. The operations performed were 63 subtotal resections, 6 hemithyroidectomies, 4 hemithyroidectomies in combination with subtotal resection of the opposite side and 4 thyroidectomies. RESULTS: Identification of the recurrent laryngeal nerve by electrophysiologic nerve stimulation was successful in 97.4%. Recurrent nerve palsy was not seen in postoperative laryngoscopic control. CONCLUSIONS: Intraoperative electromyography improves the identification rate of the recurrent laryngeal nerve and allows electrophysiologic verification of nerve function as a result of injury to the thyroid.

Adult↗
PubMed2000

Neuromonitoring of the external branch of the superior laryngeal nerve during thyroid surgery.

Changes of the voice caused by injury of the external branch of the superior laryngeal nerve (EBSLN) during thyroid surgery may have essential consequences for a patient's life. Therefore, intraoperative effort has to be made to prevent EBSLN damage. Neuromonitoring has already been described as helpful to improve the identification rate of the recurrent laryngeal nerve. We describe our surgical procedure of upper thyroid pole preparation using neuromonitoring to avoid intraoperative damage of the superior laryngeal nerve. Neuromonitoring allowed safe preparation of the upper thyroid pole without injury of the ESBLN in 108 consecutive patients.

Cranial Nerve Diseases↗
PubMed2000

[Terminal sigmoid anus praeter. Operative technique and surgical complications].

Every complication of the sigmoid stoma means a restriction of patients' quality of life. The complications of 164 patients were analyzed retrospectively (1/1996-5/1999). Indications for creation of a sigmoid stoma were malignomas of the rectum (n = 109). Hartmann's operation with or without sigmoid resection was performed in 55 patients for different reasons. Reoperation for complications was necessary in 8 patients (4.9%). Stenosis of the stoma (n = 3) and peristomal hernia (n = 2) were the most frequent complications. Other indications for reoperation were a prolapse (n = 1) of the stoma, a peristomal abscess with consecutive cutaneous necrosis (n = 1) and a metastasis of rectal cancer at the stoma site (n = 1). Operation techniques for sigmoid stoma creation and its complications are described. The own operative results are completed in an optimal manner by the work of a stoma therapist taking care of the patients both during and after hospital stay.

Adult↗
PubMed2000

[The Limberg transposition flap in surgical therapy of chronic pilonidal sinus].

The operative treatment of pilonidal sinus is characterized by an increased rate of wound healing complications and late recurrences. The Limberg transposition flap is an easy method for covering the defect after excision of the pilonidal sinus. The flap smooths out the deep skin fold of the rima ani and counteracts in this manner an important pathogenetic factor of pilonidal sinus recurrence. Between 6/96 and 7/99 we treated 42 patients using this method without complications of wound healing or recurrences. Comparison of literature results of different operative treatments (open granulation, primary suture, Z-plasty) shows lessened complication and recurrence rates for the Limberg transposition flap, which is the method of choice for chronic pilonidal sinus nowadays.

Abscess↗
PubMed2000

[Trans-sternal thymectomy. Surgical indications and perioperative management].

Between 1985 and 1998 42 transsternal thymectomies were performed. The median duration of symptoms in myasthenia gravis patients (n = 27, 25/27 patients in stadium I/II of the Ossermann classification) was 40.3 weeks and 70.8 days between first diagnosis and operation. In 12 patients a thymoma was found (11/12 patients with stadium I/II of Masaoka classification), which was associated with myasthenia gravis symptoms in 10 cases. In 3 patients thymic tumors of other origin were verified histologically. After surgery these patients have an increased risk of pulmonary complications. We changed 1996 the perioperative anesthesiological procedure using total intravenous anesthesia with propofol/remifentanil and systemic patient-controlled analgesia with piritramide in the first two days after transsternal thymectomy. This management allows a quick extubation after operation and improved lung function postoperatively.

Adolescent↗
PubMed1998

[Treatment with stents in the upper gastrointestinal tract].

A wide range of therapeutic methods for treatment of malignant and benign stenoses of the upper gastrointestinal tract is at one's disposal with esophageal mechanical dilatation, laser therapy, insertion of plastic tubes and stent implantation. It has become routine to insert flexible metal stents in the treatment of esophageal carcinoma and tracheoesophageal fistula. Case reports exist describing the use of flexible metal stents in complicated benign esophageal stenoses of stomach and duodenum. Until January 1997 we implanted 18 stents (7 Z-stents[Wilson and Cook], 4 covered and 4 uncovered Ultraflex stents [Boston Scientific], 3 Endocoil stents [Instent]) in 15 patients. We treated patients with esophageal carcinoma, recurrent stenoses after gastrectomy and tracheoesophageal fistula. They were followed by questionnaires. Four days after stent implantation 50% of the patients were able to consume normal solid food, the other half semisolids. The main problem was the stent migration (28%). The decisive factors for stent migration were the quality of surface of the stent and its position in the gastroesophageal junction. The stents which were dislocated in the stomach could easily be extracted endoscopically. The endoscopic extraction of a dislocated Z-stent in the small bowel was impossible. The high rate of stent dislocation (20-30%) in distal stent position (gastroesophageal junction) is not to be tolerated with respect to the purchase price.

Adult↗
PubMed1996

[Thoracic neurinoma: a rare tumor of the posterior mediastinum].

Neurogenic tumors of the thorax are seen mainly in young adults and children. Most of them are small, benigne, unilateral and extraspinal. Benign lesions are always almost asymptomatic, the malignant ones symptomatic. It must be sure preoperative, whether the tumor has an intraspinal component. In case of the benign neurogenic tumors, the anatomical extension is more important than the histological type of tumor, intraspinal canal extension makes necessary a combined surgical-neurosurgical procedure. Recurrence of a benigne lesion is unusual, prognosis of malignant neurogenic tumors of the thorax is poor.

Adult↗
PubMed1996

[Treatment of tumors of the small intestine. Clinical results of 31 years/review of the literature].

Tumours of the small intestine differ from gastric or colonic neoplasms because of their low incidence rate and the occurrence of histologic entities rarely seen in other gastrointestinal locations. In our institution 67 patients with small intestinal tumours were treated through 1960 to 1991, including 19 carcinomas, 15 carcinoids, 13 sarcomas and 7 lymphomas. In patients with symptomatic disease, the correct diagnosis was achieved preoperatively in 43%. Small bowel enema and CT were the most effective diagnostic procedures. Emergency laparotomy was necessary in 44%. The rate of curative tumour resections rose from 23% during 1960-1983 to 67% during 1984-1991.

Adult↗