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Biomedical subjects

R Bittner

Publications and source records attributed to R Bittner.

At least 145 records · Page 8Linked to original sources
PubMed1985

Total gastrectomy. A 15-year experience with particular reference to the patient over 70 years of age.

Between 1969 and 1984, a total of 186 patients underwent total gastrectomy. Seventy-four patients were more than 70 years of age. Surgical mortality was 13.4%, with only minor differences between those patients younger than 70 years and older patients--12.5% and 14.8%, respectively. Moreover, there was no major difference if surgery was curative or merely palliative. Of 27 patients with tumors at TNM stage IV, only one died. Of the 100 patients who were operated on during the five-year period between 1979 and 1984, only four died, for an operative mortality of 4%. These results suggest that this remarkable decline of mortality is due to a precise standardization of surgical technique and improvements in preoperative patient management and aftercare. The five-year survival was 15.9%; again, there was no major difference between the group of patients older than 70 years and those younger than 70 years (19.4% and 14.5%, respectively). The ten-year survival was 4.9%.

Age Factors↗
PubMed1985

[Early detection and chances for healing in recurrences of colorectal cancers].

In patients with colorectal carcinoma operated curatively or questionable curatively, the computer-controlled postoperative care showed that in more than one third of the patients with recurrence the diagnosis was made before clinical symptoms appeared. By early detection, the recurrence could be resected curatively in twice as many patients with regular postoperative care as in patients without regular care. Furthermore could be proved that regular postoperative care caused a clear prolongation of the survival time.

Colonic Neoplasms↗
PubMed1985

[Operative therapy of small intestine ileus with special reference to patients with advanced tumor disease].

Between 1979 and 1984 a total of 233 patients underwent surgical treatment of small bowel obstruction. In 43 patients (18.4%) the obstruction was caused by an advanced tumor disease (peritoneal carcinosis, local recurrence). In patients with benign obstruction the operative mortality was 5.2%; in the tumor patients it was 14%. Wound infection and cardio-pulmonary disturbances were the most frequent complications. The mean survival time of the tumor patients was 159 days. In 65% of these patients the operation had a significant palliative effect.

Gastrointestinal Neoplasms↗
PubMed1985

[Operative therapy of cancer of the head of the pancreas--determination of surgical status].

Therapy of ductal pancreatic carcinoma still remains a hardly resolved problem. In spite of the development of highly sensitive diagnostic methods 85 to 90% of the patients do not undergo therapy until they have already reached an incurable tumor stage. 5 years survival rate between 4 and 8% after potentially curative resections are rather depressing numbers. To patients with stages I and II duodenopancreatectomy as performed as subtotal pancreatectomy promises better mean survival and 5 years survival rates than bypass procedures only. When the tumor, however, infiltrates adjacent organs, resection might be limited to few selected cases. Substantial progress in the therapy of pancreatic carcinoma can be only expected from better understanding of the biological nature of the tumor, from earlier diagnosis and more precise selection of the patients as to the appropriate therapeutical alternatives.

Carcinoma, Intraductal, Noninfiltrating↗
PubMed1985

Duodenum-preserving resection of the head of the pancreas in patients with severe chronic pancreatitis.

A duodenum-preserving resection of the head of the pancreas was carried out in 57 patients with chronic pancreatitis and a benign tumorous enlargement of the head of the pancreas. The resected tissue showed a diameter of more than 5 cm in 64% of the patients. The postoperative mortality rate was 1.8%. The postoperative hospitalization period was 19 days (median). In a follow-up period of 2.0 years (median) with a minimum of 1 month and a maximum of 10.5 years, the late mortality rate was 3.6%. Of the patients, 85.7% are completely rehabilitated occupationally. In contrast to the Whipple procedure, the duodenum-preserving resection of the head of the pancreas preserves stomach, duodenum, jejunum, and extrahepatic bile ducts in an advantageous way. The subtotal resection of the head of the pancreas decompresses the common bile duct without disturbance of the blood flow to the duodenum.

Adult↗
PubMed1985

[Necrotizing pancreatitis: peritoneal lavage or bursa lavage? Results of a prospective consecutive controlled study].

In 111 patients with necrotizing pancreatitis two different therapeutical procedures were applied since 1974 in addition to the surgical removal of necrotic tissue. In group I with 64 patients a continuous peritoneal lavage and in group II with 47 patients a local lavage of the lesser sac were performed. In case of extrapancreatic necroses and diffuse peritonitis peritoneal lavage was done additionally in 32 patients. Local lavage of the lesser sac, in some cases combined with peritoneal lavage, is the procedure significantly superior to peritoneal lavage alone.

Acute Disease↗
PubMed1984

[Clinical aspects and fine structure of papillary cancer. With special reference to morphological carcinogenesis].

Course of the disease and microscopic work-up of the operative specimens with special consideration of morphological carcinogenesis were analysed in 72 patients with tumour of the ampulla of Vater. Mean duration since onset of symptoms was 6.6 weeks. Cardinal symptoms were jaundice, loss of weight and abdominal pain. Endoscopic-retrograde cholangio-pancreatography, computed tomography and percutaneous transhepatic cholangiography had the highest diagnostic accuracy. Resection rate of the carcinoma was 55%, hospital mortality was 6.7% for partial duodenopancreatectomy and 15.4% for palliative surgery. The mean survival rate was 20 months after partial duodenopancreatectomy and 5 months after palliative surgery. The survival rate was significantly decreased if tumour size was above 2 cm and lymph nodes were positive for tumour. In 82.8% of the examined operative specimens moderate to high-grade epithelial dysplasias were found in carcinoma-free portions of the ampulla, and in 91.4% there were adenomatous structures. It is to be assumed that carcinoma of the ampulla develops via dysplastic epithelial changes or from adenoma of the ampulla.

Aged↗
PubMed1984

[Gastrectomy in the aged].

Between 1969 and 1983 a total of 152 patients underwent total gastrectomy. 58 patients were older than 70 years. Surgical lethality was 14.47% with only minor differences between those patients younger than 70 and the older ones: 13.8 and 15.5%, respectively. Moreover, it did not make any major difference whether surgery was curative or merely palliative. Of 27 patients with the tumor stage TNM IV, only one patient died. Of the 66, who were operated upon during the recent 5 years period between 1979 and 1983, only one patient died. These results suggest that this remarkable decline of lethality is due to a precise standardisation of surgical technique, improvements in preoperative management of the patient and aftercare. 5 years survival rate was 17.3%; again there was no major difference between the group of patients older than 70 and those being younger than 70 years (16.5% and 19.4% respectively). It is of interest that the patients having additional splenectomy presented with an essentially worse prognosis as opposed to those without splenectomy although there were no differences between the TNM-stages. Even if the small numbers of patients can not yet be definitely conclusive, these preliminary results indicate that the indication for splenectomy in the course of total gastrectomy should be critically evaluated.

Age Factors↗
PubMed1984

[Duodenum-sparing pancreas head resection in chronic pancreatitis--results after 10 years' use].

During a ten years period duodenum preserving pancreatic head resection was performed in 56 patients with chronic pancreatitis and related pancreatic head tumor. Immediate lethality was 1.8%, rate of reoperation 3.6%, late lethality after an average follow-up of 24 months (minimum 1, maximum 124 months) 3.6%. At the time of follow-up 87.3% of the patients were back at work, 58% were free of abdominal symptoms, 7.4% complained about occasional to frequent abdominal pains. 72.9% gained weight postoperatively. Duodenum preserving pancreatic head resection constitutes the subtotal resection of the pancreatic head and jejunal interpostition for the parenchymal defect. The procedure is advantageous as compared to Whipple's operation in so far as stomach, duodenum and bile duct remain intact.

Adult↗
PubMed1984

[Ulcer perforation in Meckel's diverticulum].

Ectopic gastric mucosa can be found in 40-80% of Meckel's diverticula; parietal cells producing acid are not inhibited by regulatory factors, giving rise in some cases to ulcers, which may perforate. A case report of a patient with a perforated ulcer in a Meckel's diverticulum is given. Meckel's diverticula should be removed surgically when they are diagnosed or when they are found by chance during surgery because of the risk of complications.

Child↗
PubMed1984

[Results of anorectal manometry for the determination of age- and sex-dependent pressure differences].

Manometric findings in 88 anorectal healthy probands are reported. Basal (PAC) and maximal squeeze (PAC max) pressures in the anal canal as well as rectal pressure at rest (PAR) and the pressure increase in the anal canal after dilatation of the ampulla recti (delta PAC) were registered with a 2 balloon catheter and statistically analysed in the 52 male and 36 female probands, divided in three age groups (group I under 40 years, group II 40-60 years and group III over 60 years). PAC showed for all three groups a statistically significant difference for men and women as well as a statistically significant decrease with age in both sex groups. PAC max, PAR and PAC decreased statistically significantly with age in both sex groups whereas in the three age groups, men and women showed nearly equal values. These age- and sex correlated differences in the anorectal pressure profile must be considered in the evaluation of the continence function.

Adolescent↗
PubMed1983

[Peptic ulcer. Pathophysiological aspects of prepyloric stomach ulcer].

The secretory and motor function of the stomach and gastrin incretion were investigated in 68 patients with peptic ulcer of variable localization. In addition, a retrospective analysis of the course of prepyloric gastric ulcer and Billroth I resection was performed in 62 patients. Results show that gastric acid secretion and velocity of gastric emptying diminish significantly with increasing height of the localization of the ulcer. Prepyloric gastric ulcer cannot be likened to the duodenal ulcer. Moreover, experimental and clinical results suggest that prepyloric ulcer represents a disease entity per se requiring separate therapeutic approaches (gastric resection following Billroth I).

Adult↗
PubMed1982

[Necrotizing pancreatitis. Surgical indications and results in 118 patients].

In a ten years period 118 patients were operated with necrotizing pancreatitis. 42% of the patients had a 50% necrosis and 25% a subtotal/total necrosis of the pancreas. Surgical therapy principally includes: necrotectomy with drainage of the pancreas layer and postoperatively local lavage of the pancreatitic cavum (61/24 h). In 28 patients a continuous peritoneal lavage were performed additionally (24.4 +/- 14.71/day, duration 9.6 +/- 8.2 days). The total lethality was 33.9%. The course of the patients with necrotizing pancreatitis is destinated by the extention of the necrosis in the pancrease itself, the development of extrapancreatic necrosis and the bacterial contamination of the necrosis (bacterial retroperitonitis, abscess).

Acute Disease↗