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Biomedical subjects

R Függer

Publications and source records attributed to R Függer.

89 records · Page 5Linked to original sources
PubMed1990

The therapy of iatrogenic lesions of the bile duct.

Forty-three patients were operated on for iatrogenic lesions of the bile duct. Only one patient had a biliary lesion which occurred in the course of distal gastric resection. All other lesions were observed during cholecystectomy. Injury of the bile duct was detected intraoperatively in sixteen cases. In 10 patients, lesions were observed in the postoperative period and in 17 patients, the post-operative diagnosis was made on the basis of symptoms of stenosis of the bile duct. Satisfactory results can be obtained by suturing the common bile duct and splinting with a T-tube where the lesion is partial and detected in the course of surgery. In the case of patients with strictures, an anastomosis (choledochojejunostomy Roux-en-Y loop) should be performed. Strictures involving hepatic bifurcation and the right hepatic duct have a higher incidence of restenosis, and transhepatic splinting of the anastomosis can therefore produce better results. Long-term transhepatic drainage has the advantage that replacement of the drain is relatively straightforward and complete dislocation impossible. Four of our patients died postoperatively, three of multiple septic organ failure due to preoperative biliary peritonitis or cholangitis, and one of a pulmonary embolism. Satisfactory long-term results after correction of an iatrogenic lesion of the bile duct can be obtained if the corrective procedure is undertaken immediately, prior to the onset of biliary cirrhosis.

Adult↗
PubMed1990

[The value of 2 distinct prognosis scores in patients with peritonitis. The Mannheim Peritonitis Index versus the Apache II score].

Seventy patients suffering from purulent peritonitis entered this study, 31 of them were taken in prospectively, to contrast two different prognostic scores, the Mannheim Peritonitis Index (MPI) vs. the Apache II (APS II). The MPI is shown as a prognostic index for peritonitis with high accuracy in individual prognosis. The simultaneous use of both scores, the MPI as well as the APS II, leads to a negligible improvement of prognostic accuracy. Moreover, sensitivity and specificity with the MPI are of higher accuracy than calculated with the APS II.

Adolescent↗
PubMed1989

The prognostic value of plasmaproteins in patients with abdominal sepsis.

In the course of the history of patients with severe peritonitis, opsonins, complements and other proteins of the plasma showed no significant difference between the data of the patients who later died or survived. We conclude that simple parameters like platelet count, creatinine and respiratory function are more sufficient.

Adult↗
PubMed1988

[Validation study of the Mannheim Peritonitis Index].

113 patients suffering from purulent peritonitis entered this retrospective study for evaluation of the prognostic value of the Mannheim Peritonitis-Index. There was no lethality below an index x = 21, between x = 21 and x = 29, it was 29% and lethality increased to 100% in patients with an index x greater than or equal to 30. Statistical validation showed that prognosis was correct in 93% for the index x = 27, with a sensitivity and specificity of also 93%. Between x = 21 and x = 29 prognosis of the MPI was correct in at least 65%. The MPI is shown as a prognostic index for peritonitis with high accuracy in individual prognosis, that could be easy routinely documented.

Adolescent↗
PubMed1986

[Liver resection of hematogenous and infiltrating metastases].

Of a total of 245 resections for hepatic metastases 124 operations were performed for hematogenic metastases and 36 for infiltrating metastases in continuity with the primary tumour. This group of so-called "major hepatic resections" is analysed. The series comprises 83 male and 77 female patients, mean age 62.2 years. There were 85 resections of the right lobe (39 of those with intrahepatic extension to the left), 45 right) and 30 atypical hepatectomies (at least bisegmentectomies). Hematogenic hepatic metastases: 80 resections of hepatic metastases following colorectal carcinoma, 15 following cancer of the stomach and esophagus, 12 after non-gastrointestinal malignant tumours, 4 resections after unknown primary cancer (44% solitary, 32% monolobar multiple, and 24% bilateral metastases); synchronous operations were performed in 32% of the patients, in 19% so-called interval surgery (mean 7.4 weeks), and in 49% metachrone surgery (mean 30 weeks). During 1983 and 1985 our morbidity rate amounted to 10% and the letality rate to 7%, as compared to 17% morbidity and 15% letality in the period 1965-1983. In both periods, septic postoperative complications outnumbered all other causes. The mean survival rate after colorectal carcinoma was 20 months, after non-gastro-intestinal malignant growth 19 months, after carcinoma of the stomach as well as after malignant biliary tract diseases 5 months. The three-year survival rate of colorectal carcinoma amounts to 30%, the five year survival rate to 15% including all metastatic stages. The results of interval and metachrone resections in forms of survival rates are clearly better than the results of synchronous resections with a mean survival time of five months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Estrogen receptor analysis on biopsies and fine-needle aspirates from human breast carcinoma. Correlation of biochemical and immunohistochemical methods using monoclonal antireceptor antibodies.

Monoclonal antibodies against estrogen receptor (ER) were used for determination of ER status immunocytochemically in histologic specimens from 192 primary breast carcinomas. All tumors were also assayed biochemically for ER with the dextran-coated charcoal method (DCC). The comparison of biochemically and immunocytochemically determined ER status showed concordant results in 80% (P less than 0.0001). In only 2 cases (1%) with low ER levels (less than 20 fmol/mg protein) immunocytochemistry failed to detect ER. ER positivity determined with a semiquantified approach based on intensity and heterogeneity of immunocytochemical staining correlated significantly with biochemically determined ER levels (P = 0.0001). In a series of fine-needle aspirates of 34 breast carcinomas sufficient cell material was available for ER immunocytochemistry (ER-ICA). Overall, the results of ER-ICA in fine-needle aspirates were concordant with ER-ICA in histologic specimens in 88% of the samples. In a few cases with weak positivity of ER-ICA in histologic specimens, ER-ICA was negative in fine-needle aspirates. In no case was there a false-positive immunocytochemical ER determination in a tumor aspirate. Thus, ER-ICA seems to be a reliable assay which can be performed in histologic and cytologic specimens.

Antibodies, Monoclonal↗
PubMed1985

[Conservative therapy of iatrogenic esophageal perforation].

During 7336 diagnostic and therapeutic endoscopies of the upper gastrointestinal tract 10 perforations of the esophagus were seen (0.14%). After diagnostic X-ray 5 patients were operated and 5 treated conservatively. The precondition for conservative treatment were immediate diagnosis and a covered perforation of the intrathoracal esophagus without communication to pleura or trachea. Treatment consisted in alimentary restriction, parenteral nutrition and high antibiotic therapy. One patient with a esophagotracheal fistula died under conservative treatment. He could not be operated because of advanced tumour disease. The others had an uncomplicated course and, after healing of the perforation, between the 5. and 15. day oral nutrition could be started. It is proved, that the conservative treatment of iatrogenic perforation of the esophagus is a minimal stressing and very successful therapy, if the above-mentioned conditions are followed exactly.

Adolescent↗
PubMed1984

[Relaparotomy following stomach operations].

From 1977-1982, 1.442 operations of the stomach were performed. In 82 cases a relaparotomy was necessary. In 27 cases the cause was peritonitis with anastomotic insufficiency. 7 patients had generalized peritonitis without anastomotic leakage. 14 had to be reopened because of localized abscesses. 11 patients had a bowel obstruction, 7 patients massive postoperative bleeding. 6 cases developed severe pancreatitis with peritonitis and 5 others developed bile leakage. The rest had several other complications. 47.6% of the reoperated patients died, most of them because of surgical complications. Therefore immediate reoperation should be performed before severe complications occur.

Gastrectomy↗
PubMed1984

[Tumors of the endocrine pancreas].

37 patients suffering from apudomas of the pancreas are reported (18 insulinomas, 6 isletcell-hyperplasias, 9 Zollinger-Ellison syndroms, 1 glucagonoma, 3 without hormone production). In preoperative localization computerized tomography and angiography were the best with 65% positive findings. Insulinomas were enucleated, all free of recidives. 50% of operated isletcell hyperplasias had a postoperative resisting hyperinsulinism. Either gastrectomy or tumour enucleation was performed in the Zollinger-Ellison syndrome. The five-years survival rate was 43%.

Adenoma, Islet Cell↗
PubMed1984

[Clinical aspects and therapy of congenital cystic livers].

Thirty patients with congenital cystic disease of the liver are reported. Expansion with pain, jaundice, cholangitis and suspicion of malignancy are indications for surgical intervention. Operation is chosen according to localization, size, quantity of cysts and their fluid content. Resection, fenestration, punction, anastomosis and hemihepatectomy were performed. Postoperative mortality was about 3%, prognosis is well, but worsened by associated diseases like polycystic kidneys or intramural aneurysms.

Cysts↗
PubMed1983

[Apud-cell tumors (carcinoids)--immunohistochemical and pathomorphologic results].

47 carcinoid tumours originating from different sites were classified on a histological basis and immunohistochemically investigated by means of a modified PAP method using 10 different antisera. The biological behaviour and the extent of anaplasia were correlated. The results were compared with those described in the literature. 19 carcinoids showed a positive immune reaction with the antisera used. 5 hormone-producing tumours were poorly differentiated and in 9 cases metastases were recognized. More than one peptide hormone was detected in 7 carcinoids, 3 of which were malignant. Metastases or invasion of lymph and blood vessels were observed in 9 cases although the tumour cells showed no greater degree of cellular atypia. A good correlation between biological behaviour and cytological features was obtained in only 5 atypical carcinoids. Carcinoid tumours represent a group with complex biological, histological and immunohistochemical properties. The secreted peptide hormones might be of importance as tumour markers in some cases.

Carcinoid Tumor↗
PubMedDate not supplied

Open approach in pancreatic and infected pancreatic necrosis: laparostomies and preplanned revisions.

One hundred and two patients with acute necrotizing pancreatitis were treated in accordance with a combined regimen of necrosectomy, open drainage by laparostomies, and repeated re-explorations. The severity of pancreatitis was assessed by the APACHE II score (median 15 on admission). Eighty-seven (85%) patients were classified as having infected pancreatic necrosis and only 15 (15%) as having pancreatic necrosis. Overall, 36 (35%) patients died, most of multiple organ failure. Survival was significantly impaired by bacterial contamination of pancreatic necrosis (p = 0.008), bacteremia (p = 0.0001) and infected bronchial secretions (p = 0.05). The mortality rate was reduced from 53% to 28% by changing the regimen of re-explorations from on demand to regular 48 hour intervals. Despite the fact that open packing was associated with a high frequency of gastrointestinal fistulas (30%), this concept seems to be a successful and recommendable approach in the therapy of pancreatic and infected pancreatic necrosis.

Acute Disease↗