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Biomedical subjects

R Häring

Publications and source records attributed to R Häring.

At least 19 recordsLinked to original sources
PubMed1992

[Multivisceral and extended resection in tumor surgery: stomach cancer].

The aim of curative surgery in gastric cancer is the complete removal of all tumour bulk both macroscopically and microscopically (R0 resection). The operative strategy should consider the location of tumor, its histological character (Laurén classification), and the stage of disease according to the TNM-classification. Lymphadenectomy of compartments I and II does not increase operative morbidity and mortality if performed routinely, but seems to increase long-term survival in patients with stages II and IIIa disease. Routine removal of the spleen does not lead to better results. Gastrectomy in locally advanced gastric cancer with combined resection of adjacent organs can prolong survival in absence of peritoneal disseminating or distant metastases if R0 resection is achieved. The indication for gastrectomy of patients with an incurable stage of disease (peritoneal dissemination, distant metastases) should be determined after considering the individual status of the patient and surgical risk and can be performed as a so-called ultima ratio resection with the aim of palliation.

Follow-Up Studies↗
PubMed1992

[Cystadenoma and cystadenocarcinoma of the pancreas. Symptoms, diagnosis and surgical consequences].

Seven cases of cystadenomas and cystadenocarcinomas were presented and the treatment of the cystic tumours of the pancreas was discussed in a surgical point of view. Distinction between true cysts like cystadenomas and pseudocysts following pancreatitis is of paramount importance. The clinical findings are mostly uncharacteristic and determinated by the late symptoms. The diagnosis of cystic tumours can usually be made by radiological imaging technique. Intraoperative examination of the frozen-sections is of paramount importance for the choice of the surgical procedure and hence the prognosis of the patient. Radical surgery is indicated in case of cystadenoma or cystadenocarcinoma. Every mucinous cystic neoplasm should be completely examined in carefully lamillated sections in order to identify its malignancy.

Adult↗
PubMed1991

Evaluation of endosonography in TN staging of oesophageal cancer.

Strategies for the treatment of cancer of the oesophagus depend on the tumour stage at the time of diagnosis. Resection, the only curative treatment, is confined to early tumour stages. Tumours with local infiltration are usually unresectable and require palliative treatment. Computed tomography has been widely used for preoperative staging but often fails to define this correctly. Endoscopic ultrasound allows direct visualisation of the parietal wall and may be useful in staging gastrointestinal tumours. In a comparative prospective study, 52 patients with tumours of the oesophagus were investigated preoperatively both by endoscopic ultrasound and computed tomography to determine the stage of tumour infiltration and local lymph node involvement. Thirty seven of these patients underwent operation, resection, or dissection and entered the study. The intraoperative findings or the histopathological assessment, or both, were taken as a reference. For all TN stages of oesophageal tumours, correct preoperative staging was accomplished by endoscopic ultrasound in 89% for T stage and 69% for N stage compared with 51% and 51% respectively by computed tomography (highly significant using Fisher's exact test). This study shows that endoscopic ultrasound is useful in preoperative TN staging of tumours of the oesophagus.

Adult↗
PubMed1991

[Therapeutic protocols in the treatment of liver metastases].

The liver is the main site for metastatic spread from many cancer, particularly those of the colorectum. Surgical treatment of liver metastases is nowadays a safety therapeutical approach, which has been improved by the development of modern imaging procedures, clear indications and standardized surgical techniques. In carefully selected patients the 5-year survival ranges between 30-40%. Unfortunately only 20% of the patients with liver metastases are candidates for this potentially curative therapy. Palliative modalities remain for the majority of patients with unresectable metastases limited to the liver. Although various types of intrahepatic arterial chemotherapy, sometimes in combination with whole liver irradiation or embolization shows a higher response rate than systemic chemotherapy no significant impact on survival time has been proven. One of the main unsolved problem is the extrahepatic spread. For getting better results--median survival of responders ranges between 18 to 24 months versus 8 months of non-responders--a more exact selection is needed.

Antineoplastic Agents↗
PubMed1991

[Results of surgical therapy of esophageal carcinoma].

In esophageal cancer radical resection of the affected segment is the therapy of choice for tumours confined to the wall. Palliative resection at advanced tumour stages does not improve survival and markedly increases mortality. Neither chemotherapy nor radiation influence the survival rates. Tumours of the middle third are resected by the thoracic approach, while tumours of the lower third may be resected by blunt dissection. The best reconstruction is achieved by interposition of the stomach. The jejunum or colon may be interposed in the case of a previous gastric resection. In our department, postoperative mortality was 8.8%, corresponding to 137 operations with stomach interposition. The 5 year survival rate was 39.9% in stage I and II and 10.6% in stage III and IV. Complications and mortality were markedly increased in advanced tumour stages. The thoracic approach was not correlated with higher postoperative lethality.

Adult↗
PubMed1991

[Experiences with intraoperative radiotherapy in gastric carcinoma (Berlin method)].

The aim of our pilot study is to determine whether intraoperative radiotherapy in gastric cancer cannot only prevent a local relapse but also improve the survival rate. Since November 1987, 26 patients with resectable gastric cancer were irradiated intraoperatively with the linear accelerator using fast electrons (single dose: 12 to 16 Gy). Percutaneous radiotherapy was performed postoperatively with 24 to 38 Gy (4 x 2 Gy per week). For intraoperative and percutaneous radiotherapy the target absorbed dose was selected in a way that their combined effect on the tumor was approximately equivalent to that of a total dose of 60 Gy in the usual fractionating. Up to now, the median survival time for stage III patients (UICC 1987) has been twelve months. In five patients who died of a relapse or of peritoneal carcinosis, histologic evaluation revealed in every case a diffuse tumor type according to Lauren-classification. All relapses occurred within the first eight months. The two-year survival rate according to Kaplan-Meier is 67% for stage III. Advanced resectable gastric cancer of the intestinal tumor type seems to profit from adjuvant intraoperative radiotherapy. The results warrant further research within the framework of a prospective randomized multicenter study.

Adenocarcinoma↗
PubMed1990

[Prevention of thrombosis with low molecular weight heparin as the only substance and/or with DHE: results of clinical studies].

In aspect of the high incidence of thrombosis and the resulting risk of fulminant pulmonary embolism and late complications, there is a demand for a general medical prophylaxis in operative medicine. A new chance to reduce the incidence of thrombosis is the recently developed low weight molecular heparine (LWMH). Current studies of different LWMH in general and thoracic surgery prove, that an effective decrease of thrombosis can be achieved with a single daily injection. Effectiveness of LWMH in high risk patients have not been sufficient evaluated yet in some of the used preparations.

Dihydroergotamine↗
PubMed1990

[Emergency and early portasystemic shunt: indications and results].

The definitive hemostasis is the key to successful therapy of variceal bleeding. There is a difference between the emergency operation for persistent bleeding in spite of initial sclerosing therapy and the planned early operation for primary massive bleeding, early recurrence of bleeding and bleeding of fundus varicosis. The lethality is about 50% for the emergency operation, about 12% for the early operation (Berlin). For the emergency situation the portacaval end-to-side anastomosis is favoured. The result of this therapeutical concept in Bonn (1989-1990) for 47 patients admitted for bleeding was a hospital lethality of 23%.

Aged↗
PubMed1990

[Sequelae and long-term results following portasystemic anastomoses and significance of ambulatory after care].

After portocaval anastomosis 149 cirrhotic patients were treated on an outpatient basis. Liver insufficiency was observed in 24%. Encephalopathy was chronic in 14% and episodic in 11%. The most common postoperative complication was edema of the ankle (48%). Further operations bore a minimal risk (mortality 3/22). Sixty-eight percent of the patients agreed to abstain from alcohol; 85% took vacation trips and 95% were satisfied with the operation.

Aftercare↗
PubMed1990

[Differentiated cancers].

A total of 119 papillary and 67 follicular thyroid carcinomas were subdivided according to the WHO classification of 1988 in the morphological subtypes of occult, encapsulated and invasive carcinomas. The patients were monitored over a followup period of 16 years postoperatively. Initially 10.6% of all patients with early follicular carcinoma had distant metastases and 2 of 19 died of carcinoma. In cases of early papillary carcinoma there were no distant metastases and no deaths. Limited thyroid surgery is recommended as curative surgery only for such patients.

Adenocarcinoma↗
PubMed1978

[Immunoreactive parathyroid hormone in samples from thyroid veins (author's transl)].

Blood samples were obtained from 16 patients with primary or secondary hyperparathyroidism by selectively catheterising cervical and thyroid veins. Immunoreactive parathyroid hormone was measured with two aminoterminal (anti-N)- and three carboxyl-terminal (anti-C)-specific antisera. Two anti-C sera and one anti-N serum were useful in localising the parathyroid tumors. In addition, the parathyroid hormone fragments were separated by gelfiltration and the immunoreactivity in the effluent was estimated with anti-N and anti-C sera. The results suggest that the usefulness of antisera for parathyroid tissue localisation is determined by their affinity for the intact hormone, regardless of their anti-N or anti-C qualities.

Chromatography, Gel↗
PubMed1978

[Results of operative treatment of acute perforating gastroduodenal ulcer (author's transl)].

In this report of 264 operatively treated gastroduodenal perforations, differentiated, and where possible definitive, therapy is attempted. By omitting simple oversewing in favor of primary resection, bionomic operation or the combined procedure, primary lethality is reduced to one third and the late results of the survivors significantly improved. Resections are indicated in benign pyloric stenosis and gastric ulcer. The bionomic operation is particularly to be preferred in young patients.

Age Factors↗
PubMed1978

[Swine liver ultrastructure following hypothermia and hyperbaric oxygenation preservation].

The livers of 20 pigs were preserved for up to 16 hours, applying hypothermia (4 degrees C) and hyperbaric oxygenation (3 ata). As a preparation solvent we used in one group the solution by Lie (17) which is rich in potassium and glucose, and in the other group the cryoprecipitated serum by Belzer (5). After 8 and 16 hours of preservation, the fine structure was examined light- and electronmicroscopically. After 8 hours of preservation, there were only little reversible changes in both groups. After 16 hours, both groups showed distinct changes of the endoplasmatic reticulum e. g. desorganisation, vesicular dilatation, and dissociation of the mural ribosomes. In addition, there were swellings of mitochondriae and Kupffer's cells. These changes were particularly distinct after preservation in cryoprecipitated serum. In this group a cellular depletion of glucogen was noticeable.

Animals↗
PubMed1978

[Giant cavernous hemangioma of the liver. Case report and review of the literature (author's transl)].

The cavernous hemangioma of the liver is frequently seen as small tumor without any symptoms, but only rarely its diameter is more than 4 cm (161 cases in world literature). We can report on an additional patient. The peculiarities in this case were the tumor size, the presence of numerous phleboliths and the contrasting of the tumor taking place mainly from the venous part of the vascular bed of the liver. The main indication for a surgical intervention is the danger of rupture, but disturbances of the coagulation as well as intestinal suppression symptoms have also to be taken into consideration. The intraoperative tactics ought to be a standardised resection of the liver. The cavernous hemangioma must be differentiated from the hemangioendothelium: this usually occurs in children, causes cardiac failure due to a. v. shunts, and responds to conservative therapy (corticosteroids, radio-therapy).

Adult↗