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Biomedical subjects

R Kirchner

Publications and source records attributed to R Kirchner.

At least 19 recordsLinked to original sources
PubMed1992

[Stomach carcinoma: surgical strategy and therapy results 1992].

Surgical strategy for gastric carcinoma consists in total gastrectomy as a rule combined with extended lymphadenectomy. In small tumors of the intestinal type located in the distal stomach distal gastric resection can be taken into consideration. In case of high risk patients endoscopic polypectomy of a polypoid early gastric carcinoma can be sufficient. If the operation is done for cure we perform intraoperative radiotherapy within a prospective trial. For palliative situations procedures including removal of the tumor have better results with regard to quality of life and survival than bypass methods.

Gastrectomy↗
PubMed1992

[Surgery of stomach cancer--an assessment of current status].

Surgical strategy for gastric carcinoma consists of total gastrectomy as a rule combined with extended lymphadenectomy. For small tumors of the intestinal type located in the distal stomach distal gastric resection can be taken into consideration. In case of a high risk patient endoscopic polypectomy of a polypoid early gastric carcinoma can be sufficient. If the operation is done for cure intraoperative radiotherapy is employed within prospective trials in order to prevent local recurrence. Extended resections prolong survival time only if curativity will be achieved. For palliative situations procedures including removal of the tumor have better results with regard to quality of life and survival than bypass methods.

Combined Modality Therapy↗
PubMed1992

[Palliative interventions].

The German Gastric Cancer TNM Study included 1335 patients, of whom 657 (49.2%) underwent palliative surgery. The rate of resection was 50.6%. Postoperative complications occurred twice as often after palliative resectional surgery than after non-resectional procedures. In contrast, operative mortality rates did not differ. The median time of survival was 3 months after non-resectional procedures and 11 months after palliative resections. A considerable restriction of the quality of life occurred 2-3 months before death in both patient groups. Therefore, patients with non-resectional surgery hardly profit from the operation.

Follow-Up Studies↗
PubMed1990

[Colonic carcinoma localized in the chest in enterothorax due to congenital diaphragmatic hernia].

A 51-year-old man with congenital diaphragmatic hernia and enterothorax was found to have persisting leucocytosis (25,000/microliters), diarrhoea and weight loss (20 kg). Computed tomography (CT) revealed intrahepatic space-occupying lesions. CT-directed needle biopsy demonstrated adenocarcinoma metastases. Colon contrast enema was ambiguous. Since no primary tumour had been found, ambulatory treatment with 5-fluorouracil was started. After initial improvement diarrhoea and obstipation alternated so that the patient finally gave permission for coloscopy to which he had not consented at first. It revealed a carcinoma of the colon located in the thorax about 10 cm oral to the left colonic flexure. Progressive ileus necessitated an ileodescendostomy for palliation. The patient died three months later while on symptomatic treatment.

Adenocarcinoma↗
PubMed1990

[Is advanced age by itself a risk factor in large abdominal surgical interventions].

A logistic regression analysis was performed retrospectively in 237 patients over 70 years of age (group 1) who underwent surgery for diseases of the biliary tract, stomach, and colon and rectum. The data were compared with those of 273 patients with identical operations under the age of 60 years (group 2). The results of our analysis differed according to the cohort of patients. Age was shown to be a significant risk factor for perioperative mortality according to the analysis of young and old patients (group 1 and 2). Analysis of group 1 showed that the urgency of the operation and the sum of coexisting morbidities were significant. The combination of age and urgency is a significant risk factor following colorectal but not gastric and biliary surgery.

Aged↗
PubMed1990

[Is bronchoscopy a useful additional preoperative examination in esophageal carcinoma?].

Between 1980 and 1987 95 patients with esophageal carcinoma had a bronchoscopy. In 67 patients (70.5%) no pathological findings could be detected. In 24 patients (25.3%) signs of impingement were present and in 4 patients (4.2%) tumor infiltration into the tracheobronchial tree was visible. The correlation between tumor length and bronchoscopic findings revealed a marked increase of direct and indirect tumor evidence in esophageal carcinomas of more than 5 cm in length. Pathologic bronchoscopic findings were detected twice as often in patients with carcinoma of the upper third of the esophagus in comparison with those of the middle third. In 5 patients (5.3%) bronchoscopy revealed an unknown additional bronchial carcinoma. 67 of the 95 patients underwent operation. In 59 patients the esophagus was resected. Among the normal bronchoscopic findings the operability rate was 77.6%. In contrast, only half of the patients with pathological bronchoscopic findings were operable, the other patients received radiotherapy. We recommend, therefore, preoperative bronchoscopy as an important investigation for assessment of operability and for evaluation of synchronous neoplasms in patients with an esophageal carcinoma.

Adenocarcinoma↗
PubMed1990

[Injuries of the small and large intestine following blunt abdominal trauma].

From 1979 to 1987 1428 patients with blunt abdominal trauma were treated in the Department of Surgery of the University of Freiburg; 119 patients had intestinal injuries. They were mainly young adults who had sustained a car accident. 71.3% of the small bowel injuries were overseen, 14.2% needed resection, and in 14.5% an operative procedure was not necessary. The surgical procedure for colonic injuries has to be chosen with regard to the age and general condition of the patient, to the severity of the trauma, to associated injuries and to the stage of peritonitis. Accordingly, 18% of the patients were treated with and 58% without a protective colostomy, 24% could be treated conservatively. Mortality and morbidity correlated with the severity of associated injuries. Morbidity was also dependent on the time interval between accident and operative therapy.

Adult↗
PubMed1990

Cystic neoplasms of the pancreas.

Cystic neoplasms of the pancreas can be easily misdiagnosed and mistreated by the surgeon unfamiliar with the pathology, natural history, and operative strategy specific to these uncommon tumors. The authors have treated nine patients over a seven-year period involving four cystadenocarcinomas, two mucinous cystadenomas, two serous cystadenomas, and one solid and papillary epithelial tumor. Our experience illustrates the inaccuracies in both clinical and pathologic diagnosis. Suspected cystic neoplasms are optimally managed by resection. Their slow growth and late metastasis permits curative surgery after a previous drainage or bypass procedure. An aggressive surgical approach is therefore warranted, and multimodal treatment with radiation and chemotherapy may be clinically applicable to large, invasive cystadenocarcinomas.

Adult↗
PubMed1978

[Histometrical studies of liver parenchym in two cirrhotic livers (author's transl)].

Livers of two patients suffering from cirrhosis were weighed at post mortem, and found to have weights of 510 resp. 640 g. The quantity of hepatocytes was measured histometrically and estimated to be approx. 210 g in both patients; this means, that total liver mass in these patients was reduced to approximately 30% of normal, and that hepatic insufficiency had been incumbent in both of these patients. Difficulties in the methods of measuring the quantity of normal liver parenchyma in cirrhotic livers are discussed. Initiation of hepatic coma in liver cirrhosis is dependent in the first place, but not exclusively, upon the degree of reduction of liver parenchyma.

Aged↗
PubMed1978

[Metabolism of endogeneous gastrin (author's transl)].

The localization of production of gastrin is rather well known, the localization of metabolic breakdown however is still being discussed. Liver, kidneys, musculature and small intestine are being taken into consideration. Experiments were performed demonstrating a definite increase of serum gastrin after removal of the small intestine; the duodenum was not removed in these experiments, since enterogastrone is formed mainly in this organ. These results would suggest, that gastrin is metabolized in the small intestine. In order to further prove this point, truncal vagotomy was performed in rabbits, producing elevated serum gastrin levels. In other series subtotal removal of the small intestine was combined with truncal vagotomy. Serum gastrin levels were definitely higher after this latter procedure than after truncal vagotomy alone. These findings seem to support the hypothesis, that endogeneous gastrin is metabolized in the small intestine.

Animals↗
PubMed1978

[Patch widening technic of benign bile duct stenosis in dogs using teflon and Solco grafts].

In 30 dogs, weighing 20 to 30 kg, the common bile duct was ligated. Pre- and postoperative bilirubin, GOT, GPT and alc. phosphatase were controlled. Eight days later a longitudinal incision was made across the stenosed segment, which was then widened with a patch. 15 dogs received a Teflon patch - 15 other dogs a Solcograft pathch. After patch-widening-plasty laboratory parameters returned to normal within a few days. X-ray controls could not find any stenosis two years after Teflon-patch-plasty, while after Solcograft-patch-plasty four dogs showed a common bile duct-stenosis within the first following year. Four weeks after Teflon-patch-plasty the patch was covered with bile duct epithelium inside. After Solcograft-patch-plasty within the first postoperative year no epithelization could be observed.

Alanine Transaminase↗
PubMed1977

[Diagnostic value of thoracic and abdominal x-ray in acute pancreatitis (author's transl)].

Chest and abdominal films were retrospectively examined in 100 patients with acute pancreatitis excluding cases with pancreatitis concomitant to other diseases. Most frequently we found gastric and duodenal distension, diffuse distension of small bowel loops, localized meteorism of transverse colon as well as left flexure and diffuse colonic distension. The chest-films showed: elevated diaphragm and pleural effusion on the left, pneumonitis, pleuritis and and basal platelike atelectases. Pathologic radiological signs were absent in only 1% of the cases.

Acute Disease↗
PubMed1977

[Selection of procedure in the management of recurrent juvenile and aneurismatic bone cysts].

Aneurysmal and juvenile bone cysts are characterized by frequent recurrence and pathological fractures caused by such bone cysts also recur frequently. Curettage of the cyst and spongiosaplasty is often unsuccessful. According to our experience, excochleation must be followed by drilling the cyst wall and fraising off the compact substance. Densely packed homologous spongiosa must then be implanted. In case of recurrence or if the cyst increases in size, radical en-bloc resection is indicated and the defect must be bridged by osteoplastic and osteosynthetic methods. We have treated four difficult cases successfully with this procedure. In one case, resection with limb shortening lead to full recovery.

Age Factors↗
PubMed1976

[Operative treatment of massive hemorrhage from duodenal and gastric ulcers (author's transl)].

Considering the different pathogenesis of gastric and duodenal ulcers, it does not seem proper to speak of "gastroduodenal ulcer" and to postulate that bleeding gastic ulcer must be treated by resection only and the bleeding duodenal ulcer by vagotomy. Certainly our catamnestic enquiry shows that the B II gastric resection is favorable with regard to relapse and mortality rates in bleeding gastric ulcer, and the principle of vagotomy is good in bleeding duodenal ulcer; but we are of the opinion that after the introduction of controlled, selective, proximal vagotomy, only this procedure should be used for bleeding gastric and duodenal ulcers, because in this way the disadvantages of resection and the complications of truncal vagotomy can be avoided and complete intra-operative control is possible.

Adult↗
PubMed1976

Is the Gardner syndrome a separate disease? (author's transl).

A family, the members of which suffer from "Gardner's syndrome" is reported. In this family, and also in another family which is being treated in our clinic with a diagnosis of "familial polyposis of the large intestine", bronchiectasis appears with a frequency more than can be attributed to chance. Our observations suggest the following conclusions: 1. Gardner's syndrome and familial polyposis of the large intestine are diseases which cannot be strictly separated from each other, but the isolated intestinal polyposis is a monosymptomatic form of Gardner's syndrome. 2. Bronchiectasis can be considered a further symptom of this disease caused by a pleiotropic effect of a gene.

Adult↗