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Biomedical subjects

R Kirchner

Publications and source records attributed to R Kirchner.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Biliary pseudocyst as a rare complication of choledocholithiasis].

Biliary pseudocysts, so-called biliomas are reported to be an extreme rarity and mostly arising posttraumatic. We report on a case of symptomatic choledocholithiasis 7 years after cholecystectomy. The course was complicated by formation of a biliary pseudocyst. The 71-year-old, septic patient could not be operated because of pulmonal and cardiac high risks. He could be treated successfully by conservative procedure via endoscopic papillotomy, stone extraction and percutaneous, sonographic controlled drainage of the biliary pseudocyst.

Aged↗
PubMed1993

[Reliability of clinical examination of the shoulder in comparison with arthroscopy. A prospective study].

The results of clinical shoulder examination including 20 special tests were compared with subsequent arthroscopic findings in 45 patients. The sensitivity of the clinical diagnosis was 73%. Impingement syndrome was correctly diagnosed in 19 of 22 cases (86%), rotator cuff tears in 7 of 9 cases (78%). The highest sensitivity for stage II impingement was found for the supraspinatus test (85%) and the lift-up test (92%); the sensitivity of these tests for rotator cuff tears was 100% and 89% respectively. Differentiation between impingement syndrome with and without rotator cuff tear by one of these tests alone was not possible because of their low positive predictive values (26% and 56%). In contrast, in 90% of patients with negative rotator tests the rotator cuff was complete, while the negative predictive value of the supraspinatus test was 100%. Instability was confirmed in only 53% of cases; the Leffert test had the highest positive predictive value (73%). In conclusion, the clinical diagnosis of a shoulder lesion cannot reliably be achieved by single tests; rather overall evaluation by an experienced clinician is necessary.

Adolescent↗
PubMed1993

[Tracheal and bronchial rupture after blunt thoracic trauma].

Airway disruptions after blunt chest trauma are rather infrequent with an incidence of about 1%. Even in large centers with many such casualties they are episodical. The clinical picture is not an uniform one, and typical clinical signs occur often without an airway lesion. Therefore, the correct diagnosis may be delayed. Two case reports, one with a tracheal rupture, the other with complete disruption of the main right bronchus are presented. Both patients showed significant soft tissue emphysema, increasing dyspnea and hypoxia respectively within a few hours after their accident. The diagnosis was established bronchoscopically after time intervals of 8 and 32 hours respectively, followed by immediate surgical correction. Both patients experienced a smooth recovery with good longterm results. In blunt chest trauma presenting with subcutaneous emphysema, pneumomediastinum, pneumothorax, hemoptysis and respiratory distress, tracheobronchial disruption should be considered. In this case, expert bronchoscopy, preferably by a surgeon with large thoracic experience, is mandatory.

Adolescent↗
PubMed1993

[Perioperative risk factors in esophageal cancer: a retrospective study of independent variables].

The postoperative outcome of 127 patients with an esophageal carcinoma was investigated retrospectively, to identify independent factors for the perioperative mortality (hospital mortality). Chi-square single factor analysis was employed to test 35 independent variables, in a second analysis stepwise logistic regression was used to determine the factors correlating with the morality. In 41 patients the esophagus was resected by a thoraco-abdominal approach, in 86 by blunt dissection. The hospital mortality was 17.3%, the 30-day mortality 12.6%. Single factor analysis revealed a significant correlation with the variable smoking (p < 0.003), post-operative morbidity (p < 0.008), CEA (p < 0.02), time of operation (p < 0.02) and surgical procedures (p < 0.02). The influence of the surgeon's experience was significant. In the stepwise logistic regression the duration of operation (p < 0.0039), the surgical procedures (p < 0.016), and the units of blood (p < 0.03) were correlated with mortality. The logistic regression showed a significant increase of mortality for the thoracoabdominal approach with increasing duration of the operation. The estimation of survival time according to Kaplan and Meier revealed a significant correlation with the stage of the tumor, but not with the surgical procedure.

Adenocarcinoma↗
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↗
PubMed1989

[Preoperative staging of rectal cancer: endosonography versus computerized tomography].

In a prospective study in 49 patients with rectal carcinoma the correlation of pre- and post-operative staging by CT and endorectal ultrasound (EU) was compared according to TNM-classification. With CT the pre/postoperative results correlated in T1 in 9/10, in T2 in 10/16, in T3 in 13/15 and in T4 in 6/8 patients. By EU identical results were found in all T1, in 10/12 T2, in 17/20 T3 and in 6/7 T4 stages. Overall, pre- and postoperative identical results were found by CT in 38 and by EU in 43/49 patients. Overestimation of the tumor stage was similar with both methods: 5 by CT and 4 by EU. Underestimation of the stage was more often by CT in 5 than by EU in 2 cases. (CT: accuracy 77.5%, sensitivity 88.3%, specificity 94.4%; ES: accuracy 87.7% sensitivity 91.5%, specificity 97.8%). Criteria for interpretation are discussed. In early tumor stages the depth of tumor invasion can be better evaluated by EU. In late stages both methods give important information for surgical strategy.

Adenocarcinoma↗
PubMed1989

[The effectiveness of sonography in preoperative thyroid diagnosis].

Real time sonography is the main method used to distinguish between diffuse and focal pathological variations in the thyroid gland. It always detects the presence of the cysts, thus obviating the need for scintigraphy. The sensitivity of sonography for the thyroid nodules is nearly 100%, whereas its specificity is only 60%. The value of sonography in thyroid gland disease is discussed and a diagnostic scheme for thyroid nodules is given.

Diagnosis, Differential↗