Search PubMed⌕ Search

Biomedical subjects

R Pichlmayr

Publications and source records attributed to R Pichlmayr.

At least 127 records · Page 7Linked to original sources
PubMed1996

[General aspects of organ donation].

The general and surgical aspects of organ donation are of great relevance for every surgeon in every hospital, as potential organ donor situations occur in every intensive care unit. Typical organ donors are patients suffering from intracerebral bleeding. There is no upper age limit. The implementation of a potential organ donor program is the indirect responsibility and task of every hospital in order to serve the patients waiting in the geographical region of the hospital; organs retrieved in another region should be available for patients in that other region. The general aspects of organ donation concern, for example, the question of the legal aspects of brain death and adequate surgical procedures concerning the dignity of the donor. The surgical aspects include a highly standardized technique using only aortal flush at an early stage of the operation without major manipulation of the organs prior to perfusion. The liver and pancreas are removed en bloc and consecutively the kidneys, one by one. This no-touch technique is rapid and safe, especially for atypical hepatic arteries, as all the tissue between the superior mesenteric artery, celiac trunk and minor curvature of the stomach is preserved with liver, irrespective of arterial anomalies.

Brain Death↗
PubMed1996

[Is liver resection in metastases of exocrine pancreatic carcinoma justified?].

From 1971 to 1995 we have performed 23 liver resections in 22 patients because of hepatic metastases of pancreatic (n = 20) or ampullary (n = 2) carcinomas. In 16 patients the hepatic secondaries were removed synchronously with the pancreatic primary tumour. In 7 cases liver resection was performed for metachronous metastases. Only one patient died after simultaneous resection of liver and pancreas (operative lethality 4,3%). Curative R0-resection was accomplished in 69% of patients with synchronous and 100% with metachronous liver metastases. The median survival time was 8,3 months after synchronous and 5,8 months after metachronous hepatic resection. The one-year survival amounted to 41 and 40% resp. Though distant metastases are a definite sign of a progressed tumour stage, the prognosis of patients with hepatic metastases should not be considered hopeless. In view of a comparatively small operative risk there is a chance for individual patients to gain valuable survival time.

Adult↗
PubMed1996

[Liver metastases in breast carcinoma. Results of partial liver resection].

Within 11 years we performed 35 liver resections in 34 patients with liver metastases of breast cancer. The median age was 47 years. The median interval between the primary operation and the liver resection was 27.3 months. 59% of the patients had a solitary metastases. A curative (R0) resection was possible in 86%. Operative mortality was 3% (n = 1). Overall 5-year survival was 18.4% (median 27 months). Prognosis was significantly (p < 0.001) better following R0-resection (22%, median 41.5 months) than after R1/2-resection (maximum 20 months, median 5 months). Beside the radicality an unfavorable influence on the prognosis could be demonstrated only for a prior local recurrence of the primary tumor (p < 0.05). If a R0-resection was possible stage of the primary tumor, number and size of the metastases, and extension of the operative procedure were without prognostic significance. We conclude that patients with isolated liver metastases of breast cancer can have a long lasting benefit from liver resection. In individual cases even cure may be possible.

Adult↗
PubMed1996

Experience with color-coded duplex sonography after combined kidney/pancreas transplantation--preliminary results.

The value of color-coded duplex sonography in the assessment of combined kidney and pancreatic transplantations (KTX/PTX) was studied in 9 patients. In normal graft function the median resistive index (RI) was 0.69 (range 0.60-0.80) for the kidney and 0.61 (range 0.55-0.70) for the pancreas. Ten episodes of graft dysfunction (kidney n = 4; pancreas n = 6) were observed. During renal rejection and hemolytic uremic syndrome the RI was above 0.80. In pancreatic rejection the RI exceeded 0.80 while all other causes of pancreatic dysfunction were not associated with changes in the RI. Color-coded duplex sonography may prove to be a reliable noninvasive diagnostic method in the evaluation of the posttransplant course after combined KTX/PTX, in particular in the diagnosis of pancreatic rejection.

Diabetes Mellitus, Type 1↗
PubMed1996

[Possibilities and limitations of curative resections in cancers of the pancreas].

Univariate and multivariate analysis was used to assess the potential and limitations of curative resection in cancer of the pancreas. From 1971 to 1993, we operated 466 patients with cancer of the pancreas, using tumor resection in 192 cases. Among these, 40% required resection of the vessels or neighboring organs allowing RO resection in 85% of the patients. The most valuable prognostic factor was curative resection, followed by tumor grading and tumor size. Non-curative tumor resection did not improve survival over exploratory laparotomy or palliative anastomoses. Operative mortality after resection was lower than for procedures leaving the tumor in situ. Extended resection with vessel resection had no effect unless combined with local curative ablation, but cannot be indicated in cases with synchronous metastases or invasion of the neighboring organs. Preoperative explorations do not provide a precise indication of extension in cancer of the pancreas which can only be evaluated in an open procedure by an experienced surgeon.

Adenocarcinoma↗
PubMed1996

[Surgical therapy of primary malignant melanoma of the esophagus].

The case of a 59-year-old man with the extremely rare finding of a primary malignant melanoma of the oesophagus is reported. Seven months after transthoracic oesophagectomy the patient is well without signs of recurrence. The difficulties in preoperative diagnosis and therapy are discussed.

Esophageal Neoplasms↗
PubMed1996

[Value of 2-field lymphadenectomy in intrathoracic esophageal carcinoma].

Surgical procedures including the extent of systematic lymphadenectomy are still under discussion in the treatment of esophageal cancer. In the own patients' population 92 subtotal en bloc-esophagectomies with a standard two field lymphadenectomy were performed. A total of 1483 lymph nodes were resected in the thoracic and abdominal compartments with an incidence of 16.1% being metastatic. Stage pN1 disease occurred in 57.6% of the patients. The median number of lymph nodes resected in each specimen was 16, independent of tumor stage, -site or R-classification. The number of infiltrated nodes increased with tumor stages. R-classification, tumor stage and number of involved lymph nodes could be analyzed as prognostic factors. After R0-resection a median survival rate of 25.4 months could be achieved, following pN0-stage that of 27.4 months. In case of two metastatic lymph nodes the prognosis decreased significantly to 14.4 months (p < 0.01). Therefore, two field lymphadenectomy may show a therapeutic benefit only in a subgroup of patients with a limited number of lymph nodes infiltrated.

Adult↗
PubMed1996

[Systematic lymphadenectomy in stomach carcinoma--staging and therapy].

The diagnostic and therapeutic relevance of systematic (D2-) lymphadenectomy was studied in 440 resections for primary gastric carcinoma. A total of 13910 lymph nodes (mean: 31.6 (15.3)) was resected with 3716 being metastatic (mean: 8.6 (11.0)). During surgery 24% of the carcinomas were incorrectly staged when compared with the pathological stage. The prognosis was influenced by tumor stage, R-classification and number of lymph node metastases. Patients with a maximum of three metastases and R0-resection had a prognosis not significantly different from patients with pN0-stage (5-year-survival: 77% and 64% resp.; p = 0.21). Systematic lymphadenectomy in gastric carcinoma has not only diagnostic, but also therapeutic importance in patients with limited lymph node metastases.

Adenocarcinoma↗
PubMed1996

Completion thyroidectomy in 131 patients with differentiated thyroid carcinoma.

OBJECTIVE: To evaluate the prognostic factors that influence survival and recurrence after "completion" thyroidectomy (removal of the total thyroid remnant after diagnosis of carcinoma has been made in a specimen that was incompletely excised for a benign condition). DESIGN: Open study. SETTING: Teaching hospital, Germany. SUBJECTS: 131 Patients (65 with papillary and 66 with follicular thyroid cancer) who underwent completion thyroidectomy after primary subtotal resection. INTERVENTIONS: Indications for further operation were: tumour stage worse than pT1 ( n = 116), tumour stage pT1 and the suspicion of persistence of the tumour (n = 13), and incompletely resected tumour (n = 2). Multivariate analysis by Cox's proportional hazards model. MAIN OUTCOME MEASURES: Recurrence, development of metastases, and length of survival. RESULTS: Patients who underwent their completion thyroidectomies within six months of the primary operation had significantly fewer recurrences, fewer lymph node metastases, fewer haematogenous metastases and survived significantly longer than those in whom the second operation was delayed for longer than six months. The age at the time of diagnosis and the stage of the tumour influenced survival, whereas sex and type of tumour did not. CONCLUSION: Completion thyroidectomy as soon as possible after incomplete resection of the tumour may improve prognosis in differentiated thyroid cancers the stage of which is worse than pT1 or in patients whose recurrent tumour is diagnosed at follow-up.

Adenocarcinoma, Follicular↗
PubMed1996

[Results of surgical therapy of primary and recurrent retroperitoneal liposarcoma].

Between 1978 and 1994, 27 patients with a retroperitoneal liposarcoma underwent a total of 64 operations at our institution with a resectability rate of 96% of the primary and 100% of recurrent tumors. Operative morbidity (7.8%) and mortality (3.1%) were low, although multivisceral reactions were necessary in the majority of cases (73% of all primary tumors). The single most important prognostic factor was a potentially curative resection at first operation (5-year survival: RO: 75%, R1/R2: 34%), but also at first operation for tumor recurrence.

Adult↗