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Biomedical subjects

R Roscher

Publications and source records attributed to R Roscher.

At least 55 records · Page 3Linked to original sources
PubMed1988

[Expert assessment following total and partial loss of the spleen].

Post-splenectomy sepsis is a possible consequence, following traumatic loss of the spleen. An incidence of 1.05 per cent and mortality of 0.5 per cent may be assumed. The risk of infection for patients with traumatic loss of the spleen was found to be 60 times higher than that facing the general population. Spleen-preserving operations were found to ensure immune competence only in patients with not less than 30 per cent of intact spleen substance and under conditions of unimpaired blood supply. Occupational disablement usually occurs to 30 per cent of post-splenectomy patients during the first year from operation. Ten per cent were disabled for good, provided absence of complications.

Bacterial Infections↗
PubMed1988

[Necrosectomy and bursa lavage in necrotizing pancreatitis. Results of a prospective clinical study].

In a prospectively performed clinical trial a surgical management protocol including necrosectomy and postoperative local lavage of the necrosis cavity and the omental bursa was applied in 95 patients with necrotizing pancreatitis. In 80% of them severe organ failures occurred preoperatively, in spite of intensive care treatment. The median value of early prognostic signs of these patients was 4.5. Intraoperatively 59% showed extended pancreatic necroses and 66% an extension of the necroses into extrapancreatic tissue structures; in 42% bacteria were detected in the necrotic material. After necrosectomy the postoperative local lavage was performed for an average period of 25 days with 8 1 of lavage fluid per 24 hours in median. The average intensive care period came to 7.0 days, the average postoperative hospital time was 60 days. The hospital mortality amounted to 8.4%. The advantage of this management protocol including necrosectomy and postoperative local lavage lies in the continuous emptying of vasoactive and toxic substances, germs and necrotic material.

Acute Disease↗
PubMed1987

High sensitivity and specificity of CA 19-9 for pancreatic carcinoma in comparison to chronic pancreatitis. Serological and immunohistochemical findings.

The serum carbohydrate antigenic determinant (CA 19-9) was assayed in patients with various diseases (87 patients with pancreatic carcinoma, 747 patients with benign diseases, and 547 patients with extrapancreatic malignant growths) and it proved to be particularly sensitive for adenocarcinoma of the pancreas (80 of 87, 92%) as compared to only 14% in the group of patients with benign diseases. Twenty-seven percent of the patients with chronic pancreatitis and 28% of the patients with acute pancreatitis showed elevated CA 19-9 concentrations of more than the upper normal value of 37 U/ml. In 38% and 32% of our cases with carcinoma of the stomach and colorectal carcinoma, respectively, CA 19-9 was estimated as being above the normal range. The preoperatively raised CA 19-9 concentration in patients with pancreatic carcinoma decreases after curative resection of the carcinoma to values within the normal range. However, in no CA 19-9 estimation following a palliative surgical intervention or in cases of inoperable carcinomas a serum concentration of less than 37 U/ml was recorded. In immunohistochemical specimens we found a difference between CA 19-9 antigen concentrations on the cell surface and secretion in pancreatic carcinoma and chronic pancreatitis.

Adenocarcinoma↗
PubMed1987

The value of CA 19-9 in gastric and colorectal carcinoma.

We have conducted a prospective study of 441 patients, to investigate the utility of a new tumor marker CA 19-9 for the diagnosis and monitoring of patients with cancer of the gastrointestinal tract (93 patients with colorectal carcinoma, 57 with carcinoma of the stomach, 10 with esophageal carcinoma, 45 with malignancies outside the gastrointestinal tract, and 236 with benign general surgical disease). Results were compared to those obtained for carcinoembryonic antigen (CEA) in the diagnosis of carcinoma of the stomach and colon/rectum. CEA is more sensitive than CA 19-9 in all stages of carcinoma of the stomach and colon/rectum. During treatments of gastrointestinal carcinomas, CEA and CA 19-9 were determined at the same time in 66 and 165 patients with surgically treated carcinoma of the stomach and colorectal carcinoma, respectively. It was noted that CEA is more sensitive than CA 19-9 in detecting recurrence. However, CA 19-9 is more specific. The best results were obtained when both markers were used together.

Adult↗
PubMed1987

[Esophagojejunostomy--how safe is manual suture today?].

Between 1982 and 1986 a total of 137 patients were gastrectomized for cancer of the stomach. The esophago-jejunal anastomosis was always carried out as an end-to-side anastomosis applying the conventional two layer technique. Only in 1 patient (0.7%) an insufficiency of this anastomosis was observed; 9 reoperations (6.6%) were necessary and 3 patients (2.2%) died in the postoperative course. These results confirm that with a precise, standardised conventional suture technique the esophageal anastomosis can be safely performed today.

Adult↗
PubMed1986

[Long-term management of tracheoesophageal fistula--successful control by esophageal segmentation and stomach pull-up].

Following amniotic embolism a severe ARDS developed in a 21 year-old women. After two months of respirator therapy a giant tracheoesophageal fistula arose. Successful conservative treatment allowed recovery and weaning from the respirator. Our two step surgical management consisted of esophageal diversion and reconstruction of the intestinal passage by retrosternal gastric tube. The advantages and disadvantages of esophageal diversion in giant tracheoesophageal fistulas are discussed.

Adult↗
PubMed1985

Total gastrectomy. A 15-year experience with particular reference to the patient over 70 years of age.

Between 1969 and 1984, a total of 186 patients underwent total gastrectomy. Seventy-four patients were more than 70 years of age. Surgical mortality was 13.4%, with only minor differences between those patients younger than 70 years and older patients--12.5% and 14.8%, respectively. Moreover, there was no major difference if surgery was curative or merely palliative. Of 27 patients with tumors at TNM stage IV, only one died. Of the 100 patients who were operated on during the five-year period between 1979 and 1984, only four died, for an operative mortality of 4%. These results suggest that this remarkable decline of mortality is due to a precise standardization of surgical technique and improvements in preoperative patient management and aftercare. The five-year survival was 15.9%; again, there was no major difference between the group of patients older than 70 years and those younger than 70 years (19.4% and 14.5%, respectively). The ten-year survival was 4.9%.

Age Factors↗
PubMed1985

[Recurrence following ulcer operation: aggressive ulcer disease or inadequate therapy?].

Re-ulceration after surgery occurs in 2.2% following resecting procedures, in 12% following vagotomy. 10 to 30% of the re-ulcerations are unresponsive to H2-blocking agents. 70% of all patients develop re-ulceration as medical prophylaxis after re-ulceration is discontinued. The most common reasons for re-ulceration after surgery are incomplete vagotomy after inadequate organ preserving operations and too great remnant after resecting techniques.

Antacids↗
PubMed1985

[Operative therapy of small intestine ileus with special reference to patients with advanced tumor disease].

Between 1979 and 1984 a total of 233 patients underwent surgical treatment of small bowel obstruction. In 43 patients (18.4%) the obstruction was caused by an advanced tumor disease (peritoneal carcinosis, local recurrence). In patients with benign obstruction the operative mortality was 5.2%; in the tumor patients it was 14%. Wound infection and cardio-pulmonary disturbances were the most frequent complications. The mean survival time of the tumor patients was 159 days. In 65% of these patients the operation had a significant palliative effect.

Gastrointestinal Neoplasms↗
PubMed1977

[Pulmonary contusion after blunt chest trauma--an experimental model (author's transl)].

A model in the rat for pulmonary contusion after blunt chest trauma is described. It is possible to avoid trauma of the mediastinal organs, liver and spleen; therefore it is possible to produce pulmonary contusion with a good reproducebility. The parameter for the extent of contusion was the lungweight which rose statistically with a specific force of trauma. Simultaneous injection of high doses of prednisolone with the blunt chest trauma inhibits the increase of the lung weight.

Animals↗
PubMed1976

Insulin response and portal-peripheral insulin difference during the oral glucose tolerance test in patients after abdominal operations.

Following abdominal surgery, insulin and glucose concentrations in the portal vein, and a peripheral vein are compared in patients during control periods and after oral administration of glucose. During the control period, the glucose concentrations are identical in both veins. After glucose loads with the prompt increase of portal glucose concentration the portal-peripheral difference also increases (p less than 0.01). During the control period the insulin concentration in the portal vein is double as compared to peripheral blood (p less than 0.005). After glucose load the increasing portal insulin as well as the peripheral and portal glucose correlate with the portal-peripheral insulin difference (p less than 0.001). Furthermore, there is a significant positive correlation between the peripheral glucose area as a parameter of glucose tolerance and the portal insulin area as a semiquantitative parameter of insulin secretory capacity (p less than 0.001). It can be concluded that in the early postoperative period in patients with a diminished oral glucose tolerance (large glucose areas) there is an even greater insulin response in comparison to patients with normal oral glucose tolerance. On the other hand, however, in those patients with diminished glucose tolerance, the insulin response is essentially delayed.

Abdomen↗
PubMed1975

[Glucose-assimilation and dynamics of insulin secretion. Measurements after intra-abdominal operations (author's transl)].

Insulin concentrations in peripheral venous blood and portal venous blood were measured in 18 patients after intraabdominal operations during 20 standardised glucose-infusion-tests (GIT). The conclusion is as follows: 1. In spite of similar preoperative situations and operative traumatisation the islets reactivity to a constant hyperglycemia and the glucose assimilation is individually ver different. 2. Measurements of insulin concentrations in the portal venous blood in man show a significant correlation between the profile of the insulin concentration curve and the k-value; the measurement of the insulin concentrations in peripheral venous blood fails to demonstrate a significant difference. 3. In patients with a pathologic glucose assimilation it is not the insulin secretion that is delayed but the insulin regression (disappearance rate) in portal venous blood. 4. In patients with a normal glucose assimilation the insulin concentrations curve in portal venous blood shows an oscillating course during the first 30 min. These oscillations registered for the first time in humans indicate an insulin-induced feedback mechanism of insulin secretion.

Abdomen↗