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Biomedical subjects

R Winkler

Publications and source records attributed to R Winkler.

At least 199 records · Page 11Linked to original sources
PubMed1978

[Height of rectum amputation. Management, complications, disease significance].

Management of the pelvic space after rectal excision is still problematic. Two methods have to be preferred: (1) closed suction lavage drainage and (2) open wound plugging; then the pelvic floor best remains unsutured. Plugging is always indicated in difficult pelveoperitoneal suture, unsatisfactory hemostasis and fecal contamination of the pelvic space. Retardation of wound healing is compensated for by more comfort for the patient and elimination of late complications, compared with those with partially closed or secondary opened wounds. The sacroperineal scar is the origin of a lot of complaints and morbidity. The most important are: infectious complications and persistent fistula (17.3%), pseudosinus perinealis (10%), perineal hernia and genital prolapses (16%), urologic complications (recidivating infections [26.9%], changes of the position of the urinary bladder [56%], secondary retroperitoneal fibrosis with urinary restriction [19.2%] or hydronephrosis [3.8%], disturbances of bladder emptying [36.5%], frequently combined with neurogenic lesions because of intraoperatively dissected autonomous pelvic nerves), local recurrence of carcinoma (17.3% in reexamination, but still much more important), and pain, often of unknown origin (34%).

Drainage↗
PubMed1977

[Significance of liver volume for the early survival of patients with liver cirrhosis operated on porta-caval anastomosis: Clinical data and relation to pathophysiological implications (author's transl)].

It is thought that the early outcome of patients with liver cirrhosis after end-to-side porta-caval anastomosis not only depends on their clinical situation but also on the postoperative haemodynamic state of the liver. The postoperative haemodynamics can be estimated if the relation of liver volume and the predicted hepatic arterial perfusion is focused. The maximum of arterial liver perfusion seems to be 1200 ml/min in the absence of a portal liver blood supply. Thus, a postoperative perfusionindex between 0.8-1.2 like in normal subjects seems to be the best situation to prevent postoperative hepatic underperfusion. 25 patients were investigated, in which the clinical situation was classified as recommended by Child, and liver volume was estimated by means of ultrasonography. Those patients having liver volumes between 1000 and 1500 ml providing a postoperative PI between 0.8-12 survived in 100%. The early mortality rate of those, having liver volumes more or less these thresholds died in 69%. It was concluded that hepatomegaly or extreme liver atrophy are situations not to be recommended for classical porta-caval anastomosis. Other procedures are dissussed which "seem to be some good news" by clinical data and by means of experimental results. The techniques discussed consist in procedures preventing the pancreatic venous blood to shunt away from the liver.

Adult↗
PubMed1977

[Incurable colorectal cancer. Possibilities and limits of differentiated therapy (author's transl)].

The different palliative procedures in incurable colorectal cancer are critically reviewed. In regard to the progress in operative and non-operative management the aims and possibilities have to be newly defined. The alternative, colostomy or enteroanastomosis, is unable to satisfy higher demands. This also means a tendency to aggressive resection therapy in colonic and proximal rectal carcinoma as well as combined local surgical and radiological treatment in distal rectal cancer. In emergency cases the minimal intervention necessary has to be planned in preparation for a more radical effort later on. The role of chemotherapy in colorectal cancer is still not precisely defined. In complications where surgical or radiological palliation is hopeless, the limited success of a combined therapy with 5-fluorouracil and MeCCNU seems justified.

Antineoplastic Agents↗
PubMed1977

[Two-stage surgical treatment of acute complicated ulcerative colitis: indications, observations and results (author's transl)].

Among 195 patients with ulcerative colitis 30 had acute complications--toxic megacolon with or without perforations. In 16 primary treatment consisted of proctocolectomy in one stage: all patients died. Since 1971, 14 were treated by primary multiple enterostomies, with only three deaths. Indications for the latter procedure are given if after 48-72 hours of conservative treatment there is no response. Definitive treatment consists, almost without exception, of secondary proctocolectomy during the period of remission. Indications for the two-stage procedure should be extended to all acute cases requiring operation.

Adult↗
PubMed1977

[Carcinoma of colostomies. Investigation on Wistar rats and clinical observations (author's transl)].

48 surviving male Wistar rats, which achieved a double loop colostomy at the descending colon, developed spontaneous adeno-cardinomas at the proximal orifice of the stoma within 120-200 days. To differentiate the importance of fecal passage and eversion of the colon, the descending colon was separated from the fecal stream by a colostomy at the ascending colon, splitted longitudinally and inserted in the abdominal wall. Adeno-carcinoma arose in both positions, mainly within 120 days. Colonic mucosa, thus exposed, predominates to maligne transformation. The preferred development of cancer at colostomies, as seen systemically induced colonic cancer, is therefore explained to be of syncarcinogenic type. Similar lesions were found at human colostomies. The rareness of original carcinoma at human colostomies is caused by a more-years time of induction in relation to the high average age of patients getting a colostomy. In fact we regard this type of cancer as a biological phenomena comparable to the cancer of the gastric stump.

Adenocarcinoma↗
PubMed1977

[Billroth I operation for peptic ulcer (author's transl)].

The indications and early results of 605 Billroth I operations for peptic ulcer are reported. Of the 605, 302 were simple resections, and 303 combined operations with selective gastric vagotomy. There were no differences concerning postoperative complications among the two groups. No disturbances were encountered in 80%. The overall mortality rate was 4.2% caused mainly by an incidence of 14.6% in complicated ulcer cases. The greatest difference for lethal, as well as nonlethal, complications was found between emergency surgery for bleeding ulcer and elective operations for uncomplicated cases. In general, the early results of the Billroth I resection were equal to the Billroth II type. Because of better functional late results, the Billroth I operation is preferred.

Gastrectomy↗
PubMed1977

[Secondary retroperitoneal fibrosis of scars following rectum exstirpation].

Ureteral abnormalities following excision of the rectum are similar to those found in retroperitoneal fibrosis. Their frequency is surprisingly high (45 out of 53 patients under close supervision approximately equal to 85%). Medial deviation of the lumbar ureter was regularly encountered on one or both sides (most pronounced at L5). Narrowing of the lumen occurred in 31 patients combined with impaired urinary excretion in 12 cases, among these hydronephorosis in 2 cases. As reason for this secondary retroperitoneal fibrosis the retarded healing of the sacral cavity has mainly to be considered. Furthermore, the surgical trauma itself seems to be of importance in this regard. Following surgery for cancer differential diagnosis of ureteral abnormalities should include malignant retroperitoneal infiltration.

Cicatrix↗
PubMed1977

[Coecal complications in distal colonic obstruction (author's transl)].

Construction and function of the colon leads to dysfunction of the coecal region as a result of obstruction of the distal part of the colon. Painful coecal distension, ischaemic inflammatory bowel-wall disturbancy, perforation, or secondary appendicitis are the most frequent complications. Because of these complications, the real origin of the illness is often micjudged. In diagnosing appendicitis in the aged patient, distal colonic stenosis should be considered and, if possible, excluded. 6 cases of coecal complications (6,3%) in 96 patients with distal colonic cancer were observed.

Age Factors↗
PubMed1976

[Nitrosamin induced neoplasms of the colon and rectum. Investigations on the morphogenesis in rats (author's transl)].

The morphogenesis of neoplasms (carcinomas and pracecancerous polypoid lesions) induced by N-methyl-N-nitroso-N'-nitroguanidine (MNNG) was studied on 154 male Wistar rats (including controls), from which a group received a colostomy. Operated and non-operated rats were treated by intrarectal instillations of 2 mg per kg body weight MNNG twice a week during a period of 210 days.

Animals↗
PubMed1976

[Preternatural anus and its care (author's transl)].

The most careful surgical technique, the guiding principles of which are outlined, is a prerequisite for the subsequent possibilities for correct care of preternatural anus and for preventing otherwise unavoidable complications. Four different programs are available to us for care; truss pad, adhesive bag, irrigation therapy and the Erlanger magnetic closure. For prophylaxis of frequent hernias and prolapses, wearing a made-to-measure body binder is indispensable. Skin lesions, formerly feared concomitant symptoms, can now be prevented or eliminated as a result of the development of non-irritant adhesives, combinations with sterculia rings or adhesive plasters and differentiated skin care products. A more comprehensive organization of those with preternatural anus within the framework of the German Ilco and the establishment of preternatural anus clinics and therapists would be desirable.

Aftercare↗
PubMed1976

[Iodine effects in body tissues - a survey and biophysical approach to interpretation (author's transl)].

An attempt was made to interpret the therapeutic and biological effects of iodine on the basis of currently available biophysical information. The easily facilitated electron transfer from and to the external shell of the iodine atom is considered to account, first of all, for good tissue compatibility of molecular iodine as an oxidizing antiseptic, secondly, for the role of iodine as a biocatalyzer of oxidation and reduction processes, thirdly, for the role of iodine as an agent lowering the electric resistance of membranes and, finally, for a possible intracellular release of iodine from iodine-containing hormones and amino acids, thereby affecting enzyme activities. A low electrostatic charge density of iodide and, hence, a small ionic hydration shell imply two biologically significant facts: an intensified ionic mobility and a breaking of the immediate water structure (chaotropy). These physical phenomena are thought to be well suited to explain the strong binding capacity of iodide to proteins, the loosening of electrostatic and hydrophobic bonds within the tissues and an overall increase in protein solubility.

Binding Sites↗
PubMed1976

[Ulcerative colitis and pregnancy. Surgical treatment of acute complications (author's transl)].

Ulcerative colitis occurs chiefly in women in the reproductive age group. The disease tends to exacerbate in affected patients with florid colitis at time of conception. Toxic complications and severe haemorrhage are indications for surgical intervention at the earliest possible time. Treatment of choice consists of multiple enterostomies. Two female patients could be saved with this method. Proctocolectomies were always unsuccessful.

Adult↗