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T Junginger

Publications and source records attributed to T Junginger.

At least 145 records · Page 8Linked to original sources
PubMed1997

Risk factors for diagnostic delay in achalasia.

This study investigates whether the frequently delayed diagnosis of achalasia is attributable to atypical symptoms, misleading diagnostic features, or the number of physicians consulted. Eighty-seven consecutive patients with newly diagnosed achalasia were prospectively investigated with the use of structured interviews as well as manometric, endoscopic, and radiographic studies. The mean duration of symptoms was 4.7 +/- 6.4 years. Quality and intensity of symptoms had no effect on early diagnosis. Among different radiographic and manometric features, only the width of the gastric cardia showed a significant correlation with a delay in diagnosis (P < 0.01). However, the most significant association was found between the duration of symptoms prior to considering the diagnosis of achalasia and the number of unsuccessful physician consultations (P = 0.001). We conclude that the frequent delay in the diagnosis of achalasia is not due to an atypical clinical presentation of this disease but rather to misinterpretation of typical findings by the physician consulted.

Adolescent↗
PubMed1997

[Standards and controversies in preoperative bowel preparation].

Bowel preparation for colorectal surgery should lead to sufficient bowel cleansing and reduction of fecal bacterial levels. It should be well tolerable for the patient and side effects should be rare. Finally the costs should be low. Today there are mainly three methods of significance: whole gut lavage, oral bowel preparation with Golytely-solutions and Prepacol (combination of bisacodyl tablets and sodium sulphate solution). We completed a prospective cohort study including 100 patients undergoing colorectal surgery in our hospital, comparing whole gut lavage with Fordtran, a new oral polyethylene glycol solution. In patients prepared with whole gut lavage the serum chloride levels and the body weight increased significantly more, the frequency of vomiting and subjective irritation was higher. There were no differences concerning the bowel cleansing effect and frequency of postoperative complications in both groups. The costs for oral polyethylene glycol solution are considerably lower. Our results match well with the published experiences of other authors. After bowel preparation with Prepacol a higher frequency of postoperative complications is reported. Due to better patient acceptance, lower side effects and lower costs, oral polyethylene glycol solutions are recommended as preoperative bowel preparation.

Cathartics↗
PubMed1997

[A method for systematic internal quality assurance in surgery].

Between April 1993 and December 1996, the data of 3183 patients were recorded and analyzed in a program for internal quality assurance at the Department of General and Abdominal Surgery of the University of Mainz. The measuring of perioperative risk, the finding of intraoperative influences and the objective rating of quality of treatment were achieved by means of eight different operation-specific documentation sheets and the data records of the operation theater. With our system it is possible to measure differences between several surgeons and also differences in comparison to national and international results. By means of prospective collection of patient data and the built-in control mechanisms we obtain a lot of exact and nearly complete data. The information gained not only reflects the performance of a department, but can also be used as an instrument for the planning of work and deduction. Through optimized therapy the program can lead to an improvement of quality.

Abdomen↗
PubMed1997

[Long-term outcome after reconstructive interventions of the aorto-iliac segment].

From September 1985 to February 1994, 183 patients (arterial occlusive disease n = 108, abdominal aneurysm n = 75) underwent reconstruction of the abdominal aorta. In 120 patients an aorto-bi-iliac or aorto-bi-femoral reconstruction was performed and in 63 patients a tube-type reconstruction. The early and late postoperative complications are described. The complications were dependent on the choice of graft, the distal anastomosis and the preoperative risk factors. The mortality from elective repairs was compared with the mortality in emergency repairs. The role of endovascular reconstructive surgery in comparison to conventional reconstructive procedures is discussed.

Aged↗
PubMed1997

[Surgical therapy of differentiated thyroid gland carcinoma].

Surgical excision is the treatment of choice for differentiated thyroid carcinoma. Because no prospective randomized clinical trials are available, decisions regarding the extent of surgical resection and the mode of lymph node dissection must be made on the basis of imperfect retrospective data. Recommendations for surgical strategy in differentiated thyroid cancer are discussed.

Adenocarcinoma, Follicular↗
PubMed1997

[Temporary colostomies after sigmoid colon and rectum interventions--are they still justified?].

Primary anastomosis is increasingly favored even in emergency colorectal surgery. Two-stage procedures are frequently considered obsolete. The aim of this study is to define conditions when a two-staged operative strategy with a temporary colostomy is still appropriate. We analyzed a series of 126 patients who were treated by a colostomy following resection and subsequent closure of the colostomy. In 44 cases the primary operation was a Hartmann resection, in 39 cases a resection with colostomy and mucous fistula and in 43 cases a resection with primary anastomosis and proximal loop colostomy. Complications of diverticular or neoplastic disease were generally managed by resection without primary anastomosis. Protective loop colostomy was done after low anterior resection of the rectum or in cases of anastomotic leakage. Patients were hospitalized again after an average of 6 months for closure of the colostomy. Restoration of intestinal continuity carried no significant risk of severe intra- or post-operative complications. Disturbances of wound healing occurred in 4.5% (Hartmann resection), 17.9% (colostomy and mucous fistula) and 20.9% (loop colostomy) of patients. We found an anastomotic dehiscence rate of 2.4% after discontinuity resections and of 4.7% after closure of loop colostomies. Only one patient with anastomotic leakage required surgical reintervention. The mortality after closure of a colostomy was zero. The rate of anastomotic leakage of 2.4% was lower than in published series with more than 7.2% after primary anastomosis, thus emphasizing the beneficial effect of a two-stage operative strategy. In emergency situations of sigmoidal and rectal surgery or in cases of low anastomosis of the distal rectum, unnecessary surgical complications can be avoided by resection without primary anastomosis or by performing protective loop colostomies.

Aged↗
PubMed1997

[Endoscopic therapy of incidentaloma].

Since 1992 endoscopic surgical techniques have gained importance in adrenal gland surgery. In this review the actual laparoscopic and retroperitoneoscopic techniques and results-taking the own case material into consideration-are represented. The laparoscopic, transperitoneal adrenalectomy shows a low rate of complications (12%). Disadvantages of the transperitoncal approach are the risk of an intraabdominal injury and the problems caused by adhesions after abdominal operations. The retroperitoneoscopic access to the adrenal gland avoids disadvantages of the transperitoneal approach. Concerning the rising frequency of accidentally diagnosed tumors of the adrenal gland the retroperitoneoscopic approach represents a technique which allows a removal of these tumors up to a size 6 centimeters with low morbidity. In case of large tumors of the adrenal gland (size > 6 centimeters) suspected for malignancy we see the indication for the transperitoneal approach.

Adrenal Gland Neoplasms↗
PubMed1997

[Surgical management of dysfunctions of dialysis fistulas].

Due to the superficial position of shunt vessels we do not use complicated equipment or diagnostic procedures in the morphological assessment of shunt insufficiency or shunt occlusion. Preoperatively, we merely conduct a clinical examination including inspection, pulse, palpation of the shunt veins and arteries with and without venous congestion, and shunt auscultation. Subsequently, we reoperate the shunt under local anesthesia, at which time the anastomosis is usually checked and repositioned. From January 1995 to May 1996, 539 shunt operations were performed in 371 patients, whereby 263 of these were reoperations. The reoperations were performed due to shunt occlusion (n = 144), shunt stenoses (n = 60), shunt aneurysms (n = 17), steal syndrome (n = 3), and rare complications such as hematoma, shunt infection, seroma, and other disturbances (n = 6) (32 patients were treated in other clinics after reoperation or the functional disturbance of the shunt was not recorded). Angiography was only conducted if the clinical examination did not provide enough information about the shunt problems, and so, preoperatively, only six angiographic examinations were conducted (stenosis, n = 3; aneurysm, n = 1; steal syndrome, n = 2). All reoperations, with only few exceptions (PTFE shunt), were conducted under local anesthesia. At reoperation, 184 new proximal shunts were made, 14 thrombectomies conducted, seven PTFE fistulas made, 13 shunts positioned on the opposite side, five shunts ligated, and eight various other operations performed (32 patients were given further treatment elsewhere or no treatment records were available). If during reoperation flow disturbances were suspected (arterial stenosis) or the blood was flowing towards center (proximal venous stenosis) angiography was performed intraoperatively to assess the condition of the vessels. The 4% rate of early occlusion using this procedure was very low. Only 21 patients had to have more than two reoperations. After 2 years 65% of the reoperated AV fistulas were still functional. Without further diagnostic procedures, we performed immediate, outpatient reoperation under local anesthesia, preferably positioning new proximal shunts so that dialysis could be conducted immediately using the existing dialysis shunt. Only if there were particularly complex functional shunt disturbances (steal syndrome, proximal venous flow disturbance, or arterial stenosis) did we employ other diagnostic procedures (angiography, DSA). With this approach the functional shunt disturbances could be eliminated quickly and effectively, which also minimized the cost and stress for the patient.

Adult↗
PubMed1997

[Does the extent of lymph node dissection have an effect on morbidity and prognosis after resection of the head of the pancreas for ductal or periampullary pancreatic carcinoma?].

We examined the influence of lymph node dissection on morbidity and mortality of 13 patients after resection of the head of pancreas due to a ductal or periampullary carcinoma. In both groups the radicality of the operation was the main prognostic factor. In ductal pancreatic carcinoma the R-status was able to be determined better by normalisation of the postoperative Ca 19-9 serum level than by the evaluation of the surgeon or pathologist. For prognosis, the quotient of metastatic lymph nodes to resected lymph nodes indicates that an extensive lymph node dissection may increase the long term survival. A lymph node dissection is therefore to be recommended, especially since it does not increase the rate of postoperative complications.

Adenocarcinoma↗
PubMed1997

[111-indium DTPA octreotide scintigraphy in colorectal liver metastases].

The somatostatin analogue octreotide is effective in the treatment of neuroendocrine and other tumours. 111-In-labelled DTPA-octreotide scintigraphy is successful in localizing primary neuroendocrine tumours and metastases and other tumours containing somatostatin receptors. An antiproliferative effect of octreotide was also demonstrated for colorectal carcinoma. Since only about 40% of colorectal carcinomas express somatostatin receptors, we tried to establish whether 111-In-labelled DTPA-octreotide scintigraphy is able to reveal the receptor status of liver metastases in patients with colorectal liver metastases. This would be useful in selecting patients for adjuvant therapy studies with octreotide. We performed 111-In-labelled DTPA-octreotide scintigraphy in ten patients with nonresectable liver metasoffes of colorectal origin and curatively resected primary. In nine of ten patients the liver metastases were somatostatin receptor negative, in one patient somatostatin receptor positive. In the patient with somatostatin receptor-positive liver metastases after resection of a rectal carcinoma, the histological examination of the biopsies from the liver metastases showed a solid tumour of neuroendocrinal differentiation. In the repeated histological examination of the specimen of the rectal primary, a small solid tumour with neuroendocrinal differentiation was found between formations of adenocarcinoma (adenoendocrine carcinoma). In our study 111-In-labelled DTPA-octreotide scintigraphy did not indicate the receptor status of liver metastases from colorectal carcinoma and was not useful in the planning of therapeutic regimens. For the diagnosis of the receptor status of colorectal liver metastases autoradiographic investigation on tissue biopsies are still necessary. In patients with adenoendocrine carcinomas 111-In-labelled DTPA-octreotide scintigraphy may help to histologically differentiate the metastases.

Adenocarcinoma↗
PubMed1997

[Guidelines in therapy of esophageal carcinoma].

Tumor stage and tumor localization (suprabifurcal and infrabifurcal) are the two decisive criteria referred to in the surgical treatment of esophageal cancer. Complete tumor resection (R0 resection) is a prerequisite for curative efforts. The thoracic squamous cell tumors are adequately treated by an abdominothoracic resection with abdominal and mediastinal lymph node dissection. The transmediastinal approach does not meet the requirements of an oncological resection and is only indicated under special conditions. In contrast the distal adenocarcinomas (Barrett carcinoma) can be curatively resected by both surgical approaches, the transthoracic and the transmediastinal. Presently, an adjuvant therapy after R0 resection of esophageal cancer is not indicated outside of clinical studies. Neoadjuvant methods in case of a local advanced tumor are currently being clinically tested.

Adenocarcinoma↗
PubMed1997

[Evaluation and internal quality assurance in general and abdominal surgery].

The measuring of perioperative risk, the finding of intraoperative influences and the objective rating of quality of treatment were achieved by our program of quality assurance. With our system it is possible to measure differences between several surgeons and also differences in comparison to national and international results. Through optimised therapy the program can lead to an improvement of quality.

Data Collection↗
PubMed1996

Selective approach to the treatment of oesophageal cancer.

Between September 1985 and December 1994, 322 patients with oesophageal cancer were treated. Of the 190 patients who underwent operation, 173 had an oesophageal resection; in 124 this was performed as an abdominothoracic resection and in 49 by the transhiatal approach. The assessment of radicality after histological examination revealed a curative (R0) resection in 121 patients (70 per cent) and a palliative (R1-R2) resection in 52 (30 per cent). Prognosis was correlated with the extent of mediastinal lymph node dissection. In 77 patients with stage pT1-3 pN0-1 pM0 the 5-year survival rate was 40 per cent after abdominothoracic resection with two-field lymph node dissection and zero after transhiatal resection (P = 0.01). The authors propose a differentiated surgical approach involving abdominothoracic resection with two-field lymph node dissection for patients with limited tumours (pT1-3 pN0-1 M0) if the operative risk is tolerable. Transhiatal resection appears to be effective only in patients with early tumours (Union Internacional Contra la Cancrum stage 0).

Adenocarcinoma↗
PubMed1996

Results of endoscopic retroperitoneal adrenalectomy.

BACKGROUND: From March 1994 to August 1995 we performed extraperitoneal endoscopic adrenalectomy in 18 patients with adrenal gland tumors. METHODS: Two of these patients underwent bilateral adrenalectomy. For the extraperitoneal approach a pneumoretroperitoneum was established and three 10-mm trocars were inserted in the area of the conventional flank incision. Adrenalectomy was performed via these ports. Endoscopic retroperitoneal adrenalectomy was successful in 15 patients; three patients required a conventional operation via an extraperitoneal lumbar approach because of inadequate exposure of the adrenal gland. In patients with endoscopic retroperitoneal adrenalectomy median operative time amounted to 180 min (95-330). RESULTS: No postoperative complications were observed; median postoperative hospital stay was 5 days (3-12). CONCLUSIONS: The described approach produces rapid recovery and creates less postoperative pain.

Adrenal Gland Neoplasms↗
PubMed1996

[Resection of liver metastases of colorectal tumors. A uni- and multivariate analysis of prognostic factors].

Between September 1985 and December 1994, liver resections with curative intent were performed for liver metastases of colorectal primaries in 76 patients at the department for abdominal surgery of the university of Mainz. Perioperative morbidity and 30-day mortality rates were 30.3% and 6.6% respectively. The 3- and 5-year survival rate was 53% and 36% respectively. For patients with complete tumor removal (R0 resection), excluding perioperative mortality, the following factors were associated with more prolonged survival after hepatic resection in univariate analysis. N1 stage of the colorectal primary compared to N2 stage (in patients with positive mesenterial lymph nodes); diameter of the largest metastasis between 2.1 and 3.5 cm; postoperative normalized CEA level (in patients with CEA level elevated to more than 4 ng/dl preoperatively); and wedge resections compared to hemihepatectomies. Regarding disease-free survival, only N1 stage of the colorectal primary compared to N2 stage and diameter of the largest metastasis between 2.1 and 3.5 cm had a positive influence. In multivariate analysis, the diameter of the largest metastasis was the only factor associated with survival time, while disease-free survival was influenced by the largest diameter of the metastasis, patient sex and N stage of the colorectal primary. Whether adjuvant therapies (systemic or regional chemotherapy) after curative resection of colorectal liver metastases is associated with better survival times remains an open question. Some of the above-mentioned prognostic factors may be helpful in selecting patients for entry into adjuvant therapy protocols.

Adult↗