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Biomedical subjects

T Schoeller

Publications and source records attributed to T Schoeller.

At least 73 records · Page 4Linked to original sources
PubMed1997

Definite surgical treatment of complicated recurrent pilonidal disease with a modified fasciocutaneous V-Y advancement flap.

BACKGROUND: Different methods for managing pilonidal disease have been described in the literature. Recurrence impairs the success of all forms of therapy, but the lowest rates have been reported for reconstructions involving local flaps. Nevertheless, treatment of pilonidal disease with a fasciocutaneous V-Y flap is not a well-established procedure. We have modified the surgical technique and used it selectively for complicated recurrent cases. Our experience with this method is analyzed, and its validity is evaluated. METHODS: Twenty-four patients with recurrent pilonidal sinus undergoing radical excision and reconstruction with our modified fasciocutaneous V-Y advancement flap between 1986 and 1993 were studied retrospectively. RESULTS: Except for two minor transient wound dehiscences, in all cases primary healing was achieved. Furthermore, an excellent functional result and acceptable scar pattern were obtained in all twenty-four patients, with a mean follow-up of 4.5 years. Neither evidence of recurrence nor impairment of daily life activity was noted. CONCLUSIONS: Treatment of complicated recurrent pilonidal sinus with the described technique offers a safe but demanding method for definite reconstruction, and we support a more common application.

Adolescent↗
PubMed1997

Opioid availability in Latin America: the Santo Domingo report progress since the Declaration of Florianopolis.

The World Health Organization (WHO) has indicated that opioid analgesics are insufficiently available, particularly in developing countries, due to a variety of reasons, including legislative, educational, and policy issues. In its effort to promote the rational use of medical opioids and the adequate treatment of patients with cancer, WHO has sponsored a meeting of Latin American representatives every 2 years, which includes health professionals and government regulators. During March 24-27, 1996, a group of 86 representatives of cancer pain relief and palliative care programs from nine Latin American countries met in Santo Domingo under the auspices of the WHO Palliative Care Program for Latin America. For the first time since the First Latin American Meeting, government regulators were present to help address the issue of opioid availability from their perspective. During the meeting, issues pertaining to cancer pain, opioid availability, and palliative care were discussed. This report summarizes some of the events and presents a summary of the conclusions of an earlier meeting in 1994, as described in the Declaration of Florianopolis, and presents its follow-up, The Santo Domingo Report, generated following the 1996 meeting.

Analgesics, Opioid↗
PubMed1997

Free-flap monitoring with tissue-oxygen measurement.

Flap monitoring by oxygen measurement with a microcatheter pO2 probe was carried out in 17 free flaps. The probe represents a new development among monitoring methods, allowing the measurement of oxygen pressure in all types of flaps including buried free flaps and vascularized bone grafts. Fourteen flaps survived with no problem. Three flaps with different degrees of problem are reported, and the advantage, and sources of error using this monitoring method are discussed.

Adult↗
PubMed1997

Primary flap closure in complex limb injuries.

Free-tissue transfers enable surgeons to reconstruct or salvage limbs injured or amputated in high-energy traumas which result in extensive damage to soft tissue, bone, tendons, vessels and nerves. Primary free-tissue transfer is performed following debridement, bone fixation, and repair of injured structures within 24 hr after injury. Between 1987 and 1996, 57 patients who had complex extremity traumas were treated with primary free-tissue transfer, or free flaps. Long-term follow-up ranged from 4 months to 9 years (median: 4.5 years). No flap failure or serious wound-healing complication occurred using the protocol. Radical debridement and primary free-flap coverage in extensive extremity injuries can salvage limbs, provide improved functional and aesthetic results, and psychologically benefit patients through lowered morbidity. Other benefits include reduced incidence of free-flap failure, postoperative infection, secondary operative procedures, and invalidity, as well as shorter hospital stays, and lowered medical expenses.

Adult↗
PubMed1996

[Plastic surgery treatment of extensive decubitus ulcers of the pelvic area].

Between 1980 and 1995, 207 patients with 219 extensive pelvic pressure sores underwent reconstructive surgery at our department. Eighty patients operated upon between 1992 and 1995 were followed up. The postoperative complication rate was 22% and the relapse rate 27%. Pre- and postoperative management has been standardized for the purposes of quality control. The value of preoperative management, choice of flap, operative procedure and postoperative care are discussed in this paper.

Adolescent↗
PubMed1996

A simple method of free-flap monitoring using a superficial vein.

A new, simple method for flap monitoring is presented. Dissecting a superficial flap vein, which is closed by an Acland clamp, and opening the clamp shortly thereafter, allows objective, postoperative flap monitoring. The surgical technique, advantages, and possible difficulties of the procedure are discussed.

Humans↗
PubMed1996

Rapid discontinuation of hypnotics in terminal cancer patients: a prospective study.

PURPOSE: To determine the proportion of patients receiving hypnotics upon admission to a palliative care unit, the frequency and intensity of withdrawal symptoms after rapid hypnotic discontinuation, and the effect of discontinuation on insomnia and cognitive failure. PATIENTS AND METHODS: 120 consecutive admitted patients. Rapid hypnotic discontinuation (1-4 days) was attempted. Insomnia (visual analogue 0 = best, 100 = worst for insomnia, restedness during the morning and difficulty falling asleep), cognition (Mini-Mental State Questionnaire), and withdrawal signs were monitored. RESULTS: Upon admission, 92/120 patients (77%) had been receiving hypnotics for a mean of 11 (standard deviation = 8) weeks. 4/92 patients (4%) refused hypnotic discontinuation. Acute mild withdrawal was observed in 2/88 patients (2%). The intensity of insomnia was not significantly different, while cognition significantly improved after hypnotic discontinuation. CONCLUSION: A large proportion of terminal cancer patients receives hypnotic drugs chronically. These drugs are probably not useful for the treatment of their insomnia, and rapid discontinuation can be safely achieved in most patients.

Adult↗
PubMed1996

Emergency free flap cover in complex injuries of the lower extremities.

Nineteen patients with complex injuries of the lower extremities were treated with emergency free flap reconstruction after radical débridement, bone stabilisation, and primary repair of injured structures (nerves, tendons, vessels, and muscles). Two patients sustained complete below knee amputation associated with avulsion of soft tissue and had salvage free flap transfer to preserve length of stump and function of knee joint. Long-term follow up ranged from four months to eight years (median 3.5 years) No flaps failed and there were no serious complications of wound healing. Procedures were associated with minimal morbidity, a reduced number of secondary operations, shorter hospital stay, and good functional results.

Adolescent↗
PubMed1995

Opioid availability in Latin America: the declaration of Florianopolis.

Between March 27 and 29, 1994, a group of representatives of 32 palliative care programs from eight Latin American countries met under the auspices of the World Health Organization (WHO) Palliative Care Program for Latin America in Florianopolis, Brazil. The participants included physicians, nurses, psychologists, volunteers, drug regulators, hospital administrators, and representatives from the pharmaceutical industry. A comprehensive report by David Joranson (University of Wisconsin-Madison) was followed by a general discussion moderated by Jan Stjernsward, Chief of the Cancer Unit, World Health Organization, and by Eduardo Bruera, Coordinator of the WHO Cancer Pain and Palliative Care Program for Latin America. A number of issues related to opioid availability were identified and discussed. This declaration summarizes the main conclusions of the meeting. The attendants would like to encourage the widest possible distribution of this document.

Analgesics, Opioid↗
PubMed1995

A prospective multicenter assessment of the Edmonton staging system for cancer pain.

Two hundred and seventy-seven patients were admitted to this prospective multicenter study in order to assess the accuracy of a staging system for cancer pain. The staging system (SS) was completed by a trained physician during the initial consultation. This system included the assessment of pain mechanism (PM, neuropathic versus nonneuropathic), pain characteristic (PC, continuous versus incidental), previous opioid dose (OD), cognitive function (CF), psychological distress (PD), tolerance (T), past history of alcohol or drugs (A). During day 21, a final assessment of pain control was made. Agreement for staging was observed in 96% of cases for investigators 1 and 2 (kappa 0.76, P < 0.001), and in 84% of cases between investigators 1 and 3 (kappa 0.723, P < 0.001). Of 276 evaluable patients, 86/92 Stage I (good prognosis) patients achieved good PC (93%) versus 102/184 Stage II and III (poor prognosis) patients (55%, P < 0.001). Sensitivity and specificity of the system were found to be 0.93 and 0.46, respectively. Univariate correlation found significant correlation between pain control and all variables except CF. In logistic regression, CF and OD showed no significant correlation. We, therefore, propose a more simple SS of five categories (PM, PC, PD, T, and A) and two stages (good and poor prognosis). We conclude that the SS is highly accurate in predicting patients with good prognosis, but patients with "poor prognosis" can still achieve good pain control in more than 50% of cases.

Aged↗