PET with fluorine-18 deoxyglucose for pancreatic disease.
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Deoxyglucose↗
Biomedical subjects
V Schumpelick
Publications and source records attributed to V Schumpelick.
[The ileoanal reservoirs as a rectal replacement. The late complications and long-term functional results].
Late complications and functional results in 44 consecutive patients (17 women, 27 men; mean age 36 years) were collected prospectively after continence-preserving proctocolectomy for ulcerative colitis. In all patients a J-pouch was placed by direct end-to-side machine-stapled anastomosis without rectal cuff. 5 years postoperatively 12 of 13 (92%) were totally continent during the day, 11 of 13 (85%) at night. Stool frequency at that time was 6.3 +/- 2 per 24 hours; 4 patients (31%) had on average one motion during the night. Lasting sexual dysfunction occurred in three men. Fistulae, as a result of previously undiagnosed Crohn's disease, developed postoperatively in three patients: between pouch and vagina in one, between pouch and bladder in another. The pouch had to be removed in both instances. In the third patient an enterocutaneous fistula was closed. If strict indications are followed, the clinical and functional results of a pelvic ileoanal reservoir meet the daily demands of life at both a professional and social level.
Adenomatous Polyposis Coli↗
The radiation dose to surgical personnel during intraoperative radioimmunoscintimetry.
To estimate the radiation exposure to surgical personnel caused by intraoperative radioimmunoscintimetry, we measured dose rates at different distances from patients who had been injected with 950 MBq technetium-99m-labelled intact carcinoembryonic antigen (CEA)-specific antibodies (Szintimun CEA, Behring AG Marburg, FRG) for immunoscintigraphy 24 h earlier. At 0.05 m (corresponding to working positions during surgery) we found 2.0-16.0 microSv h-1 (average 6.4), which is similar to results for nuclear medicine staff. Thus, if radioimmunoscintimetry is to become a routine procedure, according to national regulations in some countries of the European Communities surgical personnel might be regarded as professionally exposed to radiation.
Colorectal Neoplasms↗
[Intestinal motility after laparoscopic vs conventional cholecystectomy. An animal experiment study and clinical observation].
First descriptions of clinical courses after laparoscopic cholecystectomy indicate a shorter period of postoperative ileus in comparison to conventional cholecystectomy. Early postoperative motility was registered in dogs (n = 10) by implanted serosal electrodes. Further on clinical signs of postoperative motility were documented in patients (n = 100) after laparoscopic and conventional cholecystectomy. In animal experiments a significantly reduced period of postoperative ileus (5.5 +/- 1 h) occurred after laparoscopic cholecystectomy in comparison with the conventional technique (46 +/- 5 h). Experimental data correlate well with earlier clinical signs of normal motility after laparoscopic cholecystectomy in patients. The shorter period of postoperative ileus is a further evidence for the minor abdominal trauma of laparoscopic techniques.
Adult↗
[Endoscopic therapy of benign anastomotic stenoses in the area of the colon and rectum by electro-incision and balloon dilatation].
21 patients with a severe anastomotic stenosis in the colorectal region were treated with hydraulic balloon dilatation and endoscopic electro-incision. The severity of symptoms directly correlates with the extent of stenosis (degree I phi 13 mm, n = 12; degree II phi 7 mm, n = 6; degree III phi 4 mm, n = 3). All patients with a stenosis of degree I and II were symptom-free after the endoscopic therapy. In 2 of 3 cases the symptoms of stenosis of degree III could clinically be improved after the treatment. The average frequency of dilatation was 1.5 x, complications such as bleeding or perforation were not registered. Animal studies explain anastomotic stenosis through an increased submucosal formation of collagen fibers followed by formation of scars in the anastomosis. The efficiency of electro-incision and balloon dilatation is based on an increased diameter in the anastomotic region without increased formation of new collagen fibers.
Adult↗
[Ultrasound diagnosis in abdominal trauma--how much experience does the surgeon need to perform ultrasonic diagnosis?].
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Abdominal Injuries↗
[Kirschner subcutaneous spermatic cord tunnel--75 years later].
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Hernia, Inguinal↗
Results of intersphincteric resection of the rectum with direct coloanal anastomosis for rectal carcinoma.
Between 1977 and 1987, 519 patients underwent operation for rectal carcinoma. Sixty-three patients underwent intersphincteric resection with direct coloanal anastomosis (CAA), and 77 had an abdominoperineal resection (APR). Curative surgery was achieved in 57 and 65 patients, respectively. Both groups were comparable regarding age, stage of tumors, and localization of tumors. During the mean period of 6.7 years (range: 3 to 13.6 years), all patients were examined according to a predefined follow-up plan. From those patients with curative surgery, 11% presented with pelvic recurrence and 33% with distant metastases after coloanal anastomosis; the rates of recurrence and distant metastases after APR were 17% and 35%, respectively. The corrected 5-year survival rates were 62% following CAA and 53% following APR. Eighty-five percent of the patients with CAA reported good functional results regarding anal continence. Our study demonstrates that the intersphincteric resection with CAA is a valuable surgical technique for rectal carcinoma with the benefit of preservation of continence. It is suitable for neoplasms with high- and medium-grade differentiation (G1 to G2) and a localization that allows a minimum distal clearence of 3 cm.
Abdominal Muscles↗
[Direct ileum pouch-anal anastomosis in ulcerative colitis. Technique and complications].
Fourty-nine patients (21 female, 28 male) with ulcerative colitis underwent formation of an J-ileal pouch and construction of a direct stapled pouch-anal anastomosis (IPAA) without rectal cuff. 16 patients had previously undergone surgical interventions. Overall after IPAA 7 patients (14%) experienced 11 major complications. Gastrointestinal complications included hemorrhage in 1 patient, pelvic sepsis and ileus in 3 patients, respectively. Pancreatitis and urinary infection occurred in 2 patients, sexual dysfunction in 3 patients. After closure of the ileostomy 3 patients developed late pouch-vaginal or pouch-vesical fistulas, leading to excision of the pouch. During the long-term follow-up small bowel obstruction developed in 3 patients, pouchitis in another 6 patients. After 3 months 84% of our patients were continent during daytime, 67% during nighttime. 24 months postoperatively these data concerning continence increased to 92% and 83%, respectively. We conclude that direct IPAA is a reliable procedure achieving its purpose in 96%.
Adenomatous Polyposis Coli↗
[Spontaneous pneumothorax. Graduated concept of surgical therapy].
The clinical course of 83 patients suffering from spontaneous pneumothorax lead to a modified surgical therapy according to the development of the underlying disease. The indication for non operative therapy, thoracic tube drainage, thoracic endoscopic methods and treatment by thoracotomy are defined and change of treatment from non-invasive procedures described in detail.
Adolescent↗
[Interrupted suture versus adhesive dressing in skin closure of pediatric inguinal hernia--a controlled randomized prospective study].
The skin closure with resorbable interrupted sutures (Dexon 6x0) was compared with adhesive plasters (Leukostrip) in a randomized prospective clinical trial with 100 children with an inguinal hernia. The same operative technique was used in both groups. There were no significant differences referring to the complication rates and the cosmetic results between both groups. Skin closure with adhesive plasters significantly saved operation-time and reduced costs. It can be recommended in cases of infantile inguinal hernias.
Bandages↗
[Results of treatment in esophageal cancer].
204 patients were treated for esophageal cancer from 1.1.1986 until 1.6.1992 (carcinoma of the hypopharynx: n = 12, adenocarcinoma of the endobrachyesophagus: n = 82, primary esophageal cancer: n = 110). Out of the primary esophageal cancers 84 tumors (76%) were resected and 24% had palliative endoscopic and/or irradiation therapy. The stage distribution of the resected patients was: stage I: 7.1%, stage IIa: 35.7%, stage IIb: 11.9%, stage III: 33.3%, stage IV: 11.9%. The total morbidity of the resected patients amounted to 32.1%, the 30 days mortality to 7.1%, and the in hospital mortality to 9%. These data show no significant difference to the results of palliative endoscopic procedures (morbidity: 42.3%, mortality: 7.7%). None of the conservatively treated patients survived longer than 12 months whereas resected individuals had a 5-year-survival rate of 20%. The most predictive factors for prognosis were: Depth of tumor invasion (p less than 0.01), R-classification (p less than 0.05), and the lymphonodular status (p less than 0.05). A perioperative irradiation was effective in T3- and T4-tumors.
Adenocarcinoma↗
[Importance of sonography in diagnosis of ileus. A retrospective study of 459 patients].
In a retrospective trial we investigated the significance of ultrasound in the diagnosis of intestinal obstruction in 459 patients. The overall sensitivity was 93.7%. In paralysis the correct diagnosis was obtained in 98% of all. Mechanical obstruction was identified in 91%. In cases of incomplete mechanical obstruction sensitivity was 89%. The corresponding value for complete obstruction was 95%. In all patients with negative findings on abdominal x-ray (10%) the correct diagnosis was established by ultrasound. Only in 71% of cases ultrasound was successful differentiating small bowel from large bowel obstruction. The underlying cause of ileus was yielded by ultrasound in 45% of the cases. On the basis of our experience ultrasound is proven to be of significant importance in the diagnosis and differentiation of ileus.
Adolescent↗
[Results of surgical therapy of choledocholithiasis--a retrospective study].
A multimodal therapeutic concept of choledocholithiasis with endoscopic and surgical procedures is presented. Between January 1986 and December 1990 106 patients with choledocholithiasis were operated. These patients are retrospectively analyzed. The success rate is 95.3%, the morbidity 18.7% and the mortality 0. These results are compared with the published data of the surgical or endoscopic therapy of the choledocholithiasis.
Adolescent↗
[Inversion of Meckel's diverticulum with consecutive small intestine invagination--a rare cause of ileus].
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Choristoma↗
[Jejunogastric invagination--a rare complication of stomach surgery].
The jejunogastric intussusception is a rare complication of gastric surgery. An acute and a chronic form of intussusception can be distinguished. Three anatomical types of jejunogastric invagination have been classified. Endoscopy is the diagnostic procedure of choice, early operative desinvagination the therapy of choice. The effectiveness of different operative procedures to prevent reinvagination is contested.
Aged↗
[Differential surgical therapy in diffuse peritonitis].
96 patients were operated on for diffuse peritonitis from January 1986 to June 1990. They underwent a differentiated therapeutical concept according to the severity of the underlying peritonitis. Mild forms were handled with the standard approach, while mid-severe cases were treated by continuous postoperative peritoneal lavage. Patients with severe peritonitis were operated on by open abdomen management. Mortality was 32% (31/96) and with that obviously better than the statistically expected mortality, based on the Mannheim-Peritonitis-Score (49%). The same findings could be demonstrated in the therapeutic subgroups. The management of diffuse peritonitis using such a differentiated surgical concept seems to be an effective approach to reduce mortality rates.
Adolescent↗
[Transposition of the gluteus maximus muscle for sphincter replacement in anal incontinence].
The replacement of the external anal sphincter by gluteus muscle in fecal incontinence is described in 4 cases. All patients, three children and one adult, had been operated on previously because of different types of anal atresia and suffered from fecal incontinence grade IV. They all showed a congenital defect of the somatic sphincter. The absent external and sphincter muscle was repaired by transposing innervated and vascularized gluteus muscle. In all cases active anal continence was achieved proven by clinical and electromanometric measures. The results, compared to other techniques, are discussed.
Adult↗