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Biomedical subjects

V Zumtobel

Publications and source records attributed to V Zumtobel.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Postoperative complications in abdominal surgery--what do they cost?].

In this study of 154 patients with major abdominal cancer surgery, 41 postoperative complications occurred and caused additional total costs of DM 205.993,-, DM 5.024,- per case, respectively, where the special personnel costs were not accounted for. There was a significant difference between single and multiple complications as well as for early and late complication costs. Economic analyses are necessary to determine budgets of medical departments with extended and cost-intensive treatment, such as cancer surgery, to maintain optimal care for the patients.

Aged↗
PubMed1996

[Long-term prognosis of the critically ill intensive care patient].

The survival rates of 380 critically ill intensive care patients (> 10 days intensive care, > 3 days mechanical ventilatory support) after gastrointestinal surgery were examined over 1 year following hospital discharge in a retrospective analysis of the years 1984-1994. Of the patients 57% survived intensive care medicine, 54% were discharged from hospital and 44% were still alive 1 year after discharge. Little difference was found between subgroups of gastrointestinal pathology. Of the survivors 28% had psychological problems in the first 6-12 months, 7% showed functional disorders and 3% showed prolonged periods of pain due to intensive therapy.

Adult↗
PubMed1996

[Video laparoscopic transperitoneal exposure of the lumbar spine for ventral fusion].

Video-laparoscopic transperitoneal ventral fusion of the lumbar spine using the Bagby-and-Kuslich (BAK) interbody fusion system combines the advantages of the conventional transperitoneal approach with the well-known advantages of minimally invasive surgery. According to our experience it is a safe procedure with an acceptable operating time, little postoperative pain, fast recovery and a short postoperative stay in hospital. Long term results need to be observed and further studies made.

Equipment Design↗
PubMed1995

Early postoperative enteral nutrition with arginine-omega-3 fatty acids and ribonucleic acid-supplemented diet versus placebo in cancer patients: an immunologic evaluation of Impact.

OBJECTIVE: To evaluate the effect of early postoperative feeding with a nutritionally complete enteral diet supplemented with the nutrients arginine, ribonucleic acid (RNA), and omega-3 fatty acids on the immune function in patients undergoing surgery for upper gastrointestinal (GI) malignancies. DESIGN: Prospective, randomized, placebo-controlled, double-blind study. SETTING: Surgical intensive care unit (ICU) in a German university hospital. PATIENTS: Forty-two consecutive patients receiving an enteral diet via needle catheter jejunostomy after GI surgery for cancer. INTERVENTIONS: Patients were randomized to receive either the arginine, RNA, and omega-3 fatty acids supplemented diet or an isocaloric and isonitrogenous placebo diet. Early enteral nutrition was started on postoperative day 1 in the surgical ICU with 20 mL/hr and progressed to the optimal goal of 80 mL/hr by postoperative day 5. MEASUREMENTS AND MAIN RESULTS: Clinical examination and adverse GI symptoms were recorded on a daily basis. Body weight was determined twice weekly. Immunoglobulin concentrations were determined by laser nephelometry. Interferon-gamma concentrations were measured with a modified enzyme-linked immunosorbent assay method. Fluorescence-activated cell scan flow cytometry was performed to analyze B cells, T lymphocytes and their subsets. Clinical patient characteristics and mean caloric intake were similar between the two groups and both formulas were well tolerated. The number of T lymphocytes and their subsets, helper T cells (CD4) and activated T cells (CD3, HLA-DR), were significantly higher in the supplemented diet group on postoperative days 10 and 16 (p < .05). Mean interferon-gamma concentration after phytohemagglutinin stimulation was higher in the supplemented diet group on postoperative day 16. In the supplemented diet group, mean immunoglobulin M concentrations were significantly higher on postoperative day 10 and mean immunoglobulin G concentrations were higher on postoperative day 16 (p < .05) compared with the results in the placebo group. B-lymphocyte indices were significantly higher in the supplemented vs. the placebo diet group on postoperative days 7 and 10 (p < .05). CONCLUSIONS: Supplementation of enteral diet with arginine, RNA, and omega-3 fatty acids in the early postoperative time period improves postoperative immunologic responses and helps to overcome more rapidly the immunologic depression after surgical trauma.

Aged↗
PubMed1995

Modulation of postoperative immune response by enteral nutrition with a diet enriched with arginine, RNA, and omega-3 fatty acids in patients with upper gastrointestinal cancer.

OBJECTIVE: To find out whether an enteral diet supplemented with arginine, RNA, and omega-3 fatty acids modulated the production of interleukin-1 (IL-1), interleukin-2 (IL-2), IL-2 receptor, interleukin-6 (IL-6), and tumour necrosis factor alpha (TNF-alpha) after operations for upper gastrointestinal cancer. DESIGN: Prospective double blind clinical study. SETTING: University hospital, Germany. SUBJECTS: 42 patients randomised into two groups (n = 21 each), one of which was given an isocaloric and isonitrogenous placebo diet and one of which was fed the same diet supplemented with arginine, RNA, and omega-3 fatty acids. INTERVENTIONS: The cytokines were measured before operation and on postoperative days 1, 3, 7, 10, and 16. MAIN OUTCOME MEASURES: Comparison of concentrations of cytokines in the two groups. RESULTS: Among those receiving the placebo diet (after spontaneous stimulation) IL-6 concentrations were significantly higher on days 3 and 7 (p < 0.05) and TNF-alpha concentrations on day 7. In contrast (after stimulation with phytohaemagglutinin) mean concentrations of IL-2 receptor were significantly higher on days 3 and 7, and of IL-1 beta and IL-2 on day 16 (p < 0.05) in the group receiving the supplemented diet. CONCLUSION: Supplementation of an enteral diet with arginine, RNA and omega-3 fatty acids can modulate the acute phase reaction as indicated by the reduction in concentrations of TNF-alpha and IL-6 in the group fed the supplemented diet. Patients receiving the supplemented diet also showed accelerated recovery in the concentrations of IL-1 beta and IL-2 receptor.

Aged↗
PubMed1994

[Subcutaneous struma recurrence as a sequela of autologous thyreocyte implantation].

Goiter recurrence is a well known fact in the surgical therapy of thyroid diseases. Extremely rare the goiter recurrence is localized in the subcutis or the muscle of the neck. We report on two patients with this type of recurrence. The reason may be an autologous implantation of thyroid follicle cells intraoperatively. It can be avoided by removing all particles of the thyroid gland from the operation area.

Aged↗
PubMed1994

[Effect of site and width of stomach tube after esophageal resection on gastric emptying].

The gastric emptying of a mixed solid-liquid meal labeled with 99 mTc was evaluated in 14 healthy volunteers and in 14 subjects after esophageal replacement. The stomach had been placed seven times in the posterior mediastinum and seven times behind the sternum. The rate of emptying was measured by an anterior gamma-camera technique. Furthermore, the width of the esophageal substitutes was determined by CT-scans. The intrathoracic stomach displayed a prolonged emptying rate, independent of its location in the anterior or posterior mediastinum. Interestingly the width of the stomach influenced the discharge of the test-meal, whereby the more narrow the substitute the faster the emptying rate.

Adenocarcinoma↗
PubMed1993

[The temperature dependence of fibrinolysis with streptokinase].

In an in-vitro study standardized test thrombi were incubated at different temperatures between 25 degrees and 43 degrees C in a constant test mixture in which all reagents necessary for fibrinolysis including streptokinase were contained in excess. At each temperature step the dilution of the standard streptokinase solution (1:1000 IU/ml) was measured at which the test thrombus dissolved in exactly 15 min (clot lysis test). The highest fibrinolysis activity (dilution of 1:1140 of the standard) was obtained at 40 degrees C, lower activities having been recorded at both higher and lower temperatures (43 degrees C:1:1000; 37 degrees C:1:900; 34 degrees C:1:550; 30 degrees C:1:255; 25 degrees C:1:90). Related to the optimal temperature of 40 degrees C (100%), the fibrinolytic activity at 25 degrees C was only 7.9%. In view of the axial temperature gradients existing in the limbs, the internal temperature in their peripheral parts lies well below the optimal temperature for fibrinolysis. This situation should be taken into account during fibrinolysis procedures for thrombotic occlusions in the limbs.

Body Temperature↗
PubMed1993

[Surgical treatment of multivisceral intra-abdominal recurrences and metastases].

From 1988 to 1990, 467 patients were operated a total of 850 times for malignant intra-abdominal tumours. Analysis of these 850 operations revealed that 205 were performed for recurrences with or without metastasis and 59 were performed for metastasis. The operations for recurrences were elective in 158 cases and consisted of 86 local radical procedures and 72 non-radical procedures. 47 operations for recurrences were performed as emergency procedures and were non-radical in 45 cases. With 55 of 59 operations for metastasis the majority of these operations was performed electively and locally radical. The majority for metastases were performed electively and were locally radical. The majority of life-threatening emergency situations were controlled (129 of 141 operations, 92%) and two-thirds of these patients left hospital with a satisfactory quality of life (Karnofsky index > 50 in 83 of the 141 operations). Consequently, repeated operations and the combination of surgery with adjuvant therapy can control malignant disease for several years with a satisfactory quality of life.

Biliary Tract Neoplasms↗
PubMed1992

[Regional hyperthermic fibrinolytic perfusion in postoperative deep venous thrombosis of the leg].

Four days after an operation for fusion of lumbar and sacral vertebrae a 30-year-old man developed bilateral deep-vein thrombosis in the legs, extending on the left from the fibular group of veins to the popliteal vein. On the right all deep veins of the lower leg were occluded, including the confluence of the popliteal vein. As systemic fibrinolysis was contraindicated, surgical thrombectomy was undertaken. After incomplete removal of the thrombi, regional hyperthermic perfusion with streptokinase was performed using a heart-lung machine. After a compression bandage had been applied to the right leg above the veins the leg was perfused via the common femoral vein at 40 degrees C from the heart-lung machine, at a flow rate of 600-800 ml/min, for 60 min with a solution containing 1 million IU streptokinase. Measurement of various components in the perfusate indicated marked fibrinolysis (fibrinogen: not measurable; fibrinogen breakdown products: > 80 micrograms; streptokinase: 100 FU/ml after 30 min, 62 FU/ml after 60 min). At the same time there was no demonstrable fibrinolytic activity in the systemic circulation. Fibrinogen concentration fell from 340 mg/dl 30 min before the onset of perfusion to 245 mg/dl 90 min after it. After 60 min of perfusion the blood from the right leg was discarded and the leg flushed through with 1.5 l of an electrolyte solution and then filled up with previously obtained and stored patient's own blood concentrate. Subsequent phlebography and venous occlusion plethysmography demonstrated complete recanalization of the deep-vein system with normal venous valve function.

Adult↗
PubMed1991

[Extremity-threatening ischemia in ergotism. Successful treatment with the intra-arterial administration of nifedipine].

A 39-year-old woman suffering from migraine took two suppositories of an ergotamine-containing proprietary drug (Cafergot, containing 2 mg ergotamine tartrate) for the first time again after an abstinence of two years. Twenty-four hours later she developed symptoms of decreased peripheral blood flow in all four limbs. Walking distance without pain was reduced to 100 m, but the severest changes affected the right arm, with livid discolorations and complete immobility 16 hours after the onset of symptoms. Despite administration of morphine derivatives the pain progressively increased. Angiography demonstrated spastic narrowing of all arm arteries below the axillary artery. No vessels were visualized below the lower-arm bifurcation. Thereupon 4 mg nifedipine were injected through the angio-catheter within 30 min (five individual doses of 0.8 mg each). This was followed by intravenous infusion of 0.5 mg/h. The pain immediately decreased and the livid discoloration as well as impaired arm movement improved. A residual deficit, incomplete lesion of the median nerve, persisted but gradually regressed during the following two months.

Acute Disease↗
PubMed1991

[Revascularization of colonic anastomoses].

The revascularization of colonic anastomosis after colon segmental resection in rabbits in 9 different end-on-end and inverting suture techniques was examined macroscopically, microangiographically, micropreparatorily and histologically. Independently of the suture technique revascularization started 4 days after surgery. 8 days postoperatively the suture line is mainly bridged, 14 days postoperatively the vasal connection to the opposite side is completed. The new vessels mainly originate from the subserosal and submucosal tissue. The adhesions participate in the revascularization, too. It (the revascularization) directly correlates with the development of granulation tissue. This is evident from the excess reactive revascularization of abscesses and ulcers in the anastomoses. There always results a vascular scar in the angioarchitecture of the colonic wall. Start and extent of the revascularization cannot--in contrast to former literature--be looked at as a guarantee of quality for the healing of anastomoses.

Anastomosis, Surgical↗
PubMed1991

[Fasting volume and contractility of the gallbladder after total and subtotal gastrectomy with Y-Roux anastomosis. A prospective study].

Gallbladder volume and contraction after a fatty meal was determined in 14 patients with gastric cancer before and 3-4 months after gastrectomy (7 total and 7 subtotal gastrectomies) with Roux-en-Y anastomosis. All patients had an increased gallbladder resting volume (p less than 0.001) and 10 of 14 patients (6 after total gastrectomy and 4 after subtotal gastrectomy) had an increased minimal residual volume after fatty meal stimulation (p less than 0.01) in the postoperative state, when compared to the preoperative values. It can be concluded that gastrectomy is followed by an impairment of gallbladder tone and contraction, both possibly increasing the risk of gallstone formation.

Adult↗
PubMed1991

[Sonographic versus radiological assessment of chronic outer ligament instability of the upper ankle joint].

Chronic instability of the lateral upper ankle joint ligament is usually diagnosed by clinical and radiological examination. For the evaluation of an ultrasound method of testing lateral instability of the ankle joint we carried out a prospective study. We examined 23 adults who were actively engaged in some form of sport (21 male, 2 female, mean age 32 years) and had a preexisting lateral instability of the ankle. The instability was measured in the standard planes using Scheuba's stress apparatus with simultaneous ultrasound monitoring. The ultrasound examination was performed by positioning the 5-MHz applicator on the lateral side of the Achilles tendon, thus defining a plane from which the instability could be measured in both examination planes by observing the deviation between dorsal inferior edge of the tibia and the dorsal border of the talar roll. For the two examination planes, Spearman's rank-correlation coefficient between the radiological and ultrasound methods was 0.83 and 0.92. The sensitivity of the ultrasound method was 0.90, and the specificity was 0.85. Our study showed a good correlation between the two methods. A pathological talar tilt according to radiological criteria was also revealed by ultrasonography. Thus, all the advantages of ultrasound are now available for the evaluation of chronic lateral instability of the ankle joint.

Adult↗
PubMed1991

[Postoperative small intestinal motility after abdominal surgery].

After abdominal surgery there is a postoperative small bowel ileus. We evaluate whether the duration of the small bowel ileus is depending on the kind of surgery or not. Over a needle catheter jejunostomy a 3-tip transducer was placed into the distal jejunum. At the end of the operations a pressure detector was connected to measure the intraluminal pressure continuously over five days. Group A consisted of three patients undergoing explorative laparotomy because of inoperable gastric cardia cancer, and group B of eight patients who underwent gastrectomy. In none of the patients a normal empty stomach motility pattern, determined by the activity of a migrating myoelectric complex (MMC) was detectable. In group A the normal MMC-activity returned after 24 +/- 4.5 h and in group B after 82 +/- 25 h. Therefore the duration of the loss of the interdigestive myoelectric complex appeared to be dependent upon the type of surgery.

Cardia↗
PubMed1991

[Monitoring of postoperative enteral feeding using the H2 breath test].

A group of 24 patients which underwent extensive abdominal surgery (gastrectomy and esophagus resection) were fed with a chemically defined diet by way of a needle catheter jejunostomy starting on day five postoperatively. On the fourth postoperative day the jejunocaecal transit time was measured by hydrogen breath test with a median of 97.5 min. Under enteral nutrition, hydrogen exhalation showed a significant rise in all patients. The 8 patients who developed diarrhea (33%) had significantly elevated hydrogen exhalation in relationship to the patients with no diarrhea. 6-12 h before diarrhea, patients had a significant increase in their hydrogen exhalation in correlation to the beginning of carbohydrate malabsorption. Therefore, the hydrogen breath test is a simple, non-invasive method to evaluate carbohydrate malabsorption and the risk of developing diarrhea under enteral nutrition.

Abdomen↗