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Biomedical subjects

W Hohenberger

Publications and source records attributed to W Hohenberger.

At least 217 records · Page 12Linked to original sources
PubMed1997

[Percutaneous laparoscopic gastrostomy].

Percutaneous endoscopic gastrostomy (PEG) has now largely replaced the conventional operative procedure of gastrostomy. However, in patients with endoscopically non-passable pharyngo-oesophageal tumours or facial injuries rendering the stomach inaccessible to endoscopy, this technique has so far been unavailable. In this group of patients it is nevertheless possible to apply minimally invasive percutaneous gastrostomy using laparoscopy (PLG). The employment of a purse-string suture clamp facilitates the performance of the procedure and makes it reliable.

Gastrostomy↗
PubMed1997

Impairment of bone and mineral metabolism after pancreatic transplantation: observations in syngeneic rats.

OBJECTIVE: To find out whether transplantation of the duodenum and pancreas results in osteopathy in immunotolerant recipient rats. DESIGN: Prospective study. SETTING: University hospital, Germany. ANIMALS: 30 male Lewis rats weighing about 315 g. INTERVENTIONS: Laparotomy alone (n = 10, control), or transplantation by one of three techniques: ectopic extraportal (EE, n = 5), ectopic intraportal (EI, n = 7), or orthotopic intraportal (OI, n = 8). MAIN OUTCOME MEASURES: Body weight; changes in mineral and bone metabolism, bone density and ash, and the breaking force of bone. RESULTS: Rats were followed for 133 plus or minus 3 days. Compared with the control group the rats that had undergone transplantation had delayed gain in body weight and the final weight was reduced. Urinary glucose and basal serum glucose and insulin concentrations were unaffected, but that of pancreatic polypeptide was low. In the transplanted groups intestinal absorption of calcium and phosphorus and serum concentrations of calcium and parathyroid hormone were within reference ranges. Serum magnesium (EI and OI) and phosphorus (EI) concentrations, and the urinary calcium (FE) and phosphorus (EI) concentrations, and the urinary hydroxyproline:serum osteocalcin ratio (FE, and EI) were significantly higher than in controls (p < 0.01). CONCLUSIONS: Transplantation failed to disturb glucometabolic functions and intestinal mineral absorption but was associated with an osteopathy which showed itself in high bone resorption and reduced bone phosphorus and magnesium concentrations. The osteopathy developed irrespective of the technique of reconstruction of the digestive tract and so may be caused by division of intestinal nerves or their incomplete regeneration.

Animals↗
PubMed1997

[Laparoscopic operation of a Morgagni hernia].

Morgagni hernias are the least common form of diaphragmatic hernias. Although they are congenital, most of them are not diagnosed until later in life. The indication for surgery is based on the patient's symptoms or on the radiological evidence of incarcerated tissue, and until quite recently involved a laparotomy or thoracotomy. Laparoscopy not only permits the suspected diagnosis to be confirmed--which is otherwise often difficult--but also makes it possible to close the hernia site by suturing. For improved security, the hernia site is augmented by fixing in place a non-absorbable mesh. The operative technique employed is described.

Hernia, Diaphragmatic↗
PubMed1997

[Suture of trocar puncture sites after laparoscopy].

The suturing of port sites measuring at least 10 mm in diameter following laparoscopy can prevent the incarceration of small bowel and/or omentum and scar hernias. This means that all port sites remaining after using trocars of at least 10 mm need to be carefully closed by suturing. In the case of oncological procedures in particular, it is important to ensure that the bite of the suture needle includes the peritoneum, to avoid leaving a fresh peritoneal wound offering favourable conditions for the implantation of tumour cells. The technique described here for port site suturing involves all the layers of the abdominal wall, including the peritoneum, and may thus help to prevent port site metastases.

Abdominal Muscles↗
PubMed1997

[Laparoscopic resection of colorectal malignancy--an oncological risk?].

Oncological risks associated with laparoscopic colorectal surgery in curative intention include inadequate radicality, seeding of tumour cells through unprotected recovery of the surgical specimen, faulty surgical technique, and failure to observe the technical and/or oncological limitations applicable to certain tumour sites. Results of laparoscopic colorectal surgery may be defined by pathohistologic findings (number of removed lymph nodes, count of tumor tears, clearance of margins) and long-term results (port-site metastases, local recurrence rate, number of distnant metastase, 5-year-survival). Current published results and first data from the Multicenter Study Group will be compared with the data of open surgery. Merely a few reports on the number of lymph nodes removed during such operations have been published. First data of the Multicenter Study Group Laparoscopis Colorectal Surgery seem to report comparable data to open surgery. There are no certain data the occurrence rate of portsite metastases as on long-term results, local recurrence rates and the 5-year-survival. So the sense and the quality of laparoscopic colorectal surgery in curative intention can't be judged nowadays. The many potential mistakes and hazards of oncological laparoscopic surgery make it mandatory that such interventions should be done only within the framework of prospective clinical studies covering limited indications.

Colectomy↗
PubMed1997

[Laparoscopic fenestration of non-parasitic liver cysts].

Cysts of the liver may be parasitic or non-parasitic, the non-parasitic cysts being further subdivided into neoplastic, inflammatory, post-traumatic and congenital. Symptomatic congenital solitary cysts represent a good indication for laparoscopic treatment. During the therapeutic procedure, the roof of the cyst is fenestrated or removed such that at least one-third of the circumference of the cyst is removed, which is best done using a harmonic scalpel. In order to prevent a recurrence, it is recommended that a portion of the greater omentum be placed in the floor of the cyst, thus filling the cystic cavity.

Cysts↗
PubMed1997

[Regional cooperation in molecular biology topics].

Research on rare events, such as the occurrence of port-site metastases, can be speeded up by pooling patients from different hospitals. Multidisciplinary approaches, involving surgeons, pathologists and molecular biologists, allow more detailed experimental results to be obtained. Research costs are kept low by using existing infrastructures over a short period of time.

Cost-Benefit Analysis↗
PubMed1997

[Verifying routine preoperative diagnosis between private practice and the surgical university clinic].

In an attempt to shorten the preoperative in-patient period and to avoid unnecessary investigations, a cooperative patient management model was established for a number of surgical operations at the University Department of Surgery, Anaesthesiology and their referring Specialist and General Practitioners. The latter were requested to carry out the previously defined preoperative routine investigations, which allowed for a marked reduction in hospital diagnostics. Ambulatory preoperative patient management and a new admission routine resulted in a 57% decrease of the average preoperative in-patient stay for the observed procedures.

Cost Savings↗
PubMed1997

[Phenotypic analysis in colorectal carcinoma: an international interdisciplinary project].

An European research network grouping surgeons, pathologists, biochemists and molecular biologists is presented. The aim of this network is to define new diagnostic, prognostic and therapeutic markers at protein and RNA levels in colorectal cancer. The methodology is based on specific sample preparation techniques, allowing the isolation of pure epithelial cells, and on differential-display techniques, such as two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) and reverse arbitrarily-primed polymerase chain reaction (RAP-PCR).

Biomarkers, Tumor↗
PubMed1996

Impact of arterialization on hepatic oxygen supply, tissue energy phosphates, and outcome after liver transplantation in the rat.

The importance of arterial reconstruction in experimental orthotopic rat liver transplantation is widely acknowledged in the literature. Non-rearterialization of the graft leads to impaired microcirculation and, in chronic models, to severe hepatobiliary damage, together with bile duct proliferation and fibrosis in such livers. The aim of the current study was to investigate the impact of rearterialization on hepatic oxygen tension (pO2), hepatic tissue content of adenine nucleotides, early graft function, and postoperative outcome. Orthotopic liver transplantation was performed in 27 male inbred rats. Ten rats underwent rearterialization and while 17 did not. A group of sham-operated animals (n = 6) served as controls. After reperfusion, liver grafts without arterial reconstruction showed significantly reduced levels of oxygen tension (mean +/- SD, 3.79 +/- 2.20 vs. 10.03 +/- 2.84 mmHg; P < 0.05) and a clear shift toward lower pO2 values in the pO2 histograms, as compared with arterialized grafts. Without arterialization, the level of liver ATP was 65% of that in sham animals, compared with 84% in arterialized livers. Without arterialization, bile secretion was reduced (0.42 +/- 0.04 vs. 0.71 +/- 0.06 mg/min x g liver; (P < 0.001), and the postoperative course of serum alanine transaminase, bilirubin, and alkaline phosphatase revealed severe hepatobiliary damage. These findings allow us to conclude that graft rearterialization is essential to ensure both an adequate oxygen supply and maintenance of tissue ATP. Arterialization may thus be a necessary part of liver transplantation models in this animal species, and should be considered when designing studies on the biochemical, microcirculatory, and histopathological status of the graft.

Adenine Nucleotides↗
PubMed1996

[Lymph node dissections in malignant melanoma].

Elective lymph node dissection and its potential as a staging procedure, the prognosis of established lymph node metastases and the sentinel lymph node identification procedure are the most important aspects of lymph node dissection in malignant melanoma. It is widely accepted that subgroups of patients benefit from elective lymph node dissection. The question of which parameters identify the relevant patients properly is still under discussion. pT-categories are the most important prognostic factor; however, localisation and type of tumour and the sex of the patients are additional parameters influencing patient selection. Recently, the first studies have identified subgroups of nodal positive patients who would profit from adjuvant chemo-/immunotherapy. Therefore, lymph node dissection as a staging procedure has to be discussed in the future. Identification of the sentinel lymph node is receiving increasing attention because of its potential influence on the reassessment of elective lymph node dissection. However, this method needs further evaluation. If lymph node metastases have occurred, the prognosis of malignant melanoma decreases by 20%-50%, depending on the extent of metastasis in the individual case. The relevant topics and results are discussed on the basis of data of the Surgical Department of the University Hospital of Erlangen-Nuremberg.

Female↗
PubMed1996

[Reconstruction of scar hernias--intraoperative tensiometry for objective determination of procedure of choice].

The reappearance of incisional hernias after reconstruction depends on the size and tension of the hernia. An additional risk factor is the number of operations that have been performed before. There are two decisive factors that influence the rate of recurrence: the operation technique and the tension applied. To reach a functional reconstruction the incisional hernia must be closed and the abdominal wall must be joined together in an anatomical way. The technique used must be able to tolerate the tension which is necessary to close the abdominal wall. Application of arbitrary tension produces a high rate of recurrence, irrespective of the kind of reconstruction used. Through the intraoperative measurement of the tension applied one can match each hernia (according to size, value and tension) to the most suitable technique. Here the inlay/onlay technique tolerates the highest tension, up to 3.5 kp. With this method and a maximum tension of 3.5 kp we achieved a complete functional reconstruction in 65% of cases and our rate of recurrence amounted to 2.3%.

Abdominal Muscles↗
PubMed1996

Laparoscopic intracorporeal anastomosis in the colon using the biofragmentable anastomotic ring--an animal study.

This experimental study examines the usefulness of a totally laparoscopic anastomotic technique in the colon with the aid of the biofragmentable anastomotic Valtrac ring and a newly developed applicator device. Following closed intracorporeal colonic resection with the linear stapler and subsequent re-opening of the proximal and distal bowel ends after placement of a pursestring suture, intracorporeal anastomosis was completed with the Valtrac ring. The technique was tested in 8 pigs. 6 pigs had no intra- or postoperative complications, while 2 pigs developed fatal peritonitis following anastomotic insufficiency in one pig and anastomotic stenosis caused by tilting of the Valtrac ring in the other animal. The results of the study show that handling of the biofragmentable anastomotic ring is facilitated by the use of the new application system. In the uncomplicated case, endoscopy and histology revealed bland healing with little scarring, and no evidence of an anastomotic stenosis.

Anastomosis, Surgical↗
PubMed1996

Is local excision of pT1-ampullary carcinomas justified?

We propose that local excision of carcinomas of the ampulla of Vater is justifiable under the following conditions: when the tumour is limited to the ampulla of Vater as diagnosed by pre-operative endoluminal sonography (uT1) and UICC-staging (pT1); and when it is graded G1 or G2 and there is no lymphatic infiltration and the tumour is completely resected (R0). Under these conditions peri-operative morbidity and mortality were significantly reduced compared with more extensive surgery. There was no local recurrence of tumour in our study and long-term survival rates were comparable with Whipple's procedure. This implies that lymphatic spread is limited in localized disease and the feasibility of the proposed procedure may therefore be analogous to localized resections in other malignant tumours, e.g. carcinoma of the rectum.

Adult↗
PubMed1996

[Optimizing a conventional documentation system on the surgical intensive care unit--a contribution to cost reduction and preventive quality management?].

In Intensive Care Units (I.C.U.), the lack of staff and funds require the mobilisation of organisational reserves in order to ensure high-quality patient care. Traditional occupational-group organised documentation systems are burdened with lack of clarity, limited utilisation by the staff, insufficient information content and difficulties in synoptic patient monitoring. They cannot meet the demands of modern intensive-care medicine. At the inauguration of our Surgical I.C.U. in June 1992, an occupational-group oriented documentation system was introduced and put into operation. Because of negative repercussions on patient care, it was replaced by a patient-centered, conventional prescription and documentation system in April 1993. In April 1994, an evaluation of the patient-centered system was carried out. We report on our initial problem analysis, the subsequent developmental and introductory phases, and the results after having used the system in our I.C.U. for one year. Data condensation, standardised data recording, as well as structured prescription, examination, assessment and decision processes, saved 730 working hours for medical and nursing staff per year, reduced the cost for documentation materials by 58% and improved the extent of data recording. In our experience, improving a conventional documentation system is a suitable instrument to support cost reduction and preventive internal quality management in the I.C.U.

Cost Savings↗