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Biomedical subjects

W Stock

Publications and source records attributed to W Stock.

At least 19 recordsLinked to original sources
PubMed1992

[Postoperative complications of elective resection of the colon in diverticulitis].

Data on 142 patients (57 men, 85 women; mean age 64.2 [37-91] years) who had elective colon resection for diverticulitis were retrospectively analysed with respect to postoperative morbidity and mortality. Associated systemic disease was present in 47.9% of patients; intraabdominal complications were found preoperatively in 55.6%. Resection with primary anastomosis was performed in 97.9% of patients. Local postoperative complications were noted in 14.1%, general complications in 31.7%. Two patients died postoperatively of the consequences of local complications. In both cases diverticulitis had been complicated by fistulas (mortality rate 1.4%). With careful preparation, standardized operative technique and intensive perioperative supervision the risk of elective colon resection for diverticulitis is low. It can thus be undertaken, even after the first severe attack of diverticulitis, in patients without associated disease.

Adult↗
PubMed1992

[Inguinal hernia repair modified by Kirschner. A critical analysis after 11 years of clinical experience].

In a retrospective study the early and late complications and the recurrence rate of inguinal hernia 10 years after elective repair by a modification of Kirschner's procedure are presented and compared with those following other established surgical techniques. Questionnaires were sent to 1400 patients, and 1029 patients (73.5) also underwent clinical examination. With all techniques, the most frequent postoperative complications were haematomas and seromas (10.1%). Postoperative mortality was 0.2%. Late complications were reported by 36.4% of the patients followed up by questionnaire. The most frequently reported symptom (by 23.8%) was transitory hypaesthesia in the scar area. In 2.7% of the male patients examined testicular atrophy was found. All patients who reported a recurrence on their questionnaire underwent follow-up examination in the clinic. Thus, the cumulative recurrence rate was 9.6%. Over two-thirds of all recurrences were lateral recurrences (P < 0.01). It was not possible to determine potential risk factors for a recurrence of inguinal hernia. The recurrence rate increased with time before follow up: among the patients examined after 5 years the recurrence rate was 5.7%, while it was 12.1% for patients examined after a period of 10 years. Kirschner's modification involves a risk of lateral recurrence that should not be underestimated, and its use should be reconsidered. The Shouldice repair appears to be the method of choice. However, further results confirming this choice should be awaited.

Adult↗
PubMed1992

A study on the mechanical reliability of the Dacomed snap gauge: implications for the differentiation between organic and psychogenic impotence.

Two experiments were conducted testing reliability of expansion chamber determined gauge element breakage ranges; 20 trials with sexually functional males provided comparative data on the gauge in actual application. Circumference of the expansion chamber and increases in penile circumference were simultaneously monitored via a mercury strain gauge. Results for both experiments indicated considerable overlap at gauge element breakpoints, and yielded an overall misdiagnosis rate of 15.5% in a young, healthy population.

Adult↗
PubMed1992

Characterization of yeast artificial chromosomes containing interleukin genes on human chromosome 5.

To understand better the organization and linkage of the interleukin genes, IL4 and IL5, we prepared long-range restriction maps of five yeast artificial chromosomes (YACs) containing IL5. We determined that IL4 and IL5 are within 100-170 kb, and that the regions surrounding these genes contain several GC-rich areas. Fluorescence in situ chromosomal analysis demonstrated that three of the five YAC clones contain non-contiguous genomic sequences originating from multiple human chromosomes.

Base Sequence↗
PubMed1992

[Perioperative treatment in elective colorectal resection in Germany].

The perioperative treatment of patients with elective colorectal resections in 1086 german hospitals was analysed. In 40% of all hospitals preoperative parenteral nutrition was administered. Following resection iv-fluids were administered in every hospital (6.2% hypo-, 72.4% normo-, 18.7% hypercaloric). Systemic chemoprophylaxis with iv-antibiotics was given in 95.4% of all hospitals. Preoperative bowel preparation included orthograde lavage in 86.1% of the hospitals and oral non-resorbable antibiotics were given in 22.5%. 40.1% of all surgeons performed intraoperative testing of colorectal anastomoses and abdominal drains were used on a regular basis in more than 83% of the hospitals. The principles in perioperative treatment of patients with elective colorectal resections are almost identical all over Germany. Minor differences in perioperative treatment occurred in association with localisation, class of hospital, size of surgical department and annual amount of resections. Also differences between clinical practice and results of recent scientific studies can be observed.

Anastomosis, Surgical↗
PubMed1992

[Preoperative esophagogastroduodenoscopy before elective surgical therapy of symptomatic cholelithiasis].

We evaluated the data of 1143 patients who underwent preoperative gastroscopy or upper gastrointestinal series before elective surgical treatment of cholelithiasis between January 1, 1981 and December 31, 1990. On these 824 women and 319 men we performed 1064 (93.1%) gastroscopies and only 78 (6.8%) upper gastrointestinal series. The incidence of pathological findings was 30.2% (345 patients), with 68.3% findings of inflammatory nature. In 28 patients (2.5%) cholecystectomy or bile duct exploration was combined with an additional gastrointestinal surgical procedure. In 227 cases (19.8%) biliary surgery was followed by pharmacological treatment of the gastrointestinal disease. Because of the high incidence of simultaneous disease of the upper gastrointestinum we believe that routine preoperative gastroscopy is indicated before elective surgical treatment of cholelithiasis.

Adult↗
PubMed1992

[Vascularized fibula transfer. A review].

The first vascularized fibula transfer was done by Ueba et al. (1983) in 1974 and has since become a standard technique for special indications in the English, French, Japanese and Chinese-world. Within the last 5 years this technique has received more and more attention in the German-speaking countries. The vascularized fibula transfer is successfully used to reconstruct segmental bone defects larger than 5 to 8 cm that are caused by trauma, tumor, pseudarthrosis or congenital defects. When used to treat osteomyelitis, the vascularized fibula transfer failed to fulfill expectations. Bone defects smaller than 10 cm can also be treated by vascularized iliac crest transfer. To achieve rapid healing, the following points must be followed carefully: when treating osteomyelitis, the infection must be healed--negative cultures and good granulation tissue--prior to bone transplantation. Application of systemic or local antibiotics and aggressive debridement of necrotic bone and soft tissue must be carried out until the cultures taken from the wound are negative. Soft tissue defects must be treated by soft tissue transfer in order to facilitate wound closure with well-vascularized tissue. Vascularized bone transfer should be the treatment of choice for the femur and upper extremities. Precise preoperative planning, especially in high-energy trauma cases, reduces the complication rate. Rigid internal fixation of the bone graft with the recipient site by a smaller proximal and distal plate or by a plate bridging the whole bone defect running parallel to the fibula graft leads to rapid healing without malalignment.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Neoplasms↗
PubMed1992

[Slit drainage--progress in drainage treatment after herniotomy].

In a prospective randomized study was conducted on 80 patients undergoing elective hernia repair to assess whether a new slit-suction drainage is less painful than a Redon-suction drainage. Main endpoint of the study was the traction power in order to remove the drain. Other endpoints were pain at the time of removal of the drain and the effectiveness to draw off secretion. To remove redon drain the average traction power was 226 pond and to remove slit drain the average traction power was only 25 pond. The difference was significant (p less than 0.01). At the time of removal patients with slit drain rarely complained about pain (p less than 0.01). On contrary, patients with Redon drain always complained about pain. Clotting were seldom shown in slit drains and were frequently shown in redon drains. Both slit drains and redon drains were effective to drain secretion. As the new slit drain was more comfortable for patients following hernia repair slit drain should always be used as subcutaneous suction drainage.

Drainage↗
PubMed1992

[Preoperative hemodilution before elective resections of colorectal cancers for sparing homologous blood transfusion].

The records of 389 patients following elective resection of colorectal carcinoma were analysed in order to examine perioperative transfusion. Preoperative hemoglobin levels of 12.8 g/dl in women and 14.2 g/dl in men were found (p less than 0.01). Only 11% of the patients had an anemia. Increasing age and sex had both a significant relation to decreasing preoperative hemoglobin level and higher frequency of transfusion (p less than 0.01). Women got perioperative more often blood transfusion (84.4%). On an average 2.1 units of blood were transfused. There were no relation to tumor stage or tumor location be found (p greater than 0.01). 48.8% of the patients had attendant diseases. Cardiac insufficiency and pulmonary diseases became more frequent. Excluding all patients with contraindication to preoperative hemodilution it was possible to do preoperative hemodilution by 61.2% of the patients. In conclusion preoperative hemodilution should be done before elective resection of colorectal cancer if there was no contraindications to reduce the number of autologous blood transfusion.

Aged↗
PubMed1991

[Port-catheter perforation into the duodenum and other early complications after port implantation before intra-arterial infusion therapy of the liver with chemotherapeutic drugs].

Early complications following implantation of intraarterial hepatic port catheter systems from 1985 to 1988 in 24 patients are reported with special view to the perforation of a port catheter into the duodenum. In this case the primary postoperative angiographic control four weeks after implantation showed correct placement and perfusion of the liver. The perforation occurred before starting any cytostatic regimen. We observed a total of 21% irregularities and complications: dislocation of port membrane (n = 1), incorrect catheter displacement but regular liver perfusion (n = 1), catheter leakage (n = 1), subhepatic abscess (n = 1) and perforation of the catheter in the duodenum. When possible we combine port-implantation with resection of the liver.

Adult↗
PubMed1991

[Individual risk-related after-care in colorectal cancer?].

Efficacy of the regular follow-up program and influence on survival rate following treatment of recurrence were evaluated. 556 follow-up records of patients after resection of colorectal cancer were analysed. The primary drop-out rate was 12.4%. Recurrences were found in 26.6% (n = 128). 53.1% of recurrences were symptomatic at diagnosis of recurrence. Curative resection of recurrence was only performed in 19.5%. 46.1% were given palliative and 34.4 no specific oncologic treatment. We define efficacy as the rate of curative asymptomatic recurrence. This was 3.5% of all patients. From the curative resection of recurrence only 6 patients were free of recurrence longer than 2 years. No second resection of recurrence was possible. Different treatment of recurrence did influence the survival rate (p = 0.09). There was no difference in prognosis for asymptomatic and symptomatic recurrences (p greater than 0.8). In order to increase the efficacy of follow-up for colorectal cancer we are introducing a new concept based on individual risk factors.

Aftercare↗
PubMed1991

Endosonographic detection of rectum anastomoses.

Following preliminary studies on 15 pig-bowel EEA anastomoses, anastomoses in 20 patients were consecutively examined between the 12th and 14th days after anterior rectum or sigmoid resection. Resections were performed on 16 patients for a malignant tumour and on 4 individuals for a benign lesion. The examination programme included detailed clinical examination of the patient, digital palpation, rectoscopy and endorectal sonography, as well as radiographic examination of the large bowel using aqueous contrast medium 1 day later. All rectoscopic and X-ray findings of anastomotic insufficiency were confirmed by means of endosonography. The sensitivity of the latter technique in verifying the radiographic detection of an insufficiency was 1 and its specificity was 0.82. Endorectal sonographic detection of an anastomotic insufficiency was successful in six cases, and suspected insufficiency was noted on three occasions. Radiographic detection of insufficiency was confirmed in three patients; radiographic results suggested an insufficiency in two cases. On one occasion, a suture insufficiency was confirmed by an immediate operation carried out without a radiographic examination. The present study shows that accurate detection of a suture insufficiency after deep resection is possible with the aid of endorectal sonography.

Anastomosis, Surgical↗
PubMed1991

[Morbidity and mortality after elective resections of colorectal cancers].

There are few actual published results about morbidity and mortality after elective resection of colorectal cancer. Out of 596 patients with colorectal cancer, the medical records of 492 who had been prepared preoperatively according to our predefined standards and electively operated on, were analysed. We studied the results of morbidity and mortality and their association with preexisting conditions and preoperative complications. We found that 50% of our patients had preexisting conditions and that 18.7% had preoperative complications (obstruction, ileus, infections). The rate of general postoperative complications was 30.5%. While for pneumonia (13%) there was age and sex relation, for urinary infection (12.7%) there was only sex relation. We were able to reduce urinary infections by half (5.7%), by using a suprapubic catheter. 11.4% of our patients had local complications (anastomotic leakage 2%, ileus 2.2%, bleeding 1.6%, fistula 1.2%). These were neither dependent on age or sex, nor on preoperative complications or preexisting conditions. Mortality within 30 days was 2% and overall mortality was 2.6%. Our results show that careful diagnosis and treatment of preexisting conditions, bowel preparation and an improvement in operating techniques can all lead to improved results after elective resection.

Aged↗
PubMed1991

The iliac crest region: donor site for vascularized bone periosteal and soft tissue flaps.

A review is presented of the classic vascularized iliac crest transfer and to show useful variations on this technique. A technical variation to reconstruct mandibular defects, the semisegmented iliac crest graft, is described. Another variation, the half iliac crest graft, is presented for use in the neovascularization of avascular necrosis of the femoral head. When such a flap is raised with a large periosteal flap and overlying muscle or skin, or both, as a composite flap, a primary osteoperiosteal tube can be created to reconstruct segmental defects in long bones. This primary osteoperiosteal tube is secondarily transformed into a completely osseous tube.

Bone Transplantation↗
PubMed1991

[Follow-up in stomach carcinoma].

For ten years after resection of stomach cancer patients were routinely examined to detect early asymptomatic recurrence, 96 records were analyzed, 21 patients with recurrence of cancer were found--3 local recurrence and 18 distant metastases. There was no anastomosis recurrence, 20 of these patients had clinical symptoms. About 90 percent of all recurrences were found in the first two years. After diagnosis of recurrence the one-year-survival-rate was only eight percent. We believe that the regular follow-up following resection of stomach cancer is not an effective method of detections asymptomatic curable recurrence. For this reason we recommend intensifying individual care and decreasing endoscopic or radiological examinations.

Adenocarcinoma↗
PubMed1991

[Post-traumatic soft tissue defects of the foot].

The weight-bearing areas of the foot have a special tissue structure. When reconstructive surgery is performed care must be taken to prevent unstable scars and ulceration. The authors present methods of soft tissue reconstruction.

Foot↗
PubMed1991

[Plastic surgery measures in combined soft tissue defects of the lower leg].

Isolated or combined soft tissue defects of the lower leg are still a challenge as regard diagnostic and differential treatment. We distinguish acute and chronic isolated or combined soft tissue defect. Acute trauma within a multiple injury pattern is a special form of the acute soft tissue defect. For diagnostic purposes we use a preoperative and intraoperative standardized diagnostic programme. A new classification oriented towards the therapeutic procedure is presented, as is therapy algorithm which has been created.

Follow-Up Studies↗