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2.
Urologe A ; 44(1): 64-7, 2005 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-15688171

RESUMO

Transrectal ultrasound-guided prostate biopsy is the standard technique to detect prostate cancer histologically. Based on a few case reports, it is known that prostate biopsy can cause a seeding of tumor cells. We report the case of a 64-year-old man who 2 years after radical prostatectomy for prostate cancer underwent proctocolectomy because of ulcerative pancolitis. In the lamina submucosa of the distal rectum a micrometastasis of the prostate cancer was found. A possible reason for this metastasis is an implantation of prostate cancer cells due to the transrectal biopsy of the prostate.


Assuntos
Adenocarcinoma/secundário , Biópsia por Agulha/efeitos adversos , Colite Ulcerativa/patologia , Mucosa Intestinal/patologia , Inoculação de Neoplasia , Complicações Pós-Operatórias/patologia , Prostatectomia , Neoplasias da Próstata/patologia , Neoplasias Retais/secundário , Glândulas Seminais/cirurgia , Adenocarcinoma/patologia , Transformação Celular Neoplásica/patologia , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Proctocolectomia Restauradora , Próstata/patologia , Neoplasias Retais/patologia , Reto/patologia , Glândulas Seminais/patologia
3.
Eur J Med Res ; 9(10): 479-84, 2004 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-15546815

RESUMO

BACKGROUND: Polyvalent IgM-enriched intravenous human immunoglobulin (IVIG) preparations are discussed to be beneficial regarding sepsis outcome. MATERIALS AND METHODS: Sixty-four patients with abdominal infection were treated with Pentaglobin or Albumin. Serum levels of endotoxin and chemokines were determined. RESULTS: Incidence of fever was 19/28 in the pentaglobin and 18/26 in the albumin group, the percentage of days with fever was 34 +/- 26 for pentaglobin and 43 +/- 25 for albumin (mean +/-SD). Procalcitonin levels of the pentaglobin treated patients fell under the upper limit of normal on day six whereas levels of albumin patients remained elevated. CONCLUSION: Pentaglobin has a positive influence on the course of post-surgery intra-abdominal infection.


Assuntos
Abdome/cirurgia , Infecções Bacterianas/tratamento farmacológico , Imunoglobulina A/uso terapêutico , Imunoglobulina M/uso terapêutico , Complicações Pós-Operatórias/tratamento farmacológico , APACHE , Adulto , Idoso , Albuminas/uso terapêutico , Calcitonina/sangue , Peptídeo Relacionado com Gene de Calcitonina , Feminino , Humanos , Interleucina-8/fisiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Precursores de Proteínas/sangue , Fator de Necrose Tumoral alfa/fisiologia
4.
Chirurg ; 74(12): 1134-42, 2003 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-14673536

RESUMO

AIMS: Cephalosporins and broad-spectrum penicillins in combination with metronidazole are suitable for treatment of secondary peritonitis. The aim of this study was to compare the clinical and bacteriological efficacy, length of hospital stay (LOS), treatment costs of ceftriaxone (CRO) in combination with metronidazole vs standard regimens (SR) 1 and 2. METHODS: Patient data were subjected to matched-pairs analysis according to four different categories of the Mannheim peritonitis index. RESULTS. From January 1998 to March 2000, a total of 365 patients from 59 surgical wards in German hospitals were included. Clinical efficacy was 90.2% vs 70.4% ( P=0.004) for CRO/SR 1 and 78.3% vs 82.6% for CRO/SR 2. Bacteriological efficacy was comparable. Antibiotic treatment costs were 593/539 Euros for CRO/SR 1 and 466/750 Euros for CRO/SR 2, i.e., costs for CRO were 37.9% lower than with SR 2. CONCLUSION: Based on clinical, bacteriological, and pharmacoeconomic results, ceftriaxone in combination with metronidazole can be regarded as a first-line antimicrobial treatment of secondary peritonitis.


Assuntos
Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Metronidazol/uso terapêutico , Peritonite/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/economia , Ceftriaxona/administração & dosagem , Ceftriaxona/economia , Criança , Custos de Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Tempo de Internação , Masculino , Metronidazol/administração & dosagem , Metronidazol/economia , Pessoa de Meia-Idade , Peritonite/diagnóstico , Peritonite/economia , Peritonite/etiologia , Estudos Prospectivos , Fatores de Tempo
6.
Chirurg ; 73(11): 1127-31, 2002 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-12430065

RESUMO

Myelosarcoma (chloroma) is a rare primary condition in patients with either a myelodysplastic syndrome, or an acute or chronic leukemia. It is an extramedullary neoplasm which does not commonly present with changes in peripheral blood or bone marrow. The rarity and histomorphological similarity to malignant non-Hodgkin lymphoma renders the diagnosis notoriously difficult. Due to its coincidental or secondary manifestation followed by myelogenous leukemia, this tumor needs to be seen as a primary systemic disease. We present a 40 year old man with myelosarcoma of the jejunum and discuss this entity and its therapeutic options.


Assuntos
Neoplasias do Jejuno/diagnóstico , Leucemia Mieloide Aguda/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/patologia , Obstrução Intestinal/cirurgia , Neoplasias do Jejuno/patologia , Neoplasias do Jejuno/cirurgia , Jejuno/patologia , Jejuno/cirurgia , Leucemia Mieloide Aguda/patologia , Leucemia Mieloide Aguda/cirurgia , Excisão de Linfonodo , Linfonodos/patologia , Masculino
7.
Zentralbl Chir ; 127(8): 651-5, 2002 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-12200724

RESUMO

With the planned introduction of Diagnosis related groups (DRG) in the German in-patient reimbursement system an economic brake will be put on the hospitals. The upcoming expected growth of the older German population and the ongoing process of better diagnostic and therapeutic procedures leads to a gap between costs and resources in the established health care system. With the introduction of the DRGs starts a process of one payment for one main diagnosis in hospital care. This requires a better resource control and leads to a tightrope walk between medical and economic aspects. The short time consequences result in great efforts of correct coding of diagnoses and procedures, as a survival strategy for surgical departments. More or less are new structures necessary, the development of "clinical pathways" and the increase or decrease of capacities will become the main tasks in the next years.


Assuntos
Grupos Diagnósticos Relacionados/economia , Custos Hospitalares/tendências , Reembolso de Seguro de Saúde/economia , Programas Nacionais de Saúde/economia , Centro Cirúrgico Hospitalar/economia , Controle de Custos/tendências , Previsões , Alemanha , Humanos
8.
Zentralbl Chir ; 127(4): 297-301, 2002 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-12085279

RESUMO

Sigmoid diverticulitis is in case of complications like perforation, abscess and peritonitis a life-threatening disease. A diagnostic work up with high sensitivity is mandatory. In a prospective study upon 247 patients with the possible diagnosis of acute diverticulitis ultrasound is a screening method with a high specificity (97 %) and leads in combination with the hydrocolonsonography and the colour flow doppler to a high sensitivity (76 %). Without any typical findings in ultrasound, helical CT scan is the best method in the evaluation of the acute diverticulitis (sensitivity and specificity 100 %), because contrast enema is inferior to CT in the evaluation of abscesses (6 %) and perforation (53 %). CT has in case of perforation and of abscesses a sensitivity of 90 % and 100 %, while ultrasound has a sensitivity of 12 % to perforation and of 39 % to abscesses.


Assuntos
Doença Diverticular do Colo/diagnóstico , Endossonografia , Doenças do Colo Sigmoide/diagnóstico , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em Cores , Abscesso/diagnóstico , Abscesso/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Diatrizoato/análogos & derivados , Doença Diverticular do Colo/cirurgia , Enema , Feminino , Humanos , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/cirurgia , Lisina/análogos & derivados , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/cirurgia , Sensibilidade e Especificidade , Doenças do Colo Sigmoide/cirurgia
12.
Zentralbl Chir ; 125(2): 111-22, 2000.
Artigo em Alemão | MEDLINE | ID: mdl-10743031

RESUMO

The aim of all efforts to reduce the need of allogeneic blood transfusions is to avoid associated risks. There should particularly be a favourable effect according to the rate of transfusion-transmitted virus infections and immunological side-effects. The acceptance of an individually adjusted lowest haematocrit level and the minimisation of intra-operative blood loss by the application of optimal surgical techniques are among the most essential strategies to reduce or even avoid allogeneic blood transfusions. In addition the following interventions are generally accepted: Preoperative autologous blood donation, where appropriate supported by erythropoietin Preoperative haemodilution, where appropriate supported by erythropoietin Intra- and postoperative blood salvage Topical or systemic pharmacologic interventions to accelerate haemostasis Controlled hypotension Efficacy and indication of the different measures always depend on the individual circumstances of the specific patient. Therefore one should develop an individual approach for every case. In this context the most important subjects are an optimal coordination and if required an appropriate combination of the discussed methods. Algorithms which preoperatively allow approximate calculation of expected transfusion need may be a meaningful tool to facilitate blood conservation planning. However, at the same time one must consider that all strategies to reduce allogeneic transfusion needs are also associated with particular risks. Therefore one has to weigh carefully the pros and cons prior to their application, including the possible alternative of allogeneic transfusion in one's decision making process.


Assuntos
Perda Sanguínea Cirúrgica/fisiopatologia , Transfusão de Sangue Autóloga , Transfusão de Sangue , Eritropoetina/administração & dosagem , Hemodiluição , Humanos , Proteínas Recombinantes
13.
Anticancer Res ; 20(6D): 4957-60, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-11326646

RESUMO

BACKGROUND: The definite diagnosis of pancreatic tumors of unknown origin remains a clinical challenge. Imaging techniques may fail to differentiate malignant tumors from inflammation, especially in chronic pancreatitis. In a considerable number of cases, the definitive diagnosis needs laparotomy. Single tumor markers as CA 19-9 or CEA are of limited value in these cases because of their limited sensitivity and specificity. This study was performed to find out, whether a classification method based on fuzzy logic analysis of tumor marker profiles is feasible in patients with pancreatic carcinoma and benign pancreatic disease. PATIENTS AND METHODS: Tumor markers and other clinical and laboratory parameters of 74 consecutive patients, either with histologically proved pancreatic carcinoma (n = 43) or presumed benign pancreatic disease (n = 31) assessed by ultrasound, endoscopic retrograde pancreatography, or computed tomography were analysed in order to detect their diagnostic value in the multi-dimensional approach of fuzzy logic analysis. RESULTS: Given a specificity of 95%, sensitivity was considerably increased by the fuzzy logic method (83%) compared with the best single tumor marker CA 19-9 (65%). CA 19-9, CYFRA 21-1 and CA 15-3 gave the most considerable contributions to the classification system, whereas CEA, CA 125, CA 72-4, AFP, liver enzymes, lipase, amylase, bilirubin, and ferritin were of no or little value. CONCLUSIONS: Tumor marker profiles analysed with the fuzzy logic method may have an improved sensitivity compared with single standard tumor markers. The diagnostic efficacy should be proved in patients with pancreatic tumors of unknown origin.


Assuntos
Biomarcadores Tumorais/análise , Antígeno CA-19-9/análise , Lógica Fuzzy , Neoplasias Pancreáticas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Desconhecidas/diagnóstico , Pancreatopatias/diagnóstico , Pancreatopatias/metabolismo , Neoplasias Pancreáticas/metabolismo , Prognóstico
14.
Clin Chem Lab Med ; 38(10): 989-95, 2000 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11140634

RESUMO

A self-developing solid-phase immunoassay (B.R.A.H.M.S. PCT-Q, B.R.A.H.M.S.-Diagnostica GmbH, Hennigsdorf, Germany) has recently become available for the semi-quantitative and rapid measurement of procalcitonin (PCT). In this study we examined the validity of this assay at daily clinical routine conditions at five different hospitals in a prospective study. After development of the assay (200 microl plasma, 30 minutes incubation), PCT levels were categorized into four groups (< 0.5 microg/l; > or = 0.5-< 2 microg/l; > or = 2-< 10 microg/l; > or = 10 microg/l) according to the provided reference scale. Samples from patients with suspected elevation of PCT of different etiology (n=237) were read by various analyzers and compared with the results of the Lumitest PCT (B.R.A.H.M.S.-Diagnostica GmbH, Hennigsdorf, Germany). A total of 74.7% of measurements were categorized according to the results of the LumitestPCT, 24.5% were read within the next lower or higher category. Using a +/- 10% range at the reference concentrations (20% at 0.5 microg/l), 82.7% of samples were correctly categorized and 16.4% within the next categories. Using a cut-off value of 2.0 microg/l, 92.0% (94.1% for +/- 10%) of the results were correctly categorized. The semi-quantitative solid phase immunoassay allows a rapid, simple and semi-quantitative measurement of plasma PCT. The validity of the test results and its ease of use are sufficient to support acute diagnostic decisions. However, for the follow-up of PCT concentrations and routine daily measurements, the quantitative luminometric assay should be preferred, when available.


Assuntos
Calcitonina/análise , Imunoensaio/métodos , Precursores de Proteínas/análise , Peptídeo Relacionado com Gene de Calcitonina , Calibragem , Reações Cruzadas , Humanos , Sistemas Automatizados de Assistência Junto ao Leito
15.
Intensive Care Med ; 26 Suppl 2: S165-9, 2000 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18470713

RESUMO

BACKGROUND: To assess the accuracy of procalcitonin as a measure of severity in patients with septic abdominal illnesses and the sepsis syndrome, to compare measurements with those of other inflammatory mediators, and to predict outcome. METHODS: We carried out a prospective clinical study from 246 patients with infective or septic episodes confirmed at laparotomy and 66 patients undergoing elective operations who acted as controls. Specimens of blood for measurement of cytokine concentrations determination were obtained daily from septic patients. In the control group specimens were obtained before operation, at the end of operation, and on each of the following days until normal recovery (day 10). Every two weeks up to 3 months for patients with metastases, who were being followed up. RESULTS: Compared with other cytokines such as tumor necrosis factor alphaa and interleukin 6 procalcitonin was closely related to the development of infective and septic complications. 59 of 246 patients (24%) with sepsis died. Procalcitonin concentrations preoperatively [median 2.05 compared with 4.2 ng/ml (p=0.08)] (Mann-Whitney U-test) did not differ, but those on the days 1,4 and at the end differed significantly [day 1: 4.9 compared with 13.8 ng/ml (p<0.01); day 4: 4.8 compared with 13.0 ng/ml (p<0.01) and 0.4 compared with 13.25 ng/ml (p<0.01) at the end of the study]. In the control group only 7 (1.6%) of all blood samples, were detected outside the normal range (up to 0.8 ng/ml). CONCLUSIONS: Procalcitonin is a new indicator of infection and sepsis. TNF and IL-6 concentrations always rise after major operations and fall in the absence of infection, indicating operative trauma. Procalcitonin is sensitive in detecting infective complications. Under routine conditions the procalcitonin concentrations seems to be valid, reproducible and detectable.


Assuntos
Infecções Bacterianas/sangue , Infecções Bacterianas/diagnóstico , Calcitonina/sangue , Precursores de Proteínas/sangue , Sepse/sangue , Sepse/diagnóstico , APACHE , Infecções Bacterianas/cirurgia , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Peptídeo Relacionado com Gene de Calcitonina , Estudos de Casos e Controles , Colo , Feminino , Humanos , Perfuração Intestinal/sangue , Perfuração Intestinal/diagnóstico , Masculino , Pancreatite/sangue , Pancreatite/diagnóstico , Peritonite/sangue , Peritonite/diagnóstico , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Sepse/cirurgia , Índice de Gravidade de Doença , Infecção da Ferida Cirúrgica/sangue , Infecção da Ferida Cirúrgica/diagnóstico
18.
Zentralbl Chir ; 124 Suppl 1: 36-9, 1999.
Artigo em Alemão | MEDLINE | ID: mdl-10436525

RESUMO

OBJECTIVE: In the present study long-term patency and limb-salvage rates of femoro-distal bypasses were compared for patients suffering from PAOD stage III and IV with and without DM. METHODS: Between 1990 and 1994, some 192 femoro-crural bypass procedures were performed; 132 reconstructions were carried out on patients with PAOD, 60 bypasses on patients with PAOD and DM. The two groups did not differ significantly regarding age, gender and risk pattern. RESULTS: The comparison of the two groups showed a significant advantage for the diabetic patients regarding the limb-salvage rate. In both groups there was also a significant difference regarding patency in favour of the diabetics. CONCLUSION: Patients suffering from DM and PAOD profit from femoro-distal bypasses. An aggressive vasosurgical reconstructive therapy is indicated for these patients.


Assuntos
Arteriopatias Oclusivas/cirurgia , Implante de Prótese Vascular , Angiopatias Diabéticas/cirurgia , Pé Diabético/cirurgia , Veias/transplante , Idoso , Amputação Cirúrgica , Arteriopatias Oclusivas/etiologia , Artérias/cirurgia , Angiopatias Diabéticas/etiologia , Pé Diabético/etiologia , Feminino , Pé/irrigação sanguínea , Humanos , Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Polietilenotereftalatos , Politetrafluoretileno , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Reoperação , Fatores de Risco , Resultado do Tratamento
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