37 results on '"Steinmüller, T"'
Search Results
2. Logopädie nach Schilddrüsenoperationen in Deutschland: eine Routinedatenanalyse von 50.676 AOK-Patienten
- Author
-
Maneck, M., Dotzenrath, C., Dralle, H., Fahlenbrach, C., Paschke, R., Steinmüller, T., Tusch, E., Jeschke, E., and Günster, C.
- Published
- 2019
- Full Text
- View/download PDF
3. Komplikationen nach Schilddrüsenoperationen in Deutschland: Eine Routinedatenanalyse von 66.902 AOK-Patienten
- Author
-
Maneck, M., Dotzenrath, C., Dralle, H., Fahlenbrach, C., Paschke, R., Steinmüller, T., Tusch, E., Jeschke, E., and Günster, C.
- Published
- 2017
- Full Text
- View/download PDF
4. Intraoperatives Neuromonitoring in der Schilddrüsenchirurgie: Empfehlungen der Chirurgischen Arbeitsgemeinschaft Endokrinologie
- Author
-
Dralle, H., Lorenz, K., Schabram, P., Musholt, T.J., Dotzenrath, C., Goretzki, P.E., Kußmann, J., Niederle, B., Nies, C., Schabram, J., Scheuba, C., Simon, D., Steinmüller, T., and Trupka, A.
- Published
- 2013
- Full Text
- View/download PDF
5. Komplikationen nach Schilddrüsenoperationen in Deutschland: Weiterführende Angaben und Routinedatenanalysen
- Author
-
Maneck, M., Dotzenrath, C., Dralle, H., Fahlenbrach, C., Paschke, R., Steinmüller, T., Tusch, E., Jeschke, E., and Günster, C.
- Published
- 2017
- Full Text
- View/download PDF
6. Intermittierendes versus kontinuierliches Neuromonitoring in der komplexen Chirurgie benigner Schilddrüsenerkrankungen
- Author
-
Caffier, PP, Sedlmaier, A, Hermanns, M, Nawka, T, Weikert, S, and Steinmüller, T
- Subjects
ddc: 610 ,610 Medical sciences ,Medicine - Abstract
Hintergrund In der komplexen benignen Schilddrüsenchirurgie ist das Risiko der intraoperativen Verletzung des N. recurrens erhöht, weshalb der routinemäßige Einsatz des intraoperativen Neuromonitorings (IONM) empfohlen wird. Das Hauptziel unserer Arbeit bestand in einem retrospektiven[zum vollständigen Text gelangen Sie über die oben angegebene URL], Phoniatrisch-pädaudiologische Aspekte 2020
- Published
- 2020
- Full Text
- View/download PDF
7. Chirurgische Therapie neuroendokriner Tumoren der Leber und der Gallengänge
- Author
-
Pascher, A., Steinmüller, T., and Neuhaus, P.
- Published
- 2004
- Full Text
- View/download PDF
8. Multiorganversagen bei septischer Granulomatose
- Author
-
Rüggeberg, A., Deja, M., Kaisers, U., Steinmüller, T., Keske, U., and Falke, T. K.
- Published
- 2002
- Full Text
- View/download PDF
9. Die kombinierte Leber- und Nierentransplantation: Indikationen und Langzeitverlauf
- Author
-
Lang, M., Neumann, U., Kahl, A., Steinmüller, T., Frei, U., and Neuhaus, P.
- Published
- 2001
- Full Text
- View/download PDF
10. Bilaterale subtotale Schilddrüsenresektion versus Hemithyreoidektomie plus kontralaterale subtotale Resektion (Dunhill Operation) bei der benignen euthyreoten Struma nodosa–Langzeitergebnisse einer prospektiv-randomisierten Studie
- Author
-
Rayes, N, Bertram, H, Denecke, T, Steinmüller, T, and Seehofer, D
- Subjects
ddc: 610 ,610 Medical sciences ,Medicine - Abstract
Einleitung: Zwei rezente Metaanalysen von größtenteils retrospektiven Studien beschreiben hohe Rezidivraten nach subtotaler Resektion der Struma multinodosa. Deshalb führen viele Kliniken mit endokrinem Schwerpunkt jetzt vorwiegend totale Thyreoidektomien durch. Als Folge davon ist die[for full text, please go to the a.m. URL], 130. Kongress der Deutschen Gesellschaft für Chirurgie
- Published
- 2013
- Full Text
- View/download PDF
11. Chirurgische Therapie von Präkanzerosen und frühen Karzinomen der Leber.
- Author
-
Ulrich, F., Jonas, S., Steinmüller, T., Seehofer, D., Tullius, S.G., and Neuhaus, P.
- Published
- 2002
- Full Text
- View/download PDF
12. Karzinogenese und chirurgische Therapie des hepatozellulären Karzinoms bei Virushepatitis und Leberzirrhose.
- Author
-
Seehofer, D., Jonas, S., Ulrich, F., Rayes, N., Berg, T., Steinmüller, T., and Neuhaus, P.
- Published
- 2002
- Full Text
- View/download PDF
13. Charakterisierung von Lebertumoren nach kontrastverstärkter Sonographie und digitaler Graustufenbestimmung
- Author
-
Chopra, Sascha Santosh, Lemke, A. J., Mäurer, J., and Steinmüller, T.
- Subjects
hepatocellular adenoma ,610 Medizin ,liver tumors ,Kontrastmittel ,haemangioma ,fokal noduläre Hyperplasie ,tumor characterization ,Metastasen ,perfusion ,Graustufen ,metastasis ,XH 7404 ,ddc:610 ,gray-scale ,hepatozelluläres Adenom ,Hämangiom ,Leber ,Sonovue ,ultrasound ,ultrasound contrast agents ,hepatocellular carcinoma ,Ultraschall ,hepatozelluläres Karzinom ,Liver ,XH 7414 ,33 Medizin - Abstract
Charakterisierung von Lebertumoren nach kontrastverstärkter Sonographie und digitaler Graustufenbestimmung Ziel: Die Charakterisierung fokaler Leberläsionen ist Bestandteil des klinischen Alltags und für Patienten von therapeutischer und prognostischer Relevanz. Auf diesem Gebiet wurde bisher die native Sonographie regulär eingesetzt. Eine sichere Artdiagnose bei unklaren Lebertumoren ist jedoch nur selten möglich. Die Einführung der kontrastmittelverstärkten Sonographie hat die differentialdiagnostischen Optionen erweitert. Ziel dieser Studie war es, den Nutzen des kontrastmittelverstärkten Ultraschalls und der anschließenden digitalen Graustufenanalyse bei fokalen Leberläsionen zu bewerten. Methodik: In einer prospektiven Studie wurde bei 50 Patienten mit CT oder MRT gesicherten Lebertumoren eine Sonographie des Oberbauches in nativer Sonographie und in Phaseninversionstechnik mit intravenöser Gabe des Ultraschallkontrastmittels SonoVue® durchgeführt. Nach Kontrastmittelgabe wurden über 120 s digitale Standbilder akquiriert. Mittels Software ermittelte man den dynamischen Graustufenverlauf für jeden einzelnen Tumor. Es folgte der Vergleich der einzelnen bildgebenden Modalitäten untereinander. Ergebnisse: Der Anteil der artdiagnostisch korrekten Zuordnungen belief sich in der CT bzw. MRT auf 78% und in der nativen Sonographie auf 60%. Mit Hilfe des kontrastmittelverstärkten Ultraschalls konnte er auf 86% gesteigert werden. Die digitale Graustufenanalyse lieferte für die einzelnen Tumorentitäten charakteristische Kurvenverläufe. Hierbei erwiesen sich die Zeitpunkte 20 s und 100 s nach Kontrastmittelgabe für die artspezifische Charakterisierung und für die Differenzierung in benigne und maligne Tumoren als optimal. Schlussfolgerung: Die kontrastmittelverstärkte Sonographie und deren digitale Graustufenbestimmung bilden eine Ergänzung der bisherigen Diagnostik von Lebertumoren und ermöglichen eine bessere Charakterisierung der Herde. Dies sollte in zusätzlichen Studien evaluiert werden. Characterization of Hepatic Tumors with Contrast-enhanced Ultrasound and Digital Gray-Scale Analysis Purpose: The characterization of liver tumors is of therapeutic and prognostic relevance. Although ltrasound offers the opportunity to detect hepatic tumors, its previous techniques did not lead towards a definitve differentiation. The purpouse of this study was the evaluation of contrast enhanced ultrasound followed by quantitative digital analysis in patients with focal hepatic tumors. Materials and Methods: In a prospective stuy, 50 patients with liver tumors previously detected by CT or MRI were examined by ultrasound of the upper abdomen using conventional and phase inversion technique after intravenous application of an ultrasound contrast agent. Digital images were stored over 120 s and software powerd digital gray-scale curves were produced for each individual lesion. Results: While the percentage of tumors correctly characterised by CT/MRI amounted to 78%, the percentage increased from 60% using conventional ultrasound to 86% using contrast enhanced ultrasound including gray-scale analysis. Typical graphs were achieved for different tumor entities on digital gray-scale analysis. Time intervals at 20 and 100 seconds showed optimal for differantiation between particualar entities. Conclusion: Quantification of contrast enhanced ultrasound is an addition to the previous diagnostic procedure in hepatic tumors. It offers the possibility of an investigator-independent characterization of lesions and should be evaluated in further studies.
- Published
- 2006
14. [Case volume and complications after thyroid gland surgery in Germany: an analysis of routine data from 48,387 AOK patients].
- Author
-
Maneck M, Dotzenrath C, Dralle H, Fahlenbrach C, Steinmüller T, Simon D, Tusch E, Jeschke E, and Günster C
- Subjects
- Germany, Humans, Postoperative Complications epidemiology, Postoperative Complications etiology, Thyroidectomy, Thyroid Gland surgery, Vocal Cord Paralysis epidemiology, Vocal Cord Paralysis etiology
- Abstract
Background: Many studies showed that hospital and surgeon volume have a significant influence on the complication rates of thyroid surgery. The present study investigates whether this relationship applies in subtotal as well as total lobe resections. Furthermore, it is still unclear which threshold for the hospital-related case volume can be determined, above which the risk of complications lies below the current national average., Material and Methods: The study was based on nationwide routine data for persons insured with the Local General Sickness Fund (AOK) who had undergone thyroid surgery in 2014-2016. Permanent vocal cord palsy, bleeding and wound infection needing revision were recorded using indicators. The effect of the case volume on the indicators and the case number threshold was determined using logistic regression., Results: Permanent vocal cord palsy was observed in 1.3% and bleeding or wound infections needing revision in 1.6% and 0.3% of the cases. Compared to hospitals with >450 surgeries per year, the risk of permanent vocal cord palsy in hospitals with fewer than 201, 101 and 51 surgeries was significantly increased (OR [95% CI]: 1.5 [1.1-2.1]; 1.5 [1.1-2.1]; 1.8 [1.3-2.5]). The threshold needed to achieve a risk for permanent vocal cord palsy below the national average (1.3%) was 265 thyroid surgeries per year (95% CI: 110-420). For bleeding or wound infection in need of revision, no association between volume and outcome was found., Conclusion: The present study showed that the risk of postoperative permanent vocal cord palsy decreased with increasing case volume. The broad confidence interval of the threshold makes clear case volume recommendation difficult. In order that the risk for a postoperative permanent vocal cord palsy is not likely above the national average, the annual case volume should reach 110 thyroid interventions.
- Published
- 2021
- Full Text
- View/download PDF
15. [Speech therapy after thyroid gland operations in Germany: analysis of routine data from 50,676 AOK patients].
- Author
-
Maneck M, Dotzenrath C, Dralle H, Fahlenbrach C, Paschke R, Steinmüller T, Tusch E, Jeschke E, and Günster C
- Subjects
- Germany, Humans, Postoperative Complications, Thyroidectomy, Speech Therapy, Thyroid Diseases surgery, Vocal Cord Paralysis
- Abstract
Background: This study investigated the frequency of postoperative speech therapy in the context of vocal cord palsy after thyroid surgery based on nationwide routine data. Additionally, volume-outcome relationships were examined., Material and Methods: Nationwide routine data from insured patients of the Local Health Insurance Fund (AOK) who underwent thyroid surgery for a benign thyroid disease between 2013 and 2015 were analyzed. Postoperative speech therapy was determined based on prescription data. Transient and permanent vocal cord palsy were determined using indicators. The effect of hospital volumes (volume quintiles) on prescription of postoperative speech therapy was determined by multivariate logistic regression., Results: A total of 50,676 thyroid gland operations were identified. The overall frequency of postoperative speech therapy prescription was 6.5%. In AOK patients with transient or permanent vocal cord palsy, the frequencies of postoperative speech therapy prescription were 56.1% and 75.2%, respectively. The prescription volume of the normal case (≥21 units of speech therapy) was exceeded in 0.7% of the AOK patients. In the two lowest case volume categories the risk of postoperative speech therapy exceeding the prescription volume of the normal case was significantly higher compared to the highest case volume hospitals (odds ratios: 1.2 and 1.8, respectively)., Conclusion: This study presents the reality of healthcare with respect to the frequency of speech therapy prescription after thyroid gland surgery in Germany. In addition, it was determined that the risk of postoperative speech therapy prescription exceeding the volume of the normal case after thyroid gland operations decreases with increasing case volumes of hospitals.
- Published
- 2019
- Full Text
- View/download PDF
16. Frühes MIBI-SPECT/CT zur Detektion eines 6 mm großen Nebenschilddrüsenadenoms im Thymus.
- Author
-
Grünwald L, Derwahl KM, Steinmüller T, and Kuwert T
- Subjects
- Humans, Male, Radiopharmaceuticals, Technetium Tc 99m Sestamibi, Young Adult, Adenoma diagnostic imaging, Parathyroid Neoplasms diagnostic imaging, Single Photon Emission Computed Tomography Computed Tomography, Thymus Gland diagnostic imaging
- Abstract
Competing Interests: Professor Kuwert hält für die Firma Siemens gelegentlich Vorträge gegen Honorar. Die Nuklearmedizinische Universitätsklinik in Erlangen hat eine Forschungsförderung durch Siemens auf dem Gebiet der SPECT/CT-Entwicklung. Die anderen Autoren erklären, dass kein Interessenskonflikt besteht.
- Published
- 2018
- Full Text
- View/download PDF
17. [Update of the S2k guidelines : Surgical treatment of benign thyroid diseases].
- Author
-
Musholt TJ, Bockisch A, Clerici T, Dotzenrath C, Dralle H, Goretzki PE, Hermann M, Holzer K, Karges W, Krude H, Kussmann J, Lorenz K, Luster M, Niederle B, Nies C, Riss P, Schabram J, Schabram P, Schmid KW, Simon D, Spitzweg C, Steinmüller T, Trupka A, Vorländer C, Weber T, and Bartsch DK
- Subjects
- Germany, Humans, Postoperative Complications, Retrospective Studies, Vocal Cord Paralysis etiology, Thyroid Diseases surgery, Thyroidectomy
- Abstract
Thyroid resections represent one of the most common operations with 76,140 interventions in the year 2016 in Germany (source Destatis). These are predominantly benign thyroid gland diseases. Recommendations for the operative treatment of benign thyroid diseases were last published by the CAEK in 2010 as S2k guidelines (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. [AWMF] 003/002) against the background of increasingly more radical resection procedures. Hemithyroidectomy and thyroidectomy are routinely performed for benign thyroid disease in practice. The operation-specific risks show a clear increase with the extent of the resection. Therefore, weighing-up of the risk-indications ratio between unilateral lobectomy or thyroidectomy necessitates an independent evaluation of the indications for both sides. This principle in particular has been used to update the guidelines. In addition, the previously published recommendations of the CAEK for correct execution and consequences of intraoperative neuromonitoring were included into the guidelines, which in particular serve the aim to avoid bilateral recurrent laryngeal nerve paralysis. Moreover, the recommendations for the treatment of postoperative complications, such as hypoparathyroidism and postoperative infections were revised. The updated guidelines therefore represent the current state of the science as well as the resulting surgical practice.
- Published
- 2018
- Full Text
- View/download PDF
18. [Complications after thyroid gland operations in Germany : Further information and routine data analysis].
- Author
-
Maneck M, Dotzenrath C, Dralle H, Fahlenbrach C, Paschke R, Steinmüller T, Tusch E, Jeschke E, and Günster C
- Subjects
- Germany, Humans, Parathyroid Glands, Thyroidectomy, Data Analysis, Thyroid Gland
- Published
- 2017
- Full Text
- View/download PDF
19. [Complications after thyroid gland operations in Germany : A routine data analysis of 66,902 AOK patients].
- Author
-
Maneck M, Dotzenrath C, Dralle H, Fahlenbrach C, Paschke R, Steinmüller T, Tusch E, Jeschke E, and Günster C
- Subjects
- Adult, Aged, Female, Germany, Humans, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Postoperative Hemorrhage epidemiology, Postoperative Hemorrhage etiology, Postoperative Hemorrhage surgery, Reoperation statistics & numerical data, Surgical Wound Infection epidemiology, Surgical Wound Infection etiology, Surgical Wound Infection surgery, Vocal Cord Paralysis epidemiology, Vocal Cord Paralysis etiology, Vocal Cord Paralysis surgery, Data Interpretation, Statistical, Hospitals, High-Volume statistics & numerical data, Hospitals, Low-Volume statistics & numerical data, Postoperative Complications epidemiology, Postoperative Complications etiology, Thyroid Diseases epidemiology, Thyroid Diseases surgery, Thyroidectomy adverse effects, Thyroidectomy statistics & numerical data
- Abstract
Background: Routine data from hospitals in the public healthcare system allow the analysis of large patient datasets without generating additional documentation efforts for hospitals. This study reports the frequencies of postoperative complications after thyroid surgery based on routine nationwide data. Moreover, volume-outcome relationships were investigated., Material and Methods: Nationwide routine data from insured patients of the Local Health Insurance Fund (AOK) who underwent thyroid surgery between 2008 and 2010 were analyzed. Complications were determined based on indicators for permanent vocal cord palsy, re-bleeding with re-operations and wound infections with specific treatment. The effect of hospital volumes (volume quintiles) on the indicators was determined by multivariate logistic regression., Results: A total of 66,902 thyroid gland operations were identified. The overall frequency of permanent vocal cord palsy was 1.5 %, re-bleeding 1.8 % and wound infections 0.4 %. In the four lowest case volume categories the risk of permanent vocal cord palsy was significantly higher compared to the highest case volume hospitals (odds ratio 1.5, 1.7, 1.7 and 2.2, respectively)., Conclusion: This study represents the reality of healthcare for thyroid surgery in Germany. Additionally, it was determined that the risk for permanent vocal cord palsy after thyroid gland operations decreased with increasing case volumes of hospitals.
- Published
- 2017
- Full Text
- View/download PDF
20. [Characterization of hepatic tumors with contrast-enhanced ultrasound and digital grey-scale analysis].
- Author
-
Lemke AJ, Chopra SS, Hengst SA, Brinkmann MJ, Steinmüller T, and Felix R
- Subjects
- Adult, Aged, Aged, 80 and over, Diagnosis, Differential, Female, Humans, Image Processing, Computer-Assisted, Liver Neoplasms secondary, Male, Middle Aged, Prognosis, Prospective Studies, Sensitivity and Specificity, Ultrasonography, Adenoma, Liver Cell diagnostic imaging, Carcinoma, Hepatocellular diagnostic imaging, Cholangiocarcinoma diagnostic imaging, Focal Nodular Hyperplasia diagnostic imaging, Hemangioma diagnostic imaging, Image Enhancement methods, Liver Neoplasms diagnostic imaging, Phospholipids, Sulfur Hexafluoride
- Abstract
Purpose: The characterization of different liver tumors is of therapeutic and prognostic relevance and has been the purpose of several studies. Although ultrasound offers the opportunity to detect hepatic tumors without ionizing radiation, its previous techniques did not lead toward a definitive differentiation of different tumor entities. The purpose of this study was the clinical evaluation of contrast enhanced ultrasound followed by quantitative digital analysis in patients with focal hepatic tumors., Materials and Methods: In a prospective study, 50 patients (18 females, 32 males, age 28 to 83 years, mean age 59.4 years) with liver tumors previously detected by CT (n = 47) or MRI (n = 3) were examined by ultrasound of the upper abdomen using conventional technique and phase inversion technique after intravenous application of sulfur-based contrast enhancer SonoVue. At scheduled intervals after application of the contrast enhancer, a digital image was stored and the characteristic signal course of each lesion determined semiquantitatively. The gold standard was either resection (n = 17), percutaneous needle biopsy (n = 19) or the clinical course (n = 14)., Results: While the percentage of tumors correctly characterized by CT/MRI amounted to 78 %, the percentage increased from 60 % using conventional ultrasound to 86 % using contrast enhanced ultrasound including grey-scale analysis. Typical graphs were achieved for different tumor entities on digital grey-scale analysis. The optimal intervals for the differentiation of particular entities were 20 and 100 seconds after injection., Conclusion: Quantification of contrast enhanced ultrasound is an addition to the previous diagnostic procedure in hepatic tumors. It offers the possibility of an investigator-independent characterization of lesions and should be evaluated in further studies.
- Published
- 2004
- Full Text
- View/download PDF
21. [Accuracy of the CT-estimated weight of the right hepatic lobe prior to living related liver donation (LRLD) for predicting the intraoperatively measured weight of the graft].
- Author
-
Lemke AJ, Brinkmann MJ, Pascher A, Steinmüller T, Settmacher U, Neuhaus P, and Felix R
- Subjects
- Adult, Aged, Cadaver, Female, Humans, Male, Middle Aged, Organ Size, Prospective Studies, Tomography, X-Ray Computed, Liver diagnostic imaging, Liver Transplantation, Living Donors, Tissue and Organ Harvesting
- Abstract
Purpose: Due to the shortage of cadaver donors, living related liver donation (LRLD) has emerged as an alternative to cadaver donation. The expected graft weight is one of the main determinants for donor selection. This study investigates the accuracy of preoperatively performed CT-volumetry to predict the actual weight of the right liver lobe graft., Materials and Methods: In a prospective study the weight of the right hepatic lobe was calculated by volumetric analysis based on CT in 33 patients (21 females, 12 males, mean age 42.1 years, median age 41 years) prior to living related liver donation. Graft weight was calculated as the product of CT-based graft volume and 1.00 g/ml (the approximated density of healthy liver parenchyma). The calculated weight was compared with the intraoperatively measured weight of the harvested right hepatic lobe. The difference was used to determine a correction factor for estimating the actual graft weight., Results: Based on the assumption of a parenchymal density of 1.00 g/ml, the preoperatively estimated graft weight (mean 980 g +/- 168 g) deviated +33 % from the intraoperatively measured right hepatic lobe weight (mean 749 g +/- 170 g). By reducing the preoperatively predicted weight of the right hepatic lobe with a correction factor of 0.75, the actual graft weight can be calculated., Conclusion: Preoperative estimation of the weight of the right hepatic lobe based on CT of living related liver donors predicts the weight of the right lobe graft with sufficient accuracy by applying a single correction factor. Intraoperative fluid loss (i.e., blood, bile) from the harvested liver as well as variations in parenchymal density may contribute to the observed preoperative overestimation of the actual graft volume by CT-based volumetry.
- Published
- 2003
- Full Text
- View/download PDF
22. [Orthotopic liver transplantation in case of TIPS stent dislocation].
- Author
-
Glanemann M, Müller AR, Stange B, Steinmüller T, and Neuhaus P
- Subjects
- Esophageal and Gastric Varices surgery, Gastrointestinal Hemorrhage surgery, Humans, Male, Mesenteric Veins surgery, Middle Aged, Reoperation methods, Splenic Vein surgery, Foreign-Body Migration surgery, Intraoperative Complications surgery, Liver Cirrhosis, Alcoholic surgery, Liver Transplantation, Portal Vein surgery, Portasystemic Shunt, Transjugular Intrahepatic instrumentation, Prosthesis Failure, Thrombosis surgery
- Abstract
Transjugular intrahepatic portosystemic shunts (TIPS) are indicated in patients with liver cirrhosis and portal hypertension for treatment of variceal bleeding or refractory ascites. Additionally implantation of stents may lead to stent dislocation or thrombosis in up to 20 % of cases. Detailed information about stent dislocation and its impact on subsequent orthotopic liver transplantation (OLT) is rare regarding the literature. We report on a patient suffering from ethyltoxic liver cirrhosis in which OLT was technically complicated by a thrombosed TIPS stent, dislocated in the portal vein. This stent was implanted prior to OLT due to refractory ascites and partial portal vein thrombosis. We conclude that TIPS stent insertion, especially in liver transplant candidates, should only be performed by radiologists in centers with expertise and experience.
- Published
- 2002
- Full Text
- View/download PDF
23. [Living donor liver transplantation of the right liver lobe between adults].
- Author
-
Steinmüller T, Pascher A, Sauer IM, Theruvath T, Müller AR, Settmacher U, and Neuhaus P
- Subjects
- Adult, Aged, Biliary Tract Diseases epidemiology, Biliary Tract Diseases etiology, Female, Graft Survival, Humans, Liver Transplantation mortality, Liver Transplantation statistics & numerical data, Male, Middle Aged, Postoperative Complications epidemiology, Postoperative Complications etiology, Risk Factors, Safety, Survival Analysis, Liver Transplantation methods, Tissue Donors statistics & numerical data
- Abstract
Background and Objective: Adult living donor liver transplantation has been established in an increasing number of transplant centres during the last few years. Donor safety and risks are important criteria influencing the further development. We report our experience with 43 adult-to-adult right lobe living donor liver transplantations., Methods: 43 patients (mean age: 49,8 +/- 16,0 years; f:m = 14:29) with end-stage liver disease received a right lobe liver graft from an adult living donor (mean age: 42,4 +/- 13,4 years; f:m = 27:16) between December 1999 and December 2001. An approval by the local ethics committee was obtained prior to the start of the programme and each donation., Results: None of the donors experienced fatal or long-term complications. The rate of surgical complications in donors (biliary leakage, bleeding) was 9 %. Actuarial recipient survival was 93 % after three months and 88 % after one year. Five patients had to be re-transplanted. Thus the actuarial 1-year graft survival was 79 %. Biliary complications occurred in 14 % of all recipients., Conclusion: According to our experience, living donor liver transplantation of the right hepatic lobe is a safe and effective procedure. Especially for patients in acute and chronic liver failure, who otherwise would have died on the waiting list, this approach offers a life-saving option.
- Published
- 2002
- Full Text
- View/download PDF
24. [Arterial port-catheter dislocation into the duodenum].
- Author
-
Pfitzmann R, Stockmann M, Steinmüller T, and Neuhaus P
- Subjects
- Chemotherapy, Adjuvant, Combined Modality Therapy, Duodenoscopy, Duodenum pathology, Foreign-Body Migration diagnosis, Hepatic Artery, Humans, Infusions, Intra-Arterial, Liver Neoplasms drug therapy, Liver Neoplasms secondary, Liver Neoplasms surgery, Male, Middle Aged, Sigmoid Neoplasms drug therapy, Sigmoid Neoplasms surgery, Catheters, Indwelling adverse effects, Duodenum surgery, Foreign-Body Migration surgery
- Abstract
Arterial port-catheter dislocations into the duodenum are rare complications. We report on a 64-year-old male with sigmoid-resection for carcinoma, left hemihepatectomy and arterial port-catheter implantation into the common hepatic artery for liver metastases in both lobes and partial dislocation of the port system into the duodenum. Therefore, the port-catheter system had to be explanted after 8 cycles of cytostatic therapy and the duodenum had to be closed by a suture. Six months after surgery the patient felt well, a new singular metastasis in the right liver lobe could be treated successfully by laserinduced thermotherapy. At present the patient has no evidence for another metastasis.
- Published
- 2002
- Full Text
- View/download PDF
25. [Surgical procedures and risk factors in therapy of benign multinodular goiter. A statistical comparison of the incidence of complications].
- Author
-
Steinmüller T, Ulrich F, Rayes N, Lang M, Seehofer D, Tullius SG, Jonas S, and Neuhaus P
- Subjects
- Female, Follow-Up Studies, Humans, Hypocalcemia etiology, Male, Recurrence, Recurrent Laryngeal Nerve Injuries, Reoperation, Retrospective Studies, Risk Factors, Treatment Outcome, Vocal Cord Paralysis etiology, Goiter, Nodular surgery, Postoperative Complications etiology, Thyroidectomy methods
- Abstract
Background: The best surgical approach for bilateral resections in the therapy of benign multinodular goiter is still controversial., Methods: The purpose of this study was to compare different modes of resection concerning differences in complication rates and risk factors influencing the outcome. 2235 thyroid resections for multinodular goiter between 1985 and 1999 were analysed., Results: When compared to bilateral subtotal resection (n = 327; 14.6%), those patients who received lobectomy and contralateral subtotal resection (n = 952; 42.6%) showed a statistically significant higher incidence of temporary hypocalcaemia (22.6% versus 15.9%) only. The "nerve at risk"-analysis demonstrated no significant difference of laryngeal nerve paralysis between the side of lobectomy and subtotal resection, respectively. In comparison to the entire patient population operations for recurrent goiters had an equal operative risk, whereas patients with goiter WHO III or an intrathoracic location had significant higher rates of temporary laryngeal nerve paralysis and hypocalcaemia., Conclusions: Lobectomy and contralateral subtotal resection offers numerous advantages concerning intraoperative variability and definitive resection of suspicious nodules. With an adequate standardized surgical technique and identification of the laryngeal nerve, the complication rate is comparable to bilateral subtotal resection.
- Published
- 2001
- Full Text
- View/download PDF
26. [Combined liver and kidney transplantation: indications and long-term follow-up].
- Author
-
Lang M, Neumann U, Kahl A, Steinmüller T, Frei U, and Neuhaus P
- Subjects
- Adult, Antilymphocyte Serum, Female, Follow-Up Studies, Graft Rejection, Histocompatibility Testing, Humans, Immunosuppression Therapy, Male, Middle Aged, Retrospective Studies, Survival Analysis, Time Factors, Kidney Transplantation mortality, Liver Transplantation mortality
- Abstract
Introduction: In patients suffering from chronic liver and kidney disease combined liver-kidney transplantation is the only therapeutic option. However, in these patients, it is mandatory to distinguish between chronic and acute renal failure prior to transplantation, because acute renal failure may recover after successful liver transplantation. In this study we investigated the indications and results of this combined procedure., Patients and Methods: We report on 27 patients who underwent liver and kidney transplantation. The underlying diseases were viral hepatitis (n = 12), polycystic liver and kidney disease (n = 9), primary hyperoxaluria (n = 4), and cryptogenic cirrhosis (n = 2) with end-stage renal disease due to glomerulonephritis, diabetic nephropathy or renal failure caused by nephrotoxicity of immunosuppressive therapy after liver transplantation. Nine patients had lymphocytotoxic antibodies and 5/27 patients had a positive crossmatch pretransplant., Results: One patient died due to bleeding complications, two patients lost the kidney graft due to initial non-function or technical problems. The incidence of acute and steroid-resistant rejections was 60% and 20% in patients with a positive cross-match compared to 32% and 14% in negative cross-match transplants. Only two patients experienced a rejection episode of the kidney (3.7%). No hyperacute rejection of the kidney graft occurred. Long-term patients and graft survival was not impaired in the presence of a positive cross-match. The 1- and 5-year survival rates of patients who underwent combined transplantation was 97% and 93% versus 91% and 83% in patients with liver transplantation alone., Conclusion: Combined liver-kidney transplantation is a safe treatment for endstage liver and kidney disease even in the face of a positive cross-match.
- Published
- 2001
- Full Text
- View/download PDF
27. [Surgical therapy of liver hilus tumors].
- Author
-
Jonas S, Steinmüller T, and Neuhaus P
- Subjects
- Bile Duct Neoplasms mortality, Bile Duct Neoplasms pathology, Cholangiocarcinoma mortality, Cholangiocarcinoma pathology, Humans, Liver Transplantation, Lymph Node Excision, Neoplasm Staging, Pancreaticoduodenectomy, Portal Vein surgery, Survival Rate, Bile Duct Neoplasms surgery, Cholangiocarcinoma surgery, Hepatectomy methods
- Abstract
Hilar resections and hemihepatectomies as surgical strategies for hilar cholangiocarcinoma achieve only limited rates of resectability and radicality. Principles of surgical oncology have to be applied in order to increase the numbers of patients undergoing resection as well as their long-term survival. Due to the anatomical architecture of the hepatic hilum and side-specific variations within the biliary tree, right trisectorectomy and principal portal vein resection have the potential to comply with basic rules of surgical oncology, i.e. wide tumor-free margins and a no-touch dissection technique. In our experience, 5-year survival after formally curative right trisectorectomy and portal vein resection is 65% in spite of advanced tumor stages. Resection of the entire biliary tract without dissection of the tumor is possible by combining total hepatectomy, partial pancreatoduodenectomy and liver transplantation. However, even this procedure does still not fully prevent tumor cell dissemination. So far, a putative alteration of tumor cell kinetics due to posttransplant immunosuppressive treatment results in an increased rate of implantation metastases.
- Published
- 2001
- Full Text
- View/download PDF
28. [Transplantation surgery. 3].
- Author
-
Pfitzmann R, Heise M, Steinmüller T, Raakow R, Settmacher U, and Neuhaus P
- Subjects
- Adult, Child, Graft Rejection diagnosis, Humans, Immunosuppressive Agents therapeutic use, Middle Aged, Postoperative Complications, Quality of Life, Reoperation, Survival Analysis, Time Factors, Tissue Donors, Intestine, Small transplantation, Kidney Transplantation methods, Kidney Transplantation mortality, Liver Transplantation methods, Liver Transplantation mortality, Pancreas Transplantation mortality
- Published
- 2001
29. [Transplantation surgery. II].
- Author
-
Pfitzmann R, Heise M, Steinmüller T, Raakow R, Settmacher U, and Neuhaus P
- Subjects
- Adult, Child, Follow-Up Studies, Graft Rejection diagnosis, Graft Rejection drug therapy, Humans, Immunosuppressive Agents therapeutic use, Survival Analysis, Time Factors, Heart Transplantation methods, Heart Transplantation mortality, Heart-Lung Transplantation methods, Heart-Lung Transplantation mortality, Lung Transplantation methods, Lung Transplantation mortality
- Published
- 2001
30. [Therapy of recurrent hepatitis B infection after liver transplantation. A retrospective analysis of 200 liver transplantations based on hepatitis B associated liver diseases].
- Author
-
Seehofer D, Rayes N, Bechstein WO, Naumann U, Neuhaus R, Berg T, Hopf U, Langrehr JM, Steinmüller T, Platz KP, Müller AR, and Neuhaus P
- Subjects
- 2-Aminopurine adverse effects, 2-Aminopurine analogs & derivatives, 2-Aminopurine therapeutic use, Adult, Antiviral Agents adverse effects, Dose-Response Relationship, Drug, Drug Administration Schedule, Drug Therapy, Combination, Famciclovir, Female, Hepatitis B, Chronic mortality, Humans, Immunization, Passive, Interferon alpha-2, Interferon-alpha adverse effects, Interferon-alpha therapeutic use, Lamivudine adverse effects, Lamivudine therapeutic use, Male, Middle Aged, Recombinant Proteins, Recurrence, Retrospective Studies, Survival Rate, Treatment Outcome, Antiviral Agents therapeutic use, Hepatitis B, Chronic drug therapy, Liver Transplantation
- Abstract
Background: Before introduction of passive immunoprophylaxis and new antiviral nucleoside analogues the course of hepatitis B recurrence after liver transplantation could hardly be influenced. The result was a inferior graft survival. In the present retrospective analysis of the efficacy of hepatitis B therapy after liver transplantation was analysed retrospectively., Patients and Methods: Between 1988 and 1998 in total 179 patients were transplanted due to hepatitis B related liver failure at our centre. All patients received passive immunoprophylaxis with hepatitis B immunoglobulin. In case of reinfection after 1993 an antiviral therapy with famciclovir 1500 mg daily was initiated (n = 26), since 1996 lamivudine (100-150 mg daily) was used (n = 12). In case of viral breakthrough under famciclovir treatment or prophylaxis therapy was switched to lamivudine (n = 22). In case of ineffectiveness of lamivudine an antiviral combination therapy with lamivudine and interferon (n = 4) or lamivudine and famciclovir (n = 4) was initiated. Before availability of antiviral agents or in case of viral breakthrough in total 12 patients were retransplanted due to acute or chronic reinfection., Results: With passive immunoprophylaxis reinfection rate was 33%, 43% and 44% after 1, 3 and 5 years respectively. Without antiviral treatment 52% of patients died within the first year after reinfection. Antiviral therapy with lamivudine or famciclovir improved the one year survival after reinfection to 79%. Suppression of viral replication was more effective with lamivudine. Under lamivudine 26 patients (76%) became HBV-DNA negative, 9 patients HBsAg negative (26%). In contrast no patient became HBsAg negative during famciclovir therapy. Lamivudine was effective also after famciclovir breakthrough in 94% of patients. In case of lamivudine resistant reinfection viral replication could be suppressed with an antiviral combination therapy up to negative HBV-DNA in the hybridization assay. Severe side effects were not observed during any of the antiviral therapies. The graft survival after retransplantation for hepatitis B reinfection was 42% and 25% after one and 3 years., Conclusion: Whereas it is generally accepted, that passive immunoprophylaxis lowers the reinfection rate it could be shown in the present study, that antiviral treatment lowers mortality of hepatitis B reinfection. The major problem of lamivudine and famciclovir is viral resistance formation. In this case an antiviral combination therapy might be useful, whereas retransplantation for hepatitis B reinfection should be considered carefully due to inferior graft survival rates.
- Published
- 2000
- Full Text
- View/download PDF
31. [Extended partial Kausch-Whipple duodenopancreatectomy by resection of tumor infiltrated vascular segments].
- Author
-
Langrehr JM, Steinmüller T, Henneken V, and Keck H
- Subjects
- Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Pancreatic Neoplasms mortality, Pancreatic Neoplasms pathology, Portal Vein pathology, Survival Rate, Vascular Neoplasms mortality, Vascular Neoplasms pathology, Vascular Neoplasms surgery, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy methods, Portal Vein surgery, Vascular Neoplasms secondary
- Abstract
The experience with standard Kausch-Whipple procedure is reviewed and compared with partial duodenopancreatectomies extended by partial resection of the portal vein. Perioperative morbidity has decreased to below 5% and survival rates with and without vessel resection are not significantly different. Therefore, infiltration of mesentericoportal vessels is not a contraindication for Kausch-Whipple procedure.
- Published
- 1998
32. [Recurrent paroxysmal neck swellings as the primary manifestation of a pheochromocytoma].
- Author
-
Böhm M, Steinmüller T, and Czarnetzki BM
- Subjects
- Adrenal Gland Neoplasms complications, Adrenal Gland Neoplasms surgery, Adrenalectomy, Chronic Disease, Diagnosis, Differential, Edema etiology, Female, Humans, Hypertension diagnosis, Hypertension etiology, Hypertension surgery, Middle Aged, Neck physiopathology, Pheochromocytoma complications, Pheochromocytoma surgery, Recurrence, Time Factors, Adrenal Gland Neoplasms diagnosis, Pheochromocytoma diagnosis
- Abstract
A 45-year-old female had been suffering for about 6 months almost daily from paroxysmal neck swellings with occasional difficulties in swallowing and from non-specific abdominal complaints. Hormone analyses, performed because of the marked blood pressure increase up to 210/120 mm Hg during such an attack, revealed an increase in vanillyl mandelic acid and epinephrine concentrations in the 24-hour urine. CT demonstrated a tumour of 4 x 5 x 5 cm size in the region of the right adrenal. The paroxysmal neck swellings and blood pressure increase could be reproduced by means of pressure applied over the tumour range with the ultrasound transducer. The tumour was extirpated and histology revealed a phaeochromocytoma. For more than one year now the patient has been free from complaints. To date, recurrent neck swellings have not been reported in association with a phaeochromocytoma. Possible causes may be an enhanced congestion of the deep neck vessels during paroxysmal blood pressure increase or an enhanced response by the adrenoreceptors of these vessels to the released catecholamines.
- Published
- 1993
- Full Text
- View/download PDF
33. [Porphyrin-induced biliary cirrhosis in protoporphyria: indications for liver transplantation].
- Author
-
Steinmüller T, Frank M, Kretschmar R, Sieg I, Bechstein WO, Neuhaus P, and Doss MO
- Subjects
- Biopsy, Coproporphyrins urine, Follow-Up Studies, Humans, Liver pathology, Liver Cirrhosis, Biliary pathology, Liver Function Tests, Male, Middle Aged, Porphyria, Hepatoerythropoietic pathology, Postoperative Complications pathology, Recurrence, Liver Cirrhosis, Biliary surgery, Liver Transplantation pathology, Porphyria, Hepatoerythropoietic surgery
- Abstract
A 51-year-old patient, who had experienced photosensitivity from childhood on, fell ill with an icterus accompanied by abdominal complaints. At the age of 46 years an erythropoietic protoprophyria had been diagnosed by an excessive protoporphyrinemia. Meanwhile, in consequence of the protoporphyria's erythrohepatic progression, a biliary liver cirrhosis developed, associated with portal hypertension and marked splenomegalie. As a remission of the protoporphyria-induced hepatobiliary complication could not be achieved by conservative medical treatment, the indication for orthotopic liver transplantation was established. The operation proceeded without complications, and the postoperative course, too, revealed no problems. With primarily good bile production, bilirubin and aminotransferases soon declined to normal values. Urinary coproporphyrin excretion was found to be normal after transplantation, only a domination of isomer I still peristed. Furthermore, a distinct elevation of protoprophyrin continued to exist both in erythrocytes and plasma as expression of the immanent enzyme deficiency typical for the genodermatosis protoporphyria. In the liver explant a micronodular transformation of parenchyma was found besides a deposition of reddish-brown protoporphyrin pigment in hepatocellular cytoplasma and Kupffer's cells, in addition to pigment casts in the canaliculi and within single portal bile ducts.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1993
34. [Liver transplantation in erythrohepatic protoporphyria].
- Author
-
Steinmüller T, Doss MO, Steffen R, Blumhardt G, Bechstein WO, Frank M, Sieg I, Kretschmar R, and Neuhaus P
- Subjects
- Cholestyramine Resin therapeutic use, Chromosome Aberrations pathology, Chromosome Disorders, Combined Modality Therapy, Humans, Liver pathology, Liver Cirrhosis, Biliary diagnosis, Liver Cirrhosis, Biliary pathology, Liver Cirrhosis, Biliary therapy, Liver Diseases pathology, Liver Diseases therapy, Male, Middle Aged, Photosensitivity Disorders diagnosis, Photosensitivity Disorders pathology, Photosensitivity Disorders therapy, Porphyrias pathology, Porphyrias therapy, Chromosome Aberrations diagnosis, Erythropoiesis, Liver Diseases diagnosis, Liver Transplantation pathology, Porphyrias diagnosis, Protoporphyria, Erythropoietic, Protoporphyrins blood
- Abstract
A 51-year-old man had for 5 years been known to have erythropoietic protoporphyria. GPT levels were raised up to 40 U/l, gamma-GT up to 120 U/l. After lengthy exposure to sun radiation an erythema with blisters, abdominal discomfort and jaundice developed (total bilirubin 7.3 mg/dl) and biliary liver cirrhosis with portal hypertension and splenomegaly were diagnosed. Because the acute hepatobiliary complications were not improved by conservative treatment (daily 750 mg ursodeoxycholic acid and 12 g colestyramine), an orthotopic liver transplantation was performed without complication. The excised liver showed small nodular parenchymal transformation and contained reddish brown protoporphyrin pigment in the hepatocellular cytoplasm, the Kupffer cells, the canaliculi and in some biliary ducts. Bilirubin and transaminase levels in blood became normal after the transplantation, as did the urinary excretion of coproporphyrin. However, isomer I was still dominant. The protoporphyrin level in erythrocytes and plasma remained elevated. After a symptom-free interval of one year biochemical and histological tests demonstrated protoporphyrin-induced damage in the transplanted liver.
- Published
- 1992
- Full Text
- View/download PDF
35. [Technique of thyroid gland operation: prevention of lesions of the superior laryngeal nerve].
- Author
-
Lefèbre B, Steffen R, Steinmüller T, and Neuhaus P
- Subjects
- Humans, Laryngeal Nerves pathology, Laryngoscopy, Risk Factors, Laryngeal Nerve Injuries, Postoperative Complications prevention & control, Thyroidectomy methods, Vocal Cord Paralysis prevention & control
- Abstract
The anatomical variant of the external branch of the superior laryngeal nerve is at risk during thyroid surgery. We recommend a careful dissection of the upper thyroid pole strictly avoiding even minor mass ligatures and all vascular structures have to be selectively identified. Of a consecutive series of 161 upper pole dissections the superior laryngeal nerve was found in 31% and no postoperative injury was detected by video stroboscopy.
- Published
- 1990
36. [Sympathetic paraganglioma. A rare, retroperitoneal tumor].
- Author
-
Steinmüller T, Weidemann H, and Chmielewski G
- Subjects
- Adult, Calcinosis surgery, Female, Humans, Paraganglioma diagnostic imaging, Paraganglioma genetics, Postoperative Complications diagnostic imaging, Retroperitoneal Neoplasms diagnostic imaging, Tomography, X-Ray Computed, Paraganglioma surgery, Retroperitoneal Neoplasms surgery
- Published
- 1990
37. [Cooperation of head dental technician and head stomatological nurse in dentistry].
- Author
-
Steinmüller T
- Subjects
- Adult, Aged, Humans, Middle Aged, Practice Management, Dental, Dental Assistants, Dental Technicians, Interprofessional Relations
- Published
- 1989
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.