12 results on '"Kirsten Meurer"'
Search Results
2. Surprising Twist in the Plot – Sister Mary Joseph’s Nodule of Pancreatic Cancer Mimicking Wound Infection after Umbilical Hernia Repair
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Andreas Minh Luu, Chris Braumann, Waldemar Uhl, Johanna Munding, Torsten Herzog, and Kirsten Meurer
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Aged, 80 and over ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Gastroenterology ,Sister Mary Joseph's Nodule ,Middle Aged ,medicine.disease ,Wound infection ,Surgery ,Pancreatic Neoplasms ,Radiation therapy ,Oncology ,Pancreatic cancer ,medicine ,Umbilical hernia repair ,Humans ,Female ,business ,Hernia, Umbilical - Published
- 2017
3. Small bowel obstruction due to a giant Meckel's diverticulum
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Waldemar Uhl, Chris Braumann, Torsten Herzog, Kirsten Meurer, Andrea Tannapfel, and Andreas Minh Luu
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Gastrointestinal bleeding ,medicine.medical_specialty ,Ileus ,medicine.medical_treatment ,Ileum ,Case Report ,digestive system ,03 medical and health sciences ,0302 clinical medicine ,Laparotomy ,medicine ,ddc:610 ,Meckel's diverticulum ,business.industry ,Gastroenterology ,medicine.disease ,Surgery ,Bowel obstruction ,medicine.anatomical_structure ,Acute abdomen ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Diverticulum - Abstract
Background: Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, with an average length of 3 cm. Complications occur in 6.4% and most commonly include inflammation and gastrointestinal bleeding. Preoperative diagnosis is demanding and achieved in 4%. Case Report: A 34-year-old otherwise healthy patient presented with an acute abdomen due to small bowel obstruction. Computed tomography scan could not identify the underlying cause. Emergency laparotomy was performed, and a torqued giant Meckel's diverticulum measuring 17 cm was found as the underlying cause for the small bowel obstruction. Resection of the affected ileum segment and ileo-ileal reconstruction were performed. The postoperative course was uneventful. Conclusion: In extremely rare cases, small bowel obstruction in an otherwise healthy patient might be caused by torsion of a symptomatic giant Meckel's diverticulum.
- Published
- 2016
4. Pancreatic Surgery in the Very Old: Face to Face With a Challenge of the Near Future
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Guelnur Kaya, Waldemar Uhl, Kirsten Meurer, Christophe A. Müller, Torsten Herzog, Orlin Belyaev, and Ansgar M. Chromik
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Male ,medicine.medical_specialty ,Pancreatic disease ,Kaplan-Meier Estimate ,Pancreaticoduodenectomy ,Pancreatectomy ,Postoperative Complications ,Risk Factors ,Germany ,Health care ,medicine ,Humans ,Intensive care medicine ,Survival rate ,Retrospective Studies ,Aged, 80 and over ,Gastric emptying ,business.industry ,Age Factors ,Pancreatic Diseases ,Retrospective cohort study ,Length of Stay ,Vascular surgery ,medicine.disease ,Survival Rate ,Treatment Outcome ,Pancreatic fistula ,Cohort ,Female ,Surgery ,business ,Hospitals, High-Volume ,Follow-Up Studies - Abstract
The proportion of octogenarians requiring surgery for pancreatic disease is rapidly growing. This trend will be continued during the next decades, posing a challenge to surgeons and the health care system worldwide. This study aimed to analyze the results of pancreatic surgery in octogenarians in terms of safety and survival based on a cohort of patients at a European high-volume center.During a 7-year period, 1,705 operations were performed, 76 in patients ≥ 80 years of age. Data on the octogenarians were retrospectively reviewed and compared to those of the whole collective and to contemporary data from the literature. Primary endpoints were mortality, morbidity, and survival.Overall, 80 % had a malignant disease, and resections were performed in 50 % of all cases. Mortality was 11.8 % and morbidity 72.4 %. There were significantly more medical than surgical complications: 56.6 versus 34.2 %. Pancreatic fistula occurred in 5.3 %, postoperative bleeding in 3.9 %, and delayed gastric emptying in 19.7 %. The median hospital stay was 15 days and the intensive care unit stay 2 days. Mean survival was 28.2 months and in patients with cancer 22.6 months. The 1-, 3-, and 5-year survival rates were 61.4, 31.3, and 18.8 %, respectively.Despite high mortality and morbidity rates, surgery remains the only chance for cure in most octogenarians with pancreatic disease. Careful patient selection is the key to success and improved long-term survival in this group, which will represent a substantial fraction of the population in the near future.
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- 2013
5. [Not Available]
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Kirsten, Meurer, Björn, Freitag, and Waldemar, Uhl
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National Health Programs ,Germany ,Surgical Procedures, Operative ,Critical Pathways ,Humans ,Laparoscopy ,Health Care Costs ,Hospital Costs ,Length of Stay ,Delivery of Health Care ,Diagnosis-Related Groups ,Herniorrhaphy - Published
- 2016
6. Altersappendizitis
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U. Mittelkötter, Kirsten Meurer, Waldemar Uhl, Ansgar M. Chromik, Andrea Tannapfel, S. Kersting, and D. Sülberg
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Gynecology ,medicine.medical_specialty ,business.industry ,medicine ,Surgery ,business - Published
- 2009
7. Das Aus für die minimal-invasive Leistenhernienversorgung durch § 115 b SGB V
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C. Winnemöller, H. Plugge, H. Laubenthal, A. Hellwig, Dirk Weyhe, K. Kasoly, Waldemar Uhl, Kirsten Meurer, and K.-H. Bauer
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Gynecology ,medicine.medical_specialty ,Transplant surgery ,business.industry ,medicine ,Surgery ,business - Abstract
Nach § 115b Abs. 1 SGB V konnen Leistenhernien zukunftig nur noch unter bestimmten Voraussetzungen stationar versorgt werden. Die Methodenwahl zur ambulanten Versorgung von Leistenhernien scheint deshalb durch einfache Marktprinzipien bestimmt zu werden. Die vorliegende Arbeit untersucht die Machbarkeit ambulanter minimal-invasiver Hernienversorgungen hinsichtlich Patientenzufriedenheit, Komplikationsraten und Okonomie. Von einem Gesamtkollektiv von 571 Patienten mit Leistenhernien wurden in einem Zeitraum von einem Jahr an zwei Operationszentren 139 Patienten (131 Manner, 8 Frauen, mittleres Alter 46 Jahre, alle ASA I) ambulant mit einem endoskopischen total extraperitonealen Bruchluckenverschluss (TEP-BLV) versorgt. Die Kosten wurden mit einer okonomischen Vorkalkulation entsprechend dem klinischen Behandlungspfad ermittelt und mit den Erlosen im EBM2000plus verglichen. Am OP-Tag wurden 96,4% der Patienten entlassen, ohne dass eine Wiederaufnahme in der Klinik erfolgte, 54% nahmen innerhalb von 14 Tagen ihre berufliche Tatigkeit wieder auf, 88,7% der Patienten wurden sich erneut ambulant mittels TEP-BLV operieren lassen. Die Erlose nach EBM2000plus betragen durchschnittlich 565 Euro, wahrend sich die Vollkosten entsprechend der Vorkalkulation auf 709 Euro belaufen. Die ambulante minimal-invasive Leistenhernienversorgung mittels TEP-BLV stellt fur ein selektioniertes Patientengut eine patientenorientierte und sichere Therapieoption dar. Trotz optimaler Prozess- und Strukturqualitat ist derzeit aber eine ambulante Hernienversorgung angesichts der schlechten Erlossituation durch den EBM2000plus bei einer Unterdeckung von 20% unter betriebswirtschaftlichen Gesichtspunkten nicht akzeptabel. Der Gesetzgeber ist aufgefordert hier Nachbesserungen vorzunehmen.
- Published
- 2006
8. Early and late postoperative changes in the quality of life after pancreatic surgery
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Ansgar M. Chromik, Orlin Belyaev, Torsten Herzog, Waldemar Uhl, and Kirsten Meurer
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Adult ,Male ,medicine.medical_specialty ,Pancreatic disease ,medicine.medical_treatment ,Disease-Free Survival ,Pancreatic Fistula ,Pancreatectomy ,Postoperative Complications ,Quality of life ,Pancreatic cancer ,Germany ,Pancreatitis, Chronic ,Surveys and Questionnaires ,medicine ,Humans ,Aged ,Retrospective Studies ,business.industry ,General surgery ,Palliative Care ,Age Factors ,Vascular surgery ,Length of Stay ,Middle Aged ,medicine.disease ,humanities ,Pancreatic Neoplasms ,Cardiothoracic surgery ,Quality of Life ,Pancreatitis ,Surgery ,Exocrine Pancreatic Insufficiency ,Female ,business ,Hospitals, High-Volume ,Abdominal surgery - Abstract
To compare health-related quality of life (QoL) before and after surgery for pancreatic disease.A retrospective analysis of prospectively gathered data is presented. A total of 174 patients of 230 planned for pancreatic surgery between March and December 2009 at a German high-volume center completed the Short Form-36 (SF-36) Health Survey preoperatively, 133 of them at 3 months and 83 at 24 months after surgery. Data was analysed according to diagnosis and procedure, and compared to German population norms.QoL in the study group was worse than that of age-matched healthy population at all time points. It decreased continuously in the cancer group, decreased early and showed a trend toward recovery late in patients with benign tumors and chronic pancreatitis. Distal pancreatectomy was the best tolerated and total pancreatectomy the worst tolerated procedure. Older age and development of pancreatic insufficiency affected negatively QoL.In patients with pancreatic disease, diagnosis determined QoL preoperatively and late after surgery, while in the early postoperative period, type and extent of surgery was the leading factor. Total pancreatectomy had a profound negative effect on QoL and should be reserved for carefully selected patients only.
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- 2012
9. Identification of patients at risk for development of tertiary peritonitis on a surgical intensive care unit
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Kirsten Meurer, D. Sülberg, Adrien Daigeler, Matthias H. Seelig, A. Meiser, Heike Vogelsang, Janine Hölling, Waldemar Uhl, and Ansgar M. Chromik
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Adult ,Male ,Reoperation ,medicine.medical_specialty ,Time Factors ,Adolescent ,Gastrointestinal Diseases ,medicine.medical_treatment ,Peritonitis ,Risk Assessment ,Severity of Illness Index ,Sepsis ,Cohort Studies ,Young Adult ,Age Distribution ,Postoperative Complications ,Predictive Value of Tests ,Recurrence ,Laparotomy ,Severity of illness ,medicine ,Humans ,Prospective Studies ,Sex Distribution ,Intensive care medicine ,Prospective cohort study ,Survival rate ,Digestive System Surgical Procedures ,Aged ,Probability ,business.industry ,Incidence ,Gastroenterology ,Bacterial Infections ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,Anti-Bacterial Agents ,Survival Rate ,Intensive Care Units ,C-Reactive Protein ,SAPS II ,Surgery ,Female ,business ,Cohort study ,Follow-Up Studies - Abstract
Tertiary peritonitis (TP) is defined as a severe recurrent or persistent intra-abdominal infection after adequate surgical source control of secondary peritonitis (SP). The aim of this study was to analyze the characteristics of patients with SP who will further develop TP in order to define early diagnostic markers for TP.Over a 1-year period, all patients on the surgical intensive care unit (ICU) with SP were prospectively assessed for the development of TP applying the definition of the ICU consensus conference. The Mannheim Peritonitis Index (MPI), C-reactive protein (CRP) and Simplified Acute Physiology Score II (SAPS II) were assessed at the initial operation (IO) that was diagnostic for SP and in the postoperative period.Among 69 patients with SP, 15 patients further developed TP, whereas 54 patients did not develop TP. Compared to SP, patients with transition to TP had significantly higher MPI at IO (28.6 vs. 19.8; p0.001), relaparotomy rate (2.00 vs. 0.11; p0.001), mortality (60% vs. 9%; p0.001), duration of ICU stay (14 vs. 4 days; p0.005), as well as SAPS II (45.1 vs. 28.4; p0.005) and CRP (265 mg/dL vs. 217 mg/dL; p0.05) on the second postoperative day after IO.The MPI at IO as well as CRP and SAPS II at the second postoperative day helps to identify patients at risk for tertiary peritonitis.
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- 2008
10. Redo-surgery following curative resection of pancreatic carcinoma: the difference between true and suspected recurrence
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Torsten Herzog, Dirk Weyhe, Andrea Tannapfel, Kirsten Meurer, Ansgar M. Chromik, Waldemar Uhl, A. Meiser, Matthias H. Seelig, M Janot, and Orlin Belyaev
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Curative resection ,Adult ,Male ,Reoperation ,medicine.medical_specialty ,Treatment outcome ,Kaplan-Meier Estimate ,Neoplasm Recurrence ,Recurrent Pancreatic Carcinoma ,Clinical Protocols ,Pancreaticojejunostomy ,medicine ,Humans ,Pancreatic carcinoma ,Prospective Studies ,Prospective cohort study ,Aged ,business.industry ,General surgery ,Carcinoma ,Gastroenterology ,Recurrent pancreatic cancer ,Middle Aged ,Magnetic Resonance Imaging ,Surgery ,Pancreatic Neoplasms ,Treatment Outcome ,Redo surgery ,Female ,Neoplasm Recurrence, Local ,business - Abstract
Background: Improving results have led to an extension of indications for re-resection of recurrent pancreatic carcinoma. Methods: Among 410 patients who received surgery for histologically proven pancreatic cancer, 17 underwent re-resection for a suspected local recurrence and were evaluated for overall survival, clinicopathological and perioperative data. Results: At the initial operation, resection was curative (R0/R1) in all 17 patients. Indication for re-resection was a suspected or proven recurrence of pancreatic cancer in all patients. Re-resection was possible in 5 patients. The remaining patients received a redo of the pancreaticojejunostomy or bilioenteric anastomosis (n = 2), exploration with biopsy (n = 4), and a palliative bypass (n = 6). Perioperative mortality was 6%. Median overall survival was 25 months (range 10–152 months) and 7 months following re-resection (5–29 months). In 5 of 17 patients, histology showed chronic pancreatitis (n = 4) or a benign stricture at the hepaticojejunostomy (n = 1), whereas all other patients had histologically proven recurrence. Re-resection or redo of the anastomosis was possible in 5 of 5 patients with chronic pancreatitis but only in 2 of 12 patients with true recurrence (p = 0.003). Conclusions: Curative reoperation for recurrent pancreatic carcinoma is rarely feasible. Due to the potential for chronic pancreatitis or benign strictures as an underlying pathology, operable patients should be explored.
- Published
- 2008
11. Do various mesh placement techniques affect the outcome in totally extraperitoneal hernia repair? What is the role of the surgeon?
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P. Harrer, Dirk Weyhe, Karl-Heinz Bauer, Volker Zumtobel, M. Senkal, Kirsten Meurer, and Orlin Belyaev
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Hernia, Inguinal ,Return to work ,Postoperative Complications ,medicine ,Humans ,Hernia ,Longitudinal Studies ,Single institution ,Physician's Role ,Retrospective Studies ,Analysis of Variance ,Groin ,business.industry ,General surgery ,Recovery of Function ,Length of Stay ,Middle Aged ,Surgical Mesh ,medicine.disease ,Hernia repair ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Operative time ,Female ,Laparoscopy ,business ,Hospital stay - Abstract
Various modifications of mesh placement are currently used in total extraperitoneal (TEP) groin hernia repair. The aim of this study was to compare three different variants of mesh placement with respect to rate of complications and clinical outcome.A series of 397 consecutive patients with a total of 534 preperitoneal groin hernia TEP repairs performed by four surgeons at a single institution between 1999 and 2003 were retrospectively analyzed. The mean follow-up was 19.7 +/- 7.5 months. A single-mesh technique was used in cases of hernial orifice1.5 cm. Larger hernial defects were closed either in a double-mesh or a modified double-mesh placement technique. The three placement techniques were compared with respect to hospital stay, operative time, early and late complications, return-to-work time, and recurrence rate.The modified double-mesh technique was associated with the longest hospital stay, the longest operative time, the slowest return to work, and significantly higher rates of early (5.6% vs. 4.6% vs. 2.9%) and late (19.1% vs. 11.3% vs. 7.9%) postoperative complications, when compared to double-and single-mesh placement. Overall recurrence rate was 1.3% after a mean follow-up of 19.7 months. The larger the experience of a surgeon with his preferred technique, the shorter the operative time and hospital stay were.Mesh placement techniques appeared to have a direct impact on clinical outcome and hospital stay. The modified double-mesh technique showed the worst postoperative results, independent of the surgeon's experience. Which mesh placement technique is most appropriate for complex hernias remains to be answered by further randomized, controlled trials.
- Published
- 2007
12. Improving outcomes in hernia repair by the use of light meshes--a comparison of different implant constructions based on a critical appraisal of the literature
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Georgios Papapostolou, Orlin Belyaev, Kirsten Meurer, Waldemar Uhl, Christophe A. Müller, Dirk Weyhe, and Karl-Heinz Bauer
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medicine.medical_specialty ,Incisional hernia ,medicine.medical_treatment ,Biocompatible Materials ,Hernia, Inguinal ,Polypropylenes ,law.invention ,Prosthesis Implantation ,Randomized controlled trial ,law ,medicine ,Animals ,Humans ,Hernia ,Cell Proliferation ,Pain, Postoperative ,Groin ,business.industry ,Foreign-Body Reaction ,Equipment Design ,Prostheses and Implants ,Surgical Mesh ,medicine.disease ,Hernia repair ,Prognosis ,Surgery ,Clinical trial ,Critical appraisal ,medicine.anatomical_structure ,Implant ,business - Abstract
Despite convincing advantages offered by meshes, their use in hernia surgery remains controversial because of fears concerning the long-term effects of their implantation. To improve biocompatibility, a large variety of newly developed light meshes has been introduced to the market. This overview of the literature aimed to establish whether absolute material reduction (g per implanted mesh), use of absorbable components, and coating by inert materials are evidence-based ways to improve biocompatibility of meshes. A review of the current English and German language literature on the outcome of groin und incisional hernia mesh repair was performed. Both basic research and clinical trials were used as sources of data. Meta-analyses and randomized controlled trials were given priority and were referred to whenever possible. Operative technique was an independent prognostic factor for the clinical outcome. Mesh construction and composition as characterized by pore size and filament structure appeared to be more important determinants of foreign body reaction after implantation than absolute material reduction of 1 g or more per implant. No data exist about an oncogenic effect of alloplastic materials in humans, but disturbed fertility in animal studies remains an issue of concern and should be further investigated. According to data from current randomized controlled trials and retrospective studies, light meshes seem to have some advantages with respect to postoperative pain and foreign body sensation. However, their use is associated with increased recurrence rates. Light meshes offer no advantages with respect to alleviating severe chronic groin pain. At the same time, experimental data reveal that material composition and mesh structure may significantly affect foreign body reaction.
- Published
- 2006
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