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Bacher H, Schweyen R, Olms C, Arnold C, Setz J, Hey J. 10-Year Clinical Comparative Study of Ceramic and Composite Veneered Metal Crowns. Eur J Prosthodont Restor Dent 2021; 29. [PMID: 33769724 DOI: 10.1922/ejprd_2148bacher11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The rejection of composite veneerings in fixed partial dentures is primarily caused by the inadequacy of the bonds between the metal framework and the composite veneering. The development of improved veneering composites necessitates an investigation of their clinical suitability compared with ceramic materials. Nineteen patients with at least two suitable, adjacent natural teeth for crowning were treated with 64 high noble alloy crowns. The adjacent crowns were veneered with ceramic (IPS inline) and composite materials (SR Adoro). Seven follow-up examinations were carried out over a period of 10 years. The crowns were investigated for mechanical defects, periodontal parameters, and discolorations. The survival rates of the ceramic veneered metal crowns (CeMCs) and composite veneered metal crowns (CoMCs) at the 10-year follow-up were 87.1 and 87.9%, respectively. The success rates of the crowns after 10 years were 83.9% for CeMCs and 51.5% for CoMCs (log-rank test, p = 0.009). No significant differences between the groups were found in the periodontal parameters (Kruskal-Wallis one-way analysis of variance, ANOVA p ⟩ 0.05). After 10 years, discoloration patterns of the two materials differed significantly (Mann-Whitney-U-test, p = 0.017). Thus, despite the improvements associated with CoMCs, CeMCs remain the gold standard for veneered metal crowns.
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Affiliation(s)
- H Bacher
- Martin-Luther-University Halle-Wittenberg, Department of Prosthodontics, Magdeburger Str. 16, 06112 Halle, Germany
| | - R Schweyen
- Martin-Luther-University Halle-Wittenberg, Department of Prosthodontics, Magdeburger Str. 16, 06112 Halle, Germany
| | - C Olms
- University of Leipzig, Department of Prosthodontics and Material Science, Liebigstr. 12, 04103 Leipzig, Germany
| | - C Arnold
- Martin-Luther-University Halle-Wittenberg, Department of Prosthodontics, Magdeburger Str. 16, 06112 Halle, Germany
| | - J Setz
- Martin-Luther-University Halle-Wittenberg, Department of Prosthodontics, Magdeburger Str. 16, 06112 Halle, Germany
| | - J Hey
- Charité - Universitätsmedizin Berlin, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Assmannshauser Strasse 4-6, 14197 Berlin
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Nanda M, Nanda R, Weiss EC, Bacher H, Lemmerer MM, Reif P, Schöll W, Tomasch G. Mehrfache manuelle Reposition trotz fortgeschrittener Schwangerschaft eines Uterus incarceratus unter Lachgas – Fallbericht. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1713221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- M Nanda
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Auenbruggerplatz 14, 8036 Graz
| | - R Nanda
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Auenbruggerplatz 14, 8036 Graz
| | - E-C Weiss
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Auenbruggerplatz 14, 8036 Graz
| | - H Bacher
- Universitätsklinik für Chirurgie, Auenbruggerplatz 29, 8036 Graz
| | - M M Lemmerer
- Universitätsklinik für Chirurgie, Auenbruggerplatz 29, 8036 Graz
| | - P Reif
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Auenbruggerplatz 14, 8036 Graz
| | - W Schöll
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Auenbruggerplatz 14, 8036 Graz
| | - G Tomasch
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Auenbruggerplatz 14, 8036 Graz
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Wagner D, Marsoner K, Tomberger A, Haybaeck J, Haas J, Werkgartner G, Cerwenka H, Bacher H, Mischinger H, Kornprat P. Low skeletal muscle mass outperforms the Charlson Comorbidity Index in risk prediction in patients undergoing pancreatic resections. Eur J Surg Oncol 2018; 44:658-663. [DOI: 10.1016/j.ejso.2018.01.095] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 12/13/2017] [Accepted: 01/19/2018] [Indexed: 12/11/2022] Open
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Werkgartner G, Cerwenka H, El Shabrawi A, Bacher H, Hauser H, Mischinger HJ, Wagner M, Wagner D. Laparoscopic versus open appendectomy for complicated appendicitis in high risk patients. Int J Colorectal Dis 2015; 30:397-401. [PMID: 25510816 DOI: 10.1007/s00384-014-2095-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Laparoscopic appendectomy is widely used for the treatment of complicated appendicitis. Its use in patients with high operative risk is still on debate. The aim of the presented study was to investigate the benefits of laparoscopic appendectomy in patients with high peri- and postoperative risk factors. METHODS We performed a retrospective analysis of all patients who underwent appendectomy in our center between 2006 and 2013. Patients were classified according to their preoperative risk (classification of the American Society of Anesthesia--ASA score). Only patients with ASA 3 and 4 were included and were divided into two groups--open appendectomy (OA group) and laparoscopic appendectomy (LA group). RESULTS The operation time was slightly longer in the LA group (p = 0.05), but hospital stay was shorter (p = 0.05). Complications graded according to the Clavien Dindo classification were slightly more frequent in patients after LA, whereas severe complications occurred more frequently in patients after OA (p = 0.01). The postoperative WBC decreased steadily and significantly in patients after OA, whereas the decrease in patients after LA was delayed (p = 0.03). CRP slightly increased after OA and decreased thereafter, whereas it steadily decreased after LA (p = 0.05). CONCLUSION Laparoscopic appendectomy can be recommended for patients with complicated appendicitis even with higher risk categories.
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Affiliation(s)
- G Werkgartner
- Department of Surgery, Division for General Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
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Mischinger HJ, Bernhard G, Cerwenka H, Hauser H, Werkgartner G, Kornprat P, El Shabrawi A, Bacher H. Management of bile duct injury after laparoscopic cholecystectomy*. Eur Surg 2011. [DOI: 10.1007/s10353-011-0060-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Schest EC, Cerwenka H, El-Shabrawi A, Bacher H, Mischinger HJ. Liver Surgery for Breast Cancer Metastases. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1225220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Cerwenka H, Bacher H, El-Shabrawi A, Kornprat P, Lemmerer M, Portugaller HR, Mischinger HJ. Management of pancreatic trauma and its consequences--guidelines or individual therapy? Hepatogastroenterology 2007; 54:581-4. [PMID: 17523326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND/AIMS Diagnosis of pancreatic trauma and its complications may be difficult due to non-specific signs and symptoms and treatment recommendations are not unequivocal. METHODOLOGY Clinical data of a series of 47 patients with pancreatic trauma were analyzed; most of them were polytraumatized and treated by an interdisciplinary team. RESULTS The most common causes were traffic accidents and sport injuries with 66% and 15%, respectively. Concomitant injuries were seen in 96% (nonpancreatic intra-abdominal injuries 85% including spleen 38% and liver 34%, extra-abdominal injuries 70%). Concomitant liver injuries were treated conservatively in 31% and operatively in 69% (including hepatic packing in 38%). Concomitant splenic injuries were usually very severe and could be managed conservatively in only 11%. All patients with pancreatic injuries grade III, IV or V (17%) according to the American Association of Surgical Trauma Classification required surgery, endoscopic treatment or interventional radiology. The most common posttraumatic complications were necrotizing pancreatitis (15%), pseudocyst formation (9%), abscesses (6%) and fistulas (4%). CONCLUSIONS The status of the pancreatic duct is the crucial point for management of pancreatic trauma and should be assessed as early as possible. Treatment has to be tailored to the individual situation, especially in patients with severe concomitant injuries or prolonged course.
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Affiliation(s)
- H Cerwenka
- Department of Visceral Surgery, Medical University of Graz, Austria.
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Cerwenka H, Bacher H, Werkgartner G, El-Shabrawi A, Kornprat P, Bernhardt GA, Mischinger HJ. Treatment of patients with pyogenic liver abscess. Chemotherapy 2005; 51:366-9. [PMID: 16227693 DOI: 10.1159/000088964] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2004] [Accepted: 06/20/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pyogenic liver abscess (PLA) remains a serious disease with a mortality of 6-14%. METHODS Clinical data of 76 patients with PLA were analyzed. Treatment options comprised antibiotics, percutaneous puncture/drainage, endoscopic papillotomy/stenting and/or surgery as indicated. RESULTS Fifty-eight patients (76%) had single and 18 patients multiple PLA (right lobe: 65%; both lobes: 22%). The most frequent etiologies were: biliary (38%), hematogenous and posttraumatic (11%). Factors associated with the need for surgery included gallbladder empyema, biliary fistulas, malignancy, perforation, multicentricity, vascular complications and foreign bodies (e.g. infected ventriculo-peritoneal shunt, toothpick). CONCLUSIONS Microbiological testing provides important information for treatment monitoring and modification. Complementary assessment of risk factors for a complicated course is crucial for timely identification of patients requiring additional treatment.
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Affiliation(s)
- H Cerwenka
- Department of Visceral Surgery, Medical University of Graz, Austria.
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Kornprat P, Bacher H, Cerwenka H, El-Shabrawi A, Langner C, Mischinger HJ. Intestinal bleeding associated with antiphospholipid antibody syndrome. Endoscopy 2005; 37:95. [PMID: 15657869 DOI: 10.1055/s-2004-826098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- P Kornprat
- Division of General Surgery, Department of Surgery, University Medical Center, Graz, Austria.
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Bernhardt GA, Bacher H, Hagen D, Zauner D, Gülly C, Cerwenka H, Zatloukal K, Mischinger HJ. Heat shock protein 70: a new biomarker for ischemic-reperfusion injury due to Pringle maneuver. Eur Surg 2004. [DOI: 10.1007/s10353-004-0100-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kornprat P, Bacher H, Cerwenka H, El-Shabrawi A, Hauser H, Langner C, Mischinger HJ. Dysontogenetic liver cysts and their surgical management. Eur Surg 2004. [DOI: 10.1007/s10353-004-0093-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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El-Shabrawi A, Bacher H, Cerwenka H, Kornprat P, El-Shabrawi Y, Höfler G, Schweiger J, Mischinger HJ. Value of reverse transcriptase polymerase chain reaction tests for detection of peripheral blood hepatocellular carcinoma cells. Eur Surg 2004. [DOI: 10.1007/s10353-004-0105-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Schweiger W, El-Shabrawi A, Werkgartner G, Bacher H, Cerwenka H, Thalhammer M, Mischinger HJ. Impact of parenchymal transection by Ultracision® harmonic scalpel in elective liver surgery. Eur Surg 2004. [DOI: 10.1007/s10353-004-0099-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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El-Shabrawi A, Bacher H, Cerwenka H, Werkgartner G, El-Shabrawi1 Y, Hofler2 G, Mischinger HJ. Is the Information Yielded by Detection of Circulating HCC Cells in Peripheral Blood of Clinical Relevance? Eur Surg 2002. [DOI: 10.1046/j.1563-2563.2002.02086.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mischinger HJ, Cerwenka H, Bacher H, Werkgartner G, El-Shabrawi A, Hoss G. Komplikationen in der Leberchirurgie und ihre Vermeidung. Eur Surg 2001. [DOI: 10.1046/j.1563-2563.2001.01152.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mischinger HJ, Bacher H. Zirkularstapler-Mukosektomie vs. geschlossene submukose Hamorrhoidektomie - eine prospektiv randomisierte Multicenter-Studie an 100 Patienten mit prolabierenden Hamorrhoidalknoten Grad III und IV. Eur Surg 2001. [DOI: 10.1046/j.1563-2563.2001.01106.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cerwenka H, Aigner R, Bacher H, Werkgartner G, el-Shabrawi A, Quehenberger F, Mischinger HJ. Pancreatitis-associated protein (PAP) in patients with pancreatic cancer. Anticancer Res 2001; 21:1471-4. [PMID: 11396234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND Pancreatitis-associated protein (PAP) is known as a marker for pancreatitis and cystic fibrosis. The aim of our study was to evaluate PAP in patients with pancreatic cancer, to assess its correlation to the extent of the disease and to compare it to CA19-9. PATIENTS AND METHODS This prospective study comprised 75 individuals. Thirty had pancreatic cancer, 30 were healthy controls and 15 had benign lesions of the pancreas. PAP was determined by enzyme-linked immunosorbent assay. Statistical analysis was by Wilcoxon test and Spearman correlation coefficients. RESULTS As compared to healthy individuals and using a cut-off of 18 micrograms/l corresponding to a sensitivity of 90%, the specificity of PAP for pancreatic cancer was 82.8%. PAP elevation in cancer patients could not be explained by concomitant pancreatitis (p = 0.649). PAP did not show correlation to tumour size (p = 0.14), T-stages (p = 0.706) or tumour grading (p = 0.105), but was significantly correlated to the overall extent of the disease according to the UICC stages (p = 0.002). No correlation between PAP and CA19-9 was seen. Jaundice was not found to influence PAP values (p = 0.4). CONCLUSION Elevation of PAP in patients with pancreatic cancer is not merely explainable by concomitant pancreatitis, but seems to be due to increased PAP production by the cancer cells and is also correlated to tumour load as expressed by the UICC stages.
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Affiliation(s)
- H Cerwenka
- Department of Visceral Surgery, Karl-Franzens University School of Medicine, Auenbruggerplatz 29, A-8036 Graz, Austria.
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Bacher H, Mischinger HJ, Cerwenka H, Werkgartner G, El-Shabrawi A, Supancic A, Porta S. Liver ischemia, catecholamines and preoperative condition influencing postoperative tachycardia in liver surgery. Life Sci 2000; 66:11-8. [PMID: 10658919 DOI: 10.1016/s0024-3205(99)00556-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of our study was to assess the influence of intraoperative hypoxic stress -unavoidably brought about by so called Pringle maneuver - on free and conjugated catecholamines during major hepatic resection. Judging from earlier results of fatigue-experiments in rats we also wanted to check the relationship between of poor general preoperative condition and conspicuously low triglyceride serum concentrations. The study included 26 patients with primary and secondary liver tumors. The mean age was 54 years (range 27-79). Twenty-one patients had segmental liver resections, 3 had hemihepatectomies and 2 hydatid cysts were treated by cystectomy. Blood samples were taken 2 days before and throughout surgery. Catecholamine plasma values were determined by high performance liquid chromatography. Statistical comparisons were made by t-test, ANOVA and chi square test. Free plasma catecholamines increased significantly during prolonged intraoperative ischemia (Pringle time 50-125 minutes). Patients with elevated intraoperative catecholamines had a significant correlation to postoperative episodes of tachycardia, and prolonged hospital stay. On the other hand, we could also see postoperative tachycardias in patients with short Pringle times (18-49 minutes) but with decreased preoperative serum triglycerides as an indicator of chronic stress and reduced general condition. Intraoperative hypoxic stress is associated with increased catecholamine values. Elevated catecholamines may well cause postoperative sinus-tachycardias (mean 20 hours) and are strongly related to postoperative liver failure and prolonged hospital stay.
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Affiliation(s)
- H Bacher
- Department of General Surgery, University of Graz, Austria
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Abstract
Because bronchogenic cysts may be found in or near any organ derived from the embryonic foregut, they sometimes pose considerable diagnostic difficulties. We describe the plain chest X-ray, computed tomographic, and angiographic findings in a patient with elevated CA 19-9 and upper quadrant abdominal pain due to a cystic tumor appearing as a hepatic mass. Surgery and histology showed a bronchogenic cyst located in the lower lobe of the right lung.
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Affiliation(s)
- H Cerwenka
- Department of General Surgery, Karl-Franzens University School of Medicine, Graz, Austria
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Cerwenka H, Khoschsorur G, Bacher H, Werkgartner G, El-Shabrawi A, Quehenberger F, Rabl H, Mischinger HJ. Normothermic liver ischemia and antioxidant treatment during hepatic resections. Free Radic Res 1999; 30:463-9. [PMID: 10400458 DOI: 10.1080/10715769900300501] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of our study was to evaluate the clinical impact of reperfusion injury after normothermic ischemia during major liver resections and the effect of an intraoperative antioxidant infusion. This prospective randomized study comprised 50 patients; half of them (treatment group) were given an antioxidant infusion containing tocopherol and ascorbate immediately prior to reperfusion onset. Venous blood samples for the determination of MDA-TBARS (malondialdehyde-thiobarbituric acid reactive substances) by a HPLC-based test as a marker of lipid peroxidation were taken prior to ischemia, 30 min after reperfusion onset and at the end of the operation. In the control group there was a significant increase of MDA-TBARS (p = 0.001) at 30 min after reperfusion onset. At the end of the operation the values had returned to the initial level. The treatment group showed only a marginal increase (p-value for the difference between the two groups: 0.007). After exclusion of the patients with histologically proven advanced cirrhosis the increase in the control group (p < 0.001) and the difference between the increase in the two groups (p = 0.001) became more significant. Prothrombin time was also significantly better in the treatment group (p = 0.003). Postoperative complications such as prolonged liver failure, bleeding disorders and infections were seen more often in the control group. In our study MDA-TBARS was increased after liver ischemia, but in patients with advanced cirrhosis the effect was smaller or even absent. This increase and possible clinical consequences of reperfusion injury could be reduced by intraoperative administration of an antioxidant infusion.
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Affiliation(s)
- H Cerwenka
- Department of General Surgery, Karl-Franzens University School of Medicine, Graz, Austria.
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Affiliation(s)
- W Schweiger
- Department of Surgery, Karl-Franzens University Graz, Austria
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Bacher H, Schweiger W, Cerwenka H, Mischinger HJ. Use of anal endosonography in diagnosis of endometriosis of the external anal sphincter: report of a case. Dis Colon Rectum 1999; 42:680-2. [PMID: 10344694 DOI: 10.1007/bf02234150] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Perianal endometriosis is an infrequent form of extragenital endometriosis and is usually situated in episiotomy scars. METHODS We report a rare case involving the external anal sphincter in a 24 year-old female. The precise anatomical location of the endometriotic lesion was confirmed using preoperative and intraoperative anal endosonography. CONCLUSION We believe this procedure to be essential when history, digital examination, and proctoscopy are not conclusive in the differential diagnosis of perianal pain or mass. Although hormonal suppression often is the therapy of choice in extrapelvic endometriosis, we think surgical excision, respecting the anatomical fiber architecture of the anal sphincter, is the best treatment for perianal endometriosis. Surgical excision is required for histological diagnosis, which is imperative in view of the albeit rare development of malignancy in extragenital endometriosis.
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Affiliation(s)
- H Bacher
- Department of Surgery, Karl-Franzens-University Graz, Austria
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Bacher H, Cerwenka H, Werkgartner G, El-Shabrawi A, Höss G, Preidler K, Klimpfinger M, Mischinger HJ. Primary biliary cystadenocarcinoma perforating the duodenum and left intrahepatic biliary tree--mimicking a hydatid cyst. Liver 1999; 19:39-41. [PMID: 9928764 DOI: 10.1111/j.1478-3231.1999.tb00007.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
We report the case of a 76-year-old woman with biliary cystadenocarcinoma perforating the left biliary tree and exhibiting intra-tumoral gas bubbles resulting from invasion of the duodenum. The clinical history included subfebrile temperatures of 3 months duration, and pains associated with an abdominal mass in the right upper quadrant. Blood tests showed leucocytosis, and radiological studies revealed the features of a partially calcified septated tumor with nodular components combined with multiple gas-fluid levels, mimicking an infected hydatid cyst. Intraoperative ultrasonography, cholangiography and frozen section histology were necessary to prove the malignant nature of this cystic tumor. Provided that complete resection with strict adherence to oncological precepts is possible, the prognosis of cystadenocarcinoma is better than in hepatocellular or cholangiocellular carcinoma.
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Affiliation(s)
- H Bacher
- Department of Surgery, Karl-Franzens-University, Graz, Austria
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Cerwenka H, Aigner R, Bacher H, Werkgartner G, el-Shabrawi A, Quehenberger F, Mischinger HJ. TUM2-PK (pyruvate kinase type tumor M2), CA19-9 and CEA in patients with benign, malignant and metastasizing pancreatic lesions. Anticancer Res 1999; 19:849-51. [PMID: 10216504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The diagnostic value of the tumor marker pyruvate kinase type tumor M2 was evaluated in patients with benign, malignant and metastasizing pancreatic lesions and compared to the reference markers CA19-9 and CEA. This prospective study comprised 166 individuals; 66 patients had various pancreatic pathologies (38 histologically proven pancreatic cancer, 28 benign pancreatic lesions such as pseudotumorous pancreatitis, pseudocysts or pancreatic (cyst)adenoma) and 100 healthy blood donors served as controls. With a cut-off value of 28 U/ml (corresponding to a specificity of 90%) the sensitivity of TUM2-PK for pancreatic cancer (as related to the control group) was 79% (CA19-9: 65%, CEA: 22%). There was a good correlation between the TUM2-PK levels and tumor metastasis (p < 0.001 for no versus distant metastasis, p = n.s. for CA19-9 and CEA). However, TUM2-PK was also elevated in 64.3% of the patients with benign pancreatic pathologies. In our study TUM2-PK had good diagnostic qualities for pancreatic cancer and also showed better correlation to metastasis than CA 19-9 and CEA.
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Affiliation(s)
- H Cerwenka
- Department of General Surgery, Karl-Franzens University School of Medicine, Graz, Austria.
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Affiliation(s)
- H Augustin
- Department of Urology, Karl-Franzens-University Graz, Austria
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Cerwenka H, Bacher H, Werkgartner G, El-Shabrawi A, Mischinger HJ. Massive liver haemorrhage and rupture caused by HELLP-syndrome treated by collagen fleeces coated with fibrin glue. Eur J Surg 1998; 164:709-11. [PMID: 9728792 DOI: 10.1080/110241598750005615] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- H Cerwenka
- Dept. of General Surgery, Karl-Franzens University School of Medicine, Graz, Austria
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Abstract
Biliary cystadenocarcinoma is a rare, usually intrahepatic neoplasm. A case is described in which an intrahepatic cystadenocarcinoma invaded the duodenum. This resulted in intratumoral gas.
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Affiliation(s)
- R Stacher
- Department of Radiology, Karl-Franzens Medical School, University Hospital, Graz, Austria
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Cerwenka H, Bacher H, Werkgartner G, El-Shabrawi A, Quehenberger F, Hauser H, Mischinger HJ. Antioxidant treatment during liver resection for alleviation of ischemia-reperfusion injury. Hepatogastroenterology 1998; 45:777-82. [PMID: 9684133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIMS Many experimental studies on ischemia-reperfusion injury in animals suggest a preventive effect of antioxidants, but the clinical significance of these findings is still unclear. The aim of our study was to evaluate the effect of antioxidant treatment with vitamins on liver function parameters during liver resection. METHODOLOGY Our prospective randomized study comprised 58 patients undergoing major liver surgery, including the Pringle maneuver. In the treatment group 32 patients received a multivitamin infusion (Omnibionta) which included 10 mg of alpha-tocopherol acetate, 2 mg of DL-alpha-tocopherol and 1 g of ascorbate. The control group consisted of 26 patients. Various parameters associated with liver function, such as transaminases, lactate, ammonia, bilirubin, cholinesterase and clotting parameters were measured preoperatively, at the beginning of liver ischemia, 15, 30 and 60 minutes after reperfusion onset and every 12 hours after the operation. RESULTS The Mann-Whitney-Wilcoxon-Test showed statistically significant differences in the postischemic changes between the treatment group and the control group for the Quick test (prothrombin time): p = 0.01. The transaminases were also markedly better in the treatment group (splitting-up slightly more delayed than with the Quick test). A smaller effect was seen with cholinesterase. Lactate, however, increased intraoperatively with a strong correlation to the duration of ischemia and returned quickly to baseline values without any remarkable influence of the antioxidant treatment. CONCLUSION In our study, antioxidant treatment with a multivitamin infusion showed a positive effect on postischemic liver function parameters.
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Affiliation(s)
- H Cerwenka
- Department of General Surgery, Karl-Franzens University School of Medicine, Graz, Austria.
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Dryka T, Radwańska-Korzeniowska U, Jesipowicz M, Hermanowicz-Dryka T, Bacher H. [The effect of heparin on the course of some organ complications in experimental acute pancreatitis in rats]. Wiad Lek 1998; 50 Suppl 1 Pt 2:89-95. [PMID: 9424934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aim of this study was to present whether the heparin has on influence on course of experimental acute pancreatitis (AP) and some organ complications. The research referred to histological changes in liver, lungs and kidneys. The study was conducted on 69 rats divided into 5 groups: I--operated, without induction AP, II--control, induction of AP without treatment, III--induction of AP and immediate administration of heparin, IV--induction of AP and administration of heparin 3 hours after, V--induction of AP and administration of heparin 6 hours after. AP was induced by administration 5% sodium taurocholate. In all groups the animals were anesthetised after the period of 3, 6 and 12 hours from the induction of AP respectively. The specimens of mentioned organs were formalinized and stained with hematoxylin/eosin, and in addition specimens of the liver with p.a.S, Sudan IV and Brachets methods. In group I we observed pulmonary oedema after 6 and 12 hours but kidneys and liver were unchanged. In group II pathological changes were most evident in lungs, while we observed on acute passive hyperaemia, pulmonary emphysema and single coagulative thrombosis in vessels. In the liver number of lining cells was increased and minor or major droplets of lipids in hepatocytes were present. Using Brachets method we revealed regular staining of hepatocytes, and p.a.S. method regular staining of their cytoplasm. In group III examined organs do not show any significant differences as compared with group II, except for lungs where the coagulative thrombosis was not present. In groups IV and V changes were similar to those described in group II. This study showed decreased inflammatory and thrombotic process in lungs in experimental AP in rats after heparin treatment.
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Affiliation(s)
- T Dryka
- I Katedry Chirurgii, I Kliniki Chirurgii Ogólnej i Transplantacyjnej Akademii Medycznej w Lublinie
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Mischinger HJ, Werkgartner G, Cerwenka H, Bacher H, El-Shabrawi A, Breinl E, Klimpfinger M, Hauser H, Hausegger KH. Management of hydatid disease of the liver—10 years' experience in a non-endemic area. ACTA ACUST UNITED AC 1997. [DOI: 10.1007/bf02489031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Cerwenka H, Aigner R, Quehenberger F, Werkgartner G, Bacher H, Hauser H, Mischinger HJ. Preoperative differential diagnosis of benign and malignant pancreatic lesions--the value of pancreatic secretory trypsin inhibitor, procarboxypeptidase B, CA19-9 and CEA. Hepatogastroenterology 1997; 44:1117-21. [PMID: 9261609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND/AIMS Pancreatic secretory trypsin inhibitor (PSTI). Procarboxypeptidase B (PCPB or Human pancreas-specific protein HPASP), CA19-9 and CEA were evaluated for their performance in preoperative differential diagnosis of benign and malignant pancreatic lesions. METHODOLOGY Our prospective study included 92 patients with pancreatic lesions diagnosed by imaging techniques. In 45 of them (group I), the lesions turned out to be malignant tumors (35 pancreatic cancer, 10 other carcinoma of the pancreatic region); 47 patients (group II) had benign lesions (38 inflammatory disease of the pancreas, 9 other benign lesions). RESULTS Statistical analysis showed significant differences between these two groups for PSTI, PCPB and CA19-9, but not for CEA. When only pancreatitis versus pancreatic cancer was analyzed, differences were more significant for PSTI and PCPB, but less significant for CA19-9. Because of a strong trend toward false positive values in patients with pancreatic inflammation, the specificity of CA19-9 in our selected patient group was only 67%, but in combination with normal PSTI (< 13.5 ng/ml), it reached 96%. CONCLUSION In our study, PSTI and PCPB were useful markers for pancreatitis. PSTI also showed good correlation with the severity of the inflammation and provided additional preoperative information, in combination with CA19-9.
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Affiliation(s)
- H Cerwenka
- Department of General Surgery, Karl-Franzens-University, School of Medicine, Graz, Austria.
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Bacher H, Mischinger HJ, Werkgartner G, Cerwenka H, El-Shabrawi A, Pfeifer J, Schweiger W. Local nitroglycerin for treatment of anal fissures: an alternative to lateral sphincterotomy? Dis Colon Rectum 1997; 40:840-5. [PMID: 9221864 DOI: 10.1007/bf02055444] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Nitric oxide is an important neurotransmitter mediating internal anal sphincter relaxation. Patients suffering from fissure-in-ano were treated with topical nitroglycerine. The clinical evidence for therapeutic adequacy was examined in a prospective, randomized study. METHODS The study included 35 patients with acute and chronic anal fissures. In Group A, including 20 patients with the clinical diagnosis of acute (12 patients) and chronic (8 patients) anal fissures, treatment consisted of topical nitroglycerine. Group B, consisting of 15 patients (10 acute and 5 chronic fissures), received topical anesthetic gel during therapy. Manometry was performed before and on days 14 and 28 in the course of topical application of either 0.2 percent glyceryl trinitrate ointment or anesthetic gel (lignocaine). Anal pressures were documented by recording the maximum resting and squeeze pressures. RESULTS In 60 percent of cases treated with topical nitroglycerine (Group A, 11 acute (91.6 percent) and 1 chronic (12.5 percent)), anal fissure healed within 14 days, in contrast to Group B in which no healing was observed. The healing rate after one month was 80 percent (11 acute (91.6 percent); 5 chronic (62.5 percent)) in Group A and was significantly superior to Group B (healing rate, 40 percent: 5 acute (50 percent); 1 chronic (20 percent)). DISCUSSION Previously increased maximum resting pressures decreased from a mean value of 110 to 87 cm H2O. This represents a mean reduction of 20 percent (P = 0.0022). We also noted a significant decrease in squeeze pressures (from 177.8 to 157.9 cm H2O (11 percent)). However, anal pressures did not decrease significantly in the four chronic fissure patients from Group A, whose fissures only healed after 28 days. Similarly to these Group A chronic fissure patients, no significant anal pressure reduction was observed in any Group B patients. Except for mild headache (20 percent), no side effects of treatment were reported. CONCLUSIONS Topical application of nitroglycerine represents a new, easily handled, and effective alternative in the treatment of anal fissures. All of our patients reported a dramatic reduction in acute anal pain. However, it should be noted that a lack of sphincter tone reduction is a likely reason for the great tendency of chronic anal fissures to recur.
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Affiliation(s)
- H Bacher
- Department of Surgery, Karl-Franzens-University, Graz, Austria
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Cerwenka H, Werkgartner G, Bacher H, el-Shabrawi A, Mischinger HJ. Intrahepatic hematoma with secondary Salmonella infection via biliary fistula. Hepatogastroenterology 1997; 44:529-32. [PMID: 9164532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Usually liver hematoma after blunt trauma is treated conservatively as long as clinically possible, in order to avoid infection via drainage. We report a patient who developed a huge liver abscess after a minor blunt trauma caused by a piece of wood that hit his hepatic region during work with a circular saw. Neither conservative treatment nor percutaneous drainage was successful and intraoperatively a biliary fistula was identified as the route of infection by salmonella. Cholecystectomy (here meaning removal of the salmonella reservoir) and consequent drainage of the gall flow via T-drain were the crucial therapeutic steps and the fistula finally closed after three months. Therapeutic possibilities in the management of blunt liver trauma, and biliary and septic complications are discussed.
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Affiliation(s)
- H Cerwenka
- Department of General Surgery, University Clinic of Surgery, Karl-Franzens University, School of Medicine, Graz, Austria
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Baradaran S, Mischinger HJ, Bacher H, Werkgartner G, Karpf E, Linck FG. [Spontaneous splenic rupture during portal triad clamping]. Langenbecks Arch Chir 1995; 380:266-8. [PMID: 7500797 DOI: 10.1007/bf00184100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A 45-year-old woman underwent a resection for a hepatic metastasis of the liver caused by a carcinoma of the colon. Shortly after the Pringle maneuver severe hemorrhage from the upper left quadrant of the abdomen was observed. Exploration revealed a spontaneous parenchymal laceration of the spleen.
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