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Biomedical subjects

A Encke

Publications and source records attributed to A Encke.

At least 91 records · Page 5Linked to original sources
PubMed1995

[Regional therapy breast cancer liver metastases].

The prognosis of patients with metastatic breast cancer in particular with an involvement of the liver has to be regarded as rather unfavourable. Up today no convincing therapy for patients with breast cancer and liver metastases could be found. From 1982 to 1991 42 patients with suspicion on liver metastases of a primary breast cancer were laparotomized. At that time 20 patients already had an extrahepatic formation of metastases. In contrast to the preexaminations an histologically benign liver tumor was intraoperatively verified in 6 patients. In the other 36 patients the operation was finished in 9 cases as explorative laparotomy (group A) because of extensive intra- and extrahepatic manifestation and/or vessel abnormalities. In 19 cases an arterial catheter system with subcutaneous port was implanted (group B). Partial liver resection combined with intraarterial catheter implantation was performed in 8 patients (group C). Postoperatively 27 patients monthly received a regional combined chemotherapy (groups B+C); a modified FAM scheme (5-Fluorouracil: 1000 mg/12 h/d/2 d, Adriamycin: 20 mg/12 h/d/3 d, Mitomycin C: 10 mg/2 h/d/1 d) was used. Response could be documented in 12 out of 17 evaluable patients (70.6%). A median overall postoperative survival time of 14.5 months for all patients in case of a proved liver metastases was calculated. A prolongation could not be realized, neither in patients with partial liver resection with regional therapy (group C) nor in patients with an intraarterial chemotherapy (group B). Only in exceptional cases a successful regional chemotherapy could influence the course favourable.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

The gasless laparoscopic cholecystectomy.

The pneumoperitoneum, generally used for all laparoscopic procedures, can lead to specific disadvantages and result in complications, and it furthermore represents a restriction of the surgeon's freedom of movement. In July, 1993 we started doing laparoscopic surgery without the pneumoperitoneum. Under direct vision and digital control, a fan-shaped wall retractor, which is attached to an electric lift arm, is introduced into the abdominal cavity. After raising the abdominal wall, the scope is introduced through the same access and the laparoscopic procedure can be started without the technical and pathophysiological problems which may occur when using a pneumoperitoneum. In this gasless laparoscopic procedure, simple valveless trocars and instruments can be used. During anaesthesia, neither an increased ventilation nor an enlarged ventilation pressure is necessary in this way we performed gasless laparoscopic cholecystectomy in 50 patients. We observed 5 wound infections as related complications. We had to change the surgical procedure seven times. The retraction technique creates a sufficient but not optimal exposure to the gallbladder. Intraoperative changes of the instruments, suction and specimen removal appeared easier. Both conventional and laparoscopic surgical instruments were introduced through the valveless trocars. Our experience demonstrates the practicability of this technique and potential advantages.

Cholecystectomy, Laparoscopic↗
PubMed1995

[Disposable versus reusable instruments in laparoscopic surgery--a controlled study].

The instruments for laparoscopic surgery are usually available in a disposable and in a reusable type. We performed a prospective, randomized study, based on the most frequent laparoscopic operation, the cholecystectomy, in order to directly quantify and compare the advantages and disadvantages of both types of instruments. 158 patients, who planned to undergo a cholecystectomy, were randomly distributed into two groups. 80 patients (group A) underwent surgery with reusable instruments and 78 patients (group B) with disposable instruments. We investigated the following parameters and compared them for both groups: length of operation, complications, conversion rate to open surgery, subjective postoperative pain, length of inability to work, technical problems during operation, postoperative hospitalization time, satisfaction of operating room personnel. The analysis of the results demonstrates no difference in the postoperative hospitalization time, in the postoperative complication rate, subjective pain sensation and postoperative inability to work. Differences in favour for the group of patients, operated with disposable instruments, were found in the conversion rate, in the length of operation and, statistically significant, in the amount of intraoperative problems, caused by instrument-technical reasons. Even if considering the greater expenses in time and personnel costs, operations with reusable instruments are in average 1015 DM cheaper.

Adolescent↗
PubMed1994

Primary gastric lymphomas: a clinicopathologic study with literature review.

Prognostic factors and treatment results were analysed in 28 consecutive patients with primary gastric lymphoma (PGL) diagnosed and treated, all by surgery and in many cases with additional chemotherapy (CT) and/or radiotherapy (RT), between 1977 and 1988. There were 13 patients in stage IE, 5 in IIE, and 10 in stage IV. The resection rate was 96.4% (27/28). Sixteen patients underwent an extended total and 11 a subtotal gastrectomy. Seventeen out of 25 cases (68%) were diagnosed by endoscopic biopsies. In 10 endoscopically diagnosed PGL cases the clinical staging and separation between stages IE and IIE from stage IV, due to ultrasonographic scan, computed tomography and bone marrow biopsy, was correct and the same with the surgical-pathological staging information. According to the Kiel-classification 18 patients had a low-grade and 9 patients a high-grade lymphoma. One patient could not be classified. All patients were completely followed-up, in an average time of 52 months. The probability of overall 5-year survival was 92% in stage IE, 75% in stage IIE, 88% in stages IE+IIE together, and 35% in stage IV. Extent of surgery (total vs. subtotal gastrectomy), Kiel-classification (low-grade vs. high-grade malignant histologic subtypes) and adjuvant CT in patients with stage IE (all 11 patients without CT remain in complete remission after an average of 45 months) did not significantly influence survival. The sole prognostic factor with proven impact on survival was the stage of disease (IE+IIE vs. IV: P = 0.001). For the Kiel-classification in particular there was no significant difference between low-grade and high-grade lymphomas with regard to the sex, symptomatic, extent of surgery, and stage at operation. These findings, together with data from the literature, suggest that gastric resection seems to be the optimal primary treatment in clinically assessed stages IE or IIE. In patients with stage IE disease, surgical resection can result in a cure, with no need for further therapy. The CT and/or RT can be effective in unresected and even bulky cases. Because of the difference in primary treatment, a preoperative clinical staging and separation between early stages from stage IV is always indicated.

Adult↗
PubMed1994

Modulation of adhesion molecule expression on endothelial cells by verapamil and other Ca++ channel blockers.

Cytokine-induced expression of adhesion molecules on leukocytes and endothelial cells (EC) is a crucial point in the process of organ transplant rejection. It has been shown that protein kinase C (PKC) is involved in this activation process. Verapamil and other calcium channel blockers seem to possess immunosuppressive qualities in vivo and in vitro; some authors suggested that this is due to PKC- or calmodulin-antagonism. Thus our objectives were to further investigate the second-messenger systems involved in the stimulation of EC and to analyze whether the beneficial influence of calcium channel blockers on the outcome of transplantation is due to impaired expression of adhesion molecules on EC. Our results, obtained in an in vitro model using human umbilical vein EC, show that IL-1-induced expression of intercellular adhesion molecule-1 (ICAM-1) is in part mediated by PKC and that parallel activation of calmodulin is required. Expression of ICAM-1 was reduced to 38.5% by PKC-inhibitor H7 and to 77.2% by calmodulin-inhibitor W7. In addition, data on the intracellular events in TNF-alpha-induced expression of vascular cell adhesion molecule-1 (VCAM-1) is presented, showing that both PKC and, to a higher extent, calmodulin, are involved in this process. Expression of VCAM-1 was reduced to 63.7% by H7 and to 27.7% by W7. IL-1-induced expression of endothelial leukocyte adhesion molecule-1 (ELAM-1) is PKC-dependent but insensitive to blocking of calmodulin. Though activation of adhesion molecule expression utilizes PKC and/or calmodulin as second-messenger pathways the investigated calcium channel blockers verapamil (R- and S-enantiomers), diltiazem and Ro 40-5967 failed to inhibit adhesion molecule expression. Surprisingly, higher concentrations of verapamil (> 12.5 micrograms/ml) or Ro 40-5967 (5 micrograms/ml) significantly enhanced IL-1-induced expression of ELAM-1. ICAM-1-expression was also enhanced by verapamil, but not by Ro 40-5967 or diltiazem. This enhancement was only seen if verapamil was added maximally one hour after the cytokine stimulus indicating that transcriptional modulation is responsible for the observed effects. Our findings indicate that calcium channel blockers have an immunomodulating effect independent of adhesion molecule expression.

1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine↗
PubMed1994

Adhesion and penetration properties of human lymphocytes acting on allogeneic vascular endothelial cells.

Lymphocyte infiltration through vascular endothelium is one important step in the course of graft rejection. To investigate this process more exactly we established a monolayer invasion assay which enabled us to discriminate between adherent and penetrated cells. Detailed studies of adhesion and penetration kinetics of peripheral blood lymphocytes (PBL) acting on allogeneic human umbilical vein endothelial cells (HUVEC) were carried out by combined phase contrast and reflection interference contrast microscopy. Between 30 and 35% of all PBL attached to HUVEC after 4 hr. Out of these less than 10% penetrated. When HUVEC were prestimulated for 2 hr by interferon (IFN)-alpha,-beta,-gamma or interleukin (IL)-1, PBL adhesion in the early phase of cellular attachment to endothelial cells was accelerated. Overall adhesion however did not increase. Long-term pretreatment of HUVEC for 72 hr with IFN-gamma or IL-1 also modified PBL-HUVEC interactions. However, a 72-hr pretreatment with IFN-alpha or -beta did not influence lymphocyte binding behaviour. PBL penetration was not only accelerated but also enhanced by IFN-alpha,-beta,-gamma, irrespective of whether HUVEC were prestimulated for 2 hr or PBL and cytokines were added simultaneously to HUVEC. On the other hand IL-1 was not able to enhance the amount of penetrated cells but only accelerated the infiltration process. Up-regulation or de novo expression of the adhesion molecules ICAM-1 (intercellular adhesion molecule), ELAM-1 (endothelial leucocyte adhesion molecule) and VCAM-1 (vascular cell adhesion molecule) did not parallel PBL binding kinetics. Therefore an ICAM-, ELAM- and VCAM-independent modulation in the early phase of lymphocyte attachment to endothelium seems likely. The lymphocyte cytoskeleton may have a role in this process.

Cell Adhesion↗
PubMed1994

[Noradrenaline-assisted selective chemoembolization of hepatocellular carcinoma].

Despite the postulated tumour affinity of Lipiodol is liver dysfunction after chemoembolization of hepatic malignancies common. Vasoconstricting action of noradrenaline to protect non malignant tissue was studied. 70 patients with unresectable HCCs (UICC IV: 61%) were treated via percutaneous catheter. After noradrenaline (0.1-0.8 mg) induced and documented vessel constriction a suspension of Lipiodol (5-8 ml) and Mitomycin C (10-20 mg) was injected. In addition minced dehydrated dura suspended in Lipiodol occluded the major tumour feeding vessels. 120 (73%) of a total of 164 chemoembolizations were performed after intrahepatic noradrenaline (0.1-0.8 mg) bolus injection. Arterial perfusion of non malignant liver parenchyma was significantly reduced in 95%. 24 hours later selective tumor retention of lipiodol was noticed in 67%. Side effects were fever (79%), thoracoabdominal pain (67%), nausea and emesis (43%) and tachycardia (15%). There were two treatment related deaths: one each from liver failure and cardiac arrest. By WHO response criteria there were 17 (23%) partial remissions (PR), 34 (49%) stable diseases (SD) and 20 (28%) patients had progression (PD). The median survival time from initiation of treatment was 312 days. Bilobal and multiple tumors reduced survival time (90 days). These findings suggest that noradrenaline guided chemoembolization is feasible in Europe and even in patients with pylethrombosis well tolerated.

Adult↗
PubMed1994

[In vitro studies on immunosuppression with verapamil].

UNLABELLED: AIMS OF THE INVESTIGATION: It is known that Verapamil and other calcium channel blockers possess immunosuppressive properties. It has been suggested that they exert their effects by antagonising protein kinase C (PKC) or calmodulin. Our aim was to investigate whether the adhesion of lymphocytes to allogenic endothelial cells and lymphocyte migration are impaired in the presence of Verapamil. The role of PKC and calmodulin during expression of adhesion molecules, the expression of adhesion molecules under the influence of Verapamil and lymphocyte motility on endothelial cell monolayers were investigated. METHODS: Human endothelial cells (EC) were obtained from umbilical chord veins and incubated as dissociate primary cultures. Expression of adhesion molecules on EC was determined by quantitative immunofluorescence using the CytoFluor 2300-system. Studies on lymphocyte motility were performed by phase contrast microscopy using video scope analysis. RESULTS: Expression of Intercellular Adhesion Molecule 1 (ICAM-1), Vascular Cell Adhesion Molecule (VCAM-1) and Endothelial Leukocyte Adhesion Molecule I (ELAM-1) was dose-dependently reduced by the application of PKC-inhibitor H7. Expression of ICAM-1 and VCAM-1 was also inhibited by the calmodulin-antagonist W7. Surprisingly, neither R- nor S-Verapamil inhibited adhesion molecule expression, we even observed significant enhancement of ELAM-1- and ICAM-1-expression. Nevertheless, lymphocyte motility on allogenic EC monolayers was impaired in the presence of R-verapamil, the enantiomer that is inactive as a calcium channel blocker. CONCLUSION: Verapamil reduces lymphocyte motility and is therefore effective in impairing lymphocyte-endothelial cell-interactions. These effects seem to be independent of calcium channel blockade and are probably not due to inhibition of PKC or calmodulin.

Calmodulin↗
PubMed1994

[Gasless laparoscopic cholecystectomy].

The pneumoperitoneum as a precondition of laparoscopic procedures represents a restriction of the surgeons freedom of movement and causes rare but typical complications. In July 1993 we started doing laparoscopic cholecystectomy without using a pneumoperitoneum. Under direct vision and digital control the retractor blades are introduced into the abdominal cavity via minilaparotomy. The retractor is attached to an electrically powered mechanical arm and raised. The scope is introduced through the same access and the laparoscopic cholecystectomy can be performed using the established technique without instilling a pneumoperitoneum. Both conventional and laparoscopic surgical instruments were introduced through valveless trocars and unlimited suction without loss of gas and exposure is possible. Metabolic and hemodynamic alterations associated with the intraperitoneal insufflation of carbon dioxide are omitted. So far we did gasless laparoscopic cholecystectomy in 22 patients. We didn't see any related complications. Four times we had to change the surgical procedure. In comparison to the traditional laparoscopic cholecystectomy with a CO2-pneumoperitoneum the results of the first gasless procedures demonstrate possible advantages.

Adult↗
PubMed1994

[Isolation and separation of human adult hepatocytes from resected liver: cellular yield and purity using different methods].

Cultivated human hepatocytes (HC) for in vitro cell culture models are not frequently used yet. Besides, there are still several different methods of isolation, separation and cultivation of HC in use. We compared various methods to obtain isolated HC. Cell yield as well as high purity of the HC cultures were the main objectives of this study. For isolation, best results were made with a modified 2-step perfusion method. The methods of disintegration having a stronger mechanical component (i.e. disintegration of tissue in a magnetic stirrer) yielded only few vital cells. To separate HC from non-parenchymal cells (NPC) after isolation we tested two methods. Best results could be reached by centrifugation in Percoll adjusted to a density of 1.065 g/ml for 10 min. at 50xg. Thus, we were able to obtain nearly pure HC suspensions having viabilities ranging between 74 and 100%. Contamination with NPC was lower than 1% as assessed by immunocytochemistry. In contrast, only lower yield and purity resulted by application of a 3-times centrifugation at 28xg for 5 minutes. For cultivation of HC, both initial adherence and survival was superior when collagen type I coated culture plates were used instead of uncoated plates. Up to now, a maximum yield of 2.14 x 10(7) viable HC per gram processed tissue and a maximum culture period of 6 weeks was reached.

Adult↗
PubMed1994

[Color doppler ultrasound in intensive care monitoring after liver transplantation].

The aim of this study was to investigate whether vascular complications after liver transplantation can be diagnosed prior to their clinical and/or biochemistral appearance. Therefore color coded ultrasonography was performed daily in 22 liver patients with altogether 27 transplanted organs. We found 2 arterial thromboses, one partial thrombosis of the portal vein and one thrombosis of the lower vena cava and another two stenoses of the lower vena cava. Angiography was performed in all patients with positive findings after duplex-sonography, except in the 2 patients with cava stenosis. In our experience angiography can be avoided in all patients after a normal duplex-sonogram. However, the early diagnosis of vascular complications prior to the manifestation of a dysfunction of the transplant could not be reached in this study.

Adult↗
PubMed1993

[Entero-enteral invagination of the small intestine in adults. A rare cause of "uncertain abdomen"].

The present paper reports on a 43-year-old female patient who complained over a number of weeks of paroxysms of crampy pain in the mesogastrium. The diagnosis of ileoileal invagination was only made after she had been admitted to hospital for the third time. The following false diagnoses had been made during the 4-week course of the condition: "pyelonephritis", "acute appendicitis", "chronic appendicitis" and, most recently "psychosomatic abdominal distress". The patient was initially treated with antibiotics and finally with psychotropic drugs. Eventually ultrasound suggested the diagnosis of invagination of the small intestine, which was then verified by conventional barium follow-through radiography. The patient subsequently underwent resection of a segment of the small intestine. Entero-enteric invagination is a very rare event in adults, in which a single (often malignant) cause is identified as triggering the invagination. Peristalsis and ingested food push the tumor distad, thus acting as a motor for invagination. The preferred localizations are the junctions between freely moving segments to retroperitoneally fixed segments (e.g., ileocecal region). Ultrasound of the abdomen is the examination of choice for diagnosis of enteroenteric invagination. Surgical resection of the invagination and its cause (generally tumors) is indicated in adults.

Abdomen, Acute↗
PubMed1993

[Repeated perioperative administration of fructose and sorbitol in a female patient with hereditary fructose intolerance [HFI)].

The present paper reports on an adult female patient whose hereditary fructose intolerance (HFI) was at first not diagnosed and who, within the space of 2 years after repeated elective surgery and the perioperative administration of fructose and sorbitol, developed "hepatic and renal failure of unclear origin." At a later stage we were able to establish the diagnosis of HFI by means of a fructose tolerance test in both she and her brother, for whom intolerance to fruit and desserts had been known since early childhood. In addition, literature references to fatalities following the parenteral application of fructose and sorbitol were analyzed. During the course of fructose infusion in both the patient and her brother with HFI, the following metabolic changes were noted: hypoglycemia, elevated rise in the blood fructose concentration, hyperlactacidemia, elevated rise in the blood fructose concentration, hyperlactacidemia, and hyperammonemia. These metabolic changes proved to be reversible after discontinuing the fructose infusion. Analysis of the literature on the fatalities following parenteral fructose administration established that fruit and dessert intolerance was known for all collated patients with HFI, and that, clearly, no regular metabolic tests had been conducted.

Acute Kidney Injury↗
PubMed1993

[Effect of extrahepatic cholestasis on amino acid metabolism in the animal experiment].

UNLABELLED: The knowledge of pathobiochemical processes in extrahepatic cholestasis is one of the prerequisites for the application of infusion solutions adjusted to meet the requirements. Early changes of amino acid metabolism in rats after bile-duct ligation, which indicate disorders in the urea cycle are reported. For this purpose 60 male Wistar rats were laparotomized and the common bile duct was twice ligated under narcosis with pentobarbital. Exsanguination of the animals from the aorta abdominalis occurred after 3, 6, 12, 24, 48 and 72 hours. Analysis of the free amino acids in serum was performed by means of middle pressure liquid column chromatography at fully automatic analytical apparatus (Liquimat III, Kontron). RESULTS: Of 23 free amino acids investigated in serum only Ornithin and Arginin showed significant changes in their serum concentrations after ligature of the common bile duct. The increase of the serum concentration of Ornithin and the simultaneous decrease of Arginin suggests the inhibition of the urea cycle induced by resorptive jaundice. This might be due to the inhibition of the ATP-dependent, mitochondrial carbamyl phosphate synthetase or to the activation of the cytoplasmatic arginase.

Amino Acids↗