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Biomedical subjects

A Encke

Publications and source records attributed to A Encke.

At least 109 records · Page 6Linked to original sources
PubMed1993

Establishment and immunological characterization of cultured human gallbladder epithelial cells.

Biliary epithelial cells are a primary site of damage in liver allograft rejection and in immunologically mediated diseases such as primary biliary cirrhosis. Human leukocyte antigens and adhesion molecules on the biliary epithelium are associated with T-lymphocytic binding, recognition and destruction. To investigate relevant cellular immunological mechanisms under standard conditions, we have established an in vitro model using human gallbladder epithelial cells. Although not directly affected in these aberrations, gallbladder epithelial cells are excellent objects for immunological investigations. More than 10(8) highly purified cells were isolated and cultured longer than 6 wk in confluent monolayers. Cell growth was routinely established on uncoated plastic culture dishes, and serum-free media could be applied for immunological experiments. Cell characterization was performed by means of specific monoclonal antibodies typical for biliary epithelial cells. Cytokeratins 1 through 8, 18 and 19 and human epithelial cell antibody 125 always showed strong positive staining. Antigen patterns were examined before and after treatment with interferon-gamma by use of immunohistochemical staining methods. Untreated human gallbladder epithelial cells expressed human leukocyte class I antigens but few or no class II antigens. After stimulation with interferon-gamma induction of human leukocyte antigen-DR, -DP and -DQ was detected. In addition, intercellular adhesion molecule 1 was induced on these gallbladder epithelial cells. Therefore an immunological competence similar to that of biliary epithelial cells could be demonstrated. In vitro cell cultures of gallbladder epithelial cells offer a promising tool for subsequent investigations concerning intrahepatic biliary epithelial cells and their interactions with cells of the immune system.

Biomarkers↗
PubMed1993

[Repair procedures in surgery of inguinal hernia in their historical evolution].

The last decades have witnessed a great number of "novelties" published for inguinal hernia surgery. However, these are generally modifications of well-known operative procedures. The sole genuinely new method is laparoscopy for which, however, no long-term results are available. An analysis of original articles shows that all surgical techniques for repair of the hernial orifice can be traced back to two simple repair principles: 1) reinforcement of the anterior wall of the inguinal canal and tightening of the external inguinal ring [Stromayr 1559, Purmann 1692, Czerny 1877]. 2) reinforcement of the posterior wall of the inguinal canal and tightening the internal inguinal ring a) externally [Lucas-Championnière 1881, Bassini 1889, Brenner 1898, Lotheissen 1898, McVay 1942, Shouldice 1945, Lichtenstein 1987, Stoppa 1989] or b) via an intra-abdominal approach (by laparotomy [Tait 1891] or laparoscopically [Ger 1990, Velez und Klein 1990]).

Europe↗
PubMed1993

[Classification of acute pancreatitis from a surgical viewpoint].

Since it has been not yet proved possible to establish an internationally accepted, uniform classification for inflammatory disorders of the pancreas, the present review contrasts and compares the various classifications for acute pancreatitis, and points out the advantages and disadvantages for surgeons in clinical practice. All the categories published so far have been based principally on five different classification criteria: the clinical course (e.g. acute, chronic) histological findings (e.g. oedematous, necrotising), aetiological factors (e.g. biliary ethyltoxic), biochemical parameters (not specifically) with prognostic value (e.g. CRP), or the morphology of the inflammatory process as shown on a CT scan. At present, a reliable, reproducible and clinically applicable classification of acute pancreatitis can only be achieved on the basis of the CT scan with concurrent intravenous contrast medium injections (contrast-enhanced computed tomography). A combination of clinical and CT findings has proven a valuable support for the surgeon, especially in defining the indications for surgery.

Acute Disease↗
PubMed1993

[Adjuvant regional chemotherapy after resection of liver metastases of primary colorectal tumors].

Due to the pattern of tumor infiltration, hepatic resection may be accomplished in 20% of all patients with colorectal liver metastases. However, a new recurrence is observed very often and early. Up to date, systemic adjuvant treatment failed to improve the overall results. Taking into account the benefit of palliative intrahepatic chemotherapy, intraarterial therapy was performed as an adjuvant to removal of metastatic colorectal liver metastases in 51 out of 90 patients over an eight year period (1982-90). Due to abnormal arterial liver arteries 5 pat. got an intraportal catheter. The following monthly treatment schedules were applied: FUDR (fluorodesoxyuridine) 0.2-0.3 mg/kg/d/14 d (N = 12), FUDR 1,2 mg/kg/d/5d (N = 21), FUDR 1.0-1.7 mg/kg/d/5 and folinic acid 30 mg/m2/d (N = 18). Mortality (5.5%) and morbidity (36%) were not increased by catheter implantation. Local and systemic side effects were mainly stomatitis 0-22% and hepatobiliary toxicity 6-42%. Including an operative mortality of 5.5%, the median survival of 45 months was associated with a disease-free interval of 15 months. Intrahepatic recurrence was diagnosed after a median time of 26 months (extrahepatic recurrence was 25 months respectively). The following prognostic factors were associated with favourable survival: solitary metastasis (p > 0.001), curative resection, segmentectomy, normal serum levels of CA 19-9 and LDH. Although both groups were not comparable, due to more extended tumor infiltration in the treatment group (p = 0.03), adjuvant arterial chemotherapy delayed after curative resection intrahepatic recurrence to 52 versus 14 months (p = 0.036). Disease-free survival was improved to 19 versus 12 months (p = 0.08) resulting in a trend to better overall survival (p = 0.07).

Adult↗
PubMed1993

[Ménétrier disease--a rare disease of the stomach].

The present reports on a 51-year-old patient who presented with weight loss, anaemia, hypoalbuminaemia and ankle oedema, and was referred for laparotomy by a radiologist on the grounds of suspected carcinoma of the stomach suggested by an upper gastrointestinal x-ray series. Surgery revealed excessively thickened rugae with gyrus-like, tortuous surface epithelium folds (histologically Ménétrier's disease). A gastrectomy was performed, and the patient has been symptom-free and active ever since. In addition, the author presents a review of the literature published to date describing case reports of patients with Ménétrier's disease. Ménétrier's disease is a benign condition of the gastric mucosa in which gastric loss of albumin has been shown to be responsible for hypoalbuminaemia. The diagnostic procedure of choice is gastroscopy because upper gastrointestinal x-ray series cannot distinguish between carcinoma of the stomach with certainty. Since this is a chronic disease that does not respond to medication, treatment of choice today is (partial) gastrectomy dictated by the extent and severity of the findings.

Diagnosis, Differential↗
PubMed1992

Simplified microvascular suture techniques for rat liver transplantation as a microsurgical model with arterial blood supply.

The methods for liver transplantation in the rat mainly used do not include reconstruction of the arterial blood supply to the liver. Furthermore, to ensure a short anhepatic phase these methods almost all entail specially developed cuff anastomoses in the recipient operation instead of the conventional microvascular suture technique. Thus an acceptable survival rate can be attained in the experimental animals. This detailed description of simplified microvascular suture techniques is intended to present an alternative to the cuff anastomoses used almost exclusively. In the donor operation with this method, the liver is dissected with an arterial pedicle including the abdominal segment of the aorta, and the liver is flushed in situ not only via the portal vein, but also via the hepatic artery. The organ is implanted in the recipient animal using simplified microvascular suture reconstruction of the arterial blood supply to the liver. Use of telescopic spectacles with 2-fold magnification has proven to be adequate for the entire procedure. With mastery of this method of rat liver transplantation, the average duration of the anhepatic phase is about 20 min, substantially below the 30-min limit which is critical for the survival of the experimental animals. The donor operation requires about 60 min, and the recipient operation 70 to 80 min. With this method, the spectrum of investigations on liver transplantation which are possible in the rat is substantially extended in that clinical conditions can be reproduced very much more exactly by combination of portal and arterial in-situ flushing in the donor operation and rearterialization of the transplant in the recipient operation, as compared to the transplanted rat liver being supplied only with portal venous blood.

Anastomosis, Surgical↗
PubMed1992

[Metabolic changes in a patient in the early phase of acute pancreatitis].

The present paper reports on the perioperative metabolic changes in a 70-year-old female patient in whom an acute (oedematous) pancreatitis occurred during the transduodenal excision of a villous adenoma of the duodenal papilla. Since blood was taken for metabolic investigations before, during and after surgery, data on the changes in the intermediary metabolism during the early phase of acute pancreatitis in humans was recorded. Raised activity of the pancreatic enzymes amylase and lipase was demonstrable just minutes after extirpation of the papillary tumour after intraoperative cholangiography had been performed via a choledochotomy. This showed occlusion of the duodenal papilla as well as imaging the pancreatic duct. The reflux of bile into the pancreatic duct is considered to be one of the causative factors of acute pancreatitis (Opie-syndrome). The following metabolic changes were registered at surgery and on the first day thereafter: reduction in the serum concentration of cholesterol ester, the triglycerides and the phospholipids by 30 to 50% of the preoperative values respectively, as well as lactacidaemia (up to 60 mg/dl). At the same time, the serum bilirubin concentration and the concentrations of the amino acids alanine and glutamate in the serum were temporarily raised. The question is, whether these metabolic changes were a direct consequence of the activity of the pancreatic enzymes of amino acid and lipid metabolism that were released into the blood, or whether reduced synthesis by the liver (lipoproteins, lecithin: cholesterol-acyl-transferase) was responsible for these changes.

Acute Disease↗
PubMed1992

Cytomegalovirus- and interferon-related effects on human endothelial cells. Cytomegalovirus infection reduces upregulation of HLA class II antigen expression after treatment with interferon-gamma.

Cultured human umbilical vein endothelial cells (HUVEs) were infected with human cytomegalovirus (HCMV) strain AD169. Up to 50% HUVEs proved to be positive for HCMV early nuclear antigens 24 hours after inoculation with virus. Following infection kinetics of surface expression of HLA class I and II, intercellular adhesion molecule (ICAM-1) and endothelial lymphocyte adhesion molecule (ELAM-1) on HUVEs were investigated by means of flow cytometry. A slight increase in HLA class I expression was observed, whereas expression of HLA class II (DR, DP, DQ) antigens was not induced by infection with HCMV. Furthermore, when compared with uninfected cells treated with interferon-gamma (IFN-gamma), reduced enhancement of HLA-DR expression was conspicuous in HCMV-infected cells treated with IFN-gamma. There is evidence that only a portion of HUVE is affected in its ability to upregulate HLA class II antigens. While expression of ICAM-1 was found to be enhanced between 8 and 20 hours after infection with a maximum at 12 hours after infection, no modulation of ELAM-1 was seen.

Cell Adhesion Molecules↗
PubMed1992

[Multi-visceral upper abdominal resection and orthotopic liver transplantation--a surgical treatment concept for regionally metastatic tumors of the endocrine pancreas].

Islet cell carcinoma is rare. Even in advanced metastasizing tumors, relatively long survival times were reported. Aim of surgical treatment is complete removal of the tumor mass, if possible. When not, palliative procedures were described to be efficient in some of the cases. In the literature, among the first patients with regional metastasizing intraabdominal malignancies and upper abdominal exenteration, some cases with neuroendocrine tumors were reported. Aim of the following study is to describe the results in 4 patients with metastasizing islet cell carcinomas, which were treated by multi-visceral upper abdominal exenteration and combined orthotopic liver transplantation.

Adenoma, Islet Cell↗
PubMed1992

[Soft tissue sarcoma in adulthood].

Soft tissue sarcomas (STS) represent a heterogenous group of malignant tumors arising in mesenchymal tissue and in the autonomal and peripheral nervous systems. Only 1% of all malignancies in adults are STS. Most of them are localized at the extremities, but they also occur in the abdomen and the thorax as well as at the abdominal and chest wall. They are usually surrounded by a pseudocapsule which contains tumor cells and they can exhibit a discontinuous growth pattern. Macroscopically undetectable branches might grow along given anatomical structures. Thus the whole sarcoma-related anatomic compartment should be judged as tumor-contaminated. The high rate of local failure is often caused by insufficiently extended primary resections. Lymph node metastases are rare. The main prognostic factors are histological grading, tumor size and surgical radicality. Diagnosis of STS is often made at a rather late state of tumor progression often too late for curative therapy. Early histological diagnosis is thus of great importance. The operation aims at the removal of the whole tumor bearing anatomic compartment. Even wide excisions of the sarcoma surrounded by 3 cm of tumor free tissue will lead to at least 60% local recurrencies. Excisions along the pseudocapsule (enucleation) will most likely leave parts of the tumor behind. Insufficient surgical radicality cannot be compensated for by adjuvant therapies. The resection should be carried out without compromises.

Adult↗
PubMed1992

Continuous regional treatment with fluoropyrimidines for metastases from colorectal carcinomas: influence of modulation with leucovorin.

Hepatic regional treatment represents an attempt to improve tumor response by increasing drug concentration with low systemic toxicities. Recently in vitro and clinical studies have shown that the cytotoxicity of 5-fluorodeoxyuridine (FUDR) and 5-fluorouracil (5FU) can be potentiated by high doses of leucovorin (LCV). Two pilot studies with intraarterial FUDR, 5FU, and LCV were initiated. Since 1982, 221 patients with colorectal liver metastases were treated by various forms of long-term monthly continuous regional treatment using implantable ports or pumps. FUDR (0.05 to 1.7 mg/kg/d) was administered alone or combined with 5-FU and leucovorin. In 61 patients curative liver resection was possible and was followed by adjuvant arterial treatment. Overall median survival time (MST) was 15 months and increased to 36 months after liver resection. This was influenced by the following important factors: treatment, number of metastases, extent of infiltration, tumor volume, and minimal intraoperatively diagnosed extrahepatic disease. The response rate varied from 69% to 23%. Time of development of extrahepatic progression was not delayed by additional systemic treatment. Local side effects significantly depended on the duration of arterial infusion. The rate of biliary sclerosis ranged from 19% to 0%. Occurrence of chemical hepatitis was between 7% and 38%. In contrast, after combined intraarterial treatment with LCV, systemic side effects, mainly stomatitis and diarrhea, were dose limiting. Despite the improvement of survival after regional treatment, further randomized trials are mandatory to compare regional with relevant systemic treatment.

Colorectal Neoplasms↗