Biomedical subjects

B Gebhard

Publications and source records attributed to B Gebhard.

At least 19 recordsLinked to original sources

PubMed2005

Intraoperative frozen section examination of the sentinel lymph node in breast cancer.

AIM OF THE STUDY: Intraoperative frozen section (FS) examination of the Sentinel node (SN) in breast cancer patients is questioned due to the relatively high number of positive SN(s) found in the permanent histological examination. This study reviews the data of the Austrian sentinel node study group on FS examination of the SN and tries to identify patients with a high risk of incorrect negative results. METHODS: 2326 breast cancer patients of the Austrian Sentinel node study group who underwent SN biopsy and intraoperative FS examination of the SN were further analysed for incorrect negative results and clinicopathologic factors indicating a higher rate of incorrect negative results. RESULTS: The FS of the SN was positive in 513 of 2326 patients (22.1%) and negative in 1813 of 2326 patients (77.9%). Permanent histological examination revealed a metastatic SN in 282 of 1813 patients. (incorrect negative rate 15.6%). 158 of 282 patients (56%) were found through H&E serial sectioning, whereas 124 of 282 patients (44%) were only seen in immunohistochemistry. Micrometastases, lobular histology and preoperative chemotherapy were associated with a higher rate of incorrect negative results. CONCLUSION: Incorrect negative results of FS examination are seen in 15% of patients and require a secondary axillary lymph node dissection. The disadvantage of missing a positive SN through FS is by far outweighed by the advantage of a single stage operation in case of a positive SN.

Breast Neoplasms↗

PubMed2001

Postprandial GLP-1, norepinephrine, and reactive hypoglycemia in dumping syndrome.

Rapid gastric emptying and exaggerated plasma concentrations of the insulinotropic hormone GLP-1 precede reactive hypoglycemia after oral glucose in gastrectomy patients. We suspected that the plasma volume drop associated with rapid gastric emptying (early dumping) would be accompanied by elevated plasma concentrations of norepinephrine. In order to study any relationship between postprandial norepinephrine, the enteroinsular axis, and plasma glucose, twelve patients with dumping syndrome and nine controls were studied. The plasma concentrations of norepinephrine, GLP-1, GIP, glucagon, insulin, and glucose were measured following a 1.5 g/kg lean body mass glucose meal. The early (0-30 min) integrated norepinephrine concentration was significantly higher in dumpers (22.1 +/- 3.8 nmol/ml/min) compared to controls (14.7 +/- 3.1 nmol/ml/min; P < 0.001) and correlated closely with the postprandial hematocrit increment (r = 0.71; P < 0.05). Early immunoreactivities of GLP-1, GIP, and glucagon peaked 30 min after glucose ingestion and were significantly higher in dumpers. Insulin peaked after 60 min and correlated with early GLP-1. In 11 of the patients glucose fell below baseline after a median interval of 120 min. Glucose at 120 min, when most of the nadirs occurred was lowest in patients with high early GLP-1 concentrations (r = 0.78; P < 0.001). Gel filtration chromatography of the dumpers' plasma revealed that pancreatic glucagon was detectable at time 0 and after 20 min, but not after 120 min. It is concluded that in dumpers pancreatic glucagon is augmented in the early postprandial period, probably through stimulation by catecholamines. At 120 min, when most of the hypoglycemias are encountered, pancreatic glucagon is no longer detectable, probably through inhibition by GLP-1.

Chromatography, Gel↗

PubMed2000

Coverage of enterococci in community acquired secondary peritonitis: results of a randomized trial.

INTRODUCTION: The increasing number of enterococcal infections in hospitals and reports about the development of resistance of these bacteria make it necessary to review their importance as co-pathogens in secondary peritonitis. MATERIALS AND METHODS: A prospective randomized controlled trial on primary therapy of secondary peritonitis was carried out in six centers comparing cephalosporin-based antibiotic therapy to acylaminopenicillin-based therapy. RESULTS: Enterococci were only cultured in 6 of 110 cases from the abdomen and were found in only 5 cases of postoperative complications. No differences were found between penicillin-based vs. cephalosporin-based therapy. CONCLUSION: The study supports the view that these bacteria continue to play a minor role in secondary peritonitis. The point has to be emphasized, however, that the patients under study were in relatively good condition (APACHE II median 9 for cephalosporins and 10 for penicillins) and that postoperative cases of peritonitis were excluded.

Adult↗

PubMed1999

[Indications and contraindications for breast preservation in patients with breast cancer].

Roughly 70% of all patients with breast cancer can be treated by breast-preserving procedures under optimal circumstances. Risk factors for the development of local recurrences are age, angioinvasion, poor differentiation of the tumor, negative steroid hormone receptors, extensive intraductal component and positive margins. Contraindications for breast preservation are large tumors without remission after preoperative chemotherapy, multicentricity, extensive intraductal component, large ductal carcinoma in situ, inflammatory breast cancer after preoperative chemotherapy, Paget disease and local recurrence after breast-conserving surgery. Preoperative needle biopsy allows determination of nearly all of the risk factors. To further increase the rate of breast conservation, preoperative chemotherapy should be used more extensively.

Breast Neoplasms↗

PubMed1998

[Value of punch biopsy in diagnosis of palpable breast tumors. A prospective analysis of 150 patients].

To reduce the need for excisional biopsies in the diagnosis of breast masses, the accuracy of core needle biopsy (CNB) was determined in a university hospital setting. 150 consecutive women with solitary palpable breast masses underwent CNB over a 2-year period. Histological diagnosis was established, and in the case of cancer the type, grade and estrogen and progesterone receptors were determined. CNB findings were compared with those independently obtained from the subsequently excised lesions. There were 103 malignant and 47 benign lesions. CNB diagnosed 136 lesions (90.7%) correctly. Fourteen biopsies were inconclusive. Histological type was correct in all cases and grading in 83.5%. Correct hormone receptor status was obtained in 97.1% of cases for estrogen and 91.3% for progesterone. Diagnosis of histological type, grading, and hormone receptors obtained from CNB material is a safe way to analyze palpable breast lesions and therefore a useful tool to select patients for preoperative treatment.

Adult↗

PubMed1998

[Neoadjuvant chemotherapy of patients with breast carcinoma].

Adjuvant therapy has shown to be of significant benefit in patients with breast cancer. Among the possibilities to further improve the results, preoperative chemotherapy is a promising tool. So far, we have treated 178 patients and found that downstaging permits breast conservation in 60% of patients who would otherwise undergo mastectomy. The significance of this method for further improvement of survival has to await results of ongoing trials.

Adult↗

PubMed1996

[Early postoperative infections after liver transplantation--pathogen spectrum and risk factors].

Infections occurring during the early postoperative phase after liver transplantation result in a significant rise in morbidity and mortality. The records of 279 orthoptic transplantations performed in 248 patients were analyzed retrospectively. 55.6% of all patients suffered from one or more episodes of bacterial and/or fungal infection during their postoperative hospitalisation. The median onset of bacterial/fungal infection was on day 7 after transplantation. Enterococci (42 episodes), Pseudomonas aeruginosa (38 episodes), staphylococci (37 episodes), Escherichia coli (17 episodes) and Candida albicans (11 episodes) were the most frequently detected organisms. 74 (29.8%) patients developed viral infections. 20 patients (8.1%) showed infection with cytomegalovirus (CMV), 32 patients (12.9%) with herpes simplex virus (HSV) and 6 patients (2.4%) with varicella zoster virus (VZV). 14 patients (5.6%) developed infection with both CMV and VZV. Triple infection with CMV, HSV and VZV occurred in one patient. Statistical analysis of potential risk factors showed a significant influence of blood volume replacement (p < 0.001) and occurrence of at least one rejection period (p < 0.02) for major bacterial/fungal infection and immunosuppression (p < 0.001), cold ischemic time (p < 0.04), occurrence of at least one rejection period (p < 0.005) and blood volume replacement (p < 0.04) for viral infection.

Adolescent↗

PubMed1996

[Revision of diffuse peritonitis: planned versus on demand].

Planned and "on-demand' reoperations are well-established concepts in the management of severe diffuse peritonitis. Both concepts were applied at our surgical department and reviewed with regard to specific complications and lethality. In the period between 1 January 1989 and 31 May 1994, 62 patients with the diagnosis of diffuse peritonitis underwent operative treatment at our surgical department. The mean age of the 29 female and 33 male patients was 58.2 years (range 17-93 years). The origin of peritonitis was the stomach in 8.1%, duodenum in 16.1%, small intestine in 12.9%, large intestine in 41.9% and the pancreas in 16.1%. Among these 62 patients, 15 were reoperated upon according to plan and 47 were reoperated upon on demand. The intraoperatively gained Mannheim peritonitis index and the Apache II score were similar in both groups. The average number of reoperations was five in the group of planned revisions and three in the group of on-demand revisions. Also lethality was similar in both groups. Regarding lethality, only the age of the patient (P < 0.03) and the preoperative Apache II score (P < 0.01) reached statistical significance. As expected, eradication of the infectious source was the precondition of survival regardless of the type of reoperation. Regarding our results, we conclude that planned or on-demand reoperations lead to similar results in the treatment of diffuse peritonitis. The crucial point for success is that elimination of the infection source take place as soon as possible.

APACHE↗

PubMed1995