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Biomedical subjects

C E Broelsch

Publications and source records attributed to C E Broelsch.

At least 127 records · Page 7Linked to original sources
PubMed1998

Extended drainage versus resection in surgery for chronic pancreatitis: a prospective randomized trial comparing the longitudinal pancreaticojejunostomy combined with local pancreatic head excision with the pylorus-preserving pancreatoduodenectomy.

OBJECTIVE: To analyze the efficacy of extended drainage--that is, longitudinal pancreaticojejunostomy combined with local pancreatic head excision (LPJ-LPHE)-and pylorus-preserving pancreatoduodenectomy (PPPD) in terms of pain relief, control of complications arising from adjacent organs, and quality of life. SUMMARY BACKGROUND DATA: Based on the hypotheses of pain origin (ductal hypertension and perineural inflammatory infiltration), drainage and resection constitute the main principles of surgery for chronic pancreatitis. METHODS: Sixty-one patients were randomly allocated to either LPJ-LPHE (n = 31) or PPPD (n = 30). The interval between symptoms and surgery ranged from 12 months to 10 years (mean 5.1 years). In addition to routine pancreatic diagnostic workup, a multidimensional psychometric quality-of-life questionnaire and a pain score were used. Endocrine and exocrine functions were assessed in terms of oral glucose tolerance and serum concentrations of insulin, C-peptide, and HbA1c, as well as fecal chymotrypsin and pancreolauryl testing. During a median follow-up of 24 months (range 12 to 36), patients were reassessed in the outpatient clinic. RESULTS: One patient died of cardiovascular failure in the LPJ-LPHE group (3.2%); there were no deaths in the PPPD group. Overall, the rate of in-hospital complications was 19.4% in the LPJ-LPHE group and 53.3% in the PPPD group, including delayed gastric emptying in 9 of 30 patients (30%; p < 0.05). Complications of adjacent organs were definitively resolved in 93.5% in the LPJ-LPHE group and in 100% in the PPPD group. The pain score decreased by 94% after LPJ-LPHE and by 95% after PPPD. Global quality of life improved by 71% in the LPJ-LPHE group and by 43% in the PPPD group (p < 0.01). CONCLUSIONS: Both procedures are equally effective in terms of pain relief and definitive control of complications affecting adjacent organs, but extended drainage by LPJ-LPHE provides a better quality of life.

Adult↗
PubMed1998

Strictureplasty with a pedunculated jejunal patch in Crohn's disease of the duodenum.

Surgical treatment for duodenal stenosis caused by Crohn's disease is only indicated in symptomatic duodenal obstruction when conservative treatment has failed. Previously described operative procedures include strictureplasty for short stenoses and bypass or resectional procedures, if duodenal stenosis is extensive. In this case of an extensive duodenal Crohn's stenosis, we performed a strictureplasty of the duodenum with a pedunculated jejunal patch. Thus, duodenal passage could be well preserved, and the patient has remained asyptomatic during a follow-up of more than 9 months.

Adult↗
PubMed1998

[Significance if ICAM-1 on lysis of human pancreatic carcinoma cells by autologous, cytotoxic T-lymphocytes].

Cytotoxic T-Lymphocytes were generated from tumor-infiltrating lymphocytes of a newly established pancreatic cancer cell line, which lysed autologous tumor cells significantly and HLA-class I restricted. ICAM-1+ tumor clones were significantly higher lysed than an ICAM-1- clone. Stimulation with IFN-gamma resulted in a higher expression of ICAM-1 and significantly higher lysis, which was inhibited by anti-ICAM-1 monoclonal antibodies.

Adenocarcinoma↗
PubMed1998

[Detection of H-ras and K-ras in tumors of gastrointestinal-pancreatic system].

The Gastro-Entero-Pancreatic System (GEP) defined a group of highly differentiated neuroendocrine tumors (Insulinomas, Gastrinomas, PP-omas, Somatostatinomas, Carcinoids). In this kind of tumors the multistage carcinogenesis is really unknown. Activated ras oncogenes could play an important role in initiation or process of carcinogenesis in different human cancers. The purpose of our study was to determe if H-ras or K-ras play a role in the carcinogenesis of GEP tumors. 20 paraffin embedded tumor tissues (1 Vipom, 1 Somatostatinom, 10 Carcinoids, 1 Gastrinoma, 4 livermetastasis of a Carcinoid, 3 Insulinomas) were analysed immunohistologic of H-ras and K-ras oncogene protein expression. Immunohistologic investigations showed a H-ras expression in 65% (13/20). K-ras protein could detected in 10% (2/20). On the basis of these data H-ras oncogene expression could play a role in the multistage carcinogenesis of GEP tumors.

Carcinoid Tumor↗
PubMed1998

[Prognostic value of gastric tonometry in peritonitis due to intestinal perforation and laparoscopic versus conventional management in the swine model].

After a 12 hour period of experimental peritonitis induced by gastric perforation mortality was significantly higher in the laparoscopically treated group of pigs when compared to the open procedure. In both groups the treatment was simple oversowing of the defect plus peritoneal lavage. Septic shock associated with peritonitis and subsequent "multi organ failure syndrome" could accurately be predicted with gastric tonometry. In both groups the decline of pHi in septic animals that died was higher than expected.

Animals↗
PubMed1998

[Growth factor a/b-FGF and PDGF have no effect on development of inflammatory tumor in chronic pancreatitis].

Extensive fibrosis combined with the development of pseudocysts, calcifications and concomittant loss of acinar cells are the characteristic features in the pathogenesis of chronic pancreatitis. In some patients an inflammatory mass is generated which is most frequently located in the pancreatic head. The inflammatory pancreatic head tumor has been postulated to be the pace maker of the course of the disease. Over expression of growth factors (GF) has been discussed to be the molecular basis of focal development of fibrosis. Aim of this study was to correlate the expression of GF-m-RNA (acidic und basic fibroblast growth factor: a/b FGF; plateled derived growth factor: PDGF-A/B) in pancreatic specimens from patients with chronic pancreatitis taken from different parts of the pancreatic gland to the generation of an inflammatory mass in the pancreatic head. Using quantitative PCR, northern blotting and in-situ-hybridisation m-RNA expression of a/b FGF and PDGF-A/B was nearly identical in the pancreatic head, corpus and tail. Furthermore the expression of these GF did not correlate to the development of an inflammatory mass in the pancreatic head. From the results of this study a causal relation between expression of these GF and the development of an inflammatory mass in the pancreatic head could not be confirmed.

Becaplermin↗
PubMed1998

[Effect of pneumoperitoneum on ultrastructure of parietal peritoneum in experimentally induced peritonitis in the rat].

Aim of this study was to analyse the effect of gastric perforation induced peritonitis and a pneumoperitoneum (PP) on the ultrastructure of the parietal peritoneum. After randomisation rats allocated to groups I and II were subjected to standardized gastrotomy simulating gastric perforation. After a 12-h-interval a PP was induced in groups I and III. After PP for 60 min a primary fixant was injected intraperitoneally as the abdominal wall was still extended, as well as 30 s, 2 h and 12 h after release of the PP. In groups II and IV simple puncture of the abdomen was performed. Animals were sacrified and tissue specimens taken from the parietal peritoneum of the left diaphragm were analysed using raster electronic miroscopy (REM: 100x to 5000x). In group II (gastric perforation without PP) microvilli appeared shrunk and coarse, while integrity of the mesothelial cell layer remained intact up to 2 h after abdominal puncture. In group I (gastric perforation with PP) distortion of the mesothelial cell layer with concomittant opening of stomata to the submesothelial tissue was observed already in specimens harvested as the abdominal wall was still extended. Concomittantly scarce microvilli appearing coarse and thickened were laid flat on top of the mesothelial cells. After desufflation a rapid process of mesothelial desintegration with disruption from the submesothelial layer and vanishing of microvilli occurred. In REM analysis of parietal peritoneum premature distortion and desintegration of the mesothelial cell layer was observed after exposure to increased abdominal pressure and to gastric perforation-induced peritonitis.

Animals↗
PubMed1998

[Immuno-isolation of xenogenic islands of Langerhans in a tissue engineered autologous cartilage capsule].

Islet transplantation is a potential cure for diabetes mellitus. The major problem for clinical application remains the prevention of transplant rejection without major side effects. Broad application in early disease will make the usage of xenogeneic tissue necessary. Immunoisolation is an experimental strategy to prevent rejection, by separating the transplanted allogeneic or xenogeneic cells from the host immune system using a barrier device. Current methods of immunoisolation use artificial, not completely inert materials as barrier devices and induce an unwanted foreign body reaction. Using recipient own cells for encapsulation the foreign body reaction could be prevented. This study describes a new method of encapsulation of islets of Langerhans within a capsule of chondrocytes, which may serve as an immunoisolation barrier utilizing the immunoprivileged properties of the chondrocyte matrix and demonstrates the functional survival of the encapsulated islets in vivo.

Animals↗
PubMed1998

[A new inherited RET proto-oncogene mutation associated with familial medullary thyroid carcinoma and polymorphisms in adjacent regions].

A new point mutation, TCG(Ser)-->GCG(Ala) in codon 891, exon 15 of the RET protooncogene was revealed in two patients from a pedigree with familial medullary thyroid carcinoma (FMTC), but not in healthy persons. A linkage analysis with two well-known and two new intragene polymorphisms showed that informative polymorphic markers, the phenotypic expression of the disease, and the mutation are cosegregated in the studied pedigree. Two new polymorphisms, G/A at position-24 of intron 14 and C/T in codon 836 of exon 14, were found in the RET protooncogene. The frequencies of allele 1 of the polymorphic site in codon 836 were the same (0.96) in the Russian and German populations. This was also characteristic of two polymorphisms revealed earlier, namely, the sites in codons 691 (0.80 and 0.81, respectively) and 904 (0.21 and 0.22). However, the frequency of allele 1 of the polymorphisms in intron 14 differed significantly (0.87 and 0.77, respectively).

Carcinoma, Medullary↗
PubMed1998

[Indirect traumatic diaphragmatic ruptures after blunt abdominal or thoracic trauma].

Traumatic diaphragmatic rupture after blunt thoracic or abdominal trauma is an indicator of serious associated injuries, but is itself often occult. Its diagnosis is still a challenge. In 14 consecutive patients with diaphragmatic rupture we developed a strategy for diagnostic work-up and therapy of diaphragmatic disruption. Ultrasound showed a sensitivity of 89% versus 50 and 29% in chest X-ray and CT scan, respectively. Ultrasound of the diaphragm directly after admission and after stabilization of the trauma patient in order to find diaphragmatic disruption early is compulsory. Early treatment will avoid associated complications.

Abdominal Injuries↗
PubMed1998

[Differences in properties of interstitial procedures and their effect on clinical applications].

The effects of percutaneous ethanol injection (PEI) and cryosurgery (CS) on normal liver tissue are investigated in a mini-pig model. It was not possible to create a circumscribed, reproducible necrosis by PEI; there was a high incidence of thromboembolic complications. Due to the discrepancy between the temperatures necessary to induce freezing and to induce total cell destruction, the necroses were smaller than the ice balls induced by CS and contained vital cells in their periphery. In conclusion, PEI should not be used when ethanol spreading into normal parenchyma has to be assumed, and the difference in size between ice ball and complete necrosis has to be considered in tumor treatment by CS.

Animals↗
PubMed1997

Expression and prognostic significance of immunoregulatory molecules in esophageal cancer.

Major histocompatibility complex molecules (HLA), the co-stimulatory molecule B7 and the intercellular adhesion molecule 1 (ICAM-1) are key molecules involved in T cell-mediated immune surveillance. We aimed at assessing the expression pattern of these immunoregulatory molecules on primary esophageal carcinomas and evaluating their prognostic significance. Representative samples of primary tumors were obtained from 53 patients who had undergone radical en bloc esophagectomy without residual tumor. Cryostat sections of these tumors were stained with monoclonal antibodies (MAbs) directed against either HLA class I, HLA class II, B7 or ICAM-1. The median follow-up was 19 months (range, 6-43). We found that HLA class I expression was deficient on 27 tumors, while a significant neo-expression of HLA class II, B7 and ICAM-1 (> or =25% positive tumor cells) was observed on 17, 29 and 25, tumors, respectively. Kaplan-Meier analyses revealed a significant beneficial influence on relapse-free survival for patients with tumors expressing HLA class I, HLA class II and B7. Cox's regression analyses demonstrated that co-expression of HLA class I and ICAM-1 was a significant and independent predictor of a reduced risk of developing tumor recurrence, whereas expression of ICAM-1 on HLA class I negative tumors was correlated with an increased risk of tumor relapse.

Adult↗
PubMed1997

Prognostic value of immunohistochemically identifiable tumor cells in lymph nodes of patients with completely resected esophageal cancer.

BACKGROUND: Current methods of disease staging often fail to detect small numbers of tumor cells in lymph nodes. Metastatic relapse may arise from these few cells. METHODS: We studied 1308 lymph nodes from 68 patients with esophageal cancer without overt metastases who had undergone radical en bloc esophagectomy. A total of 399 lymph nodes obtained from 68 patients were found to be free of tumor by routine histopathological analysis and were studied further for isolated tumor cells by immunohistochemical analysis with the monoclonal anti-epithelial-cell antibody Ber-EP4. This antibody did not stain lymph nodes from 24 control patients without carcinoma. RESULTS: Of the 399 "tumor free" lymph nodes, 67 (17 percent), obtained from 42 of the 68 patients, contained Ber-EP4-positive tumor cells. Fifteen of 30 patients who were considered free of lymph-node metastases by histopathological analysis had such cells in their lymph nodes, and 5 of the 15 had small primary tumors. Ber-EP4-positive cells found in "tumor free" nodes were independently predictive of significantly reduced relapse-free survival (P=0.008) and overall survival (P=0.03). They predicted relapse both in patients without nodal metastases (P=0.01) and in those with regional lymph-node involvement (P=0.007). All 12 patients whose lymph nodes were negative on both histopathological and immunohistochemical analysis and who were available for follow-up survived without recurrence. The presence of micrometastatic tumor cells in bone marrow had no additional prognostic value. CONCLUSIONS: Immunohistochemical examination of lymph nodes may improve the pathological staging of esophageal cancer.

Adenocarcinoma↗
PubMed1997

[Surgical therapy of primary and secondary liver tumors].

Advances in operative, diagnostic and post-operative care technique have rendered liver resections safe. Consecutively, indications for operative interventions in primary and secondary liver tumors have changed. A current state of the art is presented. Focal nodular hyperplasia, if found incidentally during laparotomy, should be removed en-passant. Large or central lesions should be biopsied and can be observed if they remain asymptomatic and stable in size. Symptomatic or growing FNH should be removed. If the diagnosis is evasive resection should be favored. Most patients with hepatocellular adenoma are symptomatic and the lesion should therefore be removed. Hemangiomas are rarely causing symptoms. In case they truly are, or if they cause complications they should be excised. Anatomical resections for hepatocellular carcinoma are only feasible in non-cirrhotic livers or in patients with cirrhosis and compensated liver function. Other patients are candidates for liver transplantation if the cancer is stage I or II. Stage III and IVa lesions are subject of current studies. Surgical resection remains the only potentially curative treatment for intrahepatic cholangiocellular carcinoma. Because of their dismal prognosis these patients are not candidates for transplantation. Resection continues to be the most effective therapy for colorectal metastases to the liver. Patients with non-colorectal, non-neuroendocrine metastases are usually only candidates for surgical palliation. Cure can be achieved in patients with renal cell carcinoma or Wilms' tumor. Additionally, neuroendocrine metastases to the liver can be resected in curative intent if extrahepatic disease was excluded. In the few symptomatic patients in whom extrahepatic disease was excluded, symptomatic treatment has failed, and the lesions are not resectable, liver transplantation can provide a reasonable therapeutic choice.

Carcinoma, Hepatocellular↗