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Biomedical subjects

C Gebhardt

Publications and source records attributed to C Gebhardt.

At least 91 records · Page 5Linked to original sources
PubMed1990

Adenocarcinoma of the pancreas with a predominant intraductal component: a special variety of ductal adenocarcinoma.

A special variety of pancreatic cancer is characterized by a predominant intraductal proliferation with a low-grade proliferation rate. Immunohistochemical peculiarities and the lack of lymph node metastases despite an extended tumor, distinguish it from usual ductal pancreatic carcinoma. Adenocarcinoma of the pancreas with a predominant intraductal component is proposed for its classification.

Adenocarcinoma↗
PubMed1990

[Chemoembolization of colorectal liver metastases].

In the Center of Surgery of the Justus-Liebig-University Giessen and in the General Hospital in Nuremberg from 1983 to 1987 21 patients with metastases of a colorectal carcinoma were treated with chemoembolization (CHE). The on average survival period of patients treated with chemoembolization after non-successful application of regional chemotherapy amounted to 6 months. The total survival period of these patients amounted to 17.4 months. Since March 1987 chemoembolization has been applied as initial therapy. The on average survival period of the patients, initially treated with cheomoembolization at present amounts to 14 months. 4 of these patients additionally got chemotherapy by the portal vein after CHE. The survival period of 2 patients, having been resected several times after CHE, at present comes to 27 months. These results are the base for a clinical study, in which CHE is combined with the portal venous infusion of a cytostatic agent (Folin acid 5-FU).

Adult↗
PubMed1990

[Differential surgical treatment of ileus of the large intestine].

This is a report about 191 patients with colonic obstruction who were operatively treated between 1984 and 1988. A resection of the tumour was carried out in 106 cases while the other patients underwent palliative surgical treatment for various reasons. - A traditional surgical concept proved to be most satisfactory despite the modern forms of treatment such as primary subtotal colectomy, intraoperative lavage of the colon with resection and primary anastomosis, the internal bypass or preoperative laser dilatation. According to this concept tumours of the right half of the colon are primarily resected in the form of a right hemicolectomy; tumours of the left flexure undergo a two stage and those distal to the left flexure a three stage procedure. These principles were consistently applied in our patients and this resulted in an operative mortality of 0% after excluding patients who had a primary septic condition. In contrast, the operative mortality in the patients who were septic because of a colonic perforation (n = 23) was 47.8%. The worst prognosis could be found in cases with a perforation away from the tumour in the oral overdistended bowel such as coecum and ascending (n = 12). Here, the mortality was even 75% while true tumour perforations - which were usually sealed off - had a mortality of only 10% (n = 10). The main problem in the treatment of colonic obstruction, therefore, seems to be the patients who have a concomitant septic condition.

Aged↗
PubMed1990

Surgical treatment of pain in chronic pancreatitis. Role of the Whipple procedure.

Partial pancreaticoduodenectomy with occlusion of the remaining tail of the pancreas with Ethibloc to induce rapid exocrine atrophy was introduced by us in January 1978 for the treatment of severe chronic pancreatitis affecting the head of the gland. Between 1978 and 1986 this procedure was done for 289 patients; morbidity was 12%, mortality 1%, and relapse of the pancreatitis occurred in 2%. Of the patients who survived, 88% became completely free of pain and lost their symptoms, and 11% had minor complaints. We conclude that partial pancreaticoduodenectomy with occlusion of the pancreatic duct with Ethibloc is the procedure of choice in severe chronic pancreatitis mainly affecting the head of the gland.

Adult↗
PubMed1990

[Laser therapy of colorectal tumors].

Between Jan. 1, 1986 and March 31, 1988 a total of 128 patients with tumours of the colon and rectum were treated by Nd-Yag laser at Nürnberg City Hospital. There were 36 benign and 92 malignant lesions. The indications for laser therapy were stenosis, bleeding, spasms of the pelvic floor and increased mucous production. Initial control of these problems could be achieved in 105 patients (82%), however, the symptoms recurred in 50% of the malignant and 47% of the benign tumours. Complications of laser treatment were encountered in 13 patients necessitating an operative intervention in 6. In all, 34 patients underwent additional surgery after laser treatment. Most frequently, a diverting colostomy had to be provided (n = 18) while 12 patients underwent anterior resection; in three an abdomino-perineal resection was performed and in one patient a Hartman procedure was necessary. The median observation time of patients with benign tumours is, at present, 16 months with 72% being free of disease. In malignant tumours the median survival time of patients with laser therapy only is 4.5 months; those with additional surgical treatment survived a median of 17.5 months.

Adult↗
PubMed1990

Duodenal pancreatectomy with occlusion of the pancreatic duct.

In 1978 partial duodenopancreatectomy with Ethibloc duct occlusion of the pancreatic remnant was introduced for use in patients with severe chronic cephalic pancreatitis. Our intention was to remove the largely destroyed part of the gland, and to induce controlled glandular atrophy in the residual portion in order to prevent further recurrence of pancreatitis. Since then this surgical procedure has been performed in 328 patients. The perioperative mortality was 1.2%, the complication rate requiring relaparotomy 7.1%. So far pancreatitis has recurred in only 2.2% of cases, due, we believe, to incomplete ductal block. Some 53% of the patients remained free of pain and symptoms, while 35% have occasional minor complaints. In a prospective follow-up study of 23 patients, Ethibloc duct occlusion was shown to be highly effective in inducing controlled atrophy of the gland and thereby terminating the inflammatory process. Endocrine function was preserved at the post-resectional level.

Adult↗
PubMed1989

[Treatment of spontaneous pneumothorax].

Experience with 300 episodes of spontaneous pneumothorax in 209 patients is reported. The treatment results of two time periods 1980-1983 (A) and 1985-1987 (B) are compared. During the second period the diagnostic work-up was much more extensive and included pleurography, CT-scan and thoracoscopy. This resulted in a more differentiated therapy and a reduction in the recurrence rate from 41% to 22%. Among the different modes of treatment chest-tube drainage alone had the worst results with a 44% rate of early and late recurrence. Better results were obtained with pleurodesis using fibrin adhesive either through a pleural catheter (24%) or thoracoscopically (13%). Operative treatment had the lowest recurrence rate (4%). In the primary treatment of spontaneous pneumothorax chest-tube drainage had a recurrence rate of 33% and catheter-pleurodesis with fibrin adhesive of 18% while no relapse could be observed in the group treated by thoracoscopy or operation. In the treatment of recurrent pneumothorax chest-tube drainage alone is unsuitable because of a failure rate of 64%. Catheter pleurodesis also had a high rate of recurrence (30%). The best results were again obtained by thoracoscopic (19%) and operative treatment (4%). On the basis of the described experience an individualized approach to the treatment of spontaneous pneumothorax is recommended.

Adolescent↗
PubMed1989

[Resection of the superior vena cava in tumor occlusion].

Report about three cases of resection of the superior vena cava for tumor stenosis or occlusion. In one patient no reconstruction was performed while in the other two interposition of an armored PTFE-prosthesis between right brachio-cephalic vein and vena cava superior was carried out. In agreement with other authors it is concluded that best results can be obtained by reconstruction with a PTFE-prosthesis or autologous vein graft.

Adult↗
PubMed1989

[Early endoscopic retrograde cholangiopancreatography in acute pancreatitis].

Based on a prospective trial on 91 patients diagnostic and therapeutic evaluation of ERCP in the early phase of acute pancreatitis was carried out. Detection of biliary stone disease and visualization of tumours of the papilla or main bile duct leads to therapeutic consequences (Papillotomy, exstirpation of the tumour). In addition to that, ERCP yields radiomorphologic informations, which seem to be typical for necrotizing pancreatitis. Showing a correlation to severity and prognosis of necrotizing pancreatitis these informations can be used for planning surgical tactics in the course of the disease.

Acute Disease↗
PubMed1988

[Villous adenoma of the papilla of Vater and acute necrotizing pancreatitis].

In two patients a villous adenoma of the papilla of Vater was found to be the cause of an acute necrotizing pancreatitis. The diagnosis was largely made by early gastroduodenoscopy and endoscopic retrograde cholangiopancreatography. After initially conservative treatment of the pancreatitis the adenoma was excised transduodenally in both patients. Histological examination in both revealed a completely removed benign villous adenoma. Both patients have remained free of symptoms after 18 and 6 months, respectively. These observations support the call for intensive diagnostic measures when a diagnosis of pancreatitis has been made: tumours of the pancreas and of the periampullar region should be ruled out.

Acute Disease↗
PubMed1988

[Wound healing of the pelvis following abdominoperineal rectum extirpation. A comparison of 2 drainage procedures in a prospective randomized study].

In a prospectively randomized study we used two different ways of drainage of the sacral space after an abdomino-perineal-resection of the rectum. One group with 25 patients had a drainage anteriorly through the abdominal wall, the other 25 patients got a drainage posteriorly through the buttocks. In each case we used two closed silicone-drainage-systems without active suction. In 60% of the anterior and in 50% of the posterior drained cases we saw an unaffected primary healing of the sacral wound. There was no significant difference. The patients felt the anterior way of drainage to be more convenient. Contamination of the sacral space by disrupture of the rectum during the operation was followed by a sacral abscess in 50%.

Adult↗
PubMed1988

[Diagnosis and surgical tactics in adrenal gland tumors].

Adrenal tumours are relatively rare. For localisation and reliable identification, stepwise radiological or nuclearmedical diagnosis should be added to targeted endocrinological diagnosis. Highest accuracy has been recordable from computed tomography, followed by phlebography, and arterial angiography. The authors feel that the extraperitoneal, lumbar approach can be considered a non-invasive, low-complication surgical method. It should be applied more often to cope with benign unilateral adrenal processes.

Adrenal Gland Neoplasms↗
PubMed1987

Whipple's procedure plus intraoperative pancreatic duct occlusion for severe chronic pancreatitis: clinical, exocrine, and endocrine consequences during a 3-year follow-up.

The present investigation provides follow-up data (up to 36 months) of exocrine and endocrine pancreatic function, inflammatory activity, pain, and body weight in 23 chronic pancreatitis patients submitted to Whipple's procedure plus intraoperative Ethibloc occlusion of the remaining pancreatic duct system between January 1983 and February 1984. Clinically, Whipple's procedure plus intraoperative pancreatic duct occlusion resulted in almost complete and continuous cessation of pain as well as significant (p less than 0.05) increase in body weight. With regard to exocrine pancreatic function (Secretin-Pancreozymin test, plasma amino acid consumption test, Pankreolauryl test, fecal chymotrypsin determination), intraoperative pancreatic duct occlusion was shown to induce high-grade insufficiency and thus exocrine parenchymal atrophy in all patients. Simultaneously, the inflammatory process (represented by serum levels of trypsin, lipase, and pancreatic isoamylase) was terminated in all 23 patients. Endocrine pancreatic function, evaluated by serum levels of insulin and C-peptide measured under fasting conditions and subsequent maximal combined beta-cell stimulation as well as corresponding integrated hormone releases, was reduced by partial pancreas resection by about 50%, while there was no further impairment during the 36-month follow-up period in consequence of additional intraoperative pancreatic duct occlusion. Altogether, Whipple's procedure plus intraoperative Ethibloc occlusion of the residual pancreatic duct system seems suitable for termination of the inflammatory process and thus preservation of residual endocrine pancreatic function in chronic pancreatitis.

Chronic Disease↗
PubMed1986

Primary structure and differential expression of glutamine synthetase genes in nodules, roots and leaves of Phaseolus vulgaris.

In plants, glutamine synthetase (GS) is the enzyme primarily responsible for the assimilation of ammonia into organic nitrogen. In Phaseolus vulgaris a number of isoenzymic forms of GS are found, each of which consists of eight subunits of mol. wt 41 000-45 000. The GS subunits of P. vulgaris have previously been shown to be encoded by a small multigene family and a partial cDNA clone for a nodule-specific GS subunit has been obtained. We report here the isolation and nucleotide sequencing of two essentially full-length GS cDNA clones (pR-1 and pR-2) from a root cDNA library and the deduced amino acid sequences of the corresponding GS subunits (355 amino acid residues each). The coding sequences of pR-1 and pR-2 are closely related (80% nucleotide homology, 88% amino acid homology), but their 5'- and 3'-untranslated regions have diverged almost completely. Both pR-1 and pR-2 are related to, but distinct from, the nodule GS clone, pcPvNGS-01 (or pN-1). Hybridization to genomic Southern blots showed that the three GS mRNAs are encoded by three seperate genes and indicated the existence of a fourth class of GS gene. An S1 nuclease protection assay demonstrated the presence of R-1 and R-2 mRNA in both roots and leaves and confirmed that expression of the N-1 gene is nodule-specific. Expression of the R-1 and R-2 genes in the roots did not change significantly during nodulation. However, only the R-1 gene is expressed in the nodules themselves, indicating that the R-2 gene is specifically repressed during nodule development.

Journal Article↗
PubMed1986

Upper gastrointestinal bleeding as an unusual presentation of a duodenal carcinoid.

Carcinoid tumors may develop in any part of the gastrointestinal tract. They constitute 1.5% of all gastrointestinal tumors (1). The duodenum is one of the least common sites of this tumor, with a reported incidence varying between 0.2% and 8.9% (2, 3). We report on a case of a bleeding duodenal carcinoid in a patient who underwent bilateral nephrectomy for malignant hypertension.

Carcinoid Tumor↗