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Biomedical subjects

C Hottenrott

Publications and source records attributed to C Hottenrott.

At least 37 records · Page 2Linked to original sources
PubMed1988

[Therapy of stomach carcinoma in older people].

Of 242 gastric cancer patients undergoing surgery in this clinic between 1979 and 1986, 84 (35%) were aged over 70. Staging of patients by the UICC (1978) classification was I: 4.8%, II: 16.7%, III: 18% and IV: 60.5%. Resection rate was 71.4% (60/84) with postoperative hospital mortality of 11.7% (7/60). Mortality in non-resected patients was 25% (6/24). Mortality after total gastrectomy was 11% and after distal resection 5.3%. Actuarial 5-year survival with curative resection was 43.5%, whereas no patient with palliative resection was alive 2 years (range 2-22 months) after surgery (p less than 0.01). These results show that curative resection is the therapy of choice even in elderly patients, due to the low operative risk and excellent survival.

Actuarial Analysis↗
PubMed1988

[Surgical treatment and prognosis of stomach carcinoma with special reference to gastrectomy as a standard operation].

Data on 25 early and 227 advanced gastric cancer patients treated surgically in our clinic over an eight-year period from 1979 to 1986 have been analyzed retrospectively. In 45.5% (n = 110) curative resection and in 27.3% (n = 66) palliative resection was performed. In another 27.3% (n = 66) only a non-resecting procedure was possible. The overall hospital mortality was 10.7% (26/242). It was 9.1% (16/176) after resection and 15% (10/66) after non-resecting procedures. Total gastrectomy "de principe" with compartment II lymphadenectomy was performed in 70.5% (124/176). Total hospital mortality was 8.9% (n = 11) and leakage of the proximal anastomosis was observed in 8.1% (n = 10). Hospital mortality of the remaining resected patients was 3.2% (1/31) after distal resection, 20% (3/15) after proximal resection and 16.7% (1/6) after total esophagogastrectomy with colon interposition. All patients were staged according to UICC classification and staging was I 8.5%, II 14%, III 23% and IV 54.5%. Actuarial 5-year survival in all patients surviving resection was depending on stage of disease at operation (stage I 100%, II 53.3%, III 29% and IV 0%). It differed most significantly (p less than 0.001) for curative (49%) and palliative resections (0%). These results indicate that improvement of results requires early diagnosis with immediate surgical intervention.

Adult↗
PubMed1988

[A totally implantable permanent central venous access, long-term experience with subcutaneous infusion chambers].

Subcutaneously implanted infusion chambers represent a new method of central venous access. In 57 evaluable out of 70 patients, four different models of infusion chambers with an accumulative observation time of 57 years were implanted. In 72% of the patients, up to 12 cycles of polychemotherapy were administered. Parenteral nutrition and blood drawing were also performed. After 4,970 punctions of the system and 12.2 years of use 46 complications in 38 patients were observed, however, most were minor ones, such as temporary occlusions (12) and extravasations (14). Septum luxation (1), septum perforation (1), catheter fracture (1) and catheter migration (2) as well as 7 cases of septicemia or port-pocket-infection required explanation. Infusion chambers seem to be particularly suitable for intermittent and long-term chemotherapy and emergency bolus injections with a significant advantage (10 complications per one thousand days of use) compared to externally placed venous catheters. However, follow-up and care must be performed by a skilled team.

Adolescent↗
PubMed1988

[Regional therapy of isolated liver metastases from breast cancer].

Because of the high rate of response in colorectal liver metastases, intra-arterial chemotherapy was studied in 14 patients with isolated breast cancer liver metastases. After extrahepatic metastasization had been ruled out, a catheter was placed surgically and connected to a cytostatic pump (in two cases) or to a subcutaneous infusion chamber (in 12 cases). Every four to six weeks, the patients with an infusion chamber received a modified FAM treatment (fluorouracil, doxorubicin, mitomycin C) for three days continuously. In 11 out of 14 patients (79%) a clear tumor reduction was observed (duration of remission 11 months). In an average of six cycles of chemotherapy administered, a total of 50% of the patients manifested local side effects (including two cases of toxic hepatitis, one case of biliary sclerosis). Systemic side effects were negligible. Termination of therapy was necessitated by three catheter tip migrations and two thromboses of the hepatic artery. Extrahepatic metastases occurred in six patients. Here, the average latency period between diagnosis of the primary tumor and that of liver metastasis was significantly shorter (x = 9 months) than in the other patients (x = 39 months). Intra-arterial chemotherapy thus represents a therapeutic method which, although complicated, is extremely effective in selected patients with isolated breast cancer liver metastases. A final evaluation must be subject to a randomized comparison with a systemic therapy.

Adult↗
PubMed1987

[Regional chemotherapy of liver metastases].

Intraarterial regional chemotherapy of the liver by implantable pumps and port-systems is currently applied predominantly in patients with isolated colorectal metastases. Therapy and evaluation of results must consider the following factors: natural course of the disease; classification of tumor extent in the liver; evidence of isolated liver metastases; vascular anatomy, optimal catheter-implantation technique, complete perfusion; choice of drugs and dosage; technical complications; local toxicity, extra-hepatic recurrence, definition of therapeutic success. Our own experiences with regional chemotherapy in 145 patients with metastases to the liver and in 9 patients with hepatocellular carcinoma are reported. Using different therapeutic modalities we found a significantly enlarged response rate and at this time a true prolongation of life of about 8 months. Further prospective studies are necessary. The use of regional chemotherapy for liver metastases seems to be recommended at this time only under study conditions.

Antineoplastic Agents↗
PubMed1987

[Controlled study comparing mechanical and manual esophago-jejunostomy following gastrectomy].

40 patients with gastric malignancies were entered into a prospective randomised study of mechanical stapling (EEA) vs. manual single layer suturing of the esophago-jejunostomy following total gastrectomy. The groups were well matched with respect to clinical features, medical risk factors and tumor stage. Following manual technique, no anastomotic leak was observed. In the group with automatic mechanical suturing one technical failure and one insufficiency was seen. This difference, however, is not statistically significant. One patient died (cardiac infarction). The analysis of operating time, morbidity and hospital stay showed no significant differences. These results indicate that by use of a precise standardized conventional suture technique the same security performing an esophago-jejunostomy can be achieved as with mechanical staplers.

Adenocarcinoma↗
PubMed1987

[Locoregional chemotherapy of liver metastases of colorectal cancer].

Intraarterial regional chemotherapy for non-resectable, isolated colorectal metastases to the liver was performed in 121 patients via implantable pumps or infuse-a-ports. FUDR alone or in combination with 5-FU and Mitomycin C was administered in different modalities. Partial response rate ranged between 35 and 71%. Median survival since starting chemotherapy was so far 8-16 months. Extrahepatic relapse occurred in 45%, technical complications in 23% (pump) and 46% (infuse a port). Local toxic side effects strongly depended on drug dosage and application modus. These results corresponded with those of 647 German collective cases and 490 cases from American literature.

Antineoplastic Agents↗
PubMed1987

[Gastric acid, pepsin secretion and mucosal blood flow--their modification by the sympathetic nervous system].

The effects of surgical and chemical sympathectomy on various gastric functions was studied in rats. From the results it is concluded that the sympatho-adrenal system inhibits gastric acid secretion and mucosal blood flow. The regulation of pepsin secretion by the sympathetic nervous system appears controversial: under normal conditions an inhibitory effect is prevailing, whereas under stress an increase in pepsin secretion is observed.

Adrenal Medulla↗
PubMed1987

[Status of regional chemotherapy of the liver].

The review of the literature and of own results show, that the local chemotherapy of hepatic only metastasis from colorectal or breast cancer and of primary liver carcinoma may result in a prolongation of life of six to eight months. There are no statistical advantages of different treatment modalities. Metastases from colorectal primaries show complete remission in about 10%. Other tumors are not suitable or need further interest. The advantage of the shown patients has to be bought by additional surgery and occasional local toxicity. The method still can not be seen as standard treatment, but should further be examined and developed by specialized centers. There is no more doubt that the surgical resection of localized tumors is of great value.

Antineoplastic Agents↗
PubMed1987

Morphological changes after intra-arterial chemotherapy of the liver.

The livers of twenty patients given intra-arterial chemotherapy to treat malignant tumors of the liver or liver metastases, were examined histologically. The results show that cytostatic chemotherapy primarily affects tumor cells, but also causes toxic damage to liver tissue. Besides necrosis of single cells or groups of cells and cholestasis in about one-third of the cases sclerosing cholangitis is a major complication. After chemoembolization, which produces a more marked therapeutic effect with regard to tumor necrosis, extensive necrosis of liver tissue, arteries, bile ducts, and nerves is most conspicuous. Nevertheless, in view of the positive therapeutic effects observed, intra-arterial chemotherapy is recommended for palliative therapy.

Antineoplastic Agents↗
PubMed1986

[Lithotripsy of intrahepatic gallstones].

After placement of a T-drain near some intrahepatic gallstones their fragmentation was successfully accomplished by extracorporeal shock-wave lithotripsy in a 35-year-old man. The fragments passed through the outside via both the drain and stool. A few fragments which remained in the T-drain and the distal bile duct were easily flushed out later.

Adult↗
PubMed1986

[Continuous intravenous or intra-arterial administration via a subcutaneous implantable infusion chamber. Preliminary clinical experiences with particular reference to intra-arterial chemotherapy].

An infusion chamber was implanted subcutaneously in 18 patients for intravenous systemic treatment and in 20 for intra-arterial treatment of the liver. Intravenous catheters were introduced via the cephalic vein, intra-arterial ones via the gastroduodenal artery, after exclusion of extrahepatic metastases. Six manageable complications were observed during a total implantation time of 102 months for i.v. treatment and usage over 500 days: three temporary occlusions; one infection; two extravasations. The intra-arterial chemotherapy, largely for hepatic metastases of breast carcinoma, was undertaken according to a modified FAM schema (fluorouracil, adriamycin, mitomycin C): It achieved a high response rate with two full and eleven partial remissions. Complications were rare, except for 4 temporary occlusions. Systemic side effects were almost completely absent, local toxicity was low. One problem was the fixation of the needle which connects to the infusion chamber. This was true for both intravenous and intra-arterial treatment.

Catheterization↗
PubMed1986

[Clinical evaluation of the tumor marker CA 19-9 in comparison with carcinoembryonic antigen (CEA) in surgical pre- and postoperative diagnosis].

A new tumor marker (CA 19-9) was investigated. CA 19-9 is a tumor-associated antigen which is detected by a monoclonal antibody. CA 19-9 (CIS-Centocor) was compared simultaneously with CEA (carcinoembryonic antigen) in 347 patients. 123 patients with gastrointestinal tumors showed a sensitivity of 31% for CA 19-9 (CEA 49%), combination increased sensitivity to 58%. The highest sensitivity was found in pancreas carcinoma (CA 19-9 75%, CEA 66%, combination 92%); it was lower in gastric, colon, and oesophagus carcinomas. In relapsed colorectal carcinomas sensitivity was 53% (CEA 78%, combination 85%). In cases of relapse, tumor markers may become positive even if they were not detectable before resection of the primary tumor. Specificity for CA 19-9 was 100% (CEA 84%) compared to a group of non-malignant diseases including patients with inflammations and patients with nicotin abuse (n = 102). Because of its high specificity and superior sensitivity to CEA in pancreas carcinomas CA 19-9 should be determined in primary and relapse diagnosis in combination with CEA.

Antigens, Neoplasm↗