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Biomedical subjects

F Glaser

Publications and source records attributed to F Glaser.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Endosonographic diagnosis in preoperative radiotherapy of locally advanced rectal carcinoma].

Endorectal ultrasound (EUS) is important for the indication of preoperative radio(chemo)therapy of locally advanced rectal carcinomas. Preoperative radio(chemo)therapy causes an increased echogenity of the ultrasound, which histologically corresponds with increased fibrosis. After preoperative radio(chemo)therapy, the accuracy rate of EUS of tumor infiltration depth (T) and lymph-node status (N) is 75% compared with postoperative histology. With the help of EUS before and after radio(chemo)therapy (n = 28 patients) "downstaging" was noticed endosonographically in 10 patients (3 times in T and 7 times in N staging) and "upstaging" in 3 patients (3 times in T and 1 times in N staging). There was no "understaging" of local tumor infiltration depth after preoperative radio(chemo)therapy.

Adenocarcinoma↗
PubMed1997

Flexible endoscopic ultrasonography of colonic tumors: indications and results.

BACKGROUND AND STUDY AIMS: Based on the positive results of endorectal ultrasound we evaluated flexible colonic endosonography for colonic tumors. At present there are no generally accepted indications for this procedure. Moreover, it is unclear whether the results are valid enough to warrant specific therapeutic interventions. PATIENTS AND METHODS: Over a one-year period we performed flexible colonic endosonography (12 MHz rotating scanner) on 31 patients with colonic tumors. The examination was only performed when therapeutic implications were expected (e.g. endoscopic procedure when there was no sign of malignancy; oncological resection when there were signs of malignancy in ulcerative colitis or familial polyposis). RESULTS: Of 40 tumors examined, 36 were correctly staged by endosonography, compared to postoperative histology as the gold standard (16 of 17 adenomas, 5 of 5 pT1 carcinomas, 8 of 8 pT3 carcinomas). In two cases pT4 carcinomas were wrongly classified endosonographically as uT3 carcinomas, because the infiltration of the visceral peritoneum was technically not recognizable. Overall the accuracy rate of staging was 85%. Lymph node staging was correct in 36 of 40 patients, amounting to an accuracy rate of 90%. CONCLUSION: Because of its high accuracy rate flexible colonic endosonography has a place in the preoperative staging of colonic tumors in selected patients, especially those with ulcerative colitis, familial adenomatous polyposis or macroscopically suspicious adenomas. It helps to clarify the extent (oncological resection, lymphadenectomy) of resection required in conventional surgery and helps to avoid laparoscopic procedures in advanced colonic cancer.

Colonic Neoplasms↗
PubMed1997

[Endosonography, CT and MRI in the diagnostic concept of rectal carcinoma].

The stage-adapted operative treatment of rectal cancer in the context of adjuvant therapy regimes necessitates accurate and, in times of diminishing financial resources, cost-effective preoperative staging. From January 1988, 424 patients with rectal cancer were examined by endosonography. In the same period 28 additional patients were staged by hydro-CT within a prospective study as the endorectal sonography probe could not be passed through the tumor stenosis. Sensitivity and specificity for T and N staging were equal or superior in the endosonography group. Compiled data in the literature for MRI staging of rectal cancer show results similar to those with endosonography. Therefore we see no indication for preoperative rectal staging methods other than endosonography unless the latter examination is technically impossible.

Cost-Benefit Analysis↗
PubMed1996

[General stress response in laparoscopic and conventional cholecystectomy].

To objectify perioperative stress response to laparoscopic (LCE) and conventional cholecystectomy (CCE) a prospective, controlled trial was planned and biochemical stress parameters were measured in the blood of patients, who underwent elective surgery because of symptomatic cholecystolithiasis. Patients with acute cholecystitis, pancreatitis, choledocholithiasis or malignant disease were excluded from the study. Values from 40 patients after LCE and from 18 patients after CCE were compared. Both groups had statistically similar patient characteristics and perioperative care. The LCE group showed a significantly lower stress response with respect to interleukin 1 beta, interleukin 6, epinephrine, norepinephrine and glucose.

Adult↗
PubMed1995

General stress response to conventional and laparoscopic cholecystectomy.

OBJECTIVE: In many retrospective and prospective observational studies, laparoscopic cholecystectomy (LC) compares favorably with conventional cholecystectomy (CC), with respect to length of hospital stay, postoperative pain, and pulmonary function, indicating a diminished operative trauma. Comparison of laboratory findings (stress hormones, blood glucose, interleukins) are a possibility to objectify stress and tissue trauma of laparoscopic and conventional cholecystectomy. SUMMARY BACKGROUND DATA: Major body injury, surgical or accidental, evokes reproducible hormonal and immunologic responses. The magnitude of many of these changes essentially is proportional to the extent of the injury. METHODS: In a prospective study, biochemical stress parameters were measured in the blood of patients undergoing elective cholecystectomy because of symptomatic cholecystolithiasis. Patients with acute cholecystitis, pancreatitis, choledocholithiasis, or malignant disease were excluded. Values from 40 patients after LC and from 18 patients after CC were compared. Both groups had similar patient characteristics, baseline values, and perioperative care, except for deeper anesthesia during CC. RESULTS: On postoperative day 1, epinephrine (p = 0,05), norepinephrine (p = 0.02), and glucose (p = 0.02) responses were higher after CC. Two days postoperatively, norepinephrine remained higher after CC (p < 0.01). Interleukin-1 beta responses were higher during (p < 0.01) and 6 hours after CC (p = 0.03). Interleukin-6 responses were higher 6 hours (p = 0.03), 1 day (p = 0.02), and 2 days (p < 0.01) after CC. CONCLUSIONS: The results show significant lower values of intraoperatively and postoperatively measured epinephrine, norepinephrine, interleukin-1 beta, and interleukin-6 in patients with laparoscopic cholecystectomy, indicating a minor stress response and tissue trauma in this group of patients. The results correspond to the favorable results of most other trials evaluating clinical aspects of laparoscopic cholecystectomy.

Adult↗
PubMed1994

Endorectal ultrasound and leiomyosarcoma of the rectum.

Leiomyosarcomas of the rectum are uncommon neoplasms accounting for fewer than 1% of all malignancies of the colon and rectum. Approximately 215 cases have been described in the literature. Distinction from leiomyoma is often difficult, but regarding dignity is important. The case reported is that of a 68-year-old man in whom a 2.2-cm rectal mass covered by mucosa was diagnosed by rectoscopy and endorectal ultrasound. After treatment by wide local excision the histological specimen revealed a low-grade, highly differentiated leiomyosarcoma. Due to the lack of a large series of this disease, there is disagreement over the therapeutic strategy. At the moment a selective treatment approach seems to be the most frequently advocated. Large tumors and those extending beyond the rectal wall are treated by radical surgical resection. Leiomyosarcomas less than 2.5 cm in size and confined to the bowel wall can be treated by wide local excision. Endosonography can provide exact assessment of tumor size and expansion and is of great value in selecting the appropriate treatment.

Aged↗
PubMed1994

[Transesophageal echocardiography in non-rheumatic atrial fibrillation: a moderately sensitive method for assessment of risk of cerebrovascular complications].

120 consecutive unselected patients with chronic non-rheumatic atrial fibrillation without anticoagulant therapy were examined by transthoracic and transoesophageal echocardiography. Patients with a history of an ischaemic cerebrovascular event (n = 4) had left atrial thrombi, spontaneous contrast or both significantly more often (n = 25, 61%) than patients in the control group (24/79 = 30%). However, when compared with controls, patients with a history of cerebrovascular events were also older, and had hypertension and left ventricular disease (ejection fraction < 45%) more often. Abnormal carotid duplex scans were also very common in this group (71%). Transoesophageal echocardiography is useful for evaluating the risk of cerebrovascular complications in non-rheumatic atrial fibrillation. However, the method is quite insensitive (61%) and therefore insufficient as the sole parameter for deciding the need for anticoagulation. It is likely that cerebrovascular complications in these polymorbid patients are partially caused by other factors than embolism from the left atrium.

Adult↗
PubMed1994

[Endo-anal ultrasound. Indications and results].

Between July 1991 and November 1993 106 patients have been examined by endoanal ultrasound with a 7.0 MHz transducer and a special hard plastic cone which is attached over the transducer. Indications for endoanal ultrasound have been anal carcinoma, perirectal or perianal fistulas, perianal abscesses and sphincter insufficiencies. All anal carcinomas and 2 anal cancer recurrences could be visualized with regard to their size and extension as well as the lymphnode infiltration. 28 of 35 fistulas have been seen by endoanal ultrasound. Endosonographical differentiation in inter- (10), trans- (12) extra- (1) or suprasphincteric (5) was possible in all detected fistulas and confirmed by operation in 27 of 28 cases. 34 cryptogen abscesses could be detected (15 intersphincteric, 12 ischiorectal, 7 pelvirectal) and confirmed by the operative situs with regard to their size and localisation. In 9 patients with a myogen sphincter insufficiency the morphological defect of the sphincter muscle could be localized by endoanal ultrasound and confirmed by the operative situs in all cases.

Abscess↗
PubMed1993

Endorectal ultrasound for control of preoperative radiotherapy of rectal cancer.

Endorectal ultrasound (EUS) is known to be a reliable method for preoperative staging of rectal tumors. In this study, EUS was used to select patients with rectal cancer suitable for preoperative radiation therapy. By performing EUS before and after radiation, the aim of the study was to evaluate the role of EUS in monitoring the effects of preoperative radiation therapy. In 17 patients with large T3 or T4 rectal tumors, a complete staging by EUS was done before and after radiation therapy. Beside a shrinkage of the tumor, there was a change of echopattern to more hyperechoic gray levels to be observed in the irradiated tumor. The rectal wall lost its normal architecture, and lymph nodes disappeared or changed their echopattern from echopoor to echorich. There was no down-staging of a tumor seen by EUS. Complete preoperative staging was correct in 13 of 17 patients because of endosonographic examination before and after preoperative radiation therapy. New interpretation criteria are given for evaluation of patients with rectal cancer treated by radiation therapy.

Adult↗
PubMed1993

[Influence of sonography on indications for laparoscopic cholecystectomy].

Because of therapeutic consequences preoperative sonography should be performed with a check list. Nevertheless false positive and false negative findings result in cases of gall-stones in the ductus cysticus, of acute cholecystitis and thickness of the gall-bladder wall. Therefore where sonographic findings differ from the intraoperative laparoscopic situs the operating surgeon should change to conventional cholecystectomy early enough to avoid complications.

Cholangitis↗
PubMed1993

[Biliary cystadenoma].

Biliary cystadenomas are rare biliary ductal neoplasms of congenital origin. There is an excellent correlation between CT and sonographic findings for number, size and location of the lesions. However, sonography can demonstrate better morphologic features such as thickened wall, mural nodules and septations. CT shows more clearly the accurate size and location of the neoplasm to surrounding structures. Angiography is not diagnostic; however, it can help to distinguish between benign and malignant lesions. MRI provides useful information for surgical planning, demonstrating well the relationship of the tumor to vascular structures and other organ systems. Complete excision is the treatment of choice to prevent recurrence or malignant transformation of biliary cystadenomas.

Adolescent↗
PubMed1993

[Endorectal ultrasound in diagnosis and therapy planning of broad-base rectal adenomas].

In this study the value of endorectal ultrasound in diagnosis and therapy of large rectal adenomas is shown. Between January 1988 and August 1992 93 patients with the primary diagnosis of adenoma proven by biopsy were examined by endorectal ultrasound. Sonographical differentiation of adenoma and carcinoma was done by echo-structure. Enlarged lymph nodes can be detected too. In 34 of 91 patients carcinoma was found by endorectal ultrasound and 28 were verified histologically. Sensitivity of endorectal ultrasound in detection of carcinoma in enlarged adenomas is 96%. Only preoperative endorectal ultrasound could give decisive criteria to take a second biopsy, to avoid mucosectomy in case of a malignoma or give the advice for a radical operation according to the tumor stage. Further staging of adenomas and small carcinomas is excellent by endorectal ultrasound and the right indication of local therapy can be confirmed.

Diagnosis, Differential↗
PubMed1992

[Analgesic consumption--laparoscopic versus conventional cholecystectomy].

We compared two groups of 50 patients each with symptomatic cholecystolithiasis treated by either conventional or by laparoscopic cholecystectomy with regard to duration of postoperative pain and sort and amount of analgetics. Laparoscopic operation time was on an average 115.4 min (65-180 min), conventionally operated 78.1 min (35-140 min). Eight patients with laparoscopic cholecystectomy did not need analgetics at all. The average number of days of postoperative pain was 2.7 days for conventional operation and 1.13 days for laparoscopic cholecystectomy. In this time the conventionally operated patients needed four to five times the amount of analgetics as well morphin analogues as low-potency analgetics.

Analgesics↗
PubMed1991

Dynamic sonography in the diagnosis of ligament and meniscal injuries of the knee.

A total of 84 patients with ligament or meniscal injuries of the knee was prospectively examined clinically and under anaesthesia, by arthroscopy and sonography. The sensitivity, specificity, positive and negative predictive values were compared. For sonography a high resolution scanner (Picker LSC 7000 with a 5-MHz transducer) was used. The sonographical examination was dynamic under normal and stress conditions. The sensitivity of sonography for diagnosis of rupture of the medial collateral ligament (LCM) was 87%, of the anterior cruciate ligament (LCA), 70% and of menisci, 89% and was thereby similar to that for examination under anaesthesia and arthroscopy and significantly superior to clinical examination alone. The specificity of sonography was very high: for rupture of the LCM 96%, the LCA 98% and the menisci 78%. Only for diagnosis of partial ligament rupture, especially partial LCA rupture, was the sensitivity of sonography low. In diagnosing ligament and meniscal injuries of the knee, sonography should be used routinely as a primary diagnostic tool after clinical examination because: 1. It is inexpensive 2. It has no side effects 3. It helps to cut down X-ray exposure 4. Anaesthesia is not required 5. It allows the recognition and avoidance of muscle tightness 6. Repetitions are possible at will 7. Documentation is included 8. Sensitivity and specificity are very good.

Adult↗
PubMed1991

[Efficacy of adjuvant chemotherapy in metastasizing cervix carcinoma. A pilot study].

There are reported preliminary results of a pilot-study in the postoperative adjuvant treatment of cervical carcinoma with involvement of the iliac lymph nodes. It was done a prospective randomized study. There were 3 groups of treatment: adjuvant chemotherapy with a combination of Cisplatin and 5-Fluorouracil over 6 cycles; adjuvant chemotherapy like in the first group over 3 cycles plus Telecobalt-irradiation till the doses of 50 Gy in the small pelvis; and postoperative irradiation with Telecobalt till the doses of 50 Gy in the small pelvis. The fate of 41 patients could be evaluated. There were no statistical differences between the 3 groups in age, histology, staging and follow-up. Also the survival rate and the rate of the disease-free time didn't show a significant difference, but it seems, that the chemotherapy with Cisplatin and 5-Fluorouracil could be able to improve the poor prognosis of the cervical carcinoma with metastases.

Adult↗
PubMed1990

Endorectal ultrasonography for the assessment of invasion of rectal tumours and lymph node involvement.

Sophisticated therapies for rectal carcinoma, such as sphincter preserving operations, pouch-anal anastomosis, preoperative irradiation or adjuvant chemotherapy, require an exact pretherapy assessment of the tumour and its lymph node involvement. A 7.0 MHz transducer was used before operation in the staging of 117 patients with rectal carcinoma or villous adenoma. In 90 per cent of cases it was possible correctly to stage the tumour before operation. Sensitivity for detection of perirectal fat infiltration was 97 per cent. Lymph node involvement was accurately identified in about 80 per cent of cases. Six carcinomas, which had developed within 31 examined tubulovillous adenomas, were detected by endorectal ultrasonography. No carcinoma remained undetected. Endorectal ultrasonography is a highly accurate tool for the staging of rectal carcinoma before operation and for the detection of lymph node involvement. Malignant change in tubulovillous adenomas are also detectable.

Adenoma↗