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Biomedical subjects

F Harder

Publications and source records attributed to F Harder.

At least 109 records · Page 6Linked to original sources
PubMed1994

[Transanal endoscopic microsurgery (TEM): indications and limitations].

Sessile polyps of the proximal and middle part of the rectum are difficult and sometimes impossible to remove by snaring techniques. The conventional transanal approach to this level results in inappropriate survey and security. Parasacral techniques and low anterior resection require disproportionate measures to treat these adenomas. Transanal endoscopic microsurgery (TEM) is a relatively new operative technique to remove sessile polyps of the entire rectum, developed by Buess et al. [1] in Germany. The system uses a special endorectal scope connected to a stereoscopic angulated optical system for visualization. A continuous pressure-controlled insufflation of carbon dioxide keeps the rectum open for exposure. The excision is done by electrocautery in the submucosal plane or as full thickness excision in the submuscular plane. The defect is closed with an intrarectal running suture. Our report demonstrates the indications and limits of this technique and compares it to conventional techniques mentioned above. 12 patients with different kinds of tumor have been selected and serve as basis for our discussion. TEM offers excellent survey in the entire rectum and permits removal of villous adenomas and incidental low risk and early rectal cancers. High risk patients tolerate this procedure well. Unsuitable are circular and long-distance adenomas and transmural growing benign tumors of the proximal rectum.

Adenoma, Villous↗
PubMed1994

[The colon-J-pouch anal reconstruction following total rectum resection: functional aspects].

Coloanal reconstruction is a sphincter saving operation following total rectal resection to treat rectal cancer 3 to 11 cm above the dentate line. Total rectal resection in this situation is justified from the oncological and surgical viewpoint because the local recurrence rate and morbidity are not different from the "gold standard", abdominoperineal resection sacrificing the anal sphincter. Although patients undergoing straight coloanal reconstruction preserve continence, they are often disturbed by high stool frequencies and imperative urge. We set out to establish whether construction of a colon-j-pouch could ameliorate the quality of defecation and thus prove useful. In this study the pre- and postoperative results of a pilot study with 4 consecutive patients following colon-j-pouch-anal reconstruction are presented. Perioperatively, 3 of 4 patients suffered from intermittent disturbances of urinary voiding. Sexual function was disturbed in 3 of 4 patients. All patients were completely continent. The preliminary results showed a decreased sphincter pressure at rest of 40 mm Hg (SD: 5) and a normal squeeze pressure. Endoanal ultrasound demonstrated a normal anal sphincter morphology. Pouch compliance yielded 4.7 ml/cm H2O and was better than after straight coloanal reconstruction in the control group (2.8 ml/cm H2O). The stool frequency at 6 months was 3/24 hours without imperative urge. The colon transit time lasted 49 hours and was in the normal range. No pouch evacuation disorders were observed. These results show a minimal morbidity in colon-j-pouch-anal reconstruction with preservation of complete continence in the follow-up time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Surgery in pheochromocytoma. 12-year development].

Hypertension (sustained and/or paroxysmal) is the most common symptom of pheochromocytoma. Correct evaluation nearly always leads to the diagnosis, and complete surgical excision is the definitive treatment. Our study deals with preoperative evaluation, operative morbidity and long-term results after surgery. During the 12-year period (1981-1992) 31 patients (48 years, 25-85) with pheochromocytoma were treated at our institution. The selected preoperative management was reviewed on the basis of patient records. Long-term follow-up was carried out consecutively and personally. All patients received alpha-adrenergic blockers to achieve preoperative normotension and volume repletion. All resections were performed by laparotomy; two of the early cases were extended into the chest. 27 of 29 patients (93.1%) had elevated levels of urinary vanillylmandelic acid; a similar sensitivity was noted in the urinary catecholamines (24/26 = 92.3%). In anatomical localization CT-scan was accurate in 100% (27/27). MIGB scintigraphy was of help in 21 of 23 (91.3%) and, in the most recent patients, MRI was helpful in 3 of 3 (100%). No patient died during the first 30 days after surgery. One patient developed an anaphylactic reaction after cephalosporin administration (morbidity: 3.2%). 2 patients (6.4%) with malignant pheochromocytoma developed a recurrent tumor during the follow-up period. Resection of pheochromocytomas by laparotomy has a low perioperative morbidity and mortality after standardized preparation. A positive MIBG scintigraphy allows extra-adrenal localization. Better resolution and multiplanar imaging are the advantages of MRI. Perioperative management and new imaging techniques--eliminating arteriography and venous sampling among others--have simplified surgical treatment and improved its safety.

Adrenal Gland Neoplasms↗
PubMed1994

[Tumor-immune system interaction in renal cell carcinoma and melanomas. Cytokine transcription in tumors at the time of surgical resection].

Tumor infiltrating lymphocytes (TIL) of many tumors express surface activation markers. An antigen driven stimulation of T-lymphocytes is expected to induce not only cell membrane activation molecules but also a unique pattern of cytokine gene transcripts. These cytokines are relevant modulators and potent effectors of immune responses, and therefore play a crucial role in tumor-immune system interaction. The gene transcription of interleukin(IL)-2, IL-4, IL-7, IL-10 and interferon(IFN)-gamma of lymphocyte infiltrated, freshly excised tumor specimens from 10 renal cell carcinomas and 6 melanomas were investigated by reverse polymerase chain reaction (PCR) technique. Autologous, peripheral mononuclear cells (PBMC) and healthy tissue of the affected organs served as controls. In all samples the transcription of the beta-actin gene as a methodological control turned out to be positive. In contrast, no cytokine gene transcription was detected in healthy tissue specimens and PBMC. IL-2 transcripts were detectable in no melanomas but in half of the renal tumor samples. IL-10 never transcribed in melanomas but was positive in 7 out of 10 renal cell carcinomas. In only 2 respectively 1 of the resected tissue probes was transcription of IL-4 and IFN-gamma detected. IL-7 was positive in 1 melanoma and in 6 urological neoplasias. The most impressive fact is the frequent transcription of the inhibiting factor IL-10 in renal cell carcinomas (7/10). This pattern of cytokine gene transcription may explain functional deficits of TIL.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Anti-reflux surgery--a boost thanks to laparoscopic techniques?].

Laparoscopic techniques also offer the patient the advantages of minimally-invasive surgery for the treatment of reflux disease. With a appropriate training it is possible to perform laparoscopic fundoplication. Our experience with the first 16 patients is favourable. The rate of conversion to open procedure (4 from 16) and the operating times (median 176 minutes) are due to the learning curve, as known from laparoscopic cholecystectomy. The indications for surgery in patients with reflux disease remain unchanged and should not be extended. However, the good early results should facilitate the decision for surgery. The generalized use of this method should be postponed until more studies have clearly demonstrated the possible short- and long-term advantages of the laparoscopic procedure over open technique.

Adult↗
PubMed1994

[Results following resection in early stomach carcinoma].

The results of surgical resection in early gastric cancer were analyzed retrospectively. These operations were performed between 1982 and 1991 on 52 consecutive patients (29 women, 23 men; average age 64 [35-85] years). The tumours were resected by total gastrectomy in 11, by subtotal gastrectomy in 31, and by Billroth I resection in 10, followed by limited lymphadenectomy of the perigastric group of lymph-nodes (D1 dissection). There was one operative death (1.9%). The tumor was confined to the mucosa in 36 patients (69%), while submucosal infiltration was present in 16 (31%) and metastases to the regional lymph-nodes in seven (13%). Follow-up examination took place in all patients, after an average period of observation of 6.1 years. For the total group the 5-year survival rate, including operative mortality, was 83.7%. It correlated with the depth of penetration of the tumour and nodal involvement. 5-year survival rate for mucosal tumour was 90%, with submucosal infiltration 66.7% (P < 0.03), without lymph-node metastasis 86.4%, with it 68.6% (P < 0.05). The extent of resection and the tumour classification (according to Laurén--intestinal or diffuse) did not influence survival.--Early gastric cancer, contrary to that in the advanced stages, has a very good prognosis. But it is significantly altered by the depth of penetration of the tumour and nodal metastasis.

Adult↗
PubMed1994

Perioperative and postoperative tranexamic acid reduces the local wound complication rate after surgery for breast cancer.

A randomized double-blind trial has shown that, in 160 women with breast cancer undergoing lumpectomy or mastectomy with axillary clearance, perioperative and postoperative administration of tranexamic acid 1 g three times daily resulted in a significant reduction in the mean postoperative drainage volume compared with patients given placebo (283 versus 432 ml, P < 0.001). The frequency of postoperative seroma formation was also decreased by tranexamic acid administration (27 versus 37 per cent, P = 0.2). Haematoma formation was infrequent in both groups and was not altered by administration of tranexamic acid. No infectious complications occurred. Age over 60 years was a significant risk factor for overall wound complications but tumour size and regional lymph node metastases were not. Tranexamic acid may be used to reduce the frequency of postoperative wound complications following surgery for breast cancer.

Age Factors↗
PubMed1994

Generation of lymphokine-activated killer activity in rodents but not in humans is nitric oxide dependent.

The role of nitric oxide (NO) in the generation of lymphokine-activated killer (LAK) cells was investigated. Here we report that L-arginine analog NG-monomethyl-L-arginine (NMMA), a specific inhibitor of nitric oxide synthase, prevents LAK cell generation from cultured rat splenic cells. Accumulated NO endproduct nitrite (NO2-), as measured in the supernatants of rat splenic cells, correlated well with the generation of LAK cells. In contrast, cell proliferation induced by rIL-2 or by Con A was not affected by NMMA. Similarly, phenotypic expression of CD25 in rIL-2-stimulated cultures was unaffected. Furthermore, we could not observe differences in percentages of CD5-CD8+ cells (NK and LAK cell phenotype markers in rats) between rIL-2-stimulated cultures performed in the presence or absence of NMMA. LAK cell generation could no longer be blocked if NMMA was added to the rat cell cultures 24 hr after rIL-2 stimulation. To further confirm the role of NO in LAK cell generation, rat splenic cells were cultured in medium without L-arginine. Under such conditions rIL-2 could not induce LAK cell generation. Hemoglobin, which is a scavenger of NO, also inhibited LAK cell generation. Finally, addition of sodium nitroprusside (SNP) which releases NO in cultures was able to overcome blocking effects of NMMA. To attempt the identification of NO-producing cells, lysosomotropic agent, L-leucine methyl ester (LME), was used. Generation of LAK cell activity was virtually abolished in cell cultures treated with LME. Addition of SNP to cultures, however, sufficed to restore LAK cell generation. These results suggest that LAK cell precursors depend on a exogenous NO supply from other cell types in order to display their full cytotoxic potential. Similar results were also obtained by using mouse splenocytes as responder cells. In contrast, NMMA did not affect generation of LAK cells from human peripheral blood or spleen mononuclear cells.

Animals↗
PubMed1994

Acute and chronic presentation of intestinal nonrotation in adults.

Intestinal nonrotation has been recognized as a cause of obstruction in neonates and children and may be complicated by volvulus and intestinal necrosis. It is very rarely seen in the adult and may present acutely as a bowel obstruction and intestinal ischemia associated with midgut or ileocecal volvulus, or chronically as vague intermittent abdominal pain. The purpose of this communication is to reveal the pathogenesis and the surgical significance of intestinal nonrotation in adults and to review the English and German language literature since 1923 to establish the optimal therapeutic management. Between 1983 and 1992, we have managed and observed prospectively 10 adults with intestinal nonrotation. In four patients the nonrotation has been detected at emergency laparotomy owing to midgut or ileocecal volvulus. Four patients suffered from chronic symptoms of intermittent volvulus or small bowel obstruction and in two patients the nonrotation has been noted as an incidental finding at laparotomy for another condition. A survey of the literature from 1923 to 1992 revealed 40 adults with symptomatic intestinal nonrotation to which we contribute nine patients. We establish that in the acute symptomatic pattern, only emergency laparotomy can provide the correct diagnosis and decrease the risk of bowel disturbance. In the chronic situation, barium studies of the upper and lower gastrointestinal tract reveal varying degrees of midgut malrotation and confirm the nonrotation in each case. Also, in these forms the explorative laparotomy with a consequent staging of the abdominal situs is to be recommended. All reported cases at our institutions are without complaints after surgery. Adult patients with intestinal nonrotation and acute or chronic obstructive symptoms or those detected incidentally at laparotomy for other conditions should undergo a Ladd procedure because of the risk of midgut volvulus. In this operation, the nonrotation is left in place and the ascending colon is sutured at the colon descendens and sigmoideum. After this procedure the mesenteric pedicle is fixed and the risk of midgut torsion remains minimal.

Abdomen, Acute↗
PubMed1994

New technique for pouch-anal reconstruction after total mesorectal excision.

PURPOSE: Surgical options in metachronous or recurrent rectal cancer after anterior or low anterior resection are limited and frequently result in abdominoperineal rectal extirpation sacrificing the sphincter or in straight coloanal reconstruction. Decreased capacity and distensibility in straight coloanal reconstruction after proctectomy correlate well with increased daily stool frequency, urgency, and incontinence. A new technique for coloanal pouch reconstruction using the ileocecal segment is proposed. METHODS: A pedunculated ileocecal segment was rotated 180 degrees counterclockwise and placed between the sigmoid colon and anal canal. Ileal end of the pouch was then anastomosed end-to-end with the transected sigmoid colon and proximal end of the ileum with distal end of the ascending colon. Functional results and defecation quality of a 67-year-old woman are described 6 and 12 months after ileocolonic interposition pouch replacing the tumor-bearing rectum. RESULTS: Twelve months postoperatively, the patient is free of disease with an excellent defecation quality, has full anal continence without soiling, is having two solid stools in 24 hours. Functional control revealed normal anal sphincter pressure and large rectal capacity and compliance. Neither outlet obstruction nor incomplete evacuation have been observed. CONCLUSION: The ileocecal interposition pouch (cecum pouch) represents an alternative technique for coloanal reconstruction in low rectal cancer, recurrent rectal cancer, or metachronous low rectal cancer with intact sphincter function. This new method presents some attractive features compared with techniques presently in use.

Aged↗
PubMed1994

Glutamine requirements in the generation of lymphokine-activated killer cells.

The role of glutamine (GLN) in the generation of lymphokine-activated killer (LAK) cell activity was investigated. LAK cells were derived from healthy donors and peripheral blood mononuclear cells (PBMC) were obtained using either unseparated PMBC or DR(-) CD3(-) CD16(+) CD56(+) enriched cells. PBMC were cultured for 6 or 10 days in medium supplemented with recombinant interleukin-2 (rlL-2; 100 U/ml) in the presence of different concentrations of GLN. K562 (natural killer-NK-sensitive targets), 1301 and U-937 (NK-resistant targets) cells were used as targets in the cytotoxic assays. Furthermore, the limiting dilution (LD) culture system was applied as an alternative to the bulk cell culture system. It was found that GLN affects the lytic potential of cultured cells while the frequency of responding cells did not significantly differ between the compared cell cultures performed in the presence of different amounts of GLN. Data on cell proliferation with IL-2 stimulation showed significant differences in cultures performed in the presence or absence of GLN. The results of present investigation suggest a supportive role of GLN in the generation of LAK cells. GLN deficit affects LAK cell killing activity by limiting the number of generated effector cells while acquisition of broad-range killing capacity was not affected.

Journal Article↗
PubMed1994

Bleeding peptic ulcer: an audit of conservative management.

One hundred and twenty-six of 157 consecutive patients (80%) admitted for a bleeding peptic ulcer were treated conservatively and retrospectively analysed. There were 52% duodenal, 41% gastric and 7% combined ulcers. The initial shock index (pulse/systolic blood pressure) was in excess of one in 10%. For 22% of the patients no transfusion was required but 10% had more than 6 units of blood during their hospital stay. Forty-nine per cent were on nonsteroidal anti-inflammatory drugs and 83% had at least one coexisting systemic disease. Six patients (5%) had a further haemorrhage, four of whom died. A total of 10 patients (8%) died. Five of them were related to the peptic ulcer disease but also had terminal or multiple systemic diseases precluding any surgery. Their poor short-term prognosis shows how difficult it will be to effectively reduce the mortality in this particular group of conservatively treated patients, even with the recent advent of endoscopic haemostasis, and stresses the importance of carefully identifying high risk patients in trials mounted to improve on the current mortality figures.

Adult↗
PubMed1994

First isolated locoregional recurrence following mastectomy for breast cancer: results of a phase III multicenter study comparing systemic treatment with observation after excision and radiation. Swiss Group for Clinical Cancer Research.

PURPOSE: We performed a randomized phase III multicenter study to compare systemic treatment versus no treatment after complete excision and radiotherapy for isolated first locoregional recurrence in patients with breast cancer. PATIENTS AND METHODS: One hundred sixty-seven good-risk patients with an estrogen receptor (ER+) positive recurrence or, in case of unknown receptor status, a disease-free interval (DFI) of greater than 12 months and < or = three recurrent tumor nodules each < or = 3 cm in diameter were entered onto the study. They were randomized to observation subsequent to local treatment or to receive tamoxifen (TAM) until disease progression. Seventy-nine percent of the patients were postmenopausal. RESULTS: The median observation period for the entire study population was 6.3 years. The median disease-free survival (DFS) duration was 26 months for observation and 82 months for TAM patients (P = .007). This was mainly due to the reduction of further local recurrences, whereas the occurrence of early distant metastases was delayed. A multivariate analysis identified DFI and treatment with TAM as significant prognostic factors for DFS. The 5-year overall survival (OS) rates were 76% and 74%, respectively (P = .77). DFI was also a prognostic factor for OS. CONCLUSION: Systemic therapy with TAM after isolated locoregional recurrence of breast cancer significantly increased 5-year DFS rates from 36% to 59% compared with observation alone and prolonged median DFS by more than 4.5 years in patients with ER+ tumors or in the case of unknown ER status with a DFI of greater than 12 months and minimal tumor burden. Treatment with TAM currently has no significant impact on OS, but the median survival duration of the study population has not yet been reached.

Adult↗
PubMed1994

Early definitive operation for bleeding peptic ulcer.

Thirty-one patients operated on for bleeding peptic ulcer were reviewed. The concept was to make an early decision to operate and proceed as soon as the patient was haemodynamically stable. In addition to haemostasis, a definitive operation was performed. Seventeen general surgeons performed the operations. Twenty-four patients (77%) were operated on within the first 24 h. During the hospital stay, two deaths (6%) occurred; four patients (13%) re-bled postoperatively, all of whom had a second operation. During a mean follow-up of 45 months, 12 deaths occurred unrelated to peptic ulcer disease and one patient had recurrent bleeding. Proximal gastric vagotomy (PGV) was used in 10 of the 14 duodenal ulcers (71%) without any hospital mortality; one patient re-bled after the operation and another during the follow-up. These results support the view that early surgery achieves a low hospital mortality and a PGV achieves good results even when carried out by several general surgeons.

Adolescent↗
PubMed1994

[Surgical training in Switzerland].

The training protocol for Swiss surgeons has become obsolete and too many new surgeons are being granted specialist diplomas. A revision of surgical training will have to take into account increasing patient demands, the multidisciplinary nature of treatments, and rapid progress in surgical techniques. It should allow the possibility of earlier specialization within the field of general surgery, but reserved to those surgeons who will remain in major hospital centres in the long term. It will have to integrate surgical research activities and recognize them as part of training. The introduction of examinations is essential to establish equivalencies with European countries and to ensure an identical level of training in all countries. This restoration of objective competitiveness will help to control the plethora of surgeons and the decreased number of active surgeons will help to group patients in a hospital system readjusted to needs and to current costs.

Curriculum↗
PubMed1994

[Intestinal drug transport: a surgical problem?].

The case of a 35-year-old man is reported, who presented himself in the emergency room with anxiety and hallucinations. He then passed a small oval pack consisting of a dark paste wrapped in cellophane with his stool. This led to the suspicion of a "body packer syndrome" with cocaine intoxication. The plain abdominal X-ray revealed multiple oval structure scattered over the entire gastrointestinal tract. Cocaine metabolites in the urine confirmed the diagnosis. During the following whole-bowel irrigation the patient had a grand mal seizure. In order to accelerate the retrieval of this threatening load, surgical evacuation was immediately executed. 78 packs containing 650 grams cocaine were removed through a gastrotomy and a coecotomy, respectively. Two of these packs were leaking. Following an uneventful postoperative course the patient was discharged from the hospital 11 days later. According to the literature the recommended treatment for cocaine body packers is whole bowel irrigation. Operative treatment is mandatory in cases of small bowel obstruction or drug intoxication due to leaking packs.

Adult↗
PubMed1994

Factors predisposing to further hemorrhage and mortality after peptic ulcer bleeding.

BACKGROUND: The mortality rate of peptic ulcer hemorrhage has remained unchanged, mainly attributable to rebleeding in an increasingly elderly population. It has been advocated that early identification of patients at high risk of rebleeding with subsequent prompt therapy may reduce the rebleeding and mortality rates. This study examines the value of clinical factors and endoscopic findings in the prediction of further hemorrhage and death. STUDY DESIGN: One hundred fifty-seven patients admitted over a two year period with bleeding from peptic ulcer were reviewed. The predictive value of individual risk factors in identifying those patients at risk of further hemorrhage or dying was determined by the chi-square test with a Yates correction. RESULTS: Nineteen patients died, 37 had further bleeding, and 31 had an early operation. Shock was the factor that best predicted further bleeding. Other significant factors were a transfusion requirement of more than four units of blood during the first 48 hours and endoscopic stigmata of recent hemorrhage. The number of coexisting illnesses per patient was strongly related to fatality rate. Other factors indicative of an increased mortality rate included steroid use, onset of bleeding during the period of hospitalization, alcohol use, further bleeding, and a need for more than four units of blood transfused during the first 48 hours. CONCLUSIONS: Shock remains the most valuable sign in predicting further bleeding and is superior to endoscopic stigmata. The close relationship between the mortality rate and coexisting illness emphasizes the fact that the most deaths result from nonpeptic ulcer disease.

Aged↗