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Biomedical subjects

F Herbst

Publications and source records attributed to F Herbst.

At least 37 records · Page 2Linked to original sources
PubMed2000

p53 gene status and expression of p53, mdm2, and p21Waf1/Cip1 proteins in colorectal cancer.

Abrogation of the normal p53 pathway is the most common molecular alteration in human cancer. p53 Gene status can be potentially assessed through the expression of proteins known to be activated by the wild-type p53 (wt p53) system, such as mdm2 and p21Waf1/Cip1. In this study, the frequency of mdm2, p21Waf1/Cip1, and p53 protein expression was investigated using immunohistochemistry (IHC) in 88 colorectal carcinomas (CRCs). The relationship between these expressions and p53 status was examined. p53 status and the immunophenotypes characterizing these tumors were correlated with standard prognostic variables. Mutation of p53 was detected using single-strand conformational polymorphism (SSCP) analysis and sequencing. Concordance between p53 gene status and p53 immunoreactivity was seen in 62 of 88 (70.45%) carcinomas. Mdm2 expression was found in 22 of 45 (48.88%) and 5 of 43 (11.62%) of the tumors with wt p53 and mutated p53 (P<0.0001), respectively. Predominantly, higher p21Waf1/Cip1 expression was associated with wt p53 (P<0.001). All wt p53 cases that expressed mdm2 also expressed p21Waf1/Cip1. These results suggest that there is a subgroup of CRCs in which p53 is functionally active, inducing transcription of mdm2 and Waf1/Cip1. Their combined evaluation may provide important clues for planning adjuvant systemic therapy and gene therapy based on the restitution of p53 function. However, no significant association was found between the immunophenotypes and the standard prognostic variables investigated.

Adult↗
PubMed2000

[Consensus of the Chronic Inflammatory Bowl Disease Study Group of the Austrian Society of Gastroenterology and Hepatology on the topic of "diagnosis and therapy of chronic inflammatory bowel diseases in adolescence"].

Although up to 20% of patients with Crohn's disease have their first flare during childhood or adolescence, there are no or only a few randomized, controlled studies. However, big differences and uncertainty may be observed between the diagnosis and therapy of pediatricians and gastroenterologists specialized for adults. In addition, special problems result from the enormous somatic and psychological evolution during adolescence. The diagnosis is done as in adult patients by enteroclysm and ileocolonoscopy (including multiple biopsies) whereas a deep sedoanalgesia or anesthesia should be performed routinely. Corticosteroids are the gold standard for therapy of Crohn's disease in the adolescence (especially in cases with high inflammatory activity), but also enteral nutrition over 4-12 weeks--or a combination of both. A recent randomized controlled study demonstrates the positive effect of 6-mercaptopurine in newly diagnosed patients with Crohn's disease in the adolescence. 5-aminosalicylates or the probably more effective azathioprine/6-mercaptopurine could be used for prevention of recurrence in Crohn's disease. The therapy of ulcerative colitis is performed as in adults including the very effective local rectal applications. An accompanying psychosomatic therapy is recommended especially in young patients with disturbed separation from the parents and inadequate coping. The indication for surgery is similar to adults. However, a specific indication for earlier surgery is given, if severe malabsorption and delay of growth takes place in spite of adequate therapy, because this delay of growth could be only caught up before puberty. A conservative therapeutic regimen is recommended in young patients with perianal Crohn's disease.

Adolescent↗
PubMed2000

Early changes of ileoanal pouch mucosa in patients with ulcerative colitis.

BACKGROUND/AIMS: Following closure of the protective ileostomy the mucosa of ileoanal pouches undergoes characteristic changes, which are thought to be caused by the new luminal environment Conventional histopathology and immunohistochemical markers were compared in serial pouch biopsies from patients with ulcerative colitis (UC) in the early period of function. METHODS: Biopsy specimens were obtained from nine patients during ileostomy closure, 24 h after the first bowel action, then 6 days, 6 weeks and 3 months postoperatively. Cryostat sections were stained with haematoxylin and eosin (H&E) for assessment of mucosal inflammation and morphometry, and for lymphocyte subtypes (CD3, CD4, CD8), macrophages (CD68), common leucocyte antigen (CD45), and HLA-DR, using a three-stage immunoperoxidase reaction. RESULTS: Within 5 days of pouch function the index for mucosal atrophy (villous height/total mucosal thickness ratio) decreased significantly from a median (range) of 0.66 (0.39-0.69) to 0.52 (0.37-0.61)(P = 0.02). Intraepithelial lymphocyte counts diminished from 10.1 (5.6-21.1) to 7.0 (2.2-8.2)(P = 0.007) per 100 epithelial cells and remained so. In the lamina propria, apart from a transient increase in CD3 positive cells at 5 days (from 92.7 (58-165) to 100.5 (57-234) per unit area; P = 0.038), no significant changes were observed. H&E grading and HLA-DR expression remained unchanged. CONCLUSIONS: While there was no significant change in mucosal morphology and mucosal leucocyte subpopulations after 24 h of pouch function, the ileal pouch mucosa in UC patients had responded significantly within 5 days. Further studies into cell function and signalling are required.

Adult↗
PubMed2000

Transrectal sonography of anal sphincter infiltration in lower rectal carcinoma.

OBJECTIVE: The purpose of the study was to assess the accuracy of transrectal sonography in determining invasion by lower rectal cancer into the anal canal. SUBJECTS AND METHODS: Thirty-eight patients (14 women, 24 men; mean age, 65 years) with lower rectal cancer underwent transrectal sonography before surgery. Both depth of infiltration and tumor invasion into the anal canal were assessed, and results were compared with histopathology of the resected specimens. RESULTS: Infiltration into the anal canal was found histopathologically in 12 (32%) of 38 patients. Transrectal sonography revealed a true-positive diagnosis in 11 of these 12 patients. A false-positive diagnosis of anal canal infiltration was made in two patients for a sensitivity of 91%, a specificity of 85%, and an accuracy of 92%. In the 11 patients diagnosed correctly on transrectal sonography, the depth of tumor infiltration into the anal canal corresponded with histopathology. CONCLUSION: This study shows that transrectal sonography is an accurate method for assessment of anal canal infiltration in lower rectal cancer.

Adenocarcinoma↗
PubMed1999

Abdominosacral resection of recurrent rectal cancer in the sacrum.

PURPOSE: Resection of the sacrum is the only curative therapy of isolated sacral recurrence after primarily resected rectal cancer. The aim of the study was to assess whether there is a benefit in terms of overall survival, morbidity, and mortality when sacrum resection is performed more radically and in cooperation between colorectal and orthopedic surgeons. Possible prognostic factors were also assessed. METHODS: Twelve consecutive patients who underwent interdisciplinary partial sacral resection were included in a retrospective cohort study. Furthermore, overall survival rate and survival time were calculated. RESULTS: Histologic examination showed tumor-free resection margins in all cases. Extended resection was necessary in seven patients, including total pelvic exenteration in two. No perioperative death occurred and no patient required early reoperation. Complications were observed in 42 percent of patients, mainly caused by poor wound healing. All patients experienced relief from pain. One-year and three-year overall survival rates were 50 and 17 percent, respectively. The overall mean survival time was 21.7 months. Patients who died of recurrent disease within one year either underwent former resection for locoregional recurrence, had extensive local recurrent tumors affecting pelvic visceral structures, or retrospectively suffered from metastatic sacral tumor manifestation. CONCLUSION: The mortality and morbidity rates observed in the present study seem to justify partial sacral resection as a means to achieve palliation of perineosacral pain in spite of rare overall long-term survival.

Adenocarcinoma↗
PubMed1999

Video assistance reduces complication rate of thoracoscopic sympathicotomy for hyperhidrosis.

BACKGROUND: Thoracoscopic sympathicotomy has proved successful in the treatment of palmar hyperhidrosis. However, up to 8% of patients experience Horner's syndrome, and about 50% show compensatory sweating. This study evaluates the role of video assistance in thoracoscopic sympathicotomy for primary hyperhidrosis of the upper limb. METHODS: Six hundred fifty-six thoracoscopic sympathicotomies were performed from below T1 to T4 in 369 patients. Of the operations, 558 were done under direct view (CTS group) and 98, with video assistance (VATS group). Follow-up was complete for 78.3% of patients after a median observation period of 16 years. RESULTS: Dry limbs were immediately achieved in 93% of the CTS group and 98% VATS group (p = 0.98). In the CTS group, Horner's syndrome occurred after 2.2% of all operations and rhinitis in 8.3%. No patient in the VATS group showed any symptom of Homer's triad (p = 0.03 versus CTS group) or rhinitis (p = 0.02 versus CTS group). Compensatory sweating was observed in 66.8% in the CTS group versus 69% in the VATS group (p = 0.73) and gustatory sweating, in 50.4% versus 27.6%, respectively (p = 0.01). CONCLUSIONS: In performing thoracoscopic sympathicotomy for excessive upper-limb hyperhidrosis, we observed a significant decrease in the incidence of Horner's syndrome, rhinitis, and gustatory sweating when the procedure was guided by video imaging.

Adolescent↗
PubMed1999

Long-term results of 45 thoracoscopic sympathicotomies for primary hyperhidrosis in children.

BACKGROUND/PURPOSE: Thoracoscopic sympathicotomy (TS) is successful in treatment of excessive hyperhidrosis of the upper limb after limited follow-up observation. The aim of the study was to assess for the first time long-term results of TS in children. METHODS: A total of 26 children (9 boys, 17 girls) aged 11 to 17 years with severe palmar or axillar hyperhidrosis underwent TS, and 19 patients were treated bilaterally. A total of 19 patients were observed after a median follow-up period of 16 years by questionnaire or clinical examination. RESULTS: Permanent relief from palmar hyperhidrosis was given in all examined patients. Twelve patients had compensatory and 12 patients gustatory sweating. Postoperatively, 1 subcutaneous emphysema and 1 temporary miosis and ptosis were noted. Eleven patients were fully satisfied with the result. Seven patients were only partially satisfied because of compensatory or gustatory sweating but would again undergo operation. One patient was not satisfied because of excessive compensatory sweating. CONCLUSIONS: TS is a safe and efficient procedure even after long-term follow-up. Severe palmar hyperhidrosis often starts in childhood; thus, early surgical treatment can improve social development. Compensatory and gustatory sweating are the most frequent and enduring side effects and should be mentioned in preoperative patient and parent information.

Adolescent↗
PubMed1999

Assessment of chronic constipation: colon transit time versus defecography.

OBJECTIVE: The aim of this study was to determine the value of radiological colon transit time (CTT) measurements in relation to defecography (DFG) in chronically constipated patients. MATERIALS AND METHODS: In 30 patients with chronic constipation, total and segmental CTT was determined using radiopaque markers. In all of these patients defecography (DFG) was obtained. The patients were divided into three groups: In group I, 11 patients were classified with idiopathic constipation based on low stool frequency, normal DFG, or absence of symptoms of abnormal defecation. In group II, ten patients with rectal intussusception were diagnosed by DFG. In group III, there were nine patients with rectal prolapse or spastic pelvic floor syndrome, based on results of DFG. RESULTS: Group I, idiopathic constipation (n = 11), showed increased total CTT (mean, 93 h) and segmental CTT (right colon, 33 h (36%), left colon, 31 h (33%), rectosigmoid, 29 h (31%)). In group II, intussusception (n = 10), patients had normal mean total CTT (54 h) and a relative decrease in rectosigmoid CTT (mean, 13 h (24%)). In group III (n =9), rectal prolapse (n = 5) or spastic pelvic floor syndrome (n = 4), patients showed elevated total (mean, 167 h) and rectosigmoidal CTT (mean, 95 h (57%)). Mean total CTT was significantly different between groups I and II and between groups II and III, and mean rectosigmoidal CTT was significantly different between all three groups (P < 0.05). CONCLUSION: The use of total and rectosigmoidal CTT helps to identify the underlying pathophysiology of chronic constipation. Furthermore CTT helps to identify patients, who may benefit from DFG.

Adult↗
PubMed1999

[Rectal carcinoma--optimizing therapy by improved preoperative staging? Is endosonography required?].

Endosonography is superior to other imaging modalities (CT, MRI) and has to be considered as the most useful and accurate method in staging rectal carcinoma inclusive the invasion of the sphincter apparatus. Selection of patients for sphincter saving operation, local excision and in case of preoperative adjuvant therapy is greatly supported by endosonography and has to be considered as inevitable in the preoperative management.

Endosonography↗
PubMed1998

Effects of loperamide on ileoanal pouch function.

BACKGROUND: Opioid analogues are used to manage increased bowel frequency in patients with an ileoanal reservoir. The aim of the study was to determine the clinical efficacy of loperamide in patients with an ileoanal reservoir and to assess its effect on pouch motility. METHODS: Fourteen patients with a pouch who had normal pouch emptying and anal function were studied. Ambulatory pouch and anal motility, and stool weights, were recorded for 24 h while taking no medication and for 24 h while receiving 8 mg loperamide. In a second analysis, patients were divided on the basis of bowel frequency into those with 4 or fewer motions (good function; n=6) and those with more than 6 per day (poor function; n=8), to determine any differential effects of loperamide. RESULTS: Loperamide decreased median bowel frequency (no loperamide 5.5 versus loperamide 4.0, P=0.03) and 24-h stool weight (610 g versus 413 g, P=0.03) but not individual stool weights. Patients with poor function had both higher bowel frequency (8.0 versus 3.5 per 24 h, P=0.004) and higher stool weight (728 g versus 430 g, P=0.05) with no treatment than those with good function. High-amplitude pouch pressure waves were greater in number before defaecation in patients with poor function and did not decrease with loperamide, in contrast to patients with good function. Pouch baseline pressure decreased after defaecation to a similar extent in both groups and was not affected by loperamide. CONCLUSION: Loperamide 8 mg per day reduces bowel frequency by reducing total stool weight, not individual stool weights. In patients with good function it also affects pouch motility. High bowel frequency is associated with increased pouch high-pressure waves.

Adenomatous Polyposis Coli↗
PubMed1998

Perinuclear anti-neutrophil cytoplasmic antibodies in ulcerative colitis after restorative proctocolectomy do not correlate with the presence of pouchitis.

BACKGROUND: Although perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) expression is strongly associated with ulcerative colitis, its relationship with the occurrence of pouchitis after restorative proctocolectomy is uncertain. METHODS: Serum p-ANCA was assayed using both indirect immunofluorescence and enzyme-linked immunosorbent assay (ELISA) in 49 patients, of whom 25 had, and 24 had not, developed pouchitis. Control sera were obtained from 15 healthy volunteers. RESULTS: By means of indirect immunofluorescence, p-ANCA was detected in 45.8% of patients without and in 48% with pouchitis (NS). Twenty-three (46.9%) of the 49 colitis patients were p-ANCA-positive, compared with none of the 15 controls (P < 0.01). By means of ELISA, p-ANCA positivity was present in 50% of patients without and in 68% with pouchitis (NS). CONCLUSION: Whereas p-ANCA was associated with ulcerative colitis as compared with normal individuals, it was not associated with pouchitis. Thus it is unlikely to be a suitable pre-operative marker to identify those patients who will develop pouchitis.

Adult↗
PubMed1998

Long-term results of 630 thoracoscopic sympathicotomies for primary hyperhidrosis: the Vienna experience.

OBJECTIVE: To evaluate of the results of thoracoscopic sympathicotomy for upper limb hyperhidrosis with a median observation period of more than 15 years. DESIGN: Retrospective clinical observation study. SETTING: University-affiliated tertiary referral centre. SUBJECTS: 630 consecutive operations in 352 patients (median age 30.1 yrs) for primary palmar (68%), axillary (12.7%) and combined hyperhidrosis (19.3%). INTERVENTIONS: Thoracoscopic sympathicotomy from below T1 to T4 including the fibres of Kuntz using electrocautery through single site access. MAIN OUTCOME MEASURES: Perioperative success and complication rates (all patients); long-term follow-up by a questionnaire and/or clinical examination (83.3% of patients) after a median period of 16 yrs. Calculation of statistical significance of differences between groups with c2-test. RESULTS: 67.8% of patients were fully satisfied, 25.7% were partially satisfied and would again agree to the operation. In 93% the procedure cured hyperhidrosis permanently. Compensatory and gustatory sweating was observed in 67% and 47% of cases, respectively. Overall success was significantly (p < 0.001) lower in the group with axillary hyperhidrosis. Main complications: drainage for pneumothorax 1.3%, Horner's syndrome in 3.8%, subcutaneous emphysema 2.1%. CONCLUSION: Thoracoscopic sympathicotomy proved to be highly effective even after long-term follow-up. Compensatory sweating impairs patients' satisfaction in some cases.

Adolescent↗
PubMed1998

[Restorative surgery of a Hartmann status for relief of chronic sphincter problems].

The Hartmann situation is a temporary intestinal diversion to treat diseases of the rectosigmoid. In case of benign rectosigmoidal disorders the entirely laparoscopic performance of the colon disconnection and reconstruction is an advantage due to its minimal invasive nature. A patient suffering from chronic anorectal fistula with temporary relief exclusively performed by laparoscopic approach is reported.

Adult↗
PubMed1997

Family history as a marker of risk for colorectal cancer: Austrian experience.

A family history of colorectal cancer is a known risk factor for the disease. As a result of different study designs from different populations, the strength of this association varies in the literature. We intended to define the incidence and the risk predictors in first-degree relatives of patients with colorectal cancer in the Austrian population. A family history was obtained from first-degree relatives of 100 consecutive patients with sporadic colorectal cancer. Life-table methods were used to compare the observed and expected incidence of colorectal cancer and the influence of differences in risk for first-degree family members. The calculated lifetime risk for colorectal cancer in Austria is 1:16. Individuals with a positive family history had a 4.6-fold risk (p </= 0.0001), particularly in the case of a young index patient (p </= 0.011) or if two or more family members were affected (p </= 0. 001). In addition, the risk for gastric cancer in relatives was increased almost fourfold (p </= 0.0001). We have confirmed for Austria that a positive family history of colorectal cancer is a strong risk factor, and that this risk is comparable to that in other Western countries. We have shown that relatives are also at increased risk for gastric cancer.

Adult↗
PubMed1997

Gastrointestinal transit and prolonged ambulatory colonic motility in health and faecal incontinence.

BACKGROUND: Colonic motor function has not been studied in the ambulatory setting over a prolonged period in the unprepared state. Furthermore, the disturbance of this function in patients with faecal incontinence is unknown. AIM: To study colonic function over two to three days in the ambulatory, unprepared state in health and in patients with idiopathic faecal incontinence. METHODS: Six healthy women and six women with faecal incontinence and a structurally intact anal sphincter ingested a dual radioisotope meal, and had a six sensor, solid state manometric probe colonoscopically inserted into the left colon. Scanning was performed until radioisotope left the gut and pressure was recorded for a median of 44 hours. RESULTS: Three of six patients showed abnormal gastric emptying. Patients showed no disturbance of colonic radioisotope transit. Controls had a median of 12, whereas patients had a median of 16, high amplitude propagated waves per 24 hours. In three patients urge incontinence was associated with high amplitude (up to 500 cm water) propagated waves which often reached the rectum. These high pressure waves were identical to those occurring in healthy subjects, the only difference being the lack of adequate sphincter response. Passive incontinence was not associated with colonic motor activity. Defaecation in all subjects was associated with identical propagated waves, and distal movement of 13% (median) of right colonic content and excretion of 32% from the left colon and rectum. The urge to defaecate was associated with either propagated waves (45%) or non-propagated contractions (55%). Rectal motor complexes were recorded in both groups of subjects, but similar rhythmic activity was also recorded in the sigmoid and descending colon. CONCLUSIONS: Normal colonic function consists of frequent high pressure propagated waves. Rhythmic activity occurs both proximal to and in the rectum. Defaecation is characterised by high pressure propagated waves associated with coordinated anal sphincter relaxation. Patients with faecal incontinence may have a widespread disturbance of gut function. Urge incontinence, an urge to defaecate, and defaecation can all be associated with identical high amplitude propagated pressure waves.

Aged↗
PubMed1997

Peritumoral tissue reaction at transrectal US as a possible cause of overstaging in rectal cancer: histopathologic correlation.

PURPOSE: To assess if peritumoral tissue reaction (PTR) can be differentiated from tumor with transrectal ultrasound (TRUS) to avert overstaging. MATERIALS AND METHODS: Preoperative TRUS results in 40 consecutive patients with biopsy-proved rectal cancer were compared with histopathologic reports on the specimens (study 1). To test the hypothesis that areas more anechoic than the tumor were deemed responsible for incorrect staging in study 1, a prospective study was undertaken in another 40 consecutive patients (study 2). The thickest part of PTR was measured, and results were compared with the histopathologic findings. RESULTS: In study 1, 28 (70%) of 40 rectal cancers were staged correctly with TRUS. PTR was responsible for the misinterpretation in six of seven overstaged cases. In study 2, 38 (95%) of 40 cancers were staged correctly, and the presence or absence of PTR was described in 39 cases (98%). A statistically significant positive correlation was noted between histopathologic classification of PTR and its thickness measured with TRUS (P = .0001). CONCLUSION: Because of its more anechoic appearance, PTR may be differentiated from the tumor by means of TRUS. This may lead to a statistically significantly higher accuracy of TRUS in the staging of rectal cancer due to the avoidance of overstaging.

Adipose Tissue↗
PubMed1997

[Hyperhidrosis of the upper extremity: long-term outcome of endoscopic thoracic sympathicotomy].

A total of 630 endoscopic thoracal sympathicotomies were performed for hyperhidrosis of the upper limbs, and complications and success rates were analyzed after a median follow-up period of 16 years (83% of patients). In all, 67.8% of patients were fully satisfied, 25.7% were partially satisfied and would again agree to the operation, and 93% the procedure terminated hyperhidrosis permanently. Compensatory and gustatory sweating was observed in 67% und 47% of cases, respectively, impairing the patients satisfaction. Overall success was significantly (p < 0.001) lower in the group with axillary hyperhidrosis.

Adult↗