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Biomedical subjects

F P Gall

Publications and source records attributed to F P Gall.

At least 37 records · Page 2Linked to original sources
PubMed1992

[Polypoid lesions of the gallbladder--preventive cholecystectomy?].

During nine years (1979-1988) there was carried out cholecystectomy in 21 patients for gallbladder polyps of unknown histology. The sex ratio female to male was 9 to 12, median age 51 (29-76) years. Most of the polyps were smaller than 5 mm, all proved to be cholesterol polyps, showing multiple localisations. Two benign adenomas had a size of 6 resp. 9 mm. Among the polyps with a diameter of more than 10 mm we found only two cholesterol polyps, but one heterotopia, one adenoma and one adenocarcinoma. Cholecystectomy is indicated for polyps with a diameter of more than 10 mm or suspicious sonographic criteria, especially sessile lesions or concomittant thickening of the gallbladder wall.

Adenocarcinoma↗
PubMed1991

[Laparoscopic cholecystectomy: experiences in Erlangen].

From February 2, 1990 to June 15, 1991, a total of 160 patients were subjected to laparoscopic cholecystectomy. The procedure was successful in 150 patients, while in ten patients the procedure was converted to conventional cholecystectomy for the following reasons: suspected malignancy (2), cystic duct stone (1), dysfunction of equipment (2), adhesions (1), concomitant liver tumor (1), abscess in the hepatoduodenal ligament following endoscopic papillotomy (1), and chronic cholecystitis (2). Four patients developed substantial complications. Two patients developed biliary leakage requiring laparotomy and endoscopy placement of a nasobiliary tube in one case each. The other two patients developed intraabdominal bleeding that forced an emergency laparotomy in one case. With increasing experience in laparoscopic cholecystectomy, we would only consider a preoperative suspicion of malignancy as an absolute contraindication.

Adolescent↗
PubMed1991

[Regional chemotherapy of diffuse liver metastases of colorectal cancer].

From 1970 to 1987, a total of 112 patients underwent regional chemotherapy as primary treatment of colorectal liver metastases. 68 patients received 250-750 mg 5-FU 2-3 times per week via external devices, 40 patients with port catheters had 5-day courses of Mitomycin C (8 mg/m2/day 1) and 5-FU (600 mg/m2/day 1-5) at 4 week intervals, and four patients were treated with FUDR (0.2 mg/m2/day 1-14/28) using an Infusaid pump. Median and maximum survival were 13.2 and 58 months, respectively. The overall response rate in patients suitable to imaging criteria who underwent treatment for more than three months and was 83% (CR 14%, PR 40%, SD 29%). The influence of various factors on Kaplan/Meier survival was checked the Logrank test. Response to treatment was of superior importance (p = 0.0000016), but hepatomegaly, Karnofski index, the percentage of liver volume replaced by tumour, and various liver related biochemical tests were also highly significant prognostic determinants (p greater than 0.01). There was no difference between external and fully implantable devices. A subgroup of 68 patients without extrahepatic disease, treatment of more than three months was retrospectively compared to 121 untreated patients with a similar stage of disease. There was no obvious effect of regional chemotherapy on survival (p = 0.16). Although the untreated patients consist a historical control group only, this result indicates that regional chemotherapy must continuously be restricted to well prospective clinical trials.

Adult↗
PubMed1991

Indicators of prognosis after hepatic resection for colorectal secondaries.

From 1960 to 1988, 266 patients underwent resection of colorectal secondaries to the liver with curative intent. All patients were followed until April 1, 1990, or death, with a median follow-up time of 52 months. Nine patients with minimal macroscopic residual disease and 38 patients with all gross tumor removed but positive margins showed a poor prognosis with a median survival time of 13.3 months, the longest being 42 months. Of the 219 patients having potentially curative resection, 12 patients died postoperatively (5.5%). Actuarial 5, 10 and 20-year survival for the remaining 207 patients was 39%, 28%, and 18%, respectively. At April 1, 1990, 77 patients were alive with no evidence of disease for up to 24 years, and 12 patients had died without recurrence. The following factors were associated with less favorable crude survival: presence and extent of mesenteric lymph node involvement (p = 0.0003), grade III/IV primary tumor (p = 0.035), synchronous diagnosis of metastases (p = 0.017), satellite metastases (p = 0.0003), limited resection margins (p = 0.019), and nonanatomic procedures (p = 0.013). With respect to disease-free survival, grading of the primary (p = 0.055) and the extent of clear margins (p = 0.019) failed to achieve statistical significance. Two other criteria are commonly recommended as absolute contraindications to hepatic resection: extrahepatic disease and the presence of four or more independent metastases. A radical excision of all detectable disease may rarely be possible in these circumstances. Nevertheless, within the curative settings, no significant predictive value regarding either overall or disease-free survival was found in this series. Three corresponding "high risk" patients are alive without disease at 5 to 11 years from hepatic resection. These patients with more advanced intrahepatic or concomitant limited extrahepatic disease require a particularly thorough diagnostic work up. As no superior therapeutic alternative is currently available, an aggressive surgical approach may occasionally be justified, and may, in a small portion, result in definite tumor control.

Adult↗
PubMed1991

Surgical treatment of ductal pancreatic carcinoma.

Among 587 patients with ductal pancreatic carcinoma who were examined between 1969 and 1987, 260 (44.3%) had distant metastases at the time of diagnosis. Tumour resections, mostly subtotal duodenopancreatectomies, were performed in 138 patients (23.5% of all patients, or 39.8% of all patients without distant metastases); in 91 patients the resection was for cure (R0). Operative mortality following tumour resection was 6% for all patients. The age-corrected 5-year survival rate was 2.9% for all patients and 16% where the resection was curative; of these 46% were in Stages I and II and 6% in Stage III. In non-curative resections, the median survival time was 7.2 months, which was significantly longer than the 3.4 months following bypass operation. Cure for pancreatic carcinoma can be achieved only through surgery, and a negative attitude towards surgery must be resisted.

Carcinoma↗
PubMed1990

Pulmonary resection for metastatic colon and upper rectum cancer. Is it useful?

The predictive value of the route of venous drainage on prognosis was investigated in a consecutive series of 44 patients who underwent curative resection of pulmonary metastases from colorectal carcinoma. The primary tumor was located in the colon in 14 patients and in the upper third of the rectum in 11 patients, thus indicating blood drainage directed toward the portal vein (Group I). In 10 and 9 cases, respectively, the initial growth was in the middle and lower thirds of the rectum with the venous outflow at least partially directed into the vena cava (Group II). There was no obvious difference between the two groups regarding the initial site of cancer relapse. The liver was involved in 4 of 15 patients failing in Group I as opposed to 4 of 13 patients with hematogenous relapse in Group II. Median survival and tumor-free survival times were significantly longer in patients in Group I (58.4 and 50.2 months) than in patients in Group II (30.9 and 16.8 months), and, even more pronounced, in colon cancer patients (75.4 and 60.2 months) when compared with rectal cancer patients (31.0 and 17.9 months). In contrast, survival curves did not differ significantly if either the two groups with different routes of drainage (5-year survival 53 percent vs. 38 percent, 5-year tumor-free survival 43 percent vs. 37 percent), or tumors of the colon and rectum (5-year survival 67 percent vs. 38 percent, 5-year tumor-free survival 60 percent vs. 32 percent) were compared using the log-rank test. Similar trends were obtained for the subgroup of 34 patients without previous or simultaneous extrapulmonary recurrent disease at the time of lung resection. The primary tumor site does therefore not become a major criterion in selecting patients for surgical resection.

Adult↗
PubMed1990

[Discontinuity resection of the colon. Indications and results].

In 83 patients discontinuity resection of the colon was performed. Due to negative selection factors postoperative mortality was 26.5%. In 37 patients continuity of the colon was restored, no patient died postoperatively. The only severe complication was formation of a colovesical fistula requiring a pull-through operation.

Adolescent↗
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

[Malignant somatostatinoma of the papilla major and minor].

In a 50-year-old man with extrahepatic cholestasis and iron-deficiency anaemia, local operative excision of a 4 cm submucous tumour of the papilla of Vater revealed on histological and immunochemical examination a somatostatinoma. Subsequent duodenopancreatectomy further demonstrated in the surgical specimen a lymph node metastasis and a 5 mm somatostatinoma in the papilla minor. The patient has now been free of symptoms for 12 months on substitution treatment with pancreatic enzymes.

Adenoma, Islet Cell↗
PubMed1989

[Effect of the transfusion of blood and hemoderivatives on the prognosis of colorectal cancer].

In recent years in the literature several investigators described a negative effect of perioperative transfusion of blood and hemoderivatives on the prognosis of malignant tumors. Concerning the patients with colorectal carcinoma operated between 1979 and 1983 at Erlangen University Hospital these results could be proven. We observed a significantly worse 5-year survival rate for patients who received perioperative blood transfusion. However, multivariant analysis in Cox-regression model revealed other factors like tumor stage and localisation responsible for the poorer prognosis. Therefore blood transfusion seems not to have any influence on the prognosis itself. Furthermore we observed a significantly poorer prognosis concerning patients who perioperatively received fresh frozen plasma (FFP). Surprisingly multivariant analysis showed that FFP substitution in contrast to blood transfusion has an own prognostic influence. This difference in prognosis cannot be explained by selection criteria. The mechanism of the negative influence of FFP on the prognosis of colorectal carcinoma remains unclear and is investigated currently in prospective studies.

Aged↗
PubMed1989

Prognostic factors in rectal carcinoma. A contribution to the further development of tumor classification.

In 597 patients with adenocarcinoma or mucinous adenocarcinoma of the rectum, the prognosis after radical resection for cure was investigated. Staging according to the fourth edition of the UICC TNM Classification showed a good correlation to prognosis. By multivariate analysis, various additional independent prognostic factors could be demonstrated. The individual additional prognostic factors are partly of significance in some pTNM defined stages and substages, but not in others. In order to obtain the most detailed knowledge of prognostic factors after radical resection for cure, multivariate analysis of prognostic factors in colorectal carcinoma must be performed not only in separate colonic and rectal groups, but also separately for each of the individual pTNM defined stages and substages.

Actuarial Analysis↗
PubMed1989

[Resection of lung metastases of colorectal cancer. Indications and indication limits].

From 1970 through 1986, a total of 62 patients underwent thoracotomy for colorectal metastases to the lungs. Four had exploration only, whereas in 13 a nonradical, and in 45 a "curative" resection was performed. There was one postoperative death. Cumulative 5-year survival following radical resection was 44%. Conversely, all other patients succumbed within 3 years. Extrapulmonary disease has not yet been associated with 5-year survival and may usually contraindicate resection. The impacts of multiple metastases exceeding 3 nodules or bilateral pulmonary involvement on prognosis can not been determined from our series, since the procedure in respective patients was not radical in the majority of cases. In turn, localisation and venous drainage of the primary tumor did not significantly influence long term survival.

Adenocarcinoma↗
PubMed1989

[Deep rectal cancer: selection of surgical methods in relation to site and extension].

The procedure of choice for most pT1 and a few pT2 tumors in the lower-third of the rectum is excision or local endoscopic polypectomy. In 602 radically resected low rectal carcinomas, the local recurrence rate for LAR was 18% and for APE 17%. There was no difference in local recurrence for UICC stage I and II tumors with a small (less than or equal to 2 cm) versus a large (greater than or equal to 3 cm) distal margin. However, in UICC stage III B and III C there was a statistically significant difference between a small (56%) and a large (22%) distal margin for LAR, while the local recurrence was 29% for APE. LAR in stage III B + C should be performed only when a distal margin of 3 cm is guaranteed.

Follow-Up Studies↗