Search PubMed⌕ Search

Biomedical subjects

F P Gall

Publications and source records attributed to F P Gall.

At least 55 records · Page 3Linked to original sources
PubMed1988

Cancer of the rectum--local excision.

Limited surgical techniques have gained an important role among treatment modalities for invasive carcinoma of the rectum. Polypoid or plateau-like tumors not larger than 3 cm in which palpation, CT, and endoluminal sonography findings suggest only a slight depth of invasion may be treated by limited surgery. According to tumor size, macroscopic appearance, and site, one can decide whether to choose endoscopic polypectomy, per anal submucosal or full-thickness disc excision, or trans-sphincteric excision. After local excision, careful pathologic examination of the specimen is essential in deciding whether the limited procedure can be regarded as curative or whether a radical resection must be added. When average operative risk is present, carcinomas limited to the submucosa (pT1 or early carcinomas) with good prognostic histomorphologic features (grade 1 or 2; no lymphatic invasion) are suitable for treatment by limited surgery. If strict selection criteria are implemented, 5-year survival rates of better than 90 per cent can be achieved. The complication rate is low, and the postoperative mortality rate, even in elderly patients, is minimal.

Anal Canal↗
PubMed1988

Significance of serum phosphohexose isomerase in gastrointestinal cancer at different stages.

The purpose of this study was to reevaluate the significance of serum PHI in gastrointestinal cancer at histopathologically defined stages prior to primary treatment. A total of 248 patients with malignant tumors of the gastrointestinal tract and a collective of 42 patients with noncancerous diseases were studied. The results are compared with those obtained with the established markers tissue polypeptide antigen (TPA) and carcinoembryonic antigen (CEA). Phosphohexose isomerase (PHI) revealed an overall diagnostic sensitivity of 69%, combined with a specificity of 74%. The corresponding data for TPA were found to be 73 and 47% while for CEA 26 and 95% respectively were determined. Even in the early stages of colorectal and esophageal carcinoma, PHI showed a sensitivity of about 60%. A continuous rise of PHI serum levels, correlating well with the extent of the tumor disease, could be detected. In contrast to TPA and CEA, PHI assay can be carried out with a minimum of laboratory efforts, in a short time and at low costs. These findings suggest that serum PHI assay is a useful aid for screening of gastrointestinal cancer, especially esophageal and gastric carcinoma, and a reliable marker for treatment control and follow-up.

Antigens, Neoplasm↗
PubMed1988

Subtotal duodeno-pancreatectomy for carcinoma of the head of the pancreas. Preliminary report of an alternative operation to total pancreatectomy.

For ductal carcinoma of the head of the pancreas and large periampullary carcinoma with wide infiltration into the head of the pancreas a subtotal duodeno-pancreatectomy with preservation of the pancreatic tail and spleen is introduced as an alternative to total pancreatectomy. A preliminary report of 38 operations shows a mortality of only 3% and a low morbidity. Diabetes mellitus increased from 17% preoperatively to 40% postoperatively, therefore, in 60% a normal carbohydrate metabolism was preserved. At present 5 of 20 patients (R0) with ductal cancer are alive and free of recurrence 18 to 55 months after the operation with a median survival of 12 months for all curatively resected patients. No negative influence on median survival time can yet be recognized. Subtotal duodeno-pancreatectomy was performed with a much lower operative risk than total pancreatectomy and seems to be as effective as total organ removal.

Adult↗
PubMed1988

[Acute diverticulitis].

A retrospective study of 310 patients from 1978 to 87 showed emergency operations for peritonitis, acute obstruction (5%) and massive hemorrhage (3%) in 22% of the patients and various procedures for abscesses, such as delayed emergency in 14% and elective resections in 41%. Conservative treatment was given to 23% of patients with acute diverticulitis without further symptoms. During followup 68% had no symptoms, while 7% required resection for complications. The death rate for diffuse peritonitis has fallen: from 33 to 16% with Hartmann operation, and for perforations without and with abscesses from 4 to 0% and 12 to 4%, and from 1.2 to 0.6% in elective primary resection.

Acute Disease↗
PubMed1988

[Surgical therapy of gallbladder cancer].

Because of the normally far advanced tumor stages of carcinomas of the gallbladder, the resection rate in the literature varies from 10 to 30 percent. Our own curative resection rate was 19% in a series of 89 patients between 1969 and 1985 first treated in our hospital. The palliative resection rate was 29%, in 10% we performed a palliative operation and in 36% an explorative laparotomy. The curative resected gallbladder carcinomas were mainly stage I and II tumors, incidentally found at operation or histopathological examination. Has the gallbladder carcinoma invaded perimuscular connective tissue, an extended operation with resection of the segments IVb and V of the liver and lymphnode dissection must be recommended. Stage III and IV carcinomas of the gallbladder with infiltration of the liver can be curatively operated organ-saving in using en-bloc resection of the gallbladder with the adjacent segments IVb and V, or IVb and VI and with lymphnode dissection of the hepatoduodenal ligament. The observed five-year-survival rate (Cutler and Ederer) including lethality of the curative resected carcinoma of the gallbladder is 56.3 +/- 25.2%.

Gallbladder↗
PubMed1987

[Chronic pancreatitis. Surgical therapy by resection procedures].

In 606 resections operative mortality fell from 10 to 1.2%. In distal resections in 66% good results were observed with a late mortality of 11%. A total mortality of 40% was found in total pancreatectomy, therefore this procedure was cancelled in 1980. In 289 partial duodeno-pancreatectomies combined with duct occlusion by Ethibloc our operative mortality was 1%. Late follow-up: Free of pain 88%, recurrence in only 2.1%. Preservation of endocrine function proven by a prospective study.

Chronic Disease↗
PubMed1987

[Ileorectostomy versus ileo-anal anastomosis with reservoir in ulcerative colitis and colonic adenomatosis].

In the last ten years, approximately 200 mucosal proctectomies have been performed as an alternative to proctocolectomy, but also as an alternative to ileorectostomy in cases of UC and AC. Operative mortality is minimal but the rate of early postoperative complications is considerable (greater than 10%). After an adaptive phase, however, functional results are generally good. The substantial risks of ileorectostomy in AC (degeneration rate up to 20%) and in UC (inflammation relapse 20-30%, secondary degeneration approximately 5%) have led to the establishment of mucosal proctectomy as the treatment of choice in the larger surgical centres.

Adenomatous Polyposis Coli↗
PubMed1987

Multivisceral resections in colorectal cancer.

From 1969 to 1983 a total of 1918 patients with colorectal cancer were treated by curative resection. One hundred twenty one patients in this group had multivisceral organ involvement, necessitating extended multivisceral radical resection. Tumor infiltration was proven histologically in 55 percent, while 45 percent had inflammatory adherence to the attached organ only. Postoperative mortality was 12 percent. Dukes' A and B stages were present in 57 percent. The five-year survival rate (postoperative mortality included) was 54 percent for patients with inflammatory adherence, 49 percent for patients with tumor infiltration resected en bloc without tumor tears of rupture, and 17 percent when the surgeon inadvertently had torn or cut into tumor tissue during resection.

Abdominal Neoplasms↗
PubMed1987

Whipple's procedure plus intraoperative pancreatic duct occlusion for severe chronic pancreatitis: clinical, exocrine, and endocrine consequences during a 3-year follow-up.

The present investigation provides follow-up data (up to 36 months) of exocrine and endocrine pancreatic function, inflammatory activity, pain, and body weight in 23 chronic pancreatitis patients submitted to Whipple's procedure plus intraoperative Ethibloc occlusion of the remaining pancreatic duct system between January 1983 and February 1984. Clinically, Whipple's procedure plus intraoperative pancreatic duct occlusion resulted in almost complete and continuous cessation of pain as well as significant (p less than 0.05) increase in body weight. With regard to exocrine pancreatic function (Secretin-Pancreozymin test, plasma amino acid consumption test, Pankreolauryl test, fecal chymotrypsin determination), intraoperative pancreatic duct occlusion was shown to induce high-grade insufficiency and thus exocrine parenchymal atrophy in all patients. Simultaneously, the inflammatory process (represented by serum levels of trypsin, lipase, and pancreatic isoamylase) was terminated in all 23 patients. Endocrine pancreatic function, evaluated by serum levels of insulin and C-peptide measured under fasting conditions and subsequent maximal combined beta-cell stimulation as well as corresponding integrated hormone releases, was reduced by partial pancreas resection by about 50%, while there was no further impairment during the 36-month follow-up period in consequence of additional intraoperative pancreatic duct occlusion. Altogether, Whipple's procedure plus intraoperative Ethibloc occlusion of the residual pancreatic duct system seems suitable for termination of the inflammatory process and thus preservation of residual endocrine pancreatic function in chronic pancreatitis.

Chronic Disease↗
PubMed1987

[Resection of liver metastases].

The result of liver resection for metastases must be calculated against the natural history without therapy, for which Wagner has found a 5-year-survival rate of only 0 to 3%. From 1970 to 1983 at our surgical unit altogether 80 liver metastases were resected by atypical resection or hemihepatectomy with a primary lethality rate of 28% in the first and 8% in the second period of survey. However, this rate has been further reduced since 1983 by the introduction of the CUSA, intraoperative sonography and the use of segmental liver resection. Since October 1984 altogether 110 liver metastases were resected with a primary lethality of only 5%. Our present 5-year-survival rate for curatively resected liver metastases specifically in colorectal cancer, calculated by the actuarial method, is 32%.

Hepatectomy↗
PubMed1987

[Current status of the therapy of rectal cancer].

Changes have taken place in the methods used for surgery of rectal carcinoma. The primary tumour is removed and the regional lymphatic drainage area left behind, when limited techniques are chosen, that is in cases in which the risk of lymph node metastasis is not significant. Such indication is based on the careful histopathological examination of the locally removed primary tumour. Differential indications are described, with reference being made to excision of the rectum as compared to anterior and deep anterior resection. Palliative tumour resection and surgical removal of hepatic metastasis improve the prognosis. Radical tumour resection requires complete mobilisation of the left colonic flexure, high ligature of the inferior mesenteric artery, and--in cases of extraperitoneal tumours--dissection along the fascias. Tubular resection of the rectum is indicated for early rectal carcinoma as well as in cases of large villous or tubular adenomas. Reference is made to adjuvant chemo- and radiotherapy.

Combined Modality Therapy↗
PubMed1987

[Early cancer of the exocrine pancreas: diagnosis and prognosis].

Early pancreatic carcinoma is defined as a tumor of less than 2 cm in diameter, limited to the pancreas without extension to adjacent structures or organs and without lymph-node and distant metastasis (T1a, N0, M0). In analysing 693 pancreatic cancer patients seen at the Surgical Clinic of Erlangen since 1969 we found only 3 early lesions (0.4%). There is a variety of diagnostic signs like unexplained abdominal pain, the development of pancreatic insufficiency, weight loss in excess of 10%, sudden onset of diabetes and elevation of serum and urine amylase. These early symptoms should be clarified by special pancreatic screening tests (ERCP, CT, US, angiography). CT and US alterations may be missing, because of the small tumor size. The proof of a pancreatic duct stenosis indicates laparotomy and resection. One of three of our patients survived longer than 6 years without recurrence. As reported, the 5-year-survival rate of early pancreatic cancer is 86%.

Biopsy, Needle↗