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Biomedical subjects

H D Becker

Publications and source records attributed to H D Becker.

At least 145 records · Page 8Linked to original sources
PubMed1996

[Local therapy of early rectal carcinoma with curative intent: implications for a change in oncologic strategy].

Patients with pT1 low-risk rectal carcinomas seem to be overtreated by a classical radical operation. A total of 170 patients with rectal carcinomas were locally treated with the transanal endoscopic microsurgery (TEM) technique. Four of the group with pT1 low-risk tumours with local therapy developed a recurrence, three of whom underwent a curative secondary procedure, bringing the failure rate to one out of 81. Two recurrences were diagnosed among the 22 patients who were re-resected after local treatment in stage pT1 low risk. Both patients died of the tumour disease, another due to dehiscence of the suture, bringing the failure rate in the re-resected group to three of 22.

Aged↗
PubMed1995

Clinical course after transanal advancement flap repair of perianal fistula in patients with Crohn's disease.

A total of 36 rectal advancement flap repairs were performed in 32 patients with perianal Crohn's disease. There were 12 anovaginal and 20 trans-sphincteric fistulas. Patients were followed prospectively for a mean of 19.5 months to evaluate postoperative recurrence rate. The prognostic influence of fistula type, rectal disease, intestinal disease and faecal diversion on recurrence was assessed. Four of 36 repairs showed primary failure, the operated fistula recurred in 11 patients after a median of 7 months, and a new fistula developed in six patients. The fistula recurrence rate was higher in patients with anovaginal fistula or Crohn's colitis but did not correlate with disease activity. Transitory mild incontinence of stool was observed in one patient only. Although rectal advancement flap repair does not cure perianal fistulas in most patients with Crohn's disease, those without Crohn's colitis may have long-term benefit. Short-term improvement of symptoms justifies this simple procedure even in patients with anovaginal fistula.

Adult↗
PubMed1995

[Ulcus cruris venosum: surgical debridement, antibiotic therapy and stimulation with thrombocytic growth factors].

Despite the availability of various topical agents and of new technics for surgical correction, venous stasis ulcers are still characterized by high recurrent rates. Experimental data from wound healing studies demonstrate stimulation of wound healing after topical application of various growth factors (TGF beta, PDGF, EGF). The results of clinical studies suggest that topical use of an autologous platelet releasate (PDWHF) containing various growth factors accelerates healing. In this prospective study the stimulating effect of autologous PDWHF on epithelialization of small ulcers (group A, < 5000 mm2) and granulation of large ulcers before mesh grafting (> 5000 mm2) will be demonstrated. Inclusion criteria were the venous aetiology of the ulcer and the failure of conventional therapy for 6 month. Exclusion criteria were arterial occlusive disease, diabetes mellitus, acute wound infection, thrombocytopenia and pregnancy. There were 24 patients with 36 ulcers, caused by postthrombotic syndrome in one-third of cases and in two-thirds by severe insufficiency of the perforating veins. The ulcer had been present for more than in 10 years in 38% of cases, while there were 6 circumferential ulcers. The overall ulcer healing rate was 77% after a mean of 14 weeks. In group A 78% of the patients were healed after a mean of 16 weeks. In group B the mesh graft procedure was successful in 90% of the patients after a mean of 13 weeks. Compared with other conventional therapy studies, we achieved a higher healing rate. PDWHF seems to create ideal granulation tissue for mesh graft, indicated by a high uptake of the skin grafts.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗
PubMed1995

Therapeutic effect of argon plasma coagulation on small malignant gastrointestinal tumors.

In endoscopy, argon plasma coagulation (APC) is a new principle of non-contact electrocoagulation and has proved to be a sufficient tool for palliative endoscopic treatment of gastrointestinal neoplasms, predominantly of the oesophagus and colorectum. In a study of 67 patients suffering from histologically confirmed and endosonographic T1-staged tumours of the gastrointestinum, 10 patients were selected for endoscopic APC treatment because of the impossibility of surgical therapy. Although the application was primarily of a palliative nature, in 9 of 10 cases of minor neoplasms, no further tumour could be detected in biopsies during the observation period (9.45 +/- 2.8 months). One patient was not cured locally. In none of the patients was any serious complication noticed during the outpatient follow-up. The effective results and lack of severe complications suggest this technique as an alternative therapy in selected patients with smaller gastrointestinal tumours.

Aged↗
PubMed1995

Level of the anastomosis does not influence functional outcome after anterior rectal resection for rectal cancer.

Anorectal function was studied in 55 patients undergoing low anterior resection for rectal adenocarcinoma. Patients were examined preoperatively and 3 months postoperatively by anorectal manometry and standardized interview. Postoperatively, the patients showed, in general, an impairment of anorectal functions. After 3 months, continence for flatus was defective, the ability to discriminate flatus from feces, and the ability to defer defecation were compromised. Stool frequency was elevated, and anal resting pressure, squeeze pressure, and rectal compliance were decreased. The rectoanal inhibitory reflex was abolished in all patients. However, the two groups with the level of the anastomosis less than or equal to 6 cm (n = 27, range 3 to 6) and more than 6 cm (n = 28, range 7 to 10) above the anal verge showed no differences in manometric values, stool frequency, or fecal continence assessed by the interview. No correlation was found between the level of the anastomosis and manometric values and between the level of the anastomosis and stool frequency (regression analysis = not significant). We concluded that anorectal function after anterior resection and low colorectal anastomosis are not influenced by the remaining length of the rectum but by the surgical trauma to the sphincter and its innervation.

Adenocarcinoma↗
PubMed1995

Cholecystokinin is partly responsible for reduced food intake and body weight loss after total gastrectomy in rats.

PURPOSE: To determine the cause of body weight loss after total gastrectomy. METHODS: We evaluated the acute effect of exogenous cholecystokinin (CCK) on food intake and the chronic effect of CCK receptor blockade on food intake and body weight after total gastrectomy in rats. RESULTS: Exogenous CCK significantly reduced food intake in gastrectomized rats; this was blocked by administration of a CCK-A but not a CCK-B receptor antagonist. Chronic treatment with a CCK-A or CCK-B receptor antagonist after total gastrectomy in rats significantly increased postoperative food intake and body weight. CONCLUSION: Our data indicate that endogenous CCK is partly responsible for reduced food intake and body weight loss after total gastrectomy in rats.

Animals↗
PubMed1995

Highly flexible self-expanding meshed metal stents for palliation of malignant esophagogastric obstruction.

BACKGROUND AND STUDY AIMS: Palliative treatment methods for esophageal and cardiac cancer include dilation, laser vaporization and other thermal methods, alcohol injection, and stent insertion. None of these procedures, however, has proved to be a simple, well-tolerated, and lasting method. We present here our results with a new, highly flexible self-expanding metal stent made of nitinol, which is considered to be particularly useful for difficult (long and tortuous) malignant strictures. PATIENTS AND METHODS: From November 1991 to December 1994, 114 patients with unresectable esophagogastric malignancies or tumor recurrences (92 men, 22 women, mean age 64 years) were treated using 138 highly flexible meshed self-expanding metal stents. Regular clinical and endoscopic follow-up was performed, and stent obstruction or overgrowth was treated by argon plasma coagulation (APC). Patients were followed up until death (n = 78; average follow-up 17 weeks, range 1-90 weeks). Thirty-six patients were alive in December 1994 and had had an average of 20 weeks of follow-up (range 1-160 weeks). RESULTS: Stent insertion was technically successful in 97% of cases, and led to a reduction of dysphagia (graded 0-4) from a mean score of 3.5 to a mean score of 1.5. Preparatory treatment to open tight strictures was necessary in 80% of cases. Balloon dilation to support stent expansion was carried out in 42 patients (37%). During follow-up, tumor ingrowth occurred in 66% of cases after a mean of seven weeks, and was successfully treated by APC. Including preparatory treatment and re-treatment, patients underwent a mean of 3.5 endoscopic procedures (range 1-12 procedures), which led to good clinical success in 73% of cases. Ninety-six percent of the patients continued to be able to swallow (dysphagia score < or = 2) during follow-up. CONCLUSIONS: Highly elastic self-expanding metal stents can be successfully implanted in the majority of patients, particularly in those with difficult malignant strictures not easily amenable to other methods. The devices provide good palliation with effective relief of dysphagia, easy handling and implantation, and offer a satisfactory quality of life to the patient. However, tumor ingrowth is a significant problem, even though it can be successfully managed by APC. Adequate covering of the stent that does not affect its mechanical properties or firm anchoring should solve at least some of these problems.

Adolescent↗
PubMed1995

[Highly flexible self-expanding metal mesh stents: a new kind of palliative therapy of malignant dysphagia].

Metal mesh stents are a new way in the treatment of malignant stenoses. Between 11/91 and 12/93 in 79 patients with malignant stenoses of the esophagus and the esophago-gastric junction 96 highly elastic, knitted, self-expanding nitinol stents (Ultraflex, Boston Scientific) were implanted. Most of the tumors being problematic, preoperated or preradiated, in 78 of 96 implantations endoscopic pretreatment (Laser, Argon Plasma Coagulation (APC), dilatation)--mostly in the same session--was necessary. Follow up time was 21 (2-108) weeks. In this pilot study 3.5 (1-27) controlendoscopies with 2.5 (1-10) endoscopic interventions were performed. 90 of 96 implantations were primarily successful and led to a functional success in 73 of 79 patients. The ability to swallow improved significantly, the score of dysphagia improved from 3.5 to 1.0 (p < 0.001). There were no relevant complications and no stent-related mortality. All stents could be kept patent during the follow up period using the new developed Argon-plasma-coagulation (APC) to treat the ingrowth of granulation tissue or tumor, which was observed during follow up in 72 of 93 implantations. Tumor ingrowth represents the main problem of the method and demands endoscopic posttreatment (APC) in cases with relevant re-obstruction. Impairment of the stent lumen by tumor ingrowth (granulation tissue plays no role) would have been observed in about 60% of the patients without such a treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

[Follow-up results of laparoscopic cholecystectomy].

Following a laparoscopic cholecystectomy 400 patients have been interviewed with a questionnaire on the late results of the surgery (15 to 40 months postop.). The cholecystectomies had been performed within the time from March 7, 1990 to April 30, 1992 in Tübingen. After a mean of 16.8 days the patients returned to work, while they themselves felt reduced for an average of 10.6 days. 11.9% of the patients complained of slight wound healing problems and in 3.1% wound infections have been registered. Although 97% of the patients were satisfied with the results of surgery, 8.7% still complained of upper abdominal trouble. Slight persistent problems like light pain or flatulence have been reported by 19%.

Absenteeism↗
PubMed1994

Endothelial cell toxicity of preservation solutions: comparison of endothelial cells of different origin and dependence on growth state.

Previously, we have shown that cultured liver endothelial cells are affected by an energy-dependent injury when incubated in cold University of Wisconsin (UW) or histidine-tryptophan-ketoglutarate solution. Here, we studied the susceptibility of other endothelial cells to this type of injury. Aortic endothelial cells in early-confluent, i.e., still proliferating, monolayer cultures were damaged more quickly during cold incubation in UW solution than during cold incubation in Krebs-Henseleit buffer. At this stage the addition of KCN did not alter the loss of viability in UW solution, but when the culture period was prolonged, cells were protected by the addition of cyanide. A paradoxical, protective effect of KCN could also be observed in late-confluent, i.e., nonproliferating, cultures of coronary endothelial cells incubated in UW solution. Similarly, liver endothelial cells in subconfluent, growing cultures were damaged by the addition of cyanide (loss of viability after 48 h, 3 +/- 1% in UW, 65 +/- 19% in UW + KCN), whereas in late-confluent cultures the addition of cyanide to UW solution was protective (loss of viability after 48 h, 100 +/- 0% in UW, 31 +/- 15% in UW + KCN). Variations of culture period and seeding density and the use of inhibitors of cell proliferation demonstrated that liver endothelial cells acquire their susceptibility to energy-dependent injury along with confluence. Subcultured cells retained this susceptibility for some hours. These results suggest that the energy-dependent injury described previously is not confined to liver endothelial cells and that the occurrence of energy-dependent injury requires a capacity of the cells that develops only after cultures have grown to confluence.

Adenosine↗
PubMed1994

Direct endoscopic percutaneous jejunostomy (EPJ). Clinical results.

Direct puncture of the small bowel under endoscopic guidance (direct EPJ) is possible in patients whose stomach has been removed or whose small bowel cannot be punctured by other methods. From January 1990 to June 1992 a total of 39 patients underwent successful direct EPJ at our institution. The indications were malnutrition after partial or total gastrectomy (n = 19), insufficient anastomosis or a stenosis after esophageal resection and esophagojejunostomy (n = 13), esophageal perforation (n = 3), fistulas (n = 2), or severe trauma (n = 2). The tubes were inserted at the bedside under local anesthesia using the string pull-through technique. The procedure was attempted in five other patients but it was technically impossible to insert the tubes in these patients. Postoperative enteral feeding was possible in all 39 patients whose direct EPJ was successful. Complications included tube dysfunction due to plugging and fracture in five patients, pressure-induced enteric ulcers in two, and local infections in three patients. The ulcers and infections were managed conservatively. We conclude that direct EPJ is a safe, effective alternative to surgical catheter-jejunostomy.

Adult↗
PubMed1994

MHC antigen presentation on the surface of hepatocytes: modulation during and after hypoxic stress.

Presentation and recognition of MHC antigen on the surface of cells is the basic process of initiating rejection and distinguishing "self and not self". This is considered to begin when a transplanted organ is reperfused with the blood of the recipient. In this study, the modulation of MHC I antigen presentation during preservation was investigated in a cell culture model using primary hepatocyte cultures of male Wistar rats. By incubation with different preservation solutions used in clinical transplantation, expression of the MHC antigen was observed during cold hypoxia. Primary hepatocyte cultures were isolated from male Wistar rats by a modified Seglen technique and seeded to glass slides, thus obtaining monolayer cultures. After 1 day of resting the cultures were incubated under different conditions using Krebs Henseleit solution (KH), Euro-Collins solution (EC), HTK solution of Bretschneider (HTK) and University of Wisconsin solution (UW) as incubation media. The conditions of incubation were warm normoxia (37 degrees C, pO2 100 mm Hg) and cold hypoxia (4 degrees C, pO2 < 0.1 mm Hg), which is the main condition of organ preservation. Incubation time was 6 h. Before starting the incubation reference cultures were fixed and every 60 min several cultures were withdrawn from the experiment and fixed also. MHC expression was studied by staining the cultures with monoclonal antibodies against rat MHC class I and class II. As expected, MHC class II was not present on the surface of hepatocytes, while MHC class I was demonstrated on the controls as well as on the cultures that were incubated using KH and EC independent of temperature and hypoxia or normoxia. At the end of the incubation they were still positive but not as strong as in the beginning. During incubation using HTK and UW, MHC I was not detectable at all phases of the experiment. In conclusion, hypoxic stress did not completely eradicate MHC I expression in rat hepatocytes, while the composition of the preservation medium may result in a hepatocyte surface negative for MHC I. Hydroxyethylstarch may be the substance in UW that covers the MHC antigen, while in HTK, mannitol or the histidine complex may play the same role. MHC negativity of the cells of a preserved transplant is another reason for the benefit of UW or HTK.

Animals↗
PubMed1994

[Liver resection in hepatocellular carcinoma].

Hepatic resection offers the only chance of cure for patients with hepatocellular carcinoma. Preoperative tumor staging is based on radiologic procedures (ultrasound, CT- and MR-imaging). Compromised hepatic function will limit resectability, leaving only palliative procedures. Unfavorable prognostic tumor factors (diameter > 5 cm, multifocal, nonencapsulated, vascular invasion) should lead to a combination of adjuvant chemotherapy/chemoembolization and surgical intervention. In irresectable situations multimodality treatment protocols (combined i.v. chemotherapy, radio-immuno-therapy) play an increasing role.

Carcinoma, Hepatocellular↗
PubMed1994

[Standardized combined pancreas and liver explantation].

Maximum use of organs from a single donor is mandatory as a result of the current organ shortage. In combined liver and pancreas allograft retrieval, it is vital that one remember the variability in the anatomy of vessels. Based on our experience, we describe a new technique of dividing the celiac trunk horizontally with subsequent arterial reconstruction, depending on the anatomical situation. Vascular division of the grafts can be performed either in situ or in an ex situ fashion in cases where cardiovascular function has deteriorated.

Arteries↗
PubMed1994

Indications and technique for TEM (transanal endoscopic microsurgery).

Transanal Endoscopic Microsurgery (TEM) was introduced into clinical practice by the Buess group in 1983. Since then vast experience has been gained in removing tumours of the rectum by the operative rectoscope. Though the indication in benign lesions for TEM as a local resection therapy is undisputed, the indication for resection of T1 or advanced carcinomas has to be evaluated. By using a 40 mm operating rectoscope sealed with a gastight working insert to prevent pressure loss after creation of a pneumorectum and a stereoscopic optic with sixfold magnification, exact visualisation of a rectal tumour can be achieved. The insertion of endoscopic surgical instruments like the high frequency knife, forceps, scissors, and suction device allows precise excision of the lesion as well as suture closure of the wound. Recently a bipolar multifunctional combination instrument has been developed for more precise dissection, less blood loss and shorter operation times.

Anal Canal↗