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Biomedical subjects

H Lang

Publications and source records attributed to H Lang.

At least 73 records · Page 4Linked to original sources
PubMed2000

Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma.

AIMS: The management of anastomotic leakage of the oesophago-jejunostomy after total gastrectomy for gastric carcinoma was evaluated in a retrospective study. PATIENTS AND METHODS: Over a 30-year period, a total of 1114 oesophago-jejunostomies were performed during total gastrectomy for gastric cancer. In 83 cases (7.5%) a leak of the oesophago-jejunostomy was diagnosed. RESULTS: Frequency of anastomotic leakage was independent of the type of reconstruction and of surgical radicality. Therapeutic management was conservative in 58 cases (69.9%), with placement of a naso-jejunal tube along the anastomoses and with percutaneous drainage of intraabdominal abscesses. In 25 patients re-operation with resuturing of the anastomoses or surgical drainage of an abscess was performed. Mortality was 11/58 (19%) after conservative treatment of the anastomotic leakage and 16/25 (64%) after re-operation. CONCLUSION: Conservative management with a naso-intestinal tube and percutaneous drainage of intraabdominal abscesses is realistic for anastomotic leaks. Re-operation results in a high morbidity and should only be considered when conservative management is not successful.

Aged↗
PubMed2000

Long-term experience after ex situ liver surgery.

BACKGROUND: Ex situ liver surgery allows liver resection and vascular reconstruction in patients who have liver tumors located at critical sites. Only a small series of studies about ex situ liver surgery is available in the literature. No long-term results have been published. METHODS: Twenty-four patients were considered for ex situ liver surgery because conventional liver surgery was considered impossible or too hazardous. The patient's ages were 51.3 +/- 7.5 years. Indications were various primary and secondary liver malignancies and benign liver tumors in 2 patients. RESULTS: In 22 of 24 patients, the ex situ liver resection and subsequent autotransplantation were performed. The anhepatic periods in these patients lasted for 5.6 +/- 1.1 hours. In the remaining 2 patients, autotransplantation was not possible and allogenic liver transplantation was performed 17 and 19 hours after hepatectomy. In 4 patients, liver failure occurred after autotransplantation and required transplantation. The confluens between hepatic veins and the inferior vena cava was reconstructed in 5 patients. Fifteen patients survived the postoperative period and were discharged after 36.5 +/- 16 days. The median survival time of 6 patients who had metastases of colonic carcinoma was 21 months. The 2 patients with benign liver disease are alive 9 and 5 years after ex situ surgery. CONCLUSIONS: Extended liver resections with difficult reconstructions of the hepatic venous confluens are feasible by ex situ liver surgery and subsequent autotransplantation. However, the early postoperative mortality rate is high, especially in patients with cholestatic livers. Early tumor recurrence remained the problem in these patients with extended local tumor spread. Ex situ liver surgery should only be performed in selected patients.

Adult↗
PubMed2000

Hepatic metastases from leiomyosarcoma: A single-center experience with 34 liver resections during a 15-year period.

OBJECTIVE: To describe a large single-center experience with hepatic resection for metastatic leiomyosarcoma. SUMMARY BACKGROUND DATA: Liver resection is the treatment of choice for hepatic metastases from colorectal carcinoma. In contrast, the role of liver resection for hepatic metastases from leiomyosarcoma has not been defined. METHODS: The records of 26 patients who between 1982 and 1996 underwent a total of 34 liver resections for hepatic metastases from leiomyosarcoma were reviewed. There were 23 first, 9 second, and 2 third liver resections. The records were analyzed with regard to survival and predictive factors. RESULTS: In the 23 first liver resections, there were 15 R0, 3 R1, and 5 R2 resections. Median survival was 32 months after R0 resection and 20.5 months after R1/2 resection. The 5-year survival rate was 13% for all patients and 20% after R0 resection. In 10 patients with extrahepatic tumor at the time of the first liver resection, 6 R0 and 4 R2 resections were achieved. After R0 resection, the median survival was 40 months (range 5-84 months), with a 5-year survival rate of 33%. After repeat liver resection, the median survival was 31 months (range 5-51 months); after R0 resection, median survival was 31 months and after R1/2 resection it was 28 months. There was no 5-year survivor in the overall group after repeat liver resection. CONCLUSIONS: Despite frequent tumor recurrence, the long-term outcome after liver resection for hepatic metastases from leiomyosarcoma is superior to that after chemotherapy and chemoembolization. Although survival after tumor debulking also seems to be more favorable than after nonoperative therapy, these data indicate that only an R0 resection offers the chance of long-term survival. The presence of extrahepatic tumor should not be considered a contraindication to liver resection if complete removal of all tumorous masses appears possible. In selected cases of intrahepatic tumor recurrence, even repeated liver resection might be worthwhile. In view of the poor results of chemoembolization and chemotherapy in hepatic metastases from leiomyosarcoma, liver resection should be attempted whenever possible.

Adult↗
PubMed2000

Isolated hyperthermic liver perfusion with high dose tumor necrosis factor alpha in pigs: an experimental study in preparation of clinical Use.

Isolated hyperthermic perfusion of the liver was performed for 45 min in 27 pigs via hepatic artery and portal vein at mean inflow temperatures between 40.7 and 41.2 degrees C. In two study groups B and C (n = 9 pigs each) 50 microg recombinant human tumor necrosis factor-alpha (rhTNFalpha) per kg body weight were added to the perfusate, whereas in a control group A liver perfusion was done without rhTNFalpha. Before reperfusion the livers were washed out with Ringer's solution in all groups followed by a protein solution in group C. At 30 and 60 min after reperfusion the maximum systemic rhTNFalpha concentrations were significantly higher in group B with 68 and 61 ng/ml compared to 14.5 and 14.9 ng/ml in group C (p < 0. 05). Mean systemic porcine TNFalpha concentration was significantly higher in group B (217 pg/ml) compared to group C (50 pg/ml) 30 min after reperfusion (p = 0.012). Survival was 7/9 in group A and C and only 2/9 in group B with 6/7 pigs dying due to severe cardiopulmonary failure within 12 h after operation. In surviving pigs of group A and C only mild and transient hepatotoxicity was registered. The presented study underlines the feasibility of high dose rhTNFalpha application in an isolated hyperthermic liver perfusion system. Washout of the liver with a protein solution before reperfusion reduces systemic TNFalpha levels as well as associated lethal cardiocirculatory and hepatotoxic side effects.

Animals↗
PubMed2000

Natural history of residual renal stone fragments after ESWL.

OBJECTIVE: After extracorporeal shock wave lithotripsy (ESWL), residual fragments (RF) 4 mm or less are usually considered as clinically insignificant. We retrospectively reviewed the natural history and clinical significance of 97 noninfected and isolated RF (4 mm or less) observed 3 months after the last ESWL session on renal tomography. PATIENTS AND METHODS: They represented 83 among 1, 216 patients treated by ESWL over a 9-year period (1989-1997). These RF were mostly localized in the inferior calyx (62%). Median follow-up was 40.6 months (range: 7-96 months). Renal tomography was always performed at the end of follow-up. RESULTS: Stone-free status, or a decreased, stable or increased amount of residual stone occurred in 27 (33%), 1 (1%), 24 (29%) and 31 (37%) of the 83 patients, respectively. During this study, 18 patients (22%) were proposed for a complementary treatment related to a size increase of the residual fragments (13 ESWL, 1 retrograde endoscopy, 3 percutaneous nephrolithotomy, and 1 polar inferior nephrectomy). CONCLUSION: The term clinically insignificant should not be employed to describe RF after ESWL. Efforts should be performed to obtain true stone-free status after ESWL.

Follow-Up Studies↗
PubMed2000

Microscopic venous invasion: a prognostic factor in renal cell carcinoma.

OBJECTIVE: Microscopic venous invasion (MVI) is characterized by local destruction of the endothelium by a tumor. The prognostic value of MVI in renal cell carcinoma (RCC) is not well established. MATERIALS AND METHODS: From 1980 until 1990, 255 patients (169 men and 86 women), aged 16-87 (mean 60) years were treated by radical nephrectomy for N0M0 RCC. There were 9 pT1, 163 pT2, 30 pT3a, 34 pT3b, and 19 pT3ab (TNM 1992). The median follow-up time was 74 months. MVI was determined by a double-blind histological study with immunohistochemical staining. RESULTS: MVI was noted in 74 patients (29%). MVI significantly increased metastatic progression (p = 0.003). Only stage and Fuhrman's grade were significant factors for metastatic progression in a multivariate analysis. MVI decreased the actuarial survival rates at 1 year (p = 0.01), but not significantly at 5 and 10 years. MVI and non-MVI survival curves were statistically different with the Peto/Wilcoxon (p = 0.04) and Gehan/Wilcoxon (p = 0.03) tests, but not with the log rank test (p = 0.06). MVI decreased survival in cases with a tumor size of 10 cm or more, capsular invasion, macroscopic venous invasion, stage pT3ab, sarcomatoid cell carcinoma and Fuhrman's grade IV. Only the stage was a significant factor for survival in a multivariate analysis. CONCLUSION: In RCC, MVI is related to cancer progression and survival, but probably not as an independent prognostic factor.

Adolescent↗
PubMed2000

Object relations and intersubjectivity in depression.

Starting with a clinical vignette the authors discuss Freud's thesis from "Mourning and Melancholia" (1917) that depression is a defense against the experience of loss: Whilst a part of the self remains identified with the lost object another part directs all the aggression against it that originally had been directed against the object. As a result the relationship between self and object becomes replaced by a pathological relationship between parts of the self. As psychoanalytical and phenomenological-hermeneutical approaches congruently show, one reason why mourning cannot proceed and feelings of guilt cannot be worked through lies in the fact that depressive patients need a symbiotic, idealizing type of identification with their objects in order to stabilize their identity. Because of their narcissistic vulnerability changes, personal failures, and disappointment by their objects, which may provoke unconscious aggression and fear of loss, can easily threaten their psychic equilibrium. This gives rise to considerable difficulties within the transference-countertransference relationship. The authors argue that to establish a feeling of autonomy in depressive patients, a secure framework within therapy has to be offered and at the same time the negative transference must thoroughly be worked through.

Adult↗
PubMed2000

[Helical CT of urinary tract: clinical applications].

Helical CT is the most useful imaging modality to evaluate kidney diseases. Different imaging protocols are used to assess the correct diagnosis in each clinical situation. The nephrographic phase (between 90 and 100 s of delay after injection) is more accurate than the cortical phase (between 30 and 40 s of delay) to depict and characterise small renal masses. Multiplanar and 3D reconstruction are useful to plan partial kidney surgery or percutaneous surgery of lithiasis. In emergency, spiral CT, if available, is suitable to assess renal colic. Spiral CT is the best modality to evaluate traumatic kidney.

Colic↗
PubMed1999

The MMN amplitude increases in hypnosis: a case study.

The neural mechanisms associated with hypnosis were investigated in a single highly hypnotizable subject by measuring the mismatch negativity (MMN) component of auditory ERP, reflecting the preattentive discrimination of change in stimulus flow, in normal baseline state and under hypnosis. It has been proposed that the frontal inhibition associated with hypnosis can be measured as a decrease in MMN. ERPs were elicited using the passive oddball paradigm with standard and deviant sine tone stimuli of 500 and 553Hz, respectively. The measurement was repeated in five separate sessions. In hypnosis the MMN was significantly larger compared to baseline. The results indicate that hypnosis can give rise to altered information processing in the brain even at a relatively early, i.e. preattentive level and that the larger MMN measured under hypnosis does not support frontal inhibition theory.

Acoustic Stimulation↗
PubMed1999

Coping, distress, and survival among patients with lung cancer.

BACKGROUND: This study addresses the question of whether coping and emotional state are predictors of survival among patients with lung cancer. The hypotheses were (1) active coping is linked with longer survival time and (2) depressive coping, emotional distress, and depression are linked with shorter survival. METHODS: The study was based on a sample of 103 patients who were investigated after their diagnosis and before the beginning of primary treatment. The psychological variables were assessed by means of self-reports and interviewer ratings. After follow-up of 7 to 8 years, 92 patients had died; survival data were censored for the remaining 11 patients. The prediction of the survival time was performed by the Cox regression, while adjusting for biomedical risk factors (tumor stage, histological classification, and Karnofsky performance status). RESULTS: The self-reported depressive coping (P = .007) and the interviewer-rated emotional distress (P = .04) were significantly associated with shorter survival, independent of the influence of the biomedical prognostic factors. CONCLUSIONS: Both coping and emotional distress had a statistically independent effect on survival among patients with lung cancer. However, the naturalistic design of the study does not allow for any causal interpretation. Thus, the nature of this relationship warrants further investigation.

Adaptation, Psychological↗
PubMed1999

[3-dimensional sonography for volume determination of liver tumors--report of initial experiences].

In a clinical trial the accuracy of volumetry by use of three-dimensional ultrasound (3-D-US) in comparison to three-dimensional computer tomography (3-D-CT) was evaluated. Overall, 42 patients with focal hepatic lesions were investigated with 2-D- and 3-D ultrasound. In 11 patients additional computerized tomographic arterial portography using spiral technique was performed. The volumes of the lesions were calculated using the ellipsoid formula (for 2-D- and 3-D-US) as well as with a planimetric reconstruction for 3-D-US and 3-D-CT. In addition the intra- and inter-investigator variability of 3-D ultrasound was determined. The volume of the investigated liver lesions (planimetric reconstruction with 3-D ultrasound) ranged between 1.5 cm3 and 1231 cm3 with a mean volume of 155 cm3 and a median volume of 68 cm3. The deviation of 2-D-US vs 3-D-CT was -62% to +68%, in the case of 3-D-US (ellipsoid) vs 3-D-CT it was -28% to +9%, and for 3-D-US (planimetry) vs 3-D-CT it was -21% to +9%. The concordance index kappa was 0.886, showing very good agreement between the two investigators. The intra-investigator variability was 5%. Our data show that volume measurement by use of 3-D-US in independent of the investigator. With regard to accuracy of volume measurements 3-D-US is comparable to 3-D-CT but more precise than 2-D-US. These results indicate that 3-D-US may be applied in the follow-up of tumor patients as an alternative diagnostic procedure to computer tomography. In addition 3-D-US might be useful in planning liver resections by virtue of better evaluation of the volume of the liver tissue remaining after resection and better visualization of the topography of liver tumors and major hepatic vessels.

Artificial Intelligence↗
PubMed1999

[Liver resection for non-colorectal, non-neuroendocrine hepatic metastases].

Over a period of 11 years a total of 140 liver resections for non-colorectal, non-neuroendocrine hepatic metastases were performed in 127 patients (73 women, 54 men; median age 53 years). There were 120 first, 14 second and 6 third liver resections. Primary tumors were: breast cancer (n = 34), leiomyosarcoma (n = 20), pancreatic cancer (n = 16), renal cell carcinoma (n = 13), melanoma (n = 9), gastric cancer (n = 9), lung cancer (n = 6) and adrenal cancer (n = 6) and miscellaneous tumors (n = 14). Extrahepatic tumor manifestation (including synchronous primary tumors) was found in 69/140 cases (49%); 61 of 120 patients with a first liver resection had extrahepatic tumor (51%). In the 120 first liver resections, 82 (68%) R0, 13 (11%) R1 and 25 (21%) R2 excisions were possible. Median survival after first liver resection was 20 months; after R0 resection a median survival of 28 months and after R1/2 resection of 8 months was achieved. The 5-year survival rate was 16% for the total group, 24% in patients with R0 resection and 0% for R1/2 resections. After a second liver resection (n = 14) there was a median survival of 28 months (5-year-survival-rate of 21%) for all patients and of 41 months (5-year survival rate 38%) after R0 resection. Morbidity and mortality after the first liver resection were 32.5% and 5.8%, respectively. In patients without extrahepatic tumor at the time of the first liver resection a median survival of 32 months (5-year survival rate 25%) and 7 months was achieved after R0 resection and R1/2 resection, respectively. In case of extrahepatic tumor the median survival was 24 months (5-year survival rate 23%) for R0 resection compared to 8 months after R1/2 resection. These data suggest that not the presence of extrahepatic tumor but rather the possibility of a R0 resection is most decisive for the prognosis after liver resection. We conclude that patients with liver metastases of non-colorectal, non-neuroendocrine tumors may benefit from liver resection. Similar to colorectal metastases, a second or third liver resection can be worthwhile in selected cases. Even in more unfavorable tumor entities, several cases of long-term survival were observed after surgical therapy. Therefore, the indication for liver resection should be considered carefully in every single case.

Breast Neoplasms↗
PubMed1999

[Results of surgical therapy of primary adenocarcinoma of the duodenum].

Between January 1983 and August 1998, a total of 18 patients (14 men, 4 women; median age 58 years, range 36-75 years) with primary adenocarcinoma of the duodenum underwent surgical therapy. Main clinical symptoms were upper abdominal pain (61%), weight loss (44%) and anaemia (38%). The tumors were resectable in 10 patients (56%), and eight Whipple operations and two segmental duodenectomies were performed. Tumor classification according to the TNM system was pT2 (n = 2), pT3 (n = 6) and pT4 (n = 2). In eight patients, local lymph nodes were tumor positive (pN1), and in two patients synchronous liver metastases were excised. The UICC stage of the resected tumors was: stage I (n = 1), stage II (n = 1), stage III (n = 6) and stage IV (n = 2). In irresectable cases (n = 8), the patients underwent palliative (n = 6) or explorative (n = 2) operations. With no operative mortality, overall morbidity was 22% (4/18). Patients' survival was 90%, 66.7% and 53.3%, respectively, at 1, 3 and 5 years after resection. None of the patients with irresectable tumors survived longer than 25 months. Survival was significantly better for the resection group (P = 0.0027). Due to the often unspecific symptoms, the diagnosis of duodenal adenocarcinoma is frequently established at advanced tumor stages, resulting in a low resectability rate. Radical surgical resection of the tumors, however, is able to provide a more favorable prognosis for duodenal carcinoma than for other periampullary tumors.

Adenocarcinoma↗
PubMed1999

Total hepatectomy and liver transplantation for metastatic neuroendocrine tumors of the pancreas - a single center experience with ten patients.

BACKGROUND: Metastatic neuroendocrine pancreatic tumors have a poor prognosis. We have studied retrospectively the efficacy of liver transplantation as ultimate therapy of otherwise untreatable symptomatic neuroendocrine hepatic metastases originating in the pancreas. METHODS: We reviewed our experience of liver transplantation (LTx) for hepatic metastases of neuroendocrine pancreatic tumors in ten patients. The indication for liver grafting was seen in cases of irresectable metastases and when patients were suffering from otherwise untreatable tumor-associated symptoms due to massive hormonal release or large intra-abdominal tumor bulk. RESULTS: In four patients, the primary tumors had been removed before LTx, in five patients simultaneously with LTx and in one case 46 months after grafting. There was no operative mortality. After hepatectomy and LTx, all patients had complete relief of symptoms and all preoperatively increased hormonal levels returned to normal. In nine of ten patients, the transplant procedure had the potential for cure, whereas, in one patient, the primary tumor had remained in situ at LTx and was removed 46 months later by an R2-resection. At present, nine patients are alive with a median follow-up of 33 months (range 13.5 months to 117 months). The one patient in whom the primary tumor was removed after transplantation died due to massive intra-abdominal tumor spread 68 months after LTx. Currently, two patients are without evidence of disease, but one of them after re-operation because of lymph-node metastases 8 months after transplantation. The longest disease-free survival is now more than 7 years. In seven of nine patients, tumor recurred between 1.5 months and 48 months after transplantation. CONCLUSIONS: Patients with otherwise untreatable symptomatic neuroendocrine hepatic metastases of pancreatic origin may benefit from total hepatectomy and liver transplantation with regard to symptomatic relief and long-term survival, despite frequent recurrence of disease. In some patients, liver transplantation may even offer the chance for cure.

Disease-Free Survival↗
PubMed1999

Pre-attentive detection of vowel contrasts utilizes both phonetic and auditory memory representations.

Event-related brain potentials (ERP) were recorded to infrequent changes of a synthesized vowel (standard) to another vowel (deviant) in speakers of Hungarian and Finnish language, which are remotely related to each other with rather similar vowel systems. Both language groups were presented with identical stimuli. One standard-deviant pair represented an across-vowel category contrast in Hungarian, but a within-category contrast in Finnish, with the other pair having the reversed role in the two languages. Both within- and across-category contrasts elicited the mismatch negativity (MMN) ERP component in the native speakers of either language. The MMN amplitude was larger in across- than within-category contrasts in both language groups. These results suggest that the pre-attentive change-detection process generating the MMN utilized both auditory (sensory) and phonetic (categorical) representations of the test vowels.

Acoustic Stimulation↗
PubMed1999

Learning styles of deaf college students and instructors' teaching emphases.

Six learning style dimensions of the Grasha-Riechmann Student Learning Style Scales (GRSLSS) were examined in this study with 100 deaf college students. In addition, six corresponding scales of teaching emphases were administered to the 16 instructors of these students. Student mean scores were higher for the dependent, participative, collaborative, and independent dimensions than for the competitive and avoidant styles. The participative learning style correlated significantly with course achievement and course interest, which suggests that an emphasis on active learning may be desirable. For instructors, as with students, the mean scores for teaching emphases were found to be higher for the collaborative, dependent, participative, and independent dimensions. the similar patterns of results for students and teachers suggest a correspondence between the learning styles and the teaching emphases.

Journal Article↗
PubMed1999

Adjunct aids in instructional prose: a multimedia study with deaf college students.

A computer-based science lesson was administered to 144 deaf college students grouped into low, middle, and high reading ability levels. Five instructional conditions were compared: (1) text only, (2) text and content movies, (3) text and sign movies, (4) text and adjunct questions, and (5) all of these together (full condition). The low reading level subjects in the adjunct question and full conditions demonstrated immediate, factual learning performance comparable to that of the high reading level subjects in the text-only condition. These and other results of this investigation suggest the compensatory potential of adjunct aids and associated mathemagenic activities to improve factual learning from instructional prose for low reading ability students.

Journal Article↗