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Biomedical subjects

H Lippert

Publications and source records attributed to H Lippert.

At least 163 records · Page 9Linked to original sources
PubMed1999

[Laparoscopic cholecystectomy. A recommendable indication in acute cholecystitis?].

While laparoscopic cholecystectomy has become the procedure of choice for the elective treatment of symptomatic cholecystolithiasis the question whether patients with acute cholecystitis should be operated laparoscopically or conventionally is still debated. Nevertheless, more and more surgeons tend to use the laparoscopic approach even in patients with acute cholecystitis. Of 1006 laparoscopic cholecystectomies performed at our hospital 42 were done for acute cholecystitis. Conversion to an open procedure was necessary in only one patient because of severe inflammatory changes. The overall mortality was zero. The average age was 45.9 years for all patients and 50.4 years for those with acute cholecystitis. The average operating time in patients with acute cholecystitis was 81 minutes compared to 62 minutes in patients who underwent elective laparoscopic cholecystectomy. The complication rate and the average hospitalization time did not differ significantly between the two groups. Our own data as well as the data retrieved from the literature seem to indicate that laparoscopic cholecystectomy is superior to the open procedure in the treatment of acute cholecystitis. Prerequisite is that the operation is performed less than 72 hours after the onset of the symptoms by an experienced operating team and the readiness to convert to open procedure if necessary. Under those circumstances laparoscopic cholecystectomy seems to be the treatment of choice for acute cholecystitis.

Acute Disease↗
PubMed1998

[Explant test with skin and peritoneum of the neonatal rat as a predictive test of tolerance of local anti-infective agents in wounds and body cavities].

In vitro culture of peritoneal explants of neonatal rats after previous application of agents simulating wound antisepsis is a sensitive screening method for the determination of the tissue compatibility of local wound antiinfectives. Two test models are differentiated: (1) separated peritoneal explants as a model for chronic or deep wounds and (2) peritoneum in situ in the experimental animal with subsequent extraction and cultivation of the explants. Considering the present state of knowledge the following conclusions can be drawn regarding antisepsis of wounds: Lavasept (0.1%) may be classified as the agent of choice for deep and chronic wounds, for drip-suck irrigation and for antiinfective lavage of body cavities inclusively for peritoneal lavage (0.05%). Taurolidin is antiseptically effective in long term application (> 6 h), and because of its antitoxic effect as well as lack of cytotoxicity it is especially suitable for peritoneal lavage. Betaisodona solution is very well suited for superficial contaminated wounds and can be used in a dilution of 1:10 for short-term rinsing of deep wounds, including body cavities but not for peritoneal lavage. Ethanol causes no inhibition of explant growth and therefore retains its importance in wound antisepsis.

Administration, Topical↗
PubMed1998

The pS2 protein in colorectal carcinomas and metastases.

Expression of pS2 protein in 50 primary tumors, metastases and recurrent tumors of colorectal carcinomas has been analyzed by immunohistochemistry. Sixty percent of the primary tumors were at least focally positive for the antigen. There was no correlation between pS2 expression and histologic grade of the lesions. In contrast, pS2 expression in T4 and T3 tumors was significantly higher than in T2 carcinomas. Immunoreactions in carcinomas with distant metastases (MI) were stronger than in M0 cases. However, this difference did not reach statistical significance. The presence of lymph node metastases did not correlate with pS2 expression. High expression of pS2 in T4 and T3 carcinomas together with the finding of pronounced expression of the antigen at invasion fronts in single cases could be interpreted as a function in tumor cell invasion and motility. However, in metastases and recurrent tumors, pS2 expression did not differ from primary lesions (53% positive lesions). All in all, under consideration of the latter finding in particular and together with the randomly distributed immunopositive tumor cells and cell clusters in the majority of cases, it is more likely that the expression pattern of pS2 in colorectal carcinomas is a result of overall tumor cell heterogeneity.

Carcinoma↗
PubMed1998

Alterations of the p16/MTS1-tumor suppressor gene in gastric cancer.

Deletions, mutations and the functional inactivation of tumor suppressor gene p16 are involved in the genesis of different neoplasias. Little is known about the role of p16 gene alterations in the genesis of gastric carcinomas. This study aimed to detect genetic alterations of the p16 gene in gastric carcinomas. We analyzed p16 gene mutations and the frequency of loss of heterozygosity (LOH) at the p16 locus in 43 gastric carcinomas. PCR-SSCP analysis of exons 1 and 2 revealed only one gene mutation in a carcinoma of the diffuse type. Besides carcinomas of the diffuse, intestinal and the mixed type, we also investigated a small-cell primary gastric carcinoma, which was the only one to show a deletion in the p16 gene. LOH analysis was performed using two polymorphic markers located near the p16 gene (D9S171, D9S162) and a sequence-tagged-site marker (c5.1). Allelic loss was noted in two carcinomas of the diffuse type and in one carcinoma of the intestinal type. Allelic instabilities were found in one tumor of the intestinal type and diffuse type each. Although only five of 43 (11.6%) gastric carcinomas had p16 alterations, tumors of the diffuse type tend to show a higher number of genetic alterations near the p16 locus.

Adenocarcinoma↗
PubMed1998

Occurrence of oxidatively modified proteins: an early event in experimental acute pancreatitis.

Free radical-mediated injury is believed to play a key role in the pathogenesis of acute pancreatitis (AP). Therefore, oxidative damage of proteins may be an important event in the development of AP. The present study was performed to investigate oxidative protein modification, quantified as 2,4-dinitrophenylhydrazine-reactive protein-carbonyls, during the time course of taurocholate-induced pancreatitis of the rat and to analyze oxidatively modified proteins by Western blotting. Protein modification in pancreatic homogenates was found as early as 30 min after induction of severe AP with 3% taurocholate preceding the elevation of serum amylase activity and the increase of malondialdehyde in the tissue. A correlation of protein-carbonyl contents to a score of pancreatic macroscopic alterations (r = .69) and to the wet weight/dry weight ratio (r = .65) was found. Infusion of 5% taurocholate resulted in fulminant AP with high lethality during the 24 h of the experiment. However, rats surviving showed significantly lower level of protein-carbonyls than animals that died between 20-24 h after AP induction. The quantitative data were confirmed by the intensity of immunostained protein-carbonyls. The present data show a rather uniform increase in the staining pattern not revealing single, selectively damaged proteins. The aldehydic product of lipid peroxidation 4-hydroxynonenal (HNE) is known for its reactivity towards proteins. Interestingly, an antibody raised against protein-bound HNE did not indicate an increased protein modification by this aldehyde. In conclusion, experimental AP is characterized by an early oxidative protein modification, possibly contributing to functional impairment of the pancreas. This protein alteration may not be mediated by HNE.

Acute Disease↗
PubMed1998

Effect of supramaximal cerulein stimulation on mitochondrial energy metabolism in rat pancreas.

Hyperstimulation with the cholecystokinin analogue cerulein induces mild edematous pancreatitis in rats. It is believed that an impaired energy metabolism diminishes the cellular defense capacity in the inflamed pancreatic tissue and, therefore, contributes to the injuries in acinar cells. In the present study, changes in the capacity of oxidative phosphorylation were quantified within the first 24 h after subcutaneous cerulein injections. Serum amylase level and pancreatic water content were maximally elevated 5 h after the first injection. The capacity of mitochondrial respiration was reduced in isolated acinar cells to 69 and 44% at 5 and 24 h, respectively, compared to that in saline controls. Simultaneously, glutamate dehydrogenase (GLDH) activity dropped to 70 and 46%. The respiration rates of acinar cells and of isolated mitochondria related to GLDH activities were not different from controls. This suggests that the major portion of the mitochondrial population within the acinar cell is inactivated in the course of cerulein treatment. After 24 h, the reduced population of functionally intact mitochondria restricted the rate of phosphorylating respiration in acinar cells (52%), which resulted in a diminution of cellular ATP to 57%. It is concluded that cerulein hyperstimulation induces a drastic and long-lasting reduction of the capacity for mitochondrial ATP production which may adversely affect energy-requiring reactions of the gland during regeneration.

Adenosine Triphosphate↗
PubMed1998

Analysis of K-ras gene mutations in rare pancreatic and ampullary tumours.

OBJECTIVE: Mutation of the K-ras oncogene is a frequent event in pancreatic ductal carcinogenesis and it is believed to occur at an early stage in the development of pancreatic cancer. However, little is known of the role of K-ras mutations in rare pancreatic epithelial neoplasms, endocrine tumours or other non-epithelial tumours of the pancreas. Furthermore, limited data are available regarding the role of K-ras mutations in the pathogenesis of ampullary tumours. DESIGN AND METHODS: Using single-strand conformation polymorphism (SSCP) and direct sequencing of polymerase chain reaction (PCR)-amplified fragments, we analysed codons 12 and 13 for the presence of oncogenic mutations of the K-ras oncogene. Tissues were obtained from patients undergoing tumour resection for various rare pancreatic or ampullary neoplasms (number of cases in brackets): ampullary adenoma (1), neuro-endocrine tumour (3), malignant fibrous histiocytoma of the pancreas (1), pancreatic cystadenocarcinoma (1), serous cystadenoma (1), and primary and metastatic adenocarcinoma of the ampulla (5) and pancreas (3). RESULTS: K-ras gene mutations at codon 12 were detected in both pancreatic adenocarcinomas and in the metastatic lesion, whereas two ampullary cancers harboured a point mutation at codon 13: GGC-->GGG and GGC-->GGT. None of the other tumours exhibited a K-ras gene mutation at codons 12 or 13. CONCLUSION: Pancreatic tumours other than ductal adenocarcinoma of the pancreas do not harbour mutations of the K-ras oncogene. In addition, ampullary adenocarcinomas may present with codon 13 mutations; however, these mutations were not associated with amino acid substitution. Therefore, K-ras gene mutations seem to be a specific genetic alteration contributing to the pathogenesis of pancreatic ductal adenocarcinoma.

Adenocarcinoma↗
PubMed1998

[Surgical strategies in treatment of breast carcinoma].

The surgical strategies in the treatment of operable breast cancer have changed basically within the last decades. Today the therapy of breast cancer is indicated by the individualization of the procedure in which the extent of the operative intervention is determined in first line in dependence of the clinical and histopathological results and the wishes of the patients. The current surgical strategies are indicated by a further reduction of radicalness in the operative procedure and a patient obtained strategy adapted to the individual risk. Goals of the reduction of the radicalness are discussed at the example of the extend of minimal tumor free margins and the technique of the "sentinel lymph node detection". The use of Van-Nuys classification is described as an example for an individual risc adapted strategy in the surgical treatment of breast cancer. Furthermore is discussed the significance of the extensive intraductal component, of lymphatic and blood vessel invasion and the patient's age for estimating the risk of of local recurrence after breast preserving therapy. Besides of all efforts there are still limits in reducing surgical radicalness of the therapy of breast cancer. That has to be taken into account in an adequate therapeutical concept.

Breast↗
PubMed1998

[Current surgical treatment status of gallstones in East Germany].

The changes of surgical treatment of gallstone disease to the laparoscopic procedure was performed just at the same time in East Germany was destroyed the socialism. That's why the new operative technique was possible in many hospitals in 1992/93 first. To describe the actually situation and the trend we started a prospective multi-institutional study included 29 East German surgical departments of all kinds. The most interesting things were perioperative antibiotic prophylaxis, laparoscopically procedures in elderly or high risc patients, the management of common bile duct stones and the minor and major complications. We discuss the results and the comparison with the results of externe quality assurance.

Adult↗
PubMed1998

[Combination of diathermy and argon plasma coagulation in treatment of cicatricial esophageal stenoses].

Scar stenoses of the esophagus are caused by peptic reflux or following surgery of the upper gastrointestinal tract. Short scar cicatricial stenoses are difficult to treat and have a high recurrence rate. Pneumatic dilatations show a short term success. We treated 5 patients with a short scar esophageal stenosis after esophagogastrostomy (n = 3) and after esophagojejunostomy (n = 2). The main symptom was dysphagia. X-ray shows the length of the stenosis (max. 1.5 cm). The stenosis was cutted by diathermy in a starshape. In all 5 cases it was possible to achieve the wide lumen. There were no complications. The combination of diathermy and argon-plasma-coagulation is a safe method, rare of complications in the treatment of short scar stenosis of the esophagus.

Adult↗
PubMed1998

[Current status of treatment of appendicitis. Results of 2 prospective multicenter studies in East Germany. East German Working Group "Outcome Assessment and Quality Assurance in Surgery" of the CAQ of the German Society of Surgery].

In a period of 10 years we carried out two prospective multicentric trials to evaluate the state of the art in treatment of appendicitis. One study was performed before introduction of laparoscopy. Important criteria like new diagnostic methods (sonography, laparoscopy), frequency of operation, perforation rate, frequency of appendectomies in case of non acute inflammation and postoperative complications were compared.

Appendectomy↗
PubMed1998

[Diagnostic laparoscopy within the scope of appendicitis treatment. East German Working Group "Outcome Assessment and Quality Assurance in Surgery" of the CAQ of the German Society of Surgery].

The diagnostic laparoscopy represents a special technique with high impact for differential diagnosis especially in patients with chronic recurrent pain in the right lower abdomen. The East-German multicentric trial confirmed the actual trend of increasing importance of the laparoscopic method especially in patients with unclear abdominal findings. In case of surgical treatment because of chronic appendicitis in 61.7% (n = 370) of all these cases an laparoscopic procedure was preferred. Unclear abdominal findings were treated in 73.7% (n = 205) laparoscopically. In case of acute appendicitis in 72.2% (n = 2934) the open procedure was preferred. The diagnostic laparoscopy can avoid the overlook of findings requiring therapy. The consequent laparoscopic approach allows to achieve a decreased rate of non necessary laparotomies as well as non detected findings requiring surgery. The rate of gynaecological findings was 16.2% (n = 184) of all women who underwent diagnostic laparoscopy versus 6.4% who underwent open appendectomy (n = 116).

Adolescent↗
PubMed1998

[Significance and value for the surgeon--the role of surgical examination. Endosonography within the scope of colon and rectal surgery].

Because of its accuracy rate, flexible rectal endosonography is a standard examination in the preoperative staging of rectal tumors, especially for uT3 tumors. Assessment of regional lymph node involvement is not as accurate as that of tumor invasion depth. The overstaging is caused by the presence of reactive swollen lymph nodes. Causes of understaging of lymph node status included the presence of metastasis solely in the extramesorectal node. The surgical strategy depends on the endosonographic tumor stage: EUS T1 N0 G1: local transanal resection; EUS T2: anterior resection, EUS T3: preoperative radiochemotherapy. After preoperative radiochemotherapy no understaging of local tumor infiltration was observed. Numerous errors in rectal cancer staging by endosonography are possible.

Colonic Neoplasms↗