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J K Seifert

Publications and source records attributed to J K Seifert.

At least 19 recordsLinked to original sources
PubMed2005

[Hamartoma of the duodenum].

HISTORY AND ADMISSION FINDINGS: A 61-year-old man had been suffering from repeated episodes of postprandial vomiting and a feeling of fullness as well as a weight loss of 8 kg for two months. Three years prior to this, a laparoscopic cholecystectomy had been carried out at a different institution after a pancreatitis on the assumption of a biliary genesis. There were no sings of jaundice or gastro-intestinal bleeding. The physical examination was -- apart from epigastric pain -- unremarkable. INVESTIGATIONS: The routine laboratory parameters and tumor markers were within normal range. Endoscopy revealed a thickened duodenal wall with a stenosis at the level of the papilla, and a tumorous mass in the duodenal bulb. The biopsy specimens gave no evidence of malignancy. The barium upper GI series revealed an excentric stenosis of the duodenal pars II. Computerized tomography showed no evidence for tumor growth extending beyond the wall or a pathologic enlargement of the adjacent lymph nodes. THERAPY AND COURSE: A pylorus-preserving partial duodenopancreatectomy was performed and the postoperative course was without any complications. The histological examination of the resectate showed -- besides a chronically fibrosing pancreatitis -- a hamartoma of the duodenal wall. CONCLUSION: Besides the endoscopic removal of a hamartoma of the duodenum a surgical transduodenal resection represents the most frequently applied procedure. The partial duodenopancreatectomy is a rather rare therapeutic option. It was chosen in our patient on account of the atypical presentation of the tumor, unclear histology and an adequate operative risk.

Duodenal Diseases↗
PubMed2004

Prognostic factors for cryotherapy of colorectal liver metastases.

BACKGROUND: Cryotherapy is a local ablative treatment option for non-resectable liver tumours. We aimed to identify prognostic indicators, that may allow better selection or stratification for adjuvant therapies of patients. METHODS: Fifty-five patients had cryotherapy for colorectal liver metastases. The patient-, tumour- and operative details were recorded prospectively. Mean follow up was 24 months. A uni- and multivariate analysis for possible prognostic factors was performed. RESULTS: There was a trend towards better survival for patients with unilobar liver metastases, preoperative serum levels of carcinoembrional antigen (CEA) not exceeding 20 ng/ml and patients undergoing 'R0'-treatment. Patients with multiple or large (>4 cm) liver metastases, patients undergoing cryotherapy combined with liver resection and patients receiving blood transfusion intraoperatively, especially when exceeding 4 units packed red cells, had a significantly impaired survival in univariate analysis. In multivariate analysis (Cox regression) the amount of intraoperative blood transfusion was the only independent prognostic indicator. CONCLUSION: Intraoperative blood transfusion has a negative impact on survival following hepatic cryotherapy for colorectal liver metastases and should be avoided by refinement of surgical technique whenever possible. Patients with multiple liver metastases or metastases of more than 4 cm in size have an impaired prognosis-therefore trials of adjuvant therapies following hepatic cryotherapy for colorectal liver metastases should include number and size of metastases for stratification of patient groups.

Adult↗
PubMed2004

Cryotherapy for liver tumors: current status, perspectives, clinical results, and review of literature.

Cryotherapy has gained importance as a locally ablative treatment option for patients with non-resectable liver tumors, especially metastases from colorectal cancer. We have used this technique since 1996 for the treatment of 77 patients with malignant liver tumors. Patient data was prospectively recorded and follow-up was until September 2002 or death. Fifty-five patients had colorectal cancer liver metastases, 16 metastases from other primaries and 6 had hepatoma. Forty patients had cryotherapy only and 37 had an additional liver resection. Morbidity and mortality were 22% and 1.3%, respectively. In 68% of patients with colorectal liver metastases and an elevated serum carcinoembryonic antigen-level preoperatively, it returned to the normal range following cryosurgery. For all 77 patients, median survival was 28 months with a 3- and 5-year-survival rate of 39% and 26%, respectively, and median survival was 29 months with a 3- and 5-year-survival rate of 44% and 26%, respectively, for the 55 patients with colorectal liver metastases. Local recurrence at the cryosite was observed in 13 of 65 patients (20%) with initially complete treatment. For cryotherapy to further establish as a treatment for malignant liver tumors in a time where many new local ablative techniques are developing, different goals need to be achieved. The trauma of the procedure and local treatment failure need to be minimized and survival results need to be optimized. Published studies and new possible fields of research regarding these goals are discussed.

Adult↗
PubMed2003

Detection of mitochondrial electron chain carrier redox status by transhepatic light intensity during rat liver reperfusion.

The aim of the study was to investigate mitochondrial electron transfer during rat liver reperfusion after cold storage and hypothermic machine perfusion. Livers from male Brown Norway rats were preserved (UW) for 10h either by cold storage (CS) or by hypothermic oxygenated perfusion extracorporal (HOPE). Transhepatic photometric analysis allowed determination of the redox status of mitochondrial cytochromes during preservation, rewarming and reperfusion. Mitochondrial electron chain carriers were inhibited at different sites with rotenone and cyanide in some experiments. reversed transcriptional polymerase chain reaction (RT-PCR) was performed after reperfusion concerning transcription of TNFalpha, caspase 9, and c-jun kinase (JNK). Increased superoxide anion formation as well as transcription of TNFalpha, caspase 9, and JNK during reperfusion after cold storage (CS) were related with completely reduced cytochromes before and during reperfusion. In contrast, hypothermic oxygenated livers (HOPE) showed oxygenated cytochromes as well as decreased superoxide anion formation and no detectable transcription of TNFalpha, caspase 9, and JNK. A similar low level of superoxide anion formation was found when electron chain transfer of cold stored livers was inhibited during reperfusion with rotenone but not with cyanide. After hypothermic oxygenation (HOPE) inhibition of mitochondrial electron chain with rotenone showed no change in formation of superoxide anion formation whereas inhibition with cyanide showed increased superoxide anion formation. Thus mitochondrial cytochrome redox status is suggested to be related: (i) with the release of reactive oxygen substances as well as (ii) with the expressions of TNFalpha, caspase 9, and JNK during reperfusion and may thus be usable as predictive marker of liver grafts.

Animals↗
PubMed2003

[Surgical treatment of colorectal liver metastases].

Resection is the only curative treatment of colorectal liver metastases proofed by a long-term follow-up. The operation is indicated if the metastases are completely removable with sufficient liver parenchyma remaining after resection and if the patient is fit for surgery. The resection is not indicated in cases with non resectable extrahepatic tumours and lymph node metastases distal the hepatoduodenal ligament. The postoperative mortality amounts to about 5 % and the 5-year-survival-rates range between 20 and 40 % depending on the selection of patients. Aims of new concepts of operative therapy are the improvement of resectability by preoperative portal vein embolization, the resection combined with local destructive methods and preoperative chemotherapy. Additionally, new drugs for adjuvant treatment after resection of metastases are studied. The interdisciplinary discussion of the course before and after therapy is essential for the individual optimal treatment.

Aged↗
PubMed2002

Chemoembolization for primary liver cancer.

AIMS: For most patients with primary liver cancer surgical treatment is not feasible and prognosis without treatment is poor. We aimed to assess the morbidity and efficacy of transarterial chemoembolization (TACE) with lipiodol and mitomycin C in these patients in a prospective case-control study. METHODS: From August 1996 to May 2000 22 patients with non-resectable hepatocellular carcinoma were treated with TACE. In case of radiological or tumour-marker response, treatment was repeated after 4--6 weeks, up to seven times per patient. RESULTS: Morbidity was 23% and usually minor, no patient died within 30 days of treatment. A decrease in size of the reference tumour or constant tumour-size in CT-scan were observed in 14 of 20 patients (70%) and of the 19 patients with elevated AFP-serum levels 12 (63%) had an AFP reduction following treatment. The median survival time was 14 months with a 1- and 2-year survival rate of 69% and 29%, respectively. Survival was not different in radiological or AFP responders vs non-responders. CONCLUSION: While TACE with lipiodol and mitomycin C for primary liver cancer is associated with considerable antitumoural efficacy, as demonstrated by tumour marker and radiological response, an effect on patient survival is not evident. New treatment options with an impact on survival are needed for these patients.

Aged↗
PubMed2002

[Cryotherapy for primary and secondary liver tumours].

AIMS: We assessed the morbidity, mortality and efficacy of cryotherapy for primary and secondary malignant liver tumours in a prospective case control study. METHODS: Since 1996 we performed 77 cryosurgical procedures on 71 patients. 6 patients had hepatocellular carcinoma, the remainders metastases, mainly of colorectal origin (n = 49). Cryotherapy was used when a complete tumour resection was not feasible, but complete tumour destruction by cryotherapy seemed possible. Mean follow-up was 21 months. RESULTS: The mean number of lesions per patient was 2.6 (1-10) with a mean maximum diameter of 3.7 cm (1-11). In 36 of 71 patients cryotherapy was used in combination with liver resection. Morbidity and hospital mortality were 23 % and 2.8 %. In 25 of 34 patients with colorectal primary and preoperatively elevated CEA it returned to normal postoperatively (74 %). 40 of the 60 patients with "R0-treatment" developed tumour recurrence, 10 of these at the cryosite (17 %). Median survival for all patients (colorectal metastases) was 28 (29) months with a 3- and 5-year survival rate of 38 % (43 %) and 30 % (33 %), respectively. CONCLUSION: Cryotherapy is an effective parenchyma sparing method for the treatment of malignant liver tumours in a curative approach. It can be performed safely and a long-term local tumour control is achieved in a high percentage of patients. Survival rates following cryotherapy appear comparable to the results of liver resection. It seems justified to conduct a prospective randomised trial comparing liver resection and cryotherapy for resectable tumours.

Adult↗
PubMed2000

Comparison of iceball diameter and temperature distribution achieved with 3-mm accuprobe cryoprobes in porcine and human liver tissue and human colorectal liver metastases in vitro.

We aimed to assess the thermal profile and size of iceballs produced by Accuprobe cryoprobes in fresh porcine and human liver and human colorectal cancer liver metastases in vitro to allow better planning of cryosurgical treatment of liver metastases. Iceballs were produced by a 20-min single freeze cycle using 8-mm cryoprobes in pig liver in a waterbath at 37 degrees C (n = 8) and 3-mm cryoprobes in pig liver (n = 8), human liver (n = 3), and human colorectal cancer liver metastases (n = 8). The iceball diameters and the temperatures at different distances from the cryoprobe were measured. Mean iceball diameters produced by 8-mm cryoprobes in pig liver were 56.3 mm and varied from 38.7 to 39.6 mm for 3-mm cryoprobes in the different tissues used. There was no significant difference in iceball size in the different tissues. The diameter of the zone of -40 degrees C or less was approximately 44 mm using 8-mm cryoprobes in porcine liver and between 27 and 31 mm using 3-mm cryoprobes in the different tissues examined. The results may allow better preoperative planning of the cryosurgical treatment of liver metastases with Accuprobe cryoprobes.

Animals↗
PubMed2000

Cryotherapy for liver metastases.

Cryotherapy is undergoing a renaissance in the treatment of nonresectable liver tumors. In a prospective case control study we assessed the morbidity, mortality, and efficacy of hepatic cryotherapy for liver metastases. Between January 1996 and September 1999 a total of 54 cryosurgical procedures were performed on 49 patients (median age 66 years, 21 women) with liver metastases. Patient, tumor, and operative details were recorded prospectively. Liver metastases originated from colorectal cancer (n=37), gastric cancer (n=3), renal cell carcinoma (n=2), and other primaries (n=7). Median follow-up was 13 months (1-32). The median number of liver metastases was 3 (range 1-10) with a median diameter of 3.9 cm (range 1.5-11). Twenty-one patients (43%) had cryoablation only, and 28 (57%) had liver resection in combination with cryoablation. One patient (2%) died within 30 postoperative days. Another 13 patients (27%) developed reversible complications. In 19 of 25 patients (76%) with preoperatively elevated serum CEA and colorectal metastases it returned to the normal range postoperatively. Twenty-eight patients (57%) developed tumor recurrence, eight of which with involvement of the cryosite. Overall median survival patients was 23 months, and survival in patients with colorectal metastases was 29 months. Hepatic cryotherapy is associated with tolerable morbidity and mortality. Efficacy is demonstrated by tumor marker results. Survival data are promising; however, long-term results must be provided to allow comparison with other treatment modalities.

Adult↗
PubMed2000

Resection with cryotherapy of colorectal hepatic metastases has the same survival as hepatic resection alone.

BACKGROUND: Hepatic resection is well established as a potentially curative treatment for hepatic colorectal cancer metastases. However, only a small proportion of patients with liver metastases are suitable for resection because they either have extrahepatic disease, or the extent and/or the distribution of their hepatic disease would make excision impossible. We have previously described the use of cryotherapy for inadequate resection margins and lesions in the remaining lobe of the liver. Combining such cryodestructive techniques with resection offers the possibility of increasing the proportion of patients to whom potentially curative treatment can be offered. The aim of this study was to compare survival in patients treated with resection and cryotherapy against those of patients treated with resection alone. Potential prognostic variables were also examined. METHOD: Patients undergoing a hepatic resection with or without cryotherapy at our unit between April 1990 and July 1997 were identified from our database and their notes reviewed. Survival was estimated using the Kaplan-Meier method and compared using the Log rank test. RESULTS: One hundred and seven patients were treated in total: 32 underwent resection alone, and 75 underwent resection combined with cryotherapy. There was no significant difference between the survival of patients treated with resection alone and those treated with resection and cryotherapy. CONCLUSIONS: Edge and contralobe cryotherapy can be combined with hepatic resection to allow a greater proportion of patients with hepatic colorectal metastases to be offered treatment, and results in similar survival figures comparable to hepatic resection for at least 3 years.

Adult↗
PubMed2000

Low preoperative serum carcinoembryonic antigen concentration is a marker of good prognosis in patients undergoing cryotherapy for low volume hepatic metastases from colorectal cancer.

BACKGROUND: Carcinoembryonic antigen (CEA) is of prognostic value in colorectal cancer and has been shown to be related to the ability of colorectal cancer cells to implant and to metastasise and to have an effect on immune function. This study attempts to separate the prognostic effects of serum CEA level and volume of hepatic metastases following cryotherapy for liver metastases from colorectal cancer. METHODS: Out of 195 patients undergoing cryotherapy for liver tumour between 4/90 and 5/97 we identified 94 patients who had cryoablation of colorectal liver metastases with known volume of metastases and preoperative serum CEA. Survival was estimated using the Kaplan-Meier method and the log-rank test was used to test for significant differences in survival of subgroups with different tumour volumes and preoperative serum CEA. RESULTS: Tumour volume was prognostic, with patients with low volume-disease having a significantly better outcome than patients with medium or high volume disease. There was clearly no effect of preoperative serum CEA level on survival in patients with high volume disease. However, in the medium and low volume group the patients with low serum CEA preoperatively have a significantly better survival than patients with a high preoperative serum CEA. CONCLUSIONS: We believe that the data supports the belief that CEA has a biological effect which significantly worsens survival following hepatic cryotherapy in patients with low volume and medium hepatic metastases from colorectal cancer. Therapeutic approaches to this phenomenon may be of value both in primary and secondary colorectal cancer.

Biomarkers, Tumor↗
PubMed1999

Pretreatment echogenicity of colorectal liver metastases predicts survival after hepatic cryotherapy.

PURPOSE: There is currently no knowledge of the prognostic value of echogenicity of colorectal liver metastases in patients receiving no treatment, hepatic cryotherapy, or any other treatment modality. We sought to determine whether differences in echogenicity of colorectal liver metastases predict prognosis after hepatic cryotherapy. METHODS: Between April 1990 and May 1997 the echogenicity of liver metastases was assessed intraoperatively in 48 patients undergoing cryotherapy for in situ destruction of colorectal liver metastases, with use of an Aloka machine with a 5-MHz scanner. Survival time was calculated by the Kaplan-Meier method, and the prognostic value of echogenicity and several other possible prognostic factors was tested with the log-rank test. RESULTS: Thirty-three patients were found to have hyperechoic metastases. These patients had a favorable outcome, with a median survival time of 50 months, as compared with a median survival time of 24 months in the 15 patients with hypoechoic metastases (P = 0.0074). Regarding the remaining prognostic factors that were tested, only age less than 51 years, absence of involved nodes at primary resection, small diameter of liver metastases, and low preoperative serum carcinoembryonic antigen levels were associated with a favorable outcome. CONCLUSION: We believe that this is an original description of the prognostic importance of echogenicity of colorectal liver metastases. Differences in echogenicity may be related to tumor biology. This will be addressed in further studies.

Adult↗
PubMed1999

World survey on the complications of hepatic and prostate cryotherapy.

Cryotherapy is used as a treatment for nonresectable liver tumors and adenocarcinoma of the prostate. Morbidity and mortality following cryotherapy are generally considered to be infrequent, but a syndrome of multiorgan failure, severe coagulopathy, and disseminated intravascular coagulation following hepatic cryotherapy has been described and referred to as the cryoshock phenomenon. In this study we aimed to assess and describe the incidence and clinical features of the cryoshock phenomenon following cryosurgery from the surveyed experience of a large number of clinical centers and to relate the data to the overall mortality and morbidity of this treatment. A questionnaire was sent to all cryotherapy users (n = 299) of whom we were aware. We requested information on the number of patients treated, the occurrence, and the clinical features of cryoshock and mortality and morbidity following cryotherapy of the prostate or liver. Altogether 134 completed questionnaires were returned (44.8%). Seventy-two centers had experience with hepatic cryotherapy and 62 with prostate cryotherapy. Following hepatic cryotherapy, the phenomenon of cryoshock was observed in 21 of 2173 patients (1%) and was responsible for 6 of 33 perioperative deaths (18.2%). Cryoshock was rare following prostate cryotherapy (2 of 5432 patients, 0.04%) and did not contribute to the overall mortality of 0.06%. Hepatic and prostate cryotherapy are safe. Cryoshock is rare after prostate cryotherapy but occurs in 1% of patients following hepatic cryotherapy. Cryoshock is associated with a high risk of death, being responsible for 18.2% of deaths in this survey. Research regarding the mechanism and possible avoidance of cryoshock is required.

Acute Kidney Injury↗
PubMed1999

Interleukin-6 and tumor necrosis factor-alpha levels following hepatic cryotherapy: association with volume and duration of freezing.

Although morbidity following cryotherapy is usually minor, a syndrome of multiorgan failure and disseminated intravascular coagulation (DIC) has been described and referred to as the cryoshock phenomenon. We hypothesized that mediators similar to those in septic shock may be involved in this syndrome. In this study we aimed to assess the plasma concentrations of the cytokines tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) following hepatic cryotherapy and to relate them to the duration and volume of freezing and to hepatocellular injury. Between April and December 1997 blood samples were taken preoperatively and at different times postoperatively from patients undergoing hepatic artery catheter-insertion (HAC) (n = 15), cryotherapy (n = 5), liver resection (n = 9), liver resection and edge cryotherapy (n = 7), or liver resection and cryotherapy of additional lesions (n = 9). They were analyzed for serum aspartate transaminase (AST) and plasma TNF-alpha and IL-6 levels. There was a significant association (Pearson correlation) of serum AST levels 1 hour postoperatively with plasma TNF-alpha and IL-6 levels at the end of the procedure. In patients undergoing cryotherapy or resection with cryotherapy of additional lesions (n = 14), the volume and duration of hepatic freezing were significantly associated with postoperative serum AST and plasma TNF-alpha and IL-6 levels at various postoperative times. Hepatic cryotherapy is followed by cytokine release, with postoperative plasma TNF-alpha and IL-6 levels associated with the degree of hepatic cryotrauma. These mediators may be involved in the occurrence of cryoshock following large-volume hepatic freezing.

Aspartate Aminotransferases↗
PubMed1999

Indicators of recurrence following cryotherapy for hepatic metastases from colorectal cancer.

BACKGROUND: This retrospective review aimed to assess the incidence of local recurrence at the cryosite, hepatic and extrahepatic recurrence and the corresponding disease-free intervals. Prognostic indicators following hepatic cryotherapy were also identified. METHODS: Eighty-five patients underwent complete cryotreatment of colorectal liver metastases between April 1990 and May 1997. Possible prognostic indicators were tested for their impact on the disease-free interval at the cryosite, liver disease-free survival and overall disease-free survival with univariate and multivariate analysis. RESULTS: At a median follow-up of 22 months 66 patients developed tumour recurrence: 18 in the liver only; 15 in the liver and lung; 22 in the liver and extrapulmonary areas; and 11 at extrahepatic sites only. Local recurrence at the cryosite occurred in 28 patients. Cryotreated metastases larger than 3 cm were associated with a shorter disease-free interval at the cryosite and liver disease-free survival; persistently raised serum carcinoembryonic antigen (CEA) levels after operation were associated with shorter liver disease-free and overall disease-free intervals in multivariate analysis. CONCLUSION: Improvements in probe placement and monitoring of the freezing process are required to allow successful treatment of large liver metastases. A failure in complete postoperative CEA response indicates that hepatic or extrahepatic disease was not detected before operation, which may be avoided with better staging procedures.

Adult↗
PubMed1998

[Cryotherapy of liver metastases. Initial results].

PATIENTS AND METHOD: Between 1 Jan 1996 and 1 Apr 1998 29 patients underwent cryosurgical therapy for liver metastasis at the Department of Surgery at the University of Mainz. RESULTS: No complications occurred following cryosurgery alone (n = 12). Within the group of patients with a combined procedure (n = 11) 1 patient had temporary liver failure and 1 patient died of sepsis. Following freezing of the cutting zone (n = 6) 1 patient showed a bile fistula and 1 ascites. In 15 cases of 28 dismissed patients with remaining destroyed tumor tissue the follow-up showed no tumor recurrence (median follow-up 11 months). On the other hand 9 patients had a tumor recurrence within the liver, 3 patients at extrahepatic regions and 7 patients developed a tumor recurrence within the freezing zone.

Colorectal Neoplasms↗
PubMed1998

Cryotherapy for neuroendocrine liver metastases.

While the prognosis for patients with untreated liver metastases from neuroendocrine primaries is rather good, they often suffer disabling symptoms due to syndromes of hormonal excess. Thirteen patients with metastatic neuroendocrine tumours were treated by hepatic cryotherapy; seven patients were symptomatic and five of these had elevated levels of hormonal tumour markers. Twelve patients are alive and mostly asymptomatic with a median follow up of 13.5 months; one patient died after 45 months of bronchopneumonia without evidence of tumour recurrence. All patients with elevated preoperative tumour markers have had a significant fall in markers postoperatively. Two patients were returned to the operating theatre for coagulopathy-associated bleeding: one patient each developed acute renal failure and pulmonary embolism, but there was no mortality. This study shows that hepatic cryotherapy offers a useful treatment option for this group of patients, alleviates symptoms and may have an impact on survival.

Adult↗