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Biomedical subjects

J M Müller

Publications and source records attributed to J M Müller.

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

Prospective randomized blinded trial of pulmonary function, pain, and cosmetic results after laparoscopic vs. microlaparoscopic cholecystectomy.

BACKGROUND: The size of laparoscopic instruments has been reduced for use in abdominal video endoscopic surgery. However, it has yet to be proven that microlaparoscopic surgery will actually result in clinically relevant benefits for patients. METHODS: Fifty patients were randomized in a blinded fashion to receive either elective laparoscopic (MINI), (n = 25) or microlaparoscopic (MICRO) (n = 25) cholecystectomy. Pulmonary function (FVC, FEV (1)), analgesic consumption during patient-controlled analgesia (PCA), pain perception by visual analogue score (VAS), and the cosmetic result (by the patient's self-assessment) were evaluated postoperatively as clinically relevant end points. RESULTS: Age, sex, body mass index (BMI), preoperative pulmonary function, pain perception, and operative time were similar for the two groups. At 8:00 PM on the day of surgery, FVC (MINI: 1.96 L [range, 1.48-2.48]; MICRO: 2.13 L) [(range, 1.61.-2.50)] and FEV (1) (MINI: 1.17 L/sec) [range, 0.87-1. 48]; MICRO: 1.34 L/sec [range, 1.05.-2.14] were also similar (each p = 0.5). From surgery to the 3rd postoperative day, cumulative PCA morphine doses were comparable (MINI: 0.15 mg/kg bw [range, 0.09-0. 23]; MICRO: 0.21 mg/kg bw [range, 0.10-0.42]; p = 0.4), but overall VAS scores for pain while coughing were higher in the laparoscopic group (406 [range, 358-514]) than in the microlaparoscopic group (365 [range, 215-427]; p = 0.02). The cosmetic result was judged to be slightly superior by the microlaparoscopic patients (10 [range, 9-10]), as compared to those in the laparoscopic (9 [range, 8-10]) group (p = 0.04). CONCLUSION: Because microlaparoscopic cholecystectomy has some minor advantages over laparoscopic surgery, it should be considered for use in selected patients.

Adult↗
PubMed2000

Pulmonary function after thoracoscopic thymectomy versus median sternotomy for myasthenia gravis.

BACKGROUND: Impaired pulmonary function due to myasthenia gravis (MG) is further compromised by thymectomy, which is necessary in most cases. Thoracoscopic thymectomy (tThx) can achieve the same resection and functional improvement of MG as median sternotomy (sThx). The possible advantage of tThx in maintaining better perioperative lung function was quantified. METHODS: In a prospective trial, 20 patients with MG were randomly allocated to undergo tThx (n = 10) by three-trocar left-sided approach or sThx (n = 10) performed as an extended procedure. Complete pulmonary function was measured at 12-hour intervals, beginning 6 hours postoperatively. Effective postoperative pain control in both groups was achieved by patient-controlled analgesia with morphine sulfate assessed by a visual analogue scale. Statistical analysis for comparison of tThx and sThx was performed using the Mann-Whitney U test. RESULTS: Postoperative vital capacity, forced vital capacity, forced expiratory volume per second, and peak expiratory flow, measured as a percentage of the individual preoperative capacity, were significantly better with tThx compared with sThx. Immediate postoperative lung function was reduced to 35% and 65% after tThx and sThx, respectively. By the third postoperative day, recovery of pulmonary function was complete after tThx but only 55% after sThx. CONCLUSIONS: Less pronounced impairment and faster recovery of pulmonary function after tThx characterize this new approach for thymectomy as minimally invasive. These results could make tThx the preferred surgical treatment of MG, which was improved to the same extent as after sThx.

Adolescent↗
PubMed2000

The impact of laparoscopic biopsy of pancreatic lymph nodes with helium and carbon dioxide on port site and liver metastasis in BOP-induced pancreatic cancer in hamster.

The influence of pancreatic biopsy during laparoscopy with carbon dioxide (CO2) and helium on the incidence of port site and liver metastasis in pancreatic carcinoma is still unknown. Ductal adenocarcinoma of the pancreas was induced in Syrian hamsters (n = 30) by injection of N-nitrosobis-2-oxopropylamin (BOP, 10 mg/kg body weight/week) for 12 weeks. In week 13, hamsters were randomized in 3 groups (n = 10): While in group 1 (gr. 1) a laparotomy and biopsy of pancreatic lymph nodes was performed, gr. 2 and gr. 3 underwent a laparoscopic biopsy either with CO2 or helium. Therefore, one trocar was located in the left (biopsy) and the right abdominal wall (camera). In the 18th week all animals were sacrificed and the incidence of abdominal wall, port site and liver metastases was histologically determined. While there were abdominal wall metastases after laparotomy in 10% (n = 1), we observed trocar metastases in the CO2 group in 20% (n = 2). However, there were no trocar metastases in the helium group. The incidence of liver metastasis did not differ between the laparotomy and the helium group (20% vs 30%), but was increased in the CO2 group (60%). Laparoscopic biopsy of pancreatic lymph nodes with CO2 increased the incidence of port site and liver metastases in pancreatic cancer. The helium group was equal to the laparotomy group in this respect. Thus, staging laparoscopy with helium might become an alternative to explorative laparotomy in pancreatic cancer.

Animals↗
PubMed2000

Does alpha-linolenic acid in combination with linoleic acid influence liver metastasis and hepatic lipid peroxidation in BOP-induced pancreatic cancer in Syrian hamsters?

Some fatty acids are reported to inhibit tumor growth of pancreatic carcinoma. However, it is still unknown if alpha-linolenic acid (ALA) and linoleic acid (LA) inhibit liver metastasis of ductal pancreatic adenocarcinoma. Therefore we studied the effect of these fatty acids on liver metastasis in the animal model of N-nitrosobis(2-oxopropyl)amine (BOP)-induced pancreatic adenocarcinoma in Syrian hamsters. Since lipid peroxidation seems to be involved in carcinogenesis and metastasis, we further analyzed the intrahepatic concentration of thiobarbituric acid-reactive substances (TBARS) and activity of glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD). We observed an increase in the incidence and the number of liver metastases in response to the combination of ALA and LA. This was accompanied by a decrease in hepatic GSH-Px activity and an increase in hepatic SOD activity and TBARS concentration. The increase in hepatic lipid peroxidation seems to be one possible mechanism of increasing liver metastasis in this study.

Adenocarcinoma↗
PubMed2000

[Complication rate after gastrectomy and pouch reconstruction with Longmire interposition].

BACKGROUND/AIMS: To determine whether a Longmire-Interposition with or without a pouch used for reconstruction after gastrectomy influences the postoperative complication rate. METHODOLOGY: 49 patients who underwent gastrectomy with Longmire-Interposition with (n = 33) or without (n = 16) an additional pouch and 46 patients with a Roux-en-Y-reconstruction were analysed retrospectively. Complication rate and mortality were studied. RESULTS: There were no significant differences between the reconstruction groups for postoperative complications (Roux-en-Y vs. Longmire-Interposition with and without pouch: 30.4% vs. 28.6% for the morbidity; 4.3% vs. 4.1% for the mortality). CONCLUSION: These findings suggest that a Longmire-Interposition with or without a pouch for reconstruction after total gastrectomy is not connected with a higher morbidity or mortality in comparison to a Roux-en-Y-reconstruction.

Adult↗
PubMed2000

[Postoperatively detected gallbladder carcinoma. Follow-up or reoperation?].

BACKGROUND: The prognosis of gallbladder carcinoma is generally poor. The 5-year survival rate amounts to less than 5% in most series due to the high proportion of advanced stages at the time of diagnosis. Early stages are commonly found only with histological work-up after cholecystectomy (CCE). In these cases the question arises whether or not reoperation for completion resection would be indicated. PATIENTS/METHODS: A retrospective analysis examined all patients of the Clinic of Surgery (Charité) in Berlin with gallbladder carcinoma operated on between January 1981 and August 1993. A literature search was carried out using the MEDLINE retrieval system for the key words "gallbladder carcinoma", "surgical therapy", and "reoperation" limited to the period after 1970. RESULTS: The retrospective results of the own clinic and the analysis of the literature review demonstrate significantly higher survival rates after reoperation compared to CCE alone and observation for all cases of gallbladder carcinoma with stages T1b or higher stages. The extended radical CCE can be performed with low morbidity. With preceding laparoscopic CCE the trocar sites have to be completely excised. DISCUSSION: To avoid the situation of postoperative diagnosis of gallbladder carcinoma, the surgeon should intraoperatively during CCE perform a careful macroscopic control of the gallbladder. Suspect findings should be followed intraoperatively by histological examination. Nevertheless, local spread of GBCa and distribution of lymphatic metastases can certainly not be assessed completely after simple CCE. Based on the published results and because of low morbidity reoperation is indicated for most cases of GBCa when diagnosed postoperatively.

Cholecystectomy↗
PubMed2000

Re-opened foramen ovale--a rare cause of postoperative dyspnea following pneumonectomy.

Dyspnea and hypoxemia are common postoperative problems following pneumonectomy. Platypnea, the increased dyspnea in the erect position relieved by assuming a prone position, has been reported as a result of right to left inter-atrial shunt. We report here on our experience with a patient who had severe platypnea with remarkable positional arterial desaturation following right pneumonectomy. After establishing the diagnosis with contrast-enhanced transesophageal echocardiography of the preoperatively undetected interatrial right-left shunt, cardiac surgery led to clinical improvement and resumption of platypnea. Given the rarity of the diagnosis, we think interatrial shunt, based on an open foramen ovale, should be taken into consideration when platypnea occurs in patients as a postoperative complication following lung surgery. Transesophageal echocardiography may be helpful in detecting patients with "anatomical closed but functional open" foramen ovale or genuine inter-atrial septal defect prior to lung surgery.

Dyspnea↗
PubMed2000

Fundoplication: a model for immunologic aspects of laparoscopic and conventional surgery.

BACKGROUND AND PURPOSE: Immunologic investigations of laparoscopic and conventional procedures have recently been performed during cholecystectomy or colon resection, but the results might have been influenced by the amount of dissection or the presence of malignant tumor. Because fundoplication is characterized by moderate dissection and no resection, we supposed it to be an appropriate procedure for comparing immunologic changes during laparoscopic and conventional surgery. PATIENTS AND METHODS: Immunologic analysis (interleukin [IL]-6, IL-10, leukocytes, HLA-DR monocytes) was carried out on the peripheral blood of 34 patients who underwent elective Nissen fundoplication by the laparoscopic (LAP; N = 26) or conventional (OPEN; N = 8) technique for gastroesophageal reflux disease. Blood samples were obtained before and 1 and 4 hours after the beginning of the operation and on days 1, 2, 4, 7 after the procedure. RESULTS: A very fast and significant (P < 0.01) increase of the proinflammatory cytokines (IL-6, IL-10) and leukocytes and a decrease of cell-mediated functions (HLR-DR monocytes) were detected. Most of the analyzed measures had returned to preoperative values by 2 days after the procedure. All of the changes were similar in the two groups with the exception of IL-6. Throughout the post-operative study period, IL-6 concentrations were higher in the OPEN group, being significant 4 hours, 1 day, 2 days, and 4 days after the operation. CONCLUSION: The investigation measures do not give evidence that laparoscopic fundoplication is superior to conventional fundoplication in its immunologic effects.

Adult↗
PubMed2000

Prognosis factors in carcinoma of the head of the pancreas.

BACKGROUND: Due to a low survival rate even after a R0 resection of cancer of the head of the pancreas, a strict indication for a pancreaticoduodenectomy seems to be sensible. We have therefore analyzed our patients for possible prognosis factors. METHODS: In a retrospective trial the courses of disease of all patients (1981-1996) with resected histologically proven carcinoma of the head of the pancreas were analyzed. The following patient-specific parameters were evaluated and examined in a single or multivariate analysis of prognosis factors: age, gender, tumor size (T status), lymph node involvement (N status), dimension of resection, operation method, time of operation, morbidity, clinic lethality and survival rate. RESULTS: Between 1981 and 1996, 500 patients with ductal adenocarcinoma of the head of the pancreas were treated surgically. The rate of resection increased from 32.1% (1981-1986) to 37.8% (1991-1996) whereas the mortality rate decreased from 13.3 to 7.3%. The 5-year survival rate after resection was 11.8% with a median survival time of 13.8 months. In a multivariate analysis, only small tumors (T1, p < 0.016), the R0 status (p < 0.017) and the resection had a significant influence on the survival rate. CONCLUSION: Prognosis factors in the treatment of pancreatic cancer were tumor size (T1), tumor resection and R0 status.

Adenocarcinoma↗
PubMed2000

Influence of octreotide and tamoxifen on tumor growth and liver metastasis in N-nitrosobis(2-oxopropyl)amine-induced pancreatic cancer in Syrian hamsters.

In prospective clinical trials single octreotide therapy or combined therapy with tamoxifen has improved the quality of life and survival time in patients with pancreatic cancer. In this study we analyzed the influence of octreotide and tamoxifen on tumor growth and liver metastases in chemically induced pancreatic adenocarcinoma in Syrian hamsters. Octreotide alone and the combined therapy (octreotide/tamoxifen) decreased the incidence of macroscopic pancreatic carcinomas as well as the number and size of liver metastases. The combined therapy showed no superior effect to octreotide alone. Furthermore, there was no difference between the tamoxifen and the control group.

Animals↗
PubMed2000

Disaster with a new type of band for gastric banding.

BACKGROUND: Laparoscopic gastric banding has become an established therapy for morbid obesity. Typical complications are band dislocation, pouch dilatation and stomach slippage. A new type of adjustable silicone band with eyes for suture fixation was proposed to avoid these complications. The experience with this new kind of band is reported. METHODS: Between April 1998 and August 1998, 15 morbidly obese patients were treated by laparoscopic adjustable gastric banding using a new band type (manufactured by MEDING, Heinsberg, Germany). The band was fixed by single sutures using the eyes at each side of the buckle. There were 13 women and 2 men, with mean age 34 (range 21-54) years and mean body-weight 138.6 (range 113-213) kg. RESULTS: Intraoperative complications did not occur. Postoperatively 8 patients (53%) had increasing capacity for food intake and 2 (13%) had uncharacteristic abdominal pain. Radiographs revealed band rupture in 13 of 15 patients 3-11 months postoperatively. These patients were operated laparoscopically using a new technique for band change. Now, a Lap-band (BioEnterics, Carpinteria, CA, USA) was inserted and fixed to the ventral stomach with three sutures similar to a ventral fundoplication. Radiographic and clinical follow-up have been uneventful in all patients until now. CONCLUSION: This series demonstrated: 1) the importance of clinical follow-up; 2) a material defect of a new band type; and 3) development of a new laparoscopic technique for band change.

Adult↗
PubMed2000

[Minimally invasive surgery in malignant tumors? A concept of quality assurance by phased evaluation exemplifed by colorectal carcinoma resection].

The concept of phased clinical scientific evaluation new surgical procedures in oncology is introduced. The principles of this concept are illustrated with the example of laparoscopic resection of colorectal carcinoma. In Phase I animal studies and anatomical studies on human cadavers it has been shown that the anatomical extent of laparoscopic and conventional colorectal resections is comparable. Uncontrolled clinical trials and registries of laparoscopic operations with a low level of evidence did not detect any severe disadvantages of laparoscopic resection of colorectal carcinoma. Controlled randomised phase III a-studies with a a high level of evidence have proven that laparoscopic colorectal resection has important short-term patient benefits when compared to conventional surgery. Controlled randomised Phase III b-Muticentertrials to compare the long-term results of laparoscopic and conventional resections or colorectal cancer are currently on their way worldwide. These multicenter trials will evaluate with the highest level of evidence wether the results of laparoscopic colorectal cancer resection are as good as those for conventional surgery. Patients scheduled for minimal-invasive resection of colorectal carcinoma should be included in one of these multicenter trials. Only after the phased clinical evaluation of the new procedure has been completed, the risk or benefit of minimal-invasive surgery for colorectal cancer can be assessed.

Colorectal Neoplasms↗
PubMed2000

Pylorus preservation after complete gastrectomy and jejunal interposition: experimental study investigating motility and alkaline reflux.

BACKGROUND: Pylorus preservation has been proposed to reduce the disturbance in gastric emptying following gastrectomy but little is known about the role of the pylorus regarding motility patterns and alkaline reflux. AIMS: To assess the motility patterns and alkaline reflux following pylorus preservation after complete gastrectomy and jejunal interposition in the pig. METHODS: Motility patterns and alkaline reflux were studied in 12 conscious pigs before and after gastrectomy and jejunal interposition with preservation of the pylorus and a 1 cm antral ring (PYL+) or excised pylorus (PYL-) 6 and 14 weeks postoperatively. Gastroduodenal motility was investigated by manometry after fasting and fed, respectively and alkaline reflux by a fiberoptic system for detecting bilirubin. RESULTS: The number of propagated phase-III activities of the jejunal interponat to the duodenum and propagating velocity were lower in the PYL+ group after 6 weeks (p < 0.05) but higher after 14 weeks (p < 0.05) compared to the PYL- group. In the PYL+ the number of intrapyloric pressure waves (IPPWs) was lower after 6 weeks (p < 0.05) but higher after 14 weeks (p < 0.05) in comparison to preoperative controls. Alkaline reflux was significantly higher in the PYL- group than in the PYL+ group throughout the time observed. CONCLUSIONS: Pyloric function shows a delay after 6 weeks but restores within 14 weeks postoperatively. Pylorus preservation was associated with a significant decrease of alkaline reflux compared to PYL- in this setting.

Animals↗
PubMed1999

The mouse p97 (CDC48) gene. Genomic structure, definition of transcriptional regulatory sequences, gene expression, and characterization of a pseudogene.

Here we present the first description of the genomic organization, transcriptional regulatory sequences, and adult and embryonic gene expression for the mouse p97(CDC48) AAA ATPase. Clones representing two distinct p97 genes were isolated in a genomic library screen, one of them likely representing a non-functional processed pseudogene. The coding region of the gene encoding the functional mRNA is interrupted by 16 introns and encompasses 20.4 kilobase pairs. Definition of the transcriptional initiation site and sequence analysis showed that the gene contains a TATA-less, GC-rich promoter region with an initiator element spanning the transcription start site. Cis-acting elements necessary for basal transcription activity reside within 410 base pairs of the flanking region as determined by transient transfection assays. In immunohistological analyses, p97 was widely expressed in embryos and adults, but protein levels were tightly controlled in a cell type- and cell differentiation-dependent manner. A remarkable heterogeneity in p97 immunostaining was found on a cellular level within a given tissue, and protein amounts in the cytoplasm and nucleus varied widely, suggesting a highly regulated and intermittent function for p97. This study provides the basis for a detailed analysis of the complex regulation of p97 and the reagents required for assessing its functional significance using targeted gene manipulation in the mouse.

Adenosine Triphosphatases↗
PubMed1999

Pulmonary function following laparoscopic or conventional colorectal resection: a randomized controlled evaluation.

BACKGROUND: Laparotomy causes a significant reduction of pulmonary function, and atelectasis and pneumonia occur after elective conventional colorectal resections. OBJECTIVE: To evaluate the hypothesis that pulmonary function is less restricted after laparoscopic than after conventional colorectal resection. DESIGN: A randomized clinical trial. SETTING: The surgical department of an academic medical center. PATIENTS: Sixty patients underwent laparoscopic (n = 30) or conventional (n = 30) resection of colorectal tumors. The 2 groups did not differ significantly in age, sex, localization or stage of tumor, or preoperative pulmonary function. MAIN OUTCOME MEASURES: Forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, mid-expiratory phase of forced expiratory flow, and oxygen saturation of arterial blood. RESULTS: The forced vital capacity (mean +/- SD values: conventional resection group, 1.73+/-0.60 L; laparoscopic surgery group, 2.59+/-1.11 L; P<.01) and the forced expiratory volume in 1 second (conventional resection group, 1.19+/-0.51 L/s; laparoscopic surgery group, 1.80+/-0.80 L/s; P<.01) were more profoundly suppressed in the patients having conventional resection than in those having laparoscopic surgery. Similar results were found for the peak expiratory flow (conventional resection group, 2.51+/-1.37 L/s; laparoscopic resection group, 3.60+/-2.22 L/s; P<.05) and the midexpiratory phase of forced expiratory flow (conventional resection group, 1.87+/-1.12 L/s; laparoscopic surgery group, 2.67+/-1.76 L/s; P<.05). The oxygen saturation of arterial blood, measured while the patients were breathing room air, was lower after conventional than after laparoscopic resections (P<.01). The recovery of the forced vital capacity and forced expiratory volume in 1 second to 80% of the preoperative value took longer in patients having conventional resection than in those having laparoscopic resection (P<.01). Pneumonia developed in 2 patients having conventional resection, but no pulmonary infection occurred in the laparoscopic resection group (P>.05). CONCLUSIONS: Pulmonary function is better preserved after laparoscopic than after conventional colorectal resection. Pulmonary complications may be reduced after laparoscopic resections because of the better postoperative pulmonary function.

Aged↗
PubMed1999

Regular scintigraphic measurements of food transit following different types of reconstruction after total gastrectomy.

HYPOTHESIS: Ideal reconstruction after gastrectomy should ensure that the patient has a sufficiently large enteric reservoir to accommodate normal meals. Little is known about the transit of food after different methods of stomach reconstruction. The hypothesis of this trial was that food transit after gastrectomy is delayed by a pouch reconstruction compared with reconstructions without a pouch. DESIGN: Prospective. SETTING: University hospital. PATIENTS AND METHODS: A total of 27 patients underwent an interposition of a jejunal loop between the esophagus and the duodenum with (n = 19) or without (n = 8) a 7- or 15-cm proximal pouch reconstruction. Standardized scintigraphic measurements were performed to evaluate the food transit at fixed postoperative times. MAIN OUTCOME MEASURE: Scintigraphically measured food transit time. RESULTS: The food transit time 1 year postoperatively was significantly prolonged in patients with the 15-cm pouch in comparison with those with the 7-cm pouch and those without a pouch reconstruction (P = .005, P = .012). Patients with a pouch reconstruction tended to have better eating habits. CONCLUSIONS: Our results confirm the hypothesis and suggest that interposition of a large 15-cm jejunal pouch can lead to a prolonged food transit time with enteric reservoir function resulting in better patient nutritional status.

Adult↗
PubMed1999

Effects of fibrin glue and growth factors released from platelets on abdominal hernia repair with a resorbable PGA mesh: experimental study.

INTRODUCTION: The purpose of this study was to investigate if the strength and quality of an abdominal wall repair with a resorbable PGA (polyglycolic acid) mesh can be improved by fibrin glue or releasates from platelets. MATERIALS AND METHODS: An abdominal wall defect in the rat was repaired using a PGA mesh in a sublay technique (CG) alone and either with additional fibrin glue (FG) or with platelet releasates (REL). Endpoints were clinical herniation pressure and hydroxyproline concentration (HP) as well as number of fibroblasts and collagen fibers at 7, 14, and 90 days after implantation. RESULTS: In both experimental groups (REL and FG) higher herniation pressures, hydroxyproline contents, and number of fibroblasts/collagen fibers were found at all times of measurement compared to the CG. The PGA mesh alone showed a significant lack of stability after 14 days which can be compensated for by the investigated components. Significant differences (P < 0.05) were observed regarding the herniation pressure (REL vs CG at 7 and 14 days; FG vs CG at 14 days) and the number of collagen fibers (REL vs CG at 14 days). CONCLUSIONS: These results suggest that the quality of a PGA mesh repair can be improved by application of fibrin glue or platelet releasates in the described experimental setting.

Animals↗