Search PubMed⌕ Search

Biomedical subjects

J Miholic

Publications and source records attributed to J Miholic.

At least 37 records · Page 2Linked to original sources
PubMed1991

[The value of transrectal sonography in assessing radiogenic rectal changes].

The clinical value of TRS in diagnosis and staging of radiogenic rectal disorders is discussed. TRS was performed on 120 patients with tumours of lower pelvis who were treated by radiotherapy. They were divided in this trial into 2 groups. Group I (n = 113, with a mean interval to radiotherapy of 2 years) including patients who were under a routine control. Group II (n = 7, with a mean interval to radiotherapy of 13 years) including patients with strong local pain of the radiotherapy zone. The sonographic changes were divided into 4 grades (0-III) and verified histologically in group II patients by means of biopsy. A control group (n = 35) was also examined by TRS. The patients of this group were not treated radiotherapeutically. We concluded in our study that TRS in radiogenic rectal disorders, give us a very precise grading of the tumours which in turn, is of great importance in the further therapeutic procedure and in the evaluation of tumour recidives and second malignomas of the rectal wall.

Aged↗
PubMed1991

[The role of intestinal resection in primary surgery of ovarian carcinoma].

In most ovarian cancer cases complete resection of the tumour masses is not possible, and tumour reduction at the primary operation has been shown to improve survival. In some cases optimal tumour reduction is only possible by resecting intestinal structures, and it remains to be shown whether aggressive approaches are justified. The impact of intestinal resection, among other prognostic factors, was analysed in 104 patients undergoing primary operation for ovarian cancer. Tumour spread to bowel, exceeding 2 cm in diameter occurred in 39% of the cases. Debulking to a maximal tumour diameter less than 2 cm was achieved in 68 (65%) cases. Successful debulking was achieved by performing large (n = 20) and small bowel (n = 4) in 22 patients with massive bowel involvement. Two patients died during the hospital stay, one after bowel resection. Four independent prognostic variables emerged from Cox's multiple proportional hazards regression: ascites (p = 0.001), massive bowel involvement (p = 0.007), residual tumour size (p = 0.002), and intestinal resection (p = 0.11). The authors contend that intestinal resection to achieve optimal tumour debulking at the primary operation will improve the survival of ovarian cancer patients.

Adolescent↗
PubMed1990

Extracellular space, blood volume, and the early dumping syndrome after total gastrectomy.

Extracellular space and blood volume were measured using 82Br dilution and 51Cr-tagged erythrocytes in 24 tumor-free patients after total gastrectomy. Eleven of the patients suffered from early dumping. Age, blood volume, and extracellular space were significantly smaller in dumpers (P less than 0.05). The dumping score could be predicted by a multiple regression model considering blood volume per lean body mass and extracellular space (r = 0.637; P = 0.0039). Rapid (t1/2 less than 360 seconds) emptying of the gastric substitute, assessed using a 99Tc-labeled solid test meal, was significantly associated with dumping in addition to extracellular space and blood volume (r = 0.876; P = 0.0018). Both rapid emptying and a narrow extracellular space seem to contribute to the early dumping syndrome.

Blood Volume↗
PubMed1990

Nutritional consequences of total gastrectomy: the relationship between mode of reconstruction, postprandial symptoms, and body composition.

Body composition, postprandial symptoms, and social performance were assessed in 41 patients who were free of tumors 16 to 63 months (median, 41 months) after total gastrectomy with Roux-en-Y esophagojejunostomy (n = 15) or jejunal interposition (n = 26). There were no significant differences with respect to age, sex, initial tumor stage, interval since operation, and premorbid weight/height2 (body mass index). The lowest postoperative body mass index (BMI) was 72% +/- 3% of the preillness BMI in patients with Roux-en-Y reconstruction and 79% +/- 2% in patients with jejunal interposition (p less than 0.05). At the time of the study the relative BMI was 88% +/- 2% of the preillness BMI in patients with jejunal interposition but only 81% +/- 3% in patients with the Roux-en-Y reconstruction (p less than 0.01). Muscle mass and lean body mass estimated from anthropometric and bioelectric impedance measurements were correlated with sex (p = 0.0001) and with the mode of reconstruction (p = 0.02) independently, which was confirmed by multiple linear regression. The postprandial symptoms were not significantly associated with changes in body composition except for an inverse relationship between Sigstad's dumping score and the extracellular mass/body cell mass ratio (r = 0.553; p = 0.0002). Of the patients under 60 years of age, 10 of 15 patients with jejunal interposition and two of eight patients with Roux-en-Y reconstruction were back at work (p = 0.057). The persons who had resumed their work had a significantly higher relative BMI (90% +/- 2% vs 82% +/- 3%), lean body mass (53 +/- 3 kg vs 46 +/- 3 kg), and muscle mass (25 +/- 2 kg vs 21 +/- 1 kg) than persons in early retirement. We concluded that preserving the duodenal transit should be a main objective of gastric replacement after total gastrectomy.

Anastomosis, Roux-en-Y↗
PubMed1989

[Ileus following radiotherapy: importance and therapeutic aspects of surgery for late radiation injuries of the intestine].

Between 1971 and 1988 74 operations for intestinal complications following radiotherapy were performed on 67 patients at the Second Surgical Department, University of Vienna. The lesions were located in the small bowel (n = 41) and in the sigmoid colon/rectum (n = 33). 98.5% of the patients were females, the most frequent cause for irradiation being ovarian cancer. Bowel stenosis with resultant chronic or acute ileus was the most frequent indication for operation, occurring in 31 cases (76%) of the small bowel lesions and in 15 cases (46%) of the colon lesions. Percutaneous irradiation resulted in a significantly higher proportion of small bowel lesions (77%, p = 0.001), whilst endocavitary irradiation was followed in 67% of cases by colorectal lesions. Different application modality of irradiation also resulted in completely different symptoms for small and large bowel lesions. The operative mortality was 9.5%. Peritonitis following anastomotic leakage was the cause of death in 6 of 7 cases. In the treatment of small bowel ileus mortality following bowel resection (9%, one of 11 cases) was comparable to that of the bypass operation (6%, one of 18 cases). Both operation methods seem to be justified. Single-layer anastomosis resulted in zero mortality in 21 cases of ileus operated on by this technique, compared with 19% mortality in 16 cases treated by double-layer anastomosis and should be preferred for operations on the irradiated bowel.

Adult↗
PubMed1989

Emptying of the gastric substitute after total gastrectomy. Jejunal interposition versus Roux-y esophagojejunostomy.

Emptying of the gastric substitute and small bowel transit time of a 99mTc-labeled solid test meal were measured in 20 tumor-free patients 13 to 63 (median, 35) months after total gastrectomy with Roux-y (n = 11) and jejunal interposition (n = 9) reconstruction. The emptying half-times ranged from 2 minutes to greater than 20 minutes. Rapid emptying was associated with dumping symptoms (p less than 0.03) and shorter orocoecal transit-time (p less than 0.05). Serum glucose concentrations rose more quickly in jejunal interposition, but the areas under the curve were identical in both groups. The median insulin-to-glucose ratio (areas under the curve) during the 20 minutes after the meal was 11.4 in jejunal interposition and 7.1 in Roux-y esophagojejunostomy (NS). Interposition cases had regained a significantly higher percentage (89%) of their premorbid weight than patients with Roux-y (78%; p less than 0.05). The weight/height2 ratio was above the 50th centile in 45% of interpositions, but below the 50th centile in all patients after the Roux-y mode of reconstruction (p less than 0.05). It is concluded that the emptying velocity of the gastric substitute has no impact on postoperative weight gain. The authors contend that the concept of a gastric substitute pouch is not supported by the findings of this study.

Anastomosis, Roux-en-Y↗
PubMed1989

Small bowel function after surgery for chronic radiation enteritis.

The retention of the gamma-emitting 75Se-homotaurocholic acid (SeHCAT) after 72 and 168 h was assessed in 10 patients after ileal resection for radiation injury (group I). 6 patients suffering from chronic postirradiation diarrhea (group II) and 6 patients in whom the ileum had been resected for other indications (group III) were also examined. The retention of SeHCAT was abnormally low (less than 50%) in all cases after 72 h and below 20% in 19 out of 21 cases after 168 h. The length of resected small bowel (groups I and III) was inversely related with SeHCAT retention after 72 h (r = 0.63; p = 0.015), but not after 168 h. There was no correlation between the diarrhea score and the extent of bowel resection, SeHCAT retention or xylose absorption. Hydrogen breath test with lactulose revealed a significantly shortened orocecal transit time in group I, compared to groups II and III. Xylose absorption was significantly reduced in patients with positive 5 g xylose-H2 breath test. In groups I and III, however, xylose absorption tended to improve with increasing time interval following resection (r = 0.79; p = 0.003). It is concluded that radiation injury in addition to small-bowel resection contributes significantly to malabsorption and diarrhea in patients after ileal resection for radiation sequelae. The chronic radiation damage seems to act mainly through impaired motility.

Body Weight↗
PubMed1989

Independent risk factors predicting acute graft rejection in cardiac transplant recipients treated by triple drug immunosuppression.

To assess independent risk factors predicting the occurrence of clinically significant acute rejection episodes in the first 6 months after cardiac transplantation, we performed a multivariate stepwise logistic regression analysis. Forty-three recipients, undergoing transplantation between September 1986 and May 1988, were eligible for analysis and received standardized, low-dose triple drug maintenance immunosuppression with cyclosporine, azathioprine, and prednisolone. Immunoprophylaxis was supplemented perioperatively with either a polyclonal (antithymocyte globulin, N = 26) or a monoclonal (OKT3, N = 17) anti-T-cell antibody. Investigated, conceivable risk factors comprised recipient and donor age, ischemic time, perioperative anti-T-cell antibody prophylaxis, recipient preoperative status, underlying disease, previous cardiac operation, and histocompatibility parameter (mismatches for HLA-A, HLA-B, HLA-DR, HLA-B+DR, HLA-A+B+DR, and Rh0[D] antigen, HLA-DRw6 positive recipient, and identify for ABO system). Univariate analysis suggested significant influence of the type of antibody used perioperatively (p = 0.0024) and the number of mismatches for HLA-A+B+DR (p = 0.0037) and for HLA-B+DR (p = 0.0043). Stepwise logistic regression yielded the number of mismatches for HLA-B+DR (p = 0.0029) and the type of antibody used perioperatively (p = 0.0031) as being highly significant predictors of acute cardiac rejection. Six-month freedom from rejection was 100%, 41%, and 27% for recipients with two, three, and four mismatches for HLA-B+DR and 59% versus 22% for recipients with polyclonal versus monoclonal antibody prophylaxis. Similar to results with kidney transplantation, these results indicate that a poor donor/recipient match for combined HLA-B+DR loci constitutes an independent risk factor for acute graft rejection in low-dose triple drug immunosuppressed cardiac recipients, which stimulates the potential concept of prospective HLA matching. In our experience OKT3 prophylaxis provides significantly less effective prevention of acute rejection than a comparable course of antithymocyte globulin.

Acute Disease↗
PubMed1989

[Surgical treatment of ileus in late radiation sequelae of the intestine].

Between 1971 and 1988 74 operations for intestinal complications following radiotherapy were performed on 67 patients at the Second Surgical Department, University of Vienna. The lesions were located in the small bowel (n = 41) and in the sigmoid colon/rectum (n = 33). 98.5% of the patients were females, the most frequent cause for irradiation being ovarian cancer. Bowel stenosis with resultant chronic or acute ileus was the most frequent indication for operation, occurring in 31 cases (76%) of the small bowel lesions and in 15 cases (46%) of the colon lesions. Percutaneous irradiation resulted in a significantly higher proportion of small bowel lesions (77%, p = 0.001), whilst endocavitary irradiation was followed in 67% of cases by colorectal lesions. Different application modality of irradiation also resulted in completely different symptoms for small and large bowel lesions. The operative mortality was 9.5%. Peritonitis following anastomotic leakage was the cause of death in 6 of 7 cases. In the treatment of small bowel ileus mortality following bowel resection (9%, one of 11 cases) was comparable to that of the bypass operation (6%, one of 18 cases). Both operation methods seem to be justified. Single-layer anastomosis resulted in zero mortality (21 cases) for ileus operation compared with 19% mortality (16 cases) in double-layer anastomosis and should be preferred for operations on the irradiated bowel.

Abdominal Neoplasms↗
PubMed1988

Surgical therapy of radiation-induced lesions of the colon and rectum.

Thirty-six operations for late sequelae of radiotherapy were carried out in 31 patients from 1971 to 1986. The most frequent indications for surgery were stricture (58 percent) and fistula (29 percent). In the first 8 year period from 1971 through 1978, 13 of 14 operations were diversions (colostomy or by-pass). From 1979 through 1986, a more aggressive approach prevailed. Only 32 percent of the operations were diversions. This more aggressive strategy was accompanied by a decrease of the postoperative mortality rate from 21 percent through 1978 to 0 in the later period. The overall complication rate was 23 percent. Complications were relatively more frequent after two-layer sutured or stapled anastomoses and after resection or fistula closure without temporary colostomy. We conclude that in radiation-induced colonic and rectal lesions, diversion should be performed in patients with unproved cure of disease or tumor persistence. Resection and fistula closure can be carried out safely, and a temporary colostomy is strongly recommended.

Adult↗
PubMed1987

Surgical therapy of radiation-induced small-bowel lesions. Report of 34 cases with a high share of patients with combined chemotherapy.

Operations on irradiation-injured bowel are rare, bear a high postoperative mortality, and the procedure of choice (resection vs bypass) is still controversial. Thirty-seven operations on small bowel for late effects of irradiation in 16 years were analyzed retrospectively. Fifty-one percent of the operations were performed in the last four years. Ovarian cancer treated by a combination of radiotherapy and chemotherapy was the most frequent underlying disease of 20 patients (58%) followed by carcinoma of the cervix (eight [24%] of the patients). The median latent period between irradiation and surgery was eight months after the combined radiotherapy/chemotherapy, and 12 months after radiotherapy alone. Thirty operations (81%) were done for small-bowel stricture, four for fistula, and three for perforation. Bypass was performed in 17 patients and resection in 16. Complications (fistula, peritonitis, perforation) occurred after 13 operations (35%). All three patients who developed peritonitis died (mortality, 8.1%): two after resection and one after bypass. Suture-associated complications occurred in three (23%) of 13 cases after single-layer and in three (35%) of 17 cases after two-layer anastomoses. Ten patients are still alive two to 76 months (median, 32 months) after operation, six of them free of tumor. All are underweight and suffer from diarrhea (four to 12 stools per day). Pernicious anemia developed in all six patients surviving more than two years.

Adult↗
PubMed1987

[Diagnosis of peritoneovenous shunt occlusion].

Reaccumulation of ascitic fluid after peritoneovenous shunt implantation demands accurate diagnostic procedure. Between 1973 and 1985 81 peritoneovenous shunts have been implanted at the IInd Surgical Department of the University of Vienna. In the same time 34 reoperations in 17 patients have been performed for reasons of shunt-dysfunction. Besides thorax x-ray, diagnosis was established in 11 cases by means of Doppler ultrasound investigation, in 26 cases by technetium scan and in 15 cases by shunt angiography. Shuntography proved to be the method of choice, with no false results. Doppler ultrasound results were unclear in a high percentage, thus this method is not used any more.

Ascites↗
PubMed1987

[Effect of endoscopic hydrothermo- and laser coagulation on the human stomach wall in vivo].

Effect of thermic and laser energy applied onto human in vivo gastric wall has not yet been reported in literature. In our study we evaluated the maximum amount of energy not harming the patient as well as principles for secure and sufficient therapy. In 8 patients hospitalized for gastric resection we applied vaporization by laser- and hydrothermosounds in this part of the stomach which should be resected. Endoscopic pictures were taken. We used a NdYAG laser (maximum performance 70 W, time of application 1-3 s) and hydrothermosounds (maximum performance 170 W, time of application 1-3 s). The stomach was resected 3-8 days following application. Comparing laser- and hydrothermosounds marks we observed a bigger area of necrosis at hydrothermosounds marks using the same amount of energy. In histological investigation correlation between depth and diameter of necrosis was found. After the same application time both depth and diameter of necrosis were bigger by hydrothermosounds than by laser. Lesions reached serosa at the maximum time of application of 3 s. Serosal lesion itself did not appear. Endoscopic treatment of tissue lesion by laser and thermic irradiation (vaporization of bleeding polyp pedicles, treatment of tumors) is secure using the maximum energy mentioned above. Serosal lesion did not appear. Bleeding lesions must be treated by higher energy because of absorption of energy by escaped blood.

Electrocoagulation↗
PubMed1987

[Human atrial natriuretic factor (hANF) in liver cirrhosis].

Mean plasma levels of hANF at admission were significantly higher in liver cirrhosis (LC) patients with ascites (93 +/- 11 ng, n = 20; p less than 0.05) than in LC-patients without ascites (32 +/- 14 ng/l, n = 11) or healthy controls (31 +/- 15 ng/l; range: 5-80 ng/l; n = 106). Diuretic treatment of patients with LC and ascites normalised hANF plasma concentrations (44 +/- 14 ng/l; p less than 0.05). Increase of plasma hANF in LC-patients with ascites after acute volume expansion was lower (relative rise: 159%) than in those without ascites (relative rise: 223%). Volume redistribution into the vascular compartment, induced by peritoneovenous shunt implantation in LC-patients with diuretic treatment-refractory ascites, resulted in a sharp increase of plasma hANF levels (344 +/- 87 ng/l = 420% of preoperative concentration). Normal and slightly increased levels of plasma hANF and the appropriate regulation to volume changes suggest an intact control of the hormone in LC-patients. Neither a lack nor an inappropriate secretion of hANF as a cause for sodium retention as postulated by the overflow theory of ascites accumulation could be found in liver cirrhosis.

Ascites↗
PubMed1987

[Transplantation of gastrointestinal tumors to immunodeficient nude mice as an in vivo model of tumor biology].

Serial transplantation of ten different types of tumours, both primary tumours and their metastases, to 170 nude mice was conducted for biological analysis of human gastro-intestinal carcinomas, with particular reference being made to the aspect of tumour growth. The types transplanted included seven colorectal carcinomas, one oesophageal carcinoma, one gastric lymphoma, and two gastric carcinomas.--Tumour growth was quantitatively monitored by means of a standardised measuring method and was statistically evaluated. The qualitative aspects of tumour growth were micromorphologically investigated. Tumour transplants were allowed to reach a defined size and were then retransplanted within the nude mouse system, with up to six tumour passages being conducted. The investigations were evaluated, with particular reference being made to comparison between primary tumours, on the one hand, and their metastases, on the other.--The average primary tumour take rate amounted to 83 per cent and was generally higher for metastatic tumours. Statistically significant findings were obtained to the effect of growth of metastases which was faster than that of their own primary tumours (p 0.05), where as no qualitative differentiation between primary tumour and metastases was possible on the basis of the micromorphological aspect. Growth of metastases.

Adenocarcinoma↗