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Biomedical subjects

J Scheele

Publications and source records attributed to J Scheele.

At least 19 recordsLinked to original sources
PubMed2000

Endosonographic examination of gastrointestinal anastomoses with suspected locoregional tumor recurrence.

BACKGROUND: Endoscopic ultrasound is considered one of the best tools for the preoperative staging of esophageal, gastric, and rectal carcinoma. Depending on the individual investigator, the sensitivity of preoperative tumor staging by endosonography of the upper gastrointestinal tract (GEUS) is 80-92% for gastric carcinoma and 86-95% for esophageal carcinoma. However, the sensitivity and specificity of endosonography for the staging of lymph node metastases is less accurate. The accuracy of rectal endosonography (REUS) is approximately 90% for tumor assessment and approximately 80% for the detection of lymph node metastases. In this study, we address the question of whether endosonography enables the surgeon to distinguish scar tissue, which is rather homogeneous and echo-rich, from changes such as an anastomositis or a locoregional tumor recurrence, which are typically non-inhomogeneous and echo-poor. METHODS: During a 24-months period, we studied patients enrolled in a special tumor follow-up care program by either upper gastrointestinal (GEUS, n = 37 patients) or rectal endosonography (REUS, n = 49 patients) for exclusion of a locoregional tumor recurrence. In each patient, local tumor recurrence was suspected because of either medical history, clinical examination, or other diagnostic procedures. RESULTS: As in previous studies, our retrospective analysis revealed that endosonography has a high sensitivity in the detection of local tumor recurrences (>90%) for both GEUS and REUS. CONCLUSION: Endosonography is a highly accurate means of detecting local tumor recurrence.

Aged↗
PubMed1999

Preconditioning of donor livers with prostaglandin I2 before retrieval decreases hepatocellular ischemia-reperfusion injury.

BACKGROUND: Prostaglandins have been shown to protect against a variety of liver insults, including ischemia-reperfusion injury. Decreased graft injury and improved survival have been demonstrated in animal studies of liver transplantation after donor pretreatment with prostaglandin before organ retrieval. This potential clinical application has not been examined in human subjects. PATIENTS AND METHODS: One hundred and six liver donors were randomly assigned to receive either prostaglandin I2 (epoprostenol, 500 microg intravenous bolus) immediately before cold perfusion or no drug as control. Donor and recipient characteristics were recorded, and liver function tests were monitored after transplant to assess the effect of epoprostenol on graft injury. RESULTS: Donor pretreatment with epoprostenol significantly improved the rapidity and homogeneity of graft reperfusion. Epoprostenol pretreatment also significantly reduced peak values of transaminases after transplantation: serum glutamic-pyruvic transaminase, control (851+/-121 international units [IU]/L) and epoprostenol (463+/-78 IU/L); serum glutamic-oxalaacetic transaminase, control (870+/-127 IU/L) and epoprostenol (463+/-78 IU/L); serum glutamate dehydrogenase, control (458+/-95 IU/L) and epoprostenol (170+/-30 IU/L); P<0.01 for all, by t test. Serum levels of bilirubin and alkaline phospatase were not significantly altered by donor pretreatment with epoprostenol. CONCLUSIONS: Reduction of ischemia-reperfusion injury by administration of epoprostenol before graft retrieval may have important applications in liver transplantation. Further studies are required to establish the mechanism of this effect and to define its precise role in clinical practice.

Adolescent↗
PubMed1999

Advantages of endoscopic therapy of gastrojejunal dissociation in critical care patients.

OBJECTIVE: To evaluate the advantages of a new three-lumen tube (Trelumina) and a percutaneous endoscopic gastrostomy (EntriStar) with a jejunal insertion tube (PEGJ) as a safe method of early enteral nutrition and simultaneous gastric decompression as well as fast reduction of the high gastric reflux in critical care patients. DESIGN: Retrospective, descriptive case series. SETTING: Two anaesthesiological and one surgical intensive care unit (ICU) in a university hospital. PATIENTS: Sixty-five consecutive critically ill patients with gastrojejunal dissociation. The mean Acute Physiology and Chronic Health Evaluation Score (APACHE II) was 19. INTERVENTIONS: Placement of 46 Trelumina and 19 PEGJ under endoscopic control. MEASUREMENTS AND MAIN RESULTS: None of the known percutaneous endoscopic gastrostomy (PEG) complications like wound infection, bleeding or organ perforation were seen. One secondary dislocation of the jejunal insertion tube and four dislocations of the jejunal part of the Trelumina were found. The average gastric reflux of the Trelumina and the PEGJ amounted to 1700 +/- 230 ml/day. Forty-three patients showed a clear decrease in the gastric reflux to 450 +/- 200 ml/day within the first 24 h of tube placement. The average time of reduction to normal gastric reflux volumes (0-200 ml/day) amounted to 4 -/+ 2 days. Forty-three (71 %) of the patients showed improved intestinal passage as expressed by regular peristalsis and defaecation. The price for 1 day enteral feeding via Trelumina or PEGJ was 10 times lower than 1 day total parenteral nutrition. CONCLUSIONS: Placement of the Trelumina and the PEGJ is a safe, successful and inexpensive means of early enteral nutrition and simultaneous gastric reflux reduction in critical care patients.

Adolescent↗
PubMed1999

Prospective randomised trial on adjuvant hepatic-artery infusion chemotherapy after R0 resection of colorectal liver metastases.

BACKGROUND AND AIMS: The liver represents the predominant site of cancer relapse after curative resection of hepatic metastases from colorectal carcinoma. Adjuvant intra-arterial chemotherapy was therefore considered a promising therapeutic approach in high-risk patients. PATIENTS/METHODS: From July 1984 to December 1985, a total of 42 consecutive patients underwent R0 resection of colorectal liver metastases. Thirty patients with mesenteric lymph-node metastases (Dukes C) were randomised into two groups. In 14 group-A patients, a hepatic artery port catheter was placed during liver resection. Four courses of adjuvant chemotherapy were administered at 4-week intervals, consisting of mitomycin C (8 mg/m2, day 1) and 5-fluorouracil (800 mg/m2, days 1-5). Sixteen group-B patients served as controls. The 12 patients with no mesenteric lymph-node metastases (Dukes A/B) were included in the follow-up program. RESULTS: After 5 years, 64% of Dukes A/B patients and 29% of Dukes C patients were alive (P<0.01). The probability of remaining free of recurrent disease after 5 years and 10 years was 55% and 18%, respectively (P<0.01). No significant difference in either 5-year survival (25% vs 31%) or long-term disease-free status (15% vs 23%) was detected between groups A and B. The initial tumour relapse was shifted towards extrahepatic sites in group-A patients, but no difference was obtained regarding the definite distribution of recurrent disease. CONCLUSION: Routine application of adjuvant regional chemotherapy after R0 liver resection is not warranted.

Adult↗
PubMed1999

Resection of colorectal liver metastases.

INTRODUCTION: Surgical resection is presently the only approach that offers patients with liver metastases from colorectal carcinoma substantial chance of cure. This article summarizes the current literature as well as the author's personal experience. BACKGROUND AND DISCUSSION: Since 1980, 5-year survival figures have ranged from 21% in collected series to 48% in single-institution series. The 30-day mortality of elective liver resection in non-cirrhotic patients ranges now between 0% and 5%. The overwhelming indicator of prognosis is the completeness of tumor removal according to the R-classification. The specific impact of all other factors should therefore be analyzed by excluding non-radical procedures and operative mortality. Among patient characteristics, age and gender do not significantly affect outcome, while the Karnofski stage is important. Regarding the primary tumor, the effect of staging and location is predominantly apparent in patients with synchronous metastases. Timing of metastasis detection is of some importance, as most authors found a slightly better outcome for metachronously detected metastases. With respect to the liver involvement, multiplicity of metastases and bilateral disease both seem to be of minor importance after R0-resection, while satellite lesions are significant in many series. The actual number of metastases is of minor effect, with a slight superiority in 5-year survival for patients with one to three nodules relative to patients with four nodules or more in most series, but identical results in the author's own experience. The maximum diameter as an indicator of tumor burden represents a significant prognosticator in half of the reports analyzed. Extrahepatic disease reduces 5-year survival, but direct tumor invasion to adjacent structures, local recurrent disease, or one or few pulmonary metastases are no contraindication to liver resection as long as a R0-situation can be achieved. In contrast, lymph-node metastases at the liver hilum predict a poor outcome. They are likely to prove as a clear contraindication. With respect to the operative approach, a clear margin of 1 cm or more should be aimed at but, if the size or location of metastases do not allow a 1-cm margin, resection should still be performed, making every surgical effort to ensure a complete rim of unaffected tissue. Anatomic resections reduce the incidence of non-radical procedures and may improve survival. Whether there is an independent effect of operative blood loss, need for blood transfusion, and intraoperative hypotension on prognosis is still unclear. Adjuvant chemotherapy or radiotherapy after R0-resection is unlikely to improve results. There are also no convincing data available demonstrating a prognostic benefit when a non-curative resection is supplemented by any medical treatment. In patients with recurrent disease, a re-resection is possible in roughly 20%. Survival from the time of re-intervention ranges from 21% to 57% after 5 years and, thus, justifies a close follow-up policy after R0-resection of the initial liver metastases. CONCLUSION: The previous "clear" contraindications to liver resection have become less important. Future efforts may be directed to more accurate patient selection and new approaches of neoadjuvant and adjuvant therapeutic strategies.

Colorectal Neoplasms↗
PubMed1999

Impact of immunoadsorption on xenogeneic extracorporeal pig liver perfusion: assessment of organ function during autologous reperfusion.

The shortage of liver grafts has resulted in an intensive search for alternative strategies of liver support in acute liver failure. Extracorporeal perfusion of pig livers (ECLP) is not a new concept, but recent improvements in cardiopulmonary bypass technology and new knowledge about xenogeneic immunologic mechanisms have made it a potential therapeutic modality. In previous suboptimal experimental and clinical models, no statements about the beneficial effect of long-lasting periods of ECLP were made. The aim of this study was to evaluate the capacity of pig liver for metabolic regeneration after xenogeneic ECLP under largely physiologic conditions. To delay hyperacute rejection (HAR), we utilized immunoadsorption (IA) of naturally preformed xenogeneic antibodies (XNAbs). This led to a stable xenogeneic ECLP for 45 min. However, IA was not able to prevent completely organ damage or loss of function resulting from insufficient autologous reperfusion. The inability to regenerate during autologous reperfusion provides a new measure of the function of a xenogeneic perfused pig liver. In addition, our results implicate that patients with fulminant liver failure will benefit from short perfusions with several fresh organs rather than from long perfusion with a single pig liver.

Animals↗
PubMed1999

Treatment of colorectal liver metastases.

BACKGROUND: Surgical resection is the only potentially curative treatment for colorectal liver metastases, with 5-year survival rates approaching 40 per cent. However, at present only 20-25 per cent of such lesions are deemed resectable. This review examines developments in neoadjuvant and adjuvant treatments of colorectal liver metastases that aim to improve the results of surgical management of this disease. METHODS: A literature review was undertaken based on a Medline search from 1970 to May 1998. RESULTS: Further evolution in surgical technique is unlikely to lead to a dramatic increase in the resectability rate of colorectal liver metastases. Recent developments in neoadjuvant and adjuvant chemotherapy schedules, together with a range of interventional radiological procedures and interstitial lytic techniques, show promise in terms of extending the limits of resectability and decreasing recurrence rates associated with these lesions. Using multimodality regimens 5-year survival rates of 40 per cent are now being reported for lesions that were initially considered irresectable. CONCLUSION: Patients with colorectal liver metastases should be assessed in units that can offer all the specialist techniques necessary to deliver optimum care. Incorporation of newer neoadjuvant and adjuvant treatments into management strategies should occur in the setting of randomized trials.

Antineoplastic Agents↗
PubMed1998

A phase II study of weekly high-dose 5-fluorouracil and leucovorin plus biweekly alternating doxorubicin and cisplatin for advanced gastric carcinoma.

On the basis of recent clinical data suggesting that high-dose continuous 5-fluorouracil (5-FU) is able to overcome resistance to 5-FU bolus application in gastric carcinoma, a phase II study was performed to evaluate the activity and toxicity of weekly high-dose 5-FU and leucovorin plus biweekly alternating doxorubicin and cisplatin as the first-line treatment in patients with advanced gastric carcinoma. Between October 1995 and September 1997, 24 consecutive patients with locally advanced (n=4) or metastatic (n=20) gastric carcinomas were treated with a combination of 500 mg/m2 leucovorin as a 2-h infusion, followed by 2.0 g/m2 5-FU as a 24-h continuous infusion once weekly for 6 weeks, plus 20 mg/m2 doxorubicin as a bolus application and 50 mg/m2 cisplatin as a 1-h infusion, week 1, 3 and 5 (FLAP regimen). Response, toxicity and survival data were evaluated. A total of 20 patients were evaluable for response and 24 for toxicity. Objective responses were observed in 11 patients (55%) with no complete remission. Four patients (20%) showed stabilization and 5 patients (25%) experienced progressive disease. The median time to disease progression was 8 months and the overall duration of survival was 14 months. Myelosuppression was significant. In 2 patients, grade 4 WHO thrombocytopenia and leukopenia/anaemia respectively were registered, but there were no treatment-related deaths. We conclude that the weekly alternating FLAP regimen is effective in advanced gastric carcinoma with tolerable toxicity. However, significant myelotoxicity and frequent hospitalization suggest that FLAP should not be preferred to other regimens used in metastatic disease. Currently we intend to establish this regimen in the neoadjuvant setting in patients with primary unresectable localized gastric carcinomas.

Adult↗
PubMed1998

Characterization of functional thrombin receptors in human pancreatic tumor cells (MIA PACA-2).

In this article, the "tethered ligand" thrombin receptor was identified on human pancreatic tumor cells, MIA PaCa-2, using immunofluorescence studies with a monoclonal anti-thrombin receptor antibody. Pharmacological characterization, using 3H-labeled thrombin receptor activating peptide-6 (TRAP-6) as radioligand, demonstrated a single class of high-affinity binding sites (KD = 9.1+/-1.8 x 10(-7) M) and a binding capacity of 13.9+/-0.7 fmol/mg protein. These binding sites represent functional thrombin receptors, as shown by alpha-thrombin- and TRAP-6-induced mobilization of free intracellular calcium, protein kinase C translocation from cytosol to the cell membrane, and stimulation of DNA synthesis in MIA PaCa-2 cells. These results provide the first identification of tethered ligand thrombin receptor in human pancreatic cancer cells and suggest thrombin receptor involvement in mechanisms of human pancreatic tumor progression.

Calcium↗
PubMed1998

[Fiber optic measurements with the Bilitec probe for quantifying bile reflux after aboral stomach resection].

Nonphysiological alkaline reflux after partial gastrectomy may produce a range of gastrointestinal disorders. The Bilitec probe is a fibroptic sensor that, for the first time, makes in vivo measurement of this reflux possible, by assay of spectrophotometric absorption of bilirubin. We studied 20 patients who had undergone partial gastrectomy for benign peptic ulcer disease. Ten patients had Billroth II reconstruction and ten had Roux-en-Y reconstruction. In the Roux-en-Y Group we found almost complete control of symptoms and no objective evidence of alkaline reflux as measured by the Bilitec probe. In the Billroth II group we detected by the fiberoptic sensor significant bile reflux into the stomach remnant. Based on these results we recommend Roux-en-Y gastrojejunostomy as the method of choice for reconstruction after distal gastric resection.

Adult↗
PubMed1998

[Laparoscopic cholecystectomy as routine intervention in acute cholecystitis].

The laparoscopic cholecystectomy has become the gold standard in the therapy of gall bladder stones in the last few years. The most contraindications of the first period of the laparoscopic era had been eliminated by the development of laparoscopic technique and growing experience. Since September 1995 the laparoscopic cholecystectomy has been established as routine procedure also for acute cholecystitis. From September 1995 to Dezember 1996 177 laparoscopic cholecystectomies were performed, 132 for symptomatic cholecystolithiasis and 45 for acute cholecystitis. Postoperative complications occurred in 8.3% in the elective group and in 8.8% in the acute cholecystitis group. There was no death in both groups. Patients left the hospital on day 3 (range 2-21) in the elective group, on day 4 (1-13) in the acute colecystitis group. There are no statistically significant differences. According to our results acute cholecystitis does not increase postoperative morbidity and mortality after laparoscopic cholecystectomy and has to be a contraindication for this method no longer.

Acute Disease↗
PubMed1998

[Value and sensitivity of abdominal ultrasound in preoperative histologic diagnosis before laparoscopic cholecystectomy].

In a retrospective study we compared the findings of our abdominal ultra-sound diagnostic of the gallbladder and the common bile duct with the results ot preoperative ERCP, intraoperative findings and the histological results. The test parameters were the size of the gallbladder, the number and the size of biliary calculi, the thickness and the constitution of the wall of the gallbladder and the consecutive grade of inflammation, the wideness of the common bile duct and the suspicion of a choledocholithiasis, respectively. In acute cholecystitis we performed laparoscopic cholecystectomy within 24 hours, in symtomatic cholecystolithiasis without cholecystitis an elective laparoscopic cholecystectomy. If there was suspicion of a choledocholithiasis we performed a preoperative ERCP. Altogether we had correct findings of the common bile duct in our ultrasound diagnostic in 133 of 136 cases (97.8%), only in 3 of 136 cases (2.2%) we had false negative ultrasound findings. With a generous indication to ERCP caused by anamnestic and/or laboratory findings the obstruction of the bile duct could be diagnosted and eliminated in 2 of these 3 cases preoperatively. In all cases of bile duct dilatation (7 mm and more) we found an obstruction of the common bile duct. Our results demonstrate that abdominal ultrasound is a high-efficiency method in the preoperative diagnostic of gallbladder and common bile duct stones.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1998

[Diagnosis and therapy of biliary complications after laparoscopic cholecystectomy by ERCP].

Biliary tract injury, although uncommon, is the most feared complication of laparoscopic cholecystectomy. Early identification or exclusion of such injury is essential for successful management. Over a two year period (1995-1996) twenty-one from a total of 413 ERCPs in this Surgical Endoscopy Unit were performed because of suspected biliary injury after laparoscopic cholecystectomy. 16 patients were referred from other units. No abnormality was demonstrated in two cases. A clip-related stenosis requiring reoperation was shown in twei patients. The remaining 17 cases had biliary leakage, related to an aberrant bile duct in 2 cases or a cystic duct leak in 15, all of which were treated endoscopically by nasobiliary tube (7), endoscopic papillotomy (5) or a combination of both (5). All of these biliary leaks healed uneventfully no ERCP-associated morbidity.

Biliary Fistula↗
PubMed1998

The middle colic vein: an alternative source of portal inflow in orthotopic liver transplantation complicated by portal vein thrombosis.

BACKGROUND: Portal vein thrombosis (PVT) was previously considered a contraindication to orthotopic liver transplantation (OLT) since adequate portal blood supply is mandatory for graft function and patient survival. Improvements in surgical technique, however, have meant that this problem now can be circumvented in most instances. Nevertheless portal vein thrombosis remains an obstacle in OLT and is associated with increased incidence of primary non-function and long-term liver failure. METHODS: A 55-yr-old patient underwent OLT for secondary biliary cirrhosis associated with hepatitis C infection and complicated by long standing PVT. Involvement of the portal, mesenteric, and splenic veins prevented standard portal venous reconstruction. Portal inflow was accomplished by a side-to-end anastomosis between the middle colic vein and the donor portal vein. RESULTS: Hepatic reperfusion and subsequent liver function were excellent. Portal blood flow, as measured by color-enhanced Doppler ultrasound, was normal following surgery until discharge. The post-operative course was complicated by abdominal wound dehiscence and recurrent cytomegalovirus (CMV) infection. The patient was discharged in good clinical condition, with excellent liver function and patent portal vein 89 d after OLT. CONCLUSIONS: The middle colic vein is a novel, not previously described, source of portal venous inflow for OLT complicated by extensive splanchnic venous inflow thrombosis.

Anastomosis, Surgical↗
PubMed1998

[Endoscopic therapy of gastrojejunal dissociation in intensive care medicine].

The object of this study was to evaluate the advantages of a new three-lumen tube (Trelumina) and a percutanous endoscopic gastrostomy (EntriStar) with a jejunal insertion tube (EntriStar) as a safe way to administer early enteral nutrition and simultaneous gastric decompression and fast reduction of high gastric reflux in critical care patients. Normalization of high gastric reflux and the patient nutrition goal were reached by Trelumina and the EntriStar within 4 days, and enteral feeding by those two systems depressed the nutrition costs by more than 90% compared to total parenteral nutrition. In conclusion, the placement of the Trelumina and the EntriStar is a safe, successful, and inexpensive means of providing early enteral nutrition and simultaneous gastric reflux reduction in critical care patients.

Critical Care↗
PubMed1997

Conversion of recurrent delta-positive hepatitis B infection to seronegativity with famciclovir after liver transplantation.

BACKGROUND: Recurrent hepatitis B infection after liver transplantation is associated with poor graft and patient survival. Famciclovir is a nucleoside with virostatic action in hepatitis B infection. We report the case of a 51-year-old patient who developed recurrent delta-positive hepatitis B infection after liver transplantation. After famciclovir treatment, he became seronegative for hepatitis B early and hepatitis B surface antigens and developed protective anti-hepatitis B surface antibody titers. METHODS: After recurrent hepatitis B was confirmed, treatment with famciclovir was initiated. RESULTS: Eighteen days after starting famciclovir, the patient became seronegative for hepatitis B early antigen and delta antigen, and hepatitis B virus DNA was no longer detectable in serum. Three months later, the patient became hepatitis B surface antigen negative and remains well 16 months later with increasing anti-hepatitis B surface levels. CONCLUSIONS: Antiviral treatment with famciclovir may be useful in treatment of delta-positive hepatitis B infection following liver transplantation. Further evaluation of famciclovir in treatment and prevention of hepatitis B in these patients is warranted.

2-Aminopurine↗
PubMed1997

[Selection criteria for conservative therapy of splenic trauma in adults].

The safety and effectiveness of nonoperative management of selected adults have been confirmed in those patients who meet selection criterias of isolated splenic injury and hemodynamic stability. The CT scan is a very precise and the most specific diagnostic procedure in splenic trauma. Nonoperative treatment is successful in 80% of adults in such selected group of patients.

Adolescent↗