Cystic lesions of the pancreas.
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Diagnosis, Differential↗
Biomedical subjects
J Scheele
Publications and source records attributed to J Scheele.
A pilot study on polychlorinated biphenyl levels in the bone marrow of healthy individuals and leukemia patients.
In this pilot study the concentrations of polychlorinated biphenyls (PCBs) was determined by capillary column gas chromatography in bone marrow from 29 adults. The highest concentration in all adult individuals was detected for PCB no. 180 (mean = 0.991) followed by two other highly chlorinated PCBs, no. 153 (mean = 0.918) and no. 138 (mean = 0.927). The less chlorinated PCBs, no. 101 (mean = 0.255), no. 52 (mean = 0.161), and no. 28 (mean = 0.324) contributed to a lesser extent. Additional samples from children (N = 19) were used to assess the dependence of PCB concentrations on patient age (Scheele et al. Eur J Pediatr 1992; 151:802-805). When comparing the data of adult leukemia and lymphoma patients with a reference group of healthy adult individuals, no significant increase in the leukemia patients was found.
Adult↗
Hepatectomy for liver metastases.
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Colonic Neoplasms↗
Small bowel prolapse and incarceration caused by a vaginal ring pessary.
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Aged↗
Use of immunoscintigraphy in the diagnosis of fever of unknown origin.
Fever of unknown origin (FUO) has been defined as an elevation in temperature (38 degrees C) for at least 2-3 weeks despite intensive investigation. The value of immunoscintigraphy with the technetium-99m-labelled anti-granulocyte antibody anti-NCA-95 (BW 250/183, IgG1) was studied retrospectively in 34 consecutive patients with FUO. Every effort was made to confirm a diagnosis, including methods such as ultrasonography, computed tomography, magnetic resonance imaging, bacteriological tests, surgical intervention and clinical follow-up. In 58.8% of the patients, an infectious cause for the fever was found, in 30.2% of the patients, a benign or malignant haematological disease, pancreatitis or thyrotoxicosis was found. No cause for fever could be found in 11%. The overall diagnostic sensitivity and specificity of immunoscintigraphy for infection were 40% and 92% respectively. The positive predictive value was calculated to be 88% and the negative predictive value was calculated to be 52%. False-negative scans were especially noted in patients with endocarditis, pneumonia and small brain abscesses, where the lesions did not exceed a diameter of 0.5 cm. If patients with endocarditis were excluded, the imaging sensitivity and specificity were increased to 57% and 95%. This study demonstrates that 99mTc-anti-NCA-95 scanning is able to localize infectious causes of FUO, other than endocarditis.
Adult↗
A technique for staunching severe bleeding of pulmonary vessels with the Fogarty catheter.
In thoracic surgery, severe bleeding of pulmonary vessels is a threatening and difficult-to-control complication. Clamping is often impossible and, furthermore, dangerous because of potential additional damage. The authors describe a technique that allows for the repair of vessel leaks, even those close to the heart, with a Fogarty catheter.
Arteries↗
Chlorinated hydrocarbons in the bone marrow of children: studies on their association with leukaemia.
Concentrations of chlorinated hydrocarbons and polychlorinated biphenyls (PCB) were determined by capillary column gas chromatography in samples of bone marrow from 38 children with leukaemia (16 samples/pools) and 15 control (5 pools). The highest mean and median concentrations were detected for total PCB (mean = 3.568 mg/kg fat basis/median 2.904 mg/kg) followed by the sum of the dichlorodiphenyltrichloroethane metabolites (1.775/1.059 mg/kg), hexachlorobenzene 0.354/0.260 mg/kg), the sum of the hexachlorocyclohexane isomers (0.133/0.093 mg/kg) and dieldrin (0.109/0.063 mg/kg). The CHC and PCB concentrations in bone marrow were two- to threefold higher than in fat tissue. Comparing children with and without leukaemia similar concentrations of CHC and PCB were found.
Bone Marrow↗
Diagnostic accuracy of 99mTc-anti-CEA immunoscintigraphy in patients with liver metastases from colorectal carcinoma.
17 patients with 43 liver metastases from colorectal carcinoma were studied by immunoscintigraphy (IS) using a 99mTc-labelled monoclonal anti-CEA antibody (BW 431/26). Sensitivity and diagnostic accuracy were 21% for all liver lesions, but 47% considering the number of patients (at least one positive finding out of multiple metastases) and 77% in patients with a single metastasis. SPECT imaging did not improve sensitivity markedly in this series. There was no correlation with CEA serum levels. Liver metastases of intermediate size with moderate tumour necrosis seem to be favourable to IS. Major reason for the low sensitivity is the poor tumour-to-background ratio caused by high unspecific uptake of 99mTc-labelled antibodies in the RES of the liver. At the moment, IS seems be only a supplementary method to conventional diagnostic procedures.
Adenocarcinoma↗
[Laparoscopic cholecystectomy: experiences in Erlangen].
From February 2, 1990 to June 15, 1991, a total of 160 patients were subjected to laparoscopic cholecystectomy. The procedure was successful in 150 patients, while in ten patients the procedure was converted to conventional cholecystectomy for the following reasons: suspected malignancy (2), cystic duct stone (1), dysfunction of equipment (2), adhesions (1), concomitant liver tumor (1), abscess in the hepatoduodenal ligament following endoscopic papillotomy (1), and chronic cholecystitis (2). Four patients developed substantial complications. Two patients developed biliary leakage requiring laparotomy and endoscopy placement of a nasobiliary tube in one case each. The other two patients developed intraabdominal bleeding that forced an emergency laparotomy in one case. With increasing experience in laparoscopic cholecystectomy, we would only consider a preoperative suspicion of malignancy as an absolute contraindication.
Adolescent↗
[Regional chemotherapy of diffuse liver metastases of colorectal cancer].
From 1970 to 1987, a total of 112 patients underwent regional chemotherapy as primary treatment of colorectal liver metastases. 68 patients received 250-750 mg 5-FU 2-3 times per week via external devices, 40 patients with port catheters had 5-day courses of Mitomycin C (8 mg/m2/day 1) and 5-FU (600 mg/m2/day 1-5) at 4 week intervals, and four patients were treated with FUDR (0.2 mg/m2/day 1-14/28) using an Infusaid pump. Median and maximum survival were 13.2 and 58 months, respectively. The overall response rate in patients suitable to imaging criteria who underwent treatment for more than three months and was 83% (CR 14%, PR 40%, SD 29%). The influence of various factors on Kaplan/Meier survival was checked the Logrank test. Response to treatment was of superior importance (p = 0.0000016), but hepatomegaly, Karnofski index, the percentage of liver volume replaced by tumour, and various liver related biochemical tests were also highly significant prognostic determinants (p greater than 0.01). There was no difference between external and fully implantable devices. A subgroup of 68 patients without extrahepatic disease, treatment of more than three months was retrospectively compared to 121 untreated patients with a similar stage of disease. There was no obvious effect of regional chemotherapy on survival (p = 0.16). Although the untreated patients consist a historical control group only, this result indicates that regional chemotherapy must continuously be restricted to well prospective clinical trials.
Adult↗
Indicators of prognosis after hepatic resection for colorectal secondaries.
From 1960 to 1988, 266 patients underwent resection of colorectal secondaries to the liver with curative intent. All patients were followed until April 1, 1990, or death, with a median follow-up time of 52 months. Nine patients with minimal macroscopic residual disease and 38 patients with all gross tumor removed but positive margins showed a poor prognosis with a median survival time of 13.3 months, the longest being 42 months. Of the 219 patients having potentially curative resection, 12 patients died postoperatively (5.5%). Actuarial 5, 10 and 20-year survival for the remaining 207 patients was 39%, 28%, and 18%, respectively. At April 1, 1990, 77 patients were alive with no evidence of disease for up to 24 years, and 12 patients had died without recurrence. The following factors were associated with less favorable crude survival: presence and extent of mesenteric lymph node involvement (p = 0.0003), grade III/IV primary tumor (p = 0.035), synchronous diagnosis of metastases (p = 0.017), satellite metastases (p = 0.0003), limited resection margins (p = 0.019), and nonanatomic procedures (p = 0.013). With respect to disease-free survival, grading of the primary (p = 0.055) and the extent of clear margins (p = 0.019) failed to achieve statistical significance. Two other criteria are commonly recommended as absolute contraindications to hepatic resection: extrahepatic disease and the presence of four or more independent metastases. A radical excision of all detectable disease may rarely be possible in these circumstances. Nevertheless, within the curative settings, no significant predictive value regarding either overall or disease-free survival was found in this series. Three corresponding "high risk" patients are alive without disease at 5 to 11 years from hepatic resection. These patients with more advanced intrahepatic or concomitant limited extrahepatic disease require a particularly thorough diagnostic work up. As no superior therapeutic alternative is currently available, an aggressive surgical approach may occasionally be justified, and may, in a small portion, result in definite tumor control.
Adult↗
Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history.
From 1960 to 1987, 1209 patients with colorectal liver metastases were recorded, and followed until 1 January 1990. In 242 cases the diagnosis was based on external imaging, whereas 967 patients had operative confirmation and staging of their liver disease. Three groups of patients were analysed: group 1 involved 921 cases, of whom 902 were deemed non-resectable whereas 19 could not be unequivocally classified. Only 21 patients lived for longer than 3 years, seven survived for 4 years, but there were no 5-year survivors. Group 2 comprised 62 highly selected patients who at laparotomy demonstrated resectable metastatic spread confined to the liver, but this was not treated mainly because of a formerly different therapeutic approach. These patients had a significantly longer median survival time (14.2 versus 6.9 months), but also failed to achieve 5-year survival. The 226 patients forming group 3 underwent hepatic resection with intent to cure. Nine of them had minimal macroscopic disease left, and 34 with all gross tumour removed had positive margins. Survival of patients with these 43 eventually non-radical resections followed an identical course as in group 2 (median survival 13.3 months, maximum 42 months). Of the 183 patients with potentially curative resection ten died after surgery (5.5 per cent). Actuarial 5 and 10-year survival rates in the remaining 173 patients were 40 and 27 per cent with 25 and seven patients alive at respective periods of time. Until 1 January 1990, 64 patients remained free from recurrent disease for up to 24 years. In three patients the tumour status at death was unclear. The other 106 patients developed definite cancer relapse. Nevertheless they demonstrated a prolongation of survival time by a median of 1 year when compared with the 43 non-radically resected patients or the 62 untreated patients with resectable liver-only metastases, and accomplished a maximum survival time of 8 years. Radical excision of colorectal secondaries to the liver therefore offers effective palliation, and in a small number the chance of a cure.
Actuarial Analysis↗
[Vasculature based segmental resection of the liver].
Complete surgical resection represents the only treatment for malignant tumors of the liver which offers the chance of long-term tumor-free survival. From this oncological perspective the segment orientated approach appears to be a valuable supplement of traditional hepatic surgery. It minimizes incomplete tumour removal, and prevents a waste of non-involved hepatic tissue. This combination of optimum local radicality and maximum parenchyma preservation also reduces operative risk. Various modern diagnostic and surgical aids such as intraoperative ultrasound, liver transection using the ultrasonic aspirator, and control of bleeding by means of infrared coagulation or fibrin tissue adhesive, all do considerably support this individualized surgical approach. However, the practical application is essentially based on the intrahepatic vasculature and the thereby defined segmental anatomy. The sequence of the operative proceeding will be illustrated for different mono- and polysegmentectomies.
Hepatectomy↗
Pulmonary resection for metastatic colon and upper rectum cancer. Is it useful?
The predictive value of the route of venous drainage on prognosis was investigated in a consecutive series of 44 patients who underwent curative resection of pulmonary metastases from colorectal carcinoma. The primary tumor was located in the colon in 14 patients and in the upper third of the rectum in 11 patients, thus indicating blood drainage directed toward the portal vein (Group I). In 10 and 9 cases, respectively, the initial growth was in the middle and lower thirds of the rectum with the venous outflow at least partially directed into the vena cava (Group II). There was no obvious difference between the two groups regarding the initial site of cancer relapse. The liver was involved in 4 of 15 patients failing in Group I as opposed to 4 of 13 patients with hematogenous relapse in Group II. Median survival and tumor-free survival times were significantly longer in patients in Group I (58.4 and 50.2 months) than in patients in Group II (30.9 and 16.8 months), and, even more pronounced, in colon cancer patients (75.4 and 60.2 months) when compared with rectal cancer patients (31.0 and 17.9 months). In contrast, survival curves did not differ significantly if either the two groups with different routes of drainage (5-year survival 53 percent vs. 38 percent, 5-year tumor-free survival 43 percent vs. 37 percent), or tumors of the colon and rectum (5-year survival 67 percent vs. 38 percent, 5-year tumor-free survival 60 percent vs. 32 percent) were compared using the log-rank test. Similar trends were obtained for the subgroup of 34 patients without previous or simultaneous extrapulmonary recurrent disease at the time of lung resection. The primary tumor site does therefore not become a major criterion in selecting patients for surgical resection.
Adult↗
[Surgical interventions in liver metastases].
Surgical treatment of hepatic metastases is predominantly aimed at "curative" resection. This can be achieved in about 20% of colorectal secondaries, and is associated with a 30-40% 5-year survival. One to three metastases in the absence of extrahepatic disease are regarded a clear indication to resection. Among patients with non-colorectal malignancies, occasional long term survival was reported in leiomyosarcoma, breast cancer, and renal cancer metastases, respectively. Endocrine tumors such as carcinoid, gastrinoma, or pheochromocytoma, are different because of their remarkable symptoms along with a protracted natural history. Quality of life may be considerably improved here by even non-radical debulking. The vast majority of patients, however, ist not suitable to undergo hepatic resection. Palliative therapeutic options involve hepatic artery ligation or embolization, cryo-surgery and percutaneous laser coagulation, and various types of regional chemotherapy. These methods may enable a temporary relief of symptoms, but no significant impact on survival time, and no true long term benefit has been proven. Prospective randomized trials against combined treatment as well as untreated patients are required for a more meaningful judgement and improved effectiveness.
Colorectal Neoplasms↗
[Differential after care for early detection of recurrence: from the surgical viewpoint].
Tumor recurrence following "curative" resection (= R0) of gastrointestinal cancer occurs in 30% (colorectal carcinoma) to 70% (ductal pancreatic cancer) of patients. Only colorectal cancer recurrence involves a substantial chance of a reintervention which again may result in complete cancer clearance (local recurrence 17%, metachronous liver metastases 20%, other abdominal intracavitary relapse 12%, pulmonary secondaries 17%). Five-year survival after complete re-resection approaches 40% irrespectively of the site of recurrent disease. Recognition of resectable recurrence in asymptomatic patients is based on ultrasound, endoscopy, and chest X-ray. Laboratory investigations alone, and even CEA-screening, do not suffice.
Adult↗
[The use of collagen fleece (Tachocomb) in pancreatic surgery].
Collagenic fleece (Tachocomb) was applied to for hemostasis in areas of pancreatectomy and in the retroperitoneum after resection on the left side in 30 patients with necrotising pancreatitis, carcinoma of the pancreas head, and chronic pancreatitis. Diffuse hemorrhages in the pancreatic bed could be stopped by means of collagenic fleece despite disturbance of coagulation without additional surgical measures for controlling hemorrhage. The application of collagenic fleece was not necessary after resection, because of chronic pancreatitis.
Blood Loss, Surgical↗
Tumor implantation from needle biopsy of hepatic metastases.
Two patients with resectable secondaries in the liver developed needle track recurrence following intraoperative "Trucut"-needle biopsy and percutaneous thin needle aspiration cytology, respectively. In both cases the nature of the hepatic lesion was already clear before biopsy, from characteristic ultrasound, CT-scan, and a progressive rise in CEA levels. Although the overall risk is presumably low, biopsy must not become a diagnostic imperative. It may compromise definitive surgery in individual patients, and should therefore be restricted to situations in which results have a therapeutic or scientific impact.
Aged↗