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Biomedical subjects

J Schirren

Publications and source records attributed to J Schirren.

31 records · Page 2Linked to original sources
PubMed1994

[Surgery for bronchial carcinoma with mediastinal lymph node involvement].

Or the 3000 patients analyzed in the prospective bronchial carcinoma field study, 1086 were operated between 1984 and 1989. Complete systematic mediastinal lymphadenectomy was performed in 661 patients to assess the PTNM stage as exactly as possible, and to improve prognosis. Lymphadenectomy removes all hylarand mediastinal lymph nodes. Although the operation is technically quite easy on the clearly structured right side, it is more difficult on the left side due to the aortic arch and its branches. The lymph nodes of the upper mediastinum of the left and right side can be completely dissected by mobilizing the aortic arch with the left subclavian artery. In contrast to what is frequently assumed, the histological findings indicate that there is no general pattern of metastatic spread in the lymph nodes. The metastases can leave out varying numbers of lymph nodes craniad as well as caudad. For this reason, the lymph nodes have to be completely resected to ensure a real R0-resection.

Female↗
PubMed1994

[Surgical therapy of lung metastases. An interdisciplinary responsibility].

Surgical therapy of lung metastases is now an established procedure. The operation's purpose is radical, and therefore potentially curative, resection. There are also diagnostic and palliative indications. Median sternotomy is the standard approach as it allows revision of both lungs, which is important even when disease seems to be unilateral. Preoperative staging does not give a reliable idea of the number and extent of metastases. From 1972 to 1991, a total of 843 operations for lung metastases were carried out in 729 patients in the surgical department of the Thorax Clinic in Heidelberg (Rohrbach). The 30-day mortality was 2.9%, and the overall 5-year survival from the date of resection of the metastases was 33%. The best results were achieved in testicular cancer, with a 5-year-survival rate of 67%, and the poorest were observed in melanomas, with only 12% 3-year survival. In addition to the primary tumour, and in some cases depending on it, several other prognostic factors were relevant: radicality, sarcoma vs. carcinoma (carcinoma involved a better prognosis), disease-free interval, type of resection, thoracic lymph node involvement. Multivariate analysis showed that the prognostic influence of the factors varies considerably with the kind of primary tumour. Surgical treatment of lung metastases is part of an interdisciplinary oncological therapeutic concept offering prolongation of survival to most of the patients concerned and even the possibility of cure to some. Even if prolongation of survival is not feasible, an improved quality of life and therefore good palliation are obtained.

Adolescent↗
PubMed1994

[Are video-assisted thoracoscopic resections in oncological surgery defensible?].

Video-assisted thoracoscopic surgery (VATS) is not to be accepted in oncologic patients at present. Up till now, the technical facilities are not as advanced as to compete with the established procedures of conventional surgery. The thoracoscopic, more indirect surgical methods are not able to adequately adjust to the specific growth pattern and paths of metastatic spread of bronchial carcinoma. Surgery for pulmonary metastasis has to be considered under the same aspects. Preoperative staging of lung cancer and the location and number of pulmonary metastases cannot be sufficiently assessed by computed tomography. Consequently, palpation of both the inflated and deflated lung is mandatory. Oncologic surgery includes complete lymph node dissection in all compartments, which cannot be achieved by VATS at present. It is irresponsible to risk the internationally quite homogenous stage-related results obtained in bronchial carcinoma for the sake of some new technical equipment. In surgery for lung metastasis, curative treatment demands to completely remove all lesions and the corresponding lymph nodes. This management alone promises benefit for the patient. VATS is established in 1) removal of coin lesions (change to open surgery in case of malignancy; 2) diagnostic resection in metastasis surgery. Results after VATS have to be assessed for quality control in VATS in the same way as it is done for open surgery.

Carcinoma, Bronchogenic↗
PubMed1994

Surgery for pulmonary metastases. The Heidelberg experience.

The surgical treatment of pulmonary metastases is now an established technique in the interdisciplinary concept of oncologic therapy. The authors' finding of a 5-year actuarial survival rate of 33% corresponds with the international standard. Unfortunately, data are only rarely provided as to whether the operations were curative or noncurative. The 5-year actuarial survival rate in 76% of the patients with potentially curative macroscopically radical operations was 38% for all organ tumors. For the time being, a series of prognostic factors should be considered in establishing the indication for surgery, and this should help to reduce the risk of undertreatment or overtreatment.

Adult↗
PubMed1992

Does ND-YAG laser extend the indications for resection of pulmonary metastases?

Surgery forms part of a combined oncological concept in the management of pulmonary metastases. The following questions are relevant for its role: Does survival depend on the type of primary tumor? Are there any prognostic factors? What are the limits on radical resection? We analyzed retrospectively 657 patients who had undergone 759 resections of pulmonary metastases between 1973 and 1990. After conducting in vitro and in vivo experiments with the non-contact neodymium aluminum garnet (Nd-YAG) laser with a generating and delivery power of 10-120 W at the site of operation for 0.1-9.9 s, we have treated 65 patients by laser resection and/or vaporization since January 1990. Our preferred surgical approach was median or transverse thoracotomy. The 5-year survival of all resected patients was 30%, ranging from 21% (soft tissue sarcoma) to 60% (testicular carcinoma). Statistically significant differences in prognosis were seen related to the type of primary tumor, the disease-free interval, the caval or portal type of metastatic spread, the number of metastases and the potential degree of radical resection. The potential degree of conventional radical resections (wedge, anatomical sub-/segmental) was negatively influenced by the number of metastases (n > 9: 79% "radical" surgery = 38% 5-year survival). Laser treatment allowed parenchyma-preserving resection in cases of metastases of more than 0.5 cm in diameter, and vaporization in smaller ones. Resection with the intention of achieving complete remission was possible in up to 72 unilateral metastases. The complication rate was comparable to conventional resections.

Female↗
PubMed1992

Results in surgery of pulmonary metastases.

Nowadays surgical treatment of pulmonary metastases is a generally accepted therapeutic concept. Between 1973 and 1991 surgical resection was indicated in 655 patients, and 752 thoracotomies were carried out including 65 laser resections. Median sternotomy has become the preferred access, as the preoperative staging is not exact enough concerning the number of the metastases. This access offers the possibility to examine both lungs during the operation. In 521 operations, wedge resections were carried out, in 199 operations, a lobectomy was necessary. Overall 30-day mortality amounted to 2.8%. The probability to survive 1 year amounted to 71%, to survive 3 years to 42% and to survive 5 years to 31%. Irrespective of the primary tumour, the radicality of the operation is a statistically prognostic factor. Carcinomas showed better prognosis than sarcomas. The isolated examination of the different groups of primary tumors (mammary carcinomas, testicular carcinomas, hypernephromas, melanomas, colorectal carcinomas, osteosarcomas and soft tissue sarcomas) revealed a different influence of various prognostic factors, e.g. the number of metastases and the disease-free interval. Surgery of pulmonary metastases is part of an interdisciplinary concept of oncological therapy, which offers a prolongation of life to most patients and cure to some. If a prolongation of life cannot be achieved, an improvement of life quality can be obtained by surgical treatment.

Adolescent↗
PubMed1992

[Extended resection in tumor surgery of the lung].

Out of 3823 prospectively followed patients with bronchial carcinoma, 1404 were operated upon. After radical resection, prognoses for 5-year survival in T3 and T4 tumors was 22% and 10%, respectively. Resection was carried out in 190 T3 tumors and 202 T4 tumors. Indications are based on existing or imminent complications in advanced locoregional tumor growth. Surgery must be decided on as palliative treatment in a high number of cases. This kind of surgical tumor management requires sophisticated techniques.

Carcinoma, Bronchogenic↗
PubMed1991

Diagnostic and therapeutic strategy in malignant pleural mesothelioma.

We retrospectively analysed 301 patients with diffuse malignant pleural mesothelioma (235 male, 66 female; median age 59 years). Prognosis depended significantly on patient age, evidence of pain, loss of weight, tumour cell type, stage, local and distant metastasis, involvement of peritoneum and surgical treatment. The overall median survival rate was 238 days, after extended pleuropneumonectomy 284 days, and after decortication 315 days - significantly better than the prognosis in patients without surgical treatment or exploratory thoracotomy. Pleuropneumonectomy should only be considered in young patients with an epithelial cell-type tumour (possibly with adjuvant chemotherapy). Decortication seems nowadays to be the treatment of choice.

Adult↗
PubMed1990

[Technique and results of surgery for lung metastasis].

Surgical treatment of pulmonary metastases is part of an interdisciplinary strategy in oncological therapy. Between 1973 and 1989, 620 thoracotomies were performed in 549 patients. The most profitable access was the median sternotomy. Thirty-day mortality was 2.7%, 5-year survival was 30% for all patients. If the resection was classified as potentially curative, 5-year survival was 35%. Patients with pulmonary metastases of testicular tumors (5-year-survival rate 70%) had the best prognosis. Prognostic factors must take the primary tumor into consideration.

Follow-Up Studies↗
PubMed1990

[Acute acalculous cholecystitis. A stress-induced complication].

The acute acalculous cholecystitis is a stress induced complication following surgery and trauma. A totally different disease is a large atonic gallbladder during parenteral nutrition. The symptoms of the acalculous cholecystitis are similar to acute cholecystitis in patients with cholelithiasis. The diagnosis can be very difficult, because in the postoperative period patients are usually very sick, treated with analgetic and antibiotic drugs and therefore the symptoms are mostly lacking or equivocal. Typical signs are fever and leucocytosis. An ultrasound scan should be performed at the intensive care unit. Although the disease is rare according to the literature, in future it may be diagnosed more frequently because of extended surgical intensive care, higher age of patients, modern methods of surgery and early ultrasound scans in equivocal cases. Having the possibility of postoperative and posttraumatic acute acalculous cholecystitis in mind, surgeons may be able to make the right diagnosis earlier than the pathologist.

Acute Disease↗
PubMed1981

[Transparent adhesive tape as postoperative dressing. Randomized, clinical study for comparison with a conventional dressing technic].

To evaluate the effect of a thin, transparent, adhesive and elastic polyurethane drape permeable only to gas and water vapor molecules but not to bacteria in comparison to a conventional drape for postoperative dressings, a randomized trial was conducted in 90 male and female patients. 44 patients had the transparent adhesive drape and 46 a conventional dressing. Both groups were reasonably well matched according to age, sex, height, weight and type of operation. There was no difference in healing of skin wounds. But reddening around the stitches was seen more often in patients with the conventional dressing than in those with the polyurethane drape (p less than 0.05). Surprisingly, most of the patients with the transparent drape (42 of 44) accepted it. The transparent adhesive drape was found to be much less expensive than the conventional dressing.

Adult↗
PubMedDate not supplied

Cathepsin B, plasminogenactivator-inhibitor (PAI-1) and plasminogenactivator-receptor (uPAR) are prognostic factors for patients with non-small cell lung cancer.

To evaluate the possible role of cysteine proteases and serine proteases, as well as their respective inhibitors and receptors, as new prognostic factors in NSCLC, we examined, for the first time, 10 biological parameters related to three proteolytic systems within a homogeneous collective of 147 cases of NSCLC. Activities (cath B(AT), cath B(A7.5)) and protein levels of cath B(C), cath L(C), uPA, PAI-1, uPAR [measured by three different assays uPAR (ADI), uPAR (HD13), uPAR (IIIF10)] and TF were measured in homogenates of lung tumour tissue and corresponding non-malignant lung parenchyma. Total cath B activity (cath B(AT)) and enzymatic activity of the fraction of cath B, which is stable and active at pH 7.5 (cath B(A7.5)), were determined by a fluorogenic assay using synthetic substrate Z-Arg-Arg-AMC. The concentrations of cath B(C), cath L(C), uPA, PAI-1, uPAR and TF were determined by ELISAs. uPAR was determined using three different ELISA formats. The median levels of cath B(AT) (5.1-fold), cath B(A7.5) (2.5-fold), cath B(C), (8.5-fold), cath L(C) (6.6-fold), uPA (6.5-fold), PAI-1 (4.2-fold), uPAR (ADI) (2.2-fold), uPAR (HD13) (4.0-fold) and uPAR (IIIF10) (2.6-fold) were higher in tumour tissue compared to the lung parenchyma. Cath B(AT), cath B(A7.5) and cath B(C) in primary tumours correlated with lymph node metastases. Regarding histologies, the concentration of PAI-1 seems to be associated with the histological cell types of NSCLC. We found the highest values of PAI-1 in large cell carcinoma > SCC, AC > carcinoid and lowest values in metastases of primary tumours of other organs. Only PAI-1 was significantly increased in poorly-differentiated cells (G3) compared to well- and moderately- differentiated cells (G1/G2). PAI-1 significantly correlated with cath B(AT) and cath B(A7.5) with uPAR (ADI), uPAR (HD13), uPAR (IIIF10) with uPA, and only weakly with TF, but not with cath B(C) and cath L(C). Significant correlations with overall survival in the total population of NSCLC patients were observed in univariate analysis for cath B(AT), cath B(C), PAI-1, uPAR (ADI), uPAR (HD13), and uPAR (IIIF10). Cath L(C) was not significantly associated with poor prognosis. Regarding the histological tumour type, only in patients with squamous cell carcinomas did cath B(A7.5) and PAI-1 remain significant prognostic factors. In multivariate survival analysis only two proteolytic factors, PAI-1 and uPAR (III101F), stayed significant. In conclusion, among 10 biological parameters evaluated within the same cohort of patients, only PAI-1, uPAR (ADI), uPAR (HD13), uPAR (IIIF10), cath B(AT) and cath B(C) are prognostic factors for overall survival of NSCLC patients. Moreover, PAI-1 and uPAR (IIIF10) add independent prognostic information with regard to established clinical and histomorphological factors in NSCLC.

Adolescent↗