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Biomedical subjects

J Sturm

Publications and source records attributed to J Sturm.

At least 37 records · Page 2Linked to original sources
PubMed2000

Sphincter-saving treatment in epidermoid anal cancer: cooperative analysis of 142 patients in five German university surgical centers.

Five southern German university centers cooperated in comparing the effect of surgical vs. nonsurgical therapy strategies on survival and sphincter preservation in the treatment of anal cancer. A standardized questionnaire was used to evaluate retrospectively (mean follow-up 30 months) treatment strategy and outcome (survival, colostomy rate, colostomy-free survival) in patients treated between 1987 and 1996. Of the 142 patients 65% had squamous cell, 20% basaloid, 6% adeno-, and 1% undifferentiated carcinoma (8% histology not recorded); 9% were classified in UICC stage I, 37% in stage II, 25% in stage III, and 4% in stage IV (25% not recorded). Primary treatment consisted of local excision (10%), excision plus radio- and/or chemotherapy (17%), radiotherapy (20%), radiochemotherapy (28%), or colostomy with or without resection, radiotherapy, and chemotherapy (23%). We observed no difference between these treatment groups in overall (P = 0.43) or colostomy-free survival (P = 0.14, log-rank). Primary colostomy was prevented in 77% of cases and decreased over the years. Mean overall survival (in months) was 42 in stage I, 38 in stage II, and 25 in stage III (P = 0.0013); mean colostomy-free survival was 36 in stage I, 26 in stage II, and 16 in stage III (P = 0.0021, log-rank). Outcome was not significantly related to therapeutic strategy (surgery or radio-chemotherapy. Primary surgical and nonsurgical strategies in treating anal cancer thus produced similar results, although radiochemotherapy is usually recommended for sphincter-endangering anal cancer. Challenges to be met in the future include the prevention of metastasis and long-term preservation of anal sphincter function.

Adenocarcinoma↗
PubMed2000

Tracking down duodenopancreatic malignancy.

BACKGROUND: Malignant tumours of the duodenum are rare and often difficult to diagnose. Due to the small clinical experience with duodenal malignancies their prognosis is unknown and resection is the treatment of choice. CASE REPORT: Adding to a small series of incidental tumours, we report the case of a 65-year-old patient with primary extranodal (MALT-) lymphoma of the duodenum infiltrating the pancreatic head. The patient was admitted because of anaemia and epigastric discomfort with a history of Helicobacter-pylori associated gastric ulceration. Physical examination and bloodchemical values were otherwise normal. Endoscopy revealed duodenal ulceration but the biopsies taken from the ulceration did not give any evidence of malignancy or residual Helicobacter pylori infection. But MRT showed a circular intramural tumour of the duodenum. On laparotomy a large duodenal tumour adherent to the pancreatic head was found and a Whipple procedure was performed. CONCLUSION: Apart from describing the case of a rare lymphoproliferative disorder of the duodenum, this report illustrates the diagnostic difficulties with uncommon neoplasm's of the duodenopancreatic region and the value of MRT prior to resection of a duodenopancreatic mass.

Aged↗
PubMed1999

MRI with superparamagnetic iron oxide: efficacy in the detection and characterization of focal hepatic lesions.

The purpose of this study was to evaluate the potential of superparamagnetic iron oxide particles (SPIO) as tissue specific contrast agent in magnetic resonance (MR) imaging in detection and characterization of focal hepatic lesions. We investigated 45 patients with focal hepatic lesions. T1-weighted SE (TR 650/TE 15 ms) and T2-weighted SE (TR 2015-2030/TE 45 and 90 ms) unenhanced images were obtained. After SPIO application we performed T1-weighted images with and T2-weighted images with and without fat suppression using the same image parameters. Liver signal intensity decreased by 74% (min 47%, max 83%) on T2-weighted images after application of the contrast agent. Benign lesions (FNH, adenoma) showed an average signal drop of 40% (min 20%, max 47%) whereas malignant lesions showed no significant change of signal intensity on post-contrast images. The mean tumor-to-liver contrast-to-noise ratio (C/N) was improved in all post-contrast sequences irrespective of the lesion type. An additional increase of tumor-to-liver contrast by use of fat suppression technique could be established in the slightly T2-weighted sequence (TE 45 ms). In metastases, divided in different size groups, we could determine a significant size relation of tumor-to-liver C/N. After SPIO application the number of detected lesions increased distinctly, especially small foci are more easily demonstrated. SPIO particles are a efficacious contrast agent for MR examinations of the liver. For tumor characterization T1- and T2-weighted pre- and post-contrast images are necessary. The T1-weighted sequences are helpful to differentiate benign lesions such as cysts and hemangiomas from malignant lesions. Detection and differential diagnoses of hepatic lesions are improved by use of the SPIO-particles.

Adult↗
PubMed1999

[Multiple trauma and the management structure].

The implementation of Quality Management Procedures is necessary in evaluating the treatment of multiple trauma-patients. The development of standards in structures of the trauma management system is the first step to insure quality (appraisal of structure). But the amount of investment in the trauma system structure is limited by 1. The resources available, 2. The efficacy of the applied resources, i.e. the principle of diminishing returns of investment. Centralization of care in Level I Trauma Centers is not realistic in every situation. Transport time can be too long and exceed the critical "golden hour". Review of current data indicates that in approximately 50% of the time, helicopter transport is not possible due to weather, geography, or other limiting factors. This leads to a fragmented transport system, often necessitating extensive transport times, resulting in less than optimal patient outcomes. In order to optimize quality, the following needs to be done: Assessment of process: 1. Realistic algorithms or protocols for primary transport must be developed. 2. Agreements must be reached between designated regional hospitals. 3. Treatment algorithms or protocols which address the different care levels, must be developed by a committee of clinical experts. 4. Quality management procedures must be implemented to monitor the quality of care delivered. Assessments of outcomes: 1. Outcome data must be reviewed on an ongoing basis to determine if changes must be made in the system design or the transportation & clinical algorithms/protocols. 2. Such outcome data should be gathered by means of a Trauma Registry.

Air Ambulances↗
PubMed1998

Migration of single-stranded DNA in polyacrylamide gels during electrophoresis.

By using fluorescence recovery after photobleaching (FRAP) and electric birefringence, the migration of single-stranded DNA in polyacrylamide gels and orientation as a response to an electric pulse were investigated. Electrophoretic mobility is in good agreement with the model of biased reptation including fluctuations. The determination of the electrophoretic mobility in solution, mu0, allows an estimation of the gel pore diameter seen by the molecule. As previously observed for double-stranded DNA, the electric birefringence results from two processes: the alignment of the molecule along the electric field and the elongation of the primitive path in the gel, for long single-stranded DNA (>2000 bases). The combination of results obtained with the two techniques allows us to propose experimental conditions to improve the separation of single-stranded DNA with pulsed field techniques.

Acrylic Resins↗
PubMed1998

[Ultrafast contrast-enhanced 3D MR angiography in the preoperative diagnosis of liver tumors].

PURPOSE: To evaluate the accuracy of 3D-MRA in preoperative staging in correlation to intraoperative and histological results. METHODS: In 30 patients with focal liver lesions axial and coronal MR sequences (T1w-Flash 2D, T2w-TSE unenhanced. T1w-Flash 2D, TRUE FISP contrast-enhanced) as well as coronal breath-hold MRA were performed. The technical parameters of the MRA were as follows; TR/TE 5/2 ms, flip angle 40 degrees, 32-40 partitions with an effective slice thickness of 2-3 mm, acquisition time 26 s, matrix 128 x 256, FOV 320 x 320 to 400 x 400. RESULTS: In 23/30 patients liver resection was performed. Correct prediction of segmental localization was achieved in preoperative MRI of 22 patients (98%). The presumed histology was correct in 20/23 cases (87%). The evaluation of the hepatic vascular structures was correctly predicted in all cases. By use of multiplanar reconstructions and single image view of the 3D data base of MRA, additional information could be obtained in 13 patients. CONCLUSIONS: Breath-hold 3D-MRA gives certain information on localization and relation of vascular structures to focal hepatic lesions. In presentation of portal venous structures MRA is superior to conventional angiography.

Adult↗
PubMed1998

[Magnetic resonance tomography in diagnosis of vascular infiltration in malignant pancreas tumors].

This study was undertaken to evaluate the accuracy of magnetic resonance angiography (MRA) in assessing venous or arterial infiltration in pancreatic cancer. In 90 patients MRA showed a sensitivity of 81.1%, a specificity of 90.2% and an accuracy of 85.9% in predicting venous infiltration and a sensitivity of 81.8%, a specificity of 90.7% and an accuracy of 88.1% in predicting arterial infiltration. From these data we conclude that MRA is an accurate method for detecting vascular infiltration in pancreatic cancer.

Arteries↗
PubMed1998

[Adjuvant radiochemotherapy with 5-FU and folinic acid in Dukes stage B and C rectum carcinoma: an interim analysis].

In a prospective multi-institutional German adjuvant trial patients with curatively resected rectal cancer (Dukes B or C) were randomly assigned to receive postoperative radiotherapy (50.4 Gy) and either 12 or 6 cycles of 5-fluorouracil and medium-dose folinic acid. Our preliminary results of the interim analysis, based on 206 patients, indicate that this adjuvant therapy is well tolerated by the patients and a prolonged chemotherapy over 12 months has no advantage over 6 months of chemotherapy. The relatively high rate of tumor recurrence (30.7%) after a median follow-up of 29.3 months in this trial emphasizes the need for dose intensification planned for a further trial.

Adult↗
PubMed1997

Trocar incision and closure: daily problems in laparoscopic procedures--a new technical aspect.

A mini-laparotomy as described by Hasson was used in a modified way in 1,500 laparoscopic procedures. In comparison with the insertion of a Veress needle, we find the open approach to be a safer and quicker technique to obtain the pneumoperitoneum. A new technique for closure of the trocar incision is described. The technique is recommended due to its easy and safe approach requiring no additional special equipment.

Humans↗
PubMed1997

[Ultra-rapid magnetic resonance tomography: a quantum leap in preoperative hepatobiliary diagnosis?].

The recent improvements in magnetic resonance (MR) imaging using the new ultrafast echo-planar technique for diagnosis of hepatobiliary lesions are outstanding. Besides the detection and preoperative evaluation of benign and malignant hepatobiliary tumors, angiography and cholangiography can be simultaneously performed using the techniques of MR angiography or MR cholangiography. Looking ahead, further advantages such as three-dimensional image reconstruction, no X-ray exposure, and short examination time, this MR technique will become the preferred diagnostic procedure for evaluating hepatobiliary lesions.

Bile Duct Neoplasms↗
PubMed1996

Dynamics of single-stranded DNA in polyacrylamide gels during pulsed field gel electrophoresis. A birefringence study.

The study of the orientation of single-stranded DNA in polyacrylamide gels in denaturing conditions has been undertaken by electric birefringence in order to determine the mechanism involved in the electrophoretic transport. The presence of an overshoot in the birefringence signal, when applying the electric field, and the study of the influences of the electric field and of the gel concentration on the dynamics show that a mechanism of reptation with elongation of the molecule occurs in polyacrylamide gels with low T values. Therefore it is suggested that the use of pulsed fields in sequencing electrophoresis is possible and can lead to a large increase of the length of the fragments that can be sequenced in one single run.

Journal Article↗
PubMed1996

Electric birefringence of polytetrafluoroethylene particles in agarose gels.

Electric birefringence studies of strongly elongated, rod-like particles of polytetrafluoroethylene (PTFE) in agarose gels show that the negative effect observed by semi-diluted aqueous suspensions at low frequencies and at low electric field strengths (the so called "anomaly') disappears. The absolute value of the low frequency effect increases 3-4 times and the amplitude of modulation decreases faster compared to that of the suspensions. This together with decreased decay relaxation times in gels make the possibilty that the PTFE particles orientation in gels is not due to dipolar but to electrophoretic orientation mechanism quite probable. Similar change in the orientation mechanism could be expected also for suspensions of higher concentrations. The further elucidation of the orientation mechanism using fractions with lower polydispersity, broader ranges of experimental conditions (particle concentration, ionic strength and composition, electric field strengths, frequencies, etc.) could be interest for several fields: colloid electro-optics and especially that of concentrated colloids, pulsed field gel electrophoresis of DNA (and especially its sinusoidal biased field variant) and of nucleoprotein complexes and for the gel research.

Journal Article↗
PubMed1996

Dynamics of DNA molecules in agarose gel under sinusoidal electric fields.

The dynamics of DNA molecules in agarose gel has been studied by measuring the birefringence in sine wave electric fields. It was found that the birefringence is the sum of a direct current (dc) component and several harmonics of the field frequency. A detailed study of these components was performed. It was found that the dynamics of DNA molecules under these conditions can be explained by a W conformation which is not detected under dc electric fields. The variation of the field frequency gives several relaxation modes in the birefringence signal, reflecting the known dynamic behavior of DNA molecules found in the reputation with elongation of the tube length regime.

Animals↗
PubMed1996

Cystic endometriosis of the upper abdominal organs. Report on three cases and review of the literature.

A 34-year-old woman with signs and symptoms of an acute abdomen was found to have a hepatic cyst on NMR- and CT-scan. With the tentative diagnosis of a liver hematoma, a right hemihepatectomy was performed. Histologically, an endometrial cyst of the liver was found. A second case of cystic endometriosis in the liver was revealed ultrasonographically in a 62-year-old woman, complaining of rightsided epigastrical pain. A 28-year-old woman was admitted to the hospital because of recurrent epigastric pain. A cystic tumor of the pancreas could be visualized ultrasonographically and was interpreted as a postinflammatory pseudocyst. Histological examination of the distal pancreatectomy specimen revealed cystic endometriosis. The clinicopathological features of hepatic and pancreatic endometriosis are discussed and the literature concerning these extremely rare lesions is reviewed.

Adult↗
PubMed1996

[Comparative study of the quality of life after stomach resection].

In the present study, 195 patients, following total gastrectomy (n = 105) or subtotal gastric resection (n = 90) for carcinoma without evidence of recurrence, were examined with regard to their quality of life using the Gastrointestinal Quality-of-Life Index (GLQI). After subtotal gastric resection patients achieved statistically significant better scores concerning disease-therapy-related symptoms and physical functions, resulting in a better overall score (p < 0.02). However, it seems to be questionable whether these statistically significant differences are of clinical relevance in the patient's daily life. Preservation of the gastric stump with the aim of improving postoperative quality of life should never be allowed to compromise oncological radicality.

Disease-Free Survival↗