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J Zieren

Publications and source records attributed to J Zieren.

At least 37 records · Page 2Linked to original sources
PubMed1999

Does dietary alpha-linolenic acid promote liver metastases in pancreatic carcinoma initiated by BOP in Syrian hamster?

BACKGROUND: alpha-Linolenic acid (ALA) has been shown to have a promoting effect on pancreatic carcinogenesis. The purpose of this study was to evaluate the influence of ALA on liver metastases in a model of BOP-induced pancreatic ductular carcinoma in the Syrian golden hamster. METHODS: While the control group (group V) received a standard diet low in fat (soya oil, 3 w/v) without ALA, groups I-IV were fed a diet high in fat (soya oil 25 w/v) with increasing percentages of ALA (2.5, 5, 7.5 and 10%) for 16 weeks. RESULTS: No significant differences in mean body weight and pancreas weight were found between the groups. But significant differences (p = 0.0001) were observed in the mean weight of the resected liver. Treatment with BOP alone resulted in the induction of well-differentiated ductal pancreatic adenocarcinoma in 91%, while all groups treated with different amounts of ALA had induction of 100%. The incidence of liver metastases differed significantly between the groups. The incidence of liver metastases in group I (2.5% ALA) was 18%, in group II (5% ALA) 27%, in group III (7.5% ALA) 50%, and in group IV (10% ALA) 91%. Moreover, the diameter of liver metastases increased significantly according to ALA supplementation (p = 0.001). CONCLUSION: The results indicate that dietary ALA increases liver metastases in BOP-initiated pancreatic cancer.

Animals↗
PubMed1998

Is tissue oxygen tension during esophagectomy a predictor of esophagogastric anastomotic healing?

PURPOSE: The genesis of anastomotic leakage and late stenosis of esophagogastrostomy is still unknown, although minimal blood flow and tissue hypoxia of the gastric tube are discussed as main reasons. However, the changes in tissue oxygen tension (PtO2) on esophagogastric anastomoses have not yet been evaluated in the perioperative course. METHODS: Submucosal tissue oxygen tension (PtO2) was measured in 33 patients with cervical esophagogastrostomy during resection of esophageal carcinoma and reconstruction by a gastric tube. Measurements were taken close to the projected resection line and latter anastomosis using a Clark-type oxygen electrode. RESULTS: Mean baseline PtO2 was 55.1 +/- 10.4 mmHg. Following the ligature of the vasa gastricae brevis and the left gastroepiploic artery (46.1 +/- 9.7 mmHg), the left gastric artery (34.8 +/- 9.8 mmHg), and the pull up of the gastric tube, PtO2 decreased to 25.8 +/- 9.4 mmHg. Anastomotic leakage occurred in 6 patients and late stenosis in 10 patients. During the operation there was no significant evidence of decreased PtO2 levels in these two groups. Postoperative PtO2 levels showed a significant increase in patients with anastomotic leakage. CONCLUSION: A disorder in oxygen consumption may cause a significant increase of PtO2 in anastomotic tissue, which is associated with anastomotic leakage.

Adult↗
PubMed1998

[Adjustable "banding" of the hepatic artery in treatment of shunt-induced heart failure in Osler-Rendu-Weber disease].

Hepatic involvement in hereditary hemorrhagic telangiectasia (HHT) is rare. Among local pathologic alterations like fibrosis and cirrhosis, arteriovenous shunts lead to hypercirculatory heart failure and require efficient therapy. Present therapeutic strategies consist of percutaneous selective embolization or complete ligation of the hepatic artery. We describe a 53-year-old woman with HHT in whom percutaneous selective embolization of the left hepatic artery failed because of unfavorable anatomy. Instead of ligation a new method of adjustable banding of the hepatic artery was tested. After small-incision laparotomy an expander prosthesis was put on the proper hepatic artery. By filling the prosthesis via the implanted port system the hepatic perfusion could be reduced under control. This method led to effective reduction of the liver perfusion and heart time volume and to successful treatment of heart failure. The method described is an alternative treatment to ligation of the hepatic artery in cases in which percutaneous embolization failed or is not possible.

Angiography↗
PubMed1998

Prospective randomized study comparing laparoscopic and open tension-free inguinal hernia repair with Shouldice's operation.

BACKGROUND: Although tension-free techniques of hernia repair using synthetic meshes revealed encouraging results, the best method of inguinal hernia repair is still unclear. METHODS: In a prospective randomized phase-II-B study, early postoperative results of laparoscopic transabdominal preperitoneal repair (n = 80), open plug and patch repair (n = 80), and Shouldice's operation (n = 80) were compared. Postoperative pain and patient's comfort were defined as main endpoints. RESULTS: The laparoscopic approach had significantly longer operation time and was more expensive (61 +/- 12 minutes; $1,211) than plug and patch repair (36 +/- 14 minutes; $124) and Shouldice's operation (47 +/- 17 minutes; $69). Main postoperative complications were wound hematomas, seromas, and superficial wound infection, without significant difference between the groups. Postoperative pain, analgesia requirements, limitation of daily activities, and return to work did not differ between laparoscopic and open tension-free repair but were significantly lower in both groups compared with Shouldice's operation. So far, no recurrence was observed after a mean follow-up of 25 months. CONCLUSION: Open plug and patch repair is a promising technique of hernia repair in adults, because it offers the same excellent patient comfort as the laparoscopic repair but is less expensive and can be performed under local anesthesia.

Adult↗
PubMed1998

Intravascular disruption of central venous ports.

Intravasal catheter disruption is a rare complication of central venous ports. Main causes are chronic trauma due to compression of the catheter between clavicle and first rib, or primary damage by sharp instruments during insertion. Utilizing the subclavian route, a more lateral insertion can minimize the risk of catheter compression. Regular postoperative X-ray controls can help to recognize progressive catheter compression. In the case of significant compression, early replacement is advisable to avoid disruption. Percutaneous transvenous snare technique is the therapy of choice to retrieve dislocated fragments.

Aged↗
PubMed1998

Quality of life after surgical treatment of gastric carcinoma.

OBJECTIVE: To see if there was a correlation between self-assessment and external evaluation of quality of life (QL) after resection of gastric carcinoma, a correlation between overall QL and different components, and the impact of social and medical factors on QL. DESIGN: Prospective study. SETTING: University hospital, Germany. SUBJECTS: 71 patients assessed once 12 months after R0-resection of gastric carcinoma and 35 patients assessed regularly, starting postoperatively. INTERVENTIONS: QL was assessed by the patients using the European Organisation for Research and Treatment of Cancer (EORTC) core QL questionnaire (QLQ-C36) and by a psychologist using the Spitzer Index. MAIN OUTCOME MEASURES: Correlations between self-assessment and external assessment, between overall scores and single items of QL, and between social and medical factors and QL, as well as changes in QL-scores during postoperative follow-up. RESULTS: Self-assessment and external evaluation of global QL showed a significant but not particularly close correlation (r = 0.40) and QL was evaluated as better by the external observer using the Spitzer Index. All physical, emotional, and social components of the QLQ-C36 correlated significantly with patients overall evaluation of QL. Postoperative QL was affected mainly by somatic complaints and physical limitations. Of several factors analysed, tumour recurrence was the decisive factor in deciding patients' QL. Compared with the preoperative assessment, QL had deteriorated on discharge from hospital but was restored during the following six months in patients who remained disease-free. CONCLUSION: Compared with the Spitzer Index the QLQ-C36 differentiates the QL of patients with gastric cancer better and disease-specific complaints are included.

Adult↗
PubMed1997

[The plug and patch repair for managing the inguinal hernia of the adult].

The basic principles of the Plug and Patch Repair of inguinal hernia are positioning of a prolene plug behind the internal ring in combination with a prolene onlay patch on the fascia transversalis. From July 1994 until December 1996 243 inguinal hernias were operated in this technique in a consecutive series of 221 patients. There were 211 primary and 32 recurrent hernias. 187 operations were performed in local anesthesia and 34 patients wished general anesthesia. No intraoperative complications were noted. The average operation time was 36 +/- 14 minutes. Postoperative complications were 8 subcutaneous hematomas and 1 superficial wound infection, which healed spontaneously. The average stay in hospital was 2 +/- 2 days and the patients returned to work after 17 +/- 11 days. Patients' self assessment of postoperative pain and limitations of daily activities revealed an excellent comfort. The follow-up rate is 97% and no late complications were observed after a median follow-up time of 21 months. The Plug and Patch technique is a very promising procedure for inguinal hernia repair in adults.

Activities of Daily Living↗
PubMed1996

Quality of life following resection of oesophageal carcinoma.

Quality of life following resection of oesophageal carcinoma was assessed by patients using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and by a psychologist using the Spitzer Index. Quality of life was evaluated in 119 patients on one occasion 12 months after operation and in 30 patients regularly, starting with a preoperative assessment. Self and external evaluation showed a significant correlation (r = 0.61), but quality of life was assessed as being higher by the external observer. Limited physical performance status and somatic complaints were the most important postoperative dysfunctions, whereas emotional, social and economic disorders were found to be less frequent and less severe. Of several factors analysed only tumour recurrence (P < 0.01) and anastomotic stricture (P < 0.05) lowered quality of life significantly. Compared with the preoperative assessment, quality of life had decreased on discharge from hospital but was restored within 6 months of operation in disease-free patients. Further studies are required to determine the impact of adjuvant therapy for quality of life in patients undergoing surgery for oesophageal cancer.

Activities of Daily Living↗
PubMed1996

[Laparoscopic or conventional repair of inguinal hernia with synthetic mesh?].

Laparoscopic inguinal hernia repair by means of the transabdominal preperitoneal technique (TAPP) was compared with open plug-and-patch-repair (PP) in a prospective study. From September 1992 until July 1994, 86 patients were operated using the TAPP technique; after introduction of PP in August 1994, 105 patients were operated using this technique. From August 1994 until April 1995, 24 more patients wanted the laparoscopic procedure. The two groups were comparable with regard to age, sex and the distribution of hernia types. Eighty-eight (84%) of the PP patients were operated under local anesthesia, while the others chose general anesthesia. The only intraoperative complication was a bleeding from the epigastric vessel in the laparoscopic group. Postoperative complications were three wound hematomas after TAPP (2.2%) and two wound hematomas and one superficial wound infection after PP (2.4%). All complications healed spontaneously. No detectable statistical difference was noted between the two groups with respect to postoperative pain, the consumption of analgetics, duration of hospitalization and reconvalescence. After a median follow-up of 34 months, two recurrences after TAPP (1.4%) and no recurrences after PP has been detected. Based on our experience we prefer PP for inguinal hernia repair in adults because it affords the same patient comfort as TAPP but is less expensive and can be performed under local anesthesia.

Adolescent↗
PubMed1996

[Assessment of quality of life after resection of colorectal carcinoma].

Quality of life (QL) following resection of carcinoma of the colon (n = 68) and rectum (n = 58) was studied in 126 patients 12 months postoperatively and in 34 patients at regularly intervals, starting with a preoperative assessment. QL was assessed by the patients themselves using the EORTC QL questionnaire (QLQ-30) and by a psychologist using the Spitzer index. Between self-assessment and evaluation by the independent observer, a significant but not very strong correlation (r = 0.48) was determined and QL was evaluated as being better by the observer. Although somatic and emotional problems were significantly more common in patients with rectal cancer following abdominoperineal resection and the Spitzer index was significantly lower in these patients, the subjectively perceived global QL did not differ from that after sphincter-preserving resection. Of several factors analysed, tumour recurrence was the decisive factor determining postoperative QL. In disease-free patients QL had deteriorated on discharge from hospital but was restored within 3-6 months postoperatively.

Activities of Daily Living↗
PubMed1995

[Surgical therapy of leiomyosarcoma of the inferior vena cava].

Leiomyosarcoma of the inferior vena cava is a rare tumor. Radical surgical resection is the treatment of choice. Depending on the localization of the tumor surgical therapy includes the local resection of the vena cava with primary closure and the segmental resection of the cava with prosthetic reconstruction. On the basis of four cases the symptomatology, diagnostic procedures, surgical therapy and the results of treatment of leiomyosarcoma of the inferior vena cava are discussed.

Aged↗
PubMed1995

Diagnosis, treatment and prognosis of the leiomyosarcoma of the inferior vena cava. Three cases and summary of published reports.

OBJECTIVE: To describe our experience with three cases of leiomyosarcoma of the inferior vena cava, and summarise current methods of diagnosis and treatment. DESIGN: Descriptive study. SETTING: University hospital, Germany. SUBJECTS: 3 Patients with histologically confirmed leiomyosarcoma of the inferior vena cava. INTERVENTIONS: Resection, with or without vascular reconstruction. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: Case 1 was diagnosed on magnetic resonance imaging, the tumour was resected, and the vena cava replaced with a polytetrafluoroethylene (PTFE) graft. She made an uncomplicated recovery and was well and free of symptoms 10 months later. Case 2 was diagnosed at operation (the differential diagnosis on computed tomography was a retroperitoneal tumour), the tumour was resected, and the defect oversewn. She made an uneventful recovery and was well and free of symptoms 14 months later. Case 3 was diagnosed at operation (a diagnosis of pancreatic cancer had been made preoperatively), the tumour was resected, and the defect oversewn. She was well and free of symptoms 10 months after operation. CONCLUSIONS: Magnetic resonance imaging is superior to computed tomography in the diagnosis of leiomyosarcoma of the inferior vena cava. The treatment of choice is resection; small defects can be closed by suture or PTFE patch, and large defects by PTFE prostheses. Reported resectability is 40% to 60%, but the prognosis is poor; the local recurrence rate is about 36%, most patients are dead within 2.5 years, and the 5-year survival is 30%. Chemotherapy and radiotherapy will give some degree of palliation, but do not affect the outcome.

Aged↗
PubMed1994

[Liver resections for primary liver malignancies. Personal results and analysis of the literature].

In a retrospective study we analysed 50 resections for primary liver tumors performed between 1 July 1979 and 31 December 1991 at the Department of Surgery of the University of Cologne. The mean resectability rate was 28%. Hospital mortality after resection was 22% and could be reduced to 4% during the last 4 years. The overall survival rates after 1, 3 and 5 years were 55%, 30% and 24% respectively. The surgical radicality is the most important prognostic factor. In a review of the literature the results of 8,725 resections for primary liver malignancies published between 1980 and 1992 were analyzed. The mean resectability rate was 32 +/- 17%. The hospital mortality after resection could be reduced from 15 +/- 5% (resections before 1970) to 6 +/- 2% (resections after 1980). The overall survival rates after 1, 3 and 5 years were 66 +/- 17%, 39 +/- 15% and 27 +/- 10%, respectively. Apart from a lower hospital mortality in Asian studies (4% vs. 7%) the resection rates and long-term results of Asian, American and European studies were similar. Long-term prognosis predominantly depended on the surgical radicality and on the size and extension of the tumor at the point of resection. The effectivity of an adjuvant tumor therapy is not analyzed sufficiently.

Carcinoma, Hepatocellular↗
PubMed1994

[Traumatic pseudoaneurysm of the axillary artery after shoulder dislocation].

By means of a case report the diagnostic and therapeutic procedures and prognosis of a pseudo-aneurysm of the axillary artery after shoulder dislocation are demonstrated. The diagnosis of aneurysms of the axillary artery is difficult in some cases. It is important to mention a possible vascular injury in case of close reduction of the shoulder. Therefore in all patients with a penetrating or blunt trauma of the shoulder or the upper arm a thorough neurovascular examination is required. In patients with neurologic deficits or alteration of the pulse a duplex ultrasound examination should be performed and in dubious cases an additional arteriography is indicated.

Aged↗
PubMed1994

Minimal invasive surgery in the local treatment of rectal cancer.

At the Surgical Department of the University of Cologne, a system has been developed for transanal endoscopic surgery, which allows all the conventional surgical techniques within the rectal cavity. The clinical and long-term results regarding local excision of broad based adenomas and small (< 4 cm) carcinomas of the rectum were the subject of the study. The main indication was the removal of sessile adenomas. Early rectal carcinomas with favourable histological grading (Grade 1 and 2) and staging (Mason I and II) were also suitable for endorectal therapeutical approach. Infiltrative cancers can be removed endoscopically in one session, but the authors performed local excisions of these cancers only in cases where the patient was unwilling to undergo extensive surgery or due to medical reasons. Nevertheless several Dukes B carcinomas were removed locally. Most of the histological findings of the subsequent radical operations (rectum resection, rectum extirpation) revealed that the carcinoma had already been totally removed. During the period July 1983 to December 1992, the techniques have been employed on 313 patients in 348 cases. Early postoperative complications consisted of intraperitoneal perforations (five cases); rectovaginal fistulae (four cases); haemorrhages (four cases), death due to cardiopulmonary failure (two cases). All the complications occurred within the first three years of the learning phase. The recurrence rate of adenomas amounted to 5%. The technique allows accurate endoscopic microsurgical excision of giant adenomas and early cancers with minimal morbidity and excellent presentation of specimens for complete histological analysis. Open invasive surgery can thus be avoided.

Adenoma↗
PubMed1994

[Laparoscopic therapy of nonparasitic liver cysts].

Minimal invasive surgery has become an important part of surgical therapy of non-parasitic cysts of the liver. At the moment there exist only a few but in all cases positive experiences with the laparoscopic unroofing of liver cysts. Until now we treated 3 patients with non-parasitic liver cysts by means of this method. In all cases we had no intra- or postoperative complications and the average hospital stay was 5 days. In agreement with other authors we think that laparoscopic unroofing of non-parasitic liver cysts is a method with promising future. The necessity of an intraoperative cholangiography in case of a bile leak respectively recurrence prophylaxis by means of an omentum major plastic will be decided by further clinical investigation.

Biliary Fistula↗
PubMed1994

[Leiomyosarcoma of the vena cava inferior--a rare retroperitoneal tumor].

The leiomyosarcoma of the inferior vena cava is a rare retroperitoneal tumor. In this article two more cases are reported and its clinical and diagnostic features including ultrasound, computed tomography and magnetic resonance tomography are described. Prevalence, localisation, complications, therapy and differential diagnosis are discussed based on the own cases and the current literature.

Aged↗