Dieulafoy lesion in a congenital double pylorus.
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Aged↗
Biomedical subjects
K Glaser
Publications and source records attributed to K Glaser.
Survival after surgical treatment of recurrent carcinoma of the rectum.
BACKGROUND: From January 1983 to January 1991, radical surgical treatment for carcinoma of the rectum was performed upon 154 patients in our department. In 30 instances, local treatment failure occurred and patients were treated either conservatively or operatively. Survival times of these 30 patients were compared to evaluate if operation, even in instances in which only palliative resection is possible, can prolong survival and if early diagnosis of recurrence leads to a higher rate of radical resections and subsequent cure. STUDY DESIGN: Patients were divided into three groups. Group 1 consisted of patients not undergoing an operation, patients in group 2 had a palliative resection and patients in group 3 had radical resections. The median survival time was estimated for each group. RESULTS: The median survival period was six months for group 1, 17 months for group 2, and 35.5 months for group 3. Four patients who underwent reoperation for cure are still alive: one with recurrent tumor after 28 months, and three without evidence of disease after 32, 42 and 43 months. The most valuable diagnostic mean in the detection of local recurrence was endosonography. CONCLUSIONS: Surgical treatment for recurrent carcinoma of the rectum is justified not only in cases having radical resection but also as a palliative approach. Compared to other investigative methods, endosonography seems to detect recurrences earlier, at a time when curative retreatment is still possible.
Adult↗
Traumatic bilhemia.
BACKGROUND: Retrospective analysis was done of three cases with severe liver trauma and excessive serum bilirubin levels caused by a traumatic biliovenous fistula. The literature is reviewed. METHODS: Diagnostic measures included laboratory findings, computed tomography, ultrasonography, and endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: The biliovenous fistula was detected by ERCP in two cases. In one case a left hemihepatectomy was carried out, and the patient was cured. The other patient received drainage of a huge necrotic cavity in the center of the liver. Ten months later the patient underwent reoperation, and left hepatic resection was performed. The patient died of liver function failure on postoperative day 7. In the third case the fistula subsided spontaneously. CONCLUSIONS: An excessively high serum level of direct bilirubin and only moderately elevated liver enzymes indicate bilhemia in trauma patients. ERCP is most reliable in localizing the fistula; computed tomography/ultrasonography are valuable in detecting the extension and localization of the parenchymal destruction. Conservative therapy is justified if the patient is in good condition or if the localization of the fistula is unclear. Spontaneous closure of the fistula may occur. Surgical treatment options are partial liver resection and suture of the fistula and T-tube drainage of the common bile duct and drainage of the rupture site.
Adolescent↗
Late complication caused by stone spillage during laparoscopic cholecystectomy.
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Abdomen↗
Students' psychosocial characteristics as predictors of academic performance in medical school.
PURPOSE: To investigate the incremental effects of selected psychosocial measures--beyond the effects of conventional admission measures--in predicting students' academic performances in medical school. METHODS: In 1989-90, 210 second-year students at Jefferson Medical College were each asked to complete 11 psychosocial questionnaires that were then used as predictors of performance measures in medical school. The students' scores on three subtests of the Medical College Admission Test (MCAT) were also used as predictors. Three composite measures of performance were used as the criterion measures: basic science examination grades, clinical examination grades, and ratings of clinical competence. A multiple regression algorithm (general linear model) was used for statistical analysis. RESULTS: The response rate was 83% (175 students). When the psychosocial measures were added to the statistical models in which the common variances of the MCAT scores were already determined, significant increments in the common variances were observed for two of the three performance measures: basic science grades and clinical examination grades. Whereas only 4% of the common variance in the ratings of clinical competence could be accounted for by the MCAT scores, 14% could be accounted for by the psychosocial measures. CONCLUSION: The "noncognitive," or psychosocial, measures increased the magnitude of the relationships between the predictive and criterion measures of the students' academic performances, beyond the magnitude attained when only the conventional admission measures were used. Therefore, psychosocial measures should be considered as significant and unique predictors of performance in medical school.
Algorithms↗
Simulated operations by pulsatile organ-perfusion in minimally invasive surgery.
The rapid amplification of indications and areas of application of laparoscopic or thoracoscopic techniques leads to increasing problems and needs in surgical training. Pulsatile perfusion of organs (POP) and organ groups in laparoscopic training devices (pelvitrainers) aids in creating optimum conditions for the simulation of difficult intraoperative situations and complications. Simple applicability, low cost, and the possibility of a noticeable reduction of the currently required animal experiments render POP an ideal training method for minimally invasive surgery.
Animals↗
Morphometry and prognosis in cancer of the pancreatic head.
The histological slides of 39 cases of cancer of the pancreatic head were analysed using an interactive image analyser system. Some 14 cases were classified as periampullary, 25 as ductal pancreatic cancer. All cases had undergone radical tumor resection according to Whipple's procedure. Morphometric data, tumor size and metastatic nodal involvement were correlated to prognosis. Univariate statistical analysis showed that the classical differentiation between ductal and periampullary cancer was a weaker prognosticator than morphometric variables. In fact, multivariant statistical analysis showed that the morphometric variable irregularity was the best prognosticator (p = 0.0001). No other variable added significant prognostic information. Irregularity is a newly developed variable describing the nuclear shape corrected for roundness. We conclude that morphometry can be of essential prognostic information for the clinician in cancer of the pancreatic head.
Carcinoma, Intraductal, Noninfiltrating↗
Distinct distributions of D-erythro-neopterin in arteries and veins and its recovery by an enterohepatic circulation.
Large amounts of D-erythro-neopterin, a pteridine derivative, are formed from guanosine triphosphate (GTP) by human macrophages upon stimulation with interferon-gamma. In addition, in humans a basal neopterin level in all body fluids is evident also in absence of immunological stimuli. Extremely high concentrations of D-erythro-neopterin were detected in biliary fluid. We therefore investigated, if an enterohepatic circulation might exist for this substance. We quantified concentrations of pteridines in serum obtained from various vessels and in biliary fluid. Samples were collected during surgery of five patients with duodenal ulcer or adenocarcinoma of the stomach. Our data clearly demonstrate the existence of an enterohepatic circulation for the recovery of neopterin which seems to be specific for this substance. The relative distributions of neopterin concentrations in the gastrointestinal tract and vessels were seen invariably in all patients and were consistent with findings in five corpses examined post mortem. In addition, significantly higher neopterin concentrations, were found in arteries than in veins. The data indicate that neopterin derivatives are consumed in the peripheral capillary system and an enterohepatic circulation is established to maintain constant blood levels of neopterin derivatives. Furthermore, we suppose that the liver is the source of constitutive neopterin concentrations.
Adenocarcinoma↗
Endosonography (ES) in the diagnosis of recurrent cancer of the rectum.
The ability of endosonography (ES) to detect local recurrence after "curative" surgery for rectal cancer was investigated in 65 patients. Fifteen patients developed local recurrence. All of these 15 patients had ES evidence of recurrence; in four cases recurrence was detected by ES alone. Ten of the 15 patients with local failure underwent reoperation. Four patients were candidates for reoperation for cure. Three patients with radical reoperation belonged to the group in which recurrence was detected by ES alone. ES is able to detect small tumors before there is evidence of recurrence in other available forms of examination.
Adult↗
Treatment of calculi of the common bile duct.
Endoscopic sphincterotomy (EST) is regarded as an alternative therapeutic approach to the surgical treatment of choledocholithiasis. To clarify the indication for each of these two methods, a prospective study has been performed comparing patients with calculi of the common bile duct who had undergone endoscopic or surgical treatment. Mortality, morbidity and stone clearance were used as criteria for the evaluation of the dependence of age on results achieved by the two modalities. Of 306 patients with choledocholithiasis, 199 underwent surgical exploration of the duct and 107 underwent endoscopic sphincterotomy. Patients who were more than 60 years of age and had previously undergone cholecystectomy underwent endoscopic sphincterotomy. All other patients had surgical treatment. There were no significant differences among the two groups with regard to mortality rates. The incidence of relevant complications as well as the incidence of surgical revisions related to postoperative complications in the operation group was, however, significantly higher (p less than 0.05). In contrast with this, the incidence of retained stones was significantly lower (p less than 0.01) in the group that underwent surgical treatment (2.5 percent) than in the group that had endoscopy (11.2 percent). When assessing the results in terms of stone clearance, complications and mortality rates, findings seem to indicate that a safe limit for the application of surgical treatment would be 60 years of age, whereas older patients should be primarily considered as candidates for EST.
Age Factors↗
[Sigmoid volvulus, diagnosis and feasibility of an interdisciplinary primary therapy].
Sigmoid volvulus is an emergency which requires rapid diagnosis and immediate adequate treatment. Diagnosis is primarily radiological. Emergency laparotomy carries a high mortality and should therefore not be the immediate treatment. In our opinion, detorsion by colonoscopy under radiological control is a promising form of treatment. Selective resection of the sigmoid, thereby removing the cause of the abnormality, should not be forgotten, since this prevents recurrences. For this method, mortality after adequate gut preparation is only 5.4%. An exception to the above is gangrene of the bowel, when an emergency laparotomy cannot be avoided.
Colonoscopy↗
Combined extracorporeal shock wave lithotripsy and laparoscopic cholecystectomy.
For many centers, laparoscopic cholecystectomy (LC) has become the treatment of choice in cholecystolithiasis. Sometimes, however, bile stones with a diameter of 1.5 cm and above can only be removed if the periumbilical incision is enlarged or the stone is crushed with a forceps intraoperatively. To keep the incision as small as possible, to be able to work with the smallest available trocars, and to shorten the operative procedure, patients in our center with stones larger than 1.5 cm are submitted to preoperative extracorporeal shock wave lithotripsy (ESWL). LC is performed the same or the next day. We have used this procedure in eight patients, and LC could be performed in all cases without enlargement of the periumbilical incision. Macromorphological changes of the gallbladder following ESWL, such as hematoma and edema, were not seen.
Cholangiography↗
Rare exocrine pancreatic cancer-operative treatment.
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Adult↗
[Individualized intraoperative radiotherapy of pancreatic cancer].
During the period from 1984-1988 at the University Clinic, Innsbruck (in cooperation with the Department of Radiotherapy and Surgery) 40 patients with pancreas carcinoma were treated with intraoperative radiotherapy. Based upon the preoperative CT's, the operation reports and the patho-anatomic judgement of the operative specimen for 19 patients the quality of the performed IORT (with curative intention combined with partial pancreaticoduodenectomy) was examined. This examination was based upon a standardized concept. In 53% of the cases the chosen irradiation field was too small and, in most cases the applied single dose was from radiooncological point of view not sufficient. These results emphasize the need for preoperative treatment planning depending from the surgical intention, the need for individually shaped cones and direct field control of the applied dose.
Adenocarcinoma↗
Nuclear DNA distribution pattern of the parenchymal cells in adenocarcinomas of the pancreas and in chronic pancreatitis. A study of archival specimens using both image and flow cytometry.
The nuclear DNA distribution pattern of the neoplastic parenchymal cells of 100 conventionally formalin-fixed and paraffin-embedded specimens from pancreatic adenocarcinomas and from 8 specimens of chronic pancreatitis was assessed by means of image cytometry. All material originated from pancreatic restrictions. Evaluable DNA histograms could be obtained for 77 carcinomas, and clinical data were available for 71 of these. In these 71 specimens, the nuclear DNA ploidy pattern was also investigated by means of flow cytometry. In 76 of the 77 cases, the image-cytometric DNA ploidy pattern obtained showed a "nondiploid" distribution with modal values as high as 8.5 c. In 21 cases, the neoplastic cells showed modal values in the "triploid" region. The analogous 71 flow-cytometric DNA histograms could only be evaluated in 50 cases because of excessively high amounts of background and/or excessively broad peaks. In 47 cases, the nuclear DNA histogram was nondiploid according to both techniques. The patients with carcinomas whose cell nuclei showed a triploid DNA distribution showed a significantly shorter survival time than those with tumor cell populations of nontriploid DNA distribution patterns. In the 8 specimens of chronic pancreatitis, the parenchymal cells were all equipped with nuclei showing diploid DNA distribution patterns.
Adenocarcinoma↗
Transesophageal sonography in central bronchial carcinoma.
A new application of transesophageal sonography was tested in eight patients suffering from central bronchial carcinoma. Due to ultrasound technology, a real time investigation is feasible which enhances the diagnostic method of computed tomography (CT) by discriminating between tumour and mediastinal organs which cannot be delineated by CT only. Different sonographic densities and the movement between organ and tumour contribute to the diagnostic accuracy of sonography if operability is questionable due to possible organ infiltration by tumour. The method is limited by the air filled organs (trachea, bronchi), as ultrasound does not penetrate adequately.
Carcinoma, Bronchogenic↗
Adaptation to bacterial lipopolysaccharide controls lipopolysaccharide-induced tumor necrosis factor production in rabbit macrophages.
These experiments provide an explanation for the observation that two intravenous injections of lipopolysaccharide (LPS) spaced 5 h apart in rabbits cause tumor necrosis factor/cachectin (TNF) levels to rise in the blood only after the first LPS injection. Herein we show that treatment of elicited peritoneal exudate rabbit macrophages (PEM) with two doses of LPS given 9 h apart results in a marked reduction in TNF production by the second LPS exposure. This state of hyporesponsiveness is a result of adaptation to LPS, is induced by LPS concentrations that are 1,000-fold less than required to induce TNF production (picograms vs. nanograms), is characterized by a decrease in LPS-induced TNF mRNA without any change in TNF mRNA half-life, is not changed by including indomethacin in cultures, and is specific for LPS since LPS-adapted cells display a TNF response to heat-killed Staphylococcus aureus that is at least as good as that observed in control PEM.
Adaptation, Physiological↗
Colonoscopic treatment of sigmoid volvulus.
Sigmoid volvulus commonly presents with signs of bowel obstruction. In the absence of an exact preoperative diagnosis, these patients have to undergo urgent surgery. We report a case of sigmoid volvulus diagnosed radiologically and managed by endoscopic derotation. When the cause of the obstruction is known to be due to sigmoid volvulus, surgery can be avoided by careful endoscopic derotation of the sigmoid colon.
Adult↗