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Biomedical subjects

L Gossner

Publications and source records attributed to L Gossner.

46 records · Page 3Linked to original sources
PubMed1996

[Photodynamic therapy of dysplasia and early cancer of the esophagus].

Photodynamic therapy (PDT) is a new local, endoscopically controlled therapeutic concept based on the selective sensitization of malignant and precancerous lesions prior to light-induced tissue destruction. The first therapeutic experiences with the conventional photosensitizer dihematopor-phyrineter in the treatment of Barrett's esophagus without or with severe dysplasia and mucosal carcinomas of the esophagus demonstrate the efficacy and the curative potential of photodynamic therapy. The unwanted skin photosensitivity and only relative selectivity of the haematoporphyrins however, are somehow unsatisfactory and therefore, an optimization of the method of PDT is necessary. The endogenous photosensitizer aminolaevulinic acid with its high mucosa specificity without phototoxic side effects of the skin which can be administered orally was successfully used by our group for the treatment of patients with severe dysplasia of Barrett's esophagus and superficial squamous cell carcinomas. In patients with severe dysplasia/carcinoma in situ of Barrett's esophagus and early squamous cell carcinomas who pose high surgical risk, photodynamic therapy might be an effective alternative treatment modality in the future.

Animals↗
PubMed1996

[Abscess development caused by ingrown nitinol spiral as a fatal complication of a partially deteriorated MEMOSOND-PEG].

Percutaneous endoscopic gastrostomy (PEG) is a safe method with a low complication rate for providing enteral nutrition. While the "pull" method is the standard technique for PEG placement, alternatively "push" methods were developed in order to minimize peristomal wound infections caused by micro-organisms from the oropharyngeal cavity. Intragastral fixation of the "push" type PEG tube has always been a problem. The MEMOSOND-PEG uses a heat activated nitinol memory spiral as an anchor-like intragastral fixation. So far, an intraabdominal dislocation and a perforation have been reported as severe complications of this type of PEG tube. Five years after insertion we observed the development of an abscess induced by ingrowth of a nitinol spiral into the stomach wall as a further fatal complication in a patient with a MEMOSOND-PEG. The memory metal spiral had pierced the stomach wall after partial destruction of the polyurethane covering. The nitinol spiral was endoscopically extracted in several fragments. Ten days after extraction however, the patient died of combined kidney and liver failure due to a sepsis with Staphylococcus.

Abdominal Abscess↗
PubMed1996

K-ras point mutations are rare events in premalignant forms of Barrett's oesophagus.

OBJECTIVE: In Barrett's adenocarcinomas, in contrast to squamous oesophageal carcinomas, K-ras point mutations are thought to be a frequent event. The frequency of K-ras point mutations in premalignant forms of Barrett's oesophagus (metaplasia, dysplasia) leading to adenocarcinoma with increased risk is currently not known. To establish the frequency of K-ras mutations in premalignant forms of Barrett's oesophagus, we investigated oesophageal biopsy specimens with Barrett's metaplastic and dysplastic epithelium for point mutations in the K-ras gene/codons 12, 13. DESIGN: A total of 412 biopsies from patients with Barrett's oesophagus were histologically classified into biopsies with metaplasia (n = 252), dysplasia (n = 105) and adenocarcinoma (n = 11), as well as biopsies distant from disease (normal, n = 37 and hyperplastic squamous epithelium, n = 7). METHODS: DNA from biopsy specimens was amplified by polymerase chain reaction (PCR) with a modified primer for generating a restriction site in the case of wild type in codon 12. Wild-type or point mutations in the K-ras gene/codons 12, 13 were detected by restriction fragment length analysis of the PCR products. RESULTS: Point mutations in K-ras/codon 12 were found in 9 biopsies (n = 1 in metaplasia, n = 4 in dysplasias, n = 4 in adenocarcinomas). All the other biopsies showed the wild type of K-ras/codon 12. No K-ras/codon 13 mutation (GGCgly-->GACasp) was observed. CONCLUSION: Mutations in K-ras/codon 12 were rarely found in premalignant forms of Barrett's oesophagus. Whereas the screening for K-ras point mutations in metaplastic sites of Barrett's epithelium seems not to be of practical value, the screening for mutations in dysplastic lesions might be helpful to estimate the individual risk for progression of Barrett's epithelium to adenocarcinoma. A further evaluation in larger numbers of patients is needed.

Adenocarcinoma↗
PubMed1995

[The risks of percutaneous endoscopic gastrostomy].

AIM OF STUDY: Percutaneous endoscopic gastrostomy (PEG) having established itself as the standard procedure and preferred method for artificial long-term intestinal nutrition, a retrospective study was undertaken to evaluate the complications and course after PEG. PATIENTS AND METHODS: 1299 patients in whom PEG had been performed between 1.8. 1984 and 1.8. 1993 were sent a standardised questionnaire, 1182 of which could be evaluated (954 males, 228 females; mean age 56.7 [3-94] years). RESULTS: Total duration of PEG was 279830 days, with a mean of 216.2 days per patient. Mortality rate due to the procedure was 0.5%. Severe complications (peritonitis, perforation or faulty puncture) occurred in 9 patients (0.9%). The most common relatively minor complications were peristomal wound infection (8.7%) and brief periods of abdominal pain (4.8%). Typical side effects specific to nutrition were gastrointestinal symptoms, like constipation, diarrhoea, meteorism, vomiting and other signs of illness (39.3%). CONCLUSION: Long-term intestinal nutrition via PEG is a safe, efficacious and cost-effective form of treatment which decreases demands on hospital care and reduces costs.

Adolescent↗
PubMed1995

Memory metal stents for palliation of malignant obstruction of the oesophagus and cardia.

Thirty patients with incurable malignant obstruction of the oesophagus and cardia were treated with self expanding oesophageal memory metal stents (Ultraflex) in a prospective study. The endoprostheses were successfully placed in all patients. Within one week after implantation dysphagia had improved in 25 of 30 patients (83%). Stent expansion was incomplete within one week after implantation in 12 of 30 patients (40%). After an average of two dilatation sessions eight of 12 stents had expanded completely. Five patients complained of retrosternal pain and three of them suffered from heartburn over several days despite acid inhibition. Major problems in the follow up period occurred in 10 of 30 patients (30%) and included late perforation (one) and tumour ingrowth/overgrowth (nine). All of these complications were treated endoscopically. Improvement of the dysphagia of the patients with tumour ingrowth/overgrowth lasted for about eight weeks (median; range: 2-38 weeks). Until November 1994 six of 30 patients were still alive with a survival time of 309 days (median; range: 103-368 days). It is concluded that oesophageal memory metal stents are easy to implant, prove effective in the palliation of malignant oesophageal obstructions, and have a low risk of severe complications. The only disadvantages are that incomplete initial stent expansion as well as tumour ingrowth/overgrowth occurred in nearly one third of the patients.

Adenocarcinoma↗
PubMed1994

[Photodynamic therapy of a gastric stump carcinoma with curative intent. The first case report of a clinical application in Germany].

Photodynamic treatment (PDT) of malignant tumours rests on the intravenous administration of a photosensitizer, which is predominantly in tumour tissue, and subsequent activation of this substance with light of a specific wavelength. The method was used in a 76-year-old man who had undergone a 2/3 gastric resection for ulcer in 1948 and was now found to have a carcinoma of the stump at the anastomosis. He refused surgical resection, but accepted PDT. 48 hours after intravenous administration of the photosensitizer dihematoporphyrin ether-ester (2 mg/kg) the 1.5 x 1.0 cm tumour was irradiated with an argon ion laser pumped colour laser system at a wavelength of 630 nm and energy density of 150 J/cm3. The irradiation was performed under endoscopic control via a specially developed applicator which had first been introduced through the biopsy channel of the endoscope. Four weeks after the first treatment biopsies from a 5 mm ulceration in the area of the tumour revealed malignant cell groups, so that a second treatment was undertaken. Two, three and six months later the ulcer was shown to have healed and biopsies were free of tumour. But nine months later tumour cells were again demonstrated and a third PDT was performed. Although biopsies were again free of tumour at the next control, it can not yet be assumed that the tumour has been cured.

Aged↗
PubMed1992

[Effect of acarbose on injection-eating interval in type I diabetes. Preliminary contribution].

In a pilot study, 7 patients with Type I diabetes received three daily doses of 100 mg acarbose for three days within the framework of intensified insulin therapy. At the same time, the 30 minute interval normally observed between injection and eating was abandoned. The blood glucose levels measured one hour post-prandial in diabetics taking acarbose and not observing the injection-eating interval were lower than those measured prior to acarbose and while observing the interval. Large-scale controlled studies are needed to investigated the theory that in insulin-dependent diabetics taking acarbose, observation of the injection-eating interval can be abandoned.

Acarbose↗