Biomedical subjects
Publications and source records attributed to P Frühmorgen.
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BACKGROUND AND STUDY AIMS: Invasive carcinoma is found at histology in 2-5% of colorectal polyps removed under flexible endoscopy. The aim of this study was to confirm that histologically complete endoscopic polypectomy under favorable low-risk conditions is sufficient therapy for pT1 carcinoma, while tumors at or close to the margin of the polypectomy, and histological high-risk criteria, require surgical resection with lymphadenectomy. PATIENTS AND METHODS: Eighty-six patients with 87 pT1 carcinomas underwent polypectomy within a twelve-and-a-half-year period. Further treatment prospectively followed the above guidelines. The follow-up was documented. RESULTS: A local tumor residue was found in 5 of 34 patients who had undergone surgical resection for doubtful or incomplete polypectomy. Two patients were found to have nodal disease in the surgical specimen, only one of them harboring a high-risk carcinoma. Two further patients with high-risk carcinomas had tumor progression, despite postpolypectomy resections without local tumor residue or lymph-node infiltration, and died. One patient had a local tumor recurrence on follow-up endoscopy eight weeks after doubtfully complete polypectomy. He underwent resection, and had no further recurrence. No further manifestations of invasive carcinoma occurred after complete polypectomy of 42 patients with low-risk carcinomas. CONCLUSIONS: This study supports the view that complete endoscopic polypectomy is an adequate therapy for low-risk carcinoma: A modification of the follow-up regimen, with less frequent endoscopic controls, is justified.
A patient with AIDS was hospitalized with a left-sided face swelling and protrusion of the bulbus. After cranial computed tomography and fine-needle aspiration biopsy of the fossa temporalis we diagnosed a mycetoma; localisation and histology made an aspergilloma most probable. Antimycotic therapy led to complete remission of the symptoms. Post mortem we only could culture Candida albicans out of the abscess cavity.
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Fragments of a puncture cylinder were obtained from a pancreas tumour, using the ultrasound-guided fine-needle puncture. The tumour appears as an echo-poor, homogeneous structure suggesting good delineation against the adjoining tissue. Histological examination of the punch cylinder revealed a chondroma of the pancreas. Clinical and clinical pathology examinations (lipase, alpha-amylase, glucose, CEA, CA 19-9 in serum) were inconspicuous. Chondroma of the pancreas does not require specific treatment.
From February 1984 to August 1991 subhepatic abscesses were detected by ultrasound in 7 patients with fever following conventional cholecystectomy. Cholecystectomy had been performed in all these patients 6 to 27 days previously. All patients had received antibiotic prophylaxis at the time of cholecystectomy. Three of the 7 patients were at first afebrile, later on again febrile. In the remaining 4 of the 7 patients antibiotic treatment was continued in the face of persistent fever. Percutaneous catheter drainage was performed in all patients. In all of the 7 cases the subhepatic abscesses resolved completely within 10 days to 7 weeks.
Evidence of a cavernous hemangioma of the liver with fistula between hepatic artery and the portal vein of a 52 year-old woman with colickly upper abdominal pain and ascites was obtained using Duplex-Doppler-ultrasound. The diagnosis was confirmed by selective arteriography. After ligation of the left hepatic artery clinical symptoms abated. The cavernous hemangioma was followed up over 7 1/2 years with ultrasound. Ultrasound has been shown to be a valuable test for diagnosis and follow up of cavernous hemangioma.
Percutaneous endoscopic gastrostomy (PEG) is an accepted and increasingly utilized means of obtaining access to the gastrointestinal tract for alimentation. The Memosond (Pfrimmer-Viggo Co.) as a new system presents advantages in comparison to the commonly used thread-guided tubes rendering a simplified technique of setting the tube and giving the possibility of later changing without repeated endoscopy. We present a case of a 65 yr female patient with advanced carcinoma of throat. A PEG using a Memosond system was performed. Two days later the distal part of the tube dislocated into the abdominal cavity. The patient died four days later of her malignant disease.
Since colorectal adenomas are very probably the precursors of colorectal cancer, their detection and removal should result in a decrease in the incidence and mortality from colorectal cancer. Individuals who harbour an adenoma have a 30-50% probability of having additional adenomas at that time, and a 30% probability of having additional adenomas later. Adenomas are prevalent in countries where colorectal cancer is prevalent, about two-thirds of them being tubular and the rest tubulovillous or villous. The initial management of patients with an adenoma consists in searching by colonoscopy the entire colon and removing all additional polyps. Surgical resection is required wherever there is invasive cancer with adverse histological factors. Follow-up in most patients can be after 2-4 years, earlier follow-up being reserved for patients with numerous polyps or with a polyp that had been removed piecemeal. The results of ongoing trials should provide firm guidelines for follow-up and could also be used in mathematical modelling to examine alternative strategies and to help understand the evolving patterns of appearance of new polyps. Finally, a deeper understanding of the biology and inherited and acquired genetics will help identify individuals at risk for adenomas initially and at follow-up. Nutritional factors may also provide a basis for prevention of adenomas in high-risk countries. Many of these issues are being addressed in current research.
Sera from 56 adult patients were screened for the presence of IgG antibodies against Helicobacter pylori by enzyme immunoassay and indirect immunofluorescence. In addition, the detection of Helicobacter pylori in antral biopsy specimens was attempted by culture and histological methods. Colonisation of the antrum mucosa with Helicobacter pylori was observed in 39 of the 56 patients. IgG antibodies against Helicobacter pylori were detected by enzyme immunoassay in 34 of 39 infected patients. Thus, the enzyme immunoassay showed a sensitivity of 87.2 percent and a specificity of 82.4 percent. IgG antibodies against Helicobacter pylori were further detected by indirect immunofluorescence in 28 of 39 infected patients. Thus, indirect immunofluorescence showed a sensitivity of 66.7 percent and a specificity of 88.2 percent. Our results demonstrate that the enzyme immunoassay for IgG antibodies and other invasive or noninvasive methods for the detection of infection with Helicobacter pylori appear to be of equal sensitivity and specificity.
All complications of diagnostic and therapeutic endoscopic procedures from Feb. 1, 1982, to Jan. 31, 1989, at the Medical Department I of the Ludwigsburg hospital were reviewed. Complications occurred in 0.02% of all esophago-gastroduodenoscopies, in 0.09% of all endoscopic retrograde cholangio-pancreaticographies and in 0.05% of all colonoscopies. Rectos-copies and laparoscopies have to date been performed without complications. For therapeutic endoscopic procedures, the incidence of complications varies depending on the type of procedure performed. In 1.2% of gastric polypectomies, in 0.52% of colonic polypectomies and in 2.22% after endoscopic papillotomy complications occurred. In summary, both diagnostic and therapeutic endoscopy with adequate training can be considered as very safe procedures and only rarely leading to complications or death.
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A predominantly cystic process of the upper abdominal region of a 61 year old female patient was punctured via the fine-needle technique. The clinical assumption had been a lymphoma. Bright red blood was aspirated. The Doppler sonographic measurement revealed an arterial pulsating aneurysmatic process, and this was subsequently proved by selective angiography and, finally, by surgical treatment.
In 24 surgical specimens of gastrointestinal tumours the extent of the tumour (T-classification) and the degree of involved lymph nodes (N-classification) were examined. In a preceding study including a subgroup of the cases the high degree of comparability between preoperative endosonography and endosonographic examination of the surgical specimen was demonstrated. The T-classification matched in 75%, an incorrect classification was found in 20%. In 5% the identification of the different layers of the wall was impossible. N-classification was very difficult because of the small amount of identified lymph nodes (25%) and the insufficient sonographic criteria of dignity.
Using a biopsy transducer 171 fine-needle punctures of focal pancreatic processes were done in 158 patients. The final diagnosis was made in the first group by surgical operation or autopsy, in the second by the further clinical course. The sensitivity of the cytological examination alone was 78% in the first group and 90% in the second. The histological examination alone had a sensitivity of 79% to 100%. Combining both ways of examination according to defined criteria the sensitivity in the first group was 84% and in the second 100%. The specificity was 100% for both. The complications were 2.9%. Of these 5 cases one pancreatitis had to be operated. There were no lethal complications. To optimize the sensitivity and specificity of the ultrasound guided fine needle puncture technique we want to recommend the following points: A biopsy transducer or puncture-aid must be available. The fine needle technique only should be done under the prerequisite of a high frequency of punctures and a high constancy in the relation between puncturer and pathologist. To receive representative material it can be necessary to make several needle passes during one session. Material for cytological und histological examination should always be taken simultaneously.
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