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Biomedical subjects

P Hermanek

Publications and source records attributed to P Hermanek.

At least 127 records · Page 7Linked to original sources
PubMed1989

[Effect of the transfusion of blood and hemoderivatives on the prognosis of colorectal cancer].

In recent years in the literature several investigators described a negative effect of perioperative transfusion of blood and hemoderivatives on the prognosis of malignant tumors. Concerning the patients with colorectal carcinoma operated between 1979 and 1983 at Erlangen University Hospital these results could be proven. We observed a significantly worse 5-year survival rate for patients who received perioperative blood transfusion. However, multivariant analysis in Cox-regression model revealed other factors like tumor stage and localisation responsible for the poorer prognosis. Therefore blood transfusion seems not to have any influence on the prognosis itself. Furthermore we observed a significantly poorer prognosis concerning patients who perioperatively received fresh frozen plasma (FFP). Surprisingly multivariant analysis showed that FFP substitution in contrast to blood transfusion has an own prognostic influence. This difference in prognosis cannot be explained by selection criteria. The mechanism of the negative influence of FFP on the prognosis of colorectal carcinoma remains unclear and is investigated currently in prospective studies.

Aged↗
PubMed1989

Prognostic factors in rectal carcinoma. A contribution to the further development of tumor classification.

In 597 patients with adenocarcinoma or mucinous adenocarcinoma of the rectum, the prognosis after radical resection for cure was investigated. Staging according to the fourth edition of the UICC TNM Classification showed a good correlation to prognosis. By multivariate analysis, various additional independent prognostic factors could be demonstrated. The individual additional prognostic factors are partly of significance in some pTNM defined stages and substages, but not in others. In order to obtain the most detailed knowledge of prognostic factors after radical resection for cure, multivariate analysis of prognostic factors in colorectal carcinoma must be performed not only in separate colonic and rectal groups, but also separately for each of the individual pTNM defined stages and substages.

Actuarial Analysis↗
PubMed1989

Colorectal carcinoma: histopathological diagnosis and staging.

It is possible to make a histopathological diagnosis of colorectal carcinoma from ulcerating lesions by means of forceps biopsy, but this presents problems in polypoid tumours. In order to make the diagnosis of invasive carcinoma, evidence of invasive growth into the submucosa is necessary. In polypoid tumours, this can be done usually only by endoscopic or surgical polypectomy. In addition to histopathological diagnosis, one of the most important tasks for the contemporary pathologist is the exact classification of colorectal tumours. The most important parameters are typing, grading, staging and the R classification, i.e. the assessment of presence or absence of residual tumour following treatment. Typing and grading is done according to the WHO recommendations; the great majority of colorectal carcinomas are adenocarcinomas or mucinous adenocarcinomas. In grading, one can differentiate into either four grades (G1 to 4) or between low and high grade. The internationally accepted TNM/pTNM system, as described in the 4th edition, is used for staging. This system has considerable advantages over the traditional, but often misused Dukes' classification. After treatment, the surgeons and the pathologists must work together to determine the R classification. Typing, grading and staging are of great importance in deciding on the indication for either a limited surgical procedure or a radical resection. Together with the R classification, they decisively influence the indications for post-treatment after surgical therapy. R classification is the most important factor for prognosis after surgical removal of tumours. Following resection for cure, the prognosis is especially affected by the pTNM classification and its corresponding stages. The independent prognostic significance of other clinical, macroscopic and histological findings cannot yet be definitively determined.

Biopsy↗
PubMed1989

Two programmes for examination of regional lymph nodes in colorectal carcinoma with regard to the new pN classification.

The new pN classification for colorectal carcinoma requires not only a statement on absence or presence of regional lymph node metastases but also, if present, a knowledge of the site and number of involved nodes. Subdivision of the fatty tissue with nodes adhering to the tumor resection specimen into two compartments is therefore the first step in pathological examination of lymph nodes. The methods for this as well as the different techniques used in searching for nodes and further histological processing of nodes are presented. We outline a minimal programme for pN classification in which step-wise sequence of examination reduces work load. An extended programme designed to answer special questions regarding lymphatic spread and surgical method is recommended only within the framework of special clinico-pathological studies.

Colorectal Neoplasms↗
PubMed1989

A comparative study of the tissue-destroying effect of the laser and electrocoagulation.

The effect of the laser on compact, glandular tissue at the dosage employed for the local palliative treatment of tumors, can largely be mimicked with the aid of high-frequency current (HF-current), applied with the aid of an electro-hydro-thermo-probe: The experiments described in the present study were performed on the livers of 70 male Wistar rats. The laser was applied for 2 seconds at an output of 80 J at a distance to the tissue of 0.5 cm. In the first stage, in the acute experiment, the effect of the HF-current was matched to that of the laser by varying the modulated and unmodulated current components. It was found that the depths of penetration into the tissue at the given laser settings could be achieved with modulated HF-current (so-called coagulation current) at an output of more than 72 watts (equipment setting K 10) coagulation being performed for 10 seconds. The admixture of modulated HF-current (so-called cutting current) reduces the depth of penetration into the tissue. In the first 5 days, the depth of penetration increases after both laser irradiation and HF-coagulation, by a factor of 2 to 3. With respect to the depths of penetration (DP), the scatter ranges, and the histological changes, no difference is to be seen between laser and HF lesions: Laser DP = 5.7 mm (confidence range: 4.4-7.0 mm); HF DP (equipment setting K 10) = 4.8 mm (confidence range: 3.6-5.4 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

[The prognostic value of the new pTNM classification and staging of kidney cancers].

In comparison with the former pTNM classification of renal cell carcinoma, the 1987 edition is characterized by a simplification of the classification by inclusion of venous invasion (former separate V classification) into pT and an advantage in estimating prognosis by the new pN classification. The new defined stages are well correlated with survival. On the basis of the presented survival data the criticism of the new TNM/pTNM by the EORTC-GU group can be rejected.

Humans↗
PubMed1989

[Prognostic factors in rectal cancer].

After surgical resection of rectal carcinoma the R (residual tumor) classification and pTNM are independent prognostic factors. In patients with residual tumor, presence or absence of distant metastases influences prognosis. The pTNM-defined stage and substage is of prognostic influence for patients without residual tumor. In a study of 597 patients multivariate analysis was used to identify additional prognostic factors for individual substages. Similar studies on larger patient material are needed for further clarification of these prognostic factors.

Follow-Up Studies↗
PubMed1989

[The new TNM classification and staging of stomach cancer].

A major revision of the TNM classification has been published in 1987. It eliminates previous differences between the UICC and AJCC versions. The new 4th edition of TNM has been accepted by all national TNM committees and enables international comparisons of data. For gastric carcinoma, the definitions for clinical and pathological primary tumor classification (T, pT) are now identical. The definition of regional lymph nodes has been revised, the stage grouping completely changed. It permits a more reliable estimation of prognosis. For the description of absence or presence of residual tumor after treatment the R classification is recommended. The reliability of classifications depends on methods used, therefore the respective requirements are discussed en detail.

Humans↗
PubMed1988

[News on the surgical pathology of colorectal cancer].

The incidence of regional lymph node metastases in colorectal carcinoma is influenced primarily by depth of invasion, but also by histological grade of malignancy and histologically demonstrable invasion of lymphatics. With regard to the indication for limited treatment of colorectal carcinoma, a differentiation between high risk and low risk tumors is recommended. In 6% of tumors with regional lymph node metastases only micrometastases are observed whose prognostic significance is not yet established. In most cases, lymphatic spread occurs regularly, in conformity with the anatomical situation, skipping of lymph nodes in less than 2% of cases with lymph node metastasis can be observed. The incidence and topography of lymph node metastases are important for the choice of surgical procedures. Because of the observed behaviour in lymphatic spread extended hemicolectomies are recommended for tumors of the transverse colon and the colonic flexures. The surgical treatment of rectal carcinoma should include the systematic node dissection along the inferior mesenteric artery.

Colectomy↗
PubMed1988

TNM classification of malignant tumors. A comparison between the new (1987) and the old editions.

A major revision of the tumor, nodes, metastasis (TNM) classification has been published. It eliminates previous differences between the International Union Against Cancer (UICC) and American Joint Committee on Cancer (AJCC) versions. It also updates existing site classifications and adds chapters on previously unclassified tumors. This article summarizes the major changes from the past to the present editions of the TNM classification.

Breast Neoplasms↗
PubMed1988

Endoscopy and pathology.

The development of endoscopy and the progress made in the development of biopsy and cytological methods have provided the possibility of microscopic assessment in the great majority of diseases of the internal organs. However, optimal results depend on certain requirements: (1) correct sampling methods, together with preservation (fixation, freezing) and processing of biopsies; (2) adequate clinical background information for the pathologist; (3) reporting according to international recommendations; (4) last but not least, well-qualified clinicians and pathologists. It is of paramount importance that clinicians and pathologists cooperate closely on a daily basis to guarantee effectiveness in biopsy diagnostics.

Endoscopy↗
PubMed1988

Preliminary results of treatment of invasive bladder carcinoma with radiotherapy and cisplatin.

From October 1985 to February 1988, 41 patients with invasive bladder cancers were treated with transurethral resection (TUR) and radiotherapy with simultaneous cisplatin chemotherapy at the University Hospital in Erlangen. Radiotherapy was performed as primary treatment in case of macroscopic residual tumor after TUR (n = 22) or as adjuvant treatment in patients with macroscopically complete transurethral resection (n = 19). Age ranged from 44 to 77 years. Radiotherapy was given in daily fractions of 1.8 Gy. The pelvis was treated with a box up to 41.4 Gy and the bladder was boosted up to 50.4 Gy by a rotation technique. Cisplatin was administered in the first and fifth treatment week on five consecutive days with 25 mg cisplatin/m2 per day as short infusion. Pathohistologic response was examined by control cystoscopy with biopsies from the deep layers 6 weeks after completing radiochemotherapy. Maximum follow-up is 24 months after control cystoscopy. After TUR plus radiochemotherapy, histologically confirmed complete remission rates according to T-stage were: 7/8 T1-, 26/31 T2-3-, and 2/2 T4-tumors. In patients with macroscopic tumor prior to radiochemotherapy, histological and cytological complete remission was achieved in 2/3 T1-, 14/18 T2-3-, and 1/1 T4-cancers with an overall complete response rate of 77%. In complete responders, 3 isolated local recurrences (2 T1- and one T3-recurrence) and two local recurrences with distant metastases have occurred until now. Six patients had only partial response. Mild to moderate side effects occurred frequently, but overall treatment tolerance was good even in older patients. Complications did not occur. So far, 7 cystectomies have been performed, 6 were a result of persistent or recurrent tumor and one a result of a contracted bladder after multiple TURs. Thirty-four of forty-one patients (83%!) maintained their bladder and normal bladder function. In conclusion, moderate dose radiation therapy (50 Gy) in combination with simultaneous cisplatin chemotherapy is a well-tolerated treatment and highly effective for controlling local disease and preservation of bladder function in invasive bladder cancers.

Aged↗
PubMed1988

Cancer of the rectum--local excision.

Limited surgical techniques have gained an important role among treatment modalities for invasive carcinoma of the rectum. Polypoid or plateau-like tumors not larger than 3 cm in which palpation, CT, and endoluminal sonography findings suggest only a slight depth of invasion may be treated by limited surgery. According to tumor size, macroscopic appearance, and site, one can decide whether to choose endoscopic polypectomy, per anal submucosal or full-thickness disc excision, or trans-sphincteric excision. After local excision, careful pathologic examination of the specimen is essential in deciding whether the limited procedure can be regarded as curative or whether a radical resection must be added. When average operative risk is present, carcinomas limited to the submucosa (pT1 or early carcinomas) with good prognostic histomorphologic features (grade 1 or 2; no lymphatic invasion) are suitable for treatment by limited surgery. If strict selection criteria are implemented, 5-year survival rates of better than 90 per cent can be achieved. The complication rate is low, and the postoperative mortality rate, even in elderly patients, is minimal.

Anal Canal↗
PubMed1988

Significance of serum phosphohexose isomerase in gastrointestinal cancer at different stages.

The purpose of this study was to reevaluate the significance of serum PHI in gastrointestinal cancer at histopathologically defined stages prior to primary treatment. A total of 248 patients with malignant tumors of the gastrointestinal tract and a collective of 42 patients with noncancerous diseases were studied. The results are compared with those obtained with the established markers tissue polypeptide antigen (TPA) and carcinoembryonic antigen (CEA). Phosphohexose isomerase (PHI) revealed an overall diagnostic sensitivity of 69%, combined with a specificity of 74%. The corresponding data for TPA were found to be 73 and 47% while for CEA 26 and 95% respectively were determined. Even in the early stages of colorectal and esophageal carcinoma, PHI showed a sensitivity of about 60%. A continuous rise of PHI serum levels, correlating well with the extent of the tumor disease, could be detected. In contrast to TPA and CEA, PHI assay can be carried out with a minimum of laboratory efforts, in a short time and at low costs. These findings suggest that serum PHI assay is a useful aid for screening of gastrointestinal cancer, especially esophageal and gastric carcinoma, and a reliable marker for treatment control and follow-up.

Antigens, Neoplasm↗