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Biomedical subjects

P Kienle

Publications and source records attributed to P Kienle.

53 records · Page 3Linked to original sources
PubMed1997

Flexible endoscopic ultrasonography of colonic tumors: indications and results.

BACKGROUND AND STUDY AIMS: Based on the positive results of endorectal ultrasound we evaluated flexible colonic endosonography for colonic tumors. At present there are no generally accepted indications for this procedure. Moreover, it is unclear whether the results are valid enough to warrant specific therapeutic interventions. PATIENTS AND METHODS: Over a one-year period we performed flexible colonic endosonography (12 MHz rotating scanner) on 31 patients with colonic tumors. The examination was only performed when therapeutic implications were expected (e.g. endoscopic procedure when there was no sign of malignancy; oncological resection when there were signs of malignancy in ulcerative colitis or familial polyposis). RESULTS: Of 40 tumors examined, 36 were correctly staged by endosonography, compared to postoperative histology as the gold standard (16 of 17 adenomas, 5 of 5 pT1 carcinomas, 8 of 8 pT3 carcinomas). In two cases pT4 carcinomas were wrongly classified endosonographically as uT3 carcinomas, because the infiltration of the visceral peritoneum was technically not recognizable. Overall the accuracy rate of staging was 85%. Lymph node staging was correct in 36 of 40 patients, amounting to an accuracy rate of 90%. CONCLUSION: Because of its high accuracy rate flexible colonic endosonography has a place in the preoperative staging of colonic tumors in selected patients, especially those with ulcerative colitis, familial adenomatous polyposis or macroscopically suspicious adenomas. It helps to clarify the extent (oncological resection, lymphadenectomy) of resection required in conventional surgery and helps to avoid laparoscopic procedures in advanced colonic cancer.

Colonic Neoplasms↗
PubMed1997

Fatal hepatic necrosis after isoflurane anaesthesia.

Several halogenated anaesthetic agents have been associated with hepatotoxicity. We report a case of fulminant, fatal hepatic necrosis after uneventful isoflurane anaesthesia in a patient without previous liver disease, who may have been sensitised by previous exposure to enflurane. Although no anti-trifluoroacetyl antibodies could be detected in the patient's serum, isoflurane hepatotoxicity seems very likely to be the reason for fulminant hepatic failure in this patient.

Adult↗
PubMed1997

[Endosonography, CT and MRI in the diagnostic concept of rectal carcinoma].

The stage-adapted operative treatment of rectal cancer in the context of adjuvant therapy regimes necessitates accurate and, in times of diminishing financial resources, cost-effective preoperative staging. From January 1988, 424 patients with rectal cancer were examined by endosonography. In the same period 28 additional patients were staged by hydro-CT within a prospective study as the endorectal sonography probe could not be passed through the tumor stenosis. Sensitivity and specificity for T and N staging were equal or superior in the endosonography group. Compiled data in the literature for MRI staging of rectal cancer show results similar to those with endosonography. Therefore we see no indication for preoperative rectal staging methods other than endosonography unless the latter examination is technically impossible.

Cost-Benefit Analysis↗
PubMed1996

[Vital preoperative function diagnosis in deep anterior rectum resection].

Restoration of continuity after deep anterior resection may lead to major functional problems. Preoperative functional evaluation of the anal sphincter should help to select patients unsuitable for reconstruction and produce more objective data for evaluation of new technical procedures. In addition to a standardized history of continence and the clinical examination, anorectal manometry and endosonography of the sphincter are adequate methods.

Anal Canal↗
PubMed1996

[Restorative proctectomy, reconstruction of continuity with or without colon J pouch].

Of 63 patients undergoing deep anterior resection of the rectum, 39 patients received a straight colo-anal anastomosis (CAA), 24 additionally had a colon-j-pouch (CPA) constructed. Local septic complications occurred in 12.5% of patients after pouch-anal anastomosis compared to 20.5% after colo-anal anastomosis: stool frequency, after pouch-anal anastomosis was 3.3 per 24 h compared to 5.2 per 24 h after straight anastomosis within the first year after ileostomy closure (p = 0.053); continence was slightly better in the pouch group (n.s.); and anal manometry showed a significant postoperative decrease only in resting pressure after straight colo-anal anastomosis (p < 0.001). Pouch construction should be considered after deep rectal resection, as it seems to improve functional outcome and has fewer local septic complications than straight anastomosis.

Fecal Incontinence↗
PubMed1996

[pHi value as a prognostic parameter in septic and polytrauma patients].

In 17 patients in septic shock and in 12 trauma patients (ISS > or = 20) the gastric pHi and systemic oxygen delivery and consumption were measured every 6 h to evaluate the prognostic significance of the pHi and to determine the relationship between the gastric mucosal oxygenation and the systemic oxygen transport parameters. In the trauma patient the initial pHi has a high prognostic significance (mean survivors = 7.38; non-survivors = 7.15; p < 0.05), while in the septic group no patient with a pathologic pHi (< 7, 35) > or = 12 h survived. Since we found no correlation between pHi and systemic oxygen transport parameters, other factors have to be of greater importance for gut mucosal oxygenation.

Critical Care↗
PubMed1993

Development and validation of an assay to measure bioactivity of human calcitonin in vitro using T47D cell membranes.

We have developed a "test-tube" assay to determine the biological activity of synthetic preparations of human calcitonin (hCT). The method is based on the dose-dependent accumulation of cyclic AMP in cell membrane preparations on stimulation with CT. As an unlimited cell source, we used the clonal cell line T47D, which possesses functional CT receptor-adenylate cyclase complexes. Half-maximal stimulation was achieved with 40-200 nmol/liter hCT. The method was able to precisely quantify the relative potencies of various hCT preparations. The intraassay and interassay coefficients of variation were 3.0 and 5.6%, respectively. The analytical performance, as estimated by additional recovery and specificity studies, was better than or comparable to the established in vivo rat hypocalcemia assay. Results obtained with these two methods were closely correlated (r = 0.83, P < 0.01). However, the in vitro membrane system allowed a higher throughput of samples, less preparation time, and better standardization and transportability of the assay, as large-scale membrane preparations were stable for at least 12 months in liquid nitrogen. This new in vitro membrane bioassay provides a convenient alternative to the currently performed in vivo rat hypocalcemia bioassays.

Animals↗