Biomedical subjects
Publications and source records attributed to P Polterauer.
A case of an early cancer of the stomach is reported, in which the development of the lesion could be followed by repeated biopsies. Because of a high cardial risk of the patient, the tumor was resected as late as 23 months after the first diagnosis. During this time the lesion changed from a borderline lesion into an early cancer with penetration into the submucosa.
alpha 1-fetoprotein and Tennessee Antigen were evaluated in sera of 23 patients with hepatocellular carcinomas as well as in 20 patients with extrahepatic carcinomas and liver metastases. The diagnosis as histologically verified in all cases. Altogether 87% out of all hepatoma patients showed increased alpha 1-fetoprotein levels, whereby the concentrations were in the range which is highly suggestive of hepatoma in 65% of all patients with hepatoma. Tennessee Antigen concentrations were increased in 87% of hepatoma patients and in 85% of patients with metastatic liver cancer. Tennessee Antigen is an unspecific tumour marker, which can be used in control assessment during chemotherapy or after tumour resection and is of particular value in the follow up of those patients whose serum alpha 1-fetoprotein concentrations are normal or only slightly increased.
Serum-alpha 1-fetoprotein (AFP) and serumferritin were evaluated in 22 patients with hepatocellular carcinomas as well as in 25 patients with metastatic liver cancer. In all cases the diagnosis was established histologically. 21 out of all patients (95.4%) with hepatocellular carcinomas had increased AFP values (greater than 9 ng/ml), but only 18 (81.8%) had increased AFP values, which were highly suggestive of hepatoma (greater than 174 ng/ml). 17 out of 22 patients (77.2%) with malignant hepatomas had increased serumferritin levels ((greater than 343 ng/ml). In 4 patients (18.2%) with hepatocellular carcinomas, which had uncharacteristically low AFP values, increased serumferritin levels indicated malignoma. In patients with metastatic liver cancer AFP was increased in 7 (28%). Serumferritin levels were increased in 22 out of 25 patients (88%). Combining the results of these two tumour markers detection of liver cancer can be increased highly. However, serumferritin has to be regarded as an unspecific tumour marker, which does not allow a differentialdiagnosis between primary liver cancer and metastatic liver cancer.
268 patients with primary liver cancer have been autopsied: 81% had hepatomas, 14% cholangiocellular carcinomas, 5% mixed carcinomas (hepatocholangiocellular) and 1% had mixed tumors (hepatoma and angiosarcoma). In contrast to cholangiomas, hepatomas were found more often in males than in females. The age peak of primary liver cancer was between 61 and 70 years. 79% of hepatomas developed in a cirrhotic liver, 71% of cholangiomas were without cirrhosis of the liver. Metastases were found in 66-67% of hepatomas and cholangiocellular carcinomas, especially in blood vessels, lymph nodes, lungs and within the liver.
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21 patients had aortoiliac reconstructions for aortic aneurysms or occlusive disease with the new PTFE Y-graft during the past 12 months. 2 patients in the aneurysm group with additional renal artery reconstruction suffered postoperative myocardial infarction and subsequently died. 2 patients older than 80 years died after aneurysm repair in cause of graft infection, respectively respiratory insufficiency. All grafts (n=17) are functioning well or did so until death of the patient (n=4). The obvious advantage of the PTFE Y-graft is the fact, that there is no need of preclotting. Suture line--even using 4-0 material at the proximal anastomosis--and graft body is absolutely tight and no blood loss has to be expected from this site. However positioning of the left limb of the y-graft can be difficult in patients with right sided extraperitoneal approach and proximal side end anastomosis. Performing an end-end anastomosis can overcome this problem. For occlusion of the prosthesis limbs two vascular clamps on each side are needed to control blood flow within the rather stiff graft. Immediate and short term function is excellent. There was no material specific complication noted until now. Further longterm experience is necessary to evaluate the definitive quality of this new prosthetic material after some years.
HLA-A, B, C, and DR antigens were studied in 27 Viennese patients with Crohn's disease and 30 patients with ulcerative colitis. The frequency of HLA-B12 was found to be significantly (p less than 0.001, pc less than 0.05) increased in patients with Crohn's disease (52%) as compared with both healthy controls (21%) and patients with ulcerative colitis (10%). The frequency of HLA-Cw5 was slightly increased in Crohn's disease; however, the corrected p value was not significant. With regard to HLA-DR antigens, differences between the study groups and the controls or between ulcerative colitis and Crohn's disease did not reach statistical significance. However, the concomitant occurrence of HLA-B12 and/or Cw5 and/or DR7 was observed in 11 Crohn's disease and no ulcerative colitis patient (pc less than 0.006); there is a known linkage disequilibrium between these antigens. Although they differ from previous reports, these data in conjunction with the recently disclosed increased HLA recombination frequency in patients with Crohn's disease indicate that genes coding for HLA antigens may play a role in the pathogenesis of Crohn's disease.
Five cases are reported with the pathological entity of proximal arterial stenosis and embolization into the peripheral vascular bed. Therapeutic management, e.g. diagnostic work-up, eradication of the embolic source and embolectomy of the peripheral arterial tree - if technically feasible - seems beyond any doubt. Sometimes the diagnosis is difficult to obtain, since in the upper extremity microembolic seeds occur, posing a differential diagnosis problem. Once a partial sternotomy and in situ removal of the lesion was employed, in the remaining cases extrathoracic repair was done. In the left subclavian artery using a carotid-subclavian-anastomosis, we obtained satisfactory results, in the right subclavian and end-to-end-anastomosis was performed after resection of the diseased arterial segment.
128 Patients were operated upon consecutively since 1965 for lesions of the carotid bulb (stadium I.: n = 21;stadium II: n = 45;stadium III: n = 33; stadium IV:n - 29), a postoperative neurological deficit was noted in 4,7%, the cerebral lethality was 1,9%. The procedure was done in general anesthesia with moderate elevation of the systemic blood pressure. In case the pressure readings obtained in the stump of the internal carotid artery were below the level of 50 mm of mercury an intraluminal shunt was used. Considered an average lethality of 7% per year 48 patients died during follow-up, 5 for cerebral. 10 for internal medical reasons, in 33 cases the results of post mortem examination was not available. After a mean follow-up time of 7 years 41 patients were re-evaluated 4,8 recurrent stenoses, 2,4% intracranial and 9,4% changes in the contralateral carotid artery were detected. Only 4,8% showed abnormalities on neurological examination, which underscores the importance of non invasive diagnostic tools.
65 consecutive renal artery stenosis reconstructions for the treatment of severe renovascular hypertension are reported. 63% of the cases were males, 37% females. The disease was caused by arteriosclerosis in 66% of cases and in 23% by fibromuscular dysplasia or other pathological changes of the renal artery; the mean age was 47 in the former. and 31 years in the latter group. An aortorenal saphenous vein bypass was performed in 35% cases, a dacron graft was used in 29% and thrombendarteriectomy was carried out in 23% cases. Positive results were achieved in 68.8% of the patients. 63% of the females became normotensive. Operative mortality due to faulty technique was 4.9% initially. The operative mortality has been zero since 1973. nor have there been any therapeutic failures on a technical basis. No significant correlation was established between age of the patients and result of operation.
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Serum alpha-1-fetoprotein (AFP) and serum lactic dehydrogenase isoenzymes (LDH I-V) were evaluated in healthy subjects as well as in 10 patients with primary liver carcinoma, in 10 patients with metastatic liver cancer and in 10 patients with cirrhosis of the liver. The diagnosis was established histologically in all cases. The upper limit of the normal AFP range was 9 ng/ml. Four out of all the patients with hepatocellular or cholangiocellular carcinomas had normal AFP values, 3 showed slightly increased AFP values, whilst a serum AFP concentration exceeding 174 ng/ml - limit which is statistically highly suggestive of hepatoma - was found in only 3 patients. Three out of the patients with metastatic liver cancer and 3 with cirrhosis showed moderately increased AFP values. In primary liver cancer LDH V is increased significantly and 8 out of all patients showed higher values of LDH V than LDH IV. By contrast, patients with metastatic liver cancer had significantly increased LDH IV, which was higher than LDH V in 9 out of all cases. Cirrhotics showed normal LDH isoenzymes. Combining these results, a definitive diagnosis could be made in 9 patients with primary carcinoma of the liver and in 9 patients with metastatic liver cancer.
The intraoperative angiography was employed in 307 vascular reconstructive procedures (thrombendarterectomies (TEA) n = 107 = 34.8%; Veinbypass (VBP) n = 145 = 47.2%; fabric grafts (KBP) n = 44 = 14.4%) within the femoro-popliteal and crural region. 11.7% unsuspected technical errors were detected (TEA 18.6%, VBP 8.2%; KBP:6.8%) by angiography and successfully revised prior to wound closure. Errors were most common after thrombendarterectomies followed by VBP and KBP. Revisions after immediate failures were performed successfully in 7.4% (TEA : 8.4%, VBP: 5.5%, KBP: 6.8%). Lesions on X-ray of questionable significance were accepted in 6.8%, and followed by 4 immediate occlusions (1.7%). In 3.6% of the angiogramms the film was not satisfactorily exposed from the technical point of view. We think intraoperative angiography is a valuable adjunct in peripheral vascular surgery helping to detect and correct technical errors.
39 Sparks-Mandril grown grafts were implanted as arterial substitute in the femoropopliteal region and followed up for a minimum of 36 and a maximum of 57 months. At 7 instances it was not possible to perform the connecting procedure, 18.7% immediate occlusions, 28.2% early failures within the first postoperative year, 12.5% pseudoaneurysmal changes were noted. 13 patients (40.6%) demonstrated function for more than one year. Dilatation, elongation and parietal thrombosis over the whole length of the graft (2 cases) and late reocclusion turned out to be the main problems. Only 2 patients carry a properly functioning graft.
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In 32 patients with primary liver tumors incidence and etiology of hypercalcemia were evaluated. Two patients revealed hypercalcemia from osteolytic metastases, one had coexistent primary hyperparathyroidism and in one patient hypercalcemia was paraneoplastic. The last two patients are presented in detail by case reports. Differential diagnostic problems appear often in patients in bad general condition, since invasive diagnostic methods are limited. The most potent substance to treat acute hypercalcemic syndrome is mithramycin. In those cases where surgical treatment is possible, complete resection of the primary liver tumor or the adenoma of the parathyroid gland is recommended.
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Submucosal lymphangiomas are benign tumors which rarely occur in the gastrointestinal tract. The current report describes the tenth case of a submucosal cavernous-cystic lymphangioma of the duodenum. The diagnosis was made during endoscopy and was confirmed histologically in a biopsy specimen. Following a brief review of the localization and symptoms of submucosal lymphangiomas of the gastrointestinal tract published thus far in the literature, therapeutic considerations are discussed.