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Biomedical subjects

R Függer

Publications and source records attributed to R Függer.

At least 73 records · Page 4Linked to original sources
PubMed1993

CCK-8 and gastrin plasma levels in cholecystectomized and colorectal cancer patients.

The elevated incidence of large bowel carcinoma after cholecystectomy has long been controversial. The pathomechanism of this entity, however, is still unclear. Many authors have demonstrated a correlation between cholecystokinin (CCK) and gastrin levels and the occurrence of colorectal cancer. As yet, no clear data are available on the potential impact of cholecystectomy on CCK level alterations. Moreover, no reports have yet been published on CCK receptors. We have investigated the role of CCK-8 and gastrin plasma levels in patients with prior cholecystectomy and CCK receptor levels in patients with colorectal cancer. 125 patients entered a prospective study. Of these, 45 served as controls. 40 patients had prior cholecystectomy, 5 patients underwent cholecystectomy during the ongoing trial. 35 patients had a colorectal cancer, 5 of these had prior cholecystectomy. No patient had elevated CCK-8 plasma levels. Gastrin levels were slightly elevated in 2 patients. There was no correlation between large bowel carcinoma and CCK-8 and gastrin levels. Elevated CCK-8 levels following cholecystectomy occur neither immediately after surgery nor on a long-term basis. Immunohistochemical studies in patients with colorectal cancer showed no CCK receptors in the normal colonic or tumor tissue. These findings are contrary to gastrin receptor data.

Cholecystectomy↗
PubMed1993

[Laparoscopic colon surgery--from experiment to initial clinical experience].

The technique of Laparoscopic resection of the colon sigmoideum was practised in an experimental model before starting a clinical program of laparoscopic colonic surgery. Until now, two resections of the colon sigmoideum, one ileocecal resection, one right colectomy, one Hartmann's procedure and one transversostomy have been performed laparoscopically. Three patients had colonic carcinoma. One sigmoid resection had to be converted to open surgery and this patient underwent relaparotomy because of postoperative ileus. The postoperative course of the other patients was uncomplicated. The promising initial experience demonstrates that laparoscopic colonic surgery is feasible, although further studies have to prove advantages and indications, especially with respect to oncology.

Adolescent↗
PubMed1993

Perioperative TNF alpha and IL-6 concentrations correlate with septic state, organ function, and APACHE II scores in intra-abdominal infection.

OBJECTIVE: To find out if concentrations of tumour necrosis factor a (TNF alpha) and interleukin-6 (IL-6) play a part in the pathophysiology of intra-abdominal infection, and try to identify patients who would benefit from immunotherapy against TNF alpha. DESIGN: Prospective open study. SETTING: University hospital. SUBJECTS: 19 consecutive patients (septic shock, n = 4; sepsis syndrome, n = 6; and no sepsis syndrome, n = 9, classified by the APACHE II score and the criteria of the Methyl-prednisolone Severe Sepsis Study Group) who were to undergo their first operation for intra-abdominal infection. MAIN OUTCOME MEASURES: Correlation between median (interquartile) concentrations of TNF alpha and IL-6 (pg/ml), and APACHE II score, plasma lactate concentration, and organ function. RESULTS: Perioperative concentrations of both TNF alpha (p = 0.001) and IL-6 (p = 0.006) were significantly higher in patients with septic shock. Preoperative cardiovascular and respiratory failure were associated with significantly raised TNF alpha (p < 0.001 in both cases) and IL-6 concentrations (p = 0.02 and p < 0.001, respectively). The preoperative APACHE II score correlated with the increased TNF alpha concentration (r = 0.5, p < 0.001) and plasma lactate concentration with that of IL-6 (r = 0.7, p = 0.003). CONCLUSION: Perioperative TNF alpha and IL-6 concentrations correlated with the severity of intra-abdominal infection, so it is possible that patients who present with either septic shock or the sepsis syndrome may benefit from immunotherapy against TNF alpha.

Abdomen↗
PubMed1993

[Bile duct injuries in laparoscopic cholecystectomy].

We report on three patients with iatrogenic lesions of the common bile duct after laparoscopic cholecystectomy. In one patient, an additional occlusion of the hepatic artery was found. The leading postoperative signs were jaundice and cholangitis. Endoscopic and radiologic intervention failed to correct the common bile duct stenosis in all three patients. Surgical correction by hepaticojejunostomy was successful, although the postoperative follow-up is still short.

Adult↗
PubMed1992

Combined sclerotherapy and operation for the treatment of bleeding oesophageal varices.

OBJECTIVE: To identify prognostic factors in a consecutive series of patients with bleeding oesophageal varices and develop an optimum regimen of treatment. DESIGN: Retrospective review. SETTING: I Department of Surgery, University Hospital, Vienna, Austria. PATIENTS: 301 consecutive patients with bleeding oesophageal varices. OUTCOME MEASURES: Median survival and survival at one year after sclerotherapy alone (n = 213), or sclerotherapy with portosystemic shunt (n = 54), Hassab's devascularisation (n = 29), or liver transplantation (n = 5). RESULTS: Prognosis was dependent on the severity of liver damage at the start of treatment. Median survival for Child's class A was 47 months, for Child's class B 54 months, and for Child's class C 2 months. The overall one year survival for patients in Child's class C was 33%, for sclerotherapy alone 28%, and for sclerotherapy and portosystemic shunt 42%, Hassab's devascularisation 50%, and liver transplantation 80%. CONCLUSION: Despite the small number of patients who underwent liver transplantation and their poor initial prognosis (Child's class C, n = 4; class B, n = 1) our results suggest that liver transplantation should be considered for the treatment of patients with end stage cirrhosis and bleeding varices.

Adolescent↗
PubMed1992

[Laparoscopic cholecystectomy--evaluation of a prospective follow-up study].

A report is presented on 105 patients who underwent laparoscopic cholecystectomy because of symptomatic gallstone disease. Preoperative and intraoperative findings, complications and results were prospectively documented. In four (3.8%) patients the laparoscopic procedure had to be converted into open cholecystectomy. There were only minor surgical complications such as wound infection and a subhepatic haematoma. On average, patients were discharged on the second postoperative day. The operating time decreased from a median of 98 minutes in the first half to 73 minutes in the second half of the study, despite augmentation of the number of surgeons and of the indications to include patients with acute cholecystitis (n = 11), previous upper abdominal surgery (n = 7) and cirrhosis (n = 2).

Aged↗
PubMed1992

[Necrosectomy and laparostoma as a surgical therapy concept of acute necrotizing pancreatitis].

121 patients with acute necrotizing pancreatitis were treated according to a surgical regimen of necrosectomy, drainage by laparostomies and repeated revisions. Changing the protocol from revisions on demand to scheduled reexplorations resulted in an improvement of mortality from 53% to 28%. The high incidence of gastrointestinal fistulas (30%) associated with this regimen could be decreased to 5% by a more individual protocol with longer intervals of revisions in the later course. Mortality was 21% following this regimen.

Acute Disease↗
PubMed1991

[Etiology and consequences of postoperative wound infection].

The incidence of postoperative wound infection ranges between 4.6% and 36% after gastrointestinal operations respectively. To evaluate the factors which influence the postoperative wound infection we prospectively analyzed our patients between 1/1989 and 1/1990. 444 patients from three general surgical units of our clinic entered this study. The overall wound infection rate was 6.3%. We classified the patients into 3 operative groups: Group I: subcutaneous operations; Group II: intraabdominal operations without opening the GI-tract; Group III: gastrointestinal operations. Wound infection rate in group I was 1.8%, in group II 7.3% and in group III 13.7%. The differences were highly significant. Both univariate (chi 2-test) as well as a multivariate (Cox-Model) analysis were done. We figured out that classification of patients (p = 0.000), operation time (p = 0.009), operating room (p = 0.000), intensive care unit (p = 0.026), long-term antibiotic prophylaxis (p = 0.001), subcutaneous haematoma (p = 0.000) and length of closed drainage time (p = 0.001) are of significant value. In the Cox model the classification of patients into 3 groups surpassed all the other factors. Postoperative hospital stay was lengthened in patients with wound infection significantly (p = 0.0025).

Austria↗
PubMed1991

Sonographic demonstration of septicaemia with gas-forming organisms after liver transplantation.

Sepsis with gas-forming organisms, e.g. Clostridium perfringens and anaerobic streptococci occurred in three of 120 liver-transplant recipients (2.5%). The diagnosis was made in all three patients by bedside ultrasound, before blood cultures revealed bacterial growth. Floating high amplitude echoes within the extra- and intrahepatic portal veins and persistent small high amplitude echoes in the non-dependent portion of the liver are indicative of portal venous gas and should prompt further laboratory investigations.

Adult↗
PubMed1991

Intraoperative course and prognostic significance of endotoxin, tumor necrosis factor-alpha and interleukin-6 in liver transplant recipients.

Early events in reaction of the host immune system to an allograft were studied by intraoperative measurements of endotoxin (ET), tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in human liver transplantation. Blood samples were collected prior to operation, before clamping of the liver vessels, at the beginning and end of the anhepatic phase, and 5 and 30 min after recirculation. Diagnosis of rejection and infection in the graft recipients was established by assessment of spontaneous blastogenesis and T-lymphocyte subpopulations in addition to clinical symptoms and results from biopsies and blood chemistry. Of the 27 unmatched liver transplantations included in this study, 8 patients had infections in the first two postoperative weeks and 6 patients showed rejection of their grafts under antithymocyte globulin immunoprophylaxis. Endotoxin was transiently elevated in plasma in the anhepatic phase (2-fold in comparison to normal values) as expected for an accumulation of intestine-derived endotoxin during clamping of liver vessels, but no correlation was found with TNF-alpha levels and specific post-transplant complications. All patients with rejections had high plasma levels of TNF-alpha immediately after recirculation (mean value 240 pg TNF-alpha/ml), in contrast to low TNF-alpha levels in graft recipients without complications or infections. These results indicate that the initiation of rejection in liver transplantation is associated with increased plasma concentrations of TNF-alpha. The measured TNF-alpha concentrations are adequate to promote the binding of lymphocytes to allograft endothelial tissue and/or to induce expression of MHC antigens in the graft. Subsequent viral or bacterial infections were preceded by high intraoperative plasma concentrations of interleukin-6 (mean value 1400 pg IL-6/ml). The correlations of rejection with high intraoperative TNF-alpha levels and of infection with those of IL-6 are statistically significant in Wilcoxon tests for the direct measurements and in Fisher's exact tests for positive test values, with limits of 90 pg/ml for TNF-alpha and 800 pg/ml for IL-6.

Adult↗
PubMed1991

Intraoperative estimation of endotoxin, TNF alpha, and IL-6 in orthotopic liver transplantation and their relation to rejection and postoperative infection.

The course of endotoxemia, TNF alpha, and IL-6 during orthotopic liver transplantation was studied in 28 transplantations performed in 27 patients to evaluate their impact on early postoperative rejection and infection. The preoperative levels of endotoxin, TNF alpha, and IL-6 were not different in patients who did or did not develop postoperative rejection and/or infection within the first 10 postoperative days. At the end of surgery, TNF alpha levels increased in patients who developed rejection (median 100 pg/ml vs. 11.5 pg/ml, P = 0.004). A TNF alpha level of greater than 100 pg/ml at the end of transplantation predicted rejection in 82% of the patients. During surgery, IL-6 levels increased significantly in patients with subsequent postoperative infection, reaching significance after revascularization of the graft (median 975 pg/ml vs. 185 pg/ml, P = 0.006). An IL-6 cutoff level of 800 pg/ml predicted postoperative infection in 75% of the patients. Endotoxins were elevated intraoperatively in patients with postoperative infection, but the difference did not reach significance. There was no prognostic relevance with respect to the intraoperative values of TNF alpha and infection or IL-6 values and rejection. An intraoperative elevation of TNF alpha seems to precede early postoperative rejection, and highly increased IL-6 may be a predictor of subsequent infection in human liver transplantation.

Adult↗
PubMed1991

Reoperation after cholecystectomy. The role of the cystic duct stump.

The so-called "Postcholecystectomy Syndrome" may be due to various pathological biliary causes. The aim of this study was to evaluate the significance of the cystic duct stump syndrome and if so, how often a long (greater than 1.5 cm) cystic duct stump was an indication for reoperation on the bile ducts after cholecystectomy in our patients. Three hundred and twenty two patients underwent a second operation on the bile ducts after cholecystectomy in the last ten years. In 35 patients (10.8%) a striking findings was a long cystic duct stump (greater than 1.5 cm). In 24 of these patients, a pathological finding, in addition to the long cystic duct stump, was found on exploration. Out of these 24 patients there were 14 with common bile duct stones; 6 with stenosis of the sphincter of Oddi; 3 with chronic pancreatitis and in one patient hepatitis was the cause of the symptoms. From the remaining 11 patients 8 had a stone in a partial gall bladder or cystic duct stump. One patient had a fistula between the cystic duct stump and duodenum and one a suture granuloma. There was only one patient where a 1.5 cm long cystic duct stump remnant was the only pathological finding. Four years after reoperation this patient is still suffering from the same intermittent gastrointestinal symptoms. We conclude that the cystic duct stump is hardly ever a cause for recurrent symptoms in itself. Total excision of the cystic duct does not eliminate the existence of postcholecystectomy symptoms.

Cholecystostomy↗
PubMed1990

Endoscopic tube implantation for the palliation of malignant esophageal stenosis.

One hundred endoscopic tube implantations were carried out on 95 patients with malignant esophageal stenosis. Palliative treatment was performed in 43% of cases because of the advanced stage of the tumor, and in 57% of cases because of risk factors which made resection inadvisable. Clinical mortality was 16%, with six deaths caused by technical complications (perforation, arrosion bleeding), and ten by cardiopulmonary problems. Dislodgement or obstruction of the prostheses was observed in 20% of cases, but could readily be corrected. The median survival time was two months, with 17% of the patients still alive after six months. Poor general health, advanced age and the presence of distant metastases were established as unfavorable prognostic indications with a significant influence on postoperative mortality. Functional results were good: 87% of patients were able to eat solid or pulpy food post-operatively.

Adult↗