Search PubMed⌕ Search

Biomedical subjects

T Junginger

Publications and source records attributed to T Junginger.

At least 235 records · Page 13Linked to original sources
PubMed1992

[The surgical therapy of gastroduodenal ulcer. The results of a survey].

A poll concerning elective treatment of gastroduodenal ulcer carried out in 1065 surgical hospitals of the Federal Republic of Germany (West) revealed that in cases of ulcer ventriculi type 1 the 2/3 resection is preferred in 91.5%. Billroth I is performed in 50.5%, Roux in 20% and Billroth II in 16.8%. Too, in cases of prepyloric ulcers the resecting procedure is favored. Various methods of vagotomies are dominating in duodenal ulcers (64.9%). There are only little differences in therapeutical concepts of gastroduodenal ulcer between university and nonuniversity hospitals.

Duodenal Ulcer↗
PubMed1992

Superficial esophageal carcinoma in achalasia, detected by endoscopic surveillance.

A 42 year old woman had undergone a Heller myotomy for achalasia of the cardia at age 28. Thereafter, she had become asymptomatic but reported for endoscopic follow-up examinations at three-yearly intervals. Fourteen years after surgery, endoscopy and biopsy revealed "carcinoma in situ" in the proximal esophagus and surgery was recommended. In the resected specimen, a circumscribed area of cancer was demonstrated that invaded the lamina propria but was confined to the mucosa. With the exception of mild and transient postoperative dysphagia, she had an uneventful postoperative course and remains well 16 months following surgery. This case demonstrates that endoscopic surveillance may detect early malignant changes in the achalasic esophagus and may possibly lead to an improvement in survival.

Adult↗
PubMed1992

[Results of stomach resection with Roux gastrojejunostomy for gastroduodenal ulcers].

In a follow-up study operative risk, postoperative functional disorders and incidence of anastomotic (recurrent) ulcer after partial gastrectomy with Roux-en-Y gastrojejunostomy for gastroduodenal ulcer were evaluated in 52 patients. Lethality for elective treatment was 0 and for emergency surgery (ulcer bleeding) 16.7%. 29.5% of the patients reported postoperative functional disorders. Because Roux-en-Y reconstruction prevented duodenogastric reflux, intragastric pH was low (median 2.2) and in the absence of ulcer protective, neutralizing reflux anastomotic ulcer occurred in 15.9% of the patients. With regard to the high rate of recurrent ulcer Roux-en-Y reconstruction after partial gastrectomy for primary ulcer surgery should be avoided and reconstruction procedures preferred, which guarantee duodenogastric reflux.

Anastomosis, Roux-en-Y↗
PubMed1991

[Surgical therapy of achalasia after prior pneumatic dilatation].

Of 15 patients operated on for achalasia in the Department of General and Abdominal Surgery at the University of Mainz between September 1985 and April 1990, 14 were followed-up. All the patients had received an extramucous myotomy combined with Dor's semifundoplication; in twelve, one or more preoperative balloon dilatations had been performed. The results are reported in this study. The average age of the patients was 55.3 years (18 to 76 years), and the average follow-up period 21 months (six to 53 months). No postoperative complications were seen in any of the case. All patients reported appreciable improvements in their symptoms, six being completely symptom-free. Occasional dysphagia was reported in six cases, one patient had occasional, another frequent, nocturnal heartburn, which however had already presented preoperatively. In all seven cases submitted to postoperative radiological examination, the diameter of the esophagogastric junction was increased, and the diameter of the middle-third of the esophagus decreased. No gastroesophageal reflux or signs of inflammation were seen in any of the cases. The low complication rate and the high success rate despite prior balloon dilatation or bougienage support the use of Heller's operation combined with Dor's semifundoplication for the surgical treatment of achalasia after failed balloon dilatation.

Adolescent↗
PubMed1991

DNA image cytometry. A prognostic tool in squamous cell carcinoma of the esophagus?

In 45 patients who underwent an esophagus resection due to a squamous cell carcinoma, in addition to the TNM classification and usual morphologic criteria, the paraffin-embedded material underwent deparaffinization, was rehydrated, and was mechanically and enzymatically processed into a single-cell solution. For evaluating the DNA histogram this was analyzed with the help of automatic single-cell cytophotometric study. The method, contrary to that of flow cytometric study, allows for the selective analysis of tumor cells due to the electronically, previously given selection criteria, whereas artifacts, stroma, and infection cells remain excluded from analysis. The multivariate analysis shows that the prognosis is only correlated with DNA content of the tumor cells. Patients with diploid tumors had a median survival time of 32 months as compared with the 22 months of patients with hypotriploid tumors, and 6.5 months with hypertriploid tumors. DNA cytometric analysis should be included when diagnosing patients with esophagus carcinoma.

Carcinoma, Squamous Cell↗
PubMed1991

[A prospective study for evaluating postoperative risk and long-term prognosis of mesenteric infarct].

In a prospective study on the patient material of the Surgical Clinic of the Johannes-Gutenberg-University Mainz the prognostically relevant factors in acute mesenteric vascular occlusion were investigated. From September 1, 1985 until August, 31, 1989 46 patients (24 men, 22 women) with an average age of 67.2 years were treated for an acute mesenteric vascular occlusion. Postoperatively 56.5% of the patients died. The postoperative lethality was correlated statistically significant to the period of anamnesis, the aetiology of the occlusion, the patient's age, the preoperative ASA score, and the length of the ischemically damaged bowel. The postoperative blood lactat level correlated with the outcome. Only two patients survived a second operation with a further bowel resection. One of these patients had a normal blood lactat level. The two year survival rate of the postoperative surviving patient's totalled at 70%. These results confirm the known prognostically relevant factors as well as the value of the blood lactat level in the postoperative period. They show as well, that an early second look operation depending on the intraoperative findings of the primarily operation and prior to an increase of the blood lactat level and prior to a deterioration in the patients condition is justified.

Aged↗
PubMed1991

[Prognostically relevant factors in papillary thyroid cancer].

Papillary cancer have the best prognosis of all thyroid carcinomas with a five year survival rate of 98%. Between 1.1.1964 and 31.12.1987 we have operated 86 patients due to an papillary thyroid carcinoma. The five year respectively ten year survival rate was 88% respectively 75%. Prognostic relevant factors were as follows: metastasis, tumor stage, tumor invasion of vessels, multifocal tumor growth, age, pT differentiation and the tumor size.

Adenocarcinoma↗
PubMed1991

[Therapy and prognosis of medullary thyroid cancer].

Medullary thyroid cancers have different morphological, endocrine and biological qualities than all the other tumors of the thyroid. Therapy is the thyroidectomy with modified, radical neck dissection. The ten year survival rate was 65% in our own patient material. The prognosis depended on tumor size, invasion of vessels by the tumor, grade of differentiation, tumor stage, metastasis and radicality of the operation.

Adult↗
PubMed1991

[Pedicled small intestine segment for circular replacement of the extrahepatic bile duct in preserved papillary passage. An animal experiment study].

The effect of a small bowel segment as a extra-hepatic bile duct replacement was examined in 12 pigs followed-up for a period of 420 days. No complications, either during the operation or postoperatively, were observed in any of the animals. The laboratory parameters were within normal range over the entire observation period of 420 days. After 2, 6, and 12 months there was no anastomotic stenosis in the PTC. The intrahepatic biliary tract was not dilated. There was obvious peristalsis of the small bowel transplant towards the papilla of Vater. The autopsy showed that the grafts had healed without any sign of irritation. Histologically the structure of the graft remained undisturbed. There was a clear distinction between the mucosa of the bile duct and that of the small bowel, with no sign of a chronic infection. In the graft as well as in the vascular pedicle the nerve fibres were intact. Liver biopsy showed no pathological changes. In the light of these experiments, a small bowel segment presents a very promising alternative replacement of the extrahepatic biliary tract.

Ampulla of Vater↗
PubMed1991

[Stomach emptying after stomach resection with and without retention of duodenal passage].

On domestic pigs 2/3 gastrectomies with retention and elimination of the duodenal passage were carried out. Postprandial gastric emptying was measured scintigraphically for 4 h and compared with a control group (laparotomy only). For the semi-solid, 99mTc-labeled test meal delayed gastric emptying after elimination of the duodenal passage by Roux reconstruction could not be shown. There was no difference in gastric emptying between B-I and Roux-en-Y partial gastrectomy. Also alteration of the length of the jejunum loop from 40 to 20 cm after Roux-en-Y reconstruction had no influence on gastric emptying. Roux reconstruction (40 cm loop) in combination with truncal vagotomy led to a non-uniform gastric emptying, but there was a statistically proven acceleration compared with B-I resection. After 240 min the mean residual intragastric activity of the control group (n = 5) was 47.8%, 78.9% after B-I resection (n = 5), 59% after Roux reconstruction with 40 cm jejunal loop (n = 5), 38.1% after Roux reconstruction with 20 cm jejunal loop (n = 5) and 20.9% after Roux-en-Y (40 cm loop) with truncal vagotomy (n = 4).

Anastomosis, Roux-en-Y↗
PubMed1991

[Therapy of bleeding esophageal varices in West Germany--results of a survey].

An inquiry concerning bleeding of esophageal varices included 1076 surgical and medical departments in the Federal Republic of Germany (West). Prevailing forms of treatment are acute sclerotherapy or esophageal balloon tamponade followed by long-term sclerotherapy. In case of medically uncontrollable bleeding oesophagogastric devascularization procedures are preferred to portacaval shunt. Beta-blockers are applied in medical departments for the prophylaxis of recurrence. Only after several rebleedings, despite of sclerotherapy, approx. half of the departments consider an elective shunt. The distal splenorenal shunt described by Warren and portacaval anastomosis clearly prevail over all other shunts.

Combined Modality Therapy↗
PubMed1991

[Endosonography in preoperative staging of gastrointestinal tumors].

29 patients with esophageal and gastric tumors, and 109 patients with rectal carcinoma were preoperatively investigated by endosonography. Tumor infiltration and lymph node spreading were assessed by endosonography and compared to the postoperative histological findings. Depth of tumor infiltration was assessed correctly in 88% of all patients investigated. Lymph node spreading of gastric and esophageal cancer was detected in 84%. In contrast lymph node metastases of rectal carcinoma were rarely seen. The high accuracy of endosonography in detection of lymph node metastases of esophageal cancer makes it possible to select the appropriate treatment, such as surgery, radiotherapy or palliative procedures. Endorectal sonography is a powerful tool to select those patients, who can only be treated by local excision.

Endoscopes, Gastrointestinal↗
PubMed1991

[Results of surgical therapy of pancreatic pseudocysts].

During the past few years pancreatic pseudocysts have been seen more frequently. Between 1.1. 1978 and 31.12. 1987 145 patients with pancreatic pseudocysts were operated at the Surgical Clinic of Mainz University. In 93 cases internal drainage was performed with a morbidity of 11.8% and a lethality of 1.1%. External drainage and pancreas resection had a lethality of 6.5% resp. 4.7%. After a mean follow-up of 7.3 years patients with non-resection therapy had a better endocrine function but a worse pain relief than those with pancreas resection. Pseudocyst recurrences developed after internal drainage in 9.3. after external drainage in 55.5% and after resection therapy in 1 of 5 cases. Cystojejunostomy within Y-Roux-anastomosis is therefore a safe method with good long-term results for the treatment of pancreatic pseudocysts.

Adult↗
PubMed1991

[Initial results of image cytometric DNA analysis in the evaluation of prognosis in papillary thyroid cancer].

In this study we analysed DNA-ploidy as a potential prognostic parameter in papillary thyroid carcinoma. Paraffin embedded histological material, obtained by resection from 19 patients with a papillary thyroid carcinoma, was selected for analysis. Tumor areas within the paraffin-embedded material were identified by HE-stained reference sections. One 50 microns section was dewaxed, rehydrated and mechanically and enzymatically prepared to form a suspension of 10,000 cells/ml. 1 ml of the suspension, which contained bare nuclei with small rests of cytoplasma, was centrifuged on glass slides. The fixed nuclei were air-dried and stained by Feulgen SITS technique, which allows for the quantitative measurement of DNA. The DNA analysis was carried out with a computer-controlled single-cell cytophotometry. In contrast to using flow cytometry, only the tumor cells were measured by image-cytometry. Overlapping nuclei, dirt and other artifacts as well as inflammatory cells were efficiently eliminated. With DNA image-cytometry, we could differentiate between diploid (n = 13) and aneuploid (n = 6) tumors. Best prognosis with a survival rate of 92% after 103 months had patients with diploid tumors in contrast to patients with aneuploid tumors who did not survive more than 72 months.

Carcinoma, Papillary↗
PubMed1991

Preoperative detection of intrathoracic tumor spread of esophageal cancer: endosonography versus computed tomography.

The results of endosonography and computed tomography, using an optimized CT technique, have been compared in the preoperative detection of intrathoracic tumor spread of esophageal cancer. In 22/40 patients with esophageal tumors complete passage of the ultrasonic endoscope was possible. Endosonography was superior to CT in the assessment of early stage of esophageal tumor (T1-2). Out of 9 tumors confined to the esophageal wall, 8 were classified correctly by endosonography and only 5 by computed tomography. The results in advanced T3 and T4 tumors (13 patients) were comparable following endosonography and computed tomography. Endosonography is an important means of selecting patients with early-stage cancers in whom a curative resection is still a possibility.

Carcinoma↗
PubMed1991

[Animal experiment studies of development of anastomosis ulcers after reflux-inducing and reflux preventing stomach resection].

In an animal experiment the role of bile reflux in development of anastomotic ulcer after partial gastrectomy was investigated. On 45 pigs 2/3 partial gastrectomies and on 5 animals only laparotomies were carried out. The ulcer risk after reconstruction procedures with possible bile reflux was compared with reflux-free techniques. Anastomotic ulcer developed after maximal exposure of the gastric remnant to bile as well as after reflux-free reconstructions: B-II-Roux, 40 cm jejunum loop (n = 5/10); B-II-Roux, 20 cm jejunum loop (n = 3/5); B-II-Roux, 40 cm jejunum loop and truncal vagotomy (n = 1/5); B-I and choledochojejunostomy (n = 2/10); B-II-Roux, 40 cm jejunum loop and cholecystogastrotomy (n = 4/5). After B-I resection with medium duodeno-gastric reflux (n = 0/10) and in the control group (n = 0/5, laparotomy only) no ulcer occurred. Because basal acid output after B-I and B-II-Roux resection was reduced to O mval/h, stimulated gastric acid seems to be important in development of anastomotic ulcer. The experimental results prove the protective role of postresectional duodenogastric reflux. After partial gastrectomy for primary ulcer surgery reconstruction procedures guaranteeing duodenogastric reflux should be preferred to Roux-en-Y gastrojejunostomy.

Anastomosis, Roux-en-Y↗