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Biomedical subjects

T Junginger

Publications and source records attributed to T Junginger.

At least 73 records · Page 4Linked to original sources
PubMed2000

[Adenocarcinoma in a tail-gut cyst: a rare cause of recurrent perianal fistula].

A 58-year-old woman was initially externally diagnosed in 1983 with a presacral mass, which was subsequently treated as an abscess. Thereafter, the patient experienced recurrent perianal fistulas. Further diagnostic studies revealed a cystic tumor, considered to be an epidermoid cyst, which was located in the inferior pelvis and was consequently removed. Histologically, cystic scar tissue was found with a highly differentiated adenocarcinoma which measured 4 cm. Later on, the patient again experienced perianal fistulas originating from a renewed presacral mass. As a result, an abdominal-perianal rectum extirpation and a partial resection of the sacrum with placement of a descendostomy were done. Histologically, adenocarcinoma tissue was found at the base of a tail-gut cyst. One year following her operation, the patient is free from any complaints and relapses. The tail-gut cyst is a very rare entity which arises from the inadequate involution of the tail-gut during embryonal development. A malignant transformation occurs in 10% of the cases. In the case of recurrent perianal fistulas and cystic masses between the rectum and os sacrum or os coccygeum, a tail-gut cyst should be taken into consideration, the goal being its complete removal.

Adenocarcinoma↗
PubMed2000

Outcome after surgery for primary hyperparathyroidism: ten-year prospective follow-up study.

Clinical outcome after surgery for primary hyperparathyroidism was evaluated in a prospective long-term, follow-up study. From August 1, 1987 to August 31, 1998 a total of 360 patients were prospectively investigated and included in a follow-up study. All patients underwent follow-up examinations at regular surveillance intervals. The postoperative course is known for 94.5% of all patients. Follow-up was 1 month to 10 years (median 24 months; mean 34.5 +/- 29.8 months). Asymptomatic primary hyperparathyroidism was rare (6%), and its true frequency could be confirmed only postoperatively because some of the patients were unaware of mild symptoms of hypercalcemic syndrome prior to surgery. Surgical cure was obtained in 97.7% of patients after initial cervical exploration; and successful parathyroidectomy provided long-term relief of symptoms. Within 2 years postoperatively, 84% of the patients recovered fully from hypercalcemic syndrome: in 58% of these patients recovery occurred within the first month after surgery. Skeletal symptoms persisted in 24% of patients 2 years postoperatively. To date no patient has developed recurrence of primary hyperparathyroidism. During follow-up in our study population mortality was significantly higher than the expected mortality risk for the German population as a whole (p = 0.00024). The present prospective follow-up study yielded conclusive outcome research data after operative therapy for primary hyperparathyroidism. The high cure rate and low morbidity, as well as the increased mortality, in our study population during follow-up after successful operative therapy for the disease emphasize the importance of early diagnosis and early surgical treatment for primary hyperparathyroidism, even in the absence of manifest symptoms.

Female↗
PubMed2000

Cryotherapy for liver metastases.

Cryotherapy is undergoing a renaissance in the treatment of nonresectable liver tumors. In a prospective case control study we assessed the morbidity, mortality, and efficacy of hepatic cryotherapy for liver metastases. Between January 1996 and September 1999 a total of 54 cryosurgical procedures were performed on 49 patients (median age 66 years, 21 women) with liver metastases. Patient, tumor, and operative details were recorded prospectively. Liver metastases originated from colorectal cancer (n=37), gastric cancer (n=3), renal cell carcinoma (n=2), and other primaries (n=7). Median follow-up was 13 months (1-32). The median number of liver metastases was 3 (range 1-10) with a median diameter of 3.9 cm (range 1.5-11). Twenty-one patients (43%) had cryoablation only, and 28 (57%) had liver resection in combination with cryoablation. One patient (2%) died within 30 postoperative days. Another 13 patients (27%) developed reversible complications. In 19 of 25 patients (76%) with preoperatively elevated serum CEA and colorectal metastases it returned to the normal range postoperatively. Twenty-eight patients (57%) developed tumor recurrence, eight of which with involvement of the cryosite. Overall median survival patients was 23 months, and survival in patients with colorectal metastases was 29 months. Hepatic cryotherapy is associated with tolerable morbidity and mortality. Efficacy is demonstrated by tumor marker results. Survival data are promising; however, long-term results must be provided to allow comparison with other treatment modalities.

Adult↗
PubMed2000

Changes in the extracellular matrix of the vein wall--the cause of primary varicosis?

BACKGROUND: Conflicting theories on the development of primary varicosis have led to the molecular biological investigation of the vein wall or, more accurately, of the extracellular matrix. It was the aim of this study to quantify matrix expression and to compare pathological changes in the vein wall with valve-orientated staging of varicosis, in order to determine indicators of the primary cause of varicosis. MATERIALS AND METHODS: Three hundred seventy-two tissue specimens of greater saphenous veins were obtained from 17 patients with varicosities and categorised according to Hach stage and procurement site. The specimens were compared with 36 specimens collected from six patients without varicosities, incubated with fluorescence-stained antibodies for collagen 4, laminin, fibronectin and tenascin prior to being assessed with confocal laser scan microscopy. In addition, 22 vein specimens (16 varicose, 6 normal veins) serving as negative controls were investigated. RESULTS: Image analysis and statistical evaluation showed that compared with normal veins, varicose veins are associated with a significant increase in matrix protein expression for collagen 4, laminin and tenascin. A trend towards an increase in matrix expression was further observed for fibronectin. There was, however, no difference between varicose veins and clinically healthy vein segments inferior to a varicose segment. CONCLUSION: If the findings of the present investigation can be confirmed by other studies, alterations in the vein wall may be regarded as the primary cause of varicosis and valvular insufficiency as the result of these changes.

Extracellular Matrix↗
PubMed2000

[Surgical therapy of primary hyperparathyroidism. Quality of life after 10 years prospective observation].

AIM OF THE STUDY: The quality of life after surgery for primary hyperparathyroidism was evaluated in a prospective long-term follow-up study. PATIENTS AND METHODS: Altogether 383 patients, 374 with the first manifestation, 6 with recurrent and 3 with persistent disease, who underwent operation from August 1, 1987 to February 15, 1999 were prospectively investigated and included in a long-term follow-up study. All patients underwent reexaminations at regular surveillance intervals. The postoperative course is known in 93.7% of all patients. We carried out 1,504 follow-up examinations (per patient: 1-12, median 4). The follow-up period ranged from 1 month to 10 years with a median of 24 months (mean 34.5 +/- 29.8 months). RESULTS: The true frequency of asymptomatic primary hyperparathyroidism could be confirmed only postoperatively, because a part of the patients were unaware of mild symptoms of hypercalcaemic syndrome prior to surgery. Therefore the prevalence of asymptomatic primary hyperparathyroidism was 5.6% in our patients. Surgical cure was obtained in 97.6% of patients after initial neck exploration. Successful parathyroidectomy provided long-term relief of symptoms in our patients. In 58% of the patients with hypercalcaemic syndrome recovery occurred within the first month after surgery. Bone and joint pain persisted for a longer period of time and was present in 24% of patients two years after the operation. During the follow-up period the mortality of our study population was significantly higher (p = 0.00024) than the expected mortality risk for the German population as a whole. CONCLUSIONS: The present prospective follow-up study yielded conclusive outcome research data after operative therapy for primary hyperparathyroidism. The high biochemical cure rate with long-term relief of symptoms, as well as the increased mortality after successful parathyroidectomy emphasize the importance of early diagnosis and early surgical treatment for primary hyperparathyroidism, even in the absence of manifest symptoms.

Adult↗
PubMed2000

[Endoscopic obesity surgery: gastric banding. A new trend without scientific basis?].

Indication for operation in morbid obesity is a body mass index greater than 40 kg/m2. Various operative procedures such as vertical banded gastroplasty and gastric bypass are used for therapy. Since 1994 the laparoscopic performed gastric banding is an alternative to conventional techniques. The mortality rate of this technique is below 1%, summarizing data from the literature of 905 patients the complication rate ranged to 24%. These results are comparable to conventional operations. Regarding the weight loss the results are comparable to the vertical banded gastroplasty. 80% of the patients loss 60% of their excess weight at 12 months. The rate of conversion to open procedure is low and ranges to 2.4%. Especially in obese patients the laparoscopic approach offers the well known advantages of endoscopic procedures. Open questions are the long-term effects and complications of laparoscopic gastric banding.

Adolescent↗
PubMed2000

[Conservative and surgical antireflux therapy as prevention of carcinoma].

INTRODUCTION: Based on findings in literature, the effectiveness of the medical versus operative antireflux therapy was examined as a prophylaxis to impede the formation of an adenocarcinoma in the case of Barrett esophagus. MEDICAL ANTIREFLUX THERAPY: Despite reports of success following the administration of Omeprazole, the inhibition of acid secretion does not lead to the regression of the endobrachyesophagus for most patients. The partial shortening of the Barrett segment is reported in up to 78% of cases, however the precancerous changes of the distal esophagus are not eliminated. In spite of medical therapy with proton pump inhibitors, up to 6% of dysplasias become metaplasias per year. In 3% of the patients, an adenocarcinoma arises. OPERATIVE ANTIREFLUX THERAPY: It is reported in the literature that there is a partial regression of the endobrachyesophagus in up to 34% of cases and complete regression in up to 11% of cases following operative antireflux therapy. Despite a macroscopically unchanged Barrett segment following a fundoplication or semifundoplication procedure, a complete regression of minor dysplasias and the complete regression of intestinal metaplasias is possible. In only 30% of patients, postoperative atypical findings were ascertainable. Nevertheless, a severe change can appear in the cylinder epithelium of the remaining Barrett segment following an operative antireflux therapy, up to the formation of an adenocarcinoma (1-9%). For this reason, the patients must be endoscopically and histologically examined at regular intervals following the antireflux operation. CONCLUSION: In the case of evidence of severe dysplasias in the Barrett segment, the attempt at carcinoma prophylaxis by means of antireflux therapy is no longer indicated. With the appearance of mild dysplasias and complete intestinal metaplasias in the Barrett esophagus, an antireflux operation can lead to a reduction in the grade of atypical cells. In cases of existing metaplasia or the presence of mild dysplasias, the administration of proton pump inhibitors or H2 blockers is only indicated as a symptomatic therapy.

Adenocarcinoma↗
PubMed2000

Calcium prevents loss of glutathione and reduces oxidative stress upon reperfusion in the perfused liver.

BACKGROUND: Addition of 1.5 mM Ca2+ to the preservation solution (UW) during static cold rat liver preservation have been shown to improve liver function upon reperfusion. Effects of adding calcium to the perfusate during liver machine perfusion are yet not described. METHODS: A recently developed model for rat liver machine perfusion (hypothermic oscillating oxygenated liver perfusion) was used to perfuse rat livers with calcium free modified UW solution (Group 1) or with modified UW + 2 mM CaCl2 (Group 2) for a period of 10 h (4 degrees C). In both experimental groups an acellular reperfusion at 37 degrees C with Ringer solution and 50 microM ferricytochrome c over a period of 90 min was performed. Liver and perfusate samples were taken before and after reperfusion to assess the cellular energy charge, metabolites, parameters of oxidative stress, cellular calcium, bile flow, enzyme release and TNF alpha. RESULTS: Hypothermic perfusion with oxygenated calcium free modified UW solution resulted in depletion of cellular calcium and glutathione. Upon reperfusion bile function was inhibited in spite of a sufficiently reloaded energy charge and low LDH release. In contrast machine perfusion with modified UW solution +2 mM Ca2+ prevented the loss of both, cellular calcium and glutathione during the preservation period and led to sufficient bile flow and less release of superoxide anions upon reperfusion. CONCLUSIONS: The loss of cellular calcium and glutathione during oxygenated machine liver perfusion appeared to be reducible by adding 2 mM Ca2+. Furthermore, upon reperfusion, livers with preserved cellular calcium demonstrated significantly lower oxidative stress and an improved liver function.

Animals↗
PubMed1999

Reduced oxidative stress during acellular reperfusion of the rat liver after hypothermic oscillating perfusion.

BACKGROUND: ATP resynthesis during reperfusion after liver preservation has been shown to be well correlated with the function of transplanted grafts. Nevertheless, the advantages of a cellular energy charge loading during the preservation period are yet not fully understood. This study evaluates the effects of different nucleotide levels at the end of preservation on metabolic changes and oxidative stress during reperfusion. METHODS: Two experimental groups were chosen reflecting different energy charge states after preservation: static cold storage for 10 hr and hypothermic oxygenated oscillating perfusion for 10 hr. In both experimental groups, normothermic ex vivo acellular reperfusion over 40 min was performed. A third group consisted of nonpreserved livers similarly reperfused for 40 min. Superoxide formation was detected by the superoxide dismutase inhibitable reduction of ferricytochrome c added to the normothermic perfusate. RESULTS: Superoxide formation and lipid peroxidation malondialdehyde were significantly lower during reperfusion after the energy charge loading before reperfusion by the hypothermic oscillating perfusion technique. However, oxygen radical formation, liver cell injury (lactate dehydrogenase [LDH] release), and TNFalpha release were significantly higher in energy charge-depleted groups (nonpreserved and cold stored livers). CONCLUSIONS: Hypothermic oscillating oxygenated perfusion led to the elevated energy charge during preservation and led to reduced oxygen radical formation as well as less lipid peroxidation during reperfusion, in contrast to cold stored livers and nonpreserved livers. This suggests a correlation between the energy charge before reperfusion and oxygen radical formation as well as liver injury at reperfusion.

Animals↗
PubMed1999

[Littoral-cell angioma--a rare differential diagnosis on splenic tumors].

UNLABELLED: HISTORY AND PRE-ADMISSION FINDINGS: Routine abdominal sonography of a 51-year-old man 6 years after removal of the right testis and radiotherapy for a seminoma revealed a 3 cm mass within the spleen. INVESTIGATIONS: All biochemical tests were normal. Computed tomography (CT) and magnetic resonance imaging confirmed the tumour which had not been present on the CT before the seminoma had been treated. No other space-occupying lesions were found in the thorax and abdomen. TREATMENT AND COURSE: A splenectomy was performed because a metachronous metastasis of the seminoma was suspected. The operation and subsequent course were uneventful. At operation the tumour had been diagnosed as an haemangioma because of its gross appearance, but histological and immunohistochemical examination revealed a littoral cell angioma. CONCLUSION: The littoral cell angioma is a benign vascular lesion in the red pulp of the spleen, which may be caused by different stimuli such as chronic infection or tumours. This case illustrates, that this tumour should be considered in the differential diagnosis of an unclear neoplasm in the spleen.

Diagnosis, Differential↗
PubMed1999

Treatment of tumors of the pancreatic head with suspected but unproved malignancy: is a nihilistic approach justified?

The aim of the present prospective observational study was to evaluate the accuracy of preoperative imaging studies and the outcome of patients after pancreaticoduodenectomy for suspected but unproved malignancy. Pancreaticoduodenectomy was performed in 186 patients with a suspected but histologically unproved malignancy of the pancreatic head: 86 with a ductal pancreatic carcinoma, 56 with a periampullary tumor, 18 with a cystadenocarcinoma, 13 with a rare malignant tumor or a metastasis, and 13 with a benign tumor. An accurate differentiation between a ductal pancreatic carcinoma and a nonductal tumor or a benign tumor was neither possible with tumor marker CA 19-9 nor with diagnostic imaging. After pancreatoduodenectomy the postoperative morbidity and mortality were 27.3% and 2.6%, respectively. The median survival time for patients with a ductal pancreatic carcinoma was 9.2 months; for those with nonductal tumors it varied (depending on the histology) between 24.5 and 44.6 months. These results show that a nihilistic approach in the case of tumors of the pancreatic head with suspected but unproved malignancy is not justified. Pancreaticoduodenectomy should be performed for any pancreatic tumor even without histologic confirmation if an experienced pancreatic surgeon cannot exclude pancreatic carcinoma.

Adolescent↗
PubMed1999

Factors influencing morbidity and mortality after pancreaticoduodenectomy: critical analysis of 221 resections.

A critical analysis of morbidity and mortality for pancreatico-duodenectomy was performed on 221 patients. During the 1960s and 1970s, the morbidity and mortality for pancreaticoduodenectomy were so high that many thought the operative procedure ought to be abandoned. During the 1980s, however, many centers reported mortality rates around 5% and a morbidity of 25% to 35%. Others still reported a mortality of more than 10% and a morbidity of up to 65%. The reasons for these discrepancies are of major interest. In a prospective case-control study 760 patients with malignant and benign diseases of the pancreas were treated in our hospital between September 1, 1985 and April 30, 1997. In 221 cases (128 men, 93 women; mean age 61 years, range 23-83 years) a partial (n = 209) or total (n = 12) pancreaticoduodenectomy, in 12 cases combined with portal vein resection, was performed. Surgical complications were seen in 25%, but less than half of them were severe. General complications were seen in 18.5%. The 30- and 90-day mortality rates were 3.1%, and 5.7%, respectively. In a regression analysis the intraoperative blood loss, preoperative serum bilirubin, diameter of the pancreatic duct, and occurrence of surgical and nonsurgical complications had an independent influence on mortality. In addition to the experience of the surgeon in selecting the patients and his or her personal technical skills when performing a pancreaticoduodenectomy, better anticipation and management of postoperative complications is essential for improving the results of this operation.

Adult↗
PubMed1999

[Palliative therapy of gastrointestinal obstruction].

Gastrointestinal obstruction is a frequently observed emergency with tumor patients. In addition to tumor relapse, the development of a second tumor or intraperitoneal tumor spreading, and benign alterations in advanced tumor stages (radiogenic stenosis, adhesions) may also be the cause for the obstruction. The main objective of therapy is an attempt to eliminate the intestinal obstruction through surgery. If this is not possible because of advanced intra-abdominal tumor expansion, several endoscopic or interventional radiology methods, and drugs are available, that are used on an individual basis and based on prevailing experience to relieve the patient's condition.

Endoscopy↗
PubMed1999

[Bilateral elastofibroma dorsi].

A 75-year-old man had painless, slowly enlarging tumors in the right and left infrascapular regions. Clinically, the tumors were nontender and semimobile. MR imaging and the operative exploration revealed tumors infiltrating the lateral thoracic muscles and periost of the scapula and underlying ribs. At surgery, the tumors were thought to be malignant, most likely liposarcomas. The histological examination showed the characteristic appearance of elastofibromas with spindle-shaped fibroblasts, which were separated by thick eosinophilic collagenous and elastic fibers. Elastofibromas are benign mesenchymal soft-tissue lesions that mainly affect elderly women. In 10 % of the patients bilateral, often asynchronous tumors are seen. Ninety-nine percent of the lesions are located in the subscapular region. Occasional elastofibromas have been described in the extremities, head, and in the abdominal and thoracic cavities.

Aged↗
PubMed1999

[Early diagnosis and reoperation in persistent primary hyperparathyroidism].

INTRODUCTION: The persistence rate of primary hyperparathyroidism after cervical exploration was estimated and early diagnosis and reoperation were evaluated in a prospective study. METHODS: Between 1 August 1987 and 31 October 1998, 370 patients underwent surgery. The postoperative course is known in 94.6 % of these patients (follow-up 1 month-10 years, median 24 months). RESULTS: Cervical exploration was successful in 97.5 % (n = 353) of the 361 patients with the first manifestation of primary hyperparathyroidism and in all patients with recurrence or persistence of the disease after initial operation elsewhere. In persistent primary hyperparathyroidism serum calcium levels remained elevated 4 days after surgery (n = 9, 2.5 %). Localization studies, preferably with (99m)Tc-MIBI-scintigraphy were attempted during the first postoperative week and could be performed in 4 patients. Four patients wished the procedure to be performed later. CONCLUSION: Within one week after the initial intervention the diagnosis of persistent primary hyperparathyroidism can be established and localization studies as well as cervical reexploration can be carried out. An interval of 3 months from the initial operation to reexploration of the parathyroid area is recommended if the reexploration is impossible within one week. Mediastinal reoperations or surgical interventions in the neck sparing the perithyroid area may be carried out without consideration of specific intervals.

Adenoma↗
PubMed1999

Interleukin-6 and tumor necrosis factor-alpha levels following hepatic cryotherapy: association with volume and duration of freezing.

Although morbidity following cryotherapy is usually minor, a syndrome of multiorgan failure and disseminated intravascular coagulation (DIC) has been described and referred to as the cryoshock phenomenon. We hypothesized that mediators similar to those in septic shock may be involved in this syndrome. In this study we aimed to assess the plasma concentrations of the cytokines tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) following hepatic cryotherapy and to relate them to the duration and volume of freezing and to hepatocellular injury. Between April and December 1997 blood samples were taken preoperatively and at different times postoperatively from patients undergoing hepatic artery catheter-insertion (HAC) (n = 15), cryotherapy (n = 5), liver resection (n = 9), liver resection and edge cryotherapy (n = 7), or liver resection and cryotherapy of additional lesions (n = 9). They were analyzed for serum aspartate transaminase (AST) and plasma TNF-alpha and IL-6 levels. There was a significant association (Pearson correlation) of serum AST levels 1 hour postoperatively with plasma TNF-alpha and IL-6 levels at the end of the procedure. In patients undergoing cryotherapy or resection with cryotherapy of additional lesions (n = 14), the volume and duration of hepatic freezing were significantly associated with postoperative serum AST and plasma TNF-alpha and IL-6 levels at various postoperative times. Hepatic cryotherapy is followed by cytokine release, with postoperative plasma TNF-alpha and IL-6 levels associated with the degree of hepatic cryotrauma. These mediators may be involved in the occurrence of cryoshock following large-volume hepatic freezing.

Aspartate Aminotransferases↗