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Biomedical subjects

T Junginger

Publications and source records attributed to T Junginger.

At least 91 records · Page 5Linked to original sources
PubMed1999

Modified cryopreservation and xenotransplantation of human parathyroid tissue.

INTRODUCTION: A modified cryopreservation technique for human parathyroid tissue was compared with the standard method using a programmed freezer. METHODS: Total parathyroidectomy was performed in three groups of 6-week-old Rowett nude rats. Group I (control) underwent no transplantation of parathyroid tissue (n=9). After 10 days, the rats of groups II (n=15) and III (n=15) underwent xenotransplantation of 20 mg cryopreserved human parathyroid tissue, which had been stored in liquid nitrogen at -196 degrees C for 1-22 months prior to xenotransplantation. The parathyroid tissue was derived from 15 parathyroidectomized patients with renal hyperparathyroidism. Two tissue samples were obtained from every patient. One sample from every patient was cryopreserved by means of the technique of programmed cryopreservation: programmed freezing of human parathyroid tissue at a controlled rate of -1 degrees C/min to -80 degrees C prior to transfer to liquid nitrogen (group II). The second sample from every patient was cryopreserved by means of a modified cryopreservation technique: immediate placement of human parathyroid tissue in a freezer at -20 degrees C and transfer to liquid nitrogen after 2 h (group III). Calcium and intact parathyroid hormone concentrations in serum were determined over a period of 60 days. Furthermore, individual differences in the calcium concentrations were assessed for each rat on the basis of the calcium levels recorded preoperatively and at day 60. RESULTS: All animals in the control group developed hypocalcemia. Serum calcium concentrations returned to normal levels 60 days after xenotransplantation of parathyroid tissue, which had been cryopreserved using the modified technique (group III) in 12 of 15 rats (80%). At day 60, serum calcium had normalized in 10 of 15 rats (67%) after xenotransplantation of parathyroid tissue cryopreserved using programmed freezing (group II). After modified cryopreservation (group III), the median individual difference in the calcium concentrations was -0.16 mmol/l after programmed freezing (group II). At the end of the study, a median level of human intact parathyroid hormone of 3.5 pg/ml and 2.4 pg/ml was estimated for groups II and III, respectively. There was no statistical significant difference of the individual differences in the calcium concentrations or of the levels of human intact parathyroid hormone between groups II and III. CONCLUSION: Human parathyroid tissue was successfully xenografted in the present experimental study. The results obtained after cryopreservation using the described modified technique were equivalent to those recorded after controlled freezing in a programmed freezer. The simplified cryopreservation technique therefore appears to be suitable for human parathyroid tissue.

Animals↗
PubMed1999

The examiner's learning effect and its influence on the quality of endoscopic ultrasonography in carcinoma of the esophagus and gastric cardia.

BACKGROUND: The preoperative diagnosis of tumors of the esophagus and the gastric cardia is an important element in their stage-oriented therapy. The goal of the present study was to evaluate the accuracy of endosonographic ultrasound (EUS) and to test its usefulness in tumor staging and the assessment of operability. METHODS: A total of 139 tumors were scanned via EUS by one examiner </=14 days prior to resection (TNM staging per UICC, 1987). RESULTS: The accuracy for completely traversable tumors was 60.8% for T1, 82.1% for T2, 77.5% for T3, and 33% for T4 stages. This accuracy was somewhat reduced in cases of nontraversable tumor stenosis (51.9%). In T staging, a significant case-dependent improvement in accuracy to 89.5% was found; this was regarded as a learning effect. In N staging, we considered only those tumors that were resected by the transthoracic approach with systematic node dissection and complete EUS (n = 80). N-stage accuracy (T1-T4) was 71.3%, and no improvement could be shown. To assess operability, discrimination between T1/T2 and T3/T4 tumors is crucial. Accuracy, sensitivity, and specifity can thus be improved significantly. CONCLUSIONS: The quality of EUS depends on the experience of the examiner. Reliable results can be obtained after >75 examinations have been done. EUS is a valuable tool in tumor staging when it is performed by an experienced examiner or under the direct supervision of such a person.

Cardia↗
PubMed1999

Alterations of the extracellular matrix of venous walls in varicous veins.

BACKGROUND: Investigation of changes in normal veins which result in the formation of varicosis led to examination of the histological organisation of the vessel wall and to histomorphological alterations in the region of the extracellular matrix. PATIENTS AND METHODS: The expression pattern of the matrix proteins collagen IV, fibronectin, laminin, tenascin, and undulin as well as the structure and orientation of elastic fibres were determined by means of immunohistochemical staining. RESULTS: All varices exhibited an increased expression pattern in comparison to healthy veins. The venous vessel wall was often non-homogeneously enlarged. The intima was always more involved than the media and showed enhanced accumulation, whereas, the adventitia was not influenced by the pathological process. Collagen IV exhibited an early accumulation, especially in the subendothelial region. The other matrix proteins demonstrated an increase in fibre propagation parallel to the enlargement of the vessel wall. Essentially, an augmented de novo synthesis of fibres with an irregular arrangement and the formation of local plaques was found. Elastic fibres were enhanced by slight involvement of the vessel wall and were reduced and fragmented during increased involvement of the venous wall which explained the rigidity of varices in contrast to normal veins.

Elastic Tissue↗
PubMed1999

Prospective study of parathyroid graft function in patients with renal hyperparathyroidism after total parathyroidectomy and heterotopic autotransplantation by measurement of the intact parathyroid hormone concentrations in both antecubital veins.

OBJECTIVE: Evaluation of the value of gradients for intact parathyroid hormone after total parathyroidectomy and heterotopic autotransplantation for renal hyperparathyroidism. DESIGN: Prospective long-term follow-up study. SETTING: Teaching hospital, Germany. SUBJECTS: A total of 115 patients operated on for renal hyperparathyroidism between 1 August 1987 to 15 August 1997. INTERVENTIONS: 100/115 had total parathyroidectomy with autotransplantation. MAIN OUTCOME MEASURES: Analyses of serum calcium, alkaline phosphatase, and intact parathormone in serum 1, 4, 8, 12, 18 and 24 months postoperatively and annually thereafter. Parathormone gradients were calculated as the ratio of the parathormone concentrations in the antecubital venous blood of the grafted and the non-grafted arm. RESULTS: During follow-up (mean 32 months, range 1 month to 9 years), 111 of the 115 patients had one to 10 re-examinations (mean: 4) and in the patients who had had total parathyroidectomy with autotransplantation a total of 437 gradients could be calculated, 91% of which were < or =20. Postoperative hypocalcaemia caused by calcium deficiency of the skeleton led to an increase in parathormone secretion and gradients. Increasing parathormone gradients during follow-up as a result of excessive parathormone secretion in the grafted-arm indicated graft-dependent recurrence. In 6 of the 9 patients with graft-dependent recurrences the gradients exceeded 20. CONCLUSION: The combined sequential assessment of gradients for intact parathyroid hormone and of serum calcium concentrations permits objective evaluation of parathyroid graft function.

Humans↗
PubMed1999

Carcinoma of the hypopharynx and the cervical oesophagus: a surgical challenge.

OBJECTIVE: To report our results after reconstruction of the upper digestive tract for locally advanced carcinoma of the hypopharynx and cervical oesophagus. DESIGN: Open study. SETTING: Teaching University hospital, Germany. SUBJECTS: Of the 517 patients who presented with carcinoma of the oesophagus between September 1985 and March 1997, 16 had a locally advanced tumour of the hypopharynx and 25 of the cervical oesophagus. INTERVENTIONS: Free jejunal grafts were used after circular resection in all patients with carcinoma of the hypopharynx, and for the 3 with oesophageal carcinoma in whom we obtained adequate resection margins. In the remainder stomach was used in 21 and colon in 1. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: After jejunal grafting 1 patient died within 30 days and 2 died in hospital. After gastric or colonic reconstruction 2 patients died within 30 days and 4 in hospital. There was 1 anastomotic leak, 1 transplant became necrotic and had to be replaced, in 2 patients the recurrent nerve was damaged, 1 patient developed a wound infection and 1 a cardiac infarction. After gastric or colonic replacement 7 patients had paralysed recurrent laryngeal nerves, there was 6 anastomotic leaks, 1 chylous leak, 1 haemorrhage, and in 1 the transplant necrosed. CONCLUSION: Despite the fact that we compared tumours in different sites, these results suggest that the jejunal graft is safer for upper oesophageal and hypopharyngeal reconstruction.

Adenocarcinoma↗
PubMed1999

Prognostic value of immunohistochemical expression of beta-1 integrin in pancreatic carcinoma.

BACKGROUND: Prognostically relevant factors based on the histological assessment of the resected pancreas are known. However, the knowledge of additional factors associated with the prognosis is helpful in planning the therapy for an individual patient. beta1 Integrin expression is known to have a prognostic influence in some malignant tumors. No data are, however, available on the prognostic value of beta1 integrins in pancreatic carcinoma. METHOD: We investigated paraffin-embedded specimens of 19 patients undergoing surgical treatment for periampullary carcinoma and of 42 patients for ductal pancreatic carcinoma by immunohistochemistry to assess the expression pattern and the prognostic impact of beta1 integrins. Neither histomorphological parameters nor the survival time of the patients were known at the time of the investigation. RESULTS: No correlation was established between histomorphological parameters and beta1 integrin expression in periampullary or ductal pancreatic carcinoma, respectively. Patients with periampullary carcinoma and beta1 integrin overexpression had a significantly poorer prognosis than patients without overexpression of beta1 integrins (median survival: 18.3 vs. 58.4 months). In ductal pancreatic carcinoma beta1 integrin expression had no influence on prognosis. CONCLUSION: beta1 Integrins exert an influence on prognosis in periampullary carcinoma but not in ductal pancreatic carcinoma. However, further investigations in larger patient samples are required to confirm these results.

Adult↗
PubMed1999

Prognostic significance of tumor ploidy and histomorphological parameters in adenocarcinoma of Barrett's esophagus.

BACKGROUND: Despite recent advances in surgical and multidisciplinary treatment, the prognosis for patients with adenocarcinoma of Barrett's esophagus remains poor. The low prognostic accuracy of even surgical pathologic TNM staging suggests that additional parameters are necessary in determining the prognosis. METHOD: In a retrospective analysis of 50 patients who underwent transhiatal or transthoracic esophageal resection due to adenocarcinoma of Barrett's esophagus, a quantitative DNA analysis using image cytometry was performed in addition to the TNM classification and usual morphological criteria. At the time of DNA analysis the histomorphological parameters and survival time were not known. RESULTS: The main prognostic parameter was the curativity (R classification) of the operation. Considering only patients after R0 resection, a multivariate analysis identified the DNA ploidy, the depth of tumor infiltration and distant metastases of prognostically independent factors. Furthermore, within pT2 and pT3 tumors, which account for 80% of all the tumors, DNA ploidy allows an additional prognostic differentiation which is not possible with pT stage alone. CONCLUSION: Patients with a diploid or tetraploid tumor without distant metastasis and a tumor stage pT1-pT3 should have curative (R0) resection. In case of an aneuploid DNA content or a pT4 tumor resection alone shows no advantage as compared to palliative nonoperative procedures.

Adenocarcinoma↗
PubMed1999

[99mTc-MIBI-scintigraphy before parathyroid surgery?].

AIM: In a non prospective study the value of preoperative parathyroid imaging with 99mTc-MIBI-scintigraphy was evaluated. PATIENTS AND METHODS: From August 1, 1987 to December 15, 1997 453 patients were operated on for hyperparathyroidism. Preoperatively 116 patients underwent 99mTc-MIBI-scanning, which had been carried out by several institutes. RESULTS: Primary hyperparathyroidism. Sensitivity of MIBI-scintigraphy in solitary parathyroid adenoma (n = 48) and first-time cervical exploration was 54% (25 true positive scans) and overall sensitivity was 50% (25 true positive scans in 53 patients). In 6 patients with persistence or recurrence of primary hyperparathyroidism MIBI-scintigraphy was true positive (sensitivity 100%). Neither the volume nor the weight of the adenomas influenced the result of MIBI-scanning. There was no correlation between preoperative serum concentrations of calcium and intact parathormone and sensitivity of MIBI-scintigraphy. Renal hyperparathyroidism. Before first-time cervical exploration sensitivity of MIBI-scintigraphy (n = 40) for detecting all abnormal parathyroid glands in the presence of diffuse hyperplasia yielded only 10%. In 5 of 7 patients, who underwent reexplorations of the neck or mediastinum for persistence or recurrence of renal hyperparathyroidism MIBI-scintigraphy was true positive (sensitivity 71%). The sensitivity for detection of hyperplastic parathyroid glands correlated with the weight as well as with the volume of the glands (p < 0.001). The weight of imaged glands ranged from 0.21 to 9.76 g, median 1.27 g and their median volume was 1.12 ml (range: 0.04-15.63 ml). For non imaged glands a median weight of 0.49 g and a median volume of 0.3 ml (ranges: 0.03-10.34 g, 0.009-9.8 ml, respectively) could be estimated. CONCLUSIONS: First-time cervical exploration for hyperparathyroidism can be carried out with a high success rate and without any preoperative localization study. Before recurrent parathyroid surgery we recommend 99mTc-MIBI-scintigraphy because of its > 90% sensitivity.

Humans↗
PubMed1999

[Risk of malignant degeneration of preoperatively-classified benign large sessile rectal polyps. A comparison with adenoma size].

From January 1986 to December 1995 307 patients with preoperatively as benign classified rectal polyps underwent transanal endoscopic microsurgery or transanal excision at the Hospital of General and Abdominal Surgery, Johannes Gutenberg-University Mainz. Mean polyp size was 3.9 cm in diameter. Postoperatively in 233 patients (75.9%) a benign rectal adenoma was found. In 69 patients (22.5%) with the preoperative diagnosis "benign rectal adenoma" the postoperative histologic result was a carcinoma. No residual polyps were encountered on snare excision in 5 patients (1.6%) with inconclusive evidence of surgical margin involvement. The mean size of malignant polyps was 3.4 cm and significantly below the mean size of benign polyps (4.1 cm, p = 0.009). Especially in polyps with a size to 1 cm and from 1 to 2 cm in diameter the part of malignant rectal polyps was unexpected high (8/15 polyps, 53.3%, respectively 16/37 polyps, 43.3%. Patients with preoperatively as benign classified large sessile rectal polyps had a high risk of malignancy even when polyp's size was small. Therefore in toto excision has to be done also in small polyps.

Adenocarcinoma↗
PubMed1999

[Breast cancer screening in surgical patients].

Between January and August 1996, 304 patients of the Department of General and Abdominal Surgery of the University of Mainz who were at least 40 year old, were interviewed about their breast cancer screening behavior. The aim of our investigation was to evaluate the attitude of the target population to breast screening and the value of breast palpation, completed with mammography, during the women's treatment in hospital. 168 (55%) of the interviewed women reported that they had a yearly clinical breast examination in the past. All patients underwent a clinical breast examination. 185 (60%) did not have a mammography in the past or within the past 2 years. These women were offered a mammographic examination during their treatment in the hospital. The investigation revealed one invasive breast cancer. 13 patients had abnormal mammographic or sonographic findings. Our investigation shows, that the compliance of the target population for breast cancer screening is low. Therefore it is necessary to point out the value of breast cancer prevention with clinical examination and mammography also for patients treated in the hospital for an other disease. Every female patient should undergo breast examination. But early detection of breast cancer before micrometastases have occurred is only possible by mammography.

Breast Neoplasms↗
PubMed1999

[Rectal carcinoma. Optimizing therapy by knowledge of anatomy with special reference to the mesorectum].

The connective tissue spaces of the pelvis and pelvic floor originate from an urogenital and perirectal mesenchymal cell complex, which can be clearly discerned. In the adult, the final compartments, which arise from these distinct tissue complexes, are still functionally separated. The perirectal tissue gives rise to the rectal fascia or rectal adventitia, also known as mesorectum. The connective tissue space between rectal and parietal pelvic fascia can be dissected as a plane free of vessels and nerves. Surgical dissection along this plane with complete mesorectum excision results in reliable excision of all relevant lymphatic pathways with extensive preservation of continence and sexual function.

Adult↗
PubMed1999

[Rectal carcinoma. Optimizing therapy by local excision].

The results of local excision and radical surgery in patients with T1-carcinomas of the rectum were compared. In a retrospective study (1.1.1985-1.7.1997) the results obtained in 107 patients with T1-rectal carcinoma ("low risk" T1: n = 83, "high risk" T1: n = 24) undergoing local excision or radical surgical therapy were compared. The complication rate in patients undergoing local excision was 3.3% (2/60) and ranged at 19% (9/47) in the group treated with radical surgery. Two out of 47 patients (4.2%) died after radical resection; there were no deaths after local excision. With regard to the actuarial 5-year survival rate, in the group with "low risk" T1 carcinoma no difference was observed between patients treated with local excision (79%) or radical resection (81%) (p = 0.72). In patients with "high risk" T1 carcinoma lymph node metastases were identified in 4 out of 11 patients undergoing radical resection (36%). 4 out of 13 patients with "high risk" T1 carcinoma treated by local excision developed recurrences, while none of the patients undergoing primary radical surgery had a recurrence. This underlines the necessity of radical surgery in "high risk" T1-carcinomas. Local excision for the treatment of "low risk" T1-carcinoma is associated with a significantly lower complication rate than the performance of a radical surgical therapy. There is no difference in five-year-survival between local and radical surgical therapy in patients with "low risk" T1 carcinoma.

Follow-Up Studies↗
PubMed1999

[Pulmonary complications following esophageal surgery. Significance of aspiration].

Objective of this study was to show the different causes and the importance of pulmonary complications after esophageal surgery and their management by general and intensive care measures. In the University Hospital for General and Abdominal Surgery of Mainz 222 patients were treated for esophageal cancer from 9/1985 to 5/1997. Data of 214 patients were available for this investigation. In 65 cases a transhiatal dissection (blunt dissection) and in 149 patients a abdomino-thoracic dissection were performed. 54 (25.2%) patients had to be reintubated. 30-day lethality was 7.9% (n = 17) and hospital lethality was 13.1% (n = 28). 82 (38.3%) patients developed pulmonal dysfunction (pneumonia) which was aggravated by a following ARDS in 16 patients (19.5%). 21 (25.6%) of these patients died. In only 24 (29.3%) patients an isolated pneumonia occurred without evidence of general or surgical complications. In 65 of 82 patients further microbiologically examinations were documented. In 39 (60%) cases gastrointestinal bacteria were found. Therefore aspiration or microaspiration respectively are considered to co-cause pulmonary complications. Postoperative psychosyndrome, recurrent nerve palsy and ASA-risk stratification were accompanied by elevated rates of pneumonia. Careful selection of patients for esophageal resection, atraumatic surgical technique and reduction of general and surgical complications and intensive care measures can help to avoid postoperative pulmonary complications. Reduction of mediators activated by surgical trauma is not feasible so in the moment prevention of aspiration seems to be the most effective therapy in the postoperative course.

Esophageal Neoplasms↗
PubMed1999

[Amputation due to chronic peripheral vascular disease. Risks and prognosis].

A series of 181 amputations in 156 patients treated between 1985 and 1996 because of chronic peripheral vascular disease was reviewed. 107 major amputations (above- and below-knee) and 74 minor amputations (foot and forefoot) were performed. 81% of the patient population had previous vascular operations. Complications, revisions and mortality of all patients were retrospectively analyzed. The operative mortality rate of major amputations was 20% and the operative mortality rate of minor amputations was 9%. By a vessel-reconstruction before amputation the complication- (wound healing) and revision-rate could be reduced. By examination of the family-doctors, the survival times of the patients and the rehabilitation status of 69 living patients were recorded. Minor amputations, below-knee amputations and knee-disarticulations had the best results of rehabilitation.

Adult↗
PubMed1998

Expression of CD44 variant proteins in adenocarcinoma of Barrett's esophagus and its relation to prognosis.

BACKGROUND: None of the commonly used staging criteria accurately determine the prognosis of a patient with adenocarcinoma of Barrett's esophagus. The authors therefore assessed the expression pattern and prognostic impact of CD44 standard and CD44 isoforms CD44v4, v5,v6,v7, and v10 in adenocarcinoma of Barrett's esophagus. METHODS: Specimens from 41 patients with adenocarcinoma of Barrett's esophagus who underwent esophageal resection were embedded in paraffin and studied immunohistochemically to determine the expression of CD44 splice variants. Histomorphologic parameters and survival time were not known at the time of the investigation. RESULTS: Correlations between favorable clinical or histomorphologic parameters and CD44s or any of the split variants could not be established. Down-regulation of CD44s and the split variant v10 was significantly correlated with pT classification. Furthermore, down-regulation of CD44v10 and up-regulation of CD44v7 were significantly correlated with ploidy. There was a significant correlation between CD44s and split variants in tumorous and nontumorous tissue from the same patient. Down-regulation of CD44s and CD44v4 had a significant influence on prognosis in that it was associated with shortened life expectancy. Multivariate analysis revealed that the expression of CD44v4 was an independent factor in prognosis. CONCLUSIONS: The results obtained for this small patient sample suggest that CD44v4 is a new independent prognostic parameter for adenocarcinoma of Barrett's esophagus that can be determined preoperatively by biopsy. It may therefore be helpful in planning therapy by allowing the identification of patients who may benefit from esophageal resection as well as those who are at high risk for morbidity and mortality even when the tumor is otherwise resectable. Further studies of larger patient samples are required to validate the results of the current study.

Adenocarcinoma↗