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T Junginger

Publications and source records attributed to T Junginger.

At least 109 records · Page 6Linked to original sources
PubMed1998

[Cryotherapy of liver metastases. Initial results].

PATIENTS AND METHOD: Between 1 Jan 1996 and 1 Apr 1998 29 patients underwent cryosurgical therapy for liver metastasis at the Department of Surgery at the University of Mainz. RESULTS: No complications occurred following cryosurgery alone (n = 12). Within the group of patients with a combined procedure (n = 11) 1 patient had temporary liver failure and 1 patient died of sepsis. Following freezing of the cutting zone (n = 6) 1 patient showed a bile fistula and 1 ascites. In 15 cases of 28 dismissed patients with remaining destroyed tumor tissue the follow-up showed no tumor recurrence (median follow-up 11 months). On the other hand 9 patients had a tumor recurrence within the liver, 3 patients at extrahepatic regions and 7 patients developed a tumor recurrence within the freezing zone.

Colorectal Neoplasms↗
PubMed1998

Resistance factors in colon cancer tissue and the adjacent normal colon tissue: glutathione S-transferases alpha and pi, glutathione and aldehyde dehydrogenase.

Glutathione S-transferases (GST) alpha and pi, glutathione (GSH) and aldehyde dehydrogenase (ADH) were determined in colorectal cancer tissue specimens and in the adjacent normal colon tissue. The median contents in normal and cancer tissue were 8.1 (2.3-30.3) (5-95% quantiles) and 15.1 (5.3-50.3) microg/mg protein for GST pi (P = 0.035), 0.0 (0.0-1.4) and 0.4 (0.0-3.5) microg/mg protein for GST alpha (P = 0.019), 7.3 (1.3-22.7) and 5.6 (2.3-26.0) microg/mg protein for GSH (P = 0.171) and 30.8 (13.0-42.0) and 23.2 (9.0-32.9) microg/mg protein for ADH (P = 0.0017), respectively. Thus, the mean GST alpha and pi both significantly increased in colon cancer compared to the adjacent normal tissue, which underlines their importance as possible resistance factors. A highly significant correlation was obtained between the GSH content in colon cancer and normal tissue (P = 0.0017). Thus, the constitutive GSH expression seems to be maintained during tumor development. A similar correlation was obtained for ADH (P = 0.0075), but the median ADH was lower in cancer tissue compared to the adjacent normal tissue (P = 0.0017). Contrary to GSH and ADH, GST pi did not correlate between normal and colon cancer tissue. Whereas GSH and ADH correlated in normal colon tissue (P = 0.014), no significant correlation for GSH and ADH was observed in colon cancer tissue (P = 0.109). In conclusion, significant correlations between colon cancer and normal tissue were obtained, suggesting that the expression levels of these resistance factors are maintained during carcinogenesis in most patients.

Aldehyde Dehydrogenase↗
PubMed1998

Rat liver preservation by hypothermic oscillating liver perfusion compared to simple cold storage.

Rat livers were preserved hypothermically for 10 or 24 h in vitro as if for transplantation. Two methods of preservation were compared using physiological and biochemical parameters: simple storage and oscillating perfusion. By measuring the nucleotides after preservation the calculated energy charge was significantly higher after 10 and 24 h of oscillating perfusion compared to the simple storage group. In addition, a significant energy charge loading was demonstrated by 10 h oscillating perfusion compared to the initial value prior to perfusion. The oscillating, computer-controlled perfusion permits continuous monitoring of perfusate temperature, O2 consumption, pCO2, portal vein pressure, and pH and also automatic sample collection and pH compensation. In addition, the perfusate can be easily exchanged by using two different pumps or be rewarmed by a heat exchanger. For measuring of short-lived metabolites (interleukins, oxygen radicals, prostaglandins) sampling can be performed directly out of the vena cava outflow. pH and temperature stability was maintained by a data acquisition and controlling system. Because of a special designed liver chamber a combination of storage and perfusion with or without substrates was possible. The demonstrated standardized perfusion technique was achieved by a combination of special equipment and computer-aided monitoring and allows further experiments to improve understanding of ischemic and reperfusion injury.

Adenine Nucleotides↗
PubMed1998

Cryoablation of human colorectal cancer in vivo in a nude mouse xenograft model.

OBJECTIVE: To establish the minimum required temperature in cryoablation of human colorectal cancer cell lines grown as subcutaneous tumors in mice. METHODS: Male nu/nu nude mice were inoculated by a sc injection of 1 x 10(6) LoVo (n = 30) or C170 (n = 32) cells. After 2 weeks the tumors were frozen using a 3-mm cryotherapy probe (LCS 3000, Cryotech, UK) to temperatures ranging from -8 to -84 degreesC. RESULTS: (LoVo) Of 21 mice evaluable for analysis no tumors recurred in 3 mice which had their tumors frozen to less than -60 degreesC as measured at the presumed tumor/host boundary, whereas all but one tumor recurred in 18 mice which had their tumors frozen to >-60 degreesC. (C170) Of 18 mice evaluable for analysis 14 mice which had their tumors frozen to between -8 and -84 degreesC as measured at the presumed tumor/host boundary developed tumor recurrence. Four mice which had their tumors frozen to -11, -58, -62, and -81 degreesC did not develop tumor recurrence. CONCLUSION: Cryotherapy of subcutaneous human colon cancer xenografts in nude mice results in tumor recurrence if tumors are frozen to temperatures of as low as -60 degreesC (LoVo) or -84 degreesC (C170) with a single freeze-thaw cycle. A critical temperature for the effective cryoablation of human colorectal cancer cell lines grown as subcutaneous tumors in mice with a single freeze-thaw cycle was not defined.

Animals↗
PubMed1998

Hypothermic oscillating liver perfusion stimulates ATP synthesis prior to transplantation.

BACKGROUND: ATP and glycogen depletion often have been demonstrated during cold storage of the liver prior to transplantation. Suppression of events that lead to metabolic depression and to lipid peroxidation could contribute to improvement of liver preservation. A new method of liver preservation for transplantation is therefore suggested, an oscillating oxygenated hypothermic liver perfusion. METHODS: Biochemical analysis of liver tissue samples and perfusate after 10 h of perfusion by the presented oscillating perfusion model were compared with results after continuous liver perfusion for 10 h as well as with data derived from cold-stored livers over a period of 10 h. Particular reference was made to nucleotide metabolites, glycogen content, lipid peroxidation, glutathione content, glycolytic metabolites, and enzyme release before and after preservation. RESULTS: Glycogen depletion occurred to the same degree in hypothermic storage and machine perfusion (oscillating as well as continuous perfusion), but the energy charge was significantly increased after oxygenated perfusion, whereas cold storage resulted in a significant energy charge depletion. In addition, perfusion by an oscillating technique yielded superior energy charge loading compared to the continuous perfusion technique and diminished the other hand lipid peroxidation. CONCLUSIONS: Hypothermic oscillating oxygenated perfusion could be important for the improvement of the quality of energy-depleted organs prior to transplantation.

Adenosine↗
PubMed1998

[Expression of CD44 and isoforms v4, v5, v6, v7, v10--new prognostic parameters in ductal pancreatic carcinoma?].

UNLABELLED: Prognostically relevant factors based on the histological assessment of the resected pancreas are known. However, additional parameters, such as biological staging of the intrinsic malignant potentiality of the tumor, would be useful. There has been no uniform finding of a relationship between CD44 variant expression and tumor progression. METHOD: We assessed the expression pattern and prognostic impact of CD44 standard and CD44 isoforms v4, v5, v6, v7 and v10 in 40 ductal pancreatic carcinomas by immunochemistry on paraffin-embedded tumor material in patients after tumor resection. At the time of the investigation neither histomorphological parameters nor the survival time were known. RESULTS: There was no correlation between the histomorphological parameter and the expression of CD44 splice variants. CD44 splice variants v4-v10 were almost only expressed in tumor tissue. In ductal pancreatic carcinoma, patients with an overexpression of CD44 splice variants had a worse prognosis. However, because of the small number of cases this was statistically not significant. CONCLUSION: CD44 splice variants may have an influence on prognosis in ductal pancreatic carcinoma. However, further investigation on a larger number of patients is necessary to confirm these results.

Adenocarcinoma↗
PubMed1998

[Cholecystectomy in high risk patients. A comparison between conventional and laparoscopic procedures].

Laparoscopic cholecystectomy offers many advantages, but cardiopulmonary impaired patients may be endangered by the haemodynamic and respiratory effects of the pneumoperitoneum. Between June 1990 and December 1995, laparoscopic cholecystectomies were performed on 19 high-risk patients (ASA IV) and conventional cholecystectomies on 26 patients with the same operative risk (ASA IV). Out of 45 patients, 5 (11.1%) suffered intraoperative cardiopulmonal complications. Three belonged to the group with laparoscopic cholecystectomy (15.8%) and two to the group with open laparotomy (7.7%). General postoperative complications occurred in 15 cases (33.3%), whereby patients of the conventional cholecystectomy group were concerned more often [46.2% (n = 12) versus 15.8% (n = 3), P = 0.03]. The number of days spent in hospital after open cholecystectomy was higher (P = 0.01) (11.6 +/- 5.6 days in the laparotomy group versus 7.6 +/- 5.0 days in the laparoscopy group). The classification as a high-risk patient indicates an elevation of the perioperative rate of complications in laparoscopic and open cholecystectomy, whereby the rate of postoperative complications is lower in the laparoscopic group.

Aged↗
PubMed1998

[Prognostic value of e-cadherin in papillary thyroid carcinoma].

The prognostic significance of e-cadherin in papillary thyroid carcinoma was evaluated in a retrospective study. From September 1985 to December 1996, 113 patients underwent surgery for papillary thyroid carcinoma. Seventy-eight formalin-fixed, paraffin-embedded tissue samples were available for immunohistochemical analysis of e-cadherin expression. In 74 of these 78 patients the postoperative course is known for 2 months to 35.2 years (median 3.6 years, mean: 4.9 +/- 4.8 years). Reduced or negative e-cadherin expression (< or = 20%) was associated with advanced T categories of the primary tumours and higher rates of synchronous lymph node involvement and distant metastasis. During follow-up in this group of patients locoregional tumour recurrence occurred more frequently and survival was shorter than in patients with tumours which exhibited e-cadherin expression of > 20%. Statistical analysis revealed e-cadherin expression (< or = 20%/ > 20%), synchronous distant metastasis (M0/pM1, cM1) and radicality of resection (R0/R1, 2) as significant risk factors for survival. Our findings provide evidence that e-cadherin is a prognostic factor in papillary thyroid carcinoma.

Adult↗
PubMed1998

[Effect of the surgeon on treatment quality in acute appendicitis].

The quality of the surgical therapy in cases of acute appendicitis is influenced by the rate of perforating appendicitis, the rate of bland appendicitis and the perioperative morbidity. During a prospective follow-up 271 patients were treated at our department between 1 April 1993 and 30 July 1996. The rate of perforating appendicitis was 3.7%, and that of bland appendicitis was 19.6%. The rate of perforating appendicitis did not differ significantly according surgeon, who decided to operate. However, the number of patients with bland appendicitis did differ significantly among different operators. There were also significant differences in the rate of wound infections. No correlation was found between the rates of perforating and bland appendicitis was not found. In summary the operator affects the quality of the surgical treatment in cases of suspected appendicitis by differences in the timing and performance of the surgical procedure.

Acute Disease↗
PubMed1998

[Unusual coincidence of partially active endocrine tumors].

We report on a female patient who developed five different tumors between the age of 53 and 62 years. The following tumors were diagnosed, three of which showed endocrine activity: uterine myoma; hemangiopericytoma of the meninges; pleural mesothelioma; preperitoneal leiomyoma; medullary carcinoma of the thyroid (sporadic form) in a hyperthyroid goiter. Coexistence of hyperthyroidism and medullary carcinoma of the thyroid is rare. Paraneoplastically induced hypoglycemia--in this patient induced by the pleural mesothelioma and less by the preperitoneal leiomyoma--is of similarly infrequent occurrence. Tumors of epithelial or mesenchymal origin may cause hypoglycemia as a result of peptide secretion, exerting an insulin-like effect. The detection of IGF-I and IGF-II in the serum confirms the diagnosis. Insulinoma can be differentiated by the absence of hyperinsulinemia.

Blood Glucose↗
PubMed1998

[Changes in the clinical picture and surgical therapy of Crohn disease. 10 years experiences].

Changes in clinical presentation of Crohn's disease (CD), patients' age at the time of disease manifestation and operation, general condition and duration of medical management were investigated in a retrospective study. 395 operations for CD were divided into consecutive groups and analysed. In an increasing number of cases patients presented with the "fibrostenotic type" rather than the "fistulizing type" of complaints. The duration of disease and of medical management increased. Patients in later groups were younger and in better general condition. We found a rise in frequency of patients with recurrent CD or prior abdominal surgery for other reasons. Primary surgery for CD increasingly consisted of resection of solitary segments of gut; in the case of recurrence, of multiple, minimal resections. The average total length of the resected intestine could be significantly reduced. The complication rate was equal in elective and emergency surgery.

Adult↗
PubMed1998

Prospective evaluation of parathyroid graft function after total parathyroidectomy and heterotopic autotransplantation in renal hyperparathyroidism by bilateral determination of intact parathormone in cubital venous blood.

The value of gradients for intact parathyroid hormone (PTH) in the assessment of graft function after total parathyroidectomy/autotransplantation for renal hyperparathyroidism was evaluated in a prospective follow-up study. Altogether 99 patients who underwent operation from August 1, 1987 to December 31, 1996 were prospectively investigated and reexamined postoperatively, including analyses of serum calcium, alkaline phosphatase, and intact PTH in the antecubital venous blood of both arms. The postoperative course is known for all patients. Of the 99 patients included in the study, 95 underwent one to nine reexaminations (median three) over follow-up periods of 1 month to 5 years (median 24 months). Reproducible PTH gradients were established during follow-up. Ninety percent of the calculated gradients were < or = 20. Intermittent postoperative hypocalcemia, due to calcium deficiency of the skeleton in renal osteopathy, led to an increase in PTH secretion and gradients. Increasing gradients > 20 during follow-up make graft-dependent recurrence probable. The presence of a gradient of approximately 1 in bilaterally elevated PTH levels may be an indication of hyperfunctioning parathyroid tissue in the neck or mediastinum. The combined assessment of the course of gradients for intact PTH, hormone levels in both arms, and serum calcium permits an objective evaluation of parathyroid graft function.

Calcium↗
PubMed1998

Preoperative diagnostics in pancreatic carcinoma: would less be better?

OBJECTIVE: The objective of this study was to investigate the value of preoperative diagnostics in patients with pancreatic carcinoma in terms of tumor diagnosis and evaluation of resectability. PATIENTS/METHODS: From 1 September 1985 to 31 December 1997, 408 patients shown by histology to have a ductal (n=330) or periampullary carcinoma (n=78) were treated at our hospital. RESULTS: In determining the presence of tumor, ultrasonography and computed tomography (CT) had a sensitivity of 88.3% and 94.0%, respectively; combined, they had a sensitivity of 96.2%. Endoscopic retrograde cholangiopancreatography (ERCP) had a sensitivity of 96.2%. Preoperative aspiration biopsy cytology had a sensitivity of 71.4%. No correlation was found in the patients undergoing surgery between the preoperative level of serum CA 19-9 and the presence of distant metastases. Tumor infiltration of the portal vein was shown with a sensitivity of 33.3%, 24.3%, and 76.5% and a specificity of 93.9%, 98.9%, and 65.6% by ultrasonography, CT, and angiography, respectively. Ultrasonography and CT detected liver metastases or peritoneal carcinomatosis with a sensitivity of 35.9% each and a specificity of 91.9% and 91.7%, respectively. CONCLUSION: This study shows that, in 96% of patients with pancreatic carcinoma, ultrasonography and CT are adequate for diagnosis and for the evaluation of resectability. ERCP is not the method of choice in the diagnosis of pancreatic carcinoma due to its invasiveness and to the fact that it fails to demonstrate the pathological anatomical location of the tumor; it should only be used if a tumor is suspected despite negative results on ultrasonography and CT or as an additional diagnostic method to differentiate between chronic pancreatitis and carcinoma. On account of the low sensitivity of percutaneous aspiration biopsy cytology, this method is not necessary preoperatively and may even lead to the spread of tumor cells. In 7% of patients, routine laparoscopy would additionally show liver metastases or peritoneal carcinomatosis not demonstrated using the imaging techniques.

Adult↗
PubMed1998

Technique and results of the retroperitoneoscopic adrenalectomy via a lumbar approach.

INTRODUCTION: Since 1992, endoscopic techniques have been used increasingly in adrenal-gland surgery. In the present paper, the technique of the retroperitoneoscopic adrenalectomy via a lumbar approach is described. METHODS: The patient is placed in a lateral decubitus position. In the first step, a dilatation trocar is introduced in the retroperitoneal space to create an artificial cavity. The dilatation trocar is replaced by a blocking trocar to close off the operating field. After insufflation of CO2, two additional trocars are introduced in the area of the conventional flank incision. Adrenalectomy is performed via these ports. Once the adrenal gland is completely mobilized, it is inserted into a sterile plastic bag and removed through the 1.5-cm incision. CONCLUSION: The retroperitoneoscopic approach to the adrenal gland appears to be suitable for benign adrenal-gland tumors up to a size of 6 cm.

Adrenalectomy↗
PubMed1998

Follow-up after transanal endoscopic microsurgery or transanal excision of large benign rectal polyps.

METHODS: Between January 1986 and December 1995, 238 patients with benign rectal polyps underwent either transanal endoscopic microsurgery (n = 226) or transanal excision (n = 12) at the Clinic of General and Abdominal Surgery, Johannes Gutenberg-University, Mainz. RESULTS: Mean polyp size was 4.2 cm; 89.1% of polyps measured more than 2 cm in diameter. In 89.1% of cases, histological analysis revealed polyps containing tubulovillous or villous adenomas. Synchronous colonic polyps were detected in 12.5% of patients. Follow-up data are available on 222 patients (94%). At follow-up examination, 169 of the 193 surviving patients (87.6%) were recurrence free. Seven of 193 patients (3.6%) had developed neoplastic colonic polyps and, in 17 patients (8.8%), metachronous polyps were detected. CONCLUSIONS: Transanal endoscopic microsurgical polypectomy was furthermore demonstrated to be a low-risk procedure with a low recurrence rate for the complete resection of large rectal polyps. At a follow-up rate of 61.1 %, the incidence of metachronous carcinoma ranged at 3.1%, which is markedly below the rate of 8-18% for tubulovillous or villous adenomas larger than 1 cm in diameter cited in the literature.

Adenoma, Villous↗
PubMed1998

Comparison of results after transanal endoscopic microsurgery and radical resection for T1 carcinoma of the rectum.

BACKGROUND: We compared the results of transanal endoscopic microsurgery and radical surgery in patients with T1 carcinomas of the rectum. METHODS: We performed a retrospective study (1985-96) to compare the results obtained in 103 patients with T1 rectal carcinomas (low-risk T1, n = 80; high-risk T1; n = 23) undergoing transanal endoscopic microsurgery and radical surgical therapy. RESULTS: The complication rate in patients undergoing local excision was 3.4% (two of 58); it was 18% (eight of 45) in the group treated with radical surgery. Two of 45 patients (3.8%) died after radical resection; there were no deaths after local excision. With regard to the actuarial 5-year survival rate, no difference was observed in the group with low-risk T1 carcinoma between patients treated with local excision (79%) and those who had radical resection (81%) (p = 0.72). In patients with high-risk T1 carcinoma, lymph node metastases were identified in four of 11 patients undergoing radical resection (36%). Four of 12 patients with high-risk T1 carcinoma treated by local excision developed recurrences, whereas none of the patients undergoing primary radical surgery had a recurrence. CONCLUSIONS: Transanal endoscopic microsurgery for the treatment of low-risk T1 carcinomas is associated with a significantly lower complication rate than radical surgical therapy. There is no difference in 5-year survival between local and radical surgical therapy in patients with low-risk T1 carcinoma.

Adenocarcinoma↗
PubMed1998

[Systematic internal quality control in surgery 1993 to 1997].

From April 1, 1993 to Dec. 31, 1997, the perioperative course of 5690 patients was recorded prospectively and postoperative morbidity and lethality was determined in the framework of a program for a systematic internal quality control. Goal of the program is the demonstration of treatment quality which possibly out quality improvement. The share of old and sicker patients was significantly increasing during the observation period. Morbidity and hospital lethality remained constant despite a rising necessity of postoperative intensive care. High risk surgery was performed on more patients in the university hospital than in non-university hospitals. The rate of postsurgical complications was lower, length of stay was equal (surgery for inguinal hernia) or lower (cholecystectomy). The rate of not indicated appendectomy could be lowered and morbidity and lethality in the treatment of esophagus carcinoma was lowered by the application of this concept. For the partial duodenopanceatectomy, the examination of the individual surgeon as a risk factor revealed a significant dependence on the experience of the surgeon. There was only a tendency of this effect demonstrable in medium or small surgery like colon resection of gastrectomy. The rate of continence preservation in rectal carcinoma was increased to 75% combined with a drop of perioperative morbidity and length of stay. The systematic internal quality control allows for the assessment of treatment quality and the fast recognition of weak spots. It is a suitable complementary tool for quality improvement in the framework of quality management in surgical patients. The extension of the concept by recording postoperative quality of life and long time results is planned.

Abdomen↗