Biomedical subjects

T Junginger

Publications and source records attributed to T Junginger.

At least 163 records · Page 9Linked to original sources

PubMed1996

[DNA content of the tumor cell. A new prognostic parameter in hepatocellular carcinoma?].

Hepatocellular carcinoma is a heterogeneous disease with considerable differences in malignant behaviour. Some relevant factors for prognosis are known. In this study we analysed DNA ploidy as a potential prognostic parameter. With DNA image cytometry we were able to differentiate between diploid, hypotriploid, triploid, hypertriploid, tetraploid and aneuploid tumours. The best prognosis was for patients with diploid, hypotriploid and tetraploid tumours with a median survival time of 41 months in contrast to 3 months for patients with triploid, hypertriploid or aneuploid tumours. There was a strong correlation between histomorphological parameters and the DNA content. The DNA content of tumour cells may be considerable clinical relevance in hepatocellular carcinoma regarding the decision as to whether or not to perform a resection. In patients with prognostically unfavorable parameters adjuvant oncological therapy may improve the prognosis.

Adult↗

PubMed1996

[Value of the CA 19-9 tumor marker in differential diagnosis of space-occupying lesions in the head of the pancreas].

In 96 patients (ductal pancreatic carcinoma, n = 34; periampullary carcinoma, n = 43; chronic pancreatitis, n = 19) the role of CA 19-9 in the diagnosis of lesions of the head of the pancreas were evaluated. The sensitivity for ductal pancreatic carcinoma was 73.3%, for periampullary carcinoma 48.8%, and specificity was 63.2%. Carcinoembryonic antigen was elevated only in every fifth patient. Even when combining the two tumor markers no increase in sensitivity could be observed. The low specificity of 63%, which decreased to 33% in the case of obstructive jaundice, does not allow adequate preoperative differentiation between cancer patients and those with chronic pancreatitis. In cases of postoperatively elevated CA 19-9 level the prognosis is worse than in patients with normal tumor markers.

Adult↗

PubMed1996

[Lymph node dissection, stage migration and perioperative risk in rectal carcinoma].

In 348 patients with an initial diagnosis of rectal carcinoma operated on between 1985 and 1994 we investigated the quality of lymph node dissection, its influence on the perioperative risk and tumor staging. The same histopathological work-up was carried out in all cases. Whether resections or extirpations were performed, the number of dissected lymph nodes increased from 5.3 and (1985/1986) to 16.7 and 17.3 (1991/1992) and to 15.8 and 17.3 (1993/1994) respectively. Neither the type of operation nor the surgeon's experience had a significant influence on the number of lymph nodes dissected. The increase in the number of lymph nodes dissected had no negative effect on the length of the operation, the amount of blood infused during the operation or the perioperative risk. We found a significant correlation between the number of lymph nodes dissected and the number of lymph node metastases (P = 0.02) and between an increase in UICC stage III (P = 0.005) and pN2 tumors (P = 0.000) and an increase in the number of lymph nodes dissected. Central lymph node dissection by high ligation of the inferior mesenteric artery did not increase the perioperative risk in spite of the fact that in recent years we have observed more patients with multiple diseases.

Adult↗

PubMed1996

[Morbidity in concomitant interventions in neck exploration for primary hyperparathyroidism. Results of a prospective study].

A prospective follow-up study was undertaken in patients undergoing surgical therapy for primary hyperparathyroidism to establish the frequency of concomitant surgical procedures and their influence on the morbidity of cervical exploration. From 1 August 1987 to October 1995, 231 patients underwent cervical exploration for primary hyperparathyroidism. In 16 patients 18 (7.8%) concomitant abdominal and thoracic surgical procedures as well as surgical interventions for soft-tissue tumors were performed. A total of 133 patients (57.6%) underwent thyroid resections of varying extent; 4.8% had carcinoma of the thyroid. Catamnestic data were obtained on the basis of a standardized follow-up in 94.4% of all patients (1-9 follow-up examinations in 216 patients). Hematoma occurred after adrenalectomy in a patient undergoing a concomitant extracervical procedure. In patients with a first manifestation of primary hyperparathyroidism due to a solitary parathyroid adenoma (n = 189), an increase in the morbidity of parathyroid surgery performed in combination with a thyroid resection was observed. Furthermore, a relationship was established between the number of intraoperatively identified parathyroid glands and the incidence of permanent hypoparathyroidism (permanent hypoparathyroidism: initial cervical intervention with parathyroid exploration alone, 2.2%; with concomitant thyroid resection, 6.5%; after secondary thyroid resection and parathyroid exploration alone, 0%; after concomitant thyroid resection, 28.6%; four parathyroid glands identified intraoperatively, 3.1%; fewer than four parathyroid glands identified, 8.2%). The increase in the morbidity of parathyroid surgery in combination with thyroid resection is justifiable, because unsuspected thyroid carcinomas can potentially be treated curatively.

Abdominal Neoplasms↗

PubMed1996

[Systematic clinical quality assurance in surgery].

Between April 1993 and December 1995 the perioperative courses of 3183 patients were recorded within the frame work of a quality assurance project at the Department of Surgery, University of Mainz. The age of the operated patients and the rate of morbidity increased significantly during the observation period. Morbidity and mortality were not correlated to increasing need for intensive care. Morbidity was dependent on the surgical approach and also on the surgeon. On the other hand, high numbers of operations did not necessarily correlate with low complications rates. The concept described makes it possible to compare quality assurance among different hospitals, helps surgeons to recognize and improve their weak points, and serves as an additional method for monitoring the quality of treatment in the clinic.

Adult↗

PubMed1996

[Is preoperative site diagnosis in organic hyperinsulinism from the viewpoint of the surgeon still necessary today? Results of a consecutive series and analysis of the literature].

To answer the open question whether a preoperative localization diagnostic is necessary in organic hyperinsulinism we prospectively investigated our 28 patients with an organic hyperinsulinism who were operated on between September 1, 1985 and December 31, 1994. Additionally we performed an analysis of the literature. In case of a solitary adenoma the preoperative localization diagnostic had a sensitivity between 28.4% (sonography) and 84% (endosonography). The combination of all preoperative localization procedures had a sensitivity between 70% (literature) and 90% (own patient material). With palpation and intraoperative sonography 97.1% (own patient material 100%) of all solitary adenomas could be found during first exploration. Multiple adenomas and reoperations have special problems. The pre- and intraoperative localization diagnostic failed in every fourth patient. In conclusion, in case of a primary operation without a MEN syndrome a preoperative localization procedure is not necessary due to the high sensitivity of the intraoperative diagnostic. In case of a MEN syndrome or reoperation a preoperative localization diagnostic is still advisable although the sensitivity is low.

Adenoma, Islet Cell↗

PubMed1996

[Experiences with various scores in evaluating the prognosis of postoperative intensive care patients].

At the intensive care unit of the Clinic for General and Abdominal Surgery and the Clinic for Emergency Medicine in Mainz, various scores (APACHE II score, HIS, TISS, ASA score), laboratory parameters (serum creatinine, white blood count, platelet count, serum lactate, serum elastase, Quick), body temperature, age as well as presence of a malignant underlying or associated disease, were analyzed with regard to their prognostic significance in 169 postoperative admissions. Apart from univariate analysis (Wilcoxon test) and a multivariate analysis (stepwise logistic regression), the value of the scores is demonstrated on the basis of sensitivity, specificity and correctness, as well as the behaviour of the scores at certain decisive points (cut-off point). Of the parameters studied, the APACHE II score, the HISS, the TISS and serum lactate had a significant influence on the outcome of intensive care. Examination of these scores and serum lactate at different decisive points (false-positive rate of 0%, point of highest sensitivity, point of maximal correctness) showed the TISS to have the best results. The TISS has, with a sensitivity of 100%, a false-positive rate of 41%, compared with 55% for the HIS, 81% for the APACHE II and 82% for serum lactate. With a false-positive rate of 0%, the sensitivity of the TISS is only 10%, of APACHE II and serum lactate 5% and of the HIS 0%. The patient with the highest HIS score has survived. The serum lactate level is another good parameter that is a lot easier to determine and is comparable to the APACHE II score and the HIS in its prognostic significance. Thus, scores are suitable for the estimation of the prognosis in certain patient groups. However, insufficient discrimination between patients who die and patients who survive means that these parameters cannot be used for individual therapeutic decisions in severely ill patients. The decision between the institution or cessation of intensive care is made by the physician or the medical team. Due to the use of prognostic factors, such as scores, decision-making can be objectified and therefore made easier.

APACHE↗

PubMed1996

[Prognostic factors in local recurrence rate after surgical therapy of rectal carcinomas].

From January 01, 1985 to December 31, 1993 515 patients with primary rectal cancer underwent operative treatment at the hospital of general and abdominal surgery of the university of Mainz. In 294 patients with conventional surgical treatment and R0-resection of the tumor we investigated the influence of tumor-, patient- and therapeutic factors on local tumor recurrence. At a univariate analysis the following factors were significant: UICC-staging (p = 0.001), pT-classification (p = 0.001), pN-classification (p = 0.013) and localisation of the tumor (p = 0.013). These results could be verified for the pT-classification and pN-classification in a multivariate analysis. The significant influence of operative treatment (p = 0.034), blood transfusion (p = 0.018) and preoperative raised CEA (p = 0.026) depended on significant differences of UICC - staging and tumor - localisation of the different groups. Grading, sex and age had no influence. Inspite of a shift of local resurrence from 13% to 50% (0% to 42.9% for resections, respectively 6.7% to 55.4% for exstirpations) we could not find a significant influence of the surgeon. This fact depended on the dividing of a small number of cases on a lot of surgeons. In our opinion the influence of the surgeon or of different hospitals on local recurrence should be investigated in further studies.

Blood Transfusion↗

PubMed1996

[Local excision of rectal carcinoma].

From January 1985 till December 1994 109 patients with rectal carcinoma were treated by local excision, in 36 patients a radical operation was performed afterwards. In the assessment of tumor infiltration endosonography was superior to rectal-digital examination. In 34 patients with local excised "low risk" T1-carcinomas and tumor free margins no local recurrence was observed. Two of ten patients with local excised "low risk" T1-carcinoma and no adequate margin of healthy tissue developed a local recurrence. Regarding our results the local excision of "low risk" T1-carcinomas seems justified, if final histological workup reveals an adequate margin of healthy tissue.

Adult↗

PubMed1996

[Esophageal diverticulum--perioperative risks and long-term follow-up].

Between 1985 and 1994 36 patients with Zenker's diverticulum were operatively treated by excision of diverticulum and cricopharyngeal myotomy at the University department of Surgery, Mainz. The complication rate was 25% (9 of 36 patients), in 2 cases a suture insufficiency was detectable. Long-term results are based on follow-up studies of 32 patients. The average follow-up interval was 59 (10-101) months, 20 patients (56%) underwent radiological examinations or endoscopy. 29 of 32 patients were totally symptomfree concerning the esophagus. After an average follow-up of almost 5 years there was no symptomatic recurrence. In 1 of 20 radiologically or endoscopically examined patients an asymptomatic recurrence could be detected. These results show that excision of the diverticulum in combination with a cricopharyngeal myotomy is an effective method with low risk for the long-term removal of pharyngoesophageal diverticulum.

Adult↗

PubMed1996

[Change in the risk of gastroduodenal ulcer hemorrhage--preventive or elective operation?].

Prophylactic (early elective) surgery of bleeding gastroduodenal ulcers is performed to avoid rebleeding with a supposed high risk. Because early elective surgery was burdened with high risk for complications and because surgery for rebleeding ulcers had no higher risk, we left these procedures and performed repeated endoscopic treatment of these patients instead. A retrospective analysis should clarify, whether the modified treatment since 1/90 changed the risk of bleeding gastroduodenal ulcers. Patients of other hospitals, who were assigned after unsuccessful attempts of conservative treatment were analysed separately from patients of the emergency ward of our department. In the second period patients from other hospitals were in worse condition, they had more concomitant diseases and more intense bleedings than in the first period. In our opinion this could be attributed to carrying too far conservative treatment. The frequency of operations decreased only little in this group, whereas the complication rate and the mortality increased slightly. With the abandonment of early elective surgery in patients of our emergency ward, we reached a decrease of the operative-frequency of more than 30%, a decrease of complications from 27.6% to 10.0% and of mortality from 10.3% to 0%. Over-all mortality was reduced from 9.8% to 4.7%.

Adult↗

PubMed1996

[Liver resections of metastases of non-colorectal primary tumors].

The records of 30 patients who had hepatic resections for non-colorectal liver metastases between 1985-1994 were analyzed retrospectively. The perioperative morbidity and mortality rates were 7% (2/30) and 3% (1/30). The patient group with curative resection (n = 25) was found to have a 5-year survival rate of 44.6% and a 3-year disease-free survival rate of 19.8%. By univariate analysis, the number of metastases and the amount of perioperative blood replacement were the only factors that affected survival after curative resection. Synchronous vs. metachronous disease was the only factor that showed a significant influence on disease-free survival after curative resection. Although the benefit of liver resection for non-colorectal metastases is limited, surgical therapy can be performed safely and offers some patients a chance of long-time survival.

Adolescent↗

PubMed1996

[Extent of radical surgery in carcinoma of Vater's ampulla].

The present series demonstrates that radical resection of ampullary cancer is the procedure of choice even in elderly patients. The most important factor influencing the survival rate is the extent of the lymph node dissection. The histopathological investigation of our pancreatoduodenectomy specimens demonstrates clearly that local excision of ampullary cancer may be indicated only in high risk patients with a pT1, well-differentiated tumor smaller than 0.6 cm in diameter.

Adult↗

PubMed1996

[Does the surgeon modify risk of local recurrence in rectal carcinoma?].

Investigating long-term operative results of nine surgeons, we found a variation in the local recurrence rate of 13% to 50%. Operative quality should not only be verified by investigating the perioperative risk, but also by investigating the local recurrence rate or prognosis.

Clinical Competence↗

PubMed1996

[Endoscopic, extraperitoneal adrenalectomy--an expansion of the approach to the adrenal gland].

From March 1994 to march 1996 we performed extraperitoneal adrenalectomy in 25 patients with adrenal gland tumors; three of these patients underwent bilateral adrenalectomy. Endoscopic extraperitoneal adrenalectomy was successful in 22 patients. No postoperative complications were observed, median postoperative hospital stay was 5 days (2-12). The described approach produces rapid recovery and creates less postoperative pain.

Adenoma↗

PubMed1995

[Diagnosis of the origin and therapy of organic hyperinsulinism].

BACKGROUND: The need for preoperative localization of an insulinoma is still under discussion. The aim of the present study was to determine the usefulness of preoperative localization of the tumour, to investigate the operative risk and to analyse the long-term course. PATIENTS AND METHODS: The sensitivity of the diagnostic workup was investigated prospectively in 26 patients operated on between 1. 9. 1985 and 31. 8. 1994 for hyperinsulinism at the surgical department of the university hospital in Mainz. RESULTS: In the case of solitary adenomas the sensitivity of preoperative sonography was 43%, that of CT 57%, and that of angiography 85%. Intraoperatively, all solitary adenomas were palpable and were to be seen at sonography. In a patient with multiple adenomas, only one tumour was seen sonographically. The postoperative course was unremarkable in 18 out of 27 operations on the pancreas; two patients died later. After a mean follow-up of 51 months, all patients were free of hypoglycaemic attacks. CONCLUSIONS: The results show that localization of the tumour prior to the first operation is no longer necessary in patients with no MEN syndrome. In the presence of the latter, however, it is recommended despite its low sensitivity. Although a permanent cure is possible with surgery, the morbidity of the operation is not negligible.

Adult↗

PubMed1995

[Endoscopic retroperitoneal adrenalectomy].

AIM OF STUDY: To determine prospectively in consecutive patients the value of endoscopic retroperitoneal adrenalectomy. PATIENTS AND METHODS: Between March 1994 and March 1995, endoscopic adrenalectomy via a retroperitoneal approach was performed in eleven patients (three men, eight women; median age 61 [48-73] years), unilateral in nine, bilateral in two. The procedure was indicated if the adrenal tumour was thought to be benign and no larger than 5 cm in diameter (two adrenal and two central Cushing's syndromes; three incidentally detected adrenal adenomas, two phaeochromocytomas, two Conn adenomas). RESULTS: Twelve of the 13 procedures were successfully performed. In one case the primary incision in the mid-axillary line had been too large and no satisfactory pneumoretroperitoneum was achieved. Median duration of operation was 180 (125-330) min, and the intraoperative blood loss was 200 (125-330) ml. There were no postoperative complications and the median postoperative hospital stay was 6 days (3-12). CONCLUSION: In small (up to 5 cm) adrenal tumours not suspected to be malignant the endoscopic retroperitoneal approach constitutes a sparing alternative to the conventional access to the adrenal gland.

Adenoma↗

PubMed1995

[Laparoscopic surgery for hepatic, splenic and mesenteric cysts].

Five women and one man (average age 62.5 [20-64] years) with symptomatic intraabdominal cysts at different sites (liver: n = 3; spleen: n = 2; mesentery: n = 1) had them removed by laparoscopic surgery. Broad fenestration was performed with the hepatic and splenic cysts, while the mesenteric cyst was enucleated from the mesentery. There were no intra- or postoperative complications. Median duration of operation was 60 (45-125) min, postoperative hospital stay was 5 (3-6) days. After a median follow-up period of 8 (1-12) months a 3 cm residual cyst was found in the patient with the splenic cyst, but all patients were free of symptoms. -Laparoscopic surgery is a low-stress alternative to conventional surgical removal of intraabdominal cysts.

Adult↗