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Biomedical subjects

T Wiggers

Publications and source records attributed to T Wiggers.

At least 109 records · Page 6Linked to original sources
PubMed1990

Treatment of manifest and impending pathologic fractures of the femoral neck by cemented hemiarthroplasty.

Thirty-four patients with manifest or impending pathologic fractures of the femoral neck were treated between 1971 and 1987. Breast carcinoma was the primary tumor in the majority of patients. All patients were treated with cemented hemiarthroplasty. Twenty-seven patients (79%) could walk at an average of nine days postoperatively. All patients experienced relief of pain. Two superficial wound dehiscences, one loosening of the prosthesis, and two prosthetic dislocations were encountered. Mean survival was 17.6 months overall (12 months for manifest fractures and 40 months for impending fractures). These results indicate that cemented hemiarthroplasty for pathologic fractures is a safe procedure resulting in long-lasting palliation without necessitating postoperative irradiation. The importance of tumor excochleation and the advantages of bone cement are emphasized.

Adult↗
PubMed1989

Peri-operative blood transfusions in colorectal cancer.

Clinical studies report reduced recurrence-free survival and increased cancer-related death after surgical treatment for cancer, when peri-operative blood transfusions were given. In this study we collected transfusion data of 212 patients who participated in a prospective study of two different resection techniques for colorectal cancer. One hundred and fifty-eight patients were transfused and 54 were not. The follow-up period for almost all patients was 5 years. The 5-year survival rate was 52% both for the transfused patients and the nontransfused patients. For subgroups of patients with Dukes' B and Dukes' C tumours no statistically significant differences were found. In the group of patients that were transfused the number of transfusions did not affect survival. In this study we could not confirm the deleterious effect of peri-operative blood transfusions on survival.

Blood Transfusion↗
PubMed1989

Post-irradiation angiosarcoma of the greater omentum.

A case of angiosarcoma of the greater omentum is reported. This angiosarcoma developed 8 years after irradiation for cervical carcinoma and presented with an intra-abdominal hemorrhage. We describe her clinical course, treatment and follow-up. Although several other locations of irradiation-induced sarcomas have been published, this is the first report in literature of a postirradiation angiosarcoma in the greater omentum.

Female↗
PubMed1988

Type IV collagen immunoreactivity in colorectal cancer. Prognostic value of basement membrane deposition.

Using antibodies to type IV collagen, basement membrane (BM) deposition at the tumor-stromal border was studied in 163 cases of colorectal carcinomas. Immunoreactivity was scored semiquantitatively as moderate/extensive versus limited BM deposition and correlated with Dukes' stages and survival data. Cases with limited BM deposition showed an overall significant shorter survival and were overrepresented in Dukes' Stages C/D. Stratification of the cases, for limited versus moderate/extensive BM deposition and Dukes' Stages A/B and C/D, showed that in Dukes' Stages C/D, cases with moderate/extensive BM deposition reached a plateau phase in the survival curve after 2 years. Cases with limited BM deposition showed a continuous downward course on the survival curve. The results suggest that immunostaining of BM in cases in Dukes' C differentiates tumors with relatively high invasive and metastatic capacity from tumors with low invasive and metastatic capacity.

Basement Membrane↗
PubMed1988

A multivariate analysis of pathologic prognostic indicators in large bowel cancer.

A multivariate analysis of the pathologic data of 350 patients with primary colorectal cancer was performed. In addition to conventional parameters such as shape and size of the primary tumor, central node involvement, angioinvasive growth, grade, and stage, new variables such as the immunoreactivity patterns of carcinoembryonic antigen (CEA), CA 19-9, mucin, serotonin, secretory component (SC), and the DNA index were tested for their potential prognostic value. Every variable except CA 19-9, serotonin, and DNA showed significant prognostic information in univariate analysis. However, in the multivariate analysis stage was the predictive factor with the highest hazard ratio, but absence of central node involvement, tumors with diameters between 3.5 cm and 6 cm, exophytic tumor growth, well-differentiated tumors, tumors with CEA immunoreactivity, absence for staining with serotonin, and diploid tumors also were included in the relative risk model. Thus, the aforementioned variables appear to play a role in the establishment of a prognostic index.

Aged↗
PubMed1988

No-touch isolation technique in colon cancer: a controlled prospective trial.

In order to assess the effect of the no-touch isolation technique, in the treatment of large bowel cancers, on the site of first recurrence and disease-free and overall survival, 236 patients were prospectively and randomly assigned to either the no-touch isolation technique (117 patients) or to a conventional resection technique (119 patients). No patient with distant metastases or unresectable disease entered the study. The two treatment groups were comparable with regard to patient characteristics. Pre- and postoperative complications (including mortality within 30 days) were similar in both groups. After a complete follow-up of 5 years, a tendency for reduction in the number of, and time to, occurrences of liver metastases was seen in the no-touch isolation group (P = 0.14). This effect was most obvious in the sigmoid colon with angio-invasive growth. Overall (P = 0.42) and corrected (P = 0.25) survival did not differ significantly among the treatment groups although in every analysis the survival data of the no-touch isolation group were superior. The data do suggest a limited benefit of the no-touch isolation technique. This observation is important since the morbidity and mortality of surgery were equal in both groups.

Aged↗
PubMed1988

Regression analysis of prognostic factors in colorectal cancer after curative resections.

The clinical, laboratory, and pathologic data of 310 patients who had curative resections were prospectively collected and analyzed in a multiple stepwise regression model. Although several factors (i.e., venous invasion) were of importance in univariate analysis, the following conclusions reflect the outcome and relative importance of the regression analysis only. Blood loss as an initial symptom and duration of symptoms were associated with a better prognosis. Location of the primary tumor, age, and sex did not appear to have prognostic value. Observations during operation such as palpable lymph nodes, fixity to adjacent organs, and tumor spill were related to a diminished tumor-free survival. Laboratory data (hemoglobin, leukocytes, ESR, GGTP, SGOT, SGPT, LDH, total protein, CEA) were tested for their potential prognostic values. Only a preoperative low protein level or an elevated CEA level were associated with an increased risk of death due to recurrent tumor. The histopathologic features (stage and grade), with the exception of venous invasion, were of relative importance in the determination of prognosis. The aforementioned variables can be included in a prognostic index on the base of which high-risk groups suitable for adjuvant studies can be identified.

Adenocarcinoma↗
PubMed1987

Retrospective analysis of the prognostic significance of DNA content and proliferative activity in large bowel carcinoma.

In the present study we have evaluated the prognostic significance of ploidy levels and proliferative activity in 279 cases of large bowel carcinomas which were included in a surgical prospective randomized trial. Ploidy levels and proliferative activity were determined on nuclei isolated from paraffin-embedded tissues of 279 colorectal carcinoma patients, with a mean follow-up of 51.9 months. Product limit survival analysis demonstrated a borderline significant association (P = 0.0689 by generalized Breslow; P = 0.0336 by generalized Savage) between ploidy and survival, with a 75th quantile survival of 49.8 months for patients with diploid tumors and 35.9 months for patients with aneuploid tumors. After stratification for staging, Dukes' C cases showed a statistically significant association between tumor ploidy and survival (P = 0.0224 by generalized Breslow, P = 0.0110 by generalized Savage). Product limit survival analysis for proliferative activity and survival showed a similar outcome with the strongest association in Dukes's C stage of disease (75th quantile survival of 38.9 months for low proliferative and 18.0 months for high proliferative tumors).

Aneuploidy↗
PubMed1987

Comparison of phenotypic and genotypic features in human primary large bowel carcinomas and lymph node metastases.

In order to test the contention that metastasis is a selective process and that therefore metastases might show a more restricted pattern of phenotypic and genotypic characteristics than primary tumors, we compared the expression of carcinoembryonic antigen, Ca 19-9, secretory component, serotonin, and mucin production as well as flow cytometric data on DNA content and percentage of S-phase cells in 87 primary large bowel carcinomas and their lymph node metastases. In a majority of the cases primary tumors and their metastases were largely identical with regard to the examined phenotypic features. In discrepant cases, however, metastases did not invariably show a more restricted pattern than primary tumors, indicating high differentiational plasticity of primary and metastatic colorectal cancer cells. In contrast, in a number of cases genotypic discrepancies were observed. We conclude that phenotypic characteristics of colorectal cancer cells cannot be used to study the pathogenesis of lymph node metastasis. Genotypic studies, however, suggest that lymphogenic metastasis may be a selective event.

Antigens, Neoplasm↗
PubMed1987

Gallstone obstruction of the intestine: an analysis of ten patients and a review of the literature.

Ten patients with gallstone ileus were studied to evaluate diagnostic and therapeutic procedures. The preoperative diagnosis was correct in four patients. All patients underwent laparotomy. In five patients, stones were removed by enterotomy and in three patients the obstruction was relieved by manual propulsion of the stones. One-stage small-bowel resection, cholecystectomy, and biliary enteric fistula repair were performed in two patients. Four patients had uneventful recovery. One episode of recurrent gallstone ileus was encountered. Three patients died of septic complications. It is concluded from the study and from a review of the literature that treatment should be aimed at relieving the obstruction, without performing additional surgical procedures, such as cholecystectomy and fistula repair. Secondary biliary surgery is to be performed only in patients with recurrent biliary disease.

Aged↗
PubMed1986

The occurrence and clinicopathological significance of serotonin immunoreactive cells in large bowel carcinoma.

We studied the incidence, clinicopathological relevance and prognostic significance of serotonin immunoreactive cells in a clinically well-documented series of 300 large bowel cancer patients. Serotonin immunoreactive cells were detected in 8 per cent of the carcinomas, occurring either as focal clusters (4.7 per cent) or as occasional single cells (3.3 per cent). Both types frequently displayed presence of mucin and/or immunoreactivity for secretory component as well. In respect of localization, stage or tumour extension and histological grade tumours with serotonin immunoreactivity showed no significant differences in comparison with carcinomas lacking this feature. In terms of survival, however, the tumours with serotonin immunoreactivity demonstrated a more aggressive clinical course in comparison with tumours without these cells. This phenomenon reached borderline statistical significance. It is therefore concluded that the study of serotonin immunoreactivity in large bowel carcinomas enables the identification of a subpopulation of colorectal carcinomas with a relatively poor prognosis.

Colonic Neoplasms↗
PubMed1986

Prognostic significance of CEA immunoreactivity patterns in large bowel carcinoma tissue.

In order to determine the clinical value of CEA detection in large bowel cancer tissue the patterns rather than the intensity of immunoreactivity of CEA reactive antibodies were analyzed in 312 large bowel cancer patients especially in relation to patient survival. CEA immunoreactivity appeared to be distinguishable into a predominantly apical/cytoplasmic and a predominantly membranous pattern. Twenty-four (7.7%) tumours were found to be CEA negative or only focally positive. Two hundred and eighty-three (90.7%) of the carcinomas showed a predominantly apical/cytoplasmic immunoreactivity pattern, whereas 5 (1.6%) of the tumours revealed mostly membranous CEA immunoreactivity. CEA negative or focally positive carcinomas and CEA positive tumours with membranous immunoreactivity were significantly more often observed in the group of poorly differentiated carcinomas (P greater than 0.001), but showed no significant correlation with stage of tumour extension (P = 0.11). Also, these carcinomas demonstrated a more aggressive course in patients compared to CEA positive tumours with an apical/cytoplasmic CEA expression pattern. We, therefore, conclude that determination of the pattern of CEA immunoreactivity in large bowel cancer tissue may enable the detection of subgroups of patients with a poor prognosis.

Carcinoembryonic Antigen↗
PubMed1984

Gastrointestinal cancer-associated antigen (GICA) immunoreactivity in colorectal carcinoma in relation to patient survival.

Immunoreactivity of gastrointestinal cancer-associated antigen (GICA) was studied in tissue sections of 311 colorectal cancer patients and the results were correlated with data on patient survival. The group of uniformly GICA-positive tumours (10.6%) tended to behave more aggressively than focally positive (53.4%) and GICA-negative tumours (36.0%), also when stratified for stage of tumour extension and histological grade. This trend, however, did not reach statistical significance, perhaps as the result of a bias introduced by the relatively small number of GICA-positive cases. There appeared to be no significant difference in clinical course between patients with GICA focally positive or GICA-negative tumours (together comprising 89.4% of the total population studied). Further studies including a larger number of patients and longer follow-up periods are needed to validate the suggestion that GICA-positive colorectal carcinomas might show a more aggressive behaviour than tumours displaying other modes of GICA expression. However, the results of our study suggest that GICA immunoreactivity in colorectal carcinoma tissue is unlikely to be a sensitive, independent parameter for the prediction of prognosis in individual patients.

Antibodies, Monoclonal↗
PubMed1984

The value of secretory component (SC) immunoreactivity in diagnosis and prognosis of colorectal carcinomas.

Immunoreactivity of secretory component (SC) was tested in routinely processed tissue specimens of 314 colorectal cancer patients and correlated with clinicopathologic parameters, such as stage and histologic grade of the tumors as well as survival data of patients. In 22% of the carcinomas almost all tumor cells were SC positive, 36% of the tumors showed SC immunoreactivity in a focal, heterogeneous pattern, whereas in 42% of the carcinomas SC immunoreactivity did not occur. Uniformly SC positive carcinomas demonstrated a tendency to occur more frequently in the low stage and grade carcinomas, whereas uniformly SC negative neoplasms showed the reverse trend. These trends were only statistically significant for stage. Focal SC immunoreactivity (SC heterogeneous tumors) was not correlated with stage nor with grade. Furthermore, inclusion of SC heterogeneous tumors in the analysis of survival data obscured the statistical significance observed in the correlation of SC immunoreactivity status and patient survival in uniformly SC positive or negative tumors. It is concluded that the prognostic value of SC immunoreactivity patterns in colorectal carcinoma tissue appears to be limited due to the occurrence of a substantial proportion of tumors with heterogeneous SC expression and is of less significance than staging. Nevertheless, determination of the SC immunoreactivity status may be of additional value for the identification of a subpopulation of patients with a more favorable prognosis.

Cell Transformation, Neoplastic↗