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Biomedical subjects

U Metzger

Publications and source records attributed to U Metzger.

At least 73 records · Page 4Linked to original sources
PubMed1989

[Blood transfusions and prognosis following curative resection of colorectal cancer: is there an association?].

More recently a number of retrospective analyses in rather ill defined patient populations demonstrated an association between perioperative blood transfusion and recurrence after curative resection of colorectal cancer. In the randomized trial (SAKK 40/81) (adjuvant cytotoxic intraportal infusion versus no further treatment) we evaluated the transfusion status in a well defined, prospectively documented and controlled patient population. Of 457 patients, 353 (77.2%) received either pre-, intra- or postoperatively blood transfusions. After a median follow-up of 4 years, the transfused patients developed significantly more recurrences (38.2%) than patients without blood transfusions (23.1%), the death-rate being 33.7% versus 23.0%, respectively. Patients without transfusion but treated with adjuvant intraportal chemotherapy are strikingly doing better (10.5% recurrences) than patients with perioperative blood transfusion not having an adjuvant treatment (44.5% recurrences).

Blood Transfusion↗
PubMed1989

[Liver transplantation: initial experiences from Zurich].

Liver transplantation program in Zurich was started in 1986. Between November 1986 and May 1988, 29 patients have been referred for evaluation. 19 (65%) of the admitted patients were accepted for transplantation, 7 patients died while waiting for a suitable organ. 9 patients have been transplanted. This report summarizes the results with the first 9 transplantations.

Follow-Up Studies↗
PubMed1989

[Blood transfusion, short perioperative intraportal chemotherapy and recurrence of colorectal cancer].

Carcinomatous tumors usually have a rather slow proliferation rate. However, this process is sensibly accelerated as soon as immunodepressive phenomena occur. Blood transfusions may result in the appearance of a considerable mass of alloantigens and in simultaneous immunomodulation. On the basis of a series of 469 patients, we are able to realize that the intra-and postoperative administration of blood during the curative resection of colorectal cancers produced a poor prognosis. We also followed up subjects who had had chemotherapy via the portal system for one week but no blood transfusion. The prognosis was definitely better in these patients, and proved to be 2 to 3 times as favorable as for patients receiving blood transfusions without chemotherapy. The various results are thoroughly analyzed, the primary aim being the study of the effects of intraoperative portal chemotherapy. This leads to advocating the restriction of blood transfusions, and the use of autotransfusion or hemodilution if required.

Animals↗
PubMed1989

[Effect of blood transfusions on the survival of patients with colorectal cancers].

Blood transfusion is reported to cause immunosuppression. An adverse relationship between perioperative blood transfusions and the risk of subsequent recurrence of cancer was reported recently. We reviewed the records of 282 patients and analyzed the interaction between blood tranfusion and the outcome of Dukes stages A, B and C colorectal cancers treated by radical resection during the years 1978-1985. 53 of these patients did not receive any blood transfusions. The actuarial survival analysis (Cutler and Ederer) showed no significant difference for the overall and recurrence-free survival. This study did not support the hypothesis that blood transfusions had an adverse effect on survival of patients with colorectal cancer.

Blood Transfusion↗
PubMed1989

[Treatment of soft tissue sarcoma. A multidisciplinary approach].

The treatment of soft tissue sarcomas is at present a multidisciplinary process. In Switzerland, patients are too often referred to specialized centers after an inadequate management. The general principles of biopsy, surgery, radiotherapy and chemotherapy are reviewed in the light of the biological behaviour of these tumors. Emphasis is made on the role of adjuvant chemotherapy that is not yet established and that is the subject of an ongoing Swiss Study. A collaboration to the study of the Swiss centers and the surgeons is needed in order to improve the quality of treatment of these tumors.

Combined Modality Therapy↗
PubMed1988

[The tumor markers CA 19.9, Ca 50 and CEA in the differential diagnosis of pancreatic carcinoma].

The tumour markers CA 19.9, CA 50 and CEA were measured preoperatively in 178 patients with symptoms of the upper abdomen and in 30 healthy individuals. Raising the cutoff of CA 19.9 and CA 50 and combining the three markers resulted in a sensitivity of 81.5% and a specificity of 86.7%. With increasing local tumour size and tumour spread, a non-significant tendency to greater tumour marker concentrations was observed. The tumour markers tested proved of great value in differentiating between pancreatic cancer and chronic pancreatitis. Sensitivity and specificity in this context were 81.5% and 100% respectively. In postoperative follow-up and in evaluation of new therapy regimens we recommend CA 19.9 as the marker most closely related to tumour progression or recurrence.

Adenocarcinoma↗
PubMed1988

Present indications and future expectations of ultrasound in surgery.

With the improvement of resolution in the ultrasound image, this technique has become more and more popular as a diagnostic means in various fields of medicine. Surgeons use diagnostic ultrasound pre-, intra- and postoperatively. Preoperatively, it is mainly employed for tumour staging, differential diagnosis of the acute abdomen, assessment of intra-abdominal and intrathoracic fluid in polytrauma and lately for arthrosonography. Intraoperative ultrasound has developed into one of the most important tools in intraoperative decision making in surgery of the liver, the bile ducts and the pancreas. Adenomas of the parathyroid glands may represent an indication for intraoperative ultrasound. Postoperative ultrasound has become increasingly important in the follow-up of tumour patients and the monitoring of patients in the intensive care unit. Interventional sonography can either be diagnostic or therapeutic. Both pre- and postoperatively, it can be used to help acquire material for microbiological, chemical and cytological examination. On the other hand, it is applied for drainage of abscesses and pancreatic pseudocysts, as well as pleural and intra-abdominal fluid collections. The main problem for the surgeon beginning to work with ultrasound today is the lack of training facilities with an experienced teacher. This is the origin of most of the other problems, such as quality control, 24-h service and interobserver-variations. With the new technologies already available or being developed, ultrasound is bound to gain even more importance for the surgeon in the future.

Diagnosis, Differential↗
PubMed1987

Adjuvant therapy for colorectal cancer. The EORTC experience and a review of the literature.

In spite of the improvements in surgical techniques and intensive care therapy, no appreciable improvement in the prognosis for patients with colorectal cancer has been made in recent years. Several types of adjuvant treatment, including radiotherapy, chemotherapy, and immunotherapy, have therefore been proposed and used in clinical trials, mainly in the United States and western Europe. The results obtained by the Gastrointestinal Group of the European Organization for Research and Treatment of Cancer (EORTC), using preoperative radiation therapy with 3450 rads, are reported here; this therapy results in a reduction in the number of local recurrences and also appears to prolong the five-year survival period, although a longer follow-up is required to confirm this. According to the Gastrointestinal Tumor Study Group (GITSG), postoperative radiation therapy with chemotherapy seems to prolong the tumor-free interval in stages B2 and C when compared to surgery alone. Nonspecific immunotherapy does not appear to improve surgical results either in terms of local recurrences or survival. Some clinical trials suggest that systemic polychemotherapy benefit subgroups of patients with colorectal cancer. Toxicity is still very high, however; 5-FU is the more active and safe single agent but, due to the low response rate, it appears essential to identify new, more active drugs. Particular attention has been focused recently on prophylactic infusion chemotherapy of the liver, and clinical trials are now being made by several groups, including the EORTC. Preliminary results seem to show a reduced incidence of liver metastases in patients infused with 5-FU after radical surgery. Adjuvant therapy in colorectal cancer patients undergoing radical surgery has so far given encouraging results. Future results are awaited with optimism, but they must be achieved through prospective clinical trials conducted by well-organized cooperative groups.

Antineoplastic Agents↗
PubMed1987

[Results of treatment of perforated stomach tumors].

Perforation of a stomach tumour is a rare experience. It occurred to 0.4 per cent of patients treated by the authors for gastro-intestinal tumours and to four per cent of those on whom emergency operations had to be performed. Surgical morbidity was found to be low but so were the chances of survival which ranged between eight and 44 months. That was equally true for patients who had apparently undergone radical surgery. Those findings were not really surprising, since it was known that only advanced carcinomas would perforate. Tumour perforation resulted in spread of carcinoma cells across the peritoneum and thus in canalicular metastasation. That would move the tumour into a phase which could no longer be curatively tackled by surgical approaches alone. Nevertheless, in cases of emergency, surgery should be as radical as possible, and the technique chosen should be identical with that used in no-emergency surgery.

Adenocarcinoma↗