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Biomedical subjects

W Hohenberger

Publications and source records attributed to W Hohenberger.

At least 19 recordsLinked to original sources
PubMed2001

Palliation of a primary malignant melanoma of the distal esophagus by stent implantation. Report of a case.

BACKGROUND: A 55-year-old woman suffering from progressive dysphagia, retrosternal pain, and annoying foetor ex ore is described. Esophagogastroscopy showed a dark, necrotic tumor extending from 28 cm below the front teeth to the esophagogastric border, and biopsy showed it to be a primary malignant melanoma. The underlying progressive tumor stage with pericardial infiltration and intra-abdominal lymph node metastasis precluded the possibility of curative surgical treatment. METHODS: For palliation, we implanted a metal stent (Ultraflex, Microvasive, Boston Scientific Corporation, Watertown, MA, USA) in the distal esophagus to alleviate the dysphagia. RESULTS: Permanent recanalization of the tumor-obstructed esophagus by stent implantation alleviates symptoms, thereby significantly improving quality of life. Radiochemotherapy can be performed despite the presence of the stent. CONCLUSIONS: Surgery is the therapy of choice for resectable primary malignant melanoma of the esophagus. Endoscopic therapy should be considered for alleviating dysphagia if surgery is impossible.

Deglutition Disorders↗
PubMed2001

Arterialization of the portal vein in liver transplantation: a new microsurgical model in the rat.

BACKGROUND: A preexisting thrombosis of the portal vein and the deep splanchnic bed can make it extremely difficult to reestablish the portal blood flow in orthotopic liver transplantation in man. Complete arterialization of the liver transplant, including the donor portal vein, might be a viable therapeutic option. A new rat transplantation model is described, in which the liver is completely arterialized. METHODS: The outflow of the portal blood in the recipient was secured via a portocaval shunt. Hepatectomy was then performed and the liver transplant placed in orthotopic position. An interposed aortic segment was used for direct arterialization of the donor portal vein. RESULTS: The laboratory parameters determined in the serum at the end of the observation period of 28 days revealed normal functioning of the transplant. The histological examinations showed largely normal cellular architecture, with no signs of necrosis, but incipient fibrosis. CONCLUSIONS: Using this new surgical technique in the rat liver transplantation model, long-term morphological and functional changes in a completely arterialized liver graft, and the regenerative capability of liver tissue perfused in this way, can be investigated.

Anastomosis, Surgical↗
PubMed2001

Adjuvant versus neoadjuvant radiochemotherapy for locally advanced rectal cancer. A progress report of a phase-III randomized trial (protocol CAO/ARO/AIO-94).

AIM: The standard treatment for patients with clinically resectable rectal cancer is surgery. Postoperative radiochemotherapy is recommended for patients with advanced disease (pT3/4 or pN+). In recent years, encouraging results of preoperative radiotherapy have been reported. This prospective randomized phase-III trial (CAO/ARO/AIO-94) compares the efficacy of neoadjuvant radiochemotherapy to standard postoperative radiochemotherapy. We report on the design of the study and first results with regard to toxicity of radiochemotherapy and postoperative morbidity. PATIENTS AND METHODS: Patients with locally advanced operable rectal cancer (uT3/4 or uN+, Mason CS III/IV) were randomly assigned to pre- or postoperative radiochemotherapy: A total dose of 50.4 Gy (single dose 1.8 Gy) was applied to the tumor and the pelvic lymph nodes. 5-FU (1,000 mg/m2/d) was administered concomitantly in the first and fifth week of radiation as 120-h continuous infusion. Four additional cycles of 5-FU chemotherapy (500 mg/m2/d, i.v. bolus) were applied. Radiochemotherapy was identical in both arms except for a small-volume boost of 5.4 Gy in the postoperative setting. Time interval between radiochemotherapy and surgery was 4-6 weeks in both arms. Techniques of surgery were standardized and included total mesorectal excision. In addition, stratification according to surgeons involved has been provided for. Primary endpoints of the study are 5-year overall-survival, local and distant control, secondary endpoints include rate of curative (R0) resections and sphincter saving procedures, toxicity of radiochemotherapy, surgical complications and quality of life. RESULTS: As of 15th November 2000, 628 patients were randomized from 26 participating institutions: 310 patients were randomized to postoperative radiochemotherapy, 318 patients to preoperative radiochemotherapy. Acute toxicity (WHO) of radiochemotherapy was low, with less than 15% of patients experiencing Grade 3 or higher toxicity: The principal toxicity was diarrhea, with 12% in the postoperative radiochemotherapy arm and 10% in the preoperative radiochemotherapy arm having Grade-3, and 1% in either arm having Grade-4 diarrhea. Erythema, nausea and leukopenia were the next common toxicities, with less than 3% of patients in either arm suffering Grade 3 or greater leukopenia or nausea. Postoperative complication rates were similar in both arms, with 12% (postoperative radiochemotherapy) and 13% (preoperative radiochemotherapy) of patients, respectively, suffering from anastomotic leakage, 4% (postoperative radiochemotherapy) and 3% (preoperative radiochemotherapy) from postoperative bleeding, and 6% (postoperative radiochemotherapy) and 5% (preoperative radiochemotherapy) from delayed wound healing. CONCLUSION: The patient accrual of our trial is satisfactory, neoadjuvant radiochemotherapy is well tolerated and bears no higher risk for postoperative morbidity.

Adult↗
PubMed2001

[Pseudoaneurysm of the hepatic artery--a rare complication after orthotopic liver transplantation].

INTRODUCTION: Pseudoaneurysm of the hepatic artery is a rare complication of liver transplantation, the most common cause of which--apart from technical surgical problems--is an infection. The most common symptoms are rupture and hemorrhage. METHOD: The present case report describes an asymptomatic pseudoaneurysm of the hepatic artery following liver transplantation, and its treatment. RESULTS: In this patient, an pseudoaneurysm involving an eroded branch of the hepatic artery was found. Surgical treatment consisted in the excision of the aneurysm and oversewing of the branch of the hepatic artery. CONCLUSION: The potential for rupture and hemorrhage makes surgical intervention mandatory even in asympotomatic patients with pseudoaneurysm of the hepatic artery. The surgical procedure depends on the local situation and the time elapsed since transplantation. Preservation or reconstruction of the arterial perfusion is essential.

Aneurysm, False↗
PubMed2001

[The anterior approach to hemihepatectomy].

When performing right hemihepatectomy, the anterior approach can be employed as an alternative to the conventional procedure in which, before dividing parenchymal tissue, the right lobe of the liver is completely mobilized, the vena cava exposed from the lateral aspect, and the veins entering it from the right half of the liver divided outside the organ. In particular, in the case of large or capsule-broaching tumors of the right liver lobe, exposure of the retrohepatic vena cava from the anterior aspect facilitates work on disection of the hepatic veins. Since with this approach the right lobe of the liver does not need to be removed out of its bed, perfusion of the remnant liver and the venous return via the vena cava remain unimpaired during the entire operation. Since manipulation of the tumor is minimal (no-touch technique), the risk of iatrogenic tumor perforation or hematogenous dissemination of malignant cells during surgery is reduced, and a surgical radical en bloc resection is facilitated. These technical and oncological benefits of the anterior approach must, however, be weighed against the increased risk of bleeding from hepatic veins during divisioning of the parenchyma, since, owing to the fact that the right lobe of the liver is not mobilised, such bleeding is frequently difficult to deal with.

Adult↗
PubMed2001

[Resection of colorectal liver metastases. What prognostic factors determine patient selection?].

AIM OF THE STUDY: Based on a consecutive series of patients undergoing liver resection for colorectal metastases, indicators of prognosis and selection criteria were evaluated. PATIENTS AND METHODS: From 1960 to 1998, a total of 654 patients underwent resection of colorectal liver metastases. In 516 patients (78.9%) this was an R0 resection for initial metastatic disease. These patients form the basis for the investigation. RESULTS: 30-day mortality in this group was 5.8%, while the total procedure-related mortality was 8.3%. Significant morbidity was observed in 16% of patients. Follow-up information until 1 January, 2000 was achieved in 99.5% of patients. Including operative mortality, the actuarial 5-, 10-, and 20-year survival is 38 +/- 5%, 27 +/- 6% und 24 +/- 24%, rising to 41 +/- 5%, 29 +/- 6% and 26 +/- 26% after excluding operative deaths. Tumor-free survival is 35 +/- 5% at 5 years. In the multivariate analysis the following factors are associated with decreased crude survival: extrahepatic tumor (P < 0.0001), intraoperative hypotension (P = 0.0001), non-anatomical procedures (P = 0.0002), a metastasis diameter > or = 5 cm (P = 0.0002), unfavourable grading of the primary tumor (P = 0.0003), satellite metastases (P = 0.0069), mesenteric lymph node involvement (P = 0.0260), use of FFP (P = 0.0307) and synchronous diagnosis of metastases (P = 0.1240). With respect to disease-free survival metastasis diameter is first, followed by extrahepatic disease (P < 0.0001 each). Satellite metastases are removed, while the primary tumor site becomes important with inferior results for rectal cancer (P = 0.0188). The other factors remain stable and in the same order. The number of independent tumor nodules as well as the width of resection margin fail to be significant in both univariate and multivariate analysis. CONCLUSION: These results underline the paramount importance of an R0 resection, but diminish the relevance of most commonly used "contraindications". For the actual decision on liver resection, beside the possibility of achieving an R0 situation, safety aspects regarding comorbidity and acceptable extent of parenchyma loss represent the prime limitation.

Adult↗
PubMed2001

Efficacy of surgical measures in preventing port-site recurrences in a porcine model.

BACKGROUND: Port-site recurrences are serious complications of laparoscopy performed for cancer. Incidences reported in the literature vary between 0% and 21%, suggesting an influence of the surgeon. METHODS: The aim of this experimental, prospective, randomized, single-blind study was to investigate the influence that the quality surgery has on the incidence of port-site recurrences. After a 12-mmHg carbon dioxide (CO2) pneumoperitoneum was created, 10(7) human HeLa cell were injected into the peritoneal cavity of 18 pigs, creating a xenogeneic tumor. Laparoscopic sigmoid resections then were performed using four trocars and a transanal double-stapling technique. The following protective measures were applied in nine animals: trocar fixation, prevention of gas leaks, rinsing of instruments with povidone-iodine, minilaparotomy protection, rinsing of trocars before removal, peritoneal closure, and rinsing of all wounds with povidoneiodine. Surgeons and type of procedures were randomized. After 4 weeks, the animals were killed and all portsites excised. Blinded immunohistologic analysis with antihuman pancytokeratin antibody was performed. RESULTS: Tumor recurrence was present in 23 of 36 port sites (63.8%) in the control group, but only in 5 of 36 port sites (13.8%) in the group that received protective measures (p = 0.002; Fisher's exact test). No peritoneal carcinosis nor anastomotic recurrences were observed. CONCLUSION: These results strongly suggest that the quality of surgical technique has an influence on the incidence of port-site recurrences. From now on, we propose to use these protective measures routinely in cancer laparoscopy.

Animals↗
PubMed2001

CEA and CA 19-9 measurement as a monitoring parameter in metastatic colorectal cancer (CRC) under palliative first-line chemotherapy with weekly 24-hour infusion of high-dose 5-fluorouracil (5-FU) and folinic acid (FA).

BACKGROUND: There have been contradictory reports on the benefit of CEA and CA 19-9 measurements in patients with metastatic colorectal cancer using palliative chemotherapy. The object of this study was to examine the diagnostic accuracy of monitoring of palliative chemotherapy by means of CEA and CA 19-9. PATIENTS AND METHODS: The tumour markers CEA and CA 19-9 were subjected to serial measurement in patients with metastatic colorectal cancer (n = 90) using palliative first-line chemotherapy with weekly 24-hour infusion of high-dose 5-FU with FA and were compared with objective response according to WHO criteria. 85 patients could be evaluated. 43 patients (51%) initially had elevated CEA (> or = 10 ng/ml) and 33 patients (39%) elevated CA19-9 (> or = 50 IE/ml). In 24 patients (28%), both markers were initially increased. With CEA positive patients, 143 cycles of chemotherapy were carried out, which showed the following response in the various cycles: 21 episodes with progressions (ePD), 69 episodes with no change (eNC), 53 episodes with partial/complete remission (ePR/eCR). With CA 19-9 positive patients, 100 cycles of chemotherapy were carried out with the following results: 21 episodes with progressions (ePD), 48 episodes with eNC, and 31 episodes with ePR/eCR. RESULTS: A CEA rise by at least 50% differentiated between ePD versus eNC/ePR/eCR with a sensitivity of 76% and specificity of 90%. With CEA decreases of at least 30% in 99% of these patient episodes (78 of 79), a tumour progression could be excluded. Patients with an initial drop in CEA after the first cycle of chemotherapy of at least 50% of the initial level had a significantly higher probability of achieving an ePR/eCR in further therapy (relative risk 2.9; P = 0.002). With an CA 19-9 increase of at least 30%, a sensitivity progression of 62% and a specifity of 90% could be calculated. A CA 19-9 decrease of at least 60% excludes a progression in 95% of the patient episodes. CONCLUSIONS: A CEA or CA 19-9 rise is only conditionally appropriate for recording progressions. A progression however, can be excluded with falling levels with high diagnostic accuracy, in which CEA offers a greater degree of certainty than CA 19-9. With a drop in CEA 79 of 143 (= 55%) of the CT scans could be saved, in which case 78 of 79 patient episodes (99%) were correctly assessed as 'no progression'. In patients with an increased CEA and CA 19-9 the CEA determination is sufficient for the further monitoring. A confirmation of these results by multicenter trials can result in a considerable decrease of monitoring costs for palliative treatment.

Adult↗
PubMed2001

Multiple primary malignancies: An epidemiological and pedigree analysis of 57 patients with at least three tumours.

AIM AND METHODS: Data of our patients with at least three primary malignancies were retrospectively analysed to detect any remarkable patterns which might be of interest for follow-up or early tumour detection and to identify a possible hereditary cancer predisposition. From 1.1.1954 to 1.8.1995 57 patients (0.1%) among a grand total of 52 398 cancer patients had a minimum of three malignancies. RESULTS: The 5-year survival rates after colorectal, bladder, prostate, uterine corpus and gastric cancer were higher than those seen in patients with the corresponding solitary tumours. In both sexes, the mean interval between the individual tumours was greater (4.0 years) between the first and second tumours than between the second and third (2.5 years). In women, the intervals were roughly twice as long (6.8 and 3.7 years) as in men (3.7 and 2.0 years). 40.4% (n=23/57) had a colorectal, 28.1% (n=16) a bladder, and 41.7% (n=15/36 men) had a prostate carcinoma. 66.7% (n=14/21 women) contracted at least one gynaecological tumour. In 24 families HNPCC, in one a Li-Fraumeni Syndrome, and in another Hereditary Diffuse Gastric Cancer was suspected.

Adult↗
PubMed2001

Weekly 24-h infusion of high-dose 5-fluorouracil (5-FU) with folinic acid (FA) in adjuvant therapy of colon cancer.

After curative resection (R-0) of primary colon cancer or curative metastases resection, the efficacy, toxicity and compliance of a weekly 24-h infusion of high-dose 5-FU with folinic acid was examined in a prospective feasibility trial. From June 1995 to June 1997, 19 patients were included, 11 patients with UICC stage III and 8 patients with UICC stage IV colon cancer. The patients received weekly 500 mg/m2 of calcium folinic acid (Rescuvolin) as a 1-2 h-infusion on an outpatient basis following a 24-h infusion of 2,000 mg/m2 5-FU via a pump system (intermate LV5 Baxter). The adjuvant therapy was administered for 6 months. 90% of the patients received the planned 18 chemotherapy applications. The total 5-FU dose given to each patient amounted to 34.4 g/m2 in 6 months, thus corresponding to 95% of the planned 5-FU total dose. The main toxicity was diarrhea CTC toxicity grade 3 in the case of 16% of the patients. After a median follow-up of 51 months (range: 37-59 months), 82% of the patients (9 out of 11) with stage III remained free of recurrence. The 2 cases of recurrence belonged to the pN2 subgroup. In stage IV only 12% of the patients (1 out of 8) remained free of recurrence. On an adjuvant basis, a weekly 24-h infusion of high-dose 5-FU with folinic acid is accompanied by a good complicance and a high-dose intensity of 5-FU. Now it is tested within randomized phase III trials of the "Arbeitsgemeinschaft Gastroenterologische Onkologie (AGO)" of the "Deutsche Gesellschaft für Verdauungs- und Stoffwechselerkrankungen" for UICC stage III colon cancer. Concerning stage IV, adjuvant therapy was not effective, a fact that seems to justify new drugs and new therapeutic strategies.

Adult↗
PubMed2001

Light-induced autofluorescence spectroscopy for the endoscopic detection of esophageal cancer.

BACKGROUND: Any innovative optical system that facilitates the early endoscopic detection of neoplastic change in the GI mucosa has the potential to greatly improve survival and quality of life for patients prone to have GI malignancies develop. The present article describes light-induced autofluorescence spectroscopy with violet-blue excitation light for in vivo diagnosis of cancerous tissue of the esophagus during routine endoscopy. METHODS: One hundred twenty-nine endogenous fluorescence spectra were obtained from normal mucosa and malignant lesions in 9 patients with squamous cell cancer and 4 with adenocarcinoma of the esophagus. Following spectrographic measurements, biopsy specimens were obtained for definitive classification of the spectra. A special light source capable of delivering either white or violet-blue light for excitation of tissue autofluorescence by means of an endoscope was used. Endogenous fluorescence spectra emitted by tissues were detected with a fiberoptic probe and analyzed with a spectrograph. RESULTS: Squamous cell cancer and adenocarcinoma of the esophagus exhibit specific changes in the emitted fluorescence spectra as compared with normal mucosa. Based on the results obtained in earlier studies, malignant and benign spectra were differentiated with the aid of a mathematical algorithm. By using this algorithm, a sensitivity of 97% and specificity of 95% were obtained for the diagnosis of esophageal carcinoma. CONCLUSIONS: Light-induced fluorescence spectroscopy is useful for the endoscopic detection of squamous cell cancer and adenocarcinoma of the esophagus. This spectroscopic study provides a basis for the design of a simplified autofluorescence imaging system for detection of esophageal neoplasms.

Adenocarcinoma↗
PubMed2000

Surgical therapy for distant metastases of malignant melanoma.

BACKGROUND: Manifestation of distant metastases in melanoma patients commonly indicates a poor prognosis. The aim of the current study was to examine the role of surgical treatment in these patients. METHODS: Data from 444 patients with distant melanoma metastases were gathered prospectively from January 1978 through December 1997. Characteristics of the primary tumor, time until the first occurrence of distant metastases, frequency and site of distant metastases, surgical therapy, and survival were evaluated by univariate and multivariate analyses. RESULTS: Histology, Breslow thickness, Clark level, and pT and pN categories (UICC 1997) significantly influenced the median interval from initial diagnosis to manifestation of distant metastases. The most common single localization was the lung (n = 83), followed by distant lymph node (n = 79), and skin metastases (n = 51). One hundred seventy-four patients received surgical treatment (39%) and 111 (25%) patients received surgical treatment with curative resection (R0, UICC 1997), most frequently in distant lymph node or skin metastases (57% and 59%, respectively). Median survival time and 2-year survival rate for all patients were 7 months and 15.8%, respectively, 17 months and 36.1% following curative resection, 6 months and 12.7% after incomplete resection (n = 63) (P < 0.0001). Conservatively treated patients survived for a median of only 4 months with a 2-year survival of 8.1%. Multivariate survival analysis showed localization of the primary tumor (head/neck/trunk vs. extremities), the number of involved sites, and surgical therapy to be independent prognostic factors. CONCLUSIONS: Surgical therapy of distant metastases was most beneficial when complete removal of metastatic tissue was achieved. Selection of patients for surgical excision should be determined by individual patient indications.

Adult↗
PubMed2000

[Retroperitoneal desmoid tumor with kidney failure in familial adenomatous polyposis].

HISTORY AND FINDINGS: A 39-year-old man was hospitalized because of continually rising urinary creatinine and blood urea nitrogen concentration. He was known to have familial adenomatous polyposis (FAP), first diagnosed 18 years previously and re-Physical examination was unremarkable except for pain on percussion over both kidney regions. There was a well-healed laparotomy scar. INVESTIGATIONS: Ultrasound revealed chronic bilateral obstructive renal disease, grade II-III, and computed tomography showed a conglomerate retroperitoneal tumour with obstruction of both ureters at the level of the lower pelvis. This tumour had first been noted first 3 years after the colectomy when the patient complained of abdominal pain. It had been identified histologically as a nonresectable retroperitoneal desmoid tumour. TREATMENT AND COURSE: An external fistula was made, relieving the renal retention. To suppress growth of the desmoid tumour Sulindac, a nonsteroid anti-inflammatory drug, was administered. Genetic molecular analysis revealed a germ line defect in codon 1690 of the APC gene. It is intended to examine other members of the family for the presence of this defect. CONCLUSION: Desmoid tumours are more common in persons with FAP and are among the most frequent extracolic causes of their death. Treatment options are critically analysed.

Adenomatous Polyposis Coli↗
PubMed2000

Hypoglycemic sensorimotor polyneuropathy associated with insulinoma.

Hypoglycemia-induced peripheral neuropathy due to insulinoma is unusual and, as far as we know, has previously been reported in only 34 patients. In this case report, we describe the clinical features, electrophysiological features, and pathological findings in a 37-year-old patient with polyneuropathy from repeated hypoglycemic episodes over a 9-year period that related to an insulinoma. The literature is discussed. The reported case is of special interest because the peripheral neuropathy led to the correct diagnosis.

Adult↗
PubMed2000

The diminished postoperative capacity of blood leukocytes to produce IL-6 is associated with high concentrations of IL-6 in the circulation.

Surgical trauma is followed both by a transient increase of interleukin 6 (IL-6) concentrations in the serum and impaired function of circulating leukocytes. Perioperatively, we investigated the relationship of IL-6 concentrations in the serum with lipopolysaccharide (LPS)-stimulated cytokine production in the whole blood of patients undergoing elective major abdominal operations. In 50 patients, we found a transient increase of IL-6 concentrations in the serum. Six hours after skin incision, in vitro stimulated production of IL-6 and TNFalpha was diminished by 72% (P<0.05). A significant increase in cytokine production was observed three days postoperatively, however this was 63% below the preoperative values. Patients with high concentrations of circulating IL-6 showed a significantly lower stimulated IL-6 production than patients with low serum concentrations of IL-6. We conclude, that two opposing effects are associated with surgery: an activation leading to IL-6-release into the circulation, and a prolonged hyporesponsiveness of circulating leukocytes. These reactions are positively related.

Abdomen↗