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Biomedical subjects

W Hohenberger

Publications and source records attributed to W Hohenberger.

At least 109 records · Page 6Linked to original sources
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

[CT-guided percutaneous core biopsy: Effective accuracy, diagnostic utility and effective costs].

PURPOSE: The value of a diagnostic technique does not only depend on its sensitivity, specificity and accuracy, but also on how its results affect clinical management. This effect is represented by the values effective accuracy and the diagnostic utility which were determined for CT-guided coaxial core biopsies in this study. MATERIALS AND METHODS: 180 consecutive biopsies were analyzed. The results were analyzed with the help of a logistic regression analysis with regard to the organ regions biopsied, the size of the needle used, and the number of tissue cores taken. Correct results that were not accepted as diagnostic clinically and resulted in additional biopsies were scored together with the false results under negative utility coefficients. RESULTS: The sensitivity, specificity and accuracy of all the tests amounted to 91.1 %, 100 %, and 93.3 %, respectively. The diagnostic utility of the biopsies varied between 66 % for the liver and pancreatic lesions, and 88 % for the non-organ related retroperitoneum. In those cases where more than three tissue cores were taken the results were statistically significantly better in terms of effective accuracy and diagnostic utility. No significant differences were found with regard to different needle sizes in the biopsied organ regions. The lowest clinical acceptance was observed for the histological findings "scar tissue" and "inflammation". CONCLUSION: CT-guided coaxial biopsies offer a high degree of sensitivity, specificity and accuracy, as well as a low rate of therapeutically relevant complications. With increasing use of differentiated strategies in therapy for malignomas percutaneous biopsies play a very important role in the management of these diseases. Prospective studies should further evaluate the effective accuracy and diagnostic utility of core biopsies also in comparison to fine needle aspiration biopsies (FNAP).

Adult↗
PubMed2001

[Quality management in surgery: treatment of pancreatic carcinoma--What is evidence-based?].

Summary. The term "evidence-based medicine" (EBM) - an Anglicism in common use in modern medicine - has of the nature of a catchword, the actual meaning of which is not always clear to all who use it. Generally speaking it is taken to mean that decision-making in the areas of diagnosis and treatment is based on data obtained from randomized, preferably double-blind and controlled, studies involving sufficient numbers of cases. This, however, is not always automatically equatable with arriving at a decision at the highest level of confirmed scientific knowledge, including the most recently acquired facts. Taking account of the current literature, the present article attempts an analysis of the following four aspects of surgical treatment of pancreatic carcinoma: the required extent of lymph node dissection, the relevance of multimodal treatment concepts, the significance of pylorus-preserving partial duodenopancreatectomy and the relevance of portal vein resection.

Combined Modality Therapy↗
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↗
PubMed2001

Endoscopic fluorescence spectroscopy in the upper GI tract for the detection of GI cancer: initial experience.

OBJECTIVE: The aim of this study was to investigate autofluorescence spectroscopy using violet-blue excitation light for the in vivo diagnosis of GI cancer during routine endoscopy. METHODS: Fluorescence spectra were obtained from normal mucosa and cancerous lesions of the esophagus and stomach. The spectroscopic system used comprised a special light source capable of delivering either white or violet-blue light to induce autofluorescence of tissue via the endoscope. Endogenous fluorescence spectra emitted by the tissue were recorded with a fiberoptic probe and analyzed with a spectrographic detector system consisting of a polychromator with a photodiode array and an optical multichannel analyzer. The data of each spectrum were sampled within the range of 450-700 nm and stored in a personal computer. RESULTS: Esophageal squamous cell cancer, adenocarcinoma of the esophagus, and adenocarcinoma of the stomach show specific differences in the emitted fluorescence spectra compared with normal mucosa. CONCLUSIONS: Light-induced fluorescence spectroscopy might be a useful tool for the endoscopic in vivo detection of dysplasia and early carcinoma in the upper GI tract. Further trials are needed to test the validity of this new optical detection system.

Adenocarcinoma↗
PubMed2001

[Laparoscopic restorative proctocolectomy in ulcerative colitis and colonic polyps].

With increasing experience, laparoscopic techniques have been applied even to extended colorectal operations as restorative proctocolectomy in ulcerative colitis and familial adenomatous polyposis. After initial medial transection of the three main vascular pedicles, the colon is dissected free laterally, from the sigmoid orally towards the ileum. The rectum is mobilized down to the pelvic floor. Over a Pfannenstiel incision, the bowel is extracted and the pouch is created. The anastomosis is completed in double-stapling technique. At two departments, 27 patients have been operated on. The median time of operation was 320 min (180-540). The median length of hospital stay was 8.1 days. There was no postoperative mortality. The complication rate was similar to conventional surgery at the same institutions. Three patients had to be re-operated on, two for ileal obstruction close to the pouch, one patient for bleeding from the pouch. In restorative proctocolectomy, laparoscopic techniques prove to be safely feasible. They have the potential to become an appealing alternative to open surgery.

Adenomatous Polyposis Coli↗
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↗
PubMed2000

p27(kip1) expression in rectal cancer correlates with disease-free survival.

BACKGROUND: The cell-cycle inhibitor p27(kip1) is a potential tumor suppressor and might serve as a prognostic marker in rectal cancer, in particular with regard to patient selection for adjuvant therapy. MATERIALS AND METHODS: Immunohistochemical analysis was performed, using an anti-p27(kip1) monoclonal antibody, on paraffin sections of two matched [age, gender, UICC stage, year of operation (1982-1991)] groups of patients (n = 2 x 82) with rectal carcinoma curatively treated by surgery alone. The groups differed only in subsequent metachronous distant metastatic spread. All patients had to meet the selection criterion "free of local disease," in order to exclude surgical influence. Follow-up was prospective (median of 74 months). The intensity of staining (-, +, ++, ) and rate of positive cells (as a percentage of total tumor volume) were judged separately for cytoplasms and nuclei. RESULTS: On multivariate analysis, cytoplasmic staining intensity proved to be the best prognostic factor of disease-free survival and approached statistical significance (P = 0.0552, Cox regression). On univariate analysis, considering cytoplasmic staining alone, intensely stained ( ) tumors showed significantly poorer disease-free survival (vs ++, +, -; Kaplan-Meier, logrank, P = 0.0185). CONCLUSIONS: The demonstrated correlation between cytoplasmic compartmentalization of p27(kip1) and increased metastatic spread as well as disease-free survival underscores the role of p27(kip1) in rectal cancer. However, since other reports emphasize the importance of nuclear p27(kip1) expression, the mechanisms of steady-state and subcellular distribution of p27(kip1) remain unclear, and further investigation is needed.

Adenocarcinoma↗
PubMed2000

Laparoscopic abdominoperineal resection: early postoperative results of a prospective study involving 116 patients. The Laparoscopic Colorectal Surgery Study Group.

PURPOSE: Although laparoscopic colorectal surgery is attracting ever more attention, its use for curative treatment of colorectal carcinoma in particular continues to be controversial. The present study was an attempt to analyze the results of the perioperative course, oncologic quality, and preliminary long-term results. METHOD: The data considered here were collected within the framework of a prospective, observational study initiated on August 1, 1995, and involving a total of 18 institutions in Germany and Austria. At the end of three years, the results are now being presented selectively, i.e., focusing only on abdominoperineal resection. RESULTS: A total of 116 patients underwent laparoscopic abdominoperineal resections, 98 (84.5 percent) of which were performed with curative intent. The mean operating time was 226 (confidence interval, 140-365) minutes. Seven patients (6 percent) experienced an intraoperative complication, which in more than one-half of the cases was a vascular injury involving the presacral venous plexus; the conversion rate was 3.4 percent. Postoperatively, 40 patients developed 97 complications--including those of a very minor nature--giving an overall morbidity rate of 34.4 percent. Reoperation in six patients (5.2 percent) had to be performed for an afterbleed in one-half of the cases and ileus in the other one-half. Postoperative mortality was a low 1.7 percent. In most of the curative resections, an oncologically radical operation with high transection of the inferior mesenteric artery and a complete dissection of the pelvis down to the floor was performed. The median number of lymph nodes investigated was 11.5, and there was wide fluctuation in the numbers among the individual institutions. Tumor cell dissemination occurred intraoperatively in five patients. In the meantime, 79 patients (81 percent) underwent at least one follow-up examination, the mean follow-up period being 491 days. Seven patients developed a local recurrence, and a further six patients developed distant metastases. For recurrence-free survival rate, the Kaplan-Meier estimation calculated a probability of 71 percent. CONCLUSION: Not all of the reservations about laparoscopic abdominoperineal resection, in particular with regard to resection with curative intent, have yet been eliminated. The present study does, however, show that a laparoscopic approach can in principle meet oncologic requirements of radicality and, with regard to the postoperative course, is associated with considerable benefits to the patient.

Abdomen↗
PubMed2000

Prognostic value of microscopic peritoneal dissemination: comparison between colon and gastric cancer.

PURPOSE: We evaluated the incidence and prognostic relevance of microscopic intraperitoneal tumor cell dissemination of colon cancer in comparison with dissemination of gastric cancer as a rational for additive intraperitoneal therapy. METHODS: Peritoneal washouts of 90 patients with colon and 111 patients with gastric cancer were investigated prospectively. Sixty patients with benign diseases and 8 patients with histologically proven gross visible peritoneal carcinomatosis served as controls. Intraoperatively, 100 ml of warm NaCl 0.9 percent were instilled and 20 ml were reaspirated. In all patients hematoxylin and eosin staining (conventional cytology) was performed. Additionally, in 36 patients with colon cancer and 47 patients with gastric cancer, immunostaining with the HEA-125 antibody (immunocytology) was prepared. The results of cytology were assessed for an association with TNM category and cancer grade, based on all patients, and with patient survival, among the R0 resected patients. RESULTS: In conventional cytology 35.5 percent (32/90) of patients with colon cancer and 42.3 percent (47/111) of patients with gastric cancer had a positive cytology. In immunocytology 47.2 percent (17/36) of patients with colon cancer and 46.8 percent (22/47) of patients with gastric cancer were positive. In colon cancer, positive conventional cytology was associated with pT and M category (P = 0.044 and P = 0.0002), whereas immunocytology was only associated with M category (P = 0.007). No association was found between nodal status and immunocytology in colon cancer and with the grading. There was a statistically significant correlation between pT M category and conventional and immunocytology in gastric cancer (P < 0.0015/P = 0.007 and P < 0.001/P = 0.009, respectively). Positive immunocytology was additionally associated with pN category (P = 0.05). In a univariate analysis of R0 resected patients (no residual tumor), positive immunocytology was significantly related to an unfavorable prognosis in patients with gastric cancer only (n = 30). Mean survival time was significantly increased in patients with gastric cancer with negative cytology compared with positive cytology (1,205 (standard error of the mean, 91) vs. 771 (standard error of the mean, 147) days; P = 0.007) but not in patients with colon cancer (1,215 (standard error of the mean, 95) vs. 1,346 (standard error of the mean, 106) days; P = 0.55). CONCLUSIONS: Because microscopic peritoneal dissemination influences survival time after R0 resections only in patients with gastric but not with colon cancer, our results may provide a basis for a decision on additive, prophylactic (intraperitoneal) therapy in gastric but not colon cancer.

Analysis of Variance↗
PubMed2000

Extensive surgery after high-dose preoperative chemoradiotherapy for locally advanced recurrent rectal cancer.

PURPOSE: This was a pilot study of high-dose preoperative concurrent radiation and chemotherapy before extensive surgery in patients with locally advanced recurrent rectal cancer. Here we report on curative resectability, acute toxicities during chemoradiotherapy, surgical complications, local control, and three-year survival rates achieved with this aggressive multimodal regimen. METHODS: Between 1994 and 1997, 35 previously nonirradiated patients with pelvic recurrence of rectal cancer were entered in the study. All patients presented with tumor contiguous or adherent to adjacent pelvic organs and were not deemed amenable to primary curative surgery. A total radiation dose of 50.4 Gy with a small-volume boost of 5.4 to 9 Gy was delivered in conventional fractionation (single dose, 1.8 Gy). 5-Fluorouracil was scheduled as a continuous infusion of 1,000 mg/m2/day on Days 1 to 5 and 29 to 33. Six weeks after completion of chemoradiotherapy, patients were reassessed for resectability, and radical surgery was attempted whenever feasible. RESULTS: After preoperative chemoradiotherapy 28 of 35 patients (80 percent) underwent resection with curative intent. In 16 of 35 patients (57 percent) extended resection of adjacent organs was performed. Resections with negative margins were achieved in 17 patients (61 percent); 9 patients had microscopic, and 2 patients had gross residual disease. There was no postoperative mortality. Fourteen patients (44 percent) experienced postoperative complications. Toxicity from chemoradiotherapy occurred mainly as diarrhea (National Cancer Institute Common Toxicity Criteria Grade 3; 23 percent), dermatitis (Grade 3; 11 percent), and leucopenia (Grade 3; 11 percent). One patient died of tumortoxic multiple organ failure during chemoradiotherapy. With a median follow-up of 27 months, local re-recurrence after curative resection was observed in only three patients (18 percent); six patients developed distant metastases. Three-year actuarial survival rate was significantly improved after complete resection (82 percent) as compared with noncurative surgery (38 percent; P = 0.03). CONCLUSION: A combination of high-dose preoperative chemoradiotherapy followed by extended surgery can achieve clear resection margins in more than 60 percent of patients with recurrent rectal tumor not amenable to primary surgery. An encouraging trend evolved for this multimodal treatment to improve long-term local control and survival rate.

Adult↗