Search PubMed⌕ Search

Biomedical subjects

W Stock

Publications and source records attributed to W Stock.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Acceptance and effectiveness of surgical vascular consultation--is it worthwhile?].

In a retrospective analysis the meaning of the vascular outpatient clinic and the follow-up after vascular reconstructive surgery were investigated. 6889 patients were checked within 8 1/2 years in the vascular consultant hour of the Marien-Hospital Düsseldorf with a fixed diagnostic schedule related to the vascular surgery. More than 40% of the patients did not have any vascular disease. Only 6.5% of the 276 patients with aortoiliac reconstructive surgery visited the follow-up terms regularly. The additional vascular training group was visited by only 1.2%. While 93 patients (33.7%) were hospitalized to further treatment because of new clinical findings, 54 patients got another vascular reconstruction and 12 patients were operated because of secondary disease. In 12 cases (10.5%) we found a clinical asymptomatic deterioration of the vascular status. The vascular consultant hour is time-consuming and expensive. The important task is the differentiation of vascular clinical findings. Although the acceptance and the effectiveness are disappointing the vascular outpatient clinic and the long-term follow-up after reconstructive vascular surgery is necessary for the improvement of the quality of care of the department and for acquiring new knowledge.

Adult↗
PubMed1995

Low incidence of TAL1 gene rearrangements in adult acute lymphoblastic leukemia: A cancer and leukemia group B study (8762)

TAL1 gene rearrangements have been described in approximately 25% of children with T cell acute lymphoblastic leukemia (ALL). Three percent of these rearrangements are the result of a reciprocal translocation, t(1;14)(p34;q11). The remainder of these rearrangements are submicroscopic and involve a nearly precise 90-kilobase pair deletion of the TAL1 gene. Detection of these submicroscopic rearrangements can be accomplished easily using Southern blot and PCR technology and may have potential value for monitoring disease during and following treatment. The incidence of TAL1 gene rearrangements in adults with ALL is unknown. In this pilot study, we performed Southern blot and PCR analysis in a group of newly diagnosed adult ALL patients to determine the incidence of TAL1 rearrangements. Thirty-three adults with T cell ALL were studied; of these, one patient had a t(1;14)(p34;q11) and molecular rearrangement of TAL1. No submicroscopic deletions of TAL1 were detected (95% confidence intervals, 0.000 and 0.106). Unlike pediatric T cell ALL, the incidence of TAL1 rearrangements in adult ALL appears to be very low.

Journal Article↗
PubMed1994

[Primary hemangiosarcoma as a rare form of an incidentally discovered mass of the adrenal glands].

A 50-year-old man with sudden onset of nausea, vomiting and diarrhoea was on ultrasonography of the upper abdomen found to have an adrenal tumour, 5.5 cm in diameter. This was excised transperitoneally with its connective-tissue pseudocapsule, there being no enlarged regional lymph nodes or other pathological findings. But the histological diagnosis was haemangiosarcoma of the adrenal. Seven months later the patient was re-admitted because of suspected acute cholecystitis. Emergency laparotomy revealed a gangrenous, stone-free gallbladder without abscess. Further exploration was not possible because of inflammatory changes and marked adhesions. Recurrent vomiting postoperatively indicated endoscopic retrograde cholangiopancreatography and computed tomography, which showed a space-occupying lesion in the right adrenal region with compression of the choledochal duct, lesser gastric curvature and duodenum. At re-laparotomy tumour recurrence was found with histologically proven intraluminal metastases of the haemangiosarcoma in the jejunum. As curative resection was not possible, a palliative gastrojejunostomy was performed. The patient died 9 months after the diagnosis had been made from the advanced malignancy. This case of a rapidly fatal very rare malignant adrenal tumour underlines the need to remove all hormone-active asymptomatic adrenal tumours 4 cm in diameter or larger.

Adrenal Gland Neoplasms↗
PubMed1994

CGG-repeat polymorphism of the BCR gene rules out predisposing alleles leading to the Philadelphia chromosome.

The Philadelphia chromosome (Ph) is associated with leukemia, most frequently of the chronic myelogenous variety. The Ph chromosome is a translocation chromosome which gains oncogenic potential through the fusion of the ABL oncogene of chromosome 9 with the BCR gene of chromosome 22. The Ph is believed to arise from random chromosome rearrangement with a subsequent selective advantage of the malignant cell line. However, alleles may be present in the population which predispose toward this specific rearrangement. We used a highly polymorphic CGG-repeat polymorphism within the first exon of the BCR gene to determine BCR allele frequencies among 26 leukemia patients with the Ph chromosome and 63 control individuals. Eight BCR alleles of variable CGG-repeat length were present in both groups at statistically similar frequencies and in Hardy-Weinberg equilibrium. We therefore concluded that there are no alleles of the BCR gene that have a major predisposing influence on the development of the Ph chromosome and subsequent leukemia.

Alleles↗
PubMed1994

[Is remodeling still possible after collapse in femur head necrosis?].

A case of a femoral head necrosis, with collapsed joint surface after fracture of the femoral neck will be presented. Following varisation osteotomy, the necrotic parts of the bone was removed and filled with cancellous bone. A standardized bone block of the iliac crest was implanted into the hole. After the operation the patient was painfree. The X-rays showed the improvement of the bony structure and later a spherical remodeling of the femoral head. This result is in opposition with the earlier opinion of the disability of femoral head remodeling in adults. It is technically very important to pack tight the hole in the femoral head with cancellous bone chips after necrectomy, and to ensure the revascularisation with vascularised bone block.

Adult↗
PubMed1994

[Risk analysis of primary endoprosthetic management of proximal femur fractures].

From 1984 to 1991 439 patients with fractures of the coxal femur (303 femoral neck fractures, 136 pertrochanteric fractures) were treated by primary arthroplasty. The average age of the 370 female and 69 male patients was 80.9 (+/- 9.9) years. In 368 patients (83.8%) concomitant diseases were diagnosed and 212 patients (48.3%) showed more than 1 risk factor. There were 205 alloarthroplasties and 234 hemiarthroplasties performed. The percentage of patients treated by total hip endoprosthesis was 31.2% in 1984 and increased to 63.1% in 1991. In 49.2% of all cases general complications occurred, pre-dominantly nosocomial infections and pressure sores. Local (surgical) complications were diagnosed after 10.5% of all operations. The 30-day-mortality was 5.2%, the in-hospital-mortality 5.9%. Statistical analysis by multivariate logistic regression showed an independent negative influence of pre-operative immobility, pertrochanteric fractures, diabetes mellitus and multiple concomitant diseases on mortality. Age, sex or other single risk factors were not independently associated with an increased mortality. Patients with the above mentioned risk factors are easy to identify pre-operatively and do perform better after intensive preparation, short operation time and early mobilisation after surgery.

Aged↗
PubMed1994

[Plastic surgery in soft tissue reconstruction in large extremity defects].

Soft-tissue defects in the extremities vary greatly, depending on the trauma mechanism, localization and a number of factors related to the patient's physical condition. We offer an overview of the plastic surgery methods in reconstruction of different soft-tissue defects in the extremities, beginning with the diagnostic, clinical and radiological measures that make classification of soft-tissue defects possible, and then giving a concentrated view of the appropriate reconstruction methods. Collaboration between traumatology and plastic surgery seems to be especially important in lesions in the extremities.

Adult↗
PubMed1994

[Effectiveness of regular after-care in R0-resected rectal carcinoma].

Regular follow-up programs after radical resections of rectal carcinoma have been introduced in numerous hospitals. The main goal of a regular follow-up program is the early diagnosis of tumor recurrence in the asymptomatic stage to allow further radical resection. We evaluated the efficiency (quote of further resections of asymptomatic tumor recurrences) of regular follow-up after resection of 288 rectal carcinomas. 88 patients developed recurrent disease (47 primary locoregional recurrence, 27 distant metastasis, 14 locoregional and distant recurrence). Only 31 patients were asymptomatic at the time of recurrence (metastasis 55.6%, locoregional recurrence 31.9%, local and distant recurrence 7.1%; p < 0.05). In 31 patients (13 asymptomatic, 18 symptomatic) further R0-resection was possible. Locoregional recurrences were resected more often following anterior resection than after abdominal perineal resection. With 13 radical resections of asymptomatic recurrence the efficiency of regular follow-up was only 4.5%. Therefore efficiency alone does not justify regular follow-up examinations. Follow-up still makes sense for psychosocial support, diagnosis of metachronous colonic carcinoma, treatment of postoperative complications and critical evaluation of the results of surgery. Furthermore the follow up data can be used to plan adjuvant therapy studies.

Aftercare↗
PubMed1994

[Total endoprosthesis or dual head prosthesis in endoprosthetic management of femoral neck fractures?].

From 1.1.1984 to 31.12.1992, a total of 363 femoral neck fractures were treated by primary hip arthroplasty, with 213 total hip endoprostheses (58.7%) and 150 bipolar endoprostheses (41.3%). The average age of the 51 (14.0%) male and 312 (86.0%) female patients was 80.3 (+/- 8.9) years. While only 15.8% of all patients were treated with alloarthroplasty in 1984, the proportion treated in this way increased to 88.9% in 1992. In the same period, the percentage of patients with total hip arthroplasty who were above 80 years rose from 15.6% to 54.5% (p < 0.05), and the percentage in this group with multiple concomitant diseases rose from 28.1% to 48.2% (p < 0.05). General postoperative complications occurred after 43.5% of the operations (total arthroplasty 38.0%, bipolar prosthesis 51.3%, p < 0.01), with no substantial change during the observation period (1984-1986, 43.6%; 1990-1992, 43.2%). Surgical complications were observed in 9.1% of all cases (total arthroplasty 11.7%, bipolar prosthesis 5.6%, p < 0.05), decreasing slightly from 11.7% in 1984-1986 to 8.1% in 1990-1992. The postoperative mortality was 3.3% (total arthroplasts 1.9%, bipolar prosthesis 5.3%, p > 0.05). The higher rate of general complications and the insignificantly higher mortality after insertion of bipolar endoprostheses cannot be attributed to the endoprosthetic technique itself; they are probably due to the higher age and poorer general condition of patients in whom hemiarthroplasty was performed. Although there has been an increasing frequency of total hip replacement even in older and sicker patients in recent years, no significant changes in morbidity and mortality were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Detection of MLL gene rearrangements in adult acute lymphoblastic leukemia. A Cancer and Leukemia Group B study.

Specific structural rearrangements involving chromosome band 11q23 occur in a variety of hematologic malignancies, including an estimated 2-7% of patients with acute lymphoblastic leukemia (ALL). Translocations involving chromosome band 11q23 have been associated with a poor prognosis in patients with ALL. Recently, a gene known as MLL has been identified which is involved in acute lymphoid and myeloid leukemias with rearrangements at 11q23. A 0.74-kilobase (kb) cDNA probe from the MLL gene can detect both common and uncommon rearrangements involving MLL on conventional Southern blots. We studied 86 newly diagnosed adults entered on an ALL clinical trial to investigate the incidence of MLL gene rearrangements and to determine clinical, morphologic, immunologic and cytogenetic characteristics of such patients. Two of 86 patients had MLL gene rearrangements detected by Southern blot analysis. One of these 86 patients had an 11q23 translocation by cytogenetic analysis whereas the second patient was unevaluable by standard cytogenetic analysis. Southern blot identification of rearrangements involving MLL, especially in patients with limited material for cytogenetic analysis, can provide critical diagnostic and prognostic information which may be useful in the clinical management of patients with these abnormalities.

Adolescent↗
PubMed1994

[Transient paraplegia of the legs after sigmoid resection--late complication after implantation of an aortic bifurcation prosthesis in arterial occlusive disease?].

Ischemic spinal lesions following graft replacement of an infrarenal aortic aneurysm are rare complications. Even more rare is the development of this complication in case of aortoiliac occlusive disease. We report one further case who developed transient paraplegia following sigma resection six years after implantation of an aortobifemoral bifurcation graft because of aortoiliac occlusive disease. The abdominal vessel and the collateral situation of this site of the caudal aorta is discussed and the possibility of late ischemic spinal lesions is pointed out.

Aged↗
PubMed1994

[Indications for 76 free surgical flaps for mandibular reconstruction].

Since 1985 76 revascularized osseous and osseocutaneous flaps collected from different donor sites were transferred. The overall rate of success amounted to 94.7%, 48.7% of the patients had previously undergone radiotherapy with tumor dose. Even though an elevated number of certain complications in cases of an irradiated recipient area occurred a critical analysis reveals the high value of the reanastomized flap in this situation. Proven indications are described in detail.

Bone Transplantation↗
PubMed1994

[Incidence of peptic ulcers in patients with arterial occlusive diseases--a further risk factor?].

Acute bleeding of the upper gastrointestinal tract found in patients with arterial occlusive disease lead us to analyse the coincidence of arterial occlusive disease and pathological changes of the upper gastrointestinal tract. While waiting for reconstructive vascular surgery between 1986 and 1992 420 patients underwent esophago-gastro-duodenoscopy for preoperative risk assessment. In 59% endoscopy revealed pathological findings in the upper gastrointestinal tract. Inflammation was found in 61.6% of the patients, in 15% gastric ulcer. Patients with gastrointestinal symptoms had no significant more pathological findings in gastroscopy (p = 0.1). We excluded 9.3% patients from primary elective vascular surgery because of their severe pathological findings. 19 patients were operated on their gastrointestinal disease at first. In 7 patients we found an unknown carcinoma of the stomach. 5 patients got a resection of the stomach, in 2 patients an operation was unable. The diagnosis and therapy of risk factors are a major objective in the treatment of arterial occlusive disease. The results of the study stress the necessity of routinely performed endoscopy in patients awaiting vascular surgery. Beside a preoperative risk assessment this will lead to a lower incidence of serious gastrointestinal complications postoperatively.

Aged↗
PubMed1994

[Results of management of pertrochanteric comminuted fractures in the elderly with a tumor shaft endoprostheses].

Pertrochanteric fractures are typical injuries of elderly people, that can be treated with osteosynthesis in most cases. From 1984 to 1991 we performed 105 implantations of tumor-endoprosthesis in elderly patients with comminuted pertrochanteric fractures with simultaneous coxarthrosis or osteoporosis. The mean age of these patients was 82.7 years. 81.9% of the patients had concomitant systemic diseases (coronary heart disease, hypertension, diabetes etc.), 51.4% showed several risk factors. General postoperative complications were diagnosed in 63.8% of all cases, mostly nosocomial urinary tract infections, pressure sores and cardiovascular disorders. In 14.3% of the patients local (surgical) complications occurred. 83.3% of the patients were able to walk when they left the hospital, the in-hospital mortality was 13.3% (30-day-mortality 12.4%). Although primary osteosynthesis of pertrochanteric fractures with dynamic hip screw or gamma-nail show a smaller risk, implantation of a tumor-endoprosthesis can be an alternative in patients with severe osteoporosis, coxarthrosis or after instable osteosynthesis.

Aged↗
PubMed1993

[Results of regular follow-up after removal of colorectal adenomas].

After resection of colorectal adenoma 453 patients were included in a follow-up program between 1. 1. 1980 and 30. 6. 1991. 275 patients underwent regular follow-up examinations, the primary drop-out rate was 39.2%. In the 275 participating patients 492 primary adenoma were removed. 174 patients (63.3%) had a single adenoma, while 101 patients showed multiple primary adenoma (36.7%). The average follow-up interval was 37 (+/- 28.2) months. During follow-up we found new adenoma in 105 patients (38.2%), the Kaplan-Meier estimation of the five-year-recurrence rate was 55.9% (95% confidence-interval 46.9 to 64.8%). The risk of recurrence was increased in patients with multiple primary adenoma (p = 0.003) and multivariate risk analysis showed an independent influence of histology on recurrence rate (p = 0.07). In six patients colorectal carcinoma were detected during adenoma follow-up. During regular follow-up examinations after surgical treatment for colorectal adenoma in more than 30% of all patients new colorectal polyps were detected and removed. Therefore follow-up for colorectal adenoma is effective in prevention of colorectal carcinoma. Still frequency of follow-up examinations have to be adapted to the individual risk of recurrence for each patient.

Adult↗