Search PubMed⌕ Search

Biomedical subjects

W Stock

Publications and source records attributed to W Stock.

At least 73 records · Page 4Linked to original sources
PubMed1996

[Maltose--an alternative in hypocaloric parenteral nutrition?].

OBJECTIVE: The carbohydrate balance and nutritive efficacy of a completed nutritional solution with maltose were compared to an isocaloric completed nutritional solution with glucose by means of a hypocaloric parenteral nutrition after colorectal resections. METHODS: Prospective, randomised, double blind phase II trial (study group: maltose; control group: glucose). The infusion rate of maltose amounted to 0.05g maltose/kg body-weight/hour and was given postoperatively over 5 days by an infusion pump. RESULTS: Plasma glucose concentrations were similar low in both groups; indeed in the study group a significant higher renal carbohydrate loss of 7.1% was found compared to the control group with 0.4% (p < 0.001). In the study group three patients showed renal carbohydrate losses over 10% without finding a risk factor for these high renal losses. The cumulative nitrogen balance amounted to -3g N in both groups (p > 0.1). The labile plasma proteins in the 2 groups revealed almost identical concentration courses. No essential surgical complications occurred; no clinical side effect or incompatibility of the maltose solution were observed. CONCLUSION: Postoperative hypocaloric nutrition with maltose is possibly nutritive and energetic sufficient under conditions of a clinical study. Indeed, the deviations of the carbohydrate balance show the problems of the low and individual different metabolic capacity of maltose. Thus general use in daily routine seems not favourable due to the necessary precise management (application by infusion pump, daily quantitative examination of renal carbohydrate losses).

Adult↗
PubMed1996

[Surgical treatment of diverticulitis of the large intestine--a plea for early elective resection].

PURPOSE: Diverticulitis of the colon is observed more and more frequently in highly developed countries. The spontaneous course of the disease is not predictably; an exact definition of risk factors for perforated diverticulitis is missing. Therefore the decision for the conservative therapy or for an early elective resection is subject of a controversial discussion. The results of an offensive surgical concept, aiming at an early elective resection for definite therapy of diverticulitis have been analysed in a retrospective study. RESULTS: From 1980-1995 337 patients were operated due to diverticular disease (rate of resection: 98.8%). In spite of the increase of cases with severe complicated diverticulitis from 36.2% (1980-1985) to 45.8% (1991-1995; p = 0.05) the incidence of protective colostomies decreased from 18.8% in the first six years to 0.6% (n = 1) in the last 4 1/2 years (p < 0.001). After elective resection general complications occurred in 30.1% (n = 101), local complications in 17.0% (n = 57). The clinical anastomotic leakage rate was 2.1% (n = 7). During the study the morbidity rate decreased significantly (p < 0.005). Especially the incidence of nosocomial infections was reduced from 37.7% (1980-1985) to 14.8% (1991-1995); severe local complications (anastomotic leakage, bowel obstruction, peritonitis, hemorrhage, abscess) were reduced from 10.1% (1980-1985) to 3.2% (1991-1995). The mortality rate was 1.2% (n = 4). CONCLUSION: By consistent early elective resection of diverticulitis together with a standardized surgical management a definitive treatment of diverticulitis with a high and safe standard is possible. Already after the first severe attack of the disease, which leads to hospitalization, the early elective resection allows the definite cure for diverticular disease analogous to cholecystectomy or appendectomy, avoiding the life threatening complications.

Aged↗
PubMed1996

[Surgical therapy of sigmoid diverticulitis in elderly patients.--What decides against early elective resection].

The results of an offensive surgical approach to diverticulitis, aimed at early elective resection, have been analysed retrospectively for 377 patients. 36.9% of older patients (> 74 years, n = 65) showed significantly higher general complications than younger patients (< 75 years, n = 312) with 26.9% (p = 0.03); local complications (18.3% vs. 12.3%; old vs. young) and mortality (1.5% vs. 1%) were similar. Age over 74 years was not a risk factor for a high morbidity and mortality in multivariate analysis. In order patients a definitive treatment for diverticular disease is also possible with high and safe standards due to early elective resection without high morbidity and mortality.

Aged↗
PubMed1995

[Long-term outcome of the donor site after free, microvascular pedicled iliac crest transplantation: experiences with 95 cases].

Using the anterior iliac crest as donor-site for free osseous, osseomuscular, and osseomyocutaneous flaps has proven itself an important reconstructive instrument both in maxillofacial and in orthopaedic surgery. We present a long-term retrospective evaluation of the donor-site situation after vascularized free anterior iliac crest transfer. The study is based in 95 cases from the years 1985 to 1993 including 11 cases from Switzerland (Kantonsspital Aarau). The patients were examined, looking for objective complications and asked questions about their subjective symptoms at the donor site. These objective and subjective results were then correlated. Herniation developed in 3% of cases, loss of sensibility in the region of the N. cutaneous femoris lateralis occurred in 9.5% and was in 6% reversible. Scars were in 7% aesthetically not satisfying with no keloids or hypertrophic scarring after all wounds healed per primam intentionem. Mostly minor alteration of the outer surface of the donor site was notable in 20 to 25% of the patients. Pain was a problem for an average of 7% of cases. Impairment in private life was named in 3.5%, in professional life in 4.7%, and in daily life in 11.9% of cases. Not content with the donor-site situation were 13.5%, not content with the preoperative information were 12% of the patients. Nonetheless were 98.8% of the patients willing to, if necessary, undergo the same operation again. Surprisingly, there is a negative correlation between objective and subjective results: Merely 25% of the patients with sensibility loss were not content with the donor-site result of the operation and vice versa only 1% of the dissatisfied patients had objectively measurable minor complications.

Adult↗
PubMed1995

[Contralateral replantation after bilateral traumatic lower leg amputation. Case report with 6 year follow-up].

A 66-year-old patient attempted suicide by jumping in front of a train. The lower extremities were amputated at different levels. On the right side, there was a complete amputation within the distal third of the lower leg. Proximal to the amputation site, there was an extensive soft-tissue and bone defect. On the left side, there was a crush injury of the tarsal and mid-tarsal bones. The left lower leg showed only few injuries. An ipsilateral (anatomical) replantation was not possible. In order to save one lower extremity, we decided to carry out a cross-over (contralateral) replantation of the right foot to the left lower leg. After a follow-up of six years, the patient is able to walk well with her prosthesis on the right side and the right foot hooked up to the left lower leg. Functionally, this treatment (cross-over replantation-one-side prosthesis of the lower leg) is much better than the prosthesis on both extremities, as the result has shown. Also from a psychological point of view, it seems to be better for the patient to preserve one extremity even with a cross-over replanted foot.

Aged↗
PubMed1995

[Is the surgeon a prognostically relevant factor after R0-resection of colorectal carcinoma?].

Although the principles of resection of colorectal carcinoma have been defined quite exactly, some studies report considerable variations in recurrence rate and survival between different surgeons and clinics. We have therefore evaluated whether this surgeon-related influence can be found within one surgical department if operative procedures are strictly standardized. The data of 651 patients who underwent R0-resection of colorectal carcinoma between 1980 and 1992 was evaluated. Since all resections were accomplished by 5 groups of surgeons who strictly obeyed the same principles of resection, patients were divided in 5 groups. These 5 groups showed similar distribution of age, sex, tumor location, operative procedures and UICC-tumor-stages. The locoregional recurrence rate ranged from 1.7%-13.3% in stage I (p > 0.05), 9.3-20.6% in stage II (p > 0.05) and 13.6-52.4% in stage III (p < 0.05). Metachronous distant metastases occurred in 3.2 to 13.3% in stage I (p > 0.05), 2.9 to 16.7% in stage II (p > 0.05) and 21.8 to 30.2% in stage III (p > 0.05). 5-year-survival-rates of the 5 groups of patients varied from 74.4-84.5% in stage I (p > 0.05), 61.6-76.8% in stage II (p > 0.05), and 38.1 to 57.7% in stage III (p < 0.05). Although the surgeon-related variability of these results was surprisingly high, multivariate analysis did not show the surgeon as a significant prognostic factor. If the same principles of resection are strictly obeyed within one department of surgery, the surgeon is not a factor of prognostic significance.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

[Gastrointestinal tuberculosis as a rare cause of perforation of the ileum].

The gastrointestinal tuberculosis is a rare disease and it can mimic a large variety of gastrointestinal diseases. The most common site of gastrointestinal tuberculosis is the ileocoecal region followed by the ascending colon and jejunum. Complications are an absolute indication for surgical intervention. Perforation is an extremely uncommon complication of mycobacterium tuberculosis infection.

Adult↗
PubMed1995

Certain HLA antigens are associated with specific morphologic and cytogenetic subsets of acute myeloid leukemia.

Although many associations have been found between specific HLA antigens and an increased susceptibility to various diseases, previous attempts to associate class I and II antigens with acute myeloid leukemia (AML) have been inconclusive, probably due in part to the heterogeneity of AML. We subdivided 165 consecutive adults with AML de novo into distinct clinical, morphological, and cytogenetic subsets and then tested for statistically significant associations with specific HLA antigens. Both morphology and cytogenetic pattern identified subsets of patients with important clinical features and different outcomes. Ten statistically significant (P < 0.05) HLA cytogenetic associations were observed: HLA-A11 with t(8;21), A26 with t(15;17), B7 with 11q23 abnormalities, B44 with +8, Cw2 with -20/del(20q), DR3 with t(15;17) and FAB-M3, DR4 with inv(16) and FAB-M4Eo, DQ2 with +8, and DQ6 with +22. HLA-DQ1 had a negative association with -5/del(5q), which was present in 13% of the 165 AML patients overall but in none of the 27 with DQ1. Certain HLA antigens were significantly correlated with more favorable remission rates, remission duration and survival. Possible mechanisms for the association of HLA antigens with particular subtypes of AML include the linkage or co-inheritance of an oncogene, the facilitation of binding of a transforming virus, toxin, or cytokine, or a permissive role involving impaired immune recognition of an emerging neoplasm. Given the heterogeneity of both the HLA system of immune recognition genes and the cytogenetic subtypes of AML, however, larger numbers of patients must be studied to have confidence that biologically important relationships truly exist.

Acute Disease↗
PubMed1995

A phase I trial of interleukin 3 (IL-3) pre-bone marrow harvest with granulocyte-macrophage colony-stimulating factor (GM-CSF) post-stem cell infusion in patients with solid tumors receiving high-dose combination chemotherapy.

In humans, interleukin 3 (IL-3) administration increases the cellularity and cycling of bone marrow progenitor cell populations. Initially, in primates and then in humans, IL-3 in sequence with GM-CSF has been shown to stimulate multilineage hematopoiesis. Based upon these effects, we designed a phase I trial of daily IL-3 administered subcutaneously for 10 days at dose levels of 2.5, 5.0, 10.0, 12.5, and 15.0 micrograms/kg followed within 72 h by bone marrow harvest, high-dose chemotherapy, and following chemotherapy, a fixed dose (5.0 micrograms/kg/day) of GM-CSF and bone marrow rescue. The study was designed to assess the toxicity and biological effects of IL-3 administered alone prior to bone marrow harvest and to determine the safety and clinical effects of IL-3 stimulated bone marrow with GM-CSF following high-dose combination chemotherapy. A total of 19 patients with chemotherapy-sensitive non-hematologic malignancies (13 breast, five ovarian, and one testicular cancer) were enrolled. IL-3 up to 15.0 micrograms/kg/day could be administered without dose-limiting toxicities. Flu-like symptoms and headaches were common and poorly tolerated at the highest IL-3 dose. Significant increases in neutrophil counts (P = 0.018) were observed following IL-3. Overall, IL-3 administration was associated with a modest, but significant increase in CFU-GM within the bone marrow (P = 0.034). IL-3 administration had no consistent effect on CD34+ cell number within bone marrow. For the entire group, engraftment of neutrophils to greater than 0.5 x 10(9)/l occurred at a median of 21 days (range of 13-63 days) and platelet independence occurred at a median of 17 days (range 11-120 days). When IL-3 dose levels were analyzed separately, engraftment of neutrophils and platelets, blood product (platelets and packed RBCs) utilization, and discharge date were not superior in those treated with the higher dose (15.0 micrograms/kg) of IL-3. While higher doses of IL-3 were associated with more toxicity, they did not appear to enhance the stem cell pool or speed engraftment later. The effects of pre-bone marrow harvest IL-3 are modest and likely not as impressive as other approaches aimed at enhancing hematologic recovery following high-dose chemotherapy.

Adolescent↗
PubMed1995

[Diverticulitis of the jejunum as a rare cause of acute gastrointestinal hemorrhage--diagnosis and therapy].

Small bowel diverticulosis is in contrast to large intestine diverticulosis an uncommon, acquired entity. In most cases it was found in duodenum and as a Meckel's diverticulum. Jejunal or ileal diverticulosis is a relatively rare disease. Although the majority of the patients do not require surgical treatment because of the absence of clinical signs, in 10% complications may necessitate small bowel resection. The clinical significance, diagnostic evaluation, and treatment of jejunal diverticular disease are reviewed.

Aged↗
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↗