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  • 1
    Electronic Resource
    Electronic Resource
    Colorectal cancer diagnosis by a direct leukocyte migration test using a panel of tumour extracts (1977)
    Springer
    Cancer immunology immunotherapy 2 (1977), S. 257-265 
    Details
    ISSN: 1432-0851
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a direct leukocyte migration test, peripheral blood leukocytes were pulsed with a high dose (2.5 and 0.5 mg/ml) of 3 M KCl extracts from 5 different colorectal tumours as well as with one 3 M KCl extract of normal colonic mucosa. Patients showing a pathological migration index (⩽0.80 and ⩾1.17), with 3 or more out of 5 tumour extracts, were considered as “positives”. With this test mode 93% (55/59) of patients with colorectal carcinomas were reactive, irrespective of the tumour stage, while only 7% (2/27) of patients with non-malignant colorectal diseases showed a “positive” reaction. Patients with malignant and non-malignant diseases of other organs were reactive in 2–3% of cases. No “positive” reactivity was observed with leukocytes from 37 healthy volunteers. Pulsing leukocytes with the normal colonic mucosal extract, a pathological migration index was found in about 20% of colorectal cancer patients, but not in healthy volunteers. Evaluating 10 single tumour extracts individually, reactivity of cancer patients' leukocytes ranged from 65–89% of tests, the difference being not statistically significant. Leukocytes from healthy volunteers showed a pathological migration index with the different extracts in 0–6% of tests. With the leukocyte migration test we could not differentiate between tumours of the colon, sigma or rectum. Patients bearing tumours in any part of the large bowel showed pathological leukocyte migration with extracts of colon-, sigma- and rectum tumours. When the cross-reactivity study was extended to tumours of the gastrointestinal tract, it was found that patients with colorectal tumours were reactive, in a high percentage of tests, with extracts of gastric tumours, but gastric as well as oesophageal and pancreatic cancer patients' leukocytes only reacted occasionally with colorectal tumour extracts. In the follow-up study, a “positive” reactivity was still found 10–14 days after surgery in 27/31 patients. After more than 2 months, the frequency of “positive” reactivity decreased to 10/70 cases. Patients with local recurrence or metastases exhibited “positive” reactivity in 6/7 cases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00206007
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  • 2
    Electronic Resource
    Electronic Resource
    Analyse der postoperativen Todesfälle beim Colon- und Rectumcarcinom (1977)
    Springer
    Langenbeck's archives of surgery 343 (1977), S. 195-204 
    Details
    ISSN: 1435-2451
    Keywords: Colorectal carcinoma ; Concomitant disease ; Tumor complications ; Causes of death ; Residual tumor
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Es wurden 200 nach operativen Eingriffen wegen eines Colon- und Rectumcarcinoms während des Klinikaufenthaltes aufgetretene und obduzierte Todesfälle ausgewertet. Nur 38,5% dieser Kranken konnten radikal operiert werden. 94,5 % der Verstorbenen waren über 50, 82,5 % über 60, 40,5 % über 70 und 10% über 80 Jahre alt. Bei den 200 Verstorbenen bestanden präoperativ 263 vom Tumorleiden unabhängige Begleitkrankheiten und belastende Faktoren. Bei 50% der Todesfälle lagen ein fortgeschrittenes Tumorleiden mit Metastasierung, bei 38% ein Ileus, bei 11% eine Peritonitis, bei 6,5% eine Absceßbildung oder schwere Blutung präoperativ vor. Als Todesursachen fanden sich Pneumonie (24,5%), Peritonitis (22%), Lungenarterienembolie (15,5%), Tumorkachexie (14%), Herzversagen (9,5%), Ileus (5,5%) und verschiedene Ursachen (9%). 1/3 der Todesfälle waren bis zum 6., die Hälfte bis zum 9. und z/3 bis zum 13. postoperativen Tag eingetreten. Ansatzpunkte zur Verringerung der Operationsletalität sind vor allem im Einsatz aller internistischen und anaesthesiologischen Möglichkeiten bei der Vorbereitung, Narkose und Nachbehandlung der Patienten, insbesondere der Pneumonie und Thromboembolie-Prophylaxe gegeben, während chirurgisch-technische Probleme in den Hintergrund treten.[/p]
    Notes: Summary Analysis of the clinical and autopsy reports of 200 deaths following surgery for colorectal cancer from 1956 to 1974, at the Dept. of Surgery, University of Heidelberg, revealed that pneumonia (24.5 %) was the most common cause of death followed by peritonitis (22%), pulmonary embolism (15.5 %), advanced tumor disease (14%), cardiac failure (9.5%), ileus (5.5%), and others (9%). The explanation for the postoperative mortality rate of 12% (cancer of colon) and 13.2% (cancer of rectum) lies in the fact that 82.5% of those who died postoperatively were beyond the age of 60, and 40.5 % beyond 70 years at the time of surgery. Moreover, in 50.5% advanced tumors with regional and/or distant metastases were found. In 55.5% severe preoperative complications (ileus: 38%, peritonitis: 11%, abscess formation or hemorrhage: 6.5%) required an emergency operation. Only 38.5% of the procedures were considered for cure. Besides the need for early recognition of the cancer, intensification of pre- and postoperative treatment appears to be the predominant task in the effort to decrease postoperative mortality.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01267991
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  • 3
    Electronic Resource
    Electronic Resource
    Zur Wahl des Operationsverfahrens im aorto-iliacalen Gefäßabschnitt Erfahrungsbericht über 1080 Rekonstruktionen (1977)
    Springer
    Langenbeck's archives of surgery 344 (1977), S. 41-52 
    Details
    ISSN: 1435-2451
    Keywords: Aorto-iliac occlusive disease ; Classification into 4 categories ; Choice of procedure ; Late results of endarterectomy and dacron bypass grafts
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung An der Heidelberger Klinik wurden von 1959-1974 1080 Wiederherstellungsoperationen zur Korrektur chronischer aorto-iliacaler Verschlüsse durchgeführt. Das Durchschnittsalter der 1071 Kranken - Geschlechtsverhältnis Männer : Frauen = 19:1 - betrug 54,2 Jahre. Ätiologisch stand die Arteriosklerose mit 87,9 % im Vordergrund. Entscheidung für die Wahl des Operationsverfahrens ist das morphologische Bild der Verschlußkrankheit, für dessen Klassifizierung 4 Typen vorgeschlagen werden: Segmentverschlüsse (Typ I, 44%); diffuse Veränderungen an Aorta und Beckenarterien (Typ II, 30%); Bifurkationstyp (Typ III, 17%); hoher Aortenverschluß (Typ IV, 9%). In den Jahren 1959-1965 kam das Bypassverfahren als erstes Rekonstruktionsprinzip im aorto-iliacalen Bereich zur Anwendung. Gleichzeitig wurden ab 1961 vereinzelt Desobliterationen durchgeführt. Von 1966 an wurde die halbgeschlossene und die offene Thrombendarteriektomie zum gleichberechtigten und langsam dominierenden Operationsverfahren. Als Indikation für die Ausschälplastik gelten der isolierte ein- oder beidseitige Segmentverschluß (Typ I), der sogenannte Bifurkationstyp (Typ III) und bei jüngeren Patienten diffuse Veränderungen im Bereich der Aorta und Beckenarterien. Die Anlage eines aorto-femoralen Bifurkationsbypass ist beim Gros der Fälle mit diffusen Veränderungen an Aorta und Beckenarterien (Typ II) und beim hohen Aortenverschlu\ (Typ IV) indiziert. 478 Verschlüsse wurden durch Ausschälplastik, 530 durch eine Bifurkationsprothese und 72 durch eine unilaterale Dacronprothese korrigiert. 77% der Fälle kamen im Stadium II nach Fontaine zur Operation. Bei 62% aller aorto-iliacalen Verschlüsse bestand zusätzlich eine Obliteration im femoropoplitealen Gefäßabschnitt. Die Operationsletalität lag bei 6.8 %. Die Ausschälplastik zeigte eine Erfolgsquote von insgesamt 90,7%, der Bifurkationsbypass von 92,2%, der unilaterale Bypass von 77,2%. Die weitere Aufschlüsselung der Ergebnisse in Abhängigkeit von der Nachbeobachtungsdauer ergab für Ausschälplastik und Bifurkationsbypass statistisch übereinstimmende Langzeitergebnisse.
    Notes: Summary An analysis has been made in 1080 aorto-iliac reconstructions performed from 1959 through 1974 at the Department of Surgery, University of Heidelberg. The ages of 1071 patients ranged from 20-97 with an average of 54.2 years. The ratio of men to women was 19 to 1. The predominant underlying lesion was atherosclerosis in 87.9 %. The choice of reconstructive procedure is dictated by the nature and extent of the occlusive process beside certain systemic factors. Morphologic characteristics allow the classification into 4 categories of aorto-iliac obliterations: Segmental occlusions (type I, 44 %), diffuse involvement of the iliac arteries and the terminal aorta (type II, 30 %); limitation of the lesion to the bifurcation (type III, 17%); propagation of the process towards the renal arteries (type IV, 9%). From 1959 through 1965 dacron bypass grafting was the most frequently employed procedure. Since 1961 a small number of endarterectomies was carried out. Since 1966 endarterectomy was used in a rising number of cases and has become the most common type of aorto-iliac recontruction in the last 4 years. The indication for endarterectomy is restricted to segmental occlusions (type I), to lesions of the bifurcation (type III) and in younger patients to diffuse obliterations of the iliac arteries and the terminal aorta (type II). The dacron bypass graft is the method of choice in the greater part of diffuse lesions (type II) and in aortic occlusions up to the renal arteries (type IV). Endarterectomy was performed in 478, bilateral bypass grafting in 530 and unilateral bypass grafting in 72 cases. Stage II, i.e. intermittent claudication, was the indication in 77%, stage III and IV, i.e. resting pain and gangrene, in 23% of all reconstructions. Associated occlusive disease of the femoropopliteal arteries was present in 62%. The over-all operative mortality was 6.8%. For all the series endarterectomy showed a patency rate of 90.7%, bilateral bypass grafts of 92.2%, and unilateral bypass grafts of 77.2%. Accumulative patency rates by the life table method do not show statistically significant differences between endarterectomy and bilateral bypass grafts. Our preference for endarterectomy over bypass procedures in recent years seems also to be justified by the uncertain fate of the prostheses and their incorporation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01259352
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