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  • 1
    Electronic Resource
    Electronic Resource
    Expression of augmenter of liver regeneration (ALR) in human liver cirrhosis and carcinoma (2005)
    Oxford, UK : Blackwell Science Ltd
    Histopathology 47 (2005), S. 0 
    Details
    ISSN: 1365-2559
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Aims : To determine the expression of a protein termed augmenter of liver regeneration (ALR), recently found to have a specific and beneficial effect on the process of liver regeneration in normal and diseased human liver.Methods and results : ALR expression in normal and cirrhotic human livers with various underlying diseases as well as in tissue samples of hepatocellular carcinoma (HCC) and cholangiocellular carcinoma (CCC) was analysed by immunohistochemistry and quantitative reverse transciptase-polymerase chain reaction (RT-PCR). Expression analysis of ALR in total liver protein extracts by Western blotting showed mainly dimeric ALR protein. Immunohistochemically, cytosolic and perinuclear immunosignals were found in hepatocytes and cholangiocytes in normal, cirrhotic or cancerous liver tissue and only weak signals in some endothelial cells in normal livers. Quantitative mRNA analysis revealed significantly increased ALR expression in cirrhosis compared with normal liver tissue. In HCC and CCC ALR mRNA expression was also significantly enhanced compared with normal liver tissue, but expression levels did not differ from the matching non-neoplastic tissue in the same patient.Conclusions : The findings suggest an important role for ALR in hepatocellular regeneration in liver cirrhosis as well as in hepatocarcinogenesis and therefore its potential value in the clinical diagnosis of hepatic cirrhosis and cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2559.2005.02172.x
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  • 2
    Electronic Resource
    Electronic Resource
    Prognostic value of microscopic peritoneal dissemination (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 92-100 
    Details
    ISSN: 1530-0358
    Keywords: Microscopic peritoneal dissemination ; Colon-cancer ; Gastric cancer ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract 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 andP=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 andP〈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.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237250
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  • 3
    Electronic Resource
    Electronic Resource
    Surgical metabolism (1997)
    Springer
    Der Chirurg 68 (1997), S. 551-558 
    Details
    ISSN: 1433-0385
    Keywords: Key words: SIRS ; Nutrition ; Catabolic state ; Surgical metabolism. ; Schlüsselwörter: Postaggressionsstoffwechsel ; Katabolie ; künstliche Ernährung ; Gesamtkörperinflammationssyndrom.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Auf die Störung der Homöostase durch Trauma, Operation oder Infektion reagiert der Organismus uniform mit einer endokrinen Umstellung und Freisetzung von Cytokinen. Als Folge der Immobilisation sowie der Mediatoren- und Hormonausschüttung kommt es zu grundlegenden Veränderungen im Substratmetabolismus mit Mobilisation der endogenen Energiereserven, aber auch Abbau von Struktur- und Funktionsproteinen wichtiger Organe wie der Darmschleimhaut. Hierdurch wird einerseits der Energiebedarf der Organe gedeckt, andererseits wichtige energieverbrauchende Syntheseleistungen ermöglicht. An klinischen Parametern resultiert ein Hypermetabolismus, eine Hyperglykämie, Lipolysesteigerung und eine erhöhte Harnstoffproduktion mit negativer Eiweißbilanz. Die metabolische Reaktionsfähigkeit wird durch erhöhtes Zirkulieren der Substrate mit Energieverbrauch erhalten. Um negative Auswirkungen bis hin zum Organversagen zu vermeiden, sind neben einer rationalen situationsadaptierten Substratzufuhr die Reduktion der katabolen und Stimulation anaboler Faktoren anzustreben. Die metabolische Betreuung und Behandlung des chirurgischen Patienten stellt einen grundlegenden Pfeiler der Behandlung dar, der nicht vernachlässigt werden darf.
    Notes: Summary. Trauma, operative interventions, infection and other disturbances of homeostasis lead to a uniform reaction of the body, namely release and activation of hormones and cytokines. Profound alterations of substrate flow result, with mobilization of energy stores and degradation of structural and functional proteins of vital organs like the gut mucosa. Due to these reactions the energy demands of the organs are met and energy-consuming synthesis of substrates is indicated. Clinically, hypermetabolism, hyperglycemia, lipolysis and increased urea production with negative nitrogen balance can be observed. The metabolic reactivity is reached by an increased substrate cycling. To avoid negative consequences such as organ dysfunction, a rational situation-adapted substrate supply is warranted as well as reduction of catabolic stimuli and stimulation of anabolic factors. The metabolic care of the surgical patient is still a basic and important task.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050229
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  • 4
    Electronic Resource
    Electronic Resource
    Nachweis und Bedeutung der Tumorzelldissemination beim Magenkarzinom (1998)
    Springer
    Der Onkologe 4 (1998), S. 294-300 
    Details
    ISSN: 1433-0415
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Für das Überleben einer malignen epithelialen Erkrankung wie dem Magenkarzinom sind mehrere Faktoren entscheidend. Die radikale Resektion des Tumors mit erweiterter Lymphknotendissektion oder en-bloc Resektion infiltrierter Nachbarorgane spielen hier die wichtigste Rolle [23]. Das Auftreten von Rezidiven in über 30% trotz kurativer lokoregionärer Therapie bei gleichzeitiger Abwesenheit von Fernmetastasen legt nahe, daß eine generalisierte okkulte Tumorzelldissemination und demnach eine systemische Tumorerkrankung schon zum Zeitpunkt der Operation vorliegen kann. Zur individuellen Risikoabschätzung sowie zur Planung adjuvanter Therapien wäre die Kenntnis über die systemische Komponente einer malignen Erkrankung notwendig und eine Charakterisierung disseminierter Tumorzellen könnte im Hinblick auf die Expression metastasierungsrelevanter Gene oder ihres Proliferationsverhaltens zu einem besseren Verständnis tumorbiologischer Vorgänge und einer verbesserten individuellen Therapieplanung führen. Die Effizienz einer systemischen Therapie könnte wiederum durch Analyse der Tumorzelldissemination überprüft werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007610050204
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  • 5
    Electronic Resource
    Electronic Resource
    Acute effects of continuous rotational therapy on ventilation-perfusion inequality in lung injury (1998)
    Springer
    Intensive care medicine 24 (1998), S. 132-137 
    Details
    ISSN: 1432-1238
    Keywords: Key words Acute lung injury ; Kinetic therapy ; Ventilation-perfusion relationships ; Intrapulmonary shunt ; Multiple inert gas elimination technique
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To investigate ventilation-perfusion (VA/Q) relationships, during continuous axial rotation and in the supine position, in patients with acute lung injury (ALI) using the multiple inert gas elimination technique. Design: Prospective investigation. Setting: Eighteen-bed intensive care unit in a university hospital. Patients and interventions: Ten patients with ALI (PaO2/FIO2 ratio 〈 300 mm Hg) were mechanically ventilated in a pressure controlled mode and placed on a kinetic treatment table. Measurements and results: Distributions of VA/Q were determined 1) during rotation (after a period of 20 min) and 2) after a resting period of 20 min in the supine position. During axial rotation, intrapulmonary shunt (19.1 ± 15 % of cardiac output) was significantly reduced in comparison with when in the supine position (23 ± 14 %, p 〈 0.05), areas with “low” VA/Q were not affected by the positioning maneuver. General VA/Q mismatch (logarithmic distribution of pulmonary blood flow) was decreased during rotation (0.87 ± 0.37) in comparison with when the patient was in the supine position (0.93 ± 0.37, p 〈 0.05). Arterial oxygenation was significantly improved during continuous rotation (PaO2/FIO2 = 217 ± 137 mm Hg) as compared with in the supine position (PaO2/FIO2 = 174 ± 82 mm Hg, p 〈 0.05). The positive response of the continuous rotation on arterial oxygenation was only demonstrated in patients with a Murray Score of 2.5 or less, indicating a “mild to moderate” lung injury, while in patients presenting with progressive ARDS (Murray Score 〉 2.5), the acute positive response was limited. Conclusions: Continuous axial rotation might be a method for an acute reduction of VA/Q mismatch in patients with mild to moderate ALI, but this technique is not effective in late or progressive ARDS. Further studies including a large data collection are needed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050534
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  • 6
    Electronic Resource
    Electronic Resource
    Koloproktologische Erkrankungen des Beckenbodens (2000)
    Springer
    Der Radiologe 40 (2000), S. 446-450 
    Details
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Beckenboden ; Rektozele ; Prolaps ; Deszensus ; Intussuszeption ; Key words Pelvic floor ; Rectocele ; Prolaps ; Descending perineum ; Intussusception
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Purpose. The aim of this review is to describe the most frequent and important coloproctologic pelvic floor disorders. Relevant diagnostic procedures of the pelvic floor will be presented. Material and methods. A host of diagnoses and symptoms such as the descending perineum syndrome, rectocele, cystocele, enterocele, uterine and vaginal descensus, anal and rectal prolaps, outlet obstruction, anismus, inertia recti and intussusception are included under the heading “pelvic floor disorders”. Although symptoms are often varied, problems concerning urinary and/or faecal continence commonly lead to primary consultation of a physician. Results. Quite often, apparently divergent symptoms such as constipation and incontinence are simultaneously mentioned. A clear gender disposition is observed with female patients inflicted nine-fold in comparison to male patients. The primary consultant may belong to a variety of specialities such as urology, proctology, gynaecology or dermatology, depending upon the predominant symptom. A feeling of trust is essential for the treatment of a disorder involving highly intimate regions of the body. Discussion. An exact medical history and standardized proctologic evaluation consisting of inspection, palpation, rectoscopy and proctoscopy may be augmented by investigations such as anorectal manometry or endosonography. Conventional defecography has been replaced more and more by dynamic MRI of the pelvic floor in specialized institutions, enabling additional gynaecologic and urologic investigations avoiding ionizing radiation.
    Notes: Zusammenfassung Ziel. Die Darstellung der häufigsten und wichtigsten koloproktologischen Erkrankungen des Beckenbodens und der aktuellen Diagnosemöglichkeiten. Material und Methode. Unter Beckenbodenstörungen subsummieren sich eine Reihe von Diagnosen und Symptomen. Die Beschwerdesymptomatik ist meist vielgestaltig, am häufigsten führen Stuhl- und Urinkontinenzprobleme zum Arztbesuch. Ergebnisse. Nicht selten werden scheinbar divergierende Symptome wie Obstipationsbeschwerden und Inkontinenz gleichzeitig angegeben. Frauen sind weit häufiger betroffen als Männer mit einem Geschlechtsverhältnis von 9:1. Diskussion. Neben der ausführlichen, gezielten Anamnese und einem standardisierten proktologischen Untersuchungsgang (Inspektion, Palpation, Rektoskopie, Proktoskopie) liefern apparative Zusatzuntersuchungen wie Anorektalmanometrie und Endosonographie wichtige Informationen. In der radiologischen Diagnostik wurde die konventionelle Defäkographie durch die funktionelle Beckenboden-MRT erweitert, die neben der proktologischen Diagnostik gleichzeitig eine gynäkologische und urologische Abklärung ohne Strahlenbelastung beinhaltet.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001170050694
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  • 7
    Electronic Resource
    Electronic Resource
    Karotisendarteriektomie und Karotisstenting Pilotstudie eines prospektiven, randomisierten und kontrollierten Vergleichs (2000)
    Springer
    Der Radiologe 40 (2000), S. 813-820 
    Details
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Karotisstenose ; Karotisstenting ; Endarteriektomie ; Prospektive, randomisierte und kontrollierte Studie ; Keywords Carotid artery stenosis ; Carotid stenting ; Endarterectomy ; Prospective, randomized and controlled study
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Introduction. A prospective, randomized and controlled trial is conducted to compare carotid endarterectomy and carotid stenting in high grade symptomatic carotid artery stenoses. Methods. According to the study design symptomatic patients with a angiographically highgrade (≥70%) internal carotid artery stenosis are included. Pre- and postinterventional diagnostics during the hospitalization period includes neurological assessment, duplex sonography of the cervical and cerebral arteries and magnetic resonance imaging of the brain. Follow-up examinations are scheduled after 1, 6 and 12 months and consist of a neurological assessment and duplex sonography. After 12 months selective angiography and magnetic resonance imaging of the brain will be performed additionally. During a period of 9 months up to now 23/137 patients treated for a carotid artery stenosis were included in the study, 11 patients underwent surgery and 12 patients carotid stenting. Results. Carotid stenting and endarterectomy was primarily successful without residual stenosis 〉30% in each patient without the occurence of stroke or death. In 18 follow-up examinations (neurological assessment including duplex sonography) of 13 patients (13 follow-up examinations after 30 days, 5 after 6 months) no relevant restenosis and no stroke occured. Conclusion. As of yet, carotid stenting was a safe procedure. Due to the small number of patients a definitive conclusion can not be drawn.
    Notes: Zusammenfassung Fragestellung. In einer prospektiven, randomisierten und kontrollierten Pilotstudie werden die Karotisendarteriektomie und die Stenttherapie an einem Patientenkollektiv mit hochgradigen, symptomatischen Stenosen der extrakraniellen A. carotis interna miteinander verglichen. Methodik. Das Design der Studie sieht vor, dass symptomatische Patienten mit der Diagnose einer hochgradigen Stenose (≥70%) der A. carotis interna, die auf dem Boden einer DSA gesichert wurde, eingeschlossen werden. Vor und nach der Therapie finden während der Hospitalisationsphase jeweils eine klinisch-neurologische Untersuchung, eine Duplexsonographie der Hals- und Hirngefäße und eine MRT des Hirns statt. Das Nachsorgeprotokoll nach 1, 6 und 12 Monaten beinhaltet jeweils eine klinisch-neurologische Untersuchung und eine Duplexsonographie sowie nach 12 Monaten zusätzlich eine selektive Angiographie der behandelten Seite und eine weitere MRT des Hirns. Während eines Zeitraums von 9 Monaten wurden bisher 23 von 137 wegen einer Karotisstenose behandelten Patienten in die Studie eingeschlossen, wobei 11 Patienten dem operativen Arm und 12 Patienten dem interventionellen Arm der Studie zugeführt wurden. Ergebnisse. Bei allen 23 Patienten wurde ein Primärerfolg ohne residuelle Stenose 〉30% erzielt, eine zerebrale Ischämie oder Todesfall traten nicht auf. Die bislang durchgeführten 18 Nachuntersuchungen (neurologische Untersuchung einschließlich Duplexsonographie) bei insgesamt 13 Patienten (13 Kontrollen nach 30 Tagen, 5 Kontrollen nach 6 Monaten) ergaben keine relevante Restenosierung und keine zerebrale Ischämie. Schlussfolgerung. Bislang erwies sich die Stenttherapie in unserer Studie als komplikationsarmes Therapieverfahren. Aufgrund der geringen Patientenzahl kann zum jetzigen Zeitpunkt jedoch noch keine endgültige Bewertung erfolgen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001170050828
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  • 8
    Electronic Resource
    Electronic Resource
    Rare late complication after operation of traumatic aneurysm of the thoracic aorta (1985)
    Springer
    World journal of surgery 9 (1985), S. 367-370 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Chez un patient de 60 ans un anévrysme anastomotique s'est développé 22 ans après l'interposition d'une prothèse en dacron qui avait été mise en place pour traiter un anévrysme posttraumatique de l'aorte descendante. La tomodensitométrie et l'aortographie rétrograde par voie fémorale s'inscrivaient en faveur de la déhiscence complète de la suture et d'une prothèse flottante. L'intervention devait montrer que toutes les sutures de soie avaient disparu. Une nouvelle prothèse en Dacron® tissé de 20 mm fut alors réinséré à l'aide d'un matériel de suture irrésorbable. Nous recommandons chez tous les opérés qui portent une prothèse aortique de pratiquer régulièrement une radiographie thoracique. La tomodensitométrie simple et la tomodensitométrie après injection d'un produit de contraste sont des méthodes très utiles et très performantes pour déceler la déhiscence au niveau des sutures, la présence d'un faux anévrysme ou l'existence d'autres complications.
    Abstract: Resumen En un paciente de 60 anos de edad se produjo un aneurisma anastomótico 22 años después de la interposición de una prótesis de dacrón para tratamiento quirúrgico de un aneurisma traumático de la aorta descendente. La tomografía computadorizada y la aortografía transfemoral sugerían una dehiscencia total con flotación libre del injerto. La operación conformó la desaparición total de las suturas de seda. Se colocó una nueva prótesis de Dacron® utilizando material de sutura no absorbible. Recomendamos el seguimiento a largo plazo por medio de radiografías de tórax en todo paciente en quien se haya efectuado una reconstrucción prostética de la aorta. Los métodos no invasivos de tomografía computadorizada y de tomografía computadorizada con refuerzo de contraste han demostrado ser una modalidad muy útil y sensible para la detección de la dehiscencia de suturas, la aparición de falsos aneurismas y otras complicaciones.
    Notes: Abstract In a 60-year-old patient, an anastomotic aneurysm developed 22 years after interposition of a Dacron® prosthesis for repair of a traumatic aneurysm of the descending aorta. Computed tomography and transfemoral aortography suggested a complete suture dehiscence with a free-floating graft. Operation confirmed that the silk sutures had completely disappeared. A new 20-mm woven Dacron® prosthesis was inserted with nonresorbable suture material. We recommend long-term follow-up with chest x-ray in all patients after prosthetic aortic reconstruction. Noninvasive computed tomography and contrast-enhanced computed tomography have proven a very useful and sensitive method for detection of suture dehiscence, false aneurysm, and other complications.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01656335
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  • 9
    Electronic Resource
    Electronic Resource
    Bedeutung der Ernährung in der Intensivmedizin (1997)
    Springer
    Intensivmedizin und Notfallmedizin 34 (1997), S. 85-87 
    Details
    ISSN: 1435-1420
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003900050023
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  • 10
    Electronic Resource
    Electronic Resource
    Lusorian artery lesion as rare cause of severe upper gastrointestinal tract bleeding (1993)
    Springer
    Digestive diseases and sciences 38 (1993), S. 178-180 
    Details
    ISSN: 1573-2568
    Keywords: lusorian artery ; erosion ; gastrointestinal bleeding
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A patient in an intensive care unit experienced severe esophageal bleeding caused by erosion of a lusorian artery. The lusorian artery is a rare variant of the right subclavian artery. It originates in the descending aortic arch and crosses behind the esophagus to the right, sometimes generating esophageal compression. The patient's condition required respirator therapy and placement of a duodenal tube. At the point of crossing over of the lusorian artery and the esophagus, the duodenal tube caused esophageal necrosis, leading to erosion of the lusorian artery. This resulted in extensive esophageal bleeding, which at last required surgical intervention. To attain proper treatment and to avoid unnecessary diagnostic and therapeutic approaches, a lusorian artery lesion has to be included in the differential diagnosis of upper gastrointestinal bleeding.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01296793
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