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  • 1
    Electronic Resource
    Electronic Resource
    The role of esophageal motility in gastroesophageal reflux disease: Technique and clinical results of ambulatory 24-hour Mano/-pH-Metry (1993)
    Springer
    Dysphagia 8 (1993), S. 112-117 
    Details
    ISSN: 1432-0460
    Keywords: Gastroesophageal reflux ; Esophageal motility ; Ambulatory esophageal manometry ; Deglutition ; Deglutition disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The interplay between esophageal motility and gastroesophageal reflux (GER) was investigated with a new ambulatory system of 24-h monitoring of intraesophageal pressures and pH (MP24). The technique allows for simultaneous digital recordings and off-line data analysis. Both computer-aided and visual analyses were used, and algorithms for intercorrelation of mano- and pH-metry were developed. In a group of normal volunteers the physiological response of esophageal motility on GER was defined. In unselected patients suffering from GER disease, the esophageal motility prior to and during GER events was analyzed. In healthy people, most GER episodes occurred spontaneously and were cleared from the distal esophagus by peristaltic contractions. In GER patients, reflux episodes were often preceded by irregular contractions; during GER, esophageal motility was less often peristaltic compared with controls. Therefore, we conclude that MP24 gives relevant information in GER disease which might help in selecting patients for medical or surgical therapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02266990
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  • 2
    Electronic Resource
    Electronic Resource
    Treatment of dysphagia in esophageal carcinoma: Transthoracic En-Bloc esophagectomy and reconstruction 48 hours later (1988)
    Springer
    Dysphagia 2 (1988), S. 222-227 
    Details
    ISSN: 1432-0460
    Keywords: Esophageal cancer ; Transthoracic esophagectomy ; Mediastinal lymphadenectomy ; Delayed reconstruction ; Blunt esophageal dissection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In 82 consecutive patients with esophageal cancer (90% squamous cell carcinoma, 10% adenocarcinoma) transthoracic “en bloc” esophagotomy with regional lymphadenectomy was performed. The reconstruction with gastric interposition was carried out with delayed urgency in a second operation 48–72 h after the initial procedure. The results of this group were compared to a group of 65 patients who had transmediastinal esophagectomy without thoractotomy and mediastinal as well as suprapancreatic lymphadenectomy and immediate reconstruction by gastric interposition. The number of postoperative risk situations concerning cardiopulmonary features were comparable in both groups. The 30-day mortality rate and postoperative morbidity was not significantly different between both patient groups (mortality rate: transthoracic: 6.6%, transmediastinal: 7.7%). The advantages of a 2-stage procedure are that esophagectomy and especially mediastinal lymphadenectomy can be performed precisely without time pressure. After 2 days the stomach is hypotonic and dilated as a result of truncal vagotomy and can easily be elevated to the neck. The interval of 48–72 hours was chosen because the postoperative right-to-left shunt has nearly normalized after this time period. En bloc esophagectomy and reconstruction with delayed urgency can be performed without disadvantages compared to a 1-stage procedure. It can especially be recommended for operations in which esophagectomy and mediastinal lymphadenectomy are difficult and wearisome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02414431
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  • 3
    Electronic Resource
    Electronic Resource
    Surgical therapy of Zenker's diverticulum: Low risk and high efficiency (1990)
    Springer
    Dysphagia 5 (1990), S. 13-19 
    Details
    ISSN: 1432-0460
    Keywords: Zenker's diverticulum ; Cervical myotomy ; Diverticulectomy ; Deglutition ; Deglutition disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Surgery for the treatment of Zenker's diverticulum was performed at our institution in a total of 43 patients over 6½ years. Cervical myotomy with diverticulectomy was performed in 32 of the patients and myotomy alone in 11. Mortality totaled 0%, with a reversible lesion of the recurrent nerve occurring in 7%. In 60% of the cases investigated preoperatively (N=40), motility disorders of the upper esophageal sphincter (UES) could be demonstrated using manometry as well as with cineradiography in 92% of the patients. Follow-up studies in 39 of the cases 25 months (mean) postprocedure indicated 82% of the patients to be symptom-free, with the remaining 18% demonstrating a marked improvement. Postoperative manometry as well as cineradiography carried out in 12 patients revealed the presence of UES motility dyscoordination in 8% and 25%, respectively. There were, however, no signs of recurrence of the diverticulum. The high number of patients in our study group demonstrating motility disorders of the UES emphasizes the need for cervical myotomy as part of the surgical therapy for Zenker's diverticulum.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02407389
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  • 4
    Electronic Resource
    Electronic Resource
    pH monitoring: The gold standard in detection of gastrointestinal reflux disease? (1993)
    Springer
    Dysphagia 8 (1993), S. 118-121 
    Details
    ISSN: 1432-0460
    Keywords: Gastroesophageal reflux disease ; Diagnosis ; pH monitoring ; Diagnostic studies ; Deglutition ; Deglutition disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Gastroesophageal reflux disease (GERD) is one of the most frequent benign diseases of the gastrointestinal tract and in some cases the diagnosis may be very difficult. There are many diagnostic procedures but none of them could prove or definitely exclude the disease. The 24-h pH-monitoring is the “gold standard” for detection of gastroesophageal reflux and in many patients the reflux correlates with the GERD. The evaluation of a diagnostic method has to be done in a similar manner to the evaluation of therapeutic study (phase 1 to phase 4). For the definition of the “gold standard” for detection of a special diagnosis (e.g., the gastroesophageal reflux disease), the results of phase 3 studies for different methods had to be compared. The method with the best values for sensitivity and specificity is yet to be discovered. Until now, pH monitoring has been the gold standard for the diagnosis of GERD. However, there are many problems connected with using this method in clinical practice.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02266991
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  • 5
    Electronic Resource
    Electronic Resource
    Expression of MMP-2 is associated with progression and lymph node metastasis of gastric carcinoma (2001)
    Oxford UK : Blackwell Science Ltd
    Histopathology 39 (2001), S. 0 
    Details
    ISSN: 1365-2559
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Expression of MMP-2 is associated with progression and lymph node metastasis of gastric carcinoma Aims: One important step in tumour invasion is the penetration of the basement membrane. Matrix metalloproteinases (MMPs) play a key role in the migration of normal and malignant cells through the basement membrane. The aim of this study was to investigate correlations between matrix metalloproteinase 2 (MMP-2) immunoreactivity and currently used classification systems and possible relationships between lymph node metastasis and MMP-2 expression. Methods and results: This prospective study analysed specimens obtained from 114 gastric cancer patients (mean age 64 years; range 33–86 years) who underwent gastrectomy with extended lymphadenectomy. All specimens were categorized according to UICC classification, WHO classification, tumour differentiation, Laurén classification, Ming classification and Goseki classification. Formalin-fixed paraffin-embedded tumour specimens were stained using an avidin–biotin complex peroxidase assay. MMP-2 expression in the tumour epithelium was studied by immunohistochemistry with semiquantitative (score 0–3) evaluation. The MMP-2 staining pattern was positive (score 1–3) in 93 (81.6%) specimens and negative (score 0) in 21 (18.4%) samples. No significant correlations were found between MMP-2 expression and other variables such as age, tumour differentiation, WHO, Lauren, Goseki, and Ming classifications. In contrast, the intensity of MMP-2 staining in tumour cells correlated significantly with depth of tumour infiltration (T-stage), lymph node metastasis (N-stage), distant metastasis (M-stage), and UICC stage. Conclusions: Expression of MMP-2 is strongly associated with tumour progression and lymph node metastasis in gastric cancer. Therefore MMP-2 staining may be clinically useful as predictor of tumour progression, especially for lymph node metastasis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2559.2001.01306.x
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  • 6
    Electronic Resource
    Electronic Resource
    Comparative evaluation of the prognostic value of MUC1, MUC2, sialyl-Lewisa and sialyl-Lewisx antigens in colorectal adenocarcinoma (2002)
    Oxford UK : Blackwell Science Ltd
    Histopathology 40 (2002), S. 0 
    Details
    ISSN: 1365-2559
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Comparative evaluation of the prognostic value of MUC1, MUC2, sialyl-Lewisa and sialyl-Lewisx antigens in colorectal adenocarcinoma Aims: The significance of MUC1, MUC2 and sialylated Lewis blood group antigens as prognostic markers in colorectal adenocarcinoma was investigated in a large series of patients because previous investigations revealed inconsistent results due to unrelated tumour samples from different patient groups and methodological differences. Methods and results: Tissues from 243 patients with colorectal adenocarcinoma were stained immunohistochemically. MUC1 showed a strong immunoreactivity (in more than 35% of the tumour area) in 32.5%, MUC2 in 51.0%, sialyl-Lewisx in 67.9% and sialyl-Lewisa in 73.7% of the cases, respectively. MUC1 immunoreactivity displayed a significant correlation with tumour progression as reflected by advancing pTNM staging and poor differentiation. MUC2 expression was significantly stronger in mucinous adenocarcinomas. Sialyl-Lewisx immunostaining correlated with the extent of lymph node metastasis as well as low cytological differentiation. According to univariate and multivariate analysis (P 〈 0.0001) only MUC1 reactivity represented a marker of worse survival probability, opposed to the sialylated Lewis antigens that did not exert a predictive value. Conclusions: According to our data, MUC1 and sialyl-Lewisx immunoreactivity exhibit statistically significant correlations with established markers of tumour progression. However, only MUC1 presents as an independent prognostic factor of colorectal adenocarcinoma.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2559.2002.01389.x
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  • 7
    Electronic Resource
    Electronic Resource
    Immunoreactivity of cytokeratins (CK7, CK20) and mucin peptide core antigens (MUC1, MUC2, MUC5AC) in adenocarcinomas, normal and metaplastic tissues of the distal oesophagus, oesophago–gastric junction and proximal stomach (2003)
    Oxford, UK : Blackwell Science Ltd
    Histopathology 43 (2003), S. 0 
    Details
    ISSN: 1365-2559
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Aims:  Adenocarcinomas of the distal oesophagus and especially the oesophago–gastric junction have shown an increasing incidence during the last decade. Definition of subgroups according to different sites of development, histogenesis or aetiology may prove to be valuable for clinical diagnosis and treatment. Previous studies have shown differences in cytokeratin patterns between Barrett's metaplasia of the oesophagus and intestinal metaplasia in the stomach. The aim of our study was to investigate whether the expression of certain cytokeratins (CK7, CK20) and mucins (MUC1, MUC2, MUC5AC) exhibit clear-cut patterns, thus allowing a subclassification of adenocarcinomas of the oesophago–gastric junction. The possibility of a relationship between antigen expression and the presence or absence of Barrett's metaplastic epithelium was also studied.Methods and results:  CK7, CK20, MUC1, MUC2 and MUC5AC were visualized in six adenocarcinomas of the distal oesophagus, 29 adenocarcinomas of the oesophago–gastric junction and eight adenocarcinomas of the proximal stomach. CK7, CK20 and MUC1 were strongly expressed in the great majority of all neoplasms under study, whereas MUC2 and MUC5AC were absent or only faintly detectable. CK20 exhibited a significantly stronger expression in poorly differentiated tumours (G3) and MUC1 immunoreactivity correlated with tubular and papillary versus signet-ring cell histopathology. Other statistically significant correlations between antigens and histopathological features (pTNM stage, grading, histopathological subtype, presence/absence of Barrett's epithelium) were not observed.Conclusions:  According to our results, most adenocarcinomas of the oesophago–gastric junction show a CK7+, CK20+, MUC1+ phenotype irrespective of the presence or absence of Barrett's epithelium. The immunohistochemical data suggest a similar histogenesis of these tumours.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2559.2003.01680.x
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  • 8
    Electronic Resource
    Electronic Resource
    A double-blind study of pantoprazole and omeprazole in the treatment of reflux oesophagitis : a multicentre trial (1995)
    Oxford, UK : Blackwell Publishing Ltd
    Alimentary pharmacology & therapeutics 9 (1995), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Pantoprazole is a new substituted benzimidazole which is a potent inhibitor of gastric acid secretion by its action upon H+,K+-ATPase. Aim:To compare pantoprazole 40 mg with omeprazol 20 mg as once daily dosing in the treatment of reflux oesophagitis (grades II and III). Methods: This double-blind, randomized, multicentre study included 286 patients. Patients were reendoscoped after 4 weeks, and continued to receive a further 4 weeks of treatment if they were not healed a this time. Results: After 4 weeks of treatment, complete healing occurred in 126/170 (74%) patients in the pantoprazole group and in 67/86 (78%) patients in the omeprazole group (per-protocol analysis). At 8 weeks, the corresponding healing rates were 153/170 (90%) and 81/86 (94%). The differences between the treatment groups were not significant (P= 0.57 and 0.34). Improvement in the principal symptoms of reflux oesophagitis was also very similar between the treatment groups, with 59% and 69% at 2 weeks, and 83% and 86% at 4 weeks, respectively, being free from any individual symptom. Both treatments were well tolerated. Conclusions: This study has shown pantoprazole and omeprazole to be similarly effective and well tolerated in the treatment of mild to moderate reflux oesophagitis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2036.1995.tb00388.x
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  • 9
    Electronic Resource
    Electronic Resource
    Apoptosis and expression of bcl-2 protein are inverse factors influencing tumour cell turnover in primary carcinoid tumours of the lung (1998)
    Oxford, U.K. and Cambridge, USA : Blackwell Science Ltd
    Histopathology 33 (1998), S. 0 
    Details
    ISSN: 1365-2559
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: This study evaluates potential regulating factors in primary pulmonary carcinoid tumours, 16 typical and four atypical samples, with special emphasis on apoptosis and the bcl-2 gene family. Furthermore, p53-related oncogenes were analysed in a search for associated biological parameters.〈section xml:id="abs1-2"〉〈title type="main"〉Methods and resultsThe in-situ end-labelling technique (ISEL) was used to determine apoptotic cells, in addition to immunohistochemical methods, which were used to investigate the expression of the Ki67 antigen (avidin–biotin complex (ABC) method) and bcl-2, bcl-x, p53, p21/waf1, p27 and mdm-2 proteins (catalysed reporter deposition (CARD) technique). The incidence of apoptotic tumour cells was significantly enhanced in typical carcinoids. The bcl-2 protein was expressed to a higher degree in atypical carcinoids, which displayed a higher proliferative capacity as well. In contrast, bcl-x was observed predominantly in so-called typical carcinoids. The tumour cell turnover index was the most distinguishing parameter between both entities. All carcinoid tumours failed to show a staining for p53, p21/waf, p27 and mdm-2 proteins.〈section xml:id="abs1-3"〉〈title type="main"〉ConclusionsThe different biological behaviour of the carcinoid tumours under study seems to be influenced by the bcl-2 gene family preventing programmed cell death. We speculate that this results in a more aggressive course in atypical carcinoid tumours.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2559.1998.00466.x
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  • 10
    Electronic Resource
    Electronic Resource
    Maligne Tumoren der Hepaticusgabel – Ergebnisse der chirurgischen Therapie und Prognosefaktoren (1997)
    Springer
    Der Chirurg 68 (1997), S. 378-384 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Tumors of the hepatic bifurcation ; Bismuth classification ; Surgical treatment ; Mortality ; Prognostic factors ; Long-term outcome. ; Schlüsselwörter: Hepaticusgabeltumoren ; Bismuth-Klassifikation ; chirurgische Therapie ; Letalität ; Prognosefaktoren ; Langzeitergebnisse.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Vom 1. 1. 1986 bis zum 31. 12. 1994 wurden in der Chirurgischen Klinik 45 Patienten mit Hepaticusgabelcarcinom operiert. Es handelte sich im Sinne der Bismuth-Klassifikation (1992) um 7 Typ-I-, 4 Typ-II-, 22 Typ-III- und 12 Typ-IV-Tumore. Bei 31 der 45 Patienten (68,9 %) wurden in primär kurativer Intention folgende Operationen durchgeführt: Hepaticusgabelresektion: n = 9 (29 %), Hepaticusgabelresektion mit hilärer Leberteilresektion: n = 7 (22,6 %), Hepaticusgabelresektion mit linker Hemihepatektomie: n = 10 (32,3 %), Lebertransplantation: n = 5 (16,1 %). Bei den übrigen 14 Patienten erfolgten primär palliative (n = 6) bzw. rein diagnostische (n = 8) Eingriffe. Die Klinikletalität aller Patienten betrug 2/45 (4,2 %). Die endgültige Histologie ergab bei 17/31 (54,8 %) der Resektate eine R0-Situation, in den übrigen Fällen war eine R1/Rx-Resektion (n = 14) erfolgt. 1-, 2- und 5-Jahres-Überlebensraten lagen für die 31 resezierten Patienten bei 75,4, 53,9 und 24,5 % (medianes Überleben:729 Tage), und bei 30,8, 10,3 und 0 % (medianes Überleben:153 Tage) für die rein palliative Behandlungsgruppe. Ein statistisch signifikanter Einfluß auf das Überleben konnte für den nodalen Status (N0/N1) und den Residualtumorstatus (R0/R1 und R2) nachgewiesen werden.
    Notes: Summary. Between 1 January 1986 and 31 December 1994, 45 patients with carcinoma of the hepatic bifurcation underwent operations in the department of surgery. According to Bismuth's classification (1992), there were 7 type I, 4 type II, 22 type III and 12 type IV tumors. 31 of the 45 patients (68.9 %) underwent surgical resections with curative intentions: resection of the hepatic bifurcation (n = 9, 29 %), resection of the hepatic bifurcation with hilar liver resection (n = 7, 22.6 %), resection of the hepatic bifurcation with left hemihepatectomy (n = 10, 32.3 %), orthotopic liver transplantation (n = 5, 16.1 %). The remaining 14 patients underwent palliative (n = 6) or diagnostic (n = 8) operations. Two of the 45 patients (4.2 %) died in hospital. Histological examination demonstrated R0 resection in 17 of 31 (54.8 %) of the patients, while in the remaining 14 cases, only a R1/RX resection had been achieved. One-, 2- and 5-year survival rates were 75.4 %, 53.9 % and 24.5 % (median survival: 729 days) in the 31 resected patients, and 30.8 %, 10.3 % and 0 % (median survival: 153 days) in the palliative treatment group. A statistically significant influence on survival could be demonstrated for nodal status (N0/N1) and residual tumor status (R0/R1, R2).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050201
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