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Biomedical subjects

B Mentges

Publications and source records attributed to B Mentges.

36 records · Page 2Linked to original sources

[Steroid hormone receptor status of colorectal cancers].

Tumor samples of 26 consecutive colorectal carcinomas were studied for the presence of steroid hormone receptors for estrogen and progesterone. In all cases, the estradiol receptor binding capacity was below 2 fmol/mg cytosol protein. In 4 of 26 samples, progesterone receptor levels from 13 to 23 fmol/mg cytosol protein were observed. Because of the identification of steroid receptors in some cases and single reports in literature about tumor regression under hormone therapy of colorectal carcinoma, further investigations seem indicated to study the hormone sensitivity of colorectal carcinoma.

Aged↗

[Surgical treatment of liver metastases from colorectal carcinoma].

Between 1978 and 1985 a total of 49 patients (20 women and 29 men, aged 31-78 years) were operated upon for liver metastases of a colorectal carcinoma. Metastasis recurrences occurred in 42 of 46 patients (91%). Three patients died in connection with the operation (6.1%). The five-year survival rate was 10.7%. Neither number, site and volume of the metastases, level of carcinoembryonic antigen concentration, tumour differentiation, stage or site of primary tumour, nor type of operation (enucleation or hemihepatectomy) had any influence on survival rate. Since most of the recurrences in the liver had occurred after enucleation at the site of the previous resection, it is feasible that the results could be improved by extending the area of resection.

Adult↗

Sonography versus peritoneal lavage in blunt abdominal trauma.

The reliability of sonography and peritoneal lavage in assessing the need for immediate surgical intervention in blunt abdominal trauma was examined in a prospective study (n = 71). Statistical analysis revealed a sensitivity of 100% for peritoneal lavage compared to 84% for sonography; the accuracy was 99% versus 86%, the predictive value 97% vs. 89%. The statistical difference was significant (p less than 0.05). The results demonstrate that sonography cannot replace peritoneal lavage in the diagnosis of blunt abdominal trauma. The discussion of the advantages and disadvantages of both methods shows that sonography and peritoneal lavage are not competing, but rather, are complementary examinations.

Abdominal Injuries↗

[Prognostic criteria and risk groups in colorectal cancer].

A normal CEA value turned out to be the most important prognostic factor on primary and secondary procedure because of colorectal carcinoma. Five-year-survival after first operation was 65% and 35% after second procedure in case of negative CEA-test. Early tumour stage (pT1-3N0M0), good tumour differentiation, location in colon ascendens and age between 40 and 60 years were further relevant variables of prognosis. The history after secondary procedure was dependent of the kind of symptoms at the time of recurrence, intensity of postoperative follow-up and the length of recurrence free interval.

Adult↗

[Type and prognosis of loco-regional recurrence in rectal carcinoma: a follow-up study].

The recurrence rate after 438 curative operations for rectal carcinoma was 44.1% (193 cases). It was independent of age and sex, but correlated closely with tumour stage. Tumours in an early stage recurred rarely and late. The success of a second operation was influenced by the type of local-regional recurrence. Only three of 34 presacral recurrences were again treated surgically with cure as the aim, compared with seven of 17 anastomosis recurrences, five of eight perineal recurrences, four of six recurrences after local dissection, and all colostomy recurrences, vaginal recurrences and metachronic second tumours. The further course demonstrated that about three quarters of patients who had undergone seemingly curative operations died from their tumour. The cure rate was only 8.8% for all patients after operations for recurrence and 22.6% for those who had undergone "curative" second operations.

Adult↗

[Effect of serial CEA determination on diagnosis, therapy and prognosis of recurrent colorectal cancer].

A rising CEA level did not indicate an early tumour recurrence in the follow-up of 660 patients with curative surgery because of colorectal carcinoma. In case of rectal carcinoma the first rise of the tumour marker preceded diagnosis of recurrence by other means 7.9 months on an average, in case of colonic carcinoma 5.1 months. The long-term survival after secondary procedure was 17.5% for patients with normal CEA value at time of reoperation and surmounted life expectancy of patients with rising tumour-marker level significantly (5.9%). The worst prognosis was found for the collective with rising CEA before diagnosis of relapse by other means, none of whom was saved by reoperation. The resectability rate of metastases was higher than that of local recurrences with nearly identical survival for both groups. Because of the long CEA lead times advances in therapy by second-look procedures are to be expected mainly for patients with pelvic recurrences after abdominoperineal extirpation.

Carcinoembryonic Antigen↗

[Controversies in the after-care of colon cancer].

A recurrence rate of 37 per cent (n = 155) was recorded from 414 patients who had undergone curative operations for colon carcinoma, between 1970 and 1980. Reoperation was performed on 100 patients and was successfully completed in 33 per cent. The five-year survival rate amounted to 24 per cent, following curative reoperation. No patient in a group without regular follow-up after reoperation survived 5 additional years. Related to all cases of recurrence, 5 year survival was recorded from only 5 per cent. 10 year survival rates of all patients with follow-up differed significantly from those without.

Colonic Neoplasms↗

[Relevance of histopathologic grading in colonic cancer].

The histopathological grading exerted a significant influence on prognosis in patients with colonic carcinoma. More than half of the well differentiated tumors were found in early stage pT1-3 N0 M0 compared to 25% of the G2- and 10% of the G3-tumors. The percentage of incurable cases in G2-tumors was twice as high and in G3-tumors three times as high as in patients with well differentiated carcinomas. The recurrence rate increased significantly with decreasing tumor differentiation from 21% to 51%. Despite the correlation with tumor stage the histopathological grading could be established as an independent prognostic variable and had an influence on the recurrence rate especially within tumor stage pT1-3 N0 M0.

Colon↗

[Stomach cancer in patients under 40].

Fifty-one patients below the age of forty were treated for stomach carcinoma at the Surgical Hospital of Mainz University, between 1970 and 1986. They accounted for 5.2 per cent of all patients with stomach carcinoma. Diagnosis had been delayed under the following characteristic circumstances: The interval between onset of symptoms and diagnosis had been more than a year in 34 per cent of all cases. Fifty per cent of the patients had been originally hospitalised, following false suspicious diagnosis. Primary examination for gastro-intestinal passage produced falsely negative results in 43 per cent. The same falsely negative outcome was recorded from 24 per cent, following gastroscopy, and from twelve per cent, following gastroscopy combined with tissue sampling. The percentage of early stomach carcinomas was twice as high as that recorded from patients over forty. Undifferentiated carcinomas, on the other hand, were predominant in patients below forty, whereas adenocarcinomas were primarily recorded from patients over forty. Curative resection was successful in 55 per cent of the over-forties and 44 per cent of the under-forties. No-recurrence intervals were longer among the over-forties. However, five-year survival rates in Stages I, II, and III were better among the under-forties. Hence, the conclusion has been drawn from these findings that stomach carcinoma prognosis of patients below forty is better than that in higher age groups. This, however, is contradictory to other investigations reported in the literature.

Adult↗

[Colon carcinoma. Preoperative CEA, tumor differentiation and prognosis].

Investigations on 279 patients with colon carcinoma revealed an increase in the sensitivity of the CEA (carcinoembryonic antigen) test with regard to tumor stage from 42% (Dukes A) to 86% (Dukes D). Curative operable carcinoma without lymph-node or distant metastases had CEA levels up to 70 ng/ml. CEA values below 20 ng/ml had no predictive value concerning resectability at first operation. When the CEA level rose above 20 ng/ml, the proportion of curative operations fell from 83% (CEA values below 20 ng/ml) to 17%. Recurrence rate rose with the preoperative level of CEA from 22% (CEA less than 2.5 ng/ml) to 62% (CEA greater than 10 ng/ml). The resection rate at second operation had a closer relationship than at first operation to the preoperative CEA level; it fell from 50% (CEA less than 5.0 ng/ml) to 0% (CEA greater than 20 ng/ml). At operation, highly differentiated tumors were found to be at an early stage in 50% of cases, compared to 26% of G2 and 11% of G3 tumors. In 44% of dedifferentiated tumors CEA levels were above 20 ng/ml. An influence of tumor differentiation on CEA remained even after division into the individual tumor stages.

Adenocarcinoma↗

[Effectiveness of after-care in colonic cancer].

52% of recurrences of the group with regular check-up after curative surgery for colonic carcinoma were diagnosed within the first postoperative year compared to 38% of the patients without medical control. Diagnosis of recurrent disease was made in 75% during a regular check-up, i.e. in state of asymptomatic relapse. Patients without postoperative control attended a physician in 96% because of symptomatic recurrence. 31% of the controlled group were free of lymph node involvement or metastases at the time of secondary procedure as compared to 20% of the group without check-up. 37% of secondary operations could be performed curatively for the patients with examinations compared to 17% of the patients without control. Five-year-survival-rate after secondary procedure was 11% for the group with check-up and 0% for the patients without control. Therefore the high personal, financial and temporal expense and the handicap of patients by a regular postoperative check-up seems justified in case of colonic carcinoma.

Colonic Neoplasms↗

[Principles of radical treatment in surgery of colonic cancer].

The principles of radical surgical treatment of carcinomas of the colon are: 1) the en-bloc-resection of tumor, regional lymph nodes and lymph vessels and nearby organs, 2) avoiding of tumor spreading caused by the operation itself. To avoid tumor spreading, there are different kinds of treatment, the value of which are unknown, but which do not rise the risk of the operation. Predisposition for the evaluation of the radical surgical treatment of colon carcinoma is a standard operative technique and a standard pathohistological evaluation.

Colectomy↗

[Spontaneous course of metachronous metastases following curative intervention for colonic cancer: a total review].

The rate of metachronous metastases after curative surgery because of colonic carcinomas was 17% (n = 70). Women (20%) developed metastases more frequently than men (13%). Procedures in third to ninth decennium were followed in decreasing frequency (100 to 8.7%) by metachronous metastases. Primary tumors located in coecum showed by far the strongest tendency to recurrent metastatic disease (29%). Rate of metastases after curative surgery in tumorstage T 1-3 N0M0 was 9%, after stage T4 N0 M0 17% and after resection of tumors with lymph node involvement 32%. Liver metastases arose late when originating from primary in early tumorstage. Survival after diagnosis of liver metastases decreased with extension of primary tumor. These results give some aspects to formation of high-risk-groups to be followed-up according to a special program postoperatively.

Adult↗

[Cancer of the colon: prognostic factors].

The course of 675 patients operated on for carcinoma of the colon was analysed in relation to various prognostically relevant factors. The most important one in case of recurrence was a negative CEA (carcino-embryonal antigen) test. In this case the five-year survival rate after a second operation was 44%, compared with 6%, if the test was positive. Radical second operation was associated with a negative CEA test in 70% of cases. The five-year survival rate after second operation in stage rT1-3 N0M0 was 26%. Patients who had regular follow-ups survived the second operation with a five-year survival rate of 11%, none survived who had been without medical follow-up. Five-year survival rate of 16% was achieved by the group of patients who were symptom-free; none with symptomatic recurrence survived. Other prognostically favourable factors were: male sex; tumour localized to the ascending colon; onset in the fifth decade; long recurrence-free interval; and early stage of the tumour at first operation.

Adult↗

[Intraoperative ultrasound study in surgery].

Report on intraoperative sonography in 257 patients (89 with pancreatic and 67 with liver disease, 24 with vascular surgery and 24 with bile duct disease). Intraoperative sonography was helpful for the detection of tumors not evident by inspection and palpation. In vascular surgery it proved to be an excellent means for quality control. The main problems encountered concerned the evaluation of the bile ducts and of haemodynamically insignificant vessel wall lesions.

Bile Duct Diseases↗

[The problem of recurrence in colonic cancer].

In this study the incidence of recurrence in radical procedure for carcinoma of colon is more than 37.4%. Of 100 patients undergoing second laparotomy because of recurrence 33% could be resected curatively. The rate of recurrence was independent on sex, negatively correlated with age and positively correlated with tumor stage of former operations. Curative operations located at the ascending colon and hepatic flexure had less recurrences than others. Second operations in curative aims were twice as successful in men than in woman and equally possible in all decades. Results of recurrences of splenic flexure and transverse colon were better than other locations. Tumors of early stages relapsed later. The probability of a radical procedure in recurrence related operations was better in those cases with a long recurrence-free interval. The resectability +/- rate and tumor stage of second-look operation were depending on tumor stage in the first operation. This means further history of tumor disease is determined closely by tumor stage in the first operation.

Adult↗

LaparoLith. A new instrument for stone fragmentation in laparoscopic cholecystectomy.

Laparoscopic cholecystectomy can be performed with incisions of a maximum diameter of 10 mm. The removal of a stone-filled gallbladder at the end of an operation via the 10-mm port needs often-extensive tissue-consuming manipulations for stone removal or minilaparotomy. Stone fragmentation can be achieved by mechanical crushing and by ultrasound-, electrohydraulic-, and tunable dye laser lithotripsy. The clinical employment of the LaparoLith (Baxter Healthcare Corporation), an instrument which allows mechanical fragmentation of stones inside the gallbladder, is presented here. We have used the LaparoLith in nine patients and have been successful in stone fragmentation in seven of these. The LaparoLith seems to be helpful in laparoscopic cholecystectomy, preventing extension of the subnavel incision.

Cholecystectomy, Laparoscopic↗