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C Herfarth

Publications and source records attributed to C Herfarth.

At least 19 recordsLinked to original sources
PubMed1995

Deletion mapping defines different regions in 1p34.2-pter that may harbor genetic information related to human colorectal cancer.

Cytogenetic and molecular analyses of colorectal cancer cells have revealed deletions at 1p as prominent alterations, suggesting that genetic information on the short arm of chromosome 1 has a role in tumorigenesis. In this study we have used 33 microsatellite markers to fine map deletions at 1p in primary colorectal carcinomas. We found 1p-deletions in 84% of the cases (31/37). High frequencies of loss of heterozygosity (LOH), often the result of small independent interstitial deletions in the same tumor, defined three regions, that may harbor genetic information relevant for colorectal cancer: (i) region A between D1S243 and D1S468 (7cM; 1p36.3); (ii) region B between D1S436 and D1S199 (7cM; 1p35.1-36.31) and (iii) region C between D1S496 and D1S255 (1cM; 1p34.2-35). In addition we identified seven cell lines with LOH at 1p, all of which have deletions that span at least from the distal border of region A to the proximal border of region C.

Chromosome Deletion↗
PubMed1995

Significance of tenascin serum level as tumor marker in primary colorectal carcinoma.

Tenascin serum levels were evaluated in 118 patients with primary colorectal carcinoma and in a control group of 51 healthy persons in a double-sided sandwich ELISA. The data were correlated with post-operative TNM-staging. Patients with colorectal carcinomas had significantly higher serum levels of tenascin than the control group. At the 95% level of specificity, sensitivity was 25%. Tumor grading obviously had no influence on the level of tenascin in serum. With increasing pT-category, tenascin levels increased as well. In patients with distant metastatic disease, serum tenascin levels were significantly higher than in patients without distant metastases. These data suggest that, in colorectal carcinoma, the preoperative level of serum tenasin reflects the total tumor burden and correlates with metastatic disease. Our observation warrants a prospective study of the relevance of tenascin serum levels with regard to prognosis and as an indicator of relapse.

Adult↗
PubMed1995

Isovolemic hemodilution with dextran prevents contrast medium induced impairment of pancreatic microcirculation in necrotizing pancreatitis of the rat.

BACKGROUND: Previous studies demonstrated that intravenous contrast medium (CM), as used in contrast enhanced computed tomography, aggravates the impairment of pancreatic microcirculation (PM) characteristic of severe pancreatitis and increases necrosis and mortality in necrotizing pancreatitis (NP) in rats. This study evaluates the use of isovolemic hemodilution, which can enhance the microcirculation in severe pancreatitis, for preventing CM-induced injury. METHODS: NP was induced in 30 dextran-tolerant Wistar rats by intraductal glycodeoxycholic acid and intravenous cerulein for 6 hours. PM was quantified by intravital microscopy using fluorescein isothiocyanate labeled erythrocytes. Based on previous results, areas with low blood flow (< 1.6 nL/min/cap) were identified and baseline recordings of capillary blood flow taken. A reduction of hematocrit to 75% of baseline was achieved by replacement of 5 mL/kg of blood with 25 mL/kg Ringer's lactate (RL) or by exchange of 8 mL/kg of blood for the same amount of dextran 70.6%. Thereafter, the nonionic CM iopamidol (Solutrast, Byk Gulden, Konstanz, Germany) was injected during 1 minute and PM measurements repeated after 30 and 60 minutes. RESULTS: Despite hemodilution with RL, pancreatic capillary perfusion was significantly decreased to 87% of baseline (0.83 +/- 0.04 mL/min/cap; n = 216) 60 minutes after CM infusion (P < 0.05). In contrast, capillary blood flow was significantly increased to 161% (1.56 +/- 0.05 nL/min/cap; n = 278) in the group treated with dextran. Moreover, the percentage of capillaries developing complete stasis was significantly lower in the dextran group (2.3 +/- 1.2%) compared to animals diluted with RL (22.3 +/- 4.8%) (P < 0.002). CONCLUSION: Isovolemic hemodilution with dextran prevents the additional impairment of pancreatic microcirculation induced by CM in NP.

Acute Disease↗
PubMed1995

Hyperoncotic dextran and systemic aprotinin in necrotizing rodent pancreatitis.

BACKGROUND: Dextrans improve pancreatic microcirculation in acute experimental pancreatitis. They could therefore facilitate the transport of a protease inhibitor to ischemic areas of tissue injury and be of additional benefit. METHODS: To compare the effects of dextrans with and without aprotinin, necrotizing pancreatitis was induced in 33 male dextran-resistant Wistar rats by intraductal infusion of low-dose glycodeoxycholic acid (10 mmol/l) followed by intravenous cerulein (5 micrograms/kg/h) for 6 h. Three and four hours after the start of the cerulein infusion the animals received infusions of either Ringer's lactate (RL) (12 ml/kg), 70,000 Da dextran (10%) (DEX-70) (4 ml/kg) alone, or DEX-70 (4 ml/kg) with aprotinin (5000 IU/kg) (DEX-70/A). RESULTS: The death rate was 60% within 9 h in the RL group (6 of 10) but only 10% in the DEX-70 group (1 of 10) (p < 0.03; Fisher's exact test) and 23% in the DEX-70/A group (3 of 13). Histomorphometry demonstrated a significant reduction of acinar necrosis in both treatment groups compared with control animals (p < 0.014; t test). Total amounts of trypsinogen activation peptides (TAP) in ascites were also significantly lower in these groups (p < 0.05; t test). CONCLUSIONS: DEX-70 given 3 h and 4 h after induction of pancreatitis significantly reduced the levels of TAP, limited acinar necrosis, and improved survival rate in acute necrotizing rodent pancreatitis. There was no additional benefit from the combination with aprotinin.

Acute Disease↗
PubMed1995

[Ischemic type lesions of the bile ducts after liver transplantation: 2 years results].

Ischemic type lesions (ITL) after orthotopic liver transplantation are characterized by bile duct necroses leading to alterations of the ductal lumen, biliary leakage, cast formation and, thereby, to cholestasis. After exclusion of causative factors, such as arterial thrombosis, ABO incompatibility and chronic rejection, ITL occurred in 21 of 165 patients. The rate of ITL after UW preservation was higher (25%) in grafts preserved for > 10 hours in comparison to < 10 hours (7%; p < 0.05). Treatment consisted of endoscopic and percutaneous intervention, surgical revision and retransplantation. Retransplantation is indicated in many patients with lesions of extra- and intrahepatic bile ducts (type A). Other methods are of palliative character and may only be successful in type B (extrahepatic) lesions. Morbidity in patients with ITL is considerable. In comparison to patients without ITL, mortality, however, is not increased.

Bile Ducts↗
PubMed1995

[Surgical therapy of recurrent Crohn disease].

The surgical therapy of recurrent Crohn's disease requires due to a recurrence rate of 60% after 15 years special precautions. The major principle of therapy is a minimal resecting surgery. This concerns mainly strictures and stenosis. Strictures should be treated by stricturoplasty and stenosis by limited resection. Recurrent fistulas should be treated conservatively. Just in case of interenteric and enterocutaneous fistula with a concomitant short bowel syndrome, in blind ending fistulas with an abscess or in enterovesical fistulas we recommend immediate operation. The therapy of recurrent anorectal Crohn's disease underlies the same rules as the primary therapy. If necessary, proctectomy remains an important option. Also emergency surgery in recurrent Crohn's disease follows the same rules as in elective surgery.

Crohn Disease↗
PubMed1995

[Subjective assessment of quality of life, pain and surgical success after laparotomy for Crohn disease].

239 patients following major surgery for Crohn's disease (mean 8 years after first operation) were interviewed by mailed questionnaire. Main target parameters included reduction of quality of life, intensity/frequency of abdominal pain, and grading of success of the most recent operation for Crohn's disease. These targets were correlated in univariate as well as multivariate statistics with 28 different parameters of general medical history, surgical pretreatment, actual somatic and psychosocial findings. Reduction of quality of life correlated with stool frequency, employment status, rectal involvement, hematochezia, liquid stools, extraintestinal manifestations and time since first operation (all with p < 0.05 in multivariate analysis; listed in decreasing levels of significance). Abdominal pain at time of interview was significantly associated with actual intake of corticosteroids, stool frequency, employment status, extraintestinal manifestations, dietary restrictions, and number of previous operations (other than laparotomies). Regarding success of most recent laparotomy important parameters included stool frequency, intake of corticosteroids, number of previous laparotomies, hematochezia, and history of enterostomy. Overall, parameters of disease activity were found to be more important than characteristics of medical history or previous surgery. Despite marked symptoms in many cases 92% of the patients regarded the most recent laparotomy to be fully or partially successful. The results provide direct and indirect evidence that besides momentary disease activity the individual personality profile may be far more important than type and number of previous surgery in coping with this chronic disease.

Activities of Daily Living↗
PubMed1995

[Intraoperative radiotherapy within the treatment concept of retroperitoneal soft tissue sarcomas].

Sarcomas of the retroperitoneum are characterized by a high rate of local recurrence. External beam radiotherapy is known to improve local control after surgical therapy. To increase local dosage of radiotherapy without affection of sensitive structures we applied intraoperative radiotherapy (IORT) since 1991 in a dedicated operative unit. To compare morbidity and tumor control we used a partly historic control group of patients treated since 1988 for retroperitoneal soft tissue sarcoma. 25 patients with a mean age of 53 years were operated. Tumor histology was dominated by liposarcoma and leiomyosarcoma, UICC stage IIB (T2 G2 N0 M0) was present in 45% of cases. Distant metastasis were diagnosed in 19% at therapeutic intervention. Tumor free margins were achieved in 55% while 29% showed microscopic and 16% macroscopic tumor residues after surgical intervention. 11 patients received IORT with a mean of 18 Gy, eight of those patients were treated additionally with a mean of 40,4 Gy externally. There were no differences in distribution of known risk factors for recurrence in the group of patients treated with or without IORT. The analysis showed no difference for perioperative morbidity. Tolerance for IORT and additional external beam radiotherapy was good. Local tumor control tended to be improved by IORT (p = 0.082) while overall survival was not affected at a mean follow-up of 24 months.

Adolescent↗
PubMed1995

Improved survival in acute necrotizing pancreatitis despite limiting the indications for surgical debridement.

OBJECTIVE: To reassess our criteria for the stratification of attacks of acute pancreatitis, and indications for operation in patients with necrotising pancreatitis. DESIGN: Retrospective analysis of casenotes. SETTING: University Hospital, Germany. SUBJECT: 341 Consecutive patients who presented with a first attack of acute pancreatitis between December 1979 and January 1991. MAIN OUTCOME CRITERIA: Morbidity and mortality in relation to clinical (Ranson, Kümmerle, Goris) and radiological (Balthazar) criteria. RESULTS: 78 Patients developed necrotising pancreatitis judged radiologically. Mortality was 15/38 (39%) in the period 1980-85 and 6/40 (15%) in the period 1986-1990. During the first period patients were operated on if their unfavourable clinical signs did not start to resolve within 72 hours, whereas in the second period operation was restricted to those patients who developed signs of multiple organ failure. This policy resulted in the number of operations being reduced from 26/38 (68%) to 17/40 (42%), respectively (p = 0.03). CONCLUSION: Our data support the policy of restricting surgical debridement in necrotising pancreatitis to those patients who develop signs of multiple organ failure.

Acute Disease↗
PubMed1995

[The Heidelberg Intensive Care Unit Score. Development of a computer-assisted scoring system for documentation of treatment course and assessment of prognosis in surgical intensive care patients].

Existing scoring systems have failed to reflect the pathophysiological changes during ICU therapy, and do not provide reliable criteria for the prediction of outcome in surgical patients. The aim of the present project was to establish a comprehensive scoring system for daily evaluation of physiological parameters and therapeutic interventions in a surgical intensive care unit, and to identify score patterns in the course of ICU treatment to be used for prospective clinical decisions. In a prospective study of 123 consecutive patients who required intensive care for more than two consecutive days we documented 10 physiological parameters and a set of 14 therapeutic interventions on a daily basis over a total of 1274 days. Evaluation of the new scoring system, called the Heidelberg Intensive Ward Score (HDWS), included comparison with APACHE II and a set of unfavorable HDWS-patterns at different time points during ICU treatment. All variables were implemented into a notebook computer to be used at bedside. Neither HDWS nor APACHE II obtained on admission differentiated between survivors and non-survivors. In contrast, scores of non survivors were significantly higher than scores of survivors at day 7. At that point, HDWS was superior to APACHE II with respect to the predictive power as assessed by receiver operator characteristic curves. No patient who fulfilled all four unfavorable HDWS-patterns during the first week of ICU treatment survived (but these were only two patients). We conclude that the limited power of scores obtained on admission to predict outcome in surgical patients may be improved by trend analysis of scores over time which also take into account the patients' response to therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

APACHE↗
PubMed1995

[Incontinence after ileo-anal pouch anastomosis--diagnostic criteria and therapeutic sequelae].

After ileo-pouch-anal anastomosis (IPAA) there is an increased risk of incontinence due to intraoperative damage of the anal sphincter. We present a new concept to identify a potential incontinence prior to the closure of ileostomy by clinical and anal manometrical examinations. In 11 of 121 (9.1%) patients we diagnosed a potential incontinence. By biofeedback training we could achieve in this way a sufficient continence after the closure of ileostomy. After an average of 5.0 +/- 4.3 months of training rest pressures improved from 19.3 +/- 2.1 mmHg to 33.0 +/- 3.5 mmHg and squeeze pressures from 60.5 +/- 27.7 mmHg to 93.5 +/- 17.3 mmHg. Prior to IPAA patients with potential incontinence show significantly reduced rest pressures of 51.0 +/- 18.4 mmHg.

Adenomatous Polyposis Coli↗
PubMed1995

[Effect of anastomosis reconstruction on vascular complications after liver transplantation].

AIM: Besides primary non function (PNF), vascular complications are responsible for the majority of early surgical and interventional therapy following liver transplantation. The purpose of this study was to evaluate the influence of the variety of arterial anastomosis on postoperative morbidity and mortality. METHOD USED: In 179 liver transplantations, vascular (arterial and portal) complications within the first 3 months were analyzed with respect to the type of reconstruction. The arterial anastomoses were divided into 3 groups according to the recipient artery used [Group (I): common hepatic artery (CHA), (II): hepatic artery (HA), (III): aorta]. For statistical analysis comparison of two proportions and the logrank test were used. RESULTS: The reconstruction was done primarily to the recipient CHA (69%, n = 124), less often to the HA (15%, n = 26) or directly to the aorta (16%, n = 29). The portal anastomosis-with the exception of two cases (dacron graft and internal iliac vein interposition)-was always end to end and resulted in four reinterventions (2.2%, kinking: n = 1, thrombosis: n = 3). Arterial complications (11.7%) like thrombosis, stenosis and dissection (n = 17), bleeding (n = 2) and steal phenomenon (n = 2) occurred more frequently. The difference in one year survival between patients with (n = 12/25, 47%) and without (n = 42/53, 79%) vascular complications was significant (chi 2 = 4.72, FG 1, logrank test p < 0.05). CONCLUSION: The rate of complications causing surgical or interventional therapy is independent of the choice of arterial reconstruction. The one year survival rate in patients with vascular complications is significantly decreased.

Adolescent↗
PubMed1995

[Induction of impaired hepatic microcirculation by in situ hilus preparation in liver explantation].

AIM: Usually, in-situ preparation of the hepatic hilar structures is performed prior to the perfusion with preservation solution. Aim of this study was to investigate mechanical effects of liver preparation on the hepatic microcirculation. METHODS: 16 pigs (German landrace) were randomized in two groups. In both groups, laparotomy was performed after intratracheal intubation. Subsequently, a thermal diffusion probe was implanted into the medial left liver lobe for quantification of microperfusion. In group A (n = 8), bile duct, hepatic artery, and portal vein were exposed and the lesser omentum transsected thereafter. Ultrasound-volume-probes were placed around the hepatic artery and portal vein. Simultaneous measurement of hepatic microperfusion and total liver blood flow was performed five minutes after the end of liver preparation. In group B (n = 8) hepatic microperfusion was quantified 45 minutes after laparotomy without further manipulations. RESULTS: By the preparation, liver perfusion was significantly reduced in group A from 78 +/- 13 ml/100g/min to 61 +/- 16 ml/100g/min. After preparation a total liver blood flow of 137 +/- 46 ml/100g/min was recorded indicating a shunt fraction of 51 +/- 21%. In contrast, hepatic microperfusion in group B remained at baseline during the whole observation period (79 +/- 3 ml/100g/min vs. 78 +/- 5 ml/100g/min). CONCLUSION: In-situ liver preparation induces a relevant disturbance of hepatic microcirculation. Preservation perfusion shortly after surgical manipulation could become ineffective because of an increase in shunt flow. If the regeneration period is too short, e.g. lack of heart explantation, the quality of the liver graft could be limited.

Animals↗