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C J Krones

Publications and source records attributed to C J Krones.

At least 19 recordsLinked to original sources
PubMed2006

Different matrix micro-environments in colon cancer and diverticular disease.

BACKGROUND AND AIMS: The extracellular matrix and the interactive signalling between its components are thought to play a pivotal role for tumour development and metastasis formation. An altered matrix composition as potential underlying pathology for the development of colorectal cancer was hypothesized. METHODS: In a retrospective study of patients with colon cancer, the extracellular matrix in tumour-free bowel specimen was investigated in comparison with non-infected bowel specimen from patients operated on for colonic diverticulosis. The following matrix parameters with known associations to tumour formation, cell proliferation, invasion and metastasis were analysed by immunohistochemistry and quantified by a scoring system: VEGF, TGF-beta, ESDN, CD117, c-erb-2, cyclin D1, p53, p27, COX-2, YB-1, collagen I/III, MMP-13, PAI and uPAR. Expression profiles and correlations were calculated. RESULTS: The comparison of the two groups revealed a significantly decreased immunostaining for CD117 and TGF-beta in the cancer group (8.5+/-2.6 vs 10.3+/-2,1 and 4.9+/-1.5 vs 8.1+/-3, respectively), whereas PAI scores were significantly higher than in patients with diverticular disease (8.1+/-1.6 vs 6.2+/-0.9). Overall correlation patterns of matrix parameters indicated pronounced differences between tumour-free tissue in cancer patients compared with patients with diverticular disease. CONCLUSIONS: Our results indicate distinct differences in the colonic tissue architecture between cancer patients and patients with diverticulitis that support the notion of an altered matrix composition predisposing to the development of colon cancer.

Collagen Type I↗
PubMed2006

Evaluation of anastomotic microcirculation after low anterior rectal resection: an experimental study with different reconstruction forms in dogs.

BACKGROUND: Data on anastomotic microcirculation of coloanal anastomoses are contradictory. Therefore, it was the aim of the present study to investigate perianastomotic blood perfusion in a standardized experimental setting comparing three forms of reconstruction using laser fluorescence videography, a new method for the evaluation of microcirculation. METHODS: After a standardised rectal resection in dogs, reconstruction was performed as straight end-to-end (n = 6), side-to-end (n = 6), or J-pouch (n = 6) coloanal anastomosis. Bowel perfusion was evaluated using IC-View laser fluorescence videography. RESULTS: The perfusion index was significantly reduced in all three groups compared to the reference regions: endto-end anastomosis, median, 93% (range, 63%-136%); side-to-end-anastomosis, 65% (35%-138%); colonic-J-pouch anal anastomosis, 52% (32%-72%); p < 0.001). CONCLUSIONS: Straight coloanal anastomoses provide better anastomotic microcirculation after rectal resections than colonic-J-pouch anal anastomoses or side-to-end anastomoses. However this effect does not seem to be decisive for the prevention of anastomotic leaks.

Anastomosis, Surgical↗
PubMed2006

[Current patient perceptions of the physician].

BACKGROUND: The structure and organisation of German hospitals currently are undergoing radical change forced by reforms in the German public health system. Operating procedures, efficiency assays, and management programs compete with the traditional philanthropic relationship between physician and patient. To analyse this problem by scientific means, inpatients were interviewed in standardised fashion on current expectations, ideals, and experience with that relationship. PATIENTS AND METHODS: During 4 weeks, 507 inpatients were interviewed. The structured questionnaire used consisted of nine closed multiple-choice questions. The proband sex ratio was balanced, and their age pattern represented the typical patient collective in our clinic. RESULTS AND CONCLUSION: The patient perception of physicians' roles described clear priorities. Besides a skilled expert, the patients were looking for a friend and guide through their disease, diagnosis, and therapy. The paternalistic relationship between physician and patient thus is not very antiquated. In contrast, material institutional criteria, provision of services, and hotel-like atmosphere played secondary roles.

Aged↗
PubMed2005

Influence of polyglecaprone 25 (Monocryl) supplementation on the biocompatibility of a polypropylene mesh for hernia repair.

BACKGROUND: Supplementary polyglecaprone 25 (Monocryl) monofilaments were added to a lightweight pure monofilament polypropylene mesh (PP mesh) to improve intraoperative handling (PP+M mesh). This study was designed to evaluate the influence of this additional supplementation on the biocompatibility in a rodent animal model. METHODS: Two mesh materials, a composite mesh (PP+M) and the pure polypropylene variant (PP), were compared after subcutaneous implantation in a standardized rat model. Histological analysis of the inflammatory response was performed after 28, 56 and 84 days of implantation. Material absorption, inflammatory tissue reaction, fibrosis and granuloma formation were investigated, as well as the percentage of proliferating and apoptotic cells at the interface. RESULTS: Both mesh materials showed a slight foreign body reaction involving mainly macrophages and foreign body giant cells. Total absorption of the Monocryl filaments of the PP+M mesh occurred between 56 and 84 days of implantation. Both the inflammatory and the fibrotic reaction were decreased (n.s.) in the PP+M mesh group compared to the pure PP mesh. Whereas the percentage of proliferating cells showed no significant difference, the rate of apoptotic cells was significantly decreased in the PP+M mesh group over the whole implantation period. CONCLUSION: Compared to the pure polypropylene mesh, our data confirm that the use of a polypropylene mesh supplemented with absorbable Monocryl filaments is feasible without additional short-term mesh-related complications in the experimental model or negative side effects on biocompatibility.

Animals↗
PubMed2005

Validation of IC-VIEW fluorescence videography in a rabbit model of mesenteric ischaemia and reperfusion.

BACKGROUND/AIMS: Mortality in mesenteric ischaemia can be reduced by an optimised extent of resection. Up to now, no technique supplementing a surgeon's experience has achieved clinical acceptance. Besides a qualitative interpretation, the new technique of computer-assisted laser-fluorescence videography affords quantification of staining intensities. The aim of this study was to investigate the scientific value of this technique in mesenteric ischaemia in a rabbit model of controlled mesenteric ischaemia and reperfusion. METHODS: We used an established rabbit model of mesenteric ischaemia (group I, n=6) and reperfusion (group II, n=6). In each animal, three loops (each of 10 cm) of the small intestine were clamped (group I, 40 min; group II, 60 and 20 min reperfusion). For further evaluation, all loops were divided into five segments of 2 x 2 cm (total number of investigated areas, n=180). Measurement of vascular patency was performed by laser-fluorescence videography (pixel intensity per second). As standard, we used radioactive microspheres (impulse per minute per gram). In addition, the extent of ischaemic tissue damage was identified by histological examination. Statistical data were analysed by using regression analysis to define the regression coefficient r. RESULTS/FINDINGS: Laser-fluorescence videography and the microsphere technique demonstrated a close and linear correlation: ischaemic segments, r=0.90+/-0.07; reperfusion segments, r=0.85+/-0.02; overall, r=0.92+/-0.07. There was no reproducible correlation to cellular damage in histology. INTERPRETATION/CONCLUSION: Computer-assisted laser-fluorescence videography is a feasible, reliable, and valid experimental method for the detection of mesenteric blood supply and intestinal microcirculation. Clinical application is conceivable in mesenteric ischaemia and infarction as well as the operative transposition of intestine. As limiting values to identify the irreversible necrosis are not yet defined, further studies have to analyse the clinical impact more precisely.

Animals↗
PubMed2005

Incisional intercostal hernia after a nephrectomy.

The aim of the present case report is to present the diagnostic and therapeutic challenge of intercostal incisional hernia. We report on a female patient with leftsided intercostal incisional hernia between the eleventh and twelfth rib due to preceding lumbar incision for tumor nephrectomy. Because of its infrequence, diagnosis was established late although simple clinical examination and ultrasound investigation displayed the hernia. At laparotomy, a 5x5 cm(2) fascial defect with a colonic sliding hernia was found. Hernia repair using permanent mesh reinforcement in the retromuscular position is described. Abdominal incisional hernia in the intercostal region is rare and therefore easily overlooked. As with other incisional hernias, the hernia repair using mesh implantation in the retromuscular region is technically feasible and represents the treatment of choice.

Hernia, Ventral↗
PubMed2005

The rare epidemiologic coincidence of diverticular disease and advanced colonic neoplasia.

BACKGROUND AND AIMS: In Western industrialised countries the prevalence of neoplastic colonic lesions and diverticular disease markedly increases with age. In contrast, the coincident occurrence of both diseases seems to fall below their individual epidemiologic estimates. Because directly comparing data are rare, this retrospective study evaluates the coincidence of neoplastic lesions and diverticular disease. PATIENT AND METHODS: A total of 1,838 patients from 1986 to 2000 were admitted to the study. For 1,326 patients-56% male (n=741), 44% female (n=585), mean age 64 (+/-11.83 SD)-with a resection due to colonic cancer, the documented findings of colonoscopy, colonic contrast enema, and/or histopathology were analysed with regard to the prevalence of colonic diverticulosis. In 512 patients--51% male (n=263), 49% female (n=249), mean age 60 (+/-12.59 SD)--with a colonic resection due to diverticulitis, the synchronous or metachronous occurrence of neoplastic colonic lesions was recorded using the database of the Tumour Centre, Aachen. To compare the observed results with published epidemiology, statistical analysis included age-referred binomial tests and an age-stratified analysis (Cochran-Mantel-Haenszel test). Odds ratios (OR) were also calculated. P<0.05 was considered to indicate locally statistical significance. RESULTS: In the cancer group, we found a statistically significant reduced rate of diverticula in nearly all age categories and the age-stratified analyses (corresponding OR 0.30-0.51). Consistently, the diverticulitis group revealed a statistically significant decreased rate of advanced colonic neoplastic lesion in nearly all age categories and all age-stratified analyses (corresponding OR 0.13-0.43). CONCLUSION: Our results indicate that patients with colonic neoplastic lesions or diverticular disease probably form heterogeneous groups. Because current results from molecular biology emphasize the impact of the extracellular matrix on the genesis of diverticulosis and colonic cancer, the observed heterogeneity could be an expression of a distinct composition of the local milieu.

Adult↗
PubMed2005

[Isolated edematous swelling of Bauhin's valve -- sonographically suspected diagnosis of a rare ileocoecal disease].

Isolated edematous swelling of Bauhin's valve is a rare finding in cases of non-specific abdominal complaints in the lower right abdominal quadrant. The differential diagnosis includes entities such as tumours, chronic gastrointestinal inflammation and ileocoecal intussusception as well as specific infections, all of which require individual therapy. Based on two current cases and a review of the literature, aetiology, clinical picture and diagnostic findings of isolated edema of the ileocoecal valve are described. The typical ultrasound findings are presented. Due to its potential of excluding other diseases, modern ultrasound offers promising results in the case of isolated edematous swelling of Bauhin's valve.

Adult↗
PubMed2004

[Foreign body-induced disruption of the gastrointestinal tract-anatomy of the ileocoecal opening].

INTRODUCTION: Over 75% of ingested foreign bodies pass the gastrointestinal tract without any complications. Blunt foreign bodies may lead to a disruption of the intestinal passage, mainly in the area of the ileocoecal opening. The size of the reported foreign bodies varies considerably. The aim of this study was the anatomic investigation to clarify the possible causes of obstruction and its influence on the diameter of the ileocoecal opening. MATERIAL AND METHOD: We investigate anatomically and describe the ileocoecal opening on the basis of 27 specimens. RESULTS: We found not a flap mechanism but a valve mechanism in the ileocoecal junction. The median diameter of the formalin-fixated specimens was 10.9 mm respectively 21.8 mm according to an assumed correction factor of 2. The cause for intestinal obstruction most probably is the ingestion of blunt, angular foreign bodies in the ostium ileale. CONCLUSION: The intraindividual differences as well as the considerable size of foreign bodies that pass the ileoceocal opening support the hypothesis, that the complications described are more a consequence of an ingestion of blunt, cornered foreign bodies in the ostium ileale independent ofn the size of the ileocoecal opening itself.

Cecum↗
PubMed2003

Inguinal hernia on the internet: a critical comparison of Germany and the UK.

Despite containing an increasing amount of medical information, the Internet provides only rare benefits for surgical patients. Using "inguinal hernia" as a catchword, an amateur search was imitated on the British Internet market. Sixty-five pages, standardised regarding quality and efficiency, were evaluated. A comparison to the German Internet market was added. In summary, the broad majority of the pages revealed poor results. Technical appearance, quality of content, and target grouping show big deficiencies. The applicable laws on the European market are not yet established. The ranking lists of the search engines do not reflect the quality of the pages. Patients need competent guides to process surgical information from the Internet. The establishment of specialised institutions to control surgical Web sites according to quality, content, and legality on the European level is urgent.

Germany↗
PubMed2003

[Partial intestinal obstruction after swallowing a self-expanding sponge for weight reduction].

HISTORY AND ADMISSION FINDINGS: A 21-year-old woman presented with predominantly right-sided cramp-like abdominal pain which had started the previous day. The abdomen was soft on palpation, the peristaltic sounds increased. Body temperature was normal. INVESTIGATIONS: Routine laboratory tests were unremarkable, including white cell count (4.5 G/l). and C-reactive protein. TREATMENT AND COURSE: She was admitted to hospital for observation. Because the symptoms persisted she underwent a right lower laparotomy because acute appendicitis was suspected. Intraperitoneal examination of the intestines revealed a soft, sponge-like foreign body just above the ileocecal valve. The overlying ileum was incised and a sponge removed. Postoperatively the patient reported having taken 4 capsules of CM3, a weight-reducing preparation, about 14 days ago. These capsules dissolve in the stomach and each releases a small sponge which expands and mechanically induces a feeling of satiation. The further course was unremarkable and she was discharged on the 8th postoperative day. CONCLUSION: When producing weight-reducing preparations that act according to physico-mechanical principles, anatomical circumstances should be considered, and they should only be taken under medical supervision.

Abdominal Pain↗
PubMed2003

Mesh reconstruction preventing sacral herniation.

Sacral hernias are uncommon defects developing through the pelvic floor after partial or total sacrectomy. We report on a 29-year-old woman, who has been under our care with a cystic formation after perineosacral resection of a rhabdomyosarcoma and partial sacrectomy. The cystic tumor was resected and a mesh repair performed to prevent sacral herniation. The current literature is summarized; etiology and management recommendations of this rare complication are discussed.

Adult↗
PubMed2003

[Tuberculosis of the gall bladder].

We report a case of gall bladder tuberculosis in a 64-year-old male. The gall bladder is an extremely rare localization of an infectious disease seen frequently worldwide--tuberculosis. The reason for this special resistance against the mycobacteria is not clear and is controversial. In imaging, the disease can mimic acute or chronic cholecystitis or carcinoma of the gall bladder. It is important to consider tuberculous cholecystitis in differential diagnosis and to do tuberculin skin tests in case of suspicion. This test is technically easy and cost-effective. Since 1968, isolated tuberculosis of the gall bladder has not been reported in western civilization. This case study was done because of the rareness of the disease,and we review the literature on this topic.

Cholecystectomy↗
PubMed2003

[Information on the Internet for patients and general practitioners--critical analysis using the example of inguinal hernia].

INTRODUCTION: The Internet offers an increasing amount of medical information, but its value for surgical patients is doubtful. METHODS: Using "inguinal hernia" as catchword, an amateur search was imitated on a German-speaking metasearch machine. One hundred fifty sites, standardized regarding quality and efficiency,were evaluated. RESULTS: In summary, more than 50% of the sites revealed poor results. Technical appearance, quality of content, and target grouping show big deficiencies. The applicable laws were mostly not respected. The ranking lists of the search machines do not reflect the quality of the sites. CONCLUSION: Patients need competent guides to process surgical information from the Internet. The establishment of a specialized institution to control surgical websites according to quality, content, and legality seems to be needed.

Family Practice↗
PubMed2002

[Leiomyosarcoma of the hernial sac in inguinal hernia].

Malignant tumors associated with hernial sacs are rare entities. A review of literature offers only small groups of patients. The high incidence of inguinal hernia repair operations demands recognition of this morbidity. It should be suspected in cases of tight tissue in the hernial sac in differentiation to the unreduced inguinal and femoral hernia. Therapy of choice must be a resection in toto (R0), incomplete resection causes inguinal spreading or recurrence of the tumor. The exact evaluation of the surroundings should follow. There is no other standardized therapy besides operation. A case of leiomyosarcoma in inguinal hernia will present the entity of neoplastic disease in hernial sac.

Abdominal Neoplasms↗