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Biomedical subjects

C Schleicher

Publications and source records attributed to C Schleicher.

At least 19 recordsLinked to original sources
PubMed2005

Endosonographic and histopathological staging of extrahepatic bile duct cancer: time to leave the present TNM-classification?

OBJECTIVES: The discrepancy between high rates of sensitivity, specificity, and accuracy for intraductal ultrasonography (IDUS) in extrahepatic bile duct carcinoma and the failure to depict different wall layers as defined by the TNM classification have not yet been elucidated sufficiently. METHODS: In a prospective study, endosonographic images were correlated with histomorphology including immunohistochemistry. Using IDUS, we examined fresh resection specimens of patients who had undergone pancreato-duodenectomy. For histological analysis, the formalin-fixed and paraffin-embedded specimens were stained by hematoxylin-eosin, elastica-van-Gieson, and immunohistochemically by smooth muscle-actin. To confirm our hypothesis, further cases from the archives were analyzed histopathologically and immunohistochemically. RESULTS: The various wall layers of the extrahepatic bile duct as described by the International Union Against Cancer are neither histomorphologically nor immunohistochemically consistently demonstrable. Especially, a clear differentiation between tumor invasion beyond the wall of the bile duct (T2) and invasion of the pancreas (T3) by histopathological means is often not possible. Endosonographic images using high-resolution miniprobes similarly confirm the difficulty in imaging various layers in the bile duct wall. CONCLUSIONS: Most adaptations made by the sixth edition of the TNM classification accommodate to the endosonographic and most of the histopathological findings as demonstrated in our study. In contrast to the new edition, however, our findings suggest to combine T2- and T3-staged tumors into one single class leading to clarification, and improved reproducibility of histopathological staging.

Aged↗
PubMed2001

Reticuloendothelial system blockade promotes progression from mild to severe acute pancreatitis in the opossum.

OBJECTIVE: To examine the relation between hepatic reticuloendothelial system (RES) dysfunction and the development of acute biliary pancreatitis. In an opossum model, the authors tested the hypothesis that RES blockade can turn the mild pancreatitis seen after pancreatic duct obstruction (PDO) into the severe form. SUMMARY BACKGROUND DATA: Biliary obstruction is considered the decisive event in gallstone pancreatitis. Suppression of the RES occurs during biliary obstruction. METHODS: Eighteen opossums were placed into three groups of six animals each: group A, RES blockade with lambda-carrageenan; group B, PDO; and group C, PDO and RES blockade with carrageenan. The severity of pancreatitis was evaluated by enzyme serum levels and percentage of pancreatic tissue necrosis. RES capacity was measured by dynamic liver scintigraphy, and hepatic blood flow was documented using the hydrogen clearance technique. RESULTS: No changes in hepatic blood flow occurred in groups A to C. RES capacity was suppressed in groups A and C; in group B, RES function remained unchanged. In group A, amylase and lipase levels remained normal, 3 +/- 1.9% of pancreatic tissue were necrotic. The animals in group B developed mild edematous pancreatitis with an increase in amylase and lipase levels and 15 +/- 10% of pancreatic necrosis. In group C, amylase and lipase increased significantly and histology revealed severe necrotizing pancreatitis, with 72 +/- 11% of necrotic areas. CONCLUSIONS: Artificial RES blockade can promote the progression from mild pancreatitis as observed after PDO to the severe necrotizing form of the disease. Thus, RES dysfunction resulting from biliary obstruction might be an important cofactor in the pathogenesis of bile-induced pancreatitis.

Acute Disease↗
PubMed1999

[The observed and chance-corrected agreement of the computed tomographic and histological staging results in renal-cell carcinoma].

PURPOSE: To assess the diagnostic value of abdominal computed tomography in the preoperative staging of renal cell carcinoma. METHODS: Computed tomograms of 87 renal cell carcinomas were classified according to the TNM-System. The results were correlated with the histopathological categories. The usual parameters for diagnostic tests were calculated and chance correction of the observed agreement was performed using Cohen's Kappa (kappa) test. RESULTS: T-category staging showed an overall accuracy of 60% (kappa = 0.44). The pT1 category was correctly predicted in all cases. For perirenal invasion, an accuracy of 60% (kappa = 0.27), a sensitivity of 90.5%, and a specificity of 51% were found. For venous involvement, accuracy was 92% (kappa = 0.59), sensitivity 86%, and specificity 92%. All inconspicuous adrenals on CT were histologically normal as well. An accuracy of 80% for lymphadenopathy staging was attributable to chance (kappa = 0.04). 7 distant metastases were detected in the scanned volume. CONCLUSIONS: Good CT staging results are obtained with discrimination between T1 tumors and higher categories, the assessment of venous invasion, the exclusion of adrenal involvement, and the detection of metastatic spread to abdominal organs. Insufficient results are seen with lymphadenopathy staging and the distinction of organ-confined and invasive tumors.

Adult↗
PubMed1997

[Radiation exposure of the ocular lens and thyroid gland in digital subtraction angiography of brain-supplying arteries].

PURPOSE: To find out the individual level of radiation exposure of the ocular lens and thyroid gland during DSA of arteries supplying the brain, considering the indication. MATERIAL AND METHOD: The study was conducted on 72 patients during aortic arch and cerebral artery angiographies using thermoluminescent dosimetry. RESULTS: During 20 aortic arch angiographies the measured values were within non-critical limits, whereas during carotid, vertebral or cerebral four-vessel angiography of the left ocular lens exposure values of more than 500 mGy (max. 782 mGy) were stated in two of 52 cases. The highest measured exposure relating to the right ocular lens was 126 mGy, to the thyroid gland 88 mGy. However, in 51 of 52 cases thyroid gland doses of below 51 mGy were measured. In 71 of 72 cases there was a lateral difference between right and left lens exposure up to twice the measured dose for the right ocular lens during aortic arch angiographies and up to sixteen-fold in respect of the left lens during cerebral angiographies. CONCLUSION: In addition to the fluoroscopic time, number of images, fade-in and zoom some other dose-influencing factors, radiation geometry is especially decisive for organ exposure. The risk of cataracts or thyroid gland carcinomas/hypothyrosis can be neglected with median values of 40 and 70 mGy relating to the ocular lens and 17 mGy for the thyroid gland during cerebral angiographies.

Angiography, Digital Subtraction↗
PubMed1990

[Surgery in esophageal atresia. Anatomical and functional aspects].

The first successfully operated newborn with esophageal atresia dates back more than 55 years. During this period the concept of the unity of structure and function for surgical treated malformations has been retained. Primary anastomosis offers the best prerequisites. Main life threatening complications are leakage of the anastomosis, anastomotic strictures and gastroesophageal reflux. Avoiding vital complications the aim of undisturbed function can be achieved by appropriate surgical methods. The report describes own experiences over the past 20 years.

Anastomosis, Surgical↗
PubMed1989

[Long-term results following femoro-popliteal vascular reconstruction].

All in all, 330 thromboendarterectomies (TEA) and 354 venous bypass operations (VBP) were performed on 550 patients. In 11.01 per cent of all cases in which VBP had been planned, veins were not in optimum condition. Repetitive interventions had to be applied to 111 patients. Successful reoperations could be performed on six cases with immediate TEA-closures (1.8 per cent) and another two after immediate VBP-closures (0.56 per cent). Postoperative lethality figures were 0.6 per cent after TEA and 0.28 per cent following VBP. Twenty-nine early TEA-closures (8.9 per cent) were corrected by secondary VBP in 16 cases (4.8 per cent). Three were corrected by femoral ablation and two by toe amputation in the border zone (1.7 per cent). Thirty-nine early VBP-closures (11.0 per cent) required repetitive VBP in two cases (0.5 per cent) and toe amputation in the border zone in another three instances (0.84 per cent). Eight patients each died within the first postoperative year from TEA (2.4 per cent) and after VBP (2.2 per cent). The following cumulative patency rates were recorded according to the life table method: after one year (TEA: 90.9 per cent, VBP: 88.9 per cent), after five years (TEA: 73.4 per cent, VBP: 84.6 per cent), after ten years (TEA: 38.2 per cent, VBP: 73.7 per cent), after 15 years (TEA: 9.8 per cent, VBP: 24.2 per cent). These differences were significant as early as five years from surgery. Late amputation rates were 2.1 per cent for TEA and 2.9 per cent for VBP. Late lethality rates were 28.8 per cent for TEA and 7.6 per cent for VBP.

Adult↗
PubMed1981

[Roentgenologic and endoscopic findings after papillotomy].

During 1977--1980 36 papillotomies were performed; indications for the latter were: papillary stenosis, incarcerated stones or stones which could not be removed which certainty and suspicion of a papillocarcinoma. The indications were evaluated as to whether endoscopic or surgical papillotomy should be performed. The results of the papilloplasties were considered satisfactory. In 40% of the cases a duodenobiliary reflux was observed, which however did not give troubles.

Adult↗
PubMed1981

[Early and late results of internal small intestine splinting for ileus].

The continuous inside splinting of the small intestine was carried out in 82 children and adults, because of postoperative ileus, chronic recurrent ileus and diffuse peritonitis. Possibly the splinting had contributed in one case to the perforation of the paralytic small intestine with a fatal outcome. In another case there occurred a relapse of an ileus. All other patients have no complaints in connexion with the splinting operation. Control examinations take place. A "total folding" of the small intestine was not observed by the radioscopy.

Adult↗
PubMed1981

[X-ray diagnostic procedures in cases involving craniocerebral trauma].

A well working team of examinators is one of the main presummations of getting an optimal diagnostic and treatment of head injuries (examinators of different branches of medicine). The first thing to do is exclude an intracranial bleeding (correct interpretation of clinical and roentgenological findings with an application of a suitable method in time). The cerebral angiography is one of the most effective methods of haemotoma diagnostic. The results using computed tomography can be compared with. Both methods complement themselves. The ultra-sound-diagnostic is useful to exclude haematomas (80 per cent accuracy of fire).

Adolescent↗