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Biomedical subjects

C Zornig

Publications and source records attributed to C Zornig.

At least 19 recordsLinked to original sources
PubMed1998

[Laparoscopic 2/3 resection of the stomach with intracorporal Roux-en-Y anastomosis].

In a patient with recurrent ulcer disease under medication, which was complicated by episodes of bleeding, a laparoscopic partial gastric resection with intracorporal Roux-en-Y anastomosis was performed. The operation was completed within 3 h with blood loss < 10 ml. The postoperative hospital stay of 6 days was uncomplicated as was the further follow-up (2 months so far). This operation and the study of results published in the literature showed us that a gastric resection can certainly be performed laparoscopically in the appropriate patient.

Anastomosis, Roux-en-Y↗
PubMed1998

Laparoscopic vs open repair of gastric perforation and abdominal lavage of associated peritonitis in pigs.

BACKGROUND: Laparoscopy is increasingly used in conditions complicated by peritonitis, e.g., peptic ulcer perforation. Of some theoretical concern is the capnoperitoneum, which may aggravate peritonitis and induce septic shock due to increased intraabdominal pressure and distension of the peritoneum. This animal study was devised to analyze the effectiveness of laparoscopic versus traditional open repair of gastric perforation and abdominal lavage for associated peritonitis. METHODS: To simulate gastric perforation, female Duroc pigs were subjects to standardized gastrotomy. Either 6 or 12 h after gastric perforation, the animals underwent either traditional open or laparoscopic repair of the gastric defect and peritoneal lavage. The subjects were divided into the following four groups: peritonitis for 6 h and open surgery (group I) or laparoscopic surgery (group II); peritonitis for 12 h and open surgery (group III) or laparoscopic surgery (group IV). After an observation period of 6 days, the surviving animals were killed. The main outcome criteria were survival, perioperative changes of hemodynamics suggestive for septic shock, bacteremia, and endotoxemia. RESULTS: There were no significant differences between group I and II. Mortality was 22% in group III, as compared to 78% in group IV (p = 0.045). In group IV, the incidence of perioperative bacteremia and plasma endotoxin concentrations were significantly higher than in group III. Concomitantly, decreased mean arterial pressure and systemic vascular resistance, and increased cardiac output suggested a higher incidence of septic shock in group IV. CONCLUSION: Critical appraisal of laparoscopic surgery is warranted in conditions associated with severe, longstanding peritonitis.

Animals↗
PubMed1997

Chondrosarcoma of the thumb arising from a solitary enchondroma.

Secondary chondrosarcoma of the bone of the hand arising from a solitary enchondroma is a rare entity, with only 16 published cases in the literature. We report the clinicopathologic findings of a new case arising from a preexisting solitary enchondroma. A review of the literature is discussed.

Adult↗
PubMed1997

Survival in primary soft tissue sarcoma of the extremities and trunk.

BACKGROUND: Soft tissue sarcomas (STS) of the extremities are rare. The purpose of this study was to identify prognostic risk factors associated with survival in patients with primary extremity and truncal STS. METHODS: Patient, tumor, and pathologic data from 149 consecutive patients with localized primary STS of the extremities and trunk were analyzed using Kaplan-Meier and Cox regression techniques to identify univariate and multivariate risk factors. A subgroup analysis was performed to compare factors predictive of survival in patients who received treatment before (n = 50) and after (n = 99) treatment was standardized in 1988. RESULTS: The 5-year survival rate was 76.5% with an average follow-up of 6 years. Local recurrence occurred in 23% of all patients, 40% before 1988 and 15% after 1988 (P < 0.0001). Risk factors associated with survival included resection quality (R0 vs. R1; P < 0.0001), era of operation (P = 0.002), local recurrence (P < 0.001), UICC stage (P < 0.0001), tumor size (P < 0.001), tumor depth (P = 0.002), regional lymph nodes (P < 0.0001), and histology (P < 0.0001). Multivariate analysis revealed that tumor size, tumor depth, and resection quality were independent risk factors of survival. CONCLUSIONS: These results indicate that management of STS in a specialized institution improves overall survival. Resection quality is the most important risk factor of survival. Therefore, effort should be made during primary treatment of STS to achieve wide, tumor-free resection margins.

Adolescent↗
PubMed1997

Laparoscopic treatment of nonparasitic cysts of the liver with omental transposition flap.

BACKGROUND: Between 1991 and November 1994, 18 patients with large, solitary, nonparasitic liver cysts underwent laparoscopic deroofing; the last 13 of them also received an omental transposition flap in addition. METHODS: Using three to four trocars, the cystic contents were first aspirated, and the cyst derooted widely using diathermia. An omental transposition flap was fashioned and stapled into the cyst cavity itself. RESULTS: Postoperative complications included one case of pulmonary atelectasis. Another patient developed a subhepatic bile collection which was aspirated percutaneously. On average, patients were discharged on the 4th (2-14) postoperative day. Follow-up was performed with abdominal ultrasound for 2-43 months (mean 19 months). There were two early cyst recurrences, both in cases without an omental transposition flap (overall recurrence rate, 11%; in patients with omental flap, 0). CONCLUSIONS: Deroofing in combination with an omental transposition flap is a safe and effective therapy for symptomatic solitary liver cysts and can be performed using minimal-access surgical techniques.

Adult↗
PubMed1997

Cytogenetic studies in malignant fibrous histiocytoma.

Among soft tissue sarcomas, malignant fibrous histiocytoma is considered to be the most commonly encountered tumor-type of late adult life. Cytogenetic data are, however, sparse and contradictory, without any specific anomalies. We are describing the results of cytogenetic studies in 20 malignant fibrous histiocytomas of various subtypes and gradings. Although we saw two single and therefore possibly primary rearrangements, t(13;14) and t(5;7), most tumors had complex rearrangements without sharing any characteristic aberrations. In our opinion, the heterogeneity of these findings supports the concept that malignant fibrous histiocytoma is not a distinctive entity but merely a name for a group of as yet poorly defined sarcomas.

Aged↗
PubMed1997

[Computerized tomography of retroperitoneal liposarcoma].

Besides the malignant fibrous histiocytoma, liposarcoma is one of the most common soft-tissue sarcomas seen in adults. They are most often localized in the lower extremity, followed by sarcomas in the retroperitoneal space which differ from the former in clinical appearance, epidemiology, and prognosis. The prognosis is especially dependent on tumor histology which is mainly classified into four subtypes. The aim of the study was to investigate whether there are specific CT-features for each histologic subgroup, by analyzing the examination of 20 patients. The highest percentage in fat and the biggest tumors were seen with well-differentiated liposarcomas (n = 4), whereas myxoid ones (n = 6) showed the sharpest margins. Round-cell (n = 2) and pleomorphic (n = 5) and pleomorphic (n = 5) types showed mainly soft-tissue attenuation and could not be differentiated, either from each other or from other soft-tissue tumors. A clear identification of the histologic subgroup does not seem to be possible.

Adult↗
PubMed1997

[Cytotoxic T-lymphocytes and the recognition of tumor antigens--an approach to "preventive tumor vaccination?"].

In spite of modifications of the intra- and postoperative therapeutic strategy as well as new adjuvant protocols, most malignant diseases have a poor prognosis. This demonstrates the need for new approaches in tumor therapy. One alternative is adoptive immunotherapy (AIT). AIT is based on the observation that cytotoxic T-lymphocytes (CTL) may be generated with the ability to lyse autologous tumor cells in vitro and in vivo. Aim of current research activities is to determine specific tumorantigens and the clinical applicability of cell-mediated immunotherapy. The immunobiology of the cell-mediated immune response to cancer with focus on major-histocompatibility complex class I and CD8+ T cells is reviewed. Recent advances in the identification of tumor-associated and tumor-specific antigens were summarized. Previously performed clinical studies were reviewed. We examined the implications that the discovery of these antigens might have on the development of new anticancer vaccines.

Animals↗
PubMed1997

[Surgical research and publications in Germany--an analysis of 1984-1994].

The present study analyses a selection of German and American surgical and cancer research journals from the years 1984 and 1994. The aim of the study was to evaluate the amount of publications by German surgeons in these journals. Furthermore, any influence of the impact factor on the publication criteria was analyzed. German surgical journals showed a high percentage increase in the impact factor but are, in absolute numbers, still significantly behind the American journals. In parallel, German surgeons are still the major contributors to German language journals, but increasingly publish in the American ones as well. The impact factor is one of the major selection criteria on to which journal a paper shall be submitted.

Animals↗
PubMed1996

[Results of radiotherapy in recurrences of soft tissue sarcomas].

PURPOSE: Published data for radiotherapy in soft tissue sarcomas refer in most of the cases to the use of irradiation for primary tumors. Experiences of radiotherapy in local recurrences are limited. The own treatment results of a multimodal treatment approach in a large number of patients will be analyzed for local tumor control rates, survival rates, side effects and prognostic factors and will be compared to the literature. PATIENTS AND METHODS: At the University Hospital Hamburg-Eppendorf a total of 98 patients with local recurrences of soft tissue sarcomas were irradiated between 1980 and 1993. The median age of the patients was 55 years. There was a large variety of different histologies. Grading was evaluable in 95 cases: G1 24 patients, G2 21 patients and G3 50 patients. Localisation was dominated by the extremities with 64.3%. Recurrences were reclassified: 21 patients had rT1-tumors and 77 patients had rT2-tumors. Twelve cases showed lymph node metastases and 9 patients distant metastases. Generally treatment included surgery and postoperative irradiation. R-classification showed R0 in 25, R1 in 20 and R2 in 48 cases. Neutrontherapy was prefered in 57 cases and neutron- and photontherapy in 22 cases. Local tumor control rates and survival rates were calculated using the Kaplan-Meier method. Side effects were scored using the RTOG/EORTC scoring system. Univariate and multivariate analyses were applied to evaluate prognostic factors. RESULTS: Local tumor control rates at 5 years were 56.4%, for G1 75.2%, G2 52.5%, G3 47.1%, rT1 66.0%, rT2 53.6%, R0 63.4%, R1 42.3% and R2 53.2%, N0 61.1% vs. N1 31.7%. Survival rates at 5 years were 45.2%, for G1 64.8%, G2 66.9%, G3 25.0%, rT1 60.0%, rT2 41.5%, R0 64.2%, R1 49.3% and R2 32.7%. Acute side effects were scored as grade 1 and grade 2. The rate of grade 3 and 4 late effects was about 6%. Lymph node status was a significant factor for local control. Grade, residual tumor status, type of irradiation and the applied neutron dose were significant factors for survival. CONCLUSIONS: Nowadays no standard treatment exists for local recurrences of soft tissue sarcomas. Treatment should be interdisciplinary. Local recurrences should be avoided by the consequent use of surgery and radiotherapy. It is important that local recurrences should be detected early. Neutrontherapy may bring advantages for local control of recurrences with macroscopic tumor residuals.

Adolescent↗
PubMed1996

[Therapy splitting: are intra-operative cholangiography and surgical bile duct revision still indicated?].

The role of therapeutic splitting in cases of cholecystolithiasis and choledocholithiasis has to be reviewed since laparoscopic bile duct exploration might be an alternative. To assess the need of the new approach we evaluated our results of the therapeutic splitting. Between 1988-1992 a cholecystectomy was performed in 577 cases either as an open (n = 274) or laparoscopic (n = 277) procedure. Pre- or postoperative endoscopic retrograde cholangiopancreatography (ERC/P) was performed if the clinical presentation, laboratory findings or ultrasound showed signs of choledocholithiasis. In the laparoscopic cases no intraoperative cholangiography was carried out. The patient follow-up was evaluated by a questionnaire. 128 patients were suggested to have a common bile duct (CBD) stone and had a preoperative ERC/P. In 68 cases stones were extracted. After cholecystectomy 19 ERC/P's were performed. In 4 patients residual stones after preoperative ERC/P were detected. So far occult stones were found in 5 cases. Intraoperative cholangiography was performed additionally in the patients with open cholecystectomy n = 207¿, of whom two demonstrated choledocholithiasis. Endoscopic clearance of the common bile duct was achieved in all patients. Minor complications occurred after ERC/P in 1.5%. Within a median follow-up time of 48 months patients with endoscopic papillotomy did not develop further CBD stones or a cholangitis. The therapeutical splitting facilitates in all patients with cholecysto- or choledocholithiasis a successful clearance of the CBD. Intraoperative cholangiography is not necessary according to our experience. With an experienced endoscopic team the therapeutic splitting should be the preferred treatment modality compared to the laparoscopic bile duct exploration, which will probably lead to a high complication rate if performed outside specialized centers.

Adolescent↗
PubMed1996

[Surgical correction of bile duct injuries after laparoscopic cholecystectomy].

The rate of iatrogenic bile duct lesions has raised up to 3.5% after the introduction of laparoscopic cholecystectomy. Lesions that can not be managed endoscopically require surgical intervention. In this study 12 patients that presented with iatrogenic bile duct lesions following laparoscopic cholecystectomy and underwent reconstructive surgery at our institution are included. In nine patients a hepaticojejunostomy was performed, whereas two patients underwent end-to-end anastomosis. In one patient the lesion was oversewn. There were no complications postoperatively. After a median follow-up of 24,5 months (SD +/- 8 months) all patients are without symptoms. However, in two patients a postoperative endoscopic stenting for 4 months was necessary for bouginage. Reconstructive surgery, mainly hepaticojejunostomy in bile duct lesions is a safe and efficacious treatment of endoscopic treatment failure.

Anastomosis, Surgical↗
PubMed1996

[Laparoscopic cardiomyotomy in achalasia].

Surgical therapy of choice for achalasia is cardiomyotomy. Alternative procedure is the endoscopic pneumatic dilatation. Compared with the conventional operation, the laparoscopic approach promised to have advantages concerning postoperative convalescence. Between May 94 and October 95 four patients with achalasia underwent a laparoscopic cardiomyotomy. In all patients endoscopic therapy was tried. With the minimal invasive approach a myotomy of the esophagus was only shortly extended on the stomach. All patients had an endoscopic control of extension of the myotomy and intact mucosa during the operation. An antireflux procedure was not performed. Operation time came to 60 to 130 minutes. All patients immediately could swallow without problems and were discharged between day 2 and 8 postoperatively. During the follow-up (up to 18 months) all patients were free of dysphagia and regurgitation. The dynamic x-ray of the esophagus showed a free passage into the stomach. Only one patient claimed mild symptoms of reflux. Cardiomyotomy can very well be performed laparoscopically, leads to good functional results and shows the expected advantages for patients concerning postoperative convalescence. The need for an antireflux procedure is discussed controversially in the literature. It might be unnecessary if the myotomy is only shortly extended to the stomach.

Adolescent↗
PubMed1995

Re-excision of soft tissue sarcoma after inadequate initial operation.

Between January 1988 and October 1993, 189 patients with soft tissue sarcoma of the extremities and trunk underwent surgery and since 1988, patients in whom the initial operation did not achieve safe margins underwent reoperation (67 of the 189). At re-excision an en block resection of the area with wide margins was achieved in 59 patients. Residual tumour was found in 30 specimens (45 per cent). Thirty-six patients received postoperative radiotherapy and/or chemotherapy. After a mean follow-up of 32 (range 1-69) months five patients (7 per cent) had local recurrence. In view of the high rate of local recurrence after local excision of soft tissue sarcoma (70-90 per cent), primary re-excision is indicated after an inadequate initial operation.

Adolescent↗
PubMed1995

[Local recurrence of soft tissue sarcoma of the extremities and trunk].

Soft tissue sarcomas (STS) tend to recur locally. In a series of 140 patients operated on during the past two decades with STS of the extremities and trunk, prognostic factors influencing local recurrence were determined. Statistical significance was evaluated for the quality of surgical resection (P < 0.001), regional positive lymph nodes (P = 0.03), and adjuvant radiotherapy (P = 0.01) [for resection without wide margins (R1) and low-grade (G3) tumors]. In 1988, the surgical procedure was standardized. After 1987, local recurrence decreased significantly (P < 0.001). In subfascial tumors, local recurrence occurred far less in cases of compartmental resection than with wide excision. These data indicate that the course of patients with STS can be beneficially influenced by optimal therapy. Resection with wide margins in all three dimensions is the aim of sarcoma surgery. Postoperative radiation therapy is indicated in the case of R1 resection.

Adolescent↗
PubMed1995

Effect of a pneumoperitoneum on the extent and severity of peritonitis induced by gastric ulcer perforation in the rat.

Laparoscopic surgical repair of perforated gastroduodenal ulcer is technically feasible. To study the effect of a pneumoperitoneum on the extent and severity of peritonitis this animal study was devised. In rats gastric ulceration was induced by instillation of ethanol (50%, 2 ml) and followed by gastrotomy to simulate perforation. Animals were randomly allocated to pneumoperitoneum (PP) and control groups. In PP groups CO2 was insufflated intraperitoneally 6, 9, 12, and 24 h after gastrotomy. In controls the abdomen was only punctured. Animals were sacrificed 5 h after the end of PP or abdominal puncture. Blood cultures and intraabdominal swabs were assessed. A peritonitis severity score (PSS) based on histologies from peritoneum, liver, left kidney, spleen, and first jejunal loop was estimated. Six and 9 h after gastrotomy no significant differences between the PP and control groups were observed; 12 h after gastrotomy cultures of blood samples and abdominal swabs were positive in 67% and 75% in the PP group compared to 42% (P < 0.05), and 42% (P < 0.05) in controls. The mean PSS was 20.8 (standard deviation [SD] 2.2) in the PP group compared to 11.3 (1.5) (P < 0.01) in controls; 24 h after gastrotomy cultures of blood samples and abdominal swabs were positive in 83% and 100% in the PP group compared to 42% (P < 0.05) and 50% (P < 0.01) in controls. The mean PSS was 22.1 (1.5) in the PP group compared to 11.8 (2.4) (P < 0.01) in the controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗