PubMed Health⌕ Search

Biomedical subjects

E Stoelben

Publications and source records attributed to E Stoelben.

27 records · Page 2Linked to original sources
PubMed1998

[Color Doppler sonography in liver surgery. Status of perioperative monitoring].

AIM: Resection of liver tumours is not always successful despite detailed diagnostic work-up preoperatively. In our study we compared the predictive value of colour Doppler imaging of the liver with other radiological examinations for tumour staging, surgical decision making and postoperative complications. METHODS: From 1/95 to 6/1997 we investigated 76 patients with liver tumours; 60 patients with liver metastases, 13 with primary liver carcinomas and 3 with benign lesions. Resectability was defined in colour Doppler imaging by tumour localisation, distance of the tumour to the central vessels and blood flow in the portal vein. CT-scan in all patients and angiography in patients with central tumour localisation was performed. The preoperative results were compared to intraoperative ultrasound and surgical examination. RESULTS: 108 out of 118 intrahepatic lesions were found preoperatively using high-resolution ultrasound. Ultrasound and CT-scan achieve comparable results in delineating pathologic changes in the liver. Considering only the liver findings and local resectability in 76 patients, the sensitivity achieved for B-mode-ultrasound was 77.6% (59/76); for CT-scan 78.9% (61/76) and for colour Doppler imaging 86.4% (66/76). 31 out of 76 laparotomies were terminated after exploration. Resectability was correctly predicted by ultrasound in 55 (72.4%) and by CT-scan in 57 (73.7%) patients. Colour Doppler imaging improved the ultrasound results in up to 62 (81.6%) patients. Unsuspected not resectable tumour growth was found in 9 patients with local/regional recurrences, in 4 patients with peritoneal spread and in one patient with multiple bilateral liver metastases. CONCLUSIONS: Using high-resolution ultrasound systems the preoperative detection of lesions in the liver achieves the results of CT-scan. Little isoechogenic lesions, peritoneal spread and locoregional recurrences can be missed by ultrasound examination. Colour Doppler imaging shows compared with B-mode and CT-scan a higher sensitivity for the detection of the infiltration of hilar structures and can take place of more invasive methods in preoperative liver investigations. Considering functional and morphological aspects colour Doppler imaging makes an essential contribution to the planning of liver surgery. Using lung passing contrast media the determination of tumour vascularisation and perioperative quantification of liver perfusion is possible. The use of the intraoperative ultrasound is justified to determine resection limits, detection of smallest non-palpable lesions and to control perfusion after vascular reconstruction. In experienced hands colour Doppler imaging gives valuable preoperative information with excellent cost-benefit ratio.

Equipment Design↗
PubMed1998

[VATS (video-assisted thoracoscopic surgery): possibilities and limits of surgical therapy of malignant lung diseases].

VATS is able to perform by minimal access all operations known in general thoracic surgery. Mortality (0.07-1.9%) is low and complications (4.3-14.2%) are rare, as published in four studies in the last two years. Especially long-term results of VATS in malignant disease are not clear. Indications and limitations for VATS in bronchial carcinoma and lung metastases are discussed. Surgical treatment in peripheral non-small cell lung cancer has best results after lobectomy. Limited resection decreases the oncological result (5-year-survival-rate) by 10 to 18% compared to lobectomy. Conservative treatment with radiotherapy in stage I carcinomas in patients who are not eligible for open lobectomy because of restricted lung function or other non oncological reasons has a bad prognosis (0-12% 5-y-survival). In these cases VATS resection of bronchial carcinoma should by considered. Detection of all lung metastases by preoperative radiological study is only in 56-75% possible. Between 10/93-2/98 we performed 52 thoracotomies for lung metastases at our surgical department. In eight cases bronchial carcinoma was confirmed by histological examination, nine patients with metastases of malignant germ-cell-tumors were excluded from the study. CT-scan of the lung was performed preoperatively. In 43% of the cases (n = 35) additional lesions were detected intraoperatively by palpation of the lungs. Histopathologic examination revealed benign lesions in 9% and malignant in 34%. The result of lung metastases resection is highly dependent on the completness of extirpation. We therefore conclude that lung metastases should be removed by open thoracotomy.

Carcinoma, Bronchogenic↗
PubMed1996

[Clinical significance of cytokines Il-6, Il-8 and C-reactive protein in serum of patients with acute pancreatitis].

The detection of cytokines may elucidate the pathophysiological mechanisms that produce early systemic complications in acute interstitial (i) or necrotizing (n) pancreatitis (AP). The increase in the level of cytokines in the blood of patients with AP may correlate with the severity of the disease. In a prospective clinical trial from October 1992 to August 1993, 23 patients with AP were recruited and blood samples taken for cytokine detection by commercially available Elisa kits and C-reactive protein (CRP) by laser nephelometry. Six of 11 patients with nAP died either early (n = 1) or of late septic complications. None died of iAP. The peak of cytokine and CRP level in the first 3 days of hospitalization was used for calculation. The IL-6 concentration in the blood reached up to 2600 pg/ml in the 1st few days, depending on the severity of AP, and dropped to almost zero in the next days, independently of the clinical course. The differentiation of i- versus nAP, using a cut-off line of 600 pg/ml, was correct in 20 patients [87%, sensitivity (SE): 82%, specificity (SP): 91%, P < 0.001]. The blood levels of IL-8 reached a maximum of 1381 pg/ml in the 1st few days, depending on the severity of AP, and showed a correlation with the clinical course in the following days. The peak of IL-8 blood levels indicated correctly the severity of AP in 18 out of 23 patients using a cutoff level of 200 pg/ml (accuracy: 78%, SE: 82%, SP: 75%, P < 0.01). The CRP levels increased up to a maximum of 535 mg/l and indicated the course of AP correctly in 18 out of 22 patients (SE and SP 82%, P < 0.01). There was no correlation between cytokine blood levels and mortality. In the blood samples of five patients with i- or nAP, no TNF-alpha was detectable. The blood levels of IL-6, and to a lesser extent of IL-8 and CRP, can predict the severity and early systemic complications of AP. The excessive rise in cytokines can be explained by the stimulation of immunological cells (macrophages, lymphocytes and endothelial cells) in the course of AP, inducing early systemic complications.

Acute Disease↗
PubMed1996

Newcastle disease virus-infected intact autologous tumor cell vaccine for adjuvant active specific immunotherapy of resected colorectal carcinoma.

An active specific immunization (ASI) procedure with two types of autologous tumor cell vaccines (ATVs) is tested for adjuvant immunotherapy of resected colorectal carcinoma to provide preliminary information on local immunological skin responses, side effects, and 2-year survival rates. For vaccine preparation, the tumor-derived freshly isolated and cryopreserved cells were thawed, purified by Percoll density centrifugation, and depleted of tumor-infiltrating lymphocytes by immunomagnetic beads. After inactivation by 200 Gy, the cells of this ATV were either infected by Newcastle disease virus (NDV) or they were admixed with Bacillus Calmette Guérin (BCG) organisms. Vaccination was performed in the arm beginning 6-8 weeks after operation, three times at 2-week intervals. Of 57 patients that received ASI, 48 were treated by virus-infected ATV (ATV-NDV) and 9 were treated with the BCG-admixed vaccine (ATV/BCG). The mean value of delayed hypersensitivity skin reactions from ATV-NDV-treated patients was 18 mm for the first vaccination and 26 and 29 mm for the succeeding ones. Although the application of ATV-NDV was associated with only mild side effects, the ATV/BCG vaccine led to long-lasting ulcers and to more serious side effects. The 2-year survival rate obtained with ATV-NDV was 97.9%, whereas the survival rate with ATV/BCG was 66.7%. The mean survival of 661 patients from a historical control was 73.8%. These data suggest that the type and quality of the tumor vaccine for ASI treatment is important. The findings with ATV-NDV necessitate corroboration in a prospective, randomized controlled study.

Aged↗
PubMed1995

[Resection of solitary liver metastases of malignant melanoma].

Patients with solitary metastasis of melanoma may benefit from resection, although diffuse organ involvement is common. Recent results in immunotherapy of metastatic melanoma are impaired by early local recurrence, leading to consolidation surgery. Two patients with solitary liver metastasis were treated by liver resection. In one patient in January 1993, atypical resection was performed after partial remission induced by regional adoptive immunotherapy with LAK-cells and Interleukin-2. In September 1983 right hemihepatectomy was done in one patient for large metastasis without preceding therapy. Until now there is no evidence of disease in both patients. The metastasis were 14 cm without and 3.5 cm after (5.3 cm before) immunotherapy in diameter. On histologic examination we found only a slight necrosis without marked immunological reaction like mononuclear cell infiltration or fibrotic demarcation in the specimen of the patient without forgoing therapy. In the specimen of the patient after immunotherapy, the metastasis was necrotic. It was encapsulated by fibrous tissue which was infiltrated by lymphoid cells. The microscopic evaluation revealed some clots of vital tumorcells. The resection of solitary liver metastasis of melanoma with or without immunotherapy is recommended. The rational for consolidation surgery for melanoma metastases after successful immunotherapy is based on the histologically proven vital tumor cells in necrotic metastasis, which are responsible for early local recurrence.

Combined Modality Therapy↗
PubMed1994

Immunotherapy of metastatic melanoma with interferon-alpha and interleukin-2: pattern of progression in responders and patients with stable disease with or without resection of residual lesions.

This evaluation was performed in melanoma patients after successful immunotherapy to describe the pattern of relapse. 63 patients received interferon (IFN)-alpha and high-dose interleukin (IL)-2, resulting in three complete responses (CR), 13 partial responses (PR), three mixed responses (MR) and 17 stable diseases (SD). Median duration of response was 7 months (range 3-28) without surgery. Most relapses occurred at pre-existing sites. Duration of CR was 14-37+ months. In 11 patients, residual tumour lesions were resected. Interestingly, histology revealed almost complete tumour regression in 6 patients, including 2 of 4 with SD. 5 of these 11 patients have relapsed so far, 6 patients are still free of disease with a median of 17 months (range 8-34). Following relapse, 4 of 6 patients responded to retreatment with the identical IFN alpha/IL-2 protocol. The authors conclude that initial disease progression is mostly at previous sites of disease. Resection of residual lesions may offer a chance for extended disease-free survival similar to patients with CR to immunotherapy. Retreatment of relapsing patients is favourable.

Cohort Studies↗
PubMed1994

[Results of surgical therapy of soft tissue sarcoma of the retroperitoneum].

Between 1.1.1973 and 30.6. 1993 57 patients underwent operation for soft-tissue sarcoma of the retroperitoneum. The histological classification showed in 21 cases a liposarcoma and in 14 cases a leiomyosarcoma. Other histological types like fibrosarcoma, malignant fibrous histiocytoma or malignant schwannoma were only rarely seen. Complete resection (R-0-resection) was possible in 39 cases (73.5%). 6 patients underwent partial resection (R-2-resection) and 8 patients had only an explorative laparotomy because of an unresectable tumor. To realize a complete resection in 23 cases a multivisceral resection was necessary. The postoperative staging according to AJCC showed for 47.7% of the patients a stage III- or stage IV- disease. The clinical follow-up was observed between 3 months and 14.3 years. The cumulative 5-year-survival-rate for all patients was 38.2%. The most important factor for prognosis was the complete resection, while other factors like sex and age of patients, size of the tumor and histological type did not predict outcome. After complete resection the cumulative 5-year-survival-rate was 46.7%, while after partial resection or explorative laparotomy no patient survived 5 years.

Adult↗