Biomedical subjects

F Köckerling

Publications and source records attributed to F Köckerling.

At least 91 records · Page 5Linked to original sources

PubMed1998

[Surgical therapy of liver metastases in breast carcinoma].

The literature contains little information on the surgical treatment of metastases from carcinoma of the breast. Advanced stages of mammary cancer with generalised metastatic spread are considered to be the therapeutic domain of systemic chemotherapy. Patients with isolated liver metastases may, under certain circumstances, be considered candidates for partial resection of the liver. Another therapeutic option in this group of patients is intraarterial chemotherapy via a port catheter system implanted in the hepatic artery. A number of institutions employ a combination of both treatment modalities. Overall 5-year survival rates are low for both the regional and the systemic form of treatment. A carefully selected group of patients may be expected to benefit from partial resection of the liver, intraarterial chemotherapy or a combination of the two by having their survival time prolonged--provided that due consideration is given to all contraindications, and there are no extrahepatic manifestations. Wherever possible, resections should be carried out in curative intent. However, palliative resection may be justified in individual cases where alleviation of symptoms and an improvement in the patient's quality of life is to be expected. The present paper discusses the results achieved in 21 women who underwent liver resection at the surgical department of the University of Erlangen between 1980 and 1997, and compares these results with those reported in the literature. The average age of the patients was 54 years, and 9 had a solitary metastasis. As was to be expected, the R classification had a decisive influence on survival. The 2-year survival rate was 60% for R0 resections as compared with 16.7% for R1 or R2 resections.

Adult↗

PubMed1998

[Anesthesia in laparoscopies: an overview].

In the last few years laparoscopic surgery requiring a different method of anesthesia from laparotomic procedures has been increasingly carried out. Since laparoscopic cholecystectomy was first described in 1985 almost all abdominal organs can now be operated on laparoscopically. At the same time the spectrum of the patients has changed from those who are young and healthy to older ones with many accompanying illnesses. In addition, the length of time this operations require has greatly increased. Consequently the number of critical incidents relevant to anaesthesia, during laparoscopy, has risen. Therefore new studies had been worked out which lead to a better understanding of pathophysiological changes during pneumoperitoneum.

Adult↗

PubMed1998

[Laparoscopic splenectomy].

To date more than 400 laparoscopic splenectomies have been reported in the literature. The main indications for the procedure are benign haematological diseases, in particular idiopathic thrombocytopenic purpura. Laparoscopic splenectomy to treat malignant illnesses is rare and is usually restricted to small or only moderately enlarged spleens. Technically, the lateral abdominal approach with the patient in a right decubitus position has the advantage over the anterior approach in the supine patient of permitting better access to the organ. Under the force of gravity the stomach and intestines drop out of the operating field, and the splenic ligaments are placed under tension. This facilitates dissection with the harmonic scalpel and safe divisioning of the hilar vessels using the linear stapler. The individual steps of the procedure are described in detail.

Humans↗

PubMed1998

[Surgical therapy of choledocholithiasis].

Following the introduction of endoscopic papillotomy and stone extraction, surgical bile duct revision has decreased considerably in importance during the past two decades. Surgical bile duct revision is associated with an appreciably higher rate of complications than endoscopic stone extraction. The result has been that most working groups now favour a "therapeutic splitting" approach. This means that, wherever possible, endoscopic revision of the bile duct is first attempted. If, during laparoscopic cholecystectomy, intraoperative cholangiography reveals the presence of bile duct stones, they may, after consultation with the endoscopist, be left in place for removal by endoscopic papillotomy at some later date. Only in the case of very young patients and exceptionally, a highly experienced laparoscopic surgeon may attempt a transcystic extraction of such stones. Continuing indications for conventional surgical treatment of choledocholithiasis are local factors obstructing access to the papilla (gastrectomy, stenosis of the pylorus) and other bile duct changes requiring correction (choledochocele, strictures, stenoses, Mirizzi's syndrome, over-looked impacted stone obstructing an over-long cystic duct stump, intrahepatic lithiasis).

Adult↗

PubMed1998

[Thoracoscopic resection of epiphrenic esophageal diverticula by an intracavitary/endoluminal combined intervention].

Epiphrenic oesophageal diverticula are of the pulsation type, the underlying cause is a motility disorder. Resection is indicated by severe symptoms like dysphagia, regurgitation or aspiration and should be performed after endoscopic dilatative treatment of the neuromotor disturbance. Thoracoscopic resection under endoluminal endoscopic surveillance is considered to be a reliable procedure with low morbidity for the patient.

Dilatation↗

PubMed1998

[Beta-catenin expression and its significance for metastasis in curatively operated rectum carcinoma].

Two selected groups of 77 patients each (matched for age, sex, UICC stage and year of surgery) were compared. All patients were curatively operated on for rectal cancer by surgery alone. All remained locally disease-free, differing only in distant metachronous metastatic spread. beta-Catenin expression was investigated using immunohistochemical methods. Overexpression of nuclear beta-catenin was not correlated with disease-free survival or distant metachronous metastasis. Thus, this potential oncogen cannot be used as a prognostic marker in rectal cancer. Additionally, in four cases of intense nuclear staining, after DNA isolation and sequencing of exon 3, which encodes for the GSK-3 beta phosphorylation site, no mutations could be detected.

Biomarkers, Tumor↗

PubMed1998

[Plasma separation and bilirubin adsorption therapy in excessive hyperbilirubinemia after liver transplantation].

Reduction of bilirubin levels by various means has been proposed as symptomatic therapy for excessive jaundice in various end-stage liver diseases, since it exerts multiple toxic effects and may thereby promote multiple organ failure. Plasma separation and bilirubin adsorption by an anion-exchange column (BR-350) performed in four patients with excessive hyperbilirubinemia after liver transplantation resulted in a 29%-70% reduction in total serum bilirubin, accompanied by significant improvement of multiple organ failure or encephalopathy in three patients. Bilirubin adsorption may be beneficial in complicated jaundice after hepatic transplantation and should further be evaluated for its clinical indications.

Hemoperfusion↗

PubMed1997

Standardized characterization of gene expression in human colorectal epithelium by two-dimensional electrophoresis.

New diagnostic and prognostic markers are needed in colorectal cancer. They can be found by differential analysis at DNA, RNA or protein level. The accuracy of phenotypic comparisons of tumor and normal tissues depends on the purity of the samples. We present an effective method to identify and isolate proteins that are differentially expressed under altered conditions, and a two-dimensional reference protein map of the normal human colonic epithelium. Normal colonic mucosa, primary tumors and liver metastases were prepared in the operating room. After washing in an ice-cold medium containing protease inhibitors, crypts were isolated by mechanical preparation without using metalloproteinases. Epithelial cells were then selected using Ber-EP4 Dynabeads. The samples were denaturated before processing for immobilized pH gradient two-dimensional polyacrylamide gel electrophoresis according to SWISS-2DPAGE standards. The samples contained more than 95% epithelial cells as confirmed by fluorescence-activated cell sorting using pan-anticytokeratin antibodies. Cell surfaces were not damaged, as assessed by scanning electronic microscope. A protein reference map of the normal colonic epithelium was defined. Using gel matching, N-terminal sequencing and/or immunoblotting techniques, 60 polypeptides - including proteins specifically expressed in colorectal epithelium - have now been identified. This reproducible method of sample preparation permits the comparison of protein patterns found in various pathological states with the present reference map (http://www.expasy.ch). Some of these patterns might provide diagnostic or prognostic markers, or even molecular targets for therapy in the future.

Colorectal Neoplasms↗

PubMed1997

[Errors and risks in oncologic laparoscopic surgery].

Oncological problems associated with laparoscopic colorectal surgery with curative intent include port site metastases, inadequate radicality, seeding of tumour cells through unprotected recovery of the surgical specimen, faulty surgical technique, and failure to observe the technical and/or oncological limitations applicable to certain tumour sites. Investigations so far reported reveal a preponderance of mechanical pathogenesis of port site metastases caused by the contamination of trocar entry ports by tumour cells borne on instruments, trocars and resected material. This suggests that appropriate precautionary measures could resolve the problem. It appears that the CO2 pneumoperitoneum plays only a minor role in the development of port site metastases. Owing to a lack of long-term data, the oncological radicality of laparosopic resections for colorectal carcinoma cannot be assessed; merely a few reports on the number of lymph nodes removed during such operations have been published. Nevertheless, it would appear that fewer lymph nodes were removed than with comparable conventional surgery. However, a more accurate analysis needs to take account of the fact that the indication for laparoscopic surgery is determined by the size and location of the tumour. The many potential pitfalls and hazards of oncological laparoscopic surgery make it mandatory that such interventions should be done only within the framework of prospective clinical studies covering limited indications. Randomized prospective studies to cover all tumour stages and sites cannot be recommended.

Abdominal Muscles↗

PubMed1997

The incidence of port-site metastases might be reduced.

BACKGROUND: Laparoscopic resection for cancer is controversial and port-site metastases are not infrequent. The mechanisms of occurrence of port-site metastases remain unclear. Animal experiments have suggested a role for carbon dioxide (CO2), but port-site metastases also occur after thoracoscopy, where no CO2 is used. The aim of this study was to define the role of CO2 in the seeding of tumor cells in the human patient. METHODS: CO2, instruments, trocars, suction device, and peritoneal washing were examined during 12 staging laparoscopies for pancreatic cancer. The presence, viability, and biological significance of cells were investigated using conventional cytology, polymerase chain reaction (PCR), and restriction fragment length polymorphisms (RFLPs) to detect the presence of a mutant k-ras gene as a genetic marker of cancer cells. RESULTS: Cytology exam of peritoneal washing, instruments, the suction device, and trocars revealed many cells. Tumor cells were detected in 6/12 peritoneal, in 4/12 trocars and 4/11 instruments washings, but not in 12 CO2 samples. The DNA content of CO2 was very low-as assessed by PCR. Mutant DNA was detected by RFLP in four out of 12 aerosols. Six aerosols did not contain any DNA. Two aerosols were borderline. CONCLUSIONS: During staging laparoscopy for pancreatic cancer in humans, CO2 contains only very low levels of free-floating tumor cells, even in the presence of massive peritoneal contamination. These results suggest that the incidence of port-site metastases might be reduced if mechanical contamination of the port sites with instruments or with the specimen can be avoided.

Adenocarcinoma↗

PubMed1997

[Ileostomy--cecal fistula--colostomy--which is the most suitable fecal diversion method with reference to technique, function, complications and reversal?].

In the literature the question as to what constitutes the most suitable faecal diversion procedure continues to be controversial. Between 1989 and 1994 at the Surgical Department of the University of Erlangen a total of 464 patients received intestinal stomas for a wide range of different indications. Of these procedures 41.6% (n = 193) were temporary diversion stomas (ileum n = 170, transverse colon n = 16, jejunum n = 4, sigmoid n = 2, ascending colon n = 1). Subsequently, 7.8% of the loop ileostomies and 9.7% of the loop colostomies needed revision for early or late complications. After reversal surgery none of the loop colostomies, but 2.5% of the loop ileostomies, developed complications needing operative treatment. On the basis of our own experience and the data reported in the literature it may be stated that both loop ileostomy and loop colostomy are effective faecal diversion procedures which, with appropriate bowel preparation and a meticulous surgical technique, can be reversed with a low incidence of complications. Both procedures, however, require careful preoperative planning, operative technique and care if complications are to be avoided. Used simply for the creation of a stoma, the laparoscopic approach offers certain advantages.

Cecostomy↗

PubMed1997

The prediction of lymph node metastases in colorectal cancer by expression of the nucleoside diphosphate kinase/nm23-H1 and histopathological variables.

OBJECTIVE: To ascertain the risk of locoregional lymph node metastases from colorectal cancer, we compared microscopic pathological characteristics of the primary tumor with the expression of the nm23-H1 protein. METHODS: The nm23-H1 expression of 100 colorectal carcinomas and corresponding non-neoplastic mucosa was analyzed immunohistochemically at the time of primary curative surgery (R0 resection). Conventional histopathological factors (depth of infiltration, grade of differentiation, invasion of lymph vessels or veins) that are proven indicators for metastatic involvement of locoregional lymph nodes were examined in all cases. RESULTS: Of 45 tumors with lymph node metastases, 42 (93%) had a low nm23-H1 expression whereas only 35 (78%) were of high-risk histology (G3, G4, or lymphatic invasion). Therefore, nm23-H1 expression within the primary tumor indicated the lymph node status with a sensitivity of 93% and a negative predictive value of 92%. The classic pathohistological factors (high risk vs low risk) had a sensitivity of 78% and a negative predictive value of 77%, respectively. CONCLUSION: Reduced expression of nm23-H1 within primary colorectal carcinomas could serve as an additional independent marker in estimating the nodal metastatic potential of these tumors.

Antigens, Neoplasm↗

PubMed1997

[Extraction of cystic duct occlusion calculus in laparoscopic cholecystectomy].

Occluding stones left in the stumpf of the cystic duct may account for between 17% and 25% of the cases of post-cholecystectomy syndrome. When acutely inflamed or empyemic gallbladders are removed, an occlusive cystic duct stone must almost always be expected. When performing laparoscopic cholecystectomy, therefore, care must be taken to ensure that any stone occluding the cystic duct are detected and removed. After completely freeing the cystic duct to the point of its junction with the common bile duct, it is carefully "palpated" with a 5 mm forceps for the presence of stones. Any such present are pressed out of the duct through a transverse incision, and retrieved. Bile reflux through the incision in the duct indicates freedom from stones. Finally, intraoperative cholangiography can be performed.

Cholangiography↗

PubMed1997

[Pathogenesis of puncture-site metastases after laparoscopy].

The major factor underlying the seeding of tumor cells during laparoscopy are mechanical, with CO2 playing only a secondary role. The peritoneal wound is of great importance, especially in advanced tumor stages, when cells are present within the abdominal cavity. Most reported port-site metastases were found within the extraction port when no protective measures were taken. Gasless laparoscopy is no solution to the problem, since numerous port-site metastases have been described after thoracoscopy, during which no CO2 is used. The surgeon's role in the seeding of tumor cells is based on tumor perforation, excessive manipulation and replacement of trocars. This presumably explains the large differences (0 and 21%) in the reported incidence of port-site metastases. Prospective studies now show that it is possible to keep the incidence of abdominal wall metastases to about 1%-which is comparable with that seen in open surgery-by the use of a meticulous operating technique and preventive measures.

Animals↗

PubMed1997

[Controlling complications in laparoscopic cholecystectomy: diffuse parenchyma hemorrhage in the liver parenchyma].

The inflammatory pericholecystic reaction to acute or subacute cholecystitis results in the involvement in the inflammatory process of connective tissue within the liver bed, with subsequent neovascularization. The inflamed wall of the gallbladder and the surrounding connective tissue also involved in the inflammatory process become fused together thus preventing dissection in this plane. As a result, the gallbladder affected by acute cholecystitis frequently has to be dissected directly out of the liver parenchyma. The resulting diffuse parenchymal bleeding proves difficult to control by cauterization. In addition, there is a danger of postoperative bile leakage occurring. Today, the use of fibrin sealing is accepted practice in the treatment of oozing haemorrhage from the resection surface of the liver following resective surgery, and for the prevention of postoperative biliary fistulae. Using special application systems, the two-component fibrin sealing can now also be employed under video-endoscopic control. Through direct application of the adhesive to the parenchyma in the liver bed using a flexible catheter, diffuse oozing bleeds can be effectively arrested. In addition, coagulation-related parenchymal necroses associated with the development of biliary fistulae can be avoided. The technique of video-endoscopic controlled fibrin sealing is an important method of preventing and controlling complications arising during video-endoscopic surgery.

Cholecystectomy, Laparoscopic↗

PubMed1997

[Laparoscopic cholecystectomy in antegrade (prograde) technique].

In the case of acute cholecystitis and chronic cholecystitis of lang standing, the inflammatory changes in Calot's triangle make the risk of damaging the bile duct during laparoscopic cholecystectomy particularly high. In view of the difficult anatomical situation in Calot's triangle, such patho-anatomical conditions when encountered during open surgery best dealt with by anterograde (prograde) dissection of the gallbladder beginning from the fundus and proceeding towards the neck of the gallbladder. Since this approach is considered to be safer and less risky, it should also be adopted during laparoscopic surgery. The advantage is to be seen in the initial dissection far removed from the bile ducts. Despite pronounced inflammatory changes and initial preservation of the cystic artery, the use of modern technologies permit a virtually bloodless procedure. Nevertheless, the difficult anatomical situation makes a high level of readiness to conver mandatory. Should there be any doubt, the open surgical approach is the safer modality.

Cholecystectomy, Laparoscopic↗

PubMed1997

[Thoracoscopic truncal vagotomy].

Abdominal re-operation in patients with recurrent peptic ulcer disease is associated with a high morbidity rate and a mortality rate of 5%. As an alternative procedure, therefore, transthoracic truncal vagotomy was early recommended as a less invasive intervention, and good results can be achieved with it. With the development of minimal invasive surgery, this procedure can now be performed via thoracoscopy and patient stress thus reduced even further. Via a left-sided thoracoscopy, the parietal pleura is incised and a 3-5 cm long segment of the distal oesophagus mobilised and dissected free. Both the posterior and anterior trunks of the vagus nerves are identified and, after applying clips, transected. In order to achieve complete vagotomy, further fine branches have to be searched out and, if found, also divided.

Endoscopes↗

PubMed1997

[Percutaneous laparoscopic gastrostomy].

Percutaneous endoscopic gastrostomy (PEG) has now largely replaced the conventional operative procedure of gastrostomy. However, in patients with endoscopically non-passable pharyngo-oesophageal tumours or facial injuries rendering the stomach inaccessible to endoscopy, this technique has so far been unavailable. In this group of patients it is nevertheless possible to apply minimally invasive percutaneous gastrostomy using laparoscopy (PLG). The employment of a purse-string suture clamp facilitates the performance of the procedure and makes it reliable.

Gastrostomy↗