Biomedical subjects

F Köckerling

Publications and source records attributed to F Köckerling.

At least 109 records · Page 6Linked to original sources

PubMed1997

Impairment of bone and mineral metabolism after pancreatic transplantation: observations in syngeneic rats.

OBJECTIVE: To find out whether transplantation of the duodenum and pancreas results in osteopathy in immunotolerant recipient rats. DESIGN: Prospective study. SETTING: University hospital, Germany. ANIMALS: 30 male Lewis rats weighing about 315 g. INTERVENTIONS: Laparotomy alone (n = 10, control), or transplantation by one of three techniques: ectopic extraportal (EE, n = 5), ectopic intraportal (EI, n = 7), or orthotopic intraportal (OI, n = 8). MAIN OUTCOME MEASURES: Body weight; changes in mineral and bone metabolism, bone density and ash, and the breaking force of bone. RESULTS: Rats were followed for 133 plus or minus 3 days. Compared with the control group the rats that had undergone transplantation had delayed gain in body weight and the final weight was reduced. Urinary glucose and basal serum glucose and insulin concentrations were unaffected, but that of pancreatic polypeptide was low. In the transplanted groups intestinal absorption of calcium and phosphorus and serum concentrations of calcium and parathyroid hormone were within reference ranges. Serum magnesium (EI and OI) and phosphorus (EI) concentrations, and the urinary calcium (FE) and phosphorus (EI) concentrations, and the urinary hydroxyproline:serum osteocalcin ratio (FE, and EI) were significantly higher than in controls (p < 0.01). CONCLUSIONS: Transplantation failed to disturb glucometabolic functions and intestinal mineral absorption but was associated with an osteopathy which showed itself in high bone resorption and reduced bone phosphorus and magnesium concentrations. The osteopathy developed irrespective of the technique of reconstruction of the digestive tract and so may be caused by division of intestinal nerves or their incomplete regeneration.

Animals↗

PubMed1997

[Laparoscopic operation of a Morgagni hernia].

Morgagni hernias are the least common form of diaphragmatic hernias. Although they are congenital, most of them are not diagnosed until later in life. The indication for surgery is based on the patient's symptoms or on the radiological evidence of incarcerated tissue, and until quite recently involved a laparotomy or thoracotomy. Laparoscopy not only permits the suspected diagnosis to be confirmed--which is otherwise often difficult--but also makes it possible to close the hernia site by suturing. For improved security, the hernia site is augmented by fixing in place a non-absorbable mesh. The operative technique employed is described.

Hernia, Diaphragmatic↗

PubMed1997

[Suture of trocar puncture sites after laparoscopy].

The suturing of port sites measuring at least 10 mm in diameter following laparoscopy can prevent the incarceration of small bowel and/or omentum and scar hernias. This means that all port sites remaining after using trocars of at least 10 mm need to be carefully closed by suturing. In the case of oncological procedures in particular, it is important to ensure that the bite of the suture needle includes the peritoneum, to avoid leaving a fresh peritoneal wound offering favourable conditions for the implantation of tumour cells. The technique described here for port site suturing involves all the layers of the abdominal wall, including the peritoneum, and may thus help to prevent port site metastases.

Abdominal Muscles↗

PubMed1997

[Laparoscopic resection of colorectal malignancy--an oncological risk?].

Oncological risks associated with laparoscopic colorectal surgery in curative intention include 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. Results of laparoscopic colorectal surgery may be defined by pathohistologic findings (number of removed lymph nodes, count of tumor tears, clearance of margins) and long-term results (port-site metastases, local recurrence rate, number of distnant metastase, 5-year-survival). Current published results and first data from the Multicenter Study Group will be compared with the data of open surgery. Merely a few reports on the number of lymph nodes removed during such operations have been published. First data of the Multicenter Study Group Laparoscopis Colorectal Surgery seem to report comparable data to open surgery. There are no certain data the occurrence rate of portsite metastases as on long-term results, local recurrence rates and the 5-year-survival. So the sense and the quality of laparoscopic colorectal surgery in curative intention can't be judged nowadays. The many potential mistakes 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.

Colectomy↗

PubMed1997

[Laparoscopic fenestration of non-parasitic liver cysts].

Cysts of the liver may be parasitic or non-parasitic, the non-parasitic cysts being further subdivided into neoplastic, inflammatory, post-traumatic and congenital. Symptomatic congenital solitary cysts represent a good indication for laparoscopic treatment. During the therapeutic procedure, the roof of the cyst is fenestrated or removed such that at least one-third of the circumference of the cyst is removed, which is best done using a harmonic scalpel. In order to prevent a recurrence, it is recommended that a portion of the greater omentum be placed in the floor of the cyst, thus filling the cystic cavity.

Cysts↗

PubMed1997

[Regional cooperation in molecular biology topics].

Research on rare events, such as the occurrence of port-site metastases, can be speeded up by pooling patients from different hospitals. Multidisciplinary approaches, involving surgeons, pathologists and molecular biologists, allow more detailed experimental results to be obtained. Research costs are kept low by using existing infrastructures over a short period of time.

Cost-Benefit Analysis↗

PubMed1997

[Phenotypic analysis in colorectal carcinoma: an international interdisciplinary project].

An European research network grouping surgeons, pathologists, biochemists and molecular biologists is presented. The aim of this network is to define new diagnostic, prognostic and therapeutic markers at protein and RNA levels in colorectal cancer. The methodology is based on specific sample preparation techniques, allowing the isolation of pure epithelial cells, and on differential-display techniques, such as two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) and reverse arbitrarily-primed polymerase chain reaction (RAP-PCR).

Biomarkers, Tumor↗

PubMed1996

Impact of arterialization on hepatic oxygen supply, tissue energy phosphates, and outcome after liver transplantation in the rat.

The importance of arterial reconstruction in experimental orthotopic rat liver transplantation is widely acknowledged in the literature. Non-rearterialization of the graft leads to impaired microcirculation and, in chronic models, to severe hepatobiliary damage, together with bile duct proliferation and fibrosis in such livers. The aim of the current study was to investigate the impact of rearterialization on hepatic oxygen tension (pO2), hepatic tissue content of adenine nucleotides, early graft function, and postoperative outcome. Orthotopic liver transplantation was performed in 27 male inbred rats. Ten rats underwent rearterialization and while 17 did not. A group of sham-operated animals (n = 6) served as controls. After reperfusion, liver grafts without arterial reconstruction showed significantly reduced levels of oxygen tension (mean +/- SD, 3.79 +/- 2.20 vs. 10.03 +/- 2.84 mmHg; P < 0.05) and a clear shift toward lower pO2 values in the pO2 histograms, as compared with arterialized grafts. Without arterialization, the level of liver ATP was 65% of that in sham animals, compared with 84% in arterialized livers. Without arterialization, bile secretion was reduced (0.42 +/- 0.04 vs. 0.71 +/- 0.06 mg/min x g liver; (P < 0.001), and the postoperative course of serum alanine transaminase, bilirubin, and alkaline phosphatase revealed severe hepatobiliary damage. These findings allow us to conclude that graft rearterialization is essential to ensure both an adequate oxygen supply and maintenance of tissue ATP. Arterialization may thus be a necessary part of liver transplantation models in this animal species, and should be considered when designing studies on the biochemical, microcirculatory, and histopathological status of the graft.

Adenine Nucleotides↗

PubMed1996

Laparoscopic intracorporeal anastomosis in the colon using the biofragmentable anastomotic ring--an animal study.

This experimental study examines the usefulness of a totally laparoscopic anastomotic technique in the colon with the aid of the biofragmentable anastomotic Valtrac ring and a newly developed applicator device. Following closed intracorporeal colonic resection with the linear stapler and subsequent re-opening of the proximal and distal bowel ends after placement of a pursestring suture, intracorporeal anastomosis was completed with the Valtrac ring. The technique was tested in 8 pigs. 6 pigs had no intra- or postoperative complications, while 2 pigs developed fatal peritonitis following anastomotic insufficiency in one pig and anastomotic stenosis caused by tilting of the Valtrac ring in the other animal. The results of the study show that handling of the biofragmentable anastomotic ring is facilitated by the use of the new application system. In the uncomplicated case, endoscopy and histology revealed bland healing with little scarring, and no evidence of an anastomotic stenosis.

Anastomosis, Surgical↗

PubMed1996

[Rectal prolapse--choice of procedure and minimal invasive possibilities].

Diagnostic and pathomorphological findings support the notion that external and internal rectal prolapse with and without solitary rectal ulcer are merely different stages of one and the same disease. In view of the fact that, in the last resort, the aetiology of this disease remains largely unknown, the differential approach to therapeutic decision-making makes it necessary to give careful consideration to the individual situation of the patient, age, sex, case history and current findings. Although considerably in excess of 100 different surgical techniques have been reported for the treatment of rectal prolapse, only very few have finally been accepted in practice. In very old and high-risk patients, extra-abdominal corrective procedures (Delorme's procedure, peri-anal rectosigmoidal resection) performed under spinal or peridural anaesthesia, are given preference, despite the fact that the recurrence rate and the rate of persistent incontinence is higher than that seen with transabdominal techniques. In the case of younger patients and older patients unburdened by risk factors, the trans-abdominal procedures offer better functional results and lower recurrence rates. Here, anterior and posterior rectopexy and resection of the sigmoid with rectopexy are the most widely practiced procedures. With the further development of minimal invasive surgery, laparoscopic techniques are now also available, with the aid of which anterior and posterior rectopexy and intracorporeal sigmoid resection can be performed safely and reliably. These techniques will very likely further encourage the trend towards transabdominal procedures for the correction of rectal prolapse. These operative procedures may also be indicated in selected cases, in whom conservative treatment of intussusception and/or solitary rectal ulcer has failed.

Adult↗

PubMed1996

[Open laparoscopy for prevention of puncture injuries].

Perforating lesions occurring during the establishment of the pneumoperitoneum using the Veres needle and blind introduction of the camera trocar are among the major complications of laparoscopic surgery. Even when all the necessary safety measures are observed and despite complete mastery of the technique, this complication cannot be completely avoided during the blind procedure. The technique of open laparoscopy, so-called, with the introduction of a blunt trocar under direct vision is the sole alternative available for the prevention of such injuries. The advantages of this procedure are that, with appropriate practice, it takes no longer, can be employed in all possible situations, including previous surgery, and, in particular, when assisting a surgeon who is in the process of gaining experience in laparoscopic surgery. Severe perforating injuries and their sequelae are often advanced as an argument against the use of laparoscopic surgical procedures. Through the use of open laparoscopy, injuries to blood vessels and viscera can be virtually completely eliminated, and patient safety considerably improved. On the basis of our own experience, we can unreservedly recommend open laparoscopy as the routine approach for all laparoscopic interventions.

Abdominal Injuries↗

PubMed1995

Expression of nm23-H1 predicts lymph node involvement in colorectal carcinoma.

PURPOSE: Reduced expression of the metastasis suppressor gene nm23-H1 has previously been correlated with high tumor metastatic potential and fatal clinical outcome in some tumors (e.g., breast). For colorectal carcinomas, the findings are equivocal. METHODS: We have used a monoclonal antibody against nm23-H1 to investigate the expression in colorectal carcinomas at the time of primary curative surgery (R0 resection) to assess if there was any relation between nm23-H1 expression and stage or histologic grade at the time of primary tumor removal. RESULTS: Of 100 colorectal carcinomas studied (Stages I, II, and III according UICC, all resected curatively), nm23-H1 immunoreactivity was weak in 41 (41 percent), moderate in 24 (24 percent), and strong in 35 (35 percent) cases. The grade of positivity against nm23-H1 was significantly lower in advanced stages of the disease (Stages II or III) (P < 0.001, chi-squared = 52.8). In tumors with low or weak immunoreactivity against nm23-H1, frequency of lymph node metastases was significantly higher compared with those with moderate or strong staining (P < 0.001; chi-squared = 50.58). Therefore, with a sensitivity of 93 percent and a specificity of 58 percent, low nm23-H1 immunoreactivity of the primary tumor, assessed at the time of surgery, is an indicator of the presence of lymph node metastases. CONCLUSIONS: Immunohisto-chemical evaluation of nm23-H1 in the primary tumor or in a biopsy is a useful predictor of stage of disease and presence of lymph node metastases in colorectal carcinomas and may have clinical significance, e.g., in predicting optimal therapeutic regimes.

Biomarkers, Tumor↗

PubMed1995

Partial orthotopic liver transplantation in rats.

A partial orthotopic liver transplantation technique (70% POLT) for use in rats and comparable with the corresponding recipient operation in the 'splitting transplantation' in man was developed. Body weight, liver function, histological and electron-microscopic findings were studied in comparison with whole rat liver transplantation with rearterialization, 30% POLT and corresponding liver resections. After 70 and 30% POLT typical signs of hepatic regeneration were found, but no pathological alterations in the electron-microscopic picture. This POLT model might be helpful for the investigation of unresolved questions in 'splitting transplantation'.

Animals↗

PubMed1995

[Hamartoma of aberrant breast tissue in the inguinal region].

Ectopic mammary tissue reportedly has an incidence of 1 to 6%, and is usually found in the axilla. Neoplasias in ectopic breast tissue are rarely observed. This is the first report of an hamartoma of ectopic breast tissue in the inguinal region. A 50-year old woman presented with a large tumor in the groin. The unusual site and form of the tumour preoperatively suggested a chronic incarcerated hernia. When laparoscopy excluded a hernia, the tumour was resected in accordance with oncological criteria and the histopathological work up revealed the surprising findings. This case shows that ectopic mammary tissue, in particular when it is the site of a tumor, may be a rare differential diagnosis of an inguinal tumor.

Breast↗

PubMed1995

[An unusual incidence of carcinoid tumors and secondary malignancies].

A secondary malignancy is a common finding in carcinoid tumor patients. Several authors saw 7 to 36% of their carcinoid tumor patients developing an other malignancy. From 1965 to 1990 we treated 144 patients with a carcinoid tumor. During the follow-up time 24 (17%) developed a secondary tumor commonly sited in the gastrointestinal tract (8 colon carcinomas, 3 rectal carcinomas, 2 gastric carcinomas, 1 small bowel carcinoma, 1 esophageal cancer). The incidence is elevated 8 times in comparison to the normal population. One may speculate that a carcinoid patient possesses an increased susceptibility to all forms of malignancy. As a consequence all the carcinoid tumor patients should be thoroughly investigated and should be followed up in short terms. Central point of interest should be the gastrointestinal tract.

Adenocarcinoma↗

PubMed1995

[Preoperative radiochemotherapy in primary non-resectable rectal cancer].

PURPOSE: In a pilot-study patients with primarily non-resectable rectal cancer received a pre-operative radiochemotherapy to assess the tolerance and efficacy of this treatment protocol. PATIENTS AND METHOD: Twenty patients with non-resectable rectal cancer (Mason CS III-IV) have been irradiated from September 1989 through February 1994. The total dose, calculated at the isocenter, was 50.4 Gy with 5 fractions of 1.8 Gy per week with a small volume boost in selected cases. Chemotherapy was administered on 5 consecutive days in week 1 and 5 with 1000 mg/m2 5-FU per day as continuous infusion over 120 hours. RESULTS: The treatment was well tolerated. Acute toxicity included 1 grade III-dermatitis, 7 grade II-enteritis, 1 grade III- and 3 grade II-leucopenia. Seventeen out of 20 patients were resected 6 weeks after radiochemotherapy, 3 patients had no surgery (1 toxic death due to septicemia, 1 refusal of surgery after complete remission, 1 thrombocytopenia due to liver cirrhosis), all 3 had at least partial remission of their tumors. Fourteen out of 17 (82%) resections were curative (R0) with 1 additional R1- and 2 R2-resections. Ten out of 14 (71%) curative resected patients had no lymph node metastasis. A detailed histological examination showed regression in 15/16 tumors with fibrosis and vascular wall changes. Nine out of 16 patients had only minimal residual tumor. CONCLUSIONS: In this pilot study, pre-operative radiochemotherapy was well tolerated. The relatively high rate of curative resections and marked histological tumor regressions of this approach requires further investigations in a randomized trial.

Adenocarcinoma↗

PubMed1994

Treatment of pilonidal sinuses by phenol injections.

Six female and 39 male outpatients, who suffered from acutely inflamed pilonidal sinus were treated by sclerotherapy between January 1985 and December 1988. Under local anaesthesia, 1-2 ml 80% phenol was injected into the sinus. The phenol, which was allowed to act for a minute, was washed out by irrigating the sinus with physiological common-salt solution. Of the questionnaire sent to all 45 patients, 37 proved suitable for evaluation. Complete healing occurred in 22 cases (59.8%). The healing time was 6.2 weeks on average. Besides a rather frequently observed transient reddening as a result of the local inflammation caused by the phenol, 5 patients developed an abcess which needed operative treatment. This study does not support the encouraging results of previous series.

Abscess↗

PubMed1994

[Intraperitoneal colon anastomosis with laparoscopic purse string suture clamp and Valtrac ring].

In combination with the biofragmentable Valtrac ring a newly developed purse-string suture clamp offers the possibility of performing intraperitoneal anastomoses of the small and large bowel without the need for stapling devices. During this experimental study end-to-end anastomoses of the descending colon were constructed in five pigs. One animal was re-examined on day 1 after the operation and the others were all sacrificed on day 21 after. None of the animals showed any signs of an anastomotic leakage. Little scar tissue was seen macroscopically or histologically in the anastomotic region of the animals sacrificed 3 weeks after the operation. The operative technique presented in this paper might render the so-called assisted laparoscopic procedures for the right hemicolon unnecessary in the future.

Anastomosis, Surgical↗