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Biomedical subjects

F Kallinowski

Publications and source records attributed to F Kallinowski.

At least 37 records · Page 2Linked to original sources
PubMed1997

Morphometry and classification in abdominal aortic aneurysms: patient selection for endovascular and open surgery.

PURPOSE: To evaluate the anatomic morphology of abdominal aortic aneurysms (AAAs) and compose a classification system to facilitate patient selection for endovascular graft (EVG) repair. METHODS: Data on 242 consecutive AAA patients evaluated on a nonemergent basis in a 3.5-year period to July 1996 were prospectively entered into a registry. Patients were examined using sequential intravenous spiral computed tomographic angiography and intraarterial digital subtraction angiography. The data collected and analyzed included: diameters of the supra- and infrarenal aorta, aneurysm, aortoiliac bifurcation, and iliac arteries; lengths of the proximal neck, distal cuff, and aneurysm; degrees of iliac artery tortuosity; and occlusion of the visceral, renal, or iliac arteries. RESULTS: The 242 aneurysms could be easily grouped into three distinctive categories related to the extent of the aneurysmal disease. Type I AAAs (11.2%) had nondilated, thrombus-free infrarenal (15 mm) necks and distal (10 mm) cuffs appropriate for EVG anchoring. In type II and its subgroups (72.3%), a sufficient proximal neck was present, but the aneurysm extended into the iliac arteries; 56% of these were eligible for a bifurcated endograft. In type III (16.5%), a sufficient proximal neck was missing, independent of distal involvement. In all, 51.7% were good EVG candidates based on AAA morphology. Taking into consideration relevant concomitant vascular diseases, proximal iliac kinking, and iliac, renal, or visceral occlusive disease, only 30.2% of the population were potential candidates for an efficient and secure EVG repair using the devices currently available. CONCLUSIONS: In contrast to classical open repair, detailed preoperative measurements are recommended for EVG planning. The use of liberal EVG indications may lead to a higher incidence of complications, whereas restrictive morphology-based selection criteria may offer excellent results.

Aged↗
PubMed1997

[Detection of the hemodynamic effects of renal artery stenosis with MRI flow measurement].

Data derived from the MR-CINE phase-contrast flow measurement of renal arteries correlates well with the angiographically detected degree of stenosis and scintigraphic measurements. MR data permit the quantitative analysis of altered hemodynamics and MR is a non-invasive substitute for angiography preoperatively and during follow-up. Angiography is indicated only for the evaluation of morphological criteria.

Adolescent↗
PubMed1996

Association of resistance-related protein expression with poor vascularization and low levels of oxygen in human rectal cancer.

Rectal carcinomas of previously untreated patients were analyzed for oxygen status using a computerized polarographic needle electrode histograph. Microvessel density and expression of c-jun, vascular endothelial growth factor (VEGF) and several resistance-related proteins (glutathione S-transferase-pi, GST; thymidylate synthase, TS; metallothioneine, MT) were determined using immunohistochemistry. To examine whether a relationship exists between intratumoral vessel density and tumor oxygenation, microvessel counts were determined in a 400x field using factor-VIII-related antigen and were correlated with the corresponding pO2 values. Linear regression analysis revealed a significant relationship between vessel density and oxygenation status of the tumors. Expression of c-jun, VEGF and resistance-related proteins was correlated with microvessel counts and pO2 values. Significantly lower vessel counts were found in GST- and MT-positive tumors and in tumors with overexpression of c-jun and VEGF than in negative tumors. In addition, significantly lower pO2 values were found in c-jun- and VEGF-positive tumors as well as a tendency for pO2 values to be lower in tumors where MT, GST and TS were expressed. These data show that expression of c-jun, VEGF, and resistance-related proteins is linked with poor vascularization and low oxygenation status in rectal cancer.

Glutathione Transferase↗
PubMed1996

Oxygenation of dog liver transplants as an early indicator of graft failure.

This study examines the potential value of liver oxygenation as a predictor of early graft function. pO2 measurements were performed on 10 pairs of beagle (donor) and foxhound (recipient) dogs during pentobarbital anesthesis. Two different explantation techniques were used: complete preparation and dissection before perfusion and explantation (group A) or rapid perfusion and explantation with detailed preparation of the liver and dissection of vessels ex situ after explantation (group B). In both groups, the technique of liver perfusion with 1,000 ml arterial and 500 ml portovenous application of ice-cold UW solution was equal. Local oxygen partial pressure values were obtained polarographically with miniaturized needle electrodes. The liver oxygenation directly after laparotomy was comparable in both groups (median values around 54 mm Hg). Prior to the infusion of UW solution, a reduction of the tissue oxygenation values to 24 mm Hg was observed in group A (p < 0.01 compared to postlaparotomy values). In group B, limited preexplantation surgical dissection resulted in a reduced pO2 decline to 42 mm Hg (n.s.). After transplantation, the reduced tissue oxygenation persisted in the livers of the dogs which were completely dissected in situ (group B) as compared to the preexplantation recipient and the donor liver before instrumentation (p < 0.01). In contrast, rapidly perfused livers again exhibited only an insignificant reduction of tissue oxygenation following transplantation. Survival correlated linearly with the liver oxygenation within the observation time after transplantation (p < 0.01). A significant survival advantage was found for the rapid perfusion technique (p < 0.05). We conclude that the tissue oxygenation might provide valuable information on early graft function.

Animals↗
PubMed1996

[Infrarenal abdominal aortic aneurysm: morphological classification as decision aid for therapeutic procedures].

This clinical trial aimed to prospectively investigate the morphological structure of infrarenal abdominal aortic aneurysms (AAA) to establish a valid dataset in the preoperative assessment supporting either the conventional or endovascular (TPEG) surgical approach. Regarding both the general feasibility testing and safe TPEG placing, all the anatomic AAA data must already be measured preprocedurally, due to the necessity for conversion as a frequent consequence of an intraprocedural failure. Between January 1993 and June 1995, all the patients (n = 159) admitted for elective AAA repair, were prospectively analysed. Graded on the basis of these measurements we developed a new AAA classification system supporting the kind of the surgical procedure (standard) approach vs. TPEG). Three different types of AAA were clearly defined. Due to morphological AAA criteria, 86 out of 159 patients (54.1%) might be suitable for TPEG (Type I, IIA and IIB). An infrarenal (proximal) neck < 15 mm, an infrarenal aortic diameter > 24 mm or an extension of the aneurysm to the iliac bifurcation are considered to be exclusion criteria for TPEG placement. In consideration of relevant co-morbidities (e.g. renal artery stenosis, SMA occlusion, iliac occlusive disease, simultaneous operations) only 43 out 159 patients (27.1%) were good candidates for TPEG. In general, smaller AAA are more appropriate for TPEG repair due to better proximal and distal fixation. As a consequence, indication criteria for AAA repair must not be expanded to smaller AAA.

Aged↗
PubMed1996

[Prospective preoperative morphometry of abdominal aortic aneurysms: selective patient management for endovascular surgery].

The objective of this prospective clinical investigation of 205 elective abdominal aortic aneurysm (AAA) patients over a 3-year period. 1993-1995, was both to evaluate the morphology and aortic dimensions of AAA as a management decision for patient selection for endovascular grafting and to correctly plan the custom-made TPEG size and shape prior to the procedure.

Aged↗
PubMed1995

Intraoperative radiotherapy for primary and recurrent rectal cancer.

A total of 40 primary and 20 recurrent adenocarcinomas of the rectum were treated. Intraoperative radiation therapy was combined with pre- or postoperative irradiation and 5-FU and leucovorin treatment. An abdomino-perineal excision was performed in 32 and an anterior resection in 26 cases. A Hartmann's procedure was performed in two patients. Forty-two tumours were completely resected. Residual disease was microscopically detectable in 10 cases. In eight patients, tumour residual was evident macroscopically. Postoperatively, wound infection was observed in six and anastomotic dehiscence in four cases. After a follow-up of 20 months, 46 patients revealed no evidence of disease. Local recurrences and distant metastases were detected in two patients each. Ten patients died of their disease.

Adenocarcinoma↗
PubMed1995

Microsurgical neck dissection for metastasizing medullary thyroid carcinoma.

Surgery is the only accepted method for a potentially curative treatment of metastatic medullary cancer of the thyroid (MCT). Between 5/1988 and 2/94 53 patients (mean age 43, 14-65 years) were treated. A total of 24 patients underwent surgery of both sides of the neck whereas 29 patients required only one side. Six months after surgery, a profound reduction in basal serum calcitonin levels (CT) was detected in all patients. Upon pentagastrin stimulation, CT levels remained suppressed in eight patients. A pathological increase of normalized basal CT values was noted in 33 patients. In 12 patients, basal CT concentrations remained elevated after surgery. We conclude that metastatic MCT can be effectively treated by microsurgical modified radical neck dissection.

Adolescent↗
PubMed1994

[Intraoperative radiotherapy of locally advanced and recurrent rectal cancer].

Intraoperative radiotherapy (IORT) offers a technique to increase radiation dose to the residual tumor or tumor bed while sparing neighboring radiosensitive organs. Beyond the mostly employed dedicated electron beam facilities, the afterloading--'flab'-technique was also used. In first prospective studies IORT was performed in patients with not completely resected locally advanced (T4) or recurrent tumors after complete external beam radiotherapy (50.4 Gy) as an additional boost dose, using small field sizes. This locally restricted dose escalation yielded higher local control and an increased prognosis. Nerves and ureters were dose limited. In our series IORT was performed for rectal carcinomas stages II and III. After an external beam radio- or radio-chemotherapy with 41.4 Gy, shrinking field boost irradiation was done intraoperatively with moderate doses and larger IORT field sizes. Compared to a historical control with high-dose external beam radiotherapy alone local control rate was increased. Radiogenic neuropathy or stenosis of the ureter was not observed. The impact on prognosis must awaited. Randomized studies are required to clearly describe the role of IORT in rectal carcinoma.

Brachytherapy↗
PubMed1993

Microsurgical neck dissection for occultly metastasizing medullary thyroid carcinoma. Three-year results.

BACKGROUND: Medullary thyroid carcinoma (MTC) metastasizes early into the regional lymph nodes, but distant metastases occur late. Modified radical neck dissection might improve the treatment results for occultly metastasizing MTC. METHODS: The authors report 23 patients after a minimal follow-up of 2 years (median, 36 months). There were 11 female and 12 male patients. The mean age was 43 years (+/- 13 years). The surgical technique included the meticulous dissection of all compartments of the neck, resulting in a unilateral or bilateral modified radical neck dissection with the complete removal of the lymphatic and fatty tissue between important anatomical structures. The surgical boundaries extended cranially to the mastoid, caudally to the brachiocephalic vein involving a transcervical mediastinal dissection, and laterally to the edge of the trapezoid muscle. Ten patients were treated bilaterally and 13 patients unilaterally. RESULTS: The basal calcitonin values of 18 of the 23 patients were postoperatively normalized with 4 patients having normal basal and pentagastrin-stimulated calcitonin levels. Five patients with persistently elevated basal serum calcitonin values had a marked reduction of the postoperative calcitonin levels compared with their preoperative concentrations. However, in these five patients histologic abnormalities precluded a surgical cure. The permanent complication rates were tolerable (4 of 33 neck dissections). CONCLUSIONS: The microsurgically extended neck dissection can reduce basal and pentagastrin-stimulated serum calcitonin values to normal levels even after long intervals following primary thyroidectomy.

Adolescent↗
PubMed1993

Medullary carcinoma of the thyroid--therapeutic strategy derived from fifteen years of experience.

BACKGROUND: The purpose of this investigation was to analyze our experience with patients treated for medullary carcinoma of the thyroid to identify prognostic factors and to develop a stage-related treatment strategy that might improve cure rates. METHODS: Between 1970 and 1985 a total of 40 patients with medullary thyroid carcinoma were treated (21 women, 19 men; mean age +/- SEM; 40 +/- 3 years; mean follow-up, 82 +/- 12 months). Initial operation involved total thyroidectomy (28 patients), subtotal resection (11 patients), and a lobectomy (1 patient). The initial lymph node dissection generally consisted of a selective removal of enlarged nodes. Unilateral neck dissection was performed in six cases. Secondary operation for recurrent disease was necessary in 26 patients. RESULTS: At the end of the follow-up period 10 patients were tumor free, 12 patients were scheduled for further treatment, six patients suffered from persistent but clinically occult disease, and 12 patients had died (mean survival time, 68 +/- 7 months). The paramount prognostic factor was the absence or presence of lymph node involvement at the time of primary operation (p = 0.011). Patients with distant metastases died within 2 years of diagnosis. Women, patients younger than 40 years of age, and those elicited by familial screening programs exhibited increased survival times. CONCLUSIONS: Because of the prognostic and therapeutic importance we recommend the total thyroidectomy with a complete dissection of the central lymph node compartment as primary treatment. Patients with lymph node involvement or elevated serum calcitonin levels should subsequently be treated by a modified radical neck dissection of the lateral compartments.

Adolescent↗
PubMed1992

[The value of clinical, laboratory and sonographic findings in acute appendicitis--effect of surgical experience and bacteriologic diagnosis on the rate of wound healing disorders].

A total of 361 patients were admitted to the Department of Surgery of the University of Heidelberg between January 1989 and April 1990 for acute appendicitis. Neither the physical examination nor laboratory results were unequivocally diagnostic in a third of the patients. The ultrasonographic visualization of the inflamed appendix could confirm the diagnosis in 50% of the clinically doubtful cases (predictive value: 84%). Further diagnostic procedures were rarely necessary. The perforation rate was independent of the duration of the preoperative hospitalization due to the rapid surgical treatment. Contrary to previous reports, the likelihood of an intraoperatively innocent appendix increased with delayed surgery. Wound infection rates were similar after appendectomies by surgeons in training and by fully qualified surgeons although perforated appendices were typically removed by the latter ones. Antibiotic therapy was usually administered for severely inflamed appendices depending on the intraoperative findings and for perforated appendices and reduced the rate of wound infections if more than two bacteria had been cultured from a routine intraoperative swab. The documentation used in Baden-Württemberg for quality control should include the result of an intraoperative appendiceal swab.

Adolescent↗
PubMed1992

Microsurgical lymph node dissection for metastatic asymptomatic C-cell carcinoma.

In persistent, clinically inapparent medullary thyroid carcinoma, microsurgical dissection of all lymph node compartments of the neck was performed. Between August 1988 and September 1991, 28 cases (mean age 43.3 years) were treated with 38 surgical interventions. Twenty patients had the sporadic form and eight patients the familial form. Unilateral neck dissection resulted in normalization of serum calcitonin (CT) levels even after pentagastrin stimulation in two patients whereas 16 patients exhibited abnormal CT stimulation tests. Eight of ten patients who had bilateral neck dissections had positive pentagastrin test results after surgery. The main postoperative complications included loss of local cutaneous sensation, generally temporary, and unilateral recurrent laryngeal nerve paralysis.

Adolescent↗
PubMed1991

Vascularity, perfusion rate and local tissue oxygenation of tumors derived from ras-transformed fibroblasts.

Tumors derived from ras-transformed rat fibroblasts were investigated in order to gain insight into possible interrelationships between oncogenic transformations and therapeutically relevant parameters of the metabolic micromilieu of solid tumors in vivo. Tumors grew in nude mice after injection of in vitro-passaged cells. Growth rates, early stages of angiogenesis, perfusion and tissue oxygenation were assessed. Compared with the parental cell line, both ras transformants grew very rapidly and exhibited an early onset of angiogenesis. Perfusion rates of one ras-transformed tumor line were similar to those of the parental tumors whereas reduced flow values were detected in tumors of the other ras line. The better perfused tumors exhibited more adequate tissue oxygen levels whereas reduced oxygen levels were obvious in the poorly perfused ras line. These results indicate that ras transformation alters therapeutically relevant parameters of the tumor micromilieu. However, the tumor phenotype cannot be predicted even if the transforming oncogene is known.

Animals↗
PubMed1991

Tumors growing in irradiated tissue: oxygenation, metabolic state, and pH.

Experimental tumors growing in irradiated tissue have been used to study the biological differences characteristic of locally recurrent tumors. Animal tumors were early generation isotransplants of a spontaneous fibrosarcoma in a C3Hf/Sed mouse, designated FSa-II. Since the hypoxic cell fraction of tumors growing in irradiated tissue is increased, these tumors are assumed to be metabolically deprived with hypoperfusion and acidosis. In this study we directly measured the oxygen partial pressure (pO2) distribution, metabolic state, and pH of tumors growing in an irradiated tumor bed using oxygen sensitive electrodes and 31P-NMR. The results confirmed a three-fold increase in the number of pO2 readings less than or equal to 2.5 mmHg and also showed increased acidosis with a 0.17 unit decrease in pHNMR. When tumors growing in pre-irradiated tissue reached approximately 100 mm3 in volume, a high frequency of gross and microscopic necrosis and hemorrhage was already observed. Consistent with these observations, the phosphocreatine/inorganic phosphate (PCr/Pi) and nucleoside triphosphate/inorganic phosphate (NTP/Pi) ratios were significantly lower in the tumors in a pre-irradiated bed compared to tumors in a non-irradiated bed (PCr/Pi: 0.51 vs 0.79, p less than 0.05; and NTP/Pi: 0.64 vs 0.93, p less than 0.05). The longitudinal relaxation time (T1) of Pi was numerically shorter in control tumors (consistent with the better tissue oxygenation), but this did not reach statistical significance (2.09 +/- .11 sec vs 2.25 +/- .16 sec).

Animals↗
PubMed1991

Combined tissue oxygen tension measurement and positron emission tomography studies on glucose utilization in oncogene-transformed cell line tumour xenografts in nude mice.

Glucose utilization studies using high resolution positron emission tomography and tissue oxygenation measurements using microelectrode techniques were carried out in nude mice bearing oncogene-transformed (Rat1pEJ6.6 and REFpneoMYCrasEpool) cell line tumours and a non-transformed (Rat1) cell line tumour to determine the correlation between glucose utilization, tissue oxygenation and tumour growth rate. Control measurements were performed in the subcutis of tumour-free animals. Accelerated growth rates were observed in both ras-transformed cell lines with tumour doubling times of 2.5-4 days while Rat1 tumours had a doubling time of 28 days. Since rapid growth rates necessitate elevated consumption of oxygen and nutrients, severe tumour hypoxia was observed in tumours from both ras-transformed cell lines; median pO2 being 1-5 mmHg (tumour sizes ca. 400 mm3). Size-matched Rat1 tumours exhibited a median pO2 value of 12 mmHg corresponding to the slow growth rate. Comparing both ras-transformed cell lines, Rat1pEJ6.6 tumours had a more adequate vascularization than REFpneoMYCrasEpool tumours indicated by a better tissue oxygenation (5 mmHg versus 1 mmHg) and higher glucose metabolic rates (13.4 +/- 2.2 mumol/min/100 cm3 versus 9.7 +/- 1.3 mumol/min/100 cm3). At advanced growth stages, a reduction of tissue oxygen levels is obtained which is accompanied by a 30% elevation of glucose metabolic rate. The data presented here demonstrate for the first time an impact of well defined oncogenic alterations on the therapeutically relevant parameters of the micromilieu of malignant tumours.

Animals↗