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Biomedical subjects

F Lindemann

Publications and source records attributed to F Lindemann.

15 recordsLinked to original sources
PubMed1998

[Dislocation of clips of the cystic duct stump].

The security of six different laparoscopic clips was investigated using 60 kryopreserved specimens of human cystic ducts. After fixation of the cystic duct the cross placed clips were distracted in axial direction and the maximum forces to remove the clip were registered. The mean dislocation-force was 4.6 Newton for titanium clips and 9.3 Newton for absorbable clips with a highly significant difference (p < 0.001, Wilcoxon-test). Additional to the advantage of complete biodegradibility these data favour the use of absorbable clips, because of a better hold force compared to titannium clips.

Biodegradation, Environmental↗
PubMed1997

Occult epithelial tumor cells detected in bone marrow by an enzyme immunoassay specific for cytokeratin 19.

The presence of isolated carcinoma cells detected immunocytochemically in bone marrow has been shown to be of prognostic relevance for cancer patients. Unfortunately, the immunocytochemical method (ICC) is laborious and depends on the subjective interpretation of the individual investigator. Therefore, an immunoassay was designed for detection of cytokeratin 19 (CK19). By analyzing blood samples from 52 healthy volunteers and 40 bone-marrow aspirates from control patients, a cut-off point of 250 pg/ml CK19 was determined. Application of this cut-off point enabled a specificity of 95% to be shown for bone marrow and of nearly 100% for venous blood. The assay detected 10 HT-29 colon-carcinoma cells among 5 x 10(6) peripheral-blood leukocytes. In comparison with controls, bone-marrow samples of cancer patients were found to have significantly elevated levels of CK19 (p < 0.05). In the analysis of 386 marrow aspirates of cancer patients, a significant concordance of ELISA and ICC was observed (chi 2 = 18.3; p < 0.001). Both procedures, nevertheless, differed in 147 (38%) samples, of which more than two thirds (101) were only ELISA-positive. The CK status detected by ELISA did not correlate with the TNM stage and the histological grading. The established immunoassay allowed sensitive and specific detection of disseminated epithelial tumor cells and appeared to be faster, less laborious and more objective than ICC. Follow-up studies are required to assess the prognostic relevance of this ELISA before it can be applied as a routine method for monitoring of minimal residual epithelial cancer.

Biomarkers, Tumor↗
PubMed1997

[Laparoscopically placed clips on the human cystic duct--an experimental comparison of dislocation between resorbable and titanium clips].

Kryopreserved specimens of cystic ducts were used for displacement tests to investigate the security of different laparoscopic clips. The cystic duct was fixed, and the transverse placed clips were distracted in axial direction and the forces registered. The median values of the six investigated clips ranged between 4.1 N and 11.2 N with a highly significant difference (P < 0.001, Kruskal-Wallis ANOVA). In detail, both resorbable clips (polydioxanone, polyglyconate/polyglycol acetate) were superior to the four titanium clips (P < 0.005, Wilcoxon test). In addition to the advantage of complete biodegradibility, these data favour the use of absorbable clips because holding force is better than that of titanium clips.

Biodegradation, Environmental↗
PubMed1997

[Angiosarcoma of the spleen. Case report and review of the literature].

Angiosarcoma of the spleen is a very rare but highly malignant vascular neoplasm. So far only 140 cases have been reported. A 42-year-old patient is presented in which the radiologic imaging misled to the diagnosis of infiltrating echinococcosis. After splenectomy histological and immunohistochemical staining gave proof of metastatic angiosarcoma. The patient died three months later as a consequence of multiple organ dysfunction syndrome. The literature is reviewed in regard to clinical features, diagnosis and therapy.

Adult↗
PubMed1995

A blended beam technique to decrease toxic effects of post mastectomy irradiation by combining and sequentially mixing electrons and photons.

We studied 24 patients with Stage II or Stage III breast carcinoma, post total mastectomy, who had received adjuvant loco-regional irradiation (16 patients) or were irradiated for chest wall recurrence (8 patients), along with systemic chemotherapy and/or hormonotherapy. A technique is described for combining and sequentially mixing electron and photon beams. This blended beam method results in less severe acute and chronic skin reactions. Dose distribution to the chest wall and mediastinum are improved compared to the traditional photon-only techniques. At a median followup of four years our expected loco-regional control rates are not compromised. This technique is recommended for selected post mastectomy patients to reduce toxic effects of chest wall irradiation, particularly when chemotherapy lowers skin tolerance and the reserves of the heart, lung and bone marrow.

Aged↗
PubMed1994

[Simplified combination bypass or biliodigestive anastomosis alone in nonresectable carcinoma of the head of the pancreas?].

Between January 1, 1986 and December 31, 1992 93 patients with irresectable carcinoma of the pancreatic head underwent surgical palliation: In group I (n = 51) a single loop biliary (BB)- and gastric bypass (GB) was performed. 34 times the gastrojejunostomy was performed prophylactically. In group II (n = 42) surgical palliation was carried out only by biliary decompression in Roux-Y technique. In 30.9% gastric outlet obstruction (GOO) developed during follow-up. Both groups were comparable according to effectiveness of biliary drainage (93% (n = 42) (I); 97% (n = 38) (II)) with median post-operative bilirubin levels of 3.21 mg/dl (I) and 4.1 mg/dl (II). Cholecysto-choledocho- and hepaticojejunostomy were equally effective. Median operative time, morbidity (19.6 (I) vs. 26.2 (II)) and postoperative hospitalization were similar. Since there is a high frequency of secondary GOO after single BB we think that GB should be performed in all patients that undergo BB because secondary gastrojejunostomy at a later stage significantly increases morbidity and mortality.

Adult↗
PubMed1993

Differential expression of proliferation-associated molecules in individual micrometastatic carcinoma cells.

BACKGROUND: The development of monoclonal antibodies (MAbs) to cytokeratins, which are integral components of the epithelial cytoskeleton, has made possible immunocytochemical detection of epithelial tumor cells. Importantly, this technique allows the detection of epithelial tumor cells that have metastasized from primary adenocarcinomas to secondary sites such as the bone marrow. PURPOSE: The aim of the study was not only to detect micrometastatic cells in bone marrow, but also to assess the expression of nuclear proliferation markers (Ki-67 and p120) and the erbB2 oncogene (also known as ERBB2) in these cells and, thus, hopefully improve prognostic precision. METHODS: Bone marrow aspirates were obtained from both sides of the upper iliac crest of 532 patients having definitive diagnoses of either breast or gastrointestinal cancer. The presence of micrometastatic epithelial tumor cells in bone marrow was assayed using the MAb cytokeratin 2 (CK2) to cytokeratin component 18 (CK18), in combination with the alkaline phosphatase-anti-alkaline phosphatase immunostaining technique. After primary screening of all marrow samples with MAb CK2, representative subgroups of CK18+ samples were selected for co-labeling with MAbs either to ErbB (n = 16), ErbB2 (n = 121), Ki-67 (n = 33), or p120 (n = 36) protein. An alternative labeling protocol based on the combination of immunogold and immunoenzymatic techniques was utilized to confirm the results derived from immunoenzymatic double staining. RESULTS: In total, single CK18-positive tumor cells were detected in 180 (33.8%) of 532 bone marrow aspirates, with few differences among patients with breast or gastrointestinal cancer in TNM stage M0 (i.e., no distant metastasis). In patients with overt metastasis (stage M1), however, the incidence of metastatic cells in marrow increased to 73.7% in breast cancer, 52.5% in gastric cancer, and 39.0% in colon cancer. Whereas expression of Ki-67 or p120 on micrometastatic cells was observed only in 11 (15.9%) of 69 cancer patients analyzed, ErbB2+/CK18+ cells were found in 48 (67.6%) of 71 breast cancer patients and 14 (28.0%) of 50 patients with gastrointestinal cancer (P = .0001). The incidence of ErbB2+/CK18+ cells was positively correlated with the clinical stage of tumor progression. CONCLUSIONS: The high incidence of ErbB2 expression on micrometastatic breast cancer cells in the bone marrow suggests that these cells might have been positively selected during early stages of metastasis. The majority of these cells appear to be in a dormant state of cell growth. IMPLICATIONS: Although support from clinical follow-up is still needed, this study demonstrates that, beyond the mere presence of micrometastatic cells in bone marrow, useful prognostic information can be obtained by analysis of additional cell growth markers.

Adenocarcinoma↗
PubMed1993

[Laparoscopic cholecystectomy with the ultrasound dissector].

Due to tissue selectivity the ultrasonic dissector facilitates anatomical clearance even in difficult situations. Although of no advantage in routine laparoscopic cholecystectomies and even more time consuming, it seems to be of considerable value in difficult laparoscopic cholecystectomies and offers more safety for the patient.

Cholecystectomy, Laparoscopic↗
PubMed1992

Prognostic significance of micrometastatic tumour cells in bone marrow of colorectal cancer patients.

Much of the information recorded at the time of surgery for malignant disease has been used, alone or in combination, to indicate the outlook for that patient, including probability of metastasis. However, direct evidence of tumour seeding in distant organs at that time is not available. An immunocytochemical assay for the epithelial cytokeratin protein (CK18) may fill this gap since it is a feature of epithelial cells but would not normally be in bone marrow. We looked for disseminated tumour cells preoperatively in bone marrow from 88 patients with radically resected colorectal carcinomas. Smears for 28 (32%) patients were positive for cells of epithelial origin, which were absent from aspirates taken from 102 controls with non-malignant disease. The prognostic value was assessed in a follow-up study with a median observation time of 35 (12-58) months. Patients who had bone marrow tumour cells in the aspirate showed a significantly shorter disease-free survival than those without tumour cells (p = 0.0084). In a Cox regression model multivariate analysis demonstrated that the finding of tumour cells in bone marrow is an independent, significant (p = 0.0035) determinant of relapse. Although the skeleton is not a preferred site of overt metastasis in colorectal cancer the demonstration of tumour cells in bone marrow has to be taken as evidence of the general disseminative capability of an individual tumour.

Adenocarcinoma↗
PubMed1991

Micrometastatic tumour cells in bone marrow of patients with gastric cancer: methodological aspects of detection and prognostic significance.

Monoclonal antibodies (Mab) are potent probes to identify individual tumour cells or small tumour cell clusters in bone marrow. In the present study, various antibodies directed against either cell surface or intracytoplasmic antigens of epithelial cells were assessed for their ability to detect such cells in bone marrow of patients with breast, colorectal and gastric cancer. According to the presented data, monoclonal antibodies against intracellular cytokeratin (CK) components are superior in terms of specificity and sensitivity to antibodies reacting with epitopes of the cell membrane. Using a monoclonal antibody against the cytokeratin polypeptide 18 in connection with the alkaline phosphatase anti-alkaline phosphatase detection system (APAAP), we could detect tumour cells in bone marrow of 34 out of 97 patients with gastric cancer examined at the time of primary surgery. The incidence of positive findings was correlated to established risk factors, such as histological classification and locoregional lymph node involvement. Clinical follow-up studies on 38 patients demonstrated a significantly increased relapse rate in patients presenting with CK-positive cells in their bone marrow at the time of primary surgery. Thus the described technique may help to identify patients with gastric cancer carrying a high risk of early relapse.

Antibodies, Monoclonal↗
PubMedDate not supplied

Advantages of one-stage repair in case of gallstone ileus.

BACKGROUND/AIMS: The commonly used procedure to treat gallstone ileus is enterolithotomy in combination with late cholecystectomy for persistent symptoms. It is related to a high mortality rate up to 20%. To date it has been impossible to reduce the mortality associated with this accepted surgical technique. PATIENTS AND METHODS: A seven-year retrospective study with a follow up over a period of four years and five months. Sixteen patients with gallstone ileus were entered into the study. Twelve patients were female and fourteen were more than 70 years of age. Fourteen patients were treated by enterolithotomy as well as additional cholecystectomy and resection of the fistula in a one-stage repair. RESULTS: Mortality during hospitalization amounted to one (6%) and postoperative complications to five patients (31%). Follow-up over a period of four years and five months showed one patient had died 3 years postoperatively of an advanced renal tumor. All other patients were alive and without symptoms. CONCLUSION: Our results prove that the concomitant one-stage repair for gallstone ileus significantly reduces the overall mortality rate compared to the single enterolithotomy alone and later cholecystectomy based on patient symptoms.

Aged↗