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Biomedical subjects

F P Gall

Publications and source records attributed to F P Gall.

At least 19 recordsLinked to original sources
PubMed1992

[Intensive care of geriatric patients in surgery].

BASIC REMARKS: Concomitant cardiovascular and pulmonary diseases in particular represent a considerable risk to the postoperative course in the geriatric patient. MAIN DISCUSSION POINTS: The main aim of intensive care consists in the avoidance and treatment of systemic complications. In contrast, local surgical complications as the reason for intensive care are of secondary importance in the geriatric patient. In the postoperative phase, the main problems encountered by the geriatric patient affect the cardiovascular system and pulmonary function. Age-specific pathophysiological changes affecting the lungs and heart require prophylactic measures aimed at preventing atelectasis, bronchial pneumonia and edema. As a rule, patients of advanced age require such intensive care for one to three days. CONCLUSIONS: The perioperative care of the elderly patient comprises, where possible, preoperative preparation and, postoperatively, a specific prophylactic intensive care regimen.

Aged↗
PubMed1992

Combined radiation and chemotherapy for epidermoid carcinoma of the anal canal.

Between 1985 and 1992, 46 patients with epidermoid carcinoma of the anal canal were treated prospectively by a protocol of combined radiation and chemotherapy with 5-Fluorouracil and Mitomycin C. The survival rate, NED-survival rate and local tumour control rate were 84%, 71% and 83% at 5 years. Anorectal function was retained in 33 of 41 patients (80%). We observed severe acute toxicity including three deaths, but very little late morbidity. The only marginally significant prognostic factor (P = 0.06) for local tumour control was T-stage. NED-survival was significantly affected (P = 0.02) by reduction of chemotherapy during the second course.

Adult↗
PubMed1992

[Abdominal multivisceral resection of colonic cancer].

Multivisceral resection in combination with extended lymph node dissection is used in the surgical treatment of locally advanced colon carcinoma without distant metastases. This also applies to tumours with marked peritumorous inflammation in contact with neighbouring organs where an intraoperative diagnostic attempt could result in tumour seeding. The low mortality and complication rate following multivisceral resection justifies this concept. The 5-year survival rate following multivisceral resection in advanced colon carcinoma is over 80%.

Abdominal Neoplasms↗
PubMed1992

[Pelvic multivisceral resection from the viewpoint of surgery].

Even rectal carcinomas, carcinomas of the female genital tract, and retroperitoneal sarcomas of the pelvis with invasion of adjacent organs are potentially curable by extending the operation to the relevant structures. In the Surgical Department of the University of Erlangen, 1535 patients with a first diagnosis of rectal carcinoma were treated from 1978 to 1988. Among these patients, 97 multivisceral pelvic resections (patients with distant metastases excluded) were performed. True tumor invasion had occurred in 48%, the others were operated on for inflammatory adhesion. In 54 patients, the anal sphincter was preserved. Postoperative mortality was 7%. The 5-year survival of those patients with tumor invasion of adjacent organs and R0-resection (n = 26) was 32%. Excluding the five patients with a tear or incision of the tumor (n = 5), the 5-year survival of the remaining patients was 44%. One patient who was operated on for a leiomyosarcoma of the rectum with a multivisceral resection of the rectum, prostate, and urine bladder is still alive 9 years after the operation without recurrence. The history of this patient argues for pelvic exenteration also in males, if a R0 resection can be performed.

Female↗
PubMed1992

[Laparoscopic tubular rectum and colon resection. An animal experiment study].

As our experimental studies demonstrate save laparoscopic tubular resection of colon and rectum is possible using linear staplers for resection and circular staplers for the anastomosis. As soon as linear endostaplers are available this technique can be applied in clinical work. Open colon resection and subsequent purse-string suture or endoloops to fixate the bowel ends on PCEEA-staplers turned out to be insufficient.

Animals↗
PubMed1992

[Polypoid lesions of the gallbladder--preventive cholecystectomy?].

During nine years (1979-1988) there was carried out cholecystectomy in 21 patients for gallbladder polyps of unknown histology. The sex ratio female to male was 9 to 12, median age 51 (29-76) years. Most of the polyps were smaller than 5 mm, all proved to be cholesterol polyps, showing multiple localisations. Two benign adenomas had a size of 6 resp. 9 mm. Among the polyps with a diameter of more than 10 mm we found only two cholesterol polyps, but one heterotopia, one adenoma and one adenocarcinoma. Cholecystectomy is indicated for polyps with a diameter of more than 10 mm or suspicious sonographic criteria, especially sessile lesions or concomittant thickening of the gallbladder wall.

Adenocarcinoma↗
PubMed1991

[Laparoscopic cholecystectomy: experiences in Erlangen].

From February 2, 1990 to June 15, 1991, a total of 160 patients were subjected to laparoscopic cholecystectomy. The procedure was successful in 150 patients, while in ten patients the procedure was converted to conventional cholecystectomy for the following reasons: suspected malignancy (2), cystic duct stone (1), dysfunction of equipment (2), adhesions (1), concomitant liver tumor (1), abscess in the hepatoduodenal ligament following endoscopic papillotomy (1), and chronic cholecystitis (2). Four patients developed substantial complications. Two patients developed biliary leakage requiring laparotomy and endoscopy placement of a nasobiliary tube in one case each. The other two patients developed intraabdominal bleeding that forced an emergency laparotomy in one case. With increasing experience in laparoscopic cholecystectomy, we would only consider a preoperative suspicion of malignancy as an absolute contraindication.

Adolescent↗
PubMed1991

[Regional chemotherapy of diffuse liver metastases of colorectal cancer].

From 1970 to 1987, a total of 112 patients underwent regional chemotherapy as primary treatment of colorectal liver metastases. 68 patients received 250-750 mg 5-FU 2-3 times per week via external devices, 40 patients with port catheters had 5-day courses of Mitomycin C (8 mg/m2/day 1) and 5-FU (600 mg/m2/day 1-5) at 4 week intervals, and four patients were treated with FUDR (0.2 mg/m2/day 1-14/28) using an Infusaid pump. Median and maximum survival were 13.2 and 58 months, respectively. The overall response rate in patients suitable to imaging criteria who underwent treatment for more than three months and was 83% (CR 14%, PR 40%, SD 29%). The influence of various factors on Kaplan/Meier survival was checked the Logrank test. Response to treatment was of superior importance (p = 0.0000016), but hepatomegaly, Karnofski index, the percentage of liver volume replaced by tumour, and various liver related biochemical tests were also highly significant prognostic determinants (p greater than 0.01). There was no difference between external and fully implantable devices. A subgroup of 68 patients without extrahepatic disease, treatment of more than three months was retrospectively compared to 121 untreated patients with a similar stage of disease. There was no obvious effect of regional chemotherapy on survival (p = 0.16). Although the untreated patients consist a historical control group only, this result indicates that regional chemotherapy must continuously be restricted to well prospective clinical trials.

Adult↗
PubMed1991

Indicators of prognosis after hepatic resection for colorectal secondaries.

From 1960 to 1988, 266 patients underwent resection of colorectal secondaries to the liver with curative intent. All patients were followed until April 1, 1990, or death, with a median follow-up time of 52 months. Nine patients with minimal macroscopic residual disease and 38 patients with all gross tumor removed but positive margins showed a poor prognosis with a median survival time of 13.3 months, the longest being 42 months. Of the 219 patients having potentially curative resection, 12 patients died postoperatively (5.5%). Actuarial 5, 10 and 20-year survival for the remaining 207 patients was 39%, 28%, and 18%, respectively. At April 1, 1990, 77 patients were alive with no evidence of disease for up to 24 years, and 12 patients had died without recurrence. The following factors were associated with less favorable crude survival: presence and extent of mesenteric lymph node involvement (p = 0.0003), grade III/IV primary tumor (p = 0.035), synchronous diagnosis of metastases (p = 0.017), satellite metastases (p = 0.0003), limited resection margins (p = 0.019), and nonanatomic procedures (p = 0.013). With respect to disease-free survival, grading of the primary (p = 0.055) and the extent of clear margins (p = 0.019) failed to achieve statistical significance. Two other criteria are commonly recommended as absolute contraindications to hepatic resection: extrahepatic disease and the presence of four or more independent metastases. A radical excision of all detectable disease may rarely be possible in these circumstances. Nevertheless, within the curative settings, no significant predictive value regarding either overall or disease-free survival was found in this series. Three corresponding "high risk" patients are alive without disease at 5 to 11 years from hepatic resection. These patients with more advanced intrahepatic or concomitant limited extrahepatic disease require a particularly thorough diagnostic work up. As no superior therapeutic alternative is currently available, an aggressive surgical approach may occasionally be justified, and may, in a small portion, result in definite tumor control.

Adult↗
PubMed1991

Surgical treatment of ductal pancreatic carcinoma.

Among 587 patients with ductal pancreatic carcinoma who were examined between 1969 and 1987, 260 (44.3%) had distant metastases at the time of diagnosis. Tumour resections, mostly subtotal duodenopancreatectomies, were performed in 138 patients (23.5% of all patients, or 39.8% of all patients without distant metastases); in 91 patients the resection was for cure (R0). Operative mortality following tumour resection was 6% for all patients. The age-corrected 5-year survival rate was 2.9% for all patients and 16% where the resection was curative; of these 46% were in Stages I and II and 6% in Stage III. In non-curative resections, the median survival time was 7.2 months, which was significantly longer than the 3.4 months following bypass operation. Cure for pancreatic carcinoma can be achieved only through surgery, and a negative attitude towards surgery must be resisted.

Carcinoma↗
PubMed1990

Pulmonary resection for metastatic colon and upper rectum cancer. Is it useful?

The predictive value of the route of venous drainage on prognosis was investigated in a consecutive series of 44 patients who underwent curative resection of pulmonary metastases from colorectal carcinoma. The primary tumor was located in the colon in 14 patients and in the upper third of the rectum in 11 patients, thus indicating blood drainage directed toward the portal vein (Group I). In 10 and 9 cases, respectively, the initial growth was in the middle and lower thirds of the rectum with the venous outflow at least partially directed into the vena cava (Group II). There was no obvious difference between the two groups regarding the initial site of cancer relapse. The liver was involved in 4 of 15 patients failing in Group I as opposed to 4 of 13 patients with hematogenous relapse in Group II. Median survival and tumor-free survival times were significantly longer in patients in Group I (58.4 and 50.2 months) than in patients in Group II (30.9 and 16.8 months), and, even more pronounced, in colon cancer patients (75.4 and 60.2 months) when compared with rectal cancer patients (31.0 and 17.9 months). In contrast, survival curves did not differ significantly if either the two groups with different routes of drainage (5-year survival 53 percent vs. 38 percent, 5-year tumor-free survival 43 percent vs. 37 percent), or tumors of the colon and rectum (5-year survival 67 percent vs. 38 percent, 5-year tumor-free survival 60 percent vs. 32 percent) were compared using the log-rank test. Similar trends were obtained for the subgroup of 34 patients without previous or simultaneous extrapulmonary recurrent disease at the time of lung resection. The primary tumor site does therefore not become a major criterion in selecting patients for surgical resection.

Adult↗
PubMed1990

[Discontinuity resection of the colon. Indications and results].

In 83 patients discontinuity resection of the colon was performed. Due to negative selection factors postoperative mortality was 26.5%. In 37 patients continuity of the colon was restored, no patient died postoperatively. The only severe complication was formation of a colovesical fistula requiring a pull-through operation.

Adolescent↗