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Biomedical subjects

G Kanzler

Publications and source records attributed to G Kanzler.

At least 19 recordsLinked to original sources
PubMed1994

Improved survival after colorectal cancer in patients complying with a postoperative endoscopic surveillance program.

This study investigates whether compliance with a postoperative surveillance program in patients with surgically treated colorectal cancer leads to prolongation of life. The clinical course of 212 patients who had undergone curative resections for colorectal cancer was monitored for at least five years. Eighty-eight patients adhered strictly to a rigid endoscopic surveillance program, and 124 did not. Tumor recurrences occurred in 10% of compliant and 14% of noncompliant patients. Patients with asymptomatic tumor recurrences survived significantly longer (p < 0.05; five-year actuarial survival: 42%) than those who were symptomatic (five-year actuarial survival: 8%). The overall survival rate was significantly higher (p < 0.0002) in compliant patients (five-year actuarial survival: 80%) than in noncompliant patients (five-year actuarial survival: 59%). Noncompliance increased the risk of early death by a factor of 2.5 (95% CI = 1.5; 4.2). It is concluded that postoperative endoscopic surveillance leads to early tumor detection, and is associated with an improvement in survival in patients with colorectal cancer.

Aged↗
PubMed1994

Disability and health care use in patients with Crohn's disease: a spouse control study.

OBJECTIVES: Studies reported from tertiary referral centers suggest that patients with Crohn's disease (CD) have a high rate of long-term disability. This study investigated whether this is true for less selected patient groups. METHODS: 106 outpatients who were diagnosed to have had CD between 1974 and 1985 were invited with their partners (n = 83) for a structured interview that addressed issues of lifestyle and quality of life. In addition, patient and insurance records were reviewed to compare the use of health care services and work disability of patients with CD with those of their partners. RESULTS: Twenty percent of patients and 8% of their partners believed that illness had affected their partnership, 17% versus 11% thought it had compromised their professional career, and 28% versus 10% believed it affected the overall quality of life. A significant impact of illness on these parameters (p < 0.001) occurred only if they were evaluated with the use of an analog scale. Differences between patients and their partners in the use of health care services and in work disability became insignificant after 6 yr of observation (p = 0.1415 and p = 0.4341). CONCLUSIONS: Most patients with CD and their partners experience a similar satisfaction with life. As time progresses, a decline in disability often can be observed.

Adult↗
PubMed1993

How reliable is digital examination for the evaluation of anal sphincter tone?

This study investigates whether digital examination of the anal canal can differentiate reliably between competent and incompetent sphincters. Digital examinations were performed by an experienced proctologist who was blinded with regard to the patient's history as well as manometric and endoscopic findings. There was poor correlation between manometric findings and digital assessment of anal sphincter tone. The sensitivity of digital examination for diagnosing incompetent sphincters ranged from 63% to 84%, whereas specificity was calculated as only 57%. It is concluded that even the experienced examiner needs to use more sophisticated methods than digital examination for the evaluation of anal sphincter competence.

Anal Canal↗
PubMed1992

Does endoscopic follow-up improve the outcome of patients with benign gastric ulcers and gastric cancer?

This study investigated whether an endoscopic surveillance program for patients with "benign" gastric ulcers and gastric cancer leads to early detection of neoplasms and improves survival. The clinical course of all patients diagnosed between 1977 and 1986 as having either gastric ulcers or gastric cancer was followed for a minimum of 3 years. Of 597 patients with initially benign gastric ulcers, 452 (76%) returned for the recommended endoscopic follow-up examinations. In eight patients (1.8%), repeated biopsies disclosed malignant neoplasms; four of these patients (0.9%) had become asymptomatic. Survival curves were nearly identical in patients who complied and those who did not. Of 241 patients with gastric cancer, 72 underwent partial gastric resection with curative intent and survived the first year. Resectable cancer was detected in 5 of 48 patients who complied (10%); none of these patients died of cancer. However, 5-year actuarial survival rates were similar between the patients who complied and those who did not. Although endoscopic surveillance may detect resectable cancer in selected patients, it remains to be shown that such a strategy improves survival.

Aged↗
PubMed1992

Single dilation of symptomatic Schatzki rings. A prospective evaluation of its effectiveness.

This study investigates the effect of a single dilation on the morphology of the lower esophageal ring and on the clinical course of symptomatic patients. Thirty-three patients were studied prospectively for a mean period of 24.3 +/- 19.2 months. Passage of a large bougie (46-58 F) resulted in a rupture of the ring in each instance and its mean diameter increased from 11.4 +/- 3.6 to 17.2 +/- 4.1 mm. No complications occurred, and all patients were symptom-free at the first follow-up examination four weeks after dilation. However, late symptomatic recurrences were frequent. After one year, the estimated proportion of patients remaining free of symptoms was 68% after two years 35%, and after five years 11%. Repeated treatments were performed with similar ease and effectiveness; again, no complications were encountered. Neither the initial ring size nor the presence or absence of esophagitis determined the likelihood of symptomatic recurrences. It is concluded that single dilations of symptomatic lower esophageal rings are safe, easily performed, and well tolerated. Long-term cure of episodic dysphagia is rare, but recurrences can be successfully treated by repeated dilations.

Adult↗
PubMed1991

[Pancreatitis associated with 5-aminosalicylic acid].

Acute pancreatitis with severe belt-like upper abdominal pain developed within 1-4 weeks of starting medication in three patients (29-year-old man with ulcerative colitis; 43-year-old woman and 22-year-old woman with Crohn's disease) treated, for the first time, with 5-aminosalicylic acid (mesalazine), 500 mg three times daily. Concentrations of lipase initially were 545, 1182 and 3000 U/l, and of amylase 243, 449 and 129 U/l, respectively. Symptoms receded within a few hours after the drug had been discontinued, enzyme levels returning to normal in the course of the next 2-3 weeks. On repeating the drug in two of the patients, in lower dosage, the pancreatitis recurred within a few days. These observations support the view that 5-aminosalicylic acid can cause acute pancreatitis, perhaps as an allergic reaction.

Acute Disease↗
PubMed1990

Clinical and morphological characteristics of early gastric cancer. A case-control study.

We investigated whether previously reported differences between the frequency and survival of patients with early gastric cancer in Europe and Japan represent a selection phenomenon or differences in tumor biology. Within a 10-year period, early gastric cancer was diagnosed in 51 outpatients and advanced gastric cancer in 190 patients, amounting to a 21.2% incidence of early gastric cancer. Patients with early gastric cancer had an age distribution and clinical presentation similar to those of patients with benign gastric ulcers (589) but markedly different from those in patients with advanced cancer. Histological types and tumor locations were comparable in patients with early and advanced gastric cancer, indicating a close relationship between the two neoplasms. Patients with early gastric cancer had markedly higher 5-yr survival rates (83.4%) than those with advanced gastric cancer (14.5%) and did not differ in this regard from patients with benign gastric ulcers (82.9%). None of the 51 patients with early gastric cancer died of disseminated cancer. If survival rates were estimated for matched pairs with comparable age, sex, and length of follow-up, these data remained essentially unchanged (early gastric cancer: 83.4%, 95% confidence interval 73.2%-93.4%; gastric ulcer: 87.8%, 95% confidence interval 74.7%-94.3%). We conclude that early gastric cancer in European patients is comparable to early gastric cancer in Japan with regard to its morphology, clinical presentation, and curability. Early investigation of patients with significant gastrointestinal symptoms may improve the prognoses of patients with gastric cancer.

Age Factors↗
PubMed1988

Follow-up of patients with colonic polyps containing severe atypia and invasive carcinoma. Compliance, recurrence, and survival.

Between January 1975 and December 1984 1769 polyps were endoscopically removed from 1219 patients. Eight percent of these patients had polyps containing severe atypia and 5.0% had polyps containing invasive cancer. A close postoperative surveillance program was followed by only a few patients, but compliance improved with longer follow-up intervals. Metachronous polyps were observed with similar frequency in patients with benign polyps (34.8%) and those with polyps containing severe atypia (23.8%) or cancer (41.7%). Patients in whom malignant polyps were endoscopically removed had a 5-year survival rate of 84.3% that did not differ from that of patients' whose polyps contained severe atypia (79.0%). It was concluded that endoscopic removal of malignant polyps with favorable histologic conditions does not impair survival. The follow-up program of these patients should be adapted to that of patients with benign polyps, a procedure that may even improve patient compliance.

Actuarial Analysis↗
PubMed1988

[Are filiform fibromas of the skin a marker for colonic neoplasia?].

750 consecutive out-patients undergoing diagnosis for possible disease of the colon but no history of colon neoplasia were examined for skin tags (achrocordons). They were found in 257 patients, in 30 as multiple (greater than five) lesions. Benign adenoma of the colon was found with similar frequency in patients with (27.6%) and without (22.1%) tags. However, colon carcinoma was twice as frequent in patients with skin tags (8.2%) than controls (4.1%). Patients with multiple tags had an even higher risk of colon carcinoma (odds ratio 7.8; 95% confidence limits 2.2-24.4; P less than 0.01) and a slightly increased risk of benign colon adenoma (odds ratio 2.4; 95% confidence limits 0.9-6.0; P less than 0.05). Whether this association is important in the diagnosis of colon tumours should be tested further by investigating healthy subjects with skin tags.

Aged↗
PubMed1988

Treatment of ulcerative colitis with olsalazine and sulphasalazine: efficacy and side-effects.

The effects of olsalazine were studied mainly in patients with ulcerative colitis who were intolerant to sulphasalazine, and for relapse prevention. A crossover design with sulphasalazine, 3 g/day, and olsalazine, 1.5 g/day, was applied to compare the side-effects of each drug and to evaluate their therapeutic efficacy. A total of 41 patients with mild or moderately severe left-sided colitis or proctitis were assigned to a randomized treatment schedule. Olsalazine and sulphasalazine were similar in their therapeutic efficacy. Twelve patients complained of adverse effects while on sulphasalazine and 4 patients during olsalazine treatment (p less than 0.05). It is concluded that olsalazine is a safe and effective drug for the treatment of mild or moderately severe ulcerative colitis, and is comparable to sulphasalazine, though with reduced side-effects.

Adult↗
PubMed1986

Anorectal ergotism: another cause of solitary rectal ulcers.

Anorectal ulceration was observed in 6 patients who excessively used suppositories containing ergotamine tartrate. The mucosal lesions of the rectum resembled those observed in the "solitary rectal ulcer syndrome." However, characteristic features of ergotamine-induced ulcers are absence of a mucosal prolapse, lack of a history of constipation, and rapid healing after discontinuation of the drug. Furthermore, the rectal lesion may be associated with anal ulceration, which occasionally presents as the only clinical manifestation of "anorectal ergotism."

Adult↗
PubMed1984

Eighty months persistence of poorly differentiated early gastric cancer.

A patient is presented who was diagnosed in 1976 as having a signet-ring cell carcinoma of the gastric antrum. The patient delayed surgery for 7 yr, after which time an early gastric cancer of the intramucosal type was found. It is suggested that in addition to its high cure rate, early gastric cancer may have an extraordinarily slow growth.

Adenocarcinoma, Mucinous↗
PubMed1978

[Gastric xanthelasma (author's transl)].

A report is given about 42 cases with xanthelasma of the gastric mucosa diagnosed with 5 1/2 years. The condition was found (considering the total number of gastroscopies) in men 1.38 times as often as in women; the average age of all patients at the time of diagnosis was 62.5 years. Xanthelasma lesions are yellow or yellowish-white spots in the mucosa, consisting of foam-cells microscopically. The cytoplasma stains pale pink in a HE preparation; there is almost no staining with PAS, and sudan black staining is definitely positive in most cases. PAS and sudan black staining do allow differentiation of signet ring carcinoma cells. Gastric xanthelasma occurs quite often concurrently with chronic gastritis. It is due to local, not to general disturbances of lipid metabolism. Lipids probably are formed within the mucosa cells or may--in cases of intestinal metaplasia--originate from the gastric contents. Gastric xanthelasma does not constitute a nosologic entity, it is merely a consequence of other diseases of the gastric mucosa.

Adult↗