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Biomedical subjects

G Winde

Publications and source records attributed to G Winde.

At least 55 records · Page 3Linked to original sources
PubMed1995

Immunohistochemical distribution of chromogranins A and B and secretogranin II in neuroendocrine tumours of the gastrointestinal tract.

The aim of the present study was to investigate immunohistochemically the distribution of chromogranin A, chromogranin B, and secretogranin II in a series of 152 neuroendocrine tumours of the gastrointestinal tract. Tumour tissues from 25 argyrophil gastric carcinoids, 18 gastrin and 5 somatostatin-producing tumours, 4 'gangliocytic paragangliomas', 49 classical argentaffin and 2 L cell appendiceal carcinoids, 27 classical ileal carcinoids, 17 rectal carcinoids, and 5 poorly differentiated neuroendocrine tumours of the stomach and rectum were immunostained with antibodies against chromogranin A, chromogranin B, and secretogranin II. Chromogranin A was the major granin expressed in gastric carcinoids and in serotonin-producing carcinoids of the appendix and the ileum. In contrast, strong chromogranin B and secretogranin II immunoreactivity was found in rectal carcinoids, in which chromogranin A was rarely expressed. Since chromogranin A is a widely used marker for neuroendocrine differentiation, it is of diagnostic importance that some gastrin-producing tumours, 'gangliocytic paragangliomas', poorly differentiated neuroendocrine carcinomas, and appendiceal L cell carcinoids completely lacked chromogranin A positivity. It is concluded that the various neuroendocrine tumours of the gastrointestinal tract show distinctly different patterns of granin expression, probably reflecting their histogenetical origin.

Chromogranin A↗
PubMed1995

Complete reversion and prevention of rectal adenomas in colectomized patients with familial adenomatous polyposis by rectal low-dose sulindac maintenance treatment. Advantages of a low-dose nonsteroidal anti-inflammatory drug regimen in reversing adenomas exceeding 33 months.

PURPOSE: This nonrandomized, controlled Phase II pilot study aims at the lowest effective dose of rectally applied sulindac to achieve and maintain adenoma reversion in colectomized patients with familial adenomatous polyposis (FAP). METHODS: The study group (n = 15) underwent proctoscopic and laboratory follow-up for polyp reversion every 6 to 12 weeks. Polyp reversion was followed by dose reduction in predefined steps. Proliferating cell nuclear antigen/cyclin (PCNA) and KI-67 proliferation indices (PI) were performed by point counting. Prostaglandin (PG)E2 and PGF2 alpha were quantified by time-resolved competitive fluorescence immunoassay. RESULTS: All patients responded to therapy within 6 to 24 weeks. Sixty and 87 percent of patients achieved complete adenoma reversion after 48 weeks at 53 and 67 mg of sulindac per day per patient on average, respectively. Reversion was evident compared with the control group. Dose reduction by one-sixth to one-eighth of the usual oral dose was significant (Mann's trend test, P < 0.05). PCNA and KI-67 PIs of adenomatous and flat mucosa were significantly reduced (Wilcoxon's test, P < 0.05). Correlation of PCNA and KI-67 PIs indicate similar reaction of different tissue structures (Spearman's rank correlation test, P < 0.01). Nonsteroidal anti-inflammatory drug-induced redifferentiation from high-grade to low-grade dysplasia occurred in all but two patients. Tissue-PGE2 levels were greatly reduced. Unwanted, curable side effects were rare (gastritis, n = 2), and laboratory controls are within detection limits. CONCLUSIONS: Low-dose rectal sulindac maintenance therapy is highly effective in achieving complete adenoma reversion without relapse in 87 percent of patients after 33 months. Rectal FAP phenotype should be crucial for the surgical decision. Colectomy with ileorectal anastomosis and regular chemoprevention might proceed to be a promising alternative to pouch procedures. Chemoprevention with lower incidence of FAP-related tumors via dysplasia reversion may be possible in the future.

Adenomatous Polyposis Coli↗
PubMed1995

Immunohistochemical demonstration of the calcium-binding proteins MRP8 and MRP14 and their heterodimer (27E10 antigen) in Crohn's disease.

Monospecific antibodies against the calcium-binding proteins MRP8 and MRP14 and their heterodimer MRP8/14 (epitope 27E10) were used to investigate immunohistochemically the distribution of these proteins in routinely processed small and large bowel tissues from patients with Crohn's disease. MRP8, MRP14, and complex MRP8/14 were demonstrated in most granulocytes and macrophages in active Crohn's disease. Additionally, a strong complex MRP8/14 immunoreactivity was present in epithelial cells of the terminal ileum adjacent to ulcerative and fissuring lesions, whereas epithelial cells in large bowel tissues were consistently negative. Our results morphologically confirm the clinical finding of increased MRP8/14 serum levels in patients with active Crohn's disease; there is evidence that the serum MRP8/14 increase is caused by active secretion from granulocytes, monocytes, and epithelial cells.

Antibodies, Monoclonal↗
PubMed1995

Immunohistochemically detectable p53 and mdm-2 oncoprotein expression in colorectal carcinoma: prognostic significance.

Aims-To investigate the correlation between the expression of the p53 and mdm-2 oncoproteins and to assess their prognostic value in colorectal cancer.Methods-Using a polyclonal (CM1) and a monoclonal antibody directed against p53 and mdm-2, respectively, these oncoproteins were stained immunohistochemically in 109 colorectal adenocarcinomas.Results-p53 was detected in less than 10% of tumour cells in 11 of 109 adenocarcinomas, in 10-50% of tumour cells, in 17 of 109 adenocarcinomas, and in more than 50% of tumour cells in 32 of 109 adenocarcinomas. Expression of mdm-2 was detected in 22 of 109 (20%) cases investigated, of which 19 showed concomitant p53 expression. In most cases mdm-2 immunoreactivity was strongly associated with a small proportion of p53 positive tumour cells. Both p53 and mdm-2 expression lacked statistical significance when correlated with common staging and grading parameters.Conclusions-Detection of p53 and mdm-2 oncoprotein expression, detected using immunohistochemistry, is of no prognostic value in colorectal cancer. However, the close correlation between mdm-2 immunoreactivity and the proportion of p53 positive cells provides further evidence that the mdm-2 gene product interacts with p53 protein.

Journal Article↗
PubMed1995

Monoclonal antibody 1F10 immunoreactivity in inflammatory bowel disease: a new marker specific only for continuous endothelial cells.

OBJECTIVE: To investigate in detail the immunohistochemical properties of the two endothelial-specific markers 1F10 (continuous endothelia) and MS-1 (discontinuous endothelia) in bowel tissues of patients suffering from chronic inflammatory bowel disease (IBD). METHOD: Immunohistochemical techniques were employed to study the morphology and phenotypic expression of these two proteins in routinely processed bowel tissues from 27 patients with Crohn's disease, 18 patients with ulcerative colitis, and 20 normal controls. RESULTS: All patients with IBD and controls showed a low to moderate 1F10 immunohistochemical staining restricted to the lamina propria and submucosa. In contrast to ulcerative colitis patients and healthy controls, 1F10 immunoreactivity was strongly upregulated in the muscularis propria of the small and large bowel in Crohn's disease patients regardless of the histological severity of the inflammatory process. We did not observe immunoreactivity for MS-1 on endothelial surfaces in either Crohn's disease or ulcerative colitis. CONCLUSIONS: We conclude that endothelia in patients with IBD do not undergo metaplasia. The high immunoreactivity of 1F10 antigen in the muscularis propria in Crohn's disease indicates a state of tropical immunological activation and may be important in the maintenance of chronic inflammation by facilitating leukocyte migration into sites of Crohn's disease involvement. Further studies of the factors controlling endothelial cell differentiation in the bowel of Crohn's disease patients may help to explain the features observed in this study.

Adolescent↗
PubMed1994

Immunohistochemical metallothionein expression in colorectal adenocarcinoma: correlation with tumour stage and patient survival.

Metallothioneins (MTs), a set of ubiquitous low-molecular-weight proteins essential for the protection of cells against heavy metal ion toxicity, were demonstrated immunohistochemically using a monoclonal antibody (E9) against a conserved epitope of I and II isoforms in a series of 109 colorectal adenocarcinomas. In a semiquantitative analysis strong MT expression in the majority of tumour cells was observed in 34 (31%) cases, 24 (22%) tumours showed a focal MT positivity, and 51 (47%) almost completely lacked MT expression. These differences in MT expression were statistically significantly (P < 0.05) associated with the tumour stage (Dukes classification) and the lymph node involvement at the time of operation (pN stages). However, in contrast to previous findings obtained on a variety of tumours, MT positivity was associated with a favourable clinical outcome in colonic carcinoma, which may indicate their different biological behaviour. Survival curves of cases with MT-positive and MT-negative status differed from each other in a univariate analysis (Mantel-Haenszel: 8.9, P < 0.05) but lost significance when a multivariate analysis was carried out by means of the Cox proportional regression model with Dukes' stages as a stratification factor. It is concluded that immunohistochemically demonstrated MT expression is significantly associated with tumour stages but does not represent an independent prognostic variable in colorectal cancer. However, it may provide important information about some of the biological mechanisms underlying progression in colorectal cancer.

Adenocarcinoma↗
PubMed1993

[Clinical and functional results of abdominal rectopexy using different fixation principles].

We report our results with abdominal rectopexy (modified Ripstein procedure, Ripstein/Corman) without resection of the colon in 63 patients using lyophylized dura-strips, Vicryl gauze or Dexon gauze, as the underlying fixation material for the mobilized rectum, presacral fascia and fixation suture material. Forty-five of 64 patients (71.4%) were reevaluated by proctoscopic examination and questioning; the mean follow-up time was 52.5 months (range 3-136 months). Postoperative mortality due to the method was 0%; the mortality was 1.6% (n = 1/63) in general for the first postoperative 30-day period as a result of cardiac complications. There were three complications (4.7%) the durating operation. Postoperative morbidity was 25.4% (16/63); infectious complications occurred in 12.7% (8/63) of cases, with one case of spontaneous closure of a pelvicutaneous fistula after intraoperative injury to the rectal wall. Full-thickness rectal prolapse appeared after rectopexy in 4.4% (2/45) (dura material alone) and mucosal prolapse was seen in 15.5% (7/45) of the follow-up group. Constipation was reduced by 28.6% (18/63) to 22.2% during the follow-up. Seventeen of 28 patients (60.7%) with incontinence showed an improvement; total continence was registered in 35.7% (10/28). The increase in continence as a result of abdominal rectopexy was significant (Wilcoxon, P = 0.05). The special aspects of being in an older age group, having a long history of procidentia, the number of deliveries, the length of the preoperative incontinence period all showed no influence on the postoperative degree of continence (Spearman's rank correlation). In 7/15 cases with persisting incontinence after rectopexy, postanal repair (Parks) was efficient in 7/7 cases leading to total or partial continence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

The NSAID sulindac reverses rectal adenomas in colectomized patients with familial adenomatous polyposis: clinical results of a dose-finding study on rectal sulindac administration.

After colectomy with ileorectal anastomosis (IRA) for treatment of familial adenomatous polyposis (FAP), the rectal mucosa remains, with the risk of malignant change. Locoregional (rectal) sulindac has been applied, with initial higher-dose therapy and subsequent low-dose maintenance therapy to minimise side-effects. The dose-finding study with sulindac suppositories started with a dose of 300 mg sulindac daily per patient over 6 weeks. Depending on proctoscopical evaluation of regression of polyposis, sulindac doses were reduced in predefined steps. Ten of 15 patients developed a complete remission following 42 weeks of treatment, while the rest had partial remission. Responses were recorded 6-24 weeks after beginning sulindac treatment. After 36 weeks, 13/15 patients received 25-50 mg sulindac daily. An increase in the number of partial remissions after 42 weeks of treatment at doses of 100 mg sulindac daily may indicate the first approach to a reduced dose between 100 mg to 25 mg sulindac daily, but may also point to the importance of long-term treatment rather than dose-intense therapy.

Adenomatous Polyposis Coli↗
PubMed1993

Clinical and functional results of abdominal rectopexy with absorbable mesh-graft for treatment of complete rectal prolapse.

OBJECTIVE: To report the long term results of abdominal rectopexy in patients with complete rectal prolapse. DESIGN: Ongoing prospective randomised study. SETTING: Department of Surgery, Westfälische Wilhelms-University, Münster. SUBJECTS: 47 patients with complete rectal prolapse operated on between 1982 and 1989. INTERVENTIONS: Abdominal rectopexy with absorbable mesh made of either polyglycolic acid (n = 17) or polyglactine 910 (n = 30). MAIN OUTCOME MEASURES: Postoperative complications and late results at a mean of 50.5 (range 2-102) months after operation. RESULTS: Thirteen patients (28%) developed postoperative complications, most of them minor; there was one enterocutaneous fistula. Thirty five patients (74%) were available for late follow up. There were no case of recurrent prolapse and 5 (14%) had developed mucosal prolapse. Of the 22 patients who had been incontinent before operation, 8 had become totally continent and 6 partially continent Overall continence improved in 18 (51%) of the 35 patients. Three patients who were continent before operation had become incontinent. CONCLUSION: Absorbable mesh is a suitable material for abdominal rectopexy.

Absorption↗
PubMed1993

[Therapeutic problems of cancers of the gallbladder].

Data of 32 patients who were operated for gallbladder carcinoma were evaluated in a retrospective meta-analysis. Results were compared with endoscopic retrograde cholangio-drainage (ERCP) using large size 12/14-French gauge endo-prostheses with side flaps to prevent migration. According to the TNM classification 84% of patients were classified as stage IV, 12.5% were in a stage III and 3% were in a stage II. Only 22% of cases were operated for cure (cholecystectomies, lymphadenectomy, wedge resection of the liver). All patients died in between one year on cancer, average survival was 158 days in TNM stage II, 183 days in stage III and 75 days in stage IV. Early complication rate was in stage III and 75 days in stage IV. Early complication rate was at 28% due to cardiac and pulmonary complications. No one died as a result of the operation. Endoscopic bile duct drainage (ERCP) for gallbladder carcinoma (n = 21) was shown to be superior to surgical results with an average survival of 160 days. Early complication rate (30 day interval) was at 5.6% (n = 1014), mostly due to tube occlusion with cholangitis; clinical mortality was 2.6% only (n = 393). Occlusion of the endoscopic 12/14-French gauge tube was seen after 213 days in average. Endoscopic therapy was shown to represent an independent way in gallbladder cancer treatment not only for patients defined as not suitable for operation. All own results were compared to the literature, therapeutic regimen in gallbladder carcinoma is summarized as an organigramm.

Adenocarcinoma↗
PubMed1991

Immunohistochemical double labeling of macrophages, smooth muscle cells, and apolipoprotein E in the atherosclerotic plaque.

To find out which cell types in the atherosclerotic plaque are actively involved in apolipoprotein-secretion, we stained tissue samples from the ascending aorta of patients undergoing coronary bypass surgery. We used monoclonal antibodies against macrophages, smooth muscle cells and apolipoprotein E. The present in situ-study of the atherosclerotic plaque has shown that apolipoprotein synthesis is predominantly secreted by macrophages transformed into foam cells. Besides this, there are obviously some smooth muscle cells equally transformed to foam cells, which also carry apolipoprotein E in their cytoplasm. Our data suggest that both cell types in the atherosclerotic plaque are actively involved in apolipoprotein secretion.

Apolipoproteins E↗
PubMed1991

Rupture of the spleen caused by primary angiosarcoma. Case report.

Splenic angiosarcoma is rare with only about 60 reported cases. A case is presented in which the tumor caused spontaneous rupture of the spleen and showed characteristics of an infiltrating echinococcosis of the liver and spleen in ultrasound and computed tomography imaging. The literature is reviewed in regard to clinical features, diagnosis and management.

Diagnostic Errors↗
PubMed1991

[Indications, incidence of recurrence and late results after selective vagotomy].

At the Clinic and Polyclinic for General Surgery of the Westfälische Wilhelms Universität Münster a total of 125 patients were vagotomised because of chronic duodenal ulcers during the period from 1. 1. 1973-31. 12. 1988. The case histories were analysed retrospectively. Standardised questionnaires were sent to the patients in order to gain more information about the post-operative progress and about possible complications after vagotomy had been carried out. 12.2% of the patients questioned developed a recidive ulcer 1-16 years after the operation which resulted in 8 cases in a Billroth II gastrectomy with Y-anastomosis according to Roux. 7 of the 9 recidives occurred during the first two post-operative years. The average time before relapse occurred amounts to 1.7 years in spite of drug treatment. As the initial operation was performed more than 6 years ago in 88.1% of the patients and in this respect later occurring recidives could have been detected, it is to be assumed, that relapses manifest themselves, if at all, relatively soon after the initial operation. The surgical therapy of the recidive ulcer by means of B II gastrectomy was associated with a favourable prognosis; all patients were able to resume work. A comparative analysis of the later results in 67 patients of various age structures showed that with increasing age the rate of patients who considered the operation as successful decreased. Of those up to 25 years 66.7% considered themselves as recovered, of those between 41-45 years 22.2%. It can be concluded that a selective proximal vagotomy represents a curative method in the case of chronic relapsing uncomplicated duodenal ulcers. Satisfactory results could be obtained especially in young patients who develop temporary stress ulcers. Good long-term results can be obtained here, despite the high relapse rates described in our own collective of patients as well as in literature.

Adult↗
PubMed1990

Percutaneous venous cannulation and central venous line placement by means of ultrasonography and ultrasonic Doppler.

Ultrasonography is being increasingly used in the field of anesthesiology. One major indication is visualization of central venous vessels, in particular the internal jugular vein before and during cannulation by means of ultrasonography or ultrasonic Doppler. This should facilitate puncture with a higher rate of successful cannulations and decreased rate of complications related to needle probing during catheterization attempts. Furthermore, by using ultrasonography central venous catheters can be located in the vessels. The picture quality of various central venous catheters currently used in anesthesia and intensive care does not show any noticeable difference.

Catheterization, Central Venous↗
PubMed1990

[Clinical aspects, diagnosis and therapy of genuine bile duct cysts].

During an eight-year period eight patients with intra- or extrahepatic bile duct cysts were treated at our institution. One patient belonged to Type I, four to Type IV and three to Type V according to the classification by Alonso-Lej/Todani. The main symptom among the Type IV patients was jaundice, among the Type V patients abdominal pain. The correct diagnosis could be established by ERCP in seven of eight cases. Two type V patients with disease mainly confined to one lobe of the liver could be resected, one patient was treated endoscopically, the others underwent biliary drainage procedures.

Adolescent↗
PubMed1990

[Pharmacokinetic studies of a new 20% fat emulsion containing 70% medium-chain triglycerides].

The aim of the study was to acquire basic knowledge on pharmacokinetic, metabolism and tolerance of a new 20% fatty emulsion with a 70% proportion of medium-chain triglycerides (MCT) and a 30% proportion of long-chain triglycerides (LCT) in the postoperative phase after a trauma of medium severity. - 12 female patients who had an elective rectal amputation and who needed parenteral nutrition postoperatively, were studied. The nutritional regime consisted of 4.8 g/kg/day of glucose and 1 g/kg/day of amino acids. On the second postoperative day the patients were given 0.06 g/kg body weight/h and on the third day 0.12 g/kg body weight/h of new 20% fatty emulsion during a time period of eight hours. Blood samples for the evaluation of triglycerides, free fatty acids, phospholipids, beta-hydroxybutyrate (beta-OHB), acetoacetate, cholesterol, glucose, pyruvate and lactate were taken before and after the fat application. Ketone were measured semiquantitatively. Side effects and complications were not observed. Simultaneously to the administrated triglycerides an increase in serum triglycerides was observed. After four hours fat emulsion was infused under steady state conditions. Under the graphically measured half-life of 17 minutes for the MCT/LCT emulsion, rapid and complete elimination could be seen after the infusion had been stopped. Simultaneously with the high clearance of the infused triglycerides, free fatty acids increased significantly in the plasma without reaching a plateau; 30 minutes after the fat application the laboratory results returned to the initial levels.(ABSTRACT TRUNCATED AT 250 WORDS)

3-Hydroxybutyric Acid↗