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Biomedical subjects

H Rohde

Publications and source records attributed to H Rohde.

At least 19 recordsLinked to original sources
PubMed1994

Lymph node staging in 872 patients with carcinoma of the stomach and the presumed benefit of lymphadenectomy. German Stomach Cancer TNM Study Group.

The incidence of surgically suspected and microscopically proved lymph nodes from adenocarcinoma of the stomach and the results of systematic lymphadenectomy have been studied and correlated to survival rate of 99.4 percent at a follow-up period of five years in 872 patients who underwent resection as a part of a prospective observational study in carcinoma of the proximal and distal parts of the stomach. Surgeons believe that, in the median, only one-fifth of the patients with and without systematic lymphadenectomy had positive nodes, whereas pathologists found almost three-fourths of positive lymph nodes (72.7 percent) in patients with proximal carcinoma of the stomach as compared with those without systematic lymphadenectomy (30.8 percent). The figures for middle and lower third carcinomas were even higher (63.5 versus 13.9 percent and 75.9 versus 27.1 percent). Positive nodes were most common in the perigastric area and their distribution was clearly related to the site of the tumor. Frequently, however, lymph node groups were involved, far from the primary, that is, along the hepatoduodenal ligament in 9 to 19 percent of patients with carcinoma of the proximal part of the stomach and in 7 to 16 percent of patients with carcinoma of the distal part of the stomach. There were some hints of a better survival rate for patients with systematic lymphadenectomy as compared with those without, only for low stage carcinoma of the stomach (TNM stage IA-IB, p = 0.1157, Breslow). We suggest a more extensive operation with gastric resection, always combined with systematic lymphadenectomy if no distant metastases are found.

Adenocarcinoma↗
PubMed1993

[Acceptance, side-effects and reactive ability after medicamentous anxiolysis with midazolam. A prospective study with 519 gastroscopy and 506 colonoscopy patients].

In a prospective study 519 patients had gastroscopy (393 with and 126 without midazolam-premedication) and 506 patients had colonoscopy (377 with and 129 without midazolam-premedication) to evaluate acceptance, adverse reactions and reactivity after midazolam-premedication in outpatients immediately and 24 hours later by standard telephone interview. Patients could choose whether they would have midazolam or not. Normally 2 mg midazolam for gastroscopy and 4 mg for colonoscopy were given intravenously directly before endoscopy. 71.5% of gastroscopy and 75.3% of colonoscopy patients who received midazolam afterwards accepted endoscopy only with premedication. 27.7% of our gastroscopy and 14.1% of the colonoscopy patients who than received midazolam were beforehand unable to decide about premedication by themselves. 27.5% of the gastroscopy and 13.8% of the colonoscopy group were persuaded to have midazolam by the doctor examining. 12.7% of our gastroscopy- and 27.1% of our colonoscopy-patients who wished to have midazolam were persuaded to withdraw from it. There were no cardio-pulmonal complications but fatigue was found in 35.4% of the gastroscopy Patients with and 11.9% of those without premedication; colonoscopy patients: 50.4% with and 34.9% without premedication. The incidence of headache was: gastroscopy patients: 6.4% vs. 4%; colonoscopy patients: 11.1% vs. 10.9%. Dizziness: gastroscopy patients: 6.4% vs. 3.2%; colonoscopy patients: 7.6% vs. 7%. Nausea and vomiting were rare (0 to 5%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Proximal compared with distal adenocarcinoma of the stomach: differences and consequences. German Gastric Cancer TNM Study Group.

Interest in leading prognostic determinants of proximal gastric adenocarcinoma (PGA) in comparison with distally located adenocarcinoma (DLA) of the stomach led to an analysis of data from 506 patients with PGA and 484 patients with DLA operated on between 1 April 1982 and 31 October 1984 and participating in a multicentre observational study to validate tumour node metastasis (TNM) stage groupings. The proportion of men with PGA was slightly higher than that of men with DLA (69 versus 63 per cent). Men more often had cardia carcinomas than women (14 versus 9 per cent); 74 per cent of these men but only 43 per cent of the women were less than 65 years old. Evaluation of data by a log-linear model indicated a strong partial association (P less than 0.001) between age and site; patients younger than 65 years more often had PGA than older patients. Advanced tumour stage and the intestinal type of carcinoma were more frequently seen in the elderly. More than twice as many patients with PGA in comparison with those with DLA (35 versus 15 per cent) had palliative surgery (moderate association, P less than 0.05). This may have resulted from different stages at different sites; advanced carcinomas (TNM stages IIIb and IV) were more often diagnosed in patients with PGA than in those with DLA (60 versus 38 per cent). Residual tumour left after surgery was associated with deeper infiltration (P less than 0.001). No difference between PGA and DLA groups with respect to histological type of carcinoma was established, but residual tumour was more frequently associated with a diffuse type carcinoma (P less than 0.01). An overall tendency to poorer long-term prognosis in PGA was seen for all TNM stages, with and without residual tumour, except for TNM stage II with residual tumour, even though patients with PGA were younger than those with DLA. These differences in long-term prognosis, however, are based primarily on poorer short-term survival for PGA, particularly for TNM stages Ib and II without residual tumour. A significant risk of surgical management, particularly for early-stage tumours situated in the upper part of the stomach, has therefore been recognized. Surgeons should appreciate the higher surgical mortality rate for patients with PGA when curative treatment requires more risky surgical techniques.

Adenocarcinoma↗
PubMed1991

[Early stomach cancer in comparison with advanced stomach cancer. Results of a prospective study of diagnosis and 5-year survival of 131 patients with early stomach cancer and 795 patients with advanced stomach cancer].

A multicentre prospective observational study with 22 surgical and 14 pathological units in West-Germany gathered data from 1420 patients with gastric cancer between April 1982 and October 1989, 131 patients with early gastric cancer (EGC) and 795 patients with a resectable advanced gastric cancer (AGC) were selected for comparison. Patients with EGC were younger than those with AGC (49% vs 37% younger than 60 years) and symptoms of an ulcer were found twice in comparison to AGC (40.7% vs 23.7%). EGC in comparison to AGC were frequently multifocal (9.2% vs 3.0%) and located in the middle and lower part of the stomach (83.9% vs 56.8%). Five-year-survival rates of mucosa carcinoma was 84% and of submucosal carcinoma 69% (p = 0.0741). WHO-typing of EGC and AGC were identical. But according to Laurén's classification there were more intestinal types with EGC than with AGC (60.3% vs 51.5%) and less diffuse or mixed types with EGC than with AGC (33.6% vs 44.0%). Five-year-survival rates of diffuse and intestinal types of EGC showed no significant difference (p = 0.19). Extended lymph node dissection was done in only one third of EGC and AGC. Five-year-survival rates of 36 EGC patients with and 95 EGC patients without extended lymph node dissection were 85% versus 72% (p = 0.0916). These results are a hint that systematic lymphadenectomy may have a beneficial effect on survival.

Adult↗
PubMed1991

A randomised controlled trial to evaluate the effects of flumazenil after midazolam premedication in outpatients undergoing colonoscopy.

The degree of sedation and amnesia, subjective assessment of awakening and side effects after intravenous injection of 3-4 mg midazolam and 1 mg flumazenil or placebo were studied directly after colonoscopy, and on the first and the eight day. A total of 91 patients were studied; 45 patients were given flumazenil and 46 patients a placebo. Five minutes after injection of the test drugs all 45 patients given flumazenil but only 38 patients given the placebo were alert (p = 0.006). All three response criteria (for sedation, amnesia and subjective assessment of awakening) were fulfilled by 84.4% of the patients given flumazenil and 45.7% of the patients given the placebo (p = 0.0002). Thirty minutes after injection of the test drugs dizziness, nausea, and fatigue were found in 3 patients given flumazenil and in 10 patients given placebo. One day after colonoscopy 9 of 45 patients (20%) given midazolam and flumazenil complained of fatigue and 9 of 46 patients (19.5%) given midazolam and placebo. Eight days (+/- 1 day) later two patients in each group complained of headache, nausea and fatigue. No patient developed phlebitis at the injection site. Flumazenil seems to be a safe and efficient drug for reversing the sedative effect of midazolam, premedication after colonoscopy. However, resedation due to the effects of midazolam may occur. Flumazenil thus permits administration of a higher dose of midazolam without prolongation of the surveillance time. Improved exploitation of time, space and nursing resources is thus possible without jeopardizing patient safety, although caution is necessary since patients may not be fit to resume all normal activities.

Adolescent↗
PubMed1991

Dose-related healing of duodenal ulcer with the proton pump inhibitor lansoprazole.

Lansoprazole (AG 1749) is a novel substituted benzimidazole which inhibits gastric acid secretion by blocking H+,K(+)-ATPase. This randomized, double-blind multicentre trial studied the dose-response relationship of lansoprazole on ulcer healing and compared it with ranitidine in 314 out-patients with endoscopically assessed, symptomatic duodenal ulcer. Cumulative healing rates with Lansoprazole 7.5, 15, and 30 mg o.m. were 48, 59, and 74% at 2 weeks and 75, 84, and 95% at 4 weeks, respectively (intention-to-treat); the difference of the healing rates between 7.5 and 30 mg groups was significant (P less than 0.001). Corresponding healing rates for 300 mg ranitidine nocte were 51 and 89%. Pain relief was similar in all treatment groups. Lansoprazole was well tolerated. During a follow-up of 6 months relapse rates after lansoprazole 7.5, 15, and 30 mg were 21, 29, and 22%, respectively; the relapse rate after ranitidine 300 mg was 20%. In conclusion, lansoprazole provides faster healing of duodenal ulcer than ranitidine and a similar relapse pattern. For further trials in peptic ulcer disease a daily dose of lansoprazole 30 mg o.m. is recommended.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1990

[Anxiety before gastrointestinal endoscopy--a significant problem?].

98 consecutive patients (40 men, 58 women; mean age 49 [17-83] years) who had been referred for outpatient gastroscopy or colonoscopy were questioned beforehand regarding their anxiety about the procedure, its causes and how it could be dispelled. Two thirds of them (67%) stated that they felt anxiety about the investigation; almost half of them (46%) felt very great or "terrible" anxiety. 55% of the patients had been fully informed about the nature of the procedure. 69% of the women and 48% of the men had previously experienced gastroscopy or colonoscopy. The reasons for their anxiety were varied. One quarter of those questioned (24%) had had unpleasant experiences during previous endoscopies; others had been alarmed by rumours about endoscopy (22%), and some were less worried about the procedure itself than about what it might reveal (24%). Almost two thirds (63%) wanted a tranquilizing injection. Other methods for dispelling anxiety, such as detailed information about the procedure (21%), a calm, relaxed atmosphere (19%) or the presence of a relative at the endoscopy (7%) were claimed for in a limited way. However, 37% very much wanted to watch the endoscopy on the television monitor. The findings show that the number of patients who experience anxiety before undergoing endoscopy is alarmingly great, and that more energetic measures are necessary to relieve their fears and worries.

Adolescent↗
PubMed1990

[Does an information booklet on gastrointestinal endoscopy reduce anxiety for these examinations? Results of a randomized study with 379 patients].

A randomized controlled trial was performed between June and December 1989 in 379 outpatients to evaluate whether a patient information booklet is able to reduce anxiety levels before gastroscopy or colonoscopy. Anxiety levels were measured by a Visual Analogue Scale (VAS) in all patients entering the office. Half of the patients received the information booklet about the endoscopic investigations and half did not. VAS was measured again directly before endoscopy in each patient. All patient groups were comparable. The median anxiety level of gastroscopy patients before and after reading the information booklet was 5.3 (2.5-10) and 4.9 (0.8-10), and for colonoscopy patients 6.0 (2.5-10) vs 5.0 (0.7-10). So not much difference concerning the anxiety level before and after reading the patient information booklet was found. Thus better than an information booklet, for every patient an individualized technique of the endoscopist may reduce patient anxiety before gastroscopy or colonoscopy.

Adolescent↗
PubMed1990

[Antagonizing the effect of midazolam by flumazenil in gastroscopy: results of a randomized double blind study].

The action and side effects of the benzodiazepine antagonist Flumazenil were evaluated and compared with placebo in a double blind parallel group randomized trial involving 40 patients having upper gastrointestinal endoscopy under Midazolam premedication. Flumazenil reversed the hypnotic effect of midazolam within a few minutes. The patients were alert, cooperative, oriented and had recall of events after endoscopy. The effects were better than placebo concerning alertness for up to 30 minutes after administration whereas drowsiness remained almost stable after placebo. Time to reach full alertness was shorter after Flumazenil compared with placebo (42 vs 62 minutes). There were no significant side effects. Flumazenil allows effective reversal of midazolam premedication after upper gastrointestinal endoscopy.

Adolescent↗
PubMed1989

Has there been any improvement in the staging of gastric cancer? Findings from the German Gastric Cancer TNM Study Group.

This multicenter observational study examined the survival of 1420 patients with histologically proven carcinoma of the stomach. From April 1982 through October 1984, 1360 (95%) patients underwent surgery, 988 (72%) had resections, and 372 (28%) minor surgical procedures. The percentage of patients who have been followed until death or 3 to 5 years was 99.4%. Patients were staged preoperatively and intraoperatively and by pathologists using the old (1978) and new (1987) TNM stage groupings and 5-year survival was analyzed. Subgroups of patients who changed their stage group according to the new stage definitions were analyzed separately. Only age was an important prognostic factor for survival in Stage IA (P less than 0.05) and Stage IB (P less than 0.01). Residual tumor after surgery was most important for survival in Stage II (P less than 0.01) and Stage IIIA (P less than 0.001). This indicates that improvements of stage definitions for individual prognosis can only be achieved by adding data concerning the presence or absence of residual tumor (R classification).

Adult↗
PubMed1989

[Systematic assessment of postoperative complications. A form of personal quality control].

A quality control program for the surveillance of surgical complications is described which includes all persons working at a surgical unit. The house surgeon when writing his letter for the general practitioner after the patient is demissed uses a special form for postoperative complications. Ten well defined types of complications, e.g. haematoma, fistula, abscess, pneumonia are recorded. Another surgeon responsible for the control program gathers weekly all forms presenting the results monthly at an audit to all surgeons of the unit. Here results are discussed in detail. Each surgeon gets his own complication profile monthly. Every three months the results of surveillance program are presented to all staff members including nurses, so that cooperative actions to reduce the complication rate can be taken. From January 1, 1985 to June 30, 1987, 2597 operations were performed, 213 patients (8.2%) suffered postoperative complications especially after surgery of the colon and rectum (28%), cholecystectomy (26%) and hernia repair (18%). Comparing three time periods (1985, 86, 87) no significant amelioration of complication rates were found. But factors influencing complications like very high age of patients, seriousness of the disease, and diabetes were not evenly distributed in all three samples. Therefore it might be impossible to lower the complication rate since those factors can't be influenced by better preparation for and better performing of surgery.

Germany, West↗
PubMed1987

[Radical treatment and prognosis: results of a multicenter surgical-pathologic TNM stomach cancer study].

A multicentre observational study with 22 departments of surgery and 14 departments of pathology was started on April 1st, 1982 to validate TNM classification for patients with gastric carcinoma. 1417 patients with histologically proven gastric cancer entered the study. Follow-up is now 3-5 years. A subgroup of 138 patients (age under 65 years, no metastases M 0, curative resection R 0, only T 2-T 4-carcinomas and tumors situated only in the middle and lower third of the stomach) was studied. 65 had subtotal, 73 total resection. The 3 to 5 years cumulative survival time was at least not worse with subtotal in comparison to total resection.

Aged↗
PubMed1985

Sample taking problems in measuring actual histamine levels of human gastroduodenal mucosa: specific and general relevance in clinical trials on peptic ulcer pathogenesis and selective proximal vagotomy.

Changes in histamine storage in the oxyntic mucosa of duodenal ulcer patients and their reversal by vagotomy and the histamine H2-antagonist cimetidine supported the hypothesis that histamine could be a causal factor in peptic ulcer pathogenesis. The specificity of these findings was impaired by problems in biopsy taking, however, and in the preparative steps before measuring the actual histamine contents in all parts of the gastric mucosa and in the duodenum. A prospective trial was carried out in 190 patients to identify these sources of bias and to overcome them by appropriate study designs. Usually a direct correlation was found between weight of biopsy and mucosal histamine content. This problem was solved by selecting a biopsy forceps producing smaller variations in sample size, by limiting the time of cold ischaemia to four to five minutes only and by taking three biopsy specimens for each single histamine value. The actual histamine content of mucosal biopsies remained constant for about four to five minutes only. The 'disappearance' rate was faster in control subjects than in duodenal ulcer patients. Hence by variation of the cold ischaemia time any artefacts of differences between mucosal histamine levels in controls and duodenal ulcer patients could be produced. Using the optimised sample taking procedure mucosal histamine contents of several gastric regions and the duodenal bulb were measured in 24 patients with duodenal ulcer, after selective proximal vagotomy without drainage and in control subjects without any stomach disease (randomised controlled trial). The histamine content was lower in all parts of the upper gastrointestinal tract in duodenal ulcer patients than in controls and was raised again in all regions after selective proximal vagotomy. As the most likely hypothesis it is suggested that vagal reflexes with afferent fibres coming from the oxyntic mucosa stimulate histamine release in duodenal ulcer patients by efferent peptidergic neurones to all parts of the stomach and the duodenum where the ulcer lesion is situated.

Adult↗
PubMed1983

Immunochemical properties of the aminopropeptide of procollagen type III.

The precursor-specific aminopropeptide of bovine type III procollagen is a strong immunogen in rabbits, guinea pigs and mice and induces antibodies which do not cross-react with type I procollagen. The antibody response is regulated by immune response genes associated with the major histocompatibility complex. Major antigenic determinants were found in the compact, non-collagenous domain (fragment Col 1) located at the N terminus of the aminopropeptide and were destroyed by reduction of disulfide bonds. Minor antigenic determinants independent of disulfide bonds also exist in fragment Col 1 and could be localized on a distinct tryptic peptide. Fragment Col 1 showed a lower affinity for antibody when compared with the intact aminopropeptide which causes a non-parallel shift in radioimmuno-inhibition profiles. Monovalent antibody fragments showed an average tenfold reduction in affinity constant and failed to distinguish between aminopropeptide and fragment Col 1. This indicates that the stronger binding of bivalent antibody by the triple-stranded aminopropeptide is due to multiple interactions with both antibody binding sites which are lost for a single-stranded antigen (Col 1) or with monovalent antibody fragments.

Animals↗