[Treatment results in breast carcinoma within the interdisciplinary therapy concept of the Charité].
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Adult↗
Biomedical subjects
H Wolff
Publications and source records attributed to H Wolff.
Chlamydia trachomatis induces an inflammatory response in the male genital tract and is associated with altered semen quality.
U. urealyticum with 15.8% and C. trachomatis antibodies with 15.4% were the most prevalent microbiological findings in 209 male infertility patients. The inflammatory marker granulocyte-elastase was significantly increased in men with C. trachomatis; these men also showed significantly decreased citric acid levels indicating inflammatory damage of the prostate induced by C. trachomatis.
Antibodies, Bacterial↗
[The accuracy of the imaging procedures (sonography, MRT, CT, angio-CT,nuclear medicine) in characterizing liver tumors].
In a prospective study, an attempt was made to determine the specificity of various imaging methods for defining tumours of the liver rather than their ability to demonstrate them. It was based on 130 patients with histologically confirmed lesions (33 haemangiomas, 17 FNH, 4 hepatocellular adenomas, 28 HCC, 36 adenocarcinoma metastases). The methods were MRT (130 cases), sonography (119), CT (122), dynamic arterial angio-CT (15), 99TC-EHIDA or blood pool scintigraphy (4 FNH, haemangiomas, HCC, 44 cases). MRT showed somewhat better results (accuracy 80%) than CT (73%) and angio-CT (73%) in demonstrating the type of lesion. The results of scintigraphy (53%) and sonography (69%) were rather worse. The range of accuracy for MRT, CT and sonography varied from 94% (haemangiomas with MRT) to 47% (FNH with sonography).
Biopsy↗
[Diagnosis and surgical therapy in congenital ectasias of the intra- and extrahepatic bile ducts].
31 patients with congenital ectasias of extra- and intrahepatic bile ducts have been diagnosed and treated between 1980 and 1991 at the Charité. 7 ectasias belonged to type I, two to type II, three to type III, four to type IV and fifteen to type V of classification by Alonso-Lej/Todani. The age of affection was between 8 and 80 years. Symptoms are not specified and directed to affection of liver or bile ducts. Main symptoms of type I--III were complaints in the upper abdomen and jaundice, of type IV--especially after previous surgery--fever and also jaundice. Complaints in the upper abdomen and fever dominated in type V. The right diagnosis succeeds at 27 out of 31 patients with direct cholangiography. Sonography and computerized tomography were not always in a position to attach the clinical picture to congenital ectasias. In extrahepatic ectasias is the resection of bile duct cysts--carried out in 2/3 of all cases--the therapy of choice. Once was found a carcinoma in a resected bile duct cyst 23 years after a choledochocysto-jejunostomy. By Caroli syndrome the therapy must be fixed individually. 6 patients were supplied operative (liver resection, choledochotomy, papillotomy, extraction of lithiasis). Instrumentally were carried out 9 endoscopic papillotomies with extraction of concrements and 6 lay ins of internal drainage catheters were done.
Adolescent↗
[Anomaly of the pancreatico-biliary junction and etiology of choledochal cysts].
The etiology of choledochal cysts isn't yet clarified unequivocably. Numerous theories have been worked out. One of them is the 1969 by Babbitt postulated "common-channel"-theory, which is based on an anomaly of the pancreaticobiliary connection. In case of a fusion of ductus choledochus and ductus pancreaticus widely before the papilla of Vater and the formation of a common channel with a minimum length of 15 mm the reflux of pancreatic secretion into the off-leading biliary ducts may occur and choledochal cysts may develop. In order to check up this hypothesis we evaluated retrospectively pictures of a direct cholangiography (ERCP, PTC and/or intraoperative cholangiography) of 26 patients suffering from type I, IV and V ectasias of the biliary ducts according to Todani. We found a common channel with an abnormal length in 8 of 12 patients suffering from extrahepatic ectasias of the biliary duct type I and IV (66%), but we didn't find it in patients with type V intrahepatic ectasias of the biliary duct. This analysis may be recognized as a reference to the truth of the Babbitt-theory.
Cholangiography↗
[Testing phyto-drug effects on spontaneous and chemically modified deformation of erythrocyte membranes: demonstrated with Ginkgo-Biloba extracts].
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Diterpenes↗
[Laparoscopic cholecystectomy. An alternative procedure in the treatment of symptomatic cholecystolithiasis].
The authors report about their first experiences concerning the treatment of gallbladder stones using a laparoscopic approach. 40 patients (33 female, 7 male) were treated with this new method. The age of the patients, who had undergone this procedure, varied from 24 to 76 years, the average age was 42 years. Our current indication is the symptomatical chronic gallbladder lithiasis. The average time of operation was 60 to 90 minutes. The mortality rate was zero. Slight operative bleeding from an accessory artery and vein occurred in two cases. This was controlled by electrocoagulation. We observed no complications in the postoperative phase. The patients were dismissed from the hospital on the 3. to 5. day. This method is very favourable with regard to the operative strain on the patients.
Adult↗
[Experiences and results in 200 laparoscopic cholecystectomies].
Laparoscopic guided cholecystectomy was attempted in 200 patients from September 1990 until May 1991. Wound infection rate was 6% in first 100 operations. In the second group of 100 operations the wound infection rate was 1%. Antibiotic prophylaxis was used in this group. Mortality was 0%. Complications were 7 wound infections, 1 urinary tract infection and 1 bile fistula treated by drainage. Five patients required conversion to a standard laparotomy, due to 3 cases of bleeding of a. cystica, 1 biliodigestive fistula and 1 extensive meteorism. Laparoscopic cholecystectomy is now a routine operation.
Adolescent↗
[Cardiopulmonary risk factors in patients with sleep apnea].
Since the interaction between disorders of the respiratory coordination and cardiovascular or cardiopulmonary regulation is still largely unknown the intention of the present investigation is to point out the coincidence of cardiac arrhythmias, such as premature ventricular capture (PVC) beats and conduction blocks, with obstructive sleep apnea (OSA). For the first time a group of more than 300 patients with suspected OSA is examined concerning risk factors and frequent diagnoses as obesity, hypertension, coronary heart disease (CHD), heart insufficiency, chronic obstructive pulmonary disease (COPD), and daytime hypoxaemia. Summarizing the results of lung function test, blood gas analysis, strain-ECG, Holter-ECG and inductive plethysmography with oxygen partial pressure measurement by ambulatory work-up the following statements can be made: PVC beats occurring markedly during sleep give hints for OSA being the underlying cause, especially if the patients are young and overweight. Hypoxaemia increasing during the apnea episodes should be considered as one possible pathogenetic mechanism. Second- and third degree conduction blocks and sinus arrest coincident very often with OSA. They suggest to be life-limiting factors the more so since they often go along with CHD or heart insufficiency. Systemic arterial hypertension and overweight have the highest prevalence in OSA, signs for heart insufficiency and daytime hypoxaemia are also significantly more frequent than in non-OSA patients. We could find no hints for direct pathogenetic coherence between CHD and OSA or between COPD and OSA, nevertheless pronounced nocturnal changes in blood gases and intrathoracic hemodynamics have important influence on the cardiopulmonary and cardiovascular system, as partly illuminated in other more pathogenetic oriented studies by the present time.
Arrhythmias, Cardiac↗
[Post-traumatic hemobilia in childhood].
We observed three patients with a hemobilia after surgically or conservatively treated liver lacerations. The diagnosis was suspected on clinical grounds and verified by ultrasonography, computed tomography or angiography or a combination thereof. Depending on the findings therapy was planned reaching from conservative treatment to liver resection. Because this complication is rare it should be cared for in a specialized institution.
Child↗
[Diagnosis and surgical procedure in intestinal hemorrhage as a sequela of vascular abnormalities (angiodysplasia)].
Angiodysplasia is in 5-20% the source of massive lower gastrointestinal bleeding in the elderly. The etiology is unknown. We describe 8 patients with multiple intestinal bleeding from an angiodysplasia, treated between 1986 and 1989. The mean age of the patients was 49.1 years. Four patients were older than 65 years. The localisations were in 6 cases the ascendic colon, in one case the terminal ileum and rectum each. Selective mesenteric arteriography has proved to be the best method of diagnosis. Isotope studies and endoscopies may not demonstrate the localisation in acute bleeding. The treatment of angiodysplasia is the segmental resection of the effected portion of the bowel. In 5 of 8 patients we performed the right hemicolectomy, in 3 patients the resection of the terminal ileum (n = 2) or rectum (n = 1). The follow up of our patients was 15 to 44 month.
Adult↗
Drug administration in relation to meals in the institutional setting.
To investigate adherence to literature recommendations for administration of five cardiovascular drugs in relation to mealtimes, data from records of 183 adult patients in two short-term and two long-term care settings were tabulated. Ninety-three percent of patients taking quinidine sulfate and 85% of patients taking the other four study drugs received one or more doses incorrectly. Findings show that timing recommendations for dosing in relation to meals are not considered in these institutions when drug administration schedules are established. The practice of arbitrary schedule selection could have serious consequences, including adverse physiologic and financial impact on the patient from loss of therapeutic effectiveness or development of drug toxicosis. Medication schedules need to be designed to achieve the greatest drug bioavailability.
Adult↗
[Diagnosis and therapy of thymus tumors].
In this paper we report about the treatment process of thymic tumours. Dominating among our patients are thymomas with lymphocyte predominance (n = 16) followed by epithelioid (n = 8) and spindle cell (n = 2) thymomas. For classification and for estimation of prognosis all thymomas were divided into macroscopical and histological stadiums I-IV. In the long-term process a better survival rate for patients with thymomas with lymphocyte predominance and histological stadium of invasion I was 93% over seven years. The worst results were reached by patients of the infiltration groups III and IV-the survival rate was 50%. By 17 of 26 patients suffering from a thymoma the tumours were associated with myasthenia gravis. Especially frequently we found class IIB and III according to Osserman. The survival rate in this patients was 76.5% (13 patients) in the treatment process. An improvement and stabilization of myasthenia gravis was possible for 13 patients. If the complete removal is limited by the growth of the tumor and by the infiltration rate, the further additional therapy--radiation therapy and polychemotherapy--will help to improve the prognosis.
Adolescent↗
[Value of CEA determination in follow-up of patients with liver metastasis of colorectal cancers with loco-regional chemotherapy].
The importance of carcinoembryonic antigen as a tumor marker to the follow-up of patients with liver metastases from colorectal cancer was investigated. It was reported about 29 patients receiving chemotherapy. We estimated the effect of therapy according to sonographic and computer tomographic criteria and related to the CEA-level. The correlation of the growth of cancer and the level of the CEA was positive in 81% of the patients. We do not consider as sufficient the measurement of CEA as an exclusive method for the follow-up of colorectal cancer and recommend the monthly measurement of CEA in connection with radiological examinations in the period of 3-4 month.
Adult↗
[Cushing's syndrome in CRF-producing mediastinal carcinoid].
A 36-year-old patient developed marked pigmentation, marked myopathy and severe hypokalaemic alkalosis which at first pointed towards an ectopic ACTH syndrome. The dexamethasone test at a high dose indicated cortisol suppression. A mediastinal tumour was seen radiologically, but the sella was of normal size. Computed tomography provided indirect signs of a sellar space-occupying lesion which suggested an ectopic production of corticotropin-releasing factor (CRF) as cause of the Cushing's syndrome. CRF concentration in antecubital venous blood was markedly elevated to 280 ng/l. The mediastinal tumour was excised and proved to be a carcinoid histologically. Postoperatively the CRF concentration fell to 70 ng/l. An extract of the carcinoid contained 15.5 ng/g wet-weight of CRF and 254 ng/g wet-weight of beta-endorphin. The patient died 5 weeks postoperatively of sepsis with bilateral pneumonia. At autopsy the hypophysis was of normal size but showed nodular ACTH-cell hyperplasia. This was thus a case of Cushing's syndrome resulting from ectopic CRF production in a mediastinal carcinoid tumour.
Adult↗
Differential diagnosis of immature germ cells in semen utilizing monoclonal antibody MHS-10 to the intra-acrosomal antigen SP-10.
The monoclonal antibody (mAb) MHS-10 (IgG1) is a mouse antihuman sperm antibody which recognizes a polymorphic sperm protein, (SP-10), which has previously been localized within the acrosomal matrix and the acrosomal membranes. The SP-10 antigen has been shown to be sperm-specific and is not found in somatic tissues. It is stage specific, having been immunohistologically localized to Golgi phase spermatids and all subsequent phases of spermiogenesis. In the present study, acetone-dried smears from washed human semen containing significant numbers of round cells were probed with mAb MHS-10. Monoclonal antibody-labeled cells were visualized by a standard streptavidin-biotin immunoperoxidase method using a light microscope. The MHS-10 mAb immunoreacted with mature sperm and with a subset of round cells diagnosed as developing spermatids, which had been sloughed off from the testis at varying stages of acrosome formation. To rule out possible cross-reactivity of the mAb with leukocytes in semen, a leukocyte surface marker (anti-HLe-1) was used in conjunction with MHS-10. Round cell populations staining with MHS-10 did not stain with anti-HLe-1. The mAb MHS-10 is thus a promising probe for the identification and quantitation of immature germ cells in human semen.
Antibodies, Monoclonal↗
[Diagnosis and therapy of hyperinsulinism].
The diagnosis of hyperinsulinism in our 47 patients could be confirmed by clinical signs, blood sugar, insulin and C-peptide estimation. The preoperative localisation of the insulinoma was reached by angiography in 60%, by CT in 50% and by sonography in 10%. Intraoperative tumor localisation by measurement of incorporated P32 was effective in 70%. In 37 patients we enucleated one or more adenomas. In 5 children with Nesidioblastosis the left sided pancreas resection was performed. 5 patients with islet cell carcinoma were treated by duodenopancreatectomy and Streptozotocin. The longest survival time was 6 years.
Adolescent↗
[Transplantation in primary liver cancer].
33 patients with liver malignancy underwent transplantations. The overall survival rate 1, 2 and 5 years after transplantation was 42.4%, 30% and 24.2%, respectively. These figures agree with those of other centres. 16 patients with primary hepatocellular carcinoma had a median survival of 2 years and 2 months and a 5-year-survival rate of 37.5%, the longest followup being more than 11 years. 10 patients with cholangiocellular carcinoma had a 5-year-survival rate of only 10%, the longest followup being more than 6 years. Patients with liver sarcoma and liver metastasis had a low survival rate and high tumor recurrence. Transplantation is generally well accepted for primary hepatocellular carcinoma. For other malignancies it should be considered an exception, provided that extrahepatic tumor spread has been ruled out.
Adenoma, Bile Duct↗