Biomedical subjects

H-J Gassel

Publications and source records attributed to H-J Gassel.

6 recordsLinked to original sources

PubMed2006

Retroperitoneal gas gangrene after colonoscopic polypectomy without bowel perforation in an otherwise healthy individual: report of a case.

BACKGROUND: Abdominal gas gangrene caused by clostridia species is rare and usually associated with organ perforation, immune suppression, or advanced malignoma. CASE REPORT: A 61-year-old man was admitted with severe back pain 1 day after uncomplicated colonoscopic polypectomy. With the exception of preexisting minor depression, the patient had been previously in excellent health. The computed tomography scan showed retroperitoneal emphysema in the left psoas muscle. During exploratory laparotomy, a spreading retroperitoneal phlegmon with pneumoretroperitoneum and a secondary peritonitis were found. A macroscopic perforation of the gut, particularly at the polypectomy sites was excluded. After the operation, the patient evolved in a septic shock condition and had pulmonary failure. Before hyperbaric oxygen therapy could be employed, the patient died. The autopsy showed a massive gas gangrene of the retroperitoneum caused by Clostridium perfringens, but no macroscopic bowel perforation was detected. RESULTS: This is the first report of a case of gas gangrene after uncomplicated polypectomy without macroscopic perforation in an otherwise healthy individual. A microperforation due to mucosal defect after polypectomy was most likely the entry point for the bacteria. CONCLUSION: We conclude that clostridial myonecrosis should be considered in unclear abdominal infections, even if the patient's history is not typical as in the present case.

Clostridium perfringens↗

PubMed2006

Cytotoxic T-cell response following mouse liver transplantation is independent of the initial site of T-cell priming.

BACKGROUND: Liver transplantation in the mouse results in systemic induction of tolerance. The underlying mechanisms may also account for the persistence of chronic liver infections. It has therefore been hypothesized that antigen (Ag) presentation within the liver by nonprofessional antigen-presenting cells (APC) leads to incomplete T-cell activation, ultimately resulting in tolerance induction. We tested this hypothesis in an orthotopic mouse liver transplantation model. METHODS: Mouse liver transplantation was used to manipulate antigen presentation in major histocompatibility complex (MHC)-disparate donor and recipient strains. The effect of restricted Ag presentation was studied using CD8+ T-cell receptor transgenic OT-I cells. Transgenic OT-I cells were activated by injection of their cognate peptide antigen SIINFEKL, which could be presented by the MHC class I of only one of the mouse strains. Depending on the strain combination, Ag presentation was restricted to either the transplanted liver itself, the recipient (excluding the transplanted liver), or systemically throughout the recipient. Extrahepatic Ag presentation by passenger leukocytes was eliminated by using donors of chimeric bone marrow. RESULTS: OT-I cells encountering antigen only in the transplanted liver were activated, underwent extensive proliferation, and developed effector functions, based on IFN-gamma production and in vivo cytotoxicity assays. This T-cell activation and differentiation within the liver was comparable to animals with systemic Ag presentation and to animals with absent hepatic-parenchymal Ag presentation. CONCLUSIONS: The restricted presentation of antigen in the liver showed no immunosuppressive effect on activation of CD8+ T cells. In contrast, the liver may be an excellent priming site for naive CD8+ T cells.

Animals↗

PubMed2006

Nematode infection of the liver mimicking metastasis of malignant melanoma.

BACKGROUND: The differential diagnoses of a circumscribed mass of the liver are varied. Especially if a malignant tumor, capable of setting metastases to the liver, is known in a patient's medical history, there might be difficulties in differentiating the tumor's entity. CASUISTRY: We report a case of a 40-year-old male with a history of malignant melanoma in whom follow-up investigations revealed a mass in the liver. RESULTS: The histopathological and microbiological results, however, showed an infestation of liver tissue with nematodes. Malignant tumor cells could not be detected. CONCLUSIONS: Roundworm-infections of the liver can present as lesions suspicious of being malignant. Therefore, along with e.g. microhamartoma, microabscesses and hepatocellular carcinoma, infestation with nematodes should be taken into consideration.

Adult↗

PubMed2005

[Nononcologic abdominal surgery in the elderly].

Due to rising life expectancy of the population, the proportion of elderly patients requiring surgery is rising as well. Present aspects of selected, typical, nononcologic diseases of elderly people are discussed. The key to success in their treatment is not to consider primarily the patient's calendrical age but to assess the individual profile of risk factors on the basis of comorbidities. The kind, extent, and timing of an operation has to be based on this assessment. For the treatment of acute diseases (e.g., complicated ulcera, cholecystitis, appendicitis, mesenteric ischemia, and diverticulitis), a rapid and efficacious diagnostic algorithm is essential that takes into account the reduced functional reserve of old people. Constructive interdisciplinary cooperation and minimally invasive techniques play dominant roles in both diagnosis and therapy. Given these prerequisites, there is no reason to withhold surgical intervention from elderly patients.

Abdomen↗

PubMed2003

Prospective pilot study of neoadjuvant chemotherapy with 5-fluorouracil, folinic acid and oxaliplatin in resectable liver metastases of colorectal cancer. Analysis of 42 neoadjuvant chemotherapies.

PURPOSE: Since there are currently no data available from a prospective trial, the primary objective of this prospective study was to investigate whether the rate of R0-liver resections without morbidity would be at least 50 % in patients with neoadjuvant chemotherapy for colorectal liver metastases. PATIENTS AND METHODS: 42 patients were treated with a biweekly FOLFOX regimen. Chemotherapy consisted of a 2-hour infusion of folinic acid (FOL) 500 mg/m2, followed by a 24-hour infusion of 5- fluorouracil (F) 2000 mg/m2 daily for two days. Oxaliplatin (OX) 85 mg/m 2 was given simultaneously with FOL. Treatment allocation was randomized with either 3 or 6 cycles for the final 30 patients. A liver resection was performed 2 to 5 weeks after the final infusion. RESULTS: An objective response was observed in 20 of 42 patients (response rate was 27 % higher after 6 cycles). Liver resection (R0) could be performed in 34 patients. Postoperative complications were reported in 14 patients (13 occurring within 30 days after resection) and severe complications in 5 cases (including two deaths after extended resection). Liver failure and persistent biliary fistula were the most frequently documented complications. There was no relevant difference in safety criteria between 3 and 6 applications. CONCLUSION: The use of neoadjuvant chemotherapy in resectable liver metastases induced significant remissions without increasing morbidity. The rate of severe complications and cases of no R0-resection in this study was 31 % and was with that significantly lower than 50 % (95 % CI 17.6 %-47.1 %). The risk to the patient is therefore acceptable when undergoing neoadjuvant treatment in a prospective intergroup trial.

Adult↗

PubMedDate not supplied

Primary glomangioma of the liver: imaging findings.

Glomus organs are small arteriovenous anastomoses that are chiefly responsible for thermoregulation of the distal portion of the extremities. Glomangiomas are benign tumors of these bodies. Glomangiomas occur preferentially in the fingers and toes, but some case reports have described primary glomangiomas in the respiratory or gastrointestinal tract and the genitals. To date, no glomangiomas of the liver have been observed. We report on a 61-year-old patient in whom routine ultrasound disclosed a subcapsular well-defined mass in the liver. On imaging studies, no correspondence to the usual liver tumors was found. Magnetic resonance-guided biopsy showed a primary glomangioma of the liver. Clinically, the patient had no appetite and lost weight over several months. Due to the patient's weight loss and potential malignant transformation, the tumor was excised. Histologic work-up confirmed the diagnosis of a glomangioma with no signs of malignancy.

Biopsy↗