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J Boese-Landgraf

Publications and source records attributed to J Boese-Landgraf.

At least 19 recordsLinked to original sources
PubMed1998

[Characteristics of appendicitis in patients over 70 years of age].

Chart review of our patients who were operated for acute appendicitis was performed to characterize the appendicitis in the elder patients. Celiotomy revealed perforation of the appendix in almost 40%, frequently in patients with unspecific symptoms and no leucocytosis. While mortality was 9.2% in the ninteeneighties, non of our patients died during the last 5.5 years. This might be attributed to emergency operation, improved anaesthesia and intensive medical care.

Aged↗
PubMed1997

Detection of focal liver lesions: CT of the hepatobiliary system with gadoxetic acid disodium, or Gd-EOB-DTPA.

PURPOSE: To evaluate the efficacy and safety of gadoxetic acid disodium, or Gd-EOB-DTPA, as a tissue-specific hepatobiliary contrast agent at computed tomography (CT) in patients with liver metastases. MATERIALS AND METHODS: Fifteen patients with known liver metastases underwent CT before and at 30, 80, and, in seven cases, 150 minutes after initiation of intravenous infusion of 0.2, 0.35, and 0.5 mmol Gd/kg gadoxetic acid disodium (five patients per dose group). Attenuation in liver tissue and metastases was measured at each time point. Visualization of metastases, bile ducts, and gallbladder was graded subjectively by two investigators aware of the dose administered and the imaging time point. Patients were monitored for adverse events clinically, and numerous laboratory tests were performed over the 24 hours after administration of the contrast material. RESULTS: The net mean increase in liver attenuation with 0.2, 0.35, and 0.5 mmol Gd/kg was 13 HU +/- 4 (standard deviation), 27 HU +/- 6, and 34 HU +/- 8, respectively. Visualization of liver metastases with doses of 0.35 and 0.5 mmol Gd/kg was graded as good or excellent. Visualization of the gallbladder and common bile duct with doses of 0.35 and 0.5 mmol Gd/kg was improved from minimal to excellent in 89% and 57% of patients, respectively, on 80-minute postcontrast scans. No serious adverse events occurred. Four of 15 patients experienced mild or moderate adverse events possibly or probably related to the contrast medium. Levels of aspartate and alanine aminotransferase increased in three patients by 12-26 and 21-48 U/L, respectively, from normal or moderately elevated baseline levels. These changes may be related to the contrast medium or to the metastases. CONCLUSION: Patient tolerance of gadoxetic acid disodium was acceptable, and liver enhancement and visualization of liver lesions and the biliary system was improved at CT.

Aged↗
PubMed1996

Surgical therapy of gastrointestinal non-Hodgkin's lymphomas.

Within a period of 13 years 39 patients underwent surgery for primary gastrointestinal non-Hodgkin's lymphoma. The stomach was the most frequent site of involvement (26 cases) followed by the small intestine (10 cases) and the large bowel (three cases). Operative procedures included: total gastrectomy (n = 19), subtotal gastrectomy (n = 5), partial gastrectomy (n = 2), small bowel resection (n = 7), right hemicolectomy (n = 5) and sigmoid resection (n = 1). According to Musshoff's modification of the Ann Arbor system, we found stage I in nine, stage II in 12, stage III in two and stage IV in 16 patients. Histological typing according to the Kiel classification showed low-grade malignancy in 11 cases and high-grade in 28. Twenty-eight patients received chemotherapy and/or radiation in accordance with the tumour staging and type of malignancy. The follow-up data were analysed by the method of Kaplan and Meier. Including five patients who died post-operatively from perforated or bleeding lymphomas, the overall 5-year survival rate was 53.8%.

Adult↗
PubMed1996

Positive somatostatin receptor scintigraphy correlates with the presence of somatostatin receptor subtype 2.

Somatostatin receptor scintigraphy (SRS) is positive in approximately 75% of all patients with neuroendocrine gastroenteropancreatic tumours. This study aimed to identify specific somatostatin receptor (sstr) subtypes, which are responsible for the in vivo binding of the widely used somatostatin analogue, octreotide in human neuroendocrine gastroenteropancreatic tumours. Twelve patients underwent SRS with radiolabelled octreotide. After surgical resection, tumour tissues were analysed in vitro for somatostatin and octreotide binding sites by autoradiography. In addition, for the first time, sstr subtype mRNA expression was examined by semiquantitative reverse transcription polymerase chain reaction (RT-PCR). Tumour tissues from all SRS positive patients were positive by autoradiography. Semiquantitative RT-PCR revealed most prominently sstr2 expression in scintigraphically positive tumours. Two SRS negative tumours contained in vitro octreotide binding sites as well as high levels of sstr1 and sstr2 mRNAs. Positive SRS is mainly due to sstr2. sstr1, 3, 4, and probably 5 are less important for in vivo octreotide binding. False negative scintigraphic results seem to be influenced by factors independent of the expression of specific sstr.

Adult↗
PubMed1996

[The fully implantable minimally invasive hepatic artery catheter for locoregional chemotherapy of nonresectable liver metastases in defective conventional implanted therapy catheters].

Dysfunction of arterial access devices used in association with intra-arterial chemotherapy for the treatment of unresectable liver metastases usually requires stopping the therapy or relaporotomy and reimplantation of a new arterial catheter. In this article our initial experience of a new technique, the so-called MIAH catheter (minimally invasive hepatic artery catheter) in 36 patients (age 37-78 years) are reported. The MIAH catheter was percutaneously inserted into the subclavian artery under sonographic guidance and advanced via the descending aorta selectively into the hepatic artery. Finally it was connected to a totally implantable pump. There were no deaths related to the operation. Operative or early complications occurred in 5 cases (13.8%); late complications were seen in 13 patients (36.1%). Nevertheless continuation of intra arterial chemotherapy was possible in all cases. In cases of dysfunction of conventional arterial access devices the MIAH catheter makes it possible to continue intra-arterial chemotherapy without requiring laporotomy.

Adult↗
PubMed1995

Somatostatin receptor subtypes in neuroendocrine tumor cell lines and tumor tissues.

Somatostatin receptor scintigraphy (SRS) is positive in approximately 80% of all patients who have been found to have neuroendocrine (NE) gastroenteropancreatic (GEP) tumors. The reasons for negative results are unclear. The aim of the present study was identification of the specific somatostatin receptor (SSTR) subtypes that are responsible for the in vivo binding of the widely used somatostatin (SST) analogues octreotide and lanreotide in human neuroendocrine gastroenteropancreatic tumors. Ten patients were subjected to SRS with radiolabeled octreotide. Following surgical resection, tumor tissues were analyzed for SSTR subtype mRNA expression by the reverse transcription-polymerase chain reaction (RT-PCR). In addition, SSTR subtype transcripts were investigated by Northern blot analysis and RT-PCR in neuroendocrine tumor cell lines. Expression of SSTR at the protein level was studied by chemical cross-linking experiments. Three patients were negative by SRS. However, RT-PCR revealed most prominently SSTR 2 expression in all tumor specimens. In addition, all tumor tissues analyzed by chemical crosslinking exhibited SST-14 binding sites, indicating that at least some NE tumors were false-negative on SRS.

Animals↗
PubMed1995

[Current treatment strategies in acute distal aortic occlusion].

Forty-eight acute distal aortic occlusions were treated on an inpatient basis from January 1973 to December 1993. The mean age was 66 years. Twenty-seven patients had an acute thrombotic occlusion of the distal aorta, and a cardiogenic embolism was the cause of occlusion in 21 cases. The 43 operated patients evidenced a hospital mortality of 32.6% (14/43) and an amputation rate of 7% (3/43). Reperfusion was achieved in 20 patients solely by remote thromboembolectomy with the aid of a Fogarty catheter. A TEA and patch graft were performed in six patients; an extra-anatomic bypass was established in 9 cases and an aortobifemoral bypass in 8. Severe accompanying cardiac diseases were predominant in the patients with an embolic occlusion, whereas severe arteriosclerotic risk factors prevailed in all those with thrombotic occlusions. The mortality among our patients showed a statistically significant (p < 0.05) correlation only with the preoperative ischemia time.

Adult↗
PubMed1993

[Are there prognostic parameters for predicting the success of regional chemotherapy in nonresectable liver metastases of colorectal cancer?].

When compared with systemic therapy, hepatic arterial chemotherapy significantly increases the response rate for hepatic metastases from colorectal carcinomas. However, only 2 studies showed a significant prolongation of survival. In our study on 54 patients tumor related characteristics and the response to regional chemotherapy were correlated to the success of the treatment. In a linear discriminant analysis the response to regional chemotherapy was the main prognostic factor for the 1-year survival, rate, followed by positive lymph nodes in the Lig. hepatoduodenale. The other pretherapeutic factors such as liver involvement and CEA rate were of less importance.

Adult↗
PubMed1992

Liver tumors: follow-up with P-31 MR spectroscopy after local chemotherapy and chemoembolization.

The authors examined and quantified the changes observed in the phosphorus-31 magnetic resonance (MR) spectra of liver tumors after chemotherapy and chemoembolization to investigate the suitability of P-31 MR spectroscopy for follow-up. A 1.5-T unit was used before and at specific times during therapy to obtain spectra of liver tumors in 10 patients with liver metastases from colorectal carcinoma and two patients with hepatocellular carcinoma. A marked increase in inorganic phosphate and a decrease in the alpha- and beta-nucleotide phosphate portions of the spectra were observed during the first few hours after local chemotherapy or chemoembolization. Later, the phosphomonoester signals increased markedly and the phosphodiester signals decreased slightly. The effects of successful chemoembolization or local chemotherapy become apparent in the P-31 MR spectrum during the first few hours after the start of therapy. The results demonstrate that P-31 MR spectroscopy is a suitable method for follow-up. However, long-term studies are needed to determine whether it also yields prognostic information.

Carcinoma, Hepatocellular↗
PubMed1992

A phase II trial of interferon alpha-2b with folinic acid and 5-fluorouracil administered by 4-hour infusion in metastatic colorectal carcinoma.

Preclinical data suggest that folinic acid as well as interferon alpha-2b may enhance the antitumor activity of 5-fluorouracil (5-FU). In a phase I trial, we recently showed that interferon alpha-2b (IFN), folinic acid and 5-FU can be safely administered with a 4-hour infusion of 5-FU. We therefore initiated a phase II trial evaluating the efficacy and safety of these three drugs. Forty-five evaluable patients with advanced metastatic colorectal cancer, documented progressive disease, and previously unexposed to chemotherapy were treated with sequential IFN 5 MU/d subcutaneously and folinic acid 200 mg/m2/d as bolus on days 1 to 7 followed by 5-FU in a 4-hour infusion at a dose of 500 mg/m2/d, resulting in a total dose of 3,500 mg/m2/course. This schedule was repeated on day 21. A total of 204 courses of therapy were completed. One of 45 patients (2%) achieved a complete response, and 13 of 45 patients (29%) achieved a partial response. An additional 16 patients (36%) had stable disease. The median time to disease progression was seven months (2 to 24 months). Despite the relatively high-dose intensity of 5-FU, toxicity was very mild. Grade 3 or 4 myelosuppression, stomatitis, and nausea/vomiting occurred in only three of 45 patients (7%). Four of 45 patients (9%) suffered from severe (grade 3/4) diarrhea. Neurotoxicity and infections of grade 2 to 4 did not occur. From these data we conclude that modulation of 5-FU with both folinic acid and IFN induces an overall response rate of 31% in disseminated colorectal cancer. Using a 4-hour application schedule of 5-FU, the therapeutic index can be improved even for high-dose intensity and requires further evaluation in combination with other modulators.

Adult↗
PubMed1992

A phase I trial of interferon alpha-2b with folinic acid and 5-fluorouracil administered by 4-hour infusion in metastatic colorectal carcinoma.

Preclinical data suggest that both folinic acid and interferon may enhance the efficacy of 5-fluorouracil (5-FU) in colorectal carcinoma. We therefore initiated a phase I trial evaluating the doses, safety, and pharmacokinetics of the combination of recombinant interferon (IFN) alpha-2b with folinic acid (FA) and 5-FU. Seventeen patients with colorectal cancer who failed local chemotherapy received 5-FU as a 4-hour infusion, preceded by a bolus of FA and IFN. The 5-FU dose was escalated over the range of 400 to 650 mg/m2/d for a period of 7 days. Folinic acid was administered as a bolus in a fixed dose of 200 mg/m2/d and IFN as 5 million U/d subcutaneously on days 1 to 7. A total of 89 courses of therapy were completed for the 17 patients, of which there were 10 paired courses with a combination of 5-FU and IFN or 5-FU alone, being performed to analyze the pharmacokinetics and modulation of 5-FU by IFN. The maximum tolerated dose of 5-FU using this combination and a 4-hour schedule was 600 mg/m2/d for 7 days. The dose-limiting toxicity of this regimen was diarrhea. Mucositis and myelosuppression was not a marked problem at dose levels of 400 and 500 mg/m2/d for 7 days. However, at a dose level of 600 to 650 mg/m2/d for 7 days, grade 3 and 4 (WHO) leukopenia occurred in 50% and mucositis occurred in 33%. At a given dose of 5 million U, IFN did not significantly influence 5-FU serum levels. Mean steady-state serum levels of 5-FU at 500 mg/m2 given as a 4-hour infusion were 16.55 +/- 9.34 mumol/L and 18.23 +/- 12.77 mumol/L with and without IFN, respectively. Mean area under the curve (mumol/L x min) was 4,008 +/- 2,133 and 5,114 +/- 2,567 with and without interferon, respectively. Objective responses were seen in one of 17 of these heavily pretreated patients and stable disease was seen in seven of 17 patients. The recommended dose of 5-FU for use of phase II studies is 500 mg/m2/d for 7 days. We conclude that the toxicity of 5-FU plus FA with and without IFN alpha-2b can be reduced by using a 4-hour infusion instead of a bolus.

Adult↗
PubMed1991

Combined haemoperfusion, haemofiltration and haemodialysis for systemic detoxification in locoregional 5-fluorouracil therapy.

Combined haemoperfusion, haemofiltration and haemodialysis (HPFD) was examined for its systemic effect on 5-fluorouracil (5-FU) kinetics after locoregional application to one female patient with liver metastases of a colon carcinoma. During each HPFD treatment, which lasted 4 h, 5-FU was given via a port-a-cath system into the hepatic artery on 4 separate days. The HPFD extraction rate was 99%. Extracorporal 5-FU clearance (89 ml/min) was 9% of total body clearance (1094 ml/min). The fraction eliminated within 4 h was only 6% of the applied dose (3500-4000 mg 5-FU). Sufficient extracorporal detoxification during combined HPFD can thus not be guaranteed in locoregional chemotherapy with a high dose of 5-FU.

Colonic Neoplasms↗
PubMed1991

[Therapeutic protocols in the treatment of liver metastases].

The liver is the main site for metastatic spread from many cancer, particularly those of the colorectum. Surgical treatment of liver metastases is nowadays a safety therapeutical approach, which has been improved by the development of modern imaging procedures, clear indications and standardized surgical techniques. In carefully selected patients the 5-year survival ranges between 30-40%. Unfortunately only 20% of the patients with liver metastases are candidates for this potentially curative therapy. Palliative modalities remain for the majority of patients with unresectable metastases limited to the liver. Although various types of intrahepatic arterial chemotherapy, sometimes in combination with whole liver irradiation or embolization shows a higher response rate than systemic chemotherapy no significant impact on survival time has been proven. One of the main unsolved problem is the extrahepatic spread. For getting better results--median survival of responders ranges between 18 to 24 months versus 8 months of non-responders--a more exact selection is needed.

Antineoplastic Agents↗
PubMed1991

[Experiences with intraoperative radiotherapy in gastric carcinoma (Berlin method)].

The aim of our pilot study is to determine whether intraoperative radiotherapy in gastric cancer cannot only prevent a local relapse but also improve the survival rate. Since November 1987, 26 patients with resectable gastric cancer were irradiated intraoperatively with the linear accelerator using fast electrons (single dose: 12 to 16 Gy). Percutaneous radiotherapy was performed postoperatively with 24 to 38 Gy (4 x 2 Gy per week). For intraoperative and percutaneous radiotherapy the target absorbed dose was selected in a way that their combined effect on the tumor was approximately equivalent to that of a total dose of 60 Gy in the usual fractionating. Up to now, the median survival time for stage III patients (UICC 1987) has been twelve months. In five patients who died of a relapse or of peritoneal carcinosis, histologic evaluation revealed in every case a diffuse tumor type according to Lauren-classification. All relapses occurred within the first eight months. The two-year survival rate according to Kaplan-Meier is 67% for stage III. Advanced resectable gastric cancer of the intestinal tumor type seems to profit from adjuvant intraoperative radiotherapy. The results warrant further research within the framework of a prospective randomized multicenter study.

Adenocarcinoma↗
PubMed1990

[Combined regional chemotherapy and radiotherapy of liver metastases].

In an attempt to treat patients with non-resectable liver metastases more effectively, hepatic arterial chemotherapy (12 g 5-FU in 3 weeks) was combined with simultaneous whole liver irradiation (8 Gy every week, total dose of 24 Gy). 54 of the 64 patients receiving this treatment had liver metastases from colorectal carcinoma. The objective response rate, judged by CAT scan, was nearly 60%. The median survival of responders was 18 months in contrast to 8 months for nonresponders. There have been 5 lethal complications, 3 of which were related to the combined modality. For safer and better results a more exact selection is needed.

Catheters, Indwelling↗
PubMed1990

[Surgical and oncologic principles of the removal of the rectum].

Excision of the rectum should take in account that the main lymphatic spread follows the cranial route and that dissection of the rectal wall should be performed across its adjacent anatomical lamellae. It is not clear whether an extensive pelvic dissection and high ligature of the inferior mesenteric artery are beneficial. Spontaneous or iatrogenic perforation of the tumour considerable increases the incidence of local recurrence. The frequency of postoperative urinary and sexual dysfunction ranges from 3.5-57% and 14-38% respectively. The reported surgical mortality averages 5-6%.

Follow-Up Studies↗