Conversion operation for alkaline reflux after total gastrectomy and Schloffer reconstruction.
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Anastomosis, Roux-en-Y↗
Biomedical subjects
J Fass
Publications and source records attributed to J Fass.
[Subtotal esophagectomy with stomach transposition as standard operation for adenocarcinoma of the esophagogastric junction].
A modified Ivor Lewis operation was introduced to the surgical treatment of adenocarcinoma of the oesophagogastric junction in an investigative study of 122 consecutive patients. The procedure consisted of a transmediastinal subtotal oesophagectomy with mediastinal lymphadenectomy to the level of the tracheal bifurcation, a proximal 4/5th-gastrectomy with D2-lymphadenectomy and splenic hilar dissection and was completed by a collar oesophagogastrostomy using a gastric tube from the greater curvature. The new concept was followed by good oncologic results without anastomotic recurrencies and a reduction in potential lethal complications like mediastinal anastomotic leakage.
Adenocarcinoma↗
[The outcome of D2 lymphadenectomy on staging and prognosis of stomach carcinoma--a prospective study].
The influence of D2-lymphadenectomy on staging and prognosis of gastric cancer was evaluated in a study including 195 consecutive patients (1986-1994). An impressive state migration could be proven in the UICC stages II, IIIa und IIIb, which led to significant differences in the survival rates for stages II and IIIa. We conclude that an extended lymphadenectomy contributes mainly to the accuracy of staging, while the improvement of the survival rates in studies comparing D1- with D2-lymphadenectomy is caused mainly by stage migration ("Will-Rogers phenomenon").
Gastrectomy↗
Effects of intravenous ketamine on gastrointestinal motility in the dog.
OBJECTIVE: The purpose of this trial was to clarify the effects of intravenous ketamine at anaesthetic and sub-anaesthetic dosages on gastrointestinal motility. DESIGN: 20 beagles (group 1: 3 mg/ketamine/kg/h, n = 10; group 2: 30 mg ketamine/kg/h, n = 10), were investigated. Gastric emptying (nuclide gastric emptying studies, liquid and semi-solid test meal), intestinal transit time (Hydrogen breath test with lactulose) and intestinal motor function (perfusion manometry with 8 measuring ports) were determined. As a control condition, the tests were performed on all dogs in the two groups during infusion of physiological saline solution. RESULTS: No significant differences in the motility patterns were present between 3 mg ketamine/kg/h and the control condition. For group 2, a moderately significant (p < 0.05) increase in the interdigestive motility index was observed for 30 mg ketamine/kg/h. However, this did not change the transit criteria. There was no significant difference between ketamine and control condition tests with regard to cycle and phase lengths or the propagation rate of the activity front. CONCLUSIONS: We conclude that ketamine provokes no basic changes in gastrointestinal motility, at either sub-anaesthetic doses. It can therefore be used to advantage in the continuous postoperative analgesia of intensive care patients, where repeated interventions are necessary and no cardiopulmonary contraindications are present.
Anesthetics, Dissociative↗
[Esophageal replacement--indications, technique, results].
Between November 1985 and January 1994 a total of 239 patients were operated for replacement of the esophagus and primary reconstruction. Of these 3 had benign disease and 236 had malignancy. Continuity of the alimentary tract was restored in 202 cases by stomach transposition, in 16 cases by colon interposition and in 21 cases by free jejunal autograft. Complication rate of surgical resection was 36.8%, lethality 5.1%. Lethality of coloninterposition was as low as for gastric transposition (6.3 vs 5.5%). None of the patients with free jejunal autograft died during hospital course (p < 0.001). Survival rates by life-table analysis for the whole group were 65%, 42%, 36%, 32%, and 22% after 1, 2, 3, 4 and 5 years, respectively. The malignant tumors consists of 111 esophageal carcinomas, 104 carcinomas of the esophagogastric junction and 21 carcinomas of the hypopharynx. 15.1% of the tumors were staged I, 42.7% II, 35.7% III and 6.5% IV. The collectives for esophageal carcinoma and cardia carcinoma were equal for age, sex, and distribution of tumor stages. The survival rates for both groups were similar. Differences occurred in a three times higher rate for concomittant hiatal hernia and history of reflux esophagitis in the cardia carcinoma group.
Adult↗
F-18 fluorodeoxyglucose PET in vivo evaluation of pancreatic glucose metabolism for detection of pancreatic cancer.
PURPOSE: To evaluate positron emission tomography (PET) with fluorine-18-labeled fluorodeoxyglucose (FDG) for detection of pancreatic cancer compared with computed tomography (CT) and ultrasonography (US). MATERIALS AND METHODS: Forty patients with suspected pancreatic cancer underwent static PET after intravenous injection of 150-300 MBq FDG. Focal FDG accumulation was regarded as a sign of malignancy and was quantitated by calculating differential uptake ratios (DURs) and tumor-liver ratios (TLRs). RESULTS: Malignancy was histologically proved in 27 patients. PET helped correctly classify 25 of 27 malignant conditions and 11 of 13 benign disorders. DUR and TLR were statistically significantly higher in malignant compared with benign disease (P < .01). False-negative findings were obtained in patients with insulin-dependent diabetes. False-positive findings were noted in a patient with retroperitoneal fibrosis and in one with pancreas divisum with chronic pancreatitis. PET was superior to CT and US in detection of lymph node metastases (13 of 17 vs three of 17 or one of 15, respectively. CONCLUSION: FDG PET has the potential to improve the detection of lymphadenopathy and the differential diagnosis of pancreatic masses.
Adenocarcinoma↗
Measuring esophageal motility with a new intraluminal impedance device. First clinical results in reflux patients.
BACKGROUND: The study was undertaken to determine the validity of intraluminal impedance measuring for the diagnosis of esophageal motility disorders in reflux patients. METHODS: A new impedance device was used for the detection of esophageal motility patterns in a prospective study with 10 volunteers and 10 patients with reflux esophagitis grade II-III. Perfused manometry was correlated with the impedance tracings. Test meals were saline and curd in three different preparations with liquid to semisolid viscosity. RESULTS: There was a marked delay in esophageal transport with increasing viscosity of the bolus (p < 0.01). A significant (p < 0.001) delay of the bolus transport in the inflamed esophageal areas was seen in reflux patients. A reduced contractility of the lower esophagus and the lower esophageal sphincter was detected by the impedance procedure in reflux patients, indicating that the pathologic motility patterns in reflux esophagitis are most likely secondary to the tissue inflammation. CONCLUSION: We conclude that impedance procedures may give additional significant information about bolus transport and esophageal wall movements.
Adult↗
[Prognostic improvement by R1 and R2 lymphadenectomy in stomach carcinoma].
In 1986 systematic R2 lymphadenectomy was introduced into the surgery for gastric carcinoma in our institution. In an historic analysis 381 patients of the years 1980-1992 were investigated. The effect of R2 lymphadenectomy was studied after R0 resection and exclusion of inhospital mortality. 81 matched pairs of patients with and without lymphadenectomy (LA) were restaged according to the latest classification of the UICC (1987) and compared in an univariate and multivariate analysis. A significant improvement of the estimated 5-year survival-rate was only seen in UICC-stages II (p = 0.05), IIIA (p = 0.01) and patients without lymph node metastases (pN0, p = 0.01). The multivariate analysis did not show an independent effect of LA on prognosis but of the oncological parameters pT and pN (p = 0.0001). We conclude that LA improves the prognosis of gastric carcinoma in certain early stages but the effect is not as impressive as expected.
Female↗
Uptake of radiolabeled anti-CEA antibodies in human colorectal primary tumors as a function of tumor mass.
An inverse correlation has been demonstrated between tumor uptake (u, in units of % injected dose/kg) of monoclonal antibody (Mab) and tumor mass (m, in units of g) for colorectal carcinoma in a series of 19 consecutive patients. The correlation (rho = -0.510), developed using surgical samples was of the form u = amb and was significant at the 2% level of confidence. All tumors were positive for carcinoembryonic antigen (CEA) and the radiopharmaceutical was an iodine-131 labeled anti-CEA Mab. Such correlations have been predicted earlier from murine and rat tumor uptake data. The slope parameter (b) was -0.362, a number consistent with the previous value (-0.382) found in anti-CEA experiments in mice bearing human xenograft LS174T tumors.
Carcinoembryonic Antigen↗
[Intestinal motility after jejunum interposition and Roux-Y reconstruction--an animal experiment study].
An experimental study in animals was conducted to evaluate the motility patterns after total gastrectomy. Eight male beagle dogs (22.5-27.2 kg) had total gastrectomy with standardized designs of gastric substitution: (1) jejunal interposition (JI, n = 4); (2) Roux-en-Y reconstruction (RY, n = 4). Motility patterns were detected with perfused manometry (eight measuring ports), sequential scintigraphic emptying studies of the gastric substitute (caloric and acaloric medium viscosity test meals), and a hydrogen breath test with lactulose. The preoperative studies of the same individuals served as controls (CO). To detect postgastrectomy adaptation processes the postoperative studies were conducted 6-8, 12-14, and 24-30 weeks after total gastrectomy. The emptying of the gastric substitutes was markedly accelerated compared with CO after 6 months (T50: 5.8-8.1 min). In contrast to the preoperative studies, caloric test meals caused a trend to increase the velocity of the evacuation. The intestinal transit time was accelerated too in the weeks immediately, after the operation. In JI dogs intestinal transit was then markedly slowed and led to a highly significant difference after 6 months compared to RY animals (CO: 101 +/- 26min, JI: 104 +/- 18.2min, RY: 71.3 +/- 13.4min; p < 0.01). Pathologic motility patterns could be identified as the cause of this observations: RY dogs showed a marked increase of the intestinal motility index in the proximal jejunum (p < 0.0001) and a dissociation between the motility patterns of the duodenum and the gastric substitute. The observations gave rise for the supposition that this parts of the small bowel might generate two independent pacemarkers that both influence the lower intestinal parts after RY reconstruction. We conclude that the motility patterns of the entire small bowel highly influence the postoperative function of reconstruction procedures after total gastrectomy. The emptying velocity of the jejunal gastric substitute does not seem to have a major influence on the postoperative results. According to motility patterns jejunal interposition has a better outcome than Roux-en-Y reconstruction.
Anastomosis, Roux-en-Y↗
[Radioimmunoscintimetry for intraoperative lymph node diagnosis in colorectal cancer].
In a prospective study 32 patients with primary colorectal carcinomas were studied by means of radioimmunoscintigraphy with the anti-carcinoembryonic antigen monoclonal antibody BW 431/26 labelled with either 131I (group 1, n = 17) or 99Tc (group 2, n = 15). Scintigraphy of the resected specimen was used as a model for intraoperative radioimmunoscintimetry, and all positive lymph nodes were marked during the investigation. The results were compared with the data yielded by preoperative investigations (CT, MR, endosonography) and checked by histology and immunohistochemistry. The analysis (sensitivity, specificity) included: type of investigation, time interval from antigen application, type of radionuclide, size of lymph nodes investigated, and serum level of CEA. 131I-Scintigraphy of the resected specimen gave the best results in the detection of lymph node metastases (sensitivity 1, specificity 0.57) and was superior to all other diagnostic procedures. When the investigation was performed 6-8 days after administration of the antibody the specificity improved to 1. The best results (sensitivity 1, specificity 0.91) were achieved in small (< 1 cm) lymph node metastases. A good correlation between scintigraphic diagnosis and immunohistochemical CEA detection was confirmed. Serum levels of CEA had no influence on the scintigraphic results. We conclude that intraoperative radioimmunodetection of lymph node metastases may improve the radicality in the resection of colorectal tumors. The best results are achieved with 131I-labelling and with application of the antibody 6-8 days before the operation.
Aged↗
Pancreatic cancer detected by positron emission tomography with 18F-labelled deoxyglucose: method and first results.
In order to evaluate the utility of positron emission tomography (PET) with 18F-labelled deoxyglucose (FDG) for detection of pancreatic cancer 15 patients with pancreatic masses shown by computed tomography were investigated. Static PET scans covering an axial field of view of 15 cm were obtained 45 min after intravenous injection of 150-300 MBq FDG. Focally increased FDG accumulation was present in 12 out of 13 patients with histologically proven adenocarcinoma, in particular in eight of nine lymph node and four of five liver metastases. Scans of two patients with chronic pancreatitis confirmed by surgery revealed a normal FDG distribution. Contrast between tumour and normal tissue depended the metabolic situation prior to FDG injection. High ratios were found in fasting patients whereas no elevated FDG uptake was measured in an insulin-dependent diabetic suffering from carcinoma of the pancreatic head. We conclude that FDG PET might have the potential for detection and even differentiation of pancreatic carcinoma from chronic pancreatitis. Further studies are necessary to substantiate these preliminary findings and to optimize results in diabetic patients.
Adenocarcinoma↗
[Accidental injuries of the urogenital tract within the scope of visceral surgery interventions].
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Anastomosis, Surgical↗
[Type of stomach replacement and intestinal motility after total gastrectomy].
68 disease free patients were investigated prospectively after jejunal gastric replacement [jejunal interposition (JI): n = 40; Roux en Y reconstruction (RY): n = 28]. Used function tests were: scintigraphic emptying studies, hydrogen breath test, hepatobiliary sequential scintigraphy, oral glucose tolerance test, and upper intestinal manometry with 5 measuring ports (times of investigation: 6-12. week and > 1 year postoperatively). Patients with JI showed a better weight gain (p = 0.001), a lower reflux rate (p = 0.01), a slower orocecal transit time (p = 0.05), a prompter bile flow after meal stimulation (p = 0.02), and lower peak glucose levels (p = 0.001). The emptying patterns of the different gastric substitutes were not different. A higher incidence of retrograde contractions in RY and a electromechanical coordination between duodenum and gastric substitute in JI were detected. We conclude that the postoperative function of the jejunal gastric substitute does not depend on it's emptying pattern or volume but on the motility patterns of the entire intestinal tract which seem to be strongly influenced by the choice of the jejunal reconstruction.
Adenocarcinoma↗
Quantitative analysis of anti-CEA antibody accumulation in human colorectal carcinomas.
In order to obtain quantitative data on intratumoral antibody accumulation we analyzed resected colorectal adenocarcinomas of 25 patients who had undergone immunoscintigraphy 4-14 days earlier. All had been injected with 0.5-1.0 mg intact anti-CEA antibody (BW 431/26) labelled with 70-80 MBq131I. Correlation of tissue radioactivity concentrations with tumor characteristics revealed significantly higher values in necrotic compared to viable as well as in CEA-positive compared to CEA-negative viable tumor tissue indicating action of both specific and unspecific uptake mechanisms. In contrast, diagnostic results of immunoscintigraphy were influenced by tumor size only. 11 of 12 false-negative findings were obtained in tumors < 4 cm in diameter. Since ex-vivo scintigraphy of resected specimens correctly visualized all but one of these lesions, it is concluded that technical limitations of scintigraphy are the main cause of negative results of radioimmunoimaging with 131I-labelled antibodies.
Adenocarcinoma↗
PET with fluorine-18 deoxyglucose for pancreatic disease.
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Deoxyglucose↗
The radiation dose to surgical personnel during intraoperative radioimmunoscintimetry.
To estimate the radiation exposure to surgical personnel caused by intraoperative radioimmunoscintimetry, we measured dose rates at different distances from patients who had been injected with 950 MBq technetium-99m-labelled intact carcinoembryonic antigen (CEA)-specific antibodies (Szintimun CEA, Behring AG Marburg, FRG) for immunoscintigraphy 24 h earlier. At 0.05 m (corresponding to working positions during surgery) we found 2.0-16.0 microSv h-1 (average 6.4), which is similar to results for nuclear medicine staff. Thus, if radioimmunoscintimetry is to become a routine procedure, according to national regulations in some countries of the European Communities surgical personnel might be regarded as professionally exposed to radiation.
Colorectal Neoplasms↗
[Results of treatment in esophageal cancer].
204 patients were treated for esophageal cancer from 1.1.1986 until 1.6.1992 (carcinoma of the hypopharynx: n = 12, adenocarcinoma of the endobrachyesophagus: n = 82, primary esophageal cancer: n = 110). Out of the primary esophageal cancers 84 tumors (76%) were resected and 24% had palliative endoscopic and/or irradiation therapy. The stage distribution of the resected patients was: stage I: 7.1%, stage IIa: 35.7%, stage IIb: 11.9%, stage III: 33.3%, stage IV: 11.9%. The total morbidity of the resected patients amounted to 32.1%, the 30 days mortality to 7.1%, and the in hospital mortality to 9%. These data show no significant difference to the results of palliative endoscopic procedures (morbidity: 42.3%, mortality: 7.7%). None of the conservatively treated patients survived longer than 12 months whereas resected individuals had a 5-year-survival rate of 20%. The most predictive factors for prognosis were: Depth of tumor invasion (p less than 0.01), R-classification (p less than 0.05), and the lymphonodular status (p less than 0.05). A perioperative irradiation was effective in T3- and T4-tumors.
Adenocarcinoma↗