PubMed Health⌕ Search

Biomedical subjects

J M Funovics

Publications and source records attributed to J M Funovics.

17 recordsLinked to original sources
PubMed1991

[Surgical therapy of proximal bile duct cancer].

During the past 13 years a total of 60 patients (33 male, 27 female, median age 64.8 years) were operated upon and 21 of these patients underwent resection with a resectability rate of 35%. The remaining 39 patients had a palliative procedure. In 7 patients some form of bypass procedure was performed. 25 patients underwent some form of drainage procedure and in 7 patients only an explorative laparotomy was undertaken. Patients having resection surgery had a postoperative complication rate of 29% and there were 2 postoperative deaths (9.5%). The complication rate in the palliation group was 38%. The mean survival time in patients operated on with surgical resection was 34.1 months, palliative procedures 4.8 months and in patients with nonresectable tumors 3.6 months. In the resection group (n = 21) curative resection (= R0-resection) was performed in 14 patients, whereas in 7 patients there was a histologically invasion of the bile duct (= R1-resection). The mean survival time in the R0-group was 45.7 months and 11.8 months in the R1-group (Breslow p less than 0.0098, Mantel-Cox p less than 0.0070). We conclude that radical surgical resection offers the best possibility of prolonged survival with a good quality of life in patients with hilar cancer.

Aged↗
PubMed1989

Current trends in the management of carcinoma of the pancreatic head.

Between 1965 and 1987, 783 patients were treated for ductal adenocarcinoma. Of these, 59% had carcinoma of the pancreatic head and 22% presented with carcinoma of the body or tail. In 19% of the cases the entire organ was involved. Two hundred and twenty-six patients (25.5%) underwent exploratory laparotomy; 420 patients (55%) had palliative operations, and 137 (18.5%) were resected for cure. In the past 3 years the resection rate increased from an original 18.5% to 28% (43 resective procedures in 153 patients). In 37 of the 137 patients (28%) surgery had to be extended to the portal vein, the superior mesenteric vein, the kidneys, adrenals, colon, stomach, liver and lymph nodes to ensure adequate radicality. At the same time in-hospital mortality (including deaths after extended procedures) dropped to 7%. Of the 137 patients resected for cure, 47% were alive at 1 year, 22% at 2 years, 12% at 3 years, 7% at 4 years, and 5% at 5 years. Mean survival time excluding in-hospital deaths was 18.65 months. In the first 15 months after surgery there was no difference in survival between standard resections and extended resections. Patients undergoing partial pancreaticoduodenectomy fared significantly better (p less than 0.01; Mantel) than those who had total resections, in terms of both median survival (10.8 versus 5.4 months) and mean survival (19.0 versus 7.82 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Intraductal, Noninfiltrating↗
PubMed1988

Primary hepatic cancer--the role of limited resection and total hepatectomy with orthotopic liver replacement.

Between 1977 and 1986, 172 patients with primary hepatic cancer were treated at the Department of Surgery I, University of Vienna Medical School. In 76 cases (80%) males, 20% females), cirrhosis of the liver was also present. Ninety patients underwent curative surgery (hepatic resection in 64, and liver transplantation in 26 cases). There were no early tumor stages. Forty-five large tumors were confined to one lobe, 42 involved both lobes, 3 even invaded adjacent structures, the majority (74%) being hepatocellular carcinomas. Forty-four of the 64 liver resections were performed in patients with otherwise normal livers (mortality 18%), while 20 patients had associated liver cirrhosis. In view of the extremely high mortality rates after extended liver resection, only limited local resections have been performed in cirrhotic malignancies since 1982 (mortality 25%). Perioperative mortality (25% overall) was due mainly to hepatic failure and sepsis; non-fatal complications occurred in 12 patients (26%). Seventeen of the 26 liver transplants were cirrhotic hepatomas. Nine deaths (34%) were caused by technical problems (graft failure, clotting disorder after massive transfusion) and systemic infections. The outcome for the patient after the immediate postoperative period was determined by tumor regrowth (residual liver tissue, graft, distant metastases) in both groups (median life expectancy 18.4 months after radical liver resection and 18.6 months after liver transplantation). Surgery is the only alternative for these patients (50% survival of untreated hepatoma: 2.6 months), improving both their quality of life and survival. We believe that in carefully selected candidates with non-resectable tumors liver replacement may be a useful alternative.

Carcinoma, Hepatocellular↗
PubMed1987

Progress in reconstruction after resection of the head of the pancreas.

Fistulas of the pancreas due to dehiscence of pancreaticojejunostomy after partial pancreaticoduodenectomy caused severe postoperative complications. Whereas various methods with and without anastomosis of the pancreas are recommended to deal with the pancreatic stump, mortality rates of 20 to 75 per cent have been reported. These different results prompted us to start a prospective, nonrandomized study in which three methods of reconstructing the remnant of the pancreas involving anastomosis were compared with pancreaticocutaneous drainage without anastomosis. One hundred and thirty-one patients with partial pancreaticoduodenectomy entered this trial, 54 female and 77 male patients with an average age of 55.9 years. The indications included: 42 instances of chronic pancreatitis, 44 instances of carcinoma of the pancreas and 45, periampullary carcinoma. We performed 33 end to side pancreaticojejunostomy procedures (four fistulas of the pancreas, a mortality rate of 15.0 per cent), 31 end to end anastomoses (three fistulas of the pancreas, a mortality rate of 6.5 per cent) and 48 double loops with anastomoses of the pancreatic and hepatic duct to separate jejunal loops (nine fistulas of the pancreas, a mortality rate of 2 per cent). Nineteen patients were operated upon using external drainage of the pancreatic stump by means of Penrose drains (five fistulas of the pancreas, a mortality rate of zero per cent). To reduce the fatal risks caused by combined fistulas of the pancreas and biliary tract, the use of separate intestinal loops for anastomoses of the pancreas and biliary tract offers the best solution, since no fatal complications of the pancreaticojejunostomy were observed. In contrast, pancreaticocutaneous drainage was performed upon patients with endangered pancreatic anastomoses due to local morphologic conditions, such as tender pancreatic parenchyma or thin pancreatic ducts. The total loss of exocrine function and the high morbidity rate of 37 per cent is justified in spite of the mortality rate of zero per cent. Total pancreaticoduodenectomy, for technical reasons, represents no acceptable alternative in view of higher mortality rates.

Adult↗
PubMed1986

[Liver resection of hematogenous and infiltrating metastases].

Of a total of 245 resections for hepatic metastases 124 operations were performed for hematogenic metastases and 36 for infiltrating metastases in continuity with the primary tumour. This group of so-called "major hepatic resections" is analysed. The series comprises 83 male and 77 female patients, mean age 62.2 years. There were 85 resections of the right lobe (39 of those with intrahepatic extension to the left), 45 right) and 30 atypical hepatectomies (at least bisegmentectomies). Hematogenic hepatic metastases: 80 resections of hepatic metastases following colorectal carcinoma, 15 following cancer of the stomach and esophagus, 12 after non-gastrointestinal malignant tumours, 4 resections after unknown primary cancer (44% solitary, 32% monolobar multiple, and 24% bilateral metastases); synchronous operations were performed in 32% of the patients, in 19% so-called interval surgery (mean 7.4 weeks), and in 49% metachrone surgery (mean 30 weeks). During 1983 and 1985 our morbidity rate amounted to 10% and the letality rate to 7%, as compared to 17% morbidity and 15% letality in the period 1965-1983. In both periods, septic postoperative complications outnumbered all other causes. The mean survival rate after colorectal carcinoma was 20 months, after non-gastro-intestinal malignant growth 19 months, after carcinoma of the stomach as well as after malignant biliary tract diseases 5 months. The three-year survival rate of colorectal carcinoma amounts to 30%, the five year survival rate to 15% including all metastatic stages. The results of interval and metachrone resections in forms of survival rates are clearly better than the results of synchronous resections with a mean survival time of five months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1978

Brain energy metabolism and alterations of transmitter profiles in acute hepatic coma.

Brain energy reserve, tricarboxylic cycle intermediate and some putative neurotransmitters were measured in a devascularisation model with portacaval shunt and hepatic artery ligation done in two interventions. Conditions were standardized in that physiologic parameters, i.e. body temperature, systemic arterial pressure, PO2, PCO2 and pH, were kept constant and brain tissue was obtained with the "freeze-blowing" technique designed for deep freezing brain substance in less than one second. 1. Measured values indicative of the brain energy reserve (glucose, glycogen, ATP and phosphocreatin) were not found to differ from those of sham-operated animals. 2. Of the stimulating neurotransmitters, norepinephrine, dopamine, glutamic acid and aspartic acids were reduced with the exception of acetylcholine among the inhibitory neurotransmitters GABA and cAMP were unchanged, while all others including serotonin, octopamine, and phenylethanolamine were increased. 3. The results of these experiments suggest that an inbalance of amino acids with resultant changes in neurotransmitter profiles rather than an energy deficit constitutes the factor underlying hepatic coma.

Adenosine Diphosphate↗
PubMed1977

Characteristics of release of duodenal gastrin.

Duodenal gastrin release in the dog was studied after mucosal antrectomy with intact duodenal innervation, following which basal gastrin levels fell. Acetylcholine at pH 7 but not at pH 1.5 and insulin hypoglycemia but not 2-deoxyglucose release duodenal gastrin. Glycine (pH7), physiologic saline (pH 7), and balloon distention failed to release duodenal gastrin. These findings suggest differences in release characteristics between canine antral and duodenal gastrin, and point out species differences between man and dog in respect to release of duodenal gastrin.

Acetylcholine↗
PubMed1977

[Changes in brain metabolism in hepatic coma].

After controlling the physiological parameters during 6 hours of experimental hepatic coma in Sprague-Dawley rats the results show 1. No shortage of brain energy supply of the four main cerebral energy reserves, the brain glycogen is significantly elevated, and the phosphocreatine, ATP and glucose unaltered. 2. No alterations in intermediates of the glycolytic pathway and the tricarboxylic acid cycle in brain tissue. 3. A highly significant decrease in the brain content of the "excitatory" transmitter amino acids glutamate and aspartate. These findings do not support the well-known hypothesis of BESSMAN and BESSMANN and later authors on the role of ammonia in the pathogenesis of hepatic coma.

Adenosine Triphosphate↗
PubMed1976

Brain tryptophan, plasma free tryptophan and distribution of plasma neutral amino acids.

Although rat brain tryptophan is strikingly elevated following portacaval shunt, plasma total tryptophan is unchanged and plasma free tryptophan is not elevated to the same degree as brain tryptophan. Investigation of the concentrations of the neutral amino acids (phenylalanine, tyrosine, methionine, threonine, leucine, isoleucine, and valine) revealed that their distribution and the sum of their concentrations were altered following portacaval shunt, and that this pattern was similar to that seen in humans with cirrhosis of the liver. It is suggested that both the elevation in plasma free tryptophan and the decrease in the competing neutral amino acids, act together to increase the transport of tryptophan into brain when portal blood is diverted around the liver. The implications of these findings in therapy of hepatic coma is discussed.

Amino Acids↗
PubMed1976

[Behavior of gastrin and gastric juice secretion in acute and chronic kidney failure before and after kidney transplantation].

In 50 patients (10 anephric, 10 with chronic renal failure, and 30 with acute renal failure) the correlation was studied between basal PG levels and basal and stimulated gastric acid secretion. a) The mean PG level in all 3 groups was significantly higher than in the control group, with the highest values in the anephric, which decreased to normal after kidney transplantation. b) In the patients with ARF and after transplantation there was a very positive correlation between PG levels and kidney function. c) Hemodialysis decreased PG levels moderately but significantly. d) Gastric acid studies showed in all groups a very low BAO and basal intragastric pH, with a significant release of gastric acid after pentagastrin stimulation, especially in the anephric.

Acute Kidney Injury↗
PubMed1975

An improved nonsuture method for portacaval anastomosis in the rat.

A nonsuture technique is described for performing portacaval anastomoses in rats. Improvements include reduced clamping time on critical vessels, reduced blood loss, uniformly patent anastomoses, easily manufactured buttons, and decreased mortality rates. The new procedure allows a single operator to perform 25 such operations per day, thus substantially increasing the availability of these animals for studies in hepatic metabolism following portacaval anastomoses.

Animals↗
PubMed1975

The role of plasma amino acids in hepatic encephalopathy.

The dog with an end-to-side portacaval shunt has a plasma amino acid pattern similar to that in man with chronic liver disease and encephalopathy. When dogs with end-to-side portacaval shunts manifested symptoms of hepatic encephalopathy, superior caval catheters were placed and one of three solutions was infused. Whereas almost all animals given a commercially available synthetic amino acid mixture died, a special mixture formulated to normalize plasma amino acids was associated with 100 percent survival and few neurological symptoms. The results suggest that manipulation and normalization of plasma amino acids in animals with hepatic failure may be efficacious in providing adequate nutrition while minimizing hepatic encephalopathy. Moreover, these experiments may shed some light on the mechanism of human hepatic encephalopathy.

Albumins↗