PubMed Health⌕ Search

Biomedical subjects

J M Müller

Publications and source records attributed to J M Müller.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Keloid of the earlobe after ear piercing. Not only a surgical problem].

Earlobe keloids are benign, fibrous proliferations that show a high rate of recurrence of up to 80% following surgical excision. Traumas to the earlobe such as ear piercing, burns or surgical interventions are important in the pathogenesis of the disease. In addition to surgical keloid excision and reconstruction of the earlobe, several adjuvant therapeutic concepts have been described to prevent recurrence. Here we present the case of a female patient who suffered from severe bilateral keloid development after piercing of both ears. The report gives an overview of the relevant therapeutic concepts in the treatment of earlobe keloids and their possible complications. In addition, the question of written informed consent before ear piercing is discussed.

Combined Modality Therapy↗
PubMed2002

[What is the value of the internet as a source of information for patients with inguinal hernias? First results of an observational study].

INTRODUCTION: The increasing use of the internet has led to a variety of medical web pages and an increasing amount of information about hospitals. Little is known about the extent to which this new medium is already used by patients as a source of information. For patients with inguinal hernia, for example, a frequent surgical symptom with large method variety, the value of the internet as a source of information should be examined. METHODS: One hundred patients facing an elective inguinal hernia repair at the Surgical Department Charité Berlin took part in a prospective observation study (a questionnaire with 10 questions) between July 1999 and March 2001. The questions referred to the possibility of PC/internet access, other sources of information (e.g., general practitioner, friends, internet) as well as the criteria by which the clinic was chosen. Patients were asked to answer basic questions about the development and treatment of inguinal hernia and to give a self-assessment of their knowledge of inguinal hernia (0 = no knowledge; 10 = maximum knowledge). RESULTS: The questionnaire revealed that 39% of the patients (average age 47 +/- 16 years) had a PC in their homes, 24% of those with internet access; 11% had internet access at other places. It also showed that 53% of the patients sought medical information from their general practitioner, 29% from friends, and 18% from the internet. Young patients (median age 29 years), employees and patients with private internet access use the internet with significantly more frequency. Their medical knowledge as well as their self-assessment of medical knowledge was significantly higher (median 19 versus 7 points and median 8.6 versus 5.7, respectively) and they chose the clinic because of the information from their research on the internet. CONCLUSION: At present, the internet still plays a subordinate role as a source of information for patients with an inguinal hernia. The increasing presence of this medium as well as the higher internet acceptance of future patients indicates that it has a promising future as a source of medical information.

Adult↗
PubMed2002

Immunomodulatory changes in patients with colorectal cancer.

BACKGROUND AND AIMS: Solid tumors are frequently accompanied by a depressed cellular and humoral immunity. This study analyzed changes these factors in colorectal cancer patients. PATIENTS AND METHODS: We compared cellular (leukocytes, lymphocytes, HLA-DR expression on monocytes) and humoral immune parameters (interleukin-6, interleukin-10, tumor necrosis factor alpha) in 40 patients with colorectal cancer and in 18 healthy controls. RESULTS: Leukocytes were in the normal range in patients and controls. However, tumor patients showed significant lymphopenia in comparison to controls. HLA-DR antigen expression on CD14+ monocytes was reduced in the cancer patients while IL-6 and IL-10 plasma levels were increased. Patients with UICC stage III had IL-6 and IL-10 concentrations were significantly increased as well. CONCLUSIONS: These findings suggest that colorectal tumor establishment and progression results in a malfunction of the immune system, and underline the importance of elucidating in detail the mechanisms of immune modulation in cancer patients.

Case-Control Studies↗
PubMed2002

Effects of Celebrex and Zyflo on liver metastasis and lipidperoxidation in pancreatic cancer in Syrian hamsters.

Selective inhibition of eicosanoid synthesis is thought to have effects on carcinogenesis in lung and colon cancer. However, it is still unknown whether pancreatic cancer might also be influenced. Therefore we evaluated the impact of selective cyclooxygenase-2 inhibitor Celebrex and selective 5-lipoxygenase inhibitor Zyflo on liver metastasis in a solid model of pancreatic adenocarcinoma in Syrian hamster. In week 33, the animals were sacrificed and incidence of pancreatic carcinomas and number and size of liver metastases were determined. Activities of antioxidative enzymes (GSHPX/SOD) and concentrations of products of lipidperoxidation were measured in liver metastases and non-metastatic hepatic tissue. The incidence (54.5 vs. 100%), number (3.17 +/- 0.98 vs. 6.75 +/- 0.71) and size (2.67 +/- 1.97 vs. 11.75 +/- 1.98 mm2) of liver metastases were decreased by combined therapy of Zyflo and Celebrex (P < 0.05). Furthermore, activities of GSHPX ([73.77 +/- 5.67]*10(5) vs. [15.49 +/- 4.02]*10(5) U/mg prot.; P < 0.05) and SOD (474.92 +/- 108.8 vs. 127.89 +/- 38.75 U/mg prot.; P < 0.05) were increased, while lipidperoxidation (0.31 +/- 0.08 nmol/mg prot. vs. 1.54 +/- 0.55 nmol/mg prot.; P < 0.05) was decreased by combination therapy, in non-metastatic hepatic tissue. Moreover, combined therapy increased lipidperoxidation in liver metastases (0.47 +/- 0.09 vs. 1.95 +/- 0.12 nmol/mg prot.; P < 0.05). Thus, a combination of Celebrex and Zyflo might be a new concept to decrease tumour growth in liver metastases in advanced pancreatic cancer.

Animals↗
PubMed2002

[Changing surgical therapy because of clinical studies?].

The randomised controlled clinical trial (RCT) is a powerful instrument to evaluate different therapeutic regimens. In a survey among 115 physicians visiting the 25th annual meeting of the Surgical Society of Berlin and Brandenburg, the RCT was judged to be very important when changes of therapeutic strategies are discussed. 90 % of all participants claimed to use data from RCTs in the clinical routine and 89 % would participate in such a trial. In official (e. g. discussions during coffee breaks at scientific meetings) or non-medical (e. g. non-scientific press or media) sources of information were assessed as irrelevant for decisions regarding therapeutic strategies. However, in contrast to this view laparoscopic cholecystectomy was introduced into clinical practice rapidly because patients informed by external (non-medical) sources preferred to be operated on with the "modern" technique. Clinical trials with a high level of evidence had no relevant influence on the rapid distribution of laparoscopic cholecystectomy. Controversial discussions concerning the extent of lymphadenectomy with gastric resection for carcinoma demonstrate that the value of excellent clinical RCTs is low if their results challenge a stable paradigma of the surgical scientific society. To allow a rational judgement, new surgical technologies should undergo a scientific gradual evaluation in agreement with the principles of evidence based medicine.

Attitude of Health Personnel↗
PubMed2002

[Aortic reconstruction and resection of malignant tumors--one- or two-stage procedure?].

Surgical tactics in case of aortic aneurysms and simultaneously performed cancer resections are not uniform and still remain a matter of debate. From Jan. 1, 1995 - Oct. 31, 2001 we operated on 37 patients suffering from aortic aneurysms (34 infrarenal, 2 combined thoraco- abdominal, 1 thoracic aneurysm) and cancer (11 esophageal, 6 gastric carcinomas, 3 small-bowel tumors, 5 large-bowel, and 12 renal carcino-mas). None of the above mentioned patients presented with any graft infection, or other severe p. op. complications. According to these results, the one-stage operation of aortic aneurysms and cancer resection is feasible if appropriate care is given to patients selection, technical details and the rules of antisepsis, without affecting surgical morbidity and mortality.

Aged↗
PubMed2002

Effects of Celebrex and Zyflo on BOP-induced pancreatic cancer in Syrian hamsters.

BACKGROUND/AIMS: Selective inhibition of eicosanoid synthesis decreases inflammation, however, it is still unknown whether oxidative stress and carcinogenesis might be influenced in ductal pancreatic ductal cancer as well. METHODS: 120 male hamsters were randomized into 8 groups (n = 15). While control group 1-4 received 0.5 ml normal saline s.c. weekly for 16 weeks, groups 5-8 were injected 10 mg BOP/kg body weight to induce pancreatic cancer. After establishment of pancreatic cancer, groups 1 and 5 received no therapy, groups 2 and 6 were fed 7 mg Celebrex daily, groups 3 and 7 were given 28 mg Zyflo and groups 4 and 8 received Celebrex and Zyflo orally daily in weeks 17-32. In week 33, all animals were sacrificed, macroscopic size of pancreatic carcinomas was measured, incidence of pancreatic cancer was analyzed histopathologically and activities of antioxidative enzymes and concentration of products of lipid peroxidation in tumor-free and pancreatic intratumoral tissue were determined. RESULTS: Incidence and size of macroscopic pancreatic carcinomas were decreased by single therapy with Zyflo as well as combined therapy (Zyflo + Celebrex). Activities of antioxidative enzymes were increased and the concentration of products of lipid peroxidation was decreased in tumor-free pancreas. On the other hand, lipid peroxidation was increased in pancreatic tumors. CONCLUSION: Zyflo alone or in combination with Celebrex reduce tumor growth in pancreatic cancer and thus might be a new therapeutic option in advanced pancreatic cancer.

Adenocarcinoma↗
PubMed2002

Immunologic changes during minimally invasive surgery.

Although recent experimental and clinical trials have documented that postoperative inflammation and changes in different immunologic parameters are less pronounced after laparoscopic approaches in comparison to open surgery, it still remains unclear what influence the pneumoperitoneum itself has on immunologic defense and function. This is mainly due to the endpoints of the different studies which investigate changes in the so-called immunologic parameters (cell subunits, C-reactive protein, cytokines, catecholamines or other stress hormones in plasma samples) rather than analyzing immunologic functions, such as cell activation, production of proteins, cell proliferation or in vivo immune defenses. So far, especially in clinical trials, no correlation has been demonstrated between the changes in immunologic parameters and relevant postoperative clinical endpoints, such as postoperative complications. Thus further clinical prospective randomized studies with relevant clinical endpoints and additional investigations of immunologic parameters are needed to prove the consequences of either minimally invasive surgery or open procedures on postoperative immune functions.

C-Reactive Protein↗
PubMed2002

Laparoscopic gastric banding after heart transplantation.

BACKGROUND: Obesity often complicates the postoperative course of heart transplant recipients. Laparoscopic adjustable gastric banding (LAGB) represents a minimal invasive therapeutic possibility for weight reduction in non-transplanted patients. CASE REPORT: We report a 55-year-old diabetic, morbidly obese male (weight 138 kg, height 173 m, BMI 46 kg/m2) in whom 6 years after orthotopic heart transplantation, LAGB and laparoscopic cholecystectomy were successfully performed. At follow-up of 28 months, the patient has lost 32 kg. His present weight is 106 kg (BMI 35.4). Diabetes improved, and oral diabetic medication was withdrawn. Cyclosporine dosage has not had to be changed after LAGB. CONCLUSION: In morbidly obese transplanted patients, LAGB should be considered as an effective alternative to dietetic measures to enable weight reduction and to improve comorbidities. In contrast to bariatric malabsorption techniques, like jejunoileal bypass and gastric bypass, cyclosporine pharmacokinetics do not appear to be influenced by gastric banding.

Bandages↗
PubMed2001

Laparoscopic esophagogastrostomy: an alternative minimally invasive treatment for achalasia stage III.

BACKGROUND: The surgical treatment for stage III achalasia with markedly dilated and sigmoid-shaped esophagus is a matter of controversy. Some authors recommend esophagectomy as the primary treatment because they believe that Heller myotomy cannot improve dysphagia in such cases. We present a patient with achalasia stage III in whom we successfully performed a laparoscopic esophagogastrostomy with posterior semifundoplication. METHODS: Using a five-trocar technique, the esophagogastric junction and the distal esophagus up to the tracheal bifurcation were dissected. An endoscopic stapler (Endo-GIA II) was inserted through a small gastrotomy at the cardia, with one branch placed in the gastric fundus and the other, under esophagoscopic control, in the esophagus. By two consecutive stapler applications, a wide side-to-side esophagogastrostomy was created. To prevent gastroesophageal reflux, a posterior semifundoplication was performed. RESULTS: The operation time was 170 min. Oral food intake was started after radiologic control on postoperative day 7. Radiologic study showed rapid passage of the barium meal and no reflux through the gastroesophageal junction. CONCLUSIONS: Laparoscopic esophagogastrostomy with posterior semifundoplication represents an alternative to esophagectomy and laparoscopic Heller-Dor surgery. Because of the wide side-to-side anastomoses, there is no risk of persisting stenosis such as that reported for the Heller operation, and the procedure certainly is less invasive than esophagectomy. As compared with laparoscopic extramucosal myotomy using anterior Dor fundoplication, it presents about the same technical difficulties.

Aged↗
PubMed2001

Cellular and humoral inflammatory response after laparoscopic and conventional colorectal resections.

BACKGROUND: Surgical trauma and anesthesia are known to cause transient postoperative suppression of the immune system. In randomized controlled trials, it has been shown that laparoscopic colorectal resections have short-term benefits not observed with conventional colorectal resections. We hypothesized that these benefits were due to the reduction in surgical trauma, leading to a diminished cytokine response and less depression of cell-mediated immunity after laparoscopy. METHODS: In a prospective randomized trial, colorectal cancer patients without evidence of metastatic disease underwent either laparoscopic (n = 20) or conventional (n = 20) tumor resection. Postoperative immune function was assessed by measuring the white blood cell (WBC) count, the CD4+ and CD8+ lymphocytes, the CD4+/CD8+/ratio, and the HLA-DR expression of CD14+ monocytes. In addition, the production of interleukin-6 (IL = 6) and TNF-a were measured after ex vivo stimulation of mononuclear blood cells with lipopolysaccharide (LPS) and compared to the plasma levels of these cytokines. Postoperative mean levels of the immunologic parameters for the two groups were calculated and compared using the Mann-Whitney U test. RESULTS: Preoperatively, there were no differences between the two groups in terms of patient characteristics or immunologic parameters. Although the postoperative peak concentrations of white blood cells were significant lower in the laparoscopic group than the conventional group (p < 0.05), there were no differences between the two groups in the subpopulation of lymphocytes (CD4+, CD8+). HLA-DR expression of CD14+ monocytes was lower in the conventional group on the 4th postoperative day (p < 0.05). The laparoscopic group showed higher values in cytokine production of mononuclear blood cells after LPS stimulation. Postoperative plasma peak concentrations of IL-6 and TNF-a were lower after laparoscopic resection. CONCLUSION: Postoperative cell-mediated immunity was better preserved after laparoscopic than after conventional colorectal resection. Cellular cytokine production was preserved only in the laparoscopic group, while cytokine plasma levels were significantly higher in the conventional group. These findings may have important implications for the use of laparoscopic colorectal resection, especially in patients with malignant disease.

Aged↗
PubMed2001

Identification of six methylenetetrahydrofolate reductase (MTHFR) genotypes resulting from common polymorphisms: impact on plasma homocysteine levels and development of coronary artery disease.

Although three common MTHFR polymorphisms (C677T, A1298C, T1317C) have been reported, only polymorphism C677T has been investigated intensively as a risk factor for coronary artery disease (CAD). We investigated polymorphism frequencies, allelic associations and the effect of the resulting MTHFR genotypes on total plasma homocysteine (tHcy) levels and on coronary risk in a case-control study with 1000 angiographically confirmed Middle-European CAD patients and 1000 matched controls. Three out of four theoretically possible MTHFR haplotypes were detected: *1 (677C, 1298A), *2 (677T, 1298A), and *3 (677C, 1298C). The frequencies were *1: 36.4 and 34.4%; *2: 30.8 and 32.3%; and *3: 32.8 and 33.3%, in cases and controls, respectively. Only one patient was heterozygous for 1317C. None of the six resulting genotypes showed significant influence on tHcy levels. Moreover, there was no significant association with CAD risk or with disease severity or early disease manifestation. In the subgroup presenting with acute coronary syndromes, MTHFR genotypes *2/*3 and *3/*3 were surprisingly underrepresented (relative risk of *3/*3, 0.40; 95% confidence interval 0.20-0.79, P=0.009). We conclude from our genotype-based analysis that, in this well-fed Middle-European population, the observed common allelic variants of the MTHFR gene have no significant influence on tHcy levels or on the chronic process of CAD development.

Coronary Disease↗
PubMed2001

The impact of conventional and laparoscopic colon resection (CO2 or helium) on intraperitoneal adhesion formation in a rat peritonitis model.

BACKGROUND: Although postoperative intra-abdominal adhesion formation has been shown to be less with laparoscopic procedures than with open surgery, the extent of intraperitoneal adhesion formation after open and laparoscopic colon resection in patients with intra-abdominal infection remains unclear. METHODS: A standardized fecal inoculum was intraperitoneally applied in 72 rats to induce peritonitis. The rats were randomized into four groups. The three experimental groups underwent laparoscopic resection of the cecum with carbon dioxide (n = 20) or helium (n = 20) insufflation at a pressure of 8 mmHg, or conventional open cecum resection (n = 20). In the control group, no further manipulations were performed after induction of the peritonitis (n = 12). Blood samples were taken during the perioperative course to determine the plasma levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10). The number of intraperitoneal adhesions and the bacterial species of peritoneal swabs were determined in each animal. RESULTS: The adhesions were increased in all operation groups as compared with the control group. The number of adhesions was significantly greater after conventional resection than after laparoscopic approaches (p < 0.01). The overall adhesion score was significantly lower in the helium group (p < 0.05) than in the two other operation groups. There was no difference between the laparotomy and carbon dioxide groups. Whereas postoperative TNF-alpha plasma levels were decreased, IL-10 levels were significantly greater in the helium group than in the other three groups. CONCLUSIONS: Intraperitoneal infection is reducing the benefit of laparoscopic surgery regarding postoperative adhesions. Although laparoscopic resection showed an advantage in the number of adhesions with both gases, the total adhesion score was lowest in the helium group.

Animals↗
PubMed2001

[Laparoscopic surgery of the upper gastrointestinal tract].

Laparoscopic surgery of the upper gastrointestinal tract is nowadays associated with little morbidity and mortality. Cardiomyotomy with semifundoplication for management of achalasia and the various forms of fundoplication for treatment of reflux syndrome have proved beneficial and have largely replaced conventional surgery. Independent of the operative approach, it has not yet been established with certainty whether gastroesophageal reflux can best be prevented by 360 degrees fundoplication or semifundoplication. A perforated peptic ulcer can be treated effectively by laparoscopic overstitching of omental patch-plasty, although the superiority of the laparoscopic method has yet to be proved. Benign lesions and early malignancies are currently resected laparoscopically, but the role of laparoscopy in the curative treatment of advanced gastric carcinoma remains to be clarified. Diagnostic laparoscopy is used to avoid unnecessary laparotomy in inoperable cancer and to ascertain whether neoadjuvant therapy is indicated in advanced gastric carcinoma.

Esophageal Diseases↗
PubMed2001

[Intra-gastric penetration of an adjustable gastric band].

Between November 1995 and August 2000 we performed adjustable silicone gastric banding laparoscopically in 252 patients. The body mass index varied from 37 to 86 kg/m2. We report on a 38-year-old woman who was operated on in 1997 with a body mass index of 47 kg/m2 (167 cm, 132 kg). The postoperative follow-up was uneventful until January 2000. The patient lost weight until she weighed 78 kg. Then she complained of diffuse epigastric pain. Gastroscopy revealed gastritis. Omeprazol was prescribed. No amelioration occurred. Endoscopic control showed partial intragastric migration of the band. After laparoscopic removal of the band, the patient was free of symptoms. Band erosion is a possible complication of adjustable gastric banding. As is known from intragastric penetration of the Angelchik prosthesis, the clinical symptoms of this complication may be mild. Since the follow-up of most patients with gastric banding is less than 5 years, more complications similar to that one described may be diagnosed in the future.

Adult↗
PubMed2001

Inguinal hernia repair in the new millennium: plug and patch repair with local anesthesia.

Plug and patch repair is a safe, economic method for repairing inguinal hernias, with patient comfort comparable to that with laparoscopic hernia repair. The technique is simple to perform under local anesthesia and easily learned without a learning curve. Complications are rare, and recovery and return to work are rapid. After performing plug and patch repair on 400 patients with a follow-up examination rate of 93% and a median postoperative observation time of 42 months, we have recorded a recurrence rate of only 0.25%.

Adult↗
PubMed2001

Sexual function and testicular perfusion after inguinal hernia repair with mesh.

BACKGROUND: Open tension-free techniques of hernia repair using synthetic meshes revealed an excellent patient comfort with low recurrence rates. The influence of the resulting fibrosis on testicular perfusion and sexual function is still unclear. METHODS: In a prospective observation study testicular volume, perfusion, and sexual function was investigated before plug and patch repair, after 3 months, and every 6 months thereafter. Testicular volume and perfusion was examined by a standardized scrotal ultrasound and duplex sonography. Sexual function was assessed by a validated anonymized questionnaire. RESULTS: Seventy-three patients were included and follow-up examinations by questionnaire and sonography, respectively, were completed in 73 and 68 patients after 3 months, 51 and 43 after 6, and 24 and 14 after 12 months. Preoperative testicular volume and flow volume was comparable between the side of hernia and the contralateral side (average 10.2 +/- 4.8 cm3 versus 9.8 +/- 5.3, respectively) and showed no significant differences during follow-up. In 11 (15%) patients with preexisting disorders sexual function was normalized postoperatively. Ten (14%) other patients (3 of them with neuralgia pain) described limitations of sexual activity due to inguinal pain (n = 4; 6%) or a loss of sensitivity in the inguinal area (n = 6; 8%) after the procedure. Among these, sexual function recovered spontaneously within 12 months postoperatively in 6 patients (2 with inguinal pain, 4 with loss of sensitivity). In all other patients sexual function showed no changes after inguinal hernia repair. CONCLUSIONS: So far there is no evidence for a significant impairment of the cord structures and the sexual function after inguinal hernia repair in the plug and patch technique.

Hernia, Inguinal↗