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Biomedical subjects

J Scheele

Publications and source records attributed to J Scheele.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Vasculature based segmental resection of the liver].

Complete surgical resection represents the only treatment for malignant tumors of the liver which offers the chance of long-term tumor-free survival. From this oncological perspective the segment orientated approach appears to be a valuable supplement of traditional hepatic surgery. It minimizes incomplete tumour removal, and prevents a waste of non-involved hepatic tissue. This combination of optimum local radicality and maximum parenchyma preservation also reduces operative risk. Various modern diagnostic and surgical aids such as intraoperative ultrasound, liver transection using the ultrasonic aspirator, and control of bleeding by means of infrared coagulation or fibrin tissue adhesive, all do considerably support this individualized surgical approach. However, the practical application is essentially based on the intrahepatic vasculature and the thereby defined segmental anatomy. The sequence of the operative proceeding will be illustrated for different mono- and polysegmentectomies.

Hepatectomy↗
PubMed1990

Pulmonary resection for metastatic colon and upper rectum cancer. Is it useful?

The predictive value of the route of venous drainage on prognosis was investigated in a consecutive series of 44 patients who underwent curative resection of pulmonary metastases from colorectal carcinoma. The primary tumor was located in the colon in 14 patients and in the upper third of the rectum in 11 patients, thus indicating blood drainage directed toward the portal vein (Group I). In 10 and 9 cases, respectively, the initial growth was in the middle and lower thirds of the rectum with the venous outflow at least partially directed into the vena cava (Group II). There was no obvious difference between the two groups regarding the initial site of cancer relapse. The liver was involved in 4 of 15 patients failing in Group I as opposed to 4 of 13 patients with hematogenous relapse in Group II. Median survival and tumor-free survival times were significantly longer in patients in Group I (58.4 and 50.2 months) than in patients in Group II (30.9 and 16.8 months), and, even more pronounced, in colon cancer patients (75.4 and 60.2 months) when compared with rectal cancer patients (31.0 and 17.9 months). In contrast, survival curves did not differ significantly if either the two groups with different routes of drainage (5-year survival 53 percent vs. 38 percent, 5-year tumor-free survival 43 percent vs. 37 percent), or tumors of the colon and rectum (5-year survival 67 percent vs. 38 percent, 5-year tumor-free survival 60 percent vs. 32 percent) were compared using the log-rank test. Similar trends were obtained for the subgroup of 34 patients without previous or simultaneous extrapulmonary recurrent disease at the time of lung resection. The primary tumor site does therefore not become a major criterion in selecting patients for surgical resection.

Adult↗
PubMed1990

[Surgical interventions in liver metastases].

Surgical treatment of hepatic metastases is predominantly aimed at "curative" resection. This can be achieved in about 20% of colorectal secondaries, and is associated with a 30-40% 5-year survival. One to three metastases in the absence of extrahepatic disease are regarded a clear indication to resection. Among patients with non-colorectal malignancies, occasional long term survival was reported in leiomyosarcoma, breast cancer, and renal cancer metastases, respectively. Endocrine tumors such as carcinoid, gastrinoma, or pheochromocytoma, are different because of their remarkable symptoms along with a protracted natural history. Quality of life may be considerably improved here by even non-radical debulking. The vast majority of patients, however, ist not suitable to undergo hepatic resection. Palliative therapeutic options involve hepatic artery ligation or embolization, cryo-surgery and percutaneous laser coagulation, and various types of regional chemotherapy. These methods may enable a temporary relief of symptoms, but no significant impact on survival time, and no true long term benefit has been proven. Prospective randomized trials against combined treatment as well as untreated patients are required for a more meaningful judgement and improved effectiveness.

Colorectal Neoplasms↗
PubMed1990

[Differential after care for early detection of recurrence: from the surgical viewpoint].

Tumor recurrence following "curative" resection (= R0) of gastrointestinal cancer occurs in 30% (colorectal carcinoma) to 70% (ductal pancreatic cancer) of patients. Only colorectal cancer recurrence involves a substantial chance of a reintervention which again may result in complete cancer clearance (local recurrence 17%, metachronous liver metastases 20%, other abdominal intracavitary relapse 12%, pulmonary secondaries 17%). Five-year survival after complete re-resection approaches 40% irrespectively of the site of recurrent disease. Recognition of resectable recurrence in asymptomatic patients is based on ultrasound, endoscopy, and chest X-ray. Laboratory investigations alone, and even CEA-screening, do not suffice.

Adult↗
PubMed1990

[The use of collagen fleece (Tachocomb) in pancreatic surgery].

Collagenic fleece (Tachocomb) was applied to for hemostasis in areas of pancreatectomy and in the retroperitoneum after resection on the left side in 30 patients with necrotising pancreatitis, carcinoma of the pancreas head, and chronic pancreatitis. Diffuse hemorrhages in the pancreatic bed could be stopped by means of collagenic fleece despite disturbance of coagulation without additional surgical measures for controlling hemorrhage. The application of collagenic fleece was not necessary after resection, because of chronic pancreatitis.

Blood Loss, Surgical↗
PubMed1990

Tumor implantation from needle biopsy of hepatic metastases.

Two patients with resectable secondaries in the liver developed needle track recurrence following intraoperative "Trucut"-needle biopsy and percutaneous thin needle aspiration cytology, respectively. In both cases the nature of the hepatic lesion was already clear before biopsy, from characteristic ultrasound, CT-scan, and a progressive rise in CEA levels. Although the overall risk is presumably low, biopsy must not become a diagnostic imperative. It may compromise definitive surgery in individual patients, and should therefore be restricted to situations in which results have a therapeutic or scientific impact.

Aged↗
PubMed1989

Surgery for colorectal cancer metastatic to the liver. Optimizing the results of treatment.

Overall, hepatic resection appears to be an important means of curing patients with metastatic colorectal cancer isolated to the liver. The only absolute contraindication to surgery was the impossibility of a radical removal of tumor: if residual disease will remain after the hepatic resection, this operation is not indicated. A possible second contraindication to surgery is the presence of tumor in the hepatic or celiac lymph nodes. Such metastases from liver metastases signal a biologic grade of tumor that is almost sure to spread to other sites. However, one patient of the 25 in this group did survive long term when positive lymph node groups were dissected. Further clinical experience with this form of the disease along with trials of regional adjuvant therapies such as intraperitoneal chemotherapy may be needed. The presence of extrahepatic metastases at the time of liver resection should be considered a relative contraindication to this surgery, but if the patient can be made clinically disease free, long-term disease-free survival may result. It seems imperative that all patients with hepatic metastases be evaluated by an experienced hepatic surgeon for a curative resection. If the patient has between one and four metastases, a 25 per cent long-term disease-free survival rate can be expected. Patients who have a radical resection of more than four metastases should be considered to be in an experimental group in whom more data are needed. In our current state of knowledge, making such patients clinically disease free is their only chance for long-term survival. Other factors besides the number of metastases that will affect the prognosis of the patient include the disease-free interval between colorectal resection and liver resection, the pathologic margin of resection on the liver specimen, and the presence or absence of mesenteric lymph node metastases from the primary cancer. These factors should be considered when determining the prognosis in a given patient and should be used as stratification variables in prospective trials. However, from our analysis of available data, these factors should not be considered contraindications to hepatic resection.

Adult↗
PubMed1989

[Resection of lung metastases of colorectal cancer. Indications and indication limits].

From 1970 through 1986, a total of 62 patients underwent thoracotomy for colorectal metastases to the lungs. Four had exploration only, whereas in 13 a nonradical, and in 45 a "curative" resection was performed. There was one postoperative death. Cumulative 5-year survival following radical resection was 44%. Conversely, all other patients succumbed within 3 years. Extrapulmonary disease has not yet been associated with 5-year survival and may usually contraindicate resection. The impacts of multiple metastases exceeding 3 nodules or bilateral pulmonary involvement on prognosis can not been determined from our series, since the procedure in respective patients was not radical in the majority of cases. In turn, localisation and venous drainage of the primary tumor did not significantly influence long term survival.

Adenocarcinoma↗
PubMed1989

[Segment-oriented liver resection. Principles--technic--status].

Complete surgical resection represents the only treatment for malignant tumors of the liver which offers the chance of long-term tumor-free survival. The segment orientated approach appears to be a fundamental improvement in preventing incomplete tumor removal as well as wastage of non-involved hepatic tissue. This resection technique is particularly based on a detailed knowledge of intrahepatic vascular anatomy and its variations. The use of modern diagnostic and surgical aids such as intraoperative ultrasound and liver transsection using the "ultrasonic-aspirator" expedites such technically sophisticated types of liver resection and permits their save and low risk implementation. The clinical relevance of this approach is analyzed on 452 hepatic resections consecutively performed from October, 1984, through December, 1988. 312 patients suffered from malignant disease, 224 of them from metastatic tumor. There were 159 segment orientated procedures as opposed to 167 common hepatectomies, and 126 non-anatomical resections. In 235 patients the procedure was restricted to the liver, whereas in 48 cases a perihepatic extension, and in 169 distant extrahepatic procedures were performed as well. The overall 30 days mortality was 4.4%, ranging from 50% in 8 trauma cases to 2% in 204 elective procedures restricted to a non-cirrhotic liver. Segment orientated modifications reduced the risk of hepatic failure and consecutive mortality particularly associated with right lobectomy and hepatectomy, respectively. In turn, non-radical tumor removal was significantly diminished if compared to both common as well as non-anatomical resections.

Adolescent↗
PubMed1988

Significance of serum phosphohexose isomerase in gastrointestinal cancer at different stages.

The purpose of this study was to reevaluate the significance of serum PHI in gastrointestinal cancer at histopathologically defined stages prior to primary treatment. A total of 248 patients with malignant tumors of the gastrointestinal tract and a collective of 42 patients with noncancerous diseases were studied. The results are compared with those obtained with the established markers tissue polypeptide antigen (TPA) and carcinoembryonic antigen (CEA). Phosphohexose isomerase (PHI) revealed an overall diagnostic sensitivity of 69%, combined with a specificity of 74%. The corresponding data for TPA were found to be 73 and 47% while for CEA 26 and 95% respectively were determined. Even in the early stages of colorectal and esophageal carcinoma, PHI showed a sensitivity of about 60%. A continuous rise of PHI serum levels, correlating well with the extent of the tumor disease, could be detected. In contrast to TPA and CEA, PHI assay can be carried out with a minimum of laboratory efforts, in a short time and at low costs. These findings suggest that serum PHI assay is a useful aid for screening of gastrointestinal cancer, especially esophageal and gastric carcinoma, and a reliable marker for treatment control and follow-up.

Antigens, Neoplasm↗
PubMed1988

High-molecular-mass alkaline phosphatase: simplified and highly sensitive determination by liquid chromatography.

This simplified HPLC method for measurement of high-molecular-mass alkaline phosphatase (high-Mr AP; EC 3.1.3.1) in serum and bile is rapid (time for column preparation and separation 30 min), reproducible (CV 4.2%), and highly sensitive (detects high-Mr AP in healthy controls at 1-3% of total AP activity in serum), and is suitable for processing small batches of sample. We characterized high-Mr AP in serum and bile by incubating samples with L-phenylalanine, neuraminidase, 1-butanol, or wheat-germ lectin, and by determining stability to heat. High-Mr AP activity was determined in sera of patients with various liver diseases (4-32% of total AP serum activity) and results were compared with those by electrophoresis on agarose.

Alkaline Phosphatase↗
PubMed1988

[Surgical therapy of gallbladder cancer].

Because of the normally far advanced tumor stages of carcinomas of the gallbladder, the resection rate in the literature varies from 10 to 30 percent. Our own curative resection rate was 19% in a series of 89 patients between 1969 and 1985 first treated in our hospital. The palliative resection rate was 29%, in 10% we performed a palliative operation and in 36% an explorative laparotomy. The curative resected gallbladder carcinomas were mainly stage I and II tumors, incidentally found at operation or histopathological examination. Has the gallbladder carcinoma invaded perimuscular connective tissue, an extended operation with resection of the segments IVb and V of the liver and lymphnode dissection must be recommended. Stage III and IV carcinomas of the gallbladder with infiltration of the liver can be curatively operated organ-saving in using en-bloc resection of the gallbladder with the adjacent segments IVb and V, or IVb and VI and with lymphnode dissection of the hepatoduodenal ligament. The observed five-year-survival rate (Cutler and Ederer) including lethality of the curative resected carcinoma of the gallbladder is 56.3 +/- 25.2%.

Gallbladder↗
PubMed1987

Initial experience with the endoscopic application of fibrin tissue adhesive in the upper gastrointestinal tract.

During a 15-month period, a total of 11 patients underwent endoscopic application of fibrin tissue adhesive in the upper gastrointestinal tract. Our sample consisted of 6 patients with control of bleeding, 4 patients with management of anastomotic leaks, and one very old man undergoing prophylactic sealing of a chronic gastric ulcer with a visible vessel and repeated episodes of bleeding. The method described has proven to be successful in control of bleeding in every case and has resulted in quick cleaning of perianastomotic abscess cavities, growth of granulation tissue, and complete healing in 3 of 4 cases so far. This preliminary report suggests that fibrin adhesive application is effective in the control of oozing gastrointestinal bleeding and may support the healing process in difficult situations, such as chronic peptic ulcers and anastomotic leakages.

Adult↗
PubMed1986

[Differential indications of conservative and surgical possibilities of treating splenic rupture].

Conservative therapy of splenic trauma in the adult cannot be recommended, since 2/3 of patients with polytrauma will prove to have additional abdominal organ lacerations. The new methods of local haemostasis, suture and partial resection and their application and contraindications according to Barrett's classification of splenic trauma are discussed. Our own salvage rate has been 50% (70/140) in trauma and 77% (116/151) in iatrogenic lacerations during the past 5 years.

Aprotinin↗