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Biomedical subjects

J Tonak

Publications and source records attributed to J Tonak.

At least 19 recordsLinked to original sources
PubMed1988

Diagnostic excision of the Rosenmüller's node. Screening for occult metastases before elective regional lymph node dissection in patients with lower limb melanoma?

Elective radical groin dissection was performed on 297 consecutive patients with high-risk melanoma of the leg, Anderson Stages I, IIA, IIIA. By separate histologic examination of the so-called "Rosenmüller's node," the other inguinal, and the external iliac lymph nodes, the diagnostic excision of the Rosenmüller's node was tested as a suitable mode of screening for metastases before a planned elective regional lymph node dissection. Eighty patients (27%) presented with what was histologically determined to be occult groin metastases. Rosenmüller's node was involved in 30 of these cases; in the remaining 50, however, it was not affected; that is, 63% of the cases were false-negative. Thus, the involvement of Rosenmüller's node is not representative of metastases in the other ilioinguinal lymph nodes, but is rather a matter of chance. In women with superficial spreading melanoma the rate of occult lymph node metastases was significantly lower than that in men with melanomas of the other type. Iliac lymph node involvement was observed in 18 patients (22%) depending on clinical stage and depth of invasion of the primary tumor.

Female↗
PubMed1988

[Accomplishments of tumor surgery in tumors of the small intestine].

Between 1. 1. 1970 and 31. 12. 1986/31. 12. 1987, 90 patients with primary malignancies of the small bowel were treated at the Department of Surgery of the University Erlangen-Nürnberg. Only 21% (19 of 90) of the patients had no regional or distant metastases at the time of the operation. The 5-year-survival rate of the 90 patients was 41% +/- 14%. Twenty-one of 34 patients suffering from adeno-carcinoma were treated by curative surgery. The 5-year-survival rate of these 21 patients was 44% +/- 23%. The prognosis of patients with primary malignant tumors of the small bowel depends on early diagnosis and curative surgery.

Adenocarcinoma↗
PubMed1987

Multivisceral resections in colorectal cancer.

From 1969 to 1983 a total of 1918 patients with colorectal cancer were treated by curative resection. One hundred twenty one patients in this group had multivisceral organ involvement, necessitating extended multivisceral radical resection. Tumor infiltration was proven histologically in 55 percent, while 45 percent had inflammatory adherence to the attached organ only. Postoperative mortality was 12 percent. Dukes' A and B stages were present in 57 percent. The five-year survival rate (postoperative mortality included) was 54 percent for patients with inflammatory adherence, 49 percent for patients with tumor infiltration resected en bloc without tumor tears of rupture, and 17 percent when the surgeon inadvertently had torn or cut into tumor tissue during resection.

Abdominal Neoplasms↗
PubMed1985

[Operative tactics and results in extensive operations for colorectal cancer].

Between 1969 and 1983 a total of 1918 patients with colorectal carcinoma were curatively operated. In 121 of these patients a curative procedure could be achieved despite tumor invasion of adjacent organs by extending the operation to include these involved structures. In 45% of these patients the histological examination revealed that there were only peritumorous inflammatory adhesions while in 55% of the cases a direct tumor invasion of the neighbouring organ was present. The 5-year-survival-rate in the 121 patients was 44%. The operative mortality of 12% (14 out of 121) is included. The final results were considerably worse if the tumor could not be removed en bloc.

Colonic Neoplasms↗
PubMed1983

Hyperthermic perfusion in malignant melanoma: 5-year results.

Between December 1975 and December 1980 a total of 154 patients with potentially curable malignant melanoma were treated by adjuvant hyperthermic perfusion. The basic therapy consisted in local excision of the primary tumor with elective dissection of the regional lymph nodes. The 4- and 5-year survival rates for our 103 patients with stage-I disease who were perfused are 90% +/- 9% and 80% +/- 17%. The 4- and 5-year survival rates for 51 patients with stage-II disease are 50% +/- 16% and 37% +/- 28%. Compared with historic control groups of patients who were treated at our hospital with the same surgical methods but without perfusion, essentially better results were achieved with adjuvant hyperthermic perfusion. It is concluded from our results that hyperthermic perfusion can further improve the prognosis for patients with malignant melanomas of the limbs.

Chemotherapy, Cancer, Regional Perfusion↗
PubMed1982

Incidence of local recurrence after curative operations for cancer of the rectum.

Between January 1, 1969 and December 31, 1979 a total of 248 patients with infiltrative carcinoma of the middle third of the rectum were treated curatively either by sphincter saving anterior resection (176/248) or by abdomino-perineal excision (72/248). The observed incidence of local recurrence was 21% (52/248). Among the tumor specific factors which influence the development of local recurrence the type of growth (insular - circular, exophytic - ulcerous) and the presence of lymph node metastases at the time of the primary operation proved to be statistically significant. Among the surgical factors a sufficient distal margin of safety in anterior resection could be shown to be of major importance. In order to minimize the risk of local recurrence the distal margin of safety should be at least three cm determined in the fresh operative specimen without tension. The type of operation, be it abdomino-perineal excision or anterior resection, has no influence on the incidence of local recurrence as long as a sufficient distal margin of safety is achieved during anterior resection.

Abdomen↗
PubMed1982

Influence of high caloric parenteral nutrition on catabolism and cellular immune competence in carcinoma patients.

Urea production rate and cellular immune reactivity measured by skin stamp test were used to determine the extent of protein catabolism in 30 surgical patients with histologically diagnosed gastrointestinal carcinoma. All patients received high-caloric total parenteral nutrition (TPN) preoperatively. In those patients with an urea production rate of less than 15 g/day (according to definition of non-catabolic state) TPN was discontinued and the operation performed immediately, whereas the remaining 13 patients with an urea production rate exceeding 15 g/day (according to definition a catabolic state) were given TPN a total of 10 days prior to operation. Nine of the 13 patients could be converted from a catabolic to a non-catabolic state. Only one of these patients died, whereas of the remaining 4 patients who - according to the definition - remained in a catabolic state, two died. The course of nutrition positively influenced the serum levels of IgG, IgA and IgM. The skin stamp test was positive in only three of the 13 patients. Obviously, a positive skin test reaction occurred only in those patients who could be returned to a non-catabolic state during the course of TPN. By means of preoperative TPN catabolic patients can be converted into a non-catabolic state which is associated with a reduction in morbidity and mortality. Moreover, high caloric parenteral nutrition rich in amino acids seem to improve the prognosis for patients with negative skin test reactivity.

Amino Acids↗
PubMed1981

[The physician's liability from the viewpoint of a university surgery department].

Malpractice suits against physicians have increased tremendously during the last years. We have analysed 108 cases with alleged malpractice. Twenty-two suits had not been settled yet at the time of this study. The documents were not available in twenty-one cases. There were court decisions in 65 cases. Fourty-eight times the accused physicians could be exculpated. In 12 cases a settlement out of court could be reached. The accused physician was found guilty in 4 cases. Reduction in the number of malpractice suits can be achieved in our opinion by exact documentation of clinical findings and laboratory results as well as by a better and more detailed information of the patients.

Abdomen↗
PubMed1981

[Hyperthermic perfusion with cytostatic drugs -- an adjuvant therapy in soft tissue sarcoma of the limbs (author's transl)].

Hyperthermic perfusion was used in 15 adult patients with soft tissue sarcoma of the limbs. Only patients were selected with prognostically unfavorable or recurrent tumors, which were excised with a limited safety margin. Three patients died from pulmonary metastases 16, 24 and 34 months after perfusion. In 2 patients a local recurrence developed. Ten patients are alive and free of recurrence. The follow-up period ranges from 7 - 47 months with a median of 30 months. These results encourage the further use of hyperthermic perfusion.

Antineoplastic Agents↗
PubMed1980

Microstages in malignant melanoma--the basis for an elective lymph node dissection.

Our experience has shown that an increasing depth of invasion of the primary tumor is connected with a higher incidence of regional lymph node metastases. The incidence of subsequent metastases or recurrences is compared retrospectively for two groups: (1) 175 patients with elective dissection and (2) 33 patients with excision only. All patients suffered from high-risk melanomas of clinical stage I. The frequency of subsequent metastases was 21% (N = 36) for the first group and 46% (N = 15) for the second group (p less than or equal to 0.01). The 5-year survival rate (Berkson-Gage) of patients with high-risk melanomas and secondaries is 41% for the patient group (N = 27) in which elective dissection was performed and 21% for patients with therapeutic dissection (N = 52). The results speak for the elective dissection in cases of high-risk melanomas.

Female↗
PubMed1978

Malignant melanoma: microstages and individualized therapy.

In the prognosis of malignant melanoma the clinical stage and the microstage are the most important factors. According to the microstage, malignant melanomas can be divided into low-risk and high-risk melanomas. The subungual-volar melanoma seems to be an exception. Irrespective of the microstage, the prognosis of this type is probably worse than that of other types of melanoma. In patients with clinical Stage I the therapy should be individualized. In a low-risk melanoma, a wide local excision is sufficient; in a high-risk melanoma an additional regional lymph node dissection appears to be indicated; and if the primary tumour is located on an extremity a hyperthermic perfusion is also called for.

Female↗