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Juergen Tepel

Publications and source records attributed to Juergen Tepel.

9 recordsLinked to original sources
PubMed2006

Benign abdominal and pulmonary metastasizing leiomyoma of the uterus.

BACKGROUND: Benign metastasizing leiomyoma (BML) is a rare disease in which the lung is described to be the most afflicted extrauterine organ. METHODS: We report of a 42-year-old African woman with a BML in the abdomen and lung who had undergone a hysterectomy for uterine leiomyoma 10 years ago. She was admitted to our hospital for investigation of a huge tumor mass in the pelvis consisting of multiple nodules in the abdomen and left lung. Assuming an advanced intraperitoneal malignancy was present, a 'palliative' limited tumor debulking and due to a tumor compressing the sigmoid a Hartmann's procedure was performed. RESULTS: The histopathologic examination showed a leiomyoma positive for estrogen receptor. Treatment was started with GnRH analoga. In the presence of a stable disease after 12 months, the patient underwent a re-laparotomy with a reanastomosis of the colon. Treatment was continued with GnRH analoga and the residual nodules have not increased in size during 36 months of follow-up. CONCLUSIONS: The review of the literature supports the concept that the primary tumor of BML is located in the uterus and that leiomyomas in the uterus can metastasize leading via hematogenous spread to BML. However, the origin of the tumor remains controversial.

Abdomen↗
PubMed2006

Adjuvant treatment of pancreatic carcinoma in a clinically adapted mouse resection model.

BACKGROUND: The high rate of local recurrence after radical resection of pancreatic adenocarcinoma fosters intensive efforts to develop new approaches for adjuvant treatment. The established animal models show significant limitations in simulating an adjuvant therapeutic setting. For optimal approximation to the clinical situation we therefore improved a murine orthotopic human xenotransplantation model. METHODS: Subtotal pancreatectomy in mice was performed after orthotopic inoculation of human pancreatic cancer cells and manifestation of solid tumours. The natural course of disease, tumour growth and metastases were analysed. Gemcitabine as a cytotoxic drug was tested in vitro on the cell line used in this model and the effect of adjuvant treatment with gemcitabine in vivo was investigated. RESULTS: All tumour-resected animals showed local recurrence. Organ metastases occurred in 67% in resected compared to 25% of non-resected animals. Gemcitabine in vitro was ineffective, but as adjuvant monotherapy resulted in a highly significant reduction of tumour weight and metastatic events. CONCLUSION: Subtotal pancreatectomy for xenotransplanted pancreatic cancer in SCID beige mice is feasible. Due to high rates of local recurrence and increased organ metastases, this model offers a relevant option for preclinical adjuvant testing, especially as in vitro and in vivo effects of cytotoxic drugs differ enormously.

Adenocarcinoma↗
PubMed2006

Elastofibroma dorsi as differential diagnosis in tumors of the thoracic wall.

We report the case of a 73-year-old woman who presented with a soft tissue tumor located between the scapula and the rib cage. Magnetic resonance imaging showed an inhomogeneous tumor on the right dorsolateral thoracic wall that measured 7 x 4 x 7 cm with contrast enhancement. The findings were suggestive of partial infiltration of intercostal muscles and were suspicious of a malignant tumor. After local excision at a district hospital had failed to render definitive diagnosis, the patient underwent complete resection of the tumor at our institution. Histology from the specimen was consistent with elastofibroma dorsi with free resection margins.

Aged↗
PubMed2006

A modified random oligonucleotide-based combination therapy for adjuvant treatment of pancreatic ductal adenocarcinoma.

Anti-cancer therapy in pancreatic ductal adenocarcinoma (PDAC) is mostly based on surgical removal or palliative therapy using antimetabolites, like 5'-fluorouracil or gemcitabine. Adjuvant treatment using these chemotherapeutics has recently proven a beneficial concept, though general survival rates are still poor. Most recently, combination therapy of gemcitabine with other targeted drugs was evaluated in clinical trials. We present here a study performed in a mouse orthotopic xenotransplant model of PDAC, using an oligo-nucleotide-based approach. We have shown previously that antisense oligonucleotides against p53 reduce the weight of orthotopic pancreatic tumours in immune-deficient mice. We further characterised terminal modifications of phosphorothioate oligonucleotides in vitro and found a random, unrelated control sequence carrying a D,L-alpha-tocopherol modification at the 5' and 3' ends to be most efficient in induction of cell death in PancTu-1 cells. Modified random oligonucleotide (MRON) were thus further tested in vivo. MRON showed a reduction of tumour weight in established primary orthotopic tumours in SCID/bg mice. In a surgically adapted pre-clinical model, where primary tumours were resected and animals received adjuvant treatment, MRON was very efficient in suppression of relapse and metastasis, when combined with gemcitabine. While the exact molecular mechanism of MRON activity still needs to be elucidated, the compound showed a remarkable preference for uptake into tumour cells in vivo.

Adenocarcinoma↗
PubMed2005

Feasibility and early results of interstitial intensity-modulated HDR/PDR brachytherapy (IMBT) with/without complementary external-beam radiotherapy and extended surgery in recurrent pelvic colorectal cancer.

BACKGROUND: A new multimodality treatment concept consisting of extended resection and postoperative fractionated intensity-modulated interstitial brachytherapy (IMBT) was introduced for pelvic recurrence of colorectal carcinoma. PATIENTS AND METHODS: 46 patients received extended resection and single plastic tubes were sutured directly onto the tumor bed. IMBT was started within 2 weeks postoperatively with a median dose of 24.5 Gy (5-35 Gy). Patients were treated either with high-dose-rate brachytherapy (HDR; n = 23) or with pulsed-dose-rate brachytherapy (PDR; n = 23). 25 patients received complementary 45-Gy external-beam irradiation (EBRT) to the pelvic region after explanting the plastic tubes. RESULTS: Median follow-up was 20.6 months (7-107 months) and mean patient survival 25.7 +/- 25.8 months (median 17, range 1-107 months). After 5 years overall survival, disease-free survival and local control rate were 23%, 20% and 33%, significantly influenced by the resectional state. There was a trend in favor of PDR compared to HDR, which reached statistical significance in patients who had not received additional EBRT. CONCLUSION: The combination of extended surgery and postoperative interstitial IMBT is feasible and offers effective interdisciplinary treatment of recurrent colorectal cancer. In this small and inhomogeneous cohort of patients PDR seems to be more effective than HDR, particularly when application of complementary EBRT is not possible. None of the patients who required resection of distant metastasis survived > 2 years in this study.

Brachytherapy↗
PubMed2005

Sigmoid perforation by compressed carbon dioxide.

Self-induced injuries of the bowel have various accidental mechanisms. This is a report of a 35-year-old patient with disruption of the recto-sigmoid junction caused by carbon dioxide (CO2) originating from a bottle of sparkling wine, which was introduced transanally for sexual stimulation. The patient underwent resection of the recto-sigmoid junction and primary anastomosis. The postoperative course was uneventful except for wound infection. The patient was discharged 12 days later. The physical backgrounds, the pathological pathways for perforation and diagnostic modalities including diagnostic pitfalls are critically discussed.

Accidents, Home↗
PubMed2004

Laparoscopic appendicectomy is associated with a lower complication rate even during the introductory phase.

BACKGROUND: The benefit of laparoscopic appendicectomy is under debate. To study the beneficial clinical effects of laparoscopic appendicectomy during the introductory phase we analysed, retrospectively, 493 patients from one district general hospital. PATIENTS AND METHODS: During a period of 3 years 250 patients were operated on prospectively by open appendicectomy, and 243 patients were operated on laparoscopically. Both groups were compared with regard to their demographic data, operation time, body mass index and complication rate. RESULTS: The conversion rate was 4.5%. The distribution of histological stages of inflammation was comparable in both groups. The median operating time was significantly longer for the open (40 min) than for the laparoscopic procedure (35 min, P=0.002). The body mass index in the laparoscopic group was significant higher (23.7 kg/m(2) vs 22.6 kg/m(2), P=0.009). Perioperative white blood cell count, C-reactive protein and body temperature were equal in both groups. There was no significant difference with regard to the analgesia required postoperatively between the open and the laparoscopic group. Nevertheless, the specific complication rate after open appendicectomy (18.4%) was significantly higher than that following laparoscopic appendicectomy (10.8%, P=0.03). CONCLUSION: Even during the introductory phase, laparoscopic appendicectomy is a safe and clinically beneficial operating procedure.

Adolescent↗
PubMed2003

Prospective evaluation of diagnostic modalities in suspected acute appendicitis.

BACKGROUND: The aim of this prospective study was to evaluate different diagnostic modalities routinely employed in a district hospital. METHOD: Four hundred subsequent patients presenting with acute abdominal pain were included over a period of 18 months. Patient characteristics, diagnostic work-up, intraoperative findings, histology and clinical outcome were documented. Rectal temperature, white cell count (WCC), C-reactive protein (CRP), ultrasonography (US) and Ohmann score were analysed with relation to diagnostic value. RESULTS: Negative appendicectomy rate and negative laparotomy rate on the day of admission were 22% and 21%, respectively. Sensitivity was highest for WCC and CRP (0.82 and 0.85) but US showed highest values for specificity (0.92), accuracy (0.85) and odds ratio (13.06). No patient with an Ohmann score below 6.5 suffered from acute appendicitis. With regard to different levels of training in US, experienced surgeons and radiologists had best values for specificity (1.00 and 0.98) and accuracy (0.90 and 0.94). Surprisingly, less-experienced sonographers also achieved good results with regard to specificity (up to 0.96) and positive predictive value (up to 0.89). CONCLUSION: Diagnostic accuracy of acute appendicitis remains insufficient, with an unacceptable high rate of unnecessary operations. Only the promotion of routine ultrasonography might contribute to an improvement in the near future.

Acute Disease↗