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Biomedical subjects

K Böttcher

Publications and source records attributed to K Böttcher.

At least 37 records · Page 2Linked to original sources
PubMed1995

Preoperative chemotherapy for stage III-IV gastric carcinoma: feasibility, response and outcome after complete resection.

Despite extensive resection and systematic lymphadenectomy the prognosis of patients with locally advanced gastric carcinoma remains poor. The effect of preoperative outpatient chemotherapy with etoposide, doxorubicin and cisplatin was evaluated prospectively in 30 patients who had been shown by preoperative staging (including endosonography and surgical laparoscopy) to have gastric carcinoma stages IIIA, IIIB or IV. Haematological side-effects were common and necessitated hospitalization in 13 of 30 patients. Complete clinical response to neoadjuvant therapy was observed in eight of 27 evaluable patients. Resection was performed in 27 of 30 patients, with complete macroscopic and microscopic tumour removal in 24. There were no deaths and no major morbidity following operation. On multivariate analysis complete clinical response (P < 0.01) and complete tumour resection (P < 0.01) were the major independent predictors of long-term survival after neoadjuvant chemotherapy. Actuarial survival after complete tumour removal was superior with neoadjuvant therapy compared with results in an age-, sex- and tumour stage-matched control population who had primary resection (P = 0.07). Recurrence occurred in 17 of 23 evaluable patients who had complete tumour removal, with relapse in the tumour bed or area of lymphatic drainage in 11. These data show that neoadjuvant therapy in patients with locally advanced gastric carcinoma is feasible and appears to increase the rate of complete tumour removal. More powerful and less toxic regimens are, however, required to improve the response rate and to delay or avoid recurrence after neoadjuvant chemotherapy.

Adult↗
PubMed1995

Low resolution DNA typing of the HLA-B5 cross-reactive group by nested PCR-SSP.

We have established a DNA typing system for the HLA-B5 serologically cross-reactive group (CREG) by means of a two-step PCR amplification with nested sequence-specific primers (nPCR-SSP). The present study provides a low resolution definition of the HLA-B5 CREG, i.e. identifying polymorphism equivalent to serology. Two different primer combinations allow group-specific amplification of all HLA-B5 CREG alleles and other related HLA class I alleles from genomic DNA. The amplified DNA is subjected to a second amplification step using eleven nested primer pairs. This assay permits the detection of the HLA-B5 CREG specificities B35, B51, B52, B53, and B7801 in all homozygous and heterozygous combinations. Sensitivity and specificity as judged by a blind quality control study investigating a reference panel (n = 50) is 100%. Extension of this approach should allow rapid DNA typing of all serologically defined HLA-B specificities by nPCR-SSP.

Alleles↗
PubMed1995

Surgical therapy for gastric cancer.

The aim of any surgical approach to gastric carcinoma should be a complete resection with no residual tumor left behind, that is, a R0-resection according to the UICC. Complete tumor resection in this respect refers to the primary tumor as well as the lymphatic drainage and requires an adequate safety margin. The indications for surgical therapy of gastric cancer and the choice of procedure should consequently be guided by the tumor stage. This requires accurate preoperative staging, which can today be achieved with endoscopic ultrasonography and surgical laparoscopy. Gastric carcinoma stage IA (mucosa carcinoma) can be cured by local excision. In patients with tumor stages IB (submucosa carcinoma), II, and IIIA, lymph node metastases are common. Based on the available data, this group of patients benefits from radical resection and D2 lymph node dissection. In patients with advanced gastric carcinoma, that is, tumor stages IIIB and IV, a complete tumor removal usually can not be achieved by surgical resection. Neoadjuvant therapeutic modalities should consequently be assessed in these patients. Based on tumor location and growth pattern, a total gastrectomy is the procedure of choice in patients with middle and proximal third gastric cancer. A subtotal gastrectomy may be performed in patients with tumors of the distal third and "Laurén's intestinal type" growth pattern. Depending on the individual tumor situation, the gastrectomy can be extended toward varying portions of the distal esophagus or a pancreas, preserving splenectomy and resection of the retroperitoneal lymph nodes.(ABSTRACT TRUNCATED AT 250 WORDS)

Gastrectomy↗
PubMed1994

Membrane-associated carbonic anhydrase from the crab gill: purification, characterization, and comparison with mammalian CAs.

Carbonic anhydrase (CA) was purified from the gills of the shore crab Carcinus maenas using affinity chromatography and HPLC. The predominantly membrane-bound CA was found to share several features with mammalian CA IV. Its apparent molecular weight of 36 kDa was reduced to 33 kDa by treatment with PNGase F, suggesting that crab CA is a glycoprotein with one N-linked oligosaccharide chain. More than half of the membrane-bound crab CA was released from membranes by treatment with a phosphatidylinositol-specific phospholipase C, indicating that the branchial CA is anchored to membrane surfaces by a phosphatidylinositol-glycan linkage. The enzyme also resembles mammalian CA IV in its relative sensitivity to inhibition by sulfonamides and the resistance to inhibition by halide ions. Amino acid composition of the HPLC-purified crab CA was examined and CNBr cleavage was carried out followed by N-terminal amino acid sequencing. Amino-terminal sequence of the native enzyme differed considerably from those of mammalian isozymes (human CA I and CA II, bovine CA III, human and rat CA IV). However, antisera raised against rat CA IV, CA II, and CA I all cross-reacted weakly with crab CA. Unlike mammalian CA IVs, crab gill CA was sensitive to 0.2% sodium dodecyl sulfate, suggesting that although crab gill CA is like mammalian CA IVs in many ways, it is less stabilized by intramolecular disulfide bonds.

Amino Acid Sequence↗
PubMed1994

[Risk of surgical therapy of stomach cancer in Germany. Results of the German 1992 Stomach Cancer Study. German Stomach Cancer Study Group ('92)].

The German Gastric Cancer Study (GGCS '92) permits a representative pictures of the current situation in surgery for gastric carcinoma at university centers in Germany. The analysis of frequency of resection, complication rate and mortality provides a quality measure for anybody who performs surgical therapy for gastric carcinoma. The results of multivariate analyses will have therapeutic consequences.

Cause of Death↗
PubMed1993

Prognostic factors in gastric carcinoma. Results of the German Gastric Carcinoma Study 1992.

BACKGROUND: The impact of patient- and tumor-dependent factors and the postoperative course on the prognosis of patients who underwent resection for gastric carcinoma between 1986 and 1989 were analyzed in a prospective multicenter observation study. METHODS: Resection techniques, the extent of lymph node dissection, and the histopathologic assessment of the specimen were standardized at all participating centers. A total of 1654 patients were enrolled. Follow-up is complete for 99.2% of the patients, with a median follow-up time of 48 months. Prognostic factors were assessed by multivariate analysis. RESULTS: In the total patient population there was an independent prognostic effect of nodal status, a International Union Against Cancer (UICC)-R0 resection, distant metastases, the pT category, three or more risk factors on preoperative risk analysis, and the presence of postoperative complications. Multivariate analysis in the subgroup of patients who had a UICC-R0 resection confirmed the nodal status as the major independent prognostic factor. CONCLUSION: These data suggest that the prognosis of patients who undergo gastrectomy for gastric carcinoma may be improved by a complete resection of the primary tumor and its lymphatic drainage, resulting in a UICC-R0 resection. In addition, a detailed preoperative risk analysis and identification of high-risk patients and meticulous attention to the technical details of the surgical procedure to reduce the frequency of postoperative complications may improve the prognosis.

Adult↗
PubMed1993

[The epidemiology of stomach carcinoma from the surgical viewpoint. The results of the German Stomach Carcinoma Study 1992. The German Stomach Carcinoma Study Group].

In a prospective multi-centre study data were collected on 1,999 patients (1273 men, 726 women; mean age 62.3 [19-99] years) with gastric carcinoma, admitted to one of 19 surgical departments in Germany between 1.4. 1986 to 30. 6. 1989. Previously treated patients as well as those with synchronous or metachronous tumours and carcinoma of the gastric stump had been excluded. The resection rate for gastric carcinoma was 82.7%, i.e. resection was no longer possible because of the advanced tumour stage in nearly 20%. The tumour was located in the upper third of the stomach in 30%, the antrum in 26.3%. An intestinal type of growth was present in 51.9%. An early carcinoma was diagnosed in 16.9% of operated patients; it had already metastasized to regional lymph nodes in 16.5%. Nearly 70% of patients with resectable tumours had metastases to the regional lymph-nodes, with distant metastases in 30%. An advanced tumour stage (UICC stage IIIB or IV) was present in 43%. Exclusively surgical treatment is not effective in these cases.

Adult↗
PubMed1993

Prognostic relevance of systematic lymph node dissection in gastric carcinoma. German Gastric Carcinoma Study Group.

In a prospective multicentre study of 2394 patients with gastric carcinoma the prognostic relevance of systematic lymph node dissection was evaluated. Of 1654 patients undergoing resection, 558 had a standard lymph node dissection, defined as fewer than 26 nodes in the specimen, and 1096 underwent radical lymphadenectomy, i.e. 26 or more nodes in the specimen. Radical dissection significantly improved the survival rate in patients with Union Internacional Contra la Cancrum (UICC) stages II and IIIA tumours. Multivariate analysis identified radical dissection as an independent prognostic factor in the subgroups of patients with UICC tumour stages II and IIA. Radical dissection conferred no survival advantage in patients with pN2 tumours. There was no significant difference in morbidity and mortality rates between radical and standard lymph node dissection. Radical lymphadenectomy improves survival in patients with UICC gastric cancer stages II and IIIA, and should be the recommended treatment for such patients.

Female↗
PubMed1992

[The quality of life after total gastrectomy for stomach carcinoma. Esophagojejunal plication with pouch versus esophagojejunostomy without pouch].

A group of 178 patients with total gastrectomy for gastric carcinoma were divided into two groups matched for sex, age, tumour stage and follow-up interval (29 pairs, 46 men and 12 women; mean age 63.4 [39-74] years) according to the type of reconstruction performed, oesophagojejunal plication with pouch or simple oesophagojejunostomy without pouch. Those with left-extended gastrectomy, follow-up period of 9 months or less, and local recurrence or metastasis were excluded. Quality of life was evaluated by means of three standardized questionnaires sent to all the patients: (1) general physical complaints; (2) satisfaction with life; and (3) psychosocial burden. Patients with pouch reconstruction declared more favourable results in 90 of the 94 questions contained in the questionnaire (96%) than the patients without pouch. Patients in the former group also had significantly fewer general physical complaints (P less than or equal to 0.05) and were significantly more satisfied with life (P less than or equal to 0.05) than those without pouch. Correlation analysis for the entire group (n = 58) indicated significant relationships especially between quality of life and postoperative nutrition and body weight. Technical surgical problems of total gastrectomy having largely been solved, the question of quality of life must increasingly determine the choice of treatment.

Anastomosis, Surgical↗
PubMed1987

[Stomach cancer--the current situation from the surgical viewpoint].

From July 1st 1982 to December 31st 1986, 359 patients with a histologically confirmed gastric carcinoma were operated on. At the beginning of therapy, 44.3% were in the pathological anatomical stages I and II, 55.7% in stages III and IV (UICC 1987). 307 patients could be resected (resection rate 85.5%). The proportion of R0 resections (no residual tumor) was 61.9%, R1 resections (microscopically demonstrable tumor residues) 23.1% and R2 resections (macroscopical tumor residues) 15%. Overall, a curative resection could be carried out in 61.9% of the cases and a palliative resection in 38.1% of the cases. In 21.5%, a subtotal gastric resection, in 48.2% a total gastrectomy and in 30.3% an extended total gastrectomy was necessary in addition. The lethality was 3.0% for subtotal resection, 5.4% for the simple total gastrectomy and 9.6% for the extended total gastrectomy. The prognosis corresponds to the tumor stage at the beginning of therapy (three year actuarial survival: stage I 76%, stage II and III 26%, stage IV 7%).

Gastrectomy↗