PubMed Health⌕ Search

Biomedical subjects

K Junge

Publications and source records attributed to K Junge.

At least 19 recordsLinked to original sources
PubMed2007

Gas-related impact of pneumoperitoneum on systemic wound healing.

INTRODUCTION: The aim of the present study was to investigate the gas-dependent effects of pneumoperitoneum on wound healing distant from the abdomen. MATERIALS AND METHODS: Dorsal skin incisions were performed in 54 male Sprague-Dawley rats. A CO(2) or a helium pneumoperitoneum of 3 mmHg was maintained before, with an overall duration of 30 min (each n = 18). Rats in the control group received laparotomy only (n = 18). Animals were killed after 5 and 10 days. The infiltration of macrophages (CD 68), expression of matrix metalloproteinase 13 (MMP-13) and collagen I/III ratios were analysed in the dorsal skin wounds. RESULTS: Both after 5 and 10 days, infiltration of macrophages and expression of MMP-13 were greatest after helium pneumoperitoneum. After 5 days, collagen I/III ratio was significantly increased in the helium group. After 10 days, collagen I/III ratio was lowest in the CO(2) group. CONCLUSION: Our results suggest beneficial effects on systemic wound healing for helium pneumoperitoneum as compared to CO(2).

Animals↗
PubMed2006

Different matrix micro-environments in colon cancer and diverticular disease.

BACKGROUND AND AIMS: The extracellular matrix and the interactive signalling between its components are thought to play a pivotal role for tumour development and metastasis formation. An altered matrix composition as potential underlying pathology for the development of colorectal cancer was hypothesized. METHODS: In a retrospective study of patients with colon cancer, the extracellular matrix in tumour-free bowel specimen was investigated in comparison with non-infected bowel specimen from patients operated on for colonic diverticulosis. The following matrix parameters with known associations to tumour formation, cell proliferation, invasion and metastasis were analysed by immunohistochemistry and quantified by a scoring system: VEGF, TGF-beta, ESDN, CD117, c-erb-2, cyclin D1, p53, p27, COX-2, YB-1, collagen I/III, MMP-13, PAI and uPAR. Expression profiles and correlations were calculated. RESULTS: The comparison of the two groups revealed a significantly decreased immunostaining for CD117 and TGF-beta in the cancer group (8.5+/-2.6 vs 10.3+/-2,1 and 4.9+/-1.5 vs 8.1+/-3, respectively), whereas PAI scores were significantly higher than in patients with diverticular disease (8.1+/-1.6 vs 6.2+/-0.9). Overall correlation patterns of matrix parameters indicated pronounced differences between tumour-free tissue in cancer patients compared with patients with diverticular disease. CONCLUSIONS: Our results indicate distinct differences in the colonic tissue architecture between cancer patients and patients with diverticulitis that support the notion of an altered matrix composition predisposing to the development of colon cancer.

Collagen Type I↗
PubMed2006

Risk factors related to recurrence in inguinal hernia repair: a retrospective analysis.

The aim of this study was to analyze and evaluate the long-term recurrence rate and risk factors for inguinal hernia recurrence in patients treated by the Shouldice suture repair. A total of 293 hernias treated by Shouldice suture technique in 1992 were studied retrospectively. After a 10-year follow-up, 15 potential risk factors for recurrence were assessed in 142 patients undergoing 171 Shouldice repairs. Recurrent hernias showed a significantly higher (22.0%) recurrence rate than primary inguinal hernias (7.7%). Furthermore, an age of more than 50 years, smoking, and the presence of two or more similarly affected relatives were found to be independent risk factors for recurrence. The present study underlines the importance of patient-related risk factors for the development of a recurrent inguinal hernia. Patients at risk should preoperatively be identified in order to improve treatment by, for example, the application of mesh techniques.

Adolescent↗
PubMed2006

Biomaterial-dependent MMP-2 expression in fibroblasts from patients with recurrent incisional hernias.

With regard to the pathogenesis of recurrent incisional hernia, an impaired connective tissue quality leading to an aberrant scarring process has been proposed. For the matrix metalloproteinase (MMP-2) a pathogenetic involvement in direct inguinal hernia development is reported. With mesh implantation as the gold standard treatment for incisional hernias, the aim of the present study was to investigate the MMP-2 expression in patients with recurrent incisional hernias with and without mesh-materials. In primary fibroblast cultures obtained from skin scars in patients with and without recurrent incisional hernias, MMP-2 synthesis and gene expression were investigated. Furthermore, MMP-2 synthesis and gene expression of fibroblasts were compared after incubation with two different mesh materials: polypropylene and absorbable polyglactin filaments. MMP-2 enzyme activity was determined by semiquantitative zymography and mRNA synthesis by quantitative RT-PCR. Both MMP-2 enzyme activity and mRNA expression were similar in hernia and control fibroblasts in vitro. In control fibroblasts mesh incubation did not significantly affect MMP-2 expression, whereas polypropylene mesh contact of fibroblasts from patients with recurrent incisional hernias led to a major decrease of MMP-2 activity and of mRNA expression. In the absence of biomaterials fibroblasts from recurrent incisional hernia, patients have no alterations of their MMP-2 synthesis compared to control fibroblasts, whereas a specific response was found after biomaterial contact hereby indicating differences in fibroblast phenotype.

Cells, Cultured↗
PubMed2006

Improved abdominal wall wound healing by helium pneumoperitoneum.

BACKGROUND: Despite widespread use of the endoscopic technique in the treatment of inguinal and incisional hernias, knowledge about its impact on abdominal wall wound healing is rare. Questions remain regarding the risk of port-site hernias and hernia recurrence. The current study investigated the gas-dependent effects of pneumoperitoneum on laparotomy wound healing. METHODS: Laparotomy was performed in 54 male Sprague-Dawley rats. A carbon dioxide (n = 18) or helium (n = 18) pneumoperitoneum of 3 mmHg was maintained before and after laparotomy, with an overall duration of 30 min. The rats in the control group (n = 18) received no pneumoperitoneum. The animals were killed after 5 and 10 days, and the abdominal wall was explanted for subsequent histopathologic examinations of the laparotomy wound. The granuloma formation in hematoxylin and eosin-stained sections was analyzed. Infiltration of macrophages (CD68) and expression of matrix metalloproteinases (MMP-8 and MMP-13) were examined by immunohistochemistry. The collagen type 1 to type 3 ratio was investigated by cross-polarization microscopy after Sirius Red staining. RESULTS: After 5 and 10 days, the percentages of CD68-positive cells, granuloma formation, and expression of MMP-8 did not differ between the groups. In contrast, after both 5 and 10 days, the expression of MMP-13 and the collagen 1 to 3 ratio were significantly higher after helium pneumoperitoneum than in the control animals. CONCLUSION: The results suggest that helium pneumoperitoneum may ameliorate wound healing within the abdominal wall and could therefore represent a beneficial gas for endoscopic hernia repair.

Abdominal Wall↗
PubMed2006

Modification of collagen formation using supplemented mesh materials.

BACKGROUND: Formation of recurrent inguinal and incisional hernia shows an underlying defect in the wound healing process. Even following mesh repair an altered collagen formation and insufficient mesh integration has been found as main reason for recurrences. Therefore the development of bioactive mesh materials to achieve a local modification of the scar formation to improve patients outcome is advisable. METHODS: Thirty-six male Wistar rats were used within this study. A Mersilene (R) mesh sample was implanted after midline skin incision and subcutaneous preparation. Before implantation mesh samples were incubated for 30 minutes with either one of the following agents: doxycycline, TGF-beta 3, zinc-hydrogeneaspartate, ascorbic acid, hyaluronic acid. Incubation with a physiologic 0.9 % NaCl solution served as control. Seven and 90 days after mesh implantation 3 animals from each group (n = 6) were sacrificed for morphological observations. Collagen quantity and quality was analyzed measuring the collagen/protein as well as the collagen type I/III ratio. RESULTS: Following an implantation interval of 90 days supplementation with doxycycline (39.3 +/- 7.0 microg/mg) and hyaluronic acid (34.4 +/- 5.8 microg/mg) were found to have a significantly increased collagen/protein ratio compared to implantation of the pure Mersilene (R) mesh samples (28.3 +/- 1.9 microg/mg). Furthermore, an overall increase of the collagen type I/III ratio was found in all groups indicating scar maturation over time. However, no significant differences were found after 7 and 90 days of implantation comparing collagen type I/III ratio of supplemented mesh samples and control group. CONCLUSIONS: In summary, we found an influence of supplemented mesh materials on collagen deposition. However, the investigated bioactive agents with reported influence on wound healing were not associated with an improved quality in scar formation.

Animals↗
PubMed2006

Laparoscopy and collagen metabolism.

The collagens represent a vital component within the wound healing process and physiological scar formation. Therefore, analysing the influence of new operative procedures on collagen metabolism is of great surgical interest. As the endoscopic technique has, nowadays, become routinely applied for diverse abdominal diseases worldwide, we present a review of literature facing its impact on collagen biology.

Collagen↗
PubMed2005

Influence of polyglecaprone 25 (Monocryl) supplementation on the biocompatibility of a polypropylene mesh for hernia repair.

BACKGROUND: Supplementary polyglecaprone 25 (Monocryl) monofilaments were added to a lightweight pure monofilament polypropylene mesh (PP mesh) to improve intraoperative handling (PP+M mesh). This study was designed to evaluate the influence of this additional supplementation on the biocompatibility in a rodent animal model. METHODS: Two mesh materials, a composite mesh (PP+M) and the pure polypropylene variant (PP), were compared after subcutaneous implantation in a standardized rat model. Histological analysis of the inflammatory response was performed after 28, 56 and 84 days of implantation. Material absorption, inflammatory tissue reaction, fibrosis and granuloma formation were investigated, as well as the percentage of proliferating and apoptotic cells at the interface. RESULTS: Both mesh materials showed a slight foreign body reaction involving mainly macrophages and foreign body giant cells. Total absorption of the Monocryl filaments of the PP+M mesh occurred between 56 and 84 days of implantation. Both the inflammatory and the fibrotic reaction were decreased (n.s.) in the PP+M mesh group compared to the pure PP mesh. Whereas the percentage of proliferating cells showed no significant difference, the rate of apoptotic cells was significantly decreased in the PP+M mesh group over the whole implantation period. CONCLUSION: Compared to the pure polypropylene mesh, our data confirm that the use of a polypropylene mesh supplemented with absorbable Monocryl filaments is feasible without additional short-term mesh-related complications in the experimental model or negative side effects on biocompatibility.

Animals↗
PubMed2005

Incisional intercostal hernia after a nephrectomy.

The aim of the present case report is to present the diagnostic and therapeutic challenge of intercostal incisional hernia. We report on a female patient with leftsided intercostal incisional hernia between the eleventh and twelfth rib due to preceding lumbar incision for tumor nephrectomy. Because of its infrequence, diagnosis was established late although simple clinical examination and ultrasound investigation displayed the hernia. At laparotomy, a 5x5 cm(2) fascial defect with a colonic sliding hernia was found. Hernia repair using permanent mesh reinforcement in the retromuscular position is described. Abdominal incisional hernia in the intercostal region is rare and therefore easily overlooked. As with other incisional hernias, the hernia repair using mesh implantation in the retromuscular region is technically feasible and represents the treatment of choice.

Hernia, Ventral↗
PubMed2005

The rare epidemiologic coincidence of diverticular disease and advanced colonic neoplasia.

BACKGROUND AND AIMS: In Western industrialised countries the prevalence of neoplastic colonic lesions and diverticular disease markedly increases with age. In contrast, the coincident occurrence of both diseases seems to fall below their individual epidemiologic estimates. Because directly comparing data are rare, this retrospective study evaluates the coincidence of neoplastic lesions and diverticular disease. PATIENT AND METHODS: A total of 1,838 patients from 1986 to 2000 were admitted to the study. For 1,326 patients-56% male (n=741), 44% female (n=585), mean age 64 (+/-11.83 SD)-with a resection due to colonic cancer, the documented findings of colonoscopy, colonic contrast enema, and/or histopathology were analysed with regard to the prevalence of colonic diverticulosis. In 512 patients--51% male (n=263), 49% female (n=249), mean age 60 (+/-12.59 SD)--with a colonic resection due to diverticulitis, the synchronous or metachronous occurrence of neoplastic colonic lesions was recorded using the database of the Tumour Centre, Aachen. To compare the observed results with published epidemiology, statistical analysis included age-referred binomial tests and an age-stratified analysis (Cochran-Mantel-Haenszel test). Odds ratios (OR) were also calculated. P<0.05 was considered to indicate locally statistical significance. RESULTS: In the cancer group, we found a statistically significant reduced rate of diverticula in nearly all age categories and the age-stratified analyses (corresponding OR 0.30-0.51). Consistently, the diverticulitis group revealed a statistically significant decreased rate of advanced colonic neoplastic lesion in nearly all age categories and all age-stratified analyses (corresponding OR 0.13-0.43). CONCLUSION: Our results indicate that patients with colonic neoplastic lesions or diverticular disease probably form heterogeneous groups. Because current results from molecular biology emphasize the impact of the extracellular matrix on the genesis of diverticulosis and colonic cancer, the observed heterogeneity could be an expression of a distinct composition of the local milieu.

Adult↗
PubMed2005

Intraabdominal adhesion formation of polypropylene mesh. Influence of coverage of omentum and polyglactin.

BACKGROUND: Adhesions after intraabdominal surgical procedures are related to high morbidity and mortality. Biomaterials, particularly those made of polypropylene, in the intraabdominal position have to be considered as pathophysiological cofactor in a multifactorial process of adhesion formation. To investigate the adhesive potential induced by the biomaterial, an animal model was performed. In addition, the influence of coverage by omentum or a polyglactin barrier was investigated. METHODS: In, 18 Chinchilla rabbits the biomaterial was placed laparoscopically using the intraperitoneal onlay mesh technique. Using this model, a polypropylene-polyglactin mesh compound (PPMC) was used with three different implantation techniques: group 1, PPMC implantation without coverage (PPMC): group 2, PPMC implantation with additional omentum coverage (PPMC-O): and group 3, PPMC implantation with coverage of an absorbable polyglactin mesh (PPMC-V). The degree of adhesion formation was measured 90 days after implantation by computer-assisted planimetry. Morphometric examination followed the explantation analyzing the amount of foreign body response. RESULTS: We found a significant reduction of adhesion formation for the PPMC and PPMC-O groups compared to the PPMC-V group, in which dense adhesions were found. Morphometric investigations of the perifilamental granulomas of the pure (PPMC) group revealed a typical foreign body reaction with a mild to moderate fibrosis around all mesh fibers. However, tissue specimens of the PPMC-O and PPMC-V groups indicated a similar inflammatory reaction but significantly increased connective tissue formation around the polymer fibers compared to the pure PPMC group. CONCLUSION: The intraabdominal placement of a pure PPMC shows a neoperitonealization and perifilamental collagenous ingrowth with almost no adhesions. Coverage with omentum (PPMC-O) or polyglactin mesh (PPMC-V) resulted in a significant increase in inflammation and perifilamentary connective tissue formation.

Animals↗
PubMed2005

[Ropivacain after inguinal hernia surgery. A prospective, randomised, double-blinded, controlled study].

BACKGROUND: To optimise the satisfaction of patients after repair of primary inguinal hernias under local anaesthesia, we analysed the analgetic power of Ropivacain in the postoperative period. MATERIAL AND METHODS: One hundred consecutive patients underwent repair under local anaesthesia with the same volume of 0.75% Ropivacain or 1% Mepivacain in a randomised and blinded manner. Postoperative pain analysis was carried out in all patients. RESULTS: Subjective pain levels at rest and under stress as well as impairment by pain were found to be significantly lower in the Ropivacain group at the day of operation. Decrease in vital capacity and peak flow showed similar results. The postoperative amount of analgesics and time of mobilisation showed a positive influence by the use of Ropivacain. CONCLUSION: Ropivacain reduces postoperative pain levels after hernia repair. This leads to increased comfort for patients, without elevated perioperative risk.

Adult↗
PubMed2004

Titanium coating of a polypropylene mesh for hernia repair: effect on biocompatibilty.

Titanium and its alloys are used worldwide in surgery. The favorable characteristics that make this material desirable for implantation are corrosion resistance and biocompatibility. Concerning hernia repair, a mesh modification has been developed using titanium layering of a polypropylene mesh implant, which is said to lead to an improved biocompatibility compared to commercially available mesh materials. To analyze the pure effect of titanium coating, two different mesh structures were studied using a standardized animal model. The titanium-coated monofilamentous, large porous, and lightweight mesh made of polypropylene and coated with titanium (PP+T) was compared to a pure polypropylene mesh manufactured with a similar structure and amount of material serving as a control (PP). In Sprague-Dawley rats, mesh samples were placed in a subcutaneuous position. Then 56, 84, and 182 days after mesh implantation, three animals from each group were sacrificed for morphological observations (amount of inflammatory and connective tissue formation, percentages of proliferating and apoptotic cells, percentage of macrophages). Both mesh modifications investigated showed an overall good biocompatibility. Macroscopic clinical observation after implantation of up to 182 days was uneventful. The tissue response to the PP as well as to the PP+T mesh was characterized by a moderate inflammatory tissue reaction limited to the perifilamentary region as is known for low weight, large porous, and monofilamentous mesh structures. No significant improvement of biocompatibility was found when analyzing the effect of titanium coating compared to the pure polypropylene mesh structure.

Animals↗
PubMed2004

Impact of pressure and gas type on anastomotic wound healing in rats.

BACKGROUND: Laparoscopic techniques in the treatment of various bowel diseases have become more and more popular in today's clinical routine. However, knowledge about the impact of a carbon dioxide (CO(2)) pneumoperitoneum on the quality of healing of the intra-abdominal wound is rare. We therefore investigated the effects of pressure and gas type on anastomosis healing in a rat model. METHODS: Laparotomy and twofold ileo-ileal anastomosis was performed in 78 male Sprague Dawley rats. A CO(2) or a helium pneumoperitoneum of 3 mmHg (each, n=18) or of 6 mmHg (each, n=12) was maintained before and after ileo-ileostomy. Rats in the control group ( n=18) received no pneumoperitoneum. Animals were killed after 5 and 10 days. As indicator of bowel function, mean body weights were compared between the groups. One region of the anastomosis was subjected to computerised bursting-pressure measurements, while the second was explanted for subsequent histopathological examinations: collagen synthesis and degradation was determined by the ratio of collagen type I to type III and by the matrix metalloproteinase MMP-13. The extent of new mucosal layer formation was measured in haematoxylin and eosin (H and E)-stained sections. RESULTS: Alteration in mean body weight and the mean anastomosis bursting pressures did not differ between the groups. Likewise, histological examination revealed no statistically significant differences, either in the values for collagen I/III ratios or in the extent of mucosal proliferation. After 10 days, 6 mmHg helium pneumoperitoneum was associated with a more pronounced expression of MMP-13 than that of controls. CONCLUSIONS: A CO(2) pneumoperitoneum with pressures of 3 mmHg and 6 mmHg was found to have no significant impact upon the healing of anastomosis wounds in rats. Helium pneumoperitoneum offers no advantages over CO(2).

Anastomosis, Surgical↗
PubMed2004

Miltefosine for new world cutaneous leishmaniasis.

The oral agent miltefosine has demonstrated a >95% cure rate in Indian visceral leishmaniasis. We performed a large, placebo-controlled study of miltefosine therapy (2.5 mg/kg per day orally for 28 days) against cutaneous leishmaniasis in Colombia and Guatemala. In regions in Colombia where Leishmania vianna panamensis is common, the per-protocol cure rates for miltefosine and placebo were 91% (40 of 44 patients) and 38% (9 of 24). These values are similar to historic values for the antimony standard of care and placebo. In regions in Guatemala where L. v. braziliensis and L. mexicana mexicana are common, the per-protocol cure rates were 53% (20 of 38) for miltefosine and 21% (4 of 19) for placebo. The miltefosine rate was lower than historic antimony cure rates of >90%. Miltefosine was well tolerated. Miltefosine is a useful oral agent against cutaneous leishmaniasis due to L. v. panamensis in Colombia but not against leishmaniasis due to L. v. braziliensis in Guatemala.

Administration, Oral↗
PubMed2004

[Large solitary fibrous tumors of the pleura as incidental finding. 2 case reports of a rare tumor entity].

The solitary fibrous tumor (SFT) is a very rare and usually benign neoplasm. This tumor is mostly located in the thoracic cavity, but it has also been reported in numerous sites including liver, skin, and meninges. Due to its rarity diagnosis is often difficult. Accordingly, histopathological differentiation is of major importance. Solitary fibrous tumors consistently express CD 34 and react negatively to epithelial markers. This absence of expression of epithelial markers, especially cytokeratin, is also useful to distinguish these rare entities from sarcomatous mesotheliomas. The treatment of choice for solitary fibrous tumors is extensive surgical resection. Up to now there is no evidence that radiation and chemotherapy are effective. The local recurrence or onset of metastases depends on histologic parameters. In cases of benign classification (60-80%), the recurrence rate was only 2% after surgical excision. One-half of the patients with malignant tumors can be cured; the rest develop recurrences and metastases more often. Especially in those cases, emphasis should be placed on continual follow-up examination. We report two cases of a 65- and a 75-year-old male patient with huge intrathoracic solitary fibrous subpleural tumors, discovered incidentally on routine chest X-ray.

Aged↗
PubMed2004

Abdominal musculature and the transversalis fascia: an anatomical viewpoint.

This anatomical study investigated the connection of the muscles of the abdominal wall to the transversalis fascia in the groin. In six unfixed male corpses we prepared the single levels of the inguinal abdominal wall and examined their interrelationships. Of special interest were the direction of the force vectors determined by the direction of the muscular fibers in relation to the transversalis fascia. We found no confirmation of a direct connection between the muscles of the abdominal wall and the transversalis fascia in the inguinal region. No force vector of the different muscular layers points away from the triangle of Hesselbach. By contraction each muscle thus relaxes the transversalis fascia of the Hesselbach triangle.

Abdominal Muscles↗