PubMed Health⌕ Search

Biomedical subjects

K Junge

Publications and source records attributed to K Junge.

At least 37 records · Page 2Linked to original sources
PubMed2003

A case of bilateral inguinal hernia recurrence in infancy: investigations on collagen metabolism.

BACKGROUND: Recurrent inguinal hernias in early infancy are rare. We report on a case of a 3-month-old male infant suffering bilateral inguinal hernia recurrence (RINGH). Due to previous observations of an altered collagen metabolism in hernia patients, a severe connective-tissue pathology in the infant was hypothesised. METHODS: Hernial sac tissue of the infant was analysed and compared to specimens from five children operated upon one-sided primary inguinal hernias (controls). In paraffin-embedded sections, we determined the distribution of collagen types I and III by crosspolarisation microscopy and the expression of matrix metalloproteinase 2 (MMP-2) by immunohistochemistry. In fibroblast cultures, expression of collagen types I and III and of MMP-2 was investigated by RT-PCR (real-time polymerase chain reaction) and zymography. Electron microscopical investigations were performed exemplarily in two fibroblast cultures to compare cell morphology. RESULTS: No differences in collagen I/III ratios between RINGH and controls were found either on protein or on mRNA level. Immunohistochemical and RT-PCR analysis of MMP-2 showed a lowered expression in the RINGH patient, as compared to controls, whereas the gelatinolytic activity of MMP-2 did not differ between the groups. Electron microscopical investigations showed similar cell arrangement and morphology. CONCLUSIONS: To conclude, a marked biochemical correlate to a severe connective-tissue pathology in the infant suffering inguinal hernia recurrence could not be found. With regard to the slight differences in the expression of MMP-2, a possible role in the genesis of inguinal hernia recurrence cannot be ruled out.

Abnormalities, Multiple↗
PubMed2003

Mesh reconstruction preventing sacral herniation.

Sacral hernias are uncommon defects developing through the pelvic floor after partial or total sacrectomy. We report on a 29-year-old woman, who has been under our care with a cystic formation after perineosacral resection of a rhabdomyosarcoma and partial sacrectomy. The cystic tumor was resected and a mesh repair performed to prevent sacral herniation. The current literature is summarized; etiology and management recommendations of this rare complication are discussed.

Adult↗
PubMed2003

Repair of intercostal pulmonary herniation.

Intercostal pulmonary herniation occurring years after blunt thoracic trauma is a rare phenomenon. We report on the case of a 66-year-old patient who developed a pulmonary herniation 2 years after a seat-belt injury. Thoracotomy was performed, and the thoracic wall defect was closed with approximating periostal absorbable sutures. The postoperative course was uneventful. Different surgical approaches and the use of prosthetic patches are discussed. Periostal fixation of the adjacent ribs with absorbable sutures is usually sufficient for herniation repair. In cases in which prosthetic meshes are needed, the application of PTFE might produce the best results with the least complications.

Aged↗
PubMed2003

Incisional abdominal hernia: the open mesh repair.

BACKGROUND: Mesh techniques are the methods of choice for the repair of incisional hernias since these are due to the formation of unstable scar tissue. METHODS: We review the materials and techniques used in the repair of incisional hernias. We describe in detail the operative technique performed in our clinic, the pitfalls of the repair, and the overlap behind the xiphoid and the pubic bone. RESULTS: Polypropylene is the material widely used for open mesh repair. New developments have led to low-weight, large-pore polypropylene prostheses, which are adjusted to the physiological requirements of the abdominal wall and permit a proper tissue integration. These meshes provide the possibility of forming a scar net instead of a stiff scar plate and therefore help to avoid former known mesh complications. CONCLUSIONS: The ideal position for the mesh is the retromuscular sublay position where the force of the abdominal pressure holds the prosthesis against the deep surface of the muscles. The lowest incidence rates of recurrence have been reported for the retromuscular sublay repair; even after long-term follow-up recurrence rates of 10% are possible. Attaining such good results requires an adequate size of the mesh with sufficient overlap of at least 5-6 cm in all directions. Open mesh repair using modern low-weight polypropylene meshes in the retromuscular sublay technique offers excellent results for the treatment of incisional hernias.

Digestive System Surgical Procedures↗
PubMed2003

Analysis of collagen-interacting proteins in patients with incisional hernias.

BACKGROUND: In recent years a disorder of the collagen metabolism has been suggested for the pathogenesis of abdominal wall hernias. Previous investigations of skin specimens revealed a reduction in the collagen I/III ratio and alterations in matrix metalloproteinases in patients with incisional hernias. We investigated known collagen-interacting proteins to further characterize connective tissue in these patients. PATIENTS AND METHODS: Skin scars from patients with either primary or recurrent incisional and recurrent inguinal hernias, as a subgroup of incisional hernias, were analyzed for overall collagen content and for the distribution of collagen types I and III by crosspolarization microscopy. The expression of collagen type V, collagen receptor discoidin domain receptor 2, matrix metalloproteinase 1, connective tissue-like growth factor, and tenascin was determined by immunohistochemistry. Mature abdominal skin scars from patients without evident hernia served as controls. RESULTS: Patients with recurrent incisional hernia showed lowest ratios of collagen types I to III. Contents of overall collagen and of collagen type V did not differ between the groups. In patients with either primary or recurrent incisional hernias the proportion of collagen receptor discoidin domain receptor 2 positive cells was increased. Matrix metalloproteinase 1 expression was more pronounced in patients with recurrent incisional or inguinal hernias than in controls. Connective tissue-like growth factor was significantly increased in recurrent inguinal hernia patients. The expression of tenascin was notably decreased in all hernia groups. CONCLUSIONS: The observed alterations in the expression of collagen-interacting proteins again indicate the possibility of a fundamental connective tissue disease as the causal factor in the pathogenesis of (recurrent) incisional hernias.

Aged↗
PubMed2003

Breaking strength and tissue elasticity after Shouldice repair.

There are few objective studies in the surgical literature on the strength of an inguinal hernia repair during the immediate postoperative period. To provide the relevant advice and recommendations on physical activities during the period of convalescence, a study on the strength of the Shouldice repair was carried out. Twenty-eight Shouldice repairs were performed on 17 fresh human cadavers (11 male, 17 female, mean age 79.9+/-6.2 years). Following the excision of the transversalis fascia, the breaking strength and tissue elasticity were measured using an automated test device. All tissue ruptures occurred outside the limits of the Shouldice repair. Mean breaking strength was 53.9+/-20.1 N, showing no significant differences between males and females. The measured overall elasticity of tissue samples was 4.6+/-2.3 N/cm. Again there was no marked difference between genders. However, breaking strength and elasticity were found to be significantly affected by age. The Shouldice repair demonstrated a higher tensile strength when compared to the surrounding tissue. Strength after a Shouldice repair of the floor of the inguinal canal was found to be several times higher than could be attained under physiologic conditions. Therefore, an early postoperative return to normal activity can be recommended.

Aged↗
PubMed2003

Individual inflammatory response of human blood monocytes to mesh biomaterials.

BACKGROUND: Alloplastic implants such as those employed in hernia repair induce distinct local inflammation and seroma production. As monocytes take a key position in the inflammatory foreign body reaction, their specific release of cytokines was investigated in vitro after incubation with alloplastic materials. METHODS: Human blood monocytes were isolated from buffy coats of 42 healthy blood donors. Cells were cultivated in polystyrene culture wells (4 x 10(6) cells/well) on polypropylene-polyglactin mesh, on polytetrafluoroethylene, in control wells with the addition of 1 micro g lipopolysaccharide (LPS) and on pure polystyrene. Supernatant was taken after 1 h and 5 days, and concentrations of tumour necrosis factor (TNF) alpha, interleukin (IL) 6 and IL-10 were determined. Donors were defined as 'high' or 'low' responders when concentrations of TNF-alpha were above the 75th or below the 25th percentiles, respectively. RESULTS: In contact with biomaterials, the monocytes liberated TNF-alpha, IL-6 and IL-10, similar to levels observed after stimulation with LPS. Median cytokine concentrations were not normally distributed and were influenced by donor, timepoint and applied stimulus. One donor matched the criteria for low responder and three for high responder. CONCLUSION: The individual was identified as an independent factor for the inflammatory response of monocytes to biomaterials. Moreover, high and low responders could be identified. The variability of cytokine release and the lack of a normal distribution suggest that a larger sample size should be used in future studies of cellular response.

Biocompatible Materials↗
PubMed2003

No influence of body weight on pregnancy rate in patients treated with cetrorelix according to the single- and multiple-dose protocols.

The question of whether adjustment to body weight is necessary in in-vitro fertilization (IVF) cycles using GnRH antagonists is currently under discussion. Therefore, a data analysis of five prospective studies using either the single- or the multiple-dose antagonist protocol with cetrorelix (Cetrotide) was performed. The influence of stimulation procedure, gonadotrophins and body weight on pregnancy rate was evaluated in a linear logit model. The effect of the stimulation procedure and body weight on the cumulus-oocyte complex (COC) and follicle number was explored in an ANOVA model. Cetrorelix plasma concentrations were tested for any correlation with body weight. Baseline and outcome parameters in different body weight groups (<50 kg, 50-59 kg, 60-69 kg, 70-79 kg, > or =80 kg) were assessed for human menopausal gonadotrophin and recombinant human FSH stimulation separately. Cetrorelix plasma concentrations were correlated with body weight, but no influence of the type of stimulation or body weight on pregnancy rate was found. Body weight did not influence cetrorelix plasma concentrations. In contrast, body weight significantly influenced the number of retrieved COC as well as the number of follicles on the day of human chorionic gonadotrophin administration. Body weight does not influence the outcome of treatment in cetrorelix cycles.

Body Weight↗
PubMed2003

Caecal-diverticulitis: a rare differential diagnosis for right-sided lower abdominal pain.

OBJECTIVE: There are several differential diagnoses for acute abdominal discomfort with pain referred to the right lower quadrant region. The objective of this report is to outline our experience with diverticulitis of the caecum, which is a rare condition that is particularly difficult to diagnose correctly pre-operatively. METHODS: A retrospective analysis of acute diverticulitis of the caecum was performed over the period from January 1992 to December 2000 within the Surgical Department of the RWTH Aachen, Germany. The progress of each patient was assessed by interviewing the patient and by telephone contact with the patient's general practitioner. RESULTS: Seven patients with isolated infective diverticulitis of the caecum were encountered in the course of this study. In five of these cases, the pre-operative diagnosis was either unclear or incorrect. Four patients underwent surgery for suspected appendicitis. In one patient, the diverticulitis was diagnosed during laparoscopic surgery undertaken for presumed adnexal disease. Intestinal continuity was restored in all cases. The postoperative course was uneventful. CONCLUSIONS: Right-sided caecal diverticulitis is rare in comparison to diverticulitis of the sigmoid or descending colon. Nevertheless, it should be actively considered in the differential diagnosis of patients with acute tenderness in the right lower abdominal region.

Abdominal Pain↗
PubMed2002

Influence of laparotomy closure technique on collagen synthesis in the incisional region.

BACKGROUND: Variations of suture technique have an influence on the mechanical strength of laparotomy wounds. To investigate whether these differences in biomechanical properties influence collagen synthesis in the incisional region, an animal experiment on laparotomy closure was performed. MATERIAL: In 100 rats median laparotomies were closed with polypropylene. Continuous and single sutures were applied with variations of suture length to wound length (SLWL) ratio and suture tension. METHODS: Tissue samples from the incisional region after 2 and 4 weeks were analysed spectro-photometrically for the concentration of collagen protein and by digital image analysis for the percentage of collagen type III. RESULTS: Running closure with an SLWL ratio >or=4:1 resulted in a significantly higher concentration of collagen protein than single sutures with the same SLWL ratio. In contrast, single closure with an SLWL ratio <4:1 led to in a higher collagen protein concentration than running closure with the same SLWL ratio. With an SLWL ratio >or=4:1 running sutures resulted in a significant reduction of the percentage of collagen type III after 4 weeks compared to single sutures. Closure with high suture tension led to a significant reduction of collagen protein between the 2nd and 4th week but left the percentage of collagen type III mostly unaffected. CONCLUSION: Suture technique, SLWL ratio, and suture tension have an effect on the ultrastructural composition of the regenerating tissue. This influence outlasts the period of tissue restructuring during which the presence of sutures in the incisional edges is absolutely required. Running sutures with an SLWL ratio >or=4:1 and low suture tension promote a favourable collagen composition of the incisional region.

Animals↗
PubMed2002

Phylogenetic diversity of numerically important Arctic sea-ice bacteria cultured at subzero temperature.

Heterotrophic bacteria in sea ice play a key role in carbon cycling, but little is known about the predominant players at the phylogenetic level. In a study of both algal bands and clear ice habitats within summertime Arctic pack ice from the Chukchi Sea, we determined the abundance of total bacteria and actively respiring cells in melted ice samples using epifluorescence microscopy and the stains 4', 6'-diamidino-2-phenylindole 2HCl (DAPI) and 5-cyano-2,3-ditolyl tetrazolium chloride (CTC), respectively. Organic-rich and -poor culturing media were used to determine culturable members by plating (at 0 degrees C and 5 degrees C) and most-probable-number (MPN) analyses (at -1 degrees C). Total bacterial counts ranged from 5.44 x 10(4) ml(-1) in clear ice to 2.41 x 10(6) ml(-1) in algal-band ice samples, with 2-27% metabolically active by CTC stain. Plating and MPN results revealed a high degree of culturability in both types of media, but greater success in oligotrophic media (to 62% of total abundance) and from clear ice samples. The bacterial enumeration anomaly, commonly held to mean <or= 0.01% cultured, was not demonstrated in any of our samples. Denaturing gradient gel electrophoresis was used to check the purity of 44 isolates and select representatives for subsequent sequencing. Phylogenetic analyses based on 16S rRNA sequences indicated close relationships exclusively to known marine psychrophiles within two bacterial divisions, Proteobacteria (in the genera Alteromonas, Colwellia, Glaciecola, Octadecabacter, Pseudoaltermonas and Shewanella) and Cytophaga-Flexibacter-Bacteroides (Cytophaga, Flavobacterium, Gelidibacter and Polaribacter). All cultures from the clear ice sample with highest (62%) culturability were closely related to each other or to psychrophilic Cytophaga-Flexibacter-Bacteroides (94.9-99.6% sequence similarities). Overall, these findings suggest limited, heterotrophic bacterial diversity at cold temperatures and may provide insight into the recent evolution of psychrophilic bacteria.

Arctic Regions↗
PubMed2002

Functional and morphological evaluation of a low-weight, monofilament polypropylene mesh for hernia repair.

With more than 1 million implantations per year worldwide, mesh repair has become a standard procedure for the treatment of hernias. Apart from various technical problems, the type of material has been proven to be of considerable importance for the functional and histological outcome, particularly for long-term implantation. Whereas the advantageous application of low-weight, large-pore meshes based on multifilaments can be stated without doubt, it is still open whether similar results can be achieved on the basis of pure monofilaments. In the present study, a low-weight polypropylene mesh (LW) made purely of monofilaments was compared to a common heavy-weight polypropylene mesh (HW) in regard to the functional consequences and the tissue response. After implantation in rats as an inlay for 3--90 days, the abdominal-wall mobility of the implant region was recorded by 3D stereography, and the tensile strength of both the suture zone and the mesh was measured. The morphometry of the histological reaction in regard to the inflammatory infiltrate, the connective tissue, the number of granulocytes, macrophages, and fibroblasts served to reflect the tissue response. As parameters for the remodeling process at the interface the cellular activation was evaluated by TUNEL (DNA-strand breaks or apoptosis, respectively), Ki 67 (cell proliferation), and HSP 70 (cell stress). The measured tensile strength of the LW mesh confirmed a sufficient strength of the material-reduced mesh modification. After implantation the consecutive impairment of the abdominal-wall mobility was reduced compared to the HW mesh, concomitant to the reduced fibrotic level at the interface. At the end of the observation period the foreign-body reaction was significantly lowered for the LW mesh, almost reaching physiological values. In conclusion, these data confirm the improved biocompatibility of material-reduced mesh implants.

Abdominal Wall↗
PubMed2002

Do multifilament alloplastic meshes increase the infection rate? Analysis of the polymeric surface, the bacteria adherence, and the in vivo consequences in a rat model.

Within the last decade hernia surgery has changed from suture repair to mesh repair. Biomaterials, and multifilaments in particular, are thought to increase the risk of infection. Therefore, the aim of this study was to study the influence of the presence of either a monofilament or a multifilament mesh material on the bacterial infection risk. The filament surface of a monofilament and a multifilament mesh were calculated on the basis of a theoretical model. The adherence of Staphylococcus aureus was measured in vitro by fluorescence analysis. Additionally, the two mesh materials (8-mm platelets) were implanted subcutaneously in Sprague-Dawley rats with daily surveillance for clinical signs of infection. After 7 days the meshes were explanted for histological and microbiological analysis. Calculations of the mesh surface area revealed a higher level for the multifilament mesh. The extent of adherent bacteria corresponded to the estimated filament surface in vitro. In vivo, the implantation of meshes in the presence of 5 x 10(6) S. aureus did not show an increased infection rate in rats with either monofilament or multifilament material, compared to the control groups (mesh implantation without S. aureus contamination). However, after 7 days bacteria were still detectable in the majority of the implantation sites, and a clinically inapparent intensification of local inflammation and fibrosis was induced. The increased surface area of a multifilament meshes promotes the persistence of bacteria in the implant bed, though this alone is not sufficient to create a clinically apparent infection. This might explain the development of mesh-related infections after a delay of several months or even years. In vivo, the adherence of bacteria to the implant material depends on the surface area, which favors the use of monofilament materials.

Animals↗
PubMed2002

Impact of polymer pore size on the interface scar formation in a rat model.

BACKGROUND: The surgical therapy of hernias is increasingly based on reinforcement with alloplastic material, in particular surgical meshes. The biological response to these foreign bodies largely depends on the selected material and its structure. In comparison to the physiological scar process following a simple abdominal wall incision, the chronic inflammation at the interface to the polymers lead to specific morphological alterations. MATERIALS AND METHODS: In the present study two meshes with different pore sizes were implanted into rats: a heavy-weight and small-pore-sized mesh (hw-mesh) made of nonabsorbable polypropylene monofilaments and a low-weight large-pore-sized mesh consisting of polypropylene and of absorbable polyglactin multifilaments (lw-mesh). A suture repair of a laparotomy served as control. After 7, 14, 21, and 90 days the mesh area was analyzed with regard to tissue and cellular response. RESULTS: Over the whole observation period morphometric analysis indicated an improved integration of the lw-mesh with reduction of both inflammation and fibrosis, whereas the hw-mesh induced an intense chronic inflammation concomitant with an intensified bridging scar reaction. On the cellular level these findings correspond to an elevated cell turnover, characterized by increased rates of apoptotic and proliferating cells. In contrast, the tissue reaction to the lw-mesh achieved levels almost similar to those of the physiological scaring process in the control group. CONCLUSION: In conclusion, the present data confirm the development of a chronic inflammatory foreign body reaction at the interface to both hw-meshes and lw-meshes; however, the use of lw-meshes showed superior tissue integration. With regard to the quite similar polymer surface the pore size appears to be of major importance in tissue reaction and for the biocompatibility of mesh structures.

Animals↗
PubMed2002

[Leiomyosarcoma of the hernial sac in inguinal hernia].

Malignant tumors associated with hernial sacs are rare entities. A review of literature offers only small groups of patients. The high incidence of inguinal hernia repair operations demands recognition of this morbidity. It should be suspected in cases of tight tissue in the hernial sac in differentiation to the unreduced inguinal and femoral hernia. Therapy of choice must be a resection in toto (R0), incomplete resection causes inguinal spreading or recurrence of the tumor. The exact evaluation of the surroundings should follow. There is no other standardized therapy besides operation. A case of leiomyosarcoma in inguinal hernia will present the entity of neoplastic disease in hernial sac.

Abdominal Neoplasms↗
PubMed2002

[Weakly malignant leiomyosarcoma of the inferior vena cava. A case report].

Primary vascular leiomyosarcomas of the great vessels are rare and the most common localization is the inferior vena cava. Due to nonspecific clinical signs, diagnosis is often made during operation or autopsy. At present, a radical tumor resection is the first choice of treatment. This is a case report of a 49-year-old woman who suffered from abdominal pain for 10 years because of a weakly malignant leiomyosarcoma of the inferior vena cava. A radical tumor resection and reconstruction with a prosthetic vascular graft were performed. Diagnosis, therapy, and prognosis are discussed.

Blood Vessel Prosthesis Implantation↗
PubMed2002

[Retromuscular mesh repair for ventral incision hernia in Germany].

Since the onset of an incisional hernia is caused by the biological problem of forming stable scar tissue, the mesh techniques are now the methods of choice for incisional hernia repair. Polypropylene is the material most widely used for open mesh repair. New developments have led to low-weight, large-pore polypropylene prostheses, which have been adapted to the physiological requirements of the abdominal wall and permit a reliable tissue integration. These meshes make it possible for a scar net to form rather than a stiff scar plate, thus helping to avoid the complications encountered with the use of earlier meshes. The ideal position for the mesh seems to be the retromuscular underlay position, in which the force of abdominal pressure holds the prosthesis tightly against the deep surface of the muscles. The retromuscular underlay repair technique has yielded the lowest incidence rates for recurrence: around 10% even after long-term follow up. Analysis of the failures after open mesh repair suggests that inadequate size of the mesh with insufficient overlap at the edges is the main reason for recurrence. An overlap of at least 5-6 cm all round must therefore be considered mandatory for successful reinforcement of the abdominal wall. Open mesh repair, particularly with modern low-weight polypropylene meshes applied by the retromuscular underlay technique, offers excellent results in the treatment of incision hernias, even in long-term follow-up studies.

Abdominal Wall↗