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Biomedical subjects

K Kraft

Publications and source records attributed to K Kraft.

At least 37 records · Page 2Linked to original sources
PubMed2001

Coexpression of cytokeratins typical for columnar and squamous differentiation in sinonasal inverted papillomas.

Cytokeratin (CK) expression was studied in 22 sinonasal inverted papillomas. Columnar (respiratory) epithelium in inverted papillomas abundantly expressed CK7, CK8, CK18, and CK19. Immunoreactivity for CK5/14 and CK17 was found in basal and parabasal/suprabasal cells. Transitional (cuboidal) and squamous epithelium in inverted papillomas comparably expressed CK7, CK8, CK18, and CK19. In addition CK13 was found in subluminal and surface cells. Immunoreactivity for CK5/14 and CK17 involved all layers of the epithelium. In nonpapillomatous nasal mucosa adjacent to inverted papillomas, CK expression in columnar (respiratory) epithelium exactly matched the findings in inverted papillomas. Transitional (cuboidal) and squamous epithelium in nonpaillomatous mucosa were negative for CK7, CK8, CK18, and CK19. CK13 was expressed in subluminal and surface cells. Immunoreactivity for CK5/14 and CK17 was restricted to basal and parabasal/suprabasal cells. Conclusively, transitional (cuboidal) and squamous epithelium in inverted papillomas but not in the adjacent mucosa coexpress CKs typical for columnar and squamous differentiation.

Adult↗
PubMed2000

[Laparoscopic hernia therapy (TAPP) as a teaching operation].

INTRODUCTION: Because of an increasing number of endoscopic hernia procedures, it is important to look into the possibility of standardizing these techniques helping surgeons to acquire the operative skills necessary. MATERIAL AND METHODS: To discuss these aspects, the documented data on TAPP operations that have been carried out in this department since 1993 were analyzed. The results of teaching procedures were compared with those of experts after they had gotten past the learning and development curve. RESULTS: A total of 778 teaching procedures were performed by 10 surgeons with an individual experience of 30.5 operations (median). Before starting the first procedure, 89 were done by assistants operating the camera. The morbidity of teaching operations was 1.9% compared to 1.4% for those performed by experts. After a median follow-up of 23 months there were two recurrences (0.23%) in the expert group and none in the teaching group (follow-up 16 months). CONCLUSION: Because of the potentials of standardization of the TAPP technique, the results of teaching were equal to expert operations. Therefore, TAPP is suitable for application in a routine setting.

Clinical Competence↗
PubMed2000

[Neurinoma of the nasal cavity].

A 35 years old male patient presented with serous nasal secretion, relapsing epistaxis and a slowly progredient nasal obstruction. Clinical examination and CT scans showed a tumor occupying the left middle meatus and the whole nasal cavity displosing the nasal septum to the right side. The tumor was resected by a midfacial degloving approach. Histological examination showed a neurinoma. By means of the presented case report and a review of literature, diagnosis and treatment of this rare nasal tumor are discussed.

Adult↗
PubMed2000

Scrotal hernias: a contraindication for an endoscopic procedure? Results of a single-institution experience in transabdominal preperitoneal repair.

INTRODUCTION: Endoscopic repair was introduced for use with inguinal hernia therapy more than 10 years ago. The technique as well as the indications for this method are debated, however. As a borderline inguinal hernia situation, the scrotal hernia in particular evokes vehement objections to an endoscopic procedure because of the anticipated problems and complications in dissecting the extended hernia sac. The efficiency of the laparoscopic transabdominal preperitoneal (TAPP) technique in the treatment of scrotal hernia therefore is discussed in this article. METHODS: Laparoscopic hernia repair (TAPP) has been performed in our department since 1993. Data are collected by a prospective documentation of operative and follow-up results. For evaluation, a comparison of scrotal and normal hernia repair was performed. RESULTS: Between April 1993 and June 1998 the TAPP technique was used to treat 191 scrotal hernias, 42 (22%) of which were recurrent hernias. The median operating time for a normal inguinal hernia repair was 45 min, whereas scrotal hernias required a median of 65 min and irreducible scrotral hernias a median of 68.5 min. Major complications were observed in 1.6% of scrotal and 0.6% of normal inguinal hernia repairs. The most frequent scrotal hernia repair problem was the formation of a seroma, 10.5% of which had to be evacuated. During a follow-up period of 30 months, we found a total of two recurrences (1.05%). CONCLUSION: In scrotal hernia repair, TAPP is not associated with higher complication rates and can be performed with efficiency comparable with that in normal inguinal hernia repair.

Contraindications↗
PubMed2000

Recurrence after endoscopic transperitoneal hernia repair (TAPP): causes, reparative techniques, and results of the reoperation.

BACKGROUND: Even though the introduction of endoscopic surgical techniques to inguinal hernia therapy dates back 10 years, only a few data exist concerning the problem of development of a recurrence after endoscopic repair. Similarly there are only anecdotal reports on the feasibility of an endoscopic reintervention for this situation. For the first time we are able to present data of a prospective study on both issues. STUDY DESIGN: We analyzed the data of a prospectively documented series of 46 transperitoneal hernia repair reinterventions after endoscopic hernia repair. In 33 patients from our own clinic we evaluated the cause of recurrence after transperitoneal hernia repair. Together with these and 13 more patients sent to us from external clinics we examined the efficiency of an endoscopic reoperation. RESULTS: When implanting a 13 x 8-cm mesh with an incision (phase I) we found the main cause of recurrence to be that the mesh was too small (47.4%) and the region of the mesh incision was insufficient (42.1%). After a change to a 15 x 10-cm implant without incision (phase II) the main cause of recurrence was found to be a mesh dislocation (38.9%) and the rate of recurrence dropped from 2.8% (phase I) to 0.36% (phase II). The transperitoneal reoperation lasted for a median of 75 minutes (range 45 to 170 minutes) for the medial recurrence and a median of 110 minutes (range 65 to 190 minutes) for the lateral recurrence (p = 0.009). The total rate of complications was 10.9%, and the rate of re-recurrence was 0% after a median followup of 26 months (range 2 to 72 months). CONCLUSIONS: To avoid hernia recurrence after transperitoneal hernia repair operations a sufficiently large mesh (at least 15 x 10 cm) has to be implanted, preferably without an incision, after an extensive parietalization. The endoscopic reoperation for recurrence can be done only in a transperitoneal way and is effective with comparably low complication rates. The procedure is significantly easier for a medial recurrence compared with a lateral recurrence. This method of reoperation should be reserved for endoscopically experienced surgeons.

Adult↗
PubMed2000

Prognostic value of graph theory-based tissue architecture analysis in carcinomas of the tongue.

Several studies on oral squamous cell carcinomas (OSCC) suggest that the clinical value of traditional histologic grading is limited both by poor reproducibility and by low prognostic impact. However, the prognostic potential of a strictly quantitative and highly reproducible assessment of the tissue architecture in OSCC has not been evaluated. Using image analysis, in 193 cases of T1-2 (Stage I-II) OSCC we retrospectively investigated the prognostic impact of two graph theory-derived structural features: the average Delaunay Edge Length (DEL_av) and the average homogeneity of the Ulam Tree (ELH_av). Both structural features were derived from subgraphs of the Voronoi Diagram. The geometric centers of the cell nuclei were computed, generating a two-dimensional swarm of point-like seeds from which graphs could be constructed. The impact on survival of the computed values of ELH_av and DEL_av was estimated by the method of Kaplan and Meier, with relapse-free survival and overall survival as end-points. The prognostic values of DEL_av and ELH_av as computed for the invasive front, the superficial part of the carcinoma, the total carcinoma, and the normal-appearing oral mucosa were compared. For DEL_av, significant prognostic information was found in the invasive front (p < 0.001). No significant prognostic information was found in superficial part of the carcinoma (p = 0.34), in the carcinoma as a whole (p = 0.35), or in the normal-appearing mucosa (p = 0.27). For ELH_av, significant prognostic information was found in the invasive front (p = 0.01) and, surprisingly, in putatively normal mucosa (p = 0.03). No significant prognostic information was found in superficial parts of the carcinoma (p = 0.34) or in the total carcinoma (p = 0.11). In conclusion, strictly quantitative assessment of tissue architecture in the invasive front of OSCC yields highly prognostic information.

Aged↗
PubMed2000

Long-term results of a randomized clinical trial between laparoscopic hernioplasty and shouldice repair.

BACKGROUND: At present only short-term follow-up data are available to compare endoscopic and conventional hernia surgery. This paper presents data from a randomized study 6 years after initial recruitment. METHODS: In 1993 a randomized comparative study of transabdominal preperitoneal (TAPP) and Shouldice repair was commenced. Endpoints were rate of recurrence, late complications, complaints and patient satisfaction. RESULTS: The rate of recurrence in the TAPP group was one (2 per cent) of 48 patients and in the Shouldice group two (5 per cent) of 43. Only five patients in the Shouldice and three in the TAPP group reported slight discomfort in the inguinal region at 6-year follow-up. In neither group was chronic pain syndrome observed. Altogether, 46 (96 per cent) of 48 patients in the TAPP group and 35 (81 per cent) of 43 of those having the Shouldice procedure stated complete satisfaction with the hernia repair. CONCLUSION: Long-term evaluation demonstrated greater satisfaction with the result of the repair in the endoscopic group. The difference between the groups in the recurrence rate was not significant, because of the small numbers. The TAPP method appears to be an effective surgical alternative in patients with inguinal hernia.

Adolescent↗
PubMed1999

Apoptosis in human embryonal cell carcinoma: preliminary results.

Disorders in the regulation of apoptotic cell death may contribute to cancer. Furthermore, lymphocytes are supposed to play a role in counteracting tumorigenesis by inducing apoptosis in different human tumors. In this study, for the first time, tumor cell and lymphocyte apoptosis were investigated systematically in human embryonal cell carcinoma. DNA fragmentation and DNA condensation were measured simultaneously on double-fluorescence-labeled testis tumor sections using immunofluorescence microscopy. Different apoptotic indices (AIs), based either on biochemical (DNA fragmentation) or morphological criteria (DNA condensation) alone or on a combination of both, were determined in different histological regions in and around the tumor. Using morphological criteria alone, 40-75% of all apoptotic cells were not detected. Based on previous observations this finding might be related to subsets of apoptotic cells which induce the process of DNA condensation without activation of processes responsible for DNA fragmentation. Moreover, the AIs of tumor cells and lymphocytes were highest in the tumor region, compared with regions around the tumor and distant from it; these findings are discussed in the context of the Fas/FasL system.

Apoptosis↗
PubMed1999

Laparoscopic hernia repair -- the facts, but no fashion.

BACKGROUND: For about 10 years now, laparoscopic hernia surgery has been introduced as an additional mode of therapy in the treatment of inguinal hernias. This method is being reproached with higher costs of surgery and rate of complications, as well as missing long-term results. MATERIALS AND METHODS: Within a literature research, data from 25 randomised trials and 16 prospective observational studies on endoscopic and conventional hernia surgery were evaluated. Statistics were calculated using the chi2 test. RESULTS: Compared with the conventional suture technique and tension-free surgery, the endoscopic repair proved to be advantageous with regard to postoperative pain and period of disablement. There was no significant difference between the methods when evaluating the rate of complications. In two randomised trials, there was a significant difference in favour of endoscopic repair with regard to the recurrence rates, whereas in the other studies a significant difference could not be shown. In the prospective series, recurrence rates were 0.71% for totally preperitoneal repair (TEP) and 1.06% for transabdominal preperitoneal repair (TAPP) repair. CONCLUSION: Endoscopic hernia surgery (TAPP and TEP) represents an efficient method of treatment in the therapy of inguinal hernias. Recurrent and bilateral hernias can be seen as an absolute indication for endoscopic repair.

Cost-Benefit Analysis↗
PubMed1999

Modified approach for apoptosis detection reveals changes in apoptotic processes in the seminoma-associated tissue.

Apoptosis morphology (DNA condensation) and internucleosomal DNA cleavage (TdT assay) were measured simultaneously on double fluorescence labeled testis tumor sections, employing conventional immunofluorescence microscopy. Six different apoptosis indices (Al) were determined based either solely on morphological or biochemical criteria, or on a combination of both processes. Measurements were performed in metastasized and non-metastasized seminoma, and in histological regions located distantly and associated with the tumor. Preliminary results on 19 histologies revealed that up to 66% of apoptotic cells were not detected, depending on the method used for apoptosis detection. Besides, no changes of solely morphologically defined Al was found in the different histological regions. By contrast, significant changes (p < 0.0004) in the different histological regions were detected when measuring Als, e.g., defined by DNA fragmentation occurring without DNA condensation in apoptotic cells. Those changes were not detected in metastasized seminoma. These data, for the first time allow a comparison of two widely used approaches for apoptosis detection. Furthermore, the results revealed differences in apoptotic processes in tissue associated with non-metastasized seminoma detectable by a modified evaluated TdT assay but not by morphological changes, although this TdT method fails to show the total amount fo apoptotic cells.

Journal Article↗
PubMed1999

Laparoscopic surgery complications associated with trocar tip design: review of literature and own results.

In the last 10 years, there has not been an abdominal surgical procedure that has not been performed by laparoscopic means. The enthusiasm of surgeons active in this field often neglects problems, especially with basic instruments which are important vehicles for the laparoscopic technique. The purpose of this study was to focus on trocar-related problems with special respect to the tip design. On the basis of a prospective study of laparoscopic transperitoneal hernia repair (TAPP) and laparoscopic Nissen fundoplication, we evaluated our data concerning trocar-related complications at the abdominal wall. We compared two groups of patients treated in a nonrandomized design with either sharp cutting single-use trocars or cone-shaped non-cutting reuseable trocars. The evaluation of our own data showed an incisional hernia in 1.83% of patients treated with a sharp trocar tip, a complication which could be significantly lowered, to 0.17%, with a conic tip design. Similar results could be seen with trocar-related bleeding events at the insertion site in the abdominal wall. In most publications, trocar design and related complications are unmentioned. Our data demonstrate a reasonable benefit for a conic tip design, which enables atraumatic insertion through the abdominal wall. The reuseable steel version furthermore holds a considerable cost-saving potential.

Equipment Design↗
PubMed1999

[Herbal medicine products and drug law].

Herbal medicinal products are very popular in Germany, both with patients and physicians. On the contrary, little is usually known about the effects of the drug law on this type of drugs. The following article elucidates the definition of herbal medicinal products, the importance of the terms quality, efficacy and safety, which herbal medicinal products are available only at a pharmacy and which ones in other stores. Terms such as review procedure, authorization procedure, registration, and traditionally used herbal medicinal products are explained in detail. Additionally, the special problems of non-European drugs, which have no marketing authorization in Germany, are mentioned, and a short outlook for the development in Europe and worldwide is given.

Europe↗
PubMed1999

[Effect of a standardized acupuncture treatment on complains, blood pressure and serum lipids of hypertensive, postmenopausal women. A randomized, controlled clinical study].

BACKGROUND: Acupuncture according to the Chinese syndrome is often used in patients with postmenopausal complaints. Often these patients have an increased blood pressure. As experienced therapists report that acupuncture is efficient also in hypertension, our aim was to investigate whether the acupuncture used for the treatment of postmenopausal syndrome also has an effect on blood pressure. PATIENTS AND METHODS: The efficacy of a standardized acupuncture according to the Chinese syndrome was evaluated in a randomized, single-blind, placebo-controlled cross-over study with 10 postmenopausal patients with mild hypertension. Blood pressure was measured by 24-hour ambulatory blood pressure measurement. Complaints and well-being were evaluated by validated questionnaires. In addition, serum lipids and excretion of catecholamines in the 24-hour urine were measured. RESULTS: Blood pressure was altered neither by verum nor placebo acupuncture, however, complaints were significantly reduced and well-being was improved after verum treatment. The improvement lasted less than two months. Serum lipids did not change, but the excretion of normetanephrine was reduced by verum acupuncture. CONCLUSIONS: Acupuncture with a standardized combination of acupuncture points according to the Chinese syndrome can transitorily reduce postmenopausal complaints, but does not alter blood pressure or serum lipids at the same time.

Acupuncture Therapy↗
PubMed1999

[Quality aspects of the use of complementary medicine--experiences from the work of a quality circle].

OBJECTIVES: This article reports the results of a quality circle work, carried out by physicians using complementary medicine. It illustrates the problems occurring in this subject and summarizes characteristics of the daily work in relation to quality aspects. Patient characteristics were investigated; examples of mistakes in daily care are reported. METHODS: The report is based on the two moderators' subjective impressions, on analysis of attendance lists, case reports, protocols, and surveys. RESULTS: The quality circle was started in October 1994 and consists of a group of about 16 physicians, mainly general practitioners. Several objectives mentioned in official guidelines for quality circles could not be achieved, for example, the evaluation of results, analysis and assessment of the own performance according to established criteria, the degree to which published guidelines were followed, the development and implementation of problem-solving strategies. The quality circle was mainly a platform for exchange and continuing medical education. It also was the basis for an empirical study. CONCLUSION: The continuing interest of patients in complementary medicine should motivate physicians to systematically evaluate these therapies. Participants of quality circles should prepare themselves extensively for the meetings. They should take measures to keep up-to-date with the current medical knowledge. Elements and objectives aiming at a higher quality standard can be examined and implemented in routine practice work. Research results should be integrated into the daily practice. Furthermore, academic or other independent institutions should carry out experimental research into traditional complementary therapies.

Complementary Therapies↗
PubMed1999

[Plantain (Plantago lanceolata L.): anti-inflammatory action in upper respiratory tract infections].

Plantain (Plantago lanceolata L.) is used for the therapy of infections of the upper respiratory airways. While only few clinical data are available, results of experimental research confirm e.g. antiinflammatory, spasmolytic and immunostimulatory actions. A positive benefit-risk-ratio allows the recommendation of plantain in moderate chronic irritative cough, also especially for children.

Adult↗
PubMed1998

Intercomparison of apoptosis morphology with active DNA cleavage on single cells in vitro and on testis tumours.

Apoptosis morphology (DNA condensation) and endonucleolytical DNA cleavage (TdT assay) were measured simultaneously on double fluorescence labelled cells employing confocal laser scanning and conventional immunofluorescence microscopy. In vitro experiments on irradiated HL-60 cells revealed a high correspondence of non-apoptotic (normal) cells without detectable DNA cleavage, versus apoptotic cells and apoptotic bodies showing DNA cleavage. Experiments performed on histological slides of testis tumours reflected a heterogeneous picture: non-apoptotic (normal) cells, apoptotic cells, and apoptotic bodies appeared either with or without detectable DNA cleavage. These data allowed the characterization and quantitation of the grade of disturbance/heterogeneity of the apoptosis programme in vivo. Furthermore, the measured apoptotic index (AI) based on apoptosis morphology was lower than the AI assessed by DNA cleavage, in contrast to published work. Taken together, these methods represent a new approach and might be suitable for improved correlation with clinical parameters. In addition, the data presented confirm frequently published doubts regarding the ability of the TdT assay to detect apoptosis as defined by morphological criteria in tumours.

Apoptosis↗