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Biomedical subjects

K W Jauch

Publications and source records attributed to K W Jauch.

At least 19 recordsLinked to original sources
PubMed1992

Paraneoplastic chronic intestinal pseudoobstruction as a rare complication of bronchial carcinoid.

This report describes paraneoplastic visceral neuropathy including achalasia, gastroparesis, subileus and constipation in a 59 year old patient with metastasising atypical bronchial carcinoid. Achalasia was successfully treated by cardiomyotomy and fundoplication; additionally, extramucosal pylorectomy was undertaken to improve gastric emptying. Endoscopic papillotomy was necessary because of a functional stenosis of the sphincter of Oddi with development of obstructive jaundice. Symptoms of intestinal pseudoobstruction did not improve with cisapride or corticosteroid treatment. Histological examination of gastrointestinal specimens revealed a lymphocytic infiltration of the myenteric plexus associated with loss of neurones. The rheumatoid factor was positive, there was evidence of circulating immune complexes and antibodies to Sm-antigen were present, suggesting a possible autoimmune pathogenesis.

Bronchial Neoplasms↗
PubMed1992

Esophageal carcinoma: prognostic features and comparison between blunt transhiatal dissection and transthoracic resection.

Among 86 patients who underwent resection for thoracic esophageal carcinoma between 1982 and 1989, 49 were resected by a transhiatal blunt esophagectomy (THE) and 37 underwent a transthoracic-abdominal esophagectomy (TTE). The two groups were statistically comparable with respect to preoperative characteristics. Overall morbidity and respiratory complications were high for both groups (71% vs 62% and 45% vs 46%; P = NS). The rate of cardiac, renal, neurological and bleeding complications, as well as recurrent nerve injuries was similar in both groups. An anastomotic leak occurred in 39% (19/49) of THE patients and in 11% (4/37) (P < 0.05) of TTE patients. Hospital mortality was 16% (8/49) in the THE group (4 resulting from cervical anastomotic leaks, 4 from respiratory complications) and 13% (5/37) in the TTE patients (1 from myocardial infarction, 4 from respiratory failures; P = NS). Actuarial survival curves for all THE and TTE patients (5-year survival rate: 20% vs 22%) and separate analysis for N0 and N1 tumors revealed no significant difference between these two techniques. Of the different preoperative variables, only tobacco addiction, beside lymph node involvement, was an independent predictor of outcome. Respiratory complications and hospital mortality were significantly lower for the non-smokers and long term survival was significantly higher for the N0 stages.

Actuarial Analysis↗
PubMed1992

[Crohn disease in advanced age].

Crohn's disease of late onset (greater than 65 years) is rare condition. Typical features are the localisation in the distal gastrointestinal tract and the presence of associated diseases such as cardiovascular disorders and/or diverticulitis. In about 25% of the cases mild intestinal hemorrhage occurs. Delay in diagnosis is sometimes due to coexistent diverticulitis. Ischemia has been suggested to be responsible for the development of the histological changes which occur in Crohn's colitis. Therefore, we carried out a retrospective analysis of our patients treated between 1978-1988 to reevaluate the resected specimens. 10 patients (6.2% of all surgical patients with Crohn's disease) were at least 65 years old at the time of primary operation. In 5 cases hematochezia was one of the symptoms before operation, two patients presented with massive hemorrhage of the lower GI-tract. Granulomas were seen only in 5 patients, whereas in all specimens transmural inflammation was detected. In 8 out of 10 patients vascular lesions were seen, among those thickening of the intimal and medial layers, thrombosis or bleeding. Our findings support the thesis that ischemia might play a role in the pathogenesis of Crohn's disease of late onset.

Aged↗
PubMed1991

[Detection of tumor cells in bone marrow: a deciding aid for adjuvant therapy in node negative patients with breast cancer. Concept for a multicenter study and results of the pilot phase].

In node-negative breast cancer some 30% of patients will suffer a tumor relapse, despite primary curative therapeutic intervention. An adjuvant therapy is therefore in discussion, especially in presence of risk factors. Immunocytochemical staining of cytokeratin-positive cells in bone marrow aspirates with monoclonal antibodies offers a chance to detect tumorcell dissemination at an early stage of single tumor cells. In 103 consecutive patients 50% showed a positive bone marrow aspirate, in node negative patients still 34%. Based on the literature and tumor biology this method may be valid in selecting node-negative breast cancer patients for adjuvant therapy. In a prospective multi-center trial the prognostic value will be evaluated in regard to other prognostic factors. Additionally the benefit of an adjuvant therapy will be studied in a randomized prospective trial.

Biomarkers, Tumor↗
PubMed1991

[Carcinoid tumor of the stomach--aspects of surgical therapy].

Carcinoid tumors of the stomach are rare (0.4% of all malignancies of the stomach). Long-lasting hypergastrinemia, most often due to chronic atrophic gastritis, leads to hyperplasia of ECL-cells in the gastric fundic mucosa with consequent dysplasia or neoplasia. Between 1974 and 1988 four patients underwent surgical treatment after diagnosis of a gastric carcinoid tumor. One patient was treated by local excision, two by subtotal resection and one patient underwent complete gastrectomy. None of the patients had local or distant metastases or died in the follow-up period due to tumor progression. The different approaches to surgical therapy are discussed.

Adult↗
PubMed1990

Effect of low-dose bradykinin on glucose metabolism and nitrogen balance in surgical patients.

Acute effects of a low-dose bradykinin infusion (30 ng/kg per min) on carbohydrate metabolism were studied in five patients after major burn injury. Peripheral glucose uptake was not affected but glucose oxidation and alanine flux were increased by 15% and 10%, respectively. These findings are compatible with an increase in glycolytic flux by an action of bradykinin. Nineteen patients who had undergone major gastro-intestinal surgery were studied in a randomised trial of chronic (6 day) bradykinin administration. Patients in the bradykinin group had a significantly improved rate of nitrogen retention (cumulative N balance, -0.014 [SE 0.064] vs -0.175 [0.048] g N/kg) in controls and significantly better nutritional indices. Manipulation of metabolism in surgical patients by bradykinin may have beneficial effects on nitrogen and protein dynamics, possibly mediated by improved aerobic and anaerobic glycolysis.

Adolescent↗
PubMed1990

[Post-aggression metabolism and peridural anesthesia: modification of catabolism by anesthesia procedures?].

Postoperative catabolic state of metabolism represents a danger for patients in regard to protein degradation. As postoperative nutrition seems already quite optimal, we examined if anaesthesia, predominantly peridural anaesthesia, would be able to reduce postaggressive metabolism. 20 patients with gastrectomy or subtotal gastric resection were randomized either for a combined anaesthesia with PDA and intubation or for balanced fentanyl analgesia. In both groups the typical characteristics of postaggressive metabolism could be demonstrated without any difference.

Adult↗
PubMed1990

Ifosfamide plus etoposide combined with regional hyperthermia in patients with locally advanced sarcomas: a phase II study.

From July 1986 to July 1989, 40 patients (92% pretreated) with deep-seated, advanced soft tissue sarcomas (STS, 25 patients), Ewing's sarcomas (ES, eight patients), osteosarcomas (OS, three patients) and chondrosarcomas (ChS, four patients) were treated at the University of Munich in a protocol involving regional hyperthermia (RHT) combined with ifosfamide plus etoposide. A total of 265 RHT treatments (mean, 6.6 RHT per patient) were applied including 33 pelvic, four extremity, and three abdominal sites. The mean tumor volume was 537 cc (range, 50 to 2,980 cc). For systemic chemotherapy, all patients received ifosfamide (1.5 g/m2, days 1 to 5), etoposide (100 mg/m2, days 1, 3, and 5), and mesna (300 mg/m2 x 4, days 1 to 5) with RHT given only on days 1 and 5 in repeated cycles every 4 weeks. Acute toxicity consisted primarily of pain (57%) combined with local discomfort within the annular phased array applicator (AA) of the BSD hyperthermia system (BSD Medical Corp, Salt Lake City, UT). The average maximum systemic temperature was 37.4 +/- 0.5 degrees C, and there was no indication of enhanced bone marrow toxicity due to the addition of RHT to the systemic chemotherapy. Detailed thermal mapping by invasive thermometry was performed in all patients. In 38 assessable patients, the overall objective response rate was 37%: six complete responses (CRs), four partial responses (PRs), and four favorable histologic responses (FHRs) (95% confidence limits, 22% to 54%). Complete responders are alive and disease-free at 40, 35, 23, 19, 19, and 8 months. Of patients with PR and FHR, two died from metastatic disease after 4 and 17 months and one died from other disease after 27 months. The remaining five patients are stable at 37, 25, 21, 13, and 8 months. Eleven patients showed no change (NC), and 13 patients showed local tumor progression (PD). The mean observation time for all patients was 11.6 months. The time-averaged temperatures (Ts) of all RHT treatments calculated as 20% (T20), 50% (T50), or 90% (T90) of measured tumor sites differed significantly between responders and nonresponders (T20, P = .003; T50, P = .006; and T90, P = .004; respectively). These data support activity for ifosfamide-etoposide combined with RHT in pretreated patients with advanced sarcomas.

Adolescent↗
PubMed1990

[Elimination and metabolism of MCT-containing fat emulsions in postoperative patients in the framework of total parenteral nutrition].

Medium chain triglycerides (MCT) may be particularly well-suited for rapid energy supply in postoperative patients because of their rapid availability. We compared the elimination and metabolization of 10% and 20% MCT/LCT-containing infusions (Lipofundin MCT) in 29 non diabetic patients to 10% and 20% LCT-containing infusions during a course of a 7-day TPN. The speed of the provision of triglycerides does not depend on the composition of the fat emulsions. The maximum TG-levels after fat infusion over 12 hours remained under 3 mmol/l. In the MCT/LCT 20% group we found the lowest half-life of the triglycerides with 77 min at the 1st, 133 min at the 4th, and 72 min at the 7th postoperative day. In addition this group showed persistent low half-lives for free fatty acids: 85 min on day 1, 42 min on day 4, and 39 min on day 7. A comparable liberation of fatty acids in corresponding half-lives could be observed in the LCT-groups only after a course of 7 days: 0.86 resp. 0.69 mmol/l (LCT 10% resp. 20%) on day 1, 1.25 resp. 1.26 mmol/l on day 4, and 1.31 resp. 1.97 mmol/l on day 7. The results of the MCT/LCT 20%-group may be due to a quicker metabolization of these emulsions with favourable availability.

Adult↗
PubMed1990

Effects of kinins on glucose metabolism in vivo.

Current concepts of the physiological importance of the kinin/prostaglandin system view these tissue factors as part of a defense system, which protects tissues from potentially noxious factors, such as hypoxia or destructive inflammatory reactions. This kinin-triggered defense reaction includes an improvement in cellular energy metabolism. The latter is brought about in peripheral tissues by an increased availability of glucose for anaerobic and aerobic glycolysis, whereas in liver tissue, energy-consuming reactions such as gluconeogenesis are attenuated. There is evidence that such favorable effects can also be produced in man when kinins are administered systemically. Prostaglandins are most likely the second messengers of kinin-induced metabolic effects. Thus, it may be advantageous to increase the availability of kinins either by exogenous infusion or by inhibiting endogenous degradation during postoperative stress or in diseases such as diabetes mellitus, in which glucose metabolism is severely disturbed.

Blood Glucose↗