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Biomedical subjects

M Büchler

Publications and source records attributed to M Büchler.

At least 181 records · Page 10Linked to original sources
PubMed1989

Correlation of imaging and function in chronic pancreatitis.

Chronic pancreatitis is a slowly progressive disease. Initially, only focal changes occur, but diffuse structural abnormalities accompanied by various degrees of functional impairment are seen in the late stage. Morphological abnormalities in chronic pancreatitis can now be detected with high accuracy by several imaging methods. The most sensitive method is ERP, which is able to detect slight ductal changes at an early stage. High-resolution US has become a valid alternative to CT for the visualization of parenchymal abnormalities. However, CT is more accurate than US in detecting small cysts and calcifications. By comparing ductal abnormalities (ERP) and parenchymal lesions (CT, US) with pancreatic function impairment, it has become quite clear that the morphofunctional correlation is tight only in the "late" or severe stages of chronic pancreatitis. In "early" or "moderate" stages of chronic pancreatitis, correlation of the degree of morphological abnormalities and pancreatic dysfunction is frequently poor. Studies comparing the value of the different imaging methods with pancreatic function tests in the diagnosis of chronic pancreatitis have found ERP and the duodenal intubation SC test to have the highest diagnostic accuracies. Correlation between the degree of ductal abnormalities (ERP) and pancreatic dysfunction in the SC test, and between the degree of parenchymal abnormalities (CT and US) and the SC test both proved significant. However, prediction of exocrine function based on morphological alterations, or vice versa, is not possible. The value of combining function testing with imaging is enhancement of the diagnostic accuracy in the presence of only "mild" morphologic abnormalities detected with the imaging techniques. In advanced stages of chronic pancreatitis, function testing is a valid complementary tool to characterize the clinical stage of the disease and may have an impact on therapeutic decisions in patients with advanced stages of chronic pancreatitis. Invasive function testing (SC test) can be replaced by oral pancreatic function tests, which yield equivalent results or clinical decisions.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1989

[Cephalic pancreatectomy with conservation of the duodenum in chronic pancreatitis with inflammatory lesions of the head of pancreas. Results of 15 years' experience].

In 122 patients with severe chronic pancreatitis and inflammatory enlargement of the head of the pancreas a duodenum-preserving resection of the pancreatic head was performed. Postoperative hospitalization was 16 days in median, the frequency of re-operation was 4.9%. In the early postoperative phase one patient died and hospital mortality amounted to 0.8%. Following a medium follow-up period of 4.2 years (min. 6 months, max. 15 years) 7 patients died (late mortality 4.9%). 77% of the patients were completely free of abdominal pain, 84% went back to their previous occupation. During the follow-up period in 81% of the patients the glucose metabolism was unchanged, in 13% it deteriorated, and in 5% it improved permanently; 80% of the patients had a marked increase in weight averaging 8.7 kg. Compared to the Whipple procedure the duodenum-preserving resection of the head of the pancreas spares the patient with chronic pancreatitis a gastric resection, the duodenectomy, and the resection of the extrahepatic bile ducts. The limited operative intervention at the head of the pancreas in terms of a subtotal resection and the preservation of the duodenum explains the low early and late postoperative morbidity and mortality.

Adult↗
PubMed1989

[Data on surgical indications in necrotizing pancreatitis--results of a validation study].

134 patients with necrotizing pancreatitis were operated. Preoperative organ insufficiency (pulmonary or renal), the presence of shock or sepsis and the intraoperative morbidity factors: parenchymal necroses greater than 30%, extrapancreatic necroses, ascites and in particular bacterial contamination were directly correlated with prognosis and mortality. The occurrence of these morbidity factors consequently signifies an urgent indication for operation.

Acute Disease↗
PubMed1989

[Therapy of pancreatic carcinoma with the monoclonal antibody BW 494/32: first clinical results].

In a phase-I clinical trial the monoclonal antibody BW 494/32 was administered to 18 patients with advanced pancreatic cancer of ductal origin. This murine immunoglobulin mediates an ADCC. The majority of patients tolerated this treatment without any side effects. There were no tumor remissions. 12 patients showed a progression of their pancreatic carcinoma after therapy. A stable course of the disease was observed in 6 patients for at least 3 months after therapy.

Aged↗
PubMed1988

Comparative studies on the expression of tumor-associated glycoprotein (TAG-72), CA 19-9 and DU-PAN-2 in normal, benign and malignant pancreatic tissue.

Expression of tumor-associated glycoprotein (TAG-72) was examined by immunohistochemistry in pancreatic specimens from normal donors, and from patients with chronic pancreatitis and pancreatic cancer, and was compared with expression of CA 19-9 and DU-PAN-2. In the normal pancreas, TAG-72 was expressed in fewer ductal and ductular cells than were CA 19-9 (p less than 0.05) and DU-PAN-2 (p less than 0.01 and 0.001 respectively), whereas in chronic pancreatitis all 3 antigens were expressed in ductal cells but only CA 19-9 and DU-PAN-2 in ductular cells (p less than 0.001). In the specimens from normal pancreas and chronic pancreatitis cases, TAG-72 was localized in the Golgi region, whereas CA 19-9 and DU-PAN-2 showed diffuse cytoplasmic and glycocalyx patterns. In pancreatic cancer, although the rate of expression of all 3 antigens was similar, their cellular localization differed significantly: only TAG-72 was expressed in the Golgi region (p less than 0.001), whereas CA 19-9 showed mainly glycocalyx (p less than 0.05) and/or intra-luminal patterns (p less than 0.01) compared with that of the other 2 antigens. We conclude that, due to differences in expression of TAG-72 in benign versus malignant cells, the monoclonal antibody against TAG-72 (B72.3) may be suitable for radio-immunodetection or radio-immunotherapy of pancreatic cancer.

Adenocarcinoma↗
PubMed1988

[Immunotherapy of advanced pancreatic carcinoma with the monoclonal antibody BW 494].

In the course of a phase I study monoclonal antibody BW 494 was injected i.v. at a dose of 180-340 mg to 18 patients with advanced ductal pancreatic carcinoma. The murine IgG1-antibody is directed against a pancreatic carcinoma-associated glycoprotein. The antibody inhibits the functions of human pancreatic carcinoma cells. Diffuse muscle pain, which disappeared spontaneously, was noted by two patients 14 days after injection. Other side-effects were anaphylactoid reactions in two patients 12 and 19 days, respectively, on repeat antibody infusions. This event led to changes in the administration schema so that the total amount was given within ten days, after which there were no further allergic side-effects. Terminal antibody half-life was 47.8 h (initial half-life 0.2 h). Human anti-mouse antibodies in all eight patients tested for them developed within two to three weeks of the end of treatment. There were no tumour remissions. Progression of the tumour after treatment occurred in 12 patients (67%). In five patients the course was stable for at least three months after treatment, i.e. unchanged clinical status, unchanged tumour extent (CT), and stable tumour markers (CEA, CA 19-9) in serum. One female patient with a T3N1M0 carcinoma has so far lived for 16 months in full employment. The results justify the use of the monoclonal antibody in future controlled trials.

Aged↗
PubMed1988

Necrosectomy and postoperative local lavage in necrotizing pancreatitis.

Necrosectomy with postoperative continuous local lavage was performed in a prospective study involving 95 patients with necrotizing pancreatitis. In the same period 567 patients with oedematous-interstitial pancreatitis were treated non-operatively with a hospital mortality rate of 0.7 per cent. In patients with necrotizing pancreatitis the median Ranson criteria score was 4.5 points; operation was required at a median of 7 days after the onset of symptoms because of non-response to conservative treatment. In all, 59 per cent of the patients (56 out of 95) developed extended intrapancreatic parenchymal necrosis, 70 per cent had ascites, and 66 per cent had intra- and extrapancreatic necrosis; 42 per cent of the patients had bacterial infection of the necrotic tissue. For lavage a median of 8 l/24 h of fluid were instilled postoperatively for 25 days (median). The lavage fluid showed high levels of immunoreactive trypsin, phospholipase A2, and endotoxin in the early postoperative period. Hospital mortality rate was 8.4 per cent. Necrosectomy and continuous postoperative lavage can achieve high survival rates in patients with necrotizing pancreatitis. Postoperative local lavage allows the continuous non-operative evacuation of biologically active compounds and devitalized tissue, and avoids damage to remaining vital exocrine and endocrine pancreatic tissue.

Acute Disease↗
PubMed1988

Immunotherapy of pancreatic cancer with monoclonal antibody BW 494.

In a phase I trial 34 patients with pancreatic cancer were treated with the murine monoclonal antibody (MAb) BW 494 (BI 51.011) directed against a glycoprotein antigen. The patients received repeated doses of MAb over a time period from 5 to 14 days (highest single dose 100 mg, highest cumulative dose 490 mg). During this treatment serum levels of murine IgG increased to 43.4 micrograms/ml. The serum half life of murine IgG ranged from 2 to 3 days. Repeated injections of MAb BW 494 were normally well-tolerated when given within the first 15 days. Two patients presented with fatigue and a neuritis-like syndrome 2 weeks after the last IgG infusion which had resolved spontaneously by the next day. Severe allergic reactions were observed in 3 patients after repeated injections of the MAb. These 3 patients had high levels of human anti-murine antibodies (HAMA). Four weeks after the first application of MAb BW 494, 17/18 patients presented with HAMA (IgG). It could be demonstrated that the anti-murine response was in part anti-idiotypic. At the moment 16/34 patients are eligible for evaluation of tumor response. There was no complete or partial remission; however, 2 patients responded with minor tumor regression up to 32 weeks documented by reduction of liver metastases and primary tumor in CAT scan. Five additional patients presented with a long period of stable disease after immunotherapy (up to 40 weeks). Nine patients had progressive tumor disease in spite of MAb treatment.

Adult↗