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Biomedical subjects

M Storck

Publications and source records attributed to M Storck.

16 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

Prognostic value of deoxyribonucleic acid aneuploidy in primary non-small-cell lung carcinomas and their metastases.

The ploidy status of the deoxyribonucleic acid of a malignant lung tumor provides additional information besides histologic grading and tumor staging according to lymph node infiltration and tumor metastasis. Ninety-nine surgical specimens from patients with non-small-cell lung carcinoma were investigated by flow cytometry. Deoxyribonucleic acid aneuploidy was found in 48% of the primary tumors. Patients with deoxyribonucleic acid-euploid tumors showed better survival (p < 0.01) than those with deoxyribonucleic acid-aneuploid carcinomas independent of tumor stage. Deoxyribonucleic acid ploidy status of the primary tumor was compared with that of N2 lymph node metastases in 29 cases. Seven samples showed a change from deoxyribonucleic acid aneuploidy in the primary tumor to deoxyribonucleic acid euploidy in the lymph node metastases. Survival was significantly better for patients with euploid primary tumors and lymph node metastases, followed by patients with deoxyribonucleic acid-aneuploid primary tumors and euploid lymph node metastases. Survival was poorest in patients with deoxyribonucleic acid-aneuploid primary tumors and lymph node metastases. It was observed that only the simultaneous determination of deoxyribonucleic acid ploidy of primary tumors and lymph node metastases permits accurate prognostic evaluation in case of lymph node infiltration.

Actuarial Analysis↗
PubMed1992

Functional analysis of monocyte activity through synthesis patterns of proinflammatory cytokines and neopterin in patients in surgical intensive care.

This study was designed to further differentiate monocyte behavior in critically ill patients with operative or accidental trauma. The patient population studied consisted of 39 patients (17 patients undergoing elective surgery [ES], seven patients with major multiple injuries [MI], and 15 patients in an acute septic state [S]). Immunologic parameters assessed included monocyte phenotyping with the monoclonal antibody LeuM3, measurement of the cytokines interleukin (IL)-1, IL-6, and IL-8 in lipopolysaccharide-stimulated in vitro cultures of mononuclear leukocytes (PBMCs), and determination of neopterin in gamma-interferon-stimulated in vitro cultures and corresponding serum samples. Serum neopterin levels were very high in S patients (89.0 nmol/L; p less than 0.05) compared with control values (4.6 nmol/L), with a rise to 16.4 nmol/L in ES patients on day 7 and 13.4 nmol/L in MI patients on day 7. The concentrations of gamma-interferon-induced neopterin in the supernatants of the PBMC cultures were elevated in all patient groups. Severe impairment of IL-1 synthesis was seen in MI and S patients. IL-8 synthesis (818 +/- 150 units/ml, control value) was also suppressed (p less than 0.05) in MI patients; the values were 135 +/- 65 units/ml on day 1,231 +/- 110 units/ml on day 3,347 +/- 131 units/ml on day 7, and 355 +/- 107 units/ml in S patients. The kinetic patterns of synthesis were comparable for IL-1 and IL-8 in all patient groups. Lipopolysaccharide-induced IL-6 synthesis (9.4 +/- 1.5 x 10(3) units/ml, control value) was significantly elevated in the PBMC cultures of all patient groups, with the exception of the early phase after accidental trauma. Maximum amounts of IL-6 synthesis after surgery were 19.6 +/- 7 x 10(3) units/ml in S patients and 19.0 +/- 2.2 x 10(3) units/ml in ES patients. These results demonstrate (1) the impairment of the functional capacity of circulating monocytes and (2) that the degree of functional impairment is proportional to the severity of the injury.

Adolescent↗
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

Comparison of pump-driven and spontaneous continuous haemofiltration in postoperative acute renal failure.

In a comparison of spontaneous continuous arteriovenous haemofiltration (CAVH) and pump-driven haemofiltration (PDHF) for acute renal failure after surgery, 116 patients admitted to a surgical intensive care unit were assigned CAVH (48) or PDHF (68). The method of assignment was that a patient was treated by PDHF if he or she was the only patient requiring treatment at that time (only one pump was available); any other patient coming to the unit would be treated by CAVH. The groups were slightly unbalanced because there were fewer simultaneous cases than expected. The main endpoints were survival rate, control of uraemia, and additional application of haemodialysis. There were no differences between the patient groups in age, duration of treatment, severity of illness, serum creatinine concentration at the start of treatment, or cause of acute renal failure. Both treatments adequately controlled uraemia and fluid overload. However, the survival rate was significantly higher with PDHF than with CAVH (6 [12.5%] vs 20 [29.4%]; p less than 0.05). The daily ultrafiltrate volume was significantly higher with PDHF than with CAVH (15.7 [95% confidence interval 13.6-17.8] vs 7.0 [6.6-7.4] l/day; p less than 0.05). The volume of ultrafiltrate in patients with ischaemic or sepsis-induced acute renal failure was correlated with the survival rate. This finding suggests that the better survival rate in the PDHF group was due to faster elimination of toxic mediators (of molecular weight 800-1000 daltons) through the filter membrane by high-volume haemofiltration.

Acute Kidney Injury↗
PubMed1991

Vascular anastomoses with absorbable suture material: an experimental study.

A synthetic, monofilament, absorbable suture material, polytrimethylene carbonate, was tested to determine its suitability for use in arterial anastomoses. The material studied is a copolymer made of trimethylene carbonate and polyglycolic acid, with a retention time in the tissue of up to six months. In an experimental group of 12 mongrel dogs, using simple end-to-end anastomoses, aortic and femoral patch grafts of bovine heterograft material and iliofemoral bypass implants of 5 mm of expanded polytetrafluoroethylene prostheses were performed and arteriographically and histologically documented. Direct intraindividual comparisons were made with the absorbable (polytrimethylene carbonate) and nonabsorbable (polypropylene, expanded polytetrafluoroethylene suture) materials, a total of 108 anastomoses. No suture material-related complications such as ruptures or suture line aneurysms occurred. Polytrimethylene carbonate sutures led to less inflammation and scar tissue formation than polypropylene sutures. Complete absorption of the suture material by hydrolytic decomposition was followed by an almost complete regeneration in all layers of the vessel wall. Regeneration of the connective tissue structures of the media was noted. Initial associated reactions in the intima eventually disappeared. Both suture materials were equivalent histologically in the early months of the study, but after 10 month follow-up differences were observed, especially in the structure of the media, apart from the fact that polytrimethylene carbonate is absorbed completely after four to seven months.

Anastomosis, Surgical↗
PubMed1991

[Improved survival rate of postoperative renal failure caused by high volume hemofiltration].

Continuous arteriovenous hemofiltration is the treatment of choice for postoperative acute renal failure (ARF). The clinical value of two different treatment modalities (spontaneous vs. pump-driven hemofiltration PDHF) were compared in two groups of patients with postoperative ARF. There were no differences in both groups regarding age, duration of treatment, severity of illness or cause of renal failure. The survival rate of patients treated with PDHF was significantly higher (29.4 vs. 12.5%). PDHF also led to a significantly larger daily ultrafiltrate volume (15.6 +/- 1.9 vs. 7.0 +/- 0.4 l/d, p less than 0.05). The accelerated elimination of toxic mediators through the filtration membrane in high-volume filtration using a pump system (PDHF) may have been responsible for the improved survival rate.

Acute Kidney Injury↗
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

Kinetics of interleukin-2 and interleukin-6 synthesis following major mechanical trauma.

Although it is known that mitogen-induced lymphocyte proliferation and interleukin-2 (IL-2) synthesis are depressed following mechanical trauma, it is not known whether these defects are due to high levels of circulating prostaglandin E2 released by macrophages, suppressor T-lymphocytes, and serum suppressive factors or due to intracellular defects in T-lymphocytes. Moreover, the kinetic of interleukin-6 (IL-6), a new multifunctional cytokine, following trauma is not known. To study this, highly purified T-cell cultures were prepared from 21 patients with major mechanical trauma on Days 3, 7, 10, 14, and 21 post-trauma and assayed for proliferative response to phytohemagglutinin, IL-2, and IL-6 synthesis. T-lymphocyte proliferation of patients was unaltered on all days post-trauma compared to that of healthy controls. Interleukin-2 synthesis of patients showed a significant (P less than 0.01) reduction ranging from 23% of control values on Day 3 to 40% on Day 21. Interleukin-6 synthesis in contrast was markedly increased (P less than 0.05) in the patient group on all days up to sixfold (Day 3) with a tendency toward normalization on Day 21. High levels of IL-6 correlated with the appearance of infectious complications in the post-traumatic course. These data indicate that the alterations in T-cell proliferation and IL-2 synthesis following major injury found in earlier studies are caused by different suppressor mechanisms. While T-cell proliferation is only decreased by extracellular components, IL-2 synthesis is suppressed mainly by an intracellular defect. The role of highly increased IL-6 levels and its effect on the immune response are so far unknown.

Adolescent↗
PubMed1989

Dynamics of immunoglobulin synthesis after major trauma. Influence of recombinant lymphokines.

Major mechanical trauma causes a severe suppression of B-cell differentiation and IgM synthesis in mononuclear leukocyte cultures. In this study the effect of recombinant lymphokines and physiologic T-cell supernatants on B-cell differentiation was investigated. The influence of potentially suppressing monocytes and positive regulatory T-lymphocytes was eliminated using purified B-cell cultures. Antigen-induced IgM synthesis was reduced on all days following trauma. Addition of recombinant interleukin 2 or T-cell supernatant enhanced but did not restore IgM synthesis. Although recombinant interleukin 4 and recombinant interferon gamma had a suppressive effect on IgM synthesis in controls, both lymphokines were ineffective in the patients' IgM synthesis. Spontaneous IgG production in patients was dramatically elevated, and the addition of lymphokines did not show any enhancing effect in patients. These results demonstrate that the IgM/IgG shift observed in peripheral blood mononuclear cell cultures also exists in purified B-cell cultures. Interleukin 2 partially restored suppressed IgM synthesis, while interleukin 4 and interferon gamma were ineffective in patients' B-cell differentiation. Interleukin 2 was the most effective lymphokine for the induction of Ig synthesis. These results lead us to conclude that the altered B-cell metabolism might also be responsible for the suppression of humoral immunity following trauma.

Adolescent↗
PubMed1985

A diagnostic and family study of posttraumatic stress disorder.

A family history study of 36 patients with chronic posttraumatic stress disorder revealed a positive history of familial psychopathology in 66% of the patients. Alcoholism, depression, and anxiety disorders were the disorders most commonly found. The patients also had a higher prevalence of alcoholic siblings than did a retrospectively derived control group of depressed and anxious male patients. With respect to the proportion of familial anxiety to familial depression, the probands with posttraumatic stress disorder more closely resembled probands with generalized anxiety than probands with depression. Every patient had experienced at least one significant psychiatric illness during his lifetime, most commonly alcohol abuse or depression.

Adult↗
PubMed1978

[Angiographic findings in a new method of vascular anastomosis (author's transl)].

The first angiographic findings with a new method of end-to-end anastomosis of small arteries are reported. The other-wise difficult anastomosis of small vessels is accomplished by the use of scew-ended flanges. So far the method has been used successfully on 15 dogs; there were no post-operative stenoses or other complications.

Angiography↗
PubMedDate not supplied

[Giant chondrosarcoma: a case report].

Chondrosarcoma is a slow-growing malignant tumor, with a mainly local infiltration, usually arising from skeletal cartilaginous cells. However, a few such neoplasms also arise from extraskeletal mesenchymal cells. Metastasis are usually seen with undifferentiated tumors (grade III), mainly within the lungs. The best treatment associates total surgical resection with chemotherapy. Radiotherapy is of poor use. Isolated pulmonary metastasis can be profitably withdrawn. Prognosis is about of 75% of survival after 10 years, in case of well-differentiated tumors (grade I). The prognosis is far worse for undifferentiated tumors (grade III), turning around 10% of survival after 10 years.

Abdominal Neoplasms↗