Biomedical subjects

O Horstmann

Publications and source records attributed to O Horstmann.

26 records · Page 2Linked to original sources

PubMed1996

[Laparoscopic diagnosis and therapy of closed traumatic diaphragmatic rupture].

Diagnosis of blunt diaphragmatic rupture is still a challenging problem. This injury is generally treated by direct closure of the defect via a laparotomy or a thoracotomy. As it occurs frequently in severely traumatized patients, we wondered whether those patients could benefit from the well-known advantages of minimally invasive surgery. We report the records of two patients who underwent laparoscopy for blunt diaphragmatic hernia. In both patients, the hernia was laparoscopically closed without opening the abdomen. We did not see any intra- or postoperative complications related to minimally invasive surgery; the postoperative recovery was impressively short. Taking into account the fact that diaphragmatic ruptures are frequently misdiagnosed, we recommend laparoscopy as a useful tool in cases where these injuries may be suspected. In selected patients, primary closure of the defect may be achieved within the same laparoscopy so that laparotomy can be avoided.

Adult↗

PubMed1995

[Primary non-Hodgkin lymphoma of the stomach--surgical aspects].

In each histological subtype of a primary gastric non-Hodgkin lymphoma laparotomy is performed with the intention of an R0 resection. This concept appears to be rather aggressive if you take into account the possibilities of the other treatment modalities; however, because of the diagnostic uncertainty and of the changing histologic classifications there is an uncertainty about the character and the dissemination of the tumor. Consequently total gastrectomy with systematic lymphadenectomy provides enough basic informations to plan multimodal therapeutic concepts and their clinical evaluations.

Gastrectomy↗

PubMed1995

Incidence and prognostic significance of vascular and neural invasion in squamous cell carcinomas of the esophagus.

The prognostic influence of blood-vessel invasion (BVI), lymphatic-vessel invasion (LVI) and neural invasion (NI) was evaluated retrospectively in a series of 161 patients with squamous cell carcinoma (SCC) of the esophagus who underwent esophageal resection. Evidence of BVI, LVI and NI was found in 32.9%, 48.5% and 26.1%, respectively. Incidence of BVI, LVI and NI was significantly higher in high pT categories (pT3 and pT4) than in low pT categories (pT1 and pT2) and in patients with distant metastases than in patients without distant metastases. Incidence of LVI and NI in lymph-node-positive patients was significantly higher than in lymph-node-negative patients. The 5-year survival rate was significantly lower in patients with BVI or LVI than in patients without BVI or LVI. Patients with evidence of NI showed no significant differences in 5-year survival from patients without evidence of NI. By stepwise multivariate Cox regression analysis, BVI and LVI were shown to be independent prognostic factors. A search for vascular invasion may therefore provide additional prognostic precision in SCC of the esophagus.

Carcinoma, Squamous Cell↗

PubMed1995

[Prognostic factors in curative resection of stomach carcinoma. A uni- and multivariate analysis].

The TNM system, including tumor infiltration (T category), lymph node infiltration (N category) and metastasis (M category), is a well-established system of prognostic factors. To evaluate the prognostic importance of patient characteristics and tumor parameters 5 clinical and 13 pathological factors were analyzed. Data on 200 consecutive patients with histologically verified stomach cancer were prospectively recorded using a standardized form. In the subgroup with curative resection (R0, n = 108) a uni- and multivariate analysis was performed with respect to 5-year survival. In the univariate analysis statistical significance was demonstrated for the following factors: tumor size, tumor localization, T category, N category, number of infiltrated lymph nodes infiltrated, lymph node compartments, tumor stage, lymph node ratio: infiltrated/inspected. Multivariate analysis, taking into consideration the interaction between prognostic factors, revealed only two factors as statistically significant: number of infiltrated lymph nodes and tumor size. Our results and those in the literature indicate that the infiltration of lymph nodes is the most relevant prognostic factor. In addition to the TNM system the number of infiltrated lymph nodes seems to be of prognostic importance.

Adult↗

PubMed1995

Transhiatal oesophagectomy compared with transthoracic resection and systematic lymphadenectomy for the treatment of oesophageal cancer.

OBJECTIVE: To compare the results of transhiatal oesophagectomy with those of transthoracic resection with systematic two field en bloc lymphadenectomy in the treatment of carcinoma of the oesophagus. DESIGN: Prospective open (non-random) study. SETTING: University hospital, Germany. SUBJECTS: 87 patients with carcinoma of the oesophagus of whom 46 underwent transhiatal, and 41 transthoracic resection. MAIN OUTCOME MEASURES: Morbidity and short and long term mortality. RESULTS: The type of operation was chosen on clinical grounds, and the groups were comparable except for site and type of tumour, and nodal stage. The hospital mortality was 7/46 (15%) in the transhiatal group and 4/41 (10%) in the transthoracic group. The most common complication was anastomotic leak (23/46, 50%, compared with 10/41, 24%, p = 0.014), followed by major pulmonary complications (16/46, 35%, compared with 12/41, 29%), and cardiac complications (12/46, 26% compared with 11/41, 27%). Median survival was 350 days in the transhiatal group and 378 days in the transthoracic group. The percentage survival after one, two, and three years in the two groups was 48 and 55, 26 and 18, and 21 and 17, respectively. There were no significant differences in short or long term mortality. CONCLUSION: We have been unable to show that the oncologically more radical procedure (transthoracic resection with systematic two field en bloc lymphadenectomy) results in longer survival, but we have shown that it can be done with similar morbidity and short term mortality. Because it is possible to stage the disease exactly with a transthoracic resection, and because published reports from other centres have hinted at improved prognosis after it, we shall continue to do the operation for suitable patients.

Adult↗

PubMed1994

p53 protein expression and prognosis in squamous cell carcinoma of the esophagus.

BACKGROUND: The p53 gene product is known to regulate cell growth and proliferation. Whereas the wild-type p53 protein suppresses cell growth, the mutated p53 protein acts as an oncogene. Mutations in the p53 gene usually result in p53 protein stabilization and accumulation; so that the gene product can be detected by immunohistochemistry. Recently, the immunohistochemical detection of the p53 protein was associated with prognosis in breast, colorectal, and other types of cancer. However, its prognostic role in esophageal cancer remains to be elucidated. METHODS: p53 expression in formalin fixed, paraffin embedded samples of 204 patients with primary squamous cell carcinoma of the esophagus, who underwent esophageal resection, were analyzed immunohistochemically with DO-1, a monoclonal antibody that detects wild-type and mutant forms of p53. The relationship between p53 immunoreactivity and prognostic factors was determined by the Chi-square test, and the prognostic impact of p53 protein expression was analyzed using univariate and multivariate survival analyses. RESULTS: In 137 of 204 tumors (67.2%), nuclear immunoreactivity for the p53 protein was detected. There was no correlation with sex, age, pathologic tumor (pT) category, pathologic lymph node (pN) category, metastasis (M) category, residual cancer (R) category, histologic grade, or preoperative radiation therapy. In contrast to clinicopathologic parameters, p53 expression was not correlated with prognosis in univariate and multivariate survival analyses. CONCLUSIONS: The p53 protein can be detected by immunohistochemistry in a high percentage of squamous cell carcinomas of the esophagus. However, the overexpression of the p53 gene product has no impact on the prognosis.

Adult↗

PubMed1994

[Surgical treatment of esophageal perforations].

Spontaneous and iatrogenic esophageal perforations continue to present life threatening gastroenterologic emergencies. The results in 17 patients being treated between 1986 and 1992 are presented. In respect to localisation of the perforation, the underlying nature of the disease and the condition of the patient an early suture and wrap in all patients with benign diseases and an early esophagectomy in patients with esophageal cancer was aspired. 11 patients having been treated this way survived whereas 3 of six patients with extensive tumour burden and reduced physical state who had been treated conservatively died during the hospital stay. Thus early diagnosis and operative treatment of esophageal perforations improves patients outcome significantly.

Adult↗

PubMed1992

[Formal decision aids in gastroenterology--results of a survey].

Formal decision aids such as scores, decision-trees and expert systems, are recommended for supporting research and daily clinical work. In the field for gastroenterology it is unknown, to which degree these tools are accepted and applied in clinical routine. We therefore conducted a mail survey in order to find out whether clinical gastroenterologists know, use or want formal decision-aids. To all clinical members of a german gastroenterological scientific society (Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten, n = 584) an information leaflet and a questionnaire was sent. The form contained questions about use, knowledge and requests with respect to decision-aids in gastroenterology and concerning the attitude to computerized decision-aids in general. 584 clinicians received the questionnaire, 215 sent it back for analysis (39%). Formal decision-aids were used by half of the survey participants (56%), mainly three scores (Child-Pugh, Best and other indices for inflammatory bowel disease, Ranson) and four classifications (TNM, Forrest, Savary-Miller, Paquet). Computer-based formal decision-aids (e.g. expert systems) were used by a minority. Clinicians, who applied formal decision-aids stated more frequently a request for further decision-aids (72%) than those who did not (46%). A considerable part of the survey participants believed that computerized decision-aids will come into clinical routine (52%) and will improve education (37%) and clinical practice (35%). 88% were convinced, that decision-aids should be tested in controlled clinical trials before a clinical use can be recommended. There is a discrepancy between propagation of formal decision-aids and it's clinical use. Only a few scores and classifications are used in clinical routine.(ABSTRACT TRUNCATED AT 250 WORDS)

Artificial Intelligence↗