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Biomedical subjects

R Stangl

Publications and source records attributed to R Stangl.

31 records · Page 2Linked to original sources
PubMed1990

Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history.

From 1960 to 1987, 1209 patients with colorectal liver metastases were recorded, and followed until 1 January 1990. In 242 cases the diagnosis was based on external imaging, whereas 967 patients had operative confirmation and staging of their liver disease. Three groups of patients were analysed: group 1 involved 921 cases, of whom 902 were deemed non-resectable whereas 19 could not be unequivocally classified. Only 21 patients lived for longer than 3 years, seven survived for 4 years, but there were no 5-year survivors. Group 2 comprised 62 highly selected patients who at laparotomy demonstrated resectable metastatic spread confined to the liver, but this was not treated mainly because of a formerly different therapeutic approach. These patients had a significantly longer median survival time (14.2 versus 6.9 months), but also failed to achieve 5-year survival. The 226 patients forming group 3 underwent hepatic resection with intent to cure. Nine of them had minimal macroscopic disease left, and 34 with all gross tumour removed had positive margins. Survival of patients with these 43 eventually non-radical resections followed an identical course as in group 2 (median survival 13.3 months, maximum 42 months). Of the 183 patients with potentially curative resection ten died after surgery (5.5 per cent). Actuarial 5 and 10-year survival rates in the remaining 173 patients were 40 and 27 per cent with 25 and seven patients alive at respective periods of time. Until 1 January 1990, 64 patients remained free from recurrent disease for up to 24 years. In three patients the tumour status at death was unclear. The other 106 patients developed definite cancer relapse. Nevertheless they demonstrated a prolongation of survival time by a median of 1 year when compared with the 43 non-radically resected patients or the 62 untreated patients with resectable liver-only metastases, and accomplished a maximum survival time of 8 years. Radical excision of colorectal secondaries to the liver therefore offers effective palliation, and in a small number the chance of a cure.

Actuarial Analysis↗
PubMed1990

Pulmonary resection for metastatic colon and upper rectum cancer. Is it useful?

The predictive value of the route of venous drainage on prognosis was investigated in a consecutive series of 44 patients who underwent curative resection of pulmonary metastases from colorectal carcinoma. The primary tumor was located in the colon in 14 patients and in the upper third of the rectum in 11 patients, thus indicating blood drainage directed toward the portal vein (Group I). In 10 and 9 cases, respectively, the initial growth was in the middle and lower thirds of the rectum with the venous outflow at least partially directed into the vena cava (Group II). There was no obvious difference between the two groups regarding the initial site of cancer relapse. The liver was involved in 4 of 15 patients failing in Group I as opposed to 4 of 13 patients with hematogenous relapse in Group II. Median survival and tumor-free survival times were significantly longer in patients in Group I (58.4 and 50.2 months) than in patients in Group II (30.9 and 16.8 months), and, even more pronounced, in colon cancer patients (75.4 and 60.2 months) when compared with rectal cancer patients (31.0 and 17.9 months). In contrast, survival curves did not differ significantly if either the two groups with different routes of drainage (5-year survival 53 percent vs. 38 percent, 5-year tumor-free survival 43 percent vs. 37 percent), or tumors of the colon and rectum (5-year survival 67 percent vs. 38 percent, 5-year tumor-free survival 60 percent vs. 32 percent) were compared using the log-rank test. Similar trends were obtained for the subgroup of 34 patients without previous or simultaneous extrapulmonary recurrent disease at the time of lung resection. The primary tumor site does therefore not become a major criterion in selecting patients for surgical resection.

Adult↗
PubMed1990

[Surgical interventions in liver metastases].

Surgical treatment of hepatic metastases is predominantly aimed at "curative" resection. This can be achieved in about 20% of colorectal secondaries, and is associated with a 30-40% 5-year survival. One to three metastases in the absence of extrahepatic disease are regarded a clear indication to resection. Among patients with non-colorectal malignancies, occasional long term survival was reported in leiomyosarcoma, breast cancer, and renal cancer metastases, respectively. Endocrine tumors such as carcinoid, gastrinoma, or pheochromocytoma, are different because of their remarkable symptoms along with a protracted natural history. Quality of life may be considerably improved here by even non-radical debulking. The vast majority of patients, however, ist not suitable to undergo hepatic resection. Palliative therapeutic options involve hepatic artery ligation or embolization, cryo-surgery and percutaneous laser coagulation, and various types of regional chemotherapy. These methods may enable a temporary relief of symptoms, but no significant impact on survival time, and no true long term benefit has been proven. Prospective randomized trials against combined treatment as well as untreated patients are required for a more meaningful judgement and improved effectiveness.

Colorectal Neoplasms↗
PubMed1989

[Resection of lung metastases of colorectal cancer. Indications and indication limits].

From 1970 through 1986, a total of 62 patients underwent thoracotomy for colorectal metastases to the lungs. Four had exploration only, whereas in 13 a nonradical, and in 45 a "curative" resection was performed. There was one postoperative death. Cumulative 5-year survival following radical resection was 44%. Conversely, all other patients succumbed within 3 years. Extrapulmonary disease has not yet been associated with 5-year survival and may usually contraindicate resection. The impacts of multiple metastases exceeding 3 nodules or bilateral pulmonary involvement on prognosis can not been determined from our series, since the procedure in respective patients was not radical in the majority of cases. In turn, localisation and venous drainage of the primary tumor did not significantly influence long term survival.

Adenocarcinoma↗
PubMed1983

Primary carcinoid tumor of the orbit. A clinicopathologic study with histochemical and electron microscopic observations.

A patient with a primary carcinoid tumor of the orbit is described. No other tumor had been found during the 15-year interval since the onset of unilateral proptosis. Symptoms of the carcinoid syndrome were absent, and the urinary levels of 5-hydroxyindoleacetic acid were normal. Histologically, the bulky, noninfiltrating tumor compressed but did not invade the optic nerve. The argyrophilic cells were arranged in solid lobules and formed abundant, rosettelike structures. Pleomorphic neurosecretory granules were demonstrated by transmission electron microscopy.

Aged↗
PubMed1977

[Thyroid carcinoma metastases in choroid membrane of a 9 year old girl].

Report on a case of a total serous retinal detachment which manifested itself by inflammation and rise in tension. It was associated with an undefinable tumour of the posterior portion of the eye which had become visible after puncture of the subretinal fluid. Fluorescein angiography revealed a pattern similar to Hippel-Lindau's disease, although the clinical course was unusual. Histologic examination of a lump detected on the neck proved to be a metastatic thyroid carcinoma. This diagnosis could be confirmed after enucleation. The literature shows that ocular involvement in metastatic thyroid carcinoma seems to be extremely rare.

Child↗
PubMed1976

[Localization and separation of various amino acid arylamidases in the uterus and blastocyst of the rabbit].

Distribution patterns of amino acid arylamidases have been studied in rabbit uterus and implantation stage blastocysts using a simultaneous coupling technique. A series of beta-naphthylamides (NAs) of various amino acids were used as substrates. Tests were performed at pH 6.5 and 7.5 using both Fast Blue B and Fast Garnet GBC as diazonium salts. Despite limited substrate specificity known in arylamidases, this procedure proved to be sufficient to give some evidence for the presence in uterus and blastocyst of at least three different arylamidases. NAs of aromatic amino acids (Phe, Tyr, Trp) are hydrolyzed predominantly by an enzyme showing maximum activity in uterine epithelium and in walls of blood vessels. An amino dicarbonic acid (alpha-Glu, alpha-Asp) NAs splitting arylamidase, possibly related to "aminopeptidase A", seems to be localized more specifically in myometrium and trophoblast. When NAs of basic (Arg, Lys) or certain other (Gly, Ala) amino acids were used, a strong reaction was obtained in myometrium, uterine epithelium, blood vessels and trophoblast as well. The observed patterns of distribution did not give evidence for the existence of an enzyme splitting exclusively Arg-betaNa and Lys-betaNA ("aminopeptidase B") although the activation by Cl- ions did. The problem of identification of different amino acid arylamidases by histochemical means will be discussed. For better localization, a section freeze substitution technique was found as efficient as the use of methoxy substrates. For the study of uterine secretion, either the section freeze substitution or the membrane method may be used.

Aminopeptidases↗