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T Böttger

Publications and source records attributed to T Böttger.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Expression of CD44 and isoforms v4, v5, v6, v7, v10--new prognostic parameters in ductal pancreatic carcinoma?].

UNLABELLED: Prognostically relevant factors based on the histological assessment of the resected pancreas are known. However, additional parameters, such as biological staging of the intrinsic malignant potentiality of the tumor, would be useful. There has been no uniform finding of a relationship between CD44 variant expression and tumor progression. METHOD: We assessed the expression pattern and prognostic impact of CD44 standard and CD44 isoforms v4, v5, v6, v7 and v10 in 40 ductal pancreatic carcinomas by immunochemistry on paraffin-embedded tumor material in patients after tumor resection. At the time of the investigation neither histomorphological parameters nor the survival time were known. RESULTS: There was no correlation between the histomorphological parameter and the expression of CD44 splice variants. CD44 splice variants v4-v10 were almost only expressed in tumor tissue. In ductal pancreatic carcinoma, patients with an overexpression of CD44 splice variants had a worse prognosis. However, because of the small number of cases this was statistically not significant. CONCLUSION: CD44 splice variants may have an influence on prognosis in ductal pancreatic carcinoma. However, further investigation on a larger number of patients is necessary to confirm these results.

Adenocarcinoma↗
PubMed1998

Preoperative diagnostics in pancreatic carcinoma: would less be better?

OBJECTIVE: The objective of this study was to investigate the value of preoperative diagnostics in patients with pancreatic carcinoma in terms of tumor diagnosis and evaluation of resectability. PATIENTS/METHODS: From 1 September 1985 to 31 December 1997, 408 patients shown by histology to have a ductal (n=330) or periampullary carcinoma (n=78) were treated at our hospital. RESULTS: In determining the presence of tumor, ultrasonography and computed tomography (CT) had a sensitivity of 88.3% and 94.0%, respectively; combined, they had a sensitivity of 96.2%. Endoscopic retrograde cholangiopancreatography (ERCP) had a sensitivity of 96.2%. Preoperative aspiration biopsy cytology had a sensitivity of 71.4%. No correlation was found in the patients undergoing surgery between the preoperative level of serum CA 19-9 and the presence of distant metastases. Tumor infiltration of the portal vein was shown with a sensitivity of 33.3%, 24.3%, and 76.5% and a specificity of 93.9%, 98.9%, and 65.6% by ultrasonography, CT, and angiography, respectively. Ultrasonography and CT detected liver metastases or peritoneal carcinomatosis with a sensitivity of 35.9% each and a specificity of 91.9% and 91.7%, respectively. CONCLUSION: This study shows that, in 96% of patients with pancreatic carcinoma, ultrasonography and CT are adequate for diagnosis and for the evaluation of resectability. ERCP is not the method of choice in the diagnosis of pancreatic carcinoma due to its invasiveness and to the fact that it fails to demonstrate the pathological anatomical location of the tumor; it should only be used if a tumor is suspected despite negative results on ultrasonography and CT or as an additional diagnostic method to differentiate between chronic pancreatitis and carcinoma. On account of the low sensitivity of percutaneous aspiration biopsy cytology, this method is not necessary preoperatively and may even lead to the spread of tumor cells. In 7% of patients, routine laparoscopy would additionally show liver metastases or peritoneal carcinomatosis not demonstrated using the imaging techniques.

Adult↗
PubMed1998

[Endoscopic palliative treatment of tumors of the gastrointestinal tract].

Patients with nonresectable gastrointestinal tumors have a life expectancy of a few months only. Effective palliative treatment has to ensure a good quality of life with minimal morbidity and mortality. Esophageal carcinoma: Endoscopic intubation or stent implantation guarantee a prompt improvement of dysphagia with minimal morbidity and mortality in esophageal carcinoma. Only in cervical or noncircumferential stenosis laser therapy is preferable. Obstructive jaundice: Metal stents offer the best quality of life after palliative treatment of malignant obstructive jaundice. However, in patients with bad general conditions and a short life expectancy a pigtail catheter is less expensive. Colorectal cancer: Laser therapy and cryosurgery offer uncomplicated nonsurgical therapy in rectal carcinoma. Stents in the colorectum have a high complication rate. Endoscopic palliative treatment of gastrointestinal tumors can be performed with minimal morbidity and mortality. However, it is essential that a surgeon is involved in the decisionmaking between endoscopic or operative treatment.

Endoscopes↗
PubMed1997

[Influence of the number of dissected lymph nodes on local recurrence of rectal carcinomas. A staging effect].

In 386 patients with rectal carcinoma of UICC stage I-III operated on between 1 January 1985 and 31 December 1995 we investigated the influence of the number of dissected lymph nodes on tumor stage and local recurrence retrospectively. We found a significant correlation between the number of lymph nodes dissected and the number of detected lymph node metastases. Following this result we found an increase in UICC stage III (P = 0.013) and pTx pN2 tumors (P = 0.000) in correlation with the number of dissected lymph nodes. Significantly lower rates of local recurrence were found only in UICC stage I and UICC stage II. Overall and in a multivariate analysis the number of dissected lymph nodes had no influence on local recurrence. It was shown that lower local recurrence rates in UICC stage I and II did not depend on therapeutic benefit but on stage migration because of more exact tumor staging. The influence of other surgical factors, especially total mesorectal excision, remains to be discussed.

Adult↗
PubMed1997

[Long-term outcome after reconstructive interventions of the aorto-iliac segment].

From September 1985 to February 1994, 183 patients (arterial occlusive disease n = 108, abdominal aneurysm n = 75) underwent reconstruction of the abdominal aorta. In 120 patients an aorto-bi-iliac or aorto-bi-femoral reconstruction was performed and in 63 patients a tube-type reconstruction. The early and late postoperative complications are described. The complications were dependent on the choice of graft, the distal anastomosis and the preoperative risk factors. The mortality from elective repairs was compared with the mortality in emergency repairs. The role of endovascular reconstructive surgery in comparison to conventional reconstructive procedures is discussed.

Aged↗
PubMed1997

[Basedow's disease--thyroidectomy or subtotal resection?].

Postoperative complications and long-term results were retrospectively investigated after near total thyroidectomy due to Graves' disease in 73 patients. Postoperatively one permanent recurrent nerve palsy and one hypoparathyroidism were seen. Two patients had a postoperative bleeding and one patient had a wound infection. No patient died. After a median follow up time of 67 months 65 patients (89%) were seen. A recurrent hyperthyroidism developed 3% of the patients and 80% were hypothyroid. These results demonstrate the effectiveness of near total thyroidectomy in Graves' disease. With no mortality and low morbidity excellent long-term results could be achieved.

Adolescent↗
PubMed1997

[Does the extent of lymph node dissection have an effect on morbidity and prognosis after resection of the head of the pancreas for ductal or periampullary pancreatic carcinoma?].

We examined the influence of lymph node dissection on morbidity and mortality of 13 patients after resection of the head of pancreas due to a ductal or periampullary carcinoma. In both groups the radicality of the operation was the main prognostic factor. In ductal pancreatic carcinoma the R-status was able to be determined better by normalisation of the postoperative Ca 19-9 serum level than by the evaluation of the surgeon or pathologist. For prognosis, the quotient of metastatic lymph nodes to resected lymph nodes indicates that an extensive lymph node dissection may increase the long term survival. A lymph node dissection is therefore to be recommended, especially since it does not increase the rate of postoperative complications.

Adenocarcinoma↗
PubMed1996

[DNA content of the tumor cell. A new prognostic parameter in hepatocellular carcinoma?].

Hepatocellular carcinoma is a heterogeneous disease with considerable differences in malignant behaviour. Some relevant factors for prognosis are known. In this study we analysed DNA ploidy as a potential prognostic parameter. With DNA image cytometry we were able to differentiate between diploid, hypotriploid, triploid, hypertriploid, tetraploid and aneuploid tumours. The best prognosis was for patients with diploid, hypotriploid and tetraploid tumours with a median survival time of 41 months in contrast to 3 months for patients with triploid, hypertriploid or aneuploid tumours. There was a strong correlation between histomorphological parameters and the DNA content. The DNA content of tumour cells may be considerable clinical relevance in hepatocellular carcinoma regarding the decision as to whether or not to perform a resection. In patients with prognostically unfavorable parameters adjuvant oncological therapy may improve the prognosis.

Adult↗
PubMed1996

[Value of the CA 19-9 tumor marker in differential diagnosis of space-occupying lesions in the head of the pancreas].

In 96 patients (ductal pancreatic carcinoma, n = 34; periampullary carcinoma, n = 43; chronic pancreatitis, n = 19) the role of CA 19-9 in the diagnosis of lesions of the head of the pancreas were evaluated. The sensitivity for ductal pancreatic carcinoma was 73.3%, for periampullary carcinoma 48.8%, and specificity was 63.2%. Carcinoembryonic antigen was elevated only in every fifth patient. Even when combining the two tumor markers no increase in sensitivity could be observed. The low specificity of 63%, which decreased to 33% in the case of obstructive jaundice, does not allow adequate preoperative differentiation between cancer patients and those with chronic pancreatitis. In cases of postoperatively elevated CA 19-9 level the prognosis is worse than in patients with normal tumor markers.

Adult↗
PubMed1996

[Is preoperative site diagnosis in organic hyperinsulinism from the viewpoint of the surgeon still necessary today? Results of a consecutive series and analysis of the literature].

To answer the open question whether a preoperative localization diagnostic is necessary in organic hyperinsulinism we prospectively investigated our 28 patients with an organic hyperinsulinism who were operated on between September 1, 1985 and December 31, 1994. Additionally we performed an analysis of the literature. In case of a solitary adenoma the preoperative localization diagnostic had a sensitivity between 28.4% (sonography) and 84% (endosonography). The combination of all preoperative localization procedures had a sensitivity between 70% (literature) and 90% (own patient material). With palpation and intraoperative sonography 97.1% (own patient material 100%) of all solitary adenomas could be found during first exploration. Multiple adenomas and reoperations have special problems. The pre- and intraoperative localization diagnostic failed in every fourth patient. In conclusion, in case of a primary operation without a MEN syndrome a preoperative localization procedure is not necessary due to the high sensitivity of the intraoperative diagnostic. In case of a MEN syndrome or reoperation a preoperative localization diagnostic is still advisable although the sensitivity is low.

Adenoma, Islet Cell↗
PubMed1996

[Extent of radical surgery in carcinoma of Vater's ampulla].

The present series demonstrates that radical resection of ampullary cancer is the procedure of choice even in elderly patients. The most important factor influencing the survival rate is the extent of the lymph node dissection. The histopathological investigation of our pancreatoduodenectomy specimens demonstrates clearly that local excision of ampullary cancer may be indicated only in high risk patients with a pT1, well-differentiated tumor smaller than 0.6 cm in diameter.

Adult↗
PubMed1996

[Does the surgeon modify risk of local recurrence in rectal carcinoma?].

Investigating long-term operative results of nine surgeons, we found a variation in the local recurrence rate of 13% to 50%. Operative quality should not only be verified by investigating the perioperative risk, but also by investigating the local recurrence rate or prognosis.

Clinical Competence↗
PubMed1995

[Diagnosis of the origin and therapy of organic hyperinsulinism].

BACKGROUND: The need for preoperative localization of an insulinoma is still under discussion. The aim of the present study was to determine the usefulness of preoperative localization of the tumour, to investigate the operative risk and to analyse the long-term course. PATIENTS AND METHODS: The sensitivity of the diagnostic workup was investigated prospectively in 26 patients operated on between 1. 9. 1985 and 31. 8. 1994 for hyperinsulinism at the surgical department of the university hospital in Mainz. RESULTS: In the case of solitary adenomas the sensitivity of preoperative sonography was 43%, that of CT 57%, and that of angiography 85%. Intraoperatively, all solitary adenomas were palpable and were to be seen at sonography. In a patient with multiple adenomas, only one tumour was seen sonographically. The postoperative course was unremarkable in 18 out of 27 operations on the pancreas; two patients died later. After a mean follow-up of 51 months, all patients were free of hypoglycaemic attacks. CONCLUSIONS: The results show that localization of the tumour prior to the first operation is no longer necessary in patients with no MEN syndrome. In the presence of the latter, however, it is recommended despite its low sensitivity. Although a permanent cure is possible with surgery, the morbidity of the operation is not negligible.

Adult↗
PubMed1995

[Popliteal aneurysms: clinical aspects and diagnosis].

PURPOSE: To identify clinical and radiological features allowing an early diagnosis of popliteal aneurysms. MATERIAL AND METHODS: History, clinical features and radiological findings of 23 patients with 37 aneurysms were reviewed. RESULTS: 14 patients presented with a history of a sudden onset of rest pain localised in the calf or foot. Arteriography found popliteal artery occlusion in 12 of them. Amputation was necessary in one patient in spite of immediate diagnosis and therapy. In two cases embolisation of the tibial vessels caused intermittent claudication. In at least 7 patients the underlying disease was not suspected until arteriography was performed. In 16/23 patients the presence of thrombus prevented direct visualisation of the aneurysm and there were only secondary angiographic signs of the underlying condition. Thus, arteriography may fail to diagnose popliteal aneurysms. In 21/22 cases colour Doppler sonography was quick and accurate in the assessment of patent and thrombosed aneurysms. CONCLUSION: In any patient with ischaemic symptoms of the lower extremity a thorough palpation of the popliteal fossa should be performed. In patients with a prominent popliteal pulse, in pulseless popliteal tumours and in patients arteriographically shown to have popliteal artery occlusion, a sonographic study of both popliteal fossae should be performed.

Adult↗
PubMed1995

[Risk and follow-up after multi-visceral resections including the left side of the pancreas].

Aim of this study was to analyze the operative risk of multivisceral resection including the left side of the pancreas. Between September 1 th, 1985 and May 31 th, 1994 18 multivisceral resections including the left side of the pancreas and 8 left-sided pancreatic resections were performed at the University Hospital for General and Abdominal Surgery, Mainz. Postoperatively 5 of the 18 patients with multivisceral resections and 3 of the 8 patients with left-sided pancreatic resections developed minor complications (wound infections, pneumonia). One insufficiency of an esophagojejunostomy was seen. One patient died after gastrectomy and left-sided pancreatic resection due to a pneumonia. In this case the operation was performed after substitution of 22 red cell packs under emergency conditions because of an infiltration of the splenic artery by a lymphoma of the stomach. The best prognosis had patients with neuroendocrine tumors. These results show that in case of an elective operation the risk of multi-visceral resections including the left side of the pancreas is comparable to that of left-sided pancreatic resections alone.

Adrenalectomy↗