[Simplified combination bypass or single biliodigestive anastomosis in nonresectable pancreatic carcinoma?].
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Cholecystostomy↗
Biomedical subjects
T Böttger
Publications and source records attributed to T Böttger.
[Differentiated surgical therapy of esophageal carcinoma].
Between September 1985 and December 1993 280 patients suffering from esophageal cancer underwent treatment at the department of general and abdominal surgery at the University of Mainz. Of the 167 patients operated, 152 patients had an esophageal resection performed in 113 cases as abdominothoracic resection and in 39 cases via the transmediastinal approach. 104 patients were curative resected (R0). Recurrence-free and total survival were correlated to the extent of the mediastinal lymph node dissection supposing comparable operative stress. The mean recurrence-free and the mean total survival after abdominothoracic resection with 2-field lymph node dissection were 42.4 months resp. 47.3 vs. 18.9 months resp. 25.2 months after transmediastinal resection (p = 0.015 and p = 0.035). We suggest a differentiated surgical approach concerning abdominothoracic resection with 2-field lymph node dissection for limited tumor size (pT1-3 pN0-1 M0), if the operative risk is tolerable. The transmediastinal resection appears to be only enough radical in cases with early tumor stages (UICC 0-I) and also is advantageous for risk patients with simultaneously more advanced tumor (palliative resection), because of the lower operative stress.
Adenocarcinoma↗
[Free small intestine transplantation with microvascular anastomosis for complete replacement of the hypopharynx and cervical esophagus].
12 patients were operated on due to a cancer of the hypopharynx (T2-T4, N2-3). After resection, the reconstruction was performed with a free jejunal segment. Intraoperatively the venous anastomosis had to be renewed in 2 cases. One of these patients developed postoperatively a partial necrosis of the transplant. A further patient developed an insufficiency of the proximal anastomosis. One patient died on the 12th postoperative day due to a myocardial infarction. The median survival time was 17 months.
Adult↗
[Diagnostic and therapeutic strategy in multiple insulinoma].
Four of 59 patients with organic hyperinsulinism had multiple insulinomas and two patients a micro- and macroadenomatosis. Excluding patients with adenomatosis 3 of 10 tumors could be detected preoperatively by ultrasound (5 of 10 by CT). 6 of 7 macroadenomas could be visualized by angiography. Intraoperatively 9 of 10 macroadenomas were palpable. The nonpalpable tumor could be localized by intraoperative ultrasound. Pancreatic resection had better results than multiple enucleations. Excisional biopsy is recommended to exclude nesidioblastosis or microadenomatosis.
Adenoma, Islet Cell↗
[Diagnosis and prognosis of mesenterial infarct].
RESULTS: 28 cases of arterial thrombosis, 18 arterial embolism, 16 venous thrombosis and twelve cases of nonocclusive intestinal ischemia were diagnosed. History of symptoms on admission was longer in venous thrombosis (80 hours) than in arterial vascular occlusion (40 hours). There was a leukocytosis of 19.7/nl and lactate in serum was elevated in 85.1% of patients. Sonographic abdominal examination without preparation of the gut was normal in 44.6% (33/74 patients), variable distended loops of small intestine in the other cases. Sonographic measurement of mesenteric vascular flow succeeded only in 10.9%. Abdominal X-ray photography showed no characteristic signs in 21.6%. Variable degree of gaseous distension and fluid levels was described in 73.7%. Angiography was only performed in patients which were not supposed to be operated because of clinical examination (e.g. peritonitis). Eleven of 19 cases were diagnosed correctly (specificity 73.7%). Mortality rate of all patients was 70.3% and showed in further analysis significant differences in age, etiology of mesenteric ischemia, the length of ischemic and operatively resected gut. CONCLUSION: If mesenteric vascular occlusion is suspected a quick diagnostic procedure and laparotomy for resection of gangrenous bowel is to be planned.
Aged↗
[Aortoduodenal fistula. Incidence--diagnosis--therapy].
Six patients were operated on for an aortoduodenal fistula at the Department of General and Abdominal Surgery, Johannes-Gutenberg-University Mainz. All patients had received an aortic graft implant between 1 and 10 years ago. The etiology, symptoms, and diagnostic and surgical treatment of these six cases are presented, and the results are discussed in comparison with the results of other studies. The main symptom of all of our patients was gastrointestinal bleeding. In our patients arteriography and computed tomography were the best diagnostic procedures. At surgery, five patients underwent graft excision and axillobifemoral bypass (only four patients, as one died before implantation). In the other patient a local repair, with closure of the graft defect and bowel defect, followed by interposition of an omental pedicle, was performed. Two patients died within 6 days of operation due to multiple organ failure.
Aged↗
[Free small intestine patch with microsurgical vascular anastomosis for enlarging a cervical esophageal stenosis].
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Adolescent↗
[The value of quantitative DNA analysis in evaluating the prognosis of differentiated thyroid cancer].
In this study we analyzed DNA ploidy as a potential prognostic parameter in differentiated thyroid carcinoma. In the case of papillary cancer the depth of tumor infiltration, a micro- or macroinvasive tumor growth, an invasion of vessels and the ploidy had an influence on prognosis. In the case of follicular cancer depth of tumor infiltration, the presence of distant metastasis, grading, uni- or multifocal tumor growth and the ploidie had an influence on prognosis. In the case of papillary cancer the multivariate analysis for the ploidy shows a strong and independent influence on the prognosis. Even when comparing with tumor stage, EORTC score and AGES score the ploidy allows an additional prognostic differentiation. In follicular carcinomas a multivariate analysis was not possible due to the strong associations of the prognostic parameters.
Adenocarcinoma, Follicular↗
[Image analysis DNA cytometry in medullary thyroid gland cancer. Comparison with histomorphologic parameters and prognostic effect].
In 24 patients with a medullary thyroid cancer a histopathological reexamination was performed. In 16 patients the DNA content was measured. Patients with a diploid or hypotriploid tumor had a 5-year survival rate of 100% in contrast to 48% of patients with a triploid or hypertriploid aneuploid tumor. Aneuploid tumors were more often found in patients with a high pre- or postoperative calcitonin level and lymph node metastasis. No correlation was found between the DNA content and the patients age, sex, preoperative CEA value, tumor size, pT4 stage, invasion of vessels calcitonin immunoreactivity, silver or amyloid staining, and distant metastasis.
Adolescent↗
[Thoracoscopic operation of a tumor of the esophageal wall].
Improvements in video endoscopic technique opens a wide spreaded field of indications of thoracoscopic surgery especially in benign tumors of the esophagus. A 58-years old patient presented with dysphagia. Preoperatively a benign, intramural tumor of the esophagus wall was diagnosed. Enucleation of the tumor was performed by right videothoracoscopy. The use of thoracoscopic operative technique implies rapid disappearance of complaints and a reduced time of hospitalisation.
Deglutition Disorders↗
[Value of image analysis DNA cytometry in cancer of Vater's ampulla].
In 27 patients who underwent partial duodenopancreatectomy due to cancer of the ampulla of Vater, in addition to the TNM classification and usual morphologic criteria, the paraffin-embedded material underwent deparaffinization, was rehydrated, and was mechanically and enzymatically processed into a single-cell solution. For evaluating the DNA histogram this was analyzed with the help of automatic single cell cytophotometric study. At the time of DNA analysis the histomorphological data and the survival time of the patients were not known. In the univariate analysis the 5-year survival rate of patients with diploid or hypotriploid tumors (n = 12) was 69% of patients with diclonal (diploid-triploid n = 7, triploid-tetraploid n = 1) tumors was 62.5% and no patient with a triploid or hypertriploid tumor (n = 7) survived 5 years. No association could be found between the known prognostic criteria and the DNA content. The multivariate analysis shows that beside the lymph node status, the DNA content of tumor cells had a strong and independent influence on the prognosis in cancer of the ampulla of Vater.
Adenocarcinoma↗
[Image cytometric DNA analysis in the evaluation of the risk of recurrence after resection of rectal carcinoma].
Prognostically relevant factors derived from re-operative endoluminal US examination or the histopathological work-up of the surgical specimen in carcinoma of the rectum are well known. We investigated the question as to whether the DNA content of tumor cells is an independent influencing factor of prognosis after resection of rectal carcinoma. In 68 patients who underwent resection for rectal carcinoma, in addition to the TNM classification and the usual morphological evaluation, the paraffin-embedded tumor material was de-paraffinized, rehydrated and treated mechanically and enzymatically prior to application to microscope slides. These smears were analysed with the aid of automatic single cell cytometry, and DNA measurements were performed. In contrast to flow cytometry, this technique permits, on the basis of electronic selection criteria, selective analysis of the tumor cells, while artefacts, stroma and inflammatory cells can be excluded. Using DNA cytometry, we were able to differentiate between diploid, polyploid and aneuploid tumors. The best prognosis was associated with a diploid tumor, the poorest with aneuploid tumor. Regression analysis, however, showed that the DNA content of tumor cells is of only secondary significance.
Cytological Techniques↗
[Surgical stapler technique for gastric tube formation and anastomosis after esophageal resection].
55 out of 62 patients being operated of esophageal carcinoma underwent gastric tube by stapling technique at the Department of General and Abdominal Surgery, Hospitals and Clinics, Johannes Gutenberg University, Mainz. In 32 cases the intrathoric anastomosis had been performed by using the circular stapling instrument. One patient (3.2%) out of two (6.3%) showing suture dehiscencies died consequently to this complication. A stenosis of the intrathoric anastomosis developed in 11 patients. The stapling technique convinced as a surgically simple and safe method of restructing the nutrition passage after esophageal resection.
Anastomosis, Surgical↗
[Comparison of DNA analysis with histomorphologic parameters in stomach cancer].
After curative resection of stomach carcinomas (adenocarcinomas: n = 58, signet ring cell carcinomas: n = 24, undifferentiated carcinomas: n = 21) the DNA content of the tumor cells was compared with the histomorphological parameters. There was a correlation between the DNA content and the histomorphological parameters. The DNA analysis had no additionally prognostic influence. In the multivariate regression analysis the prognosis depended on lymph node status (p = 0.0009), pT-stage (p = 0.02), tumor localization (p = 0.03) and the histological type (p = 0.05). The prognosis was independent of the DNA content. Furthermore, neither did the degree of differentiation, the operative procedure, the safety distance, the size of the tumor, the sex nor the age of the patient have any influence on the prognosis.
Adenocarcinoma↗
[Risks and follow-up of choledocho-jejunostomy for nonresectable cancers of the head of the pancreas. A prospective study].
In 44 patients with palliative operative procedures due to non-resectable pancreatic cancer the preoperative risk factors and the intra- and postoperative course as well as the long-term results were prospectively investigated. Postoperatively 2 patients developed severe complications and 3 patients died. The median survival time was 5 months. The results of this investigation show, that the biliodigestive anastomosis offers a good palliation in patients with non-resectable pancreatic cancer. Indication for non-operative palliative procedure are patients in poor general condition with a life expectance of less than 4 months.
Aged↗
[Pulmonary complications following surgical abdominal interventions. Identification of various risk groups].
Incidence and type of postoperative complications were prospectively analyzed in 2280 patients undergoing gastrointestinal surgery. 6.6% had one or more pulmonary complications requiring therapeutic intervention (2.3% pneumonia, 1.6% drained pleural effusions, 1.2% atelectases). Based on univariate and logistic regression analyses, the following parameters constitute high-risk patients with regard to pulmonary complications: Elective surgery (4.3%, 61/1428): anemia (7.2% pulmonary complications), pathological blood gas analysis (9.8%), preoperative hospitalization greater than 1 week (6.3%), blood loss under operations greater than 1000 ml (10.5%), length of the operation greater than 3 h (9.7%); emergency surgery (10.4%, 89/852): upper gastrointestinal operation (16.2%), age greater than 75 (19.9%), ASA IV/V (28%), anemia (19.6%), chronic bronchitis (19%), pathological blood gas analysis (26.6%), diabetes (16.5%), heart failure (18.2%), blood loss under operation greater than 1000 ml (24.3%), length of the operation greater than 2 h (15.4%). These results allow to distinguish between different levels of pulmonary risk.
Adolescent↗
[Nesidioblastosis and adenomatosis of the pancreas as an unusual cause of organic hyperinsulinism].
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Adenoma↗
DNA image cytometry. A prognostic tool in squamous cell carcinoma of the esophagus?
In 45 patients who underwent an esophagus resection due to a squamous cell carcinoma, in addition to the TNM classification and usual morphologic criteria, the paraffin-embedded material underwent deparaffinization, was rehydrated, and was mechanically and enzymatically processed into a single-cell solution. For evaluating the DNA histogram this was analyzed with the help of automatic single-cell cytophotometric study. The method, contrary to that of flow cytometric study, allows for the selective analysis of tumor cells due to the electronically, previously given selection criteria, whereas artifacts, stroma, and infection cells remain excluded from analysis. The multivariate analysis shows that the prognosis is only correlated with DNA content of the tumor cells. Patients with diploid tumors had a median survival time of 32 months as compared with the 22 months of patients with hypotriploid tumors, and 6.5 months with hypertriploid tumors. DNA cytometric analysis should be included when diagnosing patients with esophagus carcinoma.
Carcinoma, Squamous Cell↗