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Biomedical subjects

T Junginger

Publications and source records attributed to T Junginger.

At least 19 recordsLinked to original sources
PubMed1992

DNA image cytometry in stomach carcinoma. Its relation to histomorphologic parameters and its influence on prognosis.

BACKGROUND: The influence of DNA content on the prognosis in stomach cancer is controversial. METHOD: After curative resection of stomach carcinomas (adenocarcinomas [n = 58]; signet ring cell carcinomas [n = 24]; undifferentiated carcinomas [n = 21]), the influence of the DNA content and histomorphologic parameters on the prognosis was examined. RESULTS: In the multivariate regression analysis, the prognosis depended on the lymph node status (P = 0.0009), pT stage (P = 0.02), tumor localization (P = 0.03), and histologic type (P = 0.05). The prognosis was independent of the DNA content. Furthermore, the degree of differentiation, operative procedure, safety distance, size of the tumor, and sex and age of the patient also did not influence the prognosis. CONCLUSIONS: The DNA content of the tumor cells in stomach carcinoma does not influence prognosis.

Adenocarcinoma↗
PubMed1992

[Secondary achalasia in non-Hodgkin's lymphoma of low malignancy and leiomyomatosis of the cardia].

A 28-year-old man had been dysphagic for 9 months with a weight loss of 4 kg. A preliminary diagnosis of primary achalasia was made on the basis of typical radiological and manometric findings. Despite balloon dilatation of the cardia the symptoms did not improve and further diagnostic tests were performed. Ultrasound demonstrated a 4 cm tumour below the cardia. But its type and possible malignancy remained uncertain even at laparotomy. But as a malignant tumour was suspected a gastrectomy and omentectomy with removal of the local and regional lymph nodes were performed. After this the symptoms regressed and postoperative food intake was without problem. Histological examination of the surgical specimen revealed leiomyomatosis of the cardia and the gastric fundus, combined with a low-malignant B-cell lymphoma of the mucosa-associated lymphatic tissue. Oesophagus manometry 4 months postoperatively gave normal results. The patient has been free of symptoms and without evidence of recurrence for by now 18 months postoperatively.

Adult↗
PubMed1992

[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↗
PubMed1992

A small-bowel segment as a total extrahepatic bile duct replacement.

The effect of a small-bowel segment as a total extrahepatic bile duct replacement, with preservation of the bile passage through the papilla of Vater, was examined in 12 pigs followed up for 420 days. No complications during or after surgery were observed in any of the animals. The laboratory parameters were within normal range during the entire observation period. No anastomotic stenosis was evident on percutaneous transhepatic cholangiography in animals examined 2, 6, or 12 months after surgery. The intrahepatic biliary tract was not dilated. There was obvious peristalsis of the grafted small-bowel toward the papilla of Vater. Autopsies showed that the grafts had healed without any sign of irritation. Histologically, the structure of the graft remained undisturbed. There was a clear distinction between the mucosa of the bile duct and that of the small bowel, with no sign of chronic infection. In the graft as well as in the vascular pedicle, the nerve fibers were intact. Liver biopsy showed no pathologic changes. In light of the results of these experiments, the small-bowel segment appears to be a very promising substitute for the injured extrahepatic biliary duct.

Ampulla of Vater↗
PubMed1992

[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↗
PubMed1992

[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↗
PubMed1992

[Prognostically relevant factors in intra-abdominal infection].

From 1.1.1982-30.9.1989 280 patients were treated for intraabdominal infection at the clinic for general and abdominal surgery. With regard to their prognostic significance, the extent and localization of the peritonitis, abscess formation, the number of failed organ system, patients' age, total protein, thrombocytes and leucocytes were examined in these patients. The most unfavorable prognosis showed diffuse peritonitis with a mortality rate of 47.2%. Subsequent abscessing worsened the prognosis of the illness. There was a close correlation between the number of failed organ systems at the time of hospitalization and mortality. Low total protein content or more so a necessary substitution therapy were linked to a high mortality (less than 4 g%: 81.2% mortality). A low number of thrombocytes and leucocytes and a low total protein in the serum were a sure sign for a complicated process of the illness, with these 2 situations combined, mortality was 100%. The indication for laparotomy and most of all for relaparotomy can be facilitated, if these factors are included in the decision, as their negative change are an indicator for a further existing or imminent postoperative peritonitis.

Adult↗
PubMed1992

DNA image cytometry: a prognostic tool in rectal cancer?

In 68 patients the DNA content of tumor cells was measured by image cytometry after resection of the rectum because of cancer. In the DNA histogram a differentiation between diploid (n = 19), polyploid (n = 24), hypotriploid (n = 17), and hypertriploid (n = 8) tumors was possible. The best relapse-free survival time was found in patients with diploid tumors. The prognosis worsened from polyploid to hypotriploid and was worse in hypertriploid tumors. Testing for a prognostic advantage of diploid over aneuploid tumors without adjustment for additional factors simply by means of the log-rank statistic gave a (one-sided) P of 0.1013. In a multivariate analysis the degree of differentiation turned out most important. Again, an appropriate test for prognostic relevance of DNA content failed to be significant (P = 0.3264).

Adult↗
PubMed1992

Effects of corticotropin-releasing hormone on the postoperative course of elderly patients under long-term artificial respiration.

In both human and animal studies a stimulatory effect of corticotropin-releasing hormone (CRH) on respiration and on cognitive parameters has been demonstrated. Our own studies employing human CRH (hCRH) iv in healthy volunteers and different groups of patients have shown hCRH to be a safe drug. We prospectively studied the clinical effects of a standardized dose of 100 micrograms hCRH iv in 12 elderly patients following major abdominal surgery who remained comatose and were under prolonged respirator therapy over a mean period of 37 days. Cardio-respiratory parameters, blood gas values, plasma cortisol and catecholamines were evaluated before and 30 min following hCRH injection. Furthermore, vigilance was tested using a score system. Ventilation was markedly enhanced following hCRH injection while the cardiovascular parameters were only moderately affected. Vigilance was augmented in all subjects and improved impressively in five patients. The changes were of great benefit for the patients treated and supported their respirator weaning procedures and mobilization training.

Abdomen↗
PubMed1992

[Pelvic multivisceral resection from the viewpoint of gynecology].

The pelvic exenteration procedure must be considered a multimodal therapeutic concept from a humanistic-medical point of view. Careful patient selection, radical resection of all tumor-infiltrated organs, complete interdisciplinary organ reconstruction, and optimal perioperative management including full psychosomatic rehabilitation are mandatory. This concept should only be realized in medical centers with highly sophisticated infrastructures.

Female↗
PubMed1992

[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↗
PubMed1992

[Endosonography of esophageal cancer. Results of a clinical study and in vitro analysis].

From April 1989 to June 1991 63 patients with esophageal cancer were investigated by endosonography with the object of ascertaining the depth of intrathoracic tumor infiltration and lymphnode involvement. The sensitivity in diagnosing tumor infiltration amount to 0.74; the sensitivity for involvement of regional lymphnode was 0.84, specificity 0.44. In an in-vitro analysis endosonographic criteria for the assessment of regional lymphnodes are proved. Echogenic structure seems not to be a valuable criterium.

Aged↗
PubMed1992

[Fascia dehiscence--cause and prognosis].

During a period of 5 years, 4476 interventions in abdominal surgery were prospectively analyzed. The incidence of fascial dehiscence was 0.7% (n = 30). Seventeen of these patients underwent surgery on account of intraabdominal infection (total incidence of intraabdominal infection 4.4%). Fascial dehiscence developed in 22 out of 30 patients (73%) after emergency surgery. All of them had to be operated out of routine surgical schedule with the exception of four patients. Using multivariate stepwise logistic regression analysis, main determinant factors in fascial dehiscence were the ASA score (p = 0.0001), reflecting the severity of primary or concomitant diseases, and wound infection (p = 0.0075), mostly due to intraabdominal contaminations. Fascial dehiscence was associated significantly with a higher morbidity, reflected by longer inpatient management. Nevertheless, the overall lethality of 20% was associated to serious primary or concomitant diseases. Therefore, the results emphasize the significance of diligent preoperative work-up. Adequate treatment for concomitant disorders should be performed preoperatively, whenever possible even in emergency surgery.

Abdomen↗
PubMed1992

[Cardiac morbidity and fatalities in patients with vascular surgery. Identification of risk groups].

Incidence and type of cardiac complications in 701 patients undergoing arterial vascular surgery were prospectively investigated to identify high-risk groups. Cardiac morbidity was 10.1%. Cardiac complications were responsible for 28 deaths (57%). Using logistic regression analysis, age (cardiac morbidity greater than 7017.3%), impaired renal function (19.8%), and congestive heart failure (17.3%) were the main independent risk factors. In addition, 4 risk factors (arrhythmia, coronary artery disease, anemia, emergency surgery) showed significant individual association with cardiac complications. Cardiac morbidity increased to 27.8% in patients with more than 2 of these 7 risk factors. A further association could be demonstrated between the degree of peripheral vascular disease and cardiac morbidity, but not with the extent of the operation. Based on our results a distinction between three groups of different cardiac risk can be made. A clinical algorithm for further cardiac assessment in high-risk patients is presented.

Adolescent↗
PubMed1992

[Preoperative risk assessment with the ASA classification. A prospective study of morbidity and mortality in various ASA classes in 2,937 patients in general surgery].

The value of ASA classification in assessment of perioperative risk, i.e. especially postoperative morbidity, was analyzed prospectively using the data of 2937 patients. The analysis took into account the criteria validity, reliability, and sensitivity. The incidence of post-operative morbidity after elective surgery rose from 3.9% in ASA class I to 36% in ASA class IV. Mortality was 0.6% in ASA class II, whereas 9.3% died in ASA class IV. Morbidity, mortality respectively, after emergency surgery was 10.2% in ASA class II compared to 69% in class IV, mortality 1.4% compared to 21.5%. Differences between the ASA classes were confirmed (p-value < 0.05) considering separate kinds of complications and different periods. Furthermore, ASA classification was a valuable reference to length of stay and severity of necessary therapy at the ICU.

Adult↗
PubMed1992

[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↗