Biomedical subjects

T Moesta

Publications and source records attributed to T Moesta.

3 recordsLinked to original sources

PubMed2006

[Palliative bypass surgery].

Impaired intestinal passage considerably reduces quality of life irrespective of the underlying condition. Limited life expectancy and increased operative risk of advanced malignant disease add particular weight to this issue. The indication for operative therapy results from carefully weighing individual incapacity and potential gain vs operative risk and life expectancy. Exactly because life expectancy is quite limited, selection of an effective, low-risk procedure is of utmost importance to benefit the patient.

Constriction, Pathologic↗

PubMed2004

Sentinel lymph node biopsy in rectal cancer--not yet ready for routine clinical use.

BACKGROUND: The value of sentinel node biopsy in visceral cancers is uncertain. We evaluated the feasibility and utility of radiocolloid lymphatic mapping and selective lymph node sampling in patients with rectal cancer. METHODS: Forty-eight patients with rectal cancer were investigated. Thirty-seven patients had already undergone preoperative radiochemotherapy for locally advanced tumors. Eleven patients underwent primary surgery. An endoscopic injection of 1 mL technetium 99m-sulfur-colloid into the peritumoral submucosa was performed 15 to 17 hours before surgery. Ex vivo identification of the nuclide-enriched "sentinel lymph nodes" (SLNs) was performed using a hand-held gamma-probe. The selected SLNs were then carefully and systematically examined using serial sections and immunohistochemistry. RESULTS: One or more SLNs were found in 46 of the 48 patients. The SLN detection rate was 96%. Sixteen of the 48 patients had lymph node metastases (35%). In 7 of the 16 patients, the SLNs correctly represented the nodal status. In 9 of the 16 patients, the SLN was tumor-free whereas non-SLN harbored metastases. This result represents a sensitivity of only 44%, and a false-negative rate of 56%. Further analysis showed that the method correctly predicted the nodal status only in the small subgroup of 5 patients with early cancer without preoperative radiation. In 4 patients, juxtaregional lymph nodes were excised on the basis of intraoperative radiocolloid detection, leading to upward staging in 1 patient. CONCLUSIONS: Sentinel lymph node biopsy using the radiocolloid technique with ex vivo lymph node identification shows a relatively high detection rate; however, the sensitivity in patients with locally advanced/irradiated rectal cancer is low. Nevertheless, the detection of juxtaregional metastases can improve staging in some patients. Further studies should focus on patients with early rectal cancers where the data were more promising.

False Negative Reactions↗

PubMed1995

[The Heidelberg Intensive Care Unit Score. Development of a computer-assisted scoring system for documentation of treatment course and assessment of prognosis in surgical intensive care patients].

Existing scoring systems have failed to reflect the pathophysiological changes during ICU therapy, and do not provide reliable criteria for the prediction of outcome in surgical patients. The aim of the present project was to establish a comprehensive scoring system for daily evaluation of physiological parameters and therapeutic interventions in a surgical intensive care unit, and to identify score patterns in the course of ICU treatment to be used for prospective clinical decisions. In a prospective study of 123 consecutive patients who required intensive care for more than two consecutive days we documented 10 physiological parameters and a set of 14 therapeutic interventions on a daily basis over a total of 1274 days. Evaluation of the new scoring system, called the Heidelberg Intensive Ward Score (HDWS), included comparison with APACHE II and a set of unfavorable HDWS-patterns at different time points during ICU treatment. All variables were implemented into a notebook computer to be used at bedside. Neither HDWS nor APACHE II obtained on admission differentiated between survivors and non-survivors. In contrast, scores of non survivors were significantly higher than scores of survivors at day 7. At that point, HDWS was superior to APACHE II with respect to the predictive power as assessed by receiver operator characteristic curves. No patient who fulfilled all four unfavorable HDWS-patterns during the first week of ICU treatment survived (but these were only two patients). We conclude that the limited power of scores obtained on admission to predict outcome in surgical patients may be improved by trend analysis of scores over time which also take into account the patients' response to therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

APACHE↗