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Biomedical subjects

U Adam

Publications and source records attributed to U Adam.

At least 19 recordsLinked to original sources
PubMed2007

[Portal vein embolization preparation for major hepatic resection: a new standard in liver surgery].

Preoperative portal vein embolization (PVE) is increasingly used for operative treatment of patients scheduled to undergo liver resection when the volume of the future remnant liver appears to be insufficient. Portal vein embolization should be considered when the prospective postoperative liver volume is less than 20 % or less than 40 % in patients with known liver cirrhosis. Our own results (n = 28) demonstrated an average volume increase in segments II and III of 280 +/- 95 ml to 420 +/- 98 ml within 6 weeks after selective percutaneous- transhepatic embolization of the portal vein branches (IV)-V-VIII. Thus, an expanded right resection of the liver could be performed in all patients without major complications. None of the patients suffered from clinically relevant liver insufficiency within the first few postoperative months.

Bile Duct Neoplasms↗
PubMed2006

MMP-9 in serum correlates with the development of pulmonary complications in experimental acute pancreatitis.

INTRODUCTION: The prediction of the course of acute pancreatitis and its arising complications is of clinical importance. The aim of this study was to judge the time course and relevance of matrix metalloproteinase-9 (MMP-9), a PMN-derived protease, for the development of pulmonary complications in two models of acute pancreatitis. METHODS: MMP-9 was evaluated in a standardized experimental model of acute pancreatitis. Mild edematous (n = 12) and severe necrotizing pancreatitis (n = 48) were induced by intravenous cerulein or intravenous cerulein and intraductal application of glycodeoxycholic acid and compared to control animals. 1, 6, 9, 12, 24 and 72 h after induction, rats were sacrificed and damage to the lung and the pancreas was quantified by histology and extravasation of Evans blue. At 1, 6, 9, 12, 24 and 72 h, we determined MMP-9 in serum by ELISA. RESULTS: In our model, MMP-9 in serum was increased in the group with severe acute pancreatitis in comparison to mild edematous pancreatitis and controls at each evaluated time point (p < 0.05). The maximum release of MMP-9 preceded the development of pulmonary complications, verified by histology and extravasation of Evans blue. MMP-9 showed a negative predictive value of 96.2% and a positive predictive value of 100% for the development of pulmonary complications. CONCLUSION: MMP-9 in serum allows a valid grouping to severe and mild courses of experimental acute pancreatitis with a good predictive value for the development of pulmonary complications. MMP-9 should be evaluated as a valid single marker for the prediction of progression and the development of pulmonary complications in acute pancreatitis in clinical studies.

Animals↗
PubMed2006

[Therapeutic splitting as standard treatment for cholelithiasis].

At the moment, therapeutic splitting is still regarded by the vast majority of surgeons as the gold standard for stones in the common bile duct. Endoscopic clearance of the duct certainly is much less invasive than open exploration. However, this does not apply when compared with laparoscopic stone removal. Both are equivalent in respect to stone clearance rates, but the laparoscopic techniques protect patients from the long-term sequelae of endoscopic papillotomy. This can be important particularly for younger patients. Laparoscopic bile duct exploration is cost-effective and safe. Special experience in laparoscopic surgical techniques, however, is mandatory. Thus, surgeons should intensify their training in laparoscopic bile duct exploration in order to increase the acceptance of these techniques.

Cholangiography↗
PubMed2004

Heterotopic pancreatitis with obstruction of the major duodenal papill--a rare trigger of obstructive orthotopic pancreatitis.

BACKGROUND: Heterotopic pancreas appears in 0.5 to 13% of autopsies. The most frequent locations are stomach, duodenum or upper jejunum. Pancreatitis in heterotopic pancreas is rarely described, and clinical symptoms caused by this heterotopic inflammation are uncommon. METHOD: We report a case of heterotopic pancreatitis localized in the major duodenal papilla causing biliary obstruction and mimicking a pancreatic head tumor. Clinically and radiologically, malignancy was suspected. Preoperative biopsies showed only fibrosis. A pylorus preserving resection of the pancreatic head was performed followed by an uneventful postoperative course. RESULT: Macroscopically, in the periampullary region on the pancreatic side a thickened duodenal wall with multiple lobules and cysts was found, compressing the common bile duct. Microscopic examination showed heterotopic pancreas with inflammatory lesions surrounding the ampulla. In the orthotopic pancreas a diffuse chronic pancreatitis with marked inflammation, fibrosis and atrophy of exocrine tissue was found. CONCLUSION: In our case it was impossible to differentiate between chronic pancreatitis and pancreas carcinoma preoperatively. Radiological findings and endoscopic biopsies were not sufficient to distinguish heterotopic pancreatitis from other tumors of the pancreatic head. Clear diagnosis could only be made by complete histological examinations after pancreatic head resection, being the treatment of choice for pancreatic head tumors of unclear dignity. The differential diagnosis of heterotopic pancreatitis as trigger of unclear enlargement of the pancreatic head is very seldom.

Cholestasis↗
PubMed2004

[Leakage after biliary and pancreatic surgery].

The frequency of anastomotic leaks after pancreatic resection is still significant. The majority of such leaks will heal without major clinical symptoms. In one fifth of patients, however, the sequelae of pancreatic leakage are serious and sometimes life-threatening. Management of such leaks ranges from local drainage to operative revision and completion pancreatectomy. The frequency of anastomotic leakage depends on a series of patient- and organ-specific risk factors. Surgical experience also plays a major role. Whether the prophylactic application of octreotide is able to reduce the frequency of pancreatic leaks is still a matter of debate. Leaks from direct bile duct sutures or biliodigestive anastomoses are rather seldom. Their clinical importance is limited. In case of a leak after direct bile duct anastomosis, endoscopic insertion of a stent seems to be the therapy of choice. Leaks from biliodigestive anastomoses which are diagnosed during the first 3 postoperative days should be treated by immediate operative revision. Late biliary leaks can be treated by local drainage. The results of bile duct surgery, too, are clearly dependent on the experience of the operating surgeon.

Anastomosis, Surgical↗
PubMed2004

Islet autotransplantation combined with pancreatectomy for treatment of pancreatic adenocarcinoma: a case report.

Extensive pancreatectomy (EP) may increase the resection rate of pancreatic adenocarcinoma (PA). Unfortunately, EP often results in unstable diabetes. Recently, islet autotransplantation (auto-Tx) has offered the potential to prevent this metabolic disorder. Because of the fear of contamination of prepared islets by malignant cells, this procedure has so far not been used as a treatment for PA. We herein report a case of a 63-year-old nondiabetic patient who underwent EP combined with islet auto-Tx in an emergency operation following histologically proved R(0)-resection for PA (pT(3)pN(1)G(2)). Islets were isolated from the excised pancreas using a continuous digestion filtration device. The resultant preparation was injected into the portal vein. Owing to the moderate fasting hyperglycemia, postoperative exogenous insulin therapy was necessary (26 U/d). After discharge, the patient's daily insulin dose was gradually reduced. At 1-year follow-up the fasting C-peptide level was 0.66 ng/mL, and an oral glucose tolerance test (oGTT) and an intravenous (IV) glucagon stimulation (GS) showed functioning engrafted islets. The K-ras mutations were detected in the paraffin-embedded PA, but not in the prepared islets or in the peripheral blood. Computed tomographic (CT) imaging revealed neither local tumor recurrence nor liver metastases. At 2-year follow-up, the patient was on a balanced food regimen and gaining weight. Although he remains insulin-dependent (16 U/d), he is metabolically stable (HbA(1)(c) 5.9%). The fasting C-peptide level is 0.68 ng/mL. The peak value of C-peptide in response to oGTT was 0.92 ng/mL and to GS 0.89 ng/mL. At this time Ca19-9 and CEA are increased to 35.3 U/mL and 19.2 ng/mL, respectively. The patient died 2.5 years after operation owing to tumor recurrence. There was no evidence for liver metastases. We postulate that histologic evaluation (R(0)-resection) and detection of K-ras mutations may be useful techniques. However, islet auto-Tx after EP for adenocarcinoma should only be regarded for rescue therapy. Studies on strategies to exclude possible contamination of islet tissue with carcinoma cells are critically important.

Adenocarcinoma↗
PubMed2004

Effects of elderberry juice on fasting and postprandial serum lipids and low-density lipoprotein oxidation in healthy volunteers: a randomized, double-blind, placebo-controlled study.

BACKGROUND: In a recent pilot study, the intake of elderberry juice resulted in a significant decrease in serum cholesterol concentrations and an increase in low-density lipoprotein (LDL) stability. This study was designed to verify the preliminary results. OBJECTIVE: We investigated the impact of elderberry juice on cholesterol and triglyceride concentrations as well as antioxidant status in a cohort of young volunteers. DESIGN: Study A: The randomized, placebo-controlled trial for studying the effect of anthocyanes on lipid and antioxidant status, 34 subjects took capsules with 400 mg spray-dried powder containing 10% anthocyanes t.i.d. equivalent to 5 ml elderberry juice for 2 weeks. A subgroup of 14 subjects continued for an additional week to test for resistance to oxidation of LDL. Study B: To investigate the short-term effects on serum lipid concentrations, six subjects took a single dose of 50 ml of elderberry juice (equivalent to 10 capsules) along with a high-fat breakfast. RESULTS: In the placebo-controlled study, there was only a small, statistically not significant change in cholesterol concentrations in the elderberry group (from 199 to 190 mg/dl) compared to the placebo group (from 192 to 196 mg/dl). The resistance to copper-induced oxidation of LDL did not change within 3 weeks. In the single-dose experiment increases in postprandial triglyceride concentrations were not significantly different when the six subjects were investigated with and without elderberry juice. CONCLUSIONS: Elderberry spray-dried extract at a low dose exerts a minor effect on serum lipids and antioxidative capacity. Higher, but nutritionally relevant doses might significantly reduce postprandial serum lipids.

Antioxidants↗
PubMed2004

[Prophylactic splenectomy for splenic vein thrombosis in patients undergoing resection for chronic pancreatitis].

AIM: Chronic pancreatitis (CP) is the leading cause of splenic vein thrombosis (SVT). SVT occurs in about 15 % of patients with CP. The risk of variceal bleeding in SVT is approximately 10 %. Splenectomy is indicated in symptomatic SVT but its role in asymptomatic SVT is discussed controversially. Aim of our study was to evaluate the outcome of splenectomy performed during pancreatic resection in patients with CP and asymptomatic SVT. METHODS: 33 of 198 patients undergoing resection for CP underwent concomitant prophylactic splenectomy for asymptomatic SVT. Perioperative data were compared in the groups of patients with or without splenectomy. Follow-up was complete in 84 % (average 31 months). RESULTS: Median operative time, postoperative morbidity, reoperation rate and mortality were not different in patients with or without splenectomy. The median number of blood units transfused was higher in patients with prophylactic splenectomy (6 vs 4 units; p < 0.01). One complication of splenectomy (postoperative bleeding) occurred (3 %). During follow-up no variceal bleeding, no episode of postsplenectomy sepsis or thrombosis due to temporary thrombocytosis occurred. CONCLUSIONS: Complications of prophylactic splenectomy are rare and less frequent than reported episodes of variceal bleeding. In the presence of asymptomatic SVT splenectomy should be considered during pancreatic resection to facilitate surgery and to avoid further variceal bleeding.

Chronic Disease↗
PubMed2004

[Surgical therapy of inflammatory and malignant strictures of the common bile duct].

Although there are growing possibilities of interventional endoscopic treatment of benign and malignant stenosis of the distal common bile duct the definitive operative drainage by terminolateral hepaticojejunostomy is in many cases the therapy of choice. In patients with chronic pancreatitis and bile duct stricture the modified duodenum preserving pancreatic head resection ("Beger operation") enables a resection of the inflammatory mass together with a drainage of the bile. Of 391 patients from our clinic being operated due to a bile duct stricture 337 underwent a biliary drainage together with a pancreatic head resection. Early postoperative biliary complications were in 0.3 % strictures of the duct and 1.5 % bile fistulas. Half of those complications could be managed conservatively. In high volume centers the operative therapy of distal common bile duct stenosis is a safe procedure with high patency rate.

Anastomosis, Surgical↗
PubMed2002

[Primary aortoduodenal fistula as a late complication of para-aortic radiation therapy. A case report].

Primary aortoenteric fistulae (AEFs) are rare vascular entities. More than 75% of primary AEFs involve the duodenum, with the overwhelming majority located in the third or fourth portion. Atherosclerosis, leading to formation of an aortic aneurysm, remains the most common etiology, accounting for more than 3/4 of the cases reported. Primary aortoenteric fistulae following radiotherapy are rare. The case of a 49-year-old man with aortoduodenal fistula 22 years after para-aortic radiation is presented. In November 1997, the patient suddenly developed hematemesis and melena. Endoscopy suggested the presence of an ulcus but no definitive bleeding source could be seen. Bleeding stopped spontaneously. Six hours later he developed massive hematemesis and was transferred to our department. An emergency operation was performed. We found an aorto-duodenal fistula in the third portion of the duodenum without an aortic aneurysm. We directly sutured the aortic wall laceration and resected the third and fourth part of the duodenum. Histology revealed typical signs of radiation damage. The patient is alive and well 2 years after surgery. To our knowledge, this is the sixth case of a primary aorto-duodenal fistula following radiotherapy ever to be reported in world literature.

Aorta↗
PubMed2002

[Pancreatic leakage after pancreas resection. An analysis of 345 operated patients].

INTRODUCTION: Complications after pancreatic resections remain frequent despite a decreasing mortality. Pancreatic leakages represent a relevant part of those complications but data on risk factors for their occurrence are rare. We analyzed our experience with incidence, clinical course, and risk factors of pancreatic leakage in a large patient group. METHODS: We analyzed the prospectively documented perioperative data of 345 patients with pancreatic resections carried out between 1994 and 2001. Main indications for surgery were chronic pancreatitis (57%) and malignant tumors (37%). The following operations were performed: Whipple's operation 15%, pylorus-preserving pancreaticoduodenectomy 53%, duodenum-preserving pancreatic head resection 19%, and distal pancreatic resection 13%. Risk factors were analyzed using uni- and multivariate methods. RESULTS: Postoperative mortality and complication rate were 2.9% and 41%, respectively. A pancreatic leakage occurred in 9.9%. In the majority of patients, pancreatic leakage was asymptomatic and controlled by prolonged drainage. However, one fourth of the patients with pancreatic leakage required reoperation. The mortality of pancreatic leakage was 12%. No patient with chronic pancreatitis died as a consequence of pancreatic leakage. Impaired preoperative renal function was the only risk factor for the occurrence of postoperative pancreatic leakage. CONCLUSIONS: Although easily managed in the majority of cases, pancreatic leakage still represents a relevant postoperative complication after pancreatic resection, especially in patients with malignant disease. Because of an increased risk of developing pancreatic leakage, an impaired renal function should be considered specifically in the perioperative management of the patients.

Adolescent↗
PubMed2002

[Successful catheter-guided local thrombolysis in acute pulmonary embolism in the early postoperative period after pancreatic head resection].

Pulmonary embolism in the early postoperative period is characterized by high morbidity and mortality. Systemic application of thrombolytic agents during this time is contraindicated; operative thrombectomy also has a high mortality rate. We report a case of successful local lysis in combination with catheter fragmentation of a massive two-sided pulmonary embolism diagnosed on the 4th postoperative day after pylorus-preserving duodenopancreatectomy for distal carcinoma of the common bile duct. Thrombolysis was performed in three sessions by a combination of catheter-supported interventional fragmentation of the thrombus with local rt-PA lysis. There were no bleeding complications or disturbances of anastomotic healing. The patient was discharged from the hospital on the 23rd postoperative day after changing anticoagulation to a vitamin K antagonist. The case presented demonstrates the possibility of local lysis in combination with interventional methods as a therapeutic option for pulmonary embolism in the early postoperative period as an alternative to surgical strategies.

Adenocarcinoma↗
PubMed2001

The penetration of ciprofloxacin into human pancreatic and peripancreatic necroses in acute necrotizing pancreatitis.

BACKGROUND: Antibiotic prophylaxis in necrotizing pancreatitis has recently gained acceptance. Published studies, however, used different antibiotic regimes and some antibiotics penetrated pancreatic tissue or pancreatic necroses only poorly. The aim of this study was to assess the penetration of ciprofloxacin (CIP) into necrotic pancreatic and peripancreatic tissue. PATIENTS AND METHODS: Serum, pancreatic necroses, peripancreatic fat tissue necroses and infected omental fluid levels of CIP were measured after 51 operations in 14 patients. RESULTS: The median penetration ratio of CIP was 137.5% (range 11-196%) in infected omental bursa fluid, 59.6% (3-214%) in pancreatic necroses and 67.1% (1-250%) in peripancreatic necroses. Chemotherapeutical ratios of CIP as a marker for antimicrobial potency were high against most relevant pathogens in necrotizing pancreatitis. CONCLUSION: Due to its antimicrobial spectrum and the good penetration into the relevant compartments, CIP may be useful in preventing local infection in necrotizing pancreatitis.

Adult↗
PubMed2001

[Distal pancreatic resection--indications, techniques and complications].

AIM: Description of the indications, surgical technique and postoperative complications of distal pancreatic resection. METHODS: We analyzed the prospectively documented perioperative data of 41 patients undergoing distal pancreatectomy between 1994 and 2001. Indications for resection were chronic pancreatitis (n = 21), malignant or benign tumors (n = 19) and others (n = 1). RESULTS: Median operation time was 4.5 hours, a Y-Roux-pancreaticojejunostomy was performed in 66 %. Further organs were resected in 93 %, most frequently in form of splenectomy. A malignant vascular invasion led to positive resection margins in three patients. Mortality was 2 %. Postoperative complications occurred in 41 % with 15 % revealing pancreatic leakage. A relaparotomy was carried out in 20 %. Pancreatic leakage was more frequently seen in the first part of the study period and after oversewing of the pancreatic stump. A new onset diabetes occurred postoperatively in 6 % of the patients. CONCLUSIONS: Distal pancreatectomy can be carried out with low mortality, despite a high complication rate. The probability of postoperative diabetes is low. The frequency of pancreatic leakage may be reduced significantly by increasing hospital experience. The management of the pancreatic stump by pancreatojejunostomy should be considered in patients with a high risk of pancreatic leakage.

Adenocarcinoma↗
PubMed2001

p53 and K-ras mutations in pancreatic juice samples from patients with chronic pancreatitis.

BACKGROUND: Mutations in p53 and ras genes are frequent in pancreatic carcinoma. Several ras mutations are consistently detected in the pancreatic juice from patients with chronic pancreatitis. The p53 gene mutations have been detected occasionally in chronic pancreatitis tissue. It was the aim of this study to evaluate the presence and clinical significance of p53 and ras mutations in clinical pancreatic juice samples from patients with chronic pancreatitis. METHODS: Pancreatic juice was obtained from 66 patients with chronic pancreatitis and no evidence of pancreatic carcinoma (51 men, 15 women; age 17-86 years [mean 49.6 +/- 12.9]). Patients were followed prospectively for 26 +/- 3 (4-54) months. Detection of p53 gene mutations was by temperature gradient gel electrophoresis (TGGE) and single strand conformation polymorphism (SSCP) for exons 5-8. Analysis of ras mutations was performed by SSCP/polymerase chain reaction, restriction fragment length polymorphism/polymerase chain reaction. All mutations were confirmed by sequencing. RESULTS: Five of 66 (7.5%) pancreatic juice samples contained p53 mutations, and ras mutations were detected in 6 cases (9%). Cytology was negative in all cases. No pancreatic carcinoma developed during follow-up and neither cancer cells nor preneoplastic lesions could be detected histologically in resected specimens. Although no correlation between p53 mutations and duration of pancreatitis or drinking habits was found, K-ras mutations correlated with both heavy smoking and severity of the disease. CONCLUSION: p53 and ras mutations can be detected in a minority of pancreatic juice samples from patients with chronic pancreatitis in the absence of malignancy.

Adolescent↗
PubMed2000

Expression and function of beta-glucuronidase in pancreatic cancer: potential role in drug targeting.

Improvement of non-surgical strategies is a pivotal task in the treatment of pancreatic cancer. Response to treatment with most anticancer agents has been very poor, probably due to insufficient drug concentration in tumor tissue. Increased response rates during chemotherapy might be achieved by dose escalation; however, this approach is often hampered by severe side effects. One strategy to overcome these adverse effects is application of nontoxic glucuronide prodrugs from which the active moiety is released by beta-glucuronidase within or near the tumor. The use of glucuronide prodrugs in pancreatic cancer requires increased expression of the enzyme in the diseased tissue, a problem that has not been addressed so far. We therefore investigated function and expression of beta-glucuronidase in tissue samples from human healthy pancreas (n=7) and pancreatic adenocarcinoma (n=8), respectively. Comparing the ability of tissue homogenates to cleave the standard substrate 4-methylumbelliferyl-beta-D-glucuronide, we found a significantly increased specific beta-glucuronidase activity (P<0.05) in pancreatic cancer (median: 133; 75% percentile: 286; 25% percentile: 111 nmol/mg per h) as compared to healthy pancreas (median: 74; 75% percentile: 113; 25% percentile: 71 nmol/mg per h). Enzyme kinetic experiments with the model prodrug N-[4-beta-glucuronyl-3-nitrobenzyloxycarbonyl] doxorubicin (HMR 1826) demonstrated bioactivation of HMR 1826 by pancreatic beta-glucuronidase. Enzymatic activity was found to be closely related to enzyme contents (r=0.87) as assessed by Western blot analysis. Our data indicate that increased beta-glucuronidase activity in pancreatic cancer seems to be due to an elevated steady-state level of the protein. This may be the basis for new therapeutic strategies in treatment of pancreatic carcinoma by using glucuronide prodrugs of anticancer agents.

Adenocarcinoma↗
PubMed2000

Analysis of anthocyane glycosides in human serum.

Anthocyanins, natural food antioxidants, can be identified in human blood plasma using a restricted access phase for removal of the proteins and enrichment of the anthocyanins. In preliminary studies the spray dried elderberry juice was shown to have antioxidant activities in vitro. From the four known anthocyanins present in elderberry (Sambucus nigra) the two main components could be analysed quantitatively enabling their analysis in blood. Using a restricted access phase and a column switching set-up the injection of high volumes of concentrated protein solutions is possible. Additional, by using high injection volumes the sensitivity is increased due to a concentration of the analytes on the restricted access phase. The limit of quantification reached was 0.5 ng/mL. In this experiment the maximum concentration in blood (35 mg/mL) was observed after 1 h with a quick decay.

Anthocyanins↗