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Biomedical subjects

U Metzger

Publications and source records attributed to U Metzger.

At least 19 recordsLinked to original sources
PubMed2006

Performance of laparoscopy in identifying malignant ovarian cysts.

BACKGROUND: Peroperative identification of malignancy is crucial to management planning for ovarian cysts. The aim of this study was to evaluate the performance of laparoscopy in identifying malignant ovarian cysts. METHODS: Patients undergoing laparoscopy for ovarian cysts from 1998 to 2001 were enrolled prospectively. Physical findings, Doppler ultrasonography, and serum CA 125 served to compute two risk-of-malignancy indexes (RMI-1 and RMI-2), and laparoscopy findings served to categorize lesions as benign, possibly malignant, or malignant. Frozen sections were examined as needed. Final histology was the reference. RESULTS: Of 313 patients, 294 had benign cysts, six borderline lesions, and 13 malignancies. Sensitivity and specificity were respectively 84 and 93% for RMI-1, 92 and 80% for RMI-2, 100 and 99% for laparoscopy, 91 and 100% for frozen sections, and 100 and 100% for laparoscopy plus frozen sections, which had 100% negative predictive value. Six (1.8%) adverse events occurred. CONCLUSIONS: Laparoscopy reliably identifies ovarian cancer and borderline disease. Morbidity is low compared to oncologic surgery.

Adolescent↗
PubMed2006

Which extrauterine pelvic masses are difficult to correctly classify as benign or malignant on the basis of ultrasound findings and is there a way of making a correct diagnosis?

OBJECTIVES: To determine which extrauterine pelvic masses are difficult to correctly classify as benign or malignant on the basis of ultrasound findings, and to determine if the use of logistic regression models for calculation of individual risk of malignancy would improve the diagnostic accuracy in difficult tumors. METHODS: In a prospective, international, European multicenter study involving nine centers, 1066 women with a pelvic mass judged to be of extrauterine origin underwent transvaginal ultrasound examination by an experienced ultrasound examiner before surgery. A standardized examination technique and predefined definitions of ultrasound characteristics were used. On the basis of subjective evaluation of ultrasound findings, the examiner classified each mass as being certainly benign, probably benign, unclassifiable, probably malignant or certainly malignant. Even when the examiner found the mass unclassifiable (i.e. difficult mass) he or she was obliged to state whether the mass was more likely to be benign or malignant. Borderline tumors were classified as malignant. RESULTS: There were 90 (8%) unclassifiable masses. Multiple logistic regression analysis showed papillary projections, >10 locules in a cyst without solid components, low-level echogenicity of cyst fluid, and moderate vascularization as assessed subjectively at color Doppler examination to be ultrasound variables independently associated with unclassifiable mass. Borderline malignant tumors (n = 55) proved to be most difficult to assess with only 47% being correctly classified (i.e. classified as malignant), 29% being incorrectly classified (i.e. classified as benign) and 24% being unclassifiable vs. 90% of non-borderline tumors being correctly classified, 3% being incorrectly classified and 8% being unclassifiable (P < 0.0001). Papillary cystadeno(fibro)mas, myomas and cases of struma ovarii were also more common among the unclassifiable masses than among the classifiable ones (5.6% vs. 1.1%, P = 0.008; 4.4% vs. 0.9%, P = 0.02; 4.4% vs. 0.2%, P = 0.0006). No ultrasound variable or clinical variable (including CA 125) entered a logistic regression model to predict malignancy in difficult masses. A model could be constructed for difficult masses containing papillary projections but this model performed no better than subjective evaluation of the ultrasound image. Sensitivity and specificity of subjective evaluation with regard to malignancy in the group of unclassifiable masses were 56% (14/25) and 77% (50/65) vs. 91% (220/241) and 97% (712/735) in the classifiable masses. CONCLUSIONS: Borderline tumors cause great diagnostic difficulties, but so do papillary cystadeno(fibro)mas, struma ovarii and some myomas. Logistic regression models do not solve the diagnostic problem in difficult pelvic masses.

Adnexa Uteri↗
PubMed2005

[The osteosynthesis of fractures of distal radius with the AO/ASIF Titanium Pi Plate].

The AO/ASIF Titanium Pi Plate has been developed for dorsal plating of fractures of the distal radius. It is designed by reflection of the anatomy, to ensure stability of the angle using a juxtaarticular band and to minimize tissue reaction by low profile design. The aim of this study was to evaluate the subjective and objective outcome of 61 consecutively operated patients after a minimum of 12 months (12-29 months) postoperatively. There were 3 A2, 23 A3, 1 B1, 12 C1 and 22 C2 fractures (AO-Classification). The subjective results were good to very good. The range of motion showed over 80% compared to the uninjured side. Overall, there were no ruptures of tendons and 18% irritations. Extension, ulnar abduction and force were significantly better in patients in which the plate has been removed. In this collective the tendon irritations were only 3.8%. With the AO/ASIF Pi Plate good subjective and objective results can be achieved. The indication for removal of the plate should be given generously.

Adolescent↗
PubMed2003

Infrequent mutation of the tumour-suppressor gene Smad4 in early-stage colorectal cancer.

Smad4 is a candidate tumour-suppressor gene identified recently on chromosome 18q21.1. Both alleles are inactivated in nearly one-half of pancreatic carcinomas, but its role in the tumorigenesis of other tumours is still unknown. The aim of this study was to investigate the potential involvement of the Smad4 locus in early-stage colorectal cancers (stages I-III) in tumour samples from a randomised multicentre trial. Of a large collection of DNA samples, 73 with a loss of one allele of the Smad4 gene were analysed for the presence of point mutations in the remaining gene. Patients, from whom biopsies were isolated, were part of a previous randomised multicentre study of the Swiss Group for Clinical Cancer Research on the benefit of adjuvant chemotherapy (SAKK study 40/81). Mutation analysis was restricted to the highly conserved C-terminal domain (exons 8, 9, 10 and 11) of Smad4, using PCR and single-strand conformational variant analysis. Two of the 73 patients (3%) with loss of one allele of Smad4 had a point mutation in the remaining allele. These results indicate that whereas Smad4 point mutations are prevalent in pancreatic carcinoma, they are infrequent in early stages (I-III) of colorectal cancer.

Clinical Trials as Topic↗
PubMed2003

Perioperative detection of disseminated tumour cells is an independent prognostic factor in patients with colorectal cancer.

BACKGROUND: The objective of the present investigation was to assess the prognostic significance of disseminated tumour cells in peritoneal lavage, and peripheral and mesenteric venous blood in patients undergoing curative resection of colorectal cancer. METHODS: The prognostic impact of perioperative cytological and immunocytochemical detection of disseminated colorectal cancer cells was evaluated prospectively. Peritoneal lavage fluid, and peripheral and mesenteric venous blood from 53 consecutive patients undergoing curative surgery for colorectal cancer were analysed. The dichotomous results (positive versus negative) from the cytological and immunocytochemical analysis were used as a predictor along with other co-variates in proportional hazard regression models of disease-free and overall survival. RESULTS: Disseminated colorectal cancer cells were found in 13 of 53 patients (25 per cent) using cytology (CYT) and/or immunocytochemistry (ICC). The median follow-up at the time of the analysis was 37 months. In multivariate proportional hazard regression models CYT/ICC status was a significant predictor for disease-free (P = 0.002) and overall (P = 0.006) survival. CONCLUSION: Disseminated tumour cells detected by CYT and ICC represent an independent prognostic factor in patients undergoing surgery for colorectal cancer and may identify patients at high risk of recurrence.

Adult↗
PubMed2002

[Multiple recurrent perforated jejunal diverticulitis].

Jejunal diverticulitis is a very rare cause of acute abdomen. The treatment of choice in acute perforated jejunal diverticulitis is intestinal resection with primary anastomosis of the affected area. Data on long-term results, postoperative complications and the nature of this illness is limited. To our knowledge, a recurrent perforated jejunal diverticulitis has never have been reported in the literature. In this case,we present a patient who suffered from a recurrence of perforated jejunal diverticulitis 13 weeks after the initial intestinal resection. After the second intestinal resection (due to the recurrent infection), the patient suffered from a third period of jejunal diverticulitis.

Abdomen, Acute↗
PubMed2002

[Hysterosonography].

Hysterosonography, which consists in the injection of some cc of saline in the uterine cavity during sonography, allows an exploration of the uterine cavity and of the endometrium. Accuracy of hysterosonography is similar to that of office hysteroscopy. Hysterosonography distinguishes normal cavities from pathologic ones, endometrial atrophy from mucosal anomalies, polyps from myomas. Conversely, endometrial biopsy is still necessary for diagnosis of hyperplasia or cancer. Hysterosonography can also be proposed for first trimester bleedings, trophoblast retention or ectopic pregnancy. In the near future it could be applied to therapeutic goals such as sonographic section of polyps.

Abortion, Habitual↗
PubMed2002

Percutaneous minimal osteosynthesis of fractures of the proximal humerus in elderly patients.

INTRODUCTION: The aim of this study was to evaluate the subjective and objective outcome of the percutaneous minimal osteosynthesis in elderly patients. Untreated, unstable and dislocated proximal humeral fractures show poor functional and subjective results. Reduction and fixation of the fragments is essential to achieve a good clinical outcome. Especially noted in elderly patients, the osteosynthesis is concurrent with the implantation of a prosthesis. PATIENTS AND METHODS: We examined 31 patients with a mean age of 72 years (51-87) after an average follow-up period of 15.8 months (9-31). To assess the functional and subjective results, we used the Constant Score as well as an adapted version of the Oxford Shoulder Score. Radiographs in two planes displayed the anatomical situation, the healing of the fracture, and the evidence or absence of avascular necrosis. RESULTS: There were no local complications such as hematomas or wound infections. The results of the Constant Score showed an average of 63.5 Pts. (18-82 Points) and adapted to age and gender by 90.2% (28.1-118.8%). Compared with the uninjured arm with an average of 77.1 Points (20-89 Points) and 109.5% (29-129%) respectively, we achieved an average functionality of 82.6%, operated versus non-operated side. All but one fracture, that showed signs of avascular necrosis with disintegration of the humeral head, were fully consolidated. The subjective results were very good in 18 patients, good in 7, satisfying in 3 and poor in 3 patients. CONCLUSION: Our data indicate that the percutaneous minimal osteosynthesis is a valuable method for the fixation of proximal fractures of the humerus in elderly patients. The technique has a very low rate of complications and the time of convalescence is short. If closed reduction fails or a stable percutaneous fixation of the fracture by K-wires is not possible, the change to open reduction and internal fixation or the implantation of a prosthesis is required.

Aged↗
PubMed2002

[Solitary duodenal diverticulum with enterolith as a rare cause of acute abdomen].

Diverticula of the duodenum are not rare and in the most cases without any symptoms. The incidence of duodenal diverticula in autopsies is known to be 20-22%. Only in a very small number of cases, they are complicated and therefore clinically presented by diverticulitis, perforation, hemorrhage, pancreatitis, or biliary obstruction. The most uncommon complication is the enterolith formed within the diverticulum. In all reported cases, the enterolith--formation was associated with small bowel obstruction or perforation. Complications of duodenal diverticula have a high mortality rate (33-48%) that could be due to difficulties in diagnostics and the adequate surgical procedure. In our case report, a patient presented at our institution with symptoms of an acute abdomen caused by an enterolith inside a solitary duodenal diverticulum "ante perforationem". The ultrasound and the CT scan of the abdomen showed free intraabdominal fluid beside the duodenum, the exact diagnosis however was not made. The indication for laparotomy was given by the clinical signs. The dicerticula was resected and ligated.

Abdomen, Acute↗
PubMed2001

Combined copy status of 18q21 genes in colorectal cancer shows frequent retention of SMAD7.

Deletions of chromosome band 18q21 appear with very high frequency in a variety of carcinomas, especially in colorectal cancer. Potent tumor suppressor genes located in this region encode transforming growth factor beta (TGF-beta) signal transducers SMAD2 and SMAD4, and inactivation of either one leads to impaired TGF-beta-mediated cell growth/apoptosis. Following the assignment of SMAD7 to 18q21, we first refined the SMAD7 gene position within this region by genetically mapping SMAD7 between SMAD2 and SMAD4. Further, to compare the respective frequencies of genetic alterations of these three SMAD genes in colorectal cancer, we undertook a large-scale evaluation of the copy status of each of these genes on DNA samples from colorectal tumor biopsy material. Among a subset of 233 DNA samples for which data were available for all four genes, SMAD4, SMAD2, and the nearby gene DCC showed high deletion rates (66%, 64%, and 59%, respectively), whereas SMAD7 was deleted in only 48% of the tumors. Unexpectedly, we found some gene duplications; SMAD7 appears to be more frequently amplified (10%) than the three other genes (4-7%). Compiled data for SMAD genes in each tumor show that the most common combination (26% of all the tumors) consists of the simultaneous deletions of SMAD2 and SMAD4 associated with normal diploidy or even duplication of SMAD7. Since SMAD7 normally counteracts SMAD2 and SMAD4 in TGF-beta signaling, we hypothesize that the tumor might not benefit from simultaneous SMAD7 inactivation, thereby exerting selective pressure to retain or even to duplicate the SMAD7 gene.

Chromosome Deletion↗
PubMed2001

Prophylactic surgery in families with familial adenomatous polyposis (FAP) and in colitis.

Colorectal cancer is the second most common cause of death from malignant tumors in western countries with approximately 3800 new cases/year in Switzerland. For individuals known to be at high risk for the development of colorectal cancer, screening, chemoprevention and/or prophylactic surgery are the only tools to avoid unnecessary premature death from this disease. With modern molecular and/or genetic testing the risk of developing colorectal cancer can be more precisely estimated on an individualized basis. These individuals need to be enrolled in strong surveillance programs and are clear candidates for prophylactic surgery. The risk of prophylactic surgery (morbidity, mortality, quality of life following surgery) must be clearly weighted against the increasing risk of cancer. These patients should be treated in experienced centers for colorectal surgery in close connection with a genetic testing and counseling team, a molecular laboratory and a psychological support group.

Adenomatous Polyposis Coli↗
PubMed2001

The role of the air traffic controller in future air traffic management: an empirical study of active control versus passive monitoring.

Proposals for air traffic management such as Free Flight call for a transfer of responsibility for separation between aircraft from air traffic controllers (ATCos) to pilots. Under many proposals, the role of the ATCo will change from one of active control to passive monitoring. The present study directly compared these types of control with respect to ATCo mental workload, conflict detection, and memory. Eighteen ATCos participated in an air traffic control simulation of Free Flight procedures under moderate and high traffic load. Dependent variables included accuracy and timeliness in detecting potential conflicts, accepting and handing off aircraft, mental workload (as assessed by a secondary task, heart rate variability, and subjective ratings), and memory for aircraft location. High traffic density and passive control both degraded conflict detection performance. Actual or potential applications of this research include the recommendation that designs for future air traffic management keep authority for separation of aircraft with the controller.

Adult↗
PubMed2000

[Perforation of Meckel's diverticulum by a toothpick].

We report the case of a 31-year-old man with lower abdominal pain, leucocytosis and normal sonographic findings. When performing laparoscopy we found a Meckel's diverticulum perforated by a toothpick. Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. Symptoms normally occur only when there are complications, when bleeding, obstruction and inflammation are most frequent. Despite modern imaging techniques the diagnosis is difficult and often made intraoperatively. Resection should be performed in any case, because the risk of future complications of the diverticulum outweigh the morbidity after simple diverticulectomy.

Abdominal Pain↗
PubMed2000

[Role of lymph nodes in rectal carcinoma].

The significance of the lymph nodes for the therapy and the prognostics of the rectal cancer are reviewed. Not only the depth of penetrations, but the probability of lymph node involvement (in our series tumors staged T1 had in 12% positive lymph nodes, T2 in 20% respectively, T3 in 37% and T4 in 80%) determine the possible surgical treatment. The available data of different techniques in lymphadenectomy and lymph node staging are compared and discussed. The aim of this paper is to give the oncologically interested the opportunity to pursue the actual questions and to inform themselves about the current standards in regard to the lymphatics in rectal cancer.

Humans↗
PubMed2000

[Transfusion use in curatively operated patients with colorectal carcinomas. Swiss Study Group for Clinical Cancer Research].

OBJECTIVE: Is there an improvement of the behaviour for restrective blood transfusions after the data in the literature and especially the preliminary data of the SAKK 40/81 study have been published? They have shown a worsening of the prognosis in patients with colorectal cancer after pre-/postoperative blood transfusions have been given. MATERIAL AND METHODS: Analysis of the retrospective transfusion data of the SAKK 40/81 study in comparison with the prospective transfusion data of the study SAKK 40/87. RESULTS: The analysis of the data showed that in the SAKK 40/81 study more patients received blood transfusions than in the SAKK 40/87 study (77% versus 49%). Especially there was a diminution from 90% in the SAKK 40/81 to 59% in the SAKK 40/87 study for the rectal cancer patients respectively from 70% to 44% in the colon cancer patients having received blood transfusions. The mean value of hemoglobin of the patients not having received transfusions has decreased from 11.2 (7.8-15) g/100 ml in the SAKK 40/81 to 10.6 (5.4-15) g/100 ml in the SAKK 40/87 study (p = 0.0001). CONCLUSION: The data of the two SAKK studies showed that in Switzerland the donation of blood transfusions in patients with colorectal cancer has continuously been handled more and more restrictive. An even more restrective use may be possible in future due to new operation techniques and the possibility of preoperative administration of erythropoetin to increase the hemoglobin level.

Blood Transfusion↗
PubMed1999

[Results of therapy after primary conservative management of distal radius fractures in patients over 65 years of age].

BACKGROUND: In the clinical routine of our City Hospital Triemli, Zürich, Switzerland, we prefer to treat old patients with fractures of the distal radius conservatively. It was our aim to examine the long-term effects of this treatment on anatomical position, mobility, strength, and patient satisfaction. PATIENTS AND METHODS: We reviewed the data of 102 consecutive patients over 65 years of age. 95 were treated with a plaster cast and controlled weekly in our outpatient department, finally discharged after 50 days. After an average time of eight months, 79 patients could be controlled clinically and radiologically. RESULTS: Although a significant (p < 0.001) reduction of joint mobility and grip strength was found in all cases, we documented no loss of independence in every-day life. Radiological malalignment of the distal radius with a dorsal or palmar angle of more than 20 degrees in the lateral view or a radio-ulnar angle of less than 15 degrees in the dorsopalmar view was associated with increased complaints and patients dissatisfaction. CONCLUSION: In old-aged patients with distal radius fractures, the indication for surgical treatment should be made very carefully, since certain degrees of radiological malalignment are tolerated well.

Aged↗
PubMed1998

Prognostic value of beta1,6-branched oligosaccharides in human colorectal carcinoma.

Increase of beta1,6-branched oligosaccharides is possibly associated with tumor progression and lymph node metastasis. The aim of this study was to determine the prognostic value of beta1,6 branches in human colorectal carcinoma. Expression of beta1,6 branches was histochemically evaluated using the leukoagglutinating Phaseolus vulgaris lectin, PHA-L, in 92 clinically documented colorectal carcinomas, of which 31 had formed lymph node metastases. The follow-up time ranged between 4 and 14 years (median, 10.3 years). A PHA-L staining index (SI), taking into account staining intensity and its percentage of tumor cut surface area, was established. The carcinoma SI was highly associated with the disease-free survival (P = 0.004) and overall survival (P = 0.005). Patients with a carcinoma SI of >1, as compared to those with a SI of < or =1, were at significantly higher risk for tumor recurrence, with a shorter disease-free survival (hazard ratio = 2.59, P = 0.005) and significant higher risk of death with shorter overall survival (hazard ratio = 2.51, P = 0.007). The carcinoma SI was also associated with the presence of lymph node metastases. We conclude that PHA-L staining in human colorectal carcinoma sections provides an independent prognostic indicator for tumor recurrence and patient survival and is associated with the presence of lymph node metastases.

Adult↗