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U T Hopt

Publications and source records attributed to U T Hopt.

At least 19 recordsLinked to original sources
PubMed2007

Surgery for cystic lymphangioma in Gorlin-Goltz syndrome.

INTRODUCTION: We present a case of three major lymphomesenteric cysts in a female patient with known basal cell nevus syndrome (BCNS or Gorlin-Goltz syndrome). DISCUSSION: Although those cysts have been reported to appear in this syndrome, the exact prevalence is not known. In this case, the patient suffered from severe and recurrent abdominal pain due to bowel obstruction. CONCLUSION: By causing severe symptoms, cystic lymphangiomas are an important complication of the BCNS despite of their seldom occurrence. Surgeons confronted with intraabdominal masses in a patient with BCNS should always be aware of this manifestation of the disorder and plan interdisciplinary operations.

Abdominal Pain↗
PubMed2006

[GERD: surgical therapy].

Proton pump inhibitors (PPIs) are generally accepted as gold standard for treatment of gastro-esophageal reflux disease (GERD). Nevertheless, there are clear indications for surgical anti-reflux therapy. Principally, laparoscopic anti-reflux therapy is an excellent therapeutic alternative in all patients, who have objective or subjective problems with long-term PPI therapy. Clear cut proof of the symptomatic gastro esophageal reflux (endoscopy, 24 h pH-testing) is an absolute prerequisite for surgery. Partial or total laparoscopic fundoplication has replaced completely open operative techniques. Treatment of the hiatal hernia and the hiatoplasty are integral parts of the operation. Perioperative complication rate is low. The long-term results are good. Proper patient selection and correct indication for operation are most important in this respect.

Anti-Ulcer Agents↗
PubMed2006

Effect of liver regeneration after partial hepatectomy and ischemia-reperfusion on expression of growth factor receptors.

AIM: To investigate the effects of experimental partial hepatectomy and normothermic ischemia-reperfusion damage on the time course of the expression of four different growth factor receptors in liver regeneration. This is relevant due to the potential therapeutic use of growth factors in stimulating liver regeneration. METHODS: For partial hepatectomy (PH) 80% of the liver mass was resected in Sprague Dawley rats. Ischemia and reperfusion (I/R) were induced by occlusion of the portal vein and the hepatic artery for 15 min. The epidermal growth factor receptor, hepatic growth factor receptor, fibroblast growth factor receptor and tumour necrosis factor receptor-1 were analysed by immunohistochemistry up to 72 h after injury. Quantitative RT-PCR was performed at the time point of minimal receptor expression (24 h). RESULTS: In immunohistochemistry, EGFR, HGFR, FGFR and TNFR1 showed biphasic kinetics after partial hepatectomy with a peak up to 12 h, a nadir after 24 h and another weak increase up to 72 h. During liver regeneration, after ischemia and reperfusion, the receptor expression was lower; the nadir at 24 h after reperfusion was the same. To evaluate whether this nadir was caused by a lack of mRNA transcription, or due to a posttranslational regulation, RT-PCR was performed at 24 h and compared to resting liver. In every probe there was specific mRNA for the receptors. EGFR, FGFR and TNFR1 mRNA expression was equal or lower than in resting liver, HGFR expression after I/R was stronger than in the control. CONCLUSION: At least partially due to a post-transcriptional process, there is a nadir in the expression of the analysed receptors 24 h after liver injury. Therefore, a therapeutic use of growth factors to stimulate liver regeneration 24 h after the damage might be not successful.

Animals↗
PubMed2006

The iliopsoas abscess: aetiology, therapy, and outcome.

BACKGROUND AND AIMS: The treatment strategy for patients with a retroperitonally localised abscess is controversial as it remains open which fluid collections should be drained by open access or by percutaneously inserted drainage. PATIENTS: Therefore, the data of 40 consecutively treated patients with an iliopsoas abscess were analysed retrospectively. RESULTS: Ten patients suffered from a primary abscess and ten from a post-operative abscess; further, in 20 patients, the aetiology of the abscesses were due to Crohn's disease, neoplasia, spondylitis or other relevant concomitant diseases. Eight of 40 patients were initially treated by image-guided percutaneous drainage (PD), the other by open access drainage. Six patients died (15%), all of them had been operated; 15 (37.5%) patients had a recurrence of their abscess and needed re-operation. Factors predicting a poor outcome were age, APACHE II score, bi-lateral abscesses and a post-operative or bony cause, but the bacteriological findings did not influence the outcome. CONCLUSIONS: We suggest an algorithm for treatment of iliopsoas abscesses depending on number and volume of the abscesses.

APACHE↗
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

[Identification of surgical patients for therapy with activated Drotrecogin alfa].

There is uncertainty whether surgical patients with severe sepsis have a benefit from therapy with Drotrecogin alfa (activated). In the PROWESS and ENHANCE studies 4,068 patients were included and 3,228 were treated with Drotrecogin alfa (activated). Approximately 28% of the PROWESS patients and 41% of the ENHANCE patients were surgical patients. The subgroup of surgical patients showed the same benefit from therapy with Drotrecogin alfa (activated) as the overall cohort. The relative risk was 0.9 (95% CI 0.7-1.25, absolute risk reduction 3.2%). Patients with intraabdominal infections have a special benefit and here the relative risk was 0.7 (95% CI 0.5-1.0, absolute risk reduction 9.1%). Serious bleeding was more frequent in patients treated with Drotrecogin alfa (activated): 2.4-3.6% vs. 1.0% in the placebo group. In surgical patients bleeding was not more frequent than in non-surgical patients (3.1% vs. 2.1%, difference not significant). Surgical patients with severe sepsis, especially with peritonitis, should receive therapy with Drotrecogin alfa (activated), if severely ill.

Antifibrinolytic Agents↗
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↗
PubMed2006

[Dynamic graciloplasty vs artificial bowel sphincter in the management of severe fecal incontinence].

Dynamic graciloplasty (DGP) and the Acticon Neosphincter (artificial bowel sphincter, ABS) are well-established therapeutic instruments in patients with severe fecal incontinence. However, the success rates in the literature must be interpreted with caution. The report presented here presents firstly a critical analysis of 1510 patients in 52 studies (29 DGP vs 23 ABS). The evidence of these studies was assessed using the Oxford EBM criteria. All data were statistically analysed. Up to 94% of the studies analysed show EBM levels of only >3b. Both procedures show significant improvements in postoperative continence scores (p<0.001) and a significant advantage of ABS over DGP. Nevertheless, they are associated with a high incidence of morbidity in the long term (infection rate ABS vs DGP 21.74% vs 35.1%, revision rate ABS vs DGP 37.53% vs 40.64%, and ABS explantation rates of 30%). Presently no therapeutic recommendation can be expressed based on the few data available. Furthermore, therapy should be performed in specialized centers and patients should be given a realistic picture of the critical outcome of both surgical techniques.

Anal Canal↗
PubMed2006

[Treatment of carcinoma of the pancreatic head].

For patients with carcinoma in the head of the pancreas surgical resection remains the only chance of cure. Perioperative mortality could be reduced in the last years dramatically, postoperative morbidity, however, remains high. Only a small percentage of all patients suffering from pancreas carcinoma are good candidates for an operative therapy. The most frequent contraindications are metastases in the liver or the peritoneum or a locally too advanced tumor. The extent of surgical resection necessary in patients with pancreas carcinoma is still in discussion. Even after an operation under curative aspects long term results remain disappointing. Median survival still ranges only about 16 months. A substantial improvement of long term- survival can only be expected from new multimodal therapeutic strategies. Adjuvant chemotherapy should strongly be recommended after resection of a pancreas carcinoma. Neoadjuvant therapy on the other hand is still an experimental procedure and under evaluation in ongoing prospective randomized studies.

Antineoplastic Agents↗
PubMed2005

[Pancreas carcinoma--surgical therapy].

The incidence of pancreatic cancer is increasing. The tumor growths extremely aggressive, long-term prognosis is dismal. Nevertheless, surgical therapy provides the only chance for cure and longterm survival. Achievement of an R0 situation certainly is the primary surgical therapeutic goal. Reduction of surgical radicality in respect to the stomach and the pancreas itself obviously does not influence long-term survival of the patients. Thus, in the majority of patients the pylorus-preserving resection of the head of the pancreas seems to be the best operative strategy for resection of a carcinoma in the head of the pancreas. Concerning lymphadenectomy and resection of the portal or superior mesenteric vein surgical radicality is increasing during the last years. Perioperative mortality after resection of the head of the pancreas could be reduced in high volume centers below 5%. This is true even if parts of the portal or superior mesenteric vein are resected in addition. There are for the first time reports of patients who have survived longer than 5 years after resection of a pancreatic carcinoma. Further improvement of long-term survival, however, will not be achieved by increasing surgical aggressiveness but only by the use of new multimodal therapeutic protocols.

Biopsy↗
PubMed2005

[Comparison of various methods of surgical hernia repair].

Over the last 15 years, a number of different procedures for hernia repair have been developed. Apart from the open techniques, with or without the use of a prosthetic mesh or mesh plug, endoscopic procedures such as transabdominal preperitoneal (TAPP), and totally endoscopic preperitoneal (TEPP), hernioplasty are now established operations. In the present paper, the common open surgical procedures are compared with the minimally invasive repairs with regard to practicability, postoperative wound pain and complications, mobilization, recurrence rates and cosmesis. In the view of the authors, the standard method for inguinal hernial repair is the open Lichtenstein procedure or the Rutkow patch and plug method.

Germany↗
PubMed2005

Deletion of the tissue response against alginate-pll capsules by temporary release of co-encapsulated steroids.

Transplantation of encapsulated living cells is a promising approach for the treatment of a wide variety of diseases. Large-scale application of the technique, however, is hampered by inflammatory responses against the capsules. In the present study, we investigate whether tissue responses against alginate-PLL-alginate capsules can be modulated by co-encapsulation and temporary release of immunomodulating factors such as dexamethasone. Such an approach may be mandatory in order to increase the function and survival of encapsulated tissue since it has been shown that the tissue response can be caused by many, insurmountable factors. In an in vitro assay, we demonstrated an antiproliferative effect of dexamethasone-containing capsules on L929-mouse-fibroblasts. Subsequently, capsules prepared of purified alginate with or without solved dexamethasone were implanted in the peritoneal cavity of rats and retrieved one month later for histological evaluation. Most of the capsules without dexamethasone proved to be overgrown and adherent to the abdominal organs whereas with co-encapsulated dexamethasone the majority of the capsules were found freely floating in the peritoneal cavity without overgrowth. We conclude that co-encapsulation of dexamethasone has a profound effect on fibroblasts and macrophages adherence to immunoisolating capsules.

Alginates↗
PubMed2005

Protective effect of endotoxin preconditioning in pancreas: analysis with DNA chip arrays.

Recently we demonstrated a protective effect of endotoxin preconditioning 24 hours before pancreatic ischemia-reperfusion injury, which has also been described for other organs. The mechanisms underlying this phenomenon, such as differential gene expression, are poorly investigated. We chose to approach this question by investigating differential gene expression in the rat pancreas over the time course of endotoxin pretreatment. Male Wistar rats (5 groups, 5 animals per group) were pretreated with endotoxin intraperitoneally (1 mg/kg of body weight). After treatment at 30 minutes, and at 3 and 24 hours the pancreas was removed. Untreated animals and animals with injection of saline solution served as controls. After RNA isolation, RNA was pooled and hybridized to Affymetrix chips to measure the relative mRNA levels of 7000 genes and 1000 expression sequence tags. Three hours after administration of endotoxin there was an activation of proinflammatory transcription factors and other proinflammatory genes. After 24 hours there was a clear decrease of these proinflammatory genes, but a remaining and increasing upregulation of important antiapoptotic genes, antiproteases, and other probably protective genes. There was also a significant upregulation of complement factors. It was surprising that heat-shock proteins and other typical immediate early genes of the AP-1 complex were not upregulated. Our data show that 24 hours after endotoxin stress there is a regulation of a network of genes that represents a multifaceted preconditioning. As most important factors, inhibition of apoptosis and antiproteatic strategies are identified. Heat-shock proteins seem to play no important role in the mechanism of endotoxin preconditioning.

Animals↗
PubMed2005

Glucagon expression shift in a syngeneic single-donor intrahepatic rat islet transplantation model.

In the native rat pancreas glucagon is expressed by alpha cells in the outer layer of the spheroid islet, producing a circular immunohistochemical staining pattern. We asked whether this pattern would remain unchanged after short-term and long-term intrahepatic islet transplantation. Islets of inbred Lewis rats were isolated with liberase, purified by discontinuous density gradients, handpicked, and cultured for 24 hours. After rats were rendered diabetic with streptozotocin, islets were implanted intraportally. Transplanted animals were sacrificed at 1 to 2 days (n = 5) or 100 days (n = 6). Islet clusters were detected by hematoxylen-and-eosin staining. Serial slides were stained for glucagon and insulin with the alkaline phosphatase and alkaline phosphate method at 1 to 2 days after transplantation islets with strong insulin expression were found within the portal vein branches. However, glucagon staining showed an incomplete circular staining pattern. After 100 days insulin expression remained strong, whereas only few glucagon-expressing cells were detected. Intrapancreatic islets showed inversion of the ratio of insulin- to glucagon-positive cells in favor of the glucagon-expressing cells that now composed the major part of the islet. Streptozotocin had selectively damaged beta cells in the recipient. In transplanted islets glucagon expression faded over time, possibly due to a functional involution process or to stress/inflammatory mechanisms during the isolation, transplantation, and the posttransplantation periods.

Animals↗
PubMed2005

[Resection of combined or sequential lung and liver metastases of colorectal cancer: indication for everyone?].

UNLABELLED: Successful sequential resection of isolated hepatic and pulmonary metastases of colorectal cancer (crc) has been reported, however long-term results of large series are lacking. Therefore, we retrospectively analysed data of patients in whom sequential hepatic and pulmonary resection for metastases was performed. PATIENTS AND METHOD: From the records of our hospital we identified 25 patients (19.5 % of all patients operated for hepatic or 33 % for lung metastases due to crc) with colorectal cancer who had pulmonary and hepatic resection for metastatic disease between 1991 and 2002. 11 of these had primary colonic cancer and 14 rectal cancer. None of the patients died perioperatively. Long-term results were correlated with the staging of the primary tumour, the number of metastases, disease free interval between primary tumour operation and occurrence of metastatic disease. RESULTS: Five-year survival rate was 33.5 % following the resection of the first metastasis. Three year survival after resection of the second metastasis was 39 %. The disease free interval was 20 months (mean). Long-term results were clearly influenced by the disease free interval: < 1 year (n = 6) median 50 months after resection of the crc; > 1 year median 90 months (n = 19). Further on R0 resection was important for long-term survival: Median survival was 32.5 (+/- 4.1) months following resection of the second metastasis but only 9.9 months after R > 0 resection. CONCLUSION: These results confirm that sequential resection of hepatic and pulmonary metastases can be performed with curative intention provided a systemic spread of the disease is excluded. The surgeon's opinion of resectability should be obtained in patients with such metastases before the patient is scheduled for palliative conservative treatment.

Aged↗