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  • 1
    Electronic Resource
    Electronic Resource
    Verbesserter Nachweis gastrointestinaler Blutungsquellen mit 99 mTc-markierten autologen Erythrocyten und kontinuierlicher dynamischer Szintigraphie mit Cine-mode-Befundung (2000)
    Springer
    Der Chirurg 71 (2000), S. 292-299 
    Details
    ISSN: 1433-0385
    Keywords: Keywords: Scintigraphy – Endoscopy – Gastrointestinal bleeding – Diverticulosis – Angiodysplasia. ; Schlüsselwörter: Blutungsquellenszintigraphie – Endoskopie – gastrointestinale Blutung – Divertikel – Angiodysplasie.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Einleitung: Herkömmliche szintigraphische Techniken bei der Blutungsquellensuche benutzen in der Regel eine statische Akquisition und erfolgen selten kontinuierlich über einen längeren Zeitraum. Ziel der Studie war es, die diagnostische Genauigkeit einer dynamischen und über Stunden kontinuierlichen Blutungsquellenszintigraphie (BQS) mit 99 mTc-markierten autologen Erythrocyten bei der Abklärung ungeklärter gastrointestinaler Blutungen zu evaluieren. Methoden: Wir untersuchten 40 Patienten (mittleres Alter: 57 Jahre) mit trotz ausführlicher Diagnostik unklarer gastrointestinaler Blutung. Transfusionspflichtig waren 16 Patienten. Die Akquisition erfolgte dynamisch und kontinuierlich bis zu 6 Std p. i. . Die Auswertung erfolgte in Unkenntnis der endgültigen Diagnose unter Verwendung einer cinematographischen Darstellung. Ergebnisse: Die dynamische BQS war bei 23 Patienten positiv und identifizierte bei 22 Patienten korrekt den Ausgangsort der Blutung. Die Sensitivität und Spezifität der Szintigraphie betrug 95 % und 94 %, der positive und negative prädiktive Wert lag bei 95 % und 94 %. 43 % der Szintigraphien wurden innerhalb von 1,5 Std und 82 % innerhalb von 5 Std positiv. Transfusionspflichtige Patienten zeigten im Vergleich mit nichttransfusionspflichtigen Patienten häufiger (16 vs 7 Patienten) und früher (im Mittel 2,83 vs 5,28 Std p. i.) einen positiven Befund. Die szintigraphische Blutungslokalisation ermöglichte sowohl im Dick- als auch im distalen Dünndarmbereich ein limitiertes und befundadaptiertes chirurgisches Vorgehen. Bei einer proximalen Dünndarmblutung war die exakte Lokalisation der Blutungsquelle szintigraphisch hingegen nicht möglich. Schlußfolgerungen: Die BQS mit 99 mTc-markierten autologen Erythrocyten, die über einen ausreichend langen Zeitraum erfolgt, und eine Befundung im Cine-mode-Verfahren weisen eine hohe diagnostische Richtigkeit bei der Abklärung einer unklaren gastrointestinalen Blutung auf. Die Szintigraphie ermöglicht durch eine hinreichend genaue Lokalisationsangabe ein selektiveres und sicheres therapeutisches Vorgehen.
    Notes: Abstract. Background: Scintigraphic studies of gastrointestinal bleeding are usually performed in static acquisition mode and without continuous imaging over a longer period. The aim of this study was to evaluate the diagnostic accuracy of continuous dynamic 99 mTc red blood cell scintigraphy (BQS) and cine-mode display in the assessment of unexplained gastrointestinal bleeding. Patients and methods: We performed BQS in 40 patients (mean age 57 years) with gastrointestinal bleeding from an undetermined source. All these patients had negative findings of previous examinations. Blood transfusions were required in 16 patients. Continuous dynamic scintigraphic acquisition was performed up to 6 h post injection (p. i.). The scintigraphic data were reviewed without knowledge of the patient's final diagnosis. For this purpose we used a cine-mode display. Results: Dynamic 99 mTc red blood cell scintigraphy correctly identified the site of active bleeding in 22 of 23 patients with positive scintigraphic findings. The sensitivity of the scan was 95 %, the specificity 94 %, the positive and negative predictive values 95 % and 94 %, respectively. Forty-three percent of the scans became positive within 1.5 h and 82 % within 5 h. Positive scans were more likely in patients who required blood transfusions than in patients without transfusion requirement (16 vs 7 patients), and the bleeding site was identified earlier in the former group (mean 2.83 vs 5.28 h p. i.). The scintigraphic identification of the bleeding lesions enabled the performance of a more limited surgical approach in the colon as well as in the distal small intestine, while exact scintigraphic localization was not possible if the bleeding site was located in the proximal small intestine. Discussion: Continuous dynamic 99 mTc red blood cell scintigraphy interpreted by cine-mode display is highly accurate in the identification of a bleeding site. When performed correctly, scintigraphy enables usually segmental resection of these lesions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050048
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  • 2
    Electronic Resource
    Electronic Resource
    Prognostische faktoren beim kurativ resezierten magenkarzinom (1995)
    Springer
    Langenbeck's archives of surgery 380 (1995), S. 75-81 
    Details
    ISSN: 1435-2451
    Keywords: Stomach cancer ; Prognostic factors ; Uni- and multivariate analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In der Literatur haben sich bisher die im TNM-System zusammengefaβten Parameter Tumorin-filtration (T-Kategorie), Lymphknotenbefall (N-Kategorie) und Metastasierung (M-Kategorie) als herausragende prognostische Faktoren beim Magenkarzinom etabliert. Um den Einfluß weiterer Patientenfaktoren und Tumorcharakteristika auf die Prognose beurteilen zu können, wurden daher in der vorliegenden Arbeit 5 klinische und 13 pathologisch-anatomische Faktoren untersucht. 200 Patienten mit einem histologisch gesicherten Magenkarzinom wurden prolektiv und konsekutiv mittels eines speziell entworfenen, standardisierten EDV-gerechten Erhebungsbogens erfaßt. Die uni- und multivariate Analyse wurde in der Untergruppe der kurativ resezierten Patienten (R0, n = 108) durchgeführt. In der univariaten Analyse zeigten die Variablen Tumorgröße, Tumorlokalisation, T-Kategorie, N-Kategorie, Anzahl befallener Lymphknoten, Befall der Lymphknotenkompartimente, Stadieneinteilung und Quotient befallener/asservierter Lymphknoten einen statistisch signifikanten Einfluß. Bei gleichzeitiger Berücksichtigung mehrerer Faktoren in der multivariaten Analyse konnte ein statistisch signifikanter Einfluß nur für die Faktoren Anzahl befallener Lymphknoten und Tumorgröße nachgewiesen werden. Unter Berücksichtigung der Ergebnisse in der Literatur erscheint das Ausmaß des Lymphknotenbefalls mehr als jeder andere Faktor für die Prognoseschätzung richtungweisend zu sein, wobei der Anzahl der befallenen Lymphknoten zusätzlich zur TNM-Klassifikation eine besondere Rolle zukommt.
    Notes: Abstract The TNM system, including tumor infiltration (T category), lymph node infiltration (N category) and metastasis (M category), is a well-established system of prognostic factors. To evaluate the prognostic importance of patient characteristics and tumor parameters 5 clinical and 13 pathological factors were analyzed. Data on 200 consecutive patients with histologically verified stomach cancer were prospectively recorded using a standardized form. In the subgroup with curative resection (R0, n = 108) a uni-and multivariate analysis was performed with respect to 5-year survival. In the univariate analysis statistical significance was demonstrated for the following factors: tumor size, tumor localization, T category, N category, number of infiltrated lymph nodes infiltrated, lymph node compartments, tumor stage, lymph node ratio: infiltrated/inspected. Multivariate analysis, taking into consideration the interaction between prognostic factors, revealed only two factors as statistically significant: number of infiltrated lymph nodes and tumor size. Our results and those in the literature indicate that the infiltration of lymph nodes is the most relevant prognostic factor. In addition to the TNM system the number of infiltrated lymph nodes seems to be of prognostic importance.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00186412
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  • 3
    Electronic Resource
    Electronic Resource
    Neurotensin-related regulation of the postprandial lower-oesophageal-sphincter pressure (1999)
    Springer
    Langenbeck's archives of surgery 384 (1999), S. 467-472 
    Details
    ISSN: 1435-2451
    Keywords: Key words Hormonal control ; Lower-oesophageal-sphincter pressure ; Neurotensin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Background: Ingestion of food has been shown to modulate the lower-oesophageal-sphincter pressure (LESP). Fat is especially effective in decreasing the postprandial LESP. As there is good evidence that neurotensin (NT) is able to decrease the LESP, we conducted the present trial to determine whether NT could possibly be a mediator of the fat-induced decrease of the LESP. Methods: Six half-breed dogs were fitted for cervical side-to-side oesophagostomy to allow repeated oesophageal intubation; plasma NT immunoactivity was recorded during infusion of NT and after intragastric instillation of 200 ml of a fat solution. Experiments were repeated, with the specific NT antibody GN25 administered intravenously. Results: The optimal dose of NT required to simulate a postprandial situation was 50 pmol/kg/h. Infusion of this NT dose led to a statistically significant decrease of the LESP. Simultaneous administration of the NT antibody (immunoneutralisation) significantly inhibited this effect. Intragastric fat decreased the LESP and increased plasma NT. Immunoneutralisation of endogenously released NT led to an earlier restoration of baseline LESP, but this effect was not statistically significant. Conclusions: NT and intragastric fat modulate the LESP. NT appears to mediate the postprandial, fat-induced decrease of the LESP. Research with specific NT-receptor antagonists is necessary to determine the exact role of NT and other regulatory peptides in this context.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004230050232
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  • 4
    Electronic Resource
    Electronic Resource
    Is delayed gastric emptying following pancreaticoduodenectomy related to pylorus preservation? (1999)
    Springer
    Langenbeck's archives of surgery 384 (1999), S. 354-359 
    Details
    ISSN: 1435-2451
    Keywords: Key words Delayed gastric emptying ; Pylorus-preserving pancreaticoduodenectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Background: Delayed gastric emptying (DGE) is the most frequent postoperative complication after pylorus-preserving pancreaticoduodenectomy (PPPD). This prospective, non-randomized study was undertaken to determine whether the incidence of DGE may be reduced by modifying the original reconstructive anatomy with a retrocolic duodenojejunostomy towards an antecolic duodenojejunostomy. Patients and methods: The study was comprised of 51 patients who underwent PPPD between August 1994 and November 1997. The operation was carried out as originally described but was modified by performing the duodenojejunostomy antecolically. Clinical data were recorded prospectively, with special regard to DGE. Results: After PPPD, the nasogastric tube could be removed at a median of 2 days (range 1–22 days) postoperatively; in two patients, the nasogastric tube was reinserted because of vomiting and nausea. A liquid diet was started at a median of 5 days (3–11 days); the patients were able to tolerate a full, regular diet at a median of 10 days (7–28 days). The overall incidence of DGE was 12% (n=6). No postoperative complications other than DGE were exhibited by 36 patients (71%). In this group, DGE was only seen in one patient (3%). In the second group, where postoperative complications other than DGE occurred (n=15), five patients (30%) exhibited DGE (P=0.002). Conclusions: DGE after PPPD seems to be of minor clinical importance following uncomplicated surgery. When taking the results into consideration, it can be said that, despite the lack of a control group, antecolic duodenojejunostomy might be the key to a low incidence of DGE after PPPD. In our experience, DGE is linked to the occurrence of other postoperative complications rather than to pylorus preservation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004230050213
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