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11098484 | UFT: mechanism of drug action. | The mechanism of action of fluorouracil (5-FU) and the oral fluoropyrimidines and the importance of biochemical modulation and inhibition of dihydropyrimidine dehydrogenase for oral application of the prodrugs of 5-FU are discussed. The regulation of thymidylate synthase, as well as its roles as a target for antineoplastic activity and in drug resistance, are also mentioned. The more downstream events of 5-FU action and their implication in 5-FU resistance, with the possible involvement of the Fas/FasL system and the proteins associated with apoptosis regulation, are highlighted. Also discussed is the suggestion that the oral 5-FU prodrug tegafur and uracil (UFT) and its metabolites function as an angiogenesis inhibitor. |
11098485 | Oral DPD-inhibitory fluoropyrimidine drugs. | Over the past decade, increasing data have emphasized both the importance of dihydropyrimidine dehydrogenase (DPD), the initial, rate-limiting enzyme in the catabolism of fluorouracil (5-FU), and its role as a control step in 5-FU metabolism, regulating the availability of 5-FU for anabolism. It is now clear that DPD also accounts for much of the variability observed with therapeutic use of 5-FU, including variabilities in 5-FU levels over a 24-hour infusion, interindividual pharmacokinetics, bioavailability, toxicity, and drug response (resistance). This variability makes effective dosing of 5-FU and related drugs difficult. In order to lessen this variability, and potentially improve 5-FU pharmacology, the pharmaceutical industry has made an effort to develop DPD inhibitors to modulate 5-FU metabolism, which has resulted in the creation of a new subclass of orally administered fluoropyrimidines, known as DPD-inhibiting fluoropyrimidines (DIF). Four drugs--uracil and tegafur (UFT) or bination of UFT and leucovorin, ethynyluracil (eniluracil), S-1, and BOF-A2--have recently undergone clinical evaluation in the United States. The biochemical basis for using these drugs is reviewed. |
11098486 | UFT/leucovorin vs 5-FU/leucovorin in colon cancer. | Adjuvant chemotherapy has been shown to alter the natural history of resected colon cancer. Two regimens (fluorouracil [5-FU] plus leucovorin and 5-FU plus levamisole) have been found to prolong disease-free survival and overall survival in affected patients. parisons of these two regimens indicate that 5-FU plus leucovorin may offer a small disease-free survival and overall survival advantage. Evidence that UFT (uracil and tegafur) plus oral leucovorin is associated with significant antitumor activity and has an acceptable toxicity profile makes this a logical formulation for the adjuvant treatment of colon cancer. The National Surgical Adjuvant Breast and Bowel Project Protocol C-06 is a parison of the relative efficacies of 5-FU plus leucovorin vs UFT plus leucovorin. Preliminary analysis of the toxicity findings among 1,530 evaluable patients indicates that both regimens are well tolerated and have similar toxicity profiles. |
11098487 | UFT/leucovorin plus irinotecan in advanced or metastatic colorectal cancer. | UFT (with leucovorin) and irinotecan both have single-agent activity in colorectal cancer, with non-cross-resistant mechanisms of action. Combining these drugs would be anticipated to increase response rates while maintaining the advantages of a regimen based on an orally administered fluoropyrimidine. This trial aims to determine the maximum tolerated dose, side-effect profile, dose-limiting toxicity, and response rate for bination of UFT plus leucovorin, and irinotecan. The design is for an initial phase I study investigating escalating doses of UFT (250 to 350 mg/m2/d) and irinotecan (200 to 300 mg/m2) with fixed doses of leucovorin at 90 mg/d, in up to five cohorts of six patients each. UFT and leucovorin are given orally on days 1 to 14 of a 21-day cycle and irinotecan is given intravenously on day 1. The maximum tolerated dose is defined as the dose at which three of six patients in a cohort have a dose-limiting toxicity in the first cycle of treatment. In the second part of the study, the cohort below that experiencing maximum tolerated dose will be expanded up to a total of 20 patients in order to assess further the toxicity and response rate (phase II). To date, 17 assessable patients have been recruited, with a median age of 64 years (range: 35-80 years). At the first dose level (UFT 250 mg/m2/d and irinotecan 200 mg/m2), no dose-limiting toxicities were seen, and in cohort 2 (UFT 250 mg/m2/d and irinotecan 250 mg/m2), there was one grade 3 diarrhea. In cohort 3 (UFT 250 mg/m2/d and irinotecan 300 mg/m2), currently there have been two grade 3/4 toxicities (both neutropenic fever). Thus, the maximum tolerated dose has not yet been reached. Response has been assessed in the first six patients, with three having partial response, two having stable disease, and one having progressive disease (response rate 50%). We conclude that this regimen appears feasible with acceptable toxicity at these dose levels. There is also evidence of significant antitumor activity similar to that seen with other bination regimens but without the requirement for indwelling catheters or inpatient admission. |
11098488 | UFT/leucovorin combined with mitomycin-C in metastatic colorectal Ca. | UFT is an investigational agent that may be useful treatment for colorectal carcinoma and other cancers for which fluorinated pyrimidines are a useful treatment. bination of continuous-infusion fluorouracil (5-FU) with leucovorin and mitomycin-C can significantly delay recurrence and may prolong life. UFT may be an attractive alternative to continuous-infusion 5-FU because three-times-daily administration of UFT results parable concentrations of 5-FU in the plasma. Recently, a clinical trial investigated bination of UFT and mitomycin-C and found it demonstrated significant synergy in the treatment of advanced colorectal cancer. We describe the design of a phase II study to investigate the safety and efficacy of bined with mitomycin-C in a larger group of previously untreated patients with metastatic colorectal cancer. |
11098489 | Impact of UFT on tumoral TS and DPD levels in colorectal cancer. | This was an open lable, pilot translational clinical pharmacology study of a brief (7 day) course of UFT, 300 mg/m2/day, bination with leucovorin, 90 mg/day, in six patients with newly diagnosed advanced colorectal cancer. The primary objectives of the study were to examine the impact of this treatment course on the UFT targets which are thymidylate synthase (TS) and dihydropyrimidine dehydrogenase (DPD). The rate of tumoral TS inhibition after the 7-day UFT treatment sequence varied from 5% up to 31%. UFT treatment induced a constant and variable decrease in tumor DPD activity ranging from 13% to 60%. UFT treatment induced a constant increase in uracil concentrations both in plasma and tumors. FT, 5-FU and the metabolite fluoro-beta-alanine (FBAL) were found in plasma and tumors at variable concentrations; the highest drug concentrations were those of FBAL in plasma. The present translational clinical study provides data related to the in vivo pharmacological effects of UFT with a description of its impact on cellular targets. |
11098490 | UFT/leucovorin plus weekly irinotecan in advanced or metastatic colorectal cancer. | This is an open-label, nonrandomized phase I trial to determine the safety and maximum tolerated dose of irinotecan with a fixed dose of UFT plus oral leucovorin in patients with advanced or metastatic colorectal cancer. A secondary objective of the study is to determine the response rate in this patient population. Adult patients with histologically confirmed advanced or metastatic colorectal carcinoma and no prior chemotherapy for advanced or metastatic disease, or those patients who have received adjuvant chemotherapy (> 6 months prior to the study entry) will be eligible to participate. All patients must have measurable or evaluable lesions. Symptoms will be evaluated at baseline and every 6 weeks thereafter. Computed tomography scans will be performed at baseline and every three cycles of treatment to assess tumor response. A total of six cycles of treatment may be given, depending on patient tolerance. Patients will be followed for a maximum of 12 months for time to progression, following the last dose of the study drug. Tumor response will be defined using standard World Health Organization criteria. |
11098491 | UFT plus leucovorin for metastatic colorectal cancer: Japanese experience. | In the United States and Europe, bination of oral UFT plus leucovorin has been reported to produce objective responses and survival rates similar to those achieved with standard intravenous 5-fluorouracil plus leucovorin in patients with metastatic colorectal cancer, with reduced toxicity. However, because knowledge and experience with UFT plus leucovorin are relatively limited in Japan, we conducted a phase II study to evaluate the safety and efficacy of bination in Japanese patients with metastatic colorectal cancer. For the purposes of this study, 20 patients received oral UFT 400 mg/m2/day in two divided doses (q 12 h) and a 5-mg tablet of leucovorin (q 8 h). Treatment was administered for 5 days, followed by a 2-day rest period, for a 28-day cycle. There were six partial responses (30%) and plete response (5%) (overall response rate, 35%; 95% confidence interval, 14.1% to 55.9%). Greater efficacy of UFT plus leucovorin was demonstrated in patients with lung metastases, with a response rate of 63% (five of eight patients). Patients received a median of 4.5 courses (range, 2 to 12) of therapy. The median duration of survival was 228+ days (range, 81 to 540; six patients remain alive). Grade 3 or 4 toxicities occurred in three patients: diarrhea in two and mucositis in one. No toxicity-related hospitalization was reported. In summary, bination showed promising activity and an acceptable toxicity profile in the treatment of Japanese patients with metastatic colorectal cancer. |
11098492 | A phase I study. UFT/leucovorin combined with paclitaxel for anthracycline-pretreated advanced breast cancer. | Taxanes are the most active drugs in the treatment of metastatic breast and ovarian cancer. Weekly therapy with paclitaxel produces notable activity, with remarkably low toxicity. bination therapy with paclitaxel and fluorouracil (5-FU) exhibits high activity in anthracycline-pretreated breast cancer patients: recent studies report response rates of 54% to 69%. UFT plus oral leucovorin constitutes an orally pound that provides parable to that of intravenously administered 5-FU plus leucovorin. An open-label phase I study was initiated to determine the maximum tolerated dose and dose-limiting toxicities of bination of weekly paclitaxel and UFT plus leucovorin administered to patients with anthracycline-resistant metastatic breast cancer. |
11098493 | UFT/leucovorin plus bolus epirubicin and cyclophosphamide in advanced/metastatic breast cancer. | This article describes the design and early results of an open-label, nonrandomized phase I/II trial of oral UFT plus leucovorin therapy bination with bolus injections of epirubicin and cyclophosphamide in patients with advanced or metastatic breast cancer. This study was designed as a cohort dose-escalation study with the principal aims being to determine dose-limiting toxicity, overall toxicity, maximum tolerated dose, tumor response, and time to disease progression. Currently there are 22 patients randomized in the study. Overall response rate to date is 56% (66% in the locally advanced group). Based on the preliminary data, the dose-limiting toxicity appears to be neutropenia and the optimum dose of UFT for use in a phase II study appears to be 300 mg/m2. |
11098495 | A phase I study. Preoperative UFT/leucovorin and radiation therapy in rectal cancer. | The use bined modality regimens has been well established in the treatment of stages II and III rectal cancer. The mon chemotherapy regimens used include continuous-infusion 5-FU delivered with the help of a central venous catheter and the use of portable pumps. These regimens are expensive and can potentially develop line problems. The availability of the oral agent UFT bination with oral leucovorin prompted the development of an all-oral chemotherapy regimen that could bined with radiotherapy. At The University of Texas M. D. Anderson Cancer Center, we routinely bined chemotherapy and radiotherapy preoperatively for the treatment of rectal cancers, and decided to conduct a phase I trial in which UFT and leucovorin was used instead of the conventional 5-FU. The preliminary results are encouraging and seem to demonstrate the feasibility of this approach. |
11098494 | UFT/leucovorin plus vinorelbine combination for advanced breast cancer. | This phase I study was undertaken to define the maximum tolerated dose, the dose-limiting toxicity, and the mended dose of UFT plus leucovorin and vinorelbine bination treatment of patients with metastatic breast cancer previously treated with one chemotherapy regimen. The pharmacokinetics of UFT and vinorelbine were also evaluated. Patients were treated with escalating doses of UFT and vinorelbine, given every 4 weeks. At least three patients were treated at each dose level before escalating to the next level. As of September 1, 1999, 22 patients have been treated. Eighteen patients were evaluable for antitumor response. One patient had plete response (which was obtained after three cycles); four patients had a partial response. The area under the concentration-time curve (AUC0-6 h) of 5-fluorouracil increase was more than dose-proportional. The AUC0-6 h values of fluorouracil were significantly higher than those noted for the four patients who developed dose-limiting toxicity at day 15. The removal of one administration of vinorelbine at dose levels 3 and 4 has allowed for increased UFT dosage and AUC0-6 h of fluorouracil, with no dose-limiting toxicity reported for these patients. No pharmacokinetic interaction between UFT and vinorelbine was observed. |
11098496 | Postoperative radiation therapy for rectal cancer combined with UFT/leucovorin. | bined-modality therapy with fluorouracil (5-FU) and radiation therapy is accepted practice for high-risk rectal cancer. Postoperative pelvic radiotherapy alone may improve pelvic control, but is not associated with an improvement in survival. Protracted infusional 5-FU has been associated with decreased tumor recurrence and improved survival bined with postoperative adjuvant pelvic radiotherapy. The use of new drugs and alternative ways of administering 5-FU is desirable. UFT plus leucovorin is an oral 5-FU prodrug with efficacy equal to 5-FU plus leucovorin in metastatic colorectal cancer. bination of postoperative adjuvant UFT plus leucovorin concurrent with radiation therapy should be feasible, and the design of an ongoing phase I trial is presented. |
11098497 | UFT/leucovorin plus weekly paclitaxel in the treatment of solid tumors. | The palliation of symptoms and improvement of quality of life are important aspects of therapy in patients with incurable metastatic cancer. This article describes the preliminary results of a phase I study of uracil and tegafur, an orally available fluorouracil (5-FU) bined with oral leucovorin plus weekly intravenous paclitaxel. While the daily oral dose of UFT is fixed at 300 mg/m2 plus 90 mg leucovorin on days 1 to 28, paclitaxel is escalated in 10 mg/m2 steps starting with 50 mg/m2 weekly as a 1-hour infusion. To date, 26 patients with a median age of 57 years have been entered into the protocol and have received a median 2.2 cycles of therapy. Dose level 4 (paclitaxel 80 mg/m2) has been pleted. Major dose-limiting toxicities were fatigue syndrome (two patients) and diarrhea (five patients). Preliminary responses have been observed in three of 14 currently evaluable patients. This protocol is taking the development of protracted 5-FU administration--given orally as bination with paclitaxel one step further, using paclitaxel in a dose-dense, weekly schedule. It is hoped that an active regimen for the outpatient treatment of solid tumors will be developed. |
11098498 | UFT and its metabolites inhibit cancer-induced angiogenesis. Via a VEGF-related pathway. | Treatment with UFT for spontaneous lung metastasis of murine renal carcinoma (RENCA) after resection of the primary tumor has resulted in significant prolongation of the life span of tumor-bearing animals. UFT inhibited the growth of metastatic nodules in the lung, apparently via decreased density of microvessels in the metastatic foci. Subsequent experiments used dorsal air sac assay to directly trace newly forming microvessels. UFT abrogated the process of angiogenesis, induced by the RENCA cells, in a dose-dependent manner. The inhibitory effect appeared to originate from tegafur, ponent of UFT, and from its known metabolites: fluorouracil (5-FU), gamma-hydroxybutyric acid (GHB), and gamma-butyrolactone (GBL). The inhibition of angiogenesis by UFT appeared to be mon phenomenon, also observed in other human cancer cell lines characterized by an excessive production of vascular endothelial growth factor (VEGF)--such as gastric, lung, and colon cancers. In vitro analysis revealed that 5-FU and gamma-hydroxybutyric acid regulated VEGF-dependent responses of human umbilical vein endothelial cells. Dorsal air sac assay revealed that UFT, 5-FU, and gamma-hydroxybutyric acid strongly inhibited the angiogenesis induced by binant human VEGF. These data suggest that the antiangiogenic activity of UFT is at least partially associated with an ability of the metabolites of UFT to interfere with VEGF-dependent responses of vascular endothelial cells. |
11098499 | UFT plus carboplatin for head and neck cancer. | Cisplatin plus fluorouracil (5-FU) is widely accepted as neoadjuvant and adjuvant chemotherapy in the treatment of head and neck squamous cell carcinoma; UFT is also an active agent against this disease. In the first retrospective study, we examined the efficacy of UFT as adjuvant chemotherapy in patients with maxillary cancer. The 5-year survival rate of those treated with UFT vs those not treated was 71.4% vs 23.8%, respectively. In the second study we developed the carboplatin plus UFT regimen--as a modification of cisplatin plus 5-FU--and studied its efficacy and toxicity in patients with advanced head and neck squamous cell carcinoma. These patients received UFT plus carboplatin. The objective response rate was 53.1%; grade > or = 3 leukopenia, anemia, and thrombocytopenia were rare. These findings suggest that UFT plus carboplatin in the outpatient setting is feasible for patients with head and neck squamous cell carcinoma. |
11098500 | A phase I study of paclitaxel, UFT, and leucovorin. | This phase I study examines the dose escalation of UFT given bination with fixed doses of oral leucovorin and weekly doses of paclitaxel in patients with metastatic solid tumor malignancies (excluding colorectal cancer). There are two main objectives for this study. The first is to determine both the maximum tolerated dose and the dose-limiting toxicities of UFT when administered with leucovorin bination with weekly paclitaxel (1-hour infusions of 80 mg/m2 for 4 weeks every 6 weeks). The second is to define the appropriate dose for phase II studies. Both UFT and binations, as well as paclitaxel, are known to be effective as single agents in heavily pretreated patients with a variety of solid tumor malignancies. UFT plus leucovorin provide parable to that of intravenously administered 5-fluorouracil plus leucovorin, and weekly schedules of paclitaxel offer high dose intensity with limited hematologic toxicity. bination is advantageous in its ease of administration and could be a tolerated outpatient regimen in patients with metastatic solid tumor malignancies. |
11098502 | Evaluation of adjuvant UFT for gastric cancer. | In a trial of adjuvant chemotherapy with mitomycin and 5-FU followed by oral UFT for T1 and T2 gastric cancer after curative gastrectomy, there was no significant difference in survival between the treated and control (surgery alone) groups (5-year survival rate, 82.9% control vs 85.8% treated). Although not significantly different, 5-year survival for patients with T2 cancer was slightly higher in the treated group than in the control group (76.9% control vs 83.0% treated). This finding suggests that T2 cancer should remain the target of further trials of adjuvant chemotherapy. |
11098501 | UFT/leucovorin in advanced squamous cell carcinoma of the head and neck administered with radiotherapy. | This is an open-label, nonrandomized phase I study to determine the maximum tolerated dose and dose-limiting toxicity of UFT plus leucovorin when given itantly with hyperfractionated radiotherapy in patients with head and neck cancer. The study period is determined by the course of radiotherapy, which is given as 1.7 Gy per fraction twice daily for 5 days (Monday to Friday) in 2 consecutive weeks, followed by 1 week of rest, and subsequently another 2 weeks of radiotherapy (Monday to Friday plus Monday to Thursday). Total duration of therapy will be 5 weeks. |
11098503 | A novel weekday-on/weekend-off UFT schedule. | In a step toward a clinical trial, the tumor response and survival of a weekday-on/weekend-off schedule of UFT pared with its conventional daily schedule in a cancer-bearing rat model. The dose-intensive schedule--600 mg of UFT for 5 days followed by 2 drug-free days--amounts to a weekly dose similar to the conventional schedule of 400 mg/day. The weekday-on/weekend-off schedule provided increased survival and significantly greater antitumor activity than the conventional daily schedule, with no difference in adverse reactions. A study was also conducted in human subjects to measure fluorouracil (5-FU) concentrations that identified the pharmacokinetic activity during the 2 drug-free days of the weekday-on/weekend-off schedule. The plasma 5-FU concentration declined markedly after 24 hours, but the concentration in the tumor remained at a relatively high level after 2 days off the drug. A one-year clinical study evaluated pliance and toxicity of the weekday-on/weekend-off UFT schedule as adjuvant chemotherapy for colorectal cancer. Based on the findings of all these studies, the weekday-on/weekend-off schedule for UFT as adjuvant chemotherapy for colorectal cancer can be mended for a clinical trial. |
11098504 | Irinotecan and UFT/leucovorin in patients with advanced cancers. | bination of irinotecan and fluorouracil (5-FU) is synergistic when applied to human colon cancer cell lines in vitro and appears to be schedule-dependent: maximal activity occurs when irinotecan is administered prior to 5-FU. In this phase I study, irinotecan is administered bination with UFT and leucovorin in patients with advanced solid tumors. Irinotecan is given as a 90-minute intravenous infusion on day 1 followed by twice-daily UFT plus oral leucovorin on days 2 through 15. Cycles are repeated every 21 days. Five patients have been treated to date; four are evaluable for toxicity. Starting doses were irinotecan 200 mg/m2/day, UFT 200 mg/m2/day, and leucovorin 60 mg/day. Preliminary results indicate that irinotecan bination with UFT plus leucovorin is well tolerated at the initial doses (described in this article). |
11098505 | Limited small-cell lung cancer: a potentially curable disease. | Patients with limited-stage small-cell carcinoma of the lung are treated bined-modality therapy with the intent to cure. Standard therapy consists of bination chemotherapy, thoracic irradiation, and for responders, prophylactic cranial irradiation. Despite this aggressive approach, too few patients achieve 5-year survival. In the past several years, new chemotherapeutic agents, including the taxanes and the topoisomerase I inhibitors, have demonstrated substantial activity against small-cell carcinoma. These agents are now being incorporated into clinical trials for patients with limited-stage disease. The bination of these agents with platinum-based regimens is yet to be determined, and data supporting increased survival are awaited. Other studies are exploring thoracic radiation issues. Questions remain regarding optimal timing, dose, volume, and fractionation schemes. The most bination of thoracic irradiation and the newer chemotherapy agents also remains to be determined. The current approach to limited-stage small-cell carcinoma is reviewed, ongoing trials are described, and future directions are explored. |
11098508 | High-dose chemotherapy in poor-risk germ-cell tumors. | Testicular cancer is a highly curable cancer. However, 30% of patients are refractory to standard therapy and will need additional therapy. This article focuses on the use of high-dose chemotherapy in germ-cell tumors. High-dose chemotherapy use is discussed both in the refractory setting and as either first-salvage or first-line therapy. Various criteria for risk assessment are also discussed. |
11098511 | Indications for selective neck dissection: when, how, and why. | Selective neck dissection is a procedure that is primarily indicated in patients with clinically negative nodal disease in which there is a high risk of occult metastases. Others have advocated its use for patients with positive nodes, although under very specific circumstances and bination with postoperative radiation therapy. The type of selective neck dissection performed varies according to the site of the primary, because the pattern of metastases is unique in each case. This review presents the author's philosophy on when, how, and why to employ the procedure, based on the location of primary cancers at oral, pharyngeal, laryngeal, cutaneous, thyroid, and salivary gland sites. |
11098512 | Multidisciplinary management of pediatric soft-tissue sarcoma. | The management of pediatric soft-tissue as has improved drastically through the use of multimodal therapy. These tumors include as and as. Both are staged using physical, radiographic, and histologic evaluation, and both have intricate staging and grouping systems that correlate closely with prognosis. However, approaches to therapy for the two tumor types remain somewhat different. as are treated primarily with chemotherapy. Surgical intervention is limited to initial biopsy, wide local excision when clear margins are feasible, and resection of residual disease. Radiation therapy is reserved for patients with persistent or recurrent disease and may be delivered by external beam or brachytherapy. as are best treated primarily by surgical resection, although radiation and chemotherapy are now being used with some success. Another major difference concerns evaluation of lymphatics. as in children frequently behave similarly to adult as, and monly involve regional lymph nodes, whereas pediatric patients with as often have nodal involvement necessitating surgical evaluation of regional lymph nodes as part of the staging protocol. Multimodal therapy has led to improved survival as well as better functional and cosmetic results. With further clinical trials and improved techniques such as brachytherapy and lymphatic mapping with sentinel node biopsy, we expect to continue to optimize therapy for pediatric patients with soft-tissue as. |
11098513 | Follow-up care for cancer: making the benefits equal the cost. | Posttreatment follow-up is a staple of oncologic practice. Clinicians have traditionally presumed that close surveillance improves clinical e. However, new evidence reveals that frequent, procedure-intensive follow-up may provide no more significant benefit to patients than simpler approaches. Several recent consensus mendations from major oncology organizations support this theory. Published surveys of clinician and institutional follow-up policies reveal significant variations in practice, with many providers continuing to use costly, unproven regimens. This review highlights current data on follow-up care for mon cancers--breast, colorectal, and prostate. These data suggest an acute need for changes leading to more rational, consistent, and efficient follow-up practices. |
11098524 | Heart failure in women. | Heart failure affects more than 5 million Americans. Each year, about 400,000 individuals develop heart failure, making it the nation's most rapidly growing cardiac problem. Almost one third of these individuals have New York Heart Association Functional Class III or IV heart failure and are faced with progressive clinical deterioration and frequent hospital admissions. These figures will continue to escalate as the population ages. The success of interventional procedures and pharmacologic therapies in the management of coronary artery disease has enabled this population to survive acute events, at the same time creating a population with chronic disease. Common etiologies of heart failure in women include coronary artery disease, myocardial infarction, and valvular disease. However, women are at especially high risk for developing heart failure due to diastolic dysfunction associated with hypertension and diabetes. Heart failure in women is best managed across the care continuum, incorporating pharmacologic agents, interventional procedures when appropriate, dietary restrictions, self-monitoring, and psychosocial support. Much of the recent literature has focused on women and heart disease. This emphasis is partly due to public misconception about women's health problems and the growing body of research distinguishing gender differences. Significant advances in therapy have been made to improve the quality and span of life for people with heart disease. Despite therapeutic advances, however, women have high mortality rates from heart disease, including heart failure due to ischemic causes. In fact, women with heart failure present differently than men and have different etiologies and treatment options. As we learn more about women and heart disease, the distinguishing differences unfold and e helpful in establishing a plan of care. |
11098525 | Optimum bedside cardiac monitoring. | Correct electrode placement is critical to obtaining accurate information from any monitoring lead. The choice of lead should be based on the goals of monitoring for a specific patient population and on the individual patient's clinical situation. When using a 5-wire monitoring cable, arm electrodes should be placed on the shoulders; leg electrodes, on the lower thorax or hip area; and the chest electrode, in the desired V lead position. When using a 3-wire system, lead placement depends on which lead is desired for monitoring. If arrhythmia diagnosis is the goal of monitoring, lead V1 is the best lead; lead V6 is the next best lead. If ST segment monitoring for ischemia or reocclusion following percutaneous coronary interventions is the goal, the best lead depends on the coronary artery involved. Multiple lead monitoring is superior to single lead monitoring. If two leads are available, V1 and lead III or aVF (or a limb lead with maximal ST segment displacement) are good choices. If three leads are available, leads V1, III, and aVF are the best choices. Continuous 12-lead monitoring is available and offers several advantages. |
11098526 | Salt sensitivity and hypertension in African Americans: implications for cardiovascular nurses. | Hypertension is a major public health problem in the U.S. Salt sensitivity is an important factor associated with hypertension and plications, yet it has not been addressed in the nursing literature. Salt sensitivity is a directionally appropriate rise or fall in blood pressure when salt is added or removed, respectively. The change in blood pressure in salt-sensitive subjects occurs to a degree exceeding random blood pressure fluctuations. Salt sensitivity is present in 30% of normotensive and over 50% of hypertensive persons. It is more prevalent among African Americans, older persons, and individuals with renal insufficiency or diabetes. This paper provides nurses with an overview of salt sensitivity and its significance in hypertension. It presents conceptual and operational definitions of salt sensitivity, identifies factors contributing to its development, and describes implications for nursing practice. |
11098533 | [Therapeutic potential of thrombopoietin]. | Thrombocytopenia induced by disease and/or chemotherapy is one of the plications in the treatment of patients with hemato-oncological malignancies. The discovery of Mpl ligand, a hematopoietic growth factor that stimulates megakaryopoiesis and thrombopoiesis lineage-specifically both in vitro and in preclinical models, is an important step in the development of new treatment concepts for patients with thrombocytopenia. Two binant forms of Mpl ligand, binant human thrombopoietin (rHuTPO) and pegylated binant human megakaryocyte growth and development factor (PEG-rHuMGDF), are currently being tested in clinical trials. Development of these thrombopoietins has recently been constrained due to the observation of anti-thrombopoietin antibodies in some patients following thrombopoietin treatment. However, clinical trials performed so far provide significant insight into the therapeutic potential of these molecules. TPO/MGDF stimulates thrombopoiesis in cancer patients before chemotherapy and reduces the duration and sometimes the degree of thrombocytopenia following myelosuppressive chemotherapy. Despite marked thrombocytosis in some of these patients an increased risk for plications was not observed. Although administration of TPO/MGDF has provided some clinical benefit after autologous bone marrow transplantation, such effects have not been found in the settings of peripheral blood stem cell transplantation and aplasiogenic AML chemotherapy. The potential role of Mpl ligand in other indications such as thrombocytopenia in liver disease, plateletpheresis and stem cell expansion remains to be determined. Recent efforts in the development of thrombopoietins focus on the generation of molecules with maintained thrombopoietic activity which are not immunogenic. |
11098534 | Admission for syncope: evaluation, cost and prognosis. | Despite extensive in-hospital evaluation the cause of syncope remains unexplained in up to 40% of patients. |
11098535 | Seroprevalence of ehrlichiosis, Lyme borreliosis and tick-borne encephalitis infections in children and young adults in Slovenia. | Little is known about the seroprevalence of ehrlichiosis in adults and much less about the same in children. |
11098536 | Nontoxigenic sorbitol-fermenting Escherichia coli O157:H- associated with a family outbreak of diarrhoea. | A recent study from Germany reported the isolation of E. coli O157:H7/H- from patients with non-bloody diarrhoea and hemolytic uremic syndrome, questioning the role of Shiga toxin as the main trait of virulence for human disease. We isolated 6 sorbitol-fermenting E. coli O157:H- strains that do not contain Shiga toxin genes. The isolates originated from an outbreak (3 patients, 3 asymptomatic contacts) of non-bloody diarrhoea affecting two families sharing one household. Two children (age 10 months and 2 years) suffered severe diarrhoea over 30 and 10 days, respectively. Their uncle had moderate diarrhoea for 2 weeks. In contrast to the other isolates, the uncle's strain (EH109) did not harbour a chromosomal eae gene encoding gamma-intimin nor the plasmid gene E-hly; it also showed a PFGE pattern that was different from the unique pattern of the other isolates. Employing PFGE, phage typing, and P-gene typing, five of the six stx negative isolates were indistinguishable from the stx 2 positive "Bavarian outbreak strain". The only human serum tested, obtained from one asymptomatic contact, contained antibodies to the O157 lipopolysaccharide antigen. Our finding of five stx negative sorbitol-fermenting E. coli O157:H- isolates (harbouring eae and E-hly) associated with an outbreak of non-bloody diarrhoea supports the hypothesis that Stx production is not obligatory for the pathogenicity of E. coli O157 for humans. |
11098537 | [Importance of computer tomography in preoperative diagnostics of polyposis nasi]. | Computed tomography (CT) is a very important diagnostic tool prior to endoscopic nasal or paranasal sinus surgery. However, it is frequently notice during endonsal surgery of the paranasal sinuses, that the intraoperative results do pletely agree with the radiological ones. The objective of the present study was pare clinical and operative findings with those of CT investigations. We collected 200 cases treated during the past 2 years and studied their CT reports. Paranasal sinuses were separated into six regions, and the pathological changes due to sinusitis found by CT were classified into four groups. Altogether, we found a highly significant relationship between CT and intraoperative findings (r = 0.44; P < 0.0001), but differences were found in several regions. The highest correlation was found in the anterior ethmoid bone area (r = 0.98), posterior ethmoid bone area (r = 0.53), maxillary sinus (r = 0.36) and sphenoid sinus (r = 0.35). There was only a low agreement in the case of frontal sinus and recessus frontalis. Possible factors such as time between CT and operation or inflammation are discussed. While CT is the image modality of choice in evaluating patients with chronic paranasal sinusitis, agreement to intraoperative findings is not perfect. This should be taken into consideration when planning functional endoscopic sinus surgery. |
11098539 | [Heterotopic cystic pancreas as a growing submucous tumor close to the cardia of the stomach]. | Ectopic pancreas, presenting as a growing submucosal tumor, is a rarity in stomach surgery. Up to now, only about 250 cases of ectopic pancreas have been described. To our knowledge this is the first report of ectopic pancreas found near the cardia. A 52 year old female patient suffered from unclear upper abdominal distress. Gastroscopy revealed a submucosal growing tumor near the cardia. The tumor was locally exceeded and histologically examined showing ectopic, cystic pancreatic tissue without signs of malignancy. Wound healing was plications and the patient is now, two years later, free of symptoms. The preoperative diagnosis of ectopic pancreas still is rarely conclusive. Nevertheless, new techniques such as endoscopic sonography or transmucosal biopsies may provide a non-invasive alternative to surgery. However, currently, local excision with intraoperative frozen section still is the therapy of choice. |
11098538 | Primary breast cancer of the vulva: a case report and review of the literature. | Since 1872, 40 cases of ectopic mammary gland tissue in the vulva have been reported in the literature. Out of these, 12 had a primary cancer in the ectopic breast tissue. Seven metastases of an orthotopic breast cancer have been found in this location. We are presenting the 20th case of cancerous breast tissue in the vulva whom we classified as the 13th case of primary cancer based on clinical and histopathological criteria of primary and metastatic malignant disease. Because of the advanced age of the patient, wide local excision followed by adjuvant hormonal therapy was opted for. Nineteen months after surgery, there is no evidence of recurrent disease. Due to the rarity of this entity, its management presents therapeutic dilemmas, and variable treatment strategies are being found in the literature. In our opinion, the same basic principles used for treatment of cancers of the orthotopic breast should be applied in ectopic breast carcinoma. |
11098540 | [Myocardial contrast echocardiography. Research instrument or already clinical application?]. | Increasing interest has been focused on myocardial contrast echocardiography (MCE) since latest imaging technologies allow the detection of echocontrast agents within myocardial structures following intravenous injections. Although numerous studies on different aspects of pre-clinical and clinical applications have been published, MCE has not yet e a standard clinical application. This paper summarises and estimates the clinical value of the recent developments in this evolving field of research, particularly with regard to the new real-time perfusion imaging technologies. |
11098542 | [Myocardial contrast echocardiography with harmonic power Doppler and lung traversing SHU 563A ultrasound contrast medium for imaging myocardial perfusion disorders]. | The current approach for the assessment of myocardial perfusion using contrast echocardiography involves black-and-white gray scale imaging in b-mode. For better appreciation of perfusion abnormalities, off-line postprocessing techniques including color encoding are used. In this study, we examined whether we could exploit the contrast microbubble response to high ultrasound amplitude--the phenomenon of stimulated acoustic emission--that could be recorded with harmonic power Doppler (HPD) in color to identify myocardial perfusion defects. To assess the potential of HPD, we occluded branches of the left coronary artery for 2-3 h followed by 1 h reperfusion in 10 dogs. After transvenous administration of the new air-filled contrast agent SHU 563A, echocardiographic imaging was performed with ECG-triggered harmonic b-mode (HBM) and the harmonic power Doppler (HPD) approach in different short (SAX) and long axis (LAX) views. Post-mortem TTC staining was performed to verify infarction. HBM, HPD and TTC data were analyzed by independent observers. During coronary occlusion, HPD with SHU 563A showed perfusion defects in 10 dogs in all SAX and LAX views. HBM demonstrated perfusion defects in all dogs in SAX and in 8 dogs in LAX. The correlation of perfusion defect size between HPD and HBM images was good (SAX: r = 0.9, p < 0.001, LAX: r = 0.7, p < 0.01). One hour after reperfusion, both HPD and HBM showed perfusion defects with SHU 563A in 7 dogs. Five dogs showed TTC evidence of infarction. Perfusion defect size by HPD correlated well with residual infarct size (r = 0.8, p < 0.01), while defect size by HBM showed poor correlation (r = 0.3, p = ns). Myocardial contrast echocardiography with HPD and contrast agent SHU 563A identifies perfusion defects in acute coronary occlusion as reliably as HBM. After reperfusion HPD and SHU 563A accurately portray the site and size of residual myocardial infarction on line, in color. This approach has excellent potential for clinical application. |
11098541 | [Echocardiographic online quantification of left ventricular systolic function in children: comparison with conventional off-line determination]. | Accurate and efficient echocardiographic on-line determination of left ventricular volume would be advantageous in the care of children with congenital heart disease and children with hemodynamic instability. The prospective study was performed to evaluate the clinical usefulness of the on-line automatic border detection system (acoustic quantification: AQ) for determination of left ventricular volumes and ejection fraction parison to the conventional off-line method (manual tracing). 107 patients were enrolled in the study. The ages ranged from 0.1 to 18.8 years (mean 8.3 +/- 5.6). All patients were studied in the apical four-chamber plane for acoustic quantification (AQ) and manual tracing as well. Left ventricular volumes were determined using the mono-plane Simpson's rule. Left ventricular end-diastolic volumes obtained by AQ correlated well but were slightly pared to those determined by manual tracing (r = 0.99). Left ventricular endsystolic volumes by AQ correlated well but were also slightly pared to those obtained by manual tracing (r = 0.98). Mean ejection fraction was 61.1 +/- 6.8% by pared with 61.5 +/- 5.9% by manual tracing. Linear regression analysis demonstrated good correlation: y = 0.77x + 14.1, r = 0.89; p < 0.001. Measurement of left ventricular volumes and ejection fraction by AQ using automatic border pares well with measurements done by manual tracing. However, AQ tends to underestimate to some degree. The time necessary for acquisition of data was similar in both methods. AQ seems to be a promising method for real-time estimation of left ventricular volume, even in children. |
11098543 | [Assessment of myocardial vitality with dobutamine echocardiography: current review]. | Myocardial stunning (contractile dysfunction in the presence of normalized perfusion) and myocardial hibernation (contractile dysfunction matching reduced perfusion) have represented separate concepts of viable, but dyssynergic myocardium in the past. However, in vivo experimental and clinical work suggests that repetitive ischemia due to coronary artery disease may induce a gradual transition between stunned and hibernating myocardium. Myocardial hibernation itself can result from a spectrum of ischemic conditions ranging from impaired myocardial blood flow reserve to frank hypoperfusion. With increasing severity and duration of ischemia, degeneration of cardiac myocytes, accumulation of glycogen and cell death ensue. Additionally, there is an increase of extracellular matrix protein content leading to reparative fibrosis, which in turn limits functional recovery. In the light of these structural features, the available methods for detection of viable myocardium, in particular dobutamine echocardiography and nuclear imaging techniques, plementary rather than contradictory information. Dobutamine echo has satisfactory sensitivity, excellent specificity, and high diagnostic accuracy for the detection of viable dyssynergic myocardium. While in the past only its predictive accuracy for segmental recovery has been validated, newer data show an improved survival after revascularization if at least four viable dyssynergic left ventricular segments in a 16 segment model can be identified by dobutamine echocardiography. plete (low and high dose) dobutamine protocol can elicit several types of contractile responses (sustained improvement in contraction or monophasic response, biphasic response, new wall motion abnormality) which should be interpreted in view of other clinical data including a previous infarction. The test protocol can be used safely at the end of the first week after myocardial infarction. If ischemia or viability is documented, revascularization should be performed promptly. A similar strategy should be followed in the setting of chronic coronary heart disease with left ventricular dysfunction. Since the structural changes of hibernating myocardium are progressive, time to revascularization is critical. On the other hand, responsible therapeutic planning requires proof of ischemia or viability before initiating a potentially hazardous revascularization procedure. |
11098545 | [Indirect genotype analysis as a diagnostic procedure in Marfan syndrome]. | Marfan syndrome (MFS) is an autosomal dominant disorder of connective tissue characterized by skeletal, ocular and cardiovascular manifestations. The disease is caused by mutations in the FBN1 gene, encoding fibrillin, an ponent of elastic fibers. Diagnosis of Marfan syndrome is currently based on detailed clinical examination and/or mutation analysis in the fibrillin gene. Clinical expression varies widely both among and within families, rendering clinical diagnosis extremely difficult. In this study, we performed segregation analysis of allelic DNA polymorphisms to support diagnosis of Marfan syndrome. This type of genotype analysis is a useful, additional diagnostic tool for families with Marfan syndrome and provides incremental information of diagnosis or exclusion of Marfan syndrome based on clinical findings. |
11098546 | [Significance of matrix metalloproteinases in cardiovascular diseases]. | The cardiovascular interstitial space is posed of type I and III fibrillar collagens. Tissue structure, form and function are determined not only by the collagen content but also by the ratio of different collagens to each other. Matrix metalloproteinases are members of a family of secreted and membrane-bound enzymes that are capable of degrading highly proteolytic resistant fibrillar type I and III collagens. Collagen tissue content is determined by balanced collagen synthesis and degradation. MMP activity and adverse tissue remodeling have been identified in coronary plaques in unstable angina. It has also been linked with the progression of aortic aneurysms and with left ventricular dilatation in congestive heart failure in patients with ischemic and non-ischemic cardiomyopathy. The role of MMPs in these cardiovascular diseases and possible therapeutic options are the focus of this review. |
11098544 | [Reconstruction of the bicuspid aortic valve]. | Reconstruction of a regurgitant bicuspid aortic valve is a new alternative to aortic valve replacement. With itant aortic root dilatation adequate reconstruction is feasible by valve-sparing aortic replacement. Between 10/95 and 02/00, 30 patients underwent reconstruction of a regurgitant bicuspid aortic valve. Additional aortic replacement was performed in 23 cases. Valve reconstruction was performed by plication of the prolapsing leaflet. No patient died peri- or postoperatively. Freedom from aortic valve regurgitation > or = II as well as freedom from reoperation were 100% after 48 months. Reconstruction of a regurgitant bicuspid aortic valve is feasible with encouraging mid-term results. With itant dilatation of the ascending aorta, bination of aortic replacement and valve reconstruction can achieve stable results even in bicuspid valve anatomy. |
11098547 | [Aortic isthmus stenosis with open ductus Botalli as etiology of severe heart failure in a 36-year-old patient--case report of successful surgical treatment]. | We report on the history of a 36-year-old woman with untreated coarctation of the aorta and patent ductus arteriosus who developed refractory heart failure due to severely impaired left ventricular function. After coarctation repair and duct resection, left ventricular function improved to normal. Even in the presence of longstanding left ventricular pressure and volume overload, subsequent severe myocardial failure may be reversible by surgical repair. |
11098549 | [Progression of an intramural hematoma to dissection]. | Intramural hematoma is a spontaneous, localized bleeding in the wall of the thoracic aorta without evidence of intimal tear. Clinically, intramural hematoma manifests itself as an acute thoracical pain in patients with hypertension and therefore shows parallels with the classical aortic dissection. In the literature there is controversial discussion whether intramural hematoma can be regarded as its own aortic pathology or a precursor in the development of classical aortic dissection. We present the case of a 66 year old male who showed an intramural hematoma of the descending aorta which rapidly progressed to classical dissection within 3 months. This finding was secondarily panied by a dilatation of the descending aorta which leads to operative treatment with replacement of the proximal aorta descendens. This case supports the hypothesis that intramural hematoma is a potential early manifestation of aortic dissection and at the same time stresses the necessity for frequent follow-up investigations and, if necessary, early operative therapy. |
11098548 | [Interventional therapy of aortic isthmus stenosis with concomitant thoracic aortic aneurysm with a stent graft]. | A 23 year old male presented with hypertension and a systolic murmur. ECG and echo revealed signs of left ventricular hypertrophy. Aortography showed aortic coarctation (delta p max. 40 mmHg) bination with an aneurysm originating from the coarcted segment distal from the origin of the left subclavian artery. Coarctation and aneurysm were treated using direct placement of a stent graft and subsequent balloon dilatation. On final aortography, the outline of the stented segment was smooth with good stent apposition and the aneurysm entry was closed. The residual gradient was 10 mmHg (max). Six months later, the patient has no symptoms and a blood pressure of 120/80 mmHg on both arms. |
11098554 | [New ways of imaging diagnosis of the heart with electron beam tomography]. | Electron puted tomography is a noninvasive imaging tool for diagnosing heart disease. The method offers new insights into coronary heart disease, because the quantification of coronary artery calcification provides a fast, low-risk and cost efficient estimation of coronary risk with greater prognostic power than traditional risk estimates. With intravenous administration of an x-ray contrast agent, EBCT can detect coronary artery stenoses more accurately than other noninvasive methods. The quantification of myocardial blood flow by EBCT represents a realistic alternative to other methods of assessing myocardial perfusion. High temporal resolution allows for detailed analysis of cardiac dynamics. Other applications include the work-up of cardiac masses, pericardial disease, and investigations of the great vessels. As a dedicated cardiac imaging tool, EBCT provides new insights into cardiac physiology and disease, and offers a quantitative approach to many diagnostic problems. Limited availability, radiation exposure, and the need for a iodinated contrast agent still make EBCT an accessory modality at this time. |
11098553 | [Pathogenesis of coronary disease]. | Being overweight (OW) was recognized very early as a risk factor for coronary heart disease (CHD). Its significance in the pathogenesis of CHD has been strengthened by observations showing that OW is responsible for the development of diabetes, hypertension and lipid disorders due to its induction of insulin resistance (IR). Its key role has been underlined further by recent studies indicating that OW causes endothelial dysfunction via elevated serum fatty acids, which initiates the molecular events that further the process of CHD. It is, therefore, of the utmost importance to determine its roots. The most probable reason for its high incidence is due to the genetic outfit of most people which does not permit adequate adaptation of the cerebral cortex according to the environmental changes which have occurred since the early days. |
11098552 | An overview of the evolution of the atherosclerotic plaque: from fatty streak to plaque rupture and thrombosis. | Today, there is a wealth of information concerning the chronology of the cellular and molecular events associated with the development of cardiovascular diseases. It is now clear that atherosclerosis is largely a result of a dysregulated fibroproliferative inflammatory response [1]. Treatment of cardiovascular disease is rapidly adapting to this new knowledge and the future holds great potential for preventing the disease by blocking the process at multiple stages. This short review provides an overview of the evolution of the atherosclerotic plaque. It focuses on three basic stages of the disease processes: initiation of the fatty streak, transition of the fatty streak to an atheroma, and progression and destabilization of the lesions leading to plaque rupture and occlusive thrombosis. It includes a discussion of the molecular and cellular biology of the atherogenic process with an emphasis on key molecular mediators of the disease process and provides three tables which list examples of some of the key molecular mediators and the stages in which they are purported to play a role. |
11098555 | [New strategies in the treatment of restenosis]. | Twenty-three years after introduction of coronary angioplasty (PTCA), the inhibition of restenosis formation continues to be the major challenge for the interventional cardiologist. About 35-50% of all patients undergoing PTCA develop a renarrowing of the intravascular lumen within the following six months. The use of specific systemic drug therapy as well as different angioplastic methods (rotablation, atherectomy, laser angioplasty) all failed to significantly reduce restenosis. Local drug delivery and local gene therapy have only shown to be effective in animal experiments. Restenosis can be reduced by the use of stents; however restenosis can also develop within the stents. The treatment of choice for severe in-stent restenosis may e radiotherapy, which seems to be a promising tool also for other forms of restenosis. |
11098557 | [Percutaneous myocardial laser revascularization (PMR), a new therapeutic procedure for patients with refractory angina pectoris]. | In patients with severe angina pectoris due to coronary artery disease, who are not candidates for either percutaneous coronary angioplasty or coronary artery bypass surgery, transmyocardial laser revascularization (TMR) often leads to improvement of clinical symptoms and increased exercise capacity. One drawback of TMR is the need for surgical thoracotomy in order to gain access to the epicardial surface of the heart. Therefore, a catheter-based system has been developed, which allows creation of laser channels into the myocardium from the left ventricular cavity. Between January 1997 and November 1999, this "percutaneous myocardial laser-revascularization" (PMR) was performed in 85 patients at the Herzzentrum Leipzig. In 43 patients, only one region of the heart (anterior, lateral, inferior or septal) was treated with PMR; in 42 patients two or three regions were treated in one session. 12.3 +/- 4.3 (range 4-22) channels/region were created into the myocardium. Six months after PMR, the majority of patients reported significant improvement of clinical symptoms (CCS class at baseline: 3.3 +/- 0.4; after 6 months: 1.6 +/- 0.9) (p < 0.001) and an increased exercise capacity (baseline: 349 +/- 138 s; after 6 months: 470 +/- 193 s) (p < 0.05); however, thallium scintigraphy failed to show increased perfusion in the PMR treated regions. PMR seems to be a safe and feasible new therapeutic option for patients with refractory angina pectoris due to end-stage coronary artery disease. The first results indicate improvement of clinical symptoms and increased exercise capacity; evidence of increased perfusion in the laser-treated regions is still lacking. |
11098556 | [Neoangiogenesis by local gene therapy: a new therapeutic concept in the treatment of coronary disease]. | This article presents the results of our initial clinical experience with the human growth factor FGF-1 as applied to the ischemic human myocardium. After pletion of extensive preliminary animal experiments, the human angiogenetic growth factor FGF-1, obtained from a genetically transformed strain of E. coli was introduced into aortocoronary bypass surgery as an additional therapeutic agent. A double-blind study was carried out in a total of 40 patients with coronary heart disease. The patients were randomized into growth-factor and control groups, each containing 20 patients. All patients underwent aortocoronary bypass surgery because of their coronary multivessel disease, in each case with an IMA bypass for the LAD and single venous bypasses for the RCX and/or RCA. In order to bridge over additional stenosis of the LAD or one of its branches, the human growth factor FGF-1 was injected into the myocardium during the operation. In the control group heat-denatured growth factor was substituted for FGF-1. After three months as well as three years postoperatively, the IMA bypasses were selectively depicted by intraarterial DSA. These angiographies were then quantitatively evaluated. After the application of the growth factor, the formation of new vessels could be demonstrated after three months as well as three years postoperatively. A capillary network initiating from the coronary artery could be found and puter-supported evaluation of the angiographs revealed a significant increase in the blood supply of the region of the myocardium injected. According to the angiographic findings there was also a clinical improvement of the patients with FGF-1 pared to the patients of control group, concerning the NYHA classification as well as the need for antiangina drug therapy. In the meantime, the results of other research groups support the evidence that the induction of neoangiogenesis by human growth factor could e a therapeutic approach especially in patients with diffuse coronary artery disease. Nevertheless further studies have to be carried out in order to prove the long-term clinical profit of those patients after the growth factor treatment. |
11098558 | [Multiple myocardial revascularization on the beating heart: risks, benefits and outlooks]. | Avoidance of extracorporeal circulation during beating heart surgery (OP CAB = Off-Pump Coronary Artery Bypass Surgery) for aortocoronary bypass grafting (ACBG) is gaining increasing importance in modern cardiac surgery. With the development of new mechanical stabilization devices, the revascularization of the posterior wall of the heart and the distal right coronary artery became feasible. Especially high-risk patients with multiple risk factors for open heart surgery will profit from this approach, because the negative effects of the extracorporeal circulation are avoided. |
11098559 | Surgery of acute type A dissection: what have we learned during the past 25 years? | Every acute dissection involving the ascending aorta (Stanford type A) must undergo emergency surgical repair. However, the surgical techniques must vary according to the clinical presentation of the patients or the anatomical patterns observed. Furthermore, surgery is generally difficult because of the poor condition of the aortic tissues. To reduce those difficulties many technical artifacts have been described. In 1977, we proposed the use of gelatin-resorcin-formalin (GRF) biological glue to reinforce the suture areas. From January 1977 to July 1999, 212 patients (pts) (152 males and 60 females) aged from 15 to 80 years (mean age: 54 +/- 11 years) underwent an emergency operation for type A aortic dissection. One-hundred-seventy-eight pts (84%) were operated on within 4 hours after being referred to the hospital. Twenty-eight pts (13.2%) had Marfan's syndrome. In 44 patients (20.7%), the aortic valve was replaced either independently (6 cases--2.8%) or by means of posite graft (38 cases--17.9%). Because of the location of the intimal tear, the aortic replacement was extended to the transverse arch in 61 pts (28.7%). Hospital mortality amounts to 21.6% (46 pts), 25% in pts with arch replacement and 19.4% in pts without arch replacement (n.s). Analysis of hospital mortality demonstrates that the main causes of death were cardiac tamponade, neurologic disorders and visceral malperfusion. One-hundred-sixty-six pts were discharged and surveyed from 5 months to 22 years postoperatively (mean follow-up: 85 +/- 66 months). During this period of time, 25 pts (15%) had to be reoperated for a total of 33 reoperations. Seven pts (28%) died at reoperation. Using univariate analysis, the presence of Marfan's syndrome (p < 0.05) and absence of arch replacement (p < 0.02) were determinant risk factors for reoperation. Emergency (p < 0.01) and thoraco-abdominal replacement (p < 0.04) were determinant riskfactors for death at reoperation. The freedom from reoperation (Kaplan-Meier, CI: 95%) is 96% (90-98), 87% (79-92), 80% (70-88), 66% (51-78) at 1, 5, 10 and 15 years respectively. A total of 39 pts (24.3%) died during follow-up. The presence of Marfan's syndrome (p < 0.01), reoperation (p < 0.02), stroke (p < 0.05), and cardiac failure (p < 0.05) were determinant risk factors of late mortality. The late survival rate (K-M. C.I.: 95%), including hospital mortality, is 71% (64-77), 66% (58-73), 56% (47-64), 46% (36-56), 37% (28-44) at 1, 10, 15 and 20 years, respectively. From our experience extending over more than 23 years, GRF glue has proved to be extremely useful, making the procedure much easier and safer. Nevertheless, many factors are of importance in the pre-, intra- and postoperative management of the patients. Cardiac tamponade and visceral malperfusion must be properly diagnosed and treated. During aortic repair, the main intimal tear must be resected. The transverse arch must be checked and replaced whenever necessary. The aortic valve should be preserved whenever possible. During CPB, perfusing the aorta in the regular antegrade manner seems to dramatically reduce the rate of malperfusion. The quality of the first emergency operation seems to have a major influence on the late results, especially concerning the rate of late reoperations and aortic ruptures. However, those late results depend also on the patient's basic condition, particularly in Marfan patients. |
11098560 | [Heart failure and sudden cardiac death: pharmacological and nonpharmacological treatment possibilities from the viewpoint of the rhythmologist]. | Recent multicenter studies have shown that the implantable cardioverter defibrillator (ICD) is pared to antiarrhythmic agents after sudden cardiac death (SCD) in patients with congestive heart failure. Further ICD studies have to be performed for primary prevention of SCD in patients with heart failure. Primary prevention studies of SCD with Amiodarone or new class III agents (e.g., Dofetilide) were not able to lower cardiac mortality in these patients. How much the new method of biventricular pacing in patients with heart failure and left bundle branch block will reduce cardiac mortality has to be proven in future prospective trials. |
11098561 | [Therapeutic inhibition of platelets in a acute coronary syndrome and in coronary intervention: mechanisms and clinical results]. | Platelets play a crucial role in the pathogenesis of atherosclerosis and especially in the final ischemic consequences such as acute coronary syndromes. Furthermore, platelets are central mediators of acute or plications of coronary interventions. Therefore, therapeutic inhibition of platelet function is of major interest in cardiology. The following review describes three different therapeutic strategies for platelet inhibition and provides a representative overview on the clinical results of studies based on these strategies. First, the mechanism of acetylsalicylic acid is described and the strong meta-analytic data demonstrating a convincing positive clinical effect is discussed. Second, the mode of action of the thienopyridines is described and initial clinical results are discussed. Third, the inhibition of the platelet integrin receptor GP IIb/IIIa is described as a potent way to block the mon pathway of platelet stimulation. The structural description of GP IIb/IIIa is followed by a structural classification of the available GP IIb/IIIa inhibitors. Clinical studies, meanwhile including several thousands of patients, are discussed based on representative examples. Finally, unresolved issues regarding the various GP IIb/IIIa inhibitors, such as differences in receptor affinity and specificity, intrinsic activation and GP IIb/IIIa inhibitor induced thrombocytopenia are, discussed. |
11098562 | Left ventricular restoration by endoventricular circular patch plasty (EVCPP). | The Endoventricular Circular Patch Plasty technique, developed to reorganize the left ventricular cavity after post-ischemic modification, is described as it has been used since 1984. Experience of more than 900 cases demonstrates the efficiency of the technique in terms of left ventricular shape, left ventricular performances and long-term clinical results. Particular attention is focused on very large asynergia with congestive heart failure. |
11098563 | [Reverse remodeling by surgery--fact or fiction?]. | Mortality of chronic heart failure in industrial countries remains unacceptably high despite advances in medical therapy. Heart transplantation, the gold standard in the treatment of end-stage heart failure is reserved for only a few patients because of the shortage of donor hearts. Surgical alternatives to transplantation include dynamic cardiomyoplasty (CMP), mitral valve reconstruction, left ventricular reduction surgery (PLVR) and ventricular assist devices (VAD). Improved survival and objective physiologic improvement have not been documented for CMP in the treatment of dilative cardiomyopathy. Mitral valve reconstruction on the other hand shows promising results. PLVR is an innovative procedure in which the heart is surgically reduced in size and cardiac function is dramatically improved immediately after surgery. The presence of long-term effects is still unknown. VAD have been shown to be extremely effective as a short- and long-term "bridge" to heart transplantation. They are not approved for permanent support. A randomized trial in the U.S. is underway pare the efficacy of these devices with the efficacy of medical therapy in NYHA functional class IV patients in quality of life, survival and costs. |
11098565 | [Advances and perspectives in mechanical heart assist]. | Mechanical circulatory support devices were first developed to permanently replace the failing heart. Today, however, the majority of these devices are used as a mechanical bridge in patients awaiting heart transplantation. With this indication, important information on using mechanical assist devices has been assembled. We present our experience, which has been gained since 1987 in the area of patient selection, post-implant patient care and device maintenance. More than 450 patients have since been implanted with assist devices at our institution. Mechanical circulatory support may not only lead to recovery from secondary organ failure, but also to myocardial remodeling and recovery of the heart function in some patients. Additionally we report our experience with a newly developed implantable axial flow pump and discuss the possibility and costs of permanent support in some patients. |
11098564 | [Advances and perspectives of heart-lung transplantation]. | Thoracic organ transplantation has evolved as standard therapy in end-stage cardiac and pulmonary failure. Meanwhile more than 50,000 heart, 2500 heart-lung and 10,000 lung transplantations have been performed worldwide. Improvements in patient selection as well as in the postoperative management have led to 1-year survival rates of 70-90%. Long-term results are still influenced by the development of graft vessel disease, bronchiolitis obliterans syndrome and malignancies. Furthermore, indications and results of different procedures will be presented and new developments discussed. |
11098566 | [Robotic-guided techniques in heart surgery]. | The rigid design of conventional endoscopic instruments with limited degrees of freedom has not allowed for endoscopic cardiac surgery. Using a surgical telemanipulation system that is operated from a master console, endoscopic coronary artery bypass grafting and mitral valve repair can be performed with high precision. Closed-chest cardiopulmonary bypass systems that allow cardioplegic cardiac arrest are required. After extensive experimental testing a telemanipulation system was used clinically. |
11098567 | Loss of sinus compliance, cause of degenerative aortic valve disease, and early failure of biological valves. | Loss pliance of aortic sinuses due to aging or graft replacement causes significant aortic valve leaflet dysfunction. This event leads to stress overload and induces degenerative changes in the patient's (natural or bioprosthetic) valve and unfavorably influences leaflet longevity. |
11098568 | [Reconstructive surgery of the aortic root]. | Surgical treatment of proximal aortic disease traditionally consists posite replacement of valve and aorta. Recent reconstructive procedures on the aortic root allow for treatment of aortic dilatation and itant aortic valve regurgitation without the associated disadvantages of mechanical heart valves. From 10/95 to 09/99 we treated 84 patients for regurgitation of the aortic valve and dilatation of the aortic root. Valve preserving replacement of the root consisted of root remodeling (n = 68) or reimplantation of the aortic valve (n = 16). Operative mortality in valve-preserving surgery was not pared to overall results of proximal aortic replacement (3.6% vs 5.6%); this applied to elective procedures (1.8% vs 2.3%) as well as emergency operations (9.3% vs 16.3%). Initial aortic valve function was adequate in all cases. Actuarial freedom from regurgitation grade II or higher was 98% after root remodeling and 92% after valve reimplantation. Freedom from reoperation at two years was 96% in remodeling and 100% in valve reimplantation. Hemodynamic function of the reconstructed valve was investigated in 17 patients under conditions of rest and exercise. These pared to 9 patients with a posite valve. Patients with reconstructed valves had almost physiologic gradients during rest and exercise. These gradients were thus significantly lower than the increased gradients of patients posite replacement. Application of reconstructive procedures to the aortic root allows for restoration of aortic valve function in the majority of patients. Disadvantages of heart valve prostheses can be avoided, and the hemodynamic performance of the reconstructed valve appears almost physiologic. |
11098570 | [Lymph nodes and malignant tumors]. | The planning of locoregional tumor therapy (radical surgical resection, curative radiotherapy) is based on the knowledge of locoregional tumor spread, in particular lymph node metastasis. In general, lymphatic spread follows anatomic rules, skipping of nodes is observed maximally in 3%. According to tumor site, uni- or multidirectional lymph drainage is found. In some tumors (carcinoma of penis, malignant melanoma, breast carcinoma) the concept of detection and examination of sentinel node increasingly is of importance. Lymph node metastasis is to be distinguished from the finding of isolated tumor cells in the sinus of lymph nodes (tumor cell emboli). A definite diagnosis of lymph node metastasis requires a careful histopathologic examination. The incidence of regional lymph node metastasis predominantly depends on tumor type, histological grade of differentiation, lymphatic invasion and depth of invasion/tumor size/tumor volume. A careful histopathologic examination of tumor resection specimens in regard of lymph node metastasis is important for indication to additional postoperative treatment, estimation of prognosis and analysis of treatment results. Adequate quality assurance is necessary. |
11098571 | [Significance of immunohistochemically detectable tumor cells in lymph nodes]. | Distant metastasis is mainly determined by the tumor biology, whereas local relapse plete (R0) resection of solid tumors is largely determined by the effectiveness of the surgeon. The detection of a minimal tumor cell spread in lymph nodes became recently possible by the introduction of sensitive immunohistochemical and molecular methods and is increasingly considered as clinically relevant because of its independent prognostic significance. Furthermore, these tumor pared to solid metastases, are appropriate targets for intravenously applied anti-cancer therapeutics because they are easily accessible for macromolecules and immunologic effector cells. Double staining analyses have demonstrated that the majority of these tumor cells stay in a non proliferating phase of the cell cycle. This phenomenon could be an explanation for the extended latency period ("dormancy") between their primary diagnosis and the occurrence of a subsequent metastatic relapse, and it may furthermore explain the failure of anti-proliferative chemotherapy. Consequently, adjuvant therapeutic strategies, which are directed also against these "dormant" tumor cells are of increasing importance after radical local tumor resection (R0). |
11098572 | [Significance of lymph nodes in tumor surgery. Value of minimally invasive staging]. | Malignant tumors require an exact staging in order to initiate individual tumor related therapeutic concepts to avoid unnecessary explorative laparotomy and pare different treatment regimes. The assessment of the lymph node status with regard to tumor involvement using any of the actual imaging methods is quite unsatisfactory. For the improvement of the pretherapeutic tumor staging including N-classification the diagnostic laparoscopy and laparoscopic sonography are presently being evaluated. Both methods should be carried out according to a standardized investigation record. When limited to the pure diagnostic aspect, the morbidity is approx. 2%. Low patient figures with different tumor entities, insufficient information on the simultaneous occurrence of lymph node and distant metastases and/or of a peritoneal carcinomatosis as well as on the extent of the lymphadenectomy and histopathologic es restrict the signifying value of many studies. It seems to be only clear that, when using the laparoscopic sonography, the sensitivity of the evidence of lymph node metastases increases parison with the sole laparoscopy. Definite mendations based upon the es with the required evidence, can presently neither be made with regard to the use of the method in general nor for the laparoscopic lymph node staging in particular. The use with regard to a lymph node assessment from today's point of view seems to be appropriate above all in case of: Suspect of an advanced tumor stage (existence of M1 lymphomas) For the indication in case of justified application of multimodal therapeutic concepts (exact tumor staging/N-classification). Beyond this, the laparoscopy for lymph node staging should only be used in conjunction with prospective randomized studies. Sufficient experience in the field of laparoscopic surgery and sonography as well pliance with the rules of action for the prevention of tumor cell conveyance should be demanded. |
11098573 | [Immunotherapy in malignant melanoma]. | The malignant melanoma is because of its ability to form metastasis even at early stages of disease the deadliest of all skin tumors. Its incidence rises faster than that of any other human tumor. Today, treatment of melanoma is based on surgical removal, and depending on the stage, chemotherapy and/or biological response modifiers. The response and cure rates are, however, not satisfactory and there is, therefore, ongoing research for other approaches. The identification of melanoma antigenic peptides like Melan-A, gp100 and ras peptides has opened new possibilities in the treatment of malignant melanoma. The research on generating mainly T cell mediated immune responses against malignant melanoma using many different approaches like injection of dendritic cells pulsed with melanoma specific peptides, injection of in vitro with cytokines stimulated T cells, immunization with peptides in the presence of different adjuvants, immunization with genetically modified melanoma cells etc. has produced many encouraging results. However, the future of tumor-vaccine development still lies in generation of more potent vaccination protocols. |
11098574 | [Melanoma. Results with "sentinel node" sampling]. | Since June 1995 we have practised a gamma probe guided sentinel lymphadenectomy (SLNE) in 274 patients after injecting a colloidal 99 m-Tc labelled solution around the tumor. By this technique the detection and excision of the SLN succeeded in 99.3% of all cases. We found micrometastases in about 53.1% of patients with pT3 and pT4 melanomas. The specimen of the radical lymph node dissection contained in 30% further metastases. A regional recurrence after SLNE occurred only in one case, a SLN-negative patient. |
11098575 | [Importance of lymph node involvement in breast carcinoma for the oncologist]. | Axillary node status is the most important prognostic information regarding treatment and prognosis for breast cancer patients. Localisation and number of involved lymph nodes add further information and are of prognostic relevance as well. The problem of the involvement of different axilla levels as well as skip metastases are discussed. Sentinel lymph node dissection is still considered investigational as well as axilla downstaging by preoperative chemotherapy. New prognostic markers are helpful in individual situations but are not yet considered as standard procedures. Conclusions of practical relevance are summarised. |
11098576 | ["Sentinel" lymph node biopsy in breast carcinoma. Current experiences]. | Recent studies show the sentinel lymph node biopsy (SNB) as a reliable method for the determination of the nodal status in patients with breast cancer. We present our experience with this method during 3 years and discuss its potential and limitations. From 11/95 to 3/99 we performed a sentinel node detection in 146 patients with breast cancer stage I to III. We used the raionuclide method including preoperative lymphscintigraphy and intraoperative gamma.probe detection. The detection rate varied with the tumor size between 94% for tumors with a diameter < 1 cm, 85% (1-3 cm), 70% (3-5 cm) and 63% (> 5 cm). The accuracy of the SNB in the prediction of the nodal status varied also with the tumor diameter between 100% for very small tumors (< 1 cm), 97% (1-3 cm), 88% (3-5 cm) and 67% (> 5 cm). In the subgroup of patients restricted to T1-2-tumors (n = 106), 57 patients (53%) showed true negative, 4 (4%) false negative SNB. 38 (36%) revealed tumor cells in the HE-staining and an additional 7 patients (7%) solely in the immunohistochemical staining. The presented results show, that SNB is a reliable method for the evaluation of the nodal status in early breast cancer patients with a tumor size up to ca. 3 cm. While in about 50% of these patients a surgical intervention could be avoided after a negative SNB, an additional 5-10% of conventionally nodal negative patients can be found by the immunohistochemical examination of the sentinel node. The sn-concept can also identify parasternal metastasis and can be applied in patients after neoadjuvant therapy and patients with recurrent tumor. Indications and contraindications of this method, however, still remain to be determined. |
11098577 | [Surgical axilla dissection. Technical standard or obsolete method?]. | Axillary lymph node status remains the single most important prognostic parameter and has crucial therapeutic implications in patients with breast carcinoma. Surgical dissection of the axilla monly regarded as the standard procedure of axillary staging, its sensitivity and specificity being 99% and 100%, respectively. Apart from giving reliable information on the individual prognosis axillary dissection also contributes to efficient local tumor control in the axilla, as it reduces the risk of local recurrence to less than 1.4% if more than 10 lymph nodes are removed. Alternative, less or non-invasive axillary staging methods have either not yet been sufficiently standardized (immunoscintigraphy, PET-scan, prediction of axillary lymph node status by means of individual risk factors) or are associated with a considerable risk of false-negative staging (up to 50% of patients with positive axillary lymph nodes are not detected by palpation alone, ultrasonography or CT-scan). The basic principles of axillary sampling and axilloscopic dissection are questionable because the number of lymph nodes removed during these procedures monly less than 10. With its sensitivity/specificity parable to that of standard axillary dissection sentinel lymph node biopsy represents a highly promising approach which will in the future potentially lead to significant optimization of the clinical management of patients with breast cancer, especially those diagnosed in early stages (T1 a, T1 b and T1 c). |
11098578 | [The significance of lymph node status in papillary and follicular thyroid gland carcinoma for the nuclear medicine physician]. | The impact of lymph node metastases on prognosis of differentiated thyroid cancer is discussed controversially. Therefore the data of 596 patients with papillary or follicular thyroid cancer are analysed retrospectively, which have been treated between 1980 and 1995 at the Clinic and Policlinic for Nuclear Medicine of the University of Würzburg. The influence of lymph node metastases on prognosis with respect to survival is analysed with the univariate Kaplan-Meier-method and with the multivariate discriminant analysis. In addition, the influence of the prognostic factor "lymph node involvement" on distant metastases is analysed by a parison and an univariate test. In papillary thyroid cancer, the 15 year-survival-rate for stage pN1 is significantly lower (p < 0.001) with 88.7% pared to stage pN0 (99.4%). In patients with follicular thyroid cancer this difference is even more pronounced (64.7% versus 97.2%, p < 0.001). However, the multivariate discriminant analysis shows that the only prognostic factors are tumour stage and distant metastases, and--in papillary thyroid cancer--patient's age. So lymph node metastases are not an independent prognostic factor concerning survival. However, lymph node metastases have a prognostic unfavourable influence with respect to distant metastases especially in papillary thyroid cancer stage pT4 (distant metastases in patients with negative lymph nodes 0% and in patients with positive lymph nodes 35.3% [p < 0.001]). |
11098579 | [Pro and contra lymphadenectomy in papillary and follicular thyroid gland carcinoma]. | Patients with papillary and follicular thyroid carcinomas are said to have an excellent long-term prognosis. However, over 90% of papillary carcinomas have synchrone lymph node metastases. Based on clinical, histopathologic and molecular-biological factors, different patient groups can be defined with an increased recurrence rate and disease related mortality-rate of up to 50% in the long-term follow-up of 30 years. Therefore, not only the extent of the surgical resection of the thyroid cancer but also the lymph node dissection as an oncologic correct surgical procedure is of great importance. Although the position of surgical lymphadenectomy is still discussed controversially there are increasing reasons to support the concept of a radical initial operation following the rules of oncologic surgery. We consider total thyroidectomy and modified neck-dissection as the standard operation in well differentiated thyroid carcinoma. In unilateral carcinoma both the central and the ipsilateral cervico-lateral lymph partments are dissected. In multicentric bilateral carcinomas a bilateral cervico-central and cervico-lateral lymphadenectomy has to be performed. |
11098580 | [The value of blood transfusion in tumor surgery. Experiences from randomized trials]. | Since the first publication by Tartter in 1982 [3] multiple studies were performed concerning the association between blood transfusion and e in surgical oncology. The hypothesis was that blood transfusion-associated immunosuppression influences postoperative infection rates and long-term prognosis. Due to the fact that most of these studies were uncontrolled observational the decisive question about the causal relationship could not be answered so long. In randomized studies different methodological approaches were performed. Jeekel from Rotterdam and our group tried to control the allogeneic transfusion-associated immunosuppression by use of autologous transfusions. We found in our monocentric study with a very homogenous study population a significantly reduced infection rate in the autologous blood group which was not observed in the multicentric Dutch trial. The second approach was chosen by Jensen from Denmark and van de Velde from the Netherlands. They used leucocyte-depletion to create a less immunosuppressive blood product, which was then randomized pared with conventional allogeneic transfusions. Whereas the monocentric Dutch study showed a significant effect in the pilot study and also in the later larger confirmational study, again this was not found in the multicentric Dutch trial. Concerning the association between prognosis and transfusion the results of two randomized studies are available. The multicentric study from Jeekel from Rotterdam and our monocentric study found also in this endpoint different results. Whereas in our study allogeneic transfusions were an independent risk factor demonstrated in the parison by a clear trend (p = 0.067), this could not be detected in the multicentric Dutch study. In conclusion, the results from actually available randomized studies are pulsive. Whereas the homogeneous monocentric studies showed a significant transfusion effect for the postoperative infection rate and also for long-term prognosis, this could not be verified in two multicentric trials. Also the cumulative meta-analyses are not able to answer the decisive question concerning the causal relationship between transfusion and long-term prognosis. Therefore new and innovative study designs are mandatory. |
11098581 | [Transfusion use in curatively operated patients with colorectal carcinomas. Swiss Study Group for Clinical Cancer Research]. | 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. |
11098582 | [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 pared 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. |
11098583 | [The role of lymph nodes in colon carcinoma]. | Metastatic spread of colon cancer to intermediate lymph nodes is found, depending on tumor stage, in up to 44% of patients and to central lymph nodes in about 10%. The incidence of skip metastases is estimated not to exceed 5%. Tumorous involvement of pericolic lymph nodes occurs almost only within a 10 cm distance from the primary. There is only one prospective randomized controlled trial paring hemicolectomy versus radical segmental colectomy in patients with left colonic cancer. In this limited study there was no statistical difference regarding survival, mortality and morbidity between the two groups. However, several large retrospective studies are in favor of extended colon resection with radical clearance of lymphatic tissue. In 198 patients with colon cancer excluding rectal cancer in a 6-year period we performed 151 radical (76%) and 47 segmental (24%) colonic resections. The median length of the specimens in an unstretched and formalin-fixed state was 39 cm and 19 cm, respectively. The mean number of investigated lymph nodes was 16 and 12, respectively. 40% of our patients showed lymph node metastases. In-hospital mortality was 4/198 patients (2%) and surgical morbidity occurred in 29/198 patients (15%). We mend radical colonic resections in all potentially curable patients with colonic cancer. |
11098593 | [Biology and needs of the aged]. | The elderly age group is growing rapidly as a proportion of the total population of Italy. By the year 2020 the population aged 65 and over is expected to increase from 17% to 23%. The biological process of aging leads to a loss of functional reserves, and so elderly people are frail and affected by multiple diseases. However, health in the elderly is synonymous with self-sufficiency, which may be preserved even in the presence of a disabling disease. According to the new WHO International Classification of Functioning and Disability (ICIDH-2) the important elements in defining health status include personal activity and social participation, as well as body functions. As people age in different ways, the response to the needs of the elderly must be flexible and multidimensional. One of the priority objectives of modern medicine is to push disability to the end of life as much as possible. |
11098594 | [Work capacity and aging]. | Maintaining a good work ability depends on satisfactory health and employment status, which is supported by suitable working conditions and correct life styles. From the biological perspective, ageing means a foreseeable progressive and overall deterioration of the various physiological systems, but not of such a kind and severity to consider most people over 50 as too old or unfit for work, as has been shown by several studies that assessed work ability not only in terms of biological age, but of functional age and actual work output. From the physio-pathological perspective, we can observe either illnesses associated with the passage of time or age-related changes that might precipitate diseases, as well as environmental changes that modulate ageing and developmental changes that accelerate or retard ageing. From the practical point of view, it should taken into account that job demands often do not follow the natural biological and functional changes of the individual, consequently the relative work load can be higher in older workers. On the other hand, ageing also means a professional growth in terms of strategic ability, shrewdness, wisdom and experience. The high interindividual variability of physical, mental and social conditions that is observed with the increase in age makes it necessary to adopt flexible and personally tailored measures, as shown by recent surveys in some European countries aimed at reducing age discrimination and work disability, and at promoting work ability by means of actions directed towards both improvement of work organisation and support of psycho-physical conditions of older workers. |
11098598 | [Aging at work and musculoskeletal disorders]. | By means of a critical review of the international literature and of their own published experiences, the Authors discuss the influence of the "age" factor on work related musculoskeletal disorders of the spine and upper limbs. Regarding the spine, the lumbosacral spine in particular, there is evidence (both in relation to pathways and from epidemiological data) of the influence of age in determining a progressive increase in the occurrence of spondyloarthropathy with clear radiological signs. For upper limb disorders the influence of the "age" factor is still under debate and in any case does not seem of great importance. As far prevention is concerned for elderly workers subject to fixed postures and repetitive movements of the upper limbs it seems sufficient, to adopt the general measures used for the whole working population. However, specific measures should be adopted for elderly workers exposed to manual material handling (MMH). These consist in using reference values for the mended weight that are lower than those adopted for younger workers (aged 18-45 years) and in implementing specific programs of active health surveillance. |
11098595 | [Deficiencies and resources of working population in relation to age: a multidisciplinary approach]. | The aging of the population as a whole and the later age at which young people start work are increasing the percentage of older employees. In situations where the working conditions are highly demanding, as in shiftwork, time-pressure jobs, and adaptation to modern technology or skill diversification, this demographic trend may cause serious problems. The way in which job constraints and demands are withstood at various ages should be considered in relation to health, which is often, whether implicitly or explicitly, a selection criterion in the work place. The connection between work and health can rarely be described by a single causal relationship and requires specific epidemiological methods. Moreover, a health problem linked to age can have a feedback effect on the manner in which a job is performed. While these problems do indeed arise in the areas of work and health, they are nonetheless usually symptoms of modifications that have taken place in the work activity itself. The ergonomic approach nevertheless allows us to improve our understanding of changes in work behavior as age increases, as experience is gained, and as skills are acquired. Men and women on the job are not passive spectators of the good or poor fit between the characteristics of their jobs and their own functional state. Consciously or unconsciously, they modify their operating modes (movements, work pace, posture, etc.), reduce their effort level in some subtasks, make more plans to avoid emergency situations, check the e of their actions so as to reduce errors that would be costly to correct, and adjust the distribution of tasks in cooperative and collective work situations. But these strategies can only be implemented if the work conditions and organization foster and promote them. |
11098600 | [ESTEV study on relationship between health, work and aging in Italy]. | A longitudinal epidemiological study into the relationships between age/health/work is currently under way in different geographical areas throughout Italy. The research is co-ordinated by INRCA (Italian National Research Centres on Aging) in Ancona with the collaboration of the Universities of Ancona, Verona and Bari. This study concerns a population of approximately 2,000 employees from a variety of production sectors. The sample is made up of 5 groups of workers selected according to the year they were born and aged: 32, 37, 42, 47 and 52 years. The chosen research tool is modelled on ESTEV and VISAT researches, the former conducted on a sample of 20,000 French workers, the latter on approximately 3,000 workers and still under way. It involves a set of three questionnaires which allow for a number of variables to be taken into consideration: the first questionnaire concentrates on information regarding the occupation, both past and present; the second on the life style and self-assessed health according to the Nottingham Health Profile (NHP); the pleted by the occupational physician, contains information on current and previous illnesses, the presence of disorders of the musculo-skeletal apparatus, the taking of any drugs and some anthropometrical and clinical-instrumental parameters (Respiratory Functionality Test, Visiotest and Audiogram). The study with be carried out in two phases: a first survey (under way) and a second one five years later on the same subjects. The results of the analysis will pared with those of other European countries. |
11098601 | [Physical exercise in the prevention of musculoskeletal diseases in the elderly worker]. | This paper reviews the impact of ageing on physical work capacity in the elderly worker and the benefits of exercise programmes designed for the prevention of plaints. Physical work capacity generally declines significantly after 50 years of age as a consequence of a reduction in aerobic capacity and muscle strength. The latter is panied by a decline in the fatigue threshold. This, bination with a reduced recovery capacity after exercise, may lead to chronic overload of muscles and tendons in the elderly worker. Thus, it has been proposed that physical exercise programmes may prevent the onset of musculo-skeletal disorders. The effectiveness of different physical exercise programmes proposed in the literature for the prevention of musculo-skeletal disorders is reviewed here. The adoption of an active life-style and the rational use of ergonomic interventions, such as automatization of certain work processes, also appear to be crucial in minimizing the impact of ageing on work ability and capacity in the elderly worker. |
11098596 | [Psychological and psychosocial aspects in the elderly workers]. | The international literature is producing information about job performance of elderly workers that is in contrast with current prejudice. Objectively, the elderly worker exhibits changes in performance but these changes do not necessarily interfere in a negative way. On the contrary, they sometimes have an extremely positive value: it is up to social partners and entrepreneurs to attribute a role and a value to the elderly workers. The psychological data on populations exposed to different occupational risks carried out by the Department of Occupational Health of the University of Milan are revised according to age and seniority. Some suggestions are given to encourage elderly workers to stay at work. |
11098609 | [Incidental findings in gastroenterology. Preventing overdiagnosis]. | The use of diagnostic imaging procedures and laboratory investigations in gastroenterology can sometimes lead to findings of questionable value. This highlights the problem--also from the point of view of costs--of deciding whether further diagnostic investigation is necessary or not. No requirement for action is given, for example, in the case of shallow diverticula in the esophagus, hiatal hernia in the absence of reflux symptoms, in the case of small cysts or hemangiomas in the liver, polyps on the wall of the gallbladder, hyperplasia of Brunner's glands in the duodenum or fungi in the stools of petent persons. Of a controversial nature are the mendations with regard to Helicobacter pylori gastritis, and non-symptomatic gallstones. Further diagnostic clarification is certainly required when such findings as fatty liver, diverticula in the colon or pancreas divisum are encountered. |
11098597 | [Occupational aging and cardiovascular diseases]. | A short review of occupational aging and cardiovascular disease is presented. Coronary and stroke events are typical diseases of aging, in which rare monogenic disorders mon polymorphisms interact with environmental factors. Among these factors, particular attention has been given to social and occupational organizations. Cardiovascular mortality apparently increases with heavy industrialization processes and lower socioeconomic and educational status. Similar data are now available for incidence and case fatality. Since traditional risk factors--e.g., cholesterol, blood pressure and smoking--follow the same pattern, but with a weaker association than expected, observational and preventive studies are considering risk possibilities beyond such factors. Job demand/job decision latitude is the most widely used paradigm to evaluate specific organizational risk at work. A few cohort or population studied and many cross-sectional studies have shown an independent and inverse relationship between decreasing control of the job, coronary disease and blood pressure levels. While such results need further confirmation, they suggest the need for more accurate research on the adverse or mutually protective influences of long-lasting adaptation processes required by prevailing work organization. |
11098610 | [Incidental findings in cardiology. Diagnosing today what can cause illness tomorrow]. | Among the anatomical and functional findings in cardiology, congenitally corrected transposition of the major vessels (ventricular inversion), bicuspid aortic valve and prolapse of the mitral valve with simultaneous mitral insufficiency have at least a potential for causing future problems. In such cases, regular cardiological checks or a further diagnostic work-up is to be mended. The assessment of cardiac sounds can usually be correctly interpreted on the basis of the history, physical examination and auscultation. Among the electrocardiological plete left bundle-branch block and prolongation of the QT segment, mandate clarification of a structural heart condition. Furthermore, in the event of ventricular extrasystoles, right-ventricular cardiomyopathy needs to be excluded. Such isolated conduction disorders as left-anterior fascicular block or right bundle-branch block are of no prognostic significance. |
11098599 | [Fatiguing work, aging and health: a cross-sectional study of a group of anesthesiologists]. | A cross-sectional study was carried out to verify if work as an anaesthetician-reanimator can be considered as a fatiguing job. An anonymous self-administered questionnaire was utilized to obtain information about the general characteristics of the subjects, job organization, human relations, perceived risks and previous diseases; 1438 questionnaires were examined. The results of the study showed that in anaesthetist-reanimator: organic diseases do not occur earlier than expected; perception of the emotional aspects related to the particular occupation is low; the group relationships are difficult, on both horizontal and vertical levels, and these difficulties increase work-stress and hinder its management; age influences the occurrence of both arthritic and stress-related diseases; there is an association between jobs dissatisfaction and stress disorders; all the causal variables considered, evaluated as a group, constitute a heavy physical load, that leads to risk of stress related diseases. |
11098602 | [Aging and work: health aspects in cleaners]. | Over the last few years, studies on the relationship between ageing and work have attracted growing interest due to the increased probability among workers of developing major health problems as a consequence of ageing workers. Negative es for health are possible when an age-related imbalance appears between physical workload and physical work capacity. Cleaning could be considered as a paradigm for studying the relationship between ageing and physically demanding jobs. Cleaning workers show a high proportion of ageing women who are at the bottom level of the social-status class and are generally poorly educated with low e and social support level. This study, particularly aimed at highlighting the presence of musculo-skeletal disorders, was conducted by means of standardized questionnaires and protocols for collecting anamnestic and clinical data. The results show an increased prevalence of disorders of elbow, wrist/hand and cervical spine which could be caused by work organization and non-ergonomic tools. On the basis of the experience gained it was possible to propose solutions for the ageing working population concerning the workload, health surveillance methods and the ergonomic measures as regards organization, work place and tools. |
11098603 | [Aging and occupational accidents]. | Ageing and occupational accidents is an underestimated issue in Italy. This deals both with ings of data and proper studies in the matter and with safety culture and interventions. Nevertheless, some tables are presented showing a relation between ageing and occupational accidents both in frequency and in severity. These results are discussed in the light of a review of the literature on age-related accidents risks of three decades published in 1995. A framework is reported outlined for the purpose of identifying jobs in which ageing has either a preventive or an aggravating effect on accident occurrence. It is concluded that the safety problems of older workers may well be restricted to activities that are specifically "age-impaired". Age-related accident problems can also be specific in terms of injury type, as also demonstrated by some Italian data. Finally, it is emphasized that further research would benefit greatly from longitudinal designs, proper exposure measurements, intra-occupational investigations, consideration of the positive effect of relevant experience on occupational safety and greater precision about the type of accidents in focus. On the prevention side, a better attention to a global approach to safety problems (not only to technological aspects but also to immaterial ones, like work organization, psychosocial factors and so on) is pointed out. |
11098611 | [Incidental findings in endocrinology. When to observe and when intervention is necessary]. | Hirsutism, astia or delayed puberty are usually benign conditions. However, underlying serious disorders must be excluded. Abnormalities in thyroid hormone measurements with contraceptives, glucocorticoids or severe nonthyroid disease must be differentiated from "true" impairments of thyroid function that require specific treatment. Increasingly, abnormalities are detected incidentally (incidentaloma) by diagnostic imaging procedures in organs such as the pituitary or the adrenal gland. Apart from judgements based on the original size of the tumor or the progression in size during observation, functional evaluation is always necessary to decide whether surgery should be mended. |
11098618 | [Epidemiology, clinic and treatment of dermatomycoses caused by zoophilic dermatophytes] . | In the last 50 years the spectrum of agents of dermatophytoses changed. The change is remarkable especially in the case of zoophilic dermatophytes. Microsporum canis has displaced Trichophyton verrucosum. In the period from 1966 to 1970 2822 dermatophytoses were registered as occupational dermatoses in the former German Democratic Republic. In the following years the number of these diseases was continuously reduced, between 1981 and 1985 down to 995 cases. This reduction is predominantly the result of active immunoprophylaxis by means of inactivated, hydrolized vaccines, mainly by the Soviet live vaccine LTF-130. The scientific basis of this vaccination was established by Kielstein and co-workers. The treatment of Microsporum canis infection of the scalp requires the administration of systemically acting antimycotics over a long period (6-8 weeks). |
11098619 | [Incidence and control of cattle ringworm in Scandinavia]. | Clinical aspects, prophylactic as well as therapeutical vaccination with a live attenuated vaccine against Trichophyton verrucosum are dealt with in this article. Further, the epidemical and zoonotical view of the disease is described. The farmers' motives to vaccinate differ depending on type of herd. Hygienic and disinfectant measures in connection with the start of a vaccination program are emphasized. In Sweden, vaccination against ringworm is included in the "Faultless Hide" scheme as one amongst other preventative measures aiming to improve the hide quality. A beneficial effect on both frequency of diseased herds and quality of the hides is obtained. |
11098620 | [Molecular biological methods and their consequences in taxonomy and diagnosis of dermatophytes]. | Trichophyton rubrum, T. mentagrophytes, T. verrucosum, Microsporum canis, M. gypseum and Epidermophyton flocoosum represent the cause of human dermatomycoses isolated most often at the University Hospital of Dermatology in Graz, Austria, between 1991 and 1998. So far, identification was mainly based on the cultivation of fungal isolates on special media as well as on the analysis of their microscopic characters. Restriction enzyme length polymorphisms (RFLPs) were now used to identify these human fungal parasites. For this purpose, internal transcribed spacers (ITS) which are located between ribosomal RNA genes have been amplified by using PCR and have afterwards been used to generate species specific RFLP patterns. By this method, a fast and reliable identification of these species was made possible. Nucleotide sequence data of this region not needed for identification have been worked out to show RFLPs in more detail. |
11098621 | [Differentiation of yeasts in mastitis milk] . | Differentiating 174 yeasts from clinical samples to get a survey of those species found in mastitis milk and milking machines we identified five genera with 29 species. Species of the genus Candida dominated with 77% of all samples. More than 25% of yeasts from milk were identified as C. rugosa and more than 20% as C. catenulata. The six species found most often represented 74% of all yeasts in this group. Yeasts from milking machines were more heterogeneous. |
11098622 | [Mycozoonoses with special regard to ringworm of cattle]. | Ringworm of cattle is nearly exclusively caused by Trichophyton verrucosum. This skin disease is worldwide present in cattle and is responsible for high economic losses in cattle farming. T. verrucosum may also be responsible for severe skin diseases in man. For economic and epidemiological causes a control of ringworm in cattle is still necessary. Preventive measures consist in hygiene and vaccination of cattle with live vaccines against ringworm in cattle. |
11098623 | [Evidence of Cryptococcus neoformans in domestic and sports pigeons in Thyringia]. | 19 strains of Cryptococcus neoformans var. neoformans were isolated from 17 (= 40.5%) of 42 investigated pigeon breeder flocks in Thuringia. |
11098624 | [Asteroid bodies: host-pathogen reactions in mycoses]. | A review of the literature on asteroid bodies (Splendore-Hoeppli phenomenon) as well as an immunoelectronmicroscopic study on asteroid bodies with Candida albicans and electronmicroscopic observations on asteroid bodies with Aspergillus are presented. The following definitions are proposed: Asteroid bodies with Candida albicans: precipitate consisting of fungal antigen and antibodies of host origin in light microscopically visible dimension deposited on the cell wall surface of Candida cells in parasitic condition. Asteroid bodies with Aspergillus: precipitate consisting of fungal antigen, antibodies of host origin and necrotic cellular detritus originated from cells of host defense, in light microscopically visible dimension, deposited on the cell wall surface of abortive Aspergillus cells, reduced in longitudinal growth, in parasitic condition. |
11098625 | [Host-pathogen relations in yeasts]. | Allogenic and autogenic factors are decisive for a colonization of warmblooded hosts by yeasts where they can live inside as mensal or pathogen. To develop pathogenicity a capacity of yeasts for multiplication inside of humans or homoiothermic animals and resistance to environmental influences is not sufficient. Pathogenicity rather depends on the ability of structural morphological changes, phenomena of adherence and of petition as well as the presence of genes for down-regulation of the host defense and for enzyme production enabling a parasitic life style. Among the yeasts Cryptococcus neoformans and some Candida species meet these requirements. |
11098626 | [Molecular biological differentiation of yeasts]. | Regarding the rise and the epidemiological shifts in Candida infections, accurate and rapid identification of yeasts to species level is exceedingly important. Furthermore, non-albicans species (e.g. C. glabrata, C. dubliniensis, C. inconspicua, C. krusei and C. norvegensis) have recently emerged as azole-resistant pathogens. Standard methods for cultivation and differentiation of Candida species are time-consuming, often insensitive and can fail to distinguish non-albicans species. To e low sensitivity, poor specificity and untolerable delay, molecular tools to the diagnosis of Candida infection have been adopted, particularly the polymerase chain reaction (PCR). Several genus and species specific amplification-based diagnostic methods for detection of medically important yeasts have been published. As the incidence of ial Candida infections has been risen significantly, typing has e increasingly important in candidal epidemiology to define infectious processes as well as sources and modes of transmission. For the development of rational infection-control measures, modern genotyping methods based on genomic DNA polymorphism (e.g. pulsed-field gel electrophoresis, DNA amplification-based methods) have replaced conventional physiological techniques. However, reliability, sensitivity and efficiency of genotyping methods have been controversially discussed and these DNA-based methods are mostly insufficiently standardized. Criteria as typeability, reproducibility and discriminatory power should be considered in evaluating typing systems. |
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