148. Magencarcinom und Serumelektrophorese

Zusammenfassung Es werden Merkmale des Magencarcinoms mit den Elektrophoresewerten von 350 Patienten korreliert. Bei folgenden Kriterien sind die Albumine vermindert, die -Globuline vermehrt: Höheres Alter, größerer Gewichtsverlust, zunehmende Penetration, Fernmetastasen (gegenüber Metastasenfreiheit). Hohe -Globuline finden sich beim Ulcuscarcinom und niedrige bei Lymphknotenmetastasen. Mit größerem Tumordurchmesser steigt nur das ₂-Globulin, nicht das ₁-Globulin. -Globuline zeigen ein divergierendes Verhalten. Auf die prognostische Bedeutung der Proteinfraktionen beim Magencarcinom wird hingewiesen.     

Complex role of tumor cell transforming growth factor (TGF)-βs on breast carcinoma progression

Growth inhibition by the TGF-s has been extensively studied in both normal and transformed mammary epithelial cells. It has been proposed that loss of autocrine TGF- mediated growth regulation is a critical event in breast tumorigenesis and several lines ofin vitro andin vivo data support this hypothesis. However, a positive association between the expression of TGF-s by tumor cells and the progression or maintenance of breast cancinoma cells has been observed in many studies inin vivo tumor models. Possible mechanisms for these growth enhancing effects of TGF- include immunosuppression mediated by tumor TGF-s, enhanced angiogenesis, increased peritumoral stroma formation, and cell adhesion. The net effect of tumor cell TGF- on the biology of breast carcinogenesis would depend on the balance between autocrine growth inhibition of mammary epithelial cells and these growth enhancing effects.     

Nasal anatomy: The muscles and tip sensation

The author stresses the importance of columellar sensation, nasal tip sensation, and the role of the nasalis muscles in determining the postoperative results of corrective rhinoplasty, especially as these have an influence on the drooping tip and the columellar base. Specific anatomic details of this area are emphasized in order to help the plastic surgeon understand better the normal anatomy of this region and the effects that operative procedures have on successful results if the surgeon understands especially the role of the nasalis muscles.     

Abdominoplasty combined with correction of the flaccidity of the lateral lower abdomen and the flanks

The author describes a surgical technique for correction of adiposity and flaccidity of both the abdominal wall and the flank region. The technique produces a better final outcome with regard to the resultant lateral dog-ears and flaccidity of the flanks that may result after routine abdominoplasty operation.     

Spinal neurotoxicity and tolerance after repeated intrathecal administration of YM 872, an AMPA receptor antagonist,in rats

Purpose Although the -amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) receptor antagonist, YM 872, has been considered to be useful in analgesia for both acute and chronic pain, there are no studies of its neurotoxicity and tolerance. We examined the spinal neurotoxicity and tolerance of YM 872 analgesia by repeated intrathecal administration in rats.Methods Male Sprague-Dawley rats with lumbar intrathecal catheters received YM 872 at 1µg·10µl^–1 (eight rats; YM group) or normal saline 10µl (eight rats; C group) intrathecally once a day for 30 days. We evaluated the analgesic effects every 3 days, by tail-flick test and behavioral side effects. On the 31st day, the lumbar spinal cord was removed from four randomly selected rats in each group for histological examination.Results The YM group showed significantly longer tail-flick latency when subjected to a high-intensity light beam than the C group at each measurement time point, although no significant changes in the latency according to the time course of the study were observed for the entire study period of 30 days in either group. No rats showed any side effects. Histologically, only slight lymphocytic cell infiltration and degeneration of myelinated fibers occurred, similarly in both groups. No changes were observed in the spinal cord in either group.Conclusion Administration of YM 872 (1µg) once a day for 30 days did not induce any tolerance and caused no histological changes in the spinal cord.     

ESWL: stone-free efficacy based upon stone size and location

Summary Extracorporeal shock wave lithotripsy was used for the treatment of 1060 patients or 1128 kidneys with solitary stones. There were 528 pelvic stones, 82 upper caliceal stones, 120 middle caliceal stones and 398 lower caliceal stones. These groups were divided into two subgroups of large (>15 mm) and small (15 mm) stones. A total of 1232 treatments were carried out (1.16/patient or 1.09/kidney) and 91% of the patients underwent a single treatment. Auxiliary procedures were required in 5% of the patients and the complication rate was 3%. Overall, 74% of the patients were stone-free after 3 months of follow-up. Of the 26% with residual stones, 18% had sand (2 mm fragments) or match-heads (4 mm), 6% had fragments (5 mm) and 2% had no fragmentation at all. A stone-free result occurred in approximately 87% with small pelvic and upper caliceal stones, whereas large stones in these locations became stone-free in approximately 70% of cases. Both large and small stones in the lower half of the kidney (mid and lower calices) become stone-free less frequently (to a statistically significant degree) than do similar stones located in the pelvis or upper calices.     

Antibodies directed at mouse IL-2-R α and β chains act in synergy to abolish T-cell proliferation in vitro and delayed type hypersensitivity reaction in vivo

The anti-mouse IL-2-R chain mAb TM-1 which, by itself, does not affect IL-2-dependent proliferation throught the high affinity mouse IL-2 receptor, was shown to cooperate in a synergistic way with a set of anti-IL-2-R chain mAbs both in vitro and in vivo. In vitro, when associated at equimolar concentrations, the TM-1/anti- mAb association was four to ten times more efficient at inhibiting the proliferation of the CTL-L2 cell line than was a similar concentration of anti- mAb alone. In addition, a bispecific antibody in which a Fab' fragment of TM-1 was covalently linked to a Fab' fragment of one of the anti- mAb (5A2) was shown to be as efficient as the TM-1/5A2 association. The association of TM-1 with 5A2 was also tested in vivo in a sheep red blood cell-induced delayed type hypersensitivity (DTH) model. TM-1 which, by itself, had no effect on DTH, induced a two- to threefold decrease in the doses of 5A2 required to suppress this cell-mediated immune reaction.     

Wear of ultra-high-molecular-weight polyethylene cup articulating with 22.225 mm zirconia diameter head in cemented total hip arthroplasty

A number of studies have highlighted the increasing incidence of aseptic cup loosening with increasing depth of cup penetration by the metal head. We present our experience with a 22.225mm diameter zirconia head on a 9–10 taper articulating with an ultra-high-molecular-weight polyethylene (UHMWPE) cup in cemented total hip arthroplasties. We prospectively studied the wear of the UHMWPE cup articulating with a 22.225mm diameter zirconia head in cemented total hip arthroplasties. A total of 339 patients (153 men, 186 women, 373 hips) were included. The patients mean age at surgery was 52 years (17–76 years), with 41% age 50 years or younger. Their mean weight was 72.4kg (24–125kg). At a mean follow-up of 4.3 years (0–8 years) the mean penetration rate of the cup was 0.03mm/year (0–0.51mm/year). Altogether, 289 (77.5%) showed no measurable wear, 38 (10.2%) had a penetration rate of 0.11mm/year or less, 33 (8.9%) had a rate of 0.12–0.2mm/year, and in 13 (3.5%) the rate was more than 0.2mm/year. Ceramic–UHMWPE is the next stage in the evolution of total hip arthroplasty for addressing wear and any possible related issues.     

Differential expression of transforming growth factor-β1 and β3 as well as C-FOS mRNA in normal human prostate,benign prostatic hyperplasia and prostatic cancer

Summary The discrepancy between the incidence of latent prostate cancer and that of clinically overt carcinoma suggests that there can be different courses in the biological progression of prostate cancer. As this cancer is detected increasingly at an infraclinical stage, markers are needed to indicate which lesions will progress and lead to the patient's death. To investigate the possibility that specific growth factors and/or proto-oncogenes are expressed differentially, we measured mRNA levels of transforming growth factors 1 (TGF-1), TGF-2 and TGF-3 and of the c-fos and c-jun oncogenes by Northern blotting in normal prostate, benign prostatic hyperplasia (BPH) and prostate cancer. Our data demonstrate that expression of TGF-1 increased, whereas that of TGF-3 fell to an almost undetectable level in carcinoma. Expression of c-fos followed the TGF-1 pattern, whereas no difference could be seen in c-jun expression in cancer as compared with BPH and normal prostate. The differential expression of TGF-1, TGF-3 and c-fos could possibly be used to improve the characterisation of prostate cancer. Long-term follow-up of patients may indicate whether mRNA levels of these growth factors and oncogenes correlate clinically and whether they can be used as markers for progression in human prostate cancer.     

Surgical treatment of the atonic bladder (“vesical cap”)

Summary As demonstrated in animal experiments and in five patients with atonic bladders, vesical cap surgery causally solves detrusor impairment by functionally reinforcing it with a vital muscle layer from an ileal seromuscular flap. All other genuine components of the bladder are kept intact, which is very beneficial for bladder function.     

Potentiation of transforming growth factor (TGF-β1) by natural coral and fibrin in a rabbit cranioplasty model

The association of a biodegradable material and a growth factor could be of clinical value for treating bone defects. We therefore tested the association of transforming growth factor (TGF-1) in fibrin glue and coral granules to heal skull defects in rabbits. Adult rabbits underwent a double trepanation symmetrically in both parietal bones. Using histomorphometry, we compared bone repair after 1 month in control animals (n=5) and in animals treated with either TGF-1 as a single injection of 1 g in methylcellulose (n=5) or in fibrin glue (n=5), or with coral granules in fibrin glue (n=4) or with coral granules and TGF-1 1 g in fibrin glue (n=5). We measured the diameter of the remaining defect and the surface of the bone growth. TGF-1 without coral in either methyl cellulose or fibrin induced a partial closure of the defect as assessed by a significant decrease in the defect diameter, compared with the control group. However, the association of TGF-1 in fibrin and coral induced an area of the bone growth higher than in any other groups (P<0.05). Two months after surgery, this triple association induced a better healing of the defect than coral alone or control group. In each group treated with TGF-1, the mineralization rate was increased not only at the treated side but also in the contralateral defect which was untreated, suggesting a diffusion of the growth factor. Indeed, when pooled together, the diameter of the defect at the contralateral side of 14 animals that had received TGF-1 was reduced compared with the control group. Significant coral granules resorption occurred between month 1 and 2 and was unchanged by the addition of TGF-1. In conclusion, the triple association of coral granules and TGF-1 in fibrin could be of interest for treating bone defects.     

Impact of Age on Quality of Life in Patients with Rectal Cancer

Some studies indicate that age at the time of surgery has a general effect on outcomes. The impact of age on the quality of life (QOL) of patients with rectal cancer, however, has not been investigated. The present study was conducted to address this issue. Over a 5-year period the European Organization for Research and Treatment of Cancer (EORTC)-QLQ-C-30 and a tumor-specific module were prospectively administered to patients before surgery, at discharge, and at 3, 6, 12, and 24 months postoperatively. Comparisons were made between age groups. A total of 519 patients participated in the study. QOL data were available for 253 patients. Significant differences were observed only between patients aged 69 years and younger (69 years) (169/253) and those aged 70 years and older (70 years) (85/253). Physical and role functioning was better for patients 69 years; patients 70 years suffered from increased pain and fatigue. Younger patients had more difficulty with sexual enjoyment, and over time sexual strain was worse for patients aged 70 years during the early postoperative period but improved, whereas patients aged 69 years had increasing levels of strain over time. The findings in this study confirmed that QOL is dynamic over time and that age has an impact on QOL and sexuality. Patients aged 70 years are affected by impaired physical functioning, global health, and fatigue, whereas increased treatment strain during the early postoperative period improves over time. Patients aged 69 years experience increased strain because of impaired sexual function.     

Demonstration of the 5-flap technique

Summary Demonstration of the 5-flap technique which is double opposed Z-plasty and Y – V advancement is presented. A 4×4 gauze serves to demonstrate this technique.The authors dedicate this paper to the dear memory of their teacher, the late Prof. Zvi Neuman, who passed away untimely on March 22, 1977     

Interrelationship between immunocompetent and structural cells in post-burn scars

It has been suggested that immunological factors play a major role in the pathogenesis of hypertrophic scars. Characteristically there is an onset of typical clinical features and, after a variable period of activity, there is a phase of remission. The factors which produce this progressive change in the scars are not clear, and it is not known if their manipulation could provide a therapeutic progress. In order to further investigate the pathophysiology, morphological studies have been performed. In active hypertrophic scars lymphocytic infiltrates are abundant. Among them activated T-cells represent 70% of infiltrates while in normotrophic scar activated T-cells make up 30% of lymphocytes, suggesting a role of these cells in the mechanisms leading to scar hypertrophy. Upon activation, the lesional T-cells release several cytokines which may induce anomalous expression of activation markers (HLA-DR, ICAM-1, CD36, IL-2R) on keratinocytes and fibroblasts of hypertrophic tissue. A wide range of cytokines has been examined: among those analyzed the only one that changes in the remission phase is IFN. In fact, IFN is highly expressed in lymphocytes in active hypertrophic scars while it is less expressed in the remission phase and in control samples.Presented at the European Burns Association State of the Art Symposium, Control of the Burn Scar, Amsterdam, The Netherlands, October 4–5, 1996     

Influence of age,comorbidity, type of operation and other variables on lethality and duration of post-operative hospital stay in patients with peptic ulcer

Three hundred and three consecutive patients operated on for peptic ulcer for the first time between 1 January 1984 and 31 December 1993 were evaluated in this retrospective study. Eleven variables (Period when operation took place, gender, smoking behaviour, history of former ulcers, ulcerogenic drug intake, ulcer location, epigastric pain, number of blood units substituted, patient's age, type of operation, comorbidity) were investigated regarding their influence on peri- and post-operative mortality and on the length of hospital stay after operation. We found that a high comorbidity score (>2) and the indication emergency operation (vs elective operation) had an adverse impact on survival. The importance of age was marginal. The duration of post-operative hospital stay in survivors was negatively influenced by age higher than 60 years, more than two red cell units substituted and a high comorbidity score according to Charlson.

---

Einfluß von alter, komorbidität, art der operation und anderen variablen auf die letalität und die dauer des postoperativen krankenhausaufenthalts bei patienten mit peptischem ulkus. Eine analyse von 303 chirurgisch behandelten patienten

Zusammenfassung In dieser retrospektiven Studie wurden im Zeitraum zwischen dem 1.1.1984 und dem 31.12.1993 303 operativ behandelte Ulkuspatienten erfaßt. Elf potentielle Einflugröen (Zeitraum der Operation, Geschlecht, Raucherverhalten, Ulkusanamnese, Einnahme ulzerogener Medikamente, Ulkuslokalisation, Magenschmerz, Anzahl der substituierten Blutkonserven, Alter der Patienten, Operationsindikation, Komorbidität) wurden hinsichtlich ihres Einflußes auf die peri- und postoperative Sterblichkeit sowie die Krankenhausverweildauer untersucht. Hohe Komorbidität (>2) und die Indikation Notfalloperation (gegen elektive Operation) zeigten einen negativen Einfluß hinsichtlich des Überlebens. Dem Alter kam nur eine geringe Bedeutung zu. Die postoperative Aufenthaltsdauer wurde hauptsächlich durch hohes Alter (>60 Jahre), eine hohe Anzahl (>2) substituierter Blutkonserven und einen hohen Komorbiditätsscore nach Charlson negativ beeinflußt.

The paper contains major parts of R. J. Ricker's thesis at the University of Ulm     

The ErbB Receptors as Targets for Breast Cancer Therapy

Breast carcinomas express high levels of ErbBreceptors and their ligands, and their overexpressionhas been associated with a more aggressive clinicalbehavior. For these reasons therapies directed at these receptors have the potential to be usefulanti-cancer treatments. A series of monoclonalantibodies (MAbs)³ directed against the EGF(ErbB1) receptor and the closely related HER2/Neu(ErbB2) receptor are currently under evaluation. These MAbs haveshown promising preclinical activity andchimeric and humanized MAbshave been produced in order to obviate the problem ofhost immune reactions. These antibodies are currently being tested inclinical trials either alone or in combination withchemotherapeutic agents. Clinical activity with one ofthese antibodies, trastuzumab, a humanized anti-ErbB2 MAb, has been documented in patients withbreast cancer in a series of clinical trials and hasrecently been approved for the therapy of patients withmetastatic ErbB2 overexpressing breast cancer. Inaddition to antibodies, compounds that inhibit receptortyrosine kinases have shown significant preclinicalactivity and are currently being evaluated in theclinic.     

Effects of thiopental on cardiac energy metabolisms in postischemic reperfusion in rat

In experiments on isolated rat heart lung preparation, the effects of thiopental on myocardial metabolisms in postischemic reperfusion were evaluated with intramyocardial high energy phosphates, lactate, pyruvate and glycogen. The release of CPK in the perfusate blood was also measured at the end of reperfusion. After 10min perfusion, hearts were made globally ischemic for 8min and reperfused for 12min. Large dose of thiopental (100µg/ml) reduced the energy charge and glycogen content. Reperfusion with an anesthetic dose of thiopental (10µg/ml) resulted in an exacerbation of the CPK release. Protection by thiopental during ischemia was not observed and its high dose may be harmful.(Kashimoto S et al.: Effects of thiopental on cardiac energy metabolisms in postischemic reperfusion in rat. J Anesth 1: 77–81, 1987)     

The role of TGF-β in patterning and growth of the mammary ductal tree

Evidence that transforming growth factor beta (TGF-)⁴ influences pattern formation in the developing mammary gland and negatively regulates ductal growth is reviewed. In the mouse, overexpression of TGF- transgenes during puberty reduces the rate of growth of the ductal tree and simplifies the pattern of arborization, while expression during pregnancy also interferes with lactation. Expression studies in the normal mouse gland indicate that TGF- is synthesized in the mammary epithelium, with the three isoforms showing somewhat different spatial and temporal distributions. Exogenous TGF- applied directly to the glandin situ inhibits epithelial cell division within hours, and strongly stimulates extracellular matrix synthesis over a longer time course. Normal human breast cells as well as certain breast cancer cell lines also secrete TGF- and are themselves inhibited by it, suggesting an autoregulatory feedback circuit, that in some cases appears to be modulated by estradiol. Taken together, the evidence suggests a model in which growth and patterning of the mammary ductal tree are regulated, at least in part, by TGF- operating through an autocrine feedback mechanism and by paracrine circuits associated with epithelial-stromal interactions.     

242. Korrelation klinischer und biochemischer Befunde mit dem Schweregrad einer bakteriellen Peritonitis

Zusammenfassung Anhand von Verlaufsdaten 66 chirurgischer Patienten mit einer bakteriologisch gesicherten Peritonitis sollten harte und weiche Kriterien zur Beurteilung des Schweregrades differenziert werden. Untersuchungskriterien: 1) regionale Ausbreitung, 2) Entwicklung eines Organod. Systemversagens, 3) Leukocytose/Thrombopenie, Körpertemperatur, 4) die Plasmamediatoren Endotoxin/Prostaglandin F₂ (PGF₂), 5) Anamnesedauer (Erstsymptom bis OP), 6) Anzahl erforderlicher Reoperationen und 7) Lebensalter. Zuzuordnende Schweregrade: Grad 1: überlebt, Grad 2: mit Komplikationen überlebt, Grad 3: nicht überlebt. Danach erweisen sich als harte Kriterien: 1) Lokalisation, 2) Anamnesedauer, 3) Leukocytose, 4) Endotoxin > 100 Eu/ml, PGF₂ > 500 pg/ml, 5) Körpertemperatur 38,5°C.     

Vertical lengthening of the unilateral cleft lip after a triangular flap repair

Summary A triangular flap repair for unilateral cleft lip is stated to have the potential problem of creating a lip that is too long. Although preoperative measurements were performed with calipers, the gap created in the medial segment was directly measured during the procedure, in order to determine the size of the flap more precisely. Ninety patients with complete unilateral cleft lips underwent a triangular flap repair using this method. The symmetry of the Cupid's bow was evaluated at a follow-up period averaging between six years and three months. Sixty-two lips obtained symmetry and the remaining 28 cases showed a lip which was too long; none of the lips were too short. The comparison between 27 primary palate clefts (UCLA) and 63 primary and secondary palate clefts (UCLP) showed no significant difference in the surgical result. The preoperative shortness of the lip on the cleft side was significantly greater in the too long group (5.01 ± 0.95 mm) than in the symmetry group (4.40 ± 0.87 mm). The width of the flap used was significantly larger in the too long group (3.76 ± 0.79 mm) than in the symmetry group (3.42 ± 0.69 mm). The triangular flap repair with intraoperative measurements is considered to be beneficial, although preoperative measurements provide an optimal design in most cases. It is suggested that the use of a wider triangular flap results in a lip which tends to be too long in spite of the preoperative shortness on the cleft side.