Jörg Tschmelitsch - Academia.edu (original) (raw)

Papers by Jörg Tschmelitsch

Ejso, Sep 1, 2012

5). Statistical analysis was performed to evaluate the difference of complication rates between t... more 5). Statistical analysis was performed to evaluate the difference of complication rates between the different BMI groups. Results: Some 444 patients were included for analysis. Overall 300 (67.6%) of the 444 patients did not develop postoperative complications, 82 (18.4%) patients suffered from minor (grade 1+2) and 56 (12.6%) from major (grade 3+4) complications. Six (1.4%) patients died (grade 5). Fisher«s exact test indicated no statistically significant difference of complication rates between the different BMI groups (p¼0.3716). Conclusion: Compared with nonobese or normal-weight patients, obese patients do not have a statistically significant higher risk to develop postoperative complications after rectal resection for carcinoma.

Annals of Surgical Oncology, Sep 1, 2000

Over one third of patients with stage II colonic adenocarcinoma experience tumor recurrence. Beca... more Over one third of patients with stage II colonic adenocarcinoma experience tumor recurrence. Because effective adjuvant therapy is now available, it is important to identify subsets of patients at higher risk for relapse who may benefit from early treatment. Immunohistochemistry has been used to detect microscopic metastases in histologically uninvolved mesenteric lymph nodes, but the prognostic significance of minimal nodal involvement has not been established. Hematoxylin and eosin (H&E)-stained recuts of 900 mesenteric lymph nodes from 55 patients (range, 2-47; mean, 16.4 nodes per case) with resected pT3 or pT4, N0, M0 (TNM stage II) colonic adenocarcinomas were re-examined for the presence of metastases and then stained immunohistochemically for keratin using the AE1:AE3 antibody. Twenty-seven patients did not experience recurrence of tumor within 5 years following resection (no evidence of disease [NED]); 28 patients relapsed during the same time frame. Lymph nodes from 10 patients having colonic resections for nonneoplastic disorders also were stained as controls. Keratin-positive cells and cell clusters were quantified in the lymph nodes, and comparisons were made between patients with and without tumor relapse. In the relapse group, four patients had positive nodes already identified on the H&E-stained recuts and had to be excluded from further analysis. Sixteen additional patients had keratin-positive cells; thus, 16 of 24 (67%) had micrometastases. In the NED group, one patient had a positive node on H&E staining and 22 additional patients had keratin-positive cells, so 22 of 26 (84%) patients had micrometastases. In the patients who had micrometastases, there was a mean of 3.5 and 4.6 positive nodes in the relapse and NED groups, respectively, and a mean of 11.3 and 12.4 keratin-positive cells or clusters in the relapse and NED groups, respectively. No keratin-positive cells were found in the 1 to 21 (mean, 9.1) nodes per case studied in the control patients. Micrometastases to histologically uninvolved mesenteric lymph nodes commonly are detected in patients with pT3 or pT4 colonic adenocarcinomas on recuts stained immunohistochemically for keratin. Nodal micrometastases detected by immunohistochemical staining are not useful for identifying stage II patients at higher risk for relapse.

Acta chirurgica Austriaca, Jul 1, 1998

ABSTRACT Background: The aim of this paper is to analyze our experience with liver resection for ... more ABSTRACT Background: The aim of this paper is to analyze our experience with liver resection for metastatic colorectal cancer and to evaluate the prognostic significance of various parameters. Methods: 40 consecutive patients treated with potentially curative liver resection between 1984 and 1996 were included. The prognostic significance of various parameters was evaluated with respect to survival. Univariate and multivariate analyses were performed for following factors: age, gender, site and stage and grading of the primary tumor, size of metastases, number of metastases, lobar distribution of metastases, diagnostic interval, type of liver resection, resection margin, perioperative blood transfusion and preoperative carcinoembryonic antigen (CEA) level. Results: 3-year- and 5-year survival was 54% and 33%, median survival was 37 months. The 30 day mortality rate was 0%, postoperative complications occurred in 8 patients (20%). As single factors the following significantly affected the prognosis: number of metastases (p=0.0001), mesenteric lymphnode involvement of the primary tumor (p=0.002), lobar distribution (p=0.002) and intraoperative units of blood (p=0.05). Multivariate analysis revealed that age, gender, mesenteric lymphnode involvement, number of metastases and synchronous versus metachronous metastatic disease were independent predictors of survival. Conclusions: Liver resection is effective in selected patients with hepatic metastases from colorectal cancer. In resectable patients it is not possible to establish a clear prognosis based on the investigated factors. Therefore, patients with adverse prognostic factors should not be denied resection. Grundlagen: Das Ziel dieser Studie war unsere Ergebnisse von Leberresektionen bei metastasierenden kolorektalen Karzinomen zu analysieren. Der Einfluß verschiedener Faktoren auf das Überleben wurde bestimmt und diskutiert. Methodik: 40 Patienten mit radikalen Resektionen von synchronen oder metachronen Lebermetastasen wurden in die Studie eingeschlossen. Folgende Faktoren wurden in einer univariaten und multivariaten Analyse hinsichtlich ihrer Bedeutung auf das Überleben untersucht: Alter, Geschlecht, Lokalisation, Stadium und Grading des Primärtumors, Größe der Metastasen, Anzahl der Metastasen, Lappenverteilung der Metastasen, Zeitpunkt des Auftretens der Metastasen, Art der Leberresektion, Resektionsrand, Blutkonserven, und präoperativer CEA-Spiegel. Ergebnisse: Das 3-Jahres- und 5-Jahres-Überleben war 54% und 33%, das mediane Überleben betrug 37 Monate. Die perioperative Mortalität (30 Tage) betrug 0%, Komplikationen traten bei 8 Patienten (20%) auf. In der univariaten Analyse waren die Anzahl der Metastasen (0.0001), N-Stadium des Primärtumors (0.002), Lappenverteilung der Metastasen (0.002) und die Gabe von Blutkonserven (0.05) unabhängige prognostische Faktoren bezüglich des Überlebens. In der multivariaten Analyse erwiesen sich Alter, Geschlecht, N-Stadium des Primärtumors, Anzahl der Metastasen und Zeitpunkt des Auftretens der Metastasen als unabhängige prognostische Faktoren. Schlußfolgerungen: Die Resektion kolorektaler Lebermetastasen ist eine wirksame und sichere Form der Therapie bei einem selektionierten Patientengut. Bei Patienten mit resektablen Lebermetastasen erlauben präoperativ erhobene Befunde keine klare Aussage hinsichtlich der Prognose. Es sollte daher das Vorhandensein prognostisch ungünstiger Faktoren nicht als absolute Kontraindikation für eine Resektion gelten. Alle Patienten mit offensichtlich radikal resektablen Lebermetastasen kolorektaler Karzinome sollten als Kandidaten für eine Operation angesehen werden.

Southern Medical Journal, Nov 1, 2011

Objective: Evaluate whether depth of infiltration within T3 colorectal tumors influences long-ter... more Objective: Evaluate whether depth of infiltration within T3 colorectal tumors influences long-term oncologic outcome. Patients and Methods: Patients with stage pT3 colon and rectal tumors were divided into four subgroups according to the depth of infiltration. The influence on overall and disease-free survival was tested for each subgroup and compared in univariate and multivariate analyses. Results: A total of 368 patients were evaluated, with a median follow-up time of 92.5 months. In 181 patients with colon cancer 5-and 10-year overall survival rates were 82.7% and 65.0%, respectively, and 5-and 10-year disease-free survival rates were 80.9% and 64.4%, respectively. For 187 patients, rectal cancer 5-and 10-year overall survival rates were 69.0% and 50.5%, respectively, and disease-free survival rates were 61.3% and 47.5%, respectively. In either colon or rectal cancer, different pT3 categories showed neither a statistically significant influence on survival nor the occurrence of local or distant recurrence in univariate and multivariate analyses; however, higher pT3 subgroups had a significant influence on lymph node involvement and vessel invasion in patients with rectal cancer. Conclusions: Subdivision of pT3 tumors in colon cancer based on depth of infiltration does not provide additional information about prognosis. In rectal cancer, T3 substages were associated with lymph node involvement; however, we could not demonstrate an impact on recurrence or survival.

PubMed, Oct 1, 1995

Laparoscopic ultrasound (LUS) was performed in 24 patients undergoing routine laparoscopic cholec... more Laparoscopic ultrasound (LUS) was performed in 24 patients undergoing routine laparoscopic cholecystectomy at the Second Surgical Department of the University Hospital of Innsbruck, Austria. After introduction of the ultrasonic probe via the umbilical incision, liver, biliary tract, pancreas, kidneys, stomach, and colon were investigated to assess the sonomorphology of these organs and to judge whether or not LUS is a feasible and reliable means for screening the abdominal organs during routine surgery or laparoscopic staging of upper gastrointestinal (GI) tumors. In all cases, a very accurate investigation of these organs was possible, and the laparoscopic procedure was prolonged for only 15 to 20 min. In eight further patients, LUS was performed to investigate pancreatic pathology (six cases), stomach cancer (one patient), and primary hepatocellular carcinoma (one patient). Three additional patients (pancreatic lesions) who underwent intraoperative ultrasonography with the LUS probe were excluded from this evaluation.

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PubMed, Oct 1, 1999

This article compares the effectiveness of radiation delivered by a radiolabeled monoclonal antib... more This article compares the effectiveness of radiation delivered by a radiolabeled monoclonal antibody, 131I-labeled A33, that targets colorectal carcinoma, with that of 10 fractions of conventional 320 kVp x-rays. Methods: Human colorectal cancer xenografts (SW1222) ranging between 0.14 and 0.84 g were grown in nude mice. These were treated either with escalating activities (3.7-18.5 MBq) of 131I-labeled A33 or 10 fractions of 320 kVp x-rays (fraction sizes from 1.5 to 5 Gy). Tumor dosimetry was determined from a similar group of tumor-bearing animals by serial kill, tumor resection and counting of radioactivity in a gamma counter. The relative effectiveness of the two radiation therapy treatment approaches was compared in terms of tumor regrowth delay and probability of tumor cure. Results: The absorbed dose to tumor per MBq administered was estimated as 3.7 Gy (+/-1 Gy; 95% confidence interval). We observed a close to linear increase in tumor regrowth delay with escalating administered activity. Equitumor response of 1311 monoclonal antibody A33 was observed at average radiation doses to the tumor three times greater than when delivered by fractionated external beam radiotherapy. The relationship between the likelihood of tumor cure and administered activity was less predictable than that for regrowth delay. Conclusion: The relative effectiveness per unit dose of radiation therapy delivered by 131I-labeled A33 monoclonal antibodies was approximately one third of that produced by fractionated external beam radiotherapy, when measured by tumor regrowth delay.

PubMed, Jul 1, 1994

Background: From January 1983 to January 1991, radical surgical treatment for carcinoma of the re... more Background: From January 1983 to January 1991, radical surgical treatment for carcinoma of the rectum was performed upon 154 patients in our department. In 30 instances, local treatment failure occurred and patients were treated either conservatively or operatively. Survival times of these 30 patients were compared to evaluate if operation, even in instances in which only palliative resection is possible, can prolong survival and if early diagnosis of recurrence leads to a higher rate of radical resections and subsequent cure. Study design: Patients were divided into three groups. Group 1 consisted of patients not undergoing an operation, patients in group 2 had a palliative resection and patients in group 3 had radical resections. The median survival time was estimated for each group. Results: The median survival period was six months for group 1, 17 months for group 2, and 35.5 months for group 3. Four patients who underwent reoperation for cure are still alive: one with recurrent tumor after 28 months, and three without evidence of disease after 32, 42 and 43 months. The most valuable diagnostic mean in the detection of local recurrence was endosonography. Conclusions: Surgical treatment for recurrent carcinoma of the rectum is justified not only in cases having radical resection but also as a palliative approach. Compared to other investigative methods, endosonography seems to detect recurrences earlier, at a time when curative retreatment is still possible.

Journal of Clinical Oncology, May 20, 2009

4109 Background: Pre-operative chemoradiation is a standard treatment for LARC. X and C are syner... more 4109 Background: Pre-operative chemoradiation is a standard treatment for LARC. X and C are synergistic with radiotherapy and active in colorectal neoplasms. This phase II multicenter trial was designed to assess the feasability and tolerability of a preoperative combination of X, C, plus RT in patients with LARC. Secondary endpoints were downstaging-rate and induction of complete pathological response (CPR). Only patients (pts.) with MRT-documented T3/T4-tumours were included. Methods: Pts. with potentially resectable cT4 or cT3 LARC (lower/mid rectum) were enrolled. Chemoradiotherapy consisted of X (825mg/sqm twice daily on RT-days weeks 1–4), C (400mg/sqm loading dose once per week, 200mg/sqm weekly x 4) and pelvic RT 3D conformation technique (1.8Gy/day, 45Gy total). Surgery was performed 28–42 days after completion of RT. Results: 31 pts. were enrolled, median age was 61 years (range 41 to 80), PS 0: 22 pts. (71%), PS 1: 8 pts. (26%), PS 2: 1 pt. (3%). 21 pts. (68%) presented with cT4, 10 pts. (32%) with cT3 tumors. 25 pts. (81%) had positive lymph nodes (LN) by imaging, 2 pts. were LN-negative, 4 pts. (13%) are not evaluable for N-stage. 28 pts (90%) are available for evaluation of toxicity and efficacy. Treatment with X and C plus RT was well tolerated, in only 4 pts. grade 3 toxicity was observed: acneiform skin rash 2 pts (7%), diarrhea 3 pts (11%), 1 pt. (4%) suffered from grade 4 diarrhea. Median dose intensity of X and C was >95% during the entire treatment period. Tumor downstaging was observed in 14 pts. (50%) total, 12/19 (63%) T4 tumours and 2/9 (22%) T3 tumors responded. While no patient achieved a CPR, in 14 pts. a lymph node clearing (ypN0) was observed. Conclusions: The combination of capecitabine and cetuximab plus radiotherapy is a well tolerated preoperative treatment regime for LARC (cT3/4). The main toxicity consisted of diarrhea. The combination is effective in the primary tumor as well as in the lymph nodes, both with possible impact on therapy outcome. No significant financial relationships to disclose.

Surgical Endoscopy and Other Interventional Techniques, Nov 1, 1999

Background: Rectus sheath hematoma (RSH) is a rare entity that can mimic an acute abdomen. Theref... more Background: Rectus sheath hematoma (RSH) is a rare entity that can mimic an acute abdomen. Therefore, we designed a study to analyze the etiology, frequency, diagnosis using ultrasound, and treatment of RSH. Methods: A total of 1,257 patients admitted for abdominal ultrasound for acute abdominal pain or unclear acute abdominal disorders were evaluated. Results: In 23 (1.8%) patients, an RSH was diagnosed; three of them were not diagnosed preoperatively by ultrasound. Of 13 men and 10 women (mean age, 57 ± 23 years), 13 developed RSH after local trauma, three after severe coughing, two after defecation, and five spontaneously. Fifteen had nonsurgical therapy, and eight underwent surgery. The use of anticoagulants was accompanied by a larger diameter of the RSH (p < .012), and surgical therapy was more frequently required in these patients. In the surgically treated group, more intraabdominal free fluid could be detected by ultrasound (p < .0005), patients required less analgesics (p < .001), and the mean hospital stay was shorter (p < .001). Conclusions: RSH is a rare condition that is usually associated with abdominal trauma and/or anticoagulation therapy. Ultrasound is a good screening technique. Nonsurgical therapy is appropriate but leads to a greater need for analgesics. Surgery should be restricted to cases with a large hematoma or free intraabdominal rupture.

British Journal of Surgery, Nov 1, 2021

intraperitoneal/retrorectus), and six postoperative variables (any complication, surgical-site oc... more intraperitoneal/retrorectus), and six postoperative variables (any complication, surgical-site occurrence, wound infection, seroma, haematoma, wound dehiscence) were identified as significant prognostic factors for hernia recurrence. Conclusions: This study summarized the current evidence base for predicting ventral hernia recurrence. Results should inform best practice and future research.

Gastroenterology, Apr 1, 1995

The neuropeptides substance P, vasoactiveintestinal polypeptide, and the recently discoveredpepti... more The neuropeptides substance P, vasoactiveintestinal polypeptide, and the recently discoveredpeptide secretoneurin are neurotransmitters of theintrinsic nervous system of the gut and effect gutmotility. The aim of this study was to investigatewhether these neuropeptides are involved in thepathophysiology of large bowel ileus. Five patientsunderwent colonic resections for obstructive cancer ofthe colon. Full-thickness specimens of the resected colonwere taken 10 cm proximal and 10 cm distal to the siteof tumor obstruction. Substance P-, vasoactiveintestinal polypeptide-, and secretoneurin-likeimmunoreactivities were measured in the specimens byradioimmunoassay. In addition immunocytochemistry wasperformed. Tissue levels of substance P, vasoactiveintestinal polypeptide, and secretoneurin were lower inthe prestenotic than in the poststenotic bowel segment. Inaccordance, immunocytochemistry revealed a denserstaining of ganglion cells and fibers for all threeneuropeptides in the poststenotic bowel. The decreasedtissue levels of substance P, vasoactive intestinalpolypeptide, and secretoneurin in the prestenotic bowelsegment may contribute to the final decompensation ofobstructive ileus.

European Journal of Anaesthesiology, Jun 1, 2006

A-457 Paraplegia 15 minutes after thoracic epidural puncture C. Wutti1, J. Tschmelitsch2, M. Jago... more A-457 Paraplegia 15 minutes after thoracic epidural puncture C. Wutti1, J. Tschmelitsch2, M. Jagoditsch2, J. Vogelsang3, M. Zink1 1Department of Anaesthesiology and Intensive Care Medicine, BHB St. Veit/Glan and Medical University of Graz; 2Department of Surgery, BHB St. Veit/Glan, Austria Background: Spinal haematoma with neurologic sequela is a serious complication after epidural catheterization with a frequency of 1:150.000 (1). Most of these cases are correlated with anticoagulation therapy or pre-existing coagulation disorders and have an onset of neurologic symptoms after approximately 15 hours (2). Case Report: We report the case of a 61 years old man, suffering from an acute exacerbation of a chronic pancreatitis with severe persistent pain (VAS 10). As there was good pain control with epidural analgesia in former episodes of his illness an epidural catheter was inserted between thoracic segment 8 and 9. Medical history and laboratory results showed no coagulation disorders. Pain decreased to VAS 1 to 2 for the next 6 days. On the sixth day the catheter dislocated accidentally. Following intravenous application of analgesics (Piritramid, Metamizol) was ineffective (VAS 7). Therefore we decided to insert a new epidural catheter (thoracic 7/8). Again laboratory results showed normal coagulation parameters and the interval to the last dose of 40 mg Enoxaparin was more than sixteen hours. After three attempts the catheter was inserted. A hemorragheous backflow occurred and the catheter was pulled back 1 cm. Now hemorrhage stopped. Ten minutes later the patient reported severe back pain (VAS 10) with a punctum maximum 3 segments below the puncture site, again 5 minutes later paraplegia of the legs developed. Computertomography and MRI revealed a large haematoma with neuronal compression between T4 to T9. Emergency hemilaminectomia for haematoma evacuation was performed 1 hour later and a large bleeding venous network was detected. 12 days after this procedure the patient left the hospital without any neurologic disorders. Conclusion: Paraplegia due to iatrogenic spinal hemorrhage can develop within a few minutes after epidural puncture. If severe pain a few segments below puncture site is observed one should consider the possibility of a spinal bleeding. If spinal decompression is performed without time delay neurological prognosis can be excellent. References: 1 Tryba M. Anasthesiol Intensivmed Notfallmed Schmerzther 1993; 28: 179–81. 2 Vandermeulen EP, Van Aken H, Vermylen J. Anesth Analg 1994; 79: 1165–177.

Lung Cancer, Jul 1, 1992

This report describes an unusual case of small bowel metastases secondary to carcinoma of the lun... more This report describes an unusual case of small bowel metastases secondary to carcinoma of the lung in a 60-year-old woman. The patient, who had been operated upon twice for two primary tumors of the lung in May 1985 and March 1990, presented with moderate anemia and a 6-week history of intermittent epigastric pain in October 1990. Esophagogastroduodenoscopy showed a duodenal ulcer without signs of perforation or hemorrhage. Because of the patient's history biopsies were taken and these revealed metastasis of the bronchial tumor. The few previously reported cases of small bowel metastases from lung cancer all presented with severe complications as perforation, hemorrhage or obstruction. In this case early operation prevented severe complications from small bowel metastases secondary to lung cancer.

Journal of Ultrasound in Medicine, Apr 1, 1992

The ability of endosonography (ES) to detect local recurrence after 'curative' surgery for rectal... more The ability of endosonography (ES) to detect local recurrence after 'curative' surgery for rectal cancer was investigated in 65 patients. Fifteen patients developed local recurrence. All of these 15 patients had ES evidence of recurrence; in four cases recurrence was detected by ES alone. Ten of the 15 patients with local failure underwent reoperation. Four patients were can

Southern Medical Journal, May 1, 2010

The case of a 75-year-old female suffering from recurrent abdominal pain and nausea is presented.... more The case of a 75-year-old female suffering from recurrent abdominal pain and nausea is presented. Ultrasound showed gallstones without inflammation of the gallbladder. The patient underwent laparoscopic cholecystectomy and her symptoms resolved. Histological examination of the operation specimen disclosed heterotopic pancreatic tissue within the cystic duct. An accurate clinical diagnosis of pancreatic heterotopia is difficult. The deep submucosal or intramural location of the lesion may hamper retrieval of representative biopsy material. Indications for surgery or endoscopic resection include symptomatic lesions as well as cases of unclear histological examination in order to distinguish pancreatic heterotopia from other tumors.

American Journal of Surgery, Oct 1, 2008

BACKGROUND: Controversy still exists concerning the impact of patient and tumor characteristics o... more BACKGROUND: Controversy still exists concerning the impact of patient and tumor characteristics on anastomotic dehiscence after resection for rectal cancer. METHODS: Between January 1986 and July 2006, 472 patients underwent curative rectal resection. Patient and tumor characteristics, details of treatment, and postoperative results were recorded prospectively. Univariate and multivariate analysis were applied to identify risk factors for anastomotic leakage. RESULTS: In our patients, the anastomotic leak rate was 10.4% (49 of 472 patients), and mortality was 2.2% (1 of 49 patients). In univariate analysis, tumor diameter and absence of a protective stoma were associated with increased anastomotic leak rate, whereas American Society of Anesthesiologists (ASA) score and tumor localization showed borderline significance. In multivariate analysis, tumor diameter, tumor localization, and absence of a protective stoma were significantly associated with anastomotic leakage. CONCLUSIONS: Patients with large and low lying rectal tumors are at high risk for anastomotic leakage. A protective stoma significantly decreases the rate of clinical leaks and subsequent reoperation after low anterior resection.

Colorectal Disease, Sep 1, 2003

Aim The standard treatment for patients with clinically resectable rectal cancer is surgery. Post... more Aim The standard treatment for patients with clinically resectable rectal cancer is surgery. Postoperative radiochemotherapy (RCT) is recommended for advanced disease (pT3 ⁄ 4 or pN+). In recent years, encouraging results of pre-operative radiotherapy have been reported. This prospective randomized phase-III-trial (CAO ⁄ AR-O ⁄ AIO-94) compares the efficacy of neoadjuvant RCT to standard postoperative RCT. We report on the design of the study and first results with regard to toxicity of RCT and postoperative morbidity. Conclusion The patient accrual to the trial is satisfactory. Neoadjuvant RCT is well tolerated and bears no higher risk for postoperative morbidity.

http://isrctn.com/, Jun 12, 2015

Annals of Surgery, 1989

ABSTRACT