Stephan Kriwanek - Academia.edu (original) (raw)
Papers by Stephan Kriwanek
Steroids
Human colorectal cancer cells not only express the nuclear vitamin D receptor (VDR) but are also ... more Human colorectal cancer cells not only express the nuclear vitamin D receptor (VDR) but are also endowed with 25-hydroxy-vitamin D(3)-1alpha-hydroxylase activity and therefore are able to produce the specific ligand for the VDR, the hormonally active steroid 1alpha,25-dihydroxyvitamin D(3) (1alpha,25(OH)(2)D(3)). In the present study we show by semiquantitative reverse transcriptase polymerase chain reaction (RT-PCR) as well as by Western blotting and immunohistochemical methods, that in human large intestinal carcinomas expression of the genes encoding the 25-(OH)D(3)-1alpha-hydroxylase as well as the VDR increases in parallel with ongoing dedifferentiation in the early phase of cancerogenesis, whereas in poorly differentiated late stage carcinomas only low levels of the respective mRNAs can be detected. This indicates that, through up-regulation of this intrinsic 1alpha,25(OH)(2)D(3)/VDR system which mediates the anti-mitotic effects of the steroid hormone, colorectal cancer cells...
Journal of Laparoendoscopic Surgery, 1993
... [CrossRef] 2. Soheila Raysi Dehcordi, Claudio De Tommasi, Alessandro Ricci, Sara Marzi, Crist... more ... [CrossRef] 2. Soheila Raysi Dehcordi, Claudio De Tommasi, Alessandro Ricci, Sara Marzi, Cristina Ruscitti, Gianfranco Amicucci, Renato J. Galzio. 2011. ... [CrossRef] 5. David Goitein , Pavlos Papasavas , Daniel Gagné , David Ferraro , Bruce Wilder , Philip Caushaj . 2006. ...
Obesity Surgery, 2008
Gastric sleeve resection was initially planned as the first step of bilio-pancreatic diversion wi... more Gastric sleeve resection was initially planned as the first step of bilio-pancreatic diversion with duodenal switch but it continues to emerge as a restrictive bariatric procedure on its own. We describe intermediate results in a series of 126 laparoscopic sleeve gastrectomies (LSG) compiled from three bariatric centers in eastern Austria. The stomach was laparoscopically reduced to a "sleeve" along the lesser curvature over a 48-Fr bougie. Special attention was placed on complete resection of the gastric fundus. After a mean follow-up of 19.1 months, patients had lost between 2.3 and 27 kg/m(2) or between 6.7% and 130% of their excessive weight. Sixty four percent of the patients lost >50% of their excess weight within an average of 20 months. Seven percent of the patients had an excess weight loss <25% and were therefore considered as failures. The only major surgical complication was leakage of the staple-line needing revision (three times). There were no operative mortalities. The final place of LSG in bariatric surgery is still unclear, but our results and those of others show that LSG can be a viable alternative to established procedures.
British Journal of Surgery, 1996
Since severe obesity is frequently associated with serious metabolic, cardiovascular and psycholo... more Since severe obesity is frequently associated with serious metabolic, cardiovascular and psychological co-morbid conditions, and given the usually unsuccessful results of conservative therapeutic approaches, surgical treatment based on gastric restriction procedures is increasingly recognized as a treatment of choice for morbidly obese persons. Among several surgical approaches designed to promote a substantial loss of weight, two gastric restriction procedures, i.e. the vertical banded gastroplasty and the gastric bypass, have been increasingly used during the past years. Both techniques induce an impressive loss of weight, and are surprisingly well tolerated, even by severely obese persons. The usual 50-75% reduction of initial weight excess, is followed by a clear-cut reduction, or even disappearance of, obesity-related co-morbidity, such as hypertension, diabetes mellitus or sleep apnea syndrome. While serious peri- and postoperative risks are very limited, the intractable vomiting occurring after gastroplasty, and potential sequelae related to iron and calcium malabsorption after the gastric bypass, represent much more frequent complications of the surgical treatment of obesity. There is also a tendency towards a late regain of weight, but the benefit in terms of improvement in the obesity-associated co-morbidity is in general maintained despite this partial increase in weight. Gastric procedures are, therefore, an effective treatment of severe obesity and of its co-morbid conditions. However, careful medical and nutritional supervision is necessary during the follow-up after surgery, to prevent potential nutritional or digestive complications.
Lasers In Medical Science, 1993
In order to assess the therapeutic potential of CO2 laser in breast cancer, a randomized study wa... more In order to assess the therapeutic potential of CO2 laser in breast cancer, a randomized study was performed. One hundred and thirty-nine women were randomly assigned to laser or conventional technique (scalpel and electrocautery) groups. Age, clinical tumour stage and pre-or post-menopausal state were set up as criteria of randomization. A radical mastectomy with axillary lymph node dissection was performed in our patients. Statistical analysis showed no difference between the two therapy groups regarding blood loss, post-operative drainage, operating time and hospital stay. All patients were examined on a regular basis--median follow-up time was 5.5 years. Recurrence was equal in both groups (four in each group). Kaplan-Meier evaluation of survival demonstrated no difference between the groups. Evaluation of prognostic factors by the proportional hazards regression model demonstrated an increased risk for the advanced clinical tumour stage (relative risk 2.37, p = 0.05) and for patients who did not receive hormone therapy (relative risk 4.85, p = 0.0001). The mode of surgical therapy did not affect prognosis. An interaction between treatment and clinical stage was found (ratio of relative risks, 5.87, p = 0.01). Thus a differential effect of laser treatment on survival depending on tumour size could be demonstrated. According to our study CO2 laser treatment does not in general offer significant advantage over conventional technique. However, due to the study design, our findings are preliminary; definite results have to be awaited. The therapeutic potential of laser in breast conserving surgery remains to be investigated.
Obesity surgery, 2005
Although gastric bands are safe and effective devices, severe late complications may develop in r... more Although gastric bands are safe and effective devices, severe late complications may develop in rare cases. 3 patients were treated for complete dysphagia after slippage of gastric bands. 2 of the patients were admitted for severe dehydration, 1 of whom developed cerebral venous infarction. Ischemia of the gastric pouch occurred in 1 patient. All 3 patients survived after successful medical therapy and surgical removal of the bands. Bariatric reoperations were performed in 2 patients (gastric sleeve resection, gastric bypass). Complete dysphagia on the basis of band slippage represents a life-threatening acute event, which may occur even years after implantation. Patients and doctors should be informed about this long-term risk of gastric banding.
Surgery for Obesity and Related Diseases, 2009
World Journal of Surgery, 2002
In patients operated on for severe acute pancreatitis (SAP), the factors determining outcome rema... more In patients operated on for severe acute pancreatitis (SAP), the factors determining outcome remain unclear. From 1986 to 1998 a total of 340 patients with a diagnosis of SAP and in need of operative treatment were admitted to the intensive care unit (ICU) of a university hospital and a secondary care hospital. The mean APACHE II score on the day of admission was 16.1 (range 8-35). All patients required operative therapy. Among the 340 patients, 270 (79.4%) had to be reoperated: 196 patients (72.6%) underwent operative revisions on demand, and 74 (27.4%) patients had preplanned reoperation. The overall mortality was 39.1% (133 patients). Septic organ failure in 126 patients (37.1%) and myocardial infarction or pulmonary embolism in 7 patients (2%) were the causes of death. The patient's age (p < 0.0002), APACHE II scores at admission (p < 0.0001), presence or development of (single or multiple) organ failure (p < 0.002), infection (p < 0.02) and extent (p < 0.04) of pancreatic necrosis, and surgical control of local necrosis (p < 0.0001) significantly determined survival. SAP that requires surgical treatment is associated with high in-hospital mortality. Surgical control of local necrosis is the precondition for survival. Advanced age of the patient, high APACHE II score at admission, development of organ failure, and the extent and infection of pancreatic necrosis influence the outcome.
Obesity Surgery, 2005
6. Brolin R, Kenler H, Gorman I et al. Long-limb gastric bypass in the super obese. A prospective... more 6. Brolin R, Kenler H, Gorman I et al. Long-limb gastric bypass in the super obese. A prospective randomized study. Ann Surg 1992; 215: 387-95. 7. Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus. Ann Surg 2002; 236: 554-9. 8. ...
Obesity Surgery, 2005
Background: Although gastric bands are safe and effective devices, severe late complications may ... more Background: Although gastric bands are safe and effective devices, severe late complications may develop in rare cases. Patients: 3 patients were treated for complete dysphagia after slippage of gastric bands. 2 of the patients were admitted for severe dehydration, 1 of whom developed cerebral venous infarction. Ischemia of the gastric pouch occurred in 1 patient. Results: All 3 patients survived
Obesity Surgery, 2006
Leakage and fistulization of the gastro-jejunostomy have been the major drawback of Roux-en-Y gas... more Leakage and fistulization of the gastro-jejunostomy have been the major drawback of Roux-en-Y gastric bypass (RYGBP) surgery. Most authors agree that operative treatment is the mainstay of therapy in patients with signs of sepsis. However, intestinal contents causing localized infection may impede healing of sutured leaks in some patients, and fistulas develop. Because the anastomosis cannot be disconnected or exteriorized for anatomical reasons, other forms of treatment have to be applied. The following case-reports describe a technique with implantation of coated self-expanding stents. Leakage of the gastro-jejunostomy occurred in one patient 3 days after RYGBP and resulted in formation of a fistula. A fistula developed in a second patient 63 days after RYGBP. Coated self-extending stents were implanted endoscopically in both patients on postoperative days 19 and 67. Enteral nutrition could be started 6 days later. Stents were removed 2 months after implantation without problems. Weight loss and quality of life 7 and 21 months after stent removal have been excellent in both patients. Implantation of coated self-expanding stents was an effective and minimally invasive option for gastro-jejunal anastomotic fistulas after RYGBP where surgical repair was not possible. In these cases, application of stents allows septic source control without any other intervention.
Digestive Surgery, 1998
ABSTRACT
Der Chirurg, 1999
ABSTRACT Ziel unserer Untersuchung war es, postoperative und Langzeitergebnisse des Operationskon... more ABSTRACT Ziel unserer Untersuchung war es, postoperative und Langzeitergebnisse des Operationskonzeptes einer radikalen Tumorchirurgie beim komplizierten colorectalen Carcinom zu analysieren. 126 (11,7 %) von 1.071 im Zeitraum 1986 bis 1997 wegen eines Dickdarmcarcinoms behandelten Patienten kamen wegen eines Ileus (84; 7,8 %) oder einer Perforation (42; 3,9 %) zur Operation. Die postoperative Letalität lag mit 19 % beim Ileus und 38 % bei Perforationen signifikant höher als bei unkomplizierten Carcinomen (6 %). Bei beiden Komplikationen war die postoperative Sterblichkeit beim Vorliegen eines präoperativen Organversagens erhöht. Nach Perforationen führten das Vorliegen einer diffusen Peritonitis und höherer Tumorstadien, beim Ileus kardiale Begleiterkrankungen zu erhöhten Letalitätsraten. Die Langzeitergebnisse waren nicht vom Auftreten einer Komplikation, sondern von den Tumorstadien abhängig. Das Konzept einer radikalen Tumorresektion, auch in Akutsituationen, ist nach unseren Resultaten zu befürworten, da Patienten, die die postoperative Phase überleben, keine schlechtere Prognose hatten, als jene mit unkomplizierten Carcinomen. The aim of this study was to investigate postoperative und long-term results after radical tumor surgery in complicated colorectal cancers. One hundred and twenty-six (11.7 %) of 1071 patients treated for large bowel cancer between 1986 and 1997 were operated on for bowel obstruction (84; 7.8 %) or perforation (42; 3.9 %). Postoperative mortality was significantly higher in complicated than in uncomplicated cancers (19 % after bowel obstruction, 38 % after perforation, 6 % in uncomplicated cases). Development of preoperative organ dysfunction determined survival in both complications. Mortality after perforations was influenced by the degree of peritonitis and tumor stage, while patients after bowel obstruction were at greater risk in the case of cardiac comorbidity. Long-term results depended on tumor stage but not on complications. Our concept of radical tumor surgery in emergency operations was supported by the fact that long-term results of patients surviving the acute stage of complicated colorectal cancers did not differ from those of patients with uncomplicated carcinomas.
The European Journal of Surgery, 1999
Eur J Surg 1999; 165: 952-957 ABSTRACT Objective: To evaluate risk factors, results of treatment,... more Eur J Surg 1999; 165: 952-957 ABSTRACT Objective: To evaluate risk factors, results of treatment, and prognostic influence of complications on survival from acute necrotising pancreatitis. Design: Retrospective study of prospectively collected data. Setting: Tertiary referral centre, Austria. Subjects: 100 consecutive patients operated on for necrotising pancreatitis confirmed by dynamic angio -computed tomography from 1988-1997. Interventions: 77 patients were operated on acutely followed by open management, and in 23 the operations were delayed. Main outcome measures: Morbidity, mortality, factors predisposing to complications, prognostic effect of complications on survival.
European Surgery, 1999
Zusamn~en|'assu~g: Gr,mdla,,zen: Seit Ei,H'fihrung der laparoskopischen Cholezystektomie wird dis... more Zusamn~en|'assu~g: Gr,mdla,,zen: Seit Ei,H'fihrung der laparoskopischen Cholezystektomie wird diskutiert, ob bei diesem Emgriff Einmal-oder wiedcrvcrwendbarc lnstrumente cmgesetzt werdcn solhen. Argumenten der Wirtschaftlichkeit wurden Aspekte dcr Sicherheit und Hygiene entgcgengesctzt, l_:m *.lie in Oslcrreich praktizierte Anwcndung and Bcurleihmg wm laparoskopischen Ger:~iten zu erfassen, fuhrten wir einc landesweite [.!lnfrage dnrch. Melhodik: Sannliche 116 Abteilungen in Osterreich, an denen laparoskopischc Cholczystektolnien durchgefi(lhrt werden, wurden gebeten, an der Umfrage leilzunehmcn. Folgende Daten wurden erhoben: Art und TrSgerschaft des Krankerflmuses, Anzahl dcr 1996 durchgefiJhrten CholezystekT, onlien, Bowertung yon Sichcrheit, Hygiene, Bcdicmmgskotnfort. Reparaturanffilligkei'~ und Kosten bci der lnstrumcntenwahl, detaillicrte Darsiellung des praktizierten Instrulnentcneinsatzes, Einflu6 der Spitalserhaher auf die Gerfilewahl. gmebnisse: 84% der Abteilungen (97/beleiligien sicb an dcr Umfrage. Diese Abteilungen hatten 1996 11.932 laparoskopische Cholezysiektomien durchgefiihrt. 56% setzten bei 6431 Operationen immer. 35% bei 4439 manchmal und 9% bei 1{)62 Operationcn nie Einmalinstrumente ein. Die am hiiufigsten (64%) verwendeten Einmalger~ite wares IO-mm-Ports trod Clipsetzer. Die Sicherheit wurde als wichtigster Faktor bci der lnstrumentenwaht algegeben Einmalgerffte wurden in 61% als hygieniseh w~rteilhaft, wiederverwendbare Instrt, mente in 92% als kostengiiustiger bezeichuet. 18% der Befragten gaben an, bei der Instrumentenwahl untcr starkem Druck seitens der Krankenhaustrfi,,zer, g zu stehen. S chkugfolgerungeN: 91% aller Osterreichischen Abteilungen setzcn bei der laparoskopischen Cholezysteklomie Einmalinstrumeme ein. ObwohI 92% der Befragtml die Kostenvortei~_e wiederverwendbarer GerS.te kennem werden den Aspeklen der Sicherheit und Hygiene bei der [nstrumentenwahl die grOgte Bedeumng beigemessen. Die yon der iiberwiegenden Mehrzahl 6s~terreichischer Abteitm{ge~ (84%) an~aewandte ~xoax)> nation yon wiederverwendbaren und Eimnalinstrumenten entspricht den derzeit gehenden Anlk,,rdemngen yon Qualflfitssicherheit und sinnw)llem Ressourceneinsatz.
Anticancer Research, Sep 1, 2009
Background: A cross-sectional study was performed on a cohort of colorectal cancer (CRC) patients... more Background: A cross-sectional study was performed on a cohort of colorectal cancer (CRC) patients to reveal any influence of age, gender, and subsite on grades of malignancy. Patients and Methods: Data from histopathological grading according to WHO criteria were pooled into groups of low-grade (well and moderately differentiated) and high-grade (poorly and undifferentiated) cancer and analyzed for associations. Results: In general, women with CRC were significantly older than men (p<0.05). In particular, women with high-grade cancer in the proximal and distal colon had a median age of 75 years and were thus 10-15 years older (p<0.01 and p<0.05, respectively) than their male counterparts. In contrast, high-grade rectal cancer developed in both genders around the early age of 60 years. Conclusion: Women are protected from more aggressive cancer in the colon though not in the rectum until well after menopause. This likely reflects the differential sensitivity of the mucosa at these sites against the anticancer effects triggered by activation of estrogen receptor-β.
Anticancer research, 2009
A cross-sectional study was performed on a cohort of colorectal cancer (CRC) patients to reveal a... more A cross-sectional study was performed on a cohort of colorectal cancer (CRC) patients to reveal any influence of age, gender, and subsite on grades of malignancy. Data from histopathological grading according to WHO criteria were pooled into groups of low-grade (well and moderately differentiated) and high-grade (poorly and undifferentiated) cancer and analyzed for associations. In general, women with CRC were significantly older than men (p<0.05). In particular, women with high-grade cancer in the proximal and distal colon had a median age of 75 years and were thus 10-15 years older (p<0.01 and p<0.05, respectively) than their male counterparts. In contrast, high-grade rectal cancer developed in both genders around the early age of 60 years. Women are protected from more aggressive cancer in the colon though not in the rectum until well after menopause. This likely reflects the differential sensitivity of the mucosa at these sites against the anticancer effects triggered b...
Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen, 1996
This paper discusses the long-term results after surgical treatment of necrotizing pancreatitis. ... more This paper discusses the long-term results after surgical treatment of necrotizing pancreatitis. Thirty-one patients were examined 3 years after the operation. The development of diabetes was the main problem in 29% of the patients and depended on the amount of pancreatic tissue resected (never after necrosectomy, in 47% after pancreatic resection; P = 0.005, Fischer's exact test). Of the patients, 77% were in good general condition and 68% were able to work. In 50% of the patients abdominal wall function was impaired but most of them could cope with this insufficiency. Of the patients with alcohol-induced pancreatitis, 75% were abstinent. Considering the severity of the disease, long-term results after surgical treatment of necrotizing pancreatitis are satisfactory.
Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen, 1997
Mediastinitis caused by infection with Clostridium perfringens and spontaneous rupture of the eso... more Mediastinitis caused by infection with Clostridium perfringens and spontaneous rupture of the esophagus are both life threatening conditions. The combination of these two entities led to septic multiorgan failure in a 38-year-old woman. The patient was treated successfully by esophagectomy and postoperative lavage through a partially open abdomen. The lack of information regarding emesis, the leading symptom of Boerhaave's syndrome, caused delayed diagnosis: the triad of emesis, severe epigastric pain and emphysema of the skin was not established until 30 h after the onset of symptoms.
Hepato-gastroenterology
Colonic involvement is a rare but serious event in necrotizing pancreatitis. Early detection of t... more Colonic involvement is a rare but serious event in necrotizing pancreatitis. Early detection of this complication is difficult; a delay of diagnosis may lead to perforation and peritonitis. Two strategies of therapy have been developed in the last few years: an aggressive regimen of early resection and a conservative approach with ileostomy and observation. Fourteen of 118 patients treated for necrotizing pancreatitis from 1988 to 1995 presented with colonic necrosis. The diagnosis of necrosis was made if the color of the bowel wall demonstrated ischemia or hemorrhagic infarction or pulsations of the mesocolic vessels could not be palpated. The first two patients were treated by a conservative approach the following 12 by immediate large bowel resection. Follow-up results of all surviving patients were obtained. Patients with colonic lesions demonstrated an advanced septic state compared to patients who did not present this complication. Differences in the average Apache 2 scores on admission and the incidence of multiple organ failure were significant (Apache 2 score; 16.6 versus 11.9, p = 0.028, Wilcoxon; multiple organ failure; 71% versus 35%, p = 0.028, Fisher's exact test). Results after establishment of early discontinuity-resection of colonic necrosis compared favorably to those of a conservative strategy (mortality 4/12; 33% versus 2/2; 100%). The overall mortality was 43% (6 of 14 patients). Restorative surgery was performed in 6 patients without substantial morbidity and no mortality. Follow-up results were satisfactory in the majority of the patients. Early resection of colonic lesions improves results in this dangerous complication of necrotizing pancreatitis.
Steroids
Human colorectal cancer cells not only express the nuclear vitamin D receptor (VDR) but are also ... more Human colorectal cancer cells not only express the nuclear vitamin D receptor (VDR) but are also endowed with 25-hydroxy-vitamin D(3)-1alpha-hydroxylase activity and therefore are able to produce the specific ligand for the VDR, the hormonally active steroid 1alpha,25-dihydroxyvitamin D(3) (1alpha,25(OH)(2)D(3)). In the present study we show by semiquantitative reverse transcriptase polymerase chain reaction (RT-PCR) as well as by Western blotting and immunohistochemical methods, that in human large intestinal carcinomas expression of the genes encoding the 25-(OH)D(3)-1alpha-hydroxylase as well as the VDR increases in parallel with ongoing dedifferentiation in the early phase of cancerogenesis, whereas in poorly differentiated late stage carcinomas only low levels of the respective mRNAs can be detected. This indicates that, through up-regulation of this intrinsic 1alpha,25(OH)(2)D(3)/VDR system which mediates the anti-mitotic effects of the steroid hormone, colorectal cancer cells...
Journal of Laparoendoscopic Surgery, 1993
... [CrossRef] 2. Soheila Raysi Dehcordi, Claudio De Tommasi, Alessandro Ricci, Sara Marzi, Crist... more ... [CrossRef] 2. Soheila Raysi Dehcordi, Claudio De Tommasi, Alessandro Ricci, Sara Marzi, Cristina Ruscitti, Gianfranco Amicucci, Renato J. Galzio. 2011. ... [CrossRef] 5. David Goitein , Pavlos Papasavas , Daniel Gagné , David Ferraro , Bruce Wilder , Philip Caushaj . 2006. ...
Obesity Surgery, 2008
Gastric sleeve resection was initially planned as the first step of bilio-pancreatic diversion wi... more Gastric sleeve resection was initially planned as the first step of bilio-pancreatic diversion with duodenal switch but it continues to emerge as a restrictive bariatric procedure on its own. We describe intermediate results in a series of 126 laparoscopic sleeve gastrectomies (LSG) compiled from three bariatric centers in eastern Austria. The stomach was laparoscopically reduced to a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;sleeve&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; along the lesser curvature over a 48-Fr bougie. Special attention was placed on complete resection of the gastric fundus. After a mean follow-up of 19.1 months, patients had lost between 2.3 and 27 kg/m(2) or between 6.7% and 130% of their excessive weight. Sixty four percent of the patients lost &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50% of their excess weight within an average of 20 months. Seven percent of the patients had an excess weight loss &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;25% and were therefore considered as failures. The only major surgical complication was leakage of the staple-line needing revision (three times). There were no operative mortalities. The final place of LSG in bariatric surgery is still unclear, but our results and those of others show that LSG can be a viable alternative to established procedures.
British Journal of Surgery, 1996
Since severe obesity is frequently associated with serious metabolic, cardiovascular and psycholo... more Since severe obesity is frequently associated with serious metabolic, cardiovascular and psychological co-morbid conditions, and given the usually unsuccessful results of conservative therapeutic approaches, surgical treatment based on gastric restriction procedures is increasingly recognized as a treatment of choice for morbidly obese persons. Among several surgical approaches designed to promote a substantial loss of weight, two gastric restriction procedures, i.e. the vertical banded gastroplasty and the gastric bypass, have been increasingly used during the past years. Both techniques induce an impressive loss of weight, and are surprisingly well tolerated, even by severely obese persons. The usual 50-75% reduction of initial weight excess, is followed by a clear-cut reduction, or even disappearance of, obesity-related co-morbidity, such as hypertension, diabetes mellitus or sleep apnea syndrome. While serious peri- and postoperative risks are very limited, the intractable vomiting occurring after gastroplasty, and potential sequelae related to iron and calcium malabsorption after the gastric bypass, represent much more frequent complications of the surgical treatment of obesity. There is also a tendency towards a late regain of weight, but the benefit in terms of improvement in the obesity-associated co-morbidity is in general maintained despite this partial increase in weight. Gastric procedures are, therefore, an effective treatment of severe obesity and of its co-morbid conditions. However, careful medical and nutritional supervision is necessary during the follow-up after surgery, to prevent potential nutritional or digestive complications.
Lasers In Medical Science, 1993
In order to assess the therapeutic potential of CO2 laser in breast cancer, a randomized study wa... more In order to assess the therapeutic potential of CO2 laser in breast cancer, a randomized study was performed. One hundred and thirty-nine women were randomly assigned to laser or conventional technique (scalpel and electrocautery) groups. Age, clinical tumour stage and pre-or post-menopausal state were set up as criteria of randomization. A radical mastectomy with axillary lymph node dissection was performed in our patients. Statistical analysis showed no difference between the two therapy groups regarding blood loss, post-operative drainage, operating time and hospital stay. All patients were examined on a regular basis--median follow-up time was 5.5 years. Recurrence was equal in both groups (four in each group). Kaplan-Meier evaluation of survival demonstrated no difference between the groups. Evaluation of prognostic factors by the proportional hazards regression model demonstrated an increased risk for the advanced clinical tumour stage (relative risk 2.37, p = 0.05) and for patients who did not receive hormone therapy (relative risk 4.85, p = 0.0001). The mode of surgical therapy did not affect prognosis. An interaction between treatment and clinical stage was found (ratio of relative risks, 5.87, p = 0.01). Thus a differential effect of laser treatment on survival depending on tumour size could be demonstrated. According to our study CO2 laser treatment does not in general offer significant advantage over conventional technique. However, due to the study design, our findings are preliminary; definite results have to be awaited. The therapeutic potential of laser in breast conserving surgery remains to be investigated.
Obesity surgery, 2005
Although gastric bands are safe and effective devices, severe late complications may develop in r... more Although gastric bands are safe and effective devices, severe late complications may develop in rare cases. 3 patients were treated for complete dysphagia after slippage of gastric bands. 2 of the patients were admitted for severe dehydration, 1 of whom developed cerebral venous infarction. Ischemia of the gastric pouch occurred in 1 patient. All 3 patients survived after successful medical therapy and surgical removal of the bands. Bariatric reoperations were performed in 2 patients (gastric sleeve resection, gastric bypass). Complete dysphagia on the basis of band slippage represents a life-threatening acute event, which may occur even years after implantation. Patients and doctors should be informed about this long-term risk of gastric banding.
Surgery for Obesity and Related Diseases, 2009
World Journal of Surgery, 2002
In patients operated on for severe acute pancreatitis (SAP), the factors determining outcome rema... more In patients operated on for severe acute pancreatitis (SAP), the factors determining outcome remain unclear. From 1986 to 1998 a total of 340 patients with a diagnosis of SAP and in need of operative treatment were admitted to the intensive care unit (ICU) of a university hospital and a secondary care hospital. The mean APACHE II score on the day of admission was 16.1 (range 8-35). All patients required operative therapy. Among the 340 patients, 270 (79.4%) had to be reoperated: 196 patients (72.6%) underwent operative revisions on demand, and 74 (27.4%) patients had preplanned reoperation. The overall mortality was 39.1% (133 patients). Septic organ failure in 126 patients (37.1%) and myocardial infarction or pulmonary embolism in 7 patients (2%) were the causes of death. The patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s age (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0002), APACHE II scores at admission (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), presence or development of (single or multiple) organ failure (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.002), infection (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.02) and extent (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.04) of pancreatic necrosis, and surgical control of local necrosis (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) significantly determined survival. SAP that requires surgical treatment is associated with high in-hospital mortality. Surgical control of local necrosis is the precondition for survival. Advanced age of the patient, high APACHE II score at admission, development of organ failure, and the extent and infection of pancreatic necrosis influence the outcome.
Obesity Surgery, 2005
6. Brolin R, Kenler H, Gorman I et al. Long-limb gastric bypass in the super obese. A prospective... more 6. Brolin R, Kenler H, Gorman I et al. Long-limb gastric bypass in the super obese. A prospective randomized study. Ann Surg 1992; 215: 387-95. 7. Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus. Ann Surg 2002; 236: 554-9. 8. ...
Obesity Surgery, 2005
Background: Although gastric bands are safe and effective devices, severe late complications may ... more Background: Although gastric bands are safe and effective devices, severe late complications may develop in rare cases. Patients: 3 patients were treated for complete dysphagia after slippage of gastric bands. 2 of the patients were admitted for severe dehydration, 1 of whom developed cerebral venous infarction. Ischemia of the gastric pouch occurred in 1 patient. Results: All 3 patients survived
Obesity Surgery, 2006
Leakage and fistulization of the gastro-jejunostomy have been the major drawback of Roux-en-Y gas... more Leakage and fistulization of the gastro-jejunostomy have been the major drawback of Roux-en-Y gastric bypass (RYGBP) surgery. Most authors agree that operative treatment is the mainstay of therapy in patients with signs of sepsis. However, intestinal contents causing localized infection may impede healing of sutured leaks in some patients, and fistulas develop. Because the anastomosis cannot be disconnected or exteriorized for anatomical reasons, other forms of treatment have to be applied. The following case-reports describe a technique with implantation of coated self-expanding stents. Leakage of the gastro-jejunostomy occurred in one patient 3 days after RYGBP and resulted in formation of a fistula. A fistula developed in a second patient 63 days after RYGBP. Coated self-extending stents were implanted endoscopically in both patients on postoperative days 19 and 67. Enteral nutrition could be started 6 days later. Stents were removed 2 months after implantation without problems. Weight loss and quality of life 7 and 21 months after stent removal have been excellent in both patients. Implantation of coated self-expanding stents was an effective and minimally invasive option for gastro-jejunal anastomotic fistulas after RYGBP where surgical repair was not possible. In these cases, application of stents allows septic source control without any other intervention.
Digestive Surgery, 1998
ABSTRACT
Der Chirurg, 1999
ABSTRACT Ziel unserer Untersuchung war es, postoperative und Langzeitergebnisse des Operationskon... more ABSTRACT Ziel unserer Untersuchung war es, postoperative und Langzeitergebnisse des Operationskonzeptes einer radikalen Tumorchirurgie beim komplizierten colorectalen Carcinom zu analysieren. 126 (11,7 %) von 1.071 im Zeitraum 1986 bis 1997 wegen eines Dickdarmcarcinoms behandelten Patienten kamen wegen eines Ileus (84; 7,8 %) oder einer Perforation (42; 3,9 %) zur Operation. Die postoperative Letalität lag mit 19 % beim Ileus und 38 % bei Perforationen signifikant höher als bei unkomplizierten Carcinomen (6 %). Bei beiden Komplikationen war die postoperative Sterblichkeit beim Vorliegen eines präoperativen Organversagens erhöht. Nach Perforationen führten das Vorliegen einer diffusen Peritonitis und höherer Tumorstadien, beim Ileus kardiale Begleiterkrankungen zu erhöhten Letalitätsraten. Die Langzeitergebnisse waren nicht vom Auftreten einer Komplikation, sondern von den Tumorstadien abhängig. Das Konzept einer radikalen Tumorresektion, auch in Akutsituationen, ist nach unseren Resultaten zu befürworten, da Patienten, die die postoperative Phase überleben, keine schlechtere Prognose hatten, als jene mit unkomplizierten Carcinomen. The aim of this study was to investigate postoperative und long-term results after radical tumor surgery in complicated colorectal cancers. One hundred and twenty-six (11.7 %) of 1071 patients treated for large bowel cancer between 1986 and 1997 were operated on for bowel obstruction (84; 7.8 %) or perforation (42; 3.9 %). Postoperative mortality was significantly higher in complicated than in uncomplicated cancers (19 % after bowel obstruction, 38 % after perforation, 6 % in uncomplicated cases). Development of preoperative organ dysfunction determined survival in both complications. Mortality after perforations was influenced by the degree of peritonitis and tumor stage, while patients after bowel obstruction were at greater risk in the case of cardiac comorbidity. Long-term results depended on tumor stage but not on complications. Our concept of radical tumor surgery in emergency operations was supported by the fact that long-term results of patients surviving the acute stage of complicated colorectal cancers did not differ from those of patients with uncomplicated carcinomas.
The European Journal of Surgery, 1999
Eur J Surg 1999; 165: 952-957 ABSTRACT Objective: To evaluate risk factors, results of treatment,... more Eur J Surg 1999; 165: 952-957 ABSTRACT Objective: To evaluate risk factors, results of treatment, and prognostic influence of complications on survival from acute necrotising pancreatitis. Design: Retrospective study of prospectively collected data. Setting: Tertiary referral centre, Austria. Subjects: 100 consecutive patients operated on for necrotising pancreatitis confirmed by dynamic angio -computed tomography from 1988-1997. Interventions: 77 patients were operated on acutely followed by open management, and in 23 the operations were delayed. Main outcome measures: Morbidity, mortality, factors predisposing to complications, prognostic effect of complications on survival.
European Surgery, 1999
Zusamn~en|'assu~g: Gr,mdla,,zen: Seit Ei,H'fihrung der laparoskopischen Cholezystektomie wird dis... more Zusamn~en|'assu~g: Gr,mdla,,zen: Seit Ei,H'fihrung der laparoskopischen Cholezystektomie wird diskutiert, ob bei diesem Emgriff Einmal-oder wiedcrvcrwendbarc lnstrumente cmgesetzt werdcn solhen. Argumenten der Wirtschaftlichkeit wurden Aspekte dcr Sicherheit und Hygiene entgcgengesctzt, l_:m *.lie in Oslcrreich praktizierte Anwcndung and Bcurleihmg wm laparoskopischen Ger:~iten zu erfassen, fuhrten wir einc landesweite [.!lnfrage dnrch. Melhodik: Sannliche 116 Abteilungen in Osterreich, an denen laparoskopischc Cholczystektolnien durchgefi(lhrt werden, wurden gebeten, an der Umfrage leilzunehmcn. Folgende Daten wurden erhoben: Art und TrSgerschaft des Krankerflmuses, Anzahl dcr 1996 durchgefiJhrten CholezystekT, onlien, Bowertung yon Sichcrheit, Hygiene, Bcdicmmgskotnfort. Reparaturanffilligkei'~ und Kosten bci der lnstrumcntenwahl, detaillicrte Darsiellung des praktizierten Instrulnentcneinsatzes, Einflu6 der Spitalserhaher auf die Gerfilewahl. gmebnisse: 84% der Abteilungen (97/beleiligien sicb an dcr Umfrage. Diese Abteilungen hatten 1996 11.932 laparoskopische Cholezysiektomien durchgefiihrt. 56% setzten bei 6431 Operationen immer. 35% bei 4439 manchmal und 9% bei 1{)62 Operationcn nie Einmalinstrumente ein. Die am hiiufigsten (64%) verwendeten Einmalger~ite wares IO-mm-Ports trod Clipsetzer. Die Sicherheit wurde als wichtigster Faktor bci der lnstrumentenwaht algegeben Einmalgerffte wurden in 61% als hygieniseh w~rteilhaft, wiederverwendbare Instrt, mente in 92% als kostengiiustiger bezeichuet. 18% der Befragten gaben an, bei der Instrumentenwahl untcr starkem Druck seitens der Krankenhaustrfi,,zer, g zu stehen. S chkugfolgerungeN: 91% aller Osterreichischen Abteilungen setzcn bei der laparoskopischen Cholezysteklomie Einmalinstrumeme ein. ObwohI 92% der Befragtml die Kostenvortei~_e wiederverwendbarer GerS.te kennem werden den Aspeklen der Sicherheit und Hygiene bei der [nstrumentenwahl die grOgte Bedeumng beigemessen. Die yon der iiberwiegenden Mehrzahl 6s~terreichischer Abteitm{ge~ (84%) an~aewandte ~xoax)> nation yon wiederverwendbaren und Eimnalinstrumenten entspricht den derzeit gehenden Anlk,,rdemngen yon Qualflfitssicherheit und sinnw)llem Ressourceneinsatz.
Anticancer Research, Sep 1, 2009
Background: A cross-sectional study was performed on a cohort of colorectal cancer (CRC) patients... more Background: A cross-sectional study was performed on a cohort of colorectal cancer (CRC) patients to reveal any influence of age, gender, and subsite on grades of malignancy. Patients and Methods: Data from histopathological grading according to WHO criteria were pooled into groups of low-grade (well and moderately differentiated) and high-grade (poorly and undifferentiated) cancer and analyzed for associations. Results: In general, women with CRC were significantly older than men (p<0.05). In particular, women with high-grade cancer in the proximal and distal colon had a median age of 75 years and were thus 10-15 years older (p<0.01 and p<0.05, respectively) than their male counterparts. In contrast, high-grade rectal cancer developed in both genders around the early age of 60 years. Conclusion: Women are protected from more aggressive cancer in the colon though not in the rectum until well after menopause. This likely reflects the differential sensitivity of the mucosa at these sites against the anticancer effects triggered by activation of estrogen receptor-β.
Anticancer research, 2009
A cross-sectional study was performed on a cohort of colorectal cancer (CRC) patients to reveal a... more A cross-sectional study was performed on a cohort of colorectal cancer (CRC) patients to reveal any influence of age, gender, and subsite on grades of malignancy. Data from histopathological grading according to WHO criteria were pooled into groups of low-grade (well and moderately differentiated) and high-grade (poorly and undifferentiated) cancer and analyzed for associations. In general, women with CRC were significantly older than men (p<0.05). In particular, women with high-grade cancer in the proximal and distal colon had a median age of 75 years and were thus 10-15 years older (p<0.01 and p<0.05, respectively) than their male counterparts. In contrast, high-grade rectal cancer developed in both genders around the early age of 60 years. Women are protected from more aggressive cancer in the colon though not in the rectum until well after menopause. This likely reflects the differential sensitivity of the mucosa at these sites against the anticancer effects triggered b...
Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen, 1996
This paper discusses the long-term results after surgical treatment of necrotizing pancreatitis. ... more This paper discusses the long-term results after surgical treatment of necrotizing pancreatitis. Thirty-one patients were examined 3 years after the operation. The development of diabetes was the main problem in 29% of the patients and depended on the amount of pancreatic tissue resected (never after necrosectomy, in 47% after pancreatic resection; P = 0.005, Fischer's exact test). Of the patients, 77% were in good general condition and 68% were able to work. In 50% of the patients abdominal wall function was impaired but most of them could cope with this insufficiency. Of the patients with alcohol-induced pancreatitis, 75% were abstinent. Considering the severity of the disease, long-term results after surgical treatment of necrotizing pancreatitis are satisfactory.
Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen, 1997
Mediastinitis caused by infection with Clostridium perfringens and spontaneous rupture of the eso... more Mediastinitis caused by infection with Clostridium perfringens and spontaneous rupture of the esophagus are both life threatening conditions. The combination of these two entities led to septic multiorgan failure in a 38-year-old woman. The patient was treated successfully by esophagectomy and postoperative lavage through a partially open abdomen. The lack of information regarding emesis, the leading symptom of Boerhaave's syndrome, caused delayed diagnosis: the triad of emesis, severe epigastric pain and emphysema of the skin was not established until 30 h after the onset of symptoms.
Hepato-gastroenterology
Colonic involvement is a rare but serious event in necrotizing pancreatitis. Early detection of t... more Colonic involvement is a rare but serious event in necrotizing pancreatitis. Early detection of this complication is difficult; a delay of diagnosis may lead to perforation and peritonitis. Two strategies of therapy have been developed in the last few years: an aggressive regimen of early resection and a conservative approach with ileostomy and observation. Fourteen of 118 patients treated for necrotizing pancreatitis from 1988 to 1995 presented with colonic necrosis. The diagnosis of necrosis was made if the color of the bowel wall demonstrated ischemia or hemorrhagic infarction or pulsations of the mesocolic vessels could not be palpated. The first two patients were treated by a conservative approach the following 12 by immediate large bowel resection. Follow-up results of all surviving patients were obtained. Patients with colonic lesions demonstrated an advanced septic state compared to patients who did not present this complication. Differences in the average Apache 2 scores on admission and the incidence of multiple organ failure were significant (Apache 2 score; 16.6 versus 11.9, p = 0.028, Wilcoxon; multiple organ failure; 71% versus 35%, p = 0.028, Fisher's exact test). Results after establishment of early discontinuity-resection of colonic necrosis compared favorably to those of a conservative strategy (mortality 4/12; 33% versus 2/2; 100%). The overall mortality was 43% (6 of 14 patients). Restorative surgery was performed in 6 patients without substantial morbidity and no mortality. Follow-up results were satisfactory in the majority of the patients. Early resection of colonic lesions improves results in this dangerous complication of necrotizing pancreatitis.