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Biomedical subjects

A Imdahl

Publications and source records attributed to A Imdahl.

At least 19 recordsLinked to original sources
PubMed2006

The iliopsoas abscess: aetiology, therapy, and outcome.

BACKGROUND AND AIMS: The treatment strategy for patients with a retroperitonally localised abscess is controversial as it remains open which fluid collections should be drained by open access or by percutaneously inserted drainage. PATIENTS: Therefore, the data of 40 consecutively treated patients with an iliopsoas abscess were analysed retrospectively. RESULTS: Ten patients suffered from a primary abscess and ten from a post-operative abscess; further, in 20 patients, the aetiology of the abscesses were due to Crohn's disease, neoplasia, spondylitis or other relevant concomitant diseases. Eight of 40 patients were initially treated by image-guided percutaneous drainage (PD), the other by open access drainage. Six patients died (15%), all of them had been operated; 15 (37.5%) patients had a recurrence of their abscess and needed re-operation. Factors predicting a poor outcome were age, APACHE II score, bi-lateral abscesses and a post-operative or bony cause, but the bacteriological findings did not influence the outcome. CONCLUSIONS: We suggest an algorithm for treatment of iliopsoas abscesses depending on number and volume of the abscesses.

APACHE↗
PubMed2006

[Neoadjuvant therapy in oesophageal cancer surgery].

Neoadjuvant therapy has been implemented to improve the prognosis of patients with oesophageal cancer. Operative therapy remains the therapy of choice for nonmetastatic disease in patients who can tolerate resection. Adjuvant therapy following resection is usually not indicated. For neoadjuvant therapy it seems to be confirmed that preoperative radiotherapy has only very little benefit and therefore, should not be recommended. Data for preoperative chemotherapy are conflicting. Following preoperative combined radio-chemotherapy a complete response of tumour can be expected in 20-25 % of treated patients with a marked advantage for these patients. However, there are still no markers available indicating tumour response before the start of perioperative radio-chemotherapy. Recently published meta-analyses confirm a small overall benefit for perioperative radio-chemotherapy. However, these data so far have not led to a broad agreement on the indication of neoadjuvant therapy in oesophageal cancer.

Adenocarcinoma↗
PubMed2005

[Soft-tissue tumors: primary excision or wait and see?].

Soft tissue tumors are relatively commonly seen lesions in the doctor's office. An initial differentiation between malignant and benign tumors is usually possible on the basis of the case history and a careful physical examination. In adults, primary excision under local anesthesia is the treatment of choice in many cases, while in children and in the case of large tumors suspected of being malignant, a histological diagnosis must always be obtained. A number of procedures are available for biopsy taking. If the definitive histological work-up confirms malignancy, or if the findings are uncertain, the diagnostic investigation should be extended to include such imaging procedures as CT scanning or MRI.

Adult↗
PubMed2005

[Resection of combined or sequential lung and liver metastases of colorectal cancer: indication for everyone?].

UNLABELLED: Successful sequential resection of isolated hepatic and pulmonary metastases of colorectal cancer (crc) has been reported, however long-term results of large series are lacking. Therefore, we retrospectively analysed data of patients in whom sequential hepatic and pulmonary resection for metastases was performed. PATIENTS AND METHOD: From the records of our hospital we identified 25 patients (19.5 % of all patients operated for hepatic or 33 % for lung metastases due to crc) with colorectal cancer who had pulmonary and hepatic resection for metastatic disease between 1991 and 2002. 11 of these had primary colonic cancer and 14 rectal cancer. None of the patients died perioperatively. Long-term results were correlated with the staging of the primary tumour, the number of metastases, disease free interval between primary tumour operation and occurrence of metastatic disease. RESULTS: Five-year survival rate was 33.5 % following the resection of the first metastasis. Three year survival after resection of the second metastasis was 39 %. The disease free interval was 20 months (mean). Long-term results were clearly influenced by the disease free interval: < 1 year (n = 6) median 50 months after resection of the crc; > 1 year median 90 months (n = 19). Further on R0 resection was important for long-term survival: Median survival was 32.5 (+/- 4.1) months following resection of the second metastasis but only 9.9 months after R > 0 resection. CONCLUSION: These results confirm that sequential resection of hepatic and pulmonary metastases can be performed with curative intention provided a systemic spread of the disease is excluded. The surgeon's opinion of resectability should be obtained in patients with such metastases before the patient is scheduled for palliative conservative treatment.

Aged↗
PubMed2004

Solitary fibrous tumour of the liver: case report and review of the literature.

BACKGROUND: Solitary fibrous tumours (SFTs) of the liver are very rare entities. Although firstly described to be tumours of pleural origin, SFTs have been reported in various organs such as the meninges, orbit, upper respiratory tract, thyroid, peritoneum, retroperitoneum and soft tissues. Histologically, this tumour often shows alternating cellular and relatively acellular areas. The cellular areas show a wide variety of patterns, making it difficult for it to be differentiated from other mesenchymal tumours. Its immunohistochemical positivity for CD34 and vimentin is believed to be unique. Histiogenesis of SFTs, however, is not yet fully understood. They are known to be usually benign, with only few reports indicating their ability to metastasize. PATIENTS AND METHODS: We review the literature on SFTs of the liver and report on the case of a 63-year-old female patient with a large SFT of the right liver. CONCLUSIONS: Surgical resection seems to be the treatment of choice. Local recurrence is scarce. Due to the very limited number of cases, data regarding the long-term survival of patients are lacking.

Female↗
PubMed2004

Effects of neoadjuvant radio-chemotherapy on 18F-FDG-PET in esophageal carcinoma.

AIM: To investigate whether results of [F-18]-fluorodeoxy-d-glucose (FDG) positron emission tomography (PET) of esophageal cancer (EC) before and after neoadjuvant radio-chemotherapy correlate with histopathology after esophageal resection. METHODS: Twenty consecutive patients with EC without distant metastases were examined twice with 18F-FDG-PET during primary staging and after neoadjuvant radio-chemotherapy. FDG standardised uptake values (SUV) were correlated with the histopathological findings (percentage of viable tumour cells, tumour regression grade 1-5). RESULTS: Regression analysis revealed a slight (not significant) positive correlation between SUV(pre) (R=0.41, p=0.08) and SUV(post) (R=0.37, p=0.11) and the percentage of viable tumour cells in the resectate. Although all patients showed a significant decrease in SUV after radio-chemotherapy (p < 0.01) the percentual decrease of the SUV after therapy (DeltaSUV%) did not significantly differ between the TRG-groups. In 12 of 20 patients (60%), therapy-induced esophagitis was detected in post-therapeutic PET images. CONCLUSION: In EC, a higher pre-therapeutic SUV might be correlated with a higher fraction of vital tumour cells remaining after radio-chemotherapy. Applying the neoadjuvant therapy protocol and the study design used in this examination, there is no correlation between decrease in SUV and histopathology.

Adenocarcinoma↗
PubMed2004

[Preoperative chemoradiation in esophageal cancer: experience of a single center in 102 patients].

The (dis-)advantages of preoperative chemoradiation in patients with esophageal cancer (EC) are still controversial as data are lacking showing a clear cut benefit. Therefore, data of neoadjuvant therapy of our hospital have been analyzed. Since 1994 102 patients with an EC (33 % adenocarcinoma, 67 % squamous cell cancer, scc) were operated after receiving preoperative chemoradiation (36 Gy radiation, 1.8 Gy/day for 4 weeks, 500 mg/m (2) 5-FU for 4 weeks and 20 mg/m (2) Cisplatin, day 1-5, week 1 and 4). Operation was performed usually 8-10 weeks after treatment start. In 11.7 % of patients with an adenocarcinoma a complete pathological response (CR, pT0N0M0) was observed and a pT0 stage in 20.6 %. 38.2 % of these patients were staged as pN0. Postoperative morbidity was observed in 66 % (anastomotic leakage in 20 %, recurrent nerve palsy in 23 %). In-hospital mortality was 5.9 %. 5-year survival was calculated as 30.5 %, in patients wit a CR 66 %.26.5 % of patients with a scc revealed a CR. However no effect at all was observed in 32 % of these patients. 56 % were staged as pN0. Postoperative morbidity was observed in 87 % (anastomotic leakage in 16 %, recurrent nerve palsy in 32 %). In-hospital mortality was 11.8 %. 5-year survival was calculated as 19.2 %, in patients with a CR 45 %. The impact of pN stage was significant (p = 0.0052). These results underline the benefit of neoadjuvant therapy in patients with a CR. Further on, a pN0 stage is an important prognostic indicator. However, it remains open, whether neoadjuvant therapy leads to a downstaging of lymph node involvement, as histological confirmation in clinically positive lymph node is seldom performed prospectively.

Adenocarcinoma↗
PubMed2003

[Diverticulosis: the dimensions of a growing problem].

The etiology of diverticulitis remains unexplained. One hypothesis postulates that a diet low in fiber results in low-volume feces, which in turn leads to a segmental increase in muscle tone with bulging of the mucosa. Diverticulitis then occurs through micro-/macroperforation of the resulting diverticulum. Four grades are distinguished ranging from local mesenteric inflammation (grade I) to fecal peritonitis (grade IV). Asymptomatic diverticulitis requires no treatment. Diverticular bleeding must be carefully distinguished from upper gastrointestinal tract bleeding, carcinoma, and angiodysplasia. In the case of symptomatic diverticulitis ("left-sided appendicitis") a differentiation must be made between the acute and chronic forms. The diagnosis of diverticulitis is based on laboratory findings, x-rays and CT scans. If chronic diverticulitis is suspected, it is important to exclude carcinoma of the colon. Whether treatment should be surgical or conservative will depend on the severity of the condition, and on the complications that may be expected with conservative therapy.

Adult↗
PubMed2002

[Insidious and often fatal. Appendicitis with few symptoms in the elderly patient].

The age peak for acute appendicitis is between 10 and 20 years. Although older persons more rarely develop appendicitis, in the group of over-45-year-olds the perforation and mortality rates are appreciably higher. The reason for this is the fact that in the elderly, the symptoms are often veiled, so that the diagnosis is delayed. A particular role in this connection is played by pain killers and non-specific findings. In particular, however, the commonly present co-morbidity in older patients with appendicitis often leads to recalcitrant infections, and not infrequently to sepsis with a potentially fatal outcome. For the establishment of the diagnosis, therefore, a careful physical examination and thorough history-taking, together with a comprehensive laboratory work-up is essential. Imaging procedures such as X-rays of the abdomen, ultrasonography and, where indicated, such further measures as a barium enema or a CT scan may help establish the diagnosis in patients with unclear clinical symptoms, and thus prevent perforation.

Abdominal Pain↗
PubMed2002

Predictive factors for response to neoadjuvant therapy in patients with oesophageal cancer.

BACKGROUND: Preoperative radio-chemotherapy (RCX) was introduced to improve the outcome of patients with oesophageal cancer (EC), but conflicting results have been released. Some 20-30% of patients show a complete pathological response, however, the perioperative morbidity and mortality is increased. To search for factors indicating response prior to the onset of RCX we investigated the proliferative activity (MIB-1), the expression of vascular endothelial growth factor (VEGF), and the capillary density (CD34) in samples of EC obtained by endoscopy prior to the start of the treatment. METHODS: Forty-six (MIB-1) and 21 (VEGF, CD34) tissue specimens of ECs were available from 56 patients undergoing pretherapeutic endoscopy, RCX and surgery. Perioperative morbidity was divided into surgery and non-surgery related morbidity. MIB-1, VEGF and CD34 expression were investigated immunohistochemically. Multivariate analysis was carried out to prove independence of investigated variables. RESULTS: Postoperative morbidity was noticed in 54 of 56 operated patients. Eight of 56 patients who received RCX died in hospital. Survival was significantly different between the group of complete responders (n=14) and non-responders (n=23; P=0.0026). None of the investigated tumour samples from patients with a complete response (CR) had a proliferation index of less than 45. Tumour samples from patients with a CR showed a VEGF expression of 10.7 compared with 36.58 of tumours with no response (P=0.035). CD34 expression showed a correlation with VEGF expression. The relation of mean indices of VEGF expression and proliferative activity in tumours from patients with complete, partial or no response was 10.7:58.8, 18.3:53.8 and 36.6:43.5, respectively. CONCLUSIONS: According to these results, it may be expected that tumours with a VEGF/MIB-1 ratio of 1:6 or less prior to RCX will respond to this therapy.

Adenocarcinoma↗
PubMed2001

Genesis and pathophysiology of lower gastrointestinal bleeding.

The incidence of lower gastrointestinal bleeding (LGB) is estimated to be 20-30 per 100,000 of the adult population at risk, which is clearly correlated with increasing age. The problem of LGB is identification of the bleeding source. LGB stops spontaneously in 80% of cases, but 10% of bleeding sources cannot be identified, and rebleeding occurs in 25%. The quality of LGB--hematochezia, melena, or occult bleeding--may point to the region of the bleeding source, as patient age is correlated with specific pathologies. In many patients, LGB is a leading symptom of a chronic disorder. Most acute peranal bleeding arises from the colon (80%) with colonic diverticula and angiodysplastic lesions as the most frequent reasons. In 5% of cases, LGB is caused by disorders of the small bowel, in most cases due to small-bowel tumors or to Meckel's diverticulum in younger patients. In 15-20%, acute peranal bleeding is caused by lesions in the upper gastrointestinal tract. The intensity of LGB determines the urgency of identification of the bleeding source; however, chronic occult blood loss superimposed by melena may place the patient at risk as early as a patient with hematochezia. Therefore, prompt resuscitation is required in many LGB patients before diagnostic procedures are initiated.

Gastrointestinal Hemorrhage↗
PubMed2001

Results in surgery for primary and metastatic chest wall tumors.

OBJECTIVES: Resection of chest wall tumors is often indicated for palliation from pain or chronic ulceration. However, under various conditions, it may lead to lasting tumor control and substantial freedom of disease might be achieved. Therefore, the long-term survival after chest wall resection for primary and metastatic tumors and its relation to the underlying histology was analyzed. METHODS: The medical files of 82 consecutive patients with tumors of the chest wall operated between 1 January 1989 and 31 October 1998 were reviewed. Follow-up data were collected from the outpatient's clinic and house physicians, respectively. Complete excision was accomplished in 71 patients. In 19 patients, partial or complete resection of the sternum was performed. Twenty-eight patients underwent chest wall resection extending to intrathoracic structures (lung, diaphragm, pericardium). The following subgroups were defined according to the histology: (A), sarcoma (n=32); (B), breast cancer (n=22); (C), renal cell cancer (n=9); (D), other metastases (n=7); (E), miscellaneous (n=12). The survival probability was calculated by the Kaplan-Meier method (SAS software system). RESULTS: One of 41 female patients died from postoperative complications on day 30 after resection of ulcerating breast cancer recurrence (hospital mortality, 1.2%). The median survival times in groups A-E were 27, 32, 19, 16 and 22 months, respectively. CONCLUSIONS: Chest wall resection offers immediate relief in the case of severe pain and unpleasant sequelae of ulceration. Moreover, it contributes to substantial long-term survival. This, in particular, applies to local recurrence after breast cancer.

Adolescent↗
PubMed2001

Validation of FDG positron emission tomography for differentiation of unknown pulmonary lesions.

OBJECTIVE: The impact of the (2-(fluorine-18)-fluoro-2-2deoxy-D-glucose)-positron emission tomography ((18)F-FDG-PET) for discrimination of pulmonary lesions was evaluated in a single centre prospective study. METHODS: In the study, 109 patients with pulmonary lesions of unknown origin verified by computed tomography were enrolled consecutively (April 1999--May 2000). They were subject to (18)F-FDG-PET diagnostics. (18)F-FDG-PET images were interpreted by two independent nuclear medicine physicians who were blinded to the results of other imaging procedures. In 87 patients, surgery was applied followed by histological investigation, which served as the gold standard. In 22 other patients, extensive tumour load or assumed benign dignity of the lesions prevented surgery. RESULTS: Overall sensitivity of (18)F-FDG-PET in 87 resected patients was 0.86. Differentiation in malignant (n = 69) and benign lesions (n = 18) revealed sensitivities of 0.9 and 0.72, respectively. Sensitivity of (18)F-FDG-PET in inflammatory lesions was markedly lower (0.43) than in benign tumours (0.91). Standard uptake values were significantly increased in malignant tumours compared with benign lesions (9.9 and 1.6, respectively; P = 0.035). There was a clear correlation of sensitivity with tumour size with a failure rate of 27% in lesions < or = 1cm (n = 15), 10% (n = 20) in lesions between 1 and 2 cm and 12% (n = 45) above 2 cm. In primary bronchial carcinoma, a clear correlation of sensitivity was observed with regard to tumour grading (G1, three out of five; G2, 24 out of 27; G3, 26 out of 26; and G4, one out of one). Lymph node involvement was correctly suggested in 10 out of 19 (52.6%) patients. However, false positive lymph node enhancement was indicated in one out of 18 (5.5%) operated patients with benign lesions and eight out of 39 (20.5%) with bronchial carcinoma. CONCLUSION: (18)F-FDG-PET at present does not serve as the gold standard for early detection of small and well-differentiated tumours. However, it contributes efficiently to the detection of malignancy in tumours >1cm, which are moderately or poorly differentiated. Positive lymph node imaging must not preclude surgery but requires histological proof. Discrimination of benign and malignant pulmonary tumours by (18)F-FDG-PET appears to be hampered in inflammatory lesions.

Adenocarcinoma↗