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Biomedical subjects

H Dienemann

Publications and source records attributed to H Dienemann.

At least 73 records · Page 4Linked to original sources
PubMed1997

[Incomplete resections in bronchial carcinoma: morbidity and prognosis].

Residual tumor (R1) was proven at the proximal bronchial resection margin in 88 (3.6%) of 2464 cases of lung cancer following lung resection and standard lymph node dissection. Postoperative complications (8%) were: fistula of the bronchial suture line (n = 7), bleeding (n = 2) and heart luxation (n = 1). The in-hospital mortality was 16.6%. Causes of death were: bronchial fistula (n = 7), erosion of the pulmonary artery (n = 4), respiratory failure (n = 1), and empyema (n = 1). Forty-three patients received postoperative radiation therapy. Median survival of all patients following incomplete resection was 16 months, compared to 37 months following complete resection (P < 0.001). Length of survival was independent of tumor stage, histology, site of infiltration and postoperative radiation. In conclusion, in resection for lung cancer clear margins should be verified by intraoperative frozen section. In the case of residual tumor at the bronchial resection margin, wider resection is mandatory in stage I and II if the patient meets the functional criteria. Even in stage III a and III b prognosis is significantly better after complete resection than R1-resection; the difference, however, is smaller than in lower stages.

Adult↗
PubMed1997

[Radiologic interventions in anastomosis complications after lung transplantation].

PURPOSE: Bronchial and arterial anastomotic stenoses are major complications after lung transplantation. Interventional techniques provide a definitive cure in certain cases. MATERIAL AND METHODS: Three out of four patients had ischemia-related stenoses of the bronchial anastomoses postoperatively; one patient developed malacia of the bronchus main stem 1 year after transplantation. Four patients has stenoses of the arterial anastomoses, which resulted in hemodynamic instability and reduced perfusion of the graft. RESULTS: Stent implantation in the bronchial anastomoses (n = 3) and in the main stem (n = 1) improved ventilation and oxygen saturation in all patients. The stents were incorporated by mucosal overgrowth, as demonstrated by endoscopy, as early as 6 weeks after implantation. Balloon dilatation (n = 3) and stent implantation (n = 1) were successfully performed in 4 patients with stenoses of the arterial anastomoses. The mean transstenotic pressure gradient of 9.5 mm Hg was reduced to 2.2 mm Hg after angioplasty. Lung perfusion shifted towards the grafts, as shown by 99mTc perfusion scans. CONCLUSION: The minimally invasive techniques of interventional radiology are very effective in the treatment of anastomotic complications after lung transplantation and may avoid surgery in certain cases.

Adult↗
PubMed1997

Lymphangioleiomyomatosis: recurrence after single lung transplantation.

Lymphangioleiomyomatosis (LAM) is a rare disease which afflicts young women of childbearing age. Recently, it has been listed as an indication for lung transplantation. We describe a case of recurrent LAM in a 31-year-old woman occurring in the allograft of a male donor after single lung transplantation. Nonisotopic in situ hybridization shows that the smooth muscle cell proliferation is of donor origin.

Adult↗
PubMed1997

Changes during the last decade in clinical parameters of operated lung carcinoma patients of a center for thoracic surgery and the prognostic significance of TNM, morphometric, cytometric, and glycohistochemical properties.

Two sets of patients with potentially curative resection of primary carcinomas operated in the Department of Thoracic Surgery, Thoraxklinik, Heidelberg during the period 1983-1984 (cohort I), and in 1994 (cohort II) were analyzed. The survival of patients, postsurgical TNM-stages, cell types, and exposure to potentially harmful substances were evaluated. In addition, cytometric and morphometric techniques, and various biotinylated markers have been applied to the tissue sections of the 1994 cohort. Cohort I comprised 282 patients (253 men and 29 women), cohort II all in all 171 patients (121 men and 49 women). In cohort I there were 262 heavy smokers, and 28 patients had a history of exposure to harmful environmental substances (asbestos, polycyclic aromates, etc.) compared to 145 smokers and 68 patients who inhaled potentially harmful substances in cohort II. Major changes were also seen in early lung cancer stages (pT1, pN0) which increased in cohort II, and in a decrease in the relative frequency of epidermoid carcinomas in both men and women with corresponding increase in the frequency of adenocarcinoma in both sexes. The median survival of patients operated with advanced tumor stages had remained unchanged, that of early stages (pT1, pN0, pN1) seems to have improved. Within the cytometric features syntactic structure analysis revealed that the current of structural entropy is closely associated with the survival of patients. Of prognostic significance are, in addition, the expression of binding capacities to histoblood group trisaccharides A and H, the presence and the binding of macrophage migration inhibitory factor, and the presence of ligands for the chicken liver galectin CL-16 and the LewisY antigen. Multivariant statistical analysis gave preferential prognostic importance to the glycohistochemical and morphometric parameters relative to the clinical pT and pN stages in survival analysis.

Adenocarcinoma↗
PubMed1997

Reduced lipid peroxidation and ischemia-reperfusion injury after lung transplantation using low-potassium dextran solution for lung preservation.

Ischemia-reperfusion injury is one of the significant problems in clinical lung transplantation. We investigated the effect of lung preservation with Euro-Collins solution (EC group) or low-potassium dextran solution (LPD group) on lipid peroxidation and ischemia-reperfusion injury in a pig model of lung allotransplantation. The donor lungs were preserved at 4 degrees C for 18 h. Left-sided single lung transplantation was performed, followed by 6 h of reperfusion. Lipid peroxidation was measured as thiobarbituric acid-reactive materials (TBARM) in bronchoalveolar lavage (BAL) fluid and effluent solutions from pulmonary artery (Effluent). After 18 h of ischemia, the LPD group showed lower TBARM in BAL and Effluent than the EC group (p < 0.05). After ischemia plus reperfusion, lung wetto-dry weight ratios and TBARM levels in BAL in the LPD group were lower than those of the EC group (p < 0.05). Lung wet-to-dry weight ratios correlated with TBARM levels in BAL (p < 0.05, r = 0.50). We conclude lipid peroxidation in BAL and Effluent may reflect the degree of ischemia-reperfusion injury, and lung preservation with LPD can reduce lipid peroxidation and lung injury as compared with EC.

Animals↗
PubMed1997

[Surgical information systems as instruments in quality assurance].

In various aspects, it is important to document medical procedures performed in surgical management. These records have become even more relevant because, in realizing the German health structure law, new forms of remuneration have been established, which are correlated with defined services. This means that data from medical documentation records today "rule" on financial compensation and, consequently, on the total economy of a hospital. Data are to be gathered considering multiple clinical and administrative requests; they have to register all pre-, intra- and postoperative details in their complex correlations; and, they are subject to strictly limited periods of compulsory availability. To meet these demands, data can only be recorded and evaluated by adequate computerized information systems. Starting out from a general data profile in response to questions from inside and outside of the hospitals, general criteria will be presented on what is to be recorded and how data are to be structured by surgery information systems. We will also refer to the interfaces required with information systems of other clinical departments that are part of the overall hospital information system. On this basis, guidelines are set up on how to plan, select, introduce and efficiently run these systems.

Cost Savings↗
PubMed1996

Identification of characteristics for malignancy of solitary pulmonary nodules using high-resolution computed tomography.

The aim of this prospective study was to apply the described single pathological appearance and possibilities of differentiating signs from other studies and summarize them concerning their differential diagnostic importance to improve differential diagnostic strategies concerning the dignity of solitary pulmonary nodules. 55 consecutive patients with solitary pulmonary nodules were examinated using high-resolution computed tomography (HRCT) before surgery. Thereafter HRCT-diagnosis was proven by histological assessment. Only lesions which were removed by surgery were used. No lesion was excluded by size. Necrotic areas, cavitation, satellite lesions and circumscribed pleural thickening were only found in the malignant nodules. Discrimination between benign and malignant lesions was possible by: mean diameter (P<.01), mean density (P<.01) and air inclusion (P<.05), by air bronchogram/bronchiologram (P<.05), indistinct/fogged (P<.05) and dystelectatic (P<.01) margin, the presence (P<.01) and length (P<.01) of spiculae, spiculae extended into the pleura visceralis (P<.05) and pleural distension (P<.01). A single sign can be seen in either benign or malignant nodules, but if considered together with other signs it may have a different meaning. HRCT can enable a differentiation of BSPN from MSPN in the majority of cases. As imaging methods could not get a nearly complete certainty about the dignity the chance of survival of patients could be preserved exclusively by an early surgery.

Carcinoma↗
PubMed1996

Sarcoidosis recurrence following lung transplantation.

Sarcoidosis is a rare indication for lung transplantation. In this article, our experiences with recurring sarcoidosis following lung transplantation are described. Literature concerning recurrence of the disease in kidney, liver, heart and lung transmission of sarcoidosis via transplanted organs are discussed.

Humans↗
PubMed1996

[Differentiation of solitary pulmonary coin lesions by high-resolution computerized tomography].

PURPOSE: The aim of this prospective study was not to describe individual morphological findings in benign and malignant solitary intrapulmonary nodules; it was instead to examine in a critical manner the indications for differentiation found in the literature in order to facilitate safe differential diagnosis of benign and malignant nodules. PATIENTS AND METHODS: A total of 64 solitary pulmonary nodules were examined with high-resolution computed tomography and correlated with histological findings. Only lesions that had been removed by surgery were used. No lesion was excluded on the grounds of size. RESULTS: Useful characteristics for the differentiation of benign from malignant pulmonary nodules were: diameter and density of the lesion, air inclusion, unsharp and dystelectatic margin, the presence of spicules, length of spicules, spicules extending to the visceral pleura, pleural tail sign and cirumscribed pleural thickening. CONCLUSION: For the differentiation of benign and malignant solitary pulmonary nodules meticulous assessment of the margin of the nodule is necessary. Using the criteria mentioned, a sensitivity of 85% and a specifity of 78% can be achieved for the identification of malignant pulmonary nodules. Since it was not possible to differentiate between benign and malignant nodules with certainty using imaging methods, the chance of patient survival could only be promoted by early surgery.

Adult↗
PubMed1996

Bronchoplastic resection for non-small-cell lung cancer.

During the past 12 years, among 1478 operations for non-small-cell lung cancer (NSCLC), 102 (6.9%) bronchosplastic resections were performed. There were 74 lobectomies, 19 bilobectomies, and 9 pneumonectomies done by means of 72 sleeve-, 28 wedge resections, and 2 resections of the tracheal bifurcation. Atelectasis was observed in 6%, whereas anastomotic dehiscence occurred in 4%. Local complete resection was achieved in 81%. The 30-day mortality amounted to 4%. Our results demonstrate that bronchoplastic procedures represent a safe therapeutic option in the operative treatment of central NSCLC.

Carcinoma, Non-Small-Cell Lung↗
PubMed1996

[Lymphadenectomy in bronchial carcinoma: facts and fiction].

Removal of mediastinal lymph nodes is essential for the surgical staging of lung cancer; it is therefore integral part of a curative surgical treatment. The accuracy of mediastinal staging - "biopsy" sampling or complete removal of mediastinal lymph nodes - is of significance since the N-status affects treatment and survival. Anatomical and technical considerations lead to the conclusion: Because of the anatomy of the lymph system a complete removal of all draining lymph vessels is not possible. However, accurate mediastinal staging is clearly recommended over "biopsy"-sampling. Future studies should focus on an improved histologic evaluation and should take other "new" factors affecting prognosis into consideration.

Biopsy↗
PubMed1996

[Results of operative therapy in sequential liver and lung metastasis].

During the last 16 years, 15 patients with colorectal (n = 12), gastric (n = 1), renal cell (n = 1) and adrenal (n = 1) carcinoma underwent sequential resection of both hepatic and pulmonary metastases. Median survival after diagnosis of primary tumor was 80 months (range 23-183), after liver resection 23 (range 10-131), and after lung resection 18 months (range 5-87). Compared to patients with only hepatic (median survival: 38 months) or pulmonary metastases (median survival: 30 months) survival time was not significantly different (p = 0.18).

Abdominal Neoplasms↗
PubMed1995

Thoracoscopic repair of thoracic spine trauma.

Modern concepts of treating thoracic and lumbar spinal trauma are based on posterior transpedicular fixation techniques which confer angular stability and instrument only a few levels of the spine. In addition, to prevent secondary losses in postoperative reduction of kyphotic deformities, transpedicular resection of torn discs, and inter- and intracorporeal bone grafting are included in the repair procedures for the entire damaged motion segment. However, due to the small size of the pedicles, a transpedicular approach to the injured vertebral body is not possible in the upper thoracic spine. Patients whose thoracic spine trauma is not serious enough to require ventral instrumentation through open thoracotomy, but who present with an unstable vertebral fracture, may profit from additional ventral bone grafting to stabilize the fracture. The present study examined the feasibility of thoracoscopic ventral bone grafting in seven patients with unstable fractures of the upper thoracic spine. For primary repair, we stabilized the fracture by using posterior transpedicular screw systems (rods or plates). Simultaneously, spongiosa was harvested from the posterior iliac crest and deepfrozen. Repair was completed a few days later via a ventral thoracoscopic approach. The main location of the ventral osseous defect was identified by intraoperative radiology. After mechanical removal of destroyed connective tissue and disc material, fusion was performed using the previously harvested spongiosa, which was placed into the intervertebral disc space and the anterior osseous defect. Our results show thoracoscopic bone grafting to be technically possible and associated with low morbidity, with a potential of yielding satisfactory long-term results.

Adult↗
PubMed1995

Outcome analysis after post-chemotherapy surgery in patients with non-seminomatous germ cell tumours.

BACKGROUND: The goal of the study was to analyse long-term outcome after post-chemotherapy surgery in male patients with non-seminomatous germ cell tumours (NSGCT). PATIENTS AND METHODS: We reviewed the charts of 111 patients with metastatic NSGCT treated at a single institution from 1979 to 1993 who underwent post-chemotherapy resection of residual masses after normalisation of tumour markers. The prognostic relevance of the extent of tumour residuals, the comprehensiveness of surgery and the histology at resection was analysed. RESULTS: Thirteen patients (12%) harboured viable cancer, and 46 patients (41%) mature teratoma at post-chemotherapy surgery. Only seven (54%) of the 13 patients with viable cancer remained continuously disease-free. Incomplete surgery predicted an impaired outcome (62% vs. 86% survival), although only one recurrence was observed at a site of an incompletely resected mass. Moreover, a progression-free interval < or = 3 months after post-chemotherapy surgery was correlated with worse subsequent survival (p = 0.0001). CONCLUSIONS: Post-chemotherapy surgery remains an essential part of the treatment for metastatic NSGCT. Resection of viable cancer and mature teratoma is of therapeutic benefit. Viable cancer at surgery defines the need for further chemotherapy.

Adolescent↗
PubMed1995

VLA-4 and VCAM-1 are the principal adhesion molecules involved in the interaction between blast colony-forming cells and bone marrow stromal cells.

The molecular basis and functional significance of interactions between haemopoietic progenitor cells and the stromal microenvironment is still poorly understood. Here we investigated a broad panel of surface adhesion molecules for their involvement. For this purpose, the colony-forming capacity of stroma-adherent Bl-CEC, BFU-E and GM-CFC was studied. Both mononuclear bone marrow cells (BMC) and bone marrow-derived stromal cells (BMSC) express a wide variety of adhesion molecules. However, only antibodies against beta 1-, alpha 4-integrin (both chains of the very late activation antigen-4 (VLA-4)) and vascular cell adhesion molecule (VCAM-1) inhibited colony formation from stroma-adherent Bl-CFC by 50% or more. Antibodies against a panel of other adhesion molecules, including the alpha 5-integrin chain, were without effect. Subsequent pretreatment experiments revealed that VLA-4 on progenitors interacted with stromal VCAM-1. The inhibitory antibodies did not interfere with the clonogenic capacity of but with adhesion of BFU-E and GM-CFC. Whether the inhibitory antibodies act similarly on progenitors which depend on BMSC for growth and/or differentiation, such as BI-CFC, remains to be determined.

Antibodies, Monoclonal↗
PubMed1995

[Inflammatory pseudotumors of the lung and trachea].

Inflammatory pseudotumors (synonym: plasma cell granulomas) of the lung and trachea are a group of non-neoplastic lesions of unknown etiology which may occur at any age. The complex histomorphology und proliferative capacity of these pseudotumors may result in diagnostic difficulties during intraoperative frozen section analysis. Four cases of inflammatory pseudotumors of the respiratory tract (three pulmonal, one tracheal pseudotumors) are reported. One patient (16 years, female) suffered from sudden chest pain with dyspnoe, caused by obstruction of the right main bronchus due to an intraluminal pseudotumor. Because of the intraoperative diagnosis of a malignant histiocytoma, sleeve resection of the right main bronchus with bronchotracheal anastomosis was performed. Eight years postoperative, the patient is still disease-free. Another patient (52 years, male) developed multiple inflammatory pseudotumors in both lungs with direct infiltration of the mediastinum. After three thoracotomies, there is still residual disease in the mediastinum. The third patient (52 years, male) developed an inflammatory pseudotumor in the right upper lobe after irradiation therapy for hypopharyngeal carcinoma several years before. The last case in this series is a patient (43 years, male) with suspected bronchial carcinoma in the left lower lobe. The intraoperative frozen section analysis interpreted this lesion as an bronchioloalveolar carcinoma, but the diagnosis was corrected in the paraffin embedded specimens. Clinical presentation, size and number of these tumors are very variable. Despite their rarity, inflammatory pseudotumors should be considered in the differential diagnosis.

Adolescent↗