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Biomedical subjects

H Dienemann

Publications and source records attributed to H Dienemann.

At least 91 records · Page 5Linked to original sources
PubMed1995

[Recurrent multiple leiomyomatous hamartomas of the lung].

A 40 year old female was operated because of pulmonary leiomyomatous hamartoma. Despite repeated surgical resection therapy during the following years she developed recurrent multiple hamartoma. The indication for multiple surgery only included compression of central vessels or rapid growth of the hamartomas. The history of hysterectomy--as in our patient--is common for patients with multiple leiomyomatous pulmonary hamartoma. However, revision of the histological slides revealed no hint of uterine leiomyosarcoma. Therefore, a primary pulmonal (and recurrent) multiple hamartosis seems obvious.

Adult↗
PubMed1995

[Noninvasive ventilation after lung transplantation].

BACKGROUND: Non-invasive mechanical ventilation (NIPPV) is an accepted choice of treatment in patients with chronic pulmonary disease and/or acute respiratory failure. Recently NIPPV was also proposed in the postoperative weaning period. PATIENTS AND METHODS: Six of 30 patients after lung transplantation were were extubated despite a weaning failure was predicted using well accepted weaning criteria. Therefore, the 6 patients were treated with intermittent-noninvasive ventilation using assisted modes of mechanical ventilation (PSV/CPAP). RESULTS: Both, oxygenation (increase in paO2: 18 mm Hg during PSV, 11 mm Hg during CPAP) and pulmonary mechanics (decrease in respiratory rate: 14/min during PSV, 10/min during CPAP; increase in tidal volume: 5 ml/kg during PSV, 3 ml/kg KG during CPAP) improved and the energy expenditure decreased (19% during PSV, 12% during CPAP). CONCLUSION: Non-invasive ventilation after lung transplantation enables earlier extubation and prevents weaning failure.

Humans↗
PubMed1995

[Morbidity and long-term survival after bronchoplastic resection of non-small-cell bronchial carcinoma].

During the past 12 years, among 1384 operations for NSCLC, 96 (6.9%) bronchoplastic resections were performed. There were 68 lobectomies, 19 bilobectomies and 9 pneumonectomies done by means of 66 sleeve resections, 28 wedge resections and 2 resections of the tracheal bifurcation. Atelectasis and anastomotic dehiscence were observed in 5 and 4%, respectively. A local complete resection was achieved in 81%. The 30-day mortality was 4%. The results show, that bronchoplastic procedures represent a safe therapeutic option in the operative treatment of centrally located NSCLC.

Aged↗
PubMed1994

[Heart, heart-lung and lung transplantation, 1994 status].

In recent years, heart transplantation has become a clinically routine means of treating patients with terminal cardiac disease. One-year survival rates of more than 80%, and five-year rates of about 70% vindicate the clinical acceptance of this form of treatment. Combined heart and lung transplantation has been practiced for the past ten years. Following the introduction of unilateral and bilateral lung transplantation in 1985, the combined heart/lung approach is now rarely indicated. In the treatment of interstitial, but also pulmonary vascular, diseases, unilateral and bilateral lung transplantation has been increasingly employed. Currently, the one-year survival rate of single-lung transplantation is 70%, that of two-lung or heart-lung transplantation about 60%. The main complications of such procedures remain the high incidence of infection and graft rejection. The lack of availability of suitable donor organs continues to be the major factor limiting the number of transplantations performed.

Cause of Death↗
PubMed1994

[Isolated lung transplantation. Analysis of 17 consecutive operations. Munich Lung Transplant Group].

16 patients (nine men, seven women; mean age 45 [23-62] years) with end-stage pulmonary disease underwent lung transplantation, 14 unilateral, three bilateral (one bilateral retransplantation). The diagnoses were: emphysema (n = 5), idiopathic pulmonary fibrosis (n = 5), emphysema in alpha 1-antitrypsin deficiency (n = 1), mucoviscidosis (n = 1), drug-induced fibrosis (n = 1), chronic lung rejection after heart-lung transplantation (n = 1), secondary pulmonary hypertension with persistent ductus arteriosus (n = 1), sarcoidosis (n = 1) and chronic transplant failure after unilateral transplantation (n = 1). Eleven patients survived long-term (mean follow-up period 247 [8-585] days). Ten of these patients have been independent of additional oxygen after an average of 8 months postoperatively, eight are physically active according to their age. Three patients died of reperfusion damage intraoperatively or in the early postoperative period. The two other patients died from septicaemia 5 1/2 and 7 months postoperatively. It is concluded that lung transplantation in end-stage pulmonary disease provides the only therapeutic means with any expectation of physical rehabilitation.

Activities of Daily Living↗
PubMed1994

Stent-angioplasty of an anastomotic stenosis of the pulmonary artery after lung transplantation.

Anastomotic stenosis of the pulmonary artery after lung transplantation is a rare complication, which commonly necessitates surgical correction. Transesophageal Doppler sonography and pulmonary arteriogram are standard diagnostic means for visualization of venous and arterial anastomoses. Balloon dilatation combined with implantation of a vascular endoprosthesis was successfully used for treatment of severe anastomotic stenosis of the pulmonary artery after lung transplantation.

Anastomosis, Surgical↗
PubMed1994

Sequential resection of residual abdominal and thoracic masses after chemotherapy for metastatic non-seminomatous germ cell tumours.

Thirty-eight patients with advanced non-seminomatous germ cell tumours (NSGCTs) underwent multiple surgical interventions (two in 33 patients, three in four patients, four in one patient) after cisplatin-based chemotherapy. All patients had normal serum tumour markers but persistent radiographic masses. The larger mass was routinely resected first. Fifteen patients (39%) had dissimilar histological findings at sequential surgical procedures, 12 of whom demonstrated less favourable pathological features during the first operation and three at the second. Patients who underwent both retroperitoneal lymph node dissection (RPLND) and lung resection showed less favourable histological features in the retroperitoneum in nine cases and in the lung in three cases. Eight of 16 patients (50%) without mature teratoma in their primary tumours showed complete necrosis/fibrosis at all surgical interventions, whereas all patients whose primary tumour was classified as malignant teratoma intermediate demonstrated mature teratoma at least at one anatomical site. As histology of post-chemotherapy residual masses cannot be extrapolated from one anatomical site to another, patients usually are properly managed by excision of all residual masses. In particular, in patients with necrosis/fibrosis at lung resection omission of RPLND is not advised.

Abdominal Neoplasms↗
PubMed1994

[Fine mesh metal endoprostheses for treatment of extensive cervical and intrathoracic tracheomalacia].

The treatment of tracheal stenoses caused by tracheomalacia is mainly carried out by means of sleeve resection, tracheopexy with ring support or other tracheoplastic operative procedures. If patients cannot be treated by surgical operative strategies, conventional stents are usually used to dilate the trachea. The use of a self-expanding elastic metal prosthesis in 5 patients with tracheal airway obstruction caused by tracheomalacia proved to be a true alternative in the therapy of tracheobronchial stenoses. We report on the long term use of 5 patients with tracheal stenoses treated by implantation of elastic metal wallstents. The implantation of the stents resulted in immediate improvement in respiratory function in all 5 patients. None of the patients experienced complications secondary to the stent placement. The stents were well tolerated (long-time follow-up 26 months). The implantation of self-expanding metal stents type "wallstent" seems to offer alternative possibilities for the treatment of tracheomalacia.

Aged↗
PubMed1994

[Treatment guidelines for inflammatory and malignant diseases of the thyroid gland].

Most cases of thyroiditis can be treated with antibiotics, antiphlogistics, and corticosteroids. In case of abscess caused by bacterial infection or compression of the trachea surgical therapy is required for drainage and resection. The prognosis for differentiated malignant tumours of the thyroid gland is good even if metastases have occurred. The recommended therapy includes total resection of the thyroid gland and radioiodine therapy to eliminate any remaining thyroid tissue. For anaplastic thyroid carcinomas surgery should be considered because of the extremely poor prognosis for these types of tumours. Resection should be performed to improve the patient's quality of life by avoiding tracheostoma or to ensure normal nutritional uptake. Medullary thyroid carcinoma is known in sporadic and in hereditary forms. Thyroidectomy is the accepted therapy. In 15% of the patients we observed the syndrome of multiple endocrine neoplasms (MEN), which is a form of thyroid carcinoma complicated by pheochromocytoma and hyperparathyroidism. Diagnosis of thyroid carcinomas includes examination of the patient, scintigraphy and ultrasonography of the thyroid gland, and cytological examination by aspiration biopsy. Post-operative care includes substitution of thyroid hormones, regular measurement of the thyreoglobulin levels in the blood, and examination for metastases in the lungs, the abdomen, and the bones.

Aftercare↗
PubMed1994

[Radiological diagnosis in lung transplant patients].

Based on the imaging studies obtained from 13 patients after lung transplantation, radiological findings have been correlated with the clinical charts. The intention was to describe the radiological manifestations of the particular transplant complications of these patients. 12 episodes of reimplantation response were seen in the early postoperative period as a perihilar accented perivasal consolidation with typically short-termed appearances. 16 episodes of acute rejection showed various manifestations on the radiographs. They were characterised by immediate response to a bolus therapy with corticosteroids. This decisive observation allows the exclusion of other causes contributing to a condition following thoracotomy with similar radiological manifestations. Stenoses of the pulmonary or the bronchial anastomoses occurred once each and were confirmed in the course of further examinations. Chest radiograph proved to be the appropriate tool for the diagnosis of technical complications following iatrogenic measures (pleural effusion, pneumothorax). Clinical symptoms and follow-up observations are necessary for the interpretation of the radiographs. Chest radiography represents an important help concerning problems in differential diagnosis and further therapeutic decisions.

Acute Disease↗
PubMed1994

Cytokeratin 19 fragment CYFRA 21-1 compared with carcinoembryonic antigen, squamous cell carcinoma antigen and neuron-specific enolase in lung cancer. Results of an international multicentre study.

The diagnostic value of the water-soluble cytokeratin 19 fragment CYFRA 21-1 in lung cancer was assessed in comparison with carcinoembryonic antigen, squamous cell carcinoma antigen, and neuron-specific enolase. The cut-off value, defined as 95% specificity versus a group of 526 patients suffering from benign chest diseases, was set at 3.3 micrograms/l for cytokeratin 19 fragment CYFRA 21-1 (carcinoembryonic antigen: 7.8 micrograms/l, squamous cell carcinoma antigen: 1.9 micrograms/l, neuron-specific enolase: 13.7 micrograms/l). Elevated pretreatment cytokeratin 19 fragment CYFRA 21-1 concentrations were recorded: in 112 of 244 (46%) patients with all histological types of lung cancer (carcinoembryonic antigen: 32%, squamous cell carcinoma antigen: 25%, neuron-specific enolase: 28%), in 89 of 177 (50%) patients with non-small cell lung cancer (carcinoembryonic antigen: 33%, squamous cell carcinoma antigen: 24%, neuron-specific enolase: 12%), in 47 of 81 (58%) patients with squamous cell carcinoma (carcinoembryonic antigen: 23%, squamous cell carcinoma antigen: 32%, neuron-specific enolase: 14%), in 27 of 63 (42%) patients with adenocarcinoma (carcinoembryonic antigen: 44%, squamous cell carcinoma antigen: 14%, neuron-specific enolase: 9%), in 15 of 33 (45%) patients with other non-small cell lung cancer (carcinoembryonic antigen: 36%, squamous cell carcinoma antigen: 24%, neuron-specific enolase: 14%), and in 20 of 55 (36%) patients with small cell lung cancer (carcinoembryonic antigen: 32%, neuron-specific enolase: 77%). Three of 12 patients with undefined histological type showed cytokeratin 19 fragment CYFRA 21-1 elevations. The best performance in terms of sensitivity and diagnostic accuracy was attained with the cytokeratin 19 fragment CYFRA 21-1 test in squamous cell carcinoma. In small cell lung cancer neuron-specific enolase was confirmed to be superior to the other markers. Cytokeratin 19 fragment CYFRA 21-1 concentrations increased with the extent of the malignant disease in non-small cell lung cancer. The positivity rate of cytokeratin 19 fragment CYFRA 21-1 in tumour stage TNM I was only 23% (carcinoembryonic antigen: 23%, squamous cell carcinoma antigen: 14%), i.e. the markers under study cannot be used for the diagnosis of early stage disease. Cytokeratin 19 fragment CYFRA 21-1 differentiated significantly between squamous cell carcinoma and the other histological types (p < 0.01). In addition, cytokeratin 19 fragment CYFRA 21-1 distinguished significantly the operable group TNM I-IIIa from inoperable TNM IIIb-IV (p < 0.05), but not TNM IIIa from IIIb. Out of 177 patients with non-small cell lung cancer, 90 individuals were monitored after surgery.(ABSTRACT TRUNCATED AT 400 WORDS)

Adenocarcinoma↗
PubMed1993

CYFRA 21-1. A new marker in lung cancer.

BACKGROUND: It is known that cytokeratin 19 is particularly abundant in carcinoma of the lung. METHODS: A sandwich enzyme-linked immunosorbent assay called CYFRA 21-1 was, therefore, developed to detect soluble cytokeratin 19 fragments in serum using two specific monoclonal antibodies (Ks 19.1 and BM 19.21). The authors investigated the clinical significance of this new marker compared with the established markers carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC), neuron-specific enolase (NSE), carbohydrate antigen (CA) 19-9, CA 125, CA 15-3, CA 72-4, alpha-fetoprotein, and prostate-specific antigen in a pilot study on 1741 serum samples from patients with various benign and malignant diseases. RESULTS: Postulating a specificity of 95% versus benign diseases of the lung, the diagnostic sensitivity of CYFRA 21-1 in lung cancer (independent of histologic type) at primary diagnosis was superior (47%) to CEA (27%), SCC (15%), and NSE (16%). Especially in squamous cell carcinomas of the lung, the true-positive test results were much higher for CYFRA 21-1 (60%) than for CEA (18%) or SCC (31%). CONCLUSIONS: In small cell lung carcinomas, NSE was confirmed as the marker of first choice. For all of the other solid tumors investigated, CYFRA 21-1 showed no better profile of specificity and sensitivity than the established markers.

Antibodies, Monoclonal↗
PubMed1993

[The implantation of elastic metal endoprostheses in tracheal stenosis and tracheomalacia. The initial results with 4 patients].

Narrowing of the trachea due to tracheomalacia or compression can lead to life-threatening asphyxia and may require tracheotomy with intubation or endoscopic introduction of a stent. The use of a self-expanding elastic metal prosthesis in 4 patients with airway obstruction has proved a satisfactory alternative to conventional plastic prostheses, both in the acute phase and over a long period of time. After 4 weeks total epithelium cover of the stent could be demonstrated; biopsies after 3 and 4 months showed differentiation into respiratory ciliated epithelium. Patient acceptance was excellent since there was no sensation of a foreign body, retention of secretions or cough. The physical properties of the wall stent made it a suitable mechanical replacement for an unstable or narrowed trachea during the period of observation.

Aged↗
PubMed1993

Comparison of cytokeratin fragment 19 (CYFRA 21-1), tissue polypeptide antigen (TPA) and tissue polypeptide specific antigen (TPS) as tumour markers in lung cancer.

Recently CYFRA 21-1, a new tumour marker measuring a fragment of cytokeratin 19, was introduced and proved to be suitable for the follow-up care and monitoring of the therapy of non-small cell lung carcinomas, especially squamous cell carcinomas of the lung. Besides CYFRA 21-1, there are two other tumour markers available, called tissue polypeptide antigen (TPA) and tissue polypeptide specific antigen (TPS), which also measure different cytokeratins in serum. In a retrospective study we investigated the clinical significance of these 3 cytokeratin markers in lung cancer compared with carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC) and neuron-specific enolase (NSE). We investigated the sera of 50 healthy persons, 273 patients with various benign diseases and 218 patients with histologically proven lung cancer. In a first step the specificity versus benign diseases of the lung was established for all the markers, and was fixed at 95%. Then the single and combined sensitivities were calculated. CYFRA 21-1 proved to possess the highest sensitivity in lung cancer in general (61%), in non-small cell lung carcinomas (64%), in squamous cell carcinomas (79%), in adenocarcinomas (54%) and in large cell carcinomas (65%). In small cell lung carcinomas, neuron-specific enolase proved again to be the marker of first choice (55%). Combined determinations proved clearly increased sensitivity only for large cell carcinomas (CYFRA 21-1 + TPA: 77%) and for small cell lung carcinomas (CYFRA 21-1 + NSE: 62%).(ABSTRACT TRUNCATED AT 250 WORDS)

Antigens, Neoplasm↗
PubMed1993

[Surgery of metastases--can surgery of metastases be radical?].

Resection of metastases gains more and more importance in day to day surgical work task. Mainly only liver- and pulmonary metastases can be resected with a curative aim, depending on the primary tumor and the metastasing cascade. According to tumor surgery a R0-resection is warranted. Whether a multimodal approach may improve long-term results by eliminating occult micrometastases should be answered by ongoing studies. Even in palliative situations complete resections of metastasis are preferred and in selected situations a multimodal approach may be chosen.

Bone Neoplasms↗