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Biomedical subjects

H Dienemann

Publications and source records attributed to H Dienemann.

At least 109 records · Page 6Linked to original sources
PubMed1993

[Extended resections in bronchial cancer: complications and late results].

From 1982 through April 1992, 192 patients underwent extended resection for non-small cell carcinoma of the lung (NSCLC) invading the chest wall (n = 52) or the mediastinum (n = 140). Complete resection of the tumor was possible in 81 (58%) patients with invasion of mediastinum and in 34 (65%) patients with invasion of the chest wall. The operative mortality was 9%, respiratory complications causing most of the postoperative morbidity and mortality. Incomplete resection was associated with poor prognosis. The mean survival of these patients was 10 month. The 5 year actuarial survival rate of patients having curative resection was 20%. In these patients the presence of lymphatic metastases significantly reduced survival, with a 3 year actuarial survival rate of 40% of patients with No disease, and 30% or 5% for those with N1 or N2 disease, respectively. In conclusion, extended resection for advanced NSCLC offers a significant chance for long-term survival in the absence of N2 lymphatic metastases. In the presence of N2 metastases and poor overall prognosis however, reasonable palliation is the primary goal of surgical management.

Carcinoma, Bronchogenic↗
PubMed1993

[Expandable metal mesh stents for treatment of tracheal stenoses and tracheomalacia].

The treatment of tracheo-bronchial stenosis or tracheomalacia is mainly carried out by means of resection or tracheoplastic operative strategies. Since the introduction of metal-mesh stents, a definitive endoluminal therapy has to be considered under new aspects. Six patients with malignant stenosis or tracheomalacia due to compression were treated by implantation of Palmaz- or Wallstents. Immediately after the implantation, patients were relieved from dyspnoea, the forced inspiratory volume-1 (FIV1) was normalized. All implanted stents were well tolerated, even in the long-time follow-up (19 months). Bronchoscopic control showed overgrowth of the metal meshes by respiratory epithelium. The implantation of metal-mesh stents is an adequate alternative in the treatment of malignant stenosis and tracheomalacia.

Aged↗
PubMed1993

[Video-thoracoscopic atypical lung resection].

A new era in thoracoscopy within the framework of minimal invasive thoracic surgery was introduced due to the possibilities of video-endoscopy, the development of an accordingly advanced and suitable instrumentarium as well as the production of an endoscopically applicable linear stapler. The introduction of the endo-staplers has made the thoracoscopic resection even of larger parts of lung parenchyme possible. Just as in laparoscopy a clear reduction of post-operative pain, a reduced impairment of post-operative pulmonary function, a shorter in hospital stay and an earlier return to normal activities are advantages of thoracoscopy when compared to the severely more traumatising thoracotomy. Good indications for this procedure are the spontaneous pneumothorax and the resection biopsy in the quest of finding the diagnosis of unclear pulmonary disease. For the diagnostic and should the situation arise therapeutic resection of solitary pulmonary nodules in contrast a stricter selection and handling of indications is imperative. The method however proved worthwhile under such conditions. The technique and results are reported of video thoracoscopies in 73 patients as well as 51 atypical lung resections carried out thoracoscopically with the Endo-GIA 30. A switch to open thoracotomy became necessary in 16.4%. Indications were pneumothorax (35.6%), hemothorax (1.3%), diagnostic resection of solitary nodule (42.5%), pneumopathy (11.0%), and extrapulmonary tumor (9.6%). Atypical resections were carried out only in the case of solitary nodule (51.7%), pneumothorax (39.7%), and pneumopathy (8.6%). A histological diagnosis was obtained in all cases. The average operating time for solitary nodule and pneumothorax was 1 hour, for pneumopathy 1/2 hour. Chest drains could be removed after 1.6-2.6 days. The postoperative complication rate amounted to 3.9%. There was no mortality. The introduced procedure represents a new and promising alternative in thoracic surgery.

Adult↗
PubMed1993

Cardiac inotropic as well as coronary and pulmonary artery actions of epinine in human isolated tissues.

The present study was aimed to characterize the effects of epinine, the metabolite of the p.o. active dopamine derivate ibopamine in human cardiovascular tissues such as myocardium, coronary artery and pulmonary artery. Isometric force of contraction was studied in electrically driven papillary muscle strips from nonfailing (brain death), moderately failing (New York Heart Association class II-III, mitral valve replacement) and terminally failing human myocardium (New York Heart Association class IV, heart transplants) as well as in auricular trabeculae (aortocoronary bypass operation). Epinine increased force development in a concentration-dependent manner. In comparison to isoprenaline, epinine had a significantly lower potency but a similar efficacy to enhance force of contraction. Depending on the degree of myocardial failure, the effectiveness of epinine was reduced, whereas the potency was similar. Only in nonfailing myocardium, epinine increased force of contraction as effectively as Ca++. Prestimulation with forskolin or milrinone enhanced the potency of the epinine-mediated inotropic effect. In contrast, the beta-1-selective antagonist CGP 207.12A [2-hydroxy-5-(2-(hydroxy-3-(4-((1-methyl-4-trifluoromethyl)-1-H-imidazol -2-yl)-phenoxy)-propyl)-aminoethoxyl)-benzamide] and the beta-2-selective antagonist ICI 118.551 [erythro-(+-)-1-(7-methylindan-4-yloxy)-3- isopropylaminobutan-2-ol-hydrochloride] shifted the concentration-response curve of epinine significantly to the right, indicating action at both beta-2 and beta-1 adrenoceptors. Epinine exerted higher affinity at beta-2 compared to beta-1 adrenoceptors in radioligand binding experiments ([125I]iodocyanopinodolol). In human coronary artery rings and pulmonary artery rings epinine alone as well as epinine in the presence of propranolol initiated a concentration-dependent increase in tension development in precontracted (prostaglandin F2 alpha, 0.3 mumol/l) as well as in non-precontracted rings. These results suggest that epinine exerts no direct vasodilatory activity in human coronary and pulmonary arteries at concentrations which are capable to produce positive inotropic activity. The supposed beneficial effects of ibopamine in the treatment of heart failure may not be due to positive inotropic actions as the concentrations producing positive inotropy are much higher than the clinically observed plasma concentrations.

Adenylyl Cyclases↗
PubMed1992

Mediastinal pancreatic pseudocyst.

Pseudocysts of the pancreas are a rare cause of a mediastinal mass. They are clinically characterized by the combination of thoracic symptoms (shortness of breath, dysphagia, pleural effusions) with complaints in the upper abdominal quadrants and weight loss. The diagnosis is usually made by CT scan or MRI including upper abdominal views. Internal drainage via an abdominal route performed either as cystogastrostomy or cystojejunostomy is the treatment of choice.

Aged↗
PubMed1992

Prognostic value of flow cytometrically determined DNA-ploidy, intracellular pH and esterase activity of non-small cell lung carcinomas.

30 surgical specimens of patients with non-small cell lung carcinomas (NSCLC) were investigated. Significant increases of intracellular pH values in epithelial and inflammatory cells, in the percentage of dead epithelial and inflammatory cells and in the cell volume of vital inflammatory cells in cancerous lung tissue were encountered. Furthermore, decreases of the esterase activity of vital epithelial cells and of the percentage of free cell nuclei were observed. The DNA aneuploidy in 36.6% of the tumours was frequently associated with non-squamous cell carcinomas and stage II, III, IV tumours. Patients with DNA aneuploid tumours had a significantly shorter survival rate than those with DNA euploid tumours. Within the different tumour stages a similar tendency was observed which was, however, only significant in stage III tumour patients. Stage III tumours constitute therefore a heterogeneous entity with a worse prognosis for DNA aneuploid tumour patients. The intracellular pH values and esterase activity as well as the cell volume, the percentage of free cell nuclei and dead inflammatory or epithelial cells contained no significant prognostic information.

Adult↗
PubMed1992

Importance of microscopic residual disease at the bronchial margin after resection for non-small-cell carcinoma of the lung.

A total of 805 patients underwent lung resection for non-small-cell lung carcinoma at the University of Munich Medical Center, Klinikum Grosshadern, from 1978 through 1988. Microscopic residual disease at the bronchial margin was found in 21 patients (2.6%). The tumor residues showed either a mucosal (1%) or a extramucosal (1.6%) spreading pattern. Patients with extramucosal microscopic residual disease had a poorer prognosis (median survival 10.3 months) than patients with mucosal microscopic residual disease (median survival 25 months). The prognosis was better if the tumor was squamous cell as opposed to adenocarcinoma or large-cell carcinoma. The most important prognostic factor was tumor stage. Patients with microscopic tumor infiltration and stage I or II disease survived longer than the comparable stage III group. We suggest that these patients should undergo reoperation, if possible. Patients with stage III disease, mediastinal lymph node involvement, and microscopic residual disease have the same marked reduction in survival as patients with stage III disease but without microscopic tumor infiltration. We do not recommend a follow-up operation in these patients. Complete histologic examination of mucosal and extramucosal peribronchial tissues at the resection line by frozen section is mandatory to avoid leaving microscopic tumor behind, which may adversely affect patient survival.

Bronchi↗
PubMed1990

[Traumatic segment III aneurysm of the thoracic aorta: surgical risk, technique, early and late results].

Aneurysmectomy was performed in 37 patients with a traumatic aneurysm the aorta in segment III. 34 "cross-clamping" without bypass was used, 6 after preliminary transposition of the subclavian artery. 3 patients died after surgery, two of whom were more than 70 years old. 2 patients developed a paraparesis, which has in the meantime considerably improved. Hesitation to operate is justified only in older asymtomatic patients at high cardiac risk. Cross-clamping is preferable to more elaborate procedures. Preliminary transposition of the subclavian artery simplifies the proximal anastomosis and may contribute to spinal-cord protection.

Adult↗
PubMed1990

[Bronchial stump insufficiency: treatment and results].

A bronchopleural fistula following lung resection is a dangerous complication. Records from 25 patients with a bronchopleural fistula were followed up in order to propose a therapeutic concept. An early onset of fistula should be treated as an emergency. Late fistulas can be reoperated electively because they are most often rather small and the patients are in a better condition. The suture of the stump alone was successful in only 3 out of 13 cases. Patients with fistulas following lobectomy were reoperated by pneumonectomy with good results. In fistulas due to pneumonectomy the results of either an isolated muscle-flap or a thoracoplasty were disappointing. Instead, a closure of the stump was accomplished by the combination of thoracoplasty and muscle-flap in 3 out of 4 patients. However, 2 patients with an early fistula after pneumonectomy died from septic complications after the fistulas had already been managed. Endoscopic maneuvers like gluing and insertion of spongiosa did not show any success unless combined with operative measures but rather delayed the onset of re-intervention.

Bronchial Fistula↗
PubMed1989

[Bronchial carcinoid. A clinical study of 37 patients].

To establish whether bronchoplastic procedures designed to minimize loss of lung tissue are justifiable for the treatment of bronchial carcinoid tumours, data were analysed from 37 patients (17 men, 20 women, average age 51 [22-70] years) who had undergone surgery for typical (n = 30) or atypical (n = 7) bronchial carcinoids. Conventional tumour resections had been performed in 29 cases and bronchoplastic operations in eight. After an average observation period of 54 months one patient who had undergone lobectomy for a bronchial carcinoid had died of recurrent tumour, and one other patient who had been treated by pneumonectomy for an atypical carcinoid had developed distant metastases. All the other patients were free from tumour at that time. This indicates that patients treated by bronchoplastic procedures do not have any higher incidence of recurrences or any lower chance of survival than those treated by lobectomy or pneumonectomy. A bronchoplastic operation should therefore be the treatment of first choice, provided that the adjacent lung tissue has not been destroyed by retention pneumonia and that lymph node dissection does not reveal any involvement.

Adult↗
PubMed1989

[Pleural mesothelioma--problems in diagnosis and clinical course in 25 patients].

Patients with benign pleurafibromas should undergo surgery as suspect thoracic tumors have the potential to become malignant. In benign cases diagnosis can easily be made during the operation. In such a case the prognosis is good and it is seldom necessary to undergo repeated surgery due to recurrence. In the case of malignant pleuramesothelioma the preoperative diagnosis with an exact staging of the tumor is very important to determine an adequate therapeutic regimen. X-ray, CT-scanning, tapping of the pleura fluid and biopsy of the pleura are together insufficient to diagnose a pleuramesothelioma correctly. Since it is not always possible to diagnose a malignant pleuramesothelioma even at thoracoscopy, one should not hesitate to perform an open lung biopsy in order to obtain enough material under adequate vision.

Adult↗
PubMed1988

[Transthoracic excisional biopsy of focal pulmonary lesions].

The results of percutaneous, fluoroscopically-guided cutting biopsies of focal pulmonary lesions in 126 patients were evaluated retrospectively. In 90% of malignant lesions an exact diagnosis could be made from the material obtained. In 40% of the malignant lesions, histological examination was possible, in addition to cytology. In 87% of these, there was agreement between histology and cytology. Of the cases coming to surgery, 84% of the biopsies proved correct. Specificity was 100%. Multiple punctures were necessary in only 13%. Significant complications occurred in 5%. The cutting biopsy technique has the advantage of producing more biopsy material suitable for histology.

Biopsy, Needle↗
PubMed1986

[Value of noninvasive and intraoperative diagnosis of malignant mediastinal tumors].

Among malignant tumors of the mediastinum lymphomas are no indication for operation. In our experience, however, fine needle puncture, computed tomography (CT), nuclear magnetic resonance, mediastinoscopic biopsy of lymph nodes and intraoperative freeze section histology can only rarely differentiate between lymphomas and other tumors of the mediastinum. Only CT-guided or direct parasternal biopsy including immunhistochemistry can yield a reliable preoperative diagnosis and prevent unnecessary operation of lymphomas.

Biopsy↗
PubMed1985

[Chylaskos in lymphangioleiomyomatosis. Peritoneo-venous drainage with Denver shunt].

Chylous ascites, due to a lymphangiomyomatosis and resistant to conservative therapy, occurred in a 30 year-old female. A distinct subjective and clinical improvement could be attained with the aid of a peritoneo-venous anastomosis employing a Denver-Shunt. With the preconditions that the implantation is correct and that it is reliably managed, we regard the Denver-Shunt system as a recommendable approach to the treatment of chylous ascites not controllable by conservative measures.

Adult↗
PubMed1983

Renal vascular effects of angiotensin II, arginine-vasopressin and bradykinin in rats: interactions with prostaglandins.

1. The renal vascular responses to the peptide hormones angiotensin II (ANG II), arginine-vasopressin (AVP) and bradykinin (BK) were studied in anaesthetized rats with flow-meter techniques. The contribution of prostaglandins (PG) to their renal vascular effects was assessed with the aid of the PG-synthesis inhibitor indomethacin. 2. ANG II and AVP induced a dose-dependent increase in renal vascular resistance (RVR). The renal vasoconstrictor effects of both peptides were significantly augmented in rats pretreated with indomethacin. Indomethacin alone induced an increase in RVR, but not in mesenteric vascular resistance (MVR). 3. BK in low doses (1 micrograms/kg . min) tended to decrease RVR but increased RVR in high doses (20 micrograms/kg . min). MVR was reduced after all doses. The renal vasoconstrictor effect of BK was not affected by the ANG II-antagonist saralasin but almost completely blocked by indomethacin. 4. These results suggest that in the rat, as in other animal species and in man, renal PG's attenuate the renal effects of vasoconstrictor hormones such as ANG II and AVP. Although it has no such effect in other species. BK in high doses induces renal vasoconstriction in the rat, which appears also to be mediated by PG's. This response might be peculiar to the rat, since PG's act as renal vasodilators in other species.

Angiotensin II↗