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Biomedical subjects

I Vogt-Moykopf

Publications and source records attributed to I Vogt-Moykopf.

At least 19 recordsLinked to original sources
PubMed2006

Lymphatic spread in resectable lung cancer: can we trust in a sentinel lymph node?

The aim of this study was to describe lymphatic spread in resected lung cancer patients and evaluate for the presence for a reliable sentinel lymph node. Onethousand and eighty-eight patients with NSCLC underwent resection. Twelve to sixteen percent of the patients with primaries in the upper lobes had an involvement in the upper mediastinum; in 12 %, it was subcarinal, in 6 % and 3 %, in the lower mediastinum at paraoesophageal and ligamentum pulmonale sites, respectively. The rate of "lymph node skipping" is between 31 and 74 %. An isolated involvement of mediastinal nodes is possible without involvement of the N-1 position. Irrespective of the location of the primary tumour, there is a high incidence of "lymph node skipping" because of the specific architecture of the pulmonary, hilar and medistinal lymph nodes. Therefore, a reliable sentinel lymph node in lung cancer cannot be defined. In conclusion, systematic lymph node dissection in anatomical compartments is the gold standard for evaluation of the exact pN stage. Furthermore, a complete R/O-resection is a prognostically relevant factor in the surgery of NSCLC.

Carcinoma, Non-Small-Cell Lung↗
PubMed2005

Bronchioloalveolar carcinoma: a new cancer in Peutz-Jeghers syndrome.

Besides gastrointestinal hamartomatous polyposis and melanin spots in the skin and mucosa, patients with the Peutz-Jeghers syndrome (PJS) have repeatedly been observed with a variety of tumours, including lung cancer. Available data indicate an increased cancer risk among PJS patients, which suggests that the gene involved in PJS, STK11 on chromosome 19p13.3, may be a tumour suppressor gene. Herein, bronchioloalveolar carcinoma (BAC) of mucinous type is reported in a 22-year old male PJS patient with a novel germline frameshift insertion in exon 2 at codon 118 of the STK11 gene. Molecular studies of his BAC indicated loss of heterozygosity (LOH) in the region of STK11 on chromosome 19p13.3. This observation supports the hypothesis that STK11 is a tumour suppressor gene which is involved in the development of lung adenocarcinoma.

AMP-Activated Protein Kinase Kinases↗
PubMed2001

Primary tracheal tumors: experience with 14 resected patients.

OBJECTIVE: Primary tracheal tumors are rare. Management includes interventional endoscopy, surgery and radiotherapy. METHODS: Between 1987 and 1996, 14 patients treated by resection and reconstruction of the trachea and bifurcation for primary tracheal tumors were retrospectively analyzed. RESULTS: The most common histological finding was adenoid cystic carcinoma (n=7), followed by a squamous cell carcinoma (n=2), a mucoepidermoid carcinoma (n=2), a carcinoid tumor (n=1) and two benign tumors (xanthogranuloma, pleomorphic adenoma). Various reconstruction techniques were used and one prosthesis was implanted. Eight of the patients required preoperative Nd-YAG laser recanalisation. Six were treated by postoperative external beam radiotherapy, in three cases combined with endoluminal brachytherapy. Two major postoperative wound-healing impairment at the anastomosis occurred. Four minor wound-healing disorders were successfully treated by interventional endoscopy. Two patients died postoperatively with mediastinitis respectively with bilateral pneumonia. A local recurrence was observed in only two cases. At the last follow-up in January 1998, nine patients were still alive. We observed five long-term survivors (>6 years) with an adenoid cystic carcinoma or mucoepidermoid carcinoma. CONCLUSIONS: Extensive segmental resection of the trachea is the treatment of choice for primary malignant and occasionally for benign tracheal tumors. Interventional endoscopy is a part of modern tracheal surgery.

Carcinoma, Adenoid Cystic↗
PubMed1998

[Treatment strategy in pleural mesothelioma].

The development of diffuse malignant pleural mesothelioma is associated with exposure to asbestos. The surgical treatment comprises a radical pleuropneumonectomy with resection of the pericardium and diaphragm (P3D) or palliative pleurectomy/decortication of the tumor. The prognosis in general is poor. P3D is most effective in patients with epithelial mesothelioma at an early stage. Complete resection has the best prognosis. Palliative tumor decortication is restricted to symptomatic patients with acceptable performance status. The prognosis of patients after radical resection is not significantly different from patients with pleurectomy/decortication. Preliminary results of multimodal therapy concepts, including additional chemo- and/or radiotherapy, suggest an improvement in survival. Nevertheless, so far treatment has been focused on the palliation of clinical symptoms like pain and dyspnee.

Adult↗
PubMed1998

[Resection of the trachea and bifurcation in newborn infants and children].

From 1973 to 1994, 38 tracheal and/or bifurcation resections were performed in 37 children aged 1 month to 18 years. Twenty-four children had an acquired stenosis, 8 a congenital and 5 a combined stenosis. In 16 children, the stenosis was located in the lower trachea or bifurcation. Other malformations were found in 12 children. The most common intervention was the trachea segment resection in 30 patients; resection of the cricoid cartilage was performed in another 6 cases. The resection was expanded to the bifurcation 5 times, 1 being a left sleeve pneumonectomy. The extent of resection was between 10 and 50 mm. In the 22 children with resections of the upper and middle trachea, 96% were decannulated with 0% morbidity. In the 15 children with distal resections, decannulation was performed in 87% with 6% morbidity. There were no recurrent stenoses caused by growth disorder. With interdisciplinary cooperation, single-session resection is a safe procedure.

Adolescent↗
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

[High frequency jet ventilation during tracheal resection in children and infants].

Between 1986 and 1996, 16 infants and children less than 11 years of age (m = 11, f = 5) underwent resections for acquired or congenital tracheobronchial stenoses. During this period, various techniques of total intravenous anaesthesia (TIVA) were employed (midazolam, fentanyl, pancuronium; propofol, fentanyl, pancuronium). During the phase of dividing the airways, high-frequency-jet ventilation (HFJV) into the trachea or the main bronchi by 8-12Fr catheter(s) was applied for 10-75 min with driving pressures between 0.3-1.8 bar, frequencies between 100-200/min, I:E ratio between 1:4-1:1, and FjetO2 1.0. Catheter position was controlled visually, gas exchange was monitored by pulse oximetry and blood gas analysis. There were two incidents of transient hypoxaemia (paO2 less than 60 mmHg), and 4 cases of hypercapnia (paCO2 more than 45 mmHg). No complications due to the HFJV-catheter technique, such as barotrauma or aspiration were seen. All children were kept postoperatively on a ventilator due to swelling of the airway anastomosis. In 5 children ventilator treatment exceeded 7 days, 3 children were discharged tracheostomised. These observations serve to confirm that HFJV is capable of maintaining gas exchange during tracheal resection in infants and children, if the following prerequisites are met: 1. Tracheobronchial pathology suitable for poststenotic placement of jet catheter. 2. No respiratory impairment by parenchymal pathology. 3. Monitoring by continuous visual control of respiratory mechanics, pulse oximetry and blood gas analysis. Cardiopulmonary bypass should be applied if airway pathology precludes safe placement of jet catheters, or in the presence of parenchymal respiratory failure.

Anesthesia, General↗
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

[Principles and results of systematic lymph node dissection in surgically treated bronchial carcinoma].

Lymphatic spread of bronchial carcinoma can reach any part of the mediastinum, irrespective of the localisation of the primary tumor. Metastatic spread may not affect all topographical lymph node positions, but this is unpredictable. The number of lymph nodes in each position varies. Therefore, systematic mediastinal lymph node dissection includes all ipsilateral compartments of the mediastinum. It is also possible to reach contralateral sites. In right-sided thoracotomies the lymph node dissection is standardized. Mobilizing the aortic arch and the large vessels also allows complete mediastinal dissection by a left-sided approach. The surgical technique is described. Perioperative morbidity does not increase. Systematic mediastinal lymph node dissection is the gold standard for evaluation of an exact pN stage. The stage-related survival rate is significantly improved. Therefore, it should be required that systematic mediastinal lymph node dissection be standard in the surgical treatment of bronchial carcinoma.

Carcinoma, Bronchogenic↗
PubMed1996

[Radical surgery and lymph node dissection in bronchial carcinoma].

Lymphatic spread of bronchial carcinoma can involve each position in the mediastinum. Localisation of the primary tumor has no influence. Metastatic skipping of topographical lymph node positions is not calculable. Therefore, systematic mediastinal lymph node dissection includes all ipsilateral compartments of the mediastinum. It is also possible to reach contralateral sides. In right-sided thoracotomies, the lymph node dissection is standardised. Mobilising the aortic arch and the large vessels also allows from a left-sided approach a complete mediastinal dissection. The surgical technique is described. Perioperative morbidity does not increase. Systematic mediastinal lymph node dissection is the golden standard for the evaluation of an exact pN stage. The stage-related survival rate is significantly improved. Therefore, the systematic mediastinal lymph node dissection should be a standard in the surgical therapy of bronchial carcinoma.

Carcinoma, Bronchogenic↗
PubMed1996

[Results of surgical therapy of bronchial carcinoma in advanced age].

Surgery is the treatment of choice in patients with non-small cell lung cancer stages I-IIIA. This is not restricted to younger patients, it may also be true for elderly ones. 6907 patients suffering bronchial carcinoma were analysed at the Thoraxklinik Heidelberg-Rohrbach (10/1984-12/1994). 2464 patients underwent resection of bronchial carcinoma. The age distribution was as follows: 0-64 years (n = 1734), 65-74 years (n = 662), 75-85 years (n = 67), older than 85 years (n = 1). Lobectomy was the most common type of resection for all patients. The frequency of pneumonectomy was lower in older patients, while the relative proportion of segmental resections was higher. The 30-day mortality was 6% for patients younger than 64 years and 10% for patients older than 65 years. For the latter group, the 5-year-survival probability was 44% for the combined p-stages I and II, and 19% for p-stage IIIA. In conclusion, the results indicate that, under the condition of a precise preoperative risk-to-benefit evaluation, surgical treatment of bronchial carcinoma is also indicated for elderly patients.

Adult↗
PubMed1994

Pulmonary metastasectomy as secondary treatment for testicular tumors.

Patients presenting with synchronous and metachronous metastases of nonseminomatous testicular tumors are candidates for pulmonary metastasectomy after receiving definitive primary treatment, which includes semicastration, eventually retroperitoneal lymphadenectomy, and definitely chemotherapy. One hundred four such patients (age, 14 to 79 years; median age, 27 years) underwent pulmonary metastasectomy from 1972 to 1990, representing 15.8% of the pulmonary metastasectomies performed during the same period. Of the 117 operations performed, eight were repeat operations. Median sternotomy, posterolateral and, later, transverse thoracotomies were the standard surgical approaches used to remove the single and multiple metastases randomly distributed in both lungs. Wedge resections and atypical segmentectomies (66%), lobectomies (15%), anatomic segmentectomies (9%), pneumonectomies (3%), bilobectomies (3%), and mediastinal lymphadenectomies (65.4%) were the various procedures performed. Of the 104 patients, metastasectomy was complete in 80 and incomplete in 24. The 30-day mortality was 2.0%. Life table analysis revealed a survival rate of 77%, 70%, 66%, and 59% at 1, 2, 3, and 5 years, respectively. Of all prognostic factors examined, complete resection of the metastases seems to be the most significant factor influencing the prognosis.

Adolescent↗
PubMed1994

Induction chemotherapy with and without recombinant human granulocyte colony-stimulating factor support in locally advanced stage IIIA/B non-small cell lung cancer.

Patients with non-small cell lung cancer (NSCLC) in stage IIIA with more than minimal N2 involvement or in stage IIIB are considered unresectable. Response rates to chemotherapy for these patients are in the range of 40%. Reduction of tumor mass by induction chemotherapy may lead to resectability and to improved survival. We evaluated response rates and determined influence of induction chemotherapy on survival when followed by surgery and radiotherapy in 60 patients with primarily inoperable stage IIIA/IIIB NSCLC. The following cytotoxic regimens were used: cisplatin (100 mg/m2) and vindesine (3 mg/m2); ifosfamide (10 g/m2) and etoposide (360 mg/m2); or a combination of cisplatin (75 mg/m2), ifosfamide (6 g/m2), and etoposide (360 mg/m2). Sixty patients were treated with two to four cycles of these regimens between June 1988 and October 1992. In 40 patients chemotherapy was repeated every 4 weeks. In 20 patients chemotherapy was intensified by interval reduction to 3 weeks with recombinant human granulocyte colony-stimulating factor (r-metHuG-CSF, filgrastim) support. The median patient age was 54 years, and Eastern Cooperative Oncology Group performance status was 0 to 2. Distribution of stages IIIA and IIIB was 21 and 39 in all patients and 5 and 15 in the group treated with r-metHuG-CSF support, respectively. The overall response rate (complete plus partial responses) was 35%. In patients treated with intensified chemotherapy and r-metHuG-CSF support, the response rate was 60%. In 37 patients (61.6%) tumor was resected 4 to 6 weeks after the last cycle of chemotherapy; R0 resection was achieved in 22 patients, R1 in eight patients, and R2 in seven patients. With a follow-up of 4 to 60 months, 1-year survival in patients with tumor regression after chemotherapy and tumor resection was 82.2% versus 35.7% in nonresponders; 2-year survival of responders and nonresponders was 50.9% and 12.8%, respectively; and median survival was 23 months and 9 months, respectively (P < .001). Median survival rates for responders with stage IIIA and IIIB disease were 39 and 17 months, respectively. Median survival after response to chemotherapy and incomplete resection (11 patients) was 17 months, whereas median survival after response to chemotherapy and complete resection (18 patients) has not yet been reached. Only four patients in this group have died with a follow-up of 4 to 60 months. Of 20 patients receiving accelerated chemotherapy with r-metHuG-CSF support, World Health Organization grades 3 and 4 neutropenia occurred in five and eight patients, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1994

[Surgery of lung metastasis--indications, results and prognostic factors as an interdisciplinary concept].

Surgical therapy of lung metastases nowadays is an established procedure. The operation's purpose is the radical and therefore potential curative resection. Beside there are diagnostic and palliative indications. Beside there are diagnostic and palliative indications. Median sternotomy is the standard approach for revision of both lungs even in unilateral seeming disease. Preoperative staging is not reliable concerning number and extension of metastases. From 1972 to 1991 843 operations for lung metastases were carried out in 729 patients in the surgical department of the "Thoraxklinik Heidelberg-Rohrbach". 30-day-mortality amounted to 2.9%, 5-year-survival-rate was 33% overall from date of metastases resection. The best results were achieved in testicular cancer with 67% 5-years-survival-rate, poorest survival was observed in melanomas with 12% 3-years-survival. Beside the primary tumor and partly dependent on it several prognostic factors were relevant: radicality, sarcoma vs carcinoma in favour of carcinomas, disease-free interval, type of resection, thoracic lymphnode involvement. As figured out by multivariate analysis the prognostic influence of the factors varies considerably due to the kind of primary tumor. Surgery of lung metastases is part of an interdisciplinary oncological therapeutical concept and offers a prolonged survival to most of the patients and the possibility of cure to some. Even if prolongation of life is not feasible an improved quality and therefore a good palliation is obtained.

Adolescent↗
PubMed1994

[Surgery for bronchial carcinoma with mediastinal lymph node involvement].

Or the 3000 patients analyzed in the prospective bronchial carcinoma field study, 1086 were operated between 1984 and 1989. Complete systematic mediastinal lymphadenectomy was performed in 661 patients to assess the PTNM stage as exactly as possible, and to improve prognosis. Lymphadenectomy removes all hylarand mediastinal lymph nodes. Although the operation is technically quite easy on the clearly structured right side, it is more difficult on the left side due to the aortic arch and its branches. The lymph nodes of the upper mediastinum of the left and right side can be completely dissected by mobilizing the aortic arch with the left subclavian artery. In contrast to what is frequently assumed, the histological findings indicate that there is no general pattern of metastatic spread in the lymph nodes. The metastases can leave out varying numbers of lymph nodes craniad as well as caudad. For this reason, the lymph nodes have to be completely resected to ensure a real R0-resection.

Female↗
PubMed1994

[Surgical therapy of lung metastases. An interdisciplinary responsibility].

Surgical therapy of lung metastases is now an established procedure. The operation's purpose is radical, and therefore potentially curative, resection. There are also diagnostic and palliative indications. Median sternotomy is the standard approach as it allows revision of both lungs, which is important even when disease seems to be unilateral. Preoperative staging does not give a reliable idea of the number and extent of metastases. From 1972 to 1991, a total of 843 operations for lung metastases were carried out in 729 patients in the surgical department of the Thorax Clinic in Heidelberg (Rohrbach). The 30-day mortality was 2.9%, and the overall 5-year survival from the date of resection of the metastases was 33%. The best results were achieved in testicular cancer, with a 5-year-survival rate of 67%, and the poorest were observed in melanomas, with only 12% 3-year survival. In addition to the primary tumour, and in some cases depending on it, several other prognostic factors were relevant: radicality, sarcoma vs. carcinoma (carcinoma involved a better prognosis), disease-free interval, type of resection, thoracic lymph node involvement. Multivariate analysis showed that the prognostic influence of the factors varies considerably with the kind of primary tumour. Surgical treatment of lung metastases is part of an interdisciplinary oncological therapeutic concept offering prolongation of survival to most of the patients concerned and even the possibility of cure to some. Even if prolongation of survival is not feasible, an improved quality of life and therefore good palliation are obtained.

Adolescent↗