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Biomedical subjects

L Sunder-Plassmann

Publications and source records attributed to L Sunder-Plassmann.

At least 19 recordsLinked to original sources
PubMed1998

Emergent endoluminal repair of delayed abdominal aortic rupture after blunt trauma.

PURPOSE: To report the emergency repair of a traumatic abdominal aortic rupture using endoluminal techniques. METHODS AND RESULTS: A 25-year-old female sustained multiple head, chest, and abdominal injuries in a motorcycle accident. Six days after emergency treatment (including splenectomy and repair of a superficial hepatic rupture and lacerations to the stomach, small bowel, and colon), she became hemodynamically unstable. A massive retroperitoneal hematoma had evolved from a distal aortic rupture. Owing to a hostile abdomen and possibility of bacterial contamination, a self-expanding stent-graft was inserted transfemorally to repair the aortic injury. The patient recovered uneventfully and continues in good health with a patent endograft repair 2 years after treatment. CONCLUSIONS: This experience would support the efficacy of endograft implantation for emergent repair of trauma aortic injuries; however, proper facilities, an experienced interventional team, and an assortment of endografts and stents must be available.

Adult↗
PubMed1997

Lymph node staging in non-small cell lung cancer: evaluation by [18F]FDG positron emission tomography (PET).

BACKGROUND: A study was undertaken to investigate the accuracy of positron emission tomography (PET) with 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) in the thoracic lymph node staging of non-small cell lung cancer (NSCLC). METHODS: Forty six patients with focal pulmonary tumours who underwent preoperative computed tomographic (CT) and FDG-PET scanning were evaluated retrospectively. Thirty two patients had NSCLC and 14 patients had a benign process. The final diagnosis was established by means of histopathological examination at thoracotomy, and the nodal classification in patients with lung cancer was performed by thorough dissection of the mediastinal nodes at surgery. RESULTS: FDG-PET was 80% sensitive, 100% specific, and 87.5% accurate in staging thoracic lymph nodes in patients with NSCLC, whereas CT scanning was 50% sensitive, 75% specific, and 59.4% accurate. The absence of lymph node tumour involvement was identified by FDG-PET in all 12 patients with NO disease compared with nine by CT scanning. Lymph node metastases were correctly detected by FDG-PET in three of five patients with N1 disease compared with two by CT scanning, in nine of 11 with N2 disease compared with six by CT scanning, an in all four with N3 nodes compared with two by CT scanning. CONCLUSIONS: FDG-PET provides a new and effective method for staging thoracic lymph nodes in patients with lung cancer and is superior to CT scanning in the assessment of hilar and mediastinal nodal metastases. With regard to resectability, FDG-PET could differentiate reliably between patients with N1/N2 disease and those with unresectable N3 disease.

Adult↗
PubMed1997

Effect of felodipine on regional blood supply and collateral vascular resistance in patients with peripheral arterial occlusive disease.

This double-blinded, randomized, placebo-controlled study was designed to investigate the acute effect of felodipine on regional blood supply and collateral vascular resistance in patients with peripheral arterial occlusive disease (PAOD). Thirty men with PAOD were treated with a single dose of 5 mg felodipine or placebo. Systolic blood pressure (SBP), Doppler ankle pressure (DAP), calf blood flow (CBF) by venous occlusion plethysmography and calf transcutaneous oxygen tension (tcpO2) were measured during a cycle ergometry. Felodipine reduced SBP significantly (from 149 to 136 mmHg, p < 0.05), while placebo did not. DAP increased slightly but not significantly in both groups. The pressure gradient between SBP and DAP fell significantly in the felodipine group (60 vs 39 mmHg, p < 0.01) but not in the placebo group (59 vs 56 mmHg). There was a trend for lower velocity in tcpO2 decrease during the stress test and higher velocity of tcpO2 increase during recovery from exercise in the felodipine group although the differences between both groups were not significant. In the felodipine group, CBF increased by 35.6% (p < 0.05) whereas it did not change in the placebo group. In conclusion, while lowering SBP, felodipine increased slightly, or at least maintained, the blood supply to the calves in PAOD patients, which probably results from reducing collateral vascular resistance.

Adult↗
PubMed1997

[Atypical aortic coarctations in type I neurofibromatosis].

From 1971 through 1996, 16 patients were operated on for atypical aortic coarctation. Three of them (two women, 18 and 27 years old, one boy, 13 years old) had typical signs of neurofibromatosis type I (NF1). All had renovascular hypertension due to suprarenal and/or interrenal aortic stenosis. Two had additional bilateral renal artery stenoses, one with a poststenotic aneurysm. In all patients a thoraco-abdominal aorto-aortic bypass was implanted. The renal artery stenoses were bridged by two aorto-renal, a prothesio-renal, and a spleno-renal bypass. Only one kidney had to be explanted 13 years after revascularization for a recurring hilar aneurysm after ex-situ reconstruction was found to be impossible. At their last follow-up examination (at 16, 14, and 9 years) all patients were normotensive without medication and had normal serum-creatinine measurements. Angiography or spiral-CT done in all patients showed normal function of all bypasses. In literature we found another 27 patients with neurofibromatosis operated on for atypical aortic coarctation. In these young and otherwise healthy patients, even complex reconstructions can be performed with a low rate of complications and excellent long-term results. Surgical therapy of all relevant stenoses (at best in a single procedure) is necessary for complete relief of renovascular hypertension. Consequent follow-up is advised for the detection of possible late complications, especially after exclusion of aneurysms.

Adolescent↗
PubMed1997

[Paraganglioma of the carotid bifurcation. Diagnostic and therapeutic strategy].

The carotid body tumors are semimalignant tumors. According to our results, the best diagnostic procedure is a combination of Doppler color flow imaging ultrasound, computed tomography and selective angiography. In our opinion, the treatment of choice is radical resection of the tumor with the carotid bifurcation, especially to reduce recurrence of the tumor. Considering the problems in recurrent tumors, consequent monitoring of the patients is necessary.

Carotid Body Tumor↗
PubMed1996

Histomorphological examination of endoluminal stent grafting in the descending aorta in a sheep model.

Experiments were designed to examine the wound healing characteristics at the aorta-endograft interface. Thoracic aneurysms were induced in sheep and excluded by endovascular placement of a selfexpanding stent graft (Corvita Endovascular Graft). After a follow-up of 1, 4, or 12 weeks sheep were sacrificed and the corresponding segments of the aorta were subjected to histological examinations. Histomorphological evaluation of all groups underlined sufficient exclusion of lesions of the aortic wall by endovascular grafting. There was no evidence of proximal or distal leakage, graft dislocation or migration. The results appeared to be evidence that the endoluminal stent graft may be incorporated by the host aortic tissue.

Animals↗
PubMed1996

Pulmonary arteriovenous malformations: aspects of surgical therapy.

Pulmonary arteriovenous malformations (PAVM) may occur primarily or in association with hereditary hemorrhagic telangiectasia (HHT, Rendu-Osler-Weber syndrome). Solitary or multiple fistulas may lead to clinical symptoms such as dyspnoe on exertion, central cyanosis, polycythemia, cerebral embolism, or brain abscess formation. Major neurological events may be first symptoms of PAVM. Between 1991 and 1995, 6 patients (age 25-69 years) underwent surgical treatment (2 segmental, 1 atypical, 3 anatomical resections) due to PAVM. The highest right-to left shunt fraction was 60% in a patient with a large posttraumatic fistula following war injury 50 years ago. Average shunt fraction was significantly reduced from 24 to 3% (p < 0.01), with no recurrance during follow-up. Aims of surgical resection in patients with PAVM are to reduce shunt fraction and to prevent neurological events following repeated cerebral embolism. Atypical or segmental resection is the operative method of choice; however, this is only recommended, if all contributing arteries are identified and selectively ligated. In case of central location of large fistulas, lobectomy may be necessary. Percutaneous selective embolization is an alternative treatment for patients with high operative risk or multiple fistulas. Its role for routine therapy remains to be determined by clinical studies.

Adult↗
PubMed1996

[Prophylactic indications in thoracic aortic aneurysm].

Prophylactic operations of aneurysms of the descending thoracic aorta have to take into consideration the expansion rate, probability of rupture and individual life expectancy of patients > 70 years of age as well as the individual risk of operation. Candidates for elective surgery are those with large aneurysms and low operative risk from low comorbidity who are expected to experience death from acute rupture unless operated on in a prophylactic way. Endoluminal stent grafts--though very attractive in this aortic segment--are still in statu nascendi and not recommended for general use.

Aged↗
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↗
PubMed1995

[Aneurysm of the descending thoracic aorta in tertiary syphilis].

A 53-year-old female presented with septicaemia caused by left ureteric obstruction due to ureterolithiasis. Further diagnostic work-up for left mediastinal widening revealed an asymptomatic aneurysm of the descending aorta. Serologic tests for syphilis were highly positive (TPHA 1:10240, 19s-IgM-FTA-Abs 1:20, Cardiolipin KBR 1:72 IU/ml). After a three weeks course of Penicillin G, 19s-IgM-FTA-Abs was negative. A successful tube resection of the aneurysm was performed. The diagnosis of luetic aneurysm of the descending aorta was confirmed histologically. Although rare today, tertiary syphilis should be considered in the differential diagnosis of thoracic aneurysm in middle-aged patients lacking classical risk factors for atherosclerosis. The immune pathogenesis of cardiovascular syphilis still remains subject of controversy.

Aorta, Thoracic↗
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

[Long-term results of percutaneous transluminal angioplasty and stent implantation in venous stenoses following transfemoral thrombectomy].

Thirty consecutive patients were operated on for iliofemoral venous thromboses. In each case, a transfemoral thrombectomy was performed and an arterio-venous fistula was created. Three to six months later, a cross-over arterio-venography revealed 10 severely stenosed venous segments in 8 patients (common iliac vein 4, external iliac vein 3, common femoral vein 3). All stenoses were treated by percutaneous transvenous angioplasty (PTA). Six times a flexible, self-expanding Wallstent was placed within the stenosis after dilation (PTA+S). Complications did not occur. Median follow up was 17 months (3-23 months). PTA+S proved superior (4/6 excellent results) when compared to PTA alone (1/4 excellent result), because of frequent restenosis after the latter. Minor results following PTA+S were caused by intimal hyperplasia within the stent, when the av-fistula was kept patent for more than a year after stent placement.

Adolescent↗
PubMed1992

[Subcapsular hematoma of the liver in HELLP syndrome. An interdisciplinary emergency].

The HELLP-syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets), known as a complication during pregnancy, is associated with preeclampsia and may cause subcapsular liver hematomas. In case of hepatic rupture the lives of mother and unborn are threatened. Therefore, an interdisciplinary diagnostic and therapeutic approach is discussed and compared to two examples. The diagnosis of subcapsular liver hematoma must lead to urgent delivery through Cesarean section. Thereafter, the surgeon may decide between observation on an intensive care unit and urgent operation in case of hepatic rupture, without endangering the unborn.

Adult↗
PubMed1992

[Angiographic diagnosis in giant cell arteritis of the arm arteries].

Three women of 66, 68 and 69 years of age presented with chronic arm claudication caused by giant cell arteritic stenoses and occlusions of their arm arteries. In the early stage of the disease, arteriography revealed smooth or undulatory long-segment narrowings. Subsequently, spindle-shaped filiform stenoses developed. They were unilateral in one patient, bilateral-symmetric in another and like a string of beads in the third. In the end, untreated arteritis resulted in smoothly tapered occlusions of the diseased vessels. In patients with symptoms and signs suggestive of giant cell arteritis, typical arteriographic findings may confirm the diagnosis even if histopathological proof is lacking.

Aged↗
PubMed1992

Effect of interpleural morphine on postoperative pain and pulmonary function after thoracotomy.

We have investigated the effect of interpleural morphine on postoperative pain and pulmonary function after thoracotomy. At the end of surgery, an interpleural catheter was inserted in 17 patients and, in a double-blind and randomized manner, either a bolus of morphine 2.5 mg interpleurally (i.p.) and normal saline i.v. (group I) or, as a control for systemic absorption, morphine 2.5 mg i.v. and i.p. saline (group II) was injected. After the initial bolus, a continuous infusion of morphine 0.5 mg h-1 i.p. and saline i.v. (group I) or morphine 0.5 mg i.v. and saline i.p. (group II) was maintained for 24 h. Postoperative pain was assessed by a visual analogue scale, a numerical rating scale and the McGill Pain Questionnaire. Pulmonary function was assessed by spirometry. Supplementary analgesics, side effects, degree of sedation, vital signs and chest tube drainage were recorded. All variables were assessed on the day before surgery and 1, 2, 3, 4, 5, 6 and 24 h and 7 days after surgery. Supplementary morphine was given upon request. There was no significant difference in any pain measure or postoperative pulmonary function variable between the groups. We conclude that, after thoracotomy, interpleural morphine does not provide superior analgesia or improve pulmonary function compared with systemic morphine.

Forced Expiratory Volume↗
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

[Flow cytometric analysis in non-small-cell bronchial carcinoma and its prognostic significance].

Tumor and lymph node infiltration, and the DNA-ploidy status of a tumor contain prognostic information in addition to the information obtained by histological examination of surgical samples. Specimens from 112 patients with non-small-cell lung carcinoma obtained immediately after surgery were investigated by means of flow cytometry. DNA-aneuploidy was found in 43% of the primary tumors. Independent from tumor stage, patients with DNA-euploid tumors lived significantly longer (p less than 0.01) than with DNA-aneuploid carcinomas. In 29 cases the DNA-ploidy status of the primary tumor (PTU) could be compared with that of the N2 lymph node metastases (LM). 7 samples revealed a change from DNA aneuploidy in the PTU to DNA-euploidy in the LM. Patients with DNA-euploid PTU and DNA-euploid LM lived significantly longer than patients with DNA-aneuploid PTU/DNA-euploid LM, and patients with DNA-aneuploid PTU/DNA-aneuploid LM. In case of lymph node infiltration only the simultaneous measurement of DNA ploidy of PTU and LM offers an accurate prognostic evaluation. Local tumor recurrence exhibited stability of DNA ploidy, showing DNA euploidy in 12 out of 13 PTU and their corresponding recurrent tumor. Thus, the DNA-ploidy status offers additional prognostic informations which is useful for an extended tumor classification.

Carcinoma, Non-Small-Cell Lung↗