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Biomedical subjects

U Fink

Publications and source records attributed to U Fink.

At least 109 records · Page 6Linked to original sources
PubMed1994

Ratio of invaded to removed lymph nodes as a predictor of survival in squamous cell carcinoma of the oesophagus.

Prognostic factors that may alter the indications for primary surgical resection or that can be influenced by the extent of the procedure were analysed in a homogeneous group of 186 patients with squamous cell carcinoma of the oesophagus. All patients underwent standardized en bloc oesophagectomy and lymph node dissection with prospective documentation of the histopathological findings; follow-up was complete. Multivariate analysis identified the Union Internacional Contra la Cancrum R category (i.e. the presence of residual tumour after resection) as the most important independent prognostic factor (P < 0.001) followed by the ratio of invaded to removed lymph nodes (P < 0.001). These data suggest that only patients in whom R0 resection can be anticipated based on preoperative assessment should undergo primary resection for oesophageal cancer. Extended lymphadenectomy may improve survival in patients with a limited number of invaded mediastinal nodes.

Carcinoma, Squamous Cell↗
PubMed1994

Rotatory palmar subluxation of the lunate in post-traumatic ulnar carpal translocation.

Post-traumatic ulnar carpal translocation is a rare, severe ligamentous injury to the wrist. Radiologic findings include widening of the radiocarpal joint space at the radial styloid process and ulnar displacement of the carpus. Less than 50% of the lunate articulates with the radius in the neutral position; the lunate is tilted dorsally with palmar subluxation due to a ruptured radio-scapholunate (RSL) ligament. This malposition should be called rotatory palmar subluxation of the lunate (RPSL), by analogy to rotatory subluxation of the scaphoid (RSS). In contrast to dorsiflexed intercalated segment instability (DISI), in RPSL the RSL ligament is ruptured and, in the majority of cases, the scapholunate ligament remains intact. A prompt diagnosis should lead to successful treatment.

Adolescent↗
PubMed1994

Image analysis and synthesis of multimodal images in medicine.

Radiologic and clinical practice can be enhanced by improved access to multimodal image information. Analysis, visualization, method characteristic image processing and image synthesis is needed not only for the interpretation of the images but also for performing effective consultations with clinical colleagues and computer supported therapy planning and control strategies. A method is presented which enables the fast display, three-dimensional visualization and the modality oriented analysis of multimodal image information. Based on a unique image format, modality specific procedures and two- or three-dimensional processing tools of image analysis produce the input data for therapy planning programs. The easy use of this multimedia visualization tool enables radiologists and clinicians to deal with their image data. The description of methods and procedures, as well as typical examples of radiologic practice will demonstrate the efficiency of the presented system.

Algorithms↗
PubMed1994

5-Fluorouracil, folinic acid, etoposide and cisplatin chemotherapy for locally advanced or metastatic carcinoma of the oesophagus.

38 patients with advanced oesophageal carcinoma were treated with intravenous (i.v.) folinic acid (300 mg/m2), 5-fluorouracil (500 mg/m2), etoposide (100 mg/m2), and cisplatin (30 mg/m2) (FLEP), on days 1, 2 and 3, every 22-28 days. 26 patients had locally advanced disease (LAD) and 12 had metastatic disease (M1). Oesophagectomy was planned for patients with LAD in case of tumour regression after chemotherapy, while patients with M1 disease received chemotherapy only. The overall remission rate was 45% (17/38) including four clinical and two pathologically confirmed complete remissions. 16 patients underwent oesophagectomy, 12 after response to FLEP, and 4 after FLEP and subsequent irradiation +/- 5-fluorouracil/mitomycin. Toxicity was mainly haematological, with WHO grade 3 and 4 leukocytopenia in 50% and thrombocytopenia in 31% of the patients. Two treatment-related deaths were observed; one due to chemotherapy and one postoperatively. Median survival time of LAD patients was 13 months, and actuarial 2-year survival was 31%. Patients with complete tumour resection after FLEP had a median survival time of 18 months and a 2-year survival rate of 42%. Median survival of M1 patients was 6 months. FLEP is an active combination for oesophageal cancer, especially when used preoperatively in LAD.

Adenocarcinoma↗
PubMed1994

[The technic and value of the 3-dimensional imaging of renal calyx staghorn calculi with spiral CT].

5 patients with staghorn calculi in the renal pelvis were examined by spiral CT. From the raw data three dimensional reconstructions of the stones were obtained. In all patients it was possible to compare the three dimensional model with the stone following performance of percutaneous litholapaxy and endoscopic removal of the fragments. In all cases the three dimensional reconstruction provided a realistic image of the stones and was of practical value for the urologist for preoperative diagnosis and intraoperative control.

Endoscopy↗
PubMed1994

[The nuclear magnetic tomographic diagnosis of focal lesions of the red bone marrow. The optimization of the acquisition parameters for GE and SE sequences].

Gradient-echo (GE) imaging with repetition times equivalent to those of T1-weighted spin-echo (SE) sequences and echo times for antiphase (opposed) transverse magnetisation have proved to be sensitive for high contrast imaging of focal lesions of red bone marrow. The sensitivity of antiphase GE sequences is due to the chemical shift between water-bound and fat-bound protons which introduces a tissue parameter that is not accessible by SE sequences. Main advantage of these GE sequences is the low signal intensity of intact red marrow and the high signal intensity of tumours and inflammatory lesions which allows, similar to T2-weighted SE sequences, for positive contrast imaging of lesions. In order to evaluate and to optimise the contrast-to-noise ratio (CNR) for red bone marrow and tumour 200 GE and 40 SE sequences with repetition times (TR) between 100 and 900 ms, echo times (TE) between 14 and 21 ms and flip angles (alpha) between 10 and 90 degrees were studied. CNR was measured and optimized regarding TR, TE, and alpha. The results indicate that opposed GE sequences, relatively independent from TR and alpha, are characterized by a high contrast-to-noise ratio. According to their high sensitivity for lesion detection they are suited to replace T2-weighted SE sequences.

Artifacts↗
PubMed1994

Surgery of squamous cell carcinoma of the esophagus.

Identification of prognostic factors which may influence survival in patients with squamous cell carcinoma of the esophagus is critical for the selection of those patients who benefit from a surgical resection and the choice of the radicality of the procedure. We evaluated the tumor characteristics which independently influenced survival in 249 consecutive patients with squamous cell carcinoma of the esophagus who had undergone en bloc resection and 2-field lymphadenectomy. Multivariate analysis in the entire patient population identified (1) the pT category, (2) the pN category, (3) more than 7 positive mediastinal lymph nodes, and (4) the presence of residual tumor after resection, i.e. a R1 or R2 resection, as the only independent factors influencing survival time. In a second multivariate analysis of 94 patients who survived the procedure for at least 30 days, who had a R0 resection, and who did not have preoperative neoadjuvant therapy, only the pN-category, the presence of more than 7 positive mediastinal lymph nodes, and the ratio between positive and removed mediastinal lymph nodes independently influenced survival. These data suggest that only a R0 resection, i.e. complete macroscopic and microscopic tumor removal, can increase survival in patients with squamous cell carcinoma of the esophagus. In patients with a limited number of positive mediastinal lymph nodes the prognosis may be improved by a 2-field lymphadenectomy, if the number of removed mediastinal lymph nodes exceeds the number of positive nodes by a factor of at least 5.

Adult↗
PubMed1994

Perioperative radiotherapy +/- chemotherapy in rectal cancer.

Locoregional failure which occurs in 25%-50% of patients with rectal cancer undergoing potentially curative surgery, can be significantly reduced by either postoperative adjuvant irradiation and also by preoperative radiotherapy. In view of the possible local side effects/complications, optimal irradiation techniques including accelerator and 3-4 field techniques are mandatory. Combined treatment consisting of radiotherapy plus chemotherapy appears to be more efficient than pelvic irradiation alone. It seems that reductions in the rate of pelvic and extrapelvic tumor recurrences which are not dramatic but of clinical significance are followed by an improved survival. The 1990 Consensus conference of the National Institute of Health recommended combined postoperative radiotherapy and chemotherapy for patients with T3N0, T4N0 and any TN1-3 rectal cancer. For future trials, the main goal has to be optimization of radiotherapy plus chemotherapy in the perioperative treatment of rectal cancer. The most important unanswered question is whether the highest therapeutic ratio is obtained by pre- or postoperative treatment.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

Neoadjuvant therapy for squamous cell esophageal carcinoma.

A number of studies have demonstrated that preoperative chemotherapy (CTx) and combination radiochemotherapy (RTx/CTx) in patients with potentially resectable and locally advanced squamous cell esophageal carcinoma is feasible. In patients with potentially resectable tumors, neoadjuvant therapy followed by surgical resection has, however, so far not shown an increase in the resection rate, rate of complete macroscopic and microscopic tumor resections, i.e. R0-resections according to the UICC, or survival time as compared to patients who had surgical resection alone. In this situation a survival benefit, if at all, can be expected only in those who respond to preoperative therapy. At the present time preoperative CTx or RTx/CTx in patients with potentially resectable esophageal carcinoma must therefore be considered investigational and should not be performed outside the context of clinical trials. In patients with locally advanced esophageal carcinoma, neoadjuvant therapy markedly increases the rate of R0-resections and appears to prolong survival. Combined modality therapy in this context is, however, associated with a substantial perioperative mortality and morbidity. Open questions that have to be addressed by randomized studies include the role, extent and timing of surgical resection in the combined modality approach to patients with locally advanced squamous cell esophageal carcinoma. Research has to focus on preoperative staging modalities and the development of more effective and less toxic preoperative therapy regimen to improve identification of patients that might benefit from combined modality therapy and to more effectively combat systemic recurrences.

Antineoplastic Agents↗
PubMed1994

Current status and future directions in the treatment of localized esophageal cancer.

Due to insufficient local tumor control in the majority of esophageal carcinoma (EC) patients and due to distant recurrences, the dismal prognosis of patients with EC has not essentially changed during the past two decades. This holds true despite extended surgical procedures and improved radiation techniques. The 2-year survival rates in stage IIB/III which represent two-thirds of the patients with localized EC is still less than 20%. Therefore, clinical efforts in the management of EC focus on combined modality treatment (CTM), usually preoperative chemotherapy (CTx)/chemoradiotherapy (CTx/RTx) or CTx/RTx alone. Up to now, results of CTM in potentially resectable EC have not shown that preoperative CTx or CTx/RTx is superior to surgery alone with respect to resectability, local tumor control and overall survival. However, CTx responders who subsequently underwent a complete tumor resection had a markedly improved long term survival indicating that the inclusion of CTx in the treatment of EC may improve the prognosis. The benefit of CTx could also be demonstrated in a randomized trial comparing RTx alone versus CTx/RTx with a reduction of local and distant failures and significantly improved survival in the CTM arm. Similar observations were made with CTM in locally advanced disease. To date, there is sufficient evidence that preoperative treatment of EC may improve prognosis at least of subgroups of patients with this tumor. However, this has to be confirmed in well designed (proper staging including endoscopic ultrasound, etc.) randomized trials.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Agents↗
PubMed1994

[Non-Hodgkin's lymphoma of the stomach, surgical therapy and prognosis].

In a retrospective study, clinical and histopathologic factors of 41 patients with a primary gastric non-Hodgkin lymphoma were analysed. All patients underwent gastric resection: total gastrectomy in 44%, subtotal in 34% and extended gastric resection in 22% of the patients. In 27% of the cases gastric resection was part of a multimodal therapy. While RO resection was achieved in 80% of the cases, the overall 5-year survival rate was 74%. In a multivariate analysis using the Cox model R0-resection independently improved prognosis, whereas extended gastric resection was associated with a poorer survival rate. As R0-resection should be the aim of every oncologic surgery, preoperative identification of the R0-resectable cases by extended patient evaluation is of great importance.

Combined Modality Therapy↗
PubMed1993

[The epidemiology of stomach carcinoma from the surgical viewpoint. The results of the German Stomach Carcinoma Study 1992. The German Stomach Carcinoma Study Group].

In a prospective multi-centre study data were collected on 1,999 patients (1273 men, 726 women; mean age 62.3 [19-99] years) with gastric carcinoma, admitted to one of 19 surgical departments in Germany between 1.4. 1986 to 30. 6. 1989. Previously treated patients as well as those with synchronous or metachronous tumours and carcinoma of the gastric stump had been excluded. The resection rate for gastric carcinoma was 82.7%, i.e. resection was no longer possible because of the advanced tumour stage in nearly 20%. The tumour was located in the upper third of the stomach in 30%, the antrum in 26.3%. An intestinal type of growth was present in 51.9%. An early carcinoma was diagnosed in 16.9% of operated patients; it had already metastasized to regional lymph nodes in 16.5%. Nearly 70% of patients with resectable tumours had metastases to the regional lymph-nodes, with distant metastases in 30%. An advanced tumour stage (UICC stage IIIB or IV) was present in 43%. Exclusively surgical treatment is not effective in these cases.

Adult↗
PubMed1993

Delta-(L-alpha-aminoadipyl)-L-cysteinyl-D-valine synthetase, the multienzyme integrating the four primary reactions in beta-lactam biosynthesis, as a model peptide synthetase.

ACV synthetase forms the tripeptide precursor of penicillins and cephalosporins from alpha-aminoadipate, cysteine, and valine. Catalytic sites for substrate carboxyl activation as adenylates, peptide bond formations, epimerization and release of the tripeptide-thioester are integrated in multifunctional enzymes of 405 to 425 kD. These have been characterized from several pro- and eukaryotic beta-lactam producers. Implications of these results for the thio-template mechanism of peptide formation are discussed, as well as the use of this multienzyme as a model system for enzymatic peptide synthesis.

Amino Acid Sequence↗
PubMed1993

[Prognostic factors in primary gastric non-Hodgkin's lymphoma--results of uni- and multivariate analysis].

Retrospectively analyzed data of 41 patients with primary gastric non-Hodgkin lymphoma which were all treated by gastric resection are presented with regard to their histopathologic and clinical findings. 87% of the patients were distributed on stage EI and EII (51% high-grade and 49% low-grade lymphoma). R0 resection was achieved in 80% of our cases and in 27% of the cases gastric resection was part of a multimodal therapy. The median follow up of the living patients was 42 months, the overall 5-year survival rate 74%. Tumor stage, extent of surgical resection, histologic grade, tumor site, R0-resection and tumor size showed a significant prognostic influence on survival. The question whether R0 resectable cases benefit from an adjuvant therapy must be answered by further randomized studies.

Adult↗