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U Heise

Publications and source records attributed to U Heise.

31 records · Page 2Linked to original sources
PubMed1987

Histomorphometric changes of osteosarcoma after chemotherapy. Correlation with 99mTc methylene diphosphonate functional imaging.

An investigation to correlate histologic changes in 12 osteosarcoma specimens from patients undergoing chemotherapy was performed using functional images of regional 99mTc methylene diphosphonate (MDP) plasma clearance rates assessed from dynamic bone scintigraphies taken during chemotherapy. Residual tumor cell viability was determined by microscopic examination of multiple thin sections from surgical specimens and quantitated by histomorphometry. Regions that showed decreases in 99mTc MDP plasma clearance of more than 20% were associated with areas of necrotic tumor, and regions that showed absent decline or increasing clearance rates were associated with high residual cell viability and incomplete response to chemotherapy. Therefore, functional bone scintigraphy allows an objective presurgical assessment of tumor response to chemotherapy.

Adolescent↗
PubMed1987

Comparison of quantitative ground substance analysis in biopsy and resected tumour in osteosarcomas.

Osteosarcomas may show variable differentiation. They are divided into osteoblastic, chondroblastic and fibroblastic subgroups depending on their dominant histological differentiation. The pattern of histological differentiation of osteosarcoma is supposed to have an influence on the response to chemotherapy and in this study the relationship between the differentiation of the tumours and response to chemotherapy was examined in 22 osteosarcomas. For this purpose the nuclear size of tumour cells was determined on imprints and the area of the different ground substances on tumour sections after undecalcified preparation. Tumours with little nuclear polymorphism and those with an area of chondroblastic ground substance of more than 20% in the biopsy showed a poor response to chemotherapy. We conclude from our results that lack of nuclear polymorphism and in particular a large area of chondroblastic ground substances in the biopsy, can be regarded as an unfavourable prognostic factor in the response to primary chemotherapy. A comparison of the area of chondroblastic ground substance in biopsy and resection material proves that the biopsy delivers a representative view of the total area of chondroblastic ground substance for the groups of responder and non-responder. Patients with a large amount of chondroblastic ground substance in the biopsy probably require more aggressive chemotherapy.

Adolescent↗
PubMed1985

[Comparison of x-ray and histological findings in osteosarcomas following preoperative chemotherapy].

Since the introduction of pre-operative chemotherapy, osteosarcomas have shown a more favourable prognosis. Reaction of the tumour due to chemotherapy is judged pre-operative primarily by radiology (plain films, angiography, CT, scintigraphy). There is little evidence concerning the radiological appearances after pre-operative chemotherapy and morphological changes, particularly in respect of tumour regression. Specific radiological changes were therefore compared with pathological findings following chemotherapy and operation in 17 patients with osteosarcomas. Tumours were examined which showed radiological evidence of intra-and extra-osseous sclerosis or lysis and which still were classified as vital tumour tissue. Tumour planes were reconstructed from large histological sections of the operative specimen and compared with the radiological appearances. Sclerosis was found to be due to reactive new bone formation or to mineralisation of the osteosarcomatous tissue. Lysis correlated with persistent vital tumour, or in connective tissue. Nine out of ten cases, regarded as vital on radiological evidence, showed vital tumour cells on histological section. Lyses and scleroses were not reliable indications of the pre-operative state of the osteosarcoma following chemotherapy. On the other hand, combined qualitative radiological criteria for assessing tumour vitality, proved to be helpful.

Adolescent↗
PubMed1984

[The effect of intraoperative PEEP ventilation and postoperative CPAP breathing on postoperative lung function following upper abdominal surgery].

The problem of how to improve postoperative pulmonary function after upper abdominal surgery was investigated in a randomized study involving 64 patients who were subjected to various treatment regimens designed to increase airway pressure. Intraoperative ventilation was carried out with either zero or positive end exspiratory pressure, and postoperatively either CPAP or a nasal oxygen catheter were applied. The following groups were formed: 1. ZEEP /O2-catheter; 2. PEEP/O2-catheter; 3. ZEEP /CPAP; 4. PEEP/CPAP. The typical reduction in vital capacity occurred postoperatively, the lowest value being recorded on the 2nd postoperative day, an alteration in respiratory pattern with reduced tidal volume and increased respiratory rate together with an initially low, later normal alveolar ventilation, and an initial hypoxaemia which was at first associated with a moderate hypercapnia, on the second postoperative day with a normocapnia, were observed. At no point in time could a difference be found between the 4 groups, no measurable improvement in respiratory function being found as a result of the treatment given. Intra- and post-operative increase in airway pressure was however found to be associated with a reduction in the incidence of post-operative pulmonary complications.

Abdomen↗
PubMedDate not supplied

[The prognostic significance of tumor volume in osteosarcoma with neoadjuvant chemotherapy].

In a retrospective analysis on 128 patients from the trials COSS-80, -82, -85 and -86 initial x-ray pictures were evaluated for tumor diameters in three planes and the prognostic meaning on survival was assessed. In a subset of patients (n = 27) the measured values were compared to values obtained by CT-Scan and a good correlation (r = 0.69) was found. Several parameters for tumor size were defined: absolute tumor length (ATL), relative tumor length (RTL, proportion of tumor to the length of the involved bone), absolute tumor volume (ATV, calculated by the ellipsoid formula) and relative tumor volume (RTL, tumor volume referred to the body surface area) and univariate and multivariate survival analysis were performed. Univariate analysis of metastasis free survival (MFS) revealed a high prognostic significance of the ATL, the ATV and the RTV. The RTL in this patient group demonstrated a tendency only toward an inferior prognosis in larger tumors. None of the patients with a ATV < 70 ml (n = 19) and only one of 33 patients with an ATV < 100 ml relapsed. Cox regression analysis was performed including the variables age, sex, site and response (> 90% tumor necrosis) in 84 patients. ATL and RTL do not enter the model, while the response proves its significance as a valid prognostic factor with a p-value of 0.0004. Adding the ATV as the measure of tumor size to the model it enters as the first term (p = 0.0000) followed by the response (p = 0.0002).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Spastic paraparesis in Scheuermann disease: a case report].

A case of paraparesis due to Scheuermann's disease in a 17.5 years old boy suffering from a moderate dorsal kyphosis (Cobb angle 64 degrees) is reported. Etiologically, spastic paraparesis can be caused either by myelon compression due to extradural cysts, herniated dorsal discs, or direct myelon compression from the vertebral bodies. Radiologically, in addition an intraspinal lipom was suspected. Because of the neurological deficits surgical treatment was performed. Ventral release followed by an anterior spondylodesis was combined with a dorsal spondylodesis using the Harrington compression system. An intraspinal lipom could be excluded intraoperatively after laminectomy of the suspicious region. Three months postoperatively, no signs of any neurological deficits were observable. X-ray control demonstrated a solid spondylodesis with an Cobb angle of 38 degrees. Direct myelon compression or indirect myelon damage due to a reduced blood supply at the apex of kyphosis are supposed to be the pathophysiological pathway.

Adolescent↗
PubMedDate not supplied

[The Borggreve rotation-plasty. A surgical method in therapy of malignant bone tumors and functional results].

From 1980 to 1992, 39 Borggreve-rotation-plasties were performed in patients with malignant bone tumors at the Orthopaedic Clinic of the University of Hamburg. The rotation-plasty was first published in 1930 by Borggreve. Salzer (Wien) described the method in 1981 for the operative treatment of osteosarcomas about the knee. The rotation-plasty is feasible for tumors of the distal femur, even when other limb-saving procedures are impossible, e.g. due to skip metastases, insufficient soft tissue coverage or involvement of the knee joint. The procedure was done on 26 female and 13 male patients, the age ranging between 7 and 45 years with a mean age of 17 years. The histological diagnosis was osteosarcoma in 36 cases, MFH, Ewing's sarcoma and Giant cell tumor in one case, respectively. The operative technique was slightly modified, compared to the method described originally by Salzer. The range of error of the different preoperative imaging procedures was evaluated and compared with the tumor extent in the resected specimen. MRI was found to be most precise. We saw no local recurrencies. Three patients had early thromboses, two of those had to be amputated, slow preoperative compression of the popliteal vein being the main cause in both. One patient developed a lymphatic fistula ten years postoperatively, which was eliminated in a second operation. All patients are followed routinely in the oncologic outpatient service. The functional results were rates "excellent" or "good" for all patients in six of seven categories, according to the Enneking evaluation system.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Methods of surface measurements in idiopathic scoliosis].

The radiologic evaluation of scoliotic spines is a well established, exact method. In long follow-up histories these patients aquire a remarcable radiation exposure. Measurement of additional clinical parameters intends since decades to minimize this exposure. Documentation of surface deformities follows the presumption of a correlation between these and the radiologic angles. The analysis of 714 completely documented untreated idiopathic scoliotic curves showed a good overall correlation between surface deformity and Cobb angle, but single measurements varied too widely to make the used surface documentation a real alternative to x-rays. Treated scoliosis patients pose additional problems in the evaluation, a any treatment - brace and operation - further diminish the correlation. Obviously the usual clinical surface evaluation can only document the cosmetic appearance. Regular radiologic follow-up stays inevitable especially in treated scoliotic patients.

Adolescent↗
PubMedDate not supplied

[Neoadjuvant therapy for localized osteosarcoma of extremities. Results from the Cooperative osteosarcoma study group COSS of 925 patients].

BACKGROUND: Owing to twenty years of multicentric interdisciplinary cooperation, the COSS group has been able to collect data on a large group of osteosarcoma patients treated by neoadjuvant therapy. This paper reviews results achieved in patients with localized extremity tumors. PATIENTS AND METHODS INCLUSION CRITERIA: Registration into a completed neoadjuvant COSS-Study. Histologically confirmed, primary, localized, high-grade, central osteosarcoma of an extremity; age < 40 years; no pretreatment; interval diagnosis to chemotherapy < or = 3 weeks; no severe comorbidity. Chemotherapy: HD-methotrexate +/- doxorubicin +/- cisplatin +/- ifosfamide +/- BCD. Scheduled local therapy: Surgery. RESULTS: 925 evaluable patients from 101 institutions. Median age 15 years, m:f 1.4:1. Primary site: femur 510, tibia 251, humerus 100, fibula 51, other 13. Tumor-size < 1/3 of the involved bone 616, > or = 1/3 304. Definitive surgery in 903/925 cases, 443 limb salvage procedures. Good response (> 90% necrosis) in 469/806 (58.2%) evaluated tumors. Median follow-up for surviving patients: 5.42 years. Actuarial survival after 5 and 10 years: 72.5% (95%-CI 69.3-75.7) and 66.3% (62.5-70.0), relapse-free 62.1% (58.7-65.4) and 59.4% (55.8-63.0). 683/925 alive (601 first remission), 242 deceased (212 tumor progression, 30 other causes). 66.2% (97.3%) of all relapses within 2 (5) years. Prognosis correlates with tumor-size (< vs. > or = 1/3: 69.9% vs. 58.3% at 10 years) and -site (tibia: 74.2%, humerus: 54.5%) and -response (good vs. poor: 78.2% vs. 52.5%) (all p < 0.01). Actuarial 10-year survival by response grading I-VI according to Salzer-Kuntschik 80.9%, 82.8%, 71.1%, 60.7%, 47.7%, 27.3%. COSS-studies with preoperative 4-drug therapy more efficacious than less aggressive protocols. No impact of doxorubicin scheduling (sequential: rapid vs. 48 h-continuous infusion) or cisplatin scheduling (randomized: 5 h vs. 72 h-infusion) on prognosis detected. CONCLUSIONS: Intensive multiagent chemotherapy and delayed surgery for localized extremity osteosarcoma led to excellent oncologic results in the COSS-studies. Tumor-size, -site, and -response as well as the intensity of upfront chemotherapy correlated with outcome. Giving doxorubicin and cisplatin by continuous infusions did not result in discernible prognostic disadvantages.

Adolescent↗
PubMedDate not supplied

[Sonographic assessment of typical lesions in shoulder dislocation].

The traumatic dislocation of the shoulder joint is the most often joint luxation. The involved patients are often sporting and between the age of 20 to 40 years. The therapeutic and prognostic point of interest is to recognize and reconstruct injured structures. Among the soft tissue injuries the Bankart lesions, among the osseous injuries the Hill-Sachs defect are numeric well to the fore. Hitherto existing diagnostic methods for these injuries are either invasive or with X-rays. Its is demonstrated, that dynamic ultrasonography examination of the shoulder joint can visualize besides the rotator cuff abnormalities of the labrum glenoidale and the caput humeri outline.

Adult↗
PubMedDate not supplied

[Partial replacement of the pelvis with the hip joint and proximal femur. A possibility in tumor treatment].

In cases of extensive destructive osteolytic processes in the pelvis and hip region, alloplastic replacement of a part of the pelvis with a total hip replacement and, if necessary, partial replacement of the femur, can represent a therapeutic alternative to hemipelvectomy for preserving the limb in the presence of malignancies; it offers the same degree of radicality in removing the affected bone and soft tissue while preserving the bone. This applies with regard both to primary malignant growths as well as extensive isolated metastases and aseptic osteolysis following multiple total replacement procedures. The partial pelvic prostheses, produced individually on the basis of roentgenograms, are adapted to a great degree intraoperatively and fixed with screws, locknuts, and Palacos, and if possible lined with autogenous bone. Where the defects are extensive the pubic bone of the unaffected side is incorporated in the stabilization. Experience gathered so far and follow-up examinations show that all patients regain full mobility and weight-bearing ability, with almost complete lack of complaints and adequate to good motility. This is demonstrated by examples.

Adult↗