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W Steiner

Publications and source records attributed to W Steiner.

At least 73 records · Page 4Linked to original sources
PubMed1994

[Surgically treated thoracic aortic dissection. The angiographic follow-up of the perfusion relations].

Control angiography in arterial DSA technique was performed in 27 patients after operative treatment of acute aortic dissection (17 patients with type A dissection) respectively chronic aortic dissection (9 patients with type A dissection/1 patient with type B dissection). The mean interval between surgery and angiography was 59 months. All patients were free from symptoms due to organ complications or redissection. Persistent patency of a false lumen was observed in 40.7% (52.9% after operative treatment of an acute dissection; 20% after operative treatment of a chronic dissection). In all cases with a persistent false lumen the dissection originated at the distal anastomosis. In all patients the beginning of the dissection and the perfusion of the supra-aortal, visceral and iliac vessels whether by the true or false lumen could be shown. In 54.5% the Tr. brachiocephalic trunk was involved in the dissection. In 45.5% the left renal artery was solely perfused by the false lumen. Angiography in arterial DSA technique is evidently a valuable technique to document the beginning and extension of a dissection, sufficiency of the aortic valve, re-entries of the dissection, perfusion of the aortal branches, and the flow in both channels.

Acute Disease↗
PubMed1994

[Therapy of hypopharyngeal cancer. Part IV: Long-term results of transoral laser microsurgery of hypopharyngeal cancer].

Between 1979 and 1986, 74 patients with hypopharyngeal carcinomas were operated using transoral laser microsurgery by the first author. 32 of the patients were subdivided into 5 subgroups and considered separately because of pretreatment for head and neck tumors, simultaneous multiple tumors etc. (excluding criterias). Survival times were not significantly prolonged and lasted 1-27 months (median, 11 months), but the quality of life was improved due to preservation or restoration of natural laryngopharyngeal functions. Forty-two patients were operated with curative intention. This group primarily underwent transoral laser microsurgery, aiming at complete locoregional tumor resection with function preservation (pT1, 5; pT2, 31; pT3, 4; pT4, 2). In 29 patients 31 necks were operated, mostly as a regionally limited functional neck dissection (or "selective" neck dissection). In 90% of the cases neck metastases (pN+) were found, mostly in levels II and III; pN1, 6; pN2a, 1; pN2b, 18; pN2c, 1. Altogether, stages III and IV were found in 71.4% of the patients. A temporary tracheotomy was required in four patients. There was no secondary laryngectomy, even though it was indicated in one case. Post-treatment oncological followup (median observation time, 104 months) demonstrated loco-regional recurrences (n = 1), late or recurrent metastases (n = 4), persisting metastases in the neck with cerebral metastasis (n = 1), distant metastases (n = 4), secondary tumors (n = 9, 5 of which occurred in the head and neck). Through March 1993, 24 patients (57%) have died. Causes were TNM-related (7), second primary tumor with or without distant metastases (8) and intercurrent disease with no evidence of disease (9). Within 5 years 17% of the patients died of TNM-related tumors, 9.5% due to a second primary with or without distant metastases, as well as 9.5% with intercurrent disease. The 5-year overall survival rate was 64% and was 83% (adjusted survival rate) if only TNM-related deaths were considered.

Adult↗
PubMed1994

[Ct-portography in diffuse liver steatosis. Potential for a false-negative assessment].

CT portography is the most sensitive technique currently available for the preoperative diagnosis of liver metastases. We report on a patient with liver steatosis in whom ultrasound examination revealed two liver metastases in the follow up after resection of a papillary carcinoma. The liver metastases could be clearly identified both on plain CT and on enhanced CT with dynamic bolus contrast medium injection. Because of the small difference in attenuation values between liver parenchyma and metastases the two liver metastases had not been recognized on CT portography. When severe and diffuse liver steatosis is present CT portography may fail to detect metastases or small hepatocellular carcinoma.

Adult↗
PubMed1994

[Therapy of hypopharyngeal cancer. Part I. Review of the literature: Surgery and/or radiotherapy].

On the basis of a literature review of the last 20 years concerning the surgical and/or radiotherapeutic management of hypopharyngeal carcinoma (and in particular, pyriform sinus carcinoma), the indications for therapy are presented and the results of loco-regional control, organ preservation, quality of life and complications analyzed critically. Using this material and in the following publications, the applications of chemotherapy and its results in treatment are discussed. The concept of minimally invasive therapy is presented, especially as it involves transoral function preservation laser microsurgery and its long-term results.

Combined Modality Therapy↗
PubMed1994

[Therapy of hypopharyngeal cancer. Part III: The concept of minimally invasive therapy of cancers of the upper aerodigestive tract with special reference to hypopharyngeal cancer and trans-oral laser microsurgery].

The concept of minimally invasive therapy in the treatment of tumors of the upper aerodigestive tract is described with special respect to hypopharyngeal carcinomas and transoral laser microsurgery. Differences to conventional surgical treatment regarding operative strategy and technique and resulting advantages are shown. The individual "customized" tailored surgery corresponding to the extent of tumor generally allows maximum preservation of the affected organ and function, even in rather extended tumors. Preconditions for this method are the transoral approach and the possibility of intraoperative evaluation of the true extent of tumor by using the surgical microscope. Incisions through larger tumors enable identification of basal margins and possible infiltration of surrounding structures. The possibility for verifying histologically the margins of resection of the primary tumor is discussed as well as the technical, oncological and functional limits of transoral surgery. The advantage of this method of treatment involves leaving open intra- and postoperatively all diagnostic and therapeutic (surgical) options: i.e., endoscopic re-resections, conventional partial or radical resection and postoperative radiotherapy with or without chemotherapy. The treatment of cervical lymph nodes is usually performed as a selective uni- or bilateral neck dissection (levels II-IV) include functional procedures N0 to N2. The indications for possible adjuvant therapy (radio- and/or chemotherapy) depend on pT- and pN-staging. The prerequisites for successful treatment and our current therapeutic guidelines are described.

Humans↗
PubMed1994

[Therapy of hypopharyngeal cancer. Part II: Review of the literature for using chemotherapy within the scope of multimodality therapy].

Supplemental to the previous publication on the results of surgery and/or radiotherapy, the application of various cytostatic drugs--neoadjuvant, sequential, simultaneous, alternating or adjuvant--in addition to surgery and/or radiotherapy in the treatment of hypopharynx carcinomas is subjected to critical analysis. Exclusively for these carcinomas there are still no results of prospectively randomized studies, although this may reflect their relatively small incidence when compared with all head and neck tumors. Induction chemotherapy (before standard therapy) has been disappointing clinically, at least concerning hypopharynx carcinomas. To date, organ and function preservation with improved survival in these neoplasms has not been shown clearly, even for resectable tumors. Simultaneous radiochemotherapy is obviously superior to sequential chemotherapy and has demonstrated higher remission rates when compared to conventional radiotherapy, but the effectiveness of modified fractionizing patterns must be kept distinct from the effectiveness of simultaneous chemotherapy. Moreover, it must be defined whether the observed decline in the rate of distant metastases after adjuvant chemotherapy entails (statistically) significant higher survival rates. Only with the help of prospective randomized multicenter studies can the true benefits of chemotherapy be verified and specified in the treatment of hypopharynx carcinomas. The results of chemotherapy to date are critically reviewed and future concepts planned.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

[Therapy of hypopharyngeal carcinoma. Part V: Discussion of long-term results of transoral laser microsurgery of hypopharyngeal carcinoma].

The results of transoral laser microsurgery of hypopharyngeal carcinomas have been described in previous publications. These are discussed on the basis of literature reports on the therapy used, inclusive of surgery and/or radiotherapy and/or chemotherapy. The most important parameters of prognosis include neck and distant metastases as well as multiple tumors. In analysing results of laser therapy, prognosis has been better compared to conventional types of therapy regarding loco-regional control and survival rates. Surgical overtreatment in the sense of pseudoradicality, especially when sacrificing parts of the larynx not involved by tumor, is compared to precision surgery employing the operative microscope and the laser. The latter, presupposing the necessary experience and complying with certain precautions, offers high oncological safety in resection of the primary tumor while at the same time preserving functionally important organic structures. The difficulties arising from a comparative assessment of therapeutic results are dealt with in detail. In terms of radiobiology, radiotherapy is generally given early (after about 2 weeks) in regions well supplied with blood and has been found to be very effective. Local immunologic factors concluding minimally-invasive surgery in the neck) can also be responsible for a favorable clinical course of disease, as can psycho-oncological aspects (quick functional rehabilitation as well as reintegration into job and family). The generally accepted, but probably outdated, guidelines for conventional head and neck surgery demanding extremely radical surgery of primary tumors, block resections, etc. must be critically revised.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Pulsed versus continuous wave excitation mechanisms in photodynamic therapy of differently graded squamous cell carcinomas in tumor-implanted nude mice.

The effectiveness of photodynamic therapy (PDT) in vivo was compared between the pulsed excimer laser-pumped dye laser system (EDL) and the continuous wave (cw) argon laser-pumped dye laser system (ADL). Serial subcutaneous transplantation was used to implant thymus aplastic nude mice with different grades of malignancy of two human squamous cell carcinomas (SCCs). Forty-eight hours after i.v. injections of a hematoporphyrin derivative (Photosan 3), the animals were irradiated with either pulsed-EDL or cw-ADL laser light at a tumor depth of 4-5 mm. The irradiation data were chosen as follows: EDL and ADL wavelength 630 nm, total dose 150 J/cm2, irradiation time 27.78 min; EDL repetition rate 30 Hz, single pulse energy 3 mJ, pulse width 20 ns; ADL intensity 90 mW/cm2. The effects of PDT were studied either by long-term observation of the animals treated or by evaluation of hematoxylin-eosin and Ki-67 histological sections of tumors 48 h after treatment. The EDL system proved to be at least as efficient as the ADL system as judged by the number of complete remissions. This became particularly evident in the treatment of the lower-graded tumors, with a good response observed in both transplanted SCCs. However, the higher-graded tumors showed a better response to PDT.

Animals↗
PubMed1993

[Early detection of cancer in the upper aerodigestive tract. Part I].

It is evident that carcinomas of the upper aerodigestive tract are increasing. Unfortunately advanced tumor stages prevail when patients enter clinical treatment. The causes for delayed tumor diagnosis are manifold, they can be "organ-, tumor-, patient- and doctor-related". Only by means of a complete and thorough examination, employing both an endoscope and a microscope, as well as by consequent histological classification of visible proliferations of uncertain dignity, an adequate diagnosis and treatment of pre- and early cancer stages can be accomplished. The organ-specific characteristics and organ-independent common features are described with respect to early cancer diagnosis. By presenting the diagnostic and therapeutic procedures applied to early cancer stages, the relative merits of smear cytology and histology (cup forceps vs excision biopsy) are discussed. Ultimately, the detection of clinically occult primary tumors is dealt with by referring to a number of principal signs such as nodes in the neck, secondary otalgia, etc. The possibilities of early detection of neck metastases are pointed out and the importance of panendoscopy for early diagnosis of simultaneous secondary tumors is emphasized. In conclusion, the consequences for improved early cancer diagnosis are presented in detail.

Alcohol Drinking↗
PubMed1993

[Laser surgery].

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Animals↗
PubMed1993

[Osteosynthesis in dislocated femoral neck fracture (Garden 3 and 4). Long-term results and treatment concept].

The dislocated fracture of the femoral neck (Garden type 3 and 4) in the young patient is preferably treated by open reduction and internal fixation. In the period 1980-1989 we fixed 49 fractures with a dynamic hip screw, a 130 degrees-angled plate, screws alone, or by a valgisation osteotomy fixed with a 120 degrees-plate (Pauwels osteotomy). 30 fractures were reviewed after 66 months in average. We observed radiological signs of femoral neck necrosis in 9 patients, thereof 7 with symptoms, and radiological signs of osteoarthritis in 3 patients, two with symptoms. The possible factors causing these late complications are discussed. We advocate the immediate open reduction to evacuate the intracapsular hematoma into a slight valgus over-correction for stability. For the fixation we use 3 screws in good bone quality, the dynamic hip screw and the angled plate in osteoporotic bone often combined with an accessory screw for rotational stability. The functional long-term result was good or excellent in 70%. By avoiding technical errors this rate can be improved.

Female↗