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A Heintz

Publications and source records attributed to A Heintz.

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

[Spiral computerized tomography of esophageal carcinoma--methodology, problems, results].

Computed tomography (CT) is widely recognized as a part of the routine preoperative staging in patients with esophageal carcinoma. Applying a tailored technique, CT criteria of transmural growth and infiltration of adjacent structures are highly accurate for estimating resectability. The size-based assessment of mediastinal and abdominal lymph nodes is usually reported with low sensitivity and specificity. Spiral technology (spiral CT) increases image quality by a reduction of artifacts due to respiratory motion or cardiac pulsation, higher anatomic detail, and peak vascular opacification throughout the entire examination. Thus, an improvement of diagnostic accuracy in the staging of esophageal carcinoma can be expected. Its targeted application and a comparison with the conventional technique are presented.

Adult↗
PubMed1994

[Endoscopic, extraperitoneal adrenalectomy].

Between March and June 1994 three adrenalectomies were performed via an endoscopic extraperitoneal approach. After creating a carbon dioxide retropneumoperitoneum three 10 mm trocars were introduced in the area of conventional lumbar incision. Via these ports adrenalectomy was performed. Time of operation amount to 215, 290 and 330 min. No postoperative complications were observed. Time of postoperative hospitalisation amount to 3, 4 and 7 days. The advantage of the extraperitoneal approach is that it decreases postoperative pain and allows more rapid recovery.

Adenoma↗
PubMed1994

[Patterns of recurrence of esophageal carcinoma after esophageal resection and gastric interposition: CT findings].

PURPOSE: CT examination of recurrence patterns of oesophageal carcinoma, distinguishing normal post-operative appearances from local recurrences, lymph node metastases and postoperative complications. MATERIALS AND METHOD: 28 patients were examined following oesophageal resection and gastric interposition because of development of new symptoms. Localization and patterns of local recurrences, lymph node and distant metastases were correlated with the localization of the primary tumour. RESULTS: Eight patients (29%) were free of tumour and a further eight with lymph node or distant metastases showed normal gastric interposition. 12 patients (43%) had local recurrences at the level of the primary tumour. 10 patients (36%) had local recurrences only, seven (25%) had a combination of local and distant metastases and 3 (10%) showed only distant metastases. The localization of distant metastases was independent of the localization of the primary tumour. CONCLUSIONS: Recurrences following oesophageal carcinoma usually consist of a combination of local recurrences and lymph node and distant metastases which can only be defined completely by CT.

Aged↗
PubMed1993

Endoscopic ultrasonography in the diagnosis of regional lymph nodes in esophageal and gastric cancer--results of studies in vitro.

A total of 90 regional lymph nodes (43 benign/47 metastatic) from 16 surgical resection specimens of patients with esophageal and gastric carcinoma were examined in vitro by endosonography. The validity of endosonographic criteria of lymph node dignity (size, echogenicity, internal echo pattern and margin structure) was assessed using computer-supported B-mode analysis and compared to histopathological results. Of 26 lymph nodes with a diameter of more than 10 mm, 19 were metastatic (72%). The subjective assessment of the internal echo pattern (homogeneity) and the node margins by an experienced observer allowed the diagnosis of metastatic lymph nodes, but there was a high proportion of false positives (52%). Lymph node echogenicity, assessed either subjectively or by computer analysis, did not permit the differentiation between benign and metastatic lymph nodes.

Endoscopy↗
PubMed1993

[Diagnosis of anorectal fistula using magnetic resonance tomography].

In 17 patients with anorectal fistulae the pelvis was examined by magnetic resonance imaging (MRI). The extent and the course of the fistulae and abscesses could be visualized by proton-density- and T2-weighted images. In 6 of 17 patients fistulae were seen that could not be detected by clinical investigation. In 2 cases additional pelvirectal abscesses were found. Most of the fistulae (5 of 6) had a complicated high suprasphincteric or rectovaginal course. It is concluded that with MRI anorectal fistulae and abscesses can be visualized and that this method is a worthful additional diagnostic tool in patients with complicated fistula-in-ano.

Adult↗
PubMed1993

[Thoracoscopic operation of a tumor of the esophageal wall].

Improvements in video endoscopic technique opens a wide spreaded field of indications of thoracoscopic surgery especially in benign tumors of the esophagus. A 58-years old patient presented with dysphagia. Preoperatively a benign, intramural tumor of the esophagus wall was diagnosed. Enucleation of the tumor was performed by right videothoracoscopy. The use of thoracoscopic operative technique implies rapid disappearance of complaints and a reduced time of hospitalisation.

Deglutition Disorders↗
PubMed1993

[Risk factors of perioperative morbidity and mortality in colorectal cancer with special reference to tumor stage, site and age].

The perioperative risk was prospectively analyzed in 511 patients with colorectal cancer, out of which 5% had an emergency procedure. The morbidity rate was 23.6% without an association with tumour stage or localization. The incidence of nonsurgical complications rose with increasing age because of a rising number of concomitant illnesses (< 50: 5.7%, > 80: 28.1%). The morbidity was associated with an increasing blood loss during the operation (< 500 ml: 10.6%, > 2000 ml: 30.4%), but not with the type of treatment. The overall operative mortality rate was 2.3% with the same rate of surgical complications and complications of preexisting conditions. Morbidity and mortality following emergency procedure were 56%, respectively 20%, expressing mainly septical complications of colorectal cancer.

Adult↗
PubMed1992

[Local excision of rectal tumors. Indications, preoperative diagnosis, surgical technique and results].

Between January 1986 and October 1991 255 patients with rectal tumors were treated by local excision. In 239 patients local excision was performed by transanal endoscopic microsurgery, 16 tumors were removed with the retractor developed by Parks. Operative mortality was 1% in 189 local removed adenomas, complications were observed in two patients (2.1%), local recurrences in seven patients (3.7%). 66 rectal carcinomas were treated by local excision (operative mortality 1%, complication rate 3%). In one of 28 local excised "low risk" T1-carcinomas a recurrence was observed. Five of eleven local treated patients with "high risk" tumors developed a recurrence. Endosonography was of utmost importance in preoperative staging of rectal tumors. Between June 1987 and October 1991 204 patients with rectal tumors (92 sessile adenomas, 30 T1-carcinomas and 82 advanced carcinomas) were examined preoperatively by endosonography. The diagnosis of an adenoma or a T1-carcinoma was made with a sensitivity of 0.9, although no differentiation was possible between adenomas and T1-carcinomas. Results of digital examination were comparable to endosonography, under condition that digital examination was complete. Insufficient information was obtained from the endosonographic detection of lymph-node metastatic spread.

Adult↗
PubMed1992

[Image cytometric DNA analysis in the evaluation of the risk of recurrence after resection of rectal carcinoma].

Prognostically relevant factors derived from re-operative endoluminal US examination or the histopathological work-up of the surgical specimen in carcinoma of the rectum are well known. We investigated the question as to whether the DNA content of tumor cells is an independent influencing factor of prognosis after resection of rectal carcinoma. In 68 patients who underwent resection for rectal carcinoma, in addition to the TNM classification and the usual morphological evaluation, the paraffin-embedded tumor material was de-paraffinized, rehydrated and treated mechanically and enzymatically prior to application to microscope slides. These smears were analysed with the aid of automatic single cell cytometry, and DNA measurements were performed. In contrast to flow cytometry, this technique permits, on the basis of electronic selection criteria, selective analysis of the tumor cells, while artefacts, stroma and inflammatory cells can be excluded. Using DNA cytometry, we were able to differentiate between diploid, polyploid and aneuploid tumors. The best prognosis was associated with a diploid tumor, the poorest with aneuploid tumor. Regression analysis, however, showed that the DNA content of tumor cells is of only secondary significance.

Cytological Techniques↗
PubMed1992

[Comparison of DNA analysis with histomorphologic parameters in stomach cancer].

After curative resection of stomach carcinomas (adenocarcinomas: n = 58, signet ring cell carcinomas: n = 24, undifferentiated carcinomas: n = 21) the DNA content of the tumor cells was compared with the histomorphological parameters. There was a correlation between the DNA content and the histomorphological parameters. The DNA analysis had no additionally prognostic influence. In the multivariate regression analysis the prognosis depended on lymph node status (p = 0.0009), pT-stage (p = 0.02), tumor localization (p = 0.03) and the histological type (p = 0.05). The prognosis was independent of the DNA content. Furthermore, neither did the degree of differentiation, the operative procedure, the safety distance, the size of the tumor, the sex nor the age of the patient have any influence on the prognosis.

Adenocarcinoma↗
PubMed1992

DNA image cytometry: a prognostic tool in rectal cancer?

In 68 patients the DNA content of tumor cells was measured by image cytometry after resection of the rectum because of cancer. In the DNA histogram a differentiation between diploid (n = 19), polyploid (n = 24), hypotriploid (n = 17), and hypertriploid (n = 8) tumors was possible. The best relapse-free survival time was found in patients with diploid tumors. The prognosis worsened from polyploid to hypotriploid and was worse in hypertriploid tumors. Testing for a prognostic advantage of diploid over aneuploid tumors without adjustment for additional factors simply by means of the log-rank statistic gave a (one-sided) P of 0.1013. In a multivariate analysis the degree of differentiation turned out most important. Again, an appropriate test for prognostic relevance of DNA content failed to be significant (P = 0.3264).

Adult↗
PubMed1992

[The computed tomographic staging of gastrointestinal tumors].

During a period of six years 131 patients had CT for gastrointestinal tumours or inflammatory bowel disease; the results were analysed retrospectively according to standard criteria. The preoperative CT appearances were compared with the surgical and histological findings. Confirmation of the diagnosis was obtained at surgery and from pathological studies carried out within six weeks of the CT. There were 93 malignant and 8 benign tumours and 30 inflammatory lesions. The reliability of CT for determining tumour extent and the presence of metastases can be improved by standardising the method of examination. Altogether a sensitivity of 75-85%, a specificity of 89-96% and an accuracy of 83-86% was obtained, depending on the anatomical lesion. Correct findings of all three staging parameters T, N and M for carcinomas was, however, obtained in only 56%. Differentiation between malignant and benign tumours and from inflammatory lesions was possible in the presence of specific CT patterns.

Adult↗
PubMed1992

[Endosonography of esophageal cancer. Results of a clinical study and in vitro analysis].

From April 1989 to June 1991 63 patients with esophageal cancer were investigated by endosonography with the object of ascertaining the depth of intrathoracic tumor infiltration and lymphnode involvement. The sensitivity in diagnosing tumor infiltration amount to 0.74; the sensitivity for involvement of regional lymphnode was 0.84, specificity 0.44. In an in-vitro analysis endosonographic criteria for the assessment of regional lymphnodes are proved. Echogenic structure seems not to be a valuable criterium.

Aged↗
PubMed1992

[The value of imaging techniques in the diagnosis of non-specific abdominal pain in young patients].

In a retrospective study the use of imaging modalities in the diagnosis of non-specific abdominal pain in patients under 31 years was evaluated. 253 patients with primarily non-specific abdominal complaints were analysed. For further investigation one of the following methods had to be applied: abdominal sonography and/or upper gastrointestinal tract roentgenograms and/or enteroclysis and/or barium enema. In 66% (167/253) of all cases abdominal pain remained non-specific. Clinical history and physical examination led to the final diagnosis in 66/86 (76.7%) of patients with pathologic findings. 21/561 (3.7%) radiographic examinations revealed abnormalities of clinical importance. In 10/253 (4%) patients the final diagnosis could be established only with the help of radiologic and/or endoscopic examinations. The low efficacy of conventional radiology justifies the demand for a stricter indication in the young patient suffering from non-specific abdominal pain.

Abdominal Pain↗
PubMed1991

[Endosonography in preoperative staging of gastrointestinal tumors].

29 patients with esophageal and gastric tumors, and 109 patients with rectal carcinoma were preoperatively investigated by endosonography. Tumor infiltration and lymph node spreading were assessed by endosonography and compared to the postoperative histological findings. Depth of tumor infiltration was assessed correctly in 88% of all patients investigated. Lymph node spreading of gastric and esophageal cancer was detected in 84%. In contrast lymph node metastases of rectal carcinoma were rarely seen. The high accuracy of endosonography in detection of lymph node metastases of esophageal cancer makes it possible to select the appropriate treatment, such as surgery, radiotherapy or palliative procedures. Endorectal sonography is a powerful tool to select those patients, who can only be treated by local excision.

Endoscopes, Gastrointestinal↗
PubMed1991

Preoperative detection of intrathoracic tumor spread of esophageal cancer: endosonography versus computed tomography.

The results of endosonography and computed tomography, using an optimized CT technique, have been compared in the preoperative detection of intrathoracic tumor spread of esophageal cancer. In 22/40 patients with esophageal tumors complete passage of the ultrasonic endoscope was possible. Endosonography was superior to CT in the assessment of early stage of esophageal tumor (T1-2). Out of 9 tumors confined to the esophageal wall, 8 were classified correctly by endosonography and only 5 by computed tomography. The results in advanced T3 and T4 tumors (13 patients) were comparable following endosonography and computed tomography. Endosonography is an important means of selecting patients with early-stage cancers in whom a curative resection is still a possibility.

Carcinoma↗