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Biomedical subjects

A Rolle

Publications and source records attributed to A Rolle.

15 recordsLinked to original sources
PubMed2005

Laser resection of lung parenchyma--a new technical and clinical approach.

The introduction of a new 1318 nm wavelength Nd:YAG laser has created new possibilities in lung parenchyma surgery. The potentially curative surgical resection of pulmonary metastases in suitably selected cases had been recognized slowly. Using the new laser technology a greater number of patients can now offered salvage surgery. This paper reviews the history of surgical management of pulmonary metastases, development of new laser technology, conventional and extended indications for pulmonary metastasectomy and use of laser in thoracic surgery.

Humans↗
PubMed2005

Resection of multiple lung metastases--where are the limits?

Multiple lung metastases present a serious and challenging problem with increasing incidence for thoracic surgeons. In the lung metastasis management a significant role belongs to laser lung-parenchyma-saving resection. This parenchyma saving technique allows a removal of significant higher number of lung nodules in comparison to conventional techniques (stapler, clamp resection). Performing the lung metastasectomy by this manner, the only remaining question is the limitation of this technique. In this retrospective study, the results after Nd:YAG Laser (1318 nm, 40 Watt) interventions are being presented, the limitations of this technique are being discussed (Tab. 3, Fig. 4, Ref. 9).

Adult↗
PubMed2001

[Palliative surgery for primary and secondary thoracic malignancies].

Palliative thoracic surgical interventions aim to assure or to improve quality of life. They encompass surgical correction of vital complications, treatment of symptoms that limit daily activities, and prophylactic interventions to reduce symptoms and improve prognosis. Interventions are based on statistically proved results as well as on profound clinical experience in oncologic surgery. Because palliation does not intent to cure, such operations require precise patient information and inclusion of the respective patient in decision making. Operability depends on patient general condition and extent of the procedure. If tumor is resected local radicality is the principle goal also in palliative situations, which is adapted to each individual case, especially in the context of multimodal treatment strategies. One of the main indications of palliative thoracic surgery in pulmonary metastasectomy. Using the new laser technology loss of parenchyma is minimal and the rate of lobectomies is reduced from 25% to 4%. With mortality and morbidity of less than 1% the 5-year survival after complete metastasectomy is more than 30%. Tumors of the thoracic wall cause pain and tend to exulcerate; due to their obvious presence they induce anxiety. Their removal and subsequent plastic surgery of the chest wall defect therefore makes sense also in advanced stages. Palliative and curative surgery is one of the pillars in plurimodal treatment of mediastinal tumors, besides its role in obtaining tissue for histologic diagnosis. Thoracoscopic talc pleurodesis has a success rate of more than 90% in malignant effusions if the lung is fully expandable.

Adult↗
PubMed2000

Histologically proven extrinsic allergic alveolitis with severe obstructive pulmonary emphysema

Anamnesis: 61-year old man with progressive shortness of breath on exercise. Cough and expectoration during the last 6 years. - Exposure: Driver of cereals, massive exposure to mouldy and pest contaminated grains. Gave up his profession in 1979 due to dyspnea with short (2-3 h) latency after exposure. Since 1980 intermittent exposure during occasional jobs; renewed symptomatology. Aspergillus fumigatus detected on agar plates inoculated with material from wet areas in bathroom and kitchen. - Clinical symptoms: Barely audible vesicular breathing, barrel-shaped thorax, inspiratory-intercostal retraction. - Bodyplethysmography: Obstructive pulmonary emphysema with FEV1 0.8 l, TLC 7.8 l, RV/TLC relation 67%. - Precipitin-detection: Significantly increased IgG against Fusarium. Other moulds including Aspergillus: negative; thermophilic actinomycetes: negative; pigeon and chicken: negative; Ouchterlony with native material from patients flat: negative. - CT including HR-CT: Bilateral-substantial emphysema, no bullae, no ground glass-opacity, no signs for interstitial lung diseases, no mediastinal enlargement of lymph nodes. - Alpha-1-Antitrypsin: 1.67 to 2.3 g/l (normal range), phenotype M1. - Histology: In resected material from right-side lung-volume-resection detection of pulmonary emphysema as well as lymphocyte infiltration and numerous epitheloid cell granulomas with Langhans'giant cells without caseation assessed as residues of an exogenous allergic alveolitis. - Conclusion: In a patient with lung volume reduction surgery due to severe emphysema histologically a persistent exogenous allergic alveolitis was detected, which might have caused the emphysema.

Journal Article↗
PubMed1999

The interferon-inducible 204 gene, a member of the Ifi 200 family, is not involved in the antiviral state induction by IFN-alpha, but is required by the mouse cytomegalovirus for its replication.

To examine whether Ifi 200 genes are involved in antiviral state induction by IFNs we expressed mutant forms capable of inactivating the endogenous p204 and analyzed replication of both RNA and DNA viruses following IFN-alpha treatment. Inactivation of p204 does not impair replication of vesicular stomatitis virus, encephalomyocarditis virus, ectromelia virus, and herpes simplex virus 1 and does not alter an IFN-alpha induced antiviral state. By contrast, in cells lacking functional p204, mouse cytomegalovirus (MCMV) replication is strongly inhibited and is not further modulated by IFN-alpha. These results suggest that p204, a member of the Ifi 200 gene family, is not involved in the IFN-alpha-induced antiviral activity against some RNA or DNA viruses, but is required by MCMV for its replication.

3T3 Cells↗
PubMed1999

Extensive multiple and lobe-sparing pulmonary resections with the Nd: YAG laser and a new wavelength of 1318 nm.

AIMS: Analysing the results of extensive parenchymal resections in 110 patients we want to demonstrate the safe usage and the superiority of the second Nd: YAG laser wavelength (1318 nm) which shows significantly better lung tissue determinants. METHODS: Between 3/96 and 11/97, 110 patients (66 men and 44 women, mean age 60 years) were integrated prospectively in three groups and underwent pulmonary surgery with the Nd: YAG laser of the 1318 nm wavelength. 78 patients had suspected lung metastases of known primary malignancies (group 1); 20 patients with poor lung function had peripheral T1 or T2 lung primaries (group 2) and 12 patients had multiple pulmonary nodules but unknown malignancies (group 3). RESULTS: In group 1 we resected 353 nodules or 4.6 nodules per patient, between 5 and 60 nm. Although 41% of all lesions were deep-seated and only 28% solitary, it was in 97.5% possible to perform precision resections. In two patients (2.5%) lobectomy was necessary which demonstrates a drastic decrease of the lobectomy rate--reported between 20 and 30% in the literature. There was no mortality in all groups, and only two complications were treated conservatively. DISCUSSION: The technical improvements in this special laser (1318 nm) allow extensive parenchymal resections and should make the long-discussed advantages of lasers in open lung surgery applicable to a broad clinical usage.

Female↗
PubMed1990

[Morphology and clinical picture of thymus carcinoid].

A large mediastinal tumour was discovered radiologically in a 50-year-old man, with at times blood-tinged sputum and dyspnoea. Parasternal needle biopsy revealed a thymic carcinoid. After surgical excision of the tumour, which had argyrophilic foci (total weight of tumour 1,605 g), histochemical analysis demonstrated neuron-specific enolase, synaptophysin and chromogranin, as well as calcitonin (as the only hormone). For the first time in a thymic carcinoid, radioimmunoassay demonstrated growth-hormone-releasing hormone (2 micrograms/g tumour tissue). Post-operative radiotherapy (total dosage 50.5 Gy) was instituted because histological examination had shown invasion of the capsule and blood vessels. There has been no local recurrence or metastases after three years.

Biopsy, Needle↗
PubMed1990

[Perioperative preventive use of antibiotics in thoracic surgery--results of a controlled randomized study with optocillin].

There seems to be general agreement that antibiotic prophylaxis should be provided for patients undergoing resections of the lung. In order to obtain further information about the extent of resection beyond which this is necessary, and also to establish the type of prophylaxis that is meaningful over the long term, we carried out a controlled study involving two groups of 100 patients each. In the first group, who received minor resections, ultrashort-term prophylaxis was compared with an 0 group. We were able to show that in high-risk patients with prior pulmonary diseases, prophylaxis is indeed meaningful. In the second group of patients undergoing major resections, antibiotic prophylaxis must be provided; a one-day administration suffices, and long-term administration fails to offer any further advantages.

Drug Administration Schedule↗
PubMed1990

[Perioperative management of thoracic surgery patients].

Immediate postoperative extubation of patients submitted to chest surgery is possible in almost all cases. The intensive care unit responsible for these patients should have good facilities for bronchoscopy, and the indication for this procedure should be made, postoperatively, on a broad basis. The introduction of peri-operative antibiotic prophylaxis has led to a substantial decline in disturbances of wound healing. Due to the use of autologous blood transfusion, the need for homologous blood transfusions has been reduced significantly.

Aged↗
PubMed1989

[The scaphoid-trapezium-trapezoid arthrosis. A clinical study 1982-1985].

The present study deals with patients in whom the diagnostic procedures applied in rhizoid arthrosis were considered to reveal scaphoid-trapezium-trapezoid (STT) arthrosis. Between 1982 and 1985, 21 of 396 rhizoid arthrosis patients developed symptoms of STT arthosis. Examination of the case histories showed that in 20 STT patients the pathogenesis included trauma. In addition, the majority of these 396 patients (71.5%) had to be retreated because of new traumata and the resultant problems. The time lapse between the first trauma considered sufficiently severe to have caused STT arthrosis and its diagnosis was up to 7.1 years. Our improved facilities for diagnosis of pathologic conditions of the wrist enabled us to distinguish four types of STT arthrosis. Persistent complex instability of the capsular ligament appears to be the major cause of post-traumatic STT arthrosis. Extended diagnostic techniques based on standardized radiograms allow the development of a design for treatment aimed at preventing posttraumatic STT of the hand as far as possible.

Aged↗
PubMed1987

[Thoracic outlet compression syndrome].

In patients suffering from chronic, therapy-resistant shoulder and arm pains, the thoracic outlet compression syndrome (TOS) should be included in the differential diagnosis. It is very important to look out for neurogenic disorders as well as early signs of vascular compression in order to prevent ischaemic injuries. Although the initial complaints appear slight and can in some cases be treated successfully by conservative methods, neurogenic disorders due to TOS as well as arterial and venous manifestations of the syndrome should be treated by resection of the first rib. Only in this way can irreversible neurogenic lesions and arterial or venous complications be prevented.

Arm↗
PubMed1984

[The problem of load stability in pathological fractures. Considerations on its indications using typical cases as examples].

Differentiated management of pathological fractures and multiple bone metastases is shown by means of 7 typical case examples. In the proximal femur, the total replacement of tumor-bearing bone areas by total hip prosthesis seems to provide the best stability. The femur shaft is stabilised without risk by intramedullary nailing, whereas metaphyseal stabilisation is best done by means of the interlocking nail. In the humerus, neutralisation plates are used, but they should be chosen long enough to anchor the implant in zones free fo tumour. The limitations of operability are demonstrated in one case. On the other hand, one case is shown where multiple metastases were treated palliatively by excochleation and filling the defect with bone cement, thus preserving the functional ability of the limb and the independence of the patient.

Aged↗
PubMed1984

[Syndactylia results].

During the years 1960-1980 42 patients with syndactyly were treated at the Department for Handsurgery of the University of Munich. In addition to the conventional classification and in regard to the criteria for operative management, we stress the difference between the simple and the more complex forms of syndactyly as well as those cases in which the syndactyly is part of a syndrome. There was a relation of 1:1 between the simple and the 'complex' syndactyly. The results of former and modern operative management are reviewed and the value of some special methods is pointed out.

Adolescent↗