[Recommendations on contents of medical reports in rectal carcinoma: I: Surgical report and pathology findings. Orientating aids in interdisciplinary management].
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Documentation↗
Biomedical subjects
D Hölzel
Publications and source records attributed to D Hölzel.
[Recommendations on the contents of medical reports in rectal carcinoma: II: Physician's letter. Orienting guides in the interdisciplinary patient care process].
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Correspondence as Topic↗
Defects of the respiratory chain in the normal human liver and in cirrhosis during aging.
Defects of the respiratory chain are a typical feature of mitochondrial diseases and occur also during normal aging where they have been described in postmitotic tissues. The present study addresses the question of defect expression in the normal and cirrhotic liver. Randomly distributed defects of complex III (ubiquinone-cytochrome-c-oxidoreductase) and of complex IV (cytochrome-c-oxidase) of the respiratory chain have been detected with age-related increasing frequency both in normal and cirrhotic livers. No defects were present for complex II (succinate-dehydrogenase) and complex V (adenosine triphosphate-synthase) and in liver cell carcinomas. Sixty-one of 107 normal livers (57%) showed defects of the respiratory chain. The defects occurred in advanced age (over 50 years) in 87%. In contrast 50 of 64 cirrhotic livers (78%) had defects and approximately 60% occurred after age 50. The defects were caused by a loss of enzyme protein involving both nuclearly and mitochondrially coded subunits. Ninety-four percent of the defects (n = 275) involved complex IV selectively. In 4% selective defects of complex III were found and combined defects of both complexes occurred in only 2%. In situ hybridization and polymerase chain reaction (PCR) studies for the detection of the common deletion (4.977 bp) and of various point mutations of mitochondrial DNA (mtDNA) revealed no consistent molecular genetic abnormalities in microdissected respiratory chain defective liver cell areas. Single point mutations at nt 3243 and/or 5692 were found only in 7 of 18 microdissected probes from 6 patients. The results show that defects of the respiratory chain occur already in normal livers most probably during cell aging and at a higher rate in cirrhosis. The random defect pattern favors a stochastic process, e.g., free radical damage. However, the role of mutations of mtDNA remains to be established.
Adenosine Triphosphatases↗
p53-protein and Ki-67-antigen expression are both reliable biomarkers of prognosis in thick stage I nodular melanomas of the skin.
The maximum tumour thickness is the most important prognostic factor in malignant melanomas of the skin. However, the clinical outcome of thick nodular melanomas remains unpredictable. Therefore, we investigated possible prognostic markers in this subset of melanomas. From a melanoma data base, 12 patients with thick (> 3 mm) stage I nodular melanomas of the skin were identified, who were still without signs of progression after five years of follow-up. These tumours were compared to randomly selected series of 12 cases, who did not survive the first five years after removal of the tumours. We performed immunostaining for the p53-protein and the proliferation associated Ki-67-antigen. For quantification of immunostaining the tumours were entirely scanned. In addition, all tumours were investigated for any differences with conventionally applied prognostic features: the tumour thickness: the level of invasion; the prognostic index (tumour thickness multiplied by mitotic count); and the mean volume-weighted mean nuclear volume. We demonstrated significant differences between survivors and non-survivors exclusively in respect of the staining indices for p53 and Ki-67 (P < 0.03 and 0.02, respectively). With both antibodies the tumours of survivors showed lower counts as compared to non-survivors survivors. However, within both groups we found no significant correlations between the p53- and Ki-67-staining results. We conclude that immunostaining for p53-protein and Ki-67-antigen is helpful to identify individuals with thick nodular melanomas who are at risk of metastatic disease.
Adult↗
Management of patients with severe head injury in the preclinical phase: a prospective analysis.
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Craniocerebral Trauma↗
Design elements of a telemedical medical record.
Computerized Patient Records are becoming telemedical and multimedia documents. They should accompany the patients their whole lifetime and collect data from many different sites. Special requirements are arising to fulfill these demands. A prototype of such a system was designed and implemented at the university hospital in Grosshadern, Germany to show its feasibility, discuss the design elements and demonstrate its capabilities. A Flexible data model, interpretable contents, open communication structures and physical compilation are the cornerstones of this approach that allows communication via Internet or Smart cards.
Computer Communication Networks↗
[Breast carcinoma--revision of follow-up recommendations. 2: Special diagnostic value of bone scintigraphy, thoracic radiography, liver ultrasonic, mammography and laboratory tests].
In the past, recommendations for the follow-up of women who had undergone primary treatment for a local or locoregional breast cancer, were mostly concerned with "programmed" protocols in which the frequency of the follow-up appointments and the examinations to be performed on the respective occasions (e.g. bone scintigraphy, chest X-ray, abdominal ultrasound, mammography and laboratory investigations/tumor markers) were rigidly fixed. The usefulness of these technical procedures is examined critically on the basis of the extensive publications in the literature. With the exception of regular mammography, which is a useful means of detecting malignancies at an early stage, none of the other technical investigations is recommended in women free of symptoms after breast surgery. The reason for this is that they contribute in no way to an improvement in survival or quality of life. By discarding the use of these ineffective diagnostic procedures, considerable savings could be made in the health care sector without any associated loss in the quality of the care afforded the women affected.
Aftercare↗
[Breast carcinoma--revision of after-care recommendations. 1: Results of many large studies from the literature are in agreement].
In the past, recommendations for the follow-up of women who had undergone primary treatment for local or locoregional breast cancer, were mostly concerned with "programmed" protocols in which the frequency of the follow-up appointments, and the examinations to be performed on the respective occasions (e.g. bone scintigraphy, chest X-ray, abdominal ultrasound, mammography and laboratory investigations) were rigidly fixed. Numerous new facts reported in the literature (including prospective randomized studies and meta-analyses) now appear to show that this formalized approach to follow-up brings the patient no advantage in terms of approved chances of being cured, longer survival or better quality of life. For this reason, for breast cancer follow-up, a strategy is proposed that is based on meticulous history-taking and clinical examination, and which also emphasizes psychosocial rehabilitation aspects. Examinations using technical equipment are carried out only when justified by clinical suspicion of recurrent disease.
Aftercare↗
[Second malignancy in patients with Hodgkin disease in full remission. Interim results].
Among 345 patients with Hodgkin's disease (HD) in full remission and followed for a mean of 7.2 years (11 months-26 years) since the initial diagnosis, 33 were found to have a second malignancy. The cumulative incidence after 10 years was 13.5%, after 15 years 21%. Non-Hodgkin lymphoma was the most frequent (n = 7), followed by bronchial carcinoma (n = 5) and acute myeloid leukaemia (n = 3). There was a definitely increased risk in elder patients (P < 0.001) and in those who had had a splenectomy. There was no demonstrable effect of type of therapy, primary stage and frequency of recurrence. It is concluded that patients with Hodgkin's disease should have life-long oncological follow-up. This preliminary study is being extended into a multicentre investigation of a larger number of patients.
Adult↗
[Actuarial survival and prognostic factors of bronchial cancer].
A total of 1325 patients with bronchogenic carcinoma who were treated at the surgical clinic of the Technical University of Munich between 1981 and 1991 were enrolled in a prospective follow-up study. The 5-year actuarial survival rate of 605 patients with squamous cell carcinoma was 28.2%, of 288 patients with adenocarcinoma 38.0%, of 219 patients with small cell carcinoma 15.4%, of 74 patients with giant cell carcinoma 19.0%, and of 139 patients with other histologic findings 27.8%. In all, 680 patients (51.4%) underwent surgery. Diagnostic thoracotomy without resection was performed in 6.2% of cases. Lethality within 30 days was 1% for lobectomy, 7.3% for bilobectomy, and 7.7% for pneumonectomy including extended resections. The 5-year survival rates among the operated patients were 64.8% for T1N0M0 tumours, 49.4% for T2N0M0, 46.1% for T1N1M0, 43.4% for T2N1M0, 23.8% for T3 and 11.7% for T4. T1N0M0 adenocarcinoma was associated with a better prognosis than squamous cell carcinoma of the same early stage, with a 5-year survival rate of 82.2% vs 55.9%. The prognosis of patients with T3N2 was worse than that of patients with a T3-4 primary tumour but only N0-1 lymph node involvement (5-year survival rate 18.1% vs 31.7%). Stepwise logistic regression analysis identified tumour stage, therapy, and histologic result as the factors with the greatest impact on the prognosis. Adjuvant radiation after resection in patients with T2-3 adenocarcinoma or squamous cell carcinoma improved the prognosis by one tumour stage compared with patients who only underwent surgery. In conclusion, surgical therapy of bronchogenic carcinoma offers favourable survival rates with acceptable risk.(ABSTRACT TRUNCATED AT 250 WORDS)
Actuarial Analysis↗
[Multiple primary malignant tumors in patients with malignant melanoma of the skin].
The incidence of further malignant tumors was analyzed by means of a retrospective study in 2335 melanoma patients. During the follow up 85 patients (3.64%) developed a second malignant tumor: 29 patients multiple primary malignant melanomas (mm), 49 a mm and a further nonmelanocytic malignant tumor, and 7 multiple primary mm and an additional non-melanocytic malignant tumor. Statistical calculations revealed that female melanoma patients have a 20 fold, and male melanoma patients a 30 fold increased risk to develop further malignant melanomas. In contrast, there was no increased incidence of non-melanocytic malignant tumors, breast carcinoma included. A total skin examination has therefore to be performed during follow up investigations of melanoma patients for early detection of further malignant melanomas.
Adult↗
[The spontaneous course of compensated autonomous thyroid gland adenomas].
The spontaneous course of 58 patients with compensated autonomous adenoma of the thyroid was followed. Scintigraphic appearance (compensated (CAA) or decompensated (DAA)) was documented and the serum levels of thyroxine (T4), triiodothyronine (T3) and thyroid-stimulating hormone after TSH-stimulating hormone were measured at the beginning of observation and 3.8 years (median) later. During follow-up period, 13 patients (22%) with CAA developed DAA. 9/13 patients (15%) had overt hyperthyroidism with elevated T4 and/or T3 levels, 4/13 patients (7%) had normal thyroid hormone levels. Life table analysis showed a risk for developing hyperthyroidism of 19% at five years. The size of all adenomata measured scintigraphically was increasing during follow-up, and there was no discrimination of CAA from DAA using this technique. Eight CAA patients received iodinated contrast medium but none develop DAA. In conclusion from these results as well as from the literature, there is no indication for surgery or radioiodine therapy of patients with a CAA, even if there are plans to administer iodinated contrast medium.
Adenoma↗
[Epidemiology of prostatic carcinoma. From the Work Group Urology in the Munich Tumor Register].
At approximately 11%, carcinoma of the prostate is the third leading cause of tumor-related death. The etiology of the disease remains unknown. In 1989, 9,074 deaths from this disease were recorded in the Federal Republic of Germany. With a five-year survival rate of 75%, carcinoma of the prostate is one of the cancers with a favorable prognosis. The number of new cases occurring annually in the Federal Republic of Germany (formerly West Germany) is probably between 17,000 and 19,000, or roughly 60 per 100,000 men. The (true) number of prostatic cancer patients is about fivefold, approximately 90,000. The first population-related figures for such clinical parameters as initial symptomatology, distribution of stage and the pattern of progression are now available from the Munich Tumor Registry. Another such parameter is the figure of 15% describing patients in whom bone metastases presented at the time of the diagnosis.
Adult↗
Inflammatory cellular infiltrates in melanocytic nevi.
We examined 1,054 melanocytic nevi [137 (13%) simple lentigines, 158 (15%) junctional nevi, 337 (32%) compound nevi, and 422 (40%) dermal nevi] for the presence of lymphohistiocytic infiltrates. The following criteria were evaluated: age and sex of the patient, location, histological type, horizontal and vertical diameter, increase of melanocytes in the basal layer of the epidermis, increase of melanophages in the papillary dermis, melanin content of keratinocytes, and melanin content of nevus cells. Lymphohistiocytic infiltrates were measured semiquantitatively; their presence within the center, in the lateral margins, or both was also determined. The results were analyzed statistically by means of chi-square tests and univariate and multivariate analyses. We found that 824 lesions (78%) were associated with a lymphohistiocytic infiltrate; whereas 230 (22%) were not. This infiltrate was weak in 273 cases (33%), moderate in 411 cases (50%), pronounced in 130 cases (16%), and very strong in 10 cases (1%). Multivariate analyses revealed that the only criteria associated with the presence of lymphohistiocytic infiltrates were the increase of melanocytes in the basal layer and the vertical thickness in compound nevi. All other parameters were statistically insignificant. We conclude that melanocytic nevi with a junctional hyperplasia of melanocytes--i.e., mostly early stages such as simple lentigines, junctional nevi, and superficial compound nevi--are often associated with a moderate to pronounced cellular stromal reaction. Their presence may reflect the appearance of antigens on proliferating melanocytes. It may also represent a stromal reaction to necrotic tumor cells and keratinocytes within the dermoepidermal junction. These findings rule out any relationship to an increase of melanin pigment.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Tumors of the urogenital tract: clinico-epidemiologic facts].
Important data on the occurrence of urological tumours are presented. In particular, the actual values and estimations have been compiled. In the Federal Republic of Germany 19135 patients died of genitourinary tumours in 1988:81.3% of these were male and 47.5% had prostatic carcinoma. Death occurred after the age of 69 years in 71.7%, and in 36.7% after the age of 79 years. It is estimated that 37,000 persons become ill with a urological neoplasm each year, and that approximately 120,000 cancer patients are presently alive in whom a primary tumour has been diagnosed in the urinary system within the last 5 years. This means for instance, a relation of about 80 patients in posttreatment care to one practising urologist and 9% of urology beds are occupied by patients receiving primary treatment for a tumour. The trend in mortality has been inhomogeneous in recent years, insofar as a 50% decline of testis tumour mortality has been observed, whereas an increase of between 15% and 20% has been observed in the mortality of renal cell carcinoma and an increase of approximately 10% in the mortality of bladder carcinoma in women. Altogether, the position with regard to epidemiological data on tumours is still unsatisfactory in the Federal Republic of Germany.
Aged↗
Clinical, biochemical and cytokinetic parameters for distinguishing smouldering and rapidly proliferating variants of acute leukaemia.
In a retrospective study, 10 patients with smouldering leukaemia (SML) were examined between 1982 and 1987. These patients typically showed the morphological criteria of acute myelogenous leukaemia (greater than 30% blasts in the bone marrow) in most cases together with a long survival time (median 16 months; 5 patients more than 22 months; 5 patients between 2.3 and 6.3 months) without the use of aggressive chemotherapy. At initial diagnosis the blast cell populations of patients with SML were characterized by significantly reduced cytosolic thymidine kinase activity (TK), thymidine-incorporation (dTR) and deoxyuridine incorporation (dUR) into DNA as well as reduced amounts of DNA-synthesizing S-phase-cells (%S) in the bone marrow (BM), compared to those patients with a rapidly proliferating acute myelogenous leukaemia (AML) and to healthy individuals. None of the SML-patients showed clinical symptoms such as night-sweat, weight-loss, hepato- and splenomegaly or lymphadenopathy at initial diagnosis. For characterization of SML vs AML we recommend the use of the biochemical parameter TK activity and the observed absence of the above-mentioned clinical symptoms. The transition to the rapidly proliferating type of AML can be recognized by an increase in the values of the biochemical and cytokinetic parameters. The blast count in the bone marrow is not suitable as a diagnostic criterion for the definition of SML vs AML or its transition to the rapidly proliferating type of AML.
Adolescent↗
Excisional biopsy as the first therapeutic procedure versus primary wide excision of malignant melanoma.
The five-year disease-free rate (5-y-DFR) and five-year survival rate (5-y-SR) of 319 melanoma patients with a narrow excisional biopsy in local anesthesia as the first procedure followed by delayed wide excision, were compared with 5-y-DFR and 5-y-SR of 635 primary radically treated patients. Five-y-DFR and 5-y-SR did not differ in either group of patients. Furthermore, the time interval (less than or equal to 21 days versus greater than 21 days) between excisional biopsy and delayed wide excision had no influence on the outcome of the patients. Based on the results of the study and the literature, excisional biopsy of malignant melanoma followed by delayed wide excision is a safe procedure.
Adolescent↗