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D Hölzel

Publications and source records attributed to D Hölzel.

At least 73 records · Page 4Linked to original sources
PubMed1989

Chemotherapy of invasive thymoma. A retrospective study of 22 cases.

The authors report on combination chemotherapy in 22 patients (seven men, 15 women; age 20-67, median 38.5 years) with incompletely resected invasive thymoma. Twelve of 22 patients have had prior radiotherapy of the tumor (four of 12 local failure, eight of 12 remote metastases). By subsequent chemotherapy five of 12 obtained complete remission (CR). One of them died by relapsed tumor, another by an intercurrent infection. At 5 years after diagnosis the survival rate of the 12/22 patients was 33% (Kaplan-Meier). Ten of 22 patients received chemotherapy as primary treatment of incompletely resected thymoma. Four of 10 obtained CR. One of them was lost during follow-up, the others received adjuvant irradiation of the mediastinum and are free of disease. Two of ten obtained partial remission (PR), but relapsed within 6 months after chemotherapy. At 3 years after diagnosis the survival rate of the 10/22 patients was 34%. Thirteen of 22 patients received cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP/bleomycin as first chemotherapeutic regimen. Five of them achieved CR. Cyclophosphamide, vincristine, and prednisone (COP) or COP plus procarbazine (COPP) was administered to six of 22. Three of them obtained a CR and one a PR. In an alternating manner COPP and Einhorn regimens were given to two of 22, one of which had a CR. In one of 22 the doxorubicin, bleomycin, cisplatin, prednisone (BAPP) regimen was followed by a PR. The authors conclude that combination chemotherapy is effective in the first-line postsurgical treatment of incompletely resected thymoma and also in the treatment of local or metastatic relapses after radiotherapy.

Adult↗
PubMed1988

[A tumor after-care schedule: information content--use--optimization].

Follow-up schedules for cancer patients define standards for post treatment care. They give informations about (1) the group of patients at risk, (2) the location of metastasis, (3) the adequate diagnostic procedures, (4) the frequency of examinations, and (5) the overall duration of follow-up. Such recommendations are a concise compilation of knowledge about the course of the disease, the tumor growth kinetics, and characteristics of the diagnostic tests. The validity of routine follow-up schedules will be discussed and explained using data about liver metastases in breast cancer patients. Simple calculations and simulations about the frequency of metastatic events demonstrate that strategies oriented on prognosis should be mandatory. The frequency of the detection of secondary cancers, the therapeutic possibilities etc. should define limits for the search of metastases. The effectiveness of follow-up programs must be evaluated just as the screening for the detection of early cancers in order to optimize the cost-benefit-relations.

Aftercare↗
PubMed1987

Estimation of the operative risk of mitral valve replacement by multivariate logistic regression analysis.

The knowledge of factors determining the risk of postoperative myocardial failure (MF) should allow a more rational approach to the timing and the management of mitral valve replacement (MVR). Using multivariate logistic regression analysis the influence of 41 preoperative and perioperative variables on MF was assessed in a training group of 353 consecutive patients undergoing isolated primary MVR between 6/76 and 12/82. Early MF mortality was 4.2%. Strongest independent preoperative predictors of MF were advanced NYHA functional class (p less than 0.001), hepatomegaly (p = 0.001), and reduced body weight (p = 0.01). Amongst preoperative and perioperative variables independent determinants of MF were NYHA functional class (p less than 0.001), hepatomegaly (p = 0.002), hypotension during extracorporeal circulation (ECC) (p = 0.005), body weight (p = 0.007), ECC duration (p = 0.008), female sex (p = 0.061) and the absence of cardioplegia (p = 0.065). From the combination of these determinants estimates of the probability of MF were calculated and adjoined to low or high risk by means of an optimum cutoff point. The sensitivity of this test performed before and after operation was 0.80 and 0.93, the specificity 0.92 and 0.94, respectively. The reliability of this prognostic test was prospectively evaluated on data of 107 consecutive MVR patients between 1/83 and 12/84. The observed diagnostic characteristics of the test group were comparable to those predicted from the training group. Multivariate logistic regression analysis selects independent determinants, estimates the risk of MF or other modes of postoperative events and identifies patients with low or high risk with a definable validity as an objective aid for medical decision-making.

Bioprosthesis↗
PubMed1986

[Therapy and prognosis of malignant melanoma of the skin].

Since 1967 a total of 2403 patients with malignant melanoma have been treated according to a standardized regimen. The five-year survival rate for all patients in stage I was 79%. It was clearly dependent on tumour thickness or prognostic index, respectively. If tumour thickness was less than 0.75 mm or the prognostic index under 6, more than 90% survived for five years. With a tumour thickness of more than 3 mm or a prognostic index of greater than 13 the survival rate decreased to about 50%. Irrespective of tumour thickness the first signs of progression were local recurrence (20%), lymph-node metastases (50%), or distal metastases (30%). In case of progression symptoms recurred in about 80% within the first three years after tumour removal, in about 90% within five years. However, some 10% of progression signs occurred after more than five years. Prognosis was not significantly improved in stage I by adjuvant treatment with dacarbazine and BCG. In stage II the five-year survival rate was still about 30%. But in stage III only those patients with exclusively cutaneous distal metastases had a somewhat better prognosis. Only a few patients lived more than three years after the occurrence of organ metastases.

Adult↗
PubMed1986

[Skeletal scintigraphy in the follow-up of breast cancer. Statistical and epidemiological viewpoints].

As shown by model calculations skeletal scintigraphy in the follow-up of mammary carcinoma results in an expected predictive value of a positive scan in asymptomatic patients of 6.6%, assuming a sensitivity of 100%, a specificity of 95% and a 5-year disease-free survival rate of 55%. Divided according to clinical stages I-III, the values are 2.1% for stage I, 5.8% for stage II, and 10.7% for stage III. From a statistical and epidemiological point of view, therefore, bone scans are of questionable value in the follow-up of mammary carcinoma, at least in the favourable stages. Scientific assessment of the ever-widening range of follow-up activities is of crucial importance; for this general demand skeletal scintigraphy in mammary carcinoma is but an example.

Bone Neoplasms↗
PubMed1986

[Risk factors for breast cancer and their use in early detection. Results of a case control study].

Doubtful and established breast cancer risk factors were checked in a case/control study. Multivariate analysis with the logistical regression approach resulted in a usable separation of the cases from the controls on the basis of the five dichotimized variables: age at birth of first child, family history, Quetelet index, breast complaints, and a behavior score. On the basis of probability, the risk patterns were summarized in six risk categories, and a maximum 70-fold risk was thus established. The proportion of incidence represented by the risk groups was then estimated from distribution in the control group. Approx. 5% of new cases originate in 30% of the female population aged under 30, but approx. 51% originate in a mere 10%. Hence it is logical to use risk factors for early detection based on risk.

Adult↗
PubMed1985

[Comparison between cimetidine-pirenzepine and antacids for the prevention of stress hemorrhage in intensive care patients. A controlled clinical study on 125 patients].

In a controlled clinical trial, the efficacy of an intravenous combination of cimetidine and pirenzepine (group A: 62 patients) was compared with that of an intragastric administration of a magnesium-aluminium-hydroxide concentrate (group B: 58 patients) in preventing visible and occult upper gastrointestinal tract bleeding in intensive-care patients. It was found that both forms of therapy had the same favourable effect on the extent and incidence rate of visible and occult gastric bleeding. The antacid was more effective than the cimetidine-pirenzepine combination in raising the pH level to 4 or higher (P less than 0.05). Intensive-care patients should, therefore, be treated with the antacid whenever possible, since it is equally effective as the cimetidine-pirenzepine combination in preventing bleeding from the upper gastrointestinal tract, whereas it is superior in elevating the gastric pH. Besides, the use of the antacid is also less costly.

Adult↗
PubMed1984

Prognostic classification of malignant melanoma by clinical criteria.

In a retrospective study of 503 well-documented cases of primary malignant melanoma (stage I) clinical criteria were analysed for their prognostic relevance. The maximum elevation (in mm) of the tumour was found to be the most important single prognostic factor. There was a close association with tumour thickness, measured histologically by the method of Breslow (correlation coefficient = 0.73). A combination of elevation and three additional clinical criteria (site, nodule- or lesion-diameter, and surface defects such as erosion, ulceration or bleeding) allowed a further improvement in prognostic accuracy. This clinical classification into low-risk and high-risk melanomas was as effective as the use of tumour thickness measured histologically, and can therefore be used for the preoperative planning of treatment.

Adult↗
PubMed1983

Lack of prognostic value of T-, B- and null-lymphocytes in adult acute leukemia.

The distribution of T-, B- and null-lymphocytes was studied in the peripheral blood of 38 adult patients with acute nonlymphocytic leukemia (ANLL) and 15 with acute lymphocytic leukemia (ALL) at first diagnosis, during induction treatment, and in remission. Thirteen ANLL and 9 ALL patients were followed until relapse and during reinduction therapy. T- and B-cells were detected by specific membrane marker. The pre- and posttreatment pattern of lymphocyte subpopulations was analyzed to determine their prognostic significance for remission incidence, remission duration, and survival. It was observed that in both types of leukemia, T-cells are more affected by the leukemic process and cytostatic drugs than B-cells. Nonresponding patients possibly have a reduced potential for recruiting precursor T- and B-cells. At first diagnosis, no significant correlation was found between pre- or posttreatment variables and prognosis. At relapse, ANLL patients had a longer second remission when a high proportion of B-cells was found; ALL patients with a high lymphocyte count before and after treatment, experienced longer survival.

Acute Disease↗
PubMed1981

[Tumor register: information system for tumor centers (author's transl)].

The different activities in the scope of the tumor center already shows in the multiplicity of concepts for which incidence register, therapy register, clinical register or the supplies register are only a few examples. Such terms circumscribe a few interests from the therapeutic, epidemiologic or clinical and scientific aspects, which are projected on tumor centers as an expectation or a duty. From the compilation of these interests a bundle of unspecific aims results for which a classification according to various levels of information is suggested. Only cooperation of all levels makes possible a tumor register as an information system for medicine which supports the tasks of all those involved and makes the questions of the population more easily and more quickly answerable.

Cancer Care Facilities↗
PubMed1981

[Early complications after intra-cervical application of prostaglandin F2 alpha gel for therapeutic abortion (author's transl)].

The intracervical application of prostaglandin F2 alpha gel reduced the hospital stay compared to previous methods of therapeutic abortion by one day. The operative technique of the therapeutic abortion is simplified by the medical dilatation of the cervix by the prostaglandin gel. The early complication rate was 10% initially but was reduced to 5% when the application time of prostaglandin gel was reduced from 18 to 14 hours and suction curettage introduced instead of sharp curettage. The side effect rate of the prostaglandin gel was relatively high with 14%. Many patients complained about severe labor like pain which responds poorly to analgesics. Therefore the application of intracervical prostaglandin gel is only recommended for therapeutic abortions beyond nine weeks gestation. Prior to nine weeks gestation suction curettage only is recommended.

Abortion, Induced↗
PubMed1980

[The problem of multiple malignomas].

It is reported on three female patients who fell ill with a second and third tumour, respectively, within 4 years. The cases in question were spontaneous neoformations, since risk factors, such as radiotherapy and applications of cytostatics were not used causally.

Aged↗
PubMed1980

[Complications of percutaneous transhepatic cholangiography].

It is reported on complications which appeared in the percutaneous transhepatic cholangiography performed in n = 130. The complications were subdivided into 1. Complications at immediate performance of the intervention. 2. complications which are to be observed in radiology, 3. complications which became conspicuous in the operation which immediately followed the intervention, 4. complications in the observation of the course in non-operated patients, 5. complications by the percutaneous transhepatic cholangiography in an operation which was performed at a later time. There did not appear any severe complications which burdened the intervention, particularly no bilious peritonitides or severe haemorrhages. None of the changes observed led to the interruption of the intervention. The conclusion is drawn that the percutaneous transhepatic cholangiography is a method of the morphological diagnostics of the biliary ducts which is poor in risk.

Cholangiography↗