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Biomedical subjects

D Krumhaar

Publications and source records attributed to D Krumhaar.

At least 19 recordsLinked to original sources
PubMed1995

[High-resolution magnetic resonance tomography (HR-MRT) of the pleura and thoracic wall: normal findings and pathological changes].

AIM: To determine the value of high-resolution MRI in pleural and chest wall diseases, the normal and pathologic costal pleura and adjacent chest wall between paravertebral and the axillary region were examined with contrast enhanced high-resolution T1-weighted MRI images using a surface coil. MATERIAL AND METHODS: Normal anatomy was evaluated in 5 healthy volunteers and a normal specimen of the thoracic wall, and correlation was made with corresponding HR-CT and histologic sections. CT-proved focal and diffuse changes of the pleura and the chest wall in 36 patients underwent HR-MRI, and visual comparison of MRI and CT was done retrospectively. RESULTS: Especially sagittal T1-weighted HR-MRI images allowed accurate delineation of the peripleural fat layer (PFL) and the innermost intercostal muscle (IIM), which served as landmarks of the intact inner chest wall. PFL and IIM were well delineated in 3/4 patients with tuberculous pleuritis, and in all 7 patients with non-specific pleuritis, as opposed to impairment of the PFL and/or the IIM, which was detected in 15/18 malignancies as a pattern of malignant chest wall involvement. In one case of tuberculous pleural empyema with edema of the inner chest wall HR-MRI produced false positive diagnosis of malignant disease. CONCLUSION: HR-MRI images improved non-invasive evaluation of pleural and chest wall diseases, and allowed for differentiation of benign and malignant changes.

Adult↗
PubMed1992

[Pleural diseases in magnetic resonance tomography (MRT)].

MR images of 48 patients with histologically confirmed benign and malignant diseases of the pleura were retrospectively compared with CT and bioptically/surgically obtained findings. In 47/48 patients pathological changes of the pleura were visualized by increased signal intensities on T2-weighted and contrast enhanced T1-weighted MR images. This lead to a slightly improved sensitivity compared to CT, where pathological pleura findings were confirmed in 45/48 patients. MRI was able to identify 24/28 confirmed pleural effusions, whereas CT was successful in 26/28 patients. In two cases effusions not identified on CT were visible on T2-weighted MRI. 4 pleural effusions were missed with MRI.. On CT images differentiation of pleural changes vs effusions or adjacent lesions of lung parenchyma was successful in 20/28 and in 17/23 cases, respectively. Contrast enhanced T1-weighted images achieved the highest diagnostic accuracy with 22/28 and 20/23 cases, respectively. Signal intensities on MRI were unsuitable as sole criterion for the differentiation of benign and malignant diseases of the pleura. Contour and pattern of spreading of pleural changes were helpful in differential diagnosis. Nodular changes, thickening of more than 10 mm and mediastinal, circumferential and entire hemithoracic affection of the pleura were suggestive for malignant pleural disease. Infiltration of the diaphragm and the chest wall were most indicative for malignancy; here MRI (2/2 resp. 18/19 cases) was superior to CT (0/2 resp. 14/19 cases). CT was superior in the detection of pleural calcifications and osseous destruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Preventive operations of the lung and bronchial system].

There are four major prophylactic indications in thoracic surgery: (1) Intra-pulmonary coin lesions with malignancy up to 50% and other potentially malignant tumors (carcinoid tumor, cylindroma, mucoepidermoid tumor, papilloma); (2) mediastinal tumors with potentially malignant growth (teratoma); (3) chronic lung infections including tuberculosis (bronchiectasis, abscess, chronic pneumonia, persistent tuberculoma, tuberculous cavity, destroyed lobe/lung); (4) cystic pulmonary disease followed by frequent complications (infection, bleeding, pneumothorax).

Bronchial Diseases↗
PubMed1990

[Laser and afterloading therapy of bronchial cancer].

Endobronchial afterloading irradiation by remote control was administered to 304 patients with lung cancer. The use of a highly active 192-Iridium source (740 GBq) is possible; irradiation time lasts only a few minutes. A combined treatment modality with laser was employed in 24%, with chemotherapy in 2%. The response rate of all patients amounted to 67%. There was an improvement in 81% of patients with retrostenotic complications.

Brachytherapy↗
PubMed1989

[Dangers and errors in pleural puncture and placing suction drainage].

Mistakes during puncture and drainage of the pleural space can result in serious complications. A few case reports are presented. Injuries of intrathoracic and intraabdominal organs can occur-, the latter mainly due to underestimating the elevated level of the diaphragm. Trauma of the liver and spleen are mainly observed in such cases. To avoid such life-threatening complications "blind" puncture and drainage should be avoided and visual aids such as fluoroscopy, CT and ultrasonography should be used more frequently.

Adult↗
PubMed1988

[The so-called pituitary snuff-taker's lung. A case contribution].

A 37-year-old woman who had developed diabetes insipidus after an abortion, requiring nasal substitution treatment with desmopressin (Minirin), began to suffer from fatigue, nocturnal sweating, cough and dyspnoea on exertion. Exogenous-allergic alveolitis was demonstrated by chest x-ray, lung function tests, blood gas analysis, broncho-alveolar lavage and transbronchial lung biopsy. After changing the treatment to an intramuscularly administered preparation and starting steroid therapy the clinical, radiological and lung function findings rapidly improved.

Administration, Intranasal↗
PubMed1988

[Therapy of spontaneous pneumothorax--surgical therapy].

Spontaneous pneumothorax was treated by primary thoracotomy in 225 patients (1974-1988) in the Thoracic Unit Havelhöhe (Berlin-West). The patients' average age was 25 years (11-60 y.) and the male/female ratio was 169/56. Subpleural cystic lesions were regularly found: segment 1 was affected in 178 cases, other segments in 47 cases. Peripheral resections were performed in 218 and segmental resections in seven patients. Operative results were excellent with no postoperative deaths and no recurrence of pneumothorax. Primary thoracotomy is recommended as treatment of spontaneous pneumothorax.

Adult↗
PubMed1987

New technique for treating occlusive and stenosing tumours of the trachea and main bronchi: endobronchial irradiation by high dose iridium-192 combined with laser canalisation.

A new technique is described for treating patients with inoperable malignant tumours causing occlusion or stenosis of the trachea or main bronchi. High dose iridium-192 (20 Ci) was introduced by an afterloading device under computer control via a 4 mm delivery tube into the tumour mass. In 29 of the 56 patients the tumour mass was canalised by a neodymium-YAG laser immediately before the afterloading delivery tube was introduced. In 44 (79%) of the patients, there was impressive relief of dyspnoea, accompanied by tumour regression observed at endoscopy and also by highly significant improvement in ventilatory function values, lung perfusion scans, and levels of arterial oxygen tension. In the other 12 patients (21%) there was no detectable improvement. The findings suggest that this recently developed combination treatment is of value in patients with advanced tumours of the trachea and main bronchi in whom there is no possibility of further treatment by external irradiation or repeated laser coagulation.

Aged↗
PubMed1986

[New methods in the radiotherapy of bronchial carcinoma. Endobronchial small-field irradiation using the iridium-129 high-dose afterloading technic in combination with the neodymium-YAG laser].

106 patients with inoperable malignant tumours constricting the central bronchial tree underwent endobronchial small-field radiotherapy with iridium-192 at high dose between June 1983 and September 1985. Treatment was performed using the computer-guided after-loading technique and a flexible bronchoscope under local anaesthesia. In complete occlusion of a bronchus by the tumour, a neodymium YAG-laser was applied (57 patients) to allow insertion of the after-loading probe. Endoscopy showed tumour regression in 75% of the patients, accompanied by clinical improvement. Pulmonary function tests, arterial blood gas analyses and pulmonary perfusion scans yielded a highly significant improvement of data after treatment. The procedure also proved effective upon exhaustion of external radiation. Apart from its positive palliation, endobronchial small-field radiotherapy using high doses of iridium-192 also has a curative effect, thus opening up a new approach to the therapy of advanced bronchial carcinoma.

Aged↗
PubMed1985

Follow-up study of 100 malignant pleural mesotheliomas.

One hundred malignant pleural mesotheliomas have been treated in our hospital since 1955. Clinical and autopsy findings are analyzed and compared to X-ray changes. The most common symptoms were dyspnea (49%), pain (40%) and cough (36%). The main initial X-ray signs were pleural effusion (62%), pleural thickening (29%) and solitary nodules (6%). Prior to death a combination of effusion and pleural thickening was the usual finding. Histologically there were 49 biphasic, 32 mesenchymal and 18 epithelial malignant pleural mesotheliomas. At autopsy 82% of the cases had distant metastases, most of which had not been expected clinically. The median survival time was 7.3 months following the first clinical symptoms, and only 4 months after the first radiological signs.

Adult↗
PubMed1985

[New possibilities in radiotherapy of endobronchial tumors using the afterloading method in combination with laser technics].

New possibilities for radiotherapy of bronchial carcinomas are provided by the combined application of the recently introduced afterloading method used hitherto in the treatment of stenosing processes of bronchial carcinomas and the neodyme-YAG laser which opens the stenosis in such a manner that the afterloading probe can be inserted. This new method allows to perform without complications or disadvantages further combined therapies such as percutaneous irradiation (telecobalt, linear accelerator or betatron). An irradiation scheme leading to a decisive tumor regression can be established due to the fast reventilation of the lung obtained by both methods. Surprisingly, three patients could be submitted despite the small-field radiotherapy to rather important lung operations such as lobectomy and pneumonectomy which were performed without complications or disadvantages. The patients were not operable without laser and afterloading therapy. This method was applied several times in the treatment of other diseases such as oesophageal cancer and stenosing cancer of the antrum. In these cases, a normal ingestion due to tumor regression was obtained rapidly.

Brachytherapy↗
PubMed1984

[Malignant pleural mesotheliomas. Comparison of roentgenologic and autopsy findings].

In 100 pleural mesotheliomas follow up x-ray studies were compared to autopsy findings. Initially x-ray examinations show effusions in 62%, diffuse pleural thickening in 29% and solitary pleural nodules in 6%, prior to death effusions and pleural thickening are usually combined. In 17 tumor nodules doubling times ranged from 0.5 to 3 months. The epithelial type of mesotheliomas is predominantly combined with pleural effusions, while pleural thickening is more often found in the mesenchymal type of the tumor.

Humans↗
PubMed1979

[Localised aspergillosis and oxalosis of the lung caused by aspergillus niger: soil of ornamental plants as a reservoir of aspergilli (case report) (author's transl)].

Haemoptysis occurred in a 64-year-old man with a history of pulmonary tuberculosis, negative for M. tuberculosis. Precipitating antibodies to Aspergillus niger were found in serum and the fungus found in sputum. Autopsy revealed aspergilloma, colonization of the pulmonary cavity by A. niger and local oxalosis if the cavity wall. Ornamental plant soil containing A. niger conidia, as well as the air in the patient's living-room, was the probable source of infection.

Aspergillosis, Allergic Bronchopulmonary↗
PubMed1979

[A case of extremely severe chest injury with fracture of several ribs (author's transl)].

A 72-years old man was severely injured when a lorry rolled back and pinned him down, causing contusion of the chest, fractures of ribs 3-10 on the right and haemothorax. Treatment of the chest injuries was by drainage and by positive end-expiratory pressure ventilation because of the development of severe pneumonia with wet lung. Persistent renal insufficiency, a gastro-intestinal haemorrhage and diabetes also required treatment. The patient developed septic endomyocarditis as a late complication, possibly attributable to the central venous catheter. All pulmonary and extrapulmonary injuries and complications could be set right during the patient's 4-months' stay in the intensive care unit.

Aged↗