Biomedical subjects

F Liewald

Publications and source records attributed to F Liewald.

36 records · Page 2Linked to original sources

PubMed1994

[Percutaneous aspiration thromboembolectomy in the treatment of acute occlusion of the lower leg arteries].

Percutaneous aspiration thrombembolectomy (PAT) is a very suitable method for the recanalization of the popliteal and lower limb arteries after embolic occlusion. In thrombotic occlusion in patients with arteriosclerotic disease, PAT can easily be combined with other interventional procedures, yielding good results. With the use of PAT the dose of regionally effective fibrinolytic drugs, which may be additionally administered, can be significantly reduced.

Adult↗

PubMed1994

Alteration of integrated optical density and intercellular structure after induction chemotherapy and survival in lung carcinoma patients treated surgically.

Histologic sections of formalin-fixed, paraffin-embedded tissue consisting of 53 surgical specimens, 48 biopsy specimens and 29 intrapulmonary lymph nodes of human non-small cell lung carcinoma were Feulgen stained. The biopsy specimens were obtained before and the surgical specimens after induction chemotherapy (down staging). The integrated optical density (IOD) of tumor cell nuclei was measured using an automated image analysis system, and the attributed minimum spanning trees (MSTs) were computed. The measured features included IOD (DNA content of the nuclei), IOD entropy, S-phase-related fraction (SRF), percentage of tumor cells with an IOD > 5C (P5C), standard deviation of IOD and structural parameters (minimum distance between neighboring tumor cell nuclei, minimum distance between tumor cell nuclei and neighboring lymphocytes, MST entropy, minimum distance between neighboring proliferating tumor cell nuclei, etc.). The measured IOD and MST features showed significant differences in the biopsy specimens as compared to those measured in the surgically excised carcinomas and those growing in the intrapulmonary lymph nodes (lymph node metastases). After down staging, the SRF was significantly diminished, and the percentage of cells with an IOD > 5C increased (P < .05). The survival of patients was remarkably improved if both the carcinomas before and after induction chemotherapy displayed a low SRF, a low number of stemlines and low MST entropy.

Adenocarcinoma↗

PubMed1992

Prognostic value of flow cytometrically determined DNA-ploidy, intracellular pH and esterase activity of non-small cell lung carcinomas.

30 surgical specimens of patients with non-small cell lung carcinomas (NSCLC) were investigated. Significant increases of intracellular pH values in epithelial and inflammatory cells, in the percentage of dead epithelial and inflammatory cells and in the cell volume of vital inflammatory cells in cancerous lung tissue were encountered. Furthermore, decreases of the esterase activity of vital epithelial cells and of the percentage of free cell nuclei were observed. The DNA aneuploidy in 36.6% of the tumours was frequently associated with non-squamous cell carcinomas and stage II, III, IV tumours. Patients with DNA aneuploid tumours had a significantly shorter survival rate than those with DNA euploid tumours. Within the different tumour stages a similar tendency was observed which was, however, only significant in stage III tumour patients. Stage III tumours constitute therefore a heterogeneous entity with a worse prognosis for DNA aneuploid tumour patients. The intracellular pH values and esterase activity as well as the cell volume, the percentage of free cell nuclei and dead inflammatory or epithelial cells contained no significant prognostic information.

Adult↗

PubMed1992

[Flow cytometric analysis in non-small-cell bronchial carcinoma and its prognostic significance].

Tumor and lymph node infiltration, and the DNA-ploidy status of a tumor contain prognostic information in addition to the information obtained by histological examination of surgical samples. Specimens from 112 patients with non-small-cell lung carcinoma obtained immediately after surgery were investigated by means of flow cytometry. DNA-aneuploidy was found in 43% of the primary tumors. Independent from tumor stage, patients with DNA-euploid tumors lived significantly longer (p less than 0.01) than with DNA-aneuploid carcinomas. In 29 cases the DNA-ploidy status of the primary tumor (PTU) could be compared with that of the N2 lymph node metastases (LM). 7 samples revealed a change from DNA aneuploidy in the PTU to DNA-euploidy in the LM. Patients with DNA-euploid PTU and DNA-euploid LM lived significantly longer than patients with DNA-aneuploid PTU/DNA-euploid LM, and patients with DNA-aneuploid PTU/DNA-aneuploid LM. In case of lymph node infiltration only the simultaneous measurement of DNA ploidy of PTU and LM offers an accurate prognostic evaluation. Local tumor recurrence exhibited stability of DNA ploidy, showing DNA euploidy in 12 out of 13 PTU and their corresponding recurrent tumor. Thus, the DNA-ploidy status offers additional prognostic informations which is useful for an extended tumor classification.

Carcinoma, Non-Small-Cell Lung↗

PubMed1992

Importance of microscopic residual disease at the bronchial margin after resection for non-small-cell carcinoma of the lung.

A total of 805 patients underwent lung resection for non-small-cell lung carcinoma at the University of Munich Medical Center, Klinikum Grosshadern, from 1978 through 1988. Microscopic residual disease at the bronchial margin was found in 21 patients (2.6%). The tumor residues showed either a mucosal (1%) or a extramucosal (1.6%) spreading pattern. Patients with extramucosal microscopic residual disease had a poorer prognosis (median survival 10.3 months) than patients with mucosal microscopic residual disease (median survival 25 months). The prognosis was better if the tumor was squamous cell as opposed to adenocarcinoma or large-cell carcinoma. The most important prognostic factor was tumor stage. Patients with microscopic tumor infiltration and stage I or II disease survived longer than the comparable stage III group. We suggest that these patients should undergo reoperation, if possible. Patients with stage III disease, mediastinal lymph node involvement, and microscopic residual disease have the same marked reduction in survival as patients with stage III disease but without microscopic tumor infiltration. We do not recommend a follow-up operation in these patients. Complete histologic examination of mucosal and extramucosal peribronchial tissues at the resection line by frozen section is mandatory to avoid leaving microscopic tumor behind, which may adversely affect patient survival.

Bronchi↗

PubMed1992

Prognostic value of deoxyribonucleic acid aneuploidy in primary non-small-cell lung carcinomas and their metastases.

The ploidy status of the deoxyribonucleic acid of a malignant lung tumor provides additional information besides histologic grading and tumor staging according to lymph node infiltration and tumor metastasis. Ninety-nine surgical specimens from patients with non-small-cell lung carcinoma were investigated by flow cytometry. Deoxyribonucleic acid aneuploidy was found in 48% of the primary tumors. Patients with deoxyribonucleic acid-euploid tumors showed better survival (p < 0.01) than those with deoxyribonucleic acid-aneuploid carcinomas independent of tumor stage. Deoxyribonucleic acid ploidy status of the primary tumor was compared with that of N2 lymph node metastases in 29 cases. Seven samples showed a change from deoxyribonucleic acid aneuploidy in the primary tumor to deoxyribonucleic acid euploidy in the lymph node metastases. Survival was significantly better for patients with euploid primary tumors and lymph node metastases, followed by patients with deoxyribonucleic acid-aneuploid primary tumors and euploid lymph node metastases. Survival was poorest in patients with deoxyribonucleic acid-aneuploid primary tumors and lymph node metastases. It was observed that only the simultaneous determination of deoxyribonucleic acid ploidy of primary tumors and lymph node metastases permits accurate prognostic evaluation in case of lymph node infiltration.

Actuarial Analysis↗

PubMed1991

[Carcinoembryonic antigen in serum and pleural fluid to distinguish between bronchial carcinoma and pleural mesothelioma].

The concentrations of carcinoembryonic antigen (CEA) were measured, partly retrospectively and partly prospectively, in 94 patients with diffuse malignant mesothelioma and in 79 with bronchial carcinoma and pleural involvement. Serum concentrations were measured in all patients, pleural-fluid concentrations additionally in 53 patients of the former and 39 of the latter group. The concentrations were significantly higher in those with bronchial carcinoma (P less than 0.001). The two groups could be distinguished by serum concentrations, using 5.2 ng/ml as the limit, with a sensitivity of 68%, specificity of 98% and a predictive value of 96%. Measurement of CEA in pleural fluid (at a limit of 4.5 ng/ml) had a specificity of 94% and a positive predictive value of 90%, sensitivity being similar to that for serum. The negative predictive value for serum CEA concentration was 79%, for pleural fluid it was 81%. Thus in most cases measurement of CEA in serum and, to a lesser extent in pleural fluid, is a very simple method to exclude mesothelioma with a high degree of certainty. If the CEA concentration is below the stated level, either may be present.

Adult↗

PubMed1990

Intracellular pH, esterase activity, and DNA measurements of human lung carcinomas by flow cytometry.

An important intention of flow cytometric investigations is to obtain biochemical and biophysical information about cells which is suitable for automated tumor diagnosis. In this study, the ploidy status, the intracellular pH value, the intracellular esterase activity, and the cell volume of vital cells and the DNA and cell volume of dead cells were measured in cancerous tissue and normal lung tissue of 30 patients by flow cytometry. The cell samples were simultaneously stained with the pH and esterase indicator dye 1.4-diacetoxy-2,3-dicyanobenzene (ADB) and propidium iodide (PI). The flow cytometric measurements were performed in three-parameter list mode. The data were evaluated on an AT-compatible personal computer with the DIAGNOS1 program system for automated diagnosis of flow cytometric list mode data. Significant differences were found between normal and malignant tissue in DNA ploidy, in the intracellular esterase activity, in the cell, volume and in the percentage of inflammatory cells and parameters of necrosis. DNA-aneuploidy was observed in 38% of the lung carcinomas. The simultaneous detection of DNA-aneuploidy and tumor-associated properties in a multifactorial analysis led to correct automatic tumor diagnosis in 85% of cases. DNA-aneuploidy was found at a significant higher frequency in advanced tumors. Adenocarcinomas displayed DNA-aneuploidy more often (80%) than squamous cell carcinomas (33%).

Adenocarcinoma↗

PubMed1990

Influence of blood transfusions on tumor recurrence and survival rate in colorectal carcinoma.

Determinants for homologous blood transfusion and its influence on postoperative and long-term results were evaluated in 439 curatively resected colorectal cancer patients. The rate of transfusion was significantly higher in rectal cancer, large tumors, advanced pT stage and extended resection but not in tumor stenosis, lower graded tumors, advanced Dukes stage or less experienced surgeons. Transfused patients showed significantly more postoperative complications, higher recurrence rates as well as less favorable long-term survival. Homologous blood transfusions are negatively correlated to survival rates.

Adult↗

PubMed1990

[Traumatic segment III aneurysm of the thoracic aorta: surgical risk, technique, early and late results].

Aneurysmectomy was performed in 37 patients with a traumatic aneurysm the aorta in segment III. 34 "cross-clamping" without bypass was used, 6 after preliminary transposition of the subclavian artery. 3 patients died after surgery, two of whom were more than 70 years old. 2 patients developed a paraparesis, which has in the meantime considerably improved. Hesitation to operate is justified only in older asymtomatic patients at high cardiac risk. Cross-clamping is preferable to more elaborate procedures. Preliminary transposition of the subclavian artery simplifies the proximal anastomosis and may contribute to spinal-cord protection.

Adult↗

PubMed1990

[Bronchial stump insufficiency: treatment and results].

A bronchopleural fistula following lung resection is a dangerous complication. Records from 25 patients with a bronchopleural fistula were followed up in order to propose a therapeutic concept. An early onset of fistula should be treated as an emergency. Late fistulas can be reoperated electively because they are most often rather small and the patients are in a better condition. The suture of the stump alone was successful in only 3 out of 13 cases. Patients with fistulas following lobectomy were reoperated by pneumonectomy with good results. In fistulas due to pneumonectomy the results of either an isolated muscle-flap or a thoracoplasty were disappointing. Instead, a closure of the stump was accomplished by the combination of thoracoplasty and muscle-flap in 3 out of 4 patients. However, 2 patients with an early fistula after pneumonectomy died from septic complications after the fistulas had already been managed. Endoscopic maneuvers like gluing and insertion of spongiosa did not show any success unless combined with operative measures but rather delayed the onset of re-intervention.

Bronchial Fistula↗

PubMed1990

Lectins and immunohistochemistry of colorectal cancer, its recurrences and metastases.

In 31 patients resected specimens from primary colorectal cancers, corresponding liver metastases and local recurrences were investigated for the staining pattern of lectins (PNL, UEA, WGA, HPA, SBA, RCA) and tissue antigens (CEA, SP, ACT) by immunohistochemistry. Comparison of staining patterns showed a loss of marker expression from normal colonic mucosa to colorectal primary carcinomas, and a tendency to marker loss from the primary tumour to liver metastases. However, even a neo-expression of markers not present in the primary tumour could be observed. For clinical use, serum markers observed in patient follow-up may be valuable even where the findings are negative at the time of primary tumour surgery. In contrast to the heterogenous marker map of primary tumours and metastases, comparison of primary and locally recurrent tumour revealed a staining pattern that was almost always identical. This supports the hypothesis that locoregional recurrences develop from remnant cells of the primary tumour left behind at surgery. There is no support for the thesis that locoregional recurrences arise from mucosal changes at the anastomosis or from suture material.

Adenocarcinoma↗

PubMed1989

[Bronchial carcinoid. A clinical study of 37 patients].

To establish whether bronchoplastic procedures designed to minimize loss of lung tissue are justifiable for the treatment of bronchial carcinoid tumours, data were analysed from 37 patients (17 men, 20 women, average age 51 [22-70] years) who had undergone surgery for typical (n = 30) or atypical (n = 7) bronchial carcinoids. Conventional tumour resections had been performed in 29 cases and bronchoplastic operations in eight. After an average observation period of 54 months one patient who had undergone lobectomy for a bronchial carcinoid had died of recurrent tumour, and one other patient who had been treated by pneumonectomy for an atypical carcinoid had developed distant metastases. All the other patients were free from tumour at that time. This indicates that patients treated by bronchoplastic procedures do not have any higher incidence of recurrences or any lower chance of survival than those treated by lobectomy or pneumonectomy. A bronchoplastic operation should therefore be the treatment of first choice, provided that the adjacent lung tissue has not been destroyed by retention pneumonia and that lymph node dissection does not reveal any involvement.

Adult↗

PubMed1989

[Pleural mesothelioma--problems in diagnosis and clinical course in 25 patients].

Patients with benign pleurafibromas should undergo surgery as suspect thoracic tumors have the potential to become malignant. In benign cases diagnosis can easily be made during the operation. In such a case the prognosis is good and it is seldom necessary to undergo repeated surgery due to recurrence. In the case of malignant pleuramesothelioma the preoperative diagnosis with an exact staging of the tumor is very important to determine an adequate therapeutic regimen. X-ray, CT-scanning, tapping of the pleura fluid and biopsy of the pleura are together insufficient to diagnose a pleuramesothelioma correctly. Since it is not always possible to diagnose a malignant pleuramesothelioma even at thoracoscopy, one should not hesitate to perform an open lung biopsy in order to obtain enough material under adequate vision.

Adult↗

PubMed1988

[Effect of blood transfusion on tumor recurrence and rate of survival in colorectal cancer].

In 439 curatively resected colorectal cancer patients determinants for homologous blood transfusion and its influence on postoperative and long-term results were evaluated. The rate of transfusion was significantly higher in women, rectal cancers, large tumors, advanced pT-stage and extended resections but not in tumor-stenosis, lower graded tumors, advanced Dukes-stage or less experienced surgeons. Transfused patients showed significantly more postoperative complications, higher recurrence rates as well as less favorable long-term survival. Homologous blood transfusions are correlated with survival rates.

Adult↗

PubMedDate not supplied

Endovascular exclusion of thoracic aortic aneurysms: mid-term results of elective treatment and in contained rupture.

PURPOSE: The purpose is to present results of endovascular exclusion (stent-graft treatment) of aneurysms of the descending thoracic aorta both in elective cases and in emergencies. METHODS: Indications for stent-graft treatment were dependent on multislice angio-CT evaluation revealing a proximal neck of at least 10 mm between the left common carotid artery and the onset of aneurysm. All stent grafts were inserted in the operating room; 43 transfemoral, 2 transiliac. The stent grafts used were Corvita, Stenford, Vanguard, AneuRx, Talent, and Excluder. Deployment was achieved under fluoroscopic control, endoleaks were checked for with D S A on the operating table and postoperatively by angio-CT. Long-term follow-up consisted of evaluation with angio-CT after 6 and 12 months, and from there on once a year and with plain chest X-rays. Follow-up was achieved in all patients. RESULTS: Mean follow-up is 21 months (1-66); 30-day mortality is 3/45, no permanent neurologic deficit. Thirty patients were treated electively, 15 with contained rupture. Left subclavian artery overstenting proved to be necessary in 12 patients for proper proximal sealing of the aneurysm, type I endoleaks were observed in 10 patients, one early conversion, 7 proximal extension cuffs, one sealed spontaneously, one still at risk. Among patients where LSA had been overstented only one wanted a transposition, all others did well without left-hand ischemia or subclavian steal syndrome. CONCLUSION: Endovascular treatment is less invasive and has reasonable mortality and morbidity but is limited to well-defined morphologies. Mid-term results are promising but it has to be observed whether these will translate into long-term durability.

Aged↗

PubMedDate not supplied

Diffusion-weighted MRI: detection of cerebral ischemia before and after carotid thromboendarterectomy.

PURPOSE: Conventional postoperative evaluation of patients following carotid thromboendarterectomy (TEA) consists of a clinical neurologic examination to assess neurologic deficits, color duplex ultrasound to document the surgically reestablished patency of the carotid artery, and CT for exclusion of postoperative ischemic infarctions. Recent studies prove that diffusion-weighted MRI is more sensitive in the detection of fresh insults than conventional MRI and CT. The objective of the study was to ascertain the incidence of clinically asymptomatic peri-and postoperative ischemic infarctions visualized at MRI. METHOD: We included 52 patients in the study. Fifty-one patients (31 men, 20 women; average age 68 years) underwent cranial MR examination including a diffusion-weighted sequence at 24 h prior to carotid TEA and again 24 h following the procedure. One patient did not agree to participate. RESULTS: In 29 of 51 patients (56%), neither the pre-nor the postoperative MR scans showed any diffusion abnormalities. In 16 patients (31%), however, preoperative MRI detected fresh ischemic insults. In nine patients (17.6%), the size of the insult resulted in surgery being postponed for 4 weeks. In six patients (11.8%), postoperative MRI returned findings of fresh disturbances of diffusion suggestive of ischemia that were not visualized on preoperative scans. Discrete neurologic deficits were observed in only two (3.9%) of these patients. Deficits were transient and disappeared within 72 h. CONCLUSION: Our findings underscore MRI's capacity for visualizing perioperative ischemic events. Moreover, MRI provides evidence of clinically asymptomatic embolisms that occur perioperatively.

Acute Disease↗

PubMedDate not supplied

Management of descending aortic dissection.

The optimal timing of surgery with Stanford type B aortic dissection remains controversal. In acute-phase cases, surgical mortality is so high that medical treatment is preferable unless there are major complications. To guide the choice of medical versus surgical therapy we use survival analysis in patients with acute uncomplicated/complicated and chronic uncomplicated/complicated descending aortic dissection. Between 1992 and 1993 49 patients were diagnosed with Stanford type B aortic dissection. Emergent surgery was performed in 4 patients for rupture or impending rupture, elective surgery was done in 12 patients. The remaining 33 patients were treated medically. Our results support the continued use of medical management as the primary treatment for uncomplicated acute aortic dissection, with surgical therapy being reserved for those patients with complications such as rupture, expansion, continuing pain or ischemia of distal vascular beds.

Aortic Dissection↗