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F Willeke

Publications and source records attributed to F Willeke.

48 records · Page 3Linked to original sources
PubMed1998

[Morbidity and tumor control in limb-saving resection with intraoperative radiotherapy in a multimodality therapy concept in soft tissue sarcoma].

This study evaluates limb-saving surgery (LSS) combined with intraoperative radiotherapy (IORT) and external beam radiotherapy (EBRT) for extremity sarcoma. Prospectively gathered data was analyzed for 50 patients. Advanced stages (UICC IIB-IIIB) predominated (80%) and 50% of the tumors were recurrent. Early local morbidity amounted to 32%, including wound infection (6), skin necrosis (3), hematoma (3) and others (4). Late morbidity of 10% consisted of a fracture, a fibrosis, two chronic lymphedemas and a neuropathy. One patient died (pulmonary embolism). Local control was obtained in 91% with an overall 3-year survival rate of 81% in cases treated with curative intent (follow-up 29 months). No survival benefit was found for patients with microscopically clear margins; however, local failure occurred less frequently (p = 0.02). Our results support the use of LSS with IORT and EBRT for extremity sarcoma and emphasize the importance of the surgical margin.

Adult↗
PubMed1997

[Leiomyosarcoma of the inferior vena cava].

HISTORY AND CLINICAL FINDINGS: In a 34-year-old woman who underwent ultrasound investigation because of recurrent pyelonephritis a space-occupying lesion in the liver was an incidental finding. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed a tumour in segment I of the liver. The patient had been on contraceptives for 12 years. She had no symptoms. INVESTIGATIONS: Laboratory tests, including tumour markers, were unremarkable. Diagnostic tests to exclude malignant tumour with metastases were negative (thyroid scintigraphy, mammography, coloscopy and gastroscopy). Further tests (ultrasound, coeliaco-mesentericography, hydro-CT and spiral CT, MRI) revealed a tumour, 5 x 4 x 4 cm, in segment I of the liver, most likely an adenoma. Surgical intervention was indicated by the size and questionable malignancy of the tumor. TREATMENT AND COURSE: At operation a tumour was found which originated from the inferior vena cava (IVC) and displaced segment I of the liver. The tumour was resected and the venous wall reconstructed with a Goretex patch. Histological examination indicated a poorly differentiated leiomyosarcoma of the IVC. Adjuvant radiotherapy was undertaken postoperatively. There has been no evidence of recurrence after 10 months. CONCLUSIONS: Leiomyosarcoma of the IVC can be mistaken, both by ultrasound and tomographic diagnostic procedures, for a tumour in segment I of the liver, especially an adenoma. A leiomyosarcoma of the IVC should be included in the differential diagnosis of an hepatic tumour that lies close to segment I of the liver.

Adenoma↗
PubMed1997

[Outcome of surgical therapy in asymptomatic primary hyperparathyroidism].

Surgery for symptomatic hyperparathyroidism remains the standard therapy. Asymptomatic primary hyperparathyroidism (pHPT) is being diagnosed with increasing frequency owing to broad serum testing. Indications for surgery in this setting are controversial. For evaluation of surgical safety we performed a retrospective analysis of our patients who were being operated on for asymptomatic pHPT. From January 1988 until August 1995, 243 patients were treated for pHPT and registered prospectively at our unit. Seventy-six patients were classified as asymptomatic. In all, 75% of the patients were female; the mean age was 62 years. In this group, 87% of the patients had cervical sonography in order to localize the adenoma. Highly selective venous catheterization was required in cervical reexplorations. Statistical analysis for potential prognostic factors for the clinical outcome was performed. Successful cervical exploration was possible in 71 patients (94.7%). With 4 patients remaining hypercalcemic, the rate of persistency was 5.2%. Localization procedures were correct in 58% for cervical ultrasound and 77% for selective venous catheterization. Postoperative morbidity included one permanent recurrent laryngeal nerve palsy and 2 patients with hemorrhage who were treated by reoperation. While one case of permanent hypoparathyroidism was well controlled by oral supplementation, 18 patients recovered from temporary hypoparathyroidism. No postoperative mortality occurred. Risk factor analysis revealed only cervical reexplorations for HPT to be associated with a higher morbidity (P = 0.02). Surgery for asymptomatic pHPT can be performed with reasonable safety. Cervical reexplorations in asymptomatic patients should be reserved for special indications. Apart from this small group, all patients should be evaluated for surgery.

Adult↗
PubMed1997

Vincenz Czerny: carrying concepts into the 21st century.

Vincenz Czerny, as a pupil of Theodor Billroth and as head of the surgical departments of the Universities of Freiburg and Heidelberg between 1871 and 1906, markedly influenced the surgical development of the 19th century. Major contributions to the field of surgery included hernia operations, abdominal surgery and vaginal hysterectomy. Most importantly he recognized that surgery alone would not be able to control cancer and he developed concepts for multimodality treatment.

General Surgery↗
PubMed1996

[Decompensated acute gastric dilatation caused by a bulimic attack in anorexia nervosa].

HISTORY AND CLINICAL FINDINGS: Abdominal pain developed after a bulimic binge in a 19-year-old girl with anorexia nervosa. She had unsuccessfully tried to induce vomiting. Physical examination showed no clinical sign of peritonitis, although there was diffuse abdominal tenderness on pressure. INVESTIGATIONS: There was leukopenia (2200 G/l) and a raised serum lactate level (58 mg/dl). No free air was seen on a plain film of the abdomen. Abdominal sonography revealed little free fluid subhepatically. TREATMENT AND COURSE: Acute respiratory impairment during investigations required emergency intubation. As bronchoscopy revealed aspiration a bronchial lavage was performed. Under gastroscopic control gastric emptying was achieved through a large gastric tube. After early improvement the patient developed the full picture of sepsis. Ultrasonography and needle puncture having revealed purulent intraabdominal fluid, a laparotomy was performed, which showed necrosis of the anterior and posterior walls of the stomach with free perforation. The greater curvature was resected. The patient slowly recovered but a relaparotomy for a subphrenic abscess became necessary on the 10th postoperative day. A year later there was free food passage, but the anorexia nervosa was unchanged. CONCLUSION: A bulimic binge can become life-threatening if the stomach does not empty spontaneously. Surgical intervention is required, if the patient's condition does not improve despite gastric emptying.

Adult↗
PubMed1996

[Results of isolated hyperthermic extremity perfusion in soft tissue sarcomas within the scope of a multimodality treatment concept].

Soft-tissue sarcomas (STS) of the extremities are characterized by a high rate of local recurrences. Limb salvage approaches using multimodality therapy protocols have replaced amputation. In order to evaluate isolated hyperthermic limb perfusion (ILP) in a multimodality therapy concept, we reviewed our patients treated using this method. Between January 1982 and December 1995, 25 ILPs, using cisplatin, melphalan and adriamycin, were performed in 22 patients with STS. Forty percent were treated for local recurrences; histology was dominated by malignant fibrous histiocytoma (MFH) and synovial sarcoma. In all, 68% of the STS were classified as UICC stage IIb or IIIa/b. Most of the cases (14) underwent wide or radical resection, 4 patients received intraoperative radiotherapy, and 5 were treated with external beam radiation. Complications were recorded in 32% of the cases. With a median follow-up of 45 months (range 1-143), the 5-year overall survival rate was 81%. The median recurrence-free time was 19 months and the 5-year disease-free survival rate 34%. There were 13 local failures, and distant metastases developed in 36% of the patients. Concerning high-grade sarcomas (UICC stage IIb, IIIa/b), we found local recurrences in 75% of all cases. Five of 11 patients with local failures underwent perfusion after they refused amputation, and 7 incompletely resected STS received ILP without reoperation. All of these demonstrated local recurrence. This rate of local recurrence proved to be different from patients with tumor-free resection margins (p = 0.0001, log-rank test). The amputation rate after isolated limb perfusion was 27% (mean 11 months after treatment). Long-term results of ILP showed a considerable local recurrence rate and a low disease-free survival. Perfusion in patients without tumor-free resection margins does not prevent local recurrence. We conclude that ILP with cisplatin, melphalan and adriamycin should be considered carefully and is not an additional treatment strategy of fist choice.

Adult↗
PubMed1996

[Intraoperative radiotherapy in advanced soft tissue sarcoma of the extremities].

Radical or wide excision is the treatment of choice for soft-tissue sarcomas (STS) of the extremities. Multimodality therapy made limb-sparing surgery possible. While external beam radiotherapy is well established in this setting, few data are available about intraoperative radiotherapy (IORT). We performed an analysis of 36 patients treated with IORT and external beam radiation following resection of STS of the extremities between 1991 and 1995. Only STS classified as UICC stage IIb, III or IV were included. Operative morbidity was 17%, 14% showed late complications. Within a mean follow-up of 24 months (min. 6), there was one local recurrence in 30 patients treated curatively. The 3-year survival rate of patients treated curatively was 75%; 3-year recurrence-free survival was 65%.

Combined Modality Therapy↗
PubMed1995

[Intraoperative radiotherapy within the treatment concept of retroperitoneal soft tissue sarcomas].

Sarcomas of the retroperitoneum are characterized by a high rate of local recurrence. External beam radiotherapy is known to improve local control after surgical therapy. To increase local dosage of radiotherapy without affection of sensitive structures we applied intraoperative radiotherapy (IORT) since 1991 in a dedicated operative unit. To compare morbidity and tumor control we used a partly historic control group of patients treated since 1988 for retroperitoneal soft tissue sarcoma. 25 patients with a mean age of 53 years were operated. Tumor histology was dominated by liposarcoma and leiomyosarcoma, UICC stage IIB (T2 G2 N0 M0) was present in 45% of cases. Distant metastasis were diagnosed in 19% at therapeutic intervention. Tumor free margins were achieved in 55% while 29% showed microscopic and 16% macroscopic tumor residues after surgical intervention. 11 patients received IORT with a mean of 18 Gy, eight of those patients were treated additionally with a mean of 40,4 Gy externally. There were no differences in distribution of known risk factors for recurrence in the group of patients treated with or without IORT. The analysis showed no difference for perioperative morbidity. Tolerance for IORT and additional external beam radiotherapy was good. Local tumor control tended to be improved by IORT (p = 0.082) while overall survival was not affected at a mean follow-up of 24 months.

Adolescent↗
PubMedDate not supplied

Functional imaging and detection of local recurrence in soft tissue sarcomas by positron emission tomography.

BACKGROUND: Besides anatomically-based radiodiagnostics, functional imaging may be used for characterizing soft tissue sarcomas (STS). This study evaluates positron emission tomography (PET) with three different radiotracers (fluorine-18 deoxyglucose [FDG], carbon-11 aminoisobutyric acid [AIB] and oxygen-15-labeled water [O15-water]) for imaging STS and the detection of local recurrence. PATIENTS AND METHODS: 21 patients presented with 9 primary STS, 5 recurrent STS and 10 lesions suspicious for local recurrence (radiological tomography). Standardized uptake values (SUV) were calculated in tumor and normal tissues (muscle/blood vessels). Surgery with pathological examination or follow-up data were referred to as control criteria. RESULTS: All tracers accumulated in STS with no difference between primary and locally recurrent tumors. The uptake in STS was increased compared to muscle (FDG, P < 0.0001; AIB, P = 0.0039; O15-water, P = 0.002) and to blood vessels for FDG (P < 0.0001) as well as AIB (P = 0.0038). Of 10 patients with suspected recurrence, 6 presented neither PET criteria for recurrence nor local failure in the specimens or during follow-up, while 4 cases with positive PET scans were ultimately diagnosed with local failure. CONCLUSION: Besides FDG, AIB and O15-water were shown to accumulate in primary and recurrent STS of different histologic type. A precise differentiation from normal muscle was found for all tracers. FDG and AIB differentiated viable tumor from blood vessels. PET using FDG, AIB and O15-water is suitable for functional imaging of STS and the detection of sarcoma recurrence.

Adult↗
PubMedDate not supplied

Assessment of soft tissue lesions suspicious for liposarcoma by F18-deoxyglucose (FDG) positron emission tomography (PET).

BACKGROUND: F18-deoxyglucose (FDG) positron emission tomography (PET) is a promising imaging technique. The aim of this study was to investigate the use of FDG PET in patients with suspected liposarcomas (LS). PATIENTS AND METHODS: Forty-two masses were studied. The FDG uptake was estimated in tumor (T) and normal tissue (NT). The data were analyzed with respect to pathological findings. RESULTS: Pathology revealed 11 primary LS, 14 locally recurrent LS, 5 other sarcomas, 1 inflammation, 1 lymphoma and 10 benign lesions. FDG uptake (T-to-NT ratio) in 25 LS corresponded with the histological subtype. Pleomorphic, mixed and myxoid LS showed an increased T-to-NT ratio and were thus visualized. Four out of six well-differentiated LS presented a low FDG uptake. Like subtype, the tumor grade also corresponded to FDG uptake. The T-to-NT ratio of higher grade LS, contrary to low grade LS, was uniformly increased. Primary LS were distinguishable from benign tumors, while other sarcomas, inflammation and lymphoma were not. Recurrence was detected with a sensitivity of 86% and a specificity of 100%. False-negative diagnoses occurred only in well-differentiated recurrences. CONCLUSION: FDG uptake in LS correlates with the histological subtype and tumor grade. The diagnostic value of FDG PET in LS, therefore, is influenced by histomorphological parameters. Our data suggest that pleomorphic, mixed and higher-grade LS recurrences are preferentially amenable to FDG PET imaging.

Adolescent↗