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Biomedical subjects

H Denck

Publications and source records attributed to H Denck.

At least 37 records · Page 2Linked to original sources
PubMed1988

Anastomotic aneurysms--an unsolvable problem.

Despite the advances in reconstructive vascular surgery anastomotic pseudoaneurysms have remained a serious problem. Even if a faultless operative technique is used this complication cannot always be averted. In order to avoid rupture or thromboembolism and to improve the patient's prognosis we suggest that all pseudoaneurysms are treated surgically except in poor risk patients. Between 1981 and 1986 119 anastomotic aneurysms in 68 patients were operated on in our department. 31.0% presented as infected aneurysms. 13.1% were recurrent after preceding aneurysm repair. The most common site was the femoral region following aortobifemoral bypass. Host vessel degeneration and acute inflammation of the anastomotic site seem to be the most important causative factors. Surgical repair usually consisted of resecting the anastomosis together with part of the host artery; in septic aneurysms limb salvage was attempted using extra-anatomic bypass. Postoperative mortality was 8.8%, minor complications occurred in 10.9%; 9 patients (13.1%) had to have an amputation.

Aged↗
PubMed1988

Surgery for cure followed by combined modality treatment for small cell bronchial carcinoma. ISC Lung Cancer Study Group.

For patients with small cell lung cancer (SCLC) at early stages (TNM I, II) surgery for cure is used to eliminate the primary tumour and its regional lymph-nodes followed by intermittent chemotherapy and radiotherapy within the first six postoperative months. After the pathohistological examination of the operation-specimen a two-arm-randomization is performed: standard chemotherapy compared with sequential chemotherapy using three different drug-combinations. Thereafter tumour-free patients only receive prophylactic cranial irradiation. In preliminary evaluations of March 1988, of 121 patients from 20 cooperating departments it was found that the projected life-table survival rate, three years postoperatively, of 47 patients with SCLC at stages pT1-3 N0 M0 was 65%, of 46 patients at stages pT1-3 N1 M0, 56% and of 28 patients at stages pT1-3 N2 M0, 34%. The indication for surgery were emphasized for pTNM-stages I+II. For N2-lesions surgery would not be recommended in general, but the survival rate seemed to indicate that this treatment was not detrimental, but rather more favourable compared with chemotherapy or radiotherapy only. The continuation and enlargement of these studies seem not only justified but emphatically indicated. Multicentre cooperation has to be organized to collect within a reasonable period of time a sufficient number of patients to enable subdivisions to be made according to various prognostic factors.

Aged↗
PubMed1988

[Reconstructive interventions of the superior vena cava].

Twenty-nine reconstructions of the vena cava superior were performed: twice due to obliterating mediastinopericarditis, twice because of post-traumatic thrombosis, 4 times because of iatrogenic thrombosis, once because of an arteriovenous fistula and 24 times due to malignant tumours. In nine of the latter cases a large resection with prosthetic repair of the vena cava superior was necessary; one of these patients died and the others had no recurrence of thrombosis.

Humans↗
PubMed1987

Multimodality treatment with surgery in small-cell lung cancer.

The paper reviews the role of surgery in the local treatment of the primary tumour of small-cell bronchial carcinomas (SCLC) and the preliminary results of a multicentre cooperative prospective randomized trial with multimodality treatments of SCLC. This randomized cooperative trial was activated in 1979 comparing a new sequential intermittent polychemotherapy (sq CT) of three different drug combinations alternatingly given intermittently within one year after surgery, with a standard chemotherapy (CT) of one combination of four drugs given intermittently within three years after surgery. Observations on 25 patients at nine different cooperating surgical departments showed that sq CT was applicable and unexpected side-effects did not occur. Live table curves, calculated from 56 patients up to February 1986, indicate the improvement of the survival rate five years after surgery for the cure of 25 patients receiving sq CT after surgery in comparison with 31 patients receiving standard chemotherapy (36% : 22%). Following discussions of this and other results at the symposium "Adjuvant Therapy of Small-Cell Bronchial Carcinoma" at the 13th Congress of the International Society of Chemotherapy (ISC) 1983 in Vienna, a related new protocol was designed and activated by a further enlarged ISC-Study-Group in October 1984. This protocol for a two-armed randomized cooperative trial for patients operated for T1, 2N0M0SCLC is comparing a chemotherapy-combination 1 (CAV)--as also used in a trial of the North American Lung Cancer Study Group-0--with chemotherapy 2 (sq CT) as used in our forementioned previous study.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

[Indications for surgery in acute thrombosis of the leg and pelvic veins].

We present 817 patients treated for acute venous thrombosis in pelvis and legs during the years 1957 to 1986. 312 patients underwent surgery, 157 received thrombolytic and 348 conservative treatment. Neither surgery nor thrombolysis can prevent fatal pulmonary embolism. The incidence of PTS increases, if the crural veins and the popliteal confluence can not be opened. We recommend early thrombectomy of thrombosis in the sapheno-popliteal confluence, supported by 32 total recanalisations in 36 patients.

Acute Disease↗
PubMed1986

Combination of surgery and chemotherapy for small-cell bronchial carcinoma.

In several test model systems using spontaneous metastasizing experimental tumours, convincing data indicate the importance of the tumour burden left after surgery for the efficacy of the combination of surgery and chemotherapy. Early removal of the primary tumour by radical surgery for cure seems to improve the conditions for chemotherapy. Since 1979, in nine different departments of thoracic surgery, patients with small-cell carcinoma of the lung (SCCL) have been randomized after surgery for cure to receive a new sequential intermittent polychemotherapy (sq.CT) of 3 different alternating drug combinations given intermittently over 1 year, or one 4-drug combination chemotherapy (CT) given intermittently over 3 years. The calculation of their life table curves at 1 August 1984 indicated an improvement in the 4-year survival rate of 23 patients receiving sq.CT to about 50%, compared with a survival rate of about 30% for 29 patients receiving CT. The number of patients is still too small for firm conclusions to be drawn, but it is concluded that surgery for SCCL seems to be an advisable measure for the efficacy of aggressive intermittent long-term polychemotherapy. However, this can only be proved in large cooperative studies.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

[Portal hypertension].

The most frequent cause of portal hypertension is the intrahepatic pre-sinusoidal block in (alcoholic) liver cirrhosis. Every surgical intervention is a great stress for these patients, since it is very difficult to influence the course of cirrhosis itself. Laboratory chemistry and haemodynamical prognostic criteria are of limited value only. Especially during the acute stage clinical evaluation of the patient's general and nutritional condition, age, as well as signs of decompensation such as encephalopathy, icterus and ascites are still of greatest importance. A more or less normal volume of the liver and a perfusion index of approx. 1 is regarded to be a favourable prognostic factor.

Esophageal and Gastric Varices↗
PubMed1984

[Results of intermittent intra-arterial chemotherapy with 5-FU in liver metastases and inoperable tumors of the gastrointestinal and urogenital tracts].

The present study includes 181 patients suffering from metastases of the liver or inoperable gastrointestinal tumors, who received local chemotherapy with 5-FU in the form of loading doses of 6 g over a period of 3-6 days interrupted by intervals of 6-8 weeks. For this purpose the catheter was introducted into the main supply artery of the tumor, it was left in place for 6 days and the cytostatic agent was infused by help of an electric syringe. Remission rates amounted to 58% for liver metastases and 43% for inoperable advanced gastrointestinal tumors, which is quite remarkable. Remission periods up to 50 months were recorded for this type of intermittent treatment. Since the procedure is simple, well tolerated and bears little risk, and the therapeutical result is reasonably good for advanced cases, we feel justified in recommending this treatment in the form of a prospective study at least for cases in which direct surgical establishment of a catheter for implantation of a pump system is not performed. A comparison of treatment results with locoregional chemotherapy is limited to liver metastases, application in inoperable gastrointestinal or even urogenital tumors is still speculative, and this indication wants further observation.

Adult↗
PubMed1984

[Bronchial carcinoma from the surgical viewpoint].

The paper presents the problems of bronchogenic carcinoma and the results of surgical treatment on the basis of 10 000 patients suffering from lung cancer. 20% of all resected cases and 40% of all cases resected during the early stage lived beyond the 5-year survival limit, and during the earliest stage surgical cure can be achieved in 60% to 80% of the patients. Small cell carcinoma is just as operable as all other forms of bronchogenic carcinoma, if in addition chemotherapy and radiotherapy are administered. From the oncological point of view clip or segmental resection are not equivalent to standard lobectomy and must, therefore, remain reserved for functional risk cases. On the basis of cancer biology and in view of the frequently occurring concealed (micro)-metastases we demand adjuvant therapy after every tumor resection; this treatment will consist in immunotherapy during the early stages and in chemo- and radiotherapy during late stages.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

[Lactate in the diagnosis of acute intestinal vascular occlusions].

The diagnostic value of lactate in acute occlusion of intestinal vessels was investigated in two groups of patients: Group 1 included 86 patients with reconstructions of aorta and intestinal arteries: The lactate-concentrations measured during uncomplicated postoperative course over 24 hours remained within the normal range of 4.31 +/- 1.06 mmol/l. Only in 3 patients with acute postoperative occlusion of intestinal arteries, lactate rose to high pathologic levels up to 59.94 mmol/l. In 10 patients after reconstruction of acute mesenteric artery occlusion the postoperative lactate levels enforced the decision in 9 cases against and in one patient to second look operation. Group 2 included 36 patients with acute abdomen: In 18 patients with intestinal vascular occlusions the mean value of lactate was 7.45 +/- 2.86 mmol/l, in 18 patients without intestinal ischemia lactate was only 1.94 +/- 1.02 mmol/l. The statistical difference is significant. In summary, the results of this study document the reliable value of lactate for the diagnosis of acute occlusions of intestinal vessels during pre- and postoperative course.

Abdomen, Acute↗
PubMed1983

[Skin metastases of malignancies of internal organs].

In 4 cases with cutaneous metastases from internal cancer the primary tumours were found in the gallbladder, the breast, the lung and the kidney. The cutaneous metastases were the first symptom of the disease in 2 of 4 cases and led to the diagnosis. Course, treatment and prognosis of secondary skin tumours are discussed in detail.

Adenocarcinoma↗
PubMed1983

[New experimental documents on circulatory reversal by arteriovenous fistula in ischemia of the extremities].

The beneficial effects of circulatory reversal by lateral a.-v. fistula was confirmed in 20 hind limbs of dogs made ischaemic by Collagen embolisation. Although not done in the experiments presented here, rupture of the distal venous valves is advisable. The peripheral circulation was studied by measurement of venous pressures and by angiography. Retrograde infusions, with proximal tourniquet, confirmed reversal of flow veins to arteries. Return routes to the heart remain unknown.

Animals↗
PubMed1982

[Prevention of recurrence of small-cell lung cancer by adjuvant polychemotherapy (author's transl)].

No significant further improvement can be awaited in the results of purely surgical treatment of bronchial carcinoma. As from 1969--after preliminary studies--patients with bronchial carcinoma were treated by radical surgery and subsequently assigned within the framework of a randomized cooperative study, to a three-year course of intermittent high-dose polychemotherapy (cyclophosphamide, 5-FU, MTX and Velbe). A comparison according to the life-table method of the death rate of patients with small-cell bronchial carcinoma treated by combined polychemotherapy after surgery vis-à-vis those who received no polychemotherapy shows a rise of about 15% in the 4-year survival rate. This clear-cut improvement in survival rate emphasizes the fact that the radical operation is also indicated in these tumour forms and that the results of high-dose polychemotherapy are improved with this particular combination. With a view to confirmation and further improvement, a large international working group was established and has already submitted initial positive results concerning the applicability of a new alternating chemotherapeutic schedule. It is pointed out that the initial impetus towards undertaking such studies was given by Prof. Dr. Dr. h.c. Wolfgang Denk already in 1954 and that the consistent continuation of this combined inter-disciplinary approach to the therapy of bronchial carcinoma is founded on his scientific foresight and organisational achievements.

Carcinoma, Small Cell↗