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Biomedical subjects

H Junkermann

Publications and source records attributed to H Junkermann.

At least 37 records · Page 2Linked to original sources
PubMed1994

Breast tumors: computer-assisted quantitative assessment with color Doppler US.

PURPOSE: To compare quantified measurements with color Doppler ultrasonography (US) with those obtained with conventional duplex US in the differential diagnosis of suspect lesions in the breast. MATERIALS AND METHODS: A computer-assisted protocol was used to calculate the color pixel density (CPD) and the mean color value (MCV) in US images of breast lesions. These results were compared with conventional results in the examination of 25 patients (aged 29-78 years) with carcinomas and 32 patients (aged 23-73 years) with benign lesions of the breast. RESULTS: The sensitivity of maximum flow velocity in helping identify carcinomas was 60% and the specificity was 70%. In color Doppler US, the sensitivity for MCV in helping identify carcinomas was 92% and the specificity was 78%; for CPD the sensitivity was 64% and the specificity was 91%. Combining MCV and CPD did not improve differentiation. CONCLUSION: Computer-assisted image analysis may be superior to conventional duplex US in helping differentiate between carcinomas and benign lesions.

Adult↗
PubMed1993

[Breast cancer screening. State of the art and introduction to preventive measures].

Carcinoma of the breast is the most frequent cause of death in women aged between approximately 38 and 50 years. At present, 1 out of 14 women in Germany and 1 out of 9 in America suffer from breast cancer within a life time. To date, modern methods of treatment and hormone therapy have only been able to increase long-term survival by about 12%. Trials have shown that early diagnosis alone has been able to increase survival from 20% to 50%. Early diagnosis proved to be most effective when clinical examination plus mammography in two planes was carried out annually. An increase in survival has been achieved in post-menopausal women as a result of screening. 22 percent of breast cancers were detected at a curable in situ stage by means of screening. Even after a limited screening program of 4 examination cycles the increase in survival rate over 15-20 years was significant.

Breast Neoplasms↗
PubMed1993

[Clarification of breast lesions using core-cut, drill and fine needle biopsy].

Interest in needle biopsy methods (core cut-, drill-, and fine-needle biopsy) has recently increased considerably because of the rise in screening mammography and new developments in the therapy of breast cancer. In order to achieve adequate results using needle biopsy and to avoid complications, certain technical details must be strictly adhered to. An experienced surgeon can achieve a sensitivity of above 90% in the diagnosis of breast carcinoma with all three methods. Considering the advantages and disadvantages of these three methods of needle biopsy, we prefer--based on our own experience--high-speed core-cut biopsy for the morphological evaluation of breast lesions.

Biopsy, Needle↗
PubMed1993

[Localization of non-palpable lesions by mammography for preoperative marking and tissue removal].

Mammography screening can increase survival by 15-50%. Minute nonpalpable breast carcinomas can be detected and surgically removed using precise localization techniques. Various techniques are shown, including localization by means of grid mammography and conventional localization with several needles. Stereotactic localization is recommended if the focus cannot be detected by sonography--a procedure now almost always possible if mammography units have the necessary additional equipment. In future it will often become necessary, following a good response to pre-operative chemotherapy, for the tumor, which as a result has become nonpalpable, to be marked prior to surgery (e.g. remaining microcalcifications). This is essential if a representative area of tissue is to be made available for histological examination.

Breast Neoplasms↗
PubMed1993

[Magnetic resonance spectroscopy of breast cancer].

Conservative therapeutic concepts with initial chemotherapy for patients with breast cancer represent a challenge to non-invasive techniques for monitoring response to therapy. Experimental magnetic resonance spectroscopy studies have been able to show exemplary applications for therapy monitoring of breast cancer patients. The characteristic phosphomonoester resonances and their changes during therapy are possible clinical parameters. The additional information which can be obtained from proton and carbon spectroscopy increases the amount of detectable metabolites. On-going studies are investigating clinical applications of multinuclear spectroscopic studies in patients with breast cancer.

Breast Neoplasms↗
PubMed1992

[Recurrences, the surgical and radiological side effects and new developments in the breast-preserving treatment of breast carcinoma].

In the Department for Gynecology and the Department for Gynecologic Radiology, University of Heidelberg, breast conserving therapy was carried out in 1,330 patients with breast cancer between 1975 and 1990. The tumor size was up to 3 cm, 28% showed positive nodes. The medium age was 47.6 years, segmental resection was the standard operation, whole breast irradiation with 50 Gy and an additional boost of 10 Gy was standard irradiation schedule. After five years (n = 307) the following results were observed: local failure 6.8%, regional lymph node recurrence 2.1%, overall survival 88.3%, disease-free survival 81.2%. Five out of 36 of the death-cases died without recurrence. Significant factors for local failure were following: 1. lymphangiosis of more than 1 cm in size around the tumor (p = 0.03); 2. intra-ductal non-invasive cancer of more than 1 cm in size around the primary (p = 0.01); 3. intra-ductal non-invasive cancer reaches the margin of resection (p less than 0.00001). With segmental resection (2 cm margin macroscopically free of tumor) showed in 19% histologically tumor beyond the margins so-called residuals. In the other three quadrants additional second primaries of (multicentric cancers) macroscopical size could be confirmed in an additional study. In case of high risk for local failure more radicality in operation as well as in irradiation is recommended.

Adult↗
PubMed1992

[Breast cancer screening: current status and introduction as a preventive service].

1. Screening intervals according to Tabar: 1 year in women younger than 50 in order to minimize "interval cancers". 2 years in women older than 50 years. 2. Mammographic views according to Lundgren et al: 2 views at first round 1 oblique view in the following rounds, yearly. All women on risk should attend screening. The identification of useful "high risk groups" is not established. Palpation is recommended at each screening. Self-examination is recommended. Adjuvant therapy should not depend on lymph node status in screening-cancer cases. It should depend on clinical and histological "prognostic factors".

Adult↗
PubMed1991

Nocturnal myocardial ischemia and cardiac arrhythmia in patients with sleep apnea with and without coronary heart disease.

To study the effect of apnea and hypoventilation-induced hypoxemia on the heart, we carried out polysomnographic recordings over 4 nights with electrocardiographic tracings in 30 patients with and without coronary heart disease. Evaluations of the data were based on the 2nd and 4th nights. In six subjects, five with coronary heart disease, we found 85 episodes of nocturnal ischemia, mainly during REM sleep (83.5%), high apnea activity, and sustained and progressive hypoxemia. Complex ventricular ectopy was observed in 14/13 patients (nights 2/4) and repetitive ventricular ectopy in 5/3. There was no significant difference in the quality and quantity of ventricular ectopy during wake and sleep states between the CHD group and the control group. In one patient ventricular bigeminy was observed only at a threshold of SaO2 below 60%. Bradyarrhythmia was made evident in four subjects from the CHD group and correlated mainly with apnea activity. We suppose that patients with sleep apnea and CHD are at cardiac risk because coronary heart disease can be aggravated by insufficient arterial oxygen supply due to cumulative phase of apnea and hypoventilation. The reduced hypoxic tolerance of the heart may lead to myocardial ischemia and increased electrical instability.

Aged↗
PubMed1991

[New methods for treating surgically incomplete or inoperable recurrences of gynecologic malignancies].

Following radical or subradical surgery or an inoperable situation of recurrences of gynaecological tumours of the vaginal vault or the pelvic wall we suggest two different techniques of irradiation: 1. transtumoural afterloading-methods with a) flexible probes, and b) non-flexible probes 2. The application of iodine seeds. The objectives of these procedures are direct irradiation of the tumour or tumour-bed with limited irradiation volume, as well as the possibility of a simultaneous spacing and therefore protection of nearby pelvic and abdominal organs, which should not be irradiated and damaged. Examples of the various techniques of the distinguished operative and radiological procedures are presented.

Aged↗
PubMed1991

[Systemic therapy in recurrent and primary advanced cervix cancer].

Therapeutic results in advanced cervical cancer have not been showing any progress for more than 30 years. Only by means of systemic therapy does it seem possible, that further treatment results may be obtained similar to those in squamous cell carcinoma of the head and neck. Therefore, between 1985 and 1990 we tried to apply an aggressive polychemotherapy regimen for 5 days with cisplatinum and 5-fluorouracil with supportive treatment in 47 patients with either primary advanced inoperable (n = 25) or recurrent (n = 22) cervix carcinomas. Complete (n = 12) and partial remissions (n = 24) could be obtained in 36 out of 47 cases (= 77%). However, this high response rate conceals the fact, that this aggressive palliative treatment in case of recurrence and/or distant metastases means a considerable deterioration of quality of life with a median survival time of only 9.5 months. Although primary therapy with combined chemoradiotherapy shows good results, it is, however, only a real advantage for patients with complete response. Taking into account the short period of observation (median 25 months), the overall survival of all primary advanced cervix carcinomas is 13 + months, in case of complete remission 20 + months. It remains to be seen, whether sequential or simultaneous chemoradiotherapy will prove superior. Due to severe haematoxicity (WHO grade IV) after the first 3 treated patients, a dose reduction of 20% of chemotherapy was necessary. No further severe toxicities occurred. By means of supportive care, other side effects could also be well controlled, so that this effective polychemotherapy regimen is not only efficacious but also practicable. Prospective randomised studies are required to determine the importance of exclusive or combined chemoradiotherapy in advanced as well as in operable cancer of the cervix.

Adult↗
PubMed1991

[Sleep-related respiratory disorders and coronary heart disease].

A review of the literature shows that more than 50% of examined patients suffering from coronary heart disease were also suffering from sleep-related apnea. We were able to diagnose a pathological sleep apnea in 9 out of 25 patients (36%) suffering from an angiographically confirmed coronary 2-vessel and 3-vessel disorder. Patients with this combination--this is the hypothesis derived from our study--are at risk due to nocturnal apnea-induced myocardial ischaemia and rhythmic disorders. In 15 patients with sleep apnea and coronary heart disease or small vessel disease, nocturnal polysomnography was conducted, in parallel a 6-channel ECG was recorded. The apnea index (second night) was on the average 33 phases/h, the maximal duration of an apnea phases being 120 seconds. The minimal blood gas saturation recorded during sleep was between 46 and 89% (median 76.0%). In 4 of the 15 patients it was possible to confirm myocardial ischaemia (correlated via REM and also via NREM) with a maximum duration of 60 seconds, mainly during the phases of maximal apnea activity and blood gas desaturation. On comparing the ventricular arrhythmias waking/sleep, the Lown class did not change in 12 patients; there was deterioration in 2 patients and in one patient a qualitative improvement during the sleep phase. Patients suffering from sleep-related respiratory disorders and coronary heart disease are at cardiac risk, the more so since long-lasting apneas can lead to conditions of hypoxia at the heart in pre-existing changes in the coronary arteries, restricted coronary reserves and reduced tolerance to hypoxia. Such hypoxia can in turn induce enhanced electrical instability and a disturbance of the contractile function.

Arrhythmias, Cardiac↗
PubMed1989

Endocrinology of benign breast disease in relation to the severity of radiological dysplasia.

A link between benign breast disease and hormonal imbalance has not been conclusively determined. In women suffering from severe radiological dysplasia, it was found to be correlated with slightly raised serum hormone binding globulin (SHBG) binding capacity. SHBG is an oestrogen-sensitive protein, which may be a marker of enhanced oestrogen bioactivity. Such abnormality was not, however, detected by the measurement of peripheral steroid hormones.

Breast Diseases↗
PubMed1989

Hormonal and non-hormonal medical therapy of benign breast disease.

Mastopathy or nodular painful breast can be managed by several non-hormonal and hormonal treatments. Little data exist for effectiveness of the former. Whilst the hormonal treatments are considered to be very effective, their use can be limited by unpleasant side effects.

Breast Diseases↗
PubMed1988

[Current status of radiotherapy following ablative and breast-sparing treatment of breast cancer].

After a total mastectomy in cases of a high risk of loco-regional recurrence the postoperative irradiation of the chest wall is indicated in the following situations: Inflammatory type of carcinoma, tumor stage T3-T4, extended multifocal and multicentric primary tumor. After radical axillary surgery even in patients with positive nodes irradiation is not necessary except in cases where all axillary nodes are involved or with invasion of the axillary tissue. The supra- and infraclavicular lymph drainage regions caudal to the operated area (clip) should be irradiated with 50 Gy providing both an enlarged or subtotal involvement can be diagnosed. The irradiation of the retrosternal lymph-drainage system with 45-50 Gy is indicated as follows: Medial or central tumor site, extensive involvement of the axillary nodes and advanced stages of the primary tumor (T2-T4). Axillary irradiation alone cannot serve as a substitute for surgery. After segmental mastectomy without postoperative radiotherapy a local failure rate of 30% is to be expected during a 5 year period. After surgery with adjuvant postoperative irradiation the local failure rate can be reduced to about 5%: 50-60 Gy should be applied. In case of an unfavourable histology an additional boost dose is recommended. The objective of breast cancer irradiation is to achieve freedom of loco-regional recurrence. The survival can be improved occasionally after local irradiation, theoretically improvement of survival can be achieved in 7-10% at the most.

Breast Neoplasms↗