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Biomedical subjects

I Ebner

Publications and source records attributed to I Ebner.

12 recordsLinked to original sources

Multimodal therapy of small cell lung cancer in TNM stages I through IIIa.

Since 1977, Innsbruck University Hospital has been employing a multimodal therapy concept for small cell bronchial carcinomas in stages I to IIIa. This concept includes all three treatment forms effective in this tumor, namely, chemotherapy, surgery, and radiotherapy. The therapy scheme is stage-dependent and begins in stages T1-3 N0-1 with lung resection and in stage N2 with chemotherapy. To date, 45 patients have been included in a prospective, nonrandomized (phase II) trial: 7 in TNM stage I, 11 in stage II, and 27 in stage IIIa (6 T3 and 21 N2). The actuarial 5-year survival rate of the entire group (including therapy-related lethality, early recurrences, and protocol violations) is 36%; it is 57% for those in stage I, 28% for those in stage II, and 34% for those in stage IIIa. Median survival time is 18 months. Patients with completed multimodal treatment have a 5-year survival rate of 56% regardless of disease stage. Three patients died of tumor-unrelated causes after 47, 52, and 54 months.

Adult

Operation for N2 small cell lung carcinoma.

Of 48 patients with limited small cell lung carcinoma treated by different modes, but always including radical operation, a series of 25 patients with N2 lymph node metastases is reported. In a first period (1970 to 1977) treatment consisted solely of radical resection in 3 patients; chemotherapy was added to operation in 6, and local radiotherapy was added in 2. Since 1977, 14 patients were treated according to a comprehensive therapy protocol including radical resection (six pneumonectomies, one bilobectomy, seven lobectomies), chemotherapy, local radiotherapy, and prophylactic cranial irradiation. Eleven patients, in whom N2 disease was confirmed preoperatively, received chemotherapy as the first step, followed by "adjuvant" resection. Projected 5-year survival rate is 25% for the entire N2 group and 47% for the comprehensively treated group. Seven patients of this latter group are alive 12, 19, 30, 48, 66, 73, and 74 months after comprehensive therapy, equivalent to an observed 2-year survival rate of 38%. This is the largest reported series of patients with resected small cell lung carcinoma in the N2 stage treated at a single institution; the results are so encouraging that we can no longer advocate general refusal of radical lung resection for small cell lung carcinoma in the N2 stage if it is part of a multimodal therapeutic protocol.

Adult

[Plexus neuropathy: tumor infiltration or radiation damage].

Plexus neuropathies often occur in patients with breast cancer after varying periods following surgery and postoperative radiotherapy. In most cases this has been ascribed to radiation fibrosis. The attempt to arrive at a clinical diagnosis fails because of the similarity of symptoms in both cases namely pain and the absence of motoric and sensory reflexes. But a clear diagnosis is of fundamental importance for further treatment. Only a surgical intervention can verify the diagnosis. In this study, the results of operative findings are presented and compared with a second group of patients who had died of breast cancer having undergone surgery and radiotherapy. The findings brought a surprising fact to light: a considerably high percentage of all patients suffered from large scale tumour infiltration in the plexus. The morphology and histopathology of these lesions are described. Possible explanations are given for the difference in lesion patterns, so that a clinical diagnosis might be derived therefrom.

Adult

[The end of the deep palmar arch on its ulnar face].

In 95.5% the radial artery unites in the depth of the palma manus with an artery, which finds its origin in the ulnar artery or one of her branches. In 20.9% this artery originates from the ulnar artery proximally to the Hamulus ossis hamati and joins the Ramus profundus nervi ulnaris to reach the depth of the palma manus. In 74.6% the artery originates distally to the Hamulus ossis hamati and passes the Hypothenar muscles on their radial side to reach the radial artery. This second, rarely mentioned, artery is the branch of the Arteria digitalis palmaris propria for the ulnar margin of the fifth finger, an Arteria digitalis palmaris communis or the Arteria ulnaris.

Aged

[Patterns of the arterial vessels in the palm].

The pattern of the superficial arteries in the palma manus can be characterized in the following manner. In 58% of the cases the arteria ulnaris runs in an arch from the ulna to the radius and gives off a varying number of arteries to the fingers. There is no connection with any other artery. In 42% of the cases there are arterial connections, of which 32.1% are present in the form of an 'arcus' of a rather large diameter, formed through connection of the arteria ulnaris with the ramus palmaris superficialis of the arteria radialis or with the arteria metacarpalis dorsalis I. Likewise, in 9.9%, there is a connection between the arteries but this, which we call an 'anastomosis', is of a more delicate nature.

Aged

Morphological and biomechanical studies of the ligamentum arteriosum.

Fifteen ligaments taken from individuals aged between 60 and 80 years were used for the study of the histological structure, the composition of the ground substance and the biomechanical behavior. Remnants of the original duct are recognizable in the ligament as artery of the muscular type. What had been the intima is thickened and consists mainly of cell-poor, fiber-rich connective tissue, which often shows chondrification along with calcification. The biomechanical behavior of the ligaments, evaluated with the force-length and force-relaxation test, was similar to that of peripheral arteries.

Aged

Contribution to the significance of persisting embryonic vessels in the adult organism.

A persisting vitelline artery that remained asymptomatic during lifetime was studied by gross anatomy, histologically and by x-rays: histologically we found an extensive adaptation to mechanical stress; radiologically an anastomosis of the persisting vitelline artery with a terminal branch of the superior epigastric artery was found, which has not been described until now.

Aged

[Arterial vascularization of the tail of the pancreas with special reference to the relation of the tail and body vessels].

The cauda pancreatis has a characteristic pattern of vascularization. Among the big arterial stems surrounding it, up to 4 arteries, 'caudal arteries', nourish the arterial system of the cauda. These stems originate especially in the Arteria gastroepiploica sinistra and in the lower main splenic branch of the Arteria lienalis. The vascular relations between corpus and cauda can be of different kinds. Five basic types of relations can be identified: type I: the cauda is supplied exclusively by caudal arteries; type II: at least one caudal artery anastomoses with the vessels of the corpus; type III: the cauda is supplied both by the caudal arteries and by vessels of the corpus (non-anastomosing); type IV: combined forms of blood supply by caudal arteries and corpus arteries by way of anastomoses and non-anastomosing vessels are found; type V: the cauda is supplied exclusively be vessels stemming from the corpus. In each of these five types, individual vessels supplying the cauda can assume the function of a terminal vessel.

Aged

[Respiration-dependent shift in the region of the aortic arch].

The contents of the mediastinum take part in a different degree in its inspiratory longitudinal expansion: Heart, pulmonary root, and the bifurcation of the trachea--all of them connected with the diaphragm by pericardium or membrana bronchopericardiaca--move caudad proportional to the sinking of the diaphragm. Compared with the corona cordis the planum cardiacum moves further caudad according to its distance from the upper apertura thoracis. So the heart necessarily has to compensate for this difference by taking an upright position and by rotation to the right. The arcus aortae, however, fixed in the neck by its three main branches cannot perform such a proportional excursion. A significant distance of the left pulmonary root from the aortic arch is the result. At the same time a subaortal space, the 'spatium subaortale mediastini', unfolds into which a bulge of the pleura mediastinalis moves. This bulge is filled with tissue of the upper lobe of the left lung.

Aged

[Compensatory and stabilizing motions of the fibula].

There are two reasons why the fibula shows longitudinal motions. During dorsiflexion the push of the wedge-shaped trochlea tali causes an upward fibular motion; on the other hand, during weight bearing the contraction of the leg muscles effects a downward fibular motion. The specific level of the fibula results from these two correlating forces. While the upward fibular migration is a passive compensative movement, the downward fibular migration is an active stabilizing movement.

Ankle Joint

[The basic human thumb joint--an egg-shaped joint].

The metacarpophalangeal joint of the human thumb (Articulatio metacarpophalangea pollicis) is an ellipsoidal (condyloid) joint. The head of the first metacarpal bone is shaped like a spindle polled at either end. Its form relevant to the mobility is determined by the correlation of two flexures, expressed by the quotient R/r, where R = semi-diameter of the radio-ulnar flexure and r = semi-diameter of the dorso-palmar flexure in the middle of the head. Only the substantial kind of motion (flexion-extension) maintains the perfect contiguity of the articular surfaces. Owing to the deformability of the articular cartilage, the actual littleness of the articular surfaces as well as the relative smallness of the cavity with respect to the head permits both transverse motions (adduction-abduction) and axial motions (rotation inward and outward). The amplitude of the transverse motion unexpectedly does not correlate to the intensity of the radio-ulnar flexure of the head.

Finger Joint