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Biomedical subjects

K Ludwig

Publications and source records attributed to K Ludwig.

At least 19 recordsLinked to original sources
PubMed2007

[Tumors of the foot skeleton].

About 3-4% of all tumors and tumor-like lesions of the skeleton are located in the foot. Many of these lesions have a predilection for certain locations, so that the spectrum of entities occurring in the foot differs from the rest of the skeleton. Despite the fact that practically any entity can occur in the foot in rare cases, taken together the ten most frequent lesions make up for the vast majority of tumors and tumor-like lesions of the foot. The differential diagnosis of these lesions follows the general principles that apply in the rest of the skeleton. It is based on the analysis of the lesion's X-ray morphology and location, the patient's age, and in certain entities, the MR morphology. This article describes the most important tumors and tumor-like lesions of the foot, their differential diagnosis, and the principles of local staging.

Bone Neoplasms↗
PubMed2006

Concurrent chemoradiation with capecitabine and weekly irinotecan as preoperative treatment for rectal cancer: results from a phase I/II study.

The aim of this study was to investigate the efficacy and safety of chemoradiation using capecitabine and irinotecan as neoadjuvant therapy for patients with rectal cancer. Conventional radiation was given at daily fractions of 1.8 Gy on 5 days a week for a total dose of 55.8 (50.4 + 5.4) Gy. Concurrently, irinotecan 40 mg m(-2) once weekly and capecitabine continuously at dose levels of 500, 650, 750 and 825 mg m(-2) twice daily were administered. Surgery was performed 4-6 weeks following completion of chemoradiation. A total of 28 patients (3 UICC II, 25 UICC III) were enrolled and all received treatment. Dose-limiting toxicity was diarrhoea grade IV and hand-foot syndrome at the 825 mg m(-2) dose level. The maximum tolerated dose of capecitabine was 750 mg m(-2). Diarrhoea was the most common toxicity: grade III in nine patients. Two patients died, one due to pneumonia and one due to sudden cardiac death. A complete response and only microfocal residual tumour disease was achieved in four and three patients (27%). In all, 25 of 28 patients undergoing surgery, 24 (96%) had R0 resection. Preoperative chemoradiation based on continuous daily capecitabine and weekly irinotecan appears to tolerated and effective in patients with rectal cancer.

Aged↗
PubMed2006

[Magnetic resonance imaging of the ankle].

The ankle represents an anatomically complex region with a broad spectrum of pathologies. Magnetic resonance imaging (MRI) of the ankle offers detailed, high-resolution imaging of the bones, the ligaments and the surrounding soft tissue structures and therefore has a major role in the diagnostic evaluation of traumatic sequelae, infectious diseases or ankle pain of unknown origin. MRI is especially valuable in the detection of radiographically occult stress reactions or osteomyelitis because it can visualize bone marrow edema earlier than any other imaging method. MRI is superior to any other imaging method for visualizing the tendons and ligaments of the foot and is an important basis for further treatment planning.

Ankle Injuries↗
PubMed2006

[Computed tomography of the musculoskeletal system].

Computed tomography (CT) is an important diagnostic modality in the work-up of musculoskeletal diseases. Just as projection radiography and magnetic resonance imaging, it has specific possible uses. As a tool to guide interventional and surgical procedures, it is a significant imaging technique. The technical development of multislice spiral CT in recent years has contributed considerably to increasing the diagnostic quality of CT. In particular, the possibilities for depicting the findings with methods for secondary image reconstruction have been decidedly improved.

Bone Diseases↗
PubMed2006

Stapled transanal rectal resection under laparoscopic surveillance for rectocele and concomitant enterocele.

PURPOSE: Stapled transanal rectal resection recently became a recommended surgical procedure for obstructed defecation syndrome. One problem when using a transanal stapling device for rectal surgery is the potential threat to structures located in front of the anterior rectal wall. We decided to perform a combined procedure of transanal rectal resection with a simultaneous laparoscopy for patients with obstructed defecation syndrome and an enterocele. METHODS: Between November 2002 and May 2005 a total of 41 patients were treated surgically for obstructed defecation syndrome. Four patients with concomitant enterocele underwent stapled transanal rectal resection under laparoscopic surveillance. Before surgery all patients underwent preoperative assessment, including clinical examination, colonoscopy, conventional video defecography, dynamic magnetic resonance imaging defecography, gynecology examinations, and psychologic evaluation. RESULTS: The mean operative time was 50 (+/-16.5) minutes for the conventional stapled transanal rectal resection and 67 (+/-14.1) minutes for combined laparoscopy and stapled transanal rectal resection (P < 0.01). Three major complications were observed: two had bleeding in the staple line (one from each group) and one had a late abscess in the staple line. CONCLUSIONS: The combination of the stapled transanal rectal resection procedure and laparoscopy provides the opportunity to perform transanal rectal resection without the threat of intra-abdominal lesions caused by enterocele.

Digestive System Surgical Procedures↗
PubMed2006

Superselective embolization of deep femoral artery branch pseudoaneurysm with a coaxial microcatheter system.

This report describes the use of transluminal coil embolization to treat pseudoaneurysm of deep femoral artery branch in two patients. The pseudoaneurysms had developed after coronary angiographv in one patient and after hip replacement in the other. Immediate control angiography after embolization procedures demonstrated complete closure of the pseudoaneurysms. During follow-up of 19 and 3 months, respectively, there was no recurrent bleeding. The aim of this case report is to show the advances in endovascular microcatheter technology, and embolic materials, that made percutaneous transluminal embolization of arterial pseudoaneurysms safe and efficient. In addition, it keeps the medical personnel aware of vascular injuries at the access site related to endovascular procedures as well as vascular complications of total hip arthroplasty. It calls their attention to the possibility of endovascular treatment as an alternative to surgery.

Aged, 80 and over↗
PubMed2006

[Gas gangrene with ulcerative colitis under immunosuppressive therapy: report of a case].

We report on a 30-year-old male with ulcerative colitis who developed a spontaneous gas gangrene in the right limb, the gluteal muscles and the retroperitoneal region under immunosuppressive therapy. In spite of immediate aggressive surgical and antibiotic therapy the massive infection led to septicemia and ultimately death. Clostridium septicum was identified with multiple local manifestations in the skeletal muscles. Gas gangrene is extremely rare in patients with ulcerative colitis or Crohn's disease and immunosuppression. The therapeutic options are discussed and the relevant present literature is reviewed.

Adult↗
PubMed2006

[Management of pancreatic metastases from renal cell carcinoma report of five cases].

Pancreatic metastases from renal cell carcinoma are rare. In most cases metastases occur many years after nephrectomy. Solitary pancreatic metastases of renal cell cancer can be the only manifestation of tumor dissemination. Between 1995 and 2005 five patients after nephrectomy due to renal cell cancer were suspected of having malignant pancreatic tumor and underwent an operation. The histology revealed metastases of renal cancer. The intervals from primary renal tumor resection to recognition of metastases in the pancreas varied from 6-17 years. The prognosis of metastatic invasion to the pancreas is better than that of primary pancreatic carcinoma. Radical resection of the tumor is the treatment of choice for isolated solitary late metastases of renal cell cancer in the pancreas.

Aged↗
PubMed2005

Minimally invasive and local treatment for mucosal early gastric cancer.

BACKGROUND: Early gastric cancer (EGC) can present an indication for local resection procedures under pertain circumstances. Especially endoscopic mucosal resections (EMRs) and laparoscopic resections or those combined with endoscopy have been made possible in recent years. METHODS: From 1996 to 2004, of a total of 425 patients with gastric cancer, 58 patients with EGC (13.6%) were prospectively analyzed and observed. Of these, 35 patients had preoperatively diagnosed submucosal infiltration and subsequently underwent gastrectomy and standard lymphnodectomy. Of the 23 patients with intramucosal EGC, 22 underwent local resection. One patient displayed lymph node and liver metastasis at the time of diagnosis and received chemotherapy following staging laparoscopy. RESULTS: Among the 23 patients with intramucosal EGC, 13 were female and 10 male. The average age of the patients was 77.4 years (range: 69-86). The rate of lymph node metastasis was 12.5% (n = 35) for submucosal EGC and 4.3% (n = 23) for intramucosal EGC. Twenty-two patients with intramucosal EGC underwent local resection (four EMR, six laparoscopic intragastric resection, 12 laparoscopic wedge resection). The average tumor size was 1.2 cm (range 0.3-2.3). The definitive histological findings yielded in all patients tumor-free resection margins without venous or lymphangic infiltration. In 10 of 18 patients undergoing laparoscopic resection a simultaneous sentinel lymph node sampling (4 +/- 3 LN) was performed. There were no metastases detected. Method-specific complications did not occur. The morbidity of this patient group was 13.6% (three of 22). Mortality was zero. The average postoperative hospital stay was 6.5 days (range 2-12). In the median follow-up of 30.3 months (range 1-86) no recurrences have yet been diagnosed. Four patients died within the observation period of non-cancer-related causes. CONCLUSIONS: Minimally invasive local resection of intramucosal EGC represents a favorable option when strict determination of indication has taken place.

Aged↗
PubMed2005

Intensified concurrent chemoradiotherapy with 5-fluorouracil and irinotecan as neoadjuvant treatment in patients with locally advanced rectal cancer.

This study aimed to evaluate the feasibility and efficacy of neoadjuvant chemoradiotherapy intensified with irinotecan in patients with locally advanced rectal cancer. Eligible patients had nonmetastatic disease at a locally advanced stage that made R0 resection and sphincter preservation uncertain. They received preoperative radiation over 6 weeks to 45 Gy and boost of 5.4 Gy and concurrent continuous infusion 5-fluorouracil 250 mg m(-2) day(-1) and weekly irinotecan 40 mg m(-2). In all, 37 patients entered the study. T stage at baseline as determined by ultrasound was T2/T3/T4 in 2/19/16 patients; 31 patients had lymph node involvement. The predominant toxicity was diarrhoea (grade 3/4 in 10/2 patients). Haematologic toxicity and surgical complications were moderate. Among 36 patients undergoing surgery, 32 (89%) had R0 resection and 23 (64%) sphincter preservation. Pathologic complete response (pCR) was achieved in eight (22%) of 36 patients, and 10 patients (28%) had only microscopic residual disease. At 4 years, overall survival was 66%, disease-free survival 73%, local relapse rate 7%, and distant failure rate 24%. Extent of resection and postoperative nodal status were significant predictors of overall and disease-free survival. Intensified neoadjuvant chemoradiotherapy with irinotecan can be safely administered and results in a high pCR rate.

Adenocarcinoma↗
PubMed2005

[Prospective multicenter trial of gastric cancer surgery--a contribution to clinical research on quality control].

By the mean of a prospective multicenter observational study (East German Gastric Cancer Study - EGGCS), 1 139 consecutive patients with gastric cancer were enrolled in 80 East German surgical departments from January 1 to December 31, 2002. Out of them, 1,031 (90.5%) underwent surgical intervention. The resection rate was 86.4% (n = 891); the R0 resection rate (n = 726) was 81.5%. Gastrectomy was performed in 79.8 % (n = 649) of subjects with radical resections (n = 813). In approximately 70 % of the interventions with curative intention, lymph node resection of the D2 compartment was carried out. The postoperative hospital mortality was 8.3%. The results were compared with the data obtained in the German Gastric Cancer Study (GGCS 1992); relevant differences and aspects were discussed.

Adolescent↗
PubMed2005

[How should patients with completely resected gastrointestinal stromal tumours (GIST) be followed up?].

UNLABELLED: Gastrointestinal stromal tumours are topical because of their uncertain biological behaviour and the potential of treatment with imatinib. In the following study we have examined which pattern of follow-up is both appropriate for detecting recurrences and cost-effective. PATIENTS AND METHODS: Between July 1997 and February 2004 we treated 43 patients diagnosed with a GIST. Patients with high risk (HR), intermediate risk (IR), or overtly malignant (OM) tumours were followed-up regularly. In 2004 we screened all patients independent of their risk of malignant disease with an ultrasound scan and endoscopy followed by endosonography. Further diagnostic procedures were carried out if necessary. RESULTS: Overall, we diagnosed recurrences in five out of 33 patients at risk (two in patients with OM, one in a patient with HR, and 2 in patients with IR according to the NIH criteria). The time period between resection of the primary tumour and recurrence ranged from 4.5 to 33 months. One of the patients with a recurrence was seen before the imatinib era, the other four were treated with imatinib mesylate. CONCLUSION: In our experience, regular follow-up should be restricted to patients with OM, HR, and IR GIST. We suggest that patients are initially seen in six months intervals for two years and annually for another three years thereafter.

Adult↗
PubMed2004

Severe intra-abdominal bleeding following stapled mucosectomy due to enterocele: report of a case.

Stapled rectal mucosectomy (SRM) became a widely accepted surgical procedure for haemorrhoids. One of the rare complications is severe bleeding. We report the case of a patient who underwent SRM for thirddegree haemorrhoids. In addition, he suffered symptoms of outlet obstruction, although defecography showed no serious disease. One day after SRM, the patient complained of abdominal pain and peritonitis. Computed tomography revealed blood in the abdomen. The patient underwent laparotomy, which revealed a deep enterocele that reached down to the level of the sphincteric muscle. The ventral part of the stapled ring was placed intraperitoneally, and a longitudinal defect of the rectal serosa was observed. The serosa defect was sutured and a diverting sigmoid stoma was carried out. The patient left the hospital 10 days later. We emphasize vigilance for undetected enteroceles in mucosal prolapse syndrome combined with defecation problems.

Abdomen↗
PubMed2004

Diagnostic performance of a commercially available computer-aided diagnosis system for automatic detection of pulmonary nodules: comparison with single and double reading.

OBJECTIVE: To assess the diagnostic performance of a commercially available computer-aided diagnosis (CAD) system for automatic detection of pulmonary nodules with multi-row detector CT scans compared to single and double reading by radiologists. MATERIALS AND METHODS: A CAD system for automatic nodule detection (Siemens LungCare NEV VB10) was applied to four-detector row low-dose CT (LDCT) performed on nine patients with pulmonary metastases and compared to the findings of three radiologists. A standard-dose CT (SDCT) was acquired simultaneously and used for establishing the reference data base. The study design was approved by the Institutional Review Board and the appropriate German authorities. The reference data base consisted of 457 nodules (mean size 3.9 +/- 3.1 mm) and was established by fusion of the sets of nodules detected by three radiologists independently reading LDCT and SDCT and by CAD. An independent radiologist used thin slices to eliminate false positive findings from the reference base. RESULTS: An average sensitivity of 54 % (range 51 % to 55 %) was observed for single reading by one radiologist. CAD demonstrated a similar sensitivity of 55 %. Double reading by two radiologists increased the sensitivity to an average of 67 % (range 67 % to 68 %). The difference to single reading was significant (p < 0.001). CAD as second opinion after single reading increased the sensitivity to 79 % (range 77 % to 81 %), which proved to be significantly better than double reading (p < 0.001). CAD produced more false positive results (7.2 %) than human readers but it was acceptable in clinical routine. CONCLUSION: Double reading with CAD as second reader offered a significantly increased sensitivity compared to conventional double reading. Thus, CAD is a valuable tool for the detection of pulmonary nodules and should be used as second opinion.

Adult↗
PubMed2004

[Intraoperative laparoscopic cholangiography -- when is it useful?].

Since the introduction of laparoscopic cholecystectomy (LC), a decrease in the practice of intraoperative cholangiography (IOC) has been reported. Are there actually reasons for carrying on IOC during LC? Depending on the management of common bile duct (CBD) stones treatment a different IOC regime is recommended. If the single-stage laparoscopic extraction of ductal calculi during LC is preferred, routine IOC is generally necessary to detect all CBD stones for desobstruction via ductus cysticus or choledochotomy. When therapeutic splitting is favoured, including two-stage management with endoscopic desobstruction and later LC, routine IOC can be foregone. However, selective practice of IOC can help to reduce the rates of unnecessary preoperative investigations from 40-60 % to 20 % when postoperative endoscopic desobstruction demonstrates similar success rates of about 95 %. Regarding the preventive character of laparoscopic IOC to CBD injuries, a routine investigation should be adopted by institutions with injury rates > 0.4 % and in the learning phase of young surgeons. For all other institutions a selective practice should be recommended when difficult intraoperative conditions render recognition of the anatomical situation more difficult or for identification of dissected non-bleeding ducts near the triangle of Calot.

Cholangiography↗
PubMed2004

Influence of voriconazole and fluconazole on reconstituted multilayered oesophageal epithelium infected by Candida albicans.

Reconstituted multilayered oesophageal epithelium appears to be a good basis to test the efficacy of voriconazole (VOR) and fluconazole (FLU) in the tissue. The resulting model of a Candida oesophagitis was approaching the in vivo situation. We infected the tissue with 2 x 10(6) cfu of the Candida albicans strain SC5314. In the trials with FLU we also used clinical strains. Four hours after infection a good growth of C. albicans appeared mainly with hyphae on the surface of the tissue and a tendency to invasion. The destruction of the tissue began after 36 h. VOR (2 and 16 microg ml-1, respectively) prevented the penetration of hyphae into the tissue, when it was given 4-8 h after infection. It was less effective in reduction of Candida growth on the tissue surface. When VOR was given 16-24 h postinfection, the Candida infiltration stopped more slowly. Thirty-six hours after infection VOR application could not stop the destruction of the tissue despite reducing the fungi. The results with FLU (32 microg ml-1) were in principle the same, but not so distinct. FLU seems to be more effective against clinical strains of C. albicans than against the type strain.

Antifungal Agents↗
PubMed2004

[Mycoserologic tests in surgical intensive care patients and patients with Candida oesophagitis].

We retrospectively analysed the results of Candida serological testing of 126 surgical intensive care patients. There were high numbers of patients which were mycoserologically positive (haemagglutination test HAT 86.4%, immunoglobulin subclasses 85.3%). Positive microbiological cultures of Candida spp. were found in 43.7% of the patients. Patients with positive cultural findings had an increased HAT titre in 83.9% and increased immunoglobulins in 74.2%. These patients were suspected to have a Candida infection. The correlation to higher titres was much closer in patients with an invasive Candida infection like candidaemia and oesophagitis.

Antibodies, Fungal↗