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K-M Müller

Publications and source records attributed to K-M Müller.

At least 19 recordsLinked to original sources
PubMed2007

[Diverticulum of the ductus arteriosus. Cause of traumatic aortic ruptures?].

INTRODUCTION: According to angiographic studies 9-26% of all adult aortae show a ductus arteriosus diverticulum (DAD), i.e. an indention of the aortic wall at the insertion of the obliterated ductus arteriosus. This region is predisposed for traumatic aortic rupture. Up to now fixation at the transition from aorta transversa to fixed aorta descendens is regarded as cause. It is unclear whether ductus diverticulum favours traumatic aortic rupture. MATERIAL AND METHODS: A total of 143 thoracic aortas (female symbol:37; male symbol:106, 17-91 years) were scanned histomorphologically for DAD. Calcification was quantified by CT multislice volume scan. RESULTS: A DAD was detected in 44% of macroscopically non-calcified and slightly calcified aortic specimens. Histologically, autochthonal elastic and collagenous fibres of the media were disrupted. CT in macroscopically non-calcified aortas proved isolated calcification in 78%. DISCUSSION: The incidence of 44% DAD-higher than in angiographic studies-can be explained by the method (histopathology), allowing diagnosis of diverticula down to microm. These morphological alterations are to be seen, at least in part, as a causative factor for the predilection to traumatic aortic ruptures.

Adolescent↗
PubMed2006

[Cell reactions to amber: amber lung in experimental animals].

UNLABELLED: Workers in the amber-processing industry are heavily exposed to amber dust during the cutting and grinding. Nothing is known about the effect on the lung of inhalation of amber dust. We studied the histological changes after subcutaneous injection of amber dust in man and the rat and after inhalation of amber dust in the rat. RESULTS: 1. The subcutaneous injection of amber dust led to acute inflammation and later to inflammation with large numbers of macrophages and giant cells, forming giant cell granulomas. 2. There was brisk phagocytosis of the amber dust by macrophages. Digestion of amber could not be identified with certainty. 3. Moderate inhalation of amber led to intraalveolar and intrabronchial phagocytosis, predominantly by macrophages. 4. After intense, repeated inhalation (4 and 6 1/2 months post-inhalation) peribronchiolar foreign body granulomas and fibroblasts were seen. In contrast to the findings in the skin (probably related to grinding paste), no epithelioid cell granulomas were found in the lung. The tissue reactions in man are similar to those in the rat. The inflammatory and fibrotic interstitial reactions observed in the rat lung after prolonged intense exposure to amber dust suggest that chronic pulmonary damage ("chronic amber lung") could occur as a result of occupational exposure to amber dust during cutting/polishing.

Amber↗
PubMed2006

[Drug-induced pulmonary damage].

The frequency of drug-induced damage to the lung in inpatients is estimated to be about 10%. Pathoanatomically, varying damage patterns result, ranging from acute pulmonary edema via inflammatory reactions to pulmonary fibrosis. The ATS/ERS 2001 classification, which is based on the suggestions made by Liebow 1969, is an accepted system for classifying findings according to recurring patterns. Generally, there are no specific morphological findings which allow safe conclusions on possible administered drugs. Clinical information is mandatory. Differentiation from pulmonary alterations due to the underlying disease is often difficult. In daily routine diagnostics, it is important to consider iatrogenic causal factors in cases of "undetermined pulmonary disease".

Diagnosis, Differential↗
PubMed2006

[Mediastinal metastasis of a tubal choriocarcinoma following ectopic pregnancy as a rare cause of thoracic pain].

We report on a 26-year old female patient with thoracic pain and dyspnea, in whom a large tumorous mass in the anterior mediastinum with a pleural effusion was diagnosed by computed tomography and magnetic resonance imaging. After rapid progression of tumor growth and detection of malignant cells within the pleural effusion operative intervention including resection of the tumor was performed. Histologic examination of the tumor revealed the typical morphology of a large mediastinal choriocarcinoma. The excessively high hCG-levels returned to normal values post-operatively. A thorough history making revealed an ectopic pregnancy which had made unilateral salpingectomy necessary. Although primary histologic examination of the tubarian tissue had shown no malignancy, a secondary look revealed a choriocarcinoma with identical histological features compared to the mediastinal tumor. Thus, final diagnosis of a mediastinal metastasis of a tubarian choriocarcinoma in ectopic pregnancy was made. We discuss this extremely rare disease and provide a short overview of the literature.

Adult↗
PubMed2006

[Comparison of patterns of metastasis between malignant pleural mesotheliomas and pulmonary carcinomas].

Starting with the question whether there is a principal difference in the metastatic behaviour of pleural mesothelioma and pulmonary tumors, a detailed retrospective study of the findings of 210 post-mortem examinations between the years of 1992 to 1999 was conducted. The spectrum of metastatic sites is very large in malignant pulmonary carcinomas (n = 148) as well as in malignant pleural mesotheliomas (n = 62). There is no significant difference in the TMN-staging between both tumor groups at the time of death. One exception was the brain: there were significantly more metastases from the pulmonary tumors. Carcinomas metastasized more frequently into the skeleton, the kidneys and the adrenal glands, while metastases of mesotheliomas were more often found in the peritoneum. As of the moment there is no significant difference in the pattern of metastasis between both tumor groups discernible.

Cadaver↗
PubMed2005

[Pulmonary hypertension in chronic myeloproliferative disorders].

We report on three autopsy cases with clinical and morphological evidence of pulmonary hypertension and concurrent myeloproliferative disorders. Massive accumulations of pleomorphic, atypical megakaryocytes and thrombotic material are found within the pulmonary capillary beds. Morphometrical studies allowed us to identify on average 1,293.4 (1,145.8-1,401) megakaryocytes per one square centimetre lung tissue (standard value: 25 megakaryocytes/cm(2) lung tissue). The lungs of the controls with unaffected parenchyma show smaller numbers of megakaryocytes. It seems highly unlikely that these haematopoietic cells originate in lung capillaries in the absence of morphological correlates. Recurrent chronic microemboli consisting of megakaryocytes and thrombocytes could be held responsible for the development of secondary chronic pulmonary hypertension. Our observations suggest that pulmonary hypertension associated with chronic myeloproliferative disorders should be classified into the fourth group of the EVIAN-classification of pulmonary hypertension.

Aged↗
PubMed2005

[Comparison of chromosomal defects in primary tumor and metastases by comparative genomic hybridization (CGH)].

Molecular methods can complement the classical methods in pathology like macroscopic, histological and immunohistochemical examinations.Comparative genomic hybridization is a cytogenetic method to screen for gains and losses of chromosomal material in tumor cells. This method allows defect studies of archival paraffin-embedded and formalin-fixed tumor material. CGH can detect gains and losses of chromosomal material that are at least 10 to 20 megabases in size. This genome-wide screening method allows to study the cytogenetic relationship between differently located tumors of a patient. To answer the question if these different tumors are metastases of the primary lung tumor or independent primary tumors CGH analysis is a supplementary method that introduces new prospectives.

Chromosome Aberrations↗
PubMed2005

[Tenosynovial giant cell tumor].

Morphological, ultrastructural, and immunohistochemical findings of 12 diffuse type-tenosynovial giant cell tumors/pigmented villonodular synovitis are presented compared to 30 localized tenosynovial giant cell tumors (giant cell tumor of tendon sheath). Diffuse-type-tenosynovial giant cell tumor is characterized by a striking vascularisation pattern composed of densely arranged thin-walled, partly slit-like and partly hyalinized small blood vessels within the papillary synovial fronds. These vessels may show abnormal structures with incompletely arranged endothelial cells/pericytes. The fibrohistiocytic tumor cells probably cause considerable compression/distortion or destruction of the small vessels which might be responsible for an increased blood deposition and massive hemosiderosis. Accompanying multinucleated osteoclast-like giant cells seemingly are recruited from circulating blood monocytes. Microhemorrhagic foci with multinucleated giant cells could be detected in 83% of diffuse-type and 67% of localized-type tumors. Apart from the described vessels, typical morphological findings in diffuse-type tenosynovial giant cell tumors included "giant" hemosiderotic granules, (at least 2-3 times the diameter of an erythrocyte) "giant" siderophages, pseudoalveolar clefts and irregularly anastomosing synovial fronds. Neither mitotic rate nor the amount of giant cells/amount of nuclei of giant cells revealed statistically significant differences between localized-type and diffuse-type of tenosynovial giant cell tumor. Immunohistochemically, the diffuse-type exhibited focal expression of CD31 (in 75% of tumors) and calretinin (in 63%) besides CD68-staining.

Antigens, CD↗
PubMed2005

[Desmoid-type fibromatosis (aggressive fibromatosis)].

Desmoid-type fibromatoses (aggressive fibromatoses) represent infiltrative, locally destructively growing soft tissue tumors with a high potential for recurrence. Desmoid tumors of 33 adult patients were analysed regarding clinical and morphological aspects (sex, age distribution, site, size, mitotic rate, tumor microvessel density, surgical margins, additional radiotherapy). Possible statistical correlations were examined using log-rank-tests. No prognostic significance of tumor microvessel density was evident. A correlation between mitotic index (1 or more mitoses per 50 high power fields) and local relapse rate was notably striking, but not statistically significant (log-rank: 0.17). Additional postoperatively applied radiotherapy proved to be statistically significant to avoid local recurrences (log-rank: 0.01). The presented results may indicate an increased risk for local relapse in those desmoid-type fibromatoses which are mitotically active. Postoperative radiotherapy seems to be effective in the treatment of aggressive fibromatosis to avoid tumor recurrence. Differential diagnosis of desmoid-type fibromatosis/aggressive fibromatosis in adulthood include various fibroblastic/myofibroblastic soft tissue tumors such as nodular fasciitis, fibrosarcoma, low-grade fibromyxoid sarcoma, myofibroblastic sarcoma as well as leiomyosarcoma and soft tissue leiomyoma.

Adult↗
PubMed2005

[Leiomyosarcoma of the inferior vena cava. Review of a rare disease].

Primary sarcomas of the great vessels are rare. Their most common site is the inferior vena cava. We report a primary leiomyosarcoma of a 41 year old female patient localised just below the right renal vein. The resected tumour showed the histological signs of a well differentiated, progesterone positive leiomyosarcoma. The case is discussed on the data of the reviewed literature.

Adult↗
PubMed2005

["Pneumocytoma" or "sclerosing hemangioma": histogenetic aspects of a rare tumor of the lung].

Aspects of histogenesis and nomenclature of so called "sclerosing hemangioma" of the lung (WHO 1999) are discussed and compared with immunohistochemical findings in eight examined operation specimen. The lesion is characterised by the presence of typical surface cells, which can be related to type II pneumocytes. Progesterone-receptor positive stromal cells may derive from primitive mesenchymal cells. Endothelial proveniance of tumor cells could not be confirmed by immunohistochemistry. Therefore, this rare usually benign pulmonary neoplasm should be entitled "pneumocytoma" analogous to the suggestion of several other authors.

Female↗
PubMed2005

[Correlation of histologic results with PET findings for tumor regression and survival in locally advanced non-small cell lung cancer after neoadjuvant treatment].

UNLABELLED: CT cannot provide useful information in a timely manner after neoadjuvant treatment. To evaluate the role of (18)F FDG PET after neoadjuvant chemoradiation for early therapy response and its effect on survival as compared to histopathologic tumor response, findings in 32 patients were analyzed prospectively in an ongoing multicenter trial (LUCAS-MD). INCLUSION CRITERIA: histologically confirmed NSCLC stage IIIA/IIIB. Neoadjuvant treatment: 2-3 cycles with paclitaxel/carboplatin and a block of chemoradiation followed by surgery. Pretherapeutic staging: PET scan in addition to a spiral CT and/or MRI. Second PET scan after completion of neoadjuvant therapy prior to surgery. Documentation of lymph node involvement. Assessment of SUV and the metabolic tumor index for primary tumor and metastatic lymph nodes. Image fusion of PET with CT data followed by molecular radiation treatment planning. Evaluation of histologic regression grade and correlation with PET for primary tumor and each lymph node location. All patients (10/32) with complete response in lymph node metastases detected by PET prior to surgery, had no vital tumor cells (i.e. histologic regression grade/RG III, sensitivity 100%). In primary tumors showing complete response, the RG was IIb or III, in one patient IIa (false negative in PET). False positive findings in PET are due to inflammation (5 patients, histologically confirmed). Univariate analyses: actuarial tumor-specific survival for complete metabolic remission vs. incomplete remission after 24 months: 76 vs. 20% (p=0,0079); for RG III/IIb vs. RG IIa/I after 24 months: 63 vs. 36% (p=0,0123).(18)F FDG PET precedes CT in measuring the tumor response and may predict (long term) therapeutic outcome in stage III NSCLC. Histologic regression grade correlates well with metabolic remission as detected by PET.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

[CT-Guided transthoracic aspiration of peripheral pulmonary nodules with a special bioptic needle].

Peripheral pulmonary nodules are difficult to reach bronchoscopically, so for a long time it has been tried, by the use of imaging techniques like X-ray, ultrasound and computed tomography, to aspirate these nodules for exact histological diagnosis. The computed tomography offers the best spatial orientation for methodical reasons, thus this technique is performed increasingly and with great accuracy in pulmonary lesions. Complications like bleeding into lung parenchyma or small pneumothorax after aspiration can be detected easier by computed tomography. In this study we evaluated the use of a special bioptic technique with the AUTOVAC(R) needle in 30 cases. Causing low parenchymal damage to the lung, this bioptic needle enables extraction of representative tissue samples for further pathological examination. In 21 of 30 (70 %) cases the histological specimen led to the diagnosis of malignancy, but 8 of those malignant specimen could have been verified as primary or secondary malignancy by using additional immunocytochemical techniques. In 2 of 30 cases (7 %) harmless hemorrhage into lung parenchyma occured after aspiration. In another 4 of 30 (13 %) cases pneumothorax occurred, requiring chest tube placement. The ct-guided lung biopsy with the AUTOVAC(R) needle represents a safe, low resilient diagnostic tool to obtain large tissue samples of specimen in good quality. Even in patients with compromised lung function because of severe chronic obstructive lung disease and/or emphysema, the described aspiration technique can be performed, if at the moment of aspiration procedure a pneumologist with corresponding equipment and trained medical staff is present, in order to place a chest tube in case of pneumothorax.

Biopsy, Needle↗
PubMed2005

[Psychiatric and neuropsychological signs and symptoms in patients with fabry disease: literature review].

Fabry Disease (FD) is an X-linked lysosomal storage disorder (prevalence about 1 : 100 000) caused by a genetic defect associated with a lack of alpha-galactosidase A (alpha-GAL) enzyme activity. As a consequence, neutral glycosphingolipides can not be cleaved and metabolized, and accumulate in lysosomes of several tissues, particularly in vascular endothelium and smooth muscle cells. The most prominent symptoms comprise pain attacks and acroparesthesia, angiokeratoma, corneal opacity, renal and cardiac dysfunction, hypo- and anhidrosis, gastrointestinal symptoms, and cerebrovascular dysfunction with vertigo, headache, and cerebral ischemia. Characteristic symptoms of FD can occur in male and female patients with the same prevalence, while females with FD seem to be less severely affected. The course of untreated illness is progressive with considerable interindividual variability. Since 2001 two enzyme replacement therapies are approved which can possibly stop the disease progress and alleviate symptoms. The very few reports and clinical observations have shown that a very high proportion of FD patients develop neuropsychiatric symptoms. However, accurate data are lacking. Although the pathophysiologic mechanisms are quite unknown, it is surmised that sphingolipid deposits in the endothelium of small cerebral vessels lead to regional cerebral ischemia accompanied by neuropsychiatric symptoms and deficits. Furthermore, patients with FD are chronically distressed by pain attacks and additional somatic and psychological impairment. Frequently, pain attacks are triggered by psychosocial stress. The high interindividual variability can, thus, also be interpreted on the basis of existing stress and coping models. The present paper will review the presently available psychiatric and neuropsychological findings in FD and will discuss difficulties associated with classification and differential diagnosis of psychiatric disorders occurring in patients with FD.

Fabry Disease↗
PubMed2005

[Bronchocentric granulomatosis].

Bronchocentric granulomatosis is a rare disease, which has to be taken into consideration in the differential diagnostic of pulmonary nodules and tumors. Two cases are presented, in which only open lung biopsy made it possible to get the diagnosis of bronchocentric granulomatosis. A 78-year-old woman presented with multiple small pulmonary nodules with aspergillus colonization, whereas an 83-year-old man presented with a large mass in the left upper lobe. Corticosteroid therapy led to sustained remission in both patients. The case reports will underline that bronchocentric granulomatosis is not a uniform clinical entity, but has variable clinical and radiological appearances. Its former subdivision into two forms differing by the occurrence of asthma with the coexistence of an aspergillus colonization, does not represent the many different manifestations. Until now the etiology of bronchocentric granulomatosis is uncertain. But there are hints, that the granulomatous inflammation might be the uniform response to different causes. The definite diagnosis of bronchocentric granulomatosis can only be made histologically. This mostly requires surgical lung biopsy. With therapy -- either surgery or corticosteroid therapy or the combination of both -- the prognosis is good.

Aged↗
PubMed2005

Autofluorescence bronchoscopy with white light bronchoscopy compared with white light bronchoscopy alone for the detection of precancerous lesions: a European randomised controlled multicentre trial.

BACKGROUND: The potential of autofluorescence bronchoscopy (AFB) to detect precancerous lesions in the central airways and its role in lung cancer screening is uncertain. A study was undertaken to evaluate the prevalence of moderate/severe dysplasia (dysplasia II-III) and carcinoma in situ (CIS) using a newly developed AFB system in comparison with conventional white light bronchoscopy (WLB) alone. METHODS: In a prospective randomised multicentre trial, smokers > or = 40 years of age (> or = 20 pack-years) were stratified into four different risk groups and investigated with either WLB+AFB (arm A) or WLB alone (arm B). RESULTS: 1173 patients (916 men) of mean age 58.7 years were included. Overall (arms A and B), preinvasive lesions (dysplasia II-III and CIS) were detected in 3.9% of the patients. The prevalence of patients with preinvasive lesions in the WLB arm was 2.7% compared with 5.1% in the WLB+AFB arm (p = 0.037). For patients with dysplasia II-III, WLB+AFB increased the detection rate by a factor of 2.1 (p = 0.03), while for CIS the factor was only 1.24 (p = 0.75). The biopsy based sensitivity of WLB alone and WLB+AFB for detecting dysplasia II-III and CIS was 57.9% compared with 82.3% (1.42-fold increase). The corresponding specificity was 62.1% compared with 58.4% (0.94-fold decrease). CONCLUSIONS: This first randomised study of AFB showed that the combination of WLB+AFB was significantly superior to WLB alone in detecting preneoplastic lesions. Our findings do not support the general use of AFB as a screening tool for lung cancer, but suggest that it may be of use in certain groups. The precise indications await further study.

Adult↗
PubMed2004

Factors influencing long-term survival in mesothelioma patients--results of the German mesothelioma register.

Between 1987 and 2000, the German mesothelioma register recorded a total of 4,455 patients with malignant mesotheliomas. Survival times for 498 (11.2%) patients were available; 155 patients (study group, 3.5% of the total group) survived for more than 2 years and 343 patients (control group, 7.7% of the total group) survived for fewer than 24 months. Male patients were over-represented in both groups, with 13% of women in the study and 4.4% in the control group. The proportion of pleural mesotheliomas was more than 90% in both groups, with peritoneal cases comprising 6.5% in the study group and 3.2% in the control group. Histologically, the epithelioid subtype was represented in 58% of the study group, whereas the biphasic subtype predominated (67.6%) in the control group. Only 7% of tumours were of the sarcomatoid subtype. The average age of patients in the study group was 57.4 years, thus lower than in the control group (62.8 years). Lung dust analysis showed an increased pulmonary asbestos burden in 94% of all patients; significant differences between the study and control group were not observed. In the majority of the total group pleural effusions were the first symptoms. Therapeutic data were available in fewer than 40% of all cases. Surgical interventions were performed, partly in combination with radiation and chemotherapy and as alternative treatments. Significant deviations in survival time dependent on therapy applied could not be proved. By multivariate analysis (Cox proportional hazards regression model) favourable prognostic factors for long-term survival were epithelioid tumour subtype, comparatively young age (<60 years), and female gender ( P<0.05).

Aged↗