Biomedical subjects
Publications and source records attributed to L Heuser.
In 43 patients with a total of 86 aortocoronary bypass grafts digital subtraction angiography was employed in the early post-operative period. Contrast injection into the aortic root allowed in all instances a definitive answer whether the aortocoronary bypass was free or obstructed. The method makes it possible also to assess distal anastomoses and their connected coronary vascular bed.
Masses in the head of the pancreas area may be caused by neoplastic, inflammatory and a variety of other processes originating within the pancreas or in adjacent structures and organs. CT following intravenous bolus injection of the contrast agent and oral staining of the small bowel allows the precise anatomic localization of the lesion and helps to evaluate its dignity and pathology. Nevertheless, frequently the final can be established only at open surgery and by histopathologic examination of the resected specimen.
Based on the sonographic findings in 107 cases with proven peritoneal carcinomatosis (PCA) by either gynaecological or gastrointestinal tumors the diagnostic value of ultrasonography and its limitations in differentiation of peritoneal fluid accumulations and masses are presented.
In 38 patients suffering from mitral valve disease the findings of cardiac CT scans were compared to the results of echocardiographic, standard roentgenographic, and cineangiocardiographic studies as well as to intraoperative and histological findings. CT proved to be superior to the other imaging modalities in detecting mitral calcifications and in demonstrating the morphological changes, but cannot replace cardiac catheterization as it does not yield haemodynamic data. The indication for CT in mitral valve disease therefore is restricted to cases with extremely enlarged left atria in which the other methods do not provide satisfactory visualization, and to patients with suspected intracavitary thrombus or tumor.
Despite numerous reports about combined therapy of gastrointestinal tumours no detailed analysis of considerably manifold side effect has been established. In this study the therapeutic results and morbidity of irradiation in 64 patients are compared with 37 courses of combined therapy for recurrences and/or metastases. Modalities in combined therapy consisted of radiotherapy and hyperthermia or chemotherapy, or chemotherapy and hyperthermia respectively. Toxicity from combined therapy was seen more frequently and pronounced, requiring variations in therapy management up to 54% versus 17% in patients irradiated. Dose reductions (15% vs. 8%), intervals (30% vs. 14%) and its duration (14 vs. 6 days) extended the overall treatment times. In 21% combined therapy was interrupted totally (vs. 11% mainly caused by non therapy specific other diseases, respectively rapid tumour progression) or in another 13% continued sequentially. No improved results were seen following combined therapy, but an intolerably high risk of serious complications (up to 71% in combination of radio- and chemotherapy). With the dosages, fractionations and techniques used combined therapy can be performed only in a sequential course for palliation of advanced gastrointestinal tumours. We assume that morbidity of hyperthermia in most cases is considerably higher than its therapeutic gain.
Cisplatin (20 mg/m2 on five successive days, together with hydration and osmotic diuresis) was administered in two treatment cycles to 32 patients with locally advanced tumours (T2-4, N1-3, M0) of the head and neck region. Cisplatin-free interval was at least four weeks. At the same time there was radiotherapy with photons or electrons, daily fractions of 2 Gy four to five times weekly to a final volume dose of 60-70 Gy. Tumour resection was undertaken if there was no tumour involution of at least 50% after 40 Gy and one cisplatin cycle. Total remission rate (complete and partial) was 91%. Complete remission occurred in 22 patients (69%). Biopsies in 14 patients after 40 Gy and one cisplatin cycle indicated that in seven there was no histological evidence of tumour. There was no clinically serious rise in local toxicity. However, erythema and oedema in the radiation fields were more frequent and earlier than with radiotherapy alone. The results indicate that combined cisplatin administration and radiotherapy give the same or even better results than aggressive chemotherapy followed by radiotherapy.
We reviewed 28 cases of primary retroperitoneal tumors (1972 to 1982). We found 22 malignant and six benign tumors. The tumors revealed no special features. Cardinal symptom was a palpable abdominal mass in 21 of 28 patients (75%). Since 1978 we have at our disposal a modern radiological technique, the computerized tomography, which allows a statement of tumor localization, tumor size and infiltration of neighbouring organs. In our patients no definite statement could be made about resectability and type of the tumors. In spite of computerized tomography there is no change the road-minded operation indication. Surgical therapy is the treatment of choice because of lacking alternatives. Complete extirpation to cure, respectively exploratory laparotomy and biopsy to determine the specific nature of the tumor by histological examination should be aspired. In individual cases palliative gastrointestinal anastomoses are necessary to treat intestinal obstruction. All six benign, but only six of 22 (27%) malignant tumors were completely removable. Although in some cases neighbouring organs were respected, no patient died after operation. For a curative therapy the early diagnosis of the tumors is necessary.
Nine patients presenting with intracardiac masses were examined by ultrasound (US) and computed tomography (CT). Of these, 6 patients with atrial myxomas were diagnosed primarily by US, with the movement of the pedunculated tumors well visualized by this technique. The myxomas and the three solid tumors were demonstrated by CT as contrast defects following the intravenous administration of contrast medium. Two solid intraventricular tumors, however, were overlooked by US. In the detection of solid tumors CT is considered superior to US, owing to its better geometric resolution. Generally solid tumors require heart catheterization to obtain information about the blood supply. Visualization of atrial myxomas by CT and US, in contrast, should be followed by immediate operation without additional invasive procedures.
A case report is given of a 37-year-old patient who had echinococcus infestment the heart. Diagnosis was established after drainage of the pericardium, when cysts of a diameter between 0.5 and 3 cm were evacuated. During this procedure the pericardium and the left ventricle were searched and revised extensively and drug therapy with Mebendazole was instituted. In spite of that a new cyst developed in the pericardium and a big cyst in the abdomen, was found which had practically transformed the whole left lobe of the liver into a cyst. Both lesions were removed surgically. It must be emphasized 1) that a very careful search of all organs liable to harbour echinococcus should be performed in patients who have cardiac involvement of the disease, 2) that chemotherapy will not prevent with necessity the development of fertile elements which could not be removed during surgery and 3) that patients have to be followed through several years in order to evaluate the success of therapy.
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Isolated levocardia combined with corrected transposition of the great arteries and complete situs inversus is rare. Due to discordant interrelationships between atria and ventricles and between ventricles and great arteries, both anomalies result in a normal circulation. In the presented case no associated cardiac malformations were present and the 55-year-old woman remained symptom-free for a long time until she developed an acquired valve disease. A systematic approach to chamber localisation in complex morphologic lesions of the heart is reviewed, and the value of CT, which can be applied successfully in older children and adults is demonstrated.
In 328 patients with 611 aortocoronary bypass grafts CT was performed and 96 of them with 199 grafts were additionally studied by angiography. The results showed a sensitivity of 92,6%, a specificity of 78,1% and an overall accuracy of 87,9% for CT, which proved to be a reliable method for non-invasive direct visualization of aortocoronary bypass grafts. It can be performed within few days after surgery and also in out-patients as a follow-up study. Graft occlusion demonstrated in CT should be verified by angiography, whenever it results in a therapeutic consequence. Conversely if CT reveals patency of the graft, an angiographic control study is not necessary.
Cardiac imaging by means of CT requires administration of intravenous contrast medium which can be applied by infusion or by rapid bolus injection. Contrast infusion is easier in performance and yields opacification of all cardiac cavities. Using bolus technique selective enhancement of cardiac chambers can be obtained which provides increased image quality and better resolution of cardiac structures. Both techniques are described and the results of 221 examinations are analysed with special respect to image quality, technical amount and contrast media side effects.
Two weeks after epidemic parotitis a 10-year old boy developed an acute extrapyramidal syndrome together with pyramidal tract signs but without impairment of consciousness. The CSF showed mild pleocytosis. The CT of the brain exhibited a well defined circumscribed and symmetrical swelling and hypodensity of the basal ganglia and of the internal capsule. Only slight and transient dysrhythmia was to be found in the EEG. Therapy with Prednisolone, Biperidene and Tiapride resulted in regression of symptoms. But one year later rigor and pyramidal tract signs remained evident in spite of intensive physiotherapy and logopaedic measures. Residual symmetric atrophia of the basal ganglia became evident in the CT by dilatation of the anterior horns of the lateral ventricles caused by lacking of the vault of the caudate nuclei heads.
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This study identifies associations between the actual doubling time of primary mammary cancers with histopathologic characteristics and Wolfe's parenchymal mammographic patterns. Seventy microscopic criteria and Wolfe's mammographic parenchymal patterns were coded for 32 primary breast cancers on which actual volume doubling times were calculated from serial mammographic views of tumor nucleus shadows. Circumscribed cancer margin and papillary intraductal growth were associated with slow-growing breast cancers. More anaplastic nuclear grade was associated with faster-growing cancers. No association could be established between doubling time and parenchymal patterns as described by Wolfe.
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