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Biomedical subjects

M Hünerbein

Publications and source records attributed to M Hünerbein.

At least 73 records · Page 4Linked to original sources
PubMed1997

[Thoracoscopy is a reliable alternative to thoracotomy in peripheral lung coin lesion].

Video-assisted thoracoscopy (VATS) is useful for improving preoperative diagnosis and staging in patients with peripheral pulmonary lesions. Additional information obtained by VATS had a major influence on the therapeutic strategy in 34% of the patients, and in 39% of the patients in the conventional surgery group thoracotomy could possibly have been avoided if VATS had been available.

Diagnosis, Differential↗
PubMed1996

Laparoscopic lymph node assessment in pretherapeutic staging of gastric and esophageal cancer.

In gastric cancer lymph node metastases at the hepatoduodenal ligament and in esophageal cancer, metastases at the celiac axis are classified as distant metastases (M1 LYMPH) and implying a poor prognosis. In pretherapeutic staging, imaging procedures such as computed tomography of the abdomen or transcutaneous ultrasonic examination are of limited value in the assessment of enlarged or metastatic lymph nodes. Conversely, laparoscopic staging with subsequent biopsy of suspicious lymph nodes provides essential diagnostic information. After exclusion of distant metastases (liver, lung, bone) in 73 patients with esophageal-(n = 21) and gastric cancer (n = 52), staging laparoscopy, including laparoscopic ultrasound, were performed during an 18-month-period (July/ 93-December/94). After laparoscopic exclusion of peritoneal seedings, the hepatoduodenal ligament was examined and enlarged lymph nodes were biopsied. In a total of 73 patients, laparoscopy revealed previously undiagnosed liver metastases in 14 and peritoneal carcinosis in 19 patients. Additionally, in eight (esophageal cancer; n = 3, gastric cancer; n = 5) of the remaining 40 patients, lymph nodes in the M1-position were regarded suspicious and biopsied. In six of these, malignant spread was observed. Thus, in a further six of 40 patients, surgically incurable situations could be detected. In esophageal and gastric cancer, staging laparoscopy, including laparoscopic ultrasound and biopsy, is a sensitive technique to assess local tumor spread and distant metastases. The detection of M1- lymph node metastases is facilitated by the use of laparoscopic ultrasound. Tumor spread, which limits surgical curability, can be properly assessed and exploratory laparotomy avoided.

Esophageal Neoplasms↗
PubMed1996

Radiological modalities in the staging of colorectal tumors: new perspectives for increasing accuracy.

The purpose of this study was to evaluate the diagnostic accuracy of contrast-enhanced endorectal MRI for the staging of rectal adenoma versus rectal carcinoma in correlation to findings from biopsy and histopathology. Ten volunteers and 20 patients underwent body-coil and endorectal MRI (1.5T supraconducting unit) using plain, T1-weighted (w) T2-w SE and TSE-w sequences, a dynamic Gd-DTPA enhanced protocol (turboFLASH), and postcontrast T1-w-SE sequences. Histopathological correlation via biopsy (n = 10) and surgical resection (n = 19) were conducted for all patients. An independent, two-observer, reader evaluation was performed and qualitative and quantitative data calculated. In volunteers and all patients endorectal MRI reliably delineated normal wall layers. Rectal adenomas (n = 7) were identified by a visualization of an intact muscularis mucosae, a homogeneous inner structure, and a significant contrast enhancement. T1 carcinomas (n = 4) were best identified in dynamic turboFLASH sequences by delineation of an intact muscularis propria. The visualization of contrast-enhancing tumor tissue was indicative of a T2 carcinoma (n = 4). All T3 (n = 3) and T4 (n = 2) carcinomas were correctly staged on dynamic and static MRI. The endorectal MRI stage agreed with the staging results from pathological study in 16 of 20 (80%) patients. Endorectal surface coil MRI provides reliable data for the preoperative staging and evaluation of rectal lesions.

Adult↗
PubMed1996

External fixation of intra-articular fracture of the distal radius in young and old adults.

Forty patients (18-89 years old, mean 58 years) with comminuted intra-articular fractures of the distal radial end (AO-type C 2 or C 3) treated with external fixation could be followed for an average of 2.3 years. After 3 weeks, the distraction was released, and after another 3 weeks, the device was removed. Complications seen were one malunion, one radial shaft fracture caused by excentric drilling of a Schanz screw, one Sudeck atrophy, and one subcutaneous pin-track infection. Radial and ulnar deviations were reduced to 52% and 71% of the untreated wrist, whereas the range of motion in the other planes reached about 80% or more of the healthy side. In all, 82.5% of the patients showed good or excellent radiological and functional results. This study demonstrates that external fixation of distal radial C 2 and 3 fractures for 6 weeks results in good recovery for young patients and elderly patients with osteoporosis.

Adult↗
PubMed1996

Evaluation and biopsy of recurrent rectal cancer using three-dimensional endosonography.

PURPOSE: The value of endorectal ultrasonography for postoperative follow-up of rectal cancer is limited by the inability to distinguish recurrent malignancy from benign lesions, e.g., fibrotic tissue. This study was conducted to investigate the role of three-dimensional (3D) endosonography for evaluation and biopsy of recurrent rectal cancer. METHODS: Endorectal ultrasonography was performed in routine follow-up program after resection of rectal cancer. 3D volume scans were recorded using a bifocal multiplane 3D transducer (7.5/10 MHz) with a 100 degrees longitudinal and a 360 degrees transversal scan angle. For transrectal ultrasound-guided biopsy of pararectal lesions, a specially designed targeting device was attached to the endoprobe. RESULTS: Overall pararectal lesions were detected in 28 of 163 patients (17 percent) who were undergoing endorectal ultrasonography for follow-up after resection of rectal cancer. 3D image analysis facilitated assessment of suspicious pararectal lesions by contemporary display of three perpendicular scan planes or volume reconstructions of the scanned area. Ultrasound-guided biopsy was performed in all 28 patients with pararectal lesions identified by endorectal ultrasonography. Biopsy revealed recurrent disease or lymph node metastases in seven and two patients, respectively. Benign lesions explained the endosonographic findings in 17 patients. All patients with benign histology still have no evidence of recurrent disease after a median follow-up of seven months. Nonrepresentative material was obtained in only 2 of 28 patients (accuracy, 93 percent). Histology changed the endosonographic diagnosis in 28 percent of cases. CONCLUSIONS: 3D endosonography with ultrasound-guided biopsy improves the diagnosis of extramural recurrence after curative resection of rectal cancer. 3D image display allows precise control of the position of the biopsy needle within the target.

Biopsy↗
PubMed1996

Three-dimensional endorectal ultrasonography for staging of obstructing rectal cancer.

PURPOSE: Preoperative staging of advanced carcinoma of the rectum by conventional endorectal ultrasonography is often impossible because of the presence of obstruction, which does not allow passage of the endoprobe. In a prospective study, we investigated the value of three-dimensional endorectal ultrasonography for staging of obstructing rectal cancer. This technique permits examination of obstructing rectal tumors because scan planes can be chosen deliberately within a scanned volume. METHODS: Overall obstructing tumors not accessible for conventional endoprobes were found in 26 of 94 patients who were subjected to endorectal ultrasonography for staging of rectal cancer. Three-dimensional volume scanning was performed using a three-dimensional frontfire transducer or a three-dimensional bifocal multiplane transducer (7.5/10 MHz). Data of the three-dimensional scans were stored on a hard disk for subsequent evaluation with a combison 530 processor. RESULTS: Three-dimensional transrectal endosonography enabled visualization of local tumor spread in all 26 patients. In 18 patients, obstruction was caused by advanced primary rectal carcinoma. Endosonography accurately determined the tumor infiltration depth in three T2 tumors, eight T3 tumors, and three T4 tumors. Overall accuracy for assessment of infiltration depth was 78 percent. Accuracy for assessment of perirectal lymph node involvement was 75 percent. In eight patients, the obstruction was attributable to extramural regrowth of rectal cancer after surgery. Diameter of the lesions ranged between 3 and 6 cm. Although all lesions were clearly depicted by three-dimensional endosonography, only five lesions (62 percent) were detected by computed tomography. CONCLUSIONS: Three-dimensional endorectal ultrasonography provides previously unattainable scan planes and enables accurate staging of obstructing rectal tumors. This technique may improve therapy planning in advanced rectal cancer by selecting patients who require preoperative adjuvant therapy.

Combined Modality Therapy↗
PubMed1996

Endoscopic treatment of a choledochocele in a 2-year-old child.

Choledochocele is an extremely rare congenital lesion of the biliary tree causing abdominal pain, pancreatitis, and obstructive cholestasis. Traditionally the therapy for this malformation has been surgery. Recently endoscopic therapy has been utilized alternatively for the treatment of choledochocele in adults. We report the case of a 2-year-old girl with a choledochocele who was treated by endoscopic sphincterotomy and placement of a biliary stent. The prosthesis was removed after 4 months. After a follow-up of 20 months the patient remains free of symptoms. Our experience suggests that endoscopic treatment of congenital biliary disease can be performed accurately. Further studies will be necessary to confirm the value of stent implantation in congenital bile duct stenosis.

Child, Preschool↗
PubMed1996

Endosonography and endosonography-guided biopsy of upper-GI-tract tumors using a curved-array echoendoscope.

BACKGROUND: The purpose of the present study was to evaluate the accuracy of endoscopic ultrasonography (EUS) with a curved-array transducer and to determine the value of endosonography-guided biopsy. METHODS: EUS was performed in 162 consecutive patients for preoperative staging of gastric or esophageal cancer (n = 122) or for EUS-guided biopsy (n = 40). All patients were examined using a flexible echoendoscope (Pentax FG32-UA) equipped with a 7.5-MHz curved-array transducer. A specially designed fine needle was used for EUS-guided biopsy of submucosal or extrinsic lesions. RESULTS: Surgery was performed in 19 of 48 patients with esophageal cancer and 60 of 74 patients with gastric cancer. The accuracy in the assessment of the infiltration depth of esophageal cancer and in the determination of lymph node involvement was 84% and 88%, respectively. In gastric cancer the tumor infiltration depth was assessed correctly in only 65% of the patients. The identification of early gastric cancer proved to be a major problem. The accuracy in the detection of lymph node involvement was 73%. Obstructing tumors were examined in 17 patients with carcinoma of the esophagus or the gastric cardia. The accuracy of EUS in determining the T-stage and the N-stage of stenotic tumors was 88% and 86%, respectively. Endosonography-guided needle biopsy was successfully performed in all 40 patients. Histologic analysis revealed malignancy in 50% of the patients. Only two biopsy specimens contained nonrepresentative material (accuracy: 95%). No complications were observed related to the procedure. CONCLUSIONS: EUS with a curved-array transducer provides high accuracy rates in staging of esophageal carcinoma. Evaluation of gastric cancer with this technique appears to be more difficult than with radial transducers. A major advantage of the linear transducer is the ability to perform EUS-guided biopsies of submucosal or extamural lesions.

Adenocarcinoma↗
PubMed1996

Palliative endoscopic therapy of rectal carcinoma.

Curative surgery is not feasible in a considerable proportion of patients with rectal cancer because of extensive local spread or metastatic disease. However, most of these patients require palliative treatment to improve the symptoms of the disease, e.g. obstruction, pain and haemorrhage. Palliative surgery may be associated with a morbidity of 20-40% and a mortality of more than 10%. Endoscopic procedures can provide effective palliation with less complications. Before the development of lasers, endoscopic electrocoagulation and cryosurgery were used with some success. Currently, endoscopic Nd:YAG photocoagulation must be considered the treatment of choice in non-resectable rectal cancer. Laser therapy allows effective palliation in 85-95% of the patients, and generally, treatment-related complications occur in less than 10% of the patients and mortality is negligible. Transanal endoscopic resection may be effective in selected patients. New approaches to endoscopic palliation include photodynamic therapy (PDT) and implantation of self-expanding metal stents.

Cryosurgery↗
PubMed1996

[High-resolution magnetic resonance tomography by means of an endorectal coil--the results in rectal tumors].

PURPOSE: To assess the value of high-resolution MRI of the rectum using an endorectal coil. METHODS: 10 volunteers and in 31 patients with suspected rectal tumors were examined. In 17 patients (n = 17) with rectal carcinoma, of which 15 subsequently underwent radical surgery, the preoperatively obtained tumor stage was compared with histology. In 12 patients (n = 12) with rectal adenoma (severe and medium graded epithelial dysplasias according to the WHO) who underwent endoscopy the results of the endorectal surface coil examination were compared with endoscopy and histology. In 4 patients (n = 4) with large rectal adenomas the surface coil was used before and as follow-up after endoscopic electro laser resection and the absence of adenoma after therapy also in the deeper layers of the rectal wall could be confirmed. RESULTS: Visualization of anatomical structures of rectum and adjacent structures is improved by the use of the endorectal surface coil. The diagnosis of carcinoma and adenoma of the rectum and the documentation of the exact extension can be reached with high accuracy (85%). CONCLUSION: MRI with an endorectal surface coil may play an important role in the preoperative diagnosis of rectal carcinoma. This method is useful for primary diagnosis and follow-up of large rectal adenoma after endoscopic electro laser resection.

Adenoma↗
PubMed1996

3-D ultrasound for the evaluation of malignant disease.

In the last few years there has been increasing interest in the development of 3-D display in medical imaging techniques. 3-D imaging is capable of enhancing the anatomic information of the images. This technique facilitates the localization of normal and pathologic structures and the understanding of spatial relationships. Computer reconstructed 3-D VIews of computed tomography (CT) and magnetic resonance imaging (MRI) have improved image interpretation by clinicians especially in reconstructive and orthopaedic surgery. Although the advantageous features of 3-D display are well recognized for radiologic imaging methods, 3-D data acquisition in ultrasonography has not yet found broad clinical acceptance. This has been mainly due to the lack of hardware appropriate for clinical use and the time required for data processing of high resolution 3-D images. However, recently some experimental solutions

Journal Article↗
PubMed1995

[Endoscopic drainage of pancreatic pseudocysts].

AIM OF STUDY: To compare retrospectively the endoscopic treatment of pancreatic pseudocysts by retrograde pancreatic drainage (ERPD), cystogastrostomy (ECG) or cystoduodenostomy (ECD). PATIENTS AND METHODS: Between 1987 and 1995 pancreatic pseudocysts were successfully treated endoscopically in 30 patients (13 women, 17 men; mean age 49 [18-89] years): ERPD was accomplished through papillary insertion of 5-7 F prostheses into the cysts or pancreatic duct in 9 patients; ECG achieved drainage of cysts in the body or tail of the pancreas in 15 patients, and ECD for cysts in the head of the pancreas in three. Combined ERPD and ECG was necessary in three patients. RESULTS: Significant pain relief was achieved in all patients, accompanied by increased appetite and weight. Occlusion or dislocation of the prosthesis required renewed endoscopic drainage in three patients. The prostheses were removed, 2-12 months after implantation, when pain relief had occurred and clinical as well as radiological findings had become normal. Recurrence 10-22 months after removal of the drain was observed in four patients, of whom two had a successful second drainage procedure. Surgical intervention became necessary in three patients because of inadequate drainage or (one case) bleeding. CONCLUSION: These data indicate that endoscopic drainage of pancreatic pseudocysts gives good results with a low complication rate and no deaths. The procedure is thus an alternative to the at present prevailing operative treatment.

Adolescent↗
PubMed1995

Laparoscopy and laparoscopic ultrasound for staging of upper gastrointestinal tumours.

Conventional imaging studies are often not sensitive enough to allow accurate preoperative staging of intra-abdominal tumour spread. Laparoscopy and laparoscopic ultrasound appear to be suitable to improve staging of gastrointestinal tumors. Within a 10-month period 40 patients with upper GI tract cancer underwent laparoscopy for intra-abdominal staging. Additionally laparoscopic ultrasound was performed on 20 of these patients using a flexible echo-endoscope equipped with a curved array transducer (5/7.5 MHz). By laparoscopy additional information compared to conventional staging was obtained in 16 patients (40%). Laparoscopy revealed peritoneal carcinomatosis and liver metastases in seven and four patients, respectively. M1-lymph nodes were detected in four patients. Laparoscopic ultrasound was able to image otherwise inaccessible regions of the abdominal cavity and induced a change of staging in seven of 20 patients in whom laparoscopy was uneventful. Ultrasound also proved to be valuable for localization of M1-lymph nodes. In summary, combination of laparoscopy and laparoscopic ultrasound improved staging in 23 of 40 patients (57%). Consequently surgery was abandoned in 16 patients due to incurable or non-resectable disease, while down-staging occurred in seven patients, who subsequently underwent resection. Laparoscopy is capable of improving staging of intra-abdominal malignancy by detection and subsequent biopsy of small lesions. Laparoscopic ultrasound can replace the lack of tactile sensitivity in laparoscopy, thus enabling the detection of non-superficial lesions.

Evaluation Studies as Topic↗