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Biomedical subjects

R Achatzy

Publications and source records attributed to R Achatzy.

At least 19 recordsLinked to original sources
PubMed2002

[Primary synovial sarcoma of the lung - a rare tumor].

We present a 26 year old patient with a primary malignant synovial sarcoma of the lung that was observed for more than one year by a general practitioner and a pulmologist. Finally, because of recurrent hemoptysis a central tumor of mesenchymal origin of the left lower lobe was diagnosed by bronchoscopy. The invasion of the left atrium as far as to the mitral valve was diagnosed by MRT. The patient was operated on by extended pneumonectomy with extracorporeal circulation. The partial excision of the left atrium required plastic reconstruction. In the postoperative course the patient underwent chemo-therapy, 6 cycles adriablastine/ifosfamid. 8 months after the first operation an extensive tumor recurrency occurred with infiltration of the chest wall. The patient refused further radio- or chemotherapy and died 14 months after the operation. Because of the small number of cases therapeutic strategy conceptions do not exist. The resection of the tumor is generally recommended. Chemo- and radiotherapy are accepted as an option for advanced tumor stage.

Adult↗
PubMed2000

Ploidy, expression of erbB1, erbB2, P53 and amplification of erbB1, erbB2 and erbB3 in non-small cell lung cancer.

The aim of this study was to assess the prognostic value of deoxyribonucleic acid analysis, expression oferbB1, erbB2 and P53, and amplification levels of erbB1, erbB2 and erbB3 in non-small cell lung cancer (NSCLC). Consecutive patients with NSCLC who underwent treatment with curative intention (118) were included. In 108 cases, the cell cycle was analysed using flow cytometry and double-staining with propidium iodide and anticytokeratin. In another 108 cases, expression of erbB1, erbB2 and P53 was assessed immunhistochemically. Amplification of the erbB family was determined in the tumours of 53 patients using double-differential polymerase chain reaction. Of the tumours, 81% were aneuploid and 14% showed positive staining for erbB1, 18% for erbB2 and 41% for P53. There were normal mean gene copy numbers in 86% for erbB1, 94% for erbB2 and in 96% for erbB3. No significant correlations were noted between erbB1, erbB2 and P53 expression, ploidy status and tumour stage. In a Cox regression model, only tumour stage was shown to be prognostically significant. It seems that ploidy and expression status of erbB1, erbB2 and P53 are not prognostic parameters in non-small cell lung cancer. Amplification of the erbB family does not seem to be a frequent event in non-small cell lung cancer.

Adenocarcinoma↗
PubMed1997

[Delayed complications after extrapleural pneumonolysis for lung tuberculosis].

The epidemic spread of tuberculosis after World War II and the deficiency of appropriate antituberculotic drugs led to a renaissance of surgical procedure such as plombage thoracoplasty, initiated in 1891 by Tuffier. Especially in Germany the insertion of paraffin and polyethylene was used in order to achieve an extrapleural pneumothorax in order to collapse the tuberculous cavities in the upper lobes. Due to a high rate of early complications and the assumed cancerogenicity, in a considerable number of cases the material was removed soon after its deployment. In some cases with the filling remaining in place, 30-40 years later infections and/or neoplasms occurred. From 1985 to 1996 in two centers of thoracic surgery 13 patients underwent procedures for removal of filling material. The patients suffered from infections (n = 11), malignant lymphoma associated with infection of the plombage (n = 1) and bronchial carcinoma (n = 1). Technically, we performed the thoracoplasty described by Schede (n = 9). Schede's thoracoplasty in combination with a muscle flap repair (n = 1) or partial resection of the thoracic wall (n = 1), an empyemectomy (n = 1), and an en-bloc pleuropneumonectomy (n = 1). All patients suffered from multiple underlying diseases (COPD, coronary heart disease, diabetes mellitus). However, apart from beside two procedure related deaths (pulmonary embolism n = 1, pneumonia complicated by multi-organ failure n = 1) no other major complications were observed. The plombage material in the case of malignant lymphoma is probably carcinogenic in relation to the time of exposure and should be removed in all cases.

Adult↗
PubMed1996

[Lung surgery in elderly patients, a retrospective study (1985-1994)].

From 1985 to 1994, we performed 4568 thoracic operations, 234 of these patients (176 males, 58 females) were older than 70 years of age; the oldest patient was 82 years. Of these 234 patients, 144 suffered from bronchial carcinornas, 25 from lung metastases, 21 from recurrent pneumothoraces, 12 from thymomas, 21 from tuberculomas, hamartomas, an intrathoracic goiter or mesothelioma; in 11 patients, diagnostic thoracotomias or biopsies had been done. We did 146 anatomical resections, 59 atypical wedge resections, 14 decortications, pleurectomies, thymectomies or exstirpations of mediastinal tumors; in addition, three resections of an intrathoracic goiter were done. The hospital lethality was 3.8%, the total rate of complications 56%, mostly cardiac arrhythmias. The survival rate of the patients suffering from a bronchial carcinoma was the same as in younger patients.

Aged↗
PubMed1995

[Pleuro-mediastinitis in pulmonary actinomycosis as a rare differential bronchial carcinoma diagnosis].

A 48-year old patient complaining of immitigable coughing with purulent and sanguineous sputum and a loss of weight of 8 kg within the last three months was admitted to our hospital. Due to anamnesis and radiological findings (tumor of the right side upper lung field with infiltration of the chest wall and the mediastinum) we suspected a bronchogenic carcinoma. As bronchoscopy and histological examinations of biopsies revealed no hints to the underlying disease, we submitted the patient to a right side explorative thoracotomy. It showed a tumorous involvement of the right side upper lung field with infiltration and partial destruction of the chest wall and infiltration of the apical segment of the lower lobe of the lung and a phlegmonous infiltration of the paratracheal tissue. Histological examination confirmed chronical course of actinomycosis. Therapy consisted in resection of the affected tissue and long-term administration of antibiotics. Response to therapy was excellent concerning both radiological findings and subjective complaints.

Actinomycosis↗
PubMed1990

[Mediastinal staging of non-small cell bronchial carcinoma. The place of computed tomography and mediastinoscopy].

Sixty patients with a potentially resectable non-oat-cell lung carcinoma were examined by computed tomography and cervical mediastinoscopy. The sensitivity of computed tomography as opposed to mediastinoscopy was 74% versus 58% and the specificity in 85% versus 100%. Considering the limitations of both methods and the varying prevalence of mediastinal lymph-node metastases associated with peripheral and central lesions, three different situations can be distinguished: 1. with peripheral lesions and a normal mediastinal CT, preoperative mediastinoscopy is unnecessary. 2. With an abnormal mediastinal CT, mediastinoscopy is always indicated irrespective of the location of the tumor. 3. With large central lesions, mediastinoscopy is necessary even when the CT is normal. Using these rules, 37 of 60 mediastinoscopies in our patient group could have been avoided without influencing the resection rate (98%).

Adult↗
PubMed1990

[Thrombosis of the left jugular-subclavian vein junction as a rare late complication of oleothorax].

Thirty years after bilateral pneumolysis followed by plombage with paraffin for bilateral upper lobe tuberculosis, a 58-year-old female patient suffered a thrombosis of the left jugular- subclavian vein junction. Compression of the vessel by the plombage in addition to chronic fibrous scar tissue reaction must be assumed as the main cause of thrombosis, since infection of the plombage space was excluded.

Collapse Therapy↗
PubMed1989

The diagnosis, therapy and prognosis of diffuse malignant mesothelioma.

Between 1969 and 1985, 245 patients with diffuse malignant mesothelioma were treated (157 male, 88 female). The average age was 55.8 years and the sex ratio was 1.8:1 in favour of males. The right side was more frequently affected than the left (56.7% vs. 43.3%). A pleural effusion and dyspnoea were the presenting signs and symptoms in 83.7% of the patients and unilateral chest pain in 64.2%. Noninvasive diagnostic procedures included a chest X-ray and computed tomography of the thorax. Pleural effusion and pleural thickening were detected most frequently. Malignant cells were identified by pleural fluid cytology in 45.3% and by needle biopsy of the pleura in 42.7% of the patients. Forty-five patients were treated conservatively and 200 patients underwent operation: diagnostic thoracotomy (78); partial pleurectomy (72); total pleurectomy (46); extended pleuropneumonectomy (2); partial removal of the diaphragm (1) and total pleurectomy and upper lobectomy (1). The perioperative mortality was 6%. The conservative and postoperative treatment depended on the patients' symptoms and included radiotherapy and chemotherapy alone or in combination. The mean survival time of the 222 non-survivors was 9.2 months. After 1 year, 36% of the patients were still alive, after 2 years, 10.8% and the 5-year survival was 4.1%. The median survival time in patients treated non-operatively was 6 months--a little over half that of the patients treated surgically (10.1 months).

Adult↗
PubMed1988

[Surgery of lung metastases].

Between 1975 and 1985 76 patients underwent surgery of pulmonary metastases in our hospital. Most often the primary tumor was located in carcinomas of the colon and rectum (19 patients), followed by carcinomas of the kidney (14 patients), the breast (13 patients) and the skin (malignant melanoma: 9 patients). Conditions for pulmonary metastasectomy are radical removal of the primary tumor, metastases located only in the lung, resectability of the metastases and low operative risk. Three years after pulmonary metastasectomy 35% of the patients were still alive, the 5 year survival rate was 18%. The median survival time was 22 months. The prognosis in patients with pulmonary metastases is largely dependant upon tumor type. Pulmonary metastases of breast carcinomas and carcinomas of colon and rectum can be treated best by surgical intervention. (5 year survival rate: 35% and 33%). Hypernephroma and malignant melanoma have a 5 year survival rate of 0% and 23%. Other prognostic factors are the number of pulmonary metastases and the disease-free interval between surgery of the primary tumor and pulmonary metastasectomy. Furthermore resection techniques are of prognostic importance. Lobectomy and segmental resection showed a better 5 year survival rate than pneumonectomy (21%, 24%, 0%). Median sternotomy is recommended as standard access for pulmonary metastasectomy. Surgery of pulmonary metastases is encouraging.

Female↗
PubMed1987

Stromal composition in bronchogenic carcinomas--morphometric structure analysis.

So far little is known about the pathogenesis and development of the stroma in bronchogenic neoplasia. Clinical and radiological findings and morphological pictures of the tumor taken just after resection, don't reveal information about the pathogenesis and duration of the development of the scar tissue. Using an automatic image analyser (Quantimet 720, Imanco) it was possible to do morphometrical studies of bronchial carcinomas. We correlated the quantity of the stromal reaction in bronchial carcinomas to the size and histological type of the tumor. 60 peripheral, completely excised bronchial tumors were studied using post mortem and surgically removed specimens (25 adenocarcinomas, 22 squamous cell carcinomas, 13 oat cell carcinomas). The mesenchyme was studied histologically and morphometrically at the point of largest circumference of the tumor. Different histological stains were used to identify and correlate epithelial, mesenchymal and necrotic parts of the tumor. Adenocarcinomas on average have 48% stromal composition and even tumors sized 1.5-3 cm2 show evidence of extensive scar tissue. Squamous cell carcinomas have 37% and oat cell carcinomas have 30% fibrous tissue composition. Large adenocarcinomas have less stroma whereas large squamous cell carcinomas showed a relative increase in stromal composition. None of the above was shown in oat cell carcinomas. The amount of stromal tissue therefore depends on the histological tumor type.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1985

[Surgical treatment of the abnormal origin of the left coronary artery from the pulmonary artery. The Bland-White-Garland syndrome].

Seven children aged 6 weeks to 9 months with anomalous left coronary artery originating from the pulmonary artery and a 46-year-old female patient with pronounced formation of collaterals in Bland-White-Garland syndrome and left-right shunt were operated between July 1976 and February 1984. All children had already experienced left ventricular anterior wall infarction. Angiocardiography in 6 cases established the diagnosis, in one case echocardiography had proved sufficient. In the children, close-to-origin ligation of the left coronary artery was done after median sternotomy. One child succumbed postoperatively whereas in all others preoperative cardiac insufficiency regressed satisfactorily. In the adult female close-to-origin cutting of the left coronary artery was followed by aorto-coronary venous bypass.

Cardiomegaly↗
PubMed1985

[Indications for operative intervention in acute and acute recurring lung embolism].

From 1973 to 1983 10 patients suffering from pulmonary embolism were seen at our clinic. All 10 underwent cardiopulmonary bypass and embolectomy of the pulmonary truncus and its branches including exploration of the right heart. 6 patients survived. The embolectomy of the pulmonary artery was supplemented by clipping the inferior vena cava. In chronic recurrent pulmonary embolism we only performed the clipping procedure of the inferior vena cava.

Acute Disease↗
PubMed1984

Surgery of coarctation of the aorta: a nine-year review of 253 patients.

From 1973 to 1982, 253 patients--164 males and 89 females--underwent an operation for coarctation of the aorta in our clinic. Of the patients 72.3% presented with a circumscribed lesion and 58.5% with associated congenital cardiovascular defects. Resection with end-to-end anastomosis was performed in 138 patients (54.5%). Seventy-four patients (29.3%) had vascular graft prosthesis, 1.2% underwent the Clagett's operation, 9.1%, the indirect isthmoplasty and the rest (5.9%), the subclavian flap plastic. Ventricular fibrillation led to the intraoperative death of 3 infants with associated intracardiac and multiple somatic defects. The operative mortality was high in children under 15 months (13.2%), 1% in all the others taken together and 0% in all cases without concomitant lesions. Paraplegia occurred in only one patients (0.4%). One hundred twenty-eight patients were followed-up over a mean period of 3.6 years. The systolic and diastolic pressures decreased by a mean of 30 mmHg and 15 mmHg respectively. Eighty-seven patients (68%) had normal blood pressure at the time of examination. The rest (41 patients) had persistent postoperative hypertension necessitating medical management. The surgical technique elected did not influence the level and incidence of persistent postoperative hypertension, rather the level of the preoperative systolic right arm-to-leg pressure gradient (SPG) related closely to the incidence of persistent hypertension. Thirty patients (23.4%), among whom were 24 children under 10 years--some of them with preductal hypoplasia--presented with an SPG above 20 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗