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Biomedical subjects

R Loddenkemper

Publications and source records attributed to R Loddenkemper.

At least 55 records · Page 3Linked to original sources
PubMed2000

Mycobacterium heckeshornense sp. nov., A new pathogenic slowly growing Mycobacterium sp. Causing cavitary lung disease in an immunocompetent patient.

A pathogenic scotochromogenic Mycobacterium xenopi-like organism was isolated from the lung of an immunocompetent young woman. This pathogen caused severe bilateral cavitary lung disease, making two surgical interventions necessary after years of chronic disease. This case prompted us to characterize this mycobacterium by a polyphasic taxonomic approach. The isolate contained chemotaxonomic markers which were typical for the genus Mycobacterium, i.e., the meso isomer of 2,6-diaminopimelic acid, arabinose, and galactose as diagnostic whole-cell sugars, MK-9(H(2)) as the principal isoprenoid quinone, a mycolic acid pattern of alpha-mycolates, ketomycolates, and wax ester mycolates, unbranched saturated and unsaturated fatty acids plus a significant amount of tuberculostearic acid, and small amounts of a C(20:0) secondary alcohol. On the basis of its unique 16S rRNA and 16S-23S spacer gene sequences, we propose that the isolate should be assigned to a new species, Mycobacterium heckeshornense. This novel species is phylogenetically closely related to M. xenopi. The type strain of M. heckeshornense is strain S369 (DSM 44428(T)). The GenBank accession number of the 16S rRNA gene of M. heckeshornense is AF174290.

Adult↗
PubMed2000

Lung cancer in young females.

Previous studies suggested that the characteristics of young female lung cancer patients may differ from those of other patients. Using the cancer registry at the Lungenklinik Heckeshorn hospital, all female patients under the age of 46 yrs with primary lung cancer 1986-1995 were identified. The clinical records were reviewed for risk factors, stage, histology, therapy, and survival. The data were compared with those of other patients. Of the 4,939 patients 96 (1.9%) were females aged <46 yrs. The percentage of young females doubled within ten years from 1 to 2% of all patients (p=0.03). The main risk factor in young females was smoking. Adenocarcinoma and carcinoids were overrepresented, whereas squamous cell and small cell carcinoma were significantly rarer in the young female group. Young females and young males were more likely to have advanced disease and underwent surgery and/or combined treatment significantly more often than older patients. The overall survival was only moderately better in younger patients. The clinical features of young female patients differed from those of young males and older females, the prognosis likewise depended on tumour stage and therapy.

Adolescent↗
PubMed2000

MRI and CT in the differential diagnosis of pleural disease.

STUDY OBJECTIVE: To explore the role of MRI in the differential diagnosis of pleural disease. PATIENTS: Forty-two patients with pleural disease were included. METHOD: Retrospective study. All patients were examined with both CT and MRI. The morphologic features of pleural lesions and magnetic resonance signal intensity on T1-weighted, T2-weighted, and contrast-enhanced T1-weighted images were evaluated. RESULTS: Mediastinal pleural involvement, circumferential pleural thickening, nodularity, irregularity of pleural contour, and infiltration of the chest wall and/or diaphragm were most suggestive of a malignant cause both on CT and MRI. Pleural calcification on CT was suggestive of a benign cause. Contrary to what has been previously reported in the literature, neither on CT nor on MRI, pleural thickness >1 cm revealed significant difference between malignant and benign pleural disease (p>0.05, chi(2) test). High signal intensity in relation to intercostal muscles on T2-weighted and/or contrast-enhanced T1-weighted images was significantly suggestive for a malignant disease. Using morphologic features in combination with the signal intensity features, MRI had a sensitivity of 100% and a specificity of 93% in the detection of pleural malignancy. CONCLUSION: When signal intensity and morphologic features are assessed, MRI is more useful and therefore superior to CT in differentiation of malignant from benign pleural disease.

Adult↗
PubMed1999

[Chemotherapy of osteoarticular tuberculosis].

Bone and joint tuberculosis, as all other types of tuberculosis is generally treated with antituberculotic combination chemotherapy. This has to be continued for a minimum of six months, or nine months in case of extensive spreading. A two- to three-month initial phase with four or five different drugs (H, R, Z, and additionally E and/or S) is followed by a four- to six-month therapy with H and R alone, provided the pathogen is fully susceptible to a standard regimen. The main side effects are hepatotoxic or allergic reactions. A frequent contra-indication is existing, often toxicity-induced, liver damage. The main local complications requiring surgery are spinal instability or neurologic deficiencies.

Antitubercular Agents↗
PubMed1999

[Diagnostic value of the tumor markers TPA-M, CYPFRA 21-1 and CEA in pleural effusion. Prospective comparison of thoracoscopic investigations in patients with pleural effusion].

The diagnostic value of tumour markers in pleural effusion is not yet clearly defined. CEA (Carcinoembryonic Antigen), CYFRA 21-1 (Cytokeratin 19-Fragment) and TPA-M, a new monoclonal-based radioimmunoassay for TPA (Tissue Polypeptide Antigen), were measured in pleural fluid and sera of 125 consecutive patients who underwent medical thoracoscopy. The group consisted of 79 patients with malignant and 45 with non-malignant pleural effusion and 1 patient without definitive diagnosis, and hence 124 patients were available for assessing the diagnostic value. In pleural fluid based on a specificity of 90% versus benign diseases the sensitivity for CEA was 52.5%; with the maximum achievable specificity of 80% for CYFRA 21-1 the sensitivity was 68% and for TPA-M with 67% the sensitivity was 67%. Based on the cut-off values for these specificities the combined use of the three tumour markers resulted in a sensitivity of 85.7% but with a lower specificity of 59.1%. There is only a limited value for tumour markers in the diagnosis of pleural effusion.

Adult↗
PubMed1999

[Bronchial carcinoma in young adults].

Lung cancer in young adults has been differently described in publications from various regions of the world, in respect of relative incidence, distribution of morphology and stages, and prognosis of the disease. We analysed retrospectively the data from the cancer registry of the Lungenklinik Heckeshorn in Berlin between 1986 and 1995 with regard to this topic. 106/4939 patients were 40 years old or younger (2.1%). The proportion of female patients was higher in the younger group (42 vs. 29%). Adenocarcinoma was the leading subtype in young patients (33 vs. 24%). The younger group showed a higher proportion of inoperable stages IIIB and IV for non-small cell lung cancer (71 vs. 46%). Younger patients with operable stages I to IIIA non-small cell lung cancer underwent surgery much more often than patients older than 40 years (90 vs. 49%), but for all patients with this morphology there was no difference in survival between younger and older patients (302 vs. 314 patients). We conclude that lung cancer presents a clearly different clinical picture in younger patients but not a better prognosis.

Adult↗
PubMed1999

[Combined alternating radiochemotherapy in stage III (TNM) (limited disease) small cell bronchial carcinoma: a phase II study with carboplatin/etoposide/vincristine and alternating radiotherapy].

BACKGROUND: The combination of radio-chemotherapy is accepted standard in limited-disease small cell lung cancer, but the best way of combining the two modalities is still unknown. To test an alternating regime of early radiotherapy with hypofractionated radiotherapy we performed a phase II study in stage III small cell lung cancer. METHOD: 32 SCLC patients (n = 7 IIIa, n = 25 IIIb) were treated with a weekly alternating regime with either chemotherapy or radiotherapy. Chemotherapy included carboplatin (AUC5), etoposide (3 x 120 mg/m2) and vincristine (2 mg), repeated on day 28 for six cycles. Radiotherapy started one week before chemotherapy and was applied weekly 1 x 4 Gy, using a split-course regimen. RESULTS: Combined radio-chemotherapy was well tolerated with dose-limiting hemotoxicity and very few cases of oesophagitis. Overall response was 75%, median survival 14.5 months and the 2-year survival was 34.4%. 5 patients are still living now for more than 29 months. Treatment failure was local and systemic in 34% of the patients. Systemic failure included 6 patients with brain metastases. CONCLUSION: Combined radio-therapy in small-cell lung cancer using an alternating hypofractionated regimen is well tolerated. Response rate and 2-year survival are promising. Local and systemic failure is an ongoing problem and requires better local and systemic control of the disease.

Aged↗
PubMed1999

[High frequency diathermy--a new method in the treatment of malignant and benign stenosis of the airways].

High-frequency electrocautery is a relatively new method in the treatment of malignant or benign airway stenoses. We report on the results of 58 sessions in 41 patients (malignant condition n = 30, benign n = 11) within a three-year period. Various instruments were available for coagulation (blunt probe, knives of 4, 5 and 7 mm length, forceps and wire snare). 53/58 sessions were performed under general anaesthesia, energy was limited to 40 W with unlimited duration of pulses. The knives were the most frequently used devices, preferably with a length of 5 mm, which enabled us to either cut the tumour or scar tissue precisely slice by slice or to resect by direct coagulation. The use of the blunt probes and forceps was frequently rendered more difficult by detritus covering the instrument during coagulation. Polypes were easily resected with the wire snare, but this kind of tumour was found in four patients only. Major (> 100 ml) bleeding occurred in two patients. Obstructing fibrinous membranes were never seen after electrocautery. In conclusion, high-frequency electrocautery is an effective and safe method for endobronchial resection and can be considered a good alternative to the laser as the classical method for endobronchial resection.

Adult↗
PubMed1999

Pulmonary function after total laryngectomy.

OBJECTIVE: To present data on pulmonary function in 59 laryngectomees using a specially designed silicone adapter for connection of the stoma to the bodyplethysmograph. STUDY DESIGN: Prospective assessment of pulmonary function in 59 patients, and comparison of lung function before and after bronchodilator testing in selected cases. METHODS: The usefulness of the adapter was examined. Data of patients with airway obstruction were tabulated according to large airway obstruction (LAO), peripheral airway obstruction (PAO), and small airway disease (SAD) types. RESULTS: Findings show that pulmonary airway obstruction was present in 81% of patients and normal pulmonary function was present in only 11 of the 59 participants (19%). LAO was found in 25%, PAO in 17%, and SAD in 39% of cases. Emphysema was diagnosed in 14% of cases within the above-mentioned LAO and PAO groups. Improvement of pulmonary function was achieved in 12 of 16 laryngectomees with airway obstruction, when a bronchodilator aerosol was administered. In 60% of cases with LAO and PAO, the laryngectomees did not know of any marked obstruction of their airways, and only 10% of those knowing about their obstruction received appropriate medical treatment. CONCLUSIONS: These results suggest that 42% of the laryngectomees tested may have benefited from further medical treatment. After laryngectomy, pulmonary function assessment was performed elsewhere in 1 of 59 cases. In light of the high prevalence of airway obstruction in laryngectomees, more frequent postoperative assessments of pulmonary function should be offered to prevent or to reduce impairment of respiratory function in this postlaryngectomy vulnerable pulmonary status. Further studies are also needed to determine the effects of therapeutic intervention, e.g., assessment of therapy outcome and influence on quality of life.

Aged↗
PubMed1999

[Invasive and non-invasive home ventilation--changes between 1982 and 1996].

PATIENTS AND METHODS: In our centre, 111 patients with chronic ventilatory insufficiency (33 females, 78 males, age 48 +/- 18 years, range 3 to 76 years) were treated by intermittent positive pressure ventilation between 1982 and 1996. Underlying diseases were neuromuscular diseases in 29%, sleep-related hypoventilation in 26%, kyphoscoliosis in 15%, chronic obstructive airway disease in 15%, and post-tuberculosis syndromes in 12%. Singular indications were 1 bronchiectasis, 1 lung fibrosis and 1 cystic fibrosis. RESULTS: Until 1991, most patients were ventilated via tracheostoma (10 of 16), in the following years 87 of 95 patients could be ventilated via a nasal or facial mask. Ventilation mode was a controlled one in 80 patients and an assisted one in 31 patients, average ventilation time during night was 6 to 8 hours. In the majority of patients hypercapnia was not only removed during ventilation but also at daytime as an indicator of improvement of ventilatory insufficiency accomplished by a clearly better quality of life and daytime activity. Ten patients (9%) died due to their underlying diseases, 5 of them in the first year of intermittent ventilation.

Adolescent↗
PubMed1998

Medical thoracoscopy.

Thoracoscopy has received increasing attention over the past decade as a result of the considerable advances that have been made in the development of endoscopic instruments. In contrast to the newly established video-assisted thoracoscopic surgery, the classic way to perform thoracoscopy is using only local anesthesia and sedation (medical thoracoscopy) making the procedure less invasive and expensive. The leading diagnostic indication for medical thoracoscopy today is an exudative pleural effusion of unknown origin offering a yield of more than 90% in malignancy or tuberculous pleurisy. In addition, talc poudrage during thoracoscopy is the most effective way to perform pleurodesis. For spontaneous pneumothorax, the second most important indication, medical thoracoscopy allows staging as well as therapeutic measures such as coagulation of blebs or talc poudrage. Other indications such as biopsy for diffuse lung disease or peripheral nodules are now reserved for video-assisted thoracoscopic surgery.

Diagnosis, Differential↗