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Biomedical subjects

R Loddenkemper

Publications and source records attributed to R Loddenkemper.

At least 109 records · Page 6Linked to original sources
PubMed1991

[Diagnosis of diffuse pleural mesotheliomas].

Main clinical symptoms and signs in diffuse malignant pleura mesotheliomas are thoracic pain (58%) and gradually increasing dyspnoea (50%). Pleural effusion is the most frequent x-ray manifestation (80%), but it is haemorrhagic in only 50% of the cases. Cytology has a sensitivity of approx. 50%; with the epithelial type it yields definitely better results (76%) than with the biphasic (49%) or fibrous (25%) types. The carcinoembryonic antigen level is usually low in the effusion, but enhanced values do not exclude a diffuse malignant pleura mesothelioma. For differentiation against metastasised adenocarcinomas, which is often difficult, it is recommended to effect histological examination of the tumour tissue obtained either by pleura punch biopsy (sensitivity 40-50%) or by thoracoscopy (sensitivity 90-95%). In this manner, accurate staging is possible in conjunction with CT. Particularly in case of fibrous growth, it is sometimes only thoracotomy that enables final diagnostic clarification.

Diagnostic Imaging↗
PubMed1990

[Pulmonary histiocytosis X].

Pulmonary histiocytosis X is a histiocytic granulomatosis of yet unknown etiology and of partial immunopathogenesis. The incidence ist about 5% compared to sarcoidosis. Almost all patients are smokers, the age peak lies between 20 and 40 years. Leading symptoms are non-productive cough and dyspnea, often it is only detected radiologically by chance. The x-ray shows bilateral nodular, later reticular changes. The characteristic ring figures may be detected only by tomography. Until recently diagnosis was made exclusively by lung biopsy, but now bronchoalveolar lavage may be already diagnostic. Early corticosteroid therapy seems to prevent the progression to the fibrotic-bullous end-stage in almost all cases.

Adrenal Cortex Hormones↗
PubMed1990

[Laser and afterloading therapy of bronchial cancer].

Endobronchial afterloading irradiation by remote control was administered to 304 patients with lung cancer. The use of a highly active 192-Iridium source (740 GBq) is possible; irradiation time lasts only a few minutes. A combined treatment modality with laser was employed in 24%, with chemotherapy in 2%. The response rate of all patients amounted to 67%. There was an improvement in 81% of patients with retrostenotic complications.

Brachytherapy↗
PubMed1990

[MRI of an intrathoracic malignant tumor invading the chest wall].

22 patients with intrathoracic malignant tumors suspected of invading the chest wall were examined with CT and MRI. Chest wall invasion was operatively confirmed in 19 cases and excluded in the other 3 cases. CT showed tumor infiltration of the chest wall in 14/19 cases, no morphological changes in 5/19 cases. Thoracic wall invasion was demonstrated by MR in all 19 cases. Typical MR finding of malignant invasion was local lesion within the chest wall showing high signal intensity in post-Gd T1-weighted images and in T2-weighted images. Reactive inflammatory changes as well as malignant infiltration of the pleura showed high signal intensity on enhanced T1-weighted images and on T2-weighted images.

Adult↗
PubMed1990

[Value of magnetic resonance tomography in Pancoast and other tumors with infiltration of the thoracic wall].

Twenty-two patients with intrathoracic malignancies and suspected Pancoast and "break-out" tumours were submitted to a comparative investigation using CT scanning and MRI to detect infiltration of the chest-wall. In the patients, the lesion had been confirmed at surgery, which revealed malignant infiltration in 19 cases, and excluded in filtration in 3 cases. In 14 out of 19 patients, the CT scan revealed tumourous involvement of the chest-wall, while in five out of 19 patients, no such involvement was detected. Using MR imaging, tumour infiltration was detected in all 19 patients. A reliable MR sign of tumour involvement was the detection of signal-intensive lesions within the chest-wall in T1-weighted images following the administration of Gd-DTPA, and in the T2-weighted images. In contrast, signal enhancement of the pleura was found both in tumour involvement and in inflammation. In suspected tumorous chest-wall invasion MR imaging can demonstrate tumour involvement of the chest-wall when CT is equivocal.

Adult↗
PubMed1990

[Results of thoracoscopy in localized lung and chest wall diseases].

On the basis of 109 thoracoscopic examinations--out of a total number of 1,014 thoracoscopies performed between 1981 and 1986 at our Department--carried out to investigate localised disorders of the lungs and wall of the chest, the diagnostic effectiveness of the method for this indication has been examined. The lesions involved were 59 pulmonary foci, and 50 localised changes involving the wall of the chest, thoracic spine or diaphragm. With the aid of thoracoscopy, the diagnosis proved possible in 83% of the disorders of the chest wall, in comparison with only 46% in the case of the pulmonary lesions, since the focus is often not sufficiently sub-pleural in location, or else pleural adhesions that presented impaired the view. On the basis of the high diagnostic yield in localised diseases of the thoracic wall, thoracoscopy should be considered for this indication in particular, when clarification of the situation is not possible with radiological procedures, and surgery appears unnecessary or not feasible.

Humans↗
PubMed1990

[Gas transfer in nonspecific inhalation provocation].

In 37 patients with clinically suspected non-specific bronchial hyperreactivity, a comparative study was performed prior to and following bronchial challenge with histamine employing the following parameters: flow-volume curve, whole-body plethysmography, single-breath spirometry, capillary blood gas analysis. Four types of reaction can be distinguished: isolated bronchial reaction, isolated gas transfer disturbance, dual reaction, no reaction. A Correlation of the induced gas transfer disturbance was found only for the flow data reflecting small airways dysfunction (Vmax 25%), but not for the basic lung function parameters. The transfer factor and transfer coefficient are insensitive and, on average, show only small, non-directed changes.

Adult↗
PubMed1990

[CEA as a tumor marker on the cell surface and in the exudate. Comparison in thoracoscopy examined pleural effusions].

A prospective comparison was conducted in 43 patients to assess comparatively the ranking of cytology and CEA determined in the pleural effusions and by immunocytology on the cell surface (the latter two compared with each other) and then juxtaposed with the information obtained by histology via thoracoscopy. It was found that the yield achieved by cytology was comparable with that obtained by immunocytology. The maximum sensitivity was established with the adenocarcinoma.

Biomarkers, Tumor↗
PubMed1989

[Malignant chest wall infiltration in MR: comparison with CT and surgical findings].

CT and MRI were performed on 19 patients with pleura related thoracic tumors with respect to the detection of chest-wall invasion. All patients underwent surgery, which confirmed malignant infiltration in 16 cases, while this was excluded in three. CT showed chest-wall invasion in 12/19 patients. MRI demonstrated tumorous involvement in 16 patients. A reliable pattern of chest-wall invasion in MRI were high signal intensity lesions within the chest-wall in the T2-weighted images. However, increased signal intensity of pleural structures was found in inflammatory as well as in malignant lesions. MRI can prove the presence of chest-wall invasion when CT is equivocal.

Adult↗
PubMed1989

[Pleurodesis with tetracycline hydrochloride].

Malignant pleural effusion is a common complication of malignant disease requiring drainage and palliative sclerosing therapy in the vast majority of cases. Tetracycline in conjunction with thoracoscopic drainage is currently considered as the optimal sclerosing agent due to its high efficacy, good patient tolerance, simple and repeatable applicability and low cost of treatment. Traditional and more recent agents like fibrin-sealant may give similar results, but do not achieve a favourable all-round-properties. The relevant data from the literature are reviewed, our own results are presented. An explicit description of pleurodesis is given, also a brief discussion of possible mechanisms of action of sclerosing agents. Concepts are suggested for positioning pleurodesis in the general therapeutic approach to various tumours. The concept of pleurodesis can be similarly successful and safely applied on malignant pericardial effusion (pericardesis).

Drainage↗
PubMed1989

[Thoracoscopy in diffuse lung diseases].

Thoracoscopy was performed under local anesthesia in 419 patients suffering from a diffuse lung disease. In 85% of the cases diagnosis was clarified by thoracoscopy. All other cases were confirmed by means of an open lung biopsy. The best results were obtained in sarcoidosis of the stages II and III, the sensitivity being 0.98. Tumour-conditioned diffuse lung diseases were clarified in 88% of the cases; proof of an interstitial pulmonary fibrosis or interstitial pneumonia was established in 85% of the patients. Results regarding histiocytosis X were poor: thoracoscopic-bioptic proof was successful in only 42% of the patients. In 419 examinations we only detected a severe complication (air embolism). Drainage times were on the average between 4 and 5 days. On the whole, the method was characterised in the field of diagnosis of diffuse lung diseases by a high degree of sensitivity and satisfactory specificity. Both in respect of the invasiveness of the examination and its sensitivity it occupies an intermediate position between peripheral bronchoscopically obtained biopsy and surgical open lung biopsy, representing a valuable extension of the diagnostic instrumentarium if the indication is carefully considered.

Adult↗
PubMed1989

[Diagnostic thoracoscopy in mediastinal space-occupying lesions].

Thoracoscopy is a helpful and safe procedure for diagnosing a variety of mediastinal masses if adequate information cannot be obtained out due to biological risk or patient non-compliance. An explicit description of thoracoscopic technique is given along with case reports demonstrating the efficiency of the method.

Adult↗
PubMed1989

[Pleurodesis with tetracycline hydrochloride in spontaneous pneumothorax].

Treatment of spontaneous pneumothorax aims at avoiding relapses besides achieving immediate reexpansion of the lung. Thoracoscopy should definitely occupy a well-established position in the diagnostic and therapeutic step-by-step schedule. On the one hand, it enables local treatment methods, and on the other it helps in arriving at a decision with regard to the operation. If conditions permit, pleurodesis should be effected via the intrapleural rubber-tube drain, tetracycline hydrochloride having proved very suitable for this purpose. A retrospective review is given on the experiences with thoracoscopy and pleurodesis on the basis of own cases.

Adult↗
PubMed1988

Evidence of cross-reactivity of 'carcinoma-specific' KC4 monoclonal antibody with activated mesothelial cells and phytohemagglutinin-stimulated lymphocytes.

Carcinoma-specific antibodies would be a useful tool in immunocytology of serous effusions. We tested the carcinoma-'specific' monoclonal antibody KC4 with cells obtained from pleural effusions evaluated by thoracoscopy and pleural biopsies. KC4 reacted most strongly with carcinoma cells. However, activated mesothelial cells also expressed this marker strongly. Lymphocytes stimulated with phytohemagglutinin were also stained by KC4. Thus KC4 appears to detect a proliferation antigen rather than a carcinoma-specific antigen.

Antibodies, Monoclonal↗