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Biomedical subjects

U Heise

Publications and source records attributed to U Heise.

At least 19 recordsLinked to original sources
PubMed1992

[Transcatheter embolization of tumors of the muscular and skeletal systems].

The value of transcatheter embolisation of tumours of the musculoskeletal system is discussed on the basis of 26 cases. All procedures were performed following diagnostic angiography (DSA). By preoperative vascular occlusion it was possible to prevent major blood loss during surgery, provided the operation was carried out within three days of embolisation. Reduction in size of some large inoperable metastases before radio-iodine therapy is another indication for embolisation. As a palliative measure, vascular occlusion can be used for reducing otherwise untreatable skeletal pain and for the management of arteriovenous malformations. Bleeding from a tumour can be controlled by vascular occlusion. Our results indicate that transcatheter embolisation is an effective and reliable technique.

Adolescent↗
PubMed1990

Hydroxyapatite ceramic as a bone substitute.

We have used hydroxyapatite ceramic as a bone substitute for grafting in extensive bone replacement. Hydroxyapatite is composed of calcium phosphate and is incorporated into bone as a physiological mineral. It is not antigenic, carcinogenic or osteogenic. The material used in this study differs from other hydroxyapatite ceramics in that it is an interconnected porous system. Between 1981 and 1986 we used this material on forty five occasions in 44 patients. It was combined with autologous cancellous bone graft in 38 cases and used alone in a further seven. It was usually employed to fill defects after removal of bone cysts and for long fusions in patients with scoliosis. It was also used to fill bone defects after trauma, for non-union in the lumbosacral area, for anterior vertebral fusions, in limb sparing operations for malignant bone tumours, and in exchange operations after failed joint endoprostheses. We have not seen incompatibility or rejection of the implanted material. The rate of postoperative infection was higher than usual due to the selection of patients, but did not appear to be connected with the use of hydroxyapatite ceramic. We were able to review 36 patients up to sixty months after operation. The results are encouraging with no difference in progress compared with patients in whom simple autologous bone grafts had been used.

Adolescent↗
PubMed1990

Scintigraphic evaluation of tumor regression during preoperative chemotherapy of osteosarcoma. Correlation of 99mTc-methylene diphosphonate parametric imaging with surgical histopathology.

The effect of preoperative chemotherapy (PCT) on the uptake of 99mTc-labeled diphosphonates into tumor bone was quantitatively assessed from serial scan studies of 30 osteosarcomas and correlated with the histomorphological changes determined from the surgical specimens. The parametric images of the tumor blood pool and labeled methylene diphosphonate (99mTc-MDP) plasma clearance by the tumor bone enabled a sensitive distinction to be made preoperatively between a good (greater than 90% tumor cell destruction) and a poor (less than 90% tumor cell destruction) tumor response. Overall accuracy in presurgical prediction of tumor regression was found to be 88% and 96% for the blood pool and 99mTc-MDP clearance measurements, respectively (P less than or equal to 0.0004). In addition, it proved possible to localize resisting areas of viable tumor up to 1.0 cm in diameter. Even at the half-way stage of PCT, a poor response could be reliably predicted (overall accuracy 91% and 100%, respectively; P less than or equal to 0.011). Therefore, 99mTc-MDP parametric imaging is a highly sensitive and specific modality for an objective and accurate assessment of tumor regression during PCT of osteosarcoma.

Adolescent↗
PubMed1989

[Current indications for angiography of tumors of the muscular and skeletal systems].

CT and MRI have greatly influenced the indications for angiography as a diagnostic method for tumours of the muscular and skeletal systems. 59 patients with bone and soft tissue tumours were examined by arteriography (DSA) and the indications for arteriography were compared with CT (32 cases) and MRI (15 cases). Particular attention was paid to the presence of vessel encasement. Arteriography is the definitive method for demonstrating vascular involvement. Tomographic methods demonstrate the topographic relationships of the tumour and neuro-vascular structures. Angiography can also be used as an interventional measure pre-operatively or for palliative embolisation.

Adolescent↗
PubMed1988

Neoadjuvant chemotherapy of osteosarcoma: results of a randomized cooperative trial (COSS-82) with salvage chemotherapy based on histological tumor response.

Following observation of the predictive value of the histologic extent of tumor cell destruction after preoperative chemotherapy for metastasis-free survival (MFS) in osteosarcoma, a randomized study was undertaken with the aim of (1) sparing some patients the unpleasant side effects of highly toxic drugs like doxorubicin (DOX) and cisplatin (CPDD) by administering these drugs postoperatively only after poor response with a milder preoperative regimen, and (2) improving the prognosis of patients responding poorly to the initial treatment by use of a salvage chemotherapy postoperatively. The available patients were divided into two groups. Those in the study arm received a preoperative chemotherapy consisting of high-dose methotrexate (HDMTX) and the triple drug combination of bleomycin, cyclophosphamide, and dactinomycin (BCD) and were switched to DOX/CPDD postoperatively in case of poor response. DOX/CPDD was used besides HDMTX for initial treatment in the control arm, and BCD alternatively with CPDD/ifosfamide (IFO) for postoperative salvage treatment. The response rate of the study arm was significantly inferior to the control arm (26% v 60%; P less than .001). The actuarial 4-year MFS rate of poor responders after salvage chemotherapy also was poorest in the study arm (41%); it was unchanged in the control arm (53%) as compared with that of poor responders from the COSS-80 study without salvage chemotherapy (52%). The actuarial 4-year MFS rate of good responders was 73% in the study arm, 79% in the control arm, and not significantly different from that of the COSS-80 study (84%), although postoperative chemotherapy of good responders had been markedly shortened as compared with the COSS-80 study. The actuarial 4-year MFS rate of the study arm as a whole was inferior to that of the control arm (49% v 68%; P less than .1) and also inferior to the COSS-80 study (68%; P less than .01), indicating a failure of the employed salvage strategy in general and especially of the effort to restrict the use of the very effective but highly toxic drugs DOX and CPDD to patients resistant to a less toxic initial treatment.

Actuarial Analysis↗
PubMed1987

Histomorphometric changes of osteosarcoma after chemotherapy. Correlation with 99mTc methylene diphosphonate functional imaging.

An investigation to correlate histologic changes in 12 osteosarcoma specimens from patients undergoing chemotherapy was performed using functional images of regional 99mTc methylene diphosphonate (MDP) plasma clearance rates assessed from dynamic bone scintigraphies taken during chemotherapy. Residual tumor cell viability was determined by microscopic examination of multiple thin sections from surgical specimens and quantitated by histomorphometry. Regions that showed decreases in 99mTc MDP plasma clearance of more than 20% were associated with areas of necrotic tumor, and regions that showed absent decline or increasing clearance rates were associated with high residual cell viability and incomplete response to chemotherapy. Therefore, functional bone scintigraphy allows an objective presurgical assessment of tumor response to chemotherapy.

Adolescent↗
PubMed1987

Comparison of quantitative ground substance analysis in biopsy and resected tumour in osteosarcomas.

Osteosarcomas may show variable differentiation. They are divided into osteoblastic, chondroblastic and fibroblastic subgroups depending on their dominant histological differentiation. The pattern of histological differentiation of osteosarcoma is supposed to have an influence on the response to chemotherapy and in this study the relationship between the differentiation of the tumours and response to chemotherapy was examined in 22 osteosarcomas. For this purpose the nuclear size of tumour cells was determined on imprints and the area of the different ground substances on tumour sections after undecalcified preparation. Tumours with little nuclear polymorphism and those with an area of chondroblastic ground substance of more than 20% in the biopsy showed a poor response to chemotherapy. We conclude from our results that lack of nuclear polymorphism and in particular a large area of chondroblastic ground substances in the biopsy, can be regarded as an unfavourable prognostic factor in the response to primary chemotherapy. A comparison of the area of chondroblastic ground substance in biopsy and resection material proves that the biopsy delivers a representative view of the total area of chondroblastic ground substance for the groups of responder and non-responder. Patients with a large amount of chondroblastic ground substance in the biopsy probably require more aggressive chemotherapy.

Adolescent↗
PubMed1985

[Comparison of x-ray and histological findings in osteosarcomas following preoperative chemotherapy].

Since the introduction of pre-operative chemotherapy, osteosarcomas have shown a more favourable prognosis. Reaction of the tumour due to chemotherapy is judged pre-operative primarily by radiology (plain films, angiography, CT, scintigraphy). There is little evidence concerning the radiological appearances after pre-operative chemotherapy and morphological changes, particularly in respect of tumour regression. Specific radiological changes were therefore compared with pathological findings following chemotherapy and operation in 17 patients with osteosarcomas. Tumours were examined which showed radiological evidence of intra-and extra-osseous sclerosis or lysis and which still were classified as vital tumour tissue. Tumour planes were reconstructed from large histological sections of the operative specimen and compared with the radiological appearances. Sclerosis was found to be due to reactive new bone formation or to mineralisation of the osteosarcomatous tissue. Lysis correlated with persistent vital tumour, or in connective tissue. Nine out of ten cases, regarded as vital on radiological evidence, showed vital tumour cells on histological section. Lyses and scleroses were not reliable indications of the pre-operative state of the osteosarcoma following chemotherapy. On the other hand, combined qualitative radiological criteria for assessing tumour vitality, proved to be helpful.

Adolescent↗
PubMedDate not supplied

[Methods of surface measurements in idiopathic scoliosis].

The radiologic evaluation of scoliotic spines is a well established, exact method. In long follow-up histories these patients aquire a remarcable radiation exposure. Measurement of additional clinical parameters intends since decades to minimize this exposure. Documentation of surface deformities follows the presumption of a correlation between these and the radiologic angles. The analysis of 714 completely documented untreated idiopathic scoliotic curves showed a good overall correlation between surface deformity and Cobb angle, but single measurements varied too widely to make the used surface documentation a real alternative to x-rays. Treated scoliosis patients pose additional problems in the evaluation, a any treatment - brace and operation - further diminish the correlation. Obviously the usual clinical surface evaluation can only document the cosmetic appearance. Regular radiologic follow-up stays inevitable especially in treated scoliotic patients.

Adolescent↗