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Biomedical subjects

W Heitland

Publications and source records attributed to W Heitland.

At least 19 recordsLinked to original sources
PubMed2005

Influence of hospital volume on local recurrence and survival in a population sample of rectal cancer patients.

AIMS: To investigate the role of hospital volume and individual hospitals on long term outcomes (local recurrence and survival) of rectal cancer patients. METHODS: One thousand thirty-eight patients with rectal cancer were diagnosed between 1996 and 1998. From these, we analysed 884 patients with a resected invasive primary rectal cancer. Median follow-up was 5.7 years. The impact of hospital volume (<10, 10-30 and >30 rectal cancer patients annually) on local recurrence and survival was examined in a Cox model. Differences between the four largest clinics in the high volume group were also investigated. RESULTS: In the multivariate model predicting survival the following variables were significant: UICC stage, grade, age, local recurrence, and (neo-) adjuvant therapy treatment. In the multivariate model predicting local recurrence UICC stage, tumour localisation, and neoadjuvant therapy treatment were significant variables. Hospital volume was not a significant factor for survival or local recurrence. Within the high volume category one hospital showed significantly worse local recurrence rates than all other hospitals, but no survival difference could be seen between the four largest hospitals of the high volume group. CONCLUSIONS: This analysis of a rectal cancer population found that hospital volume did not determine survival or local recurrence. Detailed clinical data with long term follow-up from cancer registries are vital to demonstrate the quality of routine care.

Aged↗
PubMed2005

[A 67-year-old patient with diarrhoea and constipation without any pathological findings in virtual colonoscopy].

Virtual colonoscopy provides a computer-simulated endoluminal perspective of the air-filled, distended colon using modern CT scanning (spiral CT). According to recent studies the sensitivity and specificity of this technique are high for adenomatous polyps > or = 10 mm. A 67-year-old patient was admitted to our hospital because of diarrhoea and constipation, associated with abdominal pain in the lower right abdomen. Prior to admission the patient had undergone virtual colonoscopy in a specialised radiological practice which had detected no abnormalities apart from colonic diverticulosis. However, conventional video-colonoscopy revealed a subtotal circular malignant stenosis in the region of the right colonic flexure. A poorly differentiated adenocarcinoma was diagnosed histologically. Staging showed peritoneal carcinosis with infiltration of the right ureter and lymphangiosis carcinomatosa of the pectoral lobe of the left lung. After right hemicolectomy because of metastasised carcinoma of the ascending colon (pT4pN1pM1) we started palliative chemotherapy with oxaliplatin, 5-fluorouracil and leucovorin. The risk of misdiagnosis by virtual colonoscopy is clearly increased in patients with subtotal tumour stenosis of the ascending colon. Conventional video-colonoscopy remains the gold standard for the diagnosis of colorectal carcinoma.

Adenocarcinoma↗
PubMed2004

[Rectal prolapse in adults].

The etiology of rectal prolapse is unclear. Diagnosis is easy by local inspection. The ideal surgery would repair the prolapse, correct any functional problems such as incontinence or constipation, be minimally invasive and cost-effective, and result in minimal morbidity and recurrence. The best surgical repair remains controversial-whether by the transanal/perineal or abdominal approach-with or without resection and rectopexy. There are no prospective-randomized studies that convincingly answer the numerous questions. The best possible option today seems to be the abdominal/laparoscopic method with a resection rectopexy according to Frykman and Goldberg.

Adult↗
PubMed1997

[Anal and perianal tumors].

The anal canal extends from the anorectal ring to the anal verge. Different kinds of epithelium are existing. Below the dentate line is squamous epithelium, above columnar. In between is a gradual transition area, the so called transitional zone. According to the World Health Organization the anal margin is outside the anal verge and the anal canal reaches up to the superior border of the levator muscle. The lymphatic drainage of the anal margin is to the inguinal lymph nodes, from the anal canal to the inferior mesenteric nodes. Tumors of interest in the perianal location are Paget's disease and Bowen's disease as an intraepithelial adenocarcinoma or a squamous cell carcinoma in situ. Wide local excision is the treatment of choice. The true epidermoid carcinoma can be found at the anal margin and the anal canal. The symptoms are mild and unspecific. Many tumors are diagnosed late. The standard treatment has changed in the last 20 years. Local excision and abdominoperineal resections were followed by a high rate of local recurrence. The 5 year survival rate was 50% overall. The treatment of choice today is a combined chemoradiation therapy following Nigro's recommendation. The 5 year survival rate is approximately 85%.

Anus Neoplasms↗
PubMed1987

[Results of the treatment of pathologic fractures of long tubular bones].

The treatment of pathological bone fractures will be analysed by 53 patients of the Surgical Clinic of the University of Tübingen in view of fractures reason, operative providing and prognosis. The first aim consist in correction or preservation of live quality. Fractures nearly joints can be treated by endoprothetics. With the help of compound osteosynthesis most fractures can be stabilized. Conservative treatment only in final phase is legitimated.

Adult↗
PubMed1987

[Are there differences in prodromal illnesses, symptoms and prognosis for various forms of mesenteric infarct?].

Comparing 105 patients with mesenteric infarction, the typical attributes of the underlying diseases, arterial embolization (aE) (n = 26), arterial thrombosis (aT) (n = 40), venous thrombosis (vT) (n = 32) and combined arterio-venous occlusion (n = 7) could be demonstrated. Present heart disease, diabetes and arterial hypertonia, rapid onset of symptoms, severe abdominal pain and signs of peritonitis, extended gangrene of bowel and a high mortality of about 90% is the typical combination for aE. Over 70 years old patients with higher incidence of arteriosclerosis, more digitalis intake, longer duration of symptoms and with bowel problems in the past have a higher incidence of aT and a slightly better prognosis. Risk of thrombosis, long-standing symptoms and a clearly better prognosis are typical for the vT.

Aged↗
PubMed1987

[Preoperative short-term irradiation in rectal cancer].

From 1979 through 1983, 78 patients underwent short-term preirradiation before primary operation for rectal carcinoma at the Medical Radiation Institute of Tübingen. A hyperfractionated total dose of 16 Gy was applied within a maximum time of 36 hours in four fractions of 4 Gy each. Surgery was performed at the last irradiation day. The medium observation time of the total group of patients was five years and three months, at least 40 months. The local recurrence rate of all patients followed up is 9% (7/78), for stage Dukes A it is 6% (2/32), for stage Dukes B 0%(0/25), for stage Dukes C 27% (3/11), and for stage Dukes D 20% (2/10). In the group of 68 patients showing no metastases at the moment of surgery, the rate of formation of remote metastases amounts to 21%, in stage Dukes A to 13% (4/32), in stage Dukes B to 24% (6/25), and in stage Dukes C to 36% (4/11). The relapse-free survival during the follow-up period is 66% (45/68), for stage Dukes A 69% (22/32), for stage Dukes B 68% (17/25), and for stage Dukes C 55% (6/11). There were no acute or late radiogenic complications. Compared to publications about cases treated only by surgery, the present preirradiated patient's group shows a considerable lower local recurrence rate and an increased relapse-free survival rate. These improved treatment results are probably due to preoperative irradiation. The incidence of perioperative complications was not increased by preoperative irradiation.

Combined Modality Therapy↗
PubMed1986

[When is a breast-preserving operation permitted?].

Breast preserving operations in cases of breast cancer are permitted only under following conditions: Tumor extension should not exceed stage pT1. Axillary lymph nodes have to be removed completely. Histological examination requires a competent pathologist. Carefully planned and consequently applied radiotherapy with a dosage of at least 60 Gy (6000 rad) is mandatory.

Breast Neoplasms↗
PubMed1986

[Long-term intubation following tracheotomy].

Between 1981 and 1983 tracheotomy was performed on 61 patients in the Surgical University Clinic of Tübingen. The dominant factors in indication of tracheotomy was for 49% of patients the persistingly necessary artificial respiration, for 26% a better bronchial toilet and other reasons for 25%. With 40.5% of all cases pneumonia was the most frequent complication encountered with our patients. The most frequent bacteria was Pseudomonas aeruginosa. Because of the decisive advantage constituted by the possibility of unproved bronchial toilet an earlier realisation of tracheotomy is to be recommended.

Bronchitis↗
PubMed1985

[Secondary reconstruction of intestinal continuity following colectomy for ulcerative colitis].

In 37 patients with a clinically and microscopically confirmed ulcerative colitis the rectum was retained after subtotal (n = 29) or left-sided (n = 8) colectomy. In the following 1.6 years in 25 of the 37 patients the rectal stump was removed; in 9 of these cases a straight ileoanal anastomosis was constructed; after 4 years in 4 of the 8 surviving patients the anastomosis has been removed for various reasons. In 12 of 37 patients the rectum was preserved over 10.8 years only in 4 of these cases with rapidly decreasing protectitis the construction of an ileo-rectal anastomosis was possible.

Adult↗
PubMed1980

[Cytostatic therapy of GI carcinoma based on assessment of cell kinetics (author's transl)].

Flow cytometry affords an insight into the cell cycle of gastrointestinal tumors. In comparison with the normal GI mucosa, dedifferentiated carcinomas show a large SG2M peak expressing an intense proliferation. The histological examination considers normally only a small part of the tumor, whereas the flow cytometric histogram is based upon a larger amount of cells. Therefore some tumors are regarded as well differentiated by the pathologist, although they have a large SG2M peak. Considering the functioning of cytostatic drugs, all GI tumors should be treated which have a large SG2M peak in flow cytometry.

Antineoplastic Agents↗
PubMed1978

[Control mechanisms of the ribonucleotide reduction in mammalian tissue (author's transl)].

The ribonucleoside diphosphate reductase (E.C.1.17.4.1) was partially purified from Ehrlich ascites carcinoma and regenerating rat liver. The specific activity of the two enzyme preparations did not vary with regard to the reduction of UDP, ADP, CDP and GDP. Similarly the regulation of the enzyme system by deoxyribonucleoside triphosphate (dNTP) is almost identical. Through the application of deoxyribonucleosides (10(-3) or 2 x 10(-3)M) and measurement of the dNTP content it was found in Ehrlich and Yoshida ascites tumours that these control mechanisms are transmissible to whole cells. dATP inhibits the reduction of all four nucleoside diphosphates. dTTP stimulates the reduction of GDP, dCTP that of UDP and dGTP that of ADP.

Animals↗