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  • 1
    ISSN: 1433-0385
    Keywords: Key words: Lung cancer ; Staging ; Lymphadenectomy ; Lymph-node mapping. ; Schlüsselwörter: Bronchialcarcinom ; Staging ; Lymphadenektomie ; Lymphknotendokumentation.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Für die chirurgische Dokumentation des Lymphknotenbefundes bei Bronchialcarcinomen stehen verschiedene Schemata zur Verfügung. Die Benutzung eines reproduzierbaren Schemas ist eine wesentliche Grundlage für die korrekte Bestimmung des TNM-Status und für die Vergleichbarkeit der Behandlungsergebnisse verschiedener Zentren. Um das gegenwärtige Vorgehen der Lymphknotendokumentation und Lymphadenektomie zu erfragen, haben wir an 90 thoraxchirurgischen Abteilungen eine Umfrage durchgeführt. Auswertbare Antworten erhielten wir von 61 (67,7 %) Abteilungen. Die Mehrzahl der Kliniken (43 %) benutzt das Dokumentationsschema der Deutschen Gesellschaft für THG/Pneumologie, 23 % das Schema nach Naruke, weitere 25 % nehmen eine individuelle Benennung der entnommenen Lymphknoten vor. Die Anzahl der untersuchten Lymphknoten wird bei 75 % der Kliniken angegeben, der Quotient von befallenen/nichtbefallenen Lymphknoten bei 33 % der Abteilungen. Unter Berücksichtigung des intraoperativen Aspekts der Lymphknoten wird ein mediastinales „Lymphknoten-Sampling“ bei 59 % der Abteilungen durchgeführt, eine systematische mediastinale En-bloc-Resektion bei 41 % der Kliniken. Die Ergebnisse dieser Umfrage geben ein Bild des derzeitigen Stands der Lymphknotendokumentation und Lymphadenektomie bei Bronchialcarcinomen wieder und könnten als Grundlage zur Fortentwicklung eines einheitlichen Dokumentationsschemas dienen.
    Notes: Summary. A number of different mapping systems have been published for the lymph-node staging in lung cancer. The use of a reproducible map is an essential prerequisite for correct determination of the TNM status and comparing the surgical results. In order to evaluate the current status of lymph-node mapping and lymph-node dissection in Germany, we performed a mail survey involving 90 hospitals performing operations for lung cancer. Responses were obtained from 61 (67.7 %) hospitals. Currently, the majority of the departments (43 %) use the German staging system (according to the Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie/Pneumologie), 23 % lymph-node mapping according to Naruke, and 25 % an individual description of the resected lymph nodes. The number of resected lymph nodes is reported in 75 % of the departments, the quotient of involved/not involved lymph nodes in 33 %. Mediastinal lymph-node sampling guided by the intraoperative aspect of lymph nodes is performed in 59 % of the departments. A systematic mediastinal “en-bloc” resection is accomplished in 41 %. The results of this survey represent the current status of lymph-node mapping and lymphadenectomy in lung cancer in Germany and might be useful for the development of a uniform staging system.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1619-7089
    Keywords: Key words: Positron emission tomography ; Dual-detector coincidence imaging ; Fluorodeoxyglucose ; Lung cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Dual-head gamma cameras operated in coincidence mode are a new approach for tumour imaging using fluorine-18 fluorodeoxyglucose (FDG). The aim of this study was to assess the diagnostic accuracy of such a camera system in comparison with a full-ring positron emission tomography (PET) system in patients with lung cancer. Twenty-seven patients (1 female, 26 males, age 62±9 years) with lung cancer or indeterminate pulmonary nodules were studied on the same day with a full-ring PET scanner (Siemens ECAT EXACT) and a coincidence gamma camera system (ADAC Vertex MCD). Sixty minutes after injection of 185–370 MBq FDG, a scan of the chest was performed with the full-ring system. Approximately 2 h p.i., the coincidence camera study was performed. Coincidence gamma camera (CGC) and PET images with (PETac) and without attenuation correction (PETnac) were analysed independently by two blinded observers. In addition, FDG uptake in primary tumours and involved lymph nodes was quantified relative to normal contralateral lung (T/L ratios). All primary tumours were histologically proven. The lymph node status was histologically determined in 23 patients. In four patients, no lymph node sampling was performed because of extensive disease or concurrent illnesses. In the 27 patients, 25 primary lung cancers and two metastatic lesions were histologically diagnosed. The number of coincidences per centimetre axial field of view was 3.33±0.93×105 for the CGC and 1.09±0.36×106 for the dedicated PET system. All primary tumours (size: 4.6±2.6 cm) were correctly identified in the CGC and dedicated PET studies. T/L ratios were 4.7±2.5 for CGC and 6.9±2.8 for PETnac (P 〈0.001). Histopathological evaluation revealed lymph node metastases in 11 of 88 sampled lymph node stations (size: 2.3±1.0 cm). All lymph node metastases were identified in the PETac studies, while PETnac detected 10/11 and CGC 8/11. For positive lymph nodes that were visible in CGC and PETnac studies, T/L ratios were 3.7±2.3 for CGC and 6.6±3.1 for PETnac (P=0.02). The diameters of false-negative lymph nodes in the CGC studies were 0.75, 1.5 and 2 cm. False-positive FDG uptake in lymph nodes was found in two patients with all three imaging methods. For all lesions combined, T/L ratios in CGC relative to PETnac studies decreased significantly with decreasing lesion size (r=0.62; P〈0.001). In conclusion, compared with a full-ring PET system the sensitivity of CGC imaging for detection of lung cancer is limited by a lower image contrast which deteriorates with decreasing lesion size. Nevertheless, the ability of CGC imaging to detect pulmonary lesions with a diameter of at least 2 cm appears to be similar to that of a full-ring system. Both systems provide a similar specificity for the evaluation of lymph node involvement.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Neuroradiology 23 (1982), S. 219-221 
    ISSN: 1432-1920
    Keywords: Aspergillosis ; Paraplegia ; Destruction of bone ; Ribs ; Vertebrae
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A case of aspergillus fumigatus involving the lungs, ribs and thoracic vertebrae is described. Extensive osteoclasia followed by paraplegia and the primary nature of the aspergillosis make the case exceptional.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Virchows Archiv 425 (1995), S. 641-646 
    ISSN: 1432-2307
    Keywords: Paraganglioma ; Melanin ; Neurosecretory granules ; Mediastinum
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A melanotic paraganglioma occurred in a 57-year-old woman, located in the left paravertebral space of the upper mediastinum. It was totally resected. During a 5 year follow up period neither tumour reccurrence nor metastasis were observed. Histological examination of the tumour revealed a paraganglioma with monomorphous chief cell like elements which were arranged in a “zellballen” pattern. Immunohistochemical results also were in accordance with the diagnosis since neuron-specific enolase, chromogranin and synaptophysin were found in tumour cells whereas keratin was not. Additionally, neurosecretory granules were found in tumour cells during electron microscopy. A peculiar feature of the tumour was its strong pigmentation due to melanin located within the tumour cells and tumour associated melanophages. The simultaneous expression of functional properties of two different neural crest derived cells in one tumour stresses the close relationship between all neural crest elements and is in accordance with the observation of other melanotic, non-melanomatous tumours.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 380 (1995), S. 37-42 
    ISSN: 1435-2451
    Keywords: Thoraxchirurgie ; Komplikationen Mortalität ; FEV1 ; Präoperative Eigenbluttransfusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die Qualität perioperativer Maβnahmen bei thoraxchirurgischen Patienten ist im Hinblick auf Morbidität und Mortalität von gröβter Wichtigkeit. Aus diesem Grunde haben wir das eigene Vorgehen genauer untersucht. Über einen Zeitraum von 3 Jahren wurde das klinische Follow-up bei 792 Patienten (812 Thorakotomien in Folge) dokumentiert und analysiert. Die durchschnittliche Rate von Komplikationen betrug 19,7%, die Mortalität — über eine 30-Tage-Periode — 3,8%. Sekretostase, Atelektase und Pneumonie waren die häufigsten Komplikationen. Mittels Eigenblutkonserven konnte der Prozentsatz von Patienten, die Transfusionen von Fremdblut brauchten, von 27 auf 9% gesenkt werden. Eine Erhöhung der Komplikationsrate bzw. eine Verlängerung des stationären Aufenthalts war nicht festzustellen. Postoperative Wundinfektionen konnten durch perioperative antibiotische Prophylaxe signifikant verringert werden. Ähnlich signifikante Verringerungen der FEV1 nach thoraxchirurgischen Eingriffen wurden — unabhängig vom Ausmaβ des resezierten Lungengewebes — beobachtet; dies weist darauf hin, daβ das verbleibende Lungengewebe während der postoperativen Periode stark in Mitleidenschaft gezogen wird und daβ das chirurgische Trauma als solches mindestens 2 Wochen lang eine Hauptrolle für die postoperative Lungenfunktion spielt.
    Notes: Abstract The quality of perioperative treatment for patients undergoing thoracic surgery is of the utmost importance for postoperative morbidity and mortality. Hence, it was the purpose of this study to examine various aspects of our own procedure. The clinical course following 812 successive thoracotomies in 792 patients over a period of 3 years was documented and analysed. The overall complication rate was found to be 19.7%, with a mortality of 3.8% over a 30-day period. Secretostasis, atelectasis and pneumonia were the most common complications. Owing to the predeposition of autologous blood, the percentage of patients requiring allogeneic blood transfusion was reduced from 27% to 9%. There was no evidence suggesting an increase in the complication rate or a longer stay in hospital. Perioperative antibiotic prophylaxis has reduced postoperative wound infection significantly. Similar reductions in the FEV t are recorded following thoracic surgery, irrespective of the amount of lung tissue resected. This observation indicates that the remaining lung tissue is severely compromised throughout the postoperative period and that the surgical trauma alone is a major factor influencing postoperative pulmonary function for at least 2 weeks.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1435-2451
    Keywords: Aortoiliac surgery ; Postoperative sexual dysfunction ; Superior hypogastric plexus ; Retromesenteric approach ; Aortoiliacale Rekonstruktion ; Postoperative Sexualstörungen ; Plexus hypogastricus superior ; Retromesenterialer Zugang
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Zur Vermeidung von neurogenen Sexualstörungen nach Operationen im aorto-iliacalen Bereich wird ein retromesenterialer Zugang angegeben, der es ermöglicht, die terminale Aorta und die Iliacalgefäße ohne Schädigung des Plexus hypogastricus superior und seiner Varianten freizulegen. Durch dieses, den sympathischen Plexus schonende Vorgehen und durch Gewährleistung eines ausreichenden Iliacainterna-Flows konnten die postoperativen Erektionsstörungen von 17 % bei einem Kollektiv von 1199 Patienten auf 12,3 % bei 570 Patienten gesenkt werden. Die p. o. Ejaculationsstörungen gingen von 81 % auf 20 % zurück.
    Notes: Summary In order to avoid neurogenic sexual dysfunction after aortoiliac surgery, the retromesenteric approach was used. It enabled the exposure of the abdominal aorta and the iliac arteries without disrupting the superior hypogastric plexus and its variants. Using this procedure and respecting a sufficient flow in the internal iliac artery the frequency of postoperative disturbances of erection was reduced from 17 % (1199 patients) to 12.3 % (570 patients). The incidence of postoperative failure of ejaculation in the same groups of patients decreased from 81 % to 20 %.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1435-2451
    Keywords: Aortoiliac surgery ; Vasculogenic and neurogenic impotence ; Postoperative sexual dysfunction ; Superior hypogastric plexus ; Retromesenteric approach
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Es wird über neurogene und vasculäre Sexualstörungen des Mannes berichtet, die nach rekonstruktiven Eingriffen im aorto-iliacalen Bereich auftreten. Zur Vermeidung vasculärer Ursachen wird auf die Notwendigkeit hingewiesen, einen ausreichenden Flow im Iliaca-interna-Stromgebiet zu erhalten oder wiederherzustellen. Neurogen bedingte postoperative Störungen der Ejaculation sind irreversibel und erklären sich durch die Verletzung des sympathischen Plexus hypogastricus superior bei der Darstellung der Aortenbifurkation. A. v. Hochstetter hat zur Vermeidung dieser neurogenen Sexualstörungen anatomisch einen retromesenterialen Zugang zum aorto-iliacalen Bereich empfohlen, der es ermöglicht, die terminale Aorta und die Iliacalgefäße ohne Schädigung des Plexus hypogastricus superior und seiner wesentlichen Wurzeln freizulegen. Durch ein entsprechendes operatives Vorgehen, das den sympathischen Plexus schont und eine ausreichende Durchblutung des Iliacainterna-Stromgebietes gewährleistet, konnten die postoperativen Erektionsstörungen von 17% bei einem Kollektiv von 1199 Patienten auf 12 % bei 570 Patienten gesenkt werden. Die postoperativen Ejaculationsstörungen gingen von 81% auf 20% zurück.
    Notes: Summary Neurogenic and vasculogenic impotence after aortoiliac reconstruction is an unpleasant problem in vascular surgery. The importance of maintaining or restoring intraoperatively a sufficient hypogastric artery blood flow is emphasized. Postoperative neurogenic sexual disabilities are irreversible and are due to interruption of sympathetic nerve fibers supplying the genital system. Dissecting the terminal aorta and the iliac arteries the hypogastric sympathetic plexus - which descends across the bifurcation - can be easily damaged. This is the cause of the high incidence of failure of ejaculation after aortoiliac surgery. In order to avoid this neurogenic sexual dysfunction a retromesenteric approach to the aortoiliac region is anatomically suggested by A. v. Hochstetter. It enables the exposure of the abdominal aorta and the iliac arteries without disrupting the superior hypogastric plexus and its variants. Respecting the integrity of the sympathetic plexus and a sufficient flow in the internal iliac artery the frequency of postoperative disturbances of erection was reduced from 17% (1199 patients) to 12.3 % (570 patients). The incidence of postoperative loss of ejaculation in the same groups of patients decreased from 81% to 20%.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 369 (1986), S. 493-496 
    ISSN: 1435-2451
    Keywords: Recurrent pulmonary embolism ; Kimray Greenfield filter ; Rezidivierende Pulmonalembolie ; Kimray Greenfield Cava Filter
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Rezidivierende venöse Embolien in die Lunge stellen eine ständige und unkontrollierbare Gefährdung für den Patienten dar. Die Implantation eines Cava-Filters kann in Lokalanaesthesie auch bei schwerkranken Patienten durchgeführt werden. Im beschriebenen Patientengut konnten keine Komplikationen oder rezidivierende Embolien beobachtet werden. Vor allem die unbekannte Emboliequelle, aber auch Komplikationen oder Kontraindikationen der Anticoagulation oder Lysetherapie bzw. venösen Thrombektomie sind eine Indikation für die Filterimplantation.
    Notes: Summary Recurrent pulmonary embolism is a permanent risk. The caval filter is able to prevent embolism. The implantation can be done even in seriously ill patients under local anesthesia. In our patients no complication or recurrent embolism were observed. Only one case developed a thrombotic occlusion of the Kimray Greenfield filter as a result of retroperitoneal carcinosis. The relapse of embolism was prevented by the filter. All other implants were seen patent in the digital subtraction angiography.
    Type of Medium: Electronic Resource
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