[Show abstract][Hide abstract] ABSTRACT: Fast track programs, multimodal therapy strategies, have been introduced in many surgical fields to minimize postoperative morbidity and mortality. In terms of lung resections no randomized controlled trials exist to evaluate such patient care programs.
In a prospective, randomized controlled pilot study a conservative and fast track treatment regimen in patients undergoing lung resections was compared. Main differences between the two groups consisted in preoperative fasting (6h vs 2h) and analgesia (patient controlled analgesia vs patient controlled epidural analgesia). Study endpoints were pulmonary complications (pneumonia, atelectasis, prolonged air leak), overall morbidity and mortality. Analysis was performed in an intention to treat.
Both study groups were similar in terms of age, sex, preoperative forced expiratory volume in one second (FEV(1)), American Society of Anesthesiologists score and operations performed. The rate of postoperative pulmonary complications was 35% in the conservative and 6.6% in the fast track group (p=0.009). A subgroup of patients with reduced preoperative FEV(1) (<75% of predicted value) experienced less pulmonary complications in the fast track group (55% vs 7%, p=0.023). Overall morbidity was not significantly different (46% vs 26%, p=0.172), mortality was comparable in both groups (4% vs 3%).
We evaluated an optimized patient care program for patients undergoing lung resections in a prospective randomized pilot study. Using this fast track clinical pathway the rate of pulmonary complications could be significantly decreased as compared to a conservative treatment regimen; our results support the implementation of an optimized perioperative treatment in lung surgery in order to reduce pulmonary complications after major lung surgery.
European Journal of Cardio-Thoracic Surgery 07/2008; 34(1):174-80. DOI:10.1016/j.ejcts.2008.04.009 · 2.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Fast-track programs have been introduced in many surgical fields to minimize postoperative morbidity and mortality. Morbidity after elective open infrarenal aneurysm repair is as high as 30%; mortality ranges up to 10%. In terms of open infrarenal aneurysm repair, no randomized controlled trials exist to introduce and evaluate such patient care programs.
This study involved prospective randomization of 82 patients in a "traditional" and a "fast-track" treatment arm. Main differences consisted in preoperative bowel washout (none vs. 3 l cleaning solution) and analgesia (patient controlled analgesia vs. patient controlled epidural analgesia). Study endpoints were morbidity and mortality, need for postoperative mechanical ventilation, and length of stay (LOS) on intensive care unit (ICU).
The need for assisted postoperative ventilation was significantly higher in the traditional group (33.3% vs. 5.4%; p = 0.011). Median LOS on ICU was shorter in the fast-track group, 41 vs. 20 h. The rate of postoperative medical complications was significantly lower in the fast-track group, 16.2% vs. 35.7% (p = 0.045).
We introduced and evaluated an optimized patient care program for patients undergoing open infrarenal aortic aneurysm repair which showed a significant advantage for "fast-track" patients in terms of postoperative morbidity.
Langenbeck s Archives of Surgery 06/2008; 393(3):281-7. DOI:10.1007/s00423-008-0284-8 · 2.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of the study was to evaluate prospectively whether integrated 2-deoxy-2-[(18)F]fluoro-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) is more accurate for determination of malignancy in newly diagnosed pulmonary lesions compared to separate interpretation of CT and FDG-PET.
Two hundred and seventy-six patients with newly diagnosed lung lesions underwent FDG-PET/CT. Helical CT, FDG-PET, and FDG-PET/CT were interpreted separately to determine the performance of each imaging modality. Histopathology served as reference in all patients, and in further 60 patients, a benign lesion was verified at follow-up (mean follow-up of 1,040 days).
Histology revealed malignant lung tumors in 216 of 276 patients. With PET and PET/CT, a significantly lower number of lesions were classified as equivocal compared to CT alone (p < 0.001). Assuming that equivocal lesions are benign, performance of diagnostic tests was as follows: sensitivity, specificity, and accuracy for CT was 94, 75, and 90%, for PET 97, 83, and 94% (p = 0.021), and for PET/CT 96, 87, and 94% (p = 0.010). Assuming that equivocal lesions are malignant, sensitivity, specificity, and accuracy for CT was 99, 37, and 86%, for PET 99, 77, and 94% (p < 0.001), and for PET/CT 98, 68, and 92% (p = 0.002). PET and PET/CT showed the highest concordance (K = 0.912; confidence interval 0.866-0.958). In lesions less than or equal to 3 cm, there was a significant difference in the performance of PET alone and multidetector row CT as well as PET/CT and multidetector row CT (p = 0.007), irrespective if equivocal findings were judged as malignant or benign.
For differentiation of benign from malignant lung lesions, integrated FDG-PET/CT imaging was significantly more accurate than CT but not FDG-PET. The addition of metabolic imaging (FDG-PET) to morphological imaging (CT) leads to an increase in specificity and significantly reduced equivocal findings and is therefore recommended to further specify newly diagnosed lung lesions.
[Show abstract][Hide abstract] ABSTRACT: To present a single centers' 7-year experience in the endovascular treatment of acute traumatic lesions of the descending thoracic aorta (ATL of the DTA).
Between March 1999 and December 2006, 34 consecutive acute traumatic lesions of the descending aorta (23 men, mean age 44 years) were treated endovascularly. Stentgrafts used were TAG Excluder, Zenith TX2 and Talent. In 23 patients the Left Subclavian Artery (LSA) was covered. Mean procedural duration was 20 to 75 minutes.
Exclusion of the rupture site was achieved in all cases with no conversion to open surgery. Overall 30-day mortality was 8.8%. Two patients died on post operative day (pod) 1 and one on pod 22 from cranial injuries. No death or neurological deficit related to the endovascular treatment was reported. Four type I endoleaks required treatment either by balloon reexpansion (n=2) or by additional stentgraft implantation (n=2). In two patients the stentgraft collapsed totally several days postoperatively. Two patients required secondary surgical procedures (iliac access complication and revascularisation of the left subclavian artery n=1). The average follow-up was 43.8 months (1-93 months). No stentgraft related abnormality has been subsequently documented.
The endovascular treatment of ATL of the DTA may offer the best means of therapy in a polytrauma patient.
European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 12/2007; 34(6):666-72. DOI:10.1016/j.ejvs.2007.06.022 · 3.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this prospective study, reliability of integrated (18)F-FDG PET/CT for staging of NSCLC was evaluated and compared to MDCT or PET alone.
240 patients (pts) with suspected NSCLC were examined using PET/CT. Of those patients 112 underwent surgery comprising 80 patients with NSCLC (T1 n = 26, T2 n = 37, T3 n = 11, T4 n = 6). Imaging modalities were evaluated independently.
MDCT, PET and PET/CT diagnosed the correct T-stage in 40/80 pts (50%; CI: 0.39-0.61), 40/80 pts (50%; CI: 0.39-0.61) and 51/80 pts (64%; CI: 0.52-0.74), respectively, whereas equivocal T-stage was found in 15/80 pts (19%; CI: 0.11-0.19), 12/80 pts (15%; CI: 0.08-0.25) and 4/80 pts (5%; CI: 0.01-0.12), respectively. With PET/CT, T-stage was more frequently correct compared to MDCT (p = 0.003) or PET (p = 0.019). Pooling stages T1/T2, T-stage was correctly diagnosed with MDCT, PET and PET/CT in 54/80 pts (68%; CI: 0.56-0.78), 56/80 pts (70%; CI: 0.59-0.80) and 65/80 pts (81%; CI: 0.71-0.89). T3 stage was most difficult to diagnose. T3 tumors were correctly diagnosed with MDCT in 2/11 pts (18%; CI: 0.02-0.52) versus 0/11 pts (0%; CI: 0.00-0.28) with PET and 5/11 pts (45%; CI: 0.17-0.77) with PET/CT. In all imaging modalities, there were no equivocal findings for T4 tumors. Of these, MDCT found the correct tumor stage in 4/6 pts (67%; CI: 0.22-0.95), PET in 3/6 pts (50%; CI: 0.12-0.88) and PET/CT in 5/6 pts (83%; CI: 0.36-0.99).
Integrated PET/CT was significantly more accurate for T-staging of NSCLC compared to MDCT or PET alone. The advantages of PET/CT are especially pronounced combining T1- and T2-stage as well as in advanced tumors.
[Show abstract][Hide abstract] ABSTRACT: Children rarely undergo thoracic surgery. When they do, the procedures fall into five main groups: oncologic indications, immune defects, malformations, infections and trauma. In addition to considerations associated with the underlying indication, the different proportions of the anatomical structures in children require special modifications in both diagnostics and surgical technique compared to corresponding procedures in adults.
Of a total 2137 thoracic surgical procedures performed between 1992 and 2001, 49 were performed in children (n = 37; age: 3 months-15 years; median age: 8 years). Indications for surgery included underlying oncologic disease (n = 20), immunodeficiency (n = 5), thoracic or pulmonary malformation (n = 6) and trauma (n = 3). Patients' postoperative clinical course was analyzed retrospectively for all 49 procedures. Pre- and postoperative pulmonary function test results are available for 16 children. Data regarding quality of life were documented in 24 children.
The following procedures were performed: 27 atypical resections, seven lobectomies, one pneumonectomy, three decortications, four mediastinotomies or mediastinoscopies and seven other procedures. Six procedures represented second or third procedures in the same patient. Two of six patients with immune defects died during the perioperative period. Eleven of 20 oncologic patients (55%) have remained free of recurrent disease. Quality of life, as assessed by the Karnowski index in 24 children, was at least 80%.
Thoracic surgical procedures in children with underlying benign disease are associated with a good prognosis and high quality of life scores. Surgical treatment of pulmonary metastases is a feasible component of the overall oncologic therapy concept and can offer the only opportunity for curation for a selected group of patients. Because of high postoperative mortality, however, the indication for diagnostic thoracotomies in children with immunodeficiencies and poor general health should be weighed critically.
European Journal of Cardio-Thoracic Surgery 08/2005; 28(1):50-5. DOI:10.1016/j.ejcts.2005.03.010 · 2.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recently, the thymidine analogue 3'-deoxy-3'[18F]fluorothymidine (FLT) has been introduced for imaging proliferation with positron emission tomography (PET). In this prospective study, we examined the accuracy of FLT for differentiation of benign from malignant lung lesions and for tumour staging.
A total of 47 patients with newly diagnosed pulmonary nodules on chest CT suspicious for malignancy were examined with FLT-PET in addition to routine staging procedures. A total of 43 patients also underwent 2-[18F]fluoro-2-deoxy-D-glucose (FDG) PET imaging. Within 2 weeks, patients underwent resective surgery or core biopsy of the pulmonary lesion.
Histopathology revealed malignant lung tumours in 32 patients (20 non-small cell lung cancer, 1 small cell lung cancer, 1 pulmonary carcinoid, 1 non-Hodgkin's lymphoma, nine metastases from extrapulmonary tumours) and benign lesions in 15 patients. Increased FLT uptake was exclusively related to malignant tumours. FLT-PET was false negative in two patients with non-small cell lung cancer, in the patient with a pulmonary carcinoid and in three patients with lung metastases. The sensitivity of FLT-PET for detection of lung cancer was 90%, the specificity 100% and the accuracy 94%. Fifteen out of 21 patients with lung cancer had mediastinal lymph node metastases. FLT-PET was true positive in 7/15 patients, resulting in a sensitivity of 53% for N-staging (specificity 100%, accuracy 67%). Clinical TNM stage was correctly identified in 67% (20/30) patients, compared to 85% (23/27) with FDG-PET.
FLT-PET has a high specificity for the detection of malignant lung tumours. Compared with FDG, FLT-PET is less accurate for N-staging in patients with lung cancer and for detection of lung metastases. FLT-PET therefore cannot be recommended for staging of lung cancer.
European journal of nuclear medicine and molecular imaging 06/2005; 32(5):525-33. DOI:10.1007/s00259-004-1706-7 · 5.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This paper reviews the surgical management of vascular injuries. Precise clinical and ultrasound evaluation is mandatory during the first steps of emergency treatment. For further documentation of the extent and site of arterial injuries in hemodynamically stable patients, computed tomography and angiography are crucial in differential diagnosis. Especially during the acute phase, the latter is indicated for evaluating the interventional therapy. The key to successful treatment of vascular injuries is immediate surgical control of hemorrhaging vessels.
Der Chirurg 05/2005; 76(4):411-24; quiz 425-6. · 0.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Diese Arbeit soll einen berblick ber das chirurgische Management von Gefverletzungen geben. Neben der klinischen und sonographischen Basisdiagnostik liefert beim hmodynamisch stabilen Patienten vor allem die Computertomographie (CT) und in besonderen Fllen die Angiographie entscheidende Hilfen zu Differenzialdiagnosen. Die Angiographie ist in der Akutphase vor allem zur Therapieplanung und Durchfhrung interventioneller Eingriffe notwendig. Fr die erfolgreiche Therapie von Gefverletzungen ist die schnelle Exposition und Blutungskontrolle eine wesentliche Voraussetzung.This paper reviews the surgical management of vascular injuries. Precise clinical and ultrasound evaluation is mandatory during the first steps of emergency treatment. For further documentation of the extent and site of arterial injuries in hemodynamically stable patients, computed tomography and angiography are crucial in differential diagnosis. Especially during the acute phase, the latter is indicated for evaluating the interventional therapy. The key to successful treatment of vascular injuries is immediate surgical control of hemorrhaging vessels.
Der Chirurg 03/2005; 76(4):411-426. DOI:10.1007/s00104-005-1014-1 · 0.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: HintergrundNach der offenen chirurgischen Versorgung thorakoabdominaler Aortenaneurysmen resultiert im Vergleich zur Operation isolierter thorakaler oder abdomineller Aortenaneurysmen eine gesteigerte Morbiditt und Letalitt. Eine kombinierte endovaskulre und chirurgische Vorgehensweise bei der Behandlung von Patienten mit thorakoabdominalen Aortenaneurysmen erscheint nun deshalb erfolgversprechend, da zum einen die aortale Klemmphase vollstndig entfllt und zum anderen die Ischmiezeit der Nieren- und Viszeralarterien deutlichst reduziert werden kann.Material und MethodeIm Zeitraum 1995–2004 wurden 137 Patienten mit thorakalen Aortenerkrankungen stentgesttzt versorgt. Bei 7Patienten mit thorakoabdominalem Aortenaneurysma wurde ein Hybridverfahren angewandt, d.h. die Ausschaltung des Aneurysmas erfolgte endovaskulr stentgesttzt, die Revaskularisation der Nieren- bzw. Viszeralgefe wurden offen chirurgisch durch transperitoneale Bypassverfahren erreicht.ErgebnisseIn allen 7Fllen konnte der Eingriff komplikationslos durchgefhrt werden. Zwei Patienten verstarben allerdings innerhalb von 30 Tagen: urschlich verantwortlich fr den letalen Ausgang war beim ersten Patienten ein Mehrorganversagen bei ischmisch bedingter Pankreatitis; beim zweiten war fr den Tod ebenfalls ein Mehrorganversagen urschlich verantwortlich aufgrund eines protrahierten Schockgeschehens nach rupturiertem thorakoabdominalem Aortenaneurysma.SchlussfolgerungenDas Hybridverfahren stellt beim thorakoabdominalen Aortenaneurysma durchaus ein alternatives Therapiekonzept dar; infolge des fehlenden Aortenclampings und der deutlich reduzierten Ischmiezeiten fr Nieren- und Viszeralgefe erscheint das Kombinationsverfahren insbesondere fr Patienten mit schwerwiegenden kardiopulmonalen Begleiterkrankungen als auch fr Patienten geeignet, bei denen bereits in der Vorgeschichte eine thorakoabdominale Aortenfreilegung durchgefhrt wurde.IntroductionThe conventional approach for the repair of thoracoabdominal aneurysms remains complex and demanding and is associated with substantial morbidity and mortality. Moreover, in cases of reoperation the impact can be dramatic either in survival or in quality of life of the patients, despite the use of adjuncts. A combined endovascular and surgical approach with retrograde perfusion of visceral and renal vessels has been developed to minimize intraoperative and postoperative complications.Material and methodsOf 137 thoracic aortic stent grafts inserted between 1995 and 2004, 7 of the patients with thoracoabdominal aneurysms were treated with a combined endovascular and surgical approach. Five procedures were electively conducted and two on an emergency basis. The surgical approach was executed in all patients without thoracotomy or redo retroperitoneal exposure. Revascularization of the renal, superior mesenteric artery and celiac trunk was accomplished via transperitoneal bypass grafting. Aneurysmal exclusion was performed by stent graft deployment.ResultsThe entire procedure was technically successful in all patients. A 73-year-old man died due to multiorgan failure after having developed ischemia-related pancreatitis, despite the successful combined repair. A second female patient, 76 years old, with ruptured TAAA died due to shock-related multiorgan failure. No patient experienced any temporary or permanent neurological deficit.ConclusionThe combined endovascular and surgical approach is feasible, without cross-clamping of the aorta and with minimized ischemia time for renal and visceral arteries, and a thoracoabdominal transdiaphragmatic approach seems to be the appropriate strategy for high-risk and previously operated patients.
[Show abstract][Hide abstract] ABSTRACT: Mediastinal lymph node staging is essential to determine treatment options in patients with NSCLC. Positron emission tomography (PET) detects increased glucose uptake in malignant tissue using the glucose analogue 2-[(18)F]fluoro-2-deoxy-D-glucose (FDG).
In the present study were evaluated 155 patients with focal pulmonary tumors who underwent both preoperative computed tomography (CT) and FDG-PET scanning (116 malignant and 39 benign lesions).
Findings in 155 patients included 116 malignant and 39 benign lesions. For N-staging, FDG-PET showed a sensitivity of 88%, a specificity of 91%, and an accuracy of 89%. Corresponding figures for CT were 77%, 76%, and 77%, respectively.
FDG-PET is an effective, noninvasive method for staging thoracic lymph nodes in patients with lung cancer and is superior to CT scanning in the assessment of hilar and mediastinal nodal metastases. With regard to operability, FDG-PET could differentiate reliable between patients with N1/N2 disease and those with unresectable N3 disease.
The Thoracic and Cardiovascular Surgeon 05/2004; 52(2):96-101. DOI:10.1055/s-2004-817844 · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 2-[(18)F]-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography has been established as a standard diagnostic imaging method in the preoperative workup of suspicious pulmonary focal lesions, showing a sensitivity of more than 90% and a specificity of about 80%. Determination of malignant pulmonary lesions with FDG positron emission tomography depends on the assessment of glucose metabolism. However, false-positive findings can occur in inflammatory processes, such as sarcoidosis or pneumonia. The thymidine analogue 3-deoxy-3[(18)F]-fluorothymidine (FLT) is a new positron emission tomography tracer that more specifically targets proliferative activity of malignant lesions. The objective of this study was to determine whether FLT positron emission tomography, in comparison with FDG positron emission tomography, provides additional information in the preoperative workup of central pulmonary focal lesions.
In this prospective study FLT and FDG positron emission tomography examinations were performed as a part of the preoperative workup in 20 patients with histologically confirmed bronchial carcinoma, 7 patients with benign lesions, and 1 patient with an atypical carcinoid. Results were compared with final pathologic findings.
For staging of the primary tumor, FLT positron emission tomography revealed a sensitivity of 86% and a specificity of 100% compared with a sensitivity of 95% and a specificity of 73% for FDG positron emission tomography. For N staging, the sensitivity of FLT positron emission tomography was 57% and the specificity was 100%, and for FDG positron emission tomography, the sensitivity was 86% and the specificity was 100%, respectively.
Our preliminary findings indicate specific FLT uptake in malignant lesions. The number of false-positive findings in FDG positron emission tomography might be reduced with FLT positron emission tomography. Therefore positron emission tomography imaging with FLT represents a useful supplement to FDG in assessing the malignancy of central pulmonary focal lesions.
Journal of Thoracic and Cardiovascular Surgery 05/2004; 127(4):1093-9. DOI:10.1016/j.jtcvs.2003.09.003 · 3.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There is still controversial discussion concerning the therapy of limb-threatening ischaemia. In a retrospective study, we investigated and compared surgical and percutaneous interventional methods in the treatment of both embolic and thrombotic vascular occlusions in patients with pre-existing arteriosclerotic disease and attempted to propose therapy guidelines for these methods in the therapy of acute limb ischaemia. Percutaneous mechanical thrombectomy represents a viable therapeutic alternative to surgical or surgical-interventional modalities, particularly in patients with occlusions consisting of soft, embolic material or located in infrapopliteal vessels. The indication for each respective method should be interdisciplinary and must be based on the individual patients' clinical and angiographic findings. Additional intraoperative endovascular procedures increase the range of therapeutic options and permit optimal revascularisation of vessels both proximal and distal to the site of occlusion.
Der Chirurg 01/2004; 74(12):1118-27. DOI:10.1007/s00104-003-0723-6 · 0.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Die Vorgehensweise zur Erhaltung der ischmisch bedrohten Extremitt wird nach wie vor kontrovers diskutiert. In einer retrospektiven Studie wurden das chirurgisch-interventionelle und das perkutan-interventionelle Vorgehen bei rein embolischen und bei akuten thrombotischen Verschlssen mit vorbestehenden arteriosklerotischen Vernderungen miteinander verglichen. Die perkutane mechanische Thrombektomie stellt besonders bei weichem, embolischem Verschlussmaterial sowie im infrapoplitealen Bereich eine Therapiealternative zum chirurgischen bzw. chirurgisch-endovaskulren Vorgehen dar. Die interdisziplinre Indikationsstellung zur jeweiligen Verfahrenswahl sollte sich speziell am klinischen und am angiographischen Befund des einzelnen Patienten orientieren. Zustzliche intraoperative endovaskulre Therapieverfahren bieten die Mglichkeit eines erweiterten Aktionsradius und ermglichen das gezielte Vorgehen sowohl im Zustrom- als auch im Abstromgebiet. Unsere Ergebnisse zeigen klar, dass auch die chirurgische Vorgehensweise sowohl beim embolischen wie insbesondere beim thrombotischen Verschluss alle interventionellen Manahmen zur Anwendung bereithalten muss.There is still controversial discussion concerning the therapy of limb-threatening ischaemia. In a retrospective study, we investigated and compared surgical and percutaneous interventional methods in the treatment of both embolic and thrombotic vascular occlusions in patients with pre-existing arteriosclerotic disease and attempted to propose therapy guidelines for these methods in the therapy of acute limb ischaemia. Percutaneous mechanical thrombectomy represents a viable therapeutic alternative to surgical or surgical-interventional modalities, particularly in patients with occlusions consisting of soft, embolic material or located in infrapopliteal vessels. The indication for each respective method should be interdisciplinary and must be based on the individual patients' clinical and angiographic findings. Additional intraoperative endovascular procedures increase the range of therapeutic options and permit optimal revascularisation of vessels both proximal and distal to the site of occlusion.
Der Chirurg 11/2003; 74(12):1118-1127. · 0.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recently, the thymidine analog 3'-deoxy-3'-(18)F-fluorothymidine (FLT) was suggested for imaging tumoral proliferation. In this prospective study, we examined whether (18)F-FLT better determines proliferative activity in newly diagnosed lung nodules than does (18)F-FDG.
Twenty-six patients with pulmonary nodules on chest CT were examined with PET and the tracers (18)F-FDG and (18)F-FLT. Tumoral uptake was determined by calculation of standardized uptake value (SUV). Within 2 wk, patients underwent resective surgery or had core biopsy. Proliferative activity was estimated by counting nuclei stained with the Ki-67-specific monoclonal antibody MIB-1 per total number of nuclei in representative tissue specimens. The correlation between the percentage of proliferating cells and the SUVs for (18)F-FLT and (18)F-FDG was determined using linear regression analysis.
Eighteen patients had malignant tumors (13 with non-small cell lung cancer [NSCLC], 1 with small cell lung cancer, and 4 with pulmonary metastases from extrapulmonary tumors); 8 had benign lesions. In all visible lesions, mean (18)F-FDG uptake was 4.1 (median, 4.4; SD, 3.0; range, 1.0-10.6), and mean (18)F-FLT uptake was 1.8 (median, 1.2; SD, 2.0; range, 0.8-6.4). Statistical analysis revealed a significantly higher uptake of (18)F-FDG than of (18)F-FLT (Mann-Whitney U test, P < 0.05). (18)F-FLT SUV correlated better with proliferation index (P < 0.0001; r = 0.92) than did (18)F-FDG SUV (P < 0.001; r = 0.59). With the exception of 1 carcinoma in situ, all malignant tumors showed increased (18)F-FDG PET uptake. (18)F-FLT PET was false-negative in the carcinoma in situ, in another NSCLC with a low proliferation index, and in a patient with lung metastases from colorectal cancer. Increased (18)F-FLT uptake was related exclusively to malignant tumors. By contrast, (18)F-FDG PET was false-positive in 4 of 8 patients with benign lesions.
(18)F-FLT uptake correlates better with proliferation of lung tumors than does uptake of (18)F-FDG and might be more useful as a selective biomarker for tumor proliferation.
Journal of Nuclear Medicine 10/2003; 44(9):1426-31. · 5.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The covering of defects caused by chronic ulcers on limbs affected by peripheral arterial disease or chronic venous insufficiency is often difficult due to extensive secretion and edema, while chronic bacterial contamination of the wound bed further compromises the conditions for successful healing.
Vacuum-sealed dressing (VSD) offers the option of a closed dressing system for moist wound care that assures firm contact with the wound surface and protection against contamination with nosocomial microbes and decontamination of existing bacteria by means of constant drainage of secretion independent of gravity. VSD is particularly useful in difficult wounds featuring extensive secretion and unfavorable localization and offers many advantages over conventional dressing techniques in terms of improved healing of skin transplants. A total of 35 patients with chronic leg ulcers were treated with vacuum-sealed mesh graft transplantation.
Complete healing of the mesh graft transplant was observed in 20 patients (57%). Twelve patients (34%) experienced partial healing (75-90%) of the transplant, while three patients exhibited less than 75% healing of the graft and therefore required a second mesh graft transplantation.
VSD is a simple, quick and inexpensive technique that promotes excellent healing of skin transplants. It is particularly useful in difficult wounds with extensive secretion and/or contamination or infection.
[Show abstract][Hide abstract] ABSTRACT: Between 1994 and 2001 we used the vacuum-sealing technique in 478 skin grafts. Indications included large soft-tissue defects resulting from trauma, skin loss due to degloving injuries, burns, and infected/contaminated wound surfaces. The technique involves direct placement of the white polyvinyl alcohol pad directly onto the transplanted skin. The necessary negative pressure is generated by redon flasks yielding a negative pressure of 60–80kPa (high-pressure system). In extensive wounds a vacuum pump is used. The high pressure used does not result in necrosis. In 11 patients poor wound conditions resulted in only partial healing. Three patients with pseudomonas infections experienced complete loss of the graft. The vacuum-sealing technique permits a moderate moist and warm wound treatment with stable fixation of the transplant even in cases of large wounds or those with irregular contours. The method is not suitable in cases of infection or contamination with pseudomonas species.
European Journal of Plastic Surgery 06/2003; 26(4):186-190. DOI:10.1007/s00238-003-0518-5
[Show abstract][Hide abstract] ABSTRACT: StudienzielUntersuchungen ber den Stellenwert der notfallmigen endovaskulren Behandlung von Patienten mit gedeckten Rupturen im Bereich der Aorta descendens sowie im infrarenalen Aortenabschnitt.Studiendesign.Prospektive, nichtrandomisierte Studie in einer Universittsklinik.Material und MethodenIm Zeitraum zwischen 1995 und 2003 wurde bei insgesamt 338Patienten eine stentgesttzte aortale Rekonstruktion durchgefhrt. 274Eingriffe erfolgten elektiv (81%). In 64Fllen (19%) wurde die endovaskulre Versorgung notfallmig im Stadium der Ruptur durchgefhrt. Bei 29Patienten handelte es sich um ein gedeckt rupturiertes infrarenales Aortenaneurysma, bei 11Patienten um ein rupturiertes Aneurysma im Bereich der Aorta descendens, bei 3Patienten um eine Ruptur eines thorakoabdominalen Aortenaneurysmas, bei 5Patienten um eine Ruptur im ersten Segment der Aorta descendens bei akuter Typ-B Dissektion und bei weiteren 16Patienten um eine traumatische thorakale Aortenruptur loco typico. Die Diagnose wurde bei allen 64Patienten jeweils durch eine properative Spiral-CT-Untersuchung gesichert.ErgebnisseDer rupturierte Aortenabschnitt konnte bei 62Patienten endovaskulr sicher versorgt werden. Eine primre Konversion zum offenen Eingriff wurde bei 2Patienten (3,1%) notwendig. Die postoperative 30-Tage-Letalitt betrug bei 7Todesfllen 10,9%. Keiner der Patienten entwickelte postoperativ ein vorbergehendes oder dauerhaftes neurologisches Defizit. Bei 8Patienten (12,5%) waren Zweiteingriffe zum Verschluss primrer Endoleaks erforderlich und 6Patienten (9,3%) bedurften eines zweiten chirurgischen oder kombinierten endovaskulren und offenchirurgischen Vorgehens. Die mittlere Nachbeobachtungszeit (Follow-up) betrug 37Monate (1–93).SchlussfolgerungUnsere Ergebnisse zeigen, dass die stentgesttzte Rekonstruktion bei Patienten mit rupturierten Aortenlsionen technisch durchfhrbar ist und diese Technik zudem mit einer ausreichenden Sicherheit angewandt werden kann. Angesichts der im Vergleich zum offenen Vorgehen reduzierten Morbiditt und Letalitt stellt das endovaskulre stentgesttzte Verfahren bei Patienten, die anatomisch und pathomorphologisch fr eine Stentbehandlung geeignet erscheinen, ein alternatives, viel versprechendes Behandlungskonzept dar. Unsere Ergebnisse lassen zudem vermuten, dass bei rupturiertem mykotischem Aneurysma bzw. bei aortobronchialen und aortointestinalen Fisteln die endovaskulre Therapie nur als "Bridging"-Manahme angewandt werden sollte.ObjectivesTo evaluate endovascular repair in ruptured aortic lesions.DesignProspective nonrandomized study in a university hospital.Material and methodsOf 338 endovascular aortic repairs, 64 (19%) procedures were conducted as emergencies (29 ruptured infrarenal aortic aneurysms, 11 ruptured descending thoracic aortic aneurysms, 3 ruptured thoracoabdominal aortic aneurysm, 5 patients with descending aortic rupture due to acute type B dissection, and 16 patients with acute descending aortic transection). Preoperative spiral computed tomography was performed in each patient, and based on these findings the feasibility of endovascular treatment and appropriate size of stent grafts were determined.ResultsEndovascular operations were completed successfully in 96.8% (62 patients). The primary conversion rate to open repair was 3.1% (two patients). The 30-day mortality rate was 10.9% (seven deaths). In no patient did temporary or permanent paraplegia result. Of the primary endoleaks, 12.5% (eight patients) required additional intervention and 9.3% (six patients) required secondary surgical procedures. The mean follow-up was 37months (1–93months); three deaths occurred within 3months after stent graft placement. Six patients (9.3%) required secondary conversion to open repair.ConclusionEndoluminal treatment of ruptured aortic lesions is feasible and safe and may offer the best means of therapy in selected cases. Compared with open repair, endoluminal treatment holds tremendous potential in terms of reduced morbidity and mortality and confers protection against secondary aortic rupture. Continued surveillance is essential.
[Show abstract][Hide abstract] ABSTRACT: We investigated whether uptake of the thymidine analogue 3-deoxy-3-[(18)F]fluorothymidine ([(18)F]FLT) reflects proliferation in solitary pulmonary nodules (SPNs). Thirty patients with SPNs were prospectively examined with positron emission tomography. Standardized uptake values were calculated for quantification of FLT uptake. Histopathology revealed 22 malignant and 8 benign lesions. Proliferation was evaluated by Ki-67 immunostaining and showed a mean proliferation fraction of 30.9% (range, 1-65%) in malignant SPNs and <5% in benign lesions. Linear regression analysis indicated a significant correlation between FLT-standardized uptake values and proliferative activity (P < 0.0001; r = 0.87). FLT uptake was specific for malignant lesions and may be used for differential diagnosis of SPNs, assessment of proliferation, and estimation of prognosis.
Cancer Research 06/2002; 62(12):3331-4. · 9.28 Impact Factor