Diagnostic and therapeutic methods
This chapter should give you a survey about different examination and treatment methods and explain some important terms. In addition, we will explain in detail the course of two chemotherapeutic interventions.
diagnostic process and therapy
By endoscopy, examination of the inside of the body (speculum examination) with the help of an optical precision instrument - the endoscope - is understood.
The endoscopic process serves for clarification as well as for treatment of diseases. For the particular examination and treatment goals there are various systems with different names at our disposal, like for example the gastroscope. Examinations and interventions are called accordingly, that is gastroscopy for examination of the stomach.
The following listing will give you a survey about endoscopic standard examinations or interventions.
- Placing of stomach nutrition probes
(PEG - abbr. for percutaneous endoscopic gastrostomy)
(abbr. for endoscopic retrograde cholangiopancreatography); X-ray contrast depiction of the bile ducts and gall bladder and of the pancreatic ducts where contrast medium is being injected by means of a duodenoscopy.
- Placing of gall and kidney stent
Stent is a self-extending endoprostesis, a support of artificial material that keeps open duct structures.
- Endoscopic growth ablation and stopping bleeding
Radiologic diagnostic process and therapy
Apart from all X-ray standard examinations, we carry out the following diagnostic and therapeutic processes in our radiological department:
- Colon contrast depiction
(Radiography of the large intestine by enema of contrast media)
- Alimentary passage
(X-ray contrast examination of stomach, duodenum and small intestine with the help of the dicontrast method)
(X-ray depiction of (blood) vessels after injection of a contrast medium)
- Angiographical examination methods are likewise the
phlebography (Depiction of veins after direct puncture of the back of a hand or a foot vein)
- digital subtraction angiography
(X-ray contrast depiction of vessels during which depiction disturbing other body tissue is faded out by a special method.)
(A surgical process during an angiography which should remove vessels that have become narrow over a short distance - stenosis. The narrow passages of a vessel are expanded with the help of an inflated balloon of a catheter - catheter dilatation).
- Placing the arterial chemotherapy catheter
(For more information see "Chemotherapeutic interventions")
- Percutaneous*) choledochdrainage
(Making of a biliary outlet)
- Percutaneous kidney fistula (nephrostomy)
(Making a fistula of the renal pelvis by puncture; "fistula" in this context is a therapeutically made connection between body antrums or hollow organs with each other or with the body surface)
By immunosystem, we understand identification and defence mechanism of the body. With the help of the immunotherapy, the defective immunological reaction is influenced with drugs. During the growth therapy we particularly use the following preparations:
- Interferon (IFN)
- Interleukin-2 (ILN - 2)
- mistletoe and thymus preparations.
By antihormones, we mean natural or synthetic counterparts of hormones (antagonists). During tumour treatment, antihormones are used in cases where specific hormones accelerate growth formation.
What are chemotherapeutic agents and cytotoxic drugs?
The term of chemotherapeutic agents is a collective term for naturally found and for synthetically made matters that are having a damaging influence on aetiological agents or growth cells.
In growth therapy, especially cytotoxic drugs are used. These are matters that prevent or at least slow down cell division considerably.
Main targets of the cytotoxic drugs are therefore all growth cell fractions that are just growing and thus are in cell division stage.
Unfortunately, cytotoxic drugs are not only effective specifically against growth cells but they damage also healthy cells. As a result we have the possible side-effects that may occur during treatment with cytotoxic drugs.
Differentiation between systemic and regional chemotherapy
In the broadest sense, the systemic chemotherapy concerns the entire organism.
In contrast to this, the regional chemotherapy is the more specific form of treatment with cytotoxic drugs.
The great advantage of the regional chemotherapy is the more effective combat of a tumour asconcentration of the cytotoxic drugs can be increased in the organ or part of the body in question.
- Thus, a more powerful damaging effect on the tumour can be achieved.
- Especially the side-effects can be clearly reduced by this method.
Now, we would like to present to you two special chemotherapeutic treatment methods that are carried out in this form only in our hospital.
This method allows us to insert the cytotoxic drugs well-aimed into the region of the body that is infested by a tumour or its metastasis.
After a local anaesthetic - mostly into the crest - we puncture the artery and under X-ray control insert a very thin tube, the angiography catheter, into the artery that supplies the tumour with blood, for instance the liver artery.
During X-ray, we inject a contrast medium. As a result, the vascular tree can be seen and we are able to control the correct position of the catheter.
If we have succeeded in bringing this catheter in the right position, we will inject the chemotherapeutic agent which then will flow with the bloodstream to the tumour formation.
As therapy mostly must be continued for some days, the catheter stays in the artery. A compression dressing is applied in the crest that prevents secondary haemorrhage or a haematoma. The chemotherapeutic agent is then administered by appropriate short-term infusions. As a permanent infusion, we administer an anticoagulant (Heparin) so that the vessels do not close or the catheter does not become blocked.
With the catheter staying in the artery, the patient has to stay in bed calmly. Especially when raising the upper body or when turning over on to the side or even to the stomach there is a high risk the catheter slips out of its position. At the same time, the respective leg must always be extended so that compression dressing remains effective.
After completion of the therapy, the doctor removes the catheter. After short compression of the puncture by hand, a compression dressing is applied again. This must remain for 24 hours. During this time, the patient must stay in bed as well.
In tumour surgery, we use as gentle and blood saving techniques as possible. We operate also endoscopically provided that symptoms do permit it.
For example, interventions within the bladder are possibly carried out transurethral, that means through the ureter. This is done with the help of a cystoscope, the method itself is called cystoscopy.
The following listing will give you a survey of our wide surgical spectrum.
- Thyroid resection *)
- Removal of lymph nodes
- Mamma resection (breast conserving intervention)
Mastectomy (breast amputation)
- Skin-graft by swinging skin lobe
Method of transplantation where skin of neighbouring body regions are "swung over" into the skin defect.
- Oesophagus resection (removal of gullet)
- Partial lung resection
Resection of lung lobe
Pneumonectomy (removal of a lung)
- Diaphragm resection
- Stomach resection
- Pancreas resection
- Partial liver resection
Hemihepatectomy (removal of half of a liver)
- Revision or reconstruction of bile duct
- Resection of small intestine
- Resection of large intestine
- Proctectomy, rectum amputation
- Nephrectomy (removal of a kidney)
- Partial ladder resection
- Total cystectomy: Removal of the whole urinary bladder - Extended cystectomy: Additional removal of prostate and vesicle gland (male), of uterus and two third of the urethra (female).
- Resection of ureter (removal of urinary ducts)
Reconstruction of ureter
Ureter splint (Splinting urinary duct in case of growth compression)
- Hysterectomy (removal of the womb)
- Adnektomie (Entfernung der Eileiter und Eierstöcke)
- Removal of fallopian tube and ovaries
- Resection of growth on extremities
- Arterial and venous portimplantation*)