0000000000023571
AUTHOR
F. Dünschede
Lebermetastasen kolorektaler Karzinome - wie oft kann man operieren?
Recurrent liver metastases of colorectal carcinoma are frequent. The repeat hepatectomy is superior to other therapeutic options. In about 20 % of patients with recurrent liver metastases a complete resection (R 0) is possible. The morbidity of repeat hepatectomy is similar to that of first hepatectomy. The 5-year survival rate after repeat hepatectomy ranges between 30 and 40 %. Often in the follow-up additional operations become necessary for extrahepatic recurrencies. For determination of the optimal therapy an interdisciplinary approach must be chosen.
Ischämietoleranz durch α-Liponsäure — pharmakologische Präkonditionierung zur Verringerung des Reperfusionsschadens nach Leberischämie
Reaktive Sauerstoffspezies spielen in der Reperfusion nach Ischamie eine wichtige Rolle. Ob eine Verringerung des Reperfusionsschadens der Leber in vivo moglich ist durch die systemische Gabe des membranpermeablen Antioxidativum α-Liponsaure vor Ischamie im Sinne einer pharmakologischen Prakonditionierung ist nicht bekannt.
Treating iliac aneurysm using the Nellix Endovascular Sac Sealing System.
As endovascular treatment of abdominal aortic aneurysms has become established, there has been growing focus on treatment of the aneurysmal iliac artery. Isolated, large iliac aneurysms >30 mm pose a risk of rupture, but, in addition, 20% to 30% of abdominal aortic aneurysms are associated with iliac aneurysmal dilatation, which can compromise long-term outcomes. Endovascular solutions are evolving and until recently have utilized standard stent graft technology. The endovascular aortic sealing system was introduced as a new, effective method for the treatment of infrarenal aortic aneurysms. In this article, we present our recent extended use of the Nellix system, with or without a combinat…
Orthotope arterialisierte Lebertransplantation bei Ratten mit Stenttechnik der supra- und infrahepatischen v. cava
The aim of this study was to establish a liver transplant model with a reduced warm ischemic period between cold preservation and completed anastomosis. Male brown Norway rats were used. A cuff was fixed in the portal vein, stents were inserted in the A. hepatica, the suprahepatic and infrahepatic v. cava and in the bile duct. After cross clamping of the recipient liver, another stent, occluded by a small pin, was introduced in the recipient suprahepatic v. cava. After ligation of this recipient suprahepatic caval stent the recipient liver was removed and the cold prepared donor liver was pushed forward along the pin and both suprahepatic stents of recipient and donor were connected. Then c…
Beeinflussung des Leberzellmetabolismus, der Freisetzung von reaktiven Sauerstoffspezies sowie Apoptoseaktivierung durch hypotherme oxygenierte Leberperfusion
Two different methods of liver preservation were compared : simple cold storage (CS) and hypothermic oxygenated perfusion extracorporal (HOPE). After 10 h of preservation (4°C) with modified UW solution reperfusion was performed by isolated liver perfusion for 90 minutes. Reperfusion injury was estimated by release of cytosolic enzymes, formation of superoxide anions, determination of lipid peroxidation, glycolytic metabolites, bileflow and by PCR analysis. The results showed that after cold storage the formation of reactive oxygen species was significant higher as compared with perfused livers. Correspondingly expressions of mediators (TNFα, NF kappa B, MIP-2, SAPK) and apoptosis (Caspase …
Ischämietoleranz der Rattenleber durch alpha-Liponsäure
Ischemia reperfusion injury (IRI) represents a major clinical problem in liver resection and transplantation. The present work investigated the potential of α-lipoic-acid (LA), a well established drug in the therapy of diabetes, to reduce IRI of the rat liver in vivo. Two groups were chosen: one group with injection of 500 μmol α-lipoic acid 15 min before clamping of the left and median liver lobes for 90 min, the other with injection of NaCl 0,9%. Reperfusion was carried out for 1 h and 7 days. The results showed that a-lipoic acid reduced IRI. LDH, α-GST and lipid peroxidation were significantly decreased in the LA-group after 1 h reperfusion indicating less cell death during reperfusion.…
Adjunct Perfusion Branch for Reduction of Spinal Cord Ischemia in the Endovascular Repair of Thoracoabdominal Aortic Aneurysms
Background To analyze utilization of a perfusion branch for temporary sac perfusion to reduce the spinal cord ischemia (SCI) in the endovascular repair of thoracoabdominal aortic aneurysms (TAAAs). Methods Between January 2012 and August 2016, 30 patients (18, men; median age 72 years) were treated for TAAAs with total endovascular repair using customized branched/fenestrated endografts in our institution. The median aneurysm size was 6.6 cm. Types of TAAA were: type I, 9 (30%), type II, 5 (16.6%), type III, 4 (13.3%), type IV, 6 (20%), and type V, 6 (20%). Ten patients received a perfusion branch to create an intentional endoleak, which was occluded with vascular plugs in mean interval ti…
Rektummelanome – Stellenwert der modernen Therapie
Rectal melanoma is a rare disease. There is much controversy concerning cause, incidence and treatment of the disease and the spreading of recurrence. In this article, we discuss actual aspects of diagnostic, therapy and prognosis on the basis of our series of seven patients as well as a literature review. The surgical therapy in the form of local tumour excision with a disease-free margin of up to 1-2 cm is the initial therapeutic modality of choice. Large tumours that obviously could not be removed in sano should be treated with a multimodal concept. Such tumours should be treated by a combination of neoadjuvant radiation and chemotherapy for down-staging with subsequent local excision (L…
Coexpression of receptor-tyrosine-kinases in gastric adenocarcinoma-a rationale for a molecular targeting strategy?
AIM: To define the (co-)expression pattern of target receptor-tyrosine-kinases (RTK) in human gastric adenocarcinoma. METHODS: The (co-)expression pattern of VEGFR1-3, PDGFRα/β and EGFR1 was analyzed by RT-PCR in 51 human gastric adenocarcinomas. In addition, IHC staining was applied for confirmation of expression and analysis of RTK localisation. RESULTS: The majority of samples revealed a VEGFR1 (98%), VEGFR2 (80%), VEGFR3 (67%), PDGFRα (82%) and PDGFRβ (82%) expression, whereas only 62% exhibited an EGFR1 expression. 78% of cancers expressed at least four out of six RTKs. While VEGFR1-3 and PDGFRα revealed a predominantly cytoplasmatic staining in tumor cells, accompanied by an additiona…
BCL-2 UPREGULATION AFTER 3-NITROPROPIONIC ACID PRECONDITIONING IN WARM RAT LIVER ISCHEMIA
We aimed to determine whether 3-nitropropionic acid (3-NPA) preconditioning protects rat livers against warm ischemia/reperfusion injury. We hypothesized that 3-NPA mediates its protective effects by Bcl-2 upregulation. Brown-Norway rats (200 g) were injected with 3-NPA (10 mg/kg intraperitoneally) 24 h before 90 min of selective warm in situ ischemia. In additional experiments, 30-day survival was studied after 90 min of warm liver ischemia and resection of nonischemic liver tissue. We demonstrate increased mRNA and protein levels of Bcl-2 by real-time polymerase chain reaction, immunohistochemistry, and Western blot analysis in 3-NPA-pretreated rats. All treated animals survived, whereas …
Reduktion des Ischämie/Reperfusionsschadens nach warmer Leber Ischämie am Menschen durch alpha Liponsäure
Die Studie zeigt, dass alpha Liponsaure einen protektiven Einfluss auf den IRS der Leber im Rahmen von elektiven Leberresektionen ausubt. Prospektiv randomisierte Studien mussen diese vielversprechenden Ergebnisse belegen. Dennoch erscheint bei einem geringem Nebenwirkungsspektrum, niedrigen Kosten und einer einfachen sowie schnellen Applikation ein routinemasiger Einsatz von alpha Liponsaure in der Leberchirurgie denkbar.
3-NPA induziert Ischämietoleranz der Rattenleber nach warmer Ischämie
Until now little is known about the potential of 3-nitroproprionic acid (3-NPA) to reduce ischemia/ reperfusion injury (IRI) of the rat liver in vivo.
Leukocyte–platelet aggregates—a phenotypic characterization of different stages of peripheral arterial disease
The formation of monocyte-platelet aggregates and neutrophil-platelet aggregates (MPA and NPA, respectively) is influenced by inflammation, but also might contribute to an exacerbation of inflammatory responses in atherosclerotic plaque. The purpose of this study was to analyze MPA and NPA proportions in regard to different stages of peripheral arterial disease (PAD). Forty-five patients with intermittent claudication (IC) (3 groups: Rutherford (R)-1, R-2, and R-3; each n = 15), 20 patients with critical limb ischemia (CLI) (Rutherford 5 (40%) and 6 (60%)), and 20 healthy controls were studied. Analyses of monocyte (Mon) subpopulations (CD14++CD16- (classical) Mon1, CD14++CD16+ (intermediat…
Treatment of Metachronous and Simultaneous Liver Metastases of Pancreatic Cancer
<i>Aim:</i> Patients were analyzed who underwent treatment of liver metastases from pancreatic cancer. <i>Methods:</i> Selection criteria were the possibility of R0 resection of the primary and/or the liver metastases, no other sites of metastases, and the presentation of liver metastases. A comparison of treatment by surgery versus chemotherapy regarding overall survival and disease-free interval was performed. <i>Results:</i> Between 1996 and 2008, a total number of 23 patients were retrospectively identified from a prospective database of 193 cases of pancreatic cancer. In 14 cases, liver metastases were found simultaneously, and in 9 cases metachronou…
Three-Dimensional Analysis of Component Stability of the Nellix Endovascular Aneurysm Sealing System After Treatment of Infrarenal Abdominal Aortic Aneurysms
Purpose: To assess short-term stability and conformational changes of the Nellix EndoVascular Aneurysm Sealing (EVAS) System using 3-dimensional (3D) analysis. Methods: Postoperative computed tomography (CT) scans obtained at 0, 3, and 12 months in 24 patients (mean age 75±7 years; 22 men) who underwent EVAS between December 2013 and December 2014 for intact abdominal aortic aneurysm (within the instructions for use) were evaluated for stent-graft deviation in multiple planes using dedicated 3D analysis software. In addition, 2D analysis using an anatomically fixed reference landmark was performed to assess craniocaudal migration. Clinical and follow-up data of the patients were recorded a…
Endovascular Aneurysm Sealing (EVAS) and Chimney EVAS in the Treatment of Failed Endovascular Aneurysm Repairs
Purpose: To assess the technical success and clinical outcome of reinterventions using the Nellix Endovascular Aneurysm Sealing (EVAS) System to treat complications after endovascular aneurysm repair (EVAR). Methods: Fifteen consecutive patients (mean age 79 years; 14 men) with prior EVAR were treated with EVAS between March 2014 and December 2015 at 2 institutions. The failed prior EVARs included 13 bifurcated endografts, 1 bifurcated graft plus fenestrated cuff, and 1 tube endograft. Endoleaks were the predominant indications: type Ia in 10 and type III in 5 (3 type IIIa and 2 type IIIb). All patients presented with progressive aortic aneurysms (median 7.85-cm diameter; range 6.5–11). Ei…
Initial Experience in the Treatment of Extensive Iliac Artery Aneurysms With the Nellix Aneurysm Sealing System.
Purpose: To assess the feasibility and effectiveness of the Nellix prosthesis in the treatment of common iliac artery aneurysms. Methods: Between May 2013 and June 2015, 230 patients underwent implantation of the Nellix device at 2 institutions. Fifty of these patients (mean age 76 years; 35 men) were identified as having 60 common iliac artery aneurysms (CIAAs) with a median diameter of 4 cm (range 3.5–7). The majority of patients had aortoiliac aneurysms (5, 70%), 10 (20%) had isolated CIAAs, and 5 (10%) had iliac anastomotic aneurysms after aortoiliac bypass. In 20 patients, the iliac aneurysm was the indication for the intervention; in the other 30 patients, the endovascular iliac repa…
Detection of mitochondrial electron chain carrier redox status by transhepatic light intensity during rat liver reperfusion.
The aim of the study was to investigate mitochondrial electron transfer during rat liver reperfusion after cold storage and hypothermic machine perfusion. Livers from male Brown Norway rats were preserved (UW) for 10h either by cold storage (CS) or by hypothermic oxygenated perfusion extracorporal (HOPE). Transhepatic photometric analysis allowed determination of the redox status of mitochondrial cytochromes during preservation, rewarming and reperfusion. Mitochondrial electron chain carriers were inhibited at different sites with rotenone and cyanide in some experiments. reversed transcriptional polymerase chain reaction (RT-PCR) was performed after reperfusion concerning transcription of …
Laparoscopic sentinel lymph node mapping and excision of the rectum using a radioactive tracer — a prospective experimental study
Introduction: Patients with a low risk T1 rectal carcinoma can undergo the therapy of a local excision. In these patients the lymph node status remains unknown. There is a potential risk of up to 7% for nodal metastasis, in high risk cases it can rise up to 35%. To investigate the possibility of using the Sentinel lymph node (SLN) concept, which is anchored in the therapy of malignant melanoma and breast cancer, an experimental study on pigs was undertaken. The objective of the study was to laparoscopically identify and extract SLN’s from the rectum using a radioactive tracer (RT). Material und Methods: The experiment was conducted upon 30 pigs, because sample size calculation indicated tha…