0000000000361970
AUTHOR
F. Bittinger
Transarterial Chemoembolization Before Liver Transplantation in 60 Patients With Hepatocellular Carcinoma
Tumor recurrence is a major problem after orthotopic liver transplantation (OLT) in patients with hepatocellular carcinoma (HCC). In 60 patients OLT was performed for HCC after pretreatment by repeated transarterial chemoembolization (TACE). Forty-four recipients exceeded the Milan criteria. Recurrence-free 5-year survival was 65.2% and 5-year freedom from recurrence was 73.2%. During the waiting time, 14 patients experienced minimal change, which did not fulfill the definition of tumor progression according to official oncological criteria. Five-year freedom from recurrence among patients with stable compared with progressive disease was 93.3% versus 28.1%, respectively (P = .0001). A stri…
Complete gangrene of penis in patient with arterial vascular disease.
We present a clinical case of distal penile gangrene in a patient with peripheral vaso-occlusive disease that did not correlate with the extension of the intraoperative finding and required total penectomy. Surgical intervention at the onset of wet gangrene avoids the complication of sepsis.
Preoperative imaging of hilar cholangiocarcinoma: surgical evaluation of standard practises.
UNLABELLED It was the goal of this study to compare the results of the preoperative diagnostic workup (ERC, MRC, and PTC) with the tumor extent of the surgical specimen in patients with hilar cholangiocarcinoma (hilCC). PATIENTS AND METHODS Between 9/97 and 12/2002 82 patients with hilCC were treated at our institution. In 59 patients tumor resection was feasible. Preoperative ERC, MRC and PTC - blinded for the idendity of the patients - were analysed retrospectively and compared with the surgical specimen. RESULTS PTC resulted in significantly superior visualization of the bile ducts including the hilar lesion compared to ERC and MRC (p < 0.01). ERC, MRC and PTC were correct in predicting …
Methylene blue-aided cholangioscopy in patients with biliary strictures: feasibility and outcome analysis
BACKGROUND AND STUDY AIMS: Chromoendoscopy using methylene blue is employed in the gastrointestinal tract to delineate neoplastic lesions. We tested the value of chromoendoscopy during choledochoscopy for characterization of local inflammation, neoplasias, and other alterations in patients with biliary strictures. METHODS: Patients with suspected biliary lesions were scheduled for endoscopic retrograde cholangiography with subsequent cholangioscopy. After initial inspection of the bile duct, 15 ml methylene blue (0.1 %) was administered via the working channel of the cholangioscope. Newly appearing circumscribed or unstained lesions were judged according to their macroscopic type and staini…
Hyperlactacidaemia in isolated hyperthermic perfusion of tumour bearing rat limbs: a study of feasibility using a novel infusion solution.
In a methodological study the applicability of hyperlactacidaemia in isolated hyperthermic perfusion of tumour-bearing rat limbs was investigated.In 50 Sprague Dawley rats, DS-sarcoma growth was initiated on the right food dorsum by subcutaneous injection of 0.5 ml ascites cells. In the anaesthetized animals isolated limb perfusion was performed under steady state conditions for 60min using a miniature equipment. Thereafter tumour volume was measured daily. (a) Investigation of feasability: 40 rats were allocated to four groups. Group I: Normothermic perfusion at 38 degrees C, n = 10; Group II: Hyperthermic perfusion at 40-41 degrees C, n = 10; Group III: Normothermic perfusion at 38 degree…
Endosonography of the adrenal glands: normal size — pathological findings
Transabdominal sonography of the adrenal glands frequently is non-successful. It was the aim of this project to improve the imaging of the adrenal glands using high resolution sonography in order to obtain information about even small changes in these organs. Therefore, endosonographic imaging was investigated using an endosonoscope PENTAX FG32UA. The correct identification of the adrenal glands was examined in five human cadavers. A total of 58 patients with 113 adrenal glands (in 3 cases history of unilateral adrenalectomy) were investigated. 109 adrenal glands (97%) were identified and evaluated. Healthy adrenal glands are slightly hyperechoich and regarding their echogeneity comparable …
Malignant and Unclear Histological Findings in Incidentalomas
<i>Background:</i> The management of incidentalomas with tumor size 3 cm and larger is still under controversial discussion. <i>Study Design:</i> Clinical charts of 65 patients who underwent adrenalectomy for an incidentaloma were reviewed. <i>Results:</i> Sixty-five patients were operated. There were 28 men and 37 women with a median age of 56.9 years. Median size of all resected lesions was 4.1 cm. Indications for surgery were tumor size equal and larger than 3 cm, recurrent pain, hormone status and patients’ fear of malignancy. In 45 patients, the adenomas did not meet the defined criteria of malignancy. There were 9 cases of adrenal hyperplasia, and t…
Die Diagnostik des hilären Cholangiokarzinoms: Wertigkeit von präoperativer ERC, MRC und PTC im Vergleich zur Histopathologie
PURPOSE To compare the results of the preoperative workup consisting of endoscopic retrograde cholangiography (ERC), magnetic resonance cholangiography (MRC), and percutaneous resonance cholangiography (PTC) with the tumor extent of the surgical specimen in patients with hilar cholangiocarcinoma (hilCC). MATERIALS AND METHODS Between 9/1997 and 12/2002, 59 patients with hilCC tumor underwent surgical resection. Preoperative ERC, MRC, and PTC were analyzed, blinded for the identity of the patient, and compared with the surgical specimen. For this retrospective analysis, 55 of the initial 59 ERCs, 39 of the initial 40 MRCs and 32 of the initial 38 PTCs were available. Most of the ERCs and MRC…
Intraoperative assessment of liver organ condition by the procurement surgeon.
Abstract Generally the transplanting surgeon accepts or declines the offer of a marginal organ in view of all available information. Hence, in some cases it is the procurement surgeon who decides about the suitability for potential further liver transplantation. Methods From January 1, 2003 to September 30, 2005, a total of 402 organ procurement operations were performed in our region. Results Due to infrastructural problems in nine cases intraoperative evaluation of liver biopsies was not achievable in time, and the decision to reject the organs was based on the procurement surgeon’s clinical assessment. The main reason for liver rejection was alleged extreme steatosis, (6 of 9) or liver c…
Diagnosis of a Pleural Mesothelioma by Endosonography-Guided Transgastric Fine-Needle Aspiration
Konfokale Laser Scanning Mikroskopie (CLSM) kortikalen Knochens – Vergleichende Darstellung mit konventioneller Mikroskopie
Massive gastrointestinale Blutung eines 28-jährigen Patienten mit intestinalem Befall eines Morbus Behçet
A 28-year-old man was admitted to the emergency room of our hospital after syncope and acute gastrointestinal bleeding. On the basis of numerous oral and genital ulcerations as well as uveitis anterior and erythema nodosum, the diagnosis of Behcet's disease had been confirmed previously. The bleeding focus could not be detected by endoscopy. During the next days recurrent massive hemorrhages occurred in spite of immunosuppressive therapy with steroids. Angiography revealed a circumscribed bleeding source in the colon transversum near the left colonic flexure, which was treated by superselective coil embolization. A massive hemorrhage reoccurred and required a surgical approach with a Hartma…
Die Bedeutung eosinophiler Granulozyten in Beziehung zu Allergie und Aspirin-Intoleranz bei Patienten mit Sinusitis polyposa
BACKGROUND The development of nasal polyps might be influenced by different factors such as mucosal inflammation. Infiltration with eosinophils is a common finding, although in largely different quantitis. PATIENTS AND METHODS We investigated 58 patients suffering from nasal polyps who were assigned for endonasal sinus surgery based on endoscopic and CT findings. Out of these patients, 52% have already had sinus surgery and had recurrent polyps. All patients were subjected to both, allergy testing and a functional in vitro test for aspirin intolerance. During surgery, tissue samples were gained and send for histological examination with special respect to eosinophil infiltration. RESULTS Eo…
Klatskin Tumour: Meticulous Preoperative Work-Up and Resection Rate
BACKGROUND: Surgery represents the only potentially curative treatment of hilar cholangiocarcinoma (hilCC). It may be suggested that meticulous preoperative work-up in Asian countries leads to higher resection rates. METHOD: One hundred and eighty-two patients treated in our department between 1998 and 2008 were included in an analysis based on our prospectively recorded database. Among them, 75 % had a percutaneous transhepatic cholangiography as part of their diagnostic work-up. A total of 160 patients underwent explorative surgery and 123 patients were resected (77 % of patients undergoing exploration, 68 % of all patients). RESULTS: Ninety-one percent of the patients were diagnosed to h…
Image cytometric DNA analysis of mucosal biopsies in patients with primary achalasia.
(P < 0.0001), and 9c- (P = 0.0001) exceeding rate with progredient DNA alterations in the respective order. CONCLUSION: The finding that DNA aneuploidy was identifi ed by image cytometry in esophageal specimens of patients with achalasia, which may be due to specifi c chromosomal alterations presenting as precancerous lesions in 27% of patients, leads us to conclude that image cytometry represents a valuable screening tool. Abstract AIM: To determine DNA aneuploidy in mucosal biopsies of achalasia patients for subsequent rapid diagnosis. METHODS: Biopsies from the middle third of the esophagus were obtained in 15 patients with achalasia. Immunohistochemical staining was carried out with mon…
Tacrolimus Monotherapy Without Steroids After Liver Transplantation – A Prospective Randomized Double-Blinded Placebo-Controlled Trial
Early steroid withdrawal after liver transplantation (LT) is desirable in order to reduce steroid side effects. Between February 2000 and August 2004, 110 patients after LT were included in this prospective, randomized, double-blind, placebo-controlled trial. Randomization was performed before LT. In all patients, tacrolimus was used without induction therapy. All patients received methylprednisolon for 14 days, thereafter a double-blinded medication containing either placebo (n = 56) or methylprednisolon (n = 54) for 6 months, which was completely stopped thereafter. End points were patient and graft survival, acute and chronic rejection, and incidence of steroid side effects during the fi…