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  • 1
    ISSN: 1432-0509
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0509
    Keywords: Key words: Endoscopic ultrasound—Three-dimensional imaging—Esophageal cancer—Tumor staging—Colorectal cancer.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The purpose of the present study was to evaluate the feasibility of three-dimensional endoluminal ultrasound of gastrointestinal tumors. Methods: Sixteen patients with esophageal, gastric, or colorectal tumors underwent endoscopic ultrasound. Three-dimensional ultrasound data were obtained from multiple serial images of a miniprobe (360°, 12.5 MHz) and processed on a PC-based 3D workstation. Results: Adequate three-dimensional ultrasound scans were obtained in eight patients with esophageal cancer and five patients with colorectal cancer. Three-dimensional image processing enabled visualization of the data as a multiplanar display or as a life-like three-dimensional view. The availability of arbitrary scan planes improved the assessment of local tumor spread and the spatial relation of the tumor to relevant adjacent structures (e.g., major vessels). Three-dimensional presentations provided realistic views of the anatomy and facilitated the interpretation of the ultrasound images. Conclusions: Three-dimensional display and the ability to review endoluminal ultrasound data interactively may improve the staging of gastrointestinal tumors. These preliminary data encourage further evaluation of this technique.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 19 (1995), S. 282-286 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Le cancer de l'anus est rare, représentant 1–2% de tous les cancers du tube digestif. En raison de cette rareté même, et parce que plusieurs modalités thérapeutiques ont déjà été proposées et évaluées, il est difficile d'établir une conduite à tenir standardisée. Pendant une assez longue période de temps, on a pensé que la chirurgie d'exérèse radicale était le chemin à suivre, et de nos jours encore, 30% des patients ont une amputation abdomino-périnéale. Cependant, des récidives ont été observées dans 20–40% des cas après une telle mutilation. D'autres modalités thérapeutiques ont été proposées dans le but de conserver la fonction sphinctérienne comprenant la radiothérapie externe ou interne, et la chimiothérapie. Pendant ces dernières années, on s'est beaucoup intéressé à l'association radiothérapie (50 Gy) et chimiothérapie (5-fluoracile + mitomycine C) qui, à présent, semble être la modalité la plus efficace en cas de cancer avancé. Avec cette association, on obtient un contrôle tumoral dans 60–80% des cas et il semble que cette modalité combinée améliore la durée de la survie sans maladie. En dépit de sa toxicité, on conseille la radiochimiothérapie comme modalité initiale pour la plupart des patients.
    Abstract: Resumen El cáncer anal es una rara entidad clinica que representa el 1–2% de todos los cánceres del tracto gastrointestinal. Debido a lo infreenente de esta neoplasia maligna, ha sido dificil establecer guías'de aceptación general para el tratamiento, aunque diversas modalidades terapéuticas han sido evaluadas. Por un largo tiempo la cirugia radical constituyó el tratamiento primario para todos los cánceres anales y todavía alrededor de 30% de los pacientes son sometidos a proctectomia abdominoperineal. Sin embargo, se registran tasas de recurrencia del orden de 20–40% luego de este procedimiento mutilante. Es por ello que en forma creciente se usan otras opciones de tratamiento, incluyendo la radioterapia, externa o intersticial, y la quinnioterpia, con la intención de conservar la función del esfinter. En los últimos affos se ha generado considerable interés en la terapia multimodal con irradiación (50Gy) y quimioterapia (5 fluoruracilo y mitomieina C). En el momento actual la radioquimioterapia parece ser la forma más eficaz de tratamiento en el cáncer anal avanzado. Se logra el control local-regional del tumor en 60–80% de los pacientes y hay evidencía de que la radioquimioterapia puede mejorar la sobrevida libre de enfermedad. A pesar de sa considerable toxicidad, la radioquimioterapia debe ser recomendada como el tratamiento primario en la mayoría de los casos.
    Notes: Abstract Anal cancer is a rare clinical entity which represents 1–2% of all gastrointestinal tract cancers. Due to the paucity of this malignancy it has been difficult to establish generally accepted guidelines for treatment, although various therapy modalities have been evaluated. For a long time radical surgery was the primary treatment for anal cancer and still about 30% of the patients undergo abdominoperineal rectotomy. However, recurrence rates of 20–40% have been observed after this multilating procedure. Therefore, other treatment options, including external or interstitial radiotherapy and chemotherapy, are used increasingly with the intention to preserve sphincter function. In the last years much interest has been addressed to multimodal therapy with radiation (50 Gy) and chemotherapy (5 fluouracil and mitomycin C). Presently radiochemotherapy appears to be the most efficient therapy in advanced anal cancer. Locoregional tumor control is obtained in 60–80% of the patients and there is evidence that radiochemotherapy can improve disease-free survival. Despite considerable toxicity, radiochemotherapy should be recommended as primary therapy to most patients.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Der Onkologe 5 (1999), S. 203-207 
    ISSN: 1433-0415
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Die einzige kurative Therapieoption beim Pankreaskarzinom besteht in der radikalen Resektion des Tumors. Das z.Z. sensitivste Verfahren zum Nachweis einer intraabdominellen Metastasierung stellt die Staging-Laparoskopie mit laparoskopischer Sonographie dar.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Der Onkologe 3 (1997), S. 653-659 
    ISSN: 1433-0415
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Aufgrund einer teilweise erheblichen Morbidität und funktionellen Mutilation sollte der resezierende Eingriff beim Ösophaguskarzinom solchen Patienten vorbehalten sein, die auf der einen Seite eine echte kurative Chance haben (R0-Resektion möglich), bei denen andererseits diese Heilung tatsächlich nur durch die Operation und nicht auch durch weniger eingreifende Maßnahmen erreicht werden kann. Besondere Aufmerksamkeit verlangt hier das durch Screening oder zufällig entdeckte Tis- oder frühe T1-Karzinom. Für die photodynamische Therapie ist inzwischen nachgewiesen, daß sie solche frühen Tumoren effizient mit sehr günstiger Langzeitprognose zerstören kann. Im symptomatischen Stadium diagnostizierte Ösophaguskarzinome sind häufig aufgrund der Tumorausdehnung oder von Fernmetastasen nicht mehr kurativ resezierbar. Unter dem palliativen Aspekt steht somit die Wiederherstellung der Ösophaguspassage im Vordergrund. Neue Therapieverfahren wie die photodynamische Therapie müssen ihre Effizienz und Vorteile in einem sorgfältigen Vergleich zu den etablierten Verfahren der endoskopisch-mechanischen Passagewiederherstellung, aber auch der externen und lokalen Strahlentherapie (ggf. in Kombination mit systemischer Chemotherapie) erst noch nachweisen.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Der Onkologe 2 (1996), S. 393-400 
    ISSN: 1433-0415
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Surgical endoscopy and other interventional techniques 12 (1998), S. 921-925 
    ISSN: 1432-2218
    Keywords: Key words: Laparoscopy — Staging — Gastrointestinal tumors — Multimodal therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: This prospective study was conducted to evaluate the accuracy and the therapeutic relevance of staging laparoscopy. Methods: Between June 1993 and February 1997 staging laparoscopy was performed in 389 patients with various neoplasms. Additionally, 144 selected patients of this group were examined with laparoscopic ultrasound using a semiflexible ultrasound probe (7.5 MHz). Results: Compared to conventional imaging methods, laparoscopy and laparoscopic ultrasound improved the accuracy of staging in 158 of 389 patients (41%). Statistical subgroup analysis of 131 patients with gastric cancer showed that the accuracy of staging laparoscopy in the detection of distant metastases (68%) was significantly higher (p 〈 0.01) than that of ultrasound (63%) or computed tomography (58%). In the whole group, laparoscopy alone disclosed intraabdominal tumor dissemination or nonresectable disease in 111 patients. Laparoscopic ultrasound displayed additional metastases—i.e., liver metastases (n = 9), M1 lymph nodes (n = 15), or nonresectable tumors (n = 6) in 30 patients. Although metastastic disease was suggested by preoperative imaging, benign lesions were found in five patients with laparoscopy and in a further 12 patients with ultrasonography. The findings of staging laparoscopy changed the treatment strategy in 45% of the patients. Conversion to open surgery was necessary in 5% of the cases, and complications related to laparoscopy occured in 4% of the patients. Conclusions: Laparoscopy with laparoscopic ultrasound improves the staging of gastrointestinal tumors and has a significant impact on a stage-adapted surgical therapy.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Surgical endoscopy and other interventional techniques 11 (1997), S. 758 -761 
    ISSN: 1432-2218
    Keywords: Key words: Endoscopic palliation — Rectal cancer — Self-expanding metal stent — Endoprosthesis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The rationale of palliative endoscopic treatment is to avoid a colostomy in patients with advanced disease and limited life expectancy. This study was conducted to evaluate the role of endoscopic stent implantation for palliation of obstructing rectal cancer. Methods: Overall, 19 patients (aged 47–87 years) with nonresectable or metastatic rectal cancer were treated by stent insertion after laser recanalization or dilation. Three types of stents, i.e., plastic tubes (n= 8), self-expanding mesh stents (n= 6), and endocoil stents (n= 5), were used to maintain luminal patency. Results: Endoscopic stent implantation was successfully performed in all 19 patients. Long-term luminal patency and satisfactory bowel function were achieved in 16 of 19 patients (84%). After a median follow-up of 6 months, eight of the patients have died and eight are still alive without evidence of recurrent obstruction. Dislocation of the endoprosthesis occurred in two of eight plastic tubes and one of five mesh stents. Recurrent obstruction due to tumor ingrowth was only observed in patients treated with self-expanding mesh stents (n= 2). In spite of reinsertion and laser therapy a colostomy was required in three of 19 patients. There was no evidence of treatment failure in five patients who received endocoil stents. None of the patients experienced serious complications related to the endoscopic procedure. Conclusions: Endoscopic stent implantation seems to be a safe and efficient palliative approach to selected patients with obstructing rectal cancer. Currently, self-expanding coil stents are superior to other devices because of lower risk of dislocation and tumor ingrowth.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 980-984 
    ISSN: 1432-2218
    Keywords: Key words: Rectal cancer — Preoperative staging — Endorectal ultrasound — Preoperative radiochemotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: Factors limiting the accuracy of endorectal ultrasound in staging, locally advanced primary rectal cancer after preoperative neoadjuvant radiochemotherapy (RCT) were evaluated. Methods: Patients (n= 84) with initial locally advanced rectal cancer (uT3/uT4) undergoing R0 resection were investigated after preoperative treatment that combined radiotherapy up to 45 Gy with two cycles of chemotherapy (5-FU and leucovorin on d 1–5 and 22–28). At 4 to 6 weeks after completion of RCT and before tumor resection, preoperative endoluminal ultrasound was performed. Results: The accuracy to predict the depth of tumor infiltration (T-category) was found to correlate with downstaging. The T-category was correctly staged before surgery in 15 of the 51 responders (29%) and in 27 of 33 nonresponders (82%), whereas misinterpretation occurred in 36 of the responders (71%) and in 6 of the nonresponders (18%) (p 〈 0.001). Neither tumor distance from anal verge nor tumor location correlated with the staging accuracy. Lymph node involvement was correctly assessed in 48 patients (57%). Wall invasion was correctly ascertained in 42 patients (50%), with under estimation in 11 patients (13%) and overestimation in 31 patients (37%). Conclusions: After radiochemotherapy, endosonography does not provide a satisfactory accuracy for preoperative staging of rectal cancer. New interpretation and diagnostic criteria are needed for the prediction of treatment response.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 1016-1018 
    ISSN: 1432-2218
    Keywords: Key words: Choledochocele — ERCP — Sphincterotomy — Biliary drainage — Pediatric
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Choledochocele is an extremely rare congenital lesion of the biliary tree causing abdominal pain, pancreatitis, and obstructive cholestasis. Traditionally the therapy for this malformation has been surgery. Recently endoscopic therapy has been utilized alternatively for the treatment of choledocele in adults. We report the case of a 2-year-old girl with a choledochocele who was treated by endoscopic sphincterotomy and placement of a biliary stent. The prosthesis was removed after 4 months. After a follow-up of 20 months the patient remains free of symptoms. Our experience suggests that endoscopic treatment of congenital biliary disease can be performed accurately. Further studies will be necessary to confirm the value of stent implantation in congenital bile duct stenosis.
    Type of Medium: Electronic Resource
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