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  • 1
    Electronic Resource
    Electronic Resource
    Benefits of various dextrans after delayed therapy in necrotizing pancreatitis of the rat (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1207-1213 
    Details
    ISSN: 1432-1238
    Keywords: Key words Acute pancreatitis ; Therapy ; Dextran ; Hypertonic ; Colloid ; Rat
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Ultrahigh-molecular dextran (500000 Da) has been shown to prevent pancreatic necrosis when given 30 min after induction of pancreatitis. This study should clarify the following: (a) are dextrans still effective after prolongation of the therapy-free interval? (b) what is the impact of the molecular weight of the dextrans? and (c) is their effect influenced by the dextran concentration or by the addition of hypertonic saline? Animals and interventions: Acute pancreatitis was induced in 70 male dextran-tolerant Wistar rats using intraductal bile-salt infusion and intravenous hyperstimulation. After 3 h, animals were assigned to one of seven groups (n=10 per group) receiving either Ringer solution or different dextrans (10%) including 70000 Da (DEX-70), 160000 Da (DEX-160), 300000 Da (DEX-300) or 500000 Da (DEX-500). Additional groups included DEX-70 (6%) and DEX-70 (10%) in combination with hypertonic NaCl (7.5%) (HHS-70). Ringer solution was given at 24 ml/kg and all dextrans at 8 ml/kg. Measurements and results: Trypsinogen activation peptides (TAP) were quantified in ascites and acinar necrosis after death or sacrifice at 9 h. As an index of less pathological trypsinogen activation, the mean TAP levels in ascites were significantly lower in DEX-70 and DEX-160 compared to Ringer controls (p〈0.05, t-test). Furthermore, the amount of acinar necrosis was significantly lower in all dextran groups except the HHS-70 in comparison with Ringer controls (p〈0.01, t-test). Finally, mortality was significantly reduced from 60% in Ringer controls to 10 and 0%, respectively, in the groups treated with DEX-70 and DEX-160 (p〈0.03, Fisher‘s Exact test). There was a similar trend in all other groups except the HHS-70. Conclusions: Despite a therapy-free interval of 3 h, dextrans reduce trypsinogen activation, prevent acinar necrosis, and improve survival in necrotizing rodent pancreatitis. The molecular weight and concentration of dextran are of secondary importance for these beneficial effects.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709338
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  • 2
    Electronic Resource
    Electronic Resource
    Benefits of various dextrans after delayed therapy in necrotizing pancreatitis of the rat (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1207-1213 
    Details
    ISSN: 1432-1238
    Keywords: Acute pancreatitis ; Therapy ; Dextran ; Hypertonic ; Colloid ; Rat
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective Ultrahigh-molecular dextran (500 000 DA) has been shown to prevent pancreatic necrosis when given 30 min after induction of pancreatitis. This study should clarify the following: (a) are dextrans still effective after prolongation of the therapy-free interval? (b) what is the impact of the molecular weight of the dextrans? and (c) is their effect influenced by the dextran concentration or by the addition of hypertonic saline? Animals and interventions Acute pancreatitis was induced in 70 male dextran-tolerant Wistar rats using intraductal bile-salt infusion and intravenous hyperstimulation. After 3 h, animals were assigned to one of seven groups (n=10 per group) receiving either Ringer solution or different dextrans (10%) including 70 000 Da (DEX-70), 160 000 Da (DEX-160), 300 000 Da (DEX-300) or 500 000 Da (DEX-500). Additional groups included DEX-70 (6%) and DEX-70 (10%) in combination with hypertonic NaCl (7.5%) (HHS-70). Ringer solution was given at 24 ml/kg and all dextrans at 8 ml/kg. Measurements and results Trypsinogen activation peptides (TAP) were quantified in ascites and acinar necrosis after death or sacrifice at 9 h. As an index of less pathological trypsinogen activation, the mean TAP levels in ascites were significatly lower in DEX-70 and DEX-160 compared to Ringer controls (p〈0.05,t-test). Furthermore, the amount of acinar necrosis was significantly lower in all dextran groups except the HHS-70 in comparison with Ringer controls (p〈0.01,t-test). Finally, mortality was significantly reduced from 60% in Ringer controls to 10 and 0%, respectively, in the groups treated with DEX-70 and DEX-160 (p〈0.03, Fisher's Exact test). There was a similar trend in all other groups except the HHS-70. Conclusions Despite a therapy-free interval of 3 h, dextrans reduce trypsinogen activation, prevent acinar necrosis, and improve survival in necrotizing rodent pancreatitis. The molecular weight and concentration of dextran are of secondary importance for these beneficial effects.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709338
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  • 3
    Electronic Resource
    Electronic Resource
    Surgical procedures for gastric substitution (1987)
    Springer
    World journal of surgery 11 (1987), S. 689-698 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Les problèmes les plus sérieux qui se manifestent après gastrectomie totale et rétablissement de la continuité gastro-intestinale par une simple oesophago-jéjunostomie peuvent être attribuées à l'absence d'un réservoir, au lieu et place de l'estomac, et à l'oesophagite par reflux alcalin. Ils peuvent être évités à l'aide de la constitution d'une poche jouant le rôle de réservoir, à l'insertion basse du canal biliaire et au plissement du jéjunum. Les explorations post-opératoires qui ont été pratiquées plus d'un an après l'intervention ont permis aux auteurs de constater que les résultats subjectifs et objectifs étaient presque identiques à ceux des sujets porteurs de leur estomac. La seule constatation divergente a été représentée par l'élévation de l'excrétion des graisses.
    Abstract: Resumen El problema más serio que se presenta después de una gastrectomía total con reconstrucción de la continuidad gastrointestinal mediante una simple esofagoyeyunostomía puede ser achacado a la ausencia de un reservorio primario y a la esofagitis por reflujo alcalino. Estas dificultades pueden ser subsanadas por medio de la construcción de una bolsa como sustituto gástrico, una inserción baja de la desembocadura biliar, y la plicación yeyunal para prevenir el reflujo. El seguimiento personal de los patientes operados (por más de un año después del procedimiento de sustitución gástrica) ha revelado hallazgos, tanto subjetivos como objetivos, que son casi idénticos con los registrados en individuos con estómago intacto. El hallazgo más protuberante es una elevada excreción de grasa.
    Notes: Abstract The most serious of the problems that arise after total gastrectomy and reconstruction of a continuous gastrointestinal tract by means of a simple esophagojejunostomy can be ascribed to the lack of primary reservoir formation and to alkaline reflux esophagitis. These difficulties can be overcome by means of pouch formation, low insertion of the bile duct, and jejunal plication. Personal follow-up examinations in patients (over 1 year after gastric substitution have yielded both subjective and objective findings that are almost identical with those recorded in a subject with intact stomach. The one striking finding to emerge remains an elevated fat excretion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01656591
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  • 4
    Electronic Resource
    Electronic Resource
    Surgical strategies in locoregional recurrences of gastrointestinal carcinoma (1987)
    Springer
    World journal of surgery 11 (1987), S. 504-510 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Contrastant de plus en plus avec le traitement standardisé des cancers primitifs gastro-intestinaux, la thérapeutique des récidives loco-régionales n'est pas uniforme. Dans la majorité des cas le traitement des récidives ne peut être assuré par la seule chirurgie. Il est nécessaire d'avoir recours à des méthodes complémentaires. La récidive des cancers colo-rectaux dépend de facteurs propres au processus tumoral qui contre-carrent l'action de la chirurgie. Chez près de 50% des malades qui présentent une récidive locale, il est constaté une généralisation de la tumeur lors du diagnostic. Plus de 75% des malades accusant des troubles, ce fait vient discréditer les examens post-opératoires. Le pourcentage des malades opérés pour récidive locale a légèrement augmenté au cours des 25 dernières années. Il atteint 26.4% dans la série des auteurs. Le temps médian de survie est de 19 mois chez des malades qui subissent une intervention dite radicale, de 13 mois lorsque l'intervention n'est pas radicale, de 6–8 mois quand l'intervention est palliative. L'état des ganglions, allant de paire avec la tumeur primitive, représente un facteur décisif: 27% des malades N0 peuvent subir une nouvelle résection, celle-ci n'étant possible que dans 13% des cas pour les malades N1. Dans le cas du cancer gastrique les chances de guérison des récidives loco-régionales sont minimes du fait que l'exérèse des ganglions lymphatiques lors de l'intervention initiale se solde souvent par une carcinose péritonéale généralisée. Seules les récidives au niveau du moignon gastrique peuvent subir une résection secondaire susceptible d'être radicale. Le taux des malades opérés pour une récidive de cancer gastrique est inférieur à 10%. En outre, comme l'intervention exploratrice est grevée d'une lourdre mortalité, les cancers inopérables devraient être dépistés grâce aux nouvelles méthodes d'investigations. En raison de ces résultats décourageants, il semble indispensable d'avoir recours à des essais contrôlés de modalités thérapeutiques complémentaires: chimiothérapie et radiothérapie pré-, per-, et post-opératoires, ces moyens adjuvants étant susceptibles de réduire le taux des récidives.
    Abstract: Resumen En contraste con las formas cada vez más estandarizadas de tratamiento de los cánceres gastrointestinales primarios, la estrategia terapéutica frente a las recurrencias locorregionales requiere enfoques altamente individualizados. En la mayoría de los pacientes no es posible la curación, y si ésta se logra es sólo mediante la combinación de cirugía y otras modalidades terapéuticas adyuvantes. En las recurrencias del cáncer colorrectal diversos factores relativos a la biología tumoral limitan los alcances quirúrgicos. Alrededor del 50% de los pacientes presentan extensión tumoral generalizada en el momento en que se hace el diagnóstico de una recurrencia local, y más del 75% presentan síntomas contra sólo 25% en quienes un seguimiento meticuloso permite la detección de la recurrencia locorregional en el estado asintomático. El porcentaje de pacientes operados para curación ha aumentado apenas ligeramente en el curso de los últimos 25 años; en nuestra serie la tasa es de 26.4%. Estos pacientes son los que más se benefician y exhiben una supervivencia media de 19 meses, comparada con 13 meses para aquellos sometidos a procedimientos no radicales, y 6–8 meses para los sometidos a intervenciones paliativas. El estado de los ganglios del tumor primario es un factor decisivo: 27% de los pacientes en estado N0 pudieron ser resecados en contraste con sólo 13% del estado N1. En el cáncer gástrico la posibilidad de curación en recurrencias locorregionales es mínima porque la remoción de los ganglios de drenaje linfático con la operación primaria da lugar a carcinomatosis peritoneal generalizada en casi todos los casos. Solamente en el caso de recurrencia en el muñón gástrico una resección secundaria puede ser de carácter radical. La tasa de resección en pacientes con recurrencia de cáncer gástrico es de menos de 10%. Teniendo en cuenta que aún una laparotomía resulta en elevada mortalidad operatoria, las situaciones inoperables deben ser identificadas preoperatoriamente mediante procedimientos de imagenología. Puesto que no existen enfoques promisorios en el manejo de las recurrencias, deben estudiarse los ensayos clínicos con terapias adyuvantes, tales como quimio y radioterapia, intra y postoperatoria, con ocasión de la resección del tumor primario con el propósito de rebajar la tasa de recurrencias.
    Notes: Abstract In contrast to the more standardized treatment of primary gastrointestinal cancers, the therapeutic concept in locoregional recurrences requires very individualized approaches. In most patients cure cannot be obtained and those patients who are cured are cured only by combining surgery with adjunctive treatment modalities. In recurrences of colorectal cancer, tumor biological factors limit surgical efforts. In about 50% of the patients, generalized tumor spread is present at the time of diagnosis of a local relapse. More than 75% of the patients present with symptoms thus calling into question the effect of routine follow-up examinations. The percentage of patients operated on for cure has only slightly increased during the past 25 years. In our series the rate is 26.4%. These patients benefit most, showing a median survival time of 19 months compared to 13 months in nonradical procedures and 6–8 months in palliative interventions. Nodal status of the primary tumor is very important: 27% of the patients with N0 could be re-resected compared to only 13% with N1 histological findings. In gastric cancer, the chance for cure in locoregional recurrences is minimal since the removal of the draining lymph nodes at the primary operation leads to generalized peritoneal carcinomatosis in almost all patients. Only in recurrences in the gastric stump should secondary resection be radical. Less than 10% of patients undergo resection for gastric cancer recurrence. Since even explorative laparotomy yields a high operative mortality, inoperable situations should be identified preoperatively by imaging procedures. Since encouraging approaches in the treatment of recurrences are lacking, adjuvant pre-, intra-, and postoperative chemo- and radiotherapy at the time of resection of the primary tumor should be evaluated in controlled trials.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01655816
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  • 5
    Electronic Resource
    Electronic Resource
    Intraoperative and postoperative PTH secretion mode in patients with hyperparathyroidism (1990)
    Springer
    World journal of surgery 14 (1990), S. 349-353 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Le perfectionnement d'un dosage immunoradiométrique à 2 sites, sensible, qui ne détecte que la parathormone humaine intacte (PTH 1–84) a permis d'étudier les cinétiques de la sécrétion peropératoire de ia PTH. Dans une étude prospective, nous avons évalué la sécrétion peropératoire de PTH 1–84 chez 54 patients ayant un adénome, chez 14 patients ayant une hyperparathyroïdie tertiaire (HPT), et chez 2 patients ayant une HPT persistante. On a observé une chute significative de PTH 1–84 après l'ablation de tissus athéromateux ou hyperplasiques. La réduction de la sécrétion de base de PTH de 50% était atteinte plus tôt de façon significative pour les adénomes que pour les hyperplasies. Dans les 2 cas où l'exploration cervicale était négative, les concentrations en PTH 1–84 sont restées pratiquement inchangées. La reprise de la sécrétion en PTH a été étudiée chez 23 patients, dont 20 avaient un adénome solitaire; dans 2 cas, on a découvert une hyperplasie, et chez 1 patient, il y avait des signes cliniques de HPT toxique. La chute initiale de PTH 4 heures après l'opération n'était pas sensible et la reprise était rapide, moins de 24 heures après l'intervention. La PTH était dans les limites de la normale après 48–72 heures.
    Abstract: Resumen El desarrollo de una muy sensible determinación inmunoradiométrica capaz de detectar exclusivamente la HPT (1–84) humana nos ha permitido realizar un estudio de la cinética de la secreción intraoperatoria de hormona paratiroidea (PTH). En un estudio prospectivo hemos hecho la determinación del modo de secreción de PTH (1–84) en 54 pacientes con adenomas, en 14 con hiperparatiroidismo terciario, y en 2 con hiperparatiroidismo persistente. Una vez resecado el tejido adenomatoso o hiperplásico, se observó un descenso significativo de la concentración sérica de PTH (1–84). Un descenso de 50% en el nivel de la concentración basal de PTH apareció, en forma significativa, más precozmente en los adenomas que en las hiperplasias. En los 2 casos con exploración cervical negativa, la concentración de PTH (1–84) prácticamente no exhibió modificación. La recuperación de la secreción de PTH fue estudiada en 23 pacientes, 20 de los cuales tenían adenoma único, 2 hiperplasia y 1 exhibía signos clínicos de hiperparatiroidismo tóxico. Encontramos un descenso inicial de la concentración de PTH a valores por debajo del nivel de detección a las 4 horas postoperatorias y una recuperación rápida dentro de las primeras 24 horas. Las concentraciones de PTH regresaron a valores normales a las 48–72 horas.
    Notes: Abstract The development of a sensitive 2-site immunoradiometric assay which detects only intact human PTH (1–84) enabled us to study kinetics of PTH secretion intraoperatively. In a prospective study, we assessed the PTH (1–84) secretion mode intraoperatively in 54 patients with adenomas, in 14 patients with tertiary hyperparathyroidism (HPT), and in 2 patients with persistent HPT. After the removal of adenomatous or hyperplastic tissue, a significant drop of PTH (1–84) concentration was seen. A 50% decrease in the basal PTH concentration was reached significantly earlier for adenomas than for hyperplasias. In the 2 cases with unrevealing neck exploration, the PTH (1–84) concentrations showed hardly any change. The recovery of PTH secretion was studied in 23 patients, 20 of whom had a single adenoma; in 2 cases, a hyperplasia was present and 1 patient showed the clinical signs of a toxic HPT. We found an initial drop of PTH concentration 4 hours postoperatively below the limit of detection and a rapid recovery within 24 hours postoperatively. The PTH concentration values were well within the normal range after 48–72 hours.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01658524
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  • 6
    Electronic Resource
    Electronic Resource
    Grey Turner Memorial Lecture. Science-The Driving Force for the Continuous Advancement of Surgery (1996)
    Springer
    World journal of surgery 20 (1996), S. 950-952 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/
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  • 7
    Electronic Resource
    Electronic Resource
    Immunohistochemical reclassification of anaplastic carcinoma reveals small and giant cell lymphoma (1990)
    Springer
    World journal of surgery 14 (1990), S. 291-294 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Trente et un cas de tumeurs malignes de la thyroïde, classifiés à l'origine comme des carcinomes anaplasiques, ont été réexaminés en immunohistochimie pour la présence d'anticorps IgM, IgG, IgA, de cytocératine, calcitonine, lysocyme, et alpha1-antitrypsine en utilisant la méthode péroxydase/antipéroxydase. Les résultats de cette reclassification ont été comparés avec des données cliniques: symptômes cliniques, modalités thérapeutiques, et évolution clinique. On a employé la radiothérapie postopératoire dans 80% des cas et la chimiothérapie dans aucun cas. Sept des 31 tumeurs étaient positives pour les anticorps IgM (n=4), IgG (n=2), et IgA (n=1). Dans tous ces cas, les marqueurs épithéliaux étaient négatifs. De cette manière, on a pu reclasser comme lymphomes malins primitifs non seulement 3 tumeurs à petites cellules mais aussi 4 tumeurs avec des zones de cellules géantes.
    Abstract: Resumen Treinta y un casos de neoplasias malignas de la glándula tiroides originalmente clasificadas como carcinoma anaplásico fueron reexaminados por inmunohistoquímica utilizando métodos de peroxidosa:antiperoxidasa (PAP) para IgM, IgG, IgA, citoceratina, calcitonina, lisocina, y alfa-1-antitripsina. Los resultados de la reclasificación fueron comparados con la información clínica, incluyendo sintomatología, modalidades de tratamiento, y evolución final. Se realizó radioterapia postoperatoria en más de 80% de los casos, quimioterapia en ninguno. Siete de 31 tumores exhibieron tinción positiva para anticuerpos IgM (n=4), IgG (n=2), e IgA (n=1). Todos estos casos fueron negativos para marcadores epiteliales. Sorprendentemente, no sólo la totalidad de los tumores de células pequeñas (n=3) sino también 4 tejidos con áreas predominantes de células gigantes, estuvieron en el grupo de aquellos reclasificados como linfoma maligno.
    Notes: Abstract Thirty-one cases of thyroid malignancies which were originally classified as anaplastic carcinoma were reexamined immunohistochemically using PAP methods (peroxidase:antiperoxidase) for IgM, IgG, IgA, cytoceratin, calcitonin, lysozyme and alpha-1-antitrypsin. The reclassification results were compared with patient data such as clinical symptoms, treatment modalities, and clinical outcome. Postoperative radiotherapy was carried out in more than 80% of cases, chemotherapy in none. Seven of 31 tumors showed a positive staining for IgM (n=4), IgG (n=2), and IgA (n=1) antibodies. All of these cases were negative for epithelial markers. Surprisingly, not only all small cell tumors (n=3) but also 4 tissues with predominantly giant cell areas were among those reclassified as primary malignant lymphoma.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01658506
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  • 8
    Electronic Resource
    Electronic Resource
    Der Einfluß molekularer Diagnostikverfahren auf die chirurgische Therapie maligner Erkrankungen (1996)
    Springer
    Der Chirurg 67 (1996), S. 967-979 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Molecular diagnosis ; Hereditary cancer ; Minimal residual disease.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Molekularbiologische Methoden haben in den letzten Jahren die Voraussetzungen für grundsätzliche neue Ansätze in der onkologischen Diagnostik geschaffen. Die Anlage für hereditäre Krebserkrankungen kann auf molekularer Ebene schon in der Keimbahn nachgewiesen werden und ermöglicht die operative Entfernung bestimmter Organe bei betroffenen Personen noch bevor ein Tumor aufgetreten ist. Einige präneoplastische Läsionen können durch den Nachweis spezifischer molekulargenetischer Veränderungen mit hoher Sensitivität erfaßt werden. Residuale Tumorzellen können an Absetzungsrändern, locoregionären Lymphknoten, dem Knochenmark oder im peripheren Blut mit hoher Sensitivität erfaßt werden. Es zeichnet sich ab, daß diese Verfahren sowohl für neue Krebsfrüherkennungsprogramme als auch für die Indikation zu adjuvanten locoregionären oder systemischen Therapieverfahren bedeutende Konsequenzen haben werden. Dennoch ist bisher für keines dieser Verfahren die klinische Aussagekraft in kontrollierten Studien gezeigt worden. Probleme der Reproduzierbarkeit und der Qualitätssicherung müssen bei diesen sehr sensitiven Verfahren frühzeitig adressiert und gelöst werden. Ziel dieser Übersicht ist es, die Grundlagen einiger dieser neuen Verfahren zu erläutern, um so eine kritische Bewertung ihrer klinischen Aussagekraft zu erleichtern.
    Abstract: Schlüsselwörter: Molekulare Diagnostik – familiäre Krebssyndrome – Nachweis residualer Tumorzellen.
    Notes: Summary. In the past molecular biological techniques have provided the basis for principally new aspects in the diagnosis of neoplastic diseases. The genetic predisposition to hereditary cancer syndromes can be detected by germ line DNA sequence analysis and offers the opportunity for prophylactic surgery. Some preneoplastic lesions can be detected through the identification of specific molecular alterations in nucleic acid preparations derived from various clinical samples. Residual or disseminated tumor cells can be detected in resection margins, lymph nodes, bone marrow, or peripheral blood with great sensitivity. Most likely, these techniques will strongly influence cancer screening programs and provide a rational basis for adjuvant systemic or regional therapy modalities. However, the clinical value of these techniques has not yet been proven in controlled trials. The problems of reproducibility and quality assurance have to be addressed and solved. This review summarizes the basic principles of some of these new molecular diagnostic techniques to permit a critical assessment of their clinical implications.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00002514
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  • 9
    Electronic Resource
    Electronic Resource
    Primär sklerosierende Cholangitis – Colitis-ulcerosa-assoziierte Erkrankung mit chirurgischen Konsequenzen (1998)
    Springer
    Der Chirurg 69 (1998), S. 1028-1034 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Primary sclerosing cholangitis ; Ulcerative colitis ; Cancer risk ; Restorative proctocolectomy ; Liver transplantation. ; Schlüsselwörter: Primär sklerosierende Cholangitis ; Colitis ulcerosa ; Carcinomrisikoerkrankung ; restaurative Proktocolektomie ; Lebertransplantation.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Die primär sklerosierende Cholangitis (PSC) ist in der Regel mit einer Colitis ulcerosa assoziiert. Charakteristischerweise zeigt sie einen schleichenden, jedoch progressiven Krankheitsverlauf. Die PSC im Endstadium ist durch Leberversagen, Cirrhose oder Gallengangscarcinome gekennzeichnet. Die PSC stellt aber auch eine Risikoerkrankung für colorectale Carcinome bei Patienten mit gleichzeitiger Colitis ulcerosa dar. Eine allgemein anerkannte, medikamentöse Therapie existiert bislang nicht, obwohl neuere Daten ermutigende Ergebnisse nach einer Behandlung mit Ursodeoxycholsäure zeigen. Ob dieses Medikament ein Fortschreiten der Erkrankung hinauszögern oder sogar verhindern kann, ist aufgrund einer noch nicht ausreichend langen Nachbeobachtungszeit bislang unklar. Isolierte Gallengangstenosen sollten interventionell-endoskopisch behandelt werden. Welchen Einfluß eine Proktocolektomie auf den Verlauf einer PSC hat, wird bis heute kontrovers diskutiert. Die Therapie der PSC im Endstadium ist die Lebertransplantation. Das 5-Jahres-Überleben ist mit bis zu 89 % signifikant besser, als bei anderen Indikationen zur Lebertransplantation. Colitis-Patienten nach Transplantation müssen lebenslang coloskopisch-bioptisch überwacht werden, da sie trotz meist asymptomatischer Colitis ein erhöhtes Risiko für colorectale Carcinome aufweisen.
    Notes: Summary. Primary sclerosing cholangitis (PSC) is generally associated with ulcerative colitis (UC). The disease typically progresses slowly, but ultimately, and leads to cirrhosis, liver failure or bile duct cancer. PSC patients with simultanous ulcerative colitis are also at higher risk for colorectal cancer. At the present time, there is no effective treatment for PSC, although preliminary data show encouraging results after treatment with ursodeoxycholic acid. However, there are no data concerning the delay or prevention of progress of the disease with this drug, because follow-up time is not yet long enough. Isolated bile duct strictures should be treated endoscopically. The possible effect of proctocolectomy on the course of PSC is controversial. Liver transplantation is the therapy of choice for PSC in its final stage. The 5-year survival rate (89 %) is significantly better than after transplantation for other indications. Patients with ulcerative colitis have to be followed up by lifelong colonoscopy. Although the course of UC after transplantation is mostly asymptomatic, these patients are at higher risk for colorectal cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050532
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  • 10
    Electronic Resource
    Electronic Resource
    Grundlagen und Wert der Lymphadenektomie beim colorectalen Carcinom (1996)
    Springer
    Der Chirurg 67 (1996), S. 889-899 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Colon ; Rectum ; Cancer ; Lymphadenectomy ; Staging ; Prognosis.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Die systematische Lymphadenektomie in der Primärtherapie colorectaler Carcinome hat zum Ziel Lymphknotenmetastasen im unmittelbaren Drainagegebiet des Primärtumors zu entfernen. Sie setzt Kenntnisse der normalen Lymphdrainage des Colons und Rectums und der lymphatischen Metastasierungswege voraus. Als Standardresektion oder als erweiterte Resektion ist die systematische Lymphadenektomie auch Grundlage der pathohistologischen Stadienzuordnung. Die korrekte Stadienzuordnung hängt wesentlich von der Intensität der Aufarbeitung der Präparate durch den Pathologen ab. Die Ausdehnung Lymphadenektomie wird von der erreichbaren Prognoseverbesserung einerseits und von der durch die Lymphadenektomie bedingten Komplikationsrate andererseits bestimmt.
    Abstract: Schlüsselwörter: Colorectales Carcinom – Lymphadenektomie – Staging – Prognose.
    Notes: Summary. Systematic lymphadenectomy for colorectal cancer aims to remove potentially metastatic lymph nodes from the tumor's drainage basin. This requires knowledge of normal lymphatic anatomy and metastatic routes. Systematic lymphadenectomy performed as a standard or as an extended resection is a prerequisite for pathologic tumor staging. An intensive search by the pathologist for lymph node metastases is critical for precise staging. Recommendations as to the extent of lymphadenectomy are derived from potential improvement of prognosis and procedure-related complications.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00002533
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