26
|
Liese J, Moench C, Bechstein WO, Ulrich F. Living-Donor Liver Transplantation from a Monozygotic Twin. Transplantation 2012. [DOI: 10.1097/00007890-201211271-01261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
27
|
Bexten T, Burck I, Bechstein WO, Moench C. [Hepatic peliosis--a rare liver tumor and challenge for diagnostic investigation plus therapy]. Dtsch Med Wochenschr 2012; 137:1505-9. [PMID: 22869508 DOI: 10.1055/s-0032-1305176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
HISTORY AND ADMISSION FINDINGS A 42-year-old woman presented at our hospital, because of a non-specific hepatic tumor. She complained of dull pain in the right upper abdomen. Physical examination did not reveal any pathology, especially there was no evidence of an infection. Abuse of drugs, alcohol or anticontraceptives was also denied. INVESTIGATIONS UND THERAPY: Even though fine needle biopsy and extensive radiological examination were performed a malignant nature of the liver tumor could not be excluded. Therefore a hemihepatectomy was performed. TREATMENT AND COURSE The postoperative course was normal and the patient was released from hospital after 11 days. The histological examination revealed an incidental finding of an extended peliosis hepatis. CONCLUSION Peliosis hepatis is a rare disease of the liver, histologically characterized by blood filled cavities. The clinical picture of this disease is mostly asymptomatic, but it may also lead to liver failure, portal hypertention and massive intrahepatic bleeding. The preoperative differentiation is an interdisciplinary challenge, especially in terms of radiological examination (chemical shift MRI; liver specific radiocontrast). If the distinction to a malignancy cannot be excluded operative resection is indicated.
Collapse
|
28
|
Wicker S, Rabenau HF, Haberl AE, Bühren A, Bechstein WO, Sarrazin CM. [Blood-borne infections and the pregnant health care worker. Risks and preventive measures]. Chirurg 2012; 83:136-42. [PMID: 21901466 DOI: 10.1007/s00104-011-2166-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Due to the increasing proportion of women in health care, as well as changes in working conditions (implementation of safety devices, minimally invasive/endoscopic procedures) the question arises whether the applicable laws and regulations for the protection of working mothers are outdated and should be updated.Individual risk analysis, as well as the inclusion of the pregnant health care worker in the decision-making process with regard to continuation or modification of the work practice serves as a protection of the expectant mother and unborn child and allows a continuation of the occupational activities.
Collapse
|
29
|
Abstract
The resection of liver metastases offers the option of long-term survival for patients with colorectal carcinoma. With regard to resectability three clinical situations can be identified: patients with resectable liver metastases, those with potentially resectable liver metastases and patients with disseminated metastatic disease. Patients with potentially resectable liver metastases should be treated with regimens with high response rates. According to a metaanalysis patients with resectable liver metastases have a better disease-free survival with the combination of resection and chemotherapy. If neoadjuvant therapy is planned in resectable patients the FOLFOX regimen is the schedule with the highest level of evidence. In potentially resectable liver metastases the regimens FOLFIRI/cetuximab and FOLFOXIRI have demonstrated higher response and resection rates in phase III trials. During neoadjuvant therapy resectability should be regularly reevaluated. Operations should be planned as soon as resectability is achieved because a longer therapy will increase morbidity and because of uncertainty over the approach to patients with complete remission.
Collapse
|
30
|
Friedrich-Rust M, Glasemann T, Polta A, Eichler K, Holzer K, Kriener S, Herrmann E, Nierhoff J, Bon D, Bechstein WO, Vogl T, Zeuzem S, Bojunga J. Differentiation between benign and malignant adrenal mass using contrast-enhanced ultrasound. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2011; 32:460-471. [PMID: 21667434 DOI: 10.1055/s-0031-1273408] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE Adrenal masses can be detected by ultrasound with high sensitivity and specificity. The aim of the present study was to evaluate CEUS in a large patient population using CEUS patterns identified in a previous pilot study. MATERIALS AND METHODS 116 adrenal masses were evaluated by ultrasound, including CEUS with the contrast agent Sonovue®. The dynamic of contrast enhancement (CE) was analyzed using time-intensity curves. The time of the first CE in the adrenal mass was used to define four CEUS patterns: pattern I = early arterial CE, pattern II = arterial CE, pattern III = late CE, pattern IV = no CE. In addition, all patients received CT/MRI and hormonal testing. In suspicious cases biopsy or adrenalectomy was performed. RESULTS CEUS patterns I&II were seen in all patients with primary or secondary malignant lesions of the adrenal gland (n = 16). The sensitivity and specificity of CEUS for the diagnosis of malignant adrenal mass were 100 % (CI [75;100]) and 67 % (CI [56;75]), respectively. Overall histology was available as a reference method for 40 adrenal masses. In 68 % of histologically diagnosed adrenal masses, MRI/CT and CEUS were congruent concerning the characterization of malignant versus benign adrenal mass. CONCLUSION Contrast-enhanced ultrasound may be a useful method in the diagnostic work-up of adrenal mass with excellent sensitivity for the diagnosis of malignancy.
Collapse
|
31
|
Welker MW, Lubomierski N, Gog C, Herrmann E, Engels K, Vogl TJ, Bechstein WO, Zeuzem S, Trojan J. Efficacy and safety of sorafenib in advanced hepatocellular carcinoma under daily practice conditions. J Chemother 2010; 22:205-11. [PMID: 20566428 DOI: 10.1179/joc.2010.22.3.205] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Sorafenib has recently been shown to be effective for the treatment of advanced hepatocellular carcinoma in randomized controlled trials. Here, we report the experience with sorafenib in 25 patients with advanced HCC under daily practice conditions. Tolerance to sorafenib was acceptable and side effects were manageable, although the ECOG performance status was reduced in all patients. The most prevalent grade 2/3 side effects were fatigue (40%) and diarrhea (24%), and withdrawal from therapy occurred in 29% of patients. Disease stabilization was documented in 60% of patients. The median treatment time was 2.7 months and overall survival was 11.0 months. No significant serum alpha-fetoprotein decline was noted at the time of the first radiological control in a subgroup of patients with baseline levels >50 ng/ml who achieved stable disease. In conclusion, in daily practice sorafenib is safe and disease stabilization can be achieved in the majority of patients. However, intolerance to sorafenib can affect treatment adherence substantially.
Collapse
|
32
|
Friedrich-Rust M, Sperber A, Holzer K, Diener J, Grünwald F, Badenhoop K, Weber S, Kriener S, Herrmann E, Bechstein WO, Zeuzem S, Bojunga J. Real-time elastography and contrast-enhanced ultrasound for the assessment of thyroid nodules. Exp Clin Endocrinol Diabetes 2009; 118:602-9. [PMID: 19856256 DOI: 10.1055/s-0029-1237701] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Work-up of thyroid nodules remains challenging. Recent technologies enable determination of tissue elasticity and perfusion using ultrasound devices. The aim of the present study was to evaluate real-time elastography (RTE) and contrast-enhanced ultrasound with Sonovue (CEUS) for the differentiation of benign and malignant thyroid nodules. MATERIALS AND METHODS Inclusion criteria were: nodules ≥1 cm, non-functioning or hypo-functioning on radionuclide scanning, and cytological/histological assessment. All patients received conventional ultrasound, RTE and CEUS. RTE was classified as: Elasticity-Score (ES)1 = soft, ES2 = predominantly soft, ES3 = predominantly hard, ES4 = hard nodule. CEUS-video clips were digitally recorded and analyzed using time-intensity-curves within selected regions-of-interest. RESULTS Fifty-three nodules in 50 patients were available for analysis. Forty-six nodules were benign on cytology/histology, 6 nodules were papillary carcinoma and one nodule was a follicular carcinoma. Nodule margin irregularity was the ultrasound pattern most predictive of malignancy with sensitivity 57% (95% confidence interval: 18-90%) and specificity 85% (71-94% p<0.05). When using ES3&4 for the diagnosis of malignant nodules sensitivity and specificity were 86% (42-99.7%) and 87% (75-95%), respectively (p = 0.0003). The only malignant nodule missed with RTE was a follicular carcinoma. Sensitivity for the diagnosis of papillary carcinoma therefore was 100%. No specific CEUS pattern could be identified to differentiate between benign and malignant nodules. CONCLUSIONS RTE seems to be a useful tool in the work-up of thyroid nodules to exclude papillary thyroid cancer. However, follicular carcinoma remains a challenging problem. CEUS did not improve the characterization of thyroid nodules in this preliminary study.
Collapse
|
33
|
Kaiser GM, Sotiropoulos GC, Jauch KW, Löhe F, Hirner A, Kalff JC, Königsrainer A, Steurer W, Senninger N, Brockmann JG, Schlitt HJ, Zülke C, Büchler MW, Schemmer P, Settmacher U, Hauss J, Lippert H, Hopt UT, Otto G, Heiss MM, Bechstein WO, Timm S, Klar E, Hölscher AH, Rogiers X, Stangl M, Hohenberger W, Müller V, Molmenti EP, Fouzas I, Erhard J, Malagó M, Paul A, Broelsch CE, Lang H. Liver transplantation for hilar cholangiocarcinoma: a German survey. Transplant Proc 2009; 40:3191-3. [PMID: 19010230 DOI: 10.1016/j.transproceed.2008.08.039] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The present study reports a German survey addressing outcomes in nonselected historical series of liver transplantation (OLT) for hilar cholangiocarcinoma (HL). PATIENTS AND METHODS We sent to all 25 German transplant centers performing OLT a survey that addressed (1) the number of OLTs for HL and the period during which they were performed; (2) the incidence of HL diagnosed prior to OLT/rate of incidental HL (for example, in primary sclerosing cholangitis); (3) tumor stages according to Union Internationale Centre le Cancer; (4) patient survival; and (5) tumor recurrence rate. RESULTS Eighty percent of centers responded, reporting 47 patients who were transplanted for HL. Tumors were classified as pT2 (25%), pT3 (73%), or pT4 (2%). HL was diagnosed incidentally in 10% of cases. A primary diagnosis of PSC was observed in 16% of patients. Overall median survival was 35.5 months. When in-hospital mortality (n = 12) was excluded, the median survival was 45.4 months, corresponding to 3- and 5-year survival rates of 42% and 31%, versus 31% and 22% when in-hospital mortality was included. HL recurred in 34% of cases. Three- and 5-year survivals for the 15 patients transplanted since 1998 was 57% and 48%, respectively. Median survival ranged from 20 to 42 months based on the time period (P = .014). CONCLUSIONS The acceptable overall survival, the improved results after careful patient selection since 1998, and the encouraging outcomes from recent studies all suggest that OLT may be a potential treatment for selected cases of HL. Prospective multicenter randomized studies with strict selection criteria and multimodal treatments seem necessary.
Collapse
|
34
|
Kaiser GM, Sotiropoulos GC, Jauch KW, Löhe F, Hirner A, Kalff JC, Königsrainer A, Steurer W, Senninger N, Brockmann JG, Schlitt HJ, Zülke C, Büchler MW, Schemmer P, Settmacher U, Hauss J, Lippert H, Hopt UT, Otto G, Heiss MM, Bechstein WO, Timm S, Klar E, Hölscher AH, Rogiers X, Stangl M, Hohenberger W, Müller V, Molmenti EP, Fouzas I, Erhard J, Malagó M, Paul A, Broelsch CE, Lang H. Liver transplantation for hilar cholangiocarcinoma: a German survey. Transplant Proc 2009; 40:3155-7. [PMID: 19010230 DOI: 10.1016/j.transproceed.2008.08.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The present study reports a German survey addressing outcomes in nonselected historical series of liver transplantation (OLT) for hilar cholangiocarcinoma (HL). PATIENTS AND METHODS We sent to all 25 German transplant centers performing OLT a survey that addressed (1) the number of OLTs for HL and the period during which they were performed; (2) the incidence of HL diagnosed prior to OLT/rate of incidental HL (for example, in primary sclerosing cholangitis); (3) tumor stages according to Union Internationale Centre le Cancer; (4) patient survival; and (5) tumor recurrence rate. RESULTS Eighty percent of centers responded, reporting 47 patients who were transplanted for HL. Tumors were classified as pT2 (25%), pT3 (73%), or pT4 (2%). HL was diagnosed incidentally in 10% of cases. A primary diagnosis of PSC was observed in 16% of patients. Overall median survival was 35.5 months. When in-hospital mortality (n = 12) was excluded, the median survival was 45.4 months, corresponding to 3- and 5-year survival rates of 42% and 31%, versus 31% and 22% when in-hospital mortality was included. HL recurred in 34% of cases. Three- and 5-year survivals for the 15 patients transplanted since 1998 was 57% and 48%, respectively. Median survival ranged from 20 to 42 months based on the time period (P = .014). CONCLUSIONS The acceptable overall survival, the improved results after careful patient selection since 1998, and the encouraging outcomes from recent studies all suggest that OLT may be a potential treatment for selected cases of HL. Prospective multicenter randomized studies with strict selection criteria and multimodal treatments seem necessary.
Collapse
|
35
|
Bechstein WO, Lang H, Köhne C, Parisi F, Raab HR, Frilling A, Konopke R, Weitz J, Stroszczynski C, Folprecht G. Resectability and agreement between surgeons: Review of CT and MR scan of the CELIM study: (Multicenter randomized trial of cetuximab/FOLFOX versus cetuximab/FOLFIRI in unresectable liver metastases. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4091 Background: Liver resection of patients with colorectal cancer liver metastasis (mets) may provide curative therapy. The decision for resection is based on CT- or MRI scans and includes technical aspects (esp. remaining liver tissue) and prognostic factors (i.e. number of metastases). Methods: During two workshops, CT- or MRI scans at baseline (BL) and after 4 months treatment (follow-up, F-U) of CELIM-patients (pts) were presented to surgeons (surg.) who were blinded to each other, the time of investigation (BL or F-U) and clinical data. Scans were allocated to one of the following categories: (1) resection, (2) exploration, (3) borderline resectable (prior chemotherapy preferred) or (4) non-resectable If scans were allocated to category (3) or (4), the reason (technical or poor prognosis) was stated. For evaluation of resectability over time, pts were regarded as resectable according to presented imaging, if ≥ 50% of surg. voted for (1) or (2). Inter-observer variability was evaluated by a reduced model, too: operation (1+2), borderline, primary chemo therapy preferred (3) and non-resectable, chemotherapy (4). Critical disagreements were assumed if ≥1 surg. voted for (4) and ≥ 50% surg. for (1+2) or vice versa. Results: Seven surg. (≥ 5/workshop) participated at the review. A total of 180 scans were reviewed. Both, BL and F-U scans, were available for 75 pts (68% of study pts). During the review, 24 pts changed from ‘non-resectable‘ at BL to ‘resectable‘ at F-U, 5 pts from ‘resectable‘ to ‘non-resectable‘, 29 pts remained ‘non-resectable‘, and 17 pts ‘resectable‘ (19 pts more resectable at F-U; chi-square: p=.021). R0 resection was actually performed in 16/29 pts classified as ‘resectable‘ (55%) and 13/54 pts not classified as ‘resectable‘ (24%) according to presented BL- images. In the full model (6 possibilities), the agreement between surg. was 51.4 %, p<.001. In the clinically more important reduced model, the agreement was 63.5% (p<.001). Critical disagreements were observed in 18 cases (10%). Conclusions: Resectability according to scans increased significantly during the CELIM trial. Regarding the clinical approach, different surgeons had a high degree of agreement. [Table: see text]
Collapse
|
36
|
Bechstein WO. Einsatz der MRCP aus chirurgischer Sicht. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
37
|
Vogl TJ, Zangos S, Balzer JO, Nabil M, Rao P, Eichler K, Bechstein WO, Zeuzem S, Abdelkader A. [Transarterial chemoembolization (TACE) in hepatocellular carcinoma: technique, indication and results]. ROFO-FORTSCHR RONTG 2008; 179:1113-26. [PMID: 17948190 DOI: 10.1055/s-2007-963285] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
UNLABELLED To present current data on technique, indications and results of transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). The principle of TACE is the intra-arterial injection of chemotherapeutic drug combinations like doxorubicin, cisplatin and mitomycin into the hepatic artery, followed by lipiodol injection, Gelfoam for vessel occlusion and degradable microspheres. The side effects and complications after TACE range from fever, upper abdominal pain and vomiting to acute or chronic liver cell failure. The palliative effect in unresectable HCC using TACE allows local tumor control in 15 to 60% of cases and 5-year survival rates ranging from 8-43%. The potentially curative treatment option allows local tumor control from 18-63%. The neoadjuvant treatment option of TACE in combination with other treatment options like percutaneous ethanol injection (PEI) or radiofrequency ablation (RFA) reach local tumor control rates between 80-96%. The bridging effect of TACE before liver transplantation reaches 5-year survival rates from 59-93%. The symptomatic therapy option of TACE is used to counteract pain directly caused by HCC and acute/subacute bleeding in the HCC. The local tumor response reaches up to 88% and the bleeding control is from 83 to 100%. CONCLUSION TACE is a potentially curative, palliative, neoadjuvant, bridging and symptomatic therapy option for local and diffuse HCC.
Collapse
|
38
|
Reinacher-Schick AC, Bechstein WO. [Colorectal liver metastases. Neoadjuvant chemotherapy: aspects of medical and surgical oncology]. Internist (Berl) 2008; 48:51-8. [PMID: 17160665 DOI: 10.1007/s00108-006-1770-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Colorectal liver metastases are detected in 15-20% of patients at the time of diagnosis of the primary tumor, they develop in an additional 20-30% of patients during further course of the disease. Radical resection enables 5-year survival rates of 30-50%. Resectability may be increased by surgical techniques including two-stage hepatectomy and portal vein embolization. Furthermore, modern chemotherapy including various combinations of oxaliplatin, irinotecan, bevacizumab, and cetuximab has led to secondary resectability correlating to response rates which may be up to 80%. Changes of hepatic histology such as sinusoidal obstruction (e.g. following oxaliplatin) or steatohepatitis (e.g. following irinotecan) have been described. Individually, this may increase the risk of subsequent liver resection. As of today the role of neoadjuvant chemotherapy for resectable lesions has not been definitively confirmed.
Collapse
|
39
|
Bechstein WO, Strey C. Möglichkeiten der lokalen und systemischen Blutstillung bei chirurgischen Eingriffen. Chirurg 2007; 78:95-6, 98-100. [PMID: 17237955 DOI: 10.1007/s00104-006-1289-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Surgery inevitably leads to bleeding, and hemostasis aims at reducing the amount of blood loss and the need for transfusion as well as preventing rebleeding, hematoma formation, and the need for repeat surgery. Various locally applicable agents are in use including bone wax, gelatin, collagen, oxidized regenerated cellulose, fibrin sealant glues, and synthetic glues. Some evidence from randomized controlled trials (RCT) exists regarding the use of fibrin sealants on their own or combined with collagen fleece. Systemic hemostasis may be achieved with lysine analogs such as epsilon-aminocaproic acid or tranexamic acid and aprotinin, which are inhibitors of fibrinolysis. There is much albeit sometimes conflicting evidence from RCT regarding the use of these substances in surgery. The role of recombinant activated factor VII in achieving systemic hemostasis is being investigated.
Collapse
|
40
|
Rehbinder B, Wullstein C, Bechstein WO, Probst M, Engels K, Kriener S, Döbert N, Schwarz W, Brixner V, Steffan D, Gauer S, Geiger H, Hauser IA. Epstein-barr virus-associated posttransplant lymphoproliferative disorder of donor origin after simultaneous pancreas-kidney transplantation limited to pancreas allograft: A case report. Am J Transplant 2006; 6:2506-11. [PMID: 16869797 DOI: 10.1111/j.1600-6143.2006.01464.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A 45-year-old man was admitted with fever and elevated pancreas enzymes 6 months after simultaneous pancreas-kidney transplantation (SPKT). Function of the allografts was normal. Bacterial and fungal infections were excluded, while Epstein-Barr virus (EBV)-polymerase chain reaction (PCR) was positive. However, screening for EBV-associated lymphoma was negative. EBV infection did not respond to antiviral therapy. After an 18F-Fluorodeoxyglucose positron emission tomography positive signal and an abnormal computed tomography scan of the pancreas transplant, a biopsy revealed a diffuse large monomorphic B-cell lymphoma, which was confined to the grafted organ. Its origin was assigned to the donor by microsatellite analysis. Reduction of immunosuppression and immunotherapy with rituximab was unsuccessful. After 10 weeks, the patient developed an acute hemolytic uremic syndrome which required explantation of the allografts. Subsequent to the intervention, fever disappeared, EBV DNA became undetectable and lymphoma screening remained negative. In posttransplant lymphoproliferative disorder of donor origin after SPKT, transplantectomy may be a curative therapy.
Collapse
|
41
|
Vogl TJ, Pegios W, Bechstein WO, Floeter J. Radiologische Diagnostik des Rektumkarzinoms: Nachsorge und Rezidivdiagnostik. ROFO-FORTSCHR RONTG 2006; 178:970-8. [PMID: 17021976 DOI: 10.1055/s-2006-926937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Rectal carcinoma is one of the most frequent malignant tumors in adulthood. Not only after total resection but also after partial resection of the tumor with postoperative radiochemotherapy a sufficient follow-up is necessary to diagnose recurrent rectal cancer as early as possible. Various guidelines suggest different intervals for physical examinations and diagnostic methods depending on the initial tumor stage. In addition to routine examinations, the physician can choose between CT, MRI, endosonography and functional imaging techniques such as PET and immunoscintigraphy for further evaluation if a recurrent rectal cancer is suspected. Multiple studies and meta-analyses show the differences in the specificity and sensitivity of the diagnostic methods in the detection of lymph nodes, metastases, and local tumor infiltration. Endosonography and endorectal MRI show very good results in staging local tumor infiltration. However, obstructive lesions can inhibit an adequate examination. CT provides prompt and convincing results in the evaluation of the metastases. Most of the time the tumor can be identified but the lack of detailed imaging makes it hard to perform sufficient staging. Additionally image-guided biopsy can be performed. Immunoscintigraphy and PET have a high specificity because they take advantage of the tumor's metabolism. The introduction of the PET-CT has eliminated the disadvantage of low image resolution. In addition to the detection of small nodular pulmonary metastases, MRI with its "phased-array" coils is another excellent tool for the diagnosis of recurrent rectal cancer and search for metastases. This review shows the advantages and disadvantages of each diagnostic method in the visualization of recurrent rectal cancer.
Collapse
|
42
|
Probst M, Woeste G, Oertl A, Hauser IA, Geiger H, Bechstein WO, Jonas D. Gibt es eine Lernkurve bei der Etablierung eines Pankreas-/Nierentransplantationsprogrammes? Aktuelle Urol 2006. [DOI: 10.1055/s-2006-947590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
43
|
Golling M, Gog C, Woeste G, Zapletal C, Wullstein C, Bechstein WO. Lebermetastasen kolorektaler Karzinome - Neoadjuvante Konzepte zum präoperativen Downstaging. Zentralbl Chir 2006; 131:140-7. [PMID: 16612781 DOI: 10.1055/s-2006-921538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Liver resection for colorectal metastases disease can be performed with curative intent at low morbidity and mortality. Only 15-30 % of liver metastases are amenable to potentially curative resection. Five year survival following primary and repeat liver resection has consistently been reported as 25-40 %. Future strategies focus at widening the indication and extending therapeutic options. The aim of neoadjuvant treatment of irresectable liver metastasis is the conversion to secondary resectability either via increasing residual liver mass (portal vein embolisation/2-stage resection) and/or reducing tumor load via chemotherapy ("down-sizing"). Current data suggest resectability following neoadjuvant chemotherapy in around 8 % of cases but varying between 1-33 %.
Collapse
|
44
|
Woeste G, Wullstein C, Zapletal C, Hauser IA, Gossmann J, Geiger H, Bechstein WO. Evaluation of Type 1 Diabetics for Simultaneous Pancreas-Kidney Transplantation With Regard to Cardiovascular Risk. Transplant Proc 2006; 38:747-50. [PMID: 16647461 DOI: 10.1016/j.transproceed.2006.01.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The main cause of death for diabetic patients and patients on dialysis is coronary artery disease (CAD). The most common cause of graft loss following simultaneous pancreas and kidney transplantation (SPK) is death with a functioning graft due to CAD. Therefore, careful pretransplantation evaluation of CAD is mandatory. In our series, every patient undergoes a noninvasive cardiac function test like dobutamine stress echocardiography (DSE) or myocardial thallium scintigraphy using adenosine to induce medical stress. Thirty patients were evaluated for SPK: 15 patients with myocardial scintigraphy and 8 with DSE. Seven investigations showed pathological findings and we performed coronary angiograms, none of which showed coronary artery stenosis. Seven primary coronary angiograms were performed: four due to a history of CAD and three as a primary diagnostic. Following SPK one patient died at 21 days after transplantation due to myocardial infarction. He had a history of CAD with angioplasty and stent implantation. Noninvasive cardiac function tests like DSE or myocardial scintigraphy are reliable methods to evaluate CAD in patients with diabetic nephropathy awaiting SPK. In case of a suspicious finding or a history of CAD, a coronary angiogram should be performed to assess the need for revascularization. Following this algorithm we may further reduce the mortality of SPK.
Collapse
|
45
|
Richter B, Schmandra TC, Golling M, Bechstein WO. Nutritional support after open liver resection: a systematic review. Dig Surg 2006; 23:139-45. [PMID: 16809912 DOI: 10.1159/000094345] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Perioperative nutrition in patients with limited liver function after partial hepatic resection is still controversial. In particular, the significance of perioperative total enteral nutrition remains unresolved. The aim of this review is to investigate the impact of early postoperative total enteral nutrition on convalescence after partial liver resection. MATERIALS AND METHODS In an internet-based Medline-Search (time course: 1960-08/2005) a total of five prospective, randomized controlled trials were found comparing the impact of enteral and parenteral nutrition after liver resection. After study validity had been established, a systematic review was undertaken (odds ratio, 95% confidence interval, p < 0.05 level of significance; Review Manager 4.2, The Cochrane Collaboration). Primary endpoints were complication rate (infection, organ malfunction) and mortality. Standardized immune parameters were also surveyed. RESULTS Statistical analysis showed that enteral nutrition resulted in a significantly lower rate (p = 0.04) of wound infection and catheter-related complications than parenteral nutrition did. No statistically significant differences in mortality due to enteral or parenteral nutrition could be found. Patients receiving enteral nutrition showed better postoperative immune competence. CONCLUSION Early enteral nutrition after liver resection is a safe procedure. Compared to parenteral nutrition it is associated with a decreased incidence of postoperative complications. Facing the inhomogeneity of these trials, especially in nutrition protocols and end points, this first systematic review stresses the need for an update of the importance of early enteral nutrition after liver resection within randomized controlled multicenter trials.
Collapse
|
46
|
Woeste G, Zapletal C, Golling M, Usadel KH, Vogl TJ, Bechstein WO, Wullstein C. Telerobotic-assisted laparoscopic spleen-preserving partial resection of the pancreatic tail for insulinoma. HPB (Oxford) 2006; 8:233-4. [PMID: 18333283 PMCID: PMC2131675 DOI: 10.1080/13651820510003753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2004] [Indexed: 12/12/2022]
Abstract
Laparoscopic pancreatic resection is rarely described. Telerobotic-assisted laparoscopy may offer some advantages for resection of the pancreatic tail. A 49-year-old woman was diagnosed with insulinoma located in the pancreatic tail. Telerobotic-assisted laparoscopic spleen-preserving resection of the pancreatic tail was performed. Operation time was 195 minutes. The postoperative course was uneventful. The previously described advantages of a telerobotic approach with extended range of motion and three-dimensional view make more complex operations like pancreatic resection possible and may offer extended indications for laparoscopic surgery.
Collapse
|
47
|
Lehnert T, Gazis A, Wetter A, Zangos S, Thalhammer A, Balzer JO, Bechstein WO, Vogl TJ. In vivo Leberregneration nach Intervention: Vergleich der transarteriellen Chemotherapie (TACE) vs. chirurgischer Resektion mittels CT-Volumetrie und Bestimmung des Regenerations-Faktors HGF. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
48
|
Lehnert T, Gazis A, Wetter A, Hammerstingl R, Eichler K, Mack M, Bechstein WO, Vogl TJ. Hepatocyte growth factor (HGF) – Quantitative Evaluation des Zytokins HGF vor Intervention: Ergebnisse einer Langzeitstudie über die prognostische Aussagekraft für die Leberregeneration. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-940944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
49
|
Wullstein C, Woeste G, de Vries E, Persijn GG, Bechstein WO. Acceptance criteria of pancreas grafts: how do surgeons decide in Europe? Transplant Proc 2005; 37:1259-61. [PMID: 15848688 DOI: 10.1016/j.transproceed.2004.12.146] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Some donor factors, such as age, cause of death, and obesity, affect the outcomes of pancreas transplantation. Donors with a high-risk profile are usually not declined for pancreas donation. The purpose of our study was to investigate differences between accepted and refused pancreata after being procured and offered. METHODS In a retrospective study we analyzed all offered pancreata (n = 1360) in the "Eurotransplant Area" between May 25, 2002 and September 18, 2003. Included in this study were 525 pancreata transplanted (38.6%) and 608 pancreata refused for medical reasons (44.7%). A total of 227 pancreata (16.7%) refused for other than medical reasons were excluded from this analysis. RESULTS The significant differences in the donor profiles between transplanted and refused pancreata were cause of death (P < .001), donor age (P < .001), body mass index (BMI, P < .001), serum lipase and amylase (P < .05) at the time of procurement, and a history of smoking (P = .001) or alcohol abuse (P < .001). No differences were found for serum sodium (P = .188), blood leukocytes (P = .349), serum glucose at the time of procurement (P = .155), amylase and lipase at the time of admission (P = .34; P = .758), and vasopressor use at the time of admission or at the procedure (P = .802; P = .982). CONCLUSION Even after procuring and offering potentially good pancreata, nearly half the organs are refused for medical reasons. Acceptance criteria in the Eurotransplant region reveal a conservative attitude toward pancreas acceptance.
Collapse
|
50
|
Zapletal C, Faust D, Wullstein C, Woeste G, Caspary WF, Golling M, Bechstein WO. Does the liver ever age? Results of liver transplantation with donors above 80 years of age. Transplant Proc 2005; 37:1182-5. [PMID: 15848663 DOI: 10.1016/j.transproceed.2004.11.056] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Facing an increasing shortage of donor organs, donor criteria become more extended and so-called marginal organs are accepted for transplantation. For liver donation donor age above 70 years is accepted as a risk factor concerning primary dysfunction or nonfunction. Therefore, the aim of this study was to compare the early outcome of grafts older versus younger than 80 years of age. PATIENTS AND METHOD Between August 2002 and February 2004, 40 adult liver transplants were performed using triple immunosuppression with tacrolimus, MMF, and low-dose corticosteroids. Recipients with HCC received low-dose rapamycin after postoperative day 14. The outcome of grafts from donors under 80 years of age (n=35) was compared with those from donors 80 years old or more (n=5). For statistical analysis Mann-Whitney-U-Test and Fisher's Exact Test were used with P < .05 considered statistically significant. RESULTS The average donor age of our population was 54.4 +/- 17.3 years with five donors older than 80 years (80-83 years). These donors all had additional risk factors. The recipients of the latter grafts suffered from HCC and liver cirrhosis Child A (n=2) or from viral hepatitis (n=3). One recipient had advanced cirrhosis with severe complications. The outcomes of both groups were comparable concerning intraoperative and postoperative courses. All recipients of old liver grafts left the hospital with stable graft function. CONCLUSION Liver grafts over 80 years can be transplanted with good results, especially if given to recipients with malignancy and otherwise stable liver function.
Collapse
|