Profile of the multicenter cohort of the German Cancer Consortium's Clinical Communication Platform

Treatment concepts in oncology are becoming increasingly personalized and diverse. Successively, changes in standards of care mandate continuous monitoring of patient pathways and clinical outcomes based on large, representative real-world data. The German Cancer Consortium's (DKTK) Clinical Communication Platform (CCP) provides such opportunity. Connecting fourteen university hospital-based cancer centers, the CCP relies on a federated IT-infrastructure sourcing data from facility-based cancer registry units and biobanks. Federated analyses resulted in a cohort of 600,915 patients, out of which 232,991 were incident since 2013 and for which a comprehensive documentation is available. Next to demographic data (i.e., age at diagnosis: 2.0% 0-20 years, 8.3% 21-40 years, 30.9% 41-60 years, 50.1% 61-80 years, 8.8% 81+ years; and gender: 45.2% female, 54.7% male, 0.1% other) and diagnoses (five most frequent tumor origins: 22,523 prostate, 18,409 breast, 15,575 lung, 13,964 skin/malignant melanoma, 9005 brain), the cohort dataset contains information about therapeutic interventions and response assessments and is connected to 287,883 liquid and tissue biosamples. Focusing on diagnoses and therapy-sequences, showcase analyses of diagnosis-specific sub-cohorts (pancreas, larynx, kidney, thyroid gland) demonstrate the analytical opportunities offered by the cohort's data. Due to its data granularity and size, the cohort is a potential catalyst for translational cancer research. It provides rapid access to comprehensive patient groups and may improve the understanding of the clinical course of various (even rare) malignancies. Therefore, the cohort may serve as a decisions-making tool for clinical trial design and contributes to the evaluation of scientific findings under real-world conditions.

Glücklicher Ausgang einer intraoperativen Unterlassung

Four years after cholecystectomy and recurrent epigastric pain, a surgical sponge passed per anum in a 39-year-old man. Diagnostic procedures including clinical and laboratory examinations, ultrasound, coloscopy, and abdominal CT did not reveal any noteworthy residual changes by the foreign body. After 4 years in situ, the surgical sponge showed no alterations in structure. The representatives of the hospital concerned had to satisfy the patient's claims for damages. Pathology, technical diagnostic methods, and prognosis in cases of retained gauzes are presented. It is essential to count instruments and towels and advisable to use only single sponges in forceps in order to prevent intraoperative loss.

Mutational analysis of 4-coumarate:CoA ligase identifies functionally important amino acids and verifies its close relationship to other adenylate-forming enzymes

4-Coumarate:coenzyme A ligase (4CL) is a key enzyme of general phenylpropanoid metabolism which provides the precursors for a large variety of important plant secondary products, such as lignin, flavonoids, or phytoalexins. To identify amino acids important for 4CL activity, eight mutations were introduced into Arabidopsis thaliana At4CL2. Determination of specific activities and K(m) values for ATP and caffeate of the heterologously expressed and purified proteins identified four distinct classes of mutants: enzymes with little or no catalytic activity; enzymes with greatly reduced activity but wild-type K(m) values; enzymes with drastically altered K(m) values; and enzymes with almost wild-type properties. The latter class includes replacement of a cysteine residue which is strictly conserved in 4CLs and had previously been assumed to be directly involved in catalysis. These results substantiate the close relationship between 4CL and other adenylate-forming enzymes such as luciferases, peptide synthetases, and fatty acyl-CoA synthetases.

How the bacterial plant pathogen Xanthomonas campestris pv. vesicatoria conquers the host

Abstract Xanthomonas campestris pv. vesicatoria (Xcv) is the causal agent of bacterial spot disease on pepper and tomato. Pathogenicity on susceptible plants and the induction of the hypersensitive reaction (HR) on resistant plants requires a number of genes, designated hrp, most of which are clustered in a 23-kb chromosomal region. Nine hrp genes encode components of a type III protein secretion apparatus that is conserved in Gram-negative plant and animal pathogenic bacteria. We have recently demonstrated that Xcv secretes proteins into the culture medium in a hrp-dependent manner. Substrates of the Hrp secretion machinery are pathogenicity factors and avirulence proteins, e.g. AvrBs3. The AvrBs3 protein governs recognition, i.e. HR induction, when bacteria infect pepper plants carrying the corresponding resistance gene Bs3. Intriguingly, the AvrBs3 protein contains eukaryotic signatures such as nuclear localization signals (NLS), and has been shown to act inside the plant cell. We postulate that AvrBs3 is transferred into the plant cell via the Hrp type III pathway and that recognition of AvrBs3 takes place in the plant cell nucleus.

Three 4-coumarate:coenzyme A ligases in Arabidopsis thaliana represent two evolutionarily divergent classes in angiosperms

The enzyme 4-coumarate:CoA ligase (4CL) plays a key role in channelling carbon flow into diverse branch pathways of phenylpropanoid metabolism which serve important functions in plant growth and adaptation to environmental perturbations. Here we report on the cloning of the 4CL gene family from Arabidopsis thaliana and demonstrate that its three members, At4CL1, At4CL2 and At4CL3, encode isozymes with distinct substrate preference and specificities. Expression studies revealed a differential behaviour of the three genes in various plant organs and upon external stimuli such as wounding and UV irradiation or upon challenge with the fungus, Peronospora parasitica. Phylogenetic comparisons indicate that, in angiosperms, 4CL can be classified into two major clusters, class I and class II, with the At4CL1 and At4CL2 isoforms belonging to class I and At4CL3 to class II. Based on their enzymatic properties, expression characteristics and evolutionary relationships, At4CL3 is likely to participate in the biosynthetic pathway leading to flavonoids whereas At4CL1 and At4CL2 are probably involved in lignin formation and in the production of additional phenolic compounds other than flavonoids.

Determination of pH in human erythrocytes. Sources of systematic error

The results of a simultaneous determination of the pH value in erythrocytes with the potentiometric measuring method and the 14C-labelled 5,5-dimethyl-2,4-oxazolidinedione (DMO) method showed a mean method difference of 0.026 pH units. The cause of this discrepancy was assumed to be matrix-inherent liquid-junction potentials in the potentiometric measurement. Taking these into account in the calculation leads to consistent values for the methods investigated. The DMO method proved to be free of systematic errors. Another indication of this is that its mean ratio of extracellular to intracellular H+ ion concentration (H+e/H+i) substantially agreed with the distribution ratios of other freely diffusible ions and their pH dependence.

[Spontaneous rupture of aberrant bile ducts in choledocholithiasis]

It is reported on 4 patients aged 69 to 79 years suffering from rupture of aberrant subserosal bile ducts. In the first patient the gallbladder did not obtain stones, the common duct stones causing increased pressure in the intrahepatic ducts and rupture were not diagnosed, the supposed "cyst" was excised, followed by suture of the liver tissue. Due to peritonitis relaparotomy had to be done. Since now intrahepatic obstruction was supposed a hepatojejunostomy was performed. The patient died from peritonitis following insufficiency of the anastomosis and bronchopneumonia. The other patients were cured by cholecystectomy, revision of the duct, T-tube and suture at the site of perforation, in one case with additional endoscopic papillotomy.

Sex differences in age development of a mouse inbred strain: body composition, adipocyte size and organ weights of liver, heart and muscles

The mouse inbred strain HLG has only recently been submitted for international registration. It has been widely used in radiological studies. Since these mice tend to become obese, they may be of interest for studies concerning fat metabolism. Therefore, the present ageing study examines the sex-specific development of body weight, body composition, adipocyte size as well as the organ weight of liver, heart and thigh muscles of the inbred strain HLG (54 males/53 virgin females) between day 40 and 360 of life. The body weight development showed a distinct sexual dimorphism, quickly increasing in the case of males but comparatively protracted in females until maturity. Significantly higher values for body and fat-free dry weight as well as body water were found in males of all ages. Body fat and adipocyte diameter were only higher in the 80 and 120 day-old males. Thus, the increase in female body weight resulted largely through a rise in body fat as additionally evidenced by the sex-specific correlation of characteristics. A 2-fold analysis of variance showed sex differences in the relative weights of liver and muscle, but not of the heart. A sex-specific close correlation was observed between body and liver weights in males until day 180. Correlations between body fat and other characteristics were only rarely found. Differences in coefficients of variation largely depended on the characteristics. A higher variability was also found for some characteristics in the youngest groups (40 days). A sex-specific difference was only seen in the case of body fat content for 60 day-old mice (female > male).

Upright standing in the laboratory rat--time expenditure and its relation to locomotor activity

Various reports have discussed a minimal cage height of 14 cm in rat maintenance. Recommendations for heights between 18 and 22 cm have been proposed and partially put into practice. However, no quantitative data exist on the actual utilisation of higher cages by rats. Thus, upright standing in 19 and 30 cm high cages as well as locomotor activity on the floor was assessed in 54 rats using passive infra-red detectors. The results showed a continuously decreasing use of cage height. On average, adult animals exceeded even a height of 24 cm for 13.8 (strain ACI) and 5.2 (strain LEW and SPRD) minutes per day respectively, corresponding to 8.7 and 5.5% respectively of the locomotor activity on the cage floor. Obviously upright standings is an integral part of the laboratory rat's ethogram showing similar strain-dependent circadian rhythms as locomotor activity.

The ontogenesis of skin and organ characteristics in the Syrian golden hamster. III. Ontogenetic and intraspecific allometry for strain and sex as well as body weight- and age-dependent correlations

The allometric relations, i.e. bodily characteristics, body weight-relationships as well as age-dependent organ and biochemical data were studied in a total of 464 golden hamsters of both sexes of an acromelanic white inbred and agouti coloured outbred strain. In the 3 age sections studied (I = day 1-20, II = day 25-100, III = day 110-365) the body weight- and age-dependent relations were found to be altered between and within the various characteristics. The body weight correlations predominated in the case of organ weights and skin muscle thickness. By contrast, age correlations were seen above all in the skin compartments with cyclic growth, hair follicle density and reticular thickness in the age sections I and II. Papillary thickness showed a positive relation to body weight and age after weaning, but no long-term relations were observed with both plasma insulin and blood glucose levels. The allometric behaviour of skin compartments could be explained particularly by thermoregulatory and "geometric" similarities and that of the organs by metabolic and other similarities. Most sex and strain differences in the absolute data, except for the kidney and adrenal weights, disappeared on allometric analysis and were thus mainly due to differences in body weight. For long-term toxicological investigations, the documentation of age and body weight as well as the determination of ontogenetic allometry is a "must".

[Computed tomographic detection of a polypous form of eosinophilic gastroenteritis in the duodenum]

The eosinophilic granuloma of the intestine is a relatively uncommon lesion which is unrelated to the eosinophilic granuloma of lung or bone. We describe one case of this disease in the duodenum evaluated by hypotonic duodenography and computed tomography (CT). The radiographs showed sharply delineated circular intra-luminal filling defect. CT demonstrated a homogeneous soft tissue mass and excluded an extraluminal extension of the lesion. Histological examination is essential for confirming the diagnosis.

The ontogenesis of skin and organ characteristics in the Syrian golden hamster. II. Body and organ weights as well as blood glucose and plasma insulin levels

The ontogenesis of the organ weights of the liver, kidneys, adrenals, testes and ovaries as well as the blood glucose and plasma insulin levels were studied in a total of 464 golden hamsters of both sexes of the acromelanic white inbred strain Bio 1.5 and agouti coloured outbred strain Han:AURA. Familial and seasonal influences were excluded by means of randomisation (25 groups from 1-365 days of life). Body weight development was found to be sigmoid and showed significant differences in terms of age, sex, and strain. Liver and kidney weights developed in parallel. Here, too, strain differences (agoutis greater than acromelanics) were seen, and sex differences were observed in the case of the kidneys (females greater than males). The increased adrenal weight in male hamsters compared to females was in accordance with species- but not rodent-typical behaviour. Both the testes and ovarian weights varied considerably. Age as well as, in part, strain differences were seen in the case of the blood glucose and insulin levels. The continual development of body and organ weight could be explained in terms of physiological changes.

Methods for pH determination in human erythrocytes

The methods described in the literature for pH determination in human erythrocytes, i.e. the direct potentiometric measurement of haemolysed erythrocytes and the 5,5-dimethyl-2,4-oxazolidinedione (DMO) method, were examined and compared. In spite of careful optimization of the experimental technique, a statistically significant difference of a few hundredths of a pH unit remained between the results of the two methods. The calculation of the cellular water space of the erythrocytes is suggested as a possible reason for this difference; in the DMO method this leads to uncertainty in the determination of the DMO concentration and therefore in the derived intracellular pH values. For clinical use, the direct pH measurement of haemolysed erythrocytes, using the technique described here, is recommended.

Manual N-terminal microsequencing of proteins electroeluted from polyacrylamide gel slices

A simple and rapid procedure for preparation of proteins for manual microsequencing using sodium dodecyl sulfate gel electrophoresis is described. The procedure involves pre-electrophoretic labeling of the protein amino groups with a coloured Edman reagent, disk electrophoresis for purification or fractionation of the proteins, and reversed electrophoretic transfer of the separated protein from gel slices into a small volume of buffer (100 to 150 microliter) using a discontinuous conductivity gradient to recover the proteins. The pre-electrophoretic labeling facilitates location of the separated proteins in the gel and the monitoring of their complete electroelution. The isolated proteins are separated from excess of salts by acetone precipitation and solvent partitioning in pyridine/water (1:1) and subjected to manual DABITC/PITC degradation.

Improved model for the induction of proestrus-like gonadotropin surges in long-term ovariectomized rats

In long-term (greater than 4 wk) ovariectomized rats the positive response of the gonadotropin release apparatus to a priming dose of estradiol is moderate as compared with that of proestrous rats exposed to endogenous estradiol. In the present study, high sensitivity to estrogen was restored in long-term ovariectomized rats by pretreatment with estradiol benzoate (EB, 20 micrograms, day 0) and progesterone (P, 2.5 mg, day 3). Estradiol benzoate (20 micrograms) given on day 5 induced proestrus-like surges of LH and FSH in the afternoon on day 6. Additional administration of P (2.5 mg at noon on day 6) had a facilitatory effect. Stimulation of LH release could be evoked in rats by the described regimen 1, 6 or 50 wk after ovariectomy. The long-term ovariectomized rat injected with EB and P as described might provide a useful model for neuroendocrinological investigations on the gonadotropin surge mechanism.

Blood pressure in rats: a comparison of a multifactorial experimental design to measurements in an outbred stock

Systolic blood pressure was measured in males of 8 inbred strains and 1 outbred stock of rats 5 times over a period of 20 min on 5 consecutive days. The strain means ranged between 107.9 mmHg and 149.3 mmHg. The estimated variance between strains (V = 248.7 mmHg) was about 5 times higher than the variance within strains (V = 54.3 mmHg). The intraindividual variance within strains was relatively constant (V = 24.0-37.6 mmHg), while the interindividual variance varied to a great extent (V = 4.5-44.5 mmHg) from strain to strain. The outbred stock showed values of blood pressure and components of variance similar to those of a single inbred strain. Thus, by investigation of a battery of 8 inbred strains in a multifactorial experimental design a greater phenotypic variability due to genetic strain differences is achieved than by measurements in a single outbred stock.

Biological, analytical and experimental components of variance in a long-term study of plasma constituents in rat

Statistical analysis of variance was applied to data from determinations of 14 plasma constituents in 25 rats in order to evaluate the analytical, experimental and biological (inter-and intraindividual) component of variance. Blood was taken seven times in intervals of 8-10 days, the last one by catheter technique and the other by heart puncture. The analytical portion of variance was determined by the concurrent analysis of a pool plasma standard. The experimental component of variance was evaluated by the comparison of the variation of the catheter values with that of the pooled data from heart puncture. The coefficient of variation for the latter may be grouped into three categories: less than 10% for protein, Na+, K+, Ca2+; 10-20% for urea, phosphate and the enzymes as alanine aminotransferase, choline esterase, alkaline phosphatase and leucine arylamidase and 20-65% for the other enzymes lactate dehydrogenase, malate dehydrogenase, aspartate aminotransferase and creatine kinase. The results from the samples taken by catheter technique generally revealed the lower values for the mean as well as for the variance. It became evident that the procedure of heart puncture is afflicted with the most aggravating interference factors, thus accounting for most of the experimental component of variance. The observed differences between the single blood drawings, the non-Gaussian distribution for several constituents, and the interactions between the components of variance do not always fit for the statistical concept of additivity of the single components.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of bleeding procedure and some environmental conditions on stress-dependent blood constituents of laboratory rats

The influence of experimental conditions on 10 haematological and blood chemical constituents were investigated in male Han:Wistar rats. Significant differences existed between values of haematological and chemical constituents of blood, sampled within 10 s, between 10 and 30, or between 30 and 60 s after decapitation respectively, The leucocyte count decreased quickly but the lactate concentration rose after decapitation. The interindividual coefficient of variance for the majority of the blood constituents was reduced markedly if blood was sampled within 10 s of decapitation. Significant differences in plasma protein and blood lactate concentrations existed between 2 rats kept in one cage, when the first rat was decapitated 20 s before the second one. Plasma protein concentrations differed significantly between rats bled at 9.00 am and 11.00 am. Significant differences in blood glucose and lactate concentrations existed between rats bled on 5 different days within a period of 10 days. Packed cell volume, eosinophilic granulocytes and plasma protein concentration differed significantly between rats kept in a room with a 12:12 light: darkness (LD) cycle and those living in a room with a 2.3:2.3 LD cycle.

Distribution of glomeruli in the renal cortex of Munich Wistar Frömter (MWF) rats

The glomerular distribution in the renal cortex of the Munich Wistar Frömter (MWF) rat, a substrain of the Munich Wistar rat selected for superficial glomeruli, was compared to that of a control strain (LEW/Ztm) between 10 and 150 days of age. While there were no significant differences in body growth, kidney weight, or growth of the renal cortex in these two strains, the average diameter of Bowman's capsule and of the glomerular tuft was significantly larger (about 12%) in rats of the MWF strain which were older than 60 days. In histological sections of kidneys of MWF rats in all age groups, many glomeruli in direct contact with the renal capsule were found; thus, this developmental step must have taken place before 10 days of age. The appearance of superficial glomeruli was due to a shift of glomeruli to a position just under the renal surface, the subcapsular zone or 'cortex corticis', which is normally free of glomeruli. For the rest of the renal cortex there were only slight differences in glomerular density and in total number of glomeruli per section between these two strains. These results lead us to suppose that superficial glomeruli belong to a special nephron type; thus, these glomeruli are not enveloped by parts of the proximal tubule.

Spontaneous short-term fluctuations in the daily pattern of heart rate, body temperature and locomotor activity in the laboratory rat

Heart rate (HR), body temperature (BT) and locomotor activity (LA) were measured continuously over 5 days in freely moving rats. In addition to the well-known circadian rhythms, all variables exhibited considerable fluctuations in amplitude mainly during the dark, but also in the light periods. The values of HR varied from 286 +/- 12 to 470 +/- 26 b.p.m. and BT from 36.15 +/- 0.15 degrees C to 38.45 +/- 0.25 degrees C. The large variability of HR, BT and LA within a single day was due more to large short-term fluctuations within periods of about 3-5 hours duration, than to differences between the light and the dark period. Good consistency of daily patterns and similarity of the 3 variables was found within the animals. Usually there were 3 or 4 regular peaks during the dark and often another peak 3-4 hours after the onset of light. Correlation coefficients, calculated on the basis of 5-min mean values, were highly significant (P less than 0.001) for LA vs HR (0.61-0.73), LA vs BT (0.40-0.53), and HR vs BT (0.61-0.68). Between-hour correlations were higher than these common correlations of 5-min values. HR vs BT (0.76-0.83) and LA vs BT (0.63-0.79) correlated as well as LA vs HR (0.72-0.83). The short-term fluctuations (within-hours) gave lower correlation coefficients for LA vs BT (0.23-0.32) and HR vs BT (0.29-0.41) than LA vs HR (0.40-0.70). This seems to result from a physiological delay of BT relative to HR and LA.

Intraspecies allometry: correlation between kidney weight and glomerular filtration rate vs. body weight

Allometric equations of the form of Y = a*BWb were calculated between body weight (BW) on the one hand and either kidney weight (KW) or glomerular filtration rate (GFR) on the other. By using strain and sex means obtained from 24 different inbred strains of adult mice or F1-hybrids environmental and genetical influences could be separated statistically. Thus, allometric equations reported in this study describe exclusively genetic influence. The parameters for intraspecies allometric equations obtained in these studies were compared to those in the literature presenting interspecies relationships. The double logarithmic regressions of KW vs. BW gave results different from the interspecies equation. The difference between intra- and interspecies results of allometric relationships may be due to the experimental exclusion of environmental influences. The regression parameters for GFR vs. BW obtained for the inbred strains, however, agreed very well with those of the empirical equation for interspecies relationship and also with the theoretically expected value. The dependence of GFR on BW was found to be GFR = 0.036*BW0.74 +/- 0.15, where GFR is measured in ml/min and BW in g. The exponent of 0.74 seems to be a valid biological constant that is genetically determined within and across species lines.

Stress response of rats to handling and experimental procedures

The effects were observed of moving male, adult Han:Sprague rats in their cages or of exposure to ether for 1 min on the plasma concentration profiles of 25 blood characteristics linked with stress and shock reactions. 5 min after the stress serum prolactin, corticosterone, thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, triiodothyronine and thyroxin levels were elevated 150-500% compared with those in blood collected within 100 s of entering the animal room.

Heart rate (telemetrically recorded), packed cell volume,, haemoglobin and plasma protein content were 10-20% elevated 2-10 min after cage movement or 2-20 min after ether confrontation over those of controls sampled within 50 s, indicating circulatory and microcirculatory shock reactions.

Serum glucose, pyruvate and lactate concentrations rose by 20-100% 1-5 min after cage movement and 1-15 min after ether exposure. Phosphate, calcium, urea, apartate and alanine transferases, alkaline phosphalase and leucine arylamidase were not altered significantly by either stressor, while potassium and bound glycerol fell for 1 min and 5-20 min respectively.

The presence of a familiar animal attendant working in the room without touching the cages did not markedly affect the blood characteristics being studied.

pH dependency in uptake of sulfonamides by bacteria

Sulfonamide-sensitive cells of Escherichia coli were incubated under standarized conditions with various sulfonamides and the quantity of sulfonamide uptake into the bacteria measured. The test substances reached a higher concentration inside the bacteria than in the incubation medium, the degree of accumulation varying for the individual substances despite uniformly applied incubation conditions. In all cases a pH dependency was detected which varied with the pKa values of the substances tested. On the basis of the pKa dependency of the pH effect, the sulfonamide uptake can be interpreted as being a passive diffusion process. Knowing the intracellular pH value, which was determined by the DMO method, it was then possible to calculate the theoretically expected value for the accumulation as a concentration coefficient. Since the calculated and experimentally determined values differ approximately by a factor of 2, an intracellular binding of the sulfonamides is assumed. The same results were obtained in cells of sulfonamide-resistant E. coli strains.

[Acute pancreatitis following gastric secretion analysis by pentagastrin stimulation (author's transl)]

A picture of acute abdomen developed in a 25-year-old patient with recurrent duodenal ulcers after subcutaneous injection of pentagastrin for a gastric secretion test. Laparotomy undertaken for suspected perforated ulcer revealed an acute hemorrhagic pancreatitis. Healing and freedom from complaint occurred rapidly with drug therapy. The following are to be considered as possible causes for pancreatitis after subcutaneous application of pentagastrin: exacerbation of the ulcer, an acute exacerbation of chronic pancreatitis, a direct effect of pentagastrin on the pancreas, increased pancreatic secretion due to the stimulation of gastric acid, reflux of duodenal contents or bile, arterial hypotension with local acidosis in the pancreas. Attention must always be paid to contra-indications of gastric juice analysis.

[Surgical and dietetic problems of subtotal resection of the small intestine in adults (author's transl)]

The human body badly tolerates the extensive loss of the small intestine by resection. Malabsorption of various substances is followed by severe deficiency symptoms. In recent years a longer survival with a satisfactory general condition was achieved by intensive postoperative care and adequate diet--in our own cases even in adults and in old age.

[Crohn's disease with several intestinal foci ("skip lesions")]

A 35-year-old man underwent a resection of part of the ileum due to six "skip lesions" in Crohn's disease. At reoperation four years later, in addition to a typical terminal ileitis, two stenosing lesions were found at the ileal-jejunal junction. In connection with this rare observation, a report is made on multiple lesions and the diffuse type of Crohn's disease, both of which must be included in the therapeutic concept. "Adequate" resections including all segmental lesions are demanded, different resections in additional distant lesions, and conservative medical treatment in the widespread diffuse type of the disease.

[Reoperation in recurrence of carcinoma of the esophagus, Cardia and stomach (author's transl)]

Reoperative surgery is performed with the object of restoring gastrointestinal passage or of pain relief and only rarely, for example in recurrence of an early carcinoma, with the object of curative resection. Out of 31 reoperations for such a purpose, a second resection (total or extended gastrectomy) was possible in 9 cases, gastric bypass or some other palliative operation in 12; in 10 cases, only a laparotomy was possible. The interval between the 1st and 2nd operations was 29 months in the resectable group and 17 months in the nonresectable group, the survival times 11 and 3.3 months respectively. Indications have to be considered separately for each patient.

[Early gastric carcinoma]

The early gastric cancer can now be diagnosed more frequently by improved methods of roentgenology and endoscopy. At present 16.7 percent of the gastric resections for cancer in our clinic are for early gastric cancers. Indicative clinical symptoms were demonstrable in 25 of our own 27 cases described here. Infiltration of the gastric wall (mucosa- and submucosatype) and lymph-node metastases are important to the prognosis. Intraoperatively, it is essential to localize the tumor unobjectionably and to perform a sufficiently radical resection (generally subtotal gastrectomy and excision of the lymph-nodes). The 5-year-survival-rate totals 70 to nearly 100 percent. Postoperatively controls are necessary for the diagnosis and eventually the treatment of possible recurrence.