Correlation of head screw lengths in proximal humerus nailing: a CT-based study on 289 cases

INTRODUCTION

Nailing of the proximal humerus is an established method for the treatment of proximal humerus fractures. Choice of the correct length for potentially four proximal locking screws is essential for postoperative outcome. Due to positioning of the patient, intraoperative determination of the correct length of the anteroposterior (AP) screw with the x-ray beam is particularly challenging even for experienced surgeons. We hypothesized that there would be a correlation between the projected lengths of the different proximal locking screws and therefore the length of the AP-screw could be determined based on the three lateromedial (LM) screws.

MATERIALS AND METHODS

In this retrospective study (level of evidence: III) CT-scans of shoulders of 289 patients were 3D reconstructed with the program Horos. Using the manufacturer Stryker's instructions, the four proximal locking screws of the T2 Humeral Nail system were reproduced in the 3D reconstructed shoulders. The length of the AP-screw was correlated with the lengths of the LM-screws by Linear Regression and Multiple Linear Regression.

RESULTS

The results of this study showed that the lengths of proximal locking screws in proximal humeral nailing correlated significantly with each other. Based on the given data, a formula could be established to calculate the length of the AP-screw based on the lengths of the LM-screws with a probability of 76.5%.

CONCLUSIONS

This study was able to show that the length of the AP-screw could be determined from the intraoperatively measured lengths of the LM-screws. As our findings base on measurements performed in CT scans, clinical studies are needed to support our data.

Reconstruction of complex radial head fractures using fine-threaded K-wires : clinical outcome and remaining instability

Radial head replacement or ORIF are established treatment options for Mason type-III and type-IV fractures. The aim of this study was to provide results for reconstruction of these complex fractures using fine-threaded K-wires. We present results after reconstruction of 15 Mason type-III and 8 Mason type-IV fractures. Parameters used to describe the functional outcome were pain level, range of motion, and clinical scores. To estimate the elbow stability we performed ultrasound examinations under valgus/varus stress. All radial heads could be reconstructed. The average resting pain level was 0.9 of 10. The average ROM for extension/flexion was 134°, average forearm rotation was 159°. For the whole patient collective the mean MEPS was 86.5 points and the mean QuickDASH was 16.8 points with no significant difference for both groups. We can recommend ORIF with fine-threaded K-wires for Mason type-III and type-IV fractures of the radial head. Ligamentous injuries can be addressed successfully with external fixation.

Rare implant-specific complications of the MoPyC radial head prosthesis

BACKGROUND

According to currently available data, the clinical short-term results of the MoPyC radial head prosthesis (Bioprofile, Tornier, Montbonnot-Saint-Martin, France) seem favorable. However, we have encountered several implant-specific complications in recent years. Hence, this case series reports rare complications after radial head arthroplasty with the MoPyC prosthesis to make surgeons aware of their existence and to provide information about the underlying cause and possible salvage strategies.

METHODS

A retrospective chart review from 2011 to 2016 was conducted to identify all adult patients with a minimum 2-year follow-up who underwent or were referred after radial head arthroplasty with the MoPyC radial head prosthesis and experienced implant-related complications.

RESULTS

Five patients with 7 implant-related complications were found. One patient experienced breakage of the pyrocarbon head. In another patient, breakage of the stem and-after revision surgery-partial breakage were observed. Disassembly of the prosthesis was seen in 1 case. Extensive periprosthetic stress shielding was seen in 3 patients resulting in symptomatic loosening (1), periprosthetic radial neck fracture (1), and stem migration (1).

CONCLUSIONS

Whereas clinical short-term results of the MoPyC radial head prosthesis are satisfactory, rare implant-related complications can occur. Surgeons should be aware of these complications as they may lead to a poor outcome.

Presentation of the vascular supply of the proximal ulna using a sequential plastination technique

PURPOSE

The purpose of this study was to demonstrate the peri- and intraosseous vascular supply of the proximal ulna.

METHODS

Eleven fresh human cadaveric elbows were sequentially plastinated beginning with arterial injection, followed by block and secondary slice plastination of the whole elbow. With this technique, we obtained completely transparent cadaveric slices in which the peri- and intraosseous vascular architecture could be studied.

RESULTS

Proximal ulna vascularization is due to an arterial network: a superior and inferior collateral ulnar artery and the profunda brachial artery climbing to the olecranon from proximal. An anterior artery and a posterior recurrent artery climb up distally to the medial parts of the ulna and an interosseous recurrent artery is responsible for the lateral and posterolateral proximal part of the ulna. The intraosseous vascularization is due to directly penetrating branches out of the posterior recurrent ulnar artery and a vascular plexus at the olecranon tip. In addition, we saw a major distal bone penetration branch coming from the recurrent posterior artery, climbing intraosseously without junction to the proximal penetrating branches.

CONCLUSION

The peri- and intraosseous vascularization of the proximal ulna was shown. A transitional zone of the intraosseous vascularization of the proximal ulna was detected.

The bispecific immunoligand ULBP2-aCEA redirects natural killer cells to tumor cells and reveals potent anti-tumor activity against colon carcinoma

NKG2D, an activating receptor expressed on NK cells and T cells, is critically involved in tumor immunosurveillance. In this study, we explored the potential therapeutic utility of the NKG2D ligand ULBP2 for the treatment of colon carcinoma. To this end we designed a fusion protein consisting of human ULBP2 and an antibody-derived single chain targeting the tumor carcinoembryonic antigen (CEA). The bispecific recombinant fusion protein re-directed NK cells towards malignant cells by binding to both, tumor cells and NK cells, and triggered NK cell-mediated target cell killing in vitro. Moreover, tumor growth was significantly delayed in a syngeneic colon carcinoma mouse model in response to immunoligand treatment. The anti-tumor activity could be attributed to the stimulation of immune cells with an elevated expression of the activation marker CD69 on NK, T and NKT cells and the infiltration of CD45+ immune cells into the solid tumor. In summary, it was demonstrated that immunoligands provide specific tumor targeting by NK cells and exert anti-tumor activity in vitro and in vivo. This technology represents a novel immunotherapeutic strategy for solid tumors with the potential to be further developed for clinical applications.

Reconstruction of a Bryan and Morrey type I capitellar fracture in a sawbone model with four different fixation devices: an experimental study

BACKGROUND

We evaluated 4 different fixation devices for the reconstruction of a standardised Bryan and Morrey capitellar shear fracture in a sawbone model. Outcome measurements were the quality of reduction, time for reconstruction and stability.

METHODS

80 standardised Bryan and Morrey type I fractures were created for 5 different orthopaedic surgeons in 80 sawbones. Each surgeon reconstructed 16 fractures with 2mm K-wires, 3mm Herbert screws, 2.7 mm AO screws and 2.2mm fine-threaded wires (Fragment Fixation System: FFS). 4 fractures were allocated to each method with a standardised reconstruction procedure. Quality of reduction and time for reconstruction were measured after definitive fixation. Biomechanical testing was performed using a shear loading model with the application of monocyclic or polycyclic stress to the reconstructed capitulum.

RESULTS

There was no difference in the quality of reduction with the different fixation devices. Herbert and AO screw fixation was slower than the other implants (p<0.05). No difference in the time for reconstruction was observed with K-wires and FFS. Failure load was less for K-wires compared to FFS, Herbert screws and AO screws (p<0.05). With polycyclic loading, residual deformation was higher with K-wire reconstruction compared to FFS, Herbert screws and AO screws (p<0.05).

CONCLUSION

When using four different fixation devices, the fixation of standardised Bryan and Morrey type I fractures in the sawbone model differs when it comes to the time needed for reduction, but not in the quality of reduction. Stability was the same for the implants used, except for the K-wires. There is no argument in favour one of the screw implants over another in clinical use.

Reconstruction of radial capitellar fractures using fine-threaded implants (FFS)

Fractures of the capitulum humeri are rare and challenging injuries to the elbow and outcome results are limited to case series, often with different fixation devices. This article aims to present 15 patients with a fracture of the capitulum humeri treated with the same implant, fine-threaded Kirschner wires (FFS). Besides range of motion and grip strength, outcome measurements include the following scores: the Mayo Elbow Performance index (MEPI); the American Shoulder and Elbow Surgeons' Elbow Assessment (ASES) Form; the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; and the Broberg-Morrey score. Using the modified Bryan and Morrey classification, there were seven type-I injuries, three type-II, two type-III and three type-IV fractures. In addition to fractures of the capitellum, five patients were diagnosed with a complex ligamentous injury and three had suffered radial head fractures. After a minimum follow-up of 12 months, we obtained a range of motion in flexion and extension of 124° and a pro- and supination of 173°. The mean DASH showed 10.84 and the Broberg-Morrey score reached 90.8. ASES and MEPI scores were 91.5 and 90, respectively. The mean grip strength of the injured side was 217.9N versus 236.4N on the healthy side. The use of FFS for capitellar fractures of the humerus achieved good clinical results and these implants can be considered as a treatment option for this fracture entity.

Analysis of Tie2-expressing monocytes (TEM) in patients with colorectal cancer

Tie2-expressing monocytes (TEM) promote tumor angiogenesis and growth in experimental cancer models. The role of TEM in cancer patients is unknown. We studied TEM in healthy volunteers and colorectal cancer (CRC) patients. Although TEM were detectable in the blood and tumor lesions of CRC patients, their frequency and functional phenotype showed no correlation with levels of angiopoietin-2 or vascular endothelial growth factor, microvessel density, tumor markers, tumor stage, or outcome of antiangiogenic therapy. These unexpected findings are at odds with murine tumor models and question the diagnostic or therapeutic value of TEM in human cancer.

[External fixation with motion capacity in complex dislocation of the knee joint and associated injuries]

Closed and open dislocations of the knee joint with vascular and nerve injuries are treated immediately and may present an indication for external fixation. In acute trauma definitive treatment and reconstruction of the complex capsule and ligamentous injuries are often impossible. The application of a medial transarticular external fixator with motion capacity combines the treatment of remaining joint instability with the benefit of early joint movement. Disadvantages of prolonged joint immobilisation until definitive stabilisation of the knee are reduced.

Identification of serum angiopoietin-2 as a biomarker for clinical outcome of colorectal cancer patients treated with bevacizumab-containing therapy

Background:

The combination of chemotherapy with the vascular endothelial growth factor (VEGF) antibody bevacizumab is a standard of care in advanced colorectal cancer (CRC). However, biomarkers predicting outcome of bevacizumab-containing treatment are lacking. As angiopoietin-2 (Ang-2) is a key regulator of vascular remodelling in concert with VEGF, we investigated its role as a biomarker in metastatic CRC.

Methods:

Serum Ang-2 levels were measured in 33 healthy volunteers and 90 patients with CRC. Of these, 34 had metastatic disease and received bevacizumab-containing therapy. To determine the tissue of origin of Ang-2, quantitative real-time PCR was performed on microdissected cryosections of human CRC and in a murine xenograft model of CRC using species-specific amplification.

Results:

Ang-2 originated from the stromal compartment of CRC tissues. Serum Ang-2 levels were significantly elevated in patients with metastatic CRC compared with healthy controls. Amongst patients receiving bevacizumab-containing treatment, low pre-therapeutic serum Ang-2 levels were associated with a significant better response rate (82 vs 31% P<0.01), a prolonged median progression-free survival (14.1 vs 8.5 months; P<0.01) and a reduction of 91% in the hazard of death (P<0.05).

Conclusion:

Serum Ang-2 is a candidate biomarker for outcome of patients with metastatic CRC treated with bevacizumab-containing therapy, and it should be further validated to customise combined chemotherapeutic and anti-angiogenic treatment.

Olecranon fracture fixation with a new implant: biomechanical and clinical considerations

This study aims to describe the first clinical results in the treatment of dislocated olecranon fractures with 2.2-mm, fine-threaded wires with a washer. Furthermore, in the second part of the article, the stability of these new implants has been compared to standard tension band wiring in a sawbone model.

PATIENTS

The radiological and clinical outcomes in 24 patients (mean age: 53.6 years) with 24 isolated Mayo type I and II fractures of the olecranon were evaluated in a prospective study after open reduction and internal fixation (ORIF) with a new fixation device (FFS; Orthofix). The quality of reduction with the implementation of 24 FFS constructions was compared with 24 tension band-wiring procedures performed by six different surgeons in a standard sawbone Mayo type IIa fracture model. Stability was tested in all constructs using a single cycle load to failure protocol (group I), cyclic loading for 300 cycles between 10 and 500 N (group II) and incremental sinusoidal loading from 10 to 200 N with an incremental increase of 10 N per cycle (group III) in a laboratory study.

RESULTS

The Morrey elbow score was excellent in 23 patients and good in one patient, with mean DASH score of 1.6. No implant migration, secondary dislocation or nonunion was observed. In the sawbone model, the quality of reduction was the same with the FFS implants compared to the tension band wiring in the sawbone model. Here, bending moments in all three groups showed no significant difference, whereas displacement at failure was significantly greater in the tension band-wiring group at a single cycle load (p=0.017).

CONCLUSION

Clinical results were comparable to tension band wiring and stability of the implants in the sawbone model was the same; thus, we conclude that the FFS technique can serve as an alternative treatment option for isolated olecranon fractures.

Efficient activation of autologous tumor-specific T cells: a simple coculture technique of autologous dendritic cells compared to established cell fusion strategies in primary human colorectal carcinoma

Different technologies have been employed to deliver the whole spectrum of tumor antigens (TAs) to dendritic cells (DCs) to be presented to T cells. These include whole tumor RNA-transfected DCs, preparations of DCs loaded with tumor-derived apoptotic bodies or tumor cell lysates, and DC tumor cell fusions. Early clinical trials have been conducted using such techniques. The presented study was aimed to revisit the necessity of tumor cell manipulation in DC-based immunotherapy strategies for colorectal carcinoma. We investigated a simple coculture method of autologous monocyte-derived DCs and human primary colorectal carcinoma (pCC) in comparison with 2 well-described cell fusion strategies for the efficacy of uptake, processing and presentation of TAs to autologous T cells. Before coculture or fusion, pCC had been cryopreserved without further manipulation. Fluorescence microscopy and flow cytometry analyses of fluorescent dye labeled cells were used for monitoring engulfment of pCC by DCs. The coculture procedure resulted in a double positive cell fraction of up to 22% and thus was comparable to that observed after cell fusion. More important, DCs after coculture with autologous pCC induced significant tumor-specific interferon-gamma-producing autologous T cells in the same number of patients as DC/pCC fusions. Furthermore, tumor-specific major histocompatibility complex class I restricted cytotoxic T lymphocytes were generated by stimulation with DCs cocultured with pCC. In prior studies for human carcinomas coculture techniques were described to be inferior. In contrast, our data strongly suggest that at least for human pCC and autologous DCs this simple coculture method is similarly efficient compared to established fusion techniques.

Morphometric parameters of the radial neck: an anatomical study

INTRODUCTION

The purpose of this study was to describe the anatomy of the intramedullary canal of the radial neck for stem design of radial head prostheses.

METHODS

Radial neck measurement was performed from the proximal edge of the radial tuberosity to the distal border of the articular surface on 40 macerated proximal radii using X-rays and Optosil imprints of the intramedullary canal. Radial neck to shaft angle was measured under image intensification.

RESULTS

The neck length was 13.3 mm (range 8.0-20.0 mm) measured on X-rays and 13.5 mm (range 9.9-18.8 mm) on Optosil imprints. Concerning the neck's intramedullary canal we obtained a minimum diameter of 9.7 mm (range 6.3-16.4 mm) on X-ray. Corresponding Optosil imprints had a mean diameter of 11.6 mm (range 6.6-18.6 mm) at their proximal end, 10.5 mm (range 5.5-16.3 mm) in the middle and a minimum of 9.8 mm (range 6.0-16.9 mm) at the distal end. Differences between left and right sides were not significant between X-ray and Optosil imprints, nor between left X-ray and right imprints and vice versa at a P-level of 0.001. Radial neck to shaft angle was 167.8 degrees (range 160.5-178 degrees ) measured under image intensification at a rotation angle of 58.6 degrees (range 50-70 degrees ) supination.

CONCLUSION

Geometry of the radial neck's intramedullary canal has been described for stem design. The minimum diameter was seen at the distal end, just proximal to the radial tuberosity. A forearm rotation of 58.6 degrees to full supination should be considered during implantation of monopolar prostheses. The wide variety of lengths and diameters complicates standard prosthetic design, but ipsilateral and contralateral X-rays can be useful for preoperative stem size calculation.

Morphometric parameters of the radial head: an anatomical study

INTRODUCTION

Exact anatomical description of the proximal radius is imperative for the development of radial head prostheses. The purpose of this study was to measure the anatomical parameters of the radial head.

METHODS

Optosil imprints of 18 pairs of proximal radii fixed with formalin were taken. All possessed their native cartilage joint surface free of any arthritic defects. After being cut into 3 mm slices, the diameter of each slice was measured in steps of 30 degrees of rotation with the margo interosseous acting as a reference point.

RESULTS

Maximum radial head diameter was seen from the 0 to the 9 mm slice at a rotation of 30 degrees to full supination perpendicular to the proximal radioulnar joint. The diameter increased from the radiocapitular joint surface to the 6 mm slice, and then it decreased (P < 0.001). At the level of 6 mm the maximum radial head diameter was 24.13 mm (range 21.2-27.3 mm). The minimum diameter was seen perpendicular to the maximum; it also increased from the radiocapitular joint surface to the 6 mm slice and then decreased. There was a significant difference between the minimum and maximum diameter of each slice at a P-level of P < 0.001. Left and right sides were not significantly different at a P-level of 0.01.

CONCLUSION

Our data show that the radial head is neither round nor conical. It has a complex shape with an increasing size from the radiocapitular joint surface to the middle of the proximal radioulnar joint surface. No statistically significant differences could be observed between right and left radii.

Reconstruction of Mason type-III and type-IV radial head fractures with a new fixation device: 23 patients followed 1-4 years

BACKGROUND

Treatment options in radial head fractures of Mason types III and IV range from open reduction and internal fixation (ORIF) to radial head resection with or without prosthetic replacement.

PATIENTS

In a prospective study, the radiographic and clinical outcome was evaluated in 23 patients (age median 51 years) with 23 complex radial head fractures median 2 (1-4) years after ORIF using a new fixation device (FFS; Orthofix). 14 Mason type-III fractures with 2 concomitant olecranon fractures and 1 ulnar nerve lesion, and 11 type-IV fractures with 2 olecranon fractures and 2 fractures of the coronoid process were treated. 2 patients were lost to follow-up. In 7 cases of joint instability, an elbow fixator with motion capacity was applied after ORIF of the radial head.

RESULTS

No radial head resection was necessary. No secondary dislocations or nonunion occurred. The Morrey elbow score was excellent in 8 and good in 4 Mason type-III fractures and excellent in 5, good in 3, and fair in 3 Mason type-IV fractures.

INTERPRETATION

Reconstruction of comminuted radial head fractures can be performed with this device and radial head resection can be avoided.

Duodenal somatostatinoma: clinical and immunohistochemical patterns--difficult differential diagnosis in regard to gangliocytic paraganglioma: report of a case

The authors report a large duodenal somatostatinoma, a very rare tumor entity. A 8.5 cm globular mass in the area of the unicate process of the pancreas was detected in a 45 year old caucasian female by computerized tomography. The patient had only mild complaints. Initial treatment consisted of right pancreatectomy with preservation of the pylorus. Histological evaluation rendered a diagnosis of low-grade malignant neuroendocrine carcinoma with expression of somatostatin, respectively of somatostatinoma arising in the duodenum and infiltrating into the pancreas. 26 months after the initial surgery liver and lymph node metastases were detected and surgically removed. This case confirms that duodenal somatostatinomas are very difficult to diagnose preoperatively because of unspecific symptoms. Most duodenal somatostatinomas are found incidentally. Treatment of choice is radical surgical resection with a possible cure in early stages of the disease. Even a large tumor as ours is resectable with negative surgical margins. Management of recurrent or metastatic disease is also surgical. Additional chemotherapy and supportive care may be beneficial for the patient.

Ultrasonographic stress test of the metacarpophalangeal joint of the thumb

The purpose of this study was to evaluate functional ultrasound as a tool for detecting an ulnar collateral ligament injury of the thumb. The feasability of using ultrasound for imaging the thumb joint space was tested in a pilot study, using ultrasound and dissection in 14 cadaveric hand specimens. To test this method clinically, both metacarpophalangeal joints of the thumb in 461 healthy volunteers were examined using ultrasound (11 MHz) under radial stress. The distance between the innominate tubercle of the first metacarpal head to the proximal phalanx was measured. The mean distance between the first metacarpal head and the proximal phalanx (n = 461) was 4.5 mm (standard deviation, 0.65 mm) on the right side and 4.6 mm (standard deviation, 0.61 mm) on the left side. These data were compared with data of 25 patients with an operative diagnosis of rupture of the ulnar collateral ligament of the thumb. The difference in joint space between the injured and uninjured sides was 2.25 mm (standard deviation, 0.46 mm). The metacarpophalangeal joint space can be reproducibly detected on high-frequency ultrasound. An increased gap seen on ultrasound is indicative of a rupture of the ulnar collateral ligament of the thumb.

Immunomagnetic enrichment and detection of micrometastases in colorectal cancer: correlation with established clinical parameters

PURPOSE

Micrometastatic disease in bone marrow is of prognostic significance in colorectal cancer patients. However, detection rates of standard immunocytology are relatively low. We used magnetic activated cell sorting (MACS), a highly sensitive method, to increase detection rates and correlated the presence of cytokeratin (CK)-expressing cells with clinical parameters.

PATIENTS AND METHODS

Bone marrow was obtained from 51 consecutive patients with newly diagnosed colorectal adenocarcinoma who underwent primary surgery and 18 control subjects. International Union Against Cancer (UICC) stage I disease was diagnosed in 11 patients, stage II disease was diagnosed in 14 patients, stage III disease was diagnosed in 12 patients, and stage IV disease was diagnosed in 14 patients. CK-positive cells were enriched and stained with magnetically labeled CAM 5.2 antibodies directed to CK 7 and 8.

RESULTS

CK-positive cells were found in 33 (65%) patients and were absent in 18 (35%). Four of 11 (36%) patients with UICC stage I disease, nine of 14 (64%) with stage II diease, eight of 12 (67%) with stage III disease, and 12 of 14 (86%) with stage IV disease were CK-positive. Epithelial cells were more frequently found in pT3/4 (72%) than in pT1/2 (36%) tumors (P =.026), but there was no difference for lymph node status. CK-positive patients had a higher chance for elevated carcinoembryonic antigen (85% v 15%, P = NS) and CA 19-9 levels (92% v 8%, P =.019). There were no significant differences in CA 72-4, sex, age, tumor grading, or tumor localization regarding the presence of CK-positive cells. All control subjects were CK-negative.

CONCLUSION

In searching for micrometastases in colorectal cancer patients, we have achieved high detection rates by using MACS. The presence of these cells correlated significantly with tumor stage, tumor extension, and the tumor marker CA 19-9.

[Surgical palliation of pancreatic carcinoma. Results of a 7 year period]

INTRODUCTION

High perioperative complication rates in the 1980s led to preferred use of endoscopic therapy for surgical palliation of pancreatic cancer. This encouraged us to analyse our own patients retrospectively.

MATERIAL AND METHODS

In the period from 1 January 1992 to 31 December 1998, 253 patients with an exocrine carcinoma of the pancreas were operated on at the St. Elisabeth Hospital Cologne-Hohenlind: 73 patients (28.9%) underwent curative resection (R0) while 180 patients (71.1%) had palliative operative treatment (R1/R2). Palliative resection was performed in 22 patients (8.7%). Intestinal bypass surgery was done in 113 patients (44.7%) as a gastrojejunostomy and in 16 patients (6.3%) as a duodenojejunostomy. A biliodigestive anastomosis was performed in 85 patients (33.6%). This procedure was combined with a gastroenterostomy in 78 patients (30.8%). In 18 patients (7.1%) no surgical palliation was possible and the operation finished as a diagnostic laparotomy.

RESULTS

The overall mortality rate within the first 30 (60) days was 5.5% (12.7%). Patients whose carcinoma had been resected curatively had a 30 (60)-day mortality rate of 2.7% (4.1%), compared to a rate in palliatively treated patients (resection/bypass/probatoria) of 6.7% (16.1%). Patients with palliatively resected tumor had perioperative mortality of 4.5% (4.5%), whereas patients who did not undergo resection had 6.9% (17.7%). The survival rate for curatively resected patients after Kaplan-Meier extrapolation was 64.7% after 1 year and 31.2% and 26.2% after 3 and 5 years, with a median survival time of 552 days. Palliatively operated patients had a survival rate of 19.4%, 2.5% and 0% for 1, 3 and 5 years. Median survival time was 171 days in this situation. Compared to patients without resection (17.4% and 2.0%), patients with palliative resection had survival rates for 1 and 3 years of 40% und 5.9%. After 5 years none of these patients were alive.

CONCLUSIONS

Our data show a high success of surgical palliation in pancreatic cancer in centers with a high frequency of pancreatic surgery. Patients that could not be cured (R1/R2), although undergoing extensive procedures, had better survival rates than patients treated with bypass surgery. Perioperative mortality rate was comparatively low. This justifies aggressive surgical management of pancreatic carcinoma.

Two cases of colorectal cancer complicating Crohn's disease and review of the literature

Two cases of colorectal carcinoma complicating Crohn's disease are reported and the relevant literature is reviewed. It is important to be aware of this increasing complication and the specific group of patients at risk. Special attention to possible malignant transformation could lead to earlier diagnosis and treatment.

Rounded atelectasis in a patient with history of asbestos exposure. A case report

We report a case of a 68-year-old patient with a history of chronic asbestos exposure and a lung tumour, highly suspicious for bronchial carcinoma. The patient underwent left lower lobectomy and histology showed the rare diagnosis of rounded atelectasis. Rounded atelectasis is an important differential diagnosis to bronchial carcinoma.