Results of a randomised controlled trial between an ORC collagen hemostatic agent and a carrier-bound fibrin sealant.

Introduction: Despite ongoing optimisation of surgical techniques, hemostasis continues to be a fundamental challenge in many operations today. This randomised controlled trial compared the efficacy of a new hemostatic agent made of oxidised regenerated cellulose and collagen (ORC-Coll) with that of a conventional carrier-bound fibrin sealant (CBFS).

Methods: Hemostasis was investigated representatively in the case of post-thyroidectomy bleeding from the resection surface.

The significance of collagen dressings in wound management: a review.

Clinical experience and research has improved our understanding of wound healing which, in turn, has enabled health professionals to aid wound healing and manufacturers to develop modern wound dressings. The significant role of collagen in wound healing has led to the development of numerous products on the basis of this biological material. The main focus of this review is to provide a critical appraisal of publications about collagen and acellular collagen dressings with a fleece-like or spongy structure.

[Reconstruction of the Bile Duct with the Umbilical Vein after Laparoscopic Cholecystectomy].

Roux-Y hepaticojejunostomy is currently the standard surgical procedure for the reconstruction of the bile duct after iatrogenic transection in laparoscopic cholecystectomy. However, about 30 % of all hepaticojejunostomies develop a stenosis after some time and in 7 % a cholangiocellular carcinoma occurs. Therefore, alternative procedures have been investigated.

Prognostic and predictive value of circulating tumor cell analysis in colorectal cancer patients.

Objective: The aim of this study was to assess the prognostic and predictive values of circulating tumor cell (CTC) analysis in colorectal cancer patients.

Patients And Methods: Presence of CTCs was evaluated in 60 colorectal cancer patients before systemic therapy--from which 33 patients were also evaluable for CTC analysis during the first 3 months of treatment--through immunomagnetic enrichment, using the antibodies BM7 and VU1D9 (targeting mucin 1 and EpCAM, respectively), followed by real-time RT-PCR analysis of the tumor-associated genes KRT19, MUC1, EPCAM, CEACAM5 and BIRC5.

Results: Patients were stratified into groups according to CTC detection (CTC negative, when all marker genes were negative; and CTC positive when at least one of the marker genes was positive).

Development of a molecular multimarker assay for the analysis of circulating tumor cells in adenocarcinoma patients.

Background: The analysis of circulating tumor cells (CTCs) is emerging as a promising diagnostic tool in oncology. However, even if a variety of methods for CTC isolation have been already developed, their specificity and/or sensitivity still remain problematic. The aim of this study was to develop an immunomagnetic/real-time reverse transcription polymerase chain reaction (RT-PCR) assay for the molecular detection of circulating tumor cells (CTCs) in peripheral blood (PB) of adenocarcinoma cancer patients.

Endoscopic ultrasound-guided endoscopic necrosectomy of the pancreas: is irrigation necessary?

Background: Findings have shown endoscopic necrosectomy to be beneficial for patients with symptomatic pancreatic necrosis accessible for an endoscopic approach. The available studies show that endoscopic necrosectomy requires a multitude of subsequent procedures including repeat irrigation for removal of the necrotic material. This study aimed to investigate the need for additional irrigation in patients with necrotizing pancreatitis treated by endoscopic necrosectomy.

Multicenter pilot study of 5-fluorouracil, folinic acid, interferon alpha-2b and degradable starch microspheres via hepatic arterial infusion in patients with nonresectable colorectal liver metastases.

Background: It is necessary to establish therapeutic regimens for patients with nonresectable hepatic metastases of colorectal carcinoma. A new regional chemotherapy regimen was tested in a prospective study in three centers.

Patients And Methods: An arterial port system was implanted in 95 patients.

[Characteristics of appendicitis in patients over 70 years of age].

Chart review of our patients who were operated for acute appendicitis was performed to characterize the appendicitis in the elder patients. Celiotomy revealed perforation of the appendix in almost 40%, frequently in patients with unspecific symptoms and no leucocytosis. While mortality was 9.

Minimally invasive catheter implantation for regional chemotherapy of the liver: a new percutaneous transsubclavian approach.

Purpose: Development of a percutaneously implantable catheter system for regional chemotherapy of liver metastases and its application in patients with surgically implanted but dislocated catheters.

Methods: Thirty-three patients with liver metastases of colorectal tumors were submitted to percutaneous puncture of the subclavian artery and insertion of a catheter whose tip was placed in the proper hepatic artery and whose end was subcutaneously connected with an infusion pump.

Results: The mean duration of therapy via the percutaneously inserted catheter was 27 weeks (+/-14 weeks).

Detection of focal liver lesions: CT of the hepatobiliary system with gadoxetic acid disodium, or Gd-EOB-DTPA.

Purpose: To evaluate the efficacy and safety of gadoxetic acid disodium, or Gd-EOB-DTPA, as a tissue-specific hepatobiliary contrast agent at computed tomography (CT) in patients with liver metastases.

Materials And Methods: Fifteen patients with known liver metastases underwent CT before and at 30, 80, and, in seven cases, 150 minutes after initiation of intravenous infusion of 0.2, 0.

[The fully implantable minimally invasive hepatic artery catheter for locoregional chemotherapy of nonresectable liver metastases in defective conventional implanted therapy catheters].

Dysfunction of arterial access devices used in association with intra-arterial chemotherapy for the treatment of unresectable liver metastases usually requires stopping the therapy or relaporotomy and reimplantation of a new arterial catheter. In this article our initial experience of a new technique, the so-called MIAH catheter (minimally invasive hepatic artery catheter) in 36 patients (age 37-78 years) are reported. The MIAH catheter was percutaneously inserted into the subclavian artery under sonographic guidance and advanced via the descending aorta selectively into the hepatic artery.

Surgical therapy of gastrointestinal non-Hodgkin's lymphomas.

Within a period of 13 years 39 patients underwent surgery for primary gastrointestinal non-Hodgkin's lymphoma. The stomach was the most frequent site of involvement (26 cases) followed by the small intestine (10 cases) and the large bowel (three cases). Operative procedures included: total gastrectomy (n = 19), subtotal gastrectomy (n = 5), partial gastrectomy (n = 2), small bowel resection (n = 7), right hemicolectomy (n = 5) and sigmoid resection (n = 1).

Positive somatostatin receptor scintigraphy correlates with the presence of somatostatin receptor subtype 2.

Somatostatin receptor scintigraphy (SRS) is positive in approximately 75% of all patients with neuroendocrine gastroenteropancreatic tumours. This study aimed to identify specific somatostatin receptor (sstr) subtypes, which are responsible for the in vivo binding of the widely used somatostatin analogue, octreotide in human neuroendocrine gastroenteropancreatic tumours. Twelve patients underwent SRS with radiolabelled octreotide.

Somatostatin receptor subtypes in neuroendocrine tumor cell lines and tumor tissues.

Somatostatin receptor scintigraphy (SRS) is positive in approximately 80% of all patients who have been found to have neuroendocrine (NE) gastroenteropancreatic (GEP) tumors. The reasons for negative results are unclear. The aim of the present study was identification of the specific somatostatin receptor (SSTR) subtypes that are responsible for the in vivo binding of the widely used somatostatin (SST) analogues octreotide and lanreotide in human neuroendocrine gastroenteropancreatic tumors.

[Current treatment strategies in acute distal aortic occlusion].

Forty-eight acute distal aortic occlusions were treated on an inpatient basis from January 1973 to December 1993. The mean age was 66 years. Twenty-seven patients had an acute thrombotic occlusion of the distal aorta, and a cardiogenic embolism was the cause of occlusion in 21 cases.

[Are there prognostic parameters for predicting the success of regional chemotherapy in nonresectable liver metastases of colorectal cancer?].

When compared with systemic therapy, hepatic arterial chemotherapy significantly increases the response rate for hepatic metastases from colorectal carcinomas. However, only 2 studies showed a significant prolongation of survival. In our study on 54 patients tumor related characteristics and the response to regional chemotherapy were correlated to the success of the treatment.

A phase I trial of interferon alpha-2b with folinic acid and 5-fluorouracil administered by 4-hour infusion in metastatic colorectal carcinoma.

Preclinical data suggest that both folinic acid and interferon may enhance the efficacy of 5-fluorouracil (5-FU) in colorectal carcinoma. We therefore initiated a phase I trial evaluating the doses, safety, and pharmacokinetics of the combination of recombinant interferon (IFN) alpha-2b with folinic acid (FA) and 5-FU. Seventeen patients with colorectal cancer who failed local chemotherapy received 5-FU as a 4-hour infusion, preceded by a bolus of FA and IFN.

A phase II trial of interferon alpha-2b with folinic acid and 5-fluorouracil administered by 4-hour infusion in metastatic colorectal carcinoma.

Preclinical data suggest that folinic acid as well as interferon alpha-2b may enhance the antitumor activity of 5-fluorouracil (5-FU). In a phase I trial, we recently showed that interferon alpha-2b (IFN), folinic acid and 5-FU can be safely administered with a 4-hour infusion of 5-FU. We therefore initiated a phase II trial evaluating the efficacy and safety of these three drugs.

Liver tumors: follow-up with P-31 MR spectroscopy after local chemotherapy and chemoembolization.

The authors examined and quantified the changes observed in the phosphorus-31 magnetic resonance (MR) spectra of liver tumors after chemotherapy and chemoembolization to investigate the suitability of P-31 MR spectroscopy for follow-up. A 1.5-T unit was used before and at specific times during therapy to obtain spectra of liver tumors in 10 patients with liver metastases from colorectal carcinoma and two patients with hepatocellular carcinoma.

[Experiences with intraoperative radiotherapy in gastric carcinoma (Berlin method)].

The aim of our pilot study is to determine whether intraoperative radiotherapy in gastric cancer cannot only prevent a local relapse but also improve the survival rate. Since November 1987, 26 patients with resectable gastric cancer were irradiated intraoperatively with the linear accelerator using fast electrons (single dose: 12 to 16 Gy). Percutaneous radiotherapy was performed postoperatively with 24 to 38 Gy (4 x 2 Gy per week).

Combined haemoperfusion, haemofiltration and haemodialysis for systemic detoxification in locoregional 5-fluorouracil therapy.

Combined haemoperfusion, haemofiltration and haemodialysis (HPFD) was examined for its systemic effect on 5-fluorouracil (5-FU) kinetics after locoregional application to one female patient with liver metastases of a colon carcinoma. During each HPFD treatment, which lasted 4 h, 5-FU was given via a port-a-cath system into the hepatic artery on 4 separate days. The HPFD extraction rate was 99%.

[Therapeutic protocols in the treatment of liver metastases].

The liver is the main site for metastatic spread from many cancer, particularly those of the colorectum. Surgical treatment of liver metastases is nowadays a safety therapeutical approach, which has been improved by the development of modern imaging procedures, clear indications and standardized surgical techniques. In carefully selected patients the 5-year survival ranges between 30-40%.