Effect of total mesorectal excision on the outcome of rectal cancer after standardized postoperative radiochemotherapy: do randomized studies translate into clinical routine?

Purpose: To compare local control, disease-free survival and overall survival after postoperative radiochemotherapy with or without total mesorectal excision (TME) in a retrospective analysis.

Patients And Methods: Between 1993 and 2002, 103 patients with UICC stage II and III rectal cancer were treated by surgery and postoperative chemoradiation. Group B (n = 50; 1993-1998) were operated before TME era without using TME and group A (n = 53; 1998-2002) with TME; both groups received identical radiochemotherapy to a total dose of 50.

[Specificity of "combi-effect" after xenogenic discordant heart-lung transplantation].

Unlabelled: The purpose of this study was to investigate whether the "Combi-Effect" is specific for the transplanted lung tissue or not.

Method: In a Guinea-pig to rat model we compared the heterotopic heart-lung transplantation (HLTx, n = 5) with a second heart transplantation (DHTx, n = 5) and a combined heart-kidney transplantation (HKTx, n = 5). Apart from the heart transplant survival time we determined the concentrations of histamine, CH-50, IgG, IgM, leucocytes and thrombocytes in the blood.

[Difficult diagnosis: acute appendicitis and appendiceal/cecal carcinoma].

Introduction: Primary carcinoma of the appendix vermiformis/caecum is very rare. The diagnosis can often be ascertained only postoperatively by histopathological means. Preoperative diagnosis is unusual.

Simultaneous analysis of 4- and 5-series lipoxygenase and cytochrome P450 products from different biological sources by reversed-phase high-performance liquid chromatographic technique.

Quantification of lipoxygenase and cytochrome P450 products of both arachidonic acid (AA) and eicosapentaenoic acid (EPA) is of broad interest due to the multiple biological activities of these compounds. We developed a method combining (i) solid-phase extraction, (ii) isocratic reversed-phase high-performance liquid chromatographic separation, and (iii) online photodiode array detection with spectrum analysis for identification and measurement of all main 4- and 5-series eicosanoids (leukotrienes, hydroxyeicosatetraenoic acids/hydroxyeicosapentaenoic acids, epoxyeicosatrienoic acids) within one run. With these procedures, standard mixtures of AA- and EPA-derived lipid mediators were recovered from different biological liquids, like lung perfusate, human bronchoalveolar lavage fluid, and cell supernatant with linear characteristics for each compound.

[Persistent chylothorax after fracture of the 12th thoracic vertebrae].

We report on a patient who suffered chylothorax 2 months after she had undergone internal fixation of a fracture of her 12th thoracic vertebral body. The pleural effusion was treated by insertion of a chest tube. The chylothorax was managed conservatively.

[Use of preoperative infusion cholangiography before laparoscopic cholecystectomy].

In the present study, we intend to evaluate whether intravenous cholangiography, performed on a routine basis in the preoperative period, in addition ultrasonography, history or elevations of serum bilirubin and alkaline phosphatase, provides any supplementary information in detecting patients with asymptomatic calculi in the common bile duct before laparoscopic cholecystectomy is carried out. Therefore, 513 patients were included in a retrospective analysis. From our data, we conclude that preoperative intravenous cholangiography cannot be recommended, when costs and risks and a potential benefit for the patient are considered.

[Traumatic bronchus rupture. Pathogenesis, surgical and postoperative management].

Tracheobronchial injuries are rare and associated with other injuries. We report about a traumatic rupture of the left main bronchus into the segmental bronchus of the lower lobe. After resection of the lower lobe a bronchoplastic repair of the main and upper bronchus was performed.

[Value of systematic lymphadenectomy in stomach carcinoma].

In a retrospective study of 157 patients undergoing a curative resection of a gastric carcinoma between 1982 and 1992 the correlation of the lymph node status and histomorphologic parameters of the gastric cancer and the significance of the systematic lymphadenectomy were analysed. The patients were divided into two historical groups (exclusively D1- and systematic D1-/D2-lymphadenectomy). Among the histomorphological parameters only the depth of infiltration (pT) revealed a high correlation with the extent of metastatic lymph node involvement.

[The importance of mediastinoscopy for accurate lymph node staging].

The mediastinoscopy (MS) was developed 1959 by Carlens. Since the introduction of computertomography (CT) in the diagnostic of the thorax the MS was no longer used routinely. Because of the introduction of the CT in our clinic we performed only 111 MS between 1981 and 1992, in contrast to 185 MS between 1976 and 1981.

[Value of inguinal lymph node excision in anorectal melanoma].

The anorectal melanoma is a tumor with an unfavorable prognosis. The surgical removal is the therapy of choice. In the literature the different surgical centers suggest either local excision of the tumor or a more radical surgical procedure, the abdominoperineal resection either with or without inguinal and parailiacal lymph node dissection.

[Preventive lymph node excision in the treatment concept of melanoma of the extremities].

Since 1979, our treatment protocol for extremity melanoma includes regional lymph node dissection, wide tumor excision and hyperthermic limb perfusion. We report on the results of a follow-up of the 451 patients treated in the first decade. 58.

[Isolated echinococcosis of the lung].

This is a report of a 81 year old women with a cyst of echinococcus granulosus, that was almost completely taking over the lower lobe of the left lung. This case study shows on one hand the diagnosis of echinococcosis is a part of the differential diagnosis even for an elderly patient. On the other hand we were able to demonstrate, that elderly patients can benefit from the surgical treatment especially since medication has a lot of side effects and a fairly high rate of failures.

[Use of an endoscopic stapler for transanal widening of anastomotic stenosis].

Postoperative anastomotic stenosis of the colorectal region are reported in 0.5-13%. We present one patient with a benign anastomotic stenosis after resection of the sigmarectum who was treated using the linear cutter Endopath ELC 35.

[Congenital tracheoesophageal fistula in the adult].

Congenital esophago-tracheal and esophago-bronchial fistulae are rare. Symptoms are recurrent pneumonia, cough, dysphagia and pain. The diagnosis is made by bronchoscopy or esophagoscopy.

[Surgical treatment of tracheal injuries].

Traumatic and iatrogenic injuries of the trachea are rare. In case of suspected rupture of the trachea a bronchoscopy remains the 'gold standard' of diagnostic procedures. The injuries should be repaired as soon as possible through a right thoracotomy or a collar incision using resorbable sutures.

[Follow-up of heterotopic autotransplantation of splenic tissue after traumatic splenic rupture in childhood].

Children and adolescents, who received an autologous reimplant of the spleen because of traumatic injury between 1979 and 1986 were matched to a cohort of patients, splenectomized because of traumatic injury of the spleen as well and to a control group of healthy age matched individuals. In addition to a physical check-up, markers of humoral and cellular immunity (e.g.

[Localized benign pleural mesothelioma].

Benign mesothelioma of the pleura is a very rare tumor. The cells responsible originate from either the mesothelium or the submesothelium. This is why such tumors are described in the literature as fibroma of the pleura, mesothelial fibroma, localized fibrous mesothelioma and monophasic spindle cell tumor.

[Amelanotic melanoma of the rectum].

We report the very rare case of an amelanotic anorectal melanoma. Until now there are only three other well documented cases of that tumor-type reported in the literature. The course of disease is described from initial symptoms till 10 months after discharge from hospital and suggestions for staging, therapy and follow-up are made.

[Surgical treatment and regional chemotherapy in melanoma of the extremities].

Since 1979, our treatment protocol for extremity melanoma includes wide local excision, regional lymph node dissection and hyperthermic limb perfusion. We report on the results of a follow-up of the patients treated in the first decade (n = 451). According to the UICC Classification of 1987, 4% of our patients were in stage I, 36% in stage II, 50% in stage III and 9% in stage IV.

[Pancreatic pseudocysts after blunt abdominal trauma].

Pancreatic pseudocyst caused by trauma is rare. Only in 5 of 98 patients on whom we operated between 1977 and 1991 for pancreatic pseudocyst were we able to detect previous blunt abdominal trauma. In a 4-year-old girl just a slight abdominal trauma had given rise to a cyst, while in 2 other patients (aged 9 and 26 years) pancreatitis occurred after trauma that was treated medically.

[Palliative therapy of primary liver tumors].

In Europe and North America, primary liver tumors are rare. Resection is the only means of cure, but is possible in only 20-30% of the patients affected, so that in all other patients, i.e.

Intraabdominal infections: classification, mortality, scoring and pathophysiology.

Studies on intraabdominal infections have been difficult to compare in the past due to a missing system of classification for peritonitis. According to a recently developed classification system, secondary peritonitis, including spontaneous acute peritonitis, postoperative peritonitis and posttraumatic peritonitis, is the most common complication of severe intraabdominal infections. In several studies the mortality rate of postoperative peritonitis was still between 60% and 79%.

[Adamantinoma of the fibula--follow-up study].

A case of the adamantinom of the fibula has been reported. The tumor was resected six years ago. The yearly follow-up showed no sign of a relapse or metastases.