The role of growth factors in proliferation and invasion of thyroid cancer.

A growing literature has established the close association between tumor progression and growth regulatory aberrations in cancer cells. Most studies have focused on the phenomenon, that advanced tumors or metastases have lost the sensitivity to growth inhibitors. Metastasis are the primary cause of death in patients with differentiated thyroid cancer.

[Rehabilitation of patients with alcoholic liver cirrhosis after orthotopic liver transplantation: a 7-year follow-up].

Alcoholic liver cirrhosis is the main indication for orthotopic liver transplantation. Since 1988, 52 patients with alcoholic liver cirrhosis have been transplanted at the Department of Surgery of the University of Heidelberg. The survival rates are as follows: 73% of the patients survived for 1 year, 68% for 2 and 3 years, 64% for 4 years, and 57% survived for 5 years.

[Computer-based training--a new method in surgical education and continuing education].

Computer-based training (CBT) programs teach the material of a specific field and at the same time offer various ways of objectively checking the knowledge gained. The interactive use of multimedia components, such as text, graphics, animation, sound, digital slide shows, videos and quizzes, facilitates the learning process. The aim of this study was the development and evaluation of a CBT program for use by surgeons teaching students.

[Significance of diagnostic imaging for determining surgical indications in solid liver tumors].

Radiological imaging is essential for the differential-diagnostic appraisal and the assessment of size, number, and localization of neoplastic liver lesions. The results determine the decision for or against operation and the surgical strategy. Moreover, oncological contraindications against surgery are recognized by imaging procedures.

[Mutations of ret-proto-oncogene in thyroid medullary carcinoma].

Objective: To determine the importance of the molecular-genetic demonstration of germ-line mutation in the ret protooncogene for therapeutic measures in sporadic and hereditary medullary thyroid carcinoma (MTC).

Patients And Methods: Several molecular-genetic tests were performed on DNA of 35 families with hereditary and 81 patients with the sporadic form of MTC (isolation of genomic DNA; PCR amplification; DNA sequencing: demonstration of mutation in codon 918 with restriction enzyme FOK 1).

Results: A disease risk was demonstrated in 178 individuals among the 35 families, 159 of whom were investigated by molecular-genetic tests: 84 family members were found to be gene carriers.

[Transtracheal monitoring of the recurrent laryngeal nerve. Prototype of a new tube].

A new sensing device for the continuous intraoperative monitoring of the recurrent laryngeal nerve is presented. It is based on a double ballooned endotracheal tube including stimulating and tracing electrodes. The system is characterised by three advantages: 1) it is atraumatic, 2) it is operating completely outside the operating field (extraterritorially), 3) nerve function is being monitored continuously from the time of intubation to the time of extubation.

[Outcome of surgical therapy in asymptomatic primary hyperparathyroidism].

Surgery for symptomatic hyperparathyroidism remains the standard therapy. Asymptomatic primary hyperparathyroidism (pHPT) is being diagnosed with increasing frequency owing to broad serum testing. Indications for surgery in this setting are controversial.

[Calcium metabolism after thyroidectomy with modified radical neck dissection and parathyroid gland autotransplantation].

The issue of parathyroid autotransplantation in oncologic thyroid surgery is discussed controversially. In a series of 15 patients who underwent bilateral modified radical neck dissection for thyroid malignancy, parathyroid autotransplantation was carried out. Six months after surgery only one patient was hypoparathyroid, requiring permanent medication, thus autotransplantation is a safe procedure for the prevention of accidental hypoparathyroidism.

[Prevention of hepatitis B--analysis of cost-effectiveness after liver transplantation].

HBV recurrence, despite immunoprophylaxis which occurred in 67% of our patients, remains the main problem following liver transplantation for HBV infection. Pretransplant viral replication (HBV-DNA) and probably viral mutation may account to some degree for the failures involved in hyperimmunoglobulin prophylaxis. In order to improve the cost/benefit relationship, only HBV-DNA and HBeAG-negative patients should be selected or preoperatively seroconverted by nucleosides (famciclovir, lamivudine); post-operatively a variable HIG prophylaxis should be administered.

[European topic--multimodal therapy concept in gastrointestinal tumors--colorectal carcinoma].

Current knowledge of adjuvant treatment of colonic cancer demonstrates the influence of the quality of surgery per se on the oncological therapeutic outcome. The influence of the tumour stages is equivocal. Chemotherapy (perhaps vaccination treatment) exerts influence in Stage III and potentially in Stage IV.

[Use of information systems for direct surgical patient management].

The aim of this prospective study was to evaluate the use of a modern computer-based hospital information system for the management of patients in our surgical department. The results showed that the information system was well accepted by the medical staff and found to be useful throughout daily work. In addition, they justify the effort to install and maintain such a system.

[Endosonography, CT and MRI in the diagnostic concept of rectal carcinoma].

The stage-adapted operative treatment of rectal cancer in the context of adjuvant therapy regimes necessitates accurate and, in times of diminishing financial resources, cost-effective preoperative staging. From January 1988, 424 patients with rectal cancer were examined by endosonography. In the same period 28 additional patients were staged by hydro-CT within a prospective study as the endorectal sonography probe could not be passed through the tumor stenosis.

[Molecular diagnosis and therapy in surgery].

Efficiency and economy is surgical research exemplified in molecular diagnostics and therapy must be looked upon from two view points: 1.) The efficiency of molecular diagnostics is relatively easy to assess. It is more difficult to prove the therapeutic consequences of new knowledge.

Results and follow-up in eleven MEN 2A gene carriers after prophylactic thyroidectomy.

In 11 MEN 2A gene carriers prophylactic thyroidectomy was carried out between the age of 4 to 17 years. All gene carriers had pathological basal and/or pentagastrin stimulated serum calcitonin levels. On histological examination in five patients C-cell hyperplasia (CCH) and in 6 patients medullary microcarcinoma (< 1 cm, mostly multifocally) was shown.

[ICPM-independent documentation of new reimbursement forms--method and 1995 results].

The structural health care law (known as the Gesundheitsstrukturgesetz or GSG) of the Federal Republic of Germany has been enacted to replace the covering cost prices by various forms of payment. On the basis of the Godesberg Diagnosis and Therapy Catalogue, a new system has been developed that assesses all new implications of the care benefit law. With the help of intelligent plausibility tests, a particular case (PC) or a special rate (SR) is suggested.

[Endosonographic diagnosis in preoperative radiotherapy of locally advanced rectal carcinoma].

Endorectal ultrasound (EUS) is important for the indication of preoperative radio(chemo)therapy of locally advanced rectal carcinomas. Preoperative radio(chemo)therapy causes an increased echogenity of the ultrasound, which histologically corresponds with increased fibrosis. After preoperative radio(chemo)therapy, the accuracy rate of EUS of tumor infiltration depth (T) and lymph-node status (N) is 75% compared with postoperative histology.

[Results of isolated hyperthermic extremity perfusion in soft tissue sarcomas within the scope of a multimodality treatment concept].

Soft-tissue sarcomas (STS) of the extremities are characterized by a high rate of local recurrences. Limb salvage approaches using multimodality therapy protocols have replaced amputation. In order to evaluate isolated hyperthermic limb perfusion (ILP) in a multimodality therapy concept, we reviewed our patients treated using this method.