Enhanced postoperative lymphatic staging of malignant melanoma by endoscopically assisted iliacoinguinal dissection.

Radical lymphadenectomy for malignant melanoma continues to be controversial. In order to reduce morbidity but preserve prognostic informations, a minimally invasive technique for the iliac part of dissection was developed. We evaluated the practicability of this intervention under routine conditions as well as its prognostic impact.

[Hiatoplasty reinforcement by means of a lightweight titanized polypropylene mesh fixed with fibrin glue].

Introduction: Suture-based hiatoplasty is associated with a high recurrence rate. Using meshes of different shapes and materials to reinforce these sutures reduces the risk of recurrences. On the other hand morbidity attributable to the suture and tack fixation of these meshes has been observed during the development phase of these techniques.

Rare cause of acute pain in the left upper abdominal quadrant.

We report a case of a 45-year-old man with acute pain in the left upper abdominal quadrant. Extensive diagnostic workup remained inconclusive. An exploratory laparotomy revealed herniation of the entire ascending colon, together with a part of the terminal ileum through the foramen of Winslow into the bursa omentalis.

Development of a time-domain optical mammograph and first in vivo applications.

We have developed a laser-pulse mammograph capable of recording optical mammograms within approximately 3 min by measuring time-resolved transmittance at each of typically 1500 scan positions, 2.5 mm apart. As a first application two patients who have tumors were investigated successfully.

Assessment of the size, position, and optical properties of breast tumors in vivo by noninvasive optical methods.

We present a method for the noninvasive determination of the size, position, and optical properties (absorption and reduced scattering coefficients) of tumors in the human breast. The tumor is first detected by frequency-domain optical mammography. It is then sized, located, and optically characterized by use of diffusion theory as amodel for the propagation of near-infrared light in breast tissue.

Silencing of human ferrochelatase causes abundant protoporphyrin-IX accumulation in colon cancer.

Hemes and heme proteins are vital components of essentially every cell of virtually every eukaryote organism. Previously, we demonstrated accumulation of the heme precursor protoporphyrin-IX (PpIX) in gastrointestinal tumor tissues. To elucidate the mechanisms of PpIX accumulation by quantitative reverse transcriptase-polymerase chain reaction (RT-PCR), we studied expression of the relevant enzymes of the heme synthetic pathway.

Urodynamic outcome of waterjet-assisted total mesorectal excision.

Background: Waterjet dissection has been proposed for total mesorectal excision. The present study investigated its impact on urodynamic function and oncological outcome.

Methods: Thirty patients with rectal cancer were recruited to this prospective study, of whom 25 underwent urodynamic evaluation both before and after surgery.

Magnetic resonance-guided biopsy of suspicious breast lesions with a handheld vacuum biopsy device.

Purpose: To evaluate a handheld vacuum-assisted device system for magnetic resonance image (MRI)-guided breast lesion biopsy.

Material And Methods: In 32 patients, a total of 42 suspicious breast lesions (mean diameter 7.5 mm for mass lesions, 11.

In-vivo tissue optical properties derived by linear perturbation theory for edge-corrected time-domain mammograms.

A valuable method is described to analyze time-domain optical mammograms measured in the slab-like geometry of the slightly compressed female breast with a method based on linear perturbation theory including edge correction. Perturbations in scattering and absorption coefficients were mapped applying a computationally efficient point model.

Scanning time-domain optical mammography: detection and characterization of breast tumors in vivo.

Optical mammography is one of several new techniques for breast cancer detection and characterization presently under development for clinical use that provide information other than morphologic, in particular on the biochemical and metabolic state of normal and diseased tissue. In breast tissue, scattering of red to near infrared (NIR) light dominates absorption and NIR light may penetrate several centimeters through the breast. Optical mammography avoids the use of ionizing radiation and offers the power of diffuse optical spectroscopy.

Comparison of two tricarbocyanine-based dyes for fluorescence optical imaging.

Optical technologies are evolving in many biomedical areas including the biomedical imaging disciplines. Regarding the absorption properties of physiological molecules in living tissue, the optical window ranging from 700 to 900 nm allows to use fluorescent dyes for novel diagnostic solutions. Here we investigate the potential of two different carbocyanine-based dyes fluorescent in the near infrared as contrast agents for in vivo imaging of subcutaneously grown tumours in laboratory animals.

Reconstruction of optical properties of phantom and breast lesion in vivo from paraxial scanning data.

We report on the reconstruction of absorption and reduced scattering coefficients of breast tissue in vivo of a patient with mastopathic disease. Distributions of times of flight of photons through the compressed breast were recorded by paraxial scanning. From data measured at four different source-detector offsets optical properties were reconstructed within the linear Rytov approximation by a fast inverse Fourier space method.

Time-domain scanning optical mammography: I. Recording and assessment of mammograms of 154 patients.

Using a triple wavelength (670 nm, 785 nm, 843/884 nm) scanning laser-pulse mammograph we recorded craniocaudal and mediolateral projection optical mammograms of 154 patients, suspected of having breast cancer. From distributions of times of flight of photons recorded at typically 1000-2000 scan positions, optical mammograms were derived displaying (inverse) photon counts in selected time windows, absorption and reduced scattering coefficients or total haemoglobin concentration and blood oxygen saturation. Optical mammograms were analysed by comparing them with x-ray and MR mammograms, including results of histopathology, attributing a subjective visibility score to each tumour assessed.

Palliation of malignant rectal obstruction with self-expanding metal stents.

Background: Surgical management of patients with metastatic or recurrent rectal cancer remains controversial. Self-expanding metal stents are increasingly used for palliative treatment of advanced tumors, although long-term results are not yet available.

Methods: Between 1996 and 2003, 521 patients underwent surgery for rectal neoplasms.

[Increasing abdominal pain caused by abdominal tumor in a 21-year-old female].

Lymphangiomas are congenital malformations which occur mostly in the neck and head region of children. They are rarely located in the mesenterium or retroperitoneum in adults. We present a case of mesenteric cystic lymphangioma in a young woman who was admitted to hospital with a history of increasing abdominal pain.

Treatment of thoracic anastomotic leaks after esophagectomy with self-expanding plastic stents.

Objective: To evaluate the efficacy of a self-expanding plastic stent in the treatment of thoracic leaks after esophagectomy for cancer.

Summary Background Data: Anastomotic leaks are a major cause of morbidity and mortality after esophageal resection. Treatment options range from aggressive surgery to conservative management, but there remains much controversy on the best treatment.

Concentration and oxygen saturation of haemoglobin of 50 breast tumours determined by time-domain optical mammography.

Using a dual-wavelength (670 nm, 785 nm) time-domain scanning instrument we have recorded optical mammograms of 93 patients suspected of having breast cancer which was subsequently assessed histologically. Among 65 histologically confirmed carcinomas, 54 were detectable in at least one of two optical mammograms recorded of each tumour-bearing breast in craniocaudal and mediolateral projection. Optical mammograms were based on photon counts in selected time windows of measured distributions of times of flight of photons.

New concepts of staging in gastrointestinal tumors as a basis of diagnosis and multimodal therapy.

The therapy of gastrointestinal tumors is becoming more and more sophisticated and complex. This is due to an improved understanding of the pathogenesis of tumors, a more detailed classification and increasing therapeutic options. The basis of optimized therapeutic concepts is the exact evaluation of tumor spread and exact staging.

Time-domain optical mammography: initial clinical results on detection and characterization of breast tumors.

Mammograms of 35 patients suspected of breast cancer were taken along craniocaudal and mediolateral projections with a dual-wavelength scanning laser pulse mammograph measuring time-resolved transmittance. Among 26 tumors known from routine clinical diagnostics, 17 tumors were detected retrospectively in optical mammograms. Effective tumor optical properties derived from a homogeneous model were used to deduce physiological information.

Outcome analysis of 189 consecutive cancer patients referred to the intensive care unit as emergencies during a 2-year period.

The referral of critically ill cancer patients to an intensive care unit (ICU) is a matter of controversial debate. This study was conducted by an interdisciplinary clinical group to evaluate the outcome of ICU treatment in cancer patients according to their characteristics at the time of referral. A retrospective analysis was used to identify relevant subgroups among 189 consecutive cancer patients referred as emergencies to one of four ICUs during a 2-year period.

Surgery, surgical education and surgical diagnostic procedures in the digital era.

Computers have quickly proven to be an essential part of routine, everyday clinical work. New disciplines are being developed: telesurgery (surgery at a distance), computer- and robotic-aided surgery, image-guided surgery, medical teleconsultations, postoperative telefollow-up, etc. What are the future directions of computer-aided medicine? The digital revolution in medicine, which we are currently witnessing, is leading towards the development of new surgical treatment modalities, toward surgical simulation and improved surgical teaching.