[Comparative diagnosis of locally advanced rectal carcinoma after preoperative therapy].

Locally advanced rectal carcinomas were increasingly treated by preoperative combined radiochemotherapy. Alterations of the rectal wall and the lymph nodes that were caused by the treatment make the assessment of the success of the therapy during the preoperative staging extremely difficult. Methods such as endorectal ultrasound, CT and MRI used for the estimation of the depth infiltration of the tumor achieved an exactness of only approximately 50%.

[Telecommunication in routine surgical practice].

In an internal inquiry on the use of telecommunication, 267 operations were documented. In 62 cases an interruption was necessary: 43 of them for a second opinion and 29 for a new orientation resulting from findings, and in 10 cases for both. A purely verbal communication/consultation was sufficient in 8 cases, in 29 questions an on-site demonstration was necessary to come to a decision.

[Characteristics of anal carcinoma with therapeutic consequences].

Anal cancers have to be looked at either as cancers of the anal canal or those of the anal margin. During the past years, evidence has been obtained that human papilloma virus (HPV) contributes to the formation of cancers, particularly in homo-sexual males. Surgical treatment alone, may only be considered in tumors with less than 2 cm in size.

[Obligatory and facultative measures in diagnosis and staging of stomach carcinoma].

A differential therapeutic regimen in gastric cancer requires exact staging. Criteria for accurate staging include exact localization of the tumor, the tumor depth, as well as the definition of local spread (lymph node metastases) and distant metastases (liver metastases, peritoneal carcinosis). Endoscopy, endoscopic ultrasound (EUS), laparoscopy and laparoscopic ultrasound provide the most precise information concerning T-, N- and M-categories in preoperative staging.

Increased autologous blood donation in rectal cancer by recombinant human erythropoietin (rhEPO).

A randomised, placebo-controlled trial was conducted to study whether the subcutaneous administration of recombinant human erythropoietin (rhEPO) increases the donated red cell blood volume in patients with rectal cancer. Patients with resectable rectal cancer and a haemoglobin (Hb) level > or = 12.5/ > 12 g/dl (males/females) were scheduled to receive pre-operatively either erythropoietin (200 U/kg body weight daily) (n = 28) or placebo (n = 26) subcutaneously for 11 days.

[Thoracoscopic diagnosis and therapy of lung metastases].

Introduction: The purpose of this study was to evaluate the impact of thoracoscopy on staging and therapy of peripheral pulmonary nodules in patients with a cancer history.

Patients And Methods: Videothoracoscopy (VATS) was performed in patients presenting peripheral pulmonary nodules (< 3cm) in CT-scan. 65 patients (63%) presented less than 3 nodules and 39 patients (37%) had multiple lesions in the lungs.

[Phase II study on preoperative radio-chemo-thermotherapy in locally advanced rectal carcinoma].

Background: Recent studies show that preoperative radio-chemotherapy can increase resectability and local control of locally advanced rectal carcinomas. Additional regional hyperthermia might increase remission rates and tumor response. We therefore tested regional hyperthermia together with radio-chemotherapy in a phase-II study on locally advanced rectal carcinomas.

Surgical treatment of acute pancreatitis.

The most important diagnostic step in the management of patients with severe acute pancreatitis is discrimination between interstitial-oedematous and necrotizing pancreatitis. Surgical decision-making is based on clinical, bacteriological and contrast-enhanced CT-data. Persisting or progressive systemic or local organ complications occurring despite ICU-treatment are indicators for surgical management.

Evolution of socioeconomic impact assessments of HIV/AIDS.

Objective: The objective of this paper is to describe how and why socioeconomic impact assessments, as applied to HIV/AIDS in developing countries, have evolved over time and to discuss the direction that this field should be taking in the future.

Design: This paper involves a review of existing literature and incorporates the experience of AIDSCAP/Family Health International, the AIDS and Economics Network (AEN) and other organizations working in this field.

Results: Socioeconomic impact methodologies have become more rigorous over the last 10 years.

Secretory phospholipase A2 in patients with infected pancreatic necroses in acute pancreatitis.

Secretory synovial-type PLA2 (sPLA2-II) in peripheral blood is known to be associated with systemic complications in patients with severe diseases. Being the pacemaking enzyme in eicosanoid synthesis, sPLA2-II is a mediator of the inflammatory response and plays a role in host defense against bacterial infection. We evaluated the clinical role of systemic sPLA2-II in bacterial infection of pancreatic necroses in severe acute pancreatitis.

Rationale for using invasive thermometry for regional hyperthermia of pelvic tumors.

Purpose: Invasive thermometry for regional hyperthermia is time-consuming, uncomfortable, and risky for the patient. We tried to estimate the benefit/cost ratio of invasive thermometry in regional hyperthermia using the radiofrequency system BSD-2000.

Methods And Materials: We evaluated 182 patients with locally advanced pelvic tumors that underwent regional hyperthermia.

The clinical value of human pancreas-specific protein procarboxypeptidase B as an indicator of necrosis in acute pancreatitis: comparison to CRP and LDH.

Early assessment of severity in acute pancreatitis (AP) has a major impact on further treatment. Previous studies have shown that human pancreas-specific protein (hPASP)/procarboxypeptidase B (PCPB) is a new diagnostic and prognostic marker in AP. In the present study we focused on the prognostic properties of this parameter and analyzed the clinical value of hPASP in discriminating edematous from necrotizing AP.

Radiochemotherapy and hyperthermia in the treatment of rectal cancer.

We evaluated the use of regional hyperthermia with radio-chemotherapy in a phase I/II study on locally advanced rectal carcinomas. Thirty-four patients with primary advanced (stage T3/T4) rectal carcinomas (24 patients) or recurring rectal carcinomas (6 patients) were treated using preoperative radiochemo-thermotherapy. Initial tumour staging was carried out clinically (degree of fixation) and using endorectal ultrasonography and CT.

The role of staging laparoscopy for multimodal therapy of gastrointestinal cancer.

Background: This prospective study was conducted to evaluate the accuracy and the therapeutic relevance of staging laparoscopy.

Methods: Between June 1993 and February 1997 staging laparoscopy was performed in 389 patients with various neoplasms. Additionally, 144 selected patients of this group were examined with laparoscopic ultrasound using a semiflexible ultrasound probe (7.

Preoperative hyperthermia combined with radiochemotherapy in locally advanced rectal cancer: a phase II clinical trial.

Objective: A prospective phase II study was performed to determine the feasibility and efficacy in terms of response rate, resectability, and morbidity in patients with locally advanced rectal cancer who received preoperative regional hyperthermia combined with radiochemotherapy (HRCT).

Summary Background Data: Recent studies suggest that preoperative radiochemotherapy in locally advanced rectal cancer can induce downstaging, but after resection the incidence of local recurrences remains high. Hyperthermia (HT) may add tumoricidal effects and improve the efficacy of radiochemotherapy in a trimodal approach.

Role of ultrasonographically guided fine-needle aspiration cytology in the diagnosis of infected pancreatic necrosis.

Background: Early detection of infected pancreatic necrosis has a major impact on further management and outcome in acute pancreatitis. The aim of this study was to evaluate the clinical value of ultrasonographically guided fine-needle aspiration cytology (FNAC) in patients with necrotizing pancreatitis over an 8-year period.

Methods: From January 1988 to September 1996 193 (mean 2.

Video-assisted thoracic surgery. Staging and management of thoracic tumors.

Background: This prospective study was conducted to investigate the value of video-assisted thoracic surgery (VATS) for staging and therapy of thoracic tumors.

Methods: VATS was performed in 86 patients presenting peripheral pulmonary nodules. Indications for thoracoscopy included diagnosis of indeterminated pulmonary lesions (n = 55), staging of disseminated disease (n = 24), and therapeutic interventions (n = 7).

The potential role of procalcitonin and interleukin 8 in the prediction of infected necrosis in acute pancreatitis.

Background: Infection of pancreatic necrosis has a major impact on clinical course, management, and outcome in acute pancreatitis. Currently, guided fine needle aspiration is the only means for an early and accurate diagnosis of infected necrosis. Procalcitonin (PCT), a 116 amino acid propeptide of calcitonin, and interleukin 8 (IL-8), a strong neutrophil activating cytokine, are markers of severe inflammation and sepsis.

Low serum levels of soluble CD44 variant 6 are significantly associated with poor prognosis in patients with pancreatic carcinoma.

Background: Variant CD44 splice products, especially CD44 variant 6 (CD44v6), are expressed on activated lymphocytes and tumor cells. The soluble forms of CD44 standard (CD44s) and CD44v6 are present in the serum of normal individuals. The aim of the current study was to evaluate the concentrations and the prognostic potential of soluble CD44s and CD44v6 in patients with pancreatic carcinoma.

Exogenous, but not endogenous, nitric oxide increases proliferation rates in senescent human fibroblasts.

We investigated the effects of endogenously produced and exogenously applied nitric oxide (NO) on cell proliferation rates and cell cycle regulation in senescent human fibroblasts (WI38). Induction of inducible nitric oxide synthase by tumor necrosis factor-alpha, interferon-gamma and interleukin-1beta inhibited cell proliferation and led to a G1 arrest. These effects were partially reversible by N(G)-monomethyl-arginine (NMA).

Overexpression of cyclin D1 in human pancreatic carcinoma is associated with poor prognosis.

We have investigated the expression of cyclin D1 in adenocarcinoma of the pancreas and the relevance of cyclin D1 expression to clinical outcome. In comparison to normal pancreas, Southern blot analyses revealed amplification of the cyclin D1 coding gene in 25% of the cases, whereas with reverse transcription-PCR, overexpression of mRNA was observed in 82% of the examined tissues. Immunohistochemically, we could demonstrate nuclear overexpression in tumor cells in 68.

[Magnetic resonance tomography and endosonography in the preoperative staging of advanced rectal carcinomas after hyperthermoradiochemotherapy].

Purpose: Comparison of diagnostic accuracy of staging of endorectal sonography (ES) and body coil MRI after preoperative hyperthermoradiochemotherapy in patients with advanced rectal cancer.

Methods: Prospective analysis of MRI and ES in 30 patients after hyperthermoradiochemotherapy and correlation with histopathological patterns.

Results: T-staging by MRI was correct in 47% and by ES in 53% of the cases.

Surgical treatment of infected necrosis.

Over the years, experience has shown that the cornerstone for improved survival in patients with infected pancreatic necrosis is an early, precise diagnosis followed by adequate drainage combined with modern intensive care management. In experienced hands, this goal can be achieved with different surgical approaches, provided that all septic collections are thoroughly removed and that reexploration is performed promptly if there is evidence of ongoing sepsis. If there is any concept preferable, and under what conditions, future large-scale randomized trials with precise and comparable patient stratification will have to demonstrate it.

Natural course of acute pancreatitis.

Acute pancreatitis comprises, in terms of clinical, pathologic, biochemical, and bacteriologic data, four entities. Interstitial edematous pancreatitis and necrotizing pancreatitis are the most frequent clinical manifestations; pancreatic pseudocyst and pancreatic abscess are late complications after necrotizing pancreatitis, developing after 3 to 5 weeks. Determinants of the natural course of acute pancreatitis are pancreatic parenchymal necrosis, extrapancreatic retroperitoneal fatty tissue necrosis, biologically active compounds in pancreatic ascites, and infection of necrosis.

[Thoracoscopy is a reliable alternative to thoracotomy in peripheral lung coin lesion].

Video-assisted thoracoscopy (VATS) is useful for improving preoperative diagnosis and staging in patients with peripheral pulmonary lesions. Additional information obtained by VATS had a major influence on the therapeutic strategy in 34% of the patients, and in 39% of the patients in the conventional surgery group thoracotomy could possibly have been avoided if VATS had been available.