Intramural carcinoma of the oesophagogastric junction.

Most oesophageal carcinomas (>70%) are squamous cell carcinomas (SCC) arising from the surface epithelial lining. In the gastro-oesophageal junction (GEJ) adenocarcinomas occur in the setting of Barrett oesophagus (BE). These carcinomas typically present with surface ulceration.

[In vivo ICG fluorescence photometry for quantification of warm ischemia damage of to the liver in a rat model].

The clearance of indocyanine green (ICG) from the peripheral blood has been used for the study of hepatic function in clinical and experimental investigations. We describe a method of simultaneous, semiquantitative measurement of the kinetics of ICG in the peripheral blood, liver, kidney and bile system following intraoperative bolus injection. The method is based on the fluorescence of ICG in the near infrared spectrum.

Limited value of positron emission tomography in treatment of pancreatic cancer: surgeon's view.

We aimed to assess, from a surgical point of view, the value of positron emission tomography (PET) in the routine preoperative diagnostic evaluation of a pancreatic mass. In particular, we were interested in PET's ability to distinguish a malignancy from a nonmalignant process and its impact on surgical decision making. We documented prospectively the results of preoperative ultrasonography, computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), and PET in terms of a correct diagnosis of malignancy in 103 patients.

[Leiomyosarcoma of the splenic artery].

Leiomyosarcomas of vascular origin are a very rare group of tumors developing from smooth vascular muscle cells. The most common location are in large vessels, e.g.

Operative treatment of a congenital pancreatic pseudocyst: a case report.

Congenital pancreatic pseudocysts are very rare and have so far been described in only 4 cases. We report on a patient with a congenital pancreatic pseudocyst diagnosed only intraoperatively. We show with this case that diagnosis is difficult.

[Evidence-based surgery of rectal carcinoma].

The surgery of rectal cancer has seen significant development in recent years. When there is a multitude of therapeutic options available, it is essential to identify what can be considered a proven standard or, at least, what has to be included in planning a surgical treatment. Therefore, at this point of time a distal resection margin of 2 cm, total mesorectal excision, en-bloc resection of adherent structures, colonic pouch reconstruction after very deep resections and limitation of local excision to T1/G1 tumors have to be regarded as standards of the surgical strategy.

Experimental studies on small intestinal pouch motility and evacuation.

Unlabelled: The aim of the study was to investigate pouch motility and evacuation under standardised conditions with a minimum of external influence.

Methods: Ileal J-pouches had been constructed 30 cm proximal to the ileocecal valve in 10 dogs (6 pelvic/4 gastric configuration). After 8 weeks the following examinations were performed: (1) measurement of pouch compliance by balloon distension, (2) measurement of pouch contractions by strain gauge transducers, (3) radiological imaging of pouch contractions and evacuation, (4) evacuation scintigraphy and (5) radiological determination of small intestinal transit time.

Pancreatoblastoma: ultrastructural and image DNA cytometric analysis.

Background: Since the first description of a pancreatoblastoma as a malignant pancreatic tumour of childhood in 1957, approximately 60 cases have been reported. We present the symptoms, pathology, and therapy of this rare tumour in a 17-year-old girl.

Case Report: The patient initially presented with upper gastro-intestinal bleeding.

[Multiorgan surgery in rectal cancer--extended therapy or improvement of prognosis?].

About 10% of rectal cancers have to be treated by a multivisceral resection. Within a period of 14 years we performed 103 of these operations, 60 for primary cancers, 43 for recurrent cancers with a significant increase in the latter. The total or partial removal of 204 extra-rectal organs allowed for a R0 resection in 67% of cases.

[Transport management in blunt abdominal trauma. Case report of a patient with delayed diagnosis of splenic rupture].

Missed abdominal injuries after blunt abdominal trauma belong to the most frequent causes of death, especially in polytraumatized patients. Primary missing these injuries often is a tragedy due to a mortality-rate up to 50% after delayed treatment compared with a low complication- and mortality-rate after diagnosis in time. We report the case of a patient with a missed spleen lesion to discuss the special problems of the transport stages.

[Current therapy of injuries of the colon and retroperitoneum].

Injuries of the colon and retroperitoneum are rarely observed after blunt abdominal trauma and occur in about 5 - 20 % of the patients. The majority of complications are due to initial misdiagnoses and a delay in treatment. Lesions of the pancreas and duodenum are the most frequent diagnoses in the retroperitoneal space, while major vascular traumata or urogenital injuries are rare.

Prognostic value of DNA image cytometry in resected colorectal hepatic metastases.

Objective: To determine the role of DNA image cytometry (DNA ICM) as a useful predictor of outcome following the resection of colorectal hepatic metastases.

Study Design: In 75 patients (56 R0 resections) with resected colorectal hepatic metastases, DNA ICM was performed on paraffin-embedded specimens. The DNA content of 250 tumor cells was determined in each specimen, and the 2c level was evaluated using 30 granulocytes from the same sample.

[Results of sonographically guided percutaneous catheter drainage of intra-abdominal abscesses in surgery].

The results of a retrospective study concerning percutaneous catheter drainage of 62 intra-abdominal abscesses in 60 patients were demonstrated, including the procedure and complications. For the first access a thin needle was used to perform an aspiration biopsy under sonographic control. We placed a pigtail or van Sonnenberg catheter by Seldinger or trocar technique into the abscesses.

[Duodenal fistula following Port-à-cath--a rare complication of regional hepatic chemotherapy].

Arterial port systems are frequently used in the adjuvant and palliative therapy of colorectal hepatic metastasis. Specific complications are rarely documented in literature. The perforation of an arterial Port-à-cath followed by duodenal fistula is an uncommon complication of regional hepatic chemotherapy.

[Jejuno-jejunal invagination after Dennis tube insertion for ileus--a rare complication].

In contrast to childhood intussusception, the clinical signs of intussusception in adults are nonspecific. Generally organic alterations of the small bowel cause intussusception in adults. In this case report on a retrograde jejunojejunal intussusception in a 61-year-old male, following removal of an intraoperatively placed intestinal tube for ileus therapy, the clinical symptoms, diagnostic methods and therapy for intussusception are described.

Surgical therapy of severe acute pancreatitis: a flexible approach gives excellent results.

Background/aims: To evaluate the effectiveness of our surgical strategy in acute and necrotizing pancreatitis we performed this prospective uncontrolled study.

Methodology: Seventy-six patients with severe acute pancreatitis who were operated on between 1989 and 1995 were included in this study. Laparotomy aimed at removal of necrosis, treatment of ongoing necrosis, and correction of concurrent pathology were the principal goals of surgery.

[Adjuvant regional arterial port chemotherapy after resection of colorectal liver metastases].

Between 1986 and 1995 we performed radical hepatic resections (R0 resections) in 109 patients with hepatic metastases following colorectal carcinoma. In 50 patients a hepatic arterial port device was implanted for adjuvant regional chemotherapy (HAI). Mitomycin C, 5-fluorouracil, and since 1993 folinic acid have been administered during 6 monthly repeated courses.

[Value of colonoscopy in tumor after-care after colorectal carcinoma].

The significance of colonoscopic follow up is discussed controversially. Colonoscopy after resection of colorectal cancer offers the possibility of direct inspection and to take biopsies for the early detection of local recurrence or additional neoplasms. In a retrospective study we examined the benefit of regular colonoscopies.

Primary non-Hodgkin lymphoma of the stomach--role of surgery.

Thirty-one patients with Non-Hodgkin lymphoma of the stomach were retrospectively investigated. The prognostic factors regarding survival after treatment were determined in an univariate analysis. Twenty-seven of the patients revealed a stage I or II disease (according to the Ann Arbor classification) at the time of operation.

[Role of sonography as primary diagnostic method in acute abdomen--a prospective study].

A prospective study of 584 consecutive patients presenting with acute abdominal pain was conducted to evaluate the role of ultrasonography as a first-line diagnostic tool for differentiating between surgical and nonsurgical diseases. The study reveals a high sensitivity and specificity for the diagnosis of diverticulitis, cholecystitis, and bowel obstruction. In acute appendicitis the method is highly specific, but the sensitivity is rather low.

[Perioperative antibiotic prophylaxis in visceral surgery--pro and contra].

Perioperative antibiotic prophylaxis aims at reducing the enormous cost of hospital-acquired infections. Primary indications for antibiotic prophylaxis are wounds of the clean-contaminated and contaminated category. Use of antibiotic prophylaxis in clean surgery is still very controversial.

[Value of intraluminal intestinal decompression by endoscopic placement of a Dennis tube in therapy of ileus. Retrospective clinical study of 174 patients].

For determination of the efficacy of intraluminal bowel decompression by an endoscopically placed Dennis tube, 174 patients with paralytic ileus or different kinds of partial small bowel obstruction were reviewed retrospectively. There were 66 cases (37.9%) of early postoperative ileus (A), 27 (15.

Morbidity of ileostomy and colostomy closure: impact of surgical technique and perioperative treatment.

The operative results and complications after stoma closure in 548 patients operated on between 1972 and 1993 are described in this retrospective study. The patients were divided into three groups (group I,n = 74, 1972-1976; group II,n = 256, 1977-1985; group III,n = 218, 1986-1993) according to the year of operation and changing concepts in colorectal surgery. The overall mortality rate was 2.

Repeat resection of recurrent hepatic metastases--improvement in prognosis?

Objective: To find out if resection of recurrent hepatic metastases improves survival.

Design: Retrospective study.

Setting: University hospital, Germany.

[Benefits and risk of resection of liver metastases in elderly patients].

Between 1986 und 1995 we performed 60 hepatic resections in 52 patients aged over 70 years for liver metastases of different primary tumours. The results were comparable regarding morbidity, mortality and long-term prognosis to the group of 176 patients under the age of 70 undergoing a total of 210 hepatic resections for metastases during the same time period. Thus liver resections for metastases can be performed with tolerable risks even in aged patients; postoperative mortality is independent of the patients' age and is due to the extent of resection; the survival rate is mainly influenced by radical resection.