Phase II pilot trial of preoperative high-dose chemotherapy in patients with malignant tumors of the upper gastrointestinal tract.

The purpose of this trial was to test feasibility and tolerability of a multimodality treatment approach for patients with tumors in the upper gastrointestinal tract (EC, esophageal cancer; JC, cancer of the gastro-esophageal junction; GC, gastric cancer) including preoperative chemotherapy with the EAP-protocol as induction and a consecutive high-dose-chemotherapy for responding patients. Sixteen patients with locally advanced tumors of the esophagus, the gastro-esophageal junction or the stomach were treated with two cycles of EAP-chemotherapy (etoposide, 3x120 mg/m(2); adriamycin, 2x20 mg/m(2); cisplatin, 2x40 mg/m(2)). Responding (cPR, cCR) patients were included into a high-dose MCVB-chemotherapy protocol (mitomycin, 10 mg/m(2); cisplatin, 4x40 mg/m(2); vepeside, 5x200 mg/m(2); BCNU 300 mg/m(2)) and subsequent rescue with peripheral blood stem cells (PBSC).

[Tracheal rupture caused by overinflation of endotracheal tube cuff].

The authors report a tracheal rupture in a 34-year-old patient who was primarily intubated following generalised seizures and loss of consciousness (Rüsch endotracheal tube). Some hours later, she developed high ventilatory airway pressures and subcutaneous and mediastinal emphysema were noted. Reintubation with a high-volume, low-pressure endotracheal tube was planned when it was noted that the ballon of the Rüsch tube was grossly overinflated.

[Vascular malformations in the gastric fundus as a rare cause of fundus variceal hemorrhage].

In the differential diagnosis of the aetiology of portal hypertension arterio-portal fistulas as a rare cause have to be taken in account. The case of a 70-year-old male presenting with massive upper gastrointestinal bleeding secondary to gastric varices caused by a vascular malformation of the gastric fundus is reported and the problem of non-cirrhotic portal hypertension is discussed. In case of variceal bleeding aetiology of portal hypertension has to be clarified exactly before any kind of therapeutic intervention to avoid therapeutic pitfall.

[Changes in surgery of diverticulitis].

This retrospective study investigates the surgical progress in the treatment of diverticular disease during the last two decades. We reviewed 304 patients (149 women and 155 men) operated for diverticular disease from 1970-1992 at the Surgical Clinic of Steglitz Medical Center, Free University of Berlin. Comparing the results between the first and the second decade, we observed a significant increase in the total number of patients who have been treated surgically (from 118 to 186) and in the proportion of elective surgery (from 45% to 57%).