[Primary gastric lymphoma].

Primary gastric lymphoma derives from a secondary MALT system developing after a reaction of the immune system, e.g. following chronic gastritis induced by Helicobacter pylori.

[Endoscopic ultrasound in routine clinical practice for staging adenocarcinomas of the stomach and distal esophagus].

Problem: Endoscopic ultrasound (EUS) is an important diagnostic tool for determining the best therapeutic strategy (primary resection, neoadjuvant therapy or palliation only) to offer esophageal or gastric cancer patients.

Patients And Methods: In the present study (1992-2001),we evaluated the accuracy of EUS in adenocarcinomas of the distal esophagus and stomach and compared our results with pathologists findings as the gold standard.

Results: Of the 222 patients studied, the precise examination of 11% EUS was not completely possible due to severe tumor stenosis.

Laser-induced interstitial thermotherapy of liver metastases in an interventional 0.5 Tesla MRI system: technique and first clinical experiences.

Laser-induced interstitial thermotherapy (LITT) surveyed by magnetic resonance imaging (MRI) has been shown to be effective in various applications. The laser treatment of colorectal liver metastases usually requires a separate device (e.g.

[Principles of surgical management of stromal tumor].

Gastrointestinal stromal tumors (GIST) have been regarded as rare tumor manifestations of the mesenchymal tissue fraction of the intestinal building principle; however, this tumor is now established as an independent tumor entity owing to independent immunohistochemical and ultrastructural characteristics. In spite of increasing awareness of their biological behavior and their molecular-biological basis, evaluating the grade of many of these tumors remains open, not only on a preoperative but also on a postoperative basis. Thus, how radical the surgical procedure must be is not standardized, as it is in carcinoma surgery.

Primary gastric B-cell lymphoma: results of a prospective multicenter study. The German-Austrian Gastrointestinal Lymphoma Study Group.

Background & Aims: Appropriate management of primary gastric lymphoma is controversial. This prospective, multicenter study aimed to evaluate the accuracy of endoscopic biopsy diagnosis and clinical staging procedures and assess a treatment strategy based on Helicobacter pylori status and tumor stage and grade.

Methods: Of 266 patients with primary gastric B-cell lymphoma, 236 with stages EI (n = 151) or EII (n = 85) were included in an intention-to-treat analysis.

Helicobacter pylori in the upper gastrointestinal tract: medical or surgical treatment of gastric lymphoma?

The treatment of primary gastric lymphoma is controversial. The role of surgery has come to be questioned with increasing knowledge about the pathogenesis of gastric lymphoma and with new therapeutic approaches such as eradication of Helicobacter pylori. We review published clinical trials of primary gastric lymphoma, including preliminary results of our own prospective multicenter trial.

[Perspectives of virtual control of visceral surgery interventions in open MRI].

Since July 1997 we have operated on 23 patients with different visceral surgical diagnoses in an open-configured Magnetic Resonance System (MRI). Among them we found 7 patients with benign soft tissue tumors, 5 patients with anal fistulas, 1 patient with an abscess on the pelvic wall, 1 patient with a rectocele, 1 patient with an inoperable, restrictive oesophageal carcinoma, and 8 patients with metastatic lesions in the liver. In the last 8 patients we performed MRI-guided laser-induced interstitial thermotherapy, in one patient in an open development.

[Current therapeutic strategy in primary intestinal non-Hodgkin's lymphoma].

Of all surgical interventions of intestinal non-Hodgkin's lymphomas 58% (15 or 26 patients) are performed in an emergency situation. In 42% of cases, examination by ultrasonography, endosonography, intestinoscopy. Sellink's enema, thoracic, abdominal/pelvic CT and bone marrow puncture could determine the stage preoperatively.

[Perioperative therapy of HIV infections].

A meta-analysis of the literature demonstrates high operation complication rates in HIV-positive patients. Own experience connected with a general hospital in San Francisco, University of California, indicates that such an analysis provides the surgeon with the possibility of optimizing the treatment of HIV-positive patients in the perioperative phase.

[Therapy planning and surgical indications for Crohn-associated anal fistulas].

A prospective study conducted from April 1988 to April 1998 in 83 patients with anal fistulas associated Crohn's diseases registers and evaluates data regarding the type of fistula, the planned therapy, the operative procedure, and the therapy itself. The choice of the operation time with special regard to the type of fistula and the presence of proctitis as well as the interdisciplinary management in cooperation with the gastroenterologist and the strict observance of the operative procedure for the different types of fistulas enable individually defined surgical treatment of anal fistulas associated with Crohn's disease. It is important that the primary intervention be performed by a surgeon who is experienced in classifying the different types of fistulas because of the recurrence rate of 23% and the required interval between the first and final surgical intervention and so that patients are well informed.

Simple data from history and physical examination help to exclude bowel obstruction and to avoid radiographic studies in patients with acute abdominal pain.

Objective: To assess the value of plain abdominal radiographs and of data from the medical history and physical examination in the diagnosis of acute abdominal pain in general and of bowel obstruction in particular.

Design: Prospective study.

Setting: 4 university and 2 community hospitals, Germany.

Prognostic significance of urokinase-type plasminogen activator expression in squamous cell carcinomas of the esophagus.

In the present study, urokinase-type plasminogen activator (uPA) expression in 150 potentially curatively resected SCCs of the esophagus was analyzed immunohistochemically by means of a murine monoclonal antibody (American Diagnostica, Greenwich, CT) and correlated with survival. Altogether, 122 of the 150 tumors (81.3%) expressed different levels of uPA.

[Stage-adapted radical principles in gastric carcinoma].

The aim of any surgical approach to gastric carcinoma should be a complete resection with no residual tumor left behind, that is, a R0-resection according to UICC. Complete tumor resection in this respect refers to the primary tumor as well as to the lymphatic drainage and requires an adequate safety margin. The indications for surgical therapy of gastric cancer and the choice of procedure should consequently be guided by the tumor stage.

[Early stomach carcinoma--pathologic-anatomic findings and prognosis].

Background: The therapy for early gastric cancer (endoscopy, gastric resection, D1/2 dissection) is controversial.

Materials And Methods: In a retrospective study (4/86-12/95) we analyzed the prognosis of 57 early gastric cancer patients with respect to pathological findings and surgical therapy.

Results: The R0 resection rate was 100%.

The prognostic significance of epidermal growth factor receptor expression in squamous cell carcinomas of the oesophagus.

EGFR expression in 150 potentially curative resected squamous cell carcinomas of the oesophagus was analyzed immunohistochemically and correlated with survival. Altogether, 124 of 150 (82.7%) tumours expressed different levels of EGFR.

Expression of Bax, a pro-apoptotic member of the Bcl-2 family, in esophageal squamous cell carcinoma.

Samples of normal esophageal squamous epithelium (n = 10), severe squamous cell dysplasia (n = 22), carcinoma in situ (n = 15), invasive squamous cell carcinoma (n = 172), lymph-node metastasis (n = 21) and 2 permanent esophageal squamous cell carcinoma cell lines were analyzed immunohistochemically for Bax expression using a polyclonal anti-Bax antibody. Immunostaining was evaluated according to a score system (0-8 points) based on the percentage of positive tumor cells and the relative immunostaining intensity. Cytoplasmatic staining for Bax protein was found uniformly in all cell layers of the normal esophageal squamous epithelium.

Basaloid squamous cell carcinoma of the esophagus: diagnosis and prognosis.

Background: Basaloid squamous cell carcinoma (BSCC) is a recently recognized, poorly differentiated variant of squamous cell carcinoma (SCC), which is located predominantly in the upper aerodigestive tract.

Methods: In this study, clinical and pathologic parameters of 17 BSCCs and 133 typical SCCs of the esophagus that underwent potentially curative resection (no distant metastases, no residual tumor) were compared. In addition, light microscopic, electron microscopic, and immunohistochemical features of BSCC were investigated, to determine whether this type of carcinoma could be differentiated from other poorly differentiated carcinomas of the esophagus.

[Roentgen imaging in acute abdominal pain is dispensable].

Plain abdominal X-ray films are overused in patients with acute abdominal pain. Focusing on medical history and physical examination helps to reduce the number of plain films used and saves costs.

[MALT-lymphoma--surgical therapy].

To perform laparotomy in each histological sub-type of a primary gastric lymphoma with the intention of a total resection seems to be rather aggressive and should be seen with respect to other effective treatment modalities. But for curative treatment total gastrectomy with systematic lymphadenectomy or sampling respectively seem to be necessary. Classification is changing and there is an uncertainty about nature and dissemination of the tumor and even an uncertainty with respect to diagnosis.

bcl-2 expression and prognosis in squamous-cell carcinomas of the esophagus.

The bcl-2 proto-oncogene is a known inhibitor of apoptosis and may be an important regulator of tumor growth. In the present study, bcl-2-protein expression was investigated by immunohistochemistry and correlated with prognosis in a series of 150 potentially curatively resected squamous-cell carcinomas of the esophagus. For comparison, bcl-2-protein expression was analyzed in normal esophageal mucosa, severe squamous dysplasias and carcinomas in situ.

[Intra-disciplinary therapy strategy in esophageal carcinoma from a surgical viewpoint].

Extensive long segment resection for carcinoma of the esophagus including also consequent mediastinal and celiac lymph node dissection is able to achieve satisfactory radicality only in early tumor stages while there is little influence on long term prognosis for advanced tumor stages. Only better risk analyses and improved surgical outcome with reduced operative mortality has improved the overall outcome. In locally limited primary tumors and even more in locally advanced stages generalisation or dissemination of tumor disease is to be expected.

[Standard intervention in primary lymphoma of the stomach--initial results of a prospective multicenter study].

An R0 resection seems to be a rather aggressive treatment, but can be achieved in 80% of localized gastric lymphomas and should be seen in contrast to other effective treatment modalities. For curative treatment at stage EI1-EII1, total gastrectomy with systematic lymphadenectomy (D2) seems to be necessary. Basic information about the clear diagnosis, tumor dissemination and the individual prognosis only becomes available by a standardized operation as part of multimodal therapeutic concepts.

[Clinical standardization in acute abdominal pain].

The correct diagnosis in acute abdominal pain is necessary for adequate treatment. In several clinical studies it has been shown that, despite improvements in laboratory and technology medicine, errors occur in a considerable proportion of cases due to insufficient history-taking and clinical examination. By the introduction of a standardised and structured history and clinical examination, the diagnostic accuracy can be improved by at least 10%.

[Primary non-Hodgkin lymphoma of the stomach--surgical aspects].

In each histological subtype of a primary gastric non-Hodgkin lymphoma laparotomy is performed with the intention of an R0 resection. This concept appears to be rather aggressive if you take into account the possibilities of the other treatment modalities; however, because of the diagnostic uncertainty and of the changing histologic classifications there is an uncertainty about the character and the dissemination of the tumor. Consequently total gastrectomy with systematic lymphadenectomy provides enough basic informations to plan multimodal therapeutic concepts and their clinical evaluations.