Late Local Recurrence after Neoadjuvant Therapy and Radical Resection for Locally Advanced Rectal Cancer.

Neoadjuvant radiochemotherapy (RCT) and lately total neoadjuvant therapy (TNT) improved local recurrence rates of rectal cancer significantly compared to total mesorectal excision (TME) alone. Yet the occurrence and impact of late local recurrences after many years appears to be a distinct biological problem. We included = 188 patients with rectal cancer after RCT and radical resection in this study; = 38 of which had recurrent disease (sites: local (8.

Low-dose alemtuzumab induction in a tailored immunosuppression protocol for sensitized kidney transplant recipients.

Background: Induction therapy is crucial in kidney transplantation and constitutes an important cornerstone for long-term allograft survival. Alemtuzumab is a depleting CD52-specific antibody with T- and B-cell activity, leading to prolonged lymphocyte depletion for up to 12 months, with profound immunosuppression and an associated risk of serious infections. Current concepts aim to optimize dosing strategies to reduce side effects.

Inflammatory Bowel Disease.

Background: Inflammatory bowel diseases are common in Europe, with prevalences as high as 1 in 198 persons (ulcerative colitis) and 1 in 310 persons (Crohn's disease).

Methods: This review is based on pertinent articles retrieved by a search in PubMed and in German and European guidelines and Cochrane reviews of controlled trials.

Results: Typically, the main clinical features of inflammatory bowel diseases are diarrhea, abdominal pain, and, in the case of ulcerative colitis, peranal bleeding.

A Temperature of 40 °C Appears to be a Critical Threshold for Potentiating Cytotoxic Chemotherapy In Vitro and in Peritoneal Carcinomatosis Patients Undergoing HIPEC.

Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) following cytoreductive surgery is a radical but effective treatment option for patients with peritoneal carcinomatosis (PC). Unfortunately, a standardized HIPEC protocol is missing impeding systematic comparisons with regard to minimal effective temperatures.

Objective: The purpose of the present study was to systematically analyse the precise minimal temperature needed for potentiation of chemotherapy effects in vitro and for patient survival.

C-reactive protein levels in combination with abdominal CT scans is a useful tool to predict the macroscopic appearance in late-stage EPS patients prior to surgery.

Background: Diagnosis of encapsulating peritoneal sclerosis (EPS) is based on clinical symptoms, radiologic findings, and macroscopic or histological criteria. Two diagnostic scores for radiologic findings in computed tomography (CT) scans of patients with EPS have been established in the past (by Tarzi et al and Vlijm et al). The macroscopic appearance of EPS has previously been separated into three types.

Effect of suture technique on the occurrence of incisional hernia after elective midline abdominal wall closure: study protocol for a randomized controlled trial.

Background: Based on a recent meta-analysis, a continuous suture technique with a suture to wound length ratio of at least 4:1, using a slowly absorbable monofilament suture material, is recommended for primary median laparotomy closure. Incisional hernia, which develops in 9 to 20% of patients, remains the major complication of abdominal wall closure. Current clinical data indicate that the incidence of incisional hernias increases by 60% between the first and the third year after median laparotomy, implicating that a follow-up period of 1 year postoperatively is too short with regard to this common complication.

Incidence of and risk factors for hungry bone syndrome in 84 patients with secondary hyperparathyroidism.

Introduction: Secondary hyperparathyroidism develops in nearly all patients with end-stage renal disease. Parathyroidectomy is often performed when medical therapy fails. The most common postoperative complication, hungry bone syndrome (HBS), requires early recognition and treatment.

Analysis of α-klotho, fibroblast growth factor-, vitamin-D and calcium-sensing receptor in 70 patients with secondary hyperparathyroidism.

Background/aims: Secondary hyperparathyroidism (sHPT) is known as a very common complication in patients with chronic kidney disease, and G-protein-coupled calcium-sensing receptor (CaSR), Vitamin D receptor (VDR) and Fibroblast growth factor receptor (FGFR)/Klotho complexes seem to be involved in its development.

Methods: Hyperplastic parathyroid glands from 70 sHPT patients and normal parathyroid tissue from 7 patients were obtained during parathyroidectomy. Conventional morphological and immunohistochemical analysis of parathyroid glands was performed after dividing each slide in a 3x3 array.

Phenotypes of encapsulating peritoneal sclerosis--macroscopic appearance, histologic findings, and outcome.

Background: Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of peritoneal dialysis (PD), with clinical signs of abdominal pain, bowel obstruction, and weight loss in late stages.

Methods: We retrospectively analyzed all patients who were diagnosed with EPS between March 1998 and October 2011 in our department of nephrology. We focused on the 24 EPS patients who underwent surgery because of symptomatic late-stage EPS.

Involvement of α-klotho, fibroblast growth factor-, vitamin-D- and calcium-sensing receptor in 53 patients with primary hyperparathyroidism.

The presentation of patients with primary hyperparathyroidism is often atypical and ranges from normocalcemic, primary hyperparathyroidism to severe, symptomatic hypercalcemia. G-protein-coupled, calcium-sensing receptor (CaSR), vitamin D receptor (VDR), and fibroblast growth factor receptor (FGFR)/klotho complexes seem to be involved in the development of pHPT. Parathyroid glands from 53 patients with pHPT and normal parathyroid tissue from 7 patients were obtained during parathyroidectomy.

Organ donation: when should we consider intestinal donation.

Unlabelled: Although more than 2300 intestinal transplantations (IT) have been performed worldwide, a description of intestinal donor criteria is still missing. This causes confusion among transplant coordinators, OPOs, physicians at intensive care unit and transplant surgeons. A Med-line search looking for publications about donor criteria or donor selection in human IT was performed in December 2011.

Efficacy and morbidity of surgical therapy in late-stage encapsulating peritoneal sclerosis.

Background: Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of peritoneal dialysis composed of chronic abdominal pain, chronic ileus, and severe malnutrition. Operative therapy for EPS is a complex procedure, including perionectomy and enterolysis (PEEL). In contrast to simple adhesiolysis, PEEL comprises a restitution of intestinal passage and prevention of recurrent disease by decapsulation and partial deserosation.

Encapsulating peritoneal sclerosis: a rare, serious but potentially curable complication of peritoneal dialysis-experience of a referral centre in Germany.

Background: Chronic peritoneal dialysis (PD) can be complicated by encapsulating peritoneal sclerosis (EPS), the most severe complication associated with long-term PD.

Methods: In this study, we retrospectively analysed 49 EPS patients regarding clinical presentation, histopathological findings, treatment and long-term clinical outcome at our referral centre. Patients were divided into two clinical categories: severe and mild/moderate.

[Is the traditional open donor nephrectomy in living donor renal transplantation still up to date?].

Background: Living donor kidney transplantation is a well-established method to reduce time on the waiting list. Although the laparoscopic donor nephrectomy has already been established worldwide, more than 80% of the living donor nephrectomies are performed as a traditional open donor nephrectomy in Germany. The aim of our study was to analyze perioperative data and long-term outcome of donors and recipients following open donor nephrectomy.

[AB0-incompatible kidney transplantation--case 13/2009].

Unlabelled: PATIENT HISTORY AND CLINICAL FINDINGS: A 49-year old patient with chronic kidney disease was referred for evaluation of living donor kidney transplantation from his spouse in a blood group incompatible setting.

Clinical Investigations: Patient blood group was 0, donor blood group was A, subtype A. recipient isoagglutinin titer against donor erythrocytes was 1:64.

Everolimus interferes with the inflammatory phase of healing in experimental colonic anastomoses.

Background: Delayed wound healing is a serious side effect of mTOR inhibitor-based immunosuppression after solid organ transplantation. The aim of this study was to test the hypothesis that the mTOR inhibitor everolimus interferes with the inflammatory phase of healing in experimental colonic anastomoses.

Materials And Methods: Thirty male Sprague-Dawley rats received a colonic anastomosis.

The impact of a micro-lightguide spectrophotometer on the intraoperative assessment of hepatic microcirculation: a pilot study.

Introduction: The intraoperative measurement of the peripheral microperfusion after liver transplantation is connected with quite an effort and a continuous evaluation in the postoperative follow up is not possible till now.

Patients And Methods: Before mobilization of the liver during surgical intervention the following parameters were measured on the surface of the right (segment 7/8) and the left (segment 2/3) liver lobe with a probe, combining laser-Doppler-flowmetry and tissue-spectrometry: the oxygen saturation (SO2), the relative capillary hemoglobin concentration (rHB), the blood flow (flow) and the blood flow velocity (velo). In addition the peripheral oxygen saturation (SPO2), the central venous pressure (ZVP), the positive endexspiratory pressure (PEEP) and the hemoglobin (HB) were documented.

A prospective randomized multicenter trial comparing histidine-tryptophane-ketoglutarate versus University of Wisconsin perfusion solution in clinical pancreas transplantation.

We aimed to evaluate early pancreas transplant graft function after histidine-tryptophan-ketoglutarate (HTK) versus University of Wisconsin (UW) perfusion. Prospective randomized multicenter study including 68 pancreas transplantations stratified according to preservation fluid used (27 HTK vs. 41 UW).

Simultaneous adrenal and extra-adrenal myelolipoma - an uncommon incident: case report and review of the literature.

Background: Extra-adrenal myelolipomas are rare benign tumours. Other soft tissue tumours such as well-differentiated liposarcomas appear morphological almost identical. Preoperative imaging and especially biopsy are important tools to diagnose these lesions.

Preoperative evaluation of potential living related kidney donors with high-spatial-resolution magnetic resonance (MR) angiography at 3 Tesla: comparison with intraoperative findings.

Purpose: The purpose of this prospective study was to determine the feasibility and accuracy of high-spatial-resolution MR imaging at 3 Tesla (T) in the preoperative evaluation of potential living related kidney donors.

Materials And Methods: Eighteen potential donors (8 men, 10 women; mean age, 50.1 +/- 14.

The 'Blind Innsbruck Ostomy', a cutaneous enterostomy for long-term histologic surveillance after small bowel transplantation.

Intestinal transplantation has evolved into an established treatment for patients with intestinal failure. Although acute rejection episodes are reversible, late onset and chronic rejections remain major prognostic factors. We describe here our experience with endoscopic and histologic long-term monitoring through a cutaneous enterostomy.

Liver resection without hilus preparation and with selective intrahepatic hilus stapling for benign tumors and liver metastasis.

Background: Nowadays, liver resection is a routine operative procedure in surgical centers, and strategies must be aimed at avoiding additional risk factors. Extrahepatic isolation of portal vein, hepatic artery and hepatic duct, as well as lymphadenectomy of the liver hilum are generally accepted steps of liver resection, even for metastatic and benign indications. Our primary aim was to analyze the feasibility, blood loss, blood transfusion requirements, incidence of complications, and outcome using the approach for intrahepatic devascularization leaving the extrahepatic hilus untouched.