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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  133. Kongress der Deutschen Gesellschaft für Chirurgie; 20160426-20160429; Berlin; DOC16dgch249 /20160421/
    Publication Date: 2016-04-22
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 2
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  131. Kongress der Deutschen Gesellschaft für Chirurgie; 20140325-20140328; Berlin; DOC14dgch304 /20140321/
    Publication Date: 2014-03-25
    Keywords: ddc: 610
    Language: German
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  • 3
    ISSN: 1433-0385
    Keywords: Key words: Abdominal surgery ; Intensive care ; Long-term prognosis ; Quality of life ; Economy. ; Schlüsselwörter: Visceralchirurgie ; Intensivtherapie ; Langzeitprognose ; Lebensqualität ; Ökonomie.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Ressourcenknappheit erfordert heute den Nachweis von Effektivität und Effizienz medizinischer Maßnahmen. Intensivverläufe von 62 chirurgischen Patienten mit einer Dauer von ≥ 30 Tagen wurden retrospektiv in bezug auf Letalität, Langzeitprognose, Lebensqualität und das Kosten-Nutzen-Verhältnis anhand der Berechnung gewonnener qualitätskorrigierter Lebensjahre (QALY) untersucht. Die Krankenhausletalität lag bei 40,3 %. Die mediane Überlebenszeit entlassener Patienten (n = 37) betrug 3,7 Jahre und die berechnete 3-Jahres-Überlebensrate 56,4 %. Die häufigsten Todesursachen waren septische Komplikationen bzw. Multiorganversagen bei hospitalisierten und Tumorrezidive bei entlassenen Patienten. Die Mehrzahl der Überlebenden erreichte eine gute Lebensqualität (medianer gastrointestinaler Lebensqualitätsindex: 104 Punkte). Eine berufliche Rehabilitation gelang bei 30 %. Obwohl die prolongierte Intensivtherapie mit Ausgaben von 68 250,– DM pro gewonnenem QALY sehr kostenintensiv ist, ist sie vergleichbar mit anderen etablierten Maßnahmen im Gesundheitswesen (z. B. Hämodialysebehandlung). Ökonomische Gesichtspunkte dürften deshalb bei der Entscheidung zur Therapiebegrenzung keine Rolle spielen.
    Notes: Summary. Owing to increasing limitations on resources in health care, there is an urgent need to investigate effectiveness and efficiency of medical procedures. Therefore, we retrospectively studied the courses of 62 surgical patients who required at least 30 days of intensive care regarding mortality, long-term prognosis and quality of life. Additionally, a cost analysis was made using quality-adjusted life years (QALYs). The hospital mortality was 40.3 %. The overall median survival time of discharged patients (n = 37) was 3.7 years and the calculated 3-year survival was 56.4 %. The most frequent causes of death were septic complications or multiple organ failure in hospitalized patients and tumor relapses in discharged patients. In most of the surviving patients quality of life (median Gastrointestinal Quality of Life Index: 104 points) was good. About 20 % of the discharged patients were able to return to work. Although extended intensive care therapy is extremely expensive (DM 68,250 per QALY), these costs are comparable with other accepted procedures in medicine (i. e. hemodialysis). Therefore, economical aspects should not be a generalized reason for withdrawing or withholding intensive care therapy.
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  • 4
    ISSN: 1433-0385
    Keywords: Key words: Adenocarcinoma of the duodenum ; Whipple's operation ; Segmental duodenectomy. ; Schlüsselwörter: Adenocarcinom des Duodenums ; Whipple-Operation ; Duodenumsegmentresektion.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. In einer retrospektiven Auswertung wurden die Ergebnisse der chirurgischen Therapie des primären Duodenalcarcinoms analysiert. Zwischen 1983 und 1998 wurden 18 Patienten (14 Männer, 4 Frauen) mit einem medianen Alter von 58 Jahren (36–75 Jahre) wegen eines Duodenalcarcinoms behandelt. Die führenden klinischen Symptome waren unspezifische Oberbauchschmerzen (61 %), Gewichtsverlust (44 %) und Anämie (38 %). Bei 10 Patienten (56 %) konnte eine Resektion des Tumors vorgenommen werden. Es wurden 8 Whipple-Operationen und 2 Duodenumsegmentresektionen durchgeführt. Die TNM-Kategorie der 10 resezierten Tumoren zeigte 2mal ein pT2-, 6mal ein pT3- und 2mal ein pT4-Stadium. Bei 8 Patienten (80 %) fanden sich positive Lymphknoten (pN1), 2mal wurden intraoperativ Lebermetastasen (pM1) lokal excidiert. Die UICC-Klassifikation der Tumoren lautete: UICC-Stadium I (n = 1), II (n = 1), III (n = 6), IV (n = 2). In 6 der 8 irresektablen Fälle wurde eine palliative Gastroenterostomie angelegt. Kein Patient verstarb an der chirurgischen Therapie. Die Morbidität der operativen Eingriffe betrug 22 % (4/18). Die 1-, 3- und 5-Jahres-Überlebensrate nach Resektion betrugen 90 %, 66,7 % und 53,3 %. Nach palliativer Operation lebte kein Patient länger als 25 Monate, wodurch sich ein signifikanter Überlebensvorteil (p 〈 0,0027) für Patienten mit resektablen Tumoren errechnete. Die vorliegenden Daten zeigen, daß bei insgesamt eher unspezifischer klinischer Symptomatik die meisten Duodenalcarcinome erst in fortgeschrittenen Tumorstadien diagnostiziert werden. Bei dadurch eingeschränkter Resektabilität kann dennoch durch die chirurgische Therapie eine im Vergleich zu anderen periampullären Tumoren günstige Prognose erreicht werden.
    Notes: Summary. Between January 1983 and August 1998, a total of 18 patients (14 men, 4 women; median age 58 years, range 36–75 years) with primary adenocarcinoma of the duodenum underwent surgical therapy. Main clinical symptoms were upper abdominal pain (61 %), weight loss (44 %) and anaemia (38 %). The tumors were resectable in 10 patients (56 %), and eight Whipple operations and two segmental duodenectomies were performed. Tumor classification according to the TNM system was pT2 (n = 2), pT3 (n = 6) and pT4 (n = 2). In eight patients, local lymph nodes were tumor positive (pN1), and in two patients synchronous liver metastases were excised. The UICC stage of the resected tumors was: stage I (n = 1), stage II (n = 1), stage III (n = 6) and stage IV (n = 2). In irresectable cases (n = 8), the patients underwent palliative (n = 6) or explorative (n = 2) operations. With no operative mortality, overall morbidity was 22 % (4/18). Patients' survival was 90 %, 66.7 % and 53.3 %, respectively, at 1, 3 and 5 years after resection. None of the patients with irresectable tumors survived longer than 25 months. Survival was significantly better for the resection group (P = 0.0027). Due to the often unspecific symptoms, the diagnosis of duodenal adenocarcinoma is frequently established at advanced tumor stages, resulting in a low resectability rate. Radical surgical resection of the tumors, however, is able to provide a more favorable prognosis for duodenal carcinoma than for other periampullary tumors.
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  • 5
    ISSN: 1573-7276
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 6
    ISSN: 1432-1335
    Keywords: Her2/neu oncogene product p185 ; Gastric carcinoma ; Clinicopathological variables ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The expression of theHer2/neu gene product p 185 was retrospectively analyzed in 58 patients with gastric carcinoma. The results were correlated to various clinicopathological and prognostic factors. Positive membrane staining for p185 could be detected in 38% of the patients (22/58). Membrane staining was significantly greater in well and moderately differentiated tumors of the intestinal type when compared with poorly differentiated lesions and carcinomas of the diffuse type (P〈0.01). Positive membrane staining did not correlate with site and tumor stage, but T1 lesions had less membrane staining than more advanced primary tumors. Overall survival showed no difference between p185-positive and negative cases. Multivariate analysis defined a subgroup of curatively resected patients with stage III and IV disease that had a statistically significant poorer survival when p185 was overexpressed (P=0.005). Overexpression of theHer2/neu product p185 appears to be associated with intestinal-type gastric carcinoma and may sociated with intestinal-type gastric carcinoma and may help in identifying a subset of patients at increased risk for shorter survival.
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  • 7
    ISSN: 1432-1335
    Keywords: Gastric carcinoma ; Gastric surgery ; Multimodality treatment ; Chemotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Surgery still represents the therapy of choice for patients with primary gastric adenocarcinoma. The best survival results can be achieved if a potentially curative (R0) resection can be performed whatever the extent of resection of the primary tumor (total versus subtotal distal gastrectomy). Either procedure should be accompanied by systematic lymph node dissection since lymphadenectomy has relevant diagnostic (i.e. staging) and therapeutic implications (i.e. improved survival in stage II/IIIA disease). Since most gastric carcinomas are diagnosed in advanced tumor stages, the number of patients to be treated curatively by surgery alone remains limited. Multimodality treatment, consisting of chemotherapy and surgery, may be an encouraging alternative strategy. With actual chemotherapy protocols (i.e. 5-FU/doxorubicin/methotrexate, etoposide/doxorubicin/cisplatin) high remission rates in locally advanced irresectable lesions without distant metastases can be induced. Survival in these patients has been significantly improved after chemotherapy and second-look surgery. The effectiveness of these protocols in an adjuvant setting seems a worthwhile study for the future. In addition, immunological and somatic gene therapy may be of therapeutic impact in the next decade.
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  • 8
    ISSN: 1432-2218
    Keywords: Total gastrectomy ; Intra-abdominal septic complications ; Interventional therapy ; Reduction in relaparotomies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Septic complications following total gastrectomy usually require relaparotomy, which is associated with a high operative mortality. Due to the improvement of percutaneous drainage of abdominal abscesses we prefer this therapy for septic complications after total gastrectomy. Among 141 total gastrectomies, 14 patients developed subphrenic abscesses. While 2 patients required relaparotomy, 12 had interventional therapy by sonographically guided drainage and insertion of a pigtail catheter. The catheters were irrigated daily, and the patients received systemic antibiotics. Complete resolution of the abscess cavity was achieved, even in 1 case with simultaneous duodenal stump insufficiency without increasing morbidity. The hospital stay was prolonged for an average of 20 days by this “conservative” treatment. The management of septic complications following total gastrectomy with interventional techniques may reduce the number of operative reinterventions. The indication for such a therapy, however, needs to be evaluated on an individual basis.
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  • 9
    ISSN: 1435-2451
    Keywords: Gastric carcinoma ; Chemotherapy ; EAP ; Second-look operation ; Magencarcinom ; Chemotherapie ; EAP ; Sekundäreingriff
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Etoposid, Adriamycin und Cisplatin (EAP) führten bei 55 Patienten (Pat.) mit fortgeschrittenem Magencarcinom zu einer partiellen und kompletten Remission (PR + CR) von 70%. 16 Pat. hatten ein lokal fortgeschrittenes, primär irresektables Carcinom. Die PR + CR betrug hier 87% (14/16). 8 dieser Pat. wurden einem Sekundäreingriff zugeführt. Neben anderen Verfahren war in 4 Fällen eine Gastrektomie möglich. Die CR bestätigte sich bei 5 Pat. auch histologisch. Die Resektionsquote beim lokal fortgeschrittenen Magencarcinom mag durch präop. Gabe von EAP verbessert werden.
    Notes: Summary Etoposide, adriamycin, and cisplatin (EAP) led to partial or complete remission (PR + CR) in 70% in 55 patients with advanced gastric carcinoma. Sixteen patients had local advanced tumors for which primary resection was not possible. PR + CR was 87% (14/16) in this group. In eight patients, a second-look operation was performed. Among other procedures, gastrectomy was achievable in 4 cases. CR was confirmed histologically in 5 patients. The resectability rate in locally advanced gastric carcinoma may improve after preoperative application of EAR
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  • 10
    ISSN: 1435-2451
    Keywords: Gastric carcinoma ; Keratin ; Villin ; Brush border hydrolases
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Siebzehn Magenkarzinome (intestinal n=12; diffus n=1; Mischtyp n=4) und ein BarrettKarzinom wurden prospektiv hinsichtlich der Expression verschiedener Keratinpolypeptide sowie der Bürsten-saummarker Villin, Sucrase Isomaltase and Aminopeptidase N immunfluoreszenzmikroskopisch untersucht. Unabhängig vom histologischen Typ exprimierten alle Karzinome die Keratinpolypeptide 8, 18 and 19 and reagierten mit dem breit spezifischen Keratinantikbrper KL1. Das Keratin 7 hingegen wurde nur in einem Karzinom von nahezu allen Tumorzellen and bei zwei weiteren Karzinomen nur von einigen Tumorzellen exprimiert. Die weitergehende Differenzierung der verschiedenen hi stologischen Typen des Magenkarzinoms ist mit Hilfe der Keratinantikörper nicht m6glich. Villin war in 80% aller Karzinome and Sucrase Isomaltase and Aminopeptidase N waren in je 67%, wiederum ohne histologiespezifische Unterschiede, positiv. Die Nachweisbarkeit der Bürstensaummarker, charakteristisches Kennzeichen des intestinalen Epithels, verdeutlicht das hohe Maß der intestinalen Differenzierung der Magenkarzinome, ohne daß eine Zuordnung zu bestimmten histologischen Typen möglich erscheint.[/p]
    Notes: Summary Seventeen gastric carcinomas (intestinal n=12; diffuse n=1; mixed type n=4) and one Barrett's carcinoma were prospectively studied by immunohistochemistry for the expression of different keratin polypeptides and of the brush border markers villin, sucrase isomaltase and aminopeptidase N. All carcinomas expressed the keratin polypeptides 8, 18, and 19 and were stained by the broad specific keratin antibody KL1, irrespective of histologic type. Keratin 7, however, was expressed in only one carcinoma in most tumor cells and in two further carcinomas in some tumor cells. Thus, specific differentiation of the various histologic types of gastric carcinoma does not seem to be aided by the use of keratin antibodies. Villin was positive in 80% of the tumors and sucrase isomaltase and aminopeptidase N were positive in 67% respectively with no obvious histologic difference. The frequent positivity of the brush border markers, usually typical for intestinal epithelium, reflects the high degree of intestinal differentiation of gastric carcinomas, but again does not seem to be associated with a particular histologic type.[/p]
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