Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Proceed order?

Export
  • 1
    Call number: QZ268:041/3
    Type of Medium: Book
    Pages: xiii, 924p. , ill.
    ISBN: 3540659633 (alk. paper : [v. 3])
    Language: German
    Note: v. 1 Endokrine Chirurgie / M. Rothmund -- [v. 2]. Gastroenterologische Chirurgie -- [v. 3]. Onkologische Chirurgie / J.R. Siewert.
    Location: DKFZ
    Signatur Availability
    BibTip Others were also interested in ...
  • 2
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé La vidange, la sécrétion acide, les changements de la muqueuse, et l'importance du reflux duodénogastrique et gastrooesophagien de l'estomac monté dans le thorax pour remplacer l'oesophage ont été étudiés chez 12 patients 6 à 12 mois après leur intervention. Bien qu'aucune pyloroplastie n'ait été réalisé, la vidange d'un repas semi-solide était accélérée de façon significative par rapport aux contrôles. On n'a trouvé aucun résidu d'aliments dans l'estomac à l'endoscopie après une nuit de jeûne. La vidange gastrique était nettement accélérée et était corrélée avec un reflux duodénogastrique à travers le pylore dénervé. Malgré la persistance de sécrétion acide dans l'estomac vagotomisé, il n'y avait pas de reflux gastrooesophagien pathologique, ni d'oesophagite en amont de l'anastomose cervicale. Aux biopsie gastriques, on a mis en évidence une gastrite modérée de la muqueuse antrale, alors que la métaplasie était rare. Il n'est pas nécessaire d'effectuer un procédé de drainage de l'estomac monté dans le thorax pour faciliter la vidange gastrique des repas semi-solides. Le reflux oesophagien postopératoire est évité lorsque l'on pratique une transposition thoracique complète de l'estomac avec oesophagogastrostomie cervicale.
    Abstract: Resumen El vaciamiento, la secreción ácida, los cambios en la mucosa, y el reflujo duodenogástrico y gastroesofágico en el estómago intratorácico fueron estudiados en 12 pacientes, junto con la evolución clínica en los 6–12 meses posteriores al reemplazo esofágico por medio de un estómago intratorácico sin piloroplastia. Aunque no se realizó piloroplastia, el vaciamiento de una comida semisólida del estómago así interpuesto apareció significativamente acelerado en comparación con los controles. No se detectó residuo alimenticio en el estómago a la endoscopia después de una noche de ayuno. El acelerado vaciamiento gástrico se correlaciona con reflujo gastroduodenal espontáneo a través del píloro denervado. A pesar de una persistente secreción ácida en el estómago intratorácico vagotomizado, no se encontraron reflujo gastroesofágico patológico ni esofagitis proximal a la anastomosis cervical. Las biopsias gástricas generalmente revelaron gastritis leve en la mucosa antral, pero la metaplasia fue rara. El estómago intratorácico no requiere procedimientos de drenaje para facilitar el vaciamiento de alimentos semisólidos. La gastritis por reflujo postoperatorio puede ser prevenida con la transposición intratorácica total del estómago con esofagogastrostomía cervical.
    Notes: Abstract The emptying, acid secretion, mucosal changes, and duodenogastric and gastroesophageal reflux of the intrathoracic stomach were studied in 12 patients together with the clinical course 6–12 months after esophageal replacement. Although no pyloroplasty had been performed, the emptying of a semisolid meal from the interposed stomach was significantly accelerated compared to the controls. No residual food was found in the stomach at endoscopy after an overnight fast. Distinctly accelerated gastric emptying correlated with spontaneous duodenogastric reflux across the denervated pylorus. Despite a persistent acid secretion of the vagotomized intrathoracic stomach, no pathologic gastroesophageal reflux and no esophagitis were found proximal to the cervical anastomosis. Gastric biopsies mostly revealed mild gastritis of the antral mucosa, whereas metaplasia was rare. The intrathoracic stomach does not need a drainage procedure to facilitate semisolid emptying. Postoperative reflux esophagitis is prevented by complete intrathoracic stomach transposition with cervical esophagogastrostomy.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 3
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé On présente les résultats de 50 patients réopérés après échec d'une fundoplicature de Nissen: 21 patients (groupe 1) ont été opérés avant 1983; 29 patients (groupe 2) ont été opérés entre 1983 et 1988. Dans le groupe 1, la cause la plus fréquente de réintervention a été le “slipped Nissen” (48%). Dans le groupe 2, les plus fréquentes causes d'échec ont été: (1) le démontage partiel ou total de la fundoplicature (62%), (2) le “slipping” responsable d'un phénomène de télescopage (21%), et (3) la position trop basse de la fundoplicature (10%). Lorsque la grosse tubérosité était dissécable, on a refait une intervention de Nissen chaque fois que possible (42/50=84%). Dans le groupe 1, trois patients ont été traités par résection du cardia, un par une prothèse d'Angelchik et un par résection gastrique distale avec rétablissement de la continuité par une anse en Y. Dans le groupe 2, on a pratiqué une résection du fundus gastrique chez un patient; chez un autre, on a placé une prothèse d'Angelchik et chez le dernier, on a pratiqué une fundoplicature avec vagotomie gastrique sélective. Les résultats étaient excellents ou bons chez 66% des patients dans le groupe 1 et chez 76% dans le groupe 2. La mortalité opératoire était de 2% et la morbidité de 4%. En conclusion, une deuxième intervention de Nissen est recommandée quand l'anatomie de la région fundique peut être rétablie par voie abdominale. On doit faire un bilan préopératoire méticuleux avec pH et manométrie. On obtient de bons résultats dans 66 à 76% des cas après une deuxième opération de Nissen.
    Abstract: Resumen Se presentan 50 pacientes reoperados por fundoplicación de Nissen fallida; 29 (grupo 2) fueron intervenidos entre 1983 y 1988, y 21 (grupo 1) con anterioridad a 1983. En el grupo 1 el “Nissen deslizado” fue la causa más frecuente de reoperación (48%). En el grupo 2 las causas más frecuentes de falla de la operación inicial fueron: (1) ruptura parcial o total de la envoltura fúndica (62%), (2) deslizamiento de la fundoplicación dando lugar al fenómeno de “telescopización” (21%), y (3) creación de una fundoplicación demasiado baja (10%). La refundoplicación fue el procedimiento realizado en la mayoría de los casos en que fue posible disecar la envoltura fúndica previamente construida (42/50=84%). Tres pacientes del grupo 1 fueron tratados mediante resección del cardias, uno con colocación de una prótesis de Angelchik y uno mediante resección gástrica distal con anastomosis de Rouxen-Y. En el grupo 2 se realizó fundectomía en un paciente; en otro se implantó una prótesis de Angelchik y en uno tercero se realizó fundoplicación y vagotomía gástrica proximal. Los resultados fueron excelentes o buenos en 66% de los pacientes del grupo 1 y en 76% del grupo 2. La mortalidad operatoria fue 2% y la morbilidad 4%. En conclusión, se recomienda nueva fundoplicación cuando sea posible restablecer la anatomía de la región fúndica en el curso de la disección. En general la operación puede ser realizada por vía abdominal. Es necesaria una meticulosa evaluación preoperatoria de los pacientes excluyendo medición de pH de 24 horas y manometría. Se logran buenos resultados con la refundoplicación en 66% a 76% de los casos.
    Notes: Abstract Fifty patients reoperated for failed Nissen fundoplication are presented; 29 patients (group 2) were operated between 1983 and 1988 while 21 patients (group 1) were operated before 1983. In group 1, the “slipped Nissen” had been the most frequent cause of reoperation (48%). In group 2, the most frequent causes for the unsuccessful operation were: (1) partial or total disruption of the fundic wrap (62%), (2) slipping of the fundoplication, giving rise to the telescope phenomenon (21%), and (3) creation of a fundoplication which was too low (10%). Refundoplication was performed in cases where the dissection of the previously formed fundic wrap was possible (42/50=84%). In group 1, three patients were treated by resection of the cardia, one by an Angelchik prosthesis and one by a distal gastric resection with Roux-en-Y diversion. In group 2, fundectomy was performed in one patient; in another, an Angelchik device was inserted, and in a third patient, fundoplication and proximal gastric vagotomy were performed. The results were excellent or good in 66% of patients in group 1 and in 76% of group 2. Operative mortality was 2% and morbidity, 4%. In conclusion, repeat fundoplication is recommended when reestablishment of the fundic region anatomy is possible during dissection. The operation can usually be performed through an abdominal route. Meticulous preoperative evaluation of the patients including 24-hour pH measurement and manometry is necessary. Good results of refundoplication should be expected in 66%–76% of patients with recurrent disease.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 4
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé L'échoendoscopie (EES) et la tomodensitométrie (TDM) devraient être utilisées comme moyens complémentaires de l'évaluation dans la classification TMN du cancer de l'oesophage. L'EES est la modalité la plus précise pour déterminer le stade de la tumeur primitive et l'existence des métastases ganglionnaires médiastinales. La TDM doit être utilisée pour détecter l'infltration des autres structures médiastinales et l'existence de métastases à distance. La résonance magnétique n'est pas supérieure à la TDM pour le bilan du cancer de l'oesophage. L'ESS est très efficace dans la détection des métastases cervicales. La présence de métastases hépatiques, ganglionnaires abdominales, et/ou péritonéales doit être éliminée par la laparoscopie préopératoire à visée diagnostique. Les résultats de la classification préopératoire sont importants lorsqu'on considère l'ensemble des traitements qui comprend globalement la mucosectomie endoscopique, les procedés palliatifs et surtout la radio-chimiothérapie néoadjuvante. La classification correcte est capitale pour l'entrée des malades dans les essais thérapeutiques. La valeur du bilan postopératoire systématique n'a pas encore été démontrée.
    Abstract: Resumen La estadificaión del cáncer esofágico es importante para juzgar la resectabilidad del tumor y para evaluar el pronóstico del paciente. La relevancia del resultado de la estadificación preoperatoria depende de cual haya sido la estrategia utilizada para el manejo del cáncer esofégico. La ultrasonografía endoscópica (USE) y la tomografía computadorizada (TC) deben ser utilizadas como métodos complementarios para la estadificación TNM del cáncer del esófago. La USE es la modalidad más certera para estadificar el tumor primario y las metástasis ganglionares mediastinales. La TC debe ser usada para la detección de metástasis en otros órganos mediastinales y en ubicaciones distantes. En la actualidad la resonancia magnética no es un método superior, en cuanto a estadificación, a la TC. Para la detección de metástasis en los ganglios cervicales la ultrasonografía percutánea es una técnica muy apropiada. En casos de carcinoma avanzado del esófago distal deben utilizarse la laparoscopia preoperatoria para excluir la presencia metástasis hepáticas y perìtoneales, así como de infiltración tumoral de ganglios linfáticos abdominales. Los resultados de la estadificación preoperatoria tienen pertinencia si el manejo del cáncer esofágico comprende no sólo la cirugía, sino también la mucosectomía endoscópica, procedimientos paliativos primarios y, especialmente, la radio/quimioterapia neoadyuvante. En los ensayos clínicos terapéuticos es esencial disponer de una estadificación precisa antes de iniciar tratamiento para el análisis de los resultados. En la actualidad no está comprobado el papel de la estadificación postoperatoria como rutina en el curso de un programa de seguimiento.
    Notes: Abstract Endoscopic ultrasonography (EUS) and computed tomography (CT) should be used as complementary methods for TNM staging of esophageal cancer. EUS is the most accurate modality for staging primary tumor and mediastinal lymph node metastases. CT should be used to detect infiltration of other mediastinal organs and distant metastases. For esophageal cancer staging magnetic resonance imaging (MRI) is not superior to CT. For detection of cervical lymph node metastases percutaneous ultrasonography is appropriate. In patients with advanced distal carcinoma of the esophagus, hepatic and peritoneal metastases and intraabdominal lymph node infiltration should be ruled out by laparos-copy prior to surgery. The results of preoperative staging are relevant if the management of esophageal cancer comprises not only surgery but also endoscopic mucosectomy, primary palliative procedures, and especially neoadjuvant radiochemotherapy. Within therapeutic trials the precise staging prior to treatment is essential for analysis of the results. The value of routine postoperative staging during a follow-up program is yet unproved for esophageal cancer.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 5
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Minimal residual disease in patients with operable esophageal cancer is frequently missed by current noninvasive tumor staging. Here we applied an immunocytochemical cytokeratin assay that allows identification of individual esophageal carcinoma cells disseminated to bone marrow. Prior to therapy, bone marrow was aspirated from the upper iliac crest of 71 patients with esophageal cancer at various disease stages as well as an age-matched control group of 20 noncarcinoma patients. Tumor cells in cytologic bone marrow preparations were detected with monoclonal antibodies (mAbs) CK2, KL1, and A45-B/B3 to epithelial cytokeratins (CKs) using the alkaline phosphatase antialkaline phosphatase method. CK-positive cells were found in 14 (36.8%) of 38 cancer patients treated with curative intent and 16 (48.5%) of 33 patients with extended disease. The overall frequency of these cells was 1 per 4 × 105 to 82 per 4 × 105 mononuclear cells with no significant differences between patients at different tumor stages. After a short median follow-up of 9.5 months (3–24 months), 7 of 11 patients who underwent complete surgical resection but had tumor cells in bone marrow presented with tumor relapse compared to 2 of 19 corresponding patients without such cells ( p 〈 0.01). It was concluded that although bone marrow is not a preferential site of overt metastasis of esophageal cancer, the frequent occurrence of isolated tumor cells at this distant site indicates that hematogenous dissemination of viable malignant cells occurs early in tumor progression.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 6
    ISSN: 1432-2307
    Keywords: Key words E-cadherin ; Colorectal cancer ; Immunohistochemistry ; Mutation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  E-cadherin, a transmembrane cell adhesion molecule, has been observed to have an altered pattern of immunoreactivity in several types of carcinomas. In lobular breast cancer, loss of immunoreactivity has been shown to be due either to out-of-frame deletions or to nonsense mutations of the E-cadherin gene. We analysed 29 cases of completely resected colon carcinoma with immunohistochemistry using the HEC-D1 antibody. Normal protein expression similar to that in the adjacent nonmalignant mucosa was seen in 6 cases, whereas 23 tumours had reduced or absent E-cadherin expression. In the 8 cases with no expression of E-cadherin revealed by immunohistochemistry, the entire E-cadherin cDNA sequence was analysed. In these cases, sequence analysis failed to reveal any cDNA mutations despite the negative immunohistochemistry. Possible explanations for this discrepancy include regulatory defects in the E-cadherin promoter, abnormalities at the translation or protein processing levels and mutations in other parts of the gene that were not investigated by the cDNA analysis (e.g. intronic sequences), which could play a role in causing abnormal processing of the E-cadherin protein.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 7
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 8
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: p 〈 0.05). The overallrate of R0 resections was 87.2% (82.2% RTE, 87.1% THE). Overallsurvival was similar within the two study groups. Complete tumorremoval, T and N stages, and the lymph node ratio were identified asprognostic factors for long-term survival. Overall survival was betterafter RTE than after conventional THE in patients with involved lymphnodes. The mean number of resected lymph nodes per patient in the RTEgroup was 26.7. Positive lymph nodes were most common in theparacardial region and at the lesser curvature (72%/10.8% of allinvaded abdominal nodes). In the mediastinum positive nodes were mostcommon in the paraesophageal and paraaortal region (48%/27% of all mediastinal nodes). Patients with positive abdominal and mediastinallymph nodes had a poor long-term prognosis. Distal adenocarcinoma ofthe esophagus can be safely resected by RTE with two-fieldlymphadenectomy and endodissection. This technique allows radical |P`enbloc|P' resection of the tumor-bearing distal third of the esophagus, which includes the primary area of lymph node metastasis ofadenocarcinoma of the distal esophagus: the lower mediastinum andparacardial region. The analysis showed that RTE incurred fewer cardiaccomplications and a better overall survival in N1-positive patientswhen compared retrospectively to THE. Intraoperative mediastinoscopy allows controlled dissection of the upper mediastinum and biopsy of several mediastinal lymph nodes, with the advantage of providingadditional staging information.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 9
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Minimal residual disease in patients with operable pancreatic carcinoma is frequently missed by current noninvasive tumour staging. We applied an immunocytochemical cytokeratin assay that allows identification of individual pancreatic carcinoma cells disseminated to bone marrow. Prior to therapy, bone marrow was aspirated from the upper iliac crest of 48 patients with ductal adenocarcinoma of the pancreas at various disease stages and an age-matched control group of 33 noncarcinoma patients. Tumor cells in cytologic bone marrow preparations were detected with monoclonal antibodies (mAbs) CK2, KL1, and A45-B/B3 to epithelial cytokeratins (CK) using the alkaline phosphatase antialkaline phosphatase method. CK-positive cells were found in 14 (48.4%) of 31 cancer patients treated with curative intent and in 10 (58.8%) of 18 patients with extended disease. The overall frequency of these cells was 1 to 83 per 5 × 105 mononuclear cells with no significant differences between patients at different tumor stages and lymph node involvement. After a median follow-up of 22.8 months (range 3–48 months), 6 (40.0%) of 15 patients who underwent complete surgical resection but had tumor cells in bone marrow presented with distant metastasis and 7 (46.7%) had local relapse compared to none of 12 corresponding patients without such cells (p 〈 0.05). Univariate survival analyses revealed that the presence of CK-positive cells was predictive of reduced overall survival. In conclusion, anticytokeratin mAbs are reliable probes for the immunocytochemical detection of single pancreatic cancer cells disseminated to bone marrow. Thus the described technique may help identify patients with pancreatic cancer and at potentially high risk of early metastatic relapse. The results promise to be of important assistance for determining prognosis and the consequences in therapy of early stage pancreatic cancer.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 10
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Identification of pancreatic cancer in patients presenting with an enlarged pancreatic mass is a major diagnostic problem. Positron emission tomography (PET) using the radiolabeled glucose analogue 18F-fluorodeoxyglucose (FDG) has been suggested to provide excellent accuracy for noninvasive determination of suspicious pancreatic masses. We conducted a prospective study to verify these results. Forty-two patients admitted for pancreatic surgery underwent PET scanning. Image analysis was based on visual film evaluation and quantification of regional tracer uptake. PET imaging was visually analyzed by three observers blinded for the results of other diagnostic tests; they qualitatively graded the scans using a five-point scale (I = low to V = high) for the presence and intensity of focal FDG uptake. Diagnosis was proven by histology (n= 38) or follow-up (n= 4). Furthermore, the results of PET were compared with helical computed tomography (CT) and conventional ultrasonography (US), done during the routine diagnostic workup before pancreatic cancer surgery. Regarding only the results with scores of IV and V as positive for representing definite malignancy yielded a sensitivity of 71% and a specificity of 64% for film reading. Quantification of regional tracer uptake contributed no significant diagnostic advantage for differentiation between benign and malignant tumors. Helical CT revealed a sensitivity of 74% and a specificity of 45.5% and abdominal US 56% and 50%, respectively. We concluded that PET imaging provides only fair diagnostic accuracy (69%) for characterizing enlarged pancreatic masses. PET does not allow exclusion of malignant tumors. In doubtful cases, the method must be combined with other imaging modalities, such as helical CT. The results indicate that the number of invasive procedures is not significantly reduced by PET imaging.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
Close ⊗
This website uses cookies and the analysis tool Matomo. More information can be found here...