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Steinau an der Straße, Germany

Muller-Wille R.,University of Regensburg | Wohlgemuth W.A.,University of Regensburg | Heiss P.,University of Regensburg | Wiggermann P.,University of Regensburg | And 5 more authors.
CardioVascular and Interventional Radiology | Year: 2013

Purpose: To determine the feasibility and efficacy of transarterial endoleak embolization using the liquid embolic agent ethylene vinyl alcohol copolymer (Onyx). Methods: Over a 7-year period eleven patients (6 women, 5 men; mean age 68 years, range 37-83 years) underwent transarterial embolization of a type II endoleak after endovascular aortic aneurysm repair using the liquid embolic agent Onyx. Two patients (18 %) had a simple type II endoleak with only one artery in communication with the aneurysm sac, whereas 9 patients (82 %) had a complex type II endoleak with multiple communicating vessels. We retrospectively analyzed the technical and clinical success of transarterial type II endoleak embolization with Onyx. Complete embolization of the nidus was defined as technical success. Embolization was considered clinically successful when volume of the aneurysm sac was stable or decreased on follow-up CT scans. Result: Mean follow-up time was 26.0 (range 6-50) months. Clinical success was achieved in 8 of 11 patients (73 %). Transarterial nidus embolization with Onyx was technically successful in 6 of 11 patients (55 %). In three cases the nidus was embolized without direct catheterization from a more distal access through the network of collateral vessels. Conclusion: Onyx is a favorable embolic agent for transarterial endoleak embolization. To achieve the best clinical results, complete occlusion of the nidus is mandatory. © 2013 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).

Muller-Wille R.,University of Regensburg | Iesalnieks I.,University of Regensburg | Dornia C.,University of Regensburg | Ott C.,University of Regensburg | And 6 more authors.
International Journal of Colorectal Disease | Year: 2011

Purpose Severe postoperative intra-abdominal septic complications (IASC) such as an anastomotic leak, intraabdominal abscess, and fistula are significantly associated with the presence of spontaneous intra-abdominal abscess at the time of laparotomy in patients with Crohn's disease (CD). The purpose of this study was to compare the incidence of severe postoperative IASC in patients undergoing intestinal resections with and without preoperative percutaneous abscess drainage (PAD) before definitive surgery. Methods Using a prospective surgical database, we searched for patients with CD and spontaneous intra-abdominal abscesses who underwent intestinal resection at our hospital from May 2005 to February 2009. Postoperative IASC were defined as anastomotic leaks, abscess, and fistula within 1 month after surgery. We compared the incidence of postoperative IASC in patients with (group I) and without (group II) preoperative PAD (Fisher's exact test). Results We identified 25 patients (15 men, 10 women; mean age, 31 years) with spontaneous intra-abdominal abscesses. PAD was performed in 12 of 25 patients (48%), with an average of 37 days before surgery (range, 6- 83 days). The overall rate of postoperative IASC was 48% (12 of 25 patients). In group I, postoperative IASC occurred in 3 of 12 patients (25%). In group II, postoperative IASC were assessed in 9 of 13 patients (69%). The differences between these two groups were considered to be statistically significant (p=0.04). Conclusion PAD of intra-abdominal abscesses before surgery could significantly reduce the occurrence of severe postoperative IASC in patients with CD. © Springer-Verlag 2011.

Ried M.,University of Regensburg | Lehle K.,University of Regensburg | Neu R.,University of Regensburg | Diez C.,University of Regensburg | And 3 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2015

OBJECTIVES: The effects of cisplatin on the lung parenchyma during hyperthermic intrathoracic chemotherapy perfusion have not been analysed in detail. The objective of this study was to evaluate both the concentration and depth of the penetration of cisplatin in human lung tissue after hyperthermic exposure under ex vivo conditions. METHODS: This experimental study was approved by the local ethics committee. Twelve patients underwent pulmonary wedge resections after elective thoracic lobectomies were performed (resected lobe), and the lung tissue (approximately 1-2 cm3) was incubated (in vitro) with cisplatin (0.05 mg/ml; 60 min, 42°C). Subsequent tissue beds (depth, 0.5 mm; median weight, 70-92 mg) were prepared from the outside to the middle, and the amount of cisplatin per tissue weight was analysed using atomic absorption spectrometry. Afterwards, the penetration of cisplatin depth was calculated and related to the different concentrations per tissue. RESULTS: Cisplatin penetrated into the human lung tissue after ex vivo hyperthermic exposure. The median amount of platinum [nmol cisplatin/g lung tissue] decreased significantly (P ≤ 0.05) depending on the penetration depth: 32 nmol/g (1 mm), 20 nmol/g (2 mm) and 6.8 nmol/g (4 mm). The calculated median concentrations of cisplatin (μg/ml) were 2.4 μg/ml (1 mm), 1.4 μg/ml (2 mm) and 0.5 μg/ml (4 mm), respectively. CONCLUSIONS: Under ex vivo hyperthermic conditions, cisplatin diffused into human lung tissue. The median penetration depth of the cisplatin was approximately 3-4 mm. The penetration of cisplatin into lung tissue may affect the local therapy of residual tumour cells on the lung surface using hyperthermic intrathoracic chemotherapy perfusion in patients with malignant pleural tumours. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.

Lampe B.,Nightingale | Kroll N.,Nightingale | Piso P.,Krankenhaus Barmherzige Bruder Regensburg | Forner D.M.,Sana Klinikum Remscheid | Mallmann P.,Universitats Frauenklinik Cologne
International Journal of Gynecological Cancer | Year: 2015

Introduction: This study aimed to investigate Sugarbaker's peritoneal cancer index (PCI) as a prognostic indicator for the resectability of ovarian carcinoma (OC), as depicted in the study using the completeness of cytoreduction score (CCS). Currently, the intraoperative assessment of operability in OC surgery is primarily a subjective measurement that is dependent on the surgeon. Methods: The retrospective data from 98 patients with OC International Federation of Gynecology and Obstetrics (FIGO) III to IV who had received surgery between January 2010 and December 2011 were analyzed. The PCI and the CCS were determined retrospectively using surgical reports, histological findings, and intraoperative photographic documentation. Receiver operating characteristic curves and ordinal regression were applied to evaluate the predictability of CCS using the PCI. Results: Of 98 patients, 80 (81.6%) were staged FIGO III and 18 (18.4%) FIGO IV. A statistically significant correlation was demonstrated between the PCI and CCS (P G 0.01). A receiver operating characteristic curve with an area under the curve of 0.839 demonstrated the high precision in discrimination with which the PCI could predict the CCS. Using ordinal regression, it was possible to estimate the probabilities of achieving CCS 0, CCS 1, CCS 2, or CCS 3 for a given PCI (pseudo R2 according to Cox and Snell 0.428, Nagelkerke 0.476, and McFadden 0.244). Conclusions: The PCI more precisely defined the heterogeneous group of patients with OC FIGO III. The PCI provided objectivity and reproducibility, and it seems to be a possible prognostic indicator for OC resectability. Copyright © 2014 by IGCS and ESGO.

Marz L.,Krankenhaus Barmherzige Bruder Regensburg | Piso P.,Krankenhaus Barmherzige Bruder Regensburg
Onkologe | Year: 2015

Background: Pseudomyxoma peritonei (PMP) is a rare malignancy of the abdomen with an incidence of only 1–2 cases per 1 million inhabitants per year. The most common site of origin of PMP is as a mucinous neoplasm of the appendix and other extra-abdominal or intra-abdominal organs as the primary site are much rarer. Method: Research and analysis of the current literature. Results: The classification into low-grade and high-grade PMP is carried out according to the morphological appearance and growth pattern. Low-grade PMP shows cells with smooth nuclei and mostly acellular mucin, whereas high-grade PMP is characterized by massive atypia of the nuclei partly with signet ring cells and a clearly increased cell architecture in the mucin. Low-grade PMP grows in a displacing manner and high-grade PMP can infiltrate abdominal organs. The cells in PMP show a so-called redistribution phenomenon where cancer cells are distributed within the abdominal cavity and settle in peritoneal folds. Hematogenous metastasis is rare. The most common symptom of PMP is an increase in abdominal girth, followed by an unclear pelvic tumor in women and a newly developed inguinal hernia in men. In 2 out of 10,000 laparotomies PMP is an incidental finding. For the diagnostics ultrasound examination and computer tomography (CT) are most often used. Best practice in diagnostics is laparoscopy during which tissue samples should be collected. The treatment of choice, when possible, is complete cytoreduction with removal of the mucin in combination with an intraperitoneal chemotherapy which can be performed during the operation as hyperthermic intraperitoneal chemotherapy (HIPEC) or afterwards as early postoperative intraperitoneal chemotherapy (EPIC). The intraperitoneal administration of chemotherapy as an aerosol, known as pressurized intraperitoneal aerosol chemotherapy (PIPAC) is at present in the trial stage with results still pending. Other forms of treatment, such as systemic chemotherapy and abdominal irradiation are only used with palliative intent. If complete cytoreduction is achieved the prognosis is good with an average survival time of 16.3 years but the prognosis is poorer if tumor cells remain within the abdomen. If intraperitoneal chemotherapy (HIPEC or EPIC) is administered the overall survival and the progression-free interval are also increased. © 2015 Springer-Verlag Berlin Heidelberg

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