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Gunther U.,Medical Clinic i Gastroenterology | Bojarski C.,Medical Clinic i Gastroenterology | Buhr H.-J.,Vascular and Thoracic Surgery | Zeitz M.,Medical Clinic i Gastroenterology | Heller F.,Medical Clinic i Gastroenterology
International Journal of Colorectal Disease | Year: 2010

Purpose: Familial adenomatous polyposis (FAP) and Peutz-Jeghers syndrome (PJS) are hereditary polyposis syndromes with a high risk for benign small-bowel polyps and cancer. The aim of this study was to assess the prevalence of small-bowel polyps beyond the duodenum in patients with FAP and PJS and to examine the clinical value and the optimal interval of capsule endoscopy (CE) for the surveillance of small-bowel polyps in patients with FAP. Methods: Between 2002 and 2009, standard gastroscopy, duodenoscopy, and CE were performed on 19 consecutive patients with hereditary polyposis syndromes (FAP n∈=∈15; PJS n∈=∈4). The number, size, and location of polyps detected by CE were assessed. Five FAP patients had repeated CEs in intervals of 2-7 years. Results: In 13 of the 15 (87%) FAP patients, small-bowel polyps were detected by CE ranging from estimated <5 mm to >10 mm in size. Thereof, in four patients, medium-sized (5-10 mm) or large-sized (>10 mm) polyps were seen-all of them located in the proximal jejunum. In three FAP patients with repeated CEs, the latest CE displayed medium- and large-sized polyps in the proximal jejunum, whereas previous CEs had detected only small-sized (<5 mm) polyps. In three of the four PJS patients, large-sized small-bowel polyps were visualized by CE which could then be removed by double-balloon enteroscopy (DBE) or surgical resection. Conclusion: CE is an effective and safe method for small-bowel surveillance in FAP and PJS. © 2010 Springer-Verlag. Source

Frick V.O.,University of the Saarlands | Justinger C.,University of the Saarlands | Rubie C.,University of the Saarlands | Graeber S.,Saarland University | And 2 more authors.
Oncology Reports | Year: 2012

Pulmonary complications together with surgical complications are the most frequent causes for morbidity and mortality after thoracoabdominal esophagectomy. The continuous improvement of surgical techniques has led to a decrease in surgical complications, whereas up to 30% of the patients develop postoperative pulmonary complications such as acute lung injury (ALI) or even the more severe acute respiratory distress syndrome (ARDS), which are characterized by an acute inflammation in the lung parenchyma and the airspace. Evidence from several studies indicates that a complex network of inflammatory cytokines and mediators play a key role in mediation, amplification, and perpetuation of the process of lung injury and that the thoracotomy itself is a risk factor for developing ALI or ARDS. In this trial, the cytokine levels of IL6, IL8 and IL10 were measured and compared in 30 patients who had undergone an extended radical thoracoabdominal esophagectomy for esophageal cancer, via anterolateral thoracotomy (n=17) or posterolateral thoracotomy (n=13). Patients of both groups were similar in terms of age, sex and preoperative pulmonary function as well as in the anesthetic procedures they have undergone. All patients displayed significantly increased serum levels of IL6 and IL8 after thoracoabdominal esophagectomy. However, patients who were subjected to an anterolateral thoracotomy were reported with significantly higher serum levels of IL6 and IL8 compared to patients who had received a posterolateral thoracotomy. Thus, the choice of the thoracotomy method during the thoracoabdominal esophagectomy and the resultant cytokine levels may contribute to the occurrence of postoperative pulmonary complications and may have an impact on the extent and severity of the surgical stress. Source

Schmidt T.,University of Heidelberg | Lordick F.,University of Leipzig | Herrmann K.,University of Wurzburg | Ott K.,Vascular and Thoracic Surgery
JNCCN Journal of the National Comprehensive Cancer Network | Year: 2015

In esophageal cancer, functional imaging using PET can provide important additional information beyond standard staging techniques that may eventually lead to therapeutic consequences. The most commonly used tracer is fluorodeoxyglucose (FDG), which has high avidity for both squamous cell cancer and adenocarcinoma of the esophagus. The value of FDG-PET is limited in early esophageal cancer, whereas additional information is provided in 15% to 20% of locally advanced tumors. Neoadjuvant treatment is currently the standard of care in locally advanced esophageal cancer in most countries because randomized studies have shown a significant survival benefit. Because responders and nonresponders have a significantly different prognosis, functional imaging to tailor preoperative treatment would be of interest. Metabolic imaging using FDG-PET is an established method of response evaluation in clinical trials. The value of metabolic response evaluation is known to depend on the histologic subtype and the type of preoperative treatment delivered. An association of FDG-PET-based metabolic response with clinical response and prognosis was shown for absolute standardized uptake value (SUV) or a decrease of SUV levelsbefore, during, and after therapy. However, contradictory findings exist in the literature and prospective validation is missing. Additionally,no consensus exists on time points or cutoff levels for metabolic response evaluation. Furthermore, correct prediction of a posttherapeutic pathologic complete remission is currently not possible using FDG-PET. Of high interest is early response monitoring during preoperative chemotherapy, with potential subsequent therapy modification. This tailored approach still needs validation in prospective multicenter trials. © 2015 by the National Comprehensive Cancer Network. All rights reserved. Source

Staub E.,Merck KGaA | Buhr H.-J.,Vascular and Thoracic Surgery | Grone J.,Vascular and Thoracic Surgery
Oncogene | Year: 2010

Multiple expression signatures for the prediction of the site of origin of metastatic cancer of unknown primary origin (CUP) have been developed. Owing to their limited coverage of tumor types and suboptimal prediction accuracy on distinct tumors, there is still room for alternative CUP gene expression signatures. Whereas in past studies, CUP classifiers were trained solely on data from tumor samples, we now use expression patterns from normal tissues for classifier training. This approach potentially avoids pitfalls related to the representation of genetically heterogeneous tumor subtypes during classifier training. Two expression data sets of normal human tissues have been reanalyzed to derive an expression signature for liver, prostate, kidney, ovarian and lung tissues. In reciprocal validation, classifiers trained on either data set achieved overall accuracies greater than 97%. Classifiers trained on combined expression data from both normal tissue data sets were able to predict the site of origin in a cohort of 652 primary tumors with 90% accuracy. Prediction accuracies of primary cancer-based classifiers were in the same range, as determined by cross-validation on this cohort. For individual tumor types, normal tissue-based classifiers achieved sensitivities in the range of 64-99% and specificities in the range of 92-100%. Primary origins for 12 of 20 metastases were predicted correctly, with false predictions highlighting the need for accurate sample preparation to avoid contaminations by metastases-surrounding tissue. We conclude that gene expression patterns of normal tissues harbor phenotypic information that is retained in tumors and can be sufficient to recover the type of primary tumor from expression patterns alone. © 2010 Macmillan Publishers Limited All rights reserved. Source

Schaeffer B.,Ludwig Maximilians University of Munich | Johnson T.R.C.,Ludwig Maximilians University of Munich | Mang T.,Medical University of Vienna | Kreis M.E.,Vascular and Thoracic Surgery | And 2 more authors.
Academic Radiology | Year: 2014

Rationale and Objectives: To evaluate the benefits of dual-energy computed tomography (CT) colonography (DECTC) as a preoperative staging tool in patients with clinically suspected colorectal cancer (CRC). Materials and Methods: Twenty-two patients with colorectal neoplasia underwent preoperative abdominal DECTC on a dual-source scanner (SOMATOM Definition Flash; Siemens) operated at tube potentials of Sn140/100 kVp. Scans were evaluated for local tumor stage and the presence of synchronous intracolonic and extracolonic findings using dual-energy color-coded images. An enhancement ≥25 Hounsfield units (HU) was defined to indicate malignancy. Patients' effective doses were calculated. Results: Preoperative DECTC allowed for complete bowel evaluation in all patients, including subjects with stenosing CRC. DECTC revealed 22 carcinomas (mean enhancement, 47±12 HU). In total, 22 synchronous intracolonic lesions were detected, including 19 adenomas (meanenhancement, 51±19 HU). Benign structures showed enhancement <25 HU. Comparing DECTC to histopathology, 95% carcinomas and 71% synchronous lesions proximal to stenosing CRC could be verified. Mean estimated effective dose was 13.0±5.2mSv. Conclusions: Preoperative DECTC can be used as an accurate and dose-efficient primary-staging examination. Especially after incomplete optical colonoscopy, virtual colonoscopy enables full preoperative colonic assessment on the same day. Dual-energy CT enables distinction between neoplasia and non-neoplastic findings within and outside the colon. Therefore, DECTC can be regarded as a promising "one-stop" staging examination in patients with clinically suspected CRC. © 2014 AUR. Source

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