Determinants for postoperative complications after laparoscopic intestinal resection for Crohn's disease.

BACKGROUND: There is lack of studies that define parameters predictive of complications following laparoscopic resection for Crohn's disease. METHODS: Between 1998 and 2008, 182 patients underwent laparoscopic intestinal resection for Crohn's disease at a single institution. Conversion occurred in 12 patients (6.6%). We aimed to identify risk factors for short-term postoperative complications (<30 days) by using univariate and multiple regression tests. Complications were defined according to the Clavien-Dindo classification (grades I-V). Data were obtained from an institutional database and individual chart review retrospectively. RESULTS: There were 25 (13.7%) complications after surgery. According to the Clavien-Dindo classification, complications were classified as grade I in 9 patients, grade II in 9 patients, and grade IIIb in 7 patients. There were no deaths after laparoscopic surgery. A low level of hemoglobin after surgery (r (s )= -0.15, P = 0.0441) and an elevated CRP before surgery (r (s )= -0.16, P = 0.0346) seemed to increase the likelihood of postoperative complications. CONCLUSION: Laparoscopic surgery can be performed safely in Crohn's disease patients. An increased inflammation process before operation seems to be associated an eventful postoperative course.

Dendritic cell vaccination in medullary thyroid carcinoma.

PURPOSE: Prognosis and treatment effectiveness for medullary thyroid carcinoma (MTC) are strictly related to tumor stage. Palliative treatment options show no significant benefit. A promising treatment approach for human cancer is based on the vaccination of autologous dendritic cells (DCs). EXPERIMENTAL DESIGN: The objective of this study was to evaluate the effectiveness of DC vaccines in MTC patients. Therefore, we generated autologous tumor lysate-pulsed DCs from 10 patients suffering from advanced MTC for repeated vaccination. Mature DCs were derived from peripheral blood monocytes by using CD14 magnetic bead selection and subsequent culture in the presence of granulocyte macrophage colony-stimulating factor, interleukin 4, and tumor necrosis factor alpha with or without addition of IFN-gamma. DCs were loaded with tumor lysate and further injected into a groin lymph node. Toxicity, tumor marker profile, immune response, and clinical response were determined. RESULTS: Vaccination was well tolerated and induced a positive immunological response in all of the tested patients as evaluated by in vivo delayed-type hypersensitivity reactivity or in vitro intracytoplasmic IFN-gamma detection assay. Three patients had a partial response, 1 patient presented a minor response, and 2 patients showed stable disease. The remaining 4 patients had progressive disease. CONCLUSIONS: These data provide strong evidence that vaccination with tumor-lysate pulsed DCs results in the induction of a specific immune response in patients suffering from MTC. Objective clinical responses could be observed even for far-advanced disease. Therefore, we suggest that MTC is particularly suited for DC-based immunotherapy.

Extracorporeal albumin dialysis in patients with Amanita phalloides poisoning.

BACKGROUND: Ingestion of Amanita phalloides is the most common cause of lethal mushroom poisoning. The relative late onset of symptoms is a distinct diagnostic feature of Amanita intoxication and also the main reason of failure for extracorporeal removal of Amanita-specific toxins from the gut and circulation. PATIENTS AND METHODS: Extracorporeal albumin dialysis (ECAD) has been used on six consecutive patients admitted after A. phalloides poisoning with acute liver failure (ALF). RESULTS: Six patients, with mean age of 46 years (range: 9-70 years), underwent one to three ECAD treatments. The mean time from mushroom ingestion until the first ECAD treatment was 76 h. Two patients regenerated spontaneously under ECAD treatment and orthotopic liver transplantation (OLT) could be avoided. Two patients were successfully bridged to OLT and one patient died because of cerebral herniation. One patient was treated with ECAD immediately after OLT because of the graft dysfunction and survived without re-transplantation. CONCLUSION: ECAD appeared to be a successful treatment perspective in supporting liver regeneration or in sufficient bridging to OLT and also in treatment of graft dysfunction after OLT in patients with A. phalloides poisoning.