[Survival after laser-induced interstitial thermotherapy of colorectal liver metastases--a comparison of first clinical experiences with current therapy results]. / Langzeitüberleben nach laserinduzierter interstitieller Thermotherapie kolorektaler Lebermetastasen--ein Vergleich erster klinischer Erfahrungen mit aktuellen Behandlungsergebnissen.

PURPOSE: Laser-induced interstitial thermotherapy (LITT) is a minimally invasive procedure for local tumor ablation. This report discusses the long-term results of this therapy in non-surgical patients with colorectal liver metastases. MATERIALS AND METHODS: In total, we treated 163 colorectal liver metastases in 85 patients by MR-guided LITT. RESULTS: The overall lethality was 1.1%. The mean survival period of all treated patients was 3.3+/-0.3 years (CI: 2.8; 3.8; Kaplan-Meier method) with a calculation start date of the diagnosis of the metastases. The mean survival period after LITT was 2.6+/-0.2 years (CI 2.2; 3.0). There was a substantial learning curve with respect to the indication for LITT and the technical procedure of the intervention itself. In the first period (50 patients; 1998-2001), the mean survival period was 2.2+/-0.2 years (CI: 1.8; 2.7). Thereafter (35 patients 2001-2006), the mean survival period increased to 2.9+/-0.3 years (CI: 2.4; 3.4; log rank Test; p=0.0097). In the latter group, the 1-year survival rate was 93% and the 3-year survival rate was 56%. CONCLUSION: MR-guided LITT is a treatment suitable for non-surgical patients suffering from colorectal liver metastases. The complication rate of the procedure is comparatively low. The survival periods after the procedure are longer than those reported for similar patient populations after chemotherapy alone.

[Primary gastric lymphoma]. / Primäre Magenlymphome.

Primary gastric lymphoma derives from a secondary MALT system developing after a reaction of the immune system, e.g. following chronic gastritis induced by Helicobacter pylori. Morphologically, follicular hyperplasia is found in the gastric mucosa. The pathoetiologic model confirms the transformation of a malignant lymphoma from low grade to high grade by demonstrating increasing autonomous proliferation and, finally, uncontrolled dissemination. Modern diagnostic tools are essential for staging and planning an adequate therapeutic strategy. At present, the therapeutic strategies regarding primary lymphoma are under discussion. Nevertheless, the consensus of international medical and surgical associations still recommends surgical therapy with curative intention for low-grade malignant lymphomas staged I 2-II 2. In cases of high-grade malignant lymphoma, conservative therapy is supposed to be similarly successful. The recent success of noninvasive therapeutic concepts seems to justify the application of triple eradication medication in case of Hp infection as well as radio- and chemotherapy in low- and high-grade malignant lymphomas. However, in cases of nonremission or therapy-associated complications such as uncontrollable bleeding or tumor perforation, surgery is the only therapeutic option. Regarding the oncological aspects of lymphoma growth, surgery should then be performed in order to achieve R0 resection.

Laser-induced interstitial thermotherapy of liver metastases in an interventional 0.5 Tesla MRI system: technique and first clinical experiences.

Laser-induced interstitial thermotherapy (LITT) surveyed by magnetic resonance imaging (MRI) has been shown to be effective in various applications. The laser treatment of colorectal liver metastases usually requires a separate device (e.g., ultrasound or CT) to position the laser applicator. In this study, we used an interventional 0.5 T MRI system, allowing both the navigation to the target tissue and on-line thermometry. Laser irradiation was performed using a near-infrared laser source combined with a cooled laser light guide. We treated 20 patients exhibiting a total of 58 colorectal liver metastases. Clinically relevant complications did not occur. No residual tumor was observed after laser irradiation in all metastases with a diameter below 2 cm. Metastases with a mean diameter between 2 and 3 cm demonstrated total necrosis in 71%, while in larger tumors this proportion decreased to 46% (diameter, 3-4 cm) and 30% (diameter, >4 cm), respectively. We conclude that LITT, guided by the employed interventional MRI system, is feasible and safe. The results suggest a more aggressive treatment, especially for larger metastases. J. Magn. Reson. Imaging 2001;13:729-737.

Helicobacter pylori in the upper gastrointestinal tract: medical or surgical treatment of gastric lymphoma?

The treatment of primary gastric lymphoma is controversial. The role of surgery has come to be questioned with increasing knowledge about the pathogenesis of gastric lymphoma and with new therapeutic approaches such as eradication of Helicobacter pylori. We review published clinical trials of primary gastric lymphoma, including preliminary results of our own prospective multicenter trial. The results of 7 trials of H. pylori eradication and 12 prospective therapeutic trials trial are discussed. On basis of these data it is concluded that surgery with intention of R0 resection is the treatment of choice in stages EI2 and EII1 of low-grade lymphoma. In high-grade lymphomas it is still unclear whether surgery or its primary combination with radio- or chemotherapy should be preferred. The eradication of H. pylori is a promising therapeutic approach for localized low-grade mucosa-associated lymphoid tissue lymphoma. A randomized trial is needed to clarify whether medical or surgical management of localized gastric lymphoma or a combination of two is the best treatment modality.

[Current therapeutic strategy in primary intestinal non-Hodgkin's lymphoma]. / Aktuelle therapeutische Strategie des primären Intestinalen Non-Hodgkin-Lymphoms.

Of all surgical interventions of intestinal non-Hodgkin's lymphomas 58% (15 or 26 patients) are performed in an emergency situation. In 42% of cases, examination by ultrasonography, endosonography, intestinoscopy. Sellink's enema, thoracic, abdominal/pelvic CT and bone marrow puncture could determine the stage preoperatively. This could also be done by examining the regional and juxtaregional lymph nodes or performing a liver biopsy intraoperatively. Crucial for the therapy is in all cases the adequate staging even in emergency situations. Only special knowledge of the intestinal non-Hodgkin's lymphoma can lead to the necessary stage-adapted multimodal therapy--operation/irradiation/chemotherapy.

[Perspectives of virtual control of visceral surgery interventions in open MRI]. / Perspektiven der virtuellen Kontrolle viszeralchirurgischer Eingriffe im offenen MRT.

Since July 1997 we have operated on 23 patients with different visceral surgical diagnoses in an open-configured Magnetic Resonance System (MRI). Among them we found 7 patients with benign soft tissue tumors, 5 patients with anal fistulas, 1 patient with an abscess on the pelvic wall, 1 patient with a rectocele, 1 patient with an inoperable, restrictive oesophageal carcinoma, and 8 patients with metastatic lesions in the liver. In the last 8 patients we performed MRI-guided laser-induced interstitial thermotherapy, in one patient in an open development. We did not face any postoperative complications. The median duration of the intervention was 2 hours, pre- and postscans included. Our experiences show that it is possible to carry out visceral surgical interventions in the open-configured MRI. The main indications we see now are anal fistulas, soft tissue tumors and MRI-guided laser-induced interstitial thermotherapy of liver metastases.

[Therapy planning and surgical indications for Crohn-associated anal fistulas]. / Therapieplanung und Operationsindikation Crohn-assoziierter Analfisteln.

A prospective study conducted from April 1988 to April 1998 in 83 patients with anal fistulas associated Crohn's diseases registers and evaluates data regarding the type of fistula, the planned therapy, the operative procedure, and the therapy itself. The choice of the operation time with special regard to the type of fistula and the presence of proctitis as well as the interdisciplinary management in cooperation with the gastroenterologist and the strict observance of the operative procedure for the different types of fistulas enable individually defined surgical treatment of anal fistulas associated with Crohn's disease. It is important that the primary intervention be performed by a surgeon who is experienced in classifying the different types of fistulas because of the recurrence rate of 23% and the required interval between the first and final surgical intervention and so that patients are well informed.

[Perioperative therapy of HIV infections]. / Perioperative Therapie bei HIV-Infektionen.

A meta-analysis of the literature demonstrates high operation complication rates in HIV-positive patients. Own experience connected with a general hospital in San Francisco, University of California, indicates that such an analysis provides the surgeon with the possibility of optimizing the treatment of HIV-positive patients in the perioperative phase.

[Laparoscopic ileostomy and colostomy in Crohn disease patients]. / Laparoskopische Ileostomie und Colostomie bei Morbus-Crohn-Patienten.

The indications, operative procedure, postoperative complications and advantages of laparoscopic ileostomy and colostomy as compared with "open" enterostomy are described and demonstrated in our own patients with Crohn's disease. Major indications for laparoscopic enterostomy in patients with Crohn's disease are stenosis, fecal incontinence and complex anal fistulas in those with severe Crohn's proctitis. Most Crohn patients tolerate laparoscopic enterostomy and an increasing number demand this minimally invasive technique. The period of convalescence is much shorter and complications in connection with laparotomy are minimized.

[The fully-automatic analytic system Vision in horse practice in comparison with Compur M 2000 CS]. / Das vollautomatische Analysensystem Vision in der Pferdepraxis im Vergleich mit Compur M 2000 CS.

We describe the utilization of the Abbott Vision system in a horse clinic and a comparison with the Compur M 2000 CS (Bayer Diagnostics and Electronics). Discrepancies were found in respect to precision and accuracy of results. Both systems showed good practicability during routine operation but different cost-effectiveness.