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1.
Rofo ; 180(1): 35-41, 2008 Jan.
Article in German | MEDLINE | ID: mdl-18008194

ABSTRACT

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.


Subject(s)
Colorectal Neoplasms/therapy , Hyperthermia, Induced/methods , Laser Therapy/methods , Liver Neoplasms/secondary , Magnetic Resonance Imaging , Surgery, Computer-Assisted , Aged , Colorectal Neoplasms/mortality , Female , Follow-Up Studies , Humans , Kaplan-Meier Estimate , Liver/pathology , Liver Neoplasms/mortality , Liver Neoplasms/therapy , Male , Middle Aged , Palliative Care , Survival Rate
2.
Chirurg ; 75(5): 547-56; quiz 557-8, 2004 May.
Article in German | MEDLINE | ID: mdl-15118792

ABSTRACT

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.


Subject(s)
Lymphoma, B-Cell, Marginal Zone/surgery , Stomach Neoplasms/surgery , Anti-Ulcer Agents/therapeutic use , Cell Transformation, Neoplastic/pathology , Combined Modality Therapy , Gastrectomy , Gastric Mucosa/pathology , Gastritis/complications , Gastritis/drug therapy , Gastritis/pathology , Helicobacter Infections/complications , Helicobacter Infections/drug therapy , Helicobacter Infections/pathology , Helicobacter pylori , Humans , Lymphoma, B-Cell, Marginal Zone/diagnosis , Lymphoma, B-Cell, Marginal Zone/pathology , Neoplasm Staging , Practice Guidelines as Topic , Prognosis , Stomach Neoplasms/diagnosis , Stomach Neoplasms/pathology
3.
J Magn Reson Imaging ; 13(5): 729-37, 2001 May.
Article in English | MEDLINE | ID: mdl-11329194

ABSTRACT

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.


Subject(s)
Colorectal Neoplasms/therapy , Hyperthermia, Induced/instrumentation , Liver Neoplasms/secondary , Magnetic Resonance Imaging/instrumentation , Aged , Equipment Safety , Feasibility Studies , Female , Humans , Liver/pathology , Liver Neoplasms/therapy , Male , Middle Aged
4.
Langenbecks Arch Surg ; 385(2): 97-105, 2000 Mar.
Article in English | MEDLINE | ID: mdl-10796047

ABSTRACT

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.


Subject(s)
Helicobacter pylori , Lymphoma, Non-Hodgkin , Stomach Neoplasms , Clinical Trials as Topic , Combined Modality Therapy , Humans , Lymphoma, Non-Hodgkin/drug therapy , Lymphoma, Non-Hodgkin/radiotherapy , Lymphoma, Non-Hodgkin/surgery , Prospective Studies , Stomach Neoplasms/drug therapy , Stomach Neoplasms/radiotherapy , Stomach Neoplasms/surgery
6.
Article in German | MEDLINE | ID: mdl-9931900

ABSTRACT

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.


Subject(s)
Intestinal Neoplasms/therapy , Lymphoma, Non-Hodgkin/therapy , Adult , Bone Marrow/pathology , Combined Modality Therapy , Female , Humans , Intestinal Neoplasms/diagnosis , Intestinal Neoplasms/pathology , Lymph Nodes/pathology , Lymphoma, B-Cell, Marginal Zone/diagnosis , Lymphoma, B-Cell, Marginal Zone/pathology , Lymphoma, B-Cell, Marginal Zone/therapy , Lymphoma, Non-Hodgkin/diagnosis , Lymphoma, Non-Hodgkin/pathology , Male , Middle Aged , Neoplasm Staging , Patient Care Team , Prognosis
7.
Article in German | MEDLINE | ID: mdl-9931918

ABSTRACT

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.


Subject(s)
Abdomen/surgery , Abdominal Neoplasms/surgery , Magnetic Resonance Imaging/instrumentation , User-Computer Interface , Abdomen/pathology , Abdominal Neoplasms/pathology , Adult , Aged , Female , Humans , Hyperthermia, Induced/instrumentation , Liver Neoplasms/pathology , Liver Neoplasms/secondary , Liver Neoplasms/surgery , Male , Middle Aged , Palliative Care , Retrospective Studies , Stents
8.
Article in German | MEDLINE | ID: mdl-9931771

ABSTRACT

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.


Subject(s)
Crohn Disease/surgery , Patient Care Planning , Rectal Fistula/surgery , Crohn Disease/diagnosis , Female , Humans , Male , Patient Care Team , Proctitis/diagnosis , Proctitis/surgery , Rectal Fistula/diagnosis , Recurrence , Reoperation
9.
Article in German | MEDLINE | ID: mdl-9931806

ABSTRACT

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.


Subject(s)
HIV Infections/therapy , Perioperative Care , AIDS-Related Opportunistic Infections/mortality , AIDS-Related Opportunistic Infections/therapy , HIV Infections/mortality , Humans , Patient Care Team , Postoperative Complications/mortality , Postoperative Complications/therapy
10.
Chirurg ; 67(12): 1261-5, 1996 Dec.
Article in German | MEDLINE | ID: mdl-9081790

ABSTRACT

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.


Subject(s)
Colostomy/instrumentation , Crohn Disease/surgery , Ileostomy/instrumentation , Laparoscopes , Adult , Female , Follow-Up Studies , Humans , Male , Minimally Invasive Surgical Procedures , Postoperative Complications/etiology , Prospective Studies
11.
Tierarztl Prax ; 19(2): 216-21, 1991 Apr.
Article in German | MEDLINE | ID: mdl-1906202

ABSTRACT

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.


Subject(s)
Diagnosis, Computer-Assisted/veterinary , Horse Diseases/diagnosis , Animals , Cost-Benefit Analysis , Diagnosis, Computer-Assisted/economics , Diagnosis, Computer-Assisted/instrumentation , Horses , Microcomputers , Photometry , Quality Control , Software , Spectrophotometry
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