ABSTRACT
BACKGROUND AND AIMS: Previous guidelines addressing surgery of adrenal tumors required actualization in adaption of developments in the area. The present guideline aims to provide practical and qualified recommendations on an evidence-based level reviewing the prevalent literature for the surgical therapy of adrenal tumors referring to patients of all age groups in operative medicine who require adrenal surgery. It primarily addresses general and visceral surgeons but offers information for all medical doctors related to conservative, ambulatory or inpatient care, rehabilitation, and general practice as well as pediatrics. It extends to interested patients to improve the knowledge and participation in the decision-making process regarding indications and methods of management of adrenal tumors. Furthermore, it provides effective medical options for the surgical treatment of adrenal lesions and balances positive and negative effects. Specific clinical questions addressed refer to indication, diagnostic procedures, effective therapeutic alternatives to surgery, type and extent of surgery, and postoperative management and follow-up regime. METHODS: A PubMed research using specific key words identified literature to be considered and was evaluated for evidence previous to a formal Delphi decision process that finalized consented recommendations in a multidisciplinary setting. RESULTS: Overall, 12 general and 52 specific recommendations regarding surgery for adrenal tumors were generated and complementary comments provided. CONCLUSION: Effective and balanced medical options for the surgical treatment of adrenal tumors are provided on evidence-base. Specific clinical questions regarding indication, diagnostic procedures, alternatives to and type as well as extent of surgery for adrenal tumors including postoperative management are addressed.
Subject(s)
Adrenal Gland Neoplasms/surgery , Endocrine Surgical Procedures/methods , Delphi Technique , Evidence-Based Medicine , Germany , HumansABSTRACT
KKP723 (KKP), a derivative of ampicillin, is a newly developed beta-lactam antibiotic. Using an experimental endotoxemia model, the intestinal microcirculation in four groups of animals were evaluated using intravital microscopy (IVM). The groups included were a control group, an endotoxemic group (15 mg/kg i.v. LPS from E. coli), an ampicillin (50 mg/kg i.v.) treated endotoxemic group and an endotoxemic group treated with KKP (67.4 mg/kg i.v.). Ampicillin treatment resulted in a significant reduced number of firmly adhering leukocytes in intestinal submucosal venules. KKP treatment did not show this effect on leukocyte activation. We found no changes of the functional capillary density (FCD) of the intestinal wall by treatment with ampicillin or its derivative KKP. The increased leukocyte adherence in the KKP treated LPS animals may be explained by a loss of a possible ampicillin-related anti-inflammatory effect by the biotransformation process. The endotoxemia IVM model is useful to detect effects of antibiotics in an impaired microcirculation.
Subject(s)
Ampicillin/analogs & derivatives , Ampicillin/pharmacology , Endotoxemia/physiopathology , Intestines/blood supply , Microcirculation/drug effects , Animals , Disease Models, Animal , Intestinal Mucosa/blood supply , Intestinal Mucosa/drug effects , Lipopolysaccharides/toxicity , Male , Rats , Rats, Inbred LewABSTRACT
By the mean of a prospective multicenter observational study (East German Gastric Cancer Study - EGGCS), 1 139 consecutive patients with gastric cancer were enrolled in 80 East German surgical departments from January 1 to December 31, 2002. Out of them, 1,031 (90.5%) underwent surgical intervention. The resection rate was 86.4% (n = 891); the R0 resection rate (n = 726) was 81.5%. Gastrectomy was performed in 79.8 % (n = 649) of subjects with radical resections (n = 813). In approximately 70 % of the interventions with curative intention, lymph node resection of the D2 compartment was carried out. The postoperative hospital mortality was 8.3%. The results were compared with the data obtained in the German Gastric Cancer Study (GGCS 1992); relevant differences and aspects were discussed.
Subject(s)
Gastrectomy , Quality of Health Care , Stomach Neoplasms/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Esophagogastric Junction/pathology , Gastrectomy/methods , Gastroscopy , Germany , Hospital Mortality , Humans , Laparoscopy , Laparotomy , Lymph Node Excision , Middle Aged , Neoplasm Staging , Palliative Care , Postoperative Complications , Prospective Studies , Quality Control , Stomach/pathology , Stomach Neoplasms/diagnosis , Stomach Neoplasms/mortality , Stomach Neoplasms/pathology , Surveys and QuestionnairesABSTRACT
PURPOSE: In a retrospective analysis the diagnostic value of two scintigraphic methods was compared with each other. METHOD: 104 patients with acute or intermittent gastrointestinal haemorrhage were examined with 121 scintigraphic studies. We compared scintigraphic results with surgical findings, endoscopic results or final clinical diagnosis. We used two scintigraphic methods, colloid scintigraphy and in vivo/vitro red blood cell scintigraphy. RESULTS: Our scintigraphic findings reached a sensitivity of 72% and a specificity of 100%. We calculated a sensitivity of 68% for colloid scintigraphy and a sensitivity of 79% for red blood cell scintigraphy. The correct localisation of bleeding was successful in 52 (98%) cases. CONCLUSIONS: Our results demonstrate that red blood cell scintigraphy is the method of choice in detecting intermittent gastrointestinal hemorrhage. We believe that with new preparation kits for in vivo labelling red blood cell scintigraphy will become seriously competitive for the colloid scintigraphic method.
