Minimally invasive surgery for pediatric tumors - current state of the art.

During recent years, minimally invasive surgery (MIS) has become the standard approach for various operations in infants and children. This also holds true for surgery in children with solid tumors. Meanwhile, more and more oncological biopsies and resections are being performed laparoscopically or thoracoscopically. Despite its increasing role in pediatric tumor surgery, the different national and international multicenter trial groups have not yet implemented MIS within guidelines and recommendations in most of the current treatment protocols. An increasing number of reports describe a potential role of MIS in the different entities of pediatric surgical oncology. Over the time, there has been a diverse development of this approach with regard to the different neoplasms. The aim of this article is to give an overview and to describe the current state of the art of MIS in pediatric solid tumors.

Impact of endotoxin exposure after exhausting exercise on the immune system in solid organ transplant recipients.

Subsequent to prolonged exhausting exercise a transient immunosuppression is often observed in athletes. This so-called "open window" results in a reduced resistance of the athletes to viral and bacterial infections after an exhaustive exercise bout. Concerning the effect of bacterial endotoxin contact after exhausting exercise in transplant recipients, who are innately immunosuppressed by their medication, no data exists at present. After performing 81 km cycling, including ascending more than 1800 m in altitude, peripheral blood from 10 male kidney transplant recipients and from 10 healthy controls matched for age and gender was obtained. Simulating contact of the athletes with a pathogen post-exercise, the blood samples were incubated with Lipopolysaccharides (LPS). Thereafter microarray analysis was performed. Microarray analysis revealed a markedly oppositional pattern of gene expression in transplant recipients compared with their controls after LPS incubation. Especially immune response genes were significantly over-represented in controls immediately after the exhaustive exercise bout with LPS stimulation, whereas numerous apoptotic genes were over-represented in transplant recipients. Merging our previous data with these recent findings it should be discussed if transplant recipients need to reduce their immunosuppressive medication before performing exhaustive exercise.