The overall metastatic rate in early esophageal adenocarcinoma: long-time follow-up of surgically treated patients.

The overall metastatic potential of surgically treated early esophageal adenocarcinoma has not been studied in detail. This paper therefore assessed lymph node metastases at surgery, loco regional and distant metastases, in order to assess the metastatic potential of early esophageal adenocarcinoma. Two hundred and seventeen patients (53 T1a, 164 T1b; median follow-ups 87 and 75 months, 187 males) diagnosed with early esophageal adenocarcinoma and treated with esophagectomy in our tertiary center's database between July 2000 and December 2015 were included. All metastatic events were retrospectively analyzed, their topographic distribution was assessed, and the overall metastatic rate was calculated. Lymph node metastases occurred in 39 patients (18%) and 29 (13.4%) developed recurrences. Lymph node metastases were absent in m1 and m2 tumors and rare in m3 (1/18), m4 (5/21), and sm1 (4/42), but more frequent in sm2 (11/44) and sm3 tumors (18/78). Locoregional recurrences were exceedingly rare in m3 (2/18), m4 (1/21), sm1 (1/42), and sm2 (2/44), but frequent in sm3 (12/78). In contrast, distant metastases were more frequent with 2/18 in m3, 1/21 in m4, 4/42 in sm1, 4/44 in sm2, and 13/78 in sm3. Overall metastatic rates of 11.9% in sm1 (submucosal layer divided into equal thirds), 27.3% in sm2, and 32.1% in sm3 tumors were calculated. This first report of the metastatic potential of early esophageal adenocarcinoma provides a meticulous assessment of the overall metastatic risk. Metastatic events pose a relevant risk in surgically treated patients with esophageal adenocarcinoma with distant metastases being more frequent than locoregional recurrences.

[Endoscopic and surgical treatment of early gastric and esophageal carcinoma]. / Endoskopische und chirurgische Behandlungsoptionen bei Magen- und Ösophagusfrühkarzinomen.

BACKGROUND: The treatment of early gastric (EGC) and esophageal carcinomas (EEC) is an interdisciplinary challenge. The risk of lymph node metastasis (LNM) is the crucial point in choosing the correct treatment option. OBJECTIVE: This article gives an overview of the current treatment options and provides help in choosing the correct therapy. METHOD: Current concepts and therapy algorithms are presented on the basis of a literature review and data from our own center. RESULTS: Endoscopic submucosal dissection (ESD) is recommended for mucosal gastric cancer with good or moderate differentiation (G1,2) without macroscopic ulceration, in elevated type lesions smaller than 2 cm in size or depressed lesions smaller than 1 cm in size. In additional chromoendoscopy should be carried out. The extent of surgical resection is defined by the location of the tumor. A safety margin of at least 3 cm should be applied in distal gastric resections whereas the first line goal in gastrectomy is to achieve an R0 resection. In cN0 tumors a D1 lymphadenectomy (LA) seems to be sufficient. Minimally invasive techniques currently show promising results especially for a subtotal resection. The treatment strategy in EEC differs depending on the tumor entity. Mucosal squamous cell carcinoma with high risk factors (L1,V1) and all cN0 submucosal tumors without the detection of LNM should be referred to primary surgical resection. Early stage cN+ squamous cell carcinomas should be preoperatively treated with chemoradiotherapy. Adenocarcinoma with infiltration of the deeper submucosa (sm2,3) and high-risk sm1 tumors require surgical treatment. The standard operating procedure for EEC is an Ivor Lewis esophagectomy with 2­field LA preferably performed as a hybrid or by a completely minimally invasive procedure. The procedure of choice in endoscopic resection of EEC is resection with the suck and cut technique.

[Limitations of surgery for cancer of the upper gastrointestinal tract]. / Grenzen der Chirurgie bei Karzinomen des oberen Intestinaltraktes.

Cancer of the upper gastrointestinal tract is one of the leading causes for cancer related deaths worldwide. While the incidence of esophageal carcinoma is increasing, the incidence of gastric cancer has been continuously decreasing over the past decades. Most patients are often diagnosed with advanced stage disease and the prognosis is still dismal. For many patients surgery is the central part of the therapy; however, improvements in the diagnostic work-up, staging techniques and therapy concepts have led to a more individualized therapeutic approach. Endoscopic treatment of early cancer is well established with high cure rates. In advanced gastric cancer the implementation of multimodal therapies, standardized surgical techniques and optimized perioperative management has led to an improvement in prognosis and outcome. The limitations of surgery in esophagogastric cancer are defined by current scientific results, recent technical developments and patient-specific characteristics. These limitations are continuously changing and require an ongoing review.

Multipoint vibrometry with dynamic and static holograms.

We report on two multipoint vibrometers with user-adjustable position of the measurement spots. Both systems are using holograms for beam deflection. The measurement is based on heterodyne interferometry with a frequency difference of 5 MHz between reference and object beam. One of the systems uses programmable positioning of the spots in the object volume but is limited concerning the light efficiency. The other system is based on static holograms in combination with mechanical adjustment of the measurement spots and does not have such a general efficiency restriction. Design considerations are given and we show measurement results for both systems. In addition, we analyze the sensitivity of the systems which is a major limitation compared to single point scanning systems.

[A rare cause of recurrent small bowel intussusception. Case report and review of the literature]. / Eine seltene Ursache einer rezidivierenden, adulten Dünndarminvagination. Fallbericht sowie Überblick über die aktuelle Literatur.

Small bowel intussusception is a rare cause of abdominal pain in adult patients. Due to varying symptoms and different underlying causes its diagnosis and treatment is challenging for physicians. This case report describes recurrent intussusception in an adult female patient and celiac disease could only be diagnosed as the cause of these symptoms after surgery. In addition a review of the literature regarding adult intussusception is presented.

Hologram optimization for SLM-based reconstruction with regard to polarization effects.

We report on first results obtained with two modified hologram optimization algorithms. These algorithms take into account the complex modulation characteristic of the spatial light modulators employed for hologram reconstruction. To this end the Jones matrices of the modulator as well as all other components of the setup are used within a modified direct binary search and an iterative Fourier transform algorithm. Geometrical phase effects are included in the optimization. Elimination of the analyzer behind the spatial light modulator is possible by that approach and for typical setups using twisted-nematic liquid crystal modulators an enhanced overall diffraction efficiency is achieved. Possible applications are the comparative digital holography and optical tweezers. Experimental results for the reconstructions of holograms with a Holoeye LC-R 3000 modulator are presented.

Effect of different operative techniques for myocardial revascularisation on hemodynamics and myocardial perfusion in a porcine model.

BACKGROUND: During surgical coronary revascularisation hemodynamics and myocardial contractility can be affected. This in vivo study aimed to determine the effects of different operative techniques on hemodynamics and regional myocardial perfusion. METHODS: In 24 pigs IMA to LAD bypass was constructed using ECC (n = 8) and cardioplegic arrest, OPCAB techniques (n = 8), or the Impella elect 100 support device (n = 8). 8 animals received a sham operation. Mean arterial pressure (MAP), cardiac output (CO), and left ventricular pressure (LVP, LVdp/dt) were recorded. Regional myocardial perfusion (RMP) of both ventricles was assessed by fluorescent microspheres. RESULTS: MAP significantly decreased during revascularisation in all groups ( p < 0.05), staying below preoperative values thereafter ( p < 0.05). After ECC norepinephrine was administered to maintain MAP. CO and LVdp/dt were impaired more distinctly during OPCAB than with Impella ( p < 0.05) during subsequent recovery. RMP showed global reactive hyperemia during early reperfusion after ECC, remained unchanged in OPCAB, and showed low flow during and after Impella pump run ( p < 0.05). CONCLUSIONS: ECC led to hemodynamic impairment with post-ischemic reactive hyperemia. OPCAB created hemodynamic depression but left RMP unchanged. Hemodynamic depression can be reduced by the Impella pump, however regional myocardial blood flow is decreased.

Optical particle trapping with computer-generated holograms written on a liquid-crystal display.

Computer-generated holograms written on a liquid-crystal display can be used to generate dynamic light fields of arbitrary shape. This method was used to simultaneously trap polystyrene particles laterally and to displace them independently of one another.

Positioning of Noncooperative Objects by use of Joint Transform Correlation Combined with Fringe Projection.

Automated assembly and quality control require reliable systems for the detection of the position and the orientation of complicated objects. Correlation methods are well suited, but they are affected by structured backgrounds, varying illumination conditions, and textured or dirty object surfaces. Using fringe projection to exploit the three-dimensional topography of objects, we improve the performance of a nonlinear joint transform correlator. Positioning of noncooperative objects with subpixel accuracy is demonstrated. Additionally, the tilt angle of an arbitrarily shaped object is measured by projection of object-adapted fringes that produce a homogeneous fringe pattern in the image plane. An accuracy of better than 1 degrees is achieved.