[The thoracoscopic talc pleurodesis with intraoperative pleural biopsy - a retrospective analysis in patients with malignant pleural effusion]. / Die thorakoskopische Talkumpleurodese mit Pleurabiopsie - eine retrospektive Analyse bei Patienten mit malignem Pleuraerguss.

BACKGROUND: The thoracoscopic pleurodesis with talc is an established therapy in case of malignant pleural effusion. With the instillation of talc a -localised inflammation is induced. However, some-times it turns into a severe systemic reaction. In this study of the postoperative course, the -question is examined whether a pleural biopsy is an additional risk factor for morbidity and mortality after talc pleurodesis. PATIENTS AND METHODS: Between January 2002 and December 2004, 77 patients with a malignant pleural effusion were enrolled in this retrospective trial. All patients received a thoracoscopic talc pleurodesis. The patients were divided retrospectively into two groups: 50 patients with an intra-operative pleural biopsy, 27 patients without a biopsy were the control group. C-reactive protein (CrP), leukocytes, and creatinine were -analysed. RESULTS: In both groups, CrP and leukocytes increased postoperatively with a peak on day 2 or 3. In general, the analysed data for creatinine -showed in the median standard values but with a high range up to at most 317 micromol / L on the 2 (nd) postoperative day, also in both groups. At no time was any significant difference in laboratory values seen among the two groups. Concerning morbidity and mortality also no significant difference could be determined. CONCLUSIONS: There were no significant differences for the examined laboratory values or for the morbidity / mortality between the two groups. That is why a disadvantage for patients with an intraoperative pleural biopsy is not to be expected.

[Pericardial empyema due to oropharyngeal infection -- a rare entity]. / Das Perikardempyem im Rahmen einer oropharyngealen Infektion -- Eine seltene Entität.

Both the descending necrotizing mediastinitis (DNM) and the pericardial empyema are rare but life threatening situations, in which rapid aggressive surgical approach is important for the outcome. A 37-year-old man presented with reduced general health and new establishment of thoracal pain after an infection in the oropharyngeal region. The dissemination of the infection into the mediastinum (mediastinitis) diagnosed by clinic and radiography required surgical intervention. A pericardial empyema was detected intraoperatively. The patient was discharged home on the 14 (th) hospital day.

[Differential diagnosis of pulmonary infiltration after insertion of a chest tube for pneumothorax]. / Differentialdiagnose des pulmonalen Infiltrates nach Pneumothorax-Drainage.

Reexpansion injury of the lung is rare and may occur after reexpansion of a collapsed lung such as after evacuation of a large amount of air or fluid from the pleural space. Its pathogenesis, however, is not clearly understood. Pulmonary edema should always be considered if the patient's respiratory condition worsens after lung reexpansion.

Inguinal hernia repair in the new millennium: plug and patch repair with local anesthesia.

Plug and patch repair is a safe, economic method for repairing inguinal hernias, with patient comfort comparable to that with laparoscopic hernia repair. The technique is simple to perform under local anesthesia and easily learned without a learning curve. Complications are rare, and recovery and return to work are rapid. After performing plug and patch repair on 400 patients with a follow-up examination rate of 93% and a median postoperative observation time of 42 months, we have recorded a recurrence rate of only 0.25%.

[Complication rate after gastrectomy and pouch reconstruction with Longmire interposition]. / Untersuchungen zur Komplikationsrate nach Gastrektomie und Pouchrekonstruktion mit Longmire-Interposition.

BACKGROUND/AIMS: To determine whether a Longmire-Interposition with or without a pouch used for reconstruction after gastrectomy influences the postoperative complication rate. METHODOLOGY: 49 patients who underwent gastrectomy with Longmire-Interposition with (n = 33) or without (n = 16) an additional pouch and 46 patients with a Roux-en-Y-reconstruction were analysed retrospectively. Complication rate and mortality were studied. RESULTS: There were no significant differences between the reconstruction groups for postoperative complications (Roux-en-Y vs. Longmire-Interposition with and without pouch: 30.4% vs. 28.6% for the morbidity; 4.3% vs. 4.1% for the mortality). CONCLUSION: These findings suggest that a Longmire-Interposition with or without a pouch for reconstruction after total gastrectomy is not connected with a higher morbidity or mortality in comparison to a Roux-en-Y-reconstruction.

Regular scintigraphic measurements of food transit following different types of reconstruction after total gastrectomy.

HYPOTHESIS: Ideal reconstruction after gastrectomy should ensure that the patient has a sufficiently large enteric reservoir to accommodate normal meals. Little is known about the transit of food after different methods of stomach reconstruction. The hypothesis of this trial was that food transit after gastrectomy is delayed by a pouch reconstruction compared with reconstructions without a pouch. DESIGN: Prospective. SETTING: University hospital. PATIENTS AND METHODS: A total of 27 patients underwent an interposition of a jejunal loop between the esophagus and the duodenum with (n = 19) or without (n = 8) a 7- or 15-cm proximal pouch reconstruction. Standardized scintigraphic measurements were performed to evaluate the food transit at fixed postoperative times. MAIN OUTCOME MEASURE: Scintigraphically measured food transit time. RESULTS: The food transit time 1 year postoperatively was significantly prolonged in patients with the 15-cm pouch in comparison with those with the 7-cm pouch and those without a pouch reconstruction (P = .005, P = .012). Patients with a pouch reconstruction tended to have better eating habits. CONCLUSIONS: Our results confirm the hypothesis and suggest that interposition of a large 15-cm jejunal pouch can lead to a prolonged food transit time with enteric reservoir function resulting in better patient nutritional status.

[Surgical management of locoregional recurrence of gastric carcinoma]. / Die chirurgische Therapie des lokoregionären Rezidivs beim Magenkarzinom.

About half of the patients with gastric cancer subjected to total gastrectomy in curative intention die of recurrence within a few years. Most of these local recurrences occur in the first 2 years postoperatively. In an historic analysis 133 patients of the years 1985-1997 were investigated. Local recurrence was observed in 29 cases within 60 months on average. An intensive follow-up will not affect the long-term outcome of local recurrence. Improved results may be expected only if more effective therapeutic strategies for local recurrence will be developed.

Low-dose spiral computed tomography for measuring abdominal fat volume and distribution in a clinical setting.

OBJECTIVES: Computed tomography (CT) has been used to measure body composition, however, a technique with reduced radiation exposure has not yet been introduced. This study tested a low-dose spiral CT technique on a phantom to determine its validity and reproducibility. The method was then applied for volume and distribution measurements in patients. DESIGN: Construction and measurement of a phantom followed by measurement of patients referred to CT for clinical indications. SETTING: Radiology Department, University Hospital. SUBJECTS: Twenty-four post-gastrectomy patients. INTERVENTION: A 22 cm phantom with a known amount of water and fat was scanned using high- and low-dose technique, standard and double table speed during a volumetric scan. The low-dose technique was implemented in the patient group. Total volume, total fat and four defined compartmental fat volumes in the truncal area were measured. RESULTS: The mean fat volume measured using the low-dose CT technique in the phantom was 0.2% above the actual fat content. The coefficient of variation for this method was 5%. By using low-dose, double speed instead of standard-dose technique, radiation exposure to the skin was decreased by more than 90% (equivalent to 4 mGy) of what is used in diagnostic imaging. The patient scans showed that no significant differences in BMI and total measured volume existed between female and male patients, but percent fat and percent subcutaneous fat were significantly larger in women (P = 0.006 and 0.002, respectively), as were percent intraabdominal and mediastinal fat in men (P = 0.002 and 0.003 respectively). CONCLUSIONS: Low-dose spiral CT accurately measures fat volume in vitro, and can be used in vivo for compartmental fat measurements.

[Does the pouch modify food transit after gastrectomy?]. / Beeinflusst der Pouch den Nahrungstransit nach Gastrektomie?

A prospective, randomized study of patients with gastric cancer was performed to examine whether or not the jejunal pouch interposition between esophagus and duodenum after gastrectomy is of importance. At fixed postoperative times, standardized scintigraphic measurements were performed; the quality of life was evaluated by the EORTC quality of life questionnaire. Our findings suggest that interposition of a jejunal pouch reservoir between esophagus and duodenum may be due to a prolonged transit time and a better quality of life.

[A rare stomach tumor--Hodgkin's lymphoma of the stomach]. / Ein seltener Magentumor--das Hodgkin-Lymphom des Magens.

Gastric involvement of Hodgkin's disease is very rare and preoperative diagnosis is difficult. We report the case of a 50-year-old woman, who had an ulcerating tumor of the antrum, which was revealed as carcinoma by endoscopic biopsy. A gastrectomy with D2-lymph node dissection was performed. In the pathological specimen Hodgkin's disease was diagnosed because of microscopic detection of typical binucleated Reed-Sternberg cells. Although the patient refused additive chemotherapy, she is still disease-free after 12 months of follow-up.

A phase I trial of interferon alpha-2b with folinic acid and 5-fluorouracil administered by 4-hour infusion in metastatic colorectal carcinoma.

Preclinical data suggest that both folinic acid and interferon may enhance the efficacy of 5-fluorouracil (5-FU) in colorectal carcinoma. We therefore initiated a phase I trial evaluating the doses, safety, and pharmacokinetics of the combination of recombinant interferon (IFN) alpha-2b with folinic acid (FA) and 5-FU. Seventeen patients with colorectal cancer who failed local chemotherapy received 5-FU as a 4-hour infusion, preceded by a bolus of FA and IFN. The 5-FU dose was escalated over the range of 400 to 650 mg/m2/d for a period of 7 days. Folinic acid was administered as a bolus in a fixed dose of 200 mg/m2/d and IFN as 5 million U/d subcutaneously on days 1 to 7. A total of 89 courses of therapy were completed for the 17 patients, of which there were 10 paired courses with a combination of 5-FU and IFN or 5-FU alone, being performed to analyze the pharmacokinetics and modulation of 5-FU by IFN. The maximum tolerated dose of 5-FU using this combination and a 4-hour schedule was 600 mg/m2/d for 7 days. The dose-limiting toxicity of this regimen was diarrhea. Mucositis and myelosuppression was not a marked problem at dose levels of 400 and 500 mg/m2/d for 7 days. However, at a dose level of 600 to 650 mg/m2/d for 7 days, grade 3 and 4 (WHO) leukopenia occurred in 50% and mucositis occurred in 33%. At a given dose of 5 million U, IFN did not significantly influence 5-FU serum levels. Mean steady-state serum levels of 5-FU at 500 mg/m2 given as a 4-hour infusion were 16.55 +/- 9.34 mumol/L and 18.23 +/- 12.77 mumol/L with and without IFN, respectively. Mean area under the curve (mumol/L x min) was 4,008 +/- 2,133 and 5,114 +/- 2,567 with and without interferon, respectively. Objective responses were seen in one of 17 of these heavily pretreated patients and stable disease was seen in seven of 17 patients. The recommended dose of 5-FU for use of phase II studies is 500 mg/m2/d for 7 days. We conclude that the toxicity of 5-FU plus FA with and without IFN alpha-2b can be reduced by using a 4-hour infusion instead of a bolus.

A phase II trial of interferon alpha-2b with folinic acid and 5-fluorouracil administered by 4-hour infusion in metastatic colorectal carcinoma.

Preclinical data suggest that folinic acid as well as interferon alpha-2b may enhance the antitumor activity of 5-fluorouracil (5-FU). In a phase I trial, we recently showed that interferon alpha-2b (IFN), folinic acid and 5-FU can be safely administered with a 4-hour infusion of 5-FU. We therefore initiated a phase II trial evaluating the efficacy and safety of these three drugs. Forty-five evaluable patients with advanced metastatic colorectal cancer, documented progressive disease, and previously unexposed to chemotherapy were treated with sequential IFN 5 MU/d subcutaneously and folinic acid 200 mg/m2/d as bolus on days 1 to 7 followed by 5-FU in a 4-hour infusion at a dose of 500 mg/m2/d, resulting in a total dose of 3,500 mg/m2/course. This schedule was repeated on day 21. A total of 204 courses of therapy were completed. One of 45 patients (2%) achieved a complete response, and 13 of 45 patients (29%) achieved a partial response. An additional 16 patients (36%) had stable disease. The median time to disease progression was seven months (2 to 24 months). Despite the relatively high-dose intensity of 5-FU, toxicity was very mild. Grade 3 or 4 myelosuppression, stomatitis, and nausea/vomiting occurred in only three of 45 patients (7%). Four of 45 patients (9%) suffered from severe (grade 3/4) diarrhea. Neurotoxicity and infections of grade 2 to 4 did not occur. From these data we conclude that modulation of 5-FU with both folinic acid and IFN induces an overall response rate of 31% in disseminated colorectal cancer. Using a 4-hour application schedule of 5-FU, the therapeutic index can be improved even for high-dose intensity and requires further evaluation in combination with other modulators.