In vitro analysis of biopolymer coating with glycidoxypropyltrimethoxysilane on hernia meshes.

Certain coatings may improve the biocompatibility of hernia meshes. The coating with self-assembled monolayers, such as glycidoxypropyltrimethoxysilane (GOPS) can also improve the materials characteristics of implants. This approach was not yet explored in hernia meshes. It was the aim of this work to clarify if and how hernia meshes with their three-dimensional structure can be coated with GOPS and with which technique this coating can be best characterized. Commercially available meshes made from polypropylene (PP), polyester (PE), and expanded polytetrafluorethylene (ePTFE) have been coated with GOPS. The coatings were analyzed via X-ray photoelectron spectroscopy (XPS), confocal laser scanning microscopy (CLSM), and cell proliferation test (mouse fibroblasts). Cell viability and cytotoxicity were tested by MTT test. With the GOPS surface modification, the adherence of mouse fibroblasts on polyester meshes and the proliferation on ePTFE meshes were increased compared to noncoated meshes. Both XPS and CLSM are limited in their applicability and validity due to the three-dimensional mesh structure while CLSM was overall more suitable. In the MTT test, no negative effects of the GOPS coating on the cells were detected after 24 h. The present results show that GOPS coating of hernia meshes is feasible and effective. GOPS coating can be achieved in a fast and cost-efficient way. Further investigations are necessary with respect to coating quality and adverse effects before such a coating may be used in the clinical routine. In conclusion, GOPS is a promising material that warrants further research as coating of medical implants. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1083-1090, 2017.

Clinical symptoms and sonographic follow-up after surgical treatment of nonparasitic liver cysts.

BACKGROUND: The optimal treatment of nonparasitic liver cysts is still a topic of debate. Only symptomatic cysts are being considered as requiring treatment. Aim of this study is to evaluate our experience with this disease over the past ten years with a structured follow-up program. METHODS: From January 2000 to August 2010, 56 consecutive patients with nonparasitic liver cysts were treated at our institution. We assessed morbidity, recurrence and complication rates, quality of life as well as pre- and post-operative sonographic status of the cysts and course of clinical symptoms. RESULTS: In 84% of the patients surgery was started as a laparoscopic procedure. Conversion rate was 6.4%. Average diameter of deroofed cysts was 12 cm. Overall complication rate was 16% and overall recurrence rate 28.3% (8.7% recurrences at the surgical site, 19.6% new or enlarged cysts). One half of the patients were symptom-free after surgery and the other half had at least one persisting symptom post-operatively. In one half of these patients with persisting symptoms, symptoms were ameliorated by surgery. In the other half of patients the number of symptoms increased after surgery. Two thirds of the overall patients reported their post-operative health as being good or very good. CONCLUSIONS: Surgical deroofing is the most effective treatment option for symptomatic liver cysts. Half of our patient population retained at least one symptom from a group of more than ten abdominal symptoms.Only the minority of these cases may be attributed to true recurrence, de-novo cysts or growing pre-existing cysts. The analysis of our cases suggests that the persistent symptoms in our patients may in part be due to the fact that the association between clinical complaints and the liver cysts was not sufficiently established. A more rigid patient selection should be implemented in order to achieve better results from the treatment of cysts. Because even large cysts are frequently asymptomatic, patient selection should not primarily be based on the cyst size only. The decision should be based strictly on the correlation between cyst / cyst location and symptoms / clinical complaints. In our opinion, further diagnostic procedures may be necessary in individual cases to clarify such a correlation.

The PRAISE study: a prospective, multi-center, randomized, double blinded, placebo-controlled study for the evaluation of iloprost in the early postoperative period after liver transplantation (ISRCTN12622749).

BACKGROUND: Liver graft dysfunction can deteriorate to complete organ failure and increases perioperative morbidity and mortality after liver transplantation. Therapeutic strategies reducing the rate of graft dysfunction are of current clinical relevance. One approach is the systemic application of prostaglandins, which were demonstrated to be beneficial in reducing ischemia-reperfusion injury. Preliminary data indicate a positive effect of prostacyclin analogue iloprost on allograft viability after liver transplantation. The objective of the study is to evaluate the impact of iloprost in a multi-center trial. METHODS/DESIGN: A prospective, double-blinded, randomized, placebo-controlled multicenter study in a total of 365 liver transplant recipients was designed to assess the effect of intravenous iloprost after liver transplantation. Primary endpoint will be the primary graft dysfunction characterized as presentation of one or more of the following criteria: ALAT or ASAT level>2000 IU/ml within the first 7 postoperative days, bilirubine ≥ 10 mg/dl on postoperative day 7; INR ≥ 1.6 on postoperative day 7 or initial non-function. Secondary endpoints are parameters of post-transplant morbidity, like rates of infections, biliary complications, need of clotting factors or renal replacement therapy and the graft and patient survival. DISCUSSION: A well-established treatment concept to avoid graft dysfunction after liver transplantation does not exist at the moment. If the data of this research project confirm prior findings, iloprost would improve the general outcome after liver transplantation. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00003514. Current Controlled Trials Register: ISRCTN12622749.

Non-curative gastric resection for patients with stage 4 gastric cancer--a single center experience and current review of literature.

PURPOSE: The majority of patients with gastric cancer present with an advanced stage and, therefore, may not be eligible for curative treatment. The role of non-curative gastric resection in situations other than emergency treatment for life threatening tumor-related complications is still under discussion. METHODS: Data from 290 consecutive patients with advanced gastric cancer who were treated in our hospital were analyzed. A total of 48 patients underwent primary non-curative gastric resection. RESULTS: The overall survival in the non-curatively resected group was 15 months and 6 months for non-resected patients, respectively (p < 0.001). The incidence of tumor-related complications which required intervention was 63% in non-resected patients as compared to 12% in patients who underwent primary non-curative resection. Younger age, less than three tumor locations, and chemotherapy have been identified as prognostic factors for improved survival by univariate analysis. D3 lymph node involvement and chemotherapy were independent prognostic factors in the multivariate analysis. Peritoneal carcinosis did not significantly influence survival in resected patients. Non-curative resection in combination with chemotherapy resulted in longer overall survival than resection alone. CONCLUSIONS: Primary non-curative gastric resection can reduce the incidence of severe tumor-related complications and can prolong overall survival in selected subgroups. In particular, younger patients with no more than two tumor locations should be considered for this procedure.

IgG4-related systemic disease--a rare indication for multi-visceral transplantation.

Multivisceral transplantations (MVT) are rarely performed procedures. In this case report, we present a 37-year-old male patient with a large retroperitoneal tumor. After exclusion of malignancy, we performed MVT (distal stomach, liver, pancreas, and small bowel). After a follow-up of 1 year, the patient is in good clinical condition. Histologic examination revealed a chronic sclerosing IgG4-associated disease. Our case shows that MVT can be successfully performed in this rare disease.

Impact of stable PGI2 analog iloprost on early graft viability after liver transplantation: a pilot study.

BACKGROUND: Ischemia/reperfusion injury after liver transplantation (LT) may be associated with primary graft dysfunction (PDF) or non-function. Prostaglandins were demonstrated to be beneficial in reducing ischemic injury by improving microcirculation and protecting endothelial cells. The aim of this study was to analyze the effect of the continuously administered prostaglandin I(2) analog iloprost on allograft function after LT. METHODS: Eighty patients were prospectively randomized and assigned to two groups. Patients in the treatment group received iloprost for seven d after transplantation, and those in the control group did not. The primary end point was graft dysfunction. RESULTS: The incidence of PDF was 20% (n = 8) in the control group and 5% (n = 2) in the treatment group, respectively (p = 0.087). Four patients in the control group underwent re-transplantation for initial non-function (INF). There was no evidence for INF in the treatment group. Iloprost was associated with improved allograft function. Clinical course and outcome were comparable. CONCLUSIONS: We suggest iloprost to be beneficial for early post-transplant liver function. If the rate of PDF can be significantly reduced with this treatment concept, it should be analyzed in a larger number of patients (ISRCTN95672167).

Resection of liver metastases is beneficial in patients with gastric cancer: report on 15 cases and review of literature.

BACKGROUND: Although up to 9% of patients with gastric cancer develop liver metastases, liver resection is rarely performed because of co-existing non-curative factors. Furthermore, the benefit of liver resection is still controversially discussed. Our goal was to investigate the outcome of patients who underwent liver resection or radiofrequency ablation (RFA) for hepatic metastasized gastric cancer. METHODS: Retrospectively collected data from a prospectively maintained database were analyzed from 15 patients who underwent liver resection or RFA for liver metastases from gastric cancer. RESULTS: Overall 5-year survival and median survival were 27% and 48 months for resected/RFA patients. The peri-operative complication rate was low. One patient has been tumor-free for 90 months now. CONCLUSIONS: Liver resection in patients with hepatic metastasized gastric cancer is beneficial and safe if an R0 situation can be achieved. RFA might be a useful alternative in those patients where surgery is not feasible.

Impact of clinical and pathohistological characteristics on the incidence of recurrence and survival in elderly patients with gastric cancer.

BACKGROUND: Gastric cancer is one of the most frequent malignant tumors worldwide. Despite improvements in diagnostic procedures, as well as the introduction of multimodal treatment strategies, the overall prognosis remains poor. The role of gastric resection in elderly patients with gastric cancer has not been clearly defined as yet. The goal of the present study was to assess whether specific pathohistological features result in different outcomes for younger patients and elderly patients. METHODS: A total of 272 patients with advanced gastric cancer treated surgically in our hospital between 1998 and 2009 were included in the study. Data were analyzed from a prospectively maintained database. RESULTS: Median overall survival was 84 months in the younger subgroup and 37 months in the elderly subgroup (P = 0.038), whereas local recurrence occurred more frequently in younger patients (33% vs. 23%). We identified positive lymph nodes at the contralateral curvature, perilymphonodular tumor cells, and positive lymph node conglomerates as strong negative prognostic factors. There were few pathohistological characteristics that affected survival and the incidence of tumor recurrence differently in elderly and younger patients. Although only a few elderly patients underwent chemotherapy plus gastric resection (7% vs. 28% of the younger patients), there was a trend toward longer survival for those who received multimodal treatment. CONCLUSIONS: Our results suggest that there is no tumor-related prognostic difference between young and elderly patients that would preclude radical surgery in elderly patients, as long as they are generally fit for surgery.

Predictors of long-term survival in patients with colorectal liver metastases: a single center study and review of the literature.

PURPOSE: Prognosis after resection of liver metastases of colorectal cancer is influenced by a variety of clinical factors. For more than 20 years, efforts have been made to restructure and simplify prognostic parameters into clinical scores. We evaluated the influence of various clinical and pathological factors on survival and recurrence and developed a simple model for risk stratification. METHODS: We have analyzed a total of 13 prognostic factors in 382 consecutive and prospectively enrolled R0-resected patients and applied our data set to ten published prognostic scoring systems. Prognostic factors that influenced disease-specific and disease-free survival were included into a model clinical risk score. RESULTS: The 5- and 10-year observed survival rates were 43% and 28%, respectively, for all 382 patients. The disease-specific 5- and 10-year survival rates were 49% and 37%, respectively; the 5- and 10-year recurrence rates were 68% and 70%, respectively. For patients with synchronous liver metastases, survival was not affected by the timing of liver resection. The prognosis after treatment of any recurrence was best after the accomplishment of a repeated R0 situation, independent of the location of the recurrence. In the multivariate analysis, the disease-specific survival and recurrence rates were statistically significantly influenced by more than three lymph node metastases of the primary tumor, more than two lesions within the liver, and the presence of extrahepatic tumor. CONCLUSIONS: From these data, we have developed a simple score for the risk stratification which may be useful for future studies on interdisciplinary management of colorectal liver metastases.

Relationship between degree of chromosomal aberration and survival in intestinal-type gastric cancer - a preliminary report based on three cases of hepatic metastasized gastric cancer with long-time survival.

BACKGROUND: Gastric cancer is one of the most frequent malignancies worldwide. More than 50% of all patients present with advanced stage of disease, with long-time survival of less than 5%. In selected subgroups, palliative gastric resection seems to be beneficial for survival and improved quality of the remaining life time, but is still controversially discussed. PATIENTS AND METHODS: We report 3 cases of patients with intestinal-type advanced gastric cancer. All patients presented preoperatively with stage IV disease with liver metastases. The patients underwent palliative gastric resection and subsequent palliative chemotherapy. We performed a genome-wide DNA analysis of 9 gastric cancer tissue specimens using the DNA microchip array technique. RESULTS: 4 and 6 years after palliative surgery and chemotherapy, 2 of the patients show no signs of recurrence, while the third patient shows stable disease under third-line chemotherapy 4 years after the initial diagnosis. Comparative genetic analysis of 9 gastric cancer tissue specimens suggested that the degree of chromosomal aberration was closely related to survival for intestinal-type gastric cancers. CONCLUSIONS: Palliative gastric resection is beneficial for survival and quality of life in selected patients. Determination of the degree of chromosomal aberrations might be helpful in predicting the response on multimodal treatment in intestinal-type gastric cancer. A better understanding of molecular biology is needed to define prognosis markers and molecular targets.

Radio-guided parathyroidectomy in patients with primary hyperparathyroidism and concomitant multinodular goiter.

PURPOSE: We investigated possible instances where the standard bilateral neck exploration for parathyroid adenoma may be omitted in primary hyperparathyroidism (pHPT) if preoperative diagnostics for the location have been performed. METHODS: Ten patients underwent surgical treatment for pHPT and multinodular goiter between October 2006 and October 2008. Identification of the parathyroid adenomas' location with cervical ultrasound and (99m)technetium-sestamibi nuclear scanning ((99m)Tc-MIBI) was not possible in any of these patients. An extirpation of the parathyroid adenomas was performed with intraoperative use of the (99m)Tc-MIBI-guided probe technique. The median follow-up time was 17.5 months (range 2-30). RESULTS: Ten patients underwent an elective operation for solitary (n = 9) or dual (n = 1) parathyroid adenomas and concomitant thyroid disease. Definitive proof of the parathyroid adenomas was achieved in all of the patients without further neck exploration. The adenomas were 1.3 cm (range 1-2) in diameter. Calcium and parathyroid hormonal levels were reduced on the first postoperative day (P = 0.003). There were no postoperative complications. All patients were free from recurrence. CONCLUSION: The intraoperative probe technique is feasible in patients with pHPT and limited diagnostics for the location of parathyroid adenomas with concomitant goiter. This diagnostic technique identified the parathyroid adenoma in all cases, and thus rendered a bilateral neck exploration obsolete.