[Prognosis of malignant melanoma following dissection regional lymph node metastases]. / Prognose beim malignen Melanom nach Dissektion regionärer Lymphknotenmetastasen.

BACKGROUND: Malignant melanomas usually metastasize in the regional lymph nodes. This generally leads to a worsening of prognosis. Survival probability after extirpation of the tumorous regions is conditioned by various factors. Until now, the basis for differentiated therapy has been the precise understanding of the TNM classification. Clinical parameters are also relevant to therapy and of decisive importance to the further course of disease. QUESTION: Which clinical parameters are important to the prognosis of patients with regional melanoma and lymph node disease? PATIENTS AND METHODS: This study is a retrospective analysis of patients at the Clinic and Polyclinic of General Surgery of the University Hospital in Münster,Germany, together with a review of the literature. Included were 137 patients who received curative resection of lymph node metastases from malignant melanomas between 1974 and 1996. From the literature, 6,694 cases were found which allowed the establishment of 13 different prognosis parameters following lymph node metastasis resection These parameters were compared with our own results concerning established, relevant parameters. RESULTS: The cumulative 5-year survival rate for patients studied was 50.7%. The 5-year survival rates relating to characteristics varied between 12.9% and 80.0%. Of the 13 variables from the literature relevant to prognosis that were included in this analysis, four were found to be significant: Breslow penetration depth, standardized age and age at primary tumor diagnosis, recurrence, and location of the primary tumor. Considering these significant characteristics, one can arrive at a detailed prognostic classification of patient and history. This is indispensable for correctly tailoring therapy to disease stage.

Analysis of serum CYFRA 21-1 concentrations in patients with esophageal cancer.

BACKGROUND: This study was conducted to determine the use of CYFRA 21-1 for patients suffering from esophageal carcinoma. MATERIALS AND METHODS: 50 patients with malignant, 50 patients with benign esophageal lesions, 50 healthy persons and 50 patients with benign lung disease were tested for CYFRA 21-1, CEA, CA 72-4 and SCC-antigen serum concentrations. The patients with esophageal carcinoma underwent follow-up analysis for one year. RESULTS: CYFRA 21-1 (cut-off: 1.40 ng/ml) showed a sensitivity for esophageal carcinoma of 46% at a specificity of 89.3%. There was a tendency for higher serum CYFRA 21-1 concentrations in advanced T-stages. Correlations of CYFRA 21-1 with N or M stages could not be observed. The postoperative course, in terms of survival and tumor free survival showed significant correlation to pre-operative CYFRA 21-1 concentrations. Adjuvant therapy could be monitored by CYFRA 21-1 as well. Clinical tumor recurrence was preceded by CYFRA 21-1 elevation by 3.4 months. CONCLUSIONS: We recommend the use of CYFRA 21-1 in cases of esophageal carcinoma, especially in cases of squamous cell carcinoma.

[Differential anterior interosseous nerve syndrome diagnosis]. / Zur Differentialdiagnose des N.-interosseus-anterior-Syndroms.

The differential diagnosis of the rupture of flexor pollicis longus tendon and profundus tendon to index finger to the interosseus anterior nerve syndrome can be difficult and can lead to misinterpretation of the clinical impression. Two cases are reported to demonstrate this problem. In the first case a spontaneous rupture of flexor pollicis longus was found, when first an interosseus anterior nerve syndrome was suspected. In a second case surgical exploration of flexor pollicis longus tendon and profundus tendon to index finger was done on the assumption of a rupture, that revealed intact tendons. In a second operation neurolysis of the interosseus anterior nerve was carried out with full recovery of flexion of the thumb and index finger.

[Value of electrotherapy within the scope of conservative treatment of anorectal incontinence]. / Stellenwert der Schwellstromtherapie im Rahmen der konservativen Behandlung der anorektalen Inkontinenz.

The following study reports on transanal electric stimulation as a conservative method of treatment in anal incontinence. In the centre of interest are clinical examinations on 45 patients that underwent a combined treatment with the IT-system 100 from Reha-Medi and pelvic floor training. A collective of 29 patients only treated with pelvic floor training was used as a control group. The results were based on a thorough medical history ascertainment and the corresponding clinical examinations at the beginning and end of the treatment. Our findings were classified according to the modified score of incontinence of Holschneider [16]. After therapy 42.2% of patients with electric stimulation therapy and 27.6% of the control group showed continence. 40 respectively 62.1% were non responder without relevant benefit. In the electric stimulation group the median score before and after therapy amounted to 6.57 versus 9.24 points. The control group achieved 6.72 respectively 8.58 points. The differences are statistically significant (p < 0.05, Student t-test). Concerning the results in relation to the cause of the incontinence, no significant differences between idiopathic and traumatic origin of the insufficiency of the sphincter mechanism are found in both groups. Therefore all variations of anorectal incontinence are seen as indication for treatment. The international literature as well as our own results confirm that electric stimulation is effective and may be in special cases a major factor in the conservative treatment of anorectal incontinence.

[More successful and cost effective--the non-transendoscopic method of TPCD]. / Erfolgreicher und kostensparender--die nicht-transendoskopische Methode der TPCD.

With TPCD best results are gained with large diameter endoprostheses. In this instance special duodenoscopes with a working channel of 3.2 or 4.2 mm are needed for the implantation of 10 or 12 French endoprostheses. Alternatively, using the non-transendoscopic technique large diameter endoprostheses of 14 or more French can be implanted independently from the diameter of the working channel with conventional endoscopes. We have used this method developed at our institution in 1204 patients since 1982 and compared its results with 192 patients in whom the transendoscopic technique with 7-10 French endoprostheses was administered. The success-rate (non-transendoscopic technique 94 vs transendoscopic technique 79%), early complications (5 vs 11%), method-specific mortality (0.3 vs 1%), in-hospital mortality (3.6 vs 21%) and late complications (19 vs 33%) are clearly in favour of the non-transendoscopic approach. The higher rate of early complications and consecutively higher in-hospital mortality of the transendoscopic method with 7-10 French endoprostheses was mainly due to frequent episodes of early cholangitis due to insufficient biliary drainage. The higher success-rate of the non-transendoscopic approach is method specific ("Prothesenleger" guidable). A change of the endoscope is not necessary in contradiction to the transendoscopic method. Additional costs of special duodenoscopes that can be used neither for ERCP nor sphincterotomy are superfluous.(ABSTRACT TRUNCATED AT 250 WORDS)

Rupture of the spleen caused by primary angiosarcoma. Case report.

Splenic angiosarcoma is rare with only about 60 reported cases. A case is presented in which the tumor caused spontaneous rupture of the spleen and showed characteristics of an infiltrating echinococcosis of the liver and spleen in ultrasound and computed tomography imaging. The literature is reviewed in regard to clinical features, diagnosis and management.

[Indications, incidence of recurrence and late results after selective vagotomy]. / Indikationen, Rezidivhäufigkeit und Spätergebnisse nach selektiver Vagotomie.

At the Clinic and Polyclinic for General Surgery of the Westfälische Wilhelms Universität Münster a total of 125 patients were vagotomised because of chronic duodenal ulcers during the period from 1. 1. 1973-31. 12. 1988. The case histories were analysed retrospectively. Standardised questionnaires were sent to the patients in order to gain more information about the post-operative progress and about possible complications after vagotomy had been carried out. 12.2% of the patients questioned developed a recidive ulcer 1-16 years after the operation which resulted in 8 cases in a Billroth II gastrectomy with Y-anastomosis according to Roux. 7 of the 9 recidives occurred during the first two post-operative years. The average time before relapse occurred amounts to 1.7 years in spite of drug treatment. As the initial operation was performed more than 6 years ago in 88.1% of the patients and in this respect later occurring recidives could have been detected, it is to be assumed, that relapses manifest themselves, if at all, relatively soon after the initial operation. The surgical therapy of the recidive ulcer by means of B II gastrectomy was associated with a favourable prognosis; all patients were able to resume work. A comparative analysis of the later results in 67 patients of various age structures showed that with increasing age the rate of patients who considered the operation as successful decreased. Of those up to 25 years 66.7% considered themselves as recovered, of those between 41-45 years 22.2%. It can be concluded that a selective proximal vagotomy represents a curative method in the case of chronic relapsing uncomplicated duodenal ulcers. Satisfactory results could be obtained especially in young patients who develop temporary stress ulcers. Good long-term results can be obtained here, despite the high relapse rates described in our own collective of patients as well as in literature.

[Can resorbable suture material be used in surgery of the supra-aortic branches?]. / Ist resorbierbares Nahtmaterial einsetzbar in der Chirurgie der supraaortalen Aste?

The experience with the use of monofilament absorbable suture (5/0 USP) in supraaortal vessels shows the same results related to neurological complication. The postoperative technical complications (bleeding, occlusion, restenosis) could be significantly reduced (p less than or equal to 0.05). Suture ruptures of aneurysms were not observed after resorbable vascular suture. The resorbable monofilament suture material is useful in high pressure vessel system.

Cardiovascular side effects after renal allograft rejection therapy with Orthoclone: prevention with nitrendipine.

Orthoclone (OKT-3), a monoclonal antibody, is an effective immunosuppressant in organ graft recipients. One of the reported side effects is serious pulmonary edema, heart failure, hyperdynamia, and elevation of blood pressure. It should be assessed whether patients treated with OKT-3 benefit from antihypertensive therapy with a calcium channel blocker before and during the allograft rejection therapy to prevent from cardiovascular side effects. To assess a preventive cardiovascular effect of therapy with nitrendipine before and during the OKT-3 rejection therapy, the patients studied (n = 28) were randomly allocated to two study groups. Group a without nitrendipine comprised 15 patients, and group b with 2 x 10 mg of nitrendipine daily comprised 13 patients. In study group a (without nitrendipine therapy), in 8 of 15 patients, there was a short-lasting increase in blood pressure during 3 h after the first injection of OKT-3 by 20.0 +/- 12.8 (systolic)/10.1 +/- 6.7 (diastolic) mm Hg. Whereas this initial rise of blood pressure on the first day was accompanied by an increase in heart rate by 24.1 +/- 10.8 beats/min, the longer-lasting increase in blood pressure at day 2 was not associated with significant changes in heart rate. In group b (patients receiving 2 x 10 mg of nitrendipine before OKT-3 therapy was started and during the whole treatment course), in 3 of 13 patients, a short increase in blood pressure (13.7 +/- 2.9/7.8 +/- 5.1 mm Hg) was recorded 5 h after the first dose of OKT-3.(ABSTRACT TRUNCATED AT 250 WORDS)