TV news and concerns about - the EHEC-outbreak 2011 in Germany.

BACKGROUND AND AIM: In the beginning of May 2011 and finally terminated on July 26th 2011 an outbreak of infections with enterohaemorrhagic Escherichia (E.) coli (EHEC) strain O104:H4 occurred in Germany. The aim of this study is to analyse whether media coverage of the outbreak influenced the number of patients presenting with diarrhoea to the emergency room of a tertiary centre and to evaluate the influence of information on perception and rating of symptoms. METHODS: Prospectively collected data in a tertiary centre on the number of patients presenting to the emergency room with diarrhea during the EHEC outbreak was correlated with retrospectively collected data about the media coverage of the outbreak on TV and compared to the number of patients that had presented with diarrhea during a comparative period in 2010. RESULTS: A total of 1,625 patients presented to our emergency room during the observation period in 2011 between May 31st and June 13th, including 72 patients (4.4%) presenting with the predominant symptom of diarrhoea, of whom six patients (0.4%) reported haemorrhagic diarrhoea. In the comparative period in 2010, between May 31st and June 13th, twelve patients (1.6%) presenting the symptom of diarrhea were treated in our emergency room. The analysis of the news reports in 2011 revealed a total of 1,150 reports broadcast in the ARD and a total of 173 reports broadcast in the regional news channel MDR between May 29th and June 11th. In 2010 not a single report regarding our search terms was broadcast in the corresponding time period. CONCLUSION: Our data suggest a clear positive correlation of the frequency of TV reports dealing with the epidemic disease outbreak and the rate of outpatient consultations in emergency rooms because of diarrhoea and could make an important contribution for future discussions.

Gastric stimulation in treatment in type 2 diabetes mellitus.

UNLABELLED: Metabolic surgery is a dynamic field providing a wide range of new techniques. The aim of our paper is to inform about gastric electrostimulation in the treatment of type 2 diabetes mellitus. Gastric electrostimulation in type 2 diabetes mellitus treatment is performed by means of implanting Tantalus system (Metacure). When triggered by food intake, the Tantalus system generates signals for the stomach to contract. Early after the food intake, thus before the stomach distends completely, the system increases spontaneous stomach contractions. Via afferent vagal signals, these increased contractions are evaluated by the central nervous system as a sign that satiety has been reached. Three pairs of electrodes connected with a stimulator are implanted laparoscopically. The system comes equipped with a battery as well. Laparoscopically implanted system of stomach electrostimulation presents a simple and easily regulated system without disturbing the integrity of gastrointestinal tract. It is a reversible system. In accord with preliminary results, Tantalus offers a safe and effective treatment of type 2 diabetes mellitus by reducing other cardiometabolical risky factors. The operation safety is comparable with that of similar minimally invasive surgical techniques. In order to improve our understanding of diabetes mellitus pathophysiology as well as of effects of gastric electrostimulation, more trials need to be performed. The surgical diabetes treatment represents an interesting chance for patients and it might become a common technique in the future (Fig. 1, Ref. 29). KEYWORDS: diabetes mellitus, obesity, gastric stimulation, pacemaker.

The role of laparoscopic Heller myotomy in the treatment of achalasia.

AIM: To evaluate the results of laparoscopic Heller myotomy in our group of patients. METHOD: A retrospective clinical trial was carried out to evaluate the indication, technique and controversies of laparoscopic Heller myotomy in the achalasia treatment. The following symptoms were evaluated prior and after Heller myotomy: dysphagia, heartburn, nausea/vomiting after meal and asthma/coughing. The patients were evaluated by the use of Likert score. Statistical analysis was performed by using Student t test. The intra-operative (operation time, intraoperative complications, blood loss, conversion rate), and peri-operative parameters (morbidity, mortality, hospital stay) were evaluated as well. The patients who underwent laparoscopic Heller myotomy were included in the trial. All patients were perioperatively managed by a multidisciplinary team. RESULTS: The evaluation of fourteen patients was performed (average age: 53.2 yrs., eleven men, two women, BMI 23.6 kg/m(2)). The patients were indicated for surgery in all of the stages (I-III). Previous semiconservative therapeutic modalities were performed in thirteen patients. The standard laparoscopic technique for Heller myotomy with semifundoplication was applied. All the observed symptoms were statistically improved after the surgery (p=0.05). The average operating time was 89 minutes. Intraoperative blood loss was below 20 ml. There was no conversion to open surgery. An average hospital stay was 4.3 days. Morbidity was 14.3 % and mortality 0 %. In one patient esophageal mucosa perforation was intra-operatively identified and sutured. Post-operative course in this patient was without any complications. CONCLUSION: The laparoscopic Heller myotomy has become the "gold standard" procedure for achalasia. It is an excellent method allowing precise operation technique with good visualization of the esophagogastric junction. The operation with this approach is safe, efficient, and with excellent reproducible operative results. The correct and early indication for surgery is crucial. The delayed diagnosis with a late indication for surgery is not an exemption (Tab. 2, Fig. 2, Ref. 36).

[The staple line in sleeve gastrectomy]. / Staplerová linie u sleeve resekce zaludku.

INTRODUCTION: Postoperative leak and bleeding from the staple line are potentially serious early complications following laparoscopic sleeve gastrectomy. AIM: This study aims to assess the significance of oversewing the staple line after laparoscopic sleeve gastrectomy in preventing leak and bleeding in our group of patients. MATERIAL AND METHODS: Patients after laparoscopic sleeve gastrectomy were included in the trial. Two different principles of oversewing the staple line (selective vs. mandatory) were analyzed. The design of the trial was retrospective-prospective, non-randomized. Postoperative complications were recorded. RESULTS: Between October 2006 and December 2011, 638 laparoscopic sleeve gastrectomies were carried out using standard laparoscopic technique. 297 of the patients belonged to the group with selective oversewing of the staple line. The remaining 341 patients belonged to the group in which the staple line was oversewn in all cases. Both groups of patients were comparable in the basic parameters. Early postoperative leak affected one patient in both groups, 0.30% versus 0.29% (p = 0.9203), respectively. The rates of postoperative bleeding were 2.7% (selective oversewing) versus 0% (mandatory oversewing) (p = 0.0023), respectively. CONCLUSION: Our study did not demonstrate the impact of oversewing the staple line on the occurrence of postoperative leak. The rates of postoperative bleeding from the resection site were statistically significantly lower in the group with the mandatory oversewing of the staple line.

[Retroperitoneoscopic adrenalectomy with dorsal approach]. / Retroperitoneoskopická adrenalektomie dorzálním prístupem.

UNLABELLED: INTRODUSTION: Various surgical mininvasive approaches for adrenalectomy have been established over the last two decades. We are evaluating the retroperitoneoscopic adrenalectomy with dorsal approach. MATERIAL AND METHODS: The prospective open clinical trial was carried out to evaluate intra-operative (operations time, intraoperative complications, blood loss, conversion rate) and peri-operative parameters (morbidity, mortality, hospital stay). Patients who underwent retroperitoneoscopic adrenalectomy with dorsal approach were included in the trial. A tumor size above 12 cm or BMI higher than 35 kg/m2 were considered asexclusion criteria. All the patients were perioperatively managed by a multidisciplinary team. RESULTS: A total of 81 patients were assessed (average age: 45.7 yrs, 37 males, 44 females, BMI 27.8 kg/m2). The average operating time was 61 minutes. The intraoperative blood loss was below 20 ml. The mean hospital stay was 2.1 days. Morbidity was 2.7% and mortality 0%. CONCLUSION: Retroperitoneoscopic adrenalectomy with dorsal approach is considered a method of choice in our hospital. The use of this approach is safe, efficient, with excellent reproducible operative results and impressive patient recovery.

Nissen versus Dor fundoplication for treatment of gastroesophageal reflux disease: a blinded randomized clinical trial.

INTRODUCTION: Fundoplication techniques for treatment of gastroesophageal reflux are discussed concerning impairments and success. This randomized trial was conducted to compare Nissen's wrap and the anterior partial technique (Dor) concerning patients' quality of life (QoL) and functional data after a mid-term follow-up. METHODS: In a 24-month period, 64 patients were equally randomized into group A (Nissen's fundoplication) and group B (180° anterior partial fundoplication). After a mean follow-up of 18 months, all patients were examined and interviewed using standardized QoL questionnaires (Gastrointestinal Quality of Life Index), Visick score, 24-hour pH-metry and esophageal manometry. Data of 57 patients (group A: 27, group B: 30) could be analyzed. RESULTS: After partial fundoplication, 9 patients (30%) stated the operative results were worse than perfect. Only 2 patients (7%) evaluated the outcome after Nissen's fundoplication as unsuccessful (p = 0.04). However, postoperative Gastrointestinal Quality of Life Index showed no differences between groups (p = 0.5). Additionally, functional data were not different (DeMeester 10 vs. 12, p = 0.17, and lower esophageal sphincter pressure 13 vs. 12 mm Hg, p = 0.5). CONCLUSION: The anterior partial fundoplication technique did not lead to disadvantages in postoperative QoL, physiological function and reflux control when compared to Nissen's approach in a mid-term follow-up.

Laparoscopic management of spontaneous intraperitoneal perforation of urinary bladder.

The authors present two cases of spontaneous intraperitoneal perforation of urinary bladder. The first case was a 56-year old female patient with history of urothelial cancer with partial urinary bladder resection and subsequent radiotherapy six years ago. The diagnostic laparoscopy was indicated because of the clinical signs of peritonitis. The diagnostic laparoscopy revealed a perforation of urinary bladder and the management of perforation was done laparoscopically. The histological examination of specimen revealed urothelial cancer. The postoperative course was uncomplicated and the patient underwent further oncologic treatment. The second patient was a 61-year old man admitted with abdominal pain lasting for one day after excessive alcohol intake. An indication to diagnostic laparoscopy was done according to the clinical signs of peritonitis. Also in this case, perforation of urinary bladder was identified and laparoscopic management was carried out. The postoperative course was uncomplicated. Both patients denied any trauma. The diagnosis of urinary bladder perforation was not done preoperatively. The diagnosis of spontaneous perforation of urinary bladder is difficult. The case history data with no trauma do not lead to this diagnosis. It is important to consider this diagnosis in case of acute abdomen. The treatment of urinary bladder perforation is based on the identification of the defect, lavage of the peritoneal cavity, excision of the defect, reconstruction of the bladder with intact blood supply, bladder drainage supporting the defect healing, and exclusion of malignancy. The laparoscopic treatment of spontaneous perforation according to literature is not common, however very effective (Fig. 1, Ref. 41).

Complicated course after sleeve gastrectomy for obesity.

The authors present a case of a 52-year old female patient with sleeve gastrectomy for obesity. Two major complications occured after the surgery. The first one was a leakage on the third day after the surgery. The routine swallow examination on the first day after the surgery was normal. The pathological secretion from the drainage occurred on the third day after the surgery with a simultaneous increase in inflammatory markers. There were no clinical signs of sepsis. An indication for laparoscopic revision was done and a small defect in the staple line was identified. The oversewing of the small defect on the stomach was performed. Immediately after the second surgery the patient was clinicaly without any problems. The inflammatory markers decreased promptly after the surgery. The second complication was presented with decompensated psychosis, which developed on the 4th day after the second surgery. The patient complained of problems with swallowing despite the fact that the swallow contrast examination was normal. The patient received her psychiatric medication intravenously. The problem with swallowing was not based on any organic reason, and lasted for 4 weeks. During this period the patient was fed only parenterally. Almost 6 weeks after the surgery the patient became compensated and was dismissed. We would like to point out to the problems potentially occuring in patients with a psychiatric disease. Good compensation and stabilization of psychiatric disease is a condition that has to be met before a surgery (Tab. 1, Fig. 1, Ref. 21).

[Distal trachea and bronchial large lesions and suture reinforcement with Polyglicol Acid (PGA) patch. First clinical experience]. / Lesioni estese della trachea e dei bronchi principali. Prime esperienze con l'impiego di Polyglycol Acid (PGA) patch riassorbibile.

BACKGROUND: Iatrogenic lacerations of the trachea and the bronchies are mostly complications of emergent intubations or percutaneous tracheotomies. The outcome is mainly influenced by thorough diagnostics, severity of the lesions, and urgent treatment. New materials are used to reduce the tension at the sutured points during ventilation. PATIENTS AND METHODS: Four patients were operatively treated with primary suturing of trachea and bronchies with Polydioxanon. The large wounds were then covered using resorbable Soft PGA Mesh (resorbable Polyglykol Acid patch). The first two patients were found hypoxic and was orotracheally intubated in an emergency. An air leckage was detected in the hospital due to a large lesion of the pars membranacea. The third patient was operated in an emergency due to ileus caused by progressive colonic carcinoma. The weaning period on Intensive Care Unite (ICU) was unsuccessful. In a difficult procedure she underwent a percutaneous tracheotomy (dystopia of the trachea due to an arteria lusoria) mainly resulting in esophagotracheal fistulae. The fourth patient was treated by esophagectomy due to a local progressive carcinoma. A long lesion between the carina and left main bronchus resulted. All lacerations were treated by single knot suture technique with Polydioxanone and finally covered (patched) with PGA Mesh. The outcome of the surgical treatment was analyzed. RESULTS: In bronchoscopies and CT-scans no air leackages during respiratory ventilation periods were observed. The first patient could be transferred into a normal ward from ICU at day 38. The second patient was found to be tetraplegic and was discharged into another hospital at day 48. One patient died at the 15th postoperative day due to urosepsis. The fourth patient left the ICU on day 10 and was discharged home at day 23. CONCLUSIONS: Large iatrogenic airway lacerations of the distal trachea should be managed by early surgical repair due to their life-threatening outcome. Although only a small number of patients were analyzed so far, a PGA Mesh might be useful to increase the suture safety reducing the tension at the suture points due to the cuff pressure during long ventilation periods.

[Our experience with free hand camera]. / Nase zkusenosti s Free Hand kamerou.

AIM: The evaluation of the contribution of Free Hand camera to laparoscopic resection of colon sigmoideum in clinical praxis. MATERIAL AND METHOD: Free Hand camera is an automatic camera system controlled by a surgeon. In the prospective-retrospective trial we have compared two groups of 20 patients together. In the first group there were patients with laparoscopic resection of colon sigmoideum with the Free hand camera usage and in the second group there were patients with laparoscopic resection of colon sigmoideum with a human assistant. We evaluated the length of surgery and surgeon's comfort. The intraoperative data of both of the patient groups were compared with the usage of physiological and operative score (POSSUM). RESULTS: The length of surgery in the group with the human assistant and Free Hand camera were 149, and 161 minutes respectively. There is no statistically significant difference in the length of surgery (p = 0.05) in both of the groups. The surgeon in both of the patient groups evaluated the operative view and comfort as good. CONCLUSION: The pilot study has shown the usability of Free Hand in praxis. The daily usage of Free Hand camera is possible in elective as well as acute surgeries after managing of the learning curve.

[Quality of life after gastrectomy]. / Kvalita zivota po gastrektomii.

AIM: The comparison of quality of life after gastrectomy. METHOD: Quality of life after gastrectomy is compared in open, prospective, randomised trial. The group with Roux-en-Y reconctruction and "J-pouch" reconstruction are compared. "J-pouch" is created using interponate jejunum loop with keeping duodenum in passage. The standardized questionnaire according to Eypasch is tool for comparison of quality life. The statistical evaluation was performed using Student t-test. RESULTS: 67 patients were analyzed altogether. The average quality of life in the group with Roux-en-Y reconstruction was 92.6 points and in the "J-pouch" group was 102.5 points. The statistical comparison of quality of life using Student t-test in the group with Roux-en-Y and "J-pouch" reconstructions confirmed significant difference (p = 0.0067). CONCLUSION: Quality of life in patient after gastrectomy represents the most important factors after surgery. The standardised questionnaries help to quantify quality of life and provide the necessary data for evidence based medicine. The statistical comparison confirmed the higher quality of life in patients with "J-pouch" reconstruction. The possibility of reconstruction providing better nutrition and higher quality of life should be considered.

Ductal carcinoma of the breast in the pacemaker generator's pocket.

Authors present a case of a 78-year-old female patient with invasive ductal adenocarcinoma in the pacemaker, s pocket. A decubitus-like tumor had developed in this place, and has been missinterpretated as a benign lesion for 5 months. Diagnosis was done with a time delay. An excisional biopsy revealed annvasive ductal adenocarcinoma. The first step was the implantation of a new pacemaker generator performed on the opposite side. The second step was a modified radical mastectomy, according to Madden, and the removal of the originally implanted pacemaker generator. Radiotherapy and hormonal adjuvant therapy were applied after surgery. The patient was followed-up at an out-patient clinic, and died 25 months after diagnosis because of generalization of the disease (Fig. 2, Ref. 35). Full Text (Free, PDF) www.bmj.sk.

[The current view of surgical treatment of diverticular disease]. / Soucasný pohled na chirurgickou lécbu divertikulární choroby.

AIM: The aim of our prospective dynamic cohort trial is the evaluation of indication for surgery for diverticular disease and the evaluation of morbidity and mortality. MATERIAL AND METHOD: All patients operated for diverticular disease and its complications were involved in the study. The conservatively treated patients were not involved. 104 patients with diverticular disease and its complication were operated from August 2007 till July 2008.46 men and 58 women at average age of 63.9 (31-85) years were in this group. 78 patients were electively operated in noninflammatory stage of diverticular disease. 3 patients of them had colovesical or enterocolical fistulas. An elective laparoscopic colon sigmoid resection was performed by 74 patients and a laparoscopic left hemicolectomy was performed by 4 patients. An end-to-end stapled colorectal suture was performed by all patients. An excision of fistula from urinary bladder and a segment resection of small bowel were performed in the case of fistula presence. In connection with previously repeated diverticulitis attacks or after previous surgeries, adhesiolysis was performed by 23 patients. 26 patients were operated for acute complication of diverticular disease. 24 patients of this group were operated for acute diverticulitis and 2 patients for diverticular bleeding. 23 colon sigmoideum resections, 2 left hemicolectomies, and once ileocecal resection were performed. The primary bowel suture was performed by 20 patients and Hartmaruts operation was performed by 4 patients. RESULTS: The indication for surgery follows the classification according to Hansen and Stock. The abdominal postoperative complications (wound infection, anastomotic leak, prolongated bowel atonia, and others) occurred by elective operated group in 9% and by acute operated group in 26.9%. The overall abdominal postoperative complications occurred in all the involved patients in 13.4%. The extraabdominal postoperative complications (urinary infection or retention, cardiopulmonary complications, trombosis/embolia, postoperative qualitative conscious disorder, renal insufficiency, and others) occurred by elective group in 19.6% and by acute operated group in 50%. Overall extraabdominal postoperative complications occurred in all involved patients in 26.90%. The mortality was 0%. The conversion rate in elective group was 3.8% (3 pts.). An anastomosis leak occurred once (1%) by elective operated patient. An acute reoperation with resection according to Hartmann was performed. A small bowel loop perforation by coincidental adhesiolysis occurred once. A small bowel defect was identified and sutured by early laparoscopic reoperation. The conversion rate in acute group was 23.1% (6 pts.). The colonoscopy was necessary on 3rd day by 1 patient after left hemicolectomy for splenic flexure bleeding. This examination revealed bleeding from diverticulum in hepatic flexure. An endoscopic treatment was performed. An abscess in small pelvis occurred by this patient (12th postoperative day) and open drainage was performed. There was no anastomosis leak in group with acutely operated patients. CONCLUSION: The usage of standard classification is suitable for operation's indication for diverticular disease and its complications. It helps to determine the type and operation's strategy. The acute complicated diveticulitis has high morbidity and mortality. The early indication of selected patients with diverticular disease for elective colon sigmoideum resection protects against possible complication in the case of next attack of diverticulitis. It concerns the patients with recidivated uncomplicated and complicated forms of disease as well. The primary conservative treatment with percutaneous CT navigated drainage allows a postponed elective surgery. The primary resection with suture is better than the two stage surgery. The primary laparoscopic resection is safe procedure in almost all the cases. The primary suture can be safely performed in all elective cases for uncomplicated diverticulitis, chronic fistulas, obstruction, for primarily conservatively treated stages Hinchey I and II and possibly for all the selected patients with Hinchey III and IV stages with MPI lower as 21.

Leukopoiesis is not affected after intravenous treatment with the novel antineoplastic agent taurolidine. Results of an experimental study in rats.

BACKGROUND/AIM: Chemotherapy can induce serious leukopenia. The aim of our study was to investigate the effects on leukopoiesis when the antineoplastic agent taurolidine (TRD) is administered by a bolus injection or during repetitive treatment (21 cycles) over 7 days in rats. METHODS: Rats were intravenously treated with a single injection (A) or by a 7-day treatment (B) with increasing doses of TRD versus control (isotone sodium) in a standardized animal model. Hematological adverse effects on leukopoiesis were analyzed in peripheral blood. RESULTS: (A) Neither the highest TRD concentration (3%) nor 1 or 2% caused a significant difference between the control and TRD groups (p > 0.085) in the perioperative course after bolus administration. (B) The administration of TRD 3% led to a slight change of granulocyte and monocyte counts compared to the control group particularly on postoperative day 7, but this difference was not significant. In both protocols a slight postoperative increase in leukocytes was observed. CONCLUSION: We report that TRD administered intravenously in an antitumor dose does not affect leukopoiesis in rats. Thus, the agent offers a promising and safe means in cancer treatment. The effects are currently investigated in incurable cancer patients.

Does enteral nutrition of dietary polyunsaturated fatty acids promote oxidative stress and tumour growth in ductal pancreatic cancer? Experimental trial in Syrian Hamster.

BACKGROUND: Type and composition of dietary fat intake is supposed to play an important role in carcinogenesis. Thus we investigated the effects of n-3, n-6 and n-9 polyunsaturated fatty acids (PUFA) on oxidative stress (lipidperoxidation) and tumour growth in ductal pancreatic cancer. METHODS: Ninety male hamsters were randomized into 6 groups (gr.) (n=15) and allocated to 3 main dietary categories: gr. 1 and 2 received a standard high fat diet (SHF, rich in n-6 PUFA), while gr. 3 and 4 were fed with a diet containing a mixture of n-3, n-6 and n-9 PUFA (SMOF) and gr. 5 and 6 had free access to a diet rich in n-3 PUFA (FISH-OIL). Gr. 1, 3 and 5 received weekly subcutaneous (s.c.) injections of 10 mg N-nitrosobis-2-oxypropylamine (BOP)/kg body weight in order to induce ductal pancreatic adenocarcinoma. Healthy control gr. 2, 4 and 6 were treated with 0.5 ml 0.9% sodium chloride s.c. After 32 weeks all animals were sacrificed. Removed pancreata were weighed and analysed histologically and biochemically. Activities of glutathionperoxidase (GSH-Px), superoxiddismutase (SOD) and levels of lipidperoxidation were measured in samples of pancreatic carcinoma as well as in tumour-free pancreatic tissue. RESULTS: While different diets did not significantly alter the overall incidence of histologically proven pancreatic adenocarcinoma, the number of macroscopically visible tumours was decreased in the FISH-OIL-gr. CONCLUSION: Different diets did not significantly influence the incidence of histologically proven pancreatic adenocarcinoma. However, administration of a diet rich in n-3 PUFA (FISH-OIL) resulted in a decrease of macroscopically visible tumours, thus indicating its beneficial effects in respect to attenuation of tumour growth.

Matrix metalloproteinase inhibitor RO 28-2653 decreases liver metastasis by reduction of MMP-2 and MMP-9 concentration in BOP-induced ductal pancreatic cancer in Syrian Hamsters: inhibition of matrix metalloproteinases in pancreatic cancer.

BACKGROUND: Matrix metalloproteinases (MMP) are proteolytic enzymes which degrade the extracellular matrix and therefore play an important role in metastasis. However, the impact of MMP inhibitors (MMPI) on pancreatic cancer is still unclear. Thus we evaluated the influence of selective MMPI Ro 28-2653 on the incidence of liver metastases and the concentration of MMP-2 and MMP-9 in ductal pancreatic adenocarcinoma in Syrian hamster. MATERIAL AND METHODS: One hundred and thirty male Syrian hamsters were randomised into 8 groups (Gr.1-3: n=15, Gr.4-8: n=17). Pancreatic cancer was induced by weekly subcutaneous injection of 10mg N-nitrosobis-2-oxopropylamin (BOP)/kg body weight (Gr.4-8) while healthy control Gr. 1-3 received 0.5 ml sodium chloride 0.9%. Gr.1 and 4 had free access to a standard diet, Gr. 2, 3 and 5-8 received a diet rich in polyunsaturated fatty acids, which increases liver metastasis in this model. In week 17 oral therapy started: Gr.3 and 6: 60 mg Eudragit/kg body weight/d (vehicle of MMPI), Gr.7 and 8: 40 mg, respectively, 120 mg RO 28-2653/kg body weight/d; Gr.1, 2, 4, 5: no therapy. After 30 weeks all hamsters were sacrificed and histopathologically examined. Additionally concentrations of MMP-2 and MMP-9 were measured in non-metastatic liver and liver metastases. RESULTS: Concentrations of MMP-2 and MMP-9 in liver metastases were decreased by high- and low-dose therapy with MMPI. Furthermore, the incidence of liver metastases was significantly reduced by low-dose therapy with Ro 28-2653. CONCLUSION: Low-dose therapy with Ro 28-2653 decreased liver metastasis due to an inhibition of MMP-2 and MMP-9 concentration in ductal pancreatic cancer.

Impact of polyunsaturated fatty acids on hepato-pancreatic prostaglandin and leukotriene concentration in ductal pancreatic cancer -- is there a correlation to tumour growth and liver metastasis?

Type and composition of polyunsaturated fatty acids (PUFAs) are suspected to play an important role in carcinogenesis. Thus we investigated the effects of n-3, n-6 and n-9 PUFAs on tumour growth, liver metastasis and concentration of prostaglandins (PG) and leukotrienes (LT) in experimental ductal pancreatic adenocarcinoma. Ninety male hamsters were randomised into six groups (Gr.) (n=15). While Gr. 1-3 were healthy control groups, Gr. 4-6 weekly received subcutaneous injections of 10mg N-nitrosobis-2-oxypropylamine (BOP)/kg body weight for 12 weeks in order to induce ductal pancreatic adenocarcinoma. Between week 1 and 16 all animals were fed with a standard diet with a raw fat content of 2.9%. In week 17 Gr. 1-6 were allocated to three types of diets: Gr. 1: standard high fat (=SHF diet, rich in n-6 PUFAs)/Gr. 2: FISH-OIL (rich in n-3 PUFAs)/Gr. 3: SMOF (=mixture of n-3, n-6 and n-9 PUFAs)/Gr. 4: BOP+SHF/Gr. 5: BOP+SMOF/Gr. 6: BOP+FISH-OIL. After 32 weeks all animals were sacrificed and pancreas as well as liver were analysed histologically. Furthermore pancreatic and hepatic concentrations of prostaglandins (PGF1alpha, PGE(2)) and LT were measured. FISH-OIL decreased number of macroscopically visible pancreatic tumours (Gr. 4-6: 54.5% vs. 45.5% vs. 9.1%, P<0.05) as well as incidence of liver metastasis (Gr. 4-6: 90.9% vs. 72.7% vs. 36.4%, P<0.05). Furthermore concentration of PGF(1)(alpha), PGE(2) and LT were significantly increased in pancreatic carcinoma compared to tumour-free tissue. Moreover levels of PGF(1)(alpha) and PGE(2) were higher in liver metastasis than in extrametastatic hepatic tissue. However, in Gr. 6 (FISH-OIL) intrametastatic concentration of LT was significantly lower than in non-metastatic hepatic tissue as well as in Gr. 4 and Gr. 5. FISH-OIL decreased number of visible pancreatic tumours and incidence of histological proven liver metastasis. This effect might be caused by a decrease of intrametastatic concentration of LT compared to extrametastatic hepatic tissue.

Effects of selective COX-2 and 5-LOX inhibition on prostaglandin and leukotriene synthesis in ductal pancreatic cancer in Syrian hamster.

Selective inhibition of eicosanoid synthesis seems to decrease carcinogenesis, however, the effect on liver metastasis in pancreatic cancer is still unknown. Ductal pancreatic adenocarcinoma was chemically induced by weekly injection of N-nitrosobis-2-oxopropylamine (BOP) in Syrian hamster. Animals received selective inhibition of cyclooxygenase-2 (Celebrex) and 5-lipoxygenase (Zyflo). In week 33, hamsters were sacrificed and incidence of pancreatic carcinomas as well as liver metastases were examined. Furthermore, size and number of liver metastases per animal were determined and concentration of PGF1alpha, PGE2 and leukotrienes was measured in hepatic and pancreatic tissue. Combined therapy (Celebrex+Zyflo) significantly decreased incidence, number and size of liver metastases. Furthermore extra- and intrametastatic concentration of PGE2 was reduced by this treatment in hepatic tissue. Single Cox-2-inhibition (Celebrex) decreased intrametastatic hepatic PGF1alpha and PGE2 concentration while PGF1alpha concentration was reduced in non-metastatic liver (nml). Moreover 5-LOX-inhibition (Zyflo) decreased intrametastatic PGE2 concentration as well as PGF1alpha and PGE2 in nml. In pancreatic carcinomas highest LT-concentration was found after combined treatment and this therapy group was the only one revealing a significantly higher amount of LTs in carcinomas compared to tumour-free tissue. Hepatic LT-concentration was significantly lower in the control groups than in nml of the tumour groups. Combination of Cox-2-inhibition and 5-Lox-inhibition might be a suitable adjuvant therapy to prevent liver metastasis in human ductal pancreatic adenocarcinoma.

Pneumatosis intestinalis--a pitfall for surgeons?

Pneumatosis intestinalis (PI) is characterized by multiple gas cysts in the wall of the gastrointestinal tract. Primary PI is extremely rare. In most of the cases PI is due to an underlying disease (traumatic and mechanical, inflammatory and autoimmune diseases, infectious and pulmonary diseases, drug induced, immunosuppression, transplantation, or neoplasm). A 69-year-old woman was treated with mixed connective tissue disease and PI twice operatively and once conservatively in our department. Review of the English literature showed 13 more cases of PI with underlying mixed connective tissue disease. Most published cases of pneumatosis intestinalis with radiological finding of pneumoperitoneum were treated conservatively and should have not been considered as a reason for surgery. Therefore, the treatment of PI can present as a major dilemma for the surgeon.

Influence of intraperitoneal and systemic application of taurolidine and taurolidine/heparin during laparoscopy on intraperitoneal and subcutaneous tumour growth in rats.

BACKGROUND: Recent clinical and experimental studies investigated the problem and possible pathomechanisms of portsite metastases after laparoscopic resection of malignant tumours. A generally accepted approach to prevent these tumour implantations does not exist so far. METHODS: After subcutaneous and intraperitoneal injection of 10(4) cells of colon adenocarcinoma (DHD/K12/TRb) the influences of either taurolidine or taurolidine/heparin on intraperitoneal and subcutaneous tumour growth were investigated in 105 rats undergoing laparoscopy with carbon dioxide. The animals were then randomised into seven groups. A pneumoperitoneum was established using carbon dioxide for 30 min (8 mmHg). Three incisions were used: median for the insufflation needle, and a right and left approach in the lower abdomen for trocars. To investigate the intraperitoneal (local) influence of either taurolidine and heparin on tumour growth the substances were instilled intraperitoneally. Systemic effects were expected when the substances were applied intravenously (iv). Synergistic influences were tested when both application forms were combined. The number and the weight of tumours as well as the incidence of abdominal wall and port-site metastases were determined four weeks after intervention. Blood was taken to evaluate the influences of taurolidine and heparin on systemic immunologic reactions: seven days before laparoscopy. two hours, two days. seven days, and four weeks after operation, and the peripheral lymphocytes were determined. RESULTS: Intraperitoneal (ip) tumour weight in rats receiving taurolidine (median 7 mg) and taurolidine/heparin (0 mg) intraperitoneally was significantly reduced when compared to the control group (52 mg) (P = 0.001). There was no difference of subcutaneus tumour growth among the groups (P = 0.4). Trocar recurrences were decreased when taurolidine was applied ip (3115). ipiv (4/15), and ip in combination with heparin (4/15) in comparison to the control group (10/15). Immediately after intervention treated and untreated groups showed a peripheral lymphopenia. CONCLUSIONS: The intraperitoneal therapy with taurolidine and the combination with heparin inhibits the intraperitoneal tumour growth and trocar recurrences. Neither the intraperitoneal nor the systemic application or the combination of taurolidine and heparin did reduce the subcutaneous tumour growth. The intervention caused a lymphopenia which was compensated on day two.