[Experience with an interdisciplinary surgical handbook for medical students]. / Erfahrungen mit einem fächerübergreifenden Logbuch für Medizinstudenten im Chirurgischen Tertial des Praktischen Jahres am Uniklinikum Köln.

BACKGROUND: There is a lack of well-trained surgeons in Germany. The medical students get their last contact to a surgical discipline in the final year of their medical education. The student's decision for a medical discipline is surely influenced by bad experiences during the last practical training in surgery. The aim of our project was to give the medical students an engaged and structured understanding of surgery with the aid of a logbook. It was tested in a pilot phase and should increase the number of final year students and their interest in surgery in the long-term. METHODS: From 5 / 2009 the structure of the surgical part of the final year was worked over by the Clinics for General, Visceral und Tumour Surgery, Vascular Surgery, Heart and Thoracic Surgery and Trauma Surgery. A logbook was developed which includes the rotation through the 4 different surgical departments, lists the targets of study and the practical exercises in obligatory and optional schedules, defines one patient care per rotation and introduces a mentoring system. The logbook is clearly represented and the required signatures of the senior doctors are minimized. After the surgical term the students filled out a questionnaire and were interviewed about the pros and cons of the logbook. RESULTS: In December 2009 the new logbook was distributed for the first time. Until now 113 final year students have used it. The first evaluation of 45 students showed a positive rating of the clinical organization and structure of the clinic, the list of the learning targets and the practical skills. The implementation of the mentoring system and the required signatures were still incomplete. The final year students wished for more training time for the doctors. The positive response of the final year students results in an increasing number of final year students chosing a career in surgery. CONCLUSION: The new logbook for the surgical part of the final year at the University of Cologne helps the students with the daily routine of the surgical departments, gives a review of the learning targets and emphasizes a good surgical training.

Cytochrome P450 levels are altered in patients with esophageal squamous-cell carcinoma.

AIM: To investigate the role of cytochrome P450 (CYP) in the carcinogenesis of squamous-cell carcinoma (SCC) in human esophagus by determining expression patterns and protein levels of representative CYPs in esophageal tissue of patients with SCC and controls. METHODS: mRNA expression of CYP2E1, CYP2C, CYP3A4, and CYP3A5 was determined using RT-PCR in both normal and malignant esophageal tissues of patients with untreated esophageal SCC (n = 21) and in controls (n = 10). Protein levels of CYP2E1, CYP2C8, CYP3A4, and CYP3A5 were measured by Western blot. RESULTS: Within the group of SCC patients, mRNA expression of CYP 3A4 and CYP2C was significantly lower in malignant tissue (-39% and -74%, respectively, P < 0.05) than in normal tissue. Similar results were found in CYP3A4 protein levels. Between groups, CYP3A4, CYP3A5, and CYP2C8 protein concentration was significantly higher in non-malignant tissue of SCC patients (4.8-, 2.9-, and 1.9-fold elevation, P < 0.05) than in controls. In contrast, CYP2E1 protein levels were significantly higher in controls than in SCC patients (+46%, P < 0.05). CONCLUSION: Significant differences exist in protein levels of certain CYPs in non-malignant esophageal tissue (e.g. CYP2C8, CYP3A4, CYP3A5, and CYP2E1) between SCC patients and healthy subjects and may contribute to the development of SCC in the esophagus.

[Prevalence of reflux symptoms in the general population of Cologne]. / Prävalenz von Refluxbeschwerden in der Kölner Normalbevölkerung.

INTRODUCTION: Excessive gastro-esophageal reflux impairs quality of life and predisposes the development of Barrett's mucosa, a precursor to adenocarcinoma of the esophagus. At present, the prevalence of reflux symptoms in the general population has not been well enough established. MATERIALS AND METHODS: In a population-based study, five hundred residents of Cologne between the ages of 20 and 90 years (232 or 46 % males and 268 or 54 % females) were randomly selected from the city register and sent a questionnaire with reflux-related questions. 268 replies (54 %) were accepted into the study. Of these, 45 % were men with a median age of 58 years. The median female age was 54 years. RESULTS: 34 % of the respondents (n = 92) admitted having heartburn symptoms. There was no significant difference based on gender. There was little variation in heartburn frequency between individual age groups: only respondents in their forties and those in their sixties had more frequent symptoms (in 45 % of respondents). Heartburn incidence was more common in men between 40 - 50 and in women between 60 - 70 years of age. Twenty-three (25 %) of the 92 respondents with heartburn admitted to reflux symptoms more than twice per week. 45 % of these "refluxers" took medications for their heartburn. 43 % of the refluxers visited a doctor concerning their symptoms, and 72 % of these underwent endoscopy. CONCLUSION: Approximately one third of the Cologne adult population suffers gastro-esophageal reflux. Close to ten percent of the population have multiple episodes of symptoms per week. The presence of symptoms occurs indiscriminately in men and women and varies only marginally according to age.

[Combined laparoscopic/endoscopic treatment of gastric stroma tumors]. / Kombiniert laparoskopisch-endoskopische Resektion von Stromatumoren des Magens.

INTRODUCTION: Surgical therapy of Gastrointestinal stroma tumor (GIST) is the treatment of choice. Local resection will be carried out if technically possible. We describe the technique of laparoscopic wedge resection combined with intraoperative gastroscopy in order to achieve complete tumor resection. METHOD: We report on 4 cases with gastrointestinal stroma tumors which were located in the gastric corpus (n = 2) and the cardia (n = 2). RESULTS: In all patients the tumor could be removed completely without any perioperative complications using laparoscopic wedge resection controlled by intraoperative endoscopy. The duration of hospitalisation after operation was 7 days (5-10). On the basis of the mean tumor size (mean 3.8 cm) and the low mitotic activity (mean 2.75/high power fields) the tumors belong to the group with low malignant potential. There is no evidence of recurrence after a mean follow up period of 23 (6-30) months. CONCLUSION: Combined laparoscopic/endoscopic wedge resection is a safe method for total resection of GIST of the stomach and should be preferred as alternative to open surgery.

Role of retinoic acid receptors in squamous-cell carcinoma in human esophagus.

BACKGROUND: Worldwide, cancer in the esophagus ranks among the 10 most common cancers. Alterations of retinoic acid receptors (e.g. RARalpha, beta, gamma, and RXRalpha, beta, gamma) expression is considered to play an important role in development of squamous-cell carcinoma (SCC), which is the most common esophageal cancer. Alcohol consumption and smoking, which can alter retinoic acid receptor levels, have been identified as key risk factors in the development of carcinoma in the aero-digestive tract. Therefore, the aim of the present study was to evaluate protein levels of retinoic acid receptors (i.e. RARalpha, beta, gamma, and RXRbeta) in esophageal SCC and surrounding normal tissue of patients with untreated SCC and controls. METHODS: All study participants completed a questionnaire concerning smoking and alcohol drinking habits as well as anthropometrical parameters. Protein levels of RARalpha, beta, gamma, and RXRbeta were determined by Western Blot in normal esophageal tissue and tissue obtained from SCC of 21 patients with newly diagnosed esophageal SCC and normal esophageal tissue of 10 controls. RESULTS: Protein levels of RARgamma were significantly lower by approximately 68% in SCC compared to normal surrounding tissue in patients with SCC that smoked and/or consumed elevated amounts of alcohol. Furthermore, RARalpha protein levels were significantly lower (approximately- 45%) in SCC in comparison to normal esophageal mucosa in patients with elevated alcohol intake. When comparing protein levels of retinoic acid receptors between normal tissue of patients with SCC and controls, RARgamma protein levels were found to be significantly higher (approximately 2.7-fold) in normal esophageal tissue of SCC patients than in esophageal tissue obtained from controls. No differences were found for RARalpha, beta, and RXRbeta protein levels between normal esophageal tissue of patients and that of controls. CONCLUSION: In conclusion, results of the present study suggest that alterations of retinoic acid receptors protein may contribute in the development of SCC in esophagus and that in some patients life style (e.g. smoking and alcohol consumption) may be a critical component in the alteration of retinoic acid receptor levels in esophagus.

[Merendino procedure with preservation of the vagus for early carcinoma of the gastroesophageal junction]. / Operation nach Merendino mit Vaguserhaltung beim Frühkarzinom des gastroösophagealen Ubergangs.

Optimal therapy for early carcinoma of the gastroesophageal junction remains uncertain. Treatment alternatives discussed today reach from endoluminal techniques to radical esophagectomy with 2- or 3-field lymphadenectomy. In this context, the Merendino procedure with preservation of the vagal innervation to the stomach appears as an interesting therapeutic alternative. This paper summarizes indications, operative technique, and functional results with respect to postoperative quality of life in view of 2 cases operated in our department.

[Heterotopic gastric pancreas: a rare cause of abdominal complaints]. / Heterotopes Pankreasgewebe der Magenwand. Seltene Ursache abdominaler Beschwerden.

Heterotopic pancreas is an uncommon cause of gastrointestinal complaints such as epigastric pain, nausea, vomiting, and upper gastrointestinal bleeding. Despite the development of modern diagnostic procedures, it is still difficult to differentiate heterotopic pancreatic tissue from other benign or malignant gastric tumors. Local excision of the gastric wall is regarded as the diagnostic and therapeutic procedure of choice. We present two cases and an overview of the literature.

Demographic variations in the rising incidence of esophageal adenocarcinoma in white males.

BACKGROUND: The rise in adenocarcinoma (AC) of the esophagus has been reported in several papers. However, the results are only comparable to a limited extent, because they are based on differing periods and different computational methods. The purpose of the current investigation was to collect the available data and to analyze them in a unified manner. METHODS: The authors requested data on the incidence of AC of the esophagus for each year since 1960 from 43 tumor registries in North America, Europe, and Australia. The data from 22 centers were used. The trend was calculated by fitting the data to an exponential growth model. RESULTS: The incidence of AC of the esophagus in white males is rising in most countries. The highest values of the estimated incidence rate in the year 2000 were found in Great Britain (5.0- 8.7 cases per 100,000 population) and in Australia (4.8 cases per 100,000 population) followed by The Netherlands (4.4 cases per 100,000 population), the United States (3.7 cases per 100,000 population), and Denmark (2.8 cases per 100,000 population). Low rates (< 1.0 cases per 100,000 population) were found in Eastern Europe. The largest changes in incidence were reported in the Southern European countries, with an estimate of the average increase over six registries of 30% per year; in Australia, with an average increase of 23.5% per year; and in the United States, with an average increase of 20.6% per year. The rates of increase ranged from 8.7% to 17.5% on average in Northern Europe, Central Europe, and the United Kingdom. In Eastern Europe, at most, there was a minor rise in incidence. CONCLUSIONS: In the Western industrialized nations, the analyzed data show that the incidence of AC of the esophagus has been rising rapidly in the last 20 years. The only exceptions to date are the countries of Eastern Europe.

Coincidence of nutritional habits and esophageal cancer in Germany.

INTRODUCTION: The incidence rates for adenocarcinoma (AC) of the esophagus have risen rapidly in Western nations, whereas the incidence rates for esophageal squamous cell carcinoma (SCC) have remained nearly stable. There are studies about body mass index, smoking, alcohol, and development of AC or SCC. The aim of this study was to evaluate differences in nutritional habits of patients with AC or SCC compared with the population in Cologne. PATIENTS AND METHODS: From January 1, 1997 to December 31, 1998, 85 patients with esophageal cancer (SCC n = 45, AC n = 40) were interviewed about their nutritional habits using a computerized program (EBIS). By random sample, 100 citizens of Cologne who were similar of age, residence, and nationality were chosen as healthy control group (CG) and were also interviewed with EBIS. RESULTS: The known risk factors, alcohol and tobacco for SCC as well as alcohol and a high body mass index for AC, were confirmed in this study. The CG had a higher daily intake of calcium, magnesium and iron compared to patients with esophageal cancer (p < 0.05). In addition, the tumor group had a significant lower daily supply of carbohydrates, fruits, and dietary fiber (p < 0.001). About 80% of the patients ate more than 100 g meat/day in comparison to 50% of participants in the CG. Patients with AC consumed more magnesium, milk, and animal protein than patients with SCC or the participants of the CG. CONCLUSION: There are differences in nutrition between healthy controls and patients with esophageal cancer and between patients with SCC and AC. Patients with cancer of the esophagus had a nutritonal deficit in fresh fruit, vegetables, dietary fiber, and carbohydrates. Compared with the other groups, patients with AC had a higher intake of protein, fat, and milk.