Resection of pulmonary metastases from colon and rectal cancer: factors to predict survival differ regarding to the origin of the primary tumor.

BACKGROUND: The purpose of the present study was to determine differences in prognostic factors for survival of patients with pulmonary metastases resected in curative intent from colon or rectum cancer. METHODS: Between 1980 and 2006, prognostic factors after resection of pulmonary metastases in 171 patients with primary rectum or colon tumor were evaluated. Survival of patients after surgical metastasectomy was compared with that of patients receiving standard chemotherapy by matched-pair analysis. RESULTS: Median survival after pulmonary resection was 35.2 months (confidence interval 27.3-43.2). One-, 3-, and 5-year survival for patients following R0 resection was 88.8, 52.1, and 32.9 % respectively. Complete metastasectomy (R0), UICC stage of the primary tumor, pleural infiltration, and hilar or mediastinal lymph node metastases are independent prognostic factors for survival. Matched-pair analysis confirmed that pulmonary metastasectomy significantly improved survival. Although no difference in survival for patients with pulmonary metastases from lower rectal compared to upper rectal or colon cancer was observed, factors to predict survival are different for patients with lower and middle rectal cancer (R0, mediastinal and/or hilar lymph nodes, gender, UICC stage) compared with patients with upper rectal or colon cancer (R0, number of metastases). CONCLUSIONS: Our results indicate that distinct prognostic factors exist for patients with pulmonary metastases from lower rectal compared with upper rectal or colon cancer. This supports the notion that colorectal cancer should not be considered as a single-tumor entity. Metastasectomy, especially after complete resection resulted in a dramatic improvement of survival compared with patients treated with chemotherapy alone.

Nitric oxide and peroxynitrite in postischemic myocardium.

Alterations in the production of nitric oxide (NO.) are a critical factor in the injury that occurs in ischemic and reperfused myocardium; however, controversy remains regarding the alterations in NO. that occur and how these alterations cause tissue injury. As superoxide generation occurs during the early period of reperfusion, the cytotoxic oxidant peroxynitrite (ONOO-) could be formed; however, questions remain regarding ONOO- formation and its role in postischemic injury. Electron paramagnetic resonance spin trapping studies, using the NO. trap Fe(2+)-N-methyl-D-glucamine dithiocarbamate (Fe-MGD), and chemiluminescence studies, using the enhancer luminol, have been performed to measure the magnitude and time course of NO. and ONOO- formation in the normal and postischemic heart. Isolated rat hearts were subjected to control perfusion, or ischemia followed by reperfusion in the presence of Fe-MGD with electron paramagnetic resonance measurements performed on the effluent from these hearts. Whereas only trace signals were present prior to ischemia, prominent NO. adduct signals were seen during the first 2 min of reflow. The reperfusion associated increase in these NO. signals was abolished by nitric oxide synthase inhibition. In hearts perfused with luminol to detect ONOO- formation, a similar marked increase was seen during the first 2 min of reperfusion that was blocked by nitric oxide synthase inhibitors and by superoxide dismutase. Either NG-nitro-L-arginine methyl ester or superoxide dismutase treatment resulted in more than twofold higher recovery of contractile function than in untreated hearts. Immunohistology studies demonstrated that the ONOO(-)-mediated nitration product nitrotyrosine was formed in postischemic hearts, but not in normally perfused controls. Thus, NO. formation is increased during the early period of reperfusion and reacts with superoxide to form ONOO-, which results in protein nitration and myocardial injury.

[Significance of multiple organ failure for the prognosis of surgical intensive care patients]. / Bedeutung des Mehrfachorganversagens für die Prognose des chirurgischen Intensivpatienten.

BACKGROUND: The association of multiple organ failure and acute prognosis is an established fact in intensive care medicine. However, it is unclear whether the number of failing organs is an independent determinant of acute mortality, and whether there are additional effects on long-term outcome. METHODS: We performed a retrospective, observational cohort study using prospectively collected data from March 1993, through February 2005. Three different cohorts were analysed: patients with a short-term intensive care unit (ICU) stay (group I, ICU length of stay > 4 days), with a long-term ICU stay (group II, ICU length of stay > 28 days), and all patients requiring renal replacement therapy during ICU stay (group III). Organ failure was defined according to a modified Goris score. An independent effect of the number of failing organs on patient prognosis was evaluated after adjusting for more than 15 covariables. Acute prognosis was analysed in group I, whereas long-term prognosis was studied in groups II and III. RESULTS: The maximum number of failing organs was an independent determinant of acute prognosis in patients of group I, and of long-term prognosis in groups II and III. CONCLUSION: The effect of multiple organ failure on long-term prognosis emphasizes the importance of this variable for patient outcome. Therefore, multiple organ failure must be part of all therapeutic concepts in critical care. Within those, preventive measures are definitively preferable to keep the number of failing organs as small as possible.

[Rhesus incompatibility and anti-D prevention in the Düsseldorf region (a ten-year survey) (author's transl)]. / Rhesus-Inkompatibilität und Anti-D-Prophylaxe im Raum Düsseldorf

Among 116 120 children born between 1964 and 1973, 512 (0.44%) required treatment for haemolytic disease of the newborn caused by the presence of irregular antibodies. While the incidence between 1964 to 1970 ranged between 0.42 to 0.56%, it fell from 1971 to 1973 to 0.28%, evidence for effective anti-D prophylaxis since 1971. Those cases still occurring after 1971 were largely due to pregnancies which had started before 1971. In addition there were abortions, sensitizations during the first pregnancy, but also blood transfusions as cause for new sensitizations. Sensitization after pregnancy despite anti-D prophylaxis was observed twice. In the last few years there has been a relative increase of rare antibodies, increasing the complexities of serological diagnosis. Safety and speed of treatment can be further improved by more frequent identification of irregular antibodies in the mother and regular reports to the paediatrician.