[Morbidity, mortality and analysis of prognostic factors for colorectal cancer]. / Morbidität, Mortalität und Analyse prognostischer Faktoren beim kolorektalen Karzinom.

BACKGROUND: This study analyzed morbidity, mortality and prognostic factors for patient survival in a single center collective of patients with colorectal cancer and a high follow-up rate. MATERIAL AND METHODS: A total of 698 consecutive patients were included in this study. Data were collected prospectively. Descriptive and survival analyses as well as Cox regression analyses were performed to identify factors for morbidity, mortality and prognostic factors for survival. RESULTS: At presentation 78.8 % of the colon cancer patients and 83.5 % of rectal cancer patients showed symptomatic disease and 6.5 % of patients underwent an emergency procedure. Mortality was 3.6 %, morbidity was 42.7 % and 4.3 % of patients developed an anastomotic leakage with the need of reoperation. In spite of the regular application of a fast-track program, 10 % of patients had a prolonged duration of bowel paralysis. In patients with colon cancer there were no differences between overall survival (OAS) and disease-free survival, whereas there was a significant difference in patients with rectal cancer. The mean survival of all patients was 65.39 ± 1.722 months. The ASA score, cardiovascular disease, number of metastatic lymph nodes, lymph node ratio, residual tumor and general or surgery-associated complications were strongly independent influencing factors on OAS. A Cox analysis revealed age at diagnosis and microscopic residual tumor (TNM R1) as highly significant influencing factors on OAS. Other significant factors of influence on OAS were development of general or surgery-associated complications and the presence of cardiovascular diseases. CONCLUSION: Cardiovascular disease leads to a higher morbidity rate whereas age, International Union Against Cancer (UICC) stage, R-status, lymphatic spread and occurrence of complications are important prognostic factors for survival.

[Surgery of gastric cancer in a medium volume center]. / Chirurgie des Magenkarzinoms in einer Schwerpunktklinik.

BACKGROUND: The aim of the study was to evaluate prognostic factors for the surgical treatment of gastric cancer in a medium volume center. The investigation focused in particular on morbidity and mortality. PATIENTS AND METHODS: From January 2005 to August 2011 a total of 74 patients with gastric cancer were surgically treated in our medium volume center. The study of these patients included morbidity, mortality, UICC (International Union Against Cancer) stage, Laurén classification, surgical therapy procedure, American Society of Anesthesiologists (ASA) classification and duration of surgery. RESULTS: After surgery 11 patients suffered from complications with a morbidity of 14.9% and a mortality of 1.4% (n=1). No significant differences could be detected during the study period. CONCLUSION: In comparison to other studies the morbidity and mortality rates signify similar to better data than complications of high volume centers which might be due to the small group of surgeons who are specialized in gastric surgery.

[Pediatric appendicitis : Open or laparoscopic appendicectomy in a specialized visceral surgical clinic?]. / Kindliche Appendizitis : Offene oder laparoskopische Appendektomie in einer viszeralchirurgischen Schwerpunktklinik?

Following the first description of open appendicectomy using a lateral incision in the right lower abdomen by McBurney in 1894, this intervention was considered to be the standard method for treatment of appendicitis for nearly 100 years. In 1983 the gynecologist Semm presented a new option for the surgical therapy of appendicitis with the implementation of laparoscopic appendicectomy. Since then the indications for laparoscopic therapy have developed from young adults through elderly patients to children, pregnant women and finally to infants and newborns.

[Donor risk in living-related liver transplantation - the surgeon's point of view]. / Die Leberlebendspende aus chirurgischer Sicht - das Risiko des Spenders.

Living-related liver transplantation is a successful clinical approach to overcome organ shortage in hepatic transplantation. Possible advantages for the recipient of a living-donor transplant are a much shorter waiting period until transplantation and an almost elective time of operation which results in a decreased operative risk. Furthermore graft function of a living-related transplant is better than in cadaveric transplantation because of the shorter ischemic time and a careful examination of graft quality before organ donation. Removal of even more than 50 % of liver volume during the donor operation does not lead to an impairment of liver function in the organ donor. Intraoperative blood loss can usually be managed by re-transfusion of donor's own blood. Postoperative morbidity is about 10 - 15 % depending on the extent of the removed liver lobe. Most frequent postoperative complications are biliary leckages, wound infections and gastric/duodenal ulcerations. Up till now in more than 1000 living-related liver donations only three deaths occured due to thromboembolic and septic complications (< 0,3 %) (until 12/1998).

[Minimally invasive parathyroidectomy with local anesthesia in conjunction with ultrasonography, sestamibi scintigraphy and intraoperative parathyroid hormone measurement]. / Minimal-invasive Parathyreoidektomie in Lokalanaesthesie in Verbindung mit Ultrasonographie, Sestamibi-Szintigraphie und intraoperativer Parathormonmessung.

INTRODUCTION: The standard procedure in patients with primary hyperparathyroidism (pHPT) includes cervical exploration and identification of all four enlarged parathyroid glands. New localization techniques, i.e., ultrasonography associated with color duplex sonography, 99mTc-sestamibi scintigraphy and the possibility of intraoperative parathormone (iPTH) measurement permit minimally invasive parathyroidectomy (MIP). Three different methods have been established: minimally invasive open parathyroidectomy, endoscopic parathyroidectomy and video-assisted parathyroidectomy. We present our experience with open MIP with the patient under local anesthesia (LA). METHODS: In 25 patients with pHPT the operation was started under local anesthesia. Preoperatively, ultrasonography and sestamibi scintigraphy were performed in each patient. iPTH measurement was carried out intraoperatively. RESULTS: In 23 patients (92%) the operation was done successfully in LA. There were no postoperative complications. During follow-up none of the patients developed hypercalcemia again. CONCLUSION: MIP in connection with ultrasonography, sestamibi scintigraphy and intraoperative PTH measurement offers a promising treatment for patients with pHPT.

Telomerase activity in neuroendocrine tumors.

INTRODUCTION: Neuroendocrine tumors span a rather heterogenic group of tumors, which differ in malignant potential. Very few is known about the tumorigenesis of neuroendocrine tumors. Telomeres seem to stabilize chromosomes and prevent DNA degradation and provide a signal of cellular senescence. During each cell cycle of replication, telomeres are progressively shortened. Non-diseased somatic cells, when the telomere length is reduced to a critical point, exit from the cell cycle and become senescent. In tumor cells, telomere shortening is prevented by the DNA-complex telomerase. Aim of this study was to evaluate the role of telomerase activity in the pathogenesis of neuroendocrine tumors and whether it can be a clinically useful marker for malignant potential. METHODS: Telomerase activity was determined in frozen tissue samples of 31 patients with neuroendocrine tumors by means of the "telomeric repeat amplification protocol" (TRAP)-assay. Classification of the tumors was done by the clinical course and histologic examination. There were 11 benign and 20 malignant neuroendocrine tumors. Telomerase activity was expressed as percentage of the positive control. RESULTS: 25 tumors had a telomerase activity between 0-5% of the positive control (group I), 5 tumors between 5-20% (group II) and 1 tumor over 20% (group II). We were not able to distinct malignant from benign tissue by means of the telomerase activity assay. There was no association with telomerase activity and clinicopathological parameters. CONCLUSIONS: The data indicate that telomerase activity does not seem to be associated with the tumorigenesis of neuroendocrine tumors and can therefore not be used as a suitable marker for malignancy.

The efficacy of N-acetylcysteine as a hepatoprotective agent in liver transplantation.

One of the most common complications after liver transplantation is primary graft dysfunction which results from severe deterioration of the microcirculation. The data obtained from our experimental studies indicate that N-acetylcysteine (NAC) is able to reduce the severity of ischemia/reperfusion injury and improves postoperative graft function after liver transplantation in rats. The aim of this pilot study was to evaluate the efficacy of NAC as a hepatoprotective agent under clinical conditions. A group of 30 liver transplanted patients were treated with NAC, and 30 patients (control group) were treated with a 5% solution of glucose only. In the NAC group we observed a distinct reduction in ischemia/reperfusion injury and improved liver function with less elevated peak transaminases, better macrocirculation, improved liver synthesis function and a lower incidence of primary nonfunction compared with the control group. We conclude that NAC is a very promising substance for reducing graft dysfunction in clinical liver transplantation.

Identification and properties of the genes encoding the poly(A) polymerase and a small (22 kDa) and the largest subunit (147 kDa) of the DNA-dependent RNA polymerase of molluscum contagiosum virus.

The DNA-dependent RNA polymerase (DdRP) is an essential enzyme for transcription of molluscum contagiosum virus (MCV), a member of the family Poxviridae which replicates in the cytoplasm of the infected cell. Using PCR technology and oligonucleotide primers, corresponding to two conserved domains (RQP[T/S]LH and NADFDGDE) of known largest subunits of eucaryotic and procaryotic DNA-dependent RNA polymerases, the DdRP gene of the genome of molluscum contagiosum virus type 1 (MCV-1) was identified and characterized. The oligonucleotide primers were designed according to the coding usage statistics of known open reading frames of the viral genome. The gene for the largest subunit of DdRP was localized within the DNA sequences of a part of the BamHI DNA fragment A (BamHI/HindIII DNA fragment A8a; 13.5 kbp, 0.454 to 0.525 viral map units) of the MCV-1 genome. The DNA nucleotide sequence analysis of a part (6709 bp) of this DNA fragment revealed the presence of 12 open reading frames (ORFs). It was found that ORF-4 (nucleotide position (NP) 2586 to 6452) and ORF-1 (NP 1192 to 1752) encode two polypeptides comprising 1289 (147 kDa) and 187 (22 kDa) amino acid residues, respectively. The comparative analysis of the amino acid sequences of these ORFs to the amino acid sequences of two subunits (RPO1, 147 kDa and RPO6, 22 kDa) of the DdRP of vaccinia virus revealed high amino acid sequence identity/similarity of about 71.9/21.5% and 46.5/39.6%, respectively. In addition it was found that the putative gene position of ORF-11, which is located on the lower strand between the loci of the ORF-1 and ORF-4 (NP 4256 to 4657, 134 aa, 15 kDa), is similar to the genomic arrangement of the J5L protein of vaccinia virus and L5L of variola virus. The value of amino acid sequence identity/similarity between the product of ORF-11 and the corresponding gene of vaccinia virus (J5L) was found to be 43.2/28.8%. The analysis of the amino acid sequence deduced from ORF-3 (NP 261 to 1289, 343 aa, 40 kDa), which is located upstream from the locus of the RPO6 of the MCV-1 genome, showed significant identity/similarity (47.5/35.7%) to the amino acid sequence of the 40-kDa subunit of the poly(A) polymerase (PAP2) of vaccinia virus. The arrangement of the identified loci of the PAP2, RPO6, ORF-11, and RPO1 of the genome of MCV-1 shows that this particular genomic region of the mollucsum contagiosum virus and vaccina virus is colinear.