Search

In this review, we would like to illustrate our experience with the da Vinci® Xi system in case of esophageal surgery. Since the da Vinci® Xi system was installed in our department, it has resulted in a great improvement in cases of minimally invasive surgery. After the successful establishment in the field of colorectal surgery, the next step was surgery of the upper gastrointestinal tract. Due to the features of the robotic system, we can definitely observe the advantages and a positive effect in case of minimal invasive esophagectomy (MIE). We have also tried to develop an adequate surgical standard of the robotic-assisted minimal invasive esophagectomy with the da Vinci® Xi. [ABSTRACT FROM AUTHOR]

Background: The potential for a fibrin sealant patch to reduce the risk of postoperative pancreatic fistula (POPF) remains uncertain. The aim of this study was to evaluate whether a fibrin sealant patch is able to reduce POPF in patients undergoing pancreatoduodenectomy with pancreatojejunostomy. Methods: In this multicentre trial, patients undergoing pancreatoduodenectomy were randomized to receive either a fibrin patch (patch group) or no patch (control group), and stratified by gland texture, pancreatic duct size and neoadjuvant treatment. The primary endpoint was POPF. Secondary endpoints included complications, drain‐related factors and duration of hospital stay. Risk factors for POPF were identified by logistic regression analysis. Results: A total of 142 patients were enrolled. Forty‐five of 71 patients (63 per cent) in the patch group and 40 of 71 (56 per cent) in the control group developed biochemical leakage or POPF (P = 0·392). Fistulas were classified as grade B or C in 16 (23 per cent) and ten (14 per cent) patients respectively (P = 0·277). There were no differences in postoperative complications (54 patients in patch group and 50 in control group; P = 0·839), drain amylase concentration (P = 0·494), time until drain removal (mean(s.d.) 11·6(1·0) versus 13·3(1·3) days; P = 0·613), fistula closure (17·6(2·2) versus 16·5(2·1) days; P = 0·740) and duration of hospital stay (22·1(2·2) versus 18·2(0·9) days; P = 0·810) between the two groups. Multivariable logistic regression analysis confirmed that obesity (odds ratio (OR) 5·28, 95 per cent c.i. 1·20 to 23·18; P = 0·027), soft gland texture (OR 9·86, 3·41 to 28·54; P < 0·001) and a small duct (OR 5·50, 1·84 to 16·44; P = 0·002) were significant risk factors for POPF. A patch did not reduce the incidence of POPF in patients at higher risk. Conclusion: The use of a fibrin sealant patch did not reduce the occurrence of POPF and complications after pancreatoduodenectomy with pancreatojejunostomy. Registration number: 2013‐000639‐29 (EudraCT register). [ABSTRACT FROM AUTHOR]

The type of a biomarker – whether it is prognostic or predictive – is frequently not known, although such information is crucial for assessing the clinical value of a marker. In order to evaluate the type of marker TP53 is, we identified a cohort of 76 patients with colorectal liver metastases (CLM), homogeneously staged as resectable, who had been treated either with or without fluorouracil-based neoadjuvant chemotherapy. The TP53 genotype was assessed retrospectively from paraffin-embedded, diagnostic tumour biopsies using a standardised, p53 gene-specific sequencing protocol (mark53 ® kit). The overall median survival was 44.2 months, and the overall TP53 mutation frequency was 55%. A significant interaction was observed between chemotherapy and TP53 status ( P = 0.045). To illustrate this effect, the 51 patients with and the 25 patients without neoadjuvant chemotherapy were described separately. In patients with neoadjuvant chemotherapy, mutated TP53 was significantly associated with poor survival ( P = 0.0025), resulting in five-year survival rates of 22%, compared to 60% in patients with normal TP53. The hazard ratio was 3.12 (95% confidence intervals (CI): 1.46–6.95) to the disadvantage of TP53-mutated patients and 5.49 ( P = 0.0001; 95% CI: 2.28–13.24) after adjustment for known prognostic factors. In patients treated with surgery alone, a mutated TP53 did not have a negative effect on survival ( P = 0.54). A mutated TP53 status independently predicted survival disadvantage in CLM patients in the presence, but not in the absence, of neoadjuvant chemotherapy. Our data suggest that TP53 might be a pure predictive marker. [ABSTRACT FROM AUTHOR]

Copyright of Der Radiologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the present study we investigated the relationship between secondary hyperparathyroidism in renal graft recipients and post-transplantation acute tubular necrosis (ATN). Patients were divided into two groups according to graft function: group A consisted of 28 patients who had an uneventful postoperative period and did not require haemodialysis. Group B comprised 26 patients with primary non-function of the graft due to biopsy-proven ATN who required continued haemodialysis for the first postoperative week or longer (mean 14.2 ±8.7 days). Both groups had comparable donor characteristics, HLA-matching and ischaemia times. All patients were given cyclospo-rin and low-dose prednisolone for immunosuppression. Pretransplant levels of intact PTH were significantly greater in group B than in group A (203.5 ±193.1 pg/ml versus 81.7±45.2 pg/ml, <0.01). Group B patients had more transplant biopsies (50 versus 7) and a longer hospitalization time (33.4 ± 10.9 days versus 21.9 ± 11.9 days, <0.01), although serum creatinine on the day of discharge was higher in group B (1.77 ± 0.51 mg/dl versus 1.5±0.45 mg/dl, P<0.05). We conclude that patients with secondary hyperparathyroidism as assessed by measuring circulating levels of intact PTH have an increased incidence of ATN. [ABSTRACT FROM PUBLISHER]

Percutaneous transluminal angioplasty (PTA), a method combining diagnostic and therapeutic procedures, was studied prospectively in 40 patients with clinically failing a-v fistulae. Forty-seven procedures were performed in 40 patients with a variety of a-v fistulae (26 Cimino, five saphenous loops, five goretex grafts, and four upper-arm fistulae). In 43 cases the procedure was initially successful. The mean time of fistula patency after first PTA was 10.06±2.10 months. Primary failures were due either to technical inability to pass the stenosis (two patients) or to vessel perforation during the attempt (two patients). Surgical intervention had to follow both perforations. Restenosis at the dilatation site occurred in six patients, and in one a new stenosis at a different site occurred; the mean time of fistula patency in these patients was 5.8 months. Our results suggest that PTA is a highly effective therapy for the majority of cases of shunt stenosis. The success rate of the method is excellent and the complication rate low. The combination of this interventional approach with the mandatory angiographic procedure if stenosis of a fistula is suspected makes PTA a favourable first-line treatment and appears to save a considerable number of surgical interventions. [ABSTRACT FROM PUBLISHER]

B Background: b Celiac artery compression due to the median arcuate ligament is a rare but not an uncommon finding in patients undergoing pancreaticoduodenectomy. B Results: b In two patients, celiac artery compression was noticed during primary surgery; in one patient the compression was not recognized during initial surgery, this in turn caused complications and a prolonged hospital stay. During surgery the absence or limitation of blood flow within a common hepatic artery after ligation of the gastroduodenal artery should lead one to suspect compression of the celiac artery. [Extracted from the article]

Carcinoid tumors may relapse after a long time span following initial diagnosis, and relapse might be clinically inapparent despite biochemical indications due to a low sensitivity of conventional methods. We present the case of a patient who had biochemical indication for hidden disease persistence for more than two decades. In 1978, a 39-year-old man underwent surgery for a carcinoid tumour of the ileum measuring 3.5 cm with multiple local lymph-node metastases. After surgery, however, serotonin- and urinary 5-hydroxy-indole-acetic-acid (5-HIAA) remained markedly elevated, and persisted over more than 20 years at levels between 600 and 950 ng/ml for serum serotonin (normal range 40-400 ng/ml) and 29-35 mg/24 h for 5-HIAA (normal range 2-9 mg/24 h). Despite this, regular radiological follow-up, including sonography and CT-scan, did not reveal the location of suspected malignancy until 1999, when the patient was re-admitted to our hospital for a hypertensive episode. CT-scanning of the abdomen showed a singular lesion within the liver, which was verified as recurrence of the carcinoid by fine needle biopsy. Somatostatin receptor scintigraphy using [sup 111]In-DTPA-D-Phe[sup 1]-Octreotide revealed a second lesion within the liver along with local recurrence at the anastomosis, which was verified by surgery. While the propensity for late relapse of ileal carcinoids has repeatedly been demonstrated, a case with biochemical signs of disease persistence over a time span of 21 years before final diagnosis is unusual. In addition, our case reflects the low sensitivity of conventional radiological evaluation for localization of carcinoid tumours as compared to somatostatin receptor scanning. [ABSTRACT FROM AUTHOR]

Background: Current literature provides controversies about the need for histologic examination of breast tissue that is excised for gynecomastia in adolescent males. We intended to analyze the histopathologic findings from a large series of juvenile and adolescents treated for gynecomastia. Methods: Following the design of a retrospective chart review, data of all patients at the age of 21 or younger undergoing surgery for gynecomastia between January 1986 and December 2010 at a large Austrian State Hospital were obtained in an anonymized pattern. Results: A total of 72 out of 380 patients (19 %) involved juvenile and adolescent males undergoing subcutaneous mastectomy diagnosed for gynecomastia. The histologic examination revealed true fibrotic gynecomastia in 85 %. True fibrotic gynecomastia in combination with PASH was found in 10 % of all cases. Conclusions: Based on the various pathological histologic findings in our sample, we emphasize the routine histological sampling after surgical excision of breast tissue in gynecomastia to avoid the potential for overlooking pathologies. In view of the prevalence of true gynecomastia combined with PASH, surgeons have to be aware of this entity that is indeed benign with good prognosis but can be misdiagnosed as fibroadenoma or even angiosarcoma. [ABSTRACT FROM AUTHOR]