Beobachtung zystischer Pankreastumoren

At least 1 out of 40 adults without pre-existing pancreatic disease has a pancreatic cyst. Hence prophylactic resection of every cystic lesion is not a viable approach. However, in the total group of pancreatic cysts, mucinous cystic neoplasms are found in women aged 40–60 years and intraductal papillary mucinous neoplasms (IPNM) are more frequent in the group over 60 years old. Both entities bear a relevant potential of malignancy requiring a careful work-up including case history and qualified examinations with endoscopic ultrasound or magnetic resonance imaging. Using the diagnostic algorithm presented here the risk for an individual patient can be assessed. A resection of the cyst is recommended in cases of main duct IPNM, obstructive jaundice, cysts with solid parts and a lesion size of more than 3 cm. Even below this size increased attention is warranted in certain cases. For the majority of patients only one or a few control examinations are sufficient. After partial resection of the pancreas follow-up studies are necessary in cases of IPNM due to the risk of recurrence.     

Diagnostik bei zystischer Fibrose

The diagnosis of CF is only the first step to an optimal treatment. CF is still a disease with a remarkable reduced life expectancy. In most case the diagnosis of CF is made by clinical symptoms, a positive sweat test and/or genetic testing indicative for CF. In the few remaining cases methods like NPD and/or ICM are indicated. During the course of disease other diagnostic tools are needed. Early pulmonary involvement can be detected by HRCT, which demonstrate structural changes in lung tissue and MBW which is a measurement of functional changes. The two most frequent co-morbidities (CFRD and reduced bone density) have no specific early clinical symptoms. Only screening offer the possibility for early diagnosis and treatment. The new non-culture methods for detection of bacteria like PSA offer the chance for an earlier identification of e.g. PSA in the respiratory tract and a more successful treatment. All together the established and oncoming diagnostic tools offer new chances for a more successful treatment of CF if they will be used.     

Exazerbation bei Bronchiektasen und zystischer Fibrose

Cystic fibrosis and alpha-1 protein deficiency are the most common causes for bronchiectasis. The importance of antibiotics in the treatment of exacerbations is generally accepted. Knowledge of the underlying pathogens and antibiotic resistance patterns are mandatory for a successful antibiotic treatment. Therefore, microbiological investigations of respiratory samples should be performed before the use of antibiotics in order to identify antibiotic resistance. Pseudomonas aeruginosa is a frequent pathogen in elderly patients with cystic fibrosis and, therefore, empirical treatment of exacerbations of cystic fibrosis should always contain agents with anti-pseudomonal activity. In pulmonary exacerbations in patients with cystic fibrosis, high dose intravenous therapy with two antibiotics from different classes with anti-pseudomonal activity is necessary. In exacerbations of patients with bronchiectasis of other etiology than cystic fibrosis, empiric treatment with one orally administered antimicrobial agent is usually sufficient.     

Behandlung nicht mit zystischer Fibrose assoziierter Bronchiektasen (Non-CF-Bronchiektasen)

Bronchiectasis has become more rarely because of the development of antibiotic therapy and vaccination. At present the great majority of bronchiectasis is more likely caused by congenital disorders than by infective reasons. Therapeutic strategies based on the experiences from cystic fibrosis and chronic obstructive pulmonary disease are not always conferrable to patients suffering from bronchiectasis. There are not enough controlled studies to give evidence-based recommendations in the treatment of bronchiectasis, which are not associated with cystic fibrosis. Goals in the treatment are improvement of the mucociliar clearance, the therapy of infections and treatment of inflammation. Currently several agents are under examination. To improve the prognosis and therapy options it would be reasonable to build up a national register for patients with bronchiectasis.     

Transanale Resektion von breitbasigen Adenomen mit Stapler

Transanal removal of sessile adenomas from the rectum using the stapling method with the Contour® Transtar? device represents a simple, easily reproducible, and safe method to excise rectal lesions. Even extensive adenomas exceeding half the circumference can be safely and quickly excised. One prerequisite, however, is the presence of movable layers, since excision must occur in healthy tissue.     

Chirurgische Therapie maligner Lebertumoren: Resektion und Transplantation

Zum Thema Die Leberchirurgie hat in den letzten Dekaden gro?e Fortschritte erzielen k?nnen, nicht zuletzt dadurch, da? Operationstechniken und Organkonservierung wie bei der Lebertransplantation auch bei Resektionsverfahren zur Anwendung kommen. Durch verfeinerte Funktionstests, pr?diktive Scoringsysteme und ein immer exakteres Tumorstaging stehen bessere Selektionskriterien zur Verfügung. So k?nnen die Indikationsstellungen für die entsprechenden Operationsmethoden pr?zisiert und günstigere Langzeitüberlebensraten erzielt werden. An den hier dargestellten Ergebnissen der Chirurgie prim?rer und sekund?rer Lebertumoren mittels Resektion oder Transplantation (unter Einbeziehung der Ergebnisse des gro?en Krankenguts der Autoren) zeigt sich, wie immens besonders der Aufwand der Transplantation unter vielf?ltigen Gesichtspunkten ist, z.B. auch unter organisatorischen und logistischen. Zun?chst stehen viel zu wenige Spenderorgane zur Verfügung, ferner mu? zus?tzlich zum Tumorpatienten ein anderer mit Transplantationsindikation bei einem benignen Leberleiden einbestellt und vorbereitet werden, falls der Tumorbefall eine Lebertransplantation ausschlie?t. Auf diese Weise geht kein Spenderorgan verloren. Diese Schwierigkeiten zeigen, da? unter den gegebenen Umst?nden die Resektionstechniken und die pr?-, peri- und postoperativen multimodalen Behandlungsverfahren weiter verbessert werden müssen, also hier der künftige therapeutische Fortschritt chirurgischer Intervention bei malignen Lebertumoren zu suchen sein wird.     

Die multiviszerale Resektion zur Behandlung fortgeschrittener kolorektaler Karzinome

About 10% of patients with colorectal cancer have locally advanced tumors, so only a multivisceral en bloc resection offers the chance to radically remove the local disease and effect a cure. Between 1984 and 1995, 173 (7%) out of a total of 2,462 patients undergoing resection for colorectal carcinoma underwent a multivisceral resection. The mean patient age was 71 years. In the majority of cases (63%), the primary tumor originated in the sigmoid colon or rectum. In 102 patients, only a single neighboring organ was additionally removed, while the remaining patients had involvement of 2 or more contiguous organs. Topping the list were the internal female genital organs, with small bowel and urinary bladder in second place. A true, histologic proven tumor invasion of 1 or more contiguous organs was found in 55% of the patients. Postoperative surgical complications were observed in 11.4% of the patients, the 30-day mortality rate was 3.6%. The 5-year survival rate of the overall group of patients was 42%; the corresponding figure for those patients undergoing curative resection was 51%, compared with 0% for patients receiving only palliative surgery. Stage-related survivals revealed a 5-year survival rate of 58% for UICC Stage II and 43% for Stage III with no noteworthy differences to conventional non multivisceral resections.