Besonderheiten der postoperativen Peritonitis

Postoperative peritonitis is still a life-threatening complication after abdominal surgery and approximately 10,000 patients annually develop postoperative peritonitis in Germany. Early recognition and diagnosis before the onset of sepsis has remained a clinical challenge as no single specific screening test is available. The aim of therapy is a rapid and effective control of the source of infection and antimicrobial therapy. After diagnosis of diffuse postoperative peritonitis surgical revision is usually inevitable after intestinal interventions. Peritonitis after liver, biliary or pancreatic surgery is managed as a rule by means of differentiated therapy approaches depending on the severity.     

Radiation Planning for Thermal Laser Treatment

A dosimetry model was developed for the thermal laser treatment of biological tissue and applied to laser-induced thermotherapy of organ tumors. This model combines a Monte Carlo simulation for calculating photon distribution in the target volume, a finite difference method for computing heat dissipation and the Arrhenius formalism for predicting protein denaturation and subsequent tissue damage. Implementation was carried out on a Windows-based platform and enabled the three-dimensional control of the target volume. An in vitro evaluation in porcine liver revealed a difference of less than 7% with regard to the ablation volume.     

Morbidität und Letalität der hyperthermen intraperitonealen Chemoperfusion

Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) is a treatment option for peritoneal surface malignancy. Despite the survival benefits, this treatment was previously associated with a high morbidity and mortality rates, and the perception of the poor perioperative outcomes associated with this regimen remains. Careful patient selection with an optimal level of postoperative care must be advocated to avoid undesirable complications of this treatment. However, for this treatment to be accepted as standard of care, teams undertaking this treatment strategy must aim to minimize morbidity and mortality by learning from the experience of established centers and using the “global learning curve”. The HIPEC Registry and accreditation of centers will improve the quality of the treatment.     

Epstein-Barr virus and carcinomas. Expression of the viral genome in an undifferentiated gastric carcinoma.

The Epstein-Barr virus (EBV) is associated with undifferentiated nasopharyngeal carcinomas (NPCs). Recently, EBV DNA has been demonstrated also in some cases of gastric carcinoma with similar morphology as undifferentiated NPC. Here we report on the expression of EBV genes in a gastric undifferentiated carcinoma of nasopharyngeal type (UCNT). The small EBV-encoded nuclear RNAs, EBERs, were expressed in all tumor cells. The BZLF1 transactivator protein, which disrupts viral latency, was detectable in a small subset of tumor cells. The latent membrane protein and the nuclear antigen EBNA2 were not expressed. These results indicate that lytic EBV infection may be possible in undifferentiated epithelial cells. Our findings add to the growing body of evidence suggesting a strong association of gastric UCNT with EBV and point to the possibility of an involvement of the virus in the pathogenesis of this neoplasm.