Die Operationsmethodik bestimmt die Rezidivhäufigkeit colorectaler Carcinome Ein Vergleich der Ergebnisse von 2 chirurgischen Kliniken

INTRODUCTION: In order to investigate whether operative technique determines the 5-year recurrence and survival rates, we analysed the results obtained by two surgical departments using two different operative techniques. Department A: Removal of the tumour and a number of lymph nodes; department B: En-bloc resection in accordance with the requirements of standardised tumour surgery. PATIENTS AND METHODS: The surgical results obtained with all patients with colorectal carcinoma operated on between 1984 and 1988 (department A: 152 colon and 53 rectal carcinomas; department B: 124 colon and 177 rectal carcinomas). RESULTS: The local recurrence rate achieved by department A was significantly higher (colon carcinoma: department A 25 %; department B 10 %; rectal carcinoma: department A 54 %; department B 16 %). The 5-year survival rate for colon carcinoma was 65 % in department A, and 66 % in department B, the corresponding figures for rectal carcinoma being 49 % and 72 %, respectively. CONCLUSION: The results indicate that carcinoma of the colorectum should be operated on only at an institution that complies with the standards required for surgery of colorectal carcinoma.     

Dose and image quality of electron-beam CT compared with spiral CT.

RATIONALE AND OBJECTIVES: To examine dose and image quality of electron-beam CT (EBCT) with continuous volume scan versus spiral CT. METHODS: An EBCT scanner was compared with a spiral CT (SCT) scanner. Three phantoms were used to measure low-contrast resolution, high-contrast resolution, slice width, and dose. RESULTS: The EBCT scans showed 30% lower high-contrast resolution for most settings. The dose was comparable to that of spiral CT with 3 mm collimation and 76%/106% higher with EBCT for 1.5 mm/6 mm collimation. Low-contrast resolution was comparable to that of spiral CT using 3 mm collimation, slightly worse for 1.5 mm, and bad for 6 mm EBCT collimation (four times higher dose to reach comparable contrast-to-noise ratio). CONCLUSIONS: Significant restrictions were found using EBCT with continuous volume scan. The authors found that 3 mm collimation can yield acceptable high-contrast resolution and good low-contrast resolution compared with spiral CT. The use of 6 mm or 1.5 mm collimation needs to be restricted to selected cases.     

Removal and Accumulation of Cadmium and Lead by <Emphasis Type="Italic">Typha latifolia</Emphasis> Exposed to Single and Mixed Metal Solutions

We investigated the effect of Cd and Pb on the growth of the aquatic macrophyte Typha latifolia; the removal from the solution and the accumulation of these elements by the plant were also studied. Thus, small plants of T. latifolia, collected from a noncontaminated site, were exposed for 10 days to Cd and Pb, in a single solution or in mixture solutions, at two concentrations of the metals (5 and 7.5 mg/L). Our results showed that T. latifolia removed effectively Cd and Pb from solutions and was able to accumulate these metals in the roots and, to a lesser extent, in the leaves. Our findings suggested a synergistic effect of Cd and Pb with respect to the toxicity to T. latifolia. Additionally, Cd diminished the Pb absorption by T. latifolia. Our results confirmed, using scanning electron microscopy, the internalization of Cd and Pb in T. latifolia.     

Versuche mit dem überlebenden Pankreas

Zusammenfassung Pepton und Liebigextrakt, die entweder unmittelbar oder unter gewissen Bedingungen eine Gefäßerweiterung auslösen, befördern den sekretabsondernden Prozeß nicht. Histamin dagegen, das keine Gefäßreaktion oder nur eine schwache Vasodilatation hervorruft, treibt den Saft sehr intensiv. Histamin hat eine sehr bedeutende sekretausscheidende Wirkung auch bei gleichzeitiger Gefäßverengerung.     

Adoptiver Transfer von malignomreaktiven T-Zellen

Das Immunsystem hat die F?higkeit, b?sartige Zellen zu erkennen und unter gewissen Umst?nden zu zerst?ren. Spontane Regressionen von Tumoren bei Patienten zeugen von dem Vorhandensein und der Effektivit?t einer natürlichen Immunüberwachung. Eine effektive Tumorabwehr setzt das Zusammenspiel von verschiedenen Zellen und Faktoren voraus, aus der idealerweise eine Tumorabsto?ung resultiert. Dieses Zusammenwirken der Zellen zu verstehen, ist die Voraussetzung für die Entwicklung einer Immuntherapie gegen Krebs. In den letzten Jahren wurden malignomreaktive T-Zellen als Effektorzellen der immunologischen Tumorabwehr erkannt. Dieser Mechanismus soll genutzt werden durch den adoptiven Transfer von tumorreaktiven T-Zellen in Patienten mit malignen Erkrankungen.     

Belegtes zur präoperativen Therapie des Rectumcarcinoms

Zusammenfassung. Bei der Prognose der Rectumcarcinome ist die chirurgische Therapie unter Einhaltung der onkologischen Radikalit?tsprinzipien von entscheidender Bedeutung. Oberstes Therapieziel sollte die R0-Resektion sein. Neben der Monoblock-Entfernung des tumortragenden Enddarmabschnitts mit dem dazugeh?renden Mesorectum werden ausreichende orale, aborale und laterale Sicherheitsabst?nde verlangt. Der Chirurg hat durch seine adaequate Operationstechnik mit der Senkung der Lokalrezidivrate einen wesentlichen Einflu? auf die überlebenswahrscheinlichkeit seiner Patienten. Der Prognosefaktor „Chirurg“ stellt damit, wie retrospektive und prospektive Untersuchungen bewiesen, neben dem Tumorstadium die bedeutende, statistisch unabh?ngige Rolle. Durch die pr?operative Radiochemotherapie kann man sich eine Steigerung der Rate an kontinenzerhaltenden Operationen erhoffen. Endgültige Ergebnisse und eindeutige Vorteile gegenüber der postoperativen Therapiemodalit?t, die derzeit in einer Multizenterstudie geprüft stehen noch aus. Die pr?- oder postoperative Radiochemotherapie mit 5-Fluorouracil im Stadium UICC II und III stellt, wie vom Konsensuspapier der Deutschen Krebsgesellschaft vom 1.7.1999 empfohlen, im multimodalen Therapiekonzept für Patienten mit einem erh?hten Risiko an Lokalrezidiven und Fernmetastasen eine unverzichtbare Komponente dar.      

Basis for the evaluation of health care quality at the medical units of the health sector

A methodology for evaluating the quality of services rendered by the health institutions is presented. This methodology, proposed by the Basic Evaluation Group of the Health Sector, includes an operational diagnosis of the health care units, allowing the identification of service-rendering problems, this facilitating the elaboration of alternative solutions in the patient's best interests. It can be applied at all levels of the institutional hierarchy, from service and department levels to the macro dimension of health care. In order to obtain its best results, the methodology must be utilized systematically and continuously.     

Remifentanil Preconditioning Confers Cardioprotection via Cardiac κ- and δ-Opioid Receptors

Background: Remifentanil preconditioning (RPC) reduces the infarct size in anesthetized rat hearts, and this effect seems to be mediated by all three types of opioid receptors (ORs). Because there is evidence of only [kappa]- and [delta]- but not [mu]-ORs in the rat heart, the authors investigated whether RPC confers cardioprotection via cardiac [kappa]- and [delta]-OR as well as via extracardiac [mu]-OR agonist activity. The authors also investigated the involvement of signaling mechanisms, namely protein kinase C and mitochondrial adenosine triphosphate-sensitive potassium (KATP) channels.

Methods: The hearts of male Sprague-Dawley rats weighing 190-210 g were removed, mounted on a Langendorff apparatus, and perfused retrogradely at 100 cm H2O with Krebs-Ringer's solution. All hearts were subjected to 30 min of ischemia and 2 h of reperfusion. The study consisted of three series of experiments on the effect of ischemic preconditioning or RPC (10, 50, and 100 ng/ml remifentanil) after blockade of OR subtypes ([delta]-OR antagonist naltrindol, [kappa]-OR antagonist nor-binaltorphimine, and [mu]-OR antagonist CTOP). The involvement of protein kinase C or the KATP channel in the cardioprotection of RPC was also investigated using specific blockers in each group. RPC was produced by three cycles of 5-min perfusion of remifentanil in Krebs-Ringer's solution interspersed with a 5-min reperfusion with Krebs solution only. Infarct size, as a percentage of the area at risk, was determined by 2,3,5-triphenyltetrazolium staining.

Results: Infarct size as a percentage of the area at risk was significantly reduced after RPC from 51.9 +/- 5.0% (control, n = 8) to 36.2 +/- 10.0% (100 ng/ml RPC, n = 8, P < 0.01). This effect was stopped by pretreatment with naltrindol (52.3 +/- 5.2%) and nor-binaltorphimine (43.5 +/- 6.0%) but not CTOP (37.1 +/- 6.0%). Chelerythrine and GF109203X, both protein kinase C inhibitors, abolished the effects of RPC or ischemic preconditioning on infarct size as a percentage of area at risk. 5-Hydroxydecanoate (a selective mitochondrial KATP channel blocker) also abolished the cardioprotection of RPC and IPC, but HMR-1098 (a selective inhibitor of the sarcolemmal KATP channel) did not.