72. Trachearesektionen und bronchoplastische Eingriffe bei Narbenstenosen,benignen und malignen Tumoren

Zusammenfassung In der Behandlung stenosierender Atemwegserkrankungen ist die Resektion mit End-zu-End-Anastomose die Therapie der Wahl. Resektionsstrecken bis zu 70% der Trachea, d. h. 7–8cm, sind möglich geworden, da durch neue Mobilisationsmanöver die Spannung an der Anastomose erheblich reduziert werden kann. An den Bronchien kann durch Teilresektion des tumortragenden Abschnittes das Ausmaß des Lungenparenchymverlustes vermindert werden, so daß auch Patienten mit eingeschränkter Lungenfunktion operabel werden.     

Specific expression of k63-linked ubiquitination of calmodulin-like protein 5 in breast cancer of premenopausal patients

Purpose

Posttranslational modifications such as ubiquitination regulate many functions of proteins by affecting their interaction with other molecules, their activity, and their subcellular localization. In cancer biology, the ubiquitin network has gained major interest. K63-linked ubiquitination has emerged as a posttranslational modification with functional consequences, as it acts in several processes such as protein trafficking, DNA repair, and inflammation. Moreover, k63-linked ubiquitination is involved in the regulation of carcinogenesis. Based on previous findings, the aim of this study was to evaluate the ubiquitination of CALML5 in breast cancer patients.

Patients and methods

The breast cancer cell lines SkBr3, MCF7, HCC1937, and BT474 as well as 23 tumor samples of patients with primary breast cancer and the normal adjacent breast tissue were analyzed by one-dimensional immunoblot.

Results

Using specific antibodies against CALML5 and k63-linked ubiquitin, we demonstrate a k63-linked ubiquitination in the nuclear fraction of premenopausal breast cancer patients. K63-linked ubiquitination of CALML5 was found in breast cancer tissue, but not found in surrounding healthy tissue.

Conclusion

Our findings support the concept that ubiquitination of CALML5 in the nucleus is involved in the carcinogenesis of breast cancer in premenopausal women.     

The acute phase response following implantation of triclosan-bonded vascular prostheses

Objective. Infection of prosthetic material is a major complication of vascular surgery. Therapy for it includes implantation of antimicrobial prostheses bonded with different antimicrobial agents. These agents may, however, induce an acute phase reaction following implantation in the host, thus compromising follow-up of the infection. It is not known whether the antimicrobial agent triclosan induces a significant acute phase reaction when bonded to vascular prostheses. Methods. To study this, 34 adult swine weighing 20–30 kg were allotted randomly to the following groups: (1) controls with untreated prostheses, (2) control group with triclosan-bonded prostheses, (3) therapy group with untreated prostheses, local infection with Staphylococcus aureus, surgical revision, and exchange with new, untreated prostheses, and (4) therapy group with untreated prostheses, local infection with S. aureus, surgical revision, and exchange with triclosan-bonded prostheses. Serum C-reactive protein (CRP) and haptoglobin values were determined during the 28-day period after surgery. The study was performed at the Institute for Surgical Research of the Ludwig Maximilian University School of Medicine in Munich. Results. Normal ranges of serum CRP and haptoglobin values were 10.7±1.4 μg/ml and 2.5±0.3 mg/ml, respectively. Following implantation of untreated and triclosan-bonded vascular prostheses, significantly elevated serum CRP and haptoglobin values were observed. No significant differences between results with triclosan-bonded and untreated prostheses were observed in control or treatment groups. No correlation was found between acute phase reaction and the absence or presence of infection. Conclusions. Triclosan is the only antimicrobial agent that bonds to vascular prosthetic material without the need of a sealant. Our data indicate that vascular prosthesis implantation, whether untreated and triclosan-bonded, results in a sigificant acute phase reaction. No differences between antimicrobial and untreated prostheses were observed, independently of the absence or presence of infection. The antimicrobial agent itself did not induce a severe acute phase response and may, therefore, be used in patients at risk of infection. Received: 16 August 2000 / Accepted: 17 November 2000     

Transabdominal preperitoneal hernia repair (TAPP). Results of 1,000 completed operations]

It was the aim of this report to evaluate the laparoscopic transabdominal preperitoneal hernia repair (TAPP) which has been standardized at our department. Along with the demographic characterisation of 795 patients with 1000 inguinal hernia repairs we report about complications and early recurrences. The patient data were collected prospectively. The rate of follow-up amounted to 79.9% with an average follow-up of 1 year. The complications were divided into intraoperative, minor, major, as well as severe ones. In 30 repairs minor complications (3%) were detected. Major (n = 28) and severe (n = 9) complications were detected in 3.7% of the cases. There were two deaths, 3 patients with an intestinal obstruction due to adhesions (2 segmental small bowel resections), two patients with testicular atrophy, two mesh infections, two trocar hernias, 6 surgical revisions for removal of hematomas, one exploration of a testicle, 4 diagnostic laparoscopies for suspected recurrences with a negative result, and 15 patients with a nerve irritation syndrome. The early rate of recurrence was 0.7%. In 6 cases primary hernias had been repaired and in one case a recurrent hernia. The recurrent hernias became apparent in an average of 2 years (minimum 2.5 months, maximum 36 months) after surgery. The results of the clinical study demonstrate an acceptable rate of complications and a low rate of early recurrences. Based on these data we recommend the laparoscopic transabdominal preperitoneal technique and see an ideal indication in the case of bilateral, recurrent and femoral hernias.     

Chlamydia pneumoniae in Atherosclerotic Lesions of Patients Undergoing Vascular Surgery

The pathophysiological implications of Chlamydia pneumoniae in atherosclerotic lesions and its contribution to atherosclerotic complications remain unclear. Therefore, the purpose of the present study was to evaluate whether or not there is an association between the presence of Chlamydia pneumoniae in atherosclerotic lesions and the clinical manifestations as well as risk factors of atherosclerotic disease in patients undergoing vascular surgery. Specimens from atherosclerotic arteries were collected during endarterectomy of the carotid artery (n = 15), endarterectomy of the femoral artery (n = 19), or repair of an abdominal aortic aneurysm (n = 28). Detection of Chlamydia pneumoniae was performed by using immunohistochemical staining (IHC) with specific antibodies. Clinical manifestations of atherosclerotic disease were defined by the presence of cardiovascular risk factors, coronary heart disease, and previous vascular surgery. Inflammatory serum markers were determined in all patients prior to surgery. The specimens of all 62 patients revealed severe atherosclerosis in histological examination and a positive IHC was observed in 41 samples (66%). There were no differences regarding cardiovascular risk factors, coronary heart disease, events of previous vascular surgery, or inflammatory serum markers when comparing patients with positive and negative IHC. In conclusion, our findings showed no correlation between clinical or laboratory parameters of atherosclerosis and the presence of Chlamydia pneumoniae in atherosclerotic lesions. Therefore, Chlamydia pneumoniae appears to be a concomitant phenomenon rather than a causative principle in atherosclerosis.     

Acute ischemia of the upper extremity: long-term results following thrombembolectomy with the Fogarty catheter

OBJECTIVE: In 1962, the procedure of arterial thrombembolectomy with the Fogarty catheter was established. Numerous studies have been published studying thrombembolectomies of the lower extremities. Limited information, however, is available following thrombembolectomy of the upper extremity after arterial occlusion. The aim of the present study, therefore, was to determine long-term results (3-5 years after thrombembolectomy) following thrombembolectomy of the upper extremity with the Fogarty catheter in a large retrospective clinical study. DESIGN: In the present study, 251 patients were encountered. Over a period of 20 years, 283 thrombembolectomies with the Fogarty catheter were performed on the upper extremity at the surgical department of the University of Munich. MAIN OUTCOME MEASUREMENTS: The appearance of local and general complications in the postoperative phase, as well as long-term results, were evaluated. RESULTS: The results indicate that general complications - i.e., cardiac insufficiency, cerebral ischemia, etc. - occurred in 18 patients (7.2%). Local complications - i.e., wound infection, persistence of ischemia, or hematoma - were evident in 51 patients (20.3%). Re-occlusion following thrombembolectomy was found in 21 patients (8.8%). The affected extremity had to be amputated in five cases (2.0%), and 14 patients (5.6%) died during the postoperative phase. As a result of multimorbidity of the patients and average age at the time of surgery (73 years), 40% of the patients had died before the date of examination. Nonetheless, 111 patients of the 117 living patients showed no complaints or minor coldness and pain following heavy exercise. CONCLUSIONS: The results of the present study indicate that, in most cases, thrombembolectomy with the Fogarty catheter represents a successful surgical method for the acute treatment of arterial occlusion of the upper extremity.     

Cdc2 as prognostic marker in stage UICC II colon carcinomas

PurposeCyclin-dependent kinase 2 (cdc2) controls the G2–M checkpoint and, therefore, the entrance of cells into mitosis. It might play a crucial role during tumour progression in colon carcinomas (CCA). Thus, the prognostic value of cdc2 expression and connected markers relevant for proliferation and apoptosis has to be evaluated.Experimental designPunch biopsies from the tumour centre and the invasion front of 0.6 mm diameter from 392 CCA stage UICC II–IV were integrated in 14 recipient paraffin blocks. After immunohistochemical staining for cdc2, p53, caspase 3 and ki-67, a present (+) and absent (–) scoring was performed in the tissue arrays. The logrank test was used to compare distant metastasis and cancer-related survival. Multivariate Cox regression analysis was done to identify independent prognostic factors for parameters with significant influence on cancer-related survival (CRS) and distant metastasis (DM).ResultsThe pT-category (p = 0.007), nodal status (p < 0.001), extramural venous infiltration (p < 0.001) and lymphatic vessel invasion (p = 0.003) were identified as independent histological parameters for CRS. Univariate analysis relating to stage UICC II–IV CCA showed caspase 3 in the tumour centre (p = 0.047) to be a prognostic marker for CRS. In stage UICC II cdc2 (p = 0.041) and caspase 3 in the invasion front (p = 0.026) could be identified as independent prognostic factors for CRS and DM by multivariate analysis.ConclusionsCdc2 and caspase 3 could be identified as independent prognostic markers in stage UICC II CCA. They might be of value to select patients who should receive adjuvant treatment.     

Porcine Hepatocytes for Biohybrid Artificial Liver Devices: A Comparison of Hypothermic Storage Techniques

Abstract: Two hypothermic preservation techniques were investigated to assess their possible role in on-demand cell supply for bioartificial liver support devices. Porcine hepatocytes from slaughterhouse organs were isolated and either cold stored in a modified University of Wisconsin solution for up to 72 h or directly cultured in a sandwich configuration, frozen at Day 3 of culture, and stored for up to 30 days with subsequent long-term culture (14 days) in both groups. Cold storage for 72 h resulted in a decreased viability of cells (58.7 ± 7.9%) with well preserved ultrastructures in the remainder of cells. In subsequent culture, albumin secretion was slightly increased, and cytochrome P450 IA1 dependent 7-ethoxy-coumarine deethylation activity was reduced to about 40% of control values. After cryopreservation, hepato-cyte cultures revealed no severe damage to ultrastructures of cells, and functional parameters (albumin, 7-ethoxycoumarine deethylation) were comparable with controls after an initial drop in activity directly after thawing. Length of storage time did not influence results. Both hypothermic preservation protocols might eventually play an important role for bioartificial liver processing and on-demand cell supply, dependent on the individual reactor design.     

183. Die spontane kontinuierliche Hämofiltration (CAVH) als adjuvante Therapie in der chirurgischen Intensivmedizin

Zusammenfassung Seit 1979 wurden an der Chirurgischen Universitätsklinik Göttingen 182 Patienten mit einem Nierenversagen mittels CAVH behandelt. Ursache des Nierenversagens waren grösstenteils toxisch-infektiöse Schockzustände bei Peritonitis und nekrotisierender Pankreatitis. Alle Patienten hatten mindestens noch ein weiteres Organversagen. Durch die Hämolfiltration konnten die harnpflichtigen Substanzen signifikant gesenkt werden, auf Werte, die denen bei kompensierter Niereninsuffizienz entsprachen. Ausserdem besserten sich die Beatmungskonditionen und hämodynamischen Parameter. Die CAVH stellt einen wesentlichen Fortschritt in der intensiv-medizinischen Therapie schwerstkranker Patienten dar.