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ABSTRACT: In multiply traumatised patients injuries of the -liver are frequently seen. Depending on location and extent of the trauma, different techniques can be applied. In the presented case of a central liver trauma in a 21-year-old man with active bleeding, mesh-wrapping of both liver lobes was applied to achieve control of the bleeding. Postoperatively the patient developed constant hypertension, oliguria and severe anasarka of the lower half of the body caused by a near total obstruction of the inferior vena cava. After removal of the wrappings, all symptoms slowly disappeared. This case and the findings in similar cases in the literature suggest that there is an indication for wrapping a traumatised liver rather with diffuse and peripheral bleeding than with a central liver trauma.
Zentralblatt für Chirurgie 03/2010; 135(2):154-8. · 1.02 Impact Factor
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ABSTRACT: Laparoscopic surgery is a technically more demanding procedure compared to open surgery. Safe realistic training and unbiased quantitative assessment of technical skills are required for laparoscopic surgery. Virtual reality (VR) simulators may be useful tools for training and assessing basic and advanced surgical skills and procedures.
to assess the acquisition of laparoscopic skills using virtual reality simulators.
systematic review of the literature.
(1) The simulator can be used to objectively assess the laparoscopic skills of surgeons and distinguish between novices and experienced laparoscopic surgeons. (Evidence level III-B) (2) The target group as well as the benefit of a three-day practical course for laparoscopic surgery can be determined by the simulator. (Evidence level III-C) (3) Novices in laparoscopic surgery seem to benefit mostly from simulation training. (Evidence level III-B) (4) Steepness and plateau of a learning curve may be more dependent on the level of performance required by the particular training session rather than the number of repetitions during a training session. (Evidence level III-B) (5) Clinical background and understanding of the clinical value of a training program lead to faster acquisition and improvement of laparoscopic skills as performed on the laparoscopy simulator. (Evidence level III-B) (6) Non technical skills such as visual-spatial perception and stress coping positively correlates with virtual laparoscopic skills. (Evidence level III-B).
To date, the best method for teaching laparoscopic surgery has not been defined. However, the use of virtual simulators for laparoscopy training is useful when learning basic techniques allow the surgeon to improve hand dexterity and coordination in laparoscopic surgery.
La Tunisie médicale 06/2008; 86(5):419-26.
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ABSTRACT: This study evaluates the influence of visual-spatial perception on laparoscopic performance of novices with a virtual reality simulator (LapSim(R)).
Twenty-four novices completed standardized tests of visual-spatial perception (Lameris Toegepaste Natuurwetenschappelijk Onderzoek [TNO] Test(R) and Stumpf-Fay Cube Perspectives Test(R)) and laparoscopic skills were assessed objectively, while performing 1-h practice sessions on the LapSim(R), comprising of coordination, cutting, and clip application tasks. Outcome variables included time to complete the tasks, economy of motion as well as total error scores, respectively.
The degree of visual-spatial perception correlated significantly with laparoscopic performance on the LapSim(R) scores. Participants with a high degree of spatial perception (Group A) performed the tasks faster than those (Group B) who had a low degree of spatial perception (p = 0.001). Individuals with a high degree of spatial perception also scored better for economy of motion (p = 0.021), tissue damage (p = 0.009), and total error (p = 0.007).
Among novices, visual-spatial perception is associated with manual skills performed on a virtual reality simulator. This result may be important for educators to develop adequate training programs that can be individually adapted.
Child s Nervous System 07/2007; 23(6):685-9. · 1.54 Impact Factor
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ABSTRACT: The increasing use of minimally invasive surgery, which has a longer learning curve compared to open surgery lets the necessity to develop training programs to improve endoscopic skills of trainees become ever clearer. The aim of this study was to compare the endoscopic skills of neurosurgeons versus general surgeons at first exposure to a virtual reality simulator.
72 general surgeons who visited the 122nd Conference of the German Surgeons Society (DGCH in Munich 2005) and 35 neuroendoscopic surgeons, who visited the Third World Conference of the International Study Group of Neuroendoscopy (ISGNE in Marburg 2005) participated in this study. Each participant performed the basic module "clip application" on the virtual reality simulator (LapSim). All participants were given the same pretest instructions. Time to complete the task, error score and economy of motion were recorded.
The general surgeons performed the clip application faster, but with more errors than neuroendoscopic surgeons. However, the difference of both parameters was not significant. Both surgeon groups have a similar score for economy of motion.
Although neuroendoscopic surgeons were exposed to a foreign procedure and unfamiliar equipment, they were able to perform virtual endoscopy with similar accuracy as general surgeons, who are adapted to these endoscopic instruments and procedures and do these daily.
min - Minimally Invasive Neurosurgery 05/2007; 50(2):111-4. · 0.70 Impact Factor
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ABSTRACT: This study explored the impact of habitual stress-coping strategies on the laparoscopic performance of novices in surgery using a virtual reality simulator.
The SVF78 stress-coping questionnaire was administered to 12 medical students in their final year of medical school (camera holders) and to 12 inexperienced surgical residents (postgraduate years 1-3). The questionnaire included devaluation during stressful situations, distractions from stressful situations, control over stressful reactions and negative coping strategies such as stress avoidance and need for social support. Assessment of laparoscopic dexterity was based on the results of performance on a virtual reality simulator. The variables of time taken to complete the task, errors and economy of motion were analysed, with a higher score indicating poor performance. Pearson and non-parametric Spearman correlations were used to compare the subjects' results on the SVF78 with those on the LapSim.
Time taken to complete the task correlated with high values in distractive stress-coping strategies (P = 0.002) and high values in negative stress-coping strategies (P = 0.042).
Ineffective stress-coping strategies correlate with poor virtual laparoscopic performance. The need for effective intraoperative stress-coping strategies is evident.
British Journal of Surgery 01/2007; 93(12):1554-9. · 4.61 Impact Factor
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B Gerdes,
I Hassan,
K Maschuw,
K Schlosser,
J Bartholomäus,
T Neubert,
B Schwedhelm,
I Petrikowski-Schneider,
W Wissner,
M Schönert,
M Rothmund
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ABSTRACT: The improvement of surgical skills of trainees in Germany often occurs solely in the operating room. In recent years, several countries have established surgical skills labs as an essential part of surgical education, with the goal of improving and refining surgical skills before clinical application. Several years ago, training units were established by the industry wherein the curricula focused on products of the respective company. Selected training courses are still offered in a few clinics. Presently, laboratories which train the surgical skills of novices in an individually adapted form are lacking. A surgical skills lab with a comprehensive curriculum of training courses was introduced at the University Hospital of Marburg in 2005. The present article describes the development and introduction of such facilities. The authors are convinced that surgical skills labs will become increasingly important in German surgical education for improving patient safety in the operating room.
Der Chirurg 12/2006; 77(11):1033-9. · 0.70 Impact Factor
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Der Chirurg 11/2006; Suppl:308-9. · 0.70 Impact Factor
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B. Gerdes,
I. Hassan,
K. Maschuw,
K. Schlosser,
J. Bartholomäus,
T. Neubert,
B. Schwedhelm,
I. Petrikowski-Schneider,
W. Wissner,
M. Schönert,
M. Rothmund
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ABSTRACT: Die Entwicklung chirurgischer Fertigkeiten angehender Chirurgen findet in Deutschland oft nur im Operationssaal statt. Dagegen werden in verschiedenen anderen Lndern zustzlich praktische Trainingskurse (surgical skills courses) als Bestandteil der chirurgischen Weiterbildung realisiert. In Deutschland wurden bislang nur von der Industrie permanente Lehrinstitute eingerichtet, deren Angebot sich bis heute an der Produktpalette der jeweiligen Firma ausrichtet. Darber hinaus werden von einzelnen Kliniken punktuell spezielle Kurse angeboten. Trainingslabore, die kontinuierlich die Fertigkeiten angehender Chirurgen weiterbilden und sich hierbei inhaltlich am Bedarf des Faches ausrichten, fehlen dagegen bislang vollstndig. Ende 2005 wurde deshalb am Marburger Klinikum ein chirurgisches Trainingslabor mit einem umfassenden Kursprogramm etabliert. In dem Labor nehmen die chirurgischen Assistenten an einem kontinuierlichen berufsbegleitenden praktischen Weiterbildungskurrikulum teil. Die Autoren sind der berzeugung, dass die Teilnahme an Kursen fr Basis- und fortgeschrittene Techniken obligater Bestandteil der chirurgischen Weiterbildung werden sollte. Hierzu ist die Einrichtung permanenter chirurgischer Trainingslabore an Weiterbildungskliniken zu fordern, um die Sicherheit fr die Patienten im Operationssaal zu erhhen.The improvement of surgical skills of trainees in Germany often occurs solely in the operating room. In recent years, several countries have established surgical skills labs as an essential part of surgical education, with the goal of improving and refining surgical skills before clinical application. Several years ago, training units were established by the industry wherein the curricula focused on products of the respective company. Selected training courses are still offered in a few clinics. Presently, laboratories which train the surgical skills of novices in an individually adapted form are lacking. A surgical skills lab with a comprehensive curriculum of training courses was introduced at the University Hospital of Marburg in 2005. The present article describes the development and introduction of such facilities. The authors are convinced that surgical skills labs will become increasingly important in German surgical education for improving patient safety in the operating room.
Der Chirurg 10/2006; 77(11):1033-1039. · 0.70 Impact Factor
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ABSTRACT: The Union Internationale Contre le Cancer and American Joint Committee on Cancer classification propose that pN(0)-classified colorectal lymphadenectomy specimens will ordinarily include 12 or more tumor-negative lymph nodes. We performed a clinical trial to investigate whether a short-term preoperative radiotherapy (5x5 Gy) leads to a reduction of the number of lymph nodes in rectal cancer specimens after total and partial mesorectal excision (TME and PME, respectively).
Within a 5-year period, 28 (15%) of 148 rectal cancer patients underwent hypofractionated preoperative radiotherapy in this monocenter study, whereas 120 patients (85%) underwent TME/PME surgery alone. The main criterion was the number of lymph nodes in TME/PME specimens. We used a stratified one-sided Wilcoxon-Mann-Whitney test to test for a significant difference in the number of lymph nodes, stratifying for tumor location and postoperative tumor stage. Patients who were suspected of having any alterations in the number of pelvic lymph nodes were excluded from the study.
Fewer lymph nodes were detected in the TME/PME specimens of patients who received hypofractionated preoperative radiotherapy compared to patients who underwent TME/PME surgery alone (12 detectable lymph nodes vs 15; p=0.0005). Tumor location (p=0.095) and tumor stage (p=0.093) did not significantly influence the number of lymph nodes in this study.
We conclude that a 5x5 Gy short-term preoperative radiotherapy leads to a reduction in the number of lymph nodes in TME/PME specimens. Because neoadjuvant therapy in rectal cancer for T(2) and T(3) tumors has advanced a new therapeutic standard procedure, in the future, less lymph nodes will be detected in TME/PME specimens. This might influence the required number of lymph nodes in current staging systems for rectal cancer in the future.
Langenbeck s Archives of Surgery 09/2006; 391(4):364-8. · 1.81 Impact Factor
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ABSTRACT: To determine the role of clinical background when assessing the learning effect using a virtual-reality (VR) laparoscopy simulator (LapSim).
Test subjects were 12 final-year medical students (Group A) and 12 inexperienced residents (Group B) with no previous experience of VR simulators. First, to establish a baseline, both groups performed the "clip application" task twice. They then completed a training program of increasing difficulty (coordination, cutting and clip application), after which both groups were re-tested using a difficult level of the "cutting" task as an endpoint measurement. Time to complete the tasks, as well as trauma and precision parameters, were scored.
Before training, times to complete the baseline task, as well as parameters of trauma and precision, were similar for both groups. After training, Group B (residents) completed the cutting task significantly faster than Group A (students). However, the former group also showed significant improvement in trauma and precision parameter scores in the endpoint measurement.
These results suggest that clinical background and understanding of the clinical value of a training program lead to faster acquisition and improvement of laparoscopic skills as performed on the laparoscopy simulator. Thus, medical students or other personnel not involved in practical surgery may be unsuitable as candidates for assessing the value of a VR training program.
Computer Aided Surgery 04/2006; 11(2):103-6. · 0.30 Impact Factor
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ABSTRACT: The aim of this study was to validate computed virtual reality simulation as a tool to assess laparoscopic skills and to establish whether the simulator allows differentiating between surgeons with different laparoscopic experience.
27 physicians at the surgical department of the University of Marburg, Germany, with different experience in laparoscopic surgery were divided into three groups: experienced (group I), intermediate (group II), and novices (group III). Following a brief introduction to the virtual reality simulator (LapSim), each participant performed twice a training program consisting of seven tasks (examinations I and II).
Comparison of experienced surgeons with less experienced laparoscopic physicians showed a significant (P<0.05) superiority of group I at examinations I and II in most exercises. The groups' difference was more obvious in examination II, since the technique was new for all participants during examination I. Tasks of low complexity in virtual reality such as camera navigation, which are performed by young, not yet responsible surgeons in real surgery, did not show significantly different results between the three groups.
Differences in laparoscopic experience can be visualised with a virtual reality simulator, and thus a simulator is helpful for assessing surgeons' laparoscopic skills.
Der Chirurg 02/2005; 76(2):151-6. · 0.70 Impact Factor
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ABSTRACT: The solid-pseudopapillary tumor (SPT) is a very rare pancreatic neoplasm that predominantly affects young females. About 450 cases have been described in the world literature and approximately 20% of the reported patients were children. The occurrence of SPT with distant metastases in children is extremely rare with only two previously reported cases. We now report a 16-year-old Asian girl with a large SPT and synchronous multiple liver metastases who was successfully treated in a 2-step strategy, including initial pylorus-preserving partial duodenopancreatectomy, right hemicolectomy, resection and allografting of the portal vein and secondary resection of 12 liver metastases. The patient is disease free after a follow-up of 18 months after resection of the primary tumor, suggesting that an aggressive surgical treatment might also be justified for metastasized SPT.
Pancreatology 02/2005; 5(2-3):289-94. · 1.99 Impact Factor
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ABSTRACT: Ziel dieser Studie war es, die Rolle eines Laparoskopiesimulators zur Einschtzung der laparoskopischen Fhigkeiten von Chirurgen zu validieren. Hierzu stellten sich 27 rzte der Klinik fr Visceral-, Thorax- und Gefchirurgie der Universitt Marburg mit unterschiedlicher Erfahrung in der laparoskopischen Chirurgie zur Verfgung. Die rzte wurden in 3 Gruppen eingeteilt—Erfahrene (GruppeI), Fortgeschrittene (GruppeII) und Anfnger (GruppeIII)—und fhrten ein Trainingsprogramm mit 7 bungen 2-mal durch. Erfahrene Chirurgen bewltigten die bungen im 2. Untersuchungsgang mit weniger Fehlern (p<0,05) und konomischerer Instrumentenfhrung als GruppeII und III (Kameraausschlag in der bung Kameranavigation, Instrumentenausschlag in der Instrumentenkoordination, Zahl der verlorenen Klips in der bung Klipapplikation). Eine Ausnahme fand sich bei der bung Klipapplikation, bei der die Erfahrenen mehr Blutverlust aufwiesen als die GruppenII und III (p<0,05). Diese Ergebnisse zeigen, dass Unterschiede in der Erfahrung von Chirurgen mit laparoskopischen Techniken mit einem Laparoskopiesimulator abgebildet werden knnen. Somit ist ein Laparoskopiesimulator hilfreich in der Einschtzung laparoskopischer Fhigkeiten von Chirurgen.BackgroundThe aim of this study was to validate computed virtual reality simulation as a tool to assess laparoscopic skills and to establish whether the simulator allows differentiating between surgeons with different laparoscopic experience.Methods27 physicians at the surgical department of the University of Marburg, Germany, with different experience in laparoscopic surgery were divided into three groups: experienced (group I), intermediate (group II), and novices (group III). Following a brief introduction to the virtual reality simulator (LapSim), each participant performed twice a training program consisting of seven tasks (examinations I and II). ResultsComparison of experienced surgeons with less experienced laparoscopic physicians showed a significant (P<0.05) superiority of group I at examinations I and II in most exercises. The groups difference was more obvious in examination II, since the technique was new for all participants during examination I. Tasks of low complexity in virtual reality such as camera navigation, which are performed by young, not yet responsible surgeons in real surgery, did not show significantly different results between the three groups.ConclusionDifferences in laparoscopic experience can be visualised with a virtual reality simulator, and thus a simulator is helpful for assessing surgeons laparoscopic skills.
Der Chirurg 01/2005; 76(2):151-156. · 0.70 Impact Factor
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ABSTRACT: Primary intimal sarcomas of the aorta are extremely rare and aggressive tumors metastasizing into bones and visceral organs including liver, kidneys, adrenal glands, and lung. The first symptoms are often nonspecific and often caused by arterial embolism. We report a case with an incidental finding of primary intimal sarcoma in an aneurysm of a patient with claudication due to tumor embolization.
Der Chirurg 09/2004; 75(8):823-7. · 0.70 Impact Factor
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ABSTRACT: Primre Intimasarkome der Aorta sind uerst seltene und aggressive Tumoren mit einer Neigung in Knochen und viszeralen Organen, einschlielich Leber, Nieren, Nebennieren und Lunge, zu metastasieren. Die ersten Symptome sind oft unspezifisch und manifestieren sich hufig aufgrund embolischer Ereignisse. Wir berichten ber einen Fall, bei dem sich ein primres Intimasarkom als beraschungsbefund in einem Aneurysma der Bauchaorta bei einem Patienten mit Klaudikatio aufgrund einer peripheren Embolisierung fand.Primary intimal sarcomas of the aorta are extremely rare and aggressive tumors metastasizing into bones and visceral organs including liver, kidneys, adrenal glands, and lung. The first symptoms are often nonspecific and often caused by arterial embolism. We report a case with an incidental finding of primary intimal sarcoma in an aneurysm of a patient with claudication due to tumor embolization.
Der Chirurg 07/2004; 75(8):823-827. · 0.70 Impact Factor
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ABSTRACT: 13-46% of all patients with a neuroendocrine tumor of the gastrointestinal tract (NETGI, "Carcinoid") develop a carcinoma. The goal of our study was to find out the frequency of other malignancies in our patients with an NETGI and to discover which of the tumors was decisive for the clinical course.
We documented the clinical findings in 55 patients with an NETGI who underwent surgery in our hospital, noted the occurrence of other malignancies and recorded a current follow-up.
13 of 55 patients (24%) had an additional carcinoma after a median follow-up of 53 months. In 11 of the 13 patients the NETGI was identified accidentally. None of them had developed the carcinoma after the NETGI.
In most of our patients (11 out of 13) the carcinoma was clinically predominant and discovered before the NETGI. Thus, a special follow-up looking for a carcinoma is probably not mandatory after the diagnosis of an NETGI.
DMW - Deutsche Medizinische Wochenschrift 12/2003; 128(46):2413-7. · 0.53 Impact Factor
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H Rieder,
M Sina-Frey,
A Ziegler,
S A Hahn,
E Przypadlo,
R Kress, B Gerdes,
M Colombo Benkmann,
T Eberl,
R Grützmann,
M Lörken,
J Schmidt,
D K Bartsch
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ABSTRACT: The observation of a familial accumulation of ductal pancreatic adenocarcinoma (PC) and the increased risk for PC in certain hereditary tumor syndromes point to a genetic predisposition for PC. In order to evaluate the characteristics of familial PC, a German national case collection for familial pancreas cancer (FaPaCa) was established.
In FaPaCa, families of patients with PC are being collected, who have at least 1 first-degree relative with PC or with malignant melanoma. Histopathologic verification of tumor diagnoses, acquisition of clinical data, and full genetic counselling are prerequisites for the enrollment of PC families in FaPaCa.
So far, 21 families fulfilled the criteria for partaking in FaPaCa. In 11 families, PC represented the sole tumor entity. Additional tumors included malignant melanoma in 5, breast cancer in 3, and prostatic, colon or lung cancer in 2 families. Compared to the preceding generation, a younger age at diagnosis of PC was observed in the offspring of PC patients (offspring median 53 years vs. parents median 75.5 years).
The association of PC and breast cancer, and of PC and malignant melanoma suggests predisposing mutations in the BRCA2 or CDKN2A genes in about one third of the FaPaCa families. Mutational analyses in both candidate genes may help to identify individuals who are at an increased risk for developing PC. A shift towards a younger age at diagnosis in our PC families may indicate genetic anticipation and/or changes of patterns of exogenous risk factors.
Onkologie 07/2002; 25(3):262-6. · 0.87 Impact Factor
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ABSTRACT: A 44 year old male patient presented with severe hypertension. The diagnostic work-up revealed elevated levels of plasma renin activity (about 10 times the upper limit of normal) in the presence of normal plasma aldosterone levels and serum potassium concentrations. Renovascular disease was excluded by angiography. Selective renal vein sampling did not show any renin gradient. CT-scans of the abdomen demonstrated normal morphology of the kidneys and adrenals but revealed a big mass in the pancreatic corpus and tail with infiltration of the splenic vein and the presence of enlarged local lymph nodes. The endocrine nature of the pancreatic mass was further supported by a positive octreotide scintigraphy scan. Surgical removal of the tumor by left sided pancreatectomy combined with splenectomy resulted in rapid normalization of elevated renin concentrations as well as blood pressure. Histological examination of the tumor tissue revealed the presence of a neuroendocrine pancreatic carcinoma. Highly (x 70) elevated renin levels were detected by radioimmunoassay in the tumor tissue. To our knowledge this is the first renin-producing neuroendocrine pancreatic carcinoma described in the literature. The present paper describes the case in detail and reviews the available literature on clinical symptomatology, diagnosis and treatment of renin-producing tumors.
Experimental and Clinical Endocrinology & Diabetes 02/2002; 110(1):43-9. · 1.69 Impact Factor
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ABSTRACT: Perioperative decompression of the stomach is still a common procedure and can be achieved using either nasogastric tubes (NTs) or gastrostomy tubes (GTs). While both procedures appear to be equally effective, some authors believe that NTs are less convenient for patients than GTs. However, to date, no reliable prospective data are available on this issue.
We conducted a prospective, randomized trial comparing NTs versus GTs with a total of 110 patients undergoing elective colon surgery. The primary outcome measure was the patient's tube-related inconvenience and pain, assessed in a standardized interview on day 2 after surgery and quantified by means of a visual-analog scale (VAS). A questionnaire including the EORTC QLQ-C30 and additional items regarding retrospective tube-related judgements was administered on the day of discharge and 4 weeks after discharge. Secondary endpoints were the therapy-related morbidity and general complications.
When patients were asked which of their drainage tubes (all patients had three or four drainage tubes, such as decompression drains, urinary drains, central venous line) was most inconvenient, 43% (CI 33-53%) in the NT group reported that the NT was most inconvenient, while only 4% (CI 1-10%) of the GT patients judged the GT most inconvenient ( P<0.001, Chi(2) test). This effect was also found in VAS ratings of inconvenience and discomfort ( P<0.01). Also postoperatively (p.o.), NT patients evidenced less preference for their tube system (day 2 p.o.: 71%, CI 61-80%; 4 weeks p.o.: 66%, CI 56-75%) than did GT patients (day 2 p.o.: 94%, CI 88-98%; 4 weeks p.o.: 91% CI 84-96%); again, these differences were statistically significant ( P<0.02; Chi(2) test). No differences between groups emerged regarding global quality of life or conventional clinical outcomes.
This prospective randomized trial supports the clinical observation that NT causes more subjective inconvenience than GT. In cases when a prolonged postoperative ileus is expected, decisions for a prophylactic decompressing tube system have to weigh up the possibilities of different averse clinical as well as subjective outcomes. It is then preferable to include patients' preferences in the individual decision making process (shared-decision making).
Langenbeck s Archives of Surgery 11/2001; 386(6):402-9. · 1.81 Impact Factor
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ABSTRACT: p16(INK4a) alterations are considered to be an early event in pancreatic tumorigenesis and have been described in duct lesions adjacent to pancreatic cancers. This study evaluates whether duct lesions in chronic pancreatitis tissues of patients without pancreatic cancer also harbor genetic alterations in the p16(INK4a) tumor-suppressor gene, and thus represent high-risk precursors for pancreatic cancer.
Tissues were obtained from 20 pancreatic specimens taken from patients operated on for histologically verified chronic pancreatitis. Pancreatic intraductal neoplasias (PanIN) were identified in hematoxylin-and-eosin-stained slides. p16 protein expression was investigated immunohistochemically in all specimens. DNA from PanIN and non-PanIN tissue was analyzed genetically for p16(INK4a) mutations by single-strand conformation variation analysis and direct sequencing of the encoding region. Additionally, p16(INK4a) promoter methylation was analyzed by a methylation specific polymerase test.
PanIN-1a lesions were identified in 10 of the 20 chronic pancreatitis specimens. Four of these 10 PanIN specimens (40%), but none of the 20 non-PanIN tissues, revealed a loss of p16 expression in immunohistochemistry. The mutational analysis of the p16(INK4a) gene showed 1 known polymorphism (c.442G > A; A148T) but no mutations. Two of the 10 specimens with PanIN revealed an inactivating hypermethylation of the p16(INK4a) promoter.
This study shows for the first time that p16(INK4a) alterations can be observed in a considerable number of PanIN1 in chronic pancreatitis tissues not associated with pancreatic cancer. Therefore, p16(INK4a) alterations, especially promoter methylation, might indicate high-risk precursors in chronic pancreatitis that might progress to cancer.
Surgery 04/2001; 129(4):490-7. · 3.10 Impact Factor
