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Der Chirurg 08/2012; 83(8):740. · 0.70 Impact Factor
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Der Chirurg 07/2012; 83(7):671-2. · 0.70 Impact Factor
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Der Chirurg 06/2012; 83(6):575. · 0.70 Impact Factor
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ABSTRACT: The prevalence of obesity and diabetes mellitus type 2 is constantly rising worldwide and is one of the most threatening global health and health economic problems. Whereas bariatric surgery is well established in the treatment of morbid obesity, the surgical treatment options for type 2 diabetes mellitus alone are still under discussion (metabolic surgery). Bariatric procedures differ considering weight loss and influencing associated comorbidities. Detailed knowledge of available surgical treatment options for morbid obesity, the risks and requirements of laparoscopic skills, effectiveness and, as far as already known, mechanisms of action are crucial for appropriate implementation.
Der Chirurg 06/2012; 83(6):583-598; quiz 599-600. · 0.70 Impact Factor
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ABSTRACT: BACKROUND: Diabetes surgery in nonobese or moderately obese patients is an emerging topic. The identification of preoperative factors predicting diabetes outcome following bariatric surgery, especially for metabolic nonresponders, is imperative.
Between 2005 and 2011, 235 patients underwent bariatric surgery for morbid obesity. Eighty-two of 235 patients had type 2 diabetes mellitus (T2DM). Data from this subgroup were investigated with univariate and multivariate analyses to identify predictors for metabolic nonresponse after surgery.
Diabetes did not improve in 17/82 patients within 3 months after surgery. No correlation between excess body weight loss and metabolic response was detected. In univariate analysis, preoperative duration of diabetes was significantly longer in the nonresponder group (9.146 vs. 6.270 years; *p = 0.016), preoperative HbA1c levels were significantly higher among the nonresponders than among the responders (8.341 vs. 7.781 %; *p = 0.033), and more patients in the nonresponder group were reliant on a multi-drug approach preoperatively (*p = 0.045). In multivariate analysis, age, preoperative doses of insulin, and preoperative oral antidiabetics showed positive correlation to metabolic nonresponse after surgery (*p = 0.04; *p = 0.021; *p = 0.021). Metabolic failure rate was lower after Roux-en-Y gastric bypass compared to other bariatric procedures (**p = 0.008).
A long history of preoperative T2DM, high preoperative HbA1c levels, and a preoperative therapy consisting of diverse approaches to diabetes treatment may be factors predicting failure of diabetes improvement in the early postoperative course after bariatric surgery. Age, preoperative insulin, and oral antidiabetic medication can be regarded as independent, significant predictors for metabolic outcome after bariatric surgery.
Obesity Surgery 05/2012; 22(10):1521-6. · 3.29 Impact Factor
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Der Chirurg 05/2012; 83(5):484. · 0.70 Impact Factor
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Der Chirurg 03/2012; 83(4):387. · 0.70 Impact Factor
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Der Chirurg 02/2012; 83(3):283-4. · 0.70 Impact Factor
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Der Chirurg 02/2012; 83(2):179-80. · 0.70 Impact Factor
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Der Chirurg 01/2012; 83(1):75-6. · 0.70 Impact Factor
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ABSTRACT: The review article "Operative Techniques and Outcomes in Metabolic Surgery: Sleeve Gastrectomy" by Hüttl et al. is concerned with laparoscopic sleeve stomach operations ("sleeve gastrectomy") for the surgical treatment of morbid obesity (Zentralblatt für Chirurgie 2009; 134: 24-31). After an analysis of the available literature and own results, the authors concluded that the laparoscopic sleeve operation is established today as an effective standard procedure in the therapy for obesity.We would like to comment on the content of this article.
Zentralblatt für Chirurgie 02/2010; 135(1):92-4; author reply 95-7. · 1.02 Impact Factor
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ABSTRACT: The development of therapeutic strategies for treatment of metastasized colorectal carcinoma requires biologically relevant and adequate animal models generating both metastases and the dissemination of tumor cells.
To prove the efficiency of orthotopic implantation concerning induction of minimal residual disease (MRD) colorectal cancer tissue from 10 patients was transplanted orthotopically into nude mice. In the intraportal injection model 1 x 10(6) HT-29 human colon cancer cells were injected. We investigated by histological studies and CK-20 RT-PCR the occurrence of hematogenous metastases and the dissemination of human colon cancer cells in bone marrow.
Following orthotopic implantation of human colon cancer tissue the lymph node and hepatic metastasis rates were low. MRD as reflected by CK-20 positivity of the bone marrow was present in 22.2%. The intraportal injection of 1 x 10(6) HT-29 human colon cancer cells produced hepatic metastases in up to 89% of all animals. The intraportal injection of 1 x 10(6) cells also generated MRD in the bone marrow in 63% of animals.
The intraportal injection model represents a biologically relevant and adequate animal model for the induction of both reproducible hepatic metastasis and MRD in the bone marrow. In this regard it seems to be superior to the orthotopic implantation model.
European Surgical Research 02/2009; 42(3):195-200. · 0.93 Impact Factor
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ABSTRACT: Anti-EGFR targeted therapy is a potent strategy in the treatment of metastatic colorectal cancer (mCRC) but activating mutations in the KRAS gene are associated with poor response to this treatment. Therefore, KRAS mutation analysis is employed in the selection of patients for EGFR-targeted therapy and various studies have shown a high concordance between the mutation status in primary CRC and corresponding metastases. However, although development of therapy related resistance occurs also in the context of novel drugs such as tyrosine kinase-inhibitors the effect of the anti-EGFR treatment on the KRAS/BRAF mutation status itself in recurrent mCRC has not yet been clarified. Therefore, we analyzed 21 mCRCs before/after anti-EGFR therapy and found a pre-/posttherapeutic concordance of the KRAS/BRAF mutation status in 20 of the 21 cases examined. In the one discordant case, further analyses revealed that a tumor mosaicism or multiple primary tumors were present, indicating that anti-EGFR therapy has no influence on KRAS/BRAF mutation status in mCRC. Moreover, as the preselection of patients with a KRAS(wt) genotype for anti-EGFR therapy has become a standard procedure, sample sets such ours might be the basis for future studies addressing the identification of potential anti-EGFR therapy induced genetic alterations apart from KRAS/BRAF mutations.
Journal of Oncology 01/2009; 2009:831626.
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ABSTRACT: Reflux recurrence is the most common long-term complication of fundoplication. Its frequency was independent from the type of fundoplication in randomized studies. Results for different techniques of laparoscopic antireflux surgery were retrospectively evaluated after 10 years.
From 1992 to 1997, 120 patients had primary laparoscopic fundoplication with a "tailored approach" (type of wrap chosen according to esophageal peristalsis): 88 received a Nissen, 22 an anterior, and 10 a Toupet fundoplication. Follow-up of 87% of the patients included disease-related questions and the gastrointestinal quality-of-life index (GIQLI).
Of the patients, 89% would select surgery again. Heartburn was reported by 30% of the patients. Regurgitations were noted from 15% of patients after a Nissen, 44% after anterior fundoplication, and 10% after a Toupet (p = 0.04). Twenty-eight percent were on acid-suppressive drugs again. Following Nissen fundoplication, proton pump inhibitors were less frequently used (p = 0.01) and on postoperative pH-metry reflux recurrence rate was lower (p = 0.04). The GIQLI was 110 +/- 24 without significant differences for the type of fundoplication.
Ten years after laparoscopic fundoplication, overall outcome is good. A quarter of the patients are on acid-suppressive drugs. Nissen fundoplication appears to control reflux better than a partial fundoplication.
Journal of Gastrointestinal Surgery 10/2008; 12(11):1893-9. · 2.83 Impact Factor
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ABSTRACT: HintergrundDas Refluxrezidiv ist im Langzeitverlauf die häufigste Komplikation nach Fundoplikation. Die 10-Jahres-Ergebnisse nach laparoskopischer
Antirefluxoperation wurden für verschiedene Verfahren retrospektiv verglichen.
MethodenVon 1992 bis 1997 wurden 120 Patienten laparoskopisch nach dem „tailored approach“ operiert: 88 Nissen-, 22 vordere Hemi-
und 10 Toupet-Fundoplikationen. Die Nachuntersuchung von 87% der Patienten umfasste krankheitsspezifische Fragen und den gastrointestinalen
Lebensqualitätsindex (GIQLI).
Ergebnisse89% der Patienten würden sich wieder operieren lassen. Regurgitationen wurden von 15% nach Nissen, von 44% nach vorderer Hemifundoplikation
und von 10% nach Toupet berichtet (p=0,04). 28% nahmen wieder säurereduzierende Medikamente ein. Hierbei wurden Protonenpumpeninhibitoren
nach Nissen-Fundoplikation seltener eingenommen (p=0,01). Der GIQLI betrug 110±24 ohne signifikante Unterschiede bez. der
OP-Technik.
SchlussfolgerungDie Ergebnisse sind 10Jahre nach laparoskopischer Fundoplikation insgesamt zufrieden stellend. Bezüglich der Refluxkontrolle
scheint die Nissen-Fundoplikation einer Teilmanschette überlegen zu sein.
BackgroundReflux recurrence is the most common long-term complication following fundoplication. Results for different techniques of
laparoscopic antireflux surgery were retrospectively compared after 10years.
MethodsFrom 1992 to 1997, the 120 patients studied had laparoscopic fundoplication with ‘tailored’ approaches: 88 Nissen, 22 anterior,
and ten Toupet fundoplications. Follow-up of 87% of these patients included disease-related questions and the gastrointestinal
quality of life index (GIQLI).
ResultsOf the patients, 89% would select surgery again. Regurgitations after fundoplication were noted from 15% of patients after
Nissen, 44% after anterior, and 10% after Toupet types (P=0.04). Twenty-eight percent were on acid suppression therapy. Proton
pump inhibitors were used less frequently following Nissen fundoplication (P=0.01). The GIQLI score was 110±24 without significant
differences for type of fundoplication.
DiscussionOverall results are satisfactory after 10years of experience with fundoplication. Total fundoplication appears to control
reflux better than partial fundoplication.
Der Chirurg 07/2008; 79(8):759-764. · 0.70 Impact Factor
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ABSTRACT: Reflux recurrence is the most common long-term complication following fundoplication. Results for different techniques of laparoscopic antireflux surgery were retrospectively compared after 10 years.
From 1992 to 1997, the 120 patients studied had laparoscopic fundoplication with 'tailored' approaches: 88 Nissen, 22 anterior, and ten Toupet fundoplications. Follow-up of 87% of these patients included disease-related questions and the gastrointestinal quality of life index (GIQLI).
Of the patients, 89% would select surgery again. Regurgitations after fundoplication were noted from 15% of patients after Nissen, 44% after anterior, and 10% after Toupet types (P=0.04). Twenty-eight percent were on acid suppression therapy. Proton pump inhibitors were used less frequently following Nissen fundoplication (P=0.01). The GIQLI score was 110+/-24 without significant differences for type of fundoplication.
Overall results are satisfactory after 10 years of experience with fundoplication. Total fundoplication appears to control reflux better than partial fundoplication.
Der Chirurg 06/2008; 79(8):759-64. · 0.70 Impact Factor
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ABSTRACT: Advances in the medical treatment of colorectal cancer patients have resulted in considerable improvements through the introduction of new cytotoxic drugs. The significant progress in molecular and tumour biology has produced a great number of targeted, tumour-specific, monoclonal antibodies that are now in various stages of clinical development. Two of these antibodies, cetuximab (Erbitux) und bevacizumab (Avastin), directed against the epidermal growth factor receptor (EGFR) and the vascular epithelial growth factor (VEGF), respectively, have recently been approved for use in metastatic colorectal cancer. The combination of well-known and newly developed cytotoxic agents with monoclonal antibodies makes the medical treatment of colorectal cancer patients considerably more complex, but also provides additional therapeutic strategies for patients in advanced stages of disease.
Zentralblatt für Chirurgie 05/2008; 133(2):101-6. · 1.02 Impact Factor
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ABSTRACT: Derzeit befinden sich viele neue Substanzen zur Therapie gastrointestinaler Karzinome in klinischer und prklinischer Anwendung. Die Apoptose von malignen Zellen als natrliche Form der Zellzerstrung stellt ein ideales Ziel in der Krebstherapie dar. Die tatschliche Effektivitt und das Nebenwirkungsspektrum bisheriger Antikrper sind gegenwrtig von einer berzeugenden klinischen Anwendung zu weit entfernt. Verschiedene Substanzklassen von Antikrpern geben aber Hoffnung, dass in naher Zukunft die Vertrglichkeit durch vernderte Herstellung (Humanisierung, Chimrisation oder komplett humane Antikrper) und die Wirkung durch hhere Selektivitt substanziell verbessert werden.Durch den Einsatz neuer Zytostatika und die Entwicklung zielgerichteter Antikrper gegen EGFR und VEGF konnte das mediane berleben bei Patienten mit gastrointestinalen Karzinomen in den letzten Jahren deutlich verlngert werden. Insbesondere das berleben von Patienten mit fortgeschrittenen kolorektalen Karzinomen konnte auf aktuell ber 2Jahre verlngert und damit im Vergleich zur 5-FU-ra fast verdoppelt werden. Die vielfltigen Kombinationstherapien mit Chemotherapeutika und monoklonalen Antikrpern machen die Behandlung von Patienten mit gastrointestinalen Karzinomen zwar deutlich komplexer als frher, bieten aber gerade Patienten mit Metastasen wesentlich effektivere Therapieanstze. Bevacizumab und Cetuximab als Paradebeispiele der targeted therapy haben innerhalb klinischer Studien in der Erst- und Zweitlinientherapie des metastasierten kolorektalen Karzinoms berechtigterweise Einzug gehalten.The clinical and preclinical applications of new antitumor agents for the treatment of gastrointestinal cancer is a field undergoing continuous progress. The antibody derived apoptosis of tumor cells represents an ideal target in cancer therapy. However, the actual effectiveness of and tolerance to antibodies does not yet allow for a convincing clinical application. Modifications in the production of antibodies, such as humanisation, chimerisation or the establishment of totally human antibodies, provide hope for higher selectivity and less side effects in the future.Through the development of targeted therapy with antibodies against epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF), as well as the combination with new cytotoxic agents, the median overall survival in colorectal cancer patients has been significantly improved over the next few years. In particular, the survival of patients with advanced colorectal cancer could be increased by more than 2years, almost doubling that found with the classical 5-FU regimen. Thus, the use of chemotherapy and antibodies in the treatment of gastrointestinal cancer means that this has become not only more effective, particularly for patients with metastases, but also much more complex. Bevacizumab and cetuximab are excellent examples for a selectively targeted therapy in first and second-line therapy for metastatic colorectal cancer.
Der Onkologe 02/2007; 13(3):236-249. · 0.17 Impact Factor
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ABSTRACT: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. We describe here for the first time a patient with a huge GIST of the abdominal wall without any relation to the gastrointestinal tract, omentum, or mesentery. With regard to the size of 24 cm and a low mitotic index, this GIST is considered an intermediate risk for metastasis. Radical surgical resection was performed with negative pathologic resection margins. The classic immunohistochemical phenotype of the tumor described facilitates the differential diagnosis to exclude abdominal desmoid tumor and solitary fibrous tumor (SFT). In the case of metastasis, therapeutic nihilism no longer seems justified with the availability of imatinib, a tyrosine kinase inhibitor, which shows encouraging results in the therapy of metastatic GIST.
Der Chirurg 08/2004; 75(7):708-12. · 0.70 Impact Factor
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ABSTRACT: Gastrointestinale Stromatumoren (GIST) sind die hufigsten mesenchymalen Tumoren des Gastrointestinaltraktes. Wir beschreiben erstmalig einen Patienten mit einem riesigen GIST der Bauchwand, der keinerlei strukturelle Verbindung zum Gastrointestinaltrakt, Omentum oder Mesenterium zeigte. Unter Bercksichtigung der Gre von 24cm bei niedrigem Mitoseindex ist dieser GIST bezglich seiner Metastasierungspotenz als "intermediate risk" einzuschtzen. Die operative Entfernung des Tumors wurde entsprechend der allgemein anerkannten Radikalittsprinzipien durchgefhrt. Der klassische, immunhistochemische Phnotyp des hier vorliegenden Tumors ermglicht eine differenzialdiagnostische Abgrenzung zum abdominellen Desmoidtumor sowie zum "solitary fibrous tumor". Im Falle des Auftretens von Metastasen im weiteren Verlauf erscheint der therapeutische Nihilismus seit Einfhrung von Imatinib, einem Tyrosinkinaseinhibitor, der in der Behandlung des metastasierten GIST viel versprechende Ergebnisse zeigt, nicht mehr gerechtfertigt.Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. We describe here for the first time a patient with a huge GIST of the abdominal wall without any relation to the gastrointestinal tract, omentum, or mesentery. With regard to the size of 24cm and a low mitotic index, this GIST is considered an intermediate risk for metastasis. Radical surgical resection was performed with negative pathologic resection margins. The classic immunohistochemical phenotype of the tumor described facilitates the differential diagnosis to exclude abdominal desmoid tumor and solitary fibrous tumor (SFT). In the case of metastasis, therapeutic nihilism no longer seems justified with the availability of imatinib, a tyrosine kinase inhibitor, which shows encouraging results in the therapy of metastatic GIST.
Der Chirurg 06/2004; 75(7):708-712. · 0.70 Impact Factor
