Bertram Poch

• MD, PhD
• BGPS Neu-Ulm Onkologische, endokrinologische und minimalinvasive Chirurgie at BGPS Neu-Ulm Onkologische, endokrinologische und minimalinvasive Chirurgie

Pancreatoduodenectomy (PD) has a considerable surgical risk for complications and late metabolic morbidity. Parenchyma-sparing resection of benign tumors has the potential to cure patients associated with reduced procedure-related short- and long-term complications. Pubmed, Embase, and Cochrane libraries were searched for studies reporting surgery-...

Background Pancreatic benign, cystic, and neuroendocrine neoplasms are increasingly detected and recommended for surgical treatment. In multiorgan resection pancreatoduodenectomy or parenchyma-sparing, local extirpation is a challenge for decision-making regarding surgery-related early and late postoperative morbidity. Methods PubMed, Embase, and...

Introduction: Even after surgical resection and adjuvant chemotherapy in pancreatic cancer the 5-year disease-free survival times (DFS), as well as overall survival rates (OS), are still low and median survival times are below 2 years. Here we retrospectively analyzed the outcome of immunotherapy in the additional adjuvant treatment of pancreatic c...

Purpose: Despite improved diagnostic and therapeutic facilities median survival in pancreatic cancer is still unsatisfactory Here we retrospectively analyzed the outcome of immunotherapy in the additional palliative treatment of pancreatic cancer with long antigen exposition dendritic cell therapy (LANEX-DC®) in 200 patients who were treated at our...

Objective: To assess metabolic dysfunctions and steatohepatosis after standard and local pancreatic resections for benign and premalignant neoplasms. Summary of background data: Duodenopancreatectomy, hemipancreatectomy, and parenchyma-sparing, limited pancreatic resections are currently in use for nonmalignant tumors. Methods: Medline, Embase...

Background: Metabolic dysfunctions after pancreatoduodenectomy (PD) need to be considered when pancreatic head resection is likely to lead to long-term survival. Methods: Medline, Embase and Cochrane Library were searched for studies reporting measured data of metabolic function after PD and duodenum-sparing total pancreatic head resection (DPPH...

Background In contrast to the Kausch-Whipple procedure (pancreatoduodenectomy) duodenum-preserving pancreatic head resection (DPPHR) is associated with tissue sparing and maintenance of the pancreatic metabolic functions. Aim According to the results of controlled clinical trials the DPPHR procedure for benign pancreatic neoplasms is associated wi...

Background Parenchyma-sparing, local pancreatic head resection, but not pancreaticoduodenectomy (PD) preserves tissue and maintains the pancreatic metabolic functions. Methods PubMed/Medline, Embase, and Cochrane library collections were systematically searched. Twenty-six cohort studies with 523 cumulative patients, who underwent duodenum-sparing...

Objective: The aim of this study was to assess the frequency and severity of new onset of diabetes mellitus (NODM) and pancreatic exocrine insufficiency (PEI) after pancreaticoduodenectomy (PD) for benign and malignant tumors. Summary background data: When PD is performed on patients for benign tumors, the question of long-term metabolic dysfunc...

Chronic pancreatitis is most frequently caused by alcohol and cigarette smoking. In Europe 50%-70% of the patients with chronic pancreatitis develop an inflammatory mass in the head of the pancreas. The indication for duodenum-preserving pancreatic head resection (DPPHR) is based on the presence of an inflammatory mass in the head of the pancreas,...

Carcinomas of the ampulla of Vater are 1% of all digestive cancers and one-fourth of all periampullary cancers. There is a rough correlation between the size of the adenoma of the papilla and the association of a cancerous lesion. About 15% of adenomas up to 1.5 cm in diameter harbor severe dysplasia; 30%-50% of adenomas above 2.5-3 cm in diameter...

Limited surgical procedures for benign cystic neoplasms and endocrine tumours of the pancreas have the potential advantage of pancreatic tissue sparing compared to standard oncological resections. Searching PubMed/MedLine, Embase and Cochrane Library identified 86 full papers: 25 reporting on enucleation (EN), 38 on central pancreatectomy (CP) and...

Potential benefits of local extirpation of benign pancreatic head tumors are tissue conservation of pancreas, stomach, duodenum and common bile duct (CBD) and maintenance of pancreatic functions. Medline/PubMed, Embase and Cochrane Library databases were searched to identify studies applying duodenum-preserving total or partial pancreatic-head rese...

The recent evolution of limited local operative procedures for benign pancreatic lesions shifted surgical treatment options to the application of local techniques, although major resections of pancreatic head and left resection are still the standard. To evaluate the level of evidence of tumour enucleation (EN), pancreatic middle segment resection...

In pancreatic cancer median survival times range around 6, 6 to 6,9 months. Here we retrospectively analyzed the outcome of immunotherapy in the additional palliative treatment of pancreatic cancer with long antigen exposition dendritic cell therapy (LANEX-DC®) in 138 patients who were treated at our institution (intent-to- treat-analysis). Data we...

Cystic neoplasms of the pancreas are being detected and surgically treated increasingly more frequently. Intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN) are primary benign lesions; however, the 5-year risk for malignant transformation has been estimated to be 63 % and 15 %, respectively. Surgical extirpation of a...

Background: Cystic neoplasms of the pancreas are diagnosed frequently due to early use of abdominal imaging techniques. Intraductal papillary mucinous neoplasm, mucinous cystic neoplasm, and serous pseudopapillary neoplasia are considered pre-cancerous lesions because of frequent transformation to cancer. Complete surgical resection of the benign...

Infections due to pancreatic necrosis and abscesses are observed in one third of patients with severe acute pancreatitis (SAP). Based on results of double-blind, randomized, placebo-controlled trials, antibiotic prophylaxis in SAP is ineffective for reducing the frequency of infected necrosis and to decrease hospital mortality. Antibiotic treatment...

Indications for and goals of surgical treatmentSurgical proceduresReferencesPancreatic duct drainage proceduresConclusions ReferencesDuodenum-preserving pancreatic head resection in inflammatory and cystic neoplastic lesions of the pancreasDiagnostic work-upReferencesMajor pancreatic resectionsReferencesNerve ablation techniques in chronic pancreat...

Cystic neoplastic lesions of the pancreas are found in up to 10% of all pancreatic lesions. A malignant transformation of cystic neoplasia is observed in intraductal papillary mucinous tumor (IPMN) lesions in 60% and in mucinous cystic tumor (MCN) lesions in up to 30%. For cystic neoplasia located monocentrically in the pancreatic head and that do...

Introduction: For treatment of inflammatory and benign neoplastic lesions of the pancreatic head, a subtotal or total pancreatic head resection is a limited surgical procedure with the impact of replacing the application of a Whipple procedure. The objective of this work is to describe the technical modifications of subtotal and total pancreatic h...

Cancers of the pancreas are identified in 11 800 to 13 500 patients each year in Germany. Epidemiological studies prove smoking and chronic alcohol consumption as causes of about 30% of pancreatic cancers. Selective literature review. Only patients within TNM stage I and II have after oncologic tumor extirpation a chance for long term survival. Con...

Cystic neoplastic lesions of the pancreas are now found with increasing frequency. Duodenum-preserving pancreatic head resection with segmental resection of the duodenum has been introduced for the surgical treatment of inflammatory and neoplastic lesions. We report the following data from 15 patients treated surgically for cystic neoplastic lesion...

255 M E D I Z I N I n Deutschland werden zwischen 11 800 und 13 500 Neuerkrankungen an Bauchspeicheldrüsenkrebs pro Jahr registriert (1). Das mittlere Erkrankungsalter liegt für Männer bei 68 Jahren, für Frauen bei 70 Jahren. Frauen erkranken seit einigen Jahren häufiger als Män-ner (1). Die Zunahme der Häufigkeit des Pankreaskarzi-noms in den indu...

Chronic pancreatitis, which is usually caused by chronic alcohol abuse, is primarily a disease of the exocrine compartment of the pancreas. Several pathological concepts have been proposed to explain the morphological changes that occur during the disease. The most widely accepted concept is based on the observation that overconsumption of alcohol...

In industrialized countries, two-thirds of patients suffer from chronic alcoholic pancreatitis, 20% from idiopathic chronic pancreatitis, and ≤10% from hereditary chronic pancreatitis. It is believed that chronic alcoholic pancreatitis is a consequence of recurrent attacks of acute pancreatitis causing small areas of pancreatic necrosis, which lead...

Duodenum-preserving pancreatic head resection (DPPHR) was introduced in clinical practice in 1972 after experimentation on dogs to elucidate the technique of a segmental resection of pancreatic tissue with regard to early and late histology of the two pancreaticojejunostomoses and maintenance of adequate vascularization of the pancreatic head rest...

Pancreatic head resection is a major surgical procedure and even today is linked to considerable risk for severe complications. In high-volume centers, morbidity and mortality after pancreatic head resection decreased to below 5%. In the authors’ monoinstitutional experiences including 1315 patients with malignant lesion and benign tumor, the frequ...

Indications for surgeryDrainage procedureDuodenum-preserving pancreatic head resectionPylorus-preserving pancreatic head resection in chronic pancreatitisConclusion

The clinical course in acute necrotizing pancreatitis is mainly determined by bacterial infection of pancreatic and peripancreatic necrosis. The effect of two antibiotic regimens for early and late treatment was investigated in the taurocholate model of necrotizing pancreatitis in the rat. Seventy male Wistar rats were divided into five pancreatiti...

We investigated the immune status in 32 pancreatic cancer patients (PC) in comparison with healthy controls (HC). Using flow cytometry, peripheral blood lymphocytes (PBL) were characterized by the expression of surface markers for T helper cells (CD4), T suppressor cells (CD8), B cells (CD19) and NK cells (CD56). The blastogenic response of PBL was...

Recently we have shown that NSC-631570 (Ukrain) is a safe and effective drug in the treatment of unresectable pancreatic cancer. The aim of this study was to determine the effectiveness of the combined treatment with Gemcitabine and NSC-631570 in the adjuvant treatment of resected advanced pancreatic cancer. 30 patients received adjuvant chemothera...

Pancreas divisum (PD) represents a duct anomaly in the pancreatic head ducts, leading frequently leading to recurrent acute pancreatitis (rAP) or chronic pancreatitis (CP). Based on endoscopic retrograde cholangiopancreatography, pancreas divisum can be found in 1% to 6% of patients with pancreatitis. The correlation of this abnormality with pancre...

Conflicting results have been published about the effects of carbon dioxide (CO(2)) pneumoperitoneum on splanchnic and liver perfusion. Several experimental studies described a pressure-related reduction in hepatic blood flow, whereas other investigators reported an increase as long as the intraabdominal pressure (IAP) remained less than 16 mm Hg....

Severe acute pancreatitis is considered to be a subgroup of acute pancreatitis with the development of local and/or systemic complications. A significant correlation exists between the development of pancreatic necrosis, the frequency of bacterial contamination of necrosis and the evolution of systemic complications. Bacterial infection and the ext...

The outcome of severe acute pancreatitis is determined by the development of the systemic inflammatory response and subsequent multiorgan dysfunction. Using the taurocholate-induced model of acute pancreatitis in rats, we investigated the relationship between early polymorphonuclear (PMN)-mediated pancreatic tissue damage and the systemic inflammat...

Adenocarcinoma of the pancreas is associated with the worst survival of any form of gastrointestinal malignancy. In spite of the progress in surgical treatment, resulting in increasing resection rates and a decrease in treatment-related morbidity and mortality, the true figures of cure are even today below 3%. The dissemination of pancreatic cancer...

Neoadjuvant radiochemotherapy in patients suffering from pancreatic cancer is presently not well established. Neoadjuvant radiochemotherapy is recommended to be applied in 5-8 weeks. The full dose of radiotherapy is between 50 and 54 Gy with 5FU used as radiosensitator. In patients with resectable pancreatic cancer, particularly in UICC-stage II ne...

Die neoadjuvante Chemotherapie bei Pankreaskarzinom ist bisher nicht standardisiert. Die Applikation erfolgt als Radiochemotherapie innerhalb von 5–8 Wochen mit fraktionierter Radiotherapie zwischen 40 und 54 Gy und 5 FU als Radiosensitator.Bei Patienten mit resezierbaren Pankreaskarzinomen (UICC-Stadium II) bewirkt neoadjuvante Radiochemotherapie...

Common bile duct stenosis (CBDS) is one of the most frequent complications in chronic pancreatitis with inflammatory mass in the head of the pancreas (IMH). A total of 474 patients who underwent duodenum-preserving pancreatic head resection (DPPHR) between 1982 and 1998 were reevaluated; 219 patients (46%) with a mean duration of the disease of 45...

Effizientes Staging bei Verdacht auf ein Pankreaskarzinom kann zur Verminderung von unnötigen Probelaparotomien beitragen und die Grundlage für ein stadienorientiertes Therapieschema geben.

We recently showed that cyclin D1 is overexpressed in human pancreatic carcinoma cells, and that this overexpression correlates significantly with a poor prognosis. To assess the interrelations of epidermal growth factor (EGF), EGF receptor (EGFR), and cyclin D1 in human pancreatic carcinoma. In pancreatic carcinoma cell lines (BxPC-3, AsPC-1), cel...

The hallmark of severe acute pancreatitis (SAP) is massive acinar cell death by necrosis. However, programmed, apoptotic acinar cell death has also been observed. Little is known about the dynamics, localization, and inductive factors of acinar cell apoptosis in SAP. We therefore induced SAP in rats by retrograde infusion of 3% sodium taurocholate....

To evaluate, in an experimental model of acute pancreatitis, the impact of nitric oxide on the disease process and the interaction between nitric oxide and oxygen free radicals. Nitric oxide and oxygen free radicals are involved in the pathophysiology of acute pancreatitis. It is well established that oxygen free radicals play an important role in...

Aim: The association of smoking and development of ductal pancreatic cancer was studied experimentally and epidemiologically. Methods: Experimentally the tobacco derived carcinogen 4-(methylnitrosamino)-l-(3-pyridyl)-l-butanone (NKK) was measured in pancreatic juice of actively smoking and non-smoking or passively smoking patients undergoing surger...

Oxidative stress is an important factor in the pathogenesis of acute pancreatitis, as shown in vivo by the beneficial effects of scavenger treatment and in vitro by the potential of free radicals to induce acinar cell damage. However, it is still unclear whether oxygen free radicals (OFR) act only as mediators of tissue damage or represent the init...

Using a retrograde infusion sodium taurocholate pancreatitis model in the rat treatment with oxygen radical scavengers or monoclonal anti-ICAM-1 antibody decreased tissue damage and polymorphonuclear leukocytes (PMN) infiltration. Scavengers or anti-ICAM-1 treatment attenuated the activating capacity of blood PMNs following zymosan stimulation. The...

The management of 178 patients with liver trauma (132 male, 46 female; mean age 34 years (range 3-88) presenting from January 1979 to August 1996 is reviewed. There were 165 cases of blunt trauma and 13 cases of penetrating injury. 110 cases were classified as simple injuries (grade I or II) and 68 cases as complex injuries (grade III to V). The ov...

Approximately 50% of children with a clinical unilateral inguinal hernia display a patent processus vaginalis on the contralateral side; half of these children subsequently develop an inguinal hernia. The management of this problem is still controversial. The purpose of this study was to evaluate the usefulness of intraoperative laparoscopy in a no...

Background: Approximately 50 % of children with a clinical unilateral inguinal hernia display a patent processus vaginalis on the contralateral side; half of these children subsequently develop an inguinal hernia.The management of this problem is still controversial. The purpose of this study was to evaluate the usefulness of intraoperative laparos...

Background: Approximately 50% of children with a clinical unilateral inguinal hernia display a patent processus vaginalis on the contralateral side; half of these children subsequently develop an inguinal hernia.The management of this problem is still controversial. The purpose of this study was to evaluate the usefulness of intraoperative laparosc...

Duodenum-preserving pancreas resection for chronic pancreatitis results in a subtotal resection of the pancreatic head. Of 488 patients suffering from chronic pancreatitis with an inflammatory mass in the head, 48% had a common bile duct stenosis in the ERCP, 63% had a pancreatic main duct stenosis, 25% had a duodenum stenosis, and 17% showed vascu...

The management of 178 patients with liver trauma (132 male, 46 female; mean age 34 years (range 3–88) presenting from January 1979 to August 1996 is reviewed. There were 165 cases of blunt trauma and 13 cases of penetrating injury. 110 cases were classified as simple injuries (grade I or II) and 68 cases as complex injuries (grade III to V). The ov...

Approximately 40% of children with a clinical unilateral inguinal hernia display a patent processus vaginalis on the contralateral side; half of these children subsequently develop an inguinal hernia. The management of this problem is still controversial. Different strategies to identify patients who profit from an open contralateral exploration ha...

Bacterial translocation following gut barrier dysfunction is a well-documented phenomenon after major trauma and burn injury [1-5]. The clinical relevance, however, has yet to be elucidated. The same question applies to the recently observed bacterial translocation during abdominal surgery [6]. Similarly, circulating endotoxin has been described af...

The etiology of massive obesity is complex. The long-term results of conservative treatments for morbid obesity are dismal and are associated with further loss of self esteem with each regain of weight. Currently no proven drug therapy is available. Many different conventional surgical procedures have been advocated to reduce weight in the morbid o...

Variant CD44 splice products, especially CD44 variant 6 (CD44v6), are expressed on activated lymphocytes and tumor cells. The soluble forms of CD44 standard (CD44s) and CD44v6 are present in the serum of normal individuals. The aim of the current study was to evaluate the concentrations and the prognostic potential of soluble CD44s and CD44v6 in pa...

We investigated the effects of endogenously produced and exogenously applied nitric oxide (NO) on cell proliferation rates and cell cycle regulation in senescent human fibroblasts (WI38). Induction of inducible nitric oxide synthase by tumor necrosis factor-alpha, interferon-gamma and interleukin-1beta inhibited cell proliferation and led to a G1 a...

A study is made of power generation based on thermochemically recuperative (TCR) systems. The main feature of such systems is the recuperation of energy from the turbine exhaust through the reforming of a gas-steam stream. This type of cycle shows promising theoretical results for future systems which would use an inlet turbine temperature of 1700...

The role of reactive oxygen species (ROS) generated by hypoxanthine/xanthine oxidase (HX/XO) in the induction of apoptosis was studied in the human fibroblast cell line WI38. Apoptosis but not necrosis was observed in proliferating fibroblasts after 48 h incubation with 1 mM HX and 0.05 U/ml XO. Induction of apoptosis was hindered by catalase. Cell...

Die Pankreatitis ist geprägt von schweren progredienten Azinuszellschäden, starkem Ödem sowie einer im Verlauf zunehmenden Akkumulation und Migration von Entzündungszellen [1]. In einer Vielzahl von Studien in verschiedenen Modellen der experimentellen akuten Pankreatitis konnte eine frühe Freisetzung von freien Sauerstoffradikalen (OR) nachgewiese...

Für die Ausbildung von Mukosaschäden am Dünndarm während der Reperfusion nach begrenzter intestinaler Ischämie werden vor allem Sauerstoffradikale (OR) verantwortlich gemacht [3]. Bislang bekannte und als wesentlich angesehene Quellen dieser überschießenden OR-Produktion sind das Hypoxanthin/Xanthinoxidasesystem (HX/XO) und aktivierte neutrophile G...

Sauerstoffradikale (OR) spielen in vielen pathologischen Prozessen wie zum Beispiel Ischämie — Reperfusionsschäden oder Entzündungsprozessen eine wichtige Rolle [1]. Sie wirken durch Lipidperoxidation und Membrandesintegration direkt toxisch. In letzter Zeit wurde gezeigt, daß OR neben diesen direkt passiv toxischen Effekten auch spezifische aktive...

CAM 17.1-Ab is a recently described monoclonal antibody that detects a mucus glycoprotein with high specificity for intestinal mucus, particularly in the colon, small intestine, biliary tract and pancreas. We investigated the expression and release of CAM 17.1 in pancreatic carcinoma cell lines and tissue specimens of normal pancreas, chronic pancr...

15 to 30% of the patients with chronic pancreatitis develop an inflammatory mass in the pancreatic head. The leading symptoms of these patients are severe upper abdominal pain and complications of the surrounding organs. From 1969 to 1995, 380 patients were treated with a duodenumpreserving pancreatic head resection. The cause of the disease was al...

The single cell gel electrophoresis (SCG) assay was used to compare the occurrence of DNA damage in peripheral white blood cells in 6 trained (TR) and 5 untrained (UT) men after exhaustive exercise. The subjects completed an incremental treadmill test until exhaustion (maximal lactate: 12.9 +/- 1.7 in TR and 12.2 +/- 2.5 mmol.l-1 in UT). A clear an...

Oxygen derived free radicals are involved in many pathological processes such as postischemic reperfusion injuries, hepatotoxicity of drugs and inflammatory processes. Thereby these oxygen radicals induce lipid peroxidation and perturbation of cellular membranes. The aim of our present study was to determine whether oxygen radicals generated by the...

Conclusion: Anti-p53-autoantibodies (a-p53-aabs) may suppress the development of distant metastases, but not lymph node metastases. This could explain the significantly prolonged survival of patients with UICC stage III tumors who have a-p53-aabs compared to those without a-p53-aabs. Background: Mutation within the tumor suppressor gene p53 lead...

Nowadays the toxicity of oxygen radicals (OR) is uncontested. In spite of a lot of in vitro and of animal experiments it is still difficult to transform the results into the clinical routine. This is caused by the complex clinical situation. Therefore we tried to establish a human, reproducable and standardized model, allowing to study clinically t...

Variant CD44 splice products, especially CD44v6, are expressed on activated lymphocytes and tumour cells. The soluble forms of CD44s and CD44v6 are present in the serum of normal individuals. We investigated sera from patients with pancreatic cancer for the concentration of CD44v6 by using Western blots and ELISA. CD44v6 was significantly reduced i...

Viele verschiedene gastrointestinale Tumoren wie kolorektale, Magen- oder Pankreaskarzinome exprimieren Splicevarianten des CD44-Glykoproteins (CD44v) [1, 2]. Diese Varianten unterscheiden sich vom CD44-Standard (CD44s) dadurch, daß sie zusätzliche Peptiddomänen im extrazellulären Anteil des Moleküls enthalten. Diese inserierten Peptide werden von...

Die Toxizität hochreaktiver Sauerstoffradikale (OR) ist heute unbestritten. Trotzdem haben diese pathophysiologischen Erkentnisse bislang nur zu wenigen, therapierelevanten Konsequenzen geführt. Klinische Studien (z. B. Sepsisstudien), welche sich mit der Wirkung von OR beschäftigen scheitern oft an der komplexen, klinischen Situation. Auch unter s...

Hemorrhagic mucosal lesions are produced during intestinal ischemia and after reperfusion due at least in part to the accumulation and activation of polymorphonuclear leukocytes in the tissue. It has been shown in vitro that adenosine is instrumental in attenuating this pathophysiological process. Acadesine [5-amino-4-imidazolecarboxamide (AICA) ri...

The single cell gel test (SCG test or comet assay) was used to study DNA damage in peripheral white blood cells (WBC) of humans after a single bout of exhaustive exercise and the effect of vitamin supplementation. Human subjects were asked to run on a treadmill until exhaustion and blood samples were taken before and 24 h after the run. A clear inc...

It is well established that several factors such as endotoxemia or intestinal ischemia and reperfusion influence the prognosis of severly ill patients. The aim of this study was to elucidate the time sequence between intra- and postoperative endotoxemia, change of intramucosal pHi and mediator release in 52 patients who underwent major abdominal su...

Accumulation and Stimulation of PMN leukocytes, enhanced prostaglandin metabolism and tissue hypoxia lead to high concentrations of oxygen radicals and their metabolites in septic shock. Oxygen radicals seem to be responsible for the irreversible tissue damage leading to multiple organ failure in sepsis. Thereby, oxygen radicals are already present...

Freie Sauerstoffradikale (OR) spielen eine wichtige Rolle in vielen pathophysiologischen Prozessen, wie z.B. Hepatotoxizität von Medikamenten und Entzündungsreaktionen [1]. Die Akkumulation dieser Radikale im Gewebe führt zur Lipidperoxidation und Denaturierung von Proteinen, was den Verlust von Enzymfunktionen bedeuten kann [2]. Histamin ist in ba...