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Berlin Brandenburg

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  • 1
    Language: English
    In: Future oncology (London, England), April 2007, Vol.3(2), pp.119-22
    Keywords: Antineoplastic Agents -- Pharmacology ; Esophageal Neoplasms -- Drug Therapy ; Receptors, Cxcr4 -- Antagonists & Inhibitors
    ISSN: 1479-6694
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 2
    Language: English
    In: The American surgeon, February 2012, Vol.78(2), pp.195-206
    Description: The objective of this study was to establish a prediction model of lymph node status in T1b esophageal carcinoma and define the best squamous and adenocarcinoma predictors. The literature lacks a satisfactory level of evidence of T1b esophageal cancer management. We performed an analysis pooling the effects of outcomes of 2098 patients enrolled into 37 retrospective studies using "neural networks" as data mining techniques. The percentages for lymph node, lymphatic (L+), and vascular (V+) invasion in Sm1 esophageal cancers were 24, 46, and 20 per cent, respectively. The same parameters apply to Sm2 with 34, 63, and 38 per cent as opposed to Sm3 with 51, 69, and 47 per cent. The respective number of patients with well, moderate, and poor histologic differentiation totaled 267, 752, and 582. The rank order of the predictors of lymph node positivity was, respectively: Grade III, (L+), (V+), Sm3 invasion, Sm2 invasion, and Sm1 invasion. Histologic-type squamous and adenocarcinoma (ADC/SCC) was not included in the model. The best predictors for SCC lymph node positivity were sm3 invasion and (V+). As concerns ADC, the most important predictor was (L+). Submucosal esophageal cancer should be managed with surgical resection. However, this is subject to the histologic type and presence of specific predictors that could well alter the perspective of multimodality management.
    Keywords: Disease Management ; Neural Networks (Computer) ; Adenocarcinoma -- Secondary ; Carcinoma, Squamous Cell -- Secondary ; Esophageal Neoplasms -- Pathology
    E-ISSN: 1555-9823
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 3
    Language: English
    In: The American surgeon, June 2011, Vol.77(6), pp.761-72
    Description: The objective of this study is to assess transanal endoscopic microsurgery (TEM) as a surgical strategy for stage I rectal cancer. The literature lacks level I and level II evidence of the oncologic competence of TEM. Three randomized controlled, one prospective, and seven retrospective comparative studies were evaluated. End-points included perioperative outcomes, margin involvement, disease-free and overall survival, and recurrence. The number of patients with major (odds ratio (OR) = 0.24, 95% confidence interval (CI) 0.07-0.91) and overall postoperative complications (OR = 0.16, 95% CI 0.06-0.38) were significantly lower in TEM. The disease-free survival was higher in standard resection (SR) group compared with TEM (OR = 0.46, 95% CI 0.24-0.88). The number of patients with positive margins were less in the SR group (OR = 6.49, 95% CI 1.49-24.91), which was associated with lower local recurrence (OR = 4.92, 95% CI 1.81-13.41) and overall recurrence rate (OR = 2.03, 95% CI 1.15-3.57). No survival advantage was observed in favor of either procedure. TEM had lower rate of positive margins and longer disease-free survival when compared with transanal excision (TAE). TEM seems to be superior to SR concerning morbidity whilst less effective in obtaining negative surgical margins, and it is associated with higher local and overall recurrence. No survival advantage was observed in favor of either procedure. Unfavorable tumor preoperative histology does not seem to influence the selection between TEM and SR. TEM is more effective than TAE in obtaining negative surgical margins and shows a greater disease-free survival.
    Keywords: Rectal Neoplasms -- Surgery
    E-ISSN: 1555-9823
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 4
    Language: English
    In: The American surgeon, February 2005, Vol.71(2), pp.128-31
    Description: Only two treatment modalities-pneumatic dilation and Heller myotomy-promise long-term relief from dysphagia and regurgitation in patients with achalasia. The objective of this study was to determine whether both options differ in their effects on esophageal function, morphology, and improvement in symptoms. Eighty-nine patients diagnosed with achalasia between January 1980 and December 2002 at a single center were enrolled in this study. Sixty-four patients underwent pneumatic dilation and 25 Heller myotomy in combination with an anterior semifundoplication (Dor procedure). Clinical evaluation (Eckardt-Score), esophageal manometry, and barium swallow were performed before and within 6 months after treatment. Our data shows that Heller myotomy reduces the LES resting pressure more markedly (7.9 [3.7-16.9] mm Hg) than pneumatic dilation (14.5 [2.7-36.0] mm Hg) (P 0.05). Both options will lead to an immediate and significant improvement in symptoms, although the two treatment modalities did not differ in their subjective results. As only objective findings, such as those obtained by manometry and the timed barium swallow, have proven relevance for the assessment of long-term results, surgical therapy is the superior and more effective treatment option in patients with achalasia.
    Keywords: Catheterization ; Esophageal Achalasia -- Therapy ; Esophageal Sphincter, Lower -- Surgery
    ISSN: 0003-1348
    E-ISSN: 15559823
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  • 5
    Language: English
    In: The American surgeon, February 2007, Vol.73(2), pp.174-80
    Description: The long-term effect of adrenalectomy on aldosterone-producing adenomas of the adrenal gland is controversially discussed. The aim of this study was to analyze the long-term course, with special consideration of factors of persisting hypertension after endoscopic adrenalectomy, for Conn's syndrome. Between February 1994 and March 2004, 40 patients with Conn's syndrome underwent endoscopic adrenalectomy. Data were recorded prospectively. Adrenalectomy was carried out unilaterally in all patients. Twenty-three patients (57.5%) were women; the median age was 51.7 (31.2-71.4) years. Preoperatively, all patients presented with arterial hypertension persisting over a median period of 84 (5-240) months; 76.3 per cent of the patients had previously been treated with an aldosterone antagonist, and 85 per cent with specific antihypertensives, whereas 52.6 per cent of all patients were under therapy with potassium compounds at the time of admission. After a median follow-up of 45 (7-114) months, potassium substitution was discontinued in 100 per cent of patients, and the aldosterone antagonist was discontinued in 94.7 per cent of patients. In 60.5 per cent of patients, the specific antihypertensive drugs were reduced. Patients with a reduction in antihypertensive medication had, compared with patients without a reduction, a shorter preoperative duration of arterial hypertension and a lower level of serum aldosterone, and were younger. Endoscopic adrenalectomy for Conn's syndrome leads to an immediate normalization of the electrolyte balance postoperatively, whereas hypertension resolves in 60.5 per cent of patients in the long-term course. Thus, the coexistence of essential hypertension or, respectively, a long duration of preoperative hypertension with associated renovascular alterations are of significance for the long-term result.
    Keywords: Adrenalectomy ; Endoscopy ; Hyperaldosteronism -- Surgery
    ISSN: 0003-1348
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  • 6
    Language: English
    In: The American surgeon, March 2006, Vol.72(3), pp.232-7
    Description: Adrenalectomy for pheochromocytoma is per se associated with a specific intraoperative cardiovascular risk caused by catecholamine secretion during manipulation of the tumor. Bilateral or multiple, and recurrent chromaffine tumors are special subentities with a potentially more intensified and longer surgical preparation. The aim of our study was to examine these effects on hemodynamic changes compared with those observed for primary, solitary tumors. Of the 82 studied interventions between February 1992 and May 2005, 58 were seen to involve primary, unilateral tumors, 17 involved bilateral (1 trilateral) findings, and there were 7 cases of recurrency. The hemodynamic changes related to primary, solitary pheochromocytomas revealed a higher frequency of intraoperative blood pressure crises (37%) compared with the comparative groups (11.8% in bilateral and 0% in recurrent tumors), as well as higher maximum pCO2 values noted. The intraoperative blood loss was more pronounced in interventions involving recurrencies. Aside from an appropriate preliminary therapy using an alpha-blocker and the careful surgical preparation of the adrenal gland, the different hemodynamic changes possibly may be related to the presence of smaller tumors in bilateral pheochromocytoma, as well as being based upon the already existent ligature of the draining vein in the event of recurrent procedures. The extent to which the adrenergic effect of the increased maximum pCO2 value plays a role on the development of higher maximum blood pressure values and more frequent intraoperative blood pressure crises continues to remain unclear.
    Keywords: Adrenal Gland Neoplasms -- Surgery ; Adrenalectomy -- Adverse Effects ; Hypertension, Malignant -- Etiology ; Neoplasm Recurrence, Local -- Surgery ; Pheochromocytoma -- Surgery
    ISSN: 0003-1348
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  • 7
    Language: English
    In: The American surgeon, January 2008, Vol.74(1), pp.15-9
    Description: The laparoscopic management of the intrathoracic stomach is still controversial. Laparoscopic semifundoplication in gastroesophageal reflux disease results in effective long-term reflux control and is, as compared with 360 degrees Nissen fundoplication, associated with less frequent side effects such as dysphagia and gas bloat syndrome. The aim of our study was to evaluate the results of laparoscopic anterior semifundoplication in patients with intrathoracic stomach. Enrolled in this study are 19 patients (67.1 years of age; range, 37.5-83.7 years) with intrathoracic stomach undergoing laparoscopic anterior semifundoplication and a minimal follow up of 5 months postoperatively. The study covers the interval between August 1999 and March 2006. Including criterion was a minimum percentage of herniated intrathoracic stomach of 33 per cent. A standardized questionnaire was used for follow up and the modified symptomatic DeMeester score (0-9) was assessed. The median percentage of herniated stomach in the chest was 87.5 per cent (range, 33-100%). Seven patients revealed organo-axial volvulus of the stomach. Duration of preoperative symptoms was 24 months (range, 1-266 months) with a median follow up of 18 months (range, 5-76 months) postoperatively. The modified symptomatic DeMeester score was 0 (0-3). Thirteen of 19 patients were on no postoperative proton pump inhibitor medication. One patient had anatomic recurrence on late follow up at 27 months. The overall contentment with the surgical treatment on an analog scale from 0 to 10 was a median of 9. Although laparoscopic anterior semifundoplication yields satisfactory symptomatic results in patients with intrathoracic stomach, the incidence of failures and anatomical recurrences is higher than expected from subjective data. Prospective, randomized long-term studies are essential to gain further information about the "ideal" type of laparoscopic repair in large hiatal hernia with intrathoracic stomach.
    Keywords: Laparoscopy ; Fundoplication -- Methods ; Hernia, Hiatal -- Surgery
    ISSN: 0003-1348
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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