Endosonography of the rectum, combining the advantages of both endoscopy and sonography, provides information not at present available from other imaging modalities. It is remarkably accurate in the pre-operative assessment of tumor penetration. In the evaluation of lymph nodes, the specificity and sensitivity is 83% and 72%, respectively. For the detection of local recurrence in asymptomatic patients promising results can be obtained. In contrast, the potential benefits of immunoscintigraphy in patients with rectal cancer have yet to be determined but preliminary results indicate that immunoscintigraphy in combination with endosonography may assist the surgeon in confirming or excluding the suspicion of recurrence.

Endoscopes, Gastrointestinal↗

PubMedDate not supplied

Optimization of isolated hyperthermic limb perfusion.

During isolated limb perfusion, we studied the impact of limb temperature on the concentration of cytostatic drugs in the tissue to identify a possible selective absorption of cytostatic agents by the various tissues. Ten consecutive patients with malignant melanoma were randomly divided into two different groups and perfused with 1 mg cisplatin per kg body weight. In one group the cytostatic agents were injected under hyperthermic conditions (39.5 degrees C) and in the other group under normothermic conditions (37 degrees C). The platinum concentration in the melanoma was twice as high in the hyperthermic group as in the group under normothermic conditions. In the tumor-free tissue the platinum concentration decreased with temperature while it remained constant in the musculature. This selective concentration of cisplatin in the tumor under hyperthermic conditions is accompanied by fewer side effects. Follow-up will show whether the oncological results will be improved in the hyperthermic conditions as one might expect.

Chemotherapy, Cancer, Regional Perfusion↗

PubMedDate not supplied

Improved stabilization of conventional (Brooke) ileostomies with the stapler technique.

The rate of functional complications of conventional (Brooke) ileostomy is high and endangers the complete postoperative rehabilitation of the patients. About half of these complications (retraction with/without stenosis, intermittent recession, and prolapse) occur within the classical prominent stoma and are caused by displacement of the serosa surfaces. We have stabilized conventional ileostomies in 39 patients with rows of staples placed paramesenterially and longitudinally. The ileum was everted in the classical way in the primary construction of ileostomies in 19 patients. On the other hand, in 11 patients the prominence of the stoma was established by pulling the ileum out through the previously plane-sutured stoma. In addition, 9 patients with ileostomies which were not primarily stabilized were corrected with the stapler technique to treat complications. With follow-up ranging from 0.2 years to 4.2 years, there have been no complications due to sliding of the nipple in these 39 patients. In contrast, there were complications in 37% of 38 patients with non-stabilized ileostomies with follow-up to the second postoperative year. It was more easily reproducible, more exact, and less traumatic to create the stoma prominence by pulling the intestine out from a primarily plane stoma than with classical eversion. With use of the stapler in repairing complications, local ileostomy constructions were no longer required in every second patient. Consequently, a Brooke ileostomy can be constructed more easily with the stapler technique, ensuring long-term function or restoration of function.

Humans↗

PubMedDate not supplied

Modified intra-arterial calcium stimulation with venous sampling test for preoperative localization of insulinomas.

BACKGROUND: To determine the accuracy and safety of a modified intra-arterial calcium stimulation with the venous sampling test (ASVS) for preoperative localization of insulinomas. Modification included stimulation with a fixed low dose of calcium gluconate, additional stimulation in the distal splenic artery, and no insulin sampling in the left hepatic vein. METHODS: In 10 patients showing biochemical evidence of organic hyperinsulinemia, 0.45 mmol of Ca2+ was injected into the gastroduodenal, superior mesenteric, proper hepatic, proximal, and distal splenic arteries during angiography. Insulin levels were measured in samples taken from the right hepatic vein before and 30, 60, 90, 120, 180, and 300 s after Ca2+ injection. RESULTS: Insulin gradients with an increase of more than fourfold indicated direct tumor supply, two- to fourfold correlated with collateral supply, and less than twofold correlated with normal tissue vascularization. ASVS localized all the adenomas of the pancreatic head (n = 3) and body (n = 2) and two of four adenomas of the tail correctly, as confirmed by surgery. Two adenomas of the proximal pancreatic tail were erroneously localized to the body segment, but the fault was rectified by angiography. In one patient with a negative ASVS and without exploration, the diagnosis of an insulinoma was revised. CONCLUSION: ASVS with a fixed low dose of calcium gluconate is a highly accurate and safe method for preoperative localization of insulinomas. Sampling in the left hepatic vein can be routinely omitted. Additional stimulation in the distal splenic artery seems helpful in surgical decision making, but additional experience is needed.

Adult↗