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Visceral Medicine

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https://read.qxmd.com/read/30675493/clinical-management-of-appendicitis
#1
REVIEW
Peter Becker, Stefan Fichtner-Feigl, Dieter Schilling
Background: Ever since the first appendectomy has been performed, surgery has been the standard of care for acute appendicitis, with antibiotic therapy being reserved for special situations. Recent studies have shown the feasibility of antibiotic therapy for uncomplicated appendicitis. Methods: This clinical therapeutic review is based both on author expertise and a selective literature survey in PubMed based on the term 'appendicitis', combined with the terms 'acute', 'complicated', 'conservative', 'non-operative', 'therapy', 'surgery', and 'strategy'...
December 2018: Visceral Medicine
https://read.qxmd.com/read/30675492/donor-shortage-in-germany-impact-on-short-and-long-term-results-in-liver-transplantation
#2
REVIEW
Gerd Otto
With slightly more than 10 donors per million inhabitants, Germany belongs to the underdeveloped countries in Europe with regard to organ donation. Organ shortage is supposed to promote the usage of organs which are declined in case of less pronounced scarcity. This may result in deteriorated graft and patient survival. In the light of this situation, data on the centers' procedures and outcome of liver transplantation in Germany is presented based upon reports of Eurotransplant, the German Institutions for Quality Assessment, and the Deutsche Stiftung Organtransplantation...
December 2018: Visceral Medicine
https://read.qxmd.com/read/30675491/control-of-ischemia-reperfusion-injury-in-liver-transplantation-potentials-for-increasing-the-donor-pool
#3
REVIEW
Judith Kahn, Peter Schemmer
Background: Organ shortage is a growing problem, with a rising number of organs being harvested from extended criteria donors, and this trend will further continue to increase as organ donors are getting older and have more comorbidities. Since this fact is immutable, efforts have been made to reduce the extent of ischemia-reperfusion injury (IRI) as well as of direct and indirect harvest-related graft injury which affects all organs in a more or less distinct way. Methods: In liver transplantation (LT), the activation of Kupffer cells during organ reperfusion, thus provoking microcirculatory disturbances, hypoxia, and endothelial cell injury, is one of the key mechanisms causing graft dysfunction...
December 2018: Visceral Medicine
https://read.qxmd.com/read/30675490/minimally-invasive-surgery-of-pancreatic-cancer-feasibility-and-rationale
#4
REVIEW
Dirk Bausch, Tobias Keck
Minimally invasive pancreatic procedures, in particular minimally invasive pancreaticoduodenectomy, are amongst the most technically challenging procedures in general surgery. Accordingly, a high number of cases is required to master the procedures. Minimally invasive pancreatic surgery is well established for benign and premalignant lesions of the pancreas. Borderline resectable tumors with infiltration of the portal vein are also resected minimally invasively in specialized centers with appropriate expertise...
December 2018: Visceral Medicine
https://read.qxmd.com/read/30675489/translational-research-for-acute-pancreatitis-which-results-have-really-influenced-our-therapy
#5
REVIEW
Jan D'Haese, Jens Werner
Acute pancreatitis is a common disease characterized by acinar cell destruction and acute inflammatory changes of the pancreas that lead to a systemic inflammatory response. A major research effort has been undertaken to unravel the underlying pathophysiology and to identify possible therapeutic targets. Still, only very few findings have influenced our clinical practice in the treatment of acute pancreatitis. Pancreatic microcirculation and capillary blood flow have long been suspected to play a major role in the course of the disease...
December 2018: Visceral Medicine
https://read.qxmd.com/read/30675488/severe-acute-pancreatitis-how-conservative-can-we-be
#6
REVIEW
Christian Alberts, Guido Alsfasser
Background: Acute pancreatitis still is a disease with overall high mortality. Continuously improved understanding of the pathophysiology, however, led to changes in treatment algorithms within the last decades, thus resulting in decreased mortality. This knowledge of acute pancreatitis enabled a new classification system introduced by an international expert panel. This classification system is helpful in initiating treatment strategies which are adapted to the course of acute pancreatitis...
December 2018: Visceral Medicine
https://read.qxmd.com/read/30675487/impact-of-modern-drug-therapy-on-surgery-ulcerative-colitis
#7
REVIEW
Florian Kuehn, Richard A Hodin
Background: The primary treatment of ulcerative colitis (UC) is conservative, and substantial therapeutic progress has been made in the past few decades. Meanwhile, biologicals have become a mainstay in the treatment for steroid-refractory UC. Despite further development of drug therapy and an increased time span to operation, a significant proportion of patients with UC require surgical intervention. Surgical intervention needs to be carried out in medically refractory cases, imminent or malignant transformation, or complications...
December 2018: Visceral Medicine
https://read.qxmd.com/read/30675486/impact-of-modern-drug-therapy-on-surgery-crohn-s-disease
#8
REVIEW
Peter Kienle
Background: A significant number of patients with Crohn's disease needs to undergo surgery, and many of these patients are under modern drug treatment. These drugs may influence the rate of perioperative complications. This may have an impact on the chosen surgical strategy. Methods: This review considers clinical studies and guidelines on the effect of modern drug treatment on surgical complication rates and surgical strategy in patients with Crohn's disease. Results: Steroids above a certain dose significantly influence perioperative complications and should therefore be tapered down before performing elective surgery...
December 2018: Visceral Medicine
https://read.qxmd.com/read/30675485/medullary-thyroid-carcinoma-why-is-specialization-mandatory
#9
REVIEW
Theresia Weber
Medullary thyroid carcinoma (MTC) represents a distinct form of thyroid cancer with a potentially aggressive behavior, early lymph node metastases, and sporadic as well as hereditary forms. Only surgery with total thyroidectomy and lymph node dissection is able to achieve biochemical cure. Due to the uncommon nature of MTC, a specialization in endocrine surgery for diagnosis as well as therapy of MTC seem to be mandatory for a successful treatment. Knowledge of genotype-phenotype correlations for hereditary forms or routine calcitonin screening for sporadic forms is important to analyze preoperative findings and plan surgical procedures...
December 2018: Visceral Medicine
https://read.qxmd.com/read/30675484/hyperthermic-intraperitoneal-chemotherapy-fading-perspective-in-the-light-of-modern-systemic-chemotherapy
#10
REVIEW
Pankaj Kumar Garg, Andreas Brandl, Beate Rau
Background: Peritoneal metastasis (PM) in a gastrointestinal cancer is associated with a poor prognosis. Various guidelines recommend palliative chemotherapy in these patients as cure is not achievable. However, hyperthermic intraperitoneal chemotherapy (HIPEC) in combination with cytoreductive surgery (CRS) can achieve long-term survival with low morbidity in selected patients. During the last decades, CRS and HIPEC have been performed in a number of indications, aiming for long-term survival...
December 2018: Visceral Medicine
https://read.qxmd.com/read/30675483/frontiers-in-surgical-evolution-a-festschrift-honoring-ernst-klar
#11
EDITORIAL
Guido Alsfasser
No abstract text is available yet for this article.
December 2018: Visceral Medicine
https://read.qxmd.com/read/30498707/penile-metastasis-from-rectal-carcinoma-case-report-and-review-of-the-literature
#12
Justas Kuliavas, Audrius Dulskas, Julius Drachneris, Edita Miseikyte-Kaubriene, Narimantas E Samalavicius
Background: Metastasis of rectal cancer to the penis is a very rare condition with less than 40 cases found in the literature. Case Report: We here report a case of a 41-year-old man who was diagnosed with rectal cancer which later metastasized to the penis. The patient was treated with neoadjuvant radiotherapy, underwent rectal resection, had adjuvant chemotherapy, and, despite that, had penile metastasis 2 years later. Palliative penectomy as well as bilateral orchiectomy with suprapubic cystostomy were performed...
October 2018: Visceral Medicine
https://read.qxmd.com/read/30498706/comorbidities-as-an-indication-for-metabolic-surgery
#13
REVIEW
Anne-Catherine Schwarz, Adrian T Billeter, Katharina M Scheurlen, Matthias Blüher, Beat P Müller-Stich
Metabolic diseases, comprising type 2 diabetes mellitus (T2DM), dyslipidemia, and non-alcoholic steatohepatitis (NASH), are rapidly increasing worldwide. Conservative medical therapy, including the newly available drugs, has only limited effects and does neither influence survival or the development of micro- or macrovascular complications, nor the progression of NASH to liver cirrhosis, nor the development of hepatocellular carcinomas in the NASH liver. In contrast, metabolic surgery is very effective independent of the preoperative body mass index (BMI) in reducing overall and cardiovascular mortality in patients with T2DM...
October 2018: Visceral Medicine
https://read.qxmd.com/read/30498705/gastrointestinal-stromal-tumors
#14
Peter Hohenberger, Michael Montemurro, Chandrajit P Raut, Piotr Rutkowski
No abstract text is available yet for this article.
October 2018: Visceral Medicine
https://read.qxmd.com/read/30498704/surgery-for-gastrointestinal-stromal-tumors-state-of-the-art-of-laparoscopic-resection-and-surgery-for-m1-tumors
#15
REVIEW
Ulrich Ronellenfitsch, Peter Hohenberger
Background: The principles of surgery for primary gastrointestinal stromal tumor (GIST) are resection with clear margins without lymphadenectomy, thus enabling organ-preserving resection in many cases. Tumor rupture needs to be avoided, because it entails peritoneal sarcomatosis. Given these preconditions, there is a rationale for laparoscopic resection of primary GIST. In metastatic GIST, surgery cannot achieve cure, but constitutes an important cornerstone of treatment. Resection can be performed either for residual lesions in responding patients, for focally progressive lesions, or as palliative measure in generalized progression...
October 2018: Visceral Medicine
https://read.qxmd.com/read/30498703/neoadjuvant-therapy-to-downstage-the-extent-of-resection-of-gastrointestinal-stromal-tumors
#16
REVIEW
Jens Jakob, Peter Hohenberger
Introduction: Gastrointestinal stromal tumors (GIST) are rare malignant tumors in terms of incidence, and they are not linked to specific symptoms. Often, primary tumors, particularly of the stomach, rectum, or rectovaginal space, are quite large when detected, and multivisceral resection seems to be the treatment of choice as the mainstay of therapy is complete tumor removal. If a gain-of-function mutation in the KIT gene is present, drug therapy with receptor tyrosine kinase inhibitors (RTKIs) might significantly downstage primary GIST tumors...
October 2018: Visceral Medicine
https://read.qxmd.com/read/30498702/standard-approach-to-gastrointestinal-stromal-tumors-differences-between-china-and-europe
#17
REVIEW
Lin Tu, Peter Hohenberger, Heike Allgayer, Hui Cao
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. With the considerable research and application of molecular-targeted therapy for GISTs in the last two decades, GISTs have become a model of multidisciplinary oncological treatment. Although Western clinical guidelines are available for GISTs, such as those by the European Society of Medical Oncology (ESMO), the clinical situations in China are different from those in European countries. There are distinct differences between the clinical practice, diagnostic methods, surgical approach, and availability of new targeted agents in China and those in Europe...
October 2018: Visceral Medicine
https://read.qxmd.com/read/30498701/is-the-surgical-margin-in-gastrointestinal-stromal-tumors-different
#18
REVIEW
Piotr Rutkowski, Jacek Skoczylas, Piotr Wisniewski
Background: Radical surgical excision is the mainstay of therapy of primary, nonmetastatic gastrointestinal stromal tumors (GIST) and margin status after surgery is a significant prognostic factor. Methods and Results: The aim of this paper is to review principles in primary GIST surgery, i.e. differences between R0, R1, and R2 resection, to describe how surgical margin status and tumor intraperitoneal rupture influence the patients' outcome, and how this may be effected by neoadjuvant and adjuvant treatment in locally advanced tumors...
October 2018: Visceral Medicine
https://read.qxmd.com/read/30498700/tumor-biological-aspects-of-epithelial-versus-mesenchymal-tumors-of-the-gastrointestinal-tract
#19
REVIEW
Chandrajit P Raut
One of the holy grails of cancer surgery for surgical oncologists is to perform a macroscopically complete resection of the affected organ or site with negative microscopic margins. The surgical oncologist must also be mindful of what constitutes appropriately-sized negative margins. However, what is necessary, based on the best available evidence, can vary considerably for different malignancies arising within the same organ. This review compares two different gastric and rectal malignancies, one each of epithelial and of mesenchymal origin...
October 2018: Visceral Medicine
https://read.qxmd.com/read/30498699/clinical-presentation-of-gastrointestinal-stromal-tumors
#20
REVIEW
Franka Menge, Jens Jakob, Bernd Kasper, Armand Smakic, Timo Gaiser, Peter Hohenberger
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. They constitute 1-2% of all gastrointestinal neoplasms but are the most common subtype of soft tissue sarcomas, accounting for 20-25%. In the late 1990s, GISTs were more and more recognized as a particular tumor entity. The tumors are supposed to originate from the interstitial pacemaker cells of Cajal. They are usually well circumscribed and can be located in every part of the tubular gastrointestinal tract...
October 2018: Visceral Medicine
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