1
|
Mueller TC, Kehl V, Dimpel R, Blankenstein C, Egert-Schwender S, Strudthoff J, Lock JF, Wiegering A, Hadian A, Lang H, Albertsmeier M, Neuberger M, Von Ehrlich-Treuenstätt V, Mihaljevic AL, Knebel P, Pianka F, Braumann C, Uhl W, Bouchard R, Petrova E, Bork U, Distler M, Tachezy M, Izbicki JR, Reissfelder C, Herrle F, Vay C, Knoefel WT, Buia A, Hanisch E, Friess H, Reim D. Intraoperative Wound Irrigation for the Prevention of Surgical Site Infection After Laparotomy: A Randomized Clinical Trial by CHIR-Net. JAMA Surg 2024; 159:484-492. [PMID: 38381428 PMCID: PMC10882507 DOI: 10.1001/jamasurg.2023.7985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/25/2023] [Indexed: 02/22/2024]
Abstract
Importance Surgical site infections frequently occur after open abdominal surgery. Intraoperative wound irrigation as a preventive measure is a common practice worldwide, although evidence supporting this practice is lacking. Objective To evaluate the preventive effect of intraoperative wound irrigation with polyhexanide solution. Design, Setting, and Participants The Intraoperative Wound Irrigation to Prevent Surgical Site Infection After Laparotomy (IOWISI) trial was a multicenter, 3-armed, randomized clinical trial. Patients and outcome assessors were blinded to the intervention. The clinical trial was conducted in 12 university and general hospitals in Germany from September 2017 to December 2021 with 30-day follow-up. Adult patients undergoing laparotomy were eligible for inclusion. The main exclusion criteria were clean laparoscopic procedures and the inability to provide consent. Of 11 700 screened, 689 were included and 557 completed the trial; 689 were included in the intention-to-treat and safety analysis. Interventions Randomization was performed online (3:3:1 allocation) to polyhexanide 0.04%, saline, or no irrigation (control) of the operative wound before closure. Main Outcome and Measures The primary end point was surgical site infection within 30 postoperative days according to the US Centers for Disease Control and Prevention definition. Results Among the 689 patients included, 402 were male and 287 were female. The median (range) age was 65.9 (18.5-94.9) years. Participants were randomized to either wound irrigation with polyhexanide (n = 292), saline (n = 295), or no irrigation (n = 102). The procedures were classified as clean contaminated in 92 cases (8%). The surgical site infection incidence was 11.8% overall (81 of 689), 10.6% in the polyhexanide arm (31 of 292), 12.5% in the saline arm (37 of 295), and 12.8% in the no irrigation arm (13 of 102). Irrigation with polyhexanide was not statistically superior to no irrigation or saline irrigation (hazard ratio [HR], 1.23; 95% CI, 0.64-2.36 vs HR, 1.19; 95% CI, 0.74-1.94; P = .47). The incidence of serious adverse events did not differ among the 3 groups. Conclusions and Relevance In this study, intraoperative wound irrigation with polyhexanide solution did not reduce surgical site infection incidence in clean-contaminated open abdominal surgical procedures compared to saline or no irrigation. More clinical trials are warranted to evaluate the potential benefit in contaminated and septic procedures, including the emergency setting. Trial Registration drks.de Identifier: DRKS00012251.
Collapse
Affiliation(s)
- Tara Catharina Mueller
- Department of Surgery, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Victoria Kehl
- Münchner Studienzentrum, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Rebekka Dimpel
- Department of Surgery, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Christiane Blankenstein
- Münchner Studienzentrum, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Silvia Egert-Schwender
- Münchner Studienzentrum, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Judith Strudthoff
- Münchner Studienzentrum, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Johan Friso Lock
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Ali Hadian
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Markus Albertsmeier
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilians University of Munich, University Hospital, Munich, Germany
| | - Michael Neuberger
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilians University of Munich, University Hospital, Munich, Germany
| | - Viktor Von Ehrlich-Treuenstätt
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilians University of Munich, University Hospital, Munich, Germany
| | - André L. Mihaljevic
- Clinical Study Center, Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Phillip Knebel
- Clinical Study Center, Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Frank Pianka
- Clinical Study Center, Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum Hospitals, Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum Hospitals, Bochum, Germany
| | - Ralf Bouchard
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ekaterina Petrova
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ulrich Bork
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases, Dresden, Germany: German Cancer Research Center, Heidelberg; Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University of Dresden, Helmholtz Center Dresden-Rossendorf, Dresden, Germany
| | - Marius Distler
- Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases, Dresden, Germany: German Cancer Research Center, Heidelberg; Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University of Dresden, Helmholtz Center Dresden-Rossendorf, Dresden, Germany
| | - Michael Tachezy
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob R. Izbicki
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Reissfelder
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Florian Herrle
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Vay
- Department of General, Visceral, Thoracic, and Pediatric Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Wolfram Trudo Knoefel
- Department of General, Visceral, Thoracic, and Pediatric Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alexander Buia
- Asklepios Clinic Langen, Department of General, Visceral and Thoracic Surgery, Langen, Germany
| | - Ernst Hanisch
- Asklepios Clinic Langen, Department of General, Visceral and Thoracic Surgery, Langen, Germany
| | - Helmut Friess
- Department of Surgery, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Daniel Reim
- Department of Surgery, School of Medicine and Health, Technical University of Munich, Munich, Germany
| |
Collapse
|
2
|
Gambichler T, Harnischfeger F, Skrygan M, Majchrzak-Stiller B, Buchholz M, Müller T, Braumann C. In Vitro Experiments on the Effects of GP-2250 on BRAF-Mutated Melanoma Cell Lines and Benign Melanocytes. Int J Mol Sci 2023; 24:15336. [PMID: 37895015 PMCID: PMC10607550 DOI: 10.3390/ijms242015336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Enhanced glycolysis (Warburg effect) driven by the BRAF oncogene, dysregulated GAPDH expression, and activation of the PI3K/AKT/mTOR signaling pathway may significantly contribute to the resistance-targeted therapy of BRAF-mutated melanomas. Therefore, we aimed to study for the first time the anti-tumor activity of the GAPDH inhibitor GP-2250 in BRAF-mutated melanoma cell lines and benign melanocytes. We employed three melanoma cell lines and one primary melanocyte cell line (Ma-Mel-61a, Ma-Mel-86a, SH-4 and ATCC-PCS-200-013, respectively), which were exposed to different GP-2250 doses. GP-2250's effects on cell proliferation and viability were evaluated by means of the BrdU and MTT assays, respectively. The RealTime-Glo Annexin V Apoptosis and Necrosis Assay was performed for the evaluation of apoptosis and necrosis induction. RT-PCR and western blotting were implemented for the determination of AKT and STAT3 gene and protein expression analyses, respectively. The melanoma cell lines showed a dose-dependent response to GP-2250 during BrDU and MTT testing. The RealTime-Glo Annexin V assay revealed the heterogenous impact of GP-2250 on apoptosis as well as necrosis. With respect to the melanoma cell lines Ma-Mel-86a and SH-4, the responses and dosages were comparable to those used for the MTT viability assay. Using the same dose range of GP-2250 administered to melanoma cells, however, we observed neither the noteworthy apoptosis nor necrosis of GP-2250-treated benign melanocytes. The gene expression profiles in the melanoma cell lines for AKT and STAT3 were heterogenous, whereby AKT as well as STAT3 gene expression were most effectively downregulated using the highest GP-2250 doses. Immunoblotting revealed that there was a time-dependent decrease in protein expression at the highest GP-2250 dose used, whereas a time- as well as dose-dependent AKT decrease was predominantly observed in Ma-Mel-61a. The STAT3 protein expression of Ma-Mel-86a and SH-4 was reduced in a time-dependent pattern at lower and moderate doses. STAT3 expression in Ma-Me-61a was barely altered by GP-2250. In conclusion, GP-2250 has anti-neoplastic effects in BRAF-mutated melanoma cell lines regarding tumor cell viability, proliferation, and apoptosis/necrosis. GP-2250 is able to downregulate the gene and protein expression of aberrant tumorigenic pathways in melanoma cell lines. Since GP-2250 is a GAPDH inhibitor, the substance may be a promising combination therapy for tumors presenting the Warburg effect, such as melanoma.
Collapse
Affiliation(s)
- Thilo Gambichler
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany; (F.H.); (M.S.)
| | - Friederike Harnischfeger
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany; (F.H.); (M.S.)
| | - Marina Skrygan
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany; (F.H.); (M.S.)
| | - Britta Majchrzak-Stiller
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (B.M.-S.); (M.B.)
| | - Marie Buchholz
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (B.M.-S.); (M.B.)
| | | | - Chris Braumann
- Department of General, Visceral and Vascular Surgery, Evangelisches Klinikum Gelsenkirchen, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, 45878 Gelsenkirchen, Germany;
- Department of General, Visceral and Tumor Surgery, Evangelisches Klinikum Herne, Akademisches Lehrkrankenhaus der Ruhr-Universität Bochum, 44623 Herne, Germany
| |
Collapse
|
3
|
Gambichler T, Majchrzak-Stiller B, Peters I, Becker JC, Strotmann J, Abu Rached N, Müller T, Uhl W, Buchholz M, Braumann C. The effect of GP-2250 on cultured virus-negative Merkel cell carcinoma cells: preliminary results. J Cancer Res Clin Oncol 2023; 149:10831-10840. [PMID: 37311987 PMCID: PMC10423113 DOI: 10.1007/s00432-023-04960-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 06/01/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Even in the novel immunotherapy era, Merkel cell carcinoma (MCC) remains challenging in its treatment. Apart from Merkel cell polyomavirus (MCPyV) associated MCC, this cancer is linked in about 20% of cases to ultraviolet-induced mutational burden frequently causing aberrations in Notch and PI3K/AKT/mTOR signalling pathways. The recently developed agent GP-2250 is capable to inhibit growth of cells of different cancers, including pancreatic neuroendocrine tumors. The objective of the present study was to investigate the effects of GP-2250 on MCPyV-negative MCC cells. METHODS Methods We employed three cell lines (MCC13, MCC14.2, MCC26) which were exposed to different GP-2250doses. GP-2250's effects on cell viability, proliferation, and migration were evaluated by means of MTT, BrdU, and scratch assays, respectively. Flow cytometry was performed for the evaluation of apoptosis and necrosis. Western blotting was implemented for the determination of AKT, mTOR, STAT3, and Notch1 protein expression. RESULTS Cell viability, proliferation, and migration decreased with increasing GP-2250 doses. Flow cytometry revealed a dose response to GP-2250 in all three MCC cell lines. While the viable fraction decreased, the share of necrotic and in a smaller amount the apoptotic cells increased. Regarding Notch1, AKT, mTOR, and STAT3 expression a comparatively time- and dose-dependent decrease of protein expression in the MCC13 and MCC26 cell lines was observed. By contrast, Notch1, AKT, mTOR, and STAT3 expression in MCC14.2 was scarcely altered or even increased by the three dosages of GP-2250 applied. CONCLUSIONS The present study indicates GP-2250 having anti-neoplastic effects in MCPyV-negative tumor cells in regard to viability, proliferation, and migration. Moreover, the substance is capable of downregulating protein expression of aberrant tumorigenic pathways in MCPyV-negative MCC cells.
Collapse
Affiliation(s)
- Thilo Gambichler
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Britta Majchrzak-Stiller
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Ilka Peters
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Jürgen C. Becker
- Translational Skin Cancer Research, German Cancer Consortium (DKTK) Partner Site Essen/Düsseldorf, Department of Dermatology, University Duisburg-Essen, Essen, Germany
- Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - Johanna Strotmann
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Nessr Abu Rached
- Skin Cancer Center Ruhr-University, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | | | - Waldemar Uhl
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Marie Buchholz
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
- Department of General, Visceral and Vascular Surgery, Evangelische Kliniken Gelsenkirchen, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, 45878 Gelsenkirchen, Germany
| |
Collapse
|
4
|
Majchrzak-Stiller B, Buchholz M, Peters I, Waschestjuk D, Strotmann J, Höhn P, Hahn S, Braumann C, Uhl W, Müller T, Möhler H. GP-2250, a novel anticancer agent, inhibits the energy metabolism, activates AMP-Kinase and impairs the NF-kB pathway in pancreatic cancer cells. J Cell Mol Med 2023. [PMID: 37390227 DOI: 10.1111/jcmm.17825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023] Open
Abstract
GP-2250, a novel anticancer agent, severely limits the energy metabolism, as demonstrated by the inhibition of hexokinase 2 and glyceraldehyde-3-phosphate dehydrogenase and a decrease of ATP. Rescue experiments with supplementary pyruvate or oxaloacetate demonstrated that a TCA cycle deficit largely contributed to cytotoxicity. Activation of the energy-deficit sensor, AMP-dependent protein kinase, was associated with increased phosphorylation of acetyl-CoA carboxylase and Raptor, pointing to a possible deficit in the synthesis of fatty acids and proteins as essential cell components. Binding of p65 to DNA was dose-dependently reduced in nuclear lysates. A transcriptional deficit of NF-κB (nuclear factor kappa-light-chain-enhancer of activated B cells) was substantiated by the downregulation of cyclin D1 and of the anti-apoptotic Bcl2, in line with reduction in tumour cell proliferation and induction of apoptosis, respectively. The upregulation of p53 concomitant with an excess of ROS supported apoptosis. Thus, the anticancer activity of GP-2250 is a result of disruption of energy metabolism and inhibition of tumour promotion by NF-κB.
Collapse
Affiliation(s)
- Britta Majchrzak-Stiller
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Marie Buchholz
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Ilka Peters
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Daniel Waschestjuk
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Johanna Strotmann
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Philipp Höhn
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Stephan Hahn
- Department of Molecular Gastrointestinal Oncology, Ruhr-University Bochum, Bochum, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Department of General, Visceral and Vascular Surgery, Evangelische Kliniken Gelsenkirchen, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Gelsenkirchen, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | - Hanns Möhler
- Institute of Pharmacology, University of Zurich and Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| |
Collapse
|
5
|
Majchrzak-Stiller B, Buchholz M, Peters I, Strotmann J, Möhrke J, Zelichowski L, Oehlke L, Quensel C, Fein D, Höhn P, Müller T, Uhl W, Braumann C. Oxathiazinane derivatives display both antineoplastic and antibacterial activity: a structure activity study. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04799-8. [PMID: 37171614 PMCID: PMC10374762 DOI: 10.1007/s00432-023-04799-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/15/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE The Oxathiazinane substance class is characterized by a high diversity of chemical structures yet to be fully investigated. Our research group recently proved that the 1.4.5-oxathiazine-4.4-dioxide, known as substance GP-2250, possesses antineoplastic properties as shown on pancreatic carcinoma. This current study aims to gain insights into the structure and activity relationship of a series of different Oxathiazinanes regarding their antineoplastic activity and the potential correlation with antibacterial activity. We investigated the newly synthesized Oxathiazinane derivatives: 2255, 2256, 2287, 2289, 2293 and 2296 in comparison to GP-2250. METHODS The antineoplastic effect was evaluated in different cancer entities (breast, skin, pancreas and colon cancer cell lines) by viability, proliferation, and cell migration assays in vitro. Disc diffusion tests were performed on various bacteria strains to examine the antibacterial potential. Additionally, reactive oxygen species (ROS) assays were conducted to investigate mechanistic aspects. RESULTS The substances GP-2250, 2293, 2289 and 2296 not only showed antineoplastic activity in four different cancer entities but also antibacterial effects, as tested on multiple bacteria strains including MRSA (Methicillin-resistant Staphylococcus aureus). Furthermore, these substances also induced high ROS levels up to 110% in the treated cancer cell lines compared to untreated control cells. These results indicate a correlation between an antineoplastic capacity and antibacterial properties of these derivatives. Both activities appear to be ROS driven. The Oxathiazinane derivatives 2255, 2256 and 2287 lacked both, antineoplastic and antibacterial activity. CONCLUSION Thus, a comparable structure activity relationship became apparent for both the antineoplastic and antibacterial activity.
Collapse
Affiliation(s)
- B Majchrzak-Stiller
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany.
| | - M Buchholz
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - I Peters
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - J Strotmann
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - J Möhrke
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - L Zelichowski
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - L Oehlke
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - C Quensel
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - D Fein
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - P Höhn
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - T Müller
- Geistlich Pharma AG, Wolhusen, Switzerland
| | - W Uhl
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - C Braumann
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
- Department of General, Visceral and Vascular Surgery, Evangelische Kliniken Gelsenkirchen, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Gelsenkirchen, Germany
| |
Collapse
|
6
|
Buchholz M, Strotmann J, Majchrzak-Stiller B, Hahn S, Peters I, Horn J, Müller T, Höhn P, Uhl W, Braumann C. New Therapy Options for Neuroendocrine Carcinoma of the Pancreas—The Emergent Substance GP-2250 and Gemcitabine Prove to Be Highly Effective without the Development of Secondary Resistances In Vitro and In Vivo. Cancers (Basel) 2022; 14:cancers14112685. [PMID: 35681665 PMCID: PMC9179328 DOI: 10.3390/cancers14112685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Neuroendocrine carcinoma of the pancreas is a highly aggressive form of neuroendocrine tumor associated with poor survival and increasing occurrence. GP-2250 is an emergent substance showing antineoplastic properties, especially in combination with Gemcitabine. This study was the first to evaluate the antineoplastic effects of GP-2250 on pancreatic neuroendocrine carcinoma. The combination of GP-2250 and Gemcitabine showed highly synergistic effects in a cell culture model, as well as in mice, without the development of secondary resistances. These findings form the basis for further clinical evaluation of a highly promising combination therapy. Abstract Neuroendocrine carcinoma of the pancreas (pNEC) is an aggressive form of neuroendocrine tumor characterized by a rising incidence without an increase in survival rates. GP-2250 is an oxathiazinane derivate possessing antineoplastic effects, especially in combination with Gemcitabine on the pancreatic adenocarcinoma. The cytotoxic effects of the monotherapy of GP-2250 (GP-2250mono) and Gemcitabine (Gemmono), as well as the combination therapy of both, were studied in vitro using an MTT-assay on the QGP-1 and BON-1 cell lines, along with in vivo studies on a murine xenograft model of QGP-1 and a patient-derived xenograft model (PDX) of Bo99. In vitro, Gemmono and GP-2250mono showed a dose-dependent cytotoxicity. The combination of GP-2250 and Gemcitabine exhibited highly synergistic effects. In vivo, the combination therapy obtained a partial response in QGP-1, while GP-2250mono and Gemmono showed progressive disease or stable disease, respectively. In Bo99 PDX, the combination therapy led to a partial response, while the monotherapy resulted in progressive disease. No development of secondary resistances was observed, as opposed to monotherapy. This study was the first to evaluate the effects of the emerging substance GP-2250 on pNEC. The substance showed synergism in combination with Gemcitabine. The combination therapy proved to be effective in vitro and in vivo, without the development of secondary resistances.
Collapse
Affiliation(s)
- Marie Buchholz
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (J.S.); (B.M.-S.); (I.P.); (J.H.); (P.H.); (W.U.); (C.B.)
- Correspondence: ; Tel.: +49-234-509-6236
| | - Johanna Strotmann
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (J.S.); (B.M.-S.); (I.P.); (J.H.); (P.H.); (W.U.); (C.B.)
| | - Britta Majchrzak-Stiller
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (J.S.); (B.M.-S.); (I.P.); (J.H.); (P.H.); (W.U.); (C.B.)
| | - Stephan Hahn
- Department of Molecular Gastrointestinal Oncology, Ruhr-University Bochum, 44780 Bochum, Germany;
| | - Ilka Peters
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (J.S.); (B.M.-S.); (I.P.); (J.H.); (P.H.); (W.U.); (C.B.)
| | - Julian Horn
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (J.S.); (B.M.-S.); (I.P.); (J.H.); (P.H.); (W.U.); (C.B.)
| | | | - Philipp Höhn
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (J.S.); (B.M.-S.); (I.P.); (J.H.); (P.H.); (W.U.); (C.B.)
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (J.S.); (B.M.-S.); (I.P.); (J.H.); (P.H.); (W.U.); (C.B.)
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (J.S.); (B.M.-S.); (I.P.); (J.H.); (P.H.); (W.U.); (C.B.)
- Department of General, Visceral and Vascular Surgery, Evangelische Kliniken Gelsenkirchen, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, 45879 Gelsenkirchen, Germany
| |
Collapse
|
7
|
Abstract
BACKGROUND Late metastasizing into pancreatic tissue is a special hallmark of renal cell carcinomas (RCC). A very low prevalence leads to scarce data about therapy, prognosis and spreading pathways. The aim of the study was to analyze whether a high fat content in the pancreas facilitates RCC metastases formation. A model for density measurement of pancreatic tissue has been developed and evaluated. Pancreatic fat content was measured comparing Hounsfield units (HU) of CT scans. METHODS In a consecutive single centre retrospective database of 3600 patients with pancreatic resections, only 12 patients (0.3%) cases of RCC metastases in the pancreas were found. HU were measured in 3 pancreatic regions: head, body and tail in patients' CT scans. HU values were compared to a control population and results aligned with recent literature. RESULTS We revealed a prevalence of pancreatic metastases of RCC in 0.3% of cases. The formation of RCC in the pancreas occurred within 14 ± 5.6 years after initial diagnosis of RCC. 83.3% of the patients were alive after a follow-up period of up to 48 months. Clinical data analysis revealed an affinity for metastatic formation to lipomatous pancreas. This could be objectivized by HU analysis in CT scans. CONCLUSION Pancreatic metastases occur late after the first diagnosis of renal carcinoma and show an affinity for lipomatous pancreatic tissues. Due to its rarity in occurrence, multicentric studies are highly recommended to further analyze this correlation between fatty pancreas and RCC.
Collapse
Affiliation(s)
- T. Fahlbusch
- Department of General and Visceral Surgery, St. Josef-Hospital, University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - A. M. Luu
- Department of General and Visceral Surgery, St. Josef-Hospital, University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - C. Braumann
- Department of General and Visceral Surgery, St. Josef-Hospital, University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - C. Lukas
- Diagnostic and Interventional Radiology, St. Josef-Hospital, University Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - W. Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital, University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - B. M. Künzli
- Department of General and Visceral Surgery, St. Josef-Hospital, University Hospital, Ruhr-University Bochum, Bochum, Germany
- Department of Surgery, Kantonsspital Graubünden, Chur, Switzerland
| |
Collapse
|
8
|
Driouch J, Braumann C, Dehnst J, Ikram M, Alnammous G, Bausch D, Glatz T. [Results of the Limberg flap procedure in acute and chronic pilonidal abscesses]. Chirurg 2021; 93:182-189. [PMID: 34132822 PMCID: PMC8821484 DOI: 10.1007/s00104-021-01439-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 12/01/2022]
Abstract
Hintergrund In der Behandlung des Sinus pilonidalis werden unterschiedliche Therapiealgorithmen für den akuten sowie den chronischen Sinus pilonidalis empfohlen. Während sich beim chronischen Sinus pilonidalis ein einzeitiges Vorgehen als Exzision oder plastische Rekonstruktion nach Limberg oder Karydakis anbietet, ist die empfohlene Vorgehensweise beim akuten Pilonidalabszess zweizeitig. Ziel dieser Studie war es, die Ergebnisse der einzeitigen Operation mit Limberg-Plastik bei akutem Pilonidalabszess und chronischem Sinus pilonidalis bezogen auf Rezidive, Wundheilungsstörungen, stationärer Liegedauer sowie Patientenzufriedenheit zu vergleichen. Methoden Von 2009 bis 2014 wurden 39 Patienten in die prospektive Beobachtungsstudie eingeschlossen. 21 Patienten mit akutem Pilonidalabszess, 18 mit chronischem Sinus pilonidalis. Alle Patienten wurden einzeitig mittels Limberg-Rautenplastik operativ behandelt. Die Gruppen wurden in Bezug auf postoperative Komplikationsrate und Rezidivhäufigkeit miteinander verglichen. Ergebnisse Beide Gruppen waren im Wesentlichen vergleichbar. Die Analyse der postoperativen Ergebnisse zeigte eine vergleichbare Rate an Wundheilungsstörungen (10 % vs. 17 %, p = 0,647). In der Gruppe des akut abszedierten Sinus trat kein Rezidiv im Beobachtungszeitraum auf, während sich in der chronischen Gruppe 2 (11 %) Rezidive zeigten (p = 0,206). Diskussion Die Ergebnisse der Limberg-Plastik als einzeitige Therapie des Pilonidalabszesses sind mit denen beim chronischen Sinus pilonidalis vergleichbar. Es zeigt sich ein Trend zu einem geringeren Rezidivrisiko. Der Einsatz der Limberg-Plastik scheint daher auch in der akuten Infektsituation eine adäquate Therapieoption.
Collapse
Affiliation(s)
- Jamal Driouch
- Chirurgische Klinik - Allgemein- und Viszeralchirurgie, Gefäßchirurgie, Marien Hospital Herne - Universitätsklinikum, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland.
| | - C Braumann
- Klinik für Chirurgie, St. Josef Hospital Bochum, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - J Dehnst
- Klinik für Chirurgie, Paracelsus-Klinik Hemer, Breddestraße 22, 58675, Hemer, Deutschland
| | - M Ikram
- Klinik für Chirurgie, Paracelsus-Klinik Hemer, Breddestraße 22, 58675, Hemer, Deutschland
| | - G Alnammous
- Klinik für Chirurgie, Paracelsus-Klinik Hemer, Breddestraße 22, 58675, Hemer, Deutschland
| | - D Bausch
- Chirurgische Klinik - Allgemein- und Viszeralchirurgie, Gefäßchirurgie, Marien Hospital Herne - Universitätsklinikum, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland
| | - T Glatz
- Chirurgische Klinik - Allgemein- und Viszeralchirurgie, Gefäßchirurgie, Marien Hospital Herne - Universitätsklinikum, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland
| |
Collapse
|
9
|
Luu AM, Braumann C, Belyaev O, Janot-Matuschek M, Rudolf H, Praktiknjo M, Uhl W. Long-term survival after pancreaticoduodenectomy in patients with ductal adenocarcinoma of the pancreatic head. Hepatobiliary Pancreat Dis Int 2021; 20:271-278. [PMID: 33349608 DOI: 10.1016/j.hbpd.2020.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 12/02/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) has the worst prognosis of all malignant tumors due to unavailable screening methods, late diagnosis with a low proportion of resectable tumors and resistance to systemic treatment. Complete tumor resection remains the cornerstone of modern multimodal strategies aiming at long-term survival. This study was performed to investigate the overall rate of long-term survival (LTS) and its contributing factors. METHODS This was a retrospective single-center analysis of consecutive patients undergoing pancreaticoduodenectomy (PD) for PDAC between 2007 and 2014 at the St. Josef Hospital, Ruhr University Bochum, Germany. Clinical and laboratory parameters were assessed and evaluated for prediction of LTS with Cox regression analysis. RESULTS The overall rate of LTS after PD for PDAC was 20.4% (34/167). Median survival was 24 months regardless of adjuvant treatment. Carbohydrate antigen 19-9 levels, tumor grade, lymph vessel invasion, perineural invasion and reduced general condition were significantly associated with LTS in univariate analysis (P < 0.05). Serum levels of carbohydrate antigen 19-9, American Joint Committee on Cancer stage, tumor grade, abdominal pain, male, exocrine pancreatic insufficiency and duration of postoperative hospital stay were independent predictors of cancer survival in multivariable analysis. CONCLUSIONS Cancer related characteristics are associated with LTS in multimodally treated patients after curative PDAC surgery.
Collapse
Affiliation(s)
- Andreas Minh Luu
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, Bochum 44791, Germany.
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, Bochum 44791, Germany
| | - Orlin Belyaev
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, Bochum 44791, Germany
| | - Monika Janot-Matuschek
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, Bochum 44791, Germany
| | - Henrik Rudolf
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Universitaetsstrasse 105, Bochum 44789, Germany
| | - Michael Praktiknjo
- Department of Internal Medicine, University of Bonn, Venusberg-Campus 1, Bonn 53127, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, Bochum 44791, Germany
| |
Collapse
|
10
|
Luu AM, Belyaev O, Höhn P, Praktiknjo M, Janot M, Uhl W, Braumann C. Late recurrences of pancreatic cancer in patients with long-term survival after pancreaticoduodenectomy. J Gastrointest Oncol 2021; 12:474-483. [PMID: 34012641 PMCID: PMC8107632 DOI: 10.21037/jgo-20-433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/17/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Pancreatic cancer remains a relevant clinical problem due to poor prognosis. Even after curative pancreaticoduodenectomy tumor recurrences occur in up to 80%. Risk factors for postoperative tumor recurrences have been identified before, but data on risk factors for tumor recurrences in patients with long-term-survival is scarce. METHODS In this retrospective study consecutive long-term survival-patients (defined as at least 60 months survival) undergoing pancreaticoduodenectomy for pancreatic cancer from 2007-2014 were identified in the 2nd largest pancreatic surgery center in Germany. Clinical, pathohistological and laboratory values were analyzed to identify risk factors for tumor recurrence. RESULTS Thirty-four of one-hundred-sixty-seven patients were identified as long-term-survival-patients in the study period. Of those, 10 patients (29.4%) suffered from tumor recurrence. Lymph vessel invasion was identified as an independent risk factor (P=0.031, hazard ratio 13.127, 95% confidence interval: 1.270-135.698). Median postoperative time to tumor recurrence in long-term-survival-patients was 49 months. Overall survival after diagnosis of tumor recurrence was 33 months. 80% (N=8) of the patients were asymptomatic. Half of the patients (N=5) suffered from local disease, with 40% undergoing curative tumor resection. CA 19-9 levels were significantly elevated at 57 U/mL (normal <27 U/mL). CONCLUSIONS Tumor recurrence in long-term-survival-patients is typically asymptomatic. Especially long-term-survival-patients with lymph vessel invasion are more likely to develop tumor recurrence. Therefore, a structured follow-up program including CT-scans and CA 19-9 surveillance must be continued in all patients undergoing pancreaticoduodenectomy even in cases of long-term-survival.
Collapse
Affiliation(s)
- Andreas Minh Luu
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr - University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Orlin Belyaev
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr - University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Philipp Höhn
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr - University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | | | - Monika Janot
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr - University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr - University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr - University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| |
Collapse
|
11
|
Seidel D, Diedrich S, Herrle F, Thielemann H, Marusch F, Schirren R, Talaulicar R, Gehrig T, Lehwald-Tywuschik N, Glanemann M, Bunse J, Hüttemann M, Braumann C, Heizmann O, Miserez M, Krönert T, Gretschel S, Lefering R. Negative Pressure Wound Therapy vs Conventional Wound Treatment in Subcutaneous Abdominal Wound Healing Impairment: The SAWHI Randomized Clinical Trial. JAMA Surg 2021; 155:469-478. [PMID: 32293657 PMCID: PMC7160755 DOI: 10.1001/jamasurg.2020.0414] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Question Is negative pressure wound therapy (NPWT) an effective and safe treatment option for subcutaneous abdominal wound healing impairment (SAWHI) after surgery? Findings In the randomized clinical SAWHI study that included 507 adults, wounds were closed significantly faster and more often in the NPWT arm (36.1 days for 92 of 256 study participants) than with conventional wound treatment (39.1 days for 54 of 251 participants). The number of participants with wound-related adverse events was higher in the NPWT arm (48 of 234) than in the conventional wound treatment arm (27 of 201). Meaning For SAWHI after surgery, NPWT is an effective treatment alternative to conventional wound treatment but causes more wound-related adverse events. Importance Negative pressure wound therapy (NPWT) is an established treatment option, but there is no evidence of benefit for subcutaneous abdominal wound healing impairment (SAWHI). Objective To evaluate the effectiveness and safety of NPWT for SAWHI after surgery in clinical practice. Design, Setting, and Participants The multicenter, multinational, observer-blinded, randomized clinical SAWHI study enrolled patients between August 2, 2011, and January 31, 2018. The last follow-up date was June 11, 2018. The trial included 34 abdominal surgical departments of hospitals in Germany, Belgium, and the Netherlands, and 539 consecutive, compliant adult patients with SAWHI after surgery without fascia dehiscence were randomly assigned to the treatment arms in a 1:1 ratio stratified by study site and wound size using a centralized web-based tool. A total of 507 study participants (NPWT, 256; CWT, 251) were assessed for the primary end point in the modified intention-to-treat (ITT) population. Interventions Negative pressure wound therapy and conventional wound treatment (CWT). Main Outcomes and Measures The primary outcome was time until wound closure (delayed primary closure or by secondary intention) within 42 days. Safety analysis comprised the adverse events (AEs). Secondary outcomes included wound closure rate, quality of life (SF-36), pain, and patient satisfaction. Results Of the 507 study participants included in the modified ITT population, 287 were men (56.6%) (NPWT, 155 [60.5%] and CWT, 132 [52.6%]) and 220 were women (43.4%) (NPWT, 101 [39.5%] and CWT 119 [47.4%]). The median (IQR) age of the participants was 66 (18) years in the NPWT arm and 66 (20) years in the CWT arm. Mean time to wound closure was significantly shorter in the NPWT arm (36.1 days) than in the CWT arm (39.1 days) (difference, 3.0 days; 95% CI 1.6-4.4; P < .001). Wound closure rate within 42 days was significantly higher with NPWT (35.9%) than with CWT (21.5%) (difference, 14.4%; 95% CI, 6.6%-22.2%; P < .001). In the therapy-compliant population, excluding study participants with unauthorized treatment changes (NPWT, 22; CWT, 50), the risk for wound-related AEs was higher in the NPWT arm (risk ratio, 1.51; 95% CI, 0.99-2.35). Conclusions and Relevance Negative pressure wound therapy is an effective treatment option for SAWHI after surgery; however, it causes more wound-related AEs. Trial Registration ClinicalTrials.gov Identifier: NCT01528033
Collapse
Affiliation(s)
- Dörthe Seidel
- Institute for Research in Operative Medicine, University of Witten/Herdecke, Cologne, Germany
| | - Stephan Diedrich
- Department of General Surgery, Visceral, Thoracic and Vascular Surgery, Greifswald University Hospital, Greifswald, Germany
| | - Florian Herrle
- Department of Surgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Henryk Thielemann
- Department of General and Abdominal Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Frank Marusch
- Department of General and Visceral Surgery, Klinikum Ernst von Bergmann gemeinnützige GmbH, Potsdam, Germany
| | - Rebekka Schirren
- Department and Polyclinic of Surgery, Hospital Rechts der Isar -Technical University of Munich, München, Germany
| | - Recca Talaulicar
- Department of General, Visceral and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Tobias Gehrig
- Department of General and Visceral Surgery, GRN Klinik Sinsheim, Sinsheim, Germany
| | - Nadja Lehwald-Tywuschik
- Department of Surgery (A), Hospital of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Matthias Glanemann
- Department of General, Visceral, Vascular and Pediatric Surgery, Saarland University, Homburg, Germany
| | - Jörg Bunse
- Department of General and Visceral Surgery, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Martin Hüttemann
- Department of General and Visceral Surgery, Evangelisches Krankenhaus Oberhausen, Oberhausen, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, St Josef-Hospital Bochum, Bochum, Germany
| | - Oleg Heizmann
- Department of General, Visceral und Thoracic Surgery, Agaplesion Diakonieklinikum Rotenburg gemeinnützige GmbH, Rotenburg (Wümme), Germany
| | - Marc Miserez
- Department of Abdominal Surgery, University Hospitals Katholieke Universiteit Leuven, Leuven, Belgium
| | - Thomas Krönert
- Center for Vascular Medicine, Department of Vascular Surgery, Thüringen Kliniken Georgius Agricola, Saalfeld, Germany
| | - Stephan Gretschel
- Brandenburg Medical School,Department of General and Visceral Surgery, University Hospital Neuruppin, Neuruppin, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine, University of Witten/Herdecke, Cologne, Germany
| |
Collapse
|
12
|
Luu AM, Vogel SR, Braumann C, Praktiknjo M, Höhn P, Förster S, Janot M, Uhl W, Belyaev O. Risk factors for perforated marginal ulcers following pancreaticoduodenectomy and prospective analysis of marginal ulcer development. Gland Surg 2021; 10:739-750. [PMID: 33708556 DOI: 10.21037/gs-20-763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Perforated marginal ulcers (PMUs) are a feared long-term complication following pancreaticoduodenectomy (PD), which always require relaparotomy compared to marginal ulcers. Methods First, we performed a retrospective chart review for all patients who underwent PD from 2007-2016 to identify incidence and risk factors associated with PMUs. Second, we analyzed follow up gastroscopies in all patients undergoing PD from 2007-2011 to identify the overall incidence of marginal ulcers. Results A total of 725 patients underwent PD in the retrospective study period. 17 patients (2.3%) suffered from PMU at a median postoperative time of 13 months. These patients were significantly younger (median age: 49 vs. 62 years; P=0.02) and suffered most often from chronic pancreatitis (P<0.001). Smoking and alcohol consumption were significantly more common (P=0.01 and P=0.023). An elevated level of carcinoembryonic antigen and chronic pancreatitis were identified as independent risk factors. Overall, 373 patients were enrolled for prospective analysis. Marginal ulcers occurred in 5-5.9% over a postoperative period of 5 years. Conclusions Continuous treatment with proton-pump inhibitors for at least 5 years, immediate smoking cessation and follow-up gastroscopies are obligate for patients undergoing PD to avoid marginal ulcers and PMUs.
Collapse
Affiliation(s)
- Andreas Minh Luu
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
| | - Sina Rabea Vogel
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
| | - Michael Praktiknjo
- Department of Internal Medicine, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Philipp Höhn
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
| | - Sarah Förster
- Department of Pathology, University-Hospital Bergmannsheil, Bürkle de la Camp Platz 1, 44789 Bochum, Germany
| | - Monika Janot
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
| | - Orlin Belyaev
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
| |
Collapse
|
13
|
Luu AM, Braumann C, Uhl W, Janot-Matuschek M, Herzog T. Does autologous fibrin sealant (vivostat ©) reduce the incidence of postoperative pancreatic fistula after distal pancreatectomy? - a matched pairs analysis. Acta Chir Belg 2021; 121:16-22. [PMID: 31433745 DOI: 10.1080/00015458.2019.1658354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) is the most common complication following distal pancreatectomy. This retrospective study investigated the effects of autologous fibrin sealant (Vivostat©) in reducing the incidence of POPF after distal pancreatectomy. METHODS A matched pairs analysis was performed to compare the incidence of clinically relevant POPF of 41 patients who underwent a distal pancreatectomy with application of autologous fibrin sealant (Vivostat©) with a historical control group. RESULTS Clinically relevant POPF were present in 11 patients in the study group (27%) and in 13 patients in the control group (32%, p = .639). No patient of the study group required emergency angiographic treatment for postoperative hemorrhage due to POPF, whereas three patients were identified in the control group (7%, p = .079). CONCLUSIONS POPF cannot be prevented under treatment with autologous fibrin sealant (Vivostat©). We observed the tendency of a lower rate of postoperative pancreatic hemorrhage due to POPF. However, prospective randomized controlled studies are required.
Collapse
Affiliation(s)
- Andreas Minh Luu
- Department of Surgery, Katholisches Klinikum Bochum – St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Chris Braumann
- Department of Surgery, Katholisches Klinikum Bochum – St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Waldemar Uhl
- Department of Surgery, Katholisches Klinikum Bochum – St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Monika Janot-Matuschek
- Department of Surgery, Katholisches Klinikum Bochum – St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Torsten Herzog
- Department of Surgery, Katholisches Klinikum Bochum – St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| |
Collapse
|
14
|
Swanson T, Lázaro-Martínez JL, Braumann C, Kirchhoff JB, Gächter B, van Acker K. Ultrasonic-assisted wound debridement: report from a closed panel meeting. J Wound Care 2020; 29:128-135. [PMID: 32058848 DOI: 10.12968/jowc.2020.29.2.128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mechanical debridement can be considered as an alternative to surgical debridement if surgery is not available, or is considered impractical or too high risk. One form of selective mechanical debridement is ultrasonic-assisted wound (UAW) debridement. As the published evidence on this is limited, a closed international expert meeting was held to review the existing evidence base on it, present preliminary findings of research currently in progress and discuss individual cases selected from the clinical experts' own practice. The panel also explored the potential barriers to the implementation of UAW debridement and how these might be addressed. It concluded there is sufficient evidence that UAW debridement is an effective method of cleansing and debriding almost all hard-to-heal wounds. Patients who are most likely to benefit from it are not medically stable, on anticoagulants, unable to visit a hospital for wound treatment, and/or have wounds with a poor vascular supply or are close to critical structures. The panel also observed that UAW debridement can be used to prepare the wound for negative pressure wound therapy (NPWT) or as an adjunctive to it. Given the potential to experience pain during the procedure, the panel considered that patients will benefit from topical analgesia. The panel noted that health professionals, patients and visitors must be protected from the aerosolisation associated with UAW, to reduce risk of cross-contamination.
Collapse
Affiliation(s)
| | | | - Chris Braumann
- Senior Surgeon, St Josef-Hospital, Ruhr-University Bochum, Germany
| | | | - Bernd Gächter
- Senior Surgeon, Clinic for General, Trauma and Visceral Surgery, Hospital Oberengadin, Samedan, Switzerland.,Wound Care Centre, Minusio/Bellinzona, Ticino, Switzerland
| | - Kristien van Acker
- D-Foot International, Department of Diabetology and Endocrinology, CSF, Chimay, Belgium
| |
Collapse
|
15
|
Höhn P, Braumann C, Nöpel-Dünnebacke S, Munding J, Uhl W, Luu AM. Recurrence of Pancreatic Ductal Adenocarcinoma after Complete Histopathological Remission Caused by FOLFIRINOX. Visc Med 2020; 37:149-153. [PMID: 33981756 DOI: 10.1159/000509231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/08/2020] [Indexed: 02/03/2023] Open
Abstract
We previously reported 2 cases of pathologic complete response (pCR) of a pancreatic cancer (PC) following neoadjuvant FOLFIRINOX treatment. We now complete our report by a follow-up on both patients. Patient 1 achieved a disease-free survival of 12 months after initial resection until she developed a singular hepatic metastasis. Treatment by FOLFIRINOX and complete removal of the metastasis by atypical liver resection after 6 months allowed for another 12 months of disease control. After intra-abdominal tumor recurrence and development of intracerebral metastases, the patient died 34 months after primary diagnosis. Patient 2 developed hepatic tumor recurrence only 3 months after initial resection. However, treatment by FOLFIRINOX led to a stable disease for 27 months after resection and was followed by atypical liver resection of multiple segments. Six months later, another hepatic recurrence was suspected. Via next-generation sequencing (NGS) of the tumor genome, a deleterious mutation in the ataxia telangiectasia-mutated (ATM) gene, causing a BRCAness, was detected. After initial treatment by FOLFOX, maintenance therapy with the poly-ADP-ribose-polymerase (PARP) inhibitor olaparib was initiated. The patient is now alive for 54 months after initial diagnosis of metastasized pancreatic adenocarcinoma. Tumor recurrence is possible even after pCR of PC and remains challenging. In case of multifocal tumor recurrence, chemotherapy remains the standard treatment. Recently, genetic sequencing allows individualized treatments. In selected cases, highly specialized teams can offer a variety of therapeutic options leading to previously unseen clinical courses.
Collapse
Affiliation(s)
- Philipp Höhn
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Stefanie Nöpel-Dünnebacke
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Johanna Munding
- Institute of Pathology, Ruhr University Bochum, Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Andreas Minh Luu
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| |
Collapse
|
16
|
Braumann C, Buchholz M, Majchrzak - Stiller B, Hahn S, Uhl W, Kasi A, Mueller DT. Metabolism-based GP-2250 in combination with gemcitabine as a novel approach to pancreatic cancer: A mouse xenograft study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16750 Background: GP-2250, a novel oxathiazine derivative, displayed apoptotic cytotoxicity against various tumor cell lines but not normal cells. It was therefore tested whether its antineoplastic potential - alone or in combination – could be leveraged specifically against pancreatic cancer. Methods: GP-2250 is a cancer metabolism-based therapeutic. It depleted metabolic energy through inhibition of the enzyme GAPDH (glyceraldehyde-3-phosphate dehydrogenase) which is rate limiting for aerobic glycolysis. ATP was decreased in a time- and dose-dependent manner in pancreatic tumor cell lines and ROS was increased. Mitochondrial dysfunction was triggered by an increased expression of Bax and decreased expression of Bcl2, leading to apoptosis. Cytotoxicity of GP-2250 was ROS-dependent. It was blocked by N-acetylcysteine. Results: GP-2250 substantially increased the sensitivity of pancreatic tumor cells to various chemotherapeutics in particular to gemcitabine (Gem). At doses which were inactive or barely active per se, the combination of GP-2250 and Gem caused striking cytotoxicity in patient-derived primary tumor cells in vitro, pointing to a strong synergy between the two agents. This finding was substantiated in vivo by patient-derived xenograft (PDX) studies in nude mice. While GP-2250 and Gem, given as monotherapy (500 mg/kg and 50 mg/kg respectively, 2x/week), showed only a limited antineoplastic response, the combination treatment resulted in a significantly higher anti-tumor activity as shown in further PDX. Tumor regression was found in 5 out of 9 PDX based on RECIST criteria. Stable disease was reached in 3 of the remaining grafts. In 1 xenograft, which was unresponsive to Gem, the combination treatment nevertheless achieved a reduction in tumor growth which significantly exceeded that of GP-2250 monotherapy. Conclusions: GP-2250 is a novel cancer metabolism-based therapeutic. GP-2250, in combination with Gem, strongly reduces tumor growth in patient-derived xenografts exceeding by far the response to monotherapy. GP-2250 is being evaluated in a Phase I clinical trial in patients diagnosed with advanced pancreatic cancer (Clinical Trial NCT03854110).
Collapse
Affiliation(s)
- Chris Braumann
- FA für Chirurgie, Viszeralchirurgie/Spezielle Viszeralchirurgie/Proktologie, Rettungsmedizin, Bochum, Germany
| | | | | | - Stephan Hahn
- Molecular Gastrointestinal Oncology Department, Clinical Research Center (ZKF), Ruhr University Bochum, Bochum, Germany
| | - Waldemar Uhl
- Ruhr-University Bochum, St. Josef Hospital, Bochum, Germany
| | - Anup Kasi
- University of Kansas Cancer Center, Westwood, KS
| | | |
Collapse
|
17
|
Luu AM, Fahlbusch T, Munding J, Uhl W, Braumann C. The Unusual Suspects of the Pancreas-Understanding Pancreatic Acinar Cell Carcinomas and Adenomas. J Gastrointest Cancer 2020; 51:172-178. [PMID: 30953241 DOI: 10.1007/s12029-019-00231-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Acinar cell carcinomas (ACC) and adenomas (ACA) of the pancreas are rare entities. Sufficient knowledge about occurrence and prognosis is scarce. METHODS A retrospective chart review of our database was performed for all patients who had undergone pancreatic surgery between 2006 and 2018. Results were compared to recent literature findings. RESULTS Nine patients were diagnosed with ACC and four patients with ACA of the pancreas in the study period. ACC patients were older and more often male than patients of the ACA group. ACC were mainly localized in the pancreatic head, whereas ACA were more often found in the distal pancreas. Tumor markers are not necessarily elevated, even in case of malignancy. CONCLUSIONS ACC and ACA are very rare pancreatic tumors. Both entities account for less than 1% of all pancreatic neoplasms. Diagnosis is challenging due to unspecific radiologic features and clinical symptoms. Nevertheless, a patient complaining of abdominal discomfort and an unclear hypodense pancreatic lesion should undergo surgical exploration.
Collapse
Affiliation(s)
- Andreas Minh Luu
- Department of General and Visceral Surgery, St. Josef-Hospital, University Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Tim Fahlbusch
- Department of General and Visceral Surgery, St. Josef-Hospital, University Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.
| | - Johanna Munding
- Department of Pathology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-University Bochum, Bürkle de la Camp Platz 1, 44789, Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital, University Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef-Hospital, University Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| |
Collapse
|
18
|
Luu AM, Krasemann L, Fahlbusch T, Belyaev O, Janot-Matuschek M, Uhl W, Braumann C. Facing the surgeon's nightmare: Incidence and management of postoperative pancreatic fistulas grade C after pancreaticoduodenectomy based on the updated definition of the International Study Group of Pancreatic Surgery (ISGPS). J Hepatobiliary Pancreat Sci 2020; 27:171-181. [PMID: 31951086 DOI: 10.1002/jhbp.713] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/01/2019] [Accepted: 12/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Postoperative pancreatic fistulas (POPF) grade C represent a rare but feared complication following pancreaticoduodenectomy (PD). They can contribute significantly to postoperative morbidity and mortality. METHODS We performed a retrospective chart review for all patients who had undergone pancreatic head resection between 2007 and 2016 to identify those who suffered from POPF grade C according to the updated definition of the International Study Group of Pancreatic Surgery (ISGPS). RESULTS A total of 722 patients underwent PD. Twenty-three patients (3.19%) developed a POPF grade C. Cardiovascular diseases, soft pancreatic texture and main pancreatic duct diameter were identified as risk factors (P < .05). Reoperation was necessary in all affected patients on postoperative day 12 ± 9 on average. Mortality was significantly associated with POPF grade C (P < .05) being present in 39.1% (9/23). CONCLUSIONS POPF grade C after PD remains a serious complication with a high level of morbidity and mortality. Surgical treatment is the sole curative therapy and thus the treatment of choice.
Collapse
Affiliation(s)
- Andreas Minh Luu
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Lukas Krasemann
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Tim Fahlbusch
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Orlin Belyaev
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Monika Janot-Matuschek
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
19
|
Abstract
Background: Pancreatic cancer is a fatal disease most often diagnosed at an advanced stage. Most patients already suffer from irresectable tumor or distant metastases being most commonly found in the liver or the lung. However, cerebral metastases occur extremely rare.Methods: We performed a retrospective analysis of our database to identify all patients diagnosed with pancreatic cancer and cerebral metastases who underwent surgical treatment in our department from January 2004 to November 2016.Results: Only 0.2% (4 of 2492) were diagnosed with cerebral metastases. Two patients had surgical resection of the cerebral metastases. One patient underwent palliative radiation therapy and the fourth patient received only palliative therapy. Mean interval between initial diagnosis and development of brain metastases was 8.5 months (range 1-20). Mean survival period after diagnosis of brain metastases was 4.75 months (range 1-10).Conclusions: Cerebral metastases of pancreatic cancer occur extremely rare. They are associated with an advanced tumor stage, commonly liver and lung metastases. All patients presenting with neurological symptoms, multifocal metastases, and significantly elevated CA 19-9 levels are suspicious of sustaining cerebral metastases and should undergo brain imaging.
Collapse
Affiliation(s)
- Andreas Minh Luu
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Beat Künzli
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Philipp Hoehn
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Johanna Munding
- Department of Pathology, University-Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Carsten Lukas
- Department of Radiology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
20
|
Höhn P, Braumann C, Freiburger M, Koplin G, Dubiel W, Luu AM. Anti-tumorigenic Effects of Emodin and Its' Homologue BTB14431 on Vascularized Colonic Cancer in a Rat Model. Asian Pac J Cancer Prev 2020; 21:205-210. [PMID: 31983185 PMCID: PMC7294024 DOI: 10.31557/apjcp.2020.21.1.205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE New drugs for cancer treatment are being sought worldwide. Therapeutic agents derived from natural substances can provide cost-efficient options. We evaluated the effect of emodin, an active natural anthraquinone derivate, and it's in-silico homologue the novel substance BTB14431 in vivo. METHOD CC-531 colon cancer cells were implanted intraperitoneal (ip) and subcutaneous (sc) in 100 WAG/Rij rats. 28 days after tumor cell implantation, solid cancers were treated for 7 days by varying doses of BTB14431 (0.3 mg/kg body weight; 1.7 mg/kg) or emodin (2.5 mg/kg; 5 mg/kg). Treatment was applied either via an intravenous (iv) port catheter or by ip injection. Saline solution served as control. 21 days after final dose all animals were euthanized and ip tumor weight, sc tumor weight and animal body weight (bw) were determined by autopsy. Significant lower total tumor weight occurred after iv treatment with low dose BTB14431 (6.8 g; 90% confidence interval (CI) 5.3 - 8.2 g; p ≤ 0.01) and also low and high concentrations of emodin (9.4 g; CI 7.9 - 10.7 g; p ≤ 0.01 and 8.3 g; CI 7.6 - 9.3; p ≤ 0.01). Iv treatment by high dose BTB14431 did not lead to a decline in tumor weight. High dose ip treatment by emodin led to a lower overall (11.1 g; CI 10.1 - 13.8 g; p ≤ 0.01) and ip tumor weight (8.6 g; CI 6 - 10.4 g; p ≤ 0.01). Sc tumor weight was not affected. All other ip treatments did not result in changes of combined, ip or sc tumor weight. Bw decreased during iv treatment in all animals and increased after treatment was completed. Regain of bw was stronger in animals receiving low dose emodin. CONCLUSION Our study shows promising anti-cancer properties of BTB14431 and supports the evidence regarding emodin as a natural antitumorigenic agent. Optimal dosing of iv emodin and especially BTB 14431 for maximal efficacy remains unclear and should be a subject of further research. <br />.
Collapse
Affiliation(s)
- Philipp Höhn
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Maria Freiburger
- Private veterinary practice of Maria Freiburger, Lehesten, Germany
| | - Gerold Koplin
- Clinic for Minimal Invasive Surgery (MIC), Berlin, Germany
| | - Wolfgang Dubiel
- School of Pharmaceutical Sciences, Xiamen University, Xiang'an South Road, Xiamen 361102, China.,Institute of Experimental Internal Medicine, Medical Faculty, Otto von Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Andreas Minh Luu
- Department of General and Visceral Surgery, Division of Molecular and Clinical Research St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
21
|
Abstract
Modified single-loop reconstruction in pancreaticoduodenectomy separates pancreatic secretion from bile. It is performed in cases of high-risk pancreatic remnants to reduce the severity of postoperative pancreatic fistulas and moreover the overall postoperative morbidity. This reconstruction technique is characterized by an extra-long jejunal loop for the construction of the pancreaticojejunostomy and hepaticojejunostomy. The longer distance between these anastomoses and an additional jejuno-jejunostomy between the afferent and efferent limb of the hepaticojejunostomy separate the fluids and prevent backflow of bile towards the pancreaticojejunostomy. Thus, the secretions cannot activate each other and aggravate an existing anastomotic leakage. We observed a reduced rate of severe postoperative pancreatic fistulas after modified single-loop reconstruction compared to conventional single loop reconstruction. The technique is easy to perform, safe, and less time-consuming than a traditional double-loop reconstruction.
Collapse
Affiliation(s)
- Andreas M Luu
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum
| | - Ilgar Aghalarov
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum
| | - Orlin Belyaev
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum;
| |
Collapse
|
22
|
Horch RE, Braumann C, Dissemond J, Lehner B, Hirche C, Woeste G, Wozniak G, Wetzel-Roth W, Willy C. [Correction: Use of Negative Pressure Wound Therapy with Instillation and Dwell Time for Wound Treatment - Results of an Expert Consensus Conference]. Zentralbl Chir 2019; 144:152. [PMID: 30978761 DOI: 10.1055/a-0881-4595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Raymund E Horch
- Plastisch- und Handchirurgische Klinik, Universitätsklinikum Erlangen, Deutschland
| | - Chris Braumann
- Klinik für Allgemein- und Viszeralchirurgie, Katholisches Klinikum Bochum - St. Josef Hospital, Deutschland
| | - Joachim Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Deutschland
| | - Burkhard Lehner
- Sektion Orthopädische Onkologie und Klinik für Orthopädie und Unfallchirurgie, Heidelberg, Deutschland
| | - Christoph Hirche
- Klinik für Unfallchirurgie und Orthopädie, Luftrettungszentrum Rettungshubschrauber Christoph 5, Klinik für Unfallchirurgie an der Ruprecht-Karls-Universität Universität Heidelberg, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Deutschland
| | - Guido Woeste
- Allgemein- und Viszeralchirurgie, Agaplesion Elisabethenstift gGmbH, Darmstadt, Deutschland
| | - Gernold Wozniak
- Klinik für Gefäßchirurgie, Knappschaftskrankenhaus Bottrop GmbH, Deutschland
| | - Walter Wetzel-Roth
- Chirurgie und Gefäßchirurgie, Wertachkliniken KH Schwabmünchen, Buchloe, Deutschland
| | | |
Collapse
|
23
|
Luu AM, Hoehn P, Vogel SR, Reinacher-Schick A, Munding J, Uhl W, Braumann C. Pathologic Complete Response of Pancreatic Cancer following Neoadjuvant FOLFIRINOX Treatment in Hepatic Metastasized Pancreatic Cancer. Visc Med 2019; 35:387-391. [PMID: 31934588 DOI: 10.1159/000497827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/08/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction Pancreatic cancer is a lethal disease and often asymptomatic. Therefore, it is most often diagnosed at an advanced stage. The standard approach in a metastasized tumor stage is palliative chemotherapy. However, the prognosis remains extremely poor. Case Report We present the case of a patient who was diagnosed with a cancer of the head of the pancreas with hepatic metastases. After receiving palliative intended chemotherapy with the FOLFIRINOX regimen, staging computed tomography revealed the disappearance of the liver metastases and local resectability of the pancreatic head tumor. The patient underwent an uneventful Whipple's procedure. Surprisingly, pathohistological investigation revealed a complete pathological response. Conclusion Pathological complete response after FOLFIRINOX treatment in hepatic metastasized pancreatic cancer is extremely rare. It enables surgical resection and increases the survival rate significantly.
Collapse
Affiliation(s)
- Andreas Minh Luu
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Philipp Hoehn
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Sina Rabea Vogel
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | | | - Johanna Munding
- Institute of Pathology, University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| |
Collapse
|
24
|
Luu AM, Lutz T, Uhl W, Braumann C. Pancreaticogastric Fistula Due to Infiltration of a Mixed Type Intrapapillary Mucinous Neoplasia of the Pancreas. J Gastrointest Surg 2019; 23:379-380. [PMID: 29845567 DOI: 10.1007/s11605-018-3823-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/15/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND A 68-year-old asymptomatic patient was incidentally diagnosed with an intraductal papillary mucinous neoplasia (IPMN) of the pancreas with a pancreaticogastric fistula. He had a history of a right sided nephrectomy due to a renal cell carcinoma 9 years before. The patient underwent an uneventful total pancreatectomy and wedge resection of the stomach. METHODS The patient's medical history was studied and compared to recent literature via PubMed. RESULTS Pathohistological evaluation confirmed a mixed type IPMN of an intestinal subtype with pancreaticogastric fistula. CONCLUSION Pancreaticogastric fistula due to benign IPMN is extremely rare. Surgical resection including wedge resection of the stomach is the treatment of choice.
Collapse
Affiliation(s)
- Andreas Minh Luu
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany.
| | - Theodor Lutz
- Department of Radiology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef Hospital, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| |
Collapse
|
25
|
Horch R, Braumann C, Dissemond J, Lehner B, Hirche C, Woeste G, Wozniak G, Wetzel-Roth W, Willy C. Einsatz der Vakuuminstillationstherapie für die Wundbehandlung – Ergebnis einer Expertenkonsensuskonferenz. Zentralbl Chir 2018; 143:609-616. [DOI: 10.1055/a-0713-0517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
ZusammenfassungDas Spülen von Wunden mit einer Lösung zur Wundreinigung ist seit Langem ein anerkannter Eckpfeiler in der Wundbehandlung als Mittel zur Entfernung von Zelltrümmern und Oberflächenpathogenen in Wundexsudaten. In Kombination mit dem chirurgischen Débridement und einer lokalen Vakuumtherapie kann sie das Fortschreiten von der entzündlichen zur proliferativen Phase der Wundheilung erleichtern. Verfahren der topischen Vakuumtherapie mit Instillation und einer definierten Einwirk- bzw. Verweilzeit von topischen Lösungen unter zyklischer Kompression und Dekompression mit Schaumverbänden (Negative Pressure Wound Therapy with instillation and dwell time = NPWTi-d) können Rückstände entfernen, die ansonsten hemmend auf den Heilungsprozess wirken. Gleichzeitig helfen sie, die bakterielle Keimbelastung in kontaminierten oder infizierten Wunden zu verringern. Nachdem diese Technik nun kommerziell verfügbar und zunehmend verbreitet ist, wurden im Rahmen eines Konsensusmeetings durch eine interdisziplinäre Expertenkommission Empfehlungen zur Anwendung und zu den klinischen Indikationen erarbeitet. Auch wenn die Evidenzstufe von Expertenmeinungen einen geringeren Level besitzt, können allgemein gültige Richtlinien für einen sicheren und effizienten Einsatz von NPWTi-d ausgesprochen werden, die dem klinisch tätigen Arzt als Handlungsempfehlung dienen können. Die daraus abgeleiteten Konsensusempfehlungen umfassen basierend auf dem Stand der aktuellen wissenschaftlichen Datenlage die Ziele der Behandlung, die Anwendungsmodalitäten die Indikationsstellung bei verschiedenen Wunden einschließlich eventueller Kontraindikationen, Therapieeinstellungen sowie die Verwendung topischer Instillationslösungen, deren Volumen und Verweildauer (dwell time), die optimale Behandlungsdauer und zukünftige Weiterentwicklungen der NPWTi-d.
Collapse
Affiliation(s)
- Raymund Horch
- Plastisch- und Handchirurgische Klinik, Universitätsklinikum Erlangen, Deutschland
| | - Chris Braumann
- Klinik für Allgemein- und Viszeralchirurgie, Katholisches Klinikum Bochum – St. Josef Hospital, Deutschland
| | - Joachim Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Deutschland
| | - Burkhard Lehner
- Sektion Orthopädische Onkologie und Klinik für Orthopädie und Unfallchirurgie, Heidelberg, Deutschland
| | - Christoph Hirche
- Klinik für Unfallchirurgie und Orthopädie, Luftrettungszentrum Rettungshubschrauber Christoph 5, Klinik für Unfallchirurgie an der Ruprecht-Karls-Universität Universität Heidelberg, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Deutschland
| | - Guido Woeste
- Allgemein- und Viszeralchirurgie, Agaplesion Elisabethenstift gGmbH, Darmstadt, Deutschland
| | - Gernold Wozniak
- Klinik für Gefäßchirurgie, Knappschaftskrankenhaus Bottrop GmbH, Deutschland
| | - Walter Wetzel-Roth
- Chirurgie und Gefäßchirurgie, Wertachkliniken KH Schwabmünchen, Buchloe, Deutschland
| | | |
Collapse
|
26
|
Braumann C, Müller V, Knies M, Aufmesser B, Schwenk W, Koplin G. Complications After Ostomy Surgery: Emergencies and Obese Patients are at Risk—Data from the Berlin OStomy Study (BOSS). World J Surg 2018; 43:751-757. [DOI: 10.1007/s00268-018-4846-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
27
|
Künzli BM, Spohnholz J, Braumann C, Shrikhande SV, Uhl W. Clinical Impact of Iatrogenic Small Bowel Perforation Secondary to Laparoscopic Cholecystectomy: A Single-center Experience. Surg Laparosc Endosc Percutan Tech 2018; 28:309-313. [PMID: 30067585 DOI: 10.1097/sle.0000000000000561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Bowel, vascular, and biliary injuries during laparoscopic cholecystectomy (LC) have to be addressed with high priority. The focus of this study was on small bowel injury (SBI) and its impact on clinical management. METHODS We report 5 cases of SBI in a retrospective database of 2062 consecutive LC between January 2004 and December 2017. RESULTS We report isolated iatrogenic SBI in 0.24% (5 of 2062) after LC. We identified 3 cases with SBI associated with the technique of Hasson or related problems with intraoperative relaxation toward the end of the LC. All 5 patients needed at least 1 reoperation. There was no mortality in this series and all patients with iatrogenic SBI got discharged from the clinic in good health. Nevertheless, 3 of 5 patients (60%) with SBI filed a law suit. CONCLUSIONS Isolated iatrogenic SBI is a rare but dreaded complication after LC with high impact on patient's health and prone for medicolegal claims. Strict precaution on thorough relaxation throughout the operation, meticulous handling of closing technique of the fascial layer and "eternal vigilance" are mandatory to reduce risks of SBI after LC.
Collapse
Affiliation(s)
- Beat M Künzli
- Department of Surgery, University Hospital Bochum, Bochum, Germany
| | | | - Chris Braumann
- Department of Surgery, University Hospital Bochum, Bochum, Germany
| | | | - Waldemar Uhl
- Department of Surgery, University Hospital Bochum, Bochum, Germany
| |
Collapse
|
28
|
Abstract
OBJECTIVE To evaluate the safety and performance of a gelling fibre dressing, with respect to wound exudate management, maceration and periwound skin conditions. METHOD Complex (non-healing) surgical or chronic wounds healing by secondary intention were treated with a gelling fibre dressing (Biosorb, Acelity) as part of a prospective, two-centre case series product evaluation study. Dressing performance was evaluated at each change, and weekly for up to four weeks or until the wound healed, if this was in less than four weeks. The main outcome measure was dressing performance, wound bed and periwound skin condition. RESULTS A total of 15 patients, aged 26-87 years, were enrolled; 10 patients (66.7%) presented with chronic wounds including venous leg ulcers (VLUs), arterial leg ulcer, one mixed leg ulcer, pressure ulcer (PU), and diabetic foot ulcers (DFUs). The remaining wounds (33.3%) were postsurgical complex wounds healing by secondary intention, located in the upper leg, foot, abdomen, and sacrum. Mean wound area was 22.6±36.6cm2 (range: 1.3-144.0cm2). Treated wounds showed complete granulation in eight (53.0%) wounds, 75% granulation coverage in two (13.3%) wounds, 50% coverage in three (20.3%), and 25% coverage in two (13.3%) wounds. Patients evaluated the dressing effectiveness as 'excellent' or 'very good' in 45% of cases, 'moderate' in 45%, and 'poor' in 10% of cases. Results of Visual Analogue Scale (VAS) showed 70% of patients rated their pain as 'low' and 30% as 'moderate' at dressing removal. Clinicians' evaluation of dressing ability to absorb and retain wound exudate was rated 'excellent' or 'very good' in 80% of cases, and moderate in 20% and poor in 10% of cases. Overall, clinicians' impression of the dressing performance was reported as 'excellent' or 'very good' in 80% of cases and 'moderate' in 20% of cases. No patient had to be removed from the study due to adverse events directly related to the dressing or its performance. CONCLUSION These clinical findings suggest the new gelling fibre dressing to be safe and effective in wound treatment of complex (non-healing) surgical or chronic wounds, to manage exudate effectively, and to optimise the conditions of wounds healing by secondary intention.
Collapse
Affiliation(s)
- Nicola Ivins
- Clinical Research Director; Welsh Wound Innovation Centre, Rhodfa Marics, Pontyclun, Wales
| | - Chris Braumann
- Clinic for General and Visceral Surgery, St. Josef-Hospital, Ruhr University Bochum, Germany
| | - Jan-Birger Kirchhoff
- Clinic for General and Visceral Surgery, St. Josef-Hospital, Ruhr University Bochum, Germany
| | - Uhl Waldemar
- Clinic for General and Visceral Surgery, St. Josef-Hospital, Ruhr University Bochum, Germany
| | - Nia J Jones
- Welsh Wound Innovation Centre, Rhodfa Marics, Pontyclun, Wales
| |
Collapse
|
29
|
Höhn P, Braumann C, Uhl W, Luu AM. Riddle Me This: Acalculous Cholecystitis as an Unusual Complication of Immunoglobulin M Negative Mononucleosis. Cureus 2018; 10:e2505. [PMID: 29930883 PMCID: PMC6007444 DOI: 10.7759/cureus.2505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Infectious mononucleosis is a common disease of the adolescent caused by the Epstein-Barr virus (EBV). We present a rare case of a male adult with acalculous cholecystitis due to infectious mononucleosis. A correct diagnosis was challenging due to a false negative antibody test. Laboratory values were significant for a marked lymphocytosis and an early Immunoglobulin G (IgG) response without initial Immunoglobulin M (IgM) elevation. However, IgM antibodies were elevated two weeks later. Symptoms resolved quickly under symptomatic therapy. Antibody level patterns in asplenic patients with infectious mononucleosis are characterized by an atypical course with a delayed rise in IgM antibodies, which complicates the correct diagnosis of an EBV-induced acalculous cholecystitis.
Collapse
Affiliation(s)
- Philipp Höhn
- Department of General and Visceral Surgery, Katholisches Klinikum Bochum - St. Josef Hospital, Ruhr University Bochum
| | - Chris Braumann
- Department of General and Visceral Surgery, Katholisches Klinikum Bochum - St. Josef Hospital, Ruhr University Bochum
| | - Waldemar Uhl
- Department of General and Visceral Surgery, Katholisches Klinikum Bochum - St. Josef Hospital, Ruhr University Bochum
| | - Andreas M Luu
- Department of General and Visceral Surgery, Katholisches Klinikum Bochum - St. Josef Hospital, Ruhr University Bochum
| |
Collapse
|
30
|
Luu AM, Herzog T, Hoehn P, Reinacher-Schick A, Munding J, Uhl W, Braumann C. FOLFIRINOX treatment leading to pathologic complete response of a locally advanced pancreatic cancer. J Gastrointest Oncol 2018; 9:E9-E12. [PMID: 29755782 DOI: 10.21037/jgo.2018.01.07] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Pancreatic cancer (PC) is a lethal disease with a poor prognosis. It is typically asymptomatic and therefore most often diagnosed at an advanced stage. A primary unresectable PC can become resectable in case of tumor regression turning palliative into neoadjuvant therapy. We present a 67-year old female patient who was diagnosed with a locally advanced adenocarcinoma of the pancreatic head. After receiving palliative intended chemotherapy with the FOLFIRINOX regimen, staging computed tomography revealed local resectability of the pancreatic head tumor. The patient underwent an uneventful total pancreatectomy. Pathohistological investigation revealed a pathologic complete response (pCR). pCR after FOLFIRINOX treatment in primary unresectable PC is extremely rare. It might enable surgical resection and can increase the survival rate.
Collapse
Affiliation(s)
- Andreas Minh Luu
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Torsten Herzog
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Philipp Hoehn
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | - Johanna Munding
- Institute of Pathology, University-Hospital Bergmannsheil, Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
31
|
Luu AM, Meurer K, Herzog T, Uhl W, Braumann C. Diagnostic double strike in the emergency room - two cases of complete pancreatic ruptures due to bicycle handlebar injuries on two consecutive days. J Med Case Rep 2018; 12:85. [PMID: 29576017 PMCID: PMC5868062 DOI: 10.1186/s13256-018-1594-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/26/2018] [Indexed: 12/26/2022] Open
Abstract
Background Pancreatic injuries are rare in cases of blunt abdominal trauma and therefore easily misdiagnosed at time of hospital admission. They are associated with a significantly elevated morbidity and lethality. Bicycle handlebar injuries are the most common cause of pancreatic trauma in children and adolescents. Case presentation We report two cases of a 23-year-old Caucasian woman and a 15-year-old Caucasian boy who presented to our clinic with a similar history of a bicycle accident on 2 consecutive days. Both suffered from a fall from a bicycle with bicycle handlebar injury 4 and 6 days prior to admission in our clinic. Emergency distal pancreatectomies were performed in both cases. Conclusions Pancreatic injuries must be highly suspected in bicycle handlebar injuries, even if amylase/lipase levels or ultrasound findings seem unremarkable. The best initial strategies are early computed tomography and a quick referral to a level 1 trauma center. Distal pancreatectomy is the treatment of choice in cases of complete rupture of the pancreatic body.
Collapse
Affiliation(s)
- A M Luu
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr - University Bochum, Gudrunstr. 56, 44791, Bochum, Germany.
| | - K Meurer
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr - University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - T Herzog
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr - University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - W Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr - University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - C Braumann
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr - University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| |
Collapse
|
32
|
Braumann C, Koplin G, Geier C, Höhn P, Pohlenz J, Dubiel W, Rogalla S. Dose-dependent role of novel agents emodin and BTB14431 in colonic cancer treatment in rats. Acta Chir Belg 2017; 117:376-384. [PMID: 28669313 DOI: 10.1080/00015458.2017.1341145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND BTB14431 is an in silico homolog to emodin. Both were found to possess anti-tumor effects in vitro. The aim of this work was to analyze the tumor suppressing effects of both molecules in an intraperitoneal (ip) and intravenous (iv) treated rat model (WAG-Rij). METHODS A tumor cell suspension (CC531) was applied at the cecum after laparotomy and at the back. The rats where treated twice a day over 1 week with BTB14431, emodin and isotone sodium chloride solution (control). Treatment was applied iv or ip in a variety of dosages. Peripheral blood samples were taken before tumor application and on day 7. Twenty-one days after the last day of therapy animals were euthanized and tumor growth was evaluated. RESULTS Data showed an insignificant decrease of tumor growth after iv and ip treatment with low doses of BTB14431 and emodin. Differential blood analysis showed apoptosis. Increased doses of emodin clearly raised mortality rate. CONCLUSIONS Apoptosis was verified but no tumor-suppressing effects could be observed for iv and ip treatment with both agents in contrast to in vitro studies in our model. Establishing a successful ip treatment model for emotion and BTB14331 requires further studies.
Collapse
Affiliation(s)
- Chris Braumann
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Gerold Koplin
- Department of General and Visceral Surgery, Charité – Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | | | - Philipp Höhn
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Jana Pohlenz
- Department of Veterenary Medicine, Sabinensteig 15, Berlin, Germany
- Department of General, Visceral, Vascular and Thoracic Surgery, Charité, Medical University, Berlin, Germany
| | - Wolfgang Dubiel
- Department of General and Visceral Surgery/Division of Molecular Biology, Charité – Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Stephan Rogalla
- Department of Pediatrics, Molecular Imaging Program at Stanford (MIPS), James H. Clark Center, Stanford, CA, USA
| |
Collapse
|
33
|
Abstract
Background Von Hippel-Lindau (VHL) disease may occur at various localisations which can be both intra- and extrapancreatic as well as challenging to diagnose by medical imaging. Case Report A positron emission tomography/magnetic resonance imaging in a 40-year-old woman was performed to monitor a haemangioblastoma. Additionally, it showed findings which were considered to be a pancreatic neuroendocrine tumour (pNET) and retroumbilical metastasis. The suspected metastasis was laparoscopically resected; however, pathological evaluation did not lead to a clear categorisation. Consequently, the pancreatic head was resected in which a pNET and various acinar cell cystadenomas were found. Conclusion Diagnostic and therapy of advanced VHL disease can be difficult; if in doubt, a surgical approach may establish clarity.
Collapse
Affiliation(s)
- Tim Fahlbusch
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
34
|
Höhn P, Buchholz M, Majchrzak B, Uhl W, Braumann C, Chromik AM. The Physiological Incubation Biosimulator (PIBS): An Improved Ex Vivo Experimental Setup for the Mechanical Stability of Biological Sealants in Surgical Procedures. Surg Innov 2017; 24:214-222. [PMID: 28492352 DOI: 10.1177/1553350617697181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tissue-bound fibrin sealants are used in a wide array of surgical procedures. The microenvironmental interaction between sealant and application site is often poorly evaluated due to a lack of suitable experimental models. METHODS A physiological incubation biosimulator (PIBS) was developed to test biological sealants in an ex vivo setup under physiological conditions comparable to the microenvironment at application site (temperature, humidity, pressure). PIBS was validated by a study on the effectiveness of TachoSil for leak closure at pancreatic resection sites. Defined defects in a thoracic membrane of porcine origin were sealed by TachoSil. Integrity of the sealing was tested in the presence of active pancreatic fluid over 60 minutes. Heat-inactivated pancreatic fluid and electrolyte solution served as controls. The time to leakage was recorded and experimental groups were analyzed by Kaplan-Meier analysis. RESULTS PIBS produced reliable results. TachoSil lead to a leakage rate of 96% after incubation with active pancreatic fluid (p = 34), which was significantly higher compared with heat-inactivated pancreatic fluid (p = 34, 52%) or electrolyte solution (p = 20, 19%). CONCLUSION PIBS is an effective tool to evaluate microenvironmental effects on the adhesive strength of biomaterials. Tissue sealing effect of TachoSil is diminished in a "pancreatic" microenvironment rich with pancreatic enzymes. Our results might therefore explain the reason of the findings of randomized controlled trials recently published on this subject.
Collapse
Affiliation(s)
- Philipp Höhn
- 1 St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Marie Buchholz
- 1 St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | - Waldemar Uhl
- 1 St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Chris Braumann
- 1 St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | | |
Collapse
|
35
|
Buchholz M, Majchrzak-Stiller B, Hahn S, Vangala D, Pfirrmann RW, Uhl W, Braumann C, Chromik AM. Innovative substance 2250 as a highly promising anti-neoplastic agent in malignant pancreatic carcinoma - in vitro and in vivo. BMC Cancer 2017; 17:216. [PMID: 28340556 PMCID: PMC5366103 DOI: 10.1186/s12885-017-3204-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/17/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Former studies already revealed the anti-neoplastic properties of the anti-infective agent Taurolidine (TRD) against many tumor species in vitro and in vivo. Its anti-proliferative and cell death inducing capacity is largely due to its main derivative Taurultam (TRLT). In this study it could be demonstrated, that substance 2250 - a newly defined innovative structural analogue of TRLT - exhibits an anti-neoplastic effect on malignant pancreatic carcinoma in vitro and in vivo. METHODS The anti-neoplastic potential of substance 2250 as well as its mode of action was demonstrated in extensive in vitro analysis, followed by successful and effective in vivo testings, using xenograft models derived from established pancreatic cancer cell lines as well as patient derived tissue. RESULTS Our functional analysis regarding the role of oxidative stress (ROS) and caspase activated apoptosis showed, that ROS driven programmed cell death (PCD) is the major mechanisms induced by substance 2250 in pancreatic carcinoma. What is strongly relevant towards clinical practice is especially the observed inhibition of patient derived pancreatic cancer tumor growth in mice treated with this new substance in combination with its sharply higher metabolic stability. CONCLUSION These encouraging results provide new therapeutical opportunities in pancreatic cancer treatment and build the basis for further functional analysis as well as first clinical studies for this promising agent.
Collapse
Affiliation(s)
- M. Buchholz
- Division of Molecular and Clinical Research, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - B. Majchrzak-Stiller
- Division of Molecular and Clinical Research, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - S. Hahn
- Department of Molecular Gastrointestinal Oncology, Ruhr-University Bochum, Bochum, Germany
| | - D. Vangala
- Department of Molecular Gastrointestinal Oncology, Ruhr-University Bochum, Bochum, Germany
- Department of Internal Medicine, Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | | | - W. Uhl
- Division of Molecular and Clinical Research, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - C. Braumann
- Division of Molecular and Clinical Research, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - A. M. Chromik
- Division of Molecular and Clinical Research, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
36
|
Abstract
BACKGROUND Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, with an average length of 3 cm. Complications occur in 6.4% and most commonly include inflammation and gastrointestinal bleeding. Preoperative diagnosis is demanding and achieved in 4%. CASE REPORT A 34-year-old otherwise healthy patient presented with an acute abdomen due to small bowel obstruction. Computed tomography scan could not identify the underlying cause. Emergency laparotomy was performed, and a torqued giant Meckel's diverticulum measuring 17 cm was found as the underlying cause for the small bowel obstruction. Resection of the affected ileum segment and ileo-ileal reconstruction were performed. The postoperative course was uneventful. CONCLUSION In extremely rare cases, small bowel obstruction in an otherwise healthy patient might be caused by torsion of a symptomatic giant Meckel's diverticulum.
Collapse
Affiliation(s)
- Andreas Minh Luu
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Kirsten Meurer
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Torsten Herzog
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | - Chris Braumann
- Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
37
|
Affiliation(s)
- Andreas Minh Luu
- Katholisches Klinikum Bochum—St. Josef Hospital Klinik für Allgemein- und Viszeralchirurgie Bochum, Germany
| | - Torsten Herzog
- Katholisches Klinikum Bochum—St. Josef Hospital Klinik für Allgemein- und Viszeralchirurgie Bochum, Germany
| | - Waldemar Uhl
- Katholisches Klinikum Bochum—St. Josef Hospital Klinik für Allgemein- und Viszeralchirurgie Bochum, Germany
| | - Chris Braumann
- Katholisches Klinikum Bochum—St. Josef Hospital Klinik für Allgemein- und Viszeralchirurgie Bochum, Germany
| |
Collapse
|
38
|
Luu AM, Herzog T, Uhl W, Braumann C. Liver Metastases 10 Years after Resection of a "Benign" Insulinoma. Am Surg 2016; 82:326-327. [PMID: 28206926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Andreas Minh Luu
- Katholisches Klinikum Bochum-St. Josef Hospital Klinik für Allgemein- und Viszeralchirurgie Bochum, Germany
| | | | | | | |
Collapse
|
39
|
Braumann C, Müller V, Knies M, Aufmesser B, Schwenk W, Koplin G. Quality of life and need for care in patients with an ostomy: a survey of 2647 patients of the Berlin OStomy-Study (BOSS). Langenbecks Arch Surg 2016; 401:1191-1201. [PMID: 27659022 DOI: 10.1007/s00423-016-1507-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/30/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although ostomies are sometimes necessary, it is unclear which type of ostomy is advantageous for quality of life (QoL). In an observational study of 2647 patients, QoL after colostomy (CS) and small bowel stoma (SBS) formation was evaluated. METHODS The European Organisation for Research and Treatment of Cancer (EORTC)-QLQ-C30 and CR-38 questionnaires were used. Patient characteristics, retrospective information about the ostomy and previous treatments, and current stoma-related complications were recorded. All questionnaires were distributed and collected by stoma therapists at the homecare company PubliCare®. RESULTS In all, 1790 patients had a CS, and 756 had an SBS. The mean Global Health Score (mGHS-a general QoL indicator) was 52.33 in CS and 49.40 in SBS patients (p = 0.004), but the effect size (Cohen's d) was 0.1. In SBS patients, all functional scores were lower and most of the symptom scores were higher. CONCLUSIONS QoL differed significantly for CS and SBS patients, but the effect size was marginal. The care of certain patient groups, particularly (female) patients who receive emergency surgeries, must be improved. More professional education and guidance are necessary for a larger proportion of patients. This survey provided reference data for quality of life in patients with an ostomy.
Collapse
Affiliation(s)
- Chris Braumann
- Department of General- and Visceral Surgery St. Josef Hospital, Ruhr University of Bochum, Bochum, Germany
| | - Verena Müller
- Department of General, Visceral, Vascular and Thoracic Surgery, Charité - University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
- Department of General, Visceral and Transplantation Surgery, Charité - University Medicine Berlin, Campus Virchow, Berlin, Germany
| | - Moritz Knies
- Department of General, Visceral, Vascular and Thoracic Surgery, Charité - University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
- Department of General, Visceral and Transplantation Surgery, Charité - University Medicine Berlin, Campus Virchow, Berlin, Germany
| | - Birgit Aufmesser
- Department of General, Visceral, Vascular and Thoracic Surgery, Charité - University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
- Department of General, Visceral and Transplantation Surgery, Charité - University Medicine Berlin, Campus Virchow, Berlin, Germany
| | - Wolfgang Schwenk
- Department of General and Visceral Surgery, MIS, Asklepios Klinik Altona, Hamburg, Germany
| | - Gerold Koplin
- Department of General, Visceral, Vascular and Thoracic Surgery, Charité - University Medicine Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.
- Department of General, Visceral and Transplantation Surgery, Charité - University Medicine Berlin, Campus Virchow, Berlin, Germany.
| |
Collapse
|
40
|
Luu A, Braumann C, Belyaev O, Janot M, Uhl W, Herzog T. Die Pankreaslinksresektion mit autologem Fibrinkleber – Anwendung eines etablierten Versiegelungskonzepts in der Pankreaschirurgie. Zentralbl Chir 2016; 141:625-629. [DOI: 10.1055/s-0042-109979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- A. Luu
- Klinik für Allgemein- und Viszeralchirurgie, Katholisches Klinikum Bochum – St. Josef-Hospital, Deutschland
| | - C. Braumann
- Klinik für Allgemein- und Viszeralchirurgie, Katholisches Klinikum Bochum – St. Josef-Hospital, Deutschland
| | - O. Belyaev
- Klinik für Allgemein- und Viszeralchirurgie, Katholisches Klinikum Bochum – St. Josef-Hospital, Deutschland
| | - M. Janot
- Klinik für Allgemein- und Viszeralchirurgie, Katholisches Klinikum Bochum – St. Josef-Hospital, Deutschland
| | - W. Uhl
- Klinik für Allgemein- und Viszeralchirurgie, Katholisches Klinikum Bochum – St. Josef-Hospital, Deutschland
| | - T. Herzog
- Klinik für Allgemein- und Viszeralchirurgie, Katholisches Klinikum Bochum – St. Josef-Hospital, Deutschland
| |
Collapse
|
41
|
Abstract
Pneumatosis intestinalis (PI) is characterized by multiple gas cysts in the wall of the gastrointestinal tract. Primary PI is extremely rare. In most of the cases PI is due to an underlying disease (traumatic and mechanical, inflammatory and autoimmune diseases, infectious and pulmonary diseases, drug induced, immunosuppression, transplantation, or neoplasm). A 69-year-old woman was treated with mixed connective tissue disease and PI twice operatively and once conservatively in our department. Review of the english literature showed 13 more cases of PI with underlying mixed connective tissue disease. Most published cases of pneumatosis intestinalis with radiological finding of pneumoperitoneum were treated conservatively and should have not been considered as a reason for surgery. Therefore, the treatment of PI can present as a major dilemma for the surgeon.
Collapse
Affiliation(s)
- C Braumann
- Department of General, Visceral, Vascular and Thoracic Surgery, Humboldt University of Berlin, Charité Campus Mitte, Germany.
| | | | | |
Collapse
|
42
|
Braumann C, Pfirrmann RW. Taurolidine: Mode of administration in mouse tumor models. Int J Cancer 2012; 131:2719-20. [DOI: 10.1002/ijc.27570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 03/06/2012] [Indexed: 11/06/2022]
|
43
|
Kloos C, Braumann C, Janzen A, Schröder D, Leder G, Reuter F, Mittelkötter U. Wundversiegelung mit Dermabond in der aseptischen und septischen Chirurgie – eine konsekutive, prospektive Qualitätsanalyse. Zentralbl Chir 2011. [DOI: 10.1055/s-0031-1289043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
44
|
Braumann C, Guenther N, Menenakos C, Muenzberg H, Pirlich M, Lochs H, Mueller JM. Clinical experiences derived from implementation of an easy to use concept for treatment of wound healing by secondary intention and guidance in selection of appropriate dressings. Int Wound J 2011; 8:253-60. [PMID: 21401884 DOI: 10.1111/j.1742-481x.2011.00777.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The main objective of this case-cohort-type observational study conducted at different Surgical Departments of the Charité-Universitätsmedizin in Berlin was to evaluate the sequential use concept first described by Systagenix Wound Management in 2007. Fifty-two patients with different wound healing by secondary intention were treated for 7 weeks at the Charité-Universitätsmedizin in Berlin. A multidisciplinary team worked together to reach consensus in wound assessment; in classification of infection status according to the criteria described by European Wound Management Association (EWMA); in treatment protocol and on dressings to be used to 'cover' wounds. Before dressing application, all wounds were cleaned from debris. Following the sequential use concept, wounds classified as stages 2 and 3 were dressed with SILVERCEL(®) and TIELLE(®) or TIELLE PLUS(®) to 'clean' the wounds. After 2-3 weeks, treatment was changed to PROMOGRAN PRISMA(®) and TIELLE(®) to 'close and cover' wounds, thus providing optimal wound healing. Wounds classified as non infected were dressed with PROMOGRAN PRISMA(®) and TIELLE(®) during the complete treatment period. Patients were asked to evaluate the treatment using a simplified questionnaire developed at the Charité-Universitätsmedizin in Berlin. Wounds comprised 37 surgical procedures, 8 chronic mixed ulcer, 4 pressure sores, 1 diabetic foot ulcer, 1 venous leg ulcer, and 1 mixed arterial/venous ulcer. At baseline, 12 wounds were classified as stage 3, 38 wounds as stage 2 and 2 wounds as stage 1. After 7 weeks of treatment, all patients showed a positive clinical response to the sequential use treatment. Results of wound size showed a high significant progression of wound healing expressed with a profound reduction of wound area (P in all measurements <0·001, chi-square test) and improved granulation. This study summarises the clinical experiences derived from the evaluation of the sequential use concept in the daily clinical practice of wound treatment. On the basis of the wound healing results, patients' evaluation of treatment and the clinicians' and staff experiences, this concept was implemented at different Surgical Departments of the Charité-Universitätsmedizin in Berlin.
Collapse
Affiliation(s)
- Chris Braumann
- Department of General and Visceral Surgery, Campus Mitte, Charite-Universitaetsmedizin Berlin, Berlin, Germany.
| | | | | | | | | | | | | |
Collapse
|
45
|
Braumann C, Guenther N, Doerner F, Schwenk W, Junghans T. Effects of Animal Positioning on Catecholamine and Vasopressin Levels in Pigs Undergoing Laparoscopy. Eur Surg Res 2011; 47:75-80. [DOI: 10.1159/000328777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 04/20/2011] [Indexed: 11/19/2022]
|
46
|
Harenberg T, Menenakos C, Jacobi CA, Braumann C. [Distal trachea and bronchial large lesions and suture reinforcement with Polyglicol Acid (PGA) patch. First clinical experience]. G Chir 2010; 31:10-15. [PMID: 20298659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Iatrogenic lacerations of the trachea and the bronchies are mostly complications of emergent intubations or percutaneous tracheotomies. The outcome is mainly influenced by thorough diagnostics, severity of the lesions, and urgent treatment. New materials are used to reduce the tension at the sutured points during ventilation. PATIENTS AND METHODS Four patients were operatively treated with primary suturing of trachea and bronchies with Polydioxanon. The large wounds were then covered using resorbable Soft PGA Mesh (resorbable Polyglykol Acid patch). The first two patients were found hypoxic and was orotracheally intubated in an emergency. An air leckage was detected in the hospital due to a large lesion of the pars membranacea. The third patient was operated in an emergency due to ileus caused by progressive colonic carcinoma. The weaning period on Intensive Care Unite (ICU) was unsuccessful. In a difficult procedure she underwent a percutaneous tracheotomy (dystopia of the trachea due to an arteria lusoria) mainly resulting in esophagotracheal fistulae. The fourth patient was treated by esophagectomy due to a local progressive carcinoma. A long lesion between the carina and left main bronchus resulted. All lacerations were treated by single knot suture technique with Polydioxanone and finally covered (patched) with PGA Mesh. The outcome of the surgical treatment was analyzed. RESULTS In bronchoscopies and CT-scans no air leackages during respiratory ventilation periods were observed. The first patient could be transferred into a normal ward from ICU at day 38. The second patient was found to be tetraplegic and was discharged into another hospital at day 48. One patient died at the 15th postoperative day due to urosepsis. The fourth patient left the ICU on day 10 and was discharged home at day 23. CONCLUSIONS Large iatrogenic airway lacerations of the distal trachea should be managed by early surgical repair due to their life-threatening outcome. Although only a small number of patients were analyzed so far, a PGA Mesh might be useful to increase the suture safety reducing the tension at the suture points due to the cuff pressure during long ventilation periods.
Collapse
Affiliation(s)
- T Harenberg
- Divisione di Chirurgia Generale, Viscerale, Vascolare e Toracica, Chartié - Universitätsmedizin Berlin, Campus Mitte, Berlin
| | | | | | | |
Collapse
|
47
|
Braumann C, Guenther N, Loeffler LM, Dubiel W. Liver metastases after colonic carcinoma--palliative chemotherapy plus curcumin. Int J Colorectal Dis 2009; 24:859-60. [PMID: 19184061 DOI: 10.1007/s00384-009-0651-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2009] [Indexed: 02/04/2023]
|
48
|
Tsilimparis N, Menenakos C, Rogalla P, Braumann C, Hartmann J. Malignant melanoma metastasis as a cause of small-bowel perforation. ACTA ACUST UNITED AC 2009; 32:356-8. [PMID: 19521125 DOI: 10.1159/000215718] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Malignant melanoma is a disease with an increasing rate of incidence, currently at 10 cases per 100,000. In most cases, malignant melanoma metastasizes over the lymph vessels to parenchymal organs. Symptomatic metastases are found in the gastrointestinal tract in only about 2% of the patients. CASE REPORT A 43-year-old patient with a known metastasized malignant melanoma (brain, liver, bones) was admitted to the department of dermatology due to fatigue, headache and unspecified abdominal symptoms. Because of persistent abdominal symptoms, a computed tomography (CT) scan of the abdomen was performed, showing a perforation of the ileum with an abscess on the basis of multiple small-bowel metastases. A segmental small-bowel resection with primary anastomosis was performed. The postoperative course of the patient was complicated by a subcutaneous wound infection and a prolonged period of convalescence (due to multiple brain metastases). CONCLUSIONS Novel therapy concepts and medication in the treatment of patients with malignant melanoma have improved life expectancy. These patients are therefore expected to suffer more frequently from complications of the primary disease. Interdisciplinary management and cooperation is required to adequately diagnose and handle such cases.
Collapse
Affiliation(s)
- Nikolaos Tsilimparis
- Klinik für Allgemein-, Visceral-, Gefäss- und Thoraxchirurgie, Charité Campus Mitte, Universitatsmedizin Berlin, Germany.
| | | | | | | | | |
Collapse
|
49
|
Menenakos C, Tsilimparis N, Guenther N, Braumann C. Strangulated appendix within a trocar site incisional hernia following laparoscopic low anterior rectal resection. A case report. Acta Chir Belg 2009; 109:411-3. [PMID: 19943604 DOI: 10.1080/00015458.2009.11680450] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Appendix strangulation caused by an incisional trocar site hernia following laparoscopy is an extremely rare entity. A 63-year-old man was admitted to our department with continuous abdominal pain and irreducible minimal swelling in the right abdomen. His surgical history was significant for rectal cancer one year previously. The patient had undergone a laparoscopic low anterior rectal resection with construction of a protective temporary end ileostomy (pT1, pN0, G2, M0). The ileostomy was reversed 3 months after initial surgery. An incarcerated herniation was diagnosed. Subsequent surgery surprisingly revealed that the right lower trocar point incisional hernia contained a strangulated appendix. Routine appendectomy was performed and the hernias were repaired using a typical sublay technique.
Collapse
|
50
|
Braumann C, Gutt CN, Scheele J, Menenakos C, Willems W, Mueller JM, Jacobi CA. Taurolidine reduces the tumor stimulating cytokine interleukin-1beta in patients with resectable gastrointestinal cancer: a multicentre prospective randomized trial. World J Surg Oncol 2009; 7:32. [PMID: 19309495 PMCID: PMC2667516 DOI: 10.1186/1477-7819-7-32] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Accepted: 03/23/2009] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The effect of additional treatment strategies with antineoplastic agents on intraperitoneal tumor stimulating interleukin levels are unclear. Taurolidine and Povidone-iodine have been mainly used for abdominal lavage in Germany and Europe. METHODS In the settings of a multicentre (three University Hospitals) prospective randomized controlled trial 120 patients were randomly allocated to receive either 0.5% taurolidine/2,500 IU heparin (TRD) or 0.25% povidone-iodine (control) intraperitoneally for resectable colorectal, gastric or pancreatic cancers. Due to the fact that IL-1beta (produced by macrophages) is preoperatively indifferent in various gastrointestinal cancer types our major outcome criterion was the perioperative (overall) level of IL-1beta in peritoneal fluid. RESULTS Cytokine values were significantly lower after TRD lavage for IL-1beta, IL-6, and IL-10. Perioperative complications did not differ. The median follow-up was 50.0 months. The overall mortality rate (28 vs. 25, p = 0.36), the cancer-related death rate (17 vs. 19, p = .2), the local recurrence rate (7 vs. 12, p = .16), the distant metastasis rate (13 vs. 18, p = 0.2) as well as the time to relapse were not statistically significant different. CONCLUSION Reduced cytokine levels might explain a short term antitumorigenic intraperitoneal effect of TRD. But, this study analyzed different types of cancer. Therefore, we set up a multicentre randomized trial in patients undergoing curative colorectal cancer resection. TRIAL REGISTRATION ISRCTN66478538.
Collapse
Affiliation(s)
- Chris Braumann
- Department of General, Visceral, Vascular and Thoracic Surgery, Universitaetsmedizin Berlin, Charité Campus Mitte, Humboldt University, Charitéplatz 1, 10117 Berlin, Germany.
| | | | | | | | | | | | | |
Collapse
|