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Kohaut J, Fischer-Mertens J, Cernaianu G, Schulten D, Holtkamp G, Kohl S, Habbig S, Klein R, Kribs A, Gottschalk I, Berg C, Dübbers M. Postnatal surgical treatment and complications following intrauterine vesicoamniotic shunting with the SOMATEX® intrauterine shunt. A single center experience. J Pediatr Urol 2023; 19:567.e1-567.e6. [PMID: 37451915 DOI: 10.1016/j.jpurol.2023.06.027] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Intrauterine vesicoamniotic shunting (VAS) using a Somatex® shunt was shown to significantly affect survival of male fetuses with megacystis in suspected lower urinary tract obstruction (LUTO) [Figure 1]. Data on postnatal surgical management and complications are largely lacking. OBJECTIVE To describe the postnatal management of patients with prenatal VAS for megacystitis in suspected severe LUTO. STUDY DESIGN All male newborns with previous intrauterine VAS using a Somatex® shunt treated in our institution were retrospectively analyzed. We evaluated the spectrum of urethral pathologies and postnatal surgical management, especially focusing on shunt removal. RESULTS Between 2016 and 2022, 17 patients (all male) were treated postnatally in our institution after VAS for suspected severe LUTO. Five fetuses with dislocated shunts underwent re-implantation in utero. Overall, premature birth before the 38th week of gestation was observed in eight patients (8/17). Seven shunts could be removed without further anesthesia as a bedside procedure. Ten patients required surgical shunt removal under general anesthesia due to migration (59%). Laparoscopic shunt extraction was performed in 8/10 cases. Most frequently, dislocated shunts were located incorporated in the detrusor in eight cases and the removal required a bladder suture in 2/8 patients. In one case, the shunt was removed from the abdominal wall and in one case from the intestine wall [Figure 2]. Posterior urethral valves were found in 8/17 patients, 6/17 patients showed a urethral atresia and one patient had urethral duplication. In two patients, we identified a high grade bilateral vesicoureteral reflux without LUTO. CONCLUSION In our observation, more than half of the newborns with megacystis in suspected LUTO require a shunt removal surgery after early VAS using a Somatex® shunt. Urethral atresia may be found more frequently in these patients. These data should be taken into consideration for prenatal counselling of parents and planning of postnatal management.
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Affiliation(s)
- J Kohaut
- Division of Pediatric Surgery, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - J Fischer-Mertens
- Division of Pediatric Surgery, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - G Cernaianu
- Division of Pediatric Surgery, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - D Schulten
- Division of Pediatric Surgery, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - G Holtkamp
- Division of Pediatric Surgery, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - S Kohl
- Department of Pediatrics and Adolescent Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - S Habbig
- Department of Pediatrics and Adolescent Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - R Klein
- Department of Pediatrics and Adolescent Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - A Kribs
- Department of Pediatrics and Adolescent Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - I Gottschalk
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - C Berg
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - M Dübbers
- Division of Pediatric Surgery, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
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Fischer J, Balleisen J, Holzki J, Cernaianu G, Alejandre Alcàzar M, Dübbers M. Tracheoscopic Findings and Their Impact on Respiratory Symptoms in Children with Esophageal Atresia. Eur J Pediatr Surg 2020; 30:371-377. [PMID: 30900225 DOI: 10.1055/s-0039-1683871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Esophageal atresia (EA) is often accompanied by tracheobronchial malformations leading to stridor, recurrent bronchitis, and occasionally to life-threatening obstructive apnea after surgical repair. The aim of this study was to identify the presence of tracheomalacia in patients with EA and tracheoesophageal fistula (TEF) pre- and postoperatively and to find endoscopic correlates leading to clinical airway symptoms. METHODS In a cohort of 362 patients with EA-TEF who underwent 595 tracheoscopies at the Children's Hospital of Cologne between January 1983 and December 2002, impaired tracheal lumen, localization of TEF, tracheal pulsations, and corresponding clinical symptoms were retrospectively analyzed. RESULTS The incidence of tracheomalacia was higher in patients with EA and TEF (Gross B-D) compared with patients with EA alone (Gross A) and average tracheal collapse does not significantly change before and after surgical repair of the esophagus in all types. Patients with cyanosis while eating and obstructive apnea presented with an average tracheal collapse of 89%. The presence of respiratory symptoms such as cough, stridor, or bronchitis was not associated with a higher grade of tracheal collapse compared with patients without any airway symptoms (average tracheal collapse of 37% in symptomatic patients vs. 33% in nonsymptomatic patients). CONCLUSION Tracheomalacia tends to be present independently of surgical procedure. Tracheomalacia should be measured by tracheoscopy (in % of tracheal collapse). Patients with a tracheal collapse of >80%, a ventral pulsation, and obstructive apnea or cyanosis in combination, are at risk for life-threatening situations and further surgical treatment should be considered.
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Affiliation(s)
- Janina Fischer
- Medical Faculty, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany.,Medical Faculty, Division of Pediatric Surgery, University Hospital of Cologne, Cologne, Germany
| | - Johannes Balleisen
- Medical Faculty, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany.,Medical Faculty, Division of Pediatric Surgery, University Hospital of Cologne, Cologne, Germany
| | - Josef Holzki
- Former Head of Department for Paediatric Anaesthesia, Children's Hospital Cologne, Cologne, Germany
| | - Grigore Cernaianu
- Medical Faculty, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany
| | - Miguel Alejandre Alcàzar
- Medical Faculty, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany.,Medical Faculty, Experimental Pediatric Pulmonology, University Hospital of Cologne, Cologne, Germany
| | - Martin Dübbers
- Medical Faculty, Division of Pediatric Surgery, University Hospital of Cologne, Cologne, Germany
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Dübbers M, Fischer J, Keller T, Kleinert R, Alakus H, Chon SH, Tröbs RB, Cernaianu G, Schulten D. [Flap Reconstruction as Alternative Anastomosis Technique for the Surgery of Oesophageal Atresia with Distal Oesophagotracheal Fistula]. Zentralbl Chir 2019; 144:135-136. [PMID: 30646417 DOI: 10.1055/a-0800-0216] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM The creation of a primary anastomosis in newborns with oesophageal atresia and distal oesophageotracheal fistula (EA-DF) is technically challenging, especially in small children. The goal is to approximate the fragile oesophageal ends without suture disruption and to minimize the mobilisation of the lower segment. We describe an alternative anastomosis technique aiming at reducing the tension on the first sutures at the posterior wall. INDICATIONS EA-DF was corrected in 13 newborns either by open (n = 11) or thoracoscopic (n = 2) surgery using this technique. METHOD The anastomosis technique is based on creation of a dorsal flap of the upper oesophageal pouch and insertion in the spatulated lower oesophageal segment after the fistula has been separated. Subsequently, the first sutures of the posterior wall can be accomplished with reduced tension. Upon completion of the anastomosis, a diagonally shaped anastomotic plane results. CONCLUSION The method is a helpful alternative to approximate the oesophageal stumps of newborns with EA and distal oesophagotracheal fistula. By this technique, the first stabilising sutures of the posterior wall can be accomplished with reduced tension. This results in reduced tensile stress on the individual sutures and simplifies the anastomisation in comparison to the conventional end-to-end anastomosis.
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Affiliation(s)
- Martin Dübbers
- Schwerpunkt Kinderchirurgie, Universitätsklinikum Köln, Deutschland
| | - Janina Fischer
- Schwerpunkt Kinderchirurgie, Universitätsklinikum Köln, Deutschland
| | - Titus Keller
- Schwerpunkt Kinderchirurgie, Universitätsklinikum Köln, Deutschland
| | - Robert Kleinert
- Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinikum Köln, Deutschland
| | - Hakan Alakus
- Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinikum Köln, Deutschland
| | - Seung-Hun Chon
- Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinikum Köln, Deutschland
| | - Ralf-Bodo Tröbs
- Klinik für Kinderchirurgie, Marienhospital Herne, Ruhr-Universität Bochum, Herne, Deutschland
| | - Grigore Cernaianu
- Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinikum Köln, Deutschland
| | - Daisy Schulten
- Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinikum Köln, Deutschland
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Fischer J, Simon T, Hamprecht A, Hos N, Möricke A, Cernaianu G, Tharun L, Gruhn B, Plum G, Dübbers M. Surgical Implications for Diagnosis and Treatment of Intestinal Aspergillosis in Pediatric Patients with ALL. Eur J Pediatr Surg 2018; 28:477-483. [PMID: 28946164 DOI: 10.1055/s-0037-1607194] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The incidence of invasive aspergillosis (IA) in children with hematooncological malignancies is increasing as a result of intensive treatment, immunosuppression, and extended use of broad-spectrum antibiotics. Infection of the GI tract by Aspergillus spp. is a rare and fatal complication, which often requires surgical diagnostic and therapeutic exploration. OBJECTIVE The aim of this study was to determine the characteristics of symptomatic intestinal aspergillosis, diagnosis, treatment, and outcome of pediatric patients with an underlying hemato-oncologic disease. PATIENTS AND METHODS We analyzed 2,307 German patients with acute lymphoblastic leukemia (ALL) from age 1 to 17 years registered in the AIEOP-BFM ALL 2000 study from 2000 to 2006. All reported adverse events were assessed for symptoms of IA and retrospectively reviewed for any sign or proof of intestinal involvement of IA. RESULTS In this cohort, IA was reported in 30 of 2,307 patients while intestinal involvement was documented in five patients. Four of these patients had intestinal symptoms and three patients underwent explorative laparotomy. Among clinical cases with IA, gastrointestinal manifestation of IA mostly occurred in adolescent patients (10-16 years). Symptoms varied from abdominal tenderness and pain to constipation. Intestinal aspergillosis was proven by microbiological and histopathological examination and fungal infection was observed macroscopically in the jejunal lumen during surgery. Despite the extended surgery and antifungal therapy, outcome of disseminated IA with intestinal involvement remains poor. CONCLUSION Surgeons should be aware of surgical complications of intestinal aspergillosis in children with hematooncological diseases requiring exploration and resection. IA is a rare event and still difficult to diagnose due to unspecific abdominal symptoms. Thus, biopsy sampling is of utmost importance to ensure diagnosis, and resection of necrotic or perforated tissue should be attempted early.
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Affiliation(s)
- Janina Fischer
- Division of Pediatric Surgery, University Hospital of Cologne, Cologne, Germany.,Department of Pediatric Oncology, Klinikum der Universitat zu Koln Klinik und Poliklinik fur Kinder- und Jugendmedizin, Koln, Germany
| | - Thorsten Simon
- Department of Pediatric Oncology, Klinikum der Universitat zu Koln Klinik und Poliklinik fur Kinder- und Jugendmedizin, Koln, Germany
| | - Axel Hamprecht
- Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany
| | - Nina Hos
- Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany.,Cluster of Excellence in Aging-associated Diseases, Universitat zu Koln, Koln, Nordrhein-Westfalen, Germany.,German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Anja Möricke
- Department of Pediatrics, Universitatsklinikum Schleswig-Holstein Campus Kiel, Kiel, Schleswig-Holstein, Germany
| | - Grigore Cernaianu
- Division of Pediatric Surgery, University Hospital of Cologne, Cologne, Germany
| | - Lars Tharun
- Institute for Pathology, University Hospital of Schleswig Hostein-Campus Lübeck, Lübeck, Germany
| | - Bernd Gruhn
- Department of Pediatrics, Universitatsklinikum Jena, Jena, Thüringen, Germany
| | - Georg Plum
- Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany
| | - Martin Dübbers
- Division of Pediatric Surgery, University Hospital of Cologne, Cologne, Germany
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Dübbers M, Nikolaou E, Fuchs H, Fischer J, Alakus H, Leers J, Bruns C, Cernaianu G. Update on Transumbilical Single-Incision Laparoscopic Assisted Appendectomy (TULAA) - Which Children Benefit and What are the Complications? Klin Padiatr 2018; 230:194-199. [PMID: 29544230 DOI: 10.1055/s-0044-101622] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Transumbilical laparoscopic-assisted appendectomy (TULAA) is fast and cost-effective since no endoloops, staplers or wound protection devices are used. We analyzed the effects of TULAA as first approach for perforated (PA) and non-perforated (NPA) appendicitis in children. PATIENTS We performed a retrospective analysis of 181 children for whom TULAA was the first approach for appendicitis between October 2010 and March 2016. METHODS Morbidity, additional laparoscopic instrument insertion (AI), conversions to open extraumbilical appendectomy (OC), and complications were evaluated. RESULTS TULAA was initiated in 181 (87.4%) children (113 boys: 68 girls). Median age was 10.3 years (3.3-13.9 years) and BMI 16.8 kg/m2 (12.4-30.8). Appendicitis was non-perforated in 157 (86.7%) and perforated in 24 (13.3%) patients. TULAA was finalized in 142 (78.5%) patients, AI were inserted in 20 (11%) and OC were performed in 19 (10.5%) patients. Duration of surgery did not exceed 20 min for 12.8%, and 30 min for 43.6% of patients with TULAA and NPA. The rate of wound infections did not differ between procedures (TULAA 3/142 (2.1%), AI 0 (0%), OC 1/19 (5.3%), P=1.000). Further postoperative course was uneventful in 179 (98.9%) patients. CONCLUSION TULAA can be used as first approach for appendicitis in all children with a low rate of complications. Extracorporeal appendix stump closure can be safely achieved in the majority of children without using laparoscopic disposable devices.
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Affiliation(s)
- Martin Dübbers
- Division of Pediatric Surgery, University Hospital Cologne, Köln, Germany
| | - Elena Nikolaou
- Division of Pediatric Surgery, University Hospital Cologne, Köln, Germany
| | - Hans Fuchs
- Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Köln, Germany
| | - Janina Fischer
- Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Köln, Germany
| | - Hakan Alakus
- Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Köln, Germany
| | - Jessica Leers
- Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Köln, Germany
| | - Christiane Bruns
- Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Köln, Germany
| | - Grigore Cernaianu
- Division of Pediatric Surgery, University Hospital Cologne, Köln, Germany
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Dübbers M, Simon T, Berthold F, Fischer J, Volland R, Hero B, Cernaianu G. Retrospective analysis of relapsed abdominal high-risk neuroblastoma. J Pediatr Surg 2018; 53:558-566. [PMID: 29021103 DOI: 10.1016/j.jpedsurg.2017.09.002] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 09/01/2017] [Accepted: 09/02/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND/PURPOSE The impact of abdominal topography and surgical technique on resectability and local relapse pattern of relapsed abdominal high-risk neuroblastoma (R-HR-NB) is not clearly defined. METHODS A sample of thirty-nine patients with R-HR-NB enrolled in the German neuroblastoma trials between 2001 and 2010 was analyzed retrospectively using surgical and imaging reports. We evaluated resectability and local relapse pattern within 6 standardized abdominal regions, impact of extent of the first resective surgery on overall survival (OS), and of number of operations and a higher cumulative surgical assessment score (C-SAS) on OS after the first event. RESULTS In the left upper abdomen, rates for tumor persistence and relapse were 45.9% and 13.5% and in the left lower abdomen 27.7% and 8.3%, respectively. OS in months did not differ between complete and incomplete first resections (median (interquartile range): 35 (45.6) vs. 40 (65.4), P=.649). Better OS after the first event was associated with repeated as compared to single surgery (47.7 (64.7) vs. 4.3 (12.5), P=.000), and with higher as compared to lower C-SAS (47.7 (64.3) vs. 7.6 (14.7), P=.002). CONCLUSIONS OS after relapse/progression was not dependent on the extent of first resection. The number of operations was associated with better outcome after event. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE LEVEL III Retrospective comparative study.
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Affiliation(s)
- Martin Dübbers
- Division of Pediatric Surgery, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany.
| | - Thorsten Simon
- Department of Pediatric Oncology and Hematology, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany.
| | - Frank Berthold
- Department of Pediatric Oncology and Hematology, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany.
| | - Janina Fischer
- Department of Pediatric Oncology and Hematology, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany.
| | - Ruth Volland
- Department of Pediatric Oncology and Hematology, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany.
| | - Barbara Hero
- Department of Pediatric Oncology and Hematology, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany.
| | - Grigore Cernaianu
- Division of Pediatric Surgery, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany.
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Fischer J, Pohl A, Volland R, Hero B, Dübbers M, Cernaianu G, Berthold F, von Schweinitz D, Simon T. Complete surgical resection improves outcome in INRG high-risk patients with localized neuroblastoma older than 18 months. BMC Cancer 2017; 17:520. [PMID: 28778185 PMCID: PMC5543757 DOI: 10.1186/s12885-017-3493-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 05/15/2017] [Accepted: 07/20/2017] [Indexed: 12/24/2022] Open
Abstract
Background Although several studies have been conducted on the role of surgery in localized neuroblastoma, the impact of surgical timing and extent of primary tumor resection on outcome in high-risk patients remains controversial. Methods Patients from the German neuroblastoma trial NB97 with localized neuroblastoma INSS stage 1–3 age > 18 months were included for retrospective analysis. Imaging reports were reviewed by two independent physicians for Image Defined Risk Factors (IDRF). Operation notes and corresponding imaging reports were analyzed for surgical radicality. The extent of tumor resection was classified as complete resection (95–100%), gross total resection (90–95%), incomplete resection (50–90%), and biopsy (<50%) and correlated with local control rate and outcome. Patients were stratified according to the International Neuroblastoma Risk Group (INRG) staging system. Survival curves were estimated according to the method of Kaplan and Meier and compared by the log-rank test. Results A total of 179 patients were included in this study. 77 patients underwent more than one primary tumor operation. After best surgery, 68.7% of patients achieved complete resection of the primary tumor, 16.8% gross total resection, 14.0% incomplete surgery, and 0.5% biopsy only. The cumulative complication rate was 20.3% and the surgery associated mortality rate was 1.1%. Image defined risk factors (IDRF) predicted the extent of resection. Patients with complete resection had a better local-progression-free survival (LPFS), event-free survival (EFS) and OS (overall survival) than the other groups. Subgroup analyses showed better EFS, LPFS and OS for patients with complete resection in INRG high-risk patients. Multivariable analyses revealed resection (complete vs. other), and MYCN (non-amplified vs. amplified) as independent prognostic factors for EFS, LPFS and OS. Conclusions In patients with localized neuroblastoma age 18 months or older, especially in INRG high-risk patients harboring MYCN amplification, extended surgery of the primary tumor site improved local control rate and survival with an acceptable risk of complications.
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Affiliation(s)
- Janina Fischer
- Department of Pediatric Oncology and Hematology, University Children's Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany.
| | - Alexandra Pohl
- Department of Pediatric Surgery, Dr. von Haunersches Children's Hospital, Munich, Germany
| | - Ruth Volland
- Department of Pediatric Oncology and Hematology, University Children's Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - Barbara Hero
- Department of Pediatric Oncology and Hematology, University Children's Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - Martin Dübbers
- Division of Pediatric Surgery, University Children's Hospital of Cologne, Cologne, Germany
| | - Grigore Cernaianu
- Division of Pediatric Surgery, University Children's Hospital of Cologne, Cologne, Germany
| | - Frank Berthold
- Department of Pediatric Oncology and Hematology, University Children's Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | | | - Thorsten Simon
- Department of Pediatric Oncology and Hematology, University Children's Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
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Tröbs RB, Finke W, Bahr M, Roll C, Nissen M, Vahdad MR, Cernaianu G. Isolated tracheoesophageal fistula versus esophageal atresia - Early morbidity and short-term outcome. A single institution series. Int J Pediatr Otorhinolaryngol 2017; 94:104-111. [PMID: 28166998 DOI: 10.1016/j.ijporl.2017.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 10/10/2016] [Revised: 01/14/2017] [Accepted: 01/17/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE We compared the postnatal course, morbidity and early results after repair for cases of isolated or "pure" TEF with those for cases of esophageal atresia (EA) with distal tracheoesophageal fistula (TEF). METHODS Twenty-four consecutive infants were divided into two groups: isolated TEF [TEF group] (n = 5) and EA with distal TEF [EA group] (n = 19). RESULTS A high rate of prematurity (29%) and major cardiac and other surgically-relevant malformations (0.8 vs. 0.7 per infant) was found in both groups. The median age at surgery was 8 days for the TEF group vs. 1 day for the EA group (p < 0.01). Most infants of both cohorts had stable acid-base and respiratory parameters at admission. Generally, tracheoscopy provided valuable information regarding the position of the TEF. Surgery for isolated TEF was performed via right cervicotomy in 4 cases and via thoracotomy in one. Postoperative thoracostomy tubes were inserted in 3 cases and one emergency gastrostomy was created for acute gastric overextension (exclusively in patients with EA). The duration of postoperative mechanical ventilation (49 vs. 113 h, p = 0.045) and the median length of stay in the pediatric surgery unit (10 vs. 20.5 days, p = 0.003) were shorter for the isolated TEF group. Four EA patients experienced severe events. Total mortality was 8% (0 out of 5 with TEF vs. 2 out of 19 with EA). CONCLUSION Developmental delay and a high rate of morbidity were found in both groups. More complex surgery increased perioperative morbidity in cases of EA. With early recognition of isolated TEF, a less complicated course can be expected in comparison with esophageal atresia.
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Affiliation(s)
- R B Tröbs
- Department of Pediatric Surgery, St. Mary's Hospital, St. Elisabeth Group, Ruhr-University of Bochum, D-44627, Herne, Widumer Str. 8, Germany.
| | - W Finke
- Department of Anesthesiology and Surgical Intensive Care, St. Mary's Hospital, St. Elisabeth Group, Ruhr-University of Bochum, D-44627, Herne, Widumer Str. 8, Germany.
| | - M Bahr
- Department of Pediatric Surgery, St. Mary's Hospital, St. Elisabeth Group, Ruhr-University of Bochum, D-44627, Herne, Widumer Str. 8, Germany.
| | - C Roll
- Vest Children's Hospital, University of Witten-Herdecke, Department of Neonatology and Pediatric Intensive Care, Dr. Friedrich-Steiner-Str. 5, D-45711, Datteln, Germany.
| | - M Nissen
- Department of Pediatric Surgery, St. Mary's Hospital, St. Elisabeth Group, Ruhr-University of Bochum, D-44627, Herne, Widumer Str. 8, Germany.
| | - M R Vahdad
- Department of Pediatric Surgery and Pediatric Urology, University of Marburg, Universitätsklinikum, Baldingerstrasse, D-35043, Marburg, Germany.
| | - G Cernaianu
- Department of Pediatrics and Adolescent Medicine, Pediatric Surgery, University of Cologne, Kerpener Str. 26, D-50937, Cologne, Germany.
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Nissen M, Cernaianu G, Thränhardt R, Vahdad MR, Barenberg K, Tröbs RB. Does metabolic alkalosis influence cerebral oxygenation in infantile hypertrophic pyloric stenosis? J Surg Res 2017; 212:229-237. [PMID: 28550912 DOI: 10.1016/j.jss.2017.01.019] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 12/30/2016] [Accepted: 01/19/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND This pilot study focuses on regional tissue oxygenation (rSO2) in patients with infantile hypertrophic pyloric stenosis in a perioperative setting. To investigate the influence of enhanced metabolic alkalosis (MA) on cerebral (c-rSO2) and renal (r-rSO2) tissue oxygenation, two-site near-infrared spectroscopy (NIRS) technology was applied. MATERIALS AND METHODS Perioperative c-rSO2, r-rSO2, capillary blood gases, and electrolytes from 12 infants were retrospectively compared before and after correction of MA at admission (T1), before surgery (T2), and after surgery (T3). RESULTS Correction of MA was associated with an alteration of cerebral oxygenation without affecting renal oxygenation. When compared to T1, 5-min mean (± standard deviation) c-rSO2 increased after correction of MA at T2 (72.74 ± 4.60% versus 77.89 ± 5.84%; P = 0.058), reaching significance at T3 (80.79 ± 5.29%; P = 0.003). Furthermore, relative 30-min c-rSO2 values at first 3 h of metabolic compensation were significantly lowered compared with postsurgical states at 16 and 24 h. Cerebral oxygenation was positively correlated with levels of sodium (r = 0.37; P = 0.03) and inversely correlated with levels of bicarbonate (r = -0.34; P = 0.05) and base excess (r = -0.36; P = 0.04). Analysis of preoperative and postoperative cerebral and renal hypoxic burden yielded no differences. However, a negative correlation (r = -0.40; P = 0.03) regarding hematocrite and mean r-rSO2, indirectly indicative of an increased renal blood flow under hemodilution, was obtained. CONCLUSIONS NIRS seems suitable for the detection of a transiently impaired cerebral oxygenation under state of pronounced MA in infants with infantile hypertrophic pyloric stenosis. Correction of MA led to normalization of c-rSO2. NIRS technology constitutes a promising tool for optimizing perioperative management, especially in the context of a possible diminished neurodevelopmental outcome after pyloromyotomy.
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Affiliation(s)
- Matthias Nissen
- Department of Pediatric Surgery, St. Mary's Hospital, St. Elisabeth Group, Ruhr-University of Bochum, Herne, Germany.
| | - Grigore Cernaianu
- Department of Pediatrics and Adolescent Medicine, Pediatric Surgery, University of Cologne, Cologne, Germany
| | - Rene Thränhardt
- Department of Pediatric Surgery, St. Mary's Hospital, St. Elisabeth Group, Ruhr-University of Bochum, Herne, Germany
| | - Mohammad R Vahdad
- Department of Pediatric Surgery, University Hospital Giessen/Marburg, Marburg, Germany
| | - Karin Barenberg
- Department of Pediatric Surgery, St. Mary's Hospital, St. Elisabeth Group, Ruhr-University of Bochum, Herne, Germany
| | - Ralf-Bodo Tröbs
- Department of Pediatric Surgery, St. Mary's Hospital, St. Elisabeth Group, Ruhr-University of Bochum, Herne, Germany
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Vahdad MR, Nissen M, Semaan A, Klein T, Palade E, Boemers T, Foroutan HR, Troebs RB, Cernaianu G. Experiences with LESS-appendectomy in Children. Arch Iran Med 2016; 19:57-63. [PMID: 26702750 DOI: 0161901/aim.0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE To evaluate the outcome of laparoendoscopic single-site (LESS-A) through one transumbilical port vs. 3-port laparoscopic (3TA) appendectomy in children. METHODS We reviewed the records of 309 children (65 LESS-A, 244 3TA) operated on between 2008 and 2012. One hundered forty-nine patients had acute catarrhalis (CA), 133 phlegmonous (PLA), and 27 perforated appendicitis (PA). We compared the duration of operation (DO) the incidence of abdominal abscesses (AA) and wound infections (WI), as well as the degree of appendiceal inflammation (DI) among surgeons with and without board certification. RESULTS For all DI, LESS-A resulted in a shorter DO than 3TA (CA 57.9 ± 22.8 vs. 68.5 ± 23.2, P = 0.014; PLA 51.5±16.5 vs. 68.4±33.0, P = 0.006; PA 66.0 ± 29.0 vs. 97.3 ± 41.8, P = 0.039). LESS-A was not used for less complicated cases when compared to 3TA (CA 50.8% vs. 47.5%; PLA 33.8% vs. 45.5%; PA 15.4% vs. 7.0%; CA vs. PLA, P = 0.292; CA vs. PA, P = 0.142; PLA vs. PA, P = 0.031). Surgeons without board certification were assigned to a similar percentage to perform both techniques for any DI (CA 30.3% vs. 37.1%, P = 0.541; PLA 31.8% vs. 40.5%, P= 0.484; PA 40% vs. 35.3%, P = 1.0). We found no significant differences concerning AA (1.5% vs. 1.2%, P = 1.0) and WI (3.1% vs. 1.6%, P = 0.61). CONCLUSIONS LESS-A can be done by surgeons with and without board certification for all DI, with shorter DO and similar complication rates as compared to 3TA.
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Affiliation(s)
- Mohammad Reza Vahdad
- Department of Pediatric Surgery and Pediatric Urology, Kliniken der Stadt Koeln gGmbH, Koeln, Germany.
| | - Matthias Nissen
- Department of Pediatric Surgery, Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany
| | - Alexander Semaan
- Department of Pediatric Surgery and Pediatric Urology, Kliniken der Stadt Koeln gGmbH, Koeln, Germany
| | - Tobias Klein
- Department of Pediatric Surgery and Pediatric Urology, Kliniken der Stadt Koeln gGmbH, Koeln, Germany
| | - Emanuel Palade
- Department of Surgery, University Hospital Luebeck, Luebeck, Germany
| | - Thomas Boemers
- Department of Pediatric Surgery and Pediatric Urology, Kliniken der Stadt Koeln gGmbH, Koeln, Germany
| | - Hamid Reza Foroutan
- Department of Pediatric Surgery, Shiraz University School of Medicine, Laparoscopy Research Center, Shiraz, Iran
| | - Ralf-Bodo Troebs
- Department of Pediatric Surgery, Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany
| | - Grigore Cernaianu
- Department of Pediatric Surgery, University Hospital Luebeck, Luebeck, Germany
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Tröbs RB, Vahdad MR, Cernaianu G. Transumbilical cord access (TUCA) for laparoscopy in infants and children: simple, safe and fast. Surg Today 2016; 46:235-40. [PMID: 26031233 PMCID: PMC4722059 DOI: 10.1007/s00595-015-1191-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/19/2014] [Accepted: 03/16/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE We herein report a case series evaluating the safety and complication rate of transumbilical cord access (TUCA) for pediatric laparoscopic surgery. METHODS Data were collected for 556 infants and children. Access into the abdominal cavity was gained via a transverse infraumbilical stab incision passing the fibrotic umbilical cord remnant. Ninety-two infants underwent laparoscopic pyloromyotomy (LPM), 159 female infants underwent herniorrhaphy (LHR) and 309 infants underwent appendectomy (LAP). Of the total operations, 70 % were performed by board-certified surgeons and 30 % were performed by non-board-certified surgeons. The median time of follow-up was 24 months. RESULTS No cases of acute severe bleeding or organ laceration were noted. TUCA-related complications were observed in nine patients (1.6 %). Omphalitis and persistent wound secretion were detected in eight children and foreign bodies consisting of cyanoacrylate were removed from three of these patients. Meanwhile, umbilical pain leading to surgical revision was observed in one child, and eight umbilical hernias were repaired during the TUCA procedures. No signs of postoperative incisional hernia were recorded. CONCLUSIONS TUCA is a safe and comfortable access method for pediatric laparoscopic surgery in various age groups. This method is easy to learn and can be quickly and safely performed in the vast majority of children.
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Affiliation(s)
- Ralf-Bodo Tröbs
- Department of Pediatric Surgery, Catholic Foundation Marienhospital Herne, Ruhr-University of Bochum, Widumer Str. 8, 44627, Herne, Germany.
| | - M Reza Vahdad
- Department of Pediatric and Adolescent Surgery, Klinikum Der Stadt Köln, Amsterdamer Str. 59, 50735, Cologne, Germany.
| | - Grigore Cernaianu
- Department of Pediatric Surgery, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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Vahdad MR, Cernaianu G, Semaan A, Klein T, Faran S, Zemon H, Boemers T, Foroutan HR. An experimental study in six fresh human cadavers using a novel approach to avoid abdominal wall incisions in total colectomy: totally transanal laparoendoscopic single-site pull-through colectomy with J-pouch creation. Surg Endosc 2015; 30:3107-13. [PMID: 26487229 DOI: 10.1007/s00464-015-4555-5] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 09/03/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND The use of transanal laparoscopic access to completely avoid abdominal wall incisions represents the most current evolution in minimally invasive surgery. The combination of single-site surgery and natural orifice transluminal endoscopic surgery (NOTES™) can be used for totally transanal laparoendoscopic pull-through colectomy with J-pouch creation (TLPC-J). The aim of the present study was to provide evidence for the feasibility of TLPC-J in adult human cadavers. METHODS TLPC-J was performed in six fresh adult human cadavers. The procedure involved endorectal submucosal dissection from 1 cm above the dentate line to a point above the peritoneal reflection, where the rectal muscle was divided circumferentially. The edge of the mucosal cuff was closed distally in order to prevent fecal contamination and the endorectal tube was placed back into the abdomen. A Triport+™ or QuadPort+™ system was introduced transanally, and it served as a multiport device (MD). Resection of the entire colon, mobilization of the distal ileal segment, and extracorporeal suture of the ileal J-loop were performed via the transanal approach. The J-pouch was created using Endo GIA™. After removal of the MD, the J-pouch was sutured to the rectal wall. RESULTS TLPC-J was performed in all cadavers, with a mean operation duration of 236 ± 22 min. Conversion to either transabdominal laparoscopy or laparotomy was not required in any of the cadavers. No bowel perforation or damage to other organs was observed. The use of a curved endoscope greatly facilitated visualization during transanal laparoscopic dissection for partial and total colectomy, making the procedure feasible. All specimens were retrieved through the anus, eliminating the need for additional transabdominal incisions. CONCLUSIONS TLPC-J was technically feasible in adult human cadavers, and abdominal wall incisions were not required. However, clinical studies are needed to determine its feasibility in living adults.
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Affiliation(s)
- M Reza Vahdad
- Department of Pediatric Surgery and Pediatric Urology, Kliniken der Stadt Köln gGmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735, Cologne, Germany.
| | - Grigore Cernaianu
- Department of Pediatric Surgery, University Hospital Cologne, Kerpenerstr. 62, 50937, Cologne, Germany
| | - Alexander Semaan
- Department of Pediatric Surgery and Pediatric Urology, Kliniken der Stadt Köln gGmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735, Cologne, Germany
| | - Tobias Klein
- Department of Pediatric Surgery and Pediatric Urology, Kliniken der Stadt Köln gGmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735, Cologne, Germany
| | - Samuel Faran
- Olympus Surgical Technologies Europe, Kuehnstraße 61, 22045, Hamburg, Germany
| | - Harry Zemon
- White Plains Hospital, 210 Westchester Avenue, White Plains, NY, 10604, USA
| | - Thomas Boemers
- Department of Pediatric Surgery and Pediatric Urology, Kliniken der Stadt Köln gGmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735, Cologne, Germany
| | - Hamid Reza Foroutan
- Department of Pediatric Surgery, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, 7141995377, Iran
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Vahdad MR, Nissen M, Semaan A, Klein T, Palade E, Boemers T, Troebs RB, Cernaianu G. Can a simplified algorithm prevent incomplete laparoscopic pyloromyotomy? J Pediatr Surg 2015; 50:1544-8. [PMID: 25783316 DOI: 10.1016/j.jpedsurg.2014.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/08/2014] [Accepted: 12/02/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study is to analyze an algorithm intended to prevent incomplete pyloromyotomy in 3-port laparoscopic (3TP) and laparoendoscopic single-site (LESS-P) procedures in a teaching hospital. METHODS We defined the pyloroduodenal and pyloroantral junctions as anatomical margins prior pyloromyotomy by palpating and coagulating the serosa with the hook cautery instrument. Incomplete pyloromyotomies, mucosa perforations, serosa lacerations, and wound infections were recorded for pediatric surgical trainees (PST) and board-certified pediatric surgeons (BC). RESULTS We reviewed the medical files of 233 infants, who underwent LESS-P (n=21), 3TP (n=71), and open pyloromyotomy (OP, n=141). No incomplete pyloromyotomies occurred. In contrast to OP, mucosa perforations did not occur in the laparoscopic procedures during the study period (6.38% vs. 0%, P=.013). OP had insignificantly more serosal lacerations (3.5% vs. 1.4%, P=.407). There was no difference in the rate of wound infections between OP and laparoscopic procedures (2.8% vs. 4.3%, P=.715). In the latter, all wound infections were associated with the use of skin adhesive. CONCLUSIONS This algorithm helps avoiding incomplete laparoscopic pyloromyotomy during the learning curve and in a teaching setting. It is not risky to assist 3TP and LESS-P to PST as this led to a decreased rate of mucosa perforations without experiencing incomplete pyloromyotomies.
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Affiliation(s)
- M Reza Vahdad
- Department of Pediatric Surgery and Pediatric Urology Kliniken der Stadt Köln GmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735 Koeln, Germany.
| | - Matthias Nissen
- Department of Pediatric Surgery, Marienhospital Herne, Ruhr-University of Bochum, Widumerstr. 8, 44627 Herne, Germany.
| | - Alexander Semaan
- Department of Pediatric Surgery and Pediatric Urology Kliniken der Stadt Köln GmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735 Koeln, Germany.
| | - Tobias Klein
- Department of Pediatric Surgery and Pediatric Urology Kliniken der Stadt Köln GmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735 Koeln, Germany.
| | - Emanuel Palade
- Department of Surgery, University Hospital Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - Thomas Boemers
- Department of Pediatric Surgery and Pediatric Urology Kliniken der Stadt Köln GmbH, Kinderkrankenhaus Amsterdamer Strasse 59, 50735 Koeln, Germany.
| | - Ralf-Bodo Troebs
- Department of Pediatric Surgery, Marienhospital Herne, Ruhr-University of Bochum, Widumerstr. 8, 44627 Herne, Germany.
| | - Grigore Cernaianu
- Department of Pediatric Surgery, University Hospital Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
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Tröbs RB, Gharavi B, Neid M, Cernaianu G. Chondroepitrochlearis Muscle--A Phylogenetic Remnant with Clinical Importance. Klin Padiatr 2014; 227:243-6. [PMID: 25437344 DOI: 10.1055/s-0034-1395553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report on an infant, presenting with a cord-like accessory muscle crossing the anterior axillary fold. The accessory structure appeared as an axillary web and caused tethering of the humerus together with an abnormal shape of the shoulder. The chondroepitrochlearis muscle is thought to be of phylogenetic origin. In our patient the tendinous sling was resected at the age of 7 month with normalization of function and cosmetics.
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Affiliation(s)
- R-B Tröbs
- Department of Pediatric Surgery, Marienhospital Herne, Ruhr-University of Bochum, Herne, Germany
| | - B Gharavi
- Department of Pediatric and Adolescent Medicine, Marienhospital Witten, Witten, Germany
| | - M Neid
- Department of Pathology, BG-Kliniken Bergmannsheil, Bochum, Germany
| | - G Cernaianu
- Department of Pediatric Surgery, University of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
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Vahdad MR, Troebs RB, Nissen M, Burkhardt LB, Hardwig S, Cernaianu G. Laparoscopic appendectomy for perforated appendicitis in children has complication rates comparable with those of open appendectomy. J Pediatr Surg 2013; 48:555-61. [PMID: 23480912 DOI: 10.1016/j.jpedsurg.2012.07.066] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 07/23/2012] [Accepted: 07/27/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the outcome of laparoscopic (LA) vs. open appendectomy (OA) in children with perforated appendicitis (PA). METHODS We reviewed the medical files of 221 children who underwent LA (n=75), OA (n=122), and conversion (CO) (n=24), comparing duration of operation, re-admissions, re-operations, intra-abdominal abscesses (IAA), and wound infections. RESULTS Compared to OA, LA resulted in fewer re-admissions (1.3% vs. 12.3%; P=.006), fewer re-operations (4% vs. 17.2%; P=.006), and fewer wound infections (0% vs. 11.5%; P=.001). No differences in the duration of operation (72.9 ± 23.0 min vs. 77.7 ± 48.0 min; P=.392) or IAA (4% vs. 11.5%; P=.114) were observed. Compared to LA, CO had more complications. CONCLUSIONS We report that LA is superior to OA with regard to incidence of re-admission, re-operation, and wound infection.
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Affiliation(s)
- Mohammad Reza Vahdad
- Department of Pediatric Surgery, Marienhospital-Kinderchirurgische Klinik der Ruhr-Universität Bochum, Widumerstr. 8, 44627 Herne, Germany.
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Vahdad MR, Foroutan A, Najafi SM, Cernaianu G, Tröbs RB, Banani SA, Foroutan HR. Totally transanal LESS pull-through colectomy: a novel approach for avoiding abdominal wall incision in children with long-segment intestinal aganglionosis. J Laparoendosc Adv Surg Tech A 2013; 23:276-80. [PMID: 23402288 DOI: 10.1089/lap.2012.0058] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
UNLABELLED Abstract Introduction: Minimally invasive surgery in children with long-segment intestinal aganglionosis aims to reduce the number of abdominal wall incisions. Conventional laparoscopic and laparoendoscopic single-site (LESS) surgeries fulfill this goal. In children, natural orifice translumenal endoscopic surgery (NOTES™; American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society for American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) has been limited because of fear of access site complications. We present a novel technique of totally transanal LESS pull-through colectomy (TLPC), avoiding abdominal wall incision, which combines LESS technology and the NOTES approach. SUBJECTS AND METHODS Two boys and one girl (2.5 months, 6 months, and 5 years of age, respectively) with sigmoid and transverse colon aganglionosis underwent surgery. The TLPC procedure consisted of an endorectal technique with submucosal dissection starting 1 cm orally from the dentate line to above the peritoneal reflection, where the rectal muscle was divided circumferentially. After ligation of the rectal mucosa, the proximal bowel was replaced into the abdominal cavity, and a TriPort(®) (Olympus Surgical Technologies Europe, Hamburg, Germany) was introduced transanally. Mesenterial resection of the aganglionic bowel was accomplished via transanal LESS until the normoganglionic colon segment was reached and pulled down to the site of anastomosis. After removal of the port, a conventional pull-through procedure was performed. RESULTS All children displayed normal bowel movements and were complication-free during the follow-up period of up to 7 months. CONCLUSIONS TLPC combines the minimally invasive LESS surgery with the scarless concept of NOTES and allows resection of long-segment aganglionosis without abdominal incision. TLPC is a safe, effective, and feasible surgical procedure in children with long-segment intestinal aganglionosis.
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Affiliation(s)
- Mohammad Reza Vahdad
- Department of Pediatric Surgery, Ruhr-University Bochum, Marienhospital Herne, Herne, Germany.
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Cernaianu G, Tannapfel A, Nounla J, Gonzalez-Vasquez R, Wiesel T, Tröbs RB. Appendiceal carcinoid tumor with lymph node metastasis in a child: case report and review of the literature. J Pediatr Surg 2010; 45:e1-5. [PMID: 21034920 DOI: 10.1016/j.jpedsurg.2010.07.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Revised: 07/01/2010] [Accepted: 07/16/2010] [Indexed: 01/15/2023]
Abstract
Most appendiceal carcinoids (ACs) in children present without lymph node metastasis. Lymph node metastasis is rarely present when primary tumor diameter exceeds 1 cm. We present the extraordinary case of an AC with a primary tumor diameter of 0.7 cm and infiltration of the mesentery, as well as 1 positive lymph node of the mesentery in a 14-year-old boy. Besides adding a rare case, we review the data published in the current literature on AC with lymph node metastasis in children and summarize up-to-date guidelines for diagnostic workup, therapy, and follow-up.
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Affiliation(s)
- Grigore Cernaianu
- Department of Pediatric Surgery, Stiftung Katholisches Krankenhaus Marienhospital Herne, Klinikum der Ruhr-Universität Bochum, 44627 Herne, Germany.
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Cernaianu G, Brandmaier P, Scholz G, Ackermann OP, Alt R, Rothe K, Cross M, Witzigmann H, Tröbs RB. All-trans retinoic acid arrests neuroblastoma cells in a dormant state. Subsequent nerve growth factor/brain-derived neurotrophic factor treatment adds modest benefit. J Pediatr Surg 2008; 43:1284-94. [PMID: 18639684 DOI: 10.1016/j.jpedsurg.2008.01.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Revised: 12/03/2007] [Accepted: 01/06/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Therapies aiming at inducing differentiation or apoptosis of neuroblastoma (NB) are an important research topic. Although retinoic acid showed promising antitumoral results, its effects against refractory disease are limited. Putative candidates for combination therapies are nerve growth factor (NGF; Tebu-Bio/Peprotech, Offenbach, Germany) and brain-derived neurotrophic factor (BDNF; Tebu-Bio/Peprotech, Offenbach, Germany) because their receptors are of prognostic clinical value in clinical neuroblastoma. Another clinical prognostic factor is the number of Schwann cells. Substances secreted by Schwann cells proved antitumoral capacities in vitro. The aim of the study was to analyze whether retinoic acid may offer an additional line of attack acting independent from Schwann cells and whether additive treatment with the neurotrophin-receptor ligands NGF/BDNF confers additional benefit. METHODS Human SHSY-5Y NB cells were cultured in vitro. After a 7-day all-trans retinoic acid (ATRA; Sigma-Aldrich Chemie, Taufkirchen, Germany) treatment (15 mumol/L of ATRA), NB proliferation was proportional to extinction in dimethyl-thiazol-diphenyltetrazoliumbromide (MTT) tests. Fluorescence-activated cell sorter (FACS) analysis for annexin and propidium iodide determined the degree of apoptosis and necrosis as well as the expression of the Schwann type cell marker S100. The S100 messenger RNA was assessed by reverse transcriptase polymerase chain reaction. In addition, the effect on NB proliferation was investigated when ATRA was combined with a 7-day treatment with NGF or BDNF (10, 50, 100 ng/mL) either before or after the 7-day ATRA treatment. RESULTS All-trans retinoic acid reduced proliferation (0.116 +/- 0.006 SEM vs 0.359 +/- 0.010 SEM in the untreated control group; P < .001). After ATRA treatment, 95% +/- 1.82% SEM were still viable, with only 2.61% +/- 1.17% SEM apoptotic and 2.38% +/- 0.69% SEM necrotic cells. All-trans retinoic acid induced a remarkable decrease in S100 expression in FACS (16.91% +/- 1.72% SEM vs 32.33% +/- 2.54% SEM in controls; P = .009). The S100 messenger RNA levels were not increased by ATRA (DeltaDeltaT values: 1.73, 2.77, and 1.43; n = 3). Both NGF and BDNF had only a modest synergistic effect when given after ATRA treatment. No effect was seen when they were administered before ATRA treatment. CONCLUSIONS All-trans retinoic proved to be a vigorous inhibitor of NB proliferation in vitro. However, because most NB cells remained viable combination therapies are required. Treatment with NGF and BDNF showed only a modest benefit and did not reflect the strong prognostic impact of tyrosine kinase receptors in clinical NB. The ATRA-induced proliferation arrest is not related to Schwann type subdifferentiation. This suggests that substances secreted by Schwann cells could be possible independent combination partners. We suggest studies using combinations of ATRA and substances secreted by Schwann cells.
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Affiliation(s)
- Grigore Cernaianu
- Department of Pediatric Surgery, Marienhospital II-Kinderchirurgische Klinik der Ruhr-Universität Bochum, Widumerstr 8, 44627 Herne, Germany.
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Tröbs RB, Knüpffer M, Schütz A, Cernaianu G, Hirsch W, Regenthal R. Congenital oesophageal atresia discordant for tracheo-oesophageal fistula occurring in a set of dizygotic twins. Eur J Pediatr Surg 2006; 16:260-4. [PMID: 16981091 DOI: 10.1055/s-2006-924395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The authors present a set of female diamnionic and dichorionic twins with different blood types and congenital oesophageal atresia (EA) in both. Surgical management was successful. It can be assumed that EA with tracheo-oesophageal fistula in twin B occurred during an early embryological stage whereas the isolated EA in twin A was the result of a later event. To our knowledge, this is the first published set of dizygotic twins with different types of EA.
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Affiliation(s)
- R-B Tröbs
- Department of Paediatric Surgery, University of Leipzig Medical Centre, Leipzig, Germany.
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Cernaianu G, Frank S, Erbstösser K, Leonhardt S, Cross M, McIvor Z, Scholz G, Dansranjavin T, Celik I, Tannapfel A, Wittekind C, Troebs RB, Rothe K, Bennek J, Hauss J, Witzigmann H. TNP-470 fails to block the onset of angiogenesis and early tumor establishment in an intravital minimal disease model. Int J Colorectal Dis 2006; 21:143-54. [PMID: 15937694 DOI: 10.1007/s00384-005-0751-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2005] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The angiogenesis inhibitor TNP-470 (AGM-1470) has shown encouraging results in animal models of established tumors. However, results of recent clinical trials using TNP-470 have been disappointing. Since little is known about the effects of TNP-470 at the minimal disease stage, we analyzed the effects of TNP-470 on the early stages of tumor establishment. METHODS Twenty thousand green fluorescent protein (GFP)-transfected murine CT-26 (colonic carcinoma) or Panc-02-H0 (pancreatic adenocarcinoma) cells were inoculated in dorsal skin-fold chambers in BALB/c or C57BL6 mice. Tumor area and microvessel density (MVD) were quantified by intravital microscopy (IVM). Body weight was also monitored. Effects were compared with those in a conventional model involving subcutaneous (s.c.) inoculation of 10(6) tumor cells, followed by measurement of tumor volume, endogenous plasma VEGF/endostatin (ELISA) and proliferation/apoptosis/microvessel density (Ki-67/TUNEL/CD-34). TNP-470 was injected s.c. over the 10-day experimental period (30 mg/kg every 2 days [n=6] to 100 mg/kg/day [n=5 dorsal skin-fold chamber model, n=4 s.c. tumor model]). RESULTS At 30 mg/kg/every second day neither CT-26 nor PANC-02-H0 tumors were inhibited in neither of the two models. TNP-470 dosage was escalated in CT-26-bearing animals until an antiangiogenic effect could be observed. In the IVM model, only TNP-470 100 mg/kg/day reduced MVD (P=0.006), but failed to block the onset of angiogenesis and tumor area increase. Body weight decreased by 25% (P<0.05). In the subcutaneous tumor model, tumor growth was reduced (P=0.045) but not blocked, while vascular endothelial growth factor (VEGF)/endostatin synthesis and Ki67/TUNEL/CD-34 were not significantly affected. CONCLUSION While capable of reducing tumor growth in a conventional model, treatment with TNP-470 does not block the onset of angiogenesis and tumor establishment in a model of minimal disease. When used as a single agent TNP-470 does not control minimal tumor disease in experimental colonic carcinoma.
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MESH Headings
- Angiogenesis Inhibitors/pharmacology
- Animals
- Carcinoma/blood supply
- Carcinoma/drug therapy
- Carcinoma/pathology
- Cell Proliferation/drug effects
- Colonic Neoplasms/blood supply
- Colonic Neoplasms/drug therapy
- Colonic Neoplasms/pathology
- Cyclohexanes/pharmacology
- Endothelium, Vascular/drug effects
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/pathology
- Humans
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Neoplasms, Experimental/blood supply
- Neoplasms, Experimental/drug therapy
- Neoplasms, Experimental/pathology
- Neovascularization, Pathologic/metabolism
- Neovascularization, Pathologic/pathology
- Neovascularization, Pathologic/prevention & control
- O-(Chloroacetylcarbamoyl)fumagillol
- Pancreatic Neoplasms/blood supply
- Pancreatic Neoplasms/drug therapy
- Pancreatic Neoplasms/pathology
- Sesquiterpenes/pharmacology
- Treatment Failure
- Vascular Endothelial Growth Factor A/metabolism
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Affiliation(s)
- Grigore Cernaianu
- Department of Pediatric Surgery, University of Leipzig, 04317, Leipzig, Germany.
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Geyer C, Cernaianu G, Graefe G. Hydrostatic valves in treatment of paediatric hydrocephalus. Cerebrospinal Fluid Res 2005. [DOI: 10.1186/1743-8454-2-s1-s36] [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: 11/10/2022] Open
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22
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Steinbauer M, Guba M, Cernaianu G, Köhl G, Cetto M, Kunz-Schughart LA, Geissler EK, Falk W, Jauch KW. GFP-transfected tumor cells are useful in examining early metastasis in vivo, but immune reaction precludes long-term tumor development studies in immunocompetent mice. Clin Exp Metastasis 2003; 20:135-41. [PMID: 12705634 DOI: 10.1023/a:1022618909921] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
To develop effective therapeutic strategies aimed at treating tumor metastasis, critical steps in this process must be better understood. For this purpose we have established a new model to visualize and quantify early metastasis. Murine CT-26 colon adenocarcinoma cells were stably transfected with green fluorescent protein (GFP). Tumor cells were intraportally delivered to the liver of Balb/c mice and subsequently tracked by intravital fluorescence microscopy. Coinjection of fluorescent beads and in vivo propidium iodide staining allowed examination of initial tumor cell arrest, extravasation, viability and proliferation. Results showed that GFP-transfection compared to conventional labeling procedures (Calcein, cytoplasmic microspheres) did not alter early metastatic properties. However, the long-term development of liver metastases expressing GFP was markedly reduced compared to wild type CT-26 tumor cells. An increase in the size and the number of liver metastases in T- and B-cell-deficient SCID mice suggested an immune response to the GFP transfected cells responsible for the reduced metastatic growth in wild-type mice. Based on our findings, this model can be used to examine the early steps of metastasis in vivo. However, in immunocompetent mice, the use of GFP-labeled tumor cells should be limited to tracking cell arrest and extravasation, whereas evaluations of long-term metastatic growth should be performed in immunodeficient mice.
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Hehlgans T, Stoelcker B, Stopfer P, Müller P, Cernaianu G, Guba M, Steinbauer M, Nedospasov SA, Pfeffer K, Männel DN. Lymphotoxin-beta receptor immune interaction promotes tumor growth by inducing angiogenesis. Cancer Res 2002; 62:4034-40. [PMID: 12124338] [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: 02/25/2023]
Abstract
Growth of solid fibrosarcoma tumors in mice was inhibited by the release of a solublelymphotoxin-beta receptor inhibitor (LTbetaR-immunoglobulin fusion protein) from the tumor cells. Tumor growth arrest in mice deficient in the ligand LTalpha1beta2 demonstrated the requirement for activation of the LTbetaR on the tumor cells by host cell-derived LTalpha1beta2. Activation of the LTbetaR resulted in enhanced release of macrophage inflammatory protein-2. Blocked angiogenesis was revealed in LTbetaR inhibitor-producing tumor nodules by immunohistochemistry and in vivo microscopy. The growth arrest of LTbetaR inhibitor-producing fibrosarcomas was overcome by forced MIP-2 expression in the tumor cells. Thus, LTbetaR activation on tumor cells by activated host lymphocytes can initiate a novel proangiogenic pathway leading to organized tumor tissue development.
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Affiliation(s)
- Thomas Hehlgans
- Department of Pathology/Tumor Immunology, University of Regensburg, D-93042 Regensburg, Germany
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Guba M, Cernaianu G, Koehl G, Geissler EK, Jauch KW, Anthuber M, Falk W, Steinbauer M. A primary tumor promotes dormancy of solitary tumor cells before inhibiting angiogenesis. Cancer Res 2001; 61:5575-9. [PMID: 11454710] [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: 02/20/2023]
Abstract
Mechanisms that regulate the transition of micrometastases from clinically undetectable and dormant to progressively growing are critically important but poorly understood in cancer biology. Here we examined the effect of a primary tumor on the growth of solitary tumor cells in the mouse liver, as well as on the development of tumor angiogenesis in a dorsal skin-fold chamber. s.c. placement of a CT-26 (BALB/c-derived mouse colon carcinoma) primary tumor markedly inhibited development of liver metastasis in BALB/c mice after subsequent intraportal injection of tumor cells. Dorsal skin-fold chamber experiments showed that this growth inhibition paralleled a strong antiangiogenic effect by the primary tumor. Furthermore, intravital microscopy of the liver after intraportal injection of green fluorescent protein-expressing tumor cells showed that primary tumors promoted dormancy of single tumor cells for up to 7 days. Immunohistological staining for Ki-67 confirmed that these solitary cells were indeed dormant. In contrast, in the absence of a primary tumor, GFP-expressing tumor cells quickly developed into micrometastases. Thus, primary CT-26 tumor implants nearly abrogated tumor metastasis by inhibition of angiogenesis and by promoting a state of single-cell dormancy. Knowledge of the mechanism underlying this dormancy state could result in the development of new therapeutic tools to fight cancer.
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MESH Headings
- Animals
- Blood Vessels/pathology
- Green Fluorescent Proteins
- Immunohistochemistry
- Ki-67 Antigen/analysis
- Luminescent Proteins/genetics
- Luminescent Proteins/metabolism
- Male
- Mice
- Mice, Inbred BALB C
- Mice, SCID
- Neoplasm Metastasis/prevention & control
- Neoplasms, Experimental/genetics
- Neoplasms, Experimental/metabolism
- Neoplasms, Experimental/pathology
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/metabolism
- Neoplasms, Second Primary/pathology
- Neovascularization, Pathologic/prevention & control
- Recombinant Fusion Proteins/genetics
- Recombinant Fusion Proteins/metabolism
- Time Factors
- Tumor Cells, Cultured
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Affiliation(s)
- M Guba
- Department of Surgery, University of Regensburg, D-93042 Regensburg, Germany.
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Neuhof C, Soeffker G, Cernaianu G, Dapper F, Tillmanns H, Neuhof H. Effect of bradykinin B2-receptor antagonism on post-ischemic coronary reperfusion. Immunopharmacology 1997; 36:179-83. [PMID: 9228544 DOI: 10.1016/s0162-3109(97)00019-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Isolated rabbit hearts in a modified Langendorff preparation were used to study the role of bradykinin B2-receptor antagonism on recovery from cardiac ischemia. The experiments were performed to clarify a potential risk of administrating BK-receptor antagonists in patients with coronary heart disease and patients undergoing heart surgery. The hearts were perfused in an open system at a constant pressure of 70 mm Hg and at a constant temperature of 37 degrees C with Krebs-Henseleit-buffer solution containing 6.5% HAES (hydroxyethyl-amylopectin) and 10 mmol Na-pyruvate/l. The perfusate was equilibrated to a PO2 of about 500-600 mm Hg. After a steady state period of 30 min, coronary perfusion was stopped for 30 min and the hearts were subsequently reperfused for further 30 min. Pretreatment with the B2-receptor antagonist, CP-0127, significantly increased (p < 0.001) the coronary vascular resistance during reperfusion from 31.9 +/- 2.1 to 59.0 +/- 6.5 mm Hg/ml/min/10 g wt and decreased the left ventricular pressure amplitude to 44.0 +/- 15.2% (p < 0.005) of it's baseline. When ischemia was combined with hyperkalaemic cardioplegia, CP-0127 did not influence coronary vascular resistance, but depressed, only to a minor degree, left ventricular pressure amplitude to 65.1 +/- 15.4% (p < 0.005) during reperfusion. Arrhythmias during reperfusion with cardiac arrest occurred only in 2 hearts with B2-receptor inhibition when ischemia was not combined with cardioplegia. Dependent on the initial functional status of the heart B2-receptor inhibition impaired recovery from acute coronary ischemia by increasing the coronary vascular resistance and depressing the myocardial function and therefore may constitute a risk in patients undergoing heart surgery and extracorporeal circulation.
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Affiliation(s)
- C Neuhof
- Department of Internal Medicine, Justus-Liebig-University, Giessen, Germany
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Fiel MI, Cernaianu G, Burstein DE, Batheja N. Value of GCDFP-15 (BRST-2) as a specific immunocytochemical marker for breast carcinoma in cytologic specimens. Acta Cytol 1996; 40:637-41. [PMID: 8693878 DOI: 10.1159/000333931] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The diagnosis of metastatic mammary carcinoma by morphologic criteria alone can be difficult, depending on the site of metastasis and state of cell differentiation. Numerous histopathologic studies have shown GCDFP-15 (BRST-2) to be a specific marker for breast cancer in surgical specimens. To date, no studies have been done to evaluate its utility in cytologic preparations. STUDY DESIGN To evaluate the usefulness of GCDFP-15 as a marker in the cytologic diagnosis of breast carcinoma, we studied 23 cases of mammary carcinoma and compared them with 20 cases of tumors of nonmammary origin (lung, ovary, liver, colon, stomach and bladder). "Bench top" fine needle aspirates from unfixed surgical specimens of breast carcinoma, cytocentrifuge samples from body cavity fluids and cerebrospinal fluids with morphologically proven metastatic carcinoma were studied. RESULTS Expression of BRST-2 was found in 56.5% of primary and recurrent or metastatic breast carcinomas. All the nonmammary carcinomas studied were negative. Staining was found to be strongly dependent on the means of cell fixation. Slides fixed in 10% formalin and Bouin's solution gave optimal results. Except in two cases, which showed focal immunostaining, all specimens fixed in alcohol were negative. CONCLUSION Our results support the diagnostic value of GCDFP-15 in recognizing tumors of breast origin and suggest that in clinical situations in which metastatic breast carcinoma is suspected, a portion of the cytologic specimen should be fixed with an optimal fixative for BRST-2 detection.
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Affiliation(s)
- M I Fiel
- Department of Pathology, Mount Sinai Medical Center, New York, New York 10029, USA
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