[Sequential therapy concept in choledocholithiasis]

Of 4023 Patients with gallstone disease, 124 were treated for common bile duct stones by endoscopy (ERC/EPT). Stone clearance was completed in 81% of the patients. Due to a morbidity of 5.9% and a mortality of 0.6%, the concept of preoperative ERC followed by laparoscopic cholecystectomy seems to reduce risk for the patients.

[Ligation of the cystic duct--experience in 1,750 laparoscopic cholecystectomies]

Between 3/1990-3/1993 laparoscopic cholecystectomy was performed in 1750 patients in the mean age of 49.8 (7-83). In 48 patients (2.7%) the procedure had to be shifted to open surgery. The overall complication rate was 3.9%, the mortality 0.11%. The PDS-clip Absolok 300 was regularly used for occluding the cystic duct and the cystic artery. Clip-associated complications were never observed. The induced duct occlusion proved save even against operative manipulation. But special characteristics of the clip and its application had to be considered.

[Radioimmunoscintigraphy of colorectal tumors with 99m-Tc marked CEA antibodies. Indications and clinical value]

In Germany, radioimmunoscintigraphy (RIS) (scintigraphic, specific imaging of benign and malignant diseases by radioactively labelled monoclonal antibodies) has been employed since 1985 in clinical trials involving patients with colorectal cancer. After proving successful for identifying primary tumors, RIS is now increasingly being used for the early diagnosis of recurrent and metastatic lesions. In this prospective study involving 75 patients with colorectal tumors confirmed by endoscopy and biopsy, it was shown that RIS using the SPECT technique with 99m-Tc-labelled monoclonal CEA antibodies has a sensitivity of 78% in the detection of local recurrent disease in cases in which diagnostic work-up has been inconclusive.

[The value of radioimmunoscintigraphy compared to computed tomography in the diagnosis and relapse diagnosis of colorectal tumors]

Radioimmunoscintigraphy (= RIS, scintigraphic "specific" imaging of benign and malignant diseases by means of radioactively marked monoclonal antibodies) has been performed in Germany in clinical studies since 1985 in patients suffering from colorectal cancer. After having been successfully proven in primary studies, RIS is now being used in the early diagnosis of recurrences and metastases. In the prospective study presented here the clinical usefulness of RIS was assessed in comparison against well-tried diagnostic methods including computed tomography in patients suffering from colorectal cancer. It was shown that RIS in SPECT technique (= single photon emission computed tomography) with 99mTc-labelled monoclonal CEA antibodies can visualise local recurrences if diagnostic findings are doubtful, with a sensitivity of 78% versus 50% for CT findings.

Accumulation characteristics of human colon carcinomas after monoclonal antibody ex vivo perfusion

Human colon carcinomas were operatively resected and the tumour-bearing segments interposed into an oxygenised ex vivo perfusion system. Pressure, flow, temperature, pH and metabolic parameters were controlled. Over a period of 45 min the 131I-labelled monoclonal antibody AUA1 was administered and its distribution in the tumour tissue analysed scintigraphically. The accumulated activity was determined in different tissues. The results showed that the AUA1 uptake increased with the degree of histological tumour differentiation. The main tumour:non-tumour ratio reached 0.8 in poorly, 4.1 in moderately and 5.9 in highly differentiated adenocarcinomas. Introducing the oxygenised erythrocyte-enriched perfusion media significantly increased the viability of the colon tissue. The ex vivo perfusion system will help to analyse factors determining monoclonal antibody accumulation in human colon carcinomas.