Background. The formation of sporadic abdominal aortic aneurysm (AAA) is explained by remodeling of the extracellular matrix (ECM) and breakdown of structural components of the vascular wall. Matrix metalloproteinase 2 (MMP2) is one of the principal matrix-degrading proteases and is known to play a major role in the remodeling of the extracellular matrix in arterial vessels. Increased MMP2 expression in the extracellular matrix of the walls of AAAs has been shown in several studies. To investigate the possible impact of genetic variants of the MMP2 gene in the etiology of AAA, we conducted this case-control study.Patients and methods. We analyzed MMP2 single-nucleotide polymorphisms (SNPs) in 51 patients with AAA and 48 controls. Differences in genotype and allele frequencies of identified polymorphisms were determined after sequencing the entire coding region and three selected parts of the promoter.Results. Eighteen polymorphisms were identified, 6 of which are newly described, with 3 located in the introns (c.IVS1+31C > G, c.IVS7-18G > A, c.IVS10+26C > T) and 3 located in the coding region (c.124G > A, c.1368C > T, c.1860C > T). There were no statistically significant differences in genotype or allele frequencies between the two groups.Conclusions. Our analysis of the entire coding region and three parts of the promoter of the MMP2 gene failed to show an association between genetic polymorphisms and AAA, suggesting that variations in the MMP2 gene do not contribute to the development of AAA. (c) 2006 Elsevier Inc. All rights reserved.

Background: To investigate in vitro how downstream perfusion parameters influence pulsatility index (PI), resistance index (RI) and their constituting Doppler velocities. Materials and methods: We analyzed the influence of resistance, compliance, reflection coefficient and input impedance on PI and RI in an in-vitro model of arterial flow. Results: The nominators of PI and RI were determined by resistance. The numerators were determined by compliance and by the reflection coefficient. There were close relationships of PI and RI with resistance under the condition of constant compliance, but not when compliance was variable. Conclusion: PI and RI consist of velocity terms which are independently influenced by different parameters of impedance: compliance, reflection coefficient and resistance. These findings explain the contradictory results reported for the relationship between the indices and peripheral resistance in studies where compliance and reflection effects were not considered.

Background: Pancreatic cancer is one of the leading causes of cancer-related death. Using DNA gene expression analysis based on a custom made Affymetrix cancer array, we investigated the expression pattern of both primary and established pancreatic carcinoma cell lines. Methods: We analyzed the gene expression of 5 established pancreatic cancer cell lines (AsPC-1, BxPC-3, Capan-1, Capan-2 and HPAF II) and 5 primary isolates, 1 of them derived from benign pancreatic duct cells. Results: Out of 1,540 genes which were expressed in at least 3 experiments, we found 122 genes upregulated and 18 downregulated in tumor cell lines compared to benign cells with a fold change > 3. Several of the upregulated genes (like Prefoldin 5, ADAM9 and E-cadherin) have been associated with pancreatic cancer before. The other differentially regulated genes, however, play a so far unknown role in the course of human pancreatic carcinoma. By means of immunohistochemistry we could show that thymosin [β-10 (TMSB10), upregulated in tumor cell lines, is expressed in human pancreatic carcinoma, but not in non-neoplastic pancreatic tissue, suggesting a role for TMSB10 in the carcinogenesis of pancreatic carcinoma. Conclusion: Using gene expression profiling of pancreatic cell lines we were able to identify genes differentially expressed in pancreatic adenocarcinoma, which might contribute to pancreatic cancer development.

Gene expression profiling revealed ADAM9 to be distinctly overexpressed in pancreatic ductal adenocarcinoma (PDAC). We examined the relevance of ADAM9 expression in PDAC diagnosis and prognosis. A total of 59 infiltrating PDACs, 32 specimens from patients with chronic pancreatitis, 11 endocrine tumours and 24 acinar cell carcinomas were immunohistochemically analysed for ADAM9 expression. Staining for ADAM9 was detected in 58 out of 59 (98.3%) PDACs and in two out of 24 (8.3%) acinar cell carcinomas, but not in endocrine tumours. In the non-neoplastic pancreas, whether normal or chronically inflamed, ADAM9 was expressed in centroacinar and intralobular duct cells, but not in interlobular duct cells and their hyperplastic lesions. Pancreatic ductal adenocarcinomas showing cytoplasmic ADAM9 expression correlated with poor tumour differentiation and also with shorter overall survival than in cases showing only an apical membranous staining pattern ( P =0.001). Multivariate analysis identified cytoplasmic ADAM9 expression as an independent marker of shortened survival in a set of 42 curatively (R0) resected PDAC ( P <0.05, hazard ratio 2.85, 95% confidence interval: 1.21–6.71). The results show that ADAM9 expression distinguishes PDACs from other solid pancreatic tumours. In addition, cytoplasmic ADAM9 overexpression is associated with poor differentiation and shortened survival. Therefore, ADAM9 overexpression might contribute to the aggressiveness of PDACs.

Both straight and tapered arterial grafts are commonly used for infragenicular bypass surgery. Opinions vary considerably regarding the use of each type of graft and depend on individual experience, as no trial yet has assessed clinical outcomes comparing both groups. We conducted a prospective, multicenter, cohort study to analyze results for each graft type. From a total of 81 patients, 50 underwent infragenicular bypass surgery with straight PTFE prostheses and 31 with tapered prostheses in a prospective, multicenter trial. Six different centers for vascular surgery took part in the trial. In clinical follow-up at discharge as well as 3, 6, 12, 18, 24, and 36 months after revascularization, various parameters were evaluated comparing patency rates, limb salvage, and major amputation rates. Significant differences were found in limb salvage rates between the two groups. Patients receiving a straight graft fared better in this regard. Further data suggest that short-term primary patency is also improved in straight prostheses. Sixty-four percent of these remained patent after 1 year, while only 50% of tapered prostheses were still patent. No differences between the groups were found for secondary patency. The advantages of straight prostheses seem to be reduction of thrombus formation and intimal hyperplasia. Furthermore, it appears that the surgeons participating in this study prefer the use of straight prostheses. Even though the group of patients that received tapered grafts had slightly more unfavorable preoperative conditions, the data still support the superiority of straight vascular grafts. However, prospective randomized trials are necessary to evaluate the benefit of different bypass designs definitively.

ruptured abdominal aortic aneurysm (RAAA) is not well-documented.Patients and methods. The records of all patients from 1993 to 2000 who underwent resection of RAAA were reviewed. Survival data were calculated from direct contact with the patients or follow-up records. All patients who were alive at the time of our study were invited to participate in follow-up investigations. They received the internationally comparable WHO-QOL-BREF-test.Results. In a period of 7 years, 80 patients underwent surgery for RAAA. The average follow-up time was 5.1, years (1-7.9 years). Our data show that 51% of our patients died within 6 months postoperatively because of the complications of the aortic rupture (in-hospital mortality 39%). Patients who survived the first 6 months after surgery died for the same reasons as the normal population. However, patients who were younger than 75 at the time of RAAA had a higher relative survival rate than a matched sample of the population. There was no significant difference in the quality of life between the study group and the general population.Conclusions. RAAA survivors had no difference in long-term survival as compared to the general population and also had very few long-term complications. The WHOQOL-BREF-test suggests that the quality of life of survivors of RAAA is similar to the general population.

AIMS:The aim of this study was the evaluation of early results of esophageal resection for cancer including the assessment of pre-operative risk factors and post-operative mortality (risk score developed by Barthels et al. 1998).METHODS:One hundred and eighty one patients with esophageal cancer were operated with curative intention between October 1993 and December 2002. In a prospective analysis were reviewed: patient characteristics, characteristics of the esophageal cancer, part and type of esophageal resection, radicality, complications and mortality.CONCLUSION:In total, a resection of the tumor could be achieved in 143 cases (79.0%). The overall complication rate was 52.5%, mainly cardio-pulmonary complications (25.9%) were seen. The surgical complications were determined by anastomotic leak (12.6%) and recurrent nerve injury (9.1%). Both types of complications were observed significantly more often after esophageal resection with a cervical anastomosis (p = 0.03 and p < 0.01). The hospital mortality was 8.4%. The 30 days mortality was 4.9%. Using a preoperative risk score retro- and prospectively, our data showed a lower mortality in patients with a low risk profile (2.4% and 2.3%) compared to those with a medium risk profile (7.4% and 6.4%). The only patient with a high risk profile died after resection.DISCUSSION AND SUMMARY:The results of this analysis show that resection of esophageal cancer can be accomplished with acceptable morbidity and mortality. However, it has to be taken into account that the increase of pre-operative factors leads to an increase in post-operative mortality.

Pancreatic ductal adenocarcinoma (PDAC) remains an important cause of malignancy related death. Despite recent progress in understanding the molecular basis of PDAC, further studies are needed to find new molecular markers for diagnostic and therapeutic purposes. We have studied the mRNA-expression profile of microdissected PDAC, of microdissected normal pancreatic duct cells, of one primary normal pancreatic cell line, and of 5 established pancreatic cancer cell lines. We applied DNA microarray technology with a custom made Affymetrix Chip containing 6117 probesets representing 3300 genes among them 1000 known tumor-associated genes. Hierarchical clustering revealed 92 differentially expressed genes in 4 main clusters (upregulated in normal ductal cells: 30 genes; upregulated in normal and cancerous pancreatic tissue versus cell lines: 23 genes; upregulated in PDAC and tumor cell lines versus normal ductal cells: 19 genes; upregulated in cell lines versus primary tissue: 20 genes). Within the 92 genes, 16 were found to represent human genes known to be implicated in tumorigenesis of PDAC. 30 genes have been known in other tumor entities. The remaining 46 genes may represent a valuable source to identify novel tumor suppressor and oncogenes involved in the carcinogenesis of PDAC.

A 51-year-old man was admitted urgently with a 3 week history of back pain. Clinical examination revealed a tender abdomen and a temperature of 39 8C. There was a leucocytosis of 15 900. An abdominal CT scan was immediately performed and this confirmed the presence of a saccular abdominal aortic aneurysm. Because of the presence of retroperitoneal extravasation and a probable rupture, a laparotomy was performed. During para-aortic dissection a large abscess arising from the back of the aorta was found. There was a 25 mm perforation of the aorta which extended up to the left renal artery (Fig. 1). The aorta was resected obliquely above the abscess, preserving the right renal artery. The left renal artery had to be ligated. After debridement the surgical area was filled with omentum. In order to restore the blood circulation distally, we implanted a 6 mm PTFE axillobifemoral bypass. A microbiological swab taken during the procedure grew salmonella enteritidis. About three weeks later the patient suddenly developed acute abdominal pain. A CT scan showed and extended septic aneurysm which had developed around the aortic stump although the patient was on continuous treatment with metronidazole and a cephalosporin. Subsequent surgical revision revealed an infected 10 cm £ 10 cm pulsatile aneurysm surrounding the site of resection of the aorta (Fig. 1). During the following operation the aorta was resected above the celiac trunk and the visceral circulation was restored through an aorto-coeliac bypass using saphenous vein. The right renal blood supply was reestablished through a saphenous vein interposition between the right renal artery and the aorta (Fig. 2). The aneurysm cavity was opened and drained. A further laparotomy performed two days later in order to assess the blood supply of the gastrointestinal tract was satisfactory. After 65 days of ICU treatment complicated because of a protracted pseudomonas pneumonia and 93 days of hospitalisation the patient was discharge home. Antibiotic therapy was stopped three weeks after discharge. Five months later the patient was admitted as an emergency and operated on for disseminated peritonitis caused by multiple small ischaemia-induced perforations in the ascending colon. An intraoperative swab grew the same serotype of salmonella enteritidis as before, and an endogenous reinfection was diagnosed. A right hemicolectomy was performed and because of the poor intestinal blood supply, an EJVES Extra 5, 92–94 (2003) doi: 10.1016/S1533-3167(03)00030-X, available online at http://www.sciencedirect.com on

Bereits in gefäßchirurgischen Lehrbüchern wird auf das gehäufte Auftreten von Leisten- und Hodenbrüchen bei Patienten mit abdominalem Aortenaneurysma hingewiesen, ohne eine Erklärung dafür zu liefern.

Variante Genexpressionsmuster der Matrix Metalloproteinase-2 (MMP-2) in Aneu-rysmawänden von Betroffenen im Vergleich zu Normalgewebe aus der Normalpopulation sind Hinweise, dass neben exogenen Faktoren auch endogene Ursachen für sporadische Aortenaneurysmen bedeutsam sind. Durch ein Ungleichgewicht zwischen Proteinasen und Proteinase-Inhi-bitoren kommt es zu einer vermehrten Proteolyse mit nachfolgender Schwächung der Gewebetextur. Auf der Basis dieser Beobachtung formulierten wir die Hypothese, dass die Entstehung sporadischer Aortenaneurysmen mit genetischen Varianten des für die MMP-2 codierenden Genes und seines Promotors assoziiert ist. Ziel war es durch eine komplette Sequenzanalyse der codierenden und der Promotorregion des MMP-2 Genes, Genvarianten zu identifizieren. Allel-und Genotypfrequenzen wurden in einer Gruppe von Patienten mit Bauchaortenaneurysmen bestimmt und mit einer Kontrollgruppe verglichen, um eine Assoziation mit dem jeweiligen Phänotyp und eventuelle genotypische Überlappungen aufzuzeigen. Relevante Nebendiagnosen wurden parallel dazu erfasst.

In einer derzeit durchgeführten Untersuchung sollen die Lebensqualität nach elektiver chirurgischer Versorgung von Aortenaneurysmen mit der Lebensqualität nach überlebten rupturiertem Aortenaneurysma vorgestellt werden.

AIMSThe aim of this study was the evaluation of early results of esophageal resection for cancer including the assessment of pre-operative risk factors and post-operative mortality (risk score developed by Barthels et al. 1998).METHODSOne hundred and eighty one patients with esophageal cancer were operated with curative intention between October 1993 and December 2002. In a prospective analysis were reviewed: patient characteristics, characteristics of the esophageal cancer, part and type of esophageal resection, radicality, complications and mortality.CONCLUSIONIn total, a resection of the tumor could be achieved in 143 cases (79.0%). The overall complication rate was 52.5%, mainly cardio-pulmonary complications (25.9%) were seen. The surgical complications were determined by anastomotic leak (12.6%) and recurrent nerve injury (9.1%). Both types of complications were observed significantly more often after esophageal resection with a cervical anastomosis (p = 0.03 and p < 0.01). The hospital mortality was 8.4%. The 30 days mortality was 4.9%. Using a preoperative risk score retro- and prospectively, our data showed a lower mortality in patients with a low risk profile (2.4% and 2.3%) compared to those with a medium risk profile (7.4% and 6.4%). The only patient with a high risk profile died after resection.DISCUSSION AND SUMMARYThe results of this analysis show that resection of esophageal cancer can be accomplished with acceptable morbidity and mortality. However, it has to be taken into account that the increase of pre-operative factors leads to an increase in post-operative mortality.

Zielsetzung: Das Ziel der Untersuchung war die Erfassung der Fruhergebnisse nach Osophagusresektion wegen Karzinom einschliesslich der Beurteilung des Zusammenhangs von praoperativen Risikofaktoren und postoperativer Letalitat (Risikoscore nach Barthels et al. 1998). Methode: Von Oktober 1993 bis Dezember 2002 wurde bei 181 Patienten mit Osophaguskarzinom eine Operation unter kurativem Ansatz durchgefuhrt. In einer prospektiven Analyse wurden Patientendaten, Charakteristika der Osophaguskarzinome, Anteil und Art der Osophagusresektion, Radikalitat, Komplikationen und Letalitat erfasst. Ergebnisse: Insgesamt konnte in 143 Fallen (79.0%) eine Resektion der Osophaguskarzinome durchgefuhrt werden. Die Komplikationsrate betrug 52.5%, wobei kardio-pulmonale Komplikationen (25.9%) im Vordergrund standen. Die chirurgischen Komplikationen wurden von der Anastomoseninsuffizienz (12.6%) und der Rekurrensparese (9.1%) bestimmt. Beide Komplikationen wurden signifikant gehauft nach Oesophagusresektion mit zervikaler An...

Neuron-specific enolase and beta-human chorionic gonadotropin are serum markers frequently found associated with germ cell tumors. To our knowledge, we report the first case of a malignant fibrous histiocytoma producing both markers and discuss the significance of this unusual condition in the differential diagnosis of retroperitoneal tumors.

Background: There is increasing knowledge about the genetic basis of pancreatic cancer (PaCa). Tumor suppressor genes (TSGs; e.g. p53 and DPC4) and oncogenes (e.g. K-ras) have been shown to be involved in the development of PaCa. However, the extent of chromosomal changes (gains and losses) implicates that many more genes may be involved in the multistep progression of PaCa. Identification of these genes is essential for understanding the molecular events in the development of PaCa. Methods: We assembled public and proprietary libraries of more than 4 million expressed sequence tags using newly developed software tools. Results: We identified a total of 249 genes with specific expression patterns in normal and cancerous tissue of the pancreas. Of these, 27 genes were found to be preferentially expressed in normal tissue of the pancreas, while 222 genes showed significant upregulation of expression in PaCa. Of the 249 genes, 232 (93.2%) were found to represent known human genes or putative human homologues of genes characterized previously in other species, while 17 (6.8%) represent putative new genes. Conclusion: These genes may represent a valuable source to identify novel TSGs and oncogenes involved in the carcinogenesis of PaCa.

Hyperparathyroidism is no longer considered an uncommon endocrinopathy. Between 1994 and 2002, 138 patients underwent neck exploration for primary hyperparathyroidism at the Department for Surgery in the University Hospital of Dresden. Common reasons for operation failure are usually hyperplasia or remnant parathyroid tissue, inadequate parathyroidectomy at initial operation or the occurrence of abnormal hyperfunctioning supernumerary glands. To reduce the operation time, as well as the failure rate that accompanies the incomplete excision of hypersecreting parathyroid tissue, we perform an intraoperative monitoring of parathyroid hormone with an immunochemiluminometric assay (Nichols Advantagetrade mark Intact PTH). With modification of this assay, it was possible to perform the assay in the operating theatre and to attain the hormone values within 10 min. In all cases of successful operation with excision of the adenomatous parathyroid gland the PTH values declined to under 20 percent of the initial intraoperative PTH values. Our results declare the intraoperative parathyroid hormone monitoring as a cost-effective method to control the effect of surgical treatment.

During 1993 to 2000 85 patients were treated for a ruptured abdominal aortic aneurysm. The average age of the patients was 72.4 years (46-90). 71 patients showed an infrarenal rupture and the remaining 14 a suprenal rupture. 76 of 85 cases were covered ruptures. All patients were operated upon. A tube graft was required in 43 cases and 31 needed a bifurcated graft. In further two cases an extraanatomical bypass was necessary due to a mycotic aneurysm. The operation on 11 patients could not be completed and 21 patients died in hospital during the postoperative period. On the other hand, 53 patients suvived the rupture of the aneurysm. The mortality rate was 37.6%. The early non-surgical complications dominated during the postoperative period. Respiratory failure, renal failure and cardiac failure were responsible for the mortality rate. It is unforseeable which patients will survive the emergency operation. Therefore it is always appropriate to attempt the reconstruction of an acutely ruptured AAA.

The acute abdomen comprises a variety of diagnoses and represents a working hypothesis. The leading symptoms are: 1, Strong abdominal pain 2.a guarding tenderness and 3.a disturbed peristalsis. A good anamnesis and clinical examination are the basis to a quick and reliable diagnosis. The features and localization of the pain and the finding of a guarding tenderness lead the direct way to diagnosis. A collection of laboratory values and an ultrasound examination complete the basic diagnostic measures. The way of decision making now has the alternatives either to operate or to have more time for additional diagnostic measures. Although the working diagnosis acute abdomen implicates a need for action, the majority of the patients coming with this diagnosis can be treated conservatively. The art of decision making is the quick differentiation between these alternatives.