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Background: The present study aims to evaluate the long-term outcome and metastatic pattern of patients who underwent resection of a pancreatic ductal adenocarcinoma (PDAC) with portal or superior mesenteric vein (PV/SMV) resection., Methods: Patients who underwent a partial pancreatoduodenectomy or total pancreatectomy for PDAC between 2005 and 2015 were retrospectively analyzed. Three subgroups were generated, depending on PV/SMV resection (P + ) and pathohistological PV/SMV tumor infiltration (I + ): P + I + , P + I - , and P - I - . Statistical analysis was performed using the R software package., Results: The study cohort included 179 patients, 113 of whom underwent simultaneous PV/SMV resection. Thirty-six patients (31.9 %) had pathohistological tumor infiltration of the PV/SMV (P + I + ), and were matched with 66 cases without PV/SMV infiltration (P - I - ). The study revealed differences in overall median survival (11.9 [P + I + ] vs. 16.1 [P + I - ] vs. 20.1 [P - I - ] months; p = 0.01). Multivariate survival analysis identified true invasion of the PV/SMV as the only significant, negative prognostic factor (p = 0.01). Whereas the incidence of local recurrence was comparable (p = 0.96), the proportion of patients with distant metastasis showed significant differences (75 % [P + I + ] vs. 45.8 % [P + I - ] vs. 54.7 % [P - I - ], p = 0.01). Furthermore, the median time to progression was significantly shorter if the PV/SMV was involved (7.4 months [P + I + ] vs. 10.9 months [P + I - ] vs. 11.6 months [P - I - ]). Initial liver metastases occurred in 33 % of the patients., Conclusions: True invasion of the PV/SMV is an independent risk factor for overall survival, and is associated with a higher incidence of distant metastasis and shorter progressive-free survival. Radical vascular resection cannot compensate for aggressive tumor biology.

Infectious agents are likely to play a role in the pathogenesis of chronic inflammatory diseases, including abdominal aortic aneurysms (AAAs). The goal of this study was to determine if Borrelia burgdorferi sensu lato (sl), a microorganism responsible for Lyme disease, is involved in the etiology of AAAs. The presence of serum antibodies against B. burgdorferi sl was measured with enzyme-linked immunosorbent assay (ELISA) and confirmed by Western blotting in 96 AAA and 108 peripheral artery disease (PAD) patients. Polymerase chain reaction (PCR) was used for the detection of Borrelia-specific DNA in the aneurysm wall. Among AAA patients 34% and among PAD patients 16% were seropositive for B. burgdorferi sl antibodies (Fisher's exact test, p = 0.003; odds ratio [OR] 2.79; 95% confidence interval [CI] 1.37-5.85). In the German general population, 3-17% are seropositive for Borrelia antibodies. No Borrelia DNA was detected in the aneurysm wall. Our findings suggest a relationship between AAAs and B. burgdorferi sl. We hypothesize that the underlying mechanism for B. burgdorferi sl in AAA formation is similar to that by the spirochete Treponema pallidum; alternatively, AAAs could develop due to induced autoimmunity via molecular mimicry due to similarities between some of the B. burgdorferi sl proteins and aortic proteins.

Background: Tumor infiltration of the intima of the portal vein (PV) and superior mesenteric vein (SMV) by pancreatic adenocarcinoma is classically considered a criterion for unsuitability for resection and poor prognosis. This study was performed to evaluate modern color duplex imaging (CDI) for the assessment of PV/SMV infiltration by pancreatic adenocarcinomas., Method: From 1994 to 2005, Whipple's procedure or pylorus-preserving pancreato-duodenectomy (PPPD) was performed in 303 patients with pancreatic adenocarcinoma; 35 of these underwent partial PV/SMV resection. Applying a previously reported CDI score, we evaluated the integrity of the echogenic border layer between the vein and tumor (mural demarcation) and maximum blood flow velocity (V (max)) in the PV segment in contact with the tumor. The results were compared to the final histological findings in the resected venous walls., Results: CDI findings correlated well with the histological invasion grades. By measuring V (max )and evaluating mural demarcation, we observed a sensitivity of 66.7% and 100% and a specificity of 98.3% and 93.9%, respectively, in predicting full thickness vein invasion, including the intima. V (max) above 80 cm/s and lack of mural demarcation were predictors of PV/SMV invasion. The postoperative survival rates depended on the depth of tumor infiltration into the PV/SMV., Conclusions: Modern CDI is a reliable and valid technique for evaluation of morphological and hemodynamic parameters in the portal vein segment adjacent to pancreatic adenocarcinoma. Maximal blood-flow velocity in the portal segment in contact with the tumor and absence of the echogenic vessel-parenchymal sonographic interface are parameters predictive of tumor infiltration of the portal intima.

Benign oesophageal stenosis can be treated by different methods. Besides surgical procedures and established conservative treatment (e.g. dilatation), more invasive endoscopic techniques such as cryosurgery and laser therapy have recently been developed. Intubation, which has been used to treat malignant strictures, can also be used in benign oesophageal strictures. Between 1977 and 1989 a total of 43 tubes were implanted in 26 patients (mean age 62.3 years). The mean duration of intubation was 149 days. We report our experience in patients intubated for (1) acid burns, (2) actinic strictures, (3) peptic strictures, (4) postoperative stenosis, (5) postoperative complications and (6) tracheo-oesophageal fistulae. We also discuss the complications (dislocation, disintegration, bleeding, perforation, operative removal) and long-term results. Because of the prolonged survival of patients with benign oesophageal stenosis, follow-up and late complications are of particular importance in this report. Despite drawbacks, intubation is an option in the management of patients with benign oesophageal stenosis.

Sixteen patients with advanced aorto-iliac occlusive disease were examined with digital subtraction angiography (DSA) using intraarterial injection of contrast medium. The preoperative evaluation of the vessels distal to the occlusion and the visualization of the femoral and popliteal arteries were successfully performed with intraarterial DSA. As compared to conventional angiography the marked contrast enhancement of DSA is demonstrated. Less spatial resolution of DSA lacks importance as the herein discussed topic is concerned. The limited size (23 cm) of the image intensifier of the X-ray equipment used was a major drawback of the method. Using intravenous DSA aorto-iliac occlusion can be shown. In patients with long range vascular occlusion and sparse development of collaterals only intraarterial DSA can demonstrate the run-off vessels including the trifurcation of the popliteal artery.

Between 1973 and 1986, 141 patients with esophageal carcinoma have been operated. The overall resection rate was 59% (83/141). We preferred the operative resection by abdominal and right-sided thoracic approach. Only in 4 patients with generally high risk an abdomino-cervical blind dissection of the esophagus was performed. Reconstruction was done in all cases by oesophago-gastrostomy. During the last 14 years hospital mortality decreased from 36.4% (n = 8/22) in the first 7 years period to 7% (n = 3/43) during the last 4 years. Resection rate increased from 47% in the first to 65% in the second period. The 5 years survival rate of all resected patients was 23.5%.

Since 1981 12 patients (11 adenomatosis coli = AC/1 ulcerative colitis = CU) had a colectomy and mucosal proctectomy with ileo-anal anastomosis (IA) and formation of an ileal-S-pouch (IP). The mean age of 7 men and 5 women was 33 years (21-46 yrs). We preferred the synchronous abdomino-peranal operation. Protective ileostomy was closed after a mean of 4.6 months in 11 patients. Postoperative complications: IA-insufficiency = 4, sacral abscess = 1, stenosis = 3, ileus and reoperation = 2). Late results: spontaneous defecation: 11/11, continence 10/11, evacuation 6-8/day. This operative procedure seems to be good for AC and CU.

Since 1981 23 Patients (19 with adenomatosis coli, 4 with colitis ulcerosa) underwent proctocolectomy with preservation of continence: total colectomy, proctomucosectomy, ileo-anal anastomosis with formation of an ileal S-pouch, and protective loop ileostomy. In 3 patients previous operations caused difficulties in performing the procedure. Critical points of the operative technique are explained, with special regard to the possibility of previous surgery. Postoperative complications and functional results are presented.