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Gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN) are mainly found in the small intestine and pancreas. The course of the disease in patients is highly variable and depends on the degree of differentiation (G1–G3) of the neoplasm. The potential for metastasis formation of GEP-NEN is high even with good differentiation (G1). Lymph node metastases and, in many cases, liver metastases are also often found. Less common are bone metastases or peritoneal carcinomas. The treatment of these GEP-NENs is surgical, whenever possible. If an R0 resection with removal of all lymph node and liver metastases is successful, the prognosis of the patients is excellent. Patients with diffuse liver or bone metastases can no longer be cured by surgery alone. The long-term survival of these patients is nowadays possible due to the availability of drugs (e.g., somatostatin analogues, tyrosine kinase inhibitors), peptide receptor radionuclide therapy (PRRT) and liver-directed procedures, with a good quality of life. [ABSTRACT FROM AUTHOR]

This document provides a summary of the importance of mental health in the peri-operative period and its impact on surgical outcomes. It discusses how mental health conditions before surgery can contribute to poorer outcomes, such as delirium, pain, falls, and increased readmission rates. It also explores the negative effects of worsening depression on social isolation, function, and quality of life after surgery. The document highlights various psychological interventions that have been studied, but notes that more research is needed to make strong recommendations. It emphasizes the need for accurate assessment and the involvement of individuals with lived experience in research. Additionally, the document discusses the challenges of confounding variables and the potential for peri-operative interventions to improve depression and pain outcomes. It concludes by suggesting the development of prediction models incorporating mental health measures to identify high-risk patients and improve surgical outcomes. [Extracted from the article]

Despite the triumph of minimally invasive techniques in adrenal surgery, the indications for open adrenalectomy are indispensable in the canon of treatment options and must remain part of the repertoire of visceral surgery. Open adrenalectomy is indicated for advanced adrenal carcinoma (ENSAT stage III). In addition to the frequent local infiltration of these carcinomas which makes the en bloc resection of adjacent organs necessary, thromboses in the renal vein or the vena cava or multiple lymph node metastases can also necessitate an open procedure; however, open adrenalectomy is justified and must also be discussed for adrenocortical carcinoma ENSAT stages I–II (tumor size ≤ 5 cm or > 5 cm, NO). Furthermore, highly suspicious large adrenal tumors (6–8 cm, Hounsfield units > 20) without preoperative evidence of malignancy and other adrenal pathologies, such as neuroblastomas, large pheochromocytomas and also schwannomas can be an indication for open adrenalectomy. [ABSTRACT FROM AUTHOR]

Abstract Background Plaque imaging based on magnetic resonance imaging (MRI) represents a new modality for risk assessment in atherosclerosis. It allows classification of carotid plaques in high-risk and low-risk lesion types (I-VIII). Type 2 diabetes mellitus (DM 2) represents a known risk factor for atherosclerosis, but its specific influence on plaque vulnerability is not fully understood. This study investigates whether MRI-plaque imaging can reveal differences in carotid plaque features of diabetic patients compared to nondiabetics. Methods 191 patients with moderate to high-grade carotid artery stenosis were enrolled after written informed consent was obtained. Each patient underwent MRI-plaque imaging using a 1.5-T scanner with phased-array carotid coils. The carotid plaques were classified as lesion types I-VIII according to the MRI-modified AHA criteria. For 36 patients histology data was available. Results Eleven patients were excluded because of insufficient MR-image quality. DM 2 was diagnosed in 51 patients (28.3%). Concordance between histology and MRI-classification was 91.7% (33/36) and showed a Cohen's kappa value of 0.81 with a 95% CI of 0.98-1.15. MRI-defined high-risk lesion types were overrepresented in diabetic patients (n = 29; 56.8%). Multiple logistic regression analysis revealed association between DM 2 and MRI-defined high-risk lesion types (OR 2.59; 95% CI [1.15-5.81]), independent of the degree of stenosis. Conclusion DM 2 seems to represent a predictor for the development of vulnerable carotid plaques irrespective of the degree of stenosis and other risk factors. MRI-plaque imaging represents a new tool for risk stratification of diabetic patients. See Commentary: http://www.biomedcentral.com/1741-7015/8/78/abstract

The indications for surgery of benign goiter should be balanced and professional as the prevalence of benign nodular goiter in Germany is high and not all goiters must be surgically treated. Thyroid nodules are detected in up to 76% of healthy people using modern high-resolution ultrasound (US) and only a few of these nodules are malignant or symptomatic. Even today a thorough medical history, detailed examination of the neck region, a qualified US of the thyroid gland, a 99m-technetium scintigraphy and fine needle aspiration help to select patients who will benefit from thyroid surgery. In the last 10 years several thyroid imaging reporting and data systems (TI-RADS) classifications have been introduced. The TI-RADS classification is a standardized assessment of thyroid nodules and risk stratification system in thyroid US which helps to select those nodules with a high risk of cancer. Asymptomatic euthyroid nodular goiter without any suspicion of malignancy and scintigraphically cold thyroid nodules without any other evidence of malignancy are not indications for thyroid surgery. The decision to operate should be made on an interdisciplinary basis in conformity with the relevant guidelines and exhaustion of diagnostic tools. [ABSTRACT FROM AUTHOR]

Fetus acardius amorphus is a rare congenital malformation characterized by the lack of a functional heart, the presence of a bivascular umbilical cord, as well as a developed and organized skeletal system and partially organized inner organs. Fetus acardii mostly occur in multiple gestations. The pathogenesis of this entity is not clarified yet. It has been hypothesized that, although formation of anastomosing vessels between the co-twin and the anomalous embryo as well as reverse directed blood flow within the umbilical arteries of the weaker twin may allow sufficient blood flow to form rudimentary internal organs, it is insufficient to develop a fully functional heart. We had a case of fetus acardius amorphus, where we performed autopsy as well as routine histology assessment to identify different types of tissues. We showed that our fetus acardius amorphus demonstrated histomorphological features of renal tubular dysgenesis, confirmed by lack of proximal tubules, extramedullary hematopoiesis and increased number of smooth muscle actin positive vessels. This is a novel finding and has not been reported previously. [ABSTRACT FROM AUTHOR]

Kleine (<2 cm) sporadische neuroendokrine Pankreasneoplasien (pNENs) werden in funktionell aktive Tumoren und nichtaktive Tumoren unterteilt. Funktionell aktive pNENs setzen unterschiedliche Hormone wie Insulin, Gastrin, Glukagon oder vasoaktives intestinales Hormon frei und führen so, unabhängig von ihrer Größe, zu schweren Symptomen wie z. B. zu Hypoglykämie, Koma (Insulinom), Durchfällen (Gastrinom, Vipoma), Magen-Darm-Ulzera (Gastrinom) und Hyperglykämien (Glukagonom). Die asymptomatischen nichtaktiven pNENs verursachen kein hormonelles Syndrom, obwohl diese Tumoren in der Immunhistochemie eine Positivität für unterschiedliche Hormone und neuroendokrine Marker (z. B. Chromogranin oder Synaptophysin) aufweisen können. Nichtaktive kleine pNENs werden heute durch den breiten Einsatz der Schnittbildgebung deutlich häufiger gefunden und werden auch inzidentelle pNENs genannt. Die aktuellen Therapiealgorithmen der kleinen aktiven und nichtaktiven pNENs sind sehr unterschiedlich und beinhalten neben einer aktiven Überwachung (Wait-and-see-Strategie) nichtaktiver pNENs (G1, „low G2“) alle minimal-invasiven, roboterassistierten und offenen Techniken der Pankreasresektionen. Die existierenden chirurgischen und nichtchirurgischen Therapieempfehlungen begründen sich bis heute zumeist auf retrospektive Daten. [ABSTRACT FROM AUTHOR]

Introduction: Diagnostic guidelines for thyroid nodules focus on malignancy risk assessment to avoid unnecessary diagnostic operations. These guidelines recommend a combination of tests in form of a diagnostic algorithm. The present study analyzed the recommended algorithm and its implementation by different medical professionals. Methods: Preoperative diagnostic procedures, laboratory tests and histopathological findings of patients who underwent thyroid surgery between 2006 and 2013 were analyzed. The results were stratified by the assignation by specialized endocrinologists (ENP), general practitioners (GP) or Goethe-University Hospital Frankfurt (UKF). Results: 677 patients were enrolled, of these 62% were assigned by UKF, 18.5% by an ENP and 19.5% by a GP. Ultrasonography rate was significantly higher in UKF (97.6%) compared to patients assigned by GP (90.9%, p < 0.0001). Rates for fine-needle aspiration cytology ranged between 47.6% in UKF and 23.2% in ENP (p < 0.0001). In over 93% of the patients an analysis of thyroid-stimulating hormone and triiodothyronine/thyroxin was realized. The overall malignancy rate was 11.82%. The malignancy rate was significantly higher if a FNA biopsy was performed (16.35 vs. 8.94%; p = 0.0048). Conclusions: A higher malignancy rate could only be seen if the preoperative diagnostic workup included FNA. Besides this, the grade of algorithm adherence showed no effect on the malignancy rate. [ABSTRACT FROM AUTHOR]

Objectives: Due to the increasing adoption of Electronic Health Records (EHRs) for primary use, the number of electronic documents stored in such systems will soar in the near future. In order to benefit from this development in secondary fields such as medical research, it is important to define requirements for the secondary use of EHR data. Furthermore, analyses of the extent to which an IHE (Integrating the Healthcare Enterprise)-based architecture would fulfill these requirements could provide further information on upcoming obstacles for the secondary use of EHRs.Methods: A catalog of eight core requirements for secondary use of EHR data was deduced from the published literature, the risk analysis of the IHE profile MPQ (Multi-Patient Queries) and the analysis of relevant questions. The IHE-based architecture for cross-domain, patient-centered document sharing was extended to a cross-patient architecture.Results: We propose an IHE-based architecture for cross-patient and cross-domain secondary use of EHR data. Evaluation of this architecture concerning the eight core requirements revealed positive fulfillment of six and the partial fulfillment of two requirements.Conclusions: Although not regarded as a primary goal in modern electronic healthcare, the re-use of existing electronic medical documents in EHRs for research and other fields of secondary application holds enormous potential for the future. Further research in this respect is necessary. [ABSTRACT FROM AUTHOR]

Context. The intravenously administered selective α1 antagonist urapidil represents an alternative to phenoxybenzamine in the preoperative treatment of pheochromocytoma patients. Objective. The aim of the study was to investigate the blood pressure changes in pheochromocytoma patients with urapidil pretreatment with special regards to the need for interventions in order to estimate the safety of this treatment in a normal ward setting. Design. The medical records of all patients who underwent adrenalectomy for PCC were reviewed retrospectively. Systolic blood pressure values >180mmHg were defined as hypertensive episodes and systolic blood pressure values < 50mmHg as hypotensive episodes. Episodes of blood pressure instabilities were considered significant and recorded as intervention if they led to a direct action. Results. Twenty consecutive patients who received urapidil pretreatment were enrolled in this retrospective study. Preoperatively, a median of 9 blood pressure measurements per day have been performed on the ward. A total of 2 episodes of hypertension occurred, and 1 episode of hypotension has been recorded. In the period from 25-72 hours postoperatively the median number of blood pressure measurements was 5 per 24 hours. The blood pressure deviations led to a total of 3 interventions for hypertension in 1 (5%) patients and 5 interventions for hypotension in 3 (15%) patients. All interventions could be managed on the normal ward, without the need to transfer the patient to an ICU. Conclusions. Intravenous urapidil can safely be administered on a normal ward without putting patients at risk. Intensive monitoring beyond 24 hours postoperatively was not necessary, the blood pressure measurements during the shift on a normal ward were sufficient for maintaining patients' safety. [ABSTRACT FROM AUTHOR]

Gastroenteropancreatic neuroendocrine tumors (GEP-NET) are rare but an increase in incidence has been recognized worldwide. Approximately 70 % of NETs are localized in the gastrointestinal tract and in the pancreas, other locations are in the lungs (25 %) and rarely in the skin, urogenital tract and ovaries. Depending on the size, localization, grading (G1-G3) and production of hormones, the symptoms of patients can greatly vary. Outcome and survival of patients depend on the biological behavior and grading of the NET. Patients with a well differentiated G1 grade NET have a slow, sometimes also benign course over decades even with metastases in contrast to patients with G3 grade NETs. These tumors exhibit an aggressive behavior and patient survival is short. Liver and lymph node metastases are common (about 50 %) in GEP-NETs even at the initial diagnosis. The 5-year and 10-year survival of patients with GEP-NETs is increasing (currently approximately 80 % and 60 %, respectively), especially when a multidisciplinary team (e.g. surgery, endocrinology, oncology, nuclear medicine and gastroenterology) manages GEP-NET patients. [ABSTRACT FROM AUTHOR]

Vascular endothelial growth factor (VEGF) is a critical regulator of angiogenesis and is involved in tumor development. To date, the role of VEGF in benign diseases of the thyroid is not well known. The purpose of the present study is to determine the expression of VEGF and its receptors in primary cultures of human thyrocytes. Methods: 50 patients with uninodular (n = 11), multinodular (n = 15), recurrent goiter (n = 14) and Graves' disease (n = 10) were enrolled. Nodular and corresponding paranodular tissue was obtained after surgery and investigated. RNA and protein were extracted from primary thyrocyte cultures. PCR, western blot and ELISA were performed to evaluate VEGF isoforms and VEGF receptor 1 and 2. Results: Significantly increased transcription and protein expression of VEGF and its receptors were detected in nodular tissue of uninodular and recurrent goiter compared to the corresponding normal tissue. Active secretion of VEGF by thyrocytes was confirmed by ELISA. In multinodu lar goiter, no difference could be found between nodular and corresponding paranodular tissue in terms of expression of VEGF or its receptors. Furthermore, we found the highest levels of VEGF and its receptors in tissue obtained from patients with Graves' disease. Conclusion: Increased expression of VEGF and its receptors might be crucial in the proliferation of thyrocytes and therefore may contribute to the development of goiter and goiter recurrence. [ABSTRACT FROM AUTHOR]

Copyright of Colo-Proctology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Onkologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Plaque imaging based on magnetic resonance imaging (MRI) represents a new modality for risk assessment in atherosclerosis. It allows classification of carotid plaques in high-risk and low-risk lesion types (I-VIII). Type 2 diabetes mellitus (DM 2) represents a known risk factor for atherosclerosis, but its specific influence on plaque vulnerability is not fully understood. This study investigates whether MRI-plaque imaging can reveal differences in carotid plaque features of diabetic patients compared to nondiabetics. Methods: 191 patients with moderate to high-grade carotid artery stenosis were enrolled after written informed consent was obtained. Each patient underwent MRI-plaque imaging using a 1.5-T scanner with phased-array carotid coils. The carotid plaques were classified as lesion types I-VIII according to the MRI-modified AHA criteria. For 36 patients histology data was available. Results: Eleven patients were excluded because of insufficient MR-image quality. DM 2 was diagnosed in 51 patients (28.3%). Concordance between histology and MRI-classification was 91.7% (33/36) and showed a Cohen's kappa value of 0.81 with a 95% CI of 0.98-1.15. MRI-defined high-risk lesion types were overrepresented in diabetic patients (n = 29; 56.8%). Multiple logistic regression analysis revealed association between DM 2 and MRI-defined high-risk lesion types (OR 2.59; 95% CI [1.15-5.81]), independent of the degree of stenosis. Conclusion: DM 2 seems to represent a predictor for the development of vulnerable carotid plaques irrespective of the degree of stenosis and other risk factors. MRI-plaque imaging represents a new tool for risk stratification of diabetic patients. See Commentary: http://www.biomedcentral.com/1741-7015/8/78/abstract [ABSTRACT FROM AUTHOR]

Because many companies already have a 100% continuous casting ratio, further capacity increase is possible only by extensive revamping of existing machines or new investment. However, because of area restrictions expansion is difficult or sometimes impossible. It may not be easy to install additional casters without having the disadvantage of long steel transport distances from the existing steel plant to the new continuous casting machines. The compact caster concept described in this paper is designed to enable steelmakers to increase production without this disadvantage. [ABSTRACT FROM AUTHOR]