Search

BACKGROUND The DIAMOND study of de novo liver transplant patients showed that prolonged-release tacrolimus exposure in the acute post-transplant period maintained renal function over 24 weeks of treatment. To assess these findings further, we performed a post-hoc analysis in patients according to baseline kidney function, Model for End-stage Liver Disease [MELD] scores, and donor age. MATERIAL AND METHODS Patients received prolonged-release tacrolimus (initial-dose, Arm 1: 0.2 mg/kg/day, Arm 2: 0.15-0.175 mg/kg/day, Arm 3: 0.2 mg/kg/day delayed until Day 5), mycophenolate mofetil and 1 steroid bolus. Arms 2 and 3 also received basiliximab. The recommended tacrolimus target trough levels to Day 42 post-transplantation were 5-15 ng/mL in all arms. In this post-hoc analysis, change in renal outcome, based on estimated glomerular filtration rate (eGFR), Modified Diet in Renal Disease-4 (MDRD4), values from baseline to Week 24 -post-transplantation, were assessed according to baseline patient factors: eGFR (≥60 and ˂60 mL/min/1.73 m²), MELD score (˂25 and ≥25) and donor age (˂50 and ≥50 years). RESULTS Baseline characteristics were comparable (Arms 1-3: n=283, n=287, n=274, respectively). Patients with baseline renal function, eGFR ≥60 mL/min/1.73 m², experienced a decrease in eGFR in all tacrolimus treatment arms. In patients with lower baseline renal function (eGFR ˂60 mL/min/1.73 m²), an advantage for renal function was observed with both the early lower-dose and delayed higher-dose tacrolimus regimens compared with the early introduction of higher-dose tacrolimus. At Week 24, renal function was higher in the early-lower tacrolimus arm with older donors, and the delayed higher-dose tacrolimus arm with younger donors, both compared with early higher-dose tacrolimus. CONCLUSIONS Pre-transplantation factors, such as renal function and donor age, could guide the choice of prolonged-release tacrolimus regimen following liver transplantation. ispartof: ANNALS OF TRANSPLANTATION vol:24 pages:319-327 ispartof: location:United States status: published

a Department of Gastroenterology, Beaujon Hospital, Clichy , France; b Department of Oncology, Institut Catala d’Oncologia, Barcelona , Spain; c Department of Surgery, Verona University, Verona , Italy; d Department of Endocrinology and Metabolism, Genimatas Hospital, Athens , Greece; e Department of Gastroenterology, Beaujon Hospital, Clichy , France; f Department of Endocrinology, Erasmus MC University, Rotterdam , The Netherlands; g Department of Internal Medicine, Martin University, Martin , Slovakia; h Department of Propaedeutic Internal Medicine, Laiko Hospital, Athens , Greece; i Department of Nuclear Medicine, Erasmus MC University, Rotterdam , The Netherlands; j Department of Gastroenterology, Beaujon Hospital, Clichy , France; k Department of Gastroenterology, Royal Free Hospital, London , UK; l Department of Cell Biology, National Institute of Health, Bethesda, Md. , USA; m Department of Endocrinology, University Hospital, Uppsala , Sweden

Einleitung: Die Lebenserwartung sowie die Inzidenz der kolorektalen Karzinome in den Industrienationen steigen stetig an. Diese Studie untersucht die Unterschiede in der postoperativen Morbidität und Letalität bei Patienten über 65 Jahre nach onkologischen kolorektalen Resektionen. [zum vollständigen Text gelangen Sie über die oben angegebene URL], 133. Kongress der Deutschen Gesellschaft für Chirurgie

Einleitung: Die Verwendung eines synthetischen oder biologischen Implantates bei der Versorgung von komplexen Hernien in kontaminierten oder infizierten Gebieten (Ventral Hernia Working Group (VHWG) Grad 3 und 4) wird kontrovers gesehen. Umfragen unter Chirurgen in Deutschland zeigen eine deutliche [zum vollständigen Text gelangen Sie über die oben angegebene URL], 133. Kongress der Deutschen Gesellschaft für Chirurgie

Summary Background Surgical resection alone is regarded as the standard of care for patients with liver metastases from colorectal cancer, but relapse is common. We assessed the combination of perioperative chemotherapy and surgery compared with surgery alone for patients with initially resectable liver metastases from colorectal cancer. Methods This parallel-group study reports the trial's final data for progression-free survival for a protocol unspecified interim time-point, while overall survival is still being monitored. 364 patients with histologically proven colorectal cancer and up to four liver metastases were randomly assigned to either six cycles of FOLFOX4 before and six cycles after surgery or to surgery alone (182 in perioperative chemotherapy group vs 182 in surgery group). Patients were centrally randomised by minimisation, adjusting for centre and risk score. The primary objective was to detect a hazard ratio (HR) of 0·71 or less for progression-free survival. Primary analysis was by intention to treat. Analyses were repeated for all eligible (171 vs 171) and resected patients (151 vs 152). This trial is registered with ClinicalTrials.gov, number NCT00006479. Findings In the perioperative chemotherapy group, 151 (83%) patients were resected after a median of six (range 1–6) preoperative cycles and 115 (63%) patients received a median six (1–8) postoperative cycles. 152 (84%) patients were resected in the surgery group. The absolute increase in rate of progression-free survival at 3 years was 7·3% (from 28·1% [95·66% CI 21·3–35·5] to 35·4% [28·1–42·7]; HR 0·79 [0·62–1·02]; p=0·058) in randomised patients; 8·1% (from 28·1% [21·2–36·6] to 36·2% [28·7–43·8]; HR 0·77 [0·60–1·00]; p=0·041) in eligible patients; and 9·2% (from 33·2% [25·3–41·2] to 42·4% [34·0–50·5]; HR 0·73 [0·55–0·97]; p=0·025) in patients undergoing resection. 139 patients died (64 in perioperative chemotherapy group vs 75 in surgery group). Reversible postoperative complications occurred more often after chemotherapy than after surgery (40/159 [25%] vs 27/170 [16%]; p=0·04). After surgery we recorded two deaths in the surgery alone group and one in the perioperative chemotherapy group. Interpretation Perioperative chemotherapy with FOLFOX4 is compatible with major liver surgery and reduces the risk of events of progression-free survival in eligible and resected patients. Funding Swedish Cancer Society, Cancer Research UK, Ligue Nationale Contre le Cancer, US National Cancer Institute, Sanofi-Aventis.

DIAMOND: multicenter, 24‐week, randomized trial investigating the effect of different once‐daily, prolonged‐release tacrolimus dosing regimens on renal function after de novo liver transplantation. Arm 1: prolonged‐release tacrolimus (initial dose 0.2mg/kg/day); Arm 2: prolonged‐release tacrolimus (0.15–0.175mg/kg/day) plus basiliximab; Arm 3: prolonged‐release tacrolimus (0.2mg/kg/day delayed until Day 5) plus basiliximab. All patients received MMF plus a bolus of corticosteroid (no maintenance steroids). Primary endpoint: eGFR (MDRD4) at Week 24. Secondary endpoints: composite efficacy failure, BCAR and AEs. Baseline characteristics were comparable. Tacrolimus trough levels were readily achieved posttransplant; initially lower in Arm 2 versus 1 with delayed initiation in Arm 3. eGFR (MDRD4) was higher in Arms 2 and 3 versus 1 (p = 0.001, p = 0.047). Kaplan–Meier estimates of composite efficacy failure‐free survival were 72.0%, 77.6%, 73.9% in Arms 1–3. BCAR incidence was significantly lower in Arm 2 versus 1 and 3 (p = 0.016, p = 0.039). AEs were comparable. Prolonged‐release tacrolimus (0.15–0.175mg/kg/day) immediately posttransplant plus basiliximab and MMF (without maintenance corticosteroids) was associated with lower tacrolimus exposure, and significantly reduced renal function impairment and BCAR incidence versus prolonged‐release tacrolimus (0.2mg/kg/day) administered immediately posttransplant. Delayed higher‐dose prolonged‐release tacrolimus initiation significantly reduced renal function impairment compared with immediate posttransplant administration, but BCAR incidence was comparable., The DIAMOND study demonstrates that an initial lower dose or a delayed higher dose of prolonged‐release tacrolimus significantly reduces renal function impairment versus a higher initial dose of prolonged‐release tacrolimus administered immediately posttransplant, over 24 weeks of treatment in de novo liver transplant recipients.

Einleitung: Das Analkarzinom ist mit etwa, 132. Kongress der Deutschen Gesellschaft für Chirurgie

Einleitung: Die Anlage eines protektiven doppelläufigen Ileostomas im Rahmen tiefer anteriorer Rektumresektionen bei Patienten mit einem Rektumkarzinom hat sich als Standartverfahren etabliert und führt zu einer deutlichen Senkung klinisch apparenter Anastomoseninsuffizienzen. Bezügliche[for full text, please go to the a.m. URL], 132. Kongress der Deutschen Gesellschaft für Chirurgie

Einleitung: Die kurative Resektion kolorektaler Lebermetastasen (CRLM) bietet Patienten mit oligometastatischen Befunden eine signifikante Prognoseverbesserung. In Zeiten effektiver perioperativer Therapien gilt ein Resektionsrandabstand von kleiner als 1 cm als kurativ. Ziel dieser Studie war es, den[for full text, please go to the a.m. URL], 132. Kongress der Deutschen Gesellschaft für Chirurgie

Rectal carcinoma is one of the most frequent malignant tumors in adulthood. Not only after total resection but also after partial resection of the tumor with postoperative radiochemotherapy a sufficient follow-up is necessary to diagnose recurrent rectal cancer as early as possible. Various guidelines suggest different intervals for physical examinations and diagnostic methods depending on the initial tumor stage. In addition to routine examinations, the physician can choose between CT, MRI, endosonography and functional imaging techniques such as PET and immunoscintigraphy for further evaluation if a recurrent rectal cancer is suspected. Multiple studies and meta-analyses show the differences in the specificity and sensitivity of the diagnostic methods in the detection of lymph nodes, metastases, and local tumor infiltration. Endosonography and endorectal MRI show very good results in staging local tumor infiltration. However, obstructive lesions can inhibit an adequate examination. CT provides prompt and convincing results in the evaluation of the metastases. Most of the time the tumor can be identified but the lack of detailed imaging makes it hard to perform sufficient staging. Additionally image-guided biopsy can be performed. Immunoscintigraphy and PET have a high specificity because they take advantage of the tumor's metabolism. The introduction of the PET-CT has eliminated the disadvantage of low image resolution. In addition to the detection of small nodular pulmonary metastases, MRI with its "phased-array" coils is another excellent tool for the diagnosis of recurrent rectal cancer and search for metastases. This review shows the advantages and disadvantages of each diagnostic method in the visualization of recurrent rectal cancer.

PURPOSE: To evaluate volumetric CT data as a guide for indication and assessment of prognosis for transarterial chemo-embolisation (TAE) of hepatocellular carcinomas (HCC). MATERIAL AND METHOD: 74 patients with HCC were treated with repeated TAE. 50 mg Adriblastin/m2 body surface, 50 mg cisplatin/m2 body surface and 10 ml lipiodol were combined with 2-10 ml Spherex and injected selectively (25 cases) or superselectively (49 cases); in 28 patients a single injection and in 46 patients multiple injections were used. RESULTS: CT findings before and after the procedure showed a solitary lesion in 17 patients, two lesions in 18 patients and in 39 patients there were three or more lesions. Mean expectation of life was 523 days (median = 372 days; 57% of one year survival probability). In 29 patients with > 75% lipiodol retention, mean survival was 819 days; in 17 patients with 75% intra-tumoral lipiodol retention.

PURPOSE Morphology of focal liver lesions was studied by power Doppler. Plain images and images after i.v. application of galactose-based microbubbles (Levovist, Schering AG) were compared. METHODS 21 patients with focal liver lesions were studied by power Doppler before and after application of the signal enhancer. RESULTS In lesions that showed short pulsations in plain studies, vascular structures were visible after application of the signal enhancer. In hepatocellular carcinomas, multiple arteries with small diameter became visible. Peripheral veins were detected in metastases. A large feeding artery was detected in 1/2 haemangiomas with flow and in a focal nodular hyperplasia. CONCLUSION In comparison to plain amplitude-modulated colour-coded duplex ultrasound, vascular patterns of focal liver lesions were more clearly visible after injection of a signal-enhancer.