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To evaluate the impact of superior rectal artery (SRA) sparing technique on anastomotic leakage in laparoscopic sigmoidectomy for diverticular disease. A retrospective multicenter analysis of all patients undergoing laparoscopic sigmoid resection for diverticular disease between 2002 and 2015 was conducted. Data were recorded in three hospitals: University Hospital Regensburg, Marienhospital Gelsenkirchen, and Stadtisches Klinikum Munchen Bogenhausen. The SRA was resected between 2002 and 2005. Since 2005, the artery was preserved in most cases. Two hundred sixty-seven patients were included. One hundred sixty patients presented with complicated diverticulitis (60%). The SRA was resected in 102 patients (group 1) and preserved in 157 patients (group 2, no data in eight cases). Anastomotic leakage occurred in 7% of patients in group 1 and 1.9% of patients in group 2 (p = 0.053). Duration of surgery was significantly shorter (157 vs. 183 min, p

Einleitung Die „Pit-picking-Operation“ wurde bereits vor uber 30 Jahren von J. Bascom beschrieben, jedoch ist diese minimal-invasive Operationsmethode zur Behandlung des Sinus pilonidalis nichtspezialisierten Chirurgen nur wenig bekannt.

Durch verbesserte Diagnostik und vermehrten Einsatz bildgebender Verfahren werden benigne Lebertumoren immer haufiger diagnostiziert. Bei eindeutiger Diagnose und Fehlen von tumorassoziierten Symptomen besteht beim Hamangiom und der fokal nodularen Hyperplasie (FNH) keine Operationsindikation. Das Leberzelladenom (LZA) sollte bei entsprechender Grose in erster Linie aufgrund der Rupturgefahr reseziert werden. Die verbesserte Diagnostik sowie Fortschritte in der chirurgischen Therapie mit niedriger Komplikationsrate und weitgehend fehlender Mortalitat erlauben eine individualisierte Therapie von benignen Lebertumoren, die sich an evidenzbasierten Algorithmen zum Management derartiger Leberlasionen anlehnen sollte. Bei nach wie vor bestehender diagnostischer Unsicherheit und bei Fehlen wesentlicher Risikofaktoren wird der risikoarmen Resektion der Vorzug vor einer Biopsie aufgrund der publizierten Fehlerquote und Komplikationsmoglichkeiten (Blutung, Tumorzellverschleppung) gegeben.

Sirolimus is an m-TOR inhibitor without renal side effects and potentially protects against the development of malignancy. Due to a higher incidence of complications in two trials and an official warning in the drug information, the use of Sirolimus in liver transplantation is limited. The participants of this consensus meeting had to analyse and evaluate the literature with respect to the potential role of Sirolimus in liver transplantation. This consensus statement follows the scheme normally employed for the presentation of guidelines including the grading of evidence (1a-5) and the extent of recommendation (A-C). Moreover, the consensus included the experience of the authors with respect to the handling of Sirolimus after liver transplantation.

In most medical centres, ultrasonography is performed independently by several departments. In october 1997, the University hospital of Regensburg founded an ultrasound centre, integrating surgical and medical departments as well as the institutes for radiology and nuclear medicine. The aims of this centre were the concentration of organization, machines, financial resources, manpower and know-how, standardized training and quality, and strengthening of interdisciplinary cooperation in clinic, medical education and research. Booking, standardized reports and a joint archiving of reports are assisted by a collective computer system. Most examinations in the centre are performed by three all-day present gastroenterology, surgery and radiology residents who are supported by licensed sonographers of the other departments. Training is standardized, and the certification for ultrasound examinations is acquired after a test with theoretical and practical parts. The integration of various departments in the ultra-sound on-call service has led to significant savings. The pool of ultrasound machines is used jointly, department-specific resources for new machines have been put together. We are convinced that this way of a close interdisciplinary cooperation will result in improvements in quality, utilization of financial resources and clinical research.

A preoperatively undetected spontaneous mesocaval shunt lead to impairment of organ function after liver transplantation. Ischemia of the graft due to partial hepatofugal portal flow was demonstrated by color-flow Doppler sonography and angiography. The successful catheter embolization of the mesocaval shunt via a transhepatic approach is presented.

Transplant renal artery stenosis (TRAS) is a frequent complication after renal transplantation, however long-term follow-up data after interventional treatment are rare.In our transplant center 11 of 264 consecutive renal transplant recipients (4.17%) were diagnosed with TRAS. In addition, TRAS occurred in 2 renal transplant recipients that had been transplanted at other centers but who had their follow-up examinations in our center. Either a rise of the serum creatinine level and/or worsened systemic hypertension or routine examination with color Doppler sonography were indications for further diagnostic workup.Direct angiography of the transplant renal artery was performed followed by percutaneous transluminal angioplasty (PTA) after the diagnosis of TRAS was confirmed in all of these patients.The immediate success rate for PTA was 92.3% (12/13). Only 1 patient with a severe kinking of the transplant renal artery had to undergo surgery to restore renal function. No complications occurred after the interventions. Thereafter the patients were monitored for a mean observation period of 33.15 months. Serum creatinine levels were significantly lower after the intervention, and estimated glomerular filtration rate (eGFR) increased accordingly. With regard to blood pressure there was only a trend for lower blood pressure levels and less antihypertensive use, whereas the dose of the prescribed drugs decreased significantly with time after interventional treatment of TRAS. In addition, a long-lasting rise of the hemoglobin levels could also be demonstrated.In summary, the beneficial effect of PTA of TRAS on renal function is long-lasting. Therefore, PTA, usually combined with stent placement, should be first-line treatment in TRAS in all patients. Surgical revascularization is only warranted, if PTA fails.

Benign liver tumors are being detected more frequently due to the widespread use of ultrasound and complementary methods and due to improvements in diagnostic accuracy. In the case of a reliable diagnosis of asymptomatic hemangioma or focal nodular hyperplasia surgery is not indicated. Hepatic adenoma of considerable size should be resected primarily based on the risk of rupture. Improvements in diagnostic imaging as well as the optimization of surgical procedures with extremely low complication rates permit an individualized management strategy founded on evidence-based algorithms. In the case of an equivocal diagnosis, we advocate low-risk tumor resection instead of tumor biopsy due to the inherent complication rates of hemorrhage or tumor-cell dissemination and possible misleading histology.

Determinants for homologous blood transfusion and its influence on postoperative and long-term results were evaluated in 439 curatively resected colorectal cancer patients. The rate of transfusion was significantly higher in rectal cancer, large tumors, advanced pT stage and extended resection but not in tumor stenosis, lower graded tumors, advanced Dukes stage or less experienced surgeons. Transfused patients showed significantly more postoperative complications, higher recurrence rates as well as less favorable long-term survival. Homologous blood transfusions are negatively correlated to survival rates.

Overexpression of IGF-I/IGF-IR and activation of Ras/Raf signaling cascades have been implicated in angiogenesis and progression of human pancreatic cancer. Both signaling systems may up-regulate VEGF expression and mediate anti-apoptotic effects, which also promote mechanisms of chemoresistance. We therefore propose that selective blockade of IGF-IR and Raf-signaling in human pancreatic cancer cells impairs pro-angiogenic signaling, reduces VEGF and improves sensitivity to chemotherapeutic agents. Studies were performed with L3.6pl and HPAF-II human pancreatic cancer cell lines. Specific inhibitors to IGF-IR (AEW541) and Raf-kinase (AAL881) were used for experiments. Effects of specific inhibition by either compound alone, or in combination of both, on constitutive and IGF-I induced activation of signaling pathways, were assessed by Western Blots. Impact of AEW541 and/or AAL881 on VEGF secretion was determined by ELISA. Cancer cell motility was tested by in vitro assays using modified Boyden chambers. Cytotoxic effects of AEW541 and/or AAL881 in combination with Oxaliplatin were assessed by MTTs and cell death assays. In vitro, AEW541 significantly reduced constitutive and IGF-I induced phosphorylation of IGF-IR, IRS-1, MAPK/Erk1/2 and PI-3K/Akt as well as activation of the transcription factor STAT3. Combination of AEW541 and AAL881 led to significant inhibition of VEGF secretion as determined by ELISA. Furthermore, tumor cell motility in vitro was markedly impaired by combined therapy. MTT and cell death assays revealed modest cytotoxic effects of AEW541 or AAL881 alone. This effect was significantly improved by combined low-dose therapy of AEW541 and AAL881. In addition, combination therapy enhanced cytotoxic effects of Oxaliplatin. In conclusion, combined inhibition of IGF-IR and Ras/Raf-signaling cascades impairs pro-angiogenic signaling in human pancreatic cancer cells and harbors the potential to improve susceptibility to chemotherapeutic agents. Thus, targeting IGF-IR and Raf could be a promising strategy for molecular targeted therapy of pancreatic cancer.

"Fast-track" multimodal rehabilitation is increasingly entering the perioperative management strategies in colon surgery aiming at minimized perioperative morbidity and accelerated recovery. So far little is known about the complementary effects of minimally invasive surgery along with "fast-track" rehabilitation in the treatment of rectal cancer. The aim of this pilot study was to investigate the influence of "fast-track" perioperative management on morbidity, recovery and length of hospital stay in laparoscopically-assisted rectum resections and to compare those data to earlier results.An interdiciplinary "fast-track" multimodal rehabilitation strategy with avoidance of mechanical bowel cleansing, with a restrictive intravenous intra- and postoperative fluid regimen, forced mobilisation, and early enteral nutrition was introduced into clinical practice and applied in 16 laparoscopically-assisted rectum resections. Data were collected in the course af a prospective analysis. The mean patient age was 62 (42-79) years.Mean time of surgery was 245 (SD 46) min, and the mean intraoperative infusion rate was 11.2 (SD 2.6) ml/kg/BW. On day 2, 14 of the 16 patients tolerated solid food and 12 patients had had bowel movements. All patients returned to their initial body weight by day 4. The median postoperative hospital stay was 7.5 days (6-20), 12 patients were discharged between day 6 and 8. Two patients were readmitted for intestinal atony, one patient developed an anastomotic leakage."Fast-track" rehabilitation is feasible in rectum surgery and seems to complement the beneficial effects of minimally invasive surgery without increasing the complication rate.

Sirolimus is an m-TOR inhibitor without renal side effects and potentially protects against the development of malignancy. Due to a higher incidence of complications in two trials and an official warning in the drug information, the use of Sirolimus in liver transplantation is limited. The participants of this consensus meeting had to analyse and evaluate the literature with respect to the potential role of Sirolimus in liver transplantation. This consensus statement follows the scheme normally employed for the presentation of guidelines including the grading of evidence (1a-5) and the extent of recommendation (A-C). Moreover, the consensus included the experience of the authors with respect to the handling of Sirolimus after liver transplantation.

As ischemia/reperfusion injury (I/R) and rejection are closely interrelated phenomena, we aimed to examine the impact of immunosuppressive drugs on microvascular I/R injury in vivo and in vitro. By means of intravital microscopy leukocyte-endothelial interaction, functional capillary density (FCD), and microvascular permeability were investigated after application of immunosuppressive doses of Cyclosporin A(CyA, 20 mg/kg), Tacrolimus (FK 506, 0.4 mg/kg) and Mycophenolat Mofetil (MMF, 20 mg/kg) (n = 6) in a model of 3 h pressure induced ischemia in the dorsal skinfold chamber of BalbC mice. The effect of CyA, FK 506 and MMF on in vitro leukocyte adherence and adhesion molecule expression (ICAM-1, VCAM-1, E-selectin determined by FACS) on IL-1s stimulated HUVEC cells were assessed. CyA and FK 506 significantly reduced microvascular I/R injury, indicated by reduced leukocyte adhesion, improved macromolecular permeability and FCD in vivo. In vitro, CyA and FK 506 attenuated PMN adherence, ICAM-1, VCAM-1 and E-selectin expression. Although MMF inhibited endothelial adhesion molecule expression as well, it was less effective in reducing PMN adhesion in vitro as well as attenuating microvascular I/R injury in vivo, indicating an endothelial specificity of MMF. The efficacy of CyA and FK506 on I/R injury raises the question of a earlier treatment of donors and may explain the inefficiency of new drugs attenuating I/R in clinical trials

Pneumatosis cystoides intestinalis (PCI) is still a poorly understood phenomenon, currently considered to result from primary mucosal insult from varying causes. We report a case of severe PCI in a patient with chronic GVHD after bone marrow transplantation (BMT) performed to treat secondary AML. Post BMT, the patient suffered acute intestinal and cutaneous GVHD, eventually developing intestinal and biopsy-proven cutaneous chronic GVHD, which necessitated continuous steroid therapy. Chronic pancreatitis associated with GVHD was diagnosed by explorative surgery in February 2000 on the basis of increasing epigastric discomfort, tumour marker (CA 125) increase and the CT finding of a suspicious mass in the pancreas. Readmission occurred in April 2000 for rapid onset of inferior abdominal pain with distinct peritoneal signs. Relaparotomy, deemed necessary on the grounds of both clinical and radiological findings, revealed marked PCI of the ascending and transverse colon and attached mesentery in an otherwise intact gastrointestinal tract. Post-operative reconvalescence was uneventful, with no clinical or radiological recurrence of PCI in the following 10 months. In the context of a review of the relevant literature, this case report illustrates the complex underlying pathophysiology, and difficulty in making a differential diagnosis and treating PCI.

In most medical centres, ultrasonography is performed independently by several departments. In october 1997, the University hospital of Regensburg founded an ultrasound centre, integrating surgical and medical departments as well as the institutes for radiology and nuclear medicine. The aims of this centre were the concentration of organization, machines, financial resources, manpower and know-how, standardized training and quality, and strengthening of interdisciplinary cooperation in clinic, medical education and research. Booking, standardized reports and a joint archiving of reports are assisted by a collective computer system. Most examinations in the centre are performed by three all-day present gastroenterology, surgery and radiology residents who are supported by licensed sonographers of the other departments. Training is standardized, and the certification for ultrasound examinations is acquired after a test with theoretical and practical parts. The integration of various departments in the ultra-sound on-call service has led to significant savings. The pool of ultrasound machines is used jointly, department-specific resources for new machines have been put together. We are convinced that this way of a close interdisciplinary cooperation will result in improvements in quality, utilization of financial resources and clinical research.

Conventional immunosuppressive drugs have been used effectively to prevent immunologic rejection in organ transplantation. However, cancer development and recurrence are ominous risk factors for these immunocompromised patients. In the present study we show that the new immunosuppressive drug rapamycin may have a unique ability to reduce the risk of cancer development, while simultaneously providing effective immunosuppression. Experimentally, rapamycin inhibited tumor metastasis and angiogenesis in in vivo mouse models. Furthermore, rapamycin demonstrated antiangiogenic activities linked to vascular endothelial growth factor antagonism. In contrast, the most widely recognized immunosuppressive drug, cyclosporine, promoted both primary tumor growth and metastasis in our models. This study suggests that the use of rapamycin, instead of cyclosporine, may reduce the chance of recurrent, or de novo, cancer development in high-risk transplant patients.

Surgical therapy of the acute abdomen often allows only limited time for differential diagnosis to confirm the indication for surgery. Under consideration of clinical aspects and case history both common and rare causes of an acute abdomen should be investigated without undue loss of time. Differential diagnostic considerations and eventual therapy are presented in the following case of a 25-year-old Afro-american who developed multiorgan failure after an initial course of lower-back pain. In addition to the clinical setting of an acute abdomen the patient presented with acute respiratory failure and laboratory signs of severe hemolysis in combination with newly detected splenomegaly. The indication for splenectomy was made following CT-proven complete splenic infarction due to repeated acute squestration. Histologic examination of the spleen together with hemoglobin electrophoresis confirmed the clinical assumption of unusually late primary manifestation of a sickle cell crisis. In the underlying case, the hemoglobinopathy was in fact the less common form of combined sickle-cell-beta-thalassemia. A ten-day course of intensive care therapy was necessary to treat ongoing multiorgan failure due to persistent sickle cell crisis. Current diagnostic and therapeutic procedures in connection with sickle cell crisis as a rare cause of an acute abdomen with the necessity for surgical intervention are presented.

Primary dysfunction (PDF) and eventual primary nonfunction (PNF) of liver allografts have been characterized by various clinical and laboratory parameters reflecting graft function, cellular integrity and extrahepatic influence following orthotopic liver transplantation (OLT). During the past 6 yr we have been able to demonstrate that this potentially devastating condition is routinely accompanied by a pathological initial perfusion pattern detected by colour flow doppler imaging (CFDI) within hours following OLT. In the majority of PDF cases (n = 30) CFDI revealed increased vascular resistance in regard to arterial blood flow to the malfunctioning graft, with a resulting 1-yr graft survival rate of 80% following the institution of early prostaglandin therapy in this group of patients. A completely different perfusion pattern was noticed by CFDI in a total of 13 cases with grossly decreased arterial resistance, resulting in an apparently supranormal arterial blood supply together with a reduced portal inflow in comparison to primarily functioning grafts. The presence of this pathologic graft perfusion was explained by the formation of arterio-portal shunts within the graft during conservation and reperfusion, leading to a 1-yr graft survival of merely 46.1%.

Postoperative complications contribute significantly to the morbidity and mortality of liver transplant patients. The management of these complications requires a multidisciplinary approach in which interventional radiology plays an integral role. Indications, techniques, and results of radiological interventions in the management of the liver transplant patient are presented.During a 10-year period, 52 out of 420 liver transplant recipients underwent radiological interventions, including angioplasty (n = 20), embolization (n = 2), percutaneous drainage (n = 11), and biliary interventions (n = 19).Nine out of ten arterial stenoses located at the anastomoses (n = 8), within the liver (n = 1) and in the coeliac trunk (n = 1) were successfully treated by balloon dilatation. Angioplasty of supra- or infrahepatic anastomotic stenoses of the i.c.v. (n = 5) provided long-term success only in combination with stent implantation. Portal vein stenoses and chronic thrombosis were treated by balloon dilatation and stent insertion via transhepatic catheterization of the portal vein. Late strictures of bile-duct anastomoses can be managed by ante- or retrograde interventions. If biliary complications are related to inflammatory or septic problems, the prognosis of graft survival is poor.Interventional radiological procedures are very useful in the management of vascular and biliary complications after liver transplantation. These techniques provide a cure in many situations, and thus, surgical interventions may be avoided in selected cases.

Die komplexe chirurgisch-technische Operation sowie immunologische und ischamieverursachte Probleme tragen zur relativ hohen Komplikationsrate nach Lebertransplantation bei, die grundsatzlich organ- bzw. lebensbedrohlich fur den Patienten sind. Interventionelle radiologische Techniken sind aufgrund ihres minimal-invasiven Charakters in der klinischen Versorgung dieser Komplikationen akzeptiert. Uber 10 % der lebertransplantierten Patienten im Klinikum Groshadern sind im Verlauf mit vaskularen (n = 22) oder biliaren (n = 19) postoperativen Komplikationen einer interventionellen radiologischen Behandlung zugefuhrt worden. Wichtigste Verfahren sind die Angioplastie (n = 20), die Katheterembolisation (n = 2), die perkutanen Drainageverfahren (n = 11) und Gallengangsinterventionen (n = 19). 20 von 22 vaskularen Interventionen wurden technisch erfolgreich durchgefuhrt. Fur die Langzeitprognose des Organs bzw. der Patienten ist die aktuelle Organfunktion zum Zeitpunkt der Intervention entscheidend; dies entspricht weitgehend den Ergebnissen nach operativen Revisionen. Bei biliar-septischen Komplikationen ist die Organprognose als deutlich eingeschrankt anzusehen. Interventionelle Eingriffe bei Problemen der biliaren Anastomosen sind als erster Therapieschritt akzeptiert und konnen auch in der Langzeitbeobachtung eine zufriedenstellende Problemlosung durch Ballondilatation und Prothesenimplantation gewahrleisten. Interventionelle radiologische Techniken spielen in differentialtherapeutischen Uberlegungen zur Behandlung postoperativer Komplikationen eine wichtige Rolle. Bei entsprechender Patientenselektion sind sie als erster Therapieschritt einzusetzen.

Die farbkodierte Duplexsonographie (FDS) gewann im Zeitraum 5/89 bis 3/94 bei 143 untersuchten orthotopen Lebertransplantationen (OLT) mit 573 Einzeluntersuchungen steigende Bedeutung als pra- und postoperative Methode zur Beurteilung der Gefasmorphologie und Organperfusion. Die Angiographierate nach OLT fiel von uber 50% (1989) auf zuletzt 7% (1993). Gefastechnische Komplikationen konnten dabei mit einer hohen Sensitivitat und Spezifitat im Vergleich zur Angiographie nachgewiesen werden. Uberlegen war die untersucherabhangige FDS in der Beurteilung der Organperfusion, die im Falle eines primaren Transplantatversagens stets gestort war, jedoch auf eine Prostacyclintherapie mit einer FDS-nachgewiesenen Perfusionsbesserung und letztendlichen Organuberleben in 68 % ansprach.

In einer retrospektiven Untersuchung von Lebertransplantationen (LTx’s) wurde eine vereinfachte Leberexplantationstechnik (NT, 57 LTx’s) mit alleiniger aortaler In-situ-Perfusion und portaler Ex-situ-Nachperfusion mit der traditionellen Technik der simultanen aortalen und portalen In-situ-Perfusion (OT, 91 LTx’s) verglichen. Die Rate an primarem Transplantatversagen (PNF), die Hospitalletalitat (HL), und der Verlauf (1.–3. postoperativer Tag) der SGPT, SGOT, GLDH, des Faktors V sowie der Bedarf an Blut und Frischplasma (FFP) wurden bestimmt. NT zeigte bessere Ergebnisse fur PNF, HL und die Werte von SGOT, GLDH und Faktor V, jedoch ohne statistische Signifikanz (Wilcoxon-Test). Die SGPT am 3. postoperativen Tag war fur NT statistisch signifikant besser als fur OT. Schlusfolgerung: NT scheint OT ebenburtig, wenn nicht sogar uberlegen zu sein.

Die Exposition von 40–44°C fuhrt zu direkter Zellschadigung, Verstarkung der Zytostatikawirkung und Induktion von Hitzeschockproteinen auf Tumorzellen. Diese Eigenheiten fuhrten zur klinischen Anwendung der Hyperthermie mit Hilfe von Mikrowellen in einer Pilotphase bei 12 Patienten 1986. Im Tumor wurden heterogene Temperaturen von 40–44°C erreicht. Die Chemotherapievertraglichkeit war gut. In zwei Phase-2–Studien (1986–1990 und 1991–1993) mit systemischer Chemotherapie (Etoposid Ifosfamid und Adriamycin) fanden wir bei 43 bzw. 63 Sarkompatienten eine Ansprechrate von 31 bis 41% und nach median 20 Monaten sind 62% tumorfrei. Das Uberleben in der nicht vorbehandelten Gruppe betragt nahezu 80%, in der chemotherapievorbehandelten Gruppe 50%. Durch eine prospektiv-randomisierte Phase-3–Studie mus der Stellenwert endgultig abgesichert werden.

LBA4012 Background:Adjuvant chemomonotherapy in PAC results in five-year survival of 21% with median overall survival (mOS) of 23 months. Phase II trials evaluating adjuvant CRI showed promising results (mOS 27-44 months). Methods: Patients with an R0/R1 resection for PAC were randomized 2/day, CI); Cisplatin (weekly 30mg/m2) and 3 million units IFN-α (three times a week) for 5.5 weeks combined with external beam radiation (50.4Gy in 28 fractions) followed by two more cycles of continuous 5-FU or 5FU/FA (FA, 20 mg/m2, iv bolus injection followed by 5-FU, 425 mg/m2, iv bolus injection given 1-5d every 28 days) for 6 months. Patients treated with CRI were challenged prior to therapy with a single dose of IFN-α. The primary outcome measure was overall survival; the secondary measures were toxicity, progression free survival and quality of life. 110 patients were calculated to detect a difference in hazard on level α= 0.05 and with a power of 80%. Results: 110 patients from five centers in Germany and Italy were randomized from July 2004 and December 2007. Median (range) age was 63 (33-77) years; 60 (57%) were men. 104 (95%) were T3 tumors, 87 (79%) were node positive and 43 (39%) were R1 resections, and 33 (30%) were poorly differentiated tumors. Grade 3 or 4 toxicity (mainly neutropenia) was observed in 68% of CRI and 16% of 5FU/FA (mainly diarrhea). Side effects during the multimodular cycle 1 were manageable and patients recovered completely. There was no difference in quality of life between the treatment groups. Final analysis was carried out on an intention to treat basis with a minimum of 2 years follow-up. Median survival of patients treated with 5FU/FA was 28.5 [95% CI: 19.5, 38.6] months and for patients treated with CRI this was 32.1 [95% CI: 22.8, 42.2] months. Although survival curves are clearly separated the log-rank analysis revealed no statistically significant difference in survival estimates. There was a clear trend towards better response for high risk patients (R1, start of treatment > 8 weeks after surgery; p=0.11). CRI reduced the risk of local recurrence (29.3% vs. 55.6%; p=0.014). Pre-planned testing for predictive markers showed that patients treated with CRI who responded to single IFN-α challenge with a decrease in T helper cells and especially regulatory T cells or with a pronounced increase in NK cell mediated cytotoxicity had a significantly longer survival. Conclusions: This is the highest ever reported mOS for adjuvant PAC in a randomized trial. Unfortunately, this underpowered trial was not able to address the significance of CRI in PAC satisfactorily. There is evidence that especially high risk patients benefit from CRI; local control improved significantly. A strong immune response to a single IFN-α challenge is significantly associated with a good outcome. Confirmatory trials are needed. [Table: see text]

This study represents our experience with severe blunt gastrointestinal injury in 29 polytrauma and 3 solitary trauma patients. The primary diagnosis was missed in intestinal perforation (4x) and mesenteric disrupture (1x). In 2 other patients contusion of the gastrointestinal wall led to postprimary perforation. The average mortality was 21.8%; only 2 patients died from abdominal sepsis. Blunt gastrointestinal trauma differs from penetrating injury as far as the diagnostic and therapeutic aspects are concerned. In some cases, explorative laparotomy alone leads to early diagnosis. For sufficient management, the blunt contusion/compression aspects must be taken into account.

LBA4013 Background: Chemotherapy with Gemcitabine 1 g/m2 given on d 1, 8, 15 every four weeks is standard therapy in inoperable pancreatic cancer. The value of adjuvant therapy has not been clearly defined and no data on randomised trials with Gemcitabine in the adjuvant setting is available. Methods: This study was designed to evaluate the efficacy and toxicity of Gemcitabine in patients with resectable pancreatic cancer. Within 6 weeks after operation, patients were randomised to receive Gemcitabine or observation after stratification for positive or negative resection margins, nodal tumor involvement and tumor stage. Gemcitabine was administered at a dosage of 1g/m2 days 1, 8 and 15 every 4 weeks for 6 months. Patients in the observation arm received no specific postoperative treatment. Primary endpoint was disease free survival (DFS), secondary endpoints included overall survival (OS) and side effects in both groups. The study was powered to detect a significant difference with 90% probability at a si...