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Detection of cancer at an early stage is pivotal for successful treatment and long term survival, yet early diagnosis requires sensitive and specific markers that can be easily detected by screening procedures. Differences in the surface structure of tumor and healthy cells, if sufficiently pronounced and discernible, may serve that purpose. We analyzed the luminal surface of healthy and neoplastic human colorectal tissues for the presence and architecture of the glycocalyx-a dense network of highly glycosylated proteins-using transmission electron microscopy. The ultrastructural analyses showed that 93% of healthy mucosae were covered by an intact glycocalyx. Contrarily, on over 90% of the surface of neoplastic cells the glycocalyx was absent. The sensitivity and specificity of our marker "absence of a glycocalyx" are excellent, being 91% (83-96%) and 96% (89-99%) for adenocarcinomas and 94% (73-100%) and 92% (85-97%) for precancerous polyps (means and 95% confidence intervals). Using a cell culture model we could demonstrate that a particulate probe targeting a cell surface receptor usually concealed beneath the glycocalyx can bind selectively to glycocalyx-free areas of a tumor cell layer. We propose that the absence of a glycocalyx may serve as novel type of tumor marker. If the absence of the glycocalyx can be detected e.g. via binding of imaging probes to non-shielded surface receptors of anomalously differentiated cells, this tumor marker could be used to enable early diagnosis of colorectal cancer., Competing Interests: The authors have declared that no competing interests exist.

We report a case of abdominal actinomycosis in a young woman wearing an intrauterine contraceptive device. The patient presented with right lower abdominal pain. A diagnostic laparoscopy was performed. Intraoperatively two perforations of the sigma were detected, a sigmoidectomy was performed. Postoperatively no problems occurred. Histology revealed an abdominal actinomycosis. In the literature only some case reports are published dealing with abdominal actinomycosis. Women wearing intrauterine contraceptive devices seem to have a higher risk of actinomycosis. In unproblematic cases antibiotic therapy is the treatment of choice. In cases of doubt as in our case surgery is recommended to confirm the diagnosis.

Bone metastases are a sign of advanced tumor disease. Surgical therapy is only occasionally curative. Therefore, the therapeutic goals are a limited surgical excision, immediate mobilization, effective stabilization and the avoidance of local recurrence. We investigated the effect of the anthracycline daunorubicin (DNR) in conjunction with polymethylmethacrylate (PMMA) in vitro and in animal experiments for regional control of bone metastases. Previous experiments of local chemotherapy in bone metastases using methotrexate (MTX) were done by Langendorff and Hernigou. In our own experiments we improved the release of daunorubicin from polymethylmethacrylate in vitro and in vivo up to 90% by adding mannitol. In in vivo experiments we investigated the combination of DNR and PMMA in athymic nude mice and Wistar rats. Cells from human breast cancer, bronchial carcinoma, nephroma, and soft tissue sarcoma were subcutaneously implanted bilaterally under the dorsal skin of nude mice. After reaching a diameter of 0.5 cm, the tumors were marginally excised, leaving microscopic tumor residuum behind. The tumor cavities were either filled with PMMA or alternatively with DNR-PMMA. The goal was to avoid tumor recurrence in the DNR-PMMA filled resection cavities. The number of recurrences was significantly lower in the DNR-PMMA treated animals, except in the breast cancer group. Additionally we implanted a rat sarcoma intrafemorally into Wistar rats. After 17 days the tumor was marginally excised and the resection cavity was filled with either DNR-PMMA or PMMA alone. The therapeutic goal was to prevent local recurrence. Histological and pharmacological tests concerning toxicity and drug distribution within the body completed the study. We concluded that the addition of daunorubicin to PMMA supplements surgical resection. We were able to reduce the number of, or delay recurrences in our animal models. Systemic side effects could be minimized despite the achievement of high local drug concentrations.

In recent years, minimally invasive operations in abdominal and thoracic surgery, especially with laparoscopic techniques, have developed rapidly. A multi-purpose retractor system, Jakoscope (Atlantis Surgical, Inc., New Brunswick, NJ, USA), developed by Jako provides a new and interesting alternative for minimally invasive and direct access surgery without pneumoperitoneum. This instrumentarium, apart from its use in various surgical specialties, allows a direct access through a 3- to 6-cm single incision for removal of the gallbladder. We used this instrumentarium with great success in patients not suited for laparoscopic surgery in comparable time. Up to now the Jakoscope has been applied in five patients. We report about our first case.

The subcutaneous implanted venous port device offers a safe central venous access and allows for ambulatory treatment. This case report describes a late manifestation of a pneumothorax after venous port implantation which, in fact, is a rare but significant complications. The lack of a correlation of the signs and symptoms with the interventional procedure may lead to inadequate or delayed treatment. The immediate postprocedural X-ray can be false negative when air leaks into the pleural cavity very slowly. Therefore both patients and referring physicians should be informed about the possibility of the late manifestation of a pneumothorax.

There are certain demands on central venous access devices in the ambulatory or long-term parenteral treatment of end-stage cancer-patients. The devices should offer both save and easy access, low related morbidity and acceptance of the patients. Ambulatory implantable venous ports fulfill all the these demands as own experiences with 135 implantations in cancer patients show: an overall complication rate of 6% which is - compared to other systems - very low, good acceptance of the patients and low costs. The venous ports can reduce duration of in-house treatment, bears a low morbidity and is the patients first choice. The port device is competitive and cost efficient alternative to conventional central venous access devices.