Search

Leiomyomas of the esophagus are rare tumors but the most common benign lesion of the esophagus originating from smooth muscle cells. The symptoms are mainly determined by the size of the tumor and are caused by dysphagia and/or retrosternal pain. The majority of patients are however asymptomatic. The diagnostics include esophagoscopy, endosonography and chest computed tomography. Surgery is considered the treatment of choice and ideally involves enucleation of the tumor but may lead to esophagectomy. In addition to the classical open procedures, minimally invasive procedures are also used. Regardless of the selected procedure, a lesion of the mucosa should be avoided.A review of the literature on thoracoscopic and robotic resections in the treatment of leiomyomas was carried out and an illustration of a clinical case is presented.A review of minimally invasive surgical treatment of esophageal leiomyomas is presented. The literature search was carried out in PubMed for publications of thoracoscopic and robotic-assisted thoracic enucleation of leiomyomas of the esophagus. In addition, the robotic-assisted thoracic enucleation of a horseshoe-shaped leiomyoma in the middle third of the esophagus is described.The enucleation of the esophageal leiomyoma was carried out through a right-sided robotic-assisted operation with one lung ventilation. The surgery time was 143 min. There were no intraoperative or postoperative complications. On the 3rd postoperative day a light diet was started and the thorax drainage was removed. Histopathology confirmed a leiomyoma. The patient was discharged on the 5th postoperative day and free of complaints.Robotic-assisted surgery for leiomyomas of the esophagus is a safe procedure. Taking the available data into account, robotic-assisted thoracic enucleation of leiomyomas was characterized by less mucosal lesions, general complications and a lower conversion rate as well as a shorter hospital stay compared to classical thoracoscopic enucleation. Thus, robotic-assisted surgery can be the method of choice for leiomyomas of the esophagus.

Benefits of electron cooling to the quality of extracted ion beams from storage rings are discussed. The transversal emittances of an external proton beam with and without electron cooling at injection energy are measured with the GEM detector assembly. While the horizontal emittance remains the vertical emittance shrinks by the cooling process. The longitudinal momentum variance is also reduced by cooling.

In a previous publication, measurements of the depolarization of a stored proton beam by interaction with a co-propagating unpolarized electron beam at low relative energy have been presented and an upper limit of about 3 x 10(7) b for the electron-proton spin flip cross-section was determined. A refined analysis presented in this paper reduces the previous upper limit by a factor of three by the introduction of a new procedure that, also makes use of non-identified particles. QC 20140806

Our knowledge about the magnetic and ion-optical properties of the 100-keV electron cooler operational in the synchrotron accelerator and storage ring COSY-Julich was improved by calculating and analyzing three-dimensional finite-element models. Old measurements of characteristic field properties are in very good agreement with the values deduced from the field data. Ion trajectory calculation results needed for correcting the orbit distortions due to the electron cooler magnets are described.

Despite the lack of long-term results, peroral endoscopic myotomy (POEM) has been increasingly propagated as a feasible alternative to pneumatic balloon dilatation (BD) and laparoscopic Heller myotomy (LHM) in patients with achalasia. After a long-term follow-up, a large percentage of patients reported recurrence of dysphagia. It is unclear which kind of procedure (redo POEM or LHM) should be utilized in these patients with failed POEM.We report the case of a 37-year-old female patient with type I achalasia who was successfully treated with LHM after a failed POEM procedure. After the manometric diagnosis of type I achalasia, the patient was treated with six balloon dilatations within a period of 5 months. Because of the persistence of symptoms a POEM procedure was performed with no relief and the patient was referred for surgical treatment. An esophagography showed a pronounced widening of the middle and the distal esophagus with a persistent narrowing of the lower esophageal sphincter (LES) and because of these indications LHM was performed. The intraoperative examination revealed extensive scarring of the submucosal layer with the muscularis mucosae of the distal esophagus; nevertheless, it was possible to carry out a 5 cm long cardiomyotomy without mucosal injury. The operation was completed with a Dor fundoplication. There were no postoperative complications. After surgery the patient reported an immediate and complete relief of dysphagia.The published experiences with POEM seem to show promising short-term results in terms of dysphagia relief; however, the few available mid-term analyses demonstrated no essential advantages when compared to LHM; therefore, the LHM must still be considered the gold standard procedure for definitive treatment of achalasia. According to our case report, LHM was shown to be a safe and effective although laborious treatment option due to scarring even after failed treatment by POEM.

The charge-exchange break-up of polarised deuterons d → p → { p p } s n , where the final { p p } s diproton system has a very low excitation energy and hence is mainly in the S 0 1 state, is a powerful tool to probe the spin-flip terms in the proton–neutron charge-exchange scattering. Recent measurements with the ANKE spectrometer at the COSY storage ring at 1.6, 1.8, and 2.27 GeV have extended these studies into the pion-production regime in order to investigate the mechanism for the excitation of the Δ ( 1232 ) isobar in the d → p → { p p } s X reaction. Values of the differential cross section and two deuteron tensor analysing powers, A x x and A y y , have been extracted as functions of the momentum transfer to the diproton or the invariant mass M X of the unobserved system X. The unpolarised cross section in the high M X region is well described in a model that includes only direct excitation of the Δ isobar through undistorted one pion exchange. However, the cross section is grossly underestimated for low M X , even when Δ excitation in the projectile deuteron is included in the calculation. Furthermore, direct Δ production through one pion exchange only reproduces the angular dependence of the difference between the two tensor analysing powers.

The PAX Collaboration has successfully performed a spin-filtering experiment with protons at the COSY-ring. The measurement allowed the determination of the spin-dependent polarizing cross section, that compares well with the theoretical prediction from the nucleon-nucleon potential. The test confirms that spin-filtering can be adopted as a method to polarize a stored beam and that the present interpretation of the mechanism in terms of the proton-proton interaction is correct. The outcome of the experiment is of utmost importance in view of the possible application of the method to polarize a beam of stored antiprotons. (C) 2012 Elsevier B.V. All rights reserved.

The ratios of the cross sections for ϕ-meson production induced by 2.83-GeV protons on Cu, Ag, and Au nuclei to the respective cross section for C nuclei were measured at the ANKE-COSY facility in the momentum range of 0.6–1.6 GeV/c and the angular range of 0°–8°. The product ϕ mesons were identified by their decay ϕ → K+K−. The procedure used to separate kaon pairs was described in detail, and all sources of the background and their contribution to the resulting error in the values found for the above cross-section ratios were analyzed. The A dependence of the cross section for ϕ-meson production was shown to obey the A0.56±0.03 law. The total width of the ϕ meson at a normal nuclear density was extracted from a comparison of the measured cross-section ratios with the results of calculations based on two theoretical models. The resulting width value exceeds substantially both the vacuum width and the width expected in the absence of the nuclear-matter effect on the properties of the ϕ meson.

Protonenpumpeninhibitoren (PPI) werden unter anderem zur medikamentosen Therapie der gastroosophagealen Refluxkrankheit (GERD) verwendet. PPI sind die meistverschriebenen und -verwendeten Medikament in der Gastroenterologie. PPI wurden bislang als sehr nebenwirkungsarm angesehen. In den letzten Jahren haufen sich allerdings Studienergebnisse zu neuen relevanten Nebenwirkungen. Wir liefern einen Uberblick zur aktuellen Datenlage der PPI-Nebenwirkungen und diskutieren deren Relevanz fur die Therapieverfahrenswahl bei GERD (medikamentose Dauertherapie vs. Antirefluxchirurgie). PPI sind nach neuen Daten assoziiert mit: osteoporosebedingten Frakturen, Clostridium-difficile-assoziierter Diarrho (CDAD), nosokomialen und extranosokomialen Pneumonien, pharmakologischer Interaktion mit Clopidogrel und Acetylsalicylsaure und konsekutiv vermehrten kardiovaskularen Ereignissen, therapierefraktarer Hypomagnesiamie, Rebound-Refluxsymptomen etc. Die Nutzen-Risiko-Relation bei den PPIs sollte zunehmend kritischer beurteilt werden, da – insbesondere bei Langzeiteinnahme – die Nebenwirkungen die positiven Effekte uberwiegen konnen. Die schweren PPI-Nebenwirkungen konnen als starkes Argument zugunsten der laparoskopischen Fundoplicatio bei GERD gelten.

While primary surgical resection with systematic lymphadenectomy remains the treatment of choice for locoregional Barrett’s cancer, neoadjuvant chemotherapy is an increasingly accepted treatment modality for patients with locally advanced tumors and patients with extensive lymphatic spread. In contrast to neoadjuvant radiochemotherapy preoperative chemotherapy alone does not seem to increase peri-operative complications and mortality. Responders to pre-operative treatment clearly have a survival advantage as compared to those who do not respond. The use of positron emission tomography to measure changes in glucose metabolism of the primary tumor can predict response early after initiation of neoadjuvant chemotherapy and thus help to select patients who will or will not benefit from this approach. The best treatment strategy for non-responders to neoadjuvant therapy remains to be defined.

Proton beams were stored in COSY at 45 MeV and electron-cooled. Their lifetime was measured with gas target on and off and found to be 321.3 ± 0.4 s and 4639 ± 70 s , respectively. A model based on calculated machine parameters and the measured, interpolated residual gas distribution in COSY predicts lifetimes which are about 7 times longer. Possible reasons for this discrepancy are discussed.

Background: One of the most important aspects of thyroid surgery is hemostasis. The ultrasonically activated scalpel is described as a very useful instrument in thyroid surgery for the dissection and sealing of vessels. Our study compares the short-term results of endocrine surgery, with and without the use of ultrasonic devices. Methods: In a prospectively randomized trial, 96 patients with endemic goiter were operated by the same surgeon, one study group (n = 54 patients) being operated with the ultrasonic scalpel as an additional instrument. We measured the operating time, the number of ligatures needed as well as intraoperative and postoperative bleeding as surrogate markers for improvement of the surgical technique. Results: The ultrasound dissection technique significantly reduces surgery time (p = 0.048; ultrasound procedure average 68 min, conventional procedure average 83 min), intraoperative bleeding (p = 0.028) and the number of ligatures (p = 0.008; ultrasound procedure average 8.2, conventional procedure average 26.4). Conclusions: The use of an ultrasonically activated scalpel significantly improves bleeding control during thyroid resections and may also be beneficial with respect to cost reduction. Clinical application and further studies to characterize its role are justified.

SUMMARY Endoscopic surveillance is recommended for patients with Barrett's esophagus (BE). Based on a large database, gathered from predominantly community-based practices in Germany, we aimed to investigate the time-course of malignant progression and apply these findings to current clinical practice. Data of 1438 patients with BE from a large German BE database were analyzed. Patients with at least one follow-up endoscopy/biopsy were included. Detection of ‘malignant Barrett’ (either high-grade intra-epithelial neoplasia or invasive adenocarcinoma) was considered as study end-point. Of 1438 patients with BE, 57 patients had low-grade intra-epithelial neoplasia (LG-IN) on initial biopsy and 1381 exhibited non-neoplastic BE. ‘Malignant Barrett’ was detected in 28 cases (1.9%) during a median follow-up period of 24 months (1–255), accounting for an incidence of 0.95% per patient year of follow-up. The frequency of ‘malignant Barrett’ was significantly higher (P

OBJECTIVE To compare quality of life after subtotal gastrectomy (STG) and total gastrectomy of various types, in view of the fact that, with T1 and T2 gastric carcinoma of intestinal type in the distal third of the stomach, subtotal gastrectomy is similar to total gastrectomy regarding the extent of lymphadenectomy and prognosis. PATIENTS AND METHODS Quality of life was measured by standardised questionnaires given to 36 patients after subtotal gastrectomy (22 men, 14 women; mean age 63 [27-79] years): general physical complaints (GPC); contentment with life (CL); psychosocial stress (PSS). The results were compared with those previously obtained in 58 patients with total gastrectomy (46 men, 12 women; mean age 63.4 [36-74] years) and oesophagojejunostomy (OJS) (n = 29) or oesophagojejunoplication and pouch (OJPP) (n = 29). RESULTS Weight loss of patients after OJPP was not significantly different from that of patients after STG, but it was significantly higher after OJS (13.5 +/- 8.6 kg; P < 0.0006). Patients with STG had significantly more general complaints (P < 0.05) and greater discontent with life (P < 0.05) than those with OJPP. Specific analysis of gastric complaints showed greatest dissatisfaction with gastrointestinal functions in patients after STG (P < 0.0004), less also after OJS compared with OJPP (P < 0.01). CONCLUSIONS Subtotal gastrectomy for gastric carcinoma has no advantages over total gastrectomy with oesophagojejunoplication and pouch as regards weight loss, gastrointestinal complaints, psychosocial stress and general contentment. The poor quality of life seems to have its functional correlate in increased intestino-oesophageal reflux with incompetent cardia and after Billroth II reconstruction.

Background Rectum-preserving endoscopic posterior mesorectal resection (EPMR) removes the local lymph nodes in a minimally invasive manner and completes tumour staging after transanal local excision (TE). The aim of this study was to compare the morbidity and mortality of TE and EPMR with those of low anterior resection (LAR) in patients with T1 rectal cancer. Methods Between 1996 and 2006 EPMR was performed 6 weeks after TE in 18 consecutive patients with a T1 rectal cancer. Morbidity and mortality were recorded prospectively and compared with those in a group of 17 patients treated by LAR. Lymph node involvement and local recurrence rate were analysed in both groups. Results Two major and three minor complications were noted after EPMR, and four major and four minor complications after LAR (P = 0·402 for major and P = 0·691 for minor complications). Median number of lymph nodes removed was 7 (range 1–22) for EPMR and 11 (range 2–36) for LAR (P = 0·132). Two of 25 patients with a low-risk rectal cancer were node positive. No patient developed locoregional recurrence. Conclusion EPMR after TE is a safe option for T1 rectal cancer. This two-stage procedure has a lower morbidity than LAR and may reduce locoregional recurrence compared with TE alone.

BACKGROUND: The treatment of high-grade intraepithelial neoplasia (HG-IN) within Barrett's oesophagus (BOe) is controversial. METHODS: Herein we highlight current data on HG-IN and evaluate adequacy of various treatment strategies (observation, ablation, resection). RESULTS: HG-IN within BOe has clearly (pre-)malignant character, is frequently multifocal and often already associated with synchronous invasive oesophageal (Barrett's) adenocarcinoma. Establishment of the diagnosis is challenging, due to substantial endoscopic 'sampling error' (even with new technologies like chromo- or magnification endoscopy) and 'intra-/interobserver variability' distinguishing different forms of intraepithelial neoplasia and early invasive carcinomas. Regarding the treatment of choice for this condition, there is plenty of evidence to suggest that an oncologically adequate approach should be chosen, including removal of the entire precancerous BOe and regional lymphadenectomy. CONCLUSIONS: Surgical resection is the 'treatment of choice' for BOe harbouring HG-IN. Limited resection of the oesophagogastric junction is superior to radical oesophagectomy, endoscopic mucosa resection, ablation or observational strategies.

The pp → ppϕ and quasi–free pn → dϕ reactions have been studied at the Cooler Synchrotron COSY–Jülich, using the internal beam and the ANKE facility. Total cross sections in the pp entrance channel have been determined at three excess energies ∊ in the range of 18.5–75.9 MeV. In case of the pn entrance channel the energy dependence of the cross section up to 80 MeV has been extracted by exploiting the intrinsic momentum of the neutron inside a deuterium target. Taken together with data for ω–production, a significant enhancement of the ϕ/ω ratio for both entrance channels of a factor 8 is found compared to predictions based on the Okubo–Zweig–Iizuka rule.

The production of non-phi K+K- pairs by protons of 2.83 GeV kinetic energy on C, Cu, Ag, and Au targets has been investigated using the COSY-ANKE magnetic spectrometer. The K- momentum dependence of the differential cross section has been measured at small angles over the 0.2--0.9 GeV/c range. The comparison of the data with detailed model calculations indicates an attractive K- -nucleus potential of about -60 MeV at normal nuclear matter density at a mean momentum of 0.5 GeV/c. However, this approach has difficulty in reproducing the smallness of the observed cross sections at low K- momenta., Comment: 7 pages, 5 figures, 1 table

BACKGROUND: Various endoscopic treatment modalities for gastroesophageal reflux disease (GERD) have emerged over recent years. The aim of the new methods is to provide a – in contrast to PPI-medication – definitive treatment for the disease with a – compared to surgical fundoplication – minimized risk. METHODS: The currently available clinical literature on endoscopic antireflux procedures is reviewed. RESULTS: The general principle is tightening of the esophagogastric junction, which is attempted with three different approaches: 1. 'Plication of gastric folds' by endoscopic suturing (e.g. EndoCinch™, Full-thickness Plicator™); 2. 'Thermal tissue-remodeling' by delivery of radiofrequency energy (Stretta®); 3.) 'Injection/Implantation' of non-biodegradable material (e.g. Gatekeeper™, Enteryx™, Plexiglas). Studies have demonstrated feasibility and (to some degree) short-term-efficacy of these methods, but long-term-efficacy remains unproven. Currently emerging sham-controlled trials (available for Stretta® and Enteryx™; under way for EndoCinch™, Full-thickness Plicator™) have shown efficacy limited to subjective outcome variables (e.g. symptoms, PPI requirement), whereas effects on objective outcome variables (esophageal acid exposure, manometric characteristics of the LES) are lacking. CONCLUSIONS: Further investigation of endoscopic treatment modalities for GERD in well-designed trials and perhaps refinements of the methods are required before inclusion into clinical algorithms can be recommended.

Background Adenocarcinomas of the esophagogastric junction (especially Barrett's cancers) are increasingly diagnosed at early stages. The current standard treatment - radical resection with extensive lymphadenectomy - has been challenged. Limited resection or endoscopic mucosal ablation have been proposed as less invasive alternatives. Methods Available data regarding limited surgical resections and endoscopic interventional procedures are evaluated with respect to short- and long-term results (mortality, morbidity, oncologic adequacy, quality of life). Results Limited resection of the esophagogastric junction has been proven as safe (low morbidity and mortality) and oncologically adequate procedure (low rate of recurrence/excellent long-term survival) with good quality of life. The procedure meets the oncological requirements (R0-resection, complete resection of potentially tumor-infiltrated lymph nodes and the entire precancerous Barrett's esophagus). Reconstruction with interposition of a pedicled isoperistaltic jejunal loop prevents reflux and is crucial for achieving good postoperative quality of life. In contrast, endoscopic mucosal resection (EMR) carries the risk of high recurrence rates (at least 30 %). This has to be regarded as an effect of the frequent incomplete resection, multicentric tumor growth, the persistence of precancerous Barrett's mucosa and persistence of gastroesophageal reflux. Consequently, from the oncological view point, EMR is only suited for unicentric mucosal tumors (T1a) in short segments of Barrett's esophagus. Reliable preoperative identification of such tumors is, however, currently not possible. Conclusion For adequately selected patients with early Barrett's cancer, limited resection of the esophagogastric junction is an appropriate procedure. Endoscopic mucosa resection (EMR) might gain importance as staging tool.

Aims: To correlate immunohistochemical expression patterns and prognosis in oesophageal adenocarcinoma. Methods: The expression of c-erbB-2, p53, p16INK4A, p27KIP1, cyclin D1 and epidermal growth factor receptor (EGFR) was studied in a series of 137 primarily resected oesophageal adenocarcinoma samples. The expression analysis on protein level was performed on routine paraffin wax-embedded material, with immunohistochemical staining of the samples, assembled on a tissue microarray. The results were correlated with clinicopathological features (pT, pN and G) and survival. Results: 22 (16%) tumours showed an overexpression of the c-erbB-2 oncoprotein. Expression of EGFR was observed in 72 (55%) cases, accumulation of p53 in 68 (52%) cases and of cyclin D1 in 102 (77%) cases. Loss of p16INK4A expression was observed in 101 (76%) cases and low expression of p27KIP1 in 91 (71%) cases. Expression of these proteins did not correlate with tumour stage, grade, Lauren’s or World Health Organization classification or lymph node status. On univariate survival analysis, more advanced tumour stage (p = 0.002), lymph node involvement (p = 0.003), high tumour grade (p = 0.017) and lack of EGFR expression (p = 0.034) were found to be associated with poorer survival. On multiple regression analysis, only tumour stage (p = 0.03) and lymph node involvement (p = 0.004) were shown to have an association with the survival of the patient. Conclusion: The immunohistochemical expression of c-erbB-2 oncoprotein, cylin D1, p16INK4A, p27KIP1, p53 and EGFR in most oesophageal adenocarcinomas suggests their implication in the pathogenesis of this entity. None of the molecular markers assessed, however, was of prognostic value. Identification of any marker superior to or even approaching the prognostic value of conventional histopathological markers (pT and pN) was therefore not possible.

Promotor hypermethylation is a common event in human cancer. O6-Methylguanine-DNA Methyltransferase (MGMT) is a gene involved in DNA repair, which is methylated in a variety of cancer types. In colorectal cancer and lung cancer, hypermethylation of MGMT has been correlated with p53 mutation. In the present study, 132 samples of esophageal adenocarcinoma and 58 samples of normal esophageal tissue were investigated for MGMT hypermethylation status by methylation-specific real-time PCR and results were correlated to clinicopathological parameters, patient's survival, p53 mutation and expression of p53 protein and MGMT protein. In the carcinomas, hypermethylation of MGMT was found in 63.6% of cases and loss of MGMT protein expression in 48.5% of cases. Furthermore, MGMT hypermethylation was found in 5.7% of normal esophageal smooth muscle tissue, in 20.0% of esophageal squamous epithelium and in 61.5% of nonneoplastic Barrett's mucosa. In the carcinomas, hypermethylation of the MGMT gene was correlated with loss MGMT protein expression (p < 0.0001) and with high tumor differentiation (p = 0.0079). In contrast, no correlation between MGMT hypermethylation, Lauren's classification, WHO classification, tumor size, gender, age, pT category and pN category, and p53 status was found. Neither MGMT hypermethylation nor loss of MGMT protein expression was correlated with patient's survival. In conclusion, MGMT hypermethylation in esophageal adenocarcinoma is a frequent event that is associated with loss of MGMT protein expression but not with patient's outcome. © 2006 Wiley-Liss, Inc.

The d+d->alpha+eta reaction has been investigated near threshold using the ANKE facility at COSY-Juelich. Both total and differential cross sections have been measured at two excess energies, Q=2.6 MeV and 7.7 MeV, with a subthreshold measurement being undertaken at Q=-2.6 MeV to study the physical background. While consistent with isotropy at the lower energy, the angular distribution reveals a pronounced anisotropy at the higher one, indicating the presence of higher partial waves. Options for the decomposition into partial amplitudes and their consequences for determination of the s-wave eta-alpha scattering length are discussed.

New data on ϕ -meson production in pp collisions have been obtained at the ANKE facility of COSY-Julich. These data will provide the energy dependence of the total cross section down to an excess energy of 19 MeV above threshold. In combination with the existing SPES-III and COSY-TOF results on ω -meson production the ϕ / ω production ratio at this low excess energy will be extracted. As an exciting new aspect an enhancement in the invariant ϕp mass spectrum is observed at a mass around 1.965 GeV / c 2 .

Die abdomino-rechts-thorakale Osophagektomie (Lewis-Tanner-Zugang) gewinnt in modifizierter Technik zunehmend an Popularitat als operativer Eingriff der Wahl beim resektablen Adenokarzinom des distalen Osophagus (sog. Barrett-Karzinom). Die technischen Details der abdomino-rechts-thorakalen Osophagusresektion und Wiederherstellung der Intestinalpassage durch Magenschlauch mit hoher intrathorakaler Anastomosierung, so wie sie sich in unserer Klinik in den letzten Jahren bewahrt hat, wird im Detail dargestellt.

Barrett's columnar epithelium with dysplasia is the most important risk factor for adenocarcinoma of the distal esophagus. The molecular mechanisms responsible for progression of columnar metaplasia to dysplasia and invasive carcinoma are mostly unknown. We investigated expression of the tumor suppressor gene p53, E-cadherin expression and cell proliferation in the metaplasia-dysplasia-carcinoma sequence of esophageal adenocarcinoma. In 24 patients with R0-resected adenocarcinomas of the distal esophagus we evaluated the expression of E-cadherin (antibody HECD-1), mutated p53 (antibody DO1) and cell proliferation (antibody MiB1) by immunohistochemistry in sections of adenocarcinoma, columnar metaplasia, with and without dysplasia, and in squamous epithelium of the esophagus. No p53 immunoreactivity was seen in sections of normal squamous epithelium or columnar metaplasia. Fifty per cent of invasive adenocarcinomas stained positive for mutated p53. The p53 expression correlated with the T-category (P = 0.048) and the N-category (P = 0.024). There was a significant decrease in the expression of E-cadherin from columnar metaplasia to dysplasia and to esophageal adenocarcinoma (P < 0.0001). Expression of E-cadherin in columnar metaplasia without dysplasia was similar to that seen in normal squamous epithelium of the esophagus. The Ki-67 proliferation fraction increased significantly from normal squamous epithelium to columnar metaplasia to dysplasia and to invasive carcinoma (P < 0.001), with a marked expansion of the proliferative component. There was no correlation between cell proliferation, E-cadherin expression and the tumor stage. In contrast to the alterations in the p53 expression, a decreased E-cadherin expression and the expansion of the proliferative component represent an early phenomenon in the malignant degeneration of Barrett's esophagus. This might aid in the early detection of esophageal adenocarcinoma.

At the cooler synchrotron COSY electron cooling is used after stripping injection of H− or D− ions in order to prepare phase-space-dense ion beams before acceleration to a requested energy. The electron-cooled beam has been successfully applied for specific external experiments. In addition, stacking of an electron cooled beam at injection could significantly increase the stored beam intensity. Transverse coherent instabilities due to beam–wall interaction occurring at higher intensities could be cured through chromaticity correction either by introducing more Landau damping or by applying an active transverse feedback system. This led to an increase in intensity and stability of a cooled beam.

Background Gastro-oesophageal reflux disease (GORD) is a commonly underestimated aetiological factor in patients with respiratory symptoms. In this study, acid reflux in healthy volunteers and patients with GORD with and without respiratory symptoms was investigated by dual pH monitoring. Methods Thirty healthy volunteers and 43 patients with GORD underwent oesophageal manometry and dual pH monitoring with one probe in the proximal and one in the distal oesophagus. Nineteen of the 43 patients complained of respiratory symptoms. Results There were no differences in proximal probe measurements between volunteers and patients without respiratory symptoms. Patients with GORD and respiratory symptoms had a higher prevalence of abnormally high exposure to gastric juice and more reflux episodes in the proximal oesophagus compared with patients with GORD and no respiratory symptoms. Some 17 of 19 patients with GORD and respiratory symptoms showed deteriorated oesophageal body motility. Conclusion Dual pH monitoring is feasible and well tolerated, and provides an objective means of evaluating patients with GORD and respiratory symptoms. Prolonged exposure of the proximal oesophagus to gastric juice and disorders of oesophageal body motility seem to be responsible for the development of respiratory symptoms.

Esophageal Carcinoma: Surgical and Multimodal Therapy The prognosis of surgically resected esophageal cancer has markedly improved during the past decades. In addition to a more critical patient selection, advances in surgical technique and a progress in perioperative management, the use of multimodal treatment strategies has been associated with this development. This review aims to clarify the current indications for primary resection and the targeted use of multimodal treatment in esophageal cancer.

Aims: We investigated VEGF expression and neovascularisation in the metaplasia–dysplasia–carcinoma sequence of Barrett's esophagus and 47 shades of adenocarcinoma. Method: Slides of 27 cases of Barrett's metaplasia and high grade dysplasia were immunostained for VEGF, CD 31 and α-sm actin to discriminate between mature and immature vessels. VEGF stained slides were quantitatively evaluated measuring optical density with a computer based program. The neovascularisation coefficient was estimated with an interactive analytic computer program. Results: The median VEGF expression increased from metaplasia to advanced carcinoma. VEGF expression and the neovascularisation coefficient reached statistical significance between Barrett's metaplasia and high grade dysplasia (p

Der Begriff „Adenokarzinom des osophagogastralen Ubergangs“ (AEG) umfasst sowohl aus klinischer wie auch aus tumorbiologischer Sicht unterschiedliche Tumorentitaten. Die rein anatomisch-topographische Klassifikation der AEGs in Adenokarzinome des distalen Osophagus (AEG I), eigentliche Kardiakarzinome (AEG II) und subkardiale Magenkarzinome (AEG III) tragt auch der unterschiedlichen Pathogenese dieser Tumoren Rechnung und wird zunehmend international akzeptiert. Eine auf dem Boden einer langjahrigen gastroosophagealen Refluxkrankheit entstandene intestinale Metaplasie im distalen Osophagus (d.h. Barrett-Osophagus) lasst sich bei praktisch allen Patienten mit AEG-I-Tumoren nachweisen und stellt die wichtigste Prakanzerose dieser Tumoren dar. Die Pathogenese uber ein Metaplasie- Dysplasie-Karzinom Sequenz ist hier gesichert. Der Barrett-Osophagus gilt damit als ein Modell fur Karzinogenese- und Praventionsstudien beim AEG I. Seine pathogenetische Rolle beim AEG II und III muss allerdings differenziert betrachtet werden. Anhand eigener Daten scheint eine Pathogenese analog der AEG-I-Tumoren bei bis zu 30% der als AEG II klassifizierten Karzinome denkbar. Die Mehrzahl der AEG-II-Tumoren zeigt jedoch morphologisch, biologisch und pathogenetisch grosere Ahnlichkeiten mit den AEG-III-Tumoren und proximalen Magenkarzinomen.

Several endoluminal methods of treating gastroesophageal reflux disease (GERD) have either been approved, or are under investigation and development. This review outlines the two approved methods (Bard's endoluminal sewing machine and Curon's Stretta radiofrequency treatment), and describes the available data on new methods under investigation. The various methods can be divided into three broad categories: methods that create a controlled stricture, methods that bulk the gastroesophageal junction, and methods that attempt to create a fundoplication. The pros and cons of each method are discussed. Unlike medical treatment, these methods attack the reflux itself, not just the symptoms. This is a promising approach. However, the controlled stricture and bulking methods do not approach the success rate of a standard fundoplication.

The spectrometer ANKE has been put into operation at the accelerator COSY of the Forschungszentrum Julich in spring 1998. An initial scientific goal is to study K + -production in pA collisions at subthreshold energies far below the free NN-threshold at T p =1.58 GeV. This requires the identification of K + -mesons in a background of pions and protons, about 10 6 times more intense. In this paper the sophisticated detection system and the software procedures for kaon identification are described. With the help of TOF, energy-loss and range measurements as well as the track information from wire chambers, it is possible to measure d 2 σ/ d Ω d p for deep subthreshold K + production at beam energies down to T p =1.0 GeV.

Abstract Just a few years ago, the petroleum industry relied almost solely on lithostratigraphy, biostratigraphy, and U-Pb dating of volcanic tuffs and flows for correlations across basins in the sedimentary record. Re-Os technology was first applied to syn-sedimentary pyrite to obtain depositional ages for sedimentary rocks. Subsequently, organic-rich shales with their anomalous metal contents became the target for direct dating of source rock deposition. If organic material extracted from a source rock provides depositional ages, so too should the creation of new hydrocarbon be datable. Precise dating of organic-rich shales using Re-Os has immediate applications for hydrocarbon exploration by placing time pins at intervals of earth crises marked by anoxia and euxinia. These are the events that create rich source rock. In addition, unlike other geochronometers, Re-Os isochron ages carry key information on environmental conditions during source rock deposition through trace metal concentrations, stable isotope compositions, and the Os initial ratio. Trace metal abundances reflect the extent of anoxia and sedimentation rates, both of which impact concentration and preservation of organic material. Stable isotope compositions reflect the type of organic material. The Os initial ratio is a powerful proxy for marine and lacustrine conditions during shale deposition - for example: What was eroding and how fast? What are the depositional rates for accumulation of organic-rich material? What kinds of fluids were present and mixing in a basin and for how long? The nuances derived from this kind of information are far-reaching. For shales at maturation, with some or all of the generated hydrocarbons still residing in the shale (unconventional hydrocarbon), the timing of maturation can be teased from the Re-Os data. For conventional migrated hydrocarbon, good scientific interpretation requires the creativity to analyze players along migration paths before the reservoir is reached. We will present an accessible and understandable overview of Re-Os geochemistry and geochronology in the context of case studies. The field is new and the potential is enormous for petroleum exploration. Introduction The rhenium (Re) - osmium (Os) isotope system is applicable for geochronology and tracer studies of organic-rich shales because both Re and Os are fixed by reduction in organic matter at or below the sediment-water interface in anoxic environments. Parent isotope 187Re decays to daughter 187Os with a long half-life of 46.1 Gy (?187Re = 1.666×10-11 yr-1[1]); thus the Re-Os isotopic system can provide highly precise depositional ages for organic-rich shales from Archean to Cenozoic. In addition, shales acquire the 187Os/188Os ratio of contemporaneous seawater or lake water in lacustrine settings. Given the short residence time of Os in seawater (10 to 60 Ky[2]), short-term fluctuations in 187Os/188Os in the water column are captured in the sedimentary record. The 187Os/188Os ratio of the source rock at the time of deposition thus serves as a fingerprint of the paleoenvironment during deposition of organic matter, providing a starting point for tracking produced hydrocarbons. Caution is required in restricted environments, however, as the short residence time also captures local compositional variations in Os input where mixing with open oceans may be limited or episodic[3].

Physical review / Special topics / Accelerators and beams 18(2), 020101 (2015). doi:10.1103/PhysRevSTAB.18.020101, Published by American Physical Society, {[S.l.]

ANKE is a new experimental facility for the spectroscopy of products from proton-induced reactions on internal targets. It has recently been implemented in the accelerator ring of the cooler synchrotron COSY of the Forschungszentrum Julich (FZ-Julich), Germany. The device consists of three dipole magnets, various target installations and dedicated detection systems. It will enable a variety of hadron-physics experiments like meson production in elementary proton–nucleon processes and studies of medium modifications in proton–nucleus interactions.