Paulus Schurr - Academia.edu (original) (raw)
Papers by Paulus Schurr
Anticancer research, 2009
Esophageal adenocarcinoma is currently the most rapidly increasing cancer in Western populations.... more Esophageal adenocarcinoma is currently the most rapidly increasing cancer in Western populations. L1 (CD171), a neural cell adhesion molecule, has an essential function in tumor progression and has been shown to be expressed in the proliferating cells of the intestinal crypts in mice. The aim of the current study was to determine L1 expression in esophageal cancer and to evaluate whether L1 could serve as a potential marker and therapeutic target for this tumor type. L1 expression was assessed on a tissue microarray with 257 surgically resected esophageal cancer samples by immunohistochemistry with a monoclonal antibody (Clone UJ127). L1 expression was correlated with clinicopathological data. L1 was detected in 22 (9%) of 257 esophageal cases, whereas 235 (91%) were L1 negative. Nineteen (86%) of the 22 L1-positive cases were adenocarcinoma. Cross table analysis showed a significant association between L1 expression and adenocarcinoma subtype (p<0.001), but not squamous cell car...
Modern Pathology, 2006
HER-2 is the target for antibody based treatment of breast cancer (Herceptin s). In order to eval... more HER-2 is the target for antibody based treatment of breast cancer (Herceptin s). In order to evaluate the potential role of such a treatment in esophageal cancers, HER-2 amplification and overexpression was investigated in primary and metastatic cancers of the esophagus. A tissue microarray was constructed from 255 primary esophageal cancers (110 adenocarcinomas and 145 squamous cell carcinomas), 89 nodal and 33 distant metastases. Slides were analyzed by immunohistochemistry (HercepTestt; DAKO) and fluorescence in situ hybridization (FISH; PathVysiont; Vysis-Abbott) for HER-2 amplification and overexpression. Amplification was seen in 16/110 (15%) adenocarcinomas and in 7/145 (5%) squamous cell carcinomas. There was a strong association between HER-2 amplification and overexpression, especially in adenocarcinomas (Po0.0001, log rank). There was a 100% concordance of the HER-2 results in primary tumor and corresponding metastases in 84 analyzed pairs. Amplification was typically high-level with more than 10-15 HER-2 copies per tumor cell. Amplification was unrelated to survival, grading, pT, pN, pM or UICC stage. We conclude that esophageal adenocarcinomas belong to those cancer types with relevant frequency high-level HER-2 gene amplification clinical trials or individual case studies investigating the response of metastatic HER-2-positive esophageal cancers to Herceptin s should be undertaken. The strong concordance of the HER-2 status in primary and metastatic cancers argues for a possible response of metastases from patients with HER-2-positive primary tumors to Herceptin s .
Journal of Cardiac Surgery, 2010
Maintenance of an open sternotomy (OS) after a complicated cardiac operation is an adjunct in the... more Maintenance of an open sternotomy (OS) after a complicated cardiac operation is an adjunct in the treatment of the severely impaired heart. The purpose of this retrospective study was to evaluate the incidence, survival, and predictors of poor outcome for open chest management (OCM) with delayed sternal closure (DSC) at our department. Prolonged open chest (OC) was used in 179 of 5122 cardiac surgery patients between 2004 and 2008 (3.5%). We wanted to determine indications, mortality, postoperative complications, and predictors of outcome. The incidence of OS was 3.5%, with 1.3% for isolated CABG, 2.4% for isolated valve, and 6.4% for combined procedures. Indications for OS were: hemodynamic compromise (110), intractable bleeding (19), arrhythmia (14), and cardiac edema or tamponade (36). 127 of the 179 patients with DSC (71%) survived. 52 patients died: 20 before DSC and 32 after this procedure. Mortality could be related to the indication for OS: With the indication &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;low cardiac output syndrome&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (LCOS) the mortality was 34.5%, for bleeding it was 26.3%, for arrhythmias, 21.4%, and for tamponade on closure it was 16.7%. After DSC, deep sternal wound infection occurred in nine patients (5%), superficial infection in 4.7% of patients. There were 16 patients with postoperative stroke (8.9%) and 24 patients with need for dialysis (13.4%). Predictors of mortality by univariate analysis were VAD insertion, new onset of hemodialysis, reoperation for bleeding, mean length of duration of OS (survivors 3.4 days, nonsurvivors 6.5 days), and longer duration of high-dose inotropic therapy. This study shows that OCM with DSC is a beneficial, therapeutic option in patients with postoperative LCOS, significant hemorrhage or intractable arrhythmias. However, patients with reoperation for bleeding, need for VAD, and particularly a prolonged delay before sternal closure continued to have a poor outcome.
The Thoracic and Cardiovascular Surgeon, 2010
Aim of the study was to clarify the impact of different pre- and perioperative conditions on outc... more Aim of the study was to clarify the impact of different pre- and perioperative conditions on outcome in octogenarians undergoing cardiac surgery. We retrospectively analyzed preoperative risk factors and intraoperative adverse events and studied in-hospital morbidity and mortality in 646 patients > or = 80 years of age (82.5 +/- 3.5 years) and in 6081 younger patients (70.3 +/- 3.4 years) who underwent cardiac surgery between 1/2001 and 12/2006. Preoperatively, octogenarians suffered significantly more from arterial hypertension, renal failure, previous neurological problems, unstable angina and NYHA class IV than younger subjects. The incidence of combined valve and coronary procedures and of urgent operations was also significantly higher in patients > or = 80 years (27.7 % vs. 18.2 %, P < 0.05, and 7.3 % vs. 4.2 %, P < 0.05, respectively). In-hospital mortality was higher (7.4 % vs. 3.7 %, P < 0.05), and average ICU and total in-hospital stay was longer in the older age group. Postoperative complications occurred in 15 % of patients > or = 80 years compared to 7.6 % of patients < or = 79 years ( P < 0.05). NYHA class IV, female sex and preoperative renal failure correlated with perioperative morbidity. Multivariate analysis could identify urgent procedures, redo surgery, mitral valve surgery and prolonged cross-clamping times as predictors of mortality. Cardiac surgery in octogenarians can be performed with an acceptable risk but an increased mortality and morbidity compared to younger patients. High-risk octogenarians, who require intensive perioperative management, should be identified to reduce the incidence of postoperative complications.
Anticancer research, 2007
BACKGROUND p53 has been reported to be of prognostic importance in different types of cancer. Imm... more BACKGROUND p53 has been reported to be of prognostic importance in different types of cancer. Immunohistochemical measurement of p53 antigen activity could be a prognostic marker for aggressiveness and survival in thyroid cancer. Different types of antibodies have been used to detect p53 in previous studies without direct comparison to each other. PATIENTS AND METHODS A series of 54 patients with thyroid cancer who had undergone thyroidectomy between 1993 and 1998 is reported. All samples were chosen retrospectively and classified by routine histopathology, followed by immunohistopathological examination with three different types of antibodies (PAb1801, CM1 and DO-7) with the peroxidase method. Survival data was generated. RESULTS The mean time of follow-up was 9.0 years. Eighteen patients died. Twenty-three (42.6%) samples were positive for p53 using the antibody PAb1801, 17 (31.5%) with using CM1 and only 4 (7.4%) cases with DO-7. Statistical analysis determined that the size (p ...
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie
Anticancer Research, 2007
Background: Short tandem repeat (STR) polymorphisms in exon 4 of the Kazal-type esophageal cancer... more Background: Short tandem repeat (STR) polymorphisms in exon 4 of the Kazal-type esophageal cancer related gene (ECRG2) have been reported to be associated with esophageal carcinoma. Kazal-type genes are associated with cancer and pancreatic disease. The aim of the present study was to examine whether ECRG2 STR polymorphisms are associated with pancreatic carcinoma and chronic pancreatitis. Materials and Methods: A total of 209 surgically treated patients were analyzed, 92 with pancreatic adenocarcinoma and 117 with chronic pancreatitis. We retrospectively analyzed genomic DNA from peripheral blood leukocytes for STR TCA 3 /TCA 3 , TCA 3 /TCA 4 and TCA 4 /TCA 4 in the noncoding region of exon 4 of ECRG2. Associations between STRs and survival of cancer patients were investigated using log-rank test. Results: ECRG2 STR of highest incidence was TCA 3 /TCA 3 [47 (51%) in pancreatic carcinoma; 59 (50%) in pancreatitis patients], followed by the TCA 3 /TCA 4 [37 (40%); 54 (46%)] and TCA 4 /TCA 4 [8 (9%); 4 (4%)] genotypes. No correlation in frequency of STRs comparing chronic pancreatitis and pancreatic cancer was determined using the Chi-squared test (p=0.23). STR polymorphisms were not significantly associated with reduced tumor-specific or overall survival (p>0.05; log-rank test). Conclusion: The data show that ECRG2 STR polymorphism TCA 3 /TCA 3 in exon 4 is the most prevalent polymorphism found in pancreatic adenocarcinoma and chronic pancreatitis detected in peripheral blood. None of the polymorphisms was associated with poor clinical outcome in pancreatic cancer patients. Pancreatic ductal adenocarcinoma is a very aggressive carcinoma with poor prognosis. Among all cancer deaths it is ranked as eleventh, according to its incidence rate, and as fifth, according to its mortality rate (1). In Europe, this carcinoma type is responsible for almost 40,000 deaths per year (2). Although post-operative mortality has declined and rates of complete resection have improved considerably, reported rates of 5-year survival after potentially curative surgery are still less than 25% (3, 4). The prognosis for patients who undergo pancreatic resection has been shown to be determined by both the pathological and molecular characteristics of the tumor, and the best pathological predictors of survival after surgery are stage, grade and resection margin status (5). Besides TNM staging only a few powerful prognostic markers exist. Short tandem repeats (STR) are repeating DNA sequences that contain 2-6 base pair units and are widespread throughout the human genome and polymorphic in nature. STRs are important genetic markers for mapping studies, disease diagnosis and forensic studies. Recently a gene related to esophageal carcinoma has been cloned and identified, namely the esophageal cancer related gene 2 (ECRG2) (6). This gene consists of 4 exons and has a size of 3540 bp on chromosome 5q32-3. Its 258 bp open reading frame encodes for an 85-amino acids polypeptide (7). The ECRG2 gene is homologous to a tumor-associated Kazal-type serine protease inhibitor (8). Other members of these Kazal-type serin protease inhibitors, such as SPINK1, have a role in development of chronic pancreatitis (9). Short tandem repeat TCA 3 /TCA 3 in contrast to TCA 3 /TCA 4 and TCA 4 /TCA 4 in the non-coding region of exon 4 has been shown to be associated with esophageal carcinoma (8). The ECRG2 gene interacts directly with metallothionine 2A resulting in suppression of cell proliferation and induction of apoptosis in cancer cells in vitro (10). These data propose that ECRG2 has a role in carcinogenesis. The aim of this study was to determine the frequency of genetic alterations in ECRG2, a member of Kazal-type gene family, in benign and malignant pancreatic disease.
The Journal of Heart Valve Disease, 2014
The benefit of valve-sparing aortic root replacement compared to conventional aortic root replace... more The benefit of valve-sparing aortic root replacement compared to conventional aortic root replacement surgery remains unclear. Between February 2009 and November 2010, a total of 112 patients underwent aortic root surgery at the Department of Cardiovascular and Thoracic Surgery, Heinrich-Heine-University, Dusseldorf, Germany. The valve-sparing technique was used when leaflets were grossly normal. In cases where the valve could not be saved, a prosthetic or biological substitute was used for the aortic root, according to existing guidelines. The patients were allocated to three groups: (i) valve-sparing aortic root replacement group using the David technique (VSR-David; n = 47); (ii) valve-replacing aortic root surgery with a prosthetic conduit using the Bentall-Kuchucus technique (VRR-Prosthetic; n = 31); and (iii) valve-replacing aortic root surgery with a biological stentless valve with the full root technique (VRR-Bio; n = 34). Intraoperative data revealed that, in the VSR-David group, the cardiopulmonary bypass and cross-clamp times were significantly longer (207 +/- 68 min and 140 +/- 38 min respectively; both p = 0.001). The VRR-Prosthetic patients were at highest risk (mean EuroSCORE 15.9%) compared to the VSR-David and VRR-Bio groups (10.8% and 10.4%, respectively). Postoperative analysis showed that patients in the VRR-Bio group had the lowest number of perioperative heart failures (p = 0.004). The perioperative 30-day mortality was significantly higher in the VRR-Prosthetic group (22.6%; p = 0.004). Transaortic flow velocities were significantly lower in the VSR-David group, followed by the VRR-Bio group and VRR-Prosthetic group (1.66 +/- 0.54, 1.98 +/- 0.45, and 2.29 +/- 0.39 m/s, respectively; p = 0.012). The univariate and multivariate analyses of perioperative risk factors showed that only open distal anastomosis was strongly associated with negative results, but not the valve-sparing technique. Aortic valve-sparing root replacement must be considered as an excellent alternative for young patients requiring aortic root replacement when a biological valve is clinically indicated. For patients aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;65 years, or with a decreased life expectancy, the full root technique with a stentless valve should be used, given its technical simplicity and excellent postoperative results.
Histology and Histopathology Cellular and Molecular Biology, 2009
Inflammatory cytokines have been shown to mediate organ damage by their action on vascular endoth... more Inflammatory cytokines have been shown to mediate organ damage by their action on vascular endothelia and leukocytes, in part by upregulating the expression of adhesion molecules, which in turn convey transmigration of leukocytes into tissue. The upregulation and activation of vascular cell adhesion molecules on the endothelial cells avail firm leukocyte adhesion to the vascular endothelium and enhance their transmigration and consecutive tissue injury. The aim of this study was to evaluate the expression of vascular adhesion molecules CD 31 (PECAM-1), CD 106 (VCAM-1), CD 62E (E-Selectin) and CD 62P (P-Selectin) in the pancreas and distant organs of pigs suffering from acute necrotizing pancreatitis (AP). AP was induced in 13 pigs by a combination of intravenous cerulein and intraductal glycodeoxycholic acid. For immunostaining of vascular adhesion molecules slides of porcine pancreas, lung, kidney and liver tissue were stained with monoclonal antibodies (Ab) against PECAM-1-1, VCAM-1 E- and P- SELECTIN. The endothelial cell expression of CD 31 (PECAM-1), CD 106 (VCAM), CD 62E (E-Selectin) and CD 62P (P-SELECTIN) in severe porcine pancreatitis is detectable and upregulation is partly significantly.
Annals of Surgery, Feb 1, 2007
Objective: To evaluate surgical strategies for neuroendocrine pancreatic tumors (NEPT) in the lig... more Objective: To evaluate surgical strategies for neuroendocrine pancreatic tumors (NEPT) in the light of the new WHO classification from 2004 and to draw conclusions for future surgical concepts. Background: The extent of surgical resection in primary and recurrent NEPT is unclear. Methods: Between 1987 and 2004, 62 patients with sporadic NEPT were treated at our institution and sections from biopsy and resection specimen were histopathologically reclassified. Clinical presentation, surgery, metastases, and pattern of recurrence were related to survival. Results: Fifteen well-differentiated tumors (WDT, 24%), 39 lowgrade carcinomas (LGC, 63%), and 8 high-grade carcinomas (HGC, 13%) were identified. Median observation time was 30.5 months; 48 of 62 patients (78%) were surgically resected, and in 45 patients R0/R1 status was achieved. Overall 2-and 5-year survival in the latter group was 80% and 64%, respectively. Retrospective WHO classification revealed that organ-preserving segmental resections had been performed in 10 LGC and 1 HGC. These patients showed equal outcome as radically resected counterparts (n ϭ 19). Liver and other organ metastases were present in 19 of 62 patients (31%), and resection was accomplished in 7 of 19 patients, which conferred better overall survival (P ϭ 0.026, log-rank test); 21 of 45 R0/R1resected patients (47%) suffered from recurrence, and reoperation was accomplished in 9 patients, which resulted in better overall survival (P ϭ 0.066). Conclusion: Organ-preserving resections offer sufficient local control in LGC; therefore, radical resections do not seem to be justified. On the other hand, radical resection is indicated even in metastasized patients or in case of loco-regional recurrence. The silent and slow course of the disease facilitates long-term surgical control.
Anticancer Research, 2006
Background: Pancreatic adenocarcinoma is a tumor with fatal outcome. Cell adhesion molecules, suc... more Background: Pancreatic adenocarcinoma is a tumor with fatal outcome. Cell adhesion molecules, such as L1 (CD171), have an essential function in tumor progression. L1 has been shown to be specifically expressed in poorly differentiated neuroendocrine carcinomas of the pancreas. The aim of this study was to determine the expression of L1 in pancreatic adenocarcinomas to evaluate whether L1 might differentiate between pancreatic carcinomas of neuroendocrine and ductal origin. Materials and Methods: L1 expression was retrospectively analyzed in 111 cases of pancreatic adenocarcinomas by immunohistochemistry on paraffin sections of primary tumors. Staining was performed by the peroxidase technique with monoclonal antibody against human L1. All tumors were classified according to the most recent TNM classification. Results: The focal expression of L1 was detected in 2 (2%) out of 111 pancreatic carcinomas only, the remaining 109 (98%) being L1-negative. No expression was found in acinar or ductal cells of normal pancreatic tissue. Conclusion: Our data suggest that L1 is expressed in few cases of pancreatic ductal adenocarcinoma. Since L1 was previously found to be expressed specifically in neuroendocrine pancreatic carcinomas, its absence in unclear pancreatic masses might hint at a ductal origin for a malignant pancreatic tumor.
Anticancer Research, 2007
Background: p53 has been reported to be of prognostic importance in different types of cancer. Im... more Background: p53 has been reported to be of prognostic importance in different types of cancer. Immunohistochemical measurement of p53 antigen activity could be a prognostic marker for aggressiveness and survival in thyroid cancer. Different types of antibodies have been used to detect p53 in previous studies without direct comparison to each other. Patients and Methods: A series of 54 patients with thyroid cancer who had undergone thyroidectomy between 1993 and 1998 is reported. All samples were chosen retrospectively and classified by routine histopathology, followed by immunohistopathological examination with three different types of antibodies (PAb1801, CM1 and DO-7) with the peroxidase method. Survival data was generated. Results: The mean time of follow-up was 9.0 years. Eighteen patients died. Twenty-three (42.6%) samples were positive for p53 using the antibody PAb1801, 17 (31.5%) with using CM1 and only 4 (7.4%) cases with DO-7. Statistical analysis determined that the size (p=0.02) and classification of the tumor (p<0.001), the age of the patients (p=0.036), the presence of lymph node metastasis (p=0.024) and positive staining for p53 (p<0.001) were prognostic factors for overall survival by Kaplan-Meier method. Multivariate analysis revealed overexpression of p53 to be an independent significant prognostic factor of survival. Conclusion: PAb1801 is the most sensitive antibody for detection of p53 protein in this type of cancer, and p53 is a prognostic factor for survival in thyroid cancer. This may provide further information for prognosis and aggressiveness of thyroid cancer.
Anticancer Research, 2007
Background: Loss of heterozygosity (LOH) may be a valuable tool for detection of malignant procee... more Background: Loss of heterozygosity (LOH) may be a valuable tool for detection of malignant proceedings. The aim of our study was to investigate LOH in the serum of patients with adenocarcinoma of the distal oesophagus and the cardia for diagnostic and prognostic utility. Patients and Methods: Matched tumour and serum samples from 46 surgically treated patients with oesophageal adenocarcinoma and cardia carcinoma divided in two groups were analysed. Twelve markers were examined with a PCR-based microsatellite analysis. Results: A similar high frequency of LOH (range from 77% to 96%) was detected in the tumour and serum of both groups, whereas no LOH was detected in 20 healthy individuals. However, no significant correlation between LOH incidence and clinicopathological characteristics and survival was found. Conclusion: The results indicate that DNA alterations in tumours of the oesophagus and cardia are uniform. The high frequency of LOH in tumour patients underlines the utility of this molecular approach as a diagnostic tool.
Background: The chemokine and bone marrow-homing receptor CXCR4 has been implicated in metastatic... more Background: The chemokine and bone marrow-homing receptor CXCR4 has been implicated in metastatic dissemination of various cancers. We investigated CXCR4 expre ssion in esophageal cancer specimens and its association with survival, lymph node microinvolvement, and bone marrow micrometastasis. Methods: We analyzed frozen tumor specimens from 136 patients with completely resected esophageal cancer for CXCR4 expression by immunohistochemistry. Lymph node microinvolvement and bone marrow micrometastasis were assessed by immunohistochemistry with monoclonal anti bodies Ber-EP4 (against epithelial cell adhesion molecule) and pancytokeratin A45-B/B3 (against several cytokeratins), respectively. Associations between CXCR4 expression and clinicopathologic features, including tumor stage, histologic grade, lymph node metastasis and microinvolvement, bone marrow micrometastasis, and survival, were investigated with Fisher's test, log-rank test, and Cox multivariable analysis. All statistical tests were two-sided. Results: CXCR4 protein was expressed in 75 (55%) of 136 esophageal tumors examined. CXCR4 expression was statistically signifi cantly associated with reduced median overall and disease-specifi c survival, compared with CXCR4 nonexpression (P <.001; log-rank test). The median overall survival of patients with CXCR4-positive tumors was 20 months and with CXCR4-negative tumors, 76 months (difference = 56 months, 95% confi dence interval [CI] = 4 to 108 months; P <.001). The median disease-specifi c survival of patients with CXCR4-positive tumors was 25 months and with CXCR4negative tumors was 97 months (difference = 72 months, 95% CI = 34 to 110 months; P <.001). CXCR4 expression was statistically signifi cantly associated with increased lymph node microinvolvement (P <.001) and with increased bone marrow micrometastasis (P <.001). In multivariable analysis, CXCR4 expression, compared with its nonexpression, was identifi ed as the independent variable that was most strongly associated with reduced disease-specifi c survival (relative risk [RR] of death = 2.03, 95% CI = 1.20 to 3.41; P = .008) and overall survival (RR of death = 2.18, 95% CI = 1.33 to 3.59; P = .002). Conclusion: CXCR4 expression was associated with poor clinical outcome in esophageal cancer patients. CXCR4 may have a role in early metastatic spread because its expression was associated with micrometastases to both the lymph nodes and bone marrow. Thus, CXCR4 should be explored further as a target for adjuvant therapy for micrometastatic disease.
Surgery of the Esophagus, 2009
ABSTRACT Benign strictures and malignant tumors of the esophagus, when the stomach or colon canno... more ABSTRACT Benign strictures and malignant tumors of the esophagus, when the stomach or colon cannot be used as a substitute.
Chirurgische Gastroenterologie, 2007
Common surgical policy in neuroendocrine pancreatic tumors (NEPT) should be reviewed after the ap... more Common surgical policy in neuroendocrine pancreatic tumors (NEPT) should be reviewed after the appearance of the new WHO classification of 2004. A correct preoperative assessment is of paramount importance. Patients and Methods: Between 1987 and 2004, 62 patients with sporadic NEPT had been treated at our institution, and their histological specimens were reclassified. Preoperative diagnostics, clinical presentation, operations and survival
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
A 67-year-old woman with a gastrointestinal stromal tumor (GIST) of the stomach presented to our ... more A 67-year-old woman with a gastrointestinal stromal tumor (GIST) of the stomach presented to our outpatient clinic. Preoperative computed tomographic scans and endoscopic examination revealed a spherical submucosal tumor (7.7 x 6.1 x 6 cm) in the posterior wall of the stomach less than 1cm away from the cardia, on the small curvature side. The tumor, which endosonographically had a volume of 282 cm(3), was completely resected by a full-thickness laparoscopic wedge excision without discontinuous gastric resection. The whole procedure was performed using 4 working ports (one 12-mm and three 5-mm ports) and 1 camera port (12 mm). Because the resection margins were tumor free on frozen sections and the distance between the resection margin and cardia was wide enough not to compromise food passage, there was no need for total gastrectomy or upper discontinuous gastric resection. The patient was discharged on the fourth postoperative day after an uneventful clinical course. Histological e...
Anticancer research
Short tandem repeat (STR) polymorphisms in exon 4 of the Kazal-type esophageal cancer related gen... more Short tandem repeat (STR) polymorphisms in exon 4 of the Kazal-type esophageal cancer related gene (ECRG2) have been reported to be associated with esophageal carcinoma. Kazal-type genes are associated with cancer and pancreatic disease. The aim of the present study was to examine whether ECRG2 STR polymorphisms are associated with pancreatic carcinoma and chronic pancreatitis. A total of 209 surgically treated patients were analyzed, 92 with pancreatic adenocarcinoma and 117 with chronic pancreatitis. We retrospectively analyzed genomic DNA from peripheral blood leukocytes for STR TCA3/TCA3, TCA3/TCA4 and TCA4/TCA4 in the noncoding region of exon 4 of ECRG2. Associations between STRs and survival of cancer patients were investigated using log-rank test. ECRG2 STR of highest incidence was TCA3/TCA3 [47 (51%) in pancreatic carcinoma; 59 (50%) in pancreatitis patients], followed by the TCA3/TCA4 [37 (40%); 54 (46%)] and TCA4/TCA4 [8 (9%); 4 (4%)] genotypes. No correlation in frequency...
Anticancer research, 2009
Esophageal adenocarcinoma is currently the most rapidly increasing cancer in Western populations.... more Esophageal adenocarcinoma is currently the most rapidly increasing cancer in Western populations. L1 (CD171), a neural cell adhesion molecule, has an essential function in tumor progression and has been shown to be expressed in the proliferating cells of the intestinal crypts in mice. The aim of the current study was to determine L1 expression in esophageal cancer and to evaluate whether L1 could serve as a potential marker and therapeutic target for this tumor type. L1 expression was assessed on a tissue microarray with 257 surgically resected esophageal cancer samples by immunohistochemistry with a monoclonal antibody (Clone UJ127). L1 expression was correlated with clinicopathological data. L1 was detected in 22 (9%) of 257 esophageal cases, whereas 235 (91%) were L1 negative. Nineteen (86%) of the 22 L1-positive cases were adenocarcinoma. Cross table analysis showed a significant association between L1 expression and adenocarcinoma subtype (p<0.001), but not squamous cell car...
Modern Pathology, 2006
HER-2 is the target for antibody based treatment of breast cancer (Herceptin s). In order to eval... more HER-2 is the target for antibody based treatment of breast cancer (Herceptin s). In order to evaluate the potential role of such a treatment in esophageal cancers, HER-2 amplification and overexpression was investigated in primary and metastatic cancers of the esophagus. A tissue microarray was constructed from 255 primary esophageal cancers (110 adenocarcinomas and 145 squamous cell carcinomas), 89 nodal and 33 distant metastases. Slides were analyzed by immunohistochemistry (HercepTestt; DAKO) and fluorescence in situ hybridization (FISH; PathVysiont; Vysis-Abbott) for HER-2 amplification and overexpression. Amplification was seen in 16/110 (15%) adenocarcinomas and in 7/145 (5%) squamous cell carcinomas. There was a strong association between HER-2 amplification and overexpression, especially in adenocarcinomas (Po0.0001, log rank). There was a 100% concordance of the HER-2 results in primary tumor and corresponding metastases in 84 analyzed pairs. Amplification was typically high-level with more than 10-15 HER-2 copies per tumor cell. Amplification was unrelated to survival, grading, pT, pN, pM or UICC stage. We conclude that esophageal adenocarcinomas belong to those cancer types with relevant frequency high-level HER-2 gene amplification clinical trials or individual case studies investigating the response of metastatic HER-2-positive esophageal cancers to Herceptin s should be undertaken. The strong concordance of the HER-2 status in primary and metastatic cancers argues for a possible response of metastases from patients with HER-2-positive primary tumors to Herceptin s .
Journal of Cardiac Surgery, 2010
Maintenance of an open sternotomy (OS) after a complicated cardiac operation is an adjunct in the... more Maintenance of an open sternotomy (OS) after a complicated cardiac operation is an adjunct in the treatment of the severely impaired heart. The purpose of this retrospective study was to evaluate the incidence, survival, and predictors of poor outcome for open chest management (OCM) with delayed sternal closure (DSC) at our department. Prolonged open chest (OC) was used in 179 of 5122 cardiac surgery patients between 2004 and 2008 (3.5%). We wanted to determine indications, mortality, postoperative complications, and predictors of outcome. The incidence of OS was 3.5%, with 1.3% for isolated CABG, 2.4% for isolated valve, and 6.4% for combined procedures. Indications for OS were: hemodynamic compromise (110), intractable bleeding (19), arrhythmia (14), and cardiac edema or tamponade (36). 127 of the 179 patients with DSC (71%) survived. 52 patients died: 20 before DSC and 32 after this procedure. Mortality could be related to the indication for OS: With the indication &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;low cardiac output syndrome&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (LCOS) the mortality was 34.5%, for bleeding it was 26.3%, for arrhythmias, 21.4%, and for tamponade on closure it was 16.7%. After DSC, deep sternal wound infection occurred in nine patients (5%), superficial infection in 4.7% of patients. There were 16 patients with postoperative stroke (8.9%) and 24 patients with need for dialysis (13.4%). Predictors of mortality by univariate analysis were VAD insertion, new onset of hemodialysis, reoperation for bleeding, mean length of duration of OS (survivors 3.4 days, nonsurvivors 6.5 days), and longer duration of high-dose inotropic therapy. This study shows that OCM with DSC is a beneficial, therapeutic option in patients with postoperative LCOS, significant hemorrhage or intractable arrhythmias. However, patients with reoperation for bleeding, need for VAD, and particularly a prolonged delay before sternal closure continued to have a poor outcome.
The Thoracic and Cardiovascular Surgeon, 2010
Aim of the study was to clarify the impact of different pre- and perioperative conditions on outc... more Aim of the study was to clarify the impact of different pre- and perioperative conditions on outcome in octogenarians undergoing cardiac surgery. We retrospectively analyzed preoperative risk factors and intraoperative adverse events and studied in-hospital morbidity and mortality in 646 patients > or = 80 years of age (82.5 +/- 3.5 years) and in 6081 younger patients (70.3 +/- 3.4 years) who underwent cardiac surgery between 1/2001 and 12/2006. Preoperatively, octogenarians suffered significantly more from arterial hypertension, renal failure, previous neurological problems, unstable angina and NYHA class IV than younger subjects. The incidence of combined valve and coronary procedures and of urgent operations was also significantly higher in patients > or = 80 years (27.7 % vs. 18.2 %, P < 0.05, and 7.3 % vs. 4.2 %, P < 0.05, respectively). In-hospital mortality was higher (7.4 % vs. 3.7 %, P < 0.05), and average ICU and total in-hospital stay was longer in the older age group. Postoperative complications occurred in 15 % of patients > or = 80 years compared to 7.6 % of patients < or = 79 years ( P < 0.05). NYHA class IV, female sex and preoperative renal failure correlated with perioperative morbidity. Multivariate analysis could identify urgent procedures, redo surgery, mitral valve surgery and prolonged cross-clamping times as predictors of mortality. Cardiac surgery in octogenarians can be performed with an acceptable risk but an increased mortality and morbidity compared to younger patients. High-risk octogenarians, who require intensive perioperative management, should be identified to reduce the incidence of postoperative complications.
Anticancer research, 2007
BACKGROUND p53 has been reported to be of prognostic importance in different types of cancer. Imm... more BACKGROUND p53 has been reported to be of prognostic importance in different types of cancer. Immunohistochemical measurement of p53 antigen activity could be a prognostic marker for aggressiveness and survival in thyroid cancer. Different types of antibodies have been used to detect p53 in previous studies without direct comparison to each other. PATIENTS AND METHODS A series of 54 patients with thyroid cancer who had undergone thyroidectomy between 1993 and 1998 is reported. All samples were chosen retrospectively and classified by routine histopathology, followed by immunohistopathological examination with three different types of antibodies (PAb1801, CM1 and DO-7) with the peroxidase method. Survival data was generated. RESULTS The mean time of follow-up was 9.0 years. Eighteen patients died. Twenty-three (42.6%) samples were positive for p53 using the antibody PAb1801, 17 (31.5%) with using CM1 and only 4 (7.4%) cases with DO-7. Statistical analysis determined that the size (p ...
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie
Anticancer Research, 2007
Background: Short tandem repeat (STR) polymorphisms in exon 4 of the Kazal-type esophageal cancer... more Background: Short tandem repeat (STR) polymorphisms in exon 4 of the Kazal-type esophageal cancer related gene (ECRG2) have been reported to be associated with esophageal carcinoma. Kazal-type genes are associated with cancer and pancreatic disease. The aim of the present study was to examine whether ECRG2 STR polymorphisms are associated with pancreatic carcinoma and chronic pancreatitis. Materials and Methods: A total of 209 surgically treated patients were analyzed, 92 with pancreatic adenocarcinoma and 117 with chronic pancreatitis. We retrospectively analyzed genomic DNA from peripheral blood leukocytes for STR TCA 3 /TCA 3 , TCA 3 /TCA 4 and TCA 4 /TCA 4 in the noncoding region of exon 4 of ECRG2. Associations between STRs and survival of cancer patients were investigated using log-rank test. Results: ECRG2 STR of highest incidence was TCA 3 /TCA 3 [47 (51%) in pancreatic carcinoma; 59 (50%) in pancreatitis patients], followed by the TCA 3 /TCA 4 [37 (40%); 54 (46%)] and TCA 4 /TCA 4 [8 (9%); 4 (4%)] genotypes. No correlation in frequency of STRs comparing chronic pancreatitis and pancreatic cancer was determined using the Chi-squared test (p=0.23). STR polymorphisms were not significantly associated with reduced tumor-specific or overall survival (p>0.05; log-rank test). Conclusion: The data show that ECRG2 STR polymorphism TCA 3 /TCA 3 in exon 4 is the most prevalent polymorphism found in pancreatic adenocarcinoma and chronic pancreatitis detected in peripheral blood. None of the polymorphisms was associated with poor clinical outcome in pancreatic cancer patients. Pancreatic ductal adenocarcinoma is a very aggressive carcinoma with poor prognosis. Among all cancer deaths it is ranked as eleventh, according to its incidence rate, and as fifth, according to its mortality rate (1). In Europe, this carcinoma type is responsible for almost 40,000 deaths per year (2). Although post-operative mortality has declined and rates of complete resection have improved considerably, reported rates of 5-year survival after potentially curative surgery are still less than 25% (3, 4). The prognosis for patients who undergo pancreatic resection has been shown to be determined by both the pathological and molecular characteristics of the tumor, and the best pathological predictors of survival after surgery are stage, grade and resection margin status (5). Besides TNM staging only a few powerful prognostic markers exist. Short tandem repeats (STR) are repeating DNA sequences that contain 2-6 base pair units and are widespread throughout the human genome and polymorphic in nature. STRs are important genetic markers for mapping studies, disease diagnosis and forensic studies. Recently a gene related to esophageal carcinoma has been cloned and identified, namely the esophageal cancer related gene 2 (ECRG2) (6). This gene consists of 4 exons and has a size of 3540 bp on chromosome 5q32-3. Its 258 bp open reading frame encodes for an 85-amino acids polypeptide (7). The ECRG2 gene is homologous to a tumor-associated Kazal-type serine protease inhibitor (8). Other members of these Kazal-type serin protease inhibitors, such as SPINK1, have a role in development of chronic pancreatitis (9). Short tandem repeat TCA 3 /TCA 3 in contrast to TCA 3 /TCA 4 and TCA 4 /TCA 4 in the non-coding region of exon 4 has been shown to be associated with esophageal carcinoma (8). The ECRG2 gene interacts directly with metallothionine 2A resulting in suppression of cell proliferation and induction of apoptosis in cancer cells in vitro (10). These data propose that ECRG2 has a role in carcinogenesis. The aim of this study was to determine the frequency of genetic alterations in ECRG2, a member of Kazal-type gene family, in benign and malignant pancreatic disease.
The Journal of Heart Valve Disease, 2014
The benefit of valve-sparing aortic root replacement compared to conventional aortic root replace... more The benefit of valve-sparing aortic root replacement compared to conventional aortic root replacement surgery remains unclear. Between February 2009 and November 2010, a total of 112 patients underwent aortic root surgery at the Department of Cardiovascular and Thoracic Surgery, Heinrich-Heine-University, Dusseldorf, Germany. The valve-sparing technique was used when leaflets were grossly normal. In cases where the valve could not be saved, a prosthetic or biological substitute was used for the aortic root, according to existing guidelines. The patients were allocated to three groups: (i) valve-sparing aortic root replacement group using the David technique (VSR-David; n = 47); (ii) valve-replacing aortic root surgery with a prosthetic conduit using the Bentall-Kuchucus technique (VRR-Prosthetic; n = 31); and (iii) valve-replacing aortic root surgery with a biological stentless valve with the full root technique (VRR-Bio; n = 34). Intraoperative data revealed that, in the VSR-David group, the cardiopulmonary bypass and cross-clamp times were significantly longer (207 +/- 68 min and 140 +/- 38 min respectively; both p = 0.001). The VRR-Prosthetic patients were at highest risk (mean EuroSCORE 15.9%) compared to the VSR-David and VRR-Bio groups (10.8% and 10.4%, respectively). Postoperative analysis showed that patients in the VRR-Bio group had the lowest number of perioperative heart failures (p = 0.004). The perioperative 30-day mortality was significantly higher in the VRR-Prosthetic group (22.6%; p = 0.004). Transaortic flow velocities were significantly lower in the VSR-David group, followed by the VRR-Bio group and VRR-Prosthetic group (1.66 +/- 0.54, 1.98 +/- 0.45, and 2.29 +/- 0.39 m/s, respectively; p = 0.012). The univariate and multivariate analyses of perioperative risk factors showed that only open distal anastomosis was strongly associated with negative results, but not the valve-sparing technique. Aortic valve-sparing root replacement must be considered as an excellent alternative for young patients requiring aortic root replacement when a biological valve is clinically indicated. For patients aged &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;65 years, or with a decreased life expectancy, the full root technique with a stentless valve should be used, given its technical simplicity and excellent postoperative results.
Histology and Histopathology Cellular and Molecular Biology, 2009
Inflammatory cytokines have been shown to mediate organ damage by their action on vascular endoth... more Inflammatory cytokines have been shown to mediate organ damage by their action on vascular endothelia and leukocytes, in part by upregulating the expression of adhesion molecules, which in turn convey transmigration of leukocytes into tissue. The upregulation and activation of vascular cell adhesion molecules on the endothelial cells avail firm leukocyte adhesion to the vascular endothelium and enhance their transmigration and consecutive tissue injury. The aim of this study was to evaluate the expression of vascular adhesion molecules CD 31 (PECAM-1), CD 106 (VCAM-1), CD 62E (E-Selectin) and CD 62P (P-Selectin) in the pancreas and distant organs of pigs suffering from acute necrotizing pancreatitis (AP). AP was induced in 13 pigs by a combination of intravenous cerulein and intraductal glycodeoxycholic acid. For immunostaining of vascular adhesion molecules slides of porcine pancreas, lung, kidney and liver tissue were stained with monoclonal antibodies (Ab) against PECAM-1-1, VCAM-1 E- and P- SELECTIN. The endothelial cell expression of CD 31 (PECAM-1), CD 106 (VCAM), CD 62E (E-Selectin) and CD 62P (P-SELECTIN) in severe porcine pancreatitis is detectable and upregulation is partly significantly.
Annals of Surgery, Feb 1, 2007
Objective: To evaluate surgical strategies for neuroendocrine pancreatic tumors (NEPT) in the lig... more Objective: To evaluate surgical strategies for neuroendocrine pancreatic tumors (NEPT) in the light of the new WHO classification from 2004 and to draw conclusions for future surgical concepts. Background: The extent of surgical resection in primary and recurrent NEPT is unclear. Methods: Between 1987 and 2004, 62 patients with sporadic NEPT were treated at our institution and sections from biopsy and resection specimen were histopathologically reclassified. Clinical presentation, surgery, metastases, and pattern of recurrence were related to survival. Results: Fifteen well-differentiated tumors (WDT, 24%), 39 lowgrade carcinomas (LGC, 63%), and 8 high-grade carcinomas (HGC, 13%) were identified. Median observation time was 30.5 months; 48 of 62 patients (78%) were surgically resected, and in 45 patients R0/R1 status was achieved. Overall 2-and 5-year survival in the latter group was 80% and 64%, respectively. Retrospective WHO classification revealed that organ-preserving segmental resections had been performed in 10 LGC and 1 HGC. These patients showed equal outcome as radically resected counterparts (n ϭ 19). Liver and other organ metastases were present in 19 of 62 patients (31%), and resection was accomplished in 7 of 19 patients, which conferred better overall survival (P ϭ 0.026, log-rank test); 21 of 45 R0/R1resected patients (47%) suffered from recurrence, and reoperation was accomplished in 9 patients, which resulted in better overall survival (P ϭ 0.066). Conclusion: Organ-preserving resections offer sufficient local control in LGC; therefore, radical resections do not seem to be justified. On the other hand, radical resection is indicated even in metastasized patients or in case of loco-regional recurrence. The silent and slow course of the disease facilitates long-term surgical control.
Anticancer Research, 2006
Background: Pancreatic adenocarcinoma is a tumor with fatal outcome. Cell adhesion molecules, suc... more Background: Pancreatic adenocarcinoma is a tumor with fatal outcome. Cell adhesion molecules, such as L1 (CD171), have an essential function in tumor progression. L1 has been shown to be specifically expressed in poorly differentiated neuroendocrine carcinomas of the pancreas. The aim of this study was to determine the expression of L1 in pancreatic adenocarcinomas to evaluate whether L1 might differentiate between pancreatic carcinomas of neuroendocrine and ductal origin. Materials and Methods: L1 expression was retrospectively analyzed in 111 cases of pancreatic adenocarcinomas by immunohistochemistry on paraffin sections of primary tumors. Staining was performed by the peroxidase technique with monoclonal antibody against human L1. All tumors were classified according to the most recent TNM classification. Results: The focal expression of L1 was detected in 2 (2%) out of 111 pancreatic carcinomas only, the remaining 109 (98%) being L1-negative. No expression was found in acinar or ductal cells of normal pancreatic tissue. Conclusion: Our data suggest that L1 is expressed in few cases of pancreatic ductal adenocarcinoma. Since L1 was previously found to be expressed specifically in neuroendocrine pancreatic carcinomas, its absence in unclear pancreatic masses might hint at a ductal origin for a malignant pancreatic tumor.
Anticancer Research, 2007
Background: p53 has been reported to be of prognostic importance in different types of cancer. Im... more Background: p53 has been reported to be of prognostic importance in different types of cancer. Immunohistochemical measurement of p53 antigen activity could be a prognostic marker for aggressiveness and survival in thyroid cancer. Different types of antibodies have been used to detect p53 in previous studies without direct comparison to each other. Patients and Methods: A series of 54 patients with thyroid cancer who had undergone thyroidectomy between 1993 and 1998 is reported. All samples were chosen retrospectively and classified by routine histopathology, followed by immunohistopathological examination with three different types of antibodies (PAb1801, CM1 and DO-7) with the peroxidase method. Survival data was generated. Results: The mean time of follow-up was 9.0 years. Eighteen patients died. Twenty-three (42.6%) samples were positive for p53 using the antibody PAb1801, 17 (31.5%) with using CM1 and only 4 (7.4%) cases with DO-7. Statistical analysis determined that the size (p=0.02) and classification of the tumor (p<0.001), the age of the patients (p=0.036), the presence of lymph node metastasis (p=0.024) and positive staining for p53 (p<0.001) were prognostic factors for overall survival by Kaplan-Meier method. Multivariate analysis revealed overexpression of p53 to be an independent significant prognostic factor of survival. Conclusion: PAb1801 is the most sensitive antibody for detection of p53 protein in this type of cancer, and p53 is a prognostic factor for survival in thyroid cancer. This may provide further information for prognosis and aggressiveness of thyroid cancer.
Anticancer Research, 2007
Background: Loss of heterozygosity (LOH) may be a valuable tool for detection of malignant procee... more Background: Loss of heterozygosity (LOH) may be a valuable tool for detection of malignant proceedings. The aim of our study was to investigate LOH in the serum of patients with adenocarcinoma of the distal oesophagus and the cardia for diagnostic and prognostic utility. Patients and Methods: Matched tumour and serum samples from 46 surgically treated patients with oesophageal adenocarcinoma and cardia carcinoma divided in two groups were analysed. Twelve markers were examined with a PCR-based microsatellite analysis. Results: A similar high frequency of LOH (range from 77% to 96%) was detected in the tumour and serum of both groups, whereas no LOH was detected in 20 healthy individuals. However, no significant correlation between LOH incidence and clinicopathological characteristics and survival was found. Conclusion: The results indicate that DNA alterations in tumours of the oesophagus and cardia are uniform. The high frequency of LOH in tumour patients underlines the utility of this molecular approach as a diagnostic tool.
Background: The chemokine and bone marrow-homing receptor CXCR4 has been implicated in metastatic... more Background: The chemokine and bone marrow-homing receptor CXCR4 has been implicated in metastatic dissemination of various cancers. We investigated CXCR4 expre ssion in esophageal cancer specimens and its association with survival, lymph node microinvolvement, and bone marrow micrometastasis. Methods: We analyzed frozen tumor specimens from 136 patients with completely resected esophageal cancer for CXCR4 expression by immunohistochemistry. Lymph node microinvolvement and bone marrow micrometastasis were assessed by immunohistochemistry with monoclonal anti bodies Ber-EP4 (against epithelial cell adhesion molecule) and pancytokeratin A45-B/B3 (against several cytokeratins), respectively. Associations between CXCR4 expression and clinicopathologic features, including tumor stage, histologic grade, lymph node metastasis and microinvolvement, bone marrow micrometastasis, and survival, were investigated with Fisher's test, log-rank test, and Cox multivariable analysis. All statistical tests were two-sided. Results: CXCR4 protein was expressed in 75 (55%) of 136 esophageal tumors examined. CXCR4 expression was statistically signifi cantly associated with reduced median overall and disease-specifi c survival, compared with CXCR4 nonexpression (P <.001; log-rank test). The median overall survival of patients with CXCR4-positive tumors was 20 months and with CXCR4-negative tumors, 76 months (difference = 56 months, 95% confi dence interval [CI] = 4 to 108 months; P <.001). The median disease-specifi c survival of patients with CXCR4-positive tumors was 25 months and with CXCR4negative tumors was 97 months (difference = 72 months, 95% CI = 34 to 110 months; P <.001). CXCR4 expression was statistically signifi cantly associated with increased lymph node microinvolvement (P <.001) and with increased bone marrow micrometastasis (P <.001). In multivariable analysis, CXCR4 expression, compared with its nonexpression, was identifi ed as the independent variable that was most strongly associated with reduced disease-specifi c survival (relative risk [RR] of death = 2.03, 95% CI = 1.20 to 3.41; P = .008) and overall survival (RR of death = 2.18, 95% CI = 1.33 to 3.59; P = .002). Conclusion: CXCR4 expression was associated with poor clinical outcome in esophageal cancer patients. CXCR4 may have a role in early metastatic spread because its expression was associated with micrometastases to both the lymph nodes and bone marrow. Thus, CXCR4 should be explored further as a target for adjuvant therapy for micrometastatic disease.
Surgery of the Esophagus, 2009
ABSTRACT Benign strictures and malignant tumors of the esophagus, when the stomach or colon canno... more ABSTRACT Benign strictures and malignant tumors of the esophagus, when the stomach or colon cannot be used as a substitute.
Chirurgische Gastroenterologie, 2007
Common surgical policy in neuroendocrine pancreatic tumors (NEPT) should be reviewed after the ap... more Common surgical policy in neuroendocrine pancreatic tumors (NEPT) should be reviewed after the appearance of the new WHO classification of 2004. A correct preoperative assessment is of paramount importance. Patients and Methods: Between 1987 and 2004, 62 patients with sporadic NEPT had been treated at our institution, and their histological specimens were reclassified. Preoperative diagnostics, clinical presentation, operations and survival
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
A 67-year-old woman with a gastrointestinal stromal tumor (GIST) of the stomach presented to our ... more A 67-year-old woman with a gastrointestinal stromal tumor (GIST) of the stomach presented to our outpatient clinic. Preoperative computed tomographic scans and endoscopic examination revealed a spherical submucosal tumor (7.7 x 6.1 x 6 cm) in the posterior wall of the stomach less than 1cm away from the cardia, on the small curvature side. The tumor, which endosonographically had a volume of 282 cm(3), was completely resected by a full-thickness laparoscopic wedge excision without discontinuous gastric resection. The whole procedure was performed using 4 working ports (one 12-mm and three 5-mm ports) and 1 camera port (12 mm). Because the resection margins were tumor free on frozen sections and the distance between the resection margin and cardia was wide enough not to compromise food passage, there was no need for total gastrectomy or upper discontinuous gastric resection. The patient was discharged on the fourth postoperative day after an uneventful clinical course. Histological e...
Anticancer research
Short tandem repeat (STR) polymorphisms in exon 4 of the Kazal-type esophageal cancer related gen... more Short tandem repeat (STR) polymorphisms in exon 4 of the Kazal-type esophageal cancer related gene (ECRG2) have been reported to be associated with esophageal carcinoma. Kazal-type genes are associated with cancer and pancreatic disease. The aim of the present study was to examine whether ECRG2 STR polymorphisms are associated with pancreatic carcinoma and chronic pancreatitis. A total of 209 surgically treated patients were analyzed, 92 with pancreatic adenocarcinoma and 117 with chronic pancreatitis. We retrospectively analyzed genomic DNA from peripheral blood leukocytes for STR TCA3/TCA3, TCA3/TCA4 and TCA4/TCA4 in the noncoding region of exon 4 of ECRG2. Associations between STRs and survival of cancer patients were investigated using log-rank test. ECRG2 STR of highest incidence was TCA3/TCA3 [47 (51%) in pancreatic carcinoma; 59 (50%) in pancreatitis patients], followed by the TCA3/TCA4 [37 (40%); 54 (46%)] and TCA4/TCA4 [8 (9%); 4 (4%)] genotypes. No correlation in frequency...