Antje Schulz

Expression of survivin detected by immunohistochemistry in the cytoplasm and in the nucleus is associated with prognosis of leiomyosarcoma and synovial sarcoma patients.

BackgroundSurvivin, a member of the inhibitor of apoptosis-protein family suppresses apoptosis and regulates cell division. It is strongly overexpressed in the vast majority of cancers. We were interested if survivin detected by immunohistochemistry has prognostic relevance especially for patients of the two soft tissue sarcoma entities leiomyosarcoma and synovial sarcoma.MethodsTumors of leiomyosarcoma (n = 24) and synovial sarcoma patients (n = 26) were investigated for their expression of survivin by immunohistochemistry. Survivin expression was assessed in the cytoplasm and the nucleus of tumor cells using an immunoreactive scoring system (IRS).ResultsWe detected a survivin expression (IRS > 2) in the cytoplasm of 20 leiomyosarcomas and 22 synovial sarcomas and in the nucleus of 12 leiomyosarcomas and 9 synovial sarcomas, respectively. There was no significant difference between leiomyosarcoma and synovial sarcoma samples in their cytoplasmic or nuclear expression of survivin. Next, all sarcoma patients were separated in four groups according to their survivin expression in the cytoplasm and in the nucleus: group 1: negative (IRS 0 to 2); group 2: weak (IRS 3 to 4); group 3: moderate (IRS 6 to 8); group 4: strong (IRS 9 to 12). In a multivariate Coxs regression hazard analysis survivin expression detected in the cytoplasm or in the nucleus was significantly associated with overall survival of patients in group 3 (RR = 5.7; P = 0.004 and RR = 5.7; P = 0.022, respectively) compared to group 2 (reference). Patients whose tumors showed both a moderate/strong expression of survivin in the cytoplasm and a moderate expression of survivin in the nucleus (in both compartments IRS ≥ 6) possessed a 24.8-fold increased risk of tumor-related death (P = 0.003) compared to patients with a weak expression of survivin both in the cytoplasm and in the nucleus.ConclusionSurvivin protein expression in the cytoplasma and in the nucleus detected by immunohistochemistry is significantly associated with prognosis of leiomyosarcoma and synovial sarcoma patients.

Bovine Pericardium for Portal Vein Reconstruction in Abdominal Surgery: A Surgical Guide and First Experiences in a Single Center

Background: Resection and reconstruction of infiltrated vessels achieve resectability of extended pancreatic tumors. The aim of the present study was to assess the feasibility of bovine pericardium as graft material for the individualised portal vein reconstruction and demonstrate a surgical technique for abdominal vein repair. Methods: We performed a MEDLINE search to review the methods for complex abdominal vein reconstruction in the course of extended pancreatectomy. Moreover, clinical data of patients receiving portal vein reconstruction using a bovine pericardial patch at our institution were retrospectively analyzed. Results: Based on the results of a review of the literature, autologous venous grafts using the internal jugular vein represent the most popular option for segmental portal vein reconstruction in case of impossible direct suture. At our center, segmental portal vein reconstruction with bovine pericardial patch in course of pancreatic surgery was performed in 4 patients. No case of vascular complications such as occlusion, segmental stenosis or thrombosis occurred. Conclusions: Our experience suggests a surgical procedure for an individual size-matched portal vein reconstruction using bovine pericardium. Although first results appear promising, prospective studies are required to objectively assess the patency of bovine pericardium compared with autologous and synthetic interposition grafts for portal vein reconstruction.

Factors influencing hypertrophy of the left lateral liver lobe after portal vein embolization

PurposePortal vein embolization (PVE) before extended right hepatectomy leads to an increase of the future liver remnant (FLR) volume, but predictive factors for sufficient hypertrophy are still unclear. The purpose of this study was to investigate parameters influencing the growth of FLR.MethodsPatients undergoing PVE prior hepatic resection were evaluated. PVE was done using polyvinyl alcohol particles only. Volumetric analysis was performed before embolization and before hepatectomy. Success of PVE was determined as percental growth of the future liver remnant.ResultsSeventy-seven patients were included, and three cohorts were formed according to the hypertrophy of FLR. FLR increased from 448.2 ± 187 to 475.5 ± 191 in the poor, from 315.3 ± 86 to 469.1 ± 142 in the moderate, and from 283.4 ± 68 to 400.4 ± 110 in the good hypertrophy group. More cases of recanalization of the portal vein were observed in patients with poor hypertrophy (p = 0.016). Small FLR before PVE predict higher growth of the FLR (p = 0.006). Duration between PVE and surgery differed significantly: 22 (poor) vs. 32 (good) days (p = 0.040).DiscussionNo recanalization, small initial FLR and longer time were assessed with better FLR hypertrophy. More sufficient PVE techniques and postponed hepatectomy might improve the outcome. Small initial FLR should not be a disclosure for curative hepatectomy.

Der LiMAx-Test: ein neuer diagnostischer Test zur Messung der aktuellen Leberfunktionskapazität

Hintergrund ▼ Fortschritte in der chirurgischen, anästhesiologischen und intensivmedizinischen Behandlung konnten die perioperative Morbidität und Mortalität nach großen Leberteilresektionen innerhalb der letzten Jahrzehnte erheblich reduzieren. Trotzdem beträgt die Rate an postoperativer Leberinsuffizienz mit entsprechend hoher Mortalität nach großen Resektionen je nach Definitionen und Literatur bis zu 32 % [8]. Hauptindikation für Leberteilresektionen sind maligne Tumore sekundären sowie primären Ursprungs. So ist das hepatozelluläre Karzinom die häufigste zum Tod führende Erkrankung bei Patienten mit Leberzirrhose in Europa [24]. Besonders bei ausgedehnten radikal onkologischen Resektionen ist die Einschätzung der verbleibenden Leberfunktion zur Minimierung des perioperativen Risikos bedeutend. Während bei einer gesunden Leber Resektionen von bis zu 80 % möglich sind, besteht bei vorgeschädigter Leber (Zirrhose, Hepatitis, Steatosis, Cholestase, Chemotherapie) selbst nach kleinen Leberteilresektionen das Risiko für eine bedrohliche Leberinsuffizienz [25].

The role of the liver in the metabolism of adiponectin and proinsulin

Abstract Background: Adiponectin and proinsulin are commonly used biomarkers in patients with metabolic syndrome. In individuals without cirrhosis adiponectin serum levels correlate inversely with insulin resistance and

Postoperative Manifestation eines akuten Kompartmentsyndroms bei zuvor unbekannter heterozygoter Sichelzellanämie

Patients suffering from sickle cell disease show an increased ischemic intolerance due to continuous pro-inflammatory activation and dysfunction of the endothelium by recurrent vaso-occlusive episodes. The presented case shows the manifestation of a postoperative compartment syndrome of the lower leg following the intraoperative use of blood arrest in a patient with previously unknown sickle cell disease. Preexisting vulnerability for tissue hypoxia in patients at risk should be a major concern for intraoperative use of blood arrest during surgery of the extremities.ZusammenfassungDie proinflammatorische Grundaktivierung und chronische Endothelschädigung durch rezidivierende Vasookklusionen sind die Ursache für eine massive Ischämieintoleranz bei Patienten mit Sichelzellanämie. Der hier dargestellte Fall zeigt das Auftreten eines postoperativen Kompartmentsyndroms am Unterschenkel eines Patienten mit bislang unbekannter Sichelzellanämie im Zusammenhang mit dem Einsatz einer perioperativen Blutsperre. Die Indikation für den Einsatz einer Blutsperre bei Extremitäteneingriffen von Risikopatienten mit prädisponierender Vulnerabilität gegenüber einer Gewebehypoxie ist streng zustellen.AbstractPatients suffering from sickle cell disease show an increased ischemic intolerance due to continuous pro-inflammatory activation and dysfunction of the endothelium by recurrent vaso-occlusive episodes. The presented case shows the manifestation of a postoperative compartment syndrome of the lower leg following the intraoperative use of blood arrest in a patient with previously unknown sickle cell disease. Preexisting vulnerability for tissue hypoxia in patients at risk should be a major concern for intraoperative use of blood arrest during surgery of the extremities.

Postoperative Manifestation eines akuten Kompartmentsyndroms bei zuvor unbekannter heterozygoter Sichelzellanämie@@@Postoperative manifestation of acute compartment syndrome by previously unknown heterozygote sickle cell anemia: Ein klinischer Fallbericht@@@A clinical case report

Patients suffering from sickle cell disease show an increased ischemic intolerance due to continuous pro-inflammatory activation and dysfunction of the endothelium by recurrent vaso-occlusive episodes. The presented case shows the manifestation of a postoperative compartment syndrome of the lower leg following the intraoperative use of blood arrest in a patient with previously unknown sickle cell disease. Preexisting vulnerability for tissue hypoxia in patients at risk should be a major concern for intraoperative use of blood arrest during surgery of the extremities.ZusammenfassungDie proinflammatorische Grundaktivierung und chronische Endothelschädigung durch rezidivierende Vasookklusionen sind die Ursache für eine massive Ischämieintoleranz bei Patienten mit Sichelzellanämie. Der hier dargestellte Fall zeigt das Auftreten eines postoperativen Kompartmentsyndroms am Unterschenkel eines Patienten mit bislang unbekannter Sichelzellanämie im Zusammenhang mit dem Einsatz einer perioperativen Blutsperre. Die Indikation für den Einsatz einer Blutsperre bei Extremitäteneingriffen von Risikopatienten mit prädisponierender Vulnerabilität gegenüber einer Gewebehypoxie ist streng zustellen.AbstractPatients suffering from sickle cell disease show an increased ischemic intolerance due to continuous pro-inflammatory activation and dysfunction of the endothelium by recurrent vaso-occlusive episodes. The presented case shows the manifestation of a postoperative compartment syndrome of the lower leg following the intraoperative use of blood arrest in a patient with previously unknown sickle cell disease. Preexisting vulnerability for tissue hypoxia in patients at risk should be a major concern for intraoperative use of blood arrest during surgery of the extremities.

Postoperative manifestation of acute compartment syndrome by previously unknown heterozygote sickle cell anemia. A clinical case report

Patients suffering from sickle cell disease show an increased ischemic intolerance due to continuous pro-inflammatory activation and dysfunction of the endothelium by recurrent vaso-occlusive episodes. The presented case shows the manifestation of a postoperative compartment syndrome of the lower leg following the intraoperative use of blood arrest in a patient with previously unknown sickle cell disease. Preexisting vulnerability for tissue hypoxia in patients at risk should be a major concern for intraoperative use of blood arrest during surgery of the extremities.ZusammenfassungDie proinflammatorische Grundaktivierung und chronische Endothelschädigung durch rezidivierende Vasookklusionen sind die Ursache für eine massive Ischämieintoleranz bei Patienten mit Sichelzellanämie. Der hier dargestellte Fall zeigt das Auftreten eines postoperativen Kompartmentsyndroms am Unterschenkel eines Patienten mit bislang unbekannter Sichelzellanämie im Zusammenhang mit dem Einsatz einer perioperativen Blutsperre. Die Indikation für den Einsatz einer Blutsperre bei Extremitäteneingriffen von Risikopatienten mit prädisponierender Vulnerabilität gegenüber einer Gewebehypoxie ist streng zustellen.AbstractPatients suffering from sickle cell disease show an increased ischemic intolerance due to continuous pro-inflammatory activation and dysfunction of the endothelium by recurrent vaso-occlusive episodes. The presented case shows the manifestation of a postoperative compartment syndrome of the lower leg following the intraoperative use of blood arrest in a patient with previously unknown sickle cell disease. Preexisting vulnerability for tissue hypoxia in patients at risk should be a major concern for intraoperative use of blood arrest during surgery of the extremities.