Patrick Verreet

Basaloid squamous cell carcinoma of the esophagus

Basaloid squamous cell carcinoma (BSCC) is a recently recognized, poorly differentiated variant of squamous cell carcinoma (SCC), which is located predominantly in the upper aerodigestive tract.

Simple data from history and physical examination help to exclude bowel obstruction and to avoid radiographic studies in patients with acute abdominal pain

OBJECTIVE To assess the value of plain abdominal radiographs and of data from the medical history and physical examination in the diagnosis of acute abdominal pain in general and of bowel obstruction in particular. DESIGN Prospective study. SETTING 4 university and 2 community hospitals, Germany. SUBJECTS 1254 patients with acute abdominal pain lasting less than 7 days, and with no history of abdominal injury including surgery. INTERVENTIONS Standardised and structured medical history and physical examination, study of results of plain abdominal radiographs. MAIN OUTCOME MEASURES Positive predictive value and sensitivity of clinical variables and abdominal film with respect to the diagnosis at discharge. RESULTS 48 patients (3.8%) had bowel obstruction. 704 patients (56.1%) had plain abdominal films taken at the time of initial presentation. 111 studies (15.8%) showed important findings leading to diagnosis or immediate treatment, 455 (64.7%) showed unimportant or no findings. In 138 (19.6%) results of films were not reported. 16 of 45 single variables were of help in diagnosing bowel obstruction. The six with the highest sensitivity were distended abdomen, increased bowel sounds, history of constipation, previous abdominal surgery, age over 50, and vomiting. If only patients presenting with any two of these symptoms had had radiographs taken, 300 (42.6%) could have been avoided without loss in diagnostic accuracy. CONCLUSION A considerable number of plain abdominal films taken for patients with acute abdominal pain could be avoided by focusing on clinical variables relevant to the diagnosis of bowel obstruction.

bcl-2 expression and prognosis in squamous-cell carcinomas of the esophagus

The bcl‐2 proto‐oncogene is a known inhibitor of apoptosis and may be an important regulator of tumor growth. In the present study, bcl‐2‐protein expression was investigated by immunohistochemistry and correlated with prognosis in a series of 150 potentially curatively resected squamous‐cell carcinomas of the esophagus. For comparison bcl‐2‐protein expression was analyzed in normal esophageal mucosa, severe squamous dysplasias and carcinomas in situ. bcl‐2 immunoreactivity was found in 48 out of 150 invasive squamous‐cell carcinomas; the remaining carcinomas were completely negative. bcl‐2‐protein expression was found more frequently among poorly differentiated than among well‐differentiated tumors (p < 0.0001). No correlation was found between bcl‐2‐protein expression and the parameters tumor size, depth of invasion and nodal status. Moreover bcl‐2‐protein expression had no significant influence on overall survival. Whereas in normal mucosa bcl‐2 immunoreactivity was restricted to the basal‐cell layer, in 9 out of 15 severe squamous dysplasias and in 7 out of 14 carcinomas in situ bcl‐2 staining was detected in all epithelial layers. Thus bcl‐2‐protein is frequently expressed in invasive squamous‐cell carcinomas of the esophagus and in precursor lesions of esophageal cancer but has no significant impact on the outcome of esophageal cancer.

Expression of Bax, a pro‐apoptotic member of the Bcl‐2 family, in esophageal squamous cell carcinoma

Samples of normal esophageal squamous epithelium (n = 10), severe squamous cell dyplasia (n = 22), carcinoma in situ (n = 15), invasive squamous cell carcinoma (n = 172), lymph‐node metastasis (n = 21) and 2 permanent esophageal squamous cell carcinoma cell lines were analyzed immunohistochemically for Bax expression using a polyclonal anti‐Bax antibody. Immunostaining was evaluated according to a score system (0–8 points) based on the percentage of positive tumor cells and the relative immunostaining intensity. Cytoplasmatic staining for Bax protein was found uniformly in all cell layers of the normal esophageal squamous epithelium. In contrast, a gradual loss of immunoreactivity for Bax was found in a fraction of pre‐neoplastic and neoplastic lesions. Upon comparison of the amount of Bax expression between the different types of lesion, however, no significant differences were found between severe squamous cell dysplasias, carcinomas in situ, invasive carcinomas and lymph‐node metastases. In both esophageal carcinoma cell lines, immunoreactivity for Bax was found and confirmed by means of Northern blot analysis. In invasive carcinomas, Bax immunoreactivity was inversely correlated with Bcl‐2 expression (p = 0.0243) and decreased continuously with decreasing tumor differentiation (p = 0.0011). No correlation was found between Bax expression and the following parameters: depth of invasion, nodal status and tumor size. Bax expression had no influence on the post‐operative survival of esophageal cancer patients. Int. J. Cancer 73:508–513, 1997.

Klinische standardisierung bei akuten bauchschmerzen

The correct diagnosis in acute abdominal pain is necessary for adequate treatment. In several clinical studies it has been shown that, despite improvements in laboratory and technology medicine, errors occur in a considerable proportion of cases due to insufficient history-taking and clinical examination. By the introduction of a standardised and structured history and clinical examination, the diagnostic accuracy can be improved by at least 10%. The aim of this publication is to improve history-taking, clinical examination and diagnostic decision-making by exact definition of all relevant parameters. This was performed by a national clinical expert group, international standardisations were taken in consideration. The standardisation was based mainly on these existing international standardisations (World Organisation of Gastroenterology); however, revisions and corrections were necessary. In order to introduce the standardisation into clinical routine, a documentation form and a documentation program can be provided.ZusammenfassungDie richtige Diagnose bei akuten Bauchschmerzen ist eine Grundvoraussetzung für die sich anschließende adäquate Therapie. In zahlreichen klinischen Studien konnte aufgezeigt werden, daß trotz Verbesserung der Labor- und Apparatemedizin erhebliche Mängel durch unzureichende Anamneseerhebungen und klinische Untersuchungen entstehen. Durch Einführung einer standardisierten und strukturierten Anamnese und klinischen Untersuchung alleine läßt sich die diagnostische Richtigkeit um mindestens 10% verbessern. Ziel dieser Arbeit ist eine Verbesserung von Anamnese, klinischer Untersuchung und Diagnosestellung durch eine möglichst exakte Definition aller relevanten Parameter. Dies erfolgte durch eine nationale klinische Expertengruppe, wobei bereits vorliegende internationale Standardisierungen (z. B. Weltgesellschaft für Gastroenterologie) Berücksichtigung fanden. Diese Standardisierungen wurden zum überwiegenden Teil übernommen, mußten jedoch an einigen Stellen überarbeitet, weiterentwickelt und aktualisiert werden. Um eine weitgehende Verbreitung der Standardisierung zu erreichen, können ein Dokumentationsbogen und ein Dokumentationsprogramm zur Verfügung gestellt werden.The correct diagnosis in acute abdominal pain is necessary for adequate treatment. In several clinical studies it has been shown that, despite improvements in laboratory and technology medicine, errors occur in a considerable proportion of cases due to insufficient history-taking and clinical examination. By the introduction of a standardised and structured history and clinical examination, the diagnostic accuracy can be improved by at least 10%. The aim of this publication is to improve history-taking, clinical examination and diagnostic decision-making by exact definition of all relevant parameters. This was performed by a national clinical expert group, international standardisations were taken in consideration. The standardisation was based mainly on these existing international standardisations (World Organisation of Gastroenterology); however, revisions and corrections were necessary. In order to introduce the standardisation into clinical routine, a documentation form and a documentation program can be provided.

Helicobacter pylori in the upper gastrointestinal tract: medical or surgical treatment of gastric lymphoma?

Abstract The treatment of primary gastric lymphoma is controversial. The role of surgery has come to be questioned with increasing knowledge about the pathogenesis of gastric lymphoma and with new therapeutic approaches such as eradication of Helicobacter pylori. We review published clinical trials of primary gastric lymphoma, including preliminary results of our own prospective multicenter trial. The results of 7 trials of H. pylori eradication and 12 prospective therapeutic trials trial are discussed. On basis of these data it is concluded that surgery with intention of R0 resection is the treatment of choice in stages EI2 and EII1 of low-grade lymphoma. In high-grade lymphomas it is still unclear whether surgery or its primary combination with radio- or chemotherapy should be preferred. The eradication of H. pylori is a promising therapeutic approach for localized low-grade mucosa-associated lymphoid tissue lymphoma. A randomized trial is needed to clarify whether medical or surgical management of localized gastric lymphoma or a combination of two is the best treatment modality.

RONTGENNATIVAUFNAHMEN BEI AKUTEN BAUCHSCHMERZEN SIND VERMEIDBAR

Plain abdominal X-ray films are overused in patients with acute abdominal pain. Focusing on medical history and physical examination helps to reduce the number of plain films used and saves costs.

Bedeutung von Scoringsystemen bei der Diagnose der akuten Appendizitis

Die Diagnose einer akuten Appendizitis stellt immer noch ein schwieriges Problem dar. Dies wird durch die immer noch hohe Rate perforierter Appendices und durch den hohen Anteil negativer Appendektomien belegt [1], Wichtigste Voraussetzung fur die Diagnose der akuten Appendizitis ist eine standardisierte und strukturierte Anamnese und klinische Untersuchung. Daruber hinaus gibt es zahlreiche diagnostische Hilfsmittel, wie z.B. Speziallabor, Rontgen, Ultraschall, die den Diagnoseprozes sinnvoll unterstutzen konnen. In den letzten Jahren sind mit der computerunterstutzten Diagnose und mit den Scoringsystemen weitere vielversprechende Entscheidungshilfen hinzugekommen [2].