AIM: To study the prognostic value of adjuvant chemo-therapy in patients with pancreatic, ductal adenocar-cinoma.METHODS: Lymph nodes from 106 patients with resectable pancreatic ductal adenocarcinoma were systematica...AIM: To study the prognostic value of adjuvant chemo-therapy in patients with pancreatic, ductal adenocar-cinoma.METHODS: Lymph nodes from 106 patients with resectable pancreatic ductal adenocarcinoma were systematically sampled. A total of 318 lymph nodes classified histopathologically as tumor-free were examined using sensitive immunohistochemical assays. Forty-three (41%) of the 106 patients were staged as pT1/2, 63 (59%) as pT3/4, 51 (48%) as pN0, and 55 (52%) as pN1. The study population included 59 (56%) patients exhibiting G1/2, and 47 (44%) patients with G3 tumors. Patients received no adjuvant chemo- or radiation therapy and were followed up for a median of 12 (range: 3.5 to 139) mo.RESULTS: Immunostaining with Ber-EP4 revealed nodal microinvolvement in lymph nodes classified as “tumor free” by conventional histopathology in 73 (69%) out of the 106 patients. Twenty-nine (57%)of 51 patients staged histopathologically as pN0 had nodal microinvolvement. The five-year survival probability for pN0-patients was 54% for those without nodal microinvolvement and 0% for those with nodal microinvolvement. Cox-regression modeling revealed the independent prognostic effect of nodal microinvolvement on recurrence-free (relative risk 2.92, P = 0.005) and overall (relative risk 2.49, P = 0.009) survival.CONCLUSION: The study reveals strong and independent prognostic significance of nodal microinvolvement in patients with pancreatic ductal adenocarcinoma who have received no adjuvant therapy. The addition of immunohistochemical findings to histopathology reports may help to improve risk stratification of patients with pancreatic cancer.展开更多
Obesity is a multifactorial disease showing a pandemic increase within the last decades in developing, and developed countries. It is associated with several severe comorbidities such as type Ⅱ diabetes, hypertension...Obesity is a multifactorial disease showing a pandemic increase within the last decades in developing, and developed countries. It is associated with several severe comorbidities such as type Ⅱ diabetes, hypertension, sleep apnea, non-alcoholic steatosis hepatis and cancer. Due to the increasing number of overweight individuals worldwide, research in the field of obesity has become more vital than ever. Currently, great efforts are spend to understand this complex disease from a biological, psychological and sociological angle. Further insights of obesity research come from bariatric surgery that provides new information regarding hormonal changes during weight loss. The initiation of programs for obesity treatment, both interventional and pharmaceutical, are being pursued with the fullest intensity. Currently, bariatric surgery is the most effective therapy for weight loss and resolution of comorbidities in morbid obese patients. Reasons for weight loss and remission of comorbidities following Roux-en-Y-Gastric Bypass,Sleeve Gastrectomy, and other bariatric procedures are therefore under intense investigation. In this review, however, we will focus on obesity treatment, highlighting new insights and future trends of gut hormone research, the relation of obesity and cancer development via the obesity induced chronic state of inflammation, and new potential concepts of interventional and conservative obesity treatment.展开更多
Objective: Nutritional deficiencies are known side-effects of bariatric surgeries, specifically in those that bypass the proximal intestine. Therefore, in clinical practice, vitamin and mineral supplementations are of...Objective: Nutritional deficiencies are known side-effects of bariatric surgeries, specifically in those that bypass the proximal intestine. Therefore, in clinical practice, vitamin and mineral supplementations are often necessary after such operations. It was our intention to evaluate, whether alimentary deficiencies occur with the same frequency in patients following Sleeve-Gastrectomy (SG) compared to Roux-en-Y Gastric Bypass (RYGB) surgeries. Methods: We conducted a retrospective data analysis of 171 patients (121 RYGB, 50 SG). Vitamin levels were compared between SG and RYGB patients over the first post-operative year. Furthermore, regression analysis was performed with regard to vitamin and iron supplementations and their recommended dosages. Complications occurring within the first post-surgical year were documented as well. Results: Other than vitamin B6 deficiency, which was found to be more frequent in SG patients, there was no other significant difference regarding the type of operation and the number of patients who had these deficiencies. There was no significant difference in average vitamin and iron levels between RYGB and SG. A minimum dose of 1000 IU vitamin D per day was necessary to affect vitamin D levels. The intramuscular administration of vitamin B12 was the only route found to be effective. Complications within the first year were rare. Conclusions: Against common assumptions, vitamin and iron deficiencies in SG patients are not less frequent in the first post-surgical year?in comparison to RYGB patients. Standard supplementations should include iron in premenopausal women: Vitamin D at least 1000 IU per day and vitamin B12 i.m. administration in case of a deficiency.展开更多
基金Supported by the "Hamburger Krebsgesellschaft e. V."(06-04-2004) , the Roggenbuck-Stiftung, Hamburg (05-07-2004), and the Deutsche Forschungsgemeinschaft, Bonn, Germany
文摘AIM: To study the prognostic value of adjuvant chemo-therapy in patients with pancreatic, ductal adenocar-cinoma.METHODS: Lymph nodes from 106 patients with resectable pancreatic ductal adenocarcinoma were systematically sampled. A total of 318 lymph nodes classified histopathologically as tumor-free were examined using sensitive immunohistochemical assays. Forty-three (41%) of the 106 patients were staged as pT1/2, 63 (59%) as pT3/4, 51 (48%) as pN0, and 55 (52%) as pN1. The study population included 59 (56%) patients exhibiting G1/2, and 47 (44%) patients with G3 tumors. Patients received no adjuvant chemo- or radiation therapy and were followed up for a median of 12 (range: 3.5 to 139) mo.RESULTS: Immunostaining with Ber-EP4 revealed nodal microinvolvement in lymph nodes classified as “tumor free” by conventional histopathology in 73 (69%) out of the 106 patients. Twenty-nine (57%)of 51 patients staged histopathologically as pN0 had nodal microinvolvement. The five-year survival probability for pN0-patients was 54% for those without nodal microinvolvement and 0% for those with nodal microinvolvement. Cox-regression modeling revealed the independent prognostic effect of nodal microinvolvement on recurrence-free (relative risk 2.92, P = 0.005) and overall (relative risk 2.49, P = 0.009) survival.CONCLUSION: The study reveals strong and independent prognostic significance of nodal microinvolvement in patients with pancreatic ductal adenocarcinoma who have received no adjuvant therapy. The addition of immunohistochemical findings to histopathology reports may help to improve risk stratification of patients with pancreatic cancer.
文摘Obesity is a multifactorial disease showing a pandemic increase within the last decades in developing, and developed countries. It is associated with several severe comorbidities such as type Ⅱ diabetes, hypertension, sleep apnea, non-alcoholic steatosis hepatis and cancer. Due to the increasing number of overweight individuals worldwide, research in the field of obesity has become more vital than ever. Currently, great efforts are spend to understand this complex disease from a biological, psychological and sociological angle. Further insights of obesity research come from bariatric surgery that provides new information regarding hormonal changes during weight loss. The initiation of programs for obesity treatment, both interventional and pharmaceutical, are being pursued with the fullest intensity. Currently, bariatric surgery is the most effective therapy for weight loss and resolution of comorbidities in morbid obese patients. Reasons for weight loss and remission of comorbidities following Roux-en-Y-Gastric Bypass,Sleeve Gastrectomy, and other bariatric procedures are therefore under intense investigation. In this review, however, we will focus on obesity treatment, highlighting new insights and future trends of gut hormone research, the relation of obesity and cancer development via the obesity induced chronic state of inflammation, and new potential concepts of interventional and conservative obesity treatment.
文摘Objective: Nutritional deficiencies are known side-effects of bariatric surgeries, specifically in those that bypass the proximal intestine. Therefore, in clinical practice, vitamin and mineral supplementations are often necessary after such operations. It was our intention to evaluate, whether alimentary deficiencies occur with the same frequency in patients following Sleeve-Gastrectomy (SG) compared to Roux-en-Y Gastric Bypass (RYGB) surgeries. Methods: We conducted a retrospective data analysis of 171 patients (121 RYGB, 50 SG). Vitamin levels were compared between SG and RYGB patients over the first post-operative year. Furthermore, regression analysis was performed with regard to vitamin and iron supplementations and their recommended dosages. Complications occurring within the first post-surgical year were documented as well. Results: Other than vitamin B6 deficiency, which was found to be more frequent in SG patients, there was no other significant difference regarding the type of operation and the number of patients who had these deficiencies. There was no significant difference in average vitamin and iron levels between RYGB and SG. A minimum dose of 1000 IU vitamin D per day was necessary to affect vitamin D levels. The intramuscular administration of vitamin B12 was the only route found to be effective. Complications within the first year were rare. Conclusions: Against common assumptions, vitamin and iron deficiencies in SG patients are not less frequent in the first post-surgical year?in comparison to RYGB patients. Standard supplementations should include iron in premenopausal women: Vitamin D at least 1000 IU per day and vitamin B12 i.m. administration in case of a deficiency.
