Zentralblatt für Chirurgie
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Review Comparative Study
[Therapeutic decisions in patients with operable, non-metastatic oesophageal cancer].
Therapy for oesophageal carcinoma is a subject of controversial debate. The aim of this study is to answer the question how the therapeutic decision in patients with operable, non-metastatic oesophageal cancer should be made. ⋯ Therapeutic decisions in patients with oesophageal cancer should only be made after standardised staging and accurate risk analysis.
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The gastric and duodenal perforations are a life-threatening complication of peptic ulcer disease with the indication for immediate surgical intervention. To which extent laparoscopy is a suitable method in an acute situation was examined in the present investigation. ⋯ The laparoscopic treatment of gastric and duodenal perforations is a minimally invasive therapeutic option for the definitive treatment of this life-threatening disease. The indication for a laparoscopic approach has to be considered individually and depends to a decisive extent on the experience of the laparoscopic surgeon.
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The noninvasive diagnostic workup of solitary pulmonary nodules (SPNs) continues to be a challenge for radiologists and nuclear medicine physicians. Morphological evaluation is useful to differentiate between benign and malignant SPNs, but there is a considerable overlap between the benign and the malignant features, resulting in a large fraction of morphologically indeterminate SPNs. Integrated PET/CT with the glucose analogue 18F-fluorodeoxyglucose (FDG PET/CT) can simultaneously evaluate morphological characteristics, anatomic location and metabolic status of SPNs. ⋯ On the other hand, there are many causes for false positive or false negative FDG PET/CTs. Therefore, FDG PET/CT cannot replace histological evaluation of SPNs, but can be clinically helpful in specific subgroups of patients with SPNs. The goal of this review is to provide an overview of the literature on PET/CT imaging in SPNs and to describe several clinical scenarios for the use of FDG PET/CT in SPNs.
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Current understanding of the pathogenesis of colonic diverticulosis and its complications has certain implications for current therapy concepts, which are summarised here. Colonic diverticula in the Western world are pseudodiverticula predominating in the sigmoid colon. Pathogenesis is multifactorial and includes low-fibre diet, dysmotility, increased intraluminal pressure and morphological changes. ⋯ Conservative and endoscopic management is the first line and surgical resection plays a role as salvage-strategy in case of recurrent and life-threatening bleeding. Localising the bleeding, i.e., with angiography, is crucial prior to surgery. The pathophysiology of colonic diverticulosis is complex and incompletely understood and linked with several controversial issues, regarding treatment strategies.