Amelanotic Esophageal Malignant Melanoma: Case Report and Short Review of the Literature

Malignant melanoma in the esophagus is a rare condition which has been described only occasionally in case reports or in larger series of patients with esophageal disease. We describe here the very rare case of a patient who presented initially with a 2-month history of dysphagia and weight loss which led to the endoscopic diagnosis of an unclear lesion in the distal esophagus. Biopsies were taken revealing positive immunohistochemical staining against HMB-45. As there were no signs of skin melanoma and there was an absence of pigmentation, a diagnosis of primary amelanotic malignant melanoma was made. Primary staging of the lesion was completed with computed tomography (CT), which revealed a locally advanced tumor with lymph node metastases at the lesser curvature of the stomach and celiac trunk. As there is still a lack of potential protocols for multimodal neoadjuvant treatment for this rare tumor entity, a palliative abdominothoracic esophagectomy with systemic lymphadenectomy and intrathoracic anastomosis was carried out. Due to an intraoperative R2 situation, clip marking was performed to allow postoperative radiotherapy. Two months postoperatively, the planning CT scan for radiotherapy revealed progression of the retroperitoneal tumor mass, which was enclosing the celiac trunk, renal vein, and superior mesenteric artery. Multiple new liver and lung metastases were also found. During the following weeks, the patient developed acute renal failure and was admitted for dialysis, and the planned radiotherapy was deferred. At the end of May 2007, 4 months after the primary diagnosis, the patient died due to acute renal failure

Parsing human skeletons in an operating room

Multiple human pose estimation is an important yet challenging problem. In an Operating Room (OR) environment, the 3D body poses of surgeons and medical staff can provide important clues for surgical workflow analysis. For that purpose, we propose an algorithm for localizing and recovering body poses of multiple human in an OR environment under a multi-camera setup. Our model builds on 3D Pictorial Structures (3DPS) and 2D body part localization across all camera views, using Convolutional Neural Networks (ConvNets). To evaluate our algorithm, we introduce a dataset captured in a real OR environment. Our dataset is unique, challenging and publicly available with annotated ground truths. Our proposed algorithm yields to promising pose estimation results on this dataset

Oral vs. intravenous radioiodine therapy in unifocal autonomy and Graves' disease

Im Rahmen der dieser Arbeit zugrunde liegenden prospektiven, randomisierten Studie wurden im Zeitraum Juli 2001 bis August 2002 insgesamt 120 Patienten der Klinik und Poliklinik für Nuklearmedizin der Universität Würzburg mit den Diagnosen Unifokale Autonomie (UFA) und Morbus Basedow (MB) mit einer RIT behandelt. Die therapeutische Applikation des 131- I erfolgte in jeder der Diagnosegruppen entweder oral in Kapsel-, oder intravenös in flüssiger Form. Ziel dieser Arbeit war es, den Einflussgrad der Applikationsmodalität des Radionuklids, d.h. orale (Kapsel) versus intravenöse (flüssige) Verabreichung des 131- I, hinsichtlich des Therapieergebnisses zu untersuchen. Ein halbes Jahr nach der RIT zeigten in der Erkrankungsgruppe UFA 94 % der Patienten bei der oralen Applikationsform und 81 % der Patienten bei der intravenösen Applikationsform einen Behandlungserfolg. In der Diagnosegruppe MB waren im gleichen Zeitraum 67 % der Studienteilnehmer bei der oralen Applikationsform und 65 % der Studienteilnehmer bei der intravenösen Applikationsform erfolgreich therapiert. Zwischen beiden Applikationsformen wurden bei UFA und MB keine signifikanten Unterschiede hinsichtlich des Therapieergebnisses gefunden. Das Ergebnis bietet somit keinen Anhalt dafür, dass bei der oralen Applikationsform enterale Absorptionsverluste von Radioiod auftreten. Ohne eine Verschlechterung des Behandlungserfolges zu befürchten, kann die Verabreichungsmodalität des Radionuklids daher individuell getroffen werden. Aus Handhabungsgründen und wegen des Strahlenschutzes des Personals wird man aber in der Regel die Kapsel bevorzugen.In a prospective randomised study, we investigated the influence of the route of administration (oral vs. intravenous) of radioiodide on therapy outcome. 60 patients suffering from Graves disease (GD) and 60 patients with unifocal autonomy (UA) participated in the study and were randomly treated with either orally or intravenously administered radioiodide. No improvement in accuracy of dosimetry was achieved when radioiodide was administered intravenously. Mean therapeutic doses were identical following intravenous or oral administration. No differences according to treatment modality were found with regard to therapeutic outcome. In the UA group, successful treatment, defined as a normal or elevated TSH level, was observed in 94% of patients after oral administration and in 81% after intravenous administration; corresponding figures in the GD group were 67% and 65%

Complete mesocolic excision in minimally invasive surgery of colonic cancer: do we need the robot?

<jats:title>Summary</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Robotic surgery offers favorable prerequisites for complex minimally invasive surgeries which are delivered by higher degrees of freedom, improved instrument stability, and a perfect visualization in 3D which is fully surgeon controlled. In this article we aim to assess its impact on complete mesocolic excision (CME) in colon cancer and to answer the question of whether the current evidence expresses a need for robotic surgery for this indication.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Retrospective analysis and review of the current literature on complete mesocolic excision for colon cancer comparing the outcome after open, laparoscopic, and robotic approaches.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Complete mesocolic excision results in improved disease-free survival and reduced local recurrence, but turns out to be complex and prone to complications. Introduced in open surgery, the transfer to minimally invasive surgery resulted in comparable results, however, with high conversion rates. In comparison, robotic surgery shows a reduced conversion rate and a tendency toward higher lymph node yield. Data, however, are insufficient and no high-quality studies have been published to date. Almost no oncologic follow-up data are available in the literature.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>The current data do not allow for a reliable conclusion on the need of robotic surgery for CME, but show results which hypothesize an equivalence if not superiority to laparoscopy. Due to recently published technical improvements for robotic CME and supplementary features of this method, we suppose that this approach will gain in importance in the future.</jats:p> </jats:sec&gt

Studies on the mammary tumor inhibiting effect of cis-bis(glycylglycin ethyl ester)platinum(II) chloride

In vivo, cis-dichlorodiammineplatinum(II) (I) [15663-27-1] and cis-dichlorobis(glycylglycine Et ester)platinum(II) (II) [60426-60-0] inhibited the DMBA-induced hormone-dependent mammary carcinoma of the SD rat. In vitro, a marked effect on DNA synthesis by mammary tumor cells and an inhibition of estradiol-receptor interaction by I and II were demonstrated. Binding to DNA and inhibition of the proliferation-stimulating effect of endogenous estrogens by blocking the hormone receptors are discussed as modes of action of I and II