Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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The postdoctoral lecturer thesis in medicine represents an essential success factor for the career of a physician; however, there is controversial discussion on whether this reflects academic competence or is more a career booster. In this context we conducted a survey among postdoctoral medical lecturers with the aim to evaluate the significance of this qualification. ⋯ The postdoctoral lecturer qualification in medicine is highly valued and the majority of responders did not want it to be abolished. Although the chances for a full professorship were only rated low, successful graduation seems to be beneficial for the career; however, there is a need for substantial structural and international changes.
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Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor disease, which rapidly leads to death if untreated. In Germany the incidence of newly occurring disease is expected to reach a peak in the coming 5 years. An R0 resection for MPM is technically impossible; therefore, the aim of surgical procedures is to achieve the maximum amount of cytoreduction. ⋯ The type and extent of surgery are currently controversially discussed. Within multimodal therapy concepts including cytoreductive surgery, long-term remission is possible in selected patients. When choosing the appropriate surgical therapy the high incidence of recurrence has to be borne in mind.
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The resection of liver and lung metastases from colorectal cancer has not yet been completely investigated. The aim of this study was to investigate the overall survival and prognostic factors for patients with liver and lung metastases from colorectal cancer. ⋯ Metastasectomy for liver and lung metastases of colorectal cancer is associated with a good overall survival in selected cases. Patients with liver and lung metastases should not be routinely excluded from metastasectomy and patients with thoracic lymph node metastases should also not be routinely excluded. Negative prognostic factors for survival are localization of the tumor in the rectum, multiple metastases and disease progression after premetastasectomy chemotherapy. Patients with disease progression after premetastasectomy chemotherapy should be excluded from metastasectomy.
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Despite intensive research efforts peritonitis leading to subsequent sepsis remains associated with a high mortality. The initial effector cells are the locally residing cells of the peritoneum, such as mesothelial cells, mast cells, macrophages and lymphocytes. Through the secretion of chemokines, an influx of neutrophils initially takes place followed by monocytes. ⋯ This is viewed as a concomitant derailing of inflammatory as well as anti-inflammatory responses, which leads to extensive apoptosis of lymphocytes. The presentation of apoptotic cells leads to a strong immunosuppression. Due to the coexistence of hyperinflammation and immunosuppression, exact knowledge of the current immune status of the patient is a prerequisite in the development of immunotherapies for the treatment of sepsis.