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34.8 Complete recanalisation of a bilateral traumatic carotid artery dissection with high grade stenosis of the right and complete occlusion of the left side N. Meyer, B. Rodic, M. Rudin, A. Horst, Th. Hotz, K. Käch, P. Wigger (Winterthur) Objective: Treatment of traumatic carotid artery dissection is controversial. We report a case of bilateral dissection with complete occlusion on one side which completely recanalized. Methods: A 25-year old male motorcyclist was admitted after a collision with a car. He broke the windscreen by his helmet protected head. He presented with a Glasgow coma scale of 11, a blunt thoracoabdominal trauma, a scrotal hematoma and a fracture of the distal left radius. A CT-angiography of the neck and brain revealed a small sub-arachnoid-hemorrhage of the left hemisphere and a bilateral internal carotid artery dissection. The patient was admitted to the intensive care unit and developped no neurological symptoms. Duplex sonography showed complete occlusion of the left internal carotid artery (ICA) and a 70% stenosis on the right ICA. The patient was heparinized and developed a scrotal hematoma. Therefore the heparin dose was intermittently reduced for two days. The patient was discharged on oral anticoagulation 16 days after admission. Results: The patient had an asymptomatic course. After two months duplex scan showed a complete recanalisation of both ICA’s and anticoagulation (Marcoumar) was replaced through antiplatelet treatment (Aspirin 100mg). Three months after trauma a aneurysm (5x12mm) of the right ICA was diagnosed by MRA which was decreasing in size during follow up resolved completely 17 months after trauma. Antiplatelet treatment then was stopped. Conclusion: Cervicocephalic artery dissections should be considered in patients after severe head or neck trauma even if no clinical symptoms are present. There is a lack of consensus regarding treatment modalities. Anticoagulants and antiplatelet drugs may prevent ischemic stroke, but bleeding from traumatized tissues may offset the benefits of antithrombotic treatment as occured in our case. A systematic review in over 700 patients showed no difference between the two treatment regimens. The prognosis is excellent in cases limited to local signs and poor in about 15%. The incidence of recurrent cerebral ischemic events in CAD is between 1 and 2%. Healing of arterial dissections occurs within three to six months, with resolution of stenosis seen in 90%, and recanalization of occlusions in approximately 50%. The choice of antiplatelets or anticoagulants remains a personal decision of the treating physician. 34.9 Treatment of a extracranial carotid aneurysm complicating Behçet disease. X. Berard 1 , S. Déglise 2 , F. Saucy 2 , A. Mennet 2 , C. Haller 2 , J.-M. Corpataux 2 ( 1 Bordeaux/FR, 2 Lausanne) Objective: Extracranial carotid aneurysm is a rare vascular manifestation of Behçet disease (BD). To our knowledge, only 20 cases have been reported in the literature. Methods: This study presents a complex case of extracranial carotid aneurysm. Based on this experience and a review of the literature, surgical options for carotid aneurysm in patients with BD are discussed and evaluated. Results: A 28-year-old West Indian man was admitted for a rapid expanding right extracranial carotid aneurysm complicating BD. Primary treatment consisted of resection followed by interposition of a saphenous vein graft. Twelve months after vein graft reconstruction, the patient developed a nonanastomotic pseudo-aneurysm. Reoperation was performed with removal of the pseudo aneurysm followed by reconstruction using a PTFE graft. Three months after reoperation, the patient presented another pseudo-aneurysm between the remaining vein graft and PTFE graft. Endovascular treatment was undertaken but the stent occluded before discharge. The patient remained asymptomatic and was discharged without further treatment. Oral ulcerations were found prior to the first intervention and both reoperations. Medical treatment consisted of aspirin 160 mg/d and colchicine 1mg/day prednisone 20mg/d aspirin, colchicine and prednisone after the first reparation, and aspirin, colchicine, prednisone, and azathioprine after the second reoperation. Conclusion: Analysis of the literature and our report have 4 main implications in the treatment of carotid aneurysm in BD. First, synthetic grafts should be preferred to autogenous grafts. Second, endovascular exclusion based on careful CT-scan vessel sizing appears to be a promising option but further study is needed to assess long-term benefits. Third, ligature should be considered in case of intraoperative difficulty. Fourth, regardless of surgical technique, post-operative innumosuppessive therapy is necessary to control disease activity. Thoracic Surgery 35 35.1 Photodynamic therapy enhances lipodoxorubcin distribution in sarcoma lung metastasis by lowering tumor interstitial fluid pressure in a rodent model J. Y. Perentes, C. Cheng, M. Gonzalez, Y. Wang, H.-B. Ris, T. Krueger (Lausanne) Objective: The management of sarcoma metastasis by systemic chemotherapy is often unsatisfactory. This has paradoxally been attributed to the leakiness of tumor neovessels which induce high intratumor interstitial fluid pressure (IFP) and limit convection forces that are important for drug distribution. In a rodent model, we have recently shown that photodynamic (PDT) pre treatment of lung metastasis could enhance their uptake of chemotherapy. We hypothesized that PDT transiently decreases tumor IFP which enhances convection and promotes drug distribution. Methods: Sarcoma tumors were generated sub-pleurally in the lungs of 12 rats. Animals were randomized at 10 days into i. no pre-treatment (control) and ii. low dose PDT pre-treatment (0.0625 mg/kg 28 swiss knife 2010; 7: special edition Visudyne ® , 10J/cm 2 and 35 mW/cm 2 ) followed by intravenous Liposomal doxorubicin (liporubicin TM ) administration. Using the wick-in-needle technique, we determined tumor and normal tissue IFP before, during and after PDT. In parallel, the uptake of liporubicin TM was determined by high performance liquid chromatography in tumor and lung tissues. Results: Tumor IFP was significantly higher than normal tissue IFP in all animals. PDT pre-treatment did not affect normal tissue IFP but caused a significant decrease in tumor IFP (mean decrease by 2+/- 1mmHg) which lasted an average of 30 minutes before reaching baseline values. Tumor but not normal lung tissue liporubicin TM uptake was significantly increased by 67% with PDT pre-treatment when liporubicin was allowed to circulate for one hour. Conclusion: Photodynamic therapy pre-treatment enhances liporubicin TM uptake in sarcoma lung metastasis by transiently decreasing tumor IFP. These PDT conditions seem to specifically modulate tumor neovessels but not normal lung vessels. 35.2 Prevention of primary graft dysfunction in lung transplantation by n-acetylcysteine after prolonged cold ischemia I. Inci, B. Erne, S. Arni, S. Hillinger, W. Jungraithmayr, B. Leskosek, W. Weder (Zurich) Objective: Primary graft dysfunction continues to be a problem after lung transplantation resulting in significant postoperative morbidity and mortality. This study assessed the protective effect of N-acetylcysteine on primary graft dysfunction after lung transplantation. Methods: Pig single left lung transplantation was performed in two experimental groups after 24 hours of cold (4°C) ischemia. Donor and recipient animals were treated with intravenous injection of 150 mg/kg N-acetylcysteine (NAC) 60 minutes prior to harvest and reperfusion, followed by 12.5 mg/kg/hour continuous perfusion during the 8 hour observation period (NAC group). In the control group (CON) animals did not receive any treatment. Hemodynamic and respiratory parameters were recorded throughout the observation period. Bronchoalveolar lavage (BAL) nitrite/nitrate, neutrophil elastase (NE), protein, IL-8 and lung tissue and red blood cell reduced glutathione (GSH) and NFK-B (p50) levels were measured. Results: During the observation period the mean pulmonary artery pressure, oxygenation, airway pressure, and static lung compliance were significantly better in NAC compared to CON group. Extravascular lung water index was higher at all time points during the reperfusion in the CON group. BAL protein, nitrite/nitrate, NE, IL-8 levels at the end of the experiment were significantly higher in the CON compared to NAC group. Lung tissue reduced glutathione (GSH) levels were significantly higher in NAC compared to CON group. Red blood cell GSH levels were always higher in the NAC group during the reperfusion period compared to CON group. Quantitative rt-PCR for IL-8 was significantly higher in CON during the reperfusion period compared to NAC group (p=0.001). The amount of lung tissue NFK-B (p50) was significantly higher in CON compared to NAC (p=0.03). Conclusion: In this model, donor and recipient treatment with N-acetylcysteine effectively protected the lung from primary graft dysfunction after prolonged cold ischemia. 35.3 Inhibition of tissue transglutaminase by inhibition of tissue transglutaminase sensitizes TRAIL-resistant lung cancer cells through upregulation of death receptor 5 S. Frese 1 , M. Frese-Schaper 1 , J. Schardt 1 , T. Sakai 2 , R. A. Schmid 1 ( 1 Berne, 2 Kyoto/JP) Objective: Tissue transglutaminase (TG2) is a member of the transglutaminase family of proteins that is implicated to play a role in different cellular processes such as apoptosis, cell migration and cell growth, angiogenesis, and matrix assembly. Its acyl transferase activity cross-links certain proteins, among them transcription factors were described. Recent studies have demonstrated that cancer cell lines which are apoptosis resistant express elevated levels of TG2 and can be sensitized to chemotherapy-induced apoptosis by downregulation of this enzyme. Methods: Experiments were performed using TRAIL-resistant lung cancer cell lines. Apoptosis was determined by staining with propidium iodide and by measurement of caspase activity. Receptor expression was determined by flow cytometry and quantitative RT-PCR. Promoter activity was measured by transfection of cells with lucifearse-reporter plasmids. Results: In the present study we show that the highly specific and irreversible acting small molecule TG2-inhibitor KCC009 as well as downregulation of TG2 by small interference RNA reversed resistance to tumor necrosis factor-related apoptosis-inducing factor (TRAIL) in lung cancer cells. Apoptosis induced by the combination of KCC009 and TRAIL was accompanied by activation of caspase-3 and -9. As a proposed mechanism, KCC009 increased mRNA and cell surface expression of death receptor 5 (DR5) while inhibition of DR5 upregulation abrogated the effect of KCC009 on TRAIL-induced apoptosis. Using luciferase-reporter plasmids of the DR5 promoter region we further demonstrated that KCC009-mediated upregulation of DR5 required the first intron of the DR5 gene. Although binding sites for p53 and NF-kappaB are located in the first intronic region, KCC009-induced upregulation of DR5 was independent from these transcription factors. Conclusion: Inhibition of tissue transglutaminase provides an interesting strategy for the sensitization to TRAIL-induced apoptosis. The combination of TRAIL and TG2 inhibitors therewith might present a new option for the treatment of lung cancer. 35.4 Lung resection in hematologic patients with invasive pulmonary aspergillosis C. Nebiker, D. Lardinois, L. Junker, F. Gambazzi, P. Matt, A. Gratwohl, D. Heim, L. Bubendorf, M. Tamm (Basel) Objective: Invasive pulmonary aspergillosis (IPA) is a frequent complication in patients with hematologic malignancies undergoing high dose chemotherapy and autologous or allogenic stem cell trans-
plantation. With the introduction of voriconazole and other new antifungal agents the mortality of IPA dropped but remains still high, especially for patients with prolonged neutropenia. Surgical resection in addition to antifungal therapy is an option for selected cases with IPA. However this approach is often feared due to the fact that the patients are immunocompromised. Methods: We analysed the perioperative outcome of 69 hematological patients (mean age 43 years) undergoing surgery for aspergillosis over a period of 25 years at our institution. Results: 48 patients suffered from leukemia, 2 from myelodysplastic syndrome, 8 from aplastic anemia, 3 from lymphoma, 1 from melanoma and 7 from other hematologic diseases. 42 underwent high dose chemotherapy, 18 stem cell transplantation, 6 antilymphocyte globuline and 3 patients no specific therapy. On the day of surgery 42 patients were neutropenic. The mean platelet count was 87 x 109/L. Lung resection consisted of wedge resections in 42, lobectomy in 25 and enucleation in 2 cases. Fungal infection was documented histologically in 51 patients. Reoperation was performed in 4 cases: bronchial stump dehiscence, persistent airleak, chylothorax and seroma. Minor complications at the site of surgery occurred in 12 cases (6 pleural effusion, 2 hematothorax; 2 seroma; 2 prolonged airleak). In only two cases there was an uncontrolled disseminated fungal infection (pleural aspergillosis; cerebral aspergillosis). The overall mortality at 30 days was 7.2% (5/69). Medium and longterm survival was mainly influenced by progression or reoccurrence of the underlying hematologic disease and neither by the surgical procedure nor by unsuccessful resection of the fungus. Conclusion: Lung resection is a therapeutic option for patients with hematologic diseases suffering from pulmonary fungal infection. Despite the immunocompromised status of these patients the perioperative morbidity and mortality is acceptable and the prognosis is more determined by the underlying hematologic disease than the surgical intervention itself. 35.5 Prolonged amelioration of acute lung allograft rejection by sequential overexpression of human interleukin-10 and hepatocyte growth factor in rats R. Fakin, J. Hamacher, M. Gugger, A. Gazdhar, R. A. Schmid (Berne) Objective: The effect of prolonged electroporation-mediated human interleukin-10 (hIL-10) overexpression 24 hours before transplantation, combined with sequential human hepatocyte growth factor (HGF) overexpression into skeletal muscle on day 5 on rat lung allograft rejection was evaluated. Methods: Left lung allotransplantation was performed from Brown-Norway to Fischer-F344 rats. Gene transfer into skeletal muscle was enhanced by electroporation. Three groups were studied: Group I animals (n=5) received 2.5μg pCIK-hIL-10 on day -1 and 80μg pCIK-HGF on day 5. Group II animals (n=4) received 2.5μg pCIK-hIL-10 and pUbC-hIL-10 on day -1. Control Group III animals (n=4) were treated by sham electroporation on days -1 and 5. All animals received daily non-therapeutic intraperitoneal dose of Cyclosporin-A (2.5 mg/kg) and were sacrificed on day 15. Graft oxygenation and allograft rejection were evaluated. Results: Significant differences were found between study groups in graft oxygenation (PaO2) (p=0.0028 Group I vs. II and III). PaO2 was low in Group II (31±1 mmHg) and in Group III controls (34±10 mmHg), without statistically significant difference between these two groups (p=0.54). In contrast, in Group I PaO2 of recipients sequentially transduced with IL-10 and HGF plasmids was much improved with 112±39 mmHg (p
Page 1 and 2: Abstracts 97. Jahreskongress der Sc
Page 3 and 4: Der Jahreskongress der Chirurgische
Page 5 and 6: Abstracts Session Topic Page 02 Vis
Page 7 and 8: Visceral Surgery - Cholecystitis &
Page 9 and 10: performed were recorded. Descriptiv
Page 11 and 12: avec délai dans le diagnostic, ang
Page 13 and 14: group (conventional: n=13, RS=1.8 +
Page 15 and 16: time-efficient all-in-one 3D visual
Page 17 and 18: (CHI=54 [6.49%]; SWI=27[4.98%]) wer
Page 19 and 20: Conclusion: Both procedures markedl
Page 21 and 22: 22.7 Transplantation of kidneys fro
Page 23 and 24: of the remaining 40 patients with a
Page 25 and 26: and 6/2009 and were prospectively f
Page 27: Conclusion: In our patient cohort,
Page 31 and 32: Results: SLN negative patients were
Page 33 and 34: Conclusion: This is the first study
Page 35 and 36: were grouped into four age groups a
Page 37 and 38: gain up to the 20 th procedure (Fig
Page 39 and 40: ��
Page 41 and 42: normal angiogenesis induced by cell
Page 43 and 44: 52.4 Sham-feeding of patients with
Page 45 and 46: Methods: Erfasst wurden Aggressions
Page 47 and 48: Conclusion: Pharmacological inhibit
Page 49 and 50: 54.19 Gene chip analysis of A20 exp
Page 51 and 52: 55.10 Optimized intrapleural cispla
Page 53 and 54: 62.7 Posttraumatic symptomatic cyst
Page 55 and 56: Conclusion: Only patients older 75
Page 57 and 58: no sign of occlusion. No further th
Page 59 and 60: packing as part of damage control s
Page 61 and 62: sonalführung und werden auch in de
Page 63 and 64: Figure 3 Figure 2 Figure 4 71.2 Tec
Page 65 and 66: formed 5 months later, again with a
Page 67 and 68: 99.16 3-D endo-stomal ultrasound (
Page 69 and 70: tional recanalization. Conclusion:
Page 71 and 72: 99.37 Extended Clavien-Dindo classi
Page 73 and 74: ial colitis was excluded by stool c
Page 75 and 76: 99.55 Complexes de von Meyenburg(ha
Page 77 and 78: 99.64 Traumatic abdominal wall hern
Page 79 and 80:
99.75 Isolated dorso-medial disloca
Page 81 and 82:
FRAGMIN ® DER ERFAHRENE WEGGEFÄHR
Page 83 and 84:
Kalbermatten Daniel, PD Dr., CHUV C
Page 85 and 86:
Meyer Antoine, Dr., Hôpital canton
Page 87 and 88:
Covidien Switzerland Limited multip
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