Schweizerische medizinische Wochenschrift最新文献

Surgery alone may fail to cure a considerable number of locally advanced colon cancers. Clinical trials have shown a statistically significant if modest benefit from adjuvant chemotherapy in node-positive patients. In node-negative cancers, however, the data available to date do not fully support routine use of adjuvant treatment. Combinations of 5-fluorouracil are most commonly used, but current trials are exploring several new drugs with proven efficacy in metastatic colon cancer for use in the adjuvant setting. Given the considerable advances in our knowledge of the molecular biology of colon cancer, it can be expected that molecular markers will soon establish themselves as diagnostic tools to improve the selection of candidates for this treatment modality. Colon cancer has clearly moved from an exclusive surgeons' stronghold to a disease where a multimodal approach will provide better and more promising results.

Treatment of idiopathic constipation requires precise definition of the physiological and pathophysiological changes. A colorectal work-up including colonoscopy, colorectal passage, colonic transit study, anorectal manometry, cinedefecography and electromyography help to distinguish between four different forms of idiopathic constipation: slow transit constipation, outlet obstruction, a combination of both problems and irritable bowel syndrome. 70% of patients with chronic constipation suffer from irritable bowel syndrome. In these cases there is no indication for surgery. Patients with pelvic outlet obstruction due to paradoxical puborectalis contraction can be successfully treated with biofeedback. Outlet obstruction due to rectal prolapse, rectocele and intussusception require surgery. Total colectomy with ileorectal anastomosis is the surgical option for selected patients with slow transit constipation. Where there is a mixed disorder, biofeedback for the outlet obstruction must be applied prior to colectomy for the inert colon. Thorough preoperative physiologic testing is mandatory for a successful outcome. When cases are carefully diagnosed and selected, the operative results are excellent.

Functional bowel disorders are collections of symptoms attributable to the mid or lower gastrointestinal tract. The two most common disorders, irritable bowel syndrome and functional dyspepsia, have common etiopathogenetic features, notably psychosocial disturbances, dysmotility and heightened sensitivity. The control mechanisms, pathophysiology, investigation and potential pharmacotherapies of these disorders are reviewed. Serotonergic and adrenergic agents are among the novel approaches that may have a significant impact on these disorders.

"Virtual colonoscopy" is a new method of producing an endoscopic view of the colon without endoscopy. The images are derived from the data of conventional abdominal computer-tomography or magnetic resonance tomography, using modern computer programmes. The method makes it possible to detect colonic polyps or carcinomas with a sensitivity and specificity of 80%. The most interesting application of "virtual colonoscopy" may be as a screening method for colorectal polyps in preventing the development of colorectal cancer. This may improve patient acceptance for colorectal cancer screening programmes.

Colorectal cancer is a significant health problem in Western countries and is expected to grow further as life expectancy increases. Different surgical techniques have improved the treatment of colorectal cancer. Three controversial treatment modalities are reviewed: laparoscopic surgery for colon cancer, total mesorectal excision, and adjuvant radiotherapy in the management of rectal cancer. Finally, recent advances in the molecular biology of sporadic colorectal cancer are discussed.

Foetal and neonatal alloimmune thrombocytopenia is caused by transplacental transfer of antibodies directed against platelet antigens and affects approximately 1 in 1000-2500 neonates. Clinically relevant complications are the intracranial haemorrhages that occur in 10-20% of cases. 20 platelet antigen systems are currently known. However, immunisation is most frequently seen against two of these (HPA-1a and HPA-5b). Treatment options include transfusion of compatible or, if these are not available while urgently needed, random donor platelets, intravenous immunoglobulin, and steroids. We report on a case of neonatal alloimmune thrombocytopenia due to an anti-HPA-1b antibody in the third pregnancy of a 31-year-old Caucasoid woman. The infant was treated with repeated maternal and random donor platelet transfusions and with a single dose of intravenous immunoglobulin.

Tuberous sclerosis (Bourneville-Pringle) and type I neurofibromatosis (von Recklinghausen) are familial multiple tumour syndromes. Both entities have in common that the cutaneous manifestations can stigmatize the carriers and considerably reduce the quality of life. CO2-laser surgery (vaporisation) consistently yields good to excellent aesthetic results in the treatment of adenoma sebaceum in tuberous sclerosis. Patients with type I neurofibromatosis who carry several hundreds neurofibromas usually benefit from a numerical reduction in their skin lesions, despite the less predictable aesthetic result, ranging from excellent to fair. The present study reports on the treatment outcome of CO2-laser surgery in 8 patients with adenoma sebaceum and 8 with neurofibromatosis.