Zentralblatt fur Chirurgie最新文献

{"title":"[A Migrating Pulmonary Mass: a Rare Case of Thoracolithiasis].","authors":"Deborah D Wehde, Jan Reichelt, Jan Philipp Hering","doi":"10.1055/a-2566-6597","DOIUrl":"https://doi.org/10.1055/a-2566-6597","url":null,"abstract":"<p><p>We report on an 70-year old male patient with progressive dyspnoea. For further differential diagnosis he underwent a CT thorax in the pulmonary arterial phase. This revealed a solid, pleural round lesion. The lesion was located paravertebrally in the area of the distal aortic arch. Initially the dignity of the round lesion was undetermined. A subsequent examination conducted three months later, utilising HRCT, revealed no alterations in the dimensions or configuration of the mass. A change in position was observed. In this case of idiopathic phrenic nerve paralysis with diaphragmatic atrophy, diaphragmatic elevation and chronic progressive exertional dyspnoea, the surgical intervention involved a diaphragmoplasty and the surgical removal of the voluminous thoracolith by means of a muscle-sparing limited lateral thoracotomy. The diagnosis of a thoracolith was confirmed on the basis of morphologic criteria and a change in position.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Reconstruction of Complex Trunk Defects Using Pedicled and Free Flaps in Combination with AV Loops].","authors":"Vincent G J Guillaume, Tim Leypold, Benedikt Schäfer, Lara Lingens, Christian Uhl, Justus P Beier","doi":"10.1055/a-2597-7817","DOIUrl":"https://doi.org/10.1055/a-2597-7817","url":null,"abstract":"<p><p>Large trunk defects occur after extensive oncological resections, trauma, infections or adjuvant radiotherapy and often require complex reconstructions. In the case of multi-layered skin soft tissue defects without the possibility of primary closure, defect coverage using free flaps is necessary if local flap options are exhausted. AV loops can bridge to recipient vessels if local options are limited and are used in combination with free flaps. A plethora of free flaps is available in the armamentarium for defect coverage, which are selected according to the reconstruction required. Common flaps for reconstruction are the perforator-based anterolateral thigh flap (ALT flap), but also muscle-bearing flaps with and without a skin island, such as the latissimus dorsi flap or the vastus lateralis flap. Early interdisciplinary collaboration between different specialist disciplines - with the involvement of plastic-reconstructive surgeons - can enable the closure of critically large defects.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Modern Radiological Approaches to the Diagnosis and Staging of Pleural Mesothelioma].","authors":"Sabine Franckenberg, Olivia Theissen-Lauk, Thomas Frauenfelder","doi":"10.1055/a-2576-6585","DOIUrl":"https://doi.org/10.1055/a-2576-6585","url":null,"abstract":"<p><p>Pleural mesothelioma (PM) is a highly aggressive tumour, mainly associated with prior asbestos exposure. Symptoms typically do not manifest until 20 to 50 years after exposure. Depending on the histological subtype of PM, the prognosis varies, though the median survival time is only 12-18 months. Imaging plays a central role in the management of PM patients, particularly in assessing operability and treatment response. However, PM presents a unique challenge for radiology due to its rarity, complex morphology, and tendency to invade multiple tissue layers simultaneously. Contrast-enhanced computed tomography (CT) is the central imaging modality in the diagnosis, preoperative planning and therapy monitoring of pleural mesothelioma (PM). Ideally, CT should include both the thorax and abdomen to capture the entire pleural space. Tumour thickness and volume, as determined by CT, are important prognostic factors for patient survival in PM. In addition, PET/CT, using radioactively labelled fluorodeoxyglucose (¹⁸F-FDG), offers additional valuable insights into tumour metabolism. Since PM is typically metabolically active, PET/CT is particularly effective in detecting smaller lesions, occult metastases, and assessing morphologically ambiguous lesions. Magnetic resonance imaging (MRI), on the other hand, offers distinct advantages over CT, due to its superior soft tissue contrast, particularly in visualizing tumour extent and infiltration of adjacent structures. Dynamic contrast-enhanced imaging, diffusion-weighted imaging, and 4D sequences provide valuable additional information. On the basis of the \"Best Practices\" of the expert panel from the International Mesothelioma Interest Group (iMig), we provide an overview of the common imaging modalities, including conventional X-ray, CT, MRI, and PET/CT. Additionally, we discuss staging based on the TNM classification (Tumour, Node, Metastasis), which evaluates the local invasion of the tumour (T), lymph node involvement (N), and the presence of metastases (M). We also present examples of assessing treatment response and highlight recent developments in diagnostic imaging.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Malignant Tumours of the Aorta].","authors":"Steffen Wolk, Christian Reeps","doi":"10.1055/a-2590-1736","DOIUrl":"https://doi.org/10.1055/a-2590-1736","url":null,"abstract":"<p><p>Aortic malignancies are rare diseases, of which only about 200 cases have been described in the literature. Most common forms are high-grade sarcomas, in over 80% of patients, which predominantly grow intimately and which can occur at any location in the aorta. In addition to non-specific symptoms, such as fever, hypertension and general weakness, aortic sarcomas in one third of patients manifest as peripheral embolism or, in the case of mural sarcoma, as an aneurysm or aortic rupture. In diagnostic testing, MRI is considered the gold standard, as CT angiography or PET CT can only show non-specific signs. Since aortic malignancies often manifest themselves as other diseases, diagnosis and therapy are often delayed. In therapy, the focus is on radial tumour resection with aortic replacement, possibly followed by adjuvant medical therapy. The 1-, 3- and 5-year survival rates are 26%, 7.6% and 3.5%, respectively.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[3D-Printed Templates for Physician Modified Endografts - Current Concepts and New Workflows].","authors":"Sabrina Frenzel, Jan Stana, Christian Hagl, Linda Grefen, Nikolaos Tsilimparis, Maximilian Grab","doi":"10.1055/a-2577-5181","DOIUrl":"https://doi.org/10.1055/a-2577-5181","url":null,"abstract":"<p><p>Fenestrated or branded prostheses are used to treat complex abdominal aortic aneurysms. In urgent cases, \"Physician-modified endografts\" (PMEG) are used when delivery times for customised prostheses are long. In this technique, the distances between the fenestrations are measured on the patient's computer tomography data set, manually transferred to the three-dimensional surface of the prosthesis by the surgeon and the fenestrations are cut into the endoprosthesis accordingly. This process is highly dependent on the surgeon's experience. This paper provides an overview of current modification processes and presents a new, simplified workflow to produce a template for modification within 12 hours of receiving the CT data set.Preoperative CT data sets served as the basis for the development of the patient-specific templates. The three-dimensional, individualised templates were to be additively manufactured using a transparent material and placed over the standard tubular prostheses. Due to the transparency of the material and the possibility of rotating the prosthesis within the template, the optimal position of the fenestrations on the prosthesis was to be found independently of experience.Patient-specific templates for modifying prostheses were developed and additively manufactured using CT data (n = 22). For each template design, the segmentation, design and additive manufacturing process could be completed within 12 hours in a standardised manufacturing process. Material transparency, template design and easy handling of the templates permitted the positioning of the fenestrations regardless of experience. Low-resolution CT data sets, extreme curvatures or angles of the aorta were considered exclusion criteria.The patient-specific templates could be created within 12 hours using a standardised procedure with a simple development process. The transparent templates are a further step towards patient-specific medicine.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Indications for Lung Transplantation - Updates Since the Last ISHLT Recommendations].","authors":"Zsofia Kovacs, Alberto Benazzo, Peter Jaksch","doi":"10.1055/a-2563-3691","DOIUrl":"https://doi.org/10.1055/a-2563-3691","url":null,"abstract":"<p><p>Lung transplantation has evolved continuously since its first successful procedures in the 1960 s. The current guidelines from the International Society for Heart and Lung Transplantation (ISHLT) emphasise increasingly individualised patient assessment, which, in addition to the underlying lung disease, considers factors such as comorbidities, frailty, age, and social aspects. The expanded indications for lung transplantation are reflected in the refined risk assessment, which particularly includes patients with advanced chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and pulmonary arterial hypertension (PAH). Furthermore, the criteria for patients with a history of cancer and those with infections such as HIV or multidrug-resistant organisms have been made more flexible, leading to a more inclusive transplantation policy. A key focus is on early transplant counselling, allowing patients the opportunity for transplantation before they develop acute exacerbations. These updated guidelines aim to maximise both the survival rates and the quality of life of transplant patients, through differentiated and risk-adjusted decision-making.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary Hypertension and Lung Transplantation.","authors":"Sophie Kruszona, Khalil Aburahma, Nunzio Davide de Manna, Dmitry Bobylev, Arjang Ruhparwar, Christian Kuehn, Jawad Salman, Fabio Ius","doi":"10.1055/a-2590-2620","DOIUrl":"https://doi.org/10.1055/a-2590-2620","url":null,"abstract":"<p><p>Pulmonary artery hypertension (PAH), a subtype of pulmonary hypertension, is a rare end-stage lung disease. Bilateral lung and combined heart and lung transplantation have long been considered as a gold standard therapy for PAH.This manuscript reviewed the most up-to-date literature on lung transplantation for PAH, focusing particularly on risk stratification, donor allocation, bridging to transplantation (BTT), and intra- and postoperative management in both adult and pediatric patients.The last two decades have witnessed an important shift in the transplant indications and strategy for PAH. Newly introduced antihypertensive drugs have postponed the time of transplantation in eligible patients, thus reserving transplantation for severely ill high-risk patients on triple antihypertensive therapy. Furthermore, the widespread peritransplant use of veno-arterial extracorporeal membrane oxygenation (ECMO) enables cardiac remodeling after bilateral lung transplantation.The change in transplant strategy from combined heart and lung transplantation to bilateral lung transplantation renders more organs available for transplantation in an era of organ shortage. ECMO-bridging is a life-saving tool in selected PAH patients although associated with higher complications. Better organ allocation in PAH patients at high risk of decompensation may reduce the need for ECMO-bridging and may further improve outcomes.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Immunological Aspects after Lung Transplantation].","authors":"Caroline Hillebrand, Alberto Benazzo","doi":"10.1055/a-2590-9933","DOIUrl":"https://doi.org/10.1055/a-2590-9933","url":null,"abstract":"<p><p>Since the 1980 s, lung transplantation has evolved into an established therapeutic procedure, due to advancements in surgical techniques and the introduction of immunosuppressants such as cyclosporine. Despite improved short-term outcomes, the long-term prognosis remains limited, primarily due to immunological complications. With a median survival of approximately six years, the lung is the most immunogenic solid organ, owing to its constant exposure to environmental antigens and its extensive vascular endothelial surface. After lung transplantation, various forms of alloreactivity, including T cell-mediated acute and chronic rejection, play a central role. Additionally, humoral immune responses, characterised by the production of donor-specific and non-HLA antibodies, contribute significantly to graft injury. Recurrent tissue damage, such as ischemia reperfusion injury, leads to the exposure of cryptic antigens, promotes autoreactive processes, and facilitates the formation of tertiary lymphoid organs. These mechanisms sustain persistent inflammation, ultimately resulting in chronic graft dysfunction. Rejection reactions remain a major challenge. Acute forms, such as cellular and humoral rejection, require rapid and targeted therapies to prevent irreversible damage. Chronic rejection, particularly chronic lung allograft dysfunction (CLAD), progressively impairs lung function. In the main phenotypes of CLAD, bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS), are crucial for prognosis and treatment. Nevertheless, therapeutic options remain limited, and retransplantation is often the last resort. Immunosuppressive therapy forms the cornerstone of rejection prevention, and typically employs a triple combination of calcineurin inhibitors, antiproliferative agents, and corticosteroids. Induction therapy frequently involves monoclonal or polyclonal antibodies. Modern strategies aim to effectively suppress immune responses while minimising severe side effects, such as infections, malignancies, and nephrotoxicity. Future research will focus on personalised immunosuppressive strategies, optimised diagnostics, and innovative therapies to improve the long-term prognosis of lung transplant recipients.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[CT Protocols in Thoracic Surgery: a Practical Guideline].","authors":"Fiona Mankertz, Marc-David Künnemann, Johanna Reekers, Jan Philipp Hering","doi":"10.1055/a-2587-2568","DOIUrl":"https://doi.org/10.1055/a-2587-2568","url":null,"abstract":"<p><p>The use of radiological imaging has gained increasing importance in thoracic surgery, due to the development of new modalities. In particular, computed tomography (CT) not only offers significant diagnostic value but has also become essential for preoperative planning and postoperative follow-up in thoracic surgery. This review is intended to serve as a practical reference and guide for the indication, planning, and interpretation of thoracic CT imaging. It not only explains diagnostic aspects, such as the evaluation of specific conditions in CT imaging, but also provides practical guidance on how to formulate specific clinical questions. The appropriate indication for contrast-enhanced CT versus non-contrast imaging is evaluated. Additionally, the various contrast phases in CT imaging and their diagnostic relevance are discussed using specific thoracic surgery cases. The goal is to provide a structured guide for the application and assessment of radiological diagnostics in thoracic surgery.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Centralisation of Liver Transplantation: Implications for Training Transplant Surgeons].","authors":"Simon Moosburner, Nathanael Raschzok, Wenzel Schoening, Brigitta Globke, Johann Pratschke, Robert Öllinger, Felix Krenzien","doi":"10.1055/a-2587-2394","DOIUrl":"https://doi.org/10.1055/a-2587-2394","url":null,"abstract":"<p><p>The centralisation of liver transplantation in Germany is seen as a promising approach to improve care quality through higher case volumes and specialised structures. However, it poses significant challenges for surgical training. Reduced availability of training positions, limited diversity of clinical experience, and the risk of capacity bottlenecks could impact the education of young transplant surgeons in the long term. This article explores the opportunities and risks of centralisation, particularly regarding surgical education. While higher case volumes are associated with better outcomes, it is argued that complementary measures such as regional support structures, rotation programs, and, where applicable, the use of practical training models are essential to ensure comprehensive education. The implementation of regulations of minimum case volume is also discussed as a potential regulatory tool. Finally, the article highlights the need for future studies to systematically evaluate the impact of centralisation on surgical education and to provide an evidence-based foundation for decision making.</p>","PeriodicalId":23956,"journal":{"name":"Zentralblatt fur Chirurgie","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}