In this report, we present a PCR protocol for rapid identification of enterohemorrhagic Escherichia coli on a LightCycler instrument. In a multiplex assay, the genes encoding Shiga toxin 1 and Shiga toxin 2 are detected in a single reaction capillary. A complete analysis of up to 32 samples takes about 45 min

The basic principle in the treatment of rectal cancer is the complete surgical removal of the tumor together with the lymphatic drainage region, i.e. the mesorectum encased by the mesorectal ‘fascia pelvis visceralis’ according to Westhues. It was shown in the 1990s that the results of surgery alone could be improved by additional adjuvant and neoadjuvant therapy. Because of less toxicity and a lower rate of local recurrence, neoadjuvant therapies in International Union Against Cancer (UICC) stage II and III disease are now preferred over adjuvant strategies. The German Rectal Cancer study CAO/ARO/AIO-94 showed a full remission rate of 8% after a 5-fluorouracil (5-FU)based chemotherapy added to a conventional fractional radiation therapy (50.4 Gy). This figure, together with similar results of others, leads to the question whether surgical radicality in rectal cancer treatment could be limited in case of a good remission after neoadjuvant therapy. There are several promising possibilities under investigation, e.g. local excision instead of radical resection, or even no resection at all. Nevertheless, up to now these strategies did not prove to give comparable results to standard surgical procedures. Therefore, reduction of radicality in curable rectal cancer should be limited to accurately designed randomized clinical trials.

Die chirurgische Onkologie ist heute in der Lage, die Lebensqualität und die Prognose auch bei weit fortgeschrittenen primären Rektumkarzinomen und deren Rezidiven in potentiell kurativer, aber auch in palliativer Situation deutlich zu verbessern. Der vorliegende Beitrag gibt einen Überblick über die aktuelle Datenlage zu diesem Thema und beschreibt die heute verfügbaren operativen Techniken der Beckeneviszeration. Ausgedehnte Resektionen im kleinen Becken mit Beteiligung verschiedener Organsysteme kommen vorrangig in potentiell kurativer Intention in Betracht, doch auch im Rahmen der Palliativchirurgie kann die Beckeneviszeration unter Berücksichtigung individueller Gesichtspunkte mitunter ein sinnvoller Bestandteil der Behandlung sein. Insbesondere das Rektumkarzinomrezidiv stellt hohe Anforderungen an Diagnostik und chirurgische Therapie; hier sind stets Einzelfallentscheidungen zu treffen. Das interdisziplinäre Management dieser Patienten ist von großer Bedeutung. Präoperative Vorbereitung und intraoperatives Vorgehen werden durch das Zusammenwirken zwischen Viszeralchirurgie, Urologie und Gynäkologie bestimmt. Ein wesentlicher Bestandteil multimodaler Therapieansätze sind Strahlentherapie und internistische Onkologie. Betroffene Patienten sollten nach Möglichkeit in spezialisierten Zentren behandelt werden.

Background: Tumor response after neoadjuvant radiochemotherapy (NRC) prior to surgery and other parameters are likely to have an influence on the survival rate of patients suffering from T3 rectal cancer. Methods: 51 patients (17 female, 34 male; 59.0 years; Apache < 9 points: 95.1%; ASA I-II 88.3% and ASA III 11.8%) were treated with NRC (50.4 Gy; 5-fluorouracil/folinic acid) 4-6 weeks prior to surgery because of uT3 rectal cancer (G2: 96%; adenocarcinoma 86.3%; cUICC II 62.7%). NRC led to a tumor response (TR) (ypT0-ypT2) in 45.1% (ypT0N0M0 7.8%). Results: Neither the age of patients nor Apache/ASA score, histology, UICC staging, ypTNM, Dukes staging, infiltration of vessels, surgical procedure, local recurrence nor TR had a significant influence on the patients' survival time. Patients with metachronous distant metastasis (MDM) during the follow-up period (mean: 8.2 years; 1 month to 14.5 years) and patients with ypN1-ypN2 had a significantly shorter survival time. Conclusions: NRC prior to surgery leads to a remarkable TR rate but has no significant impact of TR on the patients' survival time. Occurrence of MDM during the follow-up period and ypN1/N2 status do have a greater influence. It is necessary to investigate larger cohorts of patients in the future to obtain more conclusive results and to define factors with influence on survival.

During the last decade no gastrointestinal tumor underwent such profound modifications in diagnostics and therapy as rectal cancer (total mesorectal excision, multimodal therapy). Despite all efforts and continuous improvements in the results of oncological treatment, local recurrence of rectal carcinoma is still a considerable problem. Optimized surgery methods and multimodal therapies allow a local recurrence rate lowered to about 6%. Without surgical intervention the 5-year survival rate after local recurrence is approximately 4%, and the median survival time in a palliative situation is about 13 months and often associated with considerable restriction of quality of life. Morbidity after complex pelvic surgery is still high, but its mortality rate in highly professional surgical centers has reached an acceptable level of about 6%. Surgical oncology today has the ability for remarkable improvement in the prognosis of locally recurrent rectal cancer. After R0 resection the 5-year survival rate is nearly 30%.

A 60-year-old man was admitted for surgical treatment with a diagnosis of distal oesophageal carcinoma. A lymph node metastasis in the area of the hepatoduodenal ligament was suspected by preoperative CT scan and endosonographic examination. During the course of the oesophagectomy, a saccular tumour encircling the common hepatic artery was shown. The vessel and surrounding tumour were resected en bloc. Histology demonstrated a completely thrombosed true aneurysm of the common hepatic artery.