In this large, randomized trial, laparoscopic cholecystectomy within 24 hours of hospital admission was shown to be superior to the conservative approach concerning morbidity and costs. Therefore, we believe that immediate laparoscopic cholecystectomy should become therapy of choice for acute cholecystitis in operable patients. (NCT00447304).

A total of 199 patients with abdominal aortic aneurysms were followed up to investigate the influence of selective management on the prognosis and the risk rupture of abdominal aortic aneurysms. Decisions to operate or to continue watchful waiting with treatment of risk factors for expansion were based on aneurysm size, expansion rate, aneurysm-related symptoms, and individual operative risk. Rupture occurred in eight cases. All aneurysms were larger than 5 cm, and six were larger than 6 cm in diameter at the last measurement before rupture. The resulting overall 5-year cumulative rate of rupture was 7.3% (Kaplan Meier). The 134 patients who underwent more than one ultrasound examination were observed for an average of 4.0 years (536 patient-years). The expansion rate was significantly correlated with the initial diameter and the diastolic blood pressure (best subset multiple regression analysis: r = 0.403; P < 0.001). A correlation with the systolic blood pressure was found only in univariate analysis (r = 0.236; P = 0.011). Amplitude of blood pressure, serum cholesterol level, low-density and high-density lipoproteins, ratio of low- to high-density lipoproteins age, and the extent of smoking habits were not correlated with the expansion rate. Our conclusion is that larger diameter and higher diastolic blood pressure are important risk factors for expansion of abdominal aortic aneurysms. Selective management of abdominal aortic aneurysms based on aneurysmal size, expansion rate, and patient characteristics may result in a low rate of rupture.

Ligation is the most effective treatment option. No significant difference was found between the efficacy of sclerotherapy and treatment with somatostatin or octreotide.

Objective: High-dose vitamin C therapy might mediate beneficial clinical effects by counteracting reactive oxygen species. However, concerns are raised whether this approach might provoke diametrical (ie pro-oxidative) effects. The objective was to determine ascorbyl free radical (AFR) concentrations and potential variables of pro-oxidative damage. Design: Crossover study; six healthy males received daily infusions of 750 or 7500 mg vitamin C for six consecutive days. Fasting concentrations of vitamin C and AFR were determined daily. On day 1, concentrations of vitamin C and AFR were measured at 0.25, 0.5, 1, 2, 4 and 8 h post infusion. Plasma concentrations of thiobarbituric acid-reactive substances (TBARS), tocopherol and urine concentrations of 8-oxoguanosine were determined on days 1 and 6. Results: Kinetic studies on day 1 showed that concentrations of vitamin C and AFR displayed parallel dose-and time-dependent kinetics and elimination was highly efficient. Vitamin C and AFR fasting concentrations on days 2-6 were slightly above the baseline, suggesting new, stable steady states. TBARS decreased in both groups, whereas tocopherol and 8-oxoguanosine concentrations remained unchanged. Conclusion: Kinetics of AFR largely depend on plasma vitamin C concentrations and AFR is eliminated efficiently. Our data do not support induction of pro-oxidative effects in healthy volunteers given intravenous high-dose vitamin C. Sponsorship:

HCC and ICC differ to some extent in their CEUS enhancement pattern. Incomplete arterial hyperenhancement is more often seen in ICC than in HCC. A rim sign seems to be specific for ICC, but is only rarely present. However, in a case-to-case decision, due to overlapping characteristics, a reliable differentiation between the two tumor types by CEUS alone is very often not possible.

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Background and Aims: Self-expandable metal stents are used for the treatment of anastomotic leaks after gastro- esophageal surgery. Predictors for treatment failure and complications are unknown. In this observational retrospective study, we summarize our experience with self-expandable metal stents for the treatment of anastomotic leaks, in order to determine the predictors of treatment failure. Methods: Between 2009 and 2015, 34 patients with anastomotic leak after curative resection of gastro- esophageal cancer were treated with self-expandable metal stents. Gender, histology, comorbidity, body mass index, neoadjuvant therapy, previous surgery, leak size, and stent diameter were analyzed for their predictive value according to treatment success and complication rate. Results: Leak closure rate was 76%. Risk factors for treatment failure were neoadjuvant chemo-radiotherapy, squamous cell histology, and esophageal tumor location. Gender, comorbidity, body mass index, neoadjuvant chemotherapy, and previous surgery were not correlated with outcome. Mortality rate was 20%, most often due to uncontrolled leak. Severe stent-related complications occurred in 15% of patients, most of them following insertion of a large-sized stent. Conclusion: Squamous cell histology, neoadjuvant chemo-radiotherapy, and esophageal tumor location are predictors for treatment failure. Severe stent-related complications seem to be preferentially associated with the use of large-sized stents.

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