Abstract:
BACKGROUND:Early gastro-esophageal cancer is staged as m1 to m3 depending on the infiltration of the anatomical layers of the mucosa or, analogously, as sm1 to sm3 depending on the depth of infiltration into the submucosa. The risk of lymph node metastases is low in mucosal carcinoma but increases with the depth of infiltration into the submucosa. METHODS:This review is based on pertinent publications retrieved by a selective search in MEDLINE, PubMed, the Cochrane Library, and the International Standard Randomised Controlled Trial Number (ISRCTN) registry. RESULTS:New technologies such as narrow-band imaging have improved the endo- scopic diagnosis and staging of early gastro-esophageal cancer. The development of endoscopic submucosal dissection has led to a higher R0 resection rate, a lower risk of recurrence, and an increase in the number of endoscopic resections that are performed with curative intent. In squamous-cell carcinoma of the esophagus, surgical oncological esophagectomy is indicated if the cancer infiltrates into the third mucosal layer (T1a, m3) or deeper. In esophageal adenocarcinoma, the prevalence of lymph node metastases is low if the cancer is restricted to the mucosa and in- creases only when the submucosa is infiltrated. In the current German S3 guideline, endoscopic resection is recommended for intramucosal adenocarcinoma as long as there are no further histopathological risk factors. Lymph node metastasis in gastric carcinoma begins in the deep mucosal infiltration stage (m3). If certain special con- ditions ("extended criteria") are met, carcinoma expanding into the first submucosal layer (sm1) can be removed endoscopically. All further stages must be treated with total or subtotal gastrectomy with systematic D2 lymphadenectomy. CONCLUSION:Borderline cases between endoscopic and surgical resection of early carcinoma of the esophagus or stomach must be managed with an interdisciplinary treatment algorithm. If there is a risk of lymph node metastasis, surgical oncological resection is indicated. Such resections of gastroesophageal cancer in the locally advanced stage should always be part of a multimodal treatment approach.
journal_name
Dtsch Arztebl Intjournal_title
Deutsches Arzteblatt internationalauthors
Gockel I,Hoffmeister Adoi
10.3238/arztebl.2018.0513subject
Has Abstractpub_date
2018-08-06 00:00:00pages
513-519issue
31-32issn
1866-0452pii
arztebl.2018.0513journal_volume
115pub_type
杂志文章,评审abstract:BACKGROUND:Nail disorders can arise at any age. About half of all nail disorders are of infectious origin, 15% are due to inflammatory or metabolic conditions, and 5% are due to malignancies and pigment disturbances. The differential diagnosis of nail disorders is often an area of uncertainty. METHODS:This review is b...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2016.0509
更新日期:2016-07-25 00:00:00
abstract:BACKGROUND:The percentage of organ donors among the German population is very low, and the supply of organs does not meet the demand. Relatively few organ explantations are performed in Germany, compared to other countries. The central element leading up to organ explantation is the donor's consent. This can be express...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2020.0183
更新日期:2020-03-13 00:00:00
abstract:BACKGROUND:The effectiveness of intraoral appliances (IOA), maxillary expansion (ME), and maxillomandibular advancement (MMA) in the treatment of children and adults with obstructive sleep apnea (OSA) has not yet been adequately assessed. METHODS:An umbrella review was performed based on established guidelines for evi...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2018.0200
更新日期:2018-03-23 00:00:00
abstract:BACKGROUND:Because the course of Legg-Calvé-Perthes disease (LCPD) is highly variable, its appropriate diagnostic evaluation and treatment are still debated. METHODS:The authors selectively review the literature, present their own study findings, and discuss the guidelines of the German Society for Orthopedics and Ort...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2009.0517
更新日期:2009-07-01 00:00:00
abstract:INTRODUCTION:Intermittent paradoxical closure of the vocal cords can induce major attacks of dyspnea. Such attacks, called "vocal cord dysfunction" (VCD), are an important element in the differential diagnosis of intractable bronchial asthma. METHODS:Selective review of the literature. RESULTS:The etiology of VCD is ...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2008.0699
更新日期:2008-10-01 00:00:00
abstract:INTRODUCTION:The trauma registry of the German Society of Trauma Surgery is a multicentric prospective record of the treatment of severely injured patients. METHODS:The present study examines the effect of a quality management system on key processes and outcomes, in hospitals included in the trauma registry. The stud...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2008.0225
更新日期:2008-03-01 00:00:00
abstract:BACKGROUND:The many varieties of cystic pancreatic tumor, and especially intraductal papillary mucinous neoplasia (IPMN), have attracted increased attention recently. Their incidence may be rising, and their histopathological evaluation and classification have become more precise than before. METHODS:We discuss the cu...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2011.0788
更新日期:2011-11-01 00:00:00
abstract:BACKGROUND:Patients with acquired brain injury who have been discharged from inpatient neurological rehabilitation often continue to suffer from limited independence, participation, and quality of life. Participation-focused outpatient treatment (in German: teilhabeorientierte ambulan. METHODS:In a randomized, control...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,随机对照试验
doi:10.3238/arztebl.2016.0634
更新日期:2016-09-23 00:00:00
abstract:BACKGROUND:Multiple sclerosis (MS) is the most common autoimmune disease of the central nervous system. There are at least 150 000 persons with MS in Germany. Recent years have seen the approval of new drugs against. METHODS:This article is based on pertinent literature retrieved by a selective search in PubMed as wel...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2016.0879
更新日期:2016-12-26 00:00:00
abstract:BACKGROUND:Screening colonoscopy can lower the incidence of colorectal cancer (CRC), yet participation rates are low even in groups at high risk. The goal of this study was to double the rate of participation in screening colonoscopy among persons at familial risk and then to determine the frequency of neoplasia in thi...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.3238/arztebl.2018.0715
更新日期:2018-10-26 00:00:00
abstract:BACKGROUND:Familial hypercholesterolemia (FH) is a congenital disorder of lipid metabolism characterized by a marked elevation of the plasma concentration of LDL (low-density lipoprotein) cholesterol beginning in childhood and by the early onset of coronary heart disease. It is among the commonest genetic disorders, wi...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2014.0523
更新日期:2014-08-04 00:00:00
abstract:BACKGROUND:Most women of child-bearing age want a safe method of contraception. Numerous methods are available, with different modes of application. In situations involving particular risks, the selection of the right method poses a special challenge. METHODS:Contraceptive methods for use in various situations with in...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2019.0764
更新日期:2019-11-08 00:00:00
abstract:BACKGROUND:Current guidelines recommend using aspirin, clopidogrel, beta-blockers, statins, and angiotensin converting enzyme (ACE) inhibitors after acute myocardial infarction (AMI). Although there is evidence that patients often stop taking these medications prematurely, long-term data reflecting the actual reality o...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2011.0856
更新日期:2011-12-01 00:00:00
abstract:BACKGROUND:Numerous studies from around the world have shown a positive association between case numbers and the quality of medical care. The evidence to date suggests that conformity to guidelines for the treatment of patients with breast cancer is better in German hospitals that have higher case numbers. METHODS:We ...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,多中心研究
doi:10.3238/arztebl.2015.0585
更新日期:2015-08-31 00:00:00
abstract:BACKGROUND:The epidermal growth factor receptor (EGFR) is an important target in the treatment of metastatic colorectal carcinoma (mCRC). The combination of anti-EGFR antibodies with chemotherapy has led to a higher response rate of certain kinds of tumor as well as a significant prolongation of the progression-free in...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2009.0202
更新日期:2009-03-01 00:00:00
abstract:BACKGROUND:Proper infant nutrition promotes healthy growth and development and lowers the risk of disease in later life. METHODS:This review is based on pertinent articles retrieved by a selective search, including guidelines, meta-analyses, and systematic reviews. RESULTS:Infants should be exclusively breast-fed unt...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2016.0435
更新日期:2016-06-24 00:00:00
abstract:BACKGROUND:Dear Doctor Letters (also known as Direct Healthcare Professional Communications) inform physicians about significant newly discovered drug risks and about measures to take to reduce these risks. How far these warnings actually influence prescribing behavior is unclear. METHOD:The Geriatrics in Bavaria-Data...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2014.0255
更新日期:2014-04-11 00:00:00
abstract:BACKGROUND:Systematic reviews provide a structured summary of the results of trials that have been carried out on any particular subject. If the data from multiple trials are sufficiently homogenous, a meta-analysis can be performed to calculate pooled effect estimates. Traditional meta-analysis involves groups of tria...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,meta分析,评审
doi:10.3238/arztebl.2015.0803
更新日期:2015-11-20 00:00:00
abstract:BACKGROUND:Recent years have seen a further decline in the nationwide case fatality rate after major trauma in Germany, but it has not been clear until now whether all centers providing trauma care achieve comparable results. We have attempted to answer this question using data from the trauma registry of the German So...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,多中心研究
doi:10.3238/arztebl.2010.0463
更新日期:2010-07-01 00:00:00
abstract:BACKGROUND:Stroke is the third most common cause of death in industrialized countries, accounting for more than 10% of deaths over age 65. Most strokes are due to arteriosclerosis. Regular physical activity lowers arterial blood pressure and body weight and improves glucose and lipid metabolism, thereby slowing the dev...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,meta分析,评审
doi:10.3238/arztbl.2009.0715
更新日期:2009-10-01 00:00:00
abstract:BACKGROUND:The risk of venous thromboembolism (VTE) is 4 to 7 times higher in cancer patients than in the normal population. Moreover, cancer patients who take anticoagulants suffer more frequently from hemorrhagic complications and VTE recurrences. Patients often find low-molecular-weight heparin (LMWH) treatment unpl...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2019.0031
更新日期:2019-01-18 00:00:00
abstract:BACKGROUND:Abdominal and thoracic aortic aneurysms are diagnosed in 40 and 10 to 15 out of 100 000 persons per year, respectively. Fenestrated (fEVAR) and branched (bEVAR) stent grafts have been developed for abdominal juxtarenal and thoracoabdominal aneurysms. We discuss the patency and complication rates of fEVAR and...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,meta分析,评审
doi:10.3238/arztebl.2015.0816
更新日期:2015-11-27 00:00:00
abstract:BACKGROUND:Overweight and obesity are generally thought to elevate morbidity and mortality. New data call this supposed association into question. METHODS:The Cochrane, Pubmed, and other databases were systematically searched for a combination of relevant terms and subject headings. Meta-analyses and cohort studies ba...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,meta分析,评审
doi:10.3238/arztebl.2009.0641
更新日期:2009-10-01 00:00:00
abstract:BACKGROUND:The past decade has seen much progress in intrauterine surgery. Randomized trials have documented the benefit of some procedures of this type for the unborn child. METHOD:Selective literature review RESULTS:Randomized trials have demonstrated the benefit of fetoscopic laser coagulation of placental anastom...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2012.0603
更新日期:2012-09-01 00:00:00
abstract:BACKGROUND:Many patients in German hospitals complain of inadequate treatment of their postoperative pain. Hospital-related structural and procedural variables may affect pain perception and patient satisfaction. We studied the association of individual variables with outcome quality. METHODS:Data from the years 2011 ...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2017.0161
更新日期:2017-03-10 00:00:00
abstract:BACKGROUND:Recent years have seen major changes in the diagnosis and treatment of solid intraocular tumors, mainly owing to an improved molecular biological understanding of their pathogenesis, new therapeutic approaches for the local treatment of tumors in children, and long-term follow-up observations in clinical tri...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2018.0106
更新日期:2018-02-16 00:00:00
abstract:BACKGROUND:The German Federal Law on Radiation Control contains no special provisions for X-ray studies in children and adolescents, even though exposure to ionizing radiation must be kept especially low in young persons, because their tissues are highly radiosensitive. Children, who have many years left to live, are m...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2011.0407
更新日期:2011-06-01 00:00:00
abstract:BACKGROUND:In view of the rise in antibiotic resistance and Clostridium difficile superinfection, close monitoring of antibiotic prescribing practices is essential so that targeted quality assurance measures can be taken. METHODS:We analyzed nationwide data from multiple statutory health insurance carriers on prescrip...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2016.0454
更新日期:2016-07-01 00:00:00
abstract:BACKGROUND:Scoliosis is a three-dimensional deviation of the spinal axis. The main diagnostic criterion is spinal curvature exceeding 10° on a plain anteroposterior X-ray image. Scoliosis is called idiopathic when no other underlying disease can be identified. METHODS:Selective literature review and recommendations of...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,meta分析,评审
doi:10.3238/arztebl.2010.0875
更新日期:2010-12-01 00:00:00
abstract:BACKGROUND:Clinical guidelines recommend psychosocial care as an integral part of medical treatment, but access is often limited. Technology-based approaches provide an attractive opportunity to optimize health outcomes and quality of life in people with chronic somatic diseases e.g. by means of Internet- and mobile-ba...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2018.0659
更新日期:2018-11-05 00:00:00