Skip to main content

01.03.2018 | Review Article

Malignant tumors associated with juvenile polyposis syndrome in Japan

verfasst von: Hideyuki Ishida, Keiichiro Ishibashi, Takeo Iwama

Erschienen in: Surgery Today | Ausgabe 3/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The risk of malignant tumors developing in association with juvenile polyposis syndrome (JPS) was evaluated to explore the optimal treatment for this rare disease.

Methods

We reviewed the data on JPS cases reported in Japan between January, 1971 and March, 2016.

Results

A total of 171 cases were evaluable. Of these 171 patients, 83 (48.5%) were female and the median age at diagnosis was 28 years (range 1–80 years). The polyps were located in the stomach alone (n = 62; 36.3%), in the stomach and intestine (n = 47; 27.4%), or in the colorectum alone (n = 62; 36.3%). The sites of malignant tumors were the stomach (n = 31), colorectum (n = 29), small intestine (n = 2), breast (n = 1), and thyroid (n = 1). The lifetime risk (at 70 years) of any malignant tumor was 86.2%. The lifetime risk of gastric cancer was 73.0% and that of colorectal cancer was 51.1%. The risk of these cancers developing was dependent on the type of polyp distribution.

Conclusions

Long-term surveillance of the stomach and colorectum based on the phenotype of JPS seems a reasonable approach to monitor these patients for the development of malignant tumors.
Literatur
1.
Zurück zum Zitat Burt RW, Bishop DT, Lynch HT, Rozen P, Winawer SJ. Risk and surveillance of individuals with heritable factors for colorectal cancer. WHO Collaborating Center for the Prevention of Colorectlal Cancer. Bull World Health Organ. 1990;68:655–65.PubMedPubMedCentral Burt RW, Bishop DT, Lynch HT, Rozen P, Winawer SJ. Risk and surveillance of individuals with heritable factors for colorectal cancer. WHO Collaborating Center for the Prevention of Colorectlal Cancer. Bull World Health Organ. 1990;68:655–65.PubMedPubMedCentral
2.
Zurück zum Zitat McColl I, Busxey HJ, Veale AM, Morson BC. Juvenile polyposis coli. Proc R Soc Med. 1964;57:896–7.PubMed McColl I, Busxey HJ, Veale AM, Morson BC. Juvenile polyposis coli. Proc R Soc Med. 1964;57:896–7.PubMed
3.
Zurück zum Zitat Howe JR, Sayed MG, Ahmed AF, Ringold J, Larsen-Haidle J, Merg A, et al. The prevalence of MADH4 and BMPR1A mutations in juvenile polyposis and absence of BMPR2, BMPR1B, and ACVR1 mutations. J Med Genet. 2004;41:484–91.CrossRefPubMedPubMedCentral Howe JR, Sayed MG, Ahmed AF, Ringold J, Larsen-Haidle J, Merg A, et al. The prevalence of MADH4 and BMPR1A mutations in juvenile polyposis and absence of BMPR2, BMPR1B, and ACVR1 mutations. J Med Genet. 2004;41:484–91.CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Jass JR, Williams CB, Bussey HJ, Morson BC. Juvenile polyposis—a precancerous condition. Histopathology. 1988;13:619–30.CrossRefPubMed Jass JR, Williams CB, Bussey HJ, Morson BC. Juvenile polyposis—a precancerous condition. Histopathology. 1988;13:619–30.CrossRefPubMed
6.
Zurück zum Zitat Sachatello CR. Polypoid diseases of the gastrointestinal tract. J Ky Med Assoc. 1972;70:540–4.PubMed Sachatello CR. Polypoid diseases of the gastrointestinal tract. J Ky Med Assoc. 1972;70:540–4.PubMed
7.
Zurück zum Zitat Watanabe A, Nagashima H, Motoi M, Ogawa K. Familial juvenile polyposis of the stomach. Gastroenterology. 1979;77:148–51.PubMed Watanabe A, Nagashima H, Motoi M, Ogawa K. Familial juvenile polyposis of the stomach. Gastroenterology. 1979;77:148–51.PubMed
8.
Zurück zum Zitat Ma C, Giardiello FM, Montgomery EA. Upper tract juvenile polyps in juvenile polyposis patients: dysplasia and malignancy are associated with foveolar, intestinal, and pyloric differentiation. Am J Surg Pathol. 2014;38:1618–26.CrossRefPubMedPubMedCentral Ma C, Giardiello FM, Montgomery EA. Upper tract juvenile polyps in juvenile polyposis patients: dysplasia and malignancy are associated with foveolar, intestinal, and pyloric differentiation. Am J Surg Pathol. 2014;38:1618–26.CrossRefPubMedPubMedCentral
9.
10.
Zurück zum Zitat Dunlop MG, British Society for Gastroenterology; Association of Coloproctology for Great Britain and Ireland. Guidance on gastrointestinal surveillance for hereditary non-polyposis colorectal cancer, familial adenomatous polyposis, juvenile polyposis, and Peutz–Jeghers syndrome. Gut. 2002;Suppl 5:V21–7.CrossRef Dunlop MG, British Society for Gastroenterology; Association of Coloproctology for Great Britain and Ireland. Guidance on gastrointestinal surveillance for hereditary non-polyposis colorectal cancer, familial adenomatous polyposis, juvenile polyposis, and Peutz–Jeghers syndrome. Gut. 2002;Suppl 5:V21–7.CrossRef
11.
12.
Zurück zum Zitat Ishida H, Imajo M, Okubo Y, Maruyama H, Iwama T, Mishima Y. A case of generalized juvenile gastrointestinal polyposis; long-term follow-up by endoscopy (in Japanese with Japanese abstract). Prog Dig Endosc. 1989;34:255–9. Ishida H, Imajo M, Okubo Y, Maruyama H, Iwama T, Mishima Y. A case of generalized juvenile gastrointestinal polyposis; long-term follow-up by endoscopy (in Japanese with Japanese abstract). Prog Dig Endosc. 1989;34:255–9.
13.
Zurück zum Zitat Hizawa K, Iida M, Yao T, Aoyagi K, Fujishima M. Juvenile polyposis of the stomach: clinicopathological features and its malignant potential. J Clin Pathol. 1997;50:771–4.CrossRefPubMedPubMedCentral Hizawa K, Iida M, Yao T, Aoyagi K, Fujishima M. Juvenile polyposis of the stomach: clinicopathological features and its malignant potential. J Clin Pathol. 1997;50:771–4.CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Shikata K, Kukita Y, Matsumoto T, Esaki M, Yao T, Mochizuki Y, et al. Gastric juvenile polyposis associated with germline SM AD4 mutation. Am J Med Genet A. 2005;134:326–9.CrossRefPubMed Shikata K, Kukita Y, Matsumoto T, Esaki M, Yao T, Mochizuki Y, et al. Gastric juvenile polyposis associated with germline SM AD4 mutation. Am J Med Genet A. 2005;134:326–9.CrossRefPubMed
15.
Zurück zum Zitat Yoshida H, Tomichi N, Mori S, Niitsu Y, Nakamura R, Okada T, et al. Juvenile polyposis coli. A case report. Jpn J Surg. 1982;12:274–9.CrossRefPubMed Yoshida H, Tomichi N, Mori S, Niitsu Y, Nakamura R, Okada T, et al. Juvenile polyposis coli. A case report. Jpn J Surg. 1982;12:274–9.CrossRefPubMed
16.
Zurück zum Zitat Ushio K. Genetic and familial factors in colorectal cancer. Jpn J Clin Oncol. 1985;15:281–98.PubMed Ushio K. Genetic and familial factors in colorectal cancer. Jpn J Clin Oncol. 1985;15:281–98.PubMed
17.
Zurück zum Zitat Yoshida T, Haraguchi Y, Tanaka A, Higa A, Daimon Y, Mizuta Y, et al. A case of generalized juvenile gastrointestinal polyposis associated with gastric carcinoma. Endoscopy. 1988;20:33–5.CrossRefPubMed Yoshida T, Haraguchi Y, Tanaka A, Higa A, Daimon Y, Mizuta Y, et al. A case of generalized juvenile gastrointestinal polyposis associated with gastric carcinoma. Endoscopy. 1988;20:33–5.CrossRefPubMed
18.
Zurück zum Zitat Atsumi M, Kawamoto K, Ebisui S, Takamasu M, Nishida H, Satoh T, et al. A case report of juvenile polyposis with adenomatous change and a review of 34 cases reported in Japan. Gastroenterol Jpn. 1991;26:523–9.PubMed Atsumi M, Kawamoto K, Ebisui S, Takamasu M, Nishida H, Satoh T, et al. A case report of juvenile polyposis with adenomatous change and a review of 34 cases reported in Japan. Gastroenterol Jpn. 1991;26:523–9.PubMed
19.
Zurück zum Zitat Mitomi H, Uesugi H, Nishiyama Y, Ohida M, Arai N, Kobayashi N, et al. Low epithelial cell proliferation and absence of oncoprotein expression in juvenile polyposis of the stomach, with or without tumors. Am J Gastroenterol. 1997;92:1374–7.PubMed Mitomi H, Uesugi H, Nishiyama Y, Ohida M, Arai N, Kobayashi N, et al. Low epithelial cell proliferation and absence of oncoprotein expression in juvenile polyposis of the stomach, with or without tumors. Am J Gastroenterol. 1997;92:1374–7.PubMed
20.
Zurück zum Zitat Hizawa K, Sakamoto K, Akagi K, Kai H, Yao T, Hizawa K, et al. Fatal colorectal cancer in juvenile polyposis syndrome. J Gastroenterol. 2002;37:313–4.CrossRefPubMed Hizawa K, Sakamoto K, Akagi K, Kai H, Yao T, Hizawa K, et al. Fatal colorectal cancer in juvenile polyposis syndrome. J Gastroenterol. 2002;37:313–4.CrossRefPubMed
21.
Zurück zum Zitat Yamashita K, Saito M, Itoh M, Yamamoto E, Yamaoka S, Goto A, et al. Juvenile polyposis complicated with protein losing gastropathy. Intern Med. 2009;48:335–8.CrossRefPubMed Yamashita K, Saito M, Itoh M, Yamamoto E, Yamaoka S, Goto A, et al. Juvenile polyposis complicated with protein losing gastropathy. Intern Med. 2009;48:335–8.CrossRefPubMed
22.
Zurück zum Zitat Otake K, Uchida K, Inoue M, Matsushita K, Hashimoto K, Toiyama Y, et al. A large, solitary, semipedunculated gastric polyp in pediatric juvenile polyposis syndrome. Gastrointest Endosc. 2011;73:1313–4.CrossRefPubMed Otake K, Uchida K, Inoue M, Matsushita K, Hashimoto K, Toiyama Y, et al. A large, solitary, semipedunculated gastric polyp in pediatric juvenile polyposis syndrome. Gastrointest Endosc. 2011;73:1313–4.CrossRefPubMed
23.
Zurück zum Zitat Honda Y, Sato Y, Yokoyama J, Kobayashi M, Narisawa R, Kawauchi Y, et al. Familial juvenile polyposis syndrome with a novel SMAD4 germline mutation. Clin J Gastroenterol. 2013;6:361–7.CrossRefPubMed Honda Y, Sato Y, Yokoyama J, Kobayashi M, Narisawa R, Kawauchi Y, et al. Familial juvenile polyposis syndrome with a novel SMAD4 germline mutation. Clin J Gastroenterol. 2013;6:361–7.CrossRefPubMed
24.
Zurück zum Zitat Yamaguchi J, Nagayama S, Chino A, Sakata A, Yamamoto N, Sato Y, et al. Identification of coding exon 3 duplication in the BMPR1A gene in a patient with juvenile polyposis syndrome. Jpn J Clin Oncol. 2014;44:1004–8.CrossRefPubMed Yamaguchi J, Nagayama S, Chino A, Sakata A, Yamamoto N, Sato Y, et al. Identification of coding exon 3 duplication in the BMPR1A gene in a patient with juvenile polyposis syndrome. Jpn J Clin Oncol. 2014;44:1004–8.CrossRefPubMed
25.
Zurück zum Zitat Saito R, Fukuda T, Fujikuni N, Abe T, Amano H, Nakahara M, et al. A case of juvenile polyposis of the stomach with multiple early gastric cancers. Mol Clin Oncol. 2016;4:851–4.CrossRefPubMedPubMedCentral Saito R, Fukuda T, Fujikuni N, Abe T, Amano H, Nakahara M, et al. A case of juvenile polyposis of the stomach with multiple early gastric cancers. Mol Clin Oncol. 2016;4:851–4.CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Yasuda M, Nishikawa J, Suekane H, Sakaido I. Massive gastric polyposis associated with juvenile polyposis syndrome. Intern Med. 2016;55:1671–2.CrossRefPubMed Yasuda M, Nishikawa J, Suekane H, Sakaido I. Massive gastric polyposis associated with juvenile polyposis syndrome. Intern Med. 2016;55:1671–2.CrossRefPubMed
27.
Zurück zum Zitat International Union Against Cancer (UICC) In: Sobin LH, Gospodarowicz MK, Wittekind CH, editors. TNM classification of malignant tumours. 7th ed. New York: Wiley; 2009. International Union Against Cancer (UICC) In: Sobin LH, Gospodarowicz MK, Wittekind CH, editors. TNM classification of malignant tumours. 7th ed. New York: Wiley; 2009.
28.
Zurück zum Zitat Rustgi AK. Hereditary gastrointestinal polyposis and nonpolyposis syndromes. N Engl J Med. 1994;331:1694–702.CrossRefPubMed Rustgi AK. Hereditary gastrointestinal polyposis and nonpolyposis syndromes. N Engl J Med. 1994;331:1694–702.CrossRefPubMed
29.
Zurück zum Zitat Boardman LA. Heritable colorectal cancer syndromes: recognition and preventive management. Gastroenterol Clin N Am. 2002;31:1107–31.CrossRef Boardman LA. Heritable colorectal cancer syndromes: recognition and preventive management. Gastroenterol Clin N Am. 2002;31:1107–31.CrossRef
30.
Zurück zum Zitat Desai DC, Murday V, Phillips RK, Neale KF, Milla P, Hodgson SV. A survey of phenotypic features in juvenile polyposis. J Med Genet. 1998;35:476–81.CrossRefPubMedPubMedCentral Desai DC, Murday V, Phillips RK, Neale KF, Milla P, Hodgson SV. A survey of phenotypic features in juvenile polyposis. J Med Genet. 1998;35:476–81.CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Gallione CJ, Repetto GM, Legius E, Rustgi AK, Schelley SL, Tejpar S, et al. A combined syndrome of juvenile polyposis and hereditary haemorrhagic telangiectasia associated with mutations in MADH4 (SMAD4). Lancet. 2004;363:852–9.CrossRefPubMed Gallione CJ, Repetto GM, Legius E, Rustgi AK, Schelley SL, Tejpar S, et al. A combined syndrome of juvenile polyposis and hereditary haemorrhagic telangiectasia associated with mutations in MADH4 (SMAD4). Lancet. 2004;363:852–9.CrossRefPubMed
32.
Zurück zum Zitat Coburn MC, Princolo VE, DeLuca FG, Bland KI. Malignant potential in intestinal juvenile polyposis syndromes. Ann Surg Oncol. 1995;2:386–91.CrossRefPubMed Coburn MC, Princolo VE, DeLuca FG, Bland KI. Malignant potential in intestinal juvenile polyposis syndromes. Ann Surg Oncol. 1995;2:386–91.CrossRefPubMed
33.
Zurück zum Zitat Agnifili A, Verzaro R, Gola P, Marino M, Mancini E, Carducci G, et al. Juvenile polyposis: case report and assessment of the neoplastic risk in 271 patients reported in the literature. Dig Surg. 1999;16:161–6.CrossRefPubMed Agnifili A, Verzaro R, Gola P, Marino M, Mancini E, Carducci G, et al. Juvenile polyposis: case report and assessment of the neoplastic risk in 271 patients reported in the literature. Dig Surg. 1999;16:161–6.CrossRefPubMed
34.
Zurück zum Zitat Howe JR, Mitros FA, Summers RW. The risk of gastrointestinal carcinoma in familial juvenile polyposis. Ann Surg Oncol. 1998;5:751–6.CrossRefPubMed Howe JR, Mitros FA, Summers RW. The risk of gastrointestinal carcinoma in familial juvenile polyposis. Ann Surg Oncol. 1998;5:751–6.CrossRefPubMed
35.
Zurück zum Zitat Höfting I, Pott G, Stolte M. The syndrome of juvenile polyposis. Leber Magen Darm. 1993;23(107–8):111–2. Höfting I, Pott G, Stolte M. The syndrome of juvenile polyposis. Leber Magen Darm. 1993;23(107–8):111–2.
37.
Zurück zum Zitat Brosens LA, van Hattem A, Hylind LM, Iacobuzio-Donahue C, Romans KE, Axilbund J, et al. Risk of colorectal cancer in juvenile polyposis. Gut. 2007;56:965–7.CrossRefPubMedPubMedCentral Brosens LA, van Hattem A, Hylind LM, Iacobuzio-Donahue C, Romans KE, Axilbund J, et al. Risk of colorectal cancer in juvenile polyposis. Gut. 2007;56:965–7.CrossRefPubMedPubMedCentral
38.
Zurück zum Zitat Ishida H, Tajima Y, Gonda T, Kumamoto K, Ishibashi K, Iwama T. Update on our investigation of malignant tumors associated with Peutz–Jeghers syndrome in Japan. Surg Today. 2016;46:1231–42.CrossRefPubMed Ishida H, Tajima Y, Gonda T, Kumamoto K, Ishibashi K, Iwama T. Update on our investigation of malignant tumors associated with Peutz–Jeghers syndrome in Japan. Surg Today. 2016;46:1231–42.CrossRefPubMed
39.
Zurück zum Zitat Reichelt U, Hopfer H, Roch N, Izbicki JR, Erbersdobler A. Juvenile polyposis coli: a facultative precancerosis with some similarities to ulcerative colitis? Pathol Res Pract. 2005;201:517–20.CrossRefPubMed Reichelt U, Hopfer H, Roch N, Izbicki JR, Erbersdobler A. Juvenile polyposis coli: a facultative precancerosis with some similarities to ulcerative colitis? Pathol Res Pract. 2005;201:517–20.CrossRefPubMed
40.
41.
Zurück zum Zitat Langeveld D, van Hattem WA, de Leng WW, Morsink FH, Ten Kate FJ, Giardiello FM, et al. SMAD4 immunohistochemistry reflects genetic status in juvenile polyposis syndrome. Clin Cancer Res. 2010;16:4126–34.CrossRefPubMedPubMedCentral Langeveld D, van Hattem WA, de Leng WW, Morsink FH, Ten Kate FJ, Giardiello FM, et al. SMAD4 immunohistochemistry reflects genetic status in juvenile polyposis syndrome. Clin Cancer Res. 2010;16:4126–34.CrossRefPubMedPubMedCentral
42.
Zurück zum Zitat Schutte M, Hruban RH, Hedrick L, Cho KR, Nadasdy GM, Weinstein CL, et al. DPC4 gene in various tumor types. Cancer Res. 1996;56:2527–30.PubMed Schutte M, Hruban RH, Hedrick L, Cho KR, Nadasdy GM, Weinstein CL, et al. DPC4 gene in various tumor types. Cancer Res. 1996;56:2527–30.PubMed
43.
Zurück zum Zitat Chow E, Macrae F. A review of juvenile polyposis syndrome. J Gastroenterol Hepatol. 2005;20:1634–40.CrossRefPubMed Chow E, Macrae F. A review of juvenile polyposis syndrome. J Gastroenterol Hepatol. 2005;20:1634–40.CrossRefPubMed
44.
Zurück zum Zitat Woodford-Richens K, Bevan S, Churchman M, Dowling B, Jones D, Norbury CG, et al. Analysis of genetic and phenotypic heterogeneity in juvenile polyposis. Gut. 2000;46:656–60.CrossRefPubMedPubMedCentral Woodford-Richens K, Bevan S, Churchman M, Dowling B, Jones D, Norbury CG, et al. Analysis of genetic and phenotypic heterogeneity in juvenile polyposis. Gut. 2000;46:656–60.CrossRefPubMedPubMedCentral
45.
Zurück zum Zitat Delnatte C, Sanlaville D, Mougenot JF, Vermeesch JR, Houdayer C, Blois MC, et al. Contiguous gene deletion within chromosome arm 10q is associated with juvenile polyposis of infancy, reflecting cooperation between the BMPR1A and PTEN tumor-suppressor genes. Am J Hum Genet. 2006;78:1066–74.CrossRefPubMedPubMedCentral Delnatte C, Sanlaville D, Mougenot JF, Vermeesch JR, Houdayer C, Blois MC, et al. Contiguous gene deletion within chromosome arm 10q is associated with juvenile polyposis of infancy, reflecting cooperation between the BMPR1A and PTEN tumor-suppressor genes. Am J Hum Genet. 2006;78:1066–74.CrossRefPubMedPubMedCentral
46.
Zurück zum Zitat Stemper TJ, Kent TH, Summers RW. Juvenile polyposis and gastrointestinal carcinoma. A study of a kindred. Ann Intern Med. 1975;83:639–46.CrossRefPubMed Stemper TJ, Kent TH, Summers RW. Juvenile polyposis and gastrointestinal carcinoma. A study of a kindred. Ann Intern Med. 1975;83:639–46.CrossRefPubMed
47.
Zurück zum Zitat Scott-Conner CE, Hausmann M, Hall TJ, Skelton DS, Anglin BL, Subramony C. Familial juvenile polyposis: pattern of recurrence and implications for surgical management. J Am Coll Surg. 1995;181:407–13.PubMed Scott-Conner CE, Hausmann M, Hall TJ, Skelton DS, Anglin BL, Subramony C. Familial juvenile polyposis: pattern of recurrence and implications for surgical management. J Am Coll Surg. 1995;181:407–13.PubMed
48.
Zurück zum Zitat Oncel M, Church JM, Remzi FH, Fazio VW. Colonic surgery in patients with juvenile polyposis syndrome: a case series. Dis Colon Rectum. 2005;48:49–55 (discussion 55–6). Oncel M, Church JM, Remzi FH, Fazio VW. Colonic surgery in patients with juvenile polyposis syndrome: a case series. Dis Colon Rectum. 2005;48:49–55 (discussion 55–6).
49.
Zurück zum Zitat Järvinen HJ, Sipponen P. Gastroduodenal polyps in familial adenomatous and juvenile polyposis. Endoscopy. 1986;18:230–4.CrossRefPubMed Järvinen HJ, Sipponen P. Gastroduodenal polyps in familial adenomatous and juvenile polyposis. Endoscopy. 1986;18:230–4.CrossRefPubMed
50.
Zurück zum Zitat Walpole IR, Cullity G. Juvenile polyposis: a case with early presentation and death attributable to adenocarcinoma of the pancreas. Am J Med Genet. 1989;32:1–8.CrossRefPubMed Walpole IR, Cullity G. Juvenile polyposis: a case with early presentation and death attributable to adenocarcinoma of the pancreas. Am J Med Genet. 1989;32:1–8.CrossRefPubMed
51.
Zurück zum Zitat Shugang X, Hongfa Y, Jianpeng L, Xu Z, Jingqi F, Xiangxiang L, et al. Prognostic value of SMAD4 in pancreatic cancer: a meta-analysis. Transl Oncol. 2016;9:1–7.CrossRefPubMedPubMedCentral Shugang X, Hongfa Y, Jianpeng L, Xu Z, Jingqi F, Xiangxiang L, et al. Prognostic value of SMAD4 in pancreatic cancer: a meta-analysis. Transl Oncol. 2016;9:1–7.CrossRefPubMedPubMedCentral
Metadaten
Titel
Malignant tumors associated with juvenile polyposis syndrome in Japan
verfasst von
Hideyuki Ishida
Keiichiro Ishibashi
Takeo Iwama
Publikationsdatum
01.03.2018
Verlag
Springer Singapore
Erschienen in
Surgery Today / Ausgabe 3/2018
Print ISSN: 0941-1291
Elektronische ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-017-1538-2

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.