Evaluation der Eignung eines Port-Staplers zur Erleichterung und Verbesserung der Portimplantation bei der laparoskopischen Magenbandimplantation.

BACKGROUND:The purpose of this study was to evaluate the applicability of a port stapling device to simplify and improve port implantation in laparoscopic adjustable gastric banding (LAGB).METHODS:From November 2005 to September 2006, a prospective study was conducted on 23 consecutive patients who underwent LAGB with Swedish adjustable gastric banding. Patients were randomized to either conventional titanium-port implantation or port stapling using the "Velocity" device.RESULTS:No differences in age, body weight, body mass index, fascia depth or incision length were reported between the groups. Port implantation time was significantly less using port stapling (90+/-24 s) compared to conventional port implantation (521+/-138 s). Port related complaints postoperatively and at follow-up were equal in both groups.CONCLUSIONS:Port stapling is an excellent tool to facilitate port implantation, particularly in massively obese patients with a thick abdominal wall.

Congenital cysts are malformations developing from the endoderm and mesoderm of the digestive and respiratory system in the early weeks of gestation. Unilocular or multilocular dysontogenic cysts are most commonly thoracically located adjacent to the trachea and bronchus and the development of an oesophageal duplication cyst in the oesophageal wall is extremely rare. The duplication cyst in the adult is usually asymptomatic and an incidental diagnosis. Potential symptoms include dysphagia and retrosternal pain. Next to endoscopy and computer tomography, endoscopic ultrasonography is mandatory for a distinguished and accurate preoperative evaluation. Transthoracic excision is crucial for definitive diagnosis and inhibition of complications.

OBJECTIVE:to evaluate local surgical trauma induced by endovascular (TPEG) and conventional infrarenal aortic aneurysm repair (AAA-C), the inflammatory response and changes in cell-mediated and antibody-mediated immunity as illustrated by the type-1/type-2 T-helper (TH1/TH2) cell balance were investigated.DESIGN:prospective study.PATIENTS AND METHODS:sixteen patients were included, eight patients underwent AAA-C and eight TPEG. Venous peripheral blood samples were collected 24h preoperatively and 24, 48, 72h, 5 and 7 days postoperatively. Besides the WBC, intracellular TH1/TH2 cytokines (IFN-gamma/IL-4) and the cell surface markers HLA-DR on monocytes and CD23 on B cells were measured by four colour flow cytometry.RESULTS:statistically significant higher values in the AAA-C group were demonstrated for neutrophiles. The TH1/TH2 immunobalance (expressed by forming the ratio of IFN-(gamma/IL-4 producing T cells as well as by the ratio of HLA-DR(pos) monocytes/CD23(pos) B-cells) showed a significant shift towards TH2 immunity in the AAA-C group whereas TPEG led to a significant lesser shift 24-72h after surgery (p < 0.05).CONCLUSIONS:TPEG leads to a minor distortion of the TH1/TH2 immunobalance. This implies that TPEG is a less stressing procedure, that is especially beneficial in patients whose conditions are considered less suitable for AAA-C due to age and serious comorbidity.

Das palliative Therapieziel sollte eine schnelle, effektive und schmerzlose Beseitigung der Pleuraergüsse sein. Seit 1995 wurden bei 40 Patienten retrospektiv (23 Männer, 17 Frauen; durchschnittliches Alter 60 (21–86)) die Ergebnisse der videoassistierten thorakoskopischen Talkumpleurodese (TTP) analysiert. Häufigste Genese der malignen Pleuraergüsse waren das Mammacarcinom, gefolgt von dem Bronchialcarcinom und dem metastasiertem colorectalen Carcinom. Voraussetzung zur TTP war zuvor die Verifizierung der malignen Pleuraergüsse mittels einer Cytologie. Komplikationen: eine Pneumonie, welche antibiotisch behandelt werden konnte; ein Rezidiv. Drei Patienten starben postoperativ aufgrund ihrer fortgeschrittenen Grunderkrankung. Die durchschnittliche Liegezeit betrug 7 Tage (3–14). Die TTP stellt zur palliativen Behandlung maligner Pleuraergüsse das therapeutische Verfahren der Wahl dar, die Rezidivrate ist gering (2,5%) und das Verfahren wenig invasiv.

INTRODUCTION:Aim of the palliative therapeutic procedure should be a fast, efficient and pain free treatment of the malignant pleural effusions.PATIENTS AND METHOD:Since 1995 the results of malignant pleural effusions treatment were analyzed retrospectively in 46 patients who underwent 51 video-assisted TTP. The most frequent origin of malignant pleural effusion was breast cancer, followed by bronchial carcinoma. Precondition for video-assisted TTP was the verification of a malignant pleural effusion by cytology.RESULTS:Following TTP one patient suffered from pneumonia, two recurrent diseases occurred. Four patients died due to their severe primary malignancy. Average hospitalization was 8 days (3-55).CONCLUSION:Video-assisted TTP is the standard procedure in palliative treatment of malignant pleural effusion; the recurrence rate is low and the technique minimal invasive.

Beim Morbus Behçet handelt es sich um eine Vasculitis unklarer Genese, die sich meist durch okuläre und mucocutane Symptome äußert. In seltenen Fällen kommt es durch eine Vasculitis der Vasa vasorum großer Arterien zu Gefäßwandnekrosen mit konsekutiver Ausbildung von Aneurysmata spuria. Es wird der Fall eines 41 jährigen Patienten vorgestellt, der eine Ruptur eines infrarenalen Aneursyma spurium im Rahmen eines Morbus Behçet erlitt. Die Therapie bestand in der aorto-aortalen Interpostion einer Dacron-Prothese. Es wird anhand der Kasuistik die Diagnostik, die Therapie sowie Wert einer Sekundärprophylaxe bei Morbus Behçet diskutiert.

Behçet's disease is a vasculitis of unknown aetiology, which becomes apparent by ocular and mucocutaneous symptoms. In rare cases, owing to vasculitis of the vasa vasorum of large arteries, necrosis of the vascular wall and thus spurious aneurysms occur. The case of a 41-year-old patient is described who presented with a rupture of an infrarenal aortic aneurysm due to Behçet's disease. Therapy consisted of placement of an aortic-aortic Dacron prosthesis. On the basis of the case report, the diagnostic approach, the therapy and the value of secondary prophylaxis of Behçet's disease are discussed.

BACKGROUND:Several prospective randomized trials have shown that self-expanding stents have advantages over conventional plastic tubes. Nevertheless, the optimal stent has not yet been developed. The Polyflex stent is a completely new model that represents an improvement over the old metal stents. We have used this stent in a prospective study and herein our present preliminary results.METHODS:In 14 patients with nonresectable esophageal carcinoma, the Polyflex stent was implanted to reduce dysphagia. The grade of dysphagia, the complications following intervention, and the patients' total survival time were documented prospectively every 4 weeks.RESULTS:The implantation of the stent was successful in all cases. The grade of the dysphagia was reduced from 3.0 to 0.5 after stent implantation. One patient died during the hospital stay from a non-stent-induced complication. Stent dislocation occurred once, and tumor overgrowth at the stent margins was observed twice. The mean survival time was 6.2 months, and the reintervention rate was 21.3%.CONCLUSION:The new Polyflex stent, which is based on a completely new design, can be implanted without any difficulty and has had very good short- and long-term results. Therefore, it is a worthy alternative to the metal stents in current use.

In einer prospektiven Studie wurde die Größe des operativen Traumas der konventionellen Aortenchirurgie und der TPEG — gemessen an der Verschiebung des Verhältnisses der T-Helfer-1 zu den T-Helfer-2 Zellen (TH-1/TH-2 Zellen) verglichen.

Einleitung: Das Management des Patienten mit stumpfen Bauchtrauma hat sich in den letzten Jahren deutlich gewandelt. Nachgewiesene freie Flüssigkeit stellt heute per se keine Indikation zur explorativen Laparotomie mehr dar. Daher könnten Hohlorganverletzungen möglicherweise verspätet erkannt werden.

Der Effekt von Wachstumshormon auf die zelluläre und humorale Immunität wurde bei elektiven chirurgischen Eingriffen untersucht.

BACKGROUND/AIMS An easily performed method to measure cholesterol absorption with isotope labeled cholesterol and beta-sitostanol in humans is described. The first aim of the study was to show whether this method can also be used in rats. Secondly, to see whether complete bile diversion results in a complete loss of cholesterol absorption. METHODOLOGY Cholesterol absorption was evaluated in rats by the constant isotope feeding method using [2H6]cholesterol and [2H4]sitostanol as markers. Fecal samples were analyzed by gas-chromatography/mass spectrometry. RESULTS In 8 rats with intact enterohepatic circulation of bile acids, cholesterol absorption averaged 61 (3% (SD) (range: 54-69%)). Complete bile diversion was followed by an almost total loss of cholesterol absorption (5.5+/-0.6%, range: 2.4-6.9%, n=7). CONCLUSIONS The results indicate that deuterated cholesterol and deuterated sitostanol are reliable markers for measurement of cholesterol absorption in rats and that bile acids are essential for cholesterol absorption.

Seit dem 1.1.1996 gilt das Arbeitszeitgesetz (ArbZG) im Krankenhausbereich. Es regelt neben der Arbeitszeit die Ruhezeit, die Ruhepausen und die Arbeit an Sonn- und Feiertagen. Probleme ergeben sich bei der Umsetzung der ArbZG im Bereich der täglichen erlaubten Höchstarbeitszeit und bei den Ruhezeiten nach Bereitschaftsdiensten. Die Umsetzung der ArbZG würde zu einer erheblichen Neueinstellung von Ärzten an Krankenhäusern führen. Da dies mit einer Kostensteigerung verbunden wäre, die für die Träger nicht finanzierbar ist, bleibt neben der Leistungsreduktion lediglich die fehlende Dokumentation der erbrachten Arbeitszeit als Ausweg. Für die Chirurgen in nicht-leitender Stellung bedeutet die jetzige Situation an deutschen Krankenhäusern ein ständiger Zwiespalt zwischen Legalität und Legitimität.

For palliative endoscopic treatment of malignant dysphagia many different techniques are practiced. The differentiated usage of all techniques depending on the characteristics of the tumor leads to a good result with favorable costs. The following differentiated palliative regimen is presented: in the cervical part of the esophagus laser therapy or stent implantation are used, depending on the type of tumor growth. In the center section and the distal part of the esophagus usually palliative endoscopic pertubation is performed. If the stenosis is very soft and short a stent is implanted as alternative. In the gastroesophageal part flexible stents achieve the best results. Alternative laser therapy can be used.

For the surgical treatment of liver tumors, two initial steps are necessary: functional operability must be proven and oncological and Ideal inoperability must be ruled out. The diagnostic process consists of a series of steps, beginning with non-invasive procedures such as laboratory findings and sonography continuing with CT, CTAP, laparoscopy in the case of hepatic cirrhosis, up to explorative laparotomy, The potential operability is re-checked after each step. Function, MRI and scintigraphy are implemented in special cases. The early implementation of MRI is of particular value for the diagnosis of certain benign processes.

In Germany, the law of labor time was instituted in hospitals on January 1st, 1996 to regulate working hours, times of rest, breaks, and Sunday and holiday work. Problems in the realization of this law arise in daily practice, especially with regard to maximum working hours and post on-call times of rest. The compliance with the law would necessitate an enormous increase in new jobs for physicians, which is associated with an unfinanceable rise in costs. Solutions are either a reduction in performance or the omission to document the productivity. Therefore, surgeons in salaried employment in German hospitals constantly face the conflict of legality and legitimacy.