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Hintergrund: Um die Qualität und Quantität klinischer Studien in der Chirurgie zu verbessern, wurde mithilfe einer Förderung durch das Bundesministerium für Bildung und Forschung (BMBF) das chirurgische Studiennetzwerk CHIR-Net gegründet. Ziel war es, eine Infrastruktur aufzubauen, um qualitativ hochwertige multizentrische, randomisiert-kontrollierte Studien in der Chirurgie durchzuführen. Dabei entstanden bundesweit chirurgische Regionalzentren, die unter Einbindung auch nichtuniversitärer Kliniken Studienideen als Studienskizzen in staatliche Förderprogramme einbringen sollten. Ziel dieser Arbeit ist es, die Fördermaßnahme durch einen Vergleich von Kliniken mit und ohne CHIR-Net-Anbindung zu evaluieren.Methodik: Im Rahmen einer webbasierten Umfrage wurden 475 Chefärzte chirurgischer Abteilungen (268 Chefärzte aus CHIR-Net-Kliniken bzw. 207 Chefärzte aus Nicht-CHIR-Net-Kliniken) kontaktiert. Den Teilnehmern wurden darin 20 Fragen in den Kategorien Ausbildung, Mitarbeit und Engagement bei klinischen Studien, Publikationen sowie Antragstellung in Programmen von BMBF/der Deutschen Forschungsgesellschaft (DFG) gestellt. Die Auswertung der Umfrage erfolgte nach vorab definierten Kriterien.Ergebnisse: Die Rücklaufquote lag bei 23,4 %. Insgesamt haben sich 68 CHIR-Net-Kliniken sowie 43 Nicht-CHIR-Net-Kliniken an der Umfrage beteiligt. Der Vergleich der Ergebnisse aus den CHIR-Net- und den Nicht-CHIR-Net-Kliniken ergab, dass in den Kategorien Ausbildung in der klinischen Forschung, Infrastruktur für klinische Studien, klinische Studienaktivität, Antragstellungen bei BMBF/DFG und Publikationsleistungen Vorteile für CHIR-Net-Kliniken festgestellt werden konnten.Schlussfolgerung: Die im CHIR-Net verankerten Kliniken sind hinsichtlich klinischer Studienaktivität, vorhandener Infrastruktur, studienspezifischer Ausbildung ihrer Mitarbeiter und Einbringen von Anträgen in staatliche Förderprogramme den Nicht-CHIR-Net-Kliniken überlegen. Mit der Etablierung des CHIR-Net wurden die strukturellen Förderziele als Basis für eine positive Studienkultur in der Chirurgie erreicht. [ABSTRACT FROM AUTHOR]

Background: The development of modern videoendoscopy enables surgeons to perform laparoscopic resection of colonic cancer. Aim: This manuscript evaluated the literature concerning clinically relevant differences in the short and long-term course after laparoscopic or conventional resection of colonic cancer. Methods: An investigation of meta-analyses from randomized controlled clinical trials comparing laparoscopic and conventional surgery for colonic cancer was carried out. Results: The incidence of intraoperative complications was higher during laparoscopic surgery, the duration of surgery was increased and blood loss was less when compared to open surgery. Overall morbidity and the incidence of surgical complications were decreased after laparoscopic surgery. General morbidity and mortality were not different after laparoscopic or open resection of colonic cancer. Duration of hospital stay was shorter but was also associated with the type of perioperative care (i.e. traditional or enhanced recovery). Following minimally invasive or conventional resection, the incidence of tumor recurrence (local and distant) and the duration of survival (overall and disease-free) showed no differences. Wound implantations were rare after both operative techniques but with a tendency to occur more often after laparoscopic than open resection. Conclusion: Laparoscopic resection of colonic cancer has clinically relevant short-term benefits for the patients and long-term results are not different from open colectomy. However, most of the patients included in randomized controlled trials underwent right or left colectomy and sigmoid or rectosigmoid resections. Data with a high level of evidence concerning carcinomas of the flexures or the transverse colon do not exist. Suitable patients with colonic cancer should undergo laparoscopic resection by experienced surgeons. [ABSTRACT FROM AUTHOR]

The article focuses on a study which explores the outcomes from a prospective randomized trial comparing laparascopic and open surgery for colorectal cancer. In this study, patients undergo laparascopy in order to examine the feasibility of laparascopic resection. It concludes that there is an association between laparascopic resection of colorectal cancer and increased operating time, but does not lessen morbidity.

Plasma hyaluronan binds to fibrinogen, affecting intravascular fibrin polymerization and fibrin clot formation. It has been hypothesized that alterations in fibrin clot formation influence the risk of thromboembolism in those undergoing surgery. The aim of this study is to quantify the intravascular components, especially plasma hyaluronan levels, in laparoscopic and conventional colorectal resections that contribute to thromboembolism formation. Prospective cohort analysis of consecutive patients which were participating in the prospective randomized multi-center trial Lapkon II comparing the long-term effects of laparoscopic and conventional resection for colon cancer. Plasma samples were obtained from 15 patients at the beginning and the end of laparoscopic or conventional colorectal resections. Concentrations and activities of tissue plasminogen activator(t-PA), plasminogen activator inhibitor type 1(PAI-1), t-PA/PAI complex, fibrinogen, d-dimers and hyaluronan were determined by using commercial enzyme-linked immunosorbent assay (ELISA) kits. No differences in age, sex and type of resection between the laparoscopic and conventional-surgery groups were observed. Laparoscopic procedures lasted longer ( p < 0.05). Concentration and activities of t-PA, PAI-1, t-PA/PAI complex, fibrinogen and d-dimers did not vary between the two groups. Plasma hyaluronan decreased from 28.6 to 17.9 IU/ml ( p < 0.05) during laparoscopic compared to conventional procedures. Plasma hyaluronan levels were significantly different at the end of operation between the two groups ( p < 0.05) . Plasma hyaluronan levels were decreased in patients undergoing laparoscopic colorectal resections, compared to those undergoing conventional procedures. Therefore, interactions between plasma hyaluronan and fibrinogen may be lower, with a sequential decrease in fibrin polymerization, and a possibly reduced risk of deep venous thrombosis. [ABSTRACT FROM AUTHOR]

Summary: Background: Although visual analogue scales in conventional mechanical form (mVAS) and electronical VAS (eVAS) on PDA devices are used to evaluate pain in surgical patients, it is not clear whether results of both instruments are comparable. Therefore, the level of agreement between both VAS instruments was evaluated in patients undergoing general surgery. Methods: After general surgery, 53 patients assessed their pain at rest and while coughing by mVAS and eVAS at the same time. mVAS and eVAS data were correlated and the level of agreement between both was calculated according to the method of Bland and Altman. Thirty-three female and 20 male patients in the median age of 51 (18–78) years participated in this study and a total of 185 data sets (112 at rest, 73 while coughing) were evaluated. Results: When data at rest and while coughing were analysed together, correlation between mVAS and eVAS was very good (r =0.902, p <0.001). While the mean VAS score was 4.5cm, mVAS and eVAS differed from each other by only 0.22cm (4.4% of mean VAS score). However, standard deviation of the difference (“repeatability coefficient”) was 1cm (22% of the mean VAS) and the lower and upper level of agreement ranged from −0.21 to 0.17cm (−47 to 38%). Separate analysis for mVAS and eVAS during rest and while coughing revealed similar results. Conclusion: After elective general surgery, correlation between mVAS and eVAS was high. While measurements with both instruments differ in average only by less than 5%, those differences may vary considerably in individual measurements. The type of VAS (mVAS or eVAS) should not be changed within one trial. Results obtained with different forms of VAS should be compared only with caution. [Copyright &y& Elsevier]

The article focuses on a study which examined the effectiveness of fast-track rehabilitation in accelerating recovery, reduce general morbidity and decrease hospital stay after elective colonic surgery in rectal cancer patients. Prospective assessment of the demographic and operative data, pulmonary function, pain and fatigue, local and general complications and mortality was conducted. Incidence of local and general complications was 27 and 18 percent. There was no increase in local morbidity.

Background: A reduced peritoneal fibrinolytic capacity after surgery is currently accepted to be the main cause for postoperative adhesions. The aim of this prospective randomized trial was to determine the fibrinolytic activity in peritoneal fluid after laparoscopic as compared to conventional colorectal resection. Methods: A randomized controlled trial in parallel with the multicenter trial Lapkon II was conducted. Peritoneal fluid was sampled via drain at 2, 8, and 24 h after elective laparoscopic (n=14; LAP) and conventional (n=16; CON) colorectal resections. Activities and concentrations of tissue plasminogen activator (t-PA), plasminogen activator inhibitor type-1 (PAI-1) and t-PA/PAI complex were determined in all specimen by ELISA kits. Results: There was no difference in age, sex or body mass index between both groups. Postoperatively, t-PA activity decreased in both groups and was lower 2 h after closing the abdomen in the laparoscopic group (p<0.05). PAI-1 activity and concentration increased in both groups. Difference between the groups was measured for PAI-1 concentration after 24 h (p<0.05). There were no differences between the groups regarding t-PA concentrations, PAI-1 activity and t-PA/PAI complex. Conclusions: After closing the abdominal cavity, postoperative changes in fibrinolytic capacity of peritoneal fluid can be determined in samples collected by a drain. However, there were no major differences in the postoperative course of fibrinolytic capacity in peritoneal fluid after laparoscopic and conventional colorectal resections. [ABSTRACT FROM AUTHOR]

Background: EORTC-QLQ-C30 questionnaires and GIQLI questionnaires are used to evaluate post-operative quality of life (QoL). It was not clear whether results of both instruments are comparable. Therefore, the level of agreement between both QoL questionnaires was evaluated in patients undergoing elective colorectal cancer resection. Methods: Pre-operatively, 7 and 30 days after surgery 116 patients answered the EORTC-QLQ-C-30 and the GIQLI questionnaires in random order. Individual questions with similar content from each questionnaire were compared. Data for global QoL, physical (PF), emotional (EF) and social function (SF) were linearly transformed to fit a scale from 0 to 100. Data from the two instruments were correlated and the level of agreement between them was calculated according to the method of Bland and Altman. Results: A total of 308 data sets [(pre-op. n=116; 7th pod n=101; 30th post-operative day (pod) n=91)] were evaluated. Both instruments detected a reversible reduction of QoL after surgery and gave inferior results for patients with conditions known to impair QoL. EORTC-QLQ-C30 was more sensitive than GIQLI. The correlation between the two questionnaires for global QoL, PF and EF was good r=0.53-0.66, p<0.01), but no correlation for SF was detected (r=-0.44, p=0.44). Linearly transformed scores from the two instruments differed considerably from -13 (95%CI -51 to 24) points (QoL) to 10 (-38 to 58) points (PF). Conclusion: Although EORTC-QLQ-C30 scores and GIQLI scores from patients undergoing elective colorectal cancer surgery did correlate well, the level of agreement between the two instruments was quite low. Perioperative QoL data from the two instruments cannot be compared with each other. [ABSTRACT FROM AUTHOR]

Background: Although the pneumoperitoneum decreases venous reflux from the lower extremities, the rate of thromboembolic complcations seems to be lower after laparoscopic than after conventional procedures. Therefore, it has been assumed that laparoscopic surgery better preserves the intravasal fibrinolytic capacity. The aim of this study was to determine the influence of the operative technique on intravasal fibrinolytic capacity in colorectal resection. Methods: Randomized controlled trial conducted in parallel with the multicenter trial LAPKON II comparing the long-term effects of elective laparoscopic (group I) and conventional (group II) resections for colorectal cancer. Blood samples were taken from 30 patients preoperatively, at the beginning and end of surgery as well as 2, 8, and 24 hr postoperatively. Activities and concentrations of tissue plasminogen activator (tPA), plasminogen activator inhibitor type 1 (PAI-1), tPA/PAI complex, fibrinogen, and D-dimers were determined in all specimen with ELISA tests. Area under the curve values (AUC) were calculated for all parameters. Results: Patient characteristics and indication for surgery were not different between both groups. Preoperative values of fibrinolytic parameters were similar in both groups. Postoperatively, tPA activity decreased significantly in both groups, but AUC values for tPA and PAI-1 activity (p = 0.23; p = 0.68); concentration of tPA, PAI-1, and tPA/PAI complex (p = 0.52; p = 0.78; p = 0.95); and concentration of fibrinogen and D-dimers (p = 0.67; p = 0.71) did not differ between the groups. Conclusions: An intravasal fibrinolytic "shutdown" occurs not only after conventional but also after laparoscopic colorectal resection. Both operative techniques had similar effects on postoperative intravasal fibrinolytic capacity. Therefore, the lower incidence of thromboembolic complications after laparoscopic colorectal resections does not seem to be caused by a lesser depression of the intravasal fibrinolytic capacity. [ABSTRACT FROM AUTHOR]

Objective: To estimate the value of estrogen receptor (ER) in benign breast diseases and to find out if the response of benign breast diseases to danazol depends on the ER status of the tissue. Design: Prospective study. Setting: University hospital, India. Material: Samples of tissue from benign breast lesions, 40 fibrocystic disease and 10 fibroadenomas. Interventions: Enzyme immunoassay for the presence of cytosolic ER. Main outcome measures: ER concentrations, and correlation with effect of treatment with danazol. Results: Fibrocystic disease and fibroadenomas showed 30% and 40% ER positivity, respectively. The mean (SD) ER concentration was significantly higher in premenopausal than postmenopausal patients 14.75 (3.79) fmol/mgm compared with 6.2 (1.59) fmol/mg (p < 0.05). All ten patients with mastalgia who had ER-positive lesions (n = 26) responded to danazol, compared with 6 of 16 patients who had ER-negative lesions (p < 0.05). Lesions with diffuse fibrosis (n = 14) and five with lymphocytic infiltration on histology were all ER-negative. Conclusion The patients with ER positive breast disease responded better to danazol than patients with ER negative breast disease. [ABSTRACT FROM AUTHOR]

Background: The pneumoperitoneum is the crucial element in laparoscopic surgery. Different clinical problems are associated with this procedure, which has led to various modifications of the technique. The aim of this guideline is to define the scientifically proven standards of the pneumoperitoneum. Methods: Based on systematic literature searches (Medline, Embase, and Cochrane), an expert panel consensually formulated clinical recommendations, which were graded according to the strength of available literature evidence. Recommendations: Preoperatively, all patients should be assessed for the presence of cardiac, pulmonary, hepatic, renal, or vascular comorbidity. Presupposing appropriate perioperative measures and surgical technique, there is no reason to contraindicate pneumoperitoneum in patients with peritonitis or intraabdominal malignancy. During laparoscopy, monitoring of end tidal CO2 concentration is mandatory. The available data on closed- (Veress needle) and open-access techniques do not allow us to principally favor the use of either technique. Using 2 to 5-mm instead of 5 to 10-mm trocars improves cosmetic result and postoperative pain marginally. It is recommended to use the lowest intraabdominal pressure allowing adequate exposure of the operative field, rather than using a routine pressure. In patients with limited cardiac, pulmonary, or renal function, abdominal wall lifting combined with low-pressure pneumoperitoneum might be an alternative. Abdominal wall lifting devices have no clinically relevant advantages compared to low-pressure (5–7 mmHg) pneumoperitoneum. In patients with cardiopulmonary diseases, intra- and postoperative arterial blood gas monitoring is recommended. The clinical benefits of warmed, humidified insufflation gas are minor and contradictory. Intraoperative sequential intermittent pneumatic compression of the lower extremities is recommended for all prolonged laparoscopic procedures. For the prevention of postoperative pain a wide range of treatment options exists. Although all these options seem to reduce pain, the data currently do not justify a general recommendation. [ABSTRACT FROM AUTHOR]

Background: The size of laparoscopic instruments has been reduced for use in abdominal video endoscopic surgery. However, it has yet to be proven that microlaparoscopic surgery will actually result in clinically relevant benefits for patients.Methods: Fifty patients were randomized in a blinded fashion to receive either elective laparoscopic (MINI), (n = 25) or microlaparoscopic (MICRO) (n = 25) cholecystectomy. Pulmonary function (FVC, FEV (1)), analgesic consumption during patient-controlled analgesia (PCA), pain perception by visual analogue score (VAS), and the cosmetic result (by the patient's self-assessment) were evaluated postoperatively as clinically relevant end points.Results: Age, sex, body mass index (BMI), preoperative pulmonary function, pain perception, and operative time were similar for the two groups. At 8:00 PM on the day of surgery, FVC (MINI: 1.96 L [range, 1.48-2.48]; MICRO: 2.13 L) [(range, 1.61.-2.50)] and FEV (1) (MINI: 1.17 L/sec) [range, 0.87-1. 48]; MICRO: 1.34 L/sec [range, 1.05.-2.14] were also similar (each p = 0.5). From surgery to the 3rd postoperative day, cumulative PCA morphine doses were comparable (MINI: 0.15 mg/kg bw [range, 0.09-0. 23]; MICRO: 0.21 mg/kg bw [range, 0.10-0.42]; p = 0.4), but overall VAS scores for pain while coughing were higher in the laparoscopic group (406 [range, 358-514]) than in the microlaparoscopic group (365 [range, 215-427]; p = 0.02). The cosmetic result was judged to be slightly superior by the microlaparoscopic patients (10 [range, 9-10]), as compared to those in the laparoscopic (9 [range, 8-10]) group (p = 0.04).Conclusion: Because microlaparoscopic cholecystectomy has some minor advantages over laparoscopic surgery, it should be considered for use in selected patients. [ABSTRACT FROM AUTHOR]

Focuses on the use of thoracic epidural catheter in randomized trials. Insertion of the catheter between T7 and T9; Role of the postoperative skin prick testing; Detection of differences with a two-sided test.

SummaryBackground: The aim of the study was to evaluate whether perioperative epidural analgesia had any effect on the duration of postoperative ileus after laparoscopic sigmoid resection. Methods: Twenty patients were randomized to surgery either with (group 1; n = 10) or without (group 2; n = 10) thoracic epidural analgesia. The major endpoint of the study was the time to the first postoperative bowel movement. Secondary endpoints were the interval until oral feeding was tolerated, incidence of postoperative vomiting, postoperative analgesic consumption use of patient-controlled analgesia (PCA) until the fourth day after operation, subjective pain perception and the incidence of epidural-related side-effects. Results: Age, sex and American Society of Anesthesiologists classification were similar in the two groups. The first bowel movement was documented after a median of 54 (95 per cent confidence interval 32–127) h in group 1 and 77 (31–99) h in group 2 (P = 0·8). Oral feeding without additional parenteral therapy was tolerated after 48 (40–64) h in group 1 and after 56 (48–64) h in group 2 (P = 0·6). Postoperative vomiting occurred in two patients from each group. During epidural therapy the use of PCA was lower in group 1 (0·30 (0·19–0·96) mg morphine per kg) than in group 2 (0·56 (0·37–0·80) mg/kg) (P < 0·05). Postoperative pain perception during rest and while coughing was similar in both groups. Three patients experienced reversible side-effects of epidural therapy (motor deficit, two patients; bladder dysfunction, one). Conclusion: Perioperative thoracic epidural analgesia did not have a clinically relevant effect on the duration of postoperative ileus after laparoscopic sigmoid resection. [ABSTRACT FROM AUTHOR]

A reply by the author to the letter to the editor about the article "Fibrinolytic Capacity in Peritoneal Fluid After Laparoscopic and Conventional Colorectal Resection: Data From a Randomized Controlled Trial" that was published in the November 2005 issue.

A correction to the article "Short-term outcomes from a prospective randomized trial comparing laparoscopic and open surgery for colorectal cancer" that was published in the 2009 issue is presented.

Background: The German National Surgical Trial Network (CHIR-Net) which has been funded since 2006 by the Federal Ministry of Education and Research (BMBF, funding code 01GH1001A-01GH1001F, 01GH0702) is made up of eight regional surgical centers. The aim of the CHIR-Net is the design, implementation and publication of prospective, randomized, multicenter trials to support evidence-based medicine in surgery. Two main pillars of the CHIR-Net are the surgeon on rotation program and the flying study nurse program. With these two programs the surgical hospitals are supported in their trial working by educating competent investigators and the infrastructural support of flexible and mobile study nurses. Methods: The surgeon on rotation program and the concept of the flying study nurse are presented descriptively. Furthermore, this paper provides reports of experiences of a surgeon on rotation and a flying study nurse of the CHIR-Net. Additionally, the results of an on-line evaluation of the regional surgical hospitals (belonging to the regional surgical center of the universities Witten/Herdecke and Cologne) regarding the needs and requirements of the regional surgical hospitals are presented. Results: The surgeon on rotation program of the CHIR-Net offers investigators the possibility to acquire the basics of designing, developing and implementation of high quality clinical trials. In addition, their own study projects could be intensively driven forward. The flying study nurse program enables in particular non-university surgical hospitals to be supported competitively in performing their own study projects and participating in muliticenter clinical trials. The success of these two programs has been confirmed by the conducted evaluations and the presented field reports. Conclusion: The CHIR-Net is able to develop a high quality study culture in Germany with its surgeon on rotation and flying study nurse program. In addition to the funding period by the BMBF, the continuance of the CHIR-Net should be a primary aim of further measures. [ABSTRACT FROM AUTHOR]

Abstract: Objective. – In elective large bowel surgery the incidence of general complications with standard perioperative care is up to 27%. Hospital discharge occurs 10 to 15 days after a conventional or laparoscopic colonic resection. The aim of a fast track management is to reduce the number of general complications and the length of hospital stay. Material and methods. – We prospectively evaluated a multimodal protocol in our service utilizing a combined thoracic epidural analgesia, an early mobilization and oral nutrition to accelerate postoperative recovery after elective colonic surgery. Results. – One hundred thirty-two consecutive patients aged an average of 66 years (range 22–88) were operated by laparotomy (n =71) or laparoscopy (n =61) and treated with the fast track rehabilitation protocol. Surgical complications occurred in 15 patients (11 %), four of these had an anastomotique leakage (3%). General complications occurred in 11 patients (8 %), the mortality was 1 %. The median length of hospital stay was four days (range 3–77) and 14 patients (11%) had to be readmitted. Conclusion. – Application of a fast track rehabilitation protocol lowered the number of general complications and reduced the duration of hospital stay in our study. [Copyright &y& Elsevier]

Background: Prophylactic placement of intraperitoneal drains in elective abdominal surgery is still subject to scrutiny. Objective: Do currently available data enable the practice of routine placement of abdominal drainages to be abandoned? Methods: The databases of MEDLINE, PubMed and the Cochrane Library were systematically searched for clinical trials concerning the practice of routine drainage placement in elective abdominal surgery. The available evidence was summarized for cholecystectomy, colorectal surgery, gastrectomy and pancreatic surgery, as well as for liver resection. A total of 6 Cochrane reviews including 65 randomized controlled trials (RCTs) and 9 retrospective analyses, as well as 1 more recent RCT and 3 retrospective analyses that were not included in a meta-analysis were reviewed. Conclusion: There is evidence that drains should not be routinely used in elective abdominal surgery, such as cholecystectomy, colorectal resection and gastrectomy. Even for some cases of pancreatic and liver resection, there is growing evidence that routine placement of drains is not mandatory. In conclusion, there is a need for more prospective randomized controlled trials. [ABSTRACT FROM AUTHOR]

Presents a method of assessing postoperative pain after laparoscopic cholecystectomy. Usage of a visual analogue scale (VAS); Influence of sizes of trocar incision on the pain; Correlation between VAS pain score during coughing and sitting up.

Objectives Anti-inflammatory functions of antibiotics may counteract deleterious hyperinflammation in pneumonia. Moxifloxacin reportedly exhibits immunomodulatory properties, but experimental evidence in pneumonia is lacking. Therefore, we investigated moxifloxacin in comparison with ampicillin regarding pneumonia-associated pulmonary and systemic inflammation and lung injury. Methods Ex vivo infected human lung tissue and mice with pneumococcal pneumonia were examined regarding local inflammatory response and bacterial growth. In vivo, clinical course of the disease, leucocyte dynamics, pulmonary vascular permeability, lung pathology and systemic inflammation were investigated. In addition, transcellular electrical resistance of thrombin-stimulated endothelial cell monolayers was quantified. Results Moxifloxacin reduced cytokine production in TNF-α-stimulated, but not in pneumococci-infected, human lung tissue. In vivo, moxifloxacin treatment resulted in reduced bacterial load as compared with ampicillin, whereas inflammatory parameters and lung pathology were not different. Moxifloxacin-treated mice developed less pulmonary vascular permeability during pneumonia, but neither combination therapy with moxifloxacin and ampicillin in vivo nor examination of endothelial monolayer integrity in vitro supported direct barrier-stabilizing effects of moxifloxacin. Conclusions The current experimental data do not support the hypothesis that moxifloxacin exhibits potent anti-inflammatory properties in pneumococcal pneumonia. [ABSTRACT FROM PUBLISHER]

The article focuses on the outbreaks of low pathogenic avian influenza (LPAI) subtype H7N7 which occurred in poultry farms in Germany between May and July 2011. The authors mention that the most likely hypotheses for virus entry are unidentified virus circulation in northwestern Germany, and introduction by wild birds. They note that the data collection during the epidemic confirm previous findings that LPAI virus can result in a wide range of clinical outcomes.

The demand for high quality evidence-based surgical treatment in Germany and awareness of the poor quality of surgical trials highlight the basic necessity of randomized controlled trials. In six surgical trial centers a professional infrastructure for surgical trials is in the process of being established since 2006. The aim is the initiation of surgical multicenter trials which can be effectively conducted by local networking. To accomplish a timely recruitment of patients it is necessary to integrate surgical departments outside university hospitals into multicenter trials. With a questionnaire survey of non-university surgical departments in the federal states of Berlin and Brandenburg, interest, experience in clinical trials and structural conditions in these departments were evaluated. Based on the results of this survey the possibilities to integrate non-university surgical departments into multicenter trials and how a high recruitment of patients can be motivated will be discussed in this article. [ABSTRACT FROM AUTHOR]

Background: Capnoperitoneum (CP) compromises hemodynamic function during laparoscopy. Three therapeutic concepts were evaluated with an aim to minimize the hemodynamic reaction to CP: First, a controlled increase of intrathoracic blood volume (ITBV) by intravenous fluids; second, partially reduced sympathetic activity by the beta1-blocker esmolol; and third, a decrease in mean arterial pressure (MAP) by the vasodilator sodium nitroprusside.Methods: For this study, 43 pigs were assigned to treatment with fluid and sodium nitroprusside (group A) or with esmolol (group B). In both groups, the pigs were assigned to head-up, head-down, or supine position, resulting in three different subgroups. Invasive hemodynamic monitoring was established including left heart catheter and cardiac oxygen lung water determination (COLD) measurements. Measurements were documented before CP with the animals in supine position, after induction of a 14-mmHg CP with the animals in each body position, after a 10% reduction in MAP by vasodilation, and after an increase in ITBV of about 30% by infusion of 6% hydroxyethylstarch solution.Results: Increasing ITBV improved hemodynamic function in all body positions during CP. Esmolol reduced cardiac output and myocardial contractility. Sodium nitroprusside did not improve hemodynamic function in any body position.Conclusions: Optimizing volume load is effective for minimizing hemodynamic changes during CP in the head-up and in head-down positions. In general, beta(1)-blockers cannot be recommended because they might additionally compromise myocardial contractility and suppress compensatory reaction of the sympathetic nerve system. Vasodilation has not improved hemodynamic parameters during CP. [ABSTRACT FROM AUTHOR]