Search

Zusammenfassung Epigastrische Schmerzen, Übelkeit, Erbrechen und eine obere gastrointestinale Blutung werden gelegentlich durch heterotopes Pankreasgewebe der Magenwand verursacht. Trotz moderner diagnostischer Verfahren gestaltet sich die Diagnose heterotopen Pankreasgewebes oftmals schwierig. Daher wird von vielen Autoren die Magenwandresektion und Schnellschnittuntersuchung als diagnostische und therapeutische Maßnahme befürwortet. Zwei typische Kasuistiken werden im Folgenden mit einer Literaturübersicht vorgestellt.

Zusammenfassung: Einleitung. Die Risikoabschtzung ist eine wesentliche Vorraussetzung fr die Wahl der chirurgischen Therapie.Ziel der Umfrage war daher zu untersuchen,inwieweit die properative Risikoerhebung Eingang in den Behandlungsablauf chirurgischer Kliniken in Deutschland gefunden hat. Methoden. Anhand eines Fragebogens wurden insgesamt 1.159 chirurgische Kliniken zum Thema befragt, durch wen und wie das properative Risiko erfasst wird, von welchen Faktoren der postoperative Verlauf des Patienten abhngt und ob und wie postoperative Komplikationen erfasst werden. Ergebnisse. Es wurden 636 Bgen ausgewertet. Der Einfluss bestehender Vorerkrankungen auf den Verlauf wird als gro eingestuft. Die ASA-Klassifikation wird am hufigsten verwandt.Kein properatives Risiko erfassen 12%. In 67% wird das Risiko durch Chirurgen und Ansthesisten gemeinsam beurteilt.Von den Kliniken werten 21% ihre postoperativen Komplikationen nicht regelmig aus. Schlussfolgerungen. Risikoerfassung und Kontrolle postoperativer Komplikationen sind wesentliche Standbeine chirurgischer Arbeit.

Flat Langmuir probes, a flush mounted probe and an insulated antenna were used to investigate the correlation between the plasma density and the occurrence of radio frequency- and X-band-noise as a fingerprint for parametric decay processes in a magnetized linear plasma device. The decay products of the driving microwave may influence the entire scenario of electron and ion heating in the plasma.

Zusammenfassung.: Einleitung: Die Effektivitt der perioperativen Antibioticagabe ist nachgewiesen, die Prophylaxe wird jedoch hufig inadquat angewandt. Ziel der Studie war es daher zu berprfen, inwieweit Leitlinien in der Lage sind, die Qualitt der perioperativen Gabe von Antibiotica zu verbessern. Methoden: In einer retrospektiven Analyse stellten wir bei 280 Operationen den Ist-Zustand der Antibioticaprophylaxe hinsichtlich der Kriterienwahl des Antibioticums, Dosis, Zeitpunkt, Stop nach Operationsende und 2. Gabe bei einer Operationsdauer > 3 Std fest. Nach Leitlinienerstellung und klinikinterner Fortbildung erfolgte eine erneute berprfung im Rahmen einer prospektiven Beobachtungsstudie (n = 245). Gruppenunterschiede wurden mit dem χ 2-Test berechnet. Das Signifikanzniveau wurde auf p < 0,05 festgelegt. Ergebnisse: Der Anteil der indizierten, aber nicht durchgefhrten Antibioticaprophylaxe konnte von 15,5 % auf 8,4 % (p < 0,05) reduziert werden. Die Prophylaxe wurde im Vergleich zur retrospektiven Analyse signifikant hufiger adquat zur Anwendung gebracht (35,7 % vs. 63,5 %; p < 0,05). Dies war vor allem auf die genauere Bercksichtigung der Dosis und der Operationsdauer zurckzufhren. Diskussion: Krankenhausinterne Leitlinien knnen zu einer Verbesserung der perioperativen Antibioticaprophylaxe beitragen. Um ein optimales Ergebnis zu erreichen, mssen Leitlinien durch weitere Manahmen, wie z. B. computerassistierte Programme, ergnzt werden.

Tumorgenesis and tumor growth are connected with the immune system. Therefore the role of the spleen respectively splenectomy have gained increasing influence. The existing experimental and clinical results are discussed with the help of a general review of the literature. A manipulation of the immune system by splenectomy seems possible. A common pathomechanism has not yet been found. But experimental investigations are transferrable to human beings only under special conditions.

In an experimental study with sprague-dawley-rats we tested the effect of parenteral substituted LCT-fats on tumor growth of the Yoshida sarcoma in its ascites form. Therefore we tested 4 groups with 10 tumor-bearing and 10 non-tumor-bearing rats. We added group 1–3 LCT-fats in different doses. Group 4 was fed enterally. We found that tumor-bearing rats had a higher nitrogen retention than non-tumor-bearing rats. Non-tumor-bearing rats showed a higher nitrogen concentration in the muscles. The portion of nitrogen increased with increasing portion of fat. The content of nitrogen in the ascites, the quantity and the number of tumor cells was reversed in proportion to the portion of fat. For the host we showed that he cannot make use of the energy directly. The tumor does not grow in proportion to the available energy but has to support itself from the catabolism of the host.

Summary.: Purpose: To compare the diagnostic efficacy of different imaging procedures carried out in patients with scintigraphically cold thyroid nodules. Methods: The preoperative imaging procedures carried out in all patients operated on for cold thyroid lesions at the Department of Surgery of the University of Cologne were recorded in prospective manner for 1 year. Special attention was paid to the difference between in-patient and out-patient management. Diagnostic accuracy was assessed by comparison with the intraoperative findings and histology. Results: The combination of ultrasonography and fine needle aspiration cytology proved effective. Computed tomography should be reserved for the preoperative assessment of large thyroid tumors. Repeat examinations seldom gave additional information. Conclusion: Standardized preoperative investigations may be performed on an out-patient basis, provided attention is paid to quality assurance.

Based on a late physical examination of 18 patients with splenic cysts, we discuss symptoms, diagnostics and indication to operate and the procedure of operation. We found no specific symptoms. The ultrasound is the most important diagnostic method and may be supplemented by computerized axial, tomography. The indication depends on the symptoms, the diameter within the organ and, most important, the dignity of the cyst. For pseudocysts we prefer resection of the cyst wall, because it is a simple and safe procedure. Splenectomy is the treatment of choice for cysts with unknown dignity.

Summary The importance of malnutrition as major cause of morbidity and mortality in cancer patients is well documented. It has been shown that nutritional therapy improves well-being and nutritional status of the patient, but the tumor can also be accelerated by hypercaloric nutrition. Our study does not confirm the induction of tumor growth. A high positive metabolic rate of the host lowers the tumor's growth rate and its tendency to spread. The retention of nitrogen in host increase with decreasing rate of energy and nutrition. Our results show that the tumor itself uses energy and nutrients from host cell catabolism and does not directly exploit exogenous nutrient substrates. It should not be forgotten that the animal model leads to specific changes affecting the energy and nutrient metabolism.

Three different methods of preoperative bowel preparation were tested in a prospective randomized trial examining efficacy and morbidity. In all, 163 patients were treated by gut irrigation with Ringer's lactate, Prepacol or polyethylene glycol (PEG). Fluid retention, cleansing effect, postoperative complications and subjective acceptance were documented. Relevant weight gain and decrease in haematocrit indicating fluid retention were seen only after the use of Ringer's lactate. There were no significant differences in bowel cleansing. In the Prepacol group the postoperative complication rate was significantly increased. Prepacol was tolerated best, with few side-effects. PEG was better tolerated than Ringer's lactate, but vomiting occurred in 2 and 21 per cent of patients respectively. PEG is most suitable for bowel preparation in patients undergoing colorectal surgery.