Perioperative changes in the plasma metabolome of patients receiving general anesthesia for pancreatic cancer surgery

Background: Modern anesthesia strives to offer personalized concepts to meet the patient’s individual needs in sight of clinical outcome. Still, little is known about the impact of anesthesia on the plasma metabolome, although many metabolites have been shown to modulate the function of various immune cells, making it particularly interesting in the context of oncological surgery. In this study longitudinal dynamics in the plasma metabolome during general anesthesia in patients undergoing pancreatic surgery were analyzed.Materials and Methods: Prospective, observational study with 10 patients diagnosed with pancreatic (pre-) malignancy and subjected to elective resection surgery under general anesthesia. Plasma metabolites (n = 630) were quantified at eight consecutive perioperative timepoints using mass spectrometry-based targeted metabolomics.Results: 39 metabolites significantly changed during the perioperative period. Tryptophan concentrations decreased by 45% with the maximum decrease after anesthesia induction (p = 6.24E-07), while taurine synthesis increased (p = 1.46E-04). Triacylglycerides and lysophosphatidylcholines were significantly reduced with increased liberation of free monounsaturated fatty acids (p = 0.03). Carnitine levels decreased significantly (p = 9.30E-04).Conclusions: The major finding of this study was perioperative tryptophan depletion and increased taurine synthesis. Both are essential for immune cell function and are therefore of significant interest for perioperative management. Further studies are needed to identify influencing anesthetic factors.     

Cutaneous immunofluorescence

Immunofluorescence, especially direct immunofluorescence of skin, has been widely used for diagnosis of connective tissue diseases. It is principally of value for LE and may be used also as a prognostic test for SLE. It is of relatively little value for diagnosis of other connective tissue diseases and appears not to predict the outcome of undifferentiated connective tissue disease. Cutaneous immunofluorescence is widely available and has an established place in the field of dermatopathology. As with other microscopic interpretations, substantial experience, along with an understanding of basic immunopathologic principles, is necessary for reliable results. Antibodies to certain ultrastructural components of the basement membrane zone are now available. These are being evaluated for further diagnostic applications to LE and other diseases that involve the epidermal basement membrane zone.     

Die klinische Relevanz der Ganzkörperskelettszintigraphie bei mehrfachverletzten und polytraumatisierten Patienten

The provision of care to polytraumatised patients is a particular diagnostic and therapeutic challenge. The examination data of 162 polytraumatised patients were retrospectively investigated to determine the diagnostic gain provided by skeletal scintigraphy with^99mTc-HMDP. It was found that every fresh fracture (with the exception of fractures to the skull) led to a scintigraphically clearly demonstrable remodelling reaction within ten to 14 days. The timing of the examination was of decisive importance for the information yield. Not until about the tenth to 12th day did also those fractures that showed a delayed uptake show adequately signal-intensive areas of uptake in the scintigram. Typical examples were additional fractures of the spine and pelvis in patients immobilised by fractures of the limbs. At this time, with the aim of skeletal scintigraphy, an additional fracture was found in half of all patients, and was subsequently verified radiologically. Additional diagnostic information is independent of the ability of the patient to cooperate. This was of particular importance in the case of the very severely injured and old patients. Skeletal scintigraphy can be empolyed with equal efficacy to reliably exclude bone injuries. Thus, skletal scintigraphy if of particular significance in the determination of the extent of bone injury in polytraumatised patients. This applies in particular to the preparation of an expertise. Thus, as in the case of staging of malignomas, the additional performance of bone scanning twelve to 14 days after traumatisation should form part of routine care offered to polytraumatised patients.     

Subepidermal Calcified Nodule

A subepidermal calcified nodule occurred on the face of a 15-year-old Negro boy. Histo-logical examination revealed its apparent origin in mature and immature hair follicles. Previous reports suggest that subepidermal calcified nodules may arise in nevi or in sweat glands. An additional finding in this case was transepidermal elimination of calcium.     

Assessment of biotransformation during transfer of propoxyphene and acetaminophen across the isolated perfused human placenta

The purpose of this investigation was to assess the extent of biotransformation of drugs by the human placenta during their transfer from the maternal to the fetal circulation. Propoxyphene was used to determine N-demethylation, and acetaminophen served as a substrate for glucuronide and sulfate conjugation. Human full-term placentae were dually perfused in vitro, with one or the other drug being added to the maternal circulation. Propoxyphene and acetaminophen concentrations reached an essentially constant fetal/maternal ratio within 1 hour, with a half-time of about 20 minutes. The concentrations of both drugs in the placental tissues were higher than in the perfusion fluids; this accumulation was particularly pronounced in the case of propoxyphene. No metabolites of either drug were found in the maternal or fetal circulations, but norporpoxyphene, the N-demethylated metabolite of propoxyphene, was detected in placental tissue.     

Spezielle Operationstechniken zur Versorgung traumatischer Frakturen im Bereich von Hüft- und Knieendoprothesen

Special problems are associated with fractures of bones with implanted endoprostheses. These problems are a result of unusual fracture-types often combined with damage and loosening of parts of the prosthesis, the limited applicability of standard osteosynthesisprocedures and the impaired blood supply of the bone caused by the destruction of the medullary vessels after filling the medullary canal with bone cement. Special operative techniques for the treatment of those problem-fractures are demonstrated such as the extension of the prosthesis by an elastic shaft and the concentric osteosynthesis of an unstable acetabulum by a newly developed implant.     

Transfollicular Extrusion of Sebaceous Glands: Natural Phenomenon or Artifact? A Case Report

A sebaceous gland tumor on the back of a 28-year-old man underwent periodic exudation of yellowish material in association with local irritation. Pathological examination revealed entire sebaceous gland lobes lying subcorneally in the orifices of sebaceous follicles. This case appears to represent transfollicular extrusion of sebaceous gland lobes as a natural phenomenon rather than as an artifact.     

157. Operative Behandlung der habituellen Schulterluxation nach Eden-Hybinette

Zusammenfassung Zur operativen Behandlung der habituellen Schulterluxation sind im Schrifttum zahlreiche Methoden angegeben worden. Diese Anzahl von Verfahren ist Beweis dafür, daß keine von diesen Methoden optimale Ergebnisse erbracht hat. Hier ist nicht allein die Methode als solche, sondern die Art der Durchführung der jeweiligen Operationsverfahren für Erfolg und Mißerfolg verantwortlich. In diesem Film wird die von uns seit Jahren mit Erfolg durchgeführte Operationsmethode nach Eden-Hybinette bei vorderem und hinterem Zugang während der Operation und auch als Trickzeichnung vorgeführt.