Fusarium endocarditis involving aortic valve following coronary artery surgery

This article describes a case of infective aortic valve endocarditisdue to Fusarium oxysporum occurring 4 years after coronary arterybypass grafting. It is the first reported case of endocarditiscaused by Fusarium.     

Häufigkeit pathologischer Veränderungen des oberen Gastrointestinaltraktes bei Patienten vor Herzoperationen

Resümee Schwerwiegende gastroduodenale Erkrankungen sind bei fast der Hälfte aller Patienten, die sich einer Operation am offenen Herzen unterziehen müssen, auch bei Fehlen von Symptomen nachweisbar. Das erhebliche Überwiegen von Magenläsionen spricht dafür, daß die arteriosklerotisch bedingte Perfusionsminderung der Schleimhaut die entscheidende Ursache hierfür ist. Routinemäßige präoperative Ösophago-Gastro-Duodenoskopien können die nicht unerhebliche durch gastrointestinale Komplikationen bedingte postoperative Mortalität senken helfen.

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Pathological changes in the upper gastrointestinal tract in patients awaiting open heart surgery

Summary While waiting for open heart surgery, in 153 patients (104 male, 49 female, 22–76 years of age) without gastrointestinal symptoms and/or history esophago-gastro-duodenoscopy was performed. 124 patients suffered from coronary heart disease, 29 from valvular defect, aneurysm of the sinus of Valsalva or tumor of the heart.In 47.1% endoscopy revealed serious abnormal findings: in 16.3% gastric ulcer, in 20.9% erosive gastritis, duodenal ulcer and erosive duodenitis in 5.2%, respectively, 1 case of gastric carcinoma, 2 of large polyps and 3 of reflux esophagitis of higher degree (totally 3.9%).In patients with coronary artery disease, the relation of erosive and ulcerous gastric lesions as compared with those of duodenal origin was 41, in patients with other cardiac diseases it was 21, respectively (p<0,001).Compared with a normal population, the incidence of pathological gastric findings was 54-fold higher in our patients, and 1.7-fold concerning duodenal lesions, respectively (p<0.001).51 patients on acethylsalicylic acid (160 mg/ die) showed pathologic findings in 41.2%, and 96 patients without ulcer-inducing therapy in 51%. Thus, low-dose Aspirin does not seem to have serious gastric side effects.The results of the study stress the necessity of routinely performed endoscopy of the upper gastrointestinal tract in patients awaiting open heart surgery. This will lead to a lower incidence of serious gastrointestinal complications postoperatively, which are known to have a high mortality.

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Abkürzungen ASS Azetylsalizylsäure - J. Jahre - GI-Trakt Gastrointestinaltrakt     

Role of anterior retinal cryoablation in the management of neovascular glaucoma

In a prospective study, the effect of anterior retinal cryoablation (ARC) in the management of neovascular glaucoma (NVG) was evaluated over two years, in 72 patients (74 eyes). The outcome of trabeculectomy/seton surgery preceded by 360° ARC was also analysed in 12 eyes of 12 patients (6 eyes in each group). Following ARC, pain relief with dramatic regression of anterior chamber inflammatory reaction was observed in 95% of the patients (59 eyes). At the end of the follow up, as confirmed by iris fluorescein angiography, regression of neovascularization of the iris was documented in 93.5% (58 eyes) of the cases. Intraocular pressure control (22 mm Hg) was achieved in 82.3% (51 eyes) cases. IOP control of 22 mm Hg was achieved in all the 6 eyes with the seton surgery following ARC. Similarly, control of IOP was successfully achieved in all the 6 eyes of patients with NVG with trabeculectomy with post operative course of 5-fluorouracil following ARC. ARC is strongly recommended in NVG, especially in eyes with media opacities and as a preliminary procedure for filtering surgery or drainage implant surgery.Abbreviations ARC Anterior retinal cryoablation - NVG Neovascular glaucoma - NVI Neovascularization of the iris     

Prevention of hypotony after trabeculectomies with mitomycine

Hypotony with reduced a reduced visual acuity is often seen after trabeculectomy with mitomycine. In this study we describe measures such as reattaching the sleral flap with at least seven nylon sutures and the controlled and delayed use of argon laser suture lysis. With these preventative measures the percentage of hypotonies (IOP 6 mmHg) three months after surgery was reduced from 38 to 15% and chronically reduced visual acuity was reduced from 38 to 5%. With these adaptations in the surgical technique the complication rate of trabeculectomies with mitomycine can be markedly reduced without affecting the mean IOP (10.9 mmHg versus 10.8 mmHg) three months after surgery and the percentage of eyes with IOP 18 mmHg or less without medication (94 versus 91%).     

Biliopancreatic Diversion: 170 patients in a 7-year follow-up

During the past 7 years, 170 morbidly obese patients have been subjected to a biliopancreatic diversion. Mean weight loss achieved over 2 years was greater than 70% of excess weight and was maintained. Early complications were rare. The most common side-effects are discussed. The re-operation rate because of these side-effects was 7%. Eating normal meals, together with a stable weight loss, has provided these patients with a better quality of life.     

Liposculpturing by Syringe Technique in Obesity

The author recommends liposuction by syringe technique instead of by the lipoaspirator machine. This technique has been applied to obese patients who were further stimulated to lose weight by dieting.     

Preoperative Intermaxillary Fixation has no Influence on Weight Loss Induced by Vertical Banded Gastroplasty

Surgery is the only therapeutic modality that has shown lasting results in the treatment of morbid obesity. Ability to lose weight by voluntary dieting has been associated with unsatisfactory weight loss after gastroplasty. This report examines the effect of preoperative inter-maxillary fixation (IMF) on weight reduction induced by vertical banded gastroplasty (VBG). Twenty-four patients entered the study and were randomly assigned to either 10 weeks of IMF or 10 weeks on the waiting-list. Patient groups were similar in respect to age, gender and Body Mass Index (BMI). All patients were urged to lose weight preoperatively. Patients in the IMF group lost 18 kg (−12 to −36; median, range) and the waiting list group lost 3 kg (+3 to −30) during the 10 weeks prior to surgery. Total weight loss from time of inclusion to 24 months postoperatively was the same in both groups. Our results suggest that weight loss up to 2 years after VBG is not influenced by short-term preoperative IMF. Although we found no obvious advantage in having patients pre-treated by IMF, our findings indicate that jaw wiring can be used for patients in whom moderate preoperative weight loss is desired without endangering the effect of VBG on body weight development.     

Incidence of deep venous thrombosis after gynaecological laparoscopy

目的　研究妇科腹腔镜术后深静脉血栓的发生率。方法　在澳大利亚悉尼Liverpool医院 1997年 5月～ 1997年 9月 72例妇科腹腔镜手术采用Doppler超声检查静脉血流的通畅性和血管腔内的回声团用以诊断深静脉血栓。 61例患者充气时间 <60分钟为小手术组 ,11例 >60分钟为大手术组。每例患者在术后 2 4小时内及术后 7天行两次超声Doppler检查 ,所有 72人均行术后 2 4小时内的超声Doppler检查 ,小手术组 61例中 4 0例、大手术组 11例中 9例行二次超声检查。 2 3例未行二次超声检查者均行电话随访。结果　在我们的研究中两组患者均未发现DVT。本文同时报道北京复兴医院一例腹腔镜下右卵巢巧克力囊肿剥除术、左卵巢及部分输卵管切除术患者术后并发DVT ,其诊断及治疗经过。结论　这项研究证实妇科腹腔镜手术DVT虽发生率极低 ,一旦发生需及时诊治 ,以免发生肺栓塞等致命并发症。     

Management of hemangiopericytomas in the central nervous system

目的　血管外皮细胞瘤是少见的中枢神经系统肿瘤 ,由于其易复发和转移而预后不良。本文介绍 2 6例血管外皮细胞瘤的处理经验并结合文献复习其诊治要点。方法　回顾性分析 1993年 1月至 1999年 6月华山医院收治的 2 6例血管外皮细胞瘤 ,其中 5例为复发肿瘤 ,1例为术后残留。结果　 2 6例中 2 4例病灶全切除 ,2例次全切除。术后 2 1例症状好转或不变 ,4例加重 ,1例手术后死于并发症。18例术后放疗。 18例获随访 ,随访期 1- 5 8个月 ,其中 15例恢复良好 ,2例发现转移肿瘤 ,1例复发再次手术后死亡。结论　手术全切是主要治疗方法 ,术后放疗可延缓肿瘤复发。     

Pathologic features of occult lymphatic metastasis in supraglottic carcinoma

Objective　To study the pathologic features of occult lymphatic metastasis in supraglottic carcinoma. Methods　Serial sections of 153 neck dissection specimens in 100 patients with supraglottic carcinoma were evaluated under the microspcope. Results　In 100 patients, 38 had occult metastatic lymph nodes. 51 metastatic lymph nodes were found in pathology, and their sizes ranged from 0.5 cm to 2.6 cm (average 1.1 cm). The distribution of 51 lymph nodes was 1 in level Ⅰ (2%), 37 in level Ⅱ (73%), 12 in level Ⅲ (24%), and 1 in level Ⅳ (2%). Among the 51 nodes, 21 (41%) were early stage, 18 (35%) were growth stage, 7 (14%) were tull stage, and 5 (10%) were extracapsular stage. The differentiation degree and appearance of supraglottic carcinoma was not directly related with occult metastasis. Conclusion　The occult metastatic rate of supraglottic carcinoma is high, and selective neck dissection may be necessary.