Aktuelle Indikationen zur pyloruserhaltenden Duodenopankreaskopfresektion beim Malignom

Zusammenfassung Die Pankreaskopfresektion in der Modifikation nach Traverso-Longmire, mit Erhaltung eines funktionierenden Pylorus, hat gegenüber der Kausch-Whipple-Operation die Vorteile, daß Anastomosenulzera vermieden werden und daß die Patienten postoperativ eine bessere und schnellere Gewichtszunahme haben. Indikationen waren bisher die Papillenkarzinome und periampulare Tumoren. Bei den Adenokarzinomen lassen sich mit der Pyloruserhaltung gleich gute Überlebensraten erzielen. Unsere Ergebnisse von 56 Pyloruserhaltungen, davon 32 beim duktalen Karzinom und 28 Kausch-Whipple-Operationen in den Jahren von 1985–1993, belegen gleiche Überlebensraten, wie dies bereits für das Papillenkarzinom gezeigt werden konnte. Die Überlebenskurven zeigen, daß die Radikalität nicht von der Magenteilentfernung, sondern von der Resektion an den posterioren und retroperitonealen Resektionsrändern abhängt.

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Current indications for pylorus preservation in duodenopancreatic head resection in malignancies

The Whipple procedure has been improved by preservation of a functioning pylorus. A functioning pylorus is important because marginal ulceration is avoided and, compared to the standard Whipple procedure with gastric resection, more patients can gain weight postoperatively. The most common indications are carcinomas of ampulla of Vater and periampullary tumors. In patients with pancreatic adenocarcinoma the pylorus-preserving variety results in equal or better survival rates. In 56 patients with pylorus preservation, 32 with ductal carcinoma, and 28 with Kausch-Whipple between 1985 and 1993, our results showed slightly better survival rates and better post-operative nutrition. The weakest aspect of the radical resection addresses the retroperitoneal margin of the pancreas head and not the gastric resection.

     

Testing for skin sensitization according to the notification procedure for new chemicals: the Magnusson and Kligman test

The notification procedure for new chemicals in the European Union (called the Chemicals Act in Germany) requires a skin sensitization test when the amount of a new chemical produced exceeds 100 kg/year. The preferred test is that of Magnusson and Kligman; more than 90% of the tests submitted are performed with it. Though the Magnusson and Kligman test is described in the literature, and in the test guidelines of the European Union and of the OECD, discrepancies do occur in the performance of the test between test laboratories. In this paper, recommendations are given for standardized performance of the Magnusson and Kligman test.     

Use of Vicryl mesh to support the esophageal wall after circular myotomy (Livaditis procedure) in long-gap esophageal atresia — an experimental study

Circular esophageal myotomy (CEM) is currently a well-accepted technique for elongation of the upper esophageal pouch in cases of long-gap esophageal atresia (EA). Esophageal pseudodiverticulum is a frequent and perhaps underreported sequela of this technique, characterized by ballooning or outpouching of the esophageal mucosa in the myotomized area. The present study was designed to seek a supplement for the CEM technique in order to avoid possible pseudodiverticulum formation in the myotomized area. We created an animal model to simulate the anatomic conditions present after primary repair of EA facilitated by CEM. Three groups of dogs underwent either cervical (1 group) or thoracic (2 groups) esophageal myectomy. In the cervical and first thoracic groups, the denuded mucosa was left without any support. In the second thoracic group, the denuded mucosal area was wrapped with polyglactin 910 (Vicryl) mesh. In all three groups the esophagus was narrowed by a Marlex mesh ring 3 cm distal to the myectomized zone, simulating a condition resulting from anastomotic narrowing. The dogs underwent barium swallows under fluoroscopy at different postoperative periods and were killed 4 or 6 months after surgery. The esophagi were removed for gross and radiologic investigation under maximal insufflation as well as for histologic assessment. The proposed canine model proved to be useful for study of the myectomized esophagus, mimicking the anatomy and conditions after CEM in long-gap EA repair. Wrapping the denuded mucosa with Vicryl mesh fortified the weakened esophageal wall, thus diminishing the likelihood of future pseudodiverticulum development. In light of the simplicity of the technique and the absence of any evident risk or complications, we recommend that the use of Vicryl mesh wrap be considered during CEM to reinforce the esophageal wall.Supported by the Slezak Fund for Experimental Surgery (Grant #01370791)     

成人先天性巨结肠症的诊断和治疗

目的成人先天性巨结肠症的诊断和手术方法的探讨。方法对本院31例成人先天性巨结肠症的临床表现,诊断和手术方法,进行了回顾性分析。结果 29例行 Swenson 手术,1例 Duhamel 手术,术后并发吻合口瘘5例(16.7%)。早期吻合口狭窄2例,28例获得随访,完全恢复正常排便功能23例(78%),4例轻度排便失禁,1例完全排便失禁。结论成人巨结肠症手术后并发症较婴幼儿高。全结肠显著肥厚扩张时,保留回盲部的手术,术后并发吻合口瘘的发生率高;采用全结肠直肠切除回肠直肠末端吻合,并作预防性回肠造瘘术,可预防吻合口瘘的发生。     

改良尿道板重建卷管尿道成形术与尿道板纵切卷管尿道成形术治疗儿童尿道下裂的疗效对比

目的 比较改良尿道板重建卷管尿道成形术（又称Koyanagi术）与尿道板纵切卷管尿道成形术（TIP）在儿童尿道下裂中的临床疗效。方法 回顾性分析2018年1月—2021年10月甘肃省妇幼保健院收治的104例尿道下裂患儿的临床资料,其中53例患儿行改良Koyanagi术（研究组）,51例患儿行TIP（对照组）。两组患儿术后均随访12个月。比较两组手术时间、术中出血量、术后疼痛及排尿功能、手术成功情况,对比两组术后并发症发生情况。结果 两组手术时间、术中出血量比较,差异均无统计学意义（P >0.05）。两组患儿术后4、12、24和48 h的FLACC评分比较,采用重复测量设计的方差分析,结果 ①不同时间点FLACC评分差异有统计学意义（F =10.871,P =0.000）;②研究组与对照组FLACC评分差异无统计学意义（F =1.849,P =0.157）;③研究组与对照组FLACC评分变化趋势差异无统计学意义（F =2.516,P =0.085）。两组患儿术后12个月的最大尿流率、平均尿流率、排尿量、尿流时间、手术成功率比较,差异均无统计学意义（P >0.05）。研究组术后总并发症发生率低于对照组（P <0.05）。结论 改良Koyanagi术与TIP治疗儿童尿道下裂疗效相近,均可获得满意效果,但改良Koyanagi术在降低术后并发症方面具有优势。     

Maxillary-to-petrous internal carotid artery bypass: an anatomical feasibility study

The possibility for maxillary artery (MA) to petrous internal carotid artery (ICA) bypass was investigated. Five adult cadavers were dissected bilaterally. After zygomatic arch osteotomy, the coronoid process was sectioned at its base. An extensive infratemporal craniotomy was performed at the level of foramina ovale, rotundum and spinosum. The petrous portion of the ICA was exposed by drilling away the floor of the middle fossa, posterior to the foramen ovale and medial to the foramen spinosum. The MA was identified medial to the infratemporal crest and was followed in the pterygopalatine fossa, then transected at the origin of the infraorbital artery. The MA graft was brought posteromedially to reach the petrous ICA. The mean caliber of the MA before the origin of the infraorbital artery was 2.54±0.31 mm, 2.76±0.14 mm at the site of anastomosis, and 3.46±0.32 mm after giving off the middle meningeal artery. The average length of the MA between the middle meningeal artery and the infraorbital artery was 43.4±2.35 mm, and up to the site of anastomosis was 37.64±1.68 mm. We conclude that the length and diameter of the MA are sufficient for a tension-free anastomosis between MA and petrous ICA, and such a procedure could be used in the treatment of patients with tumors of the infratemporal fossa invading the high cervical ICA.

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Electronic Supplementary Material The french version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer Link server located at

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Étude anatomique des possibilités de by-pass entre la partie pétreuse de l'artère carotide interne et l'artère maxillaire

Résumé La possibilité d'un by-pass entre l'artère maxillaire et la partie pétreuse de l'artère carotide interne a été étudiée. Cinq cadavres adultes ont été disséqués des deux côtés. Après ostéotomie de l'arcade zygomatique, le processus coronoïde était sectionné à sa base. Une large craniotomie infra-temporale était effectuée au niveau du foramen ovale, du foramen rond et du foramen épineux. La partie pétreuse de l'artère carotide interne était exposée par fraisage du plancher de la fosse cérébrale moyenne, en arrière du foramen ovale et en dedans du foramen épineux. L'artère maxillaire était identifiée en dedans de la crête infra-temporale et suivie dans la fosse ptérygo-palatine, puis sectionnée à l'origine de l'artère infra-orbitaire. Le greffon d'artère maxillaire était transposé en dedans et en arrière pour atteindre la partie pétreuse de l'artère carotide interne. Le calibre moyen de l'artère maxillaire était de 2,54±0,31 mm à l'origine de l'artère infra-orbitaire, 2,76±0,14 mm au niveau de l'anastomose, et 3,46±0,32 mm après la naissance à l'artère méningée moyenne. La longueur moyenne de l'artère maxillaire entre l'artère méningée moyenne et l'artère infra-orbitaire était de 43,4±2,35 mm et au-delà du site d'anastomose était de 37,64±1,68 mm. Nous en avons conclu que la longueur et le diamètre de l'artère maxillaire était suffisant pour une anastomose sans tension entre l'artère maxillaire et la partie pétreuse de l'artère carotide interne. Ainsi, une telle technique pourrait être utilisée pour le traitement de patients porteurs d'une tumeur de la fosse infra-temporale envahissant la partie cervicale haute de l'artère carotide interne.

     

细胞低温显微图象的计算机处理及定量分析

本文用计算机图象处理技术对细胞显微图象进行处理和定量分析,求出了细胞面积在低温保存中极其重要的参数。实验证明,计算机测量比人工精度高,误差小,同时新颖的标号去噪方法也非常有效。     

Cervical cancer screening program of Paraná: cytohistological correlation results after five years

Since its inception in November 1997, the Cervical Cancer Screening Program of Paraná (CCSPP), Brazil, has resulted in the cytological screening of 2,244,158 women, the coverage of the female population increasing from 43% to 86%. One thousand six hundred one cases screened by cytology, submitted to colposcopy, and subjected to treatment were selected. Cytopathological results were compared with those obtained on the basis of histological analyses of the loop electrical excision procedure specimens, and were subjected to statistical analyses. The data obtained were then compared with cytohistological correlation results from the first year of the program. Considering the exact correlation between cytological and histological diagnoses, the correlation index increased from 53.34% in the first year to 67.3% at the end of 5 yr of the program. Variations that occurred in each diagnostic category are discussed. This study demonstrates a significant improvement in the concordance between cytological and histological results for the 5-yr period compared with the first year of the CCSPP.     

吻合器痔上黏膜环切术与传统外剥内扎术的对比研究

目的 探讨吻合器痔上黏膜环切术(procedure for proplapse and hemorrhoids,PPH)的适应证、方法、临床应用价值.方法 总结41例PPH手术(Ⅰ组)和62例传统外剥内扎术(Milligan-Morgan手术)(Ⅱ组)临床资料,对手术时间、术后止痛次数、住院时间、术后并发症及住院费用等进行对比研究.结果 总的症状改善满意率分别为95%(Ⅰ组)及82%(Ⅱ组),除住院费用外,Ⅰ组其手术时间、术后止痛次数、住院时间明显优于Ⅱ组,并发症发生率除术后便血、早期大便失禁、早期排尿困难外,余无统计学意义.结论 PPH治疗Ⅲ°～Ⅳ°痔的近期疗效优于Milligan-Morgan手术,且具有安全、有效、手术时间短、住院时间少、恢复快等优点.     

Electron microscopic identification of aberrant melanosomes using a combined dopa/Warthin-Starry technique

A method combining the DOPA and Warthin-Starry techniques is described in order to positively establish the nature of pleomorphic granules observed in the cytoplasm of cells of putative amelanotic melanoma. The technique identifies these granules as aberrant melanosomes by discretely depositing electron dense silver on suitably prepared sections of DOPA-treated tissue blocks.