Early postoperative results of surgery for rectal carcinoma as a function of the distance of the tumor from the anal verge: results of a multicenter prospective evaluation

BACKGROUND: The problems associated with rectal surgery are frequently discussed with no reference being made to the distance of the tumor from the anal verge. This study examined the effect of the location of the tumor on early postoperative results. PATIENTS AND METHODS: This was a multicenter study involving 75 German hospitals and 3756 patients, of whom 1463 had rectal carcinoma. On the basis of the location of the tumor (distance from the anal verge), four groups were distinguished: <4, 4-7.9, 8-11.9, and 12-16 cm. RESULTS: Resection and abdominoperineal resection rates and the incidence of postoperative complications depended on the location of the tumor. Significantly higher resection rates and fewer specific complications, and a significant reduction in overall postoperative morbidity were found with tumor locations more than 8 cm from the anal verge. The highest anastomotic leak rate was observed with anastomoses less than 7 cm from the anal verge. The logistic regression showed that the distance of the tumor from the anal verge is an independent variable for the development of an anastomotic leak. CONCLUSIONS: Early results are greatly affected by the location of the rectal carcinoma. This applies to both abdominoperineal resection rates and specific postoperative complications, such as anastomotic leak rate and operation morbidity in general.     

Diagnosis of Ewing sarcoma of the thoracic spine--differential diagnostic difficulties

Spinal Ewing's sarcomas are rare and cause problems in differential diagnosis. The radiologic, nuclear medicine and CT findings in two children with histologically proven Ewing's sarcoma are presented and problems in differential diagnosis discussed. Biopsy should be done early.     

Subakute Verlegung der Atemwege infolge eines retropharyngealen H?matoms nach Halstrauma

Mechanical airway obstruction secondary to retropharyngeal bleeding is rare. In most cases such a complication is described after head and neck trauma. Complicating factors include anticoagulant therapy, tumour, aneurysm, infection or major cervical spine injury. A precise initial diagnosis is necessary to avoid a life-threatening situation. Lateral X-ray and computed tomography is essential for safe management. Treatment depends upon size of the haematoma as well as the clinical course of the patient. Smaller haematomas may be observed. Lager haematomas and those that fail to reabsorb should undergo drainage.      

The surgical risk of colectomy in patients with cirrhosis

The records of 54 patients with documented cirrhosis who underwent colectomy between January 1970 and January 1984 were studied to assess the operative risk and to determine the preoperative predictive risk factors. In-hospital mortality was 24 percent (13 patients), and postoperative complications occurred in 48 percent (26 patients). The risk of surgical intervention was significantly increased if encephalopathy, ascites, anemia, or hypoalbuminemia was present before operation. A simple operative risk index involving the presence of encephalopathy and ascites and the levels of hemoglobin and albumin is proposed to help distinguish a low-risk subgroup in whom postoperative mortality was 12.8 percent from a high-risk subgroup in whom postoperative mortality was 53.3 percent.     

Klinische Wertigkeit einer dermatoskopischen Klassifikation von Clark‐Nävi

Background and objectives: The aim of this study was to evaluate the practical value of the dermatoscopic classification of Clark nevi Patients and methods: Dermatoscopic images of 268 lesions clinically and dermatoscopically diagnosed as Clark nevi were presented to 2 dermatologists without knowledge of the histological diagnosis. The dermatologists evaluated the lesions according to a simplified version of the classification scheme for Clark nevi proposed by Hofmann‐Wellenhof and differentiated between 12 different types of Clark nevi. Results: The most common type of Clark nevus was the reticular‐homogenous type (n = 64, 23,9 %), followed by the globular‐homogeneous type (n = 32, 12 %) and by the homogenous type (n = 30, 11,2 %). The overall inter‐rater agreement between the examiners was moderate to good (kappa = 0,58). The highest level of agreement was found for the peripheral hyperpigmented type (kappa = 0,83). Histologically, 17 lesions (6,3 %) were diagnosed as melanomas. The frequency of melanoma was highest among the peripheral‐hyperpigmented type for one observer and among the homogenous type for the other observer. No melanoma was found among the globular, reticular‐globular, and the central‐hyperpigmented types. Conclusions: A dermatoscopic classification of Clark nevi is practically feasible and allows – to some extent – a risk stratification of Clark nevi, which could be useful for clinical management.     

Sauerstoff tragende L?sungen verbessern die Gewebeoxygenation im quergestreiften Hautmuskel nach kritischer Isch?miezeit

Zusammenfassung Fragestellung. Ziel der vorliegenden Untersuchung war, die Effekte der Sauerstoff tragenden freien H?moglobinl?sung (Diaspirin-crosslinked-H?moglobin, DCLHb) auf die kapillare Perfusion sowie die Oxygenation im quergestreiften Hautmuskelgewebe nach kritischer Isch?miezeit und nachfolgender Reperfusion zu analysieren. Material und Methode. Die kapillare Gewebeperfusion wurde anhand der funktionellen Kapillardichte im Hautmuskel des syrischen Goldhamsters quantitativ vor der Induktion einer 4-stündigen Isch?mie sowie nach 0,5 h, 2 h und 24 h Reperfusion mittels intravitaler Fluoreszenzmikroskopie erfasst (n=8 pro Versuchsgruppe). In separaten Tieren wurde nach demselben Versuchsansatz mit der Mehrdrahtoberfl?chenelektrode (MDO, Eschweiler, Kiel) die Gewebeoxygenation gemessen (n=8 pro Versuchsgruppe). Die Tiere der Testgruppe (n=8) erhielten 15 min vor der Reperfusion eine Kurzinfusion von 5 ml/kg KG DCLHb (Diaspirin-crosslinked-H?moglobin, 10 g/dl, Baxter, IL, USA). Die Kontrolltiere (n=8) erhielten ?quivalente Dosen einer isotonen Kochsalzl?sung (Braun, Melsungen). Ergebnisse. Die funktionelle Kapillardichte als Ma? für die L?nge von erythrozytenperfundierten Kapillaren pro Beobachtungsfeld war bei den Kontrolltieren in der Reperfusionsphase dramatisch vermindert, w?hrend bei den mit DCLHb behandelten Tieren signifikant h?here Werte nachweisbar waren (p<0,05). Diese Beobachtung spiegelte sich in einer vollst?ndigen Erholung des Gewebe-pO₂ bei den Behandlungstieren wider, was in Kontrolltieren nicht erreicht wurde. Schlussfolgerungen. Die Ergebnisse dieser Studie zeigen, dass die Sauerstoff tragende L?sung DCLHb nach kritischer Isch?mie und Reperfusion die nutritive Perfusion und Gewebeoxygenation gegenüber kristalloiden L?sungen verbessert. Die Anwendung derartiger L?sungen scheint unter den klinischen Bedingungen einer kritischen Isch?mie daher als viel versprechender adjuvanter therapeutischer Ansatz. Electronic Publication