Truncus-coeliacus-Kompressionssyndrom

The celiac axis compression syndrome is a rare disease in adults. In childhood it is extremely uncommon. Vascular reasons or chronic irritation of the celiac ganglion are discussed as causes for this syndrome, leading to chronic abdominal pain. Lateral aortography is acknowledged to be the best method for diagnosis of the celiac axis compression syndrome. New duplex scanning methods are gaining more and more importance. The indication for surgery is the subject of controversy in the current literature. We present the case of a 15-year-old girl who recovered completely after transsection of the ligamentum arcuatum medianum and resection of the celiac ganglion.     

Nichterosive und erosive gastroösohageale Refluxerkrankung

BACKGROUND: The aim of this study was to evaluate long-term results of laparoscopic anterior semifundoplication in patients with nonerosive (NERD) and erosive (ERD) gastroesophageal reflux disease.PATIENTS AND METHODS: The study includes the period from May 1997 to July 2005. Upper gastrointestinal endoscopy was performed in all 190 patients. The severity of reflux esophagitis was classified according to Savary and Miller (grades I-IV). A standardized questionnaire was used for follow-up, and the modified symptomatic DeMeester score was assessed.RESULTS: 58.5 years of age (range 27-80), patients with nonerosive reflux disease (n=83) were significantly older than those with erosive reflux disease (n=107) (48 years range 15-84) (p=0.0001). Patients with NERD had a lower modified symptomatic DeMeester score postoperatively of 0 (range 0-4) than patients with ERD, of 1 (range 0-5), though without statistical significance (p=0.151).CONCLUSION: Laparoscopic anterior semifundoplication leads to comparable symptomatic long-term results in both NERD and ERD. Anterior semifundoplication is a good therapeutic option for selected patients with persistent reflux-associated symptoms and endoscopically negative esophagitis.     

Ultraschall in der Tumornachsorge

According to the guidelines, ultrasonography (US) is now established as the cross-sectional imaging technique of choice in postoperative care of colorectal carcinoma. Although conventional percutaneous US is inferior to computed tomography (CT) and magnetic resonance imaging (MRI) for detecting hepatic metastases, the application of specific contrast media has significantly increased sensitivity and specificity to 87% and 88%, respectively. The combination of US and CT/MRI achieves the highest detection rates. During follow-up of rectal carcinoma, in up to 20% of locoregional recurrences are diagnosed solely by endorectal sonography and result in repeat resection with curative intention. In noncolorectal carcinoma, US is recommended in the guidelines for following up hepatocellular carcinoma and malignant thyroid disease, but the available data are insufficient to support those recommendations.     

Proximaler Humerusnagel bei körpernahen Oberarmbrüchen

Zusammenfassung Frakturen des proximalen Humerus stellen beim älteren Patienten, bedingt durch Osteopenie und Verletzungsschwere, eine Herausforderung für die operative Versorgung dar. Seit wenigen Jahren stehen intramedulläre Implantate zur Verfügung, mit denen auch Mehrfragmentfrakturen mit hoher Primärstabilität versorgt werden können. Bei limitierten Weichteilschäden kann durch frühe Physiotherapie ein gutes funktionelles Ergebnis erreicht werden. Seit 2003 verwenden wir den T2-PHN (Fa. Stryker) und konnten bisher 15 Patienten nach 1-jähriger Beobachtung auswerten. Bei einem Durchschnittsalter von 64,6 Jahren lag der durchschnittliche Constant-Score nach 1 Jahr bei 68,3 (±17,3) auf der betroffenen Seite, seitenadaptiert wurden 79% erreicht. Der Anteil der 4-Segment-Frakturen lag bei 60%. Bei 4 Patienten beobachteten wir eine partielle Humeruskopfnekrose ohne Therapiekonsequenz. Implantatentfernungen waren in 5 Fällen wegen überstehender Schrauben oder vorstehendem proximalem Nagelende nötig. Mit den modernen Verriegelungsmarknägeln ist eine Gewebe schonende und sehr stabile Versorgung der proximalen Humerusfrakturen möglich.     

Okulokutane Hypopigmentierung und thrombozytäre Gerinnungsstörung

Ohne Zusammenfassung     

Anforderungen des Infektionsschutzgesetzes an den Chirurgen

The German Infectious Disease Control Act of 2001 includes a modified regulation for reporting infectious diseases and infectious pathogens and new clauses for surveillance and infection control in medical institutions. For the first time, all health care facilities are obliged to conduct surveillance of nosocomial infections and multiresistant pathogens. This legal regulation including mandatory monitoring by local health departments aims at reducing the rates of nosocomial infection and frequency and dissemination of highly resistant pathogens. This article describes the effect of the Disease Control Act on surgical departments. Surveillance of postsurgical wound infection should lead to better understanding of the cause and effect of nosocomial infection and greater acceptance of high-quality hospital hygiene management.