Results of long-term conditioning in patients with myocardial infarction during phase III rehabilitation

The active kinesitherapy is an essential constituent of the whole rehabilitation process of patients with infarction. Despite the decrease due to the physiology of ageing and the progression of the coronary disease the physical functional capacity can be kept relatively constant also over many years. Thus the quality of the patients' lives can be favourably influenced. Whether the life expectancy alone can be improved at long date by the active conditioning, further on remains unclarified. Aimed differentiated medication, psychosocial measures, the consideration of secondary bronchopulmonary diseases and the well-timed selection for the coronary-surgical intervention must be included into the process of complex rehabilitation of patients with myocardial infarction. In these cases diagnostics and therapy of the somatic risk factors must particularly be taken into consideration during the whole process of rehabilitation in order to decrease the progressing of the basic disease.     

Intraoperative Milzverletzung — Organerhaltung um jeden Preis?

Ohne Zusammenfassung Redaktion: J. R. Siewert Chirurgische Klinik und Poliklinik der Technischen Universität, Klinikum rechts der Isar, Ismaninger Straße 22, D-81675 München     

The impact of laparoscopy on bariatric surgery

The rising popularity of bariatric surgery over the past several years is attributable in part to the development of laparoscopic bariatric surgery. Morbidly obese patients have associated comorbid conditions that may predispose them to postoperative morbidity. The laparoscopic approach to bariatric surgery offers a minimally invasive option that reduces the physiologic stress and provides clinical benefits, as compared with the open approach. This review summarizes the impact of laparoscopic surgery on bariatric surgery, the various risk factors that could potentially predispose morbidly obese patients to postoperative morbidity, the fundamental differences between laparoscopic and open bariatric surgery, and the physiology of reduced tissue injury associated with laparoscopic bariatric surgery.     

Pharmacological properties of hydrophilic and lipophilic derivatives of octreotate

Derivatives of somatostatin (SST) represent the most important peptides for receptor targeting in oncological applications. Whereas the pharmacophor in somatostatin receptor-affine substances has been thoroughly investigated, the influence of modifications at the N-terminal has not yet been systematically studied. In order to investigate the influence of hydrophilic versus lipophilic modifications at the N-terminal end, a series of homologous derivatives of Tyr3-octreotate modified with oligomers of ethylene glycol or fatty acids were synthesized. For this purpose, Tyr3-octreotate was assembled using solid phase peptide synthesis and the fatty acids or oligomers of ethylene glycol were conjugated to the N-terminal end. The oligomers of ethylene glycol were activated by 4-nitrophenylchloroformate to obtain carbamate-linked hydrophilic compounds. The receptor affinities of these compounds were determined by competition experiments with [125I]Tyr3-octreotide on rat cortex membranes. The hydrophilic derivatives and the short chain lipophilic derivatives revealed IC50 values between 0.66 +/- 0.02 nM and 2.16 +/- 0.31 nM respectively. After labeling with (125)I the organ distribution of selected derivatives was investigated in Lewis rats bearing the rat pancreatic tumor CA20948. All of the compounds showed high tumor uptake. The peptides conjugated to oligomers of ethylene glycol showed low uptake into the liver and kidneys. Increasing the length of the fatty acids resulted in a remarkable decrease in kidney uptake. In conclusion, the systematic modifications at the N-terminal result in a low effect on the receptor affinity but allow the modulation of the pharmacokinetic properties of octreotide derivatives.     

Repair of ventral hernias in morbidly obese patients undergoing laparoscopic gastric bypass should not be deferred

Background: There is no consensus regarding the optimal treatment of ventral hernias in patients who present for weight loss surgery. Methods: Medical records of consecutive morbidly obese patients who underwent laparoscopic Roux-en-Y (LRYGB) gastric bypass with a secondary diagnosis of ventral hernia were reviewed. Only patients who were beyond 6 months of follow-up were included. Results: The study population was 85 patients. There were three groups of patients according to the method of repair: primary repair (59), small intestine submucosa (SIS) (12), and deferred treatment (14). Average follow-up was 26 months. There was a 22% recurrence in the primary repair group. There were no recurrences in the SIS group. Five of the patients in the deferred treatment group (37.5%) presented with small bowel obstruction due to incarceration. Conclusion: Biomaterial mesh (SIS) repair of ventral hernias concomitant with LRYGB resulted in the most favorable outcome albeit having short follow-up. Concomitant primary repair is associated with a high rate of recurrence. All incarcerated ventral hernias should be repaired concomitant with LRYGB, as deferment may result in small bowel obstruction. Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Los Angeles, CA, USA, 10–15 March 2003     

Should patients with a pre-operative prostatespecific antigen greater than 15ng/ml be offered radical prostatectomy?

Background Patients with prostate cancer with a pre-operative prostate-specific antigen (PSA) τ;15ng/ml who undergo radical retropubic prostatectomy (RRP) generally do not have a good outcome, yet may have organ-confined cancer and should be offered the option of surgery. Aim To assess the outcome of patients who underwent RRP with a pre-operative PSA ≥ 15ng/ml. Methods Thirty-four patients, mean pre-operative PSA: 25.46ng/ml (15.03–76.6) and mean Gleason score: 6.4 (5–9) were assessed. Results Two groups were identified. Group I: 41% (14/34) have no biochemical recurrence to mean follow up of 58 months (30–106). Mean PSA: 18.8ng/ml (15.03–25.84). Mean Gleason score: 6.1 (5–7). Clinical stage: T1c in 80%. No patient had seminal vesicle or lymph node involvement. Group II: 59% (20/34) have biochemical recurrence or died (3) from their disease to mean follow up of 66 months (36–98). Mean PSA: 28.9ng/ml (15.28–76.6). Mean Gleason score: 6.7 (5–9). Clinical stage: T1c in 25%. Eleven patients had seminal vesicle (8) involvement or positive lymph nodes (3) or both (2). Conclusion RRP seems feasible in patients whose pre-operative PSA is between 15 and 25ng/ml with stage T1c, Gleason score ≤ 7 and negative lymph node frozen section.     

Negative and positive childhood experiences across developmental periods in psychiatric patients with different diagnoses – an explorative study

Background  

A high frequency of childhood abuse has often been reported in adult psychiatric patients. The present survey explores the relationship between psychiatric diagnoses and positive and negative life events during childhood and adulthood in psychiatric samples.     

52-jähriger Patient mit subkutaner Raumforderung unter Immunsuppression

We report the case of a 52-years-old male patient, who was diagnosed with subcutaneous alveolar echinococcosis 6 months after liver transplantation for HCV-related cirrhosis. Nether the explanted nor the transplantated liver revealed an echinococcus focus. Therefore a rare primary extrahepatic manifestation was likely. Interestingly, the echinococcal larvae had developed protoscolices. The development of mature tapeworms in human is a rarity, which could be related to the immunosuppressive therapy after liver transplantation. The patient was curatively treated by surgical removal of the subcutaneous tumor and a postoperative therapy with albendazole. Furthermore, HCV reinfection (genotype 2b) was successfully treated with interferone alpha 2b and ribavirine for 6 months.     

Phenotypic healing of factor II deficiency by liver transplantation

Zusammenfassung Der inzwischen 41-j?hrige Patient litt seit früher Kindheit an ausgepr?gten Blutungen in den Weichteilen und Muskulatur nach inad?quaten Traumata, wobei es zu keinen wesentlichen intraartikul?ren Blutungen oder Arthrosen kam. Die PTT war auf ca. 60 sec erh?ht, der Quick-Wert war gleichzeitig auf etwa 20–25% erniedrigt, die Faktor-II-Analyse zeigte eine ausgepr?gte Hypoprothrombin?mie von 2%–5% an. Im weiteren Verlauf ben?tigte der Patient zur Behandlung seiner h?morrhagischen Ereignisse alle 2–3 Monate je 1000–2000 IE Prothrombinkomplexkonzentrate (PPSB). 1993 wurde eine Hepatitis-C-Infektion festgestellt, und 1998 wurde bei Leberzirrhose Stadium C nach den Child-Pugh-Kriterien ein echoarmer Rundherd mit Halo ohne Erh?hung des α-Fetoproteins und ohne Hinweis auf weitere Metastasen festgestellt. In der 1999 durchgeführten orthotopen Lebertransplantation best?tigte sich der Verdacht auf ein hepatozellul?res Karzinom. Postoperativ normalisierten sich der Quick-Wert und die PTT, und der Faktor-II-Spiegel lag konstant bei etwa 50–60%. Klinische Symptome eines Faktor-II-Mangels bestehen nicht mehr. Dieser Fallbericht untermauert die These, wonach Prothrombin vorwiegend in der Leber synthetisiert wird, und beweist, dass der angeborene Faktor-II-Mangel durch eine Lebertransplantation geheilt werden kann.