Role of minimally invasive surgery for rectal cancer

Rectal cancer is one of the most common malignancies worldwide.Surgical resection for rectal cancer usually requires a proctectomy with respective lymphadenectomy(total mesorectal excision).This has traditionally been performed transabdominally through an open incision.Over the last thirty years,minimally invasive surgery platforms have rapidly evolved with the goal to accomplish the same quality rectal resection through a less invasive approach.There are currently three resective modalities that complement the traditional open operation:(1) Laparoscopic surgery;(2) Robotic surgery;and(3) Transanal total mesorectal excision.In addition,there are several platforms to carry out transluminal local excisions(without lymphadenectomy).Evidence on the various modalities is of mixed to moderate quality.It is unreasonable to expect a randomized comparison of all options in a single trial.This review aims at reviewing in detail the various techniques in regard to intra-/perioperative benchmarks,recovery and complications,oncological and functional outcomes.     

Two cases of autochthonous Plasmodium falciparum malaria in Germany with evidence for local transmission by indigenous Anopheles plumbeus

Autochthonous Plasmodium falciparum malaria (PFM) in Central Europe has been reported repeatedly, transmission of the parasite being attributed to blood transfusion or imported P. falciparum-infected vectors. We report two cases of PFM in German children without travel history to malaria-endemic areas. Both infections occurred during a stay in a hospital where a child from Angola with chronic P. falciparum infection was hospitalized at the time. Known routes of transmission, such as imported mosquitoes or blood transfusion, were very unlikely or could be excluded, whereas evidence was obtained for transmission by the indigenous mosquito species Anopheles plumbeus.     

Differences in Long-term Mortality for Different Emergency Department Presenting Complaints

Objectives: To characterize long‐term mortality based on previous emergency department (ED) presenting complaints. Methods: The authors followed, for 10 years, all of the 12,667 nonsurgical patients visiting an ED during 1995/1996. Differences in standardized mortality ratio (SMR) depending on presenting complaints were then investigated. Results: During follow‐up, 5,324 deaths occurred (mortality rate 6.6 per 100 person‐years at risk), giving a SMR of 1.33 (95% CI = 1.30 to 1.37, p < 0.001) when compared with the expected mortality in the catchment area. Different presenting complaints were associated with different long‐term mortality rates, independent of age and gender (p < 0.0001). The subjects with seizures had the highest SMR (2.62, 95% CI = 2.13 to 3.22) followed by intoxications (2.51, 95% CI = 2.11 to 2.98), asthmalike symptoms (1.84, 95% CI = 1.65 to 2.06), and hyperglycemia (1.67, 95% CI = 1.42 to 1.95). The largest complaint group, chest pain, had a 20% higher mortality rate than the background population (95% CI = 1.13 to 1.26). Patients with a discharge diagnosis of myocardial infarction, but without chest pain as the presenting complaint, had an increased long‐term mortality (hazard ratio [HR] 1.70, 95% CI = 1.15 to 2.42) compared to the group with chest pain. In contrast, stroke patients without strokelike symptoms had a reduced mortality (HR 0.74, 95% CI = 0.65 to 0.84) compared to patients with strokelike symptoms. Conclusions: Long‐term age‐ and gender‐adjusted mortality is the highest with seizures out of 33 presenting complaints and differs markedly between different ED admission complaints. Furthermore, depending on the admission complaint, long‐term mortality differs within the same discharge diagnosis. Hence, the presenting complaint adds unique information to the discharge diagnosis regarding long‐term mortality in nonsurgical patients.     

Characterization of Mutants of the Vitamin-D-Binding Protein/Group Specific Component: GC Aborigine (1A1) from Australian Aborigines and South African Blacks, and 2A9 from South Germany

The structure and organization of the human vitamin-D-binding protein gene (DBP, group-specific component, GC) have recently been determined. Each ex-on may now be amplified by the PCR method using oligonucleotide primers deduced from the intron sequences near their 5' ends and 3' ends. In this study we examined the anodal GC variants 1A1 and 2A9. Genomic DNA of the variant 1A1 was obtained from Australian Aborigines and from South African Bantu-speaking Blacks. Amplification and sequencing of exon 11 of 1A1 revealed a point mutation in codon 429 at the second position. It is remarkable that this mutation was found in the Australian 1A1 variant and in the African 1A1 variant, and raises the question whether the mutation in these two ethnic groups has a common origin. Genomic DNA of the 2A variant called 2A9 was obtained from South Germany and a point mutation also concerning position 429 in exon 11 was found. The nucleotide exchange in this case, however, was at the first position of the codon. The widely distributed genetic polymorphism of DBP/GC is located in exon 11 and is characterized by substitution at amino acid positions 416 and 420. Variant 1A1 is due to a second site mutation of the allele GC*1F; variant 2A9 is due to a mutation in the GC*2 allele.     

Elevated adiponectin serum levels in patients with chronic alcohol abuse rapidly decline during alcohol withdrawal

Background:  Adiponectin is a circulating protein with hepatoprotective effects.
Aims:  To study the relationship of excessive alcohol consumption and serum adiponectin levels (SAL).
Patients and Methods:  The SAL were determined in (i) heavy drinkers without advanced liver damage during the course of alcohol withdrawal, (ii) patients with chronic hepatitis C virus (HCV) infection, (iii) patients with alcohol-associated cirrhosis, and (iv) healthy volunteers that consumed excessive amounts of alcohol for only a short period of time. Further, primary human hepatocytes (PHH) and adipocytes were incubated in vitro with alcohol or serum of patients.
Results:  Patients with chronic alcohol consumption had significantly higher SAL than HCV-patients with comparable degrees of liver damage. In alcoholics, but not in HCV patients, SAL positively correlated with serum levels of aminotransferases. Further, SAL correlated with the amount of alcohol consumption but declined during the course of alcohol abstinence. After short-term excessive alcohol consumption SAL were not elevated in healthy individuals. Adiponectin mRNA was detectable in adipocytes but not in hepatocytes, and alcohol failed to induce adiponectin in both cell types. In contrast, serum of active drinkers induced adiponectin expression in adipocytes while serum from the same individuals collected after alcohol withdrawal had no effect.
Conclusions:  Alcohol exhibits a specific effect on SAL that is dose and time dependent, and correlates with the degree of hepatic damage. Alcohol does not seem to affect adiponectin expression directly in adipocytes but potentially via mediators systemically released as a result of the chronic alcohol intake.     

Effects of antibodies against octreotide in two patients with acromegaly

Two patients developed specific IgG antibodies against octreotide after 2-3 years' treatment for acromegaly with this long acting somatostatin analogue. The presence of these antibodies reduced the plasma disappearance rate of total extractable octreotide by 60 and 80% respectively. When compared to that of non-immune acromegalic patients, the plasma half-life of octreotide in these two patients was 300 and 450 vs 110 min in those with no detectable octreotide antibodies. The sole observed consequence of the immunization was a marked prolongation of the interval of maximum GH inhibition from a mean of 5 to 8 and 10 h in the two patients described after octreotide injection.     

Effectiveness of subgingival instrumentation with power-driven instruments in the hands of experienced and inexperienced operators

Abstract Power instrumentation of periodontally-diseased root surfaces is gaining in significance as an alternative to conventional curette methods. In an experimental study employing manikins with simulated bone loss, we investigated whether inexperienced and experienced operators were able to achieve greater therapeutic success with power-driven devices than with hand instruments in subgingival scaling. 10 dentists experienced in periodontal treatment and 10 inexperienced dentists instrumented 7 teeth in the upper jaw, which had been covered with artificial deposits. Hand instruments, the Perioplaner system, a sonic and an ultrasonic sealer were used. The time required for treatment was measured and the % of residual deposits was calculated by means of image-processing techniques. Weight loss was also determined for the teeth that were scaled with the hand instruments and the Perioplaner system. Experienced operators left significantly less % of residual deposits on the teeth (18±7.6%) than the inexperienced (27±8.4%), regardless of the type of instrument selected. Both experienced and inexperienced operators left the smallest amounts of residual deposits with hand instruments (13±9.8%/24±9.5%). Both treatment groups removed more hard tooth structure with hand instruments than with the Perioplaner system (53±48mg versus 47±25.9 mg). Experienced operators needed somewhat more time for debridement than unexperienced. Use of the sonic/ultrasonic device required somewhat less time than hand instrumentation. Inexperienced operators are however, unable to improve their treatment results by using the power-driven instruments included in the study.     

Restoration of Lateral Hand Grasp Using Natural Sensors

Abstract: A closed-loop control system for controlling the key grip of a C6 tetraplegic patient was developed. Natural sensors served as the source of the feedback signal. The neural signals from cutaneous receptors were picked up by an implanted cuff electrode placed around the radial branch of the median nerve innervating the lateral part of the index finger. Mechanical stress applied to the skin, like pressure and slips, resulted in an increase in amplitude of the recorded neural signal. The goal of the study was to determine whether the recorded neural signals were able to indicate the slip of an object during lateral grasp and whether the slip could be stopped by increasing the grasp force through functional electrical stimulation of the thumb adductor and flexor.     

Measuring left ventricular function after heart transplantation via digitization of M-mode echocardiograms

Abstract The aim of the study was to assess the usefulness of M-mode echocardiography for noninvasive diagnosis of cardiac rejection. For this purpose, 292 M-mode images of 26 heart transplant recipients were analyzed. The echocardiographic images were digitized into an image analysis system. The curves of left ventricular diameter changes were obtained and its first differential calculated. A total of 23 parameters were measured. The most important parameters were: peak velocity of systolic diameter change, peak velocity of diastolic diameter change, time to peak velocity of systolic diameter change, time to peak velocity of diastolic diameter change (TPEAK-D), isovolumetric relaxation time (IVRT), rapid filling time (RFT), shortening fraction (SF), and mean velocity of circumferential fiber shortening (MVCF). The echocardiographic parameters were compared to biopsy results. In 18 patients, 23 biopsy-proven moderate rejections occurred. When rejection occurred, IVRT decreased 23%± 6% ( P <0.05), SF decreased 13%± 14% ( P <0.05), MVCF decreased 18%±18% ( P < 0.05, and TPEAK-D increased 27%± 27% ( P <0.05). We concluded that the analysis of digitized M-mode images can identify heart transplant rejection.