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.     

Heparininduzierte Thrombozytopenie

Heparin-induced thrombocytopenia (HIT) represents a serious side effect caused by an atypical immune response to platelet factor 4 leading to platelet activation and thrombin formation. These patients are at high risk of thromboembolism, with a rapid drop in platelet count between days 5 and 14 after the initiation of heparin treatment. In single cases, especially after major surgery, platelet count reduction might be absent or hidden by preceding thrombocytosis. Different clinical manifestations of HIT include unspecific skin reactions with potential necrosis at the site of heparin injection, mostly after the application of unfractionated heparin but also with low molecular weight heparin. In heparin-induced skin necrosis, administration of unfractionated or low molecular weight heparin is contraindicated and heparin therapy should be stopped immediately. Instead, an alternative anticoagulant in the form of a direct thrombin inhibitor such as argatroban, and respectively lepirudin, or danaparoid sodium must be administered. Due to frequent misinterpretations of heparin-induced unspecific skin reactions, especially in the absence of thrombocytopenia, we present two case reports which should increase the awareness of HIT’s various clinical pictures.     

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.     

Medizinische Beurteilungskriterien zu bandscheibenbedingten Berufskrankheiten der Lendenwirbelsäule (II)

The first part of this serial paper dealt with the medical criteria used in evaluation of the clinical picture caused by physical stress and the evaluation of other candidate causes and was published in issue no. 3/2005 (pp. 711–752) of Trauma and Berufskrankheit. This follow-up paper (II) presents criteria to be used in the evaluation of whether it is necessary to give up the occupations putting the spine at risk and in estimation of the degree of disability.     

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     

Cancer-related anemia

Anemia has a high prevalence in patients with cancer. Its frequency and severity depend on tumor type, tumor stage, duration of disease, and treatment status. The etiology of cancer-related anemia is multifactorial and includes myelotoxicity of treatment, bone marrow infiltration, impaired erythropoietin production, blood loss, and the anemia of chronic disease. Anemia affects health-related quality of life (QOL) and may impact on tolerance or even outcome of anticancer therapy. Despite its high prevalence and impact on QOL, anemia is often under-recognized and under-treated. Treatment should correct etiologic factors, whenever possible. Symptomatic treatments are red blood cell transfusions and administration of erythropoietic growth factors. Transfusions result in rapid improvement of anemia-related symptoms but are usually only given to patients with moderate to severe anemia. Administration of epoetins (epoetin alfa, epoetin beta) or darbepoetin alfa increases hemoglobin levels, reduces the need for blood transfusions, and improves QOL in patients with cancer-related anemia. Trials determining the exact association of anemia with both response to chemo(radio)therapy and survival are ongoing. Physicians should be aware of the clinical relevance of and treatment options for anemia in cancer patients.