Pankreas annulare

Zusammenfassung Mitteilung über 4 operierte F?lle von Pankreas annulare aus dem eigenen Krankengut. In 2 neonatalen F?llen mit dem Bild der Duodenalatresie konnte durch Duodenoduodenostomie eine Heilung erzielt werden. Auf die Wichtigkeit der rechtzeitigen Diagnosestellung wird hingewiesen. In 2 F?llen bei Erwachsenen waren Schmerzen, Erbrechen und Gewichtsverlust die wichtigsten Symptome. Die Diagnose wurde trotz mehrfacher vorangegangener Operationen und zahlreicher Voruntersuchungen erst nach Jahren gestellt. Zur Behandlung kam einmal die Duodenoduodenostomie, einmal die Duodenopankreatektomie erfolgreich zur Anwendung.

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Summary This is a report on 4 operated cases of annular pancreas. In 2 neonatal cases this condition presented symptoms of a complete duodenal obstruction. Duodenoduodenostomy and temporary gastric decompression by gastrostomy was performed in both cases and has proved to be satisfactory. The importance of an early diagnosis has been emphasized. In 2 adult cases the most pronounced symptoms were pain, vomiting and loss of weight. In spite of several previous operations of the abdomen and frequent examinations the correct diagnosis was not made for years. One case was treated successfully by duodenoduodenostomy, in the second case because of pancreatic fibrosis a duodenopancreatectomy was necessary.

     

Ein Catgutfaden als Ursache einer Gallensteinbildung nach transduodenaler Papillenspaltung

Zusammenfassung Es wird über einen Fall berichtet, bei dem es durch Inkrustation eines Catgutfadens zur Gallensteinbildung in den tiefen Gallenwegen gekommen war.

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Summary We report on a case in which incrustation of a plain catgut thread caused the formation of a gallstone in the common bile duct.

     

Endarterektomie mit Ultraschall

Zusammenfassung Die Wirksamkeit des Ultraschalles zur Endarterektomie wurde bei der offenen Aussch?lung von Leichenaorten überprüft. Ultraschall hat gegenüber konventionellen Aussch?lmethoden wesentliche Vorteile. Die Aussch?lwirkung des Ultraschalles beruht nicht auf einem Vibrationseffekt, sondern auf der Kavitation, die Ultraschall in der Aussch?lebene hervorruft.     

Die Bedeutung der Süchtigkeit für die Indikationsstellung zu schmerzchirurgischen Eingriffen

Zusammenfassung Die Medikamentensucht ist eine schwere Erkrankung, die sowohl den postoperativen Verlauf als auch das Ergebnis schmerzchirurgischer Eingriffe beeinflussen kann. Eine Nachuntersuchung von 136 Chordotomien, darunter waren auch 30 süchtige Patienten, ergab, da? beide Gruppen wohl die im wesentlichen gleiche Aussicht haben, durch den Eingriff schmerzfrei zu werden, jedoch ist die Zahl der Mi?erfolge in der Gruppe der süchtigen Patienten au?erordentlich hoch. Die Süchtigkeit ist unseres Erachtens keine absolute Kontraindikation zu einer Chordotomie, mu? jedoch als ein erh?htes Operationsrisiko berücksichtigt werden. Vor der beabsichtigten Operation sollte bekannt sein, da? der Patient süchtig ist und die „stabilisierende Dosis” des Suchtgiftes sollte ermittelt werden, die in der Lage ist, das Auftreten des Abstinenz-Syndroms zu verhindern. Vegetative St?rungen, Stoffwechselst?rungen, St?rungen im Flüssigkeitshaushalt sowie eine Unterern?hrung, die bei Suchtkranken, auftreten k?nnen, müssen pr?operativ entsprechend behandelt werden. Im Hinblick auf die Suchtgef?hrdung bei Patienten, die an starken chronischen Schmerzen leiden, sollte man sich frühzeitig zu einer Chordotomie entschlie?en.

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Summary Drug addiction is a grave disease which may influence the postoperative course as well as the result of cordotomies. An examination of 136 cordotomies, including 30 patients with drug addiction, showed that both groups had essentially the same chance to be relieved from their pains, that however, the number of failures was especially high in the group of drug addicts. The preexistence of drug addiction is not necessarily a contraindication for cordotomy, it should however be considered as a greater risk for an operation. Before a cordotomy it should be known that the patient is a drug addict, furthermore it is necessary to find out the „stabilizing dose” of the drug which may prevent an abstinence-syndrom. The manifold disturbances (vegetative, fluid-balance, malnourishment and metabolism) which may occur with drug addicts, have to be treated accordingly before the planned operation. In view of the fact that patients suffering from severe chronical pain, may likely become drug-addicted, one should decide to make a cordotomy at an early sage.

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Nach einem Vortrag am Neurochirurgischen Diskussionstag, 26. Oktober 1968, Salzburg.     

Sensory gating deficits during the mid-latency phase of information processing in medicated schizophrenia patients

Sensory gating during preattentive phases of information processing has been extensively examined. Sensory gating processes that occur during subsequent phases of information processing have not been fully examined. The relationship between P50 sensory gating and schizophrenia symptoms remains underspecified and the clinical correlates of N100 and P200 gating are yet to be examined. Sensory gating indices derived from the mid-latency auditory evoked responses during preattentive (P50) and attentive (N100, P200) phases of information processing were collected from schizophrenia patients who were stable and mainly being treated with atypical antipsychotic medications (n=23) and age- and gender-matched healthy control subjects (n=23). Schizophrenia patients had demonstrable habituation or sensory gating difficulties throughout the mid-latency range of information processing. Moreover, we found no correlations between P50-derived sensory gating indices and the amplitude or latency of the more attention-related P300 evoked response. A number of N100 and P200 gating measures correlated with P300 variables. Finally, we found no correlations between sensory gating indices and schizophrenia symptoms clusters. These results suggest that sensory gating is a pervasive abnormality in schizophrenia patients that is not limited to the preattentive phase of information processing. Furthermore, the data suggest that N100 and P200 gating indices may influence subsequent information processing.     

A comparison of the therapeutic efficacy and tolerability of etoricoxib and diclofenac in patients with osteoarthritis

OBJECTIVE: To evaluate and compare the efficacy and tolerability of etoricoxib and diclofenac in patients with osteoarthritis of the knee or hip. METHODS: In this 6-week double-blind, active comparator controlled, parallel-group study eligible osteoarthritis patients were randomised to receive either etoricoxib 60 mg once daily (n = 256) or diclofenac 50 mg three times daily (n = 260). The primary study endpoint was the Western Ontario McMaster osteoarthritis index (WOMAC) pain subscale. Other endpoints included were the WOMAC stiffness and physical function subscales, and the Patient's Global Assessment of Response to Therapy (PGART) questionnaire. Early efficacy was evaluated using WOMAC first question (pain walking on a flat surface) and PGART 4 h after the morning dose of each drug on days 1 and 2. Rescue medication (paracetamol) used was also recorded. The study was designed to show comparable efficacy between etoricoxib 60 mg once daily and diclofenac 50 mg three times daily with respect to the primary endpoint and was conducted outside the United States at 67 centres in 29 countries. RESULTS: Etoricoxib (60 mg once daily) was comparable in efficacy to diclofenac (150 mg daily) on all the above parameters. The one exception was in the assessment of early efficacy where etoricoxib demonstrated significantly greater benefit within 4 h of taking the first dose on the first day of therapy (p = 0.007) as evaluated by the percentage of patients with good or excellent (PGART) responses. The treatment effects of both drugs were similar by the time day 2 was reached and were sustained throughout the 6 weeks of therapy. Both treatments were generally well tolerated. CONCLUSIONS: Etoricoxib is clinically effective in the therapy of osteoarthritis providing a magnitude of effect comparable to that of the maximum recommended daily dose of diclofenac. The onset of clinical benefit with etoricoxib on day one is more rapid than that of diclofenac. Both drugs were generally well tolerated.     

Maternal Tetanus at the University College Hospital in Ibadan Nigeria: A 15-Year Retrospective Analysis

Objective To determine the characteristics of women with maternal tetanus, pattern of presentation and outcome of management. Methods A total of 19 women were managed with maternal tetanus between 1990 and 2005 from the University College Hospital in Ibadan Nigeria. A retrospective study was performed. The medical records of all women managed as a case of maternal tetanus were retrieved from the central record department of the hospital. The pattern of presentation, characteristics of women, the duration of hospital admission, tetanus toxoid immunization, and outcome of care were measured. Results The records of 18 women managed were analyzed. The mean age at presentation was 25.2 ±5.3 years. The patients were mostly single, nulliparous and had primary school education. The maternal tetanus cases seen mainly complicated induced abortion while 5 and 2 other cases were due to childbirth complication and leg wound respectively. The portal of entry of the remaining 3 cases could not be ascertained. None of the patient managed had complete immunization schedule. The average duration of admission was 11.2 ± 6. 7 d. Five women had intensive care with 3 of them requiring ventilatory support. The case fatality rate was 66. 7%. The only factor that significantly improved survival was presence of generalized spasm at presentation （P=0.006） Conclusion The occurrence of maternal tetanus is a reflection of low quality of health care delivery and lack or inefficient routine immunization coverage in any community.     

Telethermographische Untersuchungen der Wundnaht im Tierexperiment

It is known from clinical practice that the healing of wounds is influenced by the type of wound suture applied. In general, the scar resulting from an intracutaneous suture looks better than that produced by an uninterrupted suture or by knotted suture. With respect to the appearance of the scar, the intracutaneous suture is normally superior to other wound sutures. As suggested by the results of our investigations, this may be due to an undisturbed microcirculation within the wound. Thermovision shows that a local temperature increase appears sooner in a wound closed by intracutaneous suture, whereas the temperature increases more slowly in case of uninterrupted or knotted suture. We suppose that the alterations of microcirculation in a wound closed by one of the latter types of wound suture can be considered as disturbance in blood circulation which may be followed by healing disturbances and proliferations of connective tissue.