119. Eine neue chirurgische Technik zur funktionsgerechten analen Sphincterersatzplastik im Kindesalter

Zusammenfassung In dem Bemühen, lange Wunden oder Narben weniger sichtbar erscheinen zu lassen, werden quer zur Wunde zusätzliche Incisionen und Hautresektionen vorgenommen. Auf die Technik der Versorgung halbmondförmiger Verletzungen wird eingegangen. Das Prinzip der Z-Plastik wird beschrieben.     

Alterations of Thymus Cortical Epithelium and Interdigitating Dendritic Cells but No Increase of Thymocyte Cell Death in the Early Course of Simian Immunodeficiency Virus Infection

The role of the thymus in the pathogenesis of simian acquired immunodeficiency syndrome was investigated in 18 juvenile rhesus monkeys (Macaca mulatto). The thymus was infected from the first week post-SIVmac inoculation, but the amount of virus-positive cells was very low (< 1 in 10⁴ T cells) as demonstrated by polymerase chain reaction and in situ hybridization. First morphological alteration was a narrowing of the cortex at 12 and 24 wpi. Morphometry revealed no increase of pyknotic T cells but a decrease of the proliferation rate and flow cytometry showed a reduction of the immature CD4⁺/CD8⁺ double-positive T cells. Ultrastructural analysis revealed vacuolization, shrinkage, and finally cytolysis of the cortical epithelial cells and the interdigitating dendritic cells. Immunofluorescence staining exhibited a widespread loss of cortical epithelial cells. This damage to the thymic microenvironment could explain the breakdown of the intrathymic T cell proliferation. It preceded fully developed simian acquired immunodeficiency syndrome and is therefore considered to play a major role in its pathogenesis.     

Growth of the uterus

BACKGROUND: The pattern of growth of the uterus was examined by ultrasound examinations of 358 girls who attended a paediatric endocrine outpatient department but were shown not to have any endocrine defect. METHOD: The uterus was measured in length and width at the cervix and at the fundus (cm). Endometrial thickness was measured (mm). Scans were divided by Tanner breast stage and the dimensions compared by one way analysis of variance (ANOVA, with the Student Newman Keuls post hoc test). RESULTS: There was an increase in uterine length, diameter of the fundus, and endometrial thickness at each breast stage from 1 to 5 (ANOVA, p < 0.05), and in the diameter of the cervix with each breast stage from 1 to 4 (ANOVA, p < 0.05). The ratio of the fundus to the cervix increased from 0.95 to 1.29 between breast stages 1 and 4. CONCLUSION: The onset of puberty is marked by an increase in the dimensions of the uterus and in endometrial thickness, but also by a change in the shape of the uterus from a tubular to a pear shaped organ.     

The role of the anaesthesiologist in the intra- and post-operative management of kidney transplant patients

Based on experiences with 256 kidney transplant operations in 239 patients over a period of ten years (18. 6. 1965 to 15. 4. 1975) the role of the anaesthesiologist as it had developed in our institution has been described. Some problems with regard to the anaesthetic management of living donors were discussed. The care of patients who, due to their deteriorating cerebral function, are potential donors was also described. An outline of the own anaesthetic management of the recipient has been given and alternative methods were mentioned. Some special points were specifically stressed like the choice of relaxants, fluid replacement, blood transfusion, diuretic treatment starting already intraoperatively.Good intensive care of the potential donor is of great importance for the function of the transplanted organ. Very important is also the postoperative treatment of the recipient, which in our institution is performed in a teamwork between anaesthesiologist, surgeon and nephrologist. Finally, the functional results of our own series are briefly demonstrated.     

Proctalgia Fugax in Patients with the Irritable Bowel, Peptic Ulcer, or Inflammatory Bowel Disease

One hundred forty-eight patients with gastrointestinal disease, 50 patients with the irritable bowel syndrome (IBS) and 49 each with peptic ulcer and inflammatory bowel disease, were interviewed to determine if they had proctalgia fugax (PF) and if the symptom was associated with the IBS. One-third of the patients had PF. It occurred in 51% of females and 12% of males (p less than 0.001). When corrected for sex, PF was no more prevalent in IBS than in peptic ulcer or inflammatory bowel disease. Only two of six previously described IBS symptoms were more prevalent in the PF patients. Attacks occurred in the day in 94%, and one-third of sufferers related them to defecation. The pain was localized in the anus in 90%, occurred less than five times a year in 51%, and lasted less than 1 min in 57%. In most, activity was not interrupted by this pain and only 20% had ever reported it to a physician. PF is very common among patients with abdominal symptoms, but is not related to the IBS. Since it is infrequent, benign, and transient, PF is usually not mentioned to the physician.