218. Perioperatives Risiko nach allgemeinchirurgischen Eingriffen: Erfahrungen mit einer Qualitätssicherung über 4 Jahre

Zusammenfassung Über 52 Monate wurden 4747 allgemeinchirurgische Planeingriffe prospektiv erfasst. Postoperative Komplikationen (Wundinfektion, Pneumonie, Revision, Letalität) wurden mit einem Punktescore bewertet, der die konkrete Zahl der zu erwartenden Komplikationen auf 10 Operationen der gleichen Art wiedergibt. Der Wert einer solchen Erfassung des Komplikationsrisikos zeigte sich in Verlaufsuntersuchungen, bei denen die postoperativen Komplikationen im 4-Monatsrhythmus aufgetragen wurden: Ursachen von Komplikationen konnten erforscht und beseitigt werden.     

Prolactinoma in the male

In a retrospective study the medical records of 13 male patients with macroprolactinomas were evaluated concerning anamnestic data, clinical, endocrinological and localisation-diagnostic findings as well as therapeutic measures. The main symptoms were disturbances of vision and impaired potency and impaired libido, respectively. The ophthalmological complaints nearly exclusively caused the patients to see the doctor. Clinically the signs of hypogonadism were found. The diagnosis was ascertained by increased serum prolactin levels, ophthalmological findings, X-ray of the sella, cranial computed tomography as well as angiography of the carotid. The operative treatment did not show any normalization of the serum prolactin levels. The rate of recidivations after exclusive operative treatment was high. An additional medicamentous therapy with dopamine agonists is nearly always necessary after operation. Whether or not bromocriptine shall be used as primary therapy, must be decided on in the individual case.     

The current status of intrapartum continuous fetal tissue pH measurements

Continuous tissue pH monitoring during labor has now been possible for 15 years. Tissue pH is measured in the intercellular fluid, and the value differs in some cases from the blood pH value because of local capillary flow and local metabolism. The fetal scalp seems to be an area where tissue pH and capillary blood pH values are very close, but in acute acidosis there may be a time lag of 10-15 min before tissue pH is equilibrated. Normal values of scalp tissue pH are 7.38 in early labor declining by 0.016 per hour during the first stage of labor and by 0.12 per hour during the second stage of labor. Tissue pH values below 7.15 are defined as pathological. The correlation coefficient to umbilical artery blood pH (0.71), success rate (67%) and electrode drift (below 0.04) from the largest study of tissue pH monitoring using glass pH electrodes (n = 337) are described.     

Injury of rat renal vessels following extracorporeal shock wave treatment.

The locations of extracorporeal shock wave treatment induced renal vascular injury and the sources of significant renal hemorrhage were determined in a rat model by means of two different vascular casting procedures. Silicone-rubber injected vascular preparations for light microscopy or corrosion casts for scanning electron microscopy were made following gross examination of the treated organs and their contralateral controls. After 1000 shock waves at 18 kV, five out of 20 treated kidneys appeared to be normal or minimally affected, while 15 showed gross evidence of marked vascular injury. Gross interstitial hemorrhage (15/20), subcapsular hematomas (7/20), and hemorrhages into the renal pelvis (5/20) were confirmed by extravasations of casting materials. These could be traced back to their vascular sources in several instances. Disruptions of interlobar and arcuate veins gave rise to most significant interstitial, subcapsular, and renal pelvic extravasations. On a microscopic scale cortical venules were among the most frequently injured vessels. The arterial vasculature was not spared. Arterial injury ranged from complete arcuate occlusion to small afferent arteriolar and glomerular capillary extravasations. The significance of shock wave induced vascular injury is discussed with respect to potential clinical side effects of ESWL.     

The efficacy of laparoscopic surgery in the diagnosis and treatment of peritonitis

Background: Peritonitis continues to be an important cause of morbidity and mortality and often an etiologic diagnosis is unclear. To evaluate the efficacy and safety of laparoscopy the authors analyzed their 5-year experience with this modality of treatment. Methods: A review was made of 107 consecutive nonselected laparoscopic procedures performed between October 1990 and November 1995. The diagnosis was established by clinical, laboratory, and imaging findings and confirmed by laparoscopy and/or laparotomy. Results: An etiologic diagnosis was unclear in 35% of the cases and was established in all by laparoscopy; 94 patients (87.9%) were successfully treated by laparoscopy while 13 (12.1%) required conversion. Mortality was 4.6%; 14% had postoperative complications and 7.4% had reoperations. Conclusions: Laparoscopic surgery is safe and very efficient in the diagnosis and treatment of patients with peritonitis. In most instances a definitive treatment can be carried out without conversion and has the additional and well-known advantages of minimally invasive surgery. Received: 15 March 1996/Accepted: 29 August 1996