Detection of varicella zoster virus infections using polymerase chain reaction]

The polymerase chain reaction (PCR) was used to detect varicella zoster virus (VZV) DNA in vesicle samples from patients with varicella and zoster. Primers and the oligonucleotide probe were chosen from the region of the immediate early gene 63. Procedures for preparing the DNA from the specimens were omitted, and the amplified DNA was directly detected in ethidium bromide-stained polyacrylamide or agarose gels, thus providing a rapid and less laborious assay. A total of 66 vesicle specimens including 3 crusts (collected on days 1-14 after the onset of exanthem) were tested by the simplified VZV-PCR, and 64 (97%) were positive. When the direct visualization of the amplified DNA was confirmed by DNA hybridization, a non-radioactive hybridization assay involving a digoxigenin-labelled oligonucleotide probe and detection by chemiluminescence proved as adequate as a radioactive hybridization assay. Thus, the VZV PCR described appears to be a useful diagnostic test for detecting and identifying varicella zoster virus.     

Zentrale Gallengangskarzinome

Surgical resection provides the only chance of cure for patients suffering from hilar cholangiocarcinoma. Due to the central anatomic localization within the liver hilum, established guidelines of oncologic surgery are difficult to apply. Resection of the hilar bifurcation alone or in combination with limited hepatic resection can be performed with low morbidity and low mortality but shows a high rate of local tumor recurrence. Usually, extended resection is required to achieve adequate safety margins. Right trisectionectomy complies best with the basic rules of oncologic surgery while allowing the maximum safety margin. The 5-year survival rates reported after right trisectionectomy range between 20% and 40% and reach 59% in selected patients. The increasing experience with living donor transplantation and recent advances in neoadjuvant tumor therapy may lead to renewed discussion of liver transplantation in hilar cholangiocarcinoma.     

Mindestmengen aus thoraxchirurgischer Sicht

The dependence of operation lethality on hospital volume has been scientifically determined for thoracic surgery. Conclusions on the quality of the results are possible based on the structure and quality of the procedure. Minimum quantities for specialized centers in thoracic surgery have been established as 300 resectional operations on thoracic organs without mediastinoscopy, operations with the heart-lung machine, and thoracic drainage. Minimum quantities are necessary to uphold sufficient complication management by appropriate practice and experience and to keep operation lethality down. They are also needed for financing staff (at least two full-time active specialists in thoracic surgery). The concentration of thoracic surgical services at main hospitals (minimum 300 operations per year) and organ centers (minimum 500 resectional operations on thoracic organs per year) is reasonable for the 45,500 operations expected in Germany.