Entstehung von Speiseröhrencarcinomen bei kardiomyotomierten Patienten

Zusammenfassung In einem Zeitraum von 20 Jahren kam es in sechs Fällen zu einem auf dem Boden einer Achalasie entstandenen Speiseröhrencarcinom. Von den sechs Patienten war bei vieren zuvor eine Hellersche Myotomie vorgenommen worden. Wir führten bei 50 vor 5–15 Jahren kardiomyotomierten Patienten eine endoskopische Kontrolluntersuchung durch und stellten fest, daß ein Zusammenhang zwischen der Dauer der dysphagischen Anamnese und dem Schweregrad der Schleimhautveränderungen besteht. Deshalb sind eine frühzeitige Therapie bei Achalasie und eine systematische Kontrolluntersuchung der kardiomyotomierten Patienten, wegen der erhöhten Entartungsgefahr, von besonderer Bedeutung.

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Development of esophageal carcinoma after cardiomyotomy

Summary During a 20 year period we observed that in six patients with carcinoma of the esophagus associated with achalasia, four patients had had a prior Heller operation. Fifty patients with achalasia of the esophagus took part in endoscopic and histologic surveillance 5–15 years after cardiomyotomy. We have found a correlation between the severity of histologic changes and the duration of symptoms before the operation. It seems reasonable to advise early therapy to avoid the development of a dilated, poorly emptying esophagus. Our results suggest that long-term regular surveillance of the patient with achalasia is essential even after surgical treatment.

     

Efficacy of a Three-Day Course of Azithromycin in the Treatment of Community-Acquired Pneumococcal Pneumonia. Preliminary Report.

Summary

Azithromycin is an azalide antibiotic with activity against many of the respiratory pathogens and with marked tissue affinity. In a prospective study, the efficacy of a short-course of azithromycin was evaluated in 25 patients with community-acquired pneumococcal pneumonia. Gram-positive diplococci were abundant in the sputum smears of all patients, and Streptococcus pneumoniae was isolated in the sputum cultures of 15; one patient had pneumococcal bacteremia, as well. Azithromycin was administered at a single dose of 1,000 mg on day 1, and 500 mg on subsequent days for a total of three days in 19 patients, five days in four patients, two and four days in one patient each. Defervescence occurred within 24 hours after the first dose. The overall clinical cure and bacteriologic eradication rates were 96% and 93%, respectively. One patient with pneumococcal bacteremia failed to respond and died in respiratory failure. Side-effects were encountered in three (12%) patients. In conclusion, three-day therapy with a total azithromycin dose of 1,500 mg seems effective and safe in patients with community-acquired pneumococcal pneumonia and no underlying pulmonary condition.     

Thoracic duct variations may complicate the anterior spine procedures

The aim of this study is to localize and document the anatomic features of the thoracic duct and its tributaries with special emphasis on the spinal surgery point of view. The thoracic ducts were dissected from nine formaldehyde-preserved male cadavers. The drainage patterns, diameter of the thoracic duct in upper, middle and lower thoracic segments, localization of main tributaries and morphologic features of cisterna chyli were determined. The thoracic duct was detected in all cadavers. The main tributaries were concentrated at upper thoracic (between third and fifth thoracic vertebrae) and lower thoracic segments (below the level of ninth thoracic vertebra) at the right side. However, the main lymphatic tributaries were drained into the thoracic duct only in the lower thoracic area (below the level of the tenth thoracic vertebra) at the left side. Two major anatomic variations were detected in the thoracic duct. In the first case, there were two different lymphatic drainage systems. In the second case, the thoracic duct was found as bifid at two different levels. In formaldehyde preservation, the dimensions of the soft tissues may change. For that reason, the dimensions were not discussed and they may not be a guide in surgery. Additionally, our study group is quite small. Larger series may be needed to define the anatomic variations. As a conclusion, anatomic variations of the thoracic duct are numerous and must be considered to avoid complications when doing surgery.     

Bilateral Epididymoorchitis Secondary to Brucellosis

International Urology and Nephrology -     

Verhinderung von Spätaborten und Frühgeburten

Operations at the uterine cervix to prevent miscarriages and preterm deliveries are based on two premises: (1) a cerclage can prevent premature opening of the cervix due to cervical incompetence and (2) operative occlusion of the cervical canal can prevent transcervical infections following incomplete narrowing of the internal os, insufficient mucous sealing of the cervix, or as a consequence of cervical lacerations. Cervical incompetence in the classic sense is an extremely rare finding. In women deemed to be at increased risk of cervical incompetence, cerclage was not found to prolong pregnancy significantly. It is still unclear whether cervical cerclage can improve outcomes of pregnancies in women with decreased cervical length or dilation of the internal os as detected by vaginal ultrasound. Indications and outcomes of the rare cervix occlusion operations have not as yet been studied in prospective randomized trials. In spite of this, some results suggest that women with a history of repeated miscarriages caused by ascending infections due to sealing deficits of the cervix may profit from an operation.