Endoskopische Vakuumtherapie bei Perforationen und Anastomoseninsuffizienzen

Anastomotic leakage in the upper and lower intestinal tract is associated with high morbidity and mortality. Endoscopic vacuum-assisted closure (EVAC) is a new innovative endoscopic therapy option. Initially this treatment modality was applied in rectal insufficiencies but EVAC has also been successfully applied for the treatment of intrathoracic anastomotic leakage. Additional indications for the application of EVAC, such as necrotizing pancreatitis are expected to be developed in the near future.     

Successful treatment of cervical esophageal leakage by endoscopic-vacuum assisted closure therapy

AIM: To evaluate the efficacy and safety of endoscopic-vacuum assisted closure (E-VAC) therapy in the treatment of cervical esophageal leakage.METHODS: Between May and November 2012, three male patients who developed post-operative cervical esophageal leakage were treated with E-VAC therapy. One patient had undergone surgical excision of a pharyngo-cervical liposarcoma with partial esophageal resection, and the other two patients had received surgical treatment for symptomatic Zenker’s diverticulum. Following endoscopic verification of the leakage, a trimmed polyurethane sponge was fixed to the distal end of a nasogastric silicone tube and endoscopically positioned into the wound cavity, and with decreasing cavity size the sponge was positioned intraluminally to cover the leak. Continuous suction was applied, and the vacuum drainage system was changed twice a week.RESULTS: The initial E-VAC placement was technically successful for all three patients, and complete closure of the esophageal leak was achieved without any procedure-related complications. In all three patients, the insufficiencies were located either above or slightly below the upper esophageal sphincter. The median duration of the E-VAC drainage was 29 d (range: 19-49 d), with a median of seven sponge exchanges (range: 5-12 sponge exchanges). In addition, the E-VAC therapy reduced inflammatory markers to within normal range for all three patients. Two of the patients were immediately fitted with a percutaneous enteral gastric feeding tube with jejunal extension, and the third patient received parenteral feeding. All three patients showed normal swallow function and no evidence of stricture after completion of the E-VAC therapy.CONCLUSION: E-VAC therapy for cervical esophageal leakage was well tolerated by patients. This safe and effective procedure may significantly reduce morbidity and mortality following cervical esophageal leakage.     

Sind sich Jugendliche über die Gefahren einer Hepatitis-B-Virusinfektion als Geschlechtskrankheit bewusst?

Background

No study has as yet investigated knowledge among adolescents about infectious diseases and liver diseases. The aim of this study was to investigate knowledge among German teenagers about hepatitis B, routes of HBV transmission, preventive measures and their vaccination status.

Material and methods

Altogether, 1262?students with a mean age of 14.28?years (SD 0.84; range 12–19; Gymnasium?=?high level secondary school n?=?625; Realschule?=?average level secondary school n?=?405; Hauptschule?=?low level secondary school, n?=?232) were interviewed using a standardized questionnaire.

Results

Knowledge among teenagers about hepatitis?B was highly heterogeneous. Although most students had already heard about hepatitis?B as a particular form of liver disease, 16% of students knew nothing at all about HBV. Importantly, less than half of students were aware that HBV infection can be acquired through drug abuse and sexual intercourse. In line with these findings only 30–40% knew that the use of condoms reduces the risk of HBV infection, irrespective of the level of education. Girls reported the possibility of vertical HBV transmission more often than boys (38% vs. 29%; p?=?<?0,001). That vaccination is a preventive measure against HBV was known to 80% of Gymnasium students but to only 67% of Realschule and 65% of Hauptschule students (p?<?0.001). Despite this knowledge about vaccination, only 40% of Hauptschule students knew whether that they had been vaccinated at least once. Girls knew their immunization status better than boys (56% vs. 49%; p?=?<?0.001).

Conclusion

Irrespective of school type, German adolescents show limited knowledge about the risk of HBV infection. Measures to increase awareness of preventive measures and vaccination for students with unknown vaccination status are recommended.