Laparoscopic splenectomy for idiopathic thrombocytopenic purpura

Background: Laparoscopic splenectomy is a novel approach for the treatment of idiopathic thrombocytopenic purpura (ITP) in patients requiring surgical intervention. This technique was used for treatment in 16 consecutive patients. Follow-up was initiated at a median of 13.5 months after surgery to determine whether or not laparoscopic splenectomy is a safe and successful procedure that should be used in all patients requiring splenectomy for ITP. Methods: Sixteen patients underwent laparoscopic splenectomy for ITP between May 1994 and September 1996. They were evaluated prospectively prior to surgery, immediately following surgery, at discharge, and at 13.5 months following surgery (n= 14) to determine the short- and long-term results of the procedure. Results: Mean operation time was 123.4 ± 12.1 min, and there were no significant intra- or postoperative complications. Mean intraoperative blood loss was 437.5 ± 73.5 ml. Autologous blood transfusion was necessary in one patient (6.3%). Mean organ weight was 202.2 ± 47.3 g. Mean postoperative hospital stay was 4.6 ± 0.4 days. Before discharge, mean platelet count rose by 100.7%. At follow-up (13.5 months postoperatively), it was 77.7% above preoperative values. No additional surgery was necessary in any of the patients undergoing laparoscopic splenectomy, and hematologic success was achieved in 12 patients (85.7%). Conclusions: Our results clearly indicate that laparoscopic splenectomy is a safe and successful procedure in patients suffering from ITP. It offers the well-known advantages of minimal invasive surgery as well as the surgical effectiveness of the open approach. This surgical technique should therefore be considered in all patients requiring splenectomy for the treatment of ITP.     

Antirefluxchirurgie in Deutschland Ergebnisse einer repr?sentativen Umfrage mit Analyse von 2.540 Antirefluxoperationen Ergebnisse einer repr?sentativen Umfrage mit Analyse von 2.540 Antirefluxoperationen

Einleitung. Mittels einer repr?sentativen Umfrage soll der aktuelle Stand der Antirefluxchirurgie in Deutschland analysiert werden.     

Thrombectomy after unsuccessful thrombolytic therapy of deep leg vein thromboses: an effective procedure?]

Lysis of acute thromboses of the pelvic and deep lower leg veins is not always successful. According to the literature, 11-20% of the cases remain occluded. In such cases the majority of authors continue therapy with anticoagulants (heparin, dicumarol). 31 thromboses which had been unsuccessfully treated by lysis were subsequently thrombectomized after a few hours. All external iliac veins could be opened. The amount of occluded common iliac veins could be reduced from 94% to 16%. In 19% a stenosis due to a venous spur remained. The complete patency rate of the extremity veins could be improved by 55%. This shows that a marked improvement of the primary patency rate could be reached despite the failed lysis. This is a prerequisite of a favourable longtime result. An evaluation of the late results is planned and will be published at a later date.     

Epicardial lipoma--a rare differential diagnosis in cardiovascular medicine

Cardiac lipomas are benign tumours that represent an uncommon cause of chest discomfort. We report the case of a 52-year-old woman who was admitted to our institution with a mediastinal mass. Computed tomography and magnetic resonance imaging scans revealed an intrapericardial mass mainly located around the left atrium/left ventricle. After midline sternotomy, the pericardial mass was entirely resected after luxating the heart into the right pleural space. Histopathological examination confirmed the diagnosis of two intrapericardial lipomas with a total weight of 122 g.     

Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second- and current third-generation self-expanding CoreValve prosthesis: device success and 30-day clinical outcome.

OBJECTIVES: We sought to determine both the procedural performance and safety of percutaneous implantation of the second (21-French [F])- and third (18-F)-generation CoreValve aortic valve prosthesis (CoreValve Inc., Irvine, California). BACKGROUND: Percutaneous aortic valve replacement represents an emerging alternative therapy for high-risk and inoperable patients with severe symptomatic aortic valve stenosis. METHODS: Patients with: 1) symptomatic, severe aortic valve stenosis (area <1 cm2); 2) age > or =80 years with a logistic EuroSCORE > or =20% (21-F group) or age > or =75 years with a logistic EuroSCORE > or =15% (18-F group); or 3) age > or =65 years plus additional prespecified risk factors were included. Introduction of the 18-F device enabled the transition from a multidisciplinary approach involving general anesthesia, surgical cut-down, and cardiopulmonary bypass to a truly percutaneous approach under local anesthesia without hemodynamic support. RESULTS: A total of 86 patients (21-F, n = 50; 18-F, n = 36) with a mean valve area of 0.66 +/- 0.19 cm2 (21-F) and 0.54 +/- 0.15 cm2 (18-F), a mean age of 81.3 +/- 5.2 years (21-F) and 83.4 +/- 6.7 years (18-F), and a mean logistic EuroSCORE of 23.4 +/- 13.5% (21-F) and 19.1 +/- 11.1% (18-F) were recruited. Acute device success was 88%. Successful device implantation resulted in a marked reduction of aortic transvalvular gradients (mean pre 43.7 mm Hg vs. post 9.0 mm Hg, p < 0.001) with aortic regurgitation grade remaining unchanged. Acute procedural success rate was 74% (21-F: 78%; 18-F: 69%). Procedural mortality was 6%. Overall 30-day mortality rate was 12%; the combined rate of death, stroke, and myocardial infarction was 22%. CONCLUSIONS: Treatment of severe aortic valve stenosis in high-risk patients with percutaneous implantation of the CoreValve prosthesis is feasible and associated with a lower mortality rate than predicted by risk algorithms.     

Die klinische Relevanz biochemischer Parameter für die Diagnose, Prognose und Therapie polytraumatisierter Patienten

Zusammenfassung Trotz zunehmender Erfahrung in der Diagnostik und Therapie polytraumatisierter Patienten ist die Rate der schweren sp?ten Komplikationen, wie z.B. Multiorganversagen und Sepsis, nahezu unver?ndert hoch geblieben. Etablierte anatomische und physiologische Scores sind bisher nicht in der Lage, prospektiv eine valide Aussage bezüglich Verlauf und Prognose für den einzelnen Patienten als Entscheidungshilfe für die weitergehende Therapiestrategien zu treffen.    Obwohl einige vielversprechende Daten aus Pilotstudien vorliegen, wurde bisher für keinen Parameter eine signifikante Bereicherung des diagnostischen Entscheidungsbaumes gegenüber traditionellen Beurteilungskriterien wie Blutverlust, Schockindex und -dauer, TRISS oder APACHE Score nachgewiesen.    Zur Verbesserung der Verlaufsbeurteilung und der Prognoseabsch?tzung polytraumatisierter Patienten ist am ehesten eine Kombination von anatomischen und physiologischen Scores erg?nzt durch einzelne biochemische Parameter zu erw?gen. Auch innovative diagnostische Methoden, wie z.B. die Immunstatusbestimmung auf der Basis der Einzelzelldiagnostik, müssen in der Klinik erprobt werden. An bisher etablierten Mediatoren mit signifikanter Bereicherung im klinischen Alltag sind derzeit lediglich Interleukin-6, Procalcitonin, HLA-DR und Neopterin zu nennen. Eingegangen: 17. August 2001 Akzeptiert: 26. September 2001