Experimental study of antiseptic (tauroline, taurolidine) and antibiotic (sulmycin implant) drugs in vascular prosthesis infections in a standardized infection model

It was the aim to examine whether local application of antiseptic and antibiotic substances is an effective treatment of vascular graft infection. MATERIAL AND METHODS: 19 pigs with a bodyweight between 20 and 30 kg were assigned to three different groups. Group I: control (6), group II: local treatment with Sulmycin implant, group (6) III: local treatment with Taurolin (Taurolidine) (7). An unprotected vascular graft was inserted in the right femoral artery of all pigs. After finishing the proximal and distal anastomosis and prior to closure of the incision, the vascular grafts were contaminated locally with 2 x 10(7) CFU/ml Staphylococcus aureus ATCC 29213. Seven days later all animals received another unprotected vascular prosthesis with or without additional treatment according to groups I, II, III. 28 days after primary operation the animals were euthanized and the grafts harvested. The specimens were examined for signs of infection by histology and microbiology. RESULTS: After the primary operation all animals presented with infected vascular prosthesis. At termination of the trial on day 28 all grafts of group I were contaminated, 5 out of 6 grafts in group II, and 5 out of 7 in group III presented with infected grafts. There was no significant statistical difference between the groups. Infection could not be prevented by the antimicrobial agents used. The primary infecting organism Staphylococcus aureus, however, was eliminated in all cases. CONCLUSIONS: Both antimicrobial substances examined were not effective in the treatment of vascular graft infection, but might be used as adjuvant therapy of vascular graft infection, whereby Sulmycin implant seems to be more effective regarding the incorporation of the prosthesis.     

Cortisone cataract in children with nephrotic syndrome

In a group of 16 children with idiopathic nephrotic syndrome treated with corticosteroids for longer than 12 months, 9 developed a posterior subcapsular cataract (PSC). No correlation between the frequency of PSC and the duration of treatment and the total dose of treatment with steroids was demonstrable. However, the patients with PSC had received considerably higher average daily doses than those without PSC. Two patients with normal ophthalmologic findings at the end of treatment showed PSC 6 and 9 months later respectively. Only one patient acquired a signficant impairement of visus.     

Hydroxyethyl Starch (130 kD), but Not Crystalloid Volume Support, Improves Microcirculation during Normotensive Endotoxemia

Background: Increased leukocyte-endothelial cell interaction (LE) and deterioration of capillary perfusion represent key mechanisms of septic organ dysfunction. The type of volume support, however, which may be used during septic disorders, remains controversial. Using intravital microscopy, the authors studied the effect of different regimens of clinically relevant volume support on endotoxin-induced microcirculatory disorders, including the synthetic colloid hydroxyethyl starch (HES, 130 kD) and a crystalloid regimen with isotonic saline solution (NaCl).

Methods: In Syrian Golden hamsters, normotensive endotoxemia was induced by intravenous application of Escherichia coli lipopolysaccharide (LPS, 2 mg/kg). The microcirculation was analyzed in striated muscle of skinfold preparations. HES 130 kD (Voluven(R), 16 ml/kg, n = 7) or isotonic saline (NaCl, 66 ml/kg, n = 6) were infused 3 h after LPS exposure over a 1-h period (posttreatment mode). Animals receiving LPS without volume therapy served as control subjects (n = 8, control). LE, functional capillary density (FCD), and macromolecular leakage were repeatedly analyzed in the awake animals during a 24-h period using intravital fluorescence microscopy.

Results: HES 130 kD significantly reduced LPS-induced arteriolar and venular leukocyte adherence (P < 0.05), whereas NaCl resuscitation had no effect when compared with nontreated control animals. The LPS-induced decrease in FCD and increase in macromolecular leakage were also significantly attenuated by HES 130 kD but not by NaCl. Improvement of LPS-induced microcirculatory disorders by HES was unlikely the result of macro- and microhemodynamic changes because arterial blood pressure, heart rate, and venular wall shear rate did not differ between HES- and NaCl-treated animals.     

Postoperative Endoskopie zur Diagnose und Therapie von Komplikationen

Verschiedene endoskopische Verfahren sind wesentlicher Bestandteil der diagnostischen Sicherung und Therapie unterschiedlicher Komplikationen nach viszeral- sowie thoraxchirurgischen Operationen. Typische Indikationen für endoskopische Interventionen sind Nahtinsuffizienzen, Stenosen, Blutungen, Gallenwegsl?sionen und funktionelle Probleme nach Operationen. Am h?ufigsten zur Anwendung kommende Verfahren sind Fistelklebungen, Dilatationen und Bougierungen, Blutstillungstechniken, Gallenwegsinterventionen und Stentplatzierungen. Bei insgesamt sehr guten Erfolgsraten k?nnen mithilfe endoskopischer Techniken in der Mehrzahl der F?lle operative Reinterventionen vermieden und langwierige Verl?ufe abgekürzt werden. Führen die endoskopischen Bemühungen nicht zum Erfolg, sind keine Nachteile für anschlie?ende konventionell operative Ma?nahmen zu befürchten.     

Antirefluxchirurgie in Deutschland Ergebnisse einer repräsentativen Umfrage mit Analyse von 2.540 Antirefluxoperationen

INTRODUCTION: Aim of this study was the evaluation of antireflux surgery in Germany. METHODS: An anonymous questionnaire including 288 structured items about diagnostic and therapeutic approaches, complications and mortality was sent to 33% randomly selected German general surgeons (n = 546) at the end of 2000. RESULTS: A total of 2,540 antireflux procedures was reported, 81% were performed laparoscopically; 65% were total, 31% partial fundoplications. The number of surgeons offering laparoscopic antireflux surgery increased from 0.3% in 1990 to 5% in 1995 and to 32% in 2000. Numerous modifications regarding esophageal mobilisation, crural repair, kind and extension of the wrap, use and size of a bougie, as well as an additional gastropexy were observed. Morbidity rates were significantly higher for open than for laparoscopic procedures (15.0% vs. 7.7%), mainly caused by wound healing problems (4.4% vs. 0.8%) and splenic lesions (3.1 vs. 0.6%). Gastric and esophageal perforations were similar in both groups (1.1 vs. 0.9%). Hospital mortality rate was 0.1%. We observed a frequency dependent learning curve regarding complication rates after laparoscopic antireflux surgery (< 11 fundoplication p.a.: 14.0%; 11-30 fundoplications: 7.3% (p = 0.05); > 30 fundoplications: 4.2% (p = 0.05%). Long-term-dysphagia occurred more often after 360 degrees-versus partial fundoplications (6.6% vs. 2.4%; p < 0.001) and after Nissen/Nissen-Rossetti--than after Floppy-Nissen-procedures (6.6% vs. 3.6%, p = 0.1). The recurrency rate was 9.3% without significant differences between the procedures. CONCLUSION: Laparoscopy has replaced the open technique. Different technical approaches significantly affect the outcome after laparoscopic antireflux surgery in Germany.     

Primary gastrointestinal lymphomas

From 1980 up to 1987 seven patients with primary gastrointestinal lymphoma were treated at the surgical department of the Medical University of Lübeck; six of them were women. The mean age was 73.3 years. The tumors were located in the stomach (4), the large bowel (2) and the small intestine (1), representing disease at Ann-Arbor-stage IE (5) and IIE (2). All patients underwent primary surgery, except one due to his bad general conditions. Irradiation-therapy followed in one case, chemotherapy in two cases when relapse of disease was revealed. Three patients are still alive (0.8 to 6.8 years) without evidence of recurrent lymphoma. The success of surgery as a curative treatment is closely related to the stage of disease; both are important factors influencing prognosis. Surgery is still necessary for diagnosis, tumor-staging and prevention of regional complications as bleeding or perforation, especially when conservative therapy is performed.     

Postoperative Endoskopie zur Diagnose und Therapie von Komplikationen

A variety of endoscopic methods are available as the main tools in the diagnostics and therapy of various complications after visceral and thoracic surgery. Indications for endoscopic interventions are anastomotic leaks, stenoses, GI-tract bleedings, biliary lesions and functional problems after surgical procedures. The most common are fibrin sealing of fistulas, dilatation and bougienage, injection therapy for bleeding, bile duct interventions and stent implantations. In most cases operative revisions can be avoided by using endoscopic methods with an overall good success rate. No disadvantages are foreseen following conventional operative interventions if the endoscopic treatment is not successful.     

Die percutane transhepatische Laserlithotripsie von Gallenblasensteinen — Tierexperimentelle Ergebnisse

Zusammenfassung Nachdem die laserinduzierte Stoßwellenlithotripsie von Gallengangssteinen technisch möglich ist, wurde in einer Tierversuchs reihe die percutane transhepatische Laserbehand lung von Gallenblasensteinen untersucht. In 8 Tierversuchen an weiblichen Schweinen konnte nachgewiesen werden, daß Punktion der Gallenblase, Dilatation des Arbeitskanals, (laserinduzierte) Steinzertrümmerung, Entfernung der Fragmente und des Instrumentariums in einer Sitzung möglich sind. Weder bei einfachem Hautverschluß, noch bei Fibrinklebung des Arbeitskanals wurden schwerwiegende Nebenwirkungen gesehen. Nach Laserlithotripsie finden sich Mucosadefekte und intramurale Hämatome, die sich innerhalb eines Monats komplett restituieren. Die Experimente zeigen, daß bei organerhaltender Gallenblasensteinlithotripsie die Ausbildung einer Fistel nicht abgewartet werden muß.

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Percutaneous transhepatic laser lithotripsy of gallbladder stones

Summary Since laserinduced shock wave lithotripsy of gallstones is possible for treatment of common bile duct stones, the percutaneous transhepatic laserlithotripsy of stones in the gallbladder is examined in an animal study. In 8 animal experiments it could by shown that puncture of the gallbladder, dilatation of the working channel, (laserinduced) shock wave lithotripsy, removal of the fragments and the instruments are possible in one session. Neither when performing simple closure of the wound by suture nor by fibrinsealing severe side effects could be recognized. After laserlithotripsyablation of epithelium and hematomas can be ob served, which are restituted within one month. The experiments show that in organ-saving shockwave lithotripsy there is no need for waiting for the development of a fistula and the percutaneous approach can be simplified.

     

183. Die spontane kontinuierliche H?mofiltration (CAVH) als adjuvante Therapie in der chirurgischen Intensivmedizin

Zusammenfassung 52 Intensivpatienten mit einem SAPS von 12–15, die eine adjuvante CAVH erhielten, wurden retrospektiv nachuntersucht. Die negativ bilanzierte Gruppe A (n = 35) zeigte mit Beginn der CAVH eine Abnahme der Herzfrequenz, des ZVDs, der Pulmonalarteriendrucke, des Serumkreatinins und des FIO₂ bei gleichzeitiger Steigerung des arteriellen Mitteldruckes (MAP). Trotz positiver Bilanz in Gruppe B (n = 17) konnten die gleichen Parameter stabil bzw. leicht gebessert werden. Im Hämofiltrat beider Gruppen konnten erhebliche Mengen an TXB₂ und 6 Keto-PGF1 Alpha sowie 1,7 g Protein/Liter gefunden werden. Neben dem Flüssigkeitsentzug muss in beiden Gruppen die Toxinelimination als Ursache der kardiorespiratorischen Rekompensation angesehen werden.