Chirurgische Versorgung von Leberrupturen

Zusammenfassung. Von Januar 1979 bis August 1996 wurden an der Chirurgischen Universit?tsklinik Ulm 178 Patienten aufgrund eines Lebertraumas chirurgisch versorgt. Es handelte sich dabei zu 91,6 % um stumpfe und nur zu 8,4 % um penetrierende Traumen. Bei 110 F?llen (62 %) handelte es sich um leichte Verletzungen der Schweregrade I und II, w?hrend sich bei 68 Patienten (38 %) schwere Traumen der Grade III, IV und V fanden. Die Letalit?tsrate wird vom Schweregrad der Leberruptur und der Begleitverletzung bestimmt. Die Gesamtletalit?t lag bei 32 % (57 Patienten). Davon sind 28 Patienten an den Folgen der Leberverletzung verstorben. Dies bedeutet, die reine Sterblichkeit aufgrund der Leber betrug 15,7 %. Keiner der Patienten mit einer penetrierenden Verletzung ist verstorben. Die Komplikationsrate lag bei 55 %, wobei die H?matombildung die am h?ufigsten beobachtete Komplikation darstellte (12,9 %), an zweiter Stelle folgte die Nachblutung mit 9,6 %. Die Absce?rate lag bei 2,8 %. Bei einem kreislaufstabilen Patienten sollte grunds?tzlich die konservative Therapie angestrebt werden, sofern er die gegebenen Voraussetzungen erfüllt. Bei kreislaufinstabilen Patienten ist ein operatives Vorgehen unumg?nglich. Das chirurgische Vorgehen h?ngt vom Schweregrad der Leberverletzung ab. Bei leichter Blutung steht die „einfache“ Versorgung durch Coagulation oder Naht im Vordergrund. Liegt eine schwere Blutung vor, so empfiehlt sich die Hepatotomie, die gezielte Blutstillung und Débridement (Pachters Vorgehen). Ist die Blutung nicht unter Kontrolle zu bringen, ist die perihepatische Bauchtuchtamponade das Mittel der Wahl.      

Regional Chemotherapy in Liver Metastases of Colorectal Carcinoma: Monitoring with Arterial Computed Tomography

Continuous chemotherapy was administered to 82 patients through the hepatic artery via Infusaid pumps. In order to obtain a primary status and to evaluate the success of therapy, the perfusion patterns of the liver and of the existing tumor masses in the liver were estimated by conducting arterial angiocomputed tomographies (AACTs) immediately after pump implantation of every 3 months thereafter. In 70% of the patients, findings showed both liver lobes to be homogeneously perfused, 24% demonstrated distinct inhomogeneities. The response of the latter cases should depend primarily on the efficacy of the administered cytostatic agent. Six percent of the patients showed selective perfusion of either the left or right hepatic lobe. In these cases, only me perfused liver regions exhibited stable disease or regression of the metastases, whereas the metastases of the nonperfused regions progressed. At 3-month follow-up, the majority of the patients (50-57%) showed homogeneous hepatic perfusion. Inhomogeneities were found in 26-36% of the patients, 12 patients demonstrated incomplete perfusion. There was no association between the perfusion patterns of the metastases or of the prechemotherapeutic liver involvement and the response of the metastases to regional chemotherapy. In regional chemotherapy, liver perfusion should be controlled both intraoperatively or directly postoperatively and during therapy.     

Genotypes of human papilloma virus in Sudanese women with cervical pathology

Background  

Knowledge of the distribution of human papillomavirus (HPV) genotypes among women with cervical lesion and in invasive cervical cancer is crucial to guide the introduction of prophylactic vaccines. There is no published data concerning HPV and cervical abnormalities in Sudan. This study aimed to define the prevalence of HPV and its subtypes in the cervical smears of women presenting with gynecological complains at Omdurman Military Hospital, Sudan.     

A comparison of the direct agglutination test and enzyme-linked immunosorbent assay in the sero-diagnosis of leishmaniasis in the Sudan

The sensitivity and specificity of the direct agglutination test (DAT) and the enzyme-linked immunosorbent assay (ELISA) were compared for the sero-diagnosis of visceral (VL) and cutaneous (CL) leishmaniasis in Sudanese patients. All the sera from parasitologically confirmed cases of VL were positive in both ELISA and DAT. Some minor discrepancies were apparent between the two tests in patients with clinical signs of VL, but in whom VL was not confirmed parasitologically. In parasitologically confirmed CL both tests performed equally badly, with the DAT detecting 67% of cases and ELISA 60%. For the sero-diagnosis of VL, ELISA and DAT performed equally well, but on grounds of simplicity and low cost the DAT was preferred.     

Contrast echocardiography improves the diagnostic yield of transthoracic studies performed in the intensive care setting by novice sonographers.

BACKGROUND: Bedside portable echocardiography in the intensive care department (ICU) is technically difficult, but crucial for directing patient care. Prior studies have shown contrast echocardiography (CE) in the ICU clarifies left ventricular wall motion when performed by experienced sonographers (ESO). However, in most hospitals, ESO are unavailable around the clock, and less experienced cardiovascular fellows or trainees may be asked to perform these examinations. METHODS: Transthoracic echocardiograms were retrospectively evaluated by level III trained echocardiographers for 213 patients in the ICU. Most were performed to assess left ventricular function (65% or 139 of 213) and were scanned by cardiology fellows (70% or 149 of 213) with less than 3 months echocardiography experience. Contrast agent was used in 29% (62 of 213) of all patients. RESULTS: The conversion of suboptimal or diagnostically inadequate apical 4- and 2-chamber views to diagnostically adequate with contrast was statistically significant when performed by both cardiology fellows and ESO (Fischer exact test, P < .0002). CONCLUSIONS: CE is effective in improving the diagnostic yield of transthoracic echocardiographic ICU studies performed by both novice sonographers and ESO. Using cardiology fellows to perform CE in this setting can be appropriate, particularly in after-hour situations, when ESO are not always available and the clinical question is left ventricular function. Results also suggest cardiology fellows can easily learn CE.     

Surgical treatment results in colonic obstruction

Between 1982 and 1988 94 patients with obstruction of the colon were operated (52 male, 42 female, median age 66 years). Carcinoma accounted for the majority of cases: in 51% of patients enteral, in 9% local tumor growth extraenteral, in 17% peritoneal carcinosis. Therapeutic procedures were chosen according to the necessities in benign courses and in extraenteral tumor growth. In obstructing colorectal carcinoma (48 patients) a policy of primary tumor resection was pursued. 48 patients (40%) developed postoperative complications, 3 patients (3.1%) had to be reoperated. The overall mortality rate in patients with acute obstructions of all courses was 9.6%, in patients with obstruction secondary to carcinoma 14.6%. 74% of patients with colorectal tumors had TNM tumor stage III and IV. The 5-years-survival rate amounted to 21% overall, but after primary tumor resection it was 47%.     

Life expectancy in elderly patients following burns injury

Introduction

Burn injuries commonly occur in vulnerable age and social groups. Previous research has shown that frailty may represent a more important marker of adverse outcome in healthcare rather than chronological age (Roberts et al., 2012). In this paper we determined the relationship between burn injury, frailty, co-morbidities and long-term survival.

A case of myopathy associated with hypothyroidism and hyperprolactinaemia

We report a case of a serious myopathy related to hypothyroidism with pituitary enlargement and hyperprolactinemia. CASE REPORT: Mr D.L 33 years old man suffering from myalgia, muscular weakness and cramps for six months. The laboratory check-up revealed a high serum creatin phosphokinase level, an autoimmune hypothyroidism, hyperprolactinemia and pituitary enlargement. The electromyogram was normal and the muscle biopsy showed no obvious inflammation. The outcome was favourable under L. thyroxin. DISCUSSION: The frequency of myopathy during hypothyroidism ranges from 30 to 80%. The main symptoms related are weakness, muscular cramps and myalgia. However, hyperprolactinemia and pituitary enlargement described in this case are due to reactional mechanism. These several hypothyroid manifestations improve remarkably under L.thyroxin. CONCLUSION: Proximal myopathy may rarely be displayed as the sole manifestation of hypothyroidism. Therefore, it is recommended that hypothyroid myopathy should be taken into account during differential diagnosis of proximal muscle weakness.