Streptococcal toxic shock-like syndrome as a rare surgical disease

Summary. In recent years there has been an increasing incidence of streptococcal toxic shock-like syndrome (TSLS) in otherwise healthy adults. It is characterized by fever, rash, hypotension and early shock with consecutive organ failure and a mortality rate of about 30 %. This paper describes the history of two patients with severe streptococcal TSLS. Various aspects of the pathophysiology, diagnosis and therapy are discussed. Only early, aggressive and repeated surgical debridement can reduce the bacterial load and decrease circulating exotoxins and thereby, in combination with antibiotic therapy, decrease the high mortality of this entity.      

Cholecystectomy: laparoscopic or conventional?]

Cholecystectomy remains the gold standard in the treatment of cholelithiasis. With the emerging of laparoscopic techniques a new modality in the surgical therapy is available. However efficacy, morbidity and pretended advantages have to be judged in comparison to the conventional technique. Indications for cholecystectomy are not altered by the new technique. Beside some few preoperative contraindications, the definite choice of the operative procedure is determined intraoperatively according to the anatomical facts and the experience of the surgeon. The frequency of the laparoscopic approach varies between 67 and 97%. A conversion to open cholecystectomy is necessary in 3.6-4.7%. The overall complication rate is 2.6-5.1%. Outstanding from those are the iatrogenic lesions of the bile-duct, especially in the initial learning period with 1-2%. The hospital stay is dramatically reduced to 1.2-3 days as well as the postoperative recovery period with 7-14 days. Thus resulting in a cost saving up to $1200 per patient. Because of the obvious advantages of less pain, early mobilisation, less scars and an enormous cost saving the laparoscopic cholecystectomy will be the gold standard in the future. Open cholecystectomy will be restricted to complicated cases. However, in order to prevent serious injuries of the bile-duct an appropriate training in laparoscopic surgery is necessary.     

Local versus general anesthesia for Shouldice repair of the inguinal hernia

Since February 1992 local anesthesia (LA) has been used routinely for repair of inguinal hernias at our surgical department. All patients undergoing Shouldice repair of primary uncomplicated inguinal hernia between January 1990 and March 1993 were analyzed retrospectively concerning the need for analgesics, length of stay in hospital, and rate of complications. In addition 50 patients after LA and 50 patients after general anesthesia underwent prospective pain analysis using a visual analogous score and spirometric tests (FEV₁ and peak flow). After LA we found less need of analgesics, shorter hospital stays, and fewer complications. The pain level was lower, and ventilatory function was less affected. Repair of the inguinal hernia using LA is a safe method to lower the risk of the operation and to improve the patient's comfort without increasing complications.

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Resumen A partir de febero de 1992 hemos utilizado anestesia local como rutina para la reparación de las hernias inguinales en el Departamento de Cirugía de la RWTU Aachen. En forma retrospectiva se analizaron todos los pacientes sometidos a reparación de hernias inguinales en el perìodo 1/1990 y 3/1993 en relación al requerimiento de analgésicos, estancia hospitalaria y tasa de complicaciones. Además, se efectuó el análisis prospectivo del dolor en 50 pacientes operados bajo anestesia local y en 50 pacientes operados bajo anestesia general, utilizando un índice análogo visual de puntuación y pruebas espirométricas (FEV 1 y flujo pico). Se encontró menor requerimiento de analgésicos, una estancia hospitalaria más corta y menor tasa de complicaciones luego de anestesia local. También aparecieron más bajos los niveles de dolor y menos afectada la capacidad ventilatoria. La reparación de la hernia inguinal utilizando anestesia local representa un método seguro de reducción de los riesgos de la operación y de mejorar el confort del paciente sin aumentar la tasa de complicaciones.

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Résumé Depuis Février 1992, nous utilisons l'anesthésie locale (AL) pour réparer les hernies inguinales dans le département de Chirurgie RWTU d'Aix-la-Chapelle. Tous les patients ayant une réparation de hernie inguinale primitive, non compliquée, par la technique de Shouldice, entre Janvier 1990 et Mars 1993 ont été analysés rétrospectivement en ce qui concerne le besoin en analgésie, la durée d'hospitalisation et le taux de complications. On a comparé le degré de douleur (score) d'après une échelle visuelle analogue et les tests spirométriques (vitesse maximale d'expiration 1 et débit maximal) entre 50 patients opérés sous une AL et 50 patients opérés sous anesthésie générale. Après AL, le besoin en analgésiques était réduit, la durée d'hospitalisation plus courte et il y a eu moins de complications. Le score de douleur était plus bas et les perturbations ventilatories moindres après AL. La réparation de hernie inguinale sous AL est sûre, abaisse le risque opératoire et améliore le confort du patient sans augmenter le taux de complications.

     

Verdauungsleukocytose und Verdauungsleukopenie bei Kindern

Ohne ZusammenfassungMit 5 Textabbildungen.