When should incidentalomas of the adrenal gland be surgically treated?

Between January 1981 and December 1988 a total of 95 patients underwent surgery for adrenal tumors. In 24 cases (25.3%) a so-called "incidentaloma" was found. While seven of these tumors showed hormonal activity, in seventeen patients the tumor was hormonal inactive. The size of the tumors ranged between 2 and 11 cm. Histologically all tumors were found to be benign neoplasms. Because of the lack of lethality and minimal morbidity we indicate surgery on incidentaloma of the adrenal gland for the following reasons: tumors with hormone activity, tumor size larger than 3 cm, suspecting malignoma or metastasis and finally in proven enlargement of small tumors. Only in adrenal tumors smaller than 3 cm we suggest a follow-up by ultrasound or computed tomography.     

Strukturqualit?t akut-internistischer rheumatologischer Kliniken – Projektgruppenarbeit des VRA

In der vorliegenden Projektgruppenarbeit Strukturqualit?t werden die fünf vom Verband Rheumatologischer Akutkliniken e.V. (VRA) verabschiedeten Richtlinien zur Strukturqualit?t akut-internistischer Rheumakliniken aufgeführt. Die für deren Umsetzung notwendigen r?umlichen und personellen Ressourcen sind hier entsprechend benannt.    Die Vorhaltung eines multi-disziplin?ren Teams, welches über eine hohe Kompetenz in der Betreuung meist chronisch erkrankter Rheumapatienten verfügt, pr?gt nachhaltig die Qualit?t der station?ren Versorgung.    Die Notwendigkeit der akut-station?ren internistischen rheumatologischen Versorgung für Rheumapatienten, welche nicht nur durch chronische Schmerzen wechselnder Intensit?t und den Alltag beeinflussende Funktionseinschr?nkungen belastet sind, wird in einem AEP(appropriateness evaluation protocol)-adaptierten 6-Punkte-Erfassungssystem (Entwurf) abgebildet.    Es wird die Implementierung einer funktionsplatzbezogenen EDV-Dokumentation mit Vernetzung in einem zentralen Krankenhaus-Informationssystem aus der Perspektive der Einführung des vollpauschalierten Entgeltsystems beschrieben.    Das erstellte Strukturpapier berücksichtigt bereits heute im Sinne des Benchmarking zukunftsnahe Entwicklungen im deutschen Gesundheitssystem, es wird zudem zukünftig an sich ver?ndernde gesundheitspolitische Rahmenbedingungen angepasst werden.     

Chromogranin A, neuron-specific enolase and synaptophysin as neuroendocrine cell markers in the diagnosis of tumours of the gastro-entero-pancreatic system

Neuroendocrine (NE) tumours of the gastro-entero-pancreatic tract were analysed immunohistochemically for the expression of chromogranin A, neuron-specific enolase and synaptophysin. In all cases at least one marker was present and in 17 out of 19 investigated neoplasms, at least one of the three markers could be demonstrated in more than 75% of the NE tumour cells. Monoclonal antibody chromogranin A stained a much higher proportion of NE cells in tumours with hormonal activity than in hormonally inactive ones. Immunostaining of the primary tumour as compared to its respective metastases was almost identical. Thus, chromogranin A, neuron-specific enolase and synaptophysin identify NE tumours and their metastases regardless of their localization and their state of hormonal activity. As 'panendocrine' markers of NE tumours they are of special diagnostic value in NE tumours that do not produce hormones and peptides.     

Reduction of wound infections in laparoscopic-assisted colorectal resections by plastic wound ring drapes (REDWIL)?—a randomized controlled trial

Introduction

Surgical site infections (SSIs) are frequent complications in colorectal surgery and may lead to burst abdomen, incisional hernia, and increased perioperative costs. Plastic wound ring drapes (RD) were introduced some decades ago to protect the abdominal wound from bacteria and reduce SSIs. There have been no controlled trials examining the benefit of RD in laparoscopic colorectal surgery. The Reduction of wound infections in laparoscopic assisted colorectal resections by plastic wound ring drapes (REDWIL) trial was thus designed to assess their effectiveness in preventing SSIs after elective laparoscopic colorectal resections.

Materials/methods

REDWIL is a randomized controlled monocenter trial with two parallel groups (experimental group with RD and control group without RD). Patients undergoing elective laparoscopic colorectal resection were included. The primary endpoint was SSIs. Secondary outcomes were colonization of the abdominal wall with bacteria, reoperations/readmissions, early/late postoperative complications, and cost of hospital stay. The duration of follow-up was 6?months.

Results

Between January 2008 and October 2010, 109 patients were randomly assigned to the experimental or control group (with or without RD). Forty-six patients in the RD group and 47 patients in the control group completed follow-up. SSIs developed in ten patients with RD (21.7?%) and six patients without RD (12.8?%) (p?=?0.28). An intraoperative swab taken from the abdominal wall was positive in 66.7?% of patients with RD and 57.5?% without RD (p?=?0.46). The number of species cultured within one swab was significantly higher in those without RD (p?=?0.03). The median total inpatient costs including emergency readmissions were 3,402?±?4,038 € in the RD group and 3,563?±?1,735 € in the control group (p?=?0.869).

Conclusions

RD do not reduce the rate of SSIs in laparoscopic colorectal surgery. The inpatient costs are similar with and without RD.     

Effects of ventricular rate regularization pacing on quality of life and symptoms in patients with atrial fibrillation (Atrial fibrillation symptoms mediated by pacing to mean rates [AF SYMPTOMS study])

The aim of this study was to investigate the effect of the Ventricular Response Pacing (VRP) algorithm, which regularizes ventricular rate during atrial fibrillation (AF), on symptoms, quality of life, and functional capacity. VRP regularizes the ventricular rate during AF without increasing the mean ventricular rate, thereby reducing the severity of AF-related symptoms in patients with persistent AF. However, VRP did not improve general quality of life (Medical Outcomes Study 36-item Short-Form General Health Survey), the performance of routine activities (Duke Activity Status Index), or functional capacity (hall walk) in patients with AF.     

Diagnostic value of body plethysmographic parameters in healthy and asthmatic young children is not influenced by breathing frequency

In 16 healthy and 16 asymptomatic asthmatic children (age range 5-8 yr; 8 girls, 24 boys) we studied the influence of breathing frequency on the results and the diagnostic value of body plethysmographic measurements. Airway resistance (Raw), specific airway resistance (SRaw), and thoracic gas volume (TGV) were measured during breathing (or breathing efforts against a closed shutter) at 0.4, 1, and 2 Hz. SRaw was computed by a simplified procedure directly from flow at the mouth vs. box volume-curves. The diagnostic value of each parameter was assessed as the percentage of correctly classified healthy and asthmatic subjects by means of discriminant analysis. When frequency was increased from 0.4 to 1 and 2 Hz mean TGV rose by 5 and 14% in healthy children and by 11 and 21% in asthmatic children, respectively. From 0.4 to 1 Hz mean Raw decreased by 16% (P = 0.002) in healthy children and by 25% (P = 0.0004) in asthmatic children. The differences in Raw between both groups decreased with frequency (3.5, 1.8, and 1.5 cm H2O.L-1.s at 0.4, 1, and 2 Hz, respectively) and those of TGV increased (0.13, 0.21, and 0.23 L). SRaw showed similar frequency characteristics as Raw. As intra-group variability changed in parallel with the differences the diagnostic value of the parameters remained constant with frequency. Simplified SRaw alone and TGV combined with Raw exhibited no differences in their diagnostic values (81-84% correctly classified).(ABSTRACT TRUNCATED AT 250 WORDS)     

Impact of oral ibandronate 150 mg once monthly on bone structure and density in post-menopausal osteoporosis or osteopenia derived from in vivo μCT

The effect of ibandronate 150 mg/once monthly in the treatment of post-menopausal osteopenia and osteoporosis on bone micro-structure at the distal tibia and radius has not been considered to date. Seventy post-menopausal women with osteoporosis or osteopenia were recruited. All subjects received calcium and vitamin D supplementation and were randomized to either a group which took 150 mg ibandronate oral monthly or a placebo group over a 12-month period. μCT measures of the distal tibia and radius were conducted every three months, with DXA lumbar spine and hip measurements conducted only pre and post and serum markers of bone formation and resorption measured every 6 months. After 12-months no significant impact of ibandronate on the primary outcome measures bone-volume to tissue-volume and trabecular separation at the distal tibia (p ≥ 0.15) was found. Further multiple regression analyses of the primary end-points indicated a significant effect favoring the ibandronate intervention (p = 0.045). Analysis of secondary end-points showed greater increases in distal tibia cortical thickness, cortical density and total density (p ≤ 0.043) with ibandronate and no significant effects at the distal radius, but greater increases of hip DXA-BMD and lumbar spine DXA-BMD (p ≤ 0.017). Ibandronate use resulted in a marked reduction in bone turnover (p < 0.001). While ibandronate resulted in greater mineralization of bone, this effect differed from one body region to another. There was some impact of ibandronate on bone structure (cortical thickness) at the distal tibia, but not on bone-volume to tissue-volume or trabecular separation.