Increased hospital costs are associated with low skeletal muscle mass in patients undergoing elective open aortic surgery

Objective

Low psoas muscle area is shown to be an indicator for worse postoperative outcome in patients undergoing vascular surgical. Additionally, it has been associated with longer durations of hospital stay in patients with cancer who undergo surgery and subsequently greater health care costs in Europe and the United States. We sought to evaluate this effect on hospital expenditure for patients undergoing vascular repair in a health care system with universal access.

Tumoren des oberen Gastrointestinaltrakts: Beispiele und Ergebnisse der Interdisziplinarität

Der überwiegende Anteil an Tumoren im oberen Gastrointestinaltrakt wird erst im fortgeschrittenen Stadium entdeckt. Daher bleibt die operative Resektion als Standardtherapie für die meisten Patienten palliativ.An 3 Fallbeispielen soll aufgezeigt werden,welche M?glichkeiten durch interdisziplin?re Therapie bestehen, um die l?ngerfristige Prognose der Patienten zu verbessern. PD Dr.M. Stahl Innere Klinik IV, Internistische Onkologie und H?matologie,Kliniken Essen-Mitte, Essen, E-Mail: m.stahl@kliniken-essen-mitte.de     

Hand infections caused by delayed inoculation of Vibrio vulnificus: does human skin serve as a potential reservoir of vibrios?

Vibrio vulnificus may cause severe soft tissue infections of the upper extremity. This pathogen usually gains access to soft tissues either by direct inoculation through a penetrating injury by an infected marine animal or by exposing abraded skin to contaminated water. We report five patients with Vibrio vulnificus hand infections following superficial hand injuries incurred within 24 hours after uneventful handling of fish. This clinical observation, together with the fact that the physiologic characteristics of human sweat simulate the natural environment of the Vibrio vulnificus, support the assumption that human skin may serve as a reservoir for Vibrios. The anamnesis in patients presenting with hand infection should essentially include an inquiry regarding recent, albeit uneventful, fish handling.     

Cheiralgia paresthetica — entrapment of the superficial branch of the radial nerve: a report of 15 cases

Attention is drawn to the relatively rare and poorly appreciated clinical featues of entrapment of the superficial sensory branch of the radial nerve (SBR) in the forearm. In a series of 15 patients with cheiralgia paresthetica, alleviation of pain and discomfort was achieved in 66.6% of the conservatively-treated patients and in 80% of the five non-responsive patients who required neurolysis of the nerve. Job-related symptoms were exhibited by 33.3% of the patients, which subsided upon job modification or less hand-intensive work and conservative treatment. We suggest that modalities of treatment should be appropriate for the pathophysioloy of the SBR injury, while early recognition of the syndrome reduces the necessity for surgery.     

DSA—Control of implanted devices for arterial hepatic perfusion

In contrast to conventional film angiography, the perfusion pattern of hepatic arterial chemotherapy was consistently visualized by DSA in 40 patients with implanted Infusaid pump or Port-A devices. Incomplete perfusion of a liver region by the cytotoxic agent was recognized by DSA as accurately as by nuclide scintigraphy. Furthermore, DSA appeared to be more sensitive in determining aberrantly perfused extrahepatic regions; this was especially true when there was a nonligated right hepatic artery. Specific details of vascular lesions and associated complicating events also could be satisfactorily analyzed by DSA only.     

Clinical impact of CCM mutation detection in familial cavernous angioma

Introduction and background A 3-year-old Bosnian girl with a large symptomatic brainstem and multiple supratentorial cavernous angiomas, who underwent neurosurgical treatment, is presented. As multiple cavernomas are more common in familial cases, genetic analyses and neuroradiological imaging were performed in the patient and her parents to see whether there was any evidence for inheritance. This information is important for genetic counseling and provision of medical care for at-risk relatives. Currently, no recommendation is available on how to manage these cases.Results Genetic analyses demonstrated a novel CCM1 frameshift mutation (c.1683_1684insA; p.V562SfsX6) in the child and the asymptomatic 27-year-old mother. Sensitive gradient-echo magnetic resonance imaging of the mother revealed multiple supratentorial lesions, whereas analogous imaging of the father showed no pathological findings.Conclusion This case exemplifies that seemingly sporadic cases with multiple lesions might well be hereditary and that presymptomatic genetic testing of family members may identify relatives for whom clinical and neuroradiological monitoring is indicated.