What is the value of minimizing access trauma for patients?]

Minimizing the access trauma of surgical interventions is becoming an essential task in modern surgery in order to make the treatment more comfortable for the patient. Minimally invasive surgery has had a major impact on the improvement of surgical results over the last decade. This is why such surgery is often named as the third patient friendly revolution in surgery after the introduction of asepsis and anesthesia. Operations that caused a huge strain on the patients in the past and led to immense costs for society because of the patient's lost working time and extensive rehabilitation, have lost their fear thanks to this technique. The physical strain is lower, the cosmetic effect is considerable and the costs for society might be reduced due to the significantly shorter duration of convalescence.Despite its known advantages, which have been reported in numerous studies, minimally invasive surgery has recently gained increased interest because of the installation of new accounting systems as well as strict budgeting and restricted resources.Realistic cost-benefit analysis and objectified quality controls are needed in order to guarantee innovative and patient friendly basic approaches in medicine in the future.     

Ergebnisse der tiefen Rectumresektion und intersphinctärer Rectumexstirpation

Zusammenfassung. Die tiefe Rectumresektion und intersphinct?re Rectumexstirpation beim Rectumcarcinom des distalen Rectumdrittels ist eine inzwischen akzeptierte, sphinctererhaltende Therapie. Im Zeitraum zwischen Dezember 1990 und Dezember 1994 wurden 42 Patienten, 17 Frauen und 25 M?nner, mit einem Durchschnittsalter von 67,2 Jahren dieser Operation unterzogen. An 20 Patienten wurde eine transanale Handnaht durchgeführt, bei den übrigen eine Stapler-Anastomose angelegt. Die Letalit?tsrate betrug 2,5 %; die Anastomoseninsuffizienzrate 14 %.      

Beeinflußt Heparin den Verlauf einer chronischen abszedierenden Peritonitis im Tiermodell?

After laparotomy and inoculation of aBacteroides fragilis suspension (2 ml with 10⁸ CFU/ml), we induced chronic abscess-forming peritonitis in rats (n=19, untreated). Fifteen animals were treated with heparin 30 IU, administered s.c. from day 1 after inoculation of the bacteria onwards. The main groups were divided into three subgroups (n=8/5/6 andn=5/5/5), which were observed for 3/7/14 days, respectively. On days 3 and 7, abdominal swabs were not onlyB. fragilis positive, but also showed severe polyvalent mixed infection after translocation of intestinal bacteria into the abdominal cavity. In the heparin group,B. fragilis positive swabs were reduced and translocation was inhibited (P<0.05 for days 3 and 7). In the untreated group, blood cultures wereB. fragilis positive on days 3/7/14 in 3/2/1 animals versus 0/1/1 in the heparin group. Adhesions were found in the untreated group in 1/4/5 animals, whereas in the heparin group there were no adhesions (P<0.05 for days 7 and 14). However, intra-abdominal abscesses were also diminished in the heparin group (0/2/1) compared with the untreated animals (2/4/6,P<0.05 for day 14). Therefore, heparin was shown to have a favourable influence on chronic abscess-forming peritonitis in an animal model.     

The repopulation of lymph nodes of dogs after 1200 R whole-body x-irradiation and intravenous administration of mononuclear blood leukocytes.

Fresh and cryopreserved autologous or allogeneic mononuclear blood cells (MBCs) intravenously injected in 1200 R total-body x-irradiated dogs repopulated lymph nodes within 10 days after tranfusion. Several parameters of the lymphopoietic regeneration were correlated with the number of cells transfused and with the number of colony-forming units contained in the cell suspension when they were cultured in agar (CFUc). Values within the normal or close to normal range were reached in the mesenteric nodes of most of the animals transfused with 10 X 10(9) MBC or more. These values were obtained when 5 X 10(5) CFUc or more were transfused. Axillary nodes showed lower values than mesenteric nodes. They were mostly under the normal range but well over those of the irradiated controls. Frozen and thawed MBCs seem to be as effective as fresh cells for lymphopoietic restoration. The mesenteric nodes of dogs transfused with allogeneic MBCs showed higher cellularity and larger cortical-paracortical areas than those of dogs tranfused with approximately the same number of autologous cells. The repopulation of lymph nodes parallels that of the marrow.     

Bolus versus continuous feeding regimens post gastrostomy tube placement in children

Background/purposeOwing to the frequency of gastrostomy tube placement in children and the numerous regimens used to start feeds after placement we attempted to see if it matters if the initial feeds after a gastrostomy tube placement are provided in a bolus or continuous manner.MethodsUsing a prospective randomized trial, children were randomized to initial bolus or continuous chimney feeding after gastrostomy tube placement. Feeding tolerance and complications related to the gastrostomy tube were collected for 4 weeks after placement.ResultsDemographics were similar in the two groups. Times to goal feeds were similar in both groups, but in the first two weeks more feeding modifications were required in the bolus group. Other than the rate of leakage during the second week after placement which occurred more in the bolus group, all other clinical outcomes were similar in the two groups.ConclusionsOther than minor, clinically insignificant differences noted above, the method of initial feeding after a gastrostomy tube placement does not affect feeding tolerance or gastrostomy tube complication in the first month after placement.Level of evidenceTherapeutic, level II.     

Pattern discrimination with flickering stimuli

The spatial contrast at which Observers are able to discriminate between horizontal and vertical gratings in a 2AFC task shows the same dependence on spatial and temporal frequency as does 2AFC detection. We conclude that mechanisms carrying information about spatial contrast have their sensitivity to low spatial frequency sinusoidal gratings improved by flicker and that such mechanisms are likely to mediate the detection of low spatial-frequency gratings both at low and at high temporal frequencies.