Maschineller und manueller Bronchusverschluß —ergebnisse einer konsekutiven untersuchungsserie

Zusammenfassung Experimentelle Untersuchungen haben für den maschinellen Bronchusverschluß nach Lobektomie und Pneumonektomie im Vergleich zu anderen Nahtmaterialien die geringste Entzündungsrate und die höchste Zugfestigkeit ergeben. In einer konsekutiven Serie von 233 Lungenresektionen der Chirurgischen Kliniken Köln-Lindenthal und der Klinik für Allgemein- und Abdominalchirurgie der Johannes Gutenberg-Universität Mainz ging die Häufigkeit einer Bronchus-stumpfinsuffizienz von 7,1% nach manuellem Bronchusverschluß auf 2,0% und die insuffizienzbedingte Letalität auf 0,7% bei Anwendung des Klammergeräts zurück. Die wesentlichen Vorteile des maschinellen Bronchusverschlusses sind die Einfachheit der Anwendung, die Schnelligkeit und die Gleichmäßigkeit des Verschlusses. Damit stellen die Klammernahtgeräte bei Lungenresektionen eine wertvolle Ergänzung der Operationstechnik dar.

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Mechanical and manual bronchial closure —results of a consecutive trial

Summary After lobectomy and pneumonectomy in experimental evaluations stapled bronchial closures showed the lowest incidence of inflammatory reaction and the highest strength determined by leakage pressure compared with other suture material. A total of 233 lung resections - performed at Surgical University Clinic Köln-Lindenthal and the Clinic for General and Abdominal Surgery of the Johannes-Gutenberg-Universität Mainz — were reviewed. Mechanical stapling reduced the rate of bronchopleural fistulas to 2.0% compared with 7.1 % after manual suturing. In parallel, mortality related to bronchial stump leakage decreased to 0.7%. Main advantages of bronchial closure with staplers are the simplicity of their use, the speed and the uniformity of the closure. Thereby stapling devices are valuable completions in pulmonary surgery.

     

Tumor vascular signals in renal masses: detection with Doppler US

The vascularity of 49 renal masses (26 malignant and 23 benign lesions) was investigated with duplex Doppler ultrasound. Doppler signals obtained at the margins of renal masses were defined as "tumor signals" when the Doppler-shifted frequency of the lesion exceeded the frequency shift in the ipsilateral main renal artery. These exceeded 2.5 kHz with a 3-MHz insonating frequency. Among the 26 renal masses that subsequently proved to be malignant, tumor signals were obtained in 15 of 18 (83%) untreated renal cell carcinomas, in three of four Wilms tumors, and in two patients with metastases to the kidney, but not in the one patient with lymphoma. None of the 23 benign renal masses demonstrated tumor signals. Tumor vascularity in malignant lesions gives rise to abnormal, high-velocity, Doppler-shifted signals that can help in the differential diagnosis of renal masses.     

Detection of reactive oxygen species (ROS) and apoptosis in human fragmented embryos

In human in-vitro fertilization (IVF)-embryo transfer, the in-vitro culture environment differs from in-vivo conditions in that the oxygen concentration is higher, and in such conditions the mouse embryos show a higher concentration of reactive oxygen species (ROS) in simple culture media. ROS are believed to cause damage to cell membranes and DNA fragmentation in somatic cells. This study was conducted to ascertain the level of H2O2 concentration within embryos and the morphological features of cell damage induced by H2O2. A total of 62 human oocytes and embryos (31 fragmented, 15 non-fragmented embryos, 16 unfertilized oocytes) was obtained from the IVF-embryo transfer programme. The relative intensity of H2O2 concentrations within embryos was measured using 2',7'-dichlorodihydrofluorescein diacetate by Quanti cell 500 fluorescence imaging and DNA fragmentation was observed with transmission electron microscopy and an in-situ apoptosis detection kit. The H2O2 concentrations were significantly higher in fragmented embryos (72.21 +/- 9.62, mean +/- SEM) compared to non-fragmented embryos (31.30 +/- 3.50, P < 0.05) and unfertilized oocytes (30.75 +/- 2.67, P < 0.05). Apoptosis was observed only in fragmented embryos, and was absent in non-fragmented embryos. Electron microscopic findings confirmed apoptotic bodies and cytoplasmic condensation in the fragmented blastomeres. We conclude that there is a direct relationship between increased H2O2 concentration and apoptosis, and that further studies should be undertaken to confirm these findings.