Kongressband. Deutsche Gesellschaft fur Chirurgie. Kongress最新文献

In recent years the number of the patients with occlusive disease of the peripheral arteries is increasing also in Japan. For such patients there are many methods to make final diagnosis. Among a lot of methods we have chosen color duplex sonography for functional diagnosis in the patients with occlusive disease of the peripheral artery. During 2 years we have investigated color duplex sonography in addition to digital subtraction arteriography for 40 patients (68 limbs) with occlusive disease of the peripheral artery. First of all waveform of blood flow and the systolic velocities of the dorsal- and the posterior tibial arteries as well as the brachial artery were observed and measured. The blood flow volume and the ratio of systolic velocities and flow volume of lower to upper extremity (AVI, AFI) were measured and their values were also analysed in each patient. These data were compared with Fontaine's classification as a clinical symptom. For the patients with Fontaine class I, or II conservative treatments were carried out, and operative interventions such as bypass graft, or endovascular operation were carefully performed for the patients with Fontaine's class III or IV. Consequently, clinical symptoms and waveforms of systolic flow, and its velocity were remarkably improved by surgical interventions. Thus, color duplex sonography was a useful procedure to make diagnosis and to decide operative indication in the patients with occlusive disease of the peripheral artery.

Only patients with a clinical and pathohistological response to neoadjuvant therapy have a significantly improved survival. Therefore the identification of predictors for response and procedures for the early identification of nonresponders appear to be mandatory. Preliminary data of biochemical investigations of target enzymes for several cytostatics (e.g. TS, ERCC1) appear to be promising. Early changes of the tumor metabolism in the FDG-PET enable the identification of nonresponders with a negative predictive value of 88-95%. In near future these findings should lead to consequences in the design and realization of clinical studies.

Unlabelled: Laparoscopic surgery has been proposed to have diagnostic and therapeutic advantages over conventional surgery.

Results: Laparoscopic Appendectomy (LA) is a safe procedure resulting in shorter hospitalization and sooner return to activity. The relative merits of LA and open appendectomy (OA) are evaluated in this review. There were no differences in postoperative analgesia, resumption of oral intake, or morbidity, but laparoscopic appendectomy is associated with longer operating times and increased cost. Laparoscopic appendectomy is a more expensive alternative but offers advantages related to pain relief, length of stay, return to normal activities, or morbidity.

Conclusion: In those clinical settings where surgical expertise and equipment are available and affordable, diagnostic laparoscopy and LA (either in combination or separately) seem to have various advantages over OA.

Chronic anastomotic fistulas represent a complex clinical problem following various surgical gastrointestinal interventions. The etiology of anastomotic fistula includes multiple factors. Risk factors include patient- and surgery-dependent factors and those that are influenced by pre- and perioperative therapeutic measures. Therapeutic strategies include optimization of concomitant risk factors, medical strategies to improve wound healing, and endoscopical or surgical interventions.

Breakdown of skin microcirculation is supposed to play a key role in pathophysiology of burn injury. The aim of the study was to develop a burn model, which allows repetitive quantitative in vivo analysis of microcirculation after burn injury with special focus on leukocyte endothelium interaction over a longer period of time. Male hairless mice (SKH-1/hr) were used. Deep partial thickness burns were inflicted in no-touch-technique to the ears. Intravital fluorescent microscopy in combination with FITC-dextran as a plasma-marker was used to assess standard microcirculatory parameters. Leukocytes were stained with rhodamine-6-G to study their interaction with the endothelium.

Arthroscopy is a standard procedure for the diagnosis of wrist disorders. Provided it is preceded by a thorough clinical investigation it is highly effective in detecting cartilagineous, osseous and ligamenteous lesions. Sometimes even intraarticular occult ganglia are visible. Especially triangular-fibrocartilage-lesions can be classified and give hints at instabilities of the distal radioulnar joint. Arthroscopy of the radiocarpal joint alone is not sufficient. The midcarpal joint must be visualized, too. Although disorders of the distal radioulnar joint are frequent, it is usually too narrow to permit an arthroscopic investigation.

Similar to squamous cell esophageal cancer, the lymph node status constitutes the major prognostic factor after complete tumor resection (R0-resection) in patients with adenocarcinoma of the distal esophagus (the so-called Barrett's cancer). Lymphatic spread in patients with Barrett's cancer, however, appears to follow certain rules. Lymphatic spread is closely correlated to the pT-category of the primary tumor, starts only after infiltration of the submucosa und is initially limited to the regional lymph nodes. Distant lymph node metastases are almost exclusively found in patients with multiple positive regional nodes, skipping of regional lymph nodes is rare. These observations set the stage for tailored lymphadenectomy-strategies based on the, sentinel-lymphadenectomy' concept.