Carotenoid biosynthesis of pak choi (Brassica rapa ssp. chinensis) sprouts grown under different light-emitting diodes during the diurnal course.

Light-emitting diodes (LEDs) are considered the future of greenhouse lighting. This study investigates the carotenoid concentrations of pak choi sprouts after growth under blue, red and white LEDs at six different time points. Furthermore, the diurnal changes of RNA transcripts of key genes of the carotenoid biosynthesis pathway as well as of the carotenoid cleavage dioxygenase 4 (CCD4) gene and of the transcription factor genes elongated hypocotyl 5 (HY5) and circadian clock associated 1 (CCA1) were investigated. The carotenoid concentrations were steady throughout the day, but showed a small maximum in the afternoon. An average total carotenoid concentration of 536 ± 29 ng mg-1 DM produced under white LEDs was measured, which is comparable to previously described field-grown levels. The carotenoid concentrations were slightly lower under blue or red LEDs. Moreover, the diurnal RNA transcript rhythms of most of the carotenoid biosynthesis genes showed an increase during the light period, which can be correlated to the carotenoid maxima in the afternoon. Blue LEDs caused the highest transcriptional induction of biosynthetic genes as well as of CCD4, thereby indicating an increased flux through the pathway. In addition, the highest levels of HY5 transcripts and CCA1 transcripts were determined under blue LEDs.

[Technology integration and process management. Concept and implementation of a new platform for simultaneous diagnosis and therapy of acutely ill and injured patients and for elective computer assisted surgery (CAS)]. / Technologieintegration und Prozessmanagement. Konzept und Implementierung einer neuartigen Plattform für einzeitige Diagnostik und Therapie des akut Kranken und Verletzten sowie für elektive computerassistierte Chirurgie (CAS).

Modern imaging and computer technology gain more and more importance in surgery. This is true for elective and emergency diagnosis and treatment. However integration of technology and optimization of process management is severely behind. A new diagnostic-therapeutic platform should balance this deficit. The platform is composed of a fully equipped operation room environment with integrated high end computer-tomography with navigation, a digital subtraction angiography and an OR- and imaging-table particularly developed for this set-up. The platform may be used for elective diagnosis, for diagnosis and therapy in polytraumatized patients in one and the same location (one stop shop) and for computer assisted surgery (CAS). Bringing the technology to the patient and not the patient to the technology can save time consuming and potentially dangerous transports and expensive personnel can be reduced. Navigation-technology and high quality intra-operative imaging expand the spectrum of minimally invasive surgery.

[Complicated intestinal tuberculosis of the mesenteric root]. / Die komplizierte intestinale Tuberkulose der Mesenterialwurzel.

HISTORY AND CLINICAL FINDINGS: In the course of 2 1/2 years a 72-year-old man had five episodes of intestinal bleeding with anaemia, but no cause was at first found by routine diagnostic tests. After the fourth episode a diagnostic laparotomy was performed at which a diffusely infiltrating growing tumour was found. As it encircled the mesenteric vascular axis resection was not possible. But because of threatened ileal obstruction by the tumour a segmental ileal resection was performed, but no intraoperative diagnosis could be established. INVESTIGATIONS: Repeated oesophago-gastro-duodenoscopies and a coloscopy all revealed blood, especially in the upper gastrointestinal tract, but no bleeding source was found. Angiography suggested bleeding in the terminal ileum. Computed tomography demonstrated a tumour in the region of the mesenteric root. DIAGNOSIS, TREATMENT AND COURSE: At a second laparotomy because of another bleeding, which required a blood transfusion, tuberculosis was diagnosed. Triple drug treatment was initiated and the patient has been free of symptoms and bleedings since then and fully active for 1 1/2 years. CONCLUSION: This case clearly demonstrates the difficulty of diagnosis and the long delay until specific treatment, because the combination of "tumour", bleeding and stenosis of the small intestine by an infiltrative lesion at first pointed to malignant process.

[Developments in the surgical therapy of colonic diverticulitis]. / Entwicklungen in der chirurgischen Therapie der Kolondivertikulitis.

All patients admitted to our department with diverticulitis of the left sided colon between 1980 and 1990 were retrospectively evaluated. Staging was performed according to the Hinchey classification. Altogether, 263 patients were evaluated; 71% had complicated diverticulitis and 29% simple diverticulitis. Of those patients with complicated diverticulitis, 68% required surgery due to abscess formation and/or perforation, 19% because of obstruction, 10% because of fistula formation, and 3% due to intestinal hemorrhage. While primary resection (primary reanastomosis in 82% or Hartmann procedure in 13%) was carried out in 250 patients (95%), 13 patients (5%) did not obtain this result (colostomy) following the initial operation. None of the patients who presented with simple diverticulitis died in the postoperative period. The total operative mortality and mortality for complicated diverticulitis amounted to 6.5% and 9%, respectively. In comparison to a former analysis from our department, resection of the primary focus during the initial operation led to a significant decrease in morbidity and mortality. In patients with complicated diverticulitis and peritonitis, primary resection and anastomosis also achieved favourable results in 78%.

[Sacro-coccygeal cyst: surgical techniques and results]. / Kyste sacro-coccygien: techniques opératoires et résultats.

69 patients with a chronic inflamed pilonidal sinus were reviewed. They were operated either with a deep excision to sacrum (37 patients) or with the Lord Millar technique (32 patients). 66 patients (87%) were controlled at a mean follow-up of 3.7 years after the operation. The socio-economical advantage of the Lord Millar operation is demonstrated by the shorter hospital stay (4.9 vs 7.6 days) and the shorter period of disability (14 vs 26 days). 5 recurrent episodes were observed among the 31 patients followed-up after an excision (16%) and 7 among the 29 followed-up after a Lord Millar operation (24%). In the later group one recurrence was seen in the sub-group of the 16 patients regularly epilated after the operation (6%) and 6 in the sub-group of the 13 who were not controlled (46%). We conclude that the Lord Millar operation is an alternative to the deep excision operation provided the patients is motivated enough to come regularly to the control for an epilation.

[Sacrococcygeal cysts. Is Lord Millar's procedure an alternative to exeresis?]. / Kyste sacro-coccygien. L'opération de Lord Millar représente-t-elle une alternative à l'excision?

The benignancy of sacrococcygeal cysts stands in contrast to their morbidity and rate of recurrence. Due to the differences in the results found in the literature and to the lack of recommendations as to the optimal surgical procedure, the authors have reviewed a series of 69 patients with a chronic inflammatory state. The procedure was either exeresis up to the sacrum (37 patients) or Lord Millar's procedure (32 patients). The latter consisted in a limited exeresis of the portals and in the extraction of the hairs with a brush, followed in principle by a weekly depilatory treatment until the wound was closed. The results in the 2 groups have been compared. Sixty-six patients (87%) were controlled after an average of 3.7 years. The shorter stay in hospital of the patients operated with Lord Millar's procedure (4.9 vs. 7.6 days) and the shorter period of inability to work (14 vs. 26 days) demonstrate the socioeconomical advantage of this procedure. Recurrence occurred in 5 of the 31 patients controlled after exeresis (16%) and in 7 of the 29 patients controlled after a Lord Millar's operation (24%), including one in the subgroup of 16 patients who submitted themselves to a regular postoperative epilatory treatment (6%) and 6 in the group of 13 who were not followed up in our clinic (46%). Thus Lord Millar's procedure represents an alternative to exeresis, provided the patient is motivated enough to submit himself to regular postoperative controls.

[Surgical intensive care in advanced age]. / Chirurgische Intensivtherapie im hohen Alter.

The question of sense and limits of intensive care in the critically ill or traumatized elderly induced us to analyse our own patients. In 1986, 877 patients were treated in our surgical intensive care unit. 164 (= 19%) of these patients were greater than or equal to 70 years old. Of these 22 had suffered a trauma, 142 were non-traumatized patients. 83 had an emergency operation, 76 an elective operation, and 5 were treated conservatively. Preoperative risk assessment was estimated, according to ASA classification. The median length of stay in the surgical intensive care unit was 2.9 days for all 877 patients, that of our patients greater than or equal to 70 years 1.9 days. Mortality in the intensive care unit was 6.5% for the whole group, and 6.1% for the group greater than or equal to 70 years of age. 79 of the 164 elderly patients (= 48%) could be discharged to their homes, 52 (= 32%) into another hospital, 4 (= 2.4%) were transferred to a nursing home, and 29 (= 17.7%) died during hospitalization. Two years after admission in the intensive care unit 84 (= 51%) patients were still alive. These patients looked rather optimistically on their state of health and independence, which allows certain conclusing on an acceptable quality of life. The results seem to justify an aggressive attitude regarding primary treatment of elderly patients, all the more since in the elderly feasibility of treating quite often becomes evident only after an attempt for treatment.

[Cardiac myxoma (author's transl)]. / Herzmyxome. Klinische Erscheinungsformen, Diagnose und chirurgische Therapie

Between 1965 and 1974 ten patients were operared on for cardiac myxoma. There was a striking variety of signs and symptoms caused by tumour embolization, haemodynamic obstruction, and auto-immunological reactions. The diagnosis should be made early before the occurrence of irreversible complications, especially cerebral embolism. Echocardiography is a simple technique for the detection of atrial myxoma but a negative result does not exclude it, and diagnosis has to be confirmed by angiocardiography. The tumour should be removed as soon as possible after diagnosis. There is danger of tumour embolization in the course of operation. Operative mortality is low in patients with only haemodynamic complications, but in patients with previous cerebral embolism the risk is higher because of possible bleeding in the infarcted areas of the brain resulting from anticoagulation during cardio-pulmonary bypass. Nonetheless, the operation is indicated in all cases. If removal of the myxoma is complete, recurrence is rate and long-term results are good.