Preliminary results after Single-Incision Laparoscopic Colorectal Surgery.

OBJECTIVE: Single-incision laparoscopic surgery (SILS) represents the recent advance in laparoscopic surgery claiming to be less invasive than conventional laparoscopic surgery. This study investigates the feasibility and safety of the procedure in colorectal surgery and reports the experiences in our center. METHODS: We retrospectively evaluated 41 consecutive patients surgically treated in our institution (February 2011-April 2013). The patient characteristics were evaluated for: gender, age, body mass index and ASA-score. Data included: indication, procedure, intraoperative complications, operation time, number of lymph nodes, postoperative complications, length of stay (LOS), morbidity and cosmesis. RESULTS: SILS was performed in 41 patients including 9 patients with colorectal cancer resection. We performed 3 ileocaecal resections, 11 right hemicolectomies, 7 sigmoidectomies and 20 rectosigmoidectomies. The operation time ranged from 45-210 min (median 123 min). Number of lymph nodes identified, ranged from 1-37 (median n=8). Six post-operative complications (14%) occurred: 1 gastroparesis, 1 subobstruction, 1 anastomotic leak and 3 patients needed a blood transfusion postoperatively. Median LOS was 6 days (range 4-21 days). One delayed complication (2,4%) occurred (eventration). None of the patients died. All patients had satisfactory cosmetic results. CONCLUSIONS: With the proviso that the study population was limited in size, SILS is feasible and is a save procedure in colorectal surgery and the procedure has an obvious cosmetic benefit. The results are comparable to other international reports. Still the procedure should be restricted to selected patients and performed by experienced surgeons. Additional prospective studies are essential to define the further benefit.

DNA methylation reprogramming, TE derepression, and postzygotic isolation of nascent animal species.

The genomic shock hypothesis stipulates that the stress associated with divergent genome admixture can cause transposable element (TE) derepression, which could act as a postzygotic isolation mechanism. TEs affect gene structure, expression patterns, and chromosome organization and may have deleterious consequences when released. For these reasons, they are silenced by heterochromatin formation, which includes DNA methylation. Here, we show that a significant proportion of TEs are differentially methylated between the "dwarf" (limnetic) and the "normal" (benthic) whitefish, two nascent species that diverged some 15,000 generations ago within the Coregonus clupeaformis species complex. Moreover, TEs are overrepresented among loci that were demethylated in hybrids, indicative of their transcriptional derepression. These results are consistent with earlier studies in this system that revealed TE transcriptional derepression causes abnormal embryonic development and death of hybrids. Hence, this supports a role of DNA methylation reprogramming and TE derepression in postzygotic isolation of nascent animal species.

Diagnostic emergency endoscopy in upper gastrointestinal bleeding--do we have any decision aids for patient selection?

The benefit of emergency endoscopy and therapeutic policies based on certain stigmata of bleeding has recently been demonstrated in patients with peptic ulcer hemorrhage. Applying a simple method of computer-aided diagnosis to a set of prospective data (n = 571) we investigated the question as to whether information on the history (28 variables) and clinical examination (8 variables) could be used to predict ulcer bleeding or certain stigmata of bleeding, with a view to deciding when to perform an emergency endoscopy in patients with upper gastrointestinal bleeding. The patients were assigned to either a high-risk group (probability greater than 0.50 for ulcer bleeding, arterial bleeding, etc.) or a low-risk group (p less than 0.50), and the prediction was compared with the actual findings at endoscopy. The results were disappointing, with an overall accuracy of 71% for the prediction of bleeding peptic ulcer and 71% for the prediction of a bleeding or non-bleeding visible vessel. Despite a relative risk of 2.8 for "bleeding ulcer" and 2.5 for "visible vessel" in the high-risk group, only 72% of all "bleeding ulcer" patients, and 69% of the "visible vessel" patients could be identified by the model. These results indicate that neither a bleeding ulcer nor stigmata of bleeding can be reliably predicted by the patient's history and clinical examination. Emergency endoscopy should therefore be performed in all patients with gastrointestinal bleeding.

The retroperitoneoscopic repair of a lumbar hernia of Petit. Case report and review of literature.

In this paper, we comment on a patient who consulted us because of his "lower backpain" together with the appearance of a small swelling at the left side. Anamnesis and clinical examination were suggestive and further simple diagnostic methods confirmed the exceptional diagnosis of a "lumbar hernia of Petit". We describe the retroperitoneoscopic approach of this hernia, its reduction and the fixation of a polypropylene mesh at the surrounding structures with a Tacker. This approach provided a good postoperative comfort, a shorter hospital stay and an early recovery of autonomy and activity. Furthermore, we give a review of the literature concerning lumbar hernias and the evolution of the different reconstruction techniques.

[Cholecystectomy by celioscopy: indications and safety of the method. Apropos of a consecutive series of 300 patients]. / Cholécystectomie par coelioscopie: indications et sécurité de la méthode. A propos d'une série consécutive de 300 patients.

We performed a laparoscopic cholecystectomy in 300 patients with gallstone disease complicated or not. The rate success was 97%, however involved the pathology might be. Indeed, 15% of the patients had an acute cholecystitis (10% catarrhalis, 5% empyema). Twenty-four patients with common bile duct stones had a complete endoscopic management of the biliary disease: endoscopic sphincterotomy and laparoscopic cholecystectomy. Operative mortality was absent and overall morbidity was 3.7%, exclusively minor.

[Introduction of an occupational group-spreading EDP-commission -increase of transparency and compliance]. / Einführung einer berufsgruppenübergreifenden EDV-Kommission -Erhöhung von Transparenz und Compliance.

The rising use of the EDP in hospitals of each order of magnitude raises different problems. Since each field of activity has own hard and software requests, this leads first of all to a multiplicity of heterogeneous isolated solutions, which make economic maintenance and servicing much more difficult. Besides redundancies and bad investments are pre-programmed. Secondly the central assignment for hard and software often takes place according to obscure and sometimes unreasonable criteria. Thirdly the coworkers, who are to operate locally with appropriate systems, frequently as the latter or not at all involved with the consequence of a contraproductive or boycotting adjustment of the coworkers and from this resulting reduction of the data quality. As solution for this in the Klinikum Krefeld was created 1995 a EDP-commission of the hospital physicians, that functions as official organ of the directors of hospital in EDP interests. The chronology and the solutions for the described problems are represented. - Due to the positive results of this institution in logical consequence 1999 a occupational group-spreading EDV commission was brought into being, which represents medical and nursery service, administration and EDP department and advises in all EDP interests both with strategic decisions the managing director as partner for the coworkers in EDP problems functions The chronology, the personnel composition as well as the agenda of the EDP-commission are represented. After our knowledge a such commission in Germany was not institutionalized yet, so that we want to energize to likewise transfer this due to our throughout positive experiences in the own hospital.

[Increasing incidence of HELLP syndrome. Diagnosis and treatment]. / Das zunehmend häufigere HELLP-Syndrom. Diagnostik und Behandlung.

QUESTION: The HELLP Syndrome as a complication of severe preeclampsia is becoming more frequent; because of the high risk for mother and child the immediate diagnostic and consistent therapy is of great importance. METHODS AND RESULTS: From 1989 to 1992 there were in the Frauenklinik Krefeld 17 out of 5413 deliveries with HELLP Syndrome (3.1/1000). The combination of symptoms were different: Clinical symptoms as upper abdominal pain were present in 76% (13/17), hypertension in 70% (11/17). Typical laboratory parameters as increased level of LDH were seen in 94% (16/17), elevated liver enzymes in 88% (15/17) and thrombocytopenia in 82% (14/17). It was, for the most part, primiparas from 32nd to 38th gestational week. All patients were delivered directly after diagnosis had been made by cesarean section. In one of the cases we was forced to carry out the hysterectomy because of unstoppable bleeding of placenta increta. Other complications did not occur, all the patients were released from hospital after the usual period of hospitalization without any further complaints. Regarding the children there was one case of infans mortuus, no fetus died peri- or postpartal. The complication rate was 25% (4/16). However all children were released after intensive pediatric treatment, the results of pediatric controls were all normal. CONCLUSION: By means of early diagnosis and immediate delivery it is possible to reach a significant improvement of prognosis for mother and child, even in a disease as serious as HELLP Syndrome.