[Choice of operative procedure in diverticular disease : Taking the latest treatment strategies into consideration]. / Operative Verfahrenswahl bei der Divertikelkrankheit : Unter Berücksichtigung der neuesten Therapiestrategien.

BACKGROUND: There are various procedures to be considered in the surgical treatment of complicated diverticulitis, which must be selected depending on the classification of diverticular disease (CDD) type and the condition of the patient. OBJECTIVE: Comparison of surgical procedures with respect to aspects such as morbidity, mortality, reconstructive surgery and postoperative quality of life. MATERIAL AND METHODS: Evaluation, analysis and assessment of the current literature on surgical treatment of diverticular disease. RESULTS: Laparoscopic sigmoid resection with primary anastomosis is now considered the standard procedure for complicated sigmoid diverticulitis. It is preferable to open resection because of the better results of the minimally invasive approach with respect to the incidence of wound infections, abdominal abscesses and the occurrence of fascial dehiscence. In an emergency situation with perforation and peritonitis (CDD type 2c1/2), primary anastomosis with protective ileostomy should be favored over discontinuity resection (Hartmann's procedure). In particular, it must be taken into account that in a large proportion of patients there is no restoration of continuity after Hartmann's operation. The damage control strategy can be used in perforated sigmoid diverticulitis with generalized peritonitis (CDD type 2c1/2). In individual cases, laparoscopic lavage with insertion of a drainage may be considered as a therapeutic treatment strategy for perforated sigmoid diverticulitis with purulent peritonitis (CDD type 2c1). CONCLUSION: Selection of the surgical procedure for complicated sigmoid diverticulitis remains challenging. Randomized controlled trials of new treatment strategies as well as robotic-assisted surgery should be considered in the choice of surgical procedure in the future.

Detyrosinated tubulin is decreased in fetal vessels of preeclampsia placentas.

INTRODUCTION: Preeclampsia is a hypertensive, gestational disease, which is still the leading cause of pregnancy related morbidity and mortality. The impairment of placental angiogenesis and vascularization is discussed to be of etiopathologic relevance. Deytrosination and tyrosination of α-tubulin is important for the stability and dynamics of microtubules. An increase of α-tubulin detyrosination leads to microtubule stabilization, which is an essential prerequisite for physiologic vascular tube morphogenesis during angiogenesis. So far, little is known about the specific localization of detyrosinated (detyr) and tyrosinated (tyr) tubulin in the placenta and its relevance for preeclampsia. METHODS: Placental expression of detyr- and tyr-tubulin was analyzed by immunohistochemistry, immunofluorescence and western blot. For western blot quantification we used biopsies from healthy placentas (n = 21) and placentas from pregnancies complicated with small for gestational age (n = 5), preeclampsia (n = 5) or both (n = 5). RESULTS: Specific placental localization of detyr-tubulin was detected in the fetal endothelial cells of the placenta. Villous and extravillous trophoblasts as well as villous stroma cells were tyr-tubulin positive. Detyr-tubulin protein expression was significantly decreased in placentas complicated by preeclampsia. CONCLUSIONS: In summary, we report an accumulation of detyr-tubulin in villous vessels of the placenta and a significantly reduced level of detyr-tubulin in placental biopsies of preeclampsia cases. The reduction of placental detyr-tubulin in preeclampsia could suggest a deficit in villous vascular plasticity and might be associated with the impaired arborization of the disease.

[Evaluation of the results after using of the BI-RADS categories in 1,777 clinical mammograms]. / Ergebnisse nach Verwendung der BI-RADS-Kategorien an 1777 klinischen Mammographien.

PURPOSE: The purpose of our study was to evaluate the results after using the BI-RADS categories in clinical mammography, especially in the BI-RADS 0 and BI-RADS 3 categories. MATERIAL AND METHODS: During 1 year clinical mammograms were performed in 1,777 patients. The assessment reported by radiologists was based on the American College of Radiology using BI-RADS categories. In BI-RADS 0 and BI-RADS 3 categories additional examinations, histopathological results, und follow-up results were reported. RESULTS: Of 1,777 mammograms, 135 (4.1%) were classified into the BI-RADS 0 category. In 60 of 67 (90%) findings categorized as BI-RADS 0, MR mammography was performed and the results of the mammograms were ultimately classified into the BI-RADS 2 category. In 18 of 135 (13.3%) patients with BI-RADS 0 no further examinations were done. In 113 of 1,777 (3.4%) mammograms were classified into the BI-RADS 3 category. In 11 of 113 (9.7%) patients with BI-RADS 3 histopathology was done. A follow-up mammogram after 6 months was done only in 24 of 102 (23%) patients. In 21 of 102 (18.5%) patients with BI-RADS 3 follow-up mammograms were not performed. CONCLUSIONS: Not all patients with mammographic lesions in the BI-RADS 0 category avail themselves of further diagnostic work-up. Therefore in BI-RADS 0 category lesions, additional work-up should be performed directly after mammography during the same consultation. In some cases of BI-RADS 0 category, MR mammography is able to resolve the problem. Therefore the indication for MR mammography should be more commonly used.