[MRI of the heart following implantation of a left ventricular apico-aortic conduit]. / Kernspintomografie zur umfassenden Untersuchung des Herzens nach Implantation von linksventrikulären apikoaortalen Conduits.

PURPOSE: To investigate the potential of ECG-triggered MRI for the evaluation of postoperative anatomy and function of the heart and conduit following implantation of a left-ventricular apico-aortic conduit. MATERIALS AND METHODS: 5 patients (2 female, 3 male, mean age 72.5 years) were examined using a 1.5 Tesla whole-body MRI (Gyroscan Intera, Philips Medical Systems, Best, The Netherlands) following apico-aortic conduit surgery due to severe aortic valve stenosis. The reason for performing conduit implantation instead of aortic valve replacement was the risk of injuring a bypass graft from prior coronary artery bypass surgery. Cine steady-state-free-precession (SSFP) sequences were used to assess ventricular function, navigator-gated 3D-SSFP and breath-hold, time-resolved contrast-enhanced MR angiography was used to display the postoperative anatomy, and 2D-gradient echo sequences with an inversion pulse to suppress the signal of the healthy myocardium were used to evaluate potential myocardial scarring. Flow sensitive gradient echo sequences were performed to determine the blood flow in the conduit. RESULTS: In all patients the apico-aortic conduit proved to be open with a maximum flow velocity of 126 (+ 43) cm/s. The postoperative anatomy was able to be evaluated in all patients and perioperative myocardial infarction was able to be ruled out. The mean ejection fraction of the left ventricle was 44.2 + 6.2 % with a mean volume of 80 + 20.6 ml per heart beat. CONCLUSION: ECG-triggered MRI is a reliable method for the evaluation of postoperative anatomy and function following implantation of a left ventricular apico-aortic conduit.

Inguinal hernia on the internet: a critical comparison of Germany and the UK.

Despite containing an increasing amount of medical information, the Internet provides only rare benefits for surgical patients. Using "inguinal hernia" as a catchword, an amateur search was imitated on the British Internet market. Sixty-five pages, standardised regarding quality and efficiency, were evaluated. A comparison to the German Internet market was added. In summary, the broad majority of the pages revealed poor results. Technical appearance, quality of content, and target grouping show big deficiencies. The applicable laws on the European market are not yet established. The ranking lists of the search engines do not reflect the quality of the pages. Patients need competent guides to process surgical information from the Internet. The establishment of specialised institutions to control surgical Web sites according to quality, content, and legality on the European level is urgent.

[Tuberculosis of the gall bladder]. / Gallenblasentuberkulose.

We report a case of gall bladder tuberculosis in a 64-year-old male. The gall bladder is an extremely rare localization of an infectious disease seen frequently worldwide--tuberculosis. The reason for this special resistance against the mycobacteria is not clear and is controversial. In imaging, the disease can mimic acute or chronic cholecystitis or carcinoma of the gall bladder. It is important to consider tuberculous cholecystitis in differential diagnosis and to do tuberculin skin tests in case of suspicion. This test is technically easy and cost-effective. Since 1968, isolated tuberculosis of the gall bladder has not been reported in western civilization. This case study was done because of the rareness of the disease,and we review the literature on this topic.

[Information on the Internet for patients and general practitioners--critical analysis using the example of inguinal hernia]. / Internet-Informationen für Patient und Hausarzt als Leistungsanforderer. Eine kritische Analyse am Beispiel der Leistenhernie.

INTRODUCTION: The Internet offers an increasing amount of medical information, but its value for surgical patients is doubtful. METHODS: Using "inguinal hernia" as catchword, an amateur search was imitated on a German-speaking metasearch machine. One hundred fifty sites, standardized regarding quality and efficiency,were evaluated. RESULTS: In summary, more than 50% of the sites revealed poor results. Technical appearance, quality of content, and target grouping show big deficiencies. The applicable laws were mostly not respected. The ranking lists of the search machines do not reflect the quality of the sites. CONCLUSION: Patients need competent guides to process surgical information from the Internet. The establishment of a specialized institution to control surgical websites according to quality, content, and legality seems to be needed.

Echocardiogram-gated multislice spiral CT in functionally univentricular heart following long-lasting Waterston-Cooley anastomosis.

Waterston-Cooley anastomosis may be carried out in patients with tricuspid atresia to provide pulmonary perfusion. It is associated with several complications, including preferential blood flow to the right lung, hypoplasia of the left pulmonary artery, obstruction of the anatomosis or rupture of pulmonary aneurysms. We study a patient with thrombosis in the pulmonary arteries following surgical construction of a Waterston shunt in childhood. Imaging findings and clinical symptoms are discussed with emphasis on echocardiogram-gated multislice spiral CT.

Enterostomy complications in infancy and childhood.

BACKGROUND: A number of severe gastrointestinal disorders in infancy and childhood may require the formation of an enterostomy as a crucial part of the treatment of the disease itself. This study reviews our pediatric patients with regard to the morbidity and mortality of enterostomy formation and closure over an 8-year period. PATIENTS AND METHODS: Sixty-eight enterostomies in infants and children and 60 consecutive enterostomy closures in retrospect are reported on. This includes colostomies, jejunostomies, ileostomies, and Mikulicz procedures. RESULTS: In most instances, a transverse colostomy was performed. The most frequent indications were intestinal obstruction and necrotizing enterocolitis. More than half of the children were less than 1 month of age at the time of surgery. We observed an overall complication rate of 38.2% following enterostomy formation, with stoma prolapse being the most common, but faced major complications (such as sepsis, peritonitis, and enterocutaneous fistula) in only 10.3%. Complications after enterostomy closure were encountered in 20%. The overall mortality was 7%. CONCLUSION: Enterostomy formation and closure in the pediatric age group with severe underlying disease is still associated with substantial morbidity.