[Ambulatory CT-assisted thoracic sympathetic block as an additional approach to treatment of complex regional pain syndromes after sport injuries]. / Ambulante CT-gestützte thorakale Sympathikusblockade als zusätzliche Therapieoption bei komplexem regionalen Schmerzsyndrom Typ I nach Sportverletzungen.

AIM: Also after bagatelle trauma, some patients can develop a complex regional pain syndrome (CRPS). The limb concerned usually shows a marked temperature difference to the contralateral side. Apart from a doughy swelling, the patient is impaired in particular by burning pain and a restricted range of motion. The objective of the present study was to examine the influence of early thoracic sympathetic nerve blockade on the basis of clinical and quantified blood flow parameters. METHODS: In 7 young patients (average age 17.7 [15 - 21] years) with a clinically developing type 1 CRPS after sport injuries (mountain bike, bike, skateboard, hockey and go-kart accidents), occult injury and ligament lesions were ruled out using conventional imaging and MRI. In addition to pain-adapted physiotherapy and pharmacotherapy with analgesics and calcitonin, sympathetic nerve blockade was performed three times at two-day intervals. The CT-assisted puncture was performed in the prone position at the level of the intervertebral space of the 2nd/3 rd thoracic vertebral bodies. In the correct paravertebral position, a 10-cm long, 22 G Seibel-Grönemeier needle was used for the successive injection of 6 - 10 ml Carbostesin 0.5 %. By adding a small amount of contrast medium, it was possible to visualise clearly the distribution of the sympathicolytic agent in the control scan in each case. Before and after the intervention, colour-coded duplex sonography (CCDS) of the affected limb arteries was performed on all patients. RESULTS: The injection needle was correctly placed in all patients, without complications. The medication mixture was observed to have distributed properly. After the intervention, all patients reported the immediate onset of marked pain relief, whereby they recovered fully over the further course. The increase in peripheral blood flow was shown by a significant improvement in flow in the CCDS. CONCLUSION: Outpatient CT-assisted temporary sympathetic nerve blockade is an effective and low-complication therapeutic option for the supportive treatment of patients with CRPS.

[Ambulatory CT-assisted thoracic sympathetic block as an additional approach to treatment of complex regional pain syndromes after sport injuries]. / Ambulante CT-gestützte thorakale Sympathikusblockade als zusätzliche Therapieoption bei komplexem regionalen Schmerzsyndrom Typ I nach Sportverletzungen.

AIM: Also after bagatelle trauma, some patients can develop a complex regional pain syndrome (CRPS). The limb concerned usually shows a marked temperature difference to the contralateral side. Apart from a doughy swelling, the patient is impaired in particular by burning pain and a restricted range of motion. The objective of the present study was to examine the influence of early thoracic sympathetic nerve blockade on the basis of clinical and quantified blood flow parameters. METHODS: In 7 young patients (average age 17.7 [15-21] years) with a clinically developing type 1 CRPS after sport injuries (mountain bike, bike, skateboard, hockey and go-kart accidents), occult injury and ligament lesions were ruled out using conventional imaging and MRI. In addition to pain-adapted physiotherapy and pharmacotherapy with analgesics and calcitonin, sympathetic nerve blockade was performed three times at two-day intervals. The CT-assisted puncture was performed in the prone position at the level of the intervertebral space of the 2nd/3rd thoracic vertebral bodies. In the correct paravertebral position, a 10-cm long, 22 G Seibel-Grönemeier needle was used for the successive injection of 6-10 ml Carbostesin 0.5 %. By adding a small amount of contrast medium, it was possible to visualise clearly the distribution of the sympathicolytic agent in the control scan in each case. Before and after the intervention, colour-coded duplex sonography (CCDS) of the affected limb arteries was performed on all patients. RESULTS: The injection needle was correctly placed in all patients, without complications. The medication mixture was observed to have distributed properly. After the intervention, all patients reported the immediate onset of marked pain relief, whereby they recovered fully over the further course. The increase in peripheral blood flow was shown by a significant improvement in flow in the CCDS. CONCLUSION: Outpatient CT-assisted temporary sympathetic nerve blockade is an effective and low-complication therapeutic option for the supportive treatment of patients with CRPS.

[Ambulatory, CT-assisted lumbar sympathicolysis in patients with severe peripheral artery disease: influence on peripheral blood flow and clinical outcome]. / Ambulante, CT-gestützte lumbale Sympathikolyse bei Patienten mit schwerer pAVK: Einfluss auf die periphere Perfusion sowie die klinischen Beschwerden.

PURPOSE: The clinical improvements reported by patients after lumbar sympathicolysis have been verified and quantified by colour-coded duplex sonography (CCDS) in this study. PATIENTS AND METHODS: CT-assisted lumbar sympathicolysis was performed on 136 patients (105 men, 31 women; mean age 66.1; range: 43-82 years) with PAOD (Fontaine stage II b-IV) on an outpatient basis after exhaustive surgical and interventional therapy. Puncture was performed via a dorsolateral approach, a 22 G Seibel-Grönemeyer Chiba biopsy needle was placed intercavovertebrally or interaortovertebrally at the level of the arch pedicle of the third lumbar vertebral body. A medication mixture consisting of 96% alcohol, 0.5% Carbostesin and added amounts of contrast medium was administered when the needle was correctly positioned. An average of 10 mL (6-12 mL) of the sympathicolytic agent was administered; in all cases only one side was treated per sitting. Before and around 120 min after the intervention, and 6 months post-intervention, the systolic and end-diastolic flow velocities, and blood volumes per minute were determined by CCDS. Additionally, the retroperitoneal space was examined by ultrasound after 6 months. The clinical outcome and the complications were assessed by a standardised questionnaire. RESULTS: In all patients, sympathicolysis was performed without technical complications. Starting on day 1 post-intervention, 4 patients complained of dysaesthesia in the inguinal and thigh area, another patient developed an erectile dysfunction although all these complications were completely reversible. 131/136 (96%) of the patients showed a significant increase in peripheral circulation immediately after the intervention, whereby a significant persistent effect was also seen in 120/136 (88%) after 6 months. In particular, patients in PAOD stages III and IV gained a clinical benefit. CONCLUSION: Lumbar sympathicolysis is a therapeutic option in severe PAOD that is low in complications, effective, minimally invasive and can be performed on an outpatient basis; it should be considered after angiographic-interventional and surgical measures have been exhausted. The significant clinical improvements can be explained in part by the improvement in perfusion as verified by CCDS.

Soluble intercellular adhesion molecule-1 in colorectal cancer and its relationship to acute phase proteins.

Increased concentrations of soluble intercellular adhesion molecule-I (ICAM-1) have been reported in a number of diseases including cancer. This study was undertaken to evaluate soluble ICAM-1 in colorectal cancer and its relationship to an unspecific acute phase response. Fifty six patients (25 with advanced colorectal cancer and 31 out-patients after radical surgical treatment) were included. Soluble ICAM-1 was measured by enzyme immunoassay. Four acute phase proteins (C-reactive protein, acid alpha 1-glycoprotein, haptoglobin and ceruloplasmin) were estimated by immuno-nephelometry. No significant increase of soluble ICAM-1 could be demonstrated in the patients compared to a control group (median 273 ng/ml vs. 270 ng/ml). Furthermore, patients with advanced colorectal cancer did not demonstrate elevated soluble ICAM-1 compared to follow-up out-patients. Patients with present acute phase response as determined by C-reactive protein were shown to have increased soluble ICAM-1 compared to patients without acute phase reaction. Using other acute phase proteins no difference for soluble ICAM-1 has been shown. Our data suggest an association between acute phase response and increased ICAM-1 in patients with colorectal cancer which should be considered when the diagnostic and/or prognostic usefulness of soluble ICAM-1 is to be evaluated.

[Pancreas penetration by ofloxacin--a pilot study]. / Die Pankreaspenetration von Ofloxacin--Eine Pilotstudie.

The use of antibiotics in patients with necrotizing pancreatitis is indicated since bacterial complications are the most common cause of death in this condition. Olfloxacin was studied in six patients regarding its permeation into pancreatic juice and bile and into pancreatic tissue in cases of chronic pancreatitis and pancreatic carcinoma. The peak concentrations in pancreatic juice (3.7 mg/l) and bile (12.9 mg/l) were found 20 minutes after i.v. administration of 3 mg/kg ofloxacin, these are 79 and 275% of the corresponding serum level, respectively. Pancreatic tissue concentrations varied between 54 and 333% of serum values in relation to the removal time of specimens and to the stage of inflammation. After three days and five days of ofloxacin treatment with doses of 2 x 200 mg daily even in pancreatic necroses concentrations were detected between 0.8 and 3.7 mg/kg wet weight. This suggests that in all pancreatic compartments analyzed, sufficient antibacterial ofloxacin levels above the MIC of relevant germs were found. Therefore, from a pharmacokinetic point of view, ofloxacin could be a potentially effective drug in prophylaxis and therapy of bacterial infections of the pancreas.

[Persistent ache caused by a residual meniscus (author's transl)]. / Der Restmeniskus als Ursache fortbestehender Kniegelenksbeschwerden

The residual meniscus as a cause of persistent ache of the knee is a rare condition. Permanent trouble demands an active instrumental diagnostic approach. A reliable diagnostic measure is repeated arthrography. Operative removal of the residual menicsus is the treatment of choice.

[Transformation surgery in dumping syndrome after Billroth II stomach resection]. / Umwandlungsoperationen beim Dumping-Syndrom nach Billroth-II-Magenresektion

After ineffective conservative therapy of the dumping-syndrome the transformation of Billroth's second operation into Billroth's first operation or the interposition of a jejunum segment between reamins of the stomach and duodenum are indicated. The increased risk of operation demands a careful selection of the patients. By means of these interventions an essential improvement of the complaints may be achieved.