[Sonography and computed tomography in postoperative abdominal abscesses]. / Sonographie und Computertomographie bei postoperativen, abdominellen Abszedierungen.

After abdominal surgery there is a 1.3% incidence of early relaparatomy. Peritonitis is the most frequent underlying disease, with a mortality rate of 58%, if treatment is attempted by explorative surgery. On the basis of 24 postoperative abdominal abscesses out of 1023 laparatomies during an 18-month period sonography and CT scanning proved to be most accurate in detecting postoperative inflammatory lesions despite the lack of specific criteria. Thus, both methods reduce the risks of relaparatomy by facilitating the surgical approach on the one hand, and on the other hand, they alternatively provide the possibility of percutaneous puncture or drainage.

[Critical remarks on computer tomography of the chest in the staging of bronchial cancer]. / Kritische Bemerkungen zur thorakalen Computertomographie beim Staging des Bronchuskarzinoms.

The planning of treatment in patients with non-oat cell carcinoma of the lung requires an extensive diagnostic work-up. As far as TN-staging is concerned, the role of CT is controversial. On the basis of 25 operated and histologically proven cases of non-oat cell cancer of the lung, the results of both CT and conventional radiography are critically evaluated. In the present study CT is found to be more sensitive but not more specific than conventional radiography in detecting pleural invasion and regional, especially mediastinal, lymphnode metastases. These results are in accordance with those of others. Since both modalities follow the same diagnostic criteria (lymphnode size, contact to pleura), an increase in sensitivity is intimately related to a corresponding loss of specificity. The relatively high sensitivity of CT on the one hand, and the relatively high specificity of conventional radiography on the other hand, suggest the following procedure: if conventional radiography is definitely positive, additional CT can be omitted. If CT proves negative as well, the presence of mediastinal metastases or pleural invasion is very unlikely. Positive findings on CT, however, need histologic verification.

[New diagnostic and therapeutic aspects of acute kidney failure]. / Neue diagnostische und therapeutische Aspekte des akuten Nierenversagens.

In a 20 months' period 20 patients were dialyzed at the Cantonal Hospital, Lucerne, because of acute renal failure (ARF). Contrary to expectation, the main cause was not circulatory failure but traumatic and nontraumatic rhabdomyolysis (5 patients), septicemia (9 patients) and endogenous and exogenous intoxications. In only 2 patients did shock seem an important factor in the pathogenesis of ARF. In view of the many causes of rhabdomyolysis, the frequency of patients with myoglobinuric ARF is hardly surprising. Case history, brown-colored urine with a positive reaction for hemoglobin in the absence of significant hematuria and without significant hemolysis (as judged by the color of the plasma or serum) and, most important, high creatine kinase (10(4) to 10(6) U/l) point to the correct diagnosis. In patients who had undergone trauma or surgery the main cause of ARF was uncontrollable infection. A long interval between the accident or operation and the onset of ARF was typical in these cases. Both hemodialysis and peritoneal dialysis are adequate methods of treatment for ARF. For technical reasons, however, in more than 50% of patients with ARF due to trauma or surgery, peritoneal dialysis is not feasible. On the other hand, in patients with cardiovascular instability continuous arterio-venous hemofiltration serves as an alternative to hemodialysis. With the introduction of Y-shaped dialysis catheters and the single needle system with double pump and controlled ultrafiltration, hemodialysis has become an easier and safer procedure. For patients with prolonged-course ARF the authors prefer a combination of initial hemodialysis, followed by peritoneal dialysis.(ABSTRACT TRUNCATED AT 250 WORDS)

A genetic deficiency that spans the flightin gene of Drosophila melanogaster affects the ultrastructure and function of the flight muscles.

We have developed a reverse-genetic approach to study the function of flightin, a unique protein of the flight muscle myofibril of Drosophila melanogaster. We describe the generation and characterization of Df(3L)fln1, a lethal genetic deficiency in the 76BE region of the third chromosome which deletes several genes, including the gene for flightin. We show that heterozygous flies harboring the Df(3L)fln1 mutation exhibit both impaired flight and ultrastructural defects in their flight muscle myofibrils. We found that the mutation does not interfere with assembly of the myofibril but leads to disorganization of peripheral myofilaments in adult myofibrils. Most myofibrils, nevertheless, retain an intact core that represents approximately 80 % of the normal lattice diameter. Mechanical analysis of single skinned flight muscle fibers demonstrates that the mutation has no significant effect on net power output but increases the frequency at which maximum power is delivered to the wings, potentially reducing the overall performance of the flight system. The results suggest that flightin is an indispensable part of the flight muscle contractile mechanism.

Effects of angiotensin II and noradrenaline on intrarenal haemodynamics in the rat.

The haemodynamic effects of angiotensin II and noradrenaline were studied in the rat kidney. These pressors were given by intravenous infusion in stepwise increasing doses. Intrarenal haemodynamics were analyzed by the 133xenon washout technique, 85krypton autoradiography and silastic casting of the renal vascular tree. Angiotensin II induced significant changes in intrarenal haemodynamics before any changes in systemic blood pressure were detected. The decrease in mean renal blood flow (2.91 ml.min-1.g-1 in controls, 1.76 ml.min-1.g-1 in rats given 50 mug of angiotensin II.kg-1.h-1) reflects a reduction in component I blood flow rate (from 3.9 to 2.9 ml.min-1.g-1) as well as a decrease in the fraction of total renal blood flow supplied to component I of the washout curve (from 84% to 62%). With noradrenaline an increase in total renal resistance occurred simultaneously with the elevation of mean arterial blood pressure. The resulting reduction in mean renal blood flow (from 2.76 ml.min-1.g-1 in controls to 1.55 ml.min-1.g-1 in rats given 1000 mug of noradrenaline kg-1.h-1) reflects a decrease in component I blood flow rate with lower infusion rates and a drop in component I flow fraction (from 82% to 52%) whith higher doses. In contrast to canine kidneys, no evidence for a patchy cortical vasoconstriction was found in the rat. Using autoradiography it was possible to attribute component I to the renal cortex and subcortical area of the kidney.

[Is appendectomy really performed too frequently? Results of the prospective multicenter study of the Swiss Society of General Surgery]. / Wird tatsächlich zu häufig appendektomiert? Resultate der prospektiven Multicenterstudie der Schweizerischen Gesellschaft für Allgemeinchirurgie (SGAC).

Scientific publications and provoking criticism from the lay press have recently pointed out, that appendices may be surgically removed too frequent and without indisputable necessity. In an attempt to verify these questionable statements, the Swiss Society for General Surgery (SGAC) initiated a prospective controlled multi center trial. From September 1997 to December 1998, hundred and twenty-five institutions documented 4603 appendectomies performed due to a suspected appendicitis. Histological investigation of all specimens revealed a 7% rate of normal appendices, 7.2% for patients with national health service (NHS) and 5.9% for patients with private insurances respectively. Compared to the results of the literature, where a frequency of normal appendices around 15% is judged as standard, these results are excellent. In 17.2% of the patients (15.9% NHS and 23.6% privately insured patients) an "appendicitis perforata" was observed. This percentage remains in the range reported by other authors. The analysis of time of admission (i.e. day or night) and the delay from admission to surgery shows a distribution independent to the insurance of the patients. Therefore, the planned appendectomy for patients with private insurances does not exist. A different choice of the surgical technique could be observed depending on the insurance status. In 30.4% of the private insured patients a laparoscopic appendectomy was performed as compared to 22.6% of patients with NHS. Surprisingly, an identical median hospitalization time can be observed for both groups (laparoscopic 5.5 days, open surgery 5.5 days).