Impact of laparoscopic versus open surgery on humoral immunity in patients with colorectal cancer: a systematic review and meta-analysis.

BACKGROUND: Laparoscopic surgery (LS) is hypothesized to result in milder proinflammatory reactions due to less severe operative trauma, which may contribute to the observed clinical benefits after LS. However, previous systematic reviews and meta-analyses on the impact of LS on immunocompetence are outdated, limited and heterogeneous. Therefore, the humoral response after laparoscopic and open colorectal cancer (CRC) resections was evaluated in a comprehensive systematic review and meta-analysis. METHODS: Included were randomized controlled trials (RCTs) measuring parameters of humoral immunity after LS compared to open surgery (OS) in adult patients with CRC of any stage. MEDLINE, Embase, Web of Science (SCI-EXPANDED), Cochrane Library, Google Scholar, ClinicalTrials.gov and ICTRP (World Health Organization) were systematically searched. Risk of bias (RoB) was assessed using the Cochrane RoB2 tool. Weighted inverse variance meta-analysis of mean differences was performed for C-reactive protein (CRP), interleukin (IL)-6, IL-8, tumour necrosis factor (TNF)α and vascular endothelial growth factor (VEGF) using the random-effects method. Methods were prospectively registered in PROSPERO (CRD42021264324). RESULTS: Twenty RCTs with 1131 participants were included. Narrative synthesis and meta-analysis up to 8 days after surgery was performed. Quantitative synthesis found concentrations to be significantly lower after LS at 0-2 h after surgery (IL-8), at 3-9 h (CRP, IL-6, IL-8, TNFα) and at postoperative day 1 (CRP, IL-6, IL-8, VEGF). At 3-9 h, IL-6 was notably lower in the LS group by 86.71 pg/ml (mean difference [MD] - 86.71 pg/ml [- 125.05, - 48.37], p < 0.00001). Combined narratively, 13 studies reported significantly lower concentrations of considered parameters in LS patients, whereas only one study reported lower inflammatory markers (for CRP and IL-6) after OS. CONCLUSION: The increase in postoperative concentrations of several proinflammatory parameters was significantly less pronounced after LS than after OS in this meta-analysis. Overall, the summarized evidence reinforces the view of a lower induction of inflammation due to LS.

"Prophylactic" transanal irrigation (TAI) to prevent symptoms of low anterior resection syndrome (LARS) after rectal resection: results at 12-month follow-up of a controlled randomized multicenter trial.

BACKGROUND: Low anterior resection syndrome (LARS) is associated with a severe negative impact on patients' quality of life (QOL). In a recent prospective randomized controlled trial (RCT) by our group, early ("prophylactic") use of transanal irrigation (TAI) following rectal resection for rectal cancer was shown to improve symptoms associated with LARS significantly compared with a group under supportive therapy (ST) within 1 and 3 months following closure of the protective ileostomy. The aim of the present study was to evaluate the outcome after 12 months when patients had the option to choose between the two therapeutic options and/or modify the regimen of TAI (volume and time). METHODS: In the RCT, 18 patients had been allocated to start with TAI following ileostomy closure, while 19 patients remained on ST only. Once the 3-month follow-up had been completed patients could choose between TAI or ST, respectively, and were invited for follow-up after 12 months. The maximum number of bowel movements during the day and the Wexner and LARS score as well as physical (PC) and mental (MC) component of the SF-36 questionnaire were evaluated. Furthermore, in patients who had changed their treatment arm, reasons for this decision were reported. RESULTS: Six patients were lost to follow-up (all in the ST group). One patient from the ST group started with TAI due to problems associated with LARS, bringing the total number of TAI patients to 19. Nine patients from the previous TAI arm changed to ST due to the long duration of the emptying process (n: 8) or pain during TAI (n: 1), respectively. After 12 months, the median volume of water used for irrigation was 600 ml (range 200-1000 ml). The ten patients who continued with TAI patients showed a lower number of defecation episodes per daytime (TAI median 3; 1-6, ST median 5; 2-10, p: 0.018) and per night (TAI median 0; 0-1, ST median 1; 0-5, p: 0.004) compared to the ST group. Although the LARS score was lower in patients who used TAI after 12 months (TAI median 18; 9-32, ST median 30; 3-39), this failed to reach the level of significance (p: 0.063). Evaluation of the Wexner score and the 36-item Short Form Health Survey as well as comparison of patients who remained on TAI (n: 9) versus those who had stopped TAI after 3 months (n: 9) failed to find any statistically significant difference between TAI and ST. CONCLUSIONS: This follow-up study revealed that a considerable number of patients decided to stop TAI within 12 months. However, the number of bowel movements during the day were still lower when TAI was used than when patients had ST only. CATEGORY: Randomized trial. REGISTRATION NUMBER: DRKS00011752, https://apps.who.int/trialsearch/ .

Results of the Gore Bio-A fistula plug implantation in the treatment of anal fistula: a multicentre study.

BACKGROUND: The aim of this prospective study was to determine the efficiency of the Gore Bio-A synthetic plug in the treatment of anal fistulas. METHODS: A synthetic bioabsorbable anal fistula plug was implanted in 60 patients. All fistulas were transsphincteric and cryptoglandular in origin. RESULTS: The healing rate after 1 year of follow-up was 52 % (31 out of 60 patients). No patient was lost to follow-up. The treatment had no effect on the incontinence score. The plug dislodgement rate was 10 % (6 out of 60 patients). Thirty-four per cent of the patients (16 out of 47) required reoperation. The average operating time was 32 ± 10.2 min, and the average length of hospital stay was 3.3 ± 1.8 days. CONCLUSIONS: Synthetic plugs may be an alternative to bioprosthetic fistula plugs in the treatment of transsphincteric anal fistulas. This method might have better success rates than treatment with bioprosthetic fistula plugs.

[Historical development of drug testing in Swiss equestrian sports]. / Geschichtliche Entwicklung und Analyse der Medikationskontrollen im Schweizer Pferdesport.

INTRODUCTION: The goal of this study was to describe the development of equine drug testing in horses in Switzerland. This was achieved through evaluation of a film made by the Institute of Forensic Medicine at the University of Basel entitled 'Doping von Rennpferden' [Doping of Race Horses], toxicological detection, 1962', the analysis of doping test results of the Swiss Equestrian Federation and by interviewing individuals of various professions who were involved in equine drug testing at the time. The study compares early and modern methods of drug testing and highlights the changes in the attitude of equestrian athletes, horse owners and the general public toward doping in equestrian sports. The high sensitivity of modern analytical methods allows the detection of drugs at levels considerably below therapeutic concentrations. This has resulted in a shift from zero tolerance for Controlled Medication Substances to the establishment of sub-therapeutic threshold concentrations. The lists of performance-enhancing drugs used in doping are updated continually. It became clear from this work that in the early 1960s, Switzerland played a leadership role in anti-doping in equestrian sports, and that the efforts to keep the sport free of performance-enhancing drugs remain exemplary.

INTRODUCTION: Le but du présent travail était d'étudier les débuts des contrôles de médication dans le sport équestre suisse. Il comprend l'analyse du film "Dopage de chevaux de course, mise en évidence toxicologique", un film de 1962 de l'Institut médico-légal de Bâle, une enquête auprès de témoins de l'époque provenant de divers milieux et l'exploitation des résultats des analyses de dopage de la Fédération Suisse des Sports Equestres (FSSE). Ces recherchent montrent comment les contrôles antidopage étaient effectués à l'époque en comparaison à aujourd'hui et comment le positionnement des cavaliers, des propriétaires et de la population en général sur cette question s'est modifiée au cours des années. Vu la très haute sensibilité des méthodes d'analyse utilisées actuellement, de nombreuses substances peuvent être aujourd'hui détectées dans des concentrations sans effet pharmacologique. Cela a conduit pour les médicaments contrôlés (Controlled Medication Substances) a une tendance à l'abandon de la "tolérance zéro" et à l'utilisation de valeurs-limites sans effet thérapeutique. Les listes des substances dopantes sont continuellement mises à jour. Les résultats de cette étude montrent que la Suisse, au début des années soixante, a joué un rôle de précurseur dans le contrôle de médication dans les sports équestres et que ses efforts pour le maintien d'un sport équestre propre restent exemplaires aujourd'hui.

Evaluation of the Tekscan F-SCAN system for measurement of the kicking force in horses.

INTRODUCTION: The incidence of fractures after a kick, coupled with marked soft tissue trauma at the site of injury, suggests that the force of a kick from the hind limb of a horse is enormous. The goal of this study was to measure this force and to investigate whether the Tekscan F-SCAN in-shoe pressure measuring system is suitable for quantification of the impact strength of a kick from a horse. The system was tested in 6 horses that had undergone clinical examination and gait analysis. The sensor-shoe combination was attached to each hind foot and the horse was stimulated to kick against a wall. The F-SCAN system measured the maximum vertical and horizontal force (N), the main contact area (cm2) of the sole with the floor (stance phase limb) or wall (kicking limb) and the duration (sec) that the sole was in contact with the floor or wall. In addition, each kicking event was recorded with a video camera for subjective evaluation. The mean kicking force measured was lower than that recorded in horses trotting on a treadmill, where the forces exerted on one limb were similar to the horse's body weight. The results of this study indicate that the Tekscan F-SCAN system is not ideally suited to measure the force of a kick of a horse in vivo.

INTRODUCTION: La fréquence des fractures et les importants dégâts aux tissus mous consécutifs à des coups de pieds laissent à penser que la force de frappe transmise à cette occasion doit être très importante. Le but du présent travail était de mesurer cette force et de voir si le système F-Scan Tekscan est adapté pour quantifier la force de frappe d'un cheval. Après un examen clinique et orthopédique, le système a été utilisé sur 6 chevaux, en incluant le senseur dans une hipposandale et en stimulant ensuite le cheval pour qu'il rue contre une paroi. Le système F-Scan a mesuré lors de chaque coup de pied la force maximale verticale respectivement horizontale (N), la surface de contact (cm2) de la sole avec le sol (membre à l'appui) ou avec la paroi (membre donnant le coup) ainsi que la durée de contact avec le sol respectivement avec la paroi. Chaque coup de pied a simultanément été enregistré sur vidéo et le force du coup a été estimée subjectivement. Les forces mesurées étaient toutefois plus faibles que celles enregistrées chez des chevaux au trot sur un tapis roulant dans une étude précédente. Les forces exercées sur les membres étaient globalement égales au poids du cheval. Les résultats de notre étude laissent à penser que le système F-Scan Tekscan n'est pas idéal pour mesurer la force de frappe d'un cheval.

A retrospective analysis of antimicrobial resistance in bacterial pathogens in an equine hospital (2012-2015).

INTRODUCTION: Antimicrobial resistance has become an important concern in veterinary medicine. The aim of this study was to describe the rate of antimicrobial resistance in common equine pathogens and to determine the occurrence of multidrug-resistant isolates. A retrospective analysis of all susceptibility testing results from bacterial pathogens cultured from horses at the University of Zurich Equine Hospital (2012-2015) was performed. Strains exhibiting resistance to 3 or more antimicrobial categories were defined as multidrug-resistant. Susceptibility results from 303 bacterial pathogens were analyzed, most commonly Escherichia coli (60/303, 20%) and Staphylococcus aureus (40/303, 13%). High rates of acquired resistance against commonly used antimicrobials were found in most of the frequently isolated equine pathogens. The highest rate of multidrug resistance was found in isolates of Acinetobacter baumannii (23/24, 96%), followed by Enterobacter cloacae complex (24/28, 86%) and Escherichia coli (48/60, 80%). Overall, 60% of Escherichia coli isolates were phenotypically ESBL-producing and 68% of Staphylococcus spp. were phenotypically methicillin-resistant. High rates of acquired antimicrobial resistance towards commonly used antibiotics are concerning and underline the importance of individual bacteriological and antimicrobial susceptibility testing to guide antimicrobial therapy. Minimizing and optimizing antimicrobial therapy in horses is needed.

INTRODUCTION: Une connaissance des bactéries pathogènes présentes localement est importante pour pouvoir mettre en œuvre dès le début un traitement antibiotique ciblé. Le but de cette étude était de décrire les agents infectieux les plus fréquents et leur évolution dans le temps chez les chevaux hospitalisés à l'hôpital vétérinaire de Zürich entre 1988 et 2014. Tous les résultats positifs de cultures ont été analysés rétrospectivement. Les isolats ont été classés sur la base de leur localisation, du diagnostic et de l'année de leur isolation. Diverses périodes ont été comparées au moyen d'un test de chi carré. Escherichia coli (299/1'723, 17%), Streptococcus equi ssp. zooepidemicus (295/1'723, 17%) et les staphylocoques coagulase positive (196/1'723, 11%) ont été dans l'ensemble les bactéries mises en évidence le plus souvent. Des bactéries anaérobes strictes ont été trouvées principalement dans les infections dentaires (18/66, 27%), les péritonites (6/43, 14%) et les infections des tissus mous (28/208, 13%). Des cultures mixtes étaient particulièrement fréquentes dans les infections cutanées et dentaires (24/55, 44% et 17/43, 40%). Les principaux germes isolés dans la plupart des systèmes d'organes étaient aussi bien Gram positifs que Gram négatifs. Pour cette raison, il conviendrait, jusqu'à ce que les résultats des cultures et des antibiogrammes soient connus, de choisir un médicament à large spectre d'action.

Management of rectourinary fistula after urological interventions using biodesigned mesh: first experiences of an innovative technique.

PURPOSE: Rectourinary fistula (RUF) is an uncommon but devastating condition that usually occurs as a complication of surgical treatment or radiotherapy of prostate cancer. Although operative fistula repair remains the most successful treatment, there still is no consensus concerning the management of RUF. We present first experiences and transanal surgical technique using biological mesh for fistula repair after urological intervention. MATERIAL AND METHODS: From January 2009 to December 2013, four cases of RUF were reported at our university hospital. Fistula occurred after extraperitoneal laparoscopic radical prostatectomy, open radical prostatectomy, and high-intensity focused ultrasound, respectively. All patients were initially treated with transanal Cook Biodesign™ mesh, whereas two patients received reoperation with rectal mucosa advancement flap and gracilis muscle flap interposition, respectively. Mean follow-up was 36 months (range 9-62). RESULTS: Fistula diameters ranged from 0.6 to 3.0 cm and were located 5 to 6 cm of anocutaneous line. The time from diagnosis to fistula repair was 3 to 7 weeks. The median operative time for Cook Biodesing™ mesh procedure was 79 min (IQR 60, 98). The initial success rate for biological mesh was 50 % (2/4 patients). Larger fistulae were minimalized successfully and finally closed with reoperation mentioned above. No deterioration of continence was documented. CONCLUSIONS: Management of rectourinary fistula is still challenging. Using biomaterials for fistula closure seems to be a promising and minimally invasive transanal technique in future. Further analysis including more patients is needed to clarify its exact role in comparison to traditional surgical techniques.

[Gender-specific aspects of Lynch syndrome--an update]. / Genderspezifische Aspekte des Lynch-Syndroms--Ein Update.

Approximately 3-5% of all colorectal cancers are based on a hereditary predisposition, of which Lynch syndrome is by far the most frequent hereditary cancer syndrome. Beside colorectal cancer Lynch-Syndrome is the most frequent predisposing hereditary cause of endometrial cancer and is also associated with gastric cancer, ovarian cancer, cancer of the urinary tract as well as several other cancers. Genetically Lynch syndrome is caused by a germline mutation in one of the so-called mismatch-repair-genes. Based on several epidemiological studies, increasingly differences in the penetrance of the different cancers occurring are associated with the affected gene and also gender of the patient have been reported. The lifetime risk of colorectal cancer for males with Lynch syndrome generally is significantly higher and the age of first manifestation significantly earlier compared to females. The difference is especially notable in men with a MSH6-mutation. Moreover, the lifetime risk for gastric, bladder, and urothelial cancer is much higher in males. Women with an MSH6 mutation have a much higher risk for endometrial (and ovarian) cancer than for colorectal cancer. In patients with Muir Torre syndrome again males are predominantly affected and almost all affected have a mutation in MSH2 rather than in any other MMR gene. This review is an update of the literature analyzing gen and gender specific aspects of Lynch syndrome. To date these associations are based on retrospective studies, that require confirmation in a prospective setting with large patient numbers in order to identify validated, individualized gene and gender screening recommendations in the future. Especially in a syndrome with multiple potential cancer targets, an intense yearly program comprising several invasive procedures has a negative effect on patient compliance.

[Colorectal Carcinoma with Suspected Lynch Syndrome: A Multidisciplinary Algorithm]. / Kolorektales Karzinom bei V. a. Lynch-Syndrom: ein interdisziplinärer Algorithmus.

Lynch syndrome is the most frequent hereditary cancer syndrome, accounting for approximately 3-5 % of all colorectal cancers. In addition, it is the most frequent predisposing hereditary cause of endometrial cancer and is also associated with gastric cancer, ovarian cancer, cancer of the urinary tract as well as several other cancers. In clinical practise Lynch syndrome is frequently not detected and many clinicians admit uncertainties regarding diagnostic procedures. Also, counselling of patients is considered difficult regarding therapeutic - especially prophylactic surgical and chemopreventive options and recommendations. Based on a review of available literature we discuss optimized strategies for improved detection of suspected Lynch syndrome patients. The aim of this review is to establish a clinical algorithm of how to proceed on a diagnostic level and to discuss surgical options at the time of a colorectal cancer. In order to identify patients with Lynch syndrome, family history should be ascertained and evaluated in regards to fulfilment of the Amsterdam-II- and/or the revised Bethesda criteria. Subsequently immunohistochemical staining for the mismatch-repair-genes, BRAF testing for MLH1 loss of expression, as well as testing for microsatellite instability in some, followed by genetic counselling and mutation analysis when indicated, is recommended. Pathological identification of suspected Lynch syndrome is readily feasible and straightforward. However, the need of performing these analyses in the tumor biopsy at the time of (gastroenterological) diagnosis of CRC neoplasia is essential, in order to offer patients the option of a prophylactically extended surgery and - as recommended in the German S3 guidelines - to discuss the option of a merely prophylactical hysterectomy and oophorectomy (if postmenopausal) in women. Close cooperation between gastroenterologists, pathologists and surgeons is warranted, so that patients may benefit from options of extended or prophylactically extended surgery at the time of diagnosis of a colorectal primary. Patients nowadays must be involved in informed decision-making regarding prophylactic or extended prophylactic surgery at the time of a colorectal primary. To date, however, limitations in daily clinical practise, the failure to assess family history and the lack of awareness of this important hereditary syndrome is the major asset leading to severe underdiagnosis and putting to risk the indexpatients themselves and their families to (metachronous) CRC and the associated extracolonic cancers. If at all tumors of patients fulfilling Bethesda criteria will be analysed for MSI in the surgical specimen and therefore Lynch syndrome patients are not given the opportunity to opt for extended surgery. In clinical experience the postoperative MSI-analysis is inconsistently performed - even if the Bethesda criteria are fulfilled - and in case of suspected Lynch syndrome genetically counselling is not consistently recommended. Therefore affected cancer patients are left unaware of their increased genetic risk and in average 3 high-risk gene carriers per family miss the opportunity to actively engage in the recommended screening program.

[Navicular bone fractures in horses: Prognosis after conservative and surgical treatment]. / Strahlbein-Frakturen beim Pferd: Prognose nach konservativer und chirurgischer Therapie.

INTRODUCTION: The aim of this retrospective study is to describe and compare conservative and surgical treatment of navicular fractures in horses. An attempt is made to identify critical points that can favorably influence the prognosis of this orthopedic disease. All horses treated for a navicular fracture at the Equine Clinic, Vetsuisse Faculty, University of Zurich between 2005 and 2017 were included in this study. The severity of lameness at initial examination, radiographic assessment, hoof conformation, treatment (conservative or surgical), complications and outcome were determined from the medical records. Conservative and surgical treatment consisted of stable rest, a controlled exercise program and therapeutic orthopedic shoeing. During surgical treatment, fracture reduction was also carried out with a cortical screw. Computer assisted surgery were used in five horses and computer tomography in three horses. Follow-up examinations included clinical and radiographic examinations. The outcome was divided into three categories: 1 = very good; 2 = good; 3 = poor. Twelve horses met the inclusion criteria; Four horses were treated conservatively and eight were treated surgically. After conservative treatment, two horses (50 %) had a very good outcome and two (50 %) had a good outcome. After surgical treatment, four horses (50 %) had a very good outcome and four (50 %) had a poor outcome. Overall, 67 % of horses had a very good or good outcome, although radiographic signs of bone healing was not present in any of these cases. Various complications were identified, such as the fracture of a screw, the fragmentation of the small navicular bone fragment, the development of osteoarthrosis in the coffin joint and progressive podotrochosis. This study shows that the prognosis of navicular fractures is generally cautious and that degenerative changes to the navicular apparatus worsen the prognosis. In the present study, surgical treatment did not improve the prognosis of navicular fractures despite the intrasurgical use of three-dimensional imaging. However, technical advances could reduce the complication rate in the future.

INTRODUCTION: Le but de cette étude rétrospective était de décrire et de comparer le traitement conservateur et chirurgical des fractures de l'os naviculaires chez le cheval. Une tentative est faite pour identifier les points critiques qui peuvent influencer favorablement le pronostic de cette maladie orthopédique. Tous les chevaux traités pour une fracture de l'os naviculaire à la Clinique équine de la Faculté Vetsuisse de l'Université de Zurich entre 2005 et 2017 ont été inclus dans cette étude. La gravité de la boiterie lors de l'examen initial, l'évaluation radiographique, la conformation du sabot, le traitement (conservateur ou chirurgical), les complications et le résultat ont été déterminés à partir des dossiers médicaux. Le traitement conservateur et chirurgical consistait en un repos au box, un programme d'exercice contrôlé et un ferrage orthopédique thérapeutique. Au cours du traitement chirurgical, une réduction de la fracture a également été effectuée à l'aide d'une vis corticale. La chirurgie assistée par ordinateur a été utilisée sur cinq chevaux et la tomographie assistée par ordinateur sur trois chevaux. Les examens de suivi comprenaient des examens cliniques et radiographiques. Les résultats ont été divisés en trois catégories: 1 = très bon; 2 = bon; 3 = mauvais. Douze chevaux répondaient aux critères d'inclusion ; quatre chevaux ont été traités de manière conservatrice et huit ont été traités chirurgicalement. Après un traitement conservateur, deux chevaux (50 %) ont eu un très bon résultat et deux (50 %) un bon résultat. Après le traitement chirurgical, quatre chevaux (50 %) ont eu un très bon résultat et quatre (50 %) un mauvais résultat. Dans l'ensemble, 67 % des chevaux ont eu un très bon ou un bon résultat, bien que les signes radiographiques de guérison osseuse n'aient été présents dans aucun de ces cas. Diverses complications ont été identifiées, telles que la fracture d'une vis, la fragmentation du petit fragment de l'os naviculaire, le développement d'une arthrose dans l'articulation interphalangienne distale et une podotrochlose progressive. Cette étude montre que le pronostic des fractures de l'os naviculaire est généralement réservé et que les modifications dégénératives de l'appareil naviculaire aggravent le pronostic. Dans la présente étude, le traitement chirurgical n'a pas amélioré le pronostic des fractures du naviculaire malgré l'utilisation intra-chirurgicale de l'imagerie tridimensionnelle. Cependant, les progrès techniques pourraient réduire le taux de complications dans le futur.

Health-related quality of life after laparoscopic and open surgery for rectal cancer in a randomized trial.

BACKGROUND: Previous studies comparing laparoscopic and open surgical techniques have reported improved health-related quality of life (HRQL). This analysis compared HRQL 12 months after laparoscopic versus open surgery for rectal cancer in a subset of a randomized trial. METHODS: The setting was a multicentre randomized trial (COLOR II) comparing laparoscopic and open surgery for rectal cancer. Involvement in the HRQL study of COLOR II was optional. Patients completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR38, and EuroQol - 5D (EQ-5D™) before surgery, and 4 weeks, 6, 12 and 24 months after operation. Analysis was done according to the manual for each instrument. RESULTS: Of 617 patients in hospitals participating in the HRQL study of COLOR II, 385 were included. The HRQL deteriorated to moderate/severe degrees after surgery, gradually returning to preoperative values over time. Changes in EORTC QLQ-C30 and QLQ-CR38, and EQ-5D™ were not significantly different between the groups regarding global health score or any of the dimensions or symptoms at 4 weeks, 6 or 12 months after surgery. CONCLUSION: In contrast to previous studies in patients with colonic cancer, HRQL after rectal cancer surgery was not affected by surgical approach. REGISTRATION NUMBER: NCT00297791 (http://www.clinicaltrials.gov).

[Prophylaxis of thromboembolic events in surgery. DVT prophylaxis: a comparison of out-patient and hospitalized patients]. / Prophylaxe thromboembolischer Ereignisse in der Chirurgie. TVT-Prophylaxe: Vergleich ambulant vs. stationär.

BACKGROUND: The aim of this study was to compare the efficacy and tolerability of enoxaparin for preventing thromboembolism after surgery in the out-patient and in-hospital settings. MATERIALS AND METHODS: A total of 2,005 out-patient and 1,360 hospitalized patients were included in the study. Prophylaxis was carried out with 20 or 40 mg enoxaparin and follow-up examination after 4-6 weeks. RESULTS: Out-patients were younger (mean 48.4 vs. 58.5 years, p<0.01), had less cardiovascular comorbid diseases (7.1 vs. 20.8%, p<0.01) and underwent less complex interventions (arthroscopy 33.6 vs. 7.5%, p<0.01). Out-patients also received 20 instead of 40 mg enoxaparin more frequently (60.7 vs. 38.3%, p<0.01). The mean duration of thromboprophylaxis was reduced (12.6 vs. 15.3 days). For patients treated with 20 and 40 mg minor bleeding was observed in 1.8 and 3.4%, respectively (4.7 with 20 mg and 4.5% with 40 mg in hospital), major bleeding was 0.1% for both doses in out-patients and 0.0% with 20 mg and 0.3% with 40 mg in-hospital. Deep vein thrombosis (DVT) occurred in 0.4% of out-patients receiving 20 mg enoxaparin and 0.6% with 40 mg (0.0% with 20 mg and 0.9% with 40 mg in-hospital). There were no cases of pulmonary embolism (PE) in out-patients but PE was observed in 0.2% and 0.5% with 20 mg and 40 mg in-hospital patients, respectively. CONCLUSIONS: Thromboprophylaxis with enoxaparin is well tolerated under clinical conditions as well as under out-patient treatment and severe bleeding complications are rare.

The prevalence of equine odontoclastic tooth resorption and hypercementosis and the role of interincisal angulation in disease severity in a representative cohort of horses in Switzerland.

INTRODUCTION: Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is an increasingly diagnosed degenerative dental disease in aged horses. The primary aim of this retrospective study was to determine the prevalence of EOTRH in horses admitted to the Equine Hospital, University of Zurich, for dental procedures from 2004 to 2017. A secondary goal was to measure and compare interincisal angles on two-dimensional radiographs of horses with EOTRH to determine whether the interincisal angle is associated with age and severity of the disease. Radiographs were assessed for the presence of lysis and/or hypercementosis, and the number and position of the teeth affected were determined. Each tooth was also evaluated using the modified classification system introduced by Rehrl et al. (2018), in which stage 0 indicates no radiographic abnormalities and stage 3 denotes severe abnormalities. The overall stage was defined by the tooth with the most severe lesions. The interincisal angle was determined in horses that had suitable radiographs. The medical records of 838 horses admitted for dental procedures were evaluated, and 85 (10,1 %) had clinical evidence of EOTRH. The mean interincisal angle was 136,06 ° in horses with mild to moderate EOTRH and 135,10 ° (SD = 11,90 °) in severely affected patients. In conclusion, the angle measurements on lateral radiographs were highly reproducible. However, the interincisal angle was not associated with age or the severity of EOTRH. The interincisal angle and the disease pattern were not correlated.

INTRODUCTION: La résorption et l'hypercémentose odontoclastique des dents chez le cheval (EOTRH) est une maladie dentaire dégénérative de plus en plus diagnostiquée chez les animaux âgés. L'objectif principal de cette étude rétrospective était de déterminer la prévalence de l'EOTRH chez les chevaux admis à l'Hôpital équin de l'Université de Zurich pour des interventions dentaires entre 2014 et 2017. Un objectif secondaire était de mesurer et de comparer les angles inter-incisifs sur des radiographies bidimensionnelles de chevaux atteints d'EOTRH afin de déterminer si cet angle est associé à l'âge et à la gravité de la maladie. Les radiographies ont été évaluées pour la présence de lyse et/ou d'hypercémentose, et le nombre et la position des dents affectées ont été déterminés. Chaque dent a également été évaluée à l'aide du système de classification modifié introduit par Rehrl et al. (2018), dans lequel le stade 0 indique l'absence d'anomalies radiographiques et le stade 3 indique des anomalies graves. Le stade global a été défini par la dent présentant les lésions les plus sévères. L'angle inter-incisif a été déterminé chez les chevaux qui avaient des radiographies appropriées. Les dossiers médicaux de 838 chevaux admis pour des interventions dentaires ont été évalués et 85 (10,1 %) présentaient des signes cliniques d'EOTRH. L'angle inter-incisif moyen était de 136,06° chez les chevaux présentant une EOTRH légère à modérée et de 135,10° (écart-type = 11,90°) chez les patients gravement atteints. En conclusion, les mesures d'angle sur les radiographies latérales étaient très reproductibles. Cependant, l'angle inter-incisif n'était pas associé à l'âge ou à la sévérité de l'EOTRH. L'angle inter-incisif et le profil de la maladie n'étaient pas corrélés.

[Lynch syndrome--epidemiology, clinical features, molecular genetics, screening, therapy]. / Das Lynch-Syndrom - Epidemiologie, Klinik, Genetik, Screening, Therapie.

Lynch syndrome is characterised by a familial predisposition of colorectal and endometrial carcinomas in association with a variety of other cancers. The underlying autosomal dominant inheritance has a penetrance of 85-90%. The molecular genetic underlying mechanism is a mutation in one of the mismatch-repair genes. The identification of the molecular genetic basis of Lynch syndrome enabled the implementation of predictive testing in families with a proven mutation. A prerequisite to detect patients with Lynch syndrome is a knowledge of the clinical and histopathological features of this disease. Typical for Lynch syndrome associated carcinomas is the early age of onset of about 45 years as well as the characteristic localisation within the right hemicolon. However, in order to increase the rate of identification of this underestimated syndrome, the awareness of the clinician must extend beyond this classical phenotype. For this purpose close interdisciplinary cooperation is warranted! The cancers are mostly low-differentiated with solid areas without a tubular structure. Crohn's-like lesions as well as peritumoural and tumour-infiltrating lymphocytes may frequently be found in the periphery of the malignant formation. Within the framework of the clinical evaluation of any index patient, an extended family history must be ascertained and matched with the Amsterdam-I and -II criteria as well as with the revised Bethesda criteria. If a patient fulfills these criteria, testing for microsatellite instability and if positive after genetic counselling mutation analysis should be recommended. Patients with a proven mutation and high risk individuals from families with an unidentified underlying mutation are encouraged to participate in an intensified screening programme. Due to the incomplete penetrance there is no recommendation towards prophylactic surgery in high-risk individuals without tumour manifestation. Nevertheless, the effect on quality of life of prophylactic, extended surgery in addition to the obligatory oncologic resection with or without prophylactic hysterectomy needs to be established in prospective controlled trials.

[Heart rate and faecal cortisol metabolites measurements in horses at the Sechseläuten in Zurich]. / Messung von Herzfrequenzen und Kotcortisolmetaboliten bei Pferden am Zürcher Sechseläuten.

INTRODUCTION: The Zurich's Sechseläuten is a traditional festival of the Zurich guilds, in which around 500 horses take part. After a parade through the old town of Zurich, the riders gather at a big square to canter around a burning woodpile topped with an exploding effigy (the «Böögg¼). The level of stress experienced by the horses partaking in this event is subjected to increasing scrutiny. The aim of this study was to evaluate the stress load of the horses participating in the Sechseläuten procession more objectively by measuring heart rate and faecal cortisol metabolites. Twenty-three horse-rider pairs were voluntarily recruited from the guilds for participation in the study. For comparison purposes, three sections of the procession were simulated in terms of gait and distance travelled in a normal riding environment during a test day and observed during the Sechseläuten itself 16 days later: Counter march Bahnhofstrasse, parade Limmatquai and parade around the burning «Böögg¼. All horses were equipped with a heart rate measuring system with GPS tracking (Polar Team Pro®, Polar Electro Oy, Finland). Faecal samples for measuring cortisol metabolites were taken rectally immediately before and 24 hours after the events. Thirteen of the 23 horses were sedated during the Sechseläuten (Acepromazine, 0,1-0,2 mg/kg p.o.). The differences between the observation periods and groups (sedated/unsedated) were tested by analysis of variance (P.

INTRODUCTION: Le Sechseläuten de Zurich est une fête traditionnelle des guildes zurichoises à laquelle participent environ 500 chevaux. Après un défilé dans la vieille ville de Zurich, les cavaliers se rassemblent sur une grande place pour galoper autour d'un tas de bois en feu surmonté d'une effigie qui explose (le «Böögg¼). Le niveau de stress des chevaux participant à cet événement fait l'objet d'une attention croissante. L'objectif de cette étude était d'évaluer plus objectivement le niveau de stress des chevaux participant au cortège du Sechseläuten en mesurant la fréquence cardiaque et les métabolites fécaux du cortisol. Vingt-trois couples cheval-cavalier ont été recrutés volontairement dans les guildes pour participer à l'étude. À des fins de comparaison, trois sections du cortège ont été simulées en termes d'allure et de distance parcourue dans un environnement équestre normal lors d'une journée de test et observées ensuite pendant le Sechseläuten lui-même 16 jours plus tard: Contre-marche sur la Bahnhofstrasse, cortège sur le Limmatquai et chevauchée autour du «Böögg¼ en feu. Tous les chevaux ont été équipés d'un système de mesure de la fréquence un cardiomètre avec suivi GPS (Polar Team Pro®, Polar Electro Oy, Finlande). Des échantillons fécaux destinés à mesurer les métabolites du cortisol ont été prélevés par voie rectale immédiatement avant et 24 heures après les événements. Treize des 23 chevaux ont été mis sous sédation pendant le Sechseläuten (Acépromazine, 0,1­0,2 mg/kg p.o.). Les différences entre les périodes d'observation et les groupes (sédaté/non-sédaté) ont été testées par analyse de variance (P.

Internal fixation of a fractured axis in an adult horse.

OBJECTIVE: To report internal fixation of a fractured axis with a dynamic compression plate (DCP). STUDY DESIGN: Case report. ANIMALS: A 7-year-old Warmblood gelding. METHOD: Surgery was performed under anesthesia in sternal recumbency. After fracture reduction the complete transverse fracture in the cranial third of the axis was stabilized with a 7-hole 4.5 mm DCP. Optimal positioning of the plate and the length of the screws were facilitated by fluoroscopy. Recovery from anesthesia was supervised in a pool. RESULTS: The horse had an excellent outcome and returned to its previous activity level. CONCLUSION: Surgical treatment with fracture reduction and plate fixation enables normal bearing of the head and neck and improves neck flexibility soon after surgery.

[Surgical removing of an ectopic tooth in an Iceland mare]. / Chirurgische Entfernung einer ektopischen Zahnanlage bei einer Isländerstute.

Ectopic teeth occur because of failure of the first branchial cleft to close during development and are found mostly in young horses. Such dentigerous cysts are often located at the base of the ear, forming a notable swelling with a fistula, as it was the case with the two year old Iceland mare «Runa¼. In order to confirm the diagnosis, x-ray images were taken, which is also necessary to locate the ectopic tooth correctly. While operating, the whole cystic membrane should be removed and it is important to prevent adjacent nerves and blood vessels from damage. Prognosis for complete healing after removing an ectopic tooth is excellent.

The use of computed tomography in the diagnosis of pelvic fractures involving the acetabulum in two fillies.

Two fillies with hindlimb lameness and a tentative diagnosis of a pelvic fracture involving the acetabulum were examined using computed tomography (CT). The use of CT for these two cases revealed the exact course of the fractures and fissures, as well as the size and position of fragments, thus allowing for definitive diagnosis.