Reduction of neoreflux after correctly performed ligation of the saphenofemoral junction. A randomized trial.

BACKGROUND: Neoreflux at the sapheno-femoral junction (SFJ) is an important cause of recurrent great saphenous varicose veins. This study compares four surgical methods of ligating the SFJ with the aim to reduce the rate of neoreflux. METHOD: In a prospective study, 379 patients (500 SFJ ligations) were randomised to one of four surgical procedures at the SFJ (125 groins each). In group A (control group) the SFJ was ligated in standard fashion with Vicryl (absorbable ligature); in group B, after Vicryl ligation continuous Prolene (non-absorbable) was sutured over the stump endothelium to prevent any contact with surrounding tissue; in group C. SFJ ligation was done with Ethibond (non-absorbable); in group D Ethibond ligation was followed by Prolene oversewing. The final study group included 114 patients (152 groins) who were all known to be free from recurrent groin reflux 3 months postoperatively and had colour duplex venous imaging 2 years after operation. RESULTS: Duplex imaging identified neoreflux at the SFJ in 10 out of 114 groins after 2 years (7%). There were differences in the rates between the four groups: Group A 3/31 (10%), Group B 0/32, Group C 5/44 (11%) and Group D 2/45 (4%). Neoreflux was significantly reduced in the two groups with endothelial closure (B and D): 2/70 (3%) versus 8/75 (11%, p<0.025). CONCLUSION: Recurrent reflux in the groin was reduced by over sewing the ligated SFJ in patients having varicose vein surgery. This adds weight to the theory of neovascularisation as a cause of recurrent veins and offers a means to reduce clinical recurrence rates.

Outbreak of Q fever in Lohra-Rollshausen, Germany, spring 1996.

Q fever is an acute (and sometimes chronic) febrile illness caused by the rickettsial organism Coxiella burnetii. The commonest animal reservoirs for C. burnetiiare cattle, sheep, and goats. Infected animals shed the organisms, which resist desiccation, i

[Effect of L-carnitine on post-stress metabolism in surgical patients]. / Der Einfluss von L-Carnitin auf den Postaggressionsstoffwechsel operierter Patienten.

The positive influence of L-carnitine administration on postaggression metabolism was investigated. Clinical examinations were executed on three groups of patients K1, K2, K3). Comparable surgical operations like stomach- and intestinal- resections were performed on these groups of patients. During the first three days after operation a nutritional diet (parenteral, standardized hypocaloric) with (K2: 2 g; K3: 4g) and without L-carnitine (K1) was given. The effects of L-carnitine administration were evaluated by the following parameters: free fatty acids (FFS), triglycerides (TG), beta-hydroxybutyric acid (beta-OH-BS), acetacetate (ACAC), blood sugar (BZ), insulin (INS), lactate (LAK), pyruvate (PYR), total protein (GE), cholinesterase (CHE), urea production rate (PU), nitrogen of alpha-aminogroups (alpha-AN), nitrogen balance (NB), catabolic index (KI), BUN-Creatinine-quotient (B/K), total carnitine (GC), free carnitine (FC), acetyl carnitine (AC) and also the ratio between acetyl carnitine and free carnitine (AC/FC) in serum and urine. The results show no statistical significance. But they could lead to the following conclusions: Carnitine obviously reduces the insulin resistance. But it does not influence the post-operative perturbation of glucose-utilization. Carnitine reinforces the utilization of long chain fatty acids and thus improves the energy conversion. Carnitine leads to an earlier positive nitrogen balance. By giving 4 g of carnitine a day, already after three days a repletion of tissue deposits is possible, and a dose dependence for carnitine administration exists for the utilization of long chain fatty acids and the repletion of tissue deposits.

Strength of the cement-bone interface.

The fixation of total joint components to bone using acrylic bone cement is by the penetration of the cement into the microstructure of cancellous bone to achieve a mechanical interlock. It has been shown that the method of cement application and the preparation of the cancellous surface significantly affects both the tensile and shear strengths of the cement-bone interface. Doughy cement finger-packed on an uncleaned surface resulted in a very low interface strength compared to a low-viscosity cement made to penetrate a cleaned bone surface. Maximum strengths were achieved for cancellous bone cleaned by using either a high-intensity water lavage or a polyethylene brush and by facilitating penetration of the cement for distances of 5 to 10 mm into the bone.