[Diagnosis of appendicitis using harmonic ultrasound imaging]. / Sonografische Diagnostik der Appendizitis bei Kindern - Verbesserte Darstellung mittels Harmonic Imaging.

INTRODUCTION: Harmonic Imaging (HI) is a new Ultrasound (US) modality with high contrast and spatial resolution. Aim of this study was to compare fundamental imaging (FI) and HI in the diagnosis of appendicitis. PATIENTS AND METHODS: In 50 children (male : female, 25 : 25; mean age: 9.9 years) prior to an appendectomy US of the right lower quadrant was performed in both FI and HI (Tissue Harmonic Imaging - THI - Sonoline Elegra, Siemens, 7.5 MHz linear). The images were compared with respect to delineation of surrounding, contour, wall and content of the appendix. RESULTS: In 43 / 50 (86 %) patients diagnosis of appendicitis was confirmed histologically (sensitivity 98 %, specificity 94 %). In 37 / 43 patients the appendix was depicted using FI. With HI this number was 40 / 43. HI was significantly better in delineating the contour, wall, mucosa and content of the appendix (p < 0.01). HI also exceeded in demonstrating free fluid, mesenterial lymph nodes and surrounding echogenicity. CONCLUSION: HI of appendicitis provides images with significantly better quality than FI. When both imaging options are available harmonic imaging modality should be the preferred choice for scanning the appendix.

[Long-term experiences with mechanical patient-controlled analgesia pumps for therapy of postoperative pain in general surgery]. / Langzeiterfahrungen in der Anwendung mechanischer PCA-Pumpen zur Therapie postoperativer Schmerzen in der Allgemeinchirurgie.

The efficiency and safety of patient-controlled analgesia (PCA) in the treatment of postoperative pain is well documented. An alternative to electrical systems is the disposable pump, which is cost effective. The aim of this study was to prove the efficiency and safety of PCA disposable pumps. Eighty patients (45 men, 35 women, mean age 50 +/- 16 years) were included and received single-use PCA pumps (Vygon Medical Products, Aachen, Germany) for postoperative pain control. A sufficient reduction in pain levels, measured by the Verbal Rating scale (VRS), was achieved in nearly all patients. For the first application, a single bolus of 7.0 +/- 2 mg piritramide (Dipidolor) was needed, the mean of treatment time was 56 +/- 31 h. We had two dropouts because of non-compliance, two patients felt dizzy, and one patient felt nauseous. Further side-effects were observed during treatment. Our study led us concluded that PCA therapy with mechanical, disposable pumps is a safe and efficient treatment for postoperative pain. Such a concept can be introduced without an "Acute Pain Service" if the staff are well trained.