[Watchful waiting vs surgical repair of oligosymptomatic incisional hernias: Current status of the AWARE study]. / Beobachtung vs. Operation oligosymptomatischer Narbenhernien : Aktueller Stand der AWARE-Studie.

INTRODUCTION: Incisional hernias are one of the the most frequent complications in visceral surgery and incisional hernia repair has a relevant complication rate. Therefore, there have to be solid indications before carrying out incisional hernia repair. To date, there is a lack of evidence concerning the correct indications for surgical repair of incisional hernias. The AWARE trial compares watchful waiting to surgical repair of incisional hernias. MATERIAL AND METHODS: The AWARE trial is a prospective randomized multicenter trial. Patients with asymptomatic or oligosymptomatic incisional hernia are randomized into the watchful waiting or the surgical repair group with a follow-up of 2 years. The primary endpoint is pain during normal activities due to the hernia or the hernia repair after 2 years measured on the hernia-specific surgical pain scale (SPS). RESULTS: In this study 36 centers are participating throughout Germany, more than 1600 patients had been screened up to 31 December 2014 and 234 (14.6%) of the screened patients could be recruited. CONCLUSION: The AWARE study will provide evidence concerning the two therapeutic options of watchful waiting and surgical repair of incisional hernia.

[Use of biological meshes in abdominal wall reconstruction. Results of a survey in Germany]. / Einsatz biologischer Netze bei der Bauchdeckenrekonstruktion. Ergebnisse einer Umfrage in Deutschland.

BACKGROUND: Surgical treatment of incisional hernia includes implantation of a mesh. The use of synthetic grafts in contaminated fields results in an increased risk of infection. In these cases a potential advantage is described for biological repair material. Evidence for this problem is lacking; therefore, we initiated a survey among surgeons in Germany concerning this question. MATERIAL AND METHOD: A survey concerning indications, experience and techniques of using synthetic and biological meshes was sent to 60 surgical departments. The emphasis of the survey was on the differentiation of clean and contaminated fields. RESULTS: The survey was answered by 42 %. The use of biological repair material was preferred in clean-contaminated, contaminated and soiled fields. Synthetic meshes were preferred in clean, rarely in clean-contaminated and not in contaminated or soiled situations. Primary suture repair was chosen in clean fields and barely in contaminated fields. For closure of giant hernias a component separation technique (CST) was favored by the majority of respondents. A single stage repair was preferred by most of the surgeons even in cases with simultaneous stoma takedown. A total of 72 % of the respondents were satisfied with the use of biological repair material, but the reimbursement was considered to be inappropriate. DISCUSSION: Although the response rate was low, this survey gives an idea of the attitude towards the use of synthetic and biological meshes. Biological repair material is favored for hernia repair in contaminated or soiled fields. The advantage of this choice is a one stage repair despite the contamination. As the results of this survey are not able to provide arguments for the use of different meshes this question should be further investigated with a randomized controlled trial.

Del hábito al vicio, de la enfermedad a la salud: discurso público, opinión científica y políticas prohibicionistas en Chile sobre tabaquismo: un estudio de fuentes 1867-1986 / From habit to vice, from sickness to health: public speech, opinion and jorbidding policies in Chile on nicotinism: a study of sources: 1867-1986

El artículo tiene como objeto estudiar el conocimiento del público y del Estado chileno acerca de los riesgos para la salud que conlleva el hábito de fumar. Para poder desarrollar estos temas se ha consultado diversas fuentes documentales disponibles, incluyendo leyes y regulaciones, artículos publicados en libros y diarios académicos, libros de texto, prensa, diarios científicos, y revistas entre otros. Se demuestra que desde finales del siglo XIX, por, lo menos desde 1867 en adelante, ya se habla de los efectos negativos en el ser humano. Desde mediados del siglo XX la preocupación de los médicos y científicos se hace evidente, producto de los resultados de investigaciones internacionales. Estos estudios de los grupos médicos son tomados en cuenta por organismos internacionales de salud, los cuales elaboran pautas de control y comportamiento para frenar el consumo de tabaco en el mundo. Estas pautas se desarrollan desde 1970 y ponen énfasis en temas como: prevención, educación, restricción al consumo y a la publicidad. La prensa también hace eco de esto, cerrando una cadena de información y generando un proceso denominado por algunos como lucha antitabáquica, que se observa en los países desarrollados, pero también en América Latina, como se aprecia en el caso chileno. A través del análisis del discurso informativo se demuestra la importancia que ha ido tomando el tema del tabaco en los profesionales de la salud, en los organismos del Estado y en la opinión pública, influyendo en la percepción que la sociedad tiene del tema. (AU)

[Prospective comparative observational study on the antibiotic treatment of secondary peritonitis in Germany -- efficacy and cost analysis]. / Antibiotische Behandlung der sekundären Peritonitis in Deutschland. Prospektive vergleichende Beobachtungsstudie zur Wirksamkeit und den Behandlungskosten.

AIMS: Cephalosporins and broad-spectrum penicillins in combination with metronidazole are suitable for treatment of secondary peritonitis. The aim of this study was to compare the clinical and bacteriological efficacy, length of hospital stay (LOS), treatment costs of ceftriaxone (CRO) in combination with metronidazole vs standard regimens (SR) 1 and 2. METHODS: Patient data were subjected to matched-pairs analysis according to four different categories of the Mannheim peritonitis index. RESULTS. From January 1998 to March 2000, a total of 365 patients from 59 surgical wards in German hospitals were included. Clinical efficacy was 90.2% vs 70.4% ( P=0.004) for CRO/SR 1 and 78.3% vs 82.6% for CRO/SR 2. Bacteriological efficacy was comparable. Antibiotic treatment costs were 593/539 Euros for CRO/SR 1 and 466/750 Euros for CRO/SR 2, i.e., costs for CRO were 37.9% lower than with SR 2. CONCLUSION: Based on clinical, bacteriological, and pharmacoeconomic results, ceftriaxone in combination with metronidazole can be regarded as a first-line antimicrobial treatment of secondary peritonitis.

[Diagnostic and therapeutic management of symptomatic cholecystolithiasis and pre-operatively suspected choledocholithiasis]. / Das diagnostische und therapeutische Management bei symptomatischer Cholezystolithiasis und präoperativ bestehendem Verdacht auf eine Choledocholithiasis.

The goal of this study was to examine the effectiveness of endoscopic retrograde choledocho-pancreatography (ERCP) at the Unfallkrankenhaus Berlin in the setting of pre-operative suspicion of choledocholithiasis. The predictive value of various pathologic findings with regard to choledocholithiasis was to be determined in this patient population.All patients treated operatively for symptomatic cholecystolithiasis between August 2000 and August 2001 were evaluated retrospectively for the following variables: age, gender, operative strategy, intra-operative cholangiography, sonographic findings, occurrence of choledocholithiasis. In 21.4 % of 196 patients who underwent cholecystectomy (n = 42) a pre-operative ERCP was performed. In 19 of these 42 patients, no pathology was found on ERCP. The percentage of therapeutic pre-operative investigations was 47.6 % (n = 20). In 3 patients, a juxtapapillary diverticulum was seen.69.9 % of the operations (n = 137) were performed laparoscopically. 167 patients (85.2 %) underwent intra-operative cholangiography. In 4 patients, the ERCP was performed post-operatively. The indication for 3 of those 4 examinations was an abnormal intra-operative cholangiogram. Complications occurred in 4 of the 46 patients who underwent ERCP (8.7 %). Choledocholithiasis was found in 12.2 % (n = 24) of all 196 patients. The pathologic finding with the highest positive predictive value for the diagnosis of choledocholithiasis was the finding of a dilated common bile duct to more than 8 mm diameter (PPV 75 %). Among laboratory variables investigated in this study, the elevation of serum bilirubin level exhibited the highest positive predictive value (PPV 39.2 %).

FRET-based detection of different conformations of MK2.

MAP kinase-activated protein kinase 2 (MK2 or MAPKAP K2) is a stress-activated enzyme downstream to p38 MAPK. By fusion of green fluorescent protein variants to the N- and C-terminus we analysed conformational changes in the kinase molecule in vitro and in vivo. Activation of MK2 is accompanied by a decrease in fluorescence resonance energy transfer, indicating a transition from an inactive/closed to an active/open conformation with an increase in the apparent distance between the fluorophores of approximately 9 A. The closed conformation exists exclusively in the nucleus. Upon stress, the open conformation of MK2 rapidly becomes detectable in the cytoplasm and accumulates in the nucleus only when Crm1-dependent nuclear export is blocked. Hence, in living cells activation of MK2 and its nuclear export are coupled by a phosphorylation-dependent conformational switch.

Shed L-selectin (sCD62L) load in trauma patients.

BACKGROUND: Low circulating plasma concentrations of the leukocyte adhesion molecule L-selectin (sCD62L) were found to be associated with an increased risk for subsequent lung failure and case fatality after severe trauma. The objective of this study was to determine the robustness of soluble L-selectin, correcting for a broad spectrum of physiological variables. METHODS: Patients with suspected multiple and/or trunk injuries were enrolled into this study over a 1-year period. Plasma samples were obtained on hospital presentation, and circulating soluble L-selectin was measured with a commercially available ELISA kit. Study records comprised all relevant clinical and laboratory data. Thirty-day survival rate, subsequent acute lung failure, and nosocomial pneumonia were defined as study endpoints. Statistical analysis was performed using multivariate logistic regression models. RESULTS: Seventy patients with a mean age of 35.51 years (range, 10-87 years) and a mean ISS score of 36.61 (95% CI, 31.08-42.14) entered the study. Eleven patients died, leading to an attributable mortality of 15.70%. L-Selectin levels did not differ between survivors and nonsurvivors. Five patients progressed to acute lung injury, whereas 11 patients developed hospital-acquired pneumonia. Lower L-selectin levels indicated patients at risk for lung injury with a relative odds estimated at 4.43 (P = 0.017). Statistical significance diminished in the multivariate model. In contrast, plasma concentrations of circulating sCD62L were significantly decreased in patients developing nosocomial pneumonia (P = 0.023), with a twofold increased relative odds (OR, 1.96; 95% CI, 0.51-7.50). No effect modification was observed by the included covariables. CONCLUSIONS: The results of this study highlight the independent predictive value of initially decreased soluble L-selectin levels for the identification of patients susceptible to subsequent respiratory complications after severe trauma.

[Primary hypertrophic pyloric stenosis. A are form and stomach outlet stenosis in the adult]. / Primäre hypertrophe Pylorusstenose. Eine seltene Form der Magenausgangsstenose beim Erwachsenen.

A 38-year-old white female with primary hypertrophic pyloric stenosis is presented. The patient was admitted to our service with a history of upper digestive tract pain and postprandial vomiting since her 17th year of life. Diagnosis of benign pyloric stenosis was made preoperatively and the patient was successfully treated by Finney pyloroplasty. Primary hypertrophic pyloric stenosis in adults is a rare condition of unknown etiology. Only about 200 cases of primary hypertrophic pyloric stenosis in adults have been reported in the literature.

[Standardized computer-based documentation system for diagnoses and medical performance in orthopedics and traumatology. Development and initial application]. / Standardisiertes EDV-gestütztes Befundungs- und Leistungsdokumentationssystem für die Orthopädie bzw. Traumatologie. Entwicklung und erste Anwendung.

INTRODUCTION: Increasing demands on quality assurance und medical performance documentation require an immediate and evaluable documentation in the outpatients' department. Presentation of a new computer-based diagnostic system for reporting and medical performance documentation. METHODS: Development and initial application of the system in three big orthopedical or traumatological hospitals. Judgements about the feasibility of immediate documentation in outpatients' departments. RESULTS: Presentation of an outpatients' departments diagnostic system with textblock-oriented anamnesis or anatomy-related diagnosis through pre-structured examination checklists. Coding of ICD-9/-10 as well as AO-classification and AIS (abbreviated injury scale). Implementation of scorings. Medical performance documentation through forms including pre-defined billing codes. Presentation of the documentation flow and its transfer into other contexts. DISCUSSION: Pure text-based clinical results do not allow sufficient evaluation for quality assurance and medical performance documentation. However, a computer-based and immediate documentation in outpatients' departments should not mean a significantly increased workload for physicians.

Development of a standardised computer-based documentation system for diagnoses and medical performance in orthopeadics/traumatology.

INTRODUCTION: Increasing demands on quality assurance und medical performance documentation require an immedate and evaluable documentation in the outpatients' department. Presentation of a new computer-based diagnostic system for reporting and medical performance documentation. METHODS: Development and initial application of the system in three big orthopeadical or traumatological hospitals. Judegements about the feasibility of immediate documentation in outpatients' departments. RESULTS: Presentation of an outpatients' departments diagnostic system with textblock-oriented anamnesis or anatomy-related diagnosis through pre-structured examination checklists. Coding of ICD-9/-10 as well as AO-classification and AIS (abbreviated injury scale). Implementation of scorings. Medical performance documentation through forms including pre-defined billing codes. Presentation of the documentation flow and its transfer into other contexts. DISCUSSION: Pure text-based clinical results do not allow sufficient evalutation for quality assurance and medical performance documentation. However, a computer-based and immediate documentation in outpatients' departments should not mean a significantly increased workload for physicians.