[Abdominoplasties and Suppurative Hydradenitis (Acne inversa) in Patients after Massive Weight Loss]. / Bauchdeckenstraffungen und Hidradenitis suppurativa (Acne inversa) bei Patienten nach massivem Gewichtsverlust.

Post-bariatric surgical procedures in patients after massive weight loss (MWL) are often associated with elevated minor and major complications (17-55%). If there is additionally a long history of hydradenitis suppurativa (HS) in the lower abdomen and groin area, complications of infection can appear in all patients. Differentiated pre-, peri- and postoperative therapy regime is then indicated.From 2010 to 2021, a total of 12 (66.6% women, 33.3% men) consecutive patients underwent conventional (Pittsburg rating scale [PRS]: Grade 2) or fleur-de-lis abdominoplasty (PRS: Grade 3) after massive weight loss. All patients simultaneously suffered long term HS in the lower abdomen and groin area (Hurley classification Grade 2: n = 10, Grade 3: n = 2). The prevalence in our study was 1.09%.Postoperative minor and major complications (follow-up 12 months) are determined and correlated with risk factors (e.g. age, method of weight loss, nicotine abuse…).Mean age was 45.2 years (± 10.3), mean BMI pre-operative 33.24 kg/m2 (± 8.7), the mean decrease in BMI was 19.01 kg/m2 (± 5.9) and the maximum BMI before weight loss 52.25 kg/m2. The mean duration of the suppurative hydradenitis was 31.5 years and n = 2 (17.0%) had current medical therapy against this. All patients showed further locations of the HS in other parts of the body and 66.6% had had surgical procedures because of the HS. 42.0% had nicotine abuse. The mean operation time was 98 minutes and the mean resection weight was 2210 grams. The overall complication rate was n = 10 (83.0%), and the rate of major complications n = 8 (66.4%) with surgical intervention in full anaesthesia. No patient had an infected haematoma, abscess or acute bleeding in the first 24 hours postoperatively.The antibiotic regime prevented the expected soft tissue infection in all patients. Inspection of the abdomen and groin area 4 weeks before surgery is recommended, in order to start preoperative therapy for the HS.

[Intestinal small bowel lymphomas--diagnosis and treatment]. / Primär intestinale Lymphome--Diagnosestellung mittels CT und Therapie.

Primary intestinal lymphomas are most common in the stomach. The mucosa associated lymphatic tissue (MALT)-lymphoma which is closely associated with helicobacter pylori is very well known. In most cases, these malignancies are from B-Cells origin. Another possible point of manifestation, although not well known, is the small bowel. Both tumors have enormous capabilities to enlarge in the abdominal cave. This is responding to their often asymptomatic manifestation. The symptoms, if they occur, are widespread and unspecific. Ileus, diarrhae, abdominal pain or bleeding will be observed, in rare cases also perforation or gastrointestinal or cutaneous fistulas. Diagnostic imaging often demonstrates a tumour of massive size by then, which is echopoor in the abdominal ultrasound. Our report concerns two cases of small intestine lymphomas, which were diagnosed by CT-scanning and treated in our clinic in only a short period of time. The first case was a low malignant jejunal lymphoma which was almost asymptomatic, whereas the second case had an ileus, due to compression of the intestine because of a high malignant lymphoma of the ileocecal region.

Pre-emptive antibiotic treatment vs 'standard' treatment in patients with elevated serum procalcitonin levels after elective colorectal surgery: a prospective randomised pilot study.

BACKGROUND: Procalcitonin (PCT) is regarded as a specific indicator of bacterial infection. Infectious complications in patients after colorectal surgery are a common cause of morbidity and mortality. The aim of this study was to investigate (a) whether PCT could serve as a negative predictive marker for postoperative complications and (b) whether, in patients with elevated PCT levels, a pre-emptive treatment with the third-generation cephalosporin ceftriaxone is superior to an antibiotic treatment starting later on the appearance of clinical signs and symptoms of infection. PATIENTS AND METHODS: By screening 250 patients with colorectal surgery, we identified 20 patients with PCT serum levels more than 1.5 ng/ml on at least 2 of the first 3 postoperative days. The remaining 230 patients were followed-up for the occurrence of infectious complications. The 20 patients with elevated PCT were included in a prospective randomised pilot study comparing pre-emptive antibiotic treatment with ceftriaxone vs standard treatment. RESULTS: The negative predictive value of PCT for systemic infectious complications was 98.3%. In patients receiving pre-emptive antibiotic treatment (ceftriaxone), both the incidence and the severity of postoperative systemic infections were significantly lower compared to those in a control group (Pearson's chi(2) test; p=0.001 and p=0.007, respectively). Major differences were also observed with respect to duration of antibiotic treatment and length of hospital stay. CONCLUSIONS: PCT is an early marker for systemic infectious complications after colorectal surgery with a high negative predictive value. A significant reduction in the rate of postoperative infections in patients with elevated PCT serum concentrations was achieved by means of pre-emptive antibiotic treatment.