[Minimal access surgery: A survey among surgeons in Central Germany]. / "Minimal access surgery" : Ein Meinungsbild bei Chirurgen in Mitteldeutschland.

INTRODUCTION: A survey about perceptions concerning natural orifice transluminal endoscopic surgery (NOTES) and single port operations (SPO) was conducted among medical professionals at hospitals in Central Germany. The identity of the participants remained anonymous. The focus was on the subjective perception of medical colleagues and included a statement of preferred methods if the medical professional would need to undergo surgery. METHODS: Within a radius of 120 km of the city of Erfurt, all 150 surgical departments were approached and asked to complete a series of questionnaires containing general and personal questions. The analysis was performed according to the professional rank, age and sex of the participants. The questionnaires contained questions on patient preferences, cosmetic aspects and other factors, such as marketing, industry-driven, playful approach of the surgeon and appeal of a new procedure. RESULTS: In total 83 surgical departments participated in the survey resulting in 432 eligible questionnaires. Of the participants 29 % were female, the average age was 44 years, 20 % were heads of departments, 37 % senior surgeons, 20 % specialist surgeons and 23 % residents. The proportion of conventional minimally invasive surgical procedures was on average 30 % of all surgical interventions. Two hospitals offered transvaginal hybrid NOTES (cholecystectomy), 45 % performed SPOs, 36 % of the participants agreed strongly or moderately with the concept of SPO and 34 % rejected NOTES. The factors industry-driven, promotion/marketing and appeal of a new procedure were evaluated as very important or relatively important by the majority of the participants (> 70 %). When evaluating the factor playful approach of the surgeon, the proportion was 55 %. The factor patient preferences was evaluated as very high or high by 25% of the participants while it had no impact on 8 % or only a minor impact on 36 %. In case of undergoing surgery themselves, conventional laparoscopy would be preferred and NOTES was rated last among all options. CONCLUSION: The soft factors that were analyzed (i.e. marketing, industry-driven, playful approach of the surgeon and appeal of something new) were evaluated as much more important in the surgeons' opinion compared to patient criteria (i.e. patient preferences and cosmetic results). The soft factors are, however, not to be judged as generally negative as they are to a certain extent necessary (marketing), useful (impulses from industry) or are part of the surgical creativity (playfulness). The discrepancies in the medical professional evaluation of the different factors shows that the reasoning and the motivation of the actions are not necessarily identical.

Immunohistochemical identification of Encephalitozoon cuniculi in phacoclastic uveitis in four rabbits.

PURPOSE: Encephalitozoon cuniculi is a microsporidium with a wide range of mammalian hosts. In rabbits it can be responsible for cataract and lens-induced uveitis (LIU). The aim of this study was to provide specific immunohistochemical demonstration and localization of E. cuniculi within the eye, in rabbits with LIU. MATERIAL AND METHODS: Four rabbits were presented with a white mass in the eye and iris discoloration. Complete ophthalmic examinations were performed and a presumptive diagnosis of LIU was made in all cases. Initial therapy with a topical steroid, atropine and systemic enrofloxacin was instituted while serologic (IFA or ICA tests) and cytologic lab results were pending. The final outcome in all cases was enucleation. Routine histology and immunohistochemistry (ABC method) with an antiserum anti-Encephalitozoon cuniculi were performed. RESULTS: Indirect immunofluorescence performed on one rabbit serum expressed a titer of 1 : 32; carbon immunoassay on the serum of the other three rabbits expressed a titer of 1 : 5120 in one, and a titer of 1 : 2560 in the other two cases. Histologically, an intraocular, locally extensive pyogranulomatous infiltration that partially filled the posterior chamber, encasing a wide anterior lens capsule break, was detected in all cases. Immunohistochemically, spores reacting with anti-Encephalitozoon cuniculi antiserum were present in all specimens, occasionally within macrophages and lens epithelial cells. CONCLUSION: Detection of E. cuniculi in rabbits with phacoclastic uveitis has been investigated in the past with different methods. Based on our results, we suggest that immunohistochemistry should be regarded as a useful tool both for specific demonstration of E. cuniculi and for its localization within tissues.

[Elastase-induced hyperfunction of submucous glands develops independent of elastase-induced emphysema]. / Die durch Elastase induzierte Uberfunktion submuköser Drüsen entwickelt sich unabhängig vom elastaseinduzierten Emphysem.

We instilled 2 mg of pancreatic elastase into the lungs, and insufflated a further 2 mg into the trachea of 6 male ferrets. Six control animals were given 0.9% NaCl (lungs) and glucose powder (trachea). This combined treatment was administered on days 1, 8 and 15. On these days, and again on days 29 and 39, we obtained chest x-rays. On the 39th day, we removed the lungs and measured the mean linear intercept. In tracheal sections, we measured goblet cell density, glandular structure and function by quantitative histology and autoradiography. Although, up to day 39, no emphysema developed, both structural and functional changes occurred in the glands: the volume density of the serous glands (S) decreased, that of the mucous glands (M) increased, the ratio S/M decreased from 2.0 to 1.5 (p = 0.05). The turnover of radioactive sulphur (indication of mucus synthesis) was significantly increased in animals treated with elastase (p = 0.001). Goblet cells increased from 0.9 +/- 0.4 to 3.4 +/- 1.8 cells per mm epithelium (p = 0.05). The results show that elastase induces structural and functional changes in submucosal glands and goblet cell hyperplasia, independently of emphysema.