Induction of antibody response by DNA immunization of newborn baboons against influenza virus.

Previous studies showed that DNA immunization of newborn mice with plasmids expressing influenza virus antigens induced protective immunity. We have now extended the study of neonatal responsiveness to DNA vaccines to nonhuman primates. Baboons immunized as neonates with plasmids expressing type A influenza virus hemagglutinin (HA) and nucleoprotein (NP) in doses ranging from 40 microg to 1 mg per plasmid per dose developed virus-specific humoral responses. The titer and kinetics of appearance of virus-specific IgG antibodies were dose dependent. Specific antibodies were detected by enzyme-linked immunosorbent assay (ELISA) as early as 1 month after birth in baboons immunized with the highest and intermediate doses of vaccine. Virus-neutralizing antibodies were detected in the group of baboons immunized with the highest dose. The specificity of virus-neutralizing antibodies was found to be directed against homologous determinants of HA; however, the IgG antibodies also cross-reacted with HA of a drift variant. Thus, DNA vaccination of newborn baboons with a prototype vaccine against influenza virus resulted in induction of specific humoral immunity.

Duodenum-preserving resection of the head of the pancreas in patients with severe chronic pancreatitis.

A duodenum-preserving resection of the head of the pancreas was carried out in 57 patients with chronic pancreatitis and a benign tumorous enlargement of the head of the pancreas. The resected tissue showed a diameter of more than 5 cm in 64% of the patients. The postoperative mortality rate was 1.8%. The postoperative hospitalization period was 19 days (median). In a follow-up period of 2.0 years (median) with a minimum of 1 month and a maximum of 10.5 years, the late mortality rate was 3.6%. Of the patients, 85.7% are completely rehabilitated occupationally. In contrast to the Whipple procedure, the duodenum-preserving resection of the head of the pancreas preserves stomach, duodenum, jejunum, and extrahepatic bile ducts in an advantageous way. The subtotal resection of the head of the pancreas decompresses the common bile duct without disturbance of the blood flow to the duodenum.

[Computed tomographic studies on density kinetics after the bolus injection and infusion of perfluorooctylbromide (PFOB). Animal experimental studies]. / Computertomographische Untersuchungen zur Dichtekinetik nach Bolusinjektion und Infusion von Perfluorooctylbromid (PFOB). Tierexperimentelle Untersuchungen.

We investigated the enhancement of the liver, the spleen, and of induced abscesses and the abdominal vessels after administration of 3 g/kg bodyweight. Perfluorooctylbromide (PFOB) in an animal model. Twenty-one rabbits each received the contrast medium as bolus injection and as slow infusion over half an hour. CT was performed between 2 and 48 hours after contrast medium application. Peak enhancement of the liver, the spleen and the liver abscess membrane was found between 24 and 48 hours after PFOB administration, independently of the application mode. Peak enhancement of the abdominal aorta and the IVC was observed within two hours after bolus injection. In this rabbit model PFOB permits best delineation of the vessels after bolus injection within the first two hours, while CT imaging of the liver, the spleen and the liver abscess membrane is best between 24 and 48 hours after contrast medium application, independent of the injection velocity.

Is the elimination of endotoxin and cytokines with continuous lavage an alternative procedure in necrotizing enterocolitis?

Ascites fluid was obtained intraoperatively in 12 consecutively treated neonates (6M, 6F, mean weight 940 g, mean gestational age 27th week, lethality 3/12) suffering from necrotizing enterocolitis (NEC). The concentrations of endotoxin and cytokines (IL-1, IL-6, TNF) were determined. Endotoxin and interleukins were excessively elevated in all patients, TNF only in those who survived. Postoperative treatment included the use of a continuous abdominal lavage system. This therapeutical procedure allows the elimination of endotoxin and cytokines out of the abdominal cavity in order to reduce their adverse biological effect.

Diagnosis and treatment of necrotizing enterocolitis. A retrospective evaluation of abdominal paracentesis and continuous postoperative lavage.

From 1980 to 1991, 70 preterm and 20 term infants suffering from necrotizing enterocolitis (NEC) were treated at the University of Ulm hospitals. NEC was primarily suspected from clinical signs. The diagnosis was established by plain abdominal X-rays, infection markers and abdominal paracentesis. Indication for surgery resulted from paracentesis, from radiologically proven perforation, from ileus symptoms and from rapid clinical deterioration; 44 preterm and 7 term infants underwent surgery. Bowel resections were performed in 5 of the term and in 16 of the preterm infants. An enterostomy was fashioned in 33 cases. Total necrosis of the gut was apparent in 8 infants. A continuous peritoneal lavage was performed in 34 babies. One term and 18 preterm babies, all with a birth weight less than 1000 g, died. This results in a NEC-related overall mortality of 19%.

[Video-assisted hemithyroidectomy: surgical technique and early results]. / Die videoskopisch-assistierte Hemithyreoidektomie. Operative Technik und erste Ergebnisse.

To date, there are only very few data on minimally invasive thyroid surgery. In a prospective study (11/99-11/00), videoscopically assisted hemithyroidectomy was performed on 18 patients (3 M, 15 F; age 22-56 years) with uninodular thyroid disease. The length of the cervical incision was between 15 and 25 mm; 8 patients were operated on using initial gas insufflation and 10 patients with a gasless technique. The mean operative time was 96 +/- 23 min, significantly longer than in a conventionally operated group (n = 26) during the same period. No complications were observed. Videoscopically assisted hemithyroidectomy is feasible and can be considered in selected patients.

Multi-visceral resection for locally advanced gastric cancer.

Fifty-three of sixty-four patients who underwent gastrectomy for gastric carcinoma presented with advanced gastric cancer. 8 patients underwent palliative gastrectomy. In 17 patients gastrectomy and lymphadenectomy was performed. In 28 patients with locally advanced gastric carcinoma, extended resection was performed. Patients who underwent splenectomy were only included if tumorous adherence to the spleen was present. Hospital mortality and morbidity were 3.6% and 25% in extended resection and 5.9% and 18% in gastrectomy and lymphadenectomy alone. R0 resection was performed in 26/28 and in 16/17 patients, respectively. In R0 (complete) resections the mean one and two-year-survival rates were 64% and 44% in extended resection, and 67% and 47% in gastrectomy and lymphadenectomy. In patients (11) with residual tumour (R1/R2) mean one and two-year-survival rates were 27% and 0%, respectively. If complete resection (R0) is achieved, extended resection for locally advanced gastric carcinoma provides survival time, which is comparable, stage for stage, with survival rates observed after R0 resection for cancer limited to the stomach.

[Prevention of thrombosis with low molecular weight heparin and hydroxyethyl starch in general surgery]. / Thromboseprophylaxe mit niedermolekularem Heparin (LMWH) und Hydroxyaethylstärke (HES) in der Allgemeinchirurgie.

In an open, randomized, controlled and prospective study we compared the efficacy of LMWH with unfractionated heparin (UFH) and the effects of both heparin preparations on haemostatic and fibrinolytic parameters. We also stratified subgroups which received HES intra- and postoperatively. The study groups were well matched with regard to baseline characteristics. With LMWH 4 patients (4.1%) displayed a positive fibrinogen uptake test (1 patient with HES). With UFH 5 patients (5%) demonstrated a positive uptake (3 patients with HES). Antifactor Xa levels were significant higher in the LMWH groups; all other fibrinolytic and haemostatic factors, bleeding and local wound complications did not differ. These data suggest that LMWH in equally effective and safe as UFH in general surgery. HES may have and additive effect.

Orthotopic rat liver transplantation using different combinations of four inbred strains.

Orthotopic liver transplantation in the rat was performed using different combinations of four inbred strains. The influence of infection and rejection on the early fate of the grafts were studied with a particular emphasis on histomorphological changes and their diagnostic interpretation.

Hepatocellular carcinoma in type I glycogen storage disease.

Patients suffering from Type I glycogen storage disease frequently develop hepatic tumors. Some of these were classified as carcinoma, with the majority of tumors representing benign adenomata. However, no evidence exists of malignant transformation of adenomata in these patients. Here, we describe the occurrence of a hepatocellular carcinoma in the adenomata-bearing liver of the elder of two sisters suffering from Type I glycogen storage disease at the age of 20 years, 6 years after the diagnosis had been made. Surprisingly, alpha-fetoprotein levels were normal throughout the entire course of this patient, whereas the younger sister had elevated levels despite the absence of malignant lesions. Thus, the clinical significance of alpha-fetoprotein remains unclear in both cases. Nocturnal feeding, although performed continuously over the 6 years after the diagnosis, had obviously failed to prevent the development of hepatic tumors in both patients.

[Necrotizing enterocolitis: a 12-year retrospective study]. / Die nekrotisierende Enterokolitis: eine 12-Jahres-Retrospektive.

UNLABELLED: Necrotizing enterocolitis (NEC) is the most relevant intestinal acquired complication during the neonatal period. Due to the improvements in perinatal medicine during the last decade, we wanted to work out possible differences in the incidence, diagnosis and clinical courses of NEC during a 12 years period. PATIENTS AND METHODS: All premature or term newborns were eligible for the study, if a necrotizing enterocolitis > or = stage 2a according to Bell was diagnosed between January 1980-December 1991. RESULTS: During the study period, 90 preterm or term newborns were treated for necrotizing enterocolitis, 19 infants were admitted to our hospital for therapy of established NEC from other hospitals. Forty-five infants had a birthweight of < or = 1500 g. During the years 1987-1991 there was an increase in the incidence (4-12/year, median 9/year, compared to 0-6, median 3/year during the period 1980-1986). This was paralleled by an increase in very low birthweight infants admitted to the NICU (1980-1986: 35-45/year, 1987-1991: 83-108/year). Prominent clinical signs: abdominal distension (85 infants), increased gastric residuals (72), bright blood from rectum (56). Median time of manifestation in infants < or = 30 weeks was 17 days, for infants of 31-34 weeks 8 days and for infants of > or = 35 weeks of gestation 4 days. Eleven infants were fed parenterally exclusively before NEC, 12 infants received exclusively breast milk, 67 formula. Surgical treatment was indicated in 51 infants (indication: intestinal perforation or peritonitis diagnosed by abdominal paracentesis). Seventy-one infants survived, in 17 infants who died, NEC or secondary disorders were the main cause. CONCLUSION: With increasing numbers of very preterm infants, the relevance of NEC becomes more and more important. Concepts of prevention and early diagnosis further have to be worked out.

[Abdominal sonography in primary diagnosis of blunt abdominal trauma]. / Die Abdomensonographie in der Primärdiagnostik des stumpfen Bauchtraumas.

200 patients with blunt abdominal trauma were scanned by ultrasound primarily. 152 showed a normal sonographic examination. In 24 patients an organic injury was visualised. These 20 splenic injuries, 2 lesions of the kidney, 1 splenic and renal lesion and 1 hepatic and splenic rupture were confirmed by CT in 9 cases, by laparotomy in 9 cases, by sonographic follow-up in 2 cases. 23 patients showed an intraabdominal fluid collection, in 16 patients a decrease was seen by ultrasound. 7 patients were directly operated on because of a visible increase of intraabdominal fluid. The lesions consisted of 3 hepatic ruptures, 2 retroperitoneal bleedings. Ultrasound is a reliable tool in the diagnosis of blunt abdominal trauma on the day of admittance and in the evaluation of injuries in respect of operative or conservative management.