The Da Vinci robot device represents the latest advance in laparoendoscopic surgery. We report the case of an endoscopic Nissen fundoplication performed with the aid of a telemanipulation robot system in a 10-year-old girl. To our knowledge, this is the first such case to be reported. In addition to standard monitoring, we used invasive blood pressure monitoring during the 282-min period of general anesthesia. Arterial blood gas samples were analyzed at short intervals. During surgery, which included a 172-min period of intraperitoneal insufflation of carbon dioxide (CO2), no significant changes were observed in PH, arterial oxygen pressure (PaO2), arterial carbon dioxide pressure (PaCO2), heart rate, or mean arterial pressure. Body temperature was maintained with an external warming blanket. Total intravenous anesthesia with continously administered propofol, remifentanil, and mivacurium for continous muscle relaxation allowed extubation immediately after skin closure. The girl was discharged from hospital on postoperative day 6. Robot-assisted techniques have the potential to significantly improve the performance of laparoendoscopic surgery. However, despite our encouraging first results, the potential risks of robot-assisted surgery have not yet been definitively established. Therefore, patients submitted to this type of procedure require intensive and even invasive monitoring.
Zur Analyse des Steroidhormonrezeptorenstatus kolorektaler Karzinome wurde der Östrogen- und Progesteronrezeptorgehalt von 26 aufeinanderfolgenden Tumoren bestimmt. In alien Proben lag die Estradiol-Rezeptorbindungskapazität unterhalb des meßtechnischen Cut-offs von 2 fmol/mg Cytosolprotein. In 4 von 26 Tumorproben (15%) waren Progesteron-Rezeptorspiegel zwischen 13 und 23 fmol/ mg Cytosolprotein nachweisbar. Aufgrund des Nachweises von Stero-idhormonrezeptoren in einigen Fallen und vereinzelter Berichte in der Literatur über Remissionen unter Hormontherapie kolorektaler Karzinome scheinen weitere In-vitro- und In-vivo-Versuche angezeigt, die Hormonabhängigkeit des kolorektalen Karzinoms zu erhellen.
Preliminary results seem to be very promising. Clinical follow-up as well as histological and immunohistochemical outcome in the treatment of five extensive soft-tissue defects are discussed. As in all fields of tissue engineering, long-tem studies and cost-benefit analyses are required.
Continuous improvements in surgical technique and anaesthesia for ileus have resulted in a significant reduction of perioperative complications. Postoperative outcome of surgical patients is increasingly dependent on the severity of postoperative ileus, which often determines morbidity and length of hospital stay. In the present article we discuss possible variables influencing this disease. Furthermore, means of prevention and therapeutic strategies for postoperative ileus are briefly presented.
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