Laparoscopic colorectal interventions in sigmoid diverticulitis are, for the most part, carried out as elective procedures for peridiverticulitis, stenosis, or recurrent attacks of inflammation. The conversion, complication, and mortality rates associated with these interventions are acceptable. Laparoscopic procedures in Hinchey stages I to IV sigmoid diverticulitis and in the presence of fistula and bleeding are more likely to be associated with complications, and should be carried out only by highly experienced laparoscopic surgeons.
The feasibility and safety of the laparoscopic colorectal approach is demonstrated clearly. The current study shows that the laparoscopic or laparoscopically assisted approach to colorectal surgery is not associated with a higher risk of anastomotic leaks. Morbidity and mortality rates with this method approximate those seen with conventional colorectal surgery.
Adequate diagnostic measures are mandatory in families with ascending aortic aneurysms or type-A aortic dissections to identify or exclude family members at risk for aortic diseases. Even in the absence of identifiable mutations causing isolated aortic aneurysms or aortic dissections, we recommend standardised examinations of all first-degree relatives of affected families. An indication for prophylactic aortic root replacement should be considered for patients at risk.
The peritoneal resident cell population is influenced by various inflammatory and immunogenic stimuli. The influence of intraperitoneal application of polyethyleneterephthalate (PET) (group A) and ultra-high-molecular-weight polyethylene (UHMW-PE) (group B) powders on peritoneal cell count and macrophage activity was investigated. Powders were tested to mimic wear particles from solid implant devices as these particles often cause chronic granulomatous inflammation. The results were compared with the inflammatory response following an abdominal midline incision (group C) and untreated animals (group D). On days 1, 7, 14 and 30 peritoneal cells were quantified and the number of active macrophages was assessed. Groups A and C mice showed a significant loss of macrophages in the peritoneal lavage at day 1 but this returned to normal values (group D) on day 7. In contrast, group B animals remained at low peritoneal cell counts but showed the highest number of active macrophages. Only in this latter group was adhesion formation and granulomatous clustering of polymer powder observed. Applying the parameters macrophage count and the number of active macrophages it can be concluded that PET elicits a weaker inflammatory reaction than UHMW-PE in mice peritoneal cavity. Thus this animal model may be used as a screening test for biomedical materials, especially their wear products.
Klinikum der RWTH Aachen, Abteilung PathologieSchlüsselwörter: Bioprothesen in Aortenposition, ModeUkreislauf, Regurgitation, Druckverlust Zur Ermittlung von Regurgitation und Druckverlust flexibler Bioprothesen als Aortenklappenersatz wurden vier Bioprothesen ähnlicher Größe (Nr. 27 bis Nr. 31) mit und ohne pathologischen Veränderungen in einem Kreislaufsimulator pulsierend durchströmt. Die Effektivität der Bioprothesen läßt sich mit Hilfe der gemessenen Werte von Rückfluß, Insuffizienz und Druckverlust bestimmen. Die Insuffizienz der stenosierten Bioprothese und der Klappen ohne pathologische Verände-rungen sinkt mit steigendem Herzminutenvolumen. Die Insuffizienz der Bioprothese mit Perforationen nimmt mit steigendem Herzminutenvolumen deutlich zu. Die stenosierte Klappe weist das geringste Rückstromvolumen auf; da die Taschen der Klappe infolge der Fibrosierung nicht vollständig öffnen, kommt es zu einem erhöhten Druckverlust und verringertem Durchfluß. Um die Verluste so gering wie möglich zu halten, ist die Klappe mit dem größtmöglichen freien Strömungsquerschnitt zu implantieren. In order to determine regurgitation and pressure loss of flexible bioprostheses used for aortic valve replacement, four porcine xenografts of similar size (No. 27-No. 31) with and without pathological changes, were pulse-perfused in a mock circulation. The effectiveness of bioprostheses can be determined by measurements of reflux, insufficiency, and pressure loss. Insufficiency of the stenosed bioprostheses and of the valves without pathological changes decreases with increasing cardiac Output. Insufficiency of the porcine xenograft with perforations increases with increasing cardiac Output. The stenosed valve shows the lowest reflux volume; since the cusps of the valve are not opening completely because of f ibrosis, there is a greater pressure loss and less flow. In order to keep losses äs low äs possible the bioprostheses with the largest orifice area must be implanted. l Fragestellung Seit dem Ersatz der Mitralklappe durch Starr [13] und dem Ersatz der Aortenklappe durch Harken [3] im Jahre 1960 haben die Klappenimplantationen in den letzten zehn Jahren stark zugenommen [5, 6]. Die Entwicklung begann mit der massebehafteten Kugelklappe und setzte sich über die Niederprofil-Scheibenklappe und die Kippdeckelprothese bis zur heutigen Bioprothese fort (Bild 1). Obwohl die flexiblen Bioprothesen den künstlichen Herzklappen mit starrem Schließkörper bezüglich thromboembolischer Spätkomplikationen überlegen sind, treten postoperative Komplikationen auch bei Bioprothesen auf [8, 9,10]. Wesentliche Aussage über die Funktionsfähigkeit der Bioprothesen liefert neben dem histologischen Befund die hydrodynamische Messung von Regurgitation und Druckverlust.• Mit Unterstützung der Deutschen ForechunK*8rmt«in§rh»ft,8FB109.
UntersuchungWährend pulsierender Durchströmung in einem Kreislaufsimulator wurden Regurgitation und Druckverlust von Bioprothesen als Aortenklappenersatz in Aortenposition gemessen.
MaterialBei den untersuchten Bioprothesen...
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