Despite western conditions laparoscopic D2 gastrectomy is certainly a save and feasibly approach for surgical therapy of EGC and AGC with low morbidity and mortality, and faster postoperative recovery. The oncologic outcome seems to be equivalent to open surgery.

Long-term continuous flow culture allows the investigation of dynamic biofilms under microaerophilic or aerobic conditions. We studied the biofilm formation and changes of susceptibility in 30 blood culture isolates (48 experiments) of different Candida species exposed to anidulafungin in 0.16 ml or 7.7 ml flow chambers. The flow rate (F) was adjusted to a very low rate of 1.3 ml h(-1) resulting in an exchange rate of up to 180 and 6.25 times chamber volumes per 24 hours in the small and large chambers, respectively. The results of culture at a very low flow rate were markedly different from cultures in micro well plates. Low flow rates may better mimic the in vivo situation and thus may be of higher relevance for the clinical setting. Under these conditions, a general resistance of fungal biofilms against anidulafungin cannot be confirmed. Strains of C. albicans and C. glabrata showed very uniform results whereas the C. parapsilosis group and C. lusitaniae varied from high susceptibility to resistance. Species differentiation of the C. parapsilosis group appears to be appropriate in clinical microbiological diagnostics. For the majority of the tested Candida species, anidualafungin was more effective than voriconazole. For the species C. lusitaniae and C. guilliermondii susceptibility testing should be considered prior to clinical use of echinocandin antifungals.

Bei einer Risiko-Nutzen-Analyse der bariatrischen Chirurgie stehen insbesondere das Sterblichkeitsrisiko, die Beeinflussung der Adipositas-assoziierten KomorbiditÄt sowie die damit verbundenen Gesundheitsausgaben im Mittelpunkt der Diskussion. Die Literaturdaten zeigen, dass das adjustierte Risiko, an einer nichtoperativ behandelten morbiden Adipositas mit einem BMI > 35 kg/m² (bzw. 40 kg/m²) vorzeitig zu versterben, 29–40% betrÄgt. Im Gegensatz dazu ist die 30-Tage-LetalitÄt in der bariatrischen Chirurgie in den letzten Jahren deutlich gesunken und liegt aktuell zwischen 0,3 und 2%. Die Adipositas-assoziierte MorbiditÄt wird durch eine indikationsgerechte Chirurgie deutlich verbessert. In diesem Zusammenhang konnte gezeigt werden, dass die Heilungs-oder Besserungsrate fÜr Typ-II-Diabetiker zwischen 38 und 100%, fÜr die HypercholesterinÄmie zwischen 30 und 94% sowie fÜr die Hypertonie-Herzkrankheit zwischen 31 und 87% liegt. Ein koexistentes Schlaf-Apnoe-Syndrom wird in 71–100% der FÄlle geheilt, und depressive Erkrankungen werden in zirka der HÄlfte der Patienten gebessert. Durch die Optimierung der Adipositas-assoziierten KomorbiditÄt sinken im postoperativen Follow-up die Gesundheitsausgaben. Es ist davon auszugehen, dass nach moderner bariatrischer Chirurgie eine Amortisierung der Operationskosten nach zirka 2–4 Jahren erfolgt ist. Danach steigen die jÄhrlichen Gesundheitsausgaben fÜr nichtoperativ behandelte Patienten um den Faktor 3–5. Unter diesen drei Aspekten scheint es zu einer indikationsgerechten bariatrischen Chirurgie keine konservativen Alternativen zu geben.

Despite recent advances in NOTES, NOS, SILS and related techniques, the feasibility of performing extensive surgery is still limited. Colon surgery usually requires additional access sites or complex technical means for triangulation and retraction. A method is presented that enables single-port colon surgery, supported by flexible colonoscopy. Single-port sigmoidectomy was performed in five cases on the porcine model. Flexible colonoscopy was used to manoeuvre the colon and expose its mesentery for dissection. The specimen was retrieved transrectally by invagination. Single-port sigmoidectomy supported by colonoscopy was feasible in all cases. The method provided a fixed framework, excellent organ guidance and exposition of the mesentery and enabled bowel-close mesocolic preparation. The access angle for preparation and visualisation could be altered during the procedure using the colonoscope. During autopsy on day 21, competent anastomotic healing with only rare interenteric adhesions was observed. One animal had a small preperitoneal abscess in the umbilical region while demonstrating completed skin healing. Flexible colonoscopy provided a fixed reference frame that enabled single-port preparation and dissection of the sigmoid colon. Under colonoscopic guidance, the access angle for dissection could be adapted according to the surgeon's needs. The procedures could be performed safely and effectively.

Our results confirm the increased incidence of PONV after gynaecological laparoscopic surgery under balanced anaesthesia compared to the predicted rates. Both dolasetron and metoclopramide proved to be effective prophylactic measures. Given a PONV-incidence of 38% in group D and 39% in group M, it is doubtful, whether the anaesthetic technique chosen in this study is the most suitable regimen for ambulatory gynaecological laparoscopies.