125Te NMR provides evidence of autoassociation of organo-ditellurides in solution.

The frequency of the resonance of 125Te of two organo-ditellurides, R-Te-Te-R (R = 4-CH3C6H4 and 2-(CH3)2NCH2C6H4), in solution undergoes a low-field shift as the concentration of the sample increases. In sharp contrast, the resonance of a sterically hindered ditelluride (R = (C6H5(CH3)2Si)3C) and telluric acid display the opposite effect. While the negative concentration coefficients can be explained by the change in magnetic susceptibility, the positive coefficients are consistent with autoassociation of the molecules through tellurium-centred supramolecular interactions. Although the corresponding equilibrium constants are small, the process is shown to be exothermic. However, the influence of autoassociation is much smaller than the effects of solvent polarity and the conformation of the ditelluride bond.

[Clinical course of patients with exudative-haemorrhagic age-related macular degeneration treated with ranibizumab. Eye2Eye study]. / Evolución clínica de pacientes con degeneración macular asociada a la edad de tipo exudativo-hemorrágico tratados con ranibizumab. Estudio Eye2Eye.

OBJECTIVE: To assess the mean best-corrected visual acuity (BCVA) change in patients with exudative-haemorrhagic age-related macular degeneration (EH-ARMD) after 12-month period of treatment with ranibizumab. METHODS: A retrospective, multicentre and national study of intravitreal administered ranibizumab was conducted on 2 groups of EH-ARMD patients: only one eye affected (group 1) versus second eye affected (group 2), having the first one affected. Eligible subjects were ≥ 50 years old with primary or secondary active subfoveal EH-ARMD-related choroidal neovascularisation (CNV). RESULTS: A total of 184 patients (91 group 1 and 93 group 2) were included. Mean age (SD) was 75.3 (7.5) years, and 53.6% were women. The BCVA showed a VA improvement at 12 months of 9.3 (18.0) number of letters in group 1 and 5.1 (16.8) number of letters in group 2 (P<.0001 and P=.0042, respectively). No statistical differences between groups were observed. Lesion characteristics in the total population (baseline vs 12-month) were: drusen (69.1% vs 61.1%), macular haemorrhages (59.0% vs 7.3%), lipid exudates (28.1% vs 8.2%), and retinal pigment epithelium detachment (46.8% vs 19.0%). The optical coherence tomography (OCT) in the total population (baseline vs 12-month) showed a reduction in macular oedema (73.6% vs 20.9%), subretinal fluids (71.3% vs 14.7%), and intraretinal cysts (38.5 vs 19.7%), as well as a reduction of the mean foveal thickness 377.4 ± 109.8µm vs 249.1 ± 67.8µm in group 1 and 354.1 ± 123.2µm vs 254.6 ± 67.4µm in group 2, P<.0001, both groups, with no significant differences between groups. CONCLUSIONS: Intravitreal administration of ranibizumab for a minimum of 12-months significantly improved the BCVA, decreased lesion characteristics, and reduced the initial mean foveal thickness in patients with CNV primary or secondary to EH-ARMD, both in patients with only one eye affected and in patients with a second eye affected, having the first one affected.

Evolución clínica de pacientes con degeneración macular asociada a la edad de tipo exudativo-hemorrágico tratados con ranibizumab. Estudio Eye2Eye / Clinical course of patients with exudative-haemorrhagic age-related macular degeneration treated with ranibizumab. Eye2Eye study

Objetivo: Evaluar el cambio medio de la mejor agudeza visual corregida (MAVC) en pacientes con degeneración macular asociada a la edad exudativa-hemorrágica (DMAE-EH) a los 12 meses de tratamiento con ranibizumab. Métodos: Estudio observacional, retrospectivo, multicéntrico y nacional, en dos grupos de pacientes con DMAE-EH: primer ojo afectado (grupo 1) y segundo ojo afectado (grupo 2), teniendo afectado el primer ojo. Se incluyeron pacientes ≥ 50 años, diagnosticados de neovascularización coroidea subfoveal activa principal o recurrente secundaria a DMAE-EH. Resultados: Se incluyó a 184 pacientes (91 en grupo 1 y 93 en grupo 2), edad media ± DE de 75,3 ± 7,5 años y 53,6% mujeres. La MAVC mostró una mejoría de la AV a los 12 meses de 9,3 ± 18,0 número de letras en el grupo 1 y 5,1 ± 16,8 número de letras en el grupo 2 (p < 0,0001 y p = 0,0042, respectivamente), sin observarse diferencias significativas (NS) entre ambos grupos. Las lesiones retinianas en la población total (basal vs 12 meses) fueron: drusas (69,1 vs 61,1%), hemorragias maculares (59,0 vs 7,3%), exudados lipídicos (28,1 vs 8,2%) y desprendimiento del epitelio pigmentario (46,8 vs 19,0%). Los resultados de la tomografía de coherencia óptica (OCT) en la población total (basal vs 12 meses) mostraron una reducción del edema macular (73,6 vs 20,9%), del fluido subretiniano (71,3 vs 14,7%) y de quistes intrarretinianos (38,5 vs 19,7%), así como una reducción del grosor foveal medio de 377,4 ± 109,8 μm vs 249,1 ± 67,8 μm en el grupo 1 y de 354,1 ± 123,2 μm vs 254,6 ± 67,4 μm en el grupo 2, con p < 0,0001 en ambos grupos, sin observarse diferencias significativas entre grupos (AU)

Conclusiones: La administración de ranibizumab intravítreo durante un mínimo de 12 meses conllevó una mejoría significativa en la MAVC, una disminución de las lesiones retinianas y una disminución del grosor retiniano medio inicial en pacientes con NVC principal o secundaria a DMAE-EH, tanto en los pacientes con primer ojo afectado como en los pacientes con segundo ojo afectado, teniendo afectado el primero (AU)

Objective: To assess the mean best-corrected visual acuity (BCVA) change in patients with exudative-haemorrhagic age-related macular degeneration (EH-ARMD) after 12-month period of treatment with ranibizumab. Methods: A retrospective, multicentre and national study of intravitreal administered ranibizumab was conducted on 2 groups of EH-ARMD patients: only one eye affected (group 1) versus second eye affected (group 2), having the first one affected. Eligible subjects were ≥ 50 years old with primary or secondary active subfoveal EH-ARMD-related choroidal neovascularisation (CNV). Results: A total of 184 patients (91 group 1 and 93 group 2) were included. Mean age (SD) was 75.3 (7.5) years, and 53.6% were women. The BCVA showed a VA improvement at 12 months of 9.3 (18.0) number of letters in group 1 and 5.1 (16.8) number of letters in group 2 (P<0.0001 and P=0.0042, respectively). No statistical differences between groups were observed. Lesion characteristics in the total population (baseline vs 12-month) were: drusen (69.1% vs 61.1%), macular haemorrhages (59.0% vs 7.3%), lipid exudates (28.1% vs 8.2%), and retinal pigment epithelium detachment (46.8% vs 19.0%). The optical coherence tomography (OCT) in the total population (baseline vs 12-month) showed a reduction in macular oedema (73.6% vs 20.9%), subretinal fluids (71.3% vs 14.7%), and intraretinal cysts (38.5 vs 19.7%), as well as a reduction of the mean foveal thickness 377.4 ± 109.8 μm vs 249.1 ± 67.8 μm in group 1 and 354.1 ± 123.2 μm vs 254.6 ± 67.4 μm in group 2, P<0.0001, both groups, with no significant differences between groups. Conclusions: Intravitreal administration of ranibizumab for a minimum of 12-months significantly improved the BCVA, decreased lesion characteristics, and reduced the initial mean foveal thickness in patients with CNV primary or secondary to EH-ARMD, both in patients with only one eye affected and in patients with a second eye affected, having the first one affected (AU)

Identification of polymorphisms in bovine TLR2 and CARD15,associations between CARD15 polymorphisms and milk somatic cell score in Canadian Holsteins, and functional relevance of SNP c.3020A>T.

Toll-like receptor-2 (TLR2) and caspase recruitmentdomain 15 (CARD15) are important pattern recognition receptors that play a role in the initiation of the inflammatory and subsequent immune response. They have been previously identified as susceptibility loci for inflammatory bowel diseases in humans and are, therefore, suitable candidate genes for inflammatory disease resistance in cattle. The objective of this study was to identify single nucleotide polymorphisms (SNPs) in the bovine TLR2 and CARD15 and evaluate the association of these SNPs with health and production traits in a population of Canadian Holstein bulls. A selective DNA pool was constructed based on the estimated breeding values (EBVs) for somatic cell score (SCS). Gene segments were amplified from this pool in PCR reactions and the amplicons sequenced to reveal polymorphisms. A total of four SNPs, including one in intron 10 (c.2886-14A>G) and three in exon 12 (c.3020A>T, c.4500A>C and c.4950C>T)were identified in CARD15; nonewere identified in TLR2. Canadian Holstein bulls (n=338) were genotyped and haplotypes were reconstructed. Two SNPs, c.3020A>T and c.4500A>C, were associated with EBVs for health and production traits. The SNP, c.3020A>T for example, was associated with SCS EBVs (p = 0.0097) with an allele substitution effect of 0.07 score. When compared to the most frequent haplotype Hap12(AC), Hap22(TC) was associated with increased milk (p < 0.0001) and protein (p = 0.0007) yield EBVs, and hap21(TA) was significantly associated with increased SCS EBV (p = 0.0120). All significant comparison-wise associations retained significance at 8% experimental-wise level by permutation test. The role of SNP c.3020A>T in MDP induced IL-1beta expression was investigated by real-time quantitative reverse transcription-PCR (real-time quantitative RT-PCR). The induction of IL-1beta by MDP was highly variable between individuals, and no association was observed between IL-1beta expression and SNP c.3020A>T genotypes. In summary, the association study indicates that SNP c.3020A>T might play a role in the host response against mastitis; however, it is not the sole determinant of MDP induced IL-1beta expression in blood leukocytes. Further detailed studies are needed to understand the functional implications of SNP c.3020A>T.

Genotype-specific IL8RA gene expression in bovine neutrophils in response to Escherichia coli lipopolysaccharide challenge.

Associations between the AC150887.4:c.-1768T>A SNP (rs41255711), which is located in the 5' upstream region of the IL8RA gene (also known as CXCR1), and the estimated breeding values for somatic cell score in the first (P = 0.019) and second (P = 0.035) lactations were previously reported in a population of Canadian Holstein bulls. In the present study, we evaluated the impact of this SNP on the expression of IL8RA by qRT-PCR. Neutrophils were isolated from whole blood samples from a group of cows with genotypes c.-1768AA (n = 4), c.-1768AT (n = 5) and c.-1768TT (n = 5) after the cows had been challenged in vitro with lipopolysaccharide (LPS). This study demonstrated that LPS-induced expression of IL8RA in cows with the c.-1768AA genotype was significantly greater when compared with the c.-1768AT and c.-1768TT genotypes (P < 0.05) before as well as after in vitro LPS challenge.

Polymorphisms in the 5' upstream region of the CXCR1 chemokine receptor gene, and their association with somatic cell score in Holstein cattle in Canada.

Identification of regulatory elements in 5' regions of chemokine genes is fundamental for understanding chemokine gene expression in response to infection diseases. The CXCR1 receptor is expressed on the surface of neutrophils and interacts primarily with CXCL8 (IL-8), the most potent chemoattractant for neutrophils. The aim of this study was to characterize the 5' upstream region (2.1 kb) of the bovine CXCR1 chemokine receptor gene for polymorphism content and to identify in silico potential transcription-factor binding sites. The 5' flanking region was found by mining the NCBI GenBank (www.ncbi.nlm.nih.gov/). A DNA sequence from the whole genome shotgun sequence project with reference number AC150887.4 contained the CXCR1 5' flanking sequence. Computer analysis revealed potential binding sites for the transcription factors nuclear factor kappaB (NF-kappaB), binding factor GATA-1, barbiturate inducible element (Barbie), nuclear factor of activated T-cells, and activator protein 1. Polymorphism discovery in this region was conducted by constructing an inclusive DNA pool including 2 phenotypic extreme groups, 20 bulls with high estimated breeding values (EBV) for somatic cell score (SCS), and 20 bulls with low EBV for SCS. Independent amplicons along the 5' flanking region of bovine CXCR1 were generated for polymorphism discovery by sequencing. Three novel single nucleotide polymorphisms (SNP), CXCR1c.-344T>C, CXCR1c.-1768T>A, and CXCR1c.-1830A>G, and a previously identified SNP in the coding region, CXCR1c.777G>C, were identified. The 4 SNP were genotyped in Canadian Holstein bulls (n = 338) using tetra-primer amplification refractory mutation system (ARMS)-PCR. Average allele substitution effects were estimated to investigate associations between the 4 SNP and EBV for SCS in first, second, and third and later lactations. Multiple trait analysis revealed that the SNP CXCR1c.-1768T>A was associated with EBV for SCS in the first and second lactations and over all 3 lactations. Haplotype analysis substantiated this association with EBV for SCS in the first lactation. Given the location of SNP CXCR1c.-1768T>A and the surrounding potential binding recognition sequences for NF-kappaB, GATA-1, and Barbie transcription-factors, this SNP may be implicated in gene regulation and warrants further research.

Identification of single nucleotide polymorphisms in the bovine CCL2, IL8, CCR2 and IL8RA genes and their association with health and production in Canadian Holsteins.

The aim of this study was to identify the presence of SNPs in the chemokine genes CCL2 and IL8 and the chemokine receptor genes IL8RA and CCR2, and assess their potential contribution to variation in estimated breeding values (EBVs) for somatic cell score (SCS) and four other traits in Canadian Holstein bulls. Pools of DNA for bulls with high (H) and low (L) EBVs for SCS were used for identification of 11 SNPs. Two unreported SNPs were found in the CCL2 gene and one SNP was found in the CCR2 gene. Previously reported SNPs (three in the IL8 gene and five in the IL8RA chemokine receptor) were also identified. Two SNPs in CCL2, three in IL8, one in IL8RA and one in CCR2 were genotyped in Canadian Holstein bulls (n = 338) using tetra primer ARMS-PCR. We investigated associations of these seven polymorphisms with three production traits (milk yield, fat yield and protein yield) and one conformation trait related to mastitis (udder depth). The allele substitution effect for the CCL2 rs41255713:T>C SNP was significant at an experimental-wise level for milk yield (247.5 +/- 79.9 kg) and protein yield (7.4 +/- 2.3 kg) EBVs (P T SNP on SCS was significant at the comparison-wise level (-0.04 +/- 0.02, P = 0.05), which might indicate a possible association in support of other published studies. Lastly, we assigned CCR2 to BTA22q24, where a previously QTL for SCS was identified.

Technique and survival after laparoscopically assisted right hemicolectomy.

BACKGROUND: The role of laparoscopic colon resection in the management of colon cancer is still controversial. In this article, the surgical strategy and techniques are described, with further consideration of the oncologically relevant aspects. METHODS: Between March 1993 and July 2003, we performed laparoscopic right hemicolectomy in 56 patients with right colon carcinoma. Average age was 74.5 years (range, 17-92). We performed a standardized surgical procedure that included mobilization from the vascularized mesenteric bridges with a window technique, transection of the ileocolic lymphovascular pedicle, and lateral and proximal mobilization of the ileocecum, ascending colon, right flexure, and proximale transversum. After enlargement of one of the trocar incisions the exteriorized colon was resected and an extracorporeal anastomosis was performed in the standard manner. RESULTS: There were no conversions to open. The mean operating time was 119 +/- 38 min, the mean length of resected colon was 27.8 +/- 4.48 cm, and the average width of the clear margins was 6.8 +/- 5.3 cm. One patient died. Lymph nodes were positive in 21 patients. The 5-year survival rate in the 48 patients who were operated on with curative intent was 75%. We have had two local recurrences. The overall 5-year mortality-free fraction was 63%. Cox multivariate analysis showed that the mortality-prognostic factors were tumor stage and length of resected colon, whereas Kaplan-Meier analysis showed that the mortality-prognostic factors were positive lymph nodes and tumor stage. CONCLUSIONS: Our results show that laparoscopic right hemicolectomy for colon cancer can be performed safely. Complications and recurrence rates are comparable to those for left-sided laparoscopic and open procedures. Therefore, we recommend this procedure as the method of choice. Laparoscopically treated patients with stage II and stage III disease have almost the same cumulative rate of survival.

[Laparoscopic segmental pancreas resection and pancreatic cystadenoma]. / Laparoskopische Pankreassegmentresektion bei Pankreaszystadenom.

Aside from location, the complex anatomic relationships and advanced laparoscopic skills needed in selected cases of laparoscopic pancreas surgery have increased. We report a 55-year-old woman with cystic adenoma in the area of the corpus who was treated with complete laparoscopic corpus resection while preserving the head and tail of the pancreas and the spleen. The patient was placed in lithotomy position. Four trocars were placed. After opening the bursa, the pancreas showed a 6x6x6-cm, well-bordered, cystic tumor in the corpus. Tail and head of the pancreas were free of tumor and seemed inconspicuous. After exploration of the v. porte and v. lienalis, the healthy tissue in the head area of the pancreas was divided with the linear stapler. Preparation continued in the direction of the pancreatic tail while preserving the v. lienalis. After reaching the healthy pancreas in the tail region, the tumorous segment was resected. The resected pancreas segment was placed in an endobag until removal over a slightly widened trocar incision above the symphysis. The tail segment was anastomized in situ end-to- side with the first jejunum loop behind the Treitz's ligament. There was no postoperative complication, and the postoperative course was observed. The patient returned to normal activity within 10 days after operation. Retaining high surgical standards and preserving the healthy pancreas tissue and laparoscopic anastomosis, laparoscopic surgery in cases of benign tumors of the distal pancreas is possible with all the patient benefits of minimally invasive surgery.

Laparoscopic inguinal hernia repair.

BACKGROUND: We performed a prospective study to evaluate the safety and efficacy of laparoscopic hernia repair in our hospital. METHODS: A total of 2500 consecutive laparoscopic transabdominal hernia repairs (TAPP) were performed in 1952 patients. Their average age was 59 years. We used a mesh. 12 x 15cm. RESULTS: The average operating time was 32 mins. We had a recurrence rate of 1.04%. There were 89 complications (3.56%). Three were bladder injuries, one of which necessitated conversion to an open laparotomy. Three of 38 hematomas required open exploration. Three patients were reoperated because of nerve irritation. An incarcerated trocar hernia occurred in six cases. There was one wound infection at the umbilical incision. There were no infections or incompatibility reactions at the mesh. The complication rate declined over time. At the same time, the rate of recurrence decreased as we acquired more experience in laparoscopic hernia repair. CONCLUSION: Laparoscopic hernia repair can be performed safely, with low rates of recurrences and few complications are low. This technique achieves good results combined with the benefits of minimal invasive procedures.

[Technique of right laparoscopic hemicolectomy]. / Technik der laparoskopischen Hemikolektomie rechts.

Patho-anatomic feature such as easy mobilisation of the colon segment on mesocolon, technically easy approach to the central lymphovascular pedicle, and the possibility of relative uncomplicated salvage and anastomosis warrant including this method in the procedures of modern colorectal surgery. Mobilisation from the vascularisized mesenterial bridges in a window technique, transection of the ileocolic lymphovascular pedicle, lateral and proximal mobilisation of ileocoecum, colon ascendance, right flexure and proximal transversum. After enlargement of one trocar incision the exteriorized colon is resected and an extracorporeal anastomosis is performed in the standard manner. With this standardized method, right hemicolectomy is easy, practicable, and repeatable and can be done with all the advantages of minimally invasive surgery.

Laparoscopic surgery for the cure of colorectal cancer: results of a German five-center study.

PURPOSE: The aim of this study was to assess the feasibility and safety of laparoscopic surgery for the cure of colorectal cancer with emphasis on oncologic follow-up in particular. METHODS: A study was performed of patients with colorectal cancer treated by laparoscopy in five German centers between May 1991 and September 1997. Surgical and pathologic data were recorded in an anonymous registry database and analyzed by type of resection. Standard procedures were sigmoid or left colectomy, anterior resection, abdominoperineal resection, and right hemicolectomy. Follow-up information included incidence of local, distant, and port site recurrence and cancer-related death. RESULTS: A total of 399 patients (212 females) with a mean age of 66.6 years underwent laparoscopic curative resections (sigmoid resection, 89; left colectomy, 11; anterior resection, 157; abdominoperineal resection, 102; right hemicolectomy, 40). Conversion was necessary in 6.3 percent (n = 25). Complications requiring reoperation occurred in 9 percent (n = 35). Complications that were treated conservatively occurred in 27.6 percent (n = 110). Thirty-day mortality was 1.8 percent (n = 7). First bowel movements resumed on the third postoperative day; patients did not use analgesics after a mean of five days. Mean postoperative hospitalization was two weeks. According to International Union Against Cancer classification, 147 patients had Stage I cancer, 35 had Stage II cancer, and 217 underwent curative resection for Stage III cancer. Mean number of lymph nodes resected was 12.1. At a mean follow-up of 30 months, one port site recurrence was documented. No local recurrence was observed after curative resection of Stage I colorectal cancer. Of 399 patients, local recurrence occurred in 6 patients (Stage II, 2; Stage III, 4), and distant metastases were documented in 25 patients (Stage I, 3; Stage II, 3; Stage III, 19). The highest incidence of cancer-related death occurred after abdominoperineal resection (4.9 percent). CONCLUSION: To assess the role of laparoscopic colorectal surgery for the cure of cancer objectively, prospective randomized trials are necessary.

[Endoscopic parathyroidectomy. Surgical technique in primary hyperparathyroidism]. / Endoskopische Parathyreoidektomie. Operationstechnik bei primärem Hyperparathyreoidismus.

We report our experience and technique of endoscopic removal of parathyroid adenomas in case of primary hyperparathyroidism. Scintigraphy, MRI scan and cervical ultrasound enable exact diagnosis and therefore exact localisation and placement of the three 5 mm trocars for endoscopic operation. The placement of the optic and the function trocars depends on the localisation of the adenoma. The free room to work in is created between thyroid and neck muscles and supported by insufflated CO2 with a pressure of 12 mm Hg. After the adenoma is taken out through an incision above the jugulum. With this technique we operated upon 3 patients successfully. Benefits for the patients seem to be a less painful postoperative course with minimal blood loss because of the exact exploration of the adenoma with minimal invasion of the surrounding tissue.

Eight- and 16-membered cyanuric-sulfanuric ring systems: C2N4S2-->C2N3S ring contraction.

Eight- and 16-membered cyanuric-sulfanuric ring systems of the type Ar2C2N4S2(O)2Ar'2 (3a, Ar = 4-BrC6H4, Ar' = Ph; 3b, Ar = 4-CF3C6H4, Ar' = Ph; 3c, Ar = 4-CF3C6H4, Ar' = 4-CH3C6H4) and Ar4C4N8S4(O)4Ar'4 (4b, Ar = 4-CF3C6H4, Ar' = Ph; 4c, Ar = 4-CH3C6H4, Ar' = Ph; 4d, Ar = 4-CF3C6H4, Ar' = 4-CH3C6H4), respectively, were prepared in good yields by the reaction of the corresponding sulfur(IV) systems with m-chloroperbenzoic acid. The X-ray structures of 3b, 3c.C7H14, 4b.CH2Cl2, 4c, and the S(IV) system Ar4C4N8S4Ar'4 (2c, Ar = 4-CH3C6H4, Ar' = Ph) were determined. Upon oxidation the two oxygen atoms in 3b and 3c.C7H14 adopt endo positions leading to a twist boat conformation for the C2N4S2 ring. The 16-membered C4N8S4 rings in 4b and 4c retain a cradle conformation upon oxidation. The S-N bond distances are ca. 0.06 A shorter in all the S(VI) systems compared to those in the corresponding S(IV) rings. The thermolysis of 3b at ca. 220 degrees C occurs primarily via loss of a sulfanuric group, NS(O)Ph, to give the six-membered ring (4-CF3C6H4)2C2N3S(O)Ph (6). The structure of 6 was confirmed by X-ray crystallography. Crystal data: 2c, triclinic, space group P1 with a = 13.917(2) A, b = 15.610(4) A, c = 13.491(3) A, alpha = 95.77(2) degrees, beta = 114.82(1) degrees, gamma = 76.21(2) degrees, V = 2583(1) A3, and Z = 2; 3b, monoclinic, space group P2(1)/a with a = 7.316(2) A, b = 29.508(5) A, c = 12.910(2) A, beta = 101.30(2) degrees, V = 2733(1) A3, and Z = 4; 3c.C7H14, triclinic, space group P1 with a = 12.849(4) A, b = 12.863(4) A, c = 12.610(7) A, alpha = 110.61(3) degrees, beta = 105.77(3) degrees, gamma = 62.77(2) degrees, V = 1719(1) A3, and Z = 2; 4b.CH2Cl2, triclinic, space group P1 with a = 12.647(3) A, b = 19.137(3) A, c = 12.550(2) A, alpha = 105.765(11) degrees, beta = 93.610(15) degrees, gamma = 88.877(16) degrees, V = 2917.2(9) A3, and Z = 2; 4c, orthorhombic, space group Pba2 with a = 22.657(2) A, b = 10.570(2) A, c = 10.664(3) A, alpha = beta = gamma = 90 degrees, V = 2554(1) A3, and Z = 2; 6, triclinic, space group P1 with a = 7.4667(8) A, b = 11.3406(12) A, c = 13.5470(14) A, alpha = 108.000(2) degrees, beta = 105.796(2) degrees, gamma = 94.300(2) degrees, V = 1033.8(2) A3, and Z = 2.

Voice-controlled robotic arm in laparoscopic surgery.

AIM: To report on our experience with a voice-directed robotic arm for scope management in different procedures for "solo-surgery" and in complex laparoscopic operations. METHODS: A chip card with orders for the robotic arm is individually manufactured for every user. A surgeon gives order through a microphone and the optic field is thus under direct command of the surgeon. RESULTS: We analyzed 200 cases of laparoscopic procedures (gallbladder, stomach, colon, and hernia repair) done with the robotic arm. In each procedure the robotic arm worked precisely; voice understanding was exact and functioned flawlessly. A hundred "solo-surgery" operations were performed by a single surgeon. Another 96 complex videoscopic procedures were performed by a surgeon and one assistant. In comparison to other surgical procedures, operative time was not prolonged, and the number of used ports remained unchanged. CONCLUSION: Using the robotic arm in some procedures abolishes the need for assist ance. Further benefit accrued by the use of robotic assistance includes greater stability of view, less inadvertent smearing of the lens, and the absence of fatigue. The robotic arm can be used successfully in every operating theater by all surgeons using laparoscopy.

[Laparoscopic gastric banding in morbid obesity]. / Laparoskopisches "Gastric Banding" bei Adipositas permagna.

Laparoscopic "Gastric Banding" is a modern, minimally invasive technique to induce significant weight loss in morbidly obese individuals. If performed according to the established principles of elective surgery, the procedure has to be classified as a serious offer to a specific group of patients, who have, as yet, been confronted with the option of futile conservative therapies or irreversible interventions in the gastrointestine. The technique comprises the laparoscopic placement of a silicone band below the cardia, connected to a port-system. By the hourglass-like segmentation of the stomach a "pouch" and an artificial "stoma" (outlet) is created, with the effect of decreasing food intake and--psychologically intended--inducing an early feeling of satiety. The complexity of the pathogenetic impulses leading to severe nutritional obesity requires a serious risk/benefit appreciation with multidisciplinary responder-analyse. Apart from the main indications like overweight, patient history and obesity-associated disorders it is indispensable to include the psychological status of the patient and his capability of compliance into the decision-finding. With the inflatable inner surface of the band connected to the access port, the system is designed to permit postoperative regulation of the therapeutic outcome by percutaneous stoma size adjustment without further surgery. The placement of the band as well as the specific anatomical conditions of extremely obese patients involve severe risks such as primary organ lesions, post-operative pouch dilatation or "slippage" by herniation of the gastric wall. Therefore the technical performance of the implantation demands a high level of experience and practical knowledge of abdominal laparoscopic procedures. It is to assume, that prospective validation to establish operation standards will have a critical look to the modification of the surgical procedure, the size of the implant, the pouch and the stoma.

[Technique of laparoscopic pancreatocysto-jejunostomy]. / Technik der laparoskopischen Pancreatocysto-Jejunostomie.

Usually the development of a pancreatic pseudocyst in the course of pancreatitis is followed by surgical intervention. In case of operation an internal drainage is preferred to an external according to general experience. We have developed a simplified technique of pancreatocysto-jejunostomy without Braun- or Roux-Y-anastomosis. Here we present our surgical strategy in the laparoscopic technique.

[Laparoscopic hernia repair of recurrent hernias]. / Laparoskopischer Bruchlückenverschluss von Rezidiv-Hernien.

Successful treatment of recurrent inguinal hernias is still a problem, in spite of the availability of several different methods. We present our experience with laparoscopic TAP repair, which was performed in 154 patients with 168 recurrent inguinal hernias after traditional anterior repairs. Our results show an acceptable complication rate (5.4%, n = 9) and a low re-recurrence-rate (1.8%, n = 3), combined with the benefit of the minimal access technique, so that this procedure can be recommended in recurrent inguinal hernia repair.

[Robot arm in laparoscopic surgery]. / Roboterarm in der laparoskopischen Chirurgie.

Currently laparoscopic surgery is limited by several factors. One of them is the precise handling of optics. Up to now, in our hospital 52 laparoscopic operations have been done with a voice-controlled robot arm to handle the optics in gallbladder, stomach, large bowel and hernia operations. The visual field is determined by the surgeon. In all cases handling of the robot arm was precise and the voice response exact and without technical problems. Twenty-nine operations were done by one operator as "solo surgeries". In 20 further cases there was one assistant. A robot arm can be used successfully without problems by any laparoscopic surgeon in any operating theater.