Duodenal polypectomy of Brunner's gland hyperplasia using a novel laparoscopic technique. A case report.

Brunner's gland hyperplasia rarely is associated with clinical problems, and it accounts for only about 10% of benign tumors of duodenum. Therapeutic intervention is indicated when Brunner's gland hyperplasia evokes symptoms such as indigestion, bleeding, or obstruction. Endoscopic intervention (esophagogastroduodenoscopy) often can be used effectively, and in some cases may be preferable because of its minimal invasivencss. However, when the lesion is too large to pass through the endoscopic snare, endoscopic treatment is not possible. In these cases, a laparoscopic procedure may provide a novel approach to resection of the polyp, while still serving as a minimally invasive approach. We report the case of a 28-year-old woman with a large duodenal polyp treated by laparoscopic polypectomy.

[Abdominal wall defects caused by postoperative infections]. / Bauchwanddefekte durch postoperative Infektionen.

Infectious defects of the abdominal wall often result from deeper subfascial infections of the abdominal wall caused by a persisting intraabdominal inflammation or the result of laparotomy in peritonitis. Therapies applied are first of all the removal of the sources of infection and a careful debridement of the abdominal wall. There are several ways of temporarily covering the abdominal wall, but there is no ingenious solution. In our own experience the application of zip fastening and PGS nets have proved successful. In case of deeper infections of the abdominal wall the most awkward situation is the laying open of small intestine loops in a granulating wound which may lead to a revitalization of chronic small intestine fistulae. In these cases a differentiated and repeated surgical approach and extensive resection of small intestine parts, and consequently a high rate of complications and lethality cannot be avoided. Extensive defects of the abdominal wall exposing parts of small intestines after such operations require temporary covering and in this case we use Vypro net which, under the most favourable circumstances, can represent a final solution.

Reversible thermal gelation in soft spheres.

Upon heating, concentrated solutions of star polymers and block copolymer micelles in a good solvent, representing soft spheres, undergo a reversible gelation. This phenomenon is attributed to the formation of clusters causing a partial dynamic arrest of the swollen interpenetrating spheres at high temperatures. A phase diagram analogous to that of sterically stabilized colloids is proposed.

[Infected abdominal wall and burst abdomen]. / Die infizierte Bauchdecke und der Platzbauch.

Deep wound infection of the abdominal wall and postoperative abdominal wound rupture are dangerous complications of laparotomy that require emergency operative intervention. The wound infection quota after laparotomy is between 5 and 10%. While subcutaneous infections heal without consequences after wound treatment, deep infections of incisional wounds are a problem. The cause is often an intra-abdominal infection. There are some standard operational measures: consistent debridement of the necrotic parts, careful re-exploration of the intra-abdominal site and early fascial closure with special sutures. All other procedures depend on the individual case. Abdominal wall rupture only occurs in 1% of the cases, but the mortality is high (15-45%). Besides local wound factors and the technical aspects, there a many general causes. Abdominal wall rupture also requires emergency operation. Repeated wound closure without further steps is possible in half of the cases. The mass technique should be used. Both deep wound infections and rupture are important complications in the development of incisional hernias.

[Intuition in medicine and surgery. Prerequisites and limits]. / Intuition in der Medizin und Chirurgie. Voraussetzungen und Grenzen.

Intuition as a philosophical category is commonly acknowledged, but certainly not undisputed. In medicine being a practical science and partly characterized by irrational decisions, intuitive thinking in diagnosis and therapy seems to be an essential part of successful medical activity. Preconditions for an intuitive comprehension of the patient in its whole as well as an unusual process in clinical life are know-how, experience and profound knowledge of the normal and pathological findings. Besides, the physician's and surgeon's moral integrity setting limits to the acceptance of intuition has to be rated as an aid to decision-making. Increase of technics, standards and rules narrow the intuitive scope in a high degree. Loss of intuition as a tool of medical thinking and acting may lead to a spiritual impoverishment of our profession and to a technocratic medicine.

[Below-knee amputation according to Robb-Persson. Technique and clinical results]. / Die Unterschenkelamputation nach Robb-Persson. Technik und klinische Ergebnisse.

The successful rehabilitation and the quality of life of below-knee amputees depend to a great extent on the load-bearing capacity of the amputation stump. Robb and Persson's operating method, utilizing a sagittal cut was used in 154 be low-knee amputations in the period 1982-1992 that were retrospectively analysed. In 91% of the cases, advanced vascular disorders related to diabetes mellitus were the main cause for the loss of a limb. Postoperative mortality amounted to 31.8%, the re-amputation rate was 4.5%. Rehabilitation up to full walking capability was achieved by 75% of the surviving patients. 46 patients were re-examined between 1 and 6 years after amputation. In 85% of the cases the condition of the stump was found to be good to very good. The functional rehabilitation results are comparable to those of other operating methods. The advantages of the Robb-Persson below-knee amputation method are the simplicity of the technique and a secure and longlasting effective stump cover, resulting in favourable long-term results.

[Documentation of the effects of child cap pistols]. / Dokumentation der Auswirkungen von Kinderknallpistolen.

The study presents an analysis of 20 cases of acute acoustic trauma caused by toy pistols. The problem generally involves boys within the age range from 6 to 11 years. Half of the incidents involved attacks with toy pistols used as weapons. Auditory damage appeared in two types, each of which had a notch in the audiogram at the frequency range between 10 and 14 kHz. In children, a shot close to one ear can damage both ears. Great differences in the severity of tinnitus were apparent. The most severe cases of tinnitus were observed in the children with no or minor permanent auditory damage. Children experiencing long periods of uninterrupted tinnitus suffer significantly. This is not only detrimental to family life, but also to the performance of the children at school. The total expenses of treatment for these 20 cases were estimated to be approximately 80,000 DM (40,000 Euro).

Self-diffusion of water in cartilage and cartilage components as studied by pulsed field gradient NMR.

Pulsed field gradient (PFG) nuclear magnetic resonance (NMR) was used to investigate the self-diffusion behavior of water molecules in cartilage, polymeric cartilage components, and different model polymers. The short-time self-diffusion coefficients (diffusion time delta approximately/= 13 msec) are found to decrease steadily with decreasing water content. This holds equally well for cartilage and cartilage components. The short-time diffusion coefficients are subjected to a rather nonspecific obstruction effect and mainly depend on the water content of the sample. The long-time diffusion coefficients in cartilage (delta approximately/= 500 msec), however, reflect structural properties of this tissue. Measurements with varying observation times as well as experiments involving enzymatic treatment of articular cartilage suggest that the collagenous network in cartilage is likely to be responsible for the observed restricted diffusion.

[Toy cap pistols and their effect on hearing]. / Kinderknallpistolen und ihre Wirkung auf das Gehör.

In order to understand the repeated occurrences of auditory impairments caused by toy pistols, an analysis of the circumstances involved was performed at Justus-Liebig University of Giessen. The acoustic impact of toy pistols on the ear was determined with a special measuring system for impulse noise. Results were compared with the acoustic impacts of the G3 common rifle of the German military on the ear of the soldier. It was apparent that all of the five randomly selected types of toy pistols were much louder than the military rifle, if fired close to the ear. The current standard of the European Union related to the safety of toys (EN 71-1) tolerates peaks of impulse noise from toy pistols that are actually illegal for workplaces without auditory protection. Measurements showed that the toy pistols tested were even louder than that tolerated by the EU standard. Problems related to acute acoustic trauma caused by these toys are discussed using recent examples. In order to prevent such injuries, we suggest limiting the loudness of the "worst case" instead of using unrealistic measurements.

[Anterior rectum resection and abdominoperineal rectum excision: guidelines for decision making]. / Anteriore Rektumresektion und abdominoperineale Rektumexstirpation: Richtlinien für die Entscheidungsfindung.

Carcinomae of the upper third of the rectum are, almost without exception, and without loss of continence, resectable. The diagnosis of an intact sphincter function is significant in the pre-operative phase, when deciding whether to carry out an anterior rectum resection or an abdominoperineal rectum exstirpation. Concerning tumours as from G3 in the middle and distal thirds, a safety margin of at least 5 cm distal must be kept, thus making an anterior resection impossible. Stage IV tumours whose growth has infiltrated neighbouring organs or the pelvic wall are also not suitable for resection. Should anatomical circumstances such as excessive adipositae, very large carcinomae, narrow pelvis and enlargement of the uterus or prostata prevent the safe dissection of the mesorectum a sphincter-retaining operation is also not indicated. Oncologic safety is of the highest priority when considering such cases.

Pulsed Field Gradient NMR Self-Diffusion Study in Distinct Phases of the Ternary System Water/n -Heptane/Igepal CA-520

We report on self-diffusion measurements of all the components in distinct phases of the ternary system water/n -heptane/Igepal CA-520 with pulsed field gradient NMR. The phases are also investigated with electron microscopy. The observed self-diffusion coefficients are discussed in comparison with the structural data obtained from the micrographs. They intimately reflect the effect of the phase state and phase boundaries on the molecular transport in this system.

Pulsed field gradient NMR and nuclear magnetic relaxation studies of water mobility in hydrated collagen II.

Transverse nuclear magnetic relaxation and self-diffusion of water were measured in hydrated collagen II. Self-diffusion measurements were conducted by pulsed field gradient NMR (PFG NMR) and weighting of the different species in the signal by variable T2 relaxation in the experiment. Two fractions of water protons were detected, one with a short T2 value but high diffusivity and one with a long T2 value and low, completely restricted diffusion. The distance of the diffusion barriers was determined to be 2.3 microns. Possible reasons for the restriction in the movement of the water molecules in comparison with structural models of collagen II are discussed.

[Quantitative trauma mechanics in pelvic fracture]. / Zur quantitativen Traumatomechanik der Beckenfraktur.

Quasistatic loading of the isolated pelvis and of the pelvis in situ is reported; dynamic loading with an impactor and on 90 degrees car/car side impact are then considered. The isolated pelvis was loaded laterally at the ala of the ilium and the pelvis in situ in the anterior-posterior direction in the area of the symphysis with universal dynamometer; the loading profile was a rigid disk 150 mm in diameter. Some dynamic tests were performed with an impactor with rigid disk 80 mm in diameter as impact surface; the impact was applied against the trochanter major area at a velocity of 30-35 km/h. Otherwise, the pelvic area was stressed by impact through the intrusion of the car side or by impaction of the pelvis against a rigid wall. In the tests conducted with isolated pelves, forces of 850-4850 N were measured; pelvic fractures were observed, specifically fractures of the acetabular margin, pubic bone, and ischium, and comminuted fractures of the symphysis and the iliosacral. In the impactor tests, forces of 6.5-11 kN were enough to cause, pelvic fracture except in one case, and fractures of the femoral neck were found in some cases in addition. With quasistatic anterior-posterior loading of the pelvis in situ, forces of 4,700-10,000 N were measured in cases in which fractures were found.