Laparoscopic transversus abdominis release for complex ventral hernia repair: technique and initial findings.

PURPOSE: The open Rives-Stoppa retrorectus and transversus abdominis release (TAR) techniques are well established in open ventral and incisional hernia repair. The principles are currently being translated into minimally invasive surgery with different concepts. In this study, we investigate our initial results of transperitoneal laparoscopic TAR for ventral incisional hernia repair (laparoscopic TAR). METHODS: Over a 20-month period, 23 consecutive patients with incisional hernias underwent surgery. Laparoscopic TAR was performed transperitoneally with adhesiolysis from the anterior abdominal wall, development of the retrorectus space and TAR, midline reconstruction and extraperitoneal mesh reinforcement. RESULTS: There were 23 incisional hernias, of which 70% were M2-M4 and 60% were W3. Median patient age was 68 years and the median BMI was 31. Median operating time was 313 min, and hospital stay was 4 days. Morbidity was 26% (Clavien-Dindo 1: n = 4 and 2 + 3b: n = 2). CONCLUSION: With the laparoscopic TAR, it was possible to treat a series of patients with ventral incisional hernias. The operating times were long. However, with a low rate of perioperative complications the hospital stay was short As feasibility is demonstrated, the clinical relevance of the method has to be further evaluated.

Silicon uptake and metabolism of the marine diatom Thalassiosira pseudonana: Solid-state 29Si NMR and fluorescence microscopic studies.

Uptake and metabolism of silicon by diatoms are studied by the combined use of solid-state 29Si NMR spectroscopy and confocal laser fluorescence microscopy especially with respect to the presence and nature of an intracellular silicon-storage pool. Cells of the marine diatom Thalassiosira pseudonana were synchronized by silicon starvation and frozen without any freeze-drying or chemical treatment in order to analyze integer and unmodified diatoms. The frozen samples were investigated by solid-state 29Si NMR spectroscopy to identify potential silica precursors. The developmental state of the cell culture and the formation of new siliceous girdle bands and valves were monitored by laser fluorescence microscopic studies. A comparison of fluorescence microscopic and NMR data allows the assignment of NMR spectra to the various developmental stages of the dividing diatom cells. A detailed analysis of solid-state 29Si NMR spectra suggests that the silicon-storage pool-if present-consists of four-coordinated, condensed silicon; possibly a silica sol.

Optimal maximum tracking rate of dual-chamber pacemakers required by children and young adults for a maximal cardiorespiratory performance.

INTRODUCTION: Children and young adults require a higher maximum tracking rate (MTR) for physical activity. The objective of the present study was to observe whether higher MTR of 170 or 190 beats per minute (bpm) have a positive impact on the maximal cardiorespiratory capacity of children and young adults in comparison with a lower MTR of 140 bpm. METHODS: Fifteen patients with atrioventricular block and normal sinus-node chronotropic function (age 7-24 years) with DDD- (14) or VDD-pacemakers (PM) (1) were enrolled. First, the MTR was adjusted to 140 bpm for 6 weeks and elevated in a second step to 170 or 190 bpm. At the end of each period two cardiopulmonary exercise tests, a 24-hour ECG and a PM test were performed. RESULTS: All patients increased their maximal heart rate (139.0 +/- 1.0 vs 177.0 +/- 10.0 bpm, P < 0.001), peak cardiorespiratory capacity (2.4 +/- 0.6 vs 2.8 +/- 0.7 W/kg, P < 0.001), peak oxygen uptake (28.3 +/- 7.0 vs 35.7 +/- 9.5 mL/kg/min, P < 0.005), and oxygen uptake (23.7 +/- 7.4 vs 29.3 +/- 8.4 mL/kg/min, P < 0.02) at the anaerobic threshold. There were no evident heart rhythm disturbances with elevated MTR. Patients with a Wenckebach behavior of the PM had an attenuated increase of maximal cardiorespiratory performance. CONCLUSION: Children and young adults with DDD-/VDD-PM benefit from an elevated MTR by an increased cardiorespiratory capacity, without having more heart rhythm disturbances. A Wenckebach behavior of the PM should be avoided.

A study relating to bioavailability and renal elimination of bismuth after oral administration of basic bismuth nitrate.

The extent to which bismuth is absorbed following single and multiple oral administration of basic bismuth nitrate was investigated in healthy male subjects. The blood concentration of bismuth and the amounts excreted in urine and feces were determined. The results show that only a small fraction of the administered bismuth dose given in this form is absorbed. Existing differences in the absorption kinetics between this relatively insoluble bismuth salt and colloidal bismuth citrate are discussed.

[Steroid-refractory amiodarone-induced pulmonary fibrosis. Clinical features and morphology after an amiodarone-free interval of 3 months]. / Steroidrefraktäre Lungenfibrose durch Amiodaron. Klinik und Morphologie nach einem amiodaronfreien Intervall von 3 Monaten.

Amiodarone-induced bilateral diffuse pulmonary fibrosis developed in a 47-year-old woman with idiopathic hypertrophic subvalvular aortic stenosis who had been treated with amiodarone (Cordarex), 300 mg daily for about 18 months. Although the drug was discontinued and cortisone treatment begun, the pulmonary fibrosis did not regress. When gentamicin (Refobacin) and cefotaxime (Claforan) were administered for suspected fibrosis-induced right-sided bronchopneumonia, gentamicin-induced acute tubular renal damage occurred, requiring dialysis. The patient died soon after of myocardial electro-mechanical dissociation. At necropsy there was, in addition to the idiopathic hypertrophic subvalvular cardiomyopathy, extensive bilateral pulmonary fibrosis, lamellar bodies in foam-cell intraalveolar macrophages, in hepatocytes and in the epithelium of the proximal and distal tubules. Although amiodarone had been discontinued three months previously, high concentrations of the drug were still present, especially in both lungs, fat tissue and the liver.