Influence of additional resection of the gastric fundus on excessive weight loss in laparoscopic very very long limb Roux-en-Y gastric bypass.

Roux-en-Y gastric bypass (RYGB) is the gold standard in bariatric surgery. The effect of the procedure is based on restriction, malabsorption and changes in hormonal axis. Ghrelin is an important appetite hormone which is produced mainly in the gastric fundus. By adding a resection of the gastric fundus, we hypothesized that excessive weight loss will be more prominent and the satiety feelings less pronounced compared to standard RYGB. A total of 73 patients with standard very very long limb (VVLL) RYGB (group A) were compared with 44 patients with VVLL RYGB with resection of the fundus (group B). Outcome measures were excessive weight loss (EWL), body mass index (BMI), early postoperative morbidity, change of co-morbidities, and appetite reduction as assessed by an appetite questionnaire over a postoperative period of 24 months. Groups were comparable in basic preoperative descriptions. Additional fundus resection did not influence EWL (group A 66.1 % vs. group B 70.6 %, p = 0.383) or BMI (group A 29 kg/m(2) vs. group B 27 kg/m(2), p = 0.199). No significant difference in morbidity or change of co-morbidities occurred. The appetite and satiety questionnaire showed no difference between group A and group B, respectively. Adding a resection of the gastric fundus in RYGB did not alter the clinical results, i.e., increased excessive weight loss, decrease of appetite, or increase of satiety. The value of removing a part of the ghrelin-producing cells might be overestimated.

[Effect of new technologies on diagnosis and therapy of acute appendicitis]. / Der Einfluss neuer Technologien auf Diagnostik und Therapie der Appendicitis acuta.

Acute appendicitis remains a diagnosis based primarily on the history and the physical examination performed by an experienced surgeon. Ultrasonography and CT can be an useful adjunct, but they should not be used without context to the clinical picture. In therapy, open appendicectomy remains the golden standard. Laparoscopic appendectomy is reserved for special situations. Preoperative ultrasound is useful to decide upon the operative procedure. When the clinical picture and ultrasonography reveals acute appendicitis one can expect a minimal negative appendectomy- and laparotomy rate of 2.7% and 2.1%. In these situations open appendectomy is indicated. In the case where ultrasonography reveals no appendicitis, negative appendectomy rate is 31%. In this situation further abdominal exploration and thus diagnostic laparoscopy and laparoscopic appendectomy is indicated.

PCR-based detection and typing of human adenoviruses in clinical samples.

Since human adenoviruses (Ad) are associated with a variety of diseases, there is need for a fast and sensitive diagnostic procedure. The polymerase chain reaction (PCR) has been previously applied for the detection and typing of adenoviruses directly in clinical samples. So far, only Ad8, Ad31, Ad40 and Ad41 could be typed by PCR. To extend the technique of type-specific PCR to other adenovirus serotypes, type-specific primers for Ad1, Ad2, Ad4, Ad5, Ad19 and Ad37 were evaluated. In the present study, 50 stool and 68 eye swab specimens were first tested for the presence of adenoviruses using genus-specific primers. Adenoviruses could be detected in 42 stool and 47 eye swab samples. While the adenovirus-positive stool samples were subsequently typed with primers for Ad2, Ad5, Ad31, Ad40 and Ad41, the positive eye swab specimens were typed with primers for Ad4, Ad8, Ad19 and Ad37.