Endoscopic application of hemostatic thrombin-gelatin matrix (FloSeal) in anticoagulated pigs.

Flexible endoscopy is the method of choice for the diagnosis and therapy of upper gastrointestinal bleeding, but there are still problems during therapy of patients with coagulation disorders. FloSeal((R)) is a hemostatic matrix largely independent of the body's own clotting system. A newly developed endoscopic applicator for FloSeal((R)) was tested in a survival study on pigs with impaired clotting. In a total of eight pigs ulcerous lesions Forrest Ib were induced and the bleeding stopped by applying FloSeal((R)). Thirty minutes before intervention six pigs were given full weight-adjusted heparinization or a maximum dose of ASS in advance. The Hb course was monitored over the next 48 hours and a postmortem examination was performed. In each case, FloSeal((R)) was successfully applied and all bleedings could be stopped. In both groups (except the control group) spontaneous extraintestinal bleeding occurred, but in only one case in the ASS group a gastrointestinal bleeding happened. The Hb course was stable in all other animals. FloSeal((R)) can also be used endoscopically using the applicator being presented here for the first time. It is suited for primary hemostasis of excavated sources of bleeding especially in situations where coagulation is impaired.

Hand-assisted laparoscopic sigmoid resection for diverticular disease: 100 consecutive cases.

BACKGROUND: Hand-assisted laparoscopic surgery (HALS) has been proposed as a useful alternative to conventional laparoscopic and open surgery. As compared with conventional laparoscopic surgery, it offers the advantages of tactile feedback, better exposure, and a shorter learning curve. There is increasing evidence that HALS retains the advantages of minimal-access surgery. The aim of this study was to analyze the feasibility as well as the short- and medium-term outcomes of HALS sigmoid resection for diverticular disease. METHODS: The study included 100 consecutive patients between July 1999 and August 2004. Data were prospectively recorded. Follow-up evaluation was performed by standardized telephone interview after a mean postoperative period of 19 months (range, 2-55 months). RESULTS: Two major intraoperative complications occurred: splenic laceration requiring splenectomy and ureteral injury requiring suture. There were only three conversions: one case of pararectal incision and two cases of extended lower Pfannestiel incision. There was no single case of conversion to midline laparotomy. One patient died postoperatively of myocardial infarction. The postoperative complications included intraabdominal hematoma (2%), anastomotic leakage (3%), wound infection (11%) and bladder dysfunction (1%). The reoperation rate was 5%. The median hospital stay was 8 days. In terms of satisfaction with the results, 97% of patients would choose HALS again. CONCLUSIONS: When used for diverticular disease, HALS sigmoid resection has a low intra- and postoperative complication rate. The satisfaction rate among patients is high. Even in technically difficult cases, conversion to midline laparotomy can be avoided.

Etiology and clinical features of acute epididymo-orchitis.

Seventy-nine patients presenting with acute epididymo-orchitis (AEO) were prospectively analyzed in order to study the etiology and pattern of the disease. Bacteriological, serological, biochemical, imaging, and endoscopic studies were undertaken to look for urinary tract infection (UTI), brucellosis, gonorrhea, diabetes mellitus (DM), bladder outflow obstruction (BOO), and other urinary tract pathology (UP). Thirty-nine patients also underwent, on their urethral scrapings, the direct immunofluorescence test with monoclonal antibodies (DIF) for Chlamydia trachomatis. The mean age was 44 +/- 20.4 years (median = 40 years) and 43% of the patients were married. Only one patient had urethritis, which nongonococcal. Thirty-five percent presented with pyrexia and only one had brucellosis. Fifty-three percent had significant pyuria but only 22 patients (285) had bacteriuria and E. coli was the etiological agent in 19/22 patients (86%). Eleven out of 39 patients (28%) were positive for Chlamydia trachomatis. BOO, UP, and DM were encountered in 25%, 12.5% and 10%, respectively, but no obvious cause was detected in 26 (33%) patients. Recurrent AEO, abscess formation and bacteremia occurred in 21.5%, 4%, and 1%, respectively. Recurrent AEO was significantly more common in married patients than in single patients (P<0.05) and BOO was significantly more common in patients above the age of 50 years. It is concluded that an underlying cause of AEO could be identified in only two-thirds of the patients. In the remaining one-third, the etiology continues to be obscure and investigations for viral and fastidious infections may be of help in future studies. Endoscopy and urodynamic studies for BOO can be restricted to the elderly patients to cut down the cost of management of this fairly common emergency.