[Small bowel obturation ileus related to ingestion of a medical device]. / Dünndarmobturationsileus im Zusammenhang mit der Einnahme eines Medizinproduktes.

We report the case of a 50-year-old woman who was admitted to the hospital with an acute abdomen and underwent exploratory laparotomy. Intraoperatively, we suspected Crohn's disease of the ileocecal valve and decided to treat conservatively. However, in the further clinical course the patient became severely sick and developed a necrotizing ileocecal inflammation in combination with multiple perforations, 4-quadrants peritonitis and several other complications. Histopathology revealed an unspecific inflammation of the ileocecal valve. Furthermore, numerous little cellulose sponges were found in the resected intestinal segment. They were obstructing the lumen and were identical with the contents of an appetite suppressing medical device. A connection between the ingestion of this medical device and the penetrating inflammation of the ileocecal valve has to be suspected.

[Actinomycosis of the sigmoid colon as the etiology of lower abdominal pain]. / Aktinomykose des Sigma als Ursache von Unterbauchschmerzen.

We report a case of abdominal actinomycosis in a young woman wearing an intrauterine contraceptive device. The patient presented with right lower abdominal pain. A diagnostic laparoscopy was performed. Intraoperatively two perforations of the sigma were detected, a sigmoidectomy was performed. Postoperatively no problems occurred. Histology revealed an abdominal actinomycosis. In the literature only some case reports are published dealing with abdominal actinomycosis. Women wearing intrauterine contraceptive devices seem to have a higher risk of actinomycosis. In unproblematic cases antibiotic therapy is the treatment of choice. In cases of doubt as in our case surgery is recommended to confirm the diagnosis.

Release of daunorubicin from polymethylmethacrylate for the improvement of the local growth control of bone metastasis animal experiments.

Bone metastases are a sign of advanced tumor disease. Surgical therapy is only occasionally curative. Therefore, the therapeutic goals are a limited surgical excision, immediate mobilization, effective stabilization and the avoidance of local recurrence. We investigated the effect of the anthracycline daunorubicin (DNR) in conjunction with polymethylmethacrylate (PMMA) in vitro and in animal experiments for regional control of bone metastases. Previous experiments of local chemotherapy in bone metastases using methotrexate (MTX) were done by Langendorff and Hernigou. In our own experiments we improved the release of daunorubicin from polymethylmethacrylate in vitro and in vivo up to 90% by adding mannitol. In in vivo experiments we investigated the combination of DNR and PMMA in athymic nude mice and Wistar rats. Cells from human breast cancer, bronchial carcinoma, nephroma, and soft tissue sarcoma were subcutaneously implanted bilaterally under the dorsal skin of nude mice. After reaching a diameter of 0.5 cm, the tumors were marginally excised, leaving microscopic tumor residuum behind. The tumor cavities were either filled with PMMA or alternatively with DNR-PMMA. The goal was to avoid tumor recurrence in the DNR-PMMA filled resection cavities. The number of recurrences was significantly lower in the DNR-PMMA treated animals, except in the breast cancer group. Additionally we implanted a rat sarcoma intrafemorally into Wistar rats. After 17 days the tumor was marginally excised and the resection cavity was filled with either DNR-PMMA or PMMA alone. The therapeutic goal was to prevent local recurrence. Histological and pharmacological tests concerning toxicity and drug distribution within the body completed the study. We concluded that the addition of daunorubicin to PMMA supplements surgical resection. We were able to reduce the number of, or delay recurrences in our animal models. Systemic side effects could be minimized despite the achievement of high local drug concentrations.

[Cholecystectomy by mini-laparotomy with the Jako retractor system]. / Cholezystektomie durch Minilaparotomie mit dem Retraktorsystem nach Jako.

In recent years, minimally invasive operations in abdominal and thoracic surgery, especially with laparoscopic techniques, have developed rapidly. A multi-purpose retractor system, Jakoscope (Atlantis Surgical, Inc., New Brunswick, NJ, USA), developed by Jako provides a new and interesting alternative for minimally invasive and direct access surgery without pneumoperitoneum. This instrumentarium, apart from its use in various surgical specialties, allows a direct access through a 3- to 6-cm single incision for removal of the gallbladder. We used this instrumentarium with great success in patients not suited for laparoscopic surgery in comparable time. Up to now the Jakoscope has been applied in five patients. We report about our first case.

[Manifestation of pneumothorax 7 days after port implantation. Report of a single case]. / Manifestation eines Pneumothorax sieben Tage nach Port-Implantation. Eine Einzelfallbeschreibung.

The subcutaneous implanted venous port device offers a safe central venous access and allows for ambulatory treatment. This case report describes a late manifestation of a pneumothorax after venous port implantation which, in fact, is a rare but significant complications. The lack of a correlation of the signs and symptoms with the interventional procedure may lead to inadequate or delayed treatment. The immediate postprocedural X-ray can be false negative when air leaks into the pleural cavity very slowly. Therefore both patients and referring physicians should be informed about the possibility of the late manifestation of a pneumothorax.

[Central venous access devices in treatment of patients with malignant tumors: venous port, central venous catheter and Hickman catheter. Cost-benefit analysis based on a critical review of the literature, personal experiences with 135 port implantations and patient attitude]. / Zentralvenöse Zugangsysteme in der Behandlung von Malignompatienten: Venöser Port, ZVK und Hickman-Katheter. Kosten-Nutzen-Analyse anhand einer kritischen Literaturübersicht, eigener Erfahrungen aus 135 Port-Implantationen und aus Patientensicht.

There are certain demands on central venous access devices in the ambulatory or long-term parenteral treatment of end-stage cancer-patients. The devices should offer both save and easy access, low related morbidity and acceptance of the patients. Ambulatory implantable venous ports fulfill all the these demands as own experiences with 135 implantations in cancer patients show: an overall complication rate of 6% which is - compared to other systems - very low, good acceptance of the patients and low costs. The venous ports can reduce duration of in-house treatment, bears a low morbidity and is the patients first choice. The port device is competitive and cost efficient alternative to conventional central venous access devices.