Intestinal Microbiota in Inflammatory Bowel Disease and Carcinogenesis: Implication for Therapeutics.

Trillions of bacteria inhabit our intestine, forming a community called the microbiota, whose contributions are essential to maintain host homeostasis. Disruption of this normal microbial-host communication network has deleterious consequences for the host and is associated with intestinal pathologies such as inflammatory bowel diseases (IBD) and colorectal cancer (CRC). Here we present key concepts and mechanisms by which bacteria may participate in intestinal pathology, and discuss possible means to therapeutically target the microbiome.

[Desmoid tumour around the DIEP anastomosis - a rare complication after breast reconstruction]. / Desmoidtumor an DIEP-Lappen Anastomose Eine seltene Komplikation nach Mammarekonstruktion.

Abdominal desmoid tumors are so called non-metastatic tumors. They occur by proliferation of fibroblasts of muscle, fascia or aponeuroses. After breast reconstruction with a DIEP flap (Deep Inferior epigastric Artery Perforator Flap), a progressive growth of a desmoid tumor was seen around the DIEP-anastomosis. A total excision was not possible without compromising the vascular pedicle. With taking into account a recurrence rate up to 65% another operation is probably necessary. In this case the main vessels of the graft have to be cut out and a necrosis of the flap can or may appear.

[Hereditary thrombophilia in free microvascular flaps--a case report]. / Hereditäre Thrombophilie und ihre Bedeutung für die freie mikrovaskuläre Gewebetransplantation anhand einer Falldarstellung.

Hereditary thrombophilia sums up a large number of haemostatic disorders, which cause thrombosis independently to external influences. The main cases of hereditary thrombophilias are the hereditary antithrombin defect, the activated protein C resistance, the hereditary protein C defect, the hereditary protein S defect, the antiphospholipid antibody syndrome, the hyperhomocysteinaemia, the increased factor VIII activity and the prothrombin-G20210A-polymorphism. We present a patient who was amputated in both breasts due to cancer. A bilateral microvascular TRAM-flap was planned as primary reconstruction on one breast and secondary reconstruction on the other breast. However in the operation the flap vessels revealed irreversible thromboses so that the intended reconstruction could not be completed in this operation. Postoperatively, a combined hereditary thrombophilia was diagnosed: heterocygote activated protein C resistance, antiphospholipid antibody syndrome and hyperhomocysteinaemia.

[Functional reconstruction of the radial articular surface after giant cell tumor]. / Funktionelle Rekonstruktion der Radiusgelenkfläche nach Riesenzelltumor.

Giant cell tumor is a benign locally aggressive tumor with a high tendency to recurrence, with a small rate of pulmonary metastases. In 90% of cases the tumor occurs in the long bones, especially near the epiphysis. A case of a 37-year-old female with a recurrent giant cell tumor of the distal radius including the radioulnar articular surface, successfully treated with a wide resection and reconstruction of the articular surface between the radius, scaphoid, lunatum, and ulna by an iliac crest graft, is reported.

[Correction of finger clubbing in primary hypertrophic osteoarthropathy (Touraine-Solente-Gole syndrome)]. / Korrektur der Trommelschlegelfinger unter ästhetischen Aspekten bei hereditärer hypertropher Osteoarthropathie (Touraine-Solente-Gole-Syndrom).

Finger clubbing can be a single physical finding. In Touraine-Solente-Gole syndrome, the primary form of hypertrophic osteoarthropathy, it is mostly associated with bone pain, hyperhydrosis, pachydermy and wrinkling of the forehead. In other cases, the presence of clubbing is associated with neoplastic, pulmonary, cardiac or other diseases and is then called Bamberger-Pierre-Marie syndrome, the secondary type of hypertrophic osteoarthropathy. The patient's history and careful physical examination, sometimes accompanied by laboratory and imaging studies, leads to the diagnosis. A patient with hereditary hypertrophic osteoarthropathy and its clinical symptoms is presented. Surgical correction of the clubbing fingers is demonstrated in the paper with bilateral resection and shortening of the nail bed, nail matrix and resection of soft tissue. Clubbing fingers are rare, but they might be part of a syndrome or a symptom of other diseases. Reconstructive surgery for aesthetic reasons can be performed.

[Malignant eccrine poroma]. / Das maligne ekkrine Porom.

INTRODUCTION: Malignant eccrine poroma is a very rare tumour of the sweat glands with high malignancy and presenting with a polymorph clinical and histological picture. CASE REPORT: We describe the case of a 99-year-old patient with a malignant poroma on the buttock. Despite the large size of the tumour, no metastasis was found with standard examination techniques. Radical excision and defect closure with a Limberg flap was performed. RESULT: The healing course was uneventful and without complications. CONCLUSION: The malignant poroma is a tumour of high malignancy which can easily be misdiagnosed because of its different forms of presentation. Radical surgical therapy is the only known effective treatment.

[Value of V.A.C.-therapy in the treatment of sternal infections]. / Der Stellenwert der V.A.C.-Therapie bei Sternumosteomyelitis.

Osteomyelitis of the sternum is a dreaded complication after sternotomy and is related to high mortality. Control of infection by radical debridement is the key to successful treatment. Instability of the thoracic cage can lead to a high complication rate. 16 Patients with an infected and unstable sternum underwent radical debridement with resection of the sternum and adjacent ribs. 6 Patients (group A) received an immediate defect coverage with a pedicled muscle flap. 10 Patients (group B) were treated with a vacuum-assisted closure (V.A.C.)-therapy until stabilization of their general condition and underwent defect coverage in a second operation. Healing of the flaps was uneventful in all cases despite minor problems. 5 patients of group A had severe complications with pulmonary or cardiac failure and thoracic instability which lead to prolonged periods of mechanical ventilation. 2 patients of this group died due to multi organ failure. All patients of group B survived and there were no major complications. All of the patients were free of recurrence from their osteomyelitis during follow-up. V.A.C.-therapy after radical resection of sternum osteomyelitis proved to be an effective measure to bridge time while optimizing the status of the patient and it's wound. With this approach we believe to have lowered the rate of major complications in this multi-morbid patient group by reducing the burden of one large operation and by improving thoracic stability.

[Surgical treatment of groin soft tissue defects]. / Chirurgische Therapieoptionen bei Weichteildefekten der Leiste.

BACKGROUND: Treatment of groin defects remains challenging due to their location and origin. Such defects commonly result from resection of tumours but can also occur after surgical or medical therapy. MATERIAL AND METHODS: From 2003 to 2005, 11 patients were treated with groin defects following radiation therapy and resection of lymph node metastasis, primary carcinoma, and sarcoma. Seven patients received wound closure with rectus femoris muscle flaps, and three had vertical rectus abdominis muscle flaps. One patient was amputated at the hip, and the defect was covered with dorsally pedicled muscle and skin flaps. RESULTS: All flaps healed primarily. There were no secondary infections or lymphorrhea. CONCLUSION: The flaps described here are well vascularised standard flaps which are easily harvested with no major donor site morbidity. They provide sufficient coverage for the groin, reduce long-term conservative treatment, hospitalisation, and problems such as scar contracture.

[Patients' satisfaction and social reintegration after breast reconstruction with the DIEP/TRAM flap]. / Brustrekonstruktion mit dem freien Bauchfettlappen (DIEP/TRAM): Patientenzufriedenheit und soziale Reintegration.

The aim of the study was to evaluate social reintegration and patients' perception after breast reconstruction with the free TRAM/DIEP flap. Between 2004 and 2006, 100 patients with an average age of 48 years with breast cancer, capsular contracture and lymphangioma underwent single or second stage autologous tissue transfer. In 7 patients reconstruction was performed on both sides (altogether 107 flaps). The patients were seen for postoperative evaluation and were asked for their personal acceptance after reconstruction. Postoperatively, no instability of the abdominal wall was seen. 3 patients had a total flap loss, in 2 patients a partial loss was evident, 1 had a hematoma, 2 showed successfully treated thrombosis of the flap vein, and 2 patients suffered from wound healing problems at the flap and 4 patients at the abdomen. Aesthetic results concerning natural feeling and breast symmetry were graded as excellent and patients' satisfaction was high.

[Autologous tissue transplantation (TRAM/DIEP) as an option of therapy in capsular contracture]. / Die autologe Gewebetransplantation (TRAM/DIEP) als Therapieoption bei Kapselfibrose der Brust.

Free microvascular abdominal tissue transfer (TRAM/DIEP) has become standard in breast reconstruction after mastectomy. A new indication for abdominal tissue transfer is severe capsular contracture after augmentation by implants. Capsular contracture following aesthetic or reconstructive augmentation mammaplasty occurs in only a small percentage of cases, but warrants adequate therapy. Between 1999 and 2003, six patients with an average age of 35 years with symptomatic capsular contracture after augmentation mammaplasty underwent autologous tissue transfer with the free TRAM/DIEP flap. The flap was harvested either with a perforator of the deep epigastric artery (DIEP) or as muscle sparing flap (TRAM) and was anastomosed to vessels of the subscapular system. Operation time was reduced by operating with two teams. Besides minor dog-ear deformities at the donor sites, no complications were noted. Postoperatively, neither, instability of the abdominal wall nor flap loss was seen. In some cases, a secondary mastopexy was necessary. Aesthetic results concerning natural feeling and breast symmetry were graded as excellent. In our experience, the free microvascular transfer of abdominal tissue (TRAM/DIEP flap) offers a treatment option for patients seeking alternatives other than repeated capsulectomies and implant changes for severe capsular contracture.

[Conservative treatment of facial wrinkles in the hands of the plastic surgeon]. / Konservative Faltenbehandlung in der Hand des Plastischen Chirurgen.

The conservative treatment of facial wrinkles is an integral part of the growing market for aesthetic surgery. Unfortunately, physicians of any specialty and even nonphysicians tried to occupy this lucrative field without providing serious information and knowledge about a holistic plastic surgical concept, which includes second- and third-step aesthetic surgical procedures when conservative treatment does not suffice. The following article outlines and critically evaluates the current state of knowledge.

Dynamic splinting after extensor tendon repair in zones V to VII.

This retrospective study evaluates a dynamic active motion protocol for extensor tendon repairs in zones V to VII. Fifty-eight patients with 87 extensor tendon injuries were examined. Using Geldmacher's and Kleinert and Verdan's evaluation systems, the results were graded as "excellent" and "good" in more than 94%, and as "satisfactory" in the remainder. The need for secondary tenolysis was low (6%), and no other surgical complication occurred.

[Functional bracing after operative treatment of metacarpal fractures]. / Frühfunktionelle Nachbehandlung operativ versorgter Mittelhandfrakturen.

Metacarpal fractures are frequently immobilized for several weeks in forearm plaster cast, even after operative stabilisation. The purpose of this study was to assess the results after early functional treatment using metacarpal braces. 87 patients with 105 metacarpal fractures were included in a prospective study from February 1997 until November 2000. The AO-classification of the fractures was assessed for all patients: n=33 A1,n=9 A2,n=3 A3, n=27 B1,n=6 B2,n=7 B3,n=10 C1,n=7 C2, n=3 C3.Exclusion criteria were tendon or nerve injuries,pathological fractures (tumor or metabolic),additional digital fractures of the same ray,and a patients age of less then 18 years. All fractures were treated operatively. 73 patients (84%) were recruited for follow up after an average period of nine months. Average grip strength reached 96% (Jamar II) for the power grip, 97% for the three finger and 98% for the pinch grip compared to the contra-lateral side in the group where the dominant hand was affected. It was 88% for the power grip, 91% for the three finger grip and 94% for the pinch grip after injury of the non-dominant hand. The mean postoperative pain score on the visual analog scale was 0.2 for resting conditions, 0.8 for motion and 2.2 under stress.A decreased total range of motion was observed in 15 of 73 patients (21%). The average DASH score reached 6.5 points. Physical therapy was required for an average of 6.7 weeks. Only 41% of the patients with early functional treatment required further physical therapy after removal of the brace. The metacarpal brace used in this series protects from direct trauma,and provides a high patients comfort.It has no disadvantages considering fracture retention compared to conventional plaster casts or splints. The need for physical therapy is reduced after functional fracture bracing.Thus, the metacarpal brace has proven to be a suitable tool for early functional treatment after operative stabilisation of metacarpal fractures.

[Plastic surgery reconstruction of the trunk area after resection of malignant tumors and therapy sequelae]. / Plastisch-chirurgische Rekonstruktion der Stammregion nach Resektion maligner Tumoren und deren Therapiefolgen.

Plastic surgery is playing an increasingly important role in interdisciplinary therapeutic concepts for malignant skin and soft tissue tumors. Immediate or early reconstruction of post-resection defects is important for the patient's rehabilitation. This article describes the principles of surgical oncological concepts for malignant soft tissue tumors of the trunk and gives an overview of the primary and secondary reconstructive options.

Selective inhibition of herpes simplex virus type-1 uracil-DNA glycosylase by designed substrate analogs.

Cytosine deamination and the misincorporation of 2'-dUrd into DNA during replication result in the presence of uracil in DNA. Uracil-DNA glycosylases (UDGs) initiate the excision repair of this aberrant base by catalyzing the hydrolysis of the N-glycosidic bond. UDGs are expressed by nearly all known organisms, including some viruses, in which the functional role of the UDG protein remains unresolved. This issue could in principle be addressed by the availability of designed synthetic inhibitors that target the viral UDG without affecting the endogenous human UDG. Here, we report that double-stranded and single-stranded oligonucleotides incorporating either of two dUrd analogs tightly bind and inhibit the activity of herpes simplex virus type-1 (HSV-1) UDG. Both inhibitors are exquisitely specific for the HSV-1 UDG over the human UDG. These inhibitors should prove useful in structural studies aimed at understanding substrate recognition and catalysis by UDGs, as well as in elucidating the biologic role of UDGs in the life cycle of herpesviruses.

[Covering soft tissue defects and unstable scars over the Achilles tendon by free microsurgical flap-plasty]. / Die Deckung von Weichteildefekten und instabilen Narben über der Achillessehne durch freie mikrochirurgische Lappenplastiken.

INTRODUCTION: Coverage of the exposed Achilles tendon requires thin, supple tissue to provide adequate range of motion and a satisfying aesthetic result for the distal lower extremity. Various local flaps and free flaps have been described for reconstruction of small and large defects. Small defects can be closed with local tissue, whereas free flap coverage may be necessary for coverage of large defects. METHODS: From July 1993 to September 1998 14 patients between the age of 15 and 74 years (mean 47 years; 3 female, 11 male) underwent free flap coverage for the exposed Achilles tendon due to primary trauma, chronic wounds or tumors. The mean duration of follow-up was 33.3 months. The defect size ranged from 8 x 8 to 25 x 28 cm. RESULTS: Six parascapular flaps (three with a vascularized scapular fascial extension), four radial forearm flaps and four latissimus dorsi flaps (one combined with free serratus fascia) were used for soft tissue coverage over the Achilles tendon. Thirteen flaps survived. In one case a parascapular flap had to be removed due to venous thrombosis and a free latissimus dorsi flap was used as secondary salvage procedure. The donor site morbidity was acceptable for most patients after flap harvesting in the subscapular region and also satisfactory in the forearm region. Average active range of motion in the upper ankle joint was 15-0-40 degrees for extension/flexion. All patients were satisfied with the functional and aesthetic result. CONCLUSION: Soft tissue coverage over the exposed Achilles tendon requires an optimal solution for each patient to achieve an aesthetically pleasing result and acceptable function. Microvascular free flaps can be used to reconstruct medium and large defects and to provide gliding tissue for the Achilles tendon. The complication rate of microvascular flaps is comparable with that of local flaps.

[Reconstruction of defects of the anterior abdominal wall]. / Die Rekonstruktion von Defekten der ventralen Bauchwand.

Reconstruction of the abdominal wall is of importance in many clinical situations, but may require the entire spectrum of plastic and reconstructive surgery. Indications for particular procedures depend on the clinical situation and the patient's individual profile. One has to differentiate between life-saving primary measures and secondary corrections to improve form or function. The article outlines current actual concepts of plastic surgical defect reconstruction with which the general/visceral surgeon should be acquainted, in order to integrate these concepts into a multi-disciplinary approach in pertinent clinical situations.

[Treatment strategy in complex hand injuries]. / Behandlungsstrategie bei komplexen Handverletzungen.

There are no clear definitions of serious or complex hand injuries in the literature. Multistructural injuries involving a vital risk to the affected part of the body part are usually classified as complex. The quality of the reconstruction, based on sound management principles, determines the aesthetic and functional outcome for the patient. The strategies basically consist of: Careful radical dbridement, thorough analysis of the defect and evaluation of lost functions, injury classification, Patient oriented reconstructive procedures, careful and realistic explanation of perspectives and risks to the patient. Following these principles will most likely achieve the planned objectives of treatment, such as, best possible restoration of form and function, cost-effective therapy, and early professional and social reintegration. Algorithmic approaches are an important aid in the clinical approach to these kinds of problems, making it possible to reach clear reproducible decisions that are amenable to standardization. Despite all individual decisions necessary to achieve optimal care, this standard theoretical framework will be able to improve the quality of care.