Cervical lymphadenitis due to mycobacteria other than tuberculosis--an emerging problem in children?

Therapy with antituberculosis drugs is not indicated in patients with isolated cervical lymph node infection due to mycobacteria other than tuberculosis (MOTT); resectional surgery is the treatment of choice in these cases. The reason for this study was a striking increase in the incidence of this disease in children referred to the University Hospital in Aachen. In the period from 1987 to 1990, we saw only 1 case of nontuberculous mycobacterial cervical lymphadenitis among 77 cultured specimens; in contrast to this, out of 85 specimens examined between 1991 and March 1993 were positive, with an increasing tendency. The patients were treated surgically by adequate conservative neck dissection. The outcome was excellent in all cases.

[A new suture device for continuous sutures in the intestinal tract]. / Eine neue Nähmaschine für fortlaufende Nähte am Intestinaltrakt.

A new surgical sewing device for continuous sutures of gastrointestinal anastomoses with needle and suture material was used for the first time to construct a latero-lateral enterostomy (functional end-to-end anastomosis) in the small intestine of pigs. In ten animals the course was mainly uneventful during the observation period of 10 days. One animal developed a postoperative anastomotic leakage. In five cases adhesions between the anastomotic region and the small intestine were found on postmortem examination, but there was no evidence of any slight leakage. On the whole, the sewing device operated faultlessly. At present, clinical use seems possible for long sutures, which are time-consuming when sewn manually, but it is still premature. One major disadvantage of the device is its size, which restricts its application to extra-abdominal tasks. Nonetheless, the principle of a mechanical device for running sutures should be investigated further.

Surgical or medical treatment of questionable peritonsillar abscess? The use of B-mode ultrasonography.

A prospective study was carried out to evaluate the sensitivity of sonography in the diagnosis of peritonsillar abscesses (quinsy). From 1986 to 1991 all cases of clinically doubtful peritonsillitis were subjected to B-Mode ultrasonography of the tonsils before tonsillectomy. 118 patients were examined. Sensitivity of the method in cases of clinically uncertain peritonsillar abscesses was 87%. The predictive value of the method was calculated to be 0.89; however only five false positive cases ("abscess" in ultrasound but no pus during surgery) were found. We therefore suggest that all patients suffering from questionable peritonsillitis should be examined by ultrasound. If abscess formation is suspected, surgical intervention is indicated. In all other cases I.V. antibiotics should be administered and control sonography should be carried out.

[Artificial intelligence methods for support of medial patient education before surgical interventions in the region of the neck-nose-ear]. / Methoden künstlicher Intelligenz zur Unterstützung bei der ärztlichen Aufklärung vor operativen Eingriffen im Hals-Nasen-Ohrenbereich.

As a rule, curative operations require the patient's consent. Determined by the expansion of surgical possibilities, the kind and frequency of specific complications are subjected to constant changes. The physician is encouraged to explain therapeutic methods as well as the probability of complications within the patient's grasp. It has been investigated to what extent methods of artificial intelligence (AI) are suited for assisting the physician in this task. For this purpose, a comprehensive list of surgical complications as reported in research literature has been compiled. The list has been transferred into a hierarchical structure which can be depicted as a rule tree classified according to topographic aspects. In each otolaryngological operation, the reported complications can be classed with these rules. By employing an expert system (Fig. 1), the physician is capable of compiling an individualized document of agreement (Fig. 2) which serves as a basis for the explanatory talk with the patient.

[Peritonsillar abscess in the ultrasonic image]. / Der Peritonsillarabszess im Ultraschallbild.

A prospective study was carried out to evaluate the sensitivity of ultrasonography in diagnosis of peritonsillar abscess (Quinsy). In 1986 through 1989 all cases of doubtful peritonsillitis were subjected to B-mode ultrasonography of tonsils before tonsillectomy was carried out. 36 patients were included in this clinical study. In cases of clinically uncertain peritonsillar abscesses the sensitivity of the method was 82%. However, only four false positive cases ("abscess in the scan but no pus during surgery") occurred.