[Endoscopic ultrasound in the long-term follow-up of primary lymphomas of the stomach under conservative therapy]. / Endosonographie im Langzeitverlauf primärer Magenlymphome unter konservativem Therapieansatz.

BACKGROUND AND AIMS: The stomach is the main site of primary extranodular manifestation of non-Hodgkin's lymphomas. Besides clinical staging additional to histological diagnoses, the endoscopic ultrasound (EUS) also becomes more important during follow-up courses of conservative therapy regimens (e. g. H.p. eradication; radiochemotherapy). The aim of the present study was to assess the impact of EUS during long-term observation of primary gastric lymphomas and to outline possible changes of the gastric wall. PATIENTS AND METHODS: Within the scope of 2 prospective multicenter study on primary gastrointestinal non-Hodgkin's lymphomas (GIT-NHL), which were performed at Muenster University Hospital, 26 patients undergoing conservative treatment were examined with endoscopic ultrasound at a three-month interval between 01/1992 and 11/1998. The mean survey period was 28 months (range 7-62). RESULTS: In 22 patients over a period of 21 months (range 4-51) a histological proven complete remission (CR) was found. In 2 patients only a partial remission (PR) was achieved within a time period of seven respectively eight months of survey. Two other patients developed early relapse of non-Hodgkin's lymphoma. In patients with CR the endoscopic ultrasound showed a highly significant decrease of gastric wall thickness 7 and 12 months after therapy was started. On average after 4.6 months enlarged lymph nodes were no more detectable, after 5.5 months thickness of the gastric wall and finally after 6.6 month the previous abolished layering of the gastric wall returned to normal. CONCLUSION: In patients with gastric non-Hodgkin's lymphomas endoscopic ultrasound seems to be the only valid method which demonstrates early changes of the gastric wall and its layering in an appropriate way and might therefore in addition be capable to differentiate between CR, recurrent or refractory non-Hodgkin's lymphoma.

[Patient surgical masks during regional anesthesia. Hygenic necessity or dispensable ritual?]. / Patientenmundschutz bei Regionalanästhesien. Hygienische Notwendigkeit oder entbehrliches Ritual?

OBJECTIVE: The use of surgical face masks (SFM) is believed to minimize the transmission of oro- and nasopharyngeal bacteria to wounds and surgical instruments. However, there are disadvantages for patients undergoing regional anaesthesia and wearing masks: deficient assessment of lip cyanosis, anxiety, retention of CO2, costs. Up to now no studies have been published investigating whether or not SFMs, worn by patients during regional anaesthesia, will reduce bacterial convection. METHODS: We investigated 72 patients during aseptic operations: 24 individuals with regional anaesthesia and SFMs, 22 individuals with regional anaesthesia without SFMs and 26 patients undergoing general anaesthesia. Using an air sampler (volumetric impaction method) 100 L air were collected on blood agar over 2 min. After incubation at 37 degrees C over 60 h the colony forming units (CFU) were counted and differentiated. Airborne culturable bacteria were sampled over the operation field, on the anaesthetic side of the surgical curtain, as well as 10 cm before and to the side of the patients mouth. RESULTS: At all 4 locations there were no significant differences in the number of CFUs between patients wearing a SFM or not (e.g. over the operation field: patient with SFM 5.5 +/- 1.1; no SFM 4.8 +/- 1.2; mean +/- SEM). Significantly more CFUs were detected in patients undergoing general anaesthesia (p < or = 0.05). The extent of the operation did not correlate with the number of CFUs; however, we observed a trend that more CFUs were detected with an increasing number of persons working in the operating room. CONCLUSION: Surgical face masks worn by patients during regional anaesthesia, did not reduce the concentration of airborne bacteria over the operation field in our study. Thus they are dispensable. A higher airborne germ concentration has been detected in patients during general anaesthesia. The reasons for this finding are unknown, but it may be discussed as being a result of a higher activity and number of staff involved during general anaesthesia causing more air turbulence.