A new theoretical performance landscape for suction feeding reveals adaptive kinematics in a natural population of reef damselfish

Understanding how organismal traits determine performance and, ultimately, fitness is a fundamental goal of evolutionary eco-morphology. However, multiple traits can interact in non-linear and context-dependent ways to affect performance, hindering efforts to place natural populations with respect to performance peaks or valleys. Here, we used an established mechanistic model of suction-feeding performance (SIFF) derived from hydrodynamic principles to estimate a theoretical performance landscape for zooplankton prey capture. This performance space can be used to predict prey capture performance for any combination of six morphological and kinematic trait values. We then mapped in situ high-speed video observations of suction feeding in a natural population of a coral reef zooplanktivore, Chromis viridis, onto the performance space to estimate the population's location with respect to the topography of the performance landscape. Although the kinematics of the natural population closely matched regions of high performance in the landscape, the population was not located on a performance peak. Individuals were furthest from performance peaks on the peak gape, ram speed and mouth opening speed trait axes. Moreover, we found that the trait combinations in the observed population were associated with higher performance than expected by chance, suggesting that these combinations are under selection. Our results provide a framework for assessing whether natural populations occupy performance optima.

Highlighted Article: The in situ feeding performance of Chromis viridis indicates that the population resides close to a local performance peak.

[Fluorescence angiography for esophageal anastomoses : Perfusion evaluation of the gastric conduit with indocyanine green]

BACKGROUND

The incidence of esophageal cancer continues to increase. Despite increasing experience in esophageal surgery and perioperative management, anastomotic leakage remains a frequent and severe complication.

OBJECTIVE

The aim of this article is to demonstrate the current role of fluorescence angiography (FA) with indocyanine green (ICG) in the assessment of esophageal anastomoses. The main focus is on the evaluation of the perfusion situation.

MATERIAL AND METHODS

A systematic search was carried out in PubMed and Medline on FA and ICG, especially with respect to current subjective and objective interpretation approaches of FA against the background of own research.

RESULTS

The rate of anastomotic leakage remains high despite modern surgical procedures. Assessment of neoesophageal perfusion with FA can significantly reduce the rate of anastomotic leakage. At present, FA is mostly subjectively applied in small case studies. The study situation is heterogeneous. Randomized studies do not so far exist.

CONCLUSION

The use of FA with ICG is suitable for evaluation of perfusion of the gastric tube. The implementation is simple and can be standardized. Prospective, randomized trials and objective quantification are needed in the future in order to clarify the potential of the technique.

Adaptive changes in pancreas post Roux-en-Y gastric bypass induced weight loss

BACKGROUND

Obesity has been shown to trigger adaptive increases in pancreas parenchymal and fat volume. Consecutively, pancreatic steatosis may lead to beta-cell dysfunction. However, it is not known whether the pancreatic tissue components decrease with weight loss and pancreatic steatosis is reversible following Roux-en-Y gastric bypass (RYGB). Therefore, the objective of the study was to investigate the effects of RYGB-induced weight loss on pancreatic volume and glucose homeostasis.

METHODS

Eleven patients were recruited in the Obesity Centre of the University Medical Centre Hamburg-Eppendorf. Before and 6 months after RYGB, total GLP-1 levels were measured during oral glucose tolerance test. To assess changes in visceral adipose tissue and pancreatic volume, MRI was performed. Measures of glucose homeostasis and insulin indices were assessed. Fractional beta-cell area was estimated by correlation with the C-peptide-to-glucose ratio; beta-cell mass was calculated by the product of beta-cell area and pancreas parenchymal weight.

RESULTS

Pancreas volume decreased from 83.8 (75.7-92.0) to 70.5 (58.8-82.3) cm³ (mean [95% CI], P = .001). The decrease in total volume was associated with a significant decrease in fat volume. Fasting insulin and C-peptide were lower post RYGB. HOMA-IR levels decreased, whereas insulin sensitivity increased (P = .03). This was consistent with a reduction in the estimated beta-cell area and mass.

CONCLUSIONS

Following RYGB, pancreatic volume and steatosis adaptively decreased to "normal" levels with accompanying improvement in glucose homeostasis. Moreover, obesity-driven beta-cell expansion seems to be reversible; however, future studies must define a method to more accurately estimate functional beta-cell mass to increase our understanding of glucose homeostasis after RYGB.

Customized Surgical Strategy in Chronic Pancreatitis

Despite major advances in the management of patients with chronic pancreatitis, yet the disease remains an enigmatic process of uncertain pathogenesis, unpredictable clinical course, and unclear treatment. In most of the cases intractable pain is the main indication for surgical intervention. Furthermore complications related to adjacent organs, endoscopically not permanently controlled pancreatic pseudocysts, ductal pathology, conservatively intractable internal pancreatic fistula or suspected malignancy also require surgery. The ideal surgical approach should address all these problems — tailoring the various therapeutic options to meet the individual patient's needs. In our opinion, the ideal procedure for chronic pancreatitis is the duodenum preserving pancreatic head resection in terms of an extended drainage procedure, were the extent of the pancreatic head resection may be tailored to the morphology of the pancreatic gland, thus allowing a tailored concept (to resect and/or drain as much as necessary but as little as possible). Looking at the present data, there is no need to transsect the pancreatic axis above the portal vein. If portal vein thrombosis is present, an extended drainage procedure is mandatory without transsection of the neck of the pancreas.

Heterogeneous 'proportionality constants' - A challenge to Taylor's Power Law for temporal fluctuations in abundance

Taylor's Power Law for the temporal fluctuation in population size (TL) posits that the variance in abundance scales according to aM(b); where M is the mean abundance and a and b are the 'proportionality' and 'scaling' coefficients. As one of the few empirical rules in population ecology, TL has attracted substantial theoretical and empirical attention. Much of this attention focused on the scaling coefficient; particularly its ubiquitous deviation from the null value of 2. Here we present a line of reasoning that challenges the power-law interpretation of the empirical log-linear relationship between the mean and variance of population size. At the core of our reasoning is the proposition that populations vary not only with respect to M but also with respect to a; which leaves the log-linear relationship intact but forfeits its power-law interpretation. Using the stochastic logistic-growth model as an example, we show that ignoring among-population variation in a is akin to ignoring the variation in the intrinsic rate of growth (r). Accordingly, we show that the slope of the log-linear relationship (b) is a function of the among-population (co)variation in r and the carrying-capacity. We further demonstrate that local environmental stochasticity is sufficient to generate the full range of observed values of b, and that b can in fact be insensitive to substantial differences in the balance between variance-generating and stabilizing processes.

Social foraging with partial (public) information

Group foragers can utilize public information to better estimate patch quality and arrive at more efficient patch-departure rules. However, acquiring such information may come at a cost; e.g. reduced search efficiency. We present a Bayesian group-foraging model in which social foragers do not require full awareness of their companions' foraging success; only of their number. In our model, patch departure is based on direct estimates of the number of remaining items. This is achieved by considering all likely combinations of initial patch-quality and group foraging-success; given the individual forager's experience within the patch. Slower rates of information-acquisition by our 'partially-aware' foragers lead them to over-utilize poor patches; more than fully-aware foragers. However, our model suggests that the ensuing loss in long-term intake-rates can be matched by a relatively low cost to the acquisition of full public information. In other words, we suggest that group-size offers sufficient information for optimal patch utilization by social foragers. We suggest, also, that our model is applicable to other situations where resources undergo 'background depletion', which is coincident but independent of the consumer's own utilization.

VEGFR-2, CXCR-2 and PAR-1 germline polymorphisms as predictors of survival in pancreatic carcinoma

BACKGROUND

Hypoxic environment of pancreatic cancer (PC) implicates high vascular in-growth, which may be influenced by angiogenesis-related germline polymorphisms. Our purpose was to evaluate polymorphisms of vascular endothelial growth factor receptor 2 (VEGFR-2), CXC chemokine receptor 2 (CXCR-2), proteinase-activated receptor 1 (PAR-1) and endostatin (ES) as prognostic markers for disease-free (DFS) and overall survival (OS) in PC.

PATIENTS AND METHODS

Genotyping of 173 patients, surgically treated for PC between 2004 and 2011, was carried out by TaqMan(®) genotyping assays or polymerase chain reaction. Chi-square test, Kaplan-Meier estimator and Cox regression hazard model were used to assess the prognostic value of selected polymorphisms.

RESULTS

VEGFR-2 -906 T/T and PAR-1 -506 Del/Del genotypes predicted longer DFS (P = 0.003, P = 0.014) and OS (VEGFR-2 -906, P = 0.011). CXCR-2 +1208 T/T genotype was a negative predictor for DFS (P < 0.0001). Combined analysis for DFS and OS indicated that patients with the fewest number of favorable genotypes simultaneously present (VEGFR-2 -906 T/T, CXCR-2 +1208 C/T or C/C and PAR-1 -506 Del/Del) were at the highest risk for recurrence or death (P < 0.0001).

CONCLUSION

VEGFR-2 -906 C>T, CXCR-2 +1208 C>T and PAR-1 -506 Ins/Del polymorphisms are potential predictors for survival in PC.

Metformin after bariatric surgery--an acid problem

Metformin is the oral drug of first choice in type 2 diabetes. Therefore a large number of patients undergoing bariatric surgery will be on Metformin treatment. However, use of Metformin has been associated with lactate acidosis. Weight loss following bariatric surgery is most pronounced during the first weeks after the operation and this creates a phase of negative energy balance with ketone body formation. To shed more light on this situation we measured ketone bodies in 90 patients 5 days-18 months after bariatric surgery. Ketone bodies were markedly elevated during the first 3-4 months. Metformin use should therefore be critically reconsidered after bariatric operations.

[Lateral anastomosis techniques: Partington-Rochelle and V-shaped excision]

Characteristic symptoms of chronic pancreatitis are difficult to manage conservatively. They include severe pain and endocrine and exocrine insufficiency. Surgical treatment with simple and extended draining procedures addresses pain relief and the management of chronic pancreatitis-associated complications of adjacent organs. Following the assumption that pancreatic duct changes with intraductal hypertension are the reason for pain, simple drainage procedures have reduced pain in up to 80% of patients, with low morbidity and mortality. In case of complications involving adjacent organs with inflammatory pancreatic head tumor and stenosis of the distal bile duct, extended drainage procedures with limited pancreatic head resection according to Frey and V-shaped excision of the ventral aspect of the pancreas have been performed successfully.

[Operative technique and outcome in metabolic surgery: conventional and banded gastric bypass]

BACKGROUND

The prevalence of morbid obesity and its sequelae is increasing in Germany, Europe and worldwide. Bariatric surgery is thus gaining in importance for the treatment of patients with malignant obesity. Creation of a gastric bypass is one of the most frequently performed procedures for obesity.

DISCUSSION

The gastric bypass has been used -since 1966 as a surgical means of weight reduction in obese patients. In the mean time various modifications have been developed. Thus, for example, the laparoscopic procedure represents the current standard. After the operation most patients experience an excess weight loss (EWL) of between 61 and 83 %. The comorbidities of obesity are also markedly improved and in a high percentage even cured after the operation. It is worthy of note that diabetes mellitus type II improves shortly after the operation even before any weight loss has occurred. The suggests that the operation induces more than "just" a loss of weight.

CONCLUSION

For decades the gastric bypass has been a well known standard operation of overweight and, in addition to the reduction in weight, is also a therapy for diabetes mellitus -type II.

Late morbidity after duodenum-preserving pancreatic head resection with bile duct reinsertion into the resection cavity

BACKGROUND

Reinsertion of the distal common bile duct (CBD) into the pancreatic resection cavity during duodenum-preserving pancreatic head excision (DPPHE) may be an alternative option to Whipple resection or bilioenteric anastomosis when chronic pancreatitis is associated with CBD stenosis.

METHODS

Outcome in 82 patients with chronic pancreatitis who underwent DPPHE with CBD reinsertion was compared with that in 432 who had DPPHE without reinsertion and 50 who had a Whipple procedure or pylorus-preserving pancreatoduodenectomy (PPPD).

RESULTS

There were no deaths after DPPHE with CBD reinsertion, compared with four (0.9 per cent) after DPPHE without reinsertion and three (6 per cent) after classical resection. Overall morbidity rates were 30, 28.9 and 36 per cent respectively. Fifteen patients (18 per cent) who had DPPHE with CBD reinsertion developed a stricture at the reinsertion site, compared with a long-term stricture rate of 2.3 per cent (ten patients) after DPPHE without CBD reinsertion and 4 per cent (two patients) after PPPD/Whipple resection.

CONCLUSION

Although associated with a high incidence of anastomotic stricture, reinsertion of the CBD into the resection cavity as part of DPPHE can be used to preserve duodenal passage and offers an alternative to extended resection for chronic pancreatitis.

[Arterio-venous aneurysm of splenic vessels--a rare differential diagnosis for cardio-circulatory symptoms]

Patients with arterio-venous fistula of the splenic hilum seek medical assistance because of abdominal discomfort and symptoms of portal hypertension. We report on a 43 year old female who was diagnosed with an arterio-venous aneurysm after suffering from dyspnoea, tachycardia and extrasystolies for several years. After uncomplicated distal splenopancreatectomy the patient was discharged free of symptoms.

Laparoscopic gastric tailoring for huge subcardial gastrointestinal stromal tumor

BACKGROUND

A 67-year-old woman with a gastrointestinal stromal tumor (GIST) of the stomach presented to our outpatient clinic. Preoperative computed tomographic scans and endoscopic examination revealed a spherical submucosal tumor (7.7 x 6.1 x 6 cm) in the posterior wall of the stomach less than 1cm away from the cardia, on the small curvature side.

METHODS

The tumor, which endosonographically had a volume of 282 cm(3), was completely resected by a full-thickness laparoscopic wedge excision without discontinuous gastric resection. The whole procedure was performed using 4 working ports (one 12-mm and three 5-mm ports) and 1 camera port (12 mm). Because the resection margins were tumor free on frozen sections and the distance between the resection margin and cardia was wide enough not to compromise food passage, there was no need for total gastrectomy or upper discontinuous gastric resection. The patient was discharged on the fourth postoperative day after an uneventful clinical course.

RESULTS

Histological examination revealed a malignant gastrointestinal stroma tumor of the stomach. The patient was therefore enrolled for Imatinib adjuvant therapy. Careful and long-term follow-up of 21 months showed no signs of local or distant tumor recurrence. However, further follow-up is needed to monitor for signs of possible recurrence or distant metastases.

CONCLUSION

The described technique prevented proximal gastric resection and a risk of anastomosis without compromising the food passage and radicality.

[A sizeable chance--surgical management of profound obesity concurrent with post-traumatic osteoarthrosis]

In times of plentiful nutrition an environmental advantage turns into a problem - obesity. Apart from an increase in morbidity and overall mortality the development of osteoarthrosis is well documented. Pre-arthrotic conditions may arise from trauma and can lead, depending on the pattern of injury, to full-blown arthrosis. The presence of obesity can play the role of a relevant progressive factor in this setting. Here we report about the case of an obese man (BMI 53.5 kg/m(2)), who suffered a fracture of the femoral head with acetabular participation (Pipkin IV) as well as a fracture of the tibial plateau. Operative management and rehabilitation were followed by gastric bypass surgery for weight reduction. The case is discussed with regard to the present literature.

Microscopic and Electronic Structure of Semimetallic Sb and Semiconducting AlSb Fabricated by Nanoscale Electrodeposition: An in Situ Scanning Probe Investigation

The nanoscale electrocrystallization of pure Sb and the compound semiconductor AlSb on Au(111) has been studied by in situ scanning probe techniques (STM and STS) employing an ionic liquid electrolyte, {AlCl3-[C4mim]+Cl-} (1:1) containing SbCl3. The characteristic changes of the electronic structures with varying potentials have been probed for the first time by normalized differential conductance spectra, (dI/dU)/(I/U). In the underpotential deposition range of Sb the formation of two layers is observed. For the first monolayer a (square root 3 x square root 3)R30 degrees structure is determined from atomically resolved STM images. During the deposition and dissolution of the Sb monolayers characteristic wormlike or spinodal structures appear indicating surface alloying of antimony with the gold substrate. Under overpotential conditions two different Sb structures have been observed. If the deposition potential is continuously stepped to -0.1 V, Sb nanostripes form. On the other hand, randomly dispersed small clusters occur if the potential is jumped from 0.0 to -0.3 V vs Al/Al(III). Both modifications exhibit typical semimetallic behavior as shown by the STS spectra. At -1.1 V the cyclic voltammogram shows a clear reduction wave that is assigned to AlSb compound formation. Deposits in this potential range are characterized by a homogeneous distribution of clusters with diameters of approximately 20 nm. Conductance spectra of these clusters exhibit the main features of the electronic structure of the bulk semiconductor AlSb, with a band gap of 2.0 +/- 0.2 eV. Electrodeposition experiments on both sides of the compound deposition potential show a strong doping effect that is manifest in the corresponding conductance spectra.

Management of an unclear bile duct stenosis

It is frequently difficult to determine whether a bile duct stricture is benign or harbors a malignant tumor based on medical history alone. Therefore, cholestasis of unknown etiology requires a thorough diagnostic evaluation to make a definitive diagnosis and choose the best course of treatment for the patient. We report the case of a 42-year-old man who developed cholestasis 6 years after undergoing orthotopic liver transplantation for end-stage liver disease. The bile duct was dilated by interventional endoscopy, and a brush cytology was obtained. Cytology revealed an inflammatory reaction. Three months later, the stricture persisted. We performed a forceps biopsy, and the diagnosis of a cholangiocarcinoma was confirmed histologically. We conclude that a combined application of brush biopsy/forceps biopsy and endoscopic measures is essential in cases of bile duct strictures of unknown etiology. Occasionally, surgical confirmation may be required. In any case, a single brush cytology is insufficient for diagnosis.

Intractable hiccup: an odd complication after laparoscopic fundoplication for gastroesophageal reflux disease

Intractable hiccup can be an unbearable circumstance and its treatment is often frustrating. More than 100 causes for hiccup have been described in the literature; the most common cause is gastroesophageal reflux disease (GERD). We report a case of a 31-year-old patient who suffered from intractable hiccup starting 3 weeks after laparoscopic Nissen fundoplication for GERD, a potential surgical complication that has not been described. After frustrating medical treatment, the patient underwent computed tomography and nerve stimulator-guided blockade of vagal and phrenic nerves on each side separately. Hiccup ceased only after blockade of the right phrenic nerve with 4 ml/h l% ropivacaine and relapsed soon after discontinuation. He underwent thoracoscopic right phrenicectomy, which rendered him symptom free for well over 2 months, at the time of this writing.

Effect of prenatal glucocorticoids and postnatal nitric oxide inhalation on survival of newborn rats with nitrofen-induced congenital diaphragmatic hernia

BACKGROUND/PURPOSE

Pulmonary hypertension and pulmonary hypoplasia account for the high mortality rate associated with congenital diaphragmatic hernia (CDH). In animal models of CDH, postnatal nitric oxide (NO) inhalation resulted in significantly better survival rates and antenatal glucocorticoid administration in improved lung compliance. The objective of this study was to evaluate the combined effect of prenatal glucocorticoid administration and postnatal NO inhalation on the survival rate of newborn rats with nitrofen-induced CDH.

METHODS

Right-sided CDH was induced by maternal administration of a single oral dose (100 mg, intraperitoneally) of nitrofen on day 11.5 of pregnancy. Dexamethasone (DEX, 0.25 mg/kg) was given in groups III and IV by maternal intraperitoneal injection on day 18.5 and 19.5 of pregnancy. Control animals (groups I and II) received vehicle alone. After spontaneous delivery, the newborn animals were exposed to either NO (80 ppm; groups II and IV) or room air (groups I and III). Vitality (Rat-Score), sO(2) and survival were monitored continuously for 12 hours until animals were killed. Hernia size was estimated as percentage of total thoracic content.

RESULTS

Right-sided CDH was observed in 392 of 491 newborn rats (81%). Animals with large hernias (>50%) died within 4 hours after birth, irrespective of treatment. Hernias with less than 50% of the thoracic volume were considered clinically relevant hernias. In this category, 12.5% of animals without treatment (group I) survived compared with 63.6% after NO treatment alone (group II; P <.01). Survival rate after DEX treatment alone (group III) was 69.4% (group III v I; P <.01). In group IV (DEX and NO) 95.2% of the animals survived (group IV v I; P <.001). In contrast to DEX alone, NO administration resulted in significantly better sO(2)(group II and IV) compared with group I (P <.05).

CONCLUSION

Combination of prenatal maternal glucocorticoids and postnatal NO inhalation significantly improved survival rate of newborn rats with nitrofen-induced CDH.

[Gastric substitute following gastrectomy]

Gastric substitute following gastrectomy. Following gastrectomy a variety of different reconstructive alternatives with different advantages and disadvantages have been proposed. Direct termino-lateral esophagojejunostomy with preservation of the duodenal passage or roux-en-Y jejuno-jejunostomy may be considered as current standard route of reconstruction. With current knowledge formation of a jejunal reservoir with a pouch length of 15 cm seems to be advantageous over simple roux-en-Y reconstruction. Preservation of the duodenal passage offers objective biochemical advantages, while its clinical implications have yet to be confirmed. True long term results of randomised studies are still pending. Thus, the technically easier pouch formation using the roux-en-Y reconstruction may currently be favored. Jejunoplicatio as an antirefluxive component of reconstruction is optional. Its value may well lie in the securement of a critical esophagojejunal anastomosis.

[Involvement of the peripheral nervous system in Crohn disease]

In medical literature peripheral neurological disorders are associated with Crohn's disease only in particular cases. We report on two patients who suffering from Crohn's disease developed an acute Guillain-Barré syndrome or a polyneuropathy associated with myositis. Two weeks after a 65-year old female patient developed a serious Guillain-Barré syndrome, a haemorrhagical Crohn's colitis was diagnosed. Within a few weeks the specific therapy led to a satisfying recovery. A 45-year old female had suffered from Crohn's disease since 12 years. Within 8 weeks she developed a serious sensorimotor mixed axonal and demyelinating neuropathy and a granulomatous myositis. After treatment with steroids her signs constantly decreased. These observations as well as a literature review show that polyneuropathy and Guillain-Barré syndrome can be associated with chronic inflammatory bowel diseases. Our results suggest that peripheral neurological signs could be regarded as a possible extraintestinal manifestation of inflammatory bowel disease.

[Non-cardiac chest pain]

Non-cardiac chest pain is caused in 50% by esophageal disorders. About 30% of such esophageal chest pain is induced by gastroesophageal reflux. 2/3 of esophageal chest pain is related to various esophageal motility disorders, which can be differentiated by manometry. Diagnostic procedures for esophageal dysfunction (endoscopy, radiology, long-term pH-metry) have been evaluated. Therapy of gastroesophageal reflux disease has been proven effective; maintenance therapy should be evaluated in further controlled randomized trials. Treatment of esophageal motility disorders, unsatisfactory so far, needs to be improved and standardized.

[Septic portal vein thrombosis. Its successful therapy by local fibrinolysis and a transjugular portasystemic stent-shunt (TIPS)]

HISTORY AND FINDINGS

A 68-year-old man, without any preceding hepatic or abdominal disease, suddenly developed a severe septic illness with consumptive coagulopathy and upper abdominal pain. B-mode and duplex ultrasonography revealed fresh portal vein thrombosis. Despite extensive conservative measures there was no significant improvement after one week and further thrombus extension with threatened acute mesenteric vein occlusion.

TREATMENT AND COURSE

Local fibrinolysis with recombinant plasminogen activator and urokinase via percutaneous transjugular intrahepatic catheterization of the portal vein achieved almost complete dissolution of the thrombus within 3 days. Subsequently the portal vein catheter was changed into a transjugular portosystemic stent shunt (TIPS).

CONCLUSIONS

While local or systemic fibrinolysis has been practised in previously reported cases of acute portal vein thrombosis, the described use of TIPS introduces a new element. The shunt between hepatic and portal veins assures therapeutic access to the portal venous bed. It lowers portal vein pressure and can diminish the danger of recurrent thrombosis by raising portal flow. This minimally invasive procedure may be a nearly ideal treatment even in the course of portal vein thrombosis which has a high complication rate.

[Chronic granulomatosis: a rare differential diagnosis in liver granulomas in adulthood]

A now 43-year-old man was known since childhood to have mesenteric and subcutaneous lymphadenopathy. Histological examination of liver biopsies and excision of some lymph nodes when an adult showed epithelioid granulomas, in places with Langhans giant cells. Diagnostic splenectomy revealed no pathological findings. His present admission to hospital was for an infection with high fever. On auscultation moist rales were audible over the apex of the left lung. The chest radiography showed pneumonic infiltration. Blood culture grew Pseudomonas aeruginosa. Ultrasound demonstrated hypoechogenic homogeneous and smoothly circumscribed round foci in the liver hilus and around the coeliac trunk. The upper lobe pneumonia healed under antibiotic treatment. As chronic granulomatosis was suspected, the nitroblue tetrazolium and superoxide production tests were performed. They demonstrated that the capacity of the granulocytes to form oxygen radicals was markedly diminished. Chronic granulomatosis is an inherited disorder of granulocyte function linked to the X-chromosome. It must be included in the differential diagnosis of any unclear granulomatous disease even in adults.

[Incidence of ultrasound detectable liver hematomas after ultrasound controlled fine needle puncture with the 0.95 mm cutting biopsy cannula in comparison with percutaneous liver biopsy with the 1.4 mm Menghini needle]

BACKGROUND

Recently, a high incidence of ultrasound-detected hepatic hematomas due to percutaneous liver biopsy has been reported. Until yet, little is known about the incidence of asymptomatic hepatic hematomas following sonographically guided fine-needle biopsy.

PATIENTS AND METHODS

For that reason, we carried out a prospective study with sonographic examinations before and after liver biopsy in 160 patients. 51 patients, aged 50 to 83, median 67 years, with focal liver lesions had ultrasound-guided liver biopsy using the 0.95 mm-cut biopsy-needle, in 109 patients (17 to 80, median 49 years) with diffuse liver disease percutaneous liver biopsy with the 1.4 mm-needle of Menghini was performed.

RESULT

After fine-needle biopsy none of the 51 patients with focal liver lesions displayed liver hematoma on ultrasonography. In the group of patients who underwent percutaneous Menghini biopsy a liver hematoma, sized up to 12 x 5 cm in diameter, occurred four times (3.7%).

CONCLUSION

The results of this study indicate that fine-needle biopsy of the liver is a particularly safe diagnostic procedure, when compared with percutaneous Menghini biopsy.

Prospective study of the incidence of ultrasound-detected hepatic hematomas due to percutaneous Menghini needle liver biopsy and laparoscopy-guided Silverman needle biopsy

Recently, a high incidence of sonographically detected hepatic hematomas following percutaneous liver biopsy and laparoscopy-guided liver biopsy has been reported. For this reason a prospective study in 178 patients was performed. The patients were examined by ultrasound before and 24 hours after percutaneous liver biopsy using the 1.4 mm-Menghini needle (n = 107) and by laparoscopically-guided biopsy with the 2.5 mm-Silverman needle (n = 71). Four of the 107 patients (4%) who underwent percutaneous Menghini biopsy displayed hepatic hematoma on ultrasonography, and in 2 of these cases the hematoma was > 6 cm in diameter and persisted for more than seven months. In the group of patients who underwent laparoscopy-guided Silverman biopsy (n = 71) a liver hematoma occurred twice (3%). Both hematomas were small and disappeared within several days. There was no need for special therapeutic interventions due to complications. In contrast to recent data about Tru-cut and JAM-Shidi biopsy, the results of this study indicate that percutaneous Menghini biopsy and laparoscopy-guided Silverman biopsy are relatively safe diagnostic procedures.

[Prospective study of the incidence of ultrasound detectable liver hematomas after laparoscopically controlled liver puncture with the Silverman needle]

BACKGROUND

A high incidence of hepatic haematomas detected at sonography following percutaneous liver biopsy and laparoscopy-guided liver biopsy has recently been reported.

PATIENTS AND METHODS

Prompted by this report, we carried out a prospective study on 71 patients aged between 20 and 79 years (median age: 51 years). The patients were examined by ultrasound prior to and following laparoscopy-guided biopsy with the Silverman needle.

RESULTS

Only two of the 71 patients (3%) had a hepatic haematoma after biopsy. The haemangiomas had a maximum diameter of 2.6 cm, caused no pain, and disappeared again within ten days at the latest. No therapeutic measures were required.

CONCLUSION

The results of this study indicate that laparoscopy-guided liver biopsy with the Silverman needle is associated with relatively few complications.

Diagnosis of chronic pancreatitis by means of a sonographic secretin test

The pancreatic duct can be demonstrated today by sonography in about 90% of all persons examined. In 159 persons, aged 18-79 yr, we measured sonographically the pancreatic duct diameter before and after intravenous secretin injection. After secretin stimulation, 20 healthy controls and 90 patients without pancreatic disease showed a distinct pancreatic duct dilatation of 93 and 94% of basal duct diameter lasting only several minutes. No distinct secretin-induced duct enlargement was observed in 35 of 40 patients with chronic pancreatitis. Patients with chronic pancreatitis and circumscript duct stenosis even had a marked and longer-lasting duct dilatation of 156% of basal duct diameter after secretin stimulation. This study showed a high reliability of the sonographic secretin test in the diagnosis of chronic pancreatitis--even in an early stage--recording a sensitivity of 92.5%, a specificity of 93%, and a predictive value of 84%.

[Prognostic value of long-term pH-metry in the B-II resected stomach]

In a prospective study we investigated the clinical value of ambulatory 24-hour pH monitoring in the stomach after Billroth-II-resection. Recorded data of 10 patients with and 11 patients without ulcer recurrence after gastric resection were compared. The pH medians of the record periods "total time", "supine", "upright", "fasting" and "postprandial" were evaluated. Further the cumulative recording time of pH levels pH < 1, pH < 2, etc. was determined and compared in both groups. A pH median less than 2.8 "supine" indicated a postoperative ulcer recurrence with a sensitivity of 90% and specificity of 81%. A pH median less than 2.6 "fasting" predicted an ulcer relapse with a sensitivity of 90% and specificity of 72% (p < 0.001). In patients with ulcer recurrence pH was < 4 in more than 30% of total recording rime, pH < 5 in more than 45% and pH < 6 in more than 75% (sensitivity 90%, specificity 100%). According to these findings 24-hour pH monitoring seems to be useful for the prognostic assessment of the further course of ulcer disease after B II-surgery of the stomach. Thus pH monitoring results may be helpful in defining patient groups which may be candidates for acid reducing therapy to prevent ulcer recurrence.