Evaluation of the Introduction of a Colorectal Bundle in Left Sided Colorectal Resections (EvaCol): Study Protocol of a Multicentre, Observational Trial

Purpose:

Overall complication and leak rates in colorectal surgery showed only minor improvements over the last years and remain still high. While the introduction of the WHO Safer Surgery Checklist has shown a reduction of overall operative mortality and morbidity in general surgery, only minor attempts have been made to improve outcomes by standardizing perioperative processes in colorectal surgery. Nevertheless, a number of singular interventions have been found reducing postoperative complications in colorectal surgery. The aim of the present study is to combine nine of these measures to a catalogue called colorectal bundle (CB). This will help to standardize pre-, intra-, and post-operative processes and therefore eventually reduce complication rates after colorectal surgery.

Methods:

The study will be performed among nine contributing hospitals in the extended north-western part of Switzerland. In the 6-month lasting control period the patients will be treated according to the local standard of each contributing hospital. After a short implementation phase all patients will be treated according to the CB for another 6 months. Afterwards complication rates before and after the implementation of the CB will be compared.

Discussion:

The overall complication rate in colorectal surgery is still high. The fact that only little progress has been made in recent years underlines the relevance of the current project. It has been shown for other areas of surgery that standardization is an effective measure of reducing postoperative complication rates. We hypothesize that the combination of effective, individual components into the CB can reduce the complication rate.

Trial registration:

Registered in ClinicalTrials.gov on 11/03/2020; NCT04550156.

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Evidence of having control over loss-of-coolant accidents with release of insulation material under consideration of actions taken in German BWR

The following contribution describes the main features of the demonstration of the control of loss of coolant accidents with release of insulation material under consideration of actions taken in German BWR. The general criteria for the assessment as well as comparable individual aspects are adopted from the RSK statement (374th meeting) for PWR from July 2004. After the Barsebäck event in 1992 administrative regulations were implemented for securing the plant cleanliness as well as modifications to strainers of the ECCS and the containment (e.g. the introduction of perforated plates in the control rod chamber). This contribution illustrates that sufficient examinations and tests have been performed for German BWR for a final positive evaluation that the amount of fibers which enter the core remain below the amount at which core cooling is no longer guaranteed. Currently, for one BWR an additional optimation of the ECCS systems (here the introduction of a so-called “sandwich” wire cloths in the ECCS strainers) has currently been applied for. Through this the core entry of insulation material – even for fibers with a covering small lengths spectrum – can be further reduced and currently existing safety margins further increased.

Differential release of beta-chemokines in serum and CSF of patients with relapsing-remitting multiple sclerosis

OBJECTIVE

beta-chemokines were recently demonstrated in active MS-lesions. We tested whether MCP-1 and RANTES can also be detected in CSF and serum of patients with MS and whether release is associated with inflammatory disease activity.

MATERIALS AND METHODS

CSF and serum from 34 patients with newly diagnosed relapsing-remitting MS (RR-MS), 17 patients with viral meningitis (VM) and 19 patients with non-inflammatory neurological diseases (NIND) were investigated by ELISA. RR-MS patients underwent lumbar puncture and Gd-enhanced MRI examinations within 2 days.

RESULTS

MCP-1 was strong intrathecally released in all patients. Compared to NIND CSF-levels were increased in VM (P<0.001) and were decreased in RR-MS (P<0.05). RANTES was only detected in serum in all patients. Levels were higher in VM and RR-MS compared to NIND (P<0.05). A total of 14/34 RR-MS patients exhibited active Gd-enhancing lesions on MRI. They had lower MCP-1 levels in CSF (P<0.001) and serum (P<0.05) and higher serum levels of RANTES (P<0.05) as compared to patients without active lesions.

CONCLUSIONS

MCP-1 and RANTES are differentially released during acute attacks of RR-MS, which might reflect different immunregulatory roles of these beta-chemokines in RR-MS.

[A new aspect on the development of chronic middle ear diseases in patients with cleft palate]

BACKGROUND

The prevalence of chronic middle ear disease in patients after surgery for cleft palate is about 50%. Aim of the present study was to analyse its morphological and physiological causes to prevent chronic atelectatic otitis media or cholesteatoma.

METHODS

15 adult patients with cleft palate were examined using middle ear microscopy, pure tone audiometry, EMG of the tensor veli palatini muscle and MRI of the Eustachian tube.

RESULTS

8 of 15 patients had chronic middle ear disease. With 13 of 15 patients single motor unit action potentials could be recorded from the tensor veli palatini muscle. MRI of the Eustachian tube revealed two decisive observations in patients with chronic middle ear disease: in 4 patients the pterygoid hamulus could not be detected, in all otitis patients the continuity of tensor veli palatini muscle was interrupted or disturbed by medial or lateral fixation.

CONCLUSION

Chronic middle ear disease with cleft palate patients is basically caused by impaired muscular compliance of the Eustachian tube. Thus integrity of hamulus as well as tensor veli palatini muscle must become of crucial interest in cleft palate surgery.

[Comparison of ventilation-/perfusion scintigraphy with spiral CT in acute lung embolism]

AIM

Evaluation of the validity of spiral-CT compared with ventilation/perfusion (v/p) scintigraphy, the standard diagnostic tool in patients with suspected pulmonary embolism.

PATIENTS AND METHODS

Prospective study of 70 patients with symptoms of acute pulmonary embolism: examination with both methods within 4 hours.

RESULTS

In 46 patients pulmonary embolism could be unequivocally excluded by both methods. Patients with high-probability-Tc-scans predominantly had central emboli on CT. In cases with medium or low probability-Tc-scans thrombi were usually visible in segmental arteries. In one patient with a non-suspicious scintigram spiral-CT was able to detect emboli in multiple segmental arteries.

CONCLUSION

Spiral-CT is a fast, safe and almost always available method for detection of pulmonary embolism. In our hands it is superior to v/p-scintigraphy. It allows direct detection of a thrombus and has additional advantages in differential diagnosis (e. g. lung carcinoma, infectious infiltration). In patients with clinical suspicion of pulmonary embolism spiral-CT should be the primary diagnostic modality.

[Chronic transfusion hepatitis--an underestimated disease]

BACKGROUND

The 12th Deutsche Bundestag constituted a fact-finding committee to investigate infections transmitted by blood and blood products. 1,358 patients, infected with HIV, mostly suffering from hemophilia were registered. Transfusion-associated hepatitis was not recorded.

METHODS AND RESULTS

In a general hospital, a prospective study during 12 months revealed that chronic hepatitis C was associated in 43% with previous transfusion of blood whereas no case of HIV-infection, transmitted by blood or blood products was observed (p < 0.01). The frequency of blood transfusion in patients without chronic hepatitis and without AIDS was 18.5%, also significantly different from patients with chronic hepatitis C (p < 0.025).

CONCLUSION

Frequency and impact of chronic transfusion hepatitis C is underestimated.

Twenty-four-hour pineal melatonin synthesis in the vasopressin-deficient Brattleboro rat

The diurnal time course of pineal melatonin synthesis was analyzed simultaneously in the arginine vasopressin (AVP)-deficient Brattleboro rat (BB), the Long-Evans (LE) and Sprague-Dawley (SD) rat by means of radioenzymatic determination of the rate-limiting enzyme serotonin-N-acetyltransferase (NAT) and the melatonin content over a period of 24 h. While all 3 strains displayed a distinct day-night rhythm of melatonin synthesis (low day-time, high night-time values), BB rats generally exhibited lower NAT values as compared to LE and SD rats, though reaching a significant difference at 02.99 h only. Twenty-four-hour melatonin content was characterized by distinct nocturnal maxima in LE and SD rats, while BB rats showed a plateau-like nocturnal time course. Electrophysiological and pharmacological findings in SD rats point to an inhibitory influence of AVP upon pineal melatonin synthesis. The lack of AVP obviously does not result in disinhibition of pineal melatonin synthesis but rather in a different time course of pineal melatonin content. This might either be due to strain differences or to yet unknown compensatory mechanisms in BB rats.

Magnetic field effects on pineal N-acetyltransferase activity and melatonin content in the gerbil--role of pigmentation and sex

The ambient geomagnetic field influences a variety of biological phenomena. Electrical and biochemical parameters of the rodent pineal gland are influenced by the alteration of weak magnetic fields (MF), the magnetic receptor probably residing in the retina. However, open questions concern the role of retinal pigmentation as well as species- and sex-specific differences in MF perception. We therefore exposed male and female naturally pigmented and albino Mongolian gerbils, as well as Sprague-Dawley (SD) rats to a 60 degrees rotation of the horizontal component of the ambient MF. Alteration of nocturnal pineal melatonin content and N-acetyltransferase (NAT) activity were utilized as a parameter for assessing magneto-sensitivity. In pigmented gerbils, MF exposure resulted in no significant changes in pineal melatonin synthesis. In contrast, albino gerbils and SD rats exhibited--regardless of sex--significant decreases in pineal NAT activity and melatonin content following MF exposure. These results suggest that in rodents hypopigmentation appears to favor magnetoperception. The available evidence indicates that the pigmentation of the retina could play a crucial role.