Lipödem heute: Zwischen konservativer Therapie, Liposuktion und Adipositaschirurgie

Die zunehmende Prävalenz des Lipödems geht einher mit einer demografischen Zunahme der Adipositas per magna.

Konservative und operative Maßnahmen ermöglichen eine ausgeprägte Befund- und Beschwerdebesserung.

Die exakte Diagnose und Differenzierung zwischen therapiebedürftiger Adipositas und therapiebedürftigem Lipödem entscheiden über Erfolg und Misserfolg der eingeleiteten Therapie.

Nach konservativem Therapieversuch kann die operative Versorgung bei Ausbleiben einer entsprechenden Besserung durch Liposuktion oder adipositaschirurgische Intervention bei einem erheblichen Teil der Betroffenen die konservative Therapie reduzieren bzw. teilweise sogar ganz überflüssig machen.

[Minimally invasive robot-assisted gastric bypass after open Mason reduction gastroplasty]

BACKGROUND

The introduction of robot-assisted surgery in the treatment of morbidly obese patients has enlarged the armamentarium for surgeons involved in bariatric surgery. This article describes the experiences with a conversion surgery from a complicated open Mason gastroplasty to a Roux en Y gastric bypass using the da Vinci Xi robotic system.

CASE

A 29-year-old female patient underwent a Mason reduction gastroplasty by laparotomy in 1995 (body mass index BMI 53.2 kg/m²). The course was complicated with a revision due to abscess formation and subsequent secondary healing. In 1996 an open revision of the gastroplasty due to persisting gastroesophageal reflux disease and outlet stenosis with dilatation of the outlet and an open cholecystectomy for cholecystolithiasis were performed . Abdominoplasty was performed for skin flaps in 2001 after the patient had lost 68 kg in weight. The patient presented at our hospital because of insufficient weight reduction even with weight gain since 2001 and treatment-refractive gastroesophageal reflux with adhesion problems. Clinical examination revealed normal scar tissue formation with no indications for an incisional hernia. The BMI was 48.2 kg/m² with a body weight of 124 kg. The surgery was performed using a da Vinci Xi robotic system after access via a blunt dissection with the introduction of two trocars and adhesiolysis. The gastric pouch was created using Echelon 60 mm cartridges via an additional trocar. The gastroenterostomy was constructed with a 150 cm alimentary loop and a 60 cm biliodigestive loop resulting in a Roux en Y bypass. The operating time was 224 min.

RESULTS

The postoperative course was uneventful. Enteral nutrition was resumed on day 2 and the patient was discharged from the hospital 4 days postoperation.

CONCLUSION

This preliminary experience suggests that robotic revisional surgery can be performed safely even after complicated bariatric operations.

Social differences in illness and health-related exclusion from the labour market in Denmark from 1987 to 1994

Objective: The objectives were first to analyse differences in long-standing illness, limiting long-standing illness, and perceived health as below good in relation to different indicators of social class over time; and secondly to analyse the association of long-standing illness, educational level, age, and gender with employment status.

Subjects and methods : Self-reported information on illness, educational level, employment status, and occupational class was obtained in two nationally representative Danish health interview surveys in 1987 (n= 4753) and 1994 (n= 4668).

Results: There was a marked increase in long-standing illness from 1987 (33%) to 1994 (38%), especially among women with higher education (13% in 1987 to 26% in 1994). The prevalence of perceived health below good was unchanged (c. 20%) during the same period. Among employed men in 1987 the lowest prevalence of long-standing illness was seen in upper salaried employees (21%) and the highest in skilled workers (35%). In 1994, the difference had diminished and the prevalence rates for the same classes were 28% and 29%, respectively. Among employed women, a similar pattern was seen. The lowest rate in 1987 was seen among self-employed with subordinates (15%) and the highest in self-employed without subordinates (28%). In 1994, the difference was reduced with prevalence rates of 23% and 32%, respectively. In addition, substantial differences in health status between groups with different educational backgrounds were found. The proportion of the population with long-standing illnesses was clearly higher in the group with low education compared with the group with high education. A similar social gradient was found for perceived health as below good. Those with the highest odds ratio of being a disability pensioner are women with long-standing illness, only basic education, and above 55 years of age.

Conclusion: In conclusion, the study showed that the prevalence of long-standing illness increased from the mid-1980s to the mid-1990s, whereas perceived health below good was unchanged. In 1994, there was a remarkable difference in health between employed and non-employed people, indicating a health-related exclusion from the labour market. This may explain why, in 1994, smaller occupational class differences were found in the prevalence of long-standing illness among employed people compared with the findings in 1987, whereas the health differences remained in the different educational groups. Women above 54 years of age with basic education only and long-standing illness have the highest odds ratio of permanent exclusion from the labour market.

Impact of varying outcomes and definitions of suicidality on the associations of antiepileptic drugs and suicidality: comparisons from UK Clinical Practice Research Datalink (CPRD) and Danish national registries (DNR)

PURPOSE

The purpose of this study is to quantify the impact of the different outcomes and definitions of suicidality on the association between antiepileptic drugs (AEDs) and suicidality.

METHODS

Retrospective cohort studies of selected AEDs (carbamazepine, gabapentin, lamotrigine, phenytoin, pregabalin, topiramate and valproate) using data from UK Clinical Practice Research Datalink (CPRD) alone and linked to UK Hospital Episode Statistics (HES) and UK Office of National Statistics (ONS), and from Danish national registries (DNR). Follow-up started at initiation of one of the study AEDs, divided into exposure periods, a maximum 90-day post-exposure period, and the reference period starting the day after the 90-day post-exposure period ended. Primary outcomes were completed suicide (SUI)/suicide attempt (SA) for CPRD and SUI/deliberate self-harm (DSH) for DNR. We applied adjusted Cox regression analyses and sensitivity analyses with varying outcome definitions.

RESULTS

We analyzed 84,524 AED users from CPRD-HES-ONS (1188 SUI/SA; 96 SUI) and 258,180 users from DNR (7561 SUI/DSH; 781 SUI). The adjusted hazard ratios (HRs) on SUI/SA ranged between 1.3 (95% confidence interval (CI): 0.84-2.00) for lamotrigine and 2.7 (1.24-5.81) for phenytoin in CPRD-HES-ONS, and between 0.9 (0.78-1.00) for valproate and 1.8 (1.10-3.07) for phenytoin on SUI/DSH in DNR. HRs for the primary outcomes varied consistently across exposure periods and data sources. HRs for SUI were in general lower, more stable and similar for periods of exposure and the 90-day post-exposure period.

CONCLUSION

Applying different outcomes and definitions of suicidality had an impact on the relative risks of suicidality associated with the investigated AEDs with results for SUI being most consistent and reliable.

Prevalence of antibiotic use: a comparison across various European health care data sources

Purpose

There is widespread concern about increases in antibiotic use, but comparative data from different European countries on rates of use are lacking. This study was designed to measure and understand the variation in antibiotic utilization across five European countries.

Methods

Seven European healthcare databases with access to primary care data from Denmark, Germany, the Netherlands, Spain and the UK were used to measure and compare the point and 1‐year‐period prevalence of antibiotic use between 2004 and 2009. Descriptive analyses were stratified by gender, age and type of antibiotic. Separate analyses were performed to measure the most common underlying indications leading to the prescription of an antibiotic.

Results

The average yearly period prevalence of antibiotic use varied from 15 (Netherlands) to 30 (Spain) users per 100 patients. A higher prevalence of antibiotic use by female patients, the very young (0–9 years) and old (80+ years), was observed in all databases. The lowest point prevalence was recorded in June and September and ranged from 0.51 (Netherlands) to 1.47 (UK) per 100 patients per day. Twelve percent (Netherlands) to forty‐nine (Spain) percent of all users were diagnosed with a respiratory tract infection, and the most common type of antibiotic prescribed were penicillin.

Conclusion

Using identical methodology in seven EU databases to assess antibiotic use allowed us to compare drug usage patterns across Europe. Our results contribute quantitatively to the true understanding of similarities and differences in the use of antibiotic agents in different EU countries. © 2015 The Authors. Pharmacoepidemiology and Drug Safety Published by John Wiley & Sons, Ltd.

Bridging differences in outcomes of pharmacoepidemiological studies: design and first results of the PROTECT project

Background:

Observational pharmacoepidemiological (PE) studies on drug safety have produced discrepant results that may be due to differences in design, conduct and analysis.

Purpose:

The pharmacoepidemiology work-package (WP2) of the Pharmacoepidemiological Research on Outcomes of Therapeutics by a European ConsorTium (PROTECT) project aims at developing, testing and disseminating methodological standards for design, conduct and analysis of pharmacoepidemiological studies applicable to different safety issues using different databases across European countries. This article describes the selection of the safety issues and the description of the databases to be systematically studied.

Methods:

Based on two consensus meetings and a literature search, we selected five drug-adverse event (AE) pairs to be evaluated in different databases. This selection was done according to pre-defined criteria such as regulatory and public health impact, and the potential to investigate a broad range of methodological issues.

Results:

The selected drug-AE pairs are: 1) inhaled long-acting beta-2 agonists and acute myocardial infarction; 2) antimicrobials and acute liver injury; 3) antidepressants and/or benzodiazepines and hip fracture; 4) anticonvulsants and suicide/suicide attempts; and 5) calcium channel blockers and malignancies. Six European databases, that will be used to evaluate the drug-AE pairs retrospectively, are also described.

Conclusion:

The selected drug-AE pairs will be evaluated in PE studies using common protocols. Based on consistencies and discrepancies of these studies, a framework for guiding methodological choices will be developed. This will increase the usefulness and reliability of PE studies for benefit-risk assessment and decision-making.

Different initiatives across Europe to enhance losartan utilization post generics: impact and implications

Introduction: There is an urgent need for health authorities across Europe to fully realize potential savings from increased use of generics to sustain their healthcare systems. A variety of strategies were used across Europe following the availability of generic losartan, the first angiotensin receptor blocker (ARB) to be approved and marketed, to enhance its prescribing vs. single-sourced drugs in the class. Demand-side strategies ranged from 100% co-payment for single-sourced ARBs in Denmark to no specific measures. We hypothesized this heterogeneity of approaches would provide opportunities to explore prescribing in a class following patent expiry.

Objective: Contrast the impact of the different approaches among European countries and regions to the availability of generic losartan to provide future guidance.

Methodology: Retrospective segmented regression analyses applying linear random coefficient models with country specific intercepts and slopes were used to assess the impact of the various initiatives across Europe following the availability of generic losartan. Utilization measured in defined daily doses (DDDs). Price reductions for generic losartan were also measured.

Results: Utilization of losartan was over 90% of all ARBs in Denmark by the study end. Multiple measures in Sweden and one English primary care group also appreciably enhanced losartan utilization. Losartan utilization actually fell in some countries with no specific demand-side measures. Considerable differences were seen in the prices of generic losartan.

Conclusion: Delisting single-sourced ARBs produced the greatest increase in losartan utilization. Overall, multiple demand-side measures are needed to change physician prescribing habits to fully realize savings from generics. There is no apparent “spill over” effect from one class to another to influence future prescribing patterns even if these are closely related.

Incidence rates and trends of hip/femur fractures in five European countries: comparison using e-healthcare records databases

Hip fractures represent a major public health challenge worldwide. Multinational studies using a common methodology are scarce. We aimed to estimate the incidence rates (IRs) and trends of hip/femur fractures over the period 2003-2009 in five European countries. The study was performed using seven electronic health-care records databases (DBs) from Denmark, The Netherlands, Germany, Spain, and the United Kingdom, based on the same protocol. Yearly IRs of hip/femur fractures were calculated for the general population and for those aged ≥50 years. Trends over time were evaluated using linear regression analysis for both crude and standardized IRs. Sex- and age-standardized IRs for the UK, Netherlands, and Spanish DBs varied from 9 to 11 per 10,000 person-years for the general population and from 22 to 26 for those ≥50 years old; the German DB showed slightly higher IRs (about 13 and 30, respectively), whereas the Danish DB yielded IRs twofold higher (19 and 52, respectively). IRs increased exponentially with age in both sexes. The ratio of females to males was ≥2 for patients aged ≥70-79 years in most DBs. Statistically significant trends over time were only shown for the UK DB (CPRD) (+0.7% per year, P < 0.01) and the Danish DB (-1.4% per year, P < 0.01). IRs of hip/femur fractures varied greatly across European countries. With the exception of Denmark, no decreasing trend was observed over the study period.

Impact of delisting ARBs, apart from losartan, on ARB utilisation patterns in Denmark: implications for other countries

INTRODUCTION

Renin-angiotensin inhibitor drugs have been a target for health authority initiatives across Europe with the potential for substantial savings once generic angiotensin-converting enzyme inhibitors (ACEIs) became available without compromising care. Recently, losartan was the first angiotensin receptor blocker (ARB) to lose its patent. In Denmark, the authorities removed all other ARBs from the reimbursement list, apart from losartan, as they were all seen as essentially similar for the management of hypertension or congestive heart failure at appropriate doses, but more expensive. Similarly, all other ARB fixed-dose combinations (FDCs), apart from losartan, were removed from the reimbursement list.

OBJECTIVE

The aims of the study were to (i) assess the impact of these reimbursement changes on the subsequent utilisation of losartan and other ARBs alone or as FDCs; (ii) assess changes in the prices of losartan and other ARBs post-generic losartan to calculate potential savings; and (iii) compare the impact of the policies in Denmark with other European countries to provide guidance.

METHODOLOGY

This was a retrospective segmented regression analysis of an interrupted time-series design comparing utilisation patterns before and after the changes in ARB reimbursement status. Utilisation was measured in defined daily doses (DDDs). Changes in total expenditure and expenditure/DDD were also assessed over time.

RESULTS

Losartan utilisation grew from 31 to 33 % of total single ARB utilisation before generic losartan, to 93 % by October 2011. There was a corresponding decrease in the utilisation of all other ARBs. Both changes were significant (p < 0.001). Total expenditure on single ARBs in 2011 was 77 % below 2009 levels despite a 16 % increase in utilisation. Estimated savings were 290.5 million Danish Kroner (DKK). A similar trend was seen for losartan FDCs, which was also significant (p < 0.001).

DISCUSSION

Losartan utilisation grew appreciable following the changes. The change was much greater than seen in countries that had eased prescribing restrictions for losartan but not the other ARBs. Active therapeutic switching programmes plus education and financial incentives also significantly enhanced losartan utilisation following generics in two countries and regions; however, the increase in losartan utilisation was less than that seen in Denmark.

[Impact of transtympanic miniature endoscopy of the middle ear--a conceptual cadaver study]

OBJECTIVE

Endoscopic inspections of the middle ear have already been described. So far, the low optical quality due to the small diameter is limiting this type of procedure. In this study the use of a miniature endoscope for visualization of the middle ear structures has been evaluated.

MATERIAL AND METHODS

8 human cadaveric head specimens have been inspected. Following myringotomy, 2 miniature endoscopes were placed into the middle ear and the promontory, the incudostapedial joint, the round und oval window niche with stapes footplate were visualized and fotodocumentated. After endaural approach all middle ear structures were visualized microscopically and the quality of pictures was compared. Technical picture quality and anatomical visualization were evaluated by 5 ear surgeons. In addition, 2 interventional procedures were performed (control of ossicular chain mobility and intratympanic substance application).

RESULTS

Still, the technical picture quality was significantly better for the microscope. The anatomical visualization of the middle ear structures with the miniature endoscope was not inferior compared to the microscope. The feasibility of additional interventions, e.g. control of ossicular chain mobility or intratympanic substance application could be shown. An inspection of the correct prosthesis position after tympanoplasty could be evaluated, too.

CONCLUSION

This study showed that middle ear structures can be visualized by trans-tympanic miniature endoscopy equal or even better compared to conventional microscopy in spite of reduced technical quality.

Axillary sentinel node identification in breast cancer patients: degree of radioactivity present at biopsy is critical

BACKGROUND

The radioactivity present in the patient (Act(rem) ) at sentinel node (SN) biopsy will depend on injected activity amount as well as on the time interval from tracer injection to biopsy, which both show great variations in the literature. The purpose of this study was to analyse the influence of varying Act(rem) levels on the outcome of axillary SN biopsy in patients with breast cancer (BC).

MATERIAL AND METHODS

Eight hundred and fifty-eight patients with BC were consecutively referred to SN biopsy, 21% for a same-day and 79% of the patients for a 2-day procedure. Four hundred and nineteen patients underwent scintigraphy and 439 did not. For same-day procedures, 50 MBq (99m) Tc-nanocolloid (Nanocoll(®) ) was injected, and for 2-day procedures 110 MBq. For the analysis of SN biopsy outcome, the patients were divided into three Act(rem) groups: <10 (56% of the patients), 10-20 (23%), and >20 MBq (21%). During surgery, SNs were located using a hand-held gamma probe supported by image information when available and blue dye injection. Pathology included haematoxylin-eosin staining followed by immunohistochemistry.

RESULTS

The number of SNs removed (mean value 1·87 versus 2·14, P = 0·0003) and the probability of finding a malignant SN (P = 0·034) were lower in the <10 MBq group of patients compared with higher Act(rem) >20 MBq. Of the 25 patients with SN non-detection, 20 patients had an Act(rem) <10 MBq. Imaging had no significant influence on the number of patients with a malignant SN (P = 0·48).

CONCLUSION

Act(rem) above 10 MBq for nanocolloid tracer appears important for appropriate identification of SNs in patients with BC.

[Laparoscopic recovery continuity after the Hartmann procedure]

In the period from January 2003 to June 2009 923 complex laparoscopic colorectal procedures were performed by one surgeon. Data was as­sessed prospectively in a database including 152 variables. In 15 patients (10 f, 5 m), with a median age of 61 years (range: 35-83 years), discontinuity resection of the colon was performed including 3 patients with open discontinuity resection of the sigma and 12 patients with laparoscopic Hartmann procedures. In all cases continuity of the ­colon was recovered laparoscopically. Median op­er­ation time was 100 min, conversion to an open procedure was not necessary. No intra-operative complications occurred and only one wound infection (6.6 %) was recorded postoperatively with a median postoperative stay of 8 days. Although the laparoscopic approach to recover continuity of the colon is technically challenging, we con­clude that the experienced bowel surgeon is able to perform the laparoscopic approach with a low morbidity and mortality by retaining the well known advantages of laparoscopic colonic sur­gery.

YKL-40 and mast cells are associated with detrusor fibrosis in patients diagnosed with bladder pain syndrome/interstitial cystitis according to the 2008 criteria of the European Society for the Study of Interstitial Cystitis

AIMS

Bladder pain syndrome/interstitial cystitis (BPS/IC), diagnosed according to the new 2008 criteria of the European Society for the Study of Interstitial Cystitis (ESSIC), may lead to detrusor fibrosis. In some inflammatory diseases, fibrosis is related to YKL-40. The aims were to examine YKL-40 antigenic expression in bladder tissue and levels in serum and urine in BPS/IC and to evaluate whether YKL-40 could be a non-invasive, prognostic biomarker for bladder fibrogenesis and treatment intensity.

METHODS AND RESULTS

Immunohistochemistry, immunoelectron microscopy and enzyme-linked immunosorbent assay (ELISA) analyses in 45 patients showed YKL-40 expression in detrusor mast cell granules and submucosal macrophages, and elevated YKL-40 levels in serum and urine compared to healthy individuals (median 72 versus 7 μg/l, P < 0.001). Clinicopathological parameters showed associations of detrusor fibrosis with YKL-40-positive cells (P = 0.001), mast cells (P = 0.014) and urine YKL-40 (P = 0.009). Bladder capacity correlated inversely with YKL-40-positive cells (P < 0.001) and mast cells (P = 0.029). Treatment intensity was not associated with YKL-40.

CONCLUSION

Serum and urine levels of YKL-40 may be used as non-invasive biomarkers in BPS/IC for the evaluation of bladder fibrogenesis.

Osteoporosis among Fallers without Concomitant Fracture Identified in an Emergency Department: Frequencies and Risk Factors

We aimed to determine whether the Emergency Department (ED) is a suitable entrance point for osteoporosis screening among fallers without concomitant fracture compared to referral from general practice. Furthermore, to identify factors associated with osteoporosis among fallers. Methods. Patients aged 50-80 years sustaining a low-energy fall without fracture were identified from an ED (n = 199). Patients answered a questionnaire on risk factors and underwent osteodensitometry. Data was compared to a group of patients routinely referred to osteodensitometry from general practice (n = 201). Results. Among the 199 included fallers, 41 (21%) had osteoporosis. Among these, 35 (85%) reported either previous fracture or reduced body height (>3 cm). These two risk factors were more frequent among fallers with osteoporosis compared to fallers with normal bone mineral density or osteopenia (previous fracture P = .044, height reduction P = .0016). The osteoporosis frequency among fallers from ED did not differ from a similarly aged patient-group referred from general practice (P = .34). Conclusion. Osteodensitometry should be considered among fallers without fracture presenting in the ED, especially if the patient has a prior fracture or declined body height. Since fallers generally have higher fracture risk, the ED might serve as an additional entrance to osteodensitometry compared to referral from primary care.

Increased urinary orosomucoid excretion predicts preeclampsia in pregnant women with pregestational type 1 diabetes

AIMS

We evaluated the urinary orosomucoid excretion (UOE) as a biomarker of preeclampsia and preterm delivery in pregnant women with type 1 diabetes.

METHODS

Singleton pregnant women with pregestational type 1 diabetes were included provided one urine sample had been collected before 17 gestational weeks. Serum and urinary orosomucoid were analysed by immunoturbidimetry. Primary outcome measurements were development of preeclampsia (blood pressure>140/90mmHg and proteinuria) and preterm delivery before 37 weeks.

RESULTS

In total 173 women were included. The UOE increased during pregnancy. Preeclampsia developed in 20 women and 65 women delivered preterm. Using logistic regression analysis we found that UOE>1.37mg/l (OR: 6.85 (95% CI: 1.97-23.88; p<0.003)), nulliparity (3.88 (1.10-13.72); p<0.04), systolic blood pressure>120mmHg (4.12 (1.35-12.59); p<0.02) and duration of diabetes>20 years (3.69 (1.18-11.52); p<0.03) independently predicted the development of preeclampsia. Independent predictors of preterm delivery were duration of diabetes and HbA1c>7%. The remaining covariates included in the regression models were BMI, serum creatinine, smoking and microalbuminuria.

CONCLUSIONS

Increased UOE early in pregnancy predicted preeclampsia in women with pregestational type 1 diabetes independently of albuminuria and other known risk factors. No association to preterm delivery was found.

The study design and characteristics of the Danish national health interview surveys

AIMS

The Danish National Institute of Public Health, University of Southern Denmark has carried out national representative health interview surveys among adult Danes in 1987, 1994, 2000 and 2005. The aim of this study is to describe the characteristics of the design, including the response rates of the four surveys.

METHODS

The samples in 1987 and 1994 are based on simple random sampling. The samples in 2000 and 2005 are based on stratified random sampling. In addition, all invited to the survey in 1994 were re-invited in both 2000 and 2005. Data were collected via face-to-face interview at the respondent's home. Following the interview in 1994, 2000 and 2005, all respondents were asked to complete a self-administered questionnaire.

RESULTS

The response rate for the face-to-face interview fell from 79.9% in 1987 to 66.7% in 2005 and the response rate for the self-administered questionnaire from 68.1% in 1994 to 51.5% in 2005. The decrease is particularly marked among the young. The mean interview length has increased from 33.3 minutes in 1987 to 50.2 minutes in 2005.

CONCLUSIONS

The declining response rate in the surveys is a major concern and can pose problems in generalizing data from the surveys to the Danish population. However, these surveys are essential, as the information collected cannot be gathered by means of official statistical registers. Hence, efforts to increase the response rate will be important in the forthcoming surveys.

Ultrasound scissors: new single-use instruments vs. resterilised single-use instruments - a prospective randomised study

BACKGROUND

The aim of this study was to compare reliability in handling and function of resterilised and single-use disposable ultrasonic scissors.

METHODS

In a prospective randomized study, the surgeon blindly tested new and resterilised ultrasonic scissors. The parameters were force of activation, cutting effect, coagulation effect, error messages and disturbing generator noise.

RESULTS

51 new and 49 resterilised instruments in 94 operations were evaluated. The differences in force of activation, cutting effect and coagulation were not significant. Error messages and disturbing noises were rare in both groups. 6 new instruments and 2 resterilised instruments had to be exchanged because of problems during surgery.

CONCLUSION

This study demonstrates comparable reliability in function and handling of resterilised and new ultrasonic scissors. The use of resterilised instruments leads to distinctly reduced costs and could contribute to efficiency in laparoscopic surgery.

Neurotrophin-3, but not nerve growth factor, promotes survival of human intestinal mast cells

Neurotrophins are potent regulators of neuronal cell survival and function. Nerve growth factor (NGF) was shown to reduce apoptosis in cord blood-derived mast cells. Here, we examined the effect of the neurotrophins NGF and neurotrophin (NT)-3 on survival and mediator release of human intestinal mast cells. Mast cells isolated from normal intestinal tissue were cultured in the presence of NGF, NT-3, or stem cell factor (SCF) alone or in the presence of SCF together with each neurotrophin. NGF or NT-3 alone did not promote mast cell survival. In contrast, mast cell recovery was increased twofold when mast cells were cultured with NT-3 in addition to SCF for 14 days compared with control. Mast cell recovery was further increased following a combined addition of NT-3, SCF and IL-4. NT-3 mediated mast cell growth was dependent on the primary receptor for NT-3 TrkC. NGF in combination with SCF or with SCF and IL-4 showed no effect on mast cell survival. Histamine release and histamine content per mast cell remained unchanged, whereas leukotriene C4 release decreased if mast cells were cultured with NGF or NT-3 in addition to SCF. In summary, NT-3 affects mature human mast cells by promoting mast cell survival, whereas NGF does not.

[The laparoscopic pancreas resection]

Laparoscopic surgery of the pancreas has been used for diagnostic but also for therapeutic purposes in increasing number. Case reports and multicenter studies summarizing the European and world wide experience have been published recently. The results show that laparoscopic surgery can be used for tumor staging of pancreatic cancer but also for the treatment of acute necrotizing pancreatitis and treatment of chronic pancreatitis, benign cystic lesions and solid tumors. In particular left sided pancreatic resection (90 % of the cases) is the preferred approach delivering good results. Recent studies show that the conversion rate is 14 % and mortality can be as low as 0 %. The reoperation rate is 6.3 % and the fistula formation is 17 % which is comparable to the results of open pancreatic surgery. The postoperative hospital stay seems to be limited to a mean of 7 days as compared to pancreatic surgery in the open abdomen. The laparoscopic Whipple resection with less than 3 % of the cases in the literature remains the exception.