Aspectos clínicos e laboratoriais da mastite induzida por inoculação intramamária de Staphylococcus aureus em vacas e búfalas

Vários aspectos relacionados à mastite bubalina precisam ser esclarecidos. Muitas condutas são adaptadas a essa espécie pelo conhecimento adquirido com a espécie bovina. Com este experimento, objetivou-se evidenciar particularidades da mastite em búfalas e vacas que tiveram uma glândula inoculada com 1,0 x 103 UFC de S. aureus. Os animais foram monitorados por cultura bacteriana do leite, California Mastitis Test(CMT), e escores para avaliação da severidade da mastite. Foram utilizados os seguintes critérios: temperatura retal, apetite, produção de leite (resposta sistêmica à inflamação), contagem de células somáticas (CCS), aparência/consistência da glândula e aparência da secreção láctea (resposta localizada à inflamação). Todos os animais desenvolveram mastite clínica superaguda. A bactéria foi recuperada de todas as glândulas desafiadas, sem diferença significativa no percentual de isolamento entre as espécies até o 11º dia pós-inoculação, porém com diferença (P<0,001) no 30º dia pós-inoculação. A CCS pelo método eletrônico e o CMT detectaram nas búfalas resposta mais intensa logo após a inoculação e diminuição mais rápida da contagem ao final do experimento, quando se comparou essa espécie com as vacas. Ambos os testes demonstraram correlação com a cultura bacteriana. Na avaliação da severidade da mastite, as médias do escore total, do escore da resposta local e do escore da resposta sistêmica foram mais elevadas na espécie bovina (P<0,05). Ao longo do período de observação, verificou-se uma capacidade superior das búfalas em recuperar o status sanitário adequado, chegando, ao final do experimento, com os parâmetros avaliados mais próximos dos fisiológicos.

Bestimmung der Tibiatorsion - Vergleich von klinischen Winkelmessungen zur Computertomographie

PURPOSE

To determine variability between clinical goniometric methods and computed tomography (CT) in measuring posttraumatic malrotation of the tibia.

MATERIALS AND METHODS

In a prospective study, absolute tibial torsion of both legs after unilateral fracture of the tibia as well as the difference between both legs (intra-individual torsional difference) was postoperatively determined with two goniometric and two CT methods in 40 patients (female : male = 16 : 24, mean age = 46 +/- 34 years).

RESULTS

The mean difference between goniometric and CT methods in determining intra-individual torsional difference was not significant. Nevertheless, variance of values was higher in goniometric measurement (up to +/- 11 degree), with the measurements of torsional difference showing two times greater standard deviation in interobserver variability of goniometric methods as compared to CT.

CONCLUSION

Goniometric methods do not significantly differ from the CT methods for determination of intraindividual torsional difference. The higher variance of interobserver values limits accuracy of goniometric methods. Therefore, goniometric determination of tibial torsion can only be considered an estimate but not a precise measurement.

[Manipulation of the step borer as cause of too shallow boring depth in the femoral neck with the gamma nail system]

The gamma nail step drill has been sold over 500,000 times worldwide. Depending on the construction used and the way it is handled, it can lead to a drill depth in the femoral head that is too shallow if the anatomic dimension of the femoral neck is rather long. Whenever the relationship between rotational speed and drive force is unfavorable, as it is by hand reaming, the triple-bladed drill only produces a triangular hole in the lateral cortical bone. Subsequently, it draws itself through this hole like a screw, without forming the hole into a complete circle. The drill shaft expands conically along its length preventing it from passing through the hole in the cortical bone at a depth of 90 mm. Until now, this phenomenon has been traced back to blunt drills or perhaps curved guide wires. Since the lag screws that have been used could not be screwed into undrilled cancellus bone, screws have sometimes been implanted at a sub-optimal length. The problem was noticed, however, and documented in experiments, and potential solutions were proposed.

[Quality of life assessment after surgery for diverticulitis - a follow-up study]

BACKGROUND

Laparoscopic sigmoid resection is a well established procedure for surgical treatment of benign colorectal diseases. The aim of the present study was to assess the longterm quality of life of patients who underwent laparoscopic sigmoid resection for sigmoid diverticulitis. Differences in health related life quality to the open-conventional approach were evaluated in a matched pair analysis (age, gender, Hinchey-Stage, Type of Surgery) using a validated quality of life instrument.

METHODS

A total of 45 matched pairs (laparoscopic/open) operated for diverticulitis at stage I-IIa (Hinchey classification) were included in this study. The quality of life was measured with the Short-Form-36-Health Survey (SF-36), a standardized questionnaire with 8 scales and 36 items. The follow-up period was at least 2 years (mean 62.2 months).

RESULTS

Pair members (n = 45) operated via laparoscopic or open approach for Hinchey I-IIa diverticulitis were of the same sex (21 female/24 male pairs) and age at time of surgery (range: lap.: 53.5-66 years; open: 53.5-67 years). Mean follow-up periods for patients operated laparoscopically and with open procedure were 2 (range: 1-3) and 7 (range: 5-9) years, respectively. The SF-36 scale scores for both groups appeared high and only slightly below a validated norm population. This represents a high quality of life after open as well as laparoscopic surgery for sigmadiverticulitis. No significant differences were apparent between the 45 matched-pairs. Pairs 65 years old or older presented no significantly different score values compared to those younger than 65 years.

CONCLUSIONS

The long-term follow-up data in this age and sex matched pair analysis showed favorable results after open as well as laparoscopic surgery for sigmadiverticulitis. No statistically significant differences were observed between the two surgical techniques. Self-reports by the patient concerning his or her health condition, recovery and quality of life following any surgical procedure are needed to assess valid outcome data of new surgical treatments including a critical evaluation of all its benefits and burdens.

[Blunt trocar with modified tip for open laparoscopy]

A blunt trocar for open laparoscopy is presented. Its modified design leads to better visual control of the trocar tip during insertion. Thus the risk of misplacement of the trocar is reduced.

[Spiral trocar--a new trocar concept]

INTRODUCTION

We would like to introduce a new trocar technique for minimal invasive surgery. The new trocar is a spiral whose coil becomes ever increasingly stronger towards the centre. Because of this, there is a smooth transition between spiral, screw and rod. The outer diameter remains the same. The spiral-trocar is screwed through the abdominal wall like a corkscrew. Because of this, the primary channel of puncture runs spirally. Furthermore, the channel is dilated and centralised so that the trocar's rod together with its sleeve can be pushed through the abdominal wall. This trocar design demonstrates the following advantages: The trocar can be screwed through the abdominal wall in a controlled manner without having to apply axial pressure. This prevents any unintentional perforation of organs. Because different layers of the tissue are penetrated at different places, they overlap, thus sealing one another after removal of the sleeve. The puncture channel was minimal, thus leaving very little risk of trocar site hernia.

METHODS

The spiral-trocar was examined and compared with other types of trocars in vivo and vitro.

RESULTS

During these tests, the spiral-trocar demonstrated a high level of safety and good usability.

DISCUSSION

The spiral-trocar is an easily cleanable, reusable product without a mechanical sealing device and can be used together with most sleeves. This makes it very cost effective.

Ordinary colorectal adenocarcinoma vs. primary colorectal signet-ring cell carcinoma: study matched for age, gender, grade, and stage

PURPOSE

This study contributes to the characterization of primary colorectal signet-ring cell cancer in contrast to ordinary colorectal carcinoma. Primary colorectal signet-ring cell cancer is a rare but distinctive primary neoplasm of the large bowel with still-controversial clinicopathologic features.

METHODS

Clinicopathologic features and survival data are evaluated in comparison with those of the ordinary colorectal adenocarcinoma (non-signet colorectal carcinoma) in a retrospective study matched for age, gender, grade, and stage.

RESULTS

In a series of 1,600 consecutive colorectal cancer patients since 1979, 14 patients (0.88 percent) with a signet-ring cell cancer were identified. Gender ratio was balanced, and mean age was 67.5 years. The majority of patients had an advanced tumor stage at the time of diagnosis (57.1 percent Stage IV and 35.7 percent Stage III). Median survival time was only 16 months. In a study matched for age, gender, grade, and stage, a lower survival rate was found for patients with signet-ring cell cancer, but the difference did not reach statistical significance. In contrast to non-signet colorectal carcinoma, signet-ring cell cancer was characterized by a significantly higher incidence of peritoneal tumor spread (64.3 percent) and a lower incidence of hepatic metastases (14.3 percent).

CONCLUSIONS

Signet-ring cell cancer represents a rare but distinctive primary neoplasm of the large bowel. It is frequently diagnosed in an advanced tumor stage, thus showing an overall poorer prognosis than nonsignet colorectal carcinoma. Usually only palliative surgery is possible. A high incidence of peritoneal seeding and a low incidence of hepatic metastasis is characteristic of signet-ring cell cancer.

Blood selenium and glutathione peroxidase status in patients with colorectal cancer

PURPOSE

It is still controversial whether a low selenium level and a reduced activity of the selenium-dependent enzyme, glutathione peroxidase, in blood are associated with an increased risk and poor prognosis of cancer in humans. This study evaluates whether colorectal cancer patients have lower serum selenium and glutathione peroxidase levels than a gender-matched and age-matched control group and whether there is a correlation to clinical data and prognosis.

METHODS

In a retrospective study, serum selenium and glutathione peroxidase activity of 106 patients with colorectal cancer were determined. Clinical data were provided by our long-term follow-up program for colorectal cancer patients.

RESULTS

Patients with a selenium level <70 microg/l had a significantly lower mean survival time and a lower cumulative cancer-related survival rate than patients with a selenium level >70 microg/l (P = 0.0009). When considering the different tumor stages, a decline of the mean selenium level in the T4 carcinoma group was found in the analysis of variance (P < 0.05). The lowest selenium level was found for patients with advanced tumor disease and in a preoperative situation, ie., high tumor burden. In comparison with the control group, the cancer group showed a significant reduction of serum glutathione peroxidase activity (P < 0.01) but no significant difference in selenium level.

CONCLUSIONS

These results support the hypothesis of an association between low selenium level and advanced tumor disease. From our data, it cannot be decided whether this phenomenon is more likely to be a consequence or a causative factor for development and course of the disease.

Laparoscopic implantation of Oreopoulos-Zellermann catheters for peritoneal dialysis

For the implantation of continuous ambulatory peritoneal dialysis (CAPD) catheters, both the laparoscopic technique and the use of an Oreopoulos-Zellermann catheter have been suggested to be preferable to the open technique using Tenckhoff catheters. Building on advantages of known techniques, we here describe a procedure for the laparoscopic implantation of the Oreopoulos-Zellermann catheter. The procedure is quick, efficient and unstressful to the patient. After nearly 10,000 patient-days of catheter use, we find positive results with regard to permanently good inlet and outlet flows, low incidence of exit site infections and leaks from the catheter tunnel.

[Laparoscopic implantation of Oreopoulos-Zellermann catheters for peritoneal dialysis]

For the insertion of CAPD-catheters the laparoscopic implantation technique and the use of Oreopoulos-Zellermann catheters have been shown to be advantageous if compared with the open technique using Tenckhoff catheters. The implantation procedure shown here makes it possible to place the Oreopoulos-Zellermann catheter laparoscopically, combining different advantages. The procedure is quick, efficient and not stressful for the patients. After 4700 days of catheter-use in the patients positive results are seen with regard to permanently good inlet and outlet flows, low incidences of catheter exit site infections and leakages of the catheter tunnel.

[Incisional hernias after laparoscopic interventions]

The importance of the complication incisional hernia after laparoscopic surgery was determined by analyzing our own cases and extensive review of the literature. The data recorded give its incidence as 1 in 550 cases. The most frequent event was intestinal incarceration with a high portion of Richter's hernias. To avoid postlaparoscopic hernias the important step is suturing the fascia when the trocar diameter exceeds 5 mm. When external suturing of the fascia is impossible, the laparoscopic technique using the Reverdin needle is a sufficient procedure for fascial closure after minimally invasive surgery.

Enlargement of GAD-immunopositive terminals in the lateral vestibular nucleus (LVN) of weaver mutant mice

Reorganization of cerebellar circuitry due to specific cell loss in Weaver mutants causes physiological and morphological alterations in the terminal domains of the GABAergic cerebellar corticovestibular projections. In this study sizes of anti-GAD immunopositive terminals in the dorsal part of the lateral vestibular nucleus (dLVN) of normal mice and Weaver mutants were quantified morphometrically. In anti-GAD-immunoreacted material terminal sizes in the dLVN of Weaver exceed significantly those of coprocessed wildtypes. This suggests that the cerebellar disturbances in Weaver predispose the normal synaptic remodelling observed in wildtypes towards the formation of enlarged terminals.

Emergence of insulin receptors on human lymphocytes during in vitro transformation

Essentially no specific binding sites for insulin are detected in small lymphocytes freshly isolated from human blood. Insulin-binding sites appear on the lymphocyte surface during transformation in vitro with concanavalin A, and the number of these receptors increases sharply to reach a maximum between 24 and 46 hr after exposure to the mitogen. The appearance of de novo binding sites for insulin coincides with the increase in [(3)H]thymidine uptake into nuclear DNA and clearly precedes the appearance of enlarged, morphologically transformed cells. No changes in insulin-binding are detected in unstimulated control cultures. A maximum of about 350 molecules of insulin can bind per transformed lymphocyte, while less than six insulin molecules bind to an untransformed cell. Circulating human leukemic lymphoblasts bind about as much insulin as the lymphocytes transformed in vitro. Giant, polynucleated, transformed lymphocytes cultured in the presence of cytochalasin B bind about 10 times more insulin than transformed lymphocytes, which is in harmony with a 10-fold increase in cell-surface area in these cells. Specific binding of insulin is a saturable process in transformed lymphocytes but not in the untransformed cells. In transformed cells, [(125)I]-insulin is displaced by as little as 2 ng/ml of native insulin, while in untransformed cells no significant displacement is observed with native insulin. Digestion of transformed cells with phospholipase C (EC 3.1.4.3.) enhances the specific binding of [(125)I]insulin 3-fold, but no effect occurs with untransformed cells. These observations indicate a possible functional role of insulin and of adenylate cyclase in cell growth and division.

The double glucagon test, a new liver function test

A double glucagon test was performed in 100 patients and seventeen control subjects. Two intravenous doses of glucagon (1 mg) were administered at a 1-hr interval. Glucose was determined before the first injection and 20, 25 and 30 min after both doses, and the increases after each successive dose were added up.

In normal persons, the total increase in glycaemia was higher in the second than in the first hour and reached at least 110 mg. Normal values were found in cases of obstructive jaundice, cholelithiasis and adult diabetes, and abnormal values in patients with infective hepatitis, liver congestion and cirrhosis.

The double glucagon test was found to be very useful for the differential diagnosis of liver cell impairment and hepatic obstruction.

Mutanten des hüllproteins (b-protein) des bakteriophagen fd

Spontaneous mutants of the bacteriophage fd and mutants resulting from fd-infected cultures of E. coli grown in the presence of 2.7-diaminofluoren and proflavin were isolated by means of free flow electrophoresis.The amino acid analyses of the mutant coat proteins (B-proteins) show significant differences in comparison with the amino acid analyses of wild type coat protein.