Search

Endoscopy has become established as an important component in all preoperative, intraoperative and postoperative areas of bariatric surgery. As guidelines are not yet available, relevant studies and international position papers have been collected in this article. Preoperatively, endoscopy should be performed before sleeve gastrectomy (SG, detection of reflux status) and before bypass procedures (status survey of the postoperatively no longer accessible distal stomach). Routine endoscopic monitoring should be performed 2-3 years after SG and a OAGB (one anastomosis gastric bypass) for recording of the gastroesophageal reflex disease (GERD) status. In the first line complication management of hemorrhage and leakages, endoscopic procedures have prevailed over surgical ones due to more causal therapeutic approaches (except cases of general peritonitis where lavage and drainages are needed). In the treatment of late complications such as dumping, anastomosis dilatation and stenosis, bariatric endoscopy provides versatile, organ-preserving solutions and continues to demonstrate a high degree of innovation. In these postoperative fields of application, especially in the treatment of late complications, specific knowledge of bariatric anatomy and physiology as well as surgical treatment options are required in addition to endoscopic expertise. The special field of bariatric endoscopy has developed and will have an own importance closely linked to the bariatric surgery., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

An effective (early) mobilization in COVID-19 intensive care patients with ECMO treatment is very important. Sedation, extracorporeal procedures with the danger of circuit malfunction, large lumen ECMO cannulas with a risk of dislocation and a very severe neuromuscular weakness are factors that could deem mobilization beyond stage 1 of the ICU mobility score (IMS) in some cases difficult or impossible; however, early mobilization is a key point of the ABCDEF bundle to counteract pulmonary complications, neuromuscular dysfunction and enable recovery. The case of a 53-year-old, previously healthy and active male patient with a severe and complicated course of COVID-19 and pronounced ICU-acquired weakness is described. While receiving ECMO the patient could be mobilized using a robotic system. Due to severe and rapidly progressing pulmonary fibrosis, additional low-dose methylprednisolone therapy (Meduri protocol) was implemented. Under this multimodal treatment the patient was successfully weaned from the ventilator and decannulated. Robotic assisted mobilization has the potential to be a novel and safe therapeutic option for a customized and highly effective mobilization in ECMO patients., (© Springer-Verlag GmbH Austria Ein Teil Von Springer Nature 2023.)

An effective (early) mobilization in COVID-19 intensive care patients with ECMO treatment is very important. Sedation, extracorporeal procedures with the danger of circuit malfunction, large lumen ECMO cannulas with a risk of dislocation and a very severe neuromuscular weakness are factors that could deem mobilization beyond stage 1 of the ICU mobility score (IMS) in some cases difficult or impossible; however, early mobilization is a key point of the ABCDEF bundle to counteract pulmonary complications, neuromuscular dysfunction and enable recovery. The case of a 53-year-old, previously healthy and active male patient with a severe and complicated course of COVID-19 and pronounced ICU-acquired weakness is described. While receiving ECMO the patient could be mobilized using a robotic system. Due to severe and rapidly progressing pulmonary fibrosis, additional low-dose methylprednisolone therapy (Meduri protocol) was implemented. Under this multimodal treatment the patient was successfully weaned from the ventilator and decannulated. Robotic-assisted mobilization has the potential to be a novel and safe therapeutic option for a customized and highly effective mobilization in ECMO patients., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Renal cell carcinomas (RCC) include different tumor entities, of which clear cell RCC is the most common tumor with approx. 75 % followed by the papillary RCC with 10-15 %. RCC are increasingly being diagnosed incidental in the context of abdominal diagnostics from other indications using sonography or cross-sectional imaging.The prognosis of metastatic RCC has improved significantly due to new therapy options, especially through the use of immune checkpoint inhibitors (IO). In the first line, combination therapies of the tyrosine kinase inhibitor (TKI) axitinib with the PD-1 antibody pembrolizumab or the PDL-1 antibody avelumab apply regardless of the risk profile and histological entity, as well as the combination of the CTLA4 antibody ipilimumab with the PD-1 antibody nivolumab in patients with intermediate and high risk as new standards in therapy. The combinations lead to a higher response rate and longer survival. In the second line and subsequent lines, there is no evidence-based data after combination therapies, but drugs can be used that were not yet part of the first-line therapy., Competing Interests: LB: Advisory Boards von BMS, Ipsen, EUSA, Pfizer. Study Grant von BMS an Goethe-Universität Frankfurt.AH: Advisory Board and Consultant: BMS, MSAD, Roche, AstraZeneca, Novartis, Boehringer Ingelheim, Abbvie, Cepheid, Nanostring, Qiagen, Biontech, Janssen, 3DHistotech, Diaceutics. Speaker Honoraria: BMS, MSD, Roche, AstraZeneca, Boehringer Ingelheim, Abbvie, Janssen. Research Support: Illumina, Cepheid, Biontech, Roche, Janssen, Nanostring.MA: Advisory Boards von AstraZeneca, BMS, EUSA, Ipsen, Pfizer., (© Georg Thieme Verlag KG Stuttgart · New York.)

For more than 2 decades ventral derotation spondylodesis (Zielke VDS) as a major improvement over Dwyer instrumentation (DI) was the gold standard of instrumented curve correction and stabilization from the anterior approach. As the first available system it enables a true three-dimensional curve correction. A disadvantage is the low internal stabilization capability with a need for long-term external stabilization by means of cast and brace treatment postoperatively. Meanwhile with the development of modern single and dual solid rod systems these disadvantages can be avoided completely. Video-assisted (thoracoscopic) anterior scoliosis surgery accounts for less than 2% of anteriorly treated scoliosis cases, mainly due to a long operating time and significant learning curve.From the posterior approach the Cotrel-Dubousset instrumentation (CDI) as a polysegmentally attached posterior hook threaded dual rod system used to be state of the art for a long time, since it eliminated the disadvantages of Harrington instrumentation (HI) in terms of only one-dimensional correction and low stabilization capabilities. However even with CDI effective derotation was impossible. In posterior scoliosis surgery there is a strong trend away from hook systems towards transpedicular segmentally fixed dual rod systems not only in the lumbar spine but also in the thoracic area. Advantages of these newer techniques are shorter fusion, improved correction, and less loss of correction over time.Advantages of modern anterior instrumentation systems in comparison to posterior transpedicular instrumented dual rod systems are less blood loss, better derotation, slightly shorter fusion levels, and a better influence on sagittal plane control or improvement especially for hypokyphotic thoracic scoliosis cases. Our data also document a superior spontaneous correction of the lumbar curve after selective anterior instrumented correction (Lenke 1B+C), although other studies could not find significant differences. In our experience the neurological risk of anterior instrumented correction is also lower than that of posterior scoliosis surgery, although the morbidity and mortality data of the Scoliosis Research Society could not prove that anymore in recent years. A negative effect of anterior transthoracic scoliosis surgery in comparison to posterior surgery is a more negative effect on lung function, which improves slower after surgery and does not quite reach the levels of posterior surgery at follow-up. But new data on posterior segmental transpedicular correction and fusion also prove a lordosating effect with negative effect on lung function.

In the German health system the payment of a hospital stay is standardised. The common basis is the G-DRG System (German diagnosis-related groups) in which every stay is paid by a lump sum. Scoliosis correction in our times means pedicle screw-based multilevel double rod instrumentation or anterior plate-rod instrumentation with primary stability. The outcome of those methods has improved the results of correction and decreased the complication rate but also means high costs due to the implants. Scoliosis correction is covered by DRG I06. Due to constant efforts a general improvement took place in the assessment of DRG I06. That is the reason why the losses incurred in DRG I06C could be lowered to 38% and in I06D to 22% in 2008. For an appropriate assessment further improvements are required.

One hundred and twenty men, aged 23--60 years and having various professions participated in studies on relationships between daily physical activity and physical performance capacity (PPC). The determination of daily physical activity at work and of the habitual leisure time activities has been described earlier (Ilmarinen et al. 1980). The determination of physical performance capacity was based on W170, W85% and on predicted VO2 max measured with continuously increasing work load on a bicycle ergometer. The W85% modification corresponds to the working capacity at a heart rate level of 85% of maximal heart rate. Workers with a combination of heavy physical work and active leisure time showed systematically the highest absolute and relative values of PPC. However, although the results indicated that the effect of work activity on PPC was not significant, the effects of leisure time activities on W85% and on VO2 max related to lean body mass were significant. It is concluded that the leisure time sport activities are more important than the physical activity at work in maintaining or increasing the PPC. Aerobic sport activities in leisure time are recommended both for persons with physically heavy and light work.

Four experimental series were applied to 342 prepuberal young sows to establish ovulation developments. Different periods of time were allowed to elapse between injection and slaughter. Injected were 400 IU PMS/200 IU HCG or 500 IU PMS/250 IU HCG. Onsets of ovulation were found to be highly differentiated and variable. Some of the animals had completed ovulation 72 hours after application of gonadotrophin, whereas in others had not even started 168 hours after such application. In the majority of all sows involved in the experiments ovulation occurred 96--144 hours from application of the gonadotrophis hormone. In other words, fertile semen should be present in the genital tract of sows in that period of time, if the concept of deadlineoriented insemination is followed.

The PMS and HCG doses by which to induce puberty and successfully use the first induced oestrus were tested in three experimental slaughter series on 197 prepuberal young sows. An injection of 500 International Units of PMS and 250 IU of HCG was found to bear greatest promise. While higher dosages gave higher rates of ovulation and, following insemination, higher numbers of embryos, pregnancy rates as a whole dropped severely. Since a very high percentage of all animals involved exhibited follicle stimulation, following such treatment, while only half of them displayed tolerance, it is strongly suggested to use for all animals deadline-oriented rather than toleranceoriented insemination.

Different frequencies and periods of insemination were checked with the view to optimising puberty induction to young sows, for which purpose 500 IU PMS/250 IU HCG were injected to 571 animals in seven experiments. Insemination was carried out by deadline, since follicle stimulation was exhibited by almost all animals following the above treatment, while only some of them displayed tolerance. Advantage was taken of the induced oestrus, since its ovulation rates were higher than those associated with subsequent heat cycles, and because a synchronised second oestrus was recordable only from some of those animals which exhibited follicle stimulation in response to puberty induction. The most favourable results in terms of pregnancy and number of embryoes, against the background of the great variability in ovulation onset, were obtained, if insemination was applied 72, 96, and 120 hours after gonadotrophin treatment. From among the variants with two inseminations, good results were obtained from those 96 and 120 hours after PMS/HCG treatment.

Evaluation of 2937 case notes of patients admitted for attempted suicide to the department in Lübeck between 1947 and 1968. This series can be seen as resentative for the Lübeck region. During this period the number of cases has increased about fourfold and has been rising since. Mortality could be reduced to 3% or below. Earlier typical differences between the sexes have since approached each other so that in the end men and women showed the same increase by age during the third decennium. Women were admitted significantly more frequently than men. Drugs, particularly sleeping pills and transquilizers, have greatly increased in suicide attempta. Earlier attempts occurred in 30% of cases. Measured by additional diagnoses, the morbidity of the series lay be 44.8%.

Following medical screening and physical fitness testing (W170) 52 voltuntary employees in a 31-story administration building were formed into matched pairs and randomly allocated into intervention (stairclimbing) and control (lift) groups. The intervention group was asked to climb at least 25 floors/workday or 125 floors/week. the control group was asked to use only the lift. The intervention time was 10 weeks. The physiological measurements were made before and after the intervention. The number of stairs climbed was recorded daily in a diary. The heart rate was recorded continuously over one workday before and during the interventions. The average quantity of training in the final intervention group (n = 19) was 29.9 floors/workday or 36,790 kpm/week and in the control group 4.6 and 5980 correspondingly. The average training frequency was 4.3 in intervention and 1.4 climbs/workday in the control group. The average number of continuous floors used during climbing was 7.0 in intervention and 3.4 in control group. The average number of minutes on heart rate level of 130-159 beats/min during one workday was 7.8 in intervention and 1.6 in control group. The W170 (W/kg) increased 17.8% and the predicted VO2max (ml/min/kg) 15.1% in intervention group. The difference between the intervention group and the control group was significant (p less than 0.01). It was concluded, that stairclimbing is a suitable on the job physical activity program for middle-aged, untrained men.