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Purpose: Re-anastomosis after a Hartmann procedure is associated with a higher morbidity and mortality than other elective colorectal operations. The goal of this comparative study was to evaluate whether laparoscopic reversal is a justified operative approach, although the initial operation is most often an emergency laparotomy. Methods: A retrospective analysis was conducted on data collected on all 70 patients who underwent laparoscopic and open reversal of a Hartmann procedure at the Department of Surgery, University of Schleswig-Holstein, Campus Lübeck, between January 1999 and December 2011. Together with general demographic data, the analysis included the indication for the initial Hartmann procedure, time to reversal, intraoperative findings, the choice of operative method, operating time, postoperative pain control, return of normal bowel function, length of hospital stay, and peri- and postoperative morbidity and mortality. Results: In most patients, the Hartmann procedure was performed after a perforated sigmoid diverticulitis. We were not able to find any statistically significant differences with respect to gender, body mass index (BMI) and American Society of Anesthesiologists classification between the laparoscopic group (LG) ( N = 24 patients) and the open group (OG) ( N = 46). In the LG, patients were significantly younger ( p = 0.019). The median operating time was 210 min (75-245) in the LG, which was significantly longer than in the OG (166 min; 66-230). The statistical analysis of the duration of postoperative analgesic therapy (LG 7 days [-]; OG 12 days [-] ), return to normal diet (LG 3 days [-]; OG 4 days [-] ), return of normal bowel function (LG 3 days [-]; OG 4 days [-] ) and length of hospital stay (LOS) (LG 10 days [-]; OG 15 days [8-163]) detected significant differences in advantage for the LG. Unplanned return to theatre during index admission was only necessary in the OG ( N = 7, 15.2 %). With a median follow-up of 8 months (range 1-20), we observed a comparable number of minor complications in both groups but a significantly higher number of major complications in the OG ( N = 27, 58.7 %) ( p = 0.001). Conversion occurred in three cases (12.5 %). There was no mortality in either of the two groups. Conclusions: This study was able to demonstrate the feasibility of the laparoscopic approach. In terms of postoperative results it should be seen as equivalent to the open procedure. However, the laparoscopic approach requires profound surgical expertise. The indication should be made after a careful risk/benefit analysis for each individual patient. [ABSTRACT FROM AUTHOR]

The regular colonisation of the oesophagus with a Candida species can, after oesophageal perforation, result in a contamination of the mediastinum and the pleura with a Candida species. A patient cohort of 80 patients with oesophageal perforation between 1986 and 2010 was analysed retrospectively. The most common sources with positive results for Candida were mediastinal biopsies and broncho-alveolar secretions. Candida species were detected in 30% of the patients. The mortality rate was 41% in patients with positive microbiology results for Candida, whereas it was 23% in the remaining patient cohort. This difference did not reach statistical significance ( P = 0.124). Mortality associated with oesophageal perforation was attributed mainly to septic complications, such as mediastinitis and severe pneumonia. During the study period we observed a shift towards non-albicans species that were less susceptible or resistant to fluconazole. In selected patients with risk factors as immunosuppression, granulocytopenia and long-term intensive-care treatment together with the finding of Candida, an antimycotic therapy should be started. A surgical approach offers the possibility to obtain deep tissue biopsies. The antimycotic therapy should start with an echinocandin, as the resistance to fluconazole is growing and to cover non-albicans Candida species, too. [ABSTRACT FROM AUTHOR]

Aim The increasing experience within the area of laparoscopic procedures has paved the way for technically-complex procedures, such as distal pancreatectomy. In order to avoid complications associated with concomitant splenectomy, these procedures are increasingly performed with spleen preservation. A drawback is the low number of cases, which does not allow for an evidence-based comparison between laparoscopic and open procedures, and spleen-preserving and concomitant splenectomy procedures. Patients and Methods Between 2006 and 2010, all data for patients who underwent a laparoscopic distal pancreatectomy (LDP) at the Department of Surgery, University of Schleswig- Holstein, Luebeck, Germany, were collected are stored in a prospectively-maintained database. Patients with tumours in the pancreatic tail and body that did not exceed the level of the portal vein were included in this database. Results A total of 22 patients who underwent LDP could be included in the evaluation. Ten of those patients underwent a laparoscopic spleen-preserving distal pancreatectomy ( LSPDP), while the remaining 12 received an LDP with splenectomy ( LDPwS). The median operation time was 155 min (range: 98-253) for the LSPDP group, and 201 min (range: 60-310) for the LDPwS group ( P = 0.06). The median hospital stay was 8.5 days (range: 5-23) in the LSPDP group compared to 11 days (range: 4-41) in the LDPwS group ( P = 0.06). Pancreatic fistula occurred in two patients from each group. It caused an intraabdominal haemorrhage in one patient of the LSPDP group, which required re-laparoscopy. Two patients experienced subphrenic abscesses in the LDPwS group and were treated interventionally. Histological examination revealed six cystadenomas and five pseudocysts (maximum diameter: 7 cm) in the LDPwS group, and six neuroendocrine tumours (maximum diameter: 2 cm) in the LSPDP group. Conclusion LDP can be performed safely. The optic magnification provided by laparoscopy facilitates LSPDP, as dissection of the splenic vessels can be avoided. Although not significant, there was a trend towards reduced hospital stay and operating time for LSPDP. Oncologic outcomes and morbidity seem to not be inferior to open procedures. The size of the tumours and the peripancreatic, as well as paraneoplastic, tissue alterations determine the indication for splenectomy. [ABSTRACT FROM AUTHOR]

Optimal nutrient supply in the digester is essential for efficient biogas production. The aim of this study was to analyze the effects of various micro- and macronutrients on the process stability by a field test. The digestates of 25 biogas plants across the federal state of Baden- Württemberg, Germany, were investigated. Collected data including trace elements, macronutrients, and volatile fatty acids ( VFA) concentrations, as well as the organic loading rate and hydraulic retention time were subjected to statistical analysis. High variations in the concentrations within the different biogas plants were observed. Statistically significant effects of substrate constituents and process parameters on the stability of the anaerobic digestion process were found. Several micro- and macronutrients and the relationships between these elements, as well as the process parameters propionic acid, acetic acid, and acetic acid equivalent were tested. Ni, Mo, and S had a consistent statistically significant effect, while the organic loading rate and Se only showed an effect limited to the acetic acid concentration and the acetic acid equivalent. No statistically significant effect could be shown for Fe, Co, and Na. Most of the significant interactions between the tested elements contained Ni, Fe, and Co. This shows that a balanced relation between the concentrations of these elements is of greater importance than the presence of individual elements for a digester to be able to operate at high organic loading rates and maintain low VFA concentrations. [ABSTRACT FROM AUTHOR]

This article discusses the concentrations of particulate matter in dust emission from swine facilities in Germany and Italy. The authors measured climate and airborne particulate matter using scatter light photometry and ventilation as well as animal data such as feeding times, activity and weight. A dynamic transfer function simulation model was used to model dust concentrations and emissions. They found that the measured dust peaks did not always correspond to the measured activity levels. They recommended improved continuous and accurate measurements of input variables and optimization of measuring days.