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Vaccination against coliform mastitis has become part of mastitis control programs in the past 3 decades, as a means of reducing the severity of clinical mastitis. Our study objective was to evaluate the effect of 2 commercially available vaccines on clinical, behavioral, and antibody response following Escherichia coli intramammary challenge in cows near peak lactation. Cows (n = 12 per group) were vaccinated with vaccine 1 (V1) or vaccine 2 (V2) at dry-off, 21 d pre-calving, and 14 d post-calving. Twelve cows served as unvaccinated controls (CTL). Cows were challenged with E. coli in a rear quarter at approximately 100 d in milk. Milk samples were collected pre- and post-challenge to enumerate E. coli and determine somatic cell count. Serum was collected before each vaccination and at d 0, 1, 2, 3, 6, 30, and 60 relative to challenge, to study antibody response. Milk IgA and tumor necrosis factor-α concentrations were determined in whey. Vaginal temperature, cow activity, and milk yield and components were monitored post-challenge. Bacterial count, somatic cell score, milk yield and component decline, vaginal temperature, activity measures, and antibody and cytokine response were analyzed for treatment differences. The effects of parity, breed, and a repeated measure of time were also tested. Seven cows had to be removed from the study post-challenge for antibiotic treatment (CTL and V1, n = 3 each; V2, n = 1), 2 of which were euthanized (both CTL). Vaccinated cows exhibited fever (vaginal temperature ≥39.4°C) 3 h earlier than CTL cows, but we found no differences between treatments for bacterial count, somatic cell score, or milk yield reduction. Vaccinated cows spent more time lying per rest bout 2 d post-challenge, but total daily lying time was not different from CTL cows during the 7 d post-challenge. The vaccines differed in antibody response: V1 cows had greater serum IgG1 and IgG2 post-challenge. A parity effect was also evident: primiparous cows had lower bacterial counts, somatic cell score and a smaller milk yield decline than multiparous cows, but also had lower antibody production. Immunization with either J5 bacterin did not reduce clinical signs of mastitis in cows challenged at 100 d in milk, demonstrating that the effects of J5 vaccination had diminished at peak lactation.

Parturition is often a stressful period, when the incidence of disease is high after calving, which has been associated with an uncontrolled inflammatory response. Therefore, the objective of this study was to test the effect of the administration of a nonsteroidal anti-inflammatory drug (meloxicam) on the behavior, health, and production of peripartum cows. Meloxicam was dosed at 1 mg/kg of body weight, and an empty gel capsule served as a placebo. Both were administered orally with a balling gun. Dairy cows and heifers were randomly assigned to 1 of 3 treatment groups: (1) meloxicam administration before calving, with a placebo administered after calving (MEL-PRE, n = 60), (2) placebo administered before calving, and meloxicam administered after calving (MEL-POST, n = 69), and (3) a placebo administered before calving and after calving (CTL, n = 65). To identify imminent calving events, a vaginal thermometer was inserted approximately 2 wk before the expected calving date and a drop in temperature was used to identify cows close to calving. Calving events were monitored via video cameras, and the amount of time that elapsed between the appearance of the amniotic sac at the vulva until delivery of the calf was used to determine calving difficulty score. Eutocic calving events were defined as cows that calved in ≤70 min, and dystocia was defined as cows that took longer than 70 min to calve. Milk yield and components were measured for the first 15 wk of lactation and accelerometers were used to record activity and lying behaviors. The effects of treatment, breed, parity, calving difficulty, and, when applicable, a repeated measure, along with interaction terms, were analyzed in mixed models. Regardless of the time of administration, dystocic cattle that received meloxicam were less active than dystocic CTL. Dystocic animals displayed more lying bouts on the day of calving and then displayed fewer lying bouts and were less active during the days following calving. No effect of treatment was noted on any health outcomes. Eutocic MEL-PRE animals produced 6.8 kg/d more milk than eutocic CTL. Regardless of calving difficulty, MEL-PRE animals produced more milk fat, protein, and lactose (kg/d) than CTL. In conclusion, meloxicam administration before calving appears promising in increasing milk yield in eutocic cows.

The objective was to compare the timed AI pregnancy rate of Angus-cross beef cows synchronized with a 5-d CO-Synch + CIDR (a progesterone-releasing intravaginal insert) protocol and given two doses of PGF(2 alpha) (PGF), with the first dose in conjunction with CIDR withdrawal on Day 5, and the second dose given either early or late relative to the first dose. All cows (N = 1782) at 16 locations received 100 microg of GnRH + CIDR on Day 0. Cows received 25 mg of PGF concurrent with removal of the CIDR on Day 5, and were randomly allocated within locations to receive a second PGF either early (N = 881; from 0.5 to 3.9 h) or late (N = 901; from 4.5 to 8.15 h) relative to the first PGF treatment. On Day 8 (72 h after CIDR removal), all cows were inseminated and concurrently given 100 microg of GnRH. Cows were fitted with a pressure-sensitive mount detection device (Kamar) at CIDR removal. Cows were observed twice daily through Day 7 and at the time of AI on Day 8 for estrus and Kamar status (estrus - red, partial and lost Kamar versus no estrus - white Kamar) was recorded. Accounting for location, season, AI sire, cow observed in estrus or not at or before timed AI, and treatment by cows observed in estrus interaction, timed AI pregnancy rates were greater for the late (6.45 +/- 0.03 h) than the early (2.25 +/- 0.05 h) interval, 57.2 vs. 52.7%, respectively (P < 0.05). In conclusion, cows that received the second PGF late after the first PGF on the day of CIDR removal in a 5 d CO-Synch + CIDR synchronization protocol had significantly higher timed AI pregnancy rates than those receiving the second PGF early after the first PGF.

Purpose:To study the neuroanatomic characteristics of patients with Duane’s retraction syndrome with high-resolution magnetic resonance imaging.Methods:The study included 11 consecutive cases, including five patients with type I, one patient with type II, four patients with type III, and one patient with inverse Duane’s retraction syndrome. The patients underwent magnetic resonance imaging of the brain, brain stem, cavernous sinus, and orbits.Results:In 10 patients, the abducens nerve (cranial nerve VI) was absent or showed hypoplasia in the brain stem, cavernous sinus, and orbit. However, these findings were not seen in the patient who had inverse Duane’s retraction syndrome. In two children, magnetic resonance imaging showed that the cavernous sinuses were smaller on the affected side. The inferior division of the oculomotor nerve (cranial nerve III) was traced to enter the lateral rectus muscle or had intimate continuity with the lateral rectus muscle in nine patients with type I and type III Duane’s retraction syndrome. In one patient with type III Duane’s retraction syndrome, the oculomotor foramen was significantly larger on the affected side than on the sound side. In the patient with type II Duane’s retraction syndrome, the superior division of cranial nerve III was enlarged and had three branches. In the patient with inverse Duane’s retraction syndrome, the inferior division of cranial nerve III sent two branches to the medial rectus muscle, and the patient had superior oblique muscle hypoplasia.Conclusion:Neuroimaging findings showed that the absence of cranial nerve VI, hypoplasia in the brain stem, and an extra branch of the inferior division of cranial nerve III to the lateral rectus muscle is the most common presentation of Duane’s retraction syndrome, but not the only one. The aberrant branches likely correspond to the abnormal eye movement seen in patients with this disorder.

Summary Backgrounds: A multicenter phase II trial was initiated in order to evaluate the weekly, high-dose 24-hour infusion of 5-fluorouracil (5-FU) plus folinic acid (FA) in patients with unresectable colorectal cancer hepatic metastases. Paitents and method: A weekly hepatic arterial infusion (HAI) of FA 500 mg/m2 followed by a 24-hour infusion of 5-FU 2,600 mg/m2 (later reduced to 2,200 mg/m2) was given via a surgically implanted intra-arterial port system. One treatment cycle consisted of six weekly applications followed by a two-week rest period. Toxicity was assessed according to the WHO criteria. Chemotherapy was continued until disease progression or complete response occured. Results: A total of 50 patients (40 chemonaive, 10 pretreated) entered this trial. An objective tumor response occurred in 28 patients (56%), while 13 patients (26%) had stable disease. The median progression free survival was 12 months, and the median survival 22.3 months. Due to a high rate of gastrointestinal side-effects in the initial phase of the trial, the dosage of 5-FU was reduced to 2, 200 mg/m2 for all subsequent patients. Diarrhea and nausea led to a dose reduction in 40% of applications and 24% of patients, respectively. One patient died of cardiac insufficiency unrelated to chemotherapy before response evaluation. Conclusions This HAI approach using high-dose 5-FU was relatively well tolerated when 2,200 mg/m2 instead of 2,600 mg/m2 was used. The activity of this regimen is promising and warrants further evaluation and modification.

Ofloxacin, its optical isomers levofloxacin (HR 355, DR-3355) and D-ofloxacin (DR-3354) and ciprofloxacin were administered orally to mice and rats which had systemic and localized infections. Both levofloxacin and ciprofloxacin were equally effective in treating systemic murine infections caused by staphylococci, Enterobacteriaceae or Pseudomonas aeruginosa with ED 50 s ranging from 0.18 to 15.8 mg/kg and 0.42 to 16.3 mg/kg respectively and both these agents were twice as effective as ofloxacin which had an ED 50 0.41 to 39.7 mg/kg. In contrast, D-ofloxacin was either inactive or exhibited only modest chemotherapeutic activity against the staphylococci and the Gram-negative organisms tested. When given to mice to treat staphylococcal abscesses and lung infections due to Klebsiella pneumoniae DT-S levofloxacin was up to four times more effective and produced a more pronounced bactericidal effect against the pathogens in vivo than the reference compounds. Despite possessing a similar, if not lesser, in-vitro activity against the infecting pathogens, levofloxacin was more effective than ofloxacin and ciprofloxacin in rats with localized infections caused by Enterobacteriaceae and P. aeruginosa.

Adjustable gastric banding is a popular bariatric operation in Europe. The rate of long-term complications like pouch dilatation, slippage and band migration and the long-term effect of weight loss are reported in meta-analysis and few studies for a period of more than five years. We report on experiences after gastric banding.Over a period of 10 years 168 patients with morbid obesity were treated with gastric banding. Preoperative data, postoperative weight loss and long-term complications were prospectively obtained and retrospectively analyzed.Mean age of the patients was 41.7 years with a mean preoperative BMI of 49.6 kg/m2. No intraoperative or postoperative death occurred in the first 30 postoperative days. Intraoperative conversion rate was 7.1 %. 79.8 % of the patients (n = 134) were available for follow up (mean follow-up time 66.7 months). Long-term complications occurred in 22.5 % of the patients. 30 complications (17.8 %) were related to the band and 8 (4.7 %) to the access-port or to the tube. Mean excess weight loss was 39.6, 47.3, 44.2, 43.4 and 32 % after 1, 2, 4, 5 and 8 years.Laparoscopic gastric banding can achieve an effective weight loss. However band-related and functional complications will influence the late outcome. Pathways to choose the best surgical method for the individual patient are necessary to reduce failures after gastric banding.

Due to German regulations, acceptance and consistency tests have to be obtained by 12.31.2005 for all equipment used for computed radiography according to special standards published in DIN 6868. This article familiarizes all users with the most important aspects of these standards. In addition, explanatory and background information for establishing these regulations are provided.

Recurrence after resection of colorectal liver metastases occurs after 9-12 months in up to 80% of patients. Half of the relapses is isolated to the liver. An intraarterial chemotherapy with 5-FU and folinic acid was compared to only resection. Main objective of the trial was survival. Within 14 days after resection followed the 6-month therapy with 5-FU 1000 mg/m2 continuously over 5d/28d and Folinic Acid 200 mg/m2 over 15 minutes 5d/28d. The first interim-analysis with 226 randomised patients showed in the intention-to-treat-analysis a median survival of 34.5 months (m.) with therapy versus 40.8 months (p = 0.1519 with a negative trend. (95%-Confidence interval for hazard ratio: [0.5; 1.15]) and time to progression of 14.2 m. with therapy versus 13.7 m. Severe toxicities (WHO grade III/IV) occurred in 25.6% of cycles and 62.9% of patients. Mainly registered were stomatitis (57.6%) and nausea (55.4%). The recruitment of patients for study was terminated, because in best case the risk to die could be lowered only by 15% and therefore clinical relevant prolongation of survival is not to achieve with this type of adjuvant therapy.

From 1984 to 2001, 486 operations were carried out at the surgical clinic in Gera for pancreatic neoplasms, including 49 patients with rare neoplasms of the pancreas. In 23 patients malignant pancreatic tumors were present (9 solitary metastases, 9 endocrine carcinomas, 2 cystadenocarcinomas, 2 schwannomas and one non-Hodgkin's lymphoma). In 28 benign lesions a resection of the tumor was performed, concerning 8 insulinomas, 8 serous cystadenomas, 3 mucinous cystadenomas and 4 rare cystic tumors. A sarcoidosis, an autoimmune pancreatitis and a radiation fibrosis were diagnosed in 3 patients operated under the suspicion of a malignant pancreatic tumor. By means of own case examples and data from the literature these rare entities are described with their diagnostic and therapeutic special features.

The analgetic treatment of inoperable pancreatic cancer patients is of paramount importance. The relative ineffectiveness of pharmacological agents has led many investigators to recommend chemical neurolysis of the celiac ganglions for pain control. However, the assessment of the results and the effectiveness of the block carried out during laparotomy have been unclear.After 41 intraoperative celiac neurolytic blocks pain intensity was retrospectively analysed in 38 patients suffering from unresectable pancreatic carcinoma. The mean age of the patients was 59 years, the observation period after neurolysis ranged to 6 months. All patients underwent definitive neurolysis using 50 % ethanol in 0.5 % prilocaine. Immediate and long-term efficacy, analgetic consumption and mortality were evaluated at follow-up. The calculated parenteral equivalent morphine dosage (mg per day) was evaluated before as well as at different time points after treatment as an objective parameter to describe pain intensity.7 to 34 days (at discharge from the hospital) after block pain intensity was statistically highly significant reduced (p=0.016). Long-term results were obtained from 17 (10 to 12 weeks after intervention) and 9 (up to 20 weeks after intervention) patients respectively, demonstrating a long-lasting effect of the neurolysis. A statistical analysis was not possible because of the small patient 's number.Intraoperative celiac neurolytic block is a safe and effective method of pain treatment in patients with unresectable pancreatic carcinoma. However, it alone provides complete pain relief until death only in a few cases. Therefore, it should be considered as an adjuvant treatment in the analgesic strategy. Combined palliative therapy is necessary in most of the cases.

Chronic pancreatitis leads to changes of nearby organs with possible acute and chronic complications including lesions of the spleen. Among 341 patients operated upon between January 1981 and June 2002 in the surgical department Gera, we found 7 spontaneous spleen ruptures or such after minimal trauma and 4 pseudocysts, which expanded to the splenic hilus. In all cases splenectomy was carried out with resection of the tail of the pancreas with or without drainage of the pancreas. 2 patients with a history of splenectomy after minimal trauma underwent duodenum-preserving resection of the pancreatic head to Frey, and distal pancreatectomy, resp.Lesions of the spleen belong to the rare complications of chronic pancreatitis. With known case history and mostly delayed course, the operative concept must be concentrated not only on the splenic lesion but also on the therapy of the chronic pancreatitis.

In this paper the late results after operative therapy of biliopancreatic carcinomas will be presented. Tumors of this region have many things in common. That's why we investigated the 4 tumor entities together. We studied the case histories of 434 patients treated between 1981 and 1997. We analysed the in- and outpatient data of the "Klinikum der Stadt Gera", documents of the tumor board and informations that were obtained from the ambulatory treating physicians. 283 patients suffered from pancreatic carcinoma, 50 from bile duct carcinoma, 60 from gallbladder carcinoma and 41 from carcinoma of the papilla Vateri. The survival rates after curative or palliative operative therapy of the 4 tumor entities were calculated according to Kaplan-Meier. The rate of curative operations and the 5-year-survival-rate after curative resection were 32.8% and 19.0%, resp. in pancreatic carcinoma, 28.0% and 49.0% in bile duct carcinoma, 26.7% and 50.0% in gallbladder carcinoma and 71.0% and 44.0% in carcinoma of the papilla Vateri. Due to the higher resection rate the overall results in patients with carcinoma of the papilla Vateri were much better than the results in the other analysed cancers. Up to now resection is the only way to cure the 4 entities of malignant tumors of the biliopancreatic region.

Monopolar electrosurgery is querried because of the availability of new preparation-techniques in laparoscopic cholecystectomy. The advantage of simple handling, cheap application and high efficiency has to be set against the danger of tissue lesions e. g. the damage of the bile duct as demonstrated by four own cases. Especially the bipolar preparation-method and ultrasonic dissection are safer, but expensive and not as fast and effective as monopolar technique. Laser-heated instruments exist but are not in wide clinical use. The danger of tissue-lesions can be reduced by accurate preparation-principles and caution in dissection of the Calot-triangle.

Since 1983 gastric banding has become a proven operative method, which reduces effectively excess weight in morbid obesity. Gastric banding has been popularized as a minimally invasive, completely reversible surgical treatment for morbid obesity. We report here our 4 year experiences of gastric banding with special reference to complications.There were 109 patients in total, of whom 92 were women. Median age was 41.5 years (range 17-62 years) and median body-mass-index (BMI) was 49.6 kg/m2 (range 36.7-82.6 kg/m2). From February 1995 to June 1997 39 patients were operated upon with the open technique. In June 1997 we started the laparoscopic gastric banding. 70 patients were treated with this method from June 1997 to February 1999.The weight loss 6 months postoperatively after gastric banding was 35.3% and 12 months after the operation 43.0% of the overweight. In 17 cases a re-operation was necessary. Indications for re-operations included pouch dilatation in 4 cases, slippage in 3 cases and complications connected with the port system. The operation technique and the kind of band fixation influenced the frequency of complications.A lot of complications especially after laparoscopic gastric banding can be prevented by a strong indication. Using the laparoscopic technique complications like pouch dilatation are diminished compared to the open technique. A standardized operation technique decreases the complication and re-operation rate. Conversions to the open technique were mostly necessary during the learning curve of LASGB (laparoscopic adjustable silicone gastric banding).

Controversy continues whether exploration of the contralateral, asymptomatic side should routinely be performed since Rothenberg and Barnett stated in 1955 that a contralateral hernia is present in three out of four children presenting with a symptomatic unilateral inguinal hernia (IH). In our institution, hernia operations are performed on the symptomatic side only, the exception being male infants under 1 year of age with a left-sided IH. To verify our concept and to evaluate the frequency of contralateral hernial development, the medical records of all infants under 1 year of age operated upon between 1984 and 1988 were reviewed and the children followed through December 1996. Included in the study were 882 infants, 616 boys (70%) and 266 girls (30%); 148 (17%) were born prematurely. Seventy percent were operated upon before the end of the 3rd month of life. In 761 infants clinical signs of a unilateral hernia were present, and in 121 symptomatic hernias were found on both sides; 665 infants were operated upon unilaterally. A second operation on the opposite side was necessary in 38 cases (5.7%). The highest incidence of contralateral hernial development was found in premature boys (11.5%). We conclude that even in infants below 1 year of age, IH is usually a unilateral disease and does not require routine exploration of the asymptomatic side.

The relative efficacy of HAI FUDR, HAI 5-FU/FA, and i.v. 5-FU/FA chemotherapy for the treatment of unresectable colorectal liver metastases was compared in a prospective randomized clinical trial. The response rate after HAI treatment was significantly higher as compared to i.v. treatment with no statistical benefit regarding survival and time to progression. HAI FUDR treatment was inferior as compared to HAI or i.v. 5-FU/FA. i.v. 5-FU/FA-therapy is therefore the method of choice outside clinical trials.

In 500 mamma needle biopsies that were cytologically examined we found a precision of 87.4%, with 2.6% false negative, and 6.2% false positive results. In 19 cases a cytological diagnosis was not possible resulting in a sensitivity of 0.94 and a specificity of 0.86. False positive findings were due to misinterpretations of the cytological pictures, as were also false negative findings. In the latter cases sampling mistakes could also be the reason. Cytological diagnostic should only be made using triple diagnostic technique since the methods are complementary to each other in respect to their diagnostic security. Practical experience in the puncturing technique as well as an experienced cytologist are prerequisites using this method successfully as a diagnostic tool.

In a epidemiological study 3840 clerks of state of North Rhein Westfalia were investigated concerning the frequency of atherosklerotic leasions of the carotid and femoral arteries in duplex scanning. 17% of all investigated showed independency to age, sex and risk factors alterations of the vessel walls. Men had twice as much plaques as women and male subjects with multiple risk factors had four times more plaques than those without.

Reported in this paper are eight cases of femoral fracture in childhood which were vertically extended according to Weber. Positioning is described in minute detail. Axial errors and lateral displacement were continuously reduced by extremely non-invasive reduction. Shortening and rotational errors were totally corrected.

In the rat stasis of duodenal and pancreatic juice, and of bile by ligatures at the duodenum with potential reflux into the stomach causes an inhibition of gastric secretion. The strongest effect presumably has the bile in connection with the distension of the duodenum. Moistening of the mucosa of gastric corpus with these juices seems to be unimportant.

The toxic megacolon is well known in colitis ulcerosa, in colitis ulcerosa, in colitis granulomatosa--Crohn's disease--it is by far rarer. The authors observed two cases among their patients. The emergency operation consisted in applying an ileostoma and several colostomata. The definitive treatment with colectomy and ileorectostomy was done after weeks respectively months.

Results in the treatment of the bleeding gastro-duodenal ulcer during a period of 21 years are analysed. The results refer to an early surgery intervention. A bleeding-stop must be tried, particularly in the elderly patient. If possible a causal therapy should be performed.

Quite a number of complications were found to occur time and again in the treatment of children for supracondylar humerus fracture, with displacement of the arm axis being a frequent long-term result. However, functionality of the arm usually has not been impaired.

The influence of the blood glucose level on the stress ulcer rat was investigated in the immobilised rat. The increase of the blood glucose was produced by injecting a 40 per cent glucose solution by means of a central venous catheter. A reduced secretion of the gastric acid and a reduced frequency of ulcers were observed with increased blood glucose.

Although bleedings in the part of the jejunoileum only amount to about 1% of bleedings of the whole gastrointestinal tract, they can raise outstanding problems because of the difficulties in discovering the sources of bleeding and their localization. The importance of intraoperative endoscopy will be emphasized by example of 5 patients who suffered from recurrent bleedings. All of the other diagnostic procedures like x-ray examinations (angiography included), endoscopy and scintigraphy were fruitless.

During 1977--1980 36 papillotomies were performed; indications for the latter were: papillary stenosis, incarcerated stones or stones which could not be removed which certainty and suspicion of a papillocarcinoma. The indications were evaluated as to whether endoscopic or surgical papillotomy should be performed. The results of the papilloplasties were considered satisfactory. In 40% of the cases a duodenobiliary reflux was observed, which however did not give troubles.

The authors examined in rats the importance of pyloric stenosis for the development of spontaneous acute ulcers and stress ulcers in the stomach. Spontaneous superficial lesions arise only during the first 20 days. They apparently signify an intensified narrowing by postoperative swelling with mechanical stimulation of gastrin secretion in the antrum. They were not observed during later periods. Chronic ulcers did not develop. Stress ulcers caused by immobilization were more frequently seen in rats with pyloric narrowing than without. Vagotomy protected the rats with pyloric stenosis from stress ulcer, although not as certain as in control animals.

The employment of the alpha receptor blocking Droperidol with and without combination of atropine for prophylaxis of the acute mucosal damage of the stomach was investigated in the experimental animal Wistar rat. The immobilisation stress in the stress roll was chosen as stress model. The animals get an infusion programme by a central venous catheter. The stomachs were searched for macroscopic mucosal changes after an immobilisation period of 6 hours. The results were certained statistically. The acute mucosal damage in the rat stomach could be prevented in 100% (p 0.05) by means of the drug combination Droperidol/atropine (IV).

In 2 patients suffering from multiple ulcerations of the jejunum preoperative diagnostic measures were unsuccessful. Only by oral intraoperative endoscopy was it possible to diagnose the cause of bleeding and treat it successfully.