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Objectives: The aim of this study was to assess whether age >=75 years impairs surgical, functional, and oncological outcomes after robot-assisted radical prostatectomy (RARP). Materials and methods: Patients with prostate cancer (PCa) were stratified in >=75(n 1/4 669) vs. =75 vs., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Die mediane Sternotomie ist in der Herzchirurgie der am haufigsten durchgefuhrte chirurgische Zugang. Gleichwohl treten postoperative Komplikationen dieses Zugangsweges auf. Diese sind teils nichtinfiziert (z. B. mechanische Sternuminstabilitat) bzw. teils infiziert (prasternale oder tief sternale Wundinfektion [„deep sternal wound infection“, DSWI]) und treten mit einer Pravalenz zwischen 2 und 5 % auf. „Deep sternal wound infections“ werden von einer erheblichen Morbiditat und Mortalitat zwischen 10 und 40 % begleitet. Die besten Ergebnisse der Behandlung und des Managements der DSWI lassen sich durch fruhzeitige Revision mit Debridement und kurzweilige offene Wundbehandlung mit Anwendung der Unterdrucktherapie („negative pressure wound therapy“, NPWT) erzielen. Die chirurgische Therapie der DSWI mithilfe der NPWT bietet einige Vorteile: Forderung der Granulation und der lokalen Durchblutung, Reduktion des vorhandenen Gewebsodems sowie Unterstutzung des Abtransports von Wundexsudat. Ziel ist die Uberfuhrung der Wunde aus der Reinigungs- (exsudative Phase) in die Granulationsphase. Ist die Wunde makroskopisch nekrose- und infektionsfrei, wird die Art des Sekundarverschlusses festgelegt. Bezuglich des Therapieerfolgs spielen neben der chirurgischen Sanierung mikrobiologische Aspekte, wie die Materialgewinnung und die Antibiotikatherapie, eine signifikante Rolle. Die meistgefurchtete Komplikation der NPWT ist die akute kardiale oder vaskulare Blutung.

Purpose An important rehabilitation aim following coronary artery bypass graft (CABG) surgery is to modify cardiovascular risk factors positively. Among the most potent possibilities for improvement of these factors is a lifestyle change in terms of increasing sports exercise, changing diet patterns, stress reduction, etc. An indispensable condition for these changes is the motivation to implement the necessary changes. In our working group a patient education programme was developed aimed at enhancing the motivation for lifestyle change, which was already applied in a cardiac surgery hospital. In evaluating the programme, we could observe that various cognitive factors of motivation for lifestyle change had dropped in untreated patients and risen in patients participating in the programme. Based on these preliminary findings we examined the motivation for lifestyle change one year after CABG surgery. Method Each patient was evaluated for his/her value in motivation for lifestyle change using a 30-item questionnaire which measures the six factors Vulnerability, Intention, Social Expectations, Outcome Expectation, Self-Efficacy Expectation, and Perceived Severity two days before CABG surgery as well as ten days and one year after CABG surgery. Between January and May 2002 patients in usual care were investigated as control group (n=70). From January to May 2003, n=70 patients had the opportunity to take part in a comprehensive patient education programme that was provided by a specifically trained psychologist. Data from 108 patients could be evaluated one year after CABG surgery (response rate=77.1%). The programme had comprised individualized units, as well as a group lecture. If partners were available they were included in the process. Results One year after CABG surgery no significant differences between the control group and the intervention group could be found. Conclusion The positive effects of the patient education programme measured ten days after surgery were found to have vanished one year after the operation. A possible reason is the short duration of the programme. Long-term, structured aftercare programmes should help stabilize the positive effects obtained in the short term.

Conventional biologic and mechanical prostheses have important limitations with regard to their hemodynamic characteristics and long-term durability. We evaluated the hemodynamic function of a stentless porcine aortic prosthesis in 10 patients by invasive pressure measurements and angiography with videodensitometry 8 +/- 4 days after operation, as well as by Doppler echocardiography 35 +/- 15 months after valve replacement. The early postoperative invasive study revealed a mean gradient of 8 +/- 6 mm Hg across the prosthesis, no regurgitation in eight patients, and mild regurgitation, defined as less than 20% regurgitant fraction, in the remaining two patients. The late postoperative Doppler echocardiographic study revealed a mean gradient across the aortic prosthesis of 6 +/- 3 mm Hg, mean Doppler-derived valve orifice area of 1.8 +/- 0.6 cm2, and color Doppler flow velocity mapping suggested no regurgitation in eight patients and mild regurgitation in two patients corresponding to early postoperative angiography. None of the 10 patients received anticoagulation therapy. The clinical course of all patients was without incident. This stentless aortic bioprosthesis may offer hemodynamic advantage; however, further studies are needed to allow comparison with conventional mechanical and biologic prostheses.

Background Hydroxyethyl starch (HES) is used for repletion of acute intravasal volume loss in surgical patients. However, in critically ill patients, HES is associated with acute kidney injury. We aimed to evaluate the effect of HES on perioperative cystatin C (cystC)-derived estimated glomerular filtration rates (eGFRcystC) in patients undergoing open and robot-assisted radical prostatectomy. Methods In this retrospective study we included 179 patients who underwent general anaesthesia for radical prostatectomy received HES perioperatively, and had complete cystC and fluid therapy data available. CystC and corresponding eGFRcystC at postoperative days 1, 3, and 5 were compared with preoperative baseline using Wilcox rank-sum test. Results In 179 eligible patients, 6 % HES 130/0.4 was administered in a median (25th to 75th percentile) dose of 1000 mL (1000 to 1000 mL). Baseline eGFRcystC was 109.4 mL/min (100.3 to 118.7 mL/min). eGFRcystC on postoperative days 1, 3, and 5 was 120.4 mL/min (109.4 to 134.0 mL/min), 120.4 mL/min (109.4 to 132.9 mL/min), and 117.9 mL/min (106.6 to 129.8 mL/min), respectively (p