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ZusammenfassungDie Entwicklung der Adipositas-Chirurgie hat in Deutschland eine etwas andere Entwicklung als in den meisten anderen westlichen Ländern genommen. Verursacht durch die sehr restriktive Haltung der Krankenkassen, wurde eine langsame, aber von einer guten Struktur begleitete Entwicklung der Adipositas-Chirurgie notwendig. Die niedrigen Raten an Komplikationen und einer Mortalität von weniger als 0,5%, die in den Registerstudien ausgewiesen wird, belegen die hohe Versorgungsqualität.Mit der Initiative „Leitliniengerechte Operation ohne Kostenzusage“, die seit 2018 durch die CAADIP propagiert wird, hat zu einer Vereinfachung des Verfahrens zum Nutzen der Patienten in vielen Kliniken geführt. Im internationalen Vergleich werden aber immer noch unterdurchschnittlich wenige Patienten operativ versorgt. Die Verfahrenswahl ist vergleichbar mit der des Auslandes, die Schlauchmagenoperation ist inzwischen auch in Deutschland die häufigste Operationsform geworden.

While minimally invasive surgery is a growing sector in medicine, camera assistance remains a problem. Especially in bariatric surgery, the assistant holding the camera faces certain challenges. Furthermore, unless the surgeon controls the camera movement themselves, they will be challenged by an unstable image. The aim of this study was to investigate the benefits of a robotic camera assistant (SoloAssist®, AKTORmed™ GmbH, Barbing, Germany) in bariatric surgery.Three hundred thirty one consecutive laparoscopic bariatric procedures were performed with the assistance of a camera robot, including Roux-en-Y gastric bypass, laparoscopic gastric banding, sleeve gastrectomy, and gastroplication. Failures and aborts were documented and 6 surgeons were interviewed regarding their experiences using a questionnaire.In 18 of 331 procedures, robotic assistance was aborted and the procedure was continued manually, mostly because of a need for frequent changes of position in narrow spaces and adverse angles. Two short circuits, 4 joystick faliures and one malfunction of the control unit were reported. All of the surgeons preferred robotic to human assistance, mostly because of a steady image and the capacity for self-control.The SoloAssist® is a reliable system for minimal invasive procedures, especially in bariatric surgery. It provides more comfortable conditions for the surgeon and their assistant by freeing one hand for other purposes. Even in narrow spaces (e.g., between a voluminous stomach and adipose liver), the robot guarantees a steady image. Slight movements of the camera can be precisely controlled, which leads to increased comfort for the surgeon.

Since January 1st, 2005, the current situation for bariatric surgery has been examined by means of a voluntary quality assurance study in Germany with a multicenter design in which 38 hospitals and surgical departments participated. The data are registered in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University of Magdeburg (Germany).Data describing peri-interventional characteristics were prospectively documented in an internet online data registry. All primary bariatric procedures performed since January 1st, 2005, were registered. In addition, reoperations in patients who had previously undergone primary surgical intervention were included. As a representative excerpt from the overall prospective multicenter observational study on obesity surgery, data on the type, regimen, and time course of deep venous thrombosis (DVT) prophylaxis were documented. From the number and spectrum of complications, the incidences of clinically manifest DVT or pulmonary embolism (PE) were derived during the in-hospital course and follow-up in conjunction with the type of surgical procedure and body mass index (BMI).Overall, 3,122 bariatric procedures were performed at 38 German hospitals between January 2005 and December 2007. These procedures were subdivided into 2,869 primary operations and 253 revisions (sex ratio, male to female = 25.6:74.4%). The average BMI of all patients was 48.5 kg/m(2) in 2005, 48.4 kg/m(2) in 2006, and 48.0 kg/m(2) in 2007. In 2005 and 2006, gastric banding (GB) was the most commonly performed operation, followed by Roux-en-Y gastric bypass (RYGBP). In 2007, RYGBP was carried out in 42.1% of all bariatric procedures. Interestingly, the incidence of deep venous thrombosis (DVT) was only 0.06%, whereas PE occurred in 0.06% of patients only after hospital discharge. The DVT prophylaxis protocol used has been changed for the last 2 years: the majority of patients with a BMI above 50 kg/m(2) received low-molecular-weight heparin twice a day.In Germany, a trend from GB to sleeve gastrectomy (SG) and malabsorptive approach has been evaluated. This trend is associated with differences of the DVT prophylaxis regimen in the profile of bariatric surgical patients depending on BMI and the type of bariatric procedure. Despite the low incidence of DVT and pulmonary embolism (PE) detected, there is a lack of evidence on a reasonable regimen for sufficient DVT prophylaxis in bariatric surgery; instead, there are only recommendations from the guidelines and statements of a specific medical society. Therefore, prospective studies are necessary to determine the optimal DVT prophylaxis for bariatric surgical patients as well as obese patients undergoing surgery.

Most studies on bariatric surgery outcomes are performed as clinical trials or reflect the clinical experience in single centers. The status of bariatric surgery in Germany has been examined since January 1st, 2005 with the cooperation of clinics and hospitals at the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University of Magdeburg (Germany).In this prospective multicenter observational study, the data obtained for all primary bariatric procedures, including all repeated operations, performed on consecutive patients with morbid obesity at participating hospitals from 2005 to 2007 were prospectively collected using an Internet online data registry. In particular, perioperative characteristics, such as the spectrum of diagnostic measurements, type of surgical procedures, and short- and long-term outcomes, were investigated.During the study period, 629 surgical procedures were performed at 21 hospitals in 2005, 828 procedures at 32 hospitals in 2006, and 1,666 procedures at 35 hospitals in 2007. In 2005 and 2006, gastric banding was the most frequently performed operation, followed by the Roux-en-Y gastric bypass (RYGBP). In 2007, a RYGBP was carried out in 42.1% of all bariatric procedures. Among all patients, 74.4% were female. The mean body mass index (BMI) was 48.5 kg/m(2) in 2005, 48.4 kg/m(2) in 2006, and 48.0 kg/m(2) in 2007. Follow-up data after 12 months were available for 63.8% of the patients in 2005 and 2006; these data showed greater reduction of BMI after malabsorptive rather than restrictive bariatric procedures. The mortality was 0.1% (30 days) and 0.16% (overall).As indicated by the worldwide trend, there is an ongoing change from restrictive bariatric procedures to malabsorptive procedures and sleeve gastrectomy. Although the BMIs of German patients undergoing bariatric surgery appear to be substantially higher than those of patients from most other countries, there were no differences in intraoperative and short-term complications or in overall outcomes during follow-up when compared with published studies.

BACKGROUND: Since January 1 st 2005, the situation of bariatric surgery in Germany has been examined. The data are registered in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke-University Magdeburg. METHODS: The data registration took place prospectively in an internet online data base. All primary bariatric procedures performed since January 1 st 2005 were detected as well as re-operations in patients who had been operated before. RESULTS: 629 patients underwent bariatric surgery in 21 hospitals in 2005 and 828 patients were operated in 32 hospitals in 2006. The mostly performed operation was gastric banding with 46.8 %, followed by Roux-Y gastric bypass with 38.5 %. 74.4 % of the patients were female. The medium BMI of all patients was 48.5 kg / m 2 in 2005 and 48.4 kg / m 2 in 2006. Follow-up data were available for 71.2 % of the patients operated in 2005. These data show a higher reduction of BMI after malabsorptive than after restrictive bariatric procedures. CONCLUSION: A trend from restrictive bariatric procedures to a malabsorptive approach could be observed. In Germany the BMI of patients undergoing bariatric surgery is higher than in most countries world-wide. No differences could be detected in intraoperative and short-term complications as well in the complication rate in the first year of follow-up in comparison with the literature.

Thromboembolic complications continue to be one of the main reasons for perioperative mortality in bariatric surgery. There is no consensus on which is the safest and most effective thromboprophylaxis. This prospective study aims to evaluate the significance of thrombophilia screening and a venous duplex sonography in bariatric patients. One hundred one patients were tested for coagulopathies (activated protein C (APC) resistance, factor II, antithrombin (AT)III, protein S and C). Perioperatively, the patients underwent a venous duplex sonography. A multimodal thromboprophylaxis protocol was set up: 2× 40 mg enoxaparin sodium per day and sequential pneumatic compressions of the lower extremities. In six patients, we identified previously unknown risk factors for thromboembolic complications. Protein S deficiency is found significantly more often in obese patients than in the general population. There are numerous risk factors which, in themselves, increase the risk of venous thromboembolism. In obese patients with obstructive sleep apnea or diabetes mellitus, thrombophilia is found significantly more often than in patients without these diseases. No postoperative thromboses occurred. The bariatric patient is a potential high-risk patient for venous thromboembolism. Thrombophilia is found significantly more often in obese patients than in the general population. Conceivably, existing conditions such as obstructive sleep apnea and diabetes mellitus have until today been underestimated regarding the entailing thrombosis risk. Thrombophilia screening and duplex sonography are possibilities for identifying patients at risk. The advantage of a reduced risk thanks to an adapted thromboprophylaxis based on the patient’s individual risk profile justifies the relative increase in time and cost.

Despite advances in instruments and techniques in laparoscopic surgery, one thing remains uncomfortable: the camera assistance. The aim of this study was to investigate the benefit of a joystick-guided camera holder (SoloAssist®, Aktormed, Barbing, Germany) for laparoscopic surgery and to compare the robotic assistance to human assistance. 1033 consecutive laparoscopic procedures were performed assisted by the SoloAssist®. Failures and aborts were documented and nine surgeons were interviewed by questionnaire regarding their experiences. In 71 of 1033 procedures, robotic assistance was aborted and the procedure was continued manually, mostly because of frequent changes of position, narrow spaces, and adverse angular degrees. One case of short circuit was reported. Emergency stop was necessary in three cases due to uncontrolled movement into the abdominal cavity. Eight of nine surgeons prefer robotic to human assistance, mostly because of a steady image and self-control. The SoloAssist® robot is a reliable system for laparoscopic procedures. Emergency shutdown was necessary in only three cases. Some minor weak spots could have been identified. Most surgeons prefer robotic assistance to human assistance. We feel that the SoloAssist® makes standard laparoscopic surgery more comfortable and further development is desirable, but it cannot fully replace a human assistant.

Pancreatic cancer remains a highly malignant disease. Curative treatment is only possible for patients diagnosed at a very early stage. Therefore, the vast majority of pancreatic cancer patients receive palliative treatment. Surgical palliation is offered to patients who are found not to have a resectable tumor. The treatment of obstructive jaundice is managed by stenting of the common bile duct or by a surgical bypass. The best possible surgical procedure should be based on the factors that influence hospital mortality, length of survival, and quality of life. In patients with a life expectancy of longer than 3 months, surgical bypass is recommended, with hepaticojejunostomy the treatment of choice. In the same surgical procedure, the relief of duodenal obstruction with a gastroenteric bypass should be achieved. Chemotherapy, radiotherapy, or a combination of both is employed as a neoadjuvant measure, as an adjuvant treatment, or, in most patients, as palliation. As palliative chemotherapy alone, 5-fluorouracil (5-FU) plus folinic acid is still the treatment of choice; however, newer drugs, such as gemcitabine, seem to have similar or marginally better results. Palliative radiochemotherapy with external-beam radiation plus 5-FU and folinic acid seems to lead to better local control of tumor progression but not to better survival, for which distant metastases are the limiting factor.

Background Serous cystadenoma of the pancreas is commonly considered to be a benign neoplasm and therefore a more conservative surgical attitude is suggested, leaving resection for symptomatic patients or those who develop complications. Recently some malignant forms of serous cystadenoma leading to liver metastasis, perineural invasion and vascular invasion have been reported, thus challenging the benign status of serous cystadenomas. Methods Between January 1986 and October 1998 25 patients with serous cystic neoplasms of the pancreas were operated at our Institution. Three of the 25 tumours (12%) showed a malignant behaviour on histological assessment, whereas two patients with serous cystadenoma (8%) revealed an association with ductal adenocarcinoma. Results Three patients had symptomatic lesions. The preoperative radiological imaging identified the tumours, but did not help to determine malignancy. Serum CA 19.9 values were within the normal range in the three patients with serous cystoadenocarcinoma, but were elevated in the two patients with associated ductal adenocarcinoma. All tumours could be resected in toto . In each case, histology revealed malignant behaviour: pancreatic and peripancreatic tissue infiltration associated with either lymph node metastasis ( n = 1), perineural and lymph node invasion ( n = 1), infiltration of the adjacent adrenal gland ( n = 1) or association with ductal adenocarcinoma ( n = 2). Three patients are presently alive and free of disease at a mean follow-up of 30 months. One patient with serous cystadenocarcinoma was re-operated for recurrence 19 months after the primary operation. One patient with serous cystadenocarcinoma died of a cerebrovascular accident (but free of disease) 41 months after resection. One patient with associated ductal adenocarcinoma died six months after operation because of tumour progression. Conclusion Oncological surgical resection is recommended in serous cystic neoplasms of the pancreas to rule out malignancy.

Background: The surgical therapy of ductal adenocarcinoma of the pancreas is well standardized around the world, with the exception of the extent of the resection of regional lymph nodes and peripancreatic soft tissue. This much-debated issue has become apparent after several Japanese reports that were able to demonstrate better survival after extensive lymph-node clearance. These results, however, could not be achieved using similar techniques in the Western world. The reason for these apparent differences in surgical results result from the application of two different staging systems (UICC and JPS) and the fact that the study designs of the compared trials are not comparable. The most desirable source of information coming from a randomized controlled study is, to date, only available from one trial which was not able to demonstrate a significant survival difference. Conclusion: So far, there is no substantial proof that extensive lymph-node clearance is beneficial for the patient. It has been shown, however, that in specialized centers these procedures do not carry an increased risk of perioperative morbidity and mortality compared with standard resections. In those institutions, the efficacy of extended resections needs to be further evaluated in prospective randomized trials, preferably based on the “International Documentation System for Pancreatic Cancer”, which allows data acquisition independent of the staging system applied.

Aus epidemiologischen Untersuchungen ist bekannt, das bei ca. 50 % der Kinder mit einseitiger Leistenhernie auf der Gegenseite ebenfalls ein offener Processus vaginalis vorliegt. 10–25 % dieser Kinder entwickeln in der Folge eine kontralaterale Hernie. Seit 1996 wird in unserer Klinik bei Sauglingen und Kindern mit klinisch unilateraler Leistenhernie mittels intraoperativer Laparoskopie durch den eroffneten Bruchsack der kontralaterale innere Leistenring inspiziert. Vorgehen: Bisher wurden 112 Kinder untersucht (Alter: 6 Monate bis 7 Jahre; 78 Jungen, 34 Madchen). Nach Freipraparation des Bruchsacks wurde dieser eroffnet und ein 5,5-mm-Trokar durch den inneren Leistenring eingebracht. Nach Anlage des Pneumoperitoneums erfolgte mit einer 5-mm-(30 °)-Optik zunachst die orientierende Laparoskopie, anschliesend mit der 70 °-Optik die Inspektion des kontralateralen inneren Leistenrings. Ergaben sich Hinweise fur einen breit offenen Processus vaginalis (Typ III nach Chin), wurde in gleicher Narkose diese Seite ebenfalls offen chirurgisch exploriert. Ergebnisse: Laparoskopisch fand sich bei 19 Patienten (17 %) ein nach oben genannten Kriterien pathologischer Befund (6 Madchen, 13 Jungen). Diese wurden auf der Gegenseite operiert und die laparoskopische Diagnose in allen Fallen bestatigt. Verfahrensbedingte Komplikationen traten nicht auf. Die Eingriffe erfolgten im Rahmen der Eintageschirurgie. Die Operationsdauer erhohte sich durch die intraoperative Laparoskopie um im Median 6 min (3–11 min). Deutlich haufiger fanden sich pathologische Befunde bei Patienten unter 2 Jahren (14 von 19 Patienten). Schlusfolgerungen: Das beschriebene Verfahren erlaubt ohne nennenswerten zusatzlichen Zeitbedarf, Patienten zu selektionieren, die von einer einzeitigen offenen Exploration der gegenseitigen Leistenregion profitieren. Somit konnen Zweitoperationen mit erneuter Narkose und Hospitalisierung vermieden werden. Zusatzlich erlaubt die intraoperative Laparoskopie die allgemeine Beurteilung der Abdominalorgane sowie Klarung spezieller Fragen wie, z. B. die Vitalitat reponierter Darmschlingen.

Approximately 40% of children with a clinical unilateral inguinal hernia display a patent processus vaginalis on the contralateral side; half of these children subsequently develop an inguinal hernia. The management of this problem is still controversial. Different strategies to identify patients who profit from an open contralateral exploration have been applied (diagnostic pneumoperitoneum, herniography, ultrasound). The purpose of this study was to evaluate the usefulness of intraoperative laparoscopy in a no-puncture technique through the opened hernia sack. In 75 children (age 6 months to 7 years) with clinical unilateral hernia laparoscopy (5-mm Laparoscope, 30 degrees and 70 degrees ), in cases of wide-open contralateral internal inguinal ring (Type III) an open surgical exploration was performed. Twelve patients (17%) fulfilled the laparoscopic criteria of a Type III ring. The diagnose was confirmed during open contralateral exploration. Seven children (8%) showed a patent but small processus vaginalis with a shallow internal ring. These patients were treated conservatively. In the follow-up period (median 6 months) one subsequent hernia developed. There was no technical failure, and no associated complications were seen. The median time for laparoscopy was 6 minutes. Intraoperative laparoscopy during unilateral hernia repair allows the identification of patients who profit from bilateral open surgery during the same operation with little additional operating time, and so far with no resulting complications. Application of this method may avoid a second hospitalization and operation as well as unnecessary routine bilateral open exploration. As an additional source of information through excellent visualization of the abdominal cavity, this method proved helpful to examine the incarcerated bowel after repositioning.

BACKGROUND: Most studies on bariatric surgery outcomes are performed as clinical trials or reflect the clinical experience in single centers. The status of bariatric surgery in Germany has been examined with the cooperation of clinics and hospitals at the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University of Magdeburg (Germany) since January 1, 2005. METHODS: In this prospective multicenter observational study, the data obtained for all primary bariatric procedures, including all repeated operations, performed on consecutive patients with morbid obesity at participating hospitals from 2005 to 2007 were prospectively collected using an internet online data registry. Perioperative characteristics such as the spectrum of diagnostic measurements, type of surgical procedures, and short-and long-term out comes were investigated. RESULTS: During the study period 3,123 surgical procedures were performed. In 2005 and 2006, gastric banding (GB) was the operation performed most frequently, followed by the Roux-en-Y gastric bypass (RYGBP). In 2007, a RYGBP was carried out in 42.1% of all bariatric procedures. Among all patients, 74.4% were female. The mean BMI ranged from 48.5 kg/m(2) in 2005 to 48.0 kg/m(2) in 2007. Follow-up data after 12 months were available for 63.8% of the patients operated in 2005 and 2006. The mortality was 0.1% (30 days) and 0.16% (overall). CONCLUSION: As indicated by the worldwide trend, there is an ongoing change from GB to sleeve gastrectomy (SG) and malabsorptive procedures. The BMI of German bariatric surgical patients is substantially higher than that of patients from most other countries. There were no differences in overall outcomes during follow-up as compared to published studies.

The goal of modern laparoscopic hernia repair is to achieve a high standard of patient safety with a low threshold of hernia recurrence and chronic inguinal pain. In the absence of fixating devices and the use of the self-gripping Parietene and Parietex ProGrip mesh (Covidien AG, Zurich, Switzerland) was evaluated in this prospective clinical study. The incidence of chronic pain, postoperative complications, patient satisfaction, and hernia recurrence at follow-up after 12 and 24 months was recorded.Data were collected retrospectively from patient files and were analyzed for 405 male and female patients with 483 primary inguinal hernias. All patients included had undergone surgical repair for inguinal hernia by the laparoscopic transabdominal preperitoneal (TAPP) approach using Parietex ProGrip meshes performed in the same clinical center in Germany. Pre-, peri-, and postoperative data were collected and a follow-up after 12 and 24 months was performed prospectively. Complications, pain scored on a 0 to 10 NRS scale, patient satisfaction, and hernia recurrence were assessed.The only complications were minor and were postoperative: hematoma/seroma (nine cases), secondary hemorrhage through the trocar's site (eight cases), hematuria, emphysema in the inguinal regions (both sides), and swelling above the genital organs (one case for each). Two patients had to be reoperated due to a hematoma in inguinal canal. At mean follow-up at 22.8 months, there were only eight reports of hernia recurrence: 1.9% of the hernias. Most patients (94.9%) were satisfied or very satisfied with their hernia repair with only 1.2% reporting severe pain (NRS score 7 to 10) and 3.6% reported mild pain.This study demonstrates that, in experienced hands, inguinal hernia repair surgery performed by laparoscopic transabdominal preperitoneal hernioplasty using Parietene and Parietex ProGrip self-gripping meshes is rapid, efficient, and safe with low pain and low hernia recurrence rate. Since no fixating device or glue is necessary for the procedure, additional cost-effectiveness is achieved.

Oxygen radicals mediate an important step in the initiation of acute pancreatitis. These reactive oxygen metabolites are generated at an early stage of the disease. The source of the enhanced production of oxygen radicals, however, still remains unclear. Experimentally, the effectiveness of antioxidant treatment varies from one model to the other, the differences depending on the experimental model and not on the form of pancreatitis that was induced. In most studies, the experimental animals were pretreated before acute pancreatitis was induced. This does not mirror clinical reality because patients are admitted to the hospital after the onset of the disease. It was shown in cerulein-induced pancreatitis, however, that scavenger treatment also mitigated the pancreatic tissue damage after induction of acute pancreatitis. Moreover, antioxidant treatment also attenuated the extrapancreatic complications, thus improving the final outcome of the disease. Initial indirect observations also suggest that in human acute, acute recurrent, and chronic pancreatitis, oxygen free radicals are generated and add to the damage. Concomitantly, these patients suffer from a severe depletion of oxidative stress. Whether or not this disbalance is instrumental in the development and course of disease remains unanswered. Supplementation with antioxidants that are deficient in patients with acute pancreatitis might be a feasible option to the present therapy to avoid extrapancreatic complications. Well-defined, controlled clinical trials involving patients suffering from acute pancreatitis are therefore needed to validate the role of oxygen radicals in this disease.

Obwohl Über die laparoskopische Sleeve-Gastrektomie (LSG) noch keine ausreichenden Langzeitergebnisse vorliegen, wird diese Operation mitzunehmender Euphorie durchgefÜhrt. Multicenter-Studien sind in der Rekrutierungsphase, Langzeitergebnisse werden erst in 2–3 Jahren erwartet. Die LSG wird allgemein als eine zÜgig durchfÜhrbare und wenig traumatisierende Operation angesehen. Es gelten aber die gleichen GrundsÄtze der laparoskopischen Chirurgie: sorgfÄltige PrÄparationen, Vermeidung von kreuzenden Klammernahtreihen und das frÜhe Erkennen und Beherrschen von Leckagen. Nur so kann ein hoher operativer Standard gewÄhrleistet werden. Wir verwenden einen 32-CharriÈre-Magenbougie; daraus sollte ein circa 80–100 ml großer Schlauchmagen und ein Magenresektat mit mindestens 1000 ml FÜllungsvolumen resultieren. Werden diese Benchmarks angestrebt, kÖnnen Übergewichtsverluste (EWL) von circa 60% nach 1 Jahr erzielt werden. Sleeve Gastrectomy — Technique, Safety, Success, Trends Despite the lack of sufficient data concerning the long-time results, the morbidity, and the mortality of laparoscopic sleeve resection, this operation is performed with growing enthusiasm. However, general principles of laparoscopic surgery need to be observed to ensure good results. This article describes an operative technique and indication for the operation. Attention must be turned on the complete liberation of the dorsal aspect of the stomach, the absence of crossing staple lines, and the competent handling of intraoperative leakages. The use of a 32 Fr bougie results in a residual stomach volume of about 80—100 ml. Due to a good operative technique and a competent follow-up, excess weight loss (EWL) of about 60% can be achieved within the first postoperative year.

Bituminous coals of the Sydney Basin (Nova Scotia, Canada) contain some 30 ppm of rare earth elements (REE) dispersed in illite clay and macerals or concentrated in fossil apatite and resistate minerals (monazite, florencite, xenotime, zircon). For high-ash coals, the bulk of REE are derived from suspended river sediments. Low ash bituminous coals contain some heavy REE complexed with the organic phase or adsorbed by authigenic clays and derived largely from dissolved river load. The concentration of ΣREE in coal ash (72 to 483 ppm) is similar to that of roof and seat clays except for slight local enrichments in heavy REE. Individual seams have diverse REE distribution patterns that reflect the depositional and diagenetic mineralogy, or reveal enrichment at seam margins by organic complexing or fossil apatite uptake. Chondrite-normalized profiles range from light-REE enriched, to heavy-REE enriched. Highly pyritized bands yield ash low in REE with flat profiles. Clay-rich bands yield ash with distribution patterns similar to shales with light-REE enrichment, a weak negative Eu anomaly and a profile slope correlated to Al content. Rare earth element partitioning between organic and mineral phases or between coals and associated strata, differs over the coalfield, reflecting the combined effects of sedimentation, water chemistry, ion-exchange and chelation. Coal seam correlation using REE distribution is limited by geochemical facies. Distribution patterns must be interpreted with caution because of analytical problems inherent to coal.

There is overwhelming consensus that quality of life assessment is urgently required in pancreatic cancer, yet little research has been conducted. We report on the development of a disease specific questionnaire module to supplement the EORTC core cancer module, the QLQ-C30 in patients with pancreatic cancer, using EORTC quality of life study group guidelines for module development. Relevant QoL issues were generated from literature searches and interviews with health professionals and patients with pancreatic cancer. Issues were constructed into items and provisionally translated. The provisional module was pretested in patients in 8 European centres. The resulting module the QLQ-PAN26 includes 26 items related to disease symptoms, treatment side-effects and emotional issues specific to pancreatic cancer. This should ensure that the module will be sensitive to assess the small but important disease and treatment related QoL changes in pancreatic cancer. The use of the QLQ-C30 and QLQ-PAN26 will provide a comprehensive system of QoL assessment in international trials of pancreatic cancer.

Beginning January 1, 2005, the status and outcomes of bariatric surgery were examined in Germany. Data are registered in cooperation with the An-Institute of quality assurance in surgery at the Otto-von-Guericke-University Magdeburg. The objective of this study was to examine the morbidity and mortality rates secondary to sleeve gastrectomy (SG) in Germany since 2006.Data collection occurred prospectively in an online data bank. All primary bariatric procedures performed were recorded as were all re-operations in patients that had already undergone a primary operation. Specific data compiled on the sleeve gastrectomy procedure were evaluated with a focus on operative details and complication rates.The total study cohort contains 3,122 patients. From January 2006 to December 2007, 144 sleeve gastrectomy procedures were performed in the 17 hospitals participating in the study. The mean body mass index (BMI) of all patients was 48.8 kg/m(2). The BMI of patients undergoing SG was 54.5 kg/m(2). In total, 73.8% of the patients were female and 26.2% of the patients were male. There were no significant differences between patients undergoing SG. The general complication rate after SG was 14.1%, and the surgical complication rate was 9.4%. The postoperative mortality rate was 1.4%.The complication rate during the first 2 years after SG in Germany is similar to that published in the literature. In order to improve the quality of bariatric surgery, an evaluation of data from a German multicenter trial is necessary to evaluate the position of SG in the bariatric algorithm.