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BACKGROUND AND AIMS The risk of biologics in the peri-operative setting in IBD is still discussed controversially. Recently, the large prospective PUCCINI trial could demonstrate that direct exposure to TNF-blockers within 12 weeks before abdominal surgery was not associated with a higher risk of infectious complications. However, in daily clinical practice experiences on biological treatment perioperatively are limited. In our current retrospective trial, we addressed the safety of different biologicals in a peri-operative setting. METHODS Eligible IBD patients in this single center study were recruited from our Munich IBD center between January 2012 and May 2022, who underwent bowel surgery at our Department of Surgery. Direct exposure to biologics was defined as exposure to biologics within 12 weeks before abdominal surgery. To evaluate safety, the postoperative outcome focused on minor complications, defined as infectious complications, wound healing complications and major complications, defined as insufficiency of the anastomosis and abscess formation at the surgery site postoperatively. RESULTS A total of 447 IBD patients (334 CD/113 UC, 51.9% female) were included and were followed for a median time of 45 months [range 0-113]. Median age was 44 years [19-89], median age at diagnosis was 24 years [5-84] and median age at surgery was 41 years [16/85]. Median disease duration until surgery was 11 years [0-47]. With 74.3%, the majority of IBD patients had moderate to severe IBD disease activity at date of surgery. A total of 73.9% (326/447) had medical treatment at date of surgery, 61.5% (275/447) were treated with biologics within 3 months before surgery and 42.3% (189/447) had biologics within 4 weeks before surgery. Overall, 36.9% of patients (164/447) received infliximab, 13.0% (58/447) adalimumab, 1.1% (6/447) golimumab, 5.8% (26/447) vedolizumab, 6.5% (29/447) ustekinumab, perioperatively. The majority of surgeries was planned electively (97.1%, 434/447), and performed laparoscopically (67.8%, 303/447). Minor and major postoperative complications occurred in 20.8% (93/447) of patients. Serious complications were observed in a total of 9 patients, six patients had acute bleeding complications postoperatively, 1 patient developed peritonitis and 2 CD patients died postoperatively, one with and one without biologics. No significant differences regarding complications and safety were observed between patients with versus without biologic treatment. Interestingly, CD patients with direct exposure to biologics were more likely to undergo minimal-invasive surgery (63.1%, 135/214) than patients without exposure (28.3%, 34/120, p CONCLUSIONS This retrospective single center study of 447 IBD patients could demonstrate that biologic treatment before sugery, even within 4 weeks, is not associated with a higher risk of complications.

Background/aim Colon interposition counts among the most common techniques for reconstruction after esophagectomy. Availability of data on metachronous mucosal pathologies is weak. The aim of this review was to identify all reports on the development of metachronous adenoma and adenocarcinoma in colon interposition after esophagectomy in adulthood. Materials and methods A comprehensive search was conducted in MEDLINE/PubMed, Science Direct, Cochrane Library, Bayerische Staatsbibliothek Munchen. All studies reporting on patients who received colon interposition as substitute after esophagectomy in adulthood for benign and malignant reasons were included. Results Five retrospective studies were included, reporting on 1016 patients. Therein, no interval lesion was identified. One further study, which formally must be excluded for a misfit to inclusion criteria reports on three interval carcinomas within 365 patients. Because these lesions were the only ones found within a cohort analysis, results were supplementary reported in this review. Additionally, 31 case reports including 32 patients with benign (n=7) or malignant (n=25) findings were analyzed. Median age was 63.5 years (interval carcinoma) and 69 years (benign lesion). Benign and malignant lesions were diagnosed after a median of 8.5 years. Conclusion Due to the rareness of respective cohort studies, the frequency of metachronous lesions cannot be calculated accurately. The estimated rate of interval carcinoma is 0-0.22%. Life-long endoscopic surveillance of patients with colon interposition is recommended.

Zusammenfassung Einleitung Die Stuhltransplantation (Fäkaler Mikrobiota-Transfer, FMT) stellt eine mögliche Behandlungsoption für die rezidivierende pseudomembranöse Colitis dar. Zusätzlich gibt es Hinweise, dass die FMT auch in der Behandlung der Colitis ulcerosa wirksam ist. Ziel dieser Studie ist die Untersuchung hinsichtlich Akzeptanz auf Patientenseite anhand eines Fragebogens. Methodik Ein standardisierter Fragebogen aus 27 geschlossenen Fragen wurde an eine Patientenkohorte von 262 Patienten mit Colitis ulcerosa versendet. Inhalt waren Fragen u. a. zu Ablauf der FMT, Spendern sowie möglichen Bedenken. Zusätzlich wurden Aspekte des sozialen Hintergrunds sowie zur Krankheitsaktivität der Colitis ulcerosa evaluiert. Ergebnis Die Rücklaufrate der Fragebögen lag bei 31,3 % (n = 82). 48 (58,5 %) der Patienten war die FMT bekannt. 46 (56,1 %) gaben an, bei entsprechender Indikation eine FMT durchführen zu lassen. Als Hauptmotivation wurde von 33 Patienten (40,2 %) die (vorausgesetzte) Wirksamkeit des Verfahrens sowie von 14 (17,1 %) Patienten ein Versagen aller anderen Therapien (17,1 %) genannt. Bedenken bestanden im Hinblick auf die mangelnde Testung des Transplantats hinsichtlich möglicher Infektionserreger (22, 28,9 %) sowie eine potenzielle Kontamination des Transplantats mit Gefahr einer möglichen (nachteiligen) Beeinflussung des aktuellen Krankheitsverlaufs (17, 20,7 %).Als Verabreichungsform bevorzugten 55 Patienten (67,1 %) die FMT in Tablettenform, gefolgt von einer koloskopischen Applikation (36, 43,9 %). Als Spender wurde die vom behandelnden Arzt vorgeschlagene Person (43, 52,4 %) favorisiert. Die Bereitschaft zur FMT unterschied sich bei beiden Geschlechtern nicht signifikant (56,4 % bei ♀ vs. 57,1 % bei ♂). Bei Rauchern (88,9 %), Patienten, die auf Fernsehkonsum verzichten (77,8 %) sowie Patienten mit privater Krankenversicherung (70,6 %) war die Akzeptanz der FMT besonders hoch. Schlussfolgerung Die FMT stellt für die Mehrheit der durch uns befragten Patienten mit Colitis ulcerosa eine erwägenswerte Therapieform mit bereits hohem Bekanntheitsgrad dar. Knapp die Hälfte der Befragten würden unter bestimmten Voraussetzungen trotz mindestens zufriedenstellenden Ansprechens auf die bisherige (konventionelle) Therapie eine FMT als alternative Behandlung erwägen. Erwartungsgemäß bestehen Bedenken im Hinblick auf die Übertragung möglicher Krankheitserreger sowie hinsichtlich der hygienekonformen Durchführung des Verfahrens.

Zusammenfassung Einleitung Systematische Untersuchungen zum objektiven Verständnis von Patienten bezüglich häufiger medizinischer Begriffe in Deutschland sind selten. Methodik 196 Patienten (38 % weiblich, 62 % männlich) in stationären Fachabteilungen an einem kommunalen Krankenhaus wurden mittels eines zuvor entwickelten Fragebogens untersucht. Dieser enthielt 43 Fragen zu häufig im Alltag vorkommenden medizinischen Fachbegriffen. Untersucht wurden der subjektive und objektive Bekanntheitsgrad. Zusätzlich wurde eine Assoziation mit verschiedenen potenziellen Einflussfaktoren (u. a. Ausbildung, Versicherungsstatus, Konsum bestimmter Informationsmedien) durchgeführt. Ergebnisse Durchgehend gaben mehr Patienten an, die Bedeutung medizinischer Begriffe zu kennen, als dies bei objektiver Überprüfung der Fall war. Die Assoziation des medizinischen Kenntnisstandes mit verschiedenen Einflussfaktoren ergab, dass Frauen häufiger über korrektes medizinisches Wissen verfügten als Männer (51,1 vs. 47,2 %, p = 0,12). Das Lebensalter war negativ mit dem medizinischen Kenntnisstand korreliert (p Fazit Ein hoher Bekanntheitsgrad medizinischer Begriffe kann Ärzte im Anamnesegespräch dazu verleiten, das Verständnis dieser Begriffe auch von Seiten des Patienten stillschweigend vorauszusetzen. Ärzte sollten daher durch aktives Nachfragen das Verständnis beim Patienten sicherstellen. Zukünftige Erhebungen zur Gesundheitskompetenz auf Patientenseite sollten diese Divergenz zwischen subjektiver Einschätzung und objektivem Wissen berücksichtigen.

IntroductionAcute diverticulitis of the sigmoid colon is increasingly treated by a non-operative approach. The need for colectomy after recovery from a flare of acute diverticulitis of the left colon, complicated diverticular abscess is still controversial. The primary aim of this study is to assess the risk of interval emergency surgery by systematic review and meta-analysis.Methods and analysisThe systematic review and meta-analysis will be conducted in accordance to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. PubMed/MEDLINE, Cochrane Central Register of Controlled Trials and EMBASE will be screened for the predefined searching term: (Diverticulitis OR Diverticulum) AND (Abscess OR pelvic abscess OR pericolic abscess OR intraabdominal abscess) AND (surgery OR operation OR sigmoidectomy OR drainage OR percutaneous drainage OR conservative therapy OR watchful waiting). All studies published in an English or German-speaking peer-reviewed journal will be suitable for this analysis. Case reports, case series of less than five patients, studies without follow-up information, systematic and non-systematic reviews and meta-analyses will be excluded. Primary endpoint is the rate of interval emergency surgery. Using the Review Manager Software (Review Manager/RevMan, V.5.3, Copenhagen, The Nordic Cochrane Centre, The Cochrane Collaboration, 2012) meta-analysis will be pooled using the Mantel-Haenszel method for random effects. The Risk of Bias in Non-randomized Studies of Interventions tool will be used to assess methodological quality of non-randomised studies. Risk of bias in randomised studies will be assessed using the Cochrane developed RoB 2-tool.Ethics and disseminationAs no new data are being collected, ethical approval is exempt for this study. This systematic review is to provide a new insight on the need for surgical treatment after a first attack of acute diverticulitis, complicated by intra-abdominal or pelvic abscesses. The results of this study will be presented at national and international meetings and published in a peer-reviewed journal.PROSPERO registration numberCRD42020164813.

Hepatic encephalopathy (HE), in the context of liver cirrhosis, seems to result from low-grade cerebral edema of the astrocytes. Serum brain biomarkers S-100-beta und neuron-specific enolase (NSE) are often elevated in brain injury. We hypothesized that neuromarkers S-100-beta and NSE can be used in the diagnosis of HE, compared with standardized diagnostic tools.A prospective non-randomized intervention study was performed using L-ornithine-L-aspartate (LOLA) for HE treatment. Primary endpoint was the evaluation of neuromarkers S-100-beta and NSE for detection and diagnosis of follow-up of HE. As secondary endpoints, the efficacy of LOLA on the course of HE and the diagnostic role of Portosystemic-Encephalopathy-Syndrome score (PHES) and critical flicker frequency (CFF) were analyzed. For diagnosis of covert (CHE) and overt (OHE) HE, West-Haven criteria (WHC), PHES and CFF were assessed at study entry. LOLA was applied (20 g i.v.) for 6 days. At the end of the study, HE evaluation was repeated. S-100-beta, NSE and ammonia were assessed in each patient before, during and after therapy with LOLA.30 patients were included. At study entry, CHE was diagnosed in 50% and OHE in 50% of all subjects. A total of 25 participants completed the study. After LOLA therapy, deterioration of HE occurred in11%, while most patients showed improvement (e.g. improved CFF in 79%). No significant correlation with HE severity (as diagnosed by WHC, PHES and CFF) could be demonstrated for any biochemical parameter. In addition, there were no significant changes in brain biomarkers during the treatment period.While CFF as well as PHES showed good correlation with treatment response, S-100-beta and NSE did not significantly correlate with HE severity compared to proven diagnostic methods, and do not seem reliable biochemical markers for the follow-up under therapy.A encefalopatia hepática (EH) na cirrose é vista como o resultado de edema cerebral de baixo grau dos astrócitos. Biomarcadores cerebrais serológicos S-100-beta e enolase neurónio-específica (NSE) estão frequentemente elevados na lesão cerebral. A nossa hipótese é que os neuromarcadores S-100-beta e NSE podem ser usados no diagnóstico de EH, quando comparados com os meios diagnósticos standard.Estudo prospectivo não randomizado foi realizado usando L-ornitina-L-aspartato (LOLA) no tratamento da EH. O endpoint primário foi a avaliação dos neuromarcadores S-100-beta e NSE para a deteção e vigilância da EH. Foram endpoints secundários a eficácia da LOLA no curso da EH e o papel diagnóstico doForam incluídos 30 doentes no estudo. À entrada EHO foi diagnosticada em 50% e EHD nos restantes 50% dos participantes. Um total de 25 doentes completaram o estudo. Após a terapêutica com LOLA, verificou-se deterioração da EH em11%, enquanto a maioria dos doentes melhorou (melhoria CFF em 79%). Não se demonstrou nenhuma correlação significativa com a gravidade da EH (tendo em conta os WHC, PHES e CFF) para nenhum dos parâmetros bioquímicos. Para além disso, não se demonstraram variaões significativa nos biomarcadores cerebrais durante o período de tratamento.Apesar do CFF e do PHES apresentarem boa correlação com a resposta terapêutica, a S-100-beta e a NSE não se correlacionaram significativamente com a gravidade da EH quando comparado com os outros métodos diagnósticos standard, não parecendo ser marcadores bioquímicos úteos para a vigilância da resposta terapêutica.

IntroductionDiverticulitis is among the most common abdominal disorders. The best treatment strategy for this complicated disease as well as for recurrent stages is still under debate. Moreover, little knowledge exists regarding the effect of different therapeutic strategies on the health-related quality of life (HrQoL). Therefore, the PREDIC-DIV (PREDICtors for health-related quality of life after elective sigmoidectomy for DIVerticular disease) study aims to assess predictors of a change in HrQoL in patients after elective sigmoidectomy for diverticular disease.Methods and analysisA prospective multicentre transnational observational study was started in November 2017. Patients undergoing elective sigmoid resection for diverticular disease were included. Primary outcome includes HrQoL 6 months postoperatively, staged by the Gastrointestinal Quality of Life Index (GIQLI). Secondary outcomes include HrQoL 6 months after sigmoidectomy, assessed using the Short Form 36 Questionnaire and a custom-made Visual Analogue Scale-based inventory; HrQoL after 12 and 24 months; postoperative morbidity; mortality; influence of surgical technique (conventional laparoscopic multiport operation vs robotic approach); histological grading of inflammation and morphological characteristics of the bowel wall in the resected specimen; postoperative functional changes (faecal incontinence, faecal urge, completeness of emptying, urinary incontinence, sexual function); disease-specific healthcare costs; and changes in economic productivity, measured by the iMTA Productivity Cost Questionnaire. The total follow-up will be 2 years.Ethics and disseminationThe protocol was approved by the medical ethical committee of the Bavarian Medical Council (report identification number: 2017-177). The study was conducted in accordance with the Declaration of Helsinki. The findings of this study will be submitted to a peer-reviewed journal (BMJ Open,Annals of Surgery,British Journal of Surgery,Diseases of the Colon and the Rectum). Abstracts will be submitted to relevant national and international conferences.Trial registration numberThe study is registered with the ClinicalTrials.gov register asNCT03527706; Pre-results.

Zusammenfassung Einleitung Der systemische Lupus erythematodes (SLE) stellt eine klinisch sehr variabel verlaufende Autoimmunerkrankung dar, welche zahlreiche Organsysteme befallen kann. Eine Manifestation an der Leber gilt als selten. Unklar ist insbesondere, ob eine Hepatopathie bei SLE von prognostischer Bedeutung ist und z. B. mit der Aktivität der Erkrankung korreliert. Methodik Unser Patientenkollektiv umfasste 172 Patienten mit gesichertem SLE, welche am Klinikum Bogenhausen im Zeitraum 01.01.2009 bis 31.12.2015 behandelt wurden. Ausgewertet wurden retrospektiv alle ambulanten und/oder stationären Patientenvorstellungen (n = 671; durchschnittlich 3,9 pro Patient). Eine Leberschädigung wurde laborchemisch anhand von pathologischen Leberenzymprofilen oder bildgebend diagnostiziert. Die Krankheitsaktivität des SLE wurde anhand des European Consensus Lupus Activity Measurement (ECLAM)-Score ermittelt. Zusätzlich wurden Parameter der Grunderkrankung wie Krankheitsdauer, Organschädigung sowie immunsuppressive Medikation ausgewertet und die mögliche Assoziation mit einer Hepatopathie analysiert. Ergebnisse Erhöhte Leberwerte (ASAT, ALAT, GGT, AP) als Ausdruck einer Hepatopathie waren bei 109 Patienten (63,4 % der Gesamtpopulation) nachweisbar und waren signifikant mit Krankheitsaktivität (auf der Basis des ECLAM-Score, p Diskussion Erhöhte Leberwerte kommen bei Patienten mit SLE sehr häufig vor, insbesondere bei erhöhter Krankheitsaktivität (basierend auf ECLAM-Score oder intensivierter immunsuppressiver Therapie) und längerer Erkrankungsdauer. Leberwertbestimmungen sollten daher bei Patienten mit SLE regelmäßig erfolgen und eine weitere differenzialdiagnostische Abklärung angestrebt werden. Zukünftige prospektive Studien könnten klären, ob pathologische Leberwerte in Aktivitätsindizes zur Beurteilung der Krankheitsaktivität bei SLE einbezogen werden müssen.

Optimal surgical management of perforated diverticulitis of the sigmoid colon has yet to be clearly defined. The purpose of this study was to evaluate efficacy of a “Damage Control Strategy” (DCS). Patients with perforated diverticulitis of the sigmoid colon complicated by generalized peritonitis (Hinchey III and IV) surgically treated according to a damage control strategy between May 2011 and February 2017 were enrolled in the present multicenter retrospective cohort study. Data were collected at three surgical centers. DCS comprises a two-stage concept: [1] limited resection of the perforated colon segment with oral and aboral blind closure during the emergency procedure and [2] definitive reconstruction at scheduled second laparotomy (anastomosis ∓ loop ileostomy or a Hartmann’s procedure) after 24–48 h. Fifty-eight patients were included into the analysis [W:M 28:30, median age 70.1 years (30–92)]. Eleven patients (19%) initially presented with fecal peritonitis (Hinchey IV) and 47 patients with purulent peritonitis (Hinchey III). An anastomosis could be created during the second procedure in 48 patients (83%), 14 of those received an additional loop ileostomy. In the remaining ten patients (n = 17%), an end colostomy was created at second laparotomy. A fecal diversion was performed in five patients to treat anastomotic complications. Thus, altogether, 29 patients (50%) had stoma at the end of the hospital stay. The postoperative mortality was 9% (n = 5), and median postoperative hospital stay was 18.5 days (3–66). At the end of the follow-up, 44 of 53 surviving patients were stoma free (83%). The use of the Damage Control strategy leads to a comparatively low stoma rate in patients suffering from perforated diverticulitis with generalized peritonitis.

Damage control strategy (DCS) is a two-staged procedure for the treatment of perforated diverticular disease complicated by generalized peritonitis. The aim of this retrospective multicenter cohort study was to evaluate the prognostic impact of an ongoing peritonitis at the time of second surgery. Consecutive patients who underwent DCS for perforated diverticular disease of the sigmoid colon with generalized peritonitis at four surgical centers were included. Damage control strategy is a two-stage emergency procedure: limited resection of the diseased colonic segment, closure of oral and aboral colon, and application of a negative pressure assisted abdominal closure system at the initial surgery followed by second laparotomy 48 h later. Therein, decision for definite reconstruction (anastomosis or Hartmann’s procedure (HP)) is made. An ongoing peritonitis at second surgery was defined as presence of visible fibrinous, purulent, or fecal peritoneal fluid. Microbiologic findings from peritoneal smear at first surgery were collected and analyzed. Between 5/2011 and 7/2017, 74 patients underwent a DCS for perforated diverticular disease complicated by generalized peritonitis (female: 40, male: 34). At second surgery, 55% presented with ongoing peritonitis (OP). Patients with OP had higher rate of organ failure (32 vs. 9%, p = 0.024), higher Mannheim Peritonitis Index (25.2 vs. 18.9; p = 0.001), and increased operation time (105 vs. 84 min., p = 0.008) at first surgery. An anastomosis was constructed in all patients with no OP (nOP) at second surgery as opposed to 71% in the OP group (p

Acute appendicitis is one of the most frequent disorders in abdominal surgery. Therefore, appendectomy is a matter of significant interest in that field. Yet, four different techniques are available: open appendectomy, (conventional) laparoscopic appendectomy, single port laparoscopic appendectomy and NOTES-appendectomy with its different variations. To evaluate the current state of the art in appendectomy a bibliographic search was conducted. All prospectively randomized trials and national register cohort studies published between 1/2010 and 5/2016 were included into the analysis. Overall, 25 respective studies were identified. All studies were screened for the following parameters: surgical site infection (SSI) (wound infection (WI) or intraabdominal abscess (IAA)), postoperative pain (PP), length of surgery (LoS), length of hospital stay (LHS), return to normal activities (RNA). Today the rate of laparoscopic appendectomy is reported to be up to 86% in the recent literature. Open appendectomy remains a safe and effective technique. Single port laparoscopic appendectomy presented almost equal in terms of safety and patient satisfaction. The method is still not as widespread as conventional three port laparoscopic appendectomy, presumably due to the necessity of special equipment and training. NOTES appendectomy is the newest development in appendectomy technique. First prospective cohort studies proved the safety and feasibility in experienced hands. However, the method is still experimental and further prospectively randomized trials are necessary. Concluding the current evidence, a laparoscopic approach, which is most commonly and increasingly frequently used, could be called "state of the art" in the treatment of appendicitis.

Colon interposition counts among the most common techniques for reconstruction of the intestinal passage after esophagectomy. Data on metachronous mucosal pathologies such as adenoma and adenocarcinoma in the literature are weak, and no systematic reviews or meta-analyses exist. The planned analysis aims to assess the frequency of polyp growth and/or development of adenocarcinoma in adult colon interposition patients. Therefore, a systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines in the following databases: Medline/PubMed, Science Direct, Cochrane database for randomized trials (CENTRAL), Bayerische Staatsbibliothek Munchen, Library of the University Hospital Regensburg, Germany, Library of the Charite, University Hospital Berlin. All studies (randomized and non-randomized, case series, case reports) reporting on adult patients with colon interposition for reconstruction of the intestinal passage after esophagectomy for benign (e. g., Boerhaave syndrome, trauma, corrosive injury) or malignant reasons (esophageal cancer) are eligible for data analysis. Randomized and non-randomized studies will be included into the qualitative analysis. The review protocol and the systematic review itself are constructed in accordance with the PRISMA statement and the recommendations of the Cochrane Handbook for systematic reviews. This systematic review protocol is registered with the PROSPERO International Prospective Register of Systematic Reviews ( http://www.crd.york.ac.uk/prospero ) as CRD42017082144.

To identify the impact of the severity of diverticular disease on long-term quality of life. Consecutive patients, hospitalized between October 2009 and November 2015 due to uncomplicated (UD) and complicated diverticulitis (CD) of the left colon, were analyzed. Patients undergoing emergent surgery for perforated disease were excluded. Primary endpoint was health-related quality of life (HrQol), measured by the Short Form 36 questionnaire (SF-36). Physical (PCS) and mental (MCS) compository scores were calculated from SF-36 subscales. To overcome bias, one-to-one propensity score matching and multivariable logistic regression analysis were performed. Two hundred eighty of the overall 392 patients (Male 138, Female 142; mean age 60.5 years, range 27–91) answered the SF-36 questionnaire. The median follow-up period was 37.8 months (range 15–85). After propensity score matching, each group consisted of 51 patients. Results of the SF-36 questionnaires showed a statistically significant difference, favoring patients with CD in 5 of 8 domains. Also, PCS (56.3 vs. 52.9, p = 0.13) and MCS (53.3 vs. 46.7, p = 0.005) were higher in patients treated for CD. By a multivariate analysis, complicated disease was independently associated with a better scoring on 6 out of 8 SF-36 subscales and on MCS. Treatment strategy (surgery or conservative) did not have any impact on SF-36 subscales, MCS, or PCS on multivariate analysis. In contrast to complicated disease, the uncomplicated diverticular disease is associated with an impaired long-term quality of life especially in domains composing mental health scores independently of chosen treatment strategy. The study is registered with the Research Registry at June 19, 2019. Research registry UIN: researchregistry4959 .

Systematic investigations of health literacy in German patients are rare and mostly based on subjective self-assessment.In a cross-sectional survey, 196 patients (female 38 %, male 62 %) in medical and surgical units were asked to complete a questionnaire that we had developed for this purpose. This questionnaire contained 43 questions about common medical terms. We investigated whether patients were familiar with these terms and could name the meaning according to correct definition. Furthermore, the association with the patients' socio-economic and demographic parameters (e. g. education, insurance status, utilization of media) was analyzed.Among all questions of the questionnaire, more patients claimed to know their meaning than this was the case by objective testing. Association of medical knowledge with demographic and socio-economic data revealed that correct answers were more frequent among women compared to men (51.1 % vs. 47.2 %; p = 0.12). Patients' age was negatively correlated with medical knowledge (p 0.001). Higher educational level was associated with a higher percentage of correct answers (p 0.001). Private insurance status had significant influence on medical knowledge (p = 0.002). Male patients working intellectually (compared to working physically) had a higher percentage of correct answers (p = 0.001). Other factors like reading newspapers, watching TV and number of consultations per year did not influence the percentage of correct answers.Physicians should make sure by active inquiries whether the patient understands them correctly. Furthermore, there is a considerable gap between subjective and objective medical knowledge that future evaluations of health literacy should be aware of.Systematische Untersuchungen zum objektiven Verständnis von Patienten bezüglich häufiger medizinischer Begriffe in Deutschland sind selten.196 Patienten (38 % weiblich, 62 % männlich) in stationären Fachabteilungen an einem kommunalen Krankenhaus wurden mittels eines zuvor entwickelten Fragebogens untersucht. Dieser enthielt 43 Fragen zu häufig im Alltag vorkommenden medizinischen Fachbegriffen. Untersucht wurden der subjektive und objektive Bekanntheitsgrad. Zusätzlich wurde eine Assoziation mit verschiedenen potenziellen Einflussfaktoren (u. a. Ausbildung, Versicherungsstatus, Konsum bestimmter Informationsmedien) durchgeführt.Durchgehend gaben mehr Patienten an, die Bedeutung medizinischer Begriffe zu kennen, als dies bei objektiver Überprüfung der Fall war. Die Assoziation des medizinischen Kenntnisstandes mit verschiedenen Einflussfaktoren ergab, dass Frauen häufiger über korrektes medizinisches Wissen verfügten als Männer (51,1 vs. 47,2 %, p = 0,12). Das Lebensalter war negativ mit dem medizinischen Kenntnisstand korreliert (p 0,001). Die Länge der Schulbildung war mit einem besseren medizinischen Kenntnisstand assoziiert (p 0,001). Privat versicherte Patienten waren besser medizinisch gebildet als gesetzlich Versicherte (p = 0,001). Männliche Patienten mit eher mentaler Arbeit hatten einen besseren Kenntnisstand als solche mit körperlicher Arbeit (51,1 vs. 41,8 %; p = 0,002). Zeitungs- und Fernsehkonsum sowie Anzahl der Arztkontakte waren nicht mit einer Verbesserung des medizinischen Kenntnisstandes vergesellschaftet.Ein hoher Bekanntheitsgrad medizinischer Begriffe kann Ärzte im Anamnesegespräch dazu verleiten, das Verständnis dieser Begriffe auch von Seiten des Patienten stillschweigend vorauszusetzen. Ärzte sollten daher durch aktives Nachfragen das Verständnis beim Patienten sicherstellen. Zukünftige Erhebungen zur Gesundheitskompetenz auf Patientenseite sollten diese Divergenz zwischen subjektiver Einschätzung und objektivem Wissen berücksichtigen.

The best surgical strategy for the management of perforated diverticulitis with generalized peritonitis of the sigmoid colon is not clearly defined. The aim of this retrospective cohort study was to evaluate the value of a damage control strategy. All patients who underwent emergency laparotomy for perforated diverticular disease of the sigmoid colon with generalized peritonitis between 2010 and 2015 were included. The damage control strategy (study group), included a two- stage procedure: limited resection of the diseased colonic segment, closure of proximal colon and distal stump, and application of an abdominal vacuum at the initial surgery followed by second-look laparotomy 24–48 h later At this point a choice was made between anastomosis and Hartmann’s procedure. The control group consisted of patients receiving definitive reconstruction (anastomosis or Hartmann’s procedure) at the initial operation. Thirty-seven patients were included in the study. Damage control strategy was applied in 19 patients and the control group consisted of 18 patients. Both groups were comparable in terms of demographics, severity of peritonitis, and comorbidities. The overall postoperative mortality was 11 % (n = 4). There were no statistically significant differences between both groups regarding postoperative morbidity and mortality; however, a significantly higher proportion of patients in the control group had a stoma after the initial hospital stay (83 vs. 47 %, p = 0.038). This difference was still significant after adjustment for sex, age, Mannheim Peritonitis Index, American Society of Anesthesiologists class and presence of septic shock at presentation. At the end of the follow-up period, 15 of 17 survivors in the study group and 13 of 16 survivors in the control group had their intestinal continuity restored (p = 0.66). Damage control strategy in patients with generalized peritonitis due to perforated diverticulitis leads to a significantly reduced stoma rate after the initial hospital stay without an increased risk of postoperative morbidity.

Systemic lupus erythematodes (SLE) represents an autoimmune disease with a highly variable clinical course affecting numerous organs. Hepatic manifestation seems to be rare. It is not clear whether hepatic disease in SLE is of any prognostic importance or whether it correlates with disease activity. Our patient cohort included 172 patients with proven SLE, all treated at Bogenhausen Hospital between 01.2009 and 12.2015. Retrospectively, all admissions as inpatients and outpatients were analyzed (n = 671; mean 3.9 per patient). Liver damage was diagnosed by evaluation of laboratory parameters on the basis of pathological liver enzymes and by imaging methods. Disease activity of SLE was calculated by using European Consensus Lupus Activity Measurement-(ECLAM-)Score. Additionally, parameters of SLE including disease duration, organ damage and immune suppressive medication and their possible association with hepatopathy were analyzed. Elevated liver parameters (ASAT, ALAT, GGT, AP) indicating liver damage were detectable in 109 patients (63.4 % of total population) demonstrating significant association with disease activity (on the basis of ECLAM-score, p 0.001), duration of treatment, frequency of admissions (p 0.01, respectively), number of used immunosuppressive agents (p 0.018), increased blood sedimentation rate (p 0.001) and reduction of serum complement (p 0.03). Abnormal ultrasound findings of the liver (e. g., non-alcoholic fatty liver disease) were diagnosed in 19.8 %. Elevated liver parameters occur frequently in patients with SLE, especially in context with increased disease activity (on the basis of ECLAM-Score or intensified immunosuppressive therapy) and prolonged course of the disease. Liver enzymes should be obtained regularly in patients with SLE and, if necessary, further diagnostic steps should be initiated. Further prospective studies might clarify whether abnormal liver parameters must be included in activity indices to judge disease activity in SLE. Der systemische Lupus erythematodes (SLE) stellt eine klinisch sehr variabel verlaufende Autoimmunerkrankung dar, welche zahlreiche Organsysteme befallen kann. Eine Manifestation an der Leber gilt als selten. Unklar ist insbesondere, ob eine Hepatopathie bei SLE von prognostischer Bedeutung ist und z. B. mit der Aktivität der Erkrankung korreliert. Unser Patientenkollektiv umfasste 172 Patienten mit gesichertem SLE, welche am Klinikum Bogenhausen im Zeitraum 01.01.2009 bis 31.12.2015 behandelt wurden. Ausgewertet wurden retrospektiv alle ambulanten und/oder stationären Patientenvorstellungen (n = 671; durchschnittlich 3,9 pro Patient). Eine Leberschädigung wurde laborchemisch anhand von pathologischen Leberenzymprofilen oder bildgebend diagnostiziert. Die Krankheitsaktivität des SLE wurde anhand des European Consensus Lupus Activity Measurement (ECLAM)-Score ermittelt. Zusätzlich wurden Parameter der Grunderkrankung wie Krankheitsdauer, Organschädigung sowie immunsuppressive Medikation ausgewertet und die mögliche Assoziation mit einer Hepatopathie analysiert. Erhöhte Leberwerte (ASAT, ALAT, GGT, AP) als Ausdruck einer Hepatopathie waren bei 109 Patienten (63,4 % der Gesamtpopulation) nachweisbar und waren signifikant mit Krankheitsaktivität (auf der Basis des ECLAM-Score, p 0,001), Behandlungsdauer, Häufigkeit der Vorstellungen (jeweils p 0,01), Anzahl der eingesetzten Immunsuppressiva (p 0,018), erhöhter Blutsenkungsgeschwindigkeit (p 0,001) sowie Erniedrigung des Serumkomplements (p 0,03) assoziiert. Pathologische Sonografiebefunde an der Leber (z. B. nicht-alkoholische Fettleber) waren in 19,8 % der Fälle nachweisbar. Erhöhte Leberwerte kommen bei Patienten mit SLE sehr häufig vor, insbesondere bei erhöhter Krankheitsaktivität (basierend auf ECLAM-Score oder intensivierter immunsuppressiver Therapie) und längerer Erkrankungsdauer. Leberwertbestimmungen sollten daher bei Patienten mit SLE regelmäßig erfolgen und eine weitere differenzialdiagnostische Abklärung angestrebt werden. Zukünftige prospektive Studien könnten klären, ob pathologische Leberwerte in Aktivitätsindizes zur Beurteilung der Krankheitsaktivität bei SLE einbezogen werden müssen.

Annals of hepatology 17(5), 822-829 (2018). doi:10.5604/01.3001.0012.3143, Published by Mexican Association of Hepatology, México

To evaluate the impact of superior rectal artery (SRA) sparing technique on anastomotic leakage in laparoscopic sigmoidectomy for diverticular disease. A retrospective multicenter analysis of all patients undergoing laparoscopic sigmoid resection for diverticular disease between 2002 and 2015 was conducted. Data were recorded in three hospitals: University Hospital Regensburg, Marienhospital Gelsenkirchen, and Stadtisches Klinikum Munchen Bogenhausen. The SRA was resected between 2002 and 2005. Since 2005, the artery was preserved in most cases. Two hundred sixty-seven patients were included. One hundred sixty patients presented with complicated diverticulitis (60%). The SRA was resected in 102 patients (group 1) and preserved in 157 patients (group 2, no data in eight cases). Anastomotic leakage occurred in 7% of patients in group 1 and 1.9% of patients in group 2 (p = 0.053). Duration of surgery was significantly shorter (157 vs. 183 min, p

This study identifies and characterizes a novel regulatory mechanism involved in controlling measles virus gene expression., The paramyxovirus RNA-dependent RNA-polymerase (RdRp) complex loads onto the nucleocapsid protein (N)–encapsidated viral N:RNA genome for RNA synthesis. Binding of the RdRp of measles virus (MeV), a paramyxovirus archetype, is mediated through interaction with a molecular recognition element (MoRE) located near the end of the carboxyl-terminal Ntail domain. The structurally disordered central Ntail section is thought to add positional flexibility to MoRE, but the functional importance of this Ntail region for RNA polymerization is unclear. To address this question, we dissected functional elements of Ntail by relocating MoRE into the RNA-encapsidating Ncore domain. Linker-scanning mutagenesis identified a microdomain in Ncore that tolerates insertions. MoRE relocated to Ncore supported efficient interaction with N, MoRE-deficient Ntails had a dominant-negative effect on bioactivity that was alleviated by insertion of MoRE into Ncore, and recombinant MeV encoding N with relocated MoRE grew efficiently and remained capable of mRNA editing. MoRE in Ncore also restored viability of a recombinant lacking the disordered central Ntail section, but this recombinant was temperature-sensitive, with reduced RdRp loading efficiency and a flattened transcription gradient. These results demonstrate that virus replication requires high-affinity RdRp binding sites in N:RNA, but productive RdRp binding is independent of positional flexibility of MoRE and cis-acting elements in Ntail. Rather, the disordered central Ntail section independent of the presence of MoRE in Ntail steepens the paramyxovirus transcription gradient by promoting RdRp loading and preventing the formation of nonproductive polycistronic viral mRNAs. Disordered Ntails may have evolved as a regulatory element to adjust paramyxovirus gene expression.

Hintergrund Die Appendektomie zahlt zu den haufigsten viszeralchirurgischen Eingriffen. Obwohl die laparoskopische Operationstechnik klinisch etabliert ist, wird der Verschluss des Appendixstumpfes bisher nicht standardisiert gehandhabt. Ziel dieser retrospektiven Studie war es, die Verwendung von endoskopischen Schlingen (Endoloops) und Linearstaplern zum Appendixstumpfverschluss in Bezug auf Wundinfekte (WI) und intraabdominelle Abszesse (IAA) zu vergleichen.

Surgical-site infections (SSIs) and intra-abdominal abscesses (IAAs) are the most frequent complications of appendectomy. The role of laparoscopy in the treatment of appendicitis remains controversial concerning the complication rate. The aim of this retrospective cohort study was to compare open and laparoscopic appendectomy for SSI and IAA.All patients undergoing appendectomy between January 1, 2007 and May 31, 2010 were included in the study. Perioperative data and data on postoperative complications were collected from patient files. A questionnaire was used to assess complications after discharge. Main outcome parameters were SSI and IAA. Open appendectomy (OAG) and laparoscopic appendectomy (LAG) were compared with univariate and multivariate analyses for the outcome parameters.Four hundred thirty patients were included in the study. SSI (all: 10.6%, OAG: 11.7%, LAG: 7.5%, P=0.293) and IAA (all: 2.8%, OAG: 2.4%, LAG: 3.8%, P=0.506) were not significantly different between OAG and LAG. Risk factors for SSI were age (P=0.003), body mass index (P=0.017), ASA score (P=0.001), the intraoperative grade of inflammation (P=0.004), and the histologic grade of inflammation (P=0.015). The only risk factor for IAA was the intraoperative grade of inflammation (P=0.028). ASA score (odds ratio: 1.992, P=0.032) and the intraoperative grade of inflammation (odds ratio: 1.573, P=0.006) remained significant in the multivariate analysis for SSI.A higher ASA score correlates with SSI. A higher grade of intraoperative inflammation correlates with SSI and IAA. Laparoscopy has no impact on SSI and IAA in appendectomy.

We found a case of pancreatic extraintestinal gastrointestinal stroma tumor (pEGIST) in 2014. The patient, initially suspected to suffer from pancreatic adenocarcinoma, underwent open left hemipancreatectomy and en bloc splenectomy in May 2014. Postoperative histopathology showed the unexpected manifestation of a pEGIST. Recovery was well, and a 23-month follow-up was free from recurrency by now.