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Background: Little is known about the long-term survival of patients with incidental gallbladder carcinoma (IGBC). The role of radical resection for this disease is discussed controversially in the literature. We present the long-term survival and the results of re-resection versus simple cholecystectomy of the database of the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS) from 1994 to 2004., Methods: Eighty-nine patients with histologically confirmed carcinoma of the gallbladder were identified out of 30,960 patients undergoing laparoscopic cholecystectomy. Sixty-nine patients were included in our study. Long-term survival by different T-stage and comparison of patients with extended resection versus simple cholecystectomy were calculated using the log-rank test. The time-to-event data are demonstrated by Kaplan-Meier curves., Results: The overall incidence of IGBC in patients who underwent laparoscopic cholecystectomy was 0.28% (89 of 30,960). Fifty patients underwent simple cholecystectomy [n = 2: carcinoma in situ (CIS); n = 2: pT1a; n = 10: pT1b; n = 23: pT2; n = 8: pT3; n = 5: pT4], whereas extended resection was performed in 19 cases (n = 2: pT1b; n = 11: pT2; n = 6: pT3). The comparison of simple cholecystectomy versus extended re-resection of the gallbladder bed and regional lymph node resections showed a significant benefit in overall survival for the pT2 and pT3 group (p < 0.05). The pT1b group showed no significant benefit in overall survival (p = 0.34)., Conclusion: IGBC has a low incidence (0.28%). We present a large study of patients with IGBC, comparing the overall survival by different histological findings. We observed a significant benefit for the group with pT2 and pT3. Therefore we recommend extended resection of the gallbladder bed and the regional lymph nodes for patient with incidental histologically confirmed pT2 and pT3 carcinoma of the gallbladder after performance of laparoscopic cholecystectomy. For patients with pT1b stage no recommendations can be given based on this study.

What are the acute bronchopulmonary reactions which occur in smokers when 20 cigarettes are smoked over 10 hours during the day after a 12-hour interruption of smoking at night? Nineteen healthy chronic smokers with normal lung function aged from 22 to 39 years were investigated. The inhalative smoking characteristics were documented by alterations (p < 0.0005) of nicotine, cotinine and COHb in the blood. In body plethysmography, the subjects investigated showed a fall (p < 0.0025) of the airway resistances by 0.51 (cm H2O/l/s), a decrease (p < 0.005) of the trapped air and a rise (p < 0.01) of the thoracic gas volume by 0.58 (1) and (p < 0.01) of the specific conductance by 0.04 (cm H2O x s)-1 after smoking. The frequency-dependent compliance (40 breaths per minute) did not show any change. As a result of smoking, there was a fall (p < 0.025) of the arterial partial pressure of oxygen by 3.1 (mmHg) and carbon dioxide (p < 0.025) by 1.0 (mmHg) in ergometric exercise (women 75 Watts, men 100 Watts) as well as of the partial pressure of CO2 (p < 0.05) by 0.9 (mmHg) at rest. At the same time, the alveolo-arterial CO2 difference increased (p < 0.025) by 2.5 (mmHg). The results are interpreted as acute ventilation perfusion disorders which are reversible in the nocturnal resting phase.

Echocardiography was carried out in 526 patients on a general internal medical ward, 54.8% with a clinical indication and 45.2% in screening. The results were compared with the data from the scout view chest x-ray and from the ECG. Enlargement of the cardiac cavities detected in echocardiography (UCG) can only be found in 43% in the x-rays (left atrium 27%, left ventricle 64%, right ventricle 42%). Left ventricular hypertrophy was shown in the UCG in 43% of patients with arterial hypertension: of these, 28% had a pathologic ECG. On the other hand, only 14% of all hypertensive patients show signs of left ventricular hypertrophy on x-ray. The differentiation of systolic (44%) and diastolic (38%) dysfunction was only possible by means of UCG in congestive heart failure. A chronic pulmonary hypertension detected by x-ray correlated with an enlargement of the right ventricle in the UCG. UCG is indicated when there are clinical, ECG, chest x-ray signs of heart disease, arterial hypertension or chronic pulmonary hypertension. UCG is not a screening method.

Although the signs or symptoms of rhinitis, bronchial asthma, urticaria and hypersensitivity to non-steroidal antiphlogistics, antirheumatics and analgesics as well as to some foods, seem to point towards an anaphylactic reaction, this intolerance--known in the U.S.A. as "aspirin intolerance"--is of non-allergic aetiology. In most cases the disease begins in the upper airways. Hence, early diagnosis by the ENT specialist is essential. The medical examinations and case histories of 20 patients suffering from rhinosinusitis complicated by aspirin intolerance, are discussed.

Neuromuscular syndromes and respiratory insufficiency may be caused by hypophosphataemia. This complication may occur particularly in patients with malnutrition who receive parenteral glucose, as two examples show.

In a 65-year-old man livedo reticularis occurred in the lower half of the body two days after beginning lysis with streptokinase. This was followed by skin and toe necrosis as well as acute renal failure. Autopsy showed a severe ulcerative atherosclerosis of the aorta with cholesterol crystal embolisation in numerous organs, particularly in both kidneys. The coincidence in time leads one to assume that the streptokinase treatment encouraged acute diffuse embolisation by dissolving the protective thrombi over the ulcerative atheromatous plaques.