Freyja-Maria Smolle-Jüttner

Retrosternal pedicled jejunum interposition: an alternative for reconstruction after total esophago-gastrectomy.

OBJECTIVEnIf the colon cannot be used for reconstruction after total esophago-gastrectomy, alternatives have to be sought.nnnMETHODSnFrom 1990 to 2001, retrosternal jejunum loop interposition was performed in 35 patients (male/female: 29:6; mean age 59.2, range 16-83 years) due to cancer in 32 cases and to esophageal perforation in three cases. In all patients reconstruction with stomach or colon, respectively, was impossible on behalf of the underlying histology, of previous resection of the stomach and impedient colonic diseases. A jejunal segment with abundant arcades was chosen, preserving a strong, distal arteriovenous mesenteric pedicle, while 2-3 proximal mesenteric vessels were severed. The loop was pulled up retrosternally, establishing a cervical end-to-side esophagojejunostomy. A Roux-en-Y anastomosis was done in a convenient position.nnnRESULTSnTwo patients died perioperatively due to mediastinitis and consecutive multiorgan failure (one Boerhaaves syndrome, one suicidal ingestion of acid). In one case the oral part of the loop developed venous congestion and was replaced by a free jejunal transplant. The perioperative course of 32 patients was uneventful. Seventeen patients are up and well (1-8.5 years). Sixteen patients died of metastatic disease. The functional results are satisfactory. In about 50% of patients recurrent dilatations became necessary due to anastomotic scars. However, none of the patients complained about severe dysphagia.nnnCONCLUSIONnIn cases of impedient colonic diseases, the pedicled, retrosternal jejunal loop with cervical anastomosis is an alternative for reconstruction after total esophagogastrectomy.

Creation of a prevascularized site for cell transplantation in rats

Stiegler P, Matzi V, Pierer E, Hauser O, Schaffellner S, Renner H, Greilberger J, Aigner R, Maier A, Lackner C, Iberer F, Smolle‐Jüttner F‐M, Tscheliessnigg K, Stadlbauer V. Creation of a prevascularized site for cell transplantation in rats. Xenotransplantation 2010; 17: 379–390.

In vivo determination of tumor optical parameters in esophageal carcinoma.

Dose dependence of light cannot be discussed on the basis of dose alone. On a more fundamental scientific level, the propagation of light in tissue depends on optical parameters of treated tumor tissue. In a prospective, nonrandomized study, in vivo optical parameters of esophageal carcinoma were studied.

Pneumopericardium due to intrapericardial perforation of a gastric ulcer

A 88-year-old male patient presented with fever, singultus and retrosternal pain. After 8 days of antibiotic therapy not resulting in clinical improvement, he suddenly developed a pneumopericardium. Contrast swallow and endoscopy showed intrapericardial perforation of a benign gastric ulcer. Excision of the ulcer and suturing of both the stomach and the diaphragm as well as lavage of the pericardium were done over a left thoracotomy. The patient recovered uneventfully.

Preoxygenation of different preservation solutions for porcine pancreas preservation.

INTRODUCTIONnOrgan preservation quality impacts porcine islet cell isolation and transplantation success. Among several preservation methods, the two-layer method is promising, but technically demanding and fails to deliver sufficient oxygen. The use of hyperbaric oxygenation may be an easier, more effective method to supply high partial pressure of oxygen (pO(2)) for organ storage. Therefore, the aim of this study was to test the capability of preoxygenation of various preservation solutions with HBO to maintain high pO(2) levels.nnnMETHODSnUniversity of Wisconsin (UW), Custodiol, Perfadex, or Celsior solutions were preoxygenated in a pressure chamber. NaCl served as the control. pO(2) levels were measured at defined times. The oxygen storage capability was evaluated by leaving the storage bottles open for 2 minutes.nnnRESULTSnIt was feasible to preoxygenate preservation solutions. The best solution to maintain high pO(2) tensions was Perfadex, followed by Celsior, and UW.nnnDISCUSSIONnThe greater the amount of oxygen in the preservation solution, the more oxygen can be delivered to the preserved pancreas. Further studies on the influence of preoxygenated preservation solutions on the porcine pancreas are warranted to improve organ quality, porcine islet cell isolation, and transplantation success.

Diffuse Pulmonary Arteriovenous Malformations in a Teenager with Corrected Total Anomalous Pulmonary Venous Drainage

This case report describes a 13-year-old boy with diffuse microvascular pulmonary arteriovenous malformations, in whom total anomalous pulmonary venous drainage had been corrected surgically in the newborn period. Contrast transesophageal echocardiography, cardiac catheterization and a lung perfusion scan suggested, and lung biopsy confirmed the diagnosis in our patient. Treatment with nifedipin was commenced. Conclusion: This case illustrates the diagnostic difficulties with this rare malformation.

Pharmakokinetik von Antibiotika in entzündetem und gesundem Lungengewebe

SummaryThe pharmacokinetic profile of antibiotics at the site of antiinfective action is one of the most important determinants of drug response, since it correlates the antimicrobial effect. Up to now, only limited information on the lung tissue pharmacokinetics of antibiotic agents has been available. The aim of in-vivo microdialysis is to measure antibiotic penetration into the extracellular space fluid of normal or pneumonic human lung parenchyma. The lung penetration of cefpirom in elective thoracic surgery and piperacillin in septic thoracic surgery, substances with low protein binding, was measured. Intra-, or postoperatively, respectively, microdialysis probes were inserted into normal or pneumonic lung tissue and into healthy skeletal muscle to obtain reference values. Serum and microdialysis samples were collected at 20-minute intervals for at last 8 hours. The intrapulmonary concentrations of the antibiotics exceeded the minimum inhibitory concentrations (MIC) for most relevant bacteria for 4–6 hours. The procedure was well tolerated by all patients and no adverse events or microdialysis-associated side effects were observed. This microdialysis technique enabled continuous tissue pharmacokinetic measurement of free, unbound anti-infective agents in the lung tissue, even in pneumonia.ZusammenfassungDas pharmakokinetische Profil antiinfektiver Substanzen – Antibiotika stellt einen der wesentlichen Faktoren in der medikamentösen Therapie dar. Bis dato liegen nur beschränkte Informationen bezüglich der Pharmakokinetik von Antibiotika im Lungengewebe vor. Das Ziel der In-vivo-Mikrodialyse im Lungengewebe stellt die Evaluierung der Antibiotikakonzentration im extrazellularem Raum dar. Die Lungenpenetration von Cefpirom in der elektiven wie Piperacillin in der septischen Thoraxchirurgie konnte gemessen werden. Mittels intraoperativ unter direkter Sicht implantierter Mikrodialyse Sonden wurden in 20-minütigen Abständen Perfusate gesammelt und anschließend mittels HPLC die Antibiotikakonzentration bestimmt. Es wurden keine Komplikationen beobachtet. In-vivo Mikrodialyse ermöglicht exakte Gewebspharmakokinetik sowohl in gesunder wie pneumonisch veränderter Lunge.

Transdiaphragmatic repositioning of the heart in the setting of emergency laparotomy after blunt trauma

Cardiac luxation after blunt trauma is a rare condition that carries a high mortality rate. We report a case of a left pericardial rupture with partial dislocation of the heart into the left pleural cavity and cardiac strangulation in a polytraumatized patient after a severe motor vehicle accident. This case is of special interest because the patient not only had cardiovascular compromise but was also actually in cardiac arrest and being resuscitated when an emergency repositioning of the heart through the diaphragm in the setting of damage control laparotomy restored circulation. This report stresses the need for a high index of suspicion for accurate early diagnosis of pericardial rupture.

Schmerz in der Chirurgie

Die internationale Gesellschaft zur Erforschung des Schmerzes IASP (International Association for the Study of Pain) definiert Schmerz als ein unangenehmes Sinnes- oder Gefühlserlebnis, das mit tatsächlicher oder potentieller Gewebeschädigung einhergeht oder von betroffenen Personen in einernWeise beschrieben wird, als wäre eine solche Gewebeschädigung die Ursache. Schmerz – welcher Ursache auch immer – beeinträchtigt die Lebensqualität bzw. führt zu verzögerten Heilungsprozessen.nSchmerz ist eine Tatsache des medizinischen Alltages, welche aufgrund neuer Medikamente und Applikationsformen (Schmerzpumpen) heute eigentlich kein Problem in der Behandlung darstellen sollte (1,2). Trotzdem wurde dem Schmerz in Hinblick auf Selbst- und Fremdwahrnehmung, Dokumentation und Therapie sowohl seitens konservativer als auch invasiv-chirurgischer Fächer bisher zu wenig Bedeutung beigemessen, wie Erhebungen der vergangenen Jahre in österreichischen und deutschen Krankenhäusernnzeigen (3,4). Dabei stellte sich heraus, dass eine suffiziente, mit entsprechender Patientenzufriedenheit verbundene Schmerztherapie nach wie vor nicht selbstverständlich ist.