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BACKGROUND: The aim of treatment of patients with colovesical fistulas should be prompt elimination of the infection and the social burden. We focused on the question whether a minimally invasive surgical approach as a cooperation between surgeons and urologists is possible. This requires effective diagnostics prior to the operation. METHODS: Since 2007 a total of 32 patients with the clinical suspicion of colovesical fistula have undergone extensive preoperative diagnostics. Operative treatment aimed primarily for a minimally invasive approach. In particular, the validity of preoperative diagnostics was analyzed and surgical results were characterized by clinical success, complications and long-term effects. RESULTS: The medical history significant for colovesical fistula and detected urinary infection provided the best evidence for the specific diagnosis. Cystoscopy, computed tomography (CT) scan and colonoscopy were only partially effective for predicting a fistula as subsequently diagnosed by histopathological investigations. Fistulas due to diverticulitis of the sigmoid colon occurred in 28 cases, while in 3 subjects there was a gynecological and inflammatory cause (malignant tumor growth, n = 1). A laparoscopic approach achieving repair and healing of the fistula was possible in 29 cases including conversion in 3 subjects because of intraoperative complications. The remaining patients underwent conventional treatment. The disease-related complication rate as revealed during follow-up was 10%. DISCUSSION: Laparoscopic repair and healing of a colovesical fistula is possible in the majority of cases by the recommended preoperative ureteral stenting. As part of diagnostic measures, the medical history significant for a fistula and detection of urinary infections are the most reliable aspects. In the case of this combination together with a further diagnostic measure, a laparoscopic approach is always recommended. The recurrency rate is 0%.

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BACKGROUND: Frequently, the first clinical sign of colorectal cancer is complete obstruction, which has to be considered an emergency situation. The treatment goal is to overcome ileus including reduction of the associated high morbidity and mortality. Therefore, alternative therapeutic options to emergency surgery have been sought in order to allow adequate preparation for elective surgery or stabilization of palliative patients and avoid colostoma. Therapeutic results of the placement of self-expanding metal stents (SEMS) are discussed in terms of a single-center, retrospective observational study. METHODS: In 35 patients with a clinically manifest stenosis of colonic cancer, it was attempted to insert SEMS to treat ileus as the first therapeutic step. Therapeutic results were investigated with regard to technical and clinical success, spectrum and rate of complications, and survival time, differentiating between a palliative and curative group of patients. RESULTS: Primary placement of a stent was achieved in 29 of 35 patients (82.9 %); 14 underwent the procedure with palliative and 15 with curative intention. Stent location was mainly the left hemicolon. In 2 of 15 patients (13.3 %), emergency surgery within 48 h was required because of complications, whereby in 13 patients (86.7 %), 6 patients (46.2 %) underwent elective open surgery and 7 patients (53.8 %) underwent a laparoscopic procedure. In all patients treated with curative intent, primary anastomosis was achieved, thus, avoiding a colostoma. Survival times of the palliative and curative patient groups were on average 7 and 28 months, respectively. CONCLUSION: In carefully selected cases, placement of SEMS in malignant stenosis of the left hemicolon with ileus can be considered a reasonable therapeutic alternative to emergency surgery since it allows surgical intervention with curative intention under more favorable conditions and also avoids a colostoma.

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INTRODUCTION: By minimising the invasiveness of a surgical intervention, a reduction of operative trauma can be achieved. AIM AND METHODS: The aim of this study was based on a theoretical approach to investigate (i) the feasibility of the SP approach and its overall costs, and, furthermore, (ii) the patients' outcome based on simple perioperative parameters available in daily clinical practice. Therefore, single-port (SP) and laparoscopic appendectomies (LA) were compared using a matched-pair analysis. As a prediction, an absolute match between the criteria histology, sex and ASA stage was required. RESULTS: From 01/01/2009 to 12/31/2010, 196 (60 % were females) consecutive patients underwent appendectomy. Out of them, in 23 patients with either SP or LA appendectomy the predictions for matched-pair analysis (congruence in histopathological finding, sex and ASA criteria) were fulfilled. The operating time was the target criterion for the feasibility of the new surgical method (SP), which could be shortened as seen by comparing SP No. 1-10 with 11-23 (54.6 ± 19.8 min vs. 28.5 ± 18.9 min) expressing the typical effect of a learning curve. The times were similar to those for LA. The postoperative hospital stay and complication rate used to appropriately assess patient outcome did not show a significant difference if comparing SP and LA. Based on the use of single ports, which can be re-used (which has been also a further target) in SP (34.8 %) at the end of the investigation period, SP and LA can be considered comparable surgical techniques with regard to operating times, middle-term outcome and general costs. CONCLUSION: SP is (in case of well-developed laparoscopic expertise) a surgical method that can be easily inaugurated and considered as a feasible approach in daily surgical practice; it is comparable to LA with regard to outcome and general costs. Based on this, SP can be gradually added to the spectrum of surgical procedures in clinical practice and can be performed in suitable cases. A further systematic institutional or even country-wide case register appears to be recommendable to recruit a larger case number and, thus, to achieve a better knowledge on the perioperative management as well as the especially interesting long-term outcome for an appropriate assessment of treatment quality.

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UNLABELLED: INTRODUCTION, AIM AND METHOD: Consecutive female patients undergoing hybrid NOS appendectomy (NA - with prospectively collected data) and laparoscopic appendectomy (LA - with retrospectively registered data) were compared by means of a matched-pair analysis according to selected criteria such as patient age, BMI, ASA and previous operations showing a near-perfect congruence with the following aims to: 1) demonstrate the feasibility of NA and to estimate its general costs, and 2) elucidate the outcome of the two techniques using available perioperative parameters from daily clinical practice. In particular, operating time, complications, histopathological findings, postoperative hospital stay and analgesic scores were used for comparison. A gynaecological follow-up investigation was carried out on the day of discharge and after a medium-term time period of 4 weeks in the NA group, and 6 months postoperatively, patients of both groups were interviewed using a standardised questionnaire. RESULTS: From 05/01/2008 to 02/28/2010, transvaginal NA (n = 30) was compared with the results of the conventional LA (n = 30) in 60 female patients with regard to the operative outcome. Overall, matched-pair analysis of LA with NA, the novel technique resulted in the assessment of basically comparable surgical procedures with regard to perioperative routine parameters and outcome. There were no intraoperative complications in either of the two approaches; conversion was not required in both techniques. In addition, there were no significant differences in operating time (p = 0.099), postoperative complications (p = 0.72) and analgesic scores (p = 0.33/0.46). Postoperative hospital stay was even slightly shorter in the NA group (p = 0.02). The costs of the two methods are almost identical if the same instruments are used. Patient interviews suggested a slightly faster recovery, greater satisfaction with the better cosmetic outcome as well as a reduced pain intensity in favour of transvaginal NA. CONCLUSION: Provided that a well developed laparoscopic expertise exists, it turned out i) that there are no serious reasons to resist a quick inauguration and establishment of NA for selected cases as well as ii) even to facilitate further clinical distribution of NA. Further systematic data collection appears to be indicated to analyse long-term outcome as parameters of an appropriate quality assurance.

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Surgery of complicated sigmoid diverticulitis should be as gentle as possible. Serious time pressure, unpredictable operation fields and unprepared bowel determine the surgical strategy. Hence, we examine whether minimal invasive surgery (MIS) (i. e., Hartmann procedure) is suited for emergency conditions in selected patients. Furthermore, the objective of the study was to -assess the feasibility of the reversal of Hartmann procedure in appropriate patients after a preceding classical or laparoscopic intervention. -Between 2005 and 2009 128 patients with sigma diverticulitis were operated, 72 patients of them with complicated sigmoid diverticulitis (peritonitis, haemorrhage, ileus, perforation), The classical Hartmann procedure was performed in 45 (35 %) patients, 39 of them being treated within 24 hours. The laparoscopically assisted Hartmann procedure was realised in 15 patients and could be successfully completed in 13 cases. The cor-responding mortality rate was 0 %. A Hartmann reversal could be performed in 26 patients (58 %). A laparoscopic approach was chosen in 16 patients and could be successfully completed in 14 cases. 12 patients were operated with classical Hartmann reversal. The respective mortality rates in both groups were 0 %. We therefore conclude that in cases of peritonitis due to sigmoid diverticulitis laparoscopic surgery, like laparoscopically assisted Hartmann procedure and a subsequent laparoscopically assisted reversal could be recommended in selected patients.

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The experimental animal model of human insulin-dependent diabetes mellitus (IDDM, type I diabetes), which was for the first time described by Like and Rossini (1976) for Charles River CD-1 mice and produced by the application of multiple subdiabetogenic streptozotocin (SZ) doses, has been reproduced in the mouse strain C57 Bl/KsJ which has been bred over several generations at the Central Institute for Diabetes Karlsburg (since 1975). Male mice were given subdiabetogenic intraperitoneal injections of SZ (40 mg/kg b.w.) on five days running.--The simultaneously performed metabolic, light and electron microscopical, histochemical, fluorescence microscopical, and morphometric examinations show that the small doses of SZ lead to a metabolic disturbance in the islets of Langerhans already on the third day of the experiment (after the first two SZ injections) which is associated with a high-degree reduction or an interruption of the insulin production. Subsequently, on the 8th day (three days after the last SZ injection) up to the 20th day an insulitis occurs which is characterized by a target cell reaction of lymphocytes against the beta cells and leads to the lysis of the majority of the beta cells. In the course and after the insulitis, a persisting insulin deficiency diabetes develops with lacking signs of an attempt to replace the perished beta cells. For the time being, the nature of this target beta cell destruction by lymphocytes remains unclear. According to the enzyme-histochemical and electron microscopical results, the involved lymphocytes are natural killer cells (NK cells) rather than T cells. The release of the target cell reaction is obviously effected by the initial metabolic disturbances in the beta cells intervening in the insulin synthesis. Virus bodies do not play any role in this process. The importance of this animal model to human insulin-dependent diabetes mellitus is discussed.

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The aim of the paper was to show that accurate morphological statements can be made with the help of simple concepts of the theory of probability. Binomial distribution was used to find out whether the number of male and female births in large families was random or whether a particular disposition to boys/girls was to be assumed. It was found that the relation was random as a rule. A second question was that of the connection between a number of simultaneous variations and deformities. After the injection of trypan blue, combined deformities were studies in rats and found to be independent of each other, i.e. all had been directly caused by trypan blue.

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