Laparoscopic wedge resection for benign gastric tumors

Background: Both laparoscopic wedge resection and formal laparoscopic resection are used in the treatment of benign and malignant gastric diseases. Methods: We performed totally laparoscopic wedge resection using stapling devices and three or four trocars. Patients: Four patients were treated with this technique. All four suffered from gastrointestinal stromal tumors (GIST), and one presented with an additional gastric adenoma. Two were morbidly obese, and two had additional operations performed at the same time. Two patients were admitted for acute upper GI bleeding. Results: All of the tumors were removed successfully. Operating time ranged from 135 to 215 min. Oral feeding commenced on days 2-4. Postoperative hospital stay ranged from 5 to 11 days. Conclusion: Laparoscopic wedge resection of benign gastric tumors is a safe, reliable method that should be further investigated and used on a broader scal

A dominant dwarf shrub increases diversity of herbaceous plant communities in a Trans-Himalayan rangeland

Plant communities are structured by both competition and facilitation. The interplay between the two interactions can vary depending on environmental factors, nature of stress, and plant traits. But, whether positive or negative interactions dominate in regions of high biotic and abiotic stress remains unclear.We studied herbaceous plant communities associated with a dwarf shrub Caragana versicolor in semi-arid, high altitude Trans Himalayan rangelands of Spiti, India. We surveyed 120 pairs of plots (within and outside shrub canopies) across four watersheds differing in altitude, aspect and dominant herbivores. Herbaceous communities within shrub canopies had 25% higher species richness, but similar abundance when compared to communities outside the canopy, with the shrub edge having higher diversity than the center of the canopy. Grasses and erect forbs showed positive associations with the shrub, while prostrate plants occurred at much lower abundance within the canopy. Rare species showed stronger positive associations with Caragana than abundant species. Experimental removal of herbaceous vegetation from within shrub canopies led to 42% increase in flowering in Caragana, indicating a cost to the host shrubs. Our study indicates a robust pattern of a dwarf shrub facilitating local community diversity across this alpine landscape, increasing diversity at the plot level, facilitating rare species, and yet incurring a cost to hosts from the presence of herbaceous plants. Given these large influences of this shrub on vegetation of these high altitude rangelands, we suggest that the shrub microhabitat be explicitly considered in any analyses of ecosystem health in such rangelands

Aszites und Makrohämaturie nach Bagatelltrauma unter Alkoholeinfluss

Isolierte Blasenrupturen nach Bagatelltraumen stellen eine seltene abdominelle Verletzung dar. Sowohl die Diagnostik als auch die Therapie fordern Notfallmediziner und Chirurgen heraus. Dieser Fall berichtet von einem 46-jährigen Patienten, welcher nach einem Sturz unter Alkoholeinfluss mit einer Commotio cerebri hospitalisiert wurde. Im Ultraschall des Abdomens sowie konsekutiv in der CT des Abdomens zeigte sich freie Flüssigkeit. Zudem konnte eine Makrohämaturie nachgewiesen werden. In der retrograden Zystographie kam ein intraperitonealer Kontrastmittelaustritt zur Darstellung. Die Blasenruptur wurde laparoskopisch bestätigt und zweireihig intrakorporal übernäht. Postoperativ zeigte der Patient einen komplikationslosen Verlauf mit Entlassung am vierten postoperativen Tag und korrekter retrograder Zystographie 10 Tage postoperativ sowie konsekutiver Entfernung des Blasenkatheters. = Isolated ruptures of the urinary bladder following minor traumas are a rare abdominal lesion. Diagnosis and treatment are a challenge to emergency physicians and surgeons. This case shows a 46-year-old patient admitted for a minor brain injury after falling during an episode of alcoholic intoxication. Ultrasound and CT scan of the abdomen showed intraabdominal fluid without a parenchymatous lesion. Also a hematuria was significant. The retrograde cystography showed intraabdominal contrast agent. The rupture of the urinary bladder was confirmed by laparoscopy and was intracorporal sutured in double layer technique. Without any postoperative complications the patient was discharged after 4 days. The retrograde cystography after 10 days showed no leckage and the urinary catheter could be removed