Die Verarbeitung emotionaler Informationen und automatische Responsivität der Amygdalae bei Depression

Kognitive Theorien der Depression postulieren eine stimmungskongruente Verzerrung von Denkprozessen bei Patienten auf automatischen Stufen der Informationsverarbeitung. Bei 16 Patienten und 26 Kontrollprobanden wurden die automatischen Amygdala-Antworten auf emotionale Gesichtsausdrücke durch funktionelle Magnetresonanztomographie mit Hilfe subliminaler Stimuli gemessen. Zum Nachweis der unbewussten Wahrnehmung der Stimuli wurde eine Detektions-Aufgabe durchgeführt, in der die Probanden die Stimuli tatsächlich nicht bewusst wahrnahmen. Wir fanden eine Interaktion Emotion x Gruppe in der laterobasalen rechten Amygdala. Hierbei zeigten depressive Patienten gesteigerte Reaktionen der Amygdalae auf maskierte negative Stimuli und ein reduziertes Ansprechen auf maskierte positive Stimuli im Vergleich mit gesunden Individuen. Also zeichnet sich die Depression durch eine stimmungskongruente Verarbeitung emotionaler Stimuli in der Amygdala in automatischen Stadien der Kognition aus

The Efficacy of the Prophylactic Use of Octreotide after a Pancreaticoduodenectomy

This study was performed to analyze the efficacy of the prophylactic use of octreotide (Novartis, Stein, Switzerland) for pancreatic fistula following a pancreaticoduodenectomy. The medical records of 190 patients who underwent a pancreaticoduodenectomy at the Samsung Medical Center in Seoul, Korea between January 2000 and December 2002 were reviewed. Patients were divided into either the octreotide (n = 81) or control group (n = 109). The octreotide group received subcutaneous injections of 100 µg of octreotide every 12 hours for more than five days after surgery. The control group was not treated with octreotide. The criterion of pancreatic fistula was the drainage of the amylase rich fluid, over 500 U/mL in the three days after surgery. The morbidity and mortality rates were 32.1% and 1.2% in the octreotide group and 31.2% and 0% in the control group, respectively. Pancreatic fistula was the second most common complication (8.4%). In the univariate analysis, octreotide was ineffective in reducing pancreatic fistula (p = 0.26). However, in the multivariate regression analysis, combined gastrectomy (p = 0.018), cellular origin of the disease (p = 0.049), and use of octreotide (p = 0.044) were the risk factors that increased the frequency of pancreatic fistula. Therefore, the routine use of octreotide after a pancreaticoduodenectomy should be avoided until a worldwide consensus is established

Role of Factor VII in Correcting Dilutional Coagulopathy and Reducing Re-operations for Bleeding Following Non-traumatic Major Gastrointestinal and Abdominal Surgery

Objective The objective of this study is to evaluate the effectiveness of rfVIIa in reducing blood product requirements and re-operation for postoperative bleeding after major abdominal surgery. Background Hemorrhage is a significant complication after major gastrointestinal and abdominal surgery. Clinically significant bleeding can lead to shock, transfusion of blood products, and re-operation. Recent reports suggest that activated rfVIIa may be effective in correcting coagulopathy and decreasing the need for re-operation. Methods This study was a retrospective review over a 4-year period of 17 consecutive bleeding postoperative patients who received rfVIIa to control hemorrhage and avoid re-operation. Outcome measures were blood and clotting factor transfusions, deaths, thromboembolic complications, and number of re-operations for bleeding. Results Seventeen patients with postoperative hemorrhage following major abdominal gastrointestinal surgery (nine pancreas, four sarcoma, two gastric, one carcinoid, and one fistula) were treated with rfVIIa. In these 17 patients, rfVIIa was administered for 18 episodes of bleeding (dose 2,400-9,600 mcg, 29.8-100.8 mcg/kg). Transfusion requirement of pRBC and FFP were each significantly less than pre-rfVIIa. Out of the 18 episodes, bleeding was controlled in 17 (94%) without surgery, and only one patient returned to the operating room for hemorrhage. There were no deaths and two thrombotic complications. Coagulopathy was corrected by rfVIIa from 1.37 to 0.96 (p<0.0001). Conclusion Use of rfVIIa in resuscitation for hemorrhage after non-traumatic major abdominal and gastrointestinal surgery can correct dilutional coagulopathy, reducing blood product requirements and need for re-operation

Management of Massive Arterial Hemorrhage After Pancreatobiliary Surgery: Does Embolotherapy Contribute to Successful Outcome?

Massive arterial hemorrhage is, although unusual, a life-threatening complication of major pancreatobiliary surgery. Records of 351 patients who underwent major surgery for malignant pancreatobiliary disease were reviewed in this series. Thirteen patients (3.7%) experienced massive hemorrhage after surgery. Complete hemostasis by transcatheter arterial embolization (TAE) or re-laparotomy was achieved in five patients and one patient, respectively. However, 7 of 13 cases ended in fatality, which is a 54% mortality rate. Among six survivors, one underwent selective TAE for a pseudoaneurysm of the right hepatic artery (RHA). Three patients underwent TAE proximal to the proper hepatic artery (PHA): hepatic inflow was maintained by successful TAE of the gastroduodenal artery in two and via a well-developed subphrenic artery in one. One patient had TAE of the celiac axis for a pseudoaneurysm of the splenic artery (SPA), and hepatic inflow was maintained by the arcades around the pancreatic head. One patient who experienced a pseudoaneurysm of the RHA after left hemihepatectomy successfully underwent re-laparotomy, ligation of RHA, and creation of an ileocolic arterioportal shunt. In contrast, four of seven patients with fatal outcomes experienced hepatic infarction following TAE proximal to the PHA or injury of the common hepatic artery during angiography. One patient who underwent a major hepatectomy for hilar bile duct cancer had a recurrent hemorrhage after TAE of the gastroduodenal artery and experienced hepatic failure. In the two patients with a pseudoaneurysm of the SPA or the superior mesenteric artery, an emergency re-laparotomy was required to obtain hemostasis because of worsening clinical status. Selective TAE distal to PHA or in the SPA is usually successful. TAE proximal to PHA must be restricted to cases where collateral hepatic blood flow exists. Otherwise or for a pseudoaneurysm of the superior mesenteric artery, endovascular stenting, temporary creation of an ileocolic arterioportal shunt, or vascular reconstruction by re-laparotomy is an alternative

2013 WSES guidelines for management of intra-abdominal infections

Peer reviewe

Bilateral congenital cholesteatoma - Review of literature and report of a case complicated by acute mastoiditis

Einleitung: Bilaterale genuine Cholesteatome sind eine Rarität. Gerade bei Kindern spielen Cholesteatome in Bezug auf den Spracherwerb und auf ihr meist aggressiveres Wachstum im Vergleich zum Erwachsenen eine wichtige Rolle. Eine schnelle Diagnose und suffiziente Therapie sind zur Prävention von Komplikationen entscheidend.Methoden: Wir recherchierten alle bislang berichteten 33 Fälle und werteten diese systematisch aus. Es werden vor allem die Initialsymptome inklusive der Hörminderung, der Wertigkeit einer CT und weitere Auffälligkeiten betrachtet, die im klinischen Alltag eine schnelle Diagnosefindung erleichtern. Der Fall eines bilateralen genuinen Cholesteatoms mit akuter Mastoiditis wird mit intraoperativen Bildern sowie CT-Aufnahmen im Verlauf und seiner Klinik näher dargestellt.Ergebnisse: 23/28 der Patienten sind männlich (Altersgipfel 4 bis 6 Jahre). Die CT-Diagnostik zeigte in jedem Fall mindestens eine einseitige Pathologie, einmal sogar bei blander Ohrmikroskopie. Bei 13/18 Patienten zeigte sich eine weiße Masse hinter dem Trommelfell. 5 Patienten zeigten eine Otorrhoe, 3 davon mit Otitis media. 6/17 Patienten zeigten keine Hörminderung. Eine stärkere Hörminderung korrelierte oft mit höherem Patientenalter, syndromalen Erkankungen und Komorbiditäten.Diskussion: Die Literaturrecherche sowie der Fallbericht liefern interessante, für die Klinik relevante Informationen. Durch eine gezielte klinische Diagnostik, begleitet von CT und Hörtest lassen sich auch seltene Befunde sicher und schnell ohne invasive Maßnahmen diagnostizieren. Einer otoskopischen Verlaufskontrolle kommt hierbei eine enorme Bedeutung zu, um zweizeitig auftretende Befunde zu erkennen. Genuine Cholesteatome stellen ein heterogenes Kollektiv dar und können noch in hohem Alter in Erscheinung treten.Der Erstautor gibt keinen Interessenkonflikt an