Lymphadenektomie der Axilla

Zusammenfassung: Die axilläre Lymphknotendissektion dient der lokalen Tumorkontrolle und dem Staging. Bei Mammakarzinom, malignem Melanom und vielen anderen soliden Tumoren stellt der nodale Status der wichtigste prädiktive und prognostische Faktor dar. Wegen der Morbidität dieses Eingriffes erfolgt die Lymphadenektomie im axillären Bereich heute selektiv, d.h. geleitet durch die histologische Aufarbeitung des Wachtpostenlymphknotens (Sentinel-node-Biopsie). Die chirurgische Technik der Axilladissektion wird dargestellt, Komplikationen und die onkologischen Ergebnisse für das Mammakarzinom und das maligne Melanom zusammengefass

Sample Size Matters: A Guide for Surgeons

Considerations of sample size computations in the medical literature have gained increasing importance over the past decade and are now often mandatory for scientific grant proposals, protocols, and publications. However, many surgeons are ill-prepared to understand the parameters on which the appropriate sample size is based. The present article has several objectives: first, to review the need for sample size considerations; second, to explain the ingredients necessary for sample size computations in simple, nonmathematic language; third, to provide options for reducing the sample size if it seems impracticably large; and fourth, to help avoid some of the more common mistakes encountered when computing sample size

Preservice teachers' sociopolitical consciousness in light of the racial disparities highlighted by the COVID-19 pandemic

Socioscientific issues (SSI) such as COVID-19 and climate change often highlight the inequalities that structural racism creates. If we ever wish to equitably solve these issues, we require a population that has the scientific literacy and the sociopolitical consciousness to do so. Yet, the push for culturally relevant education has had little movement in science education, partially because of the acultural view of science but also from the colorblind ideologies often held by teachers. The purpose of this pre-experimental study was to determine if a pre-service elementary science methods course that applies the SSI Teaching and Learning Framework for Social Justice promoted participant's sociopolitical consciousness, reduced their colorblind ideologies, and increased their socioscientific reasoning (SSR) skills. Linear mixed-effects regression models were run to assess these outcomes. Results indicate that preservice teachers' colorblind ideologies and socioscientific reasoning skills did not change through the semester. However, a statistically significant increase in their sociopolitical consciousness was found and this increase could be predicted by one of the components of SSR, perspective taking. Implications of these findings are discussed.Includes bibliographical references

Occurrence of Localized Intense Cation Uptake Sites in the Vascular Rings of Red Beet Storage Tissue 2

Development and decline of cation uptake capacity in discs taken from the vascular and parenchyma rings of storage tissue of red table beet (Beta vulgaris L.) were observed during 12 d of ageing. Uptake capacity for Na+ and Rb+ showed a steady rise reaching maximums by the fourth to fifth days of ageing. Thereafter, there was a steady decline in the uptake rates. Vascular ring tissues were able to develop a greater uptake capacity for both Na+ and Rb+ than the tissues of parenchyma rings. This difference, which was more pronounced for Rb+ than for Na+ uptake, is attributed to a combination of variations in cell density and differences in the acquisition and retention of the cation uptake capacity. Respiration of tissue discs showed no significant rise during ageing, nor were there significant differences in the respiration of vascular and parenchyma tissues. Vascular tissues contained significantly more betacyanin than parenchyma tissues; and they retained their pigment, as well as their acquired cation uptake capacity, for a longer period during the ageing proces

The pond biodiversity index "IBEM", a new tool for the rapid assessment of biodiversity in ponds from Switzerland. Part 2. Method description and examples of application

Ponds are now widely recognized to contribute significantly to regional freshwater biodiversity. Therefore, tools to easily and rapidly assess biological quality specificalIy for these aquatic habitats have been increasingly requested by conservation planners and nature managers. In c10se association with practitioners, we developed such a method for Switzerland; the pond biodiversity index "IBEM". The IBEM-Index is based on the assessment of the taxonomic richness of 5 groups: aquatic vege­tation, Gastropoda, Coleoptera, adult Odonata and Amphibia. No abundance data are necessary and genus level identification is required for alI groups except Amphibia (species level). The sampling methodology is a stratified random strategy and alIows the use of richness estimators to transform the observed taxonomic richness (Sobs) into true taxonomic richness (Strue). As the IBEM assessment folIows the methodology presented in the Water Framework Directive, it is based on the caIculation of the ratio of true taxonomic richness (Strue) to reference-based predicted richness (Sref)' Each of the five taxonomic groups is assessed separately and the overalI biological quality of any given pond (i.e. the IBEM-Index) is the average of the five ratios. This score is later converted into one of five quality c1asses for each pond: bad (O to 0.2), poor (> 0.2 to 0.4), moderate (> 0.4 to 0.6), good (> 0.6 to 0.8), and high (> 0.8 to 1). In this paper, the implementation of the IBEM-Index is described in detail. The sampling methodologies are developed (for the biodiversity and the environmental variables) as welI as the assessment methodology. FinalIy, two examples are presen­ted in detail, for a "good" quality pond and for a "bad" quality pond. The method implementation also includes a website (http://campus.hesge.ch/ibem) which a1lows the online caIculation of the index, and provides support for both sampling and assessment methodologies to users. The IBEM-Index is a rapid assessment method which gives an overalI value of pond biodiversity in terms of taxa richness and can be used, for example, in regional screenings or site monitoring in Switzerland. Moreover, as biodiversity is generalIy recognized as a good indicator of global ecological quality, the IBEM-Index can also be used to investigate ecosystem quality.Está ampliamente reconocido que las pequeñas masas de agua (charcas) contribuyen de forma significativa a la biodiversi­dad regional de las aguas dulces. Por tanto, las herramientas que de manera rápida y fácil evalúen especíjicamente la calidad biológica de estos hábitats acuáticos están siendo requeridas cada vez más por profesionales de la gestión y conservación del medio natural. En estrecha colaboración con estos profesionales, se ha desarrollado un método de este tipo para Suiza; el índice de biodiversidad de charcas "IBEM". El Índice-IBEM se basa en la evaluación de la riqueza taxonómica de 5 grupos: vegetación acuática, gasterópoda, coleópteros, odonatos (adultos) y anfibios. No son necesarios datos de abundancia y se requiere un nivel identificación de género para todos los grupos excepto para los anfibios (nivel de especie). Se usa un muestreo aleatorio estratificado que permite obtener estimadores para transformar la riqueza taxonómica observada (Sobs) en riqueza taxonómica real (Strue)' La evaluación IBEM sigue la metodología de la Directiva Marco del Agua, que se basa en el cálculo de la relación entre la riqueza taxonómica real (Strue) y la riqueza esperable en un estado de referencia (Sre!)' Cada uno de los cinco grupos taxonómicos se evalúa por separado y la calidad biológica de una charca determinada (Índice-IBEM) es la media de los cinco coeficientes. Este resultado es posterionnente asignado a una de las cinco clases de calidad: malo (O a 0.2), deficiente (> 0.2 a 0.4), moderado (> 0.4 a 0.6), bueno (> 0.6 to 0.8), y muy bueno (> 0.8 al). En este artículo, se describe detalladamente la aplicación del índice IBEM y se desarrollan las metodologías de mues­treo (para la biodiversidad y las variables ambientales) y de valoración utilizadas. Por último, se presentan con detalle dos ejemplos, una charca con "buena" calidad y otra con "mala" calidad. Se incluye también una página web (http://campus.hesge.ch/ibem), que permite el cálculo del índice a través de intemet y sirve de apoyo a los usuarios en las metodologías de muestreo y de valoración. El índice IBEM es un método de evaluación rápida que da un valor general de la diversidad biológica de una charca en términos de riqueza de taxones y se puede utilizar, por ejemplo, a nivel regional o en el seguimiento de una localidad, en Suiza. Además, como la biodiversidad es un buen indicador de la calidad ecológica global, el índice IBEM también se puede usar para evaluar el estado del ecosistema

Factors predicting in-breast tumor recurrence after breast-conserving surgery

Purpose: The main objectives of this study were to identify risk factors for local in-breast tumor recurrence after breast-conservation and to evaluate the impact of IBTR (in-breast tumor recurrence) on overall survival. Methods: A total of 335 consecutive patients with 346 invasive and insitu breast cancers were treated with breast conserving therapy. Univariate and multivariate statistical analysis were performed and survival rates were calculated and analyzed using the Kaplan-Meier method. Results: With a median follow-up period of 70.6months 14 patients (4%) developed an IBTR. Overall survival and the disease-free 8-year actuarial survival of patients were 95% and 93%, respectively. The overall survival of patients with tumour recurrence on any site was significantly shorter than of those without recurrence (64% versus 85% after 8years of follow-up; P<0.0001). Similarly, overall survival was significantly reduced in patients with distant metastases compared to all others without distant disease (88% versus 40% after 8years; P<0.0001). In contrast, overall survival of patients who experienced IBTR did not differ significantly from the group of patients who never developed IBTR (87% versus 70% after 8years of follow-up). By univariate analysis, lobular carcinoma, high grade tumours, multifocality, concomitant LCIS and DCIS, the absence of estrogene and progesterone receptor status, as well as R1-status, were significant predictors of IBTR. By multivariate analysis, only R1-status (P<0.002) and the presence of LCIS around the invasive tumour (P<0.03) remained as significant factors predicting IBTR. Conclusions: Concomitant lobular carcinomas insitu, as well as R1 surgical status are independent significant risk factors for in breast tumor recurrence after breast conserving therap

Simplified placement and management of cutting setons in the treatment of transsphincteric anal fistula: technical note

Background: We report one safe and standardized technique of seton placement and management. Conclusions: A simplified way to manage cutting setons helps to minimize manipulation and may reduce pain. In most patients our technique can be used with no additional anesthesia and in an outpatient settin

Laparoscopic Treatment of a Rare Right Diaphragmatic Rupture with Small Bowel Herniation after Blunt Thoracic Trauma

Blunt traumatic diaphragmatic rupture (BTDR) is a life-threatening condition with an incidence from 0,8%–1,6% in blunt trauma, mostly located on the left side. The main prognostic factors are severe side injuries and the delay of diagnosis. We present a rare case of a 68-year-old female, with an isolated right diaphragm rupture. The diagnosis was done with a delay of 4 days by thoracic radiographs, which showed a herniation of small bowel into the right thoracic cavity. A reposition of the small bowel and a closure of the diaphragmatic defect by running suture were carried out laparoscopicly. Although large prospective studies concerning the outcome of laparoscopic approach to right BTDR are still missing, we could show, that laparoscopy can be performed safely in right traumatic diaphragm rupture

Laparoscopic lLver Resection: a Single-Centre Experience

BACKGROUND The past 25 years have seen the increased use of minimally invasive surgery. The development of these techniques has impacted the domain of liver surgery. This study aimed to describe the safety, feasibility, benefits and results of laparoscopic liver resection in a single tertiary care centre. METHODS We reviewed the medical records of all patients who underwent liver surgery between January 2005 and December 2016 at the University Hospital of Basel. We selected all liver resections performed by laparoscopic surgery. To evaluate the results of the laparoscopic liver surgery, we chose the following data: the conversion rate from laparoscopy to open surgery, the median operating time, postoperative complications, the median length of stay following surgery and the median surgical margin in patients with malignant lesions. RESULTS Of the 274 liver operations, 201 (73%) were performed by open surgery and 73 (27%) by laparoscopy. Sixty-nine laparoscopic liver resections were included in this study. The selected laparoscopic liver resections were performed in 65 patients: 38 men and 27 women. The median age was 59 (range 29–85) years. Forty resections were performed for malignant lesions and 29 (42%) for benign diseases. The median operating time was 112 (range 50–247) minutes. The conversion rate was 19%. The most common cause for conversion was bleeding (69% of all conversions, 13% of all patients). Postoperative complications occurred in 15 patients (22%). The median hospitalisation time was 7.1 (range 2–23) days. Thirty-two patients (46.5% of all patients) had hepatocellular carcinoma. The mean tumour size was 25.6 (range 5–55) mm. The median surgical margin was 9 mm. CONCLUSION This study showed that in our centre laparoscopic liver surgery is a safe and effective treatment option for both benign and malignant liver lesions. Keywords: laparoscopic liver resection, laparoscopic hepatectomy, hepatocellular carcinoma, HC