ResultsOn postoperative day 1, epinephrine (p = 0,05), norepinephrine (p = 0.02), and glucose (p = 0.02) responses were higher after CC. Two days postoperatively, norepinephrine remained higher after CC (p < 0.01). Interleukin-1 f responses were higher during (p < 0.01) and 6 hours after CC (p = 0.03). Interleukin-6 responses were higher 6 hours (p = 0.03), 1 day (p = 0.02), and 2 days (p < 0.01) after CC. ConclusionsThe results show significant lower values of intraoperatively and postoperatively measured epinephrine, norepinephrine, interleukin-1 f3, and interleukin-6 in patients with laparoscopic cholecystectomy, indicating a minor stress response and tissue trauma in this group of patients. The results correspond to the favorable results of most other trials evaluating clinical aspects of laparoscopic cholecystectomy. 372

Sophisticated therapies for rectal carcinoma, such as sphincter preserving operations, pouch-anal anastomosis, preoperative irradiation or adjuvant chemotherapy, require an exact pretherapy assessment of the tumour and its lymph node involvement. A 7.0 MHz transducer was used before operation in the staging of 117 patients with rectal carcinoma or villous adenoma. In 90 per cent of cases it was possible correctly to stage the tumour before operation. Sensitivity for detection of perirectal fat infiltration was 97 per cent. Lymph node involvement was accurately identified in about 80 per cent of cases. Six carcinomas, which had developed within 31 examined tubulovillous adenomas, were detected by endorectal ultrasonography. No carcinoma remained undetected. Endorectal ultrasonography is a highly accurate tool for the staging of rectal carcinoma before operation and for the detection of lymph node involvement. Malignant change in tubulovillous adenomas are also detectable.

Laparoscopic colon resection alters the stress and immune system of healthy rats less than open colon resection. This observation is confirmed by the quicker recovery in laparoscopically operated rats.

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A total of 84 patients with ligament or meniscal injuries of the knee was prospectively examined clinically and under anaesthesia, by arthroscopy and sonography. The sensitivity, specificity, positive and negative predictive values were compared. For sonography a high resolution scanner (Picker LSC 7000 with a 5-MHz transducer) was used. The sonographical examination was dynamic under normal and stress conditions. The sensitivity of sonography for diagnosis of rupture of the medial collateral ligament (LCM) was 87%, of the anterior cruciate ligament (LCA), 70% and of menisci, 89% and was thereby similar to that for examination under anaesthesia and arthroscopy and significantly superior to clinical examination alone. The specificity of sonography was very high: for rupture of the LCM 96%, the LCA 98% and the menisci 78%. Only for diagnosis of partial ligament rupture, especially partial LCA rupture, was the sensitivity of sonography low. In diagnosing ligament and meniscal injuries of the knee, sonography should be used routinely as a primary diagnostic tool after clinical examination because: 1. It is inexpensive 2. It has no side effects 3. It helps to cut down X-ray exposure 4. Anaesthesia is not required 5. It allows the recognition and avoidance of muscle tightness 6. Repetitions are possible at will 7. Documentation is included 8. Sensitivity and specificity are very good.