Background: Patients with a rectal foreign body (RFB) are still a rare entity in general surgery departments but with an increasing incidence over the last years. This case is sometimes difficult to treat, and due to a lack of standardized treatment options, the aim of the study was to present our clinical experiences with the diagnostic and therapeutic approach to RFBs and a review of the currently available literature. Materials and methods: Data were collected retrospectively from the patient's records of 20 patients who were treated due to an RFB between 2006 and 2016. Patient's demographics, circumstances of insertion, inserted objects, clinical presentation, laboratory and imaging results, as well as surgical treatment and duration of hospital stay were analyzed. Additionally, a review of the literature was performed with the search items "rectal foreign body" and "surgical therapy". Because many publications were just case reports, we did not perform a meta-analysis or a systematic review. Results: Twenty-two cases in 20 patients (80% male) presented to the emergency room. The mean age was 38.5 ± 13.7 years. In 68.2% of the cases, the cause of RFB was due to sexual preferences. The following objects were inserted: six dildos, three vibrators, two bottles, one glass, one deodorant, one apple, one fever thermometer,

It is thought that an excessive fibrotic healing response with diffuse intra-articular scarring leads to arthrofibrosis after trauma and surgery around joints. To clarify the specific cellular mechanism of arthrofibrosis during arthrolysis we took fibrotic tissue samples from 18 patients at varying periods after knee trauma or surgery. Sections were stained with hematoxylin and eosin to study the overall histopathological changes. Major histocompatibility complex (MHC) class II expressing cells as well as CD3, CD4, CD25, CD28, CD68, CD80, and CD83 positive cells were localized immunohistologically. The results demonstrated synovial hyperplasia with fibrotic enlargement of the subintima and infiltration of inflammatory cells. The number of MHC class II expressing cells was increased. Mainly, intimal macrophages and dendritic cells showed positive immunostaining for MHC class II antigens. In the subintima moderate infiltration of T cells including activated T cells (CD25), CD4+ T helper (Th) cells and Th1 and Th2 subsets was detected. There was a slight polarization of the Th1/Th2 balance towards Th1 differentiation. Positive immunostaining for CD80/CD28 indicated the costimulatory signal for T cell activation and clonal expansion. These findings strongly support an immune response as the cause of capsulitis leading to formation of diffuse scar tissue within the knee joint. Based on our immunohistological study we conclude that a T cell mediated immune response plays a crucial role in the mechanism of arthrofibrosis.

Arthrofibrosis is a disabling complication after knee trauma and surgery and is characterised clinically by joint stiffness. Due to an immune response, the proliferation of fibroblasts and synthesis of extracellular matrix proteins are increased. The cytokines transforming growth factor beta (TGF-beta) and platelet-derived growth factor (PDGF) are critical players in tissue fibrosis, stimulating cell proliferation and the production of various extracellular matrix proteins. Tissue samples from the infrapatellar fat pad and intercondylar synovia of seven patients (age 18-49 years) suffering from arthrofibrosis were taken at surgery. The mean interval between trauma and arthrolysis was 14.3 months. All samples were stained with haematoxylin and eosin, and monoclonal and polyclonal antibodies were applied for immunohistological localisation of TGF-beta and PDGF. The percentage of both cytokines was then analysed using an image analysis system. Tissue samples with no macroscopic pathology of the synovial tissue from eight patients for anterior cruciate ligament replacement served as controls. Immunostaining for TGF-beta and PDGF was found to be increased in arthrofibrotic tissue. Both cytokines could be detected subsynovially around inflammatory cells. The profibrotic cytokines TGF-beta and PDGF play an important role in the pathogenesis of arthrofibrosis. Both cytokines are key mediators of tissue fibrosis.

HintergrundDie Prinzipien der multidisziplinären Rehabilitation nach chirurgischen Eingriffen (ERAS, "enhanced recovery after surgery") konnten bereits in der kolorektalen Chirurgie positive Effekte auf die Komplikationsraten

Implanted central venous access devices are becoming increasingly more important in oncology as an important tool for therapists and patients. As an intracorporeal system with reduced risk of infection compared to percutaneous tunnelled catheters they ensure a permanent and safe access to the central venous system. However, they can be associated with risks and sometimes severe complications which should not be underestimated so that planning and performance of the implantation require a high level of care and attention. Postoperative care and the correct allocation of all groups of persons involved in the therapy can reduce complication rates and are thus of prognostic relevance.