“Pregnancy zone” protein in sera from patients with prostatic cancer treated with oestrogens

Summary The pregnancy zone protein is a human a₂-serum globulin previously found in pregnant women and women taking oral contraceptive drugs. The occurrence of this protein in sera from 22 out of 34 patients with prostatic cancer treated with oestrogen was demonstrated by an immunological technique. Immunological identity was found between this steroid-inducible protein and that in sera from pregnant women and women taking contraceptive drugs. This protein was not detected in 27 patients with prostatic cancer not treated with oestrogens. Oral diethylstilboestrol appeared to induce the pregnancy zone protein more often than injections of polyoestradiol phosphate.     

Spontaneous spinal epidural hematomas: is the role of dural arteriovenous malformations underestimated?

Two recent observations of spinal epidural hematomas (SEH) are presented: one of them was associated with iatrogenic coagulopathy, the other, apparently spontaneous, required reoperation for early recurrence and was finally attributed to ruptured epidural arteriovenous malformation missed during the first procedure. Both patients underwent complete recovery. Although modern neuroimaging provides quick, noninvasive, and sensitive assessment of spinal epidural bleeding, we believe that preoperative spinal angiography is indicated in spontaneous SEH with subacute clinical course. Demonstration of underlying vascular anomaly would allow better surgical planning, complete obliteration of abnormal vessels, and prevention of recurrences. Essential epidemiological, pathogenetical, and clinical aspects of SEH are reviewed.     

Pilot study analysis of the histologic and bacteriologic effects of occlusive dressings in chemosurgical peel using a minipig model

The histologic changes associated with chemosurgery are well documented, but the data concerning the effects of occlusive dressings (adhesive tape, gauze, or ointments) is largely anecdotal. Wide differences of opinion exist as to the best method of phenol application and postpeel wound care regimen. Using a Yucatan minipig as our animal model, we studied the histologic and bacteriologic differences that various commonly used occlusive dressings have upon the initial burn depth and the subsequent healing of peeled skin. We also compared chemical peel with dermabrasion and chemabrasion. Our results showed to statistical difference in peel depth between wet versus moist phenol application or between occluded versus nonoccluded dressings. Based upon this animal model, we recommend that phenol solutions be applied moist rather than wet and that an occlusive dressing other than adhesive tape be used and maintained for a minimum of four days.Certificate of Excellence for presentation at the 24th Annual American Society for Aesthetic Plastic Surgery Meeting, New York City, NY, April 28–May 3, 1991. First Prize, Aesthetic Category at the 1991 National Plastic Surgery Senior Residents Conference, Madison, WI. First Prize, 1991 Senior Residents contest sponsored by the Chicago Society of Plastic Surgery, Chicago, IL     

82. Fragen der chirurgischen Weiterbildung: Gegenwärtiger Stand

Zusammenfassung Weiterbildung — die Einführung eines approbierten Arztes in ein anerkanntes Fachgebiet — ist im Begriff und System von Ausbildung (des Studenten) und lebenslanger Fortbildung (des fertigen Arztes) zu unterscheiden. Sie schafft das Fundament, auf dem sich Wissen und Können der Angehörigen einer Disziplin aufbauen, und setzt damit Wertmaßstäbe im eigenen Land und über die Grenzen hinaus. Weiterbildungsordnung (WO) und als Richtlinien bezeichnete Ausführungsbestimmungen regeln den Ablauf der Weiterbildung (W). Neu ist im wesentlichen die Verlängerung der Weiterbildungszeit von 5 auf 6 Jahre, die Einführung von Teilgebieten (in der Chirurgie Teilgebiet Kinder-Chirurgie und Teilgebiet Unfall-Chirurgie) mit dem Ziel, abgerundeten Subspezialitäten im Rahmen des Gesamt-Fachgebiets eine Autonomie zu geben, sowie ein umfangreicher Operations-Katalog. Die WO ist damit richtungweisend für die weitere Entwicklung des Fachgebietes und begründet erhebliche Anforderungen sowohl an den Facharzt-Aspiranten als auch an den Erfahrenen, der die W leitet. Die Einführung eines Befähigungsnachweises als einer in der ausschließlichen Kompetenz der ärztlichen Selbstverwaltung gelegenen Abschlußkontrolle wird befürwortet.

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Summary Postgraduate medical education in an approved specialty by definition and set-up differs from both undergraduate medical education and the life-long continuing medical education after completion of training. Postgraduate education in medicine is the basis for the knowledge and proficiency of a specialist and sets standards at home and abroad. Postgraduate education is laid down in principle in the Weiterbildungsordnung and regulated by the Richtlinien. Major innovations are a prolongation of training from 5 to 6 years, the introduction of subspecialties (pediatric surgery, traumatology), in order to give these established groups autonomy within the field of surgery and finally a sizable list of operations to be performed. The new Weiterbildungsordnung will guide the future development of surgery and imposes demands both on those in training and those responsible for it. An examination as "proof of competence"' is recommended, but should remain within the competence of the medical profession.

     

In situ cytokine production by breast cancer tumor-infiltrating lymphocytes

Background: Human breast cancers progressively grow despite the presence of extensive lymphocytic infiltration and specific antitumor immune recognition, thereby calling into question the competency of breast tumor-infiltrating lymphocytes (TIL). The function of breast TILs in vivo and their possible role in the suppression of an antitumor immune response are largely unknown. Methods: The cytokines produced in situ by lymphocytes in 89 breast carcinomas and 14 benign breast lesions were assessed using immunohistochemistry. Results: The majority of tumor and benign breast samples contained T-cell infiltrates, which were disclosed using an anti-CD3 antibody stain. The percentage of tumor samples in which 3% of the lymphocytes were producing cytokines was as follows: interleukin (IL)-2 45%, IL-4 36%, tumor necrosis factor-alpha (TNF-) 28%, transforming growth factor-beta 1 (TGF-₁) 20%, IL-10 11%, interferon-gamma (IFN-) 4%, and granulocytemacrophage colony-stimulating factor (GM-CSF) 3%. Production of IL-2, IL-4, and TGF-₁ by TILs in breast cancers exceeded that detected in benign breast lesions (p<0.005). Significantly more tumor samples contained lymphocytes producing IL-2, IL-4, TGF-₁, and TNF- than IFN- and GM-CSF (p<0.002 for each comparison). One or more of the potentially immunoinhibitory cytokines—IL-4, IL-10, or TGF-₁—were produced by lymphocytes in 44% of the specimens. No significant associations were seen between lymphocyte production of a particular cytokine and disease-free survival (median follow-up 43 months). Conclusions: Immunohistochemical techniques can be used to detect cytokine secretion by TILs in preserved tissue. The relative lack of secretion of IFN- and GM-CSF, rather than a deficiency of IL-2, may explain why the antitumor immune response to breast cancer is impaired.Presented at the 48th Annual Cancer Symposium of The Society of Surgical Oncology, Boston, Massachusetts, March 23–26, 1995.     

31. Über das Problem,Appendicitis" in unserem 10jährigen Krankengut

Zusammenfassung An der dritten chirurgischen Klinik der Semmelweis Universität Budapest haben wir von 1976 bis 1985 862 Patienten wegen Verdacht auf akute Appendicitis operiert. Bei 111 Patienten konnte ein Beweis einer Entzündung weder makroskopisch noch histologisch nachgewiesen werden. Diese Patienten wurden unter der Diagnose chronische Appendicitis geführt, die Letalität betrug 0,8%. Bei den 751 wegen akuter Appendicitis operierten Fällen betrug die Letalität 0,5%. Bei den Patienten, die wegen chronischer Appendicitis operiert wurden und bei denen der Eingriff als sogenannte prophylaktische Appendektomie gilt, waren die Komplikationen sowie die Letalität größer, als in der wegen akuter Appendicitis operierten Gruppe. Deshalb werden die aus prophylaktischen Gründen durchgeführten Appendektomien bei uns nicht befürwortet.     

7. Therapie des akuten Nierenversagens — Filtration — Dialyse,wann?

Summary Artificial organ support (artificial kidney) is part of the therapeutic regimen as a whole in patients with acute renal failure. The absolute indications for an artificial kidney (hyperkalemia, hyperhydration, uremic encephalopathy), should be prevented by modern intensive care in the majority of cases. Hemofiltration has the advantage of better cardiovascular tolerance, but is less effective than hemodialysis in respect to elimination of toxins with low molecular weight. The continuous arterio-venous hemofiltration (CAVH) bears the advantage of continuous elimination and minimal cardiovascular side effects.Zusammenfassung Bei Patienten mit akutem Nierenversagen ist der apparative Organersatz (künstliche Niere) Teil des Gesamtbehandlungsplanes. Die absoluten Indikationen für die künstliche Niere (bedrohliche Hyperkaliämie und Hyperhydratation, urämische Encephalopathie) sollten in einer modernen Intensivtherapie nur selten gegeben sein. Die künstliche Niere sollte frühzeitig eingesetzt werden. Die Hämofiltration hat gegenüber der Hämodialyse den Vorteil der besseren Kreislaufverträglichkeit, ist jedoch weniger effektiv in der Elimination. Die kontinuierliche arterio-venöse Hämofiltration (CAVH) hat den Vorteil von kontinuierlicher Entgiftung und Wasserentzug bei sehr guter Kreislaufverträglichkeit.

     

Studies on renal adaptation to altered dietary amino acid intake: reduced renal cortex taurine content increases the Vmax of taurine uptake by brush border membrane vesicles

Rats were placed on a normal taurine diet (NTD), low taurine diet (LTD) or a high taurine diet (HTD) for 14 days. -Alanine was fed to half of the animals in each group and resulted in a lowered renal cortex taurine content. Brush border membrane vesicle (BBMV) uptake of taurine was higher after -alanine feeding and was associated with an increase in V_max of uptake. -Alanine feeding to HTD animals also altered the K_m of uptake, possibly since the load of sulfur amino acids (6% of diet) was high. As a control, glycine (3%) feeding for 8 days along with each diet did not alter the plasma or renal cortex content; BBMV uptake as well as K_m and V_max of taurine accumulation were minimally altered. Accordingly, ingestion of a non-sulfur-containing -amino acid did not change -amino acid transport. This study provides evidence that whole body taurine homeostasis is maintained in the presence of a taurine-depleting agent (-alanine feeding) by an increase in the number of Na⁺-taurine uptake sites.Supported in part by grants from NIH RO1 AM 31682-02, AM 37223-01 and the Medical School and Graduate School Research Committees of The University of Wisconsin. Dr. Dabbagh is supported by the Pearl M. Stetler Foundation. Dr. Chesney was the recipient of a Research Career Development Award KO4 AM 00421.     

Renal transplantation in prune-belly syndrome

We assess the effect of the prune-belly syndrome (PBS) on renal transplantation outcome. Six renal transplantations were performed in five boys affected by PBS (median age 5.8±2.1 years, median weight 13.6±2.4kg). Renal graft survival, graft function, lower urinary tract dysfunction, urinary tract infections (UTIs), associated complications and patients survival after 1 and 5 years of follow-up were analysed. The rate for 1–5-year graft survival was 66.7% (mean serum creatinine 98–103 mol/l). The surgical treatment of the documented bladder obstruction (two patients) and the severe abdominal wall deficit (one patient) led to a reduction of UTI: the patients maintained their native urinary tract and none received prophylactic antibiotics. The lack of abdominal wall musculature led to severe mechanical complication in one patient, but Monforts abdominal wall reconstruction was able to restore the grafts function. The outcome of patients with PBS who undergo renal transplantation is good. Before the transplant, an accurate assessment of urinary tract anomalies and deficiency of the abdominal wall musculature is mandatory, to program the appropriate treatment and obtain a good long-term prognosis for the renal graft.     

Children with unilateral occlusion or stenosis of the ICA associated with surrounding Moyamoya vessels — “unilateral” Moyamoya disease

Summary The clinical features of 6 children who are probable sufferers of unilateral Moyamoya disease are here reported. They showed angiographic findings which were compatible with those of Moyamoya disease, albeit only on one side. They did not, however, show any basic aetiologic factors. The age of onset, the clinical symptoms and the findings of electroencephalography, angiography, and positron emission tomography in these cases were also quite similar to those in the cases of Moyamoya disease except for unilateral involvement. All 6 patients underwent either direct or indirect EC-IC bypass sugery. In 3 children who received encephalo-duro-arteriosynangiosis, an indirect bypass procedure, the collateral circulation was well formed postoperatively. In the follow-up study, 2 of the 6 cases starting with a unilateral lesion developed bilateral involvement later. However, the other 4 cases persisted in showing only unilateral involvement. These 4 cases may suggest the existence of unilateral Moyamoya disease in the paediatric age, and it is recommended that such cases be treated similarly to those of bilateral Moyamoya disease.     

181. Herzschrittmacher-Überwachung durch elektronische Datenverarbeitungsanlagen

Zusammenfassung Die Photo-Analyse gilt als gesichertste Methode, eine differenzierte Aussage fiber den physikalischen Funktionszustand eines implantierten Generator- Elektroden-Systems zu ermöglichen. Eine Vorhersage auf die zukünftige Funktionssicherheit eines Herzschrittmachers blieb bisher jedoch bei allen Überwachungsmethoden empirischen Schätzungen vorbehalten.Alle Kontrolldaten aus Photoanalyse, EKG und Elektrolytbestimmungen können einer EDV-Anlage fber Markierungsbelege oder on-line eingegeben werden. Durch Vergleich mit Normalwerten, subkritischen und kritischen Toleranzen wird von dem Computer neben einer Diagnostik des akuten Status eine Trend-Analyseerrechnet, deren Aussage die noch zu erwartende Lebensdauer des Generators und die daraus resultierende Zeitspanne his zur nachsten Untersuchung enthält.Computergesteuert erfolgt ebenso die automatische Einbestellung des Patienten zum erforderlichen nachsten Kontrolltermin und die Benachrichtigung des Hausarztes durch programmierte Textverarbeitung.

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The monitoring of cardiac pacemakers by electronic data processing

Summary The Photo-Analysis can be considered the most reliable method of giving detailed information on the physical function of an implanted generatorelectrode-system. However, prediction of the subsequent functional reliability of a cardiac pacemaker must still be based on empirical estimates, whatever the method of surveillance may be.All control data of the photo analysis, ECG and electrolyte measurements can be fed into the computer through special programming or on-line. By comparing these with normal values, sub-critical and critical tolerances, the computer will, in addition to assessing the present situation, provide a trend analysis which will include statements on the expected life span of the generator and, based on this, the period of time which may elapse before the next examination.Automatic notification of the patient to attend his next control-examination and the supply of information to the treating physician, by programmed study of the text, can also be computer-controlled.

     

Cranioplasty of an extremely large cranial defect caused by transitional meningioma with a knitted polypropylen-polyester prothesis “Codubix”

Summary The authors report a case of transitional cell meningioma of the convexity which destroyed a large portion of the calvarium and invaded subcutaneous tissue. The tumour was totally removed and a large cranial defect/430 cm² in size/ was filled with a polypropyleno-polyester knitted prothesis Codubix with an excellent result.The problems of chronioplastic closure of such an unusually large skull defect and the advantages of the use of the material Codubix are discussed.     

Epitheldysplasien bei Colitis ulcerosa

Zusammenfassung Aus einem Kollektiv von 249 Colitisfällen der Jahre 1967–1974 wurden 20 Patienten, bei denen die Colitis ulcerosa entweder mehr als 10 Jahre bestanden oder sich vor dem 20. Lebensjahr manifestiert hatte, ausgewählt und im Hinblick auf prae-canceröue Epitheldysplasien nachuntersucht. Unter diesen 20 Fällen fanden sich 4 Patienten mit mittelschweren bis schweren Epitheldysplasien und gleichzeitig bestehenden Carcinomen (= 1,61 des Gesamtkollektives). Bei 2 Patienten waren in verschiedenen Colonabschnitten leichte bis schwere Dysplasien entwickelt, ohne daß gleichzeitig auch Carcinome nachweisbar waren. Bei einem Patienten fanden sich sowohl im Rectum als auch im Bereich der linken Colonflexur epidermoide Epithelmetaplasien. Die biologische Wertigkeit dieser Metaplasien ist ungeklärt. Bezüglich der formalen Pathogenese handelt es sich sehr wahrscheinlich um sog. indirekte Metaplasien. Die Früherfassung des Colitis-Carcinoms kann u. E. verbessert werden durch systematische colonoskopische Untersuchungen bzw. durch coloskopische Biopsien. Prae-canceröse Epitheldysplasien, die in hohem Prozentsatz mit manifesten Carcinomen offenbar synchron auftreten, werden nicht nur im Rectum, sondern auch in anderen Colonabschnitten gefunden.

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Epithelial dysplasia in ulcerative colitisHistological possibility for the early diagnosis of Colitis-Carcinoma

Summary From 249 histologically examined cases with ulcerative colitis (within the years 1967 to 1974) 20 cases were selected, which had an onset of the disease before the 20th year of age and/or a duration of more than 10 years. These cases were checked-up for prae-cancerous epithelial dysplasia. Four of these 20 cases showed medium to severe epithelial dysplasia together with carcinoma (= 1.61 % of the entire collective). In 2 cases low grade to severe dysplasia occurred in different parts of the colon without demonstrable carcinoma. In 1 case epidermoid epithelial metaplasia were found in the splenic flexure and in the rectum. The biological significance of these metaplasia remains unclear. With reference to the formal pathogenesis these lesions are probably indirect metaplasia.The early diagnosis of colitis-carcinoma can be improved by systematic colonoscopic examinations resp. by colonoscopicbiopsies. Prae-cancerous epithelial dysplasias, which occur in a high rate together with carcinoma, are found not only in the rectum but also in other parts of the colon. Multiple biopsies from different parts of the colon as well as the rectum would thus seem to be desirable if mucosal sampling is to be employed as a screening test.

Mit Unterstützung durch die Deutsche Forschungsgemeinschaft     

Die klinische Relevanz der Sonographie in der Akutdiagnostik perforierter Gastroduodenalulcera

Zusammenfassung Anhand einer prospektiven, auslesefreien Serie von 22 Patienten mit perforierten Ulcera im Gastroduodenalbereich verweisen wir auf die begrenzte diagnostische Aussagekraft einfacher anamnestischer, klinischer und radiologischer Daten. Lediglich bei acht Patienten (36%) ergaben sich wesentliche Indizien aus Krankengeschichte und Aufnahmebefund. Bei 16 Patienten (73%) verriet die Thoraxübersichtsaufnahme durch Nachweis einer subphrenischen Luftsichel eine Perforation im Magen-Darm-Trakt. Die Ultraschalluntersuchung wird als bedeutungsvolle Ergänzungsmethode vor allem in der diagnostischen Abklärung radiologisch negativer Ulcusperforationen vorgestellt und diskutiert. Dabei werden die sonographisch faßbare flüssigkeitsbedingte Magendistension sowie das Magenwandödem als unspezifische Kriterien gewertet. Der Objektivierung einer pathologischen Magenkokarde kommt bei gleichzeitigem Nachweis freier Luft und/oder extraluminärer Ingesta sowie freier echoloser Transsudatflüssigkeit pathognomonische Beweiskraft zu. Selbige Ultraschallkriterien erlaubten im einschlägigen Krankengut bei 16 Patienten (73%) eine definitive Diagnose und erfaßte 4 Patienten mit negativem Röntgen. Die kombinierte Analyse radiologischer und sonographischer Befunde führte somit bei 20 Patienten (91 %) unverzüglich zur korrekten Diagnose.

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Perforated peptic ulcer: Diagnosis and assessment by sonography

Summary In a prospective unselected series of 22 patients with perforated gastroduodenal ulcers the diagnostic efficacy of clinical and radiologic data was modest. In eight patients only (36%), clinical data yielded sufficient evidence; in 16 patients (73%), plain X-ray demonstrated subphrenic gas. Sonography was proven to be a major advance, especially rewarding in the diagnosis of perforations with negative plain X-ray. Gastric distention and stomach wall edema are unspecifc sonographic criteria, whereas objectivation of a pathologic stomach cockade in the presence of free gas, extraluminary ingesta or echofree fluid in the peritoneal cavity are pathognomonic data. These criteria yielded a definite diagnosis in 16 patients (73%) including four patients with negative X-ray. The combined analysis of radiologic and sonographic findings yielded an immediate correct diagnosis in 20 patients (91%).

     

Construct validity

Background: This study was undertaken to establish construct validity of the Xitact LS500, a virtual reality laparoscopic cholecystectomy simulator. The primary research statement is: The clip-and-cut task on the Xitact LS500 virtual reality laparoscopic cholecystectomy simulator mimics the surgical procedure of the clipping and cutting of the cystic duct and artery during the laparoscopic cholecystectomy adequately. Methods: According to the level of experience of the surgeon, an expert group opinion was formed resulting from 37 surgeons having performed over 100 laparoscopic cholecystectomies, and a novice group opinion was formed resulting of 37 surgeons having no experience at all with performing laparoscopic cholecystectomy. Participants received an instructed hands-on tour on the Xitact simulator and performed three formal simulation runs. Results: The novice group is younger and more surgeons are female. Performance scores in the expert group are significantly higher on the second (p value 0.011) and third (p value 0.005) run, compared to the novices scores. Experts are significantly faster on completion of all three runs. There is an increase in score over runs in both groups, which is statistically significant in the expert group. Less than one-third of surgeons in either group are able to correctly predict their performance score as generated by Xitact. Both experts and novices feel it is useful to train with Xitact LS500 in the surgical curriculum. Conclusions: Three hypotheses, formulated to operationalize the primary research statement, could be answered affirmatively. Although further validation studies are needed, the Xitact LS500 simulator seems to be able to discriminate between expert and novice surgeons in this research setting, and thus the construct for this setting is considered to be valid.     

The role of TGF-β in patterning and growth of the mammary ductal tree

Evidence that transforming growth factor beta (TGF-)⁴ influences pattern formation in the developing mammary gland and negatively regulates ductal growth is reviewed. In the mouse, overexpression of TGF- transgenes during puberty reduces the rate of growth of the ductal tree and simplifies the pattern of arborization, while expression during pregnancy also interferes with lactation. Expression studies in the normal mouse gland indicate that TGF- is synthesized in the mammary epithelium, with the three isoforms showing somewhat different spatial and temporal distributions. Exogenous TGF- applied directly to the glandin situ inhibits epithelial cell division within hours, and strongly stimulates extracellular matrix synthesis over a longer time course. Normal human breast cells as well as certain breast cancer cell lines also secrete TGF- and are themselves inhibited by it, suggesting an autoregulatory feedback circuit, that in some cases appears to be modulated by estradiol. Taken together, the evidence suggests a model in which growth and patterning of the mammary ductal tree are regulated, at least in part, by TGF- operating through an autocrine feedback mechanism and by paracrine circuits associated with epithelial-stromal interactions.     

Effects of nerve stimulation on the spontaneous action potentials recorded in the proximal renal pelvis of the guinea-pig

The effects of nerve stimulation on the electrical and mechanical activity of the smooth muscle of the proximal renal pelvis of the guinea-pig were investigated using standard tension and microelectrode recording techniques. Spontaneous action potentials were deemed to have been recorded from three cell types. (1) pacemaker cells (9 of >120) had membrane potentials (MPs) of -42.1±2.9 mV and fired action potentials of a simple waveform; (2) driven cells (>100) had more stable MPs of -56.1±1.2 mV (n=36) and more complex ureter-like action potentials; (3) the remaining cells had MPs of -45.5±1.7 mV (n=15) and action potentials with a waveform intermediate to groups (1) and (2). Nifedipine (0.1–1 M) and Cd²⁺ (0.1–1 mM) blocked all spontaneous action potential discharge and depolarized the membrane to near -40 mV. Intramural nerve stimulation (10–50 Hz for 1–10 s) increased both the amplitude and frequency of the spontaneous contractile activity, this increase peaked in about 30 s and decayed slowly over several minutes Nerve stimulation depolarized pacemaker and driven cells 9.1±3.5 (n=3) and 1.6±0.7 (n=6) mV, respectively; the frequency of their action potential discharge increased from 7.6±2.7 and 9.9±1.1/min to 17.3±0.5 and 11.1±1.4/min, respectively. The duration of the action potentials in driven cells also increased significantly for several minutes. All these effects were blocked by tetrodotoxin (TTX) (1.6 M). It was concluded that the positive chronotropic and inotropic effects of nerve stimulation on renal pelvis contractility can be correlated with the changes in the frequency and duration of the action potentials recorded in driven cells.     

290. Das anatomische GT-Kniegelenksystem.

Zusammenfassung Vor 100 Jahren exstirpierte Langenbuch erstmals erfolgreich eine Gallenblase. Die retrospektive Analyse von 10 Jahren Gallenwegschirurgie verdeutlicht den Wandel: ERCP, endoskopische Papillotomie, nasobiliäry Spül-Saug-Drainage, transpapilläry hepato-duodenale Drainage mit Pigtail, endoskopische Steinextraction und Chemolitholyse erlauben ein differenziertes chirurgisches Vorgehen. Von 2901 Patienten: 48 % Cholecystektomie, 12 % Choledochusrevision, biliodigestive Anastomose oder PapillaVateri-Operation, 40 % endoskopische Therapie.     

An Evaluation of the Nephrotoxic Effects of Nonionic Low Osmolality Contrast Media Using Urinary Enzymes

A prospective clinical study was conducted to examine the usefulness of urinary enzymes as a sensitive parameter for determining nephrotoxicity caused by LOCM. Forty-seven patients were intravenously injected with 100 ml of LOCM (iohexol or iopamidol) in radiographic studies. Serum creatinine and creatinine clearance (Ccr) were determined before and 7 days after LOCM infusion. Urinary excretion of N-acetyl--D-glucosaminidase (NAG) and -glutamyltransferase (-GTP) was determined before and 1, 2, 3 and 7 days after LOCM administration. To analyze the relationship between the nephrotoxic effect of LOCM and renal function, patients were divided into group L (Ccr<70 ml/min, n = 19) and group N (Ccr70 ml/min, n = 28). No significant changes were noted in serum creatinine or Ccr in either group. Urinary NAG and -GTP levels were significantly elevated on day 1 compared with the levels prior to LOCM infusion, but these returned to the base line after day 2. The increase ratio of urinary NAG in group L was significantly higher than that in group N on days 3 and 7. No statistical difference between groups L and N was observed regarding urinary -GTP increases on any of the days. In conclusion, urinary enzymes are sensitive and useful indicators for evaluating contrast media nephrotoxicity, which cannot be detected by serum creatinine or Ccr. Careful attention should be paid in radiographic studies to patients with renal dysfunction, even when LOCM is being employed.     

Contractile behaviour of the human pyelo-ureteral musculature

Summary In normal proximal and distal pyeloureteral human strips and in pathological reflux or obstructive segments the influence of repetitive electrical stimulation at frequencies between 0.01 and 200 Hz on their contractile behaviour was studied. Between 0.01 and 1 Hz baseline tone and maximum amplitude of contraction were dependent on stimulation frequencies, but some strips showed an irregular response pattern. At frequencies between 1 and 200 Hz half of the strips showed a typical on and off contraction (at the beginning and end of the stimulus period respectively) separated by a plateau. We consider the off reaction to be a response to an ionic displacement at the end of the stimulus. Spontaneous activity was mostly observed in Tyrode solution and in calix and pyelum. Transmural nerve stimulation did not change the contraction patterns.