Das Karzinom des Nierenparenchyms

Zusammenfassung Nach Aufgliederung der prim?ren epithelialen Nierenparenchymtumoren aus pathologisch-anatomischer Sicht in 1. hypernephroide Karzinome, 2. papill?re Adenokarzinome, 3. übergangsformen von 1 und 2, werden Nierenveneneinbruch und Einbruch in das Nierenholsystem im Hinblick auf überlebenszeit bzw. H?maturie untersucht. Altersverteilung, Inivialsymptome und Laboratoriumsbefunde werden in Tabellen aufgeführt. In der R?ntgendiagnostik wird die überragende Bedeutung der Aortographie hervorgehoben und ihre Grenzen besprochen. Schlie?lich erfolgt die Darstellung der überlebensrate nach verschiedenen Einteilungsprinzipien: Tumor auf die Niere beschr?nkt, perirenale Infiltration, Veneneinbruch, makroskopisch radikal operiert und die Ergebnisse aller operierten Patienten.

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Summary Classification of the primary epithelial tumors of the kidney parenchyma from a patho-anatomical standpoint in 1. hypernephroid carcinoma, 2. papillary adenocarcinoma, 3. transition of 1 to 2, invasion to renal vene and to calyx-pelvic system in relation to survival rate and haematuria is examinated. Age distribution, initial symptoms and laboratory findings are summarized in tables. The importance of aortography in the roentgenologic diagnostic of renal is emphasized. Discussion of survival rate according to: intraparenchymal tumor, perirenal and vene invasion, nephrectomy macroscopic radical and results of all operated patients.

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Mit Unterstützung aus dem Felix-Mandl-Fonds zur F?rderung wissenschaftlicher Arbeiten an den St?dtischen Krankenanstalten der Gemeinde Wien und aus der Ludwig-Boltzmann-Gesellschaft zur F?rderung der wissenschaftlichen Forschung in ?sterreich.     

Pankreas annulare

Zusammenfassung Mitteilung über 4 operierte F?lle von Pankreas annulare aus dem eigenen Krankengut. In 2 neonatalen F?llen mit dem Bild der Duodenalatresie konnte durch Duodenoduodenostomie eine Heilung erzielt werden. Auf die Wichtigkeit der rechtzeitigen Diagnosestellung wird hingewiesen. In 2 F?llen bei Erwachsenen waren Schmerzen, Erbrechen und Gewichtsverlust die wichtigsten Symptome. Die Diagnose wurde trotz mehrfacher vorangegangener Operationen und zahlreicher Voruntersuchungen erst nach Jahren gestellt. Zur Behandlung kam einmal die Duodenoduodenostomie, einmal die Duodenopankreatektomie erfolgreich zur Anwendung.

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Summary This is a report on 4 operated cases of annular pancreas. In 2 neonatal cases this condition presented symptoms of a complete duodenal obstruction. Duodenoduodenostomy and temporary gastric decompression by gastrostomy was performed in both cases and has proved to be satisfactory. The importance of an early diagnosis has been emphasized. In 2 adult cases the most pronounced symptoms were pain, vomiting and loss of weight. In spite of several previous operations of the abdomen and frequent examinations the correct diagnosis was not made for years. One case was treated successfully by duodenoduodenostomy, in the second case because of pancreatic fibrosis a duodenopancreatectomy was necessary.

     

Ein Catgutfaden als Ursache einer Gallensteinbildung nach transduodenaler Papillenspaltung

Zusammenfassung Es wird über einen Fall berichtet, bei dem es durch Inkrustation eines Catgutfadens zur Gallensteinbildung in den tiefen Gallenwegen gekommen war.

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Summary We report on a case in which incrustation of a plain catgut thread caused the formation of a gallstone in the common bile duct.

     

Endarterektomie mit Ultraschall

Zusammenfassung Die Wirksamkeit des Ultraschalles zur Endarterektomie wurde bei der offenen Aussch?lung von Leichenaorten überprüft. Ultraschall hat gegenüber konventionellen Aussch?lmethoden wesentliche Vorteile. Die Aussch?lwirkung des Ultraschalles beruht nicht auf einem Vibrationseffekt, sondern auf der Kavitation, die Ultraschall in der Aussch?lebene hervorruft.     

Die Bedeutung der Süchtigkeit für die Indikationsstellung zu schmerzchirurgischen Eingriffen

Zusammenfassung Die Medikamentensucht ist eine schwere Erkrankung, die sowohl den postoperativen Verlauf als auch das Ergebnis schmerzchirurgischer Eingriffe beeinflussen kann. Eine Nachuntersuchung von 136 Chordotomien, darunter waren auch 30 süchtige Patienten, ergab, da? beide Gruppen wohl die im wesentlichen gleiche Aussicht haben, durch den Eingriff schmerzfrei zu werden, jedoch ist die Zahl der Mi?erfolge in der Gruppe der süchtigen Patienten au?erordentlich hoch. Die Süchtigkeit ist unseres Erachtens keine absolute Kontraindikation zu einer Chordotomie, mu? jedoch als ein erh?htes Operationsrisiko berücksichtigt werden. Vor der beabsichtigten Operation sollte bekannt sein, da? der Patient süchtig ist und die „stabilisierende Dosis” des Suchtgiftes sollte ermittelt werden, die in der Lage ist, das Auftreten des Abstinenz-Syndroms zu verhindern. Vegetative St?rungen, Stoffwechselst?rungen, St?rungen im Flüssigkeitshaushalt sowie eine Unterern?hrung, die bei Suchtkranken, auftreten k?nnen, müssen pr?operativ entsprechend behandelt werden. Im Hinblick auf die Suchtgef?hrdung bei Patienten, die an starken chronischen Schmerzen leiden, sollte man sich frühzeitig zu einer Chordotomie entschlie?en.

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Summary Drug addiction is a grave disease which may influence the postoperative course as well as the result of cordotomies. An examination of 136 cordotomies, including 30 patients with drug addiction, showed that both groups had essentially the same chance to be relieved from their pains, that however, the number of failures was especially high in the group of drug addicts. The preexistence of drug addiction is not necessarily a contraindication for cordotomy, it should however be considered as a greater risk for an operation. Before a cordotomy it should be known that the patient is a drug addict, furthermore it is necessary to find out the „stabilizing dose” of the drug which may prevent an abstinence-syndrom. The manifold disturbances (vegetative, fluid-balance, malnourishment and metabolism) which may occur with drug addicts, have to be treated accordingly before the planned operation. In view of the fact that patients suffering from severe chronical pain, may likely become drug-addicted, one should decide to make a cordotomy at an early sage.

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Nach einem Vortrag am Neurochirurgischen Diskussionstag, 26. Oktober 1968, Salzburg.     

Trefoil factor expression in biliary epithelium of graft-versus-host disease of the liver after allogeneic hematopoietic cell transplantation

BACKGROUND: The aims of this study were to determine the presence of trefoil factor family-3 (TFF3) expression in biliary epithelial cells (BECs) of chronic graft-versus-host disease (cGVHD) of the liver after allogeneic hematopoietic cell transplantation, to compare such expression in chronic liver diseases (CLD) with/without predominantly biliary disease, and to assess the effect of bile duct injury on the degree of TFF3 expression in BECs of cGVHD. METHODS: A total of 82 paraffin-embedded liver biopsy samples were reviewed. These samples were basically divided into two distinct groups according to the presence of ductal injury: group 1 with CLD and predominantly biliary disease (n=26: 17 cGVHD and 9 primary biliary cirrhosis [PBC]) and group 2 with CLD and predominantly parenchymal liver disease (n=56: 20 steatohepatitis and 36 chronic viral hepatitis). Group 2 was used as the controls. Immunohistochemistry was performed using a polyclonal anti-TFF3 antibody. Real-time quantitative PCR was used for the detection of TFF3 mRNA expression. RESULTS: Positive TFF3 immunohistochemical staining and the presence of TFF3 messenger RNA gene expression was demonstrably higher in group 1 than that in group 2 (P<0.0001 and P<0.05, respectively). No significant difference in terms of positive TFF3 stained BECs between GVHD and PBC samples was observed (P>0.05). The extent of TFF3 expression in GVHD samples with severe ductal injury were significantly more common than that of GVHD samples with mild/moderate ductal injury (P<0.0001). CONCLUSIONS: The expression of TFF3 in cGVHD of the liver is increased in response to bile duct damage and repair. Such expression seems to be related the severity of ductal injury.     

The use of a combined technique in reduction mammaplasty (inferior pyramidal and superior glandular techniques)

The management of mammary hypertrophy is a developing process. The common surgical options for reduction mammaplasty include amputation with free nipple graft as well as the bipedicled, inferior pedicle and vertical pedicle techniques. All techniques are used widely. Disadvantages of these procedures include nipple areola necrosis, insensitivity, hypopigmentation, and poor breast projection. Even with the standard modifications of the original techniques, the resultant breast and nipple may be wide and flat. The purpose of this study was to assess whether combined inferior pyramidal pedicle and superior glandular pedicle reduction mammaplasty can optimize nipple and breast projection. Attention will focus on the viability and sensation of the nipple areola complex. Nine patients with mammary hypertrophy were studied. The change in nipple position ranged from 7 to 13 cm. The amount of tissue removed from each breast ranged from 500 to 1150 g. Nipple/areola sensation was retained in all cases with the exception of one breast. Nipple/areola necrosis or hypopigmentation were not observed. Optimal central breast projection was maintained in all patients, and postoperative evaluation was carried out at 12 and 22 months. The patient satisfaction was very high.     

Sphenoid sinus mucocele causing third nerve paralysis: CT and MR findings

A 64-year-old woman presented with a 2 week history of ptosis and medial-gaze paralysis of her left eye. Computed tomography scanning of the paranasal sinuses revealed an expansile, homogeneous lesion with no contrast enhancement in the sphenoid sinus. The mass was hyperintense on all MR sequences and there was extension of the mass to the left cavernous sinus and optic canal. Operation revealed a large mucocele. Third nerve palsy disappeared 4 weeks after operation. Because the spread of mucoceles is variable, they may cause different symptoms. Radiological evaluation, especially computed tomography and magnetic resonance imaging, are useful in diagnosis of mucoceles and help to explain the clinical symptoms by showing the spread of the lesion.