Zur Casuistik der Kopfverletzungen

Ohne Zusammenfassung     

Über die Asbestosiskörperchen

Ohne ZusammenfassungMit einem Bericht über den der Arbeit zugrunde liegenden Fall von Lungenasbestosis vonH. Stroebe Mit 46 Abbildungen im Text.     

Serous cystadenocarcinoma of the pancreas

Summary Conclusion A rare case of granulocyte-colony stimulating factor (G-CSF) produced by carcinoma of the pancreas has been reported. Background This is the first case showing high G-CSF concentration in the aspirated tumor fluid (mucin) at its early stage without leukocytosis. Methods The tumor, detected incidentally in a 64-yr-old male, was removed by a distal pancreatectomy. The mass was 7.0×6.5×4.5 cm, and was histologically diagnosed as cystadenocarcinoma with prominent sarcomatous transformation. It was classified as anaplastic carcinoma. Results After 4 wk of resection, progressive leukocytosis was observed. Seven weeks after the operation, the peripheral leukocyte count increased to 126,000/mL. After 8 wk of resection, the patient died of recurrence. The serum G-CSF concentration was elevated after recurrence. The preserved mucin contained in the cystic components of the resected specimen had a G-CSF concentration higher than 2400 pg/mL. G-CSF is a known cytokine and an etiologic agent in paraneoplastic syndromes. An early diagnosis can, therefore, be made prior to the manifestation of clinical symptoms by the evaluation of the aspirated tumor fluid. This can lead to the prevention of the paraneoplastic syndrome with inhibitory cytokines in future.     

Gastric substitute after total gastrectomy – clinical relevance for reconstruction techniques

Background: More than 60 different methods of reconstruction after total gastrectomy have been described. The different surgical procedures can be reduced essentially to pouch reconstruction, pouch size and maintenance of duodenal passage. Methods: To clarify the importance of pouch reconstruction and maintenance of duodenal passage, we reviewed all controlled prospectively randomized clinical studies reporting on the various methods of reconstruction after gastrectomy. Results: After reconstruction with a pouch, 6-month postoperative patients have a better food intake, a slower food passage (t_50% 12 vs 25 min), fewer postprandial symptoms (4–10% vs 20–60%), less weight loss (7 vs 14kg), and in tendency, they have a better quality of life. With maintenance of duodenal passage, disturbance of blood sugar regulation (stimulated glucose level 22% lower) and iron deficiency anemia (hemoglobin: 13.9 vs 12.5 g/dl; iron: 18.4 vs 10.2 μmol/l) are prevented. In addition, the patients lose less body weight (8% higher) and they tend to have a better quality of life (life quality score: 84 vs 76 points). Nevertheless, in several studies the number of patients is too small to demonstrate significant differences. Conclusions: After total gastrectomy, curatively operated patients might benefit from a reconstruction with pouch and maintenance of duodenal passage. Nevertheless, the present study results are partially divergent. For definitive demonstration of the superiority of this technique, further controlled longitudinal studies should be conducted with a larger number of cases and suitable instruments for assessing the quality of life. Received: 13 August 1998 / Accepted: 13 October 1998     

281. Endotoxin bei bakterieller Peritonitis

Zusammenfassung Zwischen elektromyographischen Ableitungen der Darmwand und Darmgeräuschen ist, wie wir in einigen Versuchen zeigen konnten, eine Korrelation nachweisbar. Damit werden Darmgeräusche zu leicht meßbaren Parametern der Darmmotilität. In einigen experimentellen Untersuchungen konnte aufgrund der Darmgeräuschanalyse gezeigt werden, daß die postoperative Darmatonie mittels medikamentöser Behandlung (Dihydergot, Prostigmin) verkürzt werden kann. Bei klinischen Messungen wurden entsprechende Ergebnisse erhalten.