Exocrine pancreatic function after recovery from necrotizing pancreatitis.

The aim of the present study was to investigate the exocrine pancreatic function after recovery from necrotizing pancreatitis. The exocrine function was analysed in 53 patients who had recovered from their first attack of necrotizing pancreatitis. In a group of 23 patients (Group A), three follow-up studies were performed between four weeks and 12 months after recovery from acute pancreatitis.

Dumb-bell ganglioneuroma of the spine misinterpreted as progressive idiopathic scoliosis. Case report.

A giant ganglioneuroma generating a progressive scoliosis in a 16-year-old girl is presented. The interval between the start of the orthopaedic treatment and the diagnosis of the true nature of the disease was more than 4 years, thus allowing the development of a giant partly intracanalicularly partly retroperitonealy expanding tumor mass. The report emphasizes and describes the combined neurosurgical, general surgical and orthopaedic surgical treatment and presents the results of light- and electron microsopical, immunohistochemical and quantitative neurochemical investigations of the resected tumor.

[Segmental colonic stenosis in intestinal metastasis of breast carcinoma. A contribution to the differential diagnosis of colitis].

Four years after mastectomy for a scirrhous carcinoma a 71-year-old woman developed diarrhoea. Crohn's disease was suspected. At endoscopy a stenosis of the sigmoid colon was found which could not be passed: the mucosa was normal looking.

[Ultrasonics in acute appendicitis. A prospective study].

In a prospective study 404 unselected patients suspected of having acute appendicitis were examined by ultrasound, the results being compared with the initial clinical findings. Acute appendicitis was established in 27.2%, confirmed by histology.

Apoprotein AII in acute pancreatitis: intriguing improvement in the prediction of fatal outcome.

In spite of significant advances in the past decade, assessing of severe prognosis in acute pancreatitis remains an improvable problem. Actually the standardized means are clinical, multiple laboratory and peritoneal lavage. In a series of 20 subsequent cases of acute pancreatitis with a lethality of 30%, apolipoprotein AII has proven to be a predictor of fatal outcome with a sensitivity in the range of all other methods together.

Can the use of an endoscopic Congo red test decrease the incidence of incomplete proximal gastric vagotomy?

The endoscopic Congo red test allows accurate and rapid evaluation of the completeness of vagotomy and may result in a lower incidence of postoperative incomplete vagotomy. This report describes 44 patients tested during proximal gastric vagotomy. Evidence of incomplete vagotomy was found in over 95% at the conclusion of the conventional operation.

Significance of histamine formation and release in the development of endotoxic shock: proof of current concepts by randomized controlled studies in rats.

The significance of histamine in the initiation and progression of septic (endotoxic) shock is still uncertain. Increased new formation and increased release of histamine are the two hypotheses currently considered as the basis for a causal relationship. Both hypotheses were tested in a standardized rat model of endotoxic shock.

[Mediators in septic shock: strategies of securing them and assessment of their causal significance].

More than 100 different mediators are discussed as being responsible for the progression of the septic shock syndrome. A new concept is described to establish the causal role of a single mediator by using a decision tree which excludes different non-causal associations (different kinds of bias and chance). By definition of several criteria and methodological standards, the published studies on mediator release/formation could be analysed and evaluated (meta-analysis).

Experience with the endoscopic test for completeness of vagotomy. Results of application in two medical centers.

The need for a practicable and reliable test for completeness of vagotomy has been previously recognized. Until recently, all of the tests for completeness of vagotomy required cumbersome or delicate equipment or had deficiencies which prevented routine use. Recently we have modified the endoscopic Congo red test (ECRT) to allow more rapid and accurate performance; furthermore, we have found that the routine use of this test has affected the performance of proximal gastric vagotomy in our medical centers.

[Ultrasound-guided fine-needle puncture in the diagnosis and therapy of liver and spleen abscesses].

A total of 41 diagnostic and therapeutic fine-needle aspiration punctures were performed under ultrasound control in 28 patients with solitary or multiple abscesses of liver (26) or spleen (2). Nonoperative measures (drainage-fine needle puncture, local and systemic antibiotics) cured 19 patients; in nine, primary surgical abscess drainage was performed. One operated patient with multiple liver abscesses died of generalized sepsis (mortality rate 3.

Induced histidine decarboxylase in endotoxic shock: identification of the enzyme in rat liver and influence of its inhibitors on survival parameters.

The hypothesis of a causal relationship between a progressive and unrestrained increase of tissue histamine formation by activation of an inducible histidine decarboxylase (HDC) and lethality in endotoxic shock (Schayer's 'induced histamine concept') was tested in a standardized rat endotoxic shock model. Initial enzyme identification studies in the rat shock liver (8 hrs after endotoxin challenge) clearly demonstrate that the 'induced' histidine decarboxylase is an acid (specific) HDC. The succeeding randomized, controlled study with appropriate inhibitors of the enzyme, alpha-methyl-histidine (competitive inhibitor) and alpha-fluoromethyl-histidine (irreversible inhibitor) using doses of 2, 20 or 100 mg/kg showed no significant effect on the survival rate of rats in endotoxin shock.

[Pancreatitis: conservative therapy].

The treatment of acute pancreatitis is primary conservative independent of the degree of severeness. The aim of our multimodal concept of therapy (stomach tube, catheterisation of urinary bladder, closed peritoneal dialysis, analgetics--peridural catheter-, substitution of volume-electrolytes, colloides, protein, plasma, blood-, antibiotics, heparin H2-receptor blocker, early artificial respiration, insulin, parenteral nutrition-glucose, amino acids, fat-, hemofiltration/-dialysis, percutaneous drainage of liquid formations) is to postpone or to avoid an operation. Only the erosion bleeding or a locally conditioned sepsis ask for an emergency operation.

[Successful treatment of several metachronous pulmonary metastases of a chondroblastic osteosarcoma].

The case of an 11-year-old girl suffering from chondroblastic osteosarcoma of the left tibia head is reported. Within 19 months following the amputation of the thigh and during intensive chemotherapy a total of 7 pulmonary metastases were diagnosed and resected in 3 sessions. The patient has been free of any metastases for 5 years.

[Early operation for acute gallbladder as a therapeutic principle].

Between 1 January 1969 and 30 June 1984 904 patients with acute cholecystitis were treated as inpatients. Including 1976, initial treatment was conservative, and interval operation was recommended after 6-8 weeks. Commencing in 1977 early operation was preferred.

[Advantages of computerized tomography diagnosis in acetabular fractures].

There is a comparison of conventional radiographs and computed tomography in 23 patients presenting acetabular fracture. Four patients were treated conservatively because of their CT-findings. The result was successful.

A controlled study on the use of intravenous fat in patients suffering from acute attacks of pancreatitis.

Thirty-one acute attacks of pancreatitis in 27 patients were studied. 15 attacks were treated with standard therapeutic measurements alone, and 16 attacks were, in addition, treated with intravenous infusions of a commercial fat emulsion (Intralipid). Fat infusions were started on the 2nd day after admission in a dose of 1,5 g fat/kg B.

[Significance of oxygen hyperventilation in bronchofiberscopy in intensive medicine].

In 25 patients (group I = 15 patients, group II = 10 patients) we examined the influence of bronchoscopic aspiration on lung function. PaO2 and PaCO2 were measured before, during, and after bronchoscopic aspiration. In all cases the insertion of the bronchofiberscope was performed by means of a transnasal tube.

[Results of multiple surgical therapy in pronounced acne conglobata].

Acne conglobata - hidradenitis suppurativa - as a particular form of acne vulgaris is, in its pronounced, chronic progressive form, incontrollable by conservative means. Smaller foci of infection need only a local excision of skin and subcutis followed by primary wound closure or secondary healing. When large areas are involved, a generous excision including removal of the fistula system is followed by a 1-3 week intermediary phase with hydrotherapy and antiseptic local treatment.

[Functional treatment of extensor tendon injury of the hand].

We have treated 73 patients with 107 injuries of the extensor tendon. We started with an elastic dynamic splinting means = 9 (2-27) days after operation. The duration of functional treatment was means = 40 (13-103) days.

[Indication and technic of interlocking nailing of the femur].

Between 1973 and 1982 we treated 569 fractures of the femoral shaft by means of osteosynthesis. The internal nailing was performed in 41.6%.

[Hip dislocation with femur head fracture].

It is talked about the classification, the therapy and the late results of the traumatic dislocation of the hip joint with a fracture of the femoral head. Twelve patients with an average age of 36 years (from 18 to 77 years) were treated between the years 1972 and 1982. The rarer anterior dislocation of the hip including a fracture of the femoral head should be specifically classified, in order not to cause any errors for the therapeutic and prognostic assessment following the Pipkin classification.

[Ender nailing of subcapital fractures of the femur neck (Garden I)].

In the period between 1968 and 1982 we observed 441 subcapital fractures of the femoral neck, 55 times a tight impaction in valgus position. Including the year 1976 a conservative treatment was employed (group I); from 1977 onwards operations with the Ender-nailing technique were performed (group II). The patients' average age was 81 to 84 years.