[Tuberculosis of the large intestine--a differential diagnosis of inflammatory and neoplastic colon tumors].

We report on a case of ileocoecal tuberculosis. The clinical, radiological, endoscopic and pathologic findings are considered. The differential diagnosis between tuberculosis, chronic inflammatory bowel diseases and carcinoma of the colon are described.

Closure of acute bronchial stump insufficiency with a musculus latissimus dorsi flap.

We describe a successful closure of an acute bronchial stump insufficiency after pneumonectomy by intrathoracic transposition of the pedunculated latissimus dorsi muscle: A 56-year-old patient with a necrotizing bronchial carcinoma developed a stump insufficiency after right pneumonectomy. Repeated resection and renewed closure of the completely dehiscent stump was not possible, as the stem bronchus had been separated close to the tracheal bifurcation in the preceding operation. Therefore we transposed the pedunculated musculus latissimus dorsi into the thoracic cavity.

[Stomach and duodenal cancers in familial adenomatosis coli].

In the last years the number of patients with familial adenomatosis coli and metachrone carcinoma of the upper gastrointestinal tract is increasing. We describe two patients who, 9 and 15 years after colectomy for adenomatosis coli, developed a duodenal carcinoma. Each patient was treated with a partial duodeno-pancreatectomy.

Intraabdominal infections: classification, mortality, scoring and pathophysiology.

Studies on intraabdominal infections have been difficult to compare in the past due to a missing system of classification for peritonitis. According to a recently developed classification system, secondary peritonitis, including spontaneous acute peritonitis, postoperative peritonitis and posttraumatic peritonitis, is the most common complication of severe intraabdominal infections. In several studies the mortality rate of postoperative peritonitis was still between 60% and 79%.

A randomized controlled trial of adjuvant immunotherapy (murine monoclonal antibody 494/32) in resectable pancreatic cancer.

In a prospective randomized multicentric trial, 61 patients from six hospitals with resectable pancreatic cancer were recruited between 1987 and 1989. All patients underwent a Whipple resection. Two weeks after surgery, the patients were randomized to be given either intravenous (IV) treatment with 370 mg (100 mg loading dose, 9 x 30 mg continuing within 10 days) of monoclonal antibody (MoAb) 494/32 (Behringwerke AG, Marsburg, Germany) or no additional anti-cancer treatment.

[Bronchial rupture. Diagnosis and therapy of a rare complication of the use of double-lumen tubes].

For anesthesia during thoracic surgery, it is common to use a double-lumen endotracheal tube for one-lung ventilation. Double-lumen tubes protect the bronchial system of the healthy lung from being occluded by blood or pus coming from the operated lung. Therefore, in cases of lung abscess, bronchial hemorrhage, lung cyst, or localized lung infection the use of a double-lumen tube is advisable.

[Acute stress-induced cholecystitis].

Acute posttraumatic and postoperative cholecystitis is a serious and life-threatening complication with mortality rates ranging from 10 to 50%. The pathogenesis is multifactorial: possible reasons are blood transfusions, dehydration, narcotics, shock and positive end-expiratory pressure (PEEP). Between 1980 and 1990 12 patients underwent surgery for acute cholecystitis.

Percolation and binding of MAB BW 494 to pancreatic carcinoma tissues during high dose immunotherapy and consequences for future therapy modalities.

The distribution of the monoclonal antibody (MAb) BW494 in human pancreatic carcinoma biopsies during high dose i.v. immunotherapy was investigated.

Fluorescence studies on lung tumors.

Illumination of unstained 9 microns cryosections of lung tissue with 365 nm results in visible fluorescence light with a maximum intensity at about 460 nm. These fluorescence tomographical studies can be used for detecting carcinoma of the lung. The fluorescence pattern obtained can be matched nicely with histological findings.

Studies of pancreatic cancer utilizing monoclonal antibodies.

Since 1985, 150 patients with pancreatic ductal adenocarcinoma have been treated with the monoclonal antibody BW 494 in four different multicentric trials in Germany. The antibody recognizes a human pancreatic cancer associated antigen and mediates an antibody dependent cellular cytotoxicity (ADCC) in vitro, when human mononuclear cells are coincubated as effector cells. In patients with at advanced unresectable pancreatic cancer there where two phase-I-studies finished in 1987 and 1989, respectively, and one uncontrolled phase-II-study finished in 1988.

Percolation and binding of monoclonal antibody BW494 to pancreatic carcinoma tissues during high dose immunotherapy and consequences for future therapy modalities.

The distribution of the monoclonal antibody (MAb) BW494 in human pancreatic carcinoma biopsies during high dose intravenous immunotherapy was investigated. Using immunohistochemical techniques combined with anti-idiotypic, endothelial cell-specific and bispecific MAbs, it was shown that 3 days after onset of immunotherapy, MAb BW494 was bivalently bound to tumour cells in some highly vascularised areas near capillaries. No binding was observed in other highly vascularised tumour cell areas although the epitope detected by MAb BW494 was present.

[Value of sono- and computerized tomography as a localization procedure in primary hyperparathyroidism].

A total of 56 patients underwent preoperative high-resolution sonography (4 MHz); 33 had additional computed tomography (4 mm slices, contrast material as drip infusion) to localize abnormal parathyroid tissue in primary hyperparathyroidism. The sensitivity of sonography was 48% compared to 38% for computed tomography. The efficiency of both techniques was mostly dependent on size and location of the parathyroid.

[Therapy concepts in colorectal liver metastases. What is proven, what is open to discussion?].

Isolated liver metastases of colorectal carcinomas principally can be treated by surgical intervention or cytostatic chemotherapy. Unquestionable indications for resection therapy are either solitary metastases or metastases limited to one liver lobe, since resection provides the best long-time results. In multilocular metastases or non-resectable liver metastases systemic monochemotherapy with 5-Fluorouracil (5-FU) presents respondance rates of about 20 percent with remissions lasting 3 to 6 months.

[Monoclonal antibodies in the therapy of non-resectable pancreatic cancers. Initial experiences].

In this study 34 patients with pancreatic cancer were treated postoperatively with monoclonal antibodies (MABs). The antibody BW 494/32 is directed against a membrane antigen of differentiated adenocarcinomas of the pancreas and mediates cellular cytotoxicity. The patients suffered from non resectable tumors, mostly with lymph-node or liver metastases.

Immunotherapy of pancreatic cancer with monoclonal antibody BW 494.

In a phase I trial 34 patients with pancreatic cancer were treated with the murine monoclonal antibody (MAb) BW 494 (BI 51.011) directed against a glycoprotein antigen. The patients received repeated doses of MAb over a time period from 5 to 14 days (highest single dose 100 mg, highest cumulative dose 490 mg).

[Parenteral use of a fat emulsion in the early postoperative period].

Parenteral application of fat emulsions has been established as useful in long term artificial nutrition especially during weaning off the ventilator. In order to ascertain whether these advantages can also be proved in nonventilated patients in the immediate postoperative phase, alternatively carbohydrates versus a new fat emulsion were investigated. 30 patients were randomly allocated to three different nutrition regimens.

Short-term and long-term monitoring of the serum level of TPA after radical resection of gastrointestinal or lung cancer.

Radically operated tumour patients (gastrointestinal cancer, n = 10; lung cancer, n = 10) were subjected to continuous prospective monitoring of the serum level of tissue polypeptide antigen (TPA) prior to surgical treatment as well as during the subsequent year. The following observations were made: Immediately after radical surgery the serum level of TPA fell temporarily. During the first 2 weeks following this initial decrease, the serum level of TPA rose.

[Serum endotoxin level in the course of open peritonitis treatment].

In 27 patients with severe diffuse purulent or fecal peritonitis planned relaparotomies with peritoneal lavage or continuous dorsoventral lavage with open abdomen were performed after surgical treatment of the primary infection. During the course of the lavage treatment serum endotoxin was measured daily. The endotoxin-induced liberation of lysosomal proteases was studied by determining the elastase from polymorphonuclear leucocytes.

[Surgical therapy of ascites--results of peritoneovenous drainage with the Hakim-Cordis ascites valve].

Peritoneo-venous shunting of ascites was performed in 16 patients using the Hakim-Cordis ascites valve system. After an average of 4.3 months four patients presented with closure of the valve or deconnection of the system that is to say, complications caused by the valve system.

[Intestinal perforations in the newborn infant].

Between 1976 and March 1985 16 neonates with gastrointestinal perforations were treated. The most common site of perforation was the ileo-coecal region, the most frequent causes of perforation were due to intestinal obstruction, necrotising enterocolitis and so-called spontaneous perforations (ischemic perforations). The surgical procedure depended on the site and cause of the perforation, taking the general condition into account.

[Effect of postoperative parenteral feeding on protein metabolism in heart surgery patients. A comparative study].

To investigate the importance of amino acid infusions in immediate postoperative parenteral nutrition, cardiac patients were randomly allocated into two groups. Applicating identical carbohydrate calories (2000 kcal/day) group 1 received only essential amino acids while in group 2 a combined pattern of essential and non essential amino acids was infused. In addition to routine laboratory data several parameters of protein metabolism including nitrogen balance were evaluated.