[Is a minimally-invasive treatment concept in the late stage of pleural empyema successful?].

Introduction: Thoracoscopic treatment of pleural empyema is still a controversial method, especially in the chronic stage of the disease. The issue is raised whether the thoracoscopic approach to the empyema-possibly combined with a small additional thoracotomy in advanced stages-is successful and of low risk.

Patients And Methods: Between January 1993 and May 1995 we treated 13 patients in advanced stages of pleural empyema.

[Signet ring cell carcinoma of Vater's papilla: a very rare malignancy].

We describe a rare variant of carcinoma of the ampulla of Vater. A 70-year-old man with several illnesses and a newly appeared jaundice was investigated and a signet-ring cell carcinoma of the ampulla of Vater diagnosed. We performed a local transduodenal excision.

[Laparoscopically assisted formation of end stage and loop ileostomies and colostomies].

Especially in obese or severely ill patients, forming of an ileostomy or colostomy can be very difficult and laparotomy itself can lead to many complications. The intraabdominal part of this operations can easily be performed laparoscopically. The method is quick and simple and many complications can be avoided.

[Incidence of recurrence in long-term follow-up of 100 patients after surgery for primary hyperparathyroidism].

The percentages for recurrence or persistence of hyperparathyroidism after operation for pHPT vary between 3 and 7% according to the pertinent literature. These groups of authors have a broad experience based on a large number of patients treated. At our institute we have operated for pHPT an average of 5 patients per year.

[Rectum resection with colo-anal anastomosis and formation of a colonic J pouch in deep rectal cancer].

Sphincter-saving operations are now generally accepted for the treatment of mid-rectal cancers. Different techniques have been described: low colorectal anastomosis with staplers, pull-through procedures and coloanal anastomosis. The functional results following these procedures are impaired by loss of the reservoir function of the rectum.

[Value of systemic and local administration of antibiotics in soft tissue and bone infections].

There is little data to support the efficacy of prophylactic antibiotics in traumatology. In closed fractures three randomized controlled studies using a 1-3 day prophylaxis with Cephalosporins of the first or second generation or a Penicillinase-resistent Penicillin demonstrated a reduction of the infection rate. For the Cephalosporins of the second generation it was shown, that a single dose was less efficient than five repeated applications over 24 hours.

[Paralyses of the recurrent laryngeal nerve following strumectomy in late follow-up].

Over a period of 5 years, 323 patients underwent an operation on a goiter. A postoperative paralysis of the recurrent laryngeal nerve occurred in 31 patients, most in malignancies and recurrent goiters. 26 patients were controlled at least 1 year after operation.

A double-blind clinical trial of prophylactic cloxacillin in open fractures.

In 100 patients with first-, second-, and third-degree open fractures, a randomized, double-blind study was carried out to compare prophylactic cloxacillin and placebo. Prophylaxis was started preoperatively and continued for 10 days. The standard fracture treatment consisted of operative stabilization, mostly by means of plates or external fixators.

[Chemical structure and biological activity of cholecystokizin octapeptides with respect to the stomach and pancreas].

Dose response curves of the octapeptide of cholecystokinin (CCK-8) and 3 of its methoxinine analogues have been established in 4 conscious dogs with respect to gastric and pancreatic secretion. In the analogues the methionine was replaced by methoxinine in position 3 (B) and (D) or 6 (C). Of the 4 tested substances CCK-8 exhibited most activity with regard to pancreatic protein secretion, followed by B, C, and D.

[Antibiotic prophylaxis in colon surgery with Cefazolin].

In a prospective randomized and controlled double-blind trial the effect of prophylactic systemic administration of Cefazolin in elective colorectal surgery on postoperative wound infection was investigated. The incidence of wound infection was significantly reduced (P less than 0.01) from 32% in the control group to 10% in the treated group.

[Caerulein and the test meal: a comparison of their effects on pancreatic exocrine secretion in the dog].

Relatively small doses of caerulein (10, 20, 40, 100 ng/kg/h) were given to conscious dogs with chronic duodenal and gastric fistulas and the exocrine pancreatic response was compared with that obtained by a test meal. Test meal stimulated pancreatic secretion was nearly equivalent to that achieved with 10 ng caerulein/kg/h. Plasma secretin levels did not significantly change during test meal stimulation.

Open fractures. Long-term results in 200 consecutive cases.

Two hundred consecutive patients admitted with 214 open fractures were reevaluated 6--10 years following injury. All patients were seen in follow-up by the authors. The average hospital stay was 36 days.

[Antibiotic prophylaxis: definition and documentation].

Controlled, randomized and prospective studies were reviewed to evaluate the value of antibiotic prophylaxis in colonic and biliary tract surgery as well as in the treatment of open fractures. --Colorectal surgery: 7 studies using oral and 3 using parenteral antibiotics in addition to extensive bowel preparation have demonstrated the importance of a short term prophylaxis, instituted before surgery and discontinued soon thereafter. Different antibiotics with aerobic or anaerobic spectra reduced the incidence of wound infections significantly; further improvement could be expected from combinations covering both spectra.

[Effect of somatostatin on the endogenous release of secretin and pancreatic polypeptide in the dog].

In dogs with chronic duodenal and gastric fistula the effect of somatostatin (SST) on the endogenous release of secretin and pancretic polypeptide (PP) was investigated. The release of secretin following intraduodenal acid administration was significantly reduced by SST. While PP increased significantly after a test meal, its release was completely suppressed by SST.

Comparison of the biological potency of a new synthetic preparation of secretin with that of natural porcine secretin in the dog.

The biological activity of the new synthetic secretin, Roche, on exocrine pancreatic secretion was determined in conscious dogs with chronic gastric and duodenal fistulae and compared with that of pure porcine secretin (GIH, Karolinska Institutet, Stockholm). The two secretin preparations were found to be equipotent as to pancreatic volume and bicarbonate response on a molar basis. It was concluded that the new synthetic secretin is useful for clinical and research purposes.

The endogenous release of pancreatic polypeptide by acid and meal in dogs. Effect of somatostatin.

The response of pancreatic polypeptide (PP) to testmeal (5 ml/kg) and intraduodenal acid (4 mEq HCl/5min) and its reaction to somatostatin (3.5 microgram/kg/h following bolus injection of 3.5 microgram/kg) was studied in dogs with chronic duodenal and gastric fistulae.

Effect of somatostatin on exocrine pancreatic secretion stimulated by pancreozymin-secretin or by a test meal in the dog.

In 4 dogs with chronic duodenal and gastric fistulae, exocrine pancreatic function was assessed by cannulating the pancreatic duct and collecting the duodenal contents. Both methods were applied in each animal. Pancreatic secretion was stimulated by infusion of 2 CHR units of pancreozymin and secretin or by administration of a liquid test meal, injected into the stomach through the gastric fistula.

Influence of glucagon on exocrine pancreatic function as determined by the Lundh test in dogs.

Exocrine pancreatic function was investigated by means of the Lundh test model in dogs with chronic duodenal and gastric fistulas. The test was standardized and the effect of glucagon on exocrine pancreatic secretion was evaluated. The mean tryptic activity detected in 18 tests in 6 dogs was 32.

[Effect of somatostatin on canine exocrine pancreas secretion stimulated by pancreozymin, secretin or test meal].

In 4 dogs with pancreatic and gastric fistulae the effect of somatostatin (SST) on the pancreas was investigated during stimulation by pancreozymin-secretin or by a test meal. The pancreozymin-secretin-induced enzyme output and bile flow, as well as the enzyme concentration and duodenal volume during test meal stimulation were significantly reduced by SST. SST caused a less marked decrease in bicarbonate concentration, while volume and bicarbonate output did not change.