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  • 1
    Electronic Resource
    Electronic Resource
    Iodine-induced thyrotoxicosis — A case for subtotal thyroidectomy in severely ill patients (1985)
    Springer
    Journal of molecular medicine 63 (1985), S. 1-7 
    Details
    ISSN: 1432-1440
    Keywords: Iodine-induced thyrotoxicosis ; Prognosis ; Therapy ; Subtotal thyroidectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Iodine-induced thyrotoxicosis (IIT), due to iodine application in high amounts in patients with circumscript or disseminated thyroid autonomy, is complicated by a prolonged course, mainly due on the body's resistance to conservative therapy with thiourea derivates. Therefore, we decided to perform subtotal thyroidectomy in 16 thyrotoxic patients. This is in contrast to the common opinion that surgery should only be performed after normalization of thyroid hormones. In all 16 patients with severe IIT, including three patients with thyroid storm, hormone levels decreased within a few days after surgery to normal or subnormal values and the clinical picture of thyrotoxicosis disappeared. In the case of thyroid storm the signs of disorientation normalized within 1–3 days. One patient died 5 weeks after surgery due to severe concomitant diseases. One patient exhibited transitory respiration distress and another had postoperative hypocalcaemia. In nine patients L-thyroxine replacement became necessary because of subclinical or clinical hypothyroidism. Only by this procedure will the high intrathyroidal storage of iodine and preformed hormone be extracted. Surgery as a treatment for thyrotoxicosis should be reserved for patients with severe IIT, where conservative treatment has been shown to be ineffective. Furthermore, in rare selected cases, when a rapid normalization is required, surgery without preoperative treatment seems to be justified. The effect of surgery was impressive in all our cases and there were only minor perioperative complications. Thus, it could be shown that subtotal thyroidectomy may be a rational and effective treatment in severe IIT which should be carefully considered and weighed against other types of therapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01537479
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  • 2
    Electronic Resource
    Electronic Resource
    Invited commentary (1989)
    Springer
    World journal of surgery 13 (1989), S. 621-622 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01658885
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  • 3
    Electronic Resource
    Electronic Resource
    Defense mechanism and macroscopic tumor growth in lung tissue (1986)
    Springer
    Journal of cancer research and clinical oncology 111 (1986), S. 277-283 
    Details
    ISSN: 1432-1335
    Keywords: Lung carcinoma ; Growth pattern ; Immunologic response
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A total of 126 resection speciments from malignant lung tumors were cut into serial sections, and tumor volume and macroscopic growth pattern were computed. Four characteristic tumor growth patterns could be separated: 1 Tumors growing in bizarre, irregular shapes 2 Tumors growing in spheroid shapes 3 Tumors growing in ellipsoid shapes 4 Tumors growing in mixed growth pattern. The immunologic response of the host tissue was analyzed grading the number of lymphocytes, plasma cells, macrophages in and at the boundary of the tumor tissue. Lymphocytic subpopulations were analyzed in 46 cases using monoclonal antibodies (BS3/BS4; T3, OKT4, OKT8, OKT11, OKT14). The majority of lymphocytes were T-lymphocytes and monocytes in cases with inflammatory response of host tissue. The ratio of inducer/helper subset (OKT4+) compared to suppressor/cytotoxic subset (OKT8+) was similar in expression as reported for circulating peripheral T-lymphocytes. The different growth patterns depend upon cell type of tumor, immunologic response of the host tissue, and tumor volume. The findings indicate that tumor progression into lung tissue is partly due to “localized metastatic growth” of different tumor cell subpopulations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00389245
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  • 4
    Electronic Resource
    Electronic Resource
    138. Die chirurgische Taktik beim primären Magenstumpfcarcinom (1985)
    Springer
    Langenbeck's archives of surgery 366 (1985), S. 600-600 
    Details
    ISSN: 1435-2451
    Keywords: Primary gastric stump carcinoma ; Total gastrectomy ; Palliative surgery ; Prognosis ; Primäres Magenstumpfcarcinom ; Totale Restgastrektomie ; Palliative Resektion ; Prognose
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Der Vergleich der Zeiträume 1949–1974 und 1975–1983 zeigt einen Wandel in der Therapie und Prognose primärer Magenstumpfcarcinome. Der Anteil der resezierbaren Stumpfcarcinome stieg von 23,4% im ersten Beobachtungszeitraum auf 66,7% im zweiten Zeitraum. Wurde von 1949–1974 in mehr als der Hälfte der resezierbaren Fälle eine subtotale Nachresektion durchgeführt, stieg die Zahl der totalen Restgastrektomien von 1975–1983 auf 85%. Nahezu die Hälfte aller Resektion wurden wegen Lymphknotenmetastasen oder einer Infiltration des Malignoms in die Leber als Palliativeingriffe vorgenommen. Im Gegensatz zum Magencarcinomrezidiv infiltriert das Magenstumpfcarcinom nach Ulcusresektion erst sehr spät das Jejunum, deshalb können auch große Malinome reseziert werden.
    Notes: Summary Comparision of the period 1949–1974 and 1975–1983 shows that treatment of primary gastric stump cancer after ulcer surgery has changed. The number of gastric stump resections increased from 23.4% in the first period to 66.7% in the second period. From 1949 to 1974, subtotal gastrectomy was performed in more than 50% of the resectable cases; in the second period, 85% of the resectable carcinomas were removed by total gastrectomy. Almost 50% of the resected stomachs had lymphnode metastases or infiltration of the liver by the tumor, so that the gastric resection was done as palliative operation. In contrast to recurrent gastric cancer, primary gastric stump cancer infiltrates the jejunum very late; therefore, large stump carcinomas are resectable.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01836737
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  • 5
    Electronic Resource
    Electronic Resource
    150. Ergebnisse nach transthorakaler trunculärer Vagotomie beim Ulcus pepticum jejuni (1985)
    Springer
    Langenbeck's archives of surgery 366 (1985), S. 607-607 
    Details
    ISSN: 1435-2451
    Keywords: Indication for operation ; Complications ; Rate of marginal ulcers ; Indikationsstellung ; Komplikationen ; Rezidivrate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In der Chirurgischen Uni-Klinik Göttingen wurden von 1976–1983 40 Patienten mit einem Ulcus pepticum jejuni diagnostiziert. Eine transthorakale Vagotomie wurde 12mal durchgeführt. Die Indikationsstellung richtete sich nach der Größe des Restmagens, der Magenentleerung, der Anamnese und dem Ausschluß endokriner Ursachen. Postoperative Komplikationen traten in 4 Fällen auf (Pleuraerguß, Dystelektase). 1 Patient verstarb an einer Oesophagusvaricenblutung. 3 Patienten wiesen Rezidive auf, 2 Nachresektionen waren erforderlich. Die transthorakale Vagotomie ist im Vergleich zur Nachresektion risikoärmer. Die Rezidivrate beträgt etwa 10%. Präoperative Diagnostik zum Ausschluß endokriner Störungen ist erforderlich.
    Notes: Summary At the Department of Surgery of the University of Göttingen, 40 patients were diagnosed from 1976–1983 as having a jejunal peptic ulcer. In 12 patients transthoracic vagotomy was performed, depending on the size of the remaining stomach, undisturbed passage, anamnesis, and exclusion of endocrine disorders. Postoperative complications were seen in 4 patients (pleural exudate, dystelectasis), and 1 patient died of gastrointestinal bleeding (liver cirrhosis). Marginal ulcers were seen in 3 patients; two re-resections were necessary. Transthoracic vagotomy showed a smaller rate of complications in comparison with re-resection. Marginal ulcers amounted to up to 10%. Preoperative exclusion of endocrine disorders in necessary.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01836749
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  • 6
    Electronic Resource
    Electronic Resource
    101. Ergebnisse der Therapie des akuten Mesenterialgefäßverschlusses (1985)
    Springer
    Langenbeck's archives of surgery 366 (1985), S. 535-538 
    Details
    ISSN: 1435-2451
    Keywords: Acute visceral ischemia ; Small bowel infarction ; Angiography ; Akute viscerale Ischämie ; Dünndarminfarkt ; Angiographie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung 1979–1984 wurden 39 Patienten mit akuter Mesenterialischämie operiert (Durchschnittsalter 72,3 Jahre, 21 weiblich, 18 männlich); in 15% der Fälle war eine arterielle Embolie auslösender Mechanismus. In 34 der 39 Fälle handelte es sich um ausgedehnte Infarkte des Dünn- und Dickdarms. Segmentale Darminfarkte wurden nur in 5 Patienten gefunden. Eine geplante Second-look-Operation wurde bei 10 Patienten durchgeführt. Postoperative Angiographie bei 7 Patienten, Reihenfolge des operativen Vorgehens: 1. Revascularisation, 2. Resektion (Anastomosierung oder Diskontinuitätsausleitung), postoperative Angiographie, dann ggf. Second-look-Operation.
    Notes: Summary From 1979 to 1984 39 patients were operated on for acute mesenteric ischemia. The purpose of this retrospective study was the documentation of the therapeutic results and discussion of the value of a second-look operation and postoperative angiography. Proximal occlusion of SMA in 33 patients (85%) resulted in extended bowel infarction, whereas segmental infarction due to peripheral occlusion was found in 15%. The hospital mortality was 85%. Operative procedure consisted of revascularisation (18%), bowel resection (18%), revascularisation and resection (10%) and explorative laparotomy (18%). The second-look operation as a routine procedure has been replaced by a postoperative angiogram. Laparotomy was performed in case of reocclusion of SMA or clinical signs.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01836700
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  • 7
    Electronic Resource
    Electronic Resource
    21. Wiederherstellung der Antirefluxbarriere bei Refluxrezidiven nach Fundoplicatio (1985)
    Springer
    Langenbeck's archives of surgery 366 (1985), S. 151-151 
    Details
    ISSN: 1435-2451
    Keywords: Failures of fundoplication ; Reoperation ; Fundoplication ; Angelchik prothesis ; Antrectomy Y-Roux ; Fundoplicatio ; Refluxrezidiv ; Reoperation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Von 1974–1984 behandelten wir 47 Patienten mit einem Refluxrezidiv nach Fundoplicatio und stellten bei 28 Patienten (60%) wegen schwerer Komplikationen die Indikation zur Reoperation. Rezidivursachen waren ineffektive Primäreingriffe 9, Manschettenkomplikationen 13 und übersehene pathologische Befunde imoberen GI-Trakt 6. Wir therapierten entsprechend der vorgegebenen Situation mit folgender Heilungsrate: Refundoplicatio 15 (80%), Angelchik 3 (100%), Oesophago-Fundophrenicopexie 3 (66%), Antrektomie Y-Roux 3 (100%), transthorakale trunculäre Vagotomie 1 (Befundbesserung).
    Notes: Summary From 1974 to 1984 we treated 47 patients with failures following fundoplication and did a reoperation in 28 patients (66%) with severe complications. The reasons for recidivation of oesophagitis were ineffective primary operations 9, complications of fundoplication 13 and previously unknown diseases of the upper GI-tract 6. We treated as follows with success of healing: refundoplication 15 (80%), Angelchik 3 (100%), oesophago-fundo-phrenicopexy 3 (66%), antrectomy Y-Roux 3 (100%) and trunc.-vagotomy 1 (no complete healing).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01836621
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  • 8
    Electronic Resource
    Electronic Resource
    42. Aufrechterhaltung der Duodenalpassage - ja oder nein? (1985)
    Springer
    Langenbeck's archives of surgery 366 (1985), S. 241-247 
    Details
    ISSN: 1435-2451
    Keywords: Duodenal passage ; Glucose homeostasis ; Dumping syndrome ; Duodenalpassage ; Glucosehomeostase ; Dumping-Syndrom
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die Erhaltung der Duodenalpassage im Rahmen der chirurgischen Therapie von Magenerkrankungen ist in ihrer Bedeutung bisher nicht endgültig geklärt. Zahlreiche Verfahren führen zu einer Ausschaltung der Duodenalpassage ohne daß schwerwiegende postoperative Probleme auftreten. An Hand der Literatur und eigenen Untersuchungen läßt sich jedoch eindeutig dokumentieren, daß vor allem die Glucosehomeostase durch Erhalt oder Wiederherstellung der Duodenalpassage verbessert werden kann. Da andererseits die Operationen mit Erhaltung der Duodenalpassage meist ein etwas höheres Operationsrisiko aufweisen, kommen diese Verfahren als Primäreingriff meist nicht in Betracht. Lediglich Patienten mit schwerer Darmsymptomatik benötigen eine Wiederherstellung der Duodenalpassage.
    Notes: Summary The importance of the duodenal passage in gastric surgery is still unknown. Most gastric procedures exclude the duodenum from food passage without severe postoperative problems. Based on our own studies we are able to demonstrate the importance of the duodenal passage for glucose homeostasis. Since most primary surgical procedures with duodenal anastomoses result in a higher operative risk, the procedures should not be used in primary gastric surgery. In dumping syndrome, however, restoration of the duodenal passage is a very effective surgical treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01836641
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  • 9
    Electronic Resource
    Electronic Resource
    82. Die selbstheilende Coecalfistel nach Stelzner - Heilungsverlauf und Komplikationen (1985)
    Springer
    Langenbeck's archives of surgery 366 (1985), S. 429-433 
    Details
    ISSN: 1435-2451
    Keywords: Tube caecostomy ; Healing ; Complications ; Selbstheilende Coecalfistel ; Heilungsverlauf ; Komplikationen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Bei 83 Patienten wurde nach distalen Dickdarmresektionen eine Entlastung des Dickdarmes mit einer selbstheilenden Caecalfistel nach Stelzner vorgenommen. Neben 26 tiefen anterioren Resektionen wurden 54 anteriore Resektionen und 3 linksseitige Hemicolektomien entlastet. 10,8% der Fisteln mußten operativ verschlossen werden. Anastomoseninsuffizienzen traten in 3,8% der Fälle klinisch in Erscheinung. Die selbstheilende Coecalfistel erweist sich als wirksames Verfahren zur Anastomosenentlastung und zeigt eine geringere Eigenkomplikationsrate als die protektive Kolostomie. Kolostomie.
    Notes: Summary A retrospective study of 83 patients who underwent caecal fistula as described by Stelzner during the five-year period between 1979 to 1984 was carried out. 26 fistulas were performed after low anterior resection, 54 after anterior resection and 3 after left hemicolectomy. In 10.8% the operative closure of the fistula was necessary. An anastomotic insufficency could be recognized clinically in 3.8%. The overall complication rate was 21.7%. The caecal fistula seems to be an effective procedure with a lower complication rate than the temporary colostomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01836681
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  • 10
    Electronic Resource
    Electronic Resource
    108. Der Stellenwert des Gastrografin-Einlaufs in der Ileusdiagnostik (1985)
    Springer
    Langenbeck's archives of surgery 366 (1985), S. 569-573 
    Details
    ISSN: 1435-2451
    Keywords: Colon ; Ileus ; Gastrografin enema ; Dickdarm ; Ileus ; Gastrografineinlauf
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Von 1978–1984 wurden bei 421 Patienten eine Colonkontrastuntersuchung mit Gastrografin durchgeführt. In 246 Fällen wurde die Untersuchung wegen eines unklaren Abdomens vorgenommen, bei 172 Patienten lagen postoperative Fragestellungen vor, 3 Patienten hatten eine gastrointestinale Blutung. Unter 236 pathologischen Befunden befanden sich 81 Patienten mit einem Dickdarmileus, davon wurden 58 Patienten operiert. Ursache des Dickdarmileus waren Colontumoren, extraluminäre Tumoren sowie Perforationen und Entzündungen. In 55 Fällen wurde durch den Operationsbefund die Diagnose des Gastrografineinlaufs bestätigt, je einmal war ein falschnegativer, unsicherer und falschpositiver Befund vorhanden. Die Treffsicherheit der Befunde lag somit bei 96%.
    Notes: Summary From 1978–1984 421 patients were examined by colon enema with gastrografin. The indication in 246 cases was an acute abdomen, in 172 patients the procedure has been performed postoperatively, 3 patients suffered from gastrointestinal bleeding. 81 of 236 pathological findings showed an ileus. 58 of them underwent an operation. The cause of the ileus were tumors of the colon, extraluminal tumors as well as performations and inflammations. In 55 cases the findings of the gastrografin enema were confirmed by the operation, one was proved to be false negative, one uncertain and one false positive. Therefore the diagnostic accuracy of this procedure amounted to 96%.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01836707
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