Search

Two forms of peritonitis have been examined on 60 rats (Wistar) in three groups. Group 1 = acute peritonitis, group 2 = chronic peritonitis and group 3 = control. All animals have had an injection of an aminoglycosid antibiotic and a proteinase inhibitor into the peritoneal cavity. One intended to measure the influence of the proteinase inhibitor for different kinds of inflammation of the function of resorption of the peritoneum. Serum concentration of the antibiotic after 30, 60, and 90 min was measured. In clinical dosage the resorption of protein-bonded aminoglycosid antibiotics was decreased. The healthy control animals didn't show any effects. Connections concerning molecule size of protein-bonded substances and proteolytic ferments are in discussion. The practical relevance of these results could be found in an retarding effect of the resorption of protein-bonded toxines.

Various forms of operative duodenal exclusion with or without duodenogastric reflux were performed on 54 male Wistar rats. It was demonstrated that after duodenal exclusion with reflux peptic ulcers regularly occur at the site of anastomosis. Continuous reflux of bile and pancreatic secretion is the decisive factor in the development of ulcer at the anastomotic border between stomach and jejunum. Stasis in the excluded duodenum (syndrome of the afferent loop) promotes the ulcerogenic reflux effect. If there is no pylorus, reflux and stasis are potentiated to the highest incidence of ulcer (more than 90%). These results indicate that operations with duodenal exclusion and reflux (Billroth II) should be discontinued.

In hemorrhages from the upper gastrointestinal tract, emergency endoscopy is becoming more and more significant. Hemorrhages during the early postoperative stage, particularly in abdominal surgery, require particular attention due to the generally difficult postoperative situation. In most instances, intragastral hemorrhages are due to erosions and anastomotic bleeding. A detailed knowledge of the surgery performed may contribute to a quick and successful examination. Among the most important premises for a high rate of correct diagnoses are the experience of the examining physician as well as an early or immediate identification of the indications. In addition to the diagnostic significance, under favorable circumstances endoscopy makes possible definitive or temporary staunching of the bleeding by means of diathermy, laser beam or sclerotization.

Our results demonstrate that peritoneal absorption even of large amounts of fluid is not restricted in either acute or chronic peritonitis. According to investigations reported elsewhere, antibiotics administered intraperitonealy can be found quantitatively in the serum, if peritoneal absorption is not impaired. The retardation effect of proteinase inhibitor TRASYLOL on peritoneal absorption in peritonitis may indicate that proteolytic processes are necessary to break up the protein binding of antibiotics which only then are able to permeate the peritoneal wall. This may also pertain to other substances of pharmacologic activity, like toxins -lipoproteins, lipopolysaccharides- and medicaments. With respect to the clinical relevance of this effect it should be regarded as beneficial. Alternatively, the role of kallikrein/kinin-system for transmembranous absorption of proteins and protein split products has to be considered.

Islet cell tumors have been described the past 25 years in frequent series. Multiple symptoms lead often to prolongation of disease and misinterpretation of diagnosis. Because of its rarity most authors report only few cases. We had the chance to observe 24 patients of which four had carcinoma within 12 years. Symptoms, clinic, different surgical procedures are described. Clinical difference seems to exists between benigne and malignant islet cell tumors.

Congenital, acquired, and traumatic defects of the diaphragm are reported. Special consideration is given to positional changes of the stomach due to the above lesions. Clinical examples are used to point out the diagnostics and surgical possibilities of reparation.

Spigelian hernia is very rare. Together with the direct inguinal hernia which emerges between the inferior epigastric artery and the edge of the rectus muscle, it is more frequent. Congenital openings in the aponeurosis of the transverse muscle permit the hernia either above or under the inferior epigastric artery. Due to neglect of this type of hernia and absence of herniation, the diagnosis can be difficult. Complaints are often uncharacteristic. Surgical intervention is indicated.

Immediate post-operative complications such as obstructive jaundice, biliary fistulae or gastrointestinal hemorrhage, occurring after biliary tract surgery can be diagnosed endoscopically. The causes of bile flow obstruction and leakage from the common bile duct can be identified using ERC. In many cases the diagnosis can be followed by endoscopic treatment, therefore obviating re-laparotomy. Between 1972 and 1979 we carried out early post-operative ERC or esophago-gastro-duodenoscopy in a total of 94 patients after biliary tract surgery. In 75 patients with residual gallstones and 4 cases with overlooked stenoses of the papilla, successful papillotomies were carried out. The procedure was unsuccessful in one case with an extremely narrow papilla. Complete removal of stones was achieved in 72 cases. In two other patients with gastroduodenal stress ulcers, bleeding was stopped by submucosal infiltration.

Incidence and extent of increased alpha-amylase concentration were examined in serum and urine following routine surgical intervention in the epigastrium. Only patients with non-specific clinical symptoms (n=49) and a control group who had undergone surgery for inguinal hernia (n=10) were included in the study. Patients previously subjected to gastric surgery (selective gastric vagotomy = 10, gastric resection according to Billroth I = 10) were significantly more often found to have results within a range usually considered pathological. Patients who had undergone surgery of the bile duct were markedly less affected. The diagnosis, based on the benefit of the hindsight, of a postoperative pancreatitis in cases where specific complaints and increased maylase concentration coincide does therefore not appear justified--particularly following gastric surgery. This becomes significant if a choice between various conservative treatments or relaparotomy is being considered.

The diagnostics of benign stenosis of the papilla is based on the preoperative endoscopic retrograde cholangiopancreatography (ERCP) and preoperative cholangiography and debimetry with diagnostic dilatation of the papilla. The high rate of positive results achieved with these difficult procedures necessitate their use. The therapy of reversible stenosis consists of the eradication of the responsible inflammatory focus (cholecystolithiasis and choledocholithiasis). Irreversible stenoses of the papilla are without exception successfully treated with sphincterotomy or papillotomy.

In order to prove the hypothesis--short anamnesis; short survival time--the duration of the anamnesis and the period of survival of 230 patients with carcinoma of the colon were statistically mathematically and graphically investigated. No relationship in accordance with a rule was found between the duration of anamnesis and the time of survival. Curative surgery prolonged the period of survival significantly. The duration of the anamnesis depends on fortuitous factors and represents one of the stages of cancer. The delay after the first medical consultation is pointed out. It can be concluded that the resection of cancer in the early stage--early diagnosis--is for the survival decisive. The duration of the anamnesis is more important for the diagnosis than the surgical treatment and the prognosis.

Main symptoms and causes of subphrenic abscess are described. Localization is possible using Gallium 67 scanning. Prophylaxis and surgical approach are illustrated. In 75 patients of the surgical clinic of the University of Hamburg, the subphrenic abscess was drained by an anterolateral extrapleural incision through the diaphragm. Positive identification and localization are necessary to prevent contamination of the peritoneal cavity. Scintigraphic Gallium 67 scanning is also useful to identify synchronous subphrenic (bilateral) abscesses.

After operations the early x-ray examen of the upper intestine may show complications in the operation field. It also permits to judge the bowl's function. Most valuable is to compare pictures of the patient in lying and upright position.

Different types of duodenal by-pass operations with and without duodenogastric reflux were performed on 54 male Wistar rats. The results of our investigation show that following duodenal by-pass with reflux peptic anastomotic ulcer regularly occurs. The constant reflux of bile and pancreas juice is the most important aetiologic factor in the development of ulcer in the vicinity of the anastomosis between the stomach and small intestine. Stasis in the by-passed duodenum (afferent loop syndrome) promotes ulcerogenic action of reflux. In the absence of the pylorus the effects of reflux and stasis potentiate, resulting in a high frequency of ulcer (greater than 90%). With intact pylorus the incidence is low. Duodenogastric reflux prevents hydrochloric acid secretion significantly (p less than o,o1); hydrochloric acid thus plays a minor role in the development of experimental anastomotic ulcer of the rat. -- In considering the prophylaxis against anastomotic ulcer, these findings support the claim of avoiding surgical techniques involving duodenal by-pass and reflux (Billroth II with short loop GE). Gastric resection should, therefore, aim at the reconstruction of the orthograde peristalsis.

The indications and early results of 605 Billroth I operations for peptic ulcer are reported. Of the 605, 302 were simple resections, and 303 combined operations with selective gastric vagotomy. There were no differences concerning postoperative complications among the two groups. No disturbances were encountered in 80%. The overall mortality rate was 4.2% caused mainly by an incidence of 14.6% in complicated ulcer cases. The greatest difference for lethal, as well as nonlethal, complications was found between emergency surgery for bleeding ulcer and elective operations for uncomplicated cases. In general, the early results of the Billroth I resection were equal to the Billroth II type. Because of better functional late results, the Billroth I operation is preferred.