Steroid receptors and response to endocrine treatment and chemotherapy of advanced breast cancer.

The remission rates after endocrine and cytostatic treatment were determined in 192 female patients with advanced breast cancer depending on the estrogen, progesterone, and androgen receptor content and on the disease-dominant site. Of 60 women with tumors containing estradiol receptors 39 responded to endocrine treatment. This was only true in two of 31 women without estradiol receptors. Tumors which contained binding sites for both estradiol and progesterone had a higher remission rate after endocrine therapy than those with estradiol receptors only. Remission rates after polychemotherapy were also higher in tumors with binding sites for estradiol as well as for progesterone. The localisation of metastases seems to be of lesser importance for the remission rate than the receptor content. Liver metastases are an exception. Here, no remissions could be observed with endocrine treatment even if ER and PR were present. The median remission rate was 9 months for hormonally treated patients and 10 months for those undergoing chemotherapy. The median survival time after chemotherapy is 18 months higher for responders than for non-responders. This difference is 15 months with endocrine treatment. Two years after the start of endocrine treatment 60% of the responders but only 20% of the non-responders were still alive. Based on our results together with histomorphological studies and the evaluation of recurrence and survival it can be assumed that carcinomas, which by nature follow a more benign course, do contain estradiol receptors.

Splenic repair by fibrin tissue adhesive and collagen fleece.

A new biogenic tissue adhesive has been used for repair of traumatic and incidental splenic lesions in 108 patients. The theoretical basis of fibrin adhesive application and technical details of this method, including the combination with a collagen fleece, are described. Complete hemostasis was achieved in 100 patients. In incidental splenic lesions the success rate of the method was 94%, and the overall salvage rate 87%. The corresponding figures for traumatic lesions were 87% and 60%, respectively. Postoperative complications developed in five patients, necessitating relaparotomy in four. In three of these patients complications were not related to the splenic repair. It can be concluded that the use of fibrin tissue adhesive is a safe and reliable method for repair in the majority of incidental and traumatic splenic injuries.

Late results with Dardik-biograft in peripheral arterial surgery.

A total of 117 vascular reconstructions below the inguinal ligament were performed using Dardik's human umbilical vein. The indication for surgery was limb salvage in 91.5%. In 61.5% a previous reconstruction had failed. The distal anastomosis was done with the popliteal artery above the knee in 9 cases, below the knee in 41, and with a tibial or the peroneal artery in 60 cases. The umbilical vein was combined with a prosthesis or the autologous saphenous vein in 20 cases. The cumulative patency rates of all reconstructions were 59.6% after 3, and 46.7% after 6 years. Crural reconstructions had a cumulative patency rate of 52% 3 years after surgery. The main factors influencing patency were the preoperative grade of ischemia, the site of the distal anastomosis and the angiographic run-off. It is concluded that the human umbilical vein is the graft material of choice in long length revascularization whenever the saphenous vein is not available.

Digital transvenous angiography in follow-up examinations after carotid reconstruction: early results.

A total of 187 check-up examinations by DVSA were carried out after various types of carotid reconstructions. The results were inconclusive in only 2.7% of the cases. A good or very good postoperative result could be demonstrated in 77.5%. A slight stenosis was present in 16%, a significant stenosis in 2.7% and a complete occlusion of the internal carotid artery in 1.1%. Patch plasty alone showed the best results followed by endarterectomy and endarterectomy with patch plasty. Segmental carotid resections and dilatations led to the poorest results. Most of those cases, where a stenosis recurred, it was already present immediately after the operation and only rarely caused by progression of the basic disease or intimal proliferation. The complication rate of DVSA was low. It is concluded that DVSA is a low risk and reliable method which can routinely be used in the postoperative evaluation of patients with carotid reconstructions.

Gastrinemia, serum minerals and calciotropic hormones following highly selective vagotomy in duodenal ulcer patients. Results of a 1-year study.

Duodenal ulcer patients with normal (n = 36) or increased (n = 24) gastric acid production during maximal pentagastrin stimulation, were examined preoperatively and at different intervals (up to 1 year) after highly selective vagotomy (HSV). Fasting levels of gastrin, parathormone, calcitonin, proteins, calcium and magnesium fractions, inorganic phosphate and alkaline phosphatase were determined in serum, those of glucagon in plasma. Both types of patients have the same gastrin levels preoperatively (approx. 36 pg-equiv./ml). Magnesium and alkaline phosphatase are significantly higher in patients with a normal secretory response than in those with hypersecretion. The postoperative gastrin increase is significantly higher in the former than in the latter, while postoperative glucagon levels drop in both groups. The analysis of calcium fractions and the dissociation constant did not show any HSV-mediated change in calcium metabolism. The magnesium levels, however, are lower one year after the operation than in the pre-operative period in patients with normosecretion. In this group parathormone and calcitonin remain unchanged while in patients with a hypersecretory response a slight (parathormone) or moderate (calcitonin) tendency towards low values can be recognized in the post-operative period. We conclude that the duodenal ulcer patients probably belong to groups with different pathophysiological behaviour which do not have identical reactions to HSV. Imbalances in the metabolism of minerals and that of related hormones could not be demonstrated up to one year after HSV.

[Mediastinal germ cell tumor--recommendation for therapeutic procedure]. / Mediastinaler Keimzelltumor--Vorschlag zum therapeutischen Vorgenhen.

Report about the rare case of an extragonadal germ cell tumor in the anterior mediastinum. A therapeutic recommendation is done referring to therapy of testicular cancer.

[Resection of the superior vena cava in tumor occlusion]. / Zur Resektion der oberen Hohlvene bei Tumorverschluss.

Report about three cases of resection of the superior vena cava for tumor stenosis or occlusion. In one patient no reconstruction was performed while in the other two interposition of an armored PTFE-prosthesis between right brachio-cephalic vein and vena cava superior was carried out. In agreement with other authors it is concluded that best results can be obtained by reconstruction with a PTFE-prosthesis or autologous vein graft.

[The treatment of tracheal stenosis by segmental resection (author's transl)]. / Segmentresektion zur Behandlung der zervikalen Trachealstenose.

In the past we treated most tracheal stenoses by creating a temporary open groove with subsequent reconstruction. This method has led to unsatisfactory results in some cases and has the disadvantage of a long duration of treatment. Therefore, we replaced it by segmental resection of the trachea with an end to end anastomosis. During the last 5 years 16 patients between 28 and 57 years of age with scar stenosis or malacia of the trachea have been operated successfully. In 12 patients a tracheostomy or an open groove were present and were included in the resection 11 times and left in place once. The tracheal defects resulting from resection were of a length of 1--5.5 cm. They could in all cases be bridged by mobilization of the trachea, upper laryngeal release and fixation of the head in a flexed position. The respiration is normal in 14 patients while 2 show a slight impairment. We conclude that because of the good functional results and the short duration of treatment (maximally 3 weeks) transverse resection of the trachea with an end to end anastomosis should be preferred over other operative procedures in the therapy of tracheal stenosis.

[Morbidity and mortality following resection of an aortic aneurysm in the aged]. / Morbidität und Mortalität nach der Resektion des Aortenaneurysmas im Alter.

From August 1984-August 1985 118 abdominal aortic aneurysms were treated surgically in the City Hospital Nuremberg. The mean age was 68.9 years, with 26.3% being over 75 y.; and there was a notable decline of elective procedures in this group, which was particularly jeopardized by cardial arrhythmias and renal insufficiency. The lethality was 0 in elective procedures, but reached 50% for symptomatic and over 50% for perforated aneurysms in the old age group. The high lethality of ruptured aortic aneurysms justify elective operation of aortic aneurysms in high age.

[Anastomotic technique in tracheal resection. Animal experiments (author's transl)]. / Anastomosentechnik an der Trachea. Tierexperimentelle Untersuchungen.

In 24 rabbits and 6 dogs, two subtotal tracheal transsections each were reanastomosed using Dexon , Vicryl, Prolene and Mersilene in running or interrupted suture technique. In order to avoid traumatisation of the perichondrium, sutures included the marginal cartilagenous ring and all layers of the tracheal wall. By putting every second stitch in a 8-figure, an ideal adaptation could be achieved. Half of the anastomoses were secured by additional application of fibrin tissue adhesive. Macroscopical and histological examinations were carried out 5, 10, 21 and 63 days postoperatively. Mersilene resulted in remarkable inflammatory tissue reaction - increasing from the 5th day on - leading to extensive granulomas, abscesses, ulcerations of the mucosa and erosion of the cartilage. In contrast, by using synthetic absorbable materials as well as prolene, minimal tissue reaction occurred with an even and delicate scar formation. The findings do not support the view, that an extramucosal stitch technique is essential. The additional sealing with fibrin tissue adhesive increased the safety of the anastomoses during the early postoperative period.

[Surgical therapy of stomach cancer-stagnation or progress? Results of 2665 stomach cancer patients]. / Chirurgische Therapie des Magenkrebses-Stagnation oder Fortschritte? Ergebnisse bei 2665 Magenkrebs-Patienten.

The results of surgical therapy in 1165 patients with gastric cancer who underwent treatment between 1949 and 1964 are compared with those of 1500 patients who were operated on between 1969 and 1981. Special emphasis is placed on curability, operative methods and postoperative mortality. The 5-year survival rates of patients from the time periods 1950-1959 and 1969-1976 are compared. 1. The percentage of curatively treated patients increased significantly from 46,7% (1949-1964) to 57,0% (1969-1981). 2. The postoperative mortality after total gastrectomy was further reduced significantly: it was 25% from 1957-1964, but only 13% from 1976-1981. 3. The 5-year survival rate of all patients with gastric cancer increased significantly from 10% (1950-1959) to 17% (1969-1976). 4. The 5-year survival rate after curative operations increased from 22% to 30%; after curative distal partial gastrectomy from 22% to 42% and after curative total gastrectomy from 6% to 20%. 5. The median survival time after palliative operations without resection of the tumor was 3 months. Since 1977 more than one third of the patients who could not be treated curatively underwent resection of the tumor. The median survival time in this group is 6 months with improved quality of life.

Fasting blood values of glucose, insulin, glucagon, gastrin following highly selective vagotomy in duodenal ulcer patients.

Changes in fasting blood levels of glucose, insulin, glucagon and gastrin were determined in duodenal ulcer patients (n equal to 59) before and up to 1 year after highly selective vagotomy (HSV). There was an increase in glucose values after HSV by approximately 6 mg/dl. The rise in gastrin levels was variable depending on the maximal preoperative acid secretion during pentagastrin stimulation. Insulin values remained unchanged after HSV while there was a significant drop of glucagon levels after 1 year. There is no relationship between the extent of post-HSV gastrinemia and glucose or between the latter and glucagon. It can be assumed that HSV causes additional metabolic changes besides reducing acid production.