Free amino acids in plasma and muscle in fulminant hepatic coma during an extracorporeal liver perfusion.

A 21-year-old female patient suffering from fulminant hepatic failure was treated with extracorporeal normothermic baboon's liver perfusion for 60 hours. The amino acids (AA) uptake of the extracorporeal organ and the ratio of plasma and muscle AA at the end of the perfusion were measured. The AA uptake of the extracorporeal liver was 414 millimoles per 60 hours and even greater during hemodialysis treatment. In spite of this AA uptake, the plasma AA pattern was not normalized. At the end of the perfusion, the free AA concentration in muscle tissue was 86.25 millimoles per liter of intracellular water, an increase of 62% compared to healthy volunteers. In the patient, the ratio of glutamine to glutamine in muscle tissue was 20 to 1 compared to 5 to 1 in normals. It is concluded that (1) the extracorporeal baboon liver cannot extract the quantities of AA released by endogenous protein catabolism in hepatic failure, and (2) the muscular ammonia detoxification system gets overloaded as indicated by the increase ratio of glutamine to glutamate.

[Serum alpha-1-fetoprotein and serum lactic dehydrogenase isoenzymes in liver tumours (author's transl)]. / Serum-Alpha-1-Fetoprotein und Isoenzyme der Serumlaktatdehydrogenase bei Lebertumoren.

Serum alpha-1-fetoprotein (AFP) and serum lactic dehydrogenase isoenzymes (LDH I-V) were evaluated in healthy subjects as well as in 10 patients with primary liver carcinoma, in 10 patients with metastatic liver cancer and in 10 patients with cirrhosis of the liver. The diagnosis was established histologically in all cases. The upper limit of the normal AFP range was 9 ng/ml. Four out of all the patients with hepatocellular or cholangiocellular carcinomas had normal AFP values, 3 showed slightly increased AFP values, whilst a serum AFP concentration exceeding 174 ng/ml - limit which is statistically highly suggestive of hepatoma - was found in only 3 patients. Three out of the patients with metastatic liver cancer and 3 with cirrhosis showed moderately increased AFP values. In primary liver cancer LDH V is increased significantly and 8 out of all patients showed higher values of LDH V than LDH IV. By contrast, patients with metastatic liver cancer had significantly increased LDH IV, which was higher than LDH V in 9 out of all cases. Cirrhotics showed normal LDH isoenzymes. Combining these results, a definitive diagnosis could be made in 9 patients with primary carcinoma of the liver and in 9 patients with metastatic liver cancer.

[Surgical therapy of Crohn disease and ulcerative colitis]. / Chirurgische Therapie bei Morbus Crohn und Colitis ulcerosa.

Surgical treatment of Crohn's disease and ulcerative colitis is standardized today, despite several unresolved problems. Cooperation between gastroenterologist and surgeon is essential to establish the indication for surgery in emergency situations and during the chronic phase, as well. The surgical procedures aim for maximum preservation of function; in Crohn's disease salvage of bowel by means of limited resections and strictureplasty has priority, whilst in ulcerative colitis the preservation of sphincter function is the paramount goal, wherever possible, by means of ileorectostomy and ileal pouch procedures.

[Sphincter preservation in rectal cancer: possibilities and limits of anterior resection]. / Sphinktererhaltung beim Rektumkarzinom: Möglichkeiten und Grenzen der vorderen Resektion.

The feasibility of sphincter preservation was studied in surgery of tumours in the upper, middle and lower third of the rectum. All patients operated on for rectal cancer between January 1977 and May 1980 were included in the investigation. Preoperative localization of the tumours was performed with the rigid sigmoidoscope. Every patient was scheduled for post-operative follow up. Altogether 211 patients were operated on for rectal cancer. 111 were treated by anterior resection, 90 by abdominoperineal excision, and 10 by other sphincter-saving methods. All of the 59 tumours located in the upper third of the rectum (12 to 16 cm from the anus) were treated by anterior resection. 62 tumours were located in the middle third (8 to 12 cm). In these cases anterior resection was carried out in 60% of the men and in 82% of the women, whereas the other patients underwent abdominoperineal excision. 80 tumours were located in the lower third (4 to 8 cm). Anterior resection was possible in only 4.4% of the men and in 14% of the women. Irrespective of their localization on sigmoidoscopy, 37% of the tumours which were within reach of the finger on rectal palpation could be removed by anterior resection. Local recurrence after anterior resection occurred in 18.3%, the median follow-up time being 50 months. The cumulative probable survival for all stages was more than 5 years for 60% of the patients.

[Therapy of local recurrence after colorectal cancer]. / Die Therapie des Lokalrezidivs nach kolorektalem Karzinom.

A prospective study was undertaken of the incidence, symptoms, diagnostic measures and therapy of local recurrence of colorectal carcinoma following radical surgical management. 69 (16%) out of 434 patients developed recurrence of the tumour, which was local in 51 patients (12%). Half of the latter group was symptom free at the time of diagnosis. 45 out of the 51 patients were treated by surgery, a radical operation being feasible in 25 cases. 60% of these have survived for at least 30 months. The operative mortality was very low, with only one death, although extensive surgery was necessary in most of the cases. The preliminary results of this study support the hypothesis that a postoperative follow-up programme for patients with colorectal cancer leads to early detection of local recurrence and improves the chance of cure by surgical treatment.

[The influence of pretreatment with specific antibodies on Renal Xenograft Rejection (author's transl)]. / Beeinflussung der Nierenxenotransplantation durch Vorperfusion mit spezifischen Antikörpern.

26 pig kidneys were perfused in a "Gambro" kidney perfusion machine. The perfusates used were unmodified canine plasma and serum, as well as complement-free plasma, gamma-globulin solutions obtained from dogs immunized against pig leucocytes (ALG) and 2-mercapto-ethanol treated ALG (2 ME-ALG). The typical pig-to-dog xenograft rejection was reproduced by ex vivo perfusion with native dog plasma and serum. Using complement-free dog plasma, ALG and 2 ME-ALG pig kidneys could be perfused for several hours without significant increase in perfusion resistance. 22 pig kidneys, pretreated by perfusion for 2 hours with complement-free dog plasma, ALG and 2 ME-ALG, were transplanted on to the vessels of the neck of recipient dogs. Grafts pretreated with decomplemented dog plasma and 2 ME-ALG were rejected in the usual fashion within 5 to 20 min. Pretreatment with ALG resulted in a prolongation of graft function for 80 to 100 min. It is suggested that ALG exerted a transient blocking effect on the cytotoxic action of recipient IgM resembling passive enhancement; this phenomenon may be limited to sites with low antigen density, corresponding to in vitro findings of passive enhancement on cells with low surface antigen density.

[Value of computer tomography of the small pelvis for the early diagnosis of local recurrence after surgery of rectal cancer]. / Der Wert der Computertomographie des kleinen Beckens zur frühzeitigen Diagnose von Lokalrezidiven nach operiertem Rektumkarzinom.

The value of pelvic computed tomography (CT) in the detection of local recurrence following radical operation for rectal cancer was assessed in a prospective study on 15 patients. A positive CT finding was checked in every instance by a second-look operation (11 cases). Tumour tissue in the pelvis was found in 9 patients, whereas in 2 patients the positive CT finding was proven to be false. 5 out of 9 cases with recurrent tumour underwent radical surgery. In the 4 cases with a negative CT finding no recurrence has developed after a median observation time of 34 months. Pelvic CT is a useful and reliable method of detecting pelvic recurrence before it becomes clinically obvious. However, the method does not allow certain prediction of whether or not the recurrence will be radically operable.

[Consequences of after-care in colorectal cancer]. / Konsequenzen der Nachsorge beim kolorektalen Karzinom.

Results of a computer supported follow-up-program on patients with colorectal cancer are presented. Between 1978 and 1985 1024 patients underwent these program, the drop-out-rate was 18%. 231 recurrences in 137 patients were discovered (40% local recurrence, 30% liver metastases and 30% others). 54% of patients with local recurrence and 43% with liver metastases were free of symptoms. Radical surgery was performed in 47% of local recurrences and in 24% of liver metastases. The three year survival rate after radical surgery for recurrence amounted to 28% for local recurrences and to 31% for liver metastases.

[Regional results of human liver transplantation in Vienna]. / Regionale Ergebnisse der humanen Lebertransplantation in Wien.

21 cases of transplantation of the liver are analysed for indication, anaesthesia, operative management, anhepatic period, immunological therapy and specific post-operative problems (jaundice and rejection episodes). Causes of death are noted and prediction of survival gives a rate of 55%/1st year in the 17 patients operated on since 1982 under a standardised management schedule. The transplantation programme in Vienna provides routine treatment for otherwise untreatable primary (57% cases) and secondary metastatic (14%) tumours of the liver, and, in the second place, for end-stage hepatic cirrhosis (14%) and certain rare liver diseases (14%).

[Sphincter-preserving operations in cases of ulcerative colitis (author's transl)]. / Sphinctererhaltende Eingriffe bei Colitis ulcerosa.

Eighteen cases of operated ulcerative colitis are described. In 15 cases ileorectal anastomosis was performed. In one case, the rectum had to be excised because of a massive rectal haemorrhage; in another case, the anastomosis had to be separated Hartmann's operation) because of a dehiscence of the anastomosis. A re-examination of 13 patients shows full continence in 12 cases; one patient was incontinent with regard to flatus. The Karnofsky Index shows 100 in 10 patients, and 90 in 3 patients. The sigmoidoscopy reveals normal rectal mucosa in 6 patients, a moderate colitis in 5 patients and a severe colitis in 2 patients. There are only two indications for rectal excision in our opinion: uncontrollable rectal haemorrhage and carcinoma (dysplasia).

[Long-term study of endocrine inhibition of exocrine pancreas secretion in the conscious dog]. / Endokrine Hemmung der exokrinen Pankreassekretion am wachen Hund im Langzeitversuch.

A new model of a reversible long-term pancreatic fistula was used on an alert, unrestrained dog to test the effect of four substances of the GEP system on the exocrine pancreatic function. The results indicate that SST significantly inhibits not only the basal secretion but also the stimulated secretion of volume, bicarbonate, and trypsine. Calcitonine inhibits only the stimulated secretion whereas PGE1 inhibits only the secretin-stimulated output of trypsine. Glucagon inhibits secretin stimulation in all three parameters.

The effect of SST, glucagon, calcitonin and PGE1 on exocrine pancreatic secretion in the unrestrained dog in long-term experiments.

Using a new model of a reversible pancreatic fistula which allows the long-term-investigation under nearly physiological conditions on the unrestrained dog, we tested the effect of somatostatin (50 micrograms), calcitonin (4 micrograms), glucagon (1 microgram), and prostaglandin E1 (150 micrograms) on the exocrine pancreatic function in 45 experiments over a period of 13 h: SST inhibits the basal as well as the secretin or CCK-stimulated secretion: calcitonin shows inhibition of the stimulated secretion only; glucagon blocks the secretin-stimulated pancreatic function; and PGE1 reduces the bicarbonate concentration and trypsin output in secretin stimulation, but in one of the two series it stimulates the basal secretion.

[Plasmaperfusion through activated charcoal and amberlite XAD-7 in dogs with liver failure induced by yellow phosphorus (author's transl)]. / Plasmaperfusion über Aktivkohle und Amberlite XAD-7 bei der phosphor-induzierten Lebernekrose des Hundes.

Various sorbents were tested in-vitro for their ability to support hepatic excretory and detoxification functions, and their in-vivo perfusion with plasma was studied in an animal experiment. Amino acids, particularly phenylalanine and tyrosine, were strongest bound by activated charcoal, while Amberlite XAD-7 removed conjugated and unconjugated bilirubin and bile acids from plasma. Using a cell-separator plasma of dogs, in whom acute liver failure was induced by yellow phosphorus, was perfused through a combination of charcoal and Amberlite XAD-7 without major complications. Platelet counts remained nearly unchanged, platelet aggregation was inhibited reversibly, and circulating platelet aggregates occurred late only. It is concluded that using the method described, therapeutic trials in patients with fulminant hepatic failure can be performed.

Submucous large-bowel lipomas--presentation and management. An 18-year study.

Gastrointestinal lipomas are rare, but commonest in the colon and rectum, characteristically submucosal and seldom subserosal. An 18-year analysis revealed 17 cases of large-bowel lipoma, 13 presenting with colicky pain, abdominal discomfort, blood-stained feces or rectal bleeding and altered bowel habits and four asymptomatic. The 17 patients had totally 21 lipomas, all submucosal. No patients with multiple lipoma had evidence of lipoma at other sites. The ileocecal valve and cecum were most commonly affected, followed by the rectum, sigmoid colon and descending colon. Tumor size (largest diameter) was 0.5-10 cm, averaging 3.1 cm (3.5 cm in symptomatic, and 1.8 cm in asymptomatic patients). The primary diagnosis (with barium enema, colonoscopy and CT) was lipoma in only five cases, but CT gave the correct diagnosis in all three cases in which it was used. Two lipomas were found in surgical specimens from colorectal malignancy, while nine were misinterpreted as polyps and one as angiodysplasia. In symptomatic patients unnecessary colotomy or colonic resection may be avoidable by colonscopic removal of lipoma.

[Results of renal transplantation in childhood]. / Ergebnisse der Nierentransplantation im Kindesalter.

37 renal allografts were performed on 27 children of 2-16 years of age. In 67% function was maintained for more than a year. At the beginning of 1981, 13 children had functioning grafts with a median serum-creatinine level of 1.8 +/- 1.2 mg%. 4 children had a functioning graft for more than 7 years. All children with functioning grafts were fully rehabilitated. Hence, renal transplantation is the optimal therapy in chronic renal insufficiency in childhood.