Monitoring of the inflammatory response in early peritonitis.

The inflammatory response which is similar in all forms of peritonitis was recorded by determining the levels of parameters shown to represent the activation state of plasmatic and cellular systems as well as the inhibitory capacity of the plasma. In a selected series of patients with different underlying diseases, blood sampling was started at the time of admission when the clinical finding of an acute abdomen led to emergency laparotomy. Depending upon the duration of the illness and the severity of the peritonitis, a significant increase in fibrinopeptide A and of C3a could be detected within a few hours, which was followed by an increase in the elastase alpha-1-proteinase inhibitor complex. Differences due to variable cause could not be found. There was a striking correlation between the preoperative values of these three parameters and the postoperative course of the patients. Additionally, there was a significant enhancement of an endothelial proliferation-inhibiting capacity in the serums of the lethal group, whereas endotoxin could only be detected in trace amounts in four patients with intraabdominal infection in the preoperative period.

Indications for surgical treatment of acute pancreatitis.

The clinical spectrum of acute pancreatitis ranges from mild, self-limiting symptoms to fulminant illness that may rapidly lead to multiple organ failure and death. Differentiation between acute interstitial pancreatitis, necrotizing pancreatitis, pancreatic abscess and acute pseudocyst is mandatory for the choice of surgical treatment. If morphological evaluation by dynamic pancreatography reveals pancreatic or peripancreatic necrosis, bacteriological evaluation by CT-guided fine-needle aspiration is the mainstay of further decision-making, and should be performed if general signs of inflammation are not improved by conservative therapy. Basically, operative treatment may be directed against underlying pathology (e.g. cholelithiasis), or may aim to manage complications. Infected necrosis is the only clear indication for surgery. Whether the choice should be debridement and gravity drainage, continuous closed lavage of the lesser sac, staged relaparotomies, or open packing, depends on the extent of the process and the individual situation. Peripancreatic fluid collections and pancreatic pseudocysts without major ductal pathology rarely need operative treatment in the early stages, whereas abscesses resulting from infected necrosis should be dealt with by surgery rather than by percutaneous drainage.

[Diagnosis and therapy of pseudo-obstruction of the colon]. / Diagnose und Therapie der Pseudoobstruktion des Kolons.

Pseudo-obstruction of the colon (Ogilvie's syndrome) occurred in 18 patients as an acute abdominal emergency. It was characterized by massive distension of the caecum or the entire colon in the absence of any organic cause. Usually there was an underlying extraintestinal disease. Diagnosis of this entity depends on careful radiological investigation of the abdomen, whereby barium enema reveals the absence of organic obstruction. Increasing distension in untreated patients may lead to spontaneous perforation of the caecum.

[Endosonography of the anal canal in functional disorders of the pelvic flow. Initial experiences]. / Endosonographie des Analkanals bei Funktionsstörungen des Beckenbodens. Erste Erfahrungen.

Nine patients were examined by anal endosonography for pelvic floor disorder. Internal anal sphincter thickness was correlated with sphincter function. Six patients with idiopathic incontinence showed a reduction of internal anal sphincter thickness, one patient with outlet obstruction due to chronic anal fissure showed an increase of thickness. Traumatic lesions could be precisely localized because of defects in both internal and external anal sphincter. Anal endosonography can be recommended in the evaluation of pelvic floor disorders.

[Rectal endosonography for detection of free fluid in the abdomen]. / Die rectale Endosonographie zum Nachweis freier Flüssigkeit im Abdomen.

In a study of 60 patients suspicious of free fluid we found a very high sensitivity of 95% and specificity of 100% with endorectal sonography. In 6 patients free fluid could be shown preoperatively by endorectal ultrasound, whereas transabdominal sonography proved to be negative. We conclude that endorectal sonography should be performed in all cases with a clinical suspicion of free fluid when transabdominal sonography is negative. Rectal endosonography is an easy and less stressful examination which clarifies conditions in the pelvis which are not clearly discernible from the transabdominal sonography.

[Acute pseudoobstruction of the colon (Ogilvie syndrome)]. / Die akute Pseudoobstruktion des Colons (Ogilvie-Syndrom).

Pseudo-obstruction of the colon was observed in six patients. The cardinal feature is acute distension of the large bowel without distal obstruction. Apart from few idiopathic cases, the syndrome usually is associated with postoperative, posttraumatic or metabolic disorders of extraintestinal origin. Without treatment, increasing distension leads to cecal perforation with a high mortality. Treatment is conservative initially. If decompression by colonoscopy fails, cecostomy or right hemicolectomy are mandatory. The pathophysiologic mechanism of acute colonic pseudoobstruction is unknown. Whether Ogilvie's syndrome is a genuine clinical entity or a complication of associated diseases is still on question.

[Surgical indications in ulcerative colitis and Crohn disease]. / Operationsindikation bei Colitis ulcerosa und Morbus Crohn.

Despite the progress made in recent years, treatment of chronic inflammatory bowel disease remains problematic. The highly individual spontaneous course of such conditions always makes an interdisciplinary management strategy mandatory. In view of the fact that continence-preserving procedures are possible in ulcerative colitis as well as bowel-preserving procedures in Crohn's disease, elective interventions in patients who fail to respond to what is accepted as suitable medication may be considered supplementary to the therapeutic spectrum. A consideration of all the factors involved suggests that too many reservations vis-a-vis surgery are no longer justified.

[Humeral head fractures following epileptic attacks. Case report on a rare but typical injury]. / Oberarmkopfbrüche nach Krampfanfällen. Kasuistischer Beitrag zu einer seltenen, aber typischen Verletzung.

We report about two patients with posterior fracture-dislocation of the shoulder following convulsive seizures, one case unilateral, one case bilateral. The radiological findings are typical and similar to the cases described in literature: Impression or head splitting fracture of the ventro-medial part of the humeral head associated with posterior dislocation. The mechanism of injury, methods of treatment and late results are discussed.

Pressure studies of the ileocecal sphincter after small bowel resection in rabbits.

The function of the ileocecal sphincter (ICS) in rabbits was investigated after extensive small bowel resection. The reflux pressure in anterograde (P1) and retrograde (P2) direction was measured before, 7 days after, and 1 year after small bowel resection, nd compared with a group of rabbits in which a bypass-operation of the same length of the small bowel had been performed. After 7 days, both P1 and P2 showed a marked decrease in the resection group. One year after the operation, pressures had increased again but were still lower than before the resection. Significantly minor pressure changes were found 7 days after bypass surgery. We consider that ICS-insufficiency can be one cause of the features of short bowel syndrome.

[Electrical control activity during and after mechanical ileus--an animal experimental study on the reversibility of ileus-induced motility disorders]. / Die elektrische Kontrollaktivität während und nach mechanischem Ileus--eine tierexperimentelle Untersuchung zur Rückbildungsfähigkeit ileusbedingter Motilitätsstörungen.

The electrical control activity in the pre- and poststenotic intestine segment was recorded in rabbit during a mechanical high-located small-bowel ileus of 24 hours duration and after its release. The ligature of the intestine caused an immediate decrease of frequency in the poststenotic segment and in the prestenotic segment only after an ileus duration of 24 hours. The sw-frequencies (slow waves) normalized themselves in both bowel segments after the removal of the occlusion 48 hours later. The control activity in the control group of sham-operated animals normalized itself after a transitory decrease already 24 hours later.